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Biomedical subjects

Barry D Weiss

Publications and source records attributed to Barry D Weiss.

At least 19 recordsLinked to original sources
PubMed2006

Use of pictorial aids in medication instructions: a review of the literature.

PURPOSE: The effects of pictorial aids in medication instructions on medication recall, comprehension, and adherence are reviewed. SUMMARY: Many patients depend on medication labels and patient information leaflets for pertinent drug information, but these materials are often difficult for patients to understand. Research in psychology and marketing indicates that humans have a cognitive preference for picture-based, rather than text-based, information. Studies have shown that pictorial aids improve recall, comprehension, and adherence and are particularly useful for conveying timing of doses, instructions on when to take medicine, and the importance of completing a course of therapy. Other research has compared various techniques for using picture-based information and supports the use of integrative instructions, a combination of textual, oral, and pictorial communication, to promote comprehension and adherence. While pictures have generally proven useful for improving patient comprehension and adherence, not all picture-based interventions have produced successful results. Some icons, particularly clock icons, have been found to be too complex to enhance understanding and could not overcome the advantage provided by the familiarity of the textbased format, suggesting that patients be trained to use pictorial medication information before they are expected to use icons as an aid for medication administration. In addition to enhancing understanding, pictorial aids have been found to improve patients' satisfaction with medication instructions. CONCLUSION: The use of pictorial aids enhances patients' understanding of how they should take their medications, particularly when pictures are used in combination with written or oral instructions.

Audiovisual Aids↗
PubMed2006

The impact of literacy on health-related quality of life measurement and outcomes in cancer outpatients.

BACKGROUND: Limited evidence exists regarding the relationship between literacy and health-related quality of life (HRQL). Research is needed to develop measurement techniques for low literacy populations and to evaluate potential literacy-related measurement bias. METHODS: A Talking Touchscreen (TT) was developed for an HRQL study. Low (n = 214) and high literacy (n = 201) adult cancer outpatients participated, 70% of whom were from racial/ethnic minorities. Patients completed three questionnaires by TT: FACT-G (cancer-specific), SF-36 (generic health status), and a standard gamble utility questionnaire. Measurement bias was evaluated using item response theory (IRT). Effects of literacy on HRQL were evaluated using regression models. RESULTS: Most (97%) patients rated the TT easy to use. In IRT analysis, 6/27 FACT-G and 12/31 SF-36 items demonstrated literacy bias; this was relatively balanced (10 items 'biased against' low literacy; 8 'biased against' high literacy). Mean literacy group differences were statistically and clinically non-significant for 9/14 HRQL outcomes. Adjustment for bias and/or covariates eliminated most remaining differences. CONCLUSIONS: The TT is valid and useful for HRQL assessment in low literacy populations. There appears to be no systematic literacy bias in reporting HRQL, and low literacy is not an independent risk factor for poorer HRQL.

Cancer Care Facilities↗
PubMed2006

Suitability of written supplemental materials available on the Internet for nonprescription medications.

PURPOSE: The suitability, readability, and cultural appropriateness of written supplemental materials available on the Internet for nonprescription medications were examined. METHODS: We videotaped 48 hours of television programming, recording a total of 152 advertisements highlighting 37 unique nonprescription medications. The supplemental materials corresponding to each advertised medication were downloaded and printed in their entirety from each product-specific Web site. These materials were assessed using the Suitability Assessment of Materials (SAM) instrument. Total SAM scores were grouped as follows: not suitable (0-39%), adequate (40-69%), and superior (70-100%). The Fry readability formula was used to determine the reading grade level for the materials assessed with the SAM instrument. RESULTS: The mean +/- S.D. SAM score of all materials was 54.9% +/- 0.1% (range, 38-76%). Materials for the majority of drugs (86.5%, n = 32) were rated adequate. Materials for four drugs (10.8%) were rated superior, and the material for one drug was not suitable. While the total SAM scores were adequate for most of the materials evaluated, the majority of materials scored particularly poorly for their reading level (the materials for 81.1% of drugs were not suitable). The materials for 40.9% of drugs used uncommon words. CONCLUSION: Evaluation of the suitability, readability, and cultural appropriateness of written supplemental materials for nonprescription medications available on manufacturer-sponsored Web sites and intended for consumers or patients revealed that SAM scores were adequate for most of the materials; however, many scored poorly in the areas of reading level and used uncommon words.

Advertising↗
PubMed2006

Literacy education as treatment for depression in patients with limited literacy and depression: a randomized controlled trial.

BACKGROUND: Individuals with limited literacy and those with depression share many characteristics, including low self-esteem, feelings of worthlessness, and shame. OBJECTIVE: To determine whether literacy education, provided along with standard depression treatment to adults with depression and limited literacy, would result in greater improvement in depression than would standard depression treatment alone. DESIGN: Randomized clinical trial with patients assigned either to an intervention group that received standard depression treatment plus literacy education, or a control group that received only standard depression treatment. PARTICIPANTS: Seventy adult patients of a community health center who tested positive for depression using the 9-question Patient Health Questionnaire (PHQ-9) and had limited literacy based on the Rapid Estimate of Adult Literacy in Medicine (REALM). MEASUREMENTS: Depression severity was assessed with PHQ-9 scores at baseline and at 3 follow-up evaluations that took place up to 1 year after study enrollment. Changes in PHQ-9 scores between baseline and follow-up evaluations were compared between the intervention and control groups. RESULTS: The median PHQ-9 scores were similar in both the intervention and control groups at baseline (12.5 and 14, respectively). Nine-question Patient Health Questionnaire scores improved in both groups, but the improvement was significantly larger in the intervention group. The final follow-up PHQ-9 scores declined to 6 in the intervention group but only to 10 in the control group. CONCLUSIONS: There may be benefit to assessing the literacy skills of patients who are depressed, and recommending that patients with both depression and limited literacy consider enrolling in adult education classes as an adjuvant treatment for depression.

Adult↗
PubMed2006

Brief report: screening items to identify patients with limited health literacy skills.

BACKGROUND: Patients with limited literacy skills are routinely encountered in clinical practice, but they are not always identified by clinicians. OBJECTIVE: To evaluate 3 candidate questions to determine their accuracy in identifying patients with limited or marginal health literacy skills. METHODS: We studied 305 English-speaking adults attending a university-based primary care clinic. Demographic items, health literacy screening questions, and the Rapid Estimate of Adult Literacy in Medicine (REALM) were administered to patients. To determine the accuracy of the candidate questions for identifying limited or marginal health literacy skills, we plotted area under the receiver operating characteristic (AUROC) curves for each item, using REALM scores as a reference standard. RESULTS: The mean age of subjects was 49.5; 67.5% were female, 85.2% Caucasian, and 81.3% insured by TennCare and/or Medicare. Fifty-four (17.7%) had limited and 52 (17.0%) had marginal health literacy skills. One screening question, "How confident are you filling out medical forms by yourself?" was accurate in detecting limited (AUROC of 0.82; 95% confidence interval [CI]=0.77 to 0.86) and limited/marginal (AUROC of 0.79; 95% CI=0.74 to 0.83) health literacy skills. This question had significantly greater AUROC than either of the other questions (P<.01) and also a greater AUROC than questions based on demographic characteristics. CONCLUSIONS: One screening question may be sufficient for detecting limited and marginal health literacy skills in clinic populations.

Adolescent↗
PubMed2006

Misperceptions of medical understanding in low-literacy patients: implications for cancer prevention.

BACKGROUND: Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening. METHODS: To determine whether family medicine residents could identify patients who might have difficulty understanding medical information because of limited literacy, we measured the literacy skills of patients in a university-based family medicine clinic using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). After the patients completed their office visits with a physician, we asked family medicine residents to rate the patients' ability to understand medical information. RESULTS: Among 140 patients who met with 18 family medicine resident physicians, 24% had limited literacy skills based on testing with the S-TOFHLA. Residents identified only about half of these patients as having poor or below average understanding of medical information. CONCLUSIONS: IN many cases, family medicine residents are unable to identify patients who, based on assessment of their literacy skills, are likely to have difficulty understanding medical information. When working with residents, medical educators should promote the habit of taking poor literacy into account when communicating with patients.

Communication↗
PubMed2006

Unchanged asthma prevalence during 1990-1999 in rural Alaska Natives.

OBJECTIVES: The prevalence of asthma has been increasing throughout the world, but the reasons for the increase are unclear. Some have hypothesized that the increase is due to industrial and agricultural pollutants in urban and rural areas, respectively. The objective of this research was to determine if the prevalence of asthma has increased in a remote area of Alaska where the population lives a subsistence lifestyle and is not exposed to such pollution. STUDY DESIGN: Retrospective review of medical records to determine the prevalence of asthma. METHODS: We reviewed medical records of 1200 children, aged 0-10 years, who lived in the Yukon-Kuskokwum Delta (YKD) region of western Alaska between 1990 and 1999. The entire YKD population receives health care from a single medical system, so records provide a complete picture of each patient's health care. Data collected from the medical records included demographics, and the presence or absence of a diagnosis of asthma or reactive airway disease (RAD). RESULTS: Over the 10-year period from 1990-1999, there was no significant change in the percentage of children who had a diagnosis of asthma (2.0% in 1990 and 3% in 1999), or RAD (9.6% in 1990 and 9.6% in 1999). CONCLUSIONS: In a population of children not exposed to urban industrial, or rural agricultural pollutants, there was no change in the prevalence of wheezing or asthma between 1990 and 1999.

Alaska↗
PubMed2006

Protecting participants in family medicine research: a consensus statement on improving research integrity and participants' safety in educational research, community-based participatory research, and practice network research.

Recent events that include the deaths of research subjects and the falsification of data have drawn greater scrutiny on assuring research data integrity and protecting participants. Several organizations have created guidelines to help guide researchers working in the area of clinical trials and ensure that their research is safe and valid. However, family medicine researchers often engage in research that differs from a typical clinical trial. Investigators working in the areas of educational research, community-based participatory research, and practice-based network research would benefit from similar recommendations to guide their own research. With funding from the US Office of Research Integrity and the Association of American Medical Colleges, we convened a panel to review issues of data integrity and participant protection in educational research, community-based participatory research, and research conducted by practice-based networks. The panel generated 11 recommendations for researchers working in these areas. Three key recommendations include the need for (1) all educational research to undergo review and approval by an institutional review board (IRB), (2) community-based participatory research to be approved not just by an IRB but also by appropriate community representatives, and (3) practice-based researchers to undertake only valid and meaningful studies that can be reviewed by a central IRB, rather than separate IRBs for each participating practice.

Biomedical Research↗
PubMed2005

Selecting medications for the treatment of urinary incontinence.

In response to the growing population of older patients with incontinence, pharmaceutical companies are developing new drugs to treat the condition. Before prescribing medications for incontinence, however, physicians should determine the nature and cause of the patient's incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation, and overflow bladder. The best treatment for urge incontinence is behavior therapy in the form of pelvic floor muscle exercises. Medications, used as an adjunct to behavior therapy, can provide additional benefit. Many therapies are available for patients with stress incontinence, including pelvic floor muscle exercise, surgery, intravaginal support devices, pessaries, peri-urethral injections, magnetic chairs, and intraurethral inserts. No medication has been approved for the treatment of stress incontinence, although medications are under development.

Adrenergic Uptake Inhibitors↗
PubMed2005

Evaluation of web-based osteoporosis educational materials.

BACKGROUND: Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults. METHODS: We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites. RESULTS: Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information. CONCLUSIONS: Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

Comprehension↗
PubMed2004

Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in the medical literature.

A large number of taxonomies are used to rate the quality of an individual study and the strength of a recommendation based on a body of evidence. We have developed a new grading scale that will be used by several family medicine and primary care journals (required or optional), with the goal of allowing readers to learn one taxonomy that will apply to many sources of evidence. Our scale is called the Strength of Recommendation Taxonomy. It addresses the quality, quantity, and consistency of evidence and allows authors to rate individual studies or bodies of evidence. The taxonomy is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. An A-level recommendation is based on consistent and good-quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited-quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening. Levels of evidence from 1 to 3 for individual studies also are defined. We hope that consistent use of this taxonomy will improve the ability of authors and readers to communicate about the translation of research into practice.

Algorithms↗
PubMed2004

The talking touchscreen: a new approach to outcomes assessment in low literacy.

PURPOSE: Cancer patients who are deficient in literacy skills are particularly vulnerable to experiencing different outcomes due to disparities in care or barriers to care. Outcomes measurement in low literacy patients may provide new insight into problems previously undetected due to the challenges of completing paper-and-pencil forms. DESCRIPTION OF STUDY: A multimedia program was developed to provide a quality of life assessment platform that would be acceptable to patients with varying literacy skills and computer experience. One item at a time is presented on the computer touchscreen, accompanied by a recorded reading of the question. Various colors, fonts and graphic images are used to enhance visibility, and a small picture icon appears near each text element allowing patients to replay the sound as many times as they wish. Evaluation questions are presented to assess patient burden and preferences. RESULTS: An ethnically diverse group of 126 cancer patients with a range of literacy skills and computer experience reported that the 'talking touchscreen' (TT) was easy to use, and commented on the usefulness of the multimedia approach. CLINICAL IMPLICATIONS: The TT is a practical, user-friendly data acquisition method that provides greater opportunities to measure self-reported outcomes in patients with a range of literacy skills.

Adult↗
PubMed2004

Simplifying the language of evidence to improve patient care: Strength of recommendation taxonomy (SORT): a patient-centered approach to grading evidence in medical literature.

Several taxonomies exist for rating individual studies and the strength of recommendations, making the analysis of evidence confusing for practitioners. A new grading scale-the Strength of Recommendation Taxonomy (SORT)-will be used by several family medicine and primary care journals (required or optional), allowing readers to learn 1 consistently applied taxonomy of evidence. SORT is built around the information mastery framework, which emphasizes the use of patient-oriented outcomes that measure changes in morbidity or mortality. Levels of evidence from 1 to 3 for individual studies also are defined. An A-level recommendation is based on consistent and good-quality patient-oriented evidence; a B-level recommendation is based on inconsistent or limited-quality patient-oriented evidence; and a C-level recommendation is based on consensus, usual practice, opinion, disease-oriented evidence, or case series for studies of diagnosis, treatment, prevention, or screening.

Algorithms↗
PubMed2003

Ambulatory devices for chronic gait disorders in the elderly.

Gait disorders in the elderly are common and in most cases cannot be treated medically or surgically. Therefore, treatment often relies on ambulatory devices such as canes, crutches, and walkers. Before selecting a device, the patient should be evaluated to define whether one or both upper extremities are required to achieve balance or bear weight. Patients requiring only one upper extremity can use a cane, while patients requiring both upper extremities are best served by forearm crutches or walkers. The patient's need to bear weight through the device will help the physician choose a specific device. When measuring the device, anatomic landmarks and the angle of the elbow must be taken into consideration. Because time often is limited during a routine office visit, a physical therapist often can provide further training for patients learning to use such a device.

Aged↗