Biomedical subjects

Judy A Shea

Publications and source records attributed to Judy A Shea.

At least 19 recordsLinked to original sources

PubMed2006

Health literacy weakly but consistently predicts primary care patient dissatisfaction.

OBJECTIVES: To study relationships between health literacy and multiple satisfaction domains. Health literacy is related to some domains of patient satisfaction such as communication and understanding, but little is known about relationships of health literacy with other satisfaction domains. Moreover, the importance of health literacy in predicting satisfaction compared with other patient sociodemographics is underexplored. DESIGN: Cross-sectional survey. SETTING: Primary care waiting areas with a Veterans Administration Medical Center and a university health system. PARTICIPANTS: One thousand five hundred and twenty-eight primary care patients. MAIN OUTCOME MEASURES: A brief demographics questionnaire, the Rapid Estimate of Adult Literacy in Medicine, the Veterans Affairs ambulatory care patient satisfaction survey, and an adaptation of the Charlson Comorbidity Index. RESULTS: In unadjusted regression analyses, lower health literacy level was a significant predictor of worse satisfaction in 7 of 10 domains (P < 0.01). When adjusting for patient sociodemographics, predicted relationships remained significant in six of the seven domains (P < 0.05), with each unit change in the 4-stage literacy classification associated with a 3-6 point decrease in dissatisfaction scores (0-100 scale). Health literacy did not predict overall dissatisfaction (P = 0.55). CONCLUSIONS: These results suggest that health literacy, as assessed through a pronunciation exercise that is closely related to more comprehensive measures of literacy, has a consistent, albeit weak relationship with patient satisfaction. Future work is needed to clarify if patients with lower literacy are really receiving different care than those with higher literacy and to pinpoint the sources of their more negative responses.

Adult↗

PubMed2006

Costs and quality-of-life effects of implantable cardioverter-defibrillators.

Although the clinical efficacy of implantable cardioverter-defibrillators (ICDs) has been convincingly demonstrated in clinical trials, the impact of ICDs on health care costs and recipients' quality of life (QOL) is less certain. The existing medical research on the health care costs and QOL effects of ICDs was reviewed and summarized. Medline and the Institute for Scientific Information's Web of Knowledge were searched for publications reporting costs of care and QOL assessments of ICD recipients. Unpublished and non-peer-reviewed "gray" publications were excluded. Reports were included if they reported primary, original patient data that were collected after 1993, when nonthoracotomy defibrillators entered clinical practice. Two reviewers independently evaluated publications for relevance and quality, abstracted study data, and summarized the findings. Excessive heterogeneity among studies prevented formal meta-analysis, so a narrative synthesis was performed, and key themes were identified from the published research. There were limited published data on the costs of ICD care, especially for the primary prevention of sudden cardiac death. The published research on ICD QOL lacked large, multicenter, longitudinal studies. Many ICD QOL studies were performed in small numbers of patients at single centers. Initial ICD implantation costs ranged (in 2006 United States dollars) from $28,500 to $55,200, with annual follow-up costs ranging from $4,800 to $17,000. QOL was higher for ICD recipients than for patients treated with antiarrhythmic drugs, but there was a substantial prevalence of anxiety, depression, and "loss of control" in ICD recipients, particularly in those who had received ICD shocks. In conclusion, ICD implantation remains costly but may be becoming less expensive over time, and ICD recipients' QOL is significantly affected by their devices.

Activities of Daily Living↗

PubMed2006

Formation and validation of a telephone battery to assess cognitive function in acute respiratory distress syndrome survivors.

PURPOSE: Describe initial development and validation of a test battery composed of established instruments designed to detect, via telephone interview, cognitive abnormalities in survivors of acute respiratory distress syndrome. METHODS: Two cross-sectional studies were performed, including the following phases: (1) initial battery construction, (2) feasibility, (3) item reduction, (4) convergent and divergent validity, and (5) telephone administration compared with in-face interviews in a separate population. RESULTS: There was a broad range of cognitive function detected in the derivation population, and all subjects completed the interview. There was convergence of cognitive impairment with moderate/severe anxiety (P = .008), the Sickness Impact Profile Psychosocial Summary Score (mean difference, 15.3; 95% CI, 7.74-22.9; P = .0001), and the mental health domains of the Short Form 36. Subjects with cognitive impairment had no detectable difference in the physical function domains of the Short Form 36. When administered to the validation population, telephone tests of memory, attention, reasoning, and executive functions had good intraclass correlation with the in-face interviews (P < .01). CONCLUSIONS: Detection of cognitive abnormalities in acute respiratory distress syndrome survivors using a telephone-administered test battery derived from standard cognitive tests is feasible and has evidence of construct validity. This battery may be useful as a research tool when in-face interviews are not feasible.

Adult↗

PubMed2006

Development and validation of an instrument to measure asthma symptom control in children.

BACKGROUND: Few instruments exist to measure control of asthma symptoms in children. A brief instrument administered at healthcare visits could provide a more consistent approach to symptom recognition for patients and providers. OBJECTIVE: To develop a Pediatric Asthma Control Tool to measure asthma symptom control at pediatric healthcare visits and evaluate the instrument compared to expert assessment and an asthma-related quality-of-life (QOL) measure. DESIGN/METHOD: A preliminary 14-item instrument was generated through a process of literature review, meetings of institutional experts, and focus groups of parents and providers. The preliminary survey measured asthma control over the past 3 months in 2 domains: frequency of asthma flares and presence of symptoms when the child was at their best. Persistent symptoms were categorized according to published national asthma guidelines (NAEPP). The instrument and an asthma-related QOL measure were administered in the waiting room before a specialist visit for asthma. After the visit the specialist independently assessed asthma control in both domains on a 7-point Likert scale. Internal consistency and assessments of criterion and construct validity were calculated using standard statistics. RESULTS: A total of 200 subjects ranging from 1 to 18 years of age and their caregivers were enrolled; 60% were male. During the prior 3 months, 19% had an emergency visit and 24% described persistent asthma symptoms. After item review the instrument was shortened to five items each for frequency of flares and symptoms at best. Internal consistency was high for each of these domains (Cronbach's alpha = 0.81/0.83, respectively). Correlation of each domain was good when compared to expert assessment (r = 0.54/0.59) and QOL (r = 0.61/0.77). CONCLUSIONS: Responses to a 10-item instrument to measure control of asthma symptoms in children at a healthcare visit demonstrated internal consistency and criterion and construct validity.

Adolescent↗

PubMed2006

Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns.

PURPOSE: To explore the relationships between sleep deprivation and the evolution of mood disturbances, empathy, and burnout among a cohort of interns. METHOD: In 2002-03, 47 interns in the internal medicine resident program at the University of Pennsylvania School of Medicine completed the following instruments at baseline and at year end: sleep quantities, Epworth Sleepiness Scale, the Beck Depression Inventory-Short Form, the Interpersonal Reactivity Index, and the Maslach Burnout Inventory-Human Services Survey. The prevalences of acute and chronic sleep deprivation, subjective sleepiness, burnout, empathy, and depression at the beginning of the year were compared to prevalences at the end of internship. Associations between sleep deprivation and mood, empathy, or burnout were explored. RESULTS: The prevalence of chronic sleep deprivation, depression, burnout, and empathy increased from baseline to year end. Specifically, the prevalence of "high" scores changed for chronic sleep deprivation (9% to 43%, p = .0001). The prevalence of moderate depression increased from 4.3% to 29.8% (p = .0002). Only 4.3% reported a high level of burnout initially compared with 55.3% at year end (p < .0001). Scores that were originally more favorable than general population norms (p < .001) approached norms at the end of the year for empathic concern (p = .15). There was an association between becoming chronically sleep deprived and becoming depressed (OR = 7, p = .014). CONCLUSIONS: Given the association between chronic sleep deprivation and mood disturbances during internship, outcome assessment is warranted to see if duty-hour reform will translate into more hours slept or fewer hours worked, coincident with improved mood.

Analysis of Variance↗

PubMed2006

Are discharge summaries teachable? The effects of a discharge summary curriculum on the quality of discharge summaries in an internal medicine residency program.

BACKGROUND: Interns are often required to dictate discharge summaries without formal training. We investigated the impact of a curriculum aimed at improving the quality (i.e., complete, organized, succinct, internally consistent, and readable) of interns' discharge summaries. METHOD: Fifty-nine medicine interns were randomized to a: (1) control group; (2) discharge summary curriculum; or (3) curriculum plus individualized feedback. Pre- and post-intervention, seven discharge summaries were graded using a 9-item instrument. T-tests, analysis of covariance, and effect sizes assessed group differences. RESULTS: There were multiple, significant within-group improvements for the intervention groups and between group differences post-intervention. The average effect size was large when the curriculum plus feedback group was compared to the control group (.70) and moderate when compared to the curriculum only group (.36). CONCLUSIONS: Interns who received instruction on discharge summary skills improved the quality and of their discharge summaries. Adding feedback to the curriculum provided more benefit.

Curriculum↗

PubMed2006

Distrust of the health care system and self-reported health in the United States.

CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States. OBJECTIVE: To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States. DESIGN: Random-digit-dialing telephone survey. PARTICIPANTS: Nine hundred and sixty-one adult residents of the continental U.S. PRIMARY MEASURES: Distrust of the health care system and self-reported health status. RESULTS: Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status. CONCLUSIONS: Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved.

Adolescent↗

PubMed2006

Improvement of resident perceptions of nurse practitioners after the introduction of a collaborative care model: a benefit of work hour reform?

BACKGROUND: Nurse practitioners (NPs) are assuming larger roles in many residency programs as a result of work hour reform, which is creating the potential for collaboration with interns and residents. PURPOSE: To assess housestaff perceptions of NPs. METHODS: We used a 17-item survey before and after the implementation of a collaborative care model in a university-based medicine residency. RESULTS: The majority of residents held favorable attitudes about NPs before the introduction of the collaborative care model. After 1 year, more interns and residents appreciated NPs' clinical judgment (effect size [ES] = .26, p =.02), thought they should be able to order laboratory tests (ES = .23, p = .05) and perform basic procedures (ES = .67, p < .0001), and viewed them as colleagues (ES = .25, p = .04). Only a minority felt NPs contributed to their education. CONCLUSIONS: The promotion of collaborative care can be an unintended consequence of work hour reform. Educators are encouraged to think about how changes in the curriculum structure can provide opportunities for positive collaborative care experiences.

Cooperative Behavior↗

PubMed2006

Missing race/ethnicity data in Veterans Health Administration based disparities research: a systematic review.

Many studies evaluating racial disparities in health come from the Veterans Health Administration (VHA) and are based on secondary and administrative data. Often race/ethnicity data are missing in these sources. Knowing how investigators treat missing data is critical in evaluating potential biases. The objectives of this systematic review were to quantify: (1) the data sources for VHA racial/ethnic disparity studies; (2) how missing race/ethnicity data were handled; and (3) the extent of missing race/ethnicity data. Two trained reviewers independently abstracted 114 articles. The Patient Treatment File was the most common source of race/ethnicity data (n=49). For just over half of the articles we were unable to determine if there were missing race/ethnicity data (n=58). When missing race/ethnicity data were quantified, the proportion of instances for which the data were missing ranged from 0% to 48%. Missing race/ethnicity data are frequently present in VHA secondary and administrative data sources, but, the proportion of instances for which such data are missing is explicitly discussed or quantified in only about 50% of all articles using these sources.

Bias↗

PubMed2005

A new questionnaire for urinary incontinence diagnosis in women: development and testing.

OBJECTIVE: The purpose of this study was to develop a questionnaire for urinary incontinence diagnosis in women and to test its reliability and validity, with incontinence specialists' clinical evaluations as the gold standard. STUDY DESIGN: One hundred seventeen urogynecology outpatients with urinary incontinence symptoms completed the Questionnaire for Urinary Incontinence Diagnosis at enrollment and 1 week and 9 months later. Baseline clinical diagnoses were compared with Questionnaire for Urinary Incontinence Diagnosis diagnoses (criterion validity). Nine-month Questionnaire for Urinary Incontinence Diagnosis change scores were compared across treatment groups (responsiveness). RESULTS: Clinical diagnoses included stress (n = 15), urge (n = 26), and mixed urinary incontinence (n = 72). Internal consistency and test-retest reliability estimates were good. Sensitivity and specificity were 85% (95% CI, 75%, 91%) and 71% (95% CI, 51%, 87%), respectively, for stress urinary incontinence and 79% (95% CI, 69%, 86%) and 79% (95% CI, 54%, 94%), respectively, for urge urinary incontinence. The Questionnaire for Urinary Incontinence Diagnosis correctly diagnosed urinary incontinence type in 80% of subjects. Questionnaire for Urinary Incontinence Diagnosis Stress and Urge scores decreased significantly in treated subjects. CONCLUSION: The Questionnaire for Urinary Incontinence Diagnosis, a new 6-item questionnaire for female urinary incontinence type diagnosis, is reliable and able to diagnose stress urinary incontinence and urge urinary incontinence in a referral urogynecology patient population with accuracy.

Adult↗

PubMed2005

Performance of the English and Spanish S-TOFHLA among publicly insured Medicaid and Medicare patients.

The objective of this study was to analyze the psychometric properties of the English and Spanish S-TOFHLA for three patient populations of interest. Despite being widely used, little is written about psychometric properties of the S-TOFHLA, particularly the Spanish version. Participants were Medicaid and Medicare patients: 936 non-Hispanic and 368 Hispanic patients completed the English S-TOFHLA; 1066 Hispanics completed the Spanish S-TOFHLA. Validity of both versions of the S-TOFHLA was supported by strong positive relationships with education and inverse relationships with age. Significant differences between scores for men and women remained after adjusting for level of education. Score differences occurred across numerous items. More research is needed on the S-TOFHLA and other health literacy instruments to determine why women score differently than men. Variability in literacy skills within subgroups of patients highlights the importance of healthcare providers being sensitive to patients' literacy levels in both spoken and written communications.

Adult↗

PubMed2005

Developing an illustrated version of the Consumer Assessment of Health Plans (CAHPS).

BACKGROUND: The most commonly used tool for assessing member satisfaction with health plans in the United States is the Consumer Assessment of Health Plans (CAHPS). Yet its complexity exceeds the abilities of many patient populations. An illustrated version of the CAHPS instrument was designed for low-literacy audiences; the illustrations were tested and were then revised toreflect respondents' feedback. METHODS: Ilustrattions were developed to support the central themes in each of 63 CAHPS text items. The cognitive testing approach was used to create a systematic method to analyze key features of an item and develop the corresponding interview procedure. RESULTS: Following cognitive interviews on subsets of illustrations and items with more than 900 patients, all but 7 (11%) of the 63 items met the criterion that no more than 25% of the sample who saw the illustration could be rated as having "limited/no understanding." By the final pilot, a median of 66% had "full understanding," 20% had "partial understanding," and 14% had "limited/no understanding" of the 43 illustrations needing revision. CONCLUSIONS: The protocol helped improve the respondents' understanding of the illustrations. The experiences and lessons learned can guide design of illustration-enhanced materials for low-literacy populations.

Adult↗

PubMed2005

The association between knowledge and attitudes about genetic testing for cancer risk in the United States.

Attitudes about genetic testing are likely to be an important determinant of uptake of predictive genetic tests among the general public. Several prior studies have suggested that positive attitudes about genetic testing may be inversely related to knowledge about genetic testing. We conducted a random-digit-dialing (RDD) telephone survey of 961 adults in the continental United States to determine the associations among knowledge of, attitudes about, and perceptions of eligibility for genetic testing for cancer risk. Knowledge about genetic testing for cancer risk was generally high, with a mean accuracy score of 72%. Attitudes about genetic testing for cancer risk were also generally positive, with 87% of respondents reporting genetic testing for cancer risk would be used to help doctors manage their health care and 85% to help scientists find cures for diseases. In contrast, 58% of respondents thought genetic testing for cancer risk would be used to prevent them from getting health insurance and 31% to allow the government to label groups as inferior. Twenty-nine percent of respondents thought they were currently eligible for testing. After adjustment for sociodemographic characteristics and family cancer history, higher knowledge was correlated with more positive attitudes about testing, but not with negative attitudes or perceptions of testing eligibility. Family history was positively associated with perceptions of eligibility (OR 3.49, 95% CI 2.36-5.18), and higher levels of education were inversely associated with perceptions of eligibility (OR 0.55, 95% CI 0.32-0.94 for comparison of college or higher vs. less than high school). These results suggest that most members of the general public are knowledgeable and have positive attitudes about genetic testing for cancer risk and that greater knowledge is correlated with more positive attitudes about the benefits of testing.

Adolescent↗

PubMed2005

Mood change and empathy decline persist during three years of internal medicine training.

PURPOSE: To examine longitudinal changes in mood and empathy over the course of the internal medicine residency. METHOD: The authors conducted a cohort study of 61 residents who completed the Profile of Mood States (POMS) and the Interpersonal Reactivity Index (IRI) at six time points during their internal medicine residency at a university-based program. (POMS was administered five times, and IRI was administered six times.) The main outcomes measured were trends in mood disturbances and multiple domains of empathy over the three-year residency, and comparisons to norms. RESULTS: Response rates varied from Time 1 to Time 6 (98%, 72%, 79%, 79%, 94%, and 95%, respectively). Interns had better scores on four POMS subscales: Depression-Dejection (p = .0031), Anger-Hostility (p < .0001), Fatigue-Inertia (p < .0001), and Vigor-Activity (p < .0001) compared with later administrations, especially midinternship. By the end of residency all POMS scores were returning towards baseline (effects sizes in the .20 s), but only depression was no longer significantly different. IRI scores showed the decline in Empathic Concern remained over residency whereas Personal Distress peaked midinternship year but approached baseline at the end of residency. Compared with the general population, the graduating residents were less tense, depressed, and confused. Personal Distress was significantly lower than the norm group. CONCLUSIONS: Internal medicine residency presents challenges resulting in common mood disturbances. Although graduating residents appear to be better off than the population norms, some domains of their mood disturbances and empathy never fully recover from their internship year.

Affect↗

PubMed2005

Educational views and attitudes, and career goals of MD-PhD students at the University of Pennsylvania School of Medicine.

PURPOSE: Despite the documented contribution of graduates of MD-PhD programs to the medical profession, few data exist concerning the views, attitudes, and career goals of students before they graduate from such programs. METHOD: All 167 students enrolled in the University of Pennsylvania School of Medicine Combined Degree Program in the spring of 2002 were invited to participate in an IRB-approved online questionnaire consisting of 81 multiple-choice questions covering students' demographics, satisfaction with their educational experience, future goals and career aspirations, and attitudes and views concerning the physician-scientist model. RESULTS: The 96 MD-PhD students (57.5%) who completed the questionnaire represented a diverse group with individuals from every stage of training. The majority of students were satisfied with their overall educational experience (90.5%). Although students reported an interest in a wide range of clinical specialties, 84.4% indicated plans to pursue a career in research and 79.2% preferred a position at an academic medical center. However, a larger percentage of males (70.7%) than females (50.0%) listed research as their primary professional activity. The range of students' views and attitudes regarding the physician-scientist model suggests that additional education and discussion are warranted. CONCLUSION: The MD-PhD students surveyed at the University of Pennsylvania were satisfied with their education and most were planning research-oriented careers. Yet, the aspirations, views and concerns of individual MD-PhD students were varied. The authors believe this information in aggregate will prove useful to current and future students, combined degree programs, policymakers, and residency directors.

Adult↗

PubMed2005

A ChemoSensory questionnaire for patients treated for cancer of the head and neck.

OBJECTIVES: To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ). DESIGN: Cross sectional survey for questionnaire development and testing. METHODS: Literature, expert opinion, and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed, and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire (HRQOL) to a sample of patients. After item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. RESULTS: Two hundred six patients were included in the study. The final survey instrument consisted of eight items, four on smell and four on taste. Cronbach's alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated. CONCLUSIONS: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and is brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance.

Aged↗

PubMed2005

A randomized-controlled study of encounter cards to improve oral case presentation skills of medical students.

OBJECTIVE: To determine the feasibility of oral case presentation (OCP) encounter cards as a tool for formative evaluation, to estimate the reliability and validity of the ratings when used in a medicine clerkship, and to examine whether the use of OCP encounter cards improves students' OCP skills. DESIGN: Randomized controlled study. SETTING: Medicine core clerkship at a U.S. medical school. PARTICIPANTS/INTERVENTION: Students enrolled in the medicine core clerkship (n=164) from January to December of 2003 were randomly assigned to receive weekly feedback using OCP encounter cards rating nine presentation compentencies or receive usual feedback. Mean OCP ratings were correlated with multiple summative assessments. Performance on an end-of-clerkship OCP was compared between intervention and control groups. MAIN RESULTS: Eighty percent of cards were completed. The mean OCP rating averaged over 9 competencies was 7.7 (SD=0.8) on a 9-point scale. Standard error of ratings was 0.3. OCP ratings were correlated with inpatient evaluations (r=.58), inpatient ratings of presentation skills (r=.43), and final grades (r=.40). Final OCP performance was similar for the intervention and control groups (7.0 vs 7.2, P=.09). CONCLUSION: OCP encounter cards are a novel and feasible tool to assess clerkship students' oral case presentation skills. OCP card ratings are reproducible, and validity is suggested by their correlation with multiple markers of performance. However, encounter cards did not improve performance on summative oral presentations.

Clinical Clerkship↗

PubMed2005

Attitudes and misconceptions about predictive genetic testing for cancer risk.

OBJECTIVE: To describe awareness, knowledge, and attitudes about genetic testing for cancer risk among the general public. RESULTS: Thirty-eight adults participated in focus groups in West Philadelphia, Pennsylvania. Participants' beliefs about what genetic testing is ranged from 'dianetics' to an accurate description of DNA analysis. Themes included misconceptions about genetic tests, the ability to gain control of one's life through genetic testing, anxiety that might be caused by testing, risk of insurance and employment discrimination, use of genetic information for racial or ethnic discrimination, concerns about medical information confidentiality and lack of informed consent. CONCLUSIONS: Although there was some accurate understanding of what genetic testing is and how the results could be used, there also exist significant misconceptions. In many cases, misconceptions may be barriers to uptake of genetic testing. Dispelling these misconceptions is an important step in the translation of advances in human genomics into improvements in health.

Adult↗