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Biomedical subjects

Karen Sullivan

Publications and source records attributed to Karen Sullivan.

15 recordsLinked to original sources
PubMed2006

The nature and predictors of stroke knowledge amongst at risk elderly persons in Brisbane, Australia.

PURPOSE: The aim of the study was to investigate the nature, extent, and predictors of stroke knowledge amongst people at risk of stroke. METHOD: A total of 273 questionnaires were distributed to three types of sites in metropolitan Brisbane (retirement villages, senior citizens and bowls clubs), and this strategy yielded a response rate of 37%. Of the surveys returned, 75 were retained in this study on the basis that: (a) participants met our criteria for being at risk of stroke (i.e., they reported one or more modifiable stroke risk factor, such as hypertension), and (b) they returned a completed Stroke Knowledge Test (SKT). RESULTS: Descriptive analyses revealed the overall level of stroke knowledge in this group was fair (approximately 50% of SKT items answered correctly, on average). SKT performance trends showed that participants did not have misconceptions about stroke but that more than 50% of the sample did not know the answer to seven out of 20 SKT items. Some overlap was identified regarding the issues about which participants in this and other previously researched groups admit they lack knowledge, such as the extent of increased stroke risk associated with smoking; however, the number of knowledge gaps identified in this sample was almost double that reported previously amongst stroke survivors and the general community. Analyses undertaken to explore determinants of stroke knowledge revealed age and education but not risk factor variables as significant predictors. CONCLUSION: Overall, findings suggest that it is presently difficult to predict an individual's understanding of stroke and that there is a need to increase stroke education, especially if this can address issues that people at risk of stroke admit they do not understand.

Aged↗
PubMed2006

Suppressed working memory on the WMS-III as a marker for poor effort.

The purpose of this study was to examine the clinical utility of memory minus Working Memory Index (memory-WMI) discrepancy scores on the WMS-III for detecting poor effort in 145 personal injury litigants (19 poor effort, 126 adequate effort). On average, participants in the poor effort group performed significantly lower on all WMS-III memory indexes and demonstrated larger memory-WMI discrepancy scores compared to participants in the adequate effort group. Discriminant function analyses using memory-WMI discrepancy scores as independent variables revealed poor overall classification rates (60.0% to 63.4%). Based on the prevalence of unusually suppressed attention-concentration ability relative to memory functioning using unidirectional memory-WMI discrepancy scores, high specificity and negative predictive power values were found. However, there was unacceptably low sensitivity and positive predictive power. These results suggest that memory-WMI discrepancy scores on the WMS-III do not provide clinically useful information regarding response set and should be used cautiously as an indicator of poor effort.

Adult↗
PubMed2005

Alternate forms of prose passages for the assessment of auditory-verbal memory.

Logical memory (LM) is the most frequently administered subtest from the Wechsler Memory Scale; however, the lack of alternate equivalent forms for this subtest may limit its clinical utility. Six new paragraphs modelled on LM stories were developed. Stories were matched on attributes such as number of words and readability. Passage attributes for the six stories were compared with those of standard LM stories (WMS-R and WMS-III versions) to examine story equivalence. The psychometric properties of new passages were also calculated to assess task difficulty and interrater reliability. Results from these analyses suggest a high degree of overlap between the attributes of the new stories and some interesting discrepancies between passage attributes of WMS-R and WMS-III LM stories. In addition, interrater reliability of new passages was found to be excellent (at least .97), and when combined into three sets of passage-pairs, these pairs were found have equivalent difficulty. To reduce the potential for practice effects by use of alternate forms, these new logical memory-style passages may facilitate repeat assessment of auditory-verbal memory.

Acoustic Stimulation↗
PubMed2005

Ecological validity of the WMS-III rarely missed index in personal injury litigation.

The purpose of this study was to evaluate the clinical utility of the Rarely Missed Index (RMI) to detect cognitive exaggeration in 78 nonlitigant patients (i.e., Mixed Clinical group) and 158 personal injury litigants (i.e., 20 Suspected Exaggerators, 12 Borderline Exaggerators, 126 Genuine Responders). The base rate for probable malingered neurocognitive dysfunction in the litigant sample was 12.7%. The false positive error rate of the RMI in the Genuine Responder and Mixed Clinical group ranged from 5.4% to 8.6%. Positive RMI scores were found in 25% and 41.7% of the Suspected Exaggerator and Borderline Exaggerator groups respectively. The clinical utility of the RMI to identify Suspected Exaggerators versus individuals in the Genuine Responder and Mixed Clinical groups revealed low sensitivity (sensitivity = .25), very high specificity (range = .91 to .95), moderate positive predictive power (range = .50 to .71), and moderate to high negative predictive power (range = .68 to .83). These results do not support the use of the RMI as a reliable predictor of cognitive exaggeration.

Adult↗
PubMed2005

Stroke knowledge and misconceptions among survivors of stroke and a non-stroke survivor sample.

PURPOSE: To investigate stroke knowledge, knowledge gaps, and misconceptions about stroke among stroke survivors and non-stroke survivors. METHOD: Archival data from a stroke knowledge test administered to 38 non-stroke survivors (community sample) were compared to data collected for this study from 42 stroke survivors. RESULTS: No difference in the overall level of stroke knowledge between groups was found. There were 12 issues about which stroke survivors and non-stroke survivors appear to have good understanding (e.g., the role of aspirin in preventing stroke). There were a smaller number of issues about which participants from both groups reported they lacked knowledge (e.g., the relationship between TIAs and stroke) or held erroneous beliefs (e.g., the effect of atrial fibrillation on stroke risk). CONCLUSION: There is a continuing need for education about stroke. Particular areas on which such programs might need to focus are identified.

Atrial Fibrillation↗
PubMed2004

Two new tools for assessing patients' knowledge and beliefs about obstructive sleep apnea and continuous positive airway pressure therapy.

BACKGROUND AND PURPOSE: Patients' knowledge and beliefs about their illnesses are known to influence a range of health related variables, including treatment compliance. It may, therefore, be important to quantify these variables to assess their impact on compliance, particularly in chronic illnesses such as Obstructive Sleep Apnea (OSA) that rely on self-administered treatments. The aim of this study was to develop two new tools, the Apnea Knowledge Test (AKT) and the Apnea Beliefs Scale (ABS), to assess illness knowledge and beliefs in OSA patients. PATIENTS AND METHODS: The systematic test construction process followed to develop the AKT and the ABS included consultation with sleep experts and OSA patients. The psychometric properties of the AKT and ABS were then investigated in a clinical sample of 81 OSA patients and 33 healthy, non-sleep disordered adults. RESULTS: Results suggest both measures are easily understood by OSA patients, have adequate internal consistency, and are readily accepted by patients. A preliminary investigation of the validity of these tools, conducted by comparing patient data to that of the 33 healthy adults, revealed that apnea patients knew more about OSA, had more positive attitudes towards continuous positive airway pressure (CPAP) treatment, and attributed more importance to treating sleep disturbances than non-clinical groups. CONCLUSIONS: Overall, the results of psychometric analyses of these tests suggest these measures will be useful clinical tools with numerous beneficial applications, particularly in CPAP compliance studies and apnea education program evaluations.

Adult↗
PubMed2004

Frequency of insomnia report in patients with obstructive sleep apnoea hypopnea syndrome (OSAHS).

BACKGROUND AND PURPOSE: Insomnia and Obstructive Sleep Apnoea Hypopnea Syndrome (OSAHS) are the two most common sleep disorders, and both have significant associated health costs. Despite this, relatively little is known about the prevalence or impact of insomnia in those with OSAHS, although a recent study suggested there may be substantial comorbidity between these disorders [Chest 120 (2001) 1923-9]. The primary aim of this study was to further explore the prevalence of insomnia in OSAHS. A secondary aim was to assess the effect of factors that may impact on both conditions, including mood and sleep-beliefs. PATIENTS AND METHODS: Consecutive patients referred to an accredited Sleep Investigations Unit [n = 105] completed a brief standardized battery of validated questionnaires assessing sleep-related variables and mood. RESULTS: Results showed a high rate of prevalence of clinical insomnia in this OSAHS population, and a strong positive correlation between OSAHS and insomnia symptom severity. Further, OSAHS patients with comorbid insomnia had increased levels of depression, anxiety and stress compared to patients with OSAHS-only, and both patient groups reported similar and significant levels of dysfunctional beliefs about sleep. Findings in relation to habitual sleep, assessed using subjective (diary) and objective criteria (polysomnogram), were mixed but generally showed greater sleep disturbance among those with OSAHS-insomnia compared to those with OSAHS-only. CONCLUSIONS: Overall these findings suggest that comorbidity of insomnia in OSAHS patients may lead to increased OSAHS severity and that patients with both conditions may experience more symptoms relating to depression, anxiety and stress. These findings underscore the need for insomnia assessment and management services, even in clinics that primarily service patients with OSAHS.

Adolescent↗
PubMed2004

Neuropsychological assessment of mental capacity.

The assessment of mental capacity to assist legal determinations of competency is potentially a growth area for neuropsychology, although to date neuropsychologists have published relatively little in this area. In this paper a systematic review of methods used to assess capacity is presented, including coverage of specialized tests and interviews used for this purpose. A neuropsychological model for conducting capacity assessments is proposed. This model involves comprehensive assessment of a wide range of cognitive abilities as well as assessment of specific skills and knowledge related to the type of capacity being assessed. The purpose of proposing this model is to stimulate further discussion and debate about the contribution neuropsychologists might make in this area.

Advance Directives↗
PubMed2004

Development and validation of the stroke knowledge test.

PURPOSE: The purpose of this study was to develop a measure of stroke knowledge (the Stroke Knowledge Test [SKT]) using a systematic test construction process and to investigate the psychometric properties of this test. There are relatively few published measures of stroke knowledge, and, of those that exist, relatively little is documented about test construction or psychometric properties. Such tests are important for evaluation of stroke education programs. METHOD: Test construction involved systematic generation of pilot test items, expert review of pilot items, and calculation of pilot item properties. After final item selection, two experiments were conducted to determine if the SKT was sensitive to varying levels of stroke knowledge and to estimate the reliability of the test. RESULTS: The final version of the test included 20 items with good content coverage, acceptable item properties, and positive expert review ratings. Results from psychometric investigations suggest that SKT has relatively good reliability (internal consistency and test-retest reliability) and construct validity (i.e., SKT scores significantly increased after stroke education [cf. nonstroke education], and community-dwelling older adults who had a relative with stroke [and more prior exposure to stroke information] scored higher on the SKT than those without a stroke relative). CONCLUSION: Findings provide preliminary support for the SKT as a valid and reliable tool for assessing stroke knowledge. The SKT may be used to identify individual information needs of stroke survivors and their caregivers or as a tool to evaluate group- or community-based stroke education programs.

Adult↗
PubMed2003

Examining the influence of biological and psychological factors on cognitive performance in chronic fatigue syndrome: a randomized, double-blind, placebo-controlled, crossover study.

The pathophysiology of chronic fatigue syndrome (CFS) remains unclear; however, both biological and psychological factors have been implicated in establishing or maintaining this condition. People with CFS report significant and disabling cognitive difficulties such as impaired concentration that in some cases are exacerbated by exposure to chemical triggers. The aim of this study was to determine if neuropsychological deficits in CFS are triggered by exposure to chemicals, or perceptions about the properties of these substances. Participants were 36 people with a primary diagnosis of CFS, defined according to Centers for Disease Control (CDC) criteria. A randomized, double-blind, placebo-controlled, crossover design was used, with objective assessment of neuropsychological function and participant rating of substance type, before and after exposure to placebo or chemical trigger. Results showed decrements in neuropsychological tests scores on three out of four outcome measures when participants rated the substance they had been exposed to as "chemical." No change in performance was found based on actual substance type. These results suggest that cognitive attributions about exposure substances in people with CFS may be associated with worse performance on neuropsychological tasks. In addition, these findings suggest that psychological interventions aimed at modifying substance-related cognitions may reduce some symptoms of CFS.

Adult↗
PubMed2002

Oxygen-mediated regulation of porphobilinogen formation in Rhodobacter capsulatus.

A Rhodobacter capsulatus hemC mutant has been isolated and used to show that oxygen regulates the intracellular levels of porphobilinogen. Experiments using a hemB-cat gene fusion demonstrated that oxygen does not transcriptionally regulate hemB transcription. Porphobilinogen synthase activity is not regulated by oxygen nor is the enzyme feedback inhibited by hemin or protoporphyrin IX. It was demonstrated that less than 20% of [(14)C]aminolevulinate was incorporated into bacteriochlorophyll, suggesting that the majority of the aminolevulinate is diverted from the common tetrapyrrole pathway. Porphobilinogen oxygenase activity was not observed in this organism; however, an NADPH-linked aminolevulinate dehydrogenase activity was demonstrated. The specific activity of this enzyme increased with increasing oxygen tension. The results presented here suggest that carbon flow over the common tetrapyrrole pathway is regulated by a combination of feedback inhibition of aminolevulinate synthase and diversion of aminolevulinate from the pathway by aminolevulinate dehydrogenase.

Aminolevulinic Acid↗
PubMed2002

Malingering on the RAVLT: Part II. Detection strategies.

In this study two potential indices of malingering derived from the Rey Auditory Verbal Learning Test (RAVLT) were evaluated as a means of detecting malingering. These were indices based on discrepancies between recognition-recall scores and differences in the serial position effect (SPE). Sixty undergraduate students were randomly assigned to one of four conditions: malingerers, malingerers-with-warning, warning-only, and control. Incentives were offered to participants in all conditions to encourage faking in a believable manner (malingering conditions), or to encourage optimal performance (nonmalingering conditions). Two predictions were made. First, it was predicted that the serial position curve for subjects in malingering conditions would show suppression of primacy effects relative to nonmalingerers. Second, it was predicted that recall would be better than recognition for subjects in malingering conditions compared to nonmalingering conditions. The utility of these indices was also explored in the context of providing subjects' with warnings regarding use of methods to detect malingering. Results indicated that both indices failed to reliably differentiate between malingerers and nonmalingerers, and warnings failed to modify participants' behaviour.

Clinical Trial↗
PubMed2002

Malingering on subjective complaint tasks: an exploration of the deterrent effects of warning.

Assessing patient's subjective experience of illness is an important component of neuropsychological assessment. This information can be assessed using standardized self-reported complaint (SRC) checklists and may have specific applications in the assessment of malingering. Previous research suggests that subjective complaints can be faked under some circumstances, however, the extent to which this occurs when assessments are made using standardized SRC measures is less well understood. In addition, if complaints can be faked, this raises the question: What might reduce the likelihood of faked symptom reports? In this study, we randomly allocated 60 first-year undergraduate subjects to one of the three conditions: malingering, malinger-with-warning, and control. Using a repeated-measures analogue design, we assessed differences between groups on selected SRC measures. The measures used were the Neuropsychological Symptoms Checklist (NSC), the General Health Questionnaire-30 (GHQ-30), and the Depression, Anxiety, and Stress Scales (DASS). We expected to find that SRC measures would be vulnerable to faking, but also that warning malingerers about the possibility of detection would reduce faking behavior. Further, control group scores on SRC measures were calculated to produce preliminary complaint base rate data for these tests. Our results showed that SRC measures were vulnerable to faking. In addition, contrary to expectations, we found that warnings did not significantly deter malingering, although we observed that a trend in the expected direction and future studies with a larger sample size or a modified warning may be needed to further investigate warning efficacy. Broader implications of these findings are discussed in light of deterrence theory and recent debate over the use of SRC measures in the assessment of malingering.

Clinical Trial↗
PubMedDate not supplied

Community partnerships for an LPN to BSN career mobility project.

Based on a 6-year, learn and earn curriculum, the authors report on a year-old project that assists licensed practical nurses (LPNs) to obtain a baccalaureate degree in nursing (BSN). Partnerships with 4 area healthcare agencies employing LPNs were developed to support students with full or partial tuition reimbursement and work schedules to accommodate classes. Key university staff in the offices of admissions, financial aid, adult programs and services, and nursing advisement are assigned to this student group to provide individualized assistance. The authors discuss unique components of the project including regularly scheduled role transition seminars, faculty mentors, BSN and nurse practitioner clinical mentors, and clinical experiences in nurse-managed clinics.

Adult↗