Biomedical subjects

Kenneth E James

Publications and source records attributed to Kenneth E James.

5 recordsLinked to original sources

PubMed2006

The influence of physician gender on practice satisfaction among obstetrician gynecologists.

OBJECTIVE: A survey was conducted to investigate the hypothesis that female gender would positively affect job satisfaction among obstetrician gynecologists. STUDY DESIGN: A survey was sent to 500 randomized, age matched American College of Obstetrics and Gynecology members, 50% each men and women: 49.8% responded. Data were analyzed with the chi2 contingency test, Cochran's test for linear trends, Student t tests, and multiple regression. RESULTS: Women considered their gender an asset in deciding on a career in obstetrics and gynecology, in obtaining jobs, and in maintaining their practices. Men considered that their gender limited their practice options and were more likely to report that they would not choose a career in obstetrics and gynecology if they could choose again. The only significant difference between men and women in measures of obtaining and maintaining a practice was that men were more likely to practice in small urban or rural settings. Men reported higher incomes. Both genders were equally satisfied with their jobs. CONCLUSION: Although both genders considered female gender to be an asset in obstetrics and gynecology, this survey showed no difference in their ratings of overall career satisfaction.

Adult↗

PubMed2005

Issues in the design of multisite clinical trials of psychotherapy: VA Cooperative Study No. 494 as an example.

This article describes issues in the design of an ongoing multisite randomized clinical trial of psychotherapy for treating posttraumatic stress disorder (PTSD) in female veterans and active duty personnel. Research aimed at testing treatments for PTSD in women who have served in the military is especially important due to the high prevalence of PTSD in this population. VA Cooperative Study 494 was designed to enroll 384 participants across 12 sites. Participants are randomly assigned to receive 10 weekly sessions of individual psychotherapy: Prolonged Exposure, a specific cognitive-behavioral therapy protocol for PTSD, or present-centered therapy, a comparison treatment that addresses current interpersonal problems but avoids a trauma focus. PTSD is the primary outcome. Additional outcomes are comorbid problems such as depression and anxiety; psychosocial function and quality of life; physical health status; satisfaction with treatment; and service utilization. Follow-up assessments are conducted at the end of treatment and then 3 and 6 months after treatment. Both treatments are delivered according to a manual. Videotapes of therapy sessions are viewed by experts who provide feedback to therapists throughout the trial to ensure adherence to the treatment manual. Discussion includes issues encountered in multisite psychotherapy trials along with the rationale for our decisions about how we addressed these issues in CSP #494.

Female↗

PubMed2005

Repeated split sample validation to assess logistic regression and recursive partitioning: an application to the prediction of cognitive impairment.

Screening strategies play an important part in the identification and diagnosis of illness. Testing of such strategies in a clinical trial can have important implications for the treatment of such illnesses. Before the clinical trial, however, it is important to develop a practical screening/classification procedure that accurately predicts the presence of the illness in question. Recent published studies have shown a growing preference for classification tree/recursive partitioning procedures.This paper compares the application of logistic regression and recursive partitioning to a neuropsychological data set of 252 patients recruited from four Veterans Affairs Medical Centers. Logistic regression and recursive partitioning was used to predict cognitive impairment in 12 randomly selected exploratory/validation samples. We assessed the effect of sampling on variable selection and predictive accuracy.Predictive accuracy of the logistic regression and recursive partitioning procedures was comparable across the exploratory data samples but varied across the validation samples. Based on shrinkage, both classification procedures performed equally well for the prediction of cognitive impairment across the twelve samples. While logistic regression provided an estimated probability of outcome for each patient, it required several mathematical calculations to do so. However, logistic regression selected one or two less predictors than recursive partitioning with comparable predictive accuracy. Recursive partitioning, on the other hand, readily identified patient characteristics and variable interactions, was easy to interpret clinically and required no mathematical calculations. There was a high degree of overlap of the predictor variables between the two procedures.In the context of neuropsychological screening, logistic regression and recursive partitioning performed equally well and were quite stable in the selection of predictors for the identification of patients with cognitive impairment, although recursive partitioning may be easier to use in a clinical setting because it is based on a simple decision tree.

Cognition Disorders↗

PubMed2003

Neuropsychological screening for cognitive impairment using computer-assisted tasks.

The aim of this study was to validate a computer-assisted screening battery for classifying patients into two groups, those with and without cognitive impairment. Participants were all patients referred to the neuropsychology clinics at four VA medical centers during a 1-year period. Patients meeting the study inclusionary criteria (N = 252) were administered the Neurobehavioral Evaluation System-3 (NES3) computer-assisted battery. A detailed neuropsychological examination was carried out by an experienced neuropsychologist, who diagnosed the patient as cognitively impaired or not impaired. The neuropsychologist's diagnosis was the gold standard. Recursive partitioning analyses yielded several classification procedures using the NES3 data to predict the gold standard These procedures produced a set of six NES3 tasks that provide good sensitivity and specificity in predicting di- agnosis. Sensitivity and specificity for the least random classification procedure were 0.87 and 0.67, respectively. The results suggest that computer-assisted screening methods are a promising means of triaging patients.

Adult↗

PubMed2002

Interrater reliability of neuropsychological diagnoses: a Department of Veterans Affairs cooperative study.

This study examined the interrater reliability of neuropsychological diagnoses produced by clinical neuropsychologists across 4 medical centers. These diagnoses were based on evaluations using a comprehensive battery of commonly used neuropsychological test instruments, interview, history and medical chart review. The diagnoses of individual neuropsychologists were compared to those made by members of an external review panel for each patient evaluated. Patients were first diagnosed as showing cognitive impairment versus no cognitive impairment. If a patient was diagnosed as impaired, a specific neuropsychological diagnosis was assigned. The diagnostic classification for cognitive impairment was moderately reliable [kappa = .48 +/- s.e.(kappa) = .062]. The interrater reliability for specific diagnoses was in the fair to good range [kappa = .44 +/- s.e.(kappa) = .029]. These levels of reliability are comparable to those found for other psychiatric and neurologic specialties and for medical diagnoses made by other health care disciplines.

Adult↗