Biomedical subjects

Mark B Parshall

Publications and source records attributed to Mark B Parshall.

4 recordsLinked to original sources

PubMed2002

Psychometric characteristics of dyspnea descriptor ratings in emergency department patients with exacerbated chronic obstructive pulmonary disease.

The purpose of this study was to evaluate the reliability, content validity, and factor structure of dyspnea sensory quality descriptor ratings in emergency department (ED) patients with exacerbated chronic obstructive pulmonary disease (COPD). During an ED visit 104 patients with COPD rated the intensity of 16 dyspnea sensory quality descriptors (numerical ratings of 0-10) in relation to how they felt when they decided to come to the ED (Decision) and 1 week before the visit. Content validity of 15 descriptors was supported. Factor analysis of Decision ratings resulted in seven descriptors and three factors (alpha=.88; 74% common variance): Smothering/Suffocating/Hunger for air (alpha=.87); Effort/Work (alpha=.87); and Tight/Constricted (alpha=.74). Results indicate that the intensity of sensory quality descriptors can be measured reliably in COPD patients during an exacerbation of COPD. The initial descriptor list of descriptors could be cut by more than half while retaining satisfactory psychometric properties.

Dyspnea↗

PubMed2002

Characteristics and treatment of patients with heart failure in the emergency department.

INTRODUCTION: This study was conducted to develop a detailed profile of patients who come to the emergency department for heart failure treatment. METHODS: Patient interviews were supplemented by medical record reviews in a convenience sample of 57 participants. A structured interview guide included data concerning patient characteristics and ED treatment. RESULTS: Participants used a variety of self-care strategies before coming to the emergency department. Many of the patients studied (25%) reported barriers to medication adherence, such as memory problems and lack of knowledge regarding self-administration. The most frequently reported symptoms were breathing difficulties (88%), chest discomfort (35%), and fatigue (16%). Seventy-four percent of the participants were classified as specific activity scale class III or IV, indicating moderate to severe functional limitation. Mean quality of life at the time of interview was 5.1 (on a 1 to 10 scale). Length of stay was < or = 2 days for 33%. DISCUSSION: A number of the findings of this study have implications for ED nurses. For example, almost one third of the patients studied had not received directions for a low-sodium diet during hospitalization, when fluid volume overload with sodium retention was the most common cause of hospitalization in a study of patients with decompensated heart failure. Hospital lengths of stay of no more than 2 days suggest that early detection and treatment of acute heart failure may reduce the need for ED visits for some patients. Patients need education and support with self-help strategies and need to better understand the administration of their medication.

Adult↗

PubMedDate not supplied

Predictors of emergency department visit disposition for patients with chronic obstructive pulmonary disease.

STUDY OBJECTIVES: The study objective was to validate among patients with chronic obstructive pulmonary disease (COPD) clinical predictors of emergency department (ED) disposition (admission vs discharge) found in a previous study. We hypothesized that the initial heart rate (HR) at presentation and the number of nebulizer treatments would predict visit disposition adequately and that existing triage criteria would not. METHODS: In this correlational study, all ED visits to a university medical center related to a diagnosis of COPD over a 2-year period were identified and reviewed retrospectively (N = 114 patients and 226 visits). Associations of clinical predictors with visit disposition was by contingency table or receiver operating characteristic curve analysis. RESULTS: The overall admission rate was 60.2%. An initial HR slightly greater than normal limits (HR >/= 106 vs HR </= 105 beats/min) predicted visit disposition; receiver operating characteristic area under curve (95% confidence interval) = .67 (.60-.73); sensitivity = .61 (.52-.69); and specificity = .68 (.57-.77). Likelihood ratios for positive and negative tests were 1.93 and 0.57, corresponding to posterior probabilities of admission = .74 and .46, respectively. Triage classification did not adequately predict visit disposition. Patients receiving three or more nebulized bronchodilator treatments were more likely to be admitted than those receiving fewer treatments, but this predictor had low sensitivity and was no more discriminating than the initial HR. Women were more likely than men to be admitted, odds ratio = 2.66 (1.54-4.61), but there were few clinically meaningful differences between sexes. CONCLUSIONS: The initial HR on arrival predicted disposition of ED visits for patients with COPD with operating characteristics that were superior to the existing triage criteria. Triage of patients with COPD could be improved simply, and at no additional expense, by recognizing that almost any degree of tachycardia in a patient with COPD substantially increases the likelihood of admission.

Aged↗

PubMedDate not supplied

Assessing recalibration as a response-shift phenomenon.

BACKGROUND: Traditionally, the difference between pretest and posttest scores is used as an estimate of change. This can be problematic when repeated self-report measures are used to assess change resulting from interventions intended to change beliefs, behaviors, attitudes, or values about health or safety. If the intervention is effective, participants may apply more stringent criteria in response to a posttest questionnaire than they did at the pretest. This kind of change has been termed a recalibration response shift. OBJECTIVES: To present scale recalibration as a measurable response shift, and to illustrate a method that can be used to estimate its magnitude and direction: the retrospective pretest. METHODS: In a quasi-experimental study investigating the effectiveness in small construction companies of narrative simulation exercises targeting back and fall injuries, a retrospective pretest was administered concurrently with a delayed posttest 4 months after the simulation exercises. RESULTS: : In the first intervention year, the results from a brief (two-item) retrospective pretest pertaining to safety climate were consistent with a recalibration response shift in the intervention group, but not in the control group. In the second intervention year, when all 10 items of the safety climate questionnaire were used for the retrospective pretest, no evidence of recalibration was found. CONCLUSIONS: Although the evidence of recalibration was equivocal, the findings illustrate circumstances in which recalibration response shifts may occur and characteristic patterns of findings may suggest that recalibration has or has not occurred.

Back Injuries↗