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Biomedical subjects

Michael L Callaham

Publications and source records attributed to Michael L Callaham.

10 recordsLinked to original sources
PubMed2006

Characteristics of frequent users of emergency departments.

STUDY OBJECTIVE: We identify frequent users of the emergency department (ED) and determine the characteristics of these patients. METHODS: Using the 2000 to 2001 population-based, nationally representative Community Tracking Study Household Survey, we determined the number of adults (aged 18 and older) making 1 to 7 or more ED visits and the number of visits for which they accounted. Based on the distribution of visits, we established a definition for frequent user of 4 or more visits. Multivariate analysis assessed the likelihood that individuals with specific characteristics used the ED more frequently. RESULTS: An estimated 45.2 million adults had 1 or more ED visits. Overall, 92% of adult users made 3 or fewer visits, accounting for 72% of all adult ED visits; the 8% of users with 4 or more visits were responsible for 28% of adult ED visits. Most frequent users had health insurance (84%) and a usual source of care (81%). Characteristics independently associated with frequent use included poor physical health (odds ratio [OR] 2.54; 95% confidence interval [CI] 2.08 to 3.10), poor mental health (OR 1.70; 95% CI 1.42 to 2.02), greater than or equal to 5 outpatient visits annually (OR 3.02; 95% CI 1.94 to 4.71), and family income below the poverty threshold (OR 2.36; 95% CI 1.70 to 3.28). Uninsured individuals were more likely to report frequent use, but this result was only marginally significant (OR 2.38; 95% CI 0.99 to 5.74). Individuals who lacked a usual source of care were actually less likely to be frequent users. CONCLUSION: The majority of adults who use the ED frequently have insurance and a usual source of care but are more likely than less frequent users to be in poor health and require medical attention. Additional support systems and better access to alternative sites of care would have the benefit of improving the health of these individuals and may help to reduce ED use.

Adolescent↗
PubMed2005

Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study.

STUDY OBJECTIVE: We determined whether having a usual source of care or health insurance is associated with the likelihood of an emergency department (ED) visit. METHODS: This was a multivariate analysis of the 2000 to 2001 nationally representative Community Tracking Study Household Survey to assess the independent association of usual source of care, health insurance, income, and health status with the likelihood of making 1 or more ED visits in the previous year. RESULTS: Based on a sample of 49,603 adults, an estimated 45.3 million adults reported 79.6 million ED visits in the previous year; 83.1% of these visitors identified a usual source of care other than an ED. Persons with poor physical health status made 48.4% of visits. Adults without a usual source of care were less likely to have had an ED visit than those whose usual source of care was a private physician (odds ratio [OR] 0.75). Uninsured individuals were no more likely to have an ED visit than insured individuals. Poor physical health (OR 2.41), poor mental health (OR 1.51), 5 or more outpatient visits during the year (OR 4.05), and changes in insurance coverage (OR 1.14) or usual source of care (OR 1.32) during the year were associated with an ED visit. Enrollment in a health maintenance organization and satisfaction with one's physician were not independently associated with ED use. CONCLUSION: ED users are similar to nonusers with regard to health insurance and usual source of care but are more likely to be in poor health and have experienced disruptions in regular care. The success of efforts to decrease ED use may depend on improving delivery of outpatient care.

Adult↗
PubMed2003

Journal policy on ethics in scientific publication.

Medical journals aspire to select, through peer review, the highest quality science, and their reputations depend on the trust of readers, authors, researchers, reviewers, and patients. Almost every aspect of this process involves important ethical principles and decisions, which are seldom explicitly stated and even less often shared with the readership. A comprehensive policy on publication ethics is summarized in this article. A few of the topics addressed are study design; research subject consent; definitions and responsibilities of authorship; declaration of paid writers; types of potential conflicts of interest; management of conflicts of interest on the part of authors, journal reviewers, and members of the editorial board; blinding and confidentiality of peer review; assessment of peer review quality; public identification of degree of peer review of various portions of the journal; criteria for manuscript decisions; management of author appeals; definitions of prior publication; plagiarism; criteria for advertising and relationship between advertising and editorial matter; allegations of misconduct and journal policies for responding to them; and the relationship of the journal to the sponsoring society. Our goal in publishing these policies is to make the guiding ethical principles of this journal accessible to all of our readers and contributors.

Advertising↗
PubMed2002

A prospective multicenter study of factors associated with hospital admission among adults with acute asthma.

PURPOSE: We sought to determine patient characteristics associated with hospital admission after emergency treatment for asthma, and whether disposition guidelines are followed. SUBJECTS AND METHODS: We performed a prospective multicenter cohort study involving 64 emergency departments in the United States and Canada. Consecutive adult patients with asthma exacerbations were interviewed, and their charts were reviewed using standardized protocols. Telephone follow-up at 2 weeks determined relapse. RESULTS: Of 1805 patients, 363 (20%; 95% confidence interval [CI]: 18% to 22%) were hospitalized. Among patients with severe exacerbations (final peak flow <50% of predicted), 122 (49%; 95% CI: 43% to 55%) were hospitalized. Admission was associated with final peak flow, female sex, nonwhite race, severity of chronic illness, and severity of exacerbation. Admission predictors were similar regardless of hospital funding, region, or size. Among patients with mild or moderate exacerbations of asthma (peak flow >or=50% predicted), the likelihood of admission was associated significantly with the number of predefined risk factors for death from asthma. Of patients who were discharged from the emergency department, 62 (5%; 95% CI: 4% to 6%) relapsed within 72 hours. Relapse was not associated with final peak flow (P = 0.39). CONCLUSION: Associations between patient characteristics and disposition were similar across sites. Despite guidelines to the contrary, half of patients with final peak flow <50% were discharged. After emergency department treatment and discharge, short-term relapse was uncommon among patients with asthma, suggesting that strict peak flow cutoffs may be unnecessary if risk factors in patients with mild or moderate exacerbations are considered.

Acute Disease↗
PubMed2002

Effect of written feedback by editors on quality of reviews: two randomized trials.

CONTEXT: Better peer review is needed, but proven methods to improve quality are unknown. Our objective was to determine whether written feedback to reviewers improves subsequent reviews. METHODS: Eligible reviewers were randomized to intervention or control (receiving other reviewers' unscored reviews and the editor's decision letter). Study 1 (September 1998-September 2000) included reviewers with a median quality score of 3 or lower; study 2 (April 2000-January 2002), reviewers with median score of 4 or lower. Study 1 was designed with a power of 0.80 to detect a difference in score of 1; study 2, with a power of 0.80 to detect a difference of 0.5. All reviewers were at a peer-reviewed journal (Annals of Emergency Medicine). The main outcome measure was the editor's routine quality rating (1-5) of all reviews (blinded to study enrollment). RESULTS: For study 1, 51 reviewers were eligible and randomized and 35 had sufficient data (182 reviews) for analysis. The mean individual reviewer rating change was 0.16 (95% confidence interval [CI], -0.26 to 0.58) for control and -0.13 (-0.49 to 0.23) for intervention. For study 2, 127 reviewers were eligible and randomized, and 95 had sufficient data (324 reviews). Controls had a mean individual rating change of 0.12 (95% CI, -0.20 to 0.26) and intervention reviewers, 0.06 (-0.19 to 0.31). CONCLUSIONS: In study 1, minimal feedback from editors on review quality had no effect on subsequent performance of poor-quality reviewers, and the trend was toward a negative effect. In study 2, feedback to average reviewers was more extensive and supportive but produced no improvement in reviewer performance. Simple written feedback to reviewers seems to be an ineffective educational tool.

Evaluation Studies as Topic↗
PubMed2002

Author perception of peer review: impact of review quality and acceptance on satisfaction.

CONTEXT: To determine author perception of peer review and association between quality of review and author satisfaction. METHODS: Survey between May 1999 and October 2000 of 897 corresponding authors of manuscripts under consideration by the Annals of Emergency Medicine and had received final editorial decisions during the study period. A total of 576 authors (64%) returned the survey. Using a 5-point Likert scale, the survey assessed differences in satisfaction between authors whose manuscripts were accepted, reviewed and rejected, and rejected without full review. The association of author satisfaction with editor's assessment of review quality, publication decision, author sex, specialty, and publication experience were also assessed. RESULTS: Overall mean (SD) satisfaction score, indicated by agreement with "My experience with the review process will make me more likely to submit to Annals in the future," was 3.1 (1.0) and was significantly higher among authors of accepted papers (3.7 [0.9]) than among either group of rejected papers (rejected/reviewed, 2.8 [1.0]; rejected/no review, 3.0 [0.9]; P.05). Authors whose manuscripts were reviewed and rejected were the least satisfied with the time to decision (rejected/reviewed, 3.0 [1.2] vs accepted, 3.7 [1.0] and rejected/no review, 3.9 [0.9]; P<.05). Those whose papers were rejected without review were the least satisfied with the letter explaining the editorial decision (rejected/no review, 2.8 [1.2] vs accepted, 4.2 [0.7] and rejected/reviewed, 3.1 [1.2]; P<.05). Among respondents whose manuscripts underwent full review (accepted and rejected/reviewed), overall satisfaction was highly associated with acceptance of the manuscript for publication (odds ratio [OR], 6.12; 95% confidence interval [CI], 3.43-10.91) but not with quality rating of reviews (OR, 1.26; 95% CI, 0.84-1.90). CONCLUSION: Contributor satisfaction with peer review was modest. Authors of rejected manuscripts were dissatisfied with the time to decision and communication from the editor. Author satisfaction is associated with acceptance but not with review quality.

Authorship↗
PubMed2002

Effect of structured workshop training on subsequent performance of journal peer reviewers.

STUDY OBJECTIVE: We sought to determine whether peer reviewers who attend a formal interactive training session produce better reviews. METHODS: Peer reviewers were invited to attend a formal, 4-hour, highly interactive workshop on peer review. Attendees received a sample manuscript to read and review in writing in advance. The workshop included presentations on analyzing a study and the journal's expectations for a quality review, discussion of the sample manuscript's flaws and how to address them in a review, discussion of the reviews written by the attendees, and discussion of real reviews of other manuscripts illustrating key points. The performance of attendees on the basis of standard editor quality ratings (1 to 5) was assessed for the 2 years after workshop attendance. Control reviewers matched for previous review quality and volume were selected from nonattendees of the workshop. In study 1, all average reviewers received a standard written invitation. In study 2, 75 randomly selected average reviewers were personally and actively recruited with intensive follow-up by means of e-mail and telephone calls in an effort to reduce self-selection bias. RESULTS: In study 1, 25 reviewers volunteered for the course, were eligible for study, attended, and were compared with 25 matched control reviewers. Of attendees filling out evaluations, 19% thought it somewhat and 81% thought it very helpful. All thought it would improve their subsequent reviews, and 85% thought it would improve their review ratings. The mean change in rating after the workshop was 0.11 (95% confidence interval [CI] -0.25 to 0.48) for control reviewers and 0.10 (95% CI -0.20 to 0.39) for attendees. In study 2, of 75 reviewers intensively recruited, only 12 (41%) of those who said they would attend did. All of the participants thought the workshop would improve their performance and ratings. Test scores at the end of the workshop improved in 73% of participants compared with scores on pretests. The control reviewers' average rating changed by -0.10 (95% CI -0.49 to 0.29) versus 0.06 (95% CI -0.34 to 0.23) for attendees. CONCLUSION: Among invited peer reviewers, voluntary attendance at a highly structured and interactive workshop was low and did not improve the quality of subsequent reviews, contrary to the predictions of attendees. Efforts to aggressively recruit average reviewers to a second workshop were time consuming, had low success rates, and showed a similar lack of effect on ratings, despite improvement in scores on a test instrument. Workshop teaching formats, although traditional, are of unproven efficacy.

Case-Control Studies↗