Biomedical subjects

Richard M Shewchuk

Publications and source records attributed to Richard M Shewchuk.

13 recordsLinked to original sources

PubMed2006

Using a modified nominal group technique to elicit director of nursing input for an osteoporosis intervention.

BACKGROUND: Barriers prevent osteoporosis care in nursing homes. Successful interventions designed to circumvent these barriers benefit from target recipient input during development. OBJECTIVE: To elicit suggestions for an osteoporosis quality improvement intervention designed for use by nursing home health care professionals. DESIGN: Modified nominal group technique. SETTING: Convenience sample of Alabama nursing home directors. PARTICIPANTS: Fifteen Alabama nursing home directors of nursing were recruited by mailing. Sixty percent of respondents participated (n = 9). MEASUREMENTS: In the first phase conducted via teleconference, an experienced moderator used a preformulated question and elicited 41 suggestions to improve osteoporosis care in nursing homes. Substantively similar suggestions were combined and idiosyncratic suggestions were discarded resulting in the retention of 20 suggestions. In the second phase conducted by mail, the same participants rated the 20 suggestions based on perceived practicality and helpfulness. Elements were grouped into tertiles based on the ranking of the mean ratings of the 2 attributes and then cross-tabulated. RESULTS: All director of nursing (n = 9) participants completed both phases. The most practical, most helpful suggestions were information on fall prevention program implementation, osteoporosis treatment protocols, and osteoporosis medication information. CONCLUSIONS: A modified nominal group technique provided useful information from nursing home directors of nursing for an osteoporosis intervention. The technique proved efficient and facile to perform.

Absorptiometry, Photon↗

PubMed2006

Effect of dental practice characteristics on racial disparities in patient-specific tooth loss.

OBJECTIVE: The objective of this study was to test the hypothesis that dental practice characteristics are associated with tooth loss incidence with both tooth-specific and patient-specific characteristics already taken into account. RESEARCH DESIGN: A population-based prospective cohort study was conducted. In-person interviews and clinical examinations were done at baseline, 24, and 48 months, with telephone interviews every 6 months. Practices that coincidentally served participants in the study completed practice characteristics questionnaires. To increase inferential power when testing practice-level effects, detailed tooth-specific and patient-specific data were simultaneously taken into account in tests for association between practice-level effects and tooth loss. SETTING: Data were from the Florida Dental Care Study. The key health outcome was tooth loss, a leading measure of a population's oral health. PARTICIPANTS: Eight hundred seventy-three African-Americans and non-Hispanic whites who had at least 1 tooth. RESULTS: Certain practice characteristics were associated with tooth loss, including the racial mix of the practice's patient population; persons who attended practices with higher percentages of African-Americans were more likely to receive a dental extraction regardless of the individual patient's race. CONCLUSIONS: This is the first longitudinal report of increased risk for tooth loss resulting from practice-level effects. Although a patient-level racial disparity remained evident, and even with detailed tooth-specific and patient-level characteristics taken into account, racial differences in characteristics of practices attended independently contributed to the patient-level racial disparity in health.

Black or African American↗

PubMed2005

Beyond rankings: using cognitive mapping to understand what health care journals represent.

Studies of journal ratings are often controversial. Indices, including impact factors, acceptance rates, expert opinions, and ratings of knowledge, relevance, and quality have been used to organize journals hierarchically. While there may be some validity in consensus rankings, it is unclear what purpose is actually achieved by these endeavors. Impact factors probably help researchers identify authoritative journals, but other rankings likely indicate little more than institutionalized perceptions of prestige. Ranking schema used to derive evaluative judgments do not provide information about the organization of journals from the perspective of substantive content, emphasis, or targeted audience. A cognitive mapping approach that examines how health care management faculty members represent their perceptions of North American health care-oriented journals is presented as an alternative. A card-sort task and importance rating scale was mailed to faculty of North American health management programs who participated in a previous journal ranking study conducted by the authors. Completed assessments were returned from 147 respondents for a response rate of 39%. Multidimensional scaling and hierarchical cluster analyses of data provided a three-dimensional, seven cluster map that illustrates the perceived similarities of journals. Dimension I contrasts Applied Management Practice with Health Policy journals. Dimension II contrasts specific domain with broad-based research journals. Dimension III contrasts finance-oriented with delivery-oriented journals. The seven clusters of perceptually similar journals were weighted in terms of respondent defined importance ascribed to each journal within a cluster. This framework supplements ratings by providing insight about how journals are cognitively organized by scholars.

Adult↗

PubMed2005

Implementation of a family intervention to increase fruit and vegetable intake: the Hi5+ experience.

Family is an important, yet challenging, target for dietary intervention. This article describes the implementation of Hi5+, a family fruit and vegetable (FV) promotion program. Complementing a fourth-grade school curriculum, the seven weekly Family Fun Nites were at-home family meal sharing and game evenings. A sample of families (N = 575; 69% consented) from schools in a southeastern U.S. urban area received tailored intervention materials based on their FV attitudes and family interaction styles. A pyramidal organizational design, using peer leaders, facilitated 71% of families to complete all seven sessions, whereas 84% completed at least one session. Significant independent predictors of program completion were attending an introductory Kick-Off Nite, interactive family style, additional adults in the household, married parents, being African American, earning more than 60,000 dollars, and additional children in the household. Family-specific issues and initial program experience are important considerations for implementing a family intervention.

Adult↗

PubMed2005

Hi5+: systematic development of a family intervention to increase fruit and vegetable intake.

This article describes the development of a peer-led home-based intervention to increase fruit and vegetable (FV) intake and family interaction among fourth graders and their families. Hi5+ intervention content and delivery strategies were developed using two complementary processes: cognitive mapping (CM), a consumer-based approach to identifying salient issues, and intervention mapping (IM), a comprehensive planning model. Step 1 involved creating plans to guide the design, implementation, and evaluation of Hi5+. We delineated our performance objectives and then prioritized those determinants we felt were most salient and changeable. Step 2 involved selecting and utilizing cognitive and behavioral theory constructs to develop intervention methods and strategies. Step 3 involved designing and pilot testing the instructional materials and other intervention components. Step 4 entailed developing plans for program adoption and implementation, while the final step (Step 5) involved creating a comprehensive evaluation plan. Implications of this multistep approach to intervention development are discussed.

Adult↗

PubMed2004

Ability of the actiwatch accelerometer to predict free-living energy expenditure in young children.

OBJECTIVE: To determine whether activity counts obtained with the Actiwatch monitor are associated with total expenditure and body composition in young children. RESEARCH METHODS AND PROCEDURES: Actiwatch activity monitors were tested in 29 children 4 to 6 years old under field conditions over eight days. Total energy expenditure (TEE) was assessed with the doubly labeled water (DLW) technique. Correlation analyses were used to identify variables related to energy expenditure and percentage body fat. Multiple linear regression analyses were used to examine the variance in TEE and percentage body fat explained by activity counts after adjusting for relevant covariates. RESULTS: Both average total daily activity counts (658,816 +/- 201,657) and the pattern of activity were highly variable among subjects. TEE was significantly related to lean body mass (r = 0.45) and age (r = 0.48; p < 0.05 for both). Activity counts alone were not associated with TEE. In multiple linear regression analyses, TEE was independently associated with only lean body mass. Percentage fat mass was independently associated with body weight, being a girl, and being white, but not with average total activity counts. DISCUSSION: Activity counts obtained with the Actiwatch under free-living conditions do not reflect TEE in 4- to 6-year-old children and are not correlated with percentage fat mass. Therefore, average total activity counts obtained with the Actiwatch may be of limited value in identifying children at risk for becoming obese.

Adipose Tissue↗

PubMed2003

Social problem-solving abilities and distress among family members assuming a caregiving role.

We examined the relation of social problem-solving abilities to distress experienced by family members assuming a caregiving role for a loved one who had recently incurred a severe physical disability. Family members completed measures of problem-solving, depression and health, while their loved one participated in an inpatient rehabilitation programme. Correlational analyses indicated that a negative problem orientation was significantly predictive of caregiver distress, regardless of the degree of physical impairment of the care recipient. Women reported more distress on several measures than men, and disability severity was also associated with depression and impaired social functioning. Family members with a greater negative orientation may be at risk to develop psychological and health problems upon assuming a caregiver role. These results are discussed in light of theoretical models of social problem-solving, and implications are presented for psychological interventions and for health policy concerning family caregivers and their care recipients.

Adult↗

PubMed2002

Contribution of insulin secretion and clearance to glucose-induced insulin concentration in african-american and caucasian children.

Relative to Caucasians (C), African-American (AA) children and adults have lower indices of insulin sensitivity (S(i)) and a higher acute insulin response to glucose (AIR(g)). Among AA children, AIR(g) is greater than that which would be predicted based on lower S(i). The objectives of the present study were 1) to determine whether insulin secretory parameters differ in AA vs. C children and adolescents using C-peptide modeling, 2) to determine whether hepatic insulin extraction differs with ethnicity/race using the C-peptide to insulin molar ratio, and 3) to determine whether the relatively greater AIR(g) among African-Americans is due to greater insulin secretion or lesser clearance. Subjects (n = 76) were AA and C children (mean age, approximately 11 yr). A 3-h tolbutamide-modified iv glucose tolerance test and minimal modeling were used to determine S(i) and AIR(g). First phase C-peptide/insulin secretion and basal, first, and second phase beta-cell sensitivity to glucose were determined using C-peptide modeling with standard kinetic parameters developed in adults. The incremental C-peptide to insulin molar ratio over the 3-h test period, an index of hepatic insulin extraction, was calculated with the trapezoidal method. S(i) was lower and AIR(g) was higher in AA vs. C children. First phase C-peptide/insulin secretion and first phase beta-cell sensitivity to glucose were approximately 2-fold greater in AA vs. C children (P < 0.001); there were no between-group differences in basal or second phase beta-cell sensitivity to glucose. Hepatic insulin extraction was lower in AA vs. C (3.77 +/- 1.78% vs. 5.99 +/- 2.18%; P < 0.001). Multiple linear regression modeling indicated that first phase C-peptide/insulin secretion and hepatic insulin extraction contributed independently to AIR(g); however, it was only first phase C-peptide/insulin secretion that explained the significant independent contribution of ethnicity/race to AIR(g) after adjusting for S(i). The results of this study suggest that greater AIR(g) among AA is due to both greater insulin secretion and lesser hepatic insulin extraction, and that AIR(g) above that predicted based on lower S(i) is due to greater insulin secretion. The insulin secretion data await verification that the kinetic parameters used apply to children and AA.

Adolescent↗

PubMedDate not supplied

Upstream or downstream. Determinants of consumer willingness to recommend an HMO.

Understanding the attributes that explain an HMO members' willingness to recommend a health plan is considered by many to be critical in a competitive managed care market. The study reported in this article examines the relationship between provider panel composition on overall willingness to recommend a health plan. Our results indicate that a strong association exists between an HMO member's available choice of primary care physician and recommendation of their primary care physician with overall HMO members' recommendation of the health plan. Interestingly, a member's recommendations of hospitals and specialists did not influence HMO member's willingness to recommend a health plan.

Female↗

PubMedDate not supplied

Perceptions of medical errors by internal medicine residents: development and validation of a new scale.

Efforts to identify the underlying structure of 40 survey items dealing with perceptions of medical errors are reported on the basis of responses from 195 medical residents. Factor analysis revealed that the medical errors perceptions were represented by a 10-factor solution. The external validity of these factors was examined relative to perceptions about the cost of medical errors, the cost of errors to health care, and the need for education and interventions to address errors. Results indicated that 13.9% of the variation in the perceived cost of medical errors and 17.1% of the variation in the perceived need for additional physician education was explained by the factor structure.

Adult↗

PubMedDate not supplied

Study of the relationship between organizational culture and organizational outcomes using hierarchical linear modeling methodology.

This study examines how perceptions of organizational culture influence organizational outcomes, specially, individual employee job satisfaction. The study was conducted in the health care industry in the United States. It examined the data on employee perceptions of job attributes, organizational culture, and job satisfaction, collected by Press Ganey Associates from 88 hospitals across the country in 2002-2003. Hierarchical linear modeling was used to test how organizational culture affects individual employee job satisfaction. Results indicated that some dimensions of organizational culture, specifically, job security and performance recognition, play a role in improving employee job satisfaction.

Data Collection↗

PubMedDate not supplied

Using cognitive mapping to develop a community-based family intervention.

OBJECTIVE: To describe the development of a consumer-oriented intervention for increasing intake of fruits and vegetables (FVs) in families (n=265). METHOD: A cognitive-mapping approach was used to specify intervention performance objectives and a tailoring strategy. RESULTS: MDS and hierarchical cluster analysis indicated that FV perceptions are organized into 6 clusters arrayed along 3 dimensions. In combination with 3 general family-functioning measures, 11 perceptions explained approximately 18% of the variance in parent FVI. K-means cluster analysis revealed 4 types of families. CONCLUSION: Cognitive mapping provides a systematic approach for including qualitative data in the design of tailored interventions.

Adult↗

PubMedDate not supplied

Building an understanding of the competencies needed for health administration practice.

Rapid change in the healthcare environment has pressured healthcare organizations, health management professional associations, and educational institutions to begin examining more carefully what it means to be a fully competent healthcare executive. As a result, interest in healthcare management core competencies has increased. Most competency development initiatives seek to build consensus and typically result in the generation of five or six broad competency domains--but consensus around what? Most competency initiatives are based on literature reviews and consensus-building efforts. Typically, such efforts in healthcare management have involved defining general competency domains and attempting to specify representative behavioral exemplars that demonstrate mastery of the general competency domain. This study describes an approach that used a purposeful sample of ACHE affiliates who represent different geographic regions and health industry segments to construct a framework composed of critical healthcare issue clusters. A panel of healthcare executives then specified five sets of entry-level behavioral competencies that would be required to address the clusters of critical issues. Although the behavioral competencies identified by the executives in this study are anchored to a framework, their empirical association with performance has not been tested. Before implementing broad curriculum redesign, the effect of these competencies on performance should be established. Additionally, competencies should be examined in the context of potential moderating influences such as specific educational program focus, educational delivery format, and type and preparation of students entering healthcare management education programs. Competency, competencies, competency models, and competency-based training are all Humpty Dumpty words meaning only what the definer wants them to mean. The problem comes not from malice [or] stupidity... but instead from some basic procedural and philosophical differences among those racing to define the concept and to set the model for the way the rest of us will use competencies (Zemke 1982).

Health Facility Administrators↗