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Results for “Secondary Data Analysis”

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At least 217 records · Page 12Linked to original sources

PubMed2000

Sociodemographic predictors of adherence to annual cervical cancer screening in minority women.

The Papanicolaou (Pap) test is an effective screening mechanism for reducing morbidity and mortality from cervical cancer. Nevertheless, Pennsylvania ranks fifth in national cervical cancer incidence and fourth in national cervical cancer mortality, with a significant number of cases contributed by Philadelphia. Substantial subgroups of American women, specifically ethnic minorities, the elderly, the uninsured, and the poor, have not been screened or are not screened at regular intervals. A secondary data analysis was conducted to test whether age, income, insurance coverage, marital status, level of education, and number of persons living at home could predict whether a woman among convenience sample of 204 black and Hispanic women adhered to annual Pap testing. A woman was considered adherent to annual Pap testing if she reported undergoing a Pap smear in the 14 months preceding her enrollment in the study. African American woman who were high school graduates and had insurance coverage were more likely to be adherent to annual Pap testing. Hispanic women older than 50 years and born outside the mainland United States were less likely to be adherent to annual Pap testing. Findings suggest that cancer nurses working to promote cervical cancer screening in Philadelphia should continue to target at-risk populations, specifically uninsured and less-educated black and Hispanic women older than 50 years who were born outside the mainland United States.

Adolescent↗

PubMedDate not supplied

Age differences in post-breast cancer lymphedema signs and symptoms.

This secondary data analysis was designed to explore the age differences in lymphedema (LE) occurrence and self-reported symptoms in post-breast cancer LE. A descriptive-exploratory cross-sectional design was used with a convenience sample composed of 102 women treated and followed for breast cancer at a midwestern cancer center. Sequential circumferential arm measurement was used to estimate limb volume differences. Self-reported symptoms were assessed by the Lymphedema and Breast Cancer Questionnaire (LBCQ) designed and tested by the research team. Lymphedema occurrence was relatively higher (41.2%) in breast cancer survivors younger than 60 than in those older than 60 (30.6%). Six subjectively reported symptoms were found to occur more often (P </= .05) in the younger women with LE: numbness now and in the past year, tenderness in the past year, aching now and in the past year, increased temperature in arm now. Numbness, tenderness, and aching were the most prevalent symptoms among women in both age groups regardless of LE presence. Our findings suggest that younger breast cancer survivors may have increased LE risk and report LE-related symptoms more often. Future research should focus on age differences in LE risk, occurrence, and perceptions of LE-related symptoms in women treated for breast cancer.

Adult↗

PubMedDate not supplied

Comparing health status with healthy habits in elderly assisted-living residents.

There is a growing number of older adults in America. Assisted-living facilities have become a more prevalent residence for this increasing population. In the study described in this article, a secondary data analysis was completed using residents of several LifeTrust America, Inc.,'s assisted-living facilities across the Southeastern United States. There were 1,079 residents who completed the Healthy Generation Survey. Residents were asked whether they currently, previously, or had never had certain health conditions. They also responded to various questions about their current participation in healthy habits, such as using cigarette or tobacco products, moderate alcohol consumption, eating breakfast, eating healthy snacks, getting 7-8 hours of sleep each night, drinking the daily recommended amount of water, and participating in regular physical exercise. The research question asked if there was a relationship between current healthy habits and physical health. The study found that individuals with more current physical health conditions also reported greater participation in healthy habits. This could lead to the conclusion that after individuals acquired certain physical health conditions, they began to participate in more healthy habits. Also of significance was the finding that participation in physical exercise and recreational activity related to greater participation in all other healthy habits.

Age Distribution↗

PubMed2001

The DISC Predictive Scales (DPS): efficiently screening for diagnoses.

OBJECTIVE: To derive and test a series of brief diagnosis-specific scales to identify subjects who are at high probability of meeting diagnostic criteria and those who may safely be spared more extensive diagnostic inquiry. METHOD: Secondary data analysis of a large epidemiological data set (n = 1,286) produced a series of gate and contingent items for each diagnosis. Findings were replicated in a second retrospective analysis from a residential care sample (n = 884). The DISC Predictive Scales (DPS) were then used prospectively as a self-report questionnaire in two studies, in which parents (n = 128) and/or adolescents (n = 208) had subsequent diagnostic interviewing with the Diagnostic Interview Schedule for Children or the Schedule for Affective Disorders and Schizophrenia for School-Age Children. RESULTS: All analyses showed that gate item selection was valid and that any missed cases were due solely to inconsistent reports on the same questions. Screening performance of the full scales was shown to be good, and substantial reductions in scale length were not associated with significant changes in discriminatory power. CONCLUSIONS: The DPS can accurately determine subjects who can safely be spared further diagnostic inquiry in any diagnostic area. This has the potential to speed up structured diagnostic interviewing considerably. The full DPS can be used to screen accurately for cases of specific DSM-III-R disorders.

Adolescent↗

PubMedDate not supplied

American Indian women and cardiovascular disease: response behaviors to chest pain.

Cardiovascular disease (CVD) is currently the number one killer of American women. Consequently, CVD is a concern for all women, including ethnic women. However, little is known about CVD behaviors and responses to CVD symptomology among minority women, especially American Indian women. Response behaviors to chest pain require important actions. This article examines response behaviors to chest pain in a group of American Indian women participants of the Inter-Tribal Heart Project. In 1992 to 1994, 866 American Indian women, aged 22 years and older, participated in face-to-face interviews to answer survey questions on multiple areas related to cardiovascular disease on 3 rural reservations in Minnesota and Wisconsin. A secondary data analysis was conducted on selected variables including demographic characteristics, healthcare access, rating of health status, personal and family history of cardiovascular disease, and action in response to crushing chest pain that lasted longer than 15 minutes. Research findings report that 68% of women would actively seek healthcare immediately if experiencing crushing chest pain that lasted longer than 15 minutes. However, 264 women (32%) would take a passive action to crushing chest pain, with 23% reporting they would sit down and wait until it passed. Analysis revealed women reporting a passive response were younger in age (under age 45) and had less education (less than a high school education). These findings have implications for nurses and other healthcare providers working in rural, geographically isolated Indian reservations. How to present CVD education in a culturally appropriate manner remains a challenge.

Adult↗

PubMed2002

The relationship of empowerment and selected personality characteristics to nursing job satisfaction.

PURPOSE: This study reports on a secondary data analysis undertaken to better understand the determinants of job satisfaction for hospital nurses. Both workplace and personal factors can contribute to job satisfaction. THEORETICAL FRAMEWORK: Kanter's theory of structural empowerment and Spreitzer's theory of psychological empowerment explain logical outcomes of managerial efforts to create structural conditions of empowerment. Selected personal attributes were also considered. METHOD AND SAMPLE: Instruments used were 1) Conditions for Work Effectiveness Questionnaire; 2) psychological empowerment tool; 3) a mastery scale; 4) an achievement scale; and 5) a job satisfaction scale. The sample of 347 nurses (58% response rate) came from all specialty areas. RESULTS: Structural and psychological empowerment predicted 38% of the variance in job satisfaction. Achievement and mastery needs were not significant. Other personal attributes can be found in future research to improve job satisfaction. CONCLUSIONS: Through careful manipulation of the hospital environment, both structural and psychological empowerment can be increased, resulting in greater job and patient satisfaction and, ultimately, improved patient outcomes.

Achievement↗

PubMedDate not supplied

Generating new knowledge from existing data: the use of large data sets for nursing research.

BACKGROUND: An unprecedented amount of data from a variety of disciplines containing variables of interest to nursing are available to nurse researchers. In response, the use of large data sets is emerging as a legitimate method that can help facilitate the translation of knowledge to practice. OBJECTIVE: To explore the spectrum of methodological issues and practical applications encountered by three nurse researchers using secondary data analysis of three existing large data sets as a means to ask new questions and generate new nursing knowledge. METHODS: Three research studies using the analysis of three existing large data sets were described. The following are discussed: developing a theoretical framework, selecting an appropriate data set, operationalizing and measuring variables, preparing data for analysis, and identifying threats to validity and reliability. RESULTS: Although the use of existing data may shorten the time from question to answer, the research process remains the same. The three research studies were used to illustrate conceptual congruence, threats to internal and external validity, and threats to reliability and generalizability. DISCUSSION: Data obtained from a variety of disciplines and for a variety of reasons can and should be used to answer nursing practice and research questions. Using existing large data sets offers nurse researchers a unique opportunity to ask and answer questions that can affect how nurses care for patients in a time-effective and cost-efficient manner. Exploring the spectrum of methodological issues and practical applications involved in this work will help guide nurse researchers through the process.

Data Collection↗

PubMedDate not supplied

Is patient acuity a proxy for patient characteristics of the AACN Synergy Model for Patient Care?

PURPOSE: To test the feasibility of using patient acuity indicators as proxy measures for the AACN Synergy Model for Patient Care patient characteristics. DESIGN AND METHODS: Secondary data analysis of a convenience sample of 481 patient ratings from adult and pediatric critical and noncritical medical surgical patients. FINDINGS: Combining dichotomous patient acuity indicators into multilevel categorical variables allowed evaluation of linear relationships between acuity and patient characteristics indicators. Of the 8 patient characteristics, only participation in care exhibited meaningful correlations with the acuity indicators. According to these findings, acuity indicators should not be substituted for the Synergy Model patient characteristics.

Activities of Daily Living↗

PubMedDate not supplied

Treatment of pain for older hip fracture patients across settings.

PURPOSE: To examine the treatment of pain following hip fracture across settings (hospital to nursing home or rehabilitation facility). DESIGN: This was a secondary data analysis of two survey design studies that collected data on hip fracture patients in the hospital and for posthospital days at an institutional setting. SAMPLE: 115 subjects, 65 years or older, who had undergone surgical treatment of a hip fracture. METHODS: Medical records were reviewed to compare the amount of pain medication administered to postoperative hip fracture elders during the last 24 hours in the hospital with that of the first 24 hours in the nursing home (NH). FINDINGS: The mean length of stay following surgery was 4.8 days. Subjects received significantly less medication during the first 24 hours in the NH as compared with the last 24 hours of hospitalization. Over one third (37.4%) of the subjects received no opioid analgesic and 18.3% (n = 21) received no analgesic of any kind during the first 24 hours of NH stay. IMPLICATIONS: Rather than simply listing medications orders, hospital nursing staff should communicate type, amount, frequency and efficacy of pain medication in transfer notes to nursing home staff. Nursing home staff would benefit from postoperative pain management education.

Age Factors↗

PubMedDate not supplied

Depressive symptoms and mortality in a prospective study of 2,558 older adults.

OBJECTIVE: The authors report results from a 7-year prospective study of depression and mortality in 2,558 Medicare recipients age 65 and older. METHODS: This report is based on a secondary data analysis of a randomized controlled trial that evaluated the cost-effectiveness of preventive services for older enrollees in an HMO. RESULTS: Subjects with mild-to-moderate depression at baseline did not have an increased risk of mortality compared with those without significant depression. The 3% of older adults with the most severe depressive syndromes, however, had significant increases in mortality, even after adjusting for demographics, health risk behaviors, and chronic medical disorders. CONCLUSION: The increase in mortality in this group of older adults was comparable to that in participants with chronic medical disorders such as emphysema or heart disease.

Aged↗

PubMedDate not supplied

The impact of bispectral index monitoring on rates of propofol administration.

The purpose of this article is to examine the efficacy of Bispectral Index (BIS) monitoring as a tool for adjusting the amount of propofol patients receive to maintain a safe and adequate level of sedation in a neurocritical care setting. The BIS monitor is utilized as an adjunct for anesthesia monitoring in the operating room setting and is currently being investigated as a tool for objective sedation monitoring in the critical care setting. 1-6 Sedation is discussed in terms of patient safety and comfort. A secondary data analysis was used to test the hypothesis that BIS monitoring provides a more objective form of sedation assessment that will lead to a decrease in overall rates of propofol administration and fewer incidences of oversedation. Data were abstracted from a quality improvement study of propofol use adjusted to BIS values in patients whose sedation levels were previously adjusted to a goal Ramsay score. The results suggest that there are potential benefits to incorporating BIS into routine sedation assessment in the neurocritical care setting.

Adult↗

PubMed2005

Sexually transmitted infection testing and screening in hospital-based primary care visits by women.

OBJECTIVE: To explore determinants of sexually transmitted infection screening of asymptomatic women and sexually transmitted infection testing of women with genitourinary symptoms, to investigate the effect of specific genitourinary symptoms on sexually transmitted infection testing, and to examine trends in screening. METHODS: We performed secondary data analysis of nationally representative data from the National Hospital Ambulatory Medical Care Surveys, using 17,458 visits by nonpregnant 15- to 44-year-old women seen in primary care clinics between 1997 and 2000. Point estimates, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are presented. RESULTS: Sexually transmitted infection screening was performed in 2.4% of visits by women without genitourinary symptoms and was more likely among visits for preventive care (OR 6.9, CI 3.8-12.5), by nonwhite women (OR 4.3, CI 2.3-7.9), and in gynecology clinic (OR 3.9, CI 2.5-6.1). Sexually transmitted infection testing occurred in 13.2% of visits by women with genitourinary symptoms and was associated with Medicaid (OR 2.3, CI 1.4-3.6), preventive care (OR 2.0, CI 1.2-3.2), patient age less than 25 years (OR 1.7, CI 1.0-2.6), and nonwhite race (OR 1.7, CI 1.0-2.6). Among symptomatic women, vaginal symptoms (OR 4.8, CI 2.6-8.9) and abdominal/pelvic pain (OR 2.5, CI 1.4-4.5) were associated with sexually transmitted infection testing. Between 1997 and 2000, sexually transmitted infection screening rates remained stable. CONCLUSION: Despite national guidelines, sexually transmitted infection testing outpaces screening. Few visits by asymptomatic women under age 25 result in screening. Strategies to improve screening in primary care should target nongynecology settings and non-preventive care visits. LEVEL OF EVIDENCE: III.

Adolescent↗

PubMed2004

The use of muscle relaxant medications in acute low back pain.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To determine the characteristics of patients who take muscle relaxants for back pain after seeking care and to determine the relationship of muscle relaxant use with recovery from the episode of low back pain. SUMMARY OF BACKGROUND DATA: Low back pain is a common condition with a generally favorable short-term prognosis. Physicians in the acute setting commonly prescribe muscle relaxants. The indications for use and outcomes are not clear. METHODS: We performed a secondary data analysis of a cohort of 1633 patients who sought care from a variety of practitioners (primary care, physician of chiropractic, orthopedic surgeon, Health Maintenance Organization) for low back pain. Patients were enrolled in the physician's office and interviewed at baseline, 2, 4, 8, 12, and 24 weeks. Pain, functional status, medication use, health care utilization, and satisfaction with care were assessed. RESULTS: Muscle relaxants were used by 49% of patients; among those who sought care from doctors, 64% used muscle relaxants. Muscle relaxant users were more impaired at baseline. Over time, among patients with greater functional status impairment (Roland disability score > 12) at baseline, muscle relaxant users had somewhat slower recovery from the episode of back pain. This finding persisted after controlling for baseline functional status, age, worker's compensation status, and use of nonsteroidal inflammatory agents. CONCLUSIONS: Use of muscle relaxants was very common among patients with acute low back pain. Muscle relaxant use was not associated with more rapid functional recovery.

Acute Disease↗

PubMed2004

Physician process and patient outcome measures for diabetes care: relationships to organizational characteristics.

BACKGROUND: Optimal diabetes management relies on providers adhering to evidence-based practice guidelines in the processes of care delivery and patients adhering to self-management recommendations to maximize patient outcomes. PURPOSE: To explore: (1) the degree to which providers adhere to the guidelines; (2) the extent of glycemic, lipid, and blood pressure control in patients with diabetes; and (3) the roles of organizational and patient population characteristics in affecting both provider adherence and patient outcome measures for diabetes. DESIGN: Secondary data analysis of provider adherence and patient outcome measures from chart reviews, along with surveys of facility quality managers. SAMPLE: We sampled 109 Veterans Affairs medical centers (VAMCs). RESULTS: Analyses indicated that provider adherence to diabetes guidelines (ie, hemoglobin A1c, foot, eye, renal, and lipid screens) and patient outcome measures (ie, glycemic, lipid, and hypertension control plus nonsmoking status) are comparable or better in VAMCs than reported elsewhere. VAMCs with higher levels of provider adherence to diabetes guidelines had distinguishing organizational characteristics, including more frequent feedback on diabetes quality of care, designation of a guideline champion, timely implementation of quality-of-care changes, and greater acceptance of guideline applicability. VAMCs with better patient outcome measures for diabetes had more effective communication between physicians and nurses, used educational programs and Grand Rounds presentations to implement the diabetes guidelines, and had an overall patient population that was older and with a smaller percentage of black patients. CONCLUSIONS: Healthcare organizations can adopt many of the identified organizational characteristics to enhance the delivery of care in their settings.

Aged↗

PubMed2005

Heritability of SF-36 among middle-age, middle-class, male-male twins.

OBJECTIVE: We sought to examine the relative importance of genetic and environmental factors for the MOS SF-36; a widely used, valid, and reliable measure of health-related quality of life and to discuss incorporating genetic influences into health services research. DATA SOURCES: Data are from a nationally distributed, nonclinical cohort of 2928 middle age, middle-class, male-male twin members of the Vietnam Era Twin Registry. STUDY DESIGN: This was a secondary data analysis, classic twin heritability analysis. DATA COLLECTION: A telephone survey was used to collect information on alcohol-related problems and health services use, including the SF-36. PRINCIPAL FINDINGS: Variance component analyses indicated that additive genetic factors accounted for 17% to 33% of the variance for each of the 8 domains of the SF-36. Shared environment accounted for 0% to 12% of the variance for each domain, with the majority of variance for each domain accounted for by nonshared, or unique environment and error. Physical and mental health summary measures indicated that approximately one-third of the variance was accounted for by additive genetic factors and the remainder accounted for by nonshared environment and error. Clinical condition, history of alcohol dependence, had a small-but-significant influence for all domains. Including condition proved to be a better-fitting model. However, confidence intervals temper uniform statistical significance for genetic factors. CONCLUSIONS: This study assessed the heritability of the SF-36 in a nonclinical, community sample of middle age, middle-class all-male twins. The moderate genetic effects on SF-36 domain and summary measures are new findings and thus may affect interpretations of SF-36 as a measure of health-related quality of life. Ideally, trait-based measures should identify genetic sources of variation and thus help understand any bias of the true effects of SF-36. Still the majority of variance is accounted for by nonshared or unique environmental factors and error. By extension, increased understanding of the importance of genetic and environmental factors that influence either predictors or outcomes of interest will expand the level of scientific debate in health services research and improve predictability.

Adult↗

PubMed2006

Is there a language divide in pap test use?

OBJECTIVE: We sought to determine whether primary language use, measured by language of interview, is associated with disparities in cervical cancer screening. DATA SOURCES: We undertook a secondary data analysis of a pooled sample of the 2001 and 2003 California Health Interview Surveys. The surveys were conducted in English, Spanish, Cantonese, Mandarin, Korean, and Vietnamese. STUDY DESIGN: The study was a cross-sectional analysis of 3-year Pap test use among women ages 18 to 64, with no reported cervical cancer diagnosis or hysterectomy (n = 38,931). In addition to language of interview, other factors studied included race/ethnicity, marital status, income, educational attainment, years lived in the United States, insurance status, usual source of care, smoking status, area of residence, and self-rated health status. DATA COLLECTION/EXTRACTION METHODS: We fit weighted multivariate logit models predicting 3-year Pap test use as a function of language of interview, adjusting for the effects of specified covariates. PRINCIPAL FINDINGS: Compared with the referent English interview group, women who interviewed in Spanish were 1.65 times more likely to receive a Pap test in the past 3 years. In contrast, we observed a significantly reduced risk of screening among women who interviewed in Vietnamese (odds ratio [OR] 0.67; confidence interval [CI] 0.48-0.93), Cantonese (OR 0.44; 95% CI 0.30-0.66), Mandarin (OR 0.48; 95% CI 0.33-0.72), and Korean (OR 0.62; 0.40-0.98). CONCLUSIONS: Improved language access could reduce cancer screening disparities, especially in the Asian immigrant community.

Adolescent↗

PubMed2004

Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization.

OBJECTIVE: To identify those patients in a pediatric intensive care unit who may be at highest risk for developing persistent psychological sequelae after hospital discharge. DESIGN: A secondary data analysis was conducted to examine data gathered in an earlier study of children's psychological responses after critical illness. The current study focused exclusively on patients who required pediatric intensive care unit hospitalization. PATIENTS: Sixty children, aged 6 to 17 yrs, hospitalized in two Canadian pediatric intensive care units. PROCEDURES: Children were categorized as either high risk or low risk for developing persistent psychological sequelae after discharge based on their level of illness severity and the number of invasive procedures to which they were exposed. Outcome data were analyzed using descriptive statistics, followed by an assessment of group differences at baseline, 6 wks, and 6 mos postdischarge. Combined effects of invasive procedures and illness severity on the outcome variables were explored. OUTCOME MEASURES: Three questionnaires were completed by all children 6 wks and 6 mos postdischarge, including the Children's Impact of Events Scale, the Children's Medical Fears Scale, and the Children's Health Locus of Control Scale. RESULTS: Children in the high risk group demonstrated more psychological sequelae 6 wks and 6 mos postdischarge. Exposure to high numbers of invasive procedures was the most important predictor of group differences 6 wks postdischarge. CONCLUSIONS: Findings suggest there is a group of children in the pediatric intensive care unit who are at higher risk for developing persistent psychological sequelae postdischarge. Exposure to high numbers of invasive procedures may be the driving force behind group differences, particularly at 6 wks postdischarge. These children warrant closer observation and follow-up.

Adaptation, Psychological↗

PubMedDate not supplied

Patterns of physical symptoms and relationships with psychosocial factors in adolescents.

OBJECTIVES: Physical symptoms are common in otherwise healthy adolescents. This study sought to identify meaningful patterns of multiple physical symptoms and to examine relationships between the patterns and psychosocial factors. One-year stability of symptom patterns and factors contributing to stability were also examined. METHODS: This secondary data analysis used longitudinal data from a nationally representative sample of adolescents in grades 7 through 12 (n = 9,141) who participated in the National Longitudinal Study of Adolescent Health during 1994 to 1996. Ten selected physical symptoms (i.e., headache, stomachaches, fatigue) were used to construct clusters. Each cluster was compared in regard to demographic factors, psychological adjustment and interpersonal relationships. RESULTS: K-means in combination with Ward method clustered the sample into 4 groups according to the overall patterns of the 10 symptoms: nonsymptom (41%), moderate symptom (38%), high symptom (19%) and extreme symptom (2%). Adolescents in higher symptom clusters were more likely to be girls, nonwhites, or from families on welfare and reported high depressive symptoms, low self-esteem, and poor perceptions of parental affection and friendship quality. About 16% in clusters with lower symptom patterns develop somatizing patterns in Wave II; new onset was predicted by gender, younger age, and depressive symptoms. CONCLUSION: Symptom patterns characterized by overall high frequencies of multiple symptoms may indicate somatization. This study also suggests that adolescents with a somatizing tendency are more likely to experience psychological and interpersonal difficulties, and girls and younger adolescents are more vulnerable. Targeted prevention programs are needed for these vulnerable individuals by addressing their psychosocial functioning.

Adaptation, Psychological↗