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PubMed2000

Faculty evaluation by residents in an emergency medicine program: a new evaluation instrument.

OBJECTIVE: Evaluation of preceptors in training programs is essential; however, little research has been performed in the setting of the emergency department (ED). The goal of this pilot study was to determine the validity and reliability of a faculty evaluation instrument-the Emergency Rotation (ER) scale-developed specifically for use in emergency medicine (EM). METHODS: A prospective study comparing the ER scale with two alternative faculty evaluation instruments was completed in three of the five EDs affiliated with an EM teaching program, where emergency physicians are members of the clinical teaching faculty. The participants were 18 residents (postgraduate years 1, 2, and 3) who were completing four-week clinical rotations in EM. Residents at the end of the rotation recorded their evaluations of each emergency physician with whom they had clinical encounters on the following evaluation tools: the ER scale, a longer validated scale (Irby), and a global assessment scale (GAS). Domain scores were correlated with the previously validated scale and the GAS to determine validity using a multitrait-multimethod matrix. The reliability of the ER scale was measured using a Chronbach's alpha coefficient. RESULTS: Forty-eight preceptor evaluations were completed on 29 individual preceptors. The rating of preceptors was high using the ER scale (median: 16 of 20; IQR: 13, 18), Irby (median: 300 of 378; IQR: 267, 321), or GAS (mean: 7.8 of 10; SD: 1.3). Domain scores for each tool were used in the multitrait-multimethod matrix and the correlations between a previously validated tool and the ER scale were found to be high (>0.70) in the various domains. The internal consistency of the ER scale was also high (r = 0.85). CONCLUSIONS: The ER scale appears to be valid and reliable. It performs well when compared with previously psychometrically tested tools. It is a sensible, well-adapted tool for the teaching environment offered by EM.

Alberta↗

PubMed1980

The WHO Depression Scale. Relationship to the Newcastle Scales.

The WHO (World Health Organization) Depression Scale is a new rating scale developed to evaluate the complete clinical history and description of depression. Items of the WHO scale were transformed to cover the items of the two Newcastle scales that are designed to differentiate between endogenous and non-endogenous depressions. In 98 depressed inpatients examined prior to antidepressive therapy only moderate agreement between scores transformed to the two Newcastle scales was found. Also the distribution patterns of the scores on the two scales were different. In patients classified as endogenous on one or both scales a significant relationship between plasma levels of imipramine or clomipramine and antidepressive effect was found. In patients classified on both scales as doubtful - or non-endogenous depressions - no such correlation could be identified. The initial severity of depression, as defined by the Hamilton Depression Scale, was the same in endogenous, doubtful and non-endogenous depression according to the scores transformed to the two Newcastle scales.

Adult↗

PubMed2004

Racial differences in perceived discrimination in a community population of older blacks and whites.

OBJECTIVES: To examine the prevalence of perceived discrimination in an older biracial population and to examine its correlation with depressive symptoms. METHODS: The sample consisted of 2,652 Blacks and 1,630 Whites, 68 years old and older, from the Chicago Health and Aging Project (CHAP). Perceived discrimination was measured with a nine-item scale developed by Williams, Yu, Jackson, and Anderson (1997). RESULTS: A factor analysis of the discrimination scale revealed two subscales, unfair treatment and personal rejection. Blacks scored higher on both subscales as compared with Whites. In linear regression models, race was significantly associated with higher levels of unfair treatment and personal rejection, controlling for demographic variables and socioeconomic status (SES). Each subscale was also positively related to depressive symptoms, and these effects did not vary by race. DISCUSSION: These findings suggest that older Blacks perceive more discrimination than do older Whites. This may have important implications for health differences between older Blacks and Whites.

Aged↗

PubMed2006

Self-reported attachment, interpersonal aggression, and personality disorder in a prospective community sample of adolescents and adults.

Anxious and avoidant attachment were assessed in the Children in the Community (CIC) Study during adolescence and adulthood using self-report scales developed for this prospective study. The convergent and discriminant validity of the new CIC attachment scales were evaluated and their stability was assessed across a 17-year interval. Attachment scales predicted DSM-IV personality disorders in theoretically coherent and clinically meaningful ways, especially when supplemented with a separate measure of interpersonal aggression. Cluster B and C personality disorder symptoms were associated with elevated anxious attachment. Avoidant attachment was positively associated with Cluster A symptoms and inversely associated with Cluster B and C symptoms. Interpersonal aggression was higher in Cluster B symptoms and lower in Cluster C symptoms, thus differentiating between these symptom clusters.

Adolescent↗

PubMed1993

[Evaluation of quality of life: construction of a scale].

Research in public health has recently tended to take a more global perspective when considering the individual patient. In addition to a measure of functional status, the integration of the disease into the daily life of the individual, or his quality of life is what is being evaluated. This concept, while relatively recent (10-15 yrs), is the result, in part, of changes in the diagnosis and treatment of patients, particularly those with chronic and severe diseases. In clinical trials, what is sought is a measurement of change in the level of well being during the evolution of an illness or of the different levels that exist between two groups. The validation of a scale of this type requires both a qualitative and a quantitative phase with attention being paid to the methodological issues in scale development Specific statistical techniques are used to modify evolving versions. The adaptation of an existing scale into another language requires a rigorous qualitative phase before the quantitative phase is begun.

Data Interpretation, Statistical↗

PubMed1998

Differentiation of the epidermis during scale formation in embryos of lizard.

The formation of the first epidermal generations and in particular of the shedding complex in the developing scales of the lizards Anolis lineatopus and Podarcis muralis was studied by electron microscopy. The initially linear and bilayered epidermis turned into symmetric papillae, which became asymmetric scales. The outer periderm was more electrondense than the following layer, provisionally named 'inner periderm' but probably derived from the basal layer. Coarse thick filaments progressively filled the cytoplasm of the inner periderm or formed reticulate bodies resembling avian peridermal granules. Peridermal cells cornified slightly and could be shed in ovo. From the basal layer various suprabasal epithelial layers were produced. The first layer contained keratohyalin-like granules and was identified as a clear layer. Beneath it a spinulated (Anolis) or serrated (Podarcis) oberhäutchen differentiated. The clear and 'oberhäutchen' layers constitute the first shedding complex. The first epidermal layers that were shed consisted of flaking periderm or periderm together with the clear layer. The differentiation of a mesos layer was under way before hatching, when the epidermal morphology resembled a stage 4-5 of the adult shedding cycle. Fibroblasts under the inner side of the scale made few contacts with the basement membrane and their cytoplasmic elongations were mostly oriented parallel to the dense lamina. Instead, fibroblasts under the basal layer of the outer scale surface (BLOS) made numerous contacts with the basement membrane, suggesting that more dermal-epidermal interactions take place on this side of the scale.

Animals↗

PubMedDate not supplied

[Relationships between insight and medication adherence in subjects with psychosis].

BACKGROUND: Poor medication adherence in subjects with psychosis has a high prevalence and a negative impact on clinical outcome. Several studies have reported that a poor level of insight was a strong predictor of poor medi-cation adherence. However, few studies have investigated whether insight was associated with medication adherence, independently from other clinical and treatment characteristics. OBJECTIVE: To explore the link between insight and medi-cation adherence in subjects with psychosis, and to assess the impact of potential confounding factors on this association. METHOD: Subjects included in the study were patients aged 60 or less, consecutively admitted in a psychiatric ward, and presenting with at least one psychotic symptom (delusion or hallucination). Medication adherence was assessed using: 1) history of total discontinuation of treatment against medical advice over the 2 weeks before admission; 2) the 7-point rating scale developed by Kemp et al.; 3) the self-report questionnaire Drug Attitude Inventory (DAI). The Scale to assess Unawareness of Mental Disorder (SUMD) was used to measure level of insight. Assessment of symptoms was performed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), and the Calgary Depression Scale (CDS). DSM IV diagnoses were assessed using the Diagnostic Interview for Psychosis (DIP). The associations between level of insight (SUMD scores) and the three measures of medication adherence were explored using the non-parametric Mann-Whitney and Spearman's tests. Logistic regression models giving Odds Ratios (ORs) and 95% confidence intervals (95% CI) were used to examine the impact of potential confounding variables on the associations between level of insight and medication adherence. RESULTS: 42 patients presenting with schizophrenia broadly defined (n=25) or psychotic mood disorder (n=17) were assessed. Significant associations were found between higher SUMD scores (ie poorer insight) and discontinuation of treatment before admission (z=- 2.6, p=0.009), poor medication adherence rated using the Kemp et al.'s scale (r=- 0.64; p=0.0001), and negative perception of treatment assessed using the DAI (r=- 0.405; p=0.009). The Kemp'scale score and the DAI score were categorised into poor vs. good according to the median for logistic regression analyses. Subjects were 1.7 times more likely (OR=1.7, 95% CI 1.1-2.5, p=0.01) to have discontinued their treatment, 1.9 times more likely (OR=1.9, 95% CI 1.3-2.8), p=0.0003) to have poor medication adherence rated with the Kemp's scale, and 1.8 times (OR=1.8, 95% CI 1.2-2.6, p=0.005) more likely to have a negative perception of the treatment for one point increase at the SUMD score (ie lower level of insight). The associations between SUMD score and the three measures of medication adherence were not modified after adjustment for demographic characteristics (age, gender, educational level, occupational status, marital status) and categorical diagnosis (schizophrenia broadly defined vs. psychotic mood disorder), severity of symptoms (SANS, SAPS, CDS scores), characteristics of the psychotropic treatment, diagnosis of substance or alcohol use disorder, age at onset, and number of previous admissions. CONCLUSION: The study demonstrates that medication adherence is associated with the level of insight, independently from other patient's demographic and clinical characteristics. The association between low level of insight and poor medication adherence should be confirmed using prospective studies carried out in ambulatory patients. These findings suggest that psycho-educational programs aimed at improving insight should be developed in order to improve medication adherence.

Adult↗

PubMed1992

[Development of a scale for workers' coping behavior: its reliability and validity].

The purpose of this study is to develop a scale for measuring coping with job stressors. Stress process and coping function provide the theoretical framework. Coping is conceptualized as situation-specific behavior. We measure episodic coping, that is, the strategies that individuals actually use in coping with a particular situation. First, a preliminary scale, was prepared. It contained 39 coping behaviors with job stressor which were based on an open-ended pilot study. Next, factor analysis was conducted in order to identify the structure of the scale. Subjects of this study were 649 male employees and 91 female employees of a in manufacturing firm and research and development institute. By occupation they were comprised of 383 professionals, 99 technicians, 96 clerks, 104 miscellaneous workers and 58 of unknown occupation. Seven items in the preliminary scale were omitted because of their psychometrical properties. Finally, factor analysis showed three factors in the scale: positive action and cognition (11 items), avoidant action and cognition (10 items), and symptom management (11 items). The coping scale showed high conceptual validity and reliability.

Adaptation, Psychological↗

PubMed2003

Effects of an educational program on public attitudes towards mental illness.

The World Psychiatric Association promotes global anti-stigma programs. However, evaluation research is crucial to developing effective programs. The present study examined the effects of a lecture on mental health on public attitudes towards mental illness. Subjects were recruited from individuals employed by private companies and the government. Attitudes towards mental illness were measured using the Mental Illness and Disorder Understanding Scale developed by the authors and the Scale of Negative Attitudes Towards the Independence of People with Mental Disorders. Test scores obtained before and after the lecture were compared. The results demonstrated that scores on both scales improved significantly. The present study suggests the effectiveness of this type of educational program in reducing stigma attached to mental illness and disorder.

Adult↗

PubMed1986

A cross sectional study of somatic complaints of Nigerian females using the Enugu Somatization Scale.

Among Nigerian mentally ill a constant male-female ratio of 2:1, over-representation of single males and married females and the tendency for the females who seek psychiatric aid to be psychotic with schizoaffective disturbances have been observed. The question arose as to why this is so. To answer this, the Enugu Somatization Scale, developed in an effort to avoid the difficulty encountered in using Western diagnostic illness categories and scales for assessing mental illness in Nigeria was administered to 51 mentally ill females, 60 adolescent secondary school girls, 67 post secondary school females, 149 pregnant females, and 60 women who were once able to bear children but now no longer can. It was found that somatization is used by Nigerian females to contain their stress. The pregnant females scored lowest while those women who can no longer deliver scored highest. Pregnancy is seen as a state of rest from societal stress for the females, who otherwise are not allowed by the society to be so mentally ill as to seek a psychiatrist and who have to be psychotic to be able to do so. Various tentative, dynamic explanations of the items in the scale answered in the affirmative by a wide cross section of the women, based on the clinical experience of the author, are offered.

Adaptation, Psychological↗

PubMed2003

Psychometric properties of the Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ).

AIMS: To develop a standard measure of blood-borne virus transmission risk behaviour, and examine the underlying psychometric properties. DESIGN: The Blood-borne Virus Transmission Risk Assessment Questionnaire (BBV-TRAQ) was developed over three consecutive phases of the original BBV-TRAQ study in adherence to classical scale development procedures, culminating in the recruitment of a development sample of current injecting drug users via convenience and snowball sampling. SETTING: Needle and syringe programmes (NSPs), medical clinics, alcohol/drug agencies, peer-based and outreach organizations across inner and outer metropolitan Melbourne. PARTICIPANTS: Two hundred and nine current injecting drug users. The mean age was 27 years, 68% were male, 65% unemployed, 36% with prison history and 25% in methadone maintenance. MEASUREMENTS: BBV-TRAQ items cover specific injecting, sexual and skin penetration risk practices. BBV-TRAQ characteristics were assessed via measures of internal and test-retest reliability; collateral validation; and principal components analyses. FINDINGS: The BBV-TRAQ has satisfactory psychometric properties. Internal (a=0.87), test-retest (r=0.84) and inter-observer reliability results were high, suggesting that the instrument provides a reliable measure of BBV risk behaviour and is reliable over time and across interviewers. A principal components analysis with varimax rotation produced a parsimonious factor solution despite modest communality, and indicated that three factors (injecting, sex and skin penetration/hygiene risks) are required to describe BBV risk behaviour. CONCLUSIONS: The BBV-TRAQ is reliable and represents the first risk assessment tool to incorporate sufficient coverage of injecting, sex and other skin penetration risk practices to be considered truly content valid. The questionnaire is indicated for use in addictions research, clinical, peer education and BBV risk behaviour surveillance settings.

Adolescent↗

PubMed2000

A clinical advancement program: evaluating 10 years of progressive change.

OBJECTIVE: To report the evolution of a clinical advancement program, UEXCEL, at a western teaching hospital and the outcomes associated with evaluation over time. BACKGROUND: The clinical ladder program was initiated in 1989 to provide a professional framework for developing, evaluating, and promoting registered nurses. The program is derived from Benner's Novice to Expert model. Over a 10-year period, the program has undergone three significant revisions. Program evaluation data have been used to guide institutional change. METHODS: Structure and progression of program development and change are outlined. Evaluation data were collected using a 23-item clinical ladder satisfaction scale developed by Strzelecki. Data were collected in 1993, 1994, 1996, and 1998 using standard survey methods after institutional review board approval. Subjects were registered nurses holding clinical positions at the University of Colorado Hospital. Data were trended across units and time periods and were compared with other institutional evaluation data sets. RESULTS: Improvement in nurse satisfaction with the UEXCEL program has been steady and incremental, after low baseline measurement. Satisfaction has improved after each program revision. A significant demographic variable over time is the correlation between higher registered nurse education and program satisfaction. Human resources issues are reported with data results. CONCLUSIONS: Sustaining a clinical advancement program represents a challenge in the current health-care environment. Institutional commitment, staff involvement in revisions, and activities to improve professional nurse development are critical strategies so progress can be achieved.

Career Mobility↗

PubMed2005

Patient satisfaction with occupational health physicians, development of a questionnaire.

AIMS: To develop a questionnaire that measures specific aspects of patient satisfaction with occupational health physicians. METHODS: General patient satisfaction questionnaires, a literature survey, and interviews with patients were used. An initial questionnaire was distributed among sick listed patients (n = 432) of occupational physicians (n = 90) from different occupational health services. To reduce items and to develop scales exploratory factor analysis and reliability analysis was used. A linear regression model was used to predict satisfaction ratings from the scales of the questionnaire. RESULTS: Questions about independence of the occupational physician were difficult to ask unambiguously. The factor analysis revealed five relevant factors which were named "being taken seriously as a patient", "attitude towards occupational health services", "trust and confidentiality", "expectations", and "comfort and access". All scales could be reduced to a maximum of five items without reducing the scale reliability too much. In the regression analysis, 71% of the variance of satisfaction ratings was explained by the first four scales and most by the first scale. "Comfort and access" did not contribute significantly to the model. CONCLUSIONS: A short questionnaire was developed to measure different aspects of patient satisfaction specific for occupational health. Whether the questionnaire can effectively lead to quality improvement in occupational health services should be investigated.

Adult↗

PubMed2006

Quality of life and hormone use: new validation results of MRS scale.

BACKGROUND: The Menopause Rating Scale is a health-related Quality of Life scale developed in the early 1990s and step-by-step validated since then. Recently the MRS scale was validated as outcomes measure for hormone therapy. The suspicion however was expressed that the data were too optimistic due to methodological problems of the study. A new study became available to check how founded this suspicion was. METHOD: An open post-marketing study of 3282 women with pre- and post- treatment data of the self-administered version of the MRS scale was analyzed to evaluate the capacity of the scale to detect hormone treatment related effects with the MRS scale. The main results were then compared with the old study where the interview-based version of the MRS scale was used. RESULTS: The hormone-therapy related improvement of complaints relative to the baseline score was about or less than 30% in total or domain scores, whereas it exceeded 30% improvement in the old study. Similarly, the relative improvement after therapy, stratified by the degree of severity at baseline, was lower in the new than in the old study, but had the same slope. Although we cannot exclude different treatment effects with the study method used, this supports our hypothesis that the individual MRS interviews performed by the physician biased the results towards over-estimation of the treatment effects. This hypothesis is underlined by the degree of concordance of physician's assessment and patient's perception of treatment success (MRS results): Sensitivity (correct prediction of the positive assessment by the treating physician) of the MRS and specificity (correct prediction of a negative assessment by the physician) were lower than the results obtained with the interview-based MRS scale in the previous publication. CONCLUSION: The study confirmed evidence for the capacity of the MRS scale to measure treatment effects on quality of life across the full range of severity of complaints before treatment. The difference of the relative improvement after therapy between the old and current study as well as the observed different sensitivity/specificity is--as a matter of probability--more likely to be caused by a bias introduced by the different application of the MRS scale than by real differences in the efficacy of the therapy. A randomized clinical trial would be needed to test the impact of the latter. The message for future studies is: The MRS scale should be only used as self-administered tool where the suggestive effect of questions raised by health professionals ("therapeutic optimism") can be largely excluded.

Estrogen Replacement Therapy↗

PubMed2000

Self-confidence, self-esteem, and assumption of sex role in young men and women.

This study investigated the use of the English translation of a paper-and-pencil self-confidence scale developed in French by Garant, Charest, Alain, and Thomassin in 1995. The translated self-confidence scale measured self-confidence, or the belief that one will succeed at whatever one undertakes, as distinct from self-esteem or the feeling that one is a worthwhile person. Unlike a number of previous studies. there was no sex difference in self-confidence favoring men: however, scores on the masculinity portion of Bem's Sex role Inventory (1974) were highly correlated with self-confidence for both men (r=.59) and women (r=.69).

Adult↗

PubMed1976

Factor analysis and multivariate scaling of anthropometric variables for the assessment of body composition.

This study was designed to identify the body composition factors measured by skinfold fat (S), girth (G), and diameter (D) variables and to provide multivariate scaling models that measure fat (F) and lean body weight (LBW) factors. A total of 7S, 11G, and 7D measurements were determined on 83 young women (YW) and 95 young men (YM). Body density (BD) was determined by the hydrostatic technique. All variables were factor analyzed, and F and LBW were used to validate isolated factors. The YM data showed one F factor and two LBW factors. LBW factor I measured muscle mass and bone structure; LBW factor II, bone D. The YW data isolated four factors: the same three of YM plus a second F factor specific to the pelvic girdle. Factor score models were used to develop scaling strategies to measure F and LBW factors. Full models of all 27 variables and restricted models of 14 S, G, and D variables were developed; the correlations between factor scores scaled from the full and restricted models ranged from 0.84 to 0.98. The multiple correlation between factor scores calculated from the restricted models and laboratory-determined F and LBW ranged from 0.90 to 0.94 for YM and from 0.88 to 0.89 for YW. The multivariate scaling models provide a valid field method of measuring body composition.

Adolescent↗

PubMed1998

Prosthesis evaluation questionnaire for persons with lower limb amputations: assessing prosthesis-related quality of life.

OBJECTIVE: To develop a self-report questionnaire for persons with lower limb amputations who use a prosthesis. The resulting scales were intended to be suitable to evaluate the prosthesis and life with the prosthesis. The conceptual framework was health-related quality of life. DESIGN: Multiple steps of scale development, terminating with test-retest of the Prosthesis Evaluation Questionnaire (PEQ) by mail. SOURCE OF SAMPLE: Records from two Seattle hospitals. PATIENTS: Ninety-two patients with lower limb amputations who varied by age, reason for amputation, years since amputation, and amputation level. MAIN OUTCOME MEASURES: The 10 scales used were 4 prosthesis function scales (Usefulness, Residual Limb Health, Appearance, and Sounds), 2 mobility scales (Ambulation and Transfers), 3 psychosocial scales (Perceived Responses, Frustration, and Social Burden), and 1 Well-being scale. Validation measures were the Medical Outcomes Study Short Form-36, the Social Interaction subscale from the Sickness Impact Profile, and the Profile of Mood States-short form. RESULTS: Nine PEQ scales demonstrated high internal consistency. All met test-retest criteria for comparing group results. Validity was described based on methods used to gather original items, distribution of scores, and comparison of scores with criterion variables. CONCLUSIONS: The PEQ scales displayed good psychometric properties. Future work will assess responsiveness of PEQ scales to changes in prosthetic components. We conclude that they will be useful in evaluation of prosthetic care.

Activities of Daily Living↗

PubMed2006

Interpersonal traits in childhood: development of the child and adolescent interpersonal survey.

The Child and Adolescent Interpersonal Survey (CAIS) consists of interpersonal trait descriptions that were generated to represent the constructs of the Interpersonal Circumplex model utilizing language accessible to children in a brief self-report format. Scale development entailed examining the structure at the item and scale levels with a sample of children (fourth and sixth graders) and at the scale level with college students. Internal consistency estimates for the majority of the CAIS scales were adequate given the brevity of the scales. The fits to the circular order model for the CAIS were very well supported across the child and adult samples, with no significant differences in the fit of the model across these samples. Generally strong associations were found between corresponding scales of the CAIS and the Interpersonal Adjective Scales in a college sample, and there were many structural similarities between these measures. For the child sample, the CAIS scales of Gregarious-Extraverted and Warm-Agreeable related strongly to corresponding Five-factor scales, and remaining scales related minimally to moderately.

Adolescent↗