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Results for “scale development”

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PubMed2003

Developing a satisfaction survey for families of Ohio's nursing home residents.

PURPOSE: The purpose of this project was to develop a reliable and valid family satisfaction instrument for use in Ohio's nursing homes. DESIGN AND METHODS: Investigators worked with an advisory council to develop the survey. Purposive sampling techniques were largely used to select 12 small, medium, and large for-profit and proprietary facilities in one large county for the pretest. A total of 239 families who were "most involved" in their relative's care completed an instrument with 97 satisfaction items. RESULTS: Factor analyses identified nine factors that explained 59.44% of the variance in satisfaction. Investigator judgment modified some factors and developed scales. The scales had good internal reliability ( and above, except for one), test-retest reliability ranged from.49 to.88, and differences between families of short- and long-stay residents were in expected directions. A final instrument with 62 satisfaction and 17 background items was recommended for statewide implementation. IMPLICATIONS: Findings from the project can be used to further refine the instrument and protocols for use with larger populations in other states and by the federal government.

Aged↗

PubMed2004

Food insecurity is associated with adverse health outcomes among human infants and toddlers.

The U.S. Household Food Security Scale, developed with federal support for use in national surveys, is an effective research tool. This study uses these new measures to examine associations between food insecurity and health outcomes in young children. The purpose of this study was to determine whether household food insecurity is associated with adverse health outcomes in a sentinel population ages < or = 36 mo. We conducted a multisite retrospective cohort study with cross-sectional surveys at urban medical centers in 5 states and Washington DC, August 1998-December 2001. Caregivers of 11,539 children ages < or = 36 mo were interviewed at hospital clinics and emergency departments (ED) in central cities. Outcome measures included child's health status, hospitalization history, whether child was admitted to hospital on day of ED visit (for subsample interviewed in EDs), and a composite growth-risk variable. In this sample, 21.4% of households were food insecure (6.8% with hunger). In a logistic regression, after adjusting for confounders, food-insecure children had odds of "fair or poor" health nearly twice as great [adjusted odds ratio (AOR) = 1.90, 95% CI = 1.66-2.18], and odds of being hospitalized since birth almost a third larger (AOR = 1.31, 95% CI = 1.16-1.48) than food-secure children. A dose-response relation appeared between fair/poor health status and severity of food insecurity. Effect modification occurred between Food Stamps and food insecurity; Food Stamps attenuated (but did not eliminate) associations between food insecurity and fair/poor health. Food insecurity is associated with health problems for young, low-income children. Ensuring food security may reduce health problems, including the need for hospitalizations.

Aid to Families with Dependent Children↗

PubMed1997

Incidence of functional decline and improvement in a community-dwelling, very elderly population.

With the aging of the population, functional decline is one of the major challenges to health care systems. The objective of this study was to estimate the incidence of functional decline and improvement in a community-dwelling population of people aged 75 years and above. A representative sample of elderly people living at home in the city of Sherbrooke (Québec, Canada) was assessed yearly on three occasions (1991-1993) by a nurse. Disabilities were measured by the Functional Autonomy Measurement System, a 29-item rating scale developed according to the World Health Organization classification of disabilities. From the 655 subjects who agreed to participate, a total of 572 subjects completed the study, including 68 who subsequently died. The probability of declining was 20.1% for the first year and 12.4% for the second year. The incidence of functional decline among previously stable subjects was 11.9% (95% confidence interval (CI) 8.9-15.9). Age was strongly related to decline (relative risk (RR) = 1.15/year, 95% CI 1.09-1.21), but there was no significant sex effect (RRmale = 0.88, 95% CI 0.55-1.39). The incidence of improvement among previously disabled subjects was estimated at 7.5% (95% CI 5.1-10.9) for the first year and 17.9% (95% CI 14.0-23.0) for the second year. Neither age (RR = 1.07, 95% CI 0.99-1.15) nor sex (RRmale = 1.70, 95% CI 0.90-3.18) was significantly associated with the probability of improving. This study stresses the importance of precise measurement of disabilities and the complex and dynamic process of functional transitions.

Activities of Daily Living↗

PubMed1981

Prevalence of depression in Los Angeles County.

The occurrence of depression was determined during the summer of 1979 in a multi-ethnic probability sample of 1003 adults (66% participation) in Los Angeles County, as part of a community survey of the epidemiology of depression and help-seeking behavior. The primary measure of depression was the 20-item CES-D scale developed by the Center for Epidemiologic Studies. The overall prevalence of depression based on a CES-D cutpoint definition of 16 or greater was 19.1%. The prevalence of depression was greatest among Hispanics (27.4%) and least among whites (15.6%), with blacks and others at an intermediate level (21.8% and 21.2%, respectively). Females (23.5%) were nearly twice as likely to be depressed as males (12.9%). By age, persons 18-24 years reported the highest rate of depression (27.4%), while those 45-64 years reported the lowest (16.3%). As expected, the prevalence of depression was strongly related to family income, with the highest level reported for those earning less than $8500 (29.3%); the lowest level for those earning more than $25,000 (9.0%). After controlling for effects of selected demographic and socioeconomic variables, neither race nor ethnicity were significantly related to the presence of depression. This suggests that the economic strain experienced by many minorities may be an important determinant of higher rates of depression among blacks and Hispanics.

Adolescent↗

PubMed1995

Empirical free energy calculations of ligand-protein crystallographic complexes. I. Knowledge-based ligand-protein interaction potentials applied to the prediction of human immunodeficiency virus 1 protease binding affinity.

The steadily increasing number of high-resolution human immunodeficiency virus (HIV) 1 protease complexes has been the impetus for the elaboration of knowledge-based mean field ligand-protein interaction potentials. These potentials have been linked with the hydrophobicity and conformational entropy scales developed originally to explain protein folding and stability. Empirical free energy calculations of a diverse set of HIV-1 protease crystallographic complexes have enabled a detailed analysis of binding thermodynamics. The thermodynamic consequences of conformational changes that HIV-1 protease undergoes upon binding to all inhibitors, and a substantial concomitant loss of conformational entropy by the part of HIV-1 protease that forms the ligand-protein interface, have been examined. The quantitative breakdown of the entropy-driven changes occurring during ligand-protein association, such as the hydrophobic contribution, the conformational entropy term and the entropy loss due to a reduction of rotational and translational degrees of freedom, of a system composed to ligand, protein and crystallographic water molecules at the ligand-protein interface has been carried out. The proposed approach provides reasonable estimates of distinctions in binding affinity and gives an insight into the nature of enthalpyentropy compensation factors detected in the binding process.

Crystallization↗

PubMed2006

Evaluation of patient simulator performance as an adjunct to the oral examination for senior anesthesia residents.

BACKGROUND: Patient simulators possess features for performance assessment. However, the concurrent validity and the "added value" of simulator-based examinations over traditional examinations have not been adequately addressed. The current study compared a simulator-based examination with an oral examination for assessing the management skills of senior anesthesia residents. METHODS: Twenty senior anesthesia residents were assessed sequentially in resuscitation and trauma scenarios using two assessment modalities: an oral examination, followed by a simulator-based examination. Two independent examiners scored the performances with a previously validated global rating scale developed by the Anesthesia Oral Examination Board of the Royal College of Physicians and Surgeons of Canada. Different examiners were used to rate the oral and simulation performances. RESULTS: Interrater reliability was good to excellent across scenarios and modalities: intraclass correlation coefficients ranged from 0.77 to 0.87. The within-scenario between-modality score correlations (concurrent validity) were moderate: r = 0.52 (resuscitation) and r = 0.53 (trauma) (P < 0.05). Forty percent of the average score variance was accounted for by the participants, and 30% was accounted for by the participant-by-modality interaction. CONCLUSIONS: Variance in participant scores suggests that the examination is able to perform as expected in terms of discriminating among test takers. The rather large participant-by-modality interaction, along with the pattern of correlations, suggests that an examinee's performance varies based on the testing modality and a trainee who "knows how" in an oral examination may not necessarily be able to "show how" in a simulation laboratory. Simulation may therefore be considered a useful adjunct to the oral examination.

Adult↗

PubMed2002

A multidimensional measure of caregiving appraisal: validation of the Caregiver Appraisal Scale in traumatic brain injury.

OBJECTIVE: To investigate the factor structure and concurrent validity of the Caregiver Appraisal Scale (CAS) in a sample of caregivers of adults with traumatic brain injury (TBI). DESIGN: Prospective cohort study. SETTING: Two sites: (1) Outpatient clinics associated with a comprehensive inpatient brain injury rehabilitation program and (2) a comprehensive residential postacute rehabilitation program in the Southern United States. PARTICIPANTS: One hundred forty-nine caregivers of adults with TBI enrolled in the TBI Model Systems Project and 92 caregivers of adults with TBI admitted to a residential postacute rehabilitation program. Most caregivers were women and either parents or spouses of the injured person. MAIN OUTCOME MEASURES: Caregiver Appraisal Scale (CAS); Subjective Burden Scale (SBS); Objective Burden Scale (OBS); General Health Questionnaire (GHQ). RESULTS: Principal components analysis with varimax rotation yielded four factors: perceived burden (PB), caregiver relationship satisfaction (CRS), caregiving ideology (CI), and caregiving mastery (CM), which were found to be fairly stable across treatment settings. Adequate concurrent validity was demonstrated for the perceived burden factor, and adequate internal consistency was found for three of four scales. CONCLUSIONS: Preliminary support for the use of the CAS in caregivers of adults with TBI was obtained. However, further scale development, particularly for the CM factor, will likely improve the stability and usefulness of this instrument.

Adolescent↗

PubMedDate not supplied

A study of the relationships between self-evaluation of physical condition and perception of difficulties of life in ulcerative colitis patients.

This study was conducted to elucidate factors that influence the self-evaluation of physical condition and perception of difficulties of life in ulcerative colitis patients. A survey and clinical examination were carried out in 171 outpatients with ulcerative colitis. Self-evaluation of physical condition was assessed according to a five-grade system. Perception of difficulties of life was assessed using a scale developed by the authors and others. Physical condition of patients was assessed according to their disease state, disease symptoms, and nutritional state. Additional related factors such as mental condition, demographic attributes, and psychosocial states were also investigated. Multiple regression analyses was used to assess the relationships among variables and showed that perception of difficulties of life and disease symptoms were the main explanatory factors for the self-evaluation of physical condition. Perception of difficulties of life was comprised of physical and mental conditions, the latter being further influenced by the patients' psychosocial state.

Activities of Daily Living↗

PubMed1994

Measuring nurses' satisfaction with the quality of their work and work environment.

This article discusses the Work Quality Index, a 38-item scale developed to measure the satisfaction of nurses with their work and work culture. The instrument, which is an outgrowth of a study of 245 nurses at a large northwestern acute care medical center, was developed using factor analysis and maximum likelihood extraction techniques. The index contains six subscales: professional work environment, autonomy, work worth, professional relationships, role enactment, and benefits. It is responsive to the 1993 proposed Joint Commission on Accreditation of Healthcare Organizations standards for improvement of organizational performance.

Abstracting and Indexing↗

PubMed1996

Surgery versus functional treatment in ankle ligament tears. A prospective study.

A prospective study was performed to compare surgical treatment (primary repair plus early controlled mobilization) to functional treatment (early controlled mobilization alone) in severe (Grade III) lateral ligament injuries of the ankle. Thirty surgically treated patients were compared with 30 age, height, weight, gender, and sporting activity matched, functionally treated similar patients. In both treatment groups, all but 1 patient had a stable ankle at 9 months. Compared with the functional group, the range of motion of the ankle joint was restricted in the surgical treatment group at 6 weeks but did not normalize during the followup. The functional group showed no restrictions. A specific scoring scale developed for subjective and functional followup evaluation of in injured ankle also was used as an outcome criterion. Nine months after the injury, excellent or good scores were achieved in 87% of the functionally treated patients and 60% of the surgically treated patients, respectively. The results of this study indicated that early mobilization gives better results than surgery plus mobilization in the treatment of the complete tears of the lateral ligaments of the ankle.

Ankle Injuries↗

PubMed1998

Transrectal ultrasonography in evaluation of chronic rectal complications after radiation therapy for carcinoma of the uterine cervix.

RATIONALE AND OBJECTIVES: The authors studied the ability of transrectal ultrasonography (TRUS) to assess chronic rectal complications after radiation therapy for carcinoma of the uterine cervix. METHODS: One hundred twenty-five TRUSs were performed for 67 consecutive patients with carcinoma of the uterine cervix. Transrectal ultrasonography images of the rectal anterior wall and perirectal connective tissue adjacent to the uterine cervix were recorded with real-time scanner with 7.5 MHz transducer. The severity of TRUS abnormalities was graded on a scale developed by the authors. The relationships of the TRUS grade with the clinical grade of chronic rectal complications and with rectal radiation doses were analyzed retrospectively. RESULTS: Thickening of the perirectal connective tissue associated with obscuration of the submucosal echogenic layer in rectal anterior wall was observed between 6 months to 2 years after radiation therapy in all 19 patients who developed chronic rectal complications. The TRUS grade correlated with the clinical grade of chronic rectal complications, but did not correlate with rectal radiation doses. CONCLUSIONS: Transrectal ultrasonography can monitor the chronic rectal complications after radiation therapy for the patients with carcinoma of the uterine cervix.

Adult↗

PubMed2003

Ages of onset and rates of syndromal and subsyndromal comorbid DSM-IV diagnoses in a prepubertal and early adolescent bipolar disorder phenotype.

OBJECTIVE: To study rates and ages of onset of DSM-IV syndromal and subsyndromal comorbidity in a prepubertal and early adolescent bipolar disorder phenotype (PEA-BP) (N = 93) compared to attention-deficit/hyperactivity disorder (ADHD) (N = 81). METHOD: The WASH-U-KSADS was given by raters blinded to subject group separately to mothers about their children and to children about themselves. PEA-BP was defined as DSM-IV mania with at least one cardinal symptom of mania (elation or grandiosity) to avoid diagnosing using only symptoms that overlapped with those for ADHD. Syndromal diagnoses required a CGAS score of 60 or less to ensure severity at a level of definite "caseness." RESULTS: PEA-BP subjects were aged 10.9 (SD = 2.6) at baseline and 6.8 (SD = 3.4) at onset of first mania episode. Rates of oppositional defiant disorder and total number of comorbidities were significantly higher in the PEA-BP group than the ADHD group. In PEA-BP subjects, mean ages of onset of ADHD occurred before the first manic episode, and obsessive compulsive, oppositional defiant, social phobia, generalized anxiety, separation anxiety, and conduct disorders occurred after. CONCLUSIONS: Onsets of ADHD before mania and of oppositional defiant disorder/conduct disorder after mania have clinical and research implications. These include the need to examine for mania symptoms in children with ADHD and/or oppositional defiant disorder/conduct disorder and to develop scales to differentiate preschool mania from ADHD. Comparison with other studies demonstrated the importance of DSM system and severity scales in reporting comorbidity rates.

Adolescent↗

PubMedDate not supplied

Eosinophilic gastroenteropathy in childhood.

Eosinophilic gastroenteropathy (EG) is an uncommon, idiopathic disease in children that is characterized by eosinophilic inflammation of the intestine. Over a 7-year period 17 infants and children with EG were evaluated; the retrospective review of their clinical data constitutes the basis of this report. A scale developed for grading the degree of mucosal eosinophilia was used in the evaluation of the intestinal histopathology; all patients had eosinophilic infiltration that was far more severe than that seen in other intestinal disorders of childhood. Peripheral eosinophilia was observed in 12 patients. However, two more had evidence of rapid turnover of eosinophils with significantly increased numbers of precursors in bone marrow and intense intestinal infiltration. Serum IgE correlated with the severity of the disease; extreme elevations were associated with chronic severe illness similar to that commonly reported in adults. Evidence of viral infection in two patients and dietary responsiveness in two infants bring to question the specificity of diagnosis on histology alone. Treatment with oral cromolyn sodium and/or prednisone was effective, but some patients have remained dependent upon therapy.

Adolescent↗

PubMed1984

The dependability of medical encounter diagnostic information.

The dependability of medical billing diagnostic information was evaluated using a rating scale developed by Studney and Hakstian. Generalizability theory offers a comprehensive and flexible framework for analyzing problems associated with measures derived from multiple raters. The medical record and billing system diagnostic information from 45 patient encounters were rated according to similarity and value by three physician judges on two occasions. Data were analyzed using a three-way ANOVA design with levels of judges (3), occasions (2), and encounters (45). Examination of variance components and associated generalizability indicated that the judges and occasions factors or the interaction with occasions and other factors contributed little variance. The greatest proportion of variance was attributable to interindividual differences among the encounters and the interaction of judges and encounters. This investigation illustrates the application of a relatively new approach to practical measurement problems, generalizability theory.

Abstracting and Indexing↗

PubMedDate not supplied

Stress and coping in hypertensive and emergency room patients.

Stressful life events (SLEs) and coping behavior were compared in 25 emergency room patients with nonserious acute illness and 25 newly diagnosed hypertensive patients. Stress was evaluated with a modified Rahe's SLE questionnaire and coping with a rate scale developed by the primary investigator. Results showed that: ER patients reported significantly more (p < .05) SLEs for one year preceding illness onset, although more hypertensives subjectively rated their stress level as high; ER patients experienced significantly more SLEs in personal and social, home and family, and financial categories; hypertensives experienced significantly more health-related SLEs; age was seen as influencing SLEs; hypertensive patients used significantly more problem-oriented coping methods than did ER patients; hypertensives relied more on religion and physical activity in coping than did the ER group; ER patients more often day-dreamed or used their past experience as a guide for coping with stress; each group rated use of drugs as least important in coping; and educational level proved to be a salient variable affecting coping.

Acute Disease↗

PubMedDate not supplied

Injuries and muscle soreness during the one repetition maximum assessment in a cardiac rehabilitation population.

BACKGROUND: Strength training (ST) may be beneficial for preservation of lean tissue, increasing bone mineral content, decreasing falls, and enhancing quality of life. Strength training is becoming an appropriate mode of exercise for cardiac rehabilitation (CR) patients. One method for determining optimal exercise intensity for safe and effective ST requires one repetition maximum (1RM) testing. Clinicians may be reluctant to perform 1RM testing in CR patients because of potential muscle soreness/injury and adverse hemodynamic responses in deconditioned patients. The purpose of this investigation was to perform 1RM testing in CR patients and determine muscle soreness/injury rate. METHODS: Seventy-four CR patients stratified by risk (low n = 30, intermediate n = 21, high n = 23) and sex (males = 55, females = 19) participated. Subject's ages ranged from 39 to 76 years and time from procedure ranged from 19 days to 2 years. No patient had ever undergone 1RM testing. The method of Kraemer and Fry was used to assess 1RM. High-risk patients' heart rates/rhythms and blood pressures were monitored. Patients were evaluated for occurrence of muscle soreness/injury immediately after 1RM testing and on days 2 and 7 using a soreness scale developed by Shaw et al. Muscle soreness/injury was considered significant if a patient reported altering or stopping physical activities. RESULTS: No injury or significant muscle soreness occurred as a result of 1RM testing. No abnormal heart rate/rhythm or blood pressure responses occurred in high-risk patients. CONCLUSIONS: Results indicate that with proper technique, 1RM testing may be performed in CR patients without injury or significant muscle soreness.

Adult↗

PubMed1986

Toward a nursing definition of child maltreatment using seriousness vignettes.

To determine whether nurses operationally define child maltreatment in a like manner regardless of their practice specialty, eight practice groups (N = 596) participated in a mail survey. The survey allowed nurses to judge the potential seriousness of child maltreatment incidents. Multivariate statistical analyses revealed significant group differences. Follow-up analyses of variance (ANOVAs) revealed a difference between anesthetists and community health nurses on one factor (parental sexual mores). However, an investigator-developed scale demonstrated the differences would lack substantive value in clinical practice. It was concluded that nursing specialty groups define similarly the seriousness of child abuse and neglect despite varied backgrounds.

Child↗

PubMed2000

Strengthening local public health practice: a view to the millennium.

From a national perspective, local public health practice continues to face many of the challenges identified in the 1988 Institute of Medicine study. Unless they are addressed broadly, current trends may exacerbate further the capacity of local public health agencies. Efforts to strengthen local practice should focus on workforce development, scale of operations, and resources. New and innovative models of collaboration between academia and local practice are proposed.

Cooperative Behavior↗