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PubMedDate not supplied

MMPI indices in the identification of patients evidencing pseudoseizures.

Data are presented on the clinical utility of two Minnesota Multiphasic Personality Inventory (MMPI) indices, the Pseudo-Neurologic (Pn) Scale developed by Shaw and Matthews and the configural rule system developed by Wilkus et al. for the prediction of pseudoseizures. Particular attention is given to base rates, hit rates, and error rates in the analyses. Only the configural rule system was found to be of clinical value in ruling out the probability of pseudoseizures.

Adult↗

PubMed1999

Evaluation of Simulated Presence: a personalized approach to enhance well-being in persons with Alzheimer's disease.

OBJECTIVE: To evaluate the efficacy of Simulated Presence, a personalized approach to enhance well-being among nursing home residents with Alzheimer's disease and related dementia's (ADRD). DESIGN: Latin-Square, double blinded, 3-factor design with restrictive randomization of three treatments (the study intervention, a placebo audio tape of a person reading the newspaper, and usual care). The three factors were treatment, time, and facility type. SETTING: Nine nursing homes in Eastern Massachusetts and Southern New Hampshire. PARTICIPANTS: Fifty-four subjects with documented ADRD who were aged 50 years or older, medically stable, had resided in their current nursing home for at least 3 months, and who had no planned discharge. All subjects had a history of agitated or withdrawn behaviors. INTERVENTION: The purpose of Simulated Presence is to provide a personalized intervention for persons with moderate to severe cognitive impairment. Through a unique testing process, some of the best loved memories of the ADRD person's lifetime are identified and then those memories are introduced to the patient in the format of a telephone conversation using a continuous play audio tape system. The intervention may be used for extended periods of time because each repetition is viewed as a fresh, live telephone call as a result of the short-term memory deficit of the person with ADRD. MEASUREMENTS: Direct observations of outcomes included using a newly developed scale, the Scale for the Observation of Agitation in Persons with Dementia, an agitation visual analog scale, the Positive Affect Rating Scale (mood and "interest"), a withdrawal visual analog scale, and facial diagrams of mood. Reported measures included daily staff observation logs of responses to interventions offered, and weekly staff surveys using the short-form Cohen-Mansfield Agitation Inventory and the Multidimensional Observation Scale for Elderly Subjects (mood and "interest"). Severity of dementia was assessed by the Mini-Mental State Exam, the Test for Severe Impairment, the Bedford Alzheimer's Nursing Scale, and the ADL Self-Performance Scale. RESULTS: Chi-square analysis of direct observations, using facial diagrams, revealed that Simulated Presence was equivalent to usual care (P = .141) and superior to placebo for producing a happy facial expression (P = .001). A positive effect was also documented in nursing staff observation logs using Analysis of Variance techniques (ANOVA) for subjects during Simulated Presence phases compared with the placebo phases (P < .001) and usual care phases (P < .001). According to ANOVA analyses of "interest" from weekly surveys, Simulated Presence was superior to both usual care (P = .001) and placebo (P = .008). We were unable to find evidence of significant differences (P < .05) among interventions for other direct observations and weekly reports of overall agitation or mood aspects of withdrawal. Subjects accepted the intervention most of the time, except for five subjects who refused it more than 50% of the time. CONCLUSION: This study provided evidence that Simulated Presence can be effective in enhancing well-being and decreasing problem behaviors in the nursing home setting as a substitute for or complement to usual care.

Aged↗

PubMed2000

Survey methods for seriously ill hospitalized adults: practical lessons from SUPPORT. The Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

OBJECTIVE: To describe issues confronted in collecting questionnaire-based data in a large study of seriously ill hospitalized adults, discuss methods used to achieve acceptable results, summarize the reliability of selected measures, and explore challenges for patient-based research in this population. DESIGN: A prospective cohort study. SETTING: Five teaching hospitals in the US. PARTICIPANTS: 9105 patients, with a subset of 80 patients and 10 proxy respondents for reliability testing. MEASUREMENTS AND MAIN OUTCOMES: Response rates; percent agreement and Kappa statistics to assess test-retest reliability. RESULTS: A pretest and pilot test were used to help develop the assessment strategy, establish study procedures, and identify staff characteristics likely to facilitate the project. Achieving adequate response rates required great perseverance and flexibility by interview staff as well as close monitoring and central supervision. Standardized quality assurance with timely feedback, and social support provided by peer and supervising staff were both important. Older women proved to be the best interviewers. Reliability was acceptable for existing and newly developed scales to measure subjective health status, preferences, and satisfaction. CONCLUSIONS: It was possible to collect reliable and useful data on preferences and subjective health outcomes from a cohort of seriously ill hospitalized patients and their proxies. Achieving acceptable data quality required a large interview team, mature staff, flexibility about modes of administration, and centralized, structured quality assurance. Successful outcomes research in this population is likely to require similar planning and efforts.

Activities of Daily Living↗

PubMedDate not supplied

Mothers' perceptions of the quality of their infants' back transfer.

OBJECTIVE: To describe mothers' experiences with back transfer of their infants from a neonatal intensive-care unit (NICU) to a community hospital (CH). DESIGN: Descriptive correlational study. PARTICIPANTS: One hundred forty-three mothers whose infants were back transferred from regional NICUs to 1 of 20 Level I or Level II CHs. MAIN OUTCOME MEASURES: Quality of back transfer was measured by the NICU/CH Transfer Quality Scale developed by the investigators. Overall level of stress related to back transfer was also measured. RESULTS: More positive experiences with the NICU component of back transfer were related to fewer perceived differences in physician practice between NICUs and CH settings and fewer infant problems after transfer (R2 = 8.1%, p = .007). More positive experiences with the CH component of back transfer were related to fewer perceived differences in nursing and medical practices between settings; fewer infant problems after transfer; and more sources of pretransfer preparation (R2 = 33.4%, p < .0001). Lower levels of overall stress associated with transfer were related to fewer infant problems after transfer and greater lengths of stay in the NICU (R2 = 8.8%, p = .01). CONCLUSION: Results support the need for consistency of care and coordinated approaches to back transfer.

Adolescent↗

PubMed2004

Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus.

OBJECTIVE: To evaluate if impaired wakefulness (IW) in normal pressure hydrocephalus (NPH) is associated with reduced blood flow in regions associated with the brain arousal system. METHOD: NPH (n = 28) patients were studied before and after surgery. Wakefulness was assessed using a new developed scale. Relative regional cerebral blood flow (rrCBF) was quantified using SPECT and rectangular regions of interest analysis. RESULTS: Sixteen patients presented with IW at baseline and in 14 of these, IW vanished after surgery. Patients presenting with IW had reduced rrCBF in the anterior cingulate cortex compared with those without. After surgery, rrCBF increased significantly in thalamic, frontal and hippocampal grey matter regions. Increased hippocampal rrCBF correlated with increased basal frontal rrCBF (r = 0.64). In patients where IW vanished after surgery, rrCBF increased in the mesencephalon, hippocampus and the frontal association cortex. The postoperative increase in wakefulness correlated with increased rrCBF in frontal (r = 0.74) and parietal (r = 0.65) association cortex areas. CONCLUSION: IW in NPH is associated with reduced rrCBF in the anterior cingulate cortex. Improved wakefulness following surgery corresponds to rrCBF increments in the frontal association cortex. This study provides support for a functional coupling between frontal, hippocampal, thalamic and mesencephalic rrCBF in NPH at large.

Adult↗

PubMed1993

Admission of self-poisoned patients during one year at the Poisoning Treatment Centre, Copenhagen, Denmark.

The study comprises 541 patients admitted to the Poisoning Treatment Centre at Bispebjerg Hospital, Copenhagen; 440 of the patients were psychiatrically evaluated prospectively. The sex distribution was almost equal. In comparison with the normal population there was an overrepresentation of the age groups of 30-49 years old and of 18-19 years old. Only 20% were employed. Sixty-nine percent of the males and 40% of the females were living alone. Forty-six percent of the patients had some sort of abuse. Twenty-one percent suffered from psychotic disorder. Forty-eight percent had at least once before attempted suicide. The group was found to be at high risk of repeating suicide attempt according to a scale developed in the poisoning treatment centre in Edinburgh. The treatment of suicidal patients is discussed.

Adolescent↗

PubMed1989

Dental hygienists' influence on the patients' knowledge, motivation, self-care, and perception of change.

The purpose of this study was to assess the success of the dental hygienist in the dental health education of dental patients in general dental practice. Special emphasis was laid on health education in the field of periodontics. The answers on a questionnaire of 159 dental patients who visited a dental hygienist were compared with the answers of 302 dental patients who had never visited a dental hygienist. The comparison was done by means of t-test and regression analysis on specially developed scales with regard to knowledge, motivation, self-care, and perception of change. On all scales the dental patients who visited a dental hygienist scored better. This difference remained when social demographic variables and the dentist's influence were taken into account. This indicates that the dental hygienist is successful in the behavioral aspect of her work.

Adult↗

PubMed2004

The association between incisor trauma and occlusal characteristics in individuals 8-50 years of age.

To explore the association between incisal trauma and occlusal characteristics using oral examination and health interview data from the Third National Health and Nutrition Examination Survey 1988-1994 (NHANES III). Incisal trauma examinations were performed on 15 364 individuals 6-50 years of age using an ordinal scale developed by the National Institute of Dental and Craniofacial Research. Occlusal examinations were performed on 13 057 individuals 8-50 years of age. We fitted separate multivariate logistic regression models for maxillary and mandibular incisor trauma adjusting for socio-demographic variables (age, gender, race-ethnicity) and occlusal characteristics (overbite, overjet, open bite). 23.45% of all individuals evidenced trauma on at least one incisor, with trauma more than four times more prevalent on maxillary (22.59%) than on mandibular incisors (4.78%). Males (OR = 1.67) had greater odds of trauma than females; Whites (OR = 1.37) and non-Hispanic Blacks (OR = 1.37) had greater odds of trauma than Mexican-Americans. The odds of trauma increased with age, peaked from age 21 to 30 (OR = 2.92), and declined. As overjet increased, so did the odds of trauma. Compared to individuals with < or =0-mm overjet, odds of trauma increased from 1-3 mm (OR = 1.42) to 4-6 mm (OR = 2.42) to 7-8 mm (OR = 3.24) to >8 mm (OR = 12.47). Trauma to incisors is prevalent but mostly limited to enamel. Trauma to maxillary incisors is associated with overjet, gender, race-ethnicity, and age, while trauma to mandibular incisors is associated with gender, age, and overbite.

Adolescent↗

PubMed2006

Spiritual care practices of nurse practitioners in federally designated nonmetropolitan areas of North Carolina.

PURPOSE: The purpose of this study was to explore if and then how nurse practitioners (NPs) living in federally designated nonmetropolitan areas of North Carolina integrated spiritual care into their practices. Participants identified the frequency in which they utilize spiritual care practices, specific spiritual interventions, and their definitions of spiritual care. DATA SOURCES: A sample of 101 NPs was chosen through systematic sampling from 507 eligible NPs. Each participant was mailed a demographic data sheet and the Nurse Practitioner Spiritual Care Perspective Survey (NPSCPS). The NPSCPS was modified from the Oncology Nurse Spiritual Care Perspective Scale developed by Taylor and colleagues. Of the 101 mailings, 65 were returned and included in the analysis. CONCLUSIONS: Although most of the NPs in this study felt that spiritual care was an important part of nursing practice, 73% did not routinely provide spiritual care to their patients. Barriers and limitations to the provision of spiritual care must be explored. IMPLICATIONS FOR PRACTICE: As providers of holistic care, NPs should be proficient and comfortable in providing spiritual care to their patients. Educational programs should provide NPs and NP students with knowledge and skills to provide spiritual care.

Adult↗

PubMed1992

Factors associated with job and career satisfaction among dental hygienists.

Information concerning dental hygienists' job and career satisfaction is dated and incomplete. Because satisfaction may be important in retention of dental hygienists, a survey of all active dental hygienists in private practices in North Carolina was performed to ascertain dimensions and levels of job and career satisfaction, as well as factors associated with these constructs. Of 2,099 eligible hygienists, 51 percent responded to a survey instrument containing 202 items addressing overall satisfaction, as well as satisfaction with a variety of work-related factors. Factor analysis was used to develop scales for job and career satisfaction, and for the work-related factors. Final reduced regression models indicated that the constructs of job and career satisfaction are separate and that each has distinct general and intrinsic dimensions. Models for general job and career satisfaction had R2 values of .45 and .27, respectively, and included a variety of work-related factors such as supervisory style and satisfaction with salary. Models for intrinsic job and career satisfaction were not as strong, with R2 values of .06 and .09, respectively. These models also included work-related factors such as satisfaction with hours of work, office safety arrangements, and supervisory style. These results suggest that general job and career satisfaction levels should be amenable to change through management interventions.

Adult↗

PubMed1991

Assessing school-related stressors and coping mechanisms in adolescents.

Despite a plethora of instruments used to measure stressors and coping mechanisms in adolescents little attention has been paid to issues of reliability and validity. In an endeavour to overcome this problem, a statistical methodology was implemented to develop scales from existing item sets. Items from Kohn and Frazer's (1986) Academic Stress Scale were combined with Strutynski's (1985) list of problems and, together with items from Patterson and McCubbin's (1987) Adolescent Coping Orientation for Problem Experiences, were administered to 1699 secondary school students in Australia. Two scale, the School Stressors Inventory for Adolescents (SSIA) and the Coping Inventory for Adolescents (CIA), were produced with five and four subscales respectively. Both have strong face and factorial construct validity, and high to modest reliability.

Adaptation, Psychological↗

PubMed1997

Comparing two methods of follow up in a multicentre randomised trial.

AIMS: To evaluate a parental questionnaire as a means of providing outcome measures for a multicentre randomised controlled trial of treatment for post-haemorrhagic ventricular dilatation. METHODS: The parents of 88 survivors were sent a questionnaire before a paediatric assessment at the age of 30 months. The parents' responses to individual questions taken mainly from the Griffiths' mental development scales and their perception of the child's ability to see and hear were compared with the paediatric findings. A model, based on the parents' responses to particular questions, allowed the categorisation of the children as normal, impaired, moderately or severely disabled; this was compared with similar categorisation based on the full paediatric assessment. RESULTS: Agreement on items concerning gross motor function ranged between 81 and 99%, concerning dressing between 77 and 80%, concerning feeding between 91 and 99%, and concerning language between 85 and 93%. Similar proportions of children were identified as disabled by the parents (60%) and by the paediatrician (66%). Of 29 children who had developmental quotients less than 70, parents identified 28 as disabled, 18 of them as severely disabled. They were not so good at identifying children with impairments without functional loss. CONCLUSIONS: Further work is required but there is sufficient encouragement from the results to pursue this methodology further for use in comparing groups in randomised trials.

Cerebrospinal Fluid Shunts↗

PubMed1998

Intelligence and development in Aarskog syndrome.

AIM: To test the hypothesis that overall intelligence quotient (IQ) is decreased in patients with Aarskog syndrome. METHODS: 21 boys under 17 years of age with a confirmed clinical diagnosis of Aarskog syndrome were assessed using the Griffiths mental development scales and the British ability scales. RESULTS: IQ ranged from 68 to 128 and followed a normal distribution. CONCLUSION: This study does not support the hypothesis that Aarskog syndrome is associated with a lowering of mean IQ.

Adolescent↗

PubMed2003

Retrospective analysis of evidence base for tests used in diagnosis and monitoring of disease in respiratory medicine.

OBJECTIVES: To determine how many common clinical tests used in a respiratory medicine outpatient clinic are based on high quality evidence. DESIGN: Retrospective review of case notes. Record of first three tests for each patient. Diagnostic tests, tests used to assess existing condition, explicit trials of therapy were included. Literature search for supporting evidence and grading of best evidence for each test. SETTING: Inner city university teaching hospital in the United Kingdom. PARTICIPANTS: All new outpatients referred to a single respiratory medicine team over a period of three months. MAIN OUTCOME MEASURES: Proportion of tests supported by level 1a-1c evidence (scale developed by Centre for Evidence Based Medicine). RESULTS: Only half the tests that were used to make or exclude a diagnosis and a fifth of the tests used to assess a known condition were supported by level 1a-1c evidence. There was no evidence to support trials of therapy. CONCLUSIONS: A large proportion of clinical tests in respiratory medicine are not supported by level 1a-1c evidence. None of the therapeutic trials that were used were supported by evidence.

Diagnostic Techniques, Respiratory System↗

PubMedDate not supplied

Information technology in complex health services: organizational impediments to successful technology transfer and diffusion.

OBJECTIVE: To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. DESIGN: A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. MEASUREMENTS: Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. RESULTS: Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. CONCLUSION: The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case.

Computer User Training↗

PubMed2004

Fluctuating cognition in dementia with Lewy bodies and Alzheimer's disease is qualitatively distinct.

OBJECTIVES: To document and illustrate qualitative features of fluctuating cognition as described by care givers of patients with probable dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). To determine whether the quality of the fluctuations differs between DLB and AD. To examine the clinical utility of two recently developed rating scales. METHODS: Care givers of 13 patients with early probable DLB and 12 patients with early probable AD were interviewed using the Clinician Assessment of Fluctuation and the One Day Fluctuation Assessment Scale, both developed recently. Descriptions of fluctuating cognition were recorded verbatim, analysed, and rated. RESULTS: Descriptions of fluctuating cognition in DLB had a spontaneous, periodic, transient quality, which appeared to reflect an interruption in the ongoing flow of awareness or attention that impacted on functional abilities. Descriptions of fluctuations in AD frequently highlighted episodes of memory failure, or a more enduring state shift in the form of "good" and "bad" days, typically occurring in response to the cognitive demands of the immediate environment. These qualitative differences could be detected reliably by independent raters, but were not always captured in standard severity scores. CONCLUSION: Fluctuations occurring in DLB have particular characteristics that are distinguishable from fluctuations occurring in AD. Interpretation and application of the fluctuation criterion continues to limit the diagnostic sensitivity of the consensus criteria for DLB. Findings suggest that explicit documentation and a wider appreciation of these distinctions could improve the reliability with which less experienced clinicians identify this core diagnostic feature in the clinical setting.

Aged↗

PubMed1993

Conventional and quantitative EEG in the diagnosis of delirium among the elderly.

This study was performed to determine whether an admission quantitative EEG (QEEG) could assist in the differential diagnosis of encephalopathy among a group of elderly subjects with delirium, dementia, and delirium coexistent with dementia. Thirty four subjects from 57 to 93 years had standard 17-channel EEG and quantitative EEG studies, using a linked-ear reference. EEGs were independently rated by two electroencephalographers blind to clinical diagnosis, using conventional criteria to assess the degree of encephalopathy. Brain maps were scored by a scale developed by the authors. Numerical data examined included mean posterior dominant frequency, absolute and relative power in the delta, theta and alpha bands, and slow-wave ratios. The grouping of experimental subjects was by the discharge diagnosis, made using DSM-III-R criteria. Stepwise discriminant analysis was performed to determine which EEG and QEEG variables were best able to distinguish cases. Variables which collectively distinguished normal from encephalopathic records were Mini-Mental State Examination scores and relative power in the alpha frequency band. Variables which collectively distinguished delirium from dementia were EEG theta activity, relative power in delta, and brain map rating. The results suggest that cross-sectional QEEG study is potentially useful in the early differential diagnosis of encephalopathy, and that the variables which distinguish normal from encephalopathic patients might differ from the variables which distinguish delirium from dementia.

Aged↗

PubMed2005

Acceptability of human papillomavirus self testing in female adolescents.

OBJECTIVES: To develop scales assessing acceptability of human papillomavirus (HPV) testing in adolescents, to compare acceptability of self to clinician testing, and to identify adolescent characteristics associated with acceptability. METHODS: Female adolescents 14-21 years of age attending a hospital based teen health centre self collected vaginal samples and a clinician, using a speculum, collected cervicovaginal samples for HPV DNA. Acceptability of and preferences for self and clinician testing were assessed at baseline and 2 week visits. RESULTS: The mean age of the 121 participants was 17.8 years and 82% were black. The acceptability scales demonstrated good internal consistency, reliability, test-retest reliability, and factorial validity. Scores were significantly lower for self testing than clinician testing on the acceptability scale and three subscales measuring trust of the test result, confidence in one's ability to collect a specimen, and perceived effects of testing (p < 0.01). Of those who reported a preference, 73% preferred clinician to self testing. Acceptability scores for both self and clinician testing increased significantly pre-examination to post-examination (p < 0.01). Multivariable analyses demonstrated that race was independently associated with pre-examination and post-examination acceptability of self testing, and that sexual behaviours and gynaecological experiences were associated with specific acceptability subscales. CONCLUSIONS: This sample of adolescents found clinician testing for HPV to be more acceptable than self testing and preferred clinician to self testing. If self testing for HPV is offered in the future, clinicians should not assume that adolescent patients will prefer self testing. Instead, they should educate adolescents about available testing options and discuss any concerns regarding self collection technique or accuracy of test results.

Adolescent↗