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PubMedDate not supplied

Patterns of outcome measurement in Parkinson's disease clinical trials.

The study examines the pattern of use and clinimetric properties of clinical endpoints used in randomized trials for Parkinson's disease (PD). Randomized drug trials for PD were identified through a Medline search conducted from January 1966 until August 1998. The endpoints used in these trials were abstracted. Reports examining the clinimetric properties of the disease-specific scales used in these trials were also abstracted. Data regarding the consistency, accuracy, discrimination and feasibility of scales used in at least 10% of trials were determined. One hundred and thirty-seven articles met the inclusion criteria; 70.8% of trials used some clinical scale for PD as an endpoint. The Unified Parkinson's Disease Rating Scale (UPDRS) was the most commonly used scale (32.8%). Factors independently associated with the use of the UPDRS included: the study location in the US, mean age of subjects over 62.7 years and publication after 1994. The UPDRS was more thoroughly studied and superior in most clinimetric domains compared to scales developed earlier. Few studies included generic health status (2.9%) or cognitive measures (16.8%) as secondary endpoints. There have been definite improvements in the area of disease-specific measurement in PD trials since the introduction of the UPDRS. The results of studies that used instruments with poor or unreported clinimetric properties should be critically interpreted.

Aged↗
PubMed1992

Case management, quality of life, and satisfaction with services of long-term psychiatric patients.

Two scales developed in Great Britain, the QOL Profile and the General Satisfaction Questionnaire, were used to examine the relationship between type of case management services and quality of life and satisfaction with treatment of 68 long-term psychiatric patients in Colorado. Factor analysis identified three types of case management activities that tended to occur together: assertive outreach (direct help, out-of-office visits, and monitoring), brokerage (referral to other agencies), and counseling and assessment. Monitoring was the only variable positively associated with quality of life for all patients; brokerage was the only variable negatively associated with acceptability of services. The number of case management contacts was negatively associated with treatment satisfaction.

Adult↗
PubMed2001

Spiritual perception, attitudes about spiritual care, and spiritual care practices among nurse practitioners.

The purpose of the nonexperimental study was to examine the relationships among spiritual perception, attitudes about spiritual care, and spiritual care practices in nurse practitioners. Attitudes about providing spiritual care and spiritual care practices have been studied among nurse generalists, but little research has been conducted on nurses in advanced practice. All nurse practitioners registered by the state of Indiana were sent Reed's Spiritual Perspective Scale (SPS) and a modified version of the Nurses' Spiritual Care Perspectives Scale developed by Taylor, Highfield, and Amenta. Pearson correlation techniques were used to test for significant relationships. Statistically positive relationships were between perception of personal spirituality and 9 of the 12 spiritual care practices. Eight of the 13 items describing attitude toward providing spiritual care were statistically significant with the SPS. Implications of the findings are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

The association of physician attitudes about uncertainty and risk taking with resource use in a Medicare HMO.

PURPOSE: To explore the association between the attitudes of primary care physicians toward uncertainty and risk taking, as measured by a validated survey, with resource use in a Medicare HMO. DESIGN: All primary-care internists (n=20) in a large, multi-specialty clinic were surveyed to measure their attitudes about uncertainty and risk taking using three previously developed scales. Results were linked with administrative data for 792 consecutive patients in a recently created Medicare HMO. The patients' index visits occurred between April 1, 1995, and November 30, 1995. ANALYSIS: Charges stemming from several claim types (primary care and subspecialty physician, laboratory, radiology, and ambulatory procedures) in the 30 days following the index visit were summed. The physician scales were dichotomized at the median to seek unadjusted associations with charges. Generalized estimation equations were used to account for the correlation of charges resulting from patients' being nested within physicians and adjusted for physician characteristics (age, sex, years in practice) and patient characteristics (age, sex, comorbidity). MAIN RESULTS: The physician response rate was 90%. Most physicians (90%) were male. The mean age of the patients was 74 years, and 69% were female. The mean cost (+/-SD) per patient was $621.61+/-1,737.31. From the unadjusted analysis, high "anxiety due to uncertainty" was associated with higher patient charges ($197.85 vs $158.21, p=0.01). From the multivariable analysis, each standard deviation increase in "anxiety due to uncertainty" (3.5 points) corresponded to a 17% increase in mean charges (p < 0.01) and each similar increase in "reluctance to disclose uncertainty to patients" (1.92 points) corresponded to a 12% increase (p=0.03). However, increasing "reluctance to disclose mistakes to physicians" and increasing physician risk-taking propensity were associated with decreased total charges [-10% per standard deviation (1.34 points), p=0.02, and -8% per standard deviation (3.26 points), p=0.02, respectively]. CONCLUSION: Physician attitudes toward uncertainty were significantly associated with patient charges. Further investigation may improve prediction of patient-care charges, offer insight into the medical decision-making process, and perhaps clarify the relationship between cost, uncertainty, and quality of care.

Aged↗
PubMedDate not supplied

Arthroscopic treatment of lateral meniscal cysts using an outside-in technique.

This paper describes 19 cases of lateral meniscal cysts treated arthroscopically using an outside-in technique. In all patients, a horizontal or radial lesion (or both) of the meniscus was present. After the meniscal lesion was arthroscopically removed, the cyst was decompressed both from inside and percutaneously from outside with a motorized instrument introduced through a transmeniscal approach. The follow-up ranged from 2 to 5 years with an average of 3.3 years. On the basis of the evaluation scale developed by Cerullo et al. (1991), the results were rated excellent or good in 17 patients and fair in 2. No patient had cyst recurrence. The computed tomography follow-up examination, done in 10 of the 19 patients after an average of 3 years, showed a good remodeling of the meniscus. One of the two patients with a fair result had hypermobility of the posterior horn of the lateral meniscus due to the resection of the meniscal tissue overlying the popliteus tendon, whereas the other had pain and patellar crepitation owing to a preexisting patellofemoral abnormality.

Adult↗
PubMedDate not supplied

Deltoid and syndesmosis ligament injury of the ankle without fracture.

Ankle diastasis without fracture is a rare injury with few examples reported. We report on four male patients, aged 16 to 18 years, who sustained this injury playing football. Swelling and tenderness over both the deltoid and syndesmosis ligaments are the most common physical findings. Plain ankle radiographs demonstrated lateral talus subluxation in three patients, and a stress radiograph demonstrated subluxation of the talus in one patient. Treatment consisted of reduction and fixation of the syndesmosis with a screw followed by 6 weeks of cast immobilization. Using the scale developed by Edwards and DeLee, three patients had excellent results and one had a good result. Diagnosis of tears of the deltoid and syndesmosis ligaments without fracture requires a high index of suspicion on the physician's part. In patients whose mortise is more than 1 mm subluxated, reduction and screw fixation will produce good results.

Adolescent↗
PubMed1992

[Community services and quality of life: a study of the impact in a remote region].

This longitudinal study with a matched comparison group was conducted in Abitibi, an area in North-West Quebec. Its goal was to observe the impact of community support services on the quality of life of long term psychiatric patients living in a remote area. A cohort of 47 subjects, living in a small town with a comprehensive network of community support services, was compared with a similar group living in a neighbouring city with only outpatient services. The satisfaction with life domains scale developed by Andrews and Withey and adapted by Baker and Intagliata was used at four times during the study. According to the results, the subjective perception of the quality of life in the two groups is comparable, even though the objective conditions are less favorable for the group participating in the community support program. The highest ratings were given to the place of residence, the neighborhood and its commodities; the lowest ratings were given to their love life and financial situation. One can observe a stability of the measures of quality of life over time and for the two groups. The perceptions of the sample living in a remote area are much more favorable than the ones of a comparable group living in the Montreal area. These results are discussed in a double perspective: the role of community support services in the daily life of people who are having severe and persistent problems of mental health, and the interest of measures of quality of life.

Adult↗
PubMedDate not supplied

More than just menstrual cramps: symptoms and uncertainty among women with endometriosis.

OBJECTIVE: To examine the frequency, severity, interference with daily life, and symptom distress associated with endometriosis and to explore the relationships among symptoms, emotional distress, uncertainty, and preference for and adequacy of information. DESIGN: A descriptive, cross-sectional correlational study. SETTING: Data were collected at a conference of the Endometriosis Association in Milwaukee, Wisconsin. PARTICIPANTS: A convenience sample of 298 women attending an educational program. MAIN OUTCOME MEASURES: Endometriosis symptoms and symptom distress, emotional distress, and adequacy of information were assessed using author-developed scales. Preference for information was measured by a revision of the Krantz Health Opinion Survey Information Subscale. Uncertainty was assessed using the Mishel Uncertainty in Illness Scale-Community Form. RESULTS: Women experienced multiple symptoms associated with varying levels of distress, including symptoms not typically associated with endometriosis. Participants sought out information but were undecided about whether they had sufficient information about the disease. Uncertainty about endometriosis was relatively high and associated with emotional distress and lack of information about the disease. CONCLUSIONS: Reported symptoms demonstrate the complexity and impact of endometriosis. Women's preference for information and experience of emotional distress and uncertainty suggest the need for information and support. Prospective, controlled studies on the impact of endometriosis and interventions to inform and support patients are needed.

Activities of Daily Living↗
PubMed1996

The effects of in-hospital lactation education on breastfeeding practice.

The effectiveness of an in-hospital lactation education session on breastfeeding duration and satisfaction among postpartum women was investigated. In equal number, a total of 150 women were randomly assigned to a standardized curriculum (experimental group) or a routine-care control group. No differences were found between the groups regarding breastfeeding duration, mother's satisfaction level, or her perceived support. Item-scale analyses, however, were promising (alpha = 0.77) and a preliminary factor analysis suggested three underlying subscales: professional encouragement, satisfaction, and familial relationships. Based on a stepwise, multiple regression analysis three variables were related to length of breastfeeding experience, that is, level of satisfaction, educational level of the mother, and expected length of breastfeeding. Implications of these results toward lactation education programs and further scale development are discussed.

Adult↗
PubMed2007

Three methods of assessing values for advance care planning: comparing persons with and without dementia.

Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools-open-ended, forced-choice, and rating scale questions-and named a preferred surrogate decision maker. Responses to forced-choice items were examined at 9-month retest. Adults with and without dementia appeared equally able to respond meaningfully to questions about values regarding quality of life and health care decisions. People with dementia were generally as able as controls to respond consistently after 9 months. Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able.

Advance Care Planning↗
PubMed1994

Stressors associated with coronary bypass surgery.

The purpose of this investigation was to attempt to replicate the findings of a study by Carr and Powers (1986) which examined differences between patient and nurse perceptions of the severity of stressfulness associated with hospital- and illness-related stressors. The samples consisted of 24 patients who experienced coronary bypass surgery and 24 nurses who cared for them during their hospitalization. All participants responded to the Stressor Scale developed by Carr and Powers (1986) specifically for patients undergoing coronary bypass surgery. Findings indicated that the major findings of the original study were replicated. Three one-way analysis of variance statistical procedures indicated that cardiothoracic nurses rated all stressors and hospital-related and illness-related stressors as statistically significantly more stressful for coronary bypass patients than did the patients themselves.

Adult↗
PubMed1997

Depression, coping and level of neurological impairment in multiple sclerosis.

This study examined the relationship between coping and depression in multiple sclerosis patients, and how that relationship varies at different levels of physical impairment. One-hundred and one patients with clinically definite MS were assessed using the Kurtzke Expanded Disability Status Scale (EDSS), the Ways of Coping Inventory (WCI) with three sub-scales developed by Wineman et al, and the Beck Depression Inventory (BDI). Depression was significantly higher at more advanced levels of neurologic impairment than at lower levels. Escape-Avoidance and Emotional Respite were positively related to level of depression. Planful Problem-Solving and Cognitive Reframing were negatively related to depression. An interaction between coping, depression, and level of neurologic impairment was observed in which Planful Problem-Solving and Cognitive Reframing were more strongly related to depression at higher levels of impairment. The interaction effect for Escape-Avoidance and Emotional Respite with depression and level of impairment did not reach significance. It was concluded that there is a significant interaction between level of neurologic impairment, coping behaviors, and depression in patients with MS.

Adaptation, Psychological↗
PubMed2002

The influence of social support on breast cancer screening in a multicultural community sample.

PURPOSE/OBJECTIVES: To examine the relationship between women's reported social support and their adherence to recommended breast cancer screening guidelines. DESIGN: Descriptive, cross-sectional survey. SETTING: Community women's organizations throughout the San Francisco Bay Area. SAMPLE: 833 mostly low-income women with a mean age of 46.2 years from three racial or ethnic groups (i.e., Latina, Caucasian, and African American) who were not breast cancer survivors. METHODS: Social support was measured with a five-item, four-point, Likert scale developed for the study (Cronbach's alpha = 0.7248). Adherence to screening guidelines was measured by asking frequency of performing breast self-examination (BSE) and frequency of obtaining a clinical breast examination (CBE) and a mammogram. Research assistants and leaders of women's organizations conducted the survey in work and community settings. MAIN RESEARCH VARIABLES: Social support, performance of BSE, obtaining a CBE and a mammogram, income, education, spoken language, and level of acculturation. FINDINGS: Higher levels of social support were related to higher income and higher education. Lower levels of social support were associated with being Latina, completing the survey in Spanish, and being born abroad. Women who did not adhere to screening guidelines (for BSE or CBE) reported less social support. CONCLUSIONS: Social support is associated with adherence to breast cancer screening guidelines. IMPLICATIONS FOR NURSING: Nurses should assess women's levels of social support as a factor when evaluating adherence to breast cancer screening guidelines.

Adult↗
PubMed2002

Prediction of outcome of physiotherapy in advanced Parkinson's disease.

OBJECTIVE: Prediction of the effect of a home physiotherapy intervention on the basis of four clinical characteristics of patients with advanced Parkinson's disease. DESIGN: A repeated measures design comparing six weeks without treatment with six weeks of physiotherapy and a follow-up of 12 weeks. SUBJECTS: Persons with Parkinson's disease without dementia and suffering from considerable functional disability. INTERVENTION: Community physiotherapists treated patients in the home situation three times a week teaching cueing and conscious movement control for walking and carrying out transfers in and out of beds and chairs. MAIN OUTCOME MEASURES: Mental status, disease severity, age and mood were included as predictor variables. A new functional scale developed as part of a previous study was used as the dependent variable administered in both the hospital and the home to determine whether the outcome generalized from the learning to a different environment. RESULTS: Only disease severity was a negative predictor of treatment outcome at home. In the hospital setting none of the factors predicted the immediate effect of treatment but cognitive ability and age were determinants of whether the treatment effects were maintained in the long term. CONCLUSIONS: Using cueing and cognitive strategies benefited younger and older patients with Parkinson's disease alike. However, the findings indicate targeting of treatment at patients with milder disease severity and providing follow-up treatment for older and cognitively less able patients.

Age Factors↗
PubMed2004

Student nurse attitudes towards homeless clients: a challenge for education and practice.

The purpose of this research was to describe attitudes of nursing students (and paramedic officers) towards marginalized clients. Convenience quota sampling in a major health faculty was employed. Students participated on a voluntary basis. A 58-item Likert scale, developed by the authors, assessed the student nurses' attitudes. In general, attitudes towards homeless clients were neutral; detailed analyses, however, revealed that student nurses would decline to care for homeless clients in various situations. Personal experience with homeless patients and positive attitudes of nurses significantly contributed to increased quality of care and equality of treatment for homeless clients. Certain student nurse behaviors warrant immediate attention to prevent marginalized patients from being exposed to unfair, inaccessible and biased nursing care. Based on our results, we recommend that further research attention be paid to the role of ethics education and faculty behaviors, as faculty members serve as role models for professionalization.

Adult↗
PubMed1997

Subjective memory complaints in the elderly: depressive symptoms and future dementia.

BACKGROUND: Population studies indicate that subjective memory complaints by elderly people are correlated with cognitive performance. These complaints have some predictive power regarding the development of dementia. The present study attempted to replicate this finding, and investigated which variables determine subjective memory complaints. METHOD: Participants in the Amsterdam Study of the Elderly (n = 2114; 65-84 years of age), who were not demented and had a normal MMSE score (> 23) at baseline, were re-examined after four years. Subjective complaints were measured using a previously developed scale. Dementia and depression were measured using the Geriatric Mental State Schedule (GMS). Premorbid intelligence was measured by the Dutch Adult Reading Test (DART). RESULTS: Memory complaints at baseline contributed a small but significant amount of diagnostic information with respect to the prediction of future dementia. Depressive symptoms at baseline had no predictive value when these memory complaints were accounted for. Subjective memory complaints were associated with depression, baseline MMSE score, and premorbid intelligence. CONCLUSIONS: Subjective memory complaints are not just secondary to depression, but in part reflect realistic self-observations of cognitive decline.

Aged↗
PubMed2001

Early increases in brain myo-inositol measured by proton magnetic resonance spectroscopy in term infants with neonatal encephalopathy.

Our aim was to assess brain myo-inositol/creatine plus phosphocreatine (Cr) in the first week in term infants with neonatal encephalopathy using localized short echo time proton magnetic resonance spectroscopy and to relate this to measures of brain injury, specifically lactate/Cr in the first week, basal ganglia changes on magnetic resonance imaging (MRI), and neurodevelopmental outcome at 1 y. Fourteen term infants with neonatal encephalopathy of gestational age (mean +/- SD) 39.6 +/- 1.6 wk, birth weight 3270 +/- 490 g, underwent MRI and magnetic resonance spectroscopy at 3.5 +/- 2.1 d. Five infants were entered in a pilot study of treatment with moderate whole-body hypothermia for neonatal encephalopathy; two were being cooled at the time of the scan. T(1)- and T(2)-weighted transverse magnetic resonance images were graded as normal or abnormal according to the presence or absence of the normal signal intensity of the posterior limb of the internal capsule and signal intensity changes in the basal ganglia. Localized proton magnetic resonance spectroscopy data were obtained from an 8-cm(3) voxel in the basal ganglia using echo times of 40 and 270 ms, and the peak area ratios of myo-inositol/Cr and lactate/Cr were measured. Outcome was scored using Griffith's development scales and neurodevelopmental examination at 1 y. MRI and outcome were normal in six infants and abnormal in eight. myo-Inositol/Cr and lactate/Cr were higher in infants with abnormal MRI and outcome (p < 0.01, p < 0.01, respectively). myo-Inositol/Cr and lactate/Cr were correlated (p < 0.01) and were both correlated to the Griffith's developmental scales (p < 0.01, p < 0.01, respectively). In conclusion, these preliminary data suggest that early increases in brain basal ganglia myo-inositol/Cr in infants with neonatal encephalopathy are associated with increased lactate/Cr, MRI changes of severe injury, and a poor neurodevelopmental outcome at 1 y.

Apgar Score↗