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PubMed2001

Physicians' attitudes toward litigation and defensive practice: development of a scale.

The authors' threefold purpose in this article was to (a) propose a model of the relationship between the emotional aspects of physicians' attitudes to medical errors (e.g., fear of litigation) and their functional consequences (e.g., tendency to defensive practice); (b) develop a measure of some of these attitudes; and (c) provide empirical support for some of the relationships in the model. Medical students and physicians responded to a questionnaire concerning their attitudes toward uncertainty and medical error. The dependent variables were two dimensions of attitudes to uncertainty ("reluctance to disclose uncertainty" and "stress from uncertainty") and four dimensions of attitudes to medical error ("fear of litigation," "support for self-regulation," "tendency to defensive practice," and "self-disclosure of errors"). Stress from uncertainty correlated with fear of malpractice litigation and defensive practice. They concluded that interventions that aim to increase physicians' tolerance of uncertainty may also reduce their fear of malpractice litigation and their tendency to defensive practice.

Attitude↗
PubMedDate not supplied

Relating quality of center-based child care to early cognitive and language development longitudinally.

How quality of center-based child care relates to early cognitive and language development was examined longitudinally from 6 to 36 months of age in a sample of 89 African American children. Both structural and process measures of quality of child care were collected through observation of the infant classroom. Results indicated that higher quality child care was related to higher measures of cognitive development (Bayley Scales of Infant Development), language development (Sequenced Inventory of Communication Development), and communication skills (Communication and Symbolic Behavior Scales) across time, even after adjusting for selected child and family characteristics. In addition, classrooms that met professional recommendations regarding child:adult ratios tended to have children with better language skills. Classrooms that met recommendations regarding teacher education tended to have girls with better cognitive and receptive language skills. These findings, in conjunction with the growing child-care literature, provide further evidence that researchers and policymakers should strive to improve the quality of child care to enhance early development of such vulnerable children.

Age Factors↗
PubMed2000

Development of a scale for measuring invasive plant environmentalism.

The ecological impact of invasive plant species is a serious concern among environmental scientists and conservationists. Educating the public about invasive plant issues is a major hurdle, given that several invaders come into the environment through ornamental gardening. An important first step in planning an educational program concerning invasive plant issues is to assess public knowledge and attitudes concerning these issues. This paper describes the development of an instrument that measures invasive plant environmentalism. Responses from 237 nursery customers from the southeastern U.S. to a 17-item standardized interview were scaled using the partial credit model, a member of the family of Rasch (1960) measurement models. Our results indicate that the instrument adequately measures this construct. Substantive interpretations of the results are also discussed.

Attitude↗
PubMed1994

Development and evaluation of an inventory for rating client satisfaction with outcome in HIV counseling: the Albion Center scale.

We developed an inventory for rating client satisfaction with outcome in HIV counseling, based on interview responses with clients. The resulting 19-item scale was subject to factor analysis and four factors, accounting for 56% of the variance, emerged. The factors described dimensions of Perception of progress and improved mood; Recognition of a specific need for counseling; Behavior change from counseling; and Counseling climate. Factor-scored scales were significantly associated with time in counseling and for the Specific need for counseling scale, HIV-seropositive respondents had a significantly higher score. Scale reliabilities (Cronbach's alpha) were between 0.85 and 0.50. Concurrent administration with the Counseling Evaluation Inventory indicated that there were significant correlations between the two scales.

Adult↗
PubMedDate not supplied

Development of a health attitude scale.

A tool was developed to assess attitudes of patients with cardiac disease toward performing prescribed behaviors of their medical regimen. Two groups of subjects with heart disease were used to examine validity and reliability of the Miller Attitude Scale. One group included 480 members of Mended Hearts, Inc., and the second group consisted of 35 patients diagnosed with a first myocardial infarction. The second group repeated the attitude scale six months post-hospitalization. Performance of the medical regimen by this group was verified at the six-month follow-up period. Using Spearman Rank Correlation, there was a significant relationship between attitudes and adherence behaviors for three of the five subscales. Alpha reliabilities revealed a high degree of internal consistency of scale items for all five subscales when testing both groups. A factor analysis resulted in eight factors accounting for the majority of the variance. Each of the five behaviors of the medical regimen clearly defined a factor supporting used of the Miller Attitude Scale for assessing attitudes of heart patients toward behaviors of their medical regimen.

Attitude to Health↗
PubMed1998

Measuring lay people's perceptions of the quality of primary health care services in developing countries. Validation of a 20-item scale.

INTRODUCTION: Methodologies that have been developed and validated in accordance with accepted scientific standards are needed to monitor and assess the quality of primary health care in developing countries. OBJECTIVE: To present the results of reliability and validity testing of a new instrument of measurement intended to document the user's opinion on the quality of primary health care services. METHODS: The 20-item scale includes three subscales related to health care delivery personnel and facilities. There were 241 people in one city and two villages in Upper Guinea who responded to the questionnaire. An item analysis preceded the test of psychometric properties of the three subscales and of the total score. Reliability was estimated by analyses of internal consistency and the Cronbach's alpha coefficient. A variety of statistical procedures were used to test factorial validity, trait validity (convergent and discriminant) and nomological validity. RESULTS: The reliability of the subscales ranged from 0.71 to 0.88. The validity analyses supported the initial dimensionality and suggested good construct validity. CONCLUSION: Results confirm the value of the use of the scale developed and highlight the need to take into account the diversity of how quality is perceived by lay people in developing countries. It is suggested that the process of formalization of this type of measurement scale be pursued.

Adult↗
PubMed2004

Prediction of clinical pharmacokinetic parameters of linezolid using animal data by allometric scaling: applicability for the development of novel oxazolidinones.

1. Allometric scaling has previously been used as an effective tool for the prediction of human pharmacokinetic data. The pharmacokinetic data for linezolid, a novel oxazolidinone to treat Gram-positive pathogens, in mice, rats and dogs were subjected to simple allometric scaling. Generated allometric equations for parameters such as clearance (CL), volume of distribution (Vss) and elimination rate constant (K10) were used to predict human pharmacokinetic parameters including elimination half-lives. In addition, the human plasma concentration-time curve was simulated using a one-compartmental model. 2. Application of simple allometry (Y = aWb) for animal parameters such as CL, Vss, and K10 showed excellent allometric fit (r > or = 0.98). The allometric equations for CL, Vss, and K10 were -0.5465W(0.6595), -0.1369W(0.9246), and -0.4117W(-0.3139), respectively. The confidence in predictability of CL and Vss parameters was particularly high since the allometric exponents of CL and Vss almost approached the suggested values of 0.75 and 1.00, respectively. 3. Animal pharmacokinetic parameters generated in the present authors' laboratories for linezolid were in close agreement with reported literature values. The predicted human values for CL (4.68 l h(-1)), Vss (37.07 litres), and K10 (0.10 h(-1)) were within the range observed for linezolid in the literature (CL = 4-10.5 l h(-1); Vss = 21-53 litres; K10 = 0.09-0.3 h(-1)). The human half-life (t(1/2)) predicted using allometry (6.9 h) was similar to reported values in humans of 5 h. In summary, the retrospective analysis for linezolid suggests that allometric scaling can be used as a prospective tool for predicting human pharmacokinetic parameters of novel oxazolidinones.

Acetamides↗
PubMed2004

Development and validation of a scale for rating motor compensations used for reaching in patients with hemiparesis: the reaching performance scale.

BACKGROUND AND PURPOSE: Recent movement analysis studies have described compensatory movement strategies used by people with hemiparesis secondary to stroke during reaching and grasping tasks. The purpose of this article is to describe the development of a new scale--the Reaching Performance Scale (RPS)--for assessing compensatory movements for upper-extremity reaching in people with hemiparesis secondary to stroke. SUBJECTS: Twenty-eight individuals with hemiparesis, with a mean age of 54.9 years (SD=18.6), participated. METHODS: The study design involved scale development with expert panels and criterion standards for validity. Participants were evaluated on the new scale as well as other clinical tests for validity. They were videotaped while performing reaching and grasping movements. RESULTS: The RPS scores correlated with measurements of grip force and Chedoke-McMaster Stroke Assessment and Upper Extremity Performance Test for the Elderly (TEMPA) scores. The RPS discriminated patients with different impairment levels according to the Chedoke-McMaster Stroke Assessment. Preliminary intrarater and interrater reliability coefficients were acceptable for the whole scale. Mean kappa values on individual scale components for 3 raters represented a mean of 67% (SD=13.5%) agreement. DISCUSSION AND CONCLUSION: Although the RPS shows some types of validity, more rigorous tests of reliability are needed for meaningful conclusions. This study is a first step in validating the scale to assess efficacy of intervention for motor recovery of the arm.

Adult↗
PubMed2004

Ideals of patient autonomy in clinical decision making: a study on the development of a scale to assess patients' and physicians' views.

OBJECTIVES: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy. METHODS: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability. RESULTS: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure. DISCUSSION: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles.

Attitude of Health Personnel↗
PubMed1989

Development of diabetes attitude scale for health-care professionals.

This article describes the development of a diabetes attitude scale (DAS) that was designed to measure the attitudes of health-care professionals (HCPs). The DAS was developed through the efforts of a national panel of diabetes experts. The panel developed a 60-item scale that was pilot tested and reduced to a 50-item scale. The 50-item scale was then mailed to a national sample of HCPs with an interest in diabetes. The surveys were returned by 633 nurses, 322 dietitians, 116 physicians, and 67 others totaling 1138 returns (a return rate of 54%). The returned surveys were analyzed, and a 31-item DAS composed of 8 subscales resulted. Evidence for the reliability and validity of the 31-item DAS along with the instrument itself are included in this study.

Attitude of Health Personnel↗
PubMedDate not supplied

On quitting smoking: development of two scales measuring the use of self-change strategies in current and former smokers (SCS-CS and SCS-FS).

Smoking-cessation advice may be more effective and acceptable if it is based on strategies used by people who quit smoking on their own. The objective of this study was to identify these self-change strategies and to develop and validate questionnaires measuring the frequency of their use in current and former smokers. Development of questionnaire items was based on qualitative data provided by 120 current and former smokers, and the validation study was conducted by mail in 638 smokers and ex-smokers in Geneva, Switzerland, from 1996 to 1998. We identified 5 distinct and interpretable self-change strategies in current smokers and 5 strategies in former smokers, and measured their frequency of use with a 19-item questionnaire in current smoker (SCS-CS) and with a 17 item questionnaire in former smokers (SCS-FS). Eight items and 2 strategies were common to both current and former smokers. the scales fulfilled criteria of test-retest reliability, and content, construct, and predictive validity. Participants who quit smoking between the baseline survey and the 1-month follow-up had higher baseline scores for all self-change strategies (+0.65 to +1.16 standard deviation units) than participants who remained smokers at follow-up. These scales may be used to describe and understand the processes of smoking cessation and relapse, as well as to produce input data for computer systems which produce individually-tailored smoking cessation advice.

Adolescent↗
PubMed2004

Nutrient removal process development and full scale implementation at the 4 million p.e. main treatment plant of Vienna, Austria.

The Main Treatment Plant of Vienna is in extension for 4 million p.e. and very stringent nutrient removal requirements. The existing high rate BOD removal activated sludge plant (in operation since 1980) is extended by a second stage activated sludge plant and a newly developed flow scheme for nitrogen removal optimisation adaptable to the temperature variations over the year. For this plant pilot investigations have been performed for the development of a specific mathematical model (ASMV) and a specific aeration control strategy. The civil work of the extension is already finished and the installation of the equipment has started. Operation should start in 2004. The whole project will cost about [see symbol in text]264 million of which about one half is for civil work. The effluent standards correspond to the requirements for sensitive areas in EU Directive for Municipal Waste Water. The raw primary and excess sludge are incinerated after thickening and dewatering. This paper tries to condense the already existing literature with the construction progress and the cost situation.

Austria↗
PubMedDate not supplied

Design and development of a scale measuring fear of complications in type 1 diabetes.

BACKGROUND: There are many determinants of glycaemic control in patients with type 1 diabetes. Patients with type 1 diabetes and poor glycaemic control have been reported as being more likely to have a greater fear of hypoglycaemia. The relationship between fear of diabetes-related complications and glycaemic control is unclear, and therefore a brief measure of fear of diabetes complications was developed. METHODS: A questionnaire was designed, comprising items relating to general fears, specific fears (e.g. blindness, kidney problems, heart disease), lifestyle fears, fear of hypoglycaemia and weight gain. The questionnaire was piloted on 147 outpatients with type 1 diabetes, along with other measures such as the Hypoglycaemia Fear Survey, the Hospital Anxiety and Depression Scales, the Coping with Health, Injuries and Problems Scale and the Eysenck Personality Questionnaire. RESULTS: Factor analysis was carried out on the 30 items and, after rotation, 15 emerged as loading heavily on the first factor. Factor analysis was rerun on these 15 items and the first factor accounted for 56% of the total variance. This factor remained invariant when the scale was split randomly and by age and gender. The reliability of the scale (alpha) was 0.94. The scale did not correlate with any demographic variables but did with measures of negative affectivity (HADS anxiety = 0.34, p < 0.001; Depression = 0.24, p < 0.004), the Hypoglycaemia fear survey worry Scale (0.44, p < 0.001), presence of complications (0.17, p < 0.04) and number of complications (0.28, p < 0.001). CONCLUSIONS: These results indicate that the scale identifies a fear that is moderately related to the presence of complications and general negative affectivity but which is a uniquely diabetes-related emotion.

Adolescent↗
PubMed1978

A further look at the Institutionalized Chronic Alcoholic Scale.

Investigated a newly developed MMPI scale--the Institutionalized Chronic Alcohol Scale (ICAS)--designed to separate alcoholics from neurotics. With a sample of 75 alcoholic and 50 neurotic male Veterans Administration Hospital inpatients, the ICAS was found to separate the two groups, correctly identifying 78%, but was slightly less effective than two other previously used alcoholism scales by MacAndrew (Amac) and Holmes (Am). Data from 30 male Veterans Administration Hospital heroin addicts lend some support to the statement, which appears in the original article, that the ICAS should not be used to distinguish between alcoholics and people other than neurotics.

Adult↗
PubMed1986

Development of a patient satisfaction scale.

Three studies to develop and test an instrument to measure hospitalized patients' satisfaction with nursing care are reported. Content validation procedures involved both clinicians and patients (N = 75). An inverse relationship of satisfaction scores to negative mood states demonstrated evidence of construct validity. Factor analytic procedures (N = 664) failed to confirm the existence of the subscales initially conceptualized for this instrument and others in common use. Three new factors were identified: dissatisfaction, interpersonal support, and good impression. The dissatisfaction subscale explained 73.6% of the variance and had a high internal consistency (alpha = .91); the reliability coefficients of the other subscales also were high (alpha = .92 and .89). Reliability coefficients for the total instrument in successive testings were .92 (N = 100) and .95 (N = 533).

Adolescent↗
PubMed1996

Development and testing of the symptom experience scale.

The Symptom Experience Scale (SES) was designed to measure women's experience of symptoms associated with treatment for breast cancer. The SES, a modification of McCorkle's Symptom Distress Scale, was developed and tested in a sample of 252 women with breast cancer. Exploratory factor analysis yielded six factors, which used all 24 SES items and accounted for 83.2% of the variance. The factors were nausea and appetite, fatigue and sleep, concentration, appearance, bowel pattern, and pain. Cronbach's alpha internal consistency reliability coefficients ranged from 0.92 to 0.96; the alpha for the total SES was 0.94. Subscale to subscale correlations ranged from 0.21 to 0.56. Additional research is recommended with samples large enough to permit confirmatory factor analysis and determine the stability of the factor structure identified in the present study. Additional research also is recommended to determine the applicability of the SES for men and women of diverse ethnic groups with various types of cancer and other chronic illnesses.

Adult↗
PubMed1992

Measurement of severity for nonhospitalized injuries in the pediatric age group.

To better classify minor injuries in the pediatric outpatient population, we empirically developed a scale to predict functional impairment, one week and one month postinjury, based on data available at the time of care. A sample of 857 injured children aged five to 19 years was randomly split into two subsamples. Using logistic regression techniques, predictive models were developed and confirmed on the subsamples and then applied to the full sample. Age, location of injury, and type of injury were predictive of impairment one week post-injury; however, type of injury was the only consistently significant predictor. Type of injury, specifically fracture, dislocation, and sprain, and location of injury (lower extremity) were significant predictors of functional impairment one month postinjury; however, once again, the type of injury was the only variable consistently significant across all models. Other than the type of injury, the variables available at the time of care were too uniform between disabled and nondisabled patients to be useful in developing a severity scale for minor injuries. We conclude that other outcome measurements or scale development techniques should be explored to develop a useful classification scheme for minor injuries.

Adolescent↗