1
|
Sutcliffe S, Falke C, Fok CS, Griffith JW, Harlow BL, Kenton KA, Lewis CE, Low LK, Lowder JL, Lukacz ES, Markland AD, McGwin G, Meister MR, Mueller ER, Newman DK, Pakpahan R, Rickey LM, Rockwood T, Simon MA, Smith AR, Rudser KD, Smith AL. Lower Urinary Tract Symptoms in US Women: Contemporary Prevalence Estimates from the RISE FOR HEALTH Study. J Urol 2024:101097JU0000000000004009. [PMID: 38703067 DOI: 10.1097/ju.0000000000004009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND To estimate the prevalence of a wide range of lower urinary tract symptoms (LUTS) in US women, and to explore associations with bother and discussion with healthcare providers, friends, and family. MATERIALS AND METHODS We analyzed baseline data collected from 5/2022-12/2023 in the RISE FOR HEALTH study-a large, regionally-representative cohort study of adult female community members. LUTS and related bother were measured by the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index and discussion was assessed by a study-specific item. RESULTS Of the 3000 eligible participants, 73% (95% confidence interval [CI] = 71-74%) reported any storage symptoms, 52% (95% CI = 50-53) any voiding or emptying symptoms, and 11% (95% CI = 10-13%) any pain with bladder filling, for an overall LUTS prevalence of 79% (95% CI = 78-81%). This prevalence estimate included 43% (95% CI = 41-45%) of participants with mild-to-moderate symptoms and 37% (95% CI = 35-38%) with moderate-to-severe symptoms. Over one-third of participants reported LUTS-related bother (38%, 95% CI = 36-39%) and discussion (38%, 95% CI = 36-40%), whereas only 7.1% (95% CI = 6.2-8.1%) reported treatment. Urgency and incontinence (including urgency and stress incontinence) were associated with the greatest likelihood of bother and/or discussion (adjusted prevalence ratios = 1.3-2.3), even at mild-to-moderate levels. They were also the most commonly treated LUTS. CONCLUSIONS LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the RISE study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and bother of LUTS.
Collapse
Affiliation(s)
- Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Chloe Falke
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota
| | - Cynthia S Fok
- Department of Urology and the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, Minnesota
| | - James W Griffith
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Bernard L Harlow
- Boston University School of Public Health, Boston, Massachusetts
| | - Kimberly A Kenton
- Section of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lisa Kane Low
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Jerry L Lowder
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri
| | - Emily S Lukacz
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, and the Geriatric Research, Education, and Clinical Center at the Birmingham Veterans Affairs Health Care System, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Melanie R Meister
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of Kansas Medical Center, Kansas City, Kansas
| | - Elizabeth R Mueller
- Departments of Obstetrics and Gynecology, and Urology, Loyola University Medical Center, Loyola University Chicago, Chicago, Illinois
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ratna Pakpahan
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Leslie M Rickey
- Department of Urology and the Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Melissa A Simon
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Abigail R Smith
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kyle D Rudser
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| |
Collapse
|
2
|
Agel J, Ghimire U, Edwards NM, Nelson B, Rockwood T. An evaluation of the EASY instrument in a cross-sectional study. BMC Med Res Methodol 2024; 24:33. [PMID: 38341555 PMCID: PMC10858585 DOI: 10.1186/s12874-024-02158-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The purpose of this paper is to evaluate the impact of modifying the published scoring system to address identified potential weaknesses in the published scoring system for the Evaluation of Activity Surveys in Youth (EASY). A secondary purpose was to evaluate the EASY on children in Grades 1-5. The EASY is a self-report physical activity instrument for youth. METHODS Original EASY survey results were collected at one time point from an online panel from participants across the United States as part of a larger cross-sectional University of Minnesota project looking at children's specific activity and sports participation between June and August 2019. Data was evaluated using three common scoring methods: simple summation, mean, and transformed summation. Data was compared by Grades 1-5 and 6-8. RESULTS The summary statistics of the scores show that there is no statistically significant difference across the scoring methods by population. A paired t-test evaluation of the different scoring methods shows that while the scores are very similar within methodology (simple summation, mean, transformed sum) they are all statistically significantly different from one another, which demonstrates that for any given individual the specific scoring methodology used can result in meaningful differences. The transformed sum provided the strongest methodologic result. Analysis also concluded that administering the scale by proxy to children from grades 1-5 resulted in similar responses to those in Grades 6-8 broadening the appropriate populations able to use this scale. CONCLUSION The transformed sum is the preferred scoring method. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Julie Agel
- Department of Orthopedics, University of Minnesota, 2450 Riverside Ave, Minneapolis, Minnesota, USA.
| | - Umesh Ghimire
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, Minnesota, USA
| | - Nicholas M Edwards
- Department of Orthopedics, University of Minnesota, 2450 Riverside Ave, Minneapolis, Minnesota, USA
| | - Bradley Nelson
- Department of Orthopedics, University of Minnesota, 2450 Riverside Ave, Minneapolis, Minnesota, USA
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota School of Public Health, 420 Delaware St SE, Minneapolis, Minnesota, USA
| |
Collapse
|
3
|
Smith AL, Rudser K, Harlow BL, McGwin G, Barthold J, Brady SS, Brubaker L, Cunningham SD, Griffith JW, Kenton K, Klusaritz H, Lewis CE, Lukacz ES, Maki J, Markland AD, Mueller ER, Newman DK, Nodora J, Rickey LM, Rockwood T, Simon M, Wyman JF, Sutcliffe S. RISE FOR HEALTH: Rationale and protocol for a prospective cohort study of bladder health in women. Neurourol Urodyn 2023; 42:998-1010. [PMID: 36321762 PMCID: PMC10151425 DOI: 10.1002/nau.25074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium. METHODS AND RESULTS RISE is a population-based, multicenter, prospective longitudinal cohort study of community-dwelling, English- and Spanish-speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross-cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self-administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in-person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow-up is planned at 1 year. DISCUSSION Findings from RISE will begin to build the necessary evidence base to support much-needed, new bladder health promotion and LUTS prevention interventions in women.
Collapse
Affiliation(s)
- Ariana L. Smith
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Kyle Rudser
- University of Minnesota, Division of Biostatistics, Minneapolis, Minnesota, United States
| | - Bernard L Harlow
- Boston University School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Gerald McGwin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Julia Barthold
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Sonya S. Brady
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Linda Brubaker
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Shayna D. Cunningham
- University of Connecticut, School of Medicine, Department of Public Health Sciences, Farmington, Connecticut
| | - James W. Griffith
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois
| | - Kim Kenton
- Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Heather Klusaritz
- University of Pennsylvania, Perelman School of Medicine, Department of Family Medicine and Community Health, Philadelphia, Pennsylvania
| | - Cora E. Lewis
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Emily S. Lukacz
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Julia Maki
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri
| | - Alayne D. Markland
- University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama and Birmingham VA Medical Center Birmingham, Alabama
| | - Elizabeth R. Mueller
- Loyola University Chicago, Department of Obstetrics, Gynecology and Urology, Maywood, Illinois
| | - Diane K. Newman
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Jesse Nodora
- University of California San Diego, Herbert Wertheim School of Public Health & Human Longevity Science, La Jolla, California
| | | | - Todd Rockwood
- University of Minnesota, Division of Health Policy and Management, Minneapolis, Minnesota
| | - Melissa Simon
- Northwestern School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Jean F. Wyman
- University of Minnesota, School of Nursing, Minneapolis, Minnesota, United States
| | - Siobhan Sutcliffe
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri, United States
| |
Collapse
|
4
|
Rockwood T, Edwards NM, Nelson B, Agel J. Evaluating the Impact of Youth Early Sport Specialization on Injury: An Evolution in Measurement. Health Serv Res Manag Epidemiol 2023; 10:23333928231176207. [PMID: 37251699 PMCID: PMC10209588 DOI: 10.1177/23333928231176207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/31/2023] Open
Abstract
Objective To track youth sports participation and injury occurrence accurately and longitudinally. Results An online survey tool that captures sports participation, frequency, level of competition, and tracks injury occurrence has been developed. The survey allows for longitudinal tracking of sports participation to evaluate the change from recreational to highly specialized sports participation. To maximize the utility of this research tool we identified swimmer plots which allow for clear visualization of the data as the best method for graphical representation. Implication Longitudinal measurement of sports participation to evaluate the impact of early sports specialization on injury is feasible with this tool and enhanced by the swimmer plots for visualization.
Collapse
Affiliation(s)
- Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | | | - Bradley Nelson
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA
| | - Julie Agel
- Department of Orthopedics, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
Lukacz ES, Constantine ML, Kane Low L, Lowder JL, Markland AD, Mueller ER, Newman DK, Rickey LM, Rockwood T, Rudser K. Rationale and design of the validation of bladder health instrument for evaluation in women (VIEW) protocol. BMC Womens Health 2021; 21:18. [PMID: 33413284 PMCID: PMC7789348 DOI: 10.1186/s12905-020-01136-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/24/2020] [Indexed: 12/04/2022]
Abstract
Background Bladder health is an understudied state and difficult to measure due to lack of valid and reliable instruments. While condition specific questionnaires assess presence, severity and degree of bother from lower urinary tract symptoms, the absence of symptoms is insufficient to assume bladder health. This study describes the methodology used to validate a novel bladder health instrument to measure the spectrum of bladder health from very healthy to very unhealthy in population based and clinical research.
Methods Three samples of women are being recruited: a sample from a nationally representative general population and two locally recruited clinical center samples—women with a targeted range of symptom severity and type, and a postpartum group. The general population sample includes 694 women, 18 years or older, randomly selected from a US Postal delivery sequence file. Participants are randomly assigned to electronic or paper versions of the bladder health instrument along with a battery of criterion questionnaires and a demographic survey; followed by a retest or a two-day voiding symptom diary. A total of 354 women around 7 clinical centers are being recruited across a spectrum of self-reported symptoms and randomized to mode of completion. They complete the two-day voiding symptom diary as well as a one-day frequency volume diary prior to an in-person evaluation with a standardized cough stress test, non-invasive urine flowmetry, chemical urine analysis and post void residual measurement. Independent judge ratings of bladder health are obtained by interview with a qualified health care provider. A total of 154 postpartum women recruited around 6 of the centers are completing similar assessments within 6–12 weeks postpartum. Dimensional validity will be evaluated using factor analysis and principal components analysis with varimax rotation, and internal consistency with Cronbach’s alpha. Criterion validity will be assessed using multitrait-multimethod matrix including correlations across multiple data sources and multiple types of measures. Discussion We aim to validate a bladder health instrument to measure the degree of bladder health within the general population and among women (including postpartum) recruited from local clinical centers.
Trial registration NCT04016298 Posted July 11, 2019 (https://www.clinicaltrials.gov/ct2/show/NCT04016298?cond=bladder+health&draw=2&rank=1).
Collapse
Affiliation(s)
- Emily S Lukacz
- Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego, San Diego, CA, USA. .,Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego Health, 9500 Gilman Dr. #0971, La Jolla, CA, 92093, USA.
| | | | - Lisa Kane Low
- Practice and Professional Graduate Programs, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Jerry L Lowder
- Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama At Birmingham, Birmingham, AL, USA.,Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, AL, USA
| | - Elizabeth R Mueller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Loyola University Medical Center, Loyola University Chicago, Maywood, IL, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology and Reproductive Sciences, Yale University, New Haven, CT, USA
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | | |
Collapse
|
6
|
Robbins A, Rockwood T, Beilman G, Lemke N, Patil J, Miller C, Rosielle DA. Patient Experience with Integrated Palliative Care Consult in Lung Transplant Evaluation Process. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
7
|
Christianson B, Sharif-Mohamed F, Heath J, Roddy M, Bahta L, Omar H, Rockwood T, Kenyon C. Parental attitudes and decisions regarding MMR vaccination during an outbreak of measles among an undervaccinated Somali community in Minnesota. Vaccine 2020; 38:6979-6984. [PMID: 32981779 DOI: 10.1016/j.vaccine.2020.09.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 10/23/2022]
Abstract
Incidence of measles is increasing in the US, largely due to transmission among growing unvaccinated communities. To elucidate predictors of parental decision to obtain measles, mumps, and rubella (MMR) vaccine for unvaccinated children during a measles outbreak, we surveyed families among a vaccine-hesitant Somali community in Minnesota. The survey assessed attitudes and beliefs about MMR vaccine, motivators for vaccinating, and intention to vaccinate future children on time. Among 300 families surveyed, 95% vaccinated their child with MMR due to fear of measles. The predominating parental concern about MMR vaccine (71%) was a fallacious presumed connection between vaccination and autism. Only 41% of parents intended to vaccinate future children on time with MMR; parents who received recommendations for MMR vaccination from multiple sources were more likely than other parents to intend to do so. These findings support the importance of diverse outreach efforts to increase vaccine coverage among undervaccinated communities.
Collapse
Affiliation(s)
- Ben Christianson
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA.
| | | | - Jennifer Heath
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA
| | - Margaret Roddy
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA
| | - Lynn Bahta
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA
| | - Hinda Omar
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA
| | - Todd Rockwood
- University of Minnesota, 420 Delaware Street SE, MMC 729 Mayo, Minneapolis, MN 55455, USA
| | - Cynthia Kenyon
- Minnesota Department of Health, 625 Robert Street North, St. Paul, MN 55164, USA
| |
Collapse
|
8
|
Cernasev A, Larson WL, Peden-McAlpine C, Rockwood T, Ranelli PL, Okoro O, Schommer JC. "Stigma and HIV Are Like Brother and Sister!": The Experience of African-Born Persons Living with HIV in the US. Pharmacy (Basel) 2020; 8:pharmacy8020092. [PMID: 32486263 PMCID: PMC7357078 DOI: 10.3390/pharmacy8020092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/02/2022] Open
Abstract
Minnesota has seen an increase in the number of immigrants from Africa, notably in the mid-1990s, making up around 2% of Minnesota’s total population. This population also faces many impediments that cause important difficulties not only for HIV prevention but also for treatment and care options. The objectives of this study were to capture the experiences of Persons Living with HIV (PLWH) in Minnesota (US) and to elicit their stories about their diagnosis news and what management strategies they use for coping with the stigma associated with the disease. Participants were recruited via fliers in pharmacies, clinics, and HIV service centers located in Minnesota. Recruitment continued until thematic saturation was obtained. Fourteen subjects participated in audio-recorded, semi-structured interviews that were transcribed verbatim into written text. The transcriptions were analyzed using Thematic Analysis. Three themes emerged from the data. Theme 1: Cruel News: “HIV-Oooooo! I wish I was dead”, Theme 2: This is My Secret! and Theme 3: “Stigma and HIV are brother and sister”. The results demonstrate that stigma is an ever-present problem in African-born PLWH living in the US. Participants perceived the stigma associated with HIV status to affect their lives and culture at individual, familial, and societal levels.
Collapse
Affiliation(s)
- Alina Cernasev
- College of Pharmacy, The University of Tennessee Health Science Center, 301 S Perimeter Park Drive, Suite 220, Nashville, TN 37211, USA
- Correspondence:
| | - William L. Larson
- Allina Health Uptown Clinic, 1221 West Lake St., Suite 201, Minneapolis, MN 55455, USA;
| | - Cynthia Peden-McAlpine
- School of Nursing, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
| | - Todd Rockwood
- School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA;
| | - Paul L. Ranelli
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Olihe Okoro
- College of Pharmacy, University of Minnesota, 232 Life Science Duluth, 111 Kirby Drive, Minneapolis, MN 55812, USA; (P.L.R.); (O.O.)
| | - Jon C. Schommer
- College of Pharmacy, University of Minnesota, 308 Harvard Street SE, Minneapolis, MN 55455, USA;
| |
Collapse
|
9
|
Cernasev A, Larson WL, Rockwood T, Peden-McAlpine C, Ranelli PL, Okoro O, Schommer JC. Narrative experiences of interactions with pharmacists among African-born persons living with HIV: "It's mostly business.". Res Social Adm Pharm 2019; 16:529-534. [PMID: 31331830 DOI: 10.1016/j.sapharm.2019.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/11/2019] [Accepted: 07/14/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND African-born persons constitute 1% of the total Minnesota population, yet 24% of new HIV infections occurred in this population in 2016. Furthermore, 32% of the African born persons living with HIV [PLWH] did not check their CD4 counts or viral load in 2018. Little is known of the role of pharmacists in antiretroviral (ARV) management in the PLWH of African origin. OBJECTIVE This study aimed to describe the experiences of African-born PLWH in their interactions with pharmacists and perceptions of pharmacists' roles in fostering adherence to ARV therapy. METHODS A qualitative approach was used for this study. Recruitment via fliers for in-person interviews with African-born PLWH in Minnesota continued until saturation was achieved. Narrative Interviews with 14 participants lasting up to 2 h were conducted over five months. All interviews were audio recorded and transcribed verbatim by a professional transcription service. Conventional Content Analysis was used to analyze the data. RESULTS Three themes emerged from analyzed data "Interaction with the pharmacists," "Revealing the diagnosis to a pharmacist," and "Lack of disclosure of HIV status to a pharmacist." CONCLUSIONS The participants referred to the interaction with pharmacists as a "business" or "transactional interaction." To better understand the interaction between pharmacists and PLWH of African-born, future studies could benefit from interviewing pharmacists from different practice settings.
Collapse
Affiliation(s)
- Alina Cernasev
- University of Minnesota, College of Pharmacy, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| | - William L Larson
- Allina Health Uptown Clinic, Park Nicollet, and North Memorial Infectious Disease, Allina Health, 1221 West Lake St., Suite 201, Minneapolis, MN, 55408, USA.
| | - Todd Rockwood
- University of Minnesota, School of Public Health, 420 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Cynthia Peden-McAlpine
- University of Minnesota, School of Nursing, 308 Harvard Street SE Minneapolis, MN, 55455, USA.
| | - Paul L Ranelli
- University of Minnesota, College of Pharmacy, 232 Life Science Duluth, 111 Kirby Drive, MN, 55812, USA.
| | - Olihe Okoro
- University of Minnesota, College of Pharmacy, 232 Life Science Duluth, 111 Kirby Drive, MN, 55812, USA.
| | - Jon C Schommer
- University of Minnesota, College of Pharmacy, 308 Harvard Street SE, Minneapolis, MN, 55455, USA.
| |
Collapse
|
10
|
Johnson PJ, O’Brien M, Orionzi D, Trahan L, Rockwood T. Pilot of Community-Based Diabetes Self-Management Support for Patients at an Urban Primary Care Clinic. Diabetes Spectr 2019; 32:157-163. [PMID: 31168288 PMCID: PMC6528400 DOI: 10.2337/ds18-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Pamela Jo Johnson
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN
| | - Mollie O’Brien
- Division of Applied Research, Allina Health, Minneapolis, MN
| | - Dimpho Orionzi
- Division of Applied Research, Allina Health, Minneapolis, MN
| | - Lovel Trahan
- Division of Applied Research, Allina Health, Minneapolis, MN
| | - Todd Rockwood
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN
| |
Collapse
|
11
|
Weaver L, Beebe TJ, Rockwood T. The impact of survey mode on the response rate in a survey of the factors that influence Minnesota physicians' disclosure practices. BMC Med Res Methodol 2019; 19:73. [PMID: 30940087 PMCID: PMC6444519 DOI: 10.1186/s12874-019-0719-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/26/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is evidence that the physician response rate is declining. In response to this, methods for increasing the physician response rate are currently being explored. This paper examines the response rate and extent of non-response bias in a mixed-mode study of Minnesota physicians. METHODS This mode experiment was embedded in a survey study on the factors that influence physicians' willingness to disclose medical errors and adverse events to patients and their families. Physicians were randomly selected from a list of licensed physicians obtained from the Minnesota Board of Medical Practice. Afterwards, they were randomly assigned to either a single-mode (mail-only or web-only) or mixed-mode (web-mail or mail-web) design. Differences in response rate and nonresponse bias were assessed using Fischer's Exact Test. RESULTS The overall response rate was 18.60%. There were no statistically significant differences in the response rate across modes (p - value = 0.410). The non-response analysis indicates that responders and non-responders did not differ with respect to speciality or practice location. CONCLUSIONS The mode of administration did not affect the physician response rate.
Collapse
Affiliation(s)
- Lesley Weaver
- Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, MMC 729, Minneapolis, MN 55455 USA
| | - Timothy J. Beebe
- Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, MMC 729, Minneapolis, MN 55455 USA
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, 420 Delaware Street Southeast, MMC 729, Minneapolis, MN 55455 USA
| |
Collapse
|
12
|
|
13
|
Hardeman RR, Przedworski JM, Burke SE, Burgess DJ, Phelan SM, Dovidio JF, Nelson D, Rockwood T, van Ryn M. Mental Well-Being in First Year Medical Students: A Comparison by Race and Gender: A Report from the Medical Student CHANGE Study. J Racial Ethn Health Disparities 2016; 2:403-13. [PMID: 26413458 DOI: 10.1007/s40615-015-0087-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE In this study, authors sought to characterize race and gender disparities in mental health in a national sample of first year medical students early in their medical school experience. METHOD This study used cross-sectional baseline data of Medical Student CHANGES, a large national longitudinal study of a cohort of medical students surveyed in the winter of 2010. Authors ascertained respondents via the American Association of Medical Colleges questionnaire, a third-party vendor-compiled list, and referral sampling. RESULTS A total of 4732 first year medical students completed the baseline survey; of these, 301 were African American and 2890 were White. Compared to White students and after adjusting for relevant covariates, African American students had a greater risk of being classified as having depressive (relative risk (RR)=1.59 [95 % confidence interval, 1.37-2.40]) and anxiety symptoms (RR=1.66 [1.08-2.71]). Women also had a greater risk of being classified as having depressive (RR=1.36 [1.07-1.63]) and anxiety symptoms (RR-1.95 [1.39-2.84]). CONCLUSIONS At the start of their first year of medical school, African American and female medical students were at a higher risk for depressive symptoms and anxiety than their White and male counterparts, respectively. The findings of this study have practical implications as poor mental and overall health inhibit learning and success in medical school, and physician distress negatively affects quality of clinical care.
Collapse
Affiliation(s)
- Rachel R Hardeman
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Building 9, Mail code: 152, Minneapolis, MN 55417, USA
| | - Julia M Przedworski
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Sara E Burke
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Building 9, Mail code: 152, Minneapolis, MN 55417, USA
| | - Sean M Phelan
- Mayo Clinic College of Medicine, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Dave Nelson
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, 1 Veterans Drive, Building 9, Mail code: 152, Minneapolis, MN 55417, USA
| | - Todd Rockwood
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Michelle van Ryn
- Mayo Clinic College of Medicine, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
14
|
Affiliation(s)
- Leslie A. Grant
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Todd Rockwood
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Leif Stennes
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
15
|
Manaktala S, Rockwood T, Adam TJ. Diagnostic Characteristics of Patient Self-Assessment of Preoperative Cardiac Risk for Non-Cardiac Surgery - Foundations for Patient Driven Decision Support. AMIA Annu Symp Proc 2015; 2015:886-894. [PMID: 26958225 PMCID: PMC4765579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Todd Rockwood
- Health Services Research and Policy, School of Public Health, University of Minnesota
| | - Terrence J Adam
- Institute for Health Informatics, University of Minnesota; Minneapolis VA Healthcare System, University of Minnesota; College of Pharmacy, University of Minnesota
| |
Collapse
|
16
|
Blue CM, Rockwood T, Riggs S. Minnesota dentists׳ attitudes toward the dental therapist workforce model. Healthcare (Basel) 2015; 3:108-13. [DOI: 10.1016/j.hjdsi.2014.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 07/16/2014] [Indexed: 10/24/2022] Open
|
17
|
Abstract
We assessed client satisfaction with the home telemonitoring service provided by 14 home health care agencies in five US states. Clients were randomised to two groups. Telehealth services (health monitoring and patient safety) were provided to 450 experimental subjects. Control subjects (n = 409) received usual care. Clients were asked to rate their satisfaction with their service providers on 25 items, at baseline, 6 months post-discharge (to home) and 12 months post-discharge. The mean age of the clients was 78 years. Out of the initial 859 subjects, 490 had dropped out of the study by the 12-month follow-up, an overall attrition rate of 57%. There were similar proportions of clients reporting high satisfaction with external systems at baseline and at 6 months; at 12 months, there were significantly more clients in the experimental group who reported high satisfaction ( P = 0.049). There were similar proportions of clients reporting high satisfaction with internal systems at baseline and at 12 months; at 6 months, there were significantly more clients in the experimental group who reported high satisfaction ( P = 0.031). Clients with home monitoring were more satisfied with health-related and medical services post-discharge than those receiving usual care over a 6–12 month period.
Collapse
Affiliation(s)
- Leslie A Grant
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Todd Rockwood
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Leif Stennes
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, USA
| |
Collapse
|
18
|
Grant LA, Rockwood T, Stennes L. Testing Telehealth Using Technology-Enhanced Nurse Monitoring. J Gerontol Nurs 2014; 40:15-23. [DOI: 10.3928/00989134-20140808-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 02/02/2014] [Indexed: 11/20/2022]
|
19
|
Johnson PJ, Ghildayal N, Rockwood T, Everson-Rose SA. Differences in diabetes self-care activities by race/ethnicity and insulin use. Diabetes Educ 2014; 40:767-77. [PMID: 25253625 DOI: 10.1177/0145721714552501] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to examine differences in diabetes self-care activities by race/ethnicity and insulin use. METHODS Data were from the 2011 Behavioral Risk Factor Surveillance System for adults with diabetes. Outcomes included 5 diabetes self-care activities (blood glucose monitoring, foot checks, nonsmoking, physical activity, healthy eating) and 3 levels of diabetes self-care (high, moderate, low). Logistic regression models stratified by insulin use were used to estimate the odds of each self-care activity by race/ethnicity. RESULTS Only 20% of adults had high levels of diabetes self-care, while 64% had moderate and 16% had low self-care. Racial/ethnic differences were apparent for every self-care activity among non-insulin users but only for glucose monitoring and foot checks among insulin users. Overall, American Indian / Alaska Natives had higher odds of glucose monitoring; blacks had higher odds of foot checks; and Hispanics had higher odds of not smoking compared with non-Hispanic Whites. Non-insulin-using American Indian / Alaska Natives had higher odds of foot checks, and non-insulin-using Hispanics had higher odds of fruit/vegetable consumption. CONCLUSIONS Participation in specific diabetes self-care behaviors differs by race/ethnicity and by insulin use. Yet, few adults with diabetes of any race/ethnicity engage in high levels of self-care. Findings suggest that culturally tailored messages about diabetes self-care may be needed, in addition to more effective population promotion of healthy lifestyles and risk reduction behaviors to improve diabetes control and overall health. Diabetes educators can be a catalyst for adopting a population approach to diabetes management, which requires addressing both prevention and management of diabetes for all patients.
Collapse
Affiliation(s)
- Pamela Jo Johnson
- Medica Research Institute, Minnetonka, MN, USA (Dr Johnson, Ms Ghildayal),Center for Spirituality and Healing and the Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA (Dr Johnson)
| | - Neha Ghildayal
- Medica Research Institute, Minnetonka, MN, USA (Dr Johnson, Ms Ghildayal),Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (Ms Ghildayal, Dr Rockwood)
| | - Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA (Ms Ghildayal, Dr Rockwood)
| | - Susan A Everson-Rose
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA (Dr Everson-Rose)
| |
Collapse
|
20
|
Altomare DF, Rockwood T. Reply to Commentary on 'The TAPE score: a new scoring system for comprehensive evaluation of pelvic floor function' by Professor Søren Laurberg. Colorectal Dis 2014; 16:640-1. [PMID: 24840543 DOI: 10.1111/codi.12668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 02/08/2023]
Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy.
| | | |
Collapse
|
21
|
Altomare DF, Di Lena M, Giuratrabocchetta S, Giannini I, Falagario M, Zbar AP, Rockwood T. The Three Axial Perineal Evaluation (TAPE) score: a new scoring system for comprehensive evaluation of pelvic floor function. Colorectal Dis 2014; 16:459-68. [PMID: 24450861 DOI: 10.1111/codi.12567] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 11/27/2013] [Indexed: 12/14/2022]
Abstract
AIM Abnormalities of one pelvic floor compartment are usually associated with anomalies in the other compartments. Therapies which specifically address one clinical problem may potentially adversely affect other pelvic floor activities. A new comprehensive holistic scoring system defining global pelvic function is presented. METHOD A novel scoring system with a software program is presented expressing faecal, urinary and gynaecological functions as a geometric polygon based on symptom-specific questionnaires [the three axial pelvic evaluation (TAPE) score] where differences in overall geometric area vary from normal. After validation in healthy volunteers, its clinical performance was tested on patients with obstructed defaecation, genital prolapse and urinary/faecal incontinence treated by the stapled transanal rectal resection (STARR) procedure, colpo-hysterectomy and sacral nerve modulation, respectively. The TAPE score was correlated with the Pelvic Floor Impact Questionnaire 7 quality of life score. RESULTS There was good inter-observer variation and internal consistency between two observers recording the TAPE score in normal volunteers. In the STARR patients, constipation improved but the TAPE score was unchanged because of deterioration in other pelvic floor functions leading to an unchanged overall postoperative recorded quality of life. Conversely, incontinent patients treated with sacral nerve stimulation improved their function showing concomitant improvements in TAPE scores and quality of life indices. Similar correlative improvements were noted in patients undergoing hysterectomy for genital prolapse. CONCLUSION The TAPE score defines the impact of symptom-specific treatments on the pelvic floor and may provide an opportunity for comparison of clinical data between units and in clinical trials of specific medical and surgical pelvic floor management.
Collapse
Affiliation(s)
- D F Altomare
- Department of Emergency and Organ Transplantation, University 'Aldo Moro' of Bari, Bari, Italy
| | | | | | | | | | | | | |
Collapse
|
22
|
Johnson PJ, Kozhimannil KB, Ghildayal N, Rockwood T, Knutson L. Complementary and Alternative Medicine (CAM) Use Among Currently or Recently Pregnant Women. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5313.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pamela Jo Johnson
- (1) Medical Research Institute, University of Minnesota, Minneapolis, MN, USA
- (2) University of Minnesota, Minneapolis, MN, USA
- (3) Touchstone Mental Health, Minneapolis, MN, USA
| | - Katy B. Kozhimannil
- (1) Medical Research Institute, University of Minnesota, Minneapolis, MN, USA
- (2) University of Minnesota, Minneapolis, MN, USA
- (3) Touchstone Mental Health, Minneapolis, MN, USA
| | - Neha Ghildayal
- (1) Medical Research Institute, University of Minnesota, Minneapolis, MN, USA
- (2) University of Minnesota, Minneapolis, MN, USA
- (3) Touchstone Mental Health, Minneapolis, MN, USA
| | - Todd Rockwood
- (1) Medical Research Institute, University of Minnesota, Minneapolis, MN, USA
- (2) University of Minnesota, Minneapolis, MN, USA
- (3) Touchstone Mental Health, Minneapolis, MN, USA
| | - Lori Knutson
- (1) Medical Research Institute, University of Minnesota, Minneapolis, MN, USA
- (2) University of Minnesota, Minneapolis, MN, USA
- (3) Touchstone Mental Health, Minneapolis, MN, USA
| |
Collapse
|
23
|
Manaktala S, Rockwood T, Adam TJ. Validation of pre-operative patient self-assessment of cardiac risk for non-cardiac surgery: foundations for decision support. AMIA Annu Symp Proc 2013; 2013:931-938. [PMID: 24551384 PMCID: PMC3900225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To better characterize patient understanding of their risk of cardiac complications from non-cardiac surgery and to develop a patient driven clinical decision support system for preoperative patient risk management. METHODS A patient-driven preoperative self-assessment decision support tool for perioperative assessment was created. Patient' self-perception of cardiac risk and self-report data for risk factors were compared with gold standard preoperative physician assessment to evaluate agreement. RESULTS The patient generated cardiac risk profile was used for risk score generation and had excellent agreement with the expert physician assessment. However, patient subjective self-perception risk of cardiovascular complications had poor agreement with expert assessment. CONCLUSION A patient driven cardiac risk assessment tool provides a high degree of agreement with expert provider assessment demonstrating clinical feasibility. The limited agreement between provider risk assessment and patient self-perception underscores a need for further work including focused preoperative patient education on cardiac risk.
Collapse
Affiliation(s)
- Sharad Manaktala
- Minneapolis VA Healthcare System, University of Minnesota ; Institute for Health Informatics, University of Minnesota ; College of Pharmacy, University of Minnesota
| | - Todd Rockwood
- Health Services Research and Policy, School of Public Health, University of Minnesota
| | - Terrence J Adam
- Minneapolis VA Healthcare System, University of Minnesota ; Institute for Health Informatics, University of Minnesota ; College of Pharmacy, University of Minnesota
| |
Collapse
|
24
|
Ng W, Rockwood T, Persechini D, Chang D. High-Q Si microresonators formed by substrate transfer on silica waveguide wafers. Opt Express 2010; 18:27004-27015. [PMID: 21196977 DOI: 10.1364/oe.18.027004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We report the first demonstration of Si microresonators (MRs) fabricated via substrate transfer on a silica waveguide (WG) wafer. Specifically, these Si microdisks were fabricated on a layer of Si (0.16-0.2 μm thick) that was directly-bonded on a silica waveguide wafer. We measured the throughput and drop spectrum of these microdisks when coupled to bonded silica waveguides, and observed loaded quality-factors (Qs) of ≥10(4). We modeled, in addition, the dispersion of whispering gallery modes in these microdisks to show phase-matched coupling with an incident silica waveguide or fiber-taper. Using the measured extinction ratio and loaded-Q, we evaluated, in addition, the coupling coefficient between the incident waveguide/taper and Si MR.
Collapse
Affiliation(s)
- W Ng
- HRL Laboratories, LLC, Malibu, California, 90265 USA.
| | | | | | | |
Collapse
|
25
|
Davern M, McAlpine D, Beebe TJ, Ziegenfuss J, Rockwood T, Call KT. Are lower response rates hazardous to your health survey? An analysis of three state telephone health surveys. Health Serv Res 2010; 45:1324-44. [PMID: 20579127 DOI: 10.1111/j.1475-6773.2010.01128.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the impact of response rate variation on survey estimates and costs in three health telephone surveys. DATA SOURCE Three telephone surveys of noninstitutionalized adults in Minnesota and Oklahoma conducted from 2003 to 2005. STUDY DESIGN We examine differences in demographics and health measures by number of call attempts made before completion of the survey or whether the household initially refused to participate. We compare the point estimates we actually obtained with those we would have obtained with a less aggressive protocol and subsequent lower response rate. We also simulate what the effective sample sizes would have been if less aggressive protocols were followed. PRINCIPAL FINDINGS Unweighted bivariate analyses reveal many differences between early completers and those requiring more contacts and between those who initially refused to participate and those who did not. However, after making standard poststratification adjustments, no statistically significant differences were observed in the key health variables we examined between the early responders and the estimates derived from the full reporting sample. CONCLUSIONS Our findings demonstrate that for the surveys we examined, larger effective sample sizes (i.e., more statistical power) could have been achieved with the same amount of funding using less aggressive calling protocols. For some studies, money spent on aggressively pursuing high response rates could be better used to increase statistical power and/or to directly examine nonresponse bias.
Collapse
Affiliation(s)
- Michael Davern
- University of Chicago, 55 E. Monroe, Suite 3000, Chicago, IL 60603, USA.
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
This article looks at two of the major issues associated with the development of condition-specific quality of life measures. The first issue is the process of conceptualization. The importance of conceptualization to developing sound questions and instruments is evaluated, and the need to utilize multiple perspectives in the conceptualization process is discussed. The second issue addressed is fundamentals of writing survey questions. Questions from a range of sexual function questionnaires are presented and discussed relative to seven basic guidelines associated with question and response category development.
Collapse
Affiliation(s)
- Todd Rockwood
- Division of Health Policy and Management, University of Minnesota, 420 Delaware St SE, MMC 729, Minneapolis, MN 55455, USA.
| | | |
Collapse
|
27
|
Bordeianou L, Lee KY, Rockwood T, Baxter NN, Lowry A, Mellgren A, Parker S. Anal resting pressures at manometry correlate with the Fecal Incontinence Severity Index and with presence of sphincter defects on ultrasound. Dis Colon Rectum 2008; 51:1010-4. [PMID: 18437494 DOI: 10.1007/s10350-008-9230-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/23/2007] [Accepted: 11/17/2007] [Indexed: 02/08/2023]
Abstract
INTRODUCTION We describe the relationship between anorectal manometry, fecal incontinence severity, and findings at endoanal ultrasound. METHODS A total of 351 women completed the Fecal Incontinence Severity Index, underwent anorectal manometry, and endoanal ultrasound. Severity index and manometry pressures in 203 women with intact sphincters on ultrasound were compared with pressures in 148 women with sphincter defects. Relationships between resting and squeeze pressures, severity index, and size of sphincter defects were evaluated. RESULTS Mean severity index in patients with and without sphincter defect was 35.7 vs. 36.7 (not significant). Worsening index correlated with worsening mean and maximum resting pressure (P < 0.0001). Differences were observed in mean and maximum resting pressure between the patients with and without sphincter defects (26.6 vs. 37.2, P < 0.0001; 39.4 vs. 51.7, P < 0.001). Resting pressures correlated with the sizes of defect (P < 0.0001). CONCLUSIONS Patients with and without sphincter defects had similar severity scores, but patients with defects had a significant decrease in resting pressures. Patients with larger sphincter defects had lower severity scores and resting pressures. Until a manometry cutoff can be set to discriminate between absence and presence of defects, both manometry and ultrasound should be offered to patients with history of anal trauma.
Collapse
Affiliation(s)
- Liliana Bordeianou
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
| | | | | | | | | | | | | |
Collapse
|
28
|
Bordeianou L, Rockwood T, Baxter N, Lowry A, Mellgren A, Parker S. Does incontinence severity correlate with quality of life? Prospective analysis of 502 consecutive patients. Colorectal Dis 2008; 10:273-9. [PMID: 17608751 DOI: 10.1111/j.1463-1318.2007.01288.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The Fecal Incontinence Severity Index (FISI) is widely used in the assessment of patients with faecal incontinence, but the relationship between FISI and the measurements of quality of life, such as the Fecal Incontinence Quality of Life Scale (FIQL) and the Medical Outcomes Survey (SF-36) has not been evaluated previously. The aim of the present study was to evaluate the relationship between disease severity and quality of life in a large cohort of patients. METHOD Five hundred and two consecutive patients (84.4% female, mean age 56 years) were evaluated for faecal incontinence between May 2004 and October 2005. Patients completed FISI, FIQL and SF-36 questionnaires. Pearson's coefficients were determined for the relationships between FISI and subscales of FIQL and SF-36. Quality of life scores were compared between groups of patients with different levels of incontinence severity (mild, moderate, severe) using Student's t-test. RESULTS Sixty-eight per cent of patients were incontinent of solid stool, 62% of liquid stool, and 90% of gas or mucus. The average FISI score was 36 (0-61). Moderate correlations were found between FISI and all subscales in FIQL (negative 0.29 to 0.41; P < 0.0001). Weak correlations were found between FISI and the social functioning (-0.21) and mental health (-0.17) scales in SF-36 (P < 0.05). Scores on the FIQL differed significantly between mild, moderate and severe incontinence. CONCLUSION FISI was only moderately correlated with a disease-specific quality of life measurement (FIQL). Even though this supports the common assumption that the quality of life in the patients with faecal incontinence worsens with an increase in disease severity, it also stresses the need of measuring both variables to determine the true impact of any treatment.
Collapse
Affiliation(s)
- L Bordeianou
- Division of Colon and Rectal Surgery, University of Minnesota, St Paul, MN, USA.
| | | | | | | | | | | |
Collapse
|
29
|
Kane RL, Rockwood T, Hyer K, Desjardins K, Brassard A, Gessert C, Kane R, Mueller C. Nursing Home Staffʼs Perceived Ability to Influence Quality of Life. J Nurs Care Qual 2006; 21:248-55. [PMID: 16816606 DOI: 10.1097/00001786-200607000-00010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nurses, certified nursing assistants, activity personnel, social workers, and physicians in 5 cities rated their ability to affect each of 17 quality of life (QoL) items for 2 hypothetical cases. Those closest to the residents feel the most empowered to make a difference. Overall, certified nursing assistants were consistently the most optimistic about their ability to influence QoL. Perceptions of ability to influence QoL were correlated with attitudes about nursing homes. These perceptions may be helpful in retaining such staff.
Collapse
Affiliation(s)
- Robert L Kane
- University of Minnesota School of Public Health, Minneapolis, Minn, USA.
| | | | | | | | | | | | | | | |
Collapse
|
30
|
Reisenauer C, Krischniak A, Leonard J, Rockwood T, Königsrainer A, Stenzl S. Allgemeine Gynäkologie. Stuhlinkontinenz - Fragebogen zur Lebensqualität (SILQ). Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
31
|
Abstract
OBJECTIVES To assess how various stakeholders involved with nursing home care rate the importance of various quality-of-life (QoL) items for hypothetical residents with varying types of impairment. DESIGN A community-based exploratory description of a convenience sample. SETTING Eleven nursing homes in Florida, New Jersey, and Minnesota. PARTICIPANTS Samples of registered and licensed nurses (RNs and LPNs), certified nursing assistants (CNAs), activities personnel, social workers, physicians, residents, and family members. MEASUREMENTS Using a magnitude estimation approach, 17 QoL items were rated in order of importance on each of three hypothetical types of nursing home residents. RESULTS Overall, there was little variation in the ratings for individual items. Ratings for persons with cognitive impairment were consistently lower. RNs'/LPNs' and CNAs' ratings were generally higher than the others, and physicians' ratings were generally lower. Residents' and families' ratings were generally lower than nurses' ratings. CONCLUSION All stakeholders considered QoL to be important and felt that it deserves more attention in practice and regulation. A summary QoL score need not be weighted. Respondents (who were not cognitively impaired) considered QoL less important for residents with cognitive impairment. Value differences between those involved in nursing home care deserve more exploration.
Collapse
Affiliation(s)
- Robert L Kane
- School of Public Health, University of Minnesota, Minneapolis, Minnesota 55455, USA.
| | | | | | | | | | | | | |
Collapse
|
32
|
Kane RL, Bershadsky B, Rockwood T, Saleh K, Islam NC. Visual Analog Scale pain reporting was standardized. J Clin Epidemiol 2005; 58:618-23. [PMID: 15878476 DOI: 10.1016/j.jclinepi.2004.11.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2004] [Revised: 09/13/2004] [Accepted: 11/01/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Whereas pain is frequently measured using a visual analog scale (VAS) that can examine change over short time intervals in the same subject, such ratings are not useful in analyzing differences across subjects. We created a method for normalizing VAS pain reporting to control for the variation between different populations due to the differences in subjective perception or objective evaluation of pain. METHODS A list of 226 pains was gathered from a convenience sample of persons on the street and patients waiting at medical and orthopedic clinics. These pains were ranked according to severity by health professionals and 19 pains with the most stable rankings were selected. These 19 pains were then rated by a sample of community-dwelling persons and a method of VAS standardization was developed, based on six selected pains. RESULTS Individual variations in pain ratings were found to be independent of respondent age and gender, but were correlated with experience of the event or behavior and with self-reported health status. A new scoring method that takes into account these correlations is proposed. CONCLUSION It is possible to standardize VAS pain ratings to compare pain between different populations.
Collapse
Affiliation(s)
- Robert L Kane
- Clinical Outcomes Research Center, University of Minnesota, D351 Mayo (MMC 197), Minneapolis, 55455, USA.
| | | | | | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE To develop an instrument that can be used to assess the organizational culture of medical group practices. DATA SOURCES AND STUDY SETTING Study participants were primary care physicians in 267 medical group practices. The iterative process began in Minnesota and then expanded to practices in 21 other states. DATA COLLECTION METHODS Practice culture statements were collected using questionnaires distributed at a national medical group practice meeting and mailed questionnaires sent to a broader set of participants identified by the Medical Group Management Association. STUDY DESIGN Using a framework developed earlier, physicians in medical groups were asked to react to statements that described the basic assumptions and patterns of behavior characteristic of their practices. An iterative process involving over 500 physicians in 267 practices was used to identify and refine statements. Factor analysis was used to group the statements into cohesive cultural dimensions. PRINCIPAL FINDINGS Thirty-nine statements correlated with nine cultural dimensions were identified and a test of this instrument found that it successfully identified differences in the cultures of medical groups. CONCLUSIONS Although there is increasing agreement that the culture of medical group practices is one of the most important factors influencing the cost and quality of care, efforts to understand and manage these cultures have been hampered by the lack of a measurement instrument. This article presents an instrument that has broad face validity in the group practice field and successfully differentiates the cultures of different types of practices.
Collapse
Affiliation(s)
- John Kralewski
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, USA.
| | | | | | | | | |
Collapse
|
34
|
Abstract
Quality-of-life (QoL) is now recognized as a principal outcome marker for long-term care. However, QoL is difficult to define and measure, especially in residents with dementia. Providers of long-term care services (n = 182) were asked to rate the importance of 19 psychosocial quality-of-life elements for hypothetical residents with physical impairment and for residents with cognitive impairment. Respondents also were asked to rate their ability to influence these elements for each type of resident. Respondents rated the importance of 18 of the 19 elements and their ability to influence 17 of 19 elements lower for residents with cognitive impairment. Of the five types of respondents, certified nursing assistants (CNAs) rated their ability to influence these QoL elements the highest for both types of residents; physicians' ratings were the lowest. Pain management was given high ratings for both importance and ability to influence for both resident types; the lowest ratings were given for elements that pertained to residents' understanding. A strong correlation between ratings for importance and ability to influence was observed. Additional research is needed on the psychosocial aspects of long-term care residents' QoL, especially those with cognitive impairment.
Collapse
Affiliation(s)
- Charles E Gessert
- Division of Education and Research, St. Mary's/Duluth Clinic Health System, Duluth, Minnesota 55805, USA.
| | | | | | | | | | | | | |
Collapse
|
35
|
Abstract
Medicare's decentralized local coverage policy process leads to policy variation, raising serious equity and quality issues. The policy debate resembles a tug-of-war, with advocates favoring nationalization of all local policies or arguing for the status quo. We extensively analyzed thousands of local policies and surveyed Medicare's contractors. We found that all local policies are not the same. We classified them based on where they fall on the diffusion curve. The classification by type allows for reallocation to the national or local process to improve the decisions and satisfy Medicare's equity and quality goals.
Collapse
Affiliation(s)
- Susan Bartlett Foote
- Division of Health Services Research and Policy, University of Minnesota, School of Public Health, Minneapolis, USA
| | | | | | | |
Collapse
|
36
|
Davern M, Blewett LA, Bershadsky B, Call KT, Rockwood T. State variation in SCHIP allocations: how much is there, what are its sources, and can it be reduced? Inquiry 2003; 40:184-97. [PMID: 13677565 DOI: 10.5034/inquiryjrnl_40.2.184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Allocations for the State Children's Health Insurance Program (SCHIP) varied 22% per state between 1999 and 2002. The funding fluctuations present significant problems for states as they develop budget priorities under difficult fiscal conditions. We examine sources of the variation in state allocations during the first four years of SCHIP, focusing on the Current Population Survey's "child component" of the allocation formula. We consider the trade-offs in using alternative estimates from the American Community Survey and model-based estimation. Obtaining reliable estimates of need for SCHIP allocations is critical for states dependent on federal support for insurance programs.
Collapse
Affiliation(s)
- Michael Davern
- State Health Access Data Assistance Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55414, USA
| | | | | | | | | |
Collapse
|
37
|
Wholey DR, Christianson JB, Finch M, Knutson D, Rockwood T, Warrick L. Evaluating health plan quality 1: a conceptual model. Am J Manag Care 2003; 9 Spec No 2:SP53-64. [PMID: 12822715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To develop a theoretical foundation for measuring health plan quality from a physician's perspective. STUDY DESIGN Literature review and theory development. METHODS We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality. RESULTS A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed. CONCLUSION Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.
Collapse
Affiliation(s)
- Douglas R Wholey
- Division of Health Services Research and Policy, University of Minnesota, Minneapolis, Minn 55455, USA.
| | | | | | | | | | | |
Collapse
|
38
|
Wholey DR, Christianson JB, Finch M, Knutson D, Rockwood T, Warrick L. Evaluating health plan quality 2: survey design principles for measuring health plan quality. Am J Manag Care 2003; 9 Spec No 2:SP65-75. [PMID: 12822716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To develop principles for measuring the quality of specific health plans from a physician's perspective. STUDY DESIGN Literature review, expert review, cognitive interviews. METHODS We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys. Then, an expert review of prior survey efforts to measure health plan quality from the physician's perspective was performed. RESULTS A survey instrument based on a conceptual model of health plan quality was developed. Its purpose was to measure health plan quality from the physician's perspective. Principles for surveying physicians guided the structure of the survey. CONCLUSION Survey instruments can be designed to take into account a physician's unique perspective on health plan quality and can include measures that control for potential biases such as anti-managed care bias.
Collapse
Affiliation(s)
- Douglas R Wholey
- Division of Health Services Research and Policy, University of Minnesota, Minneapolis, Minn 55455, USA.
| | | | | | | | | | | |
Collapse
|
39
|
Wholey DR, Finch M, Christianson JB, Knutson D, Rockwood T, Warrick L. Evaluating health plan quality 3: survey measurement properties. Am J Manag Care 2003; 9 Spec No 2:SP76-87. [PMID: 12822717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE To assess the measurement and scaling properties of survey items designed to measure health plan quality from a physician's perspective. STUDY DESIGN Prospective survey design with multivariate regression analysis. METHODS Data were from 3798 physicians representing 23 health plans in 5 regions: Florida, New York, Colorado, Pennsylvania, and Washington. Scale reliability was assessed by using the Cronbach alpha. Generalist and specialist scales were compared with structural equation modeling. Multivariate analysis was used to examine internal validity by testing theoretically based hypotheses. RESULTS Scales constructed from the data were reliable, were stable across both generalist and specialist physicians, and demonstrated construct validity. Hypotheses about the relationship between physician experiences with a health plan and physician recommendations of the plan were confirmed, supporting construct validity. CONCLUSION The items on the survey instrument can be used with confidence to measure health plan quality from a physician perspective.
Collapse
Affiliation(s)
- Douglas R Wholey
- Division of Health Services Research and Policy, University of Minnesota, Minneapolis, Minn 55455, USA.
| | | | | | | | | | | |
Collapse
|
40
|
Call KT, Davidson G, Sommers AS, Feldman R, Farseth P, Rockwood T. Uncovering the missing Medicaid cases and assessing their bias for estimates of the uninsured. Inquiry 2002; 38:396-408. [PMID: 11887957 DOI: 10.5034/inquiryjrnl_38.4.396] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
General population surveys of health insurance coverage are thought to undercount Medicaid enrollment, which may bias estimates of the uninsured. This article describes the results of an experiment undertaken in conjunction with a general population survey in Minnesota. Responses to health insurance questions by a known sample of public program enrollees are analyzed to determine possible reasons for the undercount and the amount of bias introduced in estimates of uninsured people. While public program enrollees often misreport the type of coverage they have, the impact on estimates of those without insurance is negligible. Restrictions to generalizing the finding beyond this study are discussed.
Collapse
Affiliation(s)
- K T Call
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455, USA
| | | | | | | | | | | |
Collapse
|
41
|
Abstract
In an effort to develop a method for standardizing patients' reports of pain intensity, we tested seven different approaches to employing patients' ratings of four consistent types of pain as a means of correcting their reports (the average of the four standard pain measures, the average of the greater pains--finger in a door and tooth drilling, the average of the lesser pains--blister and leg cramp, the predicted back pain VAS from a regression of the standard pains, a conversion to the same scale based on population mean, the difference between individual mean and population mean of the four standard pain measures, and the difference between individual range and population range of the four standard pain measures). None of the adjustments proved to be a substantial improvement over the unstandardized approach. The best adjuster was the approach that used the average of the greater pain scores.
Collapse
Affiliation(s)
- Robert L Kane
- Division of Health Services Research and Policy, University of Minnesota School of Public Health, University of Minnesota Clinical Outcomes Research Center, 420 Delaware Street SE (Mayo Mail Code 197), Minneapolis, MN 55455, USA.
| | | | | | | | | |
Collapse
|
42
|
Abstract
This study compared the use of an interactive voice response (IVR) system with a written survey to collect data. Consecutive patients seen in an orthopedic clinic completed the Short Musculoskeletal Function Assessment (SMFA) by either IVR or written questionnaire and then were asked to complete the form again 3-7 days later using the opposite modality. Patient response rates were analyzed for differences between the self-administered IVR and written modes of administration. Three orthopedic clinics participated in the study. No significant differences between method of administration or individual differences in response per patient were found. Therefore, no significant differences in measurement are found when IVR is compared to the written SMFA.
Collapse
Affiliation(s)
- J Agel
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis 55455, USA
| | | | | | | | | |
Collapse
|
43
|
Abstract
OBJECTIVES To describe how nurse practitioners (NPs) employed by EverCare, a Medicare HMO serving exclusively nursing home residents, spend their working days. DESIGN A descriptive study based on structured self-reports. SETTING Nursing homes. PARTICIPANTS Seventeen NPs employed by EverCare in five sites. MEASUREMENTS Self-reports of time spent over a 2-week period and specific reports of how time was spent on selected cases. RESULTS NPs spend about 35% of their working day on direct patient care and another 26% in indirect care activities. Of the latter, 46% of the time was spent interacting with nursing home staff, 26% with family, and 15% with the physicians. The mean time spent on a given patient per day was 42 minutes (median 30); of this time 20 minutes was direct care (median 15). CONCLUSIONS NPs' activities are varied. Much of their time is spent communicating with vital parties, an important function that supports the physicians' primary care role and should enhance families' satisfaction with care.
Collapse
Affiliation(s)
- R L Kane
- University of Minnesota School of Public Health, Minneapolis 55455, USA
| | | | | | | |
Collapse
|
44
|
Shaw MJ, Talley NJ, Beebe TJ, Rockwood T, Carlsson R, Adlis S, Fendrick AM, Jones R, Dent J, Bytzer P. Initial validation of a diagnostic questionnaire for gastroesophageal reflux disease. Am J Gastroenterol 2001; 96:52-7. [PMID: 11197287 DOI: 10.1111/j.1572-0241.2001.03451.x] [Citation(s) in RCA: 311] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Brief, reliable, and valid self-administered questionnaires could facilitate the diagnosis of gastroesophageal reflux disease in primary care. We report the development and validation of such an instrument. METHODS Content validity was informed by literature review, expert opinion, and cognitive interviewing of 50 patients resulting in a 22-item survey. For psychometric analyses, primary care patients completed the new questionnaire at enrollment and at intervals ranging from 3 days to 3 wk. Multitrait scaling, test-retest reliability, and responsiveness were assessed. Predictive validity analyses of all scales and items used specialty physician diagnosis as the "gold standard." RESULTS Iterative factor analyses yielded three scales of four items each including heartburn, acid regurgitation, and dyspepsia. Multitrait scaling criteria including internal consistency, item interval consistency, and item discrimination were 100% satisfied. Test-retest reliability was high in those reporting stable symptoms. Scale scores significantly changed in those reporting a global change. Regressing specialty physician diagnosis on the three scales revealed significant effects for two scales (heartburn and regurgitation). Combining the two significant scales enhanced the strength of the model. Symptom response to self-directed treatment with nonprescription antisecretory medications was highly predictive of the diagnosis also, although the item demonstrated poor validity and reliability. CONCLUSIONS A brief, simple 12-item questionnaire demonstrated validity and reliability and seemed to be responsive to change for reflux and dyspeptic symptoms.
Collapse
Affiliation(s)
- M J Shaw
- Health Research Center, Park Nicollet Medical Center, Minneapolis, Minnesota 55416-2699, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Page MJ, Key NS, Rockwood T. Patient/caregiver assessment of convenience in the use of recombinant activated factor VII (rVIIa; NovoSeven) in home therapy. Blood Coagul Fibrinolysis 2000; 11 Suppl 1:S51-2. [PMID: 10850565 DOI: 10.1097/00001721-200004001-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M J Page
- Fairview-University Medical Center, Minneapolis, Minnesota 55455, USA.
| | | | | |
Collapse
|
46
|
Kane RL, Rockwood T, Philp I, Finch M. Differences in valuation of functional status components among consumers and professionals in Europe and the United States. J Clin Epidemiol 1998; 51:657-66. [PMID: 9743314 DOI: 10.1016/s0895-4356(98)00038-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The ratings of the importance of functional status items among geriatric experts and consumers in Europe and the United States differed in many cases between experts and consumers in both countries; the differences were more frequent among the U.S. samples. The overall correlation between consumer and expert rankings was .82 for both groups. In general consumers, rated instrumental activities of daily living (IADL) items more highly, whereas the experts rated the most dysfunctional activities of daily living (ADL) items higher than did consumers. This study suggests the gap in doctor-patient communication. As function is increasingly used as a clinical outcome, agreement is needed on how to weight the components. The differences uncovered in this study suggest a need for more dialogue about what ends are truly sought by various parties.
Collapse
Affiliation(s)
- R L Kane
- University of Minnesota Clinical Outcomes Research Center, Minneapolis, USA.
| | | | | | | |
Collapse
|
47
|
Kane RL, Rockwood T, Finch M, Philp I. Consumer and professional ratings of the importance of functional status components. Health Care Financ Rev 1997; 19:11-22. [PMID: 10345400 PMCID: PMC4194480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As the population ages and chronic disease becomes the more dominant form of illness, measures of functional loss and disability assume greater importance in the assessment of both quality of life and the cost-effectiveness of care. The authors studied the responses of consumers and health care professionals regarding the impact on dependency of various levels of disability. Striking differences in perception were noted, raising concerns about the ability of those providing care to assume that the recipients share their values about what is important. This study makes clear the need for more research on functional outcome measurements that incorporate the values of consumers.
Collapse
Affiliation(s)
- R L Kane
- University of Minnesota School of Public Health, Minneapolis, USA
| | | | | | | |
Collapse
|
48
|
White JR, Rockwood T, Wilson D, Bettesworth L, Icenogle T. The effects of pentoxifylline on the prevention of cyclosporine-induced nephrotoxicity in cardiac transplant patients. Clin Ther 1994; 16:673-9. [PMID: 7982255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this trial was to determine if oral pentoxifylline (PTX) reduced cyclosporine (CSA)-induced renal dysfunction in cardiac transplant patients in the 8 months following transplantation. The study was a prospective, open-label, crossover trial evaluating the renal effects of PTX in nine postcardiac transplant patients. Patients received PTX 2 weeks posttransplant and continued therapy for 4 months. Patients were evaluated for an additional 4 months thereafter. During the trial, various renal function tests were performed and CSA concentrations were measured at set intervals. Baseline measurements were compared with all subsequent measurements. In addition, "on-PTX" data were compared with "off-PTX" data. Significant alterations in results of renal function tests were not seen during the trial when compared with baseline values. Although no significant changes in renal function were observed during the study, no patient developed CSA-induced acute renal failure during the 4 months posttransplant. This finding suggests that PTX may offer a nephroprotective effect against CSA-induced toxicity.
Collapse
Affiliation(s)
- J R White
- College of Pharmacy, Washington State University, Spokane
| | | | | | | | | |
Collapse
|