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Selected AbstractsValidation of the Mayo Dysphagia QuestionnaireDISEASES OF THE ESOPHAGUS, Issue 3 2007A. B. M. Grudell SUMMARY., While multiple instruments characterize upper gastrointestinal symptoms, a validated instrument devoted to the measurement of a spectrum of esophageal dysphagia attributes is not available. Therefore, we constructed and validated the Mayo Dysphagia Questionnaire (MDQ). The 27 items of the MDQ underwent content validity, feasibility, concurrent validity, reproducibility, internal consistency, and construct validity testing. To assess content validity, five esophageal subspecialty gastroenterologists reviewed the items to ensure inclusion of pertinent domains. Feasibility testing was done with eight outpatients who refined problematic items. To assess concurrent validity, 70 patient responses on the MDQ were compared to responses gathered in a structured patient-physician interview. A separate group of 70 outpatients completed the MDQ twice to assess the reproducibility of each item. A total of 148 patients participated in the validation process (78 [53%] men; mean age 62). On average, the MDQ took 6 minutes to complete. A single item (odynophagia) tested poorly with a kappa value of < 0.4. Otherwise, the majority of concurrent validity kappa values were in the good to excellent range with a mean of 0.63 (95% CI 0.22,0.89). The majority of reproducibility kappa values were also in the good to excellent range with a median kappa value of 0.76 (interquartile range: 0.67,0.81). Cronbach's alpha values were excellent in the range of 0.86,0.88. Spearman rank correlation coefficients to assess construct validity were also excellent in the range of 0.87,0.98. Thus, the MDQ is a concise instrument that demonstrates overall excellent concurrent validity, reproducibility, internal consistency, and construct validity for the features of esophageal dysphagia. [source] Three method factors explaining the low correlations between assessment center dimension ratings and scores on personality inventories,EUROPEAN JOURNAL OF PERSONALITY, Issue 2 2004Nanja J. Kolk In general, correlations between assessment centre (AC) ratings and personality inventories are low. In this paper, we examine three method factors that may be responsible for these low correlations: differences in (i) rating source (other versus self), (ii) rating domain (general versus specific), and (iii) rating format (multi- versus single item). This study tests whether these three factors diminish correlations between AC exercise ratings and external indicators of similar dimensions. Ratings of personality and performance were combined in an analytical framework following a 2,×,2,×,2 (source, domain, format) completely crossed, within subjects design. Results showed partial support for the influence of each of the three method factors. Implications for future research are discussed. Copyright © 2004 John Wiley & Sons, Ltd. [source] The Combined Effects of Participatory Styles of Elderly Patients and Their Physicians on SatisfactionHEALTH SERVICES RESEARCH, Issue 2 2004K. Tom Xu Objectives. To test whether concordance or discordance of patient participation between patients and physicians is associated with higher satisfaction, and to examine the effects of patients' and physicians' participatory styles on patients' satisfaction with their physicians. Data. Data collected in the Texas Tech 5000 Survey of elderly patients in West Texas were used. Patient satisfaction with their physicians was measured by a single item from the Consumer Assessment of Health Plans (CAHPS), representing patients' ratings of their physicians. Patient participation was measured by an index derived from a three-item instrument and physicians' participatory decision-making (PDM) style was measured by a three-item instrument developed by the Medical Outcomes Study. Methods. An ordered logit multivariate regression was used to investigate the effects of patients' and physicians' participatory styles on satisfaction with physicians. The interaction between patients' participation and physicians' participatory styles was also included to examine the dependency of the two variables. Results. Controlling for confounding factors, a higher PDM score was associated with a higher rating of patient satisfaction with physicians. A higher patient participation score was related to a lower physician satisfaction rating. The combined effect of patients' and physicians' participation styles indicated that for a low patient participation score, a high PDM score was not needed to produce high satisfaction. The greater the discordance in this direction, the higher the satisfaction. However, with a high patient participation score, only an extremely high PDM score would produce relatively high satisfaction. Conclusions. The current study supports the discordance hypothesis. Participatory physicians and patient,physician communications concerning patient participation can promote higher satisfaction. [source] The effects of acute exercise on cognitive functioning and cigarette cravings during temporary abstinence from smokingHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 3 2008Kate Janse Van Rensburg Abstract Background Abstinence from smoking is associated with increased cravings, risk of accidents and self-reported poor concentration. A single exercise session can reduce cravings and self-reported poor concentration and can enhance cognitive performance among non-smokers. Objective To assess whether acute exercise impacts on the cognitive performance and cravings of abstaining smokers. Methods In a counterbalanced cross-over design, participants (n,=,23) did a 15,min passive or exercise condition, following cigarette abstinence. Cognitive functioning was measured by a computerised version of the Stroop colour-word interference task. Cravings were measured using the 10-item, 2-factor QSU-Brief and a single item for ,desire to smoke'. Measures were recorded at baseline, immediately post, 5, 10 and 15-min post treatment. Results A 2-way ANOVA showed no significant condition,×,time interaction for cognitive functioning. Significant interaction effects were found for desire to smoke, QSU Factor 1 (desire,behave) and 2 (desire,affect). Exercise reduced cravings for up to 15,min post treatment. Discussion Findings support previous research that acute exercise reduces cravings to smoke. Future research should determine if exercise can enhance other objective aspects of cognitive performance, and repeat the present study with a more homogeneous sample, in terms of Stroop performance. Conclusion This is the first study to show that exercise can reduce both factors of the QSU-Brief, but effects on cognitive functioning were not observed. Copyright © 2008 John Wiley & Sons, Ltd. [source] Depressive Symptoms and Self-Rated Health in Community-Dwelling Older Adults: A Longitudinal StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2002Beth Han MD OBJECTIVES: To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. DESIGN: A 2-year prospective cohort study. SETTING: Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. RESULTS: After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26,1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50,0.65). CONCLUSIONS: Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health. [source] Think really different: Continuity and specialization in the English dual form adverbsJOURNAL OF SOCIOLINGUISTICS, Issue 2 2002Sali Tagliamonte This paper analyses variation between -ly and -ø in English dual form adverbs by examining conversational data from York, U.K. Using multivariate analysis and the comparative method we assess the constraint ranking, significance and relative importance of external factors (age, sex, education level) and internal factors (lexical identity, function and meaning). The results show that -ly is dominant and has increased dramatically in apparent time. However, cross-tabulations with individual lexical items reveal that this correlation with speaker age is restricted to a single item,really. In conjunction with evidence from the history of English, we suggest that this does not reflect ongoing developments in English adverb formation, but is the result of continuous renewal in the encoding of ,intensity'. In contrast, separate analysis of the other adverbs shows that variation between -ly and zero is retained in part as a socio-symbolic resource, in particular for marking less educated male speech. Underlying this social meaning however, is a linguistic constraint which operates across all speakers. The zero adverb encodes concrete, objective meaning,a tendency which can be traced back 650 years or more. This provides yet another example of the interface between social and historical developments in language variation and change. [source] The stochastic joint replenishment problem: A new policy, analysis, and insightsNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 6 2006Banu Yüksel Özkaya Abstract In this study, we propose a new parsimonious policy for the stochastic joint replenishment problem in a single-location, N -item setting. The replenishment decisions are based on both group reorder point-group order quantity and the time since the last decision epoch. We derive the expressions for the key operating characteristics of the inventory system for both unit and compound Poisson demands. In a comprehensive numerical study, we compare the performance of the proposed policy with that of existing ones over a standard test bed. Our numerical results indicate that the proposed policy dominates the existing ones in 100 of 139 instances with comparably significant savings for unit demands. With batch demands, the savings increase as the stochasticity of demand size gets larger. We also observe that it performs well in environments with low demand diversity across items. The inventory system herein also models a two-echelon setting with a single item, multiple retailers, and cross docking at the upper echelon. © 2006 Wiley Periodicals, Inc. Naval Research Logistics, 2006 [source] Contractual agreements for coordination and vendor-managed delivery under explicit transportation considerationsNAVAL RESEARCH LOGISTICS: AN INTERNATIONAL JOURNAL, Issue 5 2006egül Toptal Abstract We consider the coordination problem between a vendor and a buyer operating under generalized replenishment costs that include fixed costs as well as stepwise freight costs. We study the stochastic demand, single-period setting where the buyer must decide on the order quantity to satisfy random demand for a single item with a short product life cycle. The full order for the cycle is placed before the cycle begins and no additional orders are accepted by the vendor. Due to the nonrecurring nature of the problem, the vendor's replenishment quantity is determined by the buyer's order quantity. Consequently, by using an appropriate pricing schedule to influence the buyer's ordering behavior, there is an opportunity for the vendor to achieve substantial savings from transportation expenses, which are represented in the generalized replenishment cost function. For the problem of interest, we prove that the vendor's expected profit is not increasing in buyer's order quantity. Therefore, unlike the earlier work in the area, it is not necessarily profitable for the vendor to encourage larger order quantities. Using this nontraditional result, we demonstrate that the concept of economies of scale may or may not work by identifying the cases where the vendor can increase his/her profits either by increasing or decreasing the buyer's order quantity. We prove useful properties of the expected profit functions in the centralized and decentralized models of the problem, and we utilize these properties to develop alternative incentive schemes for win,win solutions. Our analysis allows us to quantify the value of coordination and, hence, to identify additional opportunities for the vendor to improve his/her profits by potentially turning a nonprofitable transaction into a profitable one through the use of an appropriate tariff schedule or a vendor-managed delivery contract. We demonstrate that financial gain associated with these opportunities is truly tangible under a vendor-managed delivery arrangement that potentially improves the centralized solution. Although we take the viewpoint of supply chain coordination and our goal is to provide insights about the effect of transportation considerations on the channel coordination objective and contractual agreements, the paper also contributes to the literature by analyzing and developing efficient approaches for solving the centralized problem with stepwise freight costs in the single-period setting. © 2006 Wiley Periodicals, Inc. Naval Research Logistics, 2006 [source] Nurses' collaboration with physicians in managing medication improves patient outcome in acute psychiatric carePSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2006MIHARU NAKANISHI phd Abstract, The aim of the present paper was to examine the impact of nurses' collaboration with physicians in medication management on patient outcome in acute psychiatric care. Data for 143 patients with schizophrenia were assessed based on information given by nurses and physicians in charge. Twenty-two patients were defined as a collaborative group when physicians changed medication after receiving reports that nurses perceived the necessity to change. A control group was formed from the 50 patients when nurses perceived the necessity to change medication but did not tell physicians, or nurses advised of the necessity to physicians but medication was not changed. Physicians retrospectively evaluated patients' social functioning and acceptance of medication at admission and discharge. Social functioning was measured by Global Assessment of Functioning (GAF), and acceptance of medication by a single item using Japanese version of Schedule for Assessment of Insight (SAI-J). Changes in the scores from admission to discharge on GAF and acceptance of medication were defined as outcome measures. Nurses recognized the necessity to change medication for patients with frequent aggressive behavior and younger age. Compared with the control group, the collaborative group had less instruction for use of drugs, and more perceived necessity to decrease the current dose or the number of drugs because of stable symptoms. The collaborative group demonstrated significantly greater improvement in social functioning. The collaborative group improved acceptance of medication, although there were no significant differences between the two groups. Nurses' collaboration with physicians in medication management improved patient outcome in acute psychiatric care. [source] Agreement between parent and child report of quality of life in children with attention-deficit/hyperactivity disorderCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 4 2006A. F. Klassen Abstract Background There is little information in the research literature of agreement between parent and child in reports of child quality of life (QOL) for a sample of children diagnosed with attention-deficit/hyperactivity disorder (ADHD). The aim of our study was to determine whether parent and child concordance is greater for physical domains of QOL than for psychosocial domains; whether parents rate their child's QOL better or poorer than their child's ratings; and whether concordance is related to demographic, socioeconomic or clinical factors. Methods The study was a questionnaire survey of children aged 10,17 referred to the ADHD clinic and diagnosed with ADHD in the province of British Columbia (Canada) between November 2001 and October 2002 and their parent. Results Fifty-eight children diagnosed with ADHD and their parents completed our study questionnaire. The main outcome measure was the Child Health Questionnaire, which permitted comparisons on eight QOL domains and one single item. Intraclass correlation coefficients were moderate for five domains (range from 0.40 to 0.51), and good for three domains (range from 0.60 to 0.75). Children rated their QOL significantly better than their parents in four areas and poorer in one. Standardized Response Means indicated clinically important differences in mean scores for Behaviour and Self-esteem. Compared with population norms, across most domains, children with ADHD reported comparable health. Discrepancies between parent,child ratings were related to the presence of a comorbid oppositional/defiant disorder, a psychosocial stressor and increased ADHD symptoms. Conclusions Although self-report is an important means of eliciting QOL data, in children with ADHD, given the discrepancies in this study between parent and child report, measuring both perspectives seems appropriate. [source] Achieving symptomatic remission in out-patients with schizophrenia , a naturalistic study with quetiapineACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2009T. Wobrock Objective:, Symptomatic remission was defined as a score of mild or less on each of eight key schizophrenia symptoms on the Positive and Negative Syndrome Scale (PANSS-8). To evaluate the symptomatic remission criterion in clinical practice and to determine predictors for achieving symptomatic remission, a 12-week non-interventional study (NIS) with quetiapine was conducted in Germany. Method:, For the comparison of patients with and without symptomatic remission, sociodemographic and clinical variables of 693 patients were analyzed by logistic regression for their predictive value to achieve remission. Results:, Four hundred and four patients (58.3%) achieved symptomatic remission after 12 weeks' treatment with quetiapine. Remission was significantly predicted by a low degree of PANSS-8 total score, PANSS single items blunted affect (N1), social withdrawal (N4), lack of spontaneity (N6), mannerism and posturing (G5), and low disease severity (CGI-S) at baseline. Predictors of non-remission were older age, diagnosis of schizophrenic residuum, multiple previous episodes, longer duration of current episode, presence of concomitant diseases, and alcohol abuse. Conclusion:, This study demonstrated that the majority of schizophrenia out-patients achieved symptomatic remission after 12 weeks treatment and confirms the importance of managing negative symptoms in order to achieve disease remission. [source] Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysisINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2008S. Gauthier Abstract Introduction Behavioural disturbances are a common and distressing aspect of Alzheimer's disease (AD). This pooled analysis evaluated the specific benefits of memantine on behavioural disturbances in patients with moderate to severe AD. Methods Data were pooled from six 24/28-week, randomised, placebo-controlled, double-blind studies. Of the 2,311 patients included in these studies, 1,826 patients with moderate to severe AD (MMSE <20) were included in this analysis, corresponding to the extended indication for memantine in Europe. In this subgroup, 959 patients received memantine 20,mg/day and 867 received placebo. Behavioural symptoms were rated using the Neuropsychiatric Inventory (NPI) total and single-item scores at weeks 12 and 24/28. Results At weeks 12 and 24/28, ITT analysis demonstrated that memantine treatment produced statistically significant benefits over placebo treatment in NPI total score (p,=,0.001 and p,=,0.008), and in NPI single items: delusions (p,=,0.007,week 12, p,=,0.001,week 24/28), hallucinations (p,=,0.037,week 12), agitation/aggression (p,=,0.001,week 12, p,=,0.001,week 24/28), and irritability/lability (p,=,0.005,week 24/28), LOCF population. Analysis of the patients without symptoms at baseline indicated reduced emergence of agitation/aggression (p,=,0.002), delusions (p,=,0.047), and disinhibition (p,=,0.011), at week 12, and of agitation/aggression (p,=,0.002), irritability/lability (p,=,0.004), and night-time behaviour (p,=,0.050) at week 24/28 in those receiving memantine. OC analyses yielded similar results. Conclusions The data suggest that memantine is effective in treating and preventing the behavioural symptoms of moderate to severe AD. Specific persistent benefits were observed on the symptoms of delusions and agitation/aggression, which are known to be associated with rapid disease progression, increased caregiver burden, early institutionalisation, and increased costs of care. Copyright © 2007 John Wiley & Sons, Ltd. [source] The Norwegian version of the American pain society patient outcome questionnaire: reliability and validity of three subscalesJOURNAL OF CLINICAL NURSING, Issue 15 2008Alfhild Dihle MSc Aims and objectives., To examine some psychometric properties of the Norwegian version of the American Pain Society's Patient Outcome Questionnaire (APS-POQ-N). Background., This study is part of an investigation of Norwegian orthopaedic surgical patients, where the overall aim is to evaluate the quality of postoperative pain management. Therefore, an adequate questionnaire on the quality of postoperative pain management was needed. Methods., The sample included 114 orthopaedic postoperative patients. The instrument consists of three main subscales, namely the modified Brief Pain Inventory (modified BPI subscale), the subscale on satisfaction with pain management (Satisfaction subscale) and the subscale on beliefs about pain management (Beliefs subscale), together with six single items about pain management. The reliability of these three main subscales was estimated using Cronbach's alpha coefficients and the construct validity was evaluated using principal-axis factor analysis with oblimin rotation. Results., Face and content validity of the APS-POQ-N were satisfactory, while the modified BPI and the Beliefs subscales showed acceptable internal consistency but the Satisfaction subscale did not. Factor analyses yielded a three-factor solution for the modified BPI, a one-factor solution for the Satisfaction subscale and a two-factor solution for the Beliefs subscale. Conclusions., The APS-POQ-N appears, in general, to be an acceptable method of evaluating postoperative pain management in orthopaedic postoperative patients. However, the alpha value of the Satisfaction subscale was low, and thus the subscale is not recommended for this purpose. Relevance to clinical practice., Reliable and valid instruments are important when performing clinical research. This instrument is applicable as an indicator of quality of postoperative pain management in clinical practice and research. [source] Self-Esteem and Socioeconomic Disparities in Self-Perceived Oral HealthJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 1 2009David Locker Abstract Objective: To determine if psychosocial factors explain the socioeconomic disparities in self-perceived oral health that persist after controlling for oral status variables. Methods: Data came from the participants in the Canadian Community Health Survey 2003 who were residents in the city of Toronto. Oral health variables included self-rated oral health, a 13-item oral health scale, denture wearing, and having a tooth extracted in the previous year. The last two measures were regarded as proxy indicators of tooth loss. Psychosocial variables included a self-esteem scale, a depression scale, and single items measuring life satisfaction, life stress, and sense of cohesion. Socioeconomic status was assessed using total annual household income. Results: Interviews were completed with 2,754 dentate persons aged 20 years and over. Bivariate analyses confirmed that there were income gradients in self-rated oral health and scores on the oral health scale. Linear regression analyses confirmed that these persisted after controlling for age, gender, denture wearing, and having a tooth extracted in the previous year. In the model predicting self-rated oral health self-esteem, life satisfaction, stress, a sense of cohesion, and depression also contributed to the model, increased its explanatory power, and reduced the strength of but did not eliminate the association between income and self-rated oral health. Broadly, similar results were obtained when the oral health scale score was used as the dependent variable. In both analyses and all models, denture wearing had the strongest and most enduring effect. Conclusion: Psychosocial factors partly but do not wholly explain the socioeconomic disparities in self-perceived oral health in this population after controlling for tooth loss and denture wearing. Other variables need to be added to the models to increase their explanatory power. [source] Relationship between various clinical outcome assessments in patients with blepharospasm,MOVEMENT DISORDERS, Issue 3 2009Joseph Jankovic MD Abstract The objective was to analyze the metric properties of the Jankovic Rating Scale (JRS) and a self-rating patient response outcome scale, the Blepharospasm Disability Index (BSDI©), in blepharospasm patients. Data from a randomized, double-blind, active-control clinical trial in 300 patients with blepharospasm treated with either botulinum toxin type A (Botox®) or NT201 (Xeomin®) were used to evaluate the metric properties of the JRS and the BSDI compared with the Patient Evaluation of Global Response (PEGR) and Global Assessment Scale (GAS). The internal consistency of the BSDI was high, Cronbach's Alpha = 0.88, and the retest reliability of the BSDI single items was adequate, Spearman's rank coefficient = 0.453 < r < 0.595. The correlation between JRS sum score and BSDI weighted mean score was r = 0.487 (baseline) and r = 0.737 (control visit), respectively. Using the GAS and PEGR, the results suggest that a change of 2 points in the JRS and of 0.7 points in the BSDI are clinically meaningful. JRS and BSDI are objective indicators of clinical efficacy as suggested by their good validity when compared with physicians' and patients' rating scales. Both, JRS and BSDI, can be used to reliably assess blepharospasm in treatment trials. © 2008 Movement Disorder Society [source] Development of a disease specific questionnaire to supplement a generic tool for QoL in colorectal cancerPSYCHO-ONCOLOGY, Issue 7 2003J. Davidson-Homewood The need for disease-specific quality of life measures is highlighted in the literature. The psychometric properties of a supplementary disease-specific quality of life questionnaire developed for use with a generic Quality of Life tool in colorectal cancer patients are explored. Originally developed and tested in a German sample, the English translation was tested on a cohort of UK colorectal cancer patients. Relevance and acceptability was previously established in Germany. A rigorous factor analysis ascertained the underlying structure of two factors with a number of single items that were retained as clinically important symptom indicators. In considering validity, four conditions were assessed: Reliability using Cronbach's alpha; Construct validity by comparing patient subgroups; Clinical Validity, by testing the hypothesis that some patient subgroups experience worse quality of life; Construct Reliability using second order factor analysis with the EORTC QOLQ-C30 scales, confirming that the factors retained provide an excellent measure of physical discomfort and a good measure of physical well being. Two other such questionnaires were developed in parallel with this one and reported in the literature (FACT-C and QOLQ-CR38). However, this questionnaire provides a useful alternative tool for use in clinical trials of colorectal cancer treatments alongside a core QoL questionnaire especially when brevity is an important consideration. Copyright © 2003 John Wiley & Sons, Ltd. [source] | |||||||||||||