Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Instrument

  • appraisal instrument
  • appropriate instrument
  • assessment instrument
  • bonding instrument
  • brief screening instrument
  • collection instrument
  • commercial instrument
  • data collection instrument
  • diagnostic instrument
  • effective instrument
  • evaluation instrument
  • financial instrument
  • hrqol instrument
  • important instrument
  • item instrument
  • key instrument
  • life instrument
  • measurement instrument
  • new instrument
  • parental bonding instrument
  • policy instrument
  • q-tof instrument
  • quality-of-life instrument
  • rating instrument
  • reliable instrument
  • research instrument
  • resident assessment instrument
  • review instrument
  • satisfaction instrument
  • screening instrument
  • self-administered instrument
  • self-report instrument
  • single instrument
  • standardized instrument
  • survey instrument
  • test instrument
  • useful instrument
  • valid instrument
  • validated instrument

  • Terms modified by Instrument

  • instrument choice
  • instrument consisting
  • instrument design
  • instrument development
  • instrument performance
  • instrument type
  • instrument used

  • Selected Abstracts


    ECONOMIC AFFAIRS, Issue 1 2009
    Philip Arestis
    This paper demonstrates that fiscal policy is an effective and essential instrument of stabilisation macroeconomic policy. This is particularly so if it is co-ordinated with monetary policy, especially in the current worldwide economic situation. [source]


    Brian Jory
    This article describes development of the Intimate Justice Scale (IJS) and reports on a clinical study of the validity, reliability, and clinical usefulness of the instrument. Rather than measuring specific acts of abuse, the IJS measures ethical dynamics of couple relationships, which areevident in patterns of action and attitude expressed over the course of the relationship. Ethical dynamics appear to correlate with partner abuse. The study suggests that the IJS may reliably identify victims of abuse and may discriminate between minor and severe levels of abuse. The IJS can be completed and scored in less than 10 min and may be useful for screening in mental health, medical, and social service agencies. Clinical guidelines and a case example are presented. [source]

    Instrument to assess depersonalization-derealization in panic disorder

    Brian J. Cox Ph.D.
    Abstract There is a long history of scholarly interest on depersonalization-derealization (DD) and its role in clinical anxiety, but there is a paucity of appropriate assessment instruments available. Our objective was to develop and evaluate a self-report measure of DD for use with clinically anxious patients. Panic disorder patients (n=169) were surveyed about DD experiences and provided data on a new item pool for psychometric development. DD episodes were common and a 28-item Depersonalization-Derealization Inventory was found to possess good reliability and validity. DD appears to be prevalent and clinically relevant in panic disorder. Continued study of DD is warranted and may be facilitated by the availability of a suitable instrument with promising psychometric properties. A 12-item version of the instrument may be appropriate as a brief screen. © 2002 Wiley-Liss, Inc. [source]

    Instrument for Biopsy of Oral Lesions: An Improved Chalazion Forceps

    No abstract is available for this article. [source]

    Novel Face-Lift Suspension Suture and Inserting Instrument: Use of Large Anchors Knotted into a Suture with Attached Needle and Inserting Device Allowing for Single Entry Point Placement of Suspension Suture.

    Preliminary Report of 20 Cases with 6- to 12-Month Follow-Up
    BACKGROUND Various suspension suture techniques exist to elevate the mid-face, jowls, and neck. OBJECTIVE To assess safety and efficacy of a new suspension suture and inserting instrument with both standard and minimal incision (no-skin-excision) face-lifts. METHODS A new type of multianchor suspension suture assembled from commercially available 2-0 absorbable monofilament material, with 5 to 9 equally spaced knots through which are secured 7 to 9 mm bits of 0 thickness similar suture material, and an attached straightened needle, was used to elevate and suspend facial tissues to temporal or mastoid fascia. The suspension sutures are placed in the deep subcutaneous tissues, just above the superficial musculo aponeurotic system (SMAS), by use of a novel, blunt instrument, which does not require a second, distal exit point. The suspension suture distal end floats free. The proximal needle end is sutured to fascia. The suture was used on 20 patients. Fourteen of them underwent pure, "no-skin-excision," suspension lifts. Six had suspension suture elevation of the mid-face in conjunction with relatively conservative open lifts. Nine- to 12-month results were evaluated. RESULTS With open face-lifts, 9- to 12-month results are excellent with significant persistence of the correction initially achieved. Resulting scars remained fine line. There were no complications. With pure suspension lifts, initial results were impressive. By 6 months, correction started to fade. By 12 months 100% of initial correction for jowls, and 80 to 100% for mid-face, appeared lost. Recovery time was 2 to 4 days. There were no significant complications. CONCLUSION Large multianchor, absorbable monofilament sutures can safely and effectively enhance results of conservative lifts, with remarkable elevation of the mid-face not achievable with simple SMAS flaps. These suspension sutures can easily and safely achieve impressive, though relatively short-term results, with a minimal incision, "no-skin-excision" technique. [source]

    The Bangladesh Health SWAp: Experience of a New Aid Instrument in Practice

    Howard White
    Sector-wide approaches are being widely adopted as a new aid modality, incorporating government ownership, partnership and a move from project to programme support. The literature to date on their performance in practice is, at best, mixed. This article reviews these issues in the light of the experience of arguably the world's oldest and largest SWAp, the Bangladesh health sector programme. A positive picture emerges of an evolutionary institutional adaptation towards a programme approach, with positive systemic effects on government processes and a reduction in transaction costs in dealing with donors. There are, however, negative aspects, notably, donor dominance in ,dialogue', though with limited influence on the government's actual strategy. [source]

    Quality of life and health-related quality of life of adolescents with cerebral palsy

    Peter L Rosenbaum MD FRCP(C)
    This study assessed quality of life (QOL) and health-related quality of life (HRQOL) of 203 adolescents with cerebral palsy (111 males, 92 females; mean age 16y [SD 1y 9mo]). Participants were classified using the Gross Motor Function Classification System (GMFCS), as Level I (n=60), Level II (n=33), Level III (n=28), Level IV (n=50), or Level V (n=32). QOL was assessed by self (66.5%) or by proxy (33.5%) with the Quality of Life Instrument for People With Developmental Disabilities, which asks about the importance and satisfaction associated with the QOL domains of Being, Belonging, and Becoming; HRQOL was captured through proxy reports with the Health Utilities Index, Mark 3 (HUI3), which characterizes health in terms of eight attributes, each having five or six ordered levels of function. GMFCS level was not a source of variation for QOL domain scores but was significantly associated with the eight HRQOL attributes and overall HUI3 utility scores (p<0.05). Some QOL domain scores varied significantly by type of respondent (self vs proxy; p<0.05). Overall HUI3 utility values were significantly but weakly correlated with QOL Instrument scores for Being (r=0.37), Belonging (r=0.17), Becoming (r=0.20), and Overall QOL (r=0.28), and thus explain up to 14% of the variance (r2). These findings suggest that although QOL and HRQOL are somewhat related conceptually, they are different constructs and need to be considered as separate dimensions of the lives of people with functional limitations. [source]

    Detecting language problems: accuracy of five language screening instruments in preschool children

    H M E Van Agt MA
    To identify a simple and effective screening instrument for language delays in 3-year-old children the reliability, validity, and accuracy of five screening instruments were examined. A postal questionnaire sent to parents of 11423 children included the Dutch version of the General Language Screen (GLS), the Van Wiechen (VW) items, the Language Screening Instrument for 3- to 4-year-olds, consisting of a parent form (LSI-PF) and a child test (LSI-CT), and parents' own judgement of their child's language development on a visual analogue scale (VAS). The response rate was 78% or 8877 children. Reliability (internal consistency) was found to be acceptable (,=0.67,0.72) for all instruments. Significant correlations between the screening instruments (r=0.29,0.55, p<0.01) indicated good concurrent validity. Accuracy was estimated by the sensitivity, specificity, and receiver operating characteristic (ROC) curves against two reference tests based on parent report and specialists' judgement. If the test would classify approximately 5% of the population as screen-positive, the mean sensitivity was 50%; assigning between 20% and 30% of the population as screen-positive, the mean sensitivity was 77%. The sensitivity was lowest for the LSI-CT (range 43,62%), whereas short instruments like the LSI-PF, VW, and the one-item VAS exhibited high levels of sensitivity (range 50,86%). The area under the ROC curves, ranged from 0.75 to 0.87. Apparently, short and simple parent report instruments like the LSI-PF and the one-item VAS perform remarkably well in detecting language delays in preschool children. [source]

    Recollections of parent,child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia

    L. Turgeon
    Objective:,In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out-patients with obsessive-compulsive disorder (OCD), in out-patients with panic disorder with agoraphobia (PDA), and in non-anxious controls. Method:,The sample included 43 out-patients with OCD, 38 with PDA, and 120 controls. Participants completed the Parental Bonding Instrument and the Egna Minnen Beträffande Uppfostran or Own Memories of Parental Rearing Experiences in Childhood. Results:,No differences were found between the two anxious groups. However, compared with the control group, anxious patients recalled their parents as more protective. Conclusion:,Our findings suggest that child rearing practices such as overprotection may be a risk factor in the development of anxiety disorders. [source]

    Can High School Achievement Tests Serve to Select College Students?

    Adriana D. Cimetta
    Postsecondary schools have traditionally relied on admissions tests such as the SATand ACT to select students. With high school achievement assessments in place in many states, it is important to ascertain whether scores from those exams can either supplement or supplant conventional admissions tests. In this study we examined whether the Arizona Instrument to Measure Standards (AIMS) high school tests could serve as a useful predictor of college performance. Stepwise regression analyses with a predetermined order of variable entry revealed that AIMS generally did not account for additional performance variation when added to high school grade-point average (HSGPA) and SAT. However, in a cohort of students that took the test for graduation purposes, AIMS did account for about the same proportion of variance as SAT when added to a model that included HSGPA. The predictive value of both SAT and AIMS was generally the same for Caucasian, Hispanic, and Asian American students. The ramifications of universities using high school achievement exams as predictors of college success, in addition to or in lieu of traditional measures, are discussed. [source]

    Development and Cross-Cultural Application of a Specific Instrument to Measure Entrepreneurial Intentions

    Francisco Liñán
    This article uses Ajzen's theory of planned behavior to build an entrepreneurial intention questionnaire (EIQ) and analyzes its psychometric properties. The entrepreneurial intention model is then tested on a 519-individual sample from two rather diverse countries: Spain and Taiwan. EIQ and structural equation techniques have been used to try to overcome previous research limitations. The role of culture in explaining motivational perceptions has been specifically considered. Results indicate EIQ properties are satisfactory and strong support for the model is found. Relevant insights are derived about how cultural values modify the way individuals in each society perceive entrepreneurship. [source]

    Renewable Identification Numbers are the Tracking Instrument and Bellwether of US Biofuel Mandates Identifikationsnummern für Erneuerbare Energien als Mittel der Rückverfolgbarkeit und Indikator für US-amerikanische Biokraftstoffverpflichtungen Les numéros d'identification des carburants renouvelables sont les instruments et baromètres de suivi des obligations légales concernant les biocarburants aux États-Unis

    EUROCHOICES, Issue 3 2009
    Wyatt Thompson
    First page of article [source]

    Family Secrets and Family Functioning: The Case of Donor Assistance

    FAMILY PROCESS, Issue 4 2008
    The purpose of this study was to examine the relationship between adult offspring's perception of family functioning and of parental use of topic avoidance to maintain secrecy regarding the use of donor assistance to conceive. A cross-sectional design was used to study a convenience sample of 69 young adult donor offspring who completed a demographic questionnaire, a topic avoidance scale relative to each of their rearing parents, and the Beavers Self Report Family Instrument. Findings indicated that participants perceived both parents as avoiding the topic of donor assistance more than other topics, mothers as avoiding all topics less than fathers, and topic avoidance was negatively associated with family functioning. Mothers' general topic avoidance was the strongest predictor of family functioning. Parents' disclosing together was predictive of higher family functioning. Implications for practice and future research are suggested. RESUMEN El propósito de este estudio era examinar la relación entre la percepción que los hijos adultos tienen del funcionamiento familiar y de la práctica, por parte de los padres, de evitar ciertos temas para mantener en secreto el haber recurrido a un donante para concebir. Se utilizó un diseño transversal para estudiar una muestra de conveniencia de 69 adultos jóvenes hijos de donantes que rellenaron un cuestionario demográfico, una escala de evasión del tema sobre sus padres por separado y el Instrumento Familiar Beavers de Autoinformes (Beavers Self Report Family Instrument). Los resultados indicaron que los participantes percibían que sus padres evitaban el tema de la ayuda del donante más que otros temas, que las madres evitaban temas en general menos que los padres, y que la evasión de temas se veía negativamente asociada al funcionamiento familiar. La evasión por parte de las madres de temas en general era el factor pronóstico más fuerte del funcionamiento familiar. El afrontar el tema por parte del padre y la madre juntos era pronóstico de un funcionamiento familiar más alto. Se sugieren implicaciones para futuras prácticas e investigaciones. Palabras clave: secretos familiares, funcionamiento familiar, evasión de tema [source]

    The Hidden Politics of Administrative Reform: Cutting French Civil Service Wages with a Low-Profile Instrument

    GOVERNANCE, Issue 1 2007
    The article addresses internal and hidden politics of changes in bureaucracies by focusing on the introduction and use of policy instruments as institutional change without radical or explicit shifts in administrative systems. Beneath public administrative reforms, it examines the use of "low-profile instruments" characterized by their technical and goal-oriented dimension but also by their low visibility to external actors due to the high complexity of their commensurating purpose and the automaticity of their use. The core case study of the paper offers a historical sociology of a technique for calculating the growth of the French civil service wage bill from the mid-1960s to the 2000s. The origins, uses, and institutionalisation of this method in the French context are explored to emphasize the important way of governing the bureaucracy at times of crisis through automatic, unobtrusive, incremental, and low-profile mechanisms. While insisting on the salience of techniques for calculating, measuring, classifying, and indexing in the contemporary art of government, it also suggests the need for observing and explaining "everyday forms of retrenchment" in bureaucracies. [source]

    Measuring the productive efficiency and clinical quality of institutional long-term care for the elderly

    HEALTH ECONOMICS, Issue 3 2005
    Juha Laine
    Abstract The authors consider the association between productive efficiency and clinical quality in institutional long-term care for the elderly. Cross-sectional data were collected from 122 wards in health-centre hospitals and residential homes in Finland in 2001. Productive efficiency was measured in terms of technical efficiency, which was defined as the unit's distance from the (best practice) production frontier. The analysis employed stochastic production frontier estimation, where technical inefficiency in the production function was specified to be a function of ward characteristics and clinical quality of care. Several quality indicators based on the Resident Assessment Instrument, such as prevalence of pressure ulcers and depression with no treatment, were used in the analysis. The results did not reveal systematic association between technical efficiency and clinical quality of care. However, the prevalence of pressure ulcers, indicating poor quality of care was associated with technical efficiency, a fact which highlights the importance of including quality measures in the assessment of efficiency in long-term care. Copyright © 2004 John Wiley & Sons, Ltd. [source]

    Survey Conditioning in Self-Reported Mental Health Service Use: Randomized Comparison of Alternative Instrument Formats

    Naihua Duan
    Objective. To test the effect of survey conditioning (whether observed survey responses are affected by previous experience in the same survey or similar surveys) in a survey instrument used to assess mental health service use. Data Sources. Primary data collected in the National Latino and Asian American Study, a cross-sectional household survey of Latinos and Asian Americans residing in the United States. Study Design. Study participants are randomly assigned to a Traditional Instrument with an interleafed format placing service use questions after detailed questions on disorders, or a Modified Instrument with an ensemble format screening for service use near the beginning of the survey. We hypothesize the ensemble format to be less susceptible to survey conditioning than the interleafed format. We compare self-reported mental health services use measures (overall, aggregate categories, and specific categories) between recipients of the two instruments, using 2 × 2 ,2 tests and logistic regressions that control for key covariates. Data Collection. In-person computer-assisted interviews, conducted in respondent's preferred language (English, Spanish, Mandarin Chinese, Tagalog, or Vietnamese). Principal Findings. Higher service use rates are reported with the Modified Instrument than with the Traditional Instrument for all service use measures; odds ratios range from 1.41 to 3.10, all p -values <.001. Results are similar across ethnic groups and insensitive to model specification. Conclusions. Survey conditioning biases downward reported mental health service use when the instrument follows an interleafed format. An ensemble format should be used when it is feasible for measures that are susceptible to survey conditioning. [source]

    Psychometric Properties of the Dutch Version of the Hospital-Level Consumer Assessment of Health Plans Survey® Instrument

    Onyebuchi A. Arah
    Objectives. To assess the reliability and validity of a translated version of the American Hospital-level Consumer Assessment of Health Plans Survey® (H-CAHPS) instrument for use in Dutch health care. Data Sources/Study Setting. Primary survey data from adults aged 18 years or more who were recently discharged from two multispecialty city hospitals in the Netherlands. Study Design. We used forward and backward translation procedures and a panel of experts to adapt the 66-item pilot H-CAHPS into a 70-item Dutch instrument. Descriptive statistics and standard psychometric methods were then used to test the reliability and validity of the new instrument. Data Collection. From late November 2003 to early January 2004, the survey was administered by mail to 1,996 patients discharged within the previous 2 months. Principal Findings. Analyses supported the reliability and validity of the following 7-factor H-CAHPS structure for use in Dutch hospitals: on doctor's communication, nurses' communication, discharge information, communication about medication, pain control, physical environment of hospital, and nursing services. The internal consistency reliability of the scales ranged from 0.60 to 0.88. Items related to "family receiving help when on visit,""hospital staff introducing self," and "admission delays" did not improve the psychometric properties of the new instrument. Conclusions. These findings suggest that the H-CAHPS instrument is reliable and valid for use in the Dutch context. However, more research will be needed to support its equivalence to the United States version, and its use for between-hospital comparisons. [source]

    Managed Behavioral Health Care: An Instrument to Characterize Critical Elements of Public Sector Programs

    M. Susan Ridgely
    Objective. To develop an instrument to characterize public sector managed behavioral health care arrangements to capture key differences between managed and ,unmanaged" care and among managed care arrangements. Study Design. The instrument was developed by a multi-institutional group of collaborators with participation of an expert panel. Included are six domains predicted to have an impact on access, service utilization, costs, and quality. The domains are: characteristics of the managed care plan, enrolled population, benefit design, payment and risk arrangements, composition of provider networks, and accountability. Data are collected at three levels: managed care organization, subcontractor, and network of service providers. Data Collection Methods. Data are collected through contract abstraction and key informant interviews. A multilevel coding scheme is used to organize the data into a matrix along key domains, which is then reviewed and verified by the key informants. Principal Findings This instrument can usefully differentiate between and among Medicaid fee-for-service programs and Medicaid managed care plans along key domains of interest. Beyond documenting basic features of the plans and providing contextual information, these data will support the refinement and testing of hypotheses about the impact of public sector managed care on access, quality, costs, and outcomes of care. Conclusions. If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary. [source]

    The Experimental Appraisal Instrument: A brief overview

    Ash M. Genaidy
    Background Recently, there has been a great influx in experimental research to assess the health effects of nanoparticles/materials/fibers. Currently, there is no structured methodology to assess the methodological quality of the reported studies. Objective This article reports an experimental appraisal instrument with the goal to critically assess experimental studies. Methods A search of electronic databases was conducted to examine prior work on the subject and to extract the components of such an instrument. Results The electronic search revealed no major instrument designed to evaluate experimental strategies on health effects of nanoparticles/materials/fibers. An experimental appraisal instrument was developed and was patterned after the Epidemiological Appraisal Instrument reported by Genaidy and LeMasters (2006). Conclusions The validity and reliability of such an instrument will be reported in future work. © 2008 Wiley Periodicals, Inc. [source]

    Experimental design comparison of studies evaluating doxorubicin nanoparticles in breast cancer therapy

    Farman A. Moayed
    Background The unique properties of nanoparticles (NP) qualify these colloidal systems for a wide range of medical applications, including diagnosis and treatment. Particularly in cancer therapy, NP have significantly enhanced the potential of conventional imaging, radiotherapy, and chemotherapy and, consequently, offered new avenues for early interventions. So far, breast cancer has been one of the most studied cancer types with NP research, which can benefit the occupational breast cancer for the increasing number of women in the labor force in industry. Objectives The objective of this study is to compare the experimental designs of preclinical studies that assessed the effect of doxorubicin NP (DOX-NP) on the estrogen-dependent MCF-7 breast cancer cell line using a recently established quantitative Experimental Appraisal Instrument (ExpAI). Methods A systematic review of research articles published between August 2004 and August 2005 on NP and breast cancer treatment with doxorubicin was performed using various online databases and indexes available through the University of Cincinnati. Restrictive inclusion and exclusion criteria were defined leading to selection of four relevant articles that used comparable experimental designs. Critical appraisal of those studies was performed by five independent assessors using the ExpAI version 2.0 and the results were summarized in a table of evidence. Results The study design in the selected articles was either between groups or mixed, with sample sizes varying from n = 3,6, and the evaluation of the effect of DOX-NP either in vitro or in vivo. The cytotoxic drug doxorubicin was the input variable in all studies, whereas different end points such as pharmacokinetic parameters, cytotoxicity surrogates (e.g., growth inhibition, mitochondrial activity), and quantitative analysis of messenger RNA were used as output variables. Conclusions Although the articles assessed in this article were preclinical experimental studies, the results showed that doxorubicin NP drugs can be used effectively to enhance the delivery process in MCF-7 breast cancer cells by increasing the circulation time and targeting the tumor tissues. Considering the rising number of women in the labor force and the risk of occupational breast cancer, it can be concluded that DOX-NP may potentially be used as an effective anticancer drug on humans, but further research and studies are required to understand how DOX-NP drugs might react in the human body before using it on breast cancer patients. © 2008 Wiley Periodicals, Inc. [source]

    Productivity,quality,costs,safety: A sustained approach to competitive advantage,a systematic review of the national safety council's case studies in safety and productivity

    Tushyati Maudgalya
    The marked improvement in workplace safety levels in the past few decades has resulted in companies experiencing fewer safety accidents than before, thus making it less effective to argue that money spent on workplace safety and on injury prevention will yield much bottom-line benefit. To make a compelling business case for workplace safety investment, one must link safety objectives to other business objectives. The objective of this study is to determine whether workplace safety as a business objective adds value to the business bottom line. This research reviews published case studies to determine if there is a relationship between safety initiatives and increased productivity, quality, and cost efficiencies. Eighteen case studies (17 published by the National Safety Council) were analyzed using the Workplace Safety Intervention Appraisal Instrument. The appraisal scores ranged from 0.55 to 1.27, with an average of 0.91. The case studies were relatively strong in the Evidence Reporting and Data Analysis categories, as compared to the Subject Selection, Observation Quality, and Generalization to Other Populations categories. Following workplace safety initiatives, the studies revealed an average increase of 66% (2%,104%) in productivity, 44% (4%,73%) in quality, 82% (52%,100%) in safety records, and 71% (38%,100%) in cost benefits. In a few reported cases, it took only 8 months to obtain a payback in terms of monetary investment in the safety initiative. Although the studies did display a correlation between safety, productivity, and quality, there is insufficient evidence to categorically state that the improvements in productivity, quality, and cost efficiency were brought about by the introduction of an organization-wide safety culture. Notwithstanding, there is demonstrable evidence to indicate that safety as a business objective can assist an organization in achieving the long-term benefit of operational sustainability, that is, achieve a long-term competitive advantage by balancing business costs against social costs. Further research is required to conclusively prove the exact (possibly quantifiable) impact of safety investment on increased productivity, quality, and cost efficiency. © 2008 Wiley Periodicals, Inc. [source]

    Posttraumatic play in young children exposed to terrorism: An empirical study,

    Esther Cohen Dr.
    The phenomenon of "posttraumatic play" (PTP) has received much clinical recognition and little empirical support. The objective of this study was to examine various aspects of PTP in young children exposed to terror events and their relation to posttraumatic stress disorder (PTSD). Individual play sessions, conducted with 29 young Israeli children directly exposed to terrorism (M age = 5.47, SD = 1.34) and 25 matched unexposed children (M age = 5.62, SD = 0.87), were coded using the Children's Play Therapy Instrument,Adaptation for Terror Research (CPTI-ATR; S.E. Chazan & E. Cohen, 2003). Analyses using these ratings showed (a) significant differences between the two groups, (b) significant associations with the caregiver's reports on child's exposure, and (c) significant associations with the caregiver's reports on the child's PTSD symptoms. Play activity ratings of predominant negative affects, frequent acting-out/morbid themes, lowered developmental level, and reduced awareness of the child of him- or herself as a player significantly predicted more PTSD symptoms. PTP which included more coping strategies classified as "overwhelmed reexperiencing" and less "reenactment with soothing" was associated with a higher level of PTSD. Play analysis with the CPTI-ATR may be helpful in identifying PTSD in children and also guide the selection of therapeutic techniques. [source]

    Influence of adolescent maternal characteristics on infant development

    Rachele Aiello
    The present study proposed that several adolescent maternal variables would be associated with infant development. Using a sample of 71 adolescent mother-infant dyads, the study examined the relative influences of the adolescent's level of separation-individuation (Separation-Individuation Process Inventory), feelings of attachment towards the infant (Maternal Postnatal Attachment Scale), and feelings of anxiety regarding separation (Maternal Separation Anxiety Scale) on infant mental and motor development (Bayley Scales of Infant Development, 2nd ed.). As it was assumed that the adolescent's perceptions of being parented would provide the foundation for each of these independent variables, this factor was also included (Parental Bonding Instrument). In the current sample, adolescent separation-individuation was the only maternal psychological variable to uniquely predict infant development, but only on the mental scale. Present findings highlight the importance of considering critical developmental processes of adolescence when exploring cognitive functioning and other outcomes in infants of adolescents. A number of possible mechanisms for the influence of separation-individuation are considered in the discussion. [source]

    Analysing UDROP: An Instrument for Stabilizing the International Financial Architecture

    Axel LindnerArticle first published online: 16 DEC 200
    This paper analyses implications of a proposal, called UDROP, to reform the standards of international debt contracts. The idea is to give borrowers a roll-over option at maturity for a specified length of time. Using recently developed models of financial crises, the paper shows for which type of crisis UDROP is beneficial. Moral hazard of the borrower is one of the problems UDROP faces which can be addressed by appropriately designing the debt contract. [source]

    Parental bonding and bulimic psychopathology: The mediating role of mistrust/abuse beliefs

    Caroline Meyer
    Abstract Objective To determine whether the previously reported relationship between parental bonding and bulimic psychopathology is mediated by the development of unhealthy core beliefs. Method One hundred and two nonclinical women completed the Parental Bonding Instrument, the short form of the Young Schema Questionnaire, and the Bulimic Investigatory Test, Edinburgh. Results Mistrust/abuse beliefs were found to be a partial mediator in the relationship between paternal overprotection and the severity of bulimic attitudes. Conclusions The findings suggest that the development of mistrust/abuse beliefs is important in determining the effect that paternal overprotection has on bulimic attitudes. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 229,233, 2004. [source]

    The psychosocial spiritual experience of elderly individuals recovering from stroke: a systematic review

    Marianne Lamb RN
    Abstract Objectives, The objective of this review was to appraise and synthesise best available evidence on the psychosocial spiritual experience of elderly individuals recovering from stroke. Inclusion criteria, This review considered qualitative studies whose participants were adults, mean age of 65 years and older, and who had experienced a minimum of one stroke. Studies were included that described the participant's own experience of recovering from stroke. Search strategy, The search strategy sought to find both published and unpublished studies and papers, not limited to the English language. An initial limited search of MEDLINE and CINAHL was undertaken followed by an analysis of text words contained in the title and abstract, and of index terms used to describe the article. A second extensive search was then undertaken using all identified key words and index terms. Methodological quality, Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using the Qualitative Assessment and Review Instrument (QARI) developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data collection, Information was extracted from each paper independently by two reviewers using the data extraction tool from QARI developed by the Joanna Briggs Institute. Disagreements were resolved through consultation with a third reviewer. Data synthesis, Data synthesis aimed to portray an accurate interpretation and synthesis of concepts arising from the selected population's experience during their recovery from stroke. Results, A total of 35 studies were identified and of those 27 studies were included in the review. These qualitative studies examined the perceptions of elderly individuals who had experienced a stroke. Findings were analysed using JBI-QARI. The process of meta-synthesis using this program involved categorising findings and developing synthesised topics from the categories. Four syntheses were developed related to the perceptions and experiences of stroke survivors: sudden unexpected event, connectedness, reconstruction of life and life-altering event. Conclusion, The onset and early period following a stroke is a confusing and terrifying experience. The period of recovery involves considerable psychological and physical work for elderly individuals to reconstruct their lives. For those with a spiritual tradition, connectedness to others and spiritual connection is important during recovery. The experience of stroke is a life-altering one for most elderly individuals, involving profound changes in functioning and sense of self. [source]

    Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare

    Alan Pearson RN, FRCN, FRCNA
    Abstract Objectives, The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. Inclusion criteria, This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. Search strategy, The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological quality, Methodological quality was independently established by two reviewers, using standardised techniques from the Joanna Briggs Institute (JBI) System for the Unified Management, Assessment and Review of Information (SUMARI) package. Discussion with a third reviewer was initiated where a low level of agreement was identified for a particular paper. Following inclusion, data extraction was conducted using standardised data extraction tools from the JBI SUMARI suite for quantitative and qualitative research. Data synthesis was performed using the JBI Qualitative Assessment and Review Instrument and JBI Narrative, Opinion and Text Assessment and Review Instrument software to aggregate findings by identifying commonalities across texts. Quantitative data were presented in narrative summary, as statistical pooling was not appropriate with the included studies. Results, Of the 659 identified papers, 45 were selected for full paper retrieval, and 19 were considered to meet the inclusion criteria for this review. The results identified a number of processes that would contribute to the development of a culturally competent workforce. Appropriate and competent linguistic services, and intercultural staff training and education, were identified as key findings in this review. Conclusions, The review recommends that health provider agencies establish links with organisations that can address needs of culturally diverse groups of patients, include cultural competence in decision support systems and staff education as well as embed them in patient brochures and educational materials. The review also concluded that staff in-service programs consider the skills needed to foster a culturally competent workforce, and recruitment strategies that also explicitly address this need. [source]

    Potentially inappropriate management of depressive symptoms among Ontario home care clients

    Dawn M. Dalby
    Abstract Objective To examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients. Methods A cross-sectional study of clients receiving services from Community Care Access Centres in Ontario. Three thousand three hundred and twenty-one clients were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale (DRS), a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorize treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy. Results 12.5% (n,=,414) of clients had symptoms of depression and 17% received an appropriate antidepressant. Over half of clients (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). Age 75 years or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment. Conclusion Most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardized, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings. Copyright © 2008 John Wiley & Sons, Ltd. [source]

    Comparison of the diagnostic accuracy of the Cognitive Performance Scale (Minimum Data Set) and the Mini-Mental State Exam for the detection of cognitive impairment in nursing home residents

    Louis Paquay
    Abstract Objective To compare the diagnostic accuracy of an outcome measurement scale of the Minimum Data Set of the Resident Assessment Instrument for nursing homes (MDS/RAI-NH), the Cognitive Performance Scale (CPS) and the Mini-Mental State Exam (MMSE) for the detection of cognitive impairment. The Cambridge Examination for Mental Disorders of the Elderly , Revised (CAMDEX-R) was used as the reference standard. Study design and setting This study was part of a larger prospective study (QUALIDEM) involving a diagnostic procedure and two-year follow-up on the quality of primary care for demented patients. CAMDEX-R and MDS/RAI-NH were administered to 198 residents, aged 65 or more, living in 42 low and high care institutions for aged people. Main outcome measures Indicators of diagnostic accuracy: sensitivity, specificity, predictive values, likelihood ratios, odds ratio and area under receiver operating characteristics curve (AUC). Results The CAMDEX-based prevalence of cognitive impairment was 75%. The diagnostic values of a CPS score of two or more for the detection of cognitive impairment were: sensitivity,=,0.81; specificity,=,0.80; PPV,=,0.92; NPV,=,0.57. The diagnostic values of a MMSE score of less than or equal 23 were: sensitivity,=,0.97; specificity,=,0.59; PPV,=,0.88; NPV,=,0.85. For CPS, the area under the receiver operating characteristic (ROC) curve was 0.87 (95% CI, 0.81,0.91), and not significantly different (p,=,0.63) from the MMSE score, 0.88 (0.83,0.93). Conclusions CPS and MMSE demonstrated similar performance to detect cognitive impairment in nursing home residents. Copyright © 2006 John Wiley & Sons, Ltd. [source]

    Use of antipsychotic medications among elderly residents in long-term institutional care: a three-year follow-up

    Hanna-Mari Alanen
    Abstract Objective To analyse the use of antipsychotic medications, change over time and associated factors in a three-year follow-up among elderly residents in long-term institutional care. Design Retrospective study was designed with three identical cross-sectional samples originating from the same long-term care facilities, and collected 1 July to 31 December in 2001, 2002 and 2003, in Finland. These were extracted from the Resident Assessment Instrument (RAI) database, based on Minimum Data Set (MDS) assessments. Setting Of the data providers 16 were hospital-based institutions and 25 residential homes. Participants Each of the data sets included 3662-3867 resident assessments. Results The prevalence use of one or more antipsychotic decreased from 42% in 2001 to 39% in 2003. The overall confounder-adjusted decrease in antipsychotic use was not statistically significant. However, the use of antipsychotics decreased among residents who had wandering as a behavioural problem (OR 0.79, 95% CI 0.63,0.99) and increased among residents with concomitant use of anxiolytic medications (OR 1.23, 95% CI 1.03,1.48). Conclusions The use of antipsychotic medications among residents in long-term institutional care was common and the caring patterns were quite stable during the observation period. Adequate indications may not have been achieved in all cases. More attention should be paid to the appropriate use of antipsychotics in this frail population. Copyright © 2006 John Wiley & Sons, Ltd. [source]