ObjectivesTo evaluate the validity and psychometric properties of the Chinese Person-Centred Prim... more ObjectivesTo evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population.DesignA cross-sectional study.SettingA primary care clinic in Hong Kong.Participants300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test–retest reliability.Outcome measuresThe construct validity, reliability and sensitivity of the Chinese PCPCM.ResultsThe Chinese PCPCM was identified to have a one-factor construct, with good item fit and unidimensionality on Rasch analysis. Internal reliability was high (Cronbach’s alpha >0.8) with moderate test–retest reliability (intraclass correlation coefficient=0.622, p<0.001). Si...
Purpose: Some patients may be at greater risk than others of enrolling on a randomized clinical t... more Purpose: Some patients may be at greater risk than others of enrolling on a randomized clinical trial (RCT) without fully understanding the implications. To investigate this possibility, this study poses the question, Do non–English-speaking Latino parents of children with leukemia show differences in their discussion of and understanding of an RCT when compared with English-speaking minority parents and with English-speaking majority (ie, white) parents? This research hypothesizes that factors such as social and educational status and the role of language interpreters may account for significant differences in the discussion and understanding of an RCT among the three groups. Patients and Methods: A total of 108 parents are reported on, all of whom were observed, interviewed, and audiotaped during informed-consent discussions about participation in an RCT with their child’s oncologist. Comparisons among the groups were performed using χ2 tests and a one-way analysis of variance. Re...
Purpose To examine stability versus change in parental understanding of random assignment in rand... more Purpose To examine stability versus change in parental understanding of random assignment in randomized clinical trials (RCTs) for pediatric leukemia and to identify factors associated with changes in understanding. Methods Eighty-four parents of children diagnosed with acute lymphoblastic leukemia or acute myeloid leukemia who were enrolled onto a pediatric leukemia RCT at one of six US children's hospitals participated. Parents were interviewed twice, once within 48 hours after the Informed Consent Conference (ICC; time 1 [T1]) and again 6 months later (time 2 [T2]). Interviews focused on parental understanding of key components of the RCT, including random assignment. Interviews were audiotaped, transcribed, and later analyzed. Results Changes in understanding of random assignment occurred in 19% of parents, with 17% of parents deteriorating in understanding from T1 to T2. Forty-nine percent of parents failed to understand random assignment at both times. Factors associated w...
The purposes of this study were (a) to replicate the previously reported influence of age and edu... more The purposes of this study were (a) to replicate the previously reported influence of age and education on neuropsychological test performance with a much larger sample of adults and (b) to add to the provisional norms for adult medical-surgical patients without evidence of neurological disease. While hospitalized awaiting cardiac surgery, 322 male and female adults between the ages of 40 and 69 yr. were given the Trail Making Test (Parts A and B) from the Halstead-Reitan Battery, the Visual Reproduction subtest from the Wechsler Memory Scale Form II, and the Logical Memory Scale from the Wechsler Memory Scale Form I. Both age and level of education were strongly associated with performance on the Trail Making Test. On the two subtests of the Wechsler Memory Scale, education alone was associated with test performance. These findings point to the potential danger of falsely classifying adults of older ages or with lower education as possibly having an organic brain syndrome. Regressi...
The Journal of the American Board of Family Medicine, 1997
Background: Increasing demand for primary care physicians has led some to recommend that family p... more Background: Increasing demand for primary care physicians has led some to recommend that family physicians focus on ambulatory care, leaving inpatient care to hospital-based physicians only. This study examines the current level of family physician involvement in the care of hospitalized patients and the factors which determine that involvement. Methods: A questionnaire was sent to a random sample of 415 practicing family physician members of the American Academy of Family Physicians. An inpatient involvement score was generated based on responses to a series of hypothetical clinical scenarios involving hospitalized patients. Physician and practice characteristics were tested for associations with the involvement score. Results: The typical responding physician (n = 228) was male, married, and board certified, with an average age of 45 years and in community-based practice. The median number of annual admissions was 60. Independent predictors of inpatient involvement were younger ph...
Psychopathological and Neurological Dysfunctions Following Open-Heart Surgery, 1982
Major heart surgical procedures have become some of the most common and fastest growing types of ... more Major heart surgical procedures have become some of the most common and fastest growing types of surgical procedures performed in referral hospitals in the Unites States. While no precise data appear to be available, federal authorities estimate that over 110 000 major heart surgical procedures were performed last year in the United States. While the future incidence of congenital and rheumatic heart disease requiring surgery is uncertain, there is little doubt that coronary artery bypass graft surgery has ex perienced explosive growth in the United States within the last 10 years and that the total numbers of procedures performed annually is increasing even though its efficacy has only partly been investigated.
The Journal of Continuing Education in Nursing, 1997
A study was conducted to evaluate a substance abuse component of a workshop for nurses being prom... more A study was conducted to evaluate a substance abuse component of a workshop for nurses being promoted to the position of Advanced Clinical Nurse. We compared whether the 88 nurses who received the educational intervention increased their knowledge and enhanced their feelings of competence regarding the care of chemically dependent patients more than a control group of nurses who received the promotion workshop without the substance abuse component. The nurses in the intervention group had greater increases in knowledge and competence. This study points out the importance of providing hospital nurses with continuing education on substance abuse to compensate for their educational deficiencies, to provide the information they need and desire, and to help them meet the ANA&amp;amp;amp;amp;#39;s practice standards.
This article describes the development of scales to assess grief and anger in widowhood and divor... more This article describes the development of scales to assess grief and anger in widowhood and divorce. Widows have significantly higher grief scores than do divorcees, but the two groups do not differ in the degree of anger they report. Grief and anger scores are higher for widows and divorcees with social and psychological vulnerabilities and demographic characteristics that have been hypothesized as making them at greater risk for difficulties in adjustment. The data are from age, race, and census tract of residence-matched samples of widows and divorcees interviewed approximately 3 months after the death of or filing for divorce from their spouses.
Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic an... more Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic and biologic features. Yet few large cohort studies describing the prevalence, incidence, and risk factors for intermittent claudication have been done. The authors evaluated intermittent claudication in 10,059 Israeli men aged 40-65 years, of whom 8,343 were free of coronary heart disease and symptoms of peripheral vascular disease; this latter group was followed for 5 years from 1963 to 1968. Prevalent and incident cases of intermittent claudication were defined by the London School of Hygiene Cardiovascular Disease Questionnaire, and all cardiovascular disease risk factor evaluations were standardized. Baseline prevalence was 27.0/1,000 (211/10,029). A total of 360 previously healthy men developed intermittent claudication for a crude 5-year incidence rate of 43.1/1,000 (360/8,343) or a crude annual incidence of 8.6/1,000. Following univariate analysis with demographic, physiologic, psychosocial, and other cardiovascular disease variables, logistic regression was used to identify risk factors for intermittent claudication. These were the following: &gt; 20 cigarettes per day, odds ratio (OR) = 2.02, 95% confidence interval (CI) 1.54-2.66; serum cholesterol (50-mg/dl difference), OR = 1.35, 95% CI 1.18-1.54; 11-20 cigarettes per day, OR = 1.69, 95% CI 1.24-2.30; anxiety (high vs. low), OR = 1.85, 95% CI 1.29-2.65; socioeconomic status, OR = 1.82, 95% CI 1.26-2.64; and diabetes, OR = 1.85, 95% CI 1.25-2.75. Other significant predictors of smaller magnitude included in the regression were age, psychosocial coping factors, Quetelet&#39;s index, and exsmoking. The risk factors for intermittent claudication were a blend of those related to myocardial infarction (smoking, cholesterol, diabetes, but not hypertension) and others related to angina pectoris but not to myocardial infarction (stress and coping variables). There is reason to believe that preventing or modifying these factors will prove effective in altering the natural history and clinical outcomes of peripheral vascular disease as shown in other forms of atherosclerosis.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 31, 2016
A reliable measure capable of detecting progression towards smoking cessation would be valuable f... more A reliable measure capable of detecting progression towards smoking cessation would be valuable for evaluating and optimizing the effectiveness of low- to moderate-intensity cessation interventions, such as brief advice in the primary care setting. This article presents the development and evaluation of a brief self-report measure of Incremental Behavior Change toward Smoking cessation (IBC-S). Sequential samples of 411 and 399 adult smokers completed items representing a spectrum of behavioral and cognitive changes antecedent to smoking cessation. The dimensionality, fit, range of difficulty, and reliability of items were evaluated using factor analysis and Rasch modeling. The final 15-item IBC-S measure met fit criteria and demonstrated acceptable reliability. Participants with a significant change in IBC-S score were over four times more likely to report cessation at 6-week follow-up (OR 4.37, 95% CI 1.83-10.42). The IBC-S is brief, reliable and associated with self-report of smo...
ObjectivesTo evaluate the validity and psychometric properties of the Chinese Person-Centred Prim... more ObjectivesTo evaluate the validity and psychometric properties of the Chinese Person-Centred Primary Care Measure (PCPCM) in a Chinese-speaking population.DesignA cross-sectional study.SettingA primary care clinic in Hong Kong.Participants300 Chinese adult patients (150 males and 150 females) were recruited from a primary care clinic to complete a questionnaire containing the PCPCM, Consultation and Relational Empathy (CARE), Patient Enablement Index (PEI) and Adult (short version) Primary Care Assessment Tool (PCAT). The Chinese PCPCM was readministered to 118 participants after 14 days for test–retest reliability.Outcome measuresThe construct validity, reliability and sensitivity of the Chinese PCPCM.ResultsThe Chinese PCPCM was identified to have a one-factor construct, with good item fit and unidimensionality on Rasch analysis. Internal reliability was high (Cronbach’s alpha >0.8) with moderate test–retest reliability (intraclass correlation coefficient=0.622, p<0.001). Si...
Purpose: Some patients may be at greater risk than others of enrolling on a randomized clinical t... more Purpose: Some patients may be at greater risk than others of enrolling on a randomized clinical trial (RCT) without fully understanding the implications. To investigate this possibility, this study poses the question, Do non–English-speaking Latino parents of children with leukemia show differences in their discussion of and understanding of an RCT when compared with English-speaking minority parents and with English-speaking majority (ie, white) parents? This research hypothesizes that factors such as social and educational status and the role of language interpreters may account for significant differences in the discussion and understanding of an RCT among the three groups. Patients and Methods: A total of 108 parents are reported on, all of whom were observed, interviewed, and audiotaped during informed-consent discussions about participation in an RCT with their child’s oncologist. Comparisons among the groups were performed using χ2 tests and a one-way analysis of variance. Re...
Purpose To examine stability versus change in parental understanding of random assignment in rand... more Purpose To examine stability versus change in parental understanding of random assignment in randomized clinical trials (RCTs) for pediatric leukemia and to identify factors associated with changes in understanding. Methods Eighty-four parents of children diagnosed with acute lymphoblastic leukemia or acute myeloid leukemia who were enrolled onto a pediatric leukemia RCT at one of six US children's hospitals participated. Parents were interviewed twice, once within 48 hours after the Informed Consent Conference (ICC; time 1 [T1]) and again 6 months later (time 2 [T2]). Interviews focused on parental understanding of key components of the RCT, including random assignment. Interviews were audiotaped, transcribed, and later analyzed. Results Changes in understanding of random assignment occurred in 19% of parents, with 17% of parents deteriorating in understanding from T1 to T2. Forty-nine percent of parents failed to understand random assignment at both times. Factors associated w...
The purposes of this study were (a) to replicate the previously reported influence of age and edu... more The purposes of this study were (a) to replicate the previously reported influence of age and education on neuropsychological test performance with a much larger sample of adults and (b) to add to the provisional norms for adult medical-surgical patients without evidence of neurological disease. While hospitalized awaiting cardiac surgery, 322 male and female adults between the ages of 40 and 69 yr. were given the Trail Making Test (Parts A and B) from the Halstead-Reitan Battery, the Visual Reproduction subtest from the Wechsler Memory Scale Form II, and the Logical Memory Scale from the Wechsler Memory Scale Form I. Both age and level of education were strongly associated with performance on the Trail Making Test. On the two subtests of the Wechsler Memory Scale, education alone was associated with test performance. These findings point to the potential danger of falsely classifying adults of older ages or with lower education as possibly having an organic brain syndrome. Regressi...
The Journal of the American Board of Family Medicine, 1997
Background: Increasing demand for primary care physicians has led some to recommend that family p... more Background: Increasing demand for primary care physicians has led some to recommend that family physicians focus on ambulatory care, leaving inpatient care to hospital-based physicians only. This study examines the current level of family physician involvement in the care of hospitalized patients and the factors which determine that involvement. Methods: A questionnaire was sent to a random sample of 415 practicing family physician members of the American Academy of Family Physicians. An inpatient involvement score was generated based on responses to a series of hypothetical clinical scenarios involving hospitalized patients. Physician and practice characteristics were tested for associations with the involvement score. Results: The typical responding physician (n = 228) was male, married, and board certified, with an average age of 45 years and in community-based practice. The median number of annual admissions was 60. Independent predictors of inpatient involvement were younger ph...
Psychopathological and Neurological Dysfunctions Following Open-Heart Surgery, 1982
Major heart surgical procedures have become some of the most common and fastest growing types of ... more Major heart surgical procedures have become some of the most common and fastest growing types of surgical procedures performed in referral hospitals in the Unites States. While no precise data appear to be available, federal authorities estimate that over 110 000 major heart surgical procedures were performed last year in the United States. While the future incidence of congenital and rheumatic heart disease requiring surgery is uncertain, there is little doubt that coronary artery bypass graft surgery has ex perienced explosive growth in the United States within the last 10 years and that the total numbers of procedures performed annually is increasing even though its efficacy has only partly been investigated.
The Journal of Continuing Education in Nursing, 1997
A study was conducted to evaluate a substance abuse component of a workshop for nurses being prom... more A study was conducted to evaluate a substance abuse component of a workshop for nurses being promoted to the position of Advanced Clinical Nurse. We compared whether the 88 nurses who received the educational intervention increased their knowledge and enhanced their feelings of competence regarding the care of chemically dependent patients more than a control group of nurses who received the promotion workshop without the substance abuse component. The nurses in the intervention group had greater increases in knowledge and competence. This study points out the importance of providing hospital nurses with continuing education on substance abuse to compensate for their educational deficiencies, to provide the information they need and desire, and to help them meet the ANA&amp;amp;amp;amp;#39;s practice standards.
This article describes the development of scales to assess grief and anger in widowhood and divor... more This article describes the development of scales to assess grief and anger in widowhood and divorce. Widows have significantly higher grief scores than do divorcees, but the two groups do not differ in the degree of anger they report. Grief and anger scores are higher for widows and divorcees with social and psychological vulnerabilities and demographic characteristics that have been hypothesized as making them at greater risk for difficulties in adjustment. The data are from age, race, and census tract of residence-matched samples of widows and divorcees interviewed approximately 3 months after the death of or filing for divorce from their spouses.
Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic an... more Intermittent claudication, myocardial infarction, and angina pectoris share many epidemiologic and biologic features. Yet few large cohort studies describing the prevalence, incidence, and risk factors for intermittent claudication have been done. The authors evaluated intermittent claudication in 10,059 Israeli men aged 40-65 years, of whom 8,343 were free of coronary heart disease and symptoms of peripheral vascular disease; this latter group was followed for 5 years from 1963 to 1968. Prevalent and incident cases of intermittent claudication were defined by the London School of Hygiene Cardiovascular Disease Questionnaire, and all cardiovascular disease risk factor evaluations were standardized. Baseline prevalence was 27.0/1,000 (211/10,029). A total of 360 previously healthy men developed intermittent claudication for a crude 5-year incidence rate of 43.1/1,000 (360/8,343) or a crude annual incidence of 8.6/1,000. Following univariate analysis with demographic, physiologic, psychosocial, and other cardiovascular disease variables, logistic regression was used to identify risk factors for intermittent claudication. These were the following: &gt; 20 cigarettes per day, odds ratio (OR) = 2.02, 95% confidence interval (CI) 1.54-2.66; serum cholesterol (50-mg/dl difference), OR = 1.35, 95% CI 1.18-1.54; 11-20 cigarettes per day, OR = 1.69, 95% CI 1.24-2.30; anxiety (high vs. low), OR = 1.85, 95% CI 1.29-2.65; socioeconomic status, OR = 1.82, 95% CI 1.26-2.64; and diabetes, OR = 1.85, 95% CI 1.25-2.75. Other significant predictors of smaller magnitude included in the regression were age, psychosocial coping factors, Quetelet&#39;s index, and exsmoking. The risk factors for intermittent claudication were a blend of those related to myocardial infarction (smoking, cholesterol, diabetes, but not hypertension) and others related to angina pectoris but not to myocardial infarction (stress and coping variables). There is reason to believe that preventing or modifying these factors will prove effective in altering the natural history and clinical outcomes of peripheral vascular disease as shown in other forms of atherosclerosis.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, Jan 31, 2016
A reliable measure capable of detecting progression towards smoking cessation would be valuable f... more A reliable measure capable of detecting progression towards smoking cessation would be valuable for evaluating and optimizing the effectiveness of low- to moderate-intensity cessation interventions, such as brief advice in the primary care setting. This article presents the development and evaluation of a brief self-report measure of Incremental Behavior Change toward Smoking cessation (IBC-S). Sequential samples of 411 and 399 adult smokers completed items representing a spectrum of behavioral and cognitive changes antecedent to smoking cessation. The dimensionality, fit, range of difficulty, and reliability of items were evaluated using factor analysis and Rasch modeling. The final 15-item IBC-S measure met fit criteria and demonstrated acceptable reliability. Participants with a significant change in IBC-S score were over four times more likely to report cessation at 6-week follow-up (OR 4.37, 95% CI 1.83-10.42). The IBC-S is brief, reliable and associated with self-report of smo...
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