Measuring Health: A Guide to Rating Scales and Questionnaires

Background Epidemiologic studies have reported differences in the use of cardiovascular procedures according to the race and sex of the patient. Whether the differences stem from differences in the recommendations of physicians remains uncertain. Methods We developed a computerized survey instrument to assess physicians' recommendations for managing chest pain. Actors portrayed patients with particular characteristics in scripted interviews about their symptoms. A total of 720 physicians at two national meetings of organizations of primary care physicians participated in the survey. Each physician viewed a recorded interview and was given other data about a hypothetical patient. He or she then made recommendations about that patient's care. We used multivariate logistic-regression analysis to assess the effects of the race and sex of the patients on treatment recommendations, while controlling for the physicians' assessment of the probability of coronary artery disease as well as for the age of the patient, the level of coronary risk, the type of chest pain, and the results of an exercise stress test. Results The physicians' mean (±SD) estimates of the probability of coronary artery disease were lower for women (probability, 64.1±19.3 percent, vs. 69.2±18.2 percent for men; P<0.001), younger patients (63.8±19.5 percent for patients who were 55 years old, vs. 69.5±17.9 percent for patients who were 70 years old; P<0.001), and patients with nonanginal pain (58.3±19.0 percent, vs. 64.4±18.3 percent for patients with possible angina and 77.1±14.0 percent for those with definite angina; P<0.001). Logistic-regression analysis indicated that women (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) and blacks (odds ratio, 0.60; 95 percent confidence interval, 0.4 to 0.9; P=0.02) were less likely to be referred for cardiac catheterization than men and whites, respectively. Analysis of race–sex interactions showed that black women were significantly less likely to be referred for catheterization than white men (odds ratio, 0.4; 95 percent confidence interval, 0.2 to 0.7; P=0.004). Conclusions Our findings suggest that the race and sex of a patient independently influence how physicians manage chest pain.

The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization

Objective: To develop clinical practice guidelines for the support of the patient and family in the adult, pediatric, or neonatal patient-centered ICU. Participants: A multidisciplinary task force of experts in critical care practice was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM) to include representation from adult, pediatric, and neonatal intensive care units. Evidence: The task force members reviewed the published literature. The Cochrane library, Cinahl, and MedLine were queried for articles published between 1980 and 2003. Studies were scored according to Cochrane methodology. Where evidence did not exist or was of a low level, consensus was derived from expert opinion. Consensus Process: The topic was divided into subheadings: decision making, family coping, staff stress related to family interactions, cultural support, spiritual/religious support, family visitation, family presence on rounds, family presence at resuscitation, family environment of care, and palliative care. Each section was led by one task force member. Each section draft was reviewed by the group and debated until consensus was achieved. The draft document was reviewed by a committee of the Board of Regents of the ACCM. After steering committee approval, the draft was approved by the SCCM Council and was again subjected to peer review by this journal. Conclusions: More than 300 related studies were reviewed. However, the level of evidence in most cases is at Cochrane level 4 or 5, indicating the need for further research. Forty-three recommendations are presented that include, but are not limited to, endorsement of a shared decision-making model, early and repeated care conferencing to reduce family stress and improve consistency in communication, honoring culturally appropriate requests for truth-telling and informed refusal, spiritual support, staff education and debriefing to minimize the impact of family interactions on staff health, family presence at both rounds and resuscitation, open flexible visitation, way-finding and familyfriendly signage, and family support before, during, and after a death. (Crit Care Med 2007; 35:605‐622)

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Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005.

Guidelines for Exercise Testing and Prescription

This paper describes the development of a multidimensional self-report measure of interoceptive body awareness. The systematic mixed-methods process involved reviewing the current literature, specifying a multidimensional conceptual framework, evaluating prior instruments, developing items, and analyzing focus group responses to scale items by instructors and patients of body awareness-enhancing therapies. Following refinement by cognitive testing, items were field-tested in students and instructors of mind-body approaches. Final item selection was achieved by submitting the field test data to an iterative process using multiple validation methods, including exploratory cluster and confirmatory factor analyses, comparison between known groups, and correlations with established measures of related constructs. The resulting 32-item multidimensional instrument assesses eight concepts. The psychometric properties of these final scales suggest that the Multidimensional Assessment of Interoceptive Awareness (MAIA) may serve as a starting point for research and further collaborative refinement.

/pdf/the-multidimensional-assessment-of-interoceptive-awareness-3je7dttp62.pdf

The Multidimensional Assessment of Interoceptive Awareness (MAIA).

Gender bias in the diagnosis and treatment of coronary artery disease

Spiritual expression has been proposed as a dimension of quality of life. Persons with chronic diseases such as AIDS or cancer have described the value of spiritual expression in living with their illnesses. The authors examined the role spirituality plays in the lives of 58 people with heart failure being treated medically or by transplant. Instruments used included the Medical Outcome Survey Short Form 36 and Index of Well-Being measures of quality of life, the Spiritual Well-Being Scale, and the Relative Importance Scale. Combined spirituality scores predicted 24% of the variance in global quality of life. There were no significant gender differences in spiritual well-being or quality of life.

Spirituality in Persons with Heart Failure

This paper offers a guide for those seeking to integrate the Scholarship of Teaching and Learning (SoTL) into higher education institutions to improve the quality of student learning. The authors posit that weaving SoTL into institutional cultures requires the coordinated actions of individuals working in linked social networks rather than individuals acting in isolation. Analyzing both the barriers and potential pathways to integrating SoTL into institutional cultures, the authors provide a conceptual model along with examples of practical strategies for overcoming resistance to change within institutions. The paper provides examples from a variety of different international contexts to show how incentives and other non-coercive measures can motivate faculty and administrators to weave SoTL into institutional fabrics. Drawing on social network theory and the concept of communities of practice, the paper presents a model with attendant strategies for disseminating SoTL values and practices across all three levels of postsecondary institutions: the micro, the meso, and the macro. The authors argue that for SoTL to take root in organizational cultures, there must be 1) effective communication and dissemination of SoTL activity across all levels, 2) well established social networks and links between these levels (nodes), and 3) sustained support by senior administrationThe authors conclude by suggesting ways their model could be tested.

https://journalhosting.ucalgary.ca/index.php/TLI/article/download/57385/43158

The Power of Social Networks: A Model for Weaving the Scholarship of Teaching and Learning into Institutional Culture

Although clinical genetic testing is available for over 1,000 inherited disorders, consequences of predictive genetic testing have been most extensively examined for hereditary breast and ovarian cancer (HBOC), hereditary colon cancer, and Huntington disease (HD). These focus primarily on psychological, ethical, legal, and social aspects of genetic testing. Genetic testing may also provide information that can lead to behaviors that promote health and reduce risk for disease, reflecting options available for the disorder for which the person is at risk. However, regardless of condition, people completing a genetic test may inform relatives about the results of the test and implications for their risk to develop the condition. Literature on risk reduction behaviors and communication focuses on families with HBOC or colorectal cancer. Few reports document behaviors for other conditions. This paper presents a systematic review of the research literature on risk reduction and health promotion behaviors follow...

Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders

https://www.ccnursing.theclinics.com/article/S0899-5885(02)00028-X/pdf

Theresa A. Beery

Papers

Gender bias in the diagnosis and treatment of coronary artery disease

Spirituality in Persons with Heart Failure

The Power of Social Networks: A Model for Weaving the Scholarship of Teaching and Learning into Institutional Culture

Risk reduction and health promotion behaviors following genetic testing for adult-onset disorders

Sex differences in infection and sepsis