A systematic review of physicians' survival predictions in terminally ill cancer patients.
Humans; Terminally Ill; Survival Analysis; Longitudinal Studies; Reproducibility of Results; Analysis of Variance; Regression Analysis; Empirical Approach; Death and Euthanasia; decision making; Charting the Territory; Neoplasms/mortality; Clinical Competence/standards; Physicians/standards
OBJECTIVE: To systematically review the accuracy of physicians' clinical predictions of survival in terminally ill cancer patients. DATA SOURCES: Cochrane Library, Medline (1996-2000), Embase, Current Contents, and Cancerlit databases as well as hand searching. STUDY SELECTION: Studies were included if a physician's temporal clinical prediction of survival (CPS) and the actual survival (AS) for terminally ill cancer patients were available for statistical analysis. Study quality was assessed by using a critical appraisal tool produced by the local health authority. DATA SYNTHESIS: Raw data were pooled and analysed with regression and other multivariate techniques. RESULTS: 17 published studies were identified; 12 met the inclusion criteria, and 8 were evaluable, providing 1563 individual prediction-survival dyads. CPS was generally overoptimistic (median CPS 42 days, median AS 29 days); it was correct to within one week in 25% of cases and overestimated survival by at least four weeks in 27%. The longer the CPS the greater the variability in AS. Although agreement between CPS and AS was poor (weighted kappa 0.36), the two were highly significantly associated after log transformation (Spearman rank correlation 0.60, P < 0.001). Consideration of performance status, symptoms, and use of steroids improved the accuracy of the CPS, although the additional value was small. Heterogeneity of the studies' results precluded a comprehensive meta-analysis. CONCLUSIONS: Although clinicians consistently overestimate survival, their predictions are highly correlated with actual survival; the predictions have discriminatory ability even if they are miscalibrated. Clinicians caring for patients with terminal cancer need to be aware of their tendency to overestimate survival, as it may affect patients' prospects for achieving a good death. Accurate prognostication models incorporating clinical prediction of survival are needed.
2003
Glare P; Virik K; Jones M; Hudson M; Eychmuller S; Simes J; Christakis NA
Bmj (clinical Research Ed.)
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1136/bmj.327.7408.195" target="_blank" rel="noreferrer">10.1136/bmj.327.7408.195</a>
Parents' evaluation of developmental status: how well do parents' concerns identify children with behavioral and emotional problems?
Child; Female; Humans; Male; Parents; Age Factors; Socioeconomic Factors; Risk Factors; Reproducibility of Results; Predictive Value of Tests; Preschool; infant; Child Behavior Disorders/diagnosis/etiology; Affective Symptoms/diagnosis/etiology; Developmental Disabilities/diagnosis/etiology
This study was undertaken to determine which parental concerns are most associated with significant behavioral/emotional problems and the extent to which parents' concerns can be depended on in the detection of mental health problems. An additional goal is to view how well a recently published screening test relying on parents' concerns, Parents' Evaluation of Developmental Status (PEDS), detects behavioral and emotional problems. Subjects were a national sample of 472 parents and their children (21 months to 8 years old) who were participants in 1 of 2 test standardization and validation studies. Sites included various pediatric settings, public schools, and Head Start programs in 5 diverse geographic locations. Subjects were representative of U.S. demographics in terms of ethnicity, parental level of education, gender, and socioeconomic status. At each site, psychological examiners, educational diagnosticians, or school psychologists recruited families, and obtained informed consent. Examiners disseminated a demographics questionnaire (in English or Spanish) and a developmental screening test that relies on parents' concerns (PEDS). Examiners were blinded to PEDS' scoring and interpretation administered either by interview or in writing, the Eyberg Child Behavior Inventory (ECBI) or the Possible Problems Checklist (PPC), a subtest of the Child Development Inventory that includes items measuring emotional well-being and behavioral self-control. PEDS was used to sort children into risk for developmental disabilities according to various types of parental concern. Those identified as having high or moderate risk were nominated for diagnostic testing or screening followed by developmental and mental health services when indicated. Because their emotional and behavioral needs would have been identified and addressed, these groups were removed from the analysis (N = 177). Of the 295 children who would not have been nominated for further scrutiny on PEDS due to their low risk of developmental problems, 102 had parents with concerns not predictive of developmental disabilities (e.g., behavior, social skills, self-help skills) and 193 had no concerns at all. Of the 295 children, 12% had scores on either the ECBI or the PPC indicative of mental health problems. Two parental concerns were identified through logistic regression as predictive of mental health status: behavior (OR = 4.74, CI = 1.69-13.30); and social skills (OR = 5.76, CI = 2.46-13.50). If one or more of these concerns was present, children had 8.5 times the risk of mental health problems (CI = 3.69-19.71) In children 434 years of age and older, one or both concerns was 87% sensitive and 79% specific to mental health status, figures keeping with standards for screening test accuracy. In young children, the presence of one or both concerns was 68% sensitive and 66% specific to mental health status. The findings suggest that certain parental concerns, if carefully elicited, can be depended on to detect mental health problems when children are 41 years and older and at low risk of developmental problems. For younger children, clinicians should counsel parents in disciplinary techniques, follow up, and if suggestions were not effective, administer a behavioral-emotional screening test such as the Pediatric Symptoms Checklist or the ECBI before making a referral decision.
2003
Glascoe FP
Clinical Pediatrics
2003
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Journal Article
<a href="http://doi.org/10.1177/000992280304200206" target="_blank" rel="noreferrer">10.1177/000992280304200206</a>
Statistical aspects of measurement in palliative care
Humans; Sensitivity and Specificity; Reproducibility of Results; Bias (Epidemiology); Epidemiologic Measurements; Palliative Care/statistics & numerical data
2002
Pickering RM
Palliative Medicine
2002
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Journal Article
<a href="http://doi.org/10.1191/0269216302pm579xx" target="_blank" rel="noreferrer">10.1191/0269216302pm579xx</a>
Contrasting emotional approach coping with passive coping for chronic myofascial pain
Female; Humans; Male; Adult; Emotions; Pennsylvania; Chronic disease; Aged; Middle Aged; Socioeconomic Factors; Sex Factors; Multivariate Analysis; Activities of Daily Living; Affect; Depression; Reproducibility of Results; Regression Analysis; 80 and over; Adaptation; Psychological; Models; Facial Pain
Passive or emotion-focused coping strategies are typically related to worse pain and adjustment among chronic pain patients. Emotional approach coping (EAC), however, is a type of emotion-focused coping that appears to be adaptive in some nonpain populations but has not yet been examined in a chronic pain population. In a sample of 80 patients (75% women, M = 48.67 years of age) with chronic myofascial pain, we contrasted how EAC (assessed with the Emotional Approach Coping Scale) and 5 passive pain-coping strategies (assessed with the Vanderbilt Multidimensional Pain Coping Inventory (VMPCI)) were related to sensory and affective pain, physical impairment, and depression. Passive coping strategies were positively correlated with one another, but EAC was inversely correlated with most of them. The VMPCI passive strategies were substantially positively related to negative affect, whereas EAC was inversely related to negative affect. Controlling for potentially confounding demographics, higher EAC was related to less affective pain and depression, even after controlling for negative affect. Using passive coping strategies, in contrast, was associated with more pain, impairment, and depression, although these relations were greatly attenuated after controlling for negative affect. When considered simultaneously, EAC, but not passive coping, was related to affective pain, and both EAC and passive coping were significant correlates of depression, although in opposite directions. In secondary analyses, we found that EAC was related to less pain (particularly sensory) among men and to less depression among women. Unlike the use of passive pain-coping strategies, which are associated with worse pain and adjustment, the use of EAC (emotional processing and emotional expression) with chronic pain is associated with less pain and depression. This suggests that some emotion-focused types of pain coping may be adaptive, and it highlights the need to assess emotional coping processes that are not confounded with distress or dysfunction.
2002
Smith JA; Lumley Mark A; Longo DJ
Annals Of Behavioral Medicine: A Publication Of The Society Of Behavioral Medicine
2002
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Journal Article
<a href="http://doi.org/10.1207/s15324796abm2404_09" target="_blank" rel="noreferrer">10.1207/s15324796abm2404_09</a>
Classification and definition of disorders causing hypertonia in childhood
Child; Humans; Severity of Illness Index; Reproducibility of Results; Preschool; infant; Diagnosis; Differential; Dystonia/complications/diagnosis; Muscle Hypertonia/classification/etiology/physiopathology; Muscle Rigidity/complications/diagnosis; Muscle Spasticity/complications/diagnosis
OBJECTIVE: This report describes the consensus outcome of an interdisciplinary workshop that was held at the National Institutes of Health in April 2001. The purpose of the workshop and this article are to define the terms "spasticity," "dystonia," and "rigidity" as they are used to describe clinical features of hypertonia in children. The definitions presented here are designed to allow differentiation of clinical features even when more than 1 is present simultaneously. METHODS: A consensus agreement was obtained on the best current definitions and their application in clinical situations. RESULTS: "Spasticity" is defined as hypertonia in which 1 or both of the following signs are present: 1) resistance to externally imposed movement increases with increasing speed of stretch and varies with the direction of joint movement, and/or 2) resistance to externally imposed movement rises rapidly above a threshold speed or joint angle. "Dystonia" is defined as a movement disorder in which involuntary sustained or intermittent muscle contractions cause twisting and repetitive movements, abnormal postures, or both. "Rigidity" is defined as hypertonia in which all of the following are true: 1) the resistance to externally imposed joint movement is present at very low speeds of movement, does not depend on imposed speed, and does not exhibit a speed or angle threshold; 2) simultaneous co-contraction of agonists and antagonists may occur, and this is reflected in an immediate resistance to a reversal of the direction of movement about a joint; 3) the limb does not tend to return toward a particular fixed posture or extreme joint angle; and 4) voluntary activity in distant muscle groups does not lead to involuntary movements about the rigid joints, although rigidity may worsen. CONCLUSION: We have provided a set of definitions for the purpose of identifying different components of childhood hypertonia. We encourage the development of clinical rating scales that are based on these definitions, and we encourage research to relate the degree of hypertonia to the degree of functional ability, change over time, and societal participation in children with motor disorders.
2003
Sanger TD; Delgado MR; Gaebler-Spira D; Hallett M; Mink JW; Task Force on Childhood Motor Disorders
Pediatrics
2003
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Journal Article
<a href="http://doi.org/10.1542/peds.111.1.e89" target="_blank" rel="noreferrer">10.1542/peds.111.1.e89</a>
Content validity of a pediatric functional independence measure.
Child; Humans; Longitudinal Studies; Activities of Daily Living; Self Care; Reproducibility of Results; Psychometrics; Preschool; infant; Nursing Assessment/standards
1990
McCabe MA; Granger CV
Applied Nursing Research
1990
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Journal Article
<a href="http://doi.org/10.1016/s0897-1897(05)80128-4" target="_blank" rel="noreferrer">10.1016/s0897-1897(05)80128-4</a>
Subjective health complaints in adolescence--reliability and validity of survey methods
Female; Humans; Male; Adolescent Psychology; Interviews as Topic; Mental Health; Reproducibility of Results; Psychometrics; Health Status Indicators; Chi-Square Distribution; adolescent; Norway/epidemiology
This paper studies test-retest reliability and validity of one measure of adolescent health complaints. The test-retest included an eight-item symptom checklist developed for the survey of Health Behaviour in School-aged Children (n=344). Qualitative analysis showed adequate validity for most items. For the total sample, all items were found to have adequate intraclass correlation coefficients (ICC) in the range 0.61-0.75. There were inter-item differences and girls generally received the higher values. Most changes were within one category. Adolescents' understanding of 16 complaints was studied by interviews with 38 adolescents. A few items showed ambiguity in interviews despite adequate test-retest stability.
2001
Haugland S; Wold B
Journal Of Adolescence
2001
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Journal Article
<a href="http://doi.org/10.1006/jado.2000.0393" target="_blank" rel="noreferrer">10.1006/jado.2000.0393</a>
On the mathematical modelling of pain
Humans; Analgesia; Reproducibility of Results; Animals; Models; Pain/physiopathology; Axons/physiology; Nerve Net/physiology; Neurological; Neuronal Plasticity; Neurons/physiology; Theoretical
In this review a case is presented for the use of mathematical modelling in the study of pain. The philosophy of mathematical modelling is outlined and a recommendation is made for the use of modern nonlinear techniques and computational neuroscience in the modelling of pain. Classic and more recent examples of modelling in neurobiology in general and pain in particular, at three different levels-molecular, cellular and neural networks-are described and evaluated. Directions for further progress are indicated, particularly in plasticity and in modelling brain mechanisms. Major advantages of mathematical modelling are that it can handle extremely complex theories and it is non-invasive, and so is particularly valuable in the investigation of chronic pain.
1996
Britton NF; Skevington SM
Neurochemical Research
1996
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Journal Article
<a href="http://doi.org/10.1007/bf02532424" target="_blank" rel="noreferrer">10.1007/bf02532424</a>
Active and passive coping strategies in chronic pain patients
Female; Humans; Male; Pain; Pain Measurement; Adult; Questionnaires; Chronic disease; Aged; Middle Aged; Depression; Reproducibility of Results; Adaptation; Psychological; Sex Characteristics
This study assessed the validity of active and passive coping dimensions in chronic pain patients (n = 76) using the Coping Strategies Questionnaire and the Vanderbilt Pain Management Inventory. The validity of active and passive coping dimensions was supported; passive coping was strongly related to general psychological distress and depression, and active coping was associated with activity level and was inversely related to psychological distress. In addition, the Coping Strategies Questionnaire was found to be a more psychometrically sound measure of active and passive coping than the Vanderbilt Pain Management Inventory.
1996-03
Snow-Turek AL; Norris MP; Tan G
Pain
1996
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Journal Article
<a href="http://doi.org/10.1016/0304-3959(95)00190-5" target="_blank" rel="noreferrer">10.1016/0304-3959(95)00190-5</a>
The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress
Female; Humans; Male; Pain Measurement; Adult; Prevalence; Aged; Middle Aged; Reproducibility of Results; Analysis of Variance; Karnofsky Performance Status; 80 and over; Psychological; Stress; Neoplasms/complications; quality of life; Severity of Illness Index
The Memorial Symptom Assessment Scale (MSAS) is a new patient-rated instrument that was developed to provide multidimensional information about a diverse group of common symptoms. This study evaluated the reliability and validity of the MSAS in the cancer population. Randomly selected inpatients and outpatients (n = 246) with prostate, colon, breast or ovarian cancer were assessed using the MSAS and a battery of measures that independently evaluate phenomena related to quality of life. Symptom prevalence in the 218 evaluable patients ranged from 73.9% for lack of energy to 10.6% for difficulty swallowing. Based on a content analysis, three symptoms were deleted and two were added; the revised scale evaluates 32 physical and psychological symptoms. A factor analysis of variance yielded two factors that distinguished three major symptom groups and several subgroups. The major groups comprised psychological symptoms (PSYCH), high prevalence physical symptoms (PHYS H), and low prevalence physical symptoms (PHYS L). Internal consistency was high in the PHYS H and PSYCH groups (Cronback alpha coefficients of 0.88 and 0.83, respectively), and moderate in the PHYS L group (alpha = 0.58). Although the severity, frequency and distress dimensions were highly intercorrelated, canonical correlations and other analyses demonstrated that multidimensional assessment (frequency and distress) augments information about the impact of symptoms. High correlations with clinical status and quality of life measures support the validity of the MSAS and indicate the utility of several subscale scores, including PSYCH, PHYS, and a brief Global Distress Index. The MSAS is a reliable and valid instrument for the assessment of symptom prevalence, characteristics and distress. It provides a method for comprehensive symptom assessment that may be useful when information about symptoms is desirable, such as clinical trials that incorporate quality of life measures or studies of symptom epidemiology.
1994
Portenoy RK; Thaler HT; Kornblith AB; Lepore JM; Friedlander-Klar H; Kiyasu E; Sobel K; Coyle N; Kemeny N; Norton L; et al
European Journal Of Cancer
1994
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Journal Article
<a href="http://doi.org/10.1016/0959-8049(94)90182-1" target="_blank" rel="noreferrer">10.1016/0959-8049(94)90182-1</a>
A critical review of the Delphi technique as a research methodology for nursing
Humans; decision making; Communication; Group Processes; Reproducibility of Results; Delphi Technique; Organizational; Research Design/standards; Data Collection/methods/standards; Nursing Research/methods/standards; Questionnaires/standards
The Delphi technique is an approach used to gain consensus among a panel of experts. This is normally achieved through a series of rounds where information is fed back to panel members using questionnaires. It has been used extensively within social science research and is being increasingly employed by nurse researchers. This popularity has meant that the technique has been adapted in various ways and there is the possibility that the rigour associated with the original format has been threatened. This signals the need for a critical review of the Delphi as a robust and systematic approach to data collection. While there is a great volume of literature surrounding the "Delphi", there is a dearth of papers critically analysing the technique. This paper aims to examine critically the Delphi technique from a range of perspectives. Discussion will focus on problems of definition and the advantages and disadvantages and the techniques' application in nursing. The critique will be structured through an analysis of the key aspects of the Delphi process. These key aspects include analysis of sampling, anonymity, use of experts, rounds and application. The critical analysis highlights the increasing popularity of the Delphi and the modifications to the process which may cause methodological problems. Ultimately, the Delphi has much to offer in terms of gaining consensus from a wide range of individuals on specific topics.
2001
Keeney S; Hasson F; McKenna HP
International Journal Of Nursing Studies
2001
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Journal Article
<a href="http://doi.org/10.1016/s0020-7489(00)00044-4" target="_blank" rel="noreferrer">10.1016/s0020-7489(00)00044-4</a>
The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement
Child; Humans; Adult; Communication; Child Psychology; Reproducibility of Results; Preschool; Biomarkers of Pain; Biomarkers Reference List; Face; Pain Measurement/standards; Pain/diagnosis/psychology
The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version. In the first phase, the FPS was revised from its original seven faces to six, while maintaining its desirable psychometric properties, in order to make it compatible in scoring with other self-rating and observational scales which use a common metric (0-5 or 0-10). Using a computer-animated version of the FPS developed by Champion and colleagues (Sydney Animated Facial Expressions Scale), psychophysical methods were applied to identify four faces representing equal intervals between the scale values representing least pain and most pain. In the second phase, children used the new six-face Faces Pain Scale-Revised (FPS-R) to rate the intensity of pain from ear piercing. Its validity is supported by a strong positive correlation (r=0.93, N=76) with a visual analogue scale (VAS) measure in children aged 5-12 years. In the third phase, a clinical sample of pediatric inpatients aged 4-12 years used the FPS-R and a VAS or the colored analogue scale (CAS) to rate pain during hospitalization for surgical and non-surgical painful conditions. The validity of the FPS-R was further supported by strong positive correlations with the VAS (r=0.92, N=45) and the CAS (r=0.84, N=45) in this clinical sample. Most children in all age groups including the youngest were able to use the FPS-R in a manner that was consistent with the other measures. There were no significant differences between the means on the FPS-R and either of the analogue scales. The FPS-R is shown to be appropriate for use in assessment of the intensity of children's acute pain from age 4 or 5 onward. It has the advantage of being suitable for use with the most widely used metric for scoring (0-10), and conforms closely to a linear interval scale.
2001
Hicks CL; von Baeyer CL; Spafford PA; van Korlaar I; Goodenough B
Pain
2001
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Journal Article
<a href="http://doi.org/10.1016/s0304-3959(01)00314-1" target="_blank" rel="noreferrer">10.1016/s0304-3959(01)00314-1</a>
An evaluation of the Faces Pain Scale with young children
Child; Female; Humans; Male; Reproducibility of Results; Facial Expression; Preschool; Non-U.S. Gov't; Research Support; Pain Measurement/methods/psychology
The psychometric characteristics of the Faces Pain Scale (FPS) were evaluated in three groups of preschool and school-aged children (3. 5-4.5; 4.5-5.5 and 5.5-6.5 years, respectively). The FPS was adequately comprehended by even young children. It was easily administered and was valid and discriminating. It did not, however, possess the linear scalability claimed by its authors.
2000
Hunter M; McDowell L; Hennessy R; Cassey J
Journal Of Pain And Symptom Management
2000
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Journal Article
<a href="http://doi.org/10.1016/s0885-3924(00)00171-8" target="_blank" rel="noreferrer">10.1016/s0885-3924(00)00171-8</a>
Pediatric Functional Independence Measure: Clinical trials with disabled and nondisabled children.
Child; Female; Humans; Male; Disabled Persons; Pediatric Nursing; Longitudinal Studies; Activities of Daily Living; Reproducibility of Results; Case-Control Studies; Preschool; infant; Clinical Nursing Research; Cerebral Palsy/nursing/physiopathology; Neuromuscular Diseases/nursing/physiopathology; Nursing Assessment/methods
1996
McCabe MA
Applied Nursing Research
1996
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Journal Article
<a href="http://doi.org/10.1016/s0897-1897(96)80242-4" target="_blank" rel="noreferrer">10.1016/s0897-1897(96)80242-4</a>
Can the needs of the critically ill child be identified using scenarios? Experiences of a modified Delphi study
Child; Humans; Questionnaires; Pilot Projects; Reproducibility of Results; Delphi Technique; Evaluation Studies; Intensive Care/statistics & numerical data; Critical Illness/nursing; Health Services Needs and Demand/statistics & numerical data
The Delphi technique enables the structuring of group opinion and discussion using a survey approach, maintaining the anonymity of panel members and preventing contamination of individual responses through peer pressure. The Delphi technique was used by the authors to form an expert opinion regarding the needs of a critically ill child. The abstract and evaluative nature of need was a key issue to arise during early pilot work and stimulated the first author to undertake a concept analysis of the term 'need'. The defining attributes arising from the concept analysis were used to construct two hypothetical case studies for the modified Delphi; these were used as part of the questionnaire for all three rounds. In the first round, the panel was asked to identify the needs of the child in the two case studies; in subsequent rounds the panel activity involved modifying these need statements and indicating the importance, frequency and maximum acceptable delay in meeting each need. Extensive pilot work was required for each round of the modified Delphi. This article evaluates the use of this technique to identify needs, discusses key features arising from the results and examines the difficulties experienced by the respondents in completing the time scales.
1999
Endacott R; Clifford CM; Tripp JH
Journal Of Advanced Nursing
1999
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Journal Article
<a href="http://doi.org/10.1046/j.1365-2648.1999.01116.x" target="_blank" rel="noreferrer">10.1046/j.1365-2648.1999.01116.x</a>
Differences in pediatric ICU mortality risk over time
Child; Humans; Intensive Care Units; Logistic Models; Prospective Studies; Age Factors; Severity of Illness Index; Risk Assessment; Hospitals; Reproducibility of Results; Predictive Value of Tests; Pediatric; ICU Decision Making; United States/epidemiology; Age Distribution; Health Care; Quality Assurance; Hospital Mortality/trends; Hospital Bed Capacity; Intensive Care/standards/trends; Pediatric/standards/statistics & numerical data/trends; University
OBJECTIVES: To compare pediatric intensive care unit (ICU) mortality risk using models from two distinct time periods; and to discuss the implications of changing mortality risk for severity systems and quality-of-care assessment. DATA SOURCES AND SETTING: Consecutive admissions (n = 10,833) from 16 pediatric ICUs across the United States that participate in the Pediatric Critical Care Study Group were recorded prospectively. Data collection occurred during a 12-mo period beginning in January 1993. METHODS: Data collection for the development and validation of the original Pediatric Risk of Mortality (PRISM) score occurred from 1980 to 1985. The original PRISM coefficients were used to calculate mortality probabilities in the current data set. Updated estimates of mortality probabilities were calculated, using coefficients from a logistic regression analysis using the original PRISM variable set. Quality-of-care tests were performed using standardized mortality ratios. RESULTS: Risk of mortality from pediatric ICU admission improved considerably between the two periods. Overall, the reduction in mortality risk averaged 15% (p < .001). Analysis of mortality risk by age indicated a large improvement for younger infants. The mortality risk for infants <1 mo improved by 39% (p < .001). Mortality risk improved by 28% (p < .001) for infants between 1 and 12 mos. Analysis of mortality risk by principal diagnosis indicated substantial improvement in respiratory diseases, including respiratory diseases developing in the perinatal period. The mortality risk for respiratory diseases improved by 45% (p < .001). The improvement in mortality risk substantially deteriorated the calibration of the original PRISM severity system (p < .001). As a result of changing mortality risk, the standardized mortality ratios across the 16 pediatric ICUs demonstrated substantial disparities, depending on the choice of models. CONCLUSIONS: This study documents differences in pediatric ICU risk of mortality over time that are consistent with a general improvement in the quality of pediatric intensive care. Despite continued widespread use of the original PRISM, recent improvements in pediatric ICU quality of care have negated its usefulness for many intended applications, including quality-of-care assessment.
1998
Tilford JM; Roberson PK; Lensing S; Fiser DH
Critical Care Medicine
1998
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Journal Article
<a href="http://doi.org/10.1097/00003246-199810000-00032" target="_blank" rel="noreferrer">10.1097/00003246-199810000-00032</a>
Improvement in pediatric critical care outcomes
Humans; Intensive Care Units; Hospital Mortality; Logistic Models; Reproducibility of Results; Bias (Epidemiology); Statistical; ICU Decision Making; Data Interpretation; Outcome Assessment (Health Care)/organization & administration; Health Services Research/methods; Data Collection/methods; Pediatric/standards
2000
Tilford JM; Roberson PK; Lensing S; Fiser DH
Critical Care Medicine
2000
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Journal Article
<a href="http://doi.org/10.1097/00003246-200002000-00072" target="_blank" rel="noreferrer">10.1097/00003246-200002000-00072</a>
Measurement of the validity of utility elicitations performed by computerized interview
Humans; Adult; Aged; Middle Aged; Choice Behavior; Patient Satisfaction; Reproducibility of Results; adolescent; Non-U.S. Gov't; P.H.S.; Research Support; U.S. Gov't; Nonparametric; Statistics; Akathisia; Drug-Induced/etiology; Antipsychotic Agents/adverse effects; Dyskinesia; Interviews/standards; Multimedia/standards; Parkinson Disease; Schizophrenia/drug therapy; Schizophrenic Psychology; Secondary/chemically induced
OBJECTIVES: The authors evaluate a measure of the validity of utility elicitations and study the potential effects of invalid elicitations on population utility values. METHODS: The authors used a computerized survey to describe and measure preferences for three common side-effects of anti-psychotic drugs (tardive dyskinesia [TD], akathesia [AKA], pseudo-parkinsonism). The authors compared the validity of elicitations in 41 healthy volunteers to 22 schizophrenic patients. Preferences were measured using visual analog scale (VAS), pair-wise comparison (PWC), and the Standard Gamble (SG) methods. To assess the validity of each groups' responses, the authors compared the consistency of subjects' rank-order of the desirability of states across methods of preferences assessment (CAMPA). RESULTS: All healthy volunteers and 82% of patients completed the computer survey; of these subjects, 97% of healthy volunteers and 70% of patients indicated they thought they understood the task required of them. However, only 78% of healthy subjects and 44% of patients had a consistent rank ordering of preferences among VAS and PWC ratings; only 80% and 61%, respectively, had a consistent rank ordering preferences among SG and PWC ratings. For two of the three health states, inconsistent subjects had statistically higher SG utilities (for TD, 0.94 versus 0.87, and for AKA 0.92 versus 0.86; P < 0.05). CONCLUSIONS: The CAMPA test can identify potentially invalid preference ratings. Potentially invalid preference ratings may bias the "population" utilities for health states.
1997
Lenert LA; Morss S; Goldstein MK; Bergen MR; Faustman WO; Garber AM
Medical Care
1997
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Journal Article
<a href="http://doi.org/10.1097/00005650-199709000-00004" target="_blank" rel="noreferrer">10.1097/00005650-199709000-00004</a>
The Delphi method?
Humans; decision making; Data Collection; Research Design; Organizational Objectives; Reproducibility of Results; Delphi Technique; Organizational Policy; Non-U.S. Gov't; Research Support; Organizational; Nursing Research/methods/organization & administration
1997
Crisp J; Pelletier D; Duffield C; Adams A; Nagy S
Nursing Research
1997
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Journal Article
<a href="http://doi.org/10.1097/00006199-199703000-00010" target="_blank" rel="noreferrer">10.1097/00006199-199703000-00010</a>
The Delphi technique: a worthwhile research approach for nursing?
Humans; Choice Behavior; Reproducibility of Results; Delphi Technique; decision making; Research Personnel/psychology; Judgment; Nursing Research/education/methods/standards
Since its introduction as a research approach in the late 1940s the Delphi technique has had over 1000 published research utilizations. Most of these have been in the field of social policy. However, a review of contemporary nursing literature suggests that it is becoming a popular choice among nurse researchers. With its focus on maximizing participant's judgements and decision-making abilities the Delphi technique is a useful tool in the research armoury of a young profession. However, questions remain about its scientific respectability. This paper gives an overview of what the Delphi technique is, the criteria for selecting it as a research approach, the studies where it has been used and its advantages and disadvantages.
1994
McKenna HP
Journal Of Advanced Nursing
1994
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Journal Article
<a href="http://doi.org/10.1111/j.1365-2648.1994.tb01207.x" target="_blank" rel="noreferrer">10.1111/j.1365-2648.1994.tb01207.x</a>
Validity of the McGill Quality of Life Questionnaire in the palliative care setting: a multi-centre Canadian study demonstrating the importance of the existential domain
Humans; Palliative Care; Questionnaires; Longitudinal Studies; Mental Health; Sensitivity and Specificity; Reproducibility of Results; quality of life; Neoplasms/psychology; Mental Status Schedule; Multicenter Studies as Topic
This study was carried out in eight palliative care services in four Canadian cities. A revised version of The McGill Quality of Life Questionnaire (MQOL) is compared to a single-item scale measuring overall quality of life (SIS), and the self-administered version of the Spitzer Quality of Life Index (SA-QLI), to obtain evidence of validity. MQOL total score predicts SIS better than does SA-QLI, although much of the variance remains to be explained. The results of principal components analysis of data using this revised version of MQOL are similar to those from previous MQOL studies with different patient populations. The MQOL subscales, constructed on the basis of principal components analysis, demonstrate acceptable internal consistency reliability. The MQOL measures reflecting physical well-being and existential well-being are important for predicting SIS.
1997
Cohen SR; Mount BM; Bruera E; Provost M; Rowe J; Tong K
Palliative Medicine
1997
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Journal Article
<a href="http://doi.org/10.1177/026921639701100102" target="_blank" rel="noreferrer">10.1177/026921639701100102</a>
Assessing preferences about the DNR order: does it depend on how you ask?
Female; Humans; Male; Attitude to Health; Treatment Outcome; Choice Behavior; Resuscitation Orders; Quality-Adjusted Life Years; Research Design; Probability; Reproducibility of Results; Non-U.S. Gov't; Research Support; Students; Questionnaires/standards; Effect Modifiers (Epidemiology); Nursing/psychology; Resuscitation/adverse effects
Despite increasing emphasis on advance directives, there has been little methodologic work to assess preferences about the "do not resuscitate" (DNR) order. This developmental work assessed, in a non-patient group, the performance of a probability-trade-off task designed to assess DNR attitudes, in terms of framing effects and stability of preferences. 105 female nursing students each completed one of two versions of the task. In version I (n = 58), the trade-off moved to increasingly negative descriptions of the outcomes of resuscitation (decreasing chance of survival and increasing risk of brain death), whereas in version II (n = 47), the trade-off moved to increasingly positive descriptions. One week later, repeat assessments were obtained for versions I (n = 35) and II (n = 28). The DNR preference scores were lower and more stable when the task moved to increasingly positive descriptions; perhaps this version of the task tends to weaken risk aversion. These results imply that care should be used in applying a probability trade-off task to the assessment of DNR preferences, since artefactual effects could be induced.
1995
Percy ME; Llewellyn-Thomas HA
Medical Decision Making
1995
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Journal Article
<a href="http://doi.org/10.1177/0272989x9501500303" target="_blank" rel="noreferrer">10.1177/0272989x9501500303</a>
Using a treatment-tradeoff method to elicit preferences for the treatment of locally advanced non-small-cell lung cancer
Female; Humans; Male; Attitude to Health; Aged; Treatment Outcome; Choice Behavior; Decision Support Techniques; Survival Analysis; Feasibility Studies; Reproducibility of Results; Non-U.S. Gov't; Research Support; Comparative Study; Adjuvant; Chemotherapy; Carcinoma; Questionnaires/standards; Antineoplastic Agents/adverse effects/therapeutic use; Lung Neoplasms/psychology/radiotherapy; Non-Small-Cell Lung/psychology/radiotherapy; Prostatic Neoplasms/psychology/radiotherapy; Radiotherapy/adverse effects/methods
The study was designed to evaluate a treatment-tradeoff method for its potential in helping lung cancer patients make treatment decisions. A treatment-tradeoff interview was conducted to determine how patients weighed potential survival benefits against the potential toxicities of different treatment options: 1) low-dose versus high-dose radiotherapy, and 2) high-dose radiotherapy versus combination chemo-radiotherapy. Fifty-six patients who had experienced cancer and 20 clinic staff participated; twenty of these participants repeated the interview in an assessment of response consistency. The treatment-tradeoff method proved feasible: all staff and 53 of the 56 patients were able to complete the process. A wide range of threshold scores across participants was observed for both tradeoffs. Sixty percent of the patients would accept the more toxic combination therapy over high-dose radiotherapy if the former offered a 10% absolute improvement in three-year survival. The method also proved reliable: test-retest correlations were high (tau ranged from 0.7 to 0.87 and r from 0.82 to 0.94) and test-retest mean score differences were low (1.3-4.2). The most clinically useful measure of consistency was a "preference consistency" index, which revealed that most patients declared the same treatment preference at test and retest. The authors conclude that, while there is great interindividual variability in willingness to accept aggressive treatments for lung cancer, patients' values can be consistently elicited with the tradeoff method. The method has potential for clinical application in decision making and for health-care policy development.
1998
Brundage MD; Davidson JR; Mackillop WJ; Feldman-Stewart D; Groome P
Medical Decision Making
1998
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Journal Article
<a href="http://doi.org/10.1177/0272989x9801800302" target="_blank" rel="noreferrer">10.1177/0272989x9801800302</a>
Choices and control: parental experiences in pediatric terminal home care
Child; Humans; Choice Behavior; Internal-External Control; Reproducibility of Results; Observer Variation; adolescent; Preschool; Adaptation; Psychological; Parents/psychology; location of death; Home Care Services/statistics & numerical data; Caregivers/psychology/statistics & numerical data; Interviews/methods; Terminal Care/psychology/statistics & numerical data
During the past decade, palliative care at home has become an alternative option to hospital care for terminally ill children. This study describes the experience of caring for a dying child at home from a parent's perspective. A qualitative research design was used to conduct and analyze data. Nonstandardized, focused interviews were conducted with 10 families. Thematic content analysis assisted in deriving themes from the transcripts of the interviews. "Choice and control" was the major theme that linked all the other concepts, and it appeared to be fundamental to parental coping strategies. Most parents were willing to take responsibility for the nursing care of their child, including administration of intravenous medication. The patient's home was the overwhelming choice of parents for delivery of terminal care, with most parents perceiving it as their child's choice also.
Vickers JL; Carlisle C
Journal Of Pediatric Oncology Nursing
2000
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Journal Article
<a href="http://doi.org/10.1177/104345420001700103" target="_blank" rel="noreferrer">10.1177/104345420001700103</a>
The sorcerer's broom: medicine's rampant technology
Humans; Attitude to Health; Attitude of Health Personnel; Social Values; Risk Assessment; Reproducibility of Results; Power (Psychology); Ethics; Uncertainty; Medical; Physicians/psychology; Diffusion of Innovation; Health Care and Public Health; Technology; science; Dehumanization
Discusses the impact of technology on the practice of medicine. Effect of technology to medical inflation; Influence of technology on the attempt to reform the health care system and on the redirection of the goals of health care system; Problems related to medical technology; Technological solutions to medical problems, Pitfalls of technology as it relates to medical practice.
1993
Cassell EJ
The Hastings Center Report
1993
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Journal Article
<a href="http://doi.org/10.2307/3562922" target="_blank" rel="noreferrer">10.2307/3562922</a>
Equivalence reliability of the functional independence measure for children (WeeFIM) administration methods.
Child; Female; Humans; Male; Interviews as Topic; Longitudinal Studies; Activities of Daily Living; Reproducibility of Results; Psychometrics; Observer Variation; Disability Evaluation; Preschool; infant; Cerebral Palsy/rehabilitation; Developmental Disabilities/rehabilitation; Down Syndrome/rehabilitation
OBJECTIVE: This study examined the equivalence reliability of two administration methods for the Functional Independence Measure for Children (WeeFIM). The two methods were direct observation of child performance and parental interview. METHOD: Thirty children between the ages of 19 months and 71 months with identified developmental disabilities were included in this study. The direct observation and interview methods were administered in random order to each subject within a 3-week period. The direct observation was completed in the educational setting, and the WeeFIM interview was obtained by either in-person interview or telephone interview with the parent. RESULTS: The intraclass correlation coefficient (ICC) for total WeeFIM ratings was .93, indicating consistency between the two administration methods. Analysis of the WeeFIM Motor (13 items) and Cognitive (5 items) domains yielded ICC values of .93 and .75, respectively, suggesting greater consistency for items measuring motor-related skills. CONCLUSION: The results demonstrate good agreement for total ratings when the WeeFIM is administered by direct observation and by interview with a parent. The findings establish the clinical usefulness of information collected by clinical interview.
1997
Sperle PA; Ottenbacher KJ; Braun SL; Lane SJ; Nochajski S
The American Journal Of Occupational Therapy.: Official Publication Of The American Occupational Therapy Association
1997
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Journal Article
<a href="http://doi.org/10.5014/ajot.51.1.35" target="_blank" rel="noreferrer">10.5014/ajot.51.1.35</a>
The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability
Female; Male; Palliative Care; Adult; Aged; Reproducibility of Results; Predictive Value of Tests; Karnofsky Performance Status; 80 and over; Non-U.S. Gov't; Comparative Study; Human; quality of life; Support; Middle Age; Questionnaires; Neoplasms/psychology/therapy
This is the first report on the McGill Quality of Life Questionnaire (MQOL), a questionnaire relevant to all phases of the disease trajectory for people with a life-threatening illness. This questionnaire differs from most others in three ways: the existential domain is measured; the physical domain is important but not predominant; positive contributions to quality of life are measured. This study was conducted in a palliative care setting. Principal components analysis suggests four subscales: physical symptoms, psychological symptoms, outlook on life, and meaningful existence. Construct validity of the subscales is demonstrated through the pattern of correlations with the items from the Spitzer Quality of Life Index. The importance of measuring the existential domain is highlighted by the finding that, of all the MQOL subscales and Spitzer items, only the meaningful existence subscale correlated significantly with a single item scale rating overall quality of life.
1995
Cohen SR; Mount BM; Strobel MG; Bui F
Palliative Medicine
1995
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Journal Article
Exploring consumer views of care provided by the Macmillan nurse using the critical incident technique
Reproducibility of Results; Human; Patient Satisfaction; London; Research Design/standards; Attitude of Health Personnel; Role; Nurse Clinicians/standards; Nursing Evaluation Research/methods/standards; Oncologic Nursing/methods/standards
This study focuses on descriptive accounts of one Macmillan nurse's work, as provided by key individuals coming into contact with this specialist professional service. Twenty respondents (eight patients, five carers, five district nurses and two general practitioners) were interviewed using a variation of the critical incident technique. Data were analysed in terms of meaningful observed events (critical happenings) that were perceived as effective or ineffective with respect to the delivery of high-quality nursing care. Some variations were found between groups of respondents in their perception of the nurse's role. However, there was a general emphasis on the possession of specialist knowledge of terminal cancer care and the positive impact of interventions to both the patient and to lay and professional carers. The critical incident technique was found to be a valuable method for eliciting detailed accounts of the work of the nurse in this specialized field of practice.
1993
Cox K; Bergen A; Norman IJ
Journal Of Advanced Nursing
1993
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Journal Article
The Spanish version of the dementia quality of life questionnaire: a validation study
Female; Humans; Male; Aged; Middle Aged; Severity of Illness Index; European Continental Ancestry Group; Sensitivity and Specificity; Reproducibility of Results; Spain; Diagnostic and Statistical Manual of Mental Disorders; Language; 80 and over; Quality of Life/psychology; Questionnaires/standards; Dementia/diagnosis/physiopathology/psychology; Psychometrics/instrumentation; Translations
BACKGROUND: The aim of the study was to adapt and validate culturally the dementia-specific health-related quality of life instrument (HRQoL) into Spanish for patients with mild to moderate dementia. METHODS: Two forward translations, a reconciled version, and then a back translation were completed and subjected to expert review. A total of 112 patients with dementia, diagnosed according to DSM-IV criteria, from six centres providing care for persons with dementia in Spain participated in the study. The following patient-reported information was obtained by interview: demographics, subjective perception of health, depressive symptoms (Geriatric Depression Scale-15; GDS-15), functional ability (Barthel Index), and both generic (World Health Organization Quality of Life; WHOQOL-BREF) and dementia-specific quality of life (DQoL). RESULTS: The Spanish version of the DQoL showed acceptable psychometric properties. Internal consistency (Cronbach's alpha) was acceptable for most of the DQoL scales. As expected, associations were found between DQoL scales and the WHOQOL-BREF psychological domain and the GDS-15, indicating good validity. Neither functional status nor severity of dementia was associated with QoL; but depressive symptoms and self-reported feeling ill had a negative association on QoL. CONCLUSIONS: The results showed that the Spanish version of the DQoL has comparable psychometric properties to the US version. The DQoL appears to be a reliable and valid instrument intended to be administered to patients with mild/moderate dementia who are living at home.
Lucas-Carrasco R; Gomez-Benito J; Rejas J; Brod M
Aging & Mental Health
2011
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Journal Article
<a href="http://doi.org/10.1080/13607863.2010.543658" target="_blank" rel="noreferrer">10.1080/13607863.2010.543658</a>
The effectiveness of a self-reporting bedside pain assessment tool for oncology inpatients
Female; Humans; Male; Neoplasms; Pain Measurement; Adult; Prospective Studies; Aged; Middle Aged; Patient Satisfaction; Reproducibility of Results; Self Report; 80 and over; Republic of Korea
BACKGROUND: Pain is common during cancer treatment, and patient self-reporting of pain is an essential first step for ideal cancer pain management. However, many studies on cancer pain management report that, because pain may be underestimated, it is often inadequately managed. OBJECTIVE: The aim of this study was to evaluate the effectiveness of bedside self-assessment of pain intensity for inpatients using a self-reporting pain board. METHODS: Fifty consecutive inpatients admitted to the Oncology Department of Chungbuk National University Hospital were included in this observational prospective study from February 2011 to December 2011. The medical staff performed pain assessments by asking patients questions and using verbal rated scales (VRS) over 3 consecutive days. Then, for 3 additional days, patients used a self-reporting pain board attached to the bed, which had movable indicators representing 0-10 on a numeric rating scale (NRS) and the frequency of breakthrough pain. RESULTS: Patient reliability over the medical staff's pain assessment increased from 74% to 96% after applying the self-reporting pain board (p=0.004). The gap (mean±standard deviation [SD]) between the NRS reported by patients and the NRS recorded on the medical records decreased from 3.16±2.08 to 1.00±1.02 (p<0.001), and the level of patient satisfaction with pain management increased from 54% to 82% (p=0.002). CONCLUSION: This study suggests that the self-reporting bedside pain assessment tool provides a reliable and effective means of assessing pain in oncology inpatients.
Kim EB; Han Hye-Suk; Chung JH; Park BR; Lim Sung-Nam; Yim KH; Shin YD; Lee KH; Kim Wun-Jae; Kim ST
Journal Of Palliative Medicine
2012
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Journal Article
<a href="http://doi.org/10.1089/jpm.2012.0183" target="_blank" rel="noreferrer">10.1089/jpm.2012.0183</a>
The quality of the evidence base for clinical pathway effectiveness: room for improvement in the design of evaluation trials.
Humans; Length of Stay; Risk Assessment; Clinical Trials as Topic; Reproducibility of Results; Randomized Controlled Trials as Topic; Bias (Epidemiology); Meta-Analysis as Topic; Evidence-Based Medicine; Selection Bias; Critical Pathways/st [Standards]; Guidelines as Topic; Outcome and Process Assessment (Health Care); Research Design/st [Standards]
BACKGROUND: The purpose of this article is to report on the quality of the existing evidence base regarding the effectiveness of clinical pathway (CPW) research in the hospital setting. The analysis is based on a recently published Cochrane review of the effectiveness of CPWs., METHODS: An integral component of the review process was a rigorous appraisal of the methodological quality of published CPW evaluations. This allowed the identification of strengths and limitations of the evidence base for CPW effectiveness. We followed the validated Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria for randomized and non-randomized clinical pathway evaluations. In addition, we tested the hypotheses that simple pre-post studies tend to overestimate CPW effects reported., RESULTS: Out of the 260 primary studies meeting CPW content criteria, only 27 studies met the EPOC study design criteria, with the majority of CPW studies (more than 70%) excluded from the review on the basis that they were simple pre-post evaluations, mostly comparing two or more annual patient cohorts. Methodologically poor study designs are often used to evaluate CPWs and this compromises the quality of the existing evidence base., CONCLUSIONS: Cochrane EPOC methodological criteria, including the selection of rigorous study designs along with detailed descriptions of CPW development and implementation processes, are recommended for quantitative evaluations to improve the evidence base for the use of CPWs in hospitals.
Kinsman L; James E; Machotta A; Steyerberg EW
Bmc Medical Research Methodology
2012
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Journal Article
<a href="http://doi.org/10.1186/1471-2288-12-80" target="_blank" rel="noreferrer">10.1186/1471-2288-12-80</a>