Computerized health maintenance tracking systems: a clinician's guide to necessary and optional features. A report from the American Cancer Society Advisory Group on Preventive Health Care Reminder Systems

BACKGROUND: To promote preventive health care by primary care physicians and the development of computerized health maintenance tracking systems, the American Cancer Society sponsored an expert advisory group to define necessary and desirable, but optional features of computer-based health maintenance tracking software for use in primary care practice. METHODS: Systematic literature review and structured consensus development were followed by independent expert critique. RESULTS: Necessary input features include a comprehensive, practice-specific health maintenance protocol, multiple entry codes to indicate the current status of each procedure, and a mechanism for patient-specific exclusion or alteration of procedure frequency. Necessary features of the information management system include a linkage to a demographic data system, optional tracking of all or selected patients, identification of each patient's primary provider, and the ability to provide either a paper or electronic interface for the provider. Necessary outputs include provider reminders, patient reminders sent regularly regardless of visit status, and summary reports of provider and patient compliance. CONCLUSIONS: Although the ideal computer-based health maintenance tracking system is still evolving, knowledge of these necessary and optional features can aid clinicians interested in buying or developing a system for their own practice.     

Beginning the Decade of Behavior.

This year marks the opening of the Decade of Behavior. The idea for a Decade of Behavior began with the American Psychological Association's Board of Scientific Affairs, but it has expanded into a multidisciplinary collaboration backed by numerous behavioral and social science organizations and with an advisory committee representing a dozen disciplines. The advisory committee has developed four themes that form the core of the initiative: health, education, safety, and promoting a more prosperous and democratic society. What does this effort mean for readers of the Journal of Experimental Psychology: General? It is an occasion to celebrate our successes: to reflect on what we do that is in fact relevant to the focus areas of the Decade. It is also a time to think about how we can make this relevance more evident both within our community and to the groups of other researchers and practitioners who can enrich and apply what we do. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the preparation of interns: Views of trainers and trainees.

Surveyed 64 directors of training and 55 representative interns at American Psychological Association-approved internship sites about orientation procedures. Ss rated the importance, initial intern awareness, and orientation coverage of 18 items concerning aspects of professional functioning. Interns and directors of training agreed on the rank ordering of items but differed in the values they gave each item. Interns thought that their initial knowledge was greater than attributed to them by directors, and directors claimed their orientation was more complete than interns reported. It is suggested that interns should be questioned before orientation to determine what they need and be assessed after orientation to determine whether they have learned and integrated the necessary information. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Underperforming doctors: a postal survey of the Northern Deanery

OBJECTIVES: To discover the perceived size of pool of doctors considered to be underperforming in general practice in the Northern Deanery and to discover whether these perceptions are based on formal assessments. DESIGN: Postal questionnaire. SETTING: Area covered by the Northern Deanery. SUBJECTS: Seven health authority directors of primary care, seven secretaries of local medical committees, and 14 chief officers of community health councils. RESULTS: The response rate was 100% for directors of primary care and secretaries of local medical committees and, after one reminder, 92% for chief officers of community health councils. Numbers of doctors perceived to be underperforming ranged from none to over 15 in different health authority areas. Main areas for concern were communication skills, clinical skills, and management skills. Patients' representatives were concerned about lack of power of patients and health authorities and doctors' lack of accountability. Health authorities were concerned about lack of power, identification of underperforming doctors, and doctors' professional loyalty. Local medical committees were concerned about the problem of identifying underperformance. A number of methods were used for identification, and there was no common method applied. CONCLUSIONS: The number of doctors thought to be underperforming was small. Work still needs to be done on developing tools that can be used in everyday practice to enable doctors to confirm for themselves, their colleagues, and their patients that they are providing an adequate level of care.     

The decade of behavior: An opportunity for family psychology.

In the past, we have had the decade of the brain. Now, as behavioral scientists and practitioners, it is our turn and the period from 2000-2010 is the Decade of Behavior. The American Psychological Association's Board of Scientific Affairs initiated this idea, which is now sponsored by a host of behavioral and social science organizations. With an advisory committee representing a dozen disciplines, this is a ground-breaking multidisciplinary effort that aims to raise awareness of the importance of behavioral aspects of our lives. Five major themes guide this initiative: health, safety, education, prosperity, and democracy. I want to bring this important idea to your attention as both readers and authors of articles in the Journal of Family Psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rasch measurement for reducing the items of the Nottingham Health Profile

The present study aimed to develop a short form of the Spanish version of the Nottingham Health Profile (NHP) by means of Rasch analysis. Data from several Spanish studies that included the NHP since 1987 were collected in a common database. Forty-five different studies were included, covering a total of 9,419 subjects both from the general population and with different clinical pathologies. The overall questionnaire (38 items) was simultaneously analyzed using the dichotomous response model. Parameter estimates, model-data fit and separation statistics were computed. The items of the NHP were additionally regrouped into two different scales: Physical (19 items) and Psychological (19 items). Separated Physical and Psychological parameter estimates were produced using the simultaneous item calibrations as anchor values. Misfitting items were deleted, resulting in a 22 item final short form (NHP22)-11 Physical and 11 Psychological-. The evaluation of the item hierarchies confirmed the construct validity of the new questionnaire. To demonstrate the invariance of the NHP22 item calibrations, Rasch analyses were performed separately for each study included in the sample and for several sociodemographic and health status variables. Results confirmed the validity of using the NHP22 item calibrations to measure different groups of people categorized by gender, clinical and health status.     

Physical disability construct convergence across instruments: towards a universal metric

OBJECTIVES: This study examines the stability of a physical disability construct across instruments and samples. The purpose is not to report a formal equating of instrument calibrations, but to indicate whether such an effort would be likely to succeed. Theory. The economics transforming health care from its orientation toward crisis-driven disease reactions to population- and evidence-based preventive health management and individualized disease management demand general scale-free measures of functional independence. METHODS: A new method, pseudo-common item equating, is demonstrated. Similar, but not identical items, from different instruments, calibrated on different samples, are compared. DATA: More than 30 articles presenting Rasch analyses of physical functioning scales were reviewed. Four instruments provided data from ten of these articles, for eleven different calibrations (two instruments are both included in one article). RESULTS: The final overall average correlation disattenuated for error is .93, with an average of 7 pseudo-common items, and an average p-value of .01, meaning that measures based on these calibrations should be linearly transformable versions of the same metric. Scientific importance. The quantitative stability of different areas of physical functional independence across instruments and samples suggests that the development and deployment of a universal metric is a realizable goal.     

Student written comments: Dimensions of instructional quality.

Students' written comments to 4 open-ended questions used in end-of-semester student evaluations of 60 courses from 10 different fields, taught by instructors of different ranks, were content analyzed and classified into 22 categories. Approximately 50% of the comments were about the instructor, with 1 of 4 comments pertaining to the instructor's pedogogical skills. The degree of favorableness of written comments about the instructor and course was sufficiently convergent with ratings based on fixed alternative items measuring overall instructor performance and course quality. Students provided similar evaluations of course and instructor quality on both open-ended and fixed alternative items; nevertheless, each type of item provides useful and different information. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Procalcitonin as a marker of systemic inflammation after conventional or minimally invasive coronary artery bypass grafting

AIM: To undertake a review of cases from one dental advisory practice in England over a period of 5.5 years to provide a profile of the type of work undertaken. DESIGN AND SETTING: Compensation claims for dental negligence seen at one dental advisory practice between 1991 and 1996. METHODS: 437 claims were reviewed for: the nature of the complaint; defendant details; plaintiff details; method of funding; duration and outcome of claim. Comparisons were made with previously published data. The relationship between method of funding of a claim and the likelihood of the claim being successful was investigated. RESULTS: 28% of complaints concerned oral surgery and 24%, restorative procedures. In 72% of cases, the compensation claim was made directly against the dentist who had provided treatment for the patient. The majority of claims were gender and age biased; females (63%) and younger people (18-45 years of age) (68%) were more likely to bring actions for dental negligence. Only 3% involved elderly patients (> or = 60 years old). Claims supported by the government legal aid scheme were more likely to be withdrawn or rejected than those privately funded. Nearly all cases were completed in under one year (81%). CONCLUSIONS: Results are similar to previously published studies. A large proportion of claims concerned restorative or oral surgery procedures carried out in general or community practice.     

Psychology in the States.

Presents a collection of news items about psychology in the US states. The first item concerns the development of the new National Institute of Child Health and Human Development, directed by Robert A. Aldrich. The second item discusses a study examining the problem of classifying emotional disorders in children, and conducted by a group of psychologists in a behavioral classification project of the Florida State Board of Health. The third item presents comments on the recent Publications Board Report. Items from APA state newsletters make up the fourth item. The fifth item discusses state awards programs for outstanding students and science fair psychology projects. The sixth item addresses recognition of psychologists' services by insurance companies. The seventh item notes a Department of Justice ruling that services rendered by psychotherapists qualify as deductions under the medical expense section of the income tax return, even though services are rendered by other than medical practitioners. The eighth item concerns the meeting of new APA committees. The ninth item makes note of a new report surveying Federal scientific activity. The final item contains a "more truth than poetry" item from an old issue of Medical World News. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Confirmatory factor analysis of items with a dichotomous response format using the multidimensional Rasch model.

Two models that can be used for exploratory factor analysis of items with a dichotomous response format are discussed: threshold models and multidimensional item response models. The models arise from different traditions: The threshold model is rooted in the factor analytic tradition, the multidimensional item response model had its foundation in item response theory. Despite the different origins, it can be proved that both models are the same. Subsequently, the generalized multidimensional Rasch model is introduced. This model can be used for confirmatory factor analysis of items with a dichotomous response format. Stated otherwise, it is the confirmatory counterpart of the (exploratory) threshold and multidimensional item response models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ventilator: selection of mechanical ventilators

A comprehensive ventilator selection process can be a time-consuming and an overwhelming task. The needs assessment becomes the primary driving tool in the design of the selection process. From the needs assessment, the evaluation can be planned and organized according to the facility requirements, time constraints, and resources. The strategy can expand to an extensive project or have a succinct and condensed design. The needs assessment determines the criteria for the selection, whether it be cost, ventilator specifications, educational needs, manufacturer support needs, maintenance requirements, accessory items, or combinations of any item. Once the data have been collected, it must be analyzed and critiqued. How this examination is performed can be expansive or scaled down according to the facility's resources. Important items in the selection must be maintained and used more extensively in the decision, whereas less important items take a backseat in the operation. The final selection comes from the culmination of the entire process.     

Utilization of psychologists in positions of responsibility in public mental health programs: A national survey.

Describes a 1969 survey of mental health programs in all 50 states. To document current status and provide precedence data, the survey sought information concerning positions including these at a divisional level within state programs and as program director of community mental health centers. 1/2 the states had psychologists as divisional chiefs, while in 75% of the states, the principle of competence in the appointment of local community mental health program directors was formally recognized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a questionnaire for measurement of vision-related quality of life

PURPOSE: To define vision-related quality of life, to outline the development of a vision-specific quality of life instrument and to present the characteristics of a 10-item 'core' questionnaire. METHOD: A standard method included: 1. Generation of relevant issues by individual interviews with 38 visually impaired adults, consultation with 37 professionals and support workers and literature review. 2. Operationalisation, involving 58 ophthalmic patients. 3. Pre-testing, to maximise face validity and content validity, involving 184 individuals with a variety of different visual problems and social backgrounds. 4. Adoption of a modular approach to item selection. 5. Formal piloting in 92 individuals to establish reliability and construct validity. RESULTS: More than 232 items were tested of which 139 were considered suitable for a final question pool or 'parent' questionnaire (the VQOL). From this parent questionnaire individual items or groups of items can be selected. Ten broadly applicable items referring to physical, social and psychological issues were selected for the core questionnaire (the VCM1). The VCM1 has high reliability (alpha = 0.93) and validity. CONCLUSIONS: Any self-reported problem relating to vision may constitute a quality of life issue. A modular approach to item selection may provide the flexibility to investigate vision-related quality of life in a wide range of clinical settings, allowing detailed assessment of specific problems and also cross-study comparisons where appropriate.     

Use of log-linear models for assessing differential item functioning in a measure of psychological functioning.

Log-linear models are used to investigate contingency tables that cross-classify respondents according to item response, mental health status (MHS), and the background variables of ethnicity and gender. Specifically, log-linear models are used to examine item validity, defined as an item response by MHS interaction, and differential item functioning (DIF), defined as an interaction between item response and a background variable. The investigation focused on a set of items that measure subjective well-being and coping behavior. Female (n?=?627) and male (n?=?338) respondents represented 3 ethnic groups: African American, Anglo-American, and Hispanic/Latino. Strong evidence of item validity and some evidence of DIF was found. Most of the interaction between item response and either ethnicity or gender occurred among Ss with diminished mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of chronic alcohol consumption or Diazepam administration on item recognition and temporal ordering in a spatial working memory task in mice

This study was aimed at determining the effects of either Diazepam administration or chronic alcohol consumption (CAC) on spatial memory measured by concurrent discriminations in an eight arm radial maze using mice as subjects. Two different protocols involving a non-matching rule were used to evaluate either temporal order (recurrent items) or item recognition (non-recurrent items). Results showed that both Diazepam administration and CAC produced a memory deficit which was primarily observed in the temporal task, whereas item recognition was spared. These data show that Diazepam and CAC produced similar memory impairments. Thus, our study stressed the potential importance of the GABA/BDZ dysfunction in the production of organic amnesia of alcoholic origin. The overall analysis of the data suggests that both CAC and Diazepam injections would impair forms of memory sustained by automatic or incidental learning.     

Verification and extension of a system of personality dimensions.

This study continues a program devoted to the development of a system of factored homogeneous item dimensions (FHIDs) in the area of personality questionnaires. 6 multiple choice items were used for each of 32 personality dimensions and 4 validation scales. These items were dispersed in a questionnaire and administered to 506 volunteer male and female Ss, preponderately college students. 3 factor analyses of items, each with 72 items from 12 of the 36 dimensions, revealed 14 FHIDs for which every item had a loading of .5 or more. Factor analysis of the 36 total FHID score variables plus 9 background data variables resulted in the major personality factors: shyness, dependence, dominance, hostility, and compulsiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parameters of normalcy in transient otoacoustic emissions

This study analyzed and assessed dimensions of a questionnaire developed to measure general fears and phobias. A previous factor analysis among 109 dental phobics had revealed a five-factor structure with 22 items and an explained total variance of 54%. The present study analyzed the same material using a multivariate statistical procedure (LISREL) to reveal structural latent variables. The LISREL analysis, based on the correlation matrix, yielded a chi-square of 216.6 with 195 degrees of freedom (P = 0.138) and showed a model with seven latent variables. One was a general fear factor correlated to all 22 items. The other six factors concerned "Illness & Death" (5 items), "Failures & Embarrassment" (5 items), "Social situations" (5 items), "Physical injuries" (4 items), "Animals & Natural phenomena" (4 items). One item (opposite sex) was included in both "Failures & Embarrassment" and "Social situations". The last factor, "Social interaction", combined all the items in "Failures & Embarrassment" and "Social situations" (9 items). In conclusion, this multivariate statistical analysis (LISREL) revealed and confirmed a factor structure similar to our previous study, but added two important dimensions not shown with a traditional factor analysis. This reduced FSS-II version measures general fears and phobias and may be used on a routine clinical basis as well as in dental phobia research.