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BACKGROUND: Family and professional caregivers of individuals with dementia often witness care-receiver's lucidity events. OBJECTIVE: A qualitative data analysis was performed of documented family and professional caregivers' experiences and their respective appraisals of lucidity events. RESEARCH DESIGN AND METHODS: Using a reduction method of selection, data from 10 in-home family caregivers and 20 professional caregivers to long-term care residents was content-coded and analysed. Framed by a priori research questions, a summative approach to qualitative content analysis guided the interpretation of findings. RESULTS: Eight of 10 family- and 15 of 20 staff caregivers gave an example of what they believed was a witnessed lucid event; 88% of family- and 40% of staff caregivers' provided examples that appeared to fit the conceptual definition of lucidity. The emotional impact that the events had on both sets of caregivers was reported. Family caregivers' characterization of lucidity events reflected appraisals of a puzzling occurrence while staff caregivers depicted elements associated with dementia, and lucidity descriptors. The enhanced verbal communication followed by the brief, unexpected quality of lucidity, were the main elements highlighted by both sets of caregivers in their description of lucidity to others. The variability and complexity of the lucidity phenomenon and the potential challenges it poses for both sets of caregivers were characterized. Commonalities and divergences across responses were highlighted. DISCUSSION: Findings validated previous studies' results. The notions introduced by both types of caregivers were thought-provoking and borne practical, clinical, ethical, and assessment (measurement) applicability.
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Cuidadores , Demencia , Investigación Cualitativa , Humanos , Cuidadores/psicología , Demencia/psicología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Actitud del Personal de Salud , Emociones , Anciano de 80 o más Años , Adulto , Familia/psicología , Cuidados a Largo Plazo/psicología , ComunicaciónRESUMEN
Objectives: Resident-to-resident aggression (RRA) in long-term care facilities is gaining recognition as a serious problem. Racial/ethnic conflict may be a contributing factor to RRA incidents, but it remains insufficiently studied. Our goal was to explore overt racial/ethnic conflict in RRA. Design: We used quantitative and qualitative secondary analyses of existing data from a large, rigorously conducted study of RRA to describe the involved residents and patterns of overt racial/ethnic conflicts. Setting and Participants: The parent study included information of 2011 residents in 10 randomly selected New York State nursing homes with a wide range of racial/ethnic minority residents (4.2%-63.2%). A subset of 407 residents were involved in RRA. Methods: We re-examined data from the parent study, which used an innovative approach to identify RRA incidents by reconstructing each incident based on residents' self-reports, staff interviews, field observations, and medical chart review. Resident and facility information was collected. Results: A total of 35 residents (8.6% of those involved in RRA incidents) were identified as involved in overt racial/ethnic conflicts. These residents were more likely to have had less education than residents involved in other types of RRA but not in overt racial/ethnic conflicts. More than half (56.9%) of the 51 incidents of RRA involving overt racial/ethnic conflict between a specific pair of residents occurred repeatedly. Manifestation of racial/ethnic conflicts included physical violence, discrimination, racial/ethnic slurs, stereotypes, and microaggression. Acute precipitants of these incidents included various communal-living challenges and unmet needs at the facility, relational, and individual levels. Psychological and behavioral consequences were also described. Conclusion and Implications: We found a broad range of manifestations, acute precipitants, circumstances surrounding, and consequences of overt racial/ethnic conflicts in RRA. Additional research is needed to improve understanding of this phenomenon and how staff may effectively intervene and prevent it.
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Agresión , Cuidados a Largo Plazo , Casas de Salud , Humanos , Masculino , Femenino , Anciano , New York , Anciano de 80 o más Años , Minorías Étnicas y RacialesRESUMEN
BACKGROUND: Though prior literature has demonstrated that communication in the Neonatal Intensive Care Unit (NICU) needs to be improved, in-depth descriptions of parents' views of NICU communication are lacking. PURPOSE: We sought (1) to explore parent perceptions of communication in the NICU and (2) to understand parents' communication needs and preferences. METHODS: We conducted in-depth semi-structured cognitive interviews utilizing concurrent probes with parents of 10 patients in our urban level IV Neonatal Intensive Care Unit over a period of 4 months (July 2021-October 2021). Interview questions were derived from the Quality of Communication scale. We conducted thematic analysis of interview transcripts modeled after work by Braun and Clarke. RESULTS: Four overarching themes were identified: Strengths, Challenges, People, and Coping Strategies. Parents reported a range of communication quality in the NICU. Results revealed that the first 48 hours of NICU hospitalization represent a period of vulnerability and uncertainty for parents. Parents value clear yet hopeful communication about a baby's clinical status and expected course. IMPLICATIONS FOR PRACTICE AND RESEARCH: We hope that the concrete findings from this study can both inform practice in the NICU now and influence practice guidelines to include such components as emphasis on the first 48 hours, desire for proactive information sharing, and the importance of including hope.
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Comunicación , Unidades de Cuidado Intensivo Neonatal , Padres , Relaciones Profesional-Familia , Humanos , Padres/psicología , Recién Nacido , Femenino , Masculino , Adulto , Adaptación Psicológica , Investigación Cualitativa , Entrevistas como AsuntoRESUMEN
Importance: Resident-to-resident aggression in assisted living facilities can result in physical and psychological harm, but its prevalence is unknown. Objective: To estimate the prevalence of resident-to-resident aggression, including physical, verbal, and sexual, among residents in assisted living facilities. Design, Setting, and Participants: This study used cross-sectional, observational data from a clinical trial, in which residents of assisted living facilities were monitored for events over a 1-month period. All residents of 14 large facilities randomly selected from 2 geographic locations (N = 1067), except those receiving hospice care (n = 11), were invited to participate; 93 died or moved prior to enrollment. There were 33 family and resident refusals; 930 residents were enrolled. Data were collected between May 30, 2018, and August 11, 2022. Main Outcomes and Measures: The data are from a clinical trial testing the effectiveness of an intervention to reduce resident-to-resident aggression. In addition, the study was designed to assess prevalence using the Time 1 (baseline) data, using a probability sample of facilities to allow for this analysis. Resident-to-resident aggression was identified using a mixed-method, case-finding strategy involving 6 sources: (1) cognitively capable resident reports regarding 22 possible events, (2) direct care staff report, (3) staff member reports collected from event-reporting forms, (4) research assistant observation of events in real time, (5) facility accident or incident reports, and (6) resident records. Results: The prevalence of resident-to-resident aggression among the 930 participants (mean [SD] age, 88.0 [7.2] years; 738 women [79.4%]) during the past month was estimated to be 15.2% (141 of 930 residents; 95% CI, 12.1%-18.8%). The most common forms of aggression included verbal (11.2% [104 of 930 residents; 95% CI, 8.8%-14.2%]), physical (41 of 930 residents; 4.4% [95% CI, 3.1%-6.3%]), sexual (0.8% [7 of 930 residents; 95% CI, 0.4%-1.6%]), and other (70 of 930 residents; 7.5% [95% CI, 5.5%-10.2%]). These categories are not mutually exclusive as residents could be involved with more than 1 type of aggressive behavior. Conclusions and Relevance: In this cross-sectional, observational prevalence study, resident-to-resident aggression in assisted living facilities was highly prevalent. Verbal aggression was the most common form, and physical aggression also occurred frequently. The effects of resident-to-resident aggression can be both morbid and mortal; therefore, intervention research is needed to prevent it and to treat it when it occurs.
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Agresión , Instituciones de Vida Asistida , Humanos , Agresión/psicología , Estudios Transversales , Femenino , Masculino , Prevalencia , Instituciones de Vida Asistida/estadística & datos numéricos , Anciano , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Allostatic load (AL) has been studied in the context of biomarkers that may be affected by environmental and contextual stressors, including social determinants of health. The specific stressor studied here is the provision of caregiving to older persons with Alzheimer disease and related disorders. The aims were to examine the factor structure of stress and nonstress biomarkers, different methods for calculating AL, and the relationship of AL with other variables. METHODS: Latent variable models were used to examine biomarkers. Regression analyses were performed with the outcomes: AL calculated as percentile-based and clinically-based for both stress and nonstress components. The sample was 187 Hispanic caregivers to individuals with dementia. RESULTS: The results of the confirmatory factor analyses (CFAs) suggested defining 2 factors: nonstress and stress-related. Performance was better for the CFA results and the associations with covariates when stress and nonstress components were examined separately. Despite some limitations, this is one of the first studies of biomarkers in Hispanic caregivers to patients with dementia. It was possible to explain almost 30% of the variance in the nonstress AL component. CONCLUSION: It may be important to differentiate among biomarkers indicative of cardiovascular, metabolic, and immune response as contrasted with the more stress-related biomarkers.
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Alostasis , Enfermedad de Alzheimer , Biomarcadores , Cuidadores , Hispánicos o Latinos , Estrés Psicológico , Humanos , Cuidadores/psicología , Alostasis/fisiología , Masculino , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Hispánicos o Latinos/psicología , Anciano , Biomarcadores/sangre , Persona de Mediana Edad , AdultoRESUMEN
OBJECTIVES: Unexpected lucidity is a phenomenon of scientific, clinical, and psychological relevance to health professionals, to those who experience it, and their relatives. This paper describes qualitative methods used to develop an informant-based measure of lucidity episodes. METHODS: The approach was refinement of the operationalization of the construct; review of seminal items, modification, and purification; and confirmation of the feasibility of reporting methodology. Modified focus groups were conducted with 20 staff and 10 family members using a web-based survey. Themes included reaction when hearing the term; words that come to mind; description of and first reaction to referenced or observed 'lucidity' events. Semi-structured cognitive interviews were conducted with 10 health professionals working with older adults with cognitive impairment. Data were extracted from Qualtrics or Microsoft 365 Word® for analysis using NVivo. RESULTS: Conceptual issues, as well as issues regarding comprehension, interpretation, clarity, semantics, and standardization of definitions derived from an external advisory board, focus groups and cognitive interviews informed items' modification, and resulted in the final lucidity measure. CONCLUSIONS: An obstacle to understanding the mechanisms and estimating the prevalence of lucid events among individuals with dementia and other neurological conditions is the scarcity of reliable and valid measures. The substantive and varied data gathered from multiple methods including the collaborative work of an External Advisory Board, modified focus groups with staff and family caregivers, and structured cognitive interviews with health professionals were central in creating the revised version of the lucidity measure.
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Disfunción Cognitiva , Demencia , Humanos , Anciano , Cognición , Cuidadores , Grupos Focales , Demencia/psicologíaRESUMEN
Although clinicians caring for persons at the end of life recognize the phenomenon of paradoxical/terminal lucidity, systematic evidence is scant. The current pilot study aimed to develop a structured interview instrument for health care professionals to report lucidity. A questionnaire measuring lucidity length, degree, content, coinciding circumstances, and time from episode to death was expanded to include time of day, expressive and receptive communication, and speech during the month prior to and during the event. Thirty-three interviews were conducted; 73% of participants reported ever witnessing paradoxical lucidity. Among 29 events reported, 31% lasted several days, 20.7% lasted 1 day, and 24.1% lasted <1 day. In 78.6% of events, the person engaged in unexpected activity; 22.2% died within 3 days, and 14.8% died within 3 months of the event. The phenomenological complexity of lucidity presents challenges to eliciting reports in a systematic fashion; however, staff respondents were able to report lucidity events and detailed descriptions of person-specific characteristics. [Journal of Gerontological Nursing, 49(1), 18-26.].
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Cognición , Personal de Salud , Humanos , Proyectos Piloto , ComunicaciónRESUMEN
We applied machine learning algorithms to examine the relationship between demographics and outcomes of the social work services used by Hispanic family caregivers of persons with dementia recruited for a clinical trial in New York City. The social work service needs were largely concentrated on instrumental support to gain access to the healthcare system rather than other concrete services (e.g., housing or food programs) or to address psychological needs among the caregivers with relatively higher income. A finding from the machine learning approach was that among those who receive medical-related social work services, frequent users (≥10 times) with high family friend support(>4) were more likely than frequent users without such support to have their issues resolved (Accuracy: 81.9%, AUC: 0.82, F-measure: 0.86 by J48). Even though half of the participants received social work services multiple times, the needs of the caregivers remained unmet unless they sought social work services frequently (more than ten times).
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Cuidadores , Demencia , Cuidadores/psicología , Demencia/psicología , Necesidades y Demandas de Servicios de Salud , Hispánicos o Latinos , Humanos , Aprendizaje Automático , Apoyo Social , Servicio SocialRESUMEN
BACKGROUND: Resident-to-resident elder mistreatment (RREM) in nursing homes has serious physical and psychological consequences, but factors related to RREM occurrence remain unclear. This study identifies individual and environmental characteristics associated with involvement in RREM episodes. METHODS: The design was an observational study carried out in five urban and five suburban New York state nursing homes randomly selected on the basis of size and location. The sample consisted of 2011 residents in 10 facilities; 83% of facilities and 84% of eligible residents participated. RREM and potential correlates were identified through resident interviews, staff interviews, shift coupons, observation, chart review, and accident or incident reports. RESULTS: A multivariate analysis controlling for relevant covariates found that individuals involved in RREM incidents exhibit milder dementia, show behavioral symptoms, and are less functionally impaired. Although special care units (SCU) for dementia have benefits for residents, one potential hazard for SCU residents is elevated risk for RREM. CONCLUSIONS: Interventions to prevent and intervene in RREM incidents are greatly needed. The correlates identified in this research point to the need for targeted interventions, specifically for residents with milder impairment and with behavioral symptoms and individuals in SCUs.
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Demencia , Abuso de Ancianos , Anciano , Abuso de Ancianos/prevención & control , Humanos , New York , Casas de SaludRESUMEN
OBJECTIVE: To present challenges in assessment of applied cognition and the results of differential item functioning (DIF) analyses used to inform the development of a computerized adaptive test (CAT). DESIGN: Measurement evaluation cohort study. DIF analyses of 107 items were conducted across educational, age, and sex groups. DIF hypotheses informed the evaluation of the results. SETTING: Hospital-based rehabilitation from a single hospital system. PARTICIPANTS: A total of 2216 hospitalized patients (N=2216). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Applied cognition item pool from multiple sources. RESULTS: Many items were hypothesized to show DIF, particularly for age. Information was moderately high in the lower (cognitive disability) tail of the distribution, but some items were not informative. Reliability estimates were high (>0.89) across all studied groups, regardless of estimation method. There were 35 items with DIF of high magnitude and 19 with accompanying supportive hypotheses. CONCLUSIONS: A key clinical tool in inpatient rehabilitation medicine is assessment of applied functional cognitive ability to inform patient-centered rehabilitation strategies to improve function. This was the first study to evaluate measurement equivalence of the applied cognition item pool across large samples of hospitalized patients. Although about one-third of the item pool evidenced DIF or low discrimination, results supported placement of most items into the bank and its use across groups differing in education, age, and sex. Six items were classified with salient DIF, defined as consistent DIF of high magnitude and or impact, with confirmatory directional DIF hypotheses, generated by content experts. These were recommended for adjustment or removal from the bank; 4 were deleted from the bank and 2 had lowered CAT exposure (administration frequency) rates. Many items hypothesized to show DIF contained content measuring constructs other than applied cognition such as physical frailty, perceptual difficulties, or skills reflective of greater educational attainment. Challenges in measurement of this construct are discussed.
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Actividades Cotidianas , Cognición , Estudios de Cohortes , Humanos , Psicometría/métodos , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVES: This study describes the performance of the Multilingual Naming Test (MINT) by Chinese American older adults who are monolingual Chinese speakers. An attempt was also made to identify items that could introduce bias and warrant attention in future investigation. METHODS: The MINT was administered to 67 monolingual Chinese older adults as part of the standard dementia evaluation at the Alzheimer's Disease Research Center (ADRC) at the Icahn School of Medicine at Mount Sinai (ISMMS), New York, USA. A diagnosis of normal cognition (n = 38), mild cognitive impairment (n = 12), and dementia (n = 17) was assigned to all participants at clinical consensus conferences using criterion sheets developed at the ADRC at ISMMS. RESULTS: MINT scores were negatively correlated with age and positively correlated with education, showing sensitivity to demographic factors. One item, butterfly, showed no variations in responses across diagnostic groups. Inclusion of responses from different regions of China changed the answers from "incorrect" to "correct" on 20 items. The last five items, porthole, anvil, mortar, pestle, and axle, yielded a high nonresponse rate, with more than 70% of participants responding with "I don't know." Four items, funnel, witch, seesaw, and wig, were not ordered with respect to item difficulty in the Chinese language. Two items, gauge and witch, were identified as culturally biased for the monolingual group. CONCLUSIONS: Our study highlights the cultural and linguistic differences that might influence the test performance. Future studies are needed to revise the MINT using more universally recognized items of similar word frequency across different cultural and linguistic groups.
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Enfermedad de Alzheimer , Lenguaje , Anciano , Enfermedad de Alzheimer/diagnóstico , Sesgo , Humanos , Lingüística , Pruebas NeuropsicológicasRESUMEN
OBJECTIVE: To assess differential item functioning (DIF) in an item pool measuring the mobility of hospitalized patients across educational, age, and sex groups. DESIGN: Measurement evaluation cohort study. Content experts generated DIF hypotheses to guide the interpretation. The graded response item response theory (IRT) model was used. Primary DIF tests were Wald statistics; sensitivity analyses were conducted using the IRT ordinal logistic regression procedure. Magnitude and impact were evaluated by examining group differences in expected item and scale score functions. SETTING: Hospital-based rehabilitation. PARTICIPANTS: Hospitalized patients (N=2216). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A total of 111 self-reported mobility items. RESULTS: Two linking items among those used to set the metric across forms evidenced DIF for sex and age: "difficulty climbing stairs step-over-step without a handrail (alternating feet)" and "difficulty climbing 3-5 steps without a handrail." Conditional on the mobility state, the items were more difficult for women and older people (aged ≥65y). An additional 18 items were identified with DIF. Items with both high DIF magnitude and hypotheses related to age were difficulty "crossing road at a 4-lane traffic light with curbs," "jumping/landing on one leg," "strenuous activities," and "descending 3-5 steps with no handrail." Although DIF of higher magnitude was observed for several items, the scale-level effect was relatively small and the exposure rate for the most problematic items was low (0.35, 0.27, and 0.20). CONCLUSIONS: This was the first study to evaluate measurement equivalence of the hospital-based rehabilitation mobility item bank. Although 20 items evidenced high magnitude DIF, 5 of which were related to stairs, the scale-level effect was minimal; however, it is recommended that such items be avoided in the development of short-form measures. No items with salient DIF were removed from calibrations, supporting the use of the item bank across groups differing in education, age, and sex. The bank may thus be useful to assist clinical assessment and decision-making regarding risk for specific mobility restrictions at discharge as well as identifying mobility-related functions targeted for postdischarge interventions. Additionally, with the goal of avoiding long and burdensome assessments for patients and clinical staff, these results could be informative for those using the item bank to construct short forms.
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Cuidados Posteriores , Alta del Paciente , Anciano , Estudios de Cohortes , Femenino , Humanos , Modalidades de Fisioterapia , Psicometría/métodos , Autoinforme , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To (1) develop a patient-reported, multidomain functional assessment tool focused on medically ill patients in acute care settings; (2) characterize the measure's psychometric performance; and (3) establish clinically actionable score strata that link to easily implemented mobility preservation plans. DESIGN: This article describes the approach that our team pursued to develop and characterize this tool, the Functional Assessment in Acute Care Multidimensional Computer Adaptive Test (FAMCAT). Development involved a multistep process that included (1) expanding and refining existing item banks to optimize their salience for hospitalized patients; (2) administering candidate items to a calibration cohort; (3) estimating multidimensional item response theory models; (4) calibrating the item banks; (5) evaluating potential multidimensional computerized adaptive testing (MCAT) enhancements; (6) parameterizing the MCAT; (7) administering it to patients in a validation cohort; and (8) estimating its predictive and psychometric characteristics. SETTING: A large (2000-bed) Midwestern Medical Center. PARTICIPANTS: The overall sample included 4495 adults (2341 in a calibration cohort, 2154 in a validation cohort) who were admitted either to medical services with at least 1 chronic condition or to surgical/medical services if they required readmission after a hospitalization for surgery (N=4495). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Not applicable. RESULTS: The FAMCAT is an instrument designed to permit the efficient, precise, low-burden, multidomain functional assessment of hospitalized patients. We tried to optimize the FAMCAT's efficiency and precision, as well as its ability to perform multiple assessments during a hospital stay, by applying cutting edge methods such as the adaptive measure of change (AMC), differential item functioning computerized adaptive testing, and integration of collateral test-taking information, particularly item response times. Evaluation of these candidate methods suggested that all may enhance MCAT performance, but none were integrated into initial MCAT parameterization. CONCLUSIONS: The FAMCAT has the potential to address a longstanding need for structured, frequent, and accurate functional assessment among patients hospitalized with medical diagnoses and complications of surgery.
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BACKGROUND: Resident-to-resident elder mistreatment (R-REM) is defined as negative and aggressive physical, sexual, or verbal interactions between (long-term care) residents that in a community setting would likely be construed as unwelcome and have high potential to cause physical and/or psychological harm and distress. R-REM has been established as a serious problem that has a negative impact on the safety, physical well-being, and quality-of-life of residents living in nursing homes. Although there are no in-depth studies, there is evidence that it is prevalent in assisted living residences and associated with a variety of person, environmental, and facility characteristics. The authors conducted the first systematic, prospective study of resident-to-resident elder mistreatment in nursing homes and developed an intervention for direct care staff to enhance knowledge of R-REM and increase reporting and resident safety by reducing falls and associated injuries. The study aim was to examine the effects of this intervention in assisted living residences. The primary distal outcome is falls and injuries, and the key process outcomes are staff knowledge and reporting. METHODS: Twelve larger licensed assisted living residences with special care dementia units in two New York State regions will be enrolled on a rolling basis and randomized to intervention or usual care. Data derived from five sources, (1) resident interviews, (2) staff informants, (3) observational data, (4) chart, and (5) incident/accident report data, will be collected at baseline and 6 and 12 months with respect to 1050 residents (750 "downstate" and 300 "upstate"). The intervention is three training modules delivered on-site after baseline data collection for front line staff on all shifts in facilities randomized to the intervention. Modules relate to recognition, management, and reporting of resident-to-resident elder mistreatment. DISCUSSION: Given the movement toward alternative congregate living arrangements for older individuals with significant comorbidities, including cognitive impairment; it is critical to enhance resident safety measured by falls, accidents, and injuries and staff knowledge related to recognition, reporting, and treatment of resident-to-resident aggressive and related negative interactions in such settings. This project is important in developing approaches for ameliorating and preventing R-REM in assisted living residences and enhancing resident safety and quality of life. TRIAL REGISTRATION: ClinicalTrials.gov NCT03383289 . Registered on 26 December 2017.
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Abuso de Ancianos/diagnóstico , Abuso de Ancianos/prevención & control , Hogares para Ancianos , Casas de Salud , Anciano , Humanos , New York , Estudios Prospectivos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Literature on the outcome of pregnancy after exposure to capecitabine and temozolomide during the first trimester is scarce. Chemotherapy administration in the first trimester is generally not recommended due the potential risks to the fetus including fetal death and major congenital malformations. Capecitabine and temozolomide are oral chemotherapy agents and pregnancy category D medications, thus the use of these agents in pregnancy is not recommended. We present the case of a 17-year-old female who while receiving cancer treatment, had unintentional exposure to capecitabine and temozolomide during the first trimester of pregnancy, and subsequently delivered a healthy infant.
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OBJECTIVES: The Perceived Stress Scale (PSS) is the most widely used measure of perceived stress; however, minimal psychometric evaluation has been performed among Hispanic respondents, and even less among Hispanic caregivers to persons with Alzheimer's disease and related disorders (ADRDs). DESIGN: Secondary data analysis. SETTING: New York City, NY, USA. PARTICIPANTS: A sample of 453 community dwelling Hispanic caregivers to patients with ADRD. MEASUREMENTS: Latent variable models were used to evaluate the PSS. Exploratory and confirmatory factor analyses were used to examine unidimensionality. Differential item functioning (DIF) was examined for age, education, and language using the graded item response model. RESULTS: The factor and bifactor analyses results supported essential unidimensionality of the item set; however, positively worded items were observed using response item theory to be less informative than the negatively worded items. Reliability estimates were high. Salient DIF was not observed for age, education, or language of interview using the primary DIF detection method. Sensitivity analyses using a second DIF detection method identified uniform language-DIF for the item, "In the last month, how often have you felt that you were on top of things?" However, the non-compensatory DIF value was below the threshold considered salient. CONCLUSIONS: In summary, the 10-item PSS performed well in a sample of English- and Spanish-speaking Hispanic caregivers to patients with ADRD. Very little DIF, and none of high magnitude and impact, was observed. However, the negatively worded items, perhaps because they are more directly reflective of stress, were more informative. In the context of a short-form measure or computerized adaptive test, more informative items are those that would be selected for inclusion.
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Enfermedad de Alzheimer , Cuidadores/psicología , Hispánicos o Latinos/psicología , Calidad de Vida , Estrés Psicológico/psicología , Encuestas y Cuestionarios/normas , Adulto , Anciano , Anciano de 80 o más Años , Análisis Factorial , Femenino , Humanos , Lenguaje , Masculino , Persona de Mediana Edad , Psicometría/métodos , Reproducibilidad de los Resultados , Estrés Psicológico/etnología , TraduccionesRESUMEN
Coronavirus disease 2019 (COVID-19) has been declared a public health emergency for the entire United States. Providing access to prenatal health care while limiting exposure of both obstetric health care professionals and patients to COVID-19 is challenging. Although reductions in the frequency of prenatal visits and implementation of telehealth interventions provide some options, there still remains a need for patient-health care professional visits. A drive-through prenatal care model was developed in which pregnant women would remain in their automobiles while being assessed by the health care professional, thus reducing potential patient, health care professional, and staff exposure to COVID-19. Drive-through prenatal visits would include key elements that some institutions cannot perform by telehealth encounters, such as blood pressure measurements for evaluation for hypertensive disorders of pregnancy, fetal heart rate assessment, and selected ultrasound-based measurements or observations, as well as face-to-face patient-health care professional interaction, thereby reducing patient anxiety resulting from the reduction in the number of planned clinic visits with an obstetric health care professional as well as fear of virus exposure in the clinic setting. We describe the rapid development of a drive-through prenatal care model that is projected to reduce the number of in-person clinic visits by 33% per patient compared with the traditional prenatal care paradigm, using equipment and supplies that most obstetric clinics in the United States can access.
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Betacoronavirus , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Complicaciones Infecciosas del Embarazo/prevención & control , Atención Prenatal/métodos , Telemedicina/métodos , COVID-19 , Infecciones por Coronavirus/virología , Femenino , Humanos , Neumonía Viral/virología , Embarazo , Complicaciones Infecciosas del Embarazo/virología , SARS-CoV-2 , Estados UnidosRESUMEN
OBJECTIVE: Although the psychometric properties of the Family Satisfaction with End-of-Life Care measure have been examined in diverse settings internationally; little evidence exists regarding measurement equivalence in Hispanic caregivers. The aim was to examine the psychometric properties of a short-form of the FAMCARE in Hispanics using latent variable models and place information on differential item functioning (DIF) in an existing family satisfaction item bank. METHOD: The graded form of the item response theory model was used for the analyses of DIF; sensitivity analyses were performed using a latent variable logistic regression approach. Exploratory and confirmatory factor analyses to examine dimensionality were performed within each subgroup studied. The sample included 1,834 respondents: 317 Hispanic and 1,517 non-Hispanic White caregivers of patients with Alzheimer's disease and cancer, respectively. RESULTS: There was strong support for essential unidimensionality for both Hispanic and non-Hispanic White subgroups. Modest DIF of low magnitude and impact was observed; flagged items related to information sharing. Only 1 item was flagged with significant DIF by both a primary and sensitivity method after correction for multiple comparisons: "The way the family is included in treatment and care decisions." This item was more discriminating for the non-Hispanic, White responders than for the Hispanic subsample, and was also a more severe indicator at some levels of the trait; the Hispanic respondents located at higher satisfaction levels were more likely than White non-Hispanic respondents to report satisfaction. SIGNIFICANCE OF RESULTS: The magnitude of DIF was below the salience threshold for all items. Evidence supported the measurement equivalence and use for cross-cultural comparisons of the short-form FAMCARE among Hispanic caregivers, including those interviewed in Spanish.
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Comparación Transcultural , Familia/psicología , Satisfacción Personal , Psicometría/normas , Cuidado Terminal/normas , Anciano , Familia/etnología , Femenino , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Psicometría/instrumentación , Psicometría/métodos , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos , Grupos Raciales/etnología , Grupos Raciales/estadística & datos numéricos , Encuestas y Cuestionarios , Cuidado Terminal/métodos , Cuidado Terminal/psicologíaRESUMEN
Objective This study evaluates penicillin allergy during pregnancy to estimate the proportion that could benefit from penicillin allergy testing. Study Design Retrospective cohort study of women with penicillin allergy that delivered from January 1, 2018 to December 31, 2018. Results Among 6,321 deliveries, 446 (7%) were identified with penicillin allergy. Nine percent (41/446) had no documentation of allergy severity. Allergies associated with intolerance, low, moderate, or high risk of anaphylaxis were reported in 6% (25/446), 40% (177/446), 32% (142/446), and 14% (61/446), respectively. Nearly 74% (330/446) received an antibiotic either antepartum, at delivery, or within 6 weeks of postpartum. The majority of women, 81% (360/446) (i.e., undocumented reactions, low, or moderate risk of anaphylaxis) would have been eligible for penicillin allergy testing. Greater appropriate utilization of antibiotics occurred in women with a high 80% (39/49) or moderate risk of anaphylaxis 70% (79/112) versus low risk of anaphylaxis 55% (64/117), history of intolerance 40% (8/20), or undocumented reaction 19% (6/32), p ≤ 0.01. Conclusion Most women who report a penicillin allergy during pregnancy would be candidates for penicillin allergy testing. With the high rate of antibiotic interventions in pregnant women who report a penicillin allergy, consideration should be given for penicillin allergy assessment.
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OBJECTIVES: It is unclear whether obstetrician-gynecologists (OBGYNs) experience gender discrimination as a result of patient and organizational gender preferences. Our objective was to evaluate whether the gender preference for OBGYNs resulted in perceptions of discrimination by the physician while simultaneously assessing their patients' views for choosing their OBGYN. METHODS: A survey assessed whether OBGYNs' perceptions of patients and employers' preferences for gender in selecting an OBGYN affected their clinical practice and resulted in feelings of discrimination. Providers' patients simultaneously completed a survey to explore the role of gender in the selection of their OBGYN. The Mann-Whitney U test was used for comparisons. A P < 0.05 was considered statistically significant. RESULTS: Thirty-four physicians (97% response rate) and 803 patients (81% response rate) completed the survey. The majority of male physicians agreed that their gender negatively affects their patient practice volume (60%), whereas no female physicians agreed with this statement (0%, P < 0.01). Female physicians were more likely to agree (46%) that they are discriminated against because of gender in terms of salary as compared with male physicians (20%, P = 0.049), however. Although more women who see a female OBGYN (compared with those who see a male OBGYN) perceive that their physician's gender is important to them (62% versus 20%, P < 0.01), the most frequent reason all women chose their OBGYN is the "rating" of the physician. CONCLUSIONS: Female and male OBGYNs perceive bias because of their gender; however, the former is because of compensation and the latter is because of patient preferences. The majority of women choose their OBGYN based on the physician's rating and not on the physician's sex, however.