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Biomedical subjects

D Quade

Publications and source records attributed to D Quade.

At least 37 records · Page 2Linked to original sources
PubMed1990

Core curriculum for master's-level community health nursing education: a comparison of the views of leaders in service and education.

This study identified core components of the curriculum for master's-level community health nurses (CHNs) and assessed whether leaders in service agreed with leaders in education on the importance of these components. Through a mailed survey, 588 leaders in CHN service and education identified the following as the most important to include in the core CHN curriculum: a practicum experience; epidemiology; community health assessment and diagnosis; administration and management, including public health administration, management theory, program planning and evaluation, financial management and budgeting, and quality assurance; research methods and biostatistics; health promotion and disease prevention; intervention at the aggregate level; and leadership theory. These leaders also indicated that skills in both administration and direct care are essential for CHN practice. While there was remarkable agreement between service and education leaders in many areas, notable disagreements were seen in the importance accorded administrative skills. Service leaders rated these skills much more highly than did leaders in education.

Community Health Nursing↗
PubMed1989

A surveillance system based on a short memory scheme.

A surveillance system is proposed to detect an increase in the mean of a Poisson distribution of cases of a disease. This system, called short memory (SM), is based on conditional binomial tests which are performed sequentially at fixed time intervals. The probability of rejection at each test defines the run length distribution which has a geometric tail. A standard SM scheme outperforms other SM schemes. The CUSUM outperforms the SM schemes when the baseline mean is specified correctly. This type of misspecification does not affect the SM scheme.

Data Interpretation, Statistical↗
PubMed1989

A survey of smoking and quitting patterns among black Americans.

A sample of adult Black policyholders of the nation's largest Black-owned life insurance company was surveyed in 1986 to add to limited data on smoking and quitting patterns among Black Americans, and to provide direction for cessation initiatives targeted to Black smokers. Forty per cent of 2,958 age-eligible policyholders for whom current addresses were available returned a completed questionnaire. Population estimates for smoking status agree closely with national estimates for Blacks age 21-60 years: 50 per cent never-smokers; 36 per cent current smokers; 14 per cent ex-smokers. Current and ex-smokers reported a modal low-rate/high nicotine menthol smoking pattern. Current smokers reported a mean of 3.8 serious quit attempts, a strong desire and intention to quit smoking, and limited past use of effective quit smoking treatments and self-help resources. Correlates of motivation to quit smoking were similar to those found among smokers in the general population, including smoking-related illnesses and medical advice to quit smoking, previous quit attempts, beliefs in smoking-related health harms/quitting benefits, and expected social support for quitting. Methodological limitations and implications for the design of needed Black-focused quit smoking initiatives are discussed.

Adolescent↗
PubMed1986

Tardive dyskinesia in young mentally retarded individuals.

The results of a systematic neuroleptic withdrawal study in 38 mentally retarded children, adolescents, and young adults are described. The focus of the study was the occurrence of side effects of chronic neuroleptic treatment: tardive dyskinesia, transient withdrawal dyskinesia, nondyskinetic withdrawal symptoms, and a possible behavioral analogue of withdrawal dyskinesia. Transient side effects were noted in 34% of the subjects, and tardive dyskinesia in an equal proportion. The data suggest that cumulative neuroleptic dose may play a role as a risk factor in the development of severe tardive dyskinesia.

Adolescent↗
PubMed1986

Depression in women treated for gynecological cancer: clinical and neuroendocrine assessment.

To determine the prevalence of major depression in cancer patients and assess the usefulness of the dexamethasone suppression test (DST) and the thyrotropin-releasing hormone (TRH) stimulation test for diagnosing major depression in these patients, the authors studied 83 women hospitalized for gynecological cancer. Nineteen (23%) had major depression according to DSM-III criteria. The sensitivity and specificity of the DST were 40% and 88%, respectively. No relationship between DST and TRH test results was found. These findings indicate a high prevalence of depression in cancer patients, but further research on these tests in cancer patients is needed; their routine use with cancer patients is premature at this time.

Adult↗
PubMed1986

A method for constructing case-mix indexes, with application to hospital length of stay.

This article presents the methodological development of an index for case-mix adjustment of hospital data exemplified by our construction of an index for studying length of stay. We describe the development and evaluation of this index, including internal and external validation procedures, and show an example of its use in a policy-relevant context by applying it to the analysis of length-of-stay differences between investor-owned and voluntary hospitals. Some advantages of this approach to adjusting for case mix are applicability to many hospital or patient output measurements/diagnostic scheme situations; usefulness in reducing heterogeneity in other case-mix adjustments, e.g., the Diagnosis-Related Group (DRG) approach; interpretation possibilities; production of a single score for each patient/hospital; statistical approach allowing more accurate and reliable interpretation of hospital and patient output measurements, ability to deal with hospital deaths; and consideration of the complete set of secondary diagnoses. We also suggest other possible uses of this approach.

Diagnosis-Related Groups↗
PubMed1985

Analysis of length-of-stay differences between investor-owned and voluntary hospitals.

In contrast to assertions that investor-owned (I-O) hospitals are more efficient than voluntary hospitals, this study finds no significant difference between I-Os and voluntaries where the efficiency measure is length of hospitalization (LOH). The data base used is a national probability sample of hospitals and patients. The analysis accounts for variation in LOH by controlling for hospital characteristics other than ownership, and in particular it utilizes a new case-mix index to control for the case-mix portion of heretofore suggested differences.

Bed Occupancy↗
PubMed1985

Improving estimates of prevalence by repeated testing.

Suppose a screening or diagnostic test with unknown properties is to be used, not primarily for classifying individuals, but for estimating the prevalence of disease. Its sensitivity and specificity may be enhanced by applying it repeatedly to the same individuals, thus bringing the proportion of individuals with overall positive results closer to the true prevalence. Repeated testing also makes it possible to estimate the prevalence by maximum likelihood. Some simple designs for estimation are evaluated in terms of their accuracy and cost.

Biometry↗
PubMed1984

Tardive dyskinesia and other clinical consequences of neuroleptic treatment in children and adolescents.

Of 41 children, adolescents, and young adults who were withdrawn from chronic neuroleptic treatment, 18 developed tardive dyskinesia, withdrawal dyskinesia, nondyskinetic withdrawal symptoms, or transient behavior deterioration. Development of neuroleptic-related problems seemed to be associated with cumulative neuroleptic dose and possibly with the sex of the subject. Only 12 of the 41 subjects required resumption of neuroleptic treatment after a prolonged trial withdrawal period.

Adolescent↗
PubMed1983

Random effects in paired-comparison experiments using the Bradley-Terry model.

The Bradley-Terry model for paired-comparison experiments assumes that the parameters for treatment ratings are the same for each comparison. We generalize this model by envisioning a population of judges from which a sample is taken to perform the experiment. The preference parameters can then be treated as random variables, and this induces a correlation between outcomes involving the same judge. Such a model may be helpful in isolating variation due to judges, from true variation in the treatments, as well as in accounting for the nonindependence of judgments.

Biometry↗
PubMed1982

Nonparametric analysis of covariance by matching.

The basic problem under consideration is the comparison of treatments with respect to a response Y when a covariable X is taken into account. Various methods involving matching may be regarded as compromises between the standard analysis of covariance and the standard analysis of independent matched pairs. First, there is no need to restrict attention to independent matched pairs, but rather all matched pairs may be incorporated. Then, if X is concomitant, that is, if its distribution is the same regardless of treatment, methods may be used which are based ultimately on randomization although in practice they are based on analysis of variance. When X is not concomitant, methods related to partial correlation (between Y and 'treatment', given X) are applicable. All methods considered may use either the actual magnitudes of Y or analogues of their ranks.

Age Factors↗
PubMed1981

Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients.

To obtain estimates of the frequency of nosocomial infections nationwide, those occurring at the four major sites--urinary tract, surgical wound, lower respiratory tract and bloodstream--were diagnosed in a stratified random sample of 169,526 adult, general medical and surgical patients selected from 338 hospitals representative of the "mainstream" of U.S. hospitals. We estimate that in the mid-1970s one or more infections developed in 5.23 percent (+/- 0.16) of the patients and that 6.62 (+/- 0.24) infections occurred among every 100 admissions. Risks were significantly related to age, sex, service, duration of total and of preoperative hospitalization, presence of previous nosocomial or community-acquired infection, types of underlying illnesses and operations, duration of surgery, and treatment with urinary catheters, continuous ventilatory support or immunosuppressive medications. Seventy-one percent of the nosocomial infections occurred in the 42 percent of patients undergoing surgery and 56 percent in the 38 percent financed by Medicare, Medicaid or other public health care plans.

Adolescent↗
PubMed1980

The SENIC Project. Study on the efficacy of nosocomial infection control (SENIC Project). Summary of study design.

With the emergence of nosocomial infections as a serious problem among US hospitals, the Center for Disease Control undertook in 1974 a nationwide study to evaluate approaches to infection control. The three-phased project, now known as the Study on the Efficacy of Nosocomial Infection Control, or SENIC Project, was designed with three primary objectives: 1) to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate ofnosocomi al infection, 2) to describe the current status of ISCPs and infection rates, and 3) to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate. With data collection completed in a nationally representative sample of hospitals, analysis is underway to identify approaches to infection control that are most effective for the least cost to hospitals and to point out additional specific questions to be answered by future research.

Centers for Disease Control and Prevention, U.S.↗
PubMed1980

The SENIC sampling process: design for choosing hospitals and patients and results of sample selection.

To achieve its primary objectives, the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) focused its attention on a target population of patients referred to as SENIC-eligible admissions in a target population of hospitals referred to as the "SENIC Universe." SENIC thus required a design for sampling hospitals and patients within these hospitals and a valid procedure for projecting sample results to the target population. This paper presents the details of the sampling design used, describes the actual process of selecting hospitals and patients for the surveys, explains the procedure used to project sample results to the target population, and examines the possibility of bias in the design and hospital selection process. As with most large-scale sample surveys, the design and sample selection processes for the surveys in Phases II and III of SENIC were complicated by incomplete frame, nonresponse and measurement problems. Nevertheless, adjustments to reduce the effects of some of these problems have been made through the development of a valid procedure for projecting sample results to the target population, and it appears unlikely that practically important nonsampling biases will result from the estimation procedures applied to this sample of hospitals.

Cross Infection↗
PubMed1980

Effects of misclassifications on statistical inferences in epidemiology.

Misclassification errors caused by imperfect sensitivity (U) and specificity (V) can affect statistical inferences in epidemiology. Such errors can lead to biases and increased standard errors in estimates of rates. Furthermore, low U and V can have a catastrophic effect on the power of a test to detect a change in rate, and, if U and V change even slightly as the rate changes, the effect on power may be dramatic.

Biometry↗
PubMed1980

The accuracy of retrospective chart review in measuring nosocomial infection rates. Results of validation studies in pilot hospitals.

To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.

Cross Infection↗