Search PubMed⌕ Search

Biomedical subjects

Laura A Siminoff

Publications and source records attributed to Laura A Siminoff.

At least 37 records · Page 2Linked to original sources
PubMed2003

Development and validation of school-based asthma and allergy screening instruments for parents and students.

BACKGROUND: The increasing morbidity attributable to asthma among school-aged children suggests the potential utility of school-based asthma screening programs. OBJECTIVE: We report our efforts to develop and validate culturally sensitive and clinically useful screening questionnaires (parent and child versions) for asthma and allergies among urban US school children. METHODS: Instrument development was accomplished through literature review, expert medical and child developmental input, focus group feedback, and a rigorous trial of the instruments in a public school setting. Questionnaires were distributed to 2,800 children and their families in an urban public school system (grades kindergarten through 6). Validity was evaluated by blinded comparison of results against a standardized clinical evaluation in 107 children, with final designations determined by an expert panel. RESULTS: Questionnaires pertaining to 2,083 children were returned (participation rate of 74%). A moderate level of agreement was observed between parent and student questionnaire responses (r values = 0.36 to 0.50; P values < 0.001). The highest frequency of asthma-like symptoms was reported for African-American boys and the lowest for Caucasian girls. The items from the parent questionnaire that best predicted asthma were "breathing problems" (occurring rarely or more; odds ratio 12.8; 95% confidence interval, 4.5 to 36.1) and "problems coughing" (sometimes or more; odds ratio 9.7; 95% confidence interval, 3.6 to 26.5). Considering the presence of cough (sometimes or more) and/or breathing problem (rarely or more) yielded a sensitivity of 80%; a specificity of 75%, a positive predictive value of 50%, and a negative predictive value of 92%. Similar levels of prediction were observed for the items "trouble breathing" and "noisy breathing" as directly reported by the students. Allergic rhinitis was best predicted by report of a runny/stuffy no se (sometimes or more; sensitivity of 83%, specificity of 61%). Allergic conjunctivitis was best predicted by "itchy eyes." CONCLUSIONS: Administration of a school-based questionnaire is feasible, with a high response rate and excellent internal consistency. A high sensitivity and acceptable specificity was achieved by using one to two questions for asthma, allergic rhinitis, and allergic conjunctivitis. Among the children in grades 2 or above, comparable levels of prediction could be achieved with the student or parent version.

Adolescent↗
PubMed2003

Older patients' perceptions of quality of chronic knee or hip pain: differences by ethnicity and relationship to clinical variables.

BACKGROUND: There is marked ethnic or racial disparity in the utilization of joint replacement for osteoarthritis. The reasons are not known. Pain is the reason most patients with osteoarthritis seek care. Cultural and psychosocial factors influence how patients experience and express pain. We examined whether patient descriptions of chronic pain vary by ethnicity and if they correlate with important clinical measures used in arthritis care. METHODS: Sample consisted of 300 male veterans who were > or =50 years of age with moderate to severe symptomatic knee or hip osteoarthritis. Structured surveys were used to assess patient descriptions of pain and to collect important demographic, clinical, and psychosocial variables. Factor analysis was used to assess patterns of pain description in a comparison of African-American and Caucasian patients. Pearson correlations were used to examine relationships between pain descriptions and clinical variables. RESULTS: The two groups were similar with respect to age and other baseline clinical characteristics. A confirmatory factor analysis on quality of pain description showed that a four-factor model converged for Caucasian patients (chi square = 39.6, comparative fit index = 0.95, Tucker Lewis index = 0.93, and root mean square error of approximation = 0.047), but a three-factor model was supported by the data for African-American patients (chi square= 25.4, comparative fit index = 1.00, Tucker Lewis index = 1.05, and root mean square error of approximation < or = 0.001). Chronic pain quality descriptions correlate significantly with Western Ontario and McMaster Universities Arthritis Index scores but not with radiologic stage of disease. CONCLUSIONS: African-American and Caucasian elderly patients with chronic knee or hip symptomatic osteoarthritis describe the quality of their pain differently. Patient descriptions of quality of chronic knee or hip pain do not correlate with radiologic stage of disease.

Black or African American↗
PubMed2003

Comparison of black and white families' experiences and perceptions regarding organ donation requests.

CONTEXT: Black families donate at a lower rate than white families. To help develop effective interventions, we compared black and white families' experiences. OBJECTIVE: To compare the organ donation request experiences of black and white patients' families with the hope of identifying factors to better inform consent-rate interventions among blacks. DESIGN: Chart reviews were conducted on files of all deceased patients. Audiotaped in-person interviews were conducted with family members, and telephone interviews were conducted with involved healthcare providers and organ procurement organization staff. SETTING: Nine trauma hospitals located in southwest Pennsylvania and northeast Ohio. PARTICIPANTS: A sample of 415 families of organ donor-eligible patients (61 black, 354 white). MEASURES: Measures of families' attitudes about and experiences with donation and transplantation. RESULTS: White families were more likely to be correctly perceived as receptive to donation. Black families viewed as receptive were less likely to be engaged in discussing as many donation-related issues as white families (p <.01). They were also less likely to have spoken to an organ procurement organization representative (p =.024) and were given fewer opportunities to consider the decision with healthcare provider or organ procurement organization staff. Black families had less knowledge about their family member's wishes, expressed less-favorable attitudes toward organ donation and the health care system, and, finally, were less likely than white families to donate organs (p =.001). A minority of black families (32.8%) knew about the need for more black donors. CONCLUSIONS: Interventions to increase consent among blacks need to encourage openness about organ donation within the black community and change healthcare provider and organ procurement organization attitudes and practices toward black families as potential donor families.

Adolescent↗
PubMed2003

Families' understanding of brain death.

CONTEXT: Families' understanding of brain death may be a factor that contributes to decisions regarding organ donation. OBJECTIVE: To examine factors related to families' understanding of brain death and how those factors affect families' decisions about organ donation. DESIGN: Chart reviews were conducted on all deceased patients at 9 trauma hospitals. Interviews were then conducted with healthcare providers who spoke with families about organ donation and family decision makers. SETTING: Southwest Pennsylvania and Northeast Ohio. PARTICIPANTS: The sample consisted of 403 families of organ donor-eligible patients who reported that someone at the hospital told them the patient was brain dead. MAIN OUTCOME MEASURES: Families' awareness of brain-death testing procedures, understanding of brain death, and donation decision. RESULTS: Most families (96%) were told their family member was brain dead, but only 28.3% were able to provide a completely correct definition of brain death. No association between the definition of brain death and willingness to donate was found. Those who donated were less likely to agree with the statement that someone is dead only when the heart stops than those who did not donate. Respondents who accepted that their loved one was dead when informed the patient was brain dead were more likely to donate than those who did not consider the patient dead until mechanical support was turned off and the heart stopped.

Adolescent↗
PubMed2003

Silence and cancer: why do families and patients fail to communicate?

This study examined the phenomenon of avoidance of family communication about cancer. Thirty-seven Stage III or IV lung cancer patients and 40 caregivers, including 24 primary and 16 secondary caregivers, were interviewed; a total of 26 families were studied. The interviews were audiotaped and transcribed. Analysis of the interviews indicated that two thirds of the families (65%) experienced communication problems. The avoidance of family communication was associated with several underlying thought processes: avoidance of psychological distress; desire for "mutual protection;" and belief in positive thinking. Family communication was further hindered by the increasing difficulty of issues inherent to late-stage cancer. The adverse impact of communication avoidance and the implications of our findings are discussed.

Aged↗
PubMed2002

The nondirected live-kidney donor: ethical considerations and practice guidelines: A National Conference Report.

BACKGROUND: The success of kidney transplantation from a genetically unrelated living spouse or friend has influenced transplant physicians to consider the requests of individuals wishing to volunteer to be a kidney donor who have no intended recipient specified. Representatives of the transplant community gathered in Boston, MA, on May 31, 2001, to deliberate on the experience of live kidney donation from such volunteers, currently termed nondirected donors (NDD). OBJECTIVE OF CONFERENCE PARTICIPANTS: The objective of the conference was to recommend ethical and practice guidelines for health care professionals considering the transplantation of a kidney from a live NDD. CONFERENCE PARTICIPANTS: This conference was convened under the sponsorship of The National Kidney Foundation, with representation from The American Society of Transplantation and The American Society of Transplant Surgeons, The American Society of Nephrology, The United Resource Networks, The United Network for Organ Sharing, The Association of Organ Procurement Organizations, The National Institutes of Health, and The Division of Transplantation of the Health Resources and Services Administration (see Appendix). CONFERENCE REPORT: The suggested content of screening interviews, which provide information regarding the donation process, elicits pertinent medical and psychosocial history, and assesses NDD motivation are presented in this report. Approaches to identifying the center that would evaluate the suitability of the NDD, to performing the kidney recovery, and to selecting the NDD recipient are also proposed. Other ethical issues such as the use of prisoners as an NDD, compensation for the NDD, media involvement, and communication between the NDD and recipient are discussed. CONCLUSION: The willingness of health care professionals to consider NDD volunteers is driven by the compelling need to provide organs for an ever-expanding list of patients awaiting a kidney transplant. However, the psychological impact and emotional reward of donation has yet to be determined for NDD who may not have any relationship to the recipient or knowledge of the recipient's outcome. Transplant centers that accept NDD should document an informed consent process that details donor risks, assures donor safety, and determines that the goals and expectations of the NDD and the recipient can be realized.

Communication↗
PubMed2002

Improving the quality of hemodialysis treatment: a community-based randomized controlled trial to overcome patient-specific barriers.

CONTEXT: Mortality rates among US hemodialysis patients are the highest in the industrialized world at 23% per year. Measures of dialysis dose (Kt/V) correspond strongly with survival and are inadequate in one sixth of patients. Inadequate dialysis is also associated with increased hospitalizations and high inpatient costs. Our previous work identified 3 barriers to adequate hemodialysis: dialysis underprescription, catheter use, and shortened treatment time. OBJECTIVE: To determine the effect of a tailored intervention on adequacy of hemodialysis. DESIGN AND SETTING: Community-based randomized controlled trial with recruitment from April 1999 to June 2000 at 29 hemodialysis facilities in northeast Ohio. PARTICIPANTS: Forty-four nephrologists and their 169 randomly selected adult patients receiving inadequate hemodialysis. INTERVENTION: Nephrologists were randomly assigned to an intervention (n = 21) or control (n = 23) group. For patients in the intervention group (n = 85), depending on the barrier(s) present, a study coordinator gave nephrologists recommendations about optimizing dialysis prescriptions, expedited conversion of catheters to surgically created grafts or fistulas, and educated patients about the importance of compliance with treatment time. Patients in the control group (n = 84) continued to receive usual care. MAIN OUTCOME MEASURES: Changes in Kt/V and specific barriers after 6 months. RESULTS: At baseline, intervention and control patients had similar Kt/V measurements, specific barriers, and demographic and medical characteristics. After 6 months, intervention patients had 2-fold larger increases in Kt/V compared with control patients (+0.20 vs +0.10; P<.001) and were more likely to achieve their facility Kt/V goal (62% vs 42%; P =.01). Intervention patients also had nearly 3-fold larger increases in dialysis prescription (+0.16 vs +0.06; P<.001) and were 4 times more likely to change from use of catheters to use of fistulas/grafts (28% vs 7%; P =.04). CONCLUSIONS: An intervention tailored to patient-specific barriers resulted in increased hemodialysis dose. Extending this approach to the 33 000 persons in the United States receiving inadequate hemodialysis may substantially enhance patient survival, diminish hospitalizations, and decrease inpatient expenditures.

Catheters, Indwelling↗
PubMed2002

Differences in expectations of outcome mediate African American/white patient differences in "willingness" to consider joint replacement.

OBJECTIVE: Joint replacement therapy is an effective treatment option for end-stage osteoarthritis (OA) of the knee and/or hip. There are marked racial/ethnic disparities in the utilization of this procedure. The reasons for these disparities are not known. We sought to determine whether African American patients differ from white patients in their "willingness" to consider joint replacement and to determine the factors that influence this relationship. METHODS: We performed a cross-sectional survey of 596 elderly, male, African American or white patients with moderate-to-severe symptomatic knee or hip OA who were receiving primary care at the Department of Veterans Affairs outpatient clinics. RESULTS: The groups were similar with respect to age, severity of arthritis measured by the Lequesne Scale and the Western Ontario and McMaster Universities Osteoarthritis Index, and scores on the Charlson Comorbidity Index and Geriatric Depression Scale. Compared with whites, African Americans were less likely to be employed or married or to have attained a high school education, but were more likely to report a median annual household income of <10,000 dollars. They were also less likely than whites to be familiar with joint replacement and more likely to expect a longer duration of hospital course, pain, and functional disability following replacement surgery. African American patients were less "willing" than white patients to consider joint replacement (odds ratio 0.50, 95% confidence interval 0.30-0.84). However, this difference was explained by the between-group differences in expectations. CONCLUSION: African American patients were less likely than white patients to express "willingness" to consider joint replacement if the procedure was needed and recommended. This difference was explained by differences between the groups in their expectations of hospital course, pain, and function following replacement surgery.

Black or African American↗
PubMed2002

Knowing patients' preferences about organ donation: does it make a difference?

BACKGROUND: The purpose of this study was to examine in detail the impact of knowledge of a donor-eligible patient's preferences on organ donation decisions. METHODS: Nine trauma hospitals located in southwest Pennsylvania and northeast Ohio were selected. Data came from chart review of all dead patients and interviews with family members involved in the decision process (n = 360 patients 16 years of age or older). RESULTS: Of the families interviewed, 52.5% had to guess the patient's preferences about donation. When making the decision, 81.9% of the families considered how the patient might have felt about donation. Not knowing the patient's wishes related to refusal to donate (54.5% vs. 45.5%, p < 0.001). After adjusting for other factors, important predictors of donation were considering patients' feelings (5.03 times more likely to donate) and knowing preferences (6.90 times more likely to donate if they knew wishes were to donate and 0.03 times less likely to donate if they knew wishes were to not donate compared with not knowing preferences). CONCLUSION: Having knowledge of a patient's preference to donate increased the likelihood of donating by 6.90 times, and having enough information about the patient's wishes increased satisfaction with the decision by 3.32 times. Families only infrequently made decisions counter to patients' own wishes concerning organ donation.

Adolescent↗
PubMed2002

Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: the role of patient-level factors.

BACKGROUND: There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown. OBJECTIVES: To examine how black and white potential candidates for joint replacement compare with respect to their overall familiarity with joint replacement as an option, as well as their perceptions of the risks/benefits of this procedure. METHODS: Cross-sectional survey of 596 elderly patients with symptomatic osteoarthritis of the knee or hip or both attending primary care clinics at Cleveland VAMC. RESULTS: Black (44%) and white (56%) patients in this cohort were comparable with respect to age and clinical factors. However, black patients were less likely to be employed (8% vs. 15%, P = 0.017) or to be married (39% vs. 56%, P = 0.000), but more likely to report an annual household income of less than $10,000 (41% vs. 20%, P = 0.000) and less than high school education (43% vs. 29%, P = 0.001). Black patients were less likely than white patients to have had family or friends who had had joint replacement (OR, 0.39 [0.26-0.61]), or to report a good understanding of joint replacement as a form of treatment (OR, 0.62 [0.42-0.92]). They were more likely than white patients to expect longer hospital course (OR, 4.09 [2.57-6.54]), moderate to extreme pain (OR, 2.61 [1.74-3.89]), and moderate to extreme difficulty walking after replacement surgery (OR, 2.76 [1.83-4.16]). CONCLUSION: Black patients were less likely than white patients to be familiar with joint replacement surgery and more likely to express concerns about postsurgical pain and difficulty walking.

Black or African American↗
PubMed2002

Ethnic differences in the perception of prayer and consideration of joint arthroplasty.

CONTEXT: Ethnic differences in utilization of arthroplasty may reflect differences in health-related attitudes and beliefs. OBJECTIVE: To examine ethnic differences in the perception and use of prayer in the treatment of arthritis and its role in patients' decision making toward surgery. DESIGN: A cross-sectional survey. SETTING: VA Primary Care Clinics. PATIENTS: Patients older than 50 years with chronic moderate-to-severe knee pain, hip pain, or both. MEASURES: The "helpfulness of prayer" in the treatment of arthritis and patients' attitude toward joint arthroplasty. RESULTS: Five hundred ninety-six veterans; 44% black patients, 56% white patients. Groups were comparable with respect to age (65 +/- 9.5 vs. 66 +/- 9), disease severity as assessed by WOMAC (47 +/- 17 vs. 45 +/- 17). Black patients scored higher than white patients on the religiosity scale (77 +/- 17 vs. 70 +/- 21). In multivariate analysis, black patients were more likely than white patients to perceive prayer as helpful in the management of their arthritis (OR, 2.1; 95% CI, 1.19, 3.72). Black patients were also less likely than white patients to consider surgery for severe hip/knee pain (OR, 0.58; 95% CI 0.34, 0.99); this relationship between ethnicity and consideration of surgery is mediated by perceptions of "helpfulness of prayer." The odds ratio for this relationship changes to 0.70 (P = 0.215). CONCLUSION: In this sample, black patients were more likely than white patients to perceive prayer as helpful and to have actually used prayer for their arthritis. Perception of helpfulness of prayer may be an important explanatory variable in the relationship between ethnicity and patients' decision in considering arthroplasty.

Black or African American↗
PubMed2002

Decoupling: what is it and does it really help increase consent to organ donation?

Although the notion of decoupling is simple and potentially controllable by organ donation requestors, evidence to date of its potential has been inconsistent. The impact of the timing of requests was analyzed using data from a study of organ donor-eligible patients and their families (N = 420), involving 9 trauma hospitals located in southwest Pennsylvania and northeast Ohio. In-depth interviews where conducted with family members, healthcare professionals, and organ procurement organization staff involved in the process. Only a weak effect was found for the impact of timing on the decision using a bivariate, correlational analysis. Moreover, we found that raising the issue before rather than after the pronouncement of death was most strongly associated with consent to donation. This effect disappeared after examining decoupling in relation to other factors. However, active consideration of the patient's donation wishes and a clear understanding of the families' initial inclination toward donation were associated with consent to organ donation.

Adolescent↗
PubMedDate not supplied

Recruiting vulnerable populations for research: revisiting the ethical issues.

The successful recruitment of participants is essential to the research process. To increase the rate of subject participation, investigators have to rely on help from health care providers who often serve as gatekeepers to potential research study subjects. These well-meaning professionals may limit subject participation in a study involving vulnerable populations under the guise of protecting these individuals from harm. We describe some of the characteristics of vulnerable populations affecting their recruitment into research studies. We examine the ethical conflicts that occur when health care professionals control access to these subjects during recruitment for research studies. Finally, we discuss the implications for practice and research designed to protect the rights of vulnerable populations participating in research. We identify collaboration and dialogue between researchers, health care providers, and members of the potential subject populations as most important in recruiting sufficient numbers of subjects to ensure the scientific merit of the study.

Ethics, Research↗
PubMedDate not supplied

Decreased use of adjuvant breast cancer therapy in a randomized controlled trial of a decision aid with individualized risk information.

OBJECTIVE: Oncology patients often seek involvement in their medical consultations. Such involvement is endorsed by most health care providers and mirrored in practice guidelines. However, oncologists exhibit great variation in how they provide patients with disease-relevant information, and many remain reluctant to do so at all. The authors examined the impact of a patient-specific decision aid on women's decisions about adjuvant therapy for breast cancer. METHOD: 386 women with breast cancer were randomized to receive either an informational pamphlet about adjuvant therapy (usual care) or a patient-specific, evidence-based decision aid about adjuvant therapy. The authors compared rates of adjuvant therapy between the groups controlling for age, education, marital status, race, tumor severity, and practice type of their physician (university-based or community-based). RESULTS: Among women with low tumor severity, only 58% (35/60) of women in the decision aid group chose adjuvant therapy, compared to 87% (33/38) of their counterparts in usual care (P<0.01). CONCLUSIONS: This study illustrates the important impact of medical decision aids on treatment choices, particularly for patients for whom treatment has little benefit. In the case of adjuvant therapy for breast cancer, providing individualized, evidence-based risk information for shared decision making resulted in fewer women with low tumor severity choosing adjuvant treatment.

Aged↗