Biomedical subjects

M A Sevick

Publications and source records attributed to M A Sevick.

22 records · Page 2Linked to original sources

PubMedDate not supplied

A confirmatory factor analysis of the Caregiving Appraisal Scale for caregivers of home-based ventilator-assisted individuals.

OBJECTIVE: To confirm the underlying dimensions of the Caregiving Appraisal Scale (CAS) with use of data collected from caregivers of home-based ventilator-assisted individuals (VAIs). DESIGN: Cross-sectional survey. SETTING: Residences of home-based VAIs. SAMPLE: Two hundred seventy-seven primary family caregivers of VAIs. MEASURES: Twenty-eight-item CAS developed by Lawton et al. (1989), and an investigator-developed instrument to assess physical health and sociodemographic characteristics of both VAIs and their caregivers. INTERVENTION: None. ANALYSIS: Confirmatory factor analysis with principal components extraction. An oblique (oblimin) solution was used for rotation of the factor matrices. The number of common factors needed to obtain the best fit of the factor model was determined with use of maximum-likelihood estimation. Confirmatory factor analysis with linear structural equation modeling was also performed. RESULTS: Confirmatory factor analysis did not fully replicate the factor structure proposed by Lawton et al. CONCLUSIONS: The model proposed by Lawton et al. provides a useful foundation for examining the appraisal of family caregivers of home-based VAIs. Additional development work is needed for the CAS.

Adult↗

PubMedDate not supplied

Economic value of caregiver effort in maintaining long-term ventilator-assisted individuals at home.

OBJECTIVE: To estimate the economic value of caregivers' efforts in maintaining ventilator-assisted individuals at home. DESIGN: Nonexperimental, cross-sectional survey. SETTING: Households of home-based ventilator-assisted individuals residing in 37 states. PARTICIPANTS: Caregivers of 1404 ventilator-assisted individuals; 277 (19.7%) responses were received. OUTCOME MEASURES: The Home Ventilator Care Cost and Utilization Survey and the Modified Katz Index. METHODS: The economic value of caregiver effort was estimated deterministically by opportunity cost, aggregated market value, and aggregated replacement cost and estimated stochastically by ordinary least squares regression. Cost of formal home care services was estimated with the Medicare Schedule of Limits for Home Health Agency Costs. Estimates of total cost of home care for each method of valuing caregiver effort were calculated by summing the cost of formal home care services with the value of caregiver effort. RESULTS: The average monthly cost of formal home care services was estimated to be $6411 (SD, $8490; median, $2006; range, $0 to $38,607). After adding various values of caregiver effort to the cost of formal home care services, the average cost of home care increases by $960 to $12,483, depending on the method used to calculate the value of the caregiver's time; the median total cost of home care increased by $1403 to $17,793. Data also showed that, depending on the figure used to estimate the cost of long-term care and which method was used to calculate caregiver value, home care was more expensive for at least 4.6% of ventilator-assisted individuals and for as many as 36.7%. CONCLUSIONS: The incorporation of the caregiver's time value into cost estimates did not substantially reduce the proportion of patients for whom home care was the least expensive alternative, except when caregiver effort was valued at a registered nurse's wage rate. However, the methods used to place an economic value on caregiver effort did not take into consideration the long-term economic impact on caregivers who reduce their work hours or forego employment or educational opportunities, nor did they take into account the lost wages of the ventilator-assisted individual or the extent to which the caregiver was financially dependent on the ventilator-assisted individual.

Adult↗

PubMedDate not supplied

Measurement of continuous ambulatory peritoneal dialysis prescription adherence using a novel approach.

OBJECTIVE: The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription. DESIGN: A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time. SETTING: Patients were recruited from an outpatient dialysis center. PARTICIPANTS: A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston-Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate. MEASURES: Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened. RESULTS: One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent (p = 0.015). CONCLUSIONS: This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.

Adult↗

PubMedDate not supplied

Home-based ventilator-dependent patients: measurement of the emotional aspects of home caregiving.

OBJECTIVE: To explore the concept of caregiving appraisal with the primary family caregivers of home-based ventilator-dependent patients and test the internal consistency of instruments to measure functional dependency of the patient and caregiving appraisal. DESIGN: Nonexperimental, cross-sectional survey. Respondents were reimbursed $25 for the return of a completed questionnaire. SETTING: Caregivers of home-based ventilator-dependent patients residing in southwestern Pennsylvania. SAMPLE: Caregivers of 39 home-based ventilator-dependent patients, 27 responses (69%) were received. MEASURES: Modified Katz Index, Modified Caregiving Appraisal Scale, investigator-developed instrument to assess the health and sociodemographic characteristics of both patients and their caregivers. INTERVENTION: None. RESULTS: The needs of ventilator-dependent patients, as reported by their primary family caregivers, are extensive. Patients require considerable assistance with activities of daily living, with many patients having total care requirements in many functional domains. Caregivers are responsible for numerous pieces of high-tech equipment, as well as other special care requirements unrelated to the patient's ventilatory insufficiency. Although caregivers reportedly spend an average of 8.4 hours each day caring for their family member, the majority continue to maintain full- or part-time employment. Despite the considerable demands placed on caregivers, responses to the Modified Caregiving Appraisal Scale indicate that home placement is not perceived to be a negative experience. Internal consistency of instruments was determined by use of Cronbach's alpha, yielding the following correlation coefficients on the Modified Caregiving Appraisal Scale: burden subscale, 0.87; satisfaction subscale, 0.71; mastery subscale, 0.73; impact subscale, 0.70; and ideology subscale, 0.65. Alpha coefficients for the Katz Indexes measuring patient functional dependence, and consequent caregiver responsibility, were 0.95 and 0.90, respectively.

Activities of Daily Living↗