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Biomedical subjects

N Steen

Publications and source records attributed to N Steen.

50 records · Page 3Linked to original sources
PubMed1999

Are postal questionnaire surveys of reported activity valid? An exploration using general practitioner management of hypertension in older people.

BACKGROUND: Postal questionnaire surveys are commonly used in general practice and often ask about self-reported activity. The validity of this approach is unknown. AIM: To explore the criterion validity of questions asking about self-reported activity in a self-completion questionnaire. METHOD: A comparison was made between (a) the self-reported actions of all general practitioner (GP) principals in 51 general practices randomly selected within the nine family health services authorities of the former northern regional health authority, and (b) the contents of the medical records (case notes and computerized records) of patients classified as hypertensive from a 1 in 7 random sample of all patients registered in these practices and aged between 65 and 80. Data were gathered from the GPs by self-completion postal questionnaires. Six comparisons were made for two groups of items: first, target and achieved blood pressure; secondly, patient's weight, smoking status, alcohol consumption, exercise and salt intake. The frequency with which the data items were recorded in patient records was compared with the GPs' self-reported frequency of performing the actions. RESULTS: No relationship was found between achieved blood pressure and stated target levels. For each of the other actions, more than half of the responders reported that they usually or always performed the activity. For four of these (smoking, weight, alcohol and exercise), a significant association was noted, but the size of this varied considerably. CONCLUSIONS: There is a variable relationship between what responders report that they do in self-completion questionnaires, and what they actually do as judged by the contents of their patients' medical records. In the absence of prior, knowledge of the validity of questions on reported activity, or of concurrent attempts to establish their validity, the questions should not be asked.

Aged↗
PubMed1998

The inflammatory bowel disease questionnaire: a valid and reliable measure in ulcerative colitis patients in the North East of England.

BACKGROUND: The validity and reliability of the Inflammatory Bowel Disease Questionnaire (IBDQ) needed to be confirmed before its use in the UK. METHODS: The IBDQ was administered to 28 subjects with ulcerative colitis (UC) on 3 separate occasions over a period of 4 weeks, twice by an interviewer and once by self-completion. Convergent and concurrent validity was assessed by using the Colitis Activity Index (CAI) and the Short Form 36 Health Survey (SF-36). Test-retest reliability and internal consistency were also tested. RESULTS: There were moderately high Pearson correlations between related IBDQ domains and SF-36 dimensions and also between the CAI score and the IBDQ Bowel domain and the SF-36 Pain dimension. Cronbach's alpha, corrected item-total correlations, and intra-class correlation coefficients were high. CONCLUSIONS: The IBDQ is a valid and reliable health-related quality of life scale for use in patients with UC and is suitable for use in the UK.

Age Factors↗
PubMed1998

Measuring outpatient resource use and case mix in ophthalmology in north east England.

OBJECTIVES: To test the extent to which two existing ambulatory case mix measures (Ambulatory Visit Groups and Ambulatory Patient Groups) and other variables can explain resource use variations in ophthalmic outpatient visits. DESIGN: Three week prospective study of three consultant outpatient clinics. SETTING: One ophthalmic hospital (Sunderland Eye Infirmary, Sunderland, Tyne and Wear) and three outreach clinics (South Tyneside District Hospital, South Shields, Tyne and Wear; Dryburn Hospital, Durham, Co Durham; and Hartlepool General Hospital, Hartlepool, Cleveland). SUBJECTS: 325 patients who visited ophthalmic outpatient clinics. MAIN OUTCOME MEASURES: Mean consultation time and mean cost distributions by case mix group, analysed by analysis of variance. RESULTS: Ambulatory case mix measures can explain some of the variation in resource use for outpatient visits, but different measures differ in the extent to which they can do so. Clinicians' behaviour also accounts for a significant amount of such variation. Simpler measures of visit type, without diagnostic or procedure information, do not explain resource use variations. CONCLUSIONS: Existing measures perform reasonably well, but their data requirements may preclude their introduction in the National Health Service. Caution is required in advocating simpler measures, however. The influence of clinical practice on resource use variations is important; in this study, most differences between clinicians were not attributable to differences in case mix.

Analysis of Variance↗
PubMed1998

Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations.

BACKGROUND: Although nursing, midwifery, and professions allied to medicine are increasingly using clinical guidelines to reduce inappropriate variations in practice and ensure higher quality care, there have been no rigorous overviews of their effectiveness, 18 evaluations of guidelines were identified that meet Cochrane criteria for scientific rigor. METHODS: Guideline evaluations conducted since 1975 which used a randomised controlled trial, controlled before and after, or interrupted time series design were identified through a combination of database and hand searching. RESULTS: 18 studies met the inclusion criteria. Three studies evaluated guideline dissemination or implementation strategies, nine compared use of a guideline with a no guideline state; six studies examined skill substitution: performance of nurses operating according to a guideline were compared with standard care, generally provided by a physician. Significant changes in the process of care were found in six out of eight studies measuring process and in which guidelines were expected to have a positive impact on performance. In seven of the nine studies measuring outcomes of care, significant differences in favour of the intervention group were found. Skill substitution studies generally supported the hypothesis of no difference between protocol driven by nurses and care by a physician. Only one study included a formal economic evaluation, with equivocal findings. CONCLUSIONS: Findings from the review provide some evidence that care driven by a guideline can be effective in changing the process and outcome of care. However, many studies fell short of the criteria of the Cochrane Effective Practice and Organisation of Care Group (EPOC) for methodological quality.

Allied Health Occupations↗
PubMed1997

A new self-completion outcome measure for diabetes: is it responsive to change?

Self-completion instruments assessing subjective health are increasingly being used to measure patient outcome. However, there is very little evidence as yet of existing instruments' responsiveness to change. This paper describes a study to evaluate the responsiveness to change of a self-completion instrument for the measurement of clinical outcome in patients with diabetes. A prospective follow-up study of 48 patients with non-insulin-dependent diabetes commencing insulin therapy was carried out, with assessments at baseline (i.e. pre-intervention), 6 weeks and 3 months post-intervention. The outcome measures used were the changes in scores on the self-completion instrument for symptom level, physical function, energy, depression, psychological distress and barriers to activity, HbA1c, non-fasting serum cholesterol and the body mass index (BMI). There were significant improvements in HbA1c and non-fasting serum cholesterol and worsening of the BMI, as expected. The self-completion instrument detected significant improvements in patient-reported symptoms within 6 weeks of the intervention (p < 0.01) and in energy levels (p < 0.05). There is evidence from this study of the self-completion instrument's ability to respond to change and it has potential for use in evaluative studies.

Aged↗
PubMed1996

The Diabetes Health Profile (DHP): a new instrument for assessing the psychosocial profile of insulin requiring patients--development and psychometric evaluation.

The aim of the studies was to evaluate the psychometric properties and construct validity of the Diabetes Health Profile (DHP-1). Content for the DHP-1 was derived following in-depth interviews with 25 insulin dependent and insulin requiring patients, a review of the literature and discussions with health care professionals. Initial analysis of the factor structure of the DHP-1 was carried out on the responses of 239 insulin dependent and insulin requiring patients, with a mean age of 40.85 years (SD = 13.0), resulting in a 43 item three factor solution. The 43 item version of the DHP-1 was completed by 2,239 insulin dependent/requiring patients (mean age = 39.8, SD = 10) years. Fifty-one per cent were men. A forced three factor Principal Factoring Analysis with varimax rotation was carried out. Eleven items were excluded with item factor cross loadings > 0.30 or item factor loadings < 0.30. PAF analysis of the 32 items resulted in a three factor solution accounting for 33% of the total explained variance. The three factors were interpreted as Psychological Distress, Barriers to Activity and Disinhibited Eating. Factor congruence between subsamples were: Psychological distress (0.93), Barriers to Activity (0.93) and Disinhibited Eating (0.99). Coefficients of congruence between men and women were 0.94, 0.92 and 0.99 for Psychological Distress, Barriers to Activity and Disinhibited Eating respectively. Internal consistency of the three factors (Cronbach's alpha) were: Psychological Distress (0.86), Barriers to Activity (0.82), and Disinhibited Eating (0.77). Construct-convergent validity was investigated on a sample of 233 insulin dependent and insulin requiring patients (mean age = 51.46 years). Psychological Distress and Barriers to Activity subscales correlated with the Hospital Depression and Anxiety Scale = 0.50 to 0.62, p < 0.01) and subscales of the SF-36 (range: r = -0.17 to -0.62, p < 0.01). These findings lend support to the construct validity and reliability of the DHP-1 and that it is suitable for further development.

Adult↗
PubMed1996

The clinical course of epilepsy and its psychosocial correlates: findings from a U.K. Community study.

As part of a large community-based study, we retrospectively examined the clinical course of epilepsy in an unselected population of people who had a recent history of seizures or were receiving antiepileptic drugs (AEDs). Clinical information was collected from medial records, and information about psychosocial functioning was obtained by means of postal questionnaires sent to identified subjects. The response rate to the postal questionnaire was 71%. There were some deficiencies in the recording of clinical data, which is not unusual since data were taken from records held by primary physicians rather than from hospital clinics. Nevertheless, findings regarding the clinical course of epilepsy corresponded to those of earlier studies. Fifty-seven percent of the sample had had at least a 2-year seizure-free period and 46% of subjects were currently in a remission of at least 2-year duration. There was a clear relationship between current seizure frequency and levels of anxiety and depression, perceived impact of epilepsy, perceived stigma, and marital and employment status. The relationship of seizure frequency and other clinical variables to psychosocial function was explored by multivariate analysis techniques. The amount of variation in scores on the various measures of function accounted for by the clinical variables was small. The most important predictor was current seizure activity, which was the first variable to enter the regression analyses for six of the eight measures of psychosocial function considered. Age at epilepsy onset also emerged as a significant predictor for depression, stigma, and marital status. In individuals with epilepsy in remission, there was little evidence that psychosocial functioning was associated with length of remission, a finding which may in part reflect the nature of this study population. The results indicate that there are several more important predictors of psychopathology and social dysfunction in epilepsy and suggest several implications for treatment interventions.

Adult↗
PubMed1994

Development of a symptom based outcome measure for asthma.

Measuring symptom specific health outcome is complex, but the methodologies now exist to develop measures with the appropriate properties. As one element of a major programme to develop multidomain health outcome measures for chronic disease, a symptom based measure for asthma care has been developed for use in general practice and outpatient departments. This article outlines the development process, which used a framework recently described in the theoretical literature to show the constraints that scientific criteria place on the development of outcome measures and the means of overcoming such limiting factors. Although substantial effort is required to undertake a rigorous process of development, useful tools are the result. Two five item, symptom based outcome measures for adult asthma are described.

Ambulatory Care↗
PubMed1994

Out-patient case mix: a survey of user requirements.

Research and development of out-patient case mix systems, to plan and monitor resource use in the out-patient sector, has hitherto not been accorded priority in the NHS. As part of an investigation of their usefulness, a survey of NHS professionals' requirements for out-patient case mix was conducted. The results confirmed that there was support for developing out-patient case mix systems, although different users had different requirements. However, a common theme to emerge was the desirability of constructing holistic systems which cover in-patient, day-case and out-patient care. Additionally, development of care packages was seen as a necessary first step in constructing systems for out-patient care. Concludes that visit-based case mix systems are unlikely to fulfil users' requirements and recommends that case mix contracting projects by Healthcare Resource Groups should be extended to the out-patient sector, but must recognize that existing systems do not meet users' requirements.

Ambulatory Care↗
PubMed1994

Case mix and content of trainee consultations: findings from the north of England study of standards and performance in general practice.

BACKGROUND: Previous studies have examined the differences in the work of trainees and trainers. However, they have not investigated how many of these differences are due to differences in the case mix seen by trainees. AIM: A study was undertaken to investigate the effect of case mix on the content of consultations with trainee general practitioners. METHOD: Details of surgery consultations with 207 trainee general practitioners and 255 principals in 62 training practices in the north of England were prospectively recorded during one week in each of four consecutive years. RESULTS: Trainee general practitioners saw a higher proportion of younger patients and those categorized as suffering from an acute minor condition compared with principals. They saw a lower proportion of patients categorized as suffering from chronic intermediate, chronic major and female conditions. The reported content of trainee and principal consultations differed over all four years in that trainees examined more patients, issued more new prescriptions, issued fewer repeat prescriptions, arranged fewer return appointments and referred fewer patients. However, adjusting for case mix reduced the number of significant differences between trainees and principals to two: trainees issued fewer repeat prescriptions and had more consultations lasting longer than nine minutes. CONCLUSION: The case mix and content of consultations differ between trainees and principals and some of the differences in content are due to the differences in case mix; trainees generally behave more like principals than has been previously suggested. Thus, case mix is an important factor in understanding the content of trainee consultations.

Diagnosis-Related Groups↗
PubMed1983

The corticopontocerebellar pathway to crus I in the cat as studied with anterograde and retrograde transport of horseradish peroxidase.

In 13 cats injections of horseradish peroxidase (HRP) in various parts of the cerebral cortex were combined with injections of HRP in the cerebellar crus I in the same animal in order to study the cortical regions which may influence the crus I via the pontine nuclei. In the pons terminal regions anterogradely labeled from the cerebral cortex and cell groups retrogradely labeled from crus I were carefully plotted. Overlap between sites of ending of cortical fibers and sites of origin of fibers to crus I was relatively modest in all experiments. On the other hand, partial overlap was usually found at multiple sites. The largest single input to crus I appears to come from the parietal region, particularly the anterior part of the suprasylvian gyrus, while the sensorimotor region contributes much less. Area 6, the second somatosensory cortex and the orbital gyrus, all seem able to influence pontine cells projecting to crus I. Least overlap is found after injections of the visual cortex. The size and orientation of the dendritic fields of pontine cells were studied in Golgi-impregnated material. The dendritic fields average 187 X 339 microns in the transverse plane and are so small that they will only moderately increase the overlap. It is concluded that small subgroups of neurons projecting to crus I receive somewhat different sets of cortical afferents. The input to crus I must originate in wide areas of the cerebral cortex, and probably exhibits a high degree of spatial order, with an intricate pattern of specific divergence and convergence. The present results are compatible with previous physiological evidence from micromapping studies of a precise and complicated mosaic pattern of connections to the cerebellar hemispheres.

Afferent Pathways↗
PubMed1982

Relationship between preoperative basal serum gastrin concentration and acid secretion after proximal gastric vagotomy.

In 81 patients with duodenal ulcer, the preoperative basal serum gastrin concentration was positively correlated to basal acid output after proximal gastric vagotomy and negatively correlated to the decrease in basal acid output exerted by the operation. The preoperative basal concentration of gastrin in serum was found to distinguish between high and low basal acid output after operation, 40 pg/ml being the discriminatory level.

Adult↗