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Biomedical subjects

Susan M Perkins

Publications and source records attributed to Susan M Perkins.

36 records · Page 2Linked to original sources
PubMed2003

Differences in perceptions by stage of fluid adherence.

OBJECTIVE: The purpose of this study was to determine in a group of hemodialysis patients whether perceptions of barriers to and benefits of adherence to fluid limitations, perceived seriousness of and susceptibility to the consequences of nonadherence, self-efficacy, and thirst differed by stage of fluid adherence. DESIGN: Cross-sectional descriptive design. SETTING: There were 147 participants from rural, suburban, and urban outpatient hemodialysis units. RESULTS: Significant differences were found in perceived benefits, barriers, seriousness, susceptibility, and thirst intensity by stage of fluid adherence. There were no significant differences in self-efficacy by stage of fluid adherence. CONCLUSION: Stage of fluid adherence may be important to consider when designing interventions to reduce fluid intake.

Adult↗
PubMed2003

A prospective study of teachers' ratings of behavior problems in children with new-onset seizures.

The purpose of this study was to explore the association between seizures and behavior problems in children with new-onset seizures using teachers' ratings of behavior. Subjects were 209 children with new-onset seizures and 93 children with asthma. Teacher ratings of behavior were collected prospectively over 24 months to determine differences between children with recurrent seizures, children without recurrent seizures, and children with asthma. During the 2-year period, 155 (74%) children had at least one recurring seizure. Data were analyzed using repeated-measures analysis of variance both with and without covariates. Controlling for covariates, children experiencing recurrent seizures had higher Total (P=0.002) and Internalizing (P=0.018) Behavior Problems scores across all times than those not experiencing recurrent seizures. Children with asthma were similar to children not experiencing recurrent seizures. The association between seizures and behavioral problems was supported using behavioral ratings from teachers.

Adolescent↗
PubMed2003

Behavior and mental health problems in children with epilepsy and low IQ.

The purpose of this cross-sectional descriptive study was to describe the particular types of behavioral problems, self-concept, and symptoms of depression experienced by children with both low IQ and epilepsy. Three groups of children (83 males, 81 females; mean age 11 years 10 months, SD 1 year 10 months; age range 9 to 14 years) with epilepsy were compared: (Group 1) Low IQ (<85), n=48, 25 males, 23 females; (Group 2) Middle IQ (85 to 100), n=58, 24 males, 34 females; and (Group 3) High IQ (>100), n=58, 34 males, 24 females. The Child Behavior Checklist, Piers-Harris Self-Concept Scale, and Children's Depression Inventory were used to measure behavior, self-concept, and depression respectively. Results indicated that children in the Low IQ group had the most behavioral and mental health problems. Additionally, there were IQ group-by-sex interactions, with females in the Low IQ group being at the highest risk for poor self-concept. Findings suggest that children with both epilepsy and low IQ should be carefully assessed for mental health problems in the clinical setting.

Adolescent↗
PubMed2003

A skin cancer education initiative at a professional baseball game and results of a skin cancer survey.

BACKGROUND: It is important to develop an understanding of what the public knows about skin cancer and what sun safety precautions they are taking. Research on the evaluation of skin cancer education targeting adults is minimal. AIM: To assess the knowledge and behavior related to skin cancer and sun exposure, and to determine if an informal interaction between dermatologists and the public could promote skin cancer awareness and precautions. METHODS: In May 2000, a dermatologist-staffed educational booth was set up at an Indianapolis Indians baseball game. Attendees were educated through discussions and handouts. Attendees completed a self-administered questionnaire prior to this interaction and a mailed follow-up questionnaire in August 2000. RESULTS: One hundred and thirty-six attendees participated in May, and 60 completed the second questionnaire in August. The May results revealed that 92% believed that sun exposure caused skin cancer; 37% used sunscreens "sometimes" and 29%"never." There was a significant decrease in the number of hours spent outdoors per week during the summer of 2000 compared to 1999. CONCLUSIONS: Frequent and unprotected sun exposure occurs despite awareness of the adverse effects. Although the number of subjects in our study was small, informal education at public events has the potential to influence behavior.

Adolescent↗
PubMed2003

Community clinical data exchange for emergency medicine patients.

Little is known about the opportunities for a community clinical data exchange network to influence patient care. Rates of patient "cross-over" among different institutions can provide one estimate of the additional value such systems have over unconnected, independent institutional electronic medical records. The Indiana Network for Patient Care (INPC) represents such a system, involving a collaboration of central Indiana hospitals to improve patient care. During a one year study period, 288,696 patients made 471,640 Emergency Department (ED) visits within the INPC collaboration -- accounting for 92% of all Indianapolis ED visits. Overall 25% of the patients with more than one visit also visited one of the other five hospital systems, accounting for 19% of all visits. Our results help clarify the expected frequency within one large metropolitan area that ED patients could obtain direct benefit from a community clinical data exchange network.

Community Networks↗
PubMed2003

Clinicians' and patients' experiences and satisfaction with unscheduled, nighttime, Internet-based video conferencing for assessing acute medical problems in a nursing facility.

Videoconferencing between patients and their physicians can increase patients' access to healthcare. Unscheduled videoconferencing can benefit patients with acute medical problems but has not been studied extensively. We conducted a clinical trial of unscheduled, nighttime videoconferencing in a nursing home, where on-call physicians usually provide care by telephone from remote locations. Although most calls for medical problems did not lead to videoconferencing, physicians and nursing-home residents were satisfied with videoconferencing when it did occur, and physicians reported that making medical decisions was easier with videoconferencing. Videoconferencing was most often conducted to assess residents with changes in mental status, abnormal laboratory values, or falls. Physicians often lacked immediate access to videoconferencing equipment when medical problems with residents occurred. This application could benefit from improved access and portability of equipment.

Adult↗
PubMed2002

Assessing rater agreement using marginal association models.

New models that are useful in the assessment of rater agreement, particularly when the rating scale is ordered or partially ordered, are presented. The models are parameterized to address two important aspects of rater agreement: (i) agreement in terms of the overall frequency in which raters assign categories; and (ii) the extent to which raters agree on the category assigned to individual subjects or items. We present methodology for the simultaneous modelling of univariate marginal responses and bivariate marginal associations in the K-way contingency table representing the joint distribution of K rater responses. The univariate marginal responses provide information for evaluating agreement in terms of the overall frequency of responses, and the bivariate marginal associations provide information on category-wise agreement among pairs of raters. In addition, estimated scores within a generalized log non-linear model for bivariate associations facilitate the assessment of category distinguishability.

Carcinoma in Situ↗
PubMed2002

Acute low back pain self-management intervention for urban primary care patients: rationale, design, and predictors of participation.

OBJECTIVES: To describe the rationale and design of a self-management program for low-income, urban, primary care patients with acute low back pain. Issues related to recruitment and protocol delivery, and attendance patterns and predictors of program attendance are described. METHODS: Two hundred eleven adult patients (73% female; 60% African American) were recruited from primary care neighborhood health centers. Focus groups were conducted for program development, and participants then completed a baseline interview and were randomized into groups receiving either usual care or a self-management intervention. RESULTS: Twenty-nine percent of the intervention group attended the self-management class. Significant predictors of attendance included being older, reporting less income, and not working for pay. Attendees did not differ from nonattendees on back pain severity, symptoms, health-related quality of life, self-management processes, or satisfaction with care. CONCLUSION: Effective minimal-contact behavioral interventions are needed to reach larger portions of the patient population.

Acute Disease↗
PubMed2002

Recurrent seizures and behavior problems in children with first recognized seizures: a prospective study.

PURPOSE: Children with epilepsy have high rates of behavior problems. The purpose was to describe prospectively the association of seizures and behavior problems in children with new-onset seizures. METHODS: Subjects were 224 children with new-onset seizures (aged 4-14 years) and 159 siblings (4-18 years). Caregiver's ratings of the behavior were collected 4 times: at baseline, and at 6, 12, and 24 months. During the 2-year period, 163 (73%) children had at least one additional seizure, and 61 (27%) had none. Data were analyzed by using repeated measures analysis of variance both with and without covariates [site, age, gender, race, caregiver education (years), and seizure medications]. RESULTS: On average, children had higher CBCL Total and Internalizing Behavior Problems scores across all times when experiencing recurrent seizures than when not experiencing recurrent seizures (Total Problems, p = 0.041, controlling for demographics and seizure medications). Siblings had significantly lower Total and Internalizing Problems scores than both children experiencing (Total Problems adjusting for covariates, p = 0.0001) and not experiencing recurrent seizures (p = 0.0004). Externalizing Problems scores were not significantly different among children with recurring seizures, children without recurring seizures, and siblings. CONCLUSIONS: Recurrent seizures significantly predicted behavior problems very early in the course of a seizure condition, even when key child, demographic, and seizure variables were controlled. Explanations for these findings include the possibilities that both seizures and behavior problems are caused by an underlying neurological disorder, that seizures per se disrupt behavior, or that children have negative psychological responses to seizure activity.

Adolescent↗
PubMed2002

A randomized, controlled trial of clinical information shared from another institution.

STUDY OBJECTIVE: Emergency physicians often must deliver medical care with minimal access to historical clinical information. We demonstrate the feasibility and potential value of increased access to patients' clinical information from another hospital while they are receiving care in the emergency department. METHODS: We conducted a pilot randomized, controlled trial of providing information from a large, longitudinal, computer-based patient record system of clinical data from an urban hospital to emergency physicians at either of 2 urban EDs. We randomized patients seen at either ED to have the information from the computer-based patient record system provided to their physician or to not have the information provided. We delivered information to the emergency physician both as a printed abstract and by means of online access to the computer-based patient record. We assessed charges, hospital admissions, repeat visits to EDs, and the emergency physicians' satisfaction with the information. RESULTS: Under certain assumptions, the intervention was estimated to decrease charges for ED care by approximately $26 per encounter (P =.03) at 1 hospital, but there was no effect on charges at the other hospital. This result was likely because of marked differences in the workflows and information access at these 2 EDs. We demonstrated no differences in admission rates or repeat visits to the ED. Emergency physicians identified that remembering their passwords and the time required to search for the information were significant barriers to accessing clinical information online. CONCLUSION: Our pilot study is the first to demonstrate the feasibility of sharing clinical information between different health care systems. We observed a trend toward cost savings at 1 of 2 hospitals and no differences in the quality measures we studied. Our experience underscores the difficulties inherent in studying the effects of community-wide health care interventions on cost and quality of ED care.

Adult↗
PubMed2002

Conducting a study of Internet-based video conferencing for assessing acute medical problems in a nursing facility.

We expect the use of real-time, interactive video conferencing to grow, due to more affordable technology and new health policies. Building and implementing portable systems to enable conferencing between physicians and patients requires durable equipment, committed staff, reliable service, and adequate protection and capture of data. We are studying the use of Internet-based conferencing between on-call physicians and patients residing in a nursing facility. We describe the challenges we experienced in constructing the study. Initiating and orchestrating unscheduled conferences needs to be easy, and requirements for training staff in using equipment should be minimal. Studies of health outcomes should include identification of medical conditions most amenable to benefit from conferencing, and outcomes should include positive as well as negative effects.

Acute Disease↗
PubMedDate not supplied

Outcomes among family caregivers of aphasic versus nonaphasic stroke survivors.

Adverse consequences are known to occur in family members responsible for providing care to stroke survivors. However, the differential effect of aphasic versus nonaphasic stroke on caregivers has not been well studied. This study compares selected outcomes (e.g., perceived task difficulty, depressive symptoms, and other negative stroke-related outcomes) among caregivers of aphasic (n = 46) and nonaphasic (n = 113) stroke survivors. Results indicated that caregivers of aphasic survivors perceived greater difficulty with tasks and had more negative stroke-related outcomes than caregivers of nonaphasic survivors. Communication with the survivor was rated as most upsetting and difficult by caregivers in the aphasic group, followed by managing behaviors. Lack of time for family and friends was evident. Female caregivers and caregivers of survivors with self-care deficits also perceived greater difficulty with tasks and negative outcomes. Comprehensive assessment of the unique needs of caregivers of aphasic survivors is suggested for more individualized nursing interventions.

Adaptation, Psychological↗
PubMedDate not supplied

Examination of the effect of Dr. Brown's Natural Flow Baby Bottles on infant colic.

Thirty-six parents of colicky infants participated in this randomized, placebo-controlled clinical trial conducted via the Internet. Parents recorded a baseline state-of-arousal diary for 3 days using their usual feeding methods, and then they used six study-provided bottles for 2 weeks while recording a second state-of-arousal diary. Infants being fed with placebo bottles significantly spent more time crying (rho=.010) and fussing (rho=.002) on average than infants using Dr. Brown's Natural Flow Baby Bottles. Because these bottles decreased the time the infants spent crying and fussing, use of these bottles may be recommended for colicky infants who receive any bottle feedings.

Air↗
PubMedDate not supplied

Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale.

BACKGROUND: Family caregivers of stroke survivors experience a variety of negative social, emotional, and health-related outcomes as a result of providing care. OBJECTIVES: : To psychometrically test the revised 15-item Bakas Caregiving Outcomes Scale (BCOS) measuring life changes specifically resulting from providing care. The original 10-item BCOS was improved by adding five items addressing financial well-being, level of energy, role functioning, physical functioning, and general health. METHODS: Psychometric testing of the revised 15-item BCOS using a sample of 147 family caregivers of stroke survivors approximately 4 months after stroke was conducted to determine the quality of the items, internal consistency reliability, test-retest reliability, construct validity, and criterion-related validity. Most caregivers were women (78.9%), White (68.0%) or African American (29.9%), and either spouses (60.1%) or adult children (31.3%). RESULTS: Satisfactory evidence of internal consistency (alpha = .90) and 2-week test-retest reliability (intraclass coefficient [ICC] = .66; 95% confidence interval [CI] = 0.42-0.81) was provided, with item-to-total correlations ranging from .41 to .74. Unidimensionality was supported by confirmatory factor analysis with indices, indicating a good fit. Using hierarchical multiple regression, 36% of the BCOS variance was explained by constructs in the conceptual model [F(11,132) = 6.72, p < .001]. Criterion-related validity was supported by correlations with the 36-item Short Form (SF-36) General Health Subscale (r = .32, p < .001) and a criterion variable measuring how caregivers' lives had changed overall (r = .67, p < .001). DISCUSSION: The revised 15-item BCOS has evidence of satisfactory reliability and validity in family caregivers of stroke survivors. The BCOS is a valuable measure in research and can be used to identify priority areas for nursing interventions designed to improve caregivers' outcomes.

Adaptation, Psychological↗
PubMedDate not supplied

Development of cultural belief scales for mammography screening.

PURPOSE/OBJECTIVES: To develop instruments to measure culturally related variables that may influence mammography screening behaviors in African American women. DESIGN: Instrumentation methodology. SETTING: Community organizations and public housing in the Indianapolis, IN, area. SAMPLE: 111 African American women with a mean age of 60.2 years and 64 Caucasian women with a mean age of 60 years. METHODS: After item development, scales were administered. Data were analyzed by factor analysis, item analysis via internal consistency reliability using Cronbach's alpha, and independent t tests and logistic regression analysis to test theoretical relationships. MAIN RESEARCH VARIABLES: Personal space preferences, health temporal orientation, and perceived personal control. FINDINGS: Space items were factored into interpersonal and physical scales. Temporal orientation items were loaded on one factor, creating a one-dimensional scale. Control items were factored into internal and external control scales. Cronbach's alpha coefficients for the scales ranged from 0.76-0.88. Interpersonal space preference, health temporal orientation, and perceived internal control scales each were predictive of mammography screening adherence. CONCLUSIONS: The three tested scales were reliable and valid. Scales, on average, did not differ between African American and Caucasian populations. IMPLICATIONS FOR NURSING: These scales may be useful in future investigations aimed at increasing mammography screening in African American and Caucasian women.

Adult↗
PubMedDate not supplied

Youth With Epilepsy: Development of a Model of Children's Attitudes Toward Their Condition.

A model of children's attitudes toward their epilepsy was tested in 173 children (9-14 years) with epilepsy and their parents. Predictor variables tested were child characteristics, family mastery, child worry, child self-efficacy for seizure management, child psychosocial care needs, and seizure variables. Data were analyzed using structural equation modeling, leading to a revised model in which less child worry, greater family mastery, and greater child seizure self-efficacy were directly related to more child positive attitudes. Discussion focuses on potential targets for psychosocial interventions aimed at improving attitudes toward epilepsy.

Journal Article↗
PubMedDate not supplied

Patterns of interdialytic weight gain during the first year of hemodialysis.

This retrospective study describes patterns of interdialytic weight gain (IWG) over the first year of hemodialysis in 27 individuals. IWG increased over the first 12 weeks and appeared to reverse after 12 weeks, increasing again after 32 weeks. Interventions may need to occur after the individual has been receiving treatment for 12 weeks; booster interventions may be indicated after 32 weeks. Variability in the two measures used (mean daily interdialytic weight gain and mean daily percent above dry weight) suggests a need for further study.

Adult↗