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T V Jones

Publications and source records attributed to T V Jones.

7 recordsLinked to original sources
PubMed1996

Performance of alcoholism screening questionnaires in elderly veterans.

PURPOSE: To validate three alcoholism screening questionnaires in elderly male veterans. PATIENTS: Participants were 120 male veterans aged 65 years or older. METHODS: In this cross-sectional study, consecutive patients in the outpatient general medical practice at the Omaha VA Medical Center were interviewed with the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R) and three alcoholism screening questionnaires, the Michigan Alcoholism Screening Test-Geriatric Version (MAST-G), the CAGE, and the Alcohol Use Disorders Identification Test (AUDIT). Performance characteristics (sensitivity, specificity, predictive values, likelihood ratios, and areas under the receiver operating curve [ROC]) of the screening questionnaires were determined in comparison with the DIS-III-R. RESULTS: Forty-three participants (36%) met DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders) criteria for alcohol abuse or dependence; 23% were active drinkers and 13% were inactive. Fifty of the 120 (42%) reported abstinence from drinking during the preceding year. A MAST-G score > or = 5 had a sensitivity and specificity of 70% and 81%, respectively. A CAGE score > or = 2 had a sensitivity and specificity of 63% and 82%. Using active drinkers only, an AUDIT score of > or = 8 had a sensitivity and specificity of 33% and 91%. The positive predictive values (PPV) for the MAST-G, CAGE, and AUDIT were 67%, 66%, and 69%, respectively; the negative predictive values were 83%, 80%, and 68%, respectively. Areas under the receiver operating curves for the MAST-G, CAGE, and AUDIT were 0.84 +/- 0.04, 0.77 +/- 0.05, and 0.56 +/- 0.08, respectively. CONCLUSION: The MAST-G and the CAGE outperformed the AUDIT for detecting alcohol abuse and dependence in an elderly male veteran population. The CAGE, requiring only four easily memorized questions to achieve similar accuracy, appears to offer an advantage over the 24-item MAST-G.

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PubMed1993

Alcoholism screening questionnaires: are they valid in elderly medical outpatients?

OBJECTIVE: To assess the validity of the CAGE (cut down, annoyed, guilty feelings, eye-opener) questionnaire and the Michigan Alcoholism Screening Test (MAST) in distinguishing between elderly patients with and without alcohol abuse or dependence disorders. DESIGN: A cross-sectional study, in which patients were interviewed with a "gold standard," the alcohol module of the Revised Diagnostic Interview Schedule (DIS-III-R), and two screening questionnaires: the CAGE and the MAST. SETTING: The study was conducted in the outpatient medical practice of a university teaching hospital. PATIENTS: All English-speaking continuity patients 65 years of age or older able to participate were eligible; complete data were available for 154 (91%) of the 170 people who agreed to participate. RESULTS: Sixty-seven patients (44%) were active drinkers, whereas 87 (56%) reported abstinence. Twenty-five patients (16%) met Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for alcohol abuse or dependence. A CAGE score of 2, the conventional cutoff point, had a sensitivity and a specificity of 48% and 99%, respectively. A MAST score of 5, the originally recommended cutoff point, had a sensitivity and a specificity of 52% and 91%, respectively. The areas under the receiver operating characteristic (ROC) curves were 0.91 for the CAGE and 0.61 for the MAST. CONCLUSION: The CAGE and the MAST were both characterized by low sensitivities at conventional cutoff points, but the CAGE was significantly more effective than the MAST in discriminating between elderly medical outpatients with and without alcohol abuse or dependence.

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PubMed1990

Written case simulations: do they predict physicians' behavior?

Written case simulations are often used to investigate physicians' decision making and clinical competence. Their use rests on the assumption that physicians' responses to written simulations closely agree with their responses to actual clinical encounters, yet this assumption of criterion validity has received little attention. To determine the ability of written case simulations to predict actual clinical behavior, we applied methodologic criteria to published articles that used written simulations. Only 11 (15%) of 74 articles included an assessment of the criterion validity of their written case simulations. Only 2 of those 11 studies were designed and executed in such a way that criterion validity could be fully interpreted. No clear consensus emerged from an examination on the 11 studies on how well responses to written case simulations perform as proxy measures of actual behavior. More work is needed before assuming that written case simulations measure actual behavior.

Clinical Competence↗
PubMedDate not supplied

Approaches to urinary incontinence in a rural population: a comparison of physician assistants, nurse practitioners, and family physicians.

BACKGROUND: Although urinary incontinence is a challenge and a burden to older patients, many clinicians fail to query older patients about incontinence symptoms or, even when aware of a problem, fail to diagnose the underlying cause or recommend treatment. We wanted to compare the approaches of physician assistants, nurse practitioners, and family physicians to detection, diagnosis, and initial management of urinary incontinence in older adults seen in rural primary care practices. METHODS: One male and 2 female simulated patients portrayed otherwise healthy patients with urinary incontinence, including urge or obstruction-overflow type for the man, and stress or urge type for the women. The 3 simulated patients saw 3 physician assistants, 3 nurse practitioners, and 3 family physicians each, for a total of 27 visits during which they posed as new patients seeking primary care. RESULTS: Health professionals spontaneously asked about incontinence in only 18 percent of visits (33 percent for physician assistants, 11 percent each for nurse practitioners and family physicians). When incontinence was discussed (spontaneously or by patient prompting), queries were made about potential precipitants (ie, coughing, caffeine consumption) in 63 percent of visits. Questions about other urinary symptoms (eg, dysuria) were asked in 59 percent of visits. Rectal examinations were performed in 68 percent of the male simulated patient's visits but in none of the female simulated patients' visits. No pelvic examinations were performed. No attempts or recommendations were made to measure postvoiding residual volume. Tentative diagnoses were made in 48 percent of visits; some form of therapy was discussed in 52 percent of visits. CONCLUSIONS: Asking about incontinence was uncommon, and potentially important questions about precipitants and associated symptoms were often omitted. The providers examined areas potentially relating to incontinence and recommended supplementary assessments and specialized testing infrequently. Commonly, they made diagnoses and offered therapy at the end of an initial visit despite minimal history taking and examinations and lack of any additional assessment or testing.

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