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PubMed1983

On the social ecology of dependence and independence in elderly nursing home residents: a replication and extension.

A sample of 40 elderly residents was observed for 14 days on each of three consecutive occasions separated by 3 months. The observations focused on interactions involving the elderly resident and social partners. The results indicated a high level of stability across occasions in resident behaviors. The interactional and behavioral profiles observed were similar across length of institutionalization, sex, and health status of residents for the institutional context studied. Examination of interactional patterns for the different resident behaviors, however, revealed quite discrepant social contingencies. Following dependent self-care behaviors of residents, interactional responses by social partners represented a continuous supportive behavior contingency; following independent self-care behaviors, no social contingencies were observed. Similarly, obstructively engaged and nonengaged resident behaviors were not followed by any social contingencies; following constructively engaged behaviors of residents, an intermittent supportive contingency by social partners was found. The results are discussed in relation to learned helplessness and control.

Aged↗
PubMed1995

Impact of alcohol consumption and cigarette smoking on stroke among the elderly in Taiwan.

BACKGROUND AND PURPOSE: We investigated the influence of alcohol consumption and cigarette smoking on all types of stroke and cerebral infarction, in particular among a representative sample of elderly residents in Taiwan. METHODS: This study was a component of a nationwide survey of health and living status of residents aged 65 years or older in Taiwan in which subjects received detailed physical, neurological, and laboratory examinations. Inquiries were made about medical history, and information on the amount and duration of drinking and smoking was obtained. Diagnoses of stroke were made according to the results of brain computed tomography at the onset of disease or were based on criteria established by the World Health Organization. RESULTS: Of the 2600 subjects, there were 155 elderly persons with stroke (prevalence, 6%). Excessive drinking of more than 367.6 g/wk of alcohol was associated with a high prevalence of cerebral infarction. Consumption of < or = 367.5 g/wk of alcohol did not have an influence on stroke prevalence. The relationship between duration of alcohol drinking and stroke was equivocal. More than 30 pack-years of cigarette smoking was a significant risk factor for all types of stroke and cerebral infarction in particular. Using multiple logistic regression to control for possible confounders, it was found that smoking was an independent risk factors for all stroke and was of borderline significance for cerebral infarction. Although excessive drinking was a significant risk factor for cerebral infarction in univariate analysis, this effect was lost after adjustment for other confounders. CONCLUSIONS: Cigarette smoking was a more important risk factor for stroke and cerebral infarction than excessive drinking of alcohol.

Aged↗
PubMed1993

Exogenous calciferol (vitamin D) and vitamin D endocrine status among elderly nursing home residents in the New York City area.

OBJECTIVE: To determine the role and relative importance of sources of exogenous calciferol (vitamin D) in maintaining vitamin D endocrine status in the mid-winter and early spring in a representative sample of institutionalized elderly persons in the New York City area. DESIGN: Cross-sectional survey. SETTING: A privately-run urban nursing home and the long-term care unit of a suburban public hospital. PARTICIPANTS: Residents aged 60 years and older scheduled for a routine annual physical examination and an additional group of individuals ascertained by random sampling. Those with a history of anti-convulsant or glucocorticoid use, liver disease, chronic renal disease (or serum creatinine > 1.5 mg/dL), parathyroid disease, Paget's disease, gastric surgery, or pharmacological vitamin D use were excluded. Of 301 sampled individuals, 221 were found eligible to participate, and 109 were successfully enrolled. RESULTS: The average vitamin D intake was 379 IU/day (range 55-1006 IU/day) and total vitamin D intake was below the Recommended Dietary Allowance in 16% of subjects. Fifty percent of total vitamin D intake came from fortified milk, and 26% came from vitamin supplements. Vitamin supplement use was not associated with low dietary intake. Among subjects taking a supplement containing 400 IU/day, none had serum calcidiol levels below 15 ng/mL, while among subjects with vitamin D intake between 200 and 400 IU/day, 46% had serum calcidiol levels below 15 ng/mL and 14% had calcidiol levels below 10 ng/mL. Vitamin D intake from non-supplement sources (but not from supplements) appeared to have a negative association with serum calcitriol levels. CONCLUSIONS: Many nursing home residents may require vitamin supplements in order to achieve optimal levels of calciferol replacement. The choice of a vehicle for calciferol replacement may affect calcitriol levels.

Aged↗
PubMed2006

Determining when contamination is pollution - weight of evidence determinations for sediments and effluents.

Contamination is simply the presence of a substance where it should not be or at concentrations above background. Pollution is contamination that results in or can result in adverse biological effects to resident communities. All pollutants are contaminants, but not all contaminants are pollutants. Differentiating pollution from contamination cannot be done solely on the basis of chemical analyses because such analyses provide no information on bioavailability or on toxicity. Effects-based measures such as laboratory or field toxicity tests and measures of the status of resident, exposed communities provide key information, but cannot be used independently to determine pollution status. Laboratory studies can be predictive, but are rarely realistic. Measures of resident communities include innate natural variability and cannot easily distinguish between adaptation to contamination (a genetic process) and acclimation (a physiological process that may decrease energy reserves, possibly reducing such critical population-level parameters as reproduction). Finally, contaminant effects may not only be direct but also indirect; predicting such effects requires knowledge of the system under study as well as appropriate use of lines of evidence (LOE) such as toxicity tests directed to key species. Consequently, in sediments, effluents or other inputs/environmental compartments, determining when contamination is or may in future become pollution, requires a weight of evidence (WOE) assessment using different LOE appropriate to the situation under investigation. WOE investigations provide two different types of information: definitive conclusions regarding pollution; or, information as to what additional, investigative studies are necessary for definitive conclusions. Effectively, a WOE assessment comprises an initial screening-level ecological risk assessment (ERA), which may be followed by a detailed-level ERA if key uncertainties need to be resolved.

Geologic Sediments↗
PubMed2002

ACGME requirements for end-of-life training in selected residency and fellowship programs: a status report.

INTRODUCTION: National recommendations have been developed for physicians' end-of-life (EOL) education. No comprehensive assessment has been done to examine postgraduate (residency and fellowship) EOL training. METHOD: The authors reviewed the EOL content for 46 specialties in postgraduate training programs that affect the care of seriously ill and dying patients, using data from the 2000/2001 AMA Graduate Medical Education Directory. RESULTS: Internal medicine, geriatrics, and neurology contained the most comprehensive EOL requirements. Most surgical specialties contained no EOL requirement except ethics. Ethics (n = 25) and psychosocial care (n = 22) were the most common EOL domains mandated, although specific EOL content was not specified. Training in EOL communication (n = 1), personal awareness (n = 3), and EOL clinical experiences (n = 5) were the least often required instructional domains. Instruction in pain assessment and management was required in only one surgical specialty. CONCLUSIONS: The lack of comprehensive EOL training requirements may help explain the known problems in physicians' EOL care. Major reform in EOL requirements is needed at the level of residency review committees.

Attitude to Death↗
PubMed2000

[The analysis of the coexistence of endometrial carcinoma and uterine myoma].

OBJECTIVE: An epidemiologic study of coexistence uterus myoma with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with uterus myoma was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of Słupsk retrospectively. MATERIAL AND METHODS: Uterus myoma was coexistence with endometrial cancer in 22 cases (16.2%). Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.16), residence rate (p = 0.72), civil status rate (p = 0.37), education rate (p = 0.53), parity rate (p = 0.49), menarche age rate (p = 0.33), last menstruation age rate (p = 0.12), length of reproductive period rate (p = 0.66), blood group rate (p = 0.19), hypertension rate (p = 0.38), diabetes rate (p = 0.96), overweight status rate (p = 0.76), sterility rate (p = 0.35), histological subtype rate (p = 0.25), grading rate (p = 0.29), staging rate (p = 0.54), second primary malignant neoplasma (p = 0.77) between both patients group (with and without uterus myoma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. There is not additional risk factors for endometrial carcinoma between patients with and without coexistence uterus myoma. In the observation of patients with myoma in postmenopause, cytological investigation of endometrial aspirates, ultrasound and mammographic screening should be carried out.

Carcinoma, Squamous Cell↗
PubMed2005

Asthma in Hispanics.

Hispanic individuals trace their ancestry to countries that were previously under Spanish rule, including Mexico, large parts of Central and South America, and some Caribbean islands. Most--but not all--Hispanics have variable proportions of European, Amerindian, and African ancestry. Hispanics are diverse with regard to many factors, including racial ancestry, country of origin, area of residence, socioeconomic status, education, and access to health care. Recent findings suggest that there is marked variation in the prevalence, morbidity, and mortality of asthma in Hispanics in the United States and in Hispanic America. The reasons for differences in asthma and asthma morbidity among and within Hispanic subgroups are poorly understood but are likely due to the interaction between yet-unidentified genetic variants and other factors, including environmental tobacco smoke exposure, obesity, allergen exposure, and availability of health care. Barriers to optimal management of asthma in Hispanics in the United States and in Hispanic America include inadequate access to health care, suboptimal use of antiinflammatory medications, and lack of reference values for spirometric measures of lung function in many subgroups (e.g., Puerto Ricans). Future studies of asthma in Hispanics should include large samples of subgroups that are well characterized with regard to self-reported ethnicity, country of origin, place of birth, area of residence, and indicators of socioeconomic status. Because Hispanics are disproportionately represented among the poor in the United States, implementation of adequate access to health care and social reforms (e.g., improving housing conditions) would likely have a major impact on reducing asthma morbidity in this population.

Adolescent↗
PubMed1999

[The coexistence of endometrial cancer with second primary malignant neoplasms].

OBJECTIVE: An epidemiologic study of multiple primary malignant neoplasms with endometrial cancer patients is presented. Coexistence of endometrial carcinoma with second primary malignant neoplasms was evaluated and controlled for age, residence, civil status, education, parity, menarche age, last menstruation age, length of reproductive period, blood group, hypertension, diabetes, body mass index, sterility, histological subtype, grading, staging. DESIGN: From 1984-1998 136 endometrial carcinomas have been evaluated in the Department of Gynecology & Obstetrics in Hospital of Słupsk retrospectively. All double and triple neoplasms have been histologically recorded, doubtful cases have been excluded. MATERIAL & METHODS: Of 136 endometrial carcinomas 16 (11.6%) were multiple malignant neoplasms. Of these neoplasms 9 (6.6%) occur together with breast cancer, 3 (2.2%) with ovarian carcinoma, 1 (0.7%) with stomach carcinoma, 1 (0.7%) with rectum carcinoma, 1 (0.7%) with carcinoma in focus of endometriosis and 1 (0.7%) coexists with double neoplasms (bowel and endometriosis carcinoma) During the 14-year period of study, 15 patients (11.0%) out of 136 patients diagnosed as having endometrial cancer had double and 1 (0.6%) had triple primary malignant neoplasms. There was not significant difference in age rate (p = 0.72), residence rate (p = 0.93), civil status rate (p = 0.76), education rate (p = 0.70), parity rate (p = 0.76), menarche age rate (p = 0.46), blood group rate (p = 0.45), hypertension rate (p = 0.94), diabetes rate (p = 1.0), not overweight status rate (BMI < 29) (p = 0.55), sterility rate (p = 0.45), histological subtype rate (p = 0.39), grading rate (p = 0.67), staging rate (p = 0.26) between both patients group (with and without second primary malignant neoplasma). We observed statistically significant difference in body mass index (BMI > 32) rate (p = 0.03), last menstruation age rate (p = 0.04), length of reproductive period rate (p = 0.04) between both patients group (with and without second primary malignant neoplasma). CONCLUSION: Patients with endometrial cancer should be carefully and regularly followed up by monitoring et every anatomic site, especially the breast, stomach, and colon, in order that the development of a second primary carcinoma can be detected as early as possible, and not be overlooked in examinations. Additional risk factors for endometrial carcinoma with multiple malignant neoplasma include: menopause occurring after age fifty-one; obese women with body mass index (BMI) higher than 32; reproductive period longer than 37 years.

Adult↗
PubMed1997

Health status gender differences of newly admitted black nursing home residents.

OBJECTIVES: To investigate gender differences in health status of newly admitted black nursing home residents on the day following admission. DESIGN: Descriptive and comparative cross-sectional study of black residents drawn from a larger prospective longitudinal study on health and functional status of new nursing home residents interviewed on the first full day after admission. SETTING: Eight southern nursing homes: three not-for-profit, three for-profit, one county government-operated, and one federal government-operated. Homes ranged in size from 110 to 575 beds and were licensed for skilled and intermediate care. PARTICIPANTS: Black nursing home residents (N = 224) aged 60 years and older as admitted sequentially to nursing homes. MEASUREMENTS: Health status was assessed by the Short Portable Mental Status Questionnaire, as a measure of mental status, and the Scaled Outcome Criteria, as a measure of ability to perform activities of daily living (ADLs). Morbidity was assessed by the number of medical diagnoses, number of prescribed medications, and the medical diagnoses of hip fracture, dementia, and cancer. Resident classification data assessed the source of entry to the nursing home, payer source, and level of care required. Demographic data assessed included age, education, marital status, and number of living children. RESULTS: Both black men (n = 126) and women (n = 98) newly admitted to the nursing home had health and social deficits. Moreover, women, although not significantly different from men in average age, were more impaired in six of eight ADLs, including grooming, dressing, feeding, ambulating, transferring, and defecating. Women were also less likely to be married. No gender differences were found for five other health status variables, four other demographic variables, five resident classification variables, or five measures of morbidity. CONCLUSION: These data on southern black nursing home residents provide evidence that among older black nursing home residents, women have greater care needs than men. Findings illustrate the need to consider gender in planning nursing home care of black older residents, black women may be at greater risk for health status alterations and require more frequent health status monitoring and intervention.

Activities of Daily Living↗
PubMed1999

Nursing home resident use of care directives.

BACKGROUND: The Patient Self-Determination Act of 1991 requires that nursing homes reimbursed by Medicare or Medicaid inform all residents upon admission of their rights to enact care directives in the event of terminal illness. This study investigated the relationship between care directive use and resident functional status. METHODS: We analyzed a version of the Minimum Data Set (MDS+) from a single state. We selected residents who were admitted to a nursing home in the first half of 1993 and followed them in the nursing home through the end of 1994. We created logistic models to examine independent correlates associated with having an advance directive or a do-not-resuscitate (DNR) order on admission. We then created similar logistic models to examine independent correlates associated with writing an advance directive or DNR order subsequent to admission. RESULTS: Of the 2,780 residents, 11% (292) had advance directives and 17% (466) had DNR orders upon admission. Of those without care directives upon admission, 6% (143) subsequently had an advance directive and 15% (339) subsequently had a DNR order. Cross-sectionally, older individuals and whites were more likely to have a care directive. Having poor cognitive and physical function was associated with having a DNR order upon admission. Longitudinally, longer stayers and whites were more likely to have an advance directive. Residents who lost physical function were more likely to have an advance directive and those who lost cognitive function were more likely to have a DNR order. CONCLUSIONS: Care directive use is influenced by a number of sociodemographic and functional characteristics.

Activities of Daily Living↗
PubMed2004

Health-related quality of life among older adults with arthritis.

BACKGROUND: Health-related quality of life (HRQOL) is a key outcome in arthritis, but few population-based studies have examined the relationship of specific arthritic conditions, such as osteoarthritis (OA) and rheumatoid arthritis (RA) with HRQOL. METHODS: Older adults in Pennsylvania completed a mail version of the Centers for Disease Control and Prevention (CDC) HRQOL modules. Medicare data were used to identify subjects with OA, RA, and no arthritis diagnosis. We compared HRQOL responses among these groups, and we also examined relationships of demographic characteristics to HRQOL among subjects with arthritis. RESULTS: In analyses controlling for demographic characteristics and comorbidity, subjects with OA and RA had poorer scores than those without arthritis on all HRQOL items, including general health, physical health, mental health, activity limitation, pain, sleep, and feeling healthy and full of energy. HRQOL scores were also lower for those with RA compared to OA. Among individuals with arthritis, all subject characteristics (including age, race, sex, nursing home residence, marital status, income, and comorbid illnesses) were significantly related to at least one HRQOL item. Older age, nursing home residence, and greater comorbidity were the most consistently associated with poorer HRQOL. CONCLUSIONS: Results of this study show that both OA and RA have a significant impact on multiple dimensions of HRQOL among older adults. Results also suggest the CDC HRQOL items are suitable for use among older adults and in mail surveys. Due to the rising number of older adults in many countries, the public health burden of arthritis is expected to increase dramatically. Efforts are needed to enhance access to medical care and disseminate self-management interventions for arthritis.

Aged↗
PubMed2001

Resident contact with family and friends following nursing home admission.

PURPOSE: This study explored factors that are related to the level of contact (number of visits and calls) between newly admitted nursing home residents and their family and friends. In addition to reexamining factors studied previously, several new factors were explored: contact level prior to nursing home placement, dementia status, and resident race. DESIGN AND METHODS: Interviews were conducted with the significant others of 1,441 residents from a representative sample of nursing homes in Maryland. RESULTS: Contact decreased by approximately half following admission, compared to reported preadmission contact. Rates of contact are positively related to nonuse of Medicaid, kinship closeness, support network proximity, nondemented status, and White race. After controlling for preadmission contact, postadmission contact is positively associated with kinship closeness, support network proximity, nondemented status, and White race. IMPLICATIONS: The study identifies factors that are useful to consider when designing interventions to increase family involvement with nursing home residents.

Aged↗
PubMed1987

Socio-economic determinants of divorce in Bangladesh.

"This study examines the divorce pattern of Bangladesh with a set of socio-economic factors: education, religion, current residence, childhood residence, work status before and after marriage and age at first marriage. The source of data was ever-married women aged 15-49 of 1975 Bangladesh Fertility Survey. Multiple classification analysis technique was used for analyzing the data.... Divorce is found to have a strong inverse relation with age at marriage, and is more common among illiterates, Muslims, and rural women. The duration of marriage before divorce is found to be very low and the divorce rate is strongly associated with childlessness."

Asia↗
PubMed2006

Nursing home involuntary relocation: clinical outcomes and perceptions of residents and families.

OBJECTIVES: To examine the physical and mental health characteristics of 120 residents 3 months following their discharge from 1 transferring nursing home to 23 facilities, to compare these characteristics to their pre-transfer status, and to describe resident and family perceptions of the transfer. DESIGN: Secondary analysis of a longitudinal, prospective quasi-experimental intervention and a qualitative description of resident and family views. SETTING: The setting was 23 nursing homes in the Philadelphia metropolitan area. PARTICIPANTS: Participants included 120 nursing home residents and 56 family members. MEASUREMENTS: Minimum Data Set (MDS) and data from the Centers for Medicare and Medicaid Services (CMS) Nursing Home Compare Web site RESULTS: There was a statistically significant increase in the number of residents who fell during the post-transfer (76.9%) compared to the pre-transfer (51.2%) period (P = .0001): 76.3% of those with a history of falling prior to transfer fell during the post-transfer period while 77.4% of those without a history of falling prior to transfer fell. Residents were 3.78 times more likely to fall if they required more than supervision while walking (95% confidence interval [CI] 1.57-9.06) and 2.65 times more likely if they required more than supervision while transferring (95% CI 1.09-6.44). Logistic regression demonstrated that the mobility was also associated with falls (odds ratio 1.15, 95% CI 1.05-1.26). Residents did not demonstrate any other significant physical or mental health changes during the 3 months following the involuntary transfer when compared with their pre-transfer status. Residents and family members clearly voiced their dismay over the process of involuntary relocation. CONCLUSION: Relocation is a stressful event; however, a move to a higher quality care environment does not result in any significant physical or mental health changes. The high incidence of falls post-transfer in both those with and without a fall history points to the need for extra fall precautions in newly admitted residents. In particular, frequent reorientation reminders for the cognitively intact and a high level of staff surveillance for all new residents is indicated during the first few weeks of admission.

Adult↗
PubMed1998

Racial differences in the prevalence of monoclonal gammopathy in a community-based sample of the elderly.

PURPOSE: To determine if there is an increased prevalence of monoclonal gammopathy in elderly blacks compared with whites, analogous to the difference in incidence of multiple myeloma reported for the two racial groups and to confirm age and gender relationships. PATIENTS AND METHODS: Subjects were from the Duke Established Populations for the Epidemiologic Study of the Elderly, selected on the basis of stratified random household sampling. Blacks were oversampled to allow for increased statistical precision in racial comparisons. In all, 1,732 subjects (aged > 70 years) consented to blood drawing and constitute the sample for this study. Monoclonal immunoglobulins were determined by agarose gel electrophoresis and immunofixation. RESULTS: One hundred six subjects (6.1%) had a monoclonal gammopathy. There was a greater than twofold difference in prevalence between blacks (8.4%) and whites (3.8%) (P < 0.001); monoclonal gammopathy prevalence increased with age, and was greater in men than women. Those with monoclonal gammopathy did not differ from those without in socioeconomic status, urban/rural residence, or education. The presence of monoclonal gammopathy was not associated with any specific diseases nor with impaired functional status. There was a slight increase in serum creatinine levels and decrease in hemoglobin and albumin levels in patients with monoclonal gammopathy, but no difference in interleukin-6 (IL-6) levels. Moreover, IL-6 levels were not correlated significantly with the level of monoclonal protein. CONCLUSION: Prevalence of monoclonal gammopathy is significantly greater among blacks than whites in a community-based sample, in approximately the same ratio that multiple myeloma has been reported in the two groups. Given the absence of correlation with environmental factors, there may be a biological racial difference in susceptibility to an early event in the carcinogenic process leading to multiple myeloma.

Age Distribution↗
PubMedDate not supplied

Unrestrained pride: development of a protocol for a restraint free environment.

This article describes one facility's experience in attempting to enhance compliance with nonrestraint policy. The importance of policy implementation is emphasized, particularly as it relates to nursing care. In response to a study which revealed that a large number of wheelchair restraints were being applied indiscriminately, the extended care facility developed a flow chart in order to facilitate appropriate decision making and assessment regarding safety and restraints. The flow chart/protocol was created to bridge the gap between the conceptual policy level and the procedures for restraint application and removal. It is based on the nursing process and is dependent on ongoing assessment of the resident's status. A survey carried out one year after the initial, pre-intervention survey revealed that only 6.4% of residents were restrained using wheelchair lap belts, compared to the previous 26%, identified as problematic at the outset of the study.

Decision Trees↗
PubMed1995

Minimal trauma fractures in older nursing home residents: the interaction of functional status, trauma, and site of fracture.

OBJECTIVE: This study was conducted to determine the incidence of long bone fractures in institutionalized older persons and to describe preceding traumatic events and the functional status of individuals sustaining fractures. DESIGN: A 1-year, prospective, cumulative incidence survey. SETTING: Eleven skilled nursing care facilities in the state of Wisconsin. PATIENTS: All residents of the 11 facilities. MEASUREMENTS: All incident reports of long bone fractures, description of events preceding the fractures, and functional status of the fracture cases. In addition, demographic and medical information was collected on fracture cases and the general nursing home population. MAIN RESULTS: Overall long bone fracture incidence was 3.52 per 100 subjects per year. Minimal trauma fracture incidence was 0.84 per 100 subjects per year. Fracture location was significantly related to type of trauma. Functional status was significantly related to fracture location and to the type of trauma preceding the fracture. Minimal trauma fractures occurred in individuals who were less mobile and more likely to be bed-bound, and the location was more likely to be the lower extremity below the hip. CONCLUSION: This is the first prospective survey of long bone and spontaneous fracture incidence rates in multiple nursing home facilities. Minimal trauma fractures are common in the nursing home, and most have no clear precipitating factors other than severely impaired mobility.

Accidental Falls↗
PubMed2000

Factors affecting improvement on the American Board of Surgery In-Training Exam (ABSITE).

BACKGROUND: American Board of Surgery In-Training Exam (ABSITE) performance can be used to assess resident knowledge and to evaluate surgical curriculum. To determine factors that lead to improved resident ABSITE performance, a prospective study was performed. MATERIALS AND METHODS: Thirty-four surgical residents in Program Years 2-5 completed pre- and a post-ABSITE questionnaires about their anxiety, self-efficacy, physical preparation, and academic preparation for the ABSITE. Department records were used to determine resident probationary status and conference attendance. A preliminary analysis of ABSITE scores indicated a significant improvement between 1998 and 1999 percentile scores (paired t = -2. 25, P = 0.03; m = 11.9, SD = 30.5, median = 7). An improvement in percentile rank score was calculated and used as the dependent variable in a stepwise regression analysis. The following served as independent variables: previous exam performance, anxiety, probationary status, amount of sleep before exam, confidence to score in the 25th and the 50th percentiles, and attendance at the three conferences rated most valuable by the residents. RESULTS: Results of the regression analysis demonstrate that all factors account for 62.3% of the variance in improvement scores. A stepwise analysis indicated that the combination of attendance (40.2%) and previous performance (18.3%) was significant in explaining 58.5% of the variance in improvement scores. Furthermore, Pearson's correlations indicated that probationary status (+.58, P = 0.001), anxiety (+0.53, P = 0.001), amount of study (+0.61, P = 0.001), past ABSITE performance (-0.60, P = 0.001), and conference attendance (+0. 56, P = 0.001) were correlated with ABSITE improvement. CONCLUSIONS: This study demonstrates that resident individual effort, past ABSITE performance, and academic conference attendance have led to resident ABSITE improvement.

Anxiety↗