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A checklist to facilitate cultural awareness and sensitivity.

United States of America demographic profiles illustrate a nation rich in cultural and racial diversity. Approximately 29% of the population are minorities and demographic projections indicate an increase to 50% by the year 2050. This creates a highly mobile and constantly changing environment, revealing the need for new levels of cultural awareness and sensitivity. These issues are particularly critical in the medical community where medical professionals must understand the impact cultural differences and barriers can have on evaluation, treatment, and rehabilitation. During times of stress, such as when injury strikes, problems associated with lack of cultural sensitivity are intensified. Cultural diversity is of particular concern when standard measures for diagnosis and prognosis are derived from established norms for responding, because culture defines norms. This paper details a ten point checklist designed to facilitate cultural awareness and sensitivity in medical settings to ensure maximum successful recovery and outcomes for all patients.

Attitude to Health↗

Manuscript peer review: a helpful checklist for students and novice referees.

The ability to contribute consistent, fundamentally sound critiques is an essential element of the scientific peer review process and an important professional skill for investigators. Despite its importance, many students and junior scientists do not have an adequate working knowledge of how to effectively critique research manuscripts. Part of the problem, in our view, is that novice referees often lack a comprehensive understanding of the basic issues that should be considered in evaluating scientific articles. Specifically, they tend to overemphasize certain limitations (usually methodological), while missing other key points related to the scientific method that should be weighed much more heavily. In our journal club and graduate courses we have been using a "checklist" to help graduate students and postdoctoral fellows critically analyze original research papers. In this article we present these guidelines in the hope that they will serve as a helpful resource for students and other novice reviewers when critiquing scientific manuscripts.

Manuscripts as Topic↗

Paper stamp checklist tool enhances asthma guidelines knowledge and implementation by primary care physicians.

BACKGROUND: The Canadian Clinical Practice Guidelines (CPGs) for the management of asthmatic patients were last published in 1999, with updates in 2001 and June 2004. Large disparities exist in the implementation of these guidelines into clinical practice. OBJECTIVE: The present study evaluated the knowledge of Quebec-based primary care physicians regarding the CPGs, as well as patient outcomes before and after introducing physicians to a new clinical tool--a memory aid in the form of a self-inking paper stamp checklist summarizing CPG criteria and guidelines for assessing asthmatic patient control and therapy. The primary objective of the present study was to assess whether the stamp would improve physicians' knowledge of the CPGs, and as a secondary objective, to assess whether it would decrease patient emergency room visits and hospitalizations. METHODS: A prospective, randomized, controlled study of 104 primary care physicians located in four Quebec regions was conducted. Each physician initially responded to questions on their knowledge of the CPGs, and was then randomly assigned to one of four groups that received information about the CPGs while implementing an intervention (the stamp tool) aimed at supporting their decision-making process at the point of care. Six months later, the physicians were retested, and patient outcomes for approximately one year were obtained from the Régie de l'assurance maladie du Québec. RESULTS: The stamp significantly improved physicians' knowledge of the CPGs in all Quebec regions tested, and reduced emergency room visits and hospitalizations in patients who were followed for at least one year. CONCLUSION: A paper stamp summarizing CPGs for asthma can be used effectively to increase the knowledge of physicians and to positively affect patient outcomes.

Asthma↗

Measuring psychotherapeutic change with the symptom checklist SCL 90 R.

BACKGROUND: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. METHOD: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. RESULTS: The cutoff point between a 'functional' and a 'dysfunctional' population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a 'stepwise' clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. CONCLUSION: In the German samples investigated the move from a 'functional' to a 'dysfunctional' population and vice versa has to be taken as the criterion for a clinically significant change up to now.

Humans↗

Quality of life in end-stage renal disease patients after successful kidney transplantation: development of the ESRD symptom checklist - transplantation module.

The End-Stage Renal Disease Symptom Checklist - Transplantation Module (ESRD-SCL((R))) was developed to assess the specific physical and psychological quality of life of renal transplant recipients, with a special focus on side effects of immune system suppression therapy. A list of potentially relevant items was administered to 458 transplant recipients. The symptoms present in >20% of patients were chosen, and factor analysis was used to create the final questionnaire which consists of 43 items in six dimensions: (1) limited physical capacity (10 items; internal consistency: Cronbach's alpha = 0.85); (2) limited cognitive capacity (8 items, alpha = 0.82); (3) cardiac and renal dysfunction (7 items, alpha = 0. 76); (4) side effects of corticosteroids (5 items, alpha = 0.77); (5) increased growth of gum and hair (5 items, alpha = 0.78), and (6) transplantation-associated psychological distress (8 items, alpha = 0.80). All questions are scored on a five-point Likert scale. Validity was demonstrated in correlation with corresponding SF-36 scales and in a stepwise hierarchical regression model predicting the subscales of the ESRD-SCL by sociodemographic and medical data. The ESRD-SCL was found to have adequate reliability, test-retest correlations in a subsample of 88 stable patients after 1 year, and construct validity.

Adolescent↗

The validation of the Posttraumatic Stress Disorder Checklist Scale in posttraumatic stress disorder and nonclinical subjects.

BACKGROUND: The Posttraumatic Stress Disorder Checklist Scale (PCLS) is a short self-report inventory for assessing the 3 main syndromes of Posttraumatic Stress Disorder (PTSD). The aim of this study was the validation of the French version of the PCLS in PTSD subjects and nonclinical subjects. METHODS: One-hundred and thirteen outpatients suffering from PTSD according to DSM-IV were administered the PCLS. The patients' scores on the PCLS were then compared to those of 31 nonclinical control subjects. Thirty-five of the patients were administered the PCLS twice over an interval of 1-2 weeks and also completed questionnaires measuring depression, phobia and anxiety. RESULTS: The patients' total score and subscores on the PCLS were found to be significantly higher than those of control subjects. The cutoff score of 44 on the French version PCLS distinguishes well between the PTSD group and control group with a high diagnostic efficacy (0.94). Factor analysis revealed 3 main factors corresponding to the reexperiencing, numbing and hyperarousal syndromes. The PCLS showed satisfactory test-retest reliability and internal consistency. CONCLUSIONS: The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in psychiatric as well as in primary-care settings.

Adolescent↗

The use of a symptom checklist (SCL-90-R) as an easy method to estimate the relapse risk after alcoholism detoxification.

We tested the use of some subscales of the psychiatric symptom checklist SCL-90-R in predicting relapse within a 1-year follow-up period after a combined detoxification- and abstinence-focused day patient psychotherapy program in 20 men and 13 women with alcohol dependence. Scores of the SCL-90-R subscales interpersonal sensitivity (p = 0.008), anxiety (p = 0.022), phobic anxiety (p = 0.019) and Global Severity Index (GSI; p = 0.040) on admission were higher in the subgroup with relapse within the first year after therapy. A decrease in depression (p = 0.004), anxiety (p = 0.006) and GSI (p = 0.006) scores during therapy was associated with a longer abstinence duration (shorter vs. longer than 24 weeks). Therefore we propose to further investigate the capacity of the SCL-90-R to identify subgroups at higher risk for relapse after detoxification and abstinence therapy in patients with alcohol dependence.

Alcoholism↗

Convergent and discriminant validity of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist.

BACKGROUND: The factor structure of the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist (Y-BOCS-SC) has been well established, but its convergent and divergent reliability have yet to be studied. METHODS: Fifty-six obsessive-compulsive disorder (OCD) patients were administered the clinician-administered Y-BOCS-SC and Hamilton Rating Scale for Depression (HRSD), together with the self-administered Maudsley Obsessive Compulsive Inventory (MOCI), Padua Inventory (PI), State-Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI). RESULTS: Overall, the correspondence between the Y-BOCS-SC and self-administered measures of OCD symptoms was poor to moderate. Its convergent validity was adequate for its washing dimension but poor for its other dimensions. The discriminant validity of the Y-BOCS-SC was adequate, showing little overlap with overall illness severity (total Y-BOCS) and state measures (BDI, STAI, HRSD). In contrast, self-administered OCD measures were significantly correlated with overall illness severity and state measures. CONCLUSIONS: The convergent validity of the Y-BOCS-SC was generally poor and this could only be partially explained by the incomplete coverage of some OCD symptoms in the self-administered scales. Its discriminant validity was good. Both self- and clinician-administered measures should be used in OCD research, as they seem to measure relatively non-overlapping constructs. Further research on the psychometric properties of the Y-BOCS-SC is needed.

Adult↗

Psychological distress in alcohol-dependent patients. Evaluating inpatient treatment with the symptom checklist (SCL-90-R).

The aim of this study was to evaluate the change of psychological distress measured by the symptom checklist in alcohol dependent inpatients during treatment and at follow-up. In addition, psychological distress as a predictive variable for abstinence or relapse during a 1-year follow-up was investigated. In a sample of 314 alcohol-dependent inpatients, we found a statistically significant reduction of psychological distress during therapy. Comparison of patients within 1-year follow-up showed a significant reduction of psychological distress only for the later abstinent subgroup. Later abstinent patients were significantly less distressed at the end of therapy and at follow-up. Logistic regression indicated that a higher Global Severity Index (GSI) of psychological distress at the end of therapy increases the relapse risk.

Adult↗

Comparison of a self-rating questionnaire with a diagnostic checklist for the assessment of DSM-III-R personality disorders.

Two instruments for the assessment of the DSM-III-R personality disorders were compared: The Personality Disorders Questionnaire--Revised (PDQ-R) and the Munich Diagnostic Checklist for the assessment of DSM-III-R Personality Disorders (MDCL-P). Using kappa value as a measure of agreement, the diagnostic agreement was less than 0.40 for personality disorder vs. no personality disorder as well as for the specific personality disorders. The PDQ-R diagnosed more frequently personality disorders (58%) than did the MDCL-P (43%).

Adult↗

Comparison of a diagnostic checklist with a structured interview for the assessment of DSM-III-R and ICD-10 personality disorders.

The International Diagnostic Checklists for the assessment of the DSM-III-R and ICD-10 personality disorders (IDCL-P) were compared with a structured interview, the International Personality Disorder Examination (IPDE), using a balanced test-retest design with forty psychiatric inpatients. The results, using pairwise kappa for the calculation of agreement, were as follows: any personality disorder versus no personality disorder 0.52 for DSM-III-R diagnoses and 0.75 for ICD-10 diagnoses. The range for the single personality disorders diagnosed at least five times was from -0.07 to 0.71 for DSM-III-R diagnoses and from 0.38 to 0.68 for ICD-10 diagnoses. Only for DSM-III-R diagnoses do figures exist from three other studies comparing two structured interviews with each other. The results of all four studies suggest that 60% of the variance in personality disorder diagnoses represents variance not attributable to the patients, which is scientifically unacceptable.

Adult↗

A Pain Rating Scale and a Pain Behavior Checklist for clinical use: development, norms, and the consistency score.

A Pain Rating Scale [PRS] and a Pain Behavior Checklist [PBC] were developed for use during a clinical pain interview. Norms were based on 395 chronic pain patients referred for pain management. The PRS obtained ratings of present pain, and worst and least pain during the previous 30 days. The PBC recorded 16 pain behaviors during the 45- to 60-min interview. Normative data were given for seven measures: (1) worst pain rating, past month; (2) least pain rating, past month; (3) present pain rating; (4) difference between worst and least pain ratings; (5) pain behavior score; (6) total pain score (based on Nos. 1, 2, 3, and 5), and (7) consistency score. The consistency score reflects the agreement (or discrepancy) between the pain behavior and present pain ratings. A moderate overall relationship was found between pain behavior and present pain ratings (r = 0.46, p < 0.001). The frequency of good agreement between pain behavior and present pain ratings was unaffected by sex, race, age, pain site, type of injury, duration of pain, legal representation, and evaluating psychologist; but it varied markedly with conscious symptom magnification. Patients seen as consciously exaggerating pain (n = 127) gave higher pain ratings (all p values < 0.001); and had frequent (64.6%) discrepancies between their pain report and pain behavior compared to others (14.2%). The report of present pain was unrelated to pain behavior for conscious exaggerators (r = 0.04, NS); in contrast there was a moderately high relationship for other patients (r = 0.68, p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗

Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees.

The United States is accepting the largest number of displaced persons since World War II. Over 70% are Southeast Asians; many have suffered serious war trauma and torture. Cultural differences in health-seeking behavior and lack of specialized mental health services make the recognition of psychiatric distress in Southeast Asia refugees difficult for American health care providers. The authors describe the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. This brief, simple, and reliable instrument is well received by refugee patients, offers an effective screening method for the psychiatric symptoms of anxiety and depression, and is especially helpful for evaluating trauma victims.

Anxiety↗

Use of the pediatric symptom checklist in strategies to improve preventive behavioral health care.

OBJECTIVE: The purpose of this study was to examine the utility of the Pediatric Symptom Checklist (PSC) in identifying youth at risk of behavioral health problems and to develop strategies to meet their mental health needs. METHODS: The PSC was completed by the parents of 570 children aged two to 18 years at three urban health centers in Massachusetts. Follow-up interviews were conducted with the parents of 95 of the children. Multidisciplinary teams held case conferences to review the cases of 43 of the 95 children who were interviewed and who were determined to have moderate to severe behavioral health problems. RESULTS: Of the 570 children in the screening sample, 144 (25 percent) had moderate to severe behavioral health problems, as indicated by a positive score on the PSC, and 2 percent had a serious emotional disturbance. Of the 297 pre-school-aged children (younger than six years), 67 (23 percent) received a positive score. Of the 283 school-aged children (age six and older) from both English- and Spanish-speaking families, 77 (27 percent) received a positive score. About one-third of the severely emotionally disturbed youth were receiving some mental health treatment, but only 20 percent were rated by the multidisciplinary team as receiving adequate treatment. CONCLUSIONS: The study provided further support for the validity and reliability of the PSC and confirmed the results of earlier studies that found a high level of unmet needs for mental health services among this population. Use of the PSC in this study promoted an increase in referrals for children in need.

Adolescent↗

A comparison of the Aberrant Behavior Checklist and the GAF among adults with mental retardation and mental illness.

Psychiatric assessment among individuals with a diagnosis of both mental retardation and mental illness presents a clinical challenge. This retrospective study compared two rating scales--the Aberrant Behavior Checklist (ABC) and the Global Assessment of Functioning (GAF)--to determine the scales' utility in a partial hospital setting. Although ABC and GAF ratings were weakly correlated, the ABC revealed symptom patterns consistent with recognizable features of psychiatric syndromes and differential improvement in symptoms within and between diagnostic subgroups. The ABC provided a more useful measure of treatment response than the GAF in this patient population.

Adult↗

Relation between maternal characteristics and child behavior ratings. Implications for interpreting behavior checklists.

The present study examined the extent to which mothers' ratings of their psychological distress, marital adjustment, and negative life events were related to maternal ratings of child behavior problems. Data were collected from mothers of 110 children (ages 2 to 12 years) who were referred to a pediatric clinic for a variety of common behavioral concerns. Maternal psychological distress and marital adjustment were significantly correlated with mothers' ratings on a child behavior checklist. Maternal psychological distress also accounted for a significant amount of the variance in maternal child behavior ratings over and above that accounted for by fathers' ratings of the same behaviors. Given that maternal characteristics co-vary significantly with reports of child behavior problems, pediatricians should interpret findings derived from child behavior rating scales within the overall family context.

Adaptation, Psychological↗

Screening for psychosocial dysfunction in pediatric practice. A naturalistic study of the Pediatric Symptom Checklist.

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P < .01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.

Adolescent↗

Review of patients in general practice with a diagnosis of epilepsy: development of a practice nurse checklist and an assessment of resource implications.

BACKGROUND: SIGN has recommended annual review of all patients with epilepsy. Annual review is rewarded in the new GMS contract. There is no information on how or by whom reviews should be carried out, nor on resource implications for secondary care. AIMS: To determine whether a practice nurse can deliver annual review of patients with epilepsy, and to estimate the resource implications of such review. METHODS: Evaluation of a practice nurse checklist against review by neurologist in 62 patients with epilepsy identified from a practice list of 6240 from Southwest Glasgow LHCC, and audit of case records in 1259 patients with epilepsy identified from the whole LHCC population of 96,565. RESULTS: There were 8 discrepancies between nurse and doctor reviews in a first iteration, but none in the second. Changes suggested a training effect. The review process generated 19 epilepsy nurse appointments, 7 requests for cerebral imaging and 3 requests for video EEG. Twelve patients required continuing follow up. The LHCC audit identified a large number of patients who had inadequate documentation of information and advice (over 90% in some domains). 28.6% had not been seen by a specialist, 40.7% had not had cerebral imaging, and only 37.4% were seizure free. CONCLUSION: Annual reviews of patients with epilepsy can be carried out by practice nurses, but some training is required. The review process is likely to increase the burden on secondary care and have a significant adverse effect on neurology waiting times.

Adolescent↗