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Arozullah, A.M., Yarnold, P.R., Bennett, C.L., and others (2007, November). "Development and validation of a short-form rapid estimate of adult literacy in medicine." (AHRQ grant HS13004). Medical Care 45(11), pp. 1026-1033.

A recently developed seven-item short version of the Rapid Estimate of Adult Literacy in Medicine (REALM-SF), a word recognition test, provides clinicians with a valid quick assessment of patient health literacy. Researchers developed, validated, and field tested the REALM-SF with 1,336, 164, and 50 patients, respectively, at 4 different hospitals. They asked the patients to read seven medical words that were scored as correct, mispronounced, or not attempted: behavior, exercise, menopause, rectal, antibiotics, anemia, and jaundice. The researchers equated a score of 0 to a 3rd grade or lower literacy level; 1-4, 4th to 6th grade; 4-6, 7th to 8th grade; and 7, 9th grade or higher level. They developed the REALM-SF using a patient sample in which 43 percent of patients had less than 9th grade literacy, 45 percent were 65 years or older, and two-thirds (67 percent) were from racial/ethnic minorities. Furthermore, they validated it in a patient sample comprised of 98 percent black patients and 64 percent with less than 9th grade literacy.

Beeber, A.S. (2008). "Interdependence: Building partnerships to continue older adults' residence in the community." (AHRQ grant HS14 697). Journal of Gerontological Nursing 34 (1), pp. 19-25.

Current practice frames care of older adults in terms of independence and dependence. However, the focus is on older adults' deficits instead of how supportive services may enhance their ability to function. In contrast, interdependence, based on the idea that people rely on social networks for survival, is central to care for young adults with disabilities. Possibly because of ageism, this concept has not been applied to older adults. The author of this paper argues that through interdependence, older adults can gain support from their reciprocal relationships. Nurses can apply interdependence to the assessment for supportive services by focusing on older adults in the family context and the role of supportive services in maintaining residence in the community. Finally, interdependence can be used as a guiding framework for gerontological nursing research and practice to explore partnerships, reciprocal relationships, and service development and delivery.

Corser, W., Sikorskii, A., Olomu, A., and others (2008, April). "Concordance between comorbidity data from patient self-report interviews and medical record documentation." (AHRQ grant HS10531). BMC Health Services Research 8(85).

Comorbid conditions have an important influence on patient outcomes such as quality of life, depression, and death. The researchers sought to determine if comorbidity data obtained from different sources was in agreement. For a select group of 719 hospitalized patients with acute coronary syndrome, they compared medical records and self-report interviews to determine concordant validity between the two sources. They were especially interested in what patient characteristics predicted discordance between the results obtained from the two sources. The Charlton Comorbidity Index (CCI) was used to derive a composite comorbidity score from the medical records documentation, while the Katz self-report method was used to derive a score from the self-report interviews. The Katz method used the same 19 conditions and virtually the same individual item weightings as the CCI. The researchers found that the self-report interviews yielded reports of more comorbid conditions than the medical records. In addition, older age and higher levels of depressive symptoms were correlated with poorer data concordance.

Ellenbecker, C.H., Byleckie, J.J., and Samia, L.W. (2008). "Further psychometric testing of the home healthcare nurse job satisfaction scale." (AHRQ grant HS13477). Research in Nursing and Health 31, pp. 152-164.

Nurses' job satisfaction has been of interest since the 1960s when the first nurse shortage became a concern in the United States. To increase the understanding of nurses' job satisfaction, these researchers sought to improve the ability of the Home Healthcare Nurses' Job Satisfaction Scale (HHNJS) to measure satisfaction. They added and tested new items and revised or removed existing items from the 30-item previous version of the HHNJS. The theoretical framework suggested that there were eight factors involved in nurse satisfaction. Therefore, the researchers grouped each item into a subscale related to one of these eight factors (relationships with peers, patients, physician and organization, autonomy and control, salary and benefits, stress and workload, and professional pride). More than 2,200 registered nurses and licensed practical nurses working in home healthcare in New England filled out the survey form. The researchers found that the internal consistency of six of the eight subscales was improved, compared with the earlier version, thus contributing to a better understanding of nurse satisfaction.

Feldstein, A.C. and Glasgow, R.E. (2008, April). "A practical, robust implementation and sustainability model (PRISM) for integrating research findings into practice." (AHRQ grant HS11843). The Joint Commission Journal on Quality and Patient Safety 34(4), pp. 228-243.

Although numerous studies address the efficacy and effectiveness of health interventions, less research addresses successfully implementing and sustaining interventions. A barrier to progress is the absence of a model to help identify the factors that need to be considered and how to measure success. To help address this gap, these authors developed a comprehensive model for translating research into practice using concepts from the areas of quality improvement, chronic care, the diffusion of innovations, and measures of the population-based effectiveness of translation. The model incorporates five basic elements: program (intervention), the external environment, implementation and sustainability infrastructure, and recipients. PRISM—the Practical, Robust Implementation and Sustainability Model—evaluates how the health care program or intervention interacts with the recipients to influence program adoption, implementation, reach, and effectiveness. The PRISM model provides a new tool for researchers and health care decisionmakers that integrates existing concepts relevant to translating research into practice.

Gibbons, R.D., Segawa, E., Karabatsos, G., and others (2008). "Mixed-effects Poisson regression analysis of adverse event reports: The relationship between antidepressants and suicide." (AHRQ grant HS16973). Statistics in Medicine 27, pp. 1814-1833.

The primary tool used by the Food and Drug Administration (FDA) for post-marketing drug adverse event (AE) surveillance is the Adverse Event Reporting System (AERS). The AERS is a passive reporting system relying on reports by manufacturers, providers, and consumers and is therefore subject to selection bias as well as over- and under-reporting. To better understand the relationship between antidepressants and suicide (one of the most debated questions concerning adverse drug events), the researchers developed a data mining methodology different from that used by the FDA. This new method involves both empirical Bayes and fully Bayes estimation for each drug in a class of drugs, for a particular AE, based on a mixed-effects Poisson regression model. Using this method and data from the AERS, the researchers determined that newer antidepressants are associated with lower rates of suicide reports compared with older antidepressants. The researchers recommend that searches for other drug-AE interactions should use mixed-effects modeling and analytic methods that correct for denominators.

Han, H-R., Kim, K.B., Kang, J., and others (2007, October). "Knowledge, beliefs, and behaviors about hypertension control among middle-aged Korean Americans with hypertension." (AHRQ grant HS13160). Journal of Community Health 32(5), pp. 324-342.

The researchers gathered baseline information on beliefs and modifiable lifestyle behaviors that affect hypertension control by use of focus groups with Korean Americans, interviews, and community observations. Overall, 63 percent of men and 82 percent of women had a family history of hypertension; more than 1 in 10 had diabetes and 1 in 20 had already had a stroke. Korean American women were more likely than men to have controlled blood pressure (BP) and to have been on antihypertensive medications. Women also more commonly had lower rates of smoking, drinking, and overweight or obesity (43 vs. 56 percent) than men. One-fifth of the men were current smokers, over 8 percent drank more than 10 drinks per week, and only 12 percent engaged in moderate exercise such as brisk walking for at least 30 minutes a day on 5 or more days a week. About one-fourth of the group said that cutting down on salt was the most important behavioral factor for controlling BP, followed by exercise and antihypertensive medication.

Jensen, P.M., Saunders, R.L., Thierer, T., and Friedman, B. (2008, April). "Factors associated with oral health-related quality of life in community-dwelling elderly persons with disabilities." (AHRQ grant HS10120). Journal of the American Geriatrics Society, 56(4), pp. 711-717.

To investigate factors that affect oral health-related quality of life (OHRQOL), researchers collected information on 641 disabled, elderly Medicare recipients, living in communities in 3 States, who were not cognitively impaired. The researchers administered the 14-item Oral Health Impact Profile to determine the participants' OHRQOL. The participants' mean age was 79 years, and they were dependent for help with nearly two activities of daily living, on average, such as bathing and dressing. Overall, 43.1 percent were toothless, 77.4 percent wore a denture, 40.4 percent felt they were in need of current dental treatment, and 84.7 percent had not had a dental checkup in the past 6 months. Poor OHRQOL was significantly associated with perceived need for dental treatment, poor self-rated health, poor and fair mental health, possessing fewer than 17 teeth (of the normal 32), and relatively poor cognitive status. Low OHRQOL was not associated with less life satisfaction, living alone, or low income. Because poor cognitive status served as a risk factor for low OHRQOL, the researchers suggested that more frequent recalls with the dentist, such as every 3-4 months, be used to monitor oral health in this population. They also noted that, because neither Medicare nor Medicaid covers most dental services, it is unlikely that either would pay for cognitive screening as part of dental care for the community-dwelling elderly.

Kim, E-Y., Han, H-R., Jeong, S., and others (2007, September). "Does knowledge matter? Intentional medication nonadherence among middle-aged Korean Americans with high blood pressure." (AHRQ grant HS13160). Journal of Cardiovascular Nursing 22(5), pp. 397-404.

The Self-Help Intervention Program for high blood pressure care (SHIP-HBP) combines psychobehavioral education with self-monitoring of blood pressure and telephone counseling by bilingual nurses. Researchers found that intentional nonadherence to antihypertensive medication among the 445 middle-aged Korean Americans in the SHIP-HBP was primarily due to inadequate understanding of the medication. About 55 percent of the group was taking antihypertensive medication. Over half (54 percent) of the 208 who were not taking the medication endorsed one or more type of nonadherent behaviors. Of this group, 29.8 percent indicated unintentional nonadherence, 2.4 percent intentional nonadherence, and 21.6 percent both types of nonadherence. Those who purposely did not take their antihypertensive medication were significantly more likely to have medication-related adverse effects such as frequent urination at night, itching, heart pounding, dry mouth, and flushing of the face. Also, those who did not take their medication had significantly less knowledge about hypertension than those who did take it.

Lapane, K.L., Dube, C., Schneider, K.L., and Quilliam, B.J. (2007, August). "Patient perceptions regarding electronic prescriptions: Is the geriatric patient ready?" (AHRQ grant HS16394). Journal of the American Geriatrics Society 55, pp. 1254-1259.

Electronic prescribing (e-prescribing) involves the direct computer-to-computer transmission of prescription medication information from prescribers' offices to community pharmacies. This approach may provide opportunities for earlier and enhanced communication between geriatric patients and their clinicians. However, geriatric patients may need more education to fully engage in the prescribing process with their doctor and optimize use of e-prescribing technology. Researchers found that only about half (53 percent) of elderly patients at e-prescribing practices reported taking e-prescribed medications. Regardless of their e-prescribing experience, three-fourths of geriatric patients did not tell their physician if they did not want a prescription, and 85 percent would never tell their doctor if they did not plan to pick it up from the pharmacy. In the current study, elderly patients receiving e-prescriptions reported that their physicians checked their current medication use more frequently. They also reported discussing the importance of medication use with their doctors than patients in the same practices who did not receive an e-prescription.

Ma, J. and Stafford, R.S. (2008, May). "Screening, treatment, and control of hypertension in US private physician offices, 2003-2004." (AHRQ grant HS11313). Hypertension 51(5), pp. 1275-1281.

Researchers analyzed National Ambulatory Medical Care Survey data to examine the rates of and factors associated with hypertension screening, treatment, and control during U.S. office visits in 2003 and 2004. Blood pressure was measured in over half (56 percent) of all visits by adult patients and in 93 percent of visits by patients with hypertension. Nearly two-thirds (62 percent) of patients with hypertension were treated. They were most commonly prescribed antihypertensive agents (46 percent), with 58 percent of them prescribed combination therapy during treatment visits. However, only 39 percent of patients at these treatment visits were at recommended blood pressure goals. The likelihood of not being screened for hypertension was 10 times greater for visits with a provider other than a primary care physician or cardiologist and nearly 6 times greater for nonwell care visits. Patients in the South were 2.6 times more likely to go untreated for their hypertension than their counterparts in the Northeast. Also, those visiting a doctor for the first time were 1.6 times more likely to not be treated for hypertension than patients making return visits. Finally, patients who suffered from other medical conditions were nearly twice as likely to not have their blood pressure controlled than patients who suffered from hypertension alone.

Meropol, S.B. (2008). "Valuing reduced antibiotic use for pediatric acute otitis media," (AHRQ grant HS10399). Pediatrics 121, pp. 669-673.

It has been suggested that between 7 and 20 children suffering from ear infections (acute otitis media, AOM) must be treated with antibiotics for 1 child to derive benefit. The AAP guidelines urge clinicians to instruct parents to weigh the benefits and risks of withholding antibiotics for AOM. The author of this study performed a cost-utility analysis by describing AOM outcomes, using a common denominator of quality-adjusted life-days (QALDs), and then estimating the value of avoiding antibiotic resistance with the AAP guidelines, using a parental perspective. The study estimated that for the benefits of the AAP guidelines to at least balance the risks, the parents of a sick child considering foregoing a single antibiotic prescription must be willing to face the possibility that their child might be sick for between 7 hours and 4 days. Although this might seem rational from a societal perspective, this trade-off might not be desirable from a parental perspective. This could be a barrier to successful implementation of the AAP AOM guidelines. Other approaches to reduce antibiotic use, such as wider use of influenza vaccine and improved rapid viral diagnostic techniques, might be more successful.

Minkovitz, C.S., Strobino, D., Mistry, K.B., and others (2007, September). "Healthy Steps for Young Children: Sustained results at 5.5 years." (AHRQ grant HS13086). Pediatrics 120(3), pp. e658-e668.

This study, based on telephone interviews with parents, found that, even though the Healthy Steps for Young Children (HS) program ended at 3 years, its impact was sustained among 5-year-old children. A smaller percentage of HS parents than parents in a non-HS group ever slapped the child in the face or spanked their child with an object (10.1 vs. 14.1 percent). Also, more HS than non-HS parents often or almost always negotiated with the child (59.8 vs. 56.3 percent) and tended to often or almost always ignore misbehaviors (10.3 vs. 8.5 percent). HS parents were also more likely to encourage their child to read and to use appropriate car seat restraints. More HS than non-HS parents received desired anticipatory guidance about their child's health and safety (54.9 vs. 49.2 percent), agreed that the pediatrician or nurse practitioner provided support (82 vs. 79 percent), and ultimately remained at the HS practice (65.1 vs. 61.4 percent).

Mistry, K.B., Minkovitz, C.S., Strobino, D.M., and Borzekowski, D.L. (2007, October). "Children's television exposure and behavioral and social outcomes at 5.5 years: Does timing of exposure matter?" (AHRQ grant HS13086). Pediatrics 120(4), pp. 762-769.

This study found that one in five children 2.5 to 5.5 years of age watched television more than 2 hours a day. Also, one in six children viewed over 2 hours of television daily either at 2.5 years or at 5.5 years of age. In addition, over 40 percent of 5-year-old-children had televisions in their bedrooms. Timing of television exposure had varying impact. For example, heavy viewing by 2-year-olds was associated with later behavioral problems, but was not associated with fewer social skills at 5.5 years. However, 5-year-olds with current heavy television viewing had fewer social skills than peers without such heavy viewing. For children with only early heavy TV watching that was later reduced, there was no consistent link with later behavioral problems or social skills.

Rhodes, K.V., Frankel, R.M., Levinthal, N., and others (2007, November). "'You're not a victim of domestic violence, are you?' Provider-patient communication about domestic violence." (AHRQ grant HS11096). Annals of Internal Medicine 147(9), pp. 620-627.

Researchers examined audiotapes of 293 visits to 2 emergency department (EDs), during which clinicians screened adult women for domestic violence. ED clinicians screened for abuse in a perfunctory manner 45 percent of the time. For example, they simply asked, "Are you a victim of domestic violence?" Providers also framed their questions negatively 10 percent of the time, such as, "He's never hit you?" Moreover, ED providers probed for further information only one-third of the time, and rarely did they offer open-ended opportunities for women to talk. Most women who said they were at risk for abuse on the computer screening tool did not share this information with the provider. The opportunity to have a meaningful conversation about abuse was often diminished by provider factors. For example, ED clinicians sometimes screened women for abuse in the presence of their husband, ignored disclosure of abuse, did not assess women's safety or level of risk, and failed to link abused women with available resources. The researchers found very few instances in which ED clinicians provided counseling or social work services to women who disclosed domestic abuse.

Richards, K.M. (2008, March). "RAP Project—An instrument development study to determine common attributes for pain assessment among men and women who represent multiple pain-related diagnoses." (AHRQ grant HS10788). Pain Management Nursing 9(1), pp. 33-43.

Inadequate assessment of pain by nurses is a primary barrier to provision of optimum pain relief and may contribute to the problem of unrelieved pain. In addition, little is known about factors that may be common to the experience of pain among individuals who report a variety of pain problems. The author developed and tested an inductively derived multidimensional pain assessment instrument in patients with a variety of pain problems. The objective was to contribute to a systematic global assessment of all types of pain, which can potentially be used to inform standards for best practice in pain management nursing and improve patient outcomes. The author derived instrument items from interviews of patients suffering homogeneous pain (pain from a single illness), established the sensitivity of items to heterogeneous pain (pain from two or more illnesses) through focus groups and interviews with participants reporting multiple pain problems, and evaluated psychometric properties with those representing a variety of pain-related diagnoses. The preliminary evidence supported initial reliability and validity, indicating sensitivity of the Richards Assessment of Pain (RAP) instrument to heterogeneous pain.

Rose, J.S., Chassin, L., Presson, C., and others (2007, August 2007). "A latent class typology of young women smokers." (AHRQ grant HS14178). Addiction 102(8), pp. 1310-1319.

Researchers studied 443 Midwestern women who participated in a longitudinal tobacco-use study that began in 1980 and followed up with them in 1987, 1993, and 1999. They identified three subgroups among the women who smoked daily. The first group (48 percent of the sample) worked full time, were heavy smokers (more than half a pack each day), and were generally happy. The second group (19 percent) started smoking casually during their college years and exercised regularly. The third group (33 percent) were often mothers and smoked because they were addicted and received a psychological benefit from smoking. Identifying these groups may help determine what smoking cessation interventions and messages are appropriate for reaching them. For example, women in the first group may respond to messages appropriate to their self-confidence as a means of empowering them to quit. The college-aged women may be receptive to education campaigns on the unacceptability of smoking, its negative health effects, and the danger of addiction. The women in the third group may best be deterred by smoking bans in public places and high taxes on tobacco and may be best served by medically supervised cessation programs that address addiction and depression.

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