Ratings Of Overall Quality Research Articles

Development of an Assessment to Examine Training of the Hospice Primary Caregiver.

Key to high-quality care of dying hospice patients at home is whether the hospice provides adequate training so the caregiver can safely care for the patient. The study objective was to develop and validate a survey of hospice training for caregivers to ensure safe, high-quality care in the home setting. Our survey design was cross-sectional. Bereaved respondents of individuals who died at home under the care of hospice were surveyed three to six months postdeath. Items were developed based on advice of an expert panel, focus groups of hospice caregivers, and literature review, with 12 items developed for testing and examining 8 key processes of care. We examined the validity and reliability of the assessment using factor analysis, correlational analyses, and multivariable modeling. Our sample consisted of 262 primary caregivers (mean age 62.4, 76.7% female, 58.8% non-Hispanic white). Six questions focused on providing the caregiver with information, while another six focused on the training that hospice provided. Based on model fit and Cronbach's alpha, we dropped the information items. The items that examined hospice training demonstrated a one-factor solution and a Cronbach's of 0.90. We examined correlations of the multi-item composite with overall rating of quality of care (0.53), overall distress (0.31), and whether the respondent would recommend this hospice to others (0.49). There were no significant sociodemographic correlates of concerns with training. Sufficient preliminary reliability and validity warrants further testing of this composite to examine the adequacy of training provided to family members to care safely for the patient.

Systematic versus opportunistic risk assessment for the primary prevention of cardiovascular disease.

Screening programmes can potentially identify people at high cardiovascular risk and reduce cardiovascular disease (CVD) morbidity and mortality. However, there is currently not enough evidence showing clear clinical or economic benefits of systematic screening-like programmes over the widely practised opportunistic risk assessment of CVD in primary care settings. The primary objective of this review was to assess the effectiveness, costs and adverse effects of systematic risk assessment compared to opportunistic risk assessment for the primary prevention of CVD. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane Library, MEDLINE, EMBASE on 30 January 2015, and Web of Science Core Collection and additional databases on the Cochrane Library on 4 December 2014. We also searched two clinical trial registers and checked reference lists of relevant articles. We applied no language restrictions. We selected randomised controlled trials (RCTs) that assessed the effects of systematic risk assessment, defined as a screening-like programme involving a predetermined selection process of people, compared with opportunistic risk assessment which ranged from no risk assessment at all to incentivised case finding of CVD and related risk factors. Participants included healthy adults from the general population, including those who are at risk of CVD. Two review authors independently selected studies. One review author extracted data and assessed them for risk of bias and a second checked them. We assessed evidence quality using the GRADE approach and present this in a 'Summary of findings' table. Nine completed RCTs met the inclusion criteria, of which four were cluster-randomised. We also identified five ongoing trials. The included studies had a high or unclear risk of bias, and the GRADE ratings of overall quality were low or very low. The length of follow-up varied from one year in four studies, three years in one study, five or six years in two studies, and ten years in two studies. Eight studies recruited participants from the general population, although there were differences in the age ranges targeted. One study recruited family members of cardiac patients (high risk assessment). There were considerable differences between the studies in the interventions received by the intervention and control groups. There was insufficient evidence to stratify by the types of risk assessment approaches.Limited data were available on all-cause mortality (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.92 to 1.02; 3 studies,103,571 participants, I² = 0%; low-quality evidence) and cardiovascular mortality (RR 1.00, 95% CI 0.90 to 1.11; 2 studies, 43,955 participants, I² = 0%), and suggest that screening has no effect on these outcomes. Data were also limited for combined non-fatal endpoints; overall, evidence indicates no difference in total coronary heart disease (RR 1.01, 95% CI 0.95 to 1.07; 4 studies, 5 comparisons, 110,168 participants, I² = 0%; low-quality evidence), non-fatal coronary heart disease (RR 0.98, 95% CI 0.89 to 1.09; 2 studies, 43,955 participants, I² = 39%), total stroke (RR 0.99, 95% CI 0.90 to 1.10; 2 studies, 79,631 participants, I² = 0%, low-quality evidence), and non-fatal stroke (RR 1.17, 95% CI 0.94 to 1.47; 1 study, 20,015 participants).Overall, systematic risk assessment appears to result in lower total cholesterol levels (mean difference (MD) -0.11 mmol/l, 95% CI -0.17 to -0.04, 6 studies, 7 comparisons, 12,591 participants, I² = 57%; very low-quality evidence), lower systolic blood pressure (MD -3.05 mmHg, 95% CI -4.84 to -1.25, 6 studies, 7 comparisons, 12,591 participants, I² = 82%; very low-quality evidence) and lower diastolic blood pressure (MD -1.34 mmHg, 95% CI -1.76 to -0.93, 6 studies, 7 comparisons, 12,591 participants, I² = 0%; low-quality evidence). One study assessed adverse effects and found no difference in psychological distress at five years (1126 participants). The results are limited by the heterogeneity between trials in terms of participants recruited, interventions and duration of follow-up. Limited data suggest that systematic risk assessment for CVD has no statistically significant effects on clinical endpoints. There is limited evidence to suggest that CVD systematic risk assessment may have some favourable effects on cardiovascular risk factors. The completion of the five ongoing trials will add to the evidence base.

Is Care for the Dying Improving in the United States?

Striking changes occurred in health care in the United States between 2000 and 2013, including growth of hospice and hospital-based palliative care teams, and changes in Medicare payment policies. The aim of this study was to compare informants' reports and ratings of the quality of end-of-life care for decedents between 2000 and 2011-2013. The study design comprised retrospective national surveys. Subjects were decedents age 65 years and older residing in the community from two time periods. Similar survey questions were asked at the two time periods. Bivariate and multivariate analyses were conducted, using appropriate survey weights to examine response differences between time periods, after adjusting for the decedent's age, race, pattern of functional decline, and the presence of a cancer diagnosis, as well as the respondent's relationship to the decedent. A total of 1208 informants were interviewed; 622 in 2000 and 586 in 2011-2013. Respondents from deaths in 2011-2013 were more likely to state that their loved ones experienced an unmet need for pain management (25.2% versus 15.5% in 2000, adjusted odds ratio [AOR] 1.9, 95% confidence interval [CI] 1.1-3.3). More respondents reported that religion and spirituality were addressed in the later time period (72.4% not addressed compared with 58.3%, AOR 1.4, 95% CI 1.1-1.9). High rates of unmet need for palliation of dyspnea and anxiety/depression remained. The overall rating of quality did not improve but decreased (with 56.7% stating care was excellent in 2000 and 47.0% in the later survey, AOR 0.70, 95% CI 0.52-0.95). Substantial unmet needs in end-of-life care remain. Continued efforts are needed to improve the quality of end-of-life care.

A retrospective outcomes evaluation of cannabis use at an addictions center

Purpose – The purpose of this paper is to retrospectively evaluate outcomes measured for patients attending the Leeds Addiction Unit (LAU) for cannabis use disorders. Design/methodology/approach – The authors performed a retrospective evaluation of data for clients referred to LAU for cannabis use disorders. These clients are routinely allocated to a programme of social behaviour and network therapy (SBNT), and methods of monitoring treatment include four questionnaires completed by clients, and the collection of treatment outcomes profile (TOP) data. Data were compared using non-parametric statistical methods. Findings – Of 158 clients included in the study, 20 completed the four questionnaires at assessment and follow-up. A statistically significant improvement was found for the outcome measuring level of dependence (p=0.013). TOP data showed significant reduction in the average number of days of cannabis use over the past four weeks (p<0.001) and improved median scores for the client's rating of overall quality of life (p<0.001). Practical implications – These findings suggest that treatment using SBNT can result in clinical improvement in cannabis use disorders. The promising results of the UK Alcohol Treatment Trial naturally raised the question as to whether SBNT can be adapted to treat substance use disorders other than alcoholism. This study aims to add to the body of evidence for this proposal. Originality/value – This is the first evaluation of the service to measure outcomes for the treatment of cannabis misuse. This study is especially relevant given the recent changes made to the Diagnostic and Statistical Manual of Mental Disorders regarding cannabis use disorders, and has triggered another evaluation of cannabis treatment at LAU looking into specific pharmacotherapy.

Performance Analysis of Advanced Hybrid Speech Coding Techniques in Time domain, Spectral domain and Perceptual domain

Speech coding is the art of creating a minimally redundant representation of the speech signal that can be efficiently transmitted or stored in digital media and decoding the signal with the best possible perceptual Quality. The speech transmission in wireless networks is associated with the reduction of extra information present in signal in such a way to preserve the quality and intelligibility of speech. It is known that the lower the bit rate the lesser the quality of the reconstructed speech however there is a constant quest to achieve a better speech quality at lower bit-rates.This paper presents performance analysis for the quality of advanced hybrid speech coding techniques in Time domain, Spectral domain and perceptual domain. These analyses are implemented on three different algorithms of advanced hybrid speech coding techniques such as CELP, G729 Annex A, G723.1 to assess the quality performance for English female speaker, English male speaker and Arabic female speaker by using Mat lab simulation program. Our evaluation criterion implemented includes the following tests: Signal to Noise Ratio (SNR), Segmental Signal to Noise Ratio (SNRseg), The Log-Likelihood Ratio (LLR), The Weighted Spectral Slope (WSS), Absolute Error,Perceptual Evaluation of Speech Quality (PESQ),NONE">Rating of speechdistortion, rating of background noise and the predicted rating of overall quality.

Determinants of perceived quality of obstetric care in rural Tanzania: a cross-sectional study.

BackgroundPatients’ reported opinions of the health system need to be understood in order to provide patient-centered care. We investigated determinants of women’s ratings of the quality of care during their most recent facility delivery.MethodsWe conducted a census of all deliveries in the 6 weeks to 12 months preceding the survey, in villages served by 24 primary care clinics in rural Pwani Region, Tanzania. Women who had delivered children in a study facility were included in this analysis (n = 855). We interviewed women about demographic and obstetric factors and the quality of their obstetric care using a structured questionnaire. We created a composite index of perceived quality from six quality questions. We also assessed the functioning of the local health clinic using structured surveys. We used a multi-level model to analyze factors associated with women’s rating of the quality of care during delivery.Results14% of respondents rated the overall quality of care received during delivery as excellent. Women who listened to the radio daily reported lower quality composite scores (β: -0.99, p < 0.001). Women who reported receiving more services in ANC had higher quality scores (β: 0.46, p = 0.001), as did women receiving more delivery services (β: 0.55, p < 0.001). Women who reported disrespect and abuse during delivery had significantly lower quality scores (β: -4.13, p < 0.001).ConclusionsA woman’s expectations and prior and current experiences influence her perception of the quality of care she received. Health facility characteristics did not influence ratings of overall quality. Focusing on improving the process rather than inputs of service delivery during ANC visits and delivery may increase perceived quality of delivery care in low-resource settings.Trial registrationISRCTN17107760

Undergraduate Surgery Clerkship and the Choice of Surgery as a Career: Perspective from a Developing Country

There are concerns regarding a possible decline in the proportion of students choosing surgery as a career in some countries in sub-Saharan Africa. Published works indicate that most students choose their ultimate career during undergraduate training. The present study was undertaken to assess the medical student's perception of the surgery clerkship and determine its influence in the choice of surgery as a career. The study involved a cross-sectional survey of 2009 and 2010 graduating medical classes of the University of Nigeria based on self-administered questionnaires. The clerkship evaluation was assessed on a 3-point Likert scale (1 = poor; 3 = excellent). The response rate was 70.3 % (275/391); 179 (65.1 %) of the students were males and 96 (34.9 %), females. Sixty-one (22.2 %) rated the overall quality of their surgery clerkship as excellent (mean rating = 2). Compared with the other three major clerkships, surgery has the lowest rating for overall quality (mean rating: surgery = 2; others = 2.2). Aspects of the clerkship experience that contributed to the overall lower rating of surgery include quality of opportunity to participate in direct patient care; clarity of posting goals and objectives; experience in learning history taking skills, basic physical examination skills, and interpretation of laboratory data; accessibility of faculty; and students' perception that they were treated in a respectful manner. The major suggestions to improve clerkship quality were these: (1) more involvement in direct patient care (n = 154; 56 %), and (2) improvement in student-faculty interaction (n = 9 1; 33.1 %). Overall, 96 (34.9 %) students selected surgery as a specialty, and 39.3 % (108/275) selected the other three major specialties. Surgery was selected by 17/48 (35.4 %), 59/166 (35.5 %), and 20/61 (32.8 %) students who rated the surgery clerkship as "poor," "just right," and "excellent," respectively (p = 0.876). Factors indicated as major influences in the choice of surgical specialty included personal satisfaction 41.7 % (40/96), clerkship experience 36.4 % (35/96), and diligence of faculty 13.5 % (13/96). Periodic assessment of the satisfaction of medical students regarding their surgical clerkship experience is important. In our setting, we have identified aspects of the surgical clerkship that could be improved to enhance the quality of the experience, ensure the attractiveness of the field to the most qualified candidates, and boost interest in surgery as a career.

Overall performance evaluation of adaptive multi rate 06.90 speech codec based on code excited linear prediction algorithm using MATLAB

Today, the primary constrain in wireless communication system is limited bandwidth and power. Wireless systems involved in transmission of speech envisage that efficient and effective methods need to be developed for maintaining quality-of-speech, especially at the receiving end, with maximum saving of bandwidth and power. Amongst all elements of the communication system (transmitter, channel and receiver), transmission channel (carrier of information/data, also called the medium) is the most critical and plays a key role in the transmission and reception of information/data. Channel conditions decide the quality of speech at receiver. Modeling a channel is a complex task. Many techniques are adopted to mitigate the effect of the channel. AMR (Adaptive Multi Rate) is one such technique that counteracts the deleterious effect of the channel on speech. This technique employs variable bit rate that dynamically switches to specific modes of operation (switching bit rates--called modes of operation) depending upon the channel conditions. In this paper, the application of Code Excited Linear Prediction (CELP) source coder on speech followed by AMR codec is investigated and studied. An e-test bench using MATLAB is created to implement the CELP based AMR Codec scheme, and the same studied and investigated through a series of simulation. Here, both subjective and objective evaluations are carried out. Objective evaluations are categorized into waveform based, spectral based and perceptual based analysis. The results of the simulations are recorded and compared in various graphs and tables, which include calculation of various parameters like Absolute Error (ABS), Mean Square Error (MSE), Root Mean Square Error (RMSE), Signal to Noise Ratio (SNR), segmental SNR (segSNR) (Y. Hu and P. Loizou in Proc. IEEE Int. Conf. Acoust., Speech, Signal Process., vol. 1, pp. 153---156, 2006a; Proc. Interspeech, pp. 1447---1450, 2006b), Weighted-Slope Spectral distance (WSS) (Y. Hu and P. Loizou in Speech Commun. 49, 588---601, 2007), Perceptual Evaluation of Speech Quality (PESQ) (ITU-T rec. P.862, 2000), Log-Likelihood Ratio (LLR), Itakura-Saito Distance measure (ISD), Cepstrum Distance Measures (CEP) (V. Turbin and N. Faucheur in Proc. Online Workshop Meas. Speech Audio Quality Netw., pp. 81---84, 2005), Frequency Weighted Segmental SNR (fwSNRseg), Predicted rating of overall Quality (Covl), Rating of Speech Distortion (Csig), Rating of Background Distortion (Cbak) (ITU-T rec. P.835, 2003) and MeanOpinion Score (MOS). Simulation results clearly advocate that, it is possible to producevariable bitrates (tuning to channel conditions) in CELP coder by affecting coefficients of the coder while still maintaining a good quality of speech. Further, higher the bit-rate used, the better is the quality of speech (which can be verified from the results obtained with PESQ and MOS analysis) and at the same time offered simulation delay time also increases.

The social validity of script training related to the treatment of apraxia of speech

Background: Social validity is an important yet under-examined aspect of treatment efficacy that determines how the effects of treatment are perceived by people other than the clinician/researcher. This is particularly true of treatments to improve the speech of adults with acquired neurogenic disorders. Aims: The purposes of this investigation were to evaluate the social validity of a modified script training treatment protocol, to explore how aspects of a client's speech correspond to varying rater judgements, and to determine which of the listener ratings were most predictive of ratings of overall quality. Methods & Procedures: A total of 124 young, naïve listeners were asked to rate the quality of speech of an 81-year-old woman with moderate–severe apraxia of speech during utterances with varying levels of script correctness (low, medium, high), number of errors (low, high), and rate (slow, faster). Judgements were made on the understandability, ease of production, naturalness, and overall quality of speech. Outcomes & Results: All main effects and interactions were statistically significant. As script correctness, speaking rate, and number of errors increased, listener ratings were significantly more favourable. Interactions demonstrated increasing correctness, error, and rate with significantly more favourable listener ratings. The listener ratings that predicted improved perceptions of overall quality, weighted highest to lowest, were: understandability, naturalness, and ease of production. Error types were analysed and revealed that phrase repetitions appeared to be perceived positively and that unintelligible words and interjections appeared to be perceived negatively. Conclusions: The modified script training protocol applied to a woman with marked apraxia of speech appeared to be socially valid with these naïve raters. Listeners appeared to be sensitive to the amount and the quality of speech output generated by the speaker. Listeners appeared to perceive struggle behaviours as negative, increased speech output (including repetitions and empty speech) as positive, faster speech (closer to a normal speaker's average word per minute) as preferable to slow speech, and more understandable speech and more natural speech as better quality speech. Based on these data, the accuracy and fluency of script production are important treatment goals.

Association of spasticity and life satisfaction after spinal cord injury

ObjectiveTo identify the relationship between spasticity and life satisfaction as measured by 3 multi-item factor scales and a rating of overall quality of life among participants with spinal cord injury (SCI).Study DesignCross-sectional survey; secondary analysis of existing data by linear regression analysis between spasticity and quality of life.SettingLarge specialty hospital in the Southeastern United States.MethodsParticipants included 1,549 adults with traumatic spinal cord injuries, at least 18 years of age and a minimum of 1 year post-injury at survey. Outcome measures included: (1) Home Life Satisfaction, (2) Global Satisfaction, (3) Vocational Satisfaction, (4) Overall Quality of Life and (5) three subscales from the Patient Reported Impact of Spasticity Measure.ResultsThree aspects of spasticity (Daily Activities, Positive Impact, and spasticity at its worst) all were negatively correlated with Home Life Satisfaction, Global Satisfaction, and Overall Quality of Life. Only the Daily Activities scale and the spasticity at its worst rating had a significant negative correlation with Vocational Satisfaction.ConclusionSpasticity is negatively associated with quality of life after SCI. These negative outcomes need to be considered in an individual’s rehabilitation and treatment methods.

Quality of life among dentists in teaching hospitals in South Canara, India

This paper reports on the quality of life among dentists using World Health Organization Abbreviated Instrument for Quality of Life Assessment, comprising 26 items which measure the following broad domains: Physical health, psychological health, social relationships, and environment. The instrument was self-administered among dentists in four teaching dental institutions. A total of 191 questionnaires were given out. Of those, 187 were consented and answered, making up a response rate of 97.9%. The internal consistency of the questionnaire, measured by Cronbach's alpha was estimated at 0.75. Highest mean score was seen for Domain 3 (Social relationships) (16.15 + 2.38) and the least score was for Domain 4 (Environment) (14.72 + 2.12). Higher proportions of respondents rated their quality of life as good (65.1 percent), and also majority of dentists (63.5 percent) were satisfied with their health. Quality of life recognizes the value of an individual's health in the broader psychologic and social aspects of his/her life. In this study, the overall rating of quality of life among dentists in teaching hospitals is good.

Quality and Coordination of Care for Patients With Multiple Conditions: Results From an International Survey of Patient Experience

Previous studies using clinical performance measures suggest that quality of care for patients with multiple chronic conditions is not worse than that for others. This article presents patient-reported experiences of health care among 8,973 of chronically ill adults from eight countries, using telephone survey data. We designed a ''morbidity score'' combining the number of conditions and reported health status. Respondents with high morbidity scores reported less favorable experience with coordination of care compared to those with low morbidity scores. They also reported lower ratings of overall quality of care. There were no differences in reported experience with the individual physicians. Comparing type of comorbidity, chronic lung, and mental health problems were associated with lower ratings than hypertension, heart disease, diabetes, arthritis, and cancer. The implications and limitations of this study are discussed in the context of health care reform. Pay-for-performance programs need to account for chronic conditions to avoid penalizing physicians who care for larger shares of such patients.

Measuring the Quality of End-of-Life Care

Although there is a documented need to improve end-of-life care, there are few validated and brief questionnaires that are available as outcome measures for use in improving that care. To examine the measurement characteristics of the Quality of End-of-Life Care (QEOLC) questionnaire. In a multisite, cross-sectional study of a mailed questionnaire, patients with life-limiting illnesses, their families, and nurses completed the QEOLC questionnaire. Patients and nurses were identified by physicians, and families were identified by participating patients. Physicians included general internists, oncologists, cardiologists, and pulmonologists from the Southeast and Pacific Northwest of the United States. Eight hundred one patients, 310 of their families, and 885 nurses were identified by 85 physicians. Using structural equation modeling techniques corrected for clustering under physicians, we identified a patient-specific factor based on 11 items, a family-specific factor based on 22 items, a nurse-specific factor based on 11 items, and a common single-factor solution based on 10 items. Construct validity was supported by significant associations in the hypothesized direction between the identified QEOLC factors and each of the following: physician palliative care knowledge, patients' and families' ratings of overall quality of care, and patients' levels of symptom distress. Although continued testing in heterogeneous samples is necessary, the current study supported the construct validity of the QEOLC questionnaire to assess physician skill at end-of-life care, thereby providing valid measures of quality end-of-life care. Furthermore, this approach is a model for development and validation of patient- and family-centered assessments of quality of care.

Self-generated Domains of Quality of Life in Children with and Without Cerebral Palsy

This study was conducted to demonstrate feasibility of utilizing a modified SEIQoL-DW with children by examining self-generated domains of quality of life in children with and without cerebral palsy. Study samples were children, ages 6-12, (mean 8.9, SD 1.8) including 41 children with cerebral palsy (CP) and 60 children who were age and gender matched peers without disability. Quality of life was assessed with a modified Schedule for the Evaluation of Individual Quality of Life-Direct Weight (SEIQoL-DW). Group differences in overall ratings of quality of life were not significant; however, there were significant group differences in the frequency and hierarchy of self-generated domains. Within the group with CP, functional ability was not associated with quality of life.

Student and teaching characteristics related to ratings of instruction in medical sciences graduate programs

Background: Although the validity of students’ ratings of instruction has been documented, several student and course characteristics may be related to the ratings students give their instructors.Aims: The purpose of this study was to examine student ratings obtained from the Universal Student Ratings of Instruction (USRI) instrument. These responses were compared to various student characteristics. Also, teaching characteristics that were most closely associated with the ratings were determined.Method: A total of 1738 USRI forms were completed by graduate students enrolled in medical science courses from 1999 to 2006 in the Faculty of Medicine at a Canadian university.Results: Between group comparisons showed that negative student perceptions about the course (i.e., did not have the freedom to select), perceiving the course workload as high, and low grade expectations held were related to negative student ratings of overall quality of instruction. In terms of the student and teaching characteristics, organization of course material and perceptions of whether students felt they learned a lot in the course were most closely related to global ratings of instructional quality.Conclusion: Implications for teaching focus on improving the organization and delivery of course content that meets the learning objectives of graduate students in medical sciences.

The impact of smoking on health-related and overall quality of life: A general population survey in Finland

The objective of the study was to examine the association between overall and health-related quality of life and smoking in men and women of discrete smoking groups in Finland. The design was a Health 2000 Survey, conducted in Finland 2000--2001. The setting and participants were a two-stage, stratified, nationally representative cluster sample that comprised 8,028 persons aged 30 or over living in mainland Finland. Health-related quality of life was measured by the 15D questionnaire; and overall quality of life was assessed by a single question measure capturing the respondent's own perception and estimation of his/her quality of life. The present study showed that daily smokers had both lower health-related and overall quality of life than never-smokers among the Finnish adult population. Health-related quality of life profiles showed that daily smokers did worse than never-smokers in a considerable number of the health dimensions. The effects of smoking were observed not only through health: the daily smokers registered significantly lower ratings of overall quality of life compared with never-smokers, too. Both the health-related and overall quality of life of ex-smokers approached those of never-smokers. The results of the present study suggest that improved health is not the only benefit of smoking cessation; better quality of life and more fulfilling everyday living can also be expected. As the major health consequences of smoking usually manifest themselves only after several years of smoking, both health-related and overall quality of life measurements could be used as an intervention tool for motivating people to quit.

Quality of Health Care for Children

To assess how parent reports about the inpatient care of their children vary according to the health status of children with and without chronic conditions. We analyzed parent responses to the Picker Institute Pediatric Inpatient Survey. Thirty-nine hospitals between January 1, 1997, and December 31, 1999. Overall, 12 562 parents of children who received inpatient care at participating hospitals. Main Outcome Measure Parent rating of overall quality of care. Fifty-one percent of parents reported that their child had a chronic condition. Quality-of-care ratings varied according to health status and the presence of chronic conditions. Parents of children in the worst (fair or poor) health without chronic conditions reported lower quality of care (P < .001) and more care problems (P < .001) than did those with chronic conditions. Parents of children in the best (excellent, very good, or good) health tended to rate care highly, whether or not their children had chronic conditions. In a multivariable model, the decrement in perceived quality of care associated with poorer health was greater for those without than for those with chronic conditions (P < .001). Although children in poor health are at risk for experiencing a lower quality of health care, parents of such children who have chronic conditions report fewer care-related problems. This may be owing to the more frequent health care interactions and better continuity of care for children with chronic conditions.

What symptom and functional dimensions can be predictors for global ratings of overall quality of life in lung cancer patients?

This study explores what dimensions of a health-related quality of life (HRQOL) questionnaire predict global ratings of overall quality of life (QOL) in lung cancer patients in assessments by patients and significant others, respectively. The analyses were based on dyadic assessments from lung cancer patients and their significant others. A subset of scales and items from the Swedish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the lung-cancer-specific module, LC-13, was selected. Using multiple regression procedures, the relative importance of different symptoms and of functional impairments in predicting overall QOL was examined. The multiple regressions revealed that emotional functioning and fatigue were the only significant predictors of overall QOL for both the patients and the significant others' assessments. In addition, physical functioning was found to be another predictor in the significant others' assessments. The results emphasize that it is essential to consider both emotional functioning and fatigue as important areas for overall QOL in lung cancer patients.

The relationship between function, quality of life and coping in patients with low-grade gliomas

The principal aim of the study was to describe function, quality of life and coping with illness-related problems in patients with low-grade gliomas (LGG), to evaluate the need of support. A second aim was to investigate how function, quality of life and coping were related. Thirty-nine patients with a diagnosis of LGG answered the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and the Ways of Coping Questionnaire (WCQ). The patients' level of function was assessed in accordance with the WHO performance status scale. Nearly all patients were capable of self-care, but less than half were able to carry out normal activities without restriction. Problems with fatigue, sleep disturbances and pain were most frequent. Most difficulties were reported in the domains, Role, Cognitive and Emotional functioning. Seventeen patients (45%) had scores indicating low overall quality of life. Ratings of overall quality of life and fatigue had the strongest relationship. The trend in the results suggested that mental problems have a stronger impact on quality of life than physical ones. Emotion-focused coping dominated. There was a significant relationship between coping by escape-avoidance and lower level of emotional functioning. The results of this study indicate that a multidisciplinary team is needed for assessment and treatment of the different problems in patients with LGG. Furthermore, special attention should be paid to patients who use coping by escape-avoidance, as this is associated with emotional distress.

Patient satisfaction of female and male users of veterans health administration services

To compare patient satisfaction of male and female users of Veterans Health Administration (VHA) services. Cross-sectional study based on secondary analysis of data from VHA's Survey of Healthcare Experiences of Patients (SHEP). National random sample of 107,995 outpatients and 112,817 inpatients in FY2004. Patient's ratings of overall quality (OQ) and unique dimensions of satisfaction. Sociodemographic and health-related patient attributes. Bivariate unadjusted analyses of the association between gender and other patient attributes and the outcomes of OQ and dimensions of satisfaction were conducted followed by multivariate analyses for each outcome, adjusting for demographic and health variables. Significant differences between female and male reporting of satisfaction were found in the unadjusted analyses with males showing greater levels of satisfaction than females (P<.05). These differences disappeared or became smaller for both outpatient and inpatient services, after adjusting for covariates. For 6 of the inpatient dimensions (Transitions, Physical Comfort, Involvement Family and Friends, Courtesy, Coordination, and Access) males had higher satisfaction than females after statistical adjustment. After adjustment for patient attributes, female VHA outpatients report similar OQ with VHA services as male patients. The fact that some inpatient dimensions of satisfaction continued to show effects favoring males even after adjustment suggests areas for continued focus in improving health care quality. Covariate adjustment is essential for evaluating satisfaction with health care services. Breaking down overall satisfaction into independent aspects of services is useful. The SHEP survey has provided a useful tool for evaluating and improving satisfaction among its VHA veteran users.