Self-rated Assessments Research Articles

Comparative Analysis of Independent Reviewer-Rated and Self-Rated Fidelity Scores in Individual Placement and Support Programs: Repeated Cross-Sectional Surveys.

Fidelity assessments can contribute to maintaining the adherence to the individual placement and support (IPS) model, which enhances vocational outcomes for individuals with mental illness worldwide. While independent reviews are standard, self-assessments could broaden the implementation of IPS. This study aimed to evaluate reviewer-rated and self-rated fidelity assessments using the Japanese version of the Individualized Supported Employment Fidelity Scale (JiSEF), and to compare the two assessment methods in terms of their correlations with employment outcomes in Japan. Over the 3-year research period, fidelity assessments were conducted by independent reviewers and trained program staff members across 26 programs, totaling 58 assessments. Analyses involved kappa statistics for item-level comparison, the intra-class correlation coefficient (ICC) and paired t-testfor the overall fidelity scores, and Pearson's correlations to examine the relationship between the fidelity scores and program-level employment outcomes. Most individual JiSEF items demonstrated fair to good reliability between reviewer-rated and self-rated assessments. The ICC for the overall JiSEF scores between the two assessment methods was 0.756, yet the distribution of self-rated scores was more scattered compared with that of reviewer-rated scores. The mean total scores from self-assessments were significantly lower than those from reviewer assessments (t = 2.072, P = 0.043). While both sets of scores correlated significantly with employment rates (r = 0.640, P < 0.001 for reviewer assessments; r = 0.325, P = 0.013 for self-assessments), the correlation was stronger for reviewer ratings (z = 2.207,P = 0.027). Self-rated fidelity assessments offer several benefits. However, since independent reviews had a more normal distribution and higher correlation with employment outcome, they should remain the priority in fidelity assessments within the Japanese IPS framework.

Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms

ABSTRACT Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS. Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15–21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention. Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI’s eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = −0.97– –1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%). Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.

Decoding the misperception: Exploring measurement error in self-rated assessments of diet quality

How much should we trust self-rated diet quality? Measures based on self-perception are often used in diet evaluation, but they can sometimes be subject to diverse biases. Using a unique setting provided by the nationally representative FoodAPS data where questions about diet quality are asked twice with intermediate reminders in between, we first show that the structure of survey questions can help identify inconsistency in the respondents’ self-rated diet quality. Findings reveal that respondents tend to deliver responses that align with their earlier responses. We then validate the respondents’ self-rated diet quality against their household’s healthy eating index, an objective measure of diet quality based on actual food acquisitions. We find no statistically significant association between self-rated diet quality and healthy eating index for respondents who display inconsistency in self-assessing their diet quality. Conversely, that relationship is significant for respondents with no such inconsistency. Our findings suggest an effective question design measuring diet quality, that can be generalized to the design of health survey questions.

The association between borderline personality disorder, childhood trauma, neuroticism, and self-rated or clinician-rated functional impairment in euthymic bipolar disorder-1 patients.

In this study, we mainly evaluated the associations of borderline personality disorder (BPD), neuroticism, and childhood trauma with the self-rated and clinician-rated overall functional impairment levels of adult euthymic patients with bipolar disorder-1 (BD-1). In addition, we compared patient and healthy control groups regarding the levels of of childhood trauma, neuroticism, BPD and functional impairment. In total, 90 euthymic BD-1 patients and 90 healthy controls were enrolled. The Childhood Trauma Questionnaire-Short Form, the neuroticism subscale of the Eysenck Personality Questionnaire Revised-Abbreviated Form, the Borderline Personality Questionnaire, the Functioning Assessment Short Test, and the Sheehan Disability Scale were administered to the participants. The study revealed that the levels of BPD, neuroticism, emotional abuse, physical abuse, global childhood trauma, self-rated overall functional impairment, all the subdomains of self-rated functional impairment, clinician-rated overall functional impairment, and all the subdomains of clinician-rated functional impairment (except leisure time) were significantly higher in the patients than those in the healthy controls (p < 0.05). Clinician-rated functional impairment levels were significantly correlated with levels of BPD (r = 0.555, p<0.001), neuroticism (r = 0.429, p < 0.001), global childhood trauma (r = 0.391, p <0.001), and all subtypes of childhood trauma except sexual abuse. Self-rated functional impairment levels were significantly correlated with levels of neuroticism (r= 0.289, p = 0.006), physical neglect (r = 0.213, p = 0.044), and BPD (r = 0.557, p < 0.001). In the regression analyses, the self-rated overall functional impairment levels were only significantly associated with the BPD feature levels (β = 0.319, p < 0.001) and the clinician-rated overall functional impairment levels were only significantly associated with the BPD feature levels (β = 0.518, p < 0.001). The present study's findings suggest that BPD features should be addressed in psychosocial interventions aimed at ameliorating functional impairment in patients with BD-1. Only BPD features were associated with self-rated and clinician-rated overall functional impairment levels in the regression analyses in the BD-1 patients. Performing self-rated and clinician-rated functional impairment assessments in the same clinical trial may give rise to relevant findings in the future.

Impact of e-learning and role play-based training on psychology students’ communication skills: a feasibility study

ABSTRACT Background Given the importance of communication skills in the psychologist-patient relationship, several training programs have been proposed. Cumulative microtraining (CMT) has shown positive impacts on communication skills in previous studies. Methods The aim of this naturalistic pre–post study was to test the feasibility of a hybrid CMT program and obtain preliminary data on its impact on communication skills in French-speaking third-year psychology students. The training included an e-learning curriculum and role plays. Pre–post measures included recorded peer-to-peer role plays and self-assessments by participants themselves using the Calgary Cambridge Grid (n = 38) and assessed by an independent rater (n = 29) with a checklist focused on objective behaviors and the CARE questionnaire measuring perceived empathy. Results The results showed increases in most communication skills at different levels. Summarizing, paraphrasing, and structuring skills were significantly increased after training (all P ≤ 0.001), as were self-reported measurements (all P < 0.001), and empathy and confidence assessed by an independent rater (all p < 0.05). Conclusion This study provides new evidence on the impact of CMT, including e-learning and role plays, on both self-rated assessments and assessments by an independent rater who measured communication and empathy in a population of French-speaking students. These findings highlight the importance of implementing such instruction in initial training despite the cost involved. It demonstrates the feasibility of its inclusion in university curriculum, facilitated by the adaptation of theoretical aspects of teaching in e-learning.

Changes in non-communicable diseases, diet and exercise in a rural Bangladesh setting before and after the first wave of COVID-19.

Prevalence of non-communicable diseases (NCDs) is high in rural Bangladesh. Given the complex multi-directional relationships between NCDs, COVID-19 infections and control measures, exploring pandemic impacts in this context is important. We conducted two cross-sectional surveys of adults ≥30-years in rural Faridpur district, Bangladesh, in February to March 2020 (survey 1, pre-COVID-19), and January to March 2021 (survey 2, post-lockdown). A new random sample of participants was taken at each survey. Anthropometric measures included: blood pressure, weight, height, hip and waist circumference and fasting and 2-hour post-glucose load blood glucose. An interviewer-administered questionnaire included: socio-demographics; lifestyle and behavioural risk factors; care seeking; self-rated health, depression and anxiety assessments. Differences in NCDs, diet and exercise were compared between surveys using chi2 tests, logistic and linear regression; sub-group analyses by gender, age and socio-economic tertiles were conducted. We recruited 950 (72.0%) participants in survey 1 and 1392 (87.9%) in survey 2. The percentage of the population with hypertension increased significantly from 34.5% (95% CI: 30.7, 38.5) to 41.5% (95% CI: 38.2, 45.0; p-value = 0.011); the increase was more pronounced in men. Across all measures of self-reported health and mental health, there was a significant improvement between survey 1 and 2. For self-rated health, we observed a 10-point increase (71.3 vs 81.2, p-value = 0.005). Depression reduced from 15.3% (95% CI: 8.4, 26.1) to 6.0% (95% CI: 2.7, 12.6; p-value = 0.044) and generalised anxiety from 17.9% (95% CI: 11.3, 27.3) to 4.0% (95% CI: 2.0, 7.6; p-value<0.001). No changes in fasting blood glucose, diabetes status, BMI or abdominal obesity were observed. Our findings suggest both positive and negative health outcomes following COVID-19 lockdown in a rural Bangladeshi setting, with a concerning increase in hypertension. These findings need to be further contextualised, with prospective assessments of indirect effects on physical and mental health and care-seeking.

Examining the feasibility and effectiveness of case manager delivered problem-solving therapy on late-life depression in a real-world setting: a mixed design pilot study

To optimize outcomes in Late-Life Depression (LLD), there remains a need for innovative augmentation treatments. Problem-Solving Therapy (PST) is demonstrated as an effective augmentation psychotherapy for LLD in a one-to-one setting. This study investigated the feasibility of implementing Case Manager delivered group PST for LLD in a community setting. The design was a mixed-methods pilot one-group pre-test post-test quasi-experimental feasibility study in adults aged 60+ years meeting criteria for major depressive disorder (MDD). Feasibility measures were inclusion, attendance, and attrition rate. PST was delivered in groups of 6–9 participants over 8 weeks. Participants completed a weekly self-rated depression scale from weeks 1–8, and pre-and post-intervention rater assessed depression and self-rated assessments of quality of life, insomnia, disability, and anxiety. Focus group interviews took place at week 8 for the first and last study cohort. Twenty-nine participants (inclusion rate of 91%) were enrolled, a recruitment rate of 2.2 participants/month. Of these, 26 (90%) completed week 8 assessments and 25 (96%) attended 5 or more PST sessions, while 15 (58%) attended all sessions. Self-rated depression, anxiety, and insomnia scores decreased significantly with medium-to-large effect sizes, while there was non-significant improvement in rater-assessed depression and self-rated disability and quality of life. Qualitative data showed participants found PST an easy-to-use technique and felt empowered and hopeful in recovering from depression. The results justify a replication of the study in a large RCT exploring the efficacy of offering a group-based Case Manager facilitated PST to older adults with LLD, in a community setting. Clinical Trial Registration Number: NCT03408821

Trends in parent-rated emotional symptoms, conduct problems, and hyperactivity/inattention among U.S. children and adolescents, 2004–2019

BackgroundEvidence suggests that the prevalence of self-rated psychological symptoms among children and adolescents has changed in the past two decades. Our objective was to examine if similar trends are apparent in parent-rated assessments of psychological symptoms. MethodsParticipants were a nationally-representative sample of parents who rated psychological symptoms in their children (ages 4–17) in either the 2004 (n = 9,012) or 2019 (n = 7,092) National Health Interview Survey. Emotional symptoms, conduct problems, inattention/hyperactivity, and perceived burden of psychological symptoms were measured with the Strengths and Difficulties Questionnaire. Log-binomial regression models were used to calculate prevalence ratios (PRs) comparing the prevalence of serious psychological symptoms between 2004 and 2019. Interactions terms were included to determine if trends varied among sociodemographic subgroups defined by age, sex, and race/ethnicity. ResultsIn the complete sample, the prevalence of serious psychological symptoms did not change over time for emotional symptoms (PR=1.00, 95% CI=0.84–1.18), conduct problems (PR=0.90, 95% CI=0.74–1.09), or inattention/hyperactivity (PR=0.94, 95% CI=0.78–1.12). Trends did not differ significantly between sociodemographic subgroups. The perceived impact (β=-0.44, 95% CI=-0.64, -0.23) and burden of psychological symptoms (odds ratio [OR]=0.66, 95% CI=0.57–0.77) declined slightly over time. LimitationsTrends are based on cross-sectional samples from only two time-points. ConclusionsThe prevalence of parent-rated emotional symptoms, conduct problems, and inattention/hyperactivity did not change between 2004 and 2019 among U.S. children and adolescents. Parent-rated assessments of psychological symptoms in youth may measure different constructs than self-rated assessments.

Accuracy of self- and proxy-rated hearing among older adults with and without cognitive impairment.

Hearing loss is highly prevalent among older adults with cognitive impairment and may exacerbate neuropsychiatric symptoms and affect interactions with others. Although audiometry is the gold standard for measuring hearing, it is not always used in research or clinical settings focused on the care of individuals with cognitive impairment. Subjective assessments of hearing, both self- and proxy-rated, are widespread but may not adequately capture the presence of hearing loss as compared to audiometry. This study investigates the concordance between subjective and objective hearing assessments among older adults with and without cognitive impairment and evaluates factors associated with concordance. Participants were a subset of the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS), a prospective cohort study representing four US communities with adjudicated cognitive diagnoses and audiometric data, totaling 3326 self-rated and 520 proxy-rated hearing assessments. Sensitivity and specificity were calculated, and multivariable logistic regression estimated the magnitude of the association between the concordance of hearing assessments and variables of interest. Sensitivity and specificity for self-rated hearing status were 71.2% and 85.9% among cognitively normal older adults, 61.1% and 84.9% among persons with MCI, and 52.6% and 81.2% among persons with dementia, respectively. For proxy-rated hearing, sensitivity and specificity were 65.7% and 83.3% for persons with MCI and 73.3% and 60.3% for persons with dementia, respectively. Female sex was positively associated with concordance for self-rated hearing assessments. The low sensitivity of self- and proxy-rated hearing assessments compared to audiometry suggests that hearing loss among older adults with cognitive impairment may go underreported and unaddressed in subjective assessments. Clinicians and researchers should recognize the limitations of using self- and proxy-rated hearing assessments as measures of hearing status and incorporate objective audiometric evaluation whenever possible.

Predictors of treatment response to pharmacotherapy in patients with persistent postural-perceptual dizziness.

The study aimed to identify the predictors of response to selective serotonin reuptake inhibitors (SSRIs) for 12weeks in patients with persistent postural-perceptual dizziness (PPPD). Short-term treatment responses were studied in 197 outpatients [127 (64.5%) women, mean age ± SD = 51.7 ± 15.9] diagnosed with PPPD. Clinical and self-rated assessments were analyzed at the baseline and at the end of pharmacotherapy for 12weeks. Multivariable logistic regression analysis was used to determine the following variables as the potential predictors of treatment response as measured by scoring in clinical global impression-improvement scale (CGI-I) scores: age, sex, comorbidity, baseline CGI-S score, Beck Depression Inventory-II score, State-Trait Anxiety Inventory score, Dizziness Handicap Inventory score at the baseline, and prescribed doses of antidepressants or benzodiazepines. The overall response rate to pharmacotherapy was 65.0% (128/197). Female sex and greater disease severity at the baseline (higher CGI-S score) were associated with a better response to the pharmacotherapy. Subgroup analyses by sex identified younger age and lower anxiety as the indicators for better outcomes in men, and absence of comorbidities in women. During the initial assessment, the severity of PPPD was associated with depressive symptoms and subjective functional handicap due to dizziness. The response to pharmacotherapy is favorable in PPPD. Sex, age and initial disease severity are the predictors of the response to SSRIs in patients with PPPD.

Effect of disease related biases on the subjective assessment of social functioning in Alzheimer's disease and schizophrenia patients

BackgroundQuestionnaires are the current hallmark for quantifying social functioning in human clinical research. In this study, we compared self- and proxy-rated (caregiver and researcher) assessments of social functioning in Schizophrenia (SZ) and Alzheimer's disease (AD) patients and evaluated if the discrepancy between the two assessments is mediated by disease-related factors such as symptom severity. MethodsWe selected five items from the WHO Disability Assessment Schedule 2.0 (WHODAS) to assess social functioning in 53 AD and 61 SZ patients. Caregiver- and researcher-rated assessments of social functioning were used to calculate the discrepancies between self-rated and proxy-rated assessments. Furthermore, we used the number of communication events via smartphones to compare the questionnaire outcomes with an objective measure of social behaviour. ResultsWHODAS results revealed that both AD (p < 0.001) and SZ (p < 0.004) patients significantly overestimate their social functioning relative to the assessment of their caregivers and/or researchers. This overestimation is mediated by the severity of cognitive impairments (MMSE; p = 0.019) in AD, and negative symptoms (PANSS; p = 0.028) in SZ. Subsequently, we showed that the proxy scores correlated more strongly with the smartphone communication events of the patient when compared to the patient-rated questionnaire scores (self; p = 0.076, caregiver; p < 0.001, researcher-rated; p = 0.046). ConclusionHere we show that the observed overestimation of WHODAS social functioning scores in AD and SZ patients is partly driven by disease-related biases such as cognitive impairments and negative symptoms, respectively. Therefore, we postulate the development and implementation of objective measures of social functioning that may be less susceptible to such biases.

Using Standardized Tools to Characterize Adult Day Program Populations: Implications for Future Research and Clinical Practice

ObjectivesTo demonstrate the usefulness of primary data collection using clinician-rated and self-rated standardized measures to describe adult day program (ADP) populations and address programming issues such as identifying members at risk of dropping out. Setting and ParticipantsOne ADP in London, Ontario, and 2 ADPs in Toronto, Ontario, Canada. A total of 223 community-dwelling older adults were recruited across the 3 different programs. MethodsThe interRAI Community Health or Home Care Assessment and self-rated psychosocial assessments were collected on program enrollment. Data analyses included descriptive statistics, comparison of the populations between ADPs, and multinomial regression models to assess reasons for program withdrawal. ResultsMean ages across the 3 programs ranged from 78.3 to 83.8 years and the proportion of women ranged from 49.3% to 56.6%. Compared with one of the ADPs, members from 2 other ADPs exhibited higher use of mobility aids (P < .001), higher levels of cognitive impairment (P < .05), increased risk for institutionalization (P < .001), lower levels of depression (P < .01), and greater need for supervision for basic and instrumental activities of daily living (P < .01). Members assessed to be at higher risk for institutionalization and have increased medical complexity showed possible association with program withdrawal at one ADP. Conclusions and ImplicationsThe tools were useful in identifying differences in physical and psychosocial characteristics of members across the 3 ADPs. Information collected from interRAI and self-rated psychosocial assessments may be helpful in the development of individualized care plans, program services, and recommendations that target transitional care. By understanding member profiles and reasons for withdrawal, ADPs may be able to develop strategies to help members stay in the program and live in the community longer.

Reliability and validity of the Taiwanese version of the Neurological Disorders Depression Inventory for Epilepsy (Tw-NDDI-E)

IntroductionDepression is the most commonly seen psychiatric co-morbidity of epilepsy. Depression in patients with epilepsy (PWE) is underrecognized. The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a useful tool to screen for major depressive episodes (MDEs) in PWE. This study validated the Taiwanese version of the NDDI-E using data from adult PWE in our hospital. MethodPWE were recruited from the Taipei Veterans General Hospital from April 2017 to December 2019. The Chinese version of the NDDI-E for the Taiwanese population and the Beck Depression Inventory-II (BDI-II) were completed as part of the self-rated psychiatric assessments. The mood disorder module of the Mini International Neuropsychiatric Interview (MINI) was completed as part of the psychiatric assessment before the self-rated assessment. Internal consistency, external validation, and receiver operator characteristic (ROC) curve analysis were used to assess the utility of the Taiwanese version of the NDDI-E. ResultsWe recruited 109 patients during the 33-month study period. The mean age was 33.1 ± 8.94 years old. The mean NDDI-E score was 12.32 ± 4.96. The mean BDI-II score was 13.26 ± 12.77. All NDDI-E items were significantly positively associated with the corrected overall NDDI-E score (Cronbach’s alpha = 0.902, r = 0.825, p < 0.0001). The cut-off point for the NDDI-E determined with receiver operating characteristic (ROC) curve analysis is 15 (sensitivity = 85.0%, specificity = 87.64%). ConclusionThe Chinese version of the NDDI-E adapted for the Taiwanese population is a reliable and valid self-reported questionnaire for detecting MDE in Taiwanese PWE.

A155 VIDEO INTERVENTIONS TO IMPROVE SELF-ASSESSMENT ACCURACY IN GASTROINTESTINAL ENDOSCOPY: A SYSTEMATIC REVIEW

Abstract Background Physicians generally have inaccurate self-assessment of their performance. One type of proposed intervention to improve this inaccuracy is the use of video-based feedback. The overall impact of this intervention on self-assessment accuracy in gastrointestinal endoscopy is unclear. Aims To systematically review current literature to determine if video-based interventions can effectively improve self-assessment accuracy in endoscopy. Methods We searched the following electronic databases from inception to 2019: Ovid MEDLINE; Ovid EMBASE, the Cochrane Register of Controlled Trials (CENTRAL); Education Resources Information Center (ERIC); Education Source on EBSCO; and Canadian Business Current Affairs EBM Reviews. Specifically, we searched for terms related to self-assessment, self-report, self-efficacy, video recording, and physician. Studies were included if they met the following criteria: physicians at any level of training and/or practice; studies that used an experimental design; compared self-rated assessments with external assessments of procedural skills in endoscopy; and at least one arm of the study involved a video-based intervention. Results Our search yielded 755 articles, of which 2 met all inclusion criteria. One study explored the use of three feedback interventions (practice only with no video; observation of their own video performance; observation of expert video performance) among general surgery residents performing flexible endoscopy, which found that only participants who watched expert video performances had improved accuracy of self-assessments. The other study investigated the use of three video interventions (video of own performance; video of expert performance; video of both own and expert performances) among novice endoscopists performing esophagoduodenoscopy (EGD), which found that the video of expert performance significantly improved self-assessment accuracy compared to the group with both videos. Conclusions The current data tentatively support the use of video review of expert performance to improve self-assessment accuracy in gastrointestinal endoscopy. A meta-analysis is planned to quantitatively assess the overall impact. Funding Agencies None

Changes in Self-Rated Physical Health After Moving Into Permanent Supportive Housing.

Homelessness is associated with poor health outcomes and heightened risk of premature mortality. Permanent supportive housing (PSH) is a key solution for ending homelessness, but there is insufficient evidence of a relationship between PSH and improvements in physical health. Self-rated health-a consistent predictor of mortality-is a meaningful approach to understanding health improvements in PSH. Longitudinal, observational design with interviews at baseline, 3-months, 6-months, and 12-months (with 91% retention at 12-months). Permanent supportive housing in Los Angeles, CA. Four hundred twenty-one adults moving into PSH (baseline interview prior to/within 5 days of housing). Three self-rated health assessments: general health status, and limitations to physical and social activity because of health problems. Generalized Estimating Equations (controlling for demographics and important health covariates; n = 420) found self-rated general health status improved between baseline and 3-months (coef: 0.13; 95% confidence interval [CI]: 0.02-0.24) and persisted at 12-months (coef: 0.16; 95% CI: 0.05-0.27). Improvements in limitations to physical or social activity because of health problems started at 6-months posthousing (physical: coef: 0.25; 95% CI: 0.12-0.39; social: coef: 0.18; 95% CI: 0.05-0.32) and persisted through 12-months (physical: coef: 0.14; 95% CI: 0.01-0.27; social: coef: 0.16; 95% CI: 0.02-0.29). Despite limitations associated with observational study design, these findings provide further evidence that PSH may improve health among those with homelessness histories.

Assessment of medical students’ leadership traits in a problem/case-based learning program

ABSTRACTBackground: Healthcare delivery is shifting to team-based care and physicians are increasingly relied upon to lead and participate in healthcare teams. Educational programs to foster the development of leadership qualities in medical students are needed to prepare future physicians for these roles.Objective: Evaluate the development of leadership attributes in medical students during their first 2 years of medical school while participating in leadership training integrated into a problem/case-based learning program utilizing the Leadership Traits Questionnaire assessment tool.Design: Ninety-eight students enrolled at Zucker School of Medicine participated in Patient-Centered Explorations in Active Reasoning, Learning and Synthesis (PEARLS), a hybrid problem/case-based learning program, during the first and second years of medical school. The Leadership Traits Questionnaire, designed to measure 14 distinct leadership traits, was utilized. It was administered to students, peers in students’ PEARLS groups and their faculty facilitators. Participants completed questionnaires at three-time points during the study. Likert scale data obtained from the questionnaire was analyzed using a two-level Hierarchal Linear Model.Results: Complete data sets were available for 84 students. Four traits, including self-assured, persistent, determined, and outgoing, significantly increased over time by measurements of both peer and facilitator-rated assessments. Six additional traits significantly increased over time by measurement of facilitator-rated assessment. By contrast, a majority of student self-rated assessments trended downward during the study.Conclusions: Medical students demonstrated development of several important leadership traits during the first 2 years of medical school. This was accomplished while participating in the PEARLS program and without the addition of curricular time. Future work will examine the impact of third year clerkships on leadership traits.

Motivation deficits and use of alcohol and illicit drugs among individuals with schizophrenia

This study examined the impact of substance use on intrinsic motivation and evaluated the association between intrinsic motivation and substance use recovery among individuals with schizophrenia. Alcohol and illicit drug use and intrinsic motivation were evaluated at baseline and 6-months for 1434 individuals with schizophrenia from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) using self-rated substance use assessments and a derived motivation measure from the Heinrichs-Carpenter Quality of Life Scale. Results revealed patients had moderate motivation deficits overall and a considerable number were using alcohol or illicit drugs at baseline (n=576; 40.2%). Regression models at baseline showed patients with low levels of motivation had higher odds of substance use and those who were using substances had greater motivation deficits. At 6-months, substance using patients continued to demonstrate greater motivation deficits; however, those with high levels of motivation exhibited a greater reduction in their use of substances. Findings remained significant after adjusting for clinical confounds and were consistent across any substance, alcohol, and cannabis use. Our results emphasize concerns about substance use compounding motivation deficits in schizophrenia, and suggest that disentangling the motivation-substance use relationship in schizophrenia may facilitate efforts aimed at ameliorating these challenges and improving outcomes.

Poor self-rated health predicts mortality in patients with stable chronic heart failure.

In heart failure, a holistic approach incorporating the patient's perspective is vital for prognosis and treatment. Self-rated health has strong associations with adverse events and short-term mortality risk, but long-term data are limited. We investigated the predictive value of two consecutive self-rated health assessments with regard to long-term mortality in a large, well characterised sample of elderly patients with stable chronic heart failure. We measured self-rated health by asking 'In general, would you say your health is: 1, excellent; 2, very good; 3, good; 4, fair; 5, poor?' twice: at baseline and the end of a 12-week beta-blocker up-titration period in the CIBIS-ELD trial. Mortality was assessed in an observational follow-up after 2-4 years. A total of 720 patients (mean left ventricular ejection fraction 45±12%, mean age 73±5 years, 36% women) rated their health at both time points. During long-term follow-up, 144 patients died (all-cause mortality 20%). Fair/poor self-rated health in at least one of the two reports was associated with increased mortality (hazard ratio 1.42 per level; 95% confidence interval 1.16-1.75; P<0.001). It remained independently significant in multiple Cox regression analysis, adjusted for N-terminal pro B-type natriuretic peptide (NTproBNP), heart rate and other risk prediction covariates. Self-rated health by one level worse was as predictive for mortality as a 1.9-fold increase in NTproBNP. Poor self-rated health predicts mortality in our long-term follow-up of patients with stable chronic heart failure, even after adjustment for established risk predictors. We encourage clinicians to capture patient-reported self-rated health routinely as an easy to assess, clinically meaningful measure and pay extra attention when self-rated health is poor.

Patient-Reported Outcomes (PRO) in the Setting of Relapsed Myeloma: The Influence of Treatment Strategies and Genetic Variants Predict Quality of Life and Pain Experience

Patient-Reported Outcomes (PRO) in the Setting of Relapsed Myeloma: The Influence of Treatment Strategies and Genetic Variants Predict Quality of Life and Pain Experience

Examining perception and actual knowledge change among learners in a standardized burn course

Background Essential Burn Management (EBM) is a burn training program created for East Africa and aims to meet the needs of low- and middle-income countries. The authors present a report on objective testing of change in knowledge, with pre and post tests, and comparison of this testing with the self perception of knowledge gained to explore course utility. Objective To evaluate the ability of EBM to improve knowledge in burn care among course participants; and to explore whether participants' self-perception of knowledge gained is comparable with their actual change in knowledge. Methods Twenty health care providers from a variety of disciplines participated in EBM and completed the pre and post course burn care knowledge test. Participants also self-rated knowledge in burn care both pre and post course. All tests and self-rated assessments were anonymous and consent was obtained. Paired t tests were conducted on pre and post test scores. Improvements in pre-post scores according to module or topic area were examined to determine the proportion correct, and then analyzed using Wilcoxon signed-rank tests. Module scores pre-post course were compared with individuals' self-rating of knowledge both before and after the course for that particular module. Results Pre-post course tests reflected an increase in knowledge. An increase in self-rated knowledge was matched with a significant increase in module test scores for primary survey, burn resuscitation, wound management, infection control and electrical injury, but not inhalation injury and compartment syndrome modules. Conclusion Findings support a combination of self-report and objective pre-post testing to evaluate courses designed to teach burn management.