Variance In Use Research Articles

The influence of spatial configuration on the frequency of use of hand sanitizing stations in health care environments

The lack of user-friendly, accessible, and visible hand sanitizing stations (HSSs) in health care environments are significant factors affecting low hand hygiene compliance rates among caregivers. To determine whether the simulated parameters of visibility and global traffic flow score for an HSS can influence the frequency of use of that HSS. Space syntax was used to measure virtual simulation of spatial layouts of 3 units to provide quantitative visibility and global traffic flow scores for each HSS. The frequency of use of HSSs was measured for 2 weeks in 3 units in a community hospital through electronic tracking with self-developed motion sensors. Behavioral observations were also conducted during the same period to validate hand hygiene data obtained through electronic tracking. Linear models were used to tests how much variance in use is accounted for when visibility and/or global traffic flow are included in the model. When the visibility score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001). When the global traffic flow score for an HSS increases (decrease), frequency of use of the HSS will increase (decrease) (F [5, 65] = 13.877; P < .001). This study proposed and validated a novel approach of using space syntax simulations to predict and optimize hand hygiene behavior.

Geographical Variation in Antipsychotic Drug Use in Elderly Patients with Dementia: A Nationwide Study.

Use of antipsychotics in elderly patients with dementia has decreased in the past decade due to safety regulations; however use is still high. Geographical variation may indicate discrepancies in clinical practice and lack of adherence to evidence-based guidelines for the management of behavioral symptoms. To investigate potential geographical variances in use of antipsychotic drugs in dementia care. A registry-based cross-sectional study in the entire elderly population of Denmark (≥65 years) conducted in 2012. Data included place of residence, prescriptions filled, and hospital discharge diagnoses. Antipsychotic drug use among elderly with (n = 34,536) and without (n = 931,203) a dementia diagnosis was compared across the five regions and 98 municipalities in Denmark, adjusted for age and sex. In 2012, the national prevalence of antipsychotic drug use was 20.7% for elderly patients with dementia, with a national incidence of 3.9%. The prevalence ranged from 17.0% to 23.3% in the five regions and from 7.5% to 33.1% in the 98 municipalities, demonstrating an over four-fold difference. The observed geographical variation was more pronounced at municipal level as compared to regional level, suggesting that the variation may be related to variances in clinical practice in primary care. This study highlights an urgent need for further educating professional carers and physicians to guide non-pharmacological as well as pharmacological management of neuropsychiatric symptoms in elderly patients with dementia.

Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour, skin care management, and disease severity in young children

BackgroundThe development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group. ObjectivesTo examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents’ self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity. DesignCross-sectional study design. ParticipantsParent-child dyads (N=64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3months and no other chronic health conditions except asthma, allergic rhinitis, or allergy. MethodsParents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour. ResultsPearson’s and Spearman’s correlations identified relationships (p<0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho=0.48, p<0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r=0.35, p=0.005) and less authoritarian (r=0.41, p=0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems. ConclusionThis study revealed relationships between parents’ self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.

Estimation of the biserial correlation and its sampling variance for use in meta-analysis.

Meta-analyses are often used to synthesize the findings of studies examining the correlational relationship between two continuous variables. When only dichotomous measurements are available for one of the two variables, the biserial correlation coefficient can be used to estimate the product-moment correlation between the two underlying continuous variables. Unlike the point-biserial correlation coefficient, biserial correlation coefficients can therefore be integrated with product-moment correlation coefficients in the same meta-analysis. The present article describes the estimation of the biserial correlation coefficient for meta-analytic purposes and reports simulation results comparing different methods for estimating the coefficient's sampling variance. The findings indicate that commonly employed methods yield inconsistent estimates of the sampling variance across a broad range of research situations. In contrast, consistent estimates can be obtained using two methods that appear to be unknown in the meta-analytic literature. A variance-stabilizing transformation for the biserial correlation coefficient is described that allows for the construction of confidence intervals for individual coefficients with close to nominal coverage probabilities in most of the examined conditions. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of Identity Management

This study examined workplace interactions in which lesbian, gay, and bisexual (LGB) workers faced decisions related to revealing or concealing their LGB identities at work (i.e., identity management situations). Participants were 61 LGB adults who completed a baseline survey about their organization and, over 3 weeks, responded to event-based surveys immediately after identity management situations. Results suggested that LGB workers manage their stigmatized identity strategically according to situational characteristics. Indeed, much of the variance in use of revealing and concealing strategies was due to differences within people from situation to situation. Use of identity management strategies was predicted by interaction partner cues of acceptance or rejection as well as perception of LGB-related organizational climate and policies. Results at the within-person and between-person levels diverged in noteworthy ways.

Racial Differences in Diffusion of Intensity-Modulated Radiation Therapy for Localized Prostate Cancer.

Intensity-modulated radiation therapy (IMRT), an innovative treatment option for prostate cancer, has rapidly diffused over the past decade. To inform our understanding of racial disparities in prostate cancer treatment and outcomes, this study compared diffusion of IMRT in African American (AA) and Caucasian American (CA) prostate cancer patients during the early years of IMRT diffusion using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. A retrospective cohort of 947 AA and 10,028 CA patients diagnosed with localized prostate cancer from 2002 through 2006, who were treated with either IMRT or non-IMRT as primary treatment within 1 year of diagnoses was constructed. Logistic regression was used to examine potential differences in diffusion of IMRT in AA and CA patients, while adjusting for socioeconomic and clinical covariates. A significantly smaller proportion of AA compared with CA patients received IMRT for localized prostate cancer (45% vs. 53%, p < .0001). Racial differences were apparent in multivariable analysis though did not achieve statistical significance, as time and factors associated with race (socioeconomic, geographic, and tumor related factors) explained the preponderance of variance in use of IMRT. Further research examining improved access to innovative cancer treatment and technologies is essential to reducing racial disparities in cancer care.

Cited rationale for variance in use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian, fallopian tube, and primary peritoneal carcinoma

Cited rationale for variance in use of primary intraperitoneal chemotherapy following optimal cytoreduction for stage III ovarian, fallopian tube, and primary peritoneal carcinoma

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

Background With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training. Objective To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes. Methods Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data. Results A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary. Conclusions Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content.

Professional Experience and Referencing Context Explain Variance in Use of Spatial Frames of Reference

SummaryThe location of objects in relation to other objects can be perceived of and communicated in different ways. Assuming that variance in spatial Frame of Reference (FoR) use may be explained by practical professional requirements, we reasoned that medical professionals may increasingly use the intrinsic FoR which because of its observer‐independence is less prone to misunderstandings than relative FoRs. We compared FoR‐use of beginner and advanced medical students (n = 142) to that of law students (n = 191) using 40 ambiguous referencing tasks. We found that medical students applied the intrinsic FoR more frequently than law students in a medical yet not in a generic context. Beginners did not differ from advanced students. Within contexts, individuals were highly consistent in their FoR‐use. Investigation of latencies indicates that processing of the intrinsic FoR becomes easier with practice. Theoretical and practical implications are discussed. Copyright © 2016 John Wiley &amp; Sons, Ltd.

Usage and users of online self-management programs for adult patients with atopic dermatitis and food allergy: an explorative study.

BackgroundTwo online self-management programs for patients with atopic dermatitis (AD) or food allergy (FA) were developed with the aim of helping patients cope with their condition, follow the prescribed treatment regimen, and deal with the consequences of their illness in daily life. Both programs consist of several modules containing information, personal stories by fellow patients, videos, and exercises with feedback. Health care professionals can refer their patients to the programs. However, the use of the program in daily practice is unknown.ObjectiveThe aim of this study was to explore the use and characteristics of users of the online self-management programs “Living with eczema,” and “Living with food allergy,” and to investigate factors related to the use of the trainings.MethodsA cross-sectional design was carried out in which the outcome parameters were the number of log-ins by patients, the number of hits on the system’s core features, disease severity, quality of life, and domains of self-management. Descriptive statistics were used to summarize sample characteristics and to describe number of log-ins and hits per module and per functionality. Correlation and regression analyses were used to explore the relation between the number of log-ins and patient characteristics.ResultsSince the start, 299 adult patients have been referred to the online AD program; 173 logged in for at least one occasion. Data from 75 AD patients were available for analyses. Mean number of log-ins was 3.1 (range 1-11). Linear regression with the number of log-ins as dependent variable showed that age and quality of life contributed most to the model, with betas of .35 ( P=.002) and .26 (P=.05), respectively, and an R 2 of .23. Two hundred fourteen adult FA patients were referred to the online FA training, 124 logged in for at least one occasion and data from 45 patients were available for analysis. Mean number of log-ins was 3.0 (range 1-11). Linear regression with the number of log-ins as dependent variable revealed that adding the self-management domain “social integration and support” to the model led to an R 2 of .13. The modules with information about the disease, diagnosis, and treatment were most visited. Most hits were on the information parts of the modules (55-58%), followed by exercises (30-32%).ConclusionsThe online self-management programs “Living with eczema” and “Living with food allergy” were used by patients in addition to the usual face-to-face care. Almost 60% of all referred patients logged in, with an average of three log-ins. All modules seemed to be relevant, but there is room for improvement in the use of the training. Age, quality of life, and lower social integration and support were related to the use of the training, but only part of the variance in use could be explained by these variables.

The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

ObjectiveThis study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides. Setting and participantsA total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes. MethodWe used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides. ResultsAt the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R2 was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance. ConclusionsOur study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.

Predicting use of ineffective vegetable parenting practices with the Model of Goal Directed Behavior.

Increasing a parent's ability to influence a child's vegetable intake may require reducing the parent's use of ineffective vegetable parenting practices. The present study was designed to understand the psychosocial influences on ineffective vegetable parenting practices. A cross-sectional web-based survey was conducted to model use of ineffective vegetable parenting practices using validated scales from a Model of Goal Directed Vegetable Parenting Practices. The dependent variable was a composite ineffective vegetable parenting practices index. The independent variables included validated subscales of intention, habit, perceived barriers, desire, competence, autonomy, relatedness, attitudes, norms, perceived behavioural control and anticipated emotions. Models were analysed using block regression with backward deletion. Parents of 307 pre-school children (3-5 years old). Variables significantly positively related to ineffective vegetable parenting practices in order of relationship strength included habit of controlling vegetable practices (standardized β=0·349, P<0·0001) and desire (standardized β=0·117, P=0·025). Variables significantly negatively related to ineffective vegetable parenting practices in order of relationship strength included perceived behavioural control of negative parenting practices (standardized β=-0·215, P<0000), the habit of active child involvement in vegetable selection (standardized β=-0·142, P=0·008), anticipated negative parent emotional response to child vegetable refusal (standardized β=-0·133, P=0·009), autonomy (standardized β=-0·118, P=0.014), attitude about negative effects of vegetables (standardized β=-0·118, P=0·015) and descriptive norms (standardized β=-0·103, P=0·032). The model accounted for 40·5 % of the variance in use of ineffective vegetable parenting practices. The present study is the first report of psychometrically tested scales to predict use of ineffective vegetable parenting practices. Innovative intervention procedures will need to be designed and tested to reduce ineffective vegetable parenting practices.

Abstract 127: The Influence of Neighborhood on Emergency Medical Services Use for Acute Stroke - A Population Based Cross Sectional Study

Introduction: The identification of neighborhood level factors that are associated with use of EMS for acute stroke could identify novel targets for interventions to improve EMS activation and access to stroke treatment. Objective: To investigate the association between neighborhood level factors and use of EMS for acute stroke. Methods: We identified 2905 neurologist-adjudicated cases of ischemic stroke and intracerebral hemorrhage that presented to the emergency department in the bi-ethnic Brain Attack Surveillance in Corpus Christi stroke surveillance project (2000-2008). Cases were geocoded by home address and assigned to census tracts (proxies for neighborhoods). Clinical information and use of EMS were abstracted from medical records. Census tract data were obtained from the 2000 US Census and the Corpus Christi Police Department. The association of census tract level factors (frequencies of age over 65 years, violent crime, Hispanic ethnicity, and household income) with EMS use was estimated using hierarchical logistic regression after accounting for known patient-level predictors of EMS use for stroke. Results: 49% of stroke cases arrived by EMS. The proportion arriving by EMS ranged from 10% to 86% across census tracts (figure); however, in the fully adjusted model, only 0.3% (95% CI 0-1.1%) of the variance in use of EMS was explained by census tract. Violent crime level within census tract and all patient-level factors (except history of stroke/TIA) were associated with greater EMS use (table). Higher median income and older average age of census tract residents were associated with lower EMS use. Conclusions: While some neighborhood-level factors were associated with EMS use, nearly all variability in EMS use for stroke was explained by patient-level factors. In this community, attempts to increase EMS use should target individuals that are less likely to use EMS, such as younger adults, women, and Mexican Americans, rather than entire neighborhoods.

Testing an extended theoretical framework to explain variance in use of a public health information system.

Objectives:This study examined determinants of using an immunization registry, explaining the variance in use. The technology acceptance model (TAM) was extended with contextual factors (contextualized TAM) to test hypotheses about immunization registry usage. Commitment to change, perceived usefulness, perceived ease of use, job-task changes, subjective norm, computer self-efficacy and system interface characteristics were hypothesized to affect usage.Method:The quantitative study was a prospective design of immunization registry end-users in a state in the United States. Questionnaires were administered 100 end-users after training and system usage.Results:The results showed that perceived usefulness, perceived ease of use, subjective norm and job-tasks change influenced usage of the immunization registry directly, while computer self-efficacy and system interface characteristics influenced usage indirectly through perceived ease of use. Perceived ease of use also influenced usage indirectly through perceived usefulness. The effect of commitment to change on immunization registry usage was insignificant.Conclusion:Understanding the variables that impact information system use in the context of public health can increase the likelihood that a system will be successfully implemented and used, consequently, positively impacting the health of the public. Variables studied should be adequate to provide sufficient information about the acceptance of a specified technology by end users.

Correlates of Condom Use Among Chinese College Students in Hunan Province

A cross-sectional survey was conducted to test an integrated model of condom use with a sample of 490 sexually active Chinese college students. A number of variables in the integrated model were predictors of condom use, explaining 33.4% of the variance in use. Partner communication was the strongest predictors (β = .317, SE = .038, p < .001). Self-efficacy (β = .252, SE = .076, p < .001), positive attitudes (β = .150, SE = .060, p < .001), and social norms (β = .207, SE = .080, p < .001) were also significant predictors of condom use. Additionally, peer communication marginally significantly predicted condom use (β = .089, SE = .039, p = .055). This study provides evidence of the utility of the theories of reasoned action and planned behavior as an effective underlying theoretical framework for HIV prevention and safe sex intervention programs in a non-Western culture. The study also provides evidence that communication with sexual partners about condom use should be one of the most important factors to be considered in the development of HIV prevention and safer sex education programs for Chinese youth.

Factors predicting older adults’ use of exercise and acetaminophen for osteoarthritis pain

To identify predictors of older adults' use of exercise and/or acetaminophen, and avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs) to treat their osteoarthritis pain. Data were analyzed from 457 adults aged 60 and older with moderate or greater osteoarthritis pain intensity who responded to the Brief Pain Inventory between 2006 and 2007. The following predictors were entered into a logistic regression to predict use of exercise and/or acetaminophen and nonuse of NSAIDs: age, gender, ethnicity, race, education, arthritis treatment by a practitioner, pain treatment by a practitioner, pain intensity, functional interference from the pain, and percent of pain relief from current treatments. A total of 213 (46.6%) reported using exercise and/or acetaminophen and did not report using NSAIDs. Older adults reporting arthritis treatment by a practitioner were 2.2 (confidence interval 1.08-4.59) more likely to use recommended arthritis pain treatment, p < .03. Only 3-4% of the variance for use of recommended pain management treatment was explained by the predictors. Results underscore the importance of guidance by practitioners who are knowledgeable about safe osteoarthritis pain management for older adults.

Use of formal and informal mental health resources by cancer survivors: differences between rural and nonrural survivors and a preliminary test of the theory of planned behavior

Previous research has identified rural residence as a risk factor for poorer mental health (MH) outcomes in cancer survivors. This may be due to less use of various MH resources due to poorer access and less favorable attitudes and social norms related to MH resource utilization. The present study sought to examine use of MH resources in rural and nonrural survivors and identify factors associated with MH resource use. Cancer survivors (n=113, 1-5 years postdiagnosis) completed a questionnaire packet and telephone interview. Accessibility and postdiagnosis use of various formal and informal MH resources were assessed along with constructs potentially linked to use of MH resources by the Theory of Planned Behavior (TPB; personal attitude, social norm, perceived behavioral control). Results indicated no widespread differences between rural and nonrural cancer survivors in MH resource use although some evidence suggested poorer accessibility and less use of mental health professionals and cancer support groups among rural survivors. In general, rural survivors reported less favorable personal attitudes and social norms regarding MH resource use. TPB constructs accounted for a significant portion of variance in use of most MH resources with personal attitudes generally being the strongest predictor of MH resource use. Additional research is needed to expand the search for factors, particularly modifiable factors, which might account for disparities in MH outcomes between rural and nonrural survivors.

A case study of ISO 11064 in control centre design in the Norwegian petroleum industry

In 2006–2008 we performed a case study for the purpose of assessing the industrial application of the seven part Control Centre (CC) design standard ISO 11064 to identify positive and negative experiences among stakeholders in the Norwegian petroleum sector. We mainly focussed on ISO 11064 Part 1, because this was the most commonly used among the identified stakeholders. ISO 11064 is generally appreciated and applied in the industry, but we did observe a significant variance in use between the different parts of the standard. We also identified potential areas for improvements, like scope and application adaptation. Thus we suggest a more goal-based approach based on one normative part only.

Technology Adoption in Small Family-Owned Businesses: Accessibility, Perceived Advantage, and Information Technology Literacy

The purpose of the study was to examine the antecedents and impacts of information technology (IT) adoption by small family-owned businesses, using data from the National Family Business Survey. This research tested a model based on the Diffusion of Innovations framework and the Technology Acceptance Model (TAM). Family business managers’ prior knowledge and level of IT use, business location, and community size/type were important antecedents to the decision to adopt IT. Ease of use and decision to adopt IT accounted for over 60% of the variance in usefulness of IT and implementation of internet and IT capabilities. The implementation of IT capabilities accounted for nearly 40% of the variance in actual use of IT and perceived impact of the internet.

Health Care System and Socioeconomic Factors Associated With Variance in Use of Sentinel Lymph Node Biopsy for Melanoma in the United States

Health Care System and Socioeconomic Factors Associated With Variance in Use of Sentinel Lymph Node Biopsy for Melanoma in the United States