The physician's perception of medical error and its application to the development of an educational training tool.

It is becoming clear that if we are to impact the rate of medical errors it will have to be done at the practicing physician level. The purpose of this project was to survey the attitude of physicians in Alabama concerning their perception of medical error, and to obtain their thoughts and desires for medical education in the area of medical errors. The information will be used in the development of a physician education program.

Knowledge and Perception of the Role of Targeted Ultrasound in Detecting Down Syndrome Among a High Risk Population

The purpose of this study was to determine the perception and knowledge of targeted ultrasound in women who screen positive for Down syndrome in the first or second trimester, and to assess the perceived detection rate of Down syndrome by targeted ultrasound in this population. While several studies have reported patient perceptions’ of routine ultrasound, no study has specifically examined knowledge regarding the targeted ultrasound and its role in detecting Down syndrome. A targeted ultrasound is a special ultrasound during the second trimester offered to women who may be at a higher-than-average risk of having a baby with some type of birth defect or complication. The purpose of the ultrasound is to evaluate the overall growth and development of the baby as well as screen for birth defects and genetic conditions. Women under the age of 35 referred for an abnormal first or second trimester maternal serum screen to several Houston area clinics were asked to complete a questionnaire to obtain demographic and ultrasound knowledge information as well as assess perceived detection rate of Down syndrome by ultrasound. Seventy-seven women completed the questionnaire and participated in the study. Our findings revealed that women have limited background knowledge about the targeted ultrasound and its role in detecting Down syndrome. These findings are consistent with other studies that have reported a lack of understanding about the purpose of ultrasound examinations. One factor that seems to increase background knowledge about the targeted ultrasound is individuals having a higher level of education. However, most participants regardless of race, education, income, and exposure to targeted ultrasound information did not know the capabilities of a targeted ultrasound. This study confirmed women lack background knowledge about the targeted ultrasound and do not know enough about the technology to form a perception regarding its ability to detect Down syndrome. Additional studies to identify appropriate education techniques are necessary to determine how to best inform our patient population about targeted ultrasound.

Relationship between threshold and suprathreshold perception of position and stereoscopic depth.

We seek to determine the relationship between threshold and suprathreshold perception for position offset and stereoscopic depth perception under conditions that elevate their respective thresholds. Two threshold-elevating conditions were used: (1) increasing the interline gap and (2) dioptric blur. Although increasing the interline gap increases position (Vernier) offset and stereoscopic disparity thresholds substantially, the perception of suprathreshold position offset and stereoscopic depth remains unchanged. Perception of suprathreshold position offset also remains unchanged when the Vernier threshold is elevated by dioptric blur. We show that such normalization of suprathreshold position offset can be attributed to the topographical-map-based encoding of position. On the other hand, dioptric blur increases the stereoscopic disparity thresholds and reduces the perceived suprathreshold stereoscopic depth, which can be accounted for by a disparity-computation model in which the activities of absolute disparity encoders are multiplied by a Gaussian weighting function that is centered on the horopter. Overall, the statement "equal suprathreshold perception occurs in threshold-elevated and unelevated conditions when the stimuli are equally above their corresponding thresholds" describes the results better than the statement "suprathreshold stimuli are perceived as equal when they are equal multiples of their respective threshold values."

Generalized resistance resources of informal caregivers: A study of demands for care, competing demands, perception of burden and cognitive stress

This study examines the relationship among psychological resources (generalized resistance resources), care demands (demands for care, competing demands, perception of burden) and cognitive stress in a selected population of primary family caregivers. The study utilizes Antonovsky's Salutogenic Model of Health, specifically the concept of generalized resistance resources (GRRs), to analyze the relative effect of these resources on mediating cognitive stress, controlling for other care demands. The study is based on a sample of 784 eligible caregivers who (1) were relatives, (2) had the main responsibility for care, defined as a primary caregiver, and (3) provided a scaled stress score for the amount of overall care given to the care recipient (family member). The sample was drawn from the 1982 National Long-Term Care Survey (NLTCS) of individuals who assisted a given NLTCS sample person with ADL limitations.^ The study tests the following hypotheses: (a) There will be a negative relationship between generalized resistance resources (GRRs) and cognitive stress controlling for care demands (demands for care, competing demands, and perceptions of burden); (b) of the specific GRRs (material, cognitive, social, cultural-environmental) the social domain will represent the most significant factor predicting a decrease in cognitive stress; and (c) the social domain will be more significant for the female than the male primary family caregiver in decreasing cognitive stress.^ The study found that GRRs had a statistically significant mediating effect on cognitive stress, but the GRRs were a less significant predictor of stress than perception of burden and demands for care. Thus, although the analysis supported the underlying hypothesis, the specific hypothesis regarding GRRs' greater significance in buffering cognitive stress was not supported. Second, the results did not demonstrate the statistical significance or differences among the GRR domains. The hypothesis that the social GRR domain was most significant in mediating stress of family caregivers was not supported. Finally, the results confirmed that there are differences in the importance of social support help in mediating stress based on gender. It was found that gender and social support help were related to cognitive stress and gender had a statistically significant interaction effect with social support help. Implications for clinical practice, public health policy, and research are discussed. ^

The relationship between surgical residents' perception of leadership and patient safety culture

Introduction. Patient safety culture is the integration of interrelated practices that once developed is supported by both the culture and leadership of the organization (Sagan, 1993). The purpose of this study is to describe and examine the relationship between surgical residents’ perception of their leadership and the resulting organizational safety culture within their clinical setting. This assessment is important to understanding the extent that leadership style affects the perception of the safety culture.^ Methods. A secondary dataset was used which included data from 68 surgical residents from two survey instruments, Organizational Description Questionnaire (ODQ) and Patient Safety Climate In Healthcare Organizations (PSCHO) Survey. Multiple regressions followed by hierarchical regressions with the introduction of the Post Graduate Year (PGY) variable examined the association between the leadership styles, Transactional and Transformational and the organizational safety culture variables, Overall Emphasis on Safety, Senior management engagement, Organizational resources for safety. Independent t-tests were conducted to assess whether males and females differ among the organizational safety culture variables and either leadership style.^ Results. The surgical residents perceived their organizational leadership to have greater emphasis placed on transformational leadership culture style relative to transactional leadership culture style. The only significant association found was between Transformational leadership and Organizational resources for safety. PGY had no significant effect on the leadership or the safety culture perceived. No significant difference was found between females and males in regards to the safety culture or the leadership style.^ Discussion. These results have implications as they support the premise for the study which is surgical residents perceive their existing leadership and organizational culture to be more transformational in nature than transactional. Significance was found between the leadership perceived and one of the safety culture variables, Organizational resources for safety. The foundation for this association lies in the fact that surgical residents are the personnel which are a part of the organizational resources. Although PGY differentiation did not seem to play a difference in the leadership perceived this could be attributed to the small sample size. No gender difference were found which supports the assumption that within such a highly specialized group such as surgical residents there is no gender differences since the highly specialized field draws a certain type of person with distinct characteristics. In future research these survey tools can be used to gauge the survey audiences’ perception and safety interventions can be developed based on the results. ^

Organizational perspectives on the management and evaluation of large -scale multicenter controlled clinical trials: An exploratory study of participation in the beta -blocker heart attack trial

A review of literature related to appointment-keeping served as the basis for the development of an organizational paradigm for the study of appointment-keeping in the Beta-blocker Heart Attack Trial (BHAT). Features of the organizational environment, demographic characteristics of BHAT enrollees, organizational structure and processes and previous organizational performance variables were measured so as to provide exploratory information relating to the appointment-keeping behavior of 3,837 participants enrolled at thirty-two Clinical Centers. Results suggest that the social context of individual behavior is an important consideration for the understanding of patient compliance. In particular, the degree to which previous organizational performance--as measured by obtaining recruitment goals--and the ability to utilize resources had particularly strong bivariate associations with appointment-keeping. Implications for future theory development, research and practical implications were provided as was a suggestion for the development of multidisciplinary research efforts conducted within the context of Centers for the study and application of adherence behaviors. ^

Translation and cultural adaptation of the Stigma-Devaluation scale for use among family caregivers of mentally ill relatives in Jordan

Background/significance. Mental illness stigma is a matter of great concern to family caregivers. Few research studies have been conducted in the Arab World on family caregivers' perception of stigma associated with caring for a mentally ill relative. Review of the literature on measurement of the concept of stigma related to caring for a mentally ill relative yielded no instrument appropriate for use in a Jordanian sample. Reliable and valid instruments to measure stigma perception among family caregivers are needed for research and practice, particularly in Arabic speaking populations. ^ Purpose. The purposes of this study were: (1) translate the Stigma-Devaluation scale (SDS) into Arabic, modifying it to accurately reflect the cultural parameters specific to Jordan, and (2) test the reliability, the content and construct validity of the Arabic version of the SDS for use among a sample of family members of mentally ill relatives in Jordan. ^ Design. Methodologic, cross-sectional. ^ Methods. The SDS was translated into Arabic language, modified and culturally adapted to the Jordanian culture by a translation model which incorporates a cultural adaptation process. The Arabic SDS was evaluated in a sample of 164 family caregivers in the outpatient mental health clinic in Irbid-Jordan. Cronbach's alpha estimation of internal consistency was used to assess the reliability of the SDS. Construct validity was determined by confirmatory factor analysis (CFA). Measurements of content validity and reading level of the Arabic SDS were included. ^ Findings. Content Validity Index was determined to be 1.0. Reading level of the Arabic SDS was considered at a 6th grade or lower Cronbach's alpha coefficient of the modified Arabic SDS total scale was .87. Initial results of CFA did not fully support the proposed factor structures of the SDS or its subscales. After modifications, the indices indicated that the modified model of each subscale had satisfactory fit. ^ Conclusion. This study provided psychometric evidence that the modified Arabic SDS translated and culturally adapted instrument, is valid and conceptually consistent with the content of the original English SDS in measuring stigma perception among families of mentally ill relatives in Jordan. ^

Influence of Anchoring on Miscarriage Risk Perception Associated with Amniocentesis

INFLUENCE OF ANCHORING ON MISCARRIAGE RISK PERCEPTION ASSOCIATED WITH AMNIOCENTESIS Publication No. ___________ Regina Nuccio, BS Supervisory Professor: Claire N. Singletary, MS, CGC Amniocentesis is the most common invasive procedure performed during pregnancy (Eddleman, et al., 2006). One important factor that women consider when making a decision about amniocentesis is the risk of miscarriage associated with the procedure. People use heuristics such as anchoring, the action of using a prior belief regarding the magnitude of risk as a frame of reference for new information to be synthesized, to better understand risks that they encounter in their lives. This study aimed to determine a woman’s perception of miscarriage risk associated with amniocentesis before and after a genetic counseling session and to determine what factors are most likely to anchor a woman’s perception of miscarriage risk associated with amniocentesis. Most women perceived the risk as low or average pre-counseling and were likely to indicate the numeric risk of amniocentesis as <1% risk. A higher percentage of patients correctly identified the numeric risk as <1% post-counseling when compared to pre-counseling. However, the majority of patients’ feeling about the risk perception did not change after the genetic counseling session (60%), regardless of how they perceived the risk before discussing amniocentesis with a genetic counselor. Those whose risk perception did change after discussing amniocentesis with a genetic counselor showed a decreased risk perception (p<0.0001). Of the multitude of factors studied, only two showed significance: having a friend or relative with a personal or family history of a genetic disorder was associated with a lower risk perception (p=0.001) and having a child already was associated with a lower risk perception (p=0.038). The lack of significant factors may reflect the uniqueness of each patient’s heuristic framework and reinforces the importance of genetic counseling to elucidate individual concerns.

The Neural Substrates of Multisensory Speech Perception

Comprehending speech is one of the most important human behaviors, but we are only beginning to understand how the brain accomplishes this difficult task. One key to speech perception seems to be that the brain integrates the independent sources of information available in the auditory and visual modalities in a process known as multisensory integration. This allows speech perception to be accurate, even in environments in which one modality or the other is ambiguous in the context of noise. Previous electrophysiological and functional magnetic resonance imaging (fMRI) experiments have implicated the posterior superior temporal sulcus (STS) in auditory-visual integration of both speech and non-speech stimuli. While evidence from prior imaging studies have found increases in STS activity for audiovisual speech compared with unisensory auditory or visual speech, these studies do not provide a clear mechanism as to how the STS communicates with early sensory areas to integrate the two streams of information into a coherent audiovisual percept. Furthermore, it is currently unknown if the activity within the STS is directly correlated with strength of audiovisual perception. In order to better understand the cortical mechanisms that underlie audiovisual speech perception, we first studied the STS activity and connectivity during the perception of speech with auditory and visual components of varying intelligibility. By studying fMRI activity during these noisy audiovisual speech stimuli, we found that STS connectivity with auditory and visual cortical areas mirrored perception; when the information from one modality is unreliable and noisy, the STS interacts less with the cortex processing that modality and more with the cortex processing the reliable information. We next characterized the role of STS activity during a striking audiovisual speech illusion, the McGurk effect, to determine if activity within the STS predicts how strongly a person integrates auditory and visual speech information. Subjects with greater susceptibility to the McGurk effect exhibited stronger fMRI activation of the STS during perception of McGurk syllables, implying a direct correlation between strength of audiovisual integration of speech and activity within an the multisensory STS.

Development and preliminary validation of the cancer family impact scale for colorectal cancer

This study aimed to develop and validate The Cancer Family Impact Scale (CFIS), an instrument for use in studies investigating relationships among family factors and colorectal cancer (CRC) screening when family history is a risk factor. We used existing data to develop the measure from 1,285 participants (637 families) across the United States who were in the Johns Hopkins Colon Cancer Genetic Testing study. Participants were 94% white with an average age of 50.1 years, and 60% were women. None had a personal CRC history, and eighty percent had 1 FDR with CRC and 20% had more than one FDR with CRC. The study had three aims: (1) to identify the latent factors underlying the CFIS via exploratory factor analysis (EFA); (2) to confirm the findings of the EFA via confirmatory factor analysis (CFA); and (3) to assess the reliability of the scale via Cronbach's alpha. Exploratory analyses were performed on a split half of the sample, and the final model was confirmed on the other half. The EFA suggested the CFIS was an 18-item measure with 5 latent constructs: (1) NEGATIVE: negative effects of cancer on the family; (2) POSITIVE: positive effects of cancer on the family; (3) COMMUNICATE: how families communicate about cancer; (4) FLOW: how information about cancer is conveyed in families; and (5) NORM: how individuals react to family norms about cancer. CFA on the holdout sample showed the CFIS to have a reasonably good fit (Chi-square = 389.977, df = 122, RMSEA= 0.058 (.052-.065), CFI=.902, TLI=.877, GF1=.939). The overall reliability of the scale was α=0.65. The reliability of the subscales was: (1) NEGATIVE α = 0.682; (2) POSITIVE α = 0.686; (3) COMMUNICATE α = 0.723; (4) FLOW α = 0.467; and (5) NORM α = 0.732. ^ We concluded the CFIS to be a good measure with most fit levels over 0.90. The CFIS could be used to compare theoretically driven hypotheses about the pathways through which family factors could influence health behavior among unaffected individuals at risk due to family history, and also aid in the development and evaluation of cancer prevention interventions including a family component. ^

The impact of a child's unexpected hospitalization upon Taiwanese parents' situational anxiety

Background. The parents of a sick child likely experience situational anxiety due to their young child being unexpectedly hospitalized. The emotional upheaval may be great enough that their anxiety inhibits them in providing positive support to their hospitalized child. Because anxiety affects psychological distress as well as behavioral distress, identifying parental distress helps parents improving their coping mechanisms. ^ Purpose. The study compared situational anxiety levels between Taiwanese fathers and mothers and focused on differences between parental anxiety levels at the beginning of the child's unplanned hospitalization and at time of discharge. The study also identified factors related to the parents' distress and use of coping mechanisms. ^ Methods. A descriptive, comparative research design was used to determine the difference between the anxiety levels of 62 Taiwanese father-mother dyads during the situational crisis of their child's unexpected hospitalization. The Mandarin version (M) of Visual Analog Scale (VAS-M), State-Trait Anxiety Inventory (STAI-M), and the Index of Parent Participation/Hospitalized Child (IPP/HC-M) were used to differentiate maternal and paternal anxiety levels and identify factors related to the parents' distress. Questionnaires were completed by parents within 24-36 hours of the child's hospital admission and within 24 hours prior to discharge. A paired t-test, two sample t-test, and linear mixed regression model were used to test and support the study hypothesis. ^ Results. The findings reveal that the mothers' anxiety levels did not significantly differ from the fathers' anxiety level when their child had a sudden admission to the hospital. In particular, parental state anxiety levels did not decrease during the child's hospital stay and subsequent discharge. Moreover, anxiety levels did not differ between parents regardless of whether the child's disease was acute or chronic. The most effective factor related to parental situational anxiety was parental perception of the severity of the child's illness. ^ Conclusions. Parental anxiety was found to be significantly related to changes in their perception of the severity of their child's illness. However, the study was not able to illustrate how parental involvement in the child's hospital care was related to parental perception of the severity of their child's illness. Future studies, using a qualitative approach to gamer more information as to what variables influence parental anxiety during a situational crisis, may provide a richer database from which to modify key variables as well as the instruments used to improve the quality of the data obtained. ^

Residents' risk perception due to operations of a copper smelter located near residential communities in El Paso, Texas

A face to face survey addressing environmental risk perception was conducted in January through March 2010. The 35 question survey was administered to a random sample of 73 households in El Paso, Texas. The instrument, administered in two adjacent residential communities neighboring an inactive copper smelter solicited responses about manmade and naturally occurring health risks and sources of health information that might utilized by respondents. The objective of the study was to determine if intervention which occurred in one of the communities increased residents' perception of risk to themselves and their families. The study was undertaken subsequent to increased attention from news media and public debate surrounding the request to reopen the smelter's operations. Results of the study indicated that the perception of environmental related health concerns were not significantly correlated with residence in a community receiving outreach and intervention. Both communities identified sun exposure as their greatest perceived environmental risk followed by cigarette smoking. Though industrial by products and chemical pollution were high ranking concerns, respondents indicated they felt that the decision not to reopen the smelter reduced risk in these areas. Residents expressed confidence in information received from the local health district though most indicated they received very little information from that source indicating an opportunity for public health education in this community as a strategy to address future health concerns.^

THE RELATIONSHIP BETWEEN ATTITUDE ASSESSMENT/ROLE PERCEPTION AND THE FINANCIAL PERFORMANCE OF HOSPITAL DEPARTMENT MANAGERS

Much of the current healthcare financial literature addresses the concern of government officials, the public, and healthcare providers regarding the need for control of health care costs. The literature suggests that attitudes of hospital department managers toward their role in financial management affects their ability to effect favorable financial results.^ There were several objectives of the dissertation: (1) To identify whether or not there exists a relationship between the attitude/role perception of hospital managers and the financial performance of their departments. (2) To compile a descriptive survey data base of key factors identified in the financial literature from individual hospitals. (3) To compile a brief descriptive survey of hospital managers' financial management background and training (both formal and informal). (4) To conduct an attitude assessment/role perception survey regarding the importance or relevance of a suggested financial management role set (i.e., issues discussed in the current literature) as viewed by the selected hospital managers and their matched administrators. (5) To propose plausible theoretical models and statistical tests of seven proposed hypotheses.^ The statistical results of a variety of methods generally suggested, for the sample population, that the null hypothesis should not be rejected concerning the relationships between a department manager's financial attitudes and role perceptions and the resultant financial performance.^ The fact that the results of this study did not suggest that there was a significant relationship which existed between role perception and financial performance does not necessarily indicate that the theories supporting such a relationship in literature are false, not that such a relationship does not exist. Several alternative theories were postulated to explain the apparent lack of statistical relationship, and suggestions for refinement and/or improvement of further research were discussed. ^

Relationships of impulsivity and physical fighting history to alcohol -induced aggression in women

Research suggests women respond to the aggression-inducing effects of alcohol in a manner similar to men. Highly aggressive men are more prone to alcohol-induced aggression, but this relationship is less clear for women. This study examined whether alcohol consumption would differentially affect laboratory-measured aggression in a sample of aggressive and non-aggressive women and how those differences might be related to components of impulsive behavior. In 39 women recruited from the community (two groups: with and without histories of physical fighting) ages 21–40, laboratory aggressive behavior was assessed following placebo and 0.80 g/kg alcohol consumption (all women experienced both conditions). Baseline laboratory impulsive behavior of three impulsivity models was later assessed in the same women. In the aggression model (PSAP), participants were provoked by periodic subtractions of money, which were blamed on a fictitious partner. Aggression was operationalized as the responses the participant made to subtract money from that partner. The three components of impulsivity that were tested included: (1) response initiation (IMT/DMT), premature responses made prior to the completion of stimulus processing, (2) response inhibition (GoStop), a failure to inhibit an already initiated response, and (3) consequence sensitivity (SKIP and TCIP), the choice for a smaller-sooner reward over a larger-later reward. I hypothesized that, compared to women with no history of physical fighting, women with a history of physical fighting would exhibit higher rates of alcohol-induced laboratory aggression and higher rates of baseline impulsive responding (particularly for the IMT/DMT), which would also be related to the alcohol-induced increases aggression. Consistent with studies in men, the aggressive women showed strong associations between laboratory aggression and self-report measures, while the non-aggressive women did not. However, unlike men, following alcohol consumption it was the non-aggressive women's laboratory aggression that was related to their self-reports of aggression and impulsivity. Additionally, response initiation measures of impulsivity distinguished the two groups, while response inhibition and consequence sensitivity measures did not; commission error rates on the IMT/DMT were higher in the aggressive women compared to the non-aggressive women. Regression analyses of the behavioral measures showed no relationship between the aggression and impulsivity performance of the two groups. These results suggest that the behavioral (and potentially biological) mechanism underlying aggressive behavior of women is different than that of men. ^