Christopher J. Burant

Loss of Independence in Activities of Daily Living in Older Adults Hospitalized with Medical Illnesses: Increased Vulnerability with Age

OBJECTIVES: To describe the changes in activities of daily living (ADL) function occurring before and after hospital admission in older people hospitalized with medical illness and to assess the effect of age on loss of ADL function.

Predicting registered nurse job satisfaction and intent to leave.

Background Nurse job dissatisfaction has been the primary predictor of intent to leave; however, although many predictors of job satisfaction have been identified, little is known about the influence of variable nurse attitudes, such as psychological empowerment and hardiness, on job satisfaction. Objective The purpose of this study was to investigate the relative influence of nurse attitudes, context of care, and structure of care on job satisfaction and intent to leave. Methods A nonexperimental, predictive design evaluated these relationships in a nonrandom sample of 90 registered staff nurses using instruments with known psychometric properties. Results The major predictor of intent to leave was job dissatisfaction, and the major predictor of job satisfaction was psychological empowerment. Predictors of psychological empowerment were hardiness, transformational leadership style, nurse/physician collaboration, and group cohesion. Conclusions Results supported the influence of nurse attitude on job satisfaction relative to other contributing factors.

Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical Illness

OBJECTIVES: To compare functional outcomes in the year after discharge for older adults discharged from the hospital after an acute medical illness with a new or additional disability in their basic self‐care activities of daily living (ADL) (compared with preadmission baseline 2 weeks before admission) with those of older adults discharged with baseline ADL function and identify predictors of failure to recover to baseline function 1 year after discharge.

Understanding ethnic differences in the utilization of joint replacement for osteoarthritis: The role of patient-level factors

Background. There is a marked difference between black patients and white patients in the utilization of joint replacement therapy. The reasons behind this disparity remain unknown. Objectives. To examine how black and white potential candidates for joint replacement compare with respect to their overall familiarity with joint replacement as an option, as well as their perceptions of the risks/benefits of this procedure. Methods. Cross-sectional survey of 596 elderly patients with symptomatic osteoarthritis of the knee or hip or both attending primary care clinics at Cleveland VAMC. Results. Black (44%) and white (56%) patients in this cohort were comparable with respect to age and clinical factors. However, black patients were less likely to be employed (8% vs. 15%, P = 0.017) or to be married (39% vs. 56%, P = 0.000), but more likely to report an annual household income of less than

Variation in perceptions of treatment and self-care practices in elderly with osteoarthritis: a comparison between African American and white patients.

10,000 (41% vs. 20%, P = 0.000) and less than high school education (43% vs. 29%, P = 0.001). Black patients were less likely than white patients to have had family or friends who had had joint replacement (OR, 0.39 [0.26–0.61]), or to report a good understanding of joint replacement as a form of treatment (OR, 0.62 [0.42–0.92]). They were more likely than white patients to expect longer hospital course (OR, 4.09 [2.57–6.54]), moderate to extreme pain (OR, 2.61 [1.74–3.89]), and moderate to extreme difficulty walking after replacement surgery (OR, 2.76 [1.83–4.16]). Conclusion. Black patients were less likely than white patients to be familiar with joint replacement surgery and more likely to express concerns about postsurgical pain and difficulty walking.

Ethnic differences in the perception of prayer and consideration of joint arthroplasty

OBJECTIVE To compare elderly African American and white patients with osteoarthritis of the knee or hip with respect to their perceptions of the efficacy of traditional and complementary treatments and their self-care practices. METHODS An observational, cross-sectional study design using structured questionnaires was employed. RESULTS The sample consisted of 593 patients (44% African American and 56% white). The 2 groups were comparable with respect to age, disease severity or functional status, and comorbidities. African Americans were more likely than whites to report lower educational level and household income. African Americans were also more likely than whites to perceive various traditional and complementary care modalities as efficacious. However, they were less likely than whites to perceive joint replacement therapy as efficacious (odds ratio 0.52, 95% confidence interval 0.28-0.98). African American patients were more likely than white patients to rely on self-care measures for their arthritis. CONCLUSION African American and white patients with osteoarthritis of the knee or hip differ with respect to their perceptions of traditional and complementary treatments for arthritis and their self-care practices.

Comparison of the Informed Consent Process for Randomized Clinical Trials in Pediatric and Adult Oncology

Context. Ethnic differences in utilization of arthroplasty may reflect differences in health-related attitudes and beliefs. Objective. To examine ethnic differences in the perception and use of prayer in the treatment of arthritis and its role in patients’ decision making toward surgery. Design. A cross-sectional survey. Setting. VA Primary Care Clinics. Patients. Patients older than 50 years with chronic moderate-to-severe knee pain, hip pain, or both. Measures. The “helpfulness of prayer” in the treatment of arthritis and patients’ attitude toward joint arthroplasty. Results. Five hundred ninety-six veterans; 44% black patients, 56% white patients. Groups were comparable with respect to age (65 ± 9.5 vs. 66 ± 9), disease severity as assessed by WOMAC (47 ± 17 vs. 45 ± 17). Black patients scored higher than white patients on the religiosity scale (77 ± 17 vs. 70 ± 21). In multivariate analysis, black patients were more likely than white patients to perceive prayer as helpful in the management of their arthritis (OR, 2.1; 95% CI, 1.19, 3.72). Black patients were also less likely than white patients to consider surgery for severe hip/knee pain (OR, 0.58; 95% CI 0.34, 0.99); this relationship between ethnicity and consideration of surgery is mediated by perceptions of “helpfulness of prayer.” The odds ratio for this relationship changes to 0.70 (P = 0.215). Conclusion. In this sample, black patients were more likely than white patients to perceive prayer as helpful and to have actually used prayer for their arthritis. Perception of helpfulness of prayer may be an important explanatory variable in the relationship between ethnicity and patients’ decision in considering arthroplasty.

Validation of a self-report questionnaire version of the Child Activity Limitations Interview (CALI): The CALI-21

PURPOSE To compare the informed consent processes for phase III pediatric and adult oncology clinical trials in view of the critical importance of human subjects protection in both pediatric and adult cancer care. Findings are discussed in terms of the opportunities for improving pediatric and adult oncology informed consent. PATIENTS AND METHODS A total of 219 subjects are reported on. Adult oncology patients made up 36.1% (n = 79) of the sample. Pediatric surrogates made up the remaining 63.9% (n = 140). Subjects in both studies were observed and audiotaped in conversation with their oncologists, and interviewed afterwards. Comparisons between the adult and pediatric subjects were done using chi(2) statistics and t tests. RESULTS Differences between the pediatric and adult informed consent processes were found. Adult oncology decision makers were, on average, more fully informed and more actively engaged by their oncologists. Pediatric decision makers were, however, given more information about survival/cure, randomization, and voluntariness. Comprehension difficulties were more frequent among pediatric decision makers. Suggestions for improvement are made in view of the differences between adult and pediatric oncology research environments. CONCLUSION Ongoing efforts to improve the ethical framework of clinical cancer research need to take into account the key differences between pediatric and adult oncology informed consent. More research needs to be done to explore the differences between adult and pediatric informed consent processes in oncology.

Self-assessed global quality of life: A comparison between African-American and white older patients with arthritis

Abstract The Child Activity Limitations Interview (CALI) is a measure designed to assess functional impairment due to chronic pain in school‐age children. In this study, we present a self‐report questionnaire version of the CALI (the CALI‐21) that extends the original interview measure. The purpose of this study was to provide internal consistency, cross‐informant reliability and construct validity of the CALI‐21 on a clinical sample of children and adolescents with chronic pain conditions. One hundred fifty‐five children and adolescents (65 males, 90 females; ages 8–18 years, M = 14.31, SD = 2.45) with chronic pain completed questionnaires as part of their clinic intake procedures at their consultation visit in a pediatric pain management clinic. An exploratory factor analysis was conducted to measure latent constructs within the broader domain of functional impairment. Results of the exploratory factor analysis yielded two factors representing limitation in Active and Routine activities on both parent and child reports. Parent and child total CALI scores correlated with measures of pain intensity, however, different patterns of correlations emerged between age, pain intensity, depressive symptoms, and the Active and Routine factors. The CALI‐21 showed good internal consistency, high cross‐informant reliability, and demonstrated construct validity. The CALI‐21 provides increased flexibility via the questionnaire format in the assessment of pain‐related activity limitations in children. Factor analysis extends information about specific types of activity limitations experienced by children.

Knowledge, Attitudes, and Predictors of Advance Directive Discussions of Registered Nurses

Quality of life (QOL) perceptions influence patient decisions and preferences for care and, more importantly, physicians may render recommendations based on their impressions of the patients QOL. QOL is perceived differently by different ethnic groups. This may have implications for understanding ethnic disparities in medical procedure utilization such as joint replacement for osteoarthritis. In a study of 596 elderly male patients with moderate to severe symptomatic knee/hip osteoarthritis, we examined how African-American and white patients rate their overall QOL. We adjusted their responses for important demographic, clinical, and psychosocial potential confounders. African-American (44%) and white (56%) patients in this study were comparable, except that African-Americans reported lower socioeconomic status compared with whites. After adjusting for all other study covariates, African-American ethnicity (B= -0.121, P = 0.004) was negatively correlated with overall QOL ratings. How ethnic variations in perceptions of QOL impact observed ethnic disparity in the utilization of joint replacement therapy needs further investigation.