Jammie Price

The Determinants and Consequences of Information Seeking Among Cancer Patients

This research was designed to examine information seeking behavior among cancer patients. We present a model which identifies the determinants and consequences of information seeking and, in turn, examines the effects of prior variables on four outcome variables: whether patients discussed with their physicians information that they received from other sources, whether the information they obtained helped them make decisions about treatment or care, whether the patient sought a second opinion about his/her diagnosis or treatment, and changes in self-reported stress levels from diagnosis to the time of interview. The model is estimated separately for three groups: patients who sought information from multiple sources including the National Cancer Institutes Cancer Information Service, patients who sought information from multiple sources but did not call the Cancer Information Service, and patients who did not seek information other than from their physician(s). We discuss variables that have similar impacts on outcome variables in all three groups as well as variables that operate differently within the groups. The results indicate that the desire for information and the desire for involvement in medical care decisions are independent factors. Some patients have a strong desire for both information and involvement in making health care decisions. These patients actively seek involvement in their treatment plans. Other patients, however, want to be informed about their disease and treatment but prefer to delegate most decision-making to their physicians. Still other patients choose to delegate information gathering and decision making exclusively to their physicians. We discuss the implications of these results for both patients and providers.

Validation and Use of an Instrument to Measure the Learning Environment as Perceived by Medical Students

Background: Aiming to inform curriculum changes in medical school, we developed, administered, and validated a 31-question survey to measure the learning environment as perceived by medical students. Description: We administered the survey annually in 4 medical school classes in a Southeastern medical school from May 1994 through May 1997 (N = 619). Evaluation: The survey responses reflected 3 dimensions of the medical school learning environment: the teacher-learner relationship (T-L R), the physician-patient relationship (Phys-Pt R), and self-efficacy. We found that the 3 dimensions are equally valid and reliable for all students, but that the mean values on all 3 dimensions differed by year in school and number of survey responses. Conclusions: As students progress through school, they perceive deteriorating T-L Rs, feel diminishing self-efficacy, and accord less value to the Phys-Pt R. Based on these results, we developed training programs for faculty members to promote teaching attributes known to facilitate relationship formation between teacher and learner, and learner-centered and self-directed learning.

How do we rate? An evaluation of online student evaluations

This paper analyses the popular RateMyProfessors (RMP) website where students evaluate instructors in higher education. A study was designed to measure (1) the awareness and utilisation of the RMP website, (2) the internal and external validity of the RMP ratings in measuring teaching effectiveness, and (3) variation in the above across disciplines. It is concluded that the category of ratings, created by the website, establishes an anti‐intellectual tone that manifests itself in comments about instructors’ personality, easiness of workload and entertainment value rather than knowledge attained.

Administrative Data Versus Corrected Administrative Data

The purpose of this research was to provide insight into the use of existing administrative data and to identify changes that could be made to improve broad-based use of administrative data. Data were collected on patients hospitalized with pneumonia at a 715 bed hospital in North Carolina in 1996-1997. Patients were selected from administrative databases via diagnosis and charge codes. Outcome variables were length of stay and total hospital charges. Explanatory variables were age, sex, race, insurance type, season of year, admission source (emergency department or other), comorbidity score, care path designation, physician specialty and teaching appointment. These data were collected from administrative data and then from a limited chart review to correct the administrative data. We found no significant differences in economic outcomes between the administrative data and the corrected administrative data. Administrative data appear to be a reliable and cost-effective data source for quality assessment.The purpose of this research was to provide insight into the use of existing administrative data and to identify changes that could be made to improve broad-based use of administrative data. Data were collected on patients hospitalized with pneumonia at a 715 bed hospital in North Carolina in 1996-1997. Patients were selected from administrative databases via diagnosis and charge codes. Outcome variables were length of stay and total hospital charges. Explanatory variables were age, sex, race, insurance type, season of year, admission source (emergency department or other), comorbidity score, care path designation, physician specialty and teaching appointment. These data were collected from administrative data and then from a limited chart review to correct the administrative data. We found no significant differences in economic outcomes between the administrative data and the corrected administrative data. Administrative data appear to be a reliable and cost-effective data source for quality assessment.

Preparing Future Faculty: A New Approach at North Carolina State University.

In the fall of 2000 the Department of Sociology at North Carolina State University (NCSU) implemented a Phase IV Preparing Future Faculty (PFF) initiative. The goal of this program was (and is) to ensure that doctoral students anticipating entry into a professional position be prepared for all expectations associated with faculty life in a wide variety of college and university placements. NCSUs program combined in-house research mentoring opportunities as well as off-campus mentoring relationships with faculty at other schools to explore the teaching and service responsibilities of junior faculty members. An evaluation committee assessed the effectiveness of this new initiative. Data were collected using several methods, including surveys, interviews, and focus groups. The committee found the PFF program to be a welcome addition to graduate training; however, the NCSU program experienced struggles that provide insight for other schools that may wish to start a PFF program of their own.

Patient recall and appropriate timing for obtaining informed consent for endoscopic procedures

OBJECTIVES:Although informed consent is an issue in many medical malpractice claims, there is no standardized time or method to obtain informed consent for endoscopic procedures. The objectives of this study were to determine whether sedation for endoscopic procedures interfered with pre-endoscopic informed consent and to determine the appropriate time to obtain informed consent.METHODS:Patients undergoing a sedated esophagogastroduodenoscopy had informed consent obtained either 48–72 h before the procedure (group 1A, n = 50) or 10–60 min before the procedure (group 1B, n = 50). Patients undergoing an unsedated flexible sigmoidoscopy had informed consent obtained either 48–72 h before (group 2A, n = 47) or 10–60 min before the procedure (group 2B, n = 49). Methods of informed consent consisted of an oral and a written explanation about the procedure. Patients were sedated with midazolam and meperidine. A Trieger test evaluated recovery from sedation. Recall was assessed by asking six questions about the procedure before discharge and again 2–3 days later.RESULTS:Standard t tests and Mann-Whitney U nonparametric rank tests were used to compare the 1) 1-h recall scores, 2) 2–3-day recall scores, and 3) recall difference scores for groups 1A and 1B, 1A and 2A, 2A and 2B, and 1B and 2B. There were no differences in recall for the different groups.CONCLUSIONS:This study shows that sedation for endoscopic procedures does not interfere with pre-endoscopic informed consent. Informed consent for endoscopic procedures can be obtained at any time before sedation with similar recall.

Prospective Evaluation of a Teaching Model to Determine Competency in Performing Flexible Sigmoidoscopies

Objective:There are limited objective criteria for determining competency in performing flexible sigmoidoscopies. The authors developed a teaching model using eight objective criteria that measured both cognitive and technical skills in performing flexible sigmoidoscopies. The objective was to determine whether the teaching model was a valid method and then to compare it to a commonly used Overall Competence Score or independent observer method.Methods:A total of 120 procedures with 10 residents were evaluated using the two methods. Eight objective parameters had been determined before validating the teaching model. Preset criteria determined competency on a single procedure, and competent performance on five procedures in a row determined certification to independently perform procedures. The teaching model was separately tested for validity and then compared with the independent observer method.Results:A total of 120 procedures were graded using the teaching model method: 73 competent and 47 incompetent. Six of the seven objective parameters were associated with competency in the teaching model method. The eighth objective parameter was excluded because of lack of variation. Fifty of the 120 procedures were graded using the independent observer method: 36 competent and 14 incompetent. Two of the seven objective parameters were associated with competency in the independent observer method. Comparison of the two methods revealed seven discrepancies regarding competent and incompetent procedures. The correlation between the two methods was 0.71.Conclusion:The teaching model method offers objective criteria to evaluate skill in performing flexible sigmoidoscopies.

Latino Health Care in Southern Appalachia a Community-Engaged Examination

Between 2007 and 2009, we created a research-based community partnership to identify and assess the health care needs of Latino1 families in the Appalachian Mountains of North Carolina. This report presents the survey and focus group findings for 159 Latinos concerning their views of health care services and barriers to accessing resources. Only 20 percent of the sample reported health as a major concern in their daily lives; however, notable proportions accessed health care within the last year through free or reduced-fee clinics (36%), hospital emergency rooms (25%), and individual doctors (18%). Most (82%) reported cost of care as the most significant barrier to accessing health care along with language fluency and facing discrimination. Many suggested they waited to seek care until symptoms worsened; hence the high number of hospital visits. Most (82%) did not have any health insurance. However, based on the focus groups, respondents felt that once a serious disease afflicted them, only faith and family could help them, as accessing American health care was a luxury they could not afford.

Dimensions of pornography

In this article, definitions and dimensions of pornography are analyzed. College students (N =201) reported the degree to which they believed items in a series of statements reflecting sexual images were pornographic. Factor analysis is used to explore the multidimensional nature of pornographic imagery and produce item indices of perceived pornographic content. The analysis delineates five dimensions of pornography: consensual heterosexual and lesbian sexual images, consensual male homosexual images, skin magazines, rape images, and art. These five dimensions of pornography are interpreted as reflecting dimensions of exploitation, degradation, and objectification. It is concluded that future research on pornography should consistently implement measures of multiple dimensions of pornography. This will allow future research findings on pornography to be aggregated and, thereby, better inform social policy.

Why Parents Disenroll Children from Public Health Insurance: The Case of Southeastern North Carolina

Nationally, less than 50 percent of children reenroll in the State Childrens Health Insurance Program (SCHIP), a program for children from families with incomes too high to qualify for Medicaid, but too low to afford private health insurance. To identify why, we surveyed parents who disenrolled children from a North Carolina program in 2004. Seventy-two percent of the respondents knew that their children were disenrolled and 28 percent did not know. The most common reasons parents reported for not reenrolling their children were that they never received the reenrollment forms, or they submitted their forms late. Most said they would pay out of pocket now to purchase health care services for their children. Most respondents took their children to see a provider while enrolled in SCHIP in the last year, and most were satisfied with the care received. We conclude that the goal of increasing childrens reenrollment in public health insurance programs requires an improvement in health insurance information, an increase in trust in our social and health institutions, and a reorganization of the reenrollment process.