Petter Gustavsson

A systematic review of the psychometric properties of self-report research utilization measures used in healthcare.

BackgroundIn healthcare, a gap exists between what is known from research and what is practiced. Understanding this gap depends upon our ability to robustly measure research utilization.ObjectivesThe objectives of this systematic review were: to identify self-report measures of research utilization used in healthcare, and to assess the psychometric properties (acceptability, reliability, and validity) of these measures.MethodsWe conducted a systematic review of literature reporting use or development of self-report research utilization measures. Our search included: multiple databases, ancestry searches, and a hand search. Acceptability was assessed by examining time to complete the measure and missing data rates. Our approach to reliability and validity assessment followed that outlined in the Standards for Educational and Psychological Testing.ResultsOf 42,770 titles screened, 97 original studies (108 articles) were included in this review. The 97 studies reported on the use or development of 60 unique self-report research utilization measures. Seven of the measures were assessed in more than one study. Study samples consisted of healthcare providers (92 studies) and healthcare decision makers (5 studies). No studies reported data on acceptability of the measures. Reliability was reported in 32 (33%) of the studies, representing 13 of the 60 measures. Internal consistency (Cronbachs Alpha) reliability was reported in 31 studies; values exceeded 0.70 in 29 studies. Test-retest reliability was reported in 3 studies with Pearsons r coefficients > 0.80. No validity information was reported for 12 of the 60 measures. The remaining 48 measures were classified into a three-level validity hierarchy according to the number of validity sources reported in 50% or more of the studies using the measure. Level one measures (n = 6) reported evidence from any three (out of four possible) Standards validity sources (which, in the case of single item measures, was all applicable validity sources). Level two measures (n = 16) had evidence from any two validity sources, and level three measures (n = 26) from only one validity source.ConclusionsThis review reveals significant underdevelopment in the measurement of research utilization. Substantial methodological advances with respect to construct clarity, use of research utilization and related theory, use of measurement theory, and psychometric assessment are required. Also needed are improved reporting practices and the adoption of a more contemporary view of validity (i.e., the Standards) in future research utilization measurement studies.

Determinants of self-rating and expert rating concordance in psychiatric out-patients, using the affective subscales of the CPRS

To investigate in more detail concordance between the recently developed Comprehensive Psychopathological Rating Scale (CPRS) and the recently developed Self‐Rating Scale for Affective Syndromes (CPRS‐S‐A), a total of 101 psychiatric out‐patients were assessed using these procedures and a diagnostic interview according to DSM‐III‐R. Depressive and anxiety syndromes were the most common diagnoses on Axis I. Approximately one‐third of the patients had a diagnosis of clinical personality disorder on Axis II. The majority of the patients were assessed as predominantly manifesting either Cluster B or Cluster C traits. In general, the correlation between self‐and expert‐ratings was strong (0.83 for the Montgomery‐Åsberg Rating Scale (MADRS) depression subscale and 0.76 for the Brief Scale for Anxiety (BSA) anxiety subscale), but it tended to be weaker in the group of patients with clinical personality disorders. The correlation between the two ratings was also weaker in the group with predominantly Cluster B character traits than in the group with predominantly Cluster C traits or the group with no predominant traits, and weaker in the depressive group than in the anxiety group. However, personality disorder diagnoses were over‐represented in the depressive group. The weaker correlations in the groups mentioned above may have been attributable to psychological factors and qualitative differences in cognitive and communicative style. The CPRS‐S‐A is considered to be a useful and reliable instrument for quantitative rating of symptoms in out‐patients. Our results highlight the potential value of using appropriate self‐assessment forms as complementary tools in clinical practice and research.

Burnout levels and self-rated health prospectively predict future long-term sickness absence: a study among female health professionals

Objective: This study investigates the predictive validity of the Oldenburg Burnout Inventory (OLBI), and of three health indicators (depression, anxiety, and self-rated health), for long-term sickness absence (LTSA). Methods: Questionnaires were sent to all employees in a Swedish County Council (N = 6118), and the overall response rate was 65% (N = 3976). As 82% were women, only women were included in the study. Certified LTSA data were collected. Results: Logistic regression analyses showed that high scores on exhaustion, depression, and poor self-rated health increased the risk of future LTSA (≥90 days). Support for the proposed two-factorial structure of the OLBI was found, including the dimensions of exhaustion and disengagement from work. Conclusion: Using burnout measures might be useful to identify those at risk for LTSA, and to enable preventive solutions in organizations.

Health-related quality of life in significant others of patients dying from lung cancer

This study compares health-related quality of life (HRQOL) in significant others of patients dying from lung cancer, with a general population sample. Further, it explores the course of HRQOL from diagnosis (T1), at a time point close to the patient’s death (T2), and six months after the patient’s death (T3). The group comparisons at T1 showed that the significant others scored significantly lower on the scales in the mental domain compared with a general population sample. These results were the same at T3, when the significant others also scored lower on most of the scales in the physical and social domains. In the longitudinal analyses, there were significant changes in four scales, and three patterns of change were identified: a decrease–increase pattern for ‘self-rated health’ and ‘positive affect’; a constant decrease pattern for ‘family functioning’; and a decrease–stable pattern for ‘satisfaction with family functioning’. Thus, living with inoperable lung cancer in the family and then facing the death of a family member affects most of the HRQOL dimensions.

Monitoring the newly qualified nurses in Sweden: the Longitudinal Analysis of Nursing Education (LANE) study

BackgroundThe Longitudinal Analysis of Nursing Education (LANE) study was initiated in 2002, with the aim of longitudinally examining a wide variety of individual and work-related variables related to psychological and physical health, as well as rates of employee and occupational turnover, and professional development among nursing students in the process of becoming registered nurses and entering working life. The aim of this paper is to present the LANE study, to estimate representativeness and analyse response rates over time, and also to describe common career pathways and life transitions during the first years of working life.MethodsThree Swedish national cohorts of nursing students on university degree programmes were recruited to constitute the cohorts. Of 6138 students who were eligible for participation, a total of 4316 consented to participate and responded at baseline (response rate 70%). The cohorts will be followed prospectively for at least three years of their working life.ResultsSociodemographic data in the cohorts were found to be close to population data, as point estimates only differed by 0-3% from population values. Response rates were found to decline somewhat across time, and this decrease was present in all analysed subgroups. During the first year after graduation, nearly all participants had qualified as nurses and had later also held nursing positions. The most common reason for not working was due to maternity leave. About 10% of the cohorts who graduated in 2002 and 2004 intended to leave the profession one year after graduating, and among those who graduated in 2006 the figure was almost twice as high. Intention to leave the profession was more common among young nurses. In the cohort who graduated in 2002, nearly every fifth registered nurse continued to further higher educational training within the health professions. Moreover, in this cohort, about 2% of the participants had left the nursing profession five years after graduating.ConclusionBoth high response rates and professional retention imply a potential for a thorough analysis of professional practice and occupational health.

Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review.

Abstract Background: Instruments are frequently used in case finding, diagnosis and severity grading of major depression, but the evidence supporting their utility is weak. Aim: To systematically review the specificity and sensitivity of instruments used to diagnose and grade the severity of depression. Methods: MEDLINE, PsycInfo, Embase and the Cochrane Library databases were searched until April 2014. Fifty studies fulfilled the inclusion criteria. Risk of bias was assessed with QUADAS. The average sensitivity and specificity of each instrument was estimated with hierarchical summary receiver operating characteristics analyses and the confidence in the estimates was evaluated using GRADE. Minimum acceptable sensitivity/specificity, with structured interview as the reference, was 80%/80% for structured interviews and 80%/70% for case-finding instruments. The minimum acceptable standard for severity measures was a correlation of 0.7 with DSM-IV classification. Results: Twenty instruments were investigated. The average sensitivity/specificity was 85%/92% for the Structured Clinical Interview for DSM-IV-Axis-I Disorders (SCID-I), 95%/84% for the Mini International Neuropsychiatric Interview (MINI), < 70%/85% for the Primary Care Evaluation of Mental Disorders (PRIME-MD), 88%/78% for the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of 10, 69%/95% for PHQ-9 as a diagnostic algorithm and 70%/83% for the Hospital Anxiety and Depression Scale (HADS) with a cut-off score of 7. The confidence in the estimates for the other instruments was very low. Conclusions: Only the SCID-I, MINI and PHQ-9 with a cut-off score of 10 fulfilled the minimum criteria for sensitivity and specificity. The use of the PRIME-MD and HADS is not supported by current evidence.

Memory effects of clomipramine treatment: Relationship to CSF monoamine metabolites and drug concentrations in plasma

Performance on tasks tapping automatic and voluntary aspects of memory, attention, and motor speed was examined in 14 patients with major depressive disorder, before and after 3 weeks of treatment with clomipramine (150 mg/day), a potent serotonin and noradrenaline uptake blocker with anticholinergic side effects. Performance on tasks requiring frontal functions improved or did not change, whereas verbal learning and retention, where hippocampal functioning is critical, were impaired. The latter tasks were negatively related to cerebrospinal fluid (CSF) 5-HIAA levels and plasma concentration of clomipramine. The results provide further support for the regulatory role of monoaminergic systems in cognition. Furthermore, we found the automatic-voluntary capacity distinction less heuristically useful. Physiological mechanisms regulating different aspects of cognition and memory appeared to be more closely related to the type of task used than to its capacity-demanding properties.

What symptom and functional dimensions can be predictors for global ratings of overall quality of life in lung cancer patients

PurposeThis study explores what dimensions of a health-related quality of life (HRQOL) questionnaire predict global ratings of overall quality of life (QOL) in lung cancer patients in assessments by patients and significant others, respectively.Material and methodsThe analyses were based on dyadic assessments from lung cancer patients and their significant others. A subset of scales and items from the Swedish version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the lung-cancer-specific module, LC-13, was selected. Using multiple regression procedures, the relative importance of different symptoms and of functional impairments in predicting overall QOL was examined.ResultsThe multiple regressions revealed that emotional functioning and fatigue were the only significant predictors of overall QOL for both the patients and the significant others’ assessments. In addition, physical functioning was found to be another predictor in the significant others’ assessments.ConclusionThe results emphasize that it is essential to consider both emotional functioning and fatigue as important areas for overall QOL in lung cancer patients.

CLASSIFICATION OF SUICIDE ATTEMPTERS BY CLUSTER ANALYSIS : A STUDY OF THE TEMPERAMENTAL HETEROGENEITY IN SUICIDAL PATIENTS

Abstract As several studies have associated various temperament dimensions with suicidality when comparing suicide attempters with non-attempters, the purpose of the present study was to focus on the temperamental heterogeneity, and to identify sub-groups of suicide attempters with specific temperament profiles. The Karolinska Scales of Personality (KSP) and the Eysenck Personality Questionnaire together with the IVE-Impulsiveness scale (EPQ-I) were administered in a sample of 215 attempters aged 18–81 years, and cluster analysis procedures were performed with the KSP scales as clustering variables. The subjects were allocated into six mutually exclusive clusters with different temperament profiles. The EPQ-I was used in the attempts to validate and to further describe the cluster solution. Most of the clusters showed low Socialization scores and high scores on scales measuring trait Anxiety. We identified a sub-group with an extreme temperament profile scoring high on scales measuring trait Anxiety, Impulsiveness, Aggressivity, and on scales related to Psychoticism. We also identified an introverted and detached sub-group with high scores on Detachment (low Extraversion) and high trait Anxiety. A large sub-group showed no personality pathology in the sense that they had normal scores on all scales. Our results clearly indicate that suicide attempters are temperamentally heterogenous group, and that there are several different suicidal personalities. The temperamental heterogeneity of clinical importance and is worth further study.

Declining Sleep Quality among Nurses : A Population-Based Four-Year Longitudinal Study on the Transition from Nursing Education to Working Life.

Background Several studies have established impaired sleep is a common problem among nurses. Overworked, fatigued and stressed nurses are at a higher risk of making mistakes that threaten patient safety as well as their own health. The aim of the present study was to longitudinally monitor the development of sleep quality in nurses, starting from the last semester at the university, with three subsequent annual follow-ups once the nurses had entered working life. Methodology/Principal Findings Nationwide, longitudinal questionnaire study of nursing students and newly qualified nurses in Sweden. The results imply a continuous decline in sleep quality among nurses during the three years of follow-up, starting from their last semester of nursing education and continuing for three years into their working life. The most pronounced short-term decline in sleep quality seems to occur in the transition between student life and working life. Conclusion/Significance This finding is important since it may affect the quality of care and the health of nurses negatively.