Rebecca J. Lasek

Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases.

BackgroundAn accurate, sensitive, but brief quality-of-life outcomes measure is needed for studies of dermatologic care.ObjectiveTo construct a single-page version of Skindex (a dermatologic quality-of-life instrument) that would have two new features compared with the current 29-item version: (1) fewer items to which a majority of patients choose the same response, and (2) measurement ofbother rather than frequency of patient experiences.MethodsRandom samples of patients waiting for dermatology appointments in clinics of Veterans Affairs hospitals and in private dermatology practices completed questionnaires; 692 patients responded to the parent instrument and 541 additional patients responded to the brief version. Reproducibility, internal consistency reliability, validity, and responsiveness of the brief version of Skindex were determined.ResultsFor 16 items of the current 29-item version (55%), more than 50% of patients responded “Never.” After an explicit process of item analysis and elimination, a single-page 16-item version was composed that asks patients about bother from their experiences; responses are reported as three scales, Symptoms, Emotions, and Functioning. For 6 items of the 16-item version (38%), more than 50% of patients responded “Never.” Scale scores were reproducible after 72 hours (r = 0.88-0.90) and were internally reliable (Cronbach’s α = 0.86-0.93). The instrument demonstrated both content and construct validity: Most patients’ responses to an open-ended question about their skin disease was addressed by the items; patients with inflammatory dermatoses had higher scores than those with isolated lesions; and in an exploratory principal axes factor analysis with an oblique rotation, 74% of the common variance was explained by three factors that correlated with thea priori scales. Mean scale scores stayed the same or changed in the expected direction in patients who reported that their skin was the same or had improved.ConclusionThis brief single-page version of Skindex accurately and sensitively measures how much patients are bothered by their skin conditions.SommaireAntécédentsLa mesure des résultats relatifs à la qualité de vie lors d’études sur les soins dermatologiques doit être précise, sensible mais concise.ObjectifÉlaborer une version en une seule page du Skindex (instrument de mesure de la qualité de vie sur le plan dermatologique) qui comporterait deux nouvelles caractéristiques par rapport à la version actuelle de 29 questions: (1) moins de questions pour lesquelles la majorité des patients choisissent la même réponse, et (2) la mesure des ennuis causés par la maladie plutôt que celle de la fréquence des épisodes.MéthodesDes échantillonnages randomisés de patients en attente de rendezvous à la clinique de dermatologie des hôpitaux des Anciens Combattants et en cabinets privés ont rempli les questionnaires; 692 patients ont répondu à l’instrument de mesure principal et 541 à la version simplifiée. La reproductibilité, la cohérence interne, la fiabilité, la validité et la réactivité de la version simplifée du Skindex ont été évaluées.RésultatsPlus de 50% des patients ont répondu «jamais» à 16 des 29 questions de la version actuelle (55%). Après un travail en profondeur d’analyse et d’élimination des questions, on a rédigé une version d’une page comportant 16 questions sur les ennuis causés par la maladie, les réponses étant rapportées selon trois échelles: symptômes, émotions et fonctionnement. Plus de 50% des patients ont répondu «jamais» à 6 des 16 questions (38%). Les résultats de l’échelle étaient reproductibles après 72 heures (r = 0, 88-0,90) et fiables sur le plan interne (Cronbach’s α = 0,86-0,93). L’instrument de mesure a permis de démontrer la validité du contenu et de la conception: la plupart des réponses des patients à une question ouverte sur leur affection cutanée étaient abordées dans la question; les patients atteints de dermatoses inflammatoires avaient des résultats plus élevés que ceux présentant des lésions isolées; et dans une analyse factorielle exploratoire des principaux axes, la variance commune s’expliquait à 74% par trois facteurs qui étaient en corrélation avec les échelles établies a priori. Les résultats moyens sont demeurés les mêmes ou ont changé dans le sens attendu chez les patients qui avaient rapporté que l’état de leur peau était le même ou qu’il s’était amélioré.ConclusionCette version simplifiée d’une page du Skindex mesure de façon précise et sensible l’importance des ennuis que causent les affections cutanées aux patients.

When doctors marry doctors: a survey exploring the professional and family lives of young physicians.

Men and women in dual-doctor families differed from other physicians in many aspects of their professional and family lives, but they achieved their career and family goals as frequently.

The annual guide to "America's best hospitals". Evidence of influence among health care leaders.

To determine health care leaders’ opinions about a prominent guide to hospital quality, we surveyed 82 chief executive officers (CEOs) and 80 chiefs of staff of hospitals listed in the 1994 edition of the guide and 50 directors of employer-based coalitions. Most of the CEOs (87%) and chiefs of staff (86%) said the guide was used in advertising. More than three quarters of the CEOs, chiefs of staff, and coalition directors who were familiar with the guide thought it was accurate, and most indicated that key constituencies (e.g., physicians, corporate managers) were aware of the guide. Our results demonstrate the likely influence of one prominent guide to health care quality and highlight the need for formal independent assessment of such guides.

Category-order effects in memory span.

When Ss are required to recall lists containing both words and digits, memory span is higher when the digits precede the words than when the words precede the digits. In Experiment 1, both forward and backward recall were tested; it was demonstrated that this category-order effect reflects the input position, and not the output position, of the items. Experiment 2 revealed that this effect was not eliminated by a filled retention interval. Experiment 3 showed that the effect was eliminated when lists were presented at a fast presentation rate. In Experiment 4, the effect was eliminated when Ss engaged in articulatory suppression. A 5th experiment extended the findings of Experiment 4 to the case in which lists are composed of semantically related or unrelated words. These results suggest that category-order effects reflect mnemonic activity that Ss engage in during list presentation and do not arise from structural characteristics of the memory system.