Dataset Information

Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department.

ABSTRACT: OBJECTIVE:Threat perceptions in the emergency department (ED; e.g., patients' subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of posttraumatic stress disorder (PTSD), and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a seven-item measure of ED threat perceptions in English- and Spanish-speaking patients evaluated for ACS. METHODS:Participants were drawn from an observational cohort study of 1,000 patients evaluated for ACS between 2013 and 2016 in a large New York City hospital. Participants reported on threat perceptions in the ED and during inpatient stay (using 12 items previously identified as predictive of PTSD) and reported on cardiac-induced PTSD 1 month postdischarge. Exploratory and confirmatory factor analyses were used to establish the factor structure and test measurement invariance. Validity and reliability were examined, as was the association of ED threat perceptions with cardiac-induced PTSD. RESULTS:Factor analyses identified a seven-item measure of ED threat perceptions (e.g., "I feel helpless," "I am worried that I am going to die") for both English- and Spanish-speaking patients. ED threat perceptions demonstrated convergent validity, correlating with ED stress and ED crowdedness (r = 0.29 and r = 0.14), good internal consistency (? = 0.82), and stability (r = 0.61). Threat perceptions were associated with cardiac-induced acute stress at inpatient and PTSD symptoms at 1 month (r = 0.43 and r = 0.39). CONCLUSIONS:This brief tool assessing ED threat perceptions has clinical utility for providers to identify patients at risk for developing cardiac-induced PTSD and is critical to inform research on whether threat may be modified in-ED to reduce PTSD incidence.

SUBMITTER: Cornelius T

PROVIDER: S-EPMC6185758 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department.

Cornelius Talea T Agarwal Sachin S Garcia Othanya O Chaplin William W Edmondson Donald D Chang Bernard P BP

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 20181001 10

<h4>Objective</h4>Threat perceptions in the emergency department (ED; e.g., patients' subjective feelings of helplessness or lack of control) during evaluation for an acute coronary syndrome (ACS) are associated with the development of posttraumatic stress disorder (PTSD), and PTSD has been associated with medication nonadherence, cardiac event recurrence, and mortality. This study reports the development and validation of a seven-item measure of ED threat perceptions in English- and Spanish-spe ...[more]

PMID: 29972892

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Project description:Accurate stratification of sepsis can effectively guide the triage of patient care and shared decision making in the emergency department (ED). However, previous research on sepsis identification models focused mainly on ICU patients, and discrepancies in model performance between the development and external validation datasets are rarely evaluated. The aim of our study was to develop and externally validate a machine learning model to stratify sepsis patients in the ED. We retrospectively collected clinical data from two geographically separate institutes that provided a different level of care at different time periods. The Sepsis-3 criteria were used as the reference standard in both datasets for identifying true sepsis cases. An eXtreme Gradient Boosting (XGBoost) algorithm was developed to stratify sepsis patients and the performance of the model was compared with traditional clinical sepsis tools; quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS). There were 8296 patients (1752 (21%) being septic) in the development and 1744 patients (506 (29%) being septic) in the external validation datasets. The mortality of septic patients in the development and validation datasets was 13.5% and 17%, respectively. In the internal validation, XGBoost achieved an area under the receiver operating characteristic curve (AUROC) of 0.86, exceeding SIRS (0.68) and qSOFA (0.56). The performance of XGBoost deteriorated in the external validation (the AUROC of XGBoost, SIRS and qSOFA was 0.75, 0.57 and 0.66, respectively). Heterogeneity in patient characteristics, such as sepsis prevalence, severity, age, comorbidity and infection focus, could reduce model performance. Our model showed good discriminative capabilities for the identification of sepsis patients and outperformed the existing sepsis identification tools. Implementation of the ML model in the ED can facilitate timely sepsis identification and treatment. However, dataset discrepancies should be carefully evaluated before implementing the ML approach in clinical practice. This finding reinforces the necessity for future studies to perform external validation to ensure the generalisability of any developed ML approaches.

Project description:Assessment environment, synonymous with climate or atmosphere, is multifaceted. Although there are valid and reliable instruments for measuring the educational environment, there is no validated instrument for measuring the assessment environment in medical programs. This study aimed to develop an instrument for measuring students' perceptions of the assessment environment in an undergraduate medical program and to examine the psychometric properties of the new instrument.The Assessment Environment Questionnaire (AEQ), a 40-item, four-point (1=Strongly Disagree to 4=Strongly Agree) Likert scale instrument designed by the authors, was administered to medical undergraduates from the authors' institution. The response rate was 626/794 (78.84%). To establish construct validity, exploratory factor analysis (EFA) with principal component analysis and varimax rotation was conducted. To examine the internal consistency reliability of the instrument, Cronbach's α was computed. Mean scores for the entire AEQ and for each factor/subscale were calculated. Mean AEQ scores of students from different academic years and sex were examined.Six hundred and eleven completed questionnaires were analysed. EFA extracted four factors: feedback mechanism (seven items), learning and performance (five items), information on assessment (five items), and assessment system/procedure (three items), which together explained 56.72% of the variance. Based on the four extracted factors/subscales, the AEQ was reduced to 20 items. Cronbach's α for the 20-item AEQ was 0.89, whereas Cronbach's α for the four factors/subscales ranged from 0.71 to 0.87. Mean score for the AEQ was 2.68/4.00. The factor/subscale of 'feedback mechanism' recorded the lowest mean (2.39/4.00), whereas the factor/subscale of 'assessment system/procedure' scored the highest mean (2.92/4.00). Significant differences were found among the AEQ scores of students from different academic years.The AEQ is a valid and reliable instrument. Initial validation supports its use to measure students' perceptions of the assessment environment in an undergraduate medical program.

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Project description:ImportanceAs video-based care expands in many clinical settings, assessing patient experiences with this care modality will help optimize health care quality, safety, and communication.ObjectiveTo develop and assess the psychometric properties of the video visit user experience (VVUE) measure, a patient-reported measure of experiences with video-based technology.Design, setting, and participantsIn this survey study, veterans completed a web-based, mail, or telephone survey about their use of Veterans Healthcare Administration (VHA) virtual care between September 2021 and January 2022. The survey was completed by patients who reported having a VHA video visit on their own device or a VHA-issued device and linked to VHA utilization data for the 6 months following the survey. Data analysis was performed from March 2022 to February 2023.Main outcomes and measuresThe survey included 19 items about experiences with video visits that were rated using a 4-point Likert-type scale (strongly disagree to strongly agree). First, an exploratory factor analysis was conducted to determine the factor structure and parsimonious set of items, using the McDonald Omega test to assess internal consistency reliability. Then, a confirmatory factor analysis was conducted to test structural validity, and bivariate correlations between VVUE and VHA health care engagement were calculated to test concurrent validity. Finally, predictive validity was assessed using logistic regression to determine whether VVUE was associated with future VHA video visit use.ResultsAmong 1887 respondents included in the analyses, 83.2% (95% CI, 81.5%-84.8%) were male, 41.0% (95% CI, 38.8%-43.1%) were aged 65 years or older, and the majority had multiple chronic medical and mental health conditions. The exploratory factor analysis identified a 10-item single-factor VVUE measure (including questions about satisfaction, user-centeredness, technical quality, usefulness, and appropriateness), explaining 96% of the total variance, with acceptable internal consistency reliability (ω = 0.95). The confirmatory factor analysis results confirmed a single-factor solution (standardized root mean squared residual = 0.04). VVUE was positively associated with VHA health care engagement (ρ = 0.47; P < .001). Predictive validity models demonstrated that higher VVUE measure scores were associated with future use of video visits, where each 1-point increase on VVUE was associated with greater likelihood of having a video visit in subsequent 6 months (adjusted odds ratio, 1.04; 95% CI, 1.02-1.06).Conclusions and relevanceThe findings of this study of veterans using video visits suggest that a brief measure is valid to capture veterans' experiences receiving VHA virtual care.

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Dataset Information

Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department.

Publications

Development and Validation of a Measure to Assess Patients' Threat Perceptions in the Emergency Department.

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