WK Davis - Profile on Academia.edu (original) (raw)
Papers by WK Davis
Evaluation & the Health Professions, Mar 1, 1980
igan 48109. A total of 7931 ratings of 482 third-and fourth-year medical students were gathered o... more igan 48109. A total of 7931 ratings of 482 third-and fourth-year medical students were gathered over twelve four-week periods. Ratings were made by multiple raters, house officers, and attending faculty, on fifteen behaviorally-anchored rating scales. The data were factor analyzed separately for each of the twelve periods. Two factors consistently emerged, and the congruence coefficients across the twelve periods were high (.72 to .99). The factors were termed "problem solving" and "inter- personal skills" on the basis of their item content. The internal consistency (alpha) coefficients of the scales constructed from the two groups of items and the total fifteen-item scale were high (.83 to .95). Interrater reliability for the individual items ranged from .22 to .37 for attending faculty and from .30 to .51 for house officers. As expected, the interrater reli- ability was higher for the summed scales than for individual items, ranging from .44 to .61 for house officers and from .36 to .42 for attending faculty .
The Diabetes Educator, Dec 1, 1995
This study focused on three questions: Is there a difference in men's and women's diabetes attitu... more This study focused on three questions: Is there a difference in men's and women's diabetes attitudes? Do health professionals give different recommendations to men and women? Is there a difference between men and women in care adherence? A total of 1201 patients with diabetes were surveyed; 65% of these patients were women. Differences in diabetes attitudes (three of seven attiticdes) were most evident between men and women with insulin-dependent diabetes mellitus (IDDM). No differences were found in the attitudes of men and women with non-insulin-dependent diabetes mellitus (NIDDM) using insulin, and only one attitude was different for patients with NIDDM not using insulin. Few differences were observed in the recommendations given by health professionals to men and women. Gender differences in adherence to the components of self-care also were minimal. These findings may indicate that there are many similarities in the reactions of men and women who have been diagnosed with diabetes. Research' -6 indicates that men and women have different attitudes and behaviors related to health care. Verbrugge' I suggested that men and women have different illness orienta- tions. Women are more sensitive to illnesses, more able and likely to rest during an illness, and more willing to seek medical advice. In another study.2 women were found to have a greater interest and concern for health and were more likely to perceive symptoms. Women make greater use of health services and have a larger network of people with whom to discuss medical probleiiis.3 Women also report more illnesses than men.-1 In general, women appear to be more knowledgeable about and sensitive to the symptoms of illnesses, and seek care more frequently than men. Some of these differences may have evolved from the different roles that men and women traditionally have played within the family structure, with women having greater responsibilities for family health. Differences between men and women with regard to their attitudes and behaviors associated with chronic disease have not received as much attention in the literature. Verbrugge5 found that women reported illness more frequently than men but the illnesses usually were less serious. Verbrugge also suggested that the differences between men and women were most pronounced for prolon;~ed and iiilld (nonfatal) condi- tions. Furthermore, psychosocial factors were important in these chronic and less severe diseases. A study6 of patients with heart disease revealed that women report more symp- toms than men and the symptoms reported are of greater intensity. However, men's and women's adherence to heart disease management recommendations differed only in exer- cise behavior, men adhered more than women. Green re- ported a similar finding in a study of the self-care of common illnesses. In this study, men and women differed in terms of reporting illnesses, but their treatment behavior was similar once their condition was diagnosed. Diabetes is a chronic disease for which self-care is crucial for disease management. The impact of diabetes on a pa- tient's lifestyle can be dramatic, and self-care recommenda- tions often require substantial time and effort from the patient.7 Not surprisingly, low adherence to the different components of a diabetes regimen (eg, blood testing, foot inspection, and diet) has been reported.~
The Diabetes Educator, Jun 1, 1986
The diabetes patient education provided in ran- domly chosen primary care physician offices in sm... more The diabetes patient education provided in ran- domly chosen primary care physician offices in small and large com- munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-delivered, informal, and in- terwoven with the clinical care offered. They usually did not include a sys- tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx- imately 48 minutes per year per patient in the of- fice setting. The study suggested several developmental activities that might improve patient education in physician of- fices where the majority of patients with diabetes receive most of their care.
The Diabetes Educator, Mar 1, 1986
An educational needs assessment instrument for individuals with diabetes has been developed at th... more An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con- structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com- bined with demographic and clinical information, these scores form a comprehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individualized graphic profile that highlights possible prob- lem areas to be considered when developing patient education and management plans.
The predictive and incremental validtty of both the Old and New Medical College Admission Test (M... more The predictive and incremental validtty of both the Old and New Medical College Admission Test (MCAT) was examined and compared with a sample of over 300 medical students. Results of zero order and incremental validity coefficients, as well as prediction models resultimg from ali.possible subsets regression analyses usin Mallow's Cp criterion, were subjected to cross-validation analyses randomly dividing two medical school classes into screening and calibration samples. Results supported the incremental validity of both the Old and New MCAT. Coefficients were generally larger for the NeW than for the Old MCAT. Prediction models of National Board of
Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin... more Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes
Journal of Clinical Reasoning Procedural Competency, Mar 1, 2013
It is unknown whether group or individual practice using free-inquiry virtual patient simulations... more It is unknown whether group or individual practice using free-inquiry virtual patient simulations would most facilitate acquisition of clinical reasoning skills required of competent physicians.
Journal of Clinical Reasoning Procedural Competency, Mar 1, 2013
Physicians must be thorough yet efficient in data gathering and must use decision-making strategi... more Physicians must be thorough yet efficient in data gathering and must use decision-making strategies that limit diagnostic studies and costs, but still promote maximal diagnostic proficiency. These clinical reasoning skills are neither adequately taught nor measured in medical schools and residencies. To define clinical reasoning constructs a priori and develop clinical reasoning indices to be used with a virtual patient simulation model for teaching and assessing clinical reasoning competency. We used an experimental, pretest-posttest design to assess expected gains in clinical reasoning competency after three hours of virtual patient simulation practice. Computer transcripts (N=486) were generated by 81 medical students with complete data who solved one pretest, three practice, and two posttest simulations. Four clinical reasoning constructs were identified a priori: proficiency, efficiency, thoroughness, and strategy, and nineteen clinical reasoning indices were defined. Multivariate ANOVA and correlational analyses revealed significant pretest-posttest differences for posttest 1 (13/19 indices) and posttest 2 (14/19 indices), supporting the instructional effectiveness of virtual patient simulation practice and the construct validity of four clinical reasoning constructs and their corresponding nineteen clinical reasoning performance indicies. Reliability (stability) and concurrent validity of indices varied with case content. Instructional effectiveness, validity and stability of four constructs and nineteen corresponding clinical reasoning indices were established for a computer-based, free-inquiry virtual patient simulation model.
The Diabetes Educator, 1986
An educational needs assessment instrument for individuals with diabetes has been developed at th... more An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com bined with demographic and clinical information, these scores form a com prehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individ ualized graphic profile that highlights possible prob lem areas to be consid ered when developing patient education and management plans.
The Diabetes Educator, 1988
Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin... more Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes Education Profile (DEP). Patient performance on these instruments was compared with corresponding items in the Ambulatory Care Facilities section of the Guide lines for Diabetes Care published by the American Diabetes Associ ation and the American Associ ation of Diabetes Educators. In general, insulin-dependent persons scored higher than noninsulin-dependent persons. Those taking insulin (whether insulin-dependent or not) scored higher than noninsulin-dependent persons whose regimen did not include insulin. The findings emphasize the need to subdivide any analysis of clinical diabetes or diabetes education into groups based on i...
The Diabetes Educator, 1986
The diabetes patient education provided in ran domly chosen primary care physician offices in sma... more The diabetes patient education provided in ran domly chosen primary care physician offices in small and large com munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-de livered, informal, and in terwoven with the clinical care offered. They usually did not include a sys tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx imately 48 minutes per year per patient in the of fice setting. The study suggested several develop mental activities that might improve patient education in physician of fices where the majority of patients with diabetes receive most of their care.
The Diabetes Educator, 1995
This study focused on three questions: Is there a difference in men's and women's diabete... more This study focused on three questions: Is there a difference in men's and women's diabetes attitudes? Do health professionals give different recommendations to men and women? Is there a difference between men and women in care adherence? A total of 1201 patients with diabetes were surveyed; 65% of these patients were women. Differences in diabetes attitudes (three of seven attiticdes) were most evident between men and women with insulin-dependent diabetes mellitus (IDDM). No differences were found in the attitudes of men and women with non-insulin-dependent diabetes mellitus (NIDDM) using insulin, and only one attitude was different for patients with NIDDM not using insulin. Few differences were observed in the recommendations given by health professionals to men and women. Gender differences in adherence to the components of self-care also were minimal. These findings may indicate that there are many similarities in the reactions of men and women who have been diagnosed wit...
Evaluation & the Health Professions, 1980
A total of 7931 ratings of 482 third- and fourth-year medical students were gath ered over twelve... more A total of 7931 ratings of 482 third- and fourth-year medical students were gath ered over twelve four-week periods. Ratings were made by multiple raters, house officers, and attending faculty, on fifteen behaviorally-anchored rating scales. The data were factor analyzed separately for each of the twelve periods.
Diabetes Care, 1981
An accurate determination of the educational needs of diabetic patients is based on a wide range ... more An accurate determination of the educational needs of diabetic patients is based on a wide range of patient characteristics. In the development of an assessment instrument to determine the educational needs of patients, the relative importance of numerous patient characteristics was determined. A questionnaire was mailed to 1518 health professionals who are either members of the American Association of Diabetes Educators or community health nurses in the state of Michigan. Analyses of the responses to this questionnaire have provided information regarding the knowledge, psychosocial, and demographic characteristics of patients, which are thought to be important in an educational diagnosis. Questions to measure these identified characteristics will be incorporated into an instrument that will assess the educational needs of diabetic patients.
Diabetes Care, 1992
Objective The purpose of this study was to identify specific beliefs that differentiate health-ca... more Objective The purpose of this study was to identify specific beliefs that differentiate health-care professionals whose attitudes toward diabetes agreed most strongly with a group of national diabetes experts from those whose attitudes disagreed most strongly. Research Design and Methods The sample for this study included 271 physicians, 834 nurses, and 546 dietitians who completed a Diabetes Attitudes Survey. The sample included specialists in diabetes care and nonspecialists. Controversial beliefs about diabetes and its care were determined by comparing the beliefs of the 10% of the sample whose attitudes were most concordant (with the national panel) with the beliefs of the 10% of the sample whose attitudes were the most discordant. Ten beliefs met the criteria for being defined as controversial. Results The most controversial beliefs concerned whether the patient or the physician should be the primary decision maker in diabetes care, the meaning of patient noncompliance, and the...
Diabetes Care, 1991
The patient empowerment approach to diabetes education is intended to enable patients to make inf... more The patient empowerment approach to diabetes education is intended to enable patients to make informed decisions about their own diabetes care and to be fully responsible members of the health-care team. Facilitating patient empowerment requires a specific set of skills and attitudes on the part of diabetes educators. A professional education program designed to facilitate the acquisition and enhancement of the requisite skills and attitudes was designed, implemented, and evaluated. The program involved adhering to a simulated diabetes care regimen for 3 days followed by a 3-day intensive skills-based workshop. The 23 educators who participated in the first two offerings of this program made significant gains in their counseling skills and demonstrated a positive change in attitude.
Diabetes Care, 1986
The Board of Directors of the American Diabetes Association (ADA) recently endorsed a resolution ... more The Board of Directors of the American Diabetes Association (ADA) recently endorsed a resolution recommending third-party payment for outpatient education and nutritional counseling. One of the major rationales for the statement was that education and nutritional counseling will lead to reductions in health care costs. This article critically reviews the 13 studies cited in support of the ADA Policy Statement. Among these studies, only 2 compared a treated group with a control group. Both of the studies with control groups failed to randomly assign patients to treatment condition. Only 4 of the studies showed an accounting of program costs. Upon close inspection, it appears that some of the programs actually increased, rather than decreased, health care expenditures. Attrition from programs was reported in only a minority of cases, and was large when reported. The effect of the programs upon diabetes control was inconsistent across studies. It is suggested that the rationale for edu...
Diabetes Care, 1988
The goal of this research was to quantify therelationships between patient survival and a set of ... more The goal of this research was to quantify therelationships between patient survival and a set of explanatory variables in a randomly selected sample of community-based patients with non-insulin-dependent diabetes mellitus (NIDDM). The sample included 343 patients with NIDDM initially entered into the study in 1981–1982 and reexamined in 1985–1986. Mortality data were collected on reexamination in 1985 and updated from death-certificate data through 1 January 1986. The data collected from the patients included demographic and clinical variables, psychosocial variables related to diabetes, measures of physiologic control, hospitalization, and mortality. The Cox proportionalhazards model was used to compute a hazard rate for each individual and to determine risk covariates. The results indicated that the variables most associated with the risk of mortality were patient age, social impact of diabetes, renal function, complexity of diet regimen, and history of smoking. Two of these varia...
Continuing education in pulmonary disease for primary-care physicians
The American review of respiratory disease, 1983
A continuing medical education program was implemented and evaluated in 16 community hospitals. I... more A continuing medical education program was implemented and evaluated in 16 community hospitals. It was targeted at primary-care physicians and used physicians identified by their peers as being educationally influential for the dissemination of information. Self-study materials were used, followed by an intensive 2-wk preceptorship that resulted in a significant increase in physician knowledge. Inpatient chart audits identified a series of changes in the management of chronic obstructive pulmonary disease in the intervention hospitals that were not noted in the control hospitals. These included the increased use of intravenously administered fluids, loading doses of intravenously administered bronchodilators, aerosolized and single agent bronchodilators, and respiratory therapy services. Continuing medical education, delivered through community-based educationally influential physicians, is an effective way of changing physician behavior in small communities with no prior ongoing ed...
American Journal of Preventive Medicine, 1990
This cross-sectional study examined medical and dental students' knowledge of preventive medicine... more This cross-sectional study examined medical and dental students' knowledge of preventive medicine. The purpose of the study was to assess the knowledge of preventive medicine-both epidemiological and clinical-that students demonstrate as they enter medical and dental school and acquire during training. The results of a two-group (medical versus dental school) by three-time (first-, second-, and thirdyear level) analysis of variance of students' mean examination scores showed significant main effects for school (F = 28.3, P < .001) and training level (F = 24.5, P < .001), and a significant school-by-training level interaction (F = 13.9, P < .001). Medical students at higher training levels demonstrated greater knowledge of preventive medicine. In contrast, there were no significant differences by year of training among the dental students on the total test or on the epidemiological or clinical subscales. Both the dental and medical students demonstrated greater knowledge of clinical applications than of epidemiological foundations (t = 4.21, P < .01). Dental students performed better than medical students on items that focused on diseases and risk factors that manifest symptoms more likely to be observed in dentistry than in general medical practice. The findings underscore the need to demonstrate practice relevance when teaching preventive medicine. [Am J Prev Med
Evaluation & the Health Professions, Mar 1, 1980
igan 48109. A total of 7931 ratings of 482 third-and fourth-year medical students were gathered o... more igan 48109. A total of 7931 ratings of 482 third-and fourth-year medical students were gathered over twelve four-week periods. Ratings were made by multiple raters, house officers, and attending faculty, on fifteen behaviorally-anchored rating scales. The data were factor analyzed separately for each of the twelve periods. Two factors consistently emerged, and the congruence coefficients across the twelve periods were high (.72 to .99). The factors were termed "problem solving" and "inter- personal skills" on the basis of their item content. The internal consistency (alpha) coefficients of the scales constructed from the two groups of items and the total fifteen-item scale were high (.83 to .95). Interrater reliability for the individual items ranged from .22 to .37 for attending faculty and from .30 to .51 for house officers. As expected, the interrater reli- ability was higher for the summed scales than for individual items, ranging from .44 to .61 for house officers and from .36 to .42 for attending faculty .
The Diabetes Educator, Dec 1, 1995
This study focused on three questions: Is there a difference in men's and women's diabetes attitu... more This study focused on three questions: Is there a difference in men's and women's diabetes attitudes? Do health professionals give different recommendations to men and women? Is there a difference between men and women in care adherence? A total of 1201 patients with diabetes were surveyed; 65% of these patients were women. Differences in diabetes attitudes (three of seven attiticdes) were most evident between men and women with insulin-dependent diabetes mellitus (IDDM). No differences were found in the attitudes of men and women with non-insulin-dependent diabetes mellitus (NIDDM) using insulin, and only one attitude was different for patients with NIDDM not using insulin. Few differences were observed in the recommendations given by health professionals to men and women. Gender differences in adherence to the components of self-care also were minimal. These findings may indicate that there are many similarities in the reactions of men and women who have been diagnosed with diabetes. Research' -6 indicates that men and women have different attitudes and behaviors related to health care. Verbrugge' I suggested that men and women have different illness orienta- tions. Women are more sensitive to illnesses, more able and likely to rest during an illness, and more willing to seek medical advice. In another study.2 women were found to have a greater interest and concern for health and were more likely to perceive symptoms. Women make greater use of health services and have a larger network of people with whom to discuss medical probleiiis.3 Women also report more illnesses than men.-1 In general, women appear to be more knowledgeable about and sensitive to the symptoms of illnesses, and seek care more frequently than men. Some of these differences may have evolved from the different roles that men and women traditionally have played within the family structure, with women having greater responsibilities for family health. Differences between men and women with regard to their attitudes and behaviors associated with chronic disease have not received as much attention in the literature. Verbrugge5 found that women reported illness more frequently than men but the illnesses usually were less serious. Verbrugge also suggested that the differences between men and women were most pronounced for prolon;~ed and iiilld (nonfatal) condi- tions. Furthermore, psychosocial factors were important in these chronic and less severe diseases. A study6 of patients with heart disease revealed that women report more symp- toms than men and the symptoms reported are of greater intensity. However, men's and women's adherence to heart disease management recommendations differed only in exer- cise behavior, men adhered more than women. Green re- ported a similar finding in a study of the self-care of common illnesses. In this study, men and women differed in terms of reporting illnesses, but their treatment behavior was similar once their condition was diagnosed. Diabetes is a chronic disease for which self-care is crucial for disease management. The impact of diabetes on a pa- tient's lifestyle can be dramatic, and self-care recommenda- tions often require substantial time and effort from the patient.7 Not surprisingly, low adherence to the different components of a diabetes regimen (eg, blood testing, foot inspection, and diet) has been reported.~
The Diabetes Educator, Jun 1, 1986
The diabetes patient education provided in ran- domly chosen primary care physician offices in sm... more The diabetes patient education provided in ran- domly chosen primary care physician offices in small and large com- munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-delivered, informal, and in- terwoven with the clinical care offered. They usually did not include a sys- tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx- imately 48 minutes per year per patient in the of- fice setting. The study suggested several developmental activities that might improve patient education in physician of- fices where the majority of patients with diabetes receive most of their care.
The Diabetes Educator, Mar 1, 1986
An educational needs assessment instrument for individuals with diabetes has been developed at th... more An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con- structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com- bined with demographic and clinical information, these scores form a comprehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individualized graphic profile that highlights possible prob- lem areas to be considered when developing patient education and management plans.
The predictive and incremental validtty of both the Old and New Medical College Admission Test (M... more The predictive and incremental validtty of both the Old and New Medical College Admission Test (MCAT) was examined and compared with a sample of over 300 medical students. Results of zero order and incremental validity coefficients, as well as prediction models resultimg from ali.possible subsets regression analyses usin Mallow's Cp criterion, were subjected to cross-validation analyses randomly dividing two medical school classes into screening and calibration samples. Results supported the incremental validity of both the Old and New MCAT. Coefficients were generally larger for the NeW than for the Old MCAT. Prediction models of National Board of
Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin... more Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes
Journal of Clinical Reasoning Procedural Competency, Mar 1, 2013
It is unknown whether group or individual practice using free-inquiry virtual patient simulations... more It is unknown whether group or individual practice using free-inquiry virtual patient simulations would most facilitate acquisition of clinical reasoning skills required of competent physicians.
Journal of Clinical Reasoning Procedural Competency, Mar 1, 2013
Physicians must be thorough yet efficient in data gathering and must use decision-making strategi... more Physicians must be thorough yet efficient in data gathering and must use decision-making strategies that limit diagnostic studies and costs, but still promote maximal diagnostic proficiency. These clinical reasoning skills are neither adequately taught nor measured in medical schools and residencies. To define clinical reasoning constructs a priori and develop clinical reasoning indices to be used with a virtual patient simulation model for teaching and assessing clinical reasoning competency. We used an experimental, pretest-posttest design to assess expected gains in clinical reasoning competency after three hours of virtual patient simulation practice. Computer transcripts (N=486) were generated by 81 medical students with complete data who solved one pretest, three practice, and two posttest simulations. Four clinical reasoning constructs were identified a priori: proficiency, efficiency, thoroughness, and strategy, and nineteen clinical reasoning indices were defined. Multivariate ANOVA and correlational analyses revealed significant pretest-posttest differences for posttest 1 (13/19 indices) and posttest 2 (14/19 indices), supporting the instructional effectiveness of virtual patient simulation practice and the construct validity of four clinical reasoning constructs and their corresponding nineteen clinical reasoning performance indicies. Reliability (stability) and concurrent validity of indices varied with case content. Instructional effectiveness, validity and stability of four constructs and nineteen corresponding clinical reasoning indices were established for a computer-based, free-inquiry virtual patient simulation model.
The Diabetes Educator, 1986
An educational needs assessment instrument for individuals with diabetes has been developed at th... more An educational needs assessment instrument for individuals with diabetes has been developed at the Michigan Diabetes Research and Training Center. Responses to the 110-item questionnaire provide subscores on con structs labeled "Control Problems, " "Psychosocial Impact," "Barriers to Compliance, " "Benefits of Regimen, " "Regimen Complexity," and "Risk of Complications." Com bined with demographic and clinical information, these scores form a com prehensive summary of the patient's attitudes, beliefs, behaviors, and knowledge in relation to diabetes. This summary is in the form of an individ ualized graphic profile that highlights possible prob lem areas to be consid ered when developing patient education and management plans.
The Diabetes Educator, 1988
Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin... more Data collected on a randomly selected group of 428 patients with insulin-dependent and noninsulin-dependent diabetes from 61 physician practices in eight Michigan communities were compared with national standards for diabetes patient knowledge. Comparisons were performed using a standardized Diabetes Knowledge Test (DKT) and selected items from the Diabetes Education Profile (DEP). Patient performance on these instruments was compared with corresponding items in the Ambulatory Care Facilities section of the Guide lines for Diabetes Care published by the American Diabetes Associ ation and the American Associ ation of Diabetes Educators. In general, insulin-dependent persons scored higher than noninsulin-dependent persons. Those taking insulin (whether insulin-dependent or not) scored higher than noninsulin-dependent persons whose regimen did not include insulin. The findings emphasize the need to subdivide any analysis of clinical diabetes or diabetes education into groups based on i...
The Diabetes Educator, 1986
The diabetes patient education provided in ran domly chosen primary care physician offices in sma... more The diabetes patient education provided in ran domly chosen primary care physician offices in small and large com munities was compared with hospital-based patient education programs in those same communities. The office programs were usually physician-de livered, informal, and in terwoven with the clinical care offered. They usually did not include a sys tematic needs assessment, were not recorded, used educational materials sparsely, and often lacked evaluation. The time spent on education is approx imately 48 minutes per year per patient in the of fice setting. The study suggested several develop mental activities that might improve patient education in physician of fices where the majority of patients with diabetes receive most of their care.
The Diabetes Educator, 1995
This study focused on three questions: Is there a difference in men's and women's diabete... more This study focused on three questions: Is there a difference in men's and women's diabetes attitudes? Do health professionals give different recommendations to men and women? Is there a difference between men and women in care adherence? A total of 1201 patients with diabetes were surveyed; 65% of these patients were women. Differences in diabetes attitudes (three of seven attiticdes) were most evident between men and women with insulin-dependent diabetes mellitus (IDDM). No differences were found in the attitudes of men and women with non-insulin-dependent diabetes mellitus (NIDDM) using insulin, and only one attitude was different for patients with NIDDM not using insulin. Few differences were observed in the recommendations given by health professionals to men and women. Gender differences in adherence to the components of self-care also were minimal. These findings may indicate that there are many similarities in the reactions of men and women who have been diagnosed wit...
Evaluation & the Health Professions, 1980
A total of 7931 ratings of 482 third- and fourth-year medical students were gath ered over twelve... more A total of 7931 ratings of 482 third- and fourth-year medical students were gath ered over twelve four-week periods. Ratings were made by multiple raters, house officers, and attending faculty, on fifteen behaviorally-anchored rating scales. The data were factor analyzed separately for each of the twelve periods.
Diabetes Care, 1981
An accurate determination of the educational needs of diabetic patients is based on a wide range ... more An accurate determination of the educational needs of diabetic patients is based on a wide range of patient characteristics. In the development of an assessment instrument to determine the educational needs of patients, the relative importance of numerous patient characteristics was determined. A questionnaire was mailed to 1518 health professionals who are either members of the American Association of Diabetes Educators or community health nurses in the state of Michigan. Analyses of the responses to this questionnaire have provided information regarding the knowledge, psychosocial, and demographic characteristics of patients, which are thought to be important in an educational diagnosis. Questions to measure these identified characteristics will be incorporated into an instrument that will assess the educational needs of diabetic patients.
Diabetes Care, 1992
Objective The purpose of this study was to identify specific beliefs that differentiate health-ca... more Objective The purpose of this study was to identify specific beliefs that differentiate health-care professionals whose attitudes toward diabetes agreed most strongly with a group of national diabetes experts from those whose attitudes disagreed most strongly. Research Design and Methods The sample for this study included 271 physicians, 834 nurses, and 546 dietitians who completed a Diabetes Attitudes Survey. The sample included specialists in diabetes care and nonspecialists. Controversial beliefs about diabetes and its care were determined by comparing the beliefs of the 10% of the sample whose attitudes were most concordant (with the national panel) with the beliefs of the 10% of the sample whose attitudes were the most discordant. Ten beliefs met the criteria for being defined as controversial. Results The most controversial beliefs concerned whether the patient or the physician should be the primary decision maker in diabetes care, the meaning of patient noncompliance, and the...
Diabetes Care, 1991
The patient empowerment approach to diabetes education is intended to enable patients to make inf... more The patient empowerment approach to diabetes education is intended to enable patients to make informed decisions about their own diabetes care and to be fully responsible members of the health-care team. Facilitating patient empowerment requires a specific set of skills and attitudes on the part of diabetes educators. A professional education program designed to facilitate the acquisition and enhancement of the requisite skills and attitudes was designed, implemented, and evaluated. The program involved adhering to a simulated diabetes care regimen for 3 days followed by a 3-day intensive skills-based workshop. The 23 educators who participated in the first two offerings of this program made significant gains in their counseling skills and demonstrated a positive change in attitude.
Diabetes Care, 1986
The Board of Directors of the American Diabetes Association (ADA) recently endorsed a resolution ... more The Board of Directors of the American Diabetes Association (ADA) recently endorsed a resolution recommending third-party payment for outpatient education and nutritional counseling. One of the major rationales for the statement was that education and nutritional counseling will lead to reductions in health care costs. This article critically reviews the 13 studies cited in support of the ADA Policy Statement. Among these studies, only 2 compared a treated group with a control group. Both of the studies with control groups failed to randomly assign patients to treatment condition. Only 4 of the studies showed an accounting of program costs. Upon close inspection, it appears that some of the programs actually increased, rather than decreased, health care expenditures. Attrition from programs was reported in only a minority of cases, and was large when reported. The effect of the programs upon diabetes control was inconsistent across studies. It is suggested that the rationale for edu...
Diabetes Care, 1988
The goal of this research was to quantify therelationships between patient survival and a set of ... more The goal of this research was to quantify therelationships between patient survival and a set of explanatory variables in a randomly selected sample of community-based patients with non-insulin-dependent diabetes mellitus (NIDDM). The sample included 343 patients with NIDDM initially entered into the study in 1981–1982 and reexamined in 1985–1986. Mortality data were collected on reexamination in 1985 and updated from death-certificate data through 1 January 1986. The data collected from the patients included demographic and clinical variables, psychosocial variables related to diabetes, measures of physiologic control, hospitalization, and mortality. The Cox proportionalhazards model was used to compute a hazard rate for each individual and to determine risk covariates. The results indicated that the variables most associated with the risk of mortality were patient age, social impact of diabetes, renal function, complexity of diet regimen, and history of smoking. Two of these varia...
Continuing education in pulmonary disease for primary-care physicians
The American review of respiratory disease, 1983
A continuing medical education program was implemented and evaluated in 16 community hospitals. I... more A continuing medical education program was implemented and evaluated in 16 community hospitals. It was targeted at primary-care physicians and used physicians identified by their peers as being educationally influential for the dissemination of information. Self-study materials were used, followed by an intensive 2-wk preceptorship that resulted in a significant increase in physician knowledge. Inpatient chart audits identified a series of changes in the management of chronic obstructive pulmonary disease in the intervention hospitals that were not noted in the control hospitals. These included the increased use of intravenously administered fluids, loading doses of intravenously administered bronchodilators, aerosolized and single agent bronchodilators, and respiratory therapy services. Continuing medical education, delivered through community-based educationally influential physicians, is an effective way of changing physician behavior in small communities with no prior ongoing ed...
American Journal of Preventive Medicine, 1990
This cross-sectional study examined medical and dental students' knowledge of preventive medicine... more This cross-sectional study examined medical and dental students' knowledge of preventive medicine. The purpose of the study was to assess the knowledge of preventive medicine-both epidemiological and clinical-that students demonstrate as they enter medical and dental school and acquire during training. The results of a two-group (medical versus dental school) by three-time (first-, second-, and thirdyear level) analysis of variance of students' mean examination scores showed significant main effects for school (F = 28.3, P < .001) and training level (F = 24.5, P < .001), and a significant school-by-training level interaction (F = 13.9, P < .001). Medical students at higher training levels demonstrated greater knowledge of preventive medicine. In contrast, there were no significant differences by year of training among the dental students on the total test or on the epidemiological or clinical subscales. Both the dental and medical students demonstrated greater knowledge of clinical applications than of epidemiological foundations (t = 4.21, P < .01). Dental students performed better than medical students on items that focused on diseases and risk factors that manifest symptoms more likely to be observed in dentistry than in general medical practice. The findings underscore the need to demonstrate practice relevance when teaching preventive medicine. [Am J Prev Med