223 results on '"Wittenberg E"'
Search Results
2. Short term health-related quality of life improvement during opioid agonist treatment
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Nosyk, B, Bray, JW, Wittenberg, E, Aden, B, Eggman, AA, Weiss, RD, Potter, J, Ang, A, Hser, Y-I, Ling, W, and Schackman, BR
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Pharmacology and Pharmaceutical Sciences ,Biomedical and Clinical Sciences ,Brain Disorders ,Drug Abuse (NIDA only) ,Clinical Research ,Prescription Drug Abuse ,Clinical Trials and Supportive Activities ,Substance Misuse ,Good Health and Well Being ,Adult ,Analgesics ,Opioid ,Buprenorphine ,Naloxone Drug Combination ,Cost-Benefit Analysis ,Female ,Health Status ,Heroin ,Humans ,Male ,Methadone ,Middle Aged ,Opiate Substitution Treatment ,Opioid-Related Disorders ,Quality of Life ,Randomized Controlled Trials as Topic ,Health related quality of life ,Opioid agonist treatment ,Health utility ,HRQoL ,Opioid use disorder ,Buprenorphine/naloxone ,Suboxone ,Medical and Health Sciences ,Psychology and Cognitive Sciences ,Substance Abuse ,Biochemistry and cell biology ,Pharmacology and pharmaceutical sciences ,Epidemiology - Abstract
BackgroundOpioid dependence is associated with high levels of morbidity, yet sparse data exists regarding the health-related quality of life (HRQoL) of individuals with opioid dependence, particularly following treatment initiation. To inform cost-effectiveness analyses of treatment modalities, this study investigates short-term changes in HRQoL following enrollment into opioid agonist treatment (OAT), across treatment modalities and patient subgroups.MethodsData was analyzed from the Starting Treatment with Agonist Replacement Therapies (START) and Prescription Opioid Addiction Treatment Studies (POATS) randomized controlled trials. Participants included individuals dependent on prescription opioids (POs) or heroin, receiving limited-term or time-unlimited treatment. PO- or heroin-users in START received buprenorphine/naloxone (BUP/NX) or methadone (MET) over 24 weeks. PO-users in POATS received psychosocial care and short-term (4-week) taper with BUP/NX, with non-responders offered subsequent extended (12-week) stabilization and taper. HRQoL was assessed using the short-form SF-6D while in and out of OAT, with distinction between MMT and BUP/NX in START. Linear mixed effects regression models were fitted to determine the independent effects of OAT on HRQoL and characterize HRQoL trajectories.ResultsTreatment had a similar immediate and modest positive association with HRQoL in each patient subgroup. The association of OAT on HRQoL was statistically significant in each model, with effect sizes between 0.039 (heroin-users receiving BUP/NX) and 0.071 (PO-users receiving MET). After initial improvement, HRQoL decreased slightly, or increased at a diminished rate.ConclusionsOAT, whether delivered in time-limited or unlimited form, using BUP/NX or MET, is associated with modest immediate HRQoL improvements, with diminishing benefits thereafter.
- Published
- 2015
3. Short term health-related quality of life improvement during opioid agonist treatment
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Nosyk, B., Bray, J.W., Wittenberg, E., Aden, B., Eggman, A.A., Weiss, R.D., Potter, J., Ang, A., Hser, Y.-I., Ling, W., and Schackman, B.R.
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- 2015
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4. COMFORT Communication in the ICU: Pilot Test of a Nurse-Led Communication Intervention for Surrogates
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Chen, C., primary, Sullivan, S., additional, Lorenz, R., additional, Wittenberg, E., additional, Li, C.-S., additional, and Chang, Y.-P., additional
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- 2022
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5. Correlates of health-related quality of life in type 2 diabetes
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Wexler, D. J., Grant, R. W., Wittenberg, E., Bosch, J. L., Cagliero, E., Delahanty, L., Blais, M. A., and Meigs, J. B.
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- 2006
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6. SP2 What Is the Relative VALUE of Carer and Patient Quality of Life? a Person Trade-Off (PTO) Study with the UK Public
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Al-Janabi, H., primary, Wittenberg, E., additional, Donaldson, C., additional, and Brouwer, W., additional
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- 2020
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7. Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes
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Delahanty, L. M., Grant, R. W., Wittenberg, E., Bosch, J. L., Wexler, D. J., Cagliero, E., and Meigs, J. B.
- Published
- 2007
8. Willingness-to-pay: a burden of disease outcome reported by patients with melanoma and psoriasis: 301
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Qureshi, A, Brandling-Bennett, H, Wittenberg, E, Chen, S, Sober, A, and Kvedar, J
- Published
- 2005
9. Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial
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Adams, A. S., primary, Schmittdiel, J. A., additional, Altschuler, A., additional, Bayliss, E. A., additional, Neugebauer, R., additional, Ma, L., additional, Dyer, W., additional, Clark, J., additional, Cook, B., additional, Willyoung, D., additional, Jaffe, M., additional, Young, J. D., additional, Kim, E., additional, Boggs, J. M., additional, Prosser, L. A., additional, Wittenberg, E., additional, Callaghan, B., additional, Shainline, M., additional, Hippler, R. M., additional, and Grant, R. W., additional
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- 2018
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10. PDB127 - APPLICATION OF BEST WORST SCALING TO IMPROVE PATIENT-CENTERED TREATMENT DECISIONS IN DIABETIC PERIPHERAL NEUROPATHY
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Adams, A.S., primary, Prosser, L., additional, Altschuler, A., additional, Ma, L., additional, and Wittenberg, E., additional
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- 2018
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11. Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial.
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Adams, A. S., Schmittdiel, J. A., Altschuler, A., Bayliss, E. A., Neugebauer, R., Ma, L., Dyer, W., Clark, J., Cook, B., Willyoung, D., Jaffe, M., Young, J. D., Kim, E., Boggs, J. M., Prosser, L. A., Wittenberg, E., Callaghan, B., Shainline, M., Hippler, R. M., and Grant, R. W.
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TREATMENT of diabetic neuropathies ,ASIANS ,AUTOMATION ,BLACK people ,CLUSTER analysis (Statistics) ,CONFIDENCE intervals ,DIABETES ,HISPANIC Americans ,INTERVIEWING ,MEDICAL care ,PATIENT-professional relations ,HEALTH outcome assessment ,PATIENT education ,PATIENT monitoring ,GENERAL practitioners ,PRIMARY health care ,QUALITY assurance ,QUALITY of life ,TELEMEDICINE ,TELEPHONES ,WHITE people ,RANDOMIZED controlled trials ,TREATMENT effectiveness ,SEVERITY of illness index ,ADVERSE health care events ,ADULTS - Abstract
Aims: To evaluate the effectiveness of automated symptom and side effect monitoring on quality of life among individuals with symptomatic diabetic peripheral neuropathy. Methods: We conducted a pragmatic, cluster randomized controlled trial (July 2014 to July 2016) within a large healthcare system. We randomized 1834 primary care physicians and prospectively recruited from their lists 1270 individuals with neuropathy who were newly prescribed medications for their symptoms. Intervention participants received automated telephone‐based symptom and side effect monitoring with physician feedback over 6 months. The control group received usual care plus three non‐interactive diabetes educational calls. Our primary outcomes were quality of life (EQ‐5D) and select symptoms (e.g. pain) measured 4–8 weeks after starting medication and again 8 months after baseline. Process outcomes included receiving a clinically effective dose and communication between individuals with neuropathy and their primary care provider over 12 months. Interviewers collecting outcome data were blinded to intervention assignment. Results: Some 1252 participants completed the baseline measures [mean age (sd): 67 (11.7), 53% female, 57% white, 8% Asian, 13% black, 20% Hispanic]. In total, 1179 participants (93%) completed follow‐up (619 control, 560 intervention). Quality of life scores (intervention: 0.658 ± 0.094; control: 0.653 ± 0.092) and symptom severity were similar at baseline. The intervention had no effect on primary [EQ‐5D: −0.002 (95% CI −0.01, 0.01), P = 0.623; pain: 0.295 (−0.75, 1.34), P = 0.579; sleep disruption: 0.342 (−0.18, 0.86), P = 0.196; lower extremity functioning: −0.079 (−1.27, 1.11), P = 0.896; depression: −0.462 (−1.24, 0.32); P = 0.247] or process outcomes. Conclusions: Automated telephone monitoring and feedback alone were not effective at improving quality of life or symptoms for people with symptomatic diabetic peripheral neuropathy. Trial Registration: ClinicalTrials.gov (NCT02056431). What's new?: Frequent communication between individuals with diabetic peripheral neuropathy and primary care providers about symptoms and medication side effects is critical to optimizing medication dosing to treat painful diabetic peripheral neuropathy. Yet, there are considerable barriers to effective communication.This cluster randomized controlled trial found that a brief intervention to automatically monitor person‐reported data on symptoms and side effects, and provide the information to physicians via an electronic health record was not effective in improving the outcomes valued by individuals with neuropathy.Alerts alone are unlikely to change provider behaviour related to treatment intensification. More intensive interventions focused on individual activation or provider education may be more effective in changing prescribing behaviour and improving outcomes. [ABSTRACT FROM AUTHOR]
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- 2019
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12. Decision Making in Health and Medicine
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Hunink, Myriam, Weinstein, MC, Wittenberg, E, Drummond, MF, Pliskin, JS, Wong, JB, Glasziou, PP, and Radiology & Nuclear Medicine
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Decision making in health care involves consideration of a complex set of diagnostic, therapeutic and prognostic uncertainties. Medical therapies have side effects, surgical interventions may lead to complications, and diagnostic tests can produce misleading results. Furthermore, patient values and service costs must be considered. Decisions in clinical and health policy require careful weighing of risks and benefits and are commonly a trade-off of competing objectives: maximizing quality of life vs maximizing life expectancy vs minimizing the resources required. This text takes a proactive, systematic and rational approach to medical decision making. It covers decision trees, Bayesian revision, receiver operating characteristic curves, and cost-effectiveness analysis, as well as advanced topics such as Markov models, microsimulation, probabilistic sensitivity analysis and value of information analysis. It provides an essential resource for trainees and researchers involved in medical decision modelling, evidence-based medicine, clinical epidemiology, comparative effectiveness, public health, health economics, and health technology assessment.
- Published
- 2014
13. Using Best-Worst Scaling to Understand Patient Priorities: A Case Example of Papanicolaou Tests for Homeless Women
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Wittenberg, E., primary, Bharel, M., additional, Bridges, J. F. P., additional, Ward, Z., additional, and Weinreb, L., additional
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- 2016
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14. PRM20 TRENDS IN UTILITY ELICITATION METHODS: DIRECT VERSUS INDIRECT METHODS
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Prosser, L.A., primary and Wittenberg, E., additional
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- 2011
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15. PMC75 MEANINGFUL VERSUS USEABLE RESPONSES TO PREFERENCE SURVEYS: INSIGHTS INTO IMPROVING THE VALIDITY OF HEALTH UTILITY SCORES
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Wittenberg, E, primary and Prosser, LA, additional
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- 2009
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16. PMC30 A REVIEW AND CRITIQUE OF METHODS FOR MEASURING TEMPORARY HEALTH STATES IN COST-UTILITY ANALYSES
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Wright, DR, primary, Wittenberg, E, additional, Swan, JS, additional, Miksad, R, additional, and Prosser, L, additional
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- 2008
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17. Partial-Breast Irradiation Versus Whole-Breast Irradiation for Early-Stage Breast Cancer: A Decision Analysis
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Sher, D.J., primary, Wittenberg, E., additional, and Punglia, R., additional
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- 2007
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18. Andreas Trotzke: Sprachevolution. Eine Einführung. Berlin & Boston: De Gruyter Mouton (De Gruyter Studium) 2017
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Wittenberg Eva
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Language. Linguistic theory. Comparative grammar ,P101-410 - Published
- 2018
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19. Health utility elicitation: is there still a role for direct methods?
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Prosser LA, Grosse SD, Wittenberg E, Prosser, Lisa A, Grosse, Scott D, and Wittenberg, Eve
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- 2012
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20. Intersections of harm and health: a qualitative study of intimate partner violence in women's lives.
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Thomas KA, Joshi M, Wittenberg E, and McCloskey LA
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Eight focus groups of women with recent exposure to intimate partner violence (IPV) were conducted to elicit women's descriptions of how IPV affects their health. Their shared narratives reveal a complex relationship with three main points of intersection between IPV and health: IPV leading to adverse health effects; IPV worsening already compromised health; and women's illness or disability increasing dependency on abusive partners, thereby lengthening the duration of IPV exposure. Women describe bidirectional and cyclical ways through which IPV and health intersect over time. Service providers, including physicians, need to better understand the myriad ways that abuse affects women's health. [ABSTRACT FROM AUTHOR]
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- 2008
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21. Partial breast irradiation versus whole breast radiotherapy for early-stage breast cancer: a decision analysis.
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Sher DJ, Wittenberg E, Taghian AG, Bellon JR, Punglia RS, Sher, David J, Wittenberg, Eve, Taghian, Alphonse G, Bellon, Jennifer R, and Punglia, Rinaa S
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Purpose: To compare the quality-adjusted life expectancy between women treated with partial breast irradiation (PBI) vs. whole breast radiotherapy (WBRT) for estrogen receptor-positive early-stage breast cancer.Methods and Materials: We developed a Markov model to describe health states in the 15 years after radiotherapy for estrogen receptor-positive early-stage breast cancer. Breast cancer recurrences were separated into local recurrences and elsewhere failures. Ipsilateral breast tumor recurrence (IBTR) risk was extracted from the Oxford overview, and rates and utilities were adapted from the literature. We studied two cohorts of women (aged 40 and 55 years), both of whom received adjuvant tamoxifen.Results: Assuming a no evidence of disease (NED)-PBI utility of 0.93, quality-adjusted life expectancy after PBI (and WBRT) was 12.61 (12.57) and 12.10 (12.06) years for 40-year-old and 55-year-old women, respectively. The NED-PBI utility thresholds for preferring PBI over WBRT were 0.923 and 0.921 for 40-year-old and 55-year-old women, respectively, both slightly greater than the NED-WBRT utility. Outcomes were sensitive to the utility of NED-PBI, the PBI hazard ratio for local recurrence, the baseline IBTR risk, and the percentage of IBTRs that were local. Overall the degree of superiority of PBI over WBRT was greater for 55-year-old women than for 40-year-old women.Conclusions: For most utility values of the NED-PBI health state, PBI was the preferred treatment modality. This result was highly sensitive to patient preferences and was also dependent on patient age, PBI efficacy, IBTR risk, and the fraction of IBTRs that were local. [ABSTRACT FROM AUTHOR]- Published
- 2008
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22. Depression, self-care, and medication adherence in type 2 diabetes: relationships across the full range of symptom severity.
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Gonzalez JS, Safren SA, Cagliero E, Wexler DJ, Delahanty L, Wittenberg E, Blais MA, Meigs JB, Grant RW, Gonzalez, Jeffrey S, Safren, Steven A, Cagliero, Enrico, Wexler, Deborah J, Delahanty, Linda, Wittenberg, Eve, Blais, Mark A, Meigs, James B, and Grant, Richard W
- Abstract
Objective: We examined the association between depression, measured as either a continuous symptom severity score or a clinical disorder variable, with self-care behaviors in type 2 diabetes.Research Design and Methods: We surveyed 879 type 2 diabetic patients from two primary care clinics using the Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS), the Summary of Diabetes Self-Care Activities, and self-reported medication adherence.Results: Of the patients, 19% met the criteria for probable major depression (HANDS score >or=9), and an additional 66.5% reported at least some depressive symptoms. After controlling for covariates, patients with probable major depression reported significantly fewer days' adherent to diet, exercise, and glucose self-monitoring regimens (P < 0.01) and 2.3-fold increased odds of missing medication doses in the previous week (95% CI 1.5-3.6, P < 0.001) compared with all other respondents. Continuous depressive symptom severity scores were better predictors of nonadherence to diet, exercise, and medications than categorically defined probable major depression. Major depression was a better predictor of glucose monitoring. Among the two-thirds of patients not meeting the criteria for major depression (HANDS score <9, n = 709), increasing HANDS scores were incrementally associated with poorer self-care behaviors (P < 0.01).Conclusions: These findings challenge the conceptualization of depression as a categorical risk factor for nonadherence and suggest that even low levels of depressive symptomatology are associated with nonadherence to important aspects of diabetes self-care. Interventions aimed at alleviating depressive symptoms, which are quite common, could result in significant improvements in diabetes self-care. [ABSTRACT FROM AUTHOR]- Published
- 2007
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23. Do risk attitudes differ across domains and respondent types?
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Prosser LA and Wittenberg E
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OBJECTIVE: . To evaluate differences in risk attitude across the domains of health and money for 2 types of respondents, patients and community members. METHODS: . Two groups of respondents, patients with multiple sclerosis (n = 56) and members of the general community (n = 57), completed a survey that collected information on risk attitudes and socioeconomic and clinical variables (e.g., disability level). Risk attitude was measured using 2 standard-gamble questions on money and 1 standard-gamble question on health outcomes. Multivariate regression was used to evaluate the relationship between risk attitude and respondent type (patient v. community), adjusting for covariates that could affect risk attitude. RESULTS: . The median certainty equivalents for money gambles were significantly different from and less than the expected value of the gamble for both types of respondents. Median certainty equivalents for the health gamble were not significantly different from the expected value for either group of respondents. For all 3 gambles, there was no difference in median certainty equivalents between the 2 types of respondents in both unadjusted and adjusted analyses. CONCLUSIONS: . Risk attitude varied across domains but not by respondent type. Patients and community members were predominantly risk neutral with respect to health outcomes and risk averse with respect to money. Research on risk preferences on money outcomes may not be an appropriate proxy for risk preferences regarding health outcomes. Risk preferences may depend more on characteristics of the choice than on respondent type. [ABSTRACT FROM AUTHOR]
- Published
- 2007
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24. Community preferences for health states associated with intimate partner violence.
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Wittenberg E, Lichter EL, Ganz ML, and McCloskey LA
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BACKGROUND: One in 4 women is affected by intimate partner violence in her lifetime. This article reports on a cross-sectional survey to estimate community preferences for health states resulting from intimate partner violence.METHODS: A secondary analysis was conducted of data from a convenience sample of 93 abused and 138 nonabused women (231 total) recruited for in-person interviews from hospital outpatient department waiting rooms in metropolitan Boston, Massachusetts. SF-12 data were converted to utilities to describe community-perspective preferences for health states associated with intimate partner violence. Linear regression analysis was used to explore the association between violence and utility while controlling for other health and demographic factors.RESULTS: Median utility for intimate partner violence was between 0.58 and 0.63 on a scale of 0 (equivalent to death) to 1.0 (equivalent to optimal health), with a range from 0.64 to 0.66 for less severe violence to 0.53 to 0.62 for more severe violence. The data do not reveal whether violence itself is responsible for lower utility or whether a constellation of factors contributes to disutility experienced by women victims of abuse.DISCUSSION: The utility of health states experienced by women exposed to intimate partner violence is substantially diminished compared with optimal health and even other health conditions. These values quantify the substantial negative health impact of the experience of intimate partner violence in terms that allow comparison across diseases. They can be used in cost-effectiveness analyses to identify the benefits and potential returns from resources allocated to violence prevention and intervention efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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25. Patient utilities for advanced cancer: effect of current health on values.
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Wittenberg E, Winer EP, Weeks JC, Wittenberg, Eve, Winer, Eric P, and Weeks, Jane C
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Background: Utilities are critical inputs to economic analyses, yet some things remain unclear about their elicitation and application, particularly the impact of health status on values. Prospect theory predicts that current health affects values, and that losses loom larger than gains. If true, the use of utilities requires that additional complexities be considered.Objective: To determine the effect of current health on patient utilities for advanced cancer health states.Research Design: The research was a cross-sectional survey (n=100 patients) of utilities for 4 hypothetical advanced cancer health states. Chained gamble utilities for gains and losses in health were compared, correlations between current health status and utilities were measured, and patient utilities for experienced versus hypothetical health states were compared.Results: In this sample, gains in health were valued equivalently to losses, health status was not correlated with utility values, and patients' valuation of states equivalent to their current health did not differ from valuations of the same states by patients with better or worse current health.Conclusion: This research confirms the uncertainty surrounding the effect of health status on utilities and the question of whose values to use in analyses. The findings suggest that values for health states may be independent of current health status, supporting an objective view of utilities. This research also suggests that patients may be able to provide "experienced utilities" for states other than their own, expanding the population from whom such values can be elicited. These results may dispute prospect theory's predictions regarding health state valuations. [ABSTRACT FROM AUTHOR]- Published
- 2005
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26. The photochemical oxidation of ascorbic acid in solutions containing oxalic acid. II.
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Lampitt, L. H., Baker, L. C., and Wittenberg, E.
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- 1956
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27. Ascorbic acid-photochemical oxidation in solutions containing oxalic acid. I.-catalysis by traces of iron salts.
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Baker, L. C., Lampitt, L. H., and Wittenberg, E.
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- 1955
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28. How Lobbying Helps Make Democracy Work
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Wittenberg, E.
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Lobbying -- Economic policy - Published
- 1982
29. Getting It Done Overseas
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Wittenberg, E.
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Foreign correspondents -- Public relations ,Business -- International aspects ,Advertising, marketing and public relations ,Business - Published
- 1982
30. Where children sit in cars: the impact of Rhode Island's new legislation.
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Segui-Gomez M, Wittenberg E, Glass R, Levenson S, Hingson R, and Graham JD
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OBJECTIVES: This study evaluated the impact of Rhode Island's legislation requiring children younger than 6 years to sit in the rear of motor vehicles. METHODS: Roadside observations were conducted in Rhode Island and Massachusetts in 1997 and 1998. Multivariate regression was used to evaluate the proportion of vehicles carrying a child in the front seat. RESULTS: Data were collected on 3226 vehicles carrying at least 1 child. In 1998, Rhode Island vehicles were less likely to have a child in the front seat than in 1997 (odds ratio = 0.6; 95% confidence interval = 0.5, 0.7), whereas no significant changes in child passenger seating behavior occurred in Massachusetts during that period. CONCLUSIONS: Rhode Island's legislation seems to have promoted safer child passenger seating behavior. © 2002 by the United States Cancer Pain Relief Committee. [ABSTRACT FROM AUTHOR]
- Published
- 2001
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31. TABLES OF PROLATE SPHEROIDAL FUNCTIONS FOR M EQUALS O. VOLUME I.
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MICHIGAN UNIV ANN ARBOR RADIATION LAB, HUNTER,H. E., Kirk,D. B., Senior,T. B. A., Wittenberg,E. R., MICHIGAN UNIV ANN ARBOR RADIATION LAB, HUNTER,H. E., Kirk,D. B., Senior,T. B. A., and Wittenberg,E. R.
- Abstract
The eigenvalues lambda (c) and normalization constants N(c) are tabulated for c = 0.1(0.1)10.0 and n ranging from 0 up to a maximum of 20. The radial functions of the first and second kinds, and their first derivatives, are given for the same c and n for xi = 1.0000500, 1.0050378, 1.0206207 and 1.1547005, corresponding to prolate spheroids of length-to-width ratios 100:1, 10:1, 5:1 and 2:1 respectively. Values of the angular functions are contained in a companion report (7133-2-T). All computations were carried out on The University of Michigan IBM 7090 computer. The program, which can also be used for the determination of the functions of orders 1 and 2, is described in some detail. (Author)
- Published
- 1965
32. TABLES OF PROLATE SPHEROIDAL FUNCTIONS FOR M=0: VOLUME II.
- Author
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MICHIGAN UNIV ANN ARBOR RADIATION LAB, Hunter,H. E., Kirk,D. B., Senior,T. B. A., Wittenberg,E. R., MICHIGAN UNIV ANN ARBOR RADIATION LAB, Hunter,H. E., Kirk,D. B., Senior,T. B. A., and Wittenberg,E. R.
- Abstract
The angular prolate spheroidal functions S (c, eta) and their first derivatives have been programmed for calculation on The University of Michigan IBM 7090 computer. Values of S (c, eta) and S' (c, eta) are tabulated for c=0.1(0.1)10.0, n ranging from 0 up to a maximum of 20, and eta=0(0.05)1.0. Corresponding values of the eigenvalues, normalization constants and radial functions were given in the preceding report (7133-1-T). (Author)
- Published
- 1965
33. Decision making in health and medicine: Integrating evidence and values, second edition
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Hunink, M. G. M., Weinstein, M. C., Wittenberg, E., Drummond, M. F., Joseph Pliskin, Wong, J. B., and Glasziou, P. P.
34. Tables of Prolate Spheroidal Functions for m = 0
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Flammer, Carson, primary, Hunter, H. E., additional, Kirk, D. B., additional, Senior, T. B. A., additional, and Wittenberg, E. R., additional
- Published
- 1967
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35. The effect of time of onset on community preferences for health states: an exploratory study
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Wittenberg Eve
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Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background Health state descriptions used to describe hypothetical scenarios in community-perspective utility surveys commonly omit detail on the time of onset of a condition, despite our knowledge that among patients who have a condition, experience affects the value assigned to that condition. The debate regarding whose values to use in cost utility analysis is based in part on this observed difference between values depending on the perspective from which they are measured. This research explores the effect on community preferences for hypothetical health states of including the time of onset of a health condition in the health state description, to investigate whether this information induces community respondents to provide values closer to those of patients with experience with a condition. The goal of the research is to bridge the gap between patient and community preferences. Methods A survey of community-perspective preferences for hypothetical health states was conducted among a convenience sample of healthy adults recruited from a hospital consortium's research volunteer pool. Standard gambles for three hypothetical health states of varying severity were compared across three frames describing time of onset: six months prior onset, current onset, and no onset specified in the description. Results were compared within health state across times of onset, controlling for respondent characteristics known to affect utility scores. Sub-analyses were conducted to confirm results on values meeting inclusion criteria indicating a minimum level of understanding and compliance with the valuation task. Results Standard gamble scores from 368 completed surveys were not significantly different across times of onset described in the health state descriptions regardless of health condition severity and controlling for respondent characteristics. Similar results were found in the subset of 292 responses that excluded illogical and invariant responses. Conclusions The inclusion of information on the time of onset of a health condition in community-perspective utility survey health state descriptions may not be salient to or may not induce expression of preferences related to disease onset among respondents. Further research is required to understand community preferences regarding condition onset, and how such information might be integrated into health state descriptions to optimize the validity of utility data. Improved understanding of how the design and presentation of health state descriptions affect responses will be useful to eliciting valid preferences for incorporation into decision making.
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- 2011
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36. Measuring the effect of intimate partner violence on health-related quality of life: a qualitative focus group study
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Thomas Kristie A, Joshi Manisha, Wittenberg Eve, and McCloskey Laura A
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Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background Health related quality of life (HRQOL) can be measured by a wide range of instruments, many of which have been designed for specific conditions or uses. "Preference-based" measures assess the value individuals place on health, and are included in economic evaluations of treatments and interventions (such as cost effectiveness analysis). As economic evaluation becomes more common, it is important to assess the applicability of preference-based health related quality of life (HRQOL) measures to public health issues. This study investigated the usefulness of such instruments in the context of intimate partner violence (IPV), a public health concern that that can seriously affect quality of life. Methods The study consisted of focus groups with abused women to determine the aspects of life affected by IPV, and an analysis of existing HRQOL measures. Eight focus groups (n = 40) were conducted in which participants discussed the domains of health affected by IPV. Results were content analyzed and compared with the domains of health included in four commonly-used, preference-based HRQOL measures. Results The average focus group participant was 43 years old, unemployed, African American, with 3 children. Domains of health reported to be affected by IPV included physical functioning, emotional and psychological functioning, social functioning and children's functioning. Psychological health was the most severely affected domain. The Short Form 36, the Health Utilities Index, the EuroQol 5D, and the Quality of Well-being Scale were found to vary in the degree to which they include domains of health important in IPV. Psychological health is included to a limited extent, and the spill-over effect of a condition on other family members, including children, is not included at all. Conclusion Emotional and psychological health plays an important role in the overall HRQOL of abused women but is relatively underemphasized in preference-based HRQOL measures. This may lead to an underestimation of the impact of partner violence on HRQOL when using these measures and in economic evaluations that rely thereon. Holistic measurement approaches or expanded measures that capture the far-reaching effects of IPV on HRQOL may be needed to accurately measure the effect of this condition on women's health.
- Published
- 2007
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37. Quality of life in patients with various Barrett's esophagus associated health states
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Nishioka Norman S, Wittenberg Eve, Hur Chin, and Gazelle G Scott
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Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Abstract Background The management of Barrett's esophagus (BE), particularly high grade dysplasia (HGD), is an area of much debate and controversy. Surgical esophagectomy, intensive endoscopic surveillance and mucosal ablative techniques, especially photodynamic therapy (PDT), have been proposed as possible management strategies. The purpose of this study was to determine the health related quality of life associated with Barrett's esophagus and many of the pivotal health states associated with Barrett's HGD management. Methods 20 patients with Barrett's esophagus were enrolled in a pilot survey study at a large urban hospital. The utility of Barrett's esophagus without dysplasia (current health state) as well as various health states associated with HGD management (hypothetical states as the subject did not have HGD) were measured using a validated health utility instrument (Paper Standard Gamble). These specific health states were chosen for the study because they are considered pivotal in Barrett's HGD decision making. Information regarding Barrett's HGD was presented to the subject in a standardized format that was designed to be easily comprehendible. Results The average utility scores (0–1 with 0 = death and 1 = perfect health) for the various Barrett's esophagus associated states were: BE without dysplasia-0.95; Post-esophagectomy for HGD with dysphagia-0.92; Post-PDT for HGD with recurrence uncertainty-0.93; Post-PDT for HGD with recurrence uncertainty and dysphagia-0.91; Intensive endoscopic surveillance for HGD-0.90. Conclusion We present the scores for utilities associated with Barrett's esophagus as well as various states associated with the management of HGD. The results of our study may be useful in advising patients and providers regarding expected outcomes of the various HGD management strategies as well as providing utility scores for future cost-effectiveness analyses.
- Published
- 2006
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38. Ohio rabbi apprehended in N.Y. for alleged sex crime in MD.
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Wittenberg, E. d., Shapiro, Marc, and Norris, Heather
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CHILD sexual abuse laws ,CHILD sexual abuse - Abstract
The article discusses arrest of rabbi Ephraim Karp in New York for alleged sexual abuse of a minor in Maryland and statement issued by Ohio's assisted living facility Menorah Park Center for Senior Living's executive director Steven R. Raichilson where Karp works as spiritual living director.
- Published
- 2015
39. Deriving the PedsUtil health state classification system to measure health utilities for pediatric populations based on the PedsQL: a confirmatory factor analysis.
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Kim DeLuca E, Dalziel K, Wittenberg E, Rose AM, and Prosser LA
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- Humans, Child, Adolescent, Factor Analysis, Statistical, Female, Male, Child, Preschool, Surveys and Questionnaires standards, Australia, Psychometrics, Health Status, Longitudinal Studies, Quality of Life
- Abstract
Background: An important methodological challenge in conducting pediatric economic evaluations is estimating the preference-based health-related quality of life (HRQoL) of children. Current methods are highly variable and there is no single instrument available to value HRQoL consistently across multiple pediatric age groups. The Pediatric Quality of Life Inventory (PedsQL) is a non-preference-based generic HRQoL instrument validated for children 2-18 years, but it cannot be directly used in economic evaluations. The aim of this study was to establish the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis, which is the first step of deriving a preference-based measure of HRQoL based on the PedsQL., Methods: Four competing dimension structures of the PedsUtil health state classification system were developed based on published literature and expert opinion. Using data from the Longitudinal Study of Australian Children (LSAC) (n = 45,207), the 4 dimension structures were evaluated using the robust weighted least squares estimation method. The analyses were stratified by 2-year age intervals (from 2 to 17 years) to reflect the study design of the LSAC, as well as special healthcare needs status of the child. Model fit was evaluated by examining standardized factor loadings and various fit indices including the comparative fit index (CFI), Tucker-Lewis Index (TLI), and the root mean square error of approximation (RMSEA). Modification indices and residual correlations were examined to re-specify the models to improve model fit when necessary., Results: The findings supported a 7-dimension structure (i.e., Physical Functioning, Pain, Fatigue, Emotional Functioning, Social Functioning, School Functioning, and School Absence) of the PedsUtil health state classification system. The 7-dimension model exhibited adequate fit across subgroups with CFI values that ranged from 0.929 to 0.954, TLI values from 0.916 to 0.946, and RMSEA values from 0.058 to 0.102., Conclusions: This study established the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis. The 7-dimension structure was found to be applicable across diverse pediatric populations. Research is currently ongoing to select the most representative item within each dimension of the PedsUtil health state classification system and valuation surveys will be fielded to estimate the PedsUtil scoring system., (© 2024. The Author(s).)
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- 2024
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40. Selecting PedsQL items to derive the PedsUtil health state classification system to measure health utilities in children.
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Kim DeLuca E, Dalziel K, Wittenberg E, Henderson NC, and Prosser LA
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- Humans, Child, Adolescent, Child, Preschool, Male, Female, Australia, Surveys and Questionnaires, Health Status, Longitudinal Studies, Quality of Life, Psychometrics
- Abstract
Background: There is a lack of preference-based health-related quality of life (HRQoL) measures that consistently value health across a full range of child age groups. The PedsQL is a generic HRQoL instrument validated for children 2-18 years, but it is not preference-based. The objective of this study was to derive the PedsUtil health state classification system from the PedsQL as a basis for a preference-based HRQoL measure for children., Methods: A two-step process was used to select PedsQL items to include in the health state classification system: 1) exclude poorly functioning items according to Rasch analysis in each of the previously established seven dimensions of the PedsUtil health state classification system and 2) select a single item to represent each dimension based on Rasch and psychometric analyses, as well as input from child health experts and parents. All secondary analyses were conducted using data from the Longitudinal Study of Australian Children (LSAC). Analyses were stratified by age group (i.e., 2-5 years, 6-13 years, and 14-17 years) to represent the different developmental stages of children and to reflect the study design of the LSAC. Rasch analyses were also performed on five random subsamples for each age group to enhance robustness of results., Results: Twelve items were excluded from the PedsUtil health state classification system after the first step of the item selection process. An additional four items were excluded in the second step, resulting in seven items that were selected to represent the seven dimensions of the PedsUtil health state classification system: Physical Functioning ("participating in sports activity or exercise"), Pain ("having hurts or aches"), Fatigue ("low energy level"), Emotional Functioning ("worrying about what will happen to them"), Social Functioning ("other kids not wanting to be their friend"), School Functioning ("keeping up with schoolwork"), and School Absence ("missing school because of not feeling well")., Conclusions: The PedsUtil health state classification system was derived from the PedsQL based on several criteria and was constructed to be applicable to children two years and older. Research is ongoing to elicit preferences for the PedsUtil health state classification system to construct the PedsUtil scoring system., (© 2024. The Author(s).)
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- 2024
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41. Improving Dementia Caregiver Activation With a Brief Communication Module.
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Wittenberg E, Sullivan SS, and Rios M
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- Humans, Female, Male, Middle Aged, Aged, Palliative Care organization & administration, Health Knowledge, Attitudes, Practice, Adult, Caregivers psychology, Dementia nursing, Communication
- Abstract
Objective: Palliative care often plays a pivotal role in supporting informal caregivers of persons living with dementia who experience a lack of continuity in care. Dementia caregiver activation, the caregiver's willingness and ability to navigate care needs, requires communication skills for developing relationships with healthcare providers. Communication activation is important because caregivers facilitate physician and patient information exchange. This study aimed to explore changes in communication outcomes (attitude, knowledge, and skills) and impact on caregiver communication activation (confidence, self-report) following completion of a brief communication module. Methods: A 15-minute asynchronous online module was developed to provide caregivers with communication skills for working with doctors and nurses. Caregivers completed pre/post module measures of communication outcomes, a vignette for applying communication strategies and were interviewed within a week of module completion to assess self-reported communication activation. Module acceptability was also evaluated. Results: Communication knowledge ( P < .01) significantly increased and nearly all participants (99%) demonstrated use of module-specific communication skills after completing the module. While not statistically significant, caregiver attitudes were in the expected direction. Caregiver self-reported communication confidence ( P < .001) significantly increased and 84% of caregivers described communication activation at post-module. Caregivers (83%) were likely to recommend the module. Conclusions: The brief communication module for dementia caregivers in this project offers an online resource with low time-burden that results in caregiver communication activation. Future testing in the clinical setting will increase understanding of its efficacy and integration and could be a viable resource for palliative care providers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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42. User Experience and Evaluation of the COMFORT Communication App for Nursing Education.
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Terui S, Goldsmith JV, Wittenberg E, Williams-Click Y, and Alabere R
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- Humans, Communication, Mobile Applications, Education, Nursing
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- 2024
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43. Delayed onset facilitates subsequent retrieval of words during language comprehension.
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Karimi H, Diaz M, and Wittenberg E
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- Humans, Memory, Short-Term, Semantics, Comprehension, Language
- Abstract
Prior research has shown that during language comprehension, memory representations associated with premodified words (e.g., the injured and dangerous bear) are retrieved faster from memory than those associated with unmodified words (e.g., the bear). Current explanations attribute this effect to the semantic richness of modified words. However, it is not clear whether the presence of modifying words are in fact necessary for a retrieval benefit. Premodifiers necessarily delay the onset of the target word (i.e., bear), and temporal delays may heighten attention to upcoming stimuli, and/or strengthen encoding by producing free time during encoding, facilitating subsequent retrieval. We therefore examined whether a simple delay in the onset of the target can produce a retrieval benefit. Our results show that delayed onset facilitates the subsequent retrieval of target words in the absence of any modifying information. These results lend support to models of language comprehension according to which delays may enhance attention to upcoming words, and also to models of working memory based on which free time replenishes encoding resources, strengthening the memory trace of encoded information and facilitating its retrieval at a subsequent point. Our results also contribute to current memory-based theories of sentence comprehension by showing that retrieval from memory may be affected by nonlinguistic factors such as delay-induced attention enhancement, or free time during encoding., (© 2023. The Psychonomic Society, Inc.)
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- 2024
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44. The COMFORT Model: Moving the Initiative Outside of the Academy.
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Goldsmith JV and Wittenberg E
- Abstract
Reflexive and prospective in nature, the creators of the COMFORT model describe experiences of moving this research outside of the academy. The COMFORT model represents the seven basic principles of healthcare provider communication: C - Connect, O - Options, M - Making Meaning, F - Family Caregivers, O - Openings, R - Relating, T - Team. The COMFORT initiative began as a call for change in healthcare communication education. Originally published as a final chapter in a volume on family and palliative care communication, it was the start of an extensive translational program of trainings and tools addressing healthcare provider communication.
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- 2024
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45. Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force.
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Henry E, Al-Janabi H, Brouwer W, Cullinan J, Engel L, Griffin S, Hulme C, Kingkaew P, Lloyd A, Payakachat N, Pennington B, Peña-Longobardo LM, Prosser LA, Shah K, Ungar WJ, Wilkinson T, and Wittenberg E
- Subjects
- Humans, Cost-Benefit Analysis, Advisory Committees, Delivery of Health Care, Caregivers, Economics, Medical
- Abstract
Background: Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed., Aim: To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice., Methods: A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds., Results: This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed., Conclusions: Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation., (© 2023. The Author(s).)
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- 2024
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46. Palliative Care Communication Among Home Health Interprofessional Staff: A Randomized Controlled Trial of Feasibility, Acceptability, and Preliminary Effectiveness.
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Bigger SE, Zanville N, Wittenberg E, Towsley G, and Glenn L
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- Humans, Pilot Projects, Feasibility Studies, Communication, Palliative Care, Terminal Care methods
- Abstract
Skilled home health care (HH) is the largest and fastest growing long-term care setting in the United States. Patients in HH are served by an interprofessional team, and may have little direct contact with physicians, when discussing their progress, prognosis, and goals of care. Such conversations are part of primary palliative care communication. Evidence on primary palliative care communication training in the non-physician HH interprofessional team is lacking. The objectives of this study were to assess the feasibility, acceptability, and preliminary effectiveness of using a palliative care communication model known as COMFORT© to provide palliative care communication training to HH staff. A randomized controlled trial was conducted at a regional health system in the southeastern U.S. to test online training modules (n = 10) (Group 1) and online training modules plus face-to-face training (n = 8) (Group 2). Measures included training completion rates, staff acceptability ratings, comfort with palliative and end-of-life communication (C-COPE) and moral distress (MMD-HP). Results showed that COMFORT© training was feasible (92%), highly acceptable (>4 on a 6-point scale), and positively correlated with improved C-COPE scores ( P = .037). There was no significant difference in moral distress scores pre- and post-intervention or in effectiveness between the groups. However, acceptability of COMFORT© was positively correlated with history of leaving or considering leaving a job due to moral distress ( χ 2 = 7.6, P = .02). Preliminary findings from this pilot study suggest that administration of COMFORT© training was feasible, and it was correlated with increased HH staff comfort with palliative care communication., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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- 2024
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47. A conceptual model of the nurse's role as primary palliative care provider in goals of care communication.
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Wittenberg E, Goldsmith JV, Chen CK, and Prince-Paul M
- Abstract
Objective: Nurses have opportunities to engage in goals of care conversations that can promote palliative care communication. The purpose of this study was to describe nurses' experiences in goals of care communication as summarized in the literature and to present a conceptual model of communication pathways for nurses., Methods: An integrative review of the literature (2016-2022) addressing nurses' experiences in goals of care communication was conducted using PubMed, CINAHL, and PsychInfo databases. A total of 92 articles were retrieved. A total of 12 articles were included for this review after applying the inclusion and exclusion criteria., Results: Of the 12 articles, the majority were qualitative studies ( n = 8). Qualitative analysis of findings from all articles revealed three dominant themes: nurses' ambiguous role responsibilities, goals of care as end-of-life communication, and the need for nurse communication training., Conclusion: This article suggests an innovative conceptual model for advancing nurse communication about goals of care to facilitate primary palliative care., Innovation: The framework characterizes two communication pathways for Advanced Practice Nurses who direct goals of care discussions and Registered Nurses who support goals of care communication. The model informs future communication training aimed at supporting primary palliative care., Competing Interests: The authors have no conflicts of interest to disclose., (© 2024 The Authors. Published by Elsevier B.V.)
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- 2024
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48. Family Communication in Autism Spectrum Disorder: Applying the Family Caregiver Communication Typology to Parent Caregivers.
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Pfender EJ, Wittenberg E, Kerr AM, and Goldsmith JV
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- Child, Humans, Caregivers, Parents, Communication, Caregiver Burden, Autism Spectrum Disorder
- Abstract
Parents of children with Autism Spectrum Disorder (ASD) experience greater stress and caregiver burden than parents of children with other disabilities. To cope with the stress of long-term caregiving, they rely on professionals for support and guidance. However, parents continue to report unmet communication and support needs. To inform tailored communication for parents of a child with ASD, this study used the existing Family Caregiver Communication Typology framework which identifies four caregiver communication types (manager, carrier, partner, and lone) and their unique communication and support needs. In-depth, structured interviews were conducted with parents (n = 22) and ASD professionals (n = 28) to explore communication characteristics of ASD parent caregivers. A thematic analysis revealed communication behaviors among four ASD parent caregiver types, further validating the typology. Future research is needed to develop targeted interventions for improving family-centered care based on ASD parent caregiver types.
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- 2023
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49. Communication Openings: A Novel Approach for Serious Illness Communication in Homecare.
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Sullivan SS, Mann CM, and Wittenberg E
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- Humans, Communication, Eligibility Determination, Focus Groups, Home Care Services, Hospices
- Abstract
Serious illness communication in homecare about hospice and/or palliative care transitions is lacking due to clinical culture. The purpose of the current study was to understand communication openings using COMFORT™, a palliative care communication model used to train nurses. Qualitative, focus group interviews with 31 homecare nurses were conducted. Data were transcribed verbatim and thematically analyzed using NVivo software, followed by hand-sorting. Four themes for communication openings for initiating discussions about potential hospice and/or palliative care transitions were identified: Organizational Openings (homecare appropriateness, eligibility requirements, and staffing); Patient Openings (patient physical decline, psychosocial changes, safety concerns, and denying/stopping care); Caregiver Openings (caregiver physical changes and patient readiness); and Nurse Openings (need for hospice, checking for prognosis understanding, increasing interprofessional care needs, and providing end-of-life care). This study extends the concept of communication openings in the COMFORT model. Further development of communication openings as part of COMFORT communication is needed in educational and intervention research. [ Journal of Gerontological Nursing, 49 (11), 33-41.].
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- 2023
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50. Exploring Differences in Caregiver Communication in Serious Illness.
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Wittenberg E, Goldsmith JV, Savage MW, and Sullivan SS
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- Humans, Caregivers, Communication, Social Support, Neoplasms, Dementia
- Abstract
Background: Demographic factors, such as disease context and family relationships, are communication mediators and moderators; however, little is known about how understanding these factors can improve caregiver communication with providers. Recognition of communication differences among caregivers may aid the development of approaches to improve serious illness communication. Objective: To explore whether caregiver communication differs by disease context (cancer vs. dementia) and caregiver communication type (Manager, Carrier, Partner, and Lone). Caregiver communication type is based on communication patterns between the care recipient and caregiver. Design and Measurements: Caregivers of persons with cancer and/or dementia were surveyed from a U.S. national research registry website. Measures of caregiver communication included information needs, communication confidence, perception of provider understanding of the caregiver, perceived frequency of caregiver assessment, and caregiver stress. Analysis of variance (ANOVA) determined significant differences between caregiver communication ( p < 0.05) based on disease context and caregiver communication type. Results: Cancer caregivers reported higher unrecognized-demanded information states (i.e., not recognizing information was needed), more communication confidence, and more frequent caregiver assessment compared to dementia caregivers. Among caregiver communication types, Manager caregiver types were more confident communicating than other caregiver types and perceived greater understanding by providers than the Lone caregiver type. Manager caregivers reported significantly less stress than other caregiver communication types. Conclusions: Understanding disease context and caregiver communication type may help improve caregiver communication with health care providers.
- Published
- 2023
- Full Text
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