The content and valence of women's body image attitudes, general and enduring positive or negative feelings about the body, are studied with psychometric analyses of measures and contrasted groups. Data from two frequently used measures (Body Image Scale, Derogatis & Melisaratos, 1979; Body Satisfaction Scale, Berscheid, Walster & Bohrnstedt, 1973) provided an evaluation of the construct and the assessment of body image. Two studies are provided. The construct analyses suggest two contents for body attitude measures: a general factor of body, facial, and sexual (genital and breast) items, and a second factor assessing weight and/or its body correlates-the hips, thighs, and buttocks. Also, a method factor, a response style of negativity, may be important. Body image attitudes are correlated with some conceptually relevant criteria, such as interest in engaging in sexual activity; however, these relationships do not appear sufficiently strong to predict behavior, such as the occurrence or resolution of sexual dysfunction. Generalized body image disturbance as currently conceptualized and assessed may be difficult to document, particularly when item content and response styles are considered.Early conceptualizations of body image included deviant perceptions, feelings, and beliefs concerning the body. The construct was hypothesized as relevant to psychopathology (i.e., linked to perceptual aberration in schizophrenia; see Chapman, Chapman, & Raulin, 1978; depression; see Noles, Cash, & Winstead, 1985; and, anorexia and bulimia nervosa; see Williamson, Davis, Goreczny, & Blouin, 1989), physical attractiveness (Berscheid, Walster, & Bohrnstedt, 1973), sexual dysfunction (Derogatis & Melisaratos, 1979), and physical illness (Kriss & Kraemer, 1986). Early assessments included indirect strategies, such as figure-drawing (Goodenough, 1928), special scoring systems for the Rorschach (e.g., barrier and penetration scores; Fisher and Cleveland, 1958), perceptual distortion tasks (e.g., waist estimation; body-distorting mirror assessments; Traub, Olson, Orbach, & Cardone, 1967), and, later, questionnaire assessments including measures of body image aberration (Chapman, Chapman, & Raulin, 1978), body size ratings (Williamson et al., 1985), and body attitudes (see Mayer & Eisenberg, 1982, for a review).Despite empirical efforts and theoretical discussions (e.g., Fisher & Cleveland, 1958), body image remains ill defined. We view women's body images as attitudes-general and enduring positive or negative feelings about the body. We, like others (e.g., Derogatis & Melisaratos, 1979), anticipate that body attitudes should be related to some major life areas, such as sexual functioning, but be conceptually distinct from others (e.g., general psychological adjustment, social functioning, occupational achievement). We were interested in examining women's body attitudes and specifying both their content and valence (positive versus negative). Current assessment reviews note two general and independent contents-perceptions of...
Background The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR). Objective The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system. Methods We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR. Results Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; p < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR. After migration of the alternative CDS from the legacy to the new EHR system, PIM prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; p < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall at 11.1%. Conclusion The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased with the implementation of prescribing CDS. This decrease was not only maintained but strengthened by the transition to a new EHR system.
Background Despite guideline recommendations, vitamin D testing has increased substantially. Clinical decision support (CDS) presents an opportunity to reduce inappropriate laboratory testing. Objectives and Methods To reduce inappropriate testing of vitamin D at the Vanderbilt University Medical Center, a CDS assigned providers to receive or not receive an electronic alert each time a 25-hydroxyvitamin D assay was ordered for an adult patient unless the order was associated with a diagnosis in the patient's chart for which vitamin D testing is recommended. The CDS ran for 80 days, collecting data on number of tests, provider information, and basic patient demographics. Results During the 80 days, providers placed 12,368 orders for 25-hydroxyvitamin D. The intervention group ordered a vitamin D assay and received the alert for potentially inappropriate testing 2,181 times and completed the 25-hydroxyvitamin D order in 89.9% of encounters, while the control group ordered a vitamin D assay (without receiving an alert) 2,032 times and completed the order in 98.1% of encounters, for an absolute reduction of testing of 8% (p < 0.001). Conclusion This CDS reduced vitamin D ordering by utilizing a soft-stop approach. At a charge of $179.00 per test and a cost to the laboratory of $4.20 per test, each display of the alert led to an average reduction of $14.70 in charges and of $0.34 in spending by the laboratory (the savings/alert ratio). By describing the effectiveness of an electronic alert in terms of the savings/alert ratio, the impact of this intervention can be better appreciated and compared with other interventions.
Objective Synthea is a synthetic patient generator that creates synthetic medical records, including medication profiles. Prior to our work, Synthea produced unrealistic medication data that did not accurately reflect prescribing patterns. This project aimed to create an open-source synthetic medication database that could integrate with Synthea to create realistic patient medication profiles. Materials and Methods The Medication Diversification Tool (MDT) created from this study combines publicly available prescription data from the Medical Expenditure Panel Survey (MEPS) and standard medication terminology/classifications from RxNorm/RxClass to produce machine-readable information about medication use in the United States. Results The MDT was validated using a chi-square goodness-of-fit test by comparing medication distributions from Synthea, Synthea+MDT, and the MEPS. Using a pediatric asthma population, results show that Synthea+MDT had no statistical difference compared to the real-world MEPS with a P value = .84. Discussion The MDT is designed to generate realistic medication distributions for drugs and populations. This tool can be used to enhance medication records generated by Synthea by calculating medication-use data at a national level or specific to patient subpopulations. MDT’s contributions to synthetic data may enable the acceleration of application development, access to more realistic healthcare datasets for education, and patient-centered outcomes’ research. Conclusions The MDT, when used with Synthea, provides a free and open-source method for making synthetic patient medication profiles that mimic the real world.
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