Validation of an abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9) among patients on antihypertensive medications

<p>Abstract</p> <p>Background</p> <p>The 14-item Treatment Satisfaction Questionnaire for Medication (TSQM) Version 1.4 is a reliable and valid instrument to assess patients' satisfaction with medication, providing scores on four scales – side effects, effectiveness, convenience and global satisfaction. In naturalistic studies, administering the TSQM with the side effects domain could provoke the physician to assess the presence or absence of adverse events in a way that is clinically atypical, carrying the potential to interfere with routine medical care. As a result, an abbreviated 9-item TSQM (TSQM-9), derived from the TSQM Version 1.4 but without the five items of the side effects domain was created. In this study, an interactive voice response system (IVRS)-administered TSQM-9 was psychometrically evaluated among patients taking antihypertensive medication.</p> <p>Methods</p> <p>A total of 3,387 subjects were invited to participate in the study from an online panel who self-reported taking a prescribed antihypertensive medication. The subjects were asked to complete the IVRS-administered TSQM-9 at the start of the study, along with the modified Morisky scale, and again within 7 to 14 days. Standard psychometric analyses were conducted; including Cronbach's alpha, intraclass correlation coefficients, structural equation modeling, Spearman correlation coefficients and analysis of covariance (ANCOVA).</p> <p>Results</p> <p>A total of 396 subjects completed all the study procedures. Approximately 50% subjects were male with a good racial/ethnic mix: 58.3% white, 18.9% black, 17.7% Hispanic and 5.1% either Asian or other. There was evidence of construct validity of the TSQM-9 based on the structural equation modeling findings of the observed data fitting the Decisional Balance Model of Treatment Satisfaction even without the side effects domain. TSQM-9 domains had high internal consistency as evident from Cronbach's alpha values of 0.84 and greater. TSQM-9 domains also demonstrated good test-retest reliability with high intraclass correlation coefficients exceeding 0.70. As expected, the TSQM-9 domains were able to differentiate between individuals who were low, medium and high compliers of medication, with moderate to high effect sizes. There was evidence of convergent validity with significant correlations with the medication adherence scale.</p> <p>Conclusion</p> <p>The IVRS-administered TSQM-9 was found to be a reliable and valid measure to assess treatment satisfaction in naturalistic study designs, in which there is potential that the administration of the side effects domain of the TSQM would interfere with routine clinical care.</p

Development of Dynamic Modeling Tools for Solid Oxide and Molten Carbonate Hybrid

ABSTRACT This paper describes some generic solid oxide and molten carbonate hybrid fuel cell gas turbine systems and dynamic modeling tools that are being developed to simulate the performance of these and other hybrid fuel cell systems. The generic hybrid systems are presented to introduce issues and technical development challenges that hybrid fuel cell gas turbine systems must address and to provide a platform for the development of the dynamic modeling tools. The present goals are to develop dynamic models for the basic components of solid oxide and molten carbonate fuel cell gas turbine hybrids, ensure their reliability, and obtain a basic understanding of their performance prior to integration into a complete hybrid system model. Preliminary results for molten carbonate and solid oxide fuel cell types are presented. These results provide understanding of some of the operational characteristics of fuel cells, and indicate the complexity of the dynamic response of fuel cell hybrid components. For the fuel cell models, generic planar designs are analyzed showing voltage and current behavior following step changes in load resistance and steady state performance curves. The results provide confidence in each of the model&apos;s reliability, enabling them to be integrated for hybrid system simulation. Results from the integrated simulations will provide guidance on future hybrid technology development needs. NOMENCLATURE INTRODUCTION Fuel cells have the potential to play a significant role in meeting near-and medium-term requirements for efficient and environmentally responsible power generation. Hybrid fuel cell and gas turbine technology is potentially superior to other power generation technologies due to its high efficiency (70 to 80 percent LHV) and low emissions (less than 3 parts per million NOx and CO). However, to advance the technology to the commercial level requires a better understanding of how gas turbines and fuel cells should be integrated and how they will behave when fused into a single hybrid system. The combination of a fuel cell and a gas turbine is a natural evolution in the quest for improved generation efficiency with low emissions. Integrated hybrid cycles exhibit synergies not present in typical combined cycles with fuel-to-electricity efficiencies higher than either the fuel cell or gas turbine alone and costs for a given efficiency lower than either alone. This paper begins with a description of some basic operational characteristics of two generic hybrid systems. The paper continues with a presentation of the fuel cell submodels necessary for eventual integration into a complete hybrid model. Two commercial transient analysis software packages, ProTRAX, which is widely employed for power generation applications, and SABER, which is widely used for electronics and automotive applications, are used for model development and integration. These analysis packages contain many process elements required for typical power generation applications; however, at this time the user is required to supply specialized submodels for the fuel cells and other non-standard hybrid components

The burden of selected digestive diseases in the United States

AbstractBackground & Aims: Gastrointestinal (GI) and liver diseases inflict a heavy economic burden. Although the burden is considerable, current and accessible information on the prevalence, morbidity, and cost is sparse. This study was undertaken to estimate the economic burden of GI and liver disease in the United States for use by policy makers, health care providers, and the public. Methods: Data were extracted from a number of publicly available and proprietary national databases to determine the prevalence, direct costs, and indirect costs for 17 selected GI and liver diseases. Indirect cost calculations were purposefully very conservative. These costs were compared with National Institutes of Health (NIH) research expenditures for selected GI and liver diseases. Results: The most prevalent diseases were non–food-borne gastroenteritis (135 million cases/year), food-borne illness (76 million), gastroesophageal reflux disease (GERD; 19 million), and irritable bowel syndrome (IBS; 15 million). The disease with the highest annual direct costs in the United States was GERD ($9.3 billion), followed by gallbladder disease ($5.8 billion), colorectal cancer ($4.8 billion), and peptic ulcer disease ($3.1 billion). The estimated direct costs for these 17 diseases in 1998 dollars were $36.0 billion, with estimated indirect costs of$22.8 billion. The estimated direct costs for all digestive diseases were $85.5 billion. Total NIH research expenditures were$676 million in 2000. Conclusions: GI and liver diseases exact heavy economic and social costs in the United States. Understanding the prevalence and costs of these diseases is important to help set priorities to reduce the burden of illness.GASTROENTEROLOGY 2002;122:1500-151

Prevalence and quality-of-life burden of vasomotor symptoms associated with menopause: A European cross-sectional survey

To determine, in a European cohort, the prevalence and health-related quality-of-life (QOL) burden of moderate-to-severe vasomotor symptoms (VMS) in postmenopausal women, and among subgroups of women not taking hormone therapy (HT)