Shana Stites
Shana Stites,PsyD MS MA, is a clinician-researcher with the primary focus on the use of empirical research to inform clinical practice and health policy. Dr. Stites seeks out ways to incorporate rigorous research methods into feasible options in real-world settings.
Dr. Stites completed a doctoral degree in Clinical Psychology with a concentration in psychological assessment. She completed pre-doctoral internship at the Philadelphia VA Medical Center with a special focus in neuropsychological assessment. Her dissertation research examined the affect of mental health mitigating evidence on the outcomes of Federal capital trials.
Phone: (215) 746-7327
Address: Penn Project on Precision Medicine for the Brain (P3MB)
Department of Medical Ethics & Health Policy
Perelman School of Medicine
University of Pennsylvania
Blockley Hall, Suite 1416
423 Guardian Dr FL 14
Philadelphia PA 19104-4884
Dr. Stites completed a doctoral degree in Clinical Psychology with a concentration in psychological assessment. She completed pre-doctoral internship at the Philadelphia VA Medical Center with a special focus in neuropsychological assessment. Her dissertation research examined the affect of mental health mitigating evidence on the outcomes of Federal capital trials.
Phone: (215) 746-7327
Address: Penn Project on Precision Medicine for the Brain (P3MB)
Department of Medical Ethics & Health Policy
Perelman School of Medicine
University of Pennsylvania
Blockley Hall, Suite 1416
423 Guardian Dr FL 14
Philadelphia PA 19104-4884
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Publications by Shana Stites
Alzheimer’s disease (AD), the most common cause of dementia and MCI, presents patients and their families with psychological and social
challenges. Many of these challenges are the consequence of stigma. The social stigma associated with the diagnosis can have wide-reaching and lasting consequences for how a patient and caregiver react to the diagnosis (internalized stigma) and how others might treat them (public stigma). It can hinder their daily lives and well-being, leading to depression, isolation, and discrimination. It can also discourage participation in research, impeding efforts to discover an effective therapy. Fortunately, neurologists and other clinicians can take steps to minimize stigma.
METHODS:
This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences.
RESULTS:
While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education.
CONCLUSION:
We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.
Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain.
METHODS:
This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences.
RESULTS:
While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education.
CONCLUSION:
We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.
METHODS: Random sample of 317 adults from the U.S. public was analyzed to understand reactions toward a man with mild-stage Alzheimer's disease dementia.
RESULTS: In adjusted analyses, over half of respondents expected the person to be discriminated against by employers (55.3%; 95% confidence interval [CI] = 47.0-65.2) and be excluded from medical decision-making (55.3%; 95% CI = 46.9-65.4). Almost half expected his health insurance would be limited based on data in the medical record (46.6%; 95% CI = 38.0-57.2), a brain imaging result (45.6%, 95% CI = 37.0-56.3), or genetic test result (44.7%; 95% CI = 36.0-55.4).
DISCUSSION: Public education and policies are needed to address concerns about employment and insurance discrimination. Studies are needed to discover how advances in diagnosis and treatment may change Alzheimer's disease stigma.
This study examined how awareness of diagnostic label impacted self-reported quality of life (QOL) in persons with varying degrees of cognitive impairment.
METHOD:
Older adults (n = 259) with normal cognition, Mild Cognitive Impairment (MCI), or mild Alzheimer's disease dementia (AD) completed tests of cognition and self-report questionnaires that assessed diagnosis awareness and multiple domains of QOL: cognitive problems, activities of daily living, physical functioning, mental wellbeing, and perceptions of one's daily life. We compared measures of QOL by cognitive performance, diagnosis awareness, and diagnostic group.
RESULTS:
Persons with MCI or AD who were aware of their diagnosis reported lower average satisfaction with daily life (QOL-AD), basic functioning (BADL Scale), and physical wellbeing (SF-12 PCS), and more difficulties in daily life (DEM-QOL) than those who were unaware (all p ≤ .007). Controlling for gender, those expecting their condition to worsen over time reported greater depression (GDS), higher stress (PSS), lower quality of daily life (QOL-AD, DEM-QOL), and more cognitive difficulties (CDS) compared to others (all p < .05).
DISCUSSION:
Persons aware of their diagnostic label-either MCI or AD-and its prognosis report lower QOL than those unaware of these facts about themselves. These relationships are independent of the severity of cognitive impairment.
The incidence and severity of Clostridium difficile infection (CDI) have increased in recent years. Predictive models may help to identify at-risk patients before the onset of infection. Early identification of high-risk patients could help antimicrobial stewardship (AMS) programmes and other initiatives to better prevent C. difficile in these patients.
AIM:
To develop a predictive model that identifies patients at high risk for CDI at the time of hospitalization. This approach to early identification was evaluated to determine if it could improve upon a pre-existing AMS programme.
METHODS:
Logistic regression and receiver operating characteristic (ROC) curve analyses were used to develop an analytic model to predict risk for CDI at the time of hospitalization in a retrospective cohort of inpatients. The model was validated in a prospective cohort. Concurrence between the model's risk predictions and a pre-existing AMS programme was assessed.
FINDINGS:
The model identified 55% of patients who later tested positive as being at high risk for CDI at the time of admission. One in every 32 high-risk patients with potentially modifiable antimicrobial risk factors tested positive for CDI. Half (53%) tested positive before meeting the risk criteria for the hospital's AMS programme.
CONCLUSION:
Analytic models can identify most patients prospectively at the time of admission who later test positive for C. difficile. This approach to early identification may help AMS programmes to pursue susceptibility testing and modifications to antimicrobial therapies at an earlier stage in order to better prevent CDI.
The incidence and severity of Clostridium difficile infections (CDIs) have increased in recent years. Predictive models may help to identify at-risk patients before the onset of infection. Early identification of high-risk patients could help antimicrobial stewardship (AMS) programmes and other initiatives to better prevent C. difficile in these patients.
Aim.
The purpose of this study was to develop a predictive model that identified patients at high-risk for CDI at the time of hospitalization. This approach to early identification was evaluated to determine if it could improve upon a preexisting AMS programme.
Methods.
Generalized linear regression and receiver operand characteristic (ROC) curve analyses were used to develop an analytic model to predict CDI risk at the time of hospitalization in a retrospective cohort of inpatients. The model was then validated in a prospective cohort. Concurrence between the model’s risk predictions and a preexisting AMS programme was assessed.
Findings.
The model identified 55% of patients as high-risk for CDI at the time of admission and who later tested positive. One in every 32 high-risk patients with potentially modifiable antibiotic risk factors tested positive for CDI. Half (53%) tested positive before meeting the risk criteria for the hospital’s AMS programme.
Conclusion.
Analytic models can prospectively identify most patients at the time of admission who later test positive for C. difficile. This approach to early identification may help AMS programmes pursue susceptibility testing and modifications to antibiotic therapies sooner in order to better prevent CDI.
Introduction
The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity.
Methods
Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers.
Results
In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P ≥ .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P ≤ .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up.
Conclusion
Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF.
Alzheimer’s disease (AD), the most common cause of dementia and MCI, presents patients and their families with psychological and social
challenges. Many of these challenges are the consequence of stigma. The social stigma associated with the diagnosis can have wide-reaching and lasting consequences for how a patient and caregiver react to the diagnosis (internalized stigma) and how others might treat them (public stigma). It can hinder their daily lives and well-being, leading to depression, isolation, and discrimination. It can also discourage participation in research, impeding efforts to discover an effective therapy. Fortunately, neurologists and other clinicians can take steps to minimize stigma.
METHODS:
This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences.
RESULTS:
While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education.
CONCLUSION:
We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.
Background It has been widely reported that medical trainees experience situations with profound ethical implications during their clinical rotations. To address this most U.S. medical schools include ethics curricula in their undergraduate programs. However, the content of these curricula vary substantially. Our pilot study aimed to discover, from the students' perspective, how ethics pedagogy prepares medical students for clerkship and what gaps might remain.
METHODS:
This qualitative study organized focus groups of third- and fourth-year medical students. Participants recounted ethical concerns encountered during clerkship rotations and reflected on how their medical school ethics curriculum informed their responses to these scenarios. Transcripts of the focus group sessions were analyzed using a grounded theory approach to identify common themes that characterized the students' experiences.
RESULTS:
While students' accounts demonstrated a solid grasp of ethical theory and attunement to ethical concerns presented in the clinic, they also consistently evinced an inability to act on these issues given clerks' particular position in a complex learning hierarchy. Students felt they received too little training in the role-specific application of medical ethics as clinical trainees. We found a desire among trainees for enhanced practical ethics training in preparation for the clerkship phase of medical education.
CONCLUSION:
We recommend several strategies that can begin to address these findings. The use of roleplaying with standardized patients can enable students to practice engagement with ethical issues. Conventional ethics courses can focus more on action-based pedagogy and instruction in conflict management techniques. Finally, clear structures for reporting and seeking advice and support for addressing ethical issues can lessen students' apprehension to act on ethical concerns.
METHODS: Random sample of 317 adults from the U.S. public was analyzed to understand reactions toward a man with mild-stage Alzheimer's disease dementia.
RESULTS: In adjusted analyses, over half of respondents expected the person to be discriminated against by employers (55.3%; 95% confidence interval [CI] = 47.0-65.2) and be excluded from medical decision-making (55.3%; 95% CI = 46.9-65.4). Almost half expected his health insurance would be limited based on data in the medical record (46.6%; 95% CI = 38.0-57.2), a brain imaging result (45.6%, 95% CI = 37.0-56.3), or genetic test result (44.7%; 95% CI = 36.0-55.4).
DISCUSSION: Public education and policies are needed to address concerns about employment and insurance discrimination. Studies are needed to discover how advances in diagnosis and treatment may change Alzheimer's disease stigma.
This study examined how awareness of diagnostic label impacted self-reported quality of life (QOL) in persons with varying degrees of cognitive impairment.
METHOD:
Older adults (n = 259) with normal cognition, Mild Cognitive Impairment (MCI), or mild Alzheimer's disease dementia (AD) completed tests of cognition and self-report questionnaires that assessed diagnosis awareness and multiple domains of QOL: cognitive problems, activities of daily living, physical functioning, mental wellbeing, and perceptions of one's daily life. We compared measures of QOL by cognitive performance, diagnosis awareness, and diagnostic group.
RESULTS:
Persons with MCI or AD who were aware of their diagnosis reported lower average satisfaction with daily life (QOL-AD), basic functioning (BADL Scale), and physical wellbeing (SF-12 PCS), and more difficulties in daily life (DEM-QOL) than those who were unaware (all p ≤ .007). Controlling for gender, those expecting their condition to worsen over time reported greater depression (GDS), higher stress (PSS), lower quality of daily life (QOL-AD, DEM-QOL), and more cognitive difficulties (CDS) compared to others (all p < .05).
DISCUSSION:
Persons aware of their diagnostic label-either MCI or AD-and its prognosis report lower QOL than those unaware of these facts about themselves. These relationships are independent of the severity of cognitive impairment.
The incidence and severity of Clostridium difficile infection (CDI) have increased in recent years. Predictive models may help to identify at-risk patients before the onset of infection. Early identification of high-risk patients could help antimicrobial stewardship (AMS) programmes and other initiatives to better prevent C. difficile in these patients.
AIM:
To develop a predictive model that identifies patients at high risk for CDI at the time of hospitalization. This approach to early identification was evaluated to determine if it could improve upon a pre-existing AMS programme.
METHODS:
Logistic regression and receiver operating characteristic (ROC) curve analyses were used to develop an analytic model to predict risk for CDI at the time of hospitalization in a retrospective cohort of inpatients. The model was validated in a prospective cohort. Concurrence between the model's risk predictions and a pre-existing AMS programme was assessed.
FINDINGS:
The model identified 55% of patients who later tested positive as being at high risk for CDI at the time of admission. One in every 32 high-risk patients with potentially modifiable antimicrobial risk factors tested positive for CDI. Half (53%) tested positive before meeting the risk criteria for the hospital's AMS programme.
CONCLUSION:
Analytic models can identify most patients prospectively at the time of admission who later test positive for C. difficile. This approach to early identification may help AMS programmes to pursue susceptibility testing and modifications to antimicrobial therapies at an earlier stage in order to better prevent CDI.
The incidence and severity of Clostridium difficile infections (CDIs) have increased in recent years. Predictive models may help to identify at-risk patients before the onset of infection. Early identification of high-risk patients could help antimicrobial stewardship (AMS) programmes and other initiatives to better prevent C. difficile in these patients.
Aim.
The purpose of this study was to develop a predictive model that identified patients at high-risk for CDI at the time of hospitalization. This approach to early identification was evaluated to determine if it could improve upon a preexisting AMS programme.
Methods.
Generalized linear regression and receiver operand characteristic (ROC) curve analyses were used to develop an analytic model to predict CDI risk at the time of hospitalization in a retrospective cohort of inpatients. The model was then validated in a prospective cohort. Concurrence between the model’s risk predictions and a preexisting AMS programme was assessed.
Findings.
The model identified 55% of patients as high-risk for CDI at the time of admission and who later tested positive. One in every 32 high-risk patients with potentially modifiable antibiotic risk factors tested positive for CDI. Half (53%) tested positive before meeting the risk criteria for the hospital’s AMS programme.
Conclusion.
Analytic models can prospectively identify most patients at the time of admission who later test positive for C. difficile. This approach to early identification may help AMS programmes pursue susceptibility testing and modifications to antibiotic therapies sooner in order to better prevent CDI.
Introduction
The obesity epidemic has drawn attention to food marketing practices that may increase the likelihood of caloric overconsumption and weight gain. We explored the associations of discounted prices on supermarket purchases of selected high-calorie foods (HCF) and more healthful, low-calorie foods (LCF) by a demographic group at high risk of obesity.
Methods
Our mixed methods design used electronic supermarket purchase data from 82 low-income (primarily African American female) shoppers for households with children and qualitative data from focus groups with demographically similar shoppers.
Results
In analyses of 6,493 food purchase transactions over 65 weeks, the odds of buying foods on sale versus at full price were higher for grain-based snacks, sweet snacks, and sugar-sweetened beverages (odds ratios: 6.6, 5.9, and 2.6, respectively; all P < .001) but not for savory snacks. The odds of buying foods on sale versus full price were not higher for any of any of the LCF (P ≥ .07). Without controlling for quantities purchased, we found that spending increased as percentage saved from the full price increased for all HCF and for fruits and vegetables (P ≤ .002). Focus group participants emphasized the lure of sale items and took advantage of sales to stock up.
Conclusion
Strategies that shift supermarket sales promotions from price reductions for HCF to price reductions for LCF might help prevent obesity by decreasing purchases of HCF.