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PubMed2002

The challenge of evaluating complex interventions: a framework for evaluating media advocacy.

New health promotion and public health approaches such as media advocacy pose particular evaluation challenges. Evaluation is important to provide feedback to media advocacy practitioners on how to enhance their efforts, and to funders and researchers seeking to assess media advocacy's effectiveness as a health promotion strategy. The media advocacy evaluation literature contains some examples of promising evaluation approaches but is still evolving. A comprehensive framework for the evaluation of media advocacy is presented. Building on existing approaches to evaluation in media advocacy and on current thinking regarding evaluation in health promotion, it proposes a series of indicators and research methods for evaluating media advocacy at the levels of formative, process and outcome evaluation. The framework can be used to encourage strategic reflection on the media advocacy process, to guide evaluation of specific interventions, and to demonstrate to funders the importance and complexity of evaluation in this promising field.

Communications Media↗
PubMed2005

Assessing professionalism in early medical education: experience with peer evaluation and self-evaluation in the gross anatomy course.

INTRODUCTION: As today's healthcare model moves toward more streamlined and corporate industrialism, it is our responsibility, as doctors, to ensure the integrity of medicine's foundation in professionalism. The erosion of professional values not only creates a climate of animosity, but reverberates negatively to impact the development of students, who model their behaviour after those they most respect. This hazard has spurred an evaluation of medical school curricula, with a new emphasis on professionalism in the philosophy of medical education. Courses such as Gross Anatomy that, in the past, offered "pure content," are now being used to teach and evaluate professionalism. The goal of this study was to determine if peer evaluation and self-evaluation used in conjunction and implemented early in the medical curriculum, can serve as useful tools to assess and provide feedback regarding professional behaviour in first-year medical students. MATERIALS AND METHODS: From 1999 to 2003, students at Mayo Clinic College of Medicine evaluated themselves and their peers during the Gross and Developmental Anatomy Course. Numerical evaluations and written comments were statistically analysed within established categories of professionalism and correlated with academic performance, gender, and peer rating and self-rating. RESULTS: The majority of written comments pertained to inter-professional respect, responsibility, and excellence. Students who gave higher peer evaluation and self-evaluation scores provided more positive comments, and students performing well in the course provided more positive comments about their peers and themselves than did those struggling academically. Students consistently rated their peers higher than themselves, and male students rated themselves higher than did female students. CONCLUSIONS: Implementing peer evaluation and self-evaluation early in the medical curriculum is a valuable exercise in teaching first-year medical students assessment skills when evaluating their behaviour, as well as the behaviour of their colleagues.

Anatomy↗
PubMed2004

An inventory of evaluation studies of information technology in health care: trends in evaluation research 1982-2002.

During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into the historical context of evaluation research, we conducted a systematic overview on trends in evaluation research of information technology in health care 1982-2002. The inventory is based on a systematic literature search in PubMed. Each of the found 1.035 papers from 1982-2002 was indexed based on a taxonomy coding type of information system, clinical domain, research strategy, evaluation methods, setting and evaluation aspects. We found interesting developments in evaluation research in the last 20 years. For example, their has been a strong shift from medical journals to medical informatics journals. With regard to methods, explanative research and quantitative methods have dominated evaluation studies in the last 20 years. From 1982 to today, the number of lab studies and technical evaluation aspects has declined, while studies focusing on process quality or outcome quality of patient care have increased. Based on our results, we are inclined to talk of a kind of maturation of evaluation studies in medical informatics research.

Bibliometrics↗
PubMed1998

Carotid artery balloon test occlusion: combined clinical evaluation and xenon-enhanced computed tomographic cerebral blood flow evaluation without patient transfer or balloon reinflation: technical note.

OBJECTIVE: Clinical evaluation was combined with xenon-enhanced computed tomographic (CT) cerebral blood flow (CBF) evaluation during carotid artery balloon test occlusion (BTO), without patient transfer from the angiography suite to the CT scanner or balloon reinflation. TECHNIQUE: Thirteen patients underwent carotid artery BTO. Placement of temporary occlusion balloons was performed with patients positioned on the CT scanner table. If neurological testing revealed no changes within 10 minutes after balloon inflation, patients were positioned within the CT scanner gantry for xenon-enhanced CT CBF evaluation. CBF evaluations were begun 12 to 15 minutes after balloon inflation and required 8 minutes for completion. After completion of CBF evaluation, neurological testing continued during 30 minutes of arterial occlusion. RESULTS: One patient did not tolerate BTO, with the development of reversible hemiparesis. Reliable CBF data were not obtained because of patient motion in one case. Eleven patients clinically tolerated BTO and completed CBF evaluation. For five patients, xenon-enhanced CT scanning revealed no regions with CBF of less than 30 ml/100 g/min. For four patients, xenon-enhanced CT scanning revealed small regions with CBF of less than 30 ml/100 g/min within the anterior frontal lobe on the occluded side. For two patients, ipsilateral CBF decreased dramatically during BTO, with CBF in many regions of less than 30 ml/100 g/min and in some of less than 20 ml/100 g/min. CONCLUSION: Xenon-enhanced CT CBF evaluation can be combined with clinical testing during BTO without patient transfer, balloon reinflation, or increases in the duration of the procedure. We recognize that the value of CBF evaluation during BTO remains to be proven; our technique does, however, eliminate abbreviated clinical neurological evaluation, patient transfer, and balloon reinflation, which were previously associated with the use of xenon-enhanced CT CBF evaluation during carotid artery BTO.

Adult↗
PubMed2000

Reminiscence therapy using odor in alcohol-dependent patients--psychophysiological evaluation and psychological evaluation; power spectral analysis of heart rate variability.

OBJECTIVE: This research was based on the hypothesis that when alcohol-dependent patients describe themselves, awakening of emotion by affirmative odor stimulation may facilitate memory reframing focusing on more affirmative emotion and memories. To prove the hypothesis, physiological changes accompanied by emotional awakening were evaluated by measuring the autonomic activity. In addition, subjective evaluation by a self-report manner was examined to investigate the effectiveness of Reminiscence Therapy (RT) using odor in alcohol-dependent patients. SUBJECTS: Thirty-four patients who met the DSM-IV criteria of alcohol-related disorders and were hospitalized in a ward specialized to alcohol dependence therapy. METHODS: Each patient underwent a one-to-one interview twice. For counterbalance, one interview was performed with odor stimulation using an odor with a relaxing effect that recall pleasant emotion, and the other was without odor stimulation. As the evaluation indices of physiological changes accompanied by emotional awakening, index of autonomic function (HRV; Heart rate variability) for objective evaluation and psychological indices (STAI; State-Trait Anxiety Inventory VAS; Visual Analog Scale) for subjective evaluation were measured. RESULTS: 1) Objective evaluation: Regarding the evaluation index of the autonomic function, the sympathetic nervous system activity (LF/HF; low frequency component/high frequency component ratio) was significantly inhibited by odor stimulation (p < 0.05). 2) Subjective evaluation: Compared to the state prior to interview, state anxiety judged by STAI was significantly decreased after interview (p < 0.01). The VAS score was significantly decreased after interview regardless of the presence or absence of odor stimulation (p < 0.0001). CONCLUSIONS: A reduction in state anxiety was observed. The effect of odor was not significant on the subjective evaluation, but the objective evaluation suggested that the odor inhibited the sympathetic nervous system. Thus, it was suggested that odor can be used in RT, that is, emotional changes due to stimulation of odor may be applicable in RT.

Adult↗
PubMed2005

Trends in Evaluation Research 1982 - 2002: A Study on how the Quality of IT Evaluation Studies Develop.

During the last years the significance of evaluation studies as well as the interest in adequate methods and approaches for evaluation has grown in medical informatics. In order to put this discussion into historical perspective of evaluation research, we conducted a systematic review on trends in evaluation research of information technology in health care from 1982 to 2002. The inventory is based on a systematic literature search in PubMed.In the first step of our inventory, we concentrated on describing long-term developments in questions, approaches, setting, methods and criteria of IT evaluation studies as described in the abstracts of the identified 1.035 publications. We found some signs of a maturation of evaluation research in medical informatics. However, these findings are only based on study abstracts that do not give sufficient information to assess the quality of studies in more detail.In a second step of our inventory, we are now looking at the quality of IT evaluation studies in health care, describing in more detail study design and assessing 10 quality indicators. For this second step, we analyse a randomized sample of 105 evaluation full papers in more detail. Besides more descriptive details on study design, the results will show whether IT evaluation studies are credible, and how their quality changed in the last 20 years. An interim analysis of the first 64 papers shows a stable quality of IT evaluation studies over the last 20 years.

Delivery of Health Care↗
PubMed1985

Evaluation readiness: improved evaluation planning using a data inventory framework.

Factors intrinsic to many programs, such as ambiguously stated objectives, inadequately defined performance measures, and incomplete or unreliable databases, often conspire to limit the evaluability of these programs. Current evaluation planning approaches are somewhat constrained in their ability to overcome these obstacles and to achieve full preparedness for evaluation. In this paper, the concept of evaluation readiness is introduced as a complement to other evaluation planning approaches, most notably that of evaluability assessment. The basic products of evaluation readiness--the formal program definition and the data inventory framework--are described, along with a guide for assuring more timely and appropriate evaluation response capability to support the decision making needs of program managers. The utility of evaluation readiness for program planning, as well as for effective management, is also discussed.

Evaluation Studies as Topic↗
PubMed1996

Evaluation of an objective plan-evaluation model in the three dimensional treatment of nonsmall cell lung cancer.

PURPOSE: Evaluation of three dimensional (3D) radiotherapy plans is difficult because it requires the review of vast amounts of data. Selecting the optimal plan from a set of competing plans involves making trade-offs among the doses delivered to the target volumes and normal tissues. The purpose of this study was to test an objective plan-evaluation model and evaluate its clinical usefulness in 3D treatment planning for nonsmall cell lung cancer. METHODS AND MATERIALS: Twenty patients with inoperable nonsmall cell lung cancer treated with definitive radiotherapy were studied using full 3D techniques for treatment design and implementation. For each patient, the evaluator (the treating radiation oncologist) initially ranked three plans using room-view dose-surface displays and dose-volume histograms, and identified the issues that needed to be improved. The three plans were then ranked by the objective plan-evaluation model. A figure of merit (FOM) was computed for each plan by combining the numerical score (utility in decision-theoretic terms) for each clinical issue. The utility was computed from a probability of occurrence of the issue and a physician-specific weight indicating its clinical relevance. The FOM was used to rank the competing plans for a patient, and the utility was used to identify issues that needed to be improved. These were compared with the initial evaluations of the physician and discrepancies were analyzed. The issues identified in the best treatment plan were then used to attempt further manual optimization of this plan. RESULTS: For the 20 patients (60 plans) in the study, the final plan ranking produced by the plan-evaluation model had an initial 73% agreement with the ranking provided by the evaluator. After discrepant cases were reviewed by the physician, the model was usually judged more objective or "correct." In most cases the model was also able to correctly identify the issues that needed improvement in each plan. Subsequent replanning confirmed that further manual plan optimization could be achieved in 17 patients. CONCLUSION: The objective plan-evaluation model was able to rank lung cancer radiotherapy plans from best to worst. It was useful in improving plans and may be useful to physicians in defining goals for patients based on the ability to effectively and safely treat their tumors.

Carcinoma, Non-Small-Cell Lung↗
PubMedDate not supplied

Evaluating evaluation: assessment of the American Board of Internal Medicine Resident Evaluation Form.

The American Board of Internal Medicine suggests use of a standard form to rate residents on nine dimensions (such as clinical judgment and overall clinical competence) on a scale of 1 to 9. The authors examined the psychometric evidence for reliability and validity of 1,039 ratings of 85 residents by 135 attendings in a single internal medicine residency program. Of these ratings, 95.6% were from 6 to 9. Factor analysis revealed that high correlations among the nine dimensions (r ranged from 0.72 to 0.92) resulted from a single global factor accounting for 86% of the variance. The study also examined whether the form reliably distinguishes among residents scoring between 6 and 9. Agreement among attendings rating the same individual was weak (average reliability = 0.64, by the method of James). The rating method fails to discriminate dimensions of clinical care and has low reliability for distinguishing among competent residents.

Clinical Competence↗
PubMed1992

Human evaluative conditioning: acquisition trials, presentation schedule, evaluative style and contingency awareness.

Two different processes may be operative in human Pavlovian conditioning: signal learning and evaluative learning. Whereas most studies on evaluative conditioning focused on a mere demonstration of the phenomenon or on a theoretical analysis of the underlying processes, some basic parameters of evaluative learning are still unexplored. Hence, using the standard neutral picture--(dis)liked picture pairing paradigm (Baeyens, Eelen & Van den Bergh, 1990), in this study the effect of two parameters of evaluative conditioning was assessed on a between-subjects base, namely the Number of Acquisition Trials (2/5/10/20) and the Presentation Schedule of the stimulus pairs (blockwise or random). Additionally, the study included an exploratory analysis of the potential effects of the Evaluative Style of subjects (Feelers vs Thinkers, operationalized in terms of speed of emitting evaluations). Finally, the relationship between contingency awareness and evaluative learning was reassessed. Neutral-liked conditioning was found to be quadratically related to the number of acquisition trials (increase in effect up to 10 trials, decrease from 10 to 20 trials), whereas neutral-disliked conditioning linearly increased with increasing numbers of trials. Randomized vs blockwise presentation schedules of the stimulus pairs did differentially affect the overall pattern of conditioning, but in a way which was both unexpected and difficult to account for theoretically. Both the Evaluative Style of subjects and contingency awareness were demonstrated to be generally orthogonal to conditioned shifts in CS valence. Based on these findings, some practical suggestions are provided for the application of evaluating conditioning based therapeutical interventions to affective-behavioral disorders which are centred around inappropriate (dis)likes.

Adult↗
PubMed2001

[Facial paralysis evaluations using the Yanagihara method, the House-Brackmann method, and self-evaluation by patients].

The Yanagihara method and the House-Brackmann (H-B) method are widely used in Japan to evaluate facial paralysis. The present study focuses on the relationship between the evaluation of facial paralysis using these methods and self-evaluation by patients. One-hundred and thirty-one patients with facial paralysis were included in the study, consisting of 68 males and 63 females between the ages of 17 and 84 years (mean age: 41 +/- 18 years). In addition to the Yanagihara and H-B methods, two methods of self-evaluation were used by the patients. In the first self-evaluation method, the patient was asked to rate the degree of paralysis as a grade of one to six. In the second method, the patient was asked to rate the severity of the paralysis on a scale of 0-100. The paralysis scores and grades determined using the Yanagihara and H-B methods were correlated with the self-evaluations. However, the strength of the correlation varied among the patients, indicating that the evaluation of subjective symptoms differed among individuals. Even patients who were evaluated as either "completely paralyzed" or "cured" according to the Yanagihara and H-B methods did not always rate their subjective symptoms as being consistent with these scores. In particular, 20 to 30% of patients who were evaluated as "cured" complained of minor dyskinesia.

Adolescent↗
PubMed1982

Trivariate evaluation of a thyroid hormone panel in clinical practice compared with multiple univariate evaluation.

The results from 510 consecutive routine determinations of free thyroxine index, free triiodothyronine index and thyrotropin were evaluated using both a trivariate reference region and the combined three univariate reference intervals. The results from 109 patients were discordant when evaluated by both the trivariate and the triple univariate reference regions. In 108 of these subjects the hormone results were found to be abnormal by the triple univariate evaluation method but normal when the trivariate reference region was used. The latter evaluation was in accordance with the clinical findings of the patients, who were euthyroid as evaluated from the 105 medical records we could trace. In one subject, clinically euthyroid, trivariate evaluation misclassified the patient as abnormal in contrast to the classical univariate evaluation. We conclude that the trivariate evaluation method was in better agreement with the clinical diagnosis of the patients and should be used in the routine evaluation of trivariate data in order to diminish the number of false abnormal results.

Humans↗
PubMed1993

[Current state of evaluation of knee ligament lesions. The new IKDC knee evaluation form ].

Various scoring systems have been proposed for quantification of the disability caused by knee ligament injuries and to evaluation of the results of their treatment. None of them was found worldwide acceptance, mainly because all scoring systems attribute numerical values to factors that are not quantifiable, after which the arbitrary scores for parameters that are not comparable with each other are added together. For these reasons a group of knee surgeons from Europe and America met in 1987 and founded the International Knee Documentation Committee. A common terminology and an evaluation form were created. This form is the standard form for use in all publications on results of treatment of knee ligament injuries. It is a concise one-page form and includes a documentation section, a qualification section and a evaluation section. For evaluation there are four problem areas (subjective assessment, symptoms, range of motion and ligament examination). These are supplemented by four additional areas that are documented but are not included in the evaluation (compartmental findings, donor site pathology, X-ray findings and functional tests). The form can be used pre- and postoperatively and at follow-up. The Committee also laid down that in a publication the minimum follow-up time for short-term results should be 2 years, for medium-term results, 5 years, and for long-term results, 10 years. Most of the sheet is devoted to the qualification section. It is called "qualification" and not "scoring" section because no scores are given. Each parameter is qualified as "normal", "nearly normal", "abnormal" or "severely abnormal". This qualification is less subjective and emotional than "very good", "good", "fair" and "poor". No knee and no knee function can be better than normal, and it is rather doubtful whether any knee that has been operated on can ever be "normal" again. For evaluation, the parameters of the four problem areas "subjective assessment", "symptoms", "range of motion" and "ligament examination" are qualified for the group qualification. The worst qualification within the group is taken as the group qualification. The worst group qualification is taken as the final evaluation. If the knee is abnormal in any of the problem areas it cannot be entered as normal knee. For knees with chronic pathology it is also possible to evaluate the sum of levels of improvement or deterioration of all groups compared with the preoperative evaluation. The committee also recommends that terms describing knee ligament problems should be used according to the definitions published by Noyes et al.(ABSTRACT TRUNCATED AT 400 WORDS)

Anterior Cruciate Ligament↗
PubMed1997

Preclinical evaluation of drug-drug interaction potential: present status of the application of primary human hepatocytes in the evaluation of cytochrome P450 induction.

Cytochrome P450 (CYP) inhibition and induction are the key mechanisms in drug-drug interactions. Aside from clinical studies, primary human hepatocytes may represent the most appropriate experimental system for the evaluation of CYP induction in humans. A consensus of an international panel on the present status and future research directions in the application of primary human hepatocytes in the evaluation of CYP-induction is presented here. The following observations are concluded to be generally true: (1) Human hepatocytes isolated from both biopsy samples and transplantable livers are suitable for induction studies. (2) Hormonally-defined media can be used for the evaluation of CYP induction. (3) Isozyme-selective induction of CYP1A and 3A by known inducers are observed. (4) Reproducibility of induction could be improved by using hepatocytes plated as confluent cultures. (5) Induction could be observed for hepatocytes treated at 1-3 days after culturing. (6) Treatment duration of 2 days in general leads to near maximal induction. (7) In general, there is a good qualitative correlation between human hepatocyte results in vitro and clinical observations in vivo. (8) When the same inducers were evaluated in independent laboratories, similar data were generally observed. We conclude that primary human hepatocytes represent an appropriate model for mechanistic evaluation of CYP induction and as a screening tool for CYP induction potential of xenobiotics. A set of data acceptance criteria are proposed: (1) Positive response should be observed with concurrent positive control chemicals; (2) reproducible observation should be observed with multiple human donors; (3) for negative response, the doses used should not be cytotoxic; and (4) replicate treatment and/or multiple dose treatment should be performed to allow statistical analysis. Future studies should include the further development of on: (1) The inducibility of CYP isozymes other than CYP1A and 3A, and phase II enzymes; (2) further development of culturing condition to allow optimal gene expression; (3) evaluation of the involvement of nonparenchymal cells on CYP induction of parenchymal cells; (4) the and validation of quantitative approaches to extrapolate in vitro data to in vivo data; (5) evaluation of possible individual variations and potential genetic polymorphism in inducibility; (6) further definition of species differences in CYP induction; (7) development of a 'normal' human hepatocyte cell line for CYP induction studies; (8) improvement of cryopreservation procedure of human hepatocytes; (9) definition of the molecular mechanisms of CYP induction; and (10) evaluation of the induction of phase II metabolic pathways.

Cells, Cultured↗