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PubMed1999

An analytical approach to determining the competitive advantage of TQM in health care.

The utilization of total quality management (TQM) is advocated by some experts, as a partial remedy to the ills of the healthcare industry. However, some healthcare administrators are not yet sold on TQM. Some healthcare administrators still question the impact of TQM on the operational, financial and strategic health of their institutions. They consider the investment in TQM as unjustifiable because the return on such investment in their mind is questionable. This study illustrates how the constant market share model can be utilized to show the competitive benefits of TQM. Based on the results of this study, it is concluded that the fears of some healthcare administrators are unfounded. Not only that TQM does not compromise organizational effectiveness, but it actually improves it, as it contributes to increasing market share.

Benchmarking↗
PubMed2003

Types of natural recovery from alcohol dependence: a cluster analytic approach.

BACKGROUND: Social capital and a low severity of alcohol-related problems have been focused upon to explain the processes of natural recovery from alcohol dependence. However, studies using control groups have not found significant differences in these variables. Subtypes of natural remission which might account for this inconsistency have only been described on grounds of qualitative data. AIMS: To identify subtypes of natural remitters using cluster analysis. PARTICIPANTS: One hundred and seventy-eight media-recruited natural remitters were interviewed personally. Several triggering mechanisms and maintenance factors of remission were assessed using standardized questionnaires. Based on age of onset and severity of dependence, adverse consequences from drinking, social pressure and social support, cluster analyses were performed. RESULTS: Cluster analyses yielded three groups of natural remitters: one cluster with a high severity of dependence, low alcohol-related problems and low social support ('low problems-low support'; n = 65), one group characterized by high severity of dependence, high alcohol-related problems and medium social support ('high problems-medium support'; n = 37), and a third group which consisted of subjects with high social support, late age of onset, low severity of dependence, and low alcohol-related problems ('low problems-high support'; n = 76). Cluster solutions were confirmed using discriminant analyses. Analyses of variance (ANOVAs) revealed further group differences on other triggering and maintaining factors of remission. CONCLUSIONS: Failure to identify specific pointers to natural recovery in previous research might be due to heterogeneous subgroups of natural remitters. In order to build a conceptual framework for understanding the processes of natural recovery, interactions of different independent variables should be considered.

Adult↗
PubMed1987

Pulmonary alveolar microlithiasis. A new analytical approach.

A case of pulmonary alveolar microlithiasis is presented which has been investigated using X-ray energy spectroscopy and microscopic infrared spectroscopy. These methods gave precise details of the chemical composition of the microliths seen in this unusual disease. The pathogenesis of this disorder is discussed in the light of these findings.

Adult↗
PubMed1996

A study of nurses' attitudes towards research: a factor analytic approach.

Despite considerable top-down pressure on nurses to undertake research, the available evidence suggests that relatively few nursing studies are submitted for publication. Given the need to increase the degree to which research informs practice, this shortfall in output must of necessity constitute a cause for concern. Therefore, it seems timely that a full-scale investigation into the possible reasons for non-submission is conducted. This study, therefore, in an attempt to meet this aim, used factor analysis on the scores from an attitude-to-research scale completed by 230 nurses. The results suggested that five coherent factors underpinned the sample's general attitudes to research. These were labelled 'nurses' subjective barriers to research', 'organizational/structural barriers to research', 'doctors' reactions to nursing research', 'health care professionals' reactions to research' and 'impact of nursing research'. The variables clustering on two of these factors suggested a predictive relationship with two relevant outcome behaviours relating to research. When this was tested, the predictions were supported, indicating that these factors could be used as a quick and simple screening tool to highlight individuals or groups of nurses who might benefit maximally from specific attitude change programmes. In this way, it might be possible to increase nursing research activities and output.

Attitude of Health Personnel↗
PubMed1994

Community attitudes towards people with mental health problems: a discourse analytic approach.

This paper addresses some methodological issues related to the generation of knowledge for mental health practice. It is suggested that a knowledge and understanding of attitudes towards the mentally ill has the potential to inform policy and practice regarding the establishment of community mental health facilities in order to encourage their acceptance by the public. Traditional approaches to attitude research are outlined followed by the proposal of an alternative approach: discourse analysis. The utility of each approach is assessed with regard to the potential relevance and applicability of research findings to practice. Traditional approaches are criticized on the grounds that they fail to take into consideration the social contexts within which attitudes are naturally expressed. As a result, information which is of potential interest to mental health practitioners is lost and it is unclear how the findings of such research might relate to or be translated into practice. It is argued, that since this information is to be found in the language used to describe people with mental health problems and to express attitudes towards them, that discourse analysis is ideally suited to the study of attitudes towards the mentally ill. The potential utility of the approach is demonstrated by an empirical example. Implications for practice are considered.

Attitude to Health↗
PubMed2006

Microsatellite typing of the human leucocyte antigen region: analytical approach and contribution to rheumatoid arthritis immunogenetic studies.

Within the major histocompatibility complex (MHC), the human leucocyte antigen (HLA)-DRB1 locus is clearly associated with rheumatoid arthritis (RA). Using a microsatellite (MSat) typing approach, we aimed to identify other loci associated with RA susceptibility and/or severity within the MHC. A panel of nine MSat HLA loci [D6S291, D6S2876 (G51152), D6S1666 (DQCAR II), D6S273, D6S2789 (TNFd), D6S2810 (MIB), D6S265, D6S2222, D6S2239], and HLA-A, -B and -DRB1 genes were typed in 170 RA cases and 282 controls. For susceptibility analysis, MSat and HLA allele distribution were compared between cases and controls, before and after stratification on HLA-DRB1*04. Haplotype frequencies were estimated using an expectation-maximization algorithm in a permutation test procedure. For severity analysis, we compared the distribution of structural damage score at onset and after 4 years of follow-up in RA cases carrying susceptibility alleles. Two MSat polymorphisms were positively associated with RA susceptibility: allele*136 of D6S265 [odds ratio, OR (confidence interval, CI) = 1.55 (1.11-2.17), P= 0.007], allele*116 of D6S2239 [OR = 1.34 (1-1.79), P= 0.03] and HLA-A2 [OR = 1.46 (1.08-1.98), P= 0.01]. Two MSat polymorphisms were negatively associated with RA susceptibility: allele*133 of D6S273 [OR = 0.3 (0.1-0.75), P= 0.005] and allele*177 of D6S291 [OR = 0.72 (0.53-0.96), P= 0.02]. The association between allele*136 of D6S265 and RA susceptibility remained unchanged after stratification on HLA-DRB1*04. The haplotypic analysis showed an overrepresentation of D6S265*136/HLA-A*02 haplotype, which suggests an effect independent of HLA-DRB1 locus in RA susceptibility. While HLA-A2 and HLA-DR4 were associated with RA severity, no MSat polymorphism was associated with structural damage score.

Arthritis, Rheumatoid↗
PubMed1998

Palatability versus healthiness as determinants of food preferences in young adults: a comparison of nomothetic and idiographic analytic approaches.

Past research on adults has found that the sensory appeal or taste of foods is a primary determiner of food consumption and how people think about food. The nomothetic nature of this research may have underestimated the impact of health considerations on food choice. This study compared 'nomothetic' and 'idiographic' modes of analysis in 1) determining the relative influence of palatability and perceived healthiness of foods, on preference for the food, and 2) assessing the relationship between palatability and evaluations of healthiness. Additionally, gender differences were examined in relation to within-person correlations between the concepts of preference, palatability and healthiness. Subjects (n = 139) rated 81 foods on preference, palatability and healthiness. Findings from both the idiographic and nomothetic analyses indicated that palatability rather than health considerations determined preferences in young adults. The within-person correlational analysis indicated a large number of persons, mostly female, who preferred unhealthy food. The sample was equally split in their evaluations of healthy food as palatable or not.

Adolescent↗
PubMed2001

An economic evaluation of universal infant vaccination against hepatitis B virus using a combination vaccine (Hib-HepB): a decision analytic approach to cost effectiveness.

OBJECTIVE: To evaluate the health impact and cost effectiveness of two infant vaccination strategies for protection against hepatitis B virus (HBV) infection in the Australian population. Vaccinating only high-risk infants, assuming 65% compliance, was compared with universal vaccination of infants using a combination Hib-HepB vaccine, with 87.4% compliance. METHOD: A Markov model simulated the natural history of HBV infection and disease in an Australian birth cohort. The cohort was divided into those at high risk of infection (infants born into high-risk families) and low-risk infants. Clinical and epidemiological data used were obtained from published reports and a survey of clinical experts. The model included the health costs associated with acute and chronic HBV infection, and the sequelae of chronic HBV infection. RESULTS: The model predicted that universal hepatitis B vaccination of an Australian birth cohort (260,000 births) would result in a 77% reduction in cases of HBV infection. The incremental cost per life year gained was $11,862, which is low compared with many other health care interventions. With no discounting of costs or consequences, universal vaccination with the combination vaccine was predicted to save lives and reduce costs. CONCLUSION: There is no socially accepted threshold value for cost per life year gained to guide decisions about funding Australian health care interventions. Nevertheless, based on these results, universal hepatitis B vaccination of Australian infants using a combination Hib-HepB vaccine would almost certainly be regarded as a worthwhile investment of public funds.

Australia↗
PubMed2006

Predicting emergency evacuation and sheltering behavior: a structured analytical approach.

We offer a general approach to predicting public compliance with emergency recommendations. It begins with a formal risk assessment of an anticipated emergency, whose parameters include factors potentially affecting and affected by behavior, as identified by social science research. Standard procedures are used to elicit scientific experts' judgments regarding these behaviors and dependencies, in the context of an emergency scenario. Their judgments are used to refine the model and scenario, enabling local emergency coordinators to predict the behavior of citizens in their area. The approach is illustrated with a case study involving a radiological dispersion device (RDD) exploded in downtown Pittsburgh, PA. Both groups of experts (national and local) predicted approximately 80-90% compliance with an order to evacuate workplaces and 60-70% compliance with an order to shelter in place at home. They predicted 10% lower compliance for people asked to shelter at the office or to evacuate their homes. They predicted 10% lower compliance should the media be skeptical, rather than supportive. They also identified preparatory policies that could improve public compliance by 20-30%. We consider the implications of these results for improving emergency risk assessment models and for anticipating and improving preparedness for disasters, using Hurricane Katrina as a further case in point.

Behavior↗
PubMed1998

Statistical methodology: VII. Q-methodology, a structural analytic approach to medical subjectivity.

Q-methodology is a relatively unknown tool to medical researchers, that uses a mixed quantitative/qualitative statistical technique known as by-person factor analysis to study subjectivity. Q-methodology allows the grouping of individuals according to their subjective feelings about a topic, without requiring preconceived ideas regarding the structure of those subjective feelings. Q-methodology is demonstrated using a study in which attitudes of emergency medicine residents toward computer education are explored systematically and classified in terms of statistically distinct factor viewpoints. In this example, Q-methodology identifies 4 attitude groups, as related to computers and computer education: 1) interested, eager to learn; 2) frustrated and interested, but with reservations; 3) interested mainly in benefits, willing to expend minimal effort; and 4) knowledgeable, independent learner. Q-methodology can be used to determine the structure of attitudes on a subjective topic, often yielding new insights.

Attitude↗
PubMed1988

Temporal arteritis: a decision-analytic approach to temporal artery biopsy.

The clinical indications for temporal artery biopsy were explored using clinical decision analysis. The analysis indicated that biopsy is most useful in patients with a high likelihood of steroid side effects. It is nearly always useful when the pre-biopsy likelihood of temporal arteritis is low, but loses its value when temporal arteritis is likely on clinical grounds, except when there is a very high probability of steroid side effects. With the low biopsy sensitivity likely to exist in most institutions, the value of biopsy falls off particularly steeply with rising clinical likelihood of temporal arteritis.

Biopsy↗