[Interrelated issues in evaluation and evaluation research: an evaluator's perspective].
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Nursing Care↗
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[The nursing process: possibilities and limitations of its planned implementation (10). Evaluation of procedures involved in each process: practice and evaluation - methods of practice and objectives of the evaluation].
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Goals↗
The safety of flexible endoscopic evaluation of swallowing with sensory testing (FEESST): an analysis of 500 consecutive evaluations.
We assessed the safety of a new office or bedside method of evaluating both the motor and sensory components of swallowing called flexible endoscopic evaluation of swallowing with sensory testing (FEESST). FEESST combines the established endoscopic evaluation of swallowing with a technique that determines laryngopharyngeal sensory discrimination thresholds by endoscopically delivering air-pulse stimuli to the mucosa innervated by the superior laryngeal nerve. Endoscopic assessment of laryngopharyngeal sensory capacity followed by endoscopic visualization of deglutition was prospectively performed 500 times in 253 patients with dysphagia over a 2.5-year period in a tertiary care center. The patients had a variety of underlying diagnoses, with stroke and chronic neurological disease predominating (n = 155). To determine the safety of FEESST, the presence of epistaxis, airway compromise, and significant changes in heart rate before and after the evaluation were assessed. Patients were also asked to rate the level of discomfort of the examination; 498 evaluations were completed. There were three instances of epistaxis that were self-limited. There were no cases of airway compromise. There were no significant differences in heart rate between pre- and posttest measurements (p > 0.05). Eighty-one percent of patients noted either no discomfort or mild discomfort as a result of the examination. In conclusion, FEESST is a safe method of evaluating dysphagia in the tertiary care setting and may also have application for the chronic care setting.
Adult↗
IT, change and evaluation: an overview of the role of evaluation in health services.
Effective evaluation is important for appropriate deployment and use of information technology, especially in the current environment of changing health services. However, the broad range of roles and environments in which technology is used challenges traditional evaluation approaches. As technology has progressed, these roles have developed to the extent that information technology is now often playing a very complex role in health service organisations. In such cases there are many uncertainties in decisionmaking that are difficult to address with traditional formal evaluation techniques. There is a need to recognise and work with more complex, socially constructed decisionmaking process relying substantially on a variety of human judgements. The need for this recognition is demonstrated by exploring the difference in our ability to analyse a range of different systems, considering the role of complexity, uncertainty, theory, change and control. There is the need, then, for evaluation processes to complement these social decisionmaking processes, rather than to replace them. The nature of these processes needs to be effectively understood to enable the most appropriate types of evaluations to be undertaken. A number of different scenarios are explored to demonstrate the types of roles that evaluation may need to take.
Decision Making, Organizational↗
Use of laboratory evaluation and radiologic imaging in the diagnostic evaluation of children with sensorineural hearing loss.
OBJECTIVE: Laboratory testing and radiologic imaging are commonly used to delineate syndromic from nonsyndromic sensorineural HL (SNHL). The aim of this study was to examine the yield of laboratory tests and radiologic imaging commonly used in the diagnostic evaluation of SNHL in children. STUDY DESIGN: Retrospective analysis of 114 (54 female, 60 male) consecutively investigated children with SNHL between 1998 and 2000 at a tertiary-care university hospital. METHODS: Results of routine laboratory testing to assess autoimmunity, blood dyscrasias, endocrine abnormalities, renal function, infection, and cardiac testing were reviewed. Results of radiologic evaluation were also reviewed. In general, computed tomography (CT) was obtained in patients with symmetric SNHL, whereas magnetic resonance imaging (MRI) with or without CT was obtained in asymmetric SNHL. RESULTS: Laboratory evaluation of the blood did not yield the etiology of SNHL in any patient. Blood tests for autoimmune disease were often positive but did not correlate with clinical disease. Nonspecific elevation of erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) was present in 22% of cases. An abnormal electrocardiogram with a prolonged QT interval resulted in the diagnosis of Jervall and Lange-Nielsen syndrome. In the 97 patients who underwent radiologic studies, abnormalities were present in 38 of 97 studies (39%). Isolated inner ear malformations were twice as common as multiple abnormalities with large vestibular aqueducts as the most common isolated finding. CONCLUSION: In the evaluation of children with unexplained SNHL, routine laboratory evaluation should be reconsidered given its low diagnostic yield. However, radiologic abnormalities of the inner ear are common. Identification of inner ear malformations has direct impact on management of these children, suggesting that all children should undergo radiologic imaging as an integral component of evaluation of SNHL.
Adolescent↗
How can the evaluation of genetic tests be enhanced? Lessons learned from the ACCE framework and evaluating genetic tests in the United Kingdom.
Advances in genetic technology are increasing the availability of genetic tests, not only for rare single gene disorders, but also for common diseases such as breast and colo-rectal cancer. Before there can be widespread uptake of these tests, they must be evaluated to confirm the benefits of their use. But how should genetic tests be evaluated, given the speed at which new tests are emerging? One highly influential approach is the analytic validity, clinical validity, clinical utility and ethical, legal and social issues (ACCE) framework, which has provided a benchmark for the evaluation of genetic tests. The approach has been adopted and adapted by the United Kingdom Genetic Testing Network, with the help of the Public Health Genetics Unit in Cambridge, to evaluate new genetic tests for use in the National Health Service. We discuss a number of conceptual, methodological, and practical issues concerning the evaluation of genetic tests, based on lessons learned from applying the ACCE framework and from the UK experience, and make a number of recommendations to further strengthen the evaluation of genetic tests.
Genetic Carrier Screening↗
Contextual influences on implicit evaluation: a test of additive versus contrastive effects of evaluative context stimuli in affective priming.
Drawing on two alternative accounts of the affective priming effect (spreading activation vs. response interference), the present research investigated the underlying processes of how evaluative context stimuli influence implicit evaluations in the affective priming task. Employing two sequentially presented prime stimuli (rather than a single prime), two experiments showed that affective priming effects elicited by a given prime stimulus were more pronounced when this stimulus was preceded by a context prime of the opposite valence than when it was preceded by a context prime of the same valence. This effect consistently emerged for pictures (Experiment 1) and words (Experiment 2) as prime stimuli. These results suggest that the impact of evaluative context stimuli on implicit evaluations is mediated by contrast effects in the attention to evaluative information rather than by additive effects in the activation of evaluative information in associative memory.
Affect↗
Social evaluation research: the evaluation of two police patrolling strategies.
In most social evaluation research it is difficult to achieve the degree of experimental rigor possible in an applied behavioral study. This study illustrates how the evaluation researcher can increase experimental rigor in the analysis of social interventions. In the first evaluation, a variation of the time-series design that offered maximum experimental control given the limitations of the situation, was employed to evaluate the effects of a specialized home-burglary police patrol. This design revealed that no effects could be attributed to the patrol. In the second evaluation, a multiple baseline-like design was possible in determining the effects of a police walking patrol. This design revealed that the patrol produced an increase in crime reporting but not in arrests. Social interventions often occur in a manner that allows varying degrees of experimental analysis. The evaluation researcher must attain optimal experimental analysis given the limitations of each social intervention.
Journal Article↗
Genetic evaluation of dairy goat does for milk and fat as an extension of buck evaluation.
The current procedure for calculating genetic evaluations of dairy goat bucks provides easily accessible information for constructing genetic evaluations for dairy goat does (doe indexes). Relationships among sires are accounted for by using the additive genetic relationship matrix among sires if the doe's sire was evaluated. The sire evaluation plus a portion of residual doe effect is the basis of doe evaluation. Although direct incorporation of maternal relationships among does may be accomplished, it requires extensive computations for large data sets. An approximate procedure based on selection index principles includes information from a doe's dam with only a modest increase in computing expense over that for genetic evaluations of bucks. Doe indexes were computed and adjusted to separate breed bases. Trend in doe indexes was positive for all breeds and ranged from .54 to 1.37 kg/yr for milk yield and from .021 to .052 kg/yr for fat yield.
Animals↗
Histologic evaluation of tumor persistence at the surgical margins in oral cancer: an evaluation of all surgical margins using paraffin-embedded sections and its usefulness and limitations.
An evaluation of frozen sections at all surgical margins (Mohs' surgery) was attempted in three patients, in order to determine whether or not a tumor persisted at the surgical margins following surgery for carcinoma of the oral cavity. However, sectioning from the fresh tissue was difficult, and moreover, duration of the surgery was lengthened. It thus seems that this method is not suitable for a routine evaluation of the surgical margins. Based on this, surgical specimens after formalin fixation were evaluated in eight patients. The use of paraffin-embedded sections compensates the disadvantages in using frozen sections. On the other hand, when a residual tumor is detected, any additional excision should be delayed. In two patients, who were evaluated using paraffin-embedded sections, a persistent tumor was detected. In another patient a recurrent tumor developed, despite having completely tumor-free margins. In this patient, the growth of the tumor appeared to be discontinuous. When skip lesions are histologically suggested, adjuvant therapy including radiotherapy should be considered, even when a persistent tumor is not evident. A reliable evaluation of all surgical margins is difficult in either a T4 tumor or in a malignant tumor of the gingiva and hard palate. Microscopic evaluation of all surgical margins using paraffin-embedded sections is considered to be practical in helping to elucidate the microscopic extent of a tumor, although there are several limitations in its application.
Adult↗
A call for action to support best practices in evaluation of comprehensive tobacco control evaluation strategies.
The National Tobacco Control Best Practices Working Group convened a two-day workshop to support best practices in evaluation of comprehensive tobacco control strategies. A Better Practices Model, aimed at developing a self-correcting system for best practices, guided the workshop content and process. Organizers intended to identify a common surveillance and monitoring framework for tobacco control strategies in Canada by first building strong working relationships between 44 decision-makers, practitioners and researchers from 12 Canadian jurisdictions. Participants identified needs and recommendations related to increased understanding and use of uniform evaluation strategies, building capacity, and recognition of the complexity of the task of evaluating comprehensive tobacco control strategies. The workshop highlighted the need for increased communication to facilitate understanding across the different sectors of participants. It also identified the potential benefits of harmonization in evaluation of tobacco control strategies across jurisdictions. Priority actions include forming a national team to agree on a model for evaluation, conducting an environmental scan for indicators, planning evaluation / monitoring and research agendas and determining roles for various stakeholders.
Canada↗
[Selection of a statistical model for evaluation of the reliability of the results of toxicological analyses. I. Discussion on selected statistical models for evaluation of the systems of control of the results of toxicological analyses].
2 statistical models for evaluation of toxicological studies results have been presented. Model I. after R. Hoschek and H. J. Schittke (2) involves: 1. Elimination of the values deviating from most results-by Grubbs' method (2). 2. Analysis of the differences between the results obtained by the participants of the action and tentatively assumed value. 3. Evaluation of significant differences between the reference value and average value for a given series of measurements. 4. Thorough evaluation of laboratories based on evaluation coefficient fx. Model II after Keppler et al. As a criterion for evaluating the results the authors assumed the median. Individual evaluation of laboratories was performed on the basis of: 1. Adjusted test "t" 2. Linear regression test.
Models, Theoretical↗
The relationship between performance on computer-based clinical simulations and two written methods of evaluation: cognitive examination and self-evaluation of expertise.
The purpose of this study was to explore the relationship between computer-based clinical simulation performance and two commonly used methods of evaluation: cognitive examination and self-evaluation of expertise. The convenience sample of 68 critical care nurses completed the Basic Knowledge Assessment Tool for Critical Care (BKAT), a cardiovascular self-assessment tool (CST), and two computer-based clinical simulations requiring the management of myocardial infarction patients with tachydysrhythmias (atrial flutter and ventricular tachycardia). Simulation performance was measured by proficiency score and patient outcome (live/die). Proficiency on the atrial simulation was significantly correlated with knowledge as measured by the BKAT (r = 0.46, p 0.001) and with self-evaluation of clinical expertise (r = 0.32, p = 0.008). Atrial patient outcome was also significantly correlated with the BKAT (r = 0.28, p = 0.006) and the CST score (r = 0.22, p = 0.036). However, in the ventricular simulation only proficiency score and self-evaluation of expertise were significantly correlated (r = 0.24, p = 0.049). The modest relationships found in this study may indicate that, while clinical simulation performance is related to knowledge and self-evaluation of expertise, the constructs measured are not synonymous. This evidence provides support for the use of clinical simulations as an adjunct to other methods of evaluation.
Adult↗
A critique of an evaluation of the impact of hospital bed closures in Winnipeg, Canada: lessons to be learned from evaluation research methods.
In the last few years, the continuing increases in health care expenditures have led to a call for greater accountability in health care and have spurred evaluative research into the area of health care policy. Yet the challenge has been to develop health care policy evaluations that maximize the rigor of the evaluation process within the constraints and limitations of evaluation milieus. This paper describes the principles of evaluation research and, using the example of a study evaluating the impact of hospital bed closures on community health status in Winnipeg, Canada, demonstrates the epistemological, methodological and interpretive problems that can occur when these principles are not followed. The conclusions are that studies which fail to outline the causal links between policy actions and outcomes, and use designs and methods which threaten internal and external validity, are limited in their abilities to elucidate the impact of health care policy changes.
Health Expenditures↗
[Evaluation of the cystic duct and cysticohepatic junction with MR cholangiography: comparison of various techniques and clinical evaluation with respiratory-triggered three-dimensional multislab technique].
The purpose of this study was to evaluate depiction of the cystic duct and cysticohepatic junction by MR cholangiography (MRC). In 10 volunteers, MR cholangiograms were obtained by breath-hold two-dimensional (2D), respiratory-triggered 2D, respiratory-triggered three-dimensional (3D) single slab, and 3D multislab techniques. The images then were compared qualitatively. MRC using the respiratory-triggered 3D multislab techniques was evaluated as better than the other techniques, and was performed in 35 patients. Depiction of the anatomy of the cystic duct and cysticohepatic junction were evaluated. In 8 of 35 patients, MRC images were compared with those obtained by endoscopic retrograde cholangiography (ERC). The cystic duct and cysticohepatic junction were visualized adequately in 93% of volunteers and patients by the respiratory-triggered 3D multislab technique. Anatomic variations in the cystic duct and cysticohepatic junction were evaluated. The frequency of anatomic variations was the same as previously reported. The anatomic evaluations obtained by MRC were correlated closely with those obtained by ERC in 8 patients. In conclusion, MRC with the respiratory-triggered 3D multislab techniques is useful in evaluation of the cystic duct and cysticohepatic junction.
Adult↗
Patients evaluate accessibility and nurse telephone consultations in out-of-hours GP care: determinants of a negative evaluation.
OBJECTIVE: The shift towards large-scale organization of out-of-hours primary healthcare in different western countries has created an important role for the nurse telephone consultation. We explored the association between negative patient evaluation of nurse telephone consultations and characteristics of patients and GP cooperatives. METHODS: A cross-sectional study using postal patient questionnaires sent to patients receiving a nurse telephone consultation from one of 26 GP cooperatives in the Netherlands. RESULTS: The total response was 49.3% (2583/5239). Negative evaluations were most frequently encountered for the general information received on the GP cooperative (35%). When patients expected a centre consultation or home visit, but only received a nurse telephone consultation, they were more negative about the accessibility (OR 1.7, CI 1.4-2.1) and nurse telephone consultation (OR 4.2, CI 3.2-5.6). In the presence of a special supervising telephone doctor at the cooperative's call centre, nurse telephone consultation was evaluated significantly less negative (OR 0.4, CI 0.2-0.8). CONCLUSION: Expectation of care mode was most strongly associated with a negative evaluation of nurse telephone consultation. The presence of a supervising telephone doctor may lead to a better evaluation of nurse telephone consultations. PRACTICE IMPLICATIONS: More attention should be paid to the provision of patient information on the GP cooperative and discrepancies between the care expected and the care offered.
After-Hours Care↗
Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation--part I.
A range of psychosocial interventions (PSI) have developed as approaches to the treatment and support of people with enduring mental health problems and their carers. The impact of training mental health workers in PSI has also been subject to extensive research and evaluation for the past decade. Most previous research in the PSI and PSI training arenas have tended to adopt quasi-experimental designs and professionally defined outcomes-focused approaches to judging the success of training. This paper offers a critique of such approaches and presents a rationale for the methodology used in a qualitative study that evaluated five short PSI courses. The study emphasized a stakeholder approach to evaluation, involving collaborative activities between service users, carers, lecturers and mental health workers. These activities were intended to define what outcomes should be used to judge the success of training and how these should be examined during the research process. This paper details the processes and findings of these stakeholder activities that suggested, for service users particularly, process rather than outcome issues were the most important determinants of the success of PSI. Additionally, if outcomes were used to judge the success of interventions these should be highly individualized to reflect the aspirations of the person receiving the intervention. On the basis of the findings presented, discussion explores a proposal for a different methodological direction to the evaluation of PSI training. Part II of this paper presents and discusses the findings from the evaluation of the courses.
Cooperative Behavior↗
Manager and evaluator views of program evaluation.
This article presents the results of a 1979 national survey of federally funded community mental health centers (CMHCs). The directors and chief program evaluators of 323 CMHCs returned questionnaires which allow comparisons of the opinions of the center managers and their evaluators regarding accountability and evaluation and the level and knowledge of center evaluation staff. The CMHC directors and evaluators are also compared to a random sample of community psychologists and four other criterion groups of professionals regarding their responses to three items of the service provider accountability subscale of the Human Service Ideology scale.
Attitude↗