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At least 1,243 records · Page 69Linked to original sources
PubMed1999

Acute asthma among pregnant women presenting to the emergency department.

Asthma complicates up to 4% of pregnancies. Our objective was to compare emergency department (ED) visits for acute asthma among pregnant versus nonpregnant women. We performed a prospective cohort study, as part of the Multicenter Asthma Research Collaboration. ED patients who presented with acute asthma underwent a structured interview in the ED, and another by telephone 2 wk later. The study was performed at 36 EDs in 18 states. A total of 51 pregnant women and 500 nonpregnant women, age 18 to 39, were available for analysis. Pregnant women did not differ from nonpregnant women by duration of asthma symptoms (median: 0.75 versus 0.75 d, p = 0.57) or initial peak expiratory flow rate (PEFR) (51% versus 53% of predicted, p = 0.52). Despite this similarity, only 44% of pregnant women were treated with corticosteroids in the ED compared with 66% of nonpregnant women (p = 0.002). Pregnant women were equally likely to be admitted (24% versus 21%, p = 0.61) but less likely to be prescribed corticosteroids if sent home (38% versus 64%, p = 0.002). At 2-wk follow-up, pregnant women were 2.9 times more likely to report an ongoing exacerbation (95% CI, 1.2 to 6.8). Among women presenting to the ED with acute asthma, pregnant asthmatics are less likely to receive appropriate treatment with corticosteroids.

Acute Disease↗
PubMed2003

Managerial and environmental factors in the continuity of mental health care across institutions.

OBJECTIVE: The authors examined the association of continuity of care with factors assumed to be under the control of health care administrators and environmental factors not under managerial control. METHODS: The authors used a facility-level administrative data set for 139 Department of Veterans Affairs medical centers over a six-year period and supplemental data on environmental factors to conduct two types of analysis. First, simple correlations were used to examine bivariate associations between eight continuity-of-care measures and nine measures of the institutional environment and the social context. Second, to control for potential autocorrelation, multivariate hierarchical linear models with all nine independent measures were created. RESULTS: The strongest predictors of continuity of care were per capita outpatient expenditure and the degree of emphasis on outpatient care as measured by the percentage of all mental health expenditures devoted to outpatient care. The former was significantly associated with greater continuity of care on six of eight measures and the latter on seven of eight measures. The environmental factor of social capital (the degree of civic involvement and trust at the state level) was associated with greater continuity of care on five measures. The degree to which non-VA mental health services were funded in a state was unexpectedly found to be positively associated with greater continuity of care. In multivariate analysis using hierarchical linear modeling, significant relationships with continuity of care remained for per capita outpatient expenditures, overall outpatient emphasis, and social capital, but not for non-VA mental health funding. A linear term representing the year was positively and significantly associated with six of the eight examined continuity-of-care measures, indicating improvement in continuity of care for the period under study, although the explanation for this trend over time is unclear. CONCLUSIONS: Several factors potentially under managerial control are associated with increased mental health continuity of care.

Analysis of Variance↗
PubMed1997

A spreadsheet method for calculating maximum caseload and intake capacity for CMHC psychiatrists.

OBJECTIVE: A method was sought to help administrators of community mental health centers determine a level of psychiatric staffing that is both cost-efficient and ensures high quality of care. METHODS: A survey of staff psychiatrists was conducted at a large community mental health center with seven outpatient clinics. The survey measured variables that can affect staffing requirements, including the number of hours psychiatrists have available for direct care, their preferred intervals between a patient's return visits, and the duration of appointments for an initial psychiatric assessment and for medication maintenance. A computer spreadsheet was developed to calculate the caseload capacity and intake capacity for clinics of the center. RESULTS: The survey indicated that the psychiatrists at the center had an average of 33 hours a week available for direct care. The mean preferred time between a patient's medication maintenance visits was 7.3 weeks. The mean time required for a psychiatric assessment was 80 minutes, and for a medication maintenance visit it was 33 minutes. With these data, the spreadsheet method was used to calculate intake and caseload capacity for psychiatric staff at three of the center's clinics. CONCLUSIONS: The data-based approach to calculating capacity can be modified to meet local needs. It brings objectivity to decision making about staffing, and the methods can improve resource management and enhance relationships between stakeholders and physicians.

Community Mental Health Centers↗
PubMed2001

The impact of a community-wide self-care information project on self-care and medical care utilization.

This study assesses the effects of the Healthwise Communities Project (HCP) on use of self-care resources and health care utilization. The intervention included the distribution of the Healthwise Handbook, the provision of a telephone advice line, and a Web site. All of these products use a symptom-based approach and are aimed at a general population. A quasi-experimental design was used with two comparison communities. Measurements over time assessed the effects of the HCP while controlling for secular trends. Survey and utilization data are used to assess the effect of the intervention. Findings indicate that the community intervention increased the use of self-care resources. Users believe that these products help them make better decisions regarding when to seek care and how to self-treat problems. Most believe that using the self-care resources saved them from seeking unnecessary care. The findings from the utilization data provide some evidence to support this conclusion.

Community Health Planning↗
PubMed2003

An overview of variance inflation factors for sample-size calculation.

For power and sample-size calculations, most practicing researchers rely on power and sample-size software programs to design their studies. There are many factors that affect the statistical power that, in many situations, go beyond the coverage of commercial software programs. Factors commonly known as design effects influence statistical power by inflating the variance of the test statistics. The authors quantify how these factors affect the variances so that researchers can adjust the statistical power or sample size accordingly. The authors review design effects for factorial design, crossover design, cluster randomization, unequal sample-size design, multiarm design, logistic regression, Cox regression, and the linear mixed model, as well as missing data in various designs. To design a study, researchers can apply these design effects, also known as variance inflation factors to adjust the power or sample size calculated from a two-group parallel design using standard formulas and software.

Analysis of Variance↗
PubMed2003

Meta-analyses of cluster randomization trials. Power considerations.

A commonly cited purpose for conducting a meta-analysis of randomized trials is to increase the statistical power for detecting the effect of an intervention on a specified set of endpoints. At the same time, it also has been noted by several authors that many large-scale cluster randomization trials have not had the power to detect small or even moderate effect sizes. The loss of efficiency associated with cluster randomization relative to individual randomization, and the frequent failure of investigators to take this loss of efficiency into account at the planning stage of a trial, undoubtedly contributes to this problem. In this article, the authors present an approach that may be used to estimate the power of a planned meta-analysis that includes trials that are cluster randomized. Two examples are presented.

Cluster Analysis↗
PubMed2003

Conducting power analyses for ANOVA and ANCOVA in between-subjects designs.

Researchers are frequently asked to justify the sample size used in their quantitative inquiries. Such a justification can be provided through a power analysis. Conducting power analyses, however, can raise some difficult issues regarding the specification of the size of the effect, testing for interaction effects, the role of covariates, and the use of an estimated effect size in the power analysis. The authors present methods for conducting power analyses along with a discussion of these issues, and they make available SAS programs that can be used to implement the power analyses that are discussed.

Analysis of Variance↗
PubMed1993

Reliability of Katz's Activities of Daily Living Scale when used in telephone interviews.

The reliability of a five-item Katz's Activities of Daily Living (ADL) scale collected by self-report telephone interview is presented. A random sample of 6,472 South Carolina residents over 55 years of age selected from a statewide population is used. Factor structure, Guttman properties, internal consistency reliability, Mokken's index of test homogeneity, and Spearman's coefficient of rank-order correlation are used to show that ADL data gathered by telephone interview are reliable. Because telephone interviewing methods are faster, cheaper, and safer they are recommended as a viable way for researchers, policymakers, and practitioners to gather ADL information.

Activities of Daily Living↗
PubMed1995

Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale.

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.

Attitude of Health Personnel↗
PubMed1999

A multidisciplinary concept analysis of quality of life.

The purpose of this article is to analyze how the concept of quality of life (QOL) is currently being defined and used within health care. An on-line search of the phrase QOL in Medline, Cinahl, Psyc-Info, Eric, and Social Science Abstract provided a list of 16,021 articles published between 1993 and 1998. A convenience sample of 65 research and theoretical articles from the 1990s was examined to determine current usage and definitions of the concept of QOL across disciplines. Analysis was conducted, and a definition of the concept QOL, based on the analysis, is offered.

Data Interpretation, Statistical↗
PubMed1981

Deciding whether the conclusions of studies are justified: a review.

Critical review of original studies is a major source of medical information for the physician; it necessitates a clear understanding of the research objective of the study. The design of the study, whether experimental or observational, should be appropriate to answer the research question and, further, the study should employ accurate and precise measurements on a suitable group of subjects. The critical reader, aware of the principle of study design and analysis, can assess the validity of the author's conclusions through careful review of the article. A guide to the analysis of an original article is presented here. The reader is asked to formulate questions about a study from the abstract. The answers to these questions, which form the basis for acceptance or rejection of the author's conclusions, are in general available in the body of an article. This technique is demonstrated with two fictional studies about patients with angina.

Information Services↗
PubMedDate not supplied

Industry-sponsored economic studies in critical and intensive care versus studies sponsored by nonprofit organizations.

The purpose of this analysis of health economic studies in the field of intensive and critical care was to investigate whether any relationship could be established between type of sponsorship and (1) type of economic analysis, (2) health technology assessed, (3) sensitivity analysis performed, (4) publication status, and (5) qualitative cost assessment. Using the terms critical care or intensive care, all health economics publications in the field of critical and intensive care were identified in the Health Economic Evaluations Database (HEED, Version 1995-2001) on the basis of sponsorship and comparative studies. This search yielded a total of 42 eligible articles. Their evaluations were prepared independently by 2 investigators on the basis of specific criteria. When evaluators disagreed, a third investigator provided a deciding evaluation. There was no statistically demonstrable relationship between types of sponsorship and sensitivity analysis performed, publication status, types of economic analysis, or qualitative cost assessment.

Cost Control↗