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An organizational concept for pathologic identification in mass disasters.

The process of identifying the victims of a mass disaster can be simplified if approached in a logical manner. The organizational concept used by the Armed Forces Institute of Pathology divides the process into four phases--preliminary evaluation, data collection, data analysis, and conclusion. Much flexibility is retained within each of these phases to enable general application, but major emphasis centers upon quality control. This control consists of multiple checks during the phases of data collection and analysis and confirmation of each identification by all available methods. An intensive effort must be made to obtain complete antemortem records and descriptions as soon as possible, for no identification will be possible without this comparison data. The values of a logical organizational flow are increased efficiency and accuracy of identification.

Accidents, Aviation↗

Tell me what you mean by "sí": perceptions of quality of prenatal care among immigrant Latina women.

Individual perceptions form the basis of many health research reports related to access, utilization, continuity, and quality. Many health care providers are not well equipped for designing studies or collecting data with immigrant populations. In this article, the authors examine issues in data collection on topics related to perceptions of quality of prenatal care among immigrant Latino populations. The conceptual model is Donabedian's framework for quality. Two instruments--a qualitative interview with photographs representing components of quality and a questionnaire--were used for data collection. Examples of narrative responses given by women in response to the photo-narrative prompts are presented and compared to shorter survey responses. The authors emphasize the importance of designing research instruments that reflect the perceptions of the research subjects rather than simply those of the investigators.

Attitude to Health↗

The appropriateness and use of focus group methodology across international mental health communities.

The ability to interpret collected data across international mental health communities often proves to be difficult. The following paper reports on the use and appropriateness of focus group methodology in helping to clarify issues that could help substantiate data collection and comparison across different cultures and regions. Field tests of the focus group methodology were undertaken in different regions and this paper describes an overview of the final field test in Sofia, Bulgaria. The findings and experiences with utilizing this methodology were incorporated in subsequent data collections.

Attitude to Health↗

The Canadian Community Health Survey: mental health and well-being.

As part of the Canadian Community Health Survey (CCHS) biennial strategy, the provincial survey component of the first CCHS cycle (Cycle 1.2) focused on different aspects of the mental health and well-being of Canadians living in private dwellings. Moreover, the survey collected data on prevalences of specific mental disorders and problems, use of mental health services, and economic and personal costs of having a mental illness. Data collection began in May 2002 and extended over 8 months. More than 85% of all interviews were conducted face-to-face and used a computer-assisted application. The survey obtained a national response rate of 77%. This paper describes several key aspects of the questionnaire content, the sample design, interviewer training, and data collection procedures. A brief overview of the CCHS regional component (Cycle 1.1) is also given.

Adolescent↗

Stressors in five client populations: Neuman systems model-based literature review.

AIM: This paper reports a literature review identifying and categorizing client system stressors in Neuman systems model-based studies. BACKGROUND: To date, literature reviews related to the Neuman systems model have focused broadly on all concepts of the model. The concept of stressors has been selected by the Neuman Systems Model Research Institute as the focus for an initial collaborative research project. METHOD: Cooper's five-stage integrative review method was used: problem formulation, data collection, data evaluation, analysis and interpretation, and dissemination. The Neuman systems model research literature from 1983 to February 2005 was searched using Fawcett's Neuman systems model bibliography and a follow-up review of the CINAHL database using the keywords 'Neuman systems model' and 'stressors'. A total of 87 studies published as journal articles or book chapters between 1983 and 2005 were reviewed; 13 of the 87 studies met the definition of 'stressor studies'. FINDINGS: Stressors were identified in five client populations: caregivers, cancer survivors, ICU patients in intensive care units, care receivers, and parents whose children were undergoing day surgery. The most common data collection method was the interview, and investigator-developed interview guides were most often used. Evidence of categorization of intra-, inter- and extra-personal stressors was present. The following overall stressors were identified: burden of responsibility (caregivers); awareness of vulnerability (cancer survivors); being overwhelmed (patients in intensive care units); loss of control (parents); and frustration with role changes (care receivers). CONCLUSIONS: These data could form the basis for nursing practice as well as future research within a collaborative environment. Given the existing body of knowledge concerning Neuman system model-derived middle range theory concepts in the caregiver population, the middle-range theory of caregiver role strain could be tested empirically.

Caregivers↗

Knowing and doing phenomenology: the implications of the critique of 'nursing phenomenology' for a phenomenological inquiry: a discussion paper.

Phenomenological research in nursing has come under sustained attack in recent years with some nurse researchers accused of betraying the fundamental tenets of phenomenology and of misconstruing its key concepts. This paper aims to show how a study informed by the critique of 'nursing phenomenology' was designed and conducted. In particular, the implications of the key phenomenological concepts of intentionality and bracketing for data collection, data analysis and the presentation of findings are explored in relation to an investigation of the concept of the Clinical Placement Coordinator (CPC), an innovative student support role in Irish nursing education. The paper shows how an understanding of the key phenomenological notions of bracketing and intentionality, and careful consideration of their implications for research design and conduct, can enrich nursing research by retaining the objectivity and critique central to the phenomenological method. The illumination and clarification of contested and complex concepts can be achieved by encouraging both researcher and co-researchers to get 'back to the things themselves' by taking a fresh unprejudiced look at the necessary and sufficient elements of phenomena of interest to nursing as they appear to those who experience them.

Attitude of Health Personnel↗

Focus groups: issues of analysis and interpretation.

Focus groups have become a popular method in nursing research. Their history can be traced back to marketing research methods, but they have also been used in qualitative, ethnographic research. Our study, which used this approach as part of data collection, raised many issues of analysis and interpretation: in particular, the importance of paying attention to the sequence of focus group discussions, the individuals involved, and the social context of the focus group. We conclude that focus groups are not a 'quick and easy' method of collecting data, and that issues of validity and the relationship between focus group data and other data require careful consideration.

Aged↗

Translating research into practice: the future ahead.

OBJECTIVE: To summarize and analyze the focus and methodologies of the Translating Research into Practice (TRIP) projects funded in 1999-2000 by the US Agency for Healthcare Research and Quality (AHRQ). DATA SOURCES AND STUDY DESIGN: An analysis of the successful applications for the TRIP I and II requests for applications in 1999 and 2000 was produced from the data collected. DATA COLLECTION: The following items were abstracted from each of the successful applications: provider focus, patient population, vulnerable populations, methodologies, interventions for change, outcomes measured, and conceptual framework used. PRINCIPAL FINDINGS: AHRQ funded 27 TRIP grants in 1999 and 2000. A wide variety of health care providers, settings, and patients were the target of the grants. The most common study design was a randomized controlled trial. The most common TRIP interventions were educational and the most common frameworks were either adult learning theory or organizational theory. More than half of the projects planned to use information technology and half the projects had a focus on reducing errors. CONCLUSIONS: The TRIP projects encompass a broad range of providers, environments, patients, and interventions. The field of applied research and quality improvements should be considerably enhanced by these research projects.

Evidence-Based Medicine↗

The effect of involvement in participatory research on parent researchers in a Sure Start programme.

Involving service users, patients and members of local communities in health and social care research is becoming increasingly common. However, surprisingly little research has been carried out to examine the experiences of such lay researchers. This paper presents the findings of a study to investigate the experiences of a group of parent researchers involved in a community survey within a UK Sure Start programme. The survey was undertaken to provide insight into the early impact of the programme and inform Sure Start programme expansion. Researchers were recruited from the local community and were given an accredited training programme, before working on the development of the research itself. They took a lead role in the development, data collection, analysis and report writing phases of the survey and have been actively involved with the dissemination of findings. In order to gain insight into the experiences of the lay researchers involved in this work, three separate methods were used to collect data: questionnaires before and after the study, a focus group at the end of the data collection phase and by analysis of personal diaries kept by the parent researchers. Findings reported include lay researchers responses to the accredited training programme, the development of new skills and understanding, access and the conduct of interviews and the impact of the work both for Sure Start and the researchers themselves. Some of the strengths and difficulties of participatory research are discussed and comment made on the extent to which lay involvement impacted on the conduct of the survey.

Adult↗

Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study.

BACKGROUND: Thrombolysis for acute ischemic stroke has remained controversial. The Canadian Alteplase for Stroke Effectiveness Study, a national prospective cohort study, was conducted to assess the effectiveness of alteplase therapy for ischemic stroke in actual practice. METHODS: The study was mandated by the federal government as a condition of licensure of alteplase for the treatment of stroke in Canada. A registry was established to collect data over 2.5 years for stroke patients receiving such treatment from Feb. 17, 1999, through June 30, 2001. All centres capable of administering thrombolysis therapy according to Canadian guidelines were eligible to submit patient data to the registry. Data collection was prospective, and follow-up was completed at 90 days after stroke. Copies of head CT scans obtained at baseline and at 24-48 hours after the start of treatment were submitted to a central panel for review. RESULTS: A total of 1135 patients were enrolled at 60 centres in all major hospitals across Canada. The registry collected data for an estimated 84% of all treated ischemic stroke patients in the country. An excellent clinical outcome was observed in 37% of the patients. Symptomatic intracranial hemorrhage occurred in only 4.6% of the patients (95% confidence interval [CI] 3.4%-6.0%); however, 75% of these patients died in hospital. An additional 1.3% (95% CI 0.7%-2.2%) of patients had hemiorolingual angioedema. CONCLUSIONS: The outcomes of stroke patients undergoing thrombolysis in Canada are commensurate with the results of clinical trials. The rate of symptomatic intracranial hemorrhage was low. Stroke thrombolysis is a safe and effective therapy in actual practice.

Aged↗

Monthly variations in self-reports of alcohol consumption.

OBJECTIVE: This study examines monthly variation in reports of recent alcohol consumption behavior. METHOD: Telephone survey data collected by the Behavioral Risk Factor Surveillance System were used to measure self-reports of drinking and heavy episodic drinking in the 30 days before the interview. The sample (N = 57,758) comprised cases collected in six states in 5 selected years. Monthly variability in self-reported alcohol consumption was evaluated by logistic regression analysis, using "deviation from means coding" for the month of interview, with background variables and year of interview controlled and state-level clustering adjusted. RESULTS: Adults were significantly more likely to report past 30-day alcohol consumption when interviewed during the month of January and less likely to report consumption when interviewed during March. Respondents were also more likely to report heavy episodic drinking during the month of July. Despite large differences in alcohol consumption between male and female participants, these seasonal patterns were essentially the same for both genders. CONCLUSIONS: The findings suggest that assessments of alcohol consumption that do not consider seasonal variation may be biased. In order to minimize this bias, it is recommended that researchers avoid collecting data only during these particular times of the year or extend the data collection interval and control for seasonal variability.

Adult↗

MATLAB and graphical user interfaces: tools for experimental management.

MATLAB is a convenient platform for the development and management of psychological experiments because of its easy-to-use programming language, sophisticated graphics features, and statistics and optimization tools. Through implementation of the Brainard-Pelli Psychophysics Toolbox, the MATLAB user gains close temporal and spatial control over the CRT, while retaining the simplicity of an interpreted language conductive to rapid program development. MATLAB's abilities can be further utilized through easily programmable graphical user interfaces (GUIs). We illustrate how a GUI can serve as a powerful and intuitive tool for organizing and controlling all aspects of a psychological experiment, including design, data collection, data analysis, and theory fitting.

Computer Graphics↗

Web-based research: an innovative method for nursing research.

Although still in its infancy, the World Wide Web presents unparalleled opportunities for harnessing the power of the Internet to collect data from populations of interest in an economical and efficient manner. Web-based surveys offer a number of strengths including access to specific populations, speed of data access, and decreased data collection and data entry costs. These advantages are likely to increase as more people begin to use the Web as their primary means of communication. Nurse researchers who embrace this technology will become the pioneers in the new age of nursing research.

Computer User Training↗

Statistical methods for microarray assays.

The paper shortly reviews statistical methods used in the area of DNA microarray studies. All stages of the experiment are taken into account: planning, data collection, data preprocessing, analysis and validation. Among the methods of data analysis, the algorithms for estimating differential expression, multivariate approaches, clustering methods, as well as classification and discrimination are reviewed. The need is stressed for routine statistical data processing protocols and for the search of links of microarray data analysis with quantitative genetic models.

Computational Biology↗

No time for dying: a study of the care of dying patients in two acute care Australian hospitals.

OBJECTIVES: Research was conducted in two teaching hospitals in Australia to collect data on the care of patients dying in the acute care setting. METHODOLOGY: Non-participant observation of the care of dying patients in medical wards was the primary method of data collection and selected staff were interviewed. Observers collected data on the type of care, who gave the care, and the time given to care. Thematic analysis was applied to both the observational and interview data. PARTICIPANTS: Patients selected were over the age of 18 years, with a terminal diagnosis and an estimated six days to live. RESULTS: Three major factors emerged from the data to form the context in which patients were cared for and died: 1) the organizational factor, 2) the environmental factor, and 3) the human factor. The presence or absence of family members influenced the amount of care given. If family members were not present, dying could be an isolating experience, with minimal care focused on routine hospital activities. CONCLUSION: This research indicated that the principles of palliative care are yet to be incorporated in the acute care hospital setting.

Adult↗

Understanding death and dying in select first nations communities in northern Manitoba: issues of culture and remote service delivery in palliative care.

OBJECTIVES: The purpose of this study was to delineate and describe the local palliative care services available to residents of remote Aboriginal communities in northern Manitoba; to identify attitudes and beliefs about death, dying and palliative care in these communities; and to explore obstacles related to palliative care service delivery from the perspectives of culture and geographic isolation. STUDY DESIGN: Forty-four in-depth semi-structured interviews were conducted with a reputational sample of key informants including Aboriginal people resident in remote communities, community elders and religious leaders, doctors, nurses and allied health care providers working in First Nations Communities, as well as specialist service providers in Winnipeg. Thematic qualitative analysis was done on the data collected. Data collected from interviews with northern physicians and nurses was coded and analyzed. RESULTS: Currently, many Aboriginal people living in remote communities are transported to large urban centers to die, isolated from friends, family and their culture. However, the majority of Aboriginal people and health care providers interviewed reported that Aboriginal people living in remote communities would prefer to die at home. The issues surrounding palliative care provision in remote Aboriginal communities are cultural and geographic. Culturally sensitive care requires that patients have access to family supports and traditional services if requested. Geographic isolation requires that: 1. patient-specific care plans be created for use in the remote community; 2. effective lines of communication are established between remote health care providers and urban specialists; 3. health care providers and family care-givers be properly trained to fill their respective roles; and 4. appropriate guidelines and resources be available in the community to support this type of care. CONCLUSIONS: Providing the equipment, supports and education necessary for home-based palliative care in remote Aboriginal communities can be an effective way of addressing the medical, psycho-social, and spiritual needs of these patients.

Death↗

Closed-loop control of SaO2 in the neonate.

A microprocessor-based device has been designed to control oxygen saturation (SaO2) in neonates by adjusting the inspired air-oxygen mixture (FiO2) delivered by a mechanical blender. The user sets a target SaO2, which the controller attempts to maintain. Alarms are actuated if the neonate's SaO2 is outside predefined limits. SaO2 levels are extracted from a commercial pulse oximeter and analyzed by an eight-bit microprocessing unit (MPU). Delivered percentages of FiO2 are adjusted by a motorized air-oxygen blender. The controller has a menu-driven user interface and can graphically present four-hour trends of the SaO2, FiO2, or blender setting. Sixteen hours of collected data can be stored and later downloaded to a personal computer. A real-time multitasking operating system forms the nucleus of the controller's software. Major tasks that share MPU time are control, filtering, user display, data collection, data archiving, alarm monitoring, and user input. Analog SaO2 levels are read and converted to digital values, which are then filtered to extract noise. A differential control algorithm is used to determine the required FiO2 blender setting. The blender is then adjusted to the new setting, after which the controller waits to repeat the process of sampling SaO2 and adjusting FiO2. System response time and blender increments are adjustable to allow a user to tune the controller to the patient's needs. Alarm conditions of concern within the device are SaO2 and FiO2 sensor disconnection, blender disconnection, and SaO2 limiting errors. In preliminary trials, for a target of 92.0% SaO2, a prototype controller maintained an average of 91.6% with a standard deviation of 5.0% over a one-hour period.(ABSTRACT TRUNCATED AT 250 WORDS)

Analog-Digital Conversion↗

[Public health surveillance: historical origin, methods, and assessment].

In the last three decades disease surveillance has grown into a complete discipline, quite distinct from epidemiology. This expansion into a separate scientific area within public health has not been accompanied by parallel growth in the literature about its principles and methods. The development of the fundamental concepts of surveillance systems provides a basis on which to build a better understanding of the subject. In addition, the concepts have practical value as they can be used in designing new systems as well as understanding or evaluating currently operating systems. This article reviews the principles of surveillance, beginning with an historical survey of the roots and evolution of surveillance, and discusses the goals of the public health surveillance. Methods for data collection, data analysis, interpretation, and dissemination are then presented, together with proposed procedures for evaluating and improving a surveillance system. Finally, some points to be considered in establishing a new surveillance system are presented.

Data Collection↗