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PubMed2004

Ten Australian ICU nurses' perceptions of organisational restructuring.

The Australian healthcare system underwent radical reform in the 1990s as economic rationalist policies were embraced. As a result, there was significant organisational restructuring within hospitals. Traditional indicators, such as nursing absenteeism and attrition, increase during times of organisational change. Despite this, nurses' views of healthcare reform are under-represented in the literature and little is known about the impact of organisational restructuring on perceived performance. This study investigated the perceived impact of organisational restructuring on a group of intensive care unit (ICU) nurses' workplace performance. It employed a qualitative approach to collect data from a purposive sample of clinical nurses. The primary method of data collection was semi-structured interviews. Content analysis generated three categories of data. Participants identified constant pressure, inadequate communication and organisational components of restructuring within the hospital as issues that had a significant impact on their workplace performance. They perceived organisational restructuring was poorly communicated, and this resulted in an environment of constant pressure. Organisational components of restructuring included the subcategories of specialised service provision and an alternative administrative structure that had both positive and negative ramifications for performance. To date, there has been little investigation of nurses' perceptions of organisational restructure or the impact this type of change has in the clinical domain. Participants in this study believed reorganisation was detrimental to quality care delivery in intensive care, as a result of fiscal constraint, inadequate communication and pressure that influenced their workplace performance.

Adult↗
PubMed2002

[On-line outcome study of unruptured cerebral aneurysm in Japan (UCAS Japan)].

Information technology has been introduced in the medical field recently, and has become an essential tool for medical research in many aspects. Japanese Neurosurgical Society has been conducting a national study on the outcome of unruptured cerebral aneurysms (UCA) using on-line registration system. In this report, the author reports preliminary outcome of this study and discuss the usefulness and limits of studies using such technology. This study is a prospective cohort study and enrolled patients are cases with newly diagnosed UCA after Jan. 1,2001. So far, we have collected data of 2979 new patients (3667 aneurysms) with UCA registered from 385 institutions. Seventy five percent of the institutions sent data through the online registration. On-line registration system made data collection from all over the country very quick and easy. Analyzing such data could be achieved with minimal cost and time. Such study design can eliminate the handicap of geographic distance and can be applied for international studies. On the other hand, such system does not suit complicated study or rare disease. And On-line study design requires special consideration on various scenario and uniformity in assessing inclusion, procedure and outcome.

Humans↗
PubMed1997

Commercially motivated renal transplantation: results in 540 patients transplanted in India. The Living Non-Related Renal Transplant Study Group.

Commercial renal transplantation is widely condemned on moral and ethical grounds. Moreover, previous studies involving small numbers of patients, mostly from tertiary care centers, have reported poor patient and graft survival. The Living Non-Related Renal Transplant Study Group was established to determine the overall results and complications in a large number of patients who received this type of transplantation in India. In this study we retrospectively collected data from 22 centers on 540 patients who had received commercial renal transplantation (CRT) in India between 1978 and 1993. The data collected included demographic characteristics of patients, the primary renal disease, dialysis and pretransplant data, immunosuppressive regimen, rejection episodes, post-transplant data, as well as patient and graft outcomes. Results were compared with those of 75 recipients of emotionally related renal transplantation (ERT) performed in two participating institutions in the Middle East. Among the 540 patients, 7.5% were younger than 20 yr of age and 14.2% were 50 yr of age or older. After adjusting for several variables, the 1-, 3-, and 5-yr patient survival rates in the CRT were 97, 94, and 92%, and in the ERT 95, 91, and 91% respectively (p = 0.4921). The corresponding rates for graft survival were 90, 81, and 72%, and 90, 86, and 83%, respectively (p = 0.5336). There was a higher incidence of human immune deficiency virus (HIV) infection (4.6% vs. 0% p = 0.053), and hepatitis B virus (HbsAg) infection rate (8.1% vs. 1.4% p = 0.03) in CRT. In conclusion, patient and graft survival rates in recipients of commercial renal transplantation are similar to those in recipients of emotionally related transplantation done in our institutions. However, the incidence of serious infections with HIV and HbsAg is significantly higher.

Adult↗
PubMed2001

Assessing physicians' accuracy in diagnosing paediatric patients with acute abdominal pain: measuring accuracy for multiple diseases.

In evaluating the accuracy of diagnostic tests there are many situations where the true disease status can be one of multiple disorders. For example, when paediatric patients suffer acute abdominal pain, the underlying diagnosis could be appendicitis, intestinal obstruction, gastroenteritis, urinary tract infection, etc. In this paper we describe a format for collecting data for the case of multiple truth states. This new format allows one to make pairwise comparisons of the diagnostic accuracy between all of the different truth states. We propose a summary measure of accuracy which is a weighted average of the pairwise estimates of accuracy. Estimators are derived for the variance and covariance of the estimated summary accuracy. The small sample properties of the estimators are evaluated in a Monte Carlo simulation study. The new data collection format and summary measure were used in a paediatric acute abdominal pain study; data from this study are used to illustrate the methods.

Abdomen, Acute↗
PubMedDate not supplied

Automated image acquisition for single-particle reconstruction using p97 as the biological sample.

We have used Leginon, a fully automatic system capable of acquiring cryo-electron micrographs, to collect data of single particles, specifically of the AAA ATPase p97. The images were acquired under low-dose conditions and required no operator intervention other than the initial setup and periodic refilling of the cold-stage dewar. Each image was acquired at two different defocus values. Two-dimensional projection maps of p97 were calculated from these data and compared to results previously obtained using the conventional manual data collection methods to film. The results demonstrate that Leginon performs as well as an experienced microscopist for the acquisition of single-particle data. The general advantages of automation are discussed.

Adenosine Triphosphatases↗
PubMed2005

Deliberations of an Advisory Committee regarding priorities, sources, and methods for collecting animal antimicrobial use data in the United States.

This paper describes the methodological options for food animal antimicrobial use data collection in the United States, including data priorities, methods, and limitations that were identified by a diverse group of expert stakeholders. Four major categories of antimicrobial use data were identified based on the source of information and its proximity to actual use: end-user data, prescription data, manufacturing data, and distribution data. Criteria were developed to aid in evaluating the overall utility of each methodological option, and an attempt was made to develop a qualitative, composite "overall usefulness" score for each option. Concensus was not reached on option scores, therefore, the experts individually rated six methodological options relative to the evaluation criteria, and provided comments and rationale for each response. The responses serve as a microcosm of the issues and stakeholder perspective: most relevant to animal antimicrobial use data collection in the United States.

Animals↗
PubMed2002

Hypersensitivity to sound (hyperacusis): a prevalence study conducted via the Internet and post.

The present study explored the prevalence and descriptive characteristics of hyperacusis, defined as unusual intolerance of ordinary environmental sounds. Two ways of collecting data were used in the study: the first was a postal survey of a random sample, to which 589 responded (59.7% response rate); the second was the internet, and 595 self-recruited individuals responded to a call for participants via a banner on a web page (51.9% response rate). The point prevalence rates of hyperacusis were 9% in the internet group and 8% in the postal group. Exclusion of participants who reported hearing impairment resulted in point prevalence rates of 7.7% (n = 39) and 5.9% (n = 28) respectively. The data collection format did not result in any substantial differences. Hyperacusis was associated with concentration difficulties, use of ear protection, avoidance, tension, and sensitivity to light/colours. The present data suggest that hyperacusis is a common problem.

Adolescent↗
PubMed1998

Methods for the Hong Kong Vision Study: a pilot assessment of visual impairment in adults.

INTRODUCTION: The Hong Kong Vision Study (HKVS) was a pilot study to collect data on the prevalence of eye diseases and risk factors in Hong Kong using methodology comparable to that developed in America and Australia. AIM: The main goal was: to evaluate the application of the methodology in a different culture and language; and to determine the prevalence and risk factors of eye diseases in order to design a larger study of an ethnic Chinese population. METHOD: This study was patterned after the Melbourne Visual Impairment Project using the Chinese language in data collection and examinations. CONCLUSION: Well-designed methodology is transferable to different cultures, languages and continents. Use of similar methodology will enable better comparisons and analyses to be made from population-based data.

Adult↗
PubMed2005

Adapting developing country epidemiological assessment techniques to improve the quality of health needs assessments in developed countries.

BACKGROUND: We were commissioned to carry out three health assessments in urban areas of Dublin in Ireland. We required an epidemiologically robust method that could collect data rapidly and inexpensively. We were dealing with inadequate health information systems, weak planning data and a history of inadequate recipient involvement in health service planning. These problems had also been identified by researchers carrying out health assessments in developing countries. This paper reports our experience of adapting a cluster survey model originally developed by international organisations to assess community health needs and service coverage in developing countries and applying our adapted model to three urban areas in Dublin, Ireland METHODS: We adapted the model to control for socio-economic heterogeneity, to take account of the inadequate population list, to ensure a representative sample and to account for a higher prevalence of degenerative and chronic diseases. We employed formal as well as informal communication methods and adjusted data collection times to maximise participation. RESULTS: The model we adapted had the capacity to ascertain both health needs and health care delivery needs. The community participated throughout the process and members were trained and employed as data collectors. The assessments have been used by local health boards and non-governmental agencies to plan and deliver better or additional services. CONCLUSION: We were able to carry out high quality health needs assessments in urban areas by adapting and applying a developing country health assessment method. Issues arose relating to health needs assessment as part of the planning cycle and the role of participants in the process.

Censuses↗
PubMed2005

Development of a multicenter peripheral arterial interventional database: the PVD-QI2.

BACKGROUND: The number of peripheral vascular intervention (PVI) procedures performed is steadily increasing in the United States. PVD-QI 2 is a prospective, multicenter observational study designed to improve the quality of care for patients undergoing PVI and to better understand the effectiveness and appropriateness of PVI in improving outcomes of peripheral arterial disease. The registry aims to elucidate which comorbid conditions and procedure-related variables are associated with beneficial or adverse outcomes after vascular interventions. METHODS: Five centers are currently prospectively collecting data on consecutive PVIs performed at their institutions and will include patients with both claudication and critical limb ischemia. A common data collection form and a standard set of definitions were developed during several planning meetings. Information on patient demographics, clinical history, comorbid conditions, treatment approaches, and in hospital outcomes are being collected. Patients will be followed up at 30 days, 6 months, and 1 year after each procedure to identify recurrent vascular events, medication use, lifestyle modifications (regular exercise, dietary modification), self-reported walking scores, and mortality. Data validity will be assured through review of data form accuracy by a trained nurse, by automatic database diagnostic routines, and by site visits that include review of angiography suite logs and randomly selected charts. CONCLUSIONS: The development of a quality-controlled PVI registry requires the commitment and collaboration of clinician-investigators and hospital systems devoted to understanding factors that contribute to quality outcomes. Central to achievement of this goal is the creation of a careful diagnostic and data quality assessment system. This registry will provide important clinical insights into patient demographic and clinical characteristics, procedural characteristics, and current practice patterns that foster or impede achievement of long-term quality-based clinical outcomes for patients with peripheral arterial disease.

Databases, Factual↗
PubMed2006

The evolution of the emergency care practitioner role in England: experiences and impact.

BACKGROUND: The emergency care practitioner (ECP) is a generic practitioner who combines extended nursing and paramedic skills. The "new" role emerged out of changing workforce initiatives intended to improve staff career opportunities in the National Health Service and ensure that patients' health needs are assessed appropriately. OBJECTIVE: To describe the development of ECP Schemes in 17 sites, identify criteria contributing to a successful operational framework, analyse routinely collected data and provide a preliminary estimate of costs. METHODS: There were three methods used: (a) a quantitative survey, comprising a questionnaire to project leaders in 17 sites, and analysis of data collected routinely; (b) qualitative interpretation based on telephone interviews in six sites; and (c) an economic costing study. RESULTS: Of 17 sites, 14 (82.5%) responded to the questionnaire. Most ECPs (77.4%) had trained as paramedics. Skills and competencies have been extended through educational programmes, training, and assessment. Routine data indicate that 54% of patient contacts with the ECP service did not require a referral to another health professional or use of emergency transport. In a subset of six sites, factors contributing to a successful operational framework were strategic visions crossing traditional organisational boundaries and appropriately skilled workforce integrating flexibly with existing services. Issues across all schemes were patient safety, appropriate clinical governance, and supervision and workforce issues. On the data available, the mean cost per ECP patient contact is 24.00 pounds sterling, which is less than an ED contact of 55.00 pounds sterling. CONCLUSION: Indications are that the ECP schemes are moving forward in line with original objectives and could be having a significant impact on the emergency services workload.

Delivery of Health Care↗
PubMed1993

Risk factors for renal cell carcinoma: results of a population-based case-control study.

For a case-control study of risk factors for renal cell carcinoma, a mailed questionnaire was used to collect data on 518 cases and 1,381 population-based controls in Ontario, Canada. Active cigarette smoking increased risk twofold among males (odds ratio estimate [OR] = 2.0, 95 percent confidence interval (CI) = 1.4-2.8) and females (OR = 1.9, CI = 1.3-2.6). Passive smoking appeared to increase risk somewhat among nonsmokers (males: OR = 1.6, CI = 0.5-4.7; females: OR = 1.7, CI = 0.8-3.4). A high Quetelet index (QI) was associated with a twofold increase in risk in both sexes, although this was based on reported weight at age 25 years for males (OR = 1.9, CI = 1.2-3.1) and five years prior to data collection for females (OR = 2.5, CI = 1.4-4.6). Diuretic use was associated with significantly increased risk among females, but not among males. Phenacetin use increased risk, while acetaminophen use was not associated with altered risk, although few subjects used either compound. Multiple urinary tract infections increased risk, but only significantly in females (OR = 1.9, CI = 1.2-2.9). Our data indicate the need for further exploration of passive smoking and diuretics as risk factors, as well as elucidation of mechanisms by which high lifetime QI and frequent urinary-tract infections might increase risk of this cancer.

Adult↗
PubMed1995

A comparison of various methods of collecting self-reported health outcomes data among low-income and minority patients.

In a randomized trial of different data collection methods, we challenged the untested assumption that reliable data cannot be obtained from lower-income and/or minority patients by self-administered questionnaires. We tested three methods of data collection among a sample of lower-income and minority patients (n = 697) in Indianapolis at a site for the Type II Diabetes Patient Outcomes Research Team. The study included a questionnaire literacy screening instrument to assess patients' functional literacy. Based on their functional literacy, patients were randomized to one of three methods of data collection: mail-out/mail-back, hand-out/assisted, or the in-home interview. We constructed a tiered system for reassigning nonresponders to alternative methods of data collection, using the in-home interview as the fall-back strategy. We compared the response rates, item completion rates, and internal consistency reliabilities of self-reported health status measures between patients with and without literacy limitations and across the three methods of data collection. Patients with and without literacy limitations, across methods of data collection, provided high-quality data, as evidenced by high item completion rates (> 84%) and high reliability assessments (internal consistency reliability coefficients > .80) for each health status measure. As part of the tiered study design, nonresponders randomized to either the mail-out/mail-back or the hand-out/assisted method were interviewed. These patients were significantly older, had significantly lower education and income levels, and had significantly poorer self-reported visual function as compared with those who responded to the originally assigned method. We conclude that expensive, labor-intensive data collection methods, such as in-home interviews, are not necessary for many low-income, minority patients to generate high-quality, reliable health status data. Using appropriate screening instruments, those patient subgroups needing special help can be screening instruments, those patient subgroups needing special help can be identified and targeted for more expensive data collection methods. This tiered approach has policy implications for the cost, feasibility, and quality of data collection in health outcomes research.

Aged↗
PubMedDate not supplied

Investigating users' requirements: computer-based anatomy learning modules for multiple user test beds.

OBJECTIVE: User data and information about anatomy education were used to guide development of a learning environment that is efficient and effective. The research question focused on how to design instructional software suitable for the educational goals of different groups of users of the Visible Human data set. The ultimate goal of the study was to provide options for students and teachers to use different anatomy learning modules corresponding to key topics, for course work and professional training. DESIGN: The research used both qualitative and quantitative methods. It was driven by the belief that good instructional design must address learning context information and pedagogic content information. The data collection emphasized measurement of users' perspectives, experience, and demands in anatomy learning. MEASUREMENT: Users' requirements elicited from 12 focus groups were combined and rated by 11 researchers. Collective data were sorted and analyzed by use of multidimensional scaling and cluster analysis. RESULTS: A set of functions and features in high demand across all groups of users was suggested by the results. However, several subgroups of users shared distinct demands. The design of the learning modules will encompass both unified core components and user-specific applications. The design templates will allow sufficient flexibility for dynamic insertion of different learning applications for different users. CONCLUSION: This study describes how users' requirements, associated with users' learning experiences, were systematically collected and analyzed and then transformed into guidelines informing the iterative design of multiple learning modules. Information about learning challenges and processes was gathered to define essential anatomy teaching strategies. A prototype instrument to design and polish the Visible Human user interface system is currently being developed using ideas and feedback from users.

Anatomy↗
PubMed2001

Conducting research in culturally diverse inner-city neighborhoods: some lessons learned.

Social, behavioral, and health research among disenfranchised groups in inner cities poses problems in collecting data. It is a challenge to achieve data of sufficient quantity and quality necessary to be scientifically usable. This article describes the experiences of a research team during two phases of data collection in a mental health intervention study in New York's South Bronx. Challenges in addressing human subject concerns, the formation of a fieldwork team, enrollment and retention of respondents, and administration of instruments are described and solutions are discussed. Emphasis is placed on researchers' approaches to the selection, orientation, and safety of interviewers, interviewer-respondent race and ethnic matching, contacts and rapport with respondents, and the handling of such interpersonal issues as distrust, poor cooperation, and family dynamics. The procedures developed took into consideration the culture and life conditions of the population to ensure a satisfactory response rate and high-quality data.

Cultural Diversity↗
PubMed2005

Second year scepticism: pre-qualifying health and social care students' midpoint self-assessment, attitudes and perceptions concerning interprofessional learning and working.

A study in an English Faculty of Health and Social Care explores the effects of a pre-qualifying interprofessional curriculum incorporating interprofessional modules in each year of study. The study design involves collecting data on entry to the Faculty, after completion of the second interprofessional module, on qualification and after 9 months qualified practice. At each point, students complete questionnaires concerning communication and teamwork skills and interprofessional learning and working. This paper presents results from 723 students at the second data collection point. Although most students were positive about their communication and teamwork skills, they were less positive than on entry to the Faculty. Similarly there was a negative shift in students' attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own interprofessional relationships. Mature students' responses were more positive than those of younger students. The emergence of differences in responses based on a professional programme suggests that interprofessional education may not necessarily influence professional socialization. Demographic and professional variables affecting students' responses in their second year of study demonstrate the complexity of student learning. The planned follow-up of the students will show whether variables affecting interim data have a long-term effect on attitudes.

Attitude of Health Personnel↗
PubMed2002

Evaluation of the national control of diarrhoeal disease programme in the Philippines, 1980-93.

OBJECTIVE: To evaluate the impact of the National Control of Diarrhoeal Disease Programme (NCDDP) in the Philippines over the period 1980-93, describing levels and trends in programme activities, and relating them to severe diarrhoea morbidity and mortality among under-5-year-olds. METHODS: Routinely collected data on morbidity and mortality trends were obtained from health statistics reports of the Health Intelligence Service and the NCDDP. Socioeconomic indicators, including annual average family income and expenditures, gross national product, and unemployment rates, were derived from the Philippine population census data collected by the National Statistics Office. FINDINGS: In relation to baseline levels, diarrhoea mortality among infants and young children fell by about 5% annually over the 18-year period under review. The decline was faster than those related to acute respiratory infections (ARIs) among children of similar age and to perinatal causes. Diarrhoea hospital admission rates registered an annual decline of 2.4% relative to the baseline level. CONCLUSION: These findings suggest that the programme had a substantial impact; the period under review also witnessed some degree of improvement in other factors with positive influences on health, such as exclusive breastfeeding, nutrition and environmental sanitation. The quality, particularly completeness and reliability, of the existing data did not allow further analysis, thus, making it difficult to conclude beyond doubt that the observed trends indicate that they were solely due to NCDDP.

Breast Feeding↗
PubMed1991

Time spent in state-recommended functions by consultant dietitians in Wisconsin skilled nursing facilities.

In this study we determined how consultant dietitians working in Wisconsin skilled nursing facilities distributed their time among contracted duties. At the time of the study, the 400 skilled nursing facilities in Wisconsin employed 160 consultant dietitians. Of these, 135 consultant dietitians were eligible to participate in the study. A mailed questionnaire was used to collect data on educational background, experience, and actual time spent in state-recommended functions, additional resident-care functions, and additional non-resident-care functions. Completed, usable questionnaires were returned by 65 (48%) of the 135 consultant dietitians. Data were analyzed statistically and presented as medians, means, and standard deviations. Mean time (minutes) consultant dietitians spent per resident admission activity was as follows: data collection, 31.3; care planning, 28.9; resident counseling, 18.5; medical record review, 17.7; discharge referral, 15.4. Mean time (minutes) consultant dietitians spent per month in other activities was as follows: facility evaluation, 75.3; student training, 120; allied staff training, 38.7; foodservice staff training, 46.8; technician training, 128; menu planning, 76.9; diet manual review, 21.6; quality assurance programs, 31.8; quality assurance audits, 34; report preparation for facility administrator, 33.4; and policy development, 32.8. Mean times reported in this study may be used as time guidelines by the state of Wisconsin for evaluating how skilled nursing facilities contract for services of consultant dietitians. Other state and federal regulatory agencies could use the time guidelines for comparison and verification until future studies provide more data on time standards for state-recommended functions, additional resident-care functions, and additional non-resident-care functions.

Consultants↗