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At least 19 recordsLinked to original sources
PubMed2003

Understanding the normalization of telemedicine services through qualitative evaluation.

OBJECTIVE: Qualitative studies can help us understand the "successes" and "failures" of telemedicine to normalize within clinical service provision. This report presents the development of a robust conceptual model of normalization processes in the implementation and development of telemedicine services. DESIGN: Retrospective and cumulative analysis of longitudinal qualitative data from three studies was undertaken between 1997 and 2002. Observation and semistructured interviews produced a substantial body of data relating to approximately 582 discrete data collection episodes. Data were analyzed separately in each of three studies. Cumulative analysis was conducted by constant comparison. RESULTS: (1) Implementation of telemedicine services depends on a positive link with a (local or national) policy level sponsor. (2) Adoption of telemedicine systems in service depends on successful structural integration so that development of organizational structures takes place. (3) Translation of telemedicine technologies into clinical practice depends on the enrollment of cohesive, cooperative groups. (4) Stabilization of telemedicine systems in practice depends on integration at the level of professional knowledge and practice, where clinicians are able to accommodate telemedicine through the development of new procedures and protocols. CONCLUSION: A rationalized linear diffusion model of "telehealthcare" is inadequate in assessing the potential for normalization, and the political, organizational, and "ownership" problems that govern the process of development, implementation, and normalization need to be accounted for. This report presents a model for assessing the potential for successful implementation of telehealthcare services. This model defines the requirements for the successful normalization of telemedicine systems in clinical practice.

Diffusion of Innovation↗
PubMed2002

Evaluating qualitative assays using sensitivity and specificity.

Sensitivity and specificity are two important indices of performance of qualitative assays. Evaluating these indices usually requires one to identify the true disease state of each subject involved in a study. This implies that a perfect test, a "gold standard," is needed to test each subject. However, a gold standard test cannot always be performed on all subjects, whether because of cost or adverse effect on a subject's welfare. In these situations, a common practice is to apply both a currently used assay and an investigational assay to the same specimen. If the testing results are discordant, a gold standard test is applied. This approach has been criticized by many and, in fact, the statistics based on this approach usually overestimate sensitivity and specificity. This paper proposes two alternative methods to estimate sensitivity and specificity. Simulation results show that these methods perform better than the commonly used existing ones. This paper proposes new acceptance criteria and designs to specific topics for the evaluation of blood related assays as well. To evaluate a qualitative assay related to blood specimens, one must also perform studies of storage conditions, interfering substances, and other related factors, in order to establish the equivalency of the assay under standard and various other conditions. To conduct these studies, true negative blood donor specimens are used as a sample from a nondiseased population; and blood donor specimens with spiked analyte are used to represent a sample from a diseased population. Currently, the target-spiking ranges and sample sizes are determined subjectively. This paper presents new acceptance criteria on acceptable conditions and objective standards for selecting the target-spiking range and sample size.

Algorithms↗
PubMed2006

Bedside echocardiographic evaluation of hemodynamics in sepsis: is a qualitative evaluation sufficient?

OBJECTIVE: Transesophageal echocardiography (TEE) has proven its efficiency in assessing hemodynamics in patients by its ability to evaluate cardiac function and fluid responsiveness. Classically, it requires quantitative measurements, whereas in routine practice TEE is used in our unit especially as a qualitative procedure. We assessed the accuracy of this qualitative central hemodynamic evaluation obtained by TEE at the bedside. DESIGN AND SETTING: Prospective study conducted in a medical ICU between September 2004 and April 2005. All TEE examinations performed in consecutive patients hospitalized for septic shock and mechanically ventilated for an associated acute lung injury were eligible for evaluation. Intensivists trained in echocardiography were asked to classify (a) respiratory changes in the superior vena cava (SVC), (b) left ventricular (LV) systolic function, (c) right ventricular (RV) end-diastolic size, and (d) shape and kinetics of the interventricular septum (IVS). A post-hoc quantitative evaluation was then performed by a trained investigator unaware of the patients' status. RESULTS: We evaluated 83 examinations in 30 patients. Qualitative evaluation was easily able to distinguish patients with significant or nonsignificant SVC respiratory changes, normal, moderately or markedly depressed LV systolic function, and nondilated or dilated right ventricle. Acute cor pulmonale was also well recognized. CONCLUSION: By its ability accurately to evaluate hemodynamic status qualitative TEE could be useful for intensivists in managing circulatory failure in septic shock, rendering the more time-consuming quantitative evaluation useless.

Aged↗
PubMed2003

Health systems research training enhances workplace research skills: a qualitative evaluation.

INTRODUCTION: In-service education is a widely used means of enhancing the skills of health service providers, for example, in undertaking research. However, the transfer of skills acquired during an education course to the workplace is seldom evaluated. The objectives of this study were to assess learner, teacher, and health service manager perceptions of the usefulness, in the work setting, of skills taught on a health systems research education course in South Africa and to assess the extent to which the course stimulated awareness and development of health systems research in the work setting. METHODS: The education course was evaluated using a qualitative approach. Respondents were selected for interview using purposive sampling. Interviews were conducted with 39 respondents, including all of the major stakeholders. The interviews lasted between 20 and 60 minutes and were conducted either face to face or over the telephone. Thematic analysis was applied to the data, and key themes were identified. RESULTS: The course demystified health systems research and stimulated interest in reading and applying research findings. The course also changed participants' attitudes to routine data collection and was reported to have facilitated the application of informal research or problem-solving methods to everyday work situations. However, inadequate support within the workplace was a significant obstacle to applying the skills learned. DISCUSSION: A 2-week intensive, experiential course in health systems research methods can provide a mechanism for introducing basic research skills to a wide range of learners. Qualitative evaluation is a useful approach for assessing the impacts of education courses.

Education, Medical, Continuing↗
PubMed1998

[Qualitative evaluation of brain structure in CT in panic disorders].

This CT study was designed to assess brain morphology in panic disorder with and without agoraphobia. Twenty-one patients and 21 normal control subjects matched for age and sex were investigated. Frontal and parieto-occipital cortex, temporal cortex, lateral ventricles and 3rd ventricle were evaluated by qualitative assessment on a 3-point scale (normal, questionable, abnormal). Patients showed significant bilateral enlargement of cortical cerebrospinal fluid (CSF) spaces (p < 0.01). The rating "abnormal" was given to none (0%) of the normal controls, but to 7 (33.3%) of the patients. Explorative analysis showed that these abnormalities were predominantly located in prefrontal regions. No qualitative differences were seen in the temporal cortex, lateral ventricles or third ventricle. These findings support the hypothesis that alterations in brain morphology are involved in the etiology of panic disorder. The lack of a correlation between CSF enlargement and duration of illness suggests that frontal CSF enlargement is a neurobiological vulnerability marker in panic disorder.

Adult↗
PubMedDate not supplied

Qualitative evaluation of a stress management intervention for elderly caregivers at home: a constructivist approach.

The purpose of this project was to evaluate, using a constructivist qualitative design, an individual stress management intervention based on a stress-coping model and intended for family caregivers of elderly persons within the current context of the shift to ambulatory care. This nursing intervention comprised seven weekly encounters with caregivers following their elderly family member's discharge from hospital and a follow-up visit one month after. The aim of the qualitative evaluation was to document the feasibility and acceptability of the content of the intervention, its relevance in terms of process and structure, and the benefits to the principal stakeholders. This action research project was a case study of four participants. The assessment instruments included an intervention analysis grid, a diary, and a semistructured interview guide with the participants. Data analysis drew on Guba and Lincoln's (1989) method which made it possible to refine the intervention. Results underscored that certain implementation conditions must be respected in order to ensure the intervention's acceptability and feasibility. Above all, it must remain flexible and the nurse must possess the requisite clinical skills and theoretical knowledge. It is important also to screen judiciously for caregivers likely to benefit from the intervention. The pertinence of using a circular intervention model rather than a linear approach to stress management was highlighted as well.

Adaptation, Psychological↗
PubMed1985

The nature of explanation in qualitative evaluation.

In recent years evaluation has mushroomed dramatically as a discipline. A number of evaluation "models" or approaches have been conceived, and varieties of social science methods have been employed serving several evaluative purposes. Missing from the health profession's literature on evaluation is a discussion of the underlying explanatory purposes of evaluative inquiry. It can be argued that systematic accounts of a logical inquiry (evaluation) are inextricably bound to particular views or accounts of the logic of explanation. In this article those accounts of explanation that pertain to conventional and qualitative evaluation are reviewed and compared. The article describes what one has "bought off on" when applying the explanatory rationale underlying qualitative evaluation approaches. Problems and possibilities are described for the practice of qualitative evaluation in the health professions.

Evaluation Studies as Topic↗
PubMed1984

Are validity and reliability "relevant" in qualitative evaluation research?

Interest in and use of qualitative methodological strategies in evaluating research have increased considerably in the last few years. Many of the recent evaluation frameworks or models are entirely or partly oriented toward use of qualitative methods. A number of methodological issues and concerns have been raised, including the appropriateness of validity and reliability estimation for the measurement strategies employed in qualitative evaluations becoming more common in health and other fields. In this article, the views of prominent qualitative methodologists on this topic are briefly summarized; a case is made for the relevance of validity and reliability estimation; definitions of validity and reliability for qualitative measurement are presented; and appropriate estimation techniques are suggested. It is hoped that discussions such as this will promote increased attention to validity and reliability concerns in qualitative evaluations and thus help improve the quality of those evaluations.

Evaluation Studies as Topic↗
PubMed1994

[Qualitative evaluation of 123I-IMP SPECT using a rotating gamma camera in atherosclerotic large-artery disease].

PURPOSE Quantitative measurement of regional cerebral blood flow (rCBF) needs special equipment or invasive blood sampling. Therefore, with a popularly used rotating gamma camera, we tried to establish a convenient modality of qualitative evaluation of hemodynamics in patients with atherosclerotic large-artery disease, according to the distribution pattern of isotope-uptake on SPECT image. PATIENTS AND METHODS Forty-one patients with atherosclerotic large-artery disease [9 internal carotid artery (ICA) stenosis, 17 ICA occlusion, 8 middle cerebral artery (MCA) stenosis, and 7 MCA occlusion] and 32 control patients documented as having small cerebral infarction without atherosclerotic large-artery disease were investigated. Using the rotating gamma camera, they underwent 123I-IMP SPECT at baseline and after acetazolamide loading. According to the distribution pattern of low isotope-uptake, early images were classified into four types: Type I: no low uptake, Type II: low uptake in a single watershed, Type III: low uptake in two watersheds with or without a partial MCA territory, Type IV: low uptake in a whole MCA territory. RESULT In patients with large-artery disease, baseline images presented Type I in 12 cases, Type II in 16, Type III in 9, Type IV in 4, and loading images Type I in 3, Type II in 2, Type III in 8, Type IV in 28. Of 37 patients except for 4 belonging to Type IV at baseline, 32 (86.5%) had a more extensive low isotope-uptake area after acetazolamide loading than at baseline. In control patients, baseline images presented Type I in 25, Type II in 7, and the Type III & IV in 0, and the Type after loading was the same as the Type at baseline. CONCLUSION We established the qualitative evaluation of 123I-IMP SPECT image by detecting the "extent" of the ischemic region, taking notice of watershed. The pathognomonic findings on SPECT image of atherosclerotic large-artery disease showed that low isotope-uptake area at baseline extended into two watersheds or MCA territory by acetazolamide loading. The modality of qualitative evaluation based on these pathognomic findings of SPECT image may be useful for easily assessing patients with atherosclerotic large-artery disease using a rotating gamma camera.

Adult↗
PubMed2006

Chronic pancreatitis: MRCP versus ERCP for quantitative caliber measurement and qualitative evaluation.

PURPOSE: To retrospectively compare-in patients with chronic pancreatitis-magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) for measurement of main pancreatic duct (MPD) diameter by using area intensity measurement (AIM) at MRCP and full width at half maximum (FWHM) at ERCP and to retrospectively determine the accuracy of MRCP for depiction of pathologic changes by using ERCP as the reference standard. MATERIALS AND METHODS: The institutional review board approved this study and waived the need to obtain informed consent. Both MRCP and ERCP were performed in 24 patients with chronic pancreatitis (21 men, three women; mean age, 54 years +/- 14 [standard deviation]). The diameter of the MPD was determined by using both methods at the same sites in the head, body, and tail of the pancreas. MRCP and ERCP measurements involved AIM and FWHM techniques, respectively. For qualitative evaluation, visualization of the MPD and pathologic findings was also examined by using both methods. Paired t and Wilcoxon matched-pair signed rank tests were performed for the quantitative and qualitative evaluations, respectively. RESULTS: The mean diameter of the MPD at ERCP was 1.5 times larger, on average, than that at MRCP; differences were statistically significant for each segment, as well as for the entire duct system. For qualitative evaluation, MRCP tended to be superior to ERCP for delineation of the MPD. Overall sensitivity, specificity, and accuracy values of MRCP for delineating pathologic pancreatic changes were 88% (87 of 99), 98% (44 of 45), and 91% (131 of 144), respectively. CONCLUSION: Use of ERCP tends to result in overestimation of the caliber of the MPD. MRCP can enable accurate evaluation of the condition of the pancreatic duct and its changes in patients with chronic pancreatitis.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed2006

Taking the call-bell home: a qualitative evaluation of Tele-HomeCare for children.

Tele-HomeCare (THC) delivers health care at home using telephone technologies. A THC service was developed as an adjunct to existing hospital and community care systems. It connected healthcare providers to children and families at home, during the initial transition from hospital to home, using video-conferencing phones and remote vital signs monitors. The goal was to support the transition from hospital to home, for children with subacute healthcare needs. This paper reports the qualitative evaluation of THC and describes the experiences of families supported by THC. A total of 16 mothers, four fathers and two adolescents from 16 families participated in a series of interviews conducted before, during and after THC. The interviews focused on the impact of THC on the children, on the families, and on their overall healthcare experience. Analysis of their accounts identified three subthemes: the stable child, a sense of security, and the healthcare-proficient parent. These subthemes were consistent across all time points and participants. Together they contributed to the overall effect of THC: the timely reunification of the family at home. THC was consistently reported to be an important resource that supported children and families during the transition from hospital to home. The benefits to children and families observed in this study may have also been a consequence of returning to their home environment, since THC allowed these children to be discharged home at a much earlier period. However, our findings are consistent with previous reports of the benefits of THC. Thus, THC is a successful method of healthcare service delivery that enables a safe return home with professional support provided remotely.

Adolescent↗
PubMed2000

Electrostatics of mesophilic and psychrophilic trypsin isoenzymes: qualitative evaluation of electrostatic differences at the substrate binding site.

A qualitative evaluation of electrostatic features of the substrate binding region of seven isoenzymes of trypsin has been performed by using the continuum electrostatic model for the solution of the Poisson-Boltzmann equation. The sources of the electrostatic differences among the trypsins have been sought by comparative calculations on selective charges: all charges, conserved charges, partial charges, unique cold trypsin charges, and a number of charge mutations. As expected, most of the negative potential at the S(1) region of all trypsins is generated from Asp(189), but the potential varies significantly among the seven trypsin isoenzymes. The three cold active enzymes included in this study possess a notably lower potential at and around the S(1)-pocket compared with the warm active counterparts; this finding may be the main contribution to the increased binding affinity. The source of the differences are nonconserved charged residues outside the specificity pocket, producing electric fields at the S(1)-pocket that are different in both sign and magnitude. The surface charges of the mesophilic trypsins generally induce the S(1) pocket positively, whereas surface charges of the cold trypsins produce a negative electric field of this region. Calculations on mutants, where charged amino acids were substituted between the trypsins, showed that mutations in Loop2 (residues 221B and 224) and residue 175, in particular, were responsible for the low potential of the cold enzymes.

Amino Acid Sequence↗
PubMed2006

Qualitative evaluation of a diabetes advisory system, DiasNet.

We carried out a qualitative evaluation of the implementation of a computerized diabetes advisory system, DiasNet. Three patients with insulin-dependent diabetes used the system. The methodological frame of reference was the case study. Qualitative interviews were conducted with patients. In addition, 10 qualitative interviews were conducted with health-care professionals and one focus group interview was held. The study lasted for six months. The results showed that patients experienced greater confidence and a more personal rapport with the staff. DiasNet brought about changes in the tasks and duties performed by all professional groups in the diabetes team. From the perspective of the diabetes team, email facilitated a dialogue between the patient and the diabetes team which was independent of time and place.

Attitude of Health Personnel↗
PubMed2004

A qualitative evaluation of an adolescent cancer unit.

MULHALL A., KELLY D. & PEARCE S. (2004) European Journal of Cancer Care13, 16-22 A qualitative evaluation of an adolescent cancer unit The Expert Advisory Group on Cancer (1995) recommended that cancer centres in the UK should make provision for adolescents with cancer. However, although their number is growing, only a small number of specialist adolescent cancer units currently exist, and teenagers may often be treated in more general settings. To date, no formal evaluation of adolescent cancer units has taken place. This study adopted a qualitative approach to evaluate the first specialist adolescent oncology unit, which was established in the UK 10 years ago. The aim was to provide insight into: the culture of the unit; the experiences of patients and parents on the unit and the staff who worked there; and how the unit was valued by these groups. Semi-structured interviews were conducted with 10 teenagers with cancer, 10 parents and 14 professionals. Systematic non-participant observation of routine activities in the unit was undertaken also. Interview transcripts and observational data were analysed to identify key themes and categories. Six categories emerged from the data: (1) cancer and the cancer unit: although the word cancer had negative connotations, it provided a common supportive bond for adolescents and families on the unit; (2) what it feels like over time: key points in the adolescent cancer experience were emphasized as significant. These included diagnosis, end of treatment and recurrence of cancer; (3) physical structures and facilities: these were focused around the needs of adolescents with cancer and helped to provide a suitable environment of care; (4) the social context: approaches to care were relaxed in nature and suited the needs of adolescents and their families; (5) the family: there was an emphasis on maintaining normal routines whilst managing the impact of cancer on family relationships; and (6) specialism and expertise: the availability of an expert team of professionals with specialized insight into adolescents' needs was pivotal to creating an appropriate environment of care. In conclusion, the complex care and treatment needs of adolescents with cancer may best be met by specialist units.

Adolescent↗
PubMedDate not supplied

A qualitative evaluation of the National Centers of Excellence in Women's Health Program.

A qualitative evaluation was conducted at 15 nationally designated Centers of Excellence in Women's Health (CoEs) that were funded by the U.S. Department of Health and Human Services' (DHHS) Office on Women's Health at the time of data collection. The evaluation focused on organizational issues including: 1) the impact of CoE designation on the recipient institutions; 2) the greatest strengths and challenges affecting the CoEs and their core components of research, clinical care, professional education, leadership, and community outreach; and 3) whether the core components developed an interface and coordinated with one another as intended according to the DHHS national model. A total of 91 individuals were interviewed for the evaluation. The study indicates that the national designation served to legitimize and expand the scope of women's health within the recipient institutions. The CoEs enhanced collaboration among researchers and practitioners, and were able to leverage additional resources. The core components largely were successful at interfacing in accordance with the national model. Notwithstanding these successes, the CoEs remain susceptible to failure if they do not gain additional support for the concept of women's health within the recipient institutions, and will not remain durable without additional and stable funding sources.

Benchmarking↗
PubMed1995

Effect of depression on dementia presentation: qualitative assessment with the Qualitative Evaluation of Dementia (QED).

Two novel, bedside, dementia assessment instruments, the Executive Interview (EXIT) and the Qualitative Evaluation of Dementia (QED) were used to examine the effects of DSM-III-R major depressive episodes on the clinical presentation of patients diagnosed with NINCDS "possible" AD. Intergroup comparisons were made of the various bedside cognitive measures given to 102 of 118 consecutive patients presenting to a university geriatric assessment clinic and consultation service. The assessment instruments used were: (1) the EXIT: a 15-minute, 25-item bedside interview for the assessment of executive control function (ECF); (2) the QED: a brief, clinically based checklist that operationalizes the approach of a geriatric psychiatrist to the qualitative assessment of dementing illnesses (when QED scores are mapped against EXIT scores, a qualitative picture of dementia typology emerges); and (3) the Mini-Mental State Exam (MMSE): a familiar bedside measure of cognitive function. Depressed and nondepressed patients differed significantly on the QED. There was no overlap in the QED scores of patients with probable AD versus those with depression. The QED discriminated between depressed and nondepressed patients with possible AD. Possible AD patients with depression could not be qualitatively distinguished from those with depression alone, although they could be discriminated by the EXIT. Only 44% of possible AD cases fall within the EXIT x QED 90% confidence limits for probable AD. No differences were found on either the QED or the MMSE between depressed non-AD patients and nondepressed patients exhibiting "dementia with no cortical features." The MMSE was insensitive to cognitive impairment in non-AD cases. NINCDS "possible" AD is a qualitatively heterogeneous group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2000

Qualitative evaluation of family therapy programs: a participatory approach.

In this article, we provide examples of participatory qualitative evaluation methods that can be used within family therapy training programs. These methods can elicit useful feedback to improve programs and, at the same time, empower trainees to become partners in the evaluation process.

Evaluation Studies as Topic↗