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Outcome Domain (outcome + domain)
Selected AbstractsThe nurse,family partnership: An evidence-based preventive interventionINFANT MENTAL HEALTH JOURNAL, Issue 1 2006David L. Olds Pregnancy and the early years of the child's life offer an opportune time to prevent a host of adverse maternal, child, and family outcomes that are important in their own right, but that also reflect biological, behavioral, and social substrates in the child and family that affect family formation and future life trajectories. This article summarizes a 27-year program of research that has attempted to improve early maternal and child health and future life options with prenatal and infancy home visiting by nurses. The program is designed for low-income mothers who have had no previous live births. The home-visiting nurses have three major goals: to improve the outcomes of pregnancy by helping women improve their prenatal health, to improve the child's health and development by helping parents provide more sensitive and competent care of the child, and to improve parental life course by helping parents plan future pregnancies, complete their education, and find work. The program has been tested in three separate large-scale, randomized controlled trials with different populations living in different contexts. Results from these trials indicate that the program has been successful in achieving two of its most important goals: (a) the improvement of parental care of the child as reflected in fewer injuries and ingestions that may be associated with child abuse and neglect and better infant emotional and language development; and (b) the improvement of maternal life course, reflected in fewer subsequent pregnancies, greater work-force participation, and reduced dependence on public assistance and food stamps. The impact on pregnancy outcomes is equivocal. In the first trial, the program also produced long-term effects on the number of arrests, convictions, emergent substance use, and promiscuous sexual activity of 15-year-old children whose nurse-visited mothers were low-income and unmarried when they registered in the study during pregnancy. In general, the impact of the program was greater on those segments of the population at greater risk for the particular outcome domain under examination. Since 1996, the program has been offered for public investment outside of research contexts. Careful attention has been given to ensuring that organizational and community contexts are favorable for development of the program, to providing excellent training and guidance to the nurses in their use of the program's visit-by-visit guidelines, to monitoring the functioning of the program with a comprehensive clinical information system, and to improving the performance of the programs over time with continuous improvement strategies. [source] Can the Distress Thermometer be improved by additional mood domains?PSYCHO-ONCOLOGY, Issue 2 2010Part I. Initial validation of the Emotion Thermometers tool Abstract Purpose: To examine the value of a new screening instrument in a visual-analogue format. Methods: We report the design and validation of a new five-dimensional tool called the Emotion Thermometers (ET). This is a combination of five visual-analogue scales in the form of four predictor domains (distress, anxiety, depression, anger) and one outcome domain (need for help). Between March and August 2007, 130 patients attending the chemotherapy suite for their first chemotherapy treatment were asked to complete several questionnaires with validation for distress, anxiety and depression. Results: Of 81 with low distress on the Distress Thermometer (DT), 51% recorded emotional difficulties on the new ET tool, suggesting added value beyond the DT alone. Of those with a broadly defined emotional complication, 93.3% could be identified using the Anxiety Thermometer (AnxT) alone, compared with 54.4% who would be recognized using the DT alone. Using a cut-off of 3v4 on all thermometers against the total Hospital Anxiety and Depression Scale (HADS) score (cut-off 14v15), the optimal thermometer was the Anger Thermometer (sensitivity 61%, specificity 92%). Against HADS anxiety scale, the optimal thermometer was AnxT (sensitivity 92%, specificity 61%) and against the HADS depression scale, the optimal thermometer was the Depression Thermometer (DepT; sensitivity 60%, specificity 78%). Finally, against DSM-IV major depression, the optimal thermometer was the DepT (sensitivity 80%, specificity 79%). Further improvements may be possible by using a combination of thermometers or by repeating the screen. Conclusion: The diagnostic accuracy of the DT can be improved by the inclusion of simple addition linear domains without substantially increasing the time needed to apply the test. Copyright © 2009 John Wiley & Sons, Ltd. [source] COBRA combination therapy in patients with early rheumatoid arthritis: Long-term structural benefits of a brief interventionARTHRITIS & RHEUMATISM, Issue 2 2002Robert B. M. Landewé Objective The Combinatietherapie Bij Reumatoide Artritis (COBRA) trial demonstrated that step-down combination therapy with prednisolone, methotrexate, and sulfasalazine (SSZ) was superior to SSZ monotherapy for suppressing disease activity and radiologic progression of rheumatoid arthritis (RA). The current study was conducted to investigate whether the benefits of COBRA therapy were sustained over time, and to determine which baseline factors could predict outcome. Methods All patients had participated in the 56-week COBRA trial. During followup, they were seen by their own rheumatologists and were also assessed regularly by study nurses; no treatment protocol was specified. Disease activity, radiologic damage, and functional ability were the primary outcome domains. Two independent assessors scored radiographs in sequence according to the Sharp/van der Heijde method. Outcomes were analyzed by generalized estimating equations on the basis of intent-to-treat, starting with data obtained at the last visit of the COBRA trial (56 weeks after baseline). Results At the beginning of followup, patients in the COBRA group had a significantly lower mean time-averaged 28-joint disease activity score (DAS28) and a significantly lower median radiologic damage (Sharp) score compared with those in the SSZ monotherapy group. The functional ability score (Health Assessment Questionnaire [HAQ]) was similar in both groups. During the 4,5 year followup period, the time-averaged DAS28 decreased 0.17 points per year in the SSZ group and 0.07 in the COBRA group. The Sharp progression rate was 8.6 points per year in the SSZ group and 5.6 in the COBRA group. After adjustment for differences in treatment and disease activity during followup, the between-group difference in the rate of radiologic progression was 3.7 points per year. The HAQ score did not change significantly over time. Independent baseline predictors of radiologic progression over time (apart from treatment allocation) were rheumatoid factor positivity, Sharp score, and DAS28. Conclusion An initial 6-month cycle of intensive combination treatment that includes high-dose corticosteroids results in sustained suppression of the rate of radiologic progression in patients with early RA, independent of subsequent antirheumatic therapy. [source] The State of Child and Adolescent Psychotherapy ResearchCHILD AND ADOLESCENT MENTAL HEALTH, Issue 2 2002Alan E. Kazdin Child and adolescent therapy has progressed considerably, as reflected in the number of controlled studies, their methodological quality, and identification of evidence-based treatments. The progress is qualified by several characteristics of the therapy research that depart from the characteristics of clinical practice. Key areas of research are being neglected and this neglect greatly limits progress and what we know about treatment. Prominent among these is the neglect of research on the mechanisms of change and the moderators of treatment outcome. This article highlights progress, characteristics, and limitations of current therapy research. In addition, a research plan is offered to advance research by: 1) understanding the mechanisms or processes through which therapeutic change occurs; 2) drawing on developmental psychopathology research to inform treatment; and 3) expanding the range of questions that guide treatment research and the range of outcome domains on which treatment conclusions are based. [source] Identifying patterns in primary care consultations: a cluster analysisJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 3 2009Joachim P. Sturmberg MBBS DORACOG MFM FRACGP PhD Abstract Background, A literature review revealed that little is known about the systems context of general practice consultations and their outcomes. Objectives, To describe the systems context and resulting underlying patterns of primary care consultations in a local area. Design, Cross-sectional multi-practice study based on a three-part questionnaire. Cluster analysis of data. Setting, Stratified random sample of general practices and general practitioners , NSW-Central Coast, Australia. Participants, A total of 1104 adults attending 12 general practitioners between February and November 1999. Results and Conclusions, The study identified seven subgroups within the study population uniquely defined by variables from the health system, individual doctor and patient, consultation and consultation outcomes domains. A systems approach provides a framework in which to track and consider the important variables and their known and/or expected workings and thus offer a contextual framework to guide primary care reform. [source] Quality assurance in medical and public health genetics services: A systematic review,AMERICAN JOURNAL OF MEDICAL GENETICS, Issue 3 2009Ann F. Chou Abstract As genetic services grow in scope, issues of quality assessment in genetic services are emerging. These efforts are well developed for molecular and cytogenetic testing and laboratories, and newborn screening programs, but assessing quality in clinical services has lagged, perhaps owing to the small work force and the recent evolution from a few large training programs to multiple training sites. We surveyed the English language, peer-reviewed literature to summarize the knowledge-base of quality assessment of genetics services, organized into the tripartite categories of the Donabedian model of "structure," "process," and "outcome." MEDLINE searches from 1990 to July 2008, yielded 2,143 articles that addressed both "medical/genetic screening and counseling" and "quality indicators, control, and assurance." Of the 2,143 titles, 131 articles were extracted for in-depth analysis, and 55 were included in this review. Twenty-nine articles focused on structure, 19 on process, and seven on outcomes. Our review underscored the urgent need for a coherent model that will provide health care organizations with tools to assess, report, monitor, and improve quality. The structure, process, and outcomes domains that make up the quality framework provide a comprehensive lens through which to examine quality in medical genetics. © 2009 Wiley-Liss, Inc. [source] | ||||||||||