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Evaluation Study (evaluation + study)
Selected AbstractsSocial costs of robbery and the cost-effectiveness of substance abuse treatmentHEALTH ECONOMICS, Issue 8 2008Anirban Basu Abstract Reduced crime provides a key benefit associated with substance abuse treatment (SAT). Armed robbery is an especially costly and frequent crime committed by some drug-involved offenders. Many studies employ valuation methods that understate the true costs of robbery, and thus the true social benefits of SAT-related robbery reduction. At the same time, regression to the mean and self-report bias may lead pre,post comparisons to overstate crime reductions associated with SAT. Using 1992,1997 data from the National Treatment Improvement Evaluation Study (NTIES), we examined pre,post differences in self-reported robbery among clients in five residential and outpatient SAT modalities. Fixed-effect negative binomial regression was used to examine incidence rate reductions (IRR) in armed robbery. Published data on willingness to pay to avoid robbery were used to determine the social valuation of these effects. Differences in IRR across SAT modalities were explored to bound potential biases. All SAT modalities were associated with large and statistically significant reductions in robbery. The average number of self-reported robberies declined from 0.83/client/year pre-entry to 0.12/client/year following SAT (p<0.001). Under worst-case assumptions, monetized valuations of reductions in armed robbery associated with outpatient methadone and residential SAT exceeded economic costs of these interventions. Conventional wisdom posits the economic benefits of SAT. We find that SAT is even more beneficial than is commonly assumed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Dimensions of publicness and performance in substance abuse treatment organizationsJOURNAL OF POLICY ANALYSIS AND MANAGEMENT, Issue 1 2004Carolyn J. Heinrich Changes in funding, clientele, and treatment practices of public and privately owned substance abuse treatment programs, compelled in part by increased cost containment pressures, have prompted researchers' investigations of the implications of organizational form for treatment programs. These studies primarily probe associations between ownership status, patient characteristics, and services delivered and do not empirically link organizational form or structure to treatment outcomes. Data from the National Treatment Improvement Evaluation Study (NTIES) were used to study the relationship of ownership and other dimensions of "publicness" identified in the public management literature to patient outcomes, controlling for patient characteristics, treatment experiences, and other program characteristics. A few effects of organizational form and structure on substance abuse treatment outcomes are statistically significant (primarily improved social functioning), although the specific contributions of measures of ownership and publicness to explaining program-level variation are generally small. © 2004 by the Association for Public Policy Analysis and Management. [source] Reports of hyperkalemia after publication of RALES,a pharmacovigilance study,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2006Manfred Hauben MD Abstract Purpose A population-based study and anecdotal reports have indicated that the publication of the Randomized Aldactone Evaluation Study (RALES) was associated with not merely a broader use of spironolactone in the treatment of heart failure, but also with a coinciding sharp increase in hyperkalemia-associated morbidity/mortality in patients also being treated with ACE-inhibitors. Data mining algorithms (DMAs) are being applied to spontaneous reporting system (SRS) databases in hopes of obtaining early warnings/additional insights into post-licensure safety data. We applied two DMAs (i.e. multi-item gamma Poisson shrinker [MGPS] and proportional reporting ratios [PRRs]) to spontaneous reporting system (SRS) data to determine if these DMAs could have provided an earlier indication of a possible hyperkalemia safety issue. Methods MGPS and PRRs were retrospectively applied to US FDA-AERS, an SRS database. Year-by-year analysis and analysis of increasing cumulative time intervals were performed on cases in which both spironolactone and hyperkalemia and possibly related cardiac events had been reported. Results Neither of the DMAs initially provided a compelling signal of disproportionate reporting (SDR) for hyperkalemia after publication of RALES. However, using events consistent with clinical sequelae of hyperkalemia (e.g,. sudden death), SDRs were identified with PRRs. Conclusions The quality and usefulness of data mining analysis is highly situation dependent and may vary with the knowledge and experience of the drug safety reviewer. Our analysis suggests that contemporary DMAs may have significant limitations in detecting increased frequency of labeled events in real-life prospective pharmacovigilance. There is a paucity of research in this area and we recommend further research for new approaches to detecting increased frequency of labeled events. Copyright © 2006 John Wiley & Sons, Ltd. [source] Adolescent Substance Abuse Treatment in the United States: Exemplary Models from a National Evaluation StudyTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 6 2006Article first published online: 18 FEB 2010 No abstract is available for this article. [source] Expanding view of aldosterone action, with an emphasis on rapid actionCLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 4 2010Gavin P. Vinson Summary 1. The actions of aldosterone beyond the ,mineralocorticoid' designation continue to attract intense interest. In recent years, two aspects have received particular attention. These are, first, the potentially damaging direct actions of aldosterone on the heart and vascular system, and the clear benefit, as illustrated by the Randomized Aldactone Evaluation Study and Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival trials, of including antialdosterone therapy in the treatment of cardiovascular disease. 2. Second, the importance of non-genomic actions of aldosterone has become clear, some of which might possibly be mediated by distinct membrane receptors. Over the past 5 years, evidence has arisen to bring these two aspects together, and now emphasizes the role of rapid, nongenomic actions of aldosterone on cardiovascular events. 3. However, despite many years of study, there is still no clear view of the nature of the receptors mediating non-genomic responses. We examine the evidence, and suggest that in many cases non-genomic actions are attributable to classical mineralocorticoid receptors. [source] Safety of Spironolactone Use in Ambulatory Heart Failure PatientsCLINICAL CARDIOLOGY, Issue 11 2008Ricardo J. Lopes MD Abstract Background Since the Randomized Aldactone Evaluation Study (RALES), the use of spironolactone is recommended in systolic heart failure (HF) patients that have been in New York Heart Association (NYHA) class III or IV. There is limited information on the use, side effects, and withdrawal rate of spironolactone in routine clinical practice. Hypothesis Side effects related to spironolactone use are more common than reported in clinical trials. Methods Patients who had moderate to severe left ventricular systolic dysfunction (LVSD) under optimized medical therapy were included. We introduced spironolactone in those with serum potassium (K+) , 5 meq/L, and serum creatinine (Cr) , 2.5 mg/dL. Spironolactone was withdrawn if serum K + , 5.5 meq/L, serum Cr increased more than 30%, 50% of the baseline value, and/or if the patient had gynecomastia. Results We selected 134 patients followed in an HF clinic. In our sample, 56.7% of the patients (76 out of 134) were currently or had formerly been on spironolactone therapy. The rate of spironolactone withdrawal was 25% (19 out of 76). Reasons for suspension were hyperkalemia (17.1%), renal function deterioration (14.5%), gynecomastia (5.3% of males), and other reasons (1.3%). Conclusion Spironolactone side effects are common and are mostly related to effects on the angiotensin-aldosterone axis. Our results reinforce the need to closely monitor serum K+ and Cr levels in patients treated with spironolactone, as its side effects are more common than reported in clinical trials. Copyright © 2008 Wiley Periodicals, Inc. [source] The impact of participation in a parent education program for divorcing parents on the use of court resources: An evaluation studyCONFLICT RESOLUTION QUARTERLY, Issue 2 2003Desmond Ellis This article assesses the impact of mandatory participation in family information sessions (FIS) and selected demographic and marital experiences on the use of court resources such as motions, case conferences, and the number of days a divorce case remains active. The study, conducted in Ontario, Canada, concludes with a number of policy-practice recommendations. [source] Multiple computer-automated structure evaluation study of aquatic toxicity.ENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 3 2003Abstract An acute toxicity model was constructed on the basis of 901 chemicals tested for toxicity against the luminescent bacteria Vibrio fischeri (formerly Photobacterium phosphoreum, the Microtox® test). The model was created using the Multiple Computer-Automated Structure Evaluation (M-CASE) program. The model can correctly predict acute toxicity for 92% of the compounds with an error averaging 0.55 log units per median effect concentration (EC50). The main toxicophores, corresponding to polar and nonpolar narcosis, and other types of reactive chemicals were identified. [source] Forming partnerships with parents from a community development perspective: lessons learnt from Sure StartHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2009Virginia MacNeill FCIH PhDArticle first published online: 22 JUL 200 Abstract The aim of this study is to explore some of the issues of service user participation in the planning and delivery of public services from a community development perspective. It draws on an action research evaluation study of a local Sure Start programme, which was introduced into an area without a tradition of community involvement in decisions about local services. The study describes and analyses the challenges of parent participation in the organisation and delivery of the Sure Start programme at an operational and strategic level, using findings from semi-structured interviews, observations and critical conversations with Sure Start parents, staff and members of the Sure Start management board. The main substantive findings are that there was a lack of shared understanding of the nature of parent participation in all its facets and this undermined the efforts of parents and staff in the development of the programme. These findings also raise broader issues about participation, the place of parental partnerships with professionals and ways in which collaboration between the two may be interpreted and evolve. [source] Opportunistic screening for Chlamydia in general practice: the experience of health professionalsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Elizabeth Perkins Abstract Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call,recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery. [source] Evaluation and use of a synthetic quality control material, included in the European external quality assessment scheme for cystic fibrosis,HUMAN MUTATION, Issue 8 2008Sarah Berwouts Abstract Assuring high quality within the field of genetic testing is fundamental, as the results can have considerable impact on the patient and his or her family. The use of appropriate quality control (QC) samples is therefore essential. Diagnostic laboratories mainly use patient samples as QC material, which of course include a maximum of two mutations per sample. Bearing in mind that some assays (such as for cystic fibrosis [CF] testing) can test for more than 100 mutations, multiplex QC materials including more than two mutations could save valuable time and reagents. Based on this need, synthetic multiplex controls have been developed by Maine Molecular Quality Controls, Inc. (MMQCI) for CF. A synthetic control, containing six homozygous mutations and one polymorphism for CF transmembrane conductance regulator (CFTR), was evaluated by distributing it through the CF external quality assessment (EQA) scheme, along with the EQA samples in 2005. A total of 197 participants returned results of the yearly EQA scheme and 133 laboratories participated in the evaluation of the synthetic sample. Respectively, 76% and 73% of the participants were assigned as successful. This evaluation study revealed that the multiplex QC material performed well in the majority of assays and could be useful in method validation, as a tool to challenge interpretation skills, and as potential proficiency testing (PT) material. Hum Mutat 0, 1,8, 2008. © 2008 Wiley-Liss, Inc. [source] Parallel Delaunay mesh generation kernelINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN ENGINEERING, Issue 2 2003Nikos Chrisochoides Abstract We present the results of an evaluation study on the re-structuring of a latency-bound mesh generation algorithm into a latency-tolerant parallel kernel. We use concurrency at a fine-grain level to tolerate long, variable, and unpredictable latencies of remote data gather operations required for parallel guaranteed quality Delaunay triangulations. Our performance data from a 16 node SP2 and 32 node Cluster of Sparc Workstations suggest that more than 90% of the latency from remote data gather operations can be masked effectively at the cost of increasing communication overhead between 2 and 20% of the total run time. Despite the increase in the communication overhead the latency-tolerant mesh generation kernel we present in this paper can generate tetrahedral meshes for parallel field solvers eight to nine times faster than the traditional approach. Copyright © 2003 John Wiley & Sons, Ltd. [source] Problem-solving competency of nursing graduatesJOURNAL OF ADVANCED NURSING, Issue 5 2004Leana R. Uys DSocSc Aim., This paper reports a study describing and evaluating the outcomes of problem-based learning (PBL) programmes in nursing schools in South Africa in terms of the competence of graduates to solve problem in actual clinical settings, and comparing this competence with that of graduates from non-PBL programmes. Background., The nursing literature tends to equate problem-solving with patient-centred problems or the nursing process. However, it is also a skill used in managing the work role, working in a team and managing a health care unit. Problem-solving refers to the process of selectively attending to information in a patient care setting. The investigation of problem-solving in nursing is complicated by the complex relationships between different cognitive processes. Methods., A qualitative evaluation study, descriptive and comparative in nature, was carried out. In-depth interviews were held with graduates and their supervisors, asking them to identify problem-solving incidents in which they had been involved. Template analysis style and Benner's interpretive approach were used to analyse the data. Findings., The majority of the incidents described by the graduates (84%) were graded at the advanced beginner level or above. The majority of incidents at the novice level came from the non-PBL group. ,Using people skills' and ,being assertive' were the two problem-solving strategies most often used. The PBL group fared better than the non-problem-based group in the level of their problem-solving ability. Conclusion., The findings of this study suggest that further research is warranted into the problem-solving abilities of PBL graduates, their personal development over time and at different stages of practice. In addition, it would be interesting to follow the development of their problem-solving abilities over time. [source] Parents' experiences of a Family Support Program when a parent has incurable cancerJOURNAL OF CLINICAL NURSING, Issue 24 2009Kari E Bugge Aims and objectives., The Family Support Program was created to support children and parenting when one of the parents has incurable cancer. We chose a family-based approach to support parent's coping and to help families pull together, identify strengths in the family and learn how to seek help. Background., Cancer is usually a new experience for young families. In most cases, parents do not have the necessary knowledge about their children's need for information and support about their parent's serious illness and impending death. Design., A qualitative evaluation study based on data collected through in-depth interviews focusing on parent's experiences with the Family Support Program. Methods., Participants were patients with incurable cancer and their partners and ex-partners with children aged between 5,18 years. Thirteen parents were in-depth interviewed. Results., Parents described how the Family Support Program helped them gain greater insight into their children's thoughts and reactions and into how the situation affected their daily living. Parents reported that conflicts were reduced, they could talk more openly about the situation in the family and that they were shown how to support their children's coping. Conclusion., The Family Support Program met the parents in the study's needs for more information and support about how to cope with their children during the patient's terminal illness. Relevance to clinical practice., The Family Support Program is described in detail in a manual that makes it easy for other health workers to use the same programme. The Family Support program was in use in outpatient clinics, oncology wards and palliative care units and was provided both from nurses and social workers trained in cancer care. Parent's in the study would like the Family Support Program to be available to all patients who receive the poor prognosis that their cancer cannot be cured. [source] Comparative study of four candidate strategies to detect cervical cancer in different health care settingsJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2007Meherbano M. Kamal Abstract Aim:, Considering the differing but potentially supplementary properties of visual inspection of the cervix with acetic acid (VIA) and the cytological examination (CYTO) of cervical smears for the screening of cervical cancers, we examined the performance of these two tests and their combinations for the screening of cervical cancer in different health care settings. Methods:, In this cross-sectional diagnostic test performance evaluation study of 4235 female subjects in the reproductive age group, we assessed the screening performance of four strategies: VIA alone, CYTO alone, VIA and CYTO combined in a parallel fashion, and VIA and CYTO combined in tandem. Subjects were recruited from three settings: Hospital, Urban Community and Rural Community. Colposcopy was used as the reference standard. Screening performance was assessed using sensitivity, specificity, post-test probabilities and likelihood ratios (LR), diagnostic odds, area under receiver operating characteristic curve and LR ,2. Results:, Both VIA and CYTO when used alone had a low sensitivity but high specificity, especially in the Rural Community setting. A combination of the results of VIA and CYTO improved the diagnostic accuracy but the strategy using a parallel combination of VIA and CYTO was the most accurate. In general, all screening strategies using VIA and CYTO showed a modest screening performance. Conclusions:, In the settings of varying levels of health care and low resources, caution is needed for a generalized use of VIA for cervical cancer screening. Further evaluation of the cost-effective ways of combining VIA and CYTO is needed in these circumstances. [source] Effectiveness of an occupational health intervention program to reduce whole body vibration exposure: An evaluation study with a controlled pretest,post-test design,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009Ivo J.H. Tiemessen PhD Abstract Background An effective intervention program aiming to reduce whole body vibration (WBV) exposure at work will reduce the number of low back complaints in the near future. Methods An evaluation study with a controlled pretest,post-test design. Nine companies and 126 drivers were included in the study. Cluster randomization on company level divided the drivers and their employers in an intervention group and a "care-as-usual" group. At baseline (T0) and intervention program was implemented and evaluated after 7 months (T1). The main outcome measure was WBV exposure. Process measures included knowledge, attitude, and (intended) behavior towards reduction of WBV exposure for the drivers and knowledge and WBV policy for the employers. Results At T1, no significant reduction was found in WBV exposure within both groups compared with T0. Conclusions Probably due to poor to moderate compliance, the intervention program was not effective in reducing the WBV exposure on group level but small reductions in WBV exposure are possible when intervention compliance is high. Am. J. Ind. Med. 52:943,952, 2009. © 2009 Wiley-Liss, Inc. [source] Using Telemedicine to Avoid Transfer of Rural Emergency Department PatientsTHE JOURNAL OF RURAL HEALTH, Issue 3 2001Lanis L. Hicks Ph.D ABSTRACT: Access to emergency treatment in rural areas can often mean the difference between life and death. Telemedicine technologies have the potential of providing earlier diagnosis and intervention, of saving lives and of avoiding unnecessary transfers from rural hospital emergency departments to urban hospitals. This study examined the hypothetical impact of telemedicine services on patients served by the emergency departments of two rural Missouri liospitals and the potential financial impact on the affected hospitals. Of the 246 patients transferred to the hub hospital from the two facilities during 1996, 161 medical records (65.4 percent) were analyzed. Using a conservative approach, only 12 of these cases were identified as potentially avoidable transfers with the use of telemedicine. Of these 12, 5 were admitted to the hub hospital after transfer. In addition to this conservative estimate of avoidable transfers based on current availability of resources in the rural hospitals, two more aggressive scenarios were developed, based on an assumption of increased service availability in the rural hospitals. Economic multipliers were used to estimate the financial impacts on communities in each scenario. This evaluation study demonstrates the potential value of telemedicine use in rural emergency departments to patients, rural hospitals and rural communities. [source] Suburethral slingplasty evaluation study in North Queensland, Australia: The SUSPEND trialAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2005Yik Nyok LIM Abstract Objective:, To compare the safety and efficacy of three types of suburethral slings for the treatment of urodynamic stress incontinence. Methods:, Following ethics approval, 195 (3 × 65) patients with urodynamic stress incontinence were randomly assigned to undergo suburethral slingplasty with the Tension-free Vaginal Tape (TVT; Gynecare, Ethicon, Somerville, NJ, USA), Intravaginal Sling (IVS; Tyco Healthcare, Mansfield, MA, USA), or Suprapubic Arc Sling (SPARC; American Medical Systems, Minnetonka, MN, USA). The patients were blinded to the type of sling implanted. Main outcome measures were:, (1) operative and short-term complications; (2) pre- and postoperative symptomatology; and (3) pre- and postoperative urodynamic findings. Results:, There was a statistically significant increased rate of sling protrusion (13.1% vs. 3.3% and 1.7%; P = 0.04) in the SPARC group when compared to TVT and IVS. Otherwise, there were no significant differences between the groups with respect to the incidences of other operative complications, patients' main subjective outcomes, satisfaction rates, or postoperative urodynamic findings. The overall objective stress incontinence cure rates were 87.9%, 81.5% and 72.4% for the TVT, IVS, SPARC groups respectively (P = 0.11). Conclusions:, All three slings appear quite successful for the treatment of stress incontinence. The SPARC tapes showed more sling protrusion complications and a trend towards lower objective cure rates; probably as a result of the insertion method used in this study which favoured a loose SPARC sling placement. The authors recommend that the SPARC slings be left tighter than TVT, or for the cough test to be carried out. [source] ,Motor Magic': Evaluation of a community capacity-building approach to supporting the development of preschool childrenAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2006Naomi Priest Background and Aims:,There is a lack of literature on the evaluation of programmes addressing the motor and sensory development of preschool children. This paper presents and discusses an exploratory evaluation study of the ,Motor Magic' programme run in Adelaide, South Australia. The purpose of this study was to identify outcomes for children, parents and kindergarten staff, as well as develop hypotheses about how these outcomes occurred and in what contexts. Methods:,Using a realist approach, two focus groups were conducted, one with parents and one with kindergarten staff, to develop and refine key hypotheses. Results and Conclusion:,Evaluation results for participating children and parents suggested that this programme provided a model of best practice for supporting the development of preschool-aged children, with or at risk of, developmental delay, within their family and social environments. [source] Fathers and Mothers at Play With Their 2- and 3-Year-Olds: Contributions to Language and Cognitive DevelopmentCHILD DEVELOPMENT, Issue 6 2004Catherine S. Tamis-LeMonda Father,child and mother,child engagements were examined longitudinally in relation to children's language and cognitive development at 24 and 36 months. The study involved a racially/ethnically diverse sample of low-income, resident fathers (and their partners) from the National Early Head Start evaluation study (n=290). Father,child and mother,child engagements were videotaped for 10 min at home during semistructured free play, and children's language and cognitive status were assessed at both ages. Fathers' and mothers' supportive parenting independently predicted children's outcomes after covarying significant demographic factors. Moreover, fathers' education and income were uniquely associated with child measures, and fathers' education consistently predicted the quality of mother,child engagements. Findings suggest direct and indirect effects of fathering on child development. [source] | |||||||||||||||||||||||||||||||