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Outcome Measurement (outcome + measurement)
Kinds of Outcome Measurement Selected AbstractsInpatient treatment in child and adolescent psychiatry , a prospective study of health gain and costsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 12 2007Jonathan Green Background:, Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods:, A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. Results:, We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and post-discharge support costs were similar. Conclusions:, Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people. [source] Long-term effects of botulinum toxin A in children with cerebral palsyDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 2 2009KRISTINA TEDROFF MD The long-term effects of botulinum toxin A (BoNT-A) treatment in children with cerebral palsy (CP) are still elusive. We studied a prospective clinical cohort of 94 children with different subtypes (50% spastic diplegic CP, 22% hemiplegic CP, 25% tetraplegic CP, 3% dyskinetic CP), sex (55% male, 45% female), severity according to Gross Motor Function Classification System (29% Level I, 15% Level II, 16% Level III, 17% Level IV, 23% Level V), and age (median 5y 4mo, range 11mo,17y 8mo). The longest follow-up time was 3 years 7 months (median 1y 6mo) and included a maximum of eight injections per muscle (median two injections to a specific muscle). Outcome measurements were muscle tone (Modified Ashworth Scale) and joint range of motion (ROM). Assessments were made at a minimum before and 3 months after each injection. Ninety-five per cent confidence intervals for differences from baseline were used to identify significant changes. BoNT-A injections induced reduction of long-term spasticity in all muscle-groups examined: the gastrocnemius, hamstring, and adductor muscles. The reduction in tone was most distinct in the gastrocnemius muscle, and each repeated injection produced an immediate reduction in muscle tone. However, improvement in ROM was brief and measured only after the first injections, whereupon the ROM declined. Thus, the results suggest that BoNT-A can be effective in reducing muscle tone over a longer period, but not in preventing development of contractures in spastic muscles. The dissociation between the effects on muscle tone and ROM indicates that development of contractures is not coupled to increased muscle tone only, but might be caused by other mechanisms. [source] The importance of dental beliefs for the outcome of dental-fear treatmentEUROPEAN JOURNAL OF ORAL SCIENCES, Issue 2 2003Kajsa Henning Abrahamsson This study investigated the importance of dental beliefs and the predictive value of the Dental Belief Survey (DBS) in dental-fear treatment. The sample comprised 117 adult patients seeking treatment at a dental-fear clinic. Pretreatment data were collected during a screening procedure, including two visits to the dentist. Outcome measurements were completed after treatment. The dentist rated successful/unsuccessful treatment outcome. Patients unsuccessful in treatment (n = 48) reported more initial negative dental beliefs, while patients successful in treatment (n = 69) showed a larger decrease in negative beliefs between the first and second visit to the dentist. However, these differences were small. There was a significant difference between the groups at visit two. Thus, patients unsuccessful in treatment reported more negative beliefs about how dentists communicate. Regression analyses showed that improved dental beliefs during the first two visits to the dentist predicted dental-fear reduction, while longer avoidance time, female gender, low engagement in treatment, and depressed mood increased the risk of unsuccessful treatment outcome. Our results suggest that the DBS provides valuable information, and that patients' subjective perceptions about how dentists communicate are important for treatment outcome. However, initial dental beliefs were not found to predict clinical treatment outcome. [source] Emergency Department Use of Intravenous Procainamide for Patients with Acute Atrial Fibrillation or FlutterACADEMIC EMERGENCY MEDICINE, Issue 12 2007Ian G. Stiell MD Objectives Acute atrial fibrillation and flutter are very common arrhythmias seen in emergency department (ED) patients, but there is no consensus for their optimal management. The objective of this study was to examine the efficacy and safety of intravenous (IV) procainamide for acute atrial fibrillation or flutter. Methods This health records review included a consecutive cohort of ED patients with acute-onset atrial fibrillation or atrial flutter who received IV procainamide at one university hospital ED during a five-year period. The standard clinical protocol involved IV infusion of 1 g of procainamide over 60 minutes, followed by electrical cardioversion if necessary. A trained observer extracted data from the original clinical records. Outcome measurements included conversion to sinus rhythm, adverse events, and relapse up to seven days. Results The 341 study patients had a mean age of 63.9 years (SD ± 15.5 years), and 56.6% were male. The conversion rates were 52.2% (95% confidence interval = 47% to 58%) for 316 atrial fibrillation cases and 28.0% (95% confidence interval = 13% to 46%) for 25 atrial flutter cases. Mean dose given was 860.7 mg (SD ± 231.2 mg), and median time to conversion was 55 minutes. Adverse events occurred in 34 cases (10.0%): hypotension, 8.5%; bradycardia, 0.6%; atrioventricular block, 0.6%; and ventricular tachycardia, 0.3%. There were no cases of torsades de pointes, cerebrovascular accident, or death. Most patients (94.4%) were discharged home, but 2.9% of patients returned with a recurrence of atrial fibrillation within seven days. Conclusions This study of acute atrial fibrillation or flutter patients treated in the ED with IV procainamide suggests that this treatment is safe and effective in this setting. Procainamide should be prospectively compared with other ED strategies. [source] The talking touchscreen: A new approach to outcomes assessment in low literacyPSYCHO-ONCOLOGY, Issue 2 2004Elizabeth A. Hahn Purpose. Cancer patients who are deficient in literacy skills are particularly vulnerable to experiencing different outcomes due to disparities in care or barriers to care. Outcomes measurement in low literacy patients may provide new insight into problems previously undetected due to the challenges of completing paper-and-pencil forms. Description of study. A multimedia program was developed to provide a quality of life assessment platform that would be acceptable to patients with varying literacy skills and computer experience. One item at a time is presented on the computer touchscreen, accompanied by a recorded reading of the question. Various colors, fonts and graphic images are used to enhance visibility, and a small picture icon appears near each text element allowing patients to replay the sound as many times as they wish. Evaluation questions are presented to assess patient burden and preferences. Results. An ethnically diverse group of 126 cancer patients with a range of literacy skills and computer experience reported that the ,talking touchscreen' (TT) was easy to use, and commented on the usefulness of the multimedia approach. Clinical implications. The TT is a practical, user-friendly data acquisition method that provides greater opportunities to measure self-reported outcomes in patients with a range of literacy skills. Copyright © 2003 John Wiley & Sons, Ltd. [source] Small Vestibular Schwannomas With No Hearing: Comparison of Functional Outcomes in Stereotactic Radiosurgery and MicrosurgeryTHE LARYNGOSCOPE, Issue 11 2008Daniel H. Coelho MD Abstract Objectives: To date, numerous studies have compared functional outcomes between stereotactic radiosurgery (SRS) and microsurgery (MS) in the treatment of vestibular schwannomas (VS). However, most of them involve tumors of difference sizes, radiation dosages, and surgical approaches. Few have systematically compared issues of dysequilibrium. By studying only patients with small tumors and no hearing, we sought to minimize confounding variables. Study Design: A retrospective chart review and telephone questionnaire. Methods: From 1998,2006, 31 patients with small (<1.5 cm) VS and nonserviceable hearing (American Academy of Otolaryngology,Head and Neck Surgery [AAO-HNS] Class C or D) were treated at our institution. Twenty-two were available for follow-up and telephone questionnaire, including the University of California Los Angeles Dizziness Questionnaire (UCLA-DQ). Twelve underwent SRS and 10 underwent MS. All MS patients underwent the translabyrinthine approach to their tumors. Outcomes measurements included tumor control, facial nerve function, tinnitus, trigeminal function, and imbalance. Results: Patients undergoing SRS had comparable rates of tumor control, facial nerve function, tinnitus, and trigeminal function to MS patients. However, SRS did result in statistically significantly worse long-term imbalance when compared with MS patients. Detailed comparisons of the two modalities are made. Conclusions: In our study population, patients with small tumors and no serviceable hearing, these data suggest that MS results in comparable minimal morbidity with SRS, though posttreatment dysequilibrium is significantly decreased. While the authors recommend translabyrinthine resection of small VS with no hearing in patients able to tolerate surgery, the need for further prospective investigation is clear. [source] Developmental assessment of preterm infants at 2 years: validity of parent reportsDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2008Samantha Johnson PhD CPsychol Parental questionnaires are inexpensive alternatives to standardized testing for outcome measurement. The Parent Report of Children's Abilities has previously been revised (PARCA-R) and validated for use with very-preterm infants at 2 years of age. This study revalidated the PARCA-R for assessing cognition in a larger and more inclusive sample of preterm infants. One hundred and sixty-four children (82 males, 82 females) of <32 weeks' gestation (median 29wks, interquartile range [IQR] 28-30wks); and median birthweight 1200g (IQR 925-1463g) were evaluated using the Mental Development Index (MDI) of the Bayley Scales of Infant Development - 2nd edition (BSID-II) at 2 years' corrected age. Parents completed the PARCA-R questionnaire. Significant correlations between PARCA-R Parent Report Composite (PRC) scores and MDI scores (r=0.77, 95% confidence interval [CI] 0.69-0.82, p<0.01) demonstrated concurrent validity. A receiver operating characteristic-determined PRC cut-off of <44 had optimal discriminatory power (area under curve 0.92) for identifying MDI <70, with 85% sensitivity (95% CI 0.58-0.96), 87% specificity (95% CI 0.81-0.92), 98% negative predictive value (95% CI 0.95-1), and 37% positive predictive value (95% CI 0.22-0.54). The PARCA-R has good concurrent validity and diagnostic utility for identifying cognitive delay in very-preterm infants at 2 years of age. It is useful for outcome measurement, developmental screening, and facilitating parental involvement at folow-up. [source] Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trialsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2009Kajsa Eklund PhD Reg OT Abstract The aim of this study was to review randomised controlled trials on integrated and coordinated interventions targeting frail elderly people living in the community, their outcome measurements and their effects on the client, the caregiver and healthcare utilisation. A literature search of PubMed, AgeLine, Cinahl and AMED was carried out with the following inclusion criteria: original article; integrated intervention including case management or equivalent coordinated organisation; frail elderly people living in the community; randomised controlled trials; in the English language, and published in refereed journals between 1997 and July 2007. The final review included nine articles, each describing one original integrated intervention study. Of these, one was from Italy, three from the USA and five from Canada. Seven studies reported at least one outcome measurement significantly in favour of the intervention, one reported no difference and one was in favour of the control. Five of the studies reported at least one outcome on client level in favour of the intervention. Only two studies reported caregiver outcomes, both in favour of the intervention for caregiver satisfaction, but with no effect on caregiver burden. Outcomes focusing on healthcare utilisation were significantly in favour of the intervention in five of the studies. Five of the studies used outcome measurements with unclear psychometric properties and four used disease-specific measurements. This review provides some evidence that integrated and coordinated care is beneficial for the population of frail elderly people and reduces health care utilisation. There is a lack of knowledge about how integrated and coordinated care affects the caregiver. This review pinpoints the importance of using valid outcome measurements and describing both the content and implementation of the intervention. [source] Stakeholders' views on measuring outcomes for people with learning disabilitiesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2006Anita F. Young PhD DipCOT Abstract What works and how do we know? These are recurring questions for health and social care professionals, although mediated through differing philosophies and historical perspectives. The aims of the study reported here were to discover views of managers and commissioners of services for people with learning disabilities in Scotland regarding (a) current approaches to service evaluation (as an indication of what is to be measured) and (b) healthcare outcome measurement (as an indication of preferences regarding how this should be measured). A postal questionnaire was used to survey 94 stakeholders from the NHS, Local Authorities, and non-statutory organisations across Scotland. Respondents' views were sought on current approaches to service evaluation within learning disabilities; outcome measurement; appropriateness of specified methods of measuring health outcomes; desired future methods of outcome measurement within learning disabilities; and service user involvement in care. A 77% (73/94) response rate to the questionnaire was achieved. Different methods of service evaluation were used by different stakeholders. Staff appraisal was the most frequently identified method (used by 85% of respondents). Specific outcome measures were used by 32% of respondents although there were differences of opinion as to what constitutes specific outcome measures. Overall there was strong support for goal-setting and reviewing (83%) and individualised outcome measures (75%) as appropriate methods for use with people with learning disabilities. The hypothetical question asking what outcome measures should be introduced for this client group had by far the lowest response rate (51/73). The overwhelming majority of all respondents, 68 (92%), reported user involvement in their service. Staff ambivalence to outcome measurement was evident in the research and respondents highlighted the complexity and multidimensional nature of outcomes for this service user group. Managers recognised that outcome measurement was expected but were uncertain how to go about it. [source] European health policy challengesHEALTH ECONOMICS, Issue S1 2005Alan Maynard Abstract Few countries are immune to the international health care ,virus' of reform, with many countries regularly re-cycling changes that shift costs and benefits in ways that are arbitrary, inefficient and offer short term political palliation. Much of this activity has little evidence base and reveals lack of clarity in defining public policy goals, establishing trade-offs and aligning incentive structures with these objectives. Well established failures in health care delivery systems such as variations in medical practice and continuing absence of systematic outcome measurement, have persisted for decades as nations grapple inefficiently with recurring problems of expenditure inflation and waiting times. The lack of emphasis on evidence to inform the efficient management of chronic disease and the reduction of health inequalities is a product of perverse incentives and managerial inertia that maintains the incomes of powerful interest groups. Copyright © 2005 John Wiley & Sons, Ltd. [source] Consumer attitudes towards the use of routine outcome measures in a public mental health service: A consumer-driven studyINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2008David Guthrie ABSTRACT:, In this study conducted by consumer consultants, 50 consumers who have a Barwon Health case manager (the majority of whom were nurses) were interviewed using a structured questionnaire to ascertain their attitudes towards the routine use of outcome measures. Forty participants (80% of those interviewed) reported they had been offered the Behaviour and Symptom Identification Scale (BASIS-32) to complete in routine care by their case managers and of those, 95% (n = 38) completed it. On those who completed the BASIS-32, 42% said their case manager had explained what the BASIS-32 would be used for, 45% said that the case manager had discussed their responses with them, 76% stated that completing the BASIS-32 had helped the case manager to understand them better and 66% believed that completing the BASIS-32 had led to them receiving better care. Only 30% of the group interviewed were aware that their case manager regularly completed a Health of the Nation Outcome Scales and Life Skills Profile. Feedback about the process of completing the BASIS-32 was obtained as well as suggestions on how the process may be improved. The results indicate that consumers see the benefit of routine outcome measurement and believe it leads to improved care. More information about outcome measures, including the clinician-rated outcome measures, needs to be provided to consumers if they are to be engaged constructively in this exercise. [source] Standardized routine outcome measurement: Pot holes in the road to recoveryINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2004Richard Lakeman Abstract: Routine ,outcome measurement' is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed, in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways. [source] Venture capitalists and entrepreneurs become venture philanthropistsINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 3 2005John PepinArticle first published online: 19 AUG 200 Non-traditional charitable sources of revenue may be categorised as follows: Venture philanthropy: Human resources and funding invested as donation in the charity by entrepreneurs, venture capitalists, trusts and corporations in search of a social return on their investment. It involves high engagement over many years with fixed milestones and tangible returns and exit achieved by developing alternative, sustainable income. Commercial ventures: They seek a financial return on investment by creating a social enterprise operated by charities and their trading/holding companies alone or in partnership with the corporate sector, venture capitalists or investors to provide funding. Venture philanthropists may also ,invest' without establishing an equity position in the commercial enterprise. Any profits are re-directed to mission-related activity, although the business activity may or may not be mission related. Social venture capital: It funds commercial ventures (as above) but may not seek a complete return on investment; instead the investor may off set some or all of the investment against social outcomes. Within the context of venture philanthropy, this paper demonstrates how charities, venture capitalists and entrepreneurs may work together in strategic alliances. It explores venture philanthropy from the perspective of venture capitalists and entrepreneurs, giving examples. Charities are shown how to prepare themselves to take advantage of these entrepreneurial opportunities. Although the emphasis in this paper is on venture philanthropy, the processes outlined may be used to help a charity take advantage of opportunities within the broader social entrepreneurial context. Successful venture capitalists and entrepreneurs have demonstrated the ability to turn outline business ideas into big results, frequently in highly competitive business environments. A common characteristic that appears to unite these individuals when they divert their interest toward social ventures is a desire to apply their business-like approach, which includes planning processes, milestones and outcome measurement to their social venture activity. Copyright © 2005 John Wiley & Sons, Ltd. [source] Simulation-based learning in nurse education: systematic reviewJOURNAL OF ADVANCED NURSING, Issue 1 2010Robyn P. Cant Abstract Title.,Simulation-based learning in nurse education: systematic review. Aim., This paper is a report of a review of the quantitative evidence for medium to high fidelity simulation using manikins in nursing, in comparison to other educational strategies. Background., Human simulation is an educational process that can replicate clinical practices in a safe environment. Although endorsed in nursing curricula, its effectiveness is largely unknown. Review methods., A systematic review of quantitative studies published between 1999 and January 2009 was undertaken using the following databases: CINAHL Plus, ERIC, Embase, Medline, SCOPUS, ProQuest and ProQuest Dissertation and Theses Database. The primary search terms were ,simulation' and ,human simulation'. Reference lists from relevant papers and the websites of relevant nursing organizations were also searched. The quality of the included studies was appraised using the Critical Appraisal Skills Programme criteria. Results. Twelve studies were included in the review. These used experimental or quasi-experimental designs. All reported simulation as a valid teaching/learning strategy. Six of the studies showed additional gains in knowledge, critical thinking ability, satisfaction or confidence compared with a control group (range 7,11%). The validity and reliability of the studies varied due to differences in design and assessment methods. Conclusion. Medium and/or high fidelity simulation using manikins is an effective teaching and learning method when best practice guidelines are adhered to. Simulation may have some advantage over other teaching methods, depending on the context, topic and method. Further exploration is needed to determine the effect of team size on learning and to develop a universal method of outcome measurement. [source] Muscle Weakness and Falls in Older Adults: A Systematic Review and Meta-AnalysisJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2004Julie D. Moreland MSc Objectives: To evaluate and summarize the evidence of muscle weakness as a risk factor for falls in older adults. Design: Random-effects meta-analysis. Setting: English-language studies indexed in MEDLINE and CINAHL (1985,2002) under the key words aged and accidental falls and risk factors; bibliographies of retrieved papers. Participants: Fifty percent or more subjects in a study were aged 65 and older. Studies of institutionalized and community-dwelling subjects were included. Measurements: Prospective cohort studies that included measurement of muscle strength at inception (in isolation or with other factors) with follow-up for occurrence of falls. Methods: Sample size, population, setting, measure of muscle strength, and length of follow-up, raw data if no risk estimate, odds ratios (ORs), rate ratios, or incidence density ratios. Each study was assessed using the validity criteria: adjustment for confounders, objective definition of fall outcome, reliable method of measuring muscle strength, and blinded outcome measurement. Results: Thirty studies met the selection criteria; data were available from 13. For lower extremity weakness, the combined OR was 1.76 (95% confidence interval (CI)=1.31,2.37) for any fall and 3.06 (95% CI=1.86,5.04) for recurrent falls. For upper extremity weakness the combined OR was 1.53 (95% CI=1.01,2.32) for any fall and 1.41 (95% CI=1.25,1.59) for recurrent falls. Conclusion: Muscle strength (especially lower extremity) should be one of the factors that is assessed and treated in older adults at risk for falls. More clinical trials are needed to isolate whether muscle-strengthening exercises are effective in preventing falls. [source] An interactive education session and follow-up support as a strategy to improve clinicians' goal-writing skills: a randomized controlled trialJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Elisabeth Marsland BAppSc(OT)Hons Abstract Background, Recent research indicates that allied health clinicians have difficulty articulating client needs and priorities into specific and measurable goals. As a result, a number of strategies to facilitate improvement in allied health clinicians' goal-setting skills have been recommended in the literature. In order to assist clinicians develop the skills required to set SMART goals, it is necessary that the strategies are rigorously tested. Aim, To determine if a 50-minute education session and 3-month email and telephone support programme improves clinicians' SMART goal-writing skill and accurately predicts improved goal-writing behaviour. Methods, Concealed random allocation of participants (n = 120) into two parallel groups: (1) intervention group received education on writing goals using the SMART Goal Evaluation Method as part of a workshop on outcome measurement and received 3 months of follow-up support (n = 60); and (2) control group attended a workshop on evidence-based practice (n = 60). Results, Education and follow-up support improved clinicians' SMART goal-writing skills at both the 3- and 6-month review (Yates ,2 = 4.324, d.f. = 1, P = 0.0375). Structural equation modelling revealed education and follow-up support is an accurate predictor of SMART goal-setting behaviour change at both 3 months (standardized regression weights = 0.21; P = 0.014) and 6 months (standardized regression weights = 0.19; P = 0.02) post intervention. Changes were modest and developed over a 6-month period. Conclusion, This study provides empirical evidence that a programme of educating clinicians in a standardized method of goal setting and providing follow-up support improves allied health clinicians' SMART goal-writing skills. [source] Applying Prochaska's model of change to needs assessment, programme planning and outcome measurementJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 4 2001Kathryn Parker MA Abstract A major goal of continuing medical education (CME) is to enhance the performance of the learner. In order to accomplish this goal, careful consideration and expertise must be applied to the three primary ingredients of CME planning: assessing learner needs, programme design and outcome measurement. Traditional methods used to address these three components seldom result in CME initiatives that change performance, even in the presence of sophisticated CME formats and capable learners. In part, performance may not change because the learner is not ,ready to change'. Planners of CME are aware of this concept but have been unable to measure ,readiness to change' or employ it in assessing learner needs, and planning and evaluating CME. One theory that focuses on an individual's readiness to change is Prochaska's model, which postulates that change is a gradual process proceeding through specific stages, each of which has key characteristics. This paper examines the applicability of this model to all components of CME planning. To illustrate the importance of this model, this paper provides examples of these three components conducted both with and without implementation of this model. [source] Measuring outcomes of United Way,funded programs: Expectations and realityNEW DIRECTIONS FOR EVALUATION, Issue 119 2008Michael Hendricks In 1996, United Way of America (UWA) developed and began disseminating the most widely used approach to program outcome measurement in the nonprofit sector. Today an estimated 450 local United Ways encourage approximately 19,000 local agencies they fund to measure outcomes. The authors first describe and then assess the strengths and limitations of the distinguishing features of the UWA approach, efforts to disseminate the approach, implementation by local United Ways, and actual outcome measurement by local agencies. The chapter ends with a description of United Way's relatively new emphasis on community impact and how that initiative relates to program outcome measurement. © Wiley Periodicals, Inc. [source] Reproducibility of multiple breath washout indices in the unsedated preterm neonate,PEDIATRIC PULMONOLOGY, Issue 1 2010Sanjay Sinhal FRACP Abstract Multiple breath inert gas washout (MBW) is gaining popularity for measurements of resting lung volume and ventilation inhomogeneity. Test reproducibility is an important determinant of the clinical applicability of diagnostic tests. The between-test reproducibility of variables derived from MBW tests in newborn infants is unknown. We aimed to determine the within-test repeatability and short-term between-test reproducibility of MBW variables in unsedated preterm infants. We hypothesized that measurements obtained within a 3-day interval in clinically stable preterm infants would be reproducible and suitable for use as an objective clinical outcome measurement. In this cross-sectional observational study, clinically stable hospitalized preterm infants whose parents had given informed consent for MBW studies were tested twice within 72,hr during quiet, unsedated sleep. Functional residual capacity (FRC), lung clearance index (LCI), and the first and second to zeroeth moment ratios (M1:M0; M2:M0) were computed from MBW traces obtained using a mainstream ultrasonic flowmeter and 4% sulphur hexafluoride (MBWSF6). Within-test repeatability and between-test reproducibility were determined. Within-test repeatability (expressed as a coefficient of variability (Cv)) for differences between two and four replicate measurements on the same test occasion, were 9.3% (FRC), 9.0% (LCI), 7.6% (M1:M0), and 15.6% (M2:M0), respectively. The within-test Cv's were not statistically different to the between-tests Cv's, which were 7.7% (FRC), 10.3% (LCI), 6.1% (M1:M0), and 13.0% (M2:M0), respectively. Among unsedated preterm infants, between-test reproducibility over a 3-day interval was similar to within-test repeatability. The wide limits of agreement may limit the application of these measures to detect a clinically significant change in condition in small preterm infants. Pediatr Pulmonol. 2010; 45:62,70. © 2009 Wiley-Liss, Inc. [source] Can pediatricians accurately identify maternal depression at well-child visits?PEDIATRICS INTERNATIONAL, Issue 2 2010Hiroki Mishina Abstract Background:, The feasibility of a two-item screening tool for maternal depression in a pediatric setting was recently reported. We assessed whether the accuracy of pediatrician recognition of maternal depression during the one-month well-child visit could be improved by an educational intervention using the two-item screening tool. Methods:, We conducted an educational intervention for pediatric residents in a suburban hospital in Tokyo, Japan, with outcome measurement before and after. Resident education included knowledge about postpartum depression and its impact on children, use of the two-item screening tool and available management strategies. Sixteen pediatric residents examined 267 mother,infant dyads during well-child visits. Residents documented the presence or absence of postpartum depressive symptoms on medical records. Depressive symptoms were also determined using the Edinburgh Postnatal Depression Scale (EPDS) survey; residents were not aware of the results. Using the EPDS as a "gold standard," improvement in sensitivity and specificity of resident recognition of maternal depressive symptoms was determined. Results:, The overall prevalence of postpartum depressive symptoms based on the EPDS was 15.4%. The sensitivity of resident recognition was 8% and specificity 98% before intervention, and 12% and 96% afterwards, respectively. The difference was not statistically significant. Residents indicated fear of maternal stigmatization and mothers' receptiveness to discussing depressive symptoms, as well as lack of time and skills, as major barriers to the identification of maternal depression. Conclusions:, A simple educational intervention using a two-item screening tool did not improve the pediatrician's accuracy in detecting depressive symptoms in mothers. Additional strategies to address perceived barriers may be needed. [source] Testing equivalence of Spanish and English versions: The LaMonica,Oberst (revised) patient satisfaction with nursing care scale,RESEARCH IN NURSING & HEALTH, Issue 6 2002Jean W. Lange Abstract Despite recent emphasis on outcome measurement and an increasing proportion of Spanish speakers in the United States, most patient satisfaction studies exclude Spanish-speaking participants because Spanish versions of instruments are not available. A Spanish translation of the 15-item LaMonica,Oberst Patient Satisfaction Scale, completed by 64 Spanish-speaking patients living in the northeast and of predominantly Puerto Rican ancestry, produced two factors explaining 86.3% of score variation (,=.94 and .58). Evidence for equivalence to the English version and concurrent validity is presented. Generalizability and decision studies indicate that four additional items are needed on the dissatisfaction subscale to attain an acceptable dependability coefficient. © 2002 Wiley Periodicals, Inc. Res Nurs Health 25:438,451, 2002. [source] Family-centred outcome measurement following paediatric strokeAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2010Jane Galvin Background/aim:,Therapy programmes aim to provide services that are family-centred and address the specific needs of children. The Canadian Occupational Performance Measure (COPM) and the Perceived Efficacy and Goal Setting system (PEGS) are two measures that are available to assist in determining therapy priorities for children and their parents; however, the use of these measures has not been documented for children who have sustained a stroke. This project aimed to describe the functional concerns identified by children and their parents following paediatric stroke. Methodology:,A cross-sectional design was used. A total of 26 children were recruited from a paediatric stroke outpatient clinic, and functional concerns were identified using either the COPM or the PEGS. Results:,Children and their parents identified similar issues. Of the 26 participants, 23 (88.5%) reported ongoing functional concerns at three months or more following stroke, whereas three participants did not identify any ongoing functional concerns. Functional concerns were grouped into categories of self-care, productivity and leisure as outlined in the Canadian Model of Occupational Performance. Concerns were identified across all functional domains by both children and their parents. Conclusions:,The COPM and PEGS provided useful information about functional issues that are important to children and their parents following paediatric stroke. Use of these client-centred measures provides an opportunity to better understand the impact of paediatric stroke on children's functional abilities, and allows greater scope for service provision and planning for this group of children. [source] Routine administration of the Canadian Occupational Performance Measure: Effect on functional outcomeAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 2 2010Heather Colquhoun Background/aim:,Routinely using outcome measures as an integral component of practice has been encouraged for decades yet has not been widely adopted. There are many reasons to measure outcomes yet any positive effect of measurement on our programs or clients has not been substantiated. If the time-consuming nature of outcome measurement is to be encouraged, we need to begin addressing larger questions of the value of outcome measurement on care and outcomes. This cohort study evaluated the impact of routinely administering the Canadian Occupational Performance Measure on client outcomes on a geriatric rehabilitation unit. Methods:,Changes in Functional Independence MeasureÔ scores between an experimental group (n = 45) that received the routine use of the Canadian Occupational Performance Measure for evaluation/planning versus a historical comparison group (n = 58) that received ,usual' care were analysed using generalised linear modeling. Results:,Both groups had significant changes in Functional Independence MeasureÔ scores over time. Results for differences between groups were inconclusive with a significantly underpowered analysis; however, results suggest that a medium to large effect of this intervention cannot be expected. Conclusions:,Results are significant for the field of routine outcome measurement, suggesting that when adding the Canadian Occupational Performance Measure to routine assessment within an inpatient rehabilitation setting, substantially improved Functional Independence MeasureÔ score outcomes should not be expected. The value of routine outcome measurement on client outcomes remains largely unexplored. Routinely, using outcome measures requires additional research to determine the specific benefits to our programs and client outcomes. [source] Outcome Assessment in Emergency Medicine,A Beginning: Results of the Council of Emergency Medicine Residency Directors (CORD) Emergency Medicine Consensus Workgroup on Outcome AssessmentACADEMIC EMERGENCY MEDICINE, Issue 3 2008Cherri Hobgood MD Abstract This article is designed to serve as a guide for emergency medicine (EM) educators seeking to comply with the measurement and reporting requirements for Phase 3 of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project. A consensus workshop held during the 2006 Council of Emergency Medicine Residency Directors (CORD) "Best Practices" conference identified specific measures for five of the six EM competencies,interpersonal communication skills, patient care, practice-based learning, professionalism, and systems-based practice (medical knowledge was excluded). The suggested measures described herein should allow for ease in data collection and applicability to multiple core competencies as program directors incorporate core competency outcome measurement into their EM residency training programs. [source] Therapy goals in inpatient psychotherapy: differences between diagnostic groups and psychotherapeutic orientationsCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 1 2006Jörg Dirmaier Many studies have suggested the importance of therapy goals for the treatment process, especially in a multi-professional treatment context such as inpatient psychotherapy. However, only very few studies have examined differences between various groups of patients with regard to their respective treatment goals. Using a previously developed system for the categorization of therapy goals based on computer-assisted, qualitative data analysis, we have extracted 7157 therapy goals from a sample of 1192 discharge reports of treatment periods from inpatient psychotherapy in Germany. To test the inter-rater reliability of the system, a sample of 400 randomly chosen goals was classified by two independent raters. Logistic regression analysis was used to test whether different goal areas prove to be of different predictive value with regard to the respective dependent variables (diagnostic groups, psychotherapeutic orientations). Inter-rater reliability ranged between 0.73 and 0.82. Results of using the logistic regression model indicate that the selection of certain goal categories predicts affiliation to specific diagnostic groups and psychotherapeutic orientations. The resulting odds ratios vary between 1.2 and 16. These findings can be used for a more individualized treatment planning and outcome measurement in inpatient psychotherapeutic treatment. However, there are also goal categories that do not differentiate and therefore need to be further investigated.,Copyright © 2006 John Wiley & Sons, Ltd. [source] Standardized routine outcome measurement: Pot holes in the road to recoveryINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2004Richard Lakeman Abstract: Routine ,outcome measurement' is currently being introduced across Australian mental health services. This paper asserts that routine standardized outcome measurement in its current form can only provide a crude and narrow lens through which to witness recovery. It has only a limited capacity to capture the richness of people's recovery journeys or provide information that can usefully inform care. Indeed, in its implementation nurses may be required to collude in practices or account for practice in ways which run counter to the personal recovery paradigm. Nurses should view a focus on outcomes as an opportunity for critical reflection as well as to seek ways to account for recovery stories in meaningful ways. [source] Insulin therapy in type 2 diabetes: what is the evidence?DIABETES OBESITY & METABOLISM, Issue 5 2009Mariëlle J. P. Van Avendonk Aim:, To systematically review the literature regarding insulin use in patients with type 2 diabetes mellitus Methods:, A Medline and Embase search was performed to identify randomized controlled trials (RCT) published in English between 1 January 2000 and 1 April 2008, involving insulin therapy in adults with type 2 diabetes mellitus. The RCTs must comprise at least glycaemic control (glycosylated haemoglobin (HbA1c), postprandial plasma glucose and /or fasting blood glucose (FBG)) and hypoglycaemic events as outcome measurements. Results:, The Pubmed search resulted in 943 hits; the Embase search gave 692 hits. A total of 116 RCTs were selected by title or abstract. Eventually 78 trials met the inclusion criteria. The studies were very diverse and of different quality. They comprised all possible insulin regimens with and without combination with oral medication. Continuing metformin and/or sulphonylurea after start of therapy with basal long-acting insulin results in better glycaemic control with less insulin requirements, less weight gain and less hypoglycaemic events. Long-acting insulin analogues in combination with oral medication are associated with similar glycaemic control but fewer hypoglycaemic episodes compared with NPH insulin. Most of the trials demonstrated better glycaemic control with premix insulin therapy than with a long-acting insulin once daily, but premix insulin causes more hypoglycaemic episodes. Analogue premix provides similar HbA1c, but lower postprandial glucose levels compared with human premix, without increase in hypoglycaemic events or weight gain. Drawing conclusions from the limited number of studies concerning basal,bolus regimen seems not possible. Some studies showed that rapid-acting insulin analogues frequently result in a better HbA1c or postprandial glucose without increase of hypoglycaemia than regular human insulin. Conclusion:, A once-daily basal insulin regimen added to oral medication is an ideal starting point. All next steps, from one to two or even more injections per day should be taken very carefully and in thorough deliberation with the patient, who has to comply with such a regimen for many years. [source] The role of surveillance endoscopy and endosonography after endoscopic ablation of high-grade dysplasia and carcinoma of the esophagusDISEASES OF THE ESOPHAGUS, Issue 2 2008A. D. Savoy SUMMARY., Barrett's esophagus (BE) with high-grade dysplasia (HGD) or early carcinoma treated with surgery or photodynamic therapy (PDT) is at risk of recurrence. The efficacy of endoscopic ultrasound (EUS) for surveillance after PDT is unknown. Our objective was to determine if EUS is superior to esophagogastroduodenoscopy (EGD) and/or CT scan for surveillance of BE neoplasia after PDT. The study was designed as a retrospective review with the setting as a tertiary referral center. Consecutive patients with BE with HGD or carcinoma in situ treated with PDT were followed with EUS, CT scan and EGD with jumbo biopsies every 1 cm at 3, 4, or 6-month intervals. Exclusion criteria was < 6 months of follow up and/or < 2 EUS procedures. Main outcome measurements were residual or recurrent disease discovered by any method. Results showed that 67/97 patients met the inclusion criteria (56 men and 11 women). Median follow-up was 16 months. Recurrent or residual adenocarcinoma (ACA) was detected in four patients during follow-up. EGD with random biopsies or targeted nodule biopsies detected three patients. EUS with endoscopic mucosal resection of the nodule confirmed T1 recurrence in one of these three. In the fourth patient, CT scan revealed perigastric lymphadenopathy and EUS-FNA (fine needle aspiration) confirmed adenocarcinoma. There were two deaths, one related to disease progression and one unrelated. The rate of recurrent/persistent ACA after PDT was 4/67 = 6%. EUS did not detect disease when EGD and CT were normal. Limitations of this study include non-blinding of results and preferential status of non-invasive imaging (CT) over EUS. Our experience suggests that EUS has little role in the surveillance of these patients, unless discrete abnormalities are found on EGD or cross-sectional imaging. [source] Outcomes of coordinated and integrated interventions targeting frail elderly people: a systematic review of randomised controlled trialsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2009Kajsa Eklund PhD Reg OT Abstract The aim of this study was to review randomised controlled trials on integrated and coordinated interventions targeting frail elderly people living in the community, their outcome measurements and their effects on the client, the caregiver and healthcare utilisation. A literature search of PubMed, AgeLine, Cinahl and AMED was carried out with the following inclusion criteria: original article; integrated intervention including case management or equivalent coordinated organisation; frail elderly people living in the community; randomised controlled trials; in the English language, and published in refereed journals between 1997 and July 2007. The final review included nine articles, each describing one original integrated intervention study. Of these, one was from Italy, three from the USA and five from Canada. Seven studies reported at least one outcome measurement significantly in favour of the intervention, one reported no difference and one was in favour of the control. Five of the studies reported at least one outcome on client level in favour of the intervention. Only two studies reported caregiver outcomes, both in favour of the intervention for caregiver satisfaction, but with no effect on caregiver burden. Outcomes focusing on healthcare utilisation were significantly in favour of the intervention in five of the studies. Five of the studies used outcome measurements with unclear psychometric properties and four used disease-specific measurements. This review provides some evidence that integrated and coordinated care is beneficial for the population of frail elderly people and reduces health care utilisation. There is a lack of knowledge about how integrated and coordinated care affects the caregiver. This review pinpoints the importance of using valid outcome measurements and describing both the content and implementation of the intervention. [source] Factors affecting outcome in liver resectionHPB, Issue 3 2005CEDRIC S. F. LORENZO Abstract Background. Studies demonstrate an inverse relationship between institution/surgeon procedural volumes and patient outcomes. Similar studies exist for liver resections, which recommend referral of patients for liver resections to ,high-volume' centers. These studies did not elucidate the factors that underlie such outcomes. We believe there exists a complex interaction of patient-related and perioperative factors that determine patient outcomes after liver resection. We sought to delineate these factors. Methods. Retrospective review of 114 liver resections by a single surgeon from 1993,2003: Records were reviewed for demographics; diagnosis; type/year of surgery; American Society of Anesthesiologists (ASA) score; preoperative albumin, creatinine, and bilirubin; operative time; intraoperative blood transfusions; epidural use; and intraoperative hypotension. Main outcome measurements were postoperative morbidities, mortalities and length of stay (LOS). Data were analyzed using a multivariate linear regression model (SPSS v10.1 statistical analysis program). Results. Primary indications for resections were hepatocellular carcinoma (HCC) (N=57), metastatic colorectal cancer (N=25), and benign disease (N=18). There were no intraoperative mortalities and 4 perioperative (30-day) mortalities (3.5%). Mortality occurred in patients with malignancies who were older than 50 years. Morbidity was higher in malignant (15.6%) versus benign (5.5%) disease. Complications included bile leak/stricture (N=6), liver insufficiency (N=3), postoperative bleeding (N=2), myocardial infarction (N=2), aspiration pneumonia (N=1), renal insufficiency (N=1), and cancer implantation into the wound (N=1). Average LOS for all resections was 8.6 days. Longer operative time (p=0.04), lower albumin (p<0.001), higher ASA score (p<0.001), no epidural use (p=0.04), and higher creatinine (p<0.001) all correlated positively with longer LOS. ASA score and creatinine were the strongest predictors of LOS. LOS was not affected by patient age, sex, diagnosis, presence of malignancy, intraoperative transfusion requirements, intraoperative hypotension, preoperative bilirubin, case volume per year or year of surgery. Conclusions. Liver resections can be performed with low mortality/morbidity and with acceptable LOS by an experienced liver surgeon. Outcome as measured by LOS is most influenced by patient comorbidities entering into surgery. Annual case volume did not influence LOS and had no impact on patient safety. Length of stay may not reflect surgeon/institution performance, as LOS is multifactorial and likely related to patient population, patient selection and increased high-risk cases with a surgeon's experience. [source] | ||||||||||||||||||||||||||||||||||