Quasi-experimental Design (quasi-experimental + design)

Distribution by Scientific Domains
Distribution within Medical Sciences

Selected Abstracts

Application of Regression-Discontinuity Analysis in Pharmaceutical Health Services Research

Ilene H. Zuckerman
Objective. To demonstrate how a relatively underused design, regression-discontinuity (RD), can provide robust estimates of intervention effects when stronger designs are impossible to implement. Data Sources/Study Setting. Administrative claims from a Mid-Atlantic state Medicaid program were used to evaluate the effectiveness of an educational drug utilization review intervention. Study Design. Quasi-experimental design. Data Collection/Extraction Methods. A drug utilization review study was conducted to evaluate a letter intervention to physicians treating Medicaid children with potentially excessive use of short-acting ,2 -agonist inhalers (SAB). The outcome measure is change in seasonally-adjusted SAB use 5 months pre- and postintervention. To determine if the intervention reduced monthly SAB utilization, results from an RD analysis are compared to findings from a pretest,posttest design using repeated-measure ANOVA. Principal Findings. Both analyses indicated that the intervention significantly reduced SAB use among the high users. Average monthly SAB use declined by 0.9 canisters per month (p<.001) according to the repeated-measure ANOVA and by 0.2 canisters per month (p<.001) from RD analysis. Conclusions. Regression-discontinuity design is a useful quasi-experimental methodology that has significant advantages in internal validity compared to other pre,post designs when assessing interventions in which subjects' assignment is based on cutoff scores for a critical variable. [source]

Care management, dementia care and specialist mental health services: an evaluation

David Challis
Abstract Objective To evaluate a model of intensive case management for people with dementia based in a community-based mental health service for older people. Method Quasi-experimental design. Individuals in one community team setting received case management and were compared with those in a similar team without such a service. Fortythree matched pairs were identified. Eligible older people and their carers were interviewed at uptake and again at 6 and 12 months. Results The impact of the scheme upon placement occurred in the second year at the end of which 51% of the experimental group remained at home compared with 33% of the comparison group. For the experimental group significant improvements in the social contacts of older people were noted; a decrease in the stress of their carers was observed, together with a reduction in their input to the care of the client; and there were significant improvements on ratings of overall need reduction, aspects of daily living and level of risk. Differences between the two groups based on service receipt showed higher costs for the experimental group. Discussion The benefits to older people and their carers confirms previous findings that the most effective case management interventions are those targeted on a highly specific client group. Issues which influence the cost-effectiveness of intensive case management are discussed. The benefits of locating this service within a specialist mental health team are explored in the context of current initiatives to promote greater service integration between health and social services. Copyright © 2002 John Wiley & Sons, Ltd. [source]

Quality of Nursing Diagnoses: Evaluation of an Educational Intervention

Jan Florin RN
PURPOSE.,To investigate the effects on the quality of nursing diagnostic statements in patient records after education in the nursing process and implementation of new forms for recording. METHODS.,Quasi-experimental design. Randomly selected patient records reviewed before and after intervention from one experimental unit (n = 70) and three control units (n = 70). A scale with 14 characteristics pertaining to nursing diagnoses was developed and used together with the instrument (CAT-CH-ING) for record review. FINDINGS.,Quality of nursing diagnostic statements improved in the experimental unit, whereas no improvement was found in the control units. Serious flaws in the use of the etiology component were found. CONCLUSION.,Nurses must be more concerned with the accuracy and quality of the nursing diagnoses and the etiology component needs to be given special attention. PRACTICE IMPLICATIONS.,Education of RNs in nursing diagnostic statements and peer review using standardized evaluation instruments can be means to further enhance RNs' documentation practice. [source]

Patterns of Utilization for the Minnesota Senior Health Options Program

Robert L. Kane MD
Objectives: To compare the use of medical services provided under the Minnesota Senior Health Options (MSHO) (a special program designed to serve dually eligible older persons) with that provided to controls who received fee-for-service Medicare and Medicaid managed care. Design: Quasi-experimental design using two control groups; separate matched cohort and rolling cross-sectional analyses; regression models used to adjust for case-mix differences. Setting: Urban Minnesota community and nursing home long-term care. Participants: Dually eligible elderly MSHO enrollees in the community and in nursing homes were compared with two sets of controls; one was drawn from nonenrollees living in the same area (control-in) and another from comparable persons living in another urban area where the program was not available (control-out). Cohorts living in the community and in nursing homes were included. Measurements: Use of hospitals and emergency rooms, physician visits. Results: In the community cohort, there were no significant differences in hospital admission rates or in hospital days. MSHO enrollees had significantly fewer preventable hospital admissions and significantly fewer preventable emergency services than the control-in group. MSHO nursing home enrollees had significantly fewer hospital admissions than either control group with or without adjustment at 12 and 18 months. MSHO enrollees had significantly fewer hospital days and preventable hospitalizations than the control-in group. MSHO enrollees had significantly fewer emergency room visits and preventable emergency room visits than either control group. Conclusion: In general, the results of this evaluation are mixed but favor MSHO. The effect of MSHO was stronger for nursing home enrollees than community enrollees. The lower rate of preventable hospitalizations and emergency room visits of MSHO enrollees suggests that MSHO affected the process of care by providing more of some types of preventive and community-care services for community residents. [source]

The Effect of Three-Tier Formulary Adoption on Medication Continuation and Spending among Elderly Retirees

Haiden A. Huskamp
Objective. To assess the effect of three-tier formulary adoption on medication continuation and spending among elderly members of retiree health plans. Data Sources. Pharmacy claims and enrollment data on elderly members of four retiree plans that adopted a three-tier formulary over the period July 1999 through December 2002 and two comparison plans that maintained a two-tier formulary during this period. Study Design. We used a quasi-experimental design to compare the experience of enrollees in intervention and comparison plans. We used propensity score methods to match intervention and comparison users of each drug class and plan. We estimated repeated measures regression models for each class/plan combination for medication continuation and monthly plan, enrollee, and total spending. We estimated logit models of the probability of nonpersistent use, medication discontinuation, and medication changes. Data Collection/Extraction Methods. We used pharmacy claims to create person-level drug utilization and spending files for the year before and year after three-tier adoption. Principal Findings. Three-tier formulary adoption resulted in shifting of costs from plan to enrollee, with relatively small effects on medication continuation. Although implementation had little effect on continuation on average, a small minority of patients were more likely to have gaps in use and discontinue use relative to comparison patients. Conclusions. Moderate cost sharing increases from three-tier formulary adoption had little effect on medication continuation among elderly enrolled in retiree health plans with relatively generous drug coverage. [source]

Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study

Background: There is an evident need for improved management of elderly patients with trauma in order to avoid common and troublesome complications such as delirium. The aim of this study was to investigate whether an implementation of a multi-factorial program including intensified pre-hospital and perioperative treatment and care could reduce the incidence of delirium in elderly patients with hip fracture, cognitively intact at admission to the hospital. In addition, we explored the factors that characterize patients who developed delirium. Methods: A prospective, quasi-experimental design was used. A total of 263 patients with hip fracture (,65 years), cognitively intact at admission, were consecutively included between April 2003 and April 2004. On 1 October 2003, a new program was introduced. All patients were screened for cognitive impairment within 30 min after admission to the emergency department using The Short Portable Mental Status Questionnaire (SPMSQ). To screen for delirium, patients were tested within 4 h of admission and thereafter daily, using the Organic Brain Syndrome scale. Results: The number of patients who developed delirium during hospitalization was 74 (28.1%), with a decrease from 34% (45 of 132) in the control group to 22% (29 of 131) in the intervention group (P=0.031). Patients who developed delirium were statistically older, more often had >4 prescribed drugs at admission and scored less well in the SPMSQ test. Conclusion: The use of a multi-factorial intervention program in elderly hip fracture patients, lucid at admission, reduced the incidence of delirium during hospitalization by 35%. [source]

Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol

Eva Abad-Corpa
abad-corpa e., meseguer-liza c., martínez-corbalán j.t., zárate-riscal l., caravaca-hernández a., paredes-sidrach de cardona a., carrillo-alcaraz a., delgado-hito p. & cabrero-garcía j. (2010) Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol. Journal of Advanced Nursing,66(8), 1845,1851. Abstract Title.,Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol. Aim., To generate changes in nursing practice introducing an evidence-based clinical practice (EBCP) model through a participatory process. To evaluate the effectiveness of the changes in terms of nurse-sensitive outcome (NSO). Background., For international nursing science, it is necessary to explore the reasons for supporting EBCP and evaluate the real repercussions and effectiveness. Methods., A mixed methods study with a sequential transformative design will be conducted in the bone marrow transplant unit of a tertiary-level Spanish hospital, in two time periods >12 months (date of approval of the protocol: 2006). To evaluate the effectiveness of the intervention, we will use a prospective quasi-experimental design with two non-equivalent and non-concurrent groups. NSO and patient health data will be collected: (a) impact of psycho-social adjustment; (b) patient satisfaction; (c) symptom control; (d) adverse effects. All patients admitted during the period of time will be included, and all staff working on the unit during a participatory action research (PAR). The PAR design will be adopted from a constructivist paradigm perspective, following Checkland's "Soft Systems" theoretical model. Qualitative techniques will be used: 2-hour group meetings with nursing professionals, to be recorded and transcribed. Field diaries (participants and researchers) will be drawn up and data analysis will be carried out by content analysis. Discussion., PAR is a rigorous research method for introducing changes into practice to improve NSO. [source]

Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol

Eva Abad-Corpa
abad-corpa e., carrillo-alcaraz a., royo-morales t., pérez-garcía m.c., rodríguez-mondejar j.j., sáez-soto a. & iniesta-sánchez j. (2010) Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Journal of Advanced Nursing,66(6), 1365,1370. Abstract Title.,Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol. Aim., To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow-up planning for primary care patients with chronic obstructive pulmonary disease. Background., Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge. Methods., A quasi-experimental design will be adopted, with a control group and pseudo-randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary-level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. Discussion., The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses. [source]

Resident-oriented care in nursing homes: effects on nurses

Afke J.M.B. Berkhout PhD
Background., In a resident-oriented care model the assignment of patients to primary nurses takes place. These primary nurses are responsible for the total nursing care of their patients and make use of the nursing process. According to job demand-control models, these enlarged and enriched jobs can be described in terms of autonomy, job demands and social support, and the presence of these work characteristics has a positive influence on workers' psychological and behavioural outcomes. Aims., This paper reports a study to investigate the extent to which the various features of resident-oriented care were implemented and its effects nurses' on work characteristics and on psychological and behavioural outcomes in three Dutch nursing homes. Methods., In a quasi-experimental design, experimental and control groups were followed over 22 months, using a pretest and two post-tests with questionnaires, interviews and qualitative observations. Results., The quantitative data showed significant increases in resident assignment, the two variables measuring the nursing process and, in the psycho-geriatric experimental group, on resident-oriented tasks. The qualitative data showed that a partly task-oriented division of labour was still used and that the planned delegation of coordination tasks to primary nurses was not fully achieved. Effects on work perceptions were limited. After implementation of the new system, the experimental group showed an increase in job autonomy. Conclusions., The intervention appeared to be only partly successful. Most of the expected results regarding work characteristics and psychological and behavioural outcomes did not materialize. Theoretical and methodological reflections are presented in the light of these findings. [source]

The effectiveness of a programme of enhancing resiliency by reducing family boundary ambiguity among children with epilepsy

Pei-Fan Mu
Aim and objectives., The aim of the study was to examine the effect of a programme designed to reduce family boundary ambiguity in families who care for children with epilepsy. Background., When parents are caring for an epileptic child, they may experience unclear perceptions about whether the child is psychologically included in the family and develop unclear expectations regarding role performance in the family. Some studies have identified boundary ambiguity as a possible antecedent to relationship problems that are associated with negative outcomes in the areas of parental well-being and family functioning. There is a need to develop family nursing interventions that will reduce family boundary ambiguity when the family is caring for children with epilepsy. Design., A pretest, post-test, one group, quasi-experimental design was used in this study. Methods., This study was made up of three phases: first, the establishing of a parental needs checklist and the development of a parental education information handbook; second, the carrying out of a family assessment including the analysis of the meaning of their experiences and needs and the construction of an educational dialogue and finally, an outcomes evaluation after three months. Seventeen mothers participated in the study. Results., The study found that there were statistically significant improvements in family boundary ambiguity and maternal depression was reduced. Conclusions., This study illustrates nursing intervention that involves the integrating of phenomenological principles into the nursing care process. Specifically, Husserlian phenomenology is able to be helpful to nursing practice, especially the concepts of intentionality, intersubjectivity, empathy and bracketing. Relevance to clinical practice., This study supported the conceptual framework involved in the construction of the meaning of the situation, the enhancement of mastery over the situation and reconstruction of identity. These items are resiliency factors that provided a mechanism that helps to reduce boundary ambiguity when a family is caring for a child with epilepsy. [source]

Creating supportive clinical learning environments: an intervention study

Amanda Henderson
Aim., To assess the impact of an intervention aimed to build capacity of registered nurses to enhance the clinical learning environment for undergraduate nursing students. Workplace learning is vital for the development of skills, attributes and knowledge of student nurses. Registered nurses need to be appropriately prepared to maximise student learning during clinical placement. Background., The quality of student learning during clinical practicum is largely dependent on interactions with ward staff. Design., A quasi-experimental design. Method., Measurement of students' perceptions of the psycho social learning environment during and outside of the intervention period was used to evaluate the capacity building intervention. The capacity building intervention consisted of interactive education in clinical areas over a six-week period for registered nurses in two acute surgical wards. Results., First, second and third year students (n = 62) who undertook their clinical practicum in the two surgical wards, before, during and six months after the capacity building intervention assessed the psycho-social learning environment at the time of their clinical practicum. Findings showed that students who undertook their clinical practicum during the intervention period rated the psycho-social clinical learning environment significantly higher than students who undertook their practicum at times outside of the intervention period. Conclusions., An experienced researcher/educator conducting capacity building sessions can effectively assist and support registered nurses to engage with students. Relevance to clinical practice., Capacity building sessions can improve practice, however, structures and processes that ensure continuation of practice change need to be embedded for improvements to be sustained. [source]

Effect of an interactive computerized psycho-education system on patients suffering from depression

MPsychN, Mei-Feng Lin PhD
Aims., The aim of this study was to examine the effect of an Interactive Computerized Psycho-Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho-Education System vs. traditional pamphlet education approach. Background., Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments. Design and method., A preliminary pre and post quasi-experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho-Education System intervention programme (Interactive Computerized Psycho-Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale. Results., In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho-Education System was about 30,180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non-compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30,100, with an average score of 74.7. Conclusion., The Interactive Computerized Psycho-Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression. Relevance to clinical practice., Compared with a traditional approach, the combination of the Interactive Computerized Psycho-Education System and a nursing-consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression. [source]

Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan

Shu-Shan Lin RN
Aims., The objectives of this study were to design a structured prenatal education programme on breastfeeding and to evaluate the effectiveness of the programme. Indicators of effectiveness were selected based on Kirkpatrick's Training Evaluation Model, including satisfaction with the programme, breastfeeding knowledge, breastfeeding attitude, breastfeeding satisfaction, breastfeeding problems and rate of exclusive breastfeeding. Methods., This study applied a quasi-experimental design. The experimental group included 46 women who received a 90-minute group educational programme on breastfeeding during their 20th,36th week of pregnancy. Each experimental subject was matched by a control subject according to age, educational level, work status and pregnancy gestational age. Control subjects did not receive any intervention. Data were collected through self-administered questionnaires at preintervention, postintervention, three days postpartum and one month postpartum. Results., Satisfaction with the programme was high. The experimental group had higher scores in breastfeeding knowledge and breastfeeding attitude at three days postpartum. The experimental group showed higher breastfeeding satisfaction at three days and one month postpartum. There were no significant differences in experiencing breastfeeding problems. The rate of exclusive breastfeeding was higher for the experimental group at three days and one month postpartum, but the differences were not statistically significant. Conclusion., This study demonstrated the effectiveness of a prenatal education programme on maternal knowledge, attitude and satisfaction toward breastfeeding. Relevance to clinical practice., Other hospitals could apply this model to plan and evaluate their prenatal education programme on breastfeeding. [source]

Evaluating effects of a prenatal web-based breastfeeding education programme in Taiwan

Mei Zen Huang MS
Aims., The objectives of this study were to evaluate a web-based breastfeeding education programme provided to primigravida in the third trimester of pregnancy with the aim of deepening breastfeeding knowledge and enhancing skills. The study was conducted at a hospital in Taiwan. Background., Education is the cornerstone supporting the framework of lactation and breastfeeding. Web-based instruction is an efficient way to provide education. Design., A quasi-experimental design was used. Methods., The target population was women at 29,36 weeks gestation using the Internet on regular basis. The primigravida were assigned to either the control group (n = 60) or the experimental group (n = 60) according to time sequence. Results., Women who received web-based breastfeeding education had a higher mean breastfeeding knowledge score and more positive attitude about breastfeeding. In addition, generalized estimating equations (GEE) model was used to examine the breastfeeding rate at different time points. After adjusting for the time trend and infant birth weight, there was a significant effect in exclusive breastfeeding for the experimental group. On the other hand, the web-based breastfeeding education programme also had a significant effect on mixed feeding rate for the experimental group. Conclusion., Results suggest that web-based breastfeeding education may contribute to breastfeeding knowledge and attitude and improved breastfeeding rate. Relevance to clinical practice., Web-based breastfeeding education programme can achieve success in promoting breastfeeding and provide health professionals with an evidence-based intervention. [source]

Disaster Exercise Outcomes for Professional Emergency Personnel and Citizen Volunteers

Ronald W. Perry
It has long been argued in the research literature that conducting disaster exercises produces a variety of benefits that promote effective emergency management. In spite of nearly universal acceptance of the claim, there are few empirical studies that have explored the effects of exercises on participants. This paper reviews the role of exercises in the creation of community disaster preparedness, while making explicit the links among planning, training and exercising. Using a quasi-experimental design, the effects of disaster exercise participation on perceptions of response knowledge and teamwork are studied for police officers, fire-fighters and civilian volunteers. The exercise studied involved an annual airport disaster drill required for continuing certification. It was found that participation enhanced the perceptions of response knowledge and teamwork for all three types of participants. [source]

Participation in the design of performance management systems: a quasi-experimental field study

Ad Kleingeld
In the literature on the relationship between participation in decision making and performance, a tell-and-sell strategy is considered a viable alternative to participation. In contrast, we argue that in organizational settings, when a sensitive and important issue is at stake, participation of a form to be characterized as formal, long term, direct, and with a high degree of participant influence is more effective than a tell-and-sell strategy. Using a quasi-experimental design with a participation, a tell-and-sell, and a control condition, a ProMES performance management system was implemented in the field service department of a Dutch supplier of photocopiers. Outcome feedback to individual technicians resulted in an average performance increase in the participation condition that was significantly higher than the increase found in the tell-and-sell condition. Satisfaction with the program, and the perceived usefulness of the feedback, were significantly higher in the participation condition. In both experimental conditions, the performance increase was significant compared to the control condition. An explanation for these findings is discussed, as are implications for theory and practice. Copyright © 2004 John Wiley & Sons, Ltd. [source]

The impact of a classroom intervention on grade 10 students' argumentation skills, informal reasoning, and conceptual understanding of science

Grady J. Venville
Abstract The literature provides confounding information with regard to questions about whether students in high school can engage in meaningful argumentation about socio-scientific issues and whether this process improves their conceptual understanding of science. The purpose of this research was to explore the impact of classroom-based argumentation on high school students' argumentation skills, informal reasoning, and conceptual understanding of genetics. The research was conducted as a case study in one school with an embedded quasi-experimental design with two Grade 10 classes (n,=,46) forming the argumentation group and two Grade 10 classes (n,=,46) forming the comparison group. The teacher of the argumentation group participated in professional learning and explicitly taught argumentation skills to the students in his classes during one, 50-minute lesson and involved them in whole-class argumentation about socio-scientific issues in a further two lessons. Data were generated through a detailed, written pre- and post-instruction student survey. The findings showed that the argumentation group, but not the comparison group, improved significantly in the complexity and quality of their arguments and gave more explanations showing rational informal reasoning. Both groups improved significantly in their genetics understanding, but the improvement of the argumentation group was significantly better than the comparison group. The importance of the findings are that after only a short intervention of three lessons, improvements in the structure and complexity of students' arguments, the degree of rational informal reasoning, and students' conceptual understanding of science can occur. © 2010 Wiley Periodicals, Inc. J Res Sci Teach 47: 952,977, 2010 [source]

Evaluation of HIV/AIDS Education in Russia Using a Video Approach

Mohammad R. Torabi
ABSTRACT: HIV/AIDS has intruded upon the geographic, political, ethnic, gender, and sexual orientation of communities all over the world. As of April 1999, Russia has recorded approximately 13,532 cases of HIV infection. Since the costs of treatment are expensive for many countries, and especially for Russia, educational intervention appears to offer the most effective and affordable solution. A quasi-experimental design, with pre/post tests and intervention (through video education)/control groups, was used to study 20 public schools in St. Petersburg, Russia. Results confirmed the lack of HIV/AIDS education in schools and insufficient information sources from parents, friends, and public health education. ANCOVA statistics demonstrated that use of video education significantly improved students' scores on knowledge and attitudes related to HIV/AIDS prevention. Thus, health educators should consider video education as an effective and efficient tool to present facts to a young audience when they face constraints of shortage of funds, lack of trained teachers, and scarcity of related information. [source]

The effects of specific educational preparation on emergency nurses' clinical decisions regarding supplemental oxygen administration

Julie Considine rn, certacutecarensg(emerg), frcna, graddipnsg(acute care)
Abstract, The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses' clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses' decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre-test/post-test, quasi-experimental design was used. The intervention was a written, self-directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes. [source]

A Psychophysical Investigation of the Facial Action Coding System as an Index of Pain Variability among Older Adults with and without Alzheimer's Disease

PAIN MEDICINE, Issue 8 2007
Amanda C. Lints-Martindale MA
ABSTRACT Objective., Reflexive responses to pain such as facial reactions become increasingly important for pain assessment among patients with Alzheimer's disease (AD) because self-report capabilities diminish as cognitive abilities decline. Our goal was to study facial expressions of pain in patients with and without AD. Design., We employed a quasi-experimental design and used the Facial Action Coding System (FACS) to assess reflexive facial responses to noxious stimuli of varied intensity. Two different modalities of stimulation (mechanical and electrical) were employed. Results., The FACS identified differences in facial expression as a function of level of discomforting stimulation. As expected, there were no significant differences based on disease status (AD vs control group). Conclusions., This is the first study to discriminate among FACS measures collected during innocuous and graded levels of precisely measured painful stimuli in seniors with (mild) dementia and in healthy control group participants. We conclude that, as hypothesized, FACS can be used for the assessment of evoked pain, regardless of the presence of AD. [source]

The Influence of Experimenter Gender and Race on Pain Reporting: Does Racial or Gender Concordance Matter?

PAIN MEDICINE, Issue 1 2005
Carol S. Weisse PhD
ABSTRACT Background., Research on disparities in the treatment of pain has shown that minorities receive less aggressive pain management than nonminorities. While reasons include physician bias, the focus of this study was to examine whether differences in pain reporting behavior might occur when pain is reported to individuals of a different race or gender. Objective., To test whether gender and racial concordance might influence pain reporting and pain behavior in a laboratory setting. Design/Setting., By using a two (subject race)-by-two (subject gender)-by-two (experimenter race)-by two (experimenter gender) quasi-experimental design, pain was assessed in a laboratory through a standard cold pressor task administered by someone whose gender and/or race was similar or dissimilar. Subjects., Subjects were 343 (156 men; 187 women) undergraduates whose ages ranged from 17 to 43 years (mean 20.27 years). Outcome Measures., Pain tolerance was assessed by total immersion time in the ice bath. Pain ratings were obtained by using Gracely scales, which rate the intensity and unpleasantness of the task. Results., Total immersion time was shorter for both blacks and women, and both blacks and women reported higher pain intensity and unpleasantness. Racial and gender concordance did not influence pain reporting or pain tolerance, but interactions between subject race and experimenter gender, as well as subject gender and experimenter race, were revealed. Conclusions., Racial and gender concordance did not influence pain reporting; however, pain reporting was influenced by interactions between gender and race in the subject,experimenter dyads. [source]

The Limitations of Heuristics for Political Elites

Kristina C. Miler
Despite the extensive literature on citizens' use of cognitive heuristics in political settings, far less is known about how political elites use these shortcuts. Legislative elites benefit from the efficiency of the accessibility heuristic, but their judgments can also be flawed if accessible information is incomplete or unrepresentative. Using personal interviews and a quasi-experimental design, this paper examines the use of the accessibility heuristic by professional legislative staff when assessing the importance of natural resources issues to their constituents. Staff members recall only a small subset of the relevant constituents in the district, and this subset is biased in favor of active and resource-rich constituents over other, equally relevant constituents. This paper provides a new application of cognitive psychology to political elites and addresses important normative questions about the importance of information processing for political representation. By drawing on the psychology literature on heuristics, this paper identifies the cognitive mechanisms of congressional representation and provides new evidence of old biases. [source]

Effects of a Psychologically Based Management System on Work Motivation and Productivity

Uwe Kleinbeck
Introducing group work as a principle of work organisation to increase productivity in organisations operating in a globalising economy requires new methods of measuring performance in groups. This study describes the introduction of a measurement instrument as part of a participative productivity management (PPM) system in a medium sized factory producing rubber compounds. Using a simple quasi-experimental design, the PPM intervention was found to produce an increase in productivity and was also related to goal clarity, but not to higher group cohesion. It is concluded that PPM helps to increase productivity mainly by increasing task and goal clarity, and that increases in productivity can only be reached reliably when no competing system of performance appraisal exists besides PPM. L'introduction du travail en groupe comme principe de structuration du travail pour ame´liorer la productivite´ d'organisations e´voluant dans une e´conomie globalise´e impose de nouvelles me´thodes pour mesurer la performance dans les groupes. Cet article de´crit l'application d'un instrument de mesure comme e´tant un e´le´ment du syste`me de gestion participative de la productivite´ (PPM) dans une usine de taille moyenne produisant des composants en caoutchouc. En faisant appel a` un plan quasi expe´rimental, l'intervention PPM a ame´liore´ la productivite´ tout en e´tant relie´e a` la clarte´ des objectifs, mais pas a` une meilleure cohe´sion des groupes. On en conclut que la PPM accroit la productivite´ surtout grâce a` une meilleure transparence des objectifs et des tâches, mais que ces gains de productivite´ ne peuvent être obtenus avec certitude si un syste`me concurrent d'e´valuation de la performance fonctionne en paralle`le avec la PPM. [source]

Environmental approach to reducing agitation in older persons with dementia in a nursing home

Lesley Wilkes
Objective:,This paper reports the effects on challenging (agitated) behaviours, such as aggression, noisiness and wandering, when persons with dementia were relocated to a special unit. Methods:,The study was a simple interrupted time series quasi-experimental design. The dependent variable was agitated behaviour and the independent variables were residing in an old unit and in a Special Care Unit (SCU). Twenty-two persons with dementia from a nursing home were involved in this study. Subjects were assessed weekly for 1 month prior to the move to the SCU and weekly for 1 month at 3 and 6 months after the move. Data were entered into SPSS software and analysed. Results:,The most significant results from the study were that the verbally agitated behaviour of the subjects was reduced and sustained throughout the 6 months of the study after their move into a SCU. Conclusions:,This study has shown that environmental design does impact positively in the care of persons with dementia. [source]

An analysis of post-booking jail diversion programming for persons with co-occurring disorders,

Dr Michael S. Shafer Ph.D.
For persons with co-occurring disorders, interaction with criminal justice systems is a frequent occurrence. As a result, a variety of diversionary programs have been developed nationwide. In this study, a total of 248 individuals with co-occurring disorders of serious mental illness and substance use disorders who had been arrested and booked on misdemeanor charges participated in a post-booking jail diversion program in two urban communities. A quasi-experimental design was used with individuals assigned to diversion or non-diversion status based upon the decision processes of the mental health,criminal justice systems. The effectiveness of the jail diversion program was evaluated from a variety of sources, including structured interviews, behavioral health service utilization patterns, and criminal justice recidivism patterns. Analyses revealed general main effects for time on many of the outcome variables, with few main effects or interaction effects detected on the basis of diversion status (diverted versus non-diverted). Across all measures assessing mental health and substance abuse, study participants displayed improvements over time, irrespective of their diversion status or program location. Participants generally displayed no significant changes in their rates of accessibility to, or frequency of use of, the various mental health, substance abuse, and other services, and few changes for diversion status were detected with regard to service utilization. Although a number of indicators of criminality and violence were reduced over time, these reductions were statistically insignificant, with changes for diversionary status or time identified at follow-up. These results are discussed in light of their implications for jail diversion programming and future research in this area. Copyright © 2004 John Wiley & Sons, Ltd. [source]

Bicycle helmet campaigns and head injuries among children.

Does poverty matter?
Objectives To assess the impact of a community-based bicycle helmet programme aimed at children aged 5,12 years (about 140 000) from poor and well-off municipalities. Methods A quasi-experimental design, including a control group, was used. Changes in the risk of bicycle-related head injuries leading to hospitalization were measured, using rates ratios. Results Reductions in bicycle-related head injuries were registered in both categories of municipalities. Compared with the pre-programme period, the protective effect of the programme during the post-programme period was as significant among children from poor municipalities (RR 0.45; 95% CI 0.26,0.78) as among those from richer municipalities (RR 0.55; 95% CI 0.41,0.75). Conclusion Population-based educational programmes may have a favourable impact on injury risks in poor areas despite lower adoption of protective behaviours. [source]

Research Methods of Inquiry

Joel Rodgers MA
Incidents of significant consequence that create surge may require special research methods to provide reliable, generalizable results. This report was constructed through a process of literature review, expert panel discussion at the journal's consensus conference, and iterative development. Traditional clinical research methods that are well accepted in medicine are exceptionally difficult to use for surge incidents because the incidents are very difficult to reliably predict, the consequences vary widely, human behaviors are heterogeneous in response to incidents, and temporal conditions prioritize limited resources to response, rather than data collection. Current literature on surge research methods has found some degree of reliability and generalizability in case-control, postincident survey methods, and ethnographical designs. Novel methods that show promise for studying surge include carefully validated simulation experiments and survey methods that produce validated results from representative populations. Methodologists and research scientists should consider quasi-experimental designs and case-control studies in areas with recurrent high-consequence incidents (e.g., earthquakes and hurricanes). Specialists that need to be well represented in areas of research include emergency physicians and critical care physicians, simulation engineers, cost economists, sociobehavioral methodologists, and others. [source]

The Impact of CHIP on Children's Insurance Coverage: An Analysis Using the National Survey of America's Families

Lisa Dubay
Objective. To assess the impact of the Children's Health Insurance Program (CHIP) on the distribution of health insurance coverage for low-income children. Data Source. The primary data for the study were from the 1997, 1999, and 2002 National Survey of America's Families (NSAF), which includes a total sample of 62,497 children across all 3 years, supplemented with data from other data sources. Study Design. The study uses quasi-experimental designs and tests the sensitivity of the results to using instrumental variable and difference-in-difference approaches. A detailed Medicaid and CHIP eligibility model was developed for this study. Balanced repeated replicate weights were used to account for the complex sample of the NSAF. Descriptive and multivariate analyses were conducted. Principle Findings. The results varied depending on the approach utilized but indicated that the CHIP program led to significant increases in public coverage (14,20 percentage points); and declines in employer-sponsored coverage (6,7 percentage points) and in uninsurance (7,12 percentage points). The estimated share of CHIP enrollment attributable to crowd-out ranged from 33 to 44 percent. Smaller crowd-out effects were found for Medicaid-eligible children. Conclusions. Implementation of the CHIP program resulted in large increases in public coverage with estimates of crowd-out consistent with initial projections made by the Congressional Budget Office. This paper demonstrates that public health insurance expansions can lead to substantial reductions in uninsurance without causing a large-scale erosion of employer coverage. [source]

Simulation-based learning in nurse education: systematic review

Robyn 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]

Nursing Research and HIV Infection: State-of-the-Science

Barbara A. Goldrick
Purpose: To provide an update of the nursing research literature on HIV infection and to develop an HIV/AIDS database using arcs© computer software. Methods: Nursing research literature from 1986 through 1997 on human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) was reviewed. With an emphasis on client-focused research, 246 studies were entered into the arcs© HIV/AIDS database. Findings: Analysis of over 1,000 citations in the HIV/AIDS nursing research literature over the past decade indicated that 22% (n = 219) of the nursing studies were client- or patient-focused; 29% (n = 292) were risk-group focused; and 49% (n = 492) were provider-focused. Of the 246 studies entered into the arcs© HIV/AIDS database, 88 (35.7%) were classified in the psychologic domain, 65 (26.4%) in the physiologic domain, 24 (9.7%) in the behavioral domain, and 25 (10%) in the social domain. In addition, 17 (6.9%) of the studies were classified in the quality of life domain, and 27 (10.9%) in the stage of HIV disease domain. The majority (53%) of the 246 studies (n = 131) were correlational, 86 (35%) were descriptive, and 29 (12%) had experimental or quasi-experimental designs. Conclusions: Although nursing studies have described some of the problems that affect HIV-infected people, further research is needed, particularly related to clinical interventions. [source]