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D Quade

Publications and source records attributed to D Quade.

48 records · Page 3Linked to original sources
PubMed1980

Effects of method error on the power of a statistical test. Implications of imperfect sensitivity and specificity in retrospective chart review.

Errors in classifying individuals as to whether they have a certain characteristic may adversely affect the power of a statistical test to detect differences in the incidence of that characteristic between groups or to detect changes in the incidence over time. To determine whether the classification method to be used in the Study on the Efficacy of Nosocomial Infection Control (SENIC Project)--retrospective chart review--would provide sufficient power for a test of the study's main hypothesis, the authors calculated power as a function of the sensitivity and specificity of the method. They then contrasted the case in which sensitivity and specificity are constant for all hospitals in the study with cases in which the measures vary between groups of hospitals or between time periods. It was found that variation within the observed ranges of sensitivity and specificity, even if systematic, has little effect on power unless it is related to the hypothesis under study. The authors thus concluded that SENICs study design is adequate to detect any substantial success of infection surveilliance and control programs in combatting nosocomial infection, unless such programs affect the accuracy of the chart review method.

Cross Infection↗
PubMed1980

Effect of an infection surveillance and control program on the accuracy of retrospective chart review.

The primary analyses of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) will test the association between the presence of infection surveillance and control programs (ISCPs) and changes in nosocomial infection rates (NIRs) as measured by retrospective chart review (RCR). If the establishment of an ISCP affects the quality or completeness of information important for diagnosing infection by RCR, the analyses could be biased (i.e., there could be an increased chance of a Type I or Type II error). To determine whether this type of "ISCP effect" on the accuracy of RCR is likely to occur, the authors carried out a prospective intervention study in one hospital where 1) nosocomial infections among a pre-ISCP cohort of patients were detected by prospective data collection (PDC), 2) the hospital's first ISCP was instituted, and 3) infections were identically studied by PDC exactly two years later. Several months after the end of the second PDC, a team of trained chart reviewers read the medical records of the patients in both study cohorts and abstracted all clinical data bits used for diagnosing nosocomial infection. By a nonparametric matched correlation analysis, no significant change was found in the amount of relevant clinical information recorded in the medical records, and sensitivity and specificity did not change significantly. The authors conclude that, if an ISCP effect on RCR accuracy is present at all, it must be small.

Cross Infection↗
PubMedDate not supplied

Master's degree-level community health nursing educational needs: a national survey of leaders in service and education.

This study identified the core components of the curriculum for master's degree-level community health nurses (CHNs) and assessed whether existing educational programs provide this knowledge base. According to 588 leaders in community health nursing (CHN) service and education, all master's degree-prepared CHNs require skills in the administrative role. Interdisciplinary core content areas needed to fulfill role responsibilities include a practicum experience; epidemiology; community health assessment and diagnosis; administration and management, including program planning and evaluation, financial management, budgeting, and quality assurance; research methods and biostatistics; health promotion and disease prevention; interventions at the aggregate level; and leadership theory. There were notable discrepancies between what was considered essential and what actually was included in CHN education. This article provides suggestions and possible alternatives for initiating change to ensure adequate educational preparation for graduate-level CHN practice.

Clinical Competence↗
PubMedDate not supplied

Health outcomes of children receiving EPSDT checkups: a pilot study.

This pilot study used medical records to examine the health outcomes of children receiving care in Medicaid's Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program. Medical records from 76 children seen for EPSDT visits during a 6-month period were reviewed to assess whether health problems were identified and whether treatment, follow-up, or referral care was provided. Health problems were identified for 43% of the children; 22% received treatment, and 18% were referred for specialty care. Checkups uncovered fewer problems than would be expected in a poor, largely minority population. Almost one third of the children referred for specialty care apparently did not receive such care. The study verified the need for further research and provides direction for future study.

Adolescent↗
PubMedDate not supplied

Reporting of instrument validity and reliability in selected clinical nursing journals, 1989.

Before research findings are applied to practice, the quality of the research must be assessed so that flawed research does not lead inadvertently to flawed practice. Two critical indicators of research quality are the validity and reliability of the data collection instruments. This article summarizes the principles of instrument validity and reliability and identifies deviations from these principles in a random sample of 55 research studies published in 1989 in five refereed nursing journals targeted toward practicing clinicians. Using a valid and reliable instrument, the investigators found that even with a policy of giving authors "the benefit of the doubt," 47% of the research studies contained no evidence of validity for any data collection instruments and 36% had no evidence of reliability; 29% had no evidence of either validity or reliability. Content validity, a basic requirement for all research instruments, was addressed in only 27% of the studies. This article provides documentation, justification, and suggestions for nursing educators, journal editors, and researchers to take action to improve the reporting of instrument validity and reliability to help ensure the quality of the research on which nursing practice is based.

Clinical Nursing Research↗
PubMedDate not supplied

Evaluation of sampling methods in research reported in selected clinical nursing journals: implications for nursing practice.

This article summarizes standards relating to sampling methodology, identifies deviations from these standards in research studies reported in selected clinical nursing journals, and provides suggestions for improving sampling methods to enhance the applicability of research for nursing practice. A random sample of 30 research reports published in 1986 in five clinical nursing journals was examined. Nearly 97 per cent of the published studies contained at least one major deficiency in sampling methodology. More than two thirds failed to describe the sampling frame, sample size, or number of refusals, withdrawals, and/or cases lost. Thirteen per cent did not report sampling methods. More than half made generalizations that were inappropriate for the sampling method used; 43 per cent did not acknowledge any limitations of their sample. Sample sizes were small, and statistical power to detect significant differences was low. These deficiencies in sampling procedures could detract from the value of the research that nurses are encouraged to use as a basis for practice. This article provides specific recommendations for remedying these deficiencies to help ensure the scientific merit of the research published for nursing practice.

Clinical Nursing Research↗
PubMedDate not supplied

Treatment of depression in cancer patients is associated with better life adaptation: a pilot study.

Major depression occurs in a significant number of cancer patients, and there is evidence that cancer patients with depression do not receive adequate antidepressant treatment. In an uncontrolled pilot study, the authors assess the degree of depression and the quality of life after the initiation of antidepressant medication treatment in 12 depressed cancer patients who received adequate antidepressant drugs and in 10 depressed cancer patients who received inadequate antidepressant treatment. These preliminary findings suggest that cancer patients with major depression benefit from antidepressant medication treatment and may experience an improved psychosocial adjustment to cancer. Controlled clinical trials will be necessary to verify these preliminary findings.

Adaptation, Psychological↗
PubMedDate not supplied

Increasing participation by private physicians in the EPSDT Program in rural North Carolina.

This study evaluated a method to increase physicians' participation in Early and Periodic Screening, Diagnosis and Treatment (EPSDT), a preventive health care program for Medicaid eligible children. Use of EPSDT can improve children's health status and reduce health care costs. Although the potential benefits of EPSDT are clear, the program is underused; low rates of participation by private physicians contribute to underuse. This study targeted a population of 73 primary care physicians in six rural counties in North Carolina where the physician supply, their participation in EPSDT, and use of EPSDT were low. A mailed intervention packet attempted to address barriers to participation perceived by private providers. The packet consisted of a carefully constructed letter, an informative journal article, and an educational pamphlet. Participation in EPSDT screening increased from 15 to 25 private physicians (67 percent), at a cost, on average, of less than $30 per recruited provider. Suggestions are presented for adapting the intervention packet to other settings.

Adolescent↗
PubMedDate not supplied

Barriers to the use of preventive health care services for children.

This article describes findings from interviews of parents targeted for outreach efforts that encouraged them to use Medicaid's Early and Periodic Screening, Diagnosis and Treatment(EPSDT) Program. Begun in the 1970s, the EPSDT program held out the promise of ensuring that needy children would receive comprehensive preventive care. With only one-third of eligible children in the United States receiving EPSDT checkups, the program has yet to fulfill its promise. This study sought to understand parents' perceptions of barriers to using EPSDT by interviewing (a) 110 parents who did not schedule EPSDT checkups for their children after being exposed to outreach efforts and (b) 30 parents who did. Although the EPSDT Program is designed to provide health care at no charge and to provide assistance with appointment scheduling and transportation, these low-income parents identified significant barriers to care. Reasons for not using EPSDT services included (a) competing family or personal issues and priorities; (b) perceived or actual barriers in the health care system; and (c) issues related directly to problems with the outreach efforts. Parents who successfully negotiated these barriers and received EPSDT services encountered additional barriers, for example, scheduling and transportation difficulties, long waiting room times, or care that they perceived to be either unresponsive to their medical needs or interpersonally disrespectful. The implications for future outreach efforts and improving access to preventive health care services are discussed.

Child↗