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PubMed1998

TRISS methodology in trauma: the need for alternatives.

BACKGROUND: Trauma and Injury Severity Score (TRISS) methodology has become a standard tool for evaluating the performance of trauma centres and identifying cases for critical review. Recent work has identified several limitations and questioned the validity of the methodology in certain types of trauma. METHODS: The usefulness and limitations of the TRISS methodology were evaluated in an urban trauma centre. Trauma registry data of 5445 patients with major trauma were analysed with respect to 30 demographic, prehospital, injury severity and hospitalization attributes. The performance of TRISS was measured primarily by the percentage of misclassifications, including false positives and false negatives, comparing the survival status predicted by TRISS with the true status. Sensitivity, specificity, and positive and negative predictive values were also measured for subgroups defined by the 30 attributes. Logistic regression analysis was used to identify significant independent factors related to the performance of TRISS. RESULTS: The overall misclassification rate was 4.3 per cent. However, in many subgroups of patients with severe trauma the misclassification rate was very high: 34 per cent in patients older than 54 years with Injury Severity Score (ISS) greater than 20; 29 per cent in those with fall injuries and ISS above 20; 29 per cent in patients with injuries involving four or more body areas and ISS greater than 20; 28.6 per cent in patients with injuries needing admission to the intensive care unit (ICU) and ISS greater than 20; 26.4 per cent in patients in severe distress before reaching hospital with ISS greater than 20; and 26.1 per cent in patients whose ISS score was above 20 and who had complications in hospital. CONCLUSION: The TRISS methodology has major limitations in many subgroups of patients, especially in severe trauma. In its present form TRISS has no useful role in major urban trauma centres. Its use should be seriously reconsidered, if not abandoned.

Aged↗

PubMed2002

Journeying from the philosophical contemplation of constructivism to the methodological pragmatics of health services research.

AIM: This paper presents our journey through a contemplation of the philosophical origins of constructivism to consider its role as an active methodology in qualitative research. METHOD: The first part of the paper summarizes the philosophical background of constructivism and the five principles underpinning this paradigm as described through the works of Guba and Lincoln. The philosophical roots of constructivism are then compared with postpositivism, critical realism and participatory inquiry. The paper moves on to consider their common methodological steps, before examining how the constructivist research strategy is being adopted and adapted within the pragmatics of health service research. Recent studies will be drawn upon to illustrate the use of constructivist methodology. CONCLUSION: Questions are raised about the role of philosophy and the extent to which it should or does underpin or influence qualitative research strategies. We believe that if researchers gain an understanding of both philosophy and methodology a richer and more robust study is likely to result.

Causality↗

PubMed2003

Randomized controlled trials in psychiatry. Part 1: methodology and critical evaluation.

OBJECTIVE: To introduce clinicians to the methodology and critical appraisal of randomized controlled trials (RCTs) in psychiatry. METHOD: The methodology of RCTs in psychiatry is discussed. Using a systematic approach to critical appraisal, a published RCT of treatments for severe depression is examined and evaluated. RESULTS AND CONCLUSIONS: The RCT appraised illustrates certain problematic areas in the methodology of trials in psychiatry. A detailed knowledge of methodology and critique of RCTs is essential in determining whether reported results will influence clinicians' practice.

Cyclohexanols↗

PubMed2003

Methodological index for non-randomized studies (minors): development and validation of a new instrument.

BACKGROUND: Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. METHODS: After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialties for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. RESULTS: The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the kappa-coefficient and good internal consistency by a high Cronbach's alpha-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. CONCLUSIONS: MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.

Clinical Trials as Topic↗

PubMedDate not supplied

Focus group methodology for patients, parents, and siblings.

This report describes methodology that can be used as a guideline for the planning, conduct, analysis, and interpretation of data from focus groups for parents/caregivers, siblings, and children diagnosed with an illness; the methodology provides tools for the conduct of such groups in the same or similar populations. Separate focus group sessions were conducted for parents/guardians, siblings, and affected children. Methodological enhancements in planning and conducting the focus group sessions include development of a sampling frame to derive a representative group of participants, standardization of procedures through the use of a moderator's training manual tailored to each group, identification of topics to broaden content areas and stimulate discussion, and creation of a comfortable environment in which participants could express issues. Statistical considerations regarding design and conduct of the focus group session, as well as acquisition, analysis, and interpretation of data are presented with regard to validity, reliability, and generalizability of information gathered from focus group interviews. Scripts, topics, and timeframes that were initially devised by content experts were validated further and revised for direct use or adaptation by clinicians in the conduct of focus group sessions for parents/guardians, siblings, and affected children. Application of this methodology is intended to promote generalizability, reliability, and validity of information obtained, and to enable health care practitioners to provide better care to young patients and their families.

Family↗

PubMed2001

To quantify experience? Methodological issues in the behavioural/psychological treatment of complex partial seizures.

This paper will attempt to identify some of the major methodological hurdles that are present when treating or researching seizure conditions using neurobehavioural approaches. An overview of the unique methodological problems that arise with behavioural/psychological treatments will be discussed. The author will focus on personal experiences with complex and simple partial seizures, looking into some methodological questions that arose after his seizure activity was reduced using a behavioural technique. Several main issues will be examined as they may apply to seizure and personality type, and how they can influence treatment and results. Finally, possible directions toward improving methodology will be suggested.

Behavior Therapy↗

PubMed2002

The before/after study design in transfusion medicine: methodologic considerations.

To ascertain the effectiveness of an intervention, a randomized controlled trial (RCT) is considered the gold standard. An obstacle to conducting an RCT only rarely discussed is the universal implementation of an intervention. Universal implementation clearly precludes the feasibility of conducting an RCT. Thus, the most attractive alternative study design in such instances becomes the before/after study. This article describes important methodologic considerations in undertaking a before/after evaluation. The methodologic considerations to be discussed are (1) threats to internal validity, (2) precision and (3) generalizability. Two before/after studies evaluating the potential effectiveness of universal leukoreduction serve as examples. Because of the universal application of many transfusion interventions, one has to consider carefully the methodologic rigor as to which of these interventions are evaluated. We have outlined the major methodologic issues one must consider when undertaking a before/after study design. When properly conceived, conducted, and analyzed, such a before/after study design can yield informative associations.

Adult↗

PubMed2005

[Is there a German history of evidence-based medicine? Methodic standards of therapeutic research in the early 20th century and Paul Martini's "Methodology of therapeutic investigation" (1932)].

The article addresses the history of evidence-based medicine in Germany. Its aim was to reconstruct the standard of clinical-therapeutic investigation in Germany at the beginning of the 20 (th) century. By a historical investigation of five important German general medical journals for the time between 1918 and 1932 an overview of the situation of clinical investigation is given. 268 clinical trails are identified, and are analysed in view of their methodological design. Heterogeneous results are found: While few examples of sophisticated methodology exist, the design of the majority of the studies is poor. A response to the situation described can be seen in Paul Martini's book "Methodology of Therapeutic Investigation", first published in 1932. Paul Martini's biography, his criticism of the situation of clinical-therapeutic investigation of his time, the major points of his methodology and the reception of the book in Germany and abroad are described.

Evidence-Based Medicine↗

PubMed2001

Comparative study of Finn Chambers and T.R.U.E. test methodologies in detecting the relevant allergens inducing contact dermatitis.

T.R.U.E. Test is a ready-to-use patch test system, which contains 23 allergens and is the only Food and Drug Administration-approved source of allergens currently commercially available in the United States. Previously, allergens dispersed in either petrolatum or water and designed to be applied utilizing Finn Chambers were also commercially available in the United States. During a 5-year study at the University of Kansas Medical Center, 167 patients were patch tested using both Finn Chamber and T.R.U.E. Test methodologies. Discordant positive reactions were examined for clinical relevance. The Finn Chamber methodology was superior in detecting clinically relevant allergies to fragrance mix, balsam of Peru, and thiuram mix. T.R.U.E. Test performed somewhat better than the Finn Chamber in detecting relevant allergic reactions to nickel, neomycin, and methylchloroisothiazolinone/methylisothiazolinone. Neither T.R.U.E. Test nor Finn Chamber methodologies performed optimally in detecting relevant allergies to formaldehyde and carbamates. Practitioners limited to only the T.R.U.E. Test methodology need to be aware that relevant reactions to fragrances, rubber accelerators/pesticides (carbamates and thiurams), and formaldehyde may be missed with this system.

Allergens↗

PubMed2004

Energy and nutrient dietary reference values for children in Europe: methodological approaches and current nutritional recommendations.

The Expert Group on the Methodological Approaches and Current Nutritional Recommendations in Children and Adolescents was convened to consider the current situation across Europe with regard to dietary recommendations and reference values for children aged 2-18 years. Information was obtained for twenty-nine of the thirty-nine countries in Europe and a comprehensive compilation was made of the dietary recommendations current up to September 2002. This report presents a review of the concepts of dietary reference values and a comparison of the methodological approaches used in each country. Attention is drawn to the special considerations that are needed for establishing dietary reference values for children and adolescents. Tables are provided of the current dietary reference values for energy and for the macronutrients, vitamins, minerals, trace elements and water. Brief critiques are included to indicate the scientific foundations of the reference values for children and to offer, where possible, an explanation for the wide differences that exist between countries. This compilation demonstrated that there are considerable disparities in the perceived nutritional requirements of European children and adolescents. Although some of this diversity can be attributed to real physiological and environmental differences, most is due to differences in philosophy about the best methodological approach to use and in the way the theoretical approaches are applied. The report highlights the main methodological and technological issues that will need to be resolved before harmonization can be fully considered. Solving these issues may help to improve the quality and consistency of dietary reference values across Europe. However, there are also considerable scientific and political barriers that will need to be overcome and the question of whether harmonization of dietary reference values for children and adolescents is a desirable or achievable goal for Europe requires further consideration.

Adolescent↗

PubMed2004

How reliable are reliability studies of fracture classifications? A systematic review of their methodologies.

Two independent reviewers performed a search in MEDLINE and EMBASE for fracture classification reliability studies. Data were obtained on classifications, image modalities, fracture selection processes, sample sizes and their justification, type and number of raters, practical issues for the classification sessions, statistical methods, and results. A 10-item checklist was devised for quality assessment of methodologies. 44 studies assessing 32 fracture classification systems were included. We found a wide variation of methodologies. For instance, the median number of raters was 5 (2-36) and the median number of fractures was 50 (10-200). This selection was considered representative in 17/44 of the studies. The true distribution of classification categories was estimated in 9 studies. The kappa coefficient was mostly used (39/44) to quantify the raters' agreement. Methodological issues are discussed. Given limitations in the use and interpretation of kappa coefficients, investigators should consider alternative methods that focus upon the accuracy of the classification systems. The development and adoption of a systematic methodological approach to the development and validation of fracture classification systems is needed.

Fractures, Bone↗

PubMed2002

Researching youth culture and popular music: a methodological critique.

In this article I argue the need for critical evaluation of qualitative research methodology in sociological studies of the relationship between youth culture and popular music. As the article illustrates, there is currently an absence of critical debate concerning methodological issues in this field of sociological research. In the first part of the article I begin to account for this absence by illustrating how early research on youth and music rejected the need for empirical research, relying instead on theories and concepts drawn from cultural Marxism. The second part of the article illustrates how the legacy of this early body of work in youth and music research manifests itself in current research which, although empirically grounded, is characterized by an almost total lack of engagement with methodological issues such as negotiating access to the field, management of field relations and ethical codes. Similarly problematic is the uncritical acceptance on the part of some researchers of their insider knowledge of particular youth musics and scenes as a means of gathering empirical data. In the final part of the article I focus on the issue of insider knowledge and the need for critical evaluation of its use as a methodological tool in field-based youth and music research.

Adolescent↗

PubMed2026

Psychological skills training for sport-related outcomes: An umbrella review of evidence credibility and methodological quality.

Psychological skills training (PST) is widely used in sport, but review-level evidence remains fragmented across interventions, populations, outcomes, and methodological standards. This umbrella review synthesized evidence on PST-related interventions for sport-related outcomes, including athletic performance, psychological outcomes, cognitive performance, and sports injury, and evaluated evidence credibility, certainty, and methodological quality. A systematic literature search was conducted on 21 May 2025 in MEDLINE, PsycInfo, PubMed, Scopus, SportDiscus, Web of Science, and CINAHL Complete. Overall, 61 reviews involving 42,106 participants were included; 35 meta-analyses involving 28,076 participants were eligible for quantitative synthesis, and 26 reviews or meta-analyses involving 14,030 participants were summarized qualitatively. Quantitative findings showed generally positive point estimates for mindfulness-based interventions, imagery practice, music-based interventions, neurofeedback, perceptual-cognitive training, and multiple PST interventions, but most findings were weak or non-significant and certainty was generally very low. Qualitative evidence suggested potential benefits, but conclusions varied according to intervention definition, delivery, outcome measurement, and methodological quality. Evidence was more developed for athletic performance and psychological outcomes than for cognitive performance and sports injury. Overall, PST-related interventions may benefit sport-related outcomes, but conclusions should remain cautious because of low certainty, methodological heterogeneity, and limited evidence credibility.

Humans↗

PubMed2000

Joint FAO/WHO Geneva consultation--acute dietary intake methodology.

Significant developments have been made at the international level in the methodology for conducting dietary risk assessments. The existing chronic exposure assessment methodology has been updated so that it takes account of the level of residues to which consumers are most likely to be exposed. In addition, short-term exposure assessment methodology has also been developed. This uses portion size data and takes account of the variability in residue levels between individual units where this is appropriate to the way the commodity is consumed. Other refinements to the assessment can also be made. Although the short-term methodology has been used successfully by a number of regulatory authorities, there is a need for data on portion sizes and typical unit weights before it can be fully implemented internationally.

Congresses as Topic↗

PubMedDate not supplied

Methodological adaptations for investigating the perceptions of language-impaired adolescents regarding the relative importance of selected communication skills.

This article describes the systematic and detailed processes undertaken to modify a research methodology for use with language-impaired adolescents. The original methodology had been used previously with normally achieving adolescents and speech pathologists to obtain their opinions about the relative importance of selected communication skills for adolescents' positive peer relationships. Modifications attempted to address language-impaired adolescents' characteristic metalinguistic, literacy, cognitive, and information processing weaknesses. Revising the original wording of the communication skills, reducing the reading level of the skills from grade 10 to 4.6, using a Q-sort approach to ranking the importance of the skills, and revising the instructions and administration procedures led to what pilot testing results indicated was a valid methodology for use with language-impaired adolescents. Results of a preliminary study using the revised methodology suggested that language-impaired adolescents may perceive the relative importance of some communication skills differently from their normally achieving peers.

Adolescent↗

PubMed2006

Methodology of management of dredging operations I. Conceptual developments.

This article presents a new methodology for the management of dredging operations. Partly derived from existing methodologies (OECD, UNEP, AIPCN), its aim is to be more complete, by integrating the qualities and complementarities of former methodologies. Moreover, it was carried out in a context of sustainable development. Indeed, it supports, according to a framework of industrial ecology, the development and the implementation of solutions of waste improvement of dredged materials, in order to minimize the environmental impact of dredging. It also uses a tool of MultiCriteria Decision-Making Aid (M.C.D.M.A.), in order to integrate local characteristics. In addition, this tool, called DRAGSED, allows to a dialogue to be established between all the parties concerned with a dredging project (harbour's authorities, industrialists, municipalities, administrations, populations, associations,...). Thus, the implementation of this methodology enables consensus to be reached for the dredging solution retained. It also proposes an environmental follow-up, which will allow an evaluation during its application.

Algorithms↗

PubMed2002

Methodology for siting ambient air monitors at the neighborhood scale.

In siting a monitor to measure compliance with U.S. National Ambient Air Quality Standards (NAAQS) for particulate matter (PM), there is a need to characterize variations in PM concentration within a neighborhood-scale region to achieve monitor siting objectives. A simple methodology is provided here for the selection of a neighborhood-scale site for meeting either of the two objectives identified for PM monitoring. This methodology is based on analyzing middle-scale (from 100 to 500 m) data from within the area of interest. The required data can be obtained from widely available dispersion models and emissions databases. The performance of the siting methodology was evaluated in a neighborhood-scale field study conducted in Hudson County, NJ, to characterize the area's inhalable particulate (PM10) concentrations. Air monitors were located within a 2- by 2-km area in the vicinity of the Lincoln Tunnel entrance in Hudson County. Results indicate the siting methodology performed well, providing a positive relationship between the predicted concentration rank at each site and the actual rank experienced during the field study. Also discussed are factors that adversely affected the predictive capabilities of the model.

Air Movements↗

PubMedDate not supplied

Evaluation of three methodologies for assessing work activity during computer use.

The overall goal of this study was to evaluate three separate methodologies for gathering work activity information among computer users. These methodologies included worker self-report, work sampling, and activity monitoring. A repeated measures design was employed whereby data were collected simultaneously on each subject (n = 51) across three consecutive workdays. Exposure information gathered included keying time, mouse usage, and time spent performing various work tasks (i.e., writing, proofreading, handling documents). Subjects were recruited to represent a wide range of keyboard activity and mouse usage. The study found that worker self-reports overestimated actual keyboard usage by a factor of approximately 1.5 for workers using the keyboard an average of 4 hours per day to a factor of 4 for workers using the keyboard an average of 30 min per day. On average, there was an approximate twofold difference between worker self-reported keying time and that obtained via activity monitoring and work sampling. This trend was similar with regard to time spent using the computer mouse. Worker self-reported mouse usage was approximately twofold higher than that obtained via activity monitoring or work sampling. Self-reported exposure information not only resulted in different estimates, but showed greater variance compared with the other methodologies. The results of this study suggest that the use of worker self-reported exposure information on keying time and mouse usage may not represent an accurate account of time spent performing these tasks. In the context of epidemiological studies work sampling and/or activity monitoring would be more suitable methodologies for obtaining such information.

Adult↗