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PubMed2005

Qualitative methodology for rehabilitation research.

Qualitative research methodology focuses on individuals' lived experiences as they are presented in thoughts, ideas, feelings, attitudes and perceptions. In addition, the research approach emphasizes human behaviour and social interaction. It explores the quality of a phenomenon, not the quantity. This article outlines the major characteristics of qualitative research methodology and gives applications and examples. The aim of qualitative methodology is to develop new knowledge based on participants' own beliefs and experiences, not on pre-defined, testable hypotheses. It is inductive rather than deductive, and it is interpretative rather than predictive. The design is flexible, iterative and emergent and therefore requires of the researcher an ability to change and adapt the research process in accordance with emerging results. Qualitative research is thus different from quantitative research as it allows for flexibility throughout the research process. Several data collection methods can be used, such as individual interviews, focus group discussions or participant observations, in order to gain a deeper understanding of health, illness and rehabilitation. It can be used in combination with quantitative studies, but also as a research method of its own. In health research, the qualitative methodology has gained increasing credibility during the last decade. However, it is not yet frequently used in rehabilitation research. As rehabilitation outcomes are dependent on people's attitudes, thoughts and motivation regarding the rehabilitation process, and as the rehabilitation process in itself builds on social interaction, studies with a qualitative design could become useful tools in the development and improvement of rehabilitation.

Attitude to Health↗

PubMed2003

Q-methodology: a systematic approach to assessing learners in palliative care education.

Q-methodology is a qualitative research method that has increasingly been used to identify the complex attributes and behaviors that impact learning within medicine. Because learners bring a lifetime of experiences, values, and beliefs to a palliative care education, this method is ideal for identifying the typology of learner's present, thus making it possible to adapt the palliative care curriculum to meet the identified needs of each subgroup of learners. A step-by-step overview of the methodology using an example from pediatric graduate medical education illustrates the process. Potential uses of Q-methodology in palliative care are outlined including its application to the assessment of affective learning competencies, before and after a palliative care curriculum. The development of a universal palliative care education Q-sample, a collection of subjective opinion statements reflecting the spectrum of opinions on the topic, would advance the use of the Q-methodology in palliative medicine education.

Education, Medical↗

PubMed1998

Simulation methodology for estimating financial effects of telemedicine in West Virginia.

Understanding the full financial effects of telemedicine systems on payers, providers, and patients has been hampered by the lack of data from full-fidelity systems operating at a steady state. The vast majority of telemedicine systems in the United States have yet to achieve their full potential in serving their target populations and are operating well below capacity. The purposes of this research are two-fold: (1) to develop a methodology that compensates for the limited availability of empirical data on the financial effects of telemedicine; and (2) to test this methodology in a comprehensive telemedicine system in West Virginia. The proposed methodology utilizes simulation modeling techniques for evaluating the financial performance of a mature telemedicine system. It is particularly suitable for analyzing large, complex systems that have not yet achieved steady-state operation. Although complex, the methodology can be described simply as consisting of two major steps. The first is the identification of all of the relevant variables and parameters for modeling. The second consists of simulating "real world" decision situations involving all relevant variables and parameters. The relation among the variables and parameters are described in terms of mathematical equations. The ability of the researcher to estimate the financial effects of a given telemedicine system is a function of the extent to which the resulting model approximates conditions of the real world; i.e., the fit between model and reality.

Algorithms↗

PubMed1994

Research priorities and recommendations for dietary assessment methodology. First International Conference on Dietary Assessment Methods.

A list of research priorities related to dietary assessment methodology is presented. The priorities are based on a consensus of opinion by a multidisciplinary international group of experts who participated in the First International Conference on Dietary Assessment Methods. These experts included researchers in dietary assessment methodology, major users of dietary assessment methods, and policymakers involved in setting food and nutrition policies. The list of priorities may be used as a guide for planning future research in dietary assessment methods, for prioritizing the allocation of available research resources, and for planning subsequent conferences. A list of recommendations related to dietary assessment methodology is also presented. Procedures used by the conference planners to select the experts are described, and the need for developing objective criteria for ranking priorities is discussed. An ongoing function of the conference series will be to continue the process of revising the priorities and recommendations to reflect progress made and newly identified needs in dietary assessment methodology.

Data Collection↗

PubMed2005

Methodological issues in trials assessing primary prophylaxis of venous thrombo-embolism.

AIMS: Many trials have been conducted to assess the efficacy of various strategies in the prevention of venous thrombo-embolism (VTE). Some of these trials have been subject to methodological criticisms. We aimed to assess the methodological issues raised by VTE trials. METHODS AND RESULTS: We searched MEDLINE and the Cochrane Central Register of Controlled Trials for articles assessing primary thromboprophylaxis published between 1994 and 2003 in 60 general medical and specialty journals. A total of 77 articles were analysed by two independent reviewers using a list of items. No primary endpoint was defined in 20% of trials. Although the primary endpoint was collected before day 15 in 75% of trials, there were >/=20% missing data in 56% of articles and >/=30% in 24.2% of articles. The rate of missing data was 23.7+/-9.7% in studies using venography-detected deep-vein thrombosis as an endpoint compared with 5.6+/-6.0% in studies using other endpoints. Among the 47 superiority trials, 27 (57.4%) reported an intention-to-treat (ITT) analysis, but only 10 (21.3%) reported an analysis that complied with this principle. These results were consistent when limiting the analysis to articles published in high-impact journal (impact factor more than 5). CONCLUSION: Recent randomized controlled trials assessing prophylactic regimens in VTE have important methodological limitations in terms of primary endpoints, missing data, and compliance with the ITT principle. These methodological shortcomings should be addressed when planning future trials.

Humans↗

PubMed1999

A methodological inquiry into the evaluation of smoking cessation programmes.

This paper examines a methodological controversy and aims to show the advantages of introducing an alternative methodological approach, i.e. the 'scientific realist approach', into evaluation studies on health education programmes for smoking cessation. The methodological difficulties of the existing standard evaluation model, i.e. the quasi-experimental approach, are examined. This model fails to investigate how the programme setting influences outcomes (context problem) and draws attention away from understanding why programmes work because it adopts a 'successionist' logic (causation problem). An alternative methodology, the scientific realist approach, is proposed in order to cope with such problems. This approach adopts the 'generative' logic which looks at the matter of causation internally. This logic posits that the working of underlying mechanisms within a more basic level of reality causes relationships between visible events. According to the scientific realist approach, the actual outcomes of smoking cessation programmes follow from the workings of potential mechanisms whose functioning is afforded by contexts conducive to their operation.

Humans↗

PubMedDate not supplied

Reporting of demographics, methodology, and ethical procedures in journals in pediatric and child psychology.

OBJECTIVE: To identify potential problems in methodology reporting that may limit research interpretations and generalization. METHODS: We examined the rates at which articles in four major journals publishing research in pediatric, clinical child, and child psychology report 18 important demographic, methodological, and ethical information variables, such as participants' gender, socioeconomic status, ethnicity, inclusion/exclusion criteria, and consent and assent procedures. RESULTS: Overall, participants' ages, genders, and ethnicity were reported at moderate to high rates, whereas socioeconomic status was reported less often. Reports of research methodology frequently did not include information on how and where participants were recruited, the participation/consent rates, or attrition rates. Consent and assent procedures were not frequently described. CONCLUSIONS: There is wide variability in articles reporting key demographic, methodological, and ethical procedure information. Necessary information about characteristics of participation samples, important for drawing conclusions, is lacking in the flagship journals serving the child psychology field.

Adolescent↗

PubMed2004

Methodology for worker neutron exposure evaluation in the PDCF facility design.

A project headed by Washington Group International is meant to design the Pit Disassembly and Conversion Facility (PDCF) to convert the plutonium pits from excessed nuclear weapons into plutonium oxide for ultimate disposition. Battelle staff are performing the shielding calculations that will determine appropriate shielding so that the facility workers will not exceed target exposure levels. The target exposure levels for workers in the facility are 5 mSv y(-1) for the whole body and 100 mSv y(-1) for the extremity, which presents a significant challenge to the designers of a facility that will process tons of radioactive material. The design effort depended on shielding calculations to determine appropriate thickness and composition for glove box walls, and concrete wall thicknesses for storage vaults. Pacific Northwest National Laboratory (PNNL) staff used ORIGEN-S and SOURCES to generate gamma and neutron source terms, and Monte Carlo (computer code for) neutron photon (transport) (MCNP-4C) to calculate the radiation transport in the facility. The shielding calculations were performed by a team of four scientists, so it was necessary to develop a consistent methodology. There was also a requirement for the study to be cost-effective, so efficient methods of evaluation were required. The calculations were subject to rigorous scrutiny by internal and external reviewers, so acceptability was a major feature of the methodology. Some of the issues addressed in the development of the methodology included selecting appropriate dose factors, developing a method for handling extremity doses, adopting an efficient method for evaluating effective dose equivalent in a non-uniform radiation field, modelling the reinforcing steel in concrete, and modularising the geometry descriptions for efficiency. The relative importance of the neutron dose equivalent compared with the gamma dose equivalent varied substantially depending on the specific shielding conditions and lessons were learned from this effect. This paper addresses these issues and the resulting methodology.

Algorithms↗

PubMed1998

Frequency and methodologic rigor of quality-of-life assessments in the critical care literature.

OBJECTIVES: To present a framework for describing/measuring quality of life (QOL) and health-related quality of life (HRQL), and to assess the frequency and methodologic rigor of QOL studies in the adult critical care literature. DATA SOURCES: Computerized bibliographic search of published research, manual search of key intensive care unit (ICU) journals, and citation review of relevant articles. STUDY SELECTION: We manually searched Critical Care Medicine, American Journal of Respiratory and Critical Care Medicine, and Intensive Care Medicine for the period January 1992 to July 1995 to assess the frequency of published QOL studies. Combined with a computerized bibliographic search, we found 64 studies that met our criteria that reported on patient-related outcomes (other than mortality) after hospital discharge. DATA EXTRACTION: We abstracted data on the nature of each study, the instruments used to measure QOL, and the methodologic rigor of the QOL assessments. We evaluated each study using criteria we developed to assess the validity of HRQL measurements. MEASUREMENTS AND MAIN RESULTS: In our manual search, we found 1,073 articles relevant to the practice of adult critical care. Of these, 19 (1.7%)/1073 included QOL measurements. Combined with our comprehensive search strategy, we found 64 papers that evaluated QOL in ICU patients. These papers dealt primarily with issues of: prognosis (32 [50%]), resource allocation (23 [36%]), and clinical prediction (9 [14%]). We found no randomized trials that included post-ICU QOL as an outcome. With respect to the validity of the HRQL assessments, 63/64 (98%) studies evaluated aspects of patients' lives that we considered important. Thirty-three (52%) studies were limited in scope to specific aspects of HRQL, and 31 (48%) studies covered broad areas of HRQL. In these 64 studies, there were 108 different instruments used. The reliability and validity of the instruments used were reported in 7 (6%) and 15 (14%) cases, respectively. For 81 (75%) instruments, the investigators either explained the results or used informative, qualitative descriptors whose interpretation was self-evident. Overall, three (5%) of the included studies met all four methodologic criteria to assess the validity of HRQL assessments. CONCLUSIONS: QOL assessments occur infrequently in the ICU literature and are of limited methodologic quality. More studies using valid and reliable instruments are necessary to document the long-term QOL of critically ill patients, especially those at risk of a "poor" outcome.

Adult↗

PubMedDate not supplied

Collaborative methodologies for advancing the health of underserved women.

Collaborative methodologies that incorporate local community members offer a unique approach to conducting women's health research. These approaches actively seek to mobilize community resources to solve healthcare problems and may be effectively implemented, accepted, and sustained. Understanding differences among collaborative methodologies is needed to assist the researcher in selecting the strategy that is most consistent with the study purpose and setting. The purpose of this article is to discuss the processes involved in these methodologies and the role of the researcher and the research community and compare how these methodologies differ in identifying and evaluating healthcare outcomes for underserved women.

Community Participation↗

PubMed1980

An observation methodology for the study of interactive clinical problem-solving behavior in primary care settings.

A methodology that is adequate for a generalized description of the interactive problem-solving behavior of client and clinician must accommodate all potential types of clinical issues and client-clinician relationships. It must also be applicable to the behavior of the client as well as that of the clinician. Furthermore, behavior must be analyzable in terms of the phase of problem-solving logic that applies at the time the behavior is observed. The development, specifications, structural factors and procedures of administration of an observational methodology that is based on a 7-phase paradigm of verbal problem-solving behavior are described. Acceptable levels of consistency of coding are achievable using the methodology. Coder agreement over all phase categories was 84.8 per cent. Results of 2-way ANOVA procedures showed that the type of clinical encounter observed affected the proportion of data coded in each of the problem-solving phase categories whereas, on the whole, the identity of the coder did not. The methodology may be articulated with other methods for the study of primary care and has both research and instructional applications.

Adult↗

PubMed2000

Prediction rules for complications in coronary bypass surgery: a comparison and methodological critique.

BACKGROUND: Clinical prediction rules have been developed that use preoperative information to stratify patients according to risk of complications after cardiac surgery. OBJECTIVES: To assess the methodological standards and performance of 7 models. PARTICIPANTS: The validation portion of the Quality Measurement and Management Initiative (QMMI) cohort included a random sample of all adult patients (n = 3,261) who underwent coronary artery bypass grafting (CABG) surgery not involving valvular or other concomitant procedures at 12 medical centers from August 1993 to October 1995. OUTCOME MEASURES: Methodological standards used for model comparison were adapted from published criteria. Model performance was assessed by receiver-operating characteristic (ROC) analysis, and calibration was evaluated with the Hosmer-Lemeshow (HL) statistic and observed-expected plots. METHODS: We performed cross-validation by applying the published criteria for the development of each model to the validation subset of the QMMI cohort and by assessing the performance of each model in discriminating outcomes. RESULTS: Wide variations existed in the methodologies used to develop and validate the 5 additive scores evaluated. Cross-validation of all 5 additive scores revealed degradation in their abilities to discriminate outcomes. The 2 logistic models examined performed similarly to the additive scores examined in predicting mortality. CONCLUSIONS: Substantial variation existed both in the methodologies used to develop models and in the ability of the models to predict outcomes. Models developed at single institutions or using fewer patients may be less generalizable when applied to diverse clinical settings. Additive and logistic regression models performed similarly, as assessed by ROC and HL analyses.

Adult↗

PubMed2002

Common methodological terms in health services research and their synonyms [correction of symptoms].

OBJECTIVE: Health services researchers use methods and terminology from a variety of disciplines to understand individual and organizational behavior related to health, health care, and health insurance. Although this diversity benefits the process of research, the resulting differences in terminology can occasionally lead to confusion among even the most experienced researchers. The purpose of this paper is to clarify different methodological terms used to represent common study designs and statistical concepts in health services research. METHOD: Faculty from the departments of Health Services, Biostatistics and Epidemiology at the University of Washington were asked to provide a list of terms commonly used in health services research that had one or more methodological terms with the same or similar meaning. Consistent with the Delphi method, the initial list was then circulated to internal and external methodologists and additional terms were added for completeness. Terms related to study designs, equation specification, and estimation problems with synonymous terminology were included. RESULTS: A "methodological thesaurus" is developed and described in this paper. Many terms were found which described essentially identical concepts. In other cases, terms had slight but important differences in meaning across disciplines, leading to potential confusion in their use. CONCLUSION: In light of these differences in terminology, it is not surprising that health services researchers with a particular disciplinary orientation currently find literature within their own discipline entirely readable and literature from another discipline considerably less accessible. The "methodological thesaurus" presented in this paper should be of value to health services researchers who are interested in exploring the full array of methods developed to address a particular problem. Teachers and students of health services research should also find this article of use in relating similar concepts across disciplines in quantitative health services research publications.

Bias↗

PubMedDate not supplied

Methodologic principles of cost analyses in the nursing, medical, and health services literature, 1990-1996.

BACKGROUND: Cost analyses are needed to inform resource decisions. Oftentimes, however cost-benefit analysis (CBA), cost-effectiveness analysis (CEA), cost-minimization analysis (CMA), and cost-utility analysis (CUA) are performed using untested techniques and adhering to a variety of questionable principles. OBJECTIVES: To analyze, compare, and present a set of useful principles for the main types and methods of cost analyses through a synthesis of current information in the published literature. METHODS: The area of interest included all reports of cost research published as full articles in professional journals from January 1990 to August 1996 in the nursing, medical, and health services fields. In all, 88 sampled articles met the criteria for inclusion. A four-page data collection guide with 28 items grouped as demographics, cost-analysis types, methods, and principles was designed for the review. Incremental testing for interrater reliability using the kappa statistic for two raters was performed. Sampling, process-oriented, construct, and correlational validity were assessed. RESULTS: The 88 articles included 4 from nursing, 59 from medical, and 25 from health services journals. Of these articles, 45 (51%) reported CBA, 36 (41%) CEA, 2 CMA, 4 CUA, and 1 both CBA and CEA. Three nursing studies were authored only by nurses. Three fourths of the medical and four fifths of the health services publications had interdisciplinary authorship. Existing databases were the primary source of data in 61 (69%) publications. Adherence to six main methodologic principles was apparent in 19 (22%) articles. None of the nursing studies adhered to all six principles, whereas 16% of the health services and 25% of the medical studies did. CONCLUSIONS: Funded cost analyses of nursing interventions that adhere to the six known methodologic principles are needed to inform policy-level health care decisions. Because of the complexity of cost analysis methodology, including sensitivity analysis, future interdisciplinary efforts using existing databases may prove most effective. The six methodologic principles presented in this article can be useful for future nursing education and cost-analysis research designed to control cost and increase the quality of health care.

Costs and Cost Analysis↗

PubMed1997

Explicating middle-range theory through methodological diversity.

Debates about methodological diversity and the most appropriate paradigm for scientific inquiry are still flourishing within the community of nurse scholars. Rather than continuing to debate these controversies, the authors of this article suggest that nurse researchers set aside methodological differences and move to discover the truths that will build the foundational base of nursing practice and, thus advance the discipline. This article discusses the multiple methodological perspectives used to explicate middle-range concepts from the theory and paradigm for nursing, Modeling and Role-Modeling. Each author will demonstrate how combining different approaches and methodologies can be helpful in exploring and validating middle-range concepts.

Adaptation, Psychological↗

PubMed2003

Methodologic quality and genotyping reproducibility in studies of tumor necrosis factor -308 G-->A single nucleotide polymorphism and bacterial sepsis: implications for studies of complex traits.

OBJECTIVE: Studies of genetic associations with common diseases, such as between cytokine gene polymorphisms and severe bacterial sepsis, have reached conflicting conclusions. Failure to follow methodologic standards may have contributed to discordant findings. The -308 G-->A transition in the tumor necrosis factor-alpha promoter has been genotyped by a variety of methods. Based on our observation of genotyping inaccuracies, we sought to determine whether published studies followed a series of acceptable methodologic standards and whether failure to follow the standard of genotyping reproducibility could lead to erroneous conclusions about gene-disease associations. DESIGN: Systematic review and reanalysis of banked genetic material. We applied a published series of seven methodologic standards to five reports of the association between this variant and bacterial sepsis. We then studied the accuracy of restriction fragment length polymorphism for the -308 site using DNA from a cohort of injury victims. SETTING: Surgery research laboratory. MEASUREMENTS AND MAIN RESULTS: We observed that methodologic quality was not uniform and that reproducibility of genotyping was infrequently met. In our subjects, we found that 4 of 46 heterozygotes analyzed by restriction fragment length polymorphism were actually GG-homozygotes (9% misclassified) according to alternative genotyping methods. CONCLUSIONS: Failure to confirm genotype may have led to conclusions that this polymorphism is not associated with sepsis or outcome. Our observations have implications for the conduct and evaluation of studies of complex genetic disease.

Genetic Techniques↗

PubMed2006

An association rule mining-based methodology for automated detection of ischemic ECG beats.

Currently, an automated methodology based on association rules is presented for the detection of ischemic beats in long duration electrocardiographic (ECG) recordings. The proposed approach consists of three stages. 1) Preprocessing: Noise is removed and all the necessary ECG features are extracted. 2) Discretization: The continuous valued features are transformed to categorical. 3) CLASSIFICATION: An association rule extraction algorithm is utilized and a rule-based classification model is created. According to the proposed methodology, electrocardiogram (ECG) features extracted from the ST segment and the T-wave, as well as the patient's age, were used as inputs. The output was the classification of the beat as ischemic or not. Various algorithms were tested both for discretization and for classification using association rules. To evaluate the methodology, a cardiac beat dataset was constructed using several recordings of the European Society of Cardiology ST-T database. The obtained sensitivity (Se) and specificity (Sp) was 87% and 93%, respectively. The proposed methodology combines high accuracy with the ability to provide interpretation for the decisions made, since it is based on a set of association rules.

Arrhythmias, Cardiac↗

PubMed2006

LEAD: a methodology for learning efficient approaches to medical diagnosis.

Determining the most efficient use of diagnostic tests is one of the complex issues facing medical practitioners. With the soaring cost of healthcare, particularly in the US, there is a critical need for cutting costs of diagnostic tests, while achieving a higher level of diagnostic accuracy. This paper develops a learning based methodology that, based on patient information, recommends test(s) that optimize a suitable measure of diagnostic performance. A comprehensive performance measure is developed that accounts for the costs of testing, morbidity, and mortality associated with the tests, and time taken to reach diagnosis. The performance measure also accounts for the diagnostic ability of the tests. The methodology combines tools from the fields of data mining (rough set theory, in particular), utility theory, Markov decision processes (MDP), and reinforcement learning (RL). The rough set theory is used in extracting diagnostic information in the form of rules from the medical databases. Utility theory is used in bringing various nonhomogenous performance measures into one cost based measure. An MDP model together with an RL algorithm facilitates obtaining efficient testing strategies. The methodology is implemented on a sample problem of diagnosing solitary pulmonary nodule (SPN). The results obtained are compared with those from four alternative testing strategies. Our methodology holds significant promise to improve the process of medical diagnosis.

Algorithms↗