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PubMedDate not supplied

[Methodology of basic research in cognitive neuropsychology].

INTRODUCTION AND METHOD: The issue regarding the relations between behaviour and the brain is no longer the specific goal of neuropsychology, but rather that of the coordinated multidisciplinary activity of all the disciplines that go to make up the neurosciences. The specific contribution of neuropsychology to this multidisciplinary activity consists in trying to determine the nature of cognitive processes so that, in the future, it will be possible to ascertain the anatomophysiological foundations for each of them. The aim of basic research in cognitive neuropsychology is precisely that. The growing interest in research in this discipline that has been observed over the past few years in Spain has not usually been accompanied by the awareness of the fact that conducting research with damaged brains requires (if it is to be valid) a methodology that is specific and different to the methodology used in research with intact brains. In this study we describe some of the main fundamental principles of basic research in cognitive neuropsychology. Through the scientific analysis of a recent piece of research work, we illustrate the consequences of not bearing these principles in mind. CONCLUSIONS: We propose a methodology that can be used to approach basic research in cognitive neuropsychology that allows these undesirable consequences to be avoided. This same methodology constitutes a guide that enables us to evaluate the conclusions of the research, regardless of the statistical processing of the data that support them. Scientific criticism contributes more to the advance of science than actual research does.

Brain↗

PubMed2003

Medicare program; change in methodology for determining payment for extraordinarily high-cost cases (cost outliers) under the acute care hospital inpatient and long-term care hospital prospective payment systems. Final rule.

In this final rule, we are revising the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system (IPPS). Under the existing outlier methodology, the cost-to-charge ratios from hospitals' latest settled cost reports are used in determining a fixed-loss amount cost outlier threshold. We have become aware that, in some cases, hospitals' recent rate-of-charge increases greatly exceed their rate-of-cost increases. Because there is a time lag between the cost-to-charge ratios from the latest settled cost report and current charges, this disparity in the rate-of-increases for charges and costs results in cost-to-charge ratios that are too high, which in turn results in an overestimation of hospitals' current costs per case. Therefore, we are revising our outlier payment methodology to ensure that outlier payments are made only for truly expensive cases. We also are revising the methodology used to determine payment for high-cost outlier and short-stay outlier cases that are made to Medicare-participating long-term care hospitals (LTCHs) under the long-term care hospital prospective payment system (LTCH PPS). The policies for determining outlier payment under the LTCH PPS are modeled after the outlier payment policies under the IPPS.

Economics, Hospital↗

PubMed1999

Managing cognitive impairment in the elderly: conceptual, intervention and methodological issues.

PURPOSE: With the aging of society, the incidence of dementia in the elderly is also increasing, and thus results in increased numbers of individuals with cognitive impairment. Nurses and other researchers have investigated issues concerning the management of cognitive impairment. This article highlights conceptual, intervention and methodological issues associated with this phenomenon. CONCLUSIONS: Cognitive change is a multivariate construct that includes alterations in a variety of information processing mechanisms such as problem solving ability, memory, perception, attention and learning, and judgement. Although there is a large body of research, conceptual, intervention and methodological issues remain. Much of the clinical research on cognitive impairment is atheoretical, with this issue only recently being addressed. While many clinical interventions have been proposed, few have been adequately tested. There are also various methodological concerns, such as small sample sizes and limited statistical power; study design issues (experimental vs. non-experimental), and internal and external validity problems. Clearly, additional research designed to intervene with these difficult behaviors is needed. IMPLICATIONS: A variety of psychosocial, environmental and physical parameters must be considered in the nursing care of persons with cognitive impairment. Special attention has been given to interventions associated with disruptive behaviors. Interventions are complex and knowledge must be integrated from both the biomedical and behavioral sciences in order to deal effectively with the numerous problems that can arise over a long and changing clinical course. Some researchers and clinicians have suggested that a new culture regarding dementia care is needed, one that focuses on changing attitudes and beliefs about persons with dementia and one that changes how organizations deliver that care. This review identifies key conceptual, intervention and methodological issues and recommends how these issues might be addressed in the future.

Journal Article↗

PubMedDate not supplied

Learning to 'walk our talk': the implications of sociological theory for research methodologies in health promotion.

In recent formulations of the concept of health promotion, such as Achieving Health for All and the Ottawa Charter, emphasis is clearly placed on comprehensivity and the integration of individual and social determinants of health, broadly defined. This paper is premised on the observation that despite evidence of a paradigm shift in the way we talk about health promotion at a conceptual level, we have yet to properly articulate a 'new' research methodology to accompany the 'new' health promotion. The paper has three main sections. First, some of the limitations and contradictions that separate the rhetoric of health promotion from its current operationalization in research practice are discussed. In asserting the inherent links between theory, methodology and method, the need for a new research paradigm is demonstrated. In the second section, seven key issues derived from the literature on sociological theory are identified and discussed in terms of their implications for choosing a new research methodology for health promotion. In the third section it is suggested that using these issue areas as a 'decision map' leads to the selection of a preferred strategy which brings together both interpretive and critical perspectives to bear on our understanding of social reality as it affects health. Elements of both of these approaches and the nature of their potential complimentarity are considered. Throughout these deliberations the reader is encouraged to consider the potentially conservative or activist orientations that alternate methodologies imply, and to critically evaluate how these mesh with the emerging rhetoric of fostering empowerment that is the cornerstone of the 'new' health promotion.

Health Promotion↗

PubMed2004

[Quality of methodology and reporting of randomized controlled trials of acupuncture for obesity].

OBJECTIVE: To evaluate the quality of methodology and reporting of randomized controlled trials of acupuncture for obesity worldwide. METHODS: Collecting all the randomized controlled trials of acupuncture for obesity worldwide by systematically searching without language limitation. The quality of methodology and reporting was evaluated by the quality criteria recommended by Cochrane handbook and CONSORT (consolidate standards of reporting trial) and STRICTA (standard for reporting interventions in controlled trials of acupuncture) checklists. RESULTS: Seven randomized controlled trials of acupuncture for obesity were identified. The quality of methodology was graded as "A" in one trial, "B" in two trials and "C" in the other four trials. The reporting quality of the seven trials was graded as "C". CONCLUSIONS: The methodology quality of the randomized controlled trials of acupuncture for obesity was too poor to provide strong evidence for clinical practice, and the poor reporting quality of the trials resulted in inadequate information from the trials.

Acupuncture Therapy↗

PubMed2003

Use of biolog methodology for optimizing the degradation of hydrocarbons by bacterial consortia.

Biolog methodology was used for the preliminary screening of different cultural conditions in order to detect the best combination/s of factors influencing the metabolic performance of bacterial consortia active in the degradation of hydrocarbons. Two microbial consortia were tested for their activity on 2 hydrocarbons (nonadecane and eicosane) in presence of the following cultural coadjuvants: vegetal oil, beta-cyclodextrine, sodium acetate, mineral solution. Tests were conducted in Biolog MT plates, where only the redox indicator of microbial growth (tetrazolium violet) and no carbon sources are provided. The microwells were filled with various combinations of hydrocarbons, microbial inoculum and coadjuvants. Blanks were prepared with the same combinations but without hydrocarbons. The results obtained show the suitability of the methodology developed to identify the most active consortium and the conditions for its best degradation performance. The efficacy of Biolog methodology (Biolog Inc., USA) for the characterization of microbial communities on the basis of the metabolic profiles obtained on specific carbon sources in the microwells of Elisa-type plates, is widely acknowledged (Garland, 1997; Pietikäinen et al., 2000; Dauber and Wolters, 2000). Due to its aptitude to simultaneously evaluate multiple microbial responses and directly organize the results, it can be adapted to meet specific study purposes (Gamo and Shji, 1999). In the present research Biolog methodology was fitted for the preliminary screening of different cultural conditions, in order to detect the best combination/s of factors influencing the metabolic performance of bacterial consortia active in the degradation of aliphatic hydrocarbons, in view of their utilization for the bioremediation of polluted sites.

Alkanes↗

PubMed2005

[Criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare].

INTRODUCTION: Research of satisfaction of patients in the area of primary health care (PHC) and especially criteria how to choose best methodology and the relevant variables guided to the situation where activities were focused on description of the basic structure and processes of health care rather than on identification of needs for services and on result based assessment and satisfaction of patients with provided service. To give advantage to any of methodologies is inexplicable problem and depend of factors beyond of health service control. PURPOSE: Aim of this paper is to review existing measurements of healthcare for ones who intend to use measurements of quality of healthcare for clinical and research purposes and to recommend criteria how to choose adequate methodology and relevant variables for assessment of quality of primary healthcare. METHODOLOGY: For our study we used experience of the Cathedra for Medical Informatics, Medical faculty, University of Sarajevo with emphasis on research of quality of PHC. We selected over 3,000 users of PHC (patients-adults) in PHC units in ten cantons of Federation of Bosnia and Herzegovina. RESULTS: Statistically significant results we got when we crossed general attitude of patients about quality of healthcare with the following variables: place where patient receive healthcare, consultation with patients about patients' rights and life styles. We have not got statistically significant results when we crossed the following variables with general attitude of patients: distance from place of living to place where patients get healthcare, examination schedule in the units of PHC, continuity of healthcare, organization of field service and possibility to choose physician or nurse. CONCLUSION: Very often researchers create their own methods of measurement instead to carry out systematic review of existing ones to enable them to find appropriate one. In this paper we recommended guidelines for finding the most appropriate methods of health measurement using experience of the Cathedra for Medical Informatics, Medical faculty in Sarajevo.

Humans↗

PubMed2006

Using telephone focus groups methodology to examine the prostate cancer screening practices of African-American primary care physicians.

African-American men have a greater burden from prostate cancer than do white men and men of other races/ethnicities in the United States. To date, there have been no studies of how African-American primary care physicians screen their patients for prostate cancer. The purpose of this study was to examine the use of telephone focus groups as a methodology and to learn about this practice among a group of African-American primary care physicians. A total of 41 physicians participated in eight telephone focus groups. Results from the study are found in a separate article. Regarding telephone focus group methodology, we found that a majority of the physicians in this study preferred telephone focus groups over the conventional face-to-face focus groups. We also discuss some of the advantages (e.g., no travel, high acceptance rates, more flexibility than in-person groups, and general cost efficiency) as well as disadvantages (e.g., nonverbal communication limits and reduction of group interaction) of this methodology. This methodology may prove useful in studies involving African-American physicians, physicians in general and other difficult-to-reach healthcare professionals.

Adult↗

PubMed2006

Research methodology for the investigation of rural surgical services.

This paper describes a functional approach to the definition of rural populations for purposes of rural health care research. Rather than define "rural" directly, we created a definition of urban populations and our research target became the non-urban component. Using Geographic Information Systems technology, isochrones (drivetime zones) were created that attached suburban populations to urban centres and mapped non-urban populations into rural hospital catchment areas. For population-based analyses, we have proposed a methodology for constructing catchment areas attached to Rural, Regional and Metropolitan services. We have developed a model for calculation of travel time for patients required to travel for care. We successfully applied these methodologies to the disparate regions of rural Alberta and Northern Ontario in 2 papers that investigated the delivery of rural surgical services. This methodology represents a durable and portable designation of "rural" with potential for research applications in other areas of health research. By defining "urban" rather than "rural," we avoided many of the methodological conundrums in this research field.

Alberta↗

PubMed2006

Methodologies used in nursing research designed to improve patient safety.

Nursing research studies of patient safety for 2002-2005 were reviewed to determine methods used and methodological challenges within this field of research. Methods used in traditional clinical research and in health services research were often combined or adapted in innovative research designs to advance knowledge regarding nursing care and patient safety outcomes. This relatively new focus of complex research posed methodological challenges in areas such as measurement and the availability and analysis of data. The most frequent methods used included survey research, analysis of secondary data, and observational studies. This review points to the need to increase the incorporation of complex methodological training, including health services research, the analysis of secondary data and complex survey design in our doctoral programs, and to provide opportunities for researchers to gain further methodological training. Increased use of multi-site and multi-level studies is also needed.

Anthropology, Cultural↗

PubMed1991

A methodology for building an AIDS research file using Medicaid claims and administrative data bases.

There is a current and continuing need for health services research on the epidemiology of AIDS and its impact on health care systems. However, large data bases designed for other purposes, such as hospital discharge abstract systems and medical claims systems, are the primary source of data for AIDS research. Thus, methodologies must be developed that enable researchers to investigate AIDS using data bases designed for other purposes. In this report, we describe a methodology for utilizing Medicaid Management Information Systems (MMIS) data to conduct health services research on AIDS. We developed an ICD-9-CM diagnosis-based algorithm that accurately identified the majority of AIDS cases, both before and after AIDS-specific ICD-9-CM codes became available in October 1986. Using diagnostic categories that we had developed previously to identify AIDS cases among disabled young men in California on Medicaid, we expanded the methodology to include children, men, and women of all ages in California and New York. The algorithm worked best with young disabled males, older males, and females between 18 and 50 years of age. The algorithm worked least well with nondisabled males, females over age 50 years, and children. We also developed methodologies for defining Medicaid AIDS onset, risk group, and date of death. Our research resulted in the identification of a study population representing the majority of Medicaid AIDS cases between 1983 and 1986 in California and New York. The AIDS study population data base was used in further research on eligibility patterns, the epidemiology of the AIDS epidemic, lifetime Medicaid utilization and expenditures, and the development of a survival-based severity index for Medicaid recipients with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1988

Recent developments in single-subject methodology: methods for analyzing generalization, maintenance, and multicomponent treatments.

At the outset of this chapter we asked whether or not single-subject methodology has outlived its usefulness to behavior therapy. We did so because serious doubts have been expressed about the ability of single-subject methodology to address the salient issues of the day. This chapter allays many of these doubts. This chapter reveals that single-subject researchers are far from helpless when investigating generalization and maintenance and identifying the active (and inactive) components in their compound treatments. In fact, a number of powerful strategies are at their disposal--strategies that are not strangers to the armamentarium of single-case researchers. These strategies are in essence nothing more than extensions of the reversal, multiple baseline, and simultaneous and alternating-treatments designs. In the case of the assessment of generalization, these extensions involve little more than the inclusion of continuous measures (or regular probes) of untrained responses throughout the investigation. In the case of the assessment of maintenance, they involve the replacement of a comparison of two or more acquisition procedures with a comparison of two or more maintenance procedures. And in the case of the identification of active (and inactive) components of compound treatments, they involve the aggregation of the findings from a series of single-subject investigations. When the requirements of single-subject designs and their extensions cannot be met, investigators still have available a set of traditional group designs (e.g., factorial and additive designs) for attacking these same issues. Assessment of generalization, maintenance, and the components of compound treatments are not the only salient issues facing behavior therapy today. Another is the widening gap between the researcher and the practitioner (e.g., Barlow, 1980; Wilson, 1981). It is thought by some that single-subject methodology may be the means of bridging this gap; that through single-subject methodology a new breed of practitioner will appear: the empirical clinician (e.g., Barlow et al., 1984; Goldfried, 1984; Hayes, 1981). This new breed of practitioner will be made up of persons who, for economic and pragmatic reasons, are concerned with accountability and who use single-subject designs to achieve it (Barlow et al., 1984). The present chapter does little to help bridge the gap between the researcher and the practitioner; thus, the present chapter does little to help bring about the creation of this new breed of practitioner, the empirical clinician. In fact, the single-subject strategies described in these pages appear to be suitable for use only by the researcher.(ABSTRACT TRUNCATED AT 400 WORDS)

Behavior Therapy↗

PubMed1988

Methodologic problems in exercise testing research. Are we solving them?

To evaluate the comparative effects of methodologic factors on the reported accuracies of two standard exercise tests, 56 publications comparing the exercise thallium scintigram with the coronary angiogram were analyzed for conformation to five methodologic standards. Analyzed were adequate definition of study group, avoidance of a limited challenge group, avoidance of workup bias, and blinded analysis of the coronary angiogram and myocardial scintigram. Study group characteristics and technical factors were also reviewed. Better conformation with methodologic standards was found than has been reported previously for treadmill exercise testing. Furthermore, study group characteristics and technical factors were better predictors of sensitivity and specificity than were methodologic deficiencies. Only workup bias and test blinding were significantly associated with test accuracy. The percentage of patients with previous myocardial infarction had the highest correlation and was independently and directly related to sensitivity and inversely related to specificity.

Coronary Angiography↗

PubMed1982

Evaluation of nutrition interventions. An annotated bibliography and review of methodologies and results. Food and Agriculture Organization of the United Nations.

1. This is the second edition of an annotated bibliography covering evaluation methodology and evaluations of nutrition interventions. It contains more than 110 items on methodology and around 300 reports describing the results from evaluation studies. Included are most of the 250 items listed in the first edition, which was compiled in 1980, by G.P. Sevenhuysen and Ann Burgess. Almost all the items are available in the FAO libraries in Rome. 2. The most useful of the items are starred and also indexed in Tables 1, 2 or 3. Evaluation methodology 3. There was general agreement in the guidelines on evaluation methodology on the following points: Evaluation should be an integral routine programme activity wherever possible; Field staff must be involved at all stages of the evaluation including interpretation; Results should be rapidly 'fed-back' to allow adaptations to be made to the programme if necessary. 4. Many of the guidelines did not adequately cover the following points: How to conduct both 'operational' and 'impact' evaluation; The importance of taking into account, when designing the evaluation, the needs of the people who will use the results; How to select a representative sample; How to overcome the problem of 'drop-outs'; How to measure 'leakage' of programme inputs; How to control for non-programme variables; How to distinguish among the effects of multiple inputs; How to measure costs and cost-effectiveness; How to ensure data reliability. A review of reports of evaluation studies confirmed that better guidelines are needed in these areas. Evaluation reports 5. In only about one third of the studies examined were sufficient details available for a good assessment to be made of the reliability of the results. 6. Among the problems that made it difficult to assess the value of some of the results were: A lack of specific programme objectives and of baseline data; Inadequate statistical testing of the results; Conclusions based mainly on subjective opinion rather than objective information; A weak data base, due to an unrepresentative sample, a high 'drop-out' rate among the selected sample, or insufficient data collected; A lack of information on the 'dosage' of the input actually reaching the recipients; A lack of information on possible differences in age distribution, and other variables, in the test and control groups; No control of non-programme variables; An evaluation design that did not allow the different contributions of multiple programme inputs to be assessed; No data on costs; Lack of information on which to judge data reliability.

Evaluation Studies as Topic↗

PubMed1981

Behavioral problems in deaf children: methodologic and theoretical considerations.

Problems in methodologic and theoretical approaches to the study of behavioral problems in deaf children are discussed. The most serious and prevalent methodologic deficiencies include inaccurate definitions, poor operationalization of "deafness," and the use of inadequate comparison groups. Many of the theories developed to explain findings in this area fail to consider individual differences among the children and/or their environments. Suggestions are presented with the goal of encouraging more exactness in methodology and the development of an electric theoretical approach to research in this area. It is argued that a valid understanding of the occurrence and "causes" of behavioral problems in this group, based on sound methodology, is essential to logical decision making and to any attempts at intervention.

Child↗

PubMed1994

Alcoholism treatment matching research: methodological and clinical issues.

Client-treatment matching is an area receiving increased attention both in clinical practice and research with alcoholism. While the notion of potentially improving treatment outcomes by matching has been suggested for some time, there are a number of methodological and practical barriers that have impeded progress in the development of theoretically and clinically relevant matching models. This article provides an overview of the potential benefits of matching, the methodological factors that increase the complexity of research in this area, and some of the clinical barriers that make implementation more difficult. This overview also serves to introduce this special issue of the Journal of Studies on Alcohol, which examines in more detail each of the methodological issues involved in clinical research on treatment matching. While these methodological issues present unique challenges to the clinical researcher, the potential benefits of matching appear promising and should serve to motivate clinicians and researchers to pursue continued work in this area.

Alcoholism↗

PubMed1995

Deduction of the clonogen content of intestinal crypts: a direct comparison of two-dose and multiple-dose methodologies.

A microcolony assay was used in conjunction with fractionated gamma irradiation to determine the number of clonogens in murine intestinal crypts with varying doses of irradiation used in the determination. The experimental design allows direct comparison between two-dose methodologies, employing one and two (or two or four) equal dose fractions, and multiple-dose methodologies involving determination of the crypt survival curves for a number of fractionation regimens using equal doses per fraction. The two-dose methodology yielded estimates of clonogen number of between 3 and 4 at low delivered dose (single and double fractions each of 6.5-7.5 Gy), rising to around 40 at high biological doses (two and four fractions each of 5.75 or 6.5 Gy). The multifraction methodology yielded estimates of clonogen number which increased from 13 after a single fraction to values of 26 and 22 after three and four fractions. However, the latter values were reduced to 11 and 9, and showed little evidence of any dependence on fraction number, when data pertaining to high biologically effective doses were excluded. Hence it is concluded that the high values for clonogen number typically deduced from such multiple-dose protocols, compared with the generally lower (but dose-dependent) values obtained from two-dose protocols, may be explained at least partially by the higher biological doses generally employed in the multiple-dose protocols.

Animals↗

PubMed1993

[An alternative methodology for the teaching of anatomy in nursing studies at the University of Carabobo].

An alternative methodology for the teaching of Human Anatomy which contributes to improve academic yield by Nursing students at the Faculty of Health Sciences of the University of Carabobo is presented. A total of 50 first-year Nursing students who participated in the experiment were divided into 2 groups, control and experimental. This research project was of the almost-experimental type and the work methodology was experimental-evaluation. Three instruments were used to obtain data: an investigation of the Lickert school type consisting of 40 proposals related to the students attitude concerning the study of this discipline and in view of a teaching methodology (EAEAM), accompanied by the school of Interests of Thurstone and by the Psychometric Test of Raven, to determine relationships in accordance with the research objectives. In function of the empirical results of the experiment and of revision of the literature pertaining to this theme, a methodological proposal is presented for the teaching of Human Anatomy; its theoretical-practical nature demands: previous study, observation, discussion and, fundamentally, subdivision, as an alternative to improve academic yield by Nursing students.

Anatomy↗