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Results for “mixed methods”

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PubMed2005

'Bipolar missed states': the diagnosis and clinical salience of bipolar mixed states.

OBJECTIVE: To explore diagnostic and treatment issues concerning bipolar mixed states. METHOD: Bipolar mixed states are described and concerns about diagnostic and treatment difficulties are summarized and discussed. RESULT: Mixed states can present with equal admixtures of depressive or manic symptoms, or more commonly one component predominates. There is fair consensus, although little data, regarding the management of manic mixed states. However depressive mixed states are far more complex both in terms of recognition and management. People suffering from mixed states characteristically present with complaints of depression. CONCLUSIONS: The boundaries between depressive mixed states and agitated depression are vague, yet carry substantial therapeutic implications. Bipolar mixed states are often difficult to treat, and tend to take much longer to settle than either pure mania or depression. Furthermore there is data that treatment with antidepressants can worsen the course of mixed states. Hence missed diagnoses can potentially have negative clinical implications. Therefore in this paper the clinical presentation, diagnosis and therapy of mixed states is reviewed with a view to improving management.

Affect↗

PubMedDate not supplied

Toward an integrative approach in the analysis of dependency problems.

This article takes some preliminary steps towards an integrated analysis of dependency problems e.g., long-term tranquillizer use, alcohol dependence, problematic use of narcotics. It argues for the need to outline important theoretical, epistemological, and methodological prerequisites in the analysis of the complex dynamic developmental processes involved in dependency problems. The dynamic process leading to dependence can be studied by the aid of an artificial science neural network approach in combination with a mixed method strategy including a clarification of a combination of different epistemological positions. It is intended that the empirical output of this complex strategy will provide a starting point for a new theoretical analysis which, in turn, will lead to new and more relevant input variables in the neural network approach that will help us to extend our knowledge of the dynamic processes leading to dependency.

Comorbidity↗

PubMed2006

Comparing bloodstream infection rates: the effect of indicator specifications in the evaluation of processes and indicators in infection control (EPIC) study.

OBJECTIVE: Bloodstream infection (BSI) rates are used as comparative clinical performance indicators; however, variations in definitions and data-collection approaches make it difficult to compare and interpret rates. To determine the extent to which variation in indicator specifications affected infection rates and hospital performance rankings, we compared absolute rates and relative rankings of hospitals across 5 BSI indicators. DESIGN: Multicenter observational study. BSI rate specifications varied by data source (clinical data, administrative data, or both), scope (hospital wide or intensive care unit specific), and inclusion/exclusion criteria. As appropriate, hospital-specific infection rates and rankings were calculated by processing data from each site according to 2-5 different specifications. SETTING: A total of 28 hospitals participating in the EPIC study. PARTICIPANTS: Hospitals submitted deidentified information about all patients with BSIs from January through September 1999. RESULTS: Median BSI rates for 2 indicators based on intensive care unit surveillance data ranged from 2.23 to 2.91 BSIs per 1000 central-line days. In contrast, median rates for indicators based on administrative data varied from 0.046 to 7.03 BSIs per 100 patients. Hospital-specific rates and rankings varied substantially as different specifications were applied; the rates of 8 of 10 hospitals were both greater than and less than the mean. Correlations of hospital rankings among indicator pairs were generally low (rs=0-0.45), except when both indicators were based on intensive care unit surveillance (rs = 0.83). CONCLUSIONS: Although BSI rates seem to be a logical indicator of clinical performance, the use of various indicator specifications can produce remarkably different judgments of absolute and relative performance for a given hospital. Recent national initiatives continue to mix methods for specifying BSI rates; this practice is likely to limit the usefulness of such information for comparing and improving performance.

Cross Infection↗

PubMed2004

Exact and approximate algorithms for helical cone-beam CT.

This paper concerns image reconstruction for helical x-ray transmission tomography (CT) with multi-row detectors. We introduce two approximate cone-beam (CB) filtered-backprojection (FBP) algorithms of the Feldkamp type, obtained by extending to three dimensions (3D) two recently proposed exact FBP algorithms for 2D fan-beam reconstruction. The new algorithms are similar to the standard Feldkamp-type FBP for helical CT. In particular, they can reconstruct each transaxial slice from data acquired along an arbitrary segment of helix, thereby efficiently exploiting the available data. In contrast to the standard Feldkamp-type algorithm, however, the redundancy weight is applied after filtering, allowing a more efficient numerical implementation. To partially alleviate the CB artefacts, which increase with increasing values of the helical pitch, a frequency-mixing method is proposed. This method reconstructs the high frequency components of the image using the longest possible segment of helix, whereas the low frequencies are reconstructed using a minimal, short-scan, segment of helix to minimize CB artefacts. The performance of the algorithms is illustrated using simulated data.

Algorithms↗

PubMed2002

The clinical effectiveness of healing touch.

OBJECTIVES: (1) to determine the clinical effectiveness of Healing Touch (HT) on variables assumed to be related to health enhancement; (2) to determine whether practitioner training level moderates treatment effectiveness. DESIGN: Mixed-method repeated measures design with quasi-experimental and naturalistic approaches, paired with nomothetic and idiographic analyses. SETTING/LOCATION: Practitioner's offices or client's home. SUBJECTS: Twenty-two (22) clients who had never experienced HT. INTERVENTIONS: Three treatment conditions: no treatment (NT), HT only (standard HT care), and HT+ (Standard HT care plus music plus guided imagery). OUTCOME MEASURES: Secretory immunoglobulin A (sIgA) concentrations in saliva, self-reports of stress levels, client perceptions of health enhancement, and qualitative questionnaires about individual effects. RESULTS: Clients of practitioners with more training experienced statistically significant positive sIgA change over the HT treatment series, while clients of practitioners with less experience did not. Clients reported a statistically significant reduction of stress level after both HT conditions. Perceived enhancement of health was reported by 13 of 22 clients (59%). Themes of relaxation, connection, and enhanced awareness were identified in the qualitative analysis of the HT experience. Pain relief was reported by 6 of 11 clients (55%) experiencing pain. CONCLUSIONS: The data support the clinical effectiveness of HT in health enhancement, specifically for raising sIgA concentrations, lowering stress perceptions and relieving pain. The evidence indicates that positive responses were not exclusively as a result of placebo, that is, client beliefs, expectations, and behaviors regarding HT.

Adolescent↗

PubMed2004

HIV serostatus disclosure to sexual partners among HIV-positive injection drug users.

Utilizing mixed methods analyses with cross-sectional data from an ethnically diverse sample of HIV-seropositive injection drug users (IDUs), we sought to examine disclosure and sexual behavior based on partner type, partner serostatus, and transmission risk. Results indicated that more participants disclosed to their HIV-positive sex partners than to their HIV-negative or unknown status sex partners. However, unexpectedly, we found that more participants disclosed to casual sex partners than primary partners before first sexual contact. Consistent disclosers reported more unprotected sexual activity compared to nondisclosers, and were more likely to believe they had a responsibility to disclose. Nondisclosers were less likely than consistent disclosers to believe it was important to protect sex partners from HIV and were more resentful of wearing condoms. In terms of the qualitative data, we found that the emotionally upsetting narratives came from those we defined as "eventual disclosers." This category represented those participants who were in relationships and had not disclosed their status to their primary partners until after having had sex with that partner. These narratives indicated that researchers looking at disclosure behavior should be aware of varying disclosure contexts as well as the emotional consequences impacting disclosure decision-making within these contexts.

Adult↗

PubMed2005

Communication between physicians and family caregivers about care at the end of life: when do discussions occur and what is said?

BACKGROUND: Few studies have examined physician-family caregiver communication at the end of life, despite the important role families have in end-of-life care decisions. We examined family caregiver reports of physician communication about incurable illness, life expectancy, and hospice; the timing of these discussions; and subsequent family understanding of these issues. DESIGN: Mixed methods study using a closed-ended survey of 206 family caregivers and open-ended, in-depth interviews with 12 additional family caregivers. SETTING/SUBJECTS: Two hundred eighteen primary family caregivers of patients with cancer enrolled with hospice between October 1999 and June 2002. MEASUREMENTS: Family caregiver reports provided at the time of hospice enrollment of physician discussions of incurable illness, life expectancy, and hospice. RESULTS: Many family caregivers reported that a physician never told them the patient's illness could not be cured (20.8%), never provided life expectancy (40% of those reportedly told illness was incurable), and never discussed using hospice (32.2%). Caregivers reported the first discussion of the illness being incurable and of hospice as a possibility occurred within 1 month of the patient's death in many cases (23.5% and 41.1%, respectively). In open-ended interviews, however, family caregivers expressed ambivalence about what they wanted to know, and their difficulty comprehending and accepting "bad news" was apparent in both qualitative and quantitative data. CONCLUSION: Our findings suggest that ineffective communication about end-of-life issues likely results from both physician's lack of discussion and family caregiver's difficulty hearing the news. Future studies should examine strategies for optimal physician-family caregiver communication about incurable illness, so that families and patients can begin the physical, emotional, and spiritual work that can lead to acceptance of the irreversible condition.

Caregivers↗

PubMed2006

Mind over matter: exploring job stress among female blue-collar workers.

Although overall health has been defined holistically as the integration of a person's optimal mental, physical, social, intellectual, and spiritual well-being, a mental health focus remains on the fringe of many public health efforts. This report describes recent efforts by the Centers for Disease Control and Prevention (CDC) to explore job stress among female blue-collar workers. Using a more holistic approach to understand its impact on blue-collar women's overall health, health-related quality of life (HRQOL) was used to assess optimal human performance. Attempting to encapsulate how overall health affects one's ability to participate and fulfill daily personal/professional tasks, HRQOL yields a broader understanding of the interaction between psychological well-being (mind) and physical functioning (matter). Embedding CDC HRQOL-4 measures into a questionnaire used as part of a larger mixed methods project, blue-collar women responded to questions about their health, including both mental and physical. For these female workers, mental health appeared to be of greater consequence, which could be interpreted as mind being more significant than matter. This paper highlights the findings related to HRQOL issues experienced by these female blue-collar workers and summarizes recommendations for effective individual and organizational approaches to address job stress.

Adult↗

PubMed2003

Nursing home closures: effects on capacity and reasons for closure.

OBJECTIVES: to identify the rate of closure of nursing homes for older people, the types of homes closing and the reasons for closure. DESIGN: mixed method study including a census and telephone survey of registration and inspection units and interviews with independent providers. PARTICIPANTS: 81 of 96 health authority and joint registration and inspection unit managers in England completed the census and 39 managers participated in a further telephone survey. Twenty-five independent providers were interviewed. RESULTS: closures resulted in a net loss of 6% of nursing homes and 4.9% of nursing places during 2000-2001. Smaller homes were more likely to close and were increasingly seen as unviable. The majority of closed homes were reported to have provided good quality care. Shortages of nursing staff were of widespread concern. The dominant combination of factors identified by providers was low fees and concerns about the cost implications of the new care standards. Changes in demand were reflected in the placement of high dependency residents in residential rather than nursing homes. CONCLUSIONS: in the absence of policy interventions capacity will continue to reduce, with smaller homes most likely to disappear. There is an urgent need to address the supply and efficient use of nursing staff skills in care homes. While fee levels are the primary concern the effect of the proposed care standards was clearly having an effect. Even with subsequent amendment to these standards, unless authorities use capacity funding to raise fees and improve expectations, providers are likely to continue to exit the market.

Aged↗

PubMed2004

Variability of task-based dermal exposure measurements from a variety of workplaces.

INTRODUCTION: The RISKOFDERM project collected task-based estimates of potential dermal exposure from a wide range of industries and services from around Europe. A formal statistical analysis was carried out to explore the main components of variability in dermal exposure levels. The central research question was to what extent dermal exposure levels could be explained by generic grouping variables like 'exposure scenarios' and 'dermal exposure operation units' (DEOs) (grouping of scenarios on the basis of similarity in exposure patterns). METHODS: Mixed effect linear models were used to estimate variance components of potential dermal exposure for DEOs or scenarios and for factories, workers and time. In addition within- and between-worker variance components were estimated for single groups of workers performing a specific scenario in a specific location with potential dermal exposure to a specific agent. RESULTS: Variability in potential dermal exposure is very large. Differences in geometric mean potential dermal exposure can range over 3-5 orders of magnitude both for DEOs and scenarios. The range depends on how dermal exposure is expressed (amount or rate). Both DEOs and scenarios explain a considerable amount of variability, but large differences in dermal exposure still existed within DEOs and scenarios. In contrast, between-worker variability in mean potential dermal exposure is minimal for a given scenario carried out within a specific location with exposure to a particular agent. Temporal variability, however, is considerable, most likely due to the event-based nature of the dermal exposure process. CONCLUSION: The classification of tasks in DEOs and scenarios has proven to be useful since large differences in average dermal exposure estimates exist between DEOs and between scenarios. However, large differences also exist between scenarios within a DEO and even within a scenario. These differences are governed by local conditions determined by the actual handling of the agent, the agent's physical and chemical properties, its intrinsic toxicity, control measures taken and training and attitude of workers. For the time being, actual dermal exposure measurements and a better understanding of actual determinants of dermal exposure seem to be a necessity in order to evaluate dermal exposure hazards properly.

Analysis of Variance↗

PubMed2006

From expert-based to quantitative retrospective exposure assessment at a Soderberg aluminum smelter.

OBJECTIVES: Expert judgement of exposure levels is often only poorly or moderately correlated with directly measured levels. For a follow-up of a historical cohort study at a Söderberg aluminum smelter we updated an expert-based semiquantitative job exposure matrix of coal tar pitch volatiles (CTPV) to quantitative estimates of CTPV and benzo(a)pyrene (BaP). METHODS: Mixed effects models to predict exposure for potroom operation and maintenance jobs were constructed from personal CTPV and BaP measurements. Mean exposures of jobs in non-potroom locations were directly calculated when measurements were available. Exposure estimates for jobs/time periods with no measurements were based on proportion of time spent in exposed areas compared to jobs where exposure was modeled or measured. For pre-1977, the original expert exposure assignments were calibrated using the updated 1977 estimates. RESULTS: The rate of change in exposure levels varied by time period and was accounted for in mixed models with a linear spline time trend. Other variables significant in the models were job, potroom group and season as fixed effects, and worker as a random effect. The models for potroom operations explained 45 and 27% of the variability in the CTPV and BaP measurements, respectively. The models for maintenance jobs explained 40 and 19% of the variability in the CTPV and BaP measurements, respectively. For 1977-2000 model estimates, direct calculation of means and extrapolation from modeled/measured exposures accounted for 57, 6 and 37% of the exposed person-years, respectively. CONCLUSIONS: The above methodology maximized the use of exposure measurements and largely replaced the original expert-based estimates. Finer discrimination between exposure levels was possible with the updated exposure assessment. The new estimates are expected to reduce exposure misclassification and help better assess the exposure-response relationships.

Air Pollutants, Occupational↗

PubMed2002

Exhaled nitric oxide as a marker of lung injury in coronary artery bypass surgery.

BACKGROUND: Exhaled nitric oxide (NO) concentrations have been suggested as a marker of disease onset and severity in a number of inflammatory conditions such as acute asthma. Known markers of the onset of acute lung injury require invasive tests and laboratory based analysis and have limited clinical applicability. We performed a study of the use of exhaled NO as a marker of developing acute lung injury during and after coronary artery bypass grafting in patients requiring cardiopulmonary bypass. METHODS: Mixed expired air samples were taken from the patient breathing system and analysed for exhaled NO using chemiluminescence analysis. RESULTS: Exhaled nitric oxide concentrations in expired gas correlated with the PaO2/FlO2 ratio (r = 0.23, P < 0.01). There was a non-significant trend towards a reduction in exhaled NO levels from after induction of anaesthesia to post-bypass time points, with the lowest exhaled NO concentrations occurring at this time (P = 0.07). There was no correlation between mean arterial pressure (r = -0.1, P = 0.54) or mean pulmonary artery pressure (r = -0.1. P = 0.67) and expired NO levels. CONCLUSIONS: Further work is required to test whether exhaled NO concentration may be useful in diagnosing the onset of acute lung injury in patients undergoing coronary artery bypass grafting.

Biomarkers↗

PubMed2004

Measuring psychological well-being: insights from Thai elders.

PURPOSE: Psychological well-being, an important indicator of successful aging, may be conceptualized quite differently across cultures. Using a mixed-methods approach, we developed a measure of psychological well-being based on the indigenous expertise of Thai elders. DESIGN AND METHODS: Data were collected from older people in Thailand in four stages with staggered qualitative and quantitative methods: individual and focus group interviews (n = 67); a preliminary survey (n = 477); cognitive interviews (n = 30); and a second survey (n = 460). We analyzed the resulting psychological well-being items to identify their underlying factor structure and psychometric properties. RESULTS: Confirmatory factor analysis suggested that psychological well-being has two components: intrapersonal and interpersonal. The subscales for this measure have adequate reliability and validity. IMPLICATIONS: This research provides evidence for cultural variability in the nature of psychological well-being and highlights the importance of developing measures that are culturally relevant.

Aged↗

PubMed1999

Measuring the impact of a behaviour change intervention for commercial sex workers and their potential clients in Malawi.

A peer-education HIV/AIDS prevention programme for bar-based sex workers and their potential clients (long-distance truck drivers) in Malawi was evaluated for impact. A mixed method approach was used, the tools being structured questionnaires and focus group discussions. The results showed that in the active districts, the presence of sex worker peer educators led to a increase in condom use with paying partners (90.3 compared to 66.7 and 76.3% in the two other groups--non-active and average) and increased condom distribution. Condom use with regular non-paying partners of sex workers had, however, not increased since the baseline data. The truck driver peer educators were found to be generally inactive but companies where training had occurred were more likely to encourage and distribute condoms. The qualitative data gave a more in-depth view of several areas for concern: the reasons for the non-use of condoms with non-paying partners; acceptance of educators by their peers; and the sex workers' and truck drivers' criteria for condom use based neither on knowledge nor on their own risk awareness. These issues need to be explored further.

Condoms↗

PubMed2005

Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low-income audience.

More effective nutrition education to reach low-income and ethnic minority populations is needed. As part of a project to develop a tailored nutrition education intervention to meet the needs of low-income Hispanics and non-Hispanics, complementary, mixed methods of formative research were used to determine specific characteristics of the target population. The aim was to ensure that the full array of nutrition messages would be comprehensive enough to effectively tailor to the level of the individual. Barriers to healthy eating were delineated for three main dietary behaviors (number of items delineated in parentheses): lowering fat (11), increasing fruit (8) and increasing vegetables (6). Information was also collected regarding motivators for healthy eating (5), situational barriers to making healthy choices (4), other nutrition-related interests (8) and typical eating habits and food-related choices of the target audience.

Feeding Behavior↗

PubMed1998

The association of calcium and vitamin D, and colon and rectal cancer in Wisconsin women.

BACKGROUND: Calcium and vitamin D have been hypothesized to reduce colorectal cancer risk. Epidemiological evidence, however, is mixed. METHODS: To explore those relationships, data were collected as part of a population-based, case-control study of colorectal cancer in Wisconsin women (678 controls, 348 colon and 164 rectal cancer cases). A semi-quantitative food frequency questionnaire was used to ascertain food and dietary supplement intake 2 years prior to interview. Logistic regression models were used to calculate odds ratios (OR). RESULTS: Higher levels of calcium intake were associated with reduced colon and rectal cancer risk. The following adjusted OR and 95% confidence intervals (CI) were observed, comparing the fifth quintile (based on control intake) with the first: colon cancer: OR = 0.6, 95% CI: 0.4-1.0, P-trend: 0.03; rectal cancer: OR = 0.6, 95% CI: 0.3-1.1, P-trend: 0.07. Similar relationships were observed for vitamin D intake, although OR were closer to the null value and did not always behave in a step-wise fashion (fifth quintile versus the first--colon cancer: OR = 0.7, 95% CI: 0.4-1.1, P-trend: 0.05; rectal cancer: OR = 0.8, 95% CI: 0.5-1.5, P-trend: 0.42). CONCLUSION: These data support a protective association of calcium on colon and rectal cancer risk.

Aged↗

PubMed2005

Concept mapping: an introduction to structured conceptualization in health care.

Structured conceptualization is a specific form of concept mapping that is a mixed methods participatory approach that combines group processes (brainstorming, sorting, group interpretation) with a sequence of multivariate statistical analyses (multidimensional scaling, hierarchical cluster analysis). Concept mapping's relevance to health care quality and services is described. The basic steps and analysis sequence in the concept mapping method are outlined and a brief example of the results for a health planning project are presented. Several examples of the use of concept mapping in health are provided.

Cluster Analysis↗

PubMed2001

Trends in lipoplex physical properties dependent on cationic lipid structure, vehicle and complexation procedure do not correlate with biological activity.

Using a group of structurally related cytofectins, the effects of different vehicle constituents and mixing techniques on the physical properties and biological activity of lipoplexes were systematically examined. Physical properties were examined using a combination of dye accessibility assays, centrifugation, gel electrophoresis and dynamic light scattering. Biological activity was examined using in vitro transfection. Lipoplexes were formulated using two injection vehicles commonly used for in vivo delivery (PBS pH 7.2 and 0.9% saline), and a sodium phosphate vehicle previously shown to enhance the biological activity of naked pDNA and lipoplex formulations. Phosphate was found to be unique in its effect on lipoplexes. Specifically, the accessible pDNA in lipoplexes formulated with cytofectins containing a gamma-amine substitution in the headgroup was dependent on alkyl side chain length and sodium phosphate concentration, but the same effects were not observed when using cytofectins containing a beta-OH headgroup substitution. The physicochemical features of the phosphate anion, which give rise to this effect in gamma-amine cytofectins, were deduced using a series of phosphate analogs. The effects of the formulation vehicle on transfection were found to be cell type-dependent; however, of the formulation variables examined, the liposome/pDNA mixing method had the greatest effect on transgene expression in vitro. Thus, though predictive physical structure relationships involving the vehicle and cytofectin components of the lipoplex were uncovered, they did not extrapolate to trends in biological activity.

Animals↗