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PubMedDate not supplied

[Medical care for chronic disease: reflexions on methodologic procedures of a qualitative study].

Chronic diseases have been the focus of qualitative researchers. However, few studies have explained in depth the methodological options choOsed in the studies and their reasons. This paper presents some reflections on the methodological strategies and procedures used in a multisite, qualitative study whose focus are the individual's perspectives on chronic conditions and medical care. Such reflections are on the study's orientation, the selection of the area, the focus groups and the social relations among participants. We conclude stating that the methodological options and the strategies used, rather than being solely a technical issue, are deeply linked to the study's object, the social relations among participants and the context of research.

Chronic Disease↗

PubMedDate not supplied

[Ten contributions to the use of qualitative methodology in an audit of internal communication in primary care].

Qualitative methodology, originally belonging to the Social Sciences domain, has progressively incorporated to Health Research to the scepticism of many and the admiration of others. Nowadays, validity and fiability of these qualitative techniques is still questioned by a great amount of health researchers and their use provokes doubt among reviewers and other members of the scientific community. This article presents as a fundamental measure for the validity of the qualitative methodology its precise use to approach determinate research objectives specific to them and, echoing the extra issue of the Health Services Research on December 1999 on this methodology, gathers the contribution of the use of these techniques from a complementary point of view, in a Internal Communication Audit conducted in the Primary Care Services of four Regional Health Systems: Area II of the INSALUD (National Health Institute), Basque Health System, Canary Health System and Andalusian Health System.

Communication↗

PubMedDate not supplied

[Cognitive rehabilitation. Theoretical and methodological aspects].

AIMS: The aim of this paper is to theoretically define some aspects related with cognitive rehabilitation, as well as the methodological principles needed to draw up a programme of rehabilitation for these functions. METHOD: We performed an analysis of the definitions developed by different contemporary authors, of the theoretical approaches to cognitive rehabilitation, and the modes and models of how the functions are organised within the brain. Lastly, we set out the fundamental methodological principles to be taken into account in the production of a cognitive intervention programme, and describe the advantages offered by computer aided procedures as compared to the conventional methods of rehabilitation. CONCLUSIONS: Cognitive rehabilitation is currently considered one of the most important tasks or directions in neuropsychology and a number of theoretical and methodological approaches have been developed to deal with it. Over the past few years there has been a notable increase in the number of studies carried out involving cognitive intervention, especially in patients who are carriers of brain injuries of a traumatic or vascular aetiology and which give rise to a collection of motor, sensory and cognitive disorders. The level of development achieved in the cognitive neurosciences and IT have contributed to the conventional methods being substituted by computer applications that allow greater effectiveness in the rehabilitating process

Brain↗

PubMed2003

Translation and cultural adaptation of quality of life questionnaires: an evaluation of methodology.

OBJECTIVE: To evaluate the methodological steps currently proposed in translation and cultural adaptation of quality of life questionnaires. METHODS: Fifty patients with rheumatoid arthritis were invited to participate. Two versions each of the Stanford Health Assessment Questionnaire (HAQ), the MOS 36 Item Short-Form Health Survey (SF-36), and the Arthritis Impact Measurement Scales 2 (AIMS-2) were administered: version 1 was a literal translation of the questionnaire; version 2 resulted from a process of translation and cultural adaptation following internationally accepted guidelines. For each patient we applied 2 questionnaires before and after consultation. The questionnaire, the order of administration, and the version were randomly assigned. The interviews were performed by a single interviewer. Several clinical and laboratory outcome measures were assessed simultaneously. Descriptive statistical analysis was used to characterize the data. Spearman and intraclass correlation coefficients were used to evaluate reliability and validity of each version of each questionnaire. RESULTS: Patients' mean (SD) age was 47 (12) years and mean (SD) disease duration was 10 (7) years. The differences of the mean in the physical and affective AIMS-2 components between the literal and adapted versions (0.21 and 0.11, respectively) were similar to the differences in the intraobserver application of the same version of culturally adapted AIMS-2 components (0.03 and 0.20) (the component scores range from 0 to 10). The same results were observed when considering other components of AIMS and SF-36, as well as HAQ scores. Version 1 and 2 presented a similar clinically and statistically significant correlation with clinical and laboratory measures used in the validation process of the questionnaires. CONCLUSION: The complex methodologies proposed in the translation and validation of the questionnaires should be carefully reevaluated. The simplification of this methodology should be studied.

Adult↗

PubMed2000

Methodological issues in assisted suicide and euthanasia research.

A growing body of research has addressed various aspects of the assisted suicide debate. However, this literature is plagued by methodological shortcomings and limitations. This review describes the primary methodological issues and difficulties found in the existing suicide and euthanasia literature. The methodological issues discussed fall into several broad categories, including difficulties in operationalizing and measuring dependent variables, sampling constraints and biases, confounding influences on independent variables, and statistical considerations. These issues are discussed along with implications for the interpretation of the results reported. Where possible, potential solutions are offered, along with recommendations for future research.

Attitude to Death↗

PubMedDate not supplied

[Pharmacotherapeutic follow-up in hospitalised paediatric patients: adapting Dáder methodology].

OBJECTIVES: To adapt the DA inverted exclamation mark der methodology to identify and resolve drug related problems (DRP) in pediatric inpatients by disigning a normalized work procedure (NWP). To establish a pilot plan of pharmacotherapeutic follow-up to evaluate the NWP created. METHODS: The DA inverted exclamation mark der methodology is taken as a base adapting it to the characteristics and needs of pediatric inpatients and a NWP for their pharmacotherapeutic follow-up is created. A pilot plan consisting in a prospective longitudinal follow-up study is designed. The population and setting of the study are all the inpatients during one month in a room at the Municipal Childrenâs Hospital. RESULTS: The NWP is composed by the following steps: Previous phase: patient selection; follow-up phase: data compilation, information analysis (situation state, study phase, global evaluation), pharmaceutical intervention; results; clinical sessions; record documents. Pilot plan: 21 patients were studied; 71.4% of them presented at least 1 DRP during hospitalization period and 27 DRP were identified in all studied cases; 51.9% of DRP were effectiveness problems, 37.0% were related to safety and 11.1% to necessity; 55.6% of the health problems were resolved. CONCLUSIONS: The elaboration of the NWP allowed to adapt the DA inverted exclamation mark der methodology at the hospital setting. The pilot plan was very useful in carrying out the pharmacotherapeutic follow-up of pediatric inpatients thus showing the necessity of pharmacistâs participation in the health team to improve the quality of the inpatientâs pharmacologic treatments.

Adolescent↗

PubMed2003

[Development of an optimized formulation of damask marmalade with low energy level using Taguchi methodology].

The goal of this present study was the development of an optimized formula of damask marmalade low in calories applying Taguchi methodology to improve the quality of this product. The selection of this methodology lies on the fact that in real life conditions the result of an experiment frequently depends on the influence of several variables, therefore, one expedite way to solve this problem is utilizing factorial desings. The influence of acid, thickener, sweetener and aroma additives, as well as time of cooking, and possible interactions among some of them, were studied trying to get the best combination of these factors to optimize the sensorial quality of an experimental formulation of dietetic damask marmalade. An orthogonal array L8 (2(7)) was applied in this experience, as well as level average analysis was carried out according Taguchi methodology to determine the suitable working levels of the design factors previously choiced, to achieve a desirable product quality. A sensory trained panel was utilized to analyze the marmalade samples using a composite scoring test with a descriptive acuantitative scale ranging from 1 = Bad, 5 = Good. It was demonstrated that the design factors sugar/aspartame, pectin and damask aroma had a significant effect (p < 0.05) on the sensory quality of the marmalade with 82% of contribution on the response. The optimal combination result to be: citric acid 0.2%; pectin 1%; 30 g sugar/16 mg aspartame/100 g, damask aroma 0.5 ml/100 g, time of cooking 5 minutes. Regarding chemical composition, the most important results turned out to be the decrease in carbohydrate content compaired with traditional marmalade with a reduction of 56% in coloric value and also the amount of dietary fiber greater than similar commercial products. Assays of storage stability were carried out on marmalade samples submitted to different temperatures held in plastic bags of different density. Non percetible sensorial, microbiological and chemical changes were detected after 90 days of storage under controlled conditions.

Dietary Fiber↗

PubMed2003

Research methodology search filters: are they effective for locating research for evidence-based veterinary medicine in PubMed?

OBJECTIVE: The study examined the effectiveness of research methodology search filters developed by Haynes and colleagues and utilized by the Clinical Query feature of PubMed for locating literature for evidence-based veterinary medicine (EBVM). METHODS: A manual review of articles published in 6 commonly read veterinary journals was conducted. Articles were classified by format (original study, review, general article, conference report, decision analysis, and case report) and purpose category (etiology, prognosis, diagnosis, and treatment). Search strategies listed in PubMed's Clinical Query feature were then tested and compared to the manually reviewed data to calculate sensitivity, specificity, and precision. RESULTS: The author manually reviewed 914 articles to identify 702 original studies. Search #1 included terms determined to have the highest sensitivity and returned acceptable sensitivities over 75% for diagnosis and treatment. Search #2 included terms identified as providing the highest specificity and returned results with specificities over 75% for etiology, prognosis, and treatment. DISCUSSION: The low precision for each search prompts the question: Are research methodology search filters practical for locating literature for the practice of EBVM? A study examining terms related to appropriate research methodologies for advanced clinical veterinary research is necessary to develop filters designed to locate literature for EBVM.

Animals↗

PubMed2003

[Bayesian methodology: an alternative to regular medical practice].

The Bayes theorem provides a formula to calculate the probability of an event to occur conditioned by the occurrence of an anterior one (conditioned probability). In medicine it has been applied to calculate the probability of suffering a disease when having a positive result in a given test. This formula emphasizes the importance of prevalence of a disease (or a priori probability of the positive predictive value of a diagnostic test). The novelty of applying the bayesian methodology in clinical practice results from taking into consideration previous external information (or "a priori probability"), and to calculate how it is modified by the evidence (or "verisimilitude") provided by certain empirical tests, to obtain a new probability conditioned by the empirical evidence (or "a posteriori probability"). It also allows to perform sequential analysis (repeated observation of a given event a number of times not fixed in advance) and to incorporate the subjective probabilities to the reasoning. Some authors have proposed the use of bayesian methodology in research studies, such as clinical trials. Nevertheless, this methodology does not adapt well to this kind of reasoning which is hypothetical-deductive.

Bayes Theorem↗

PubMed2003

Stated preference methods in health care evaluation: an emerging methodological paradigm in health economics.

One focus of health economics is the trade-off between limited resources and the (health) needs of a community. Cost-effectiveness analysis (CEA), while being one of the most accepted evaluation methodologies in health economics, does not account for many important costs and benefits of health care interventions. Some health economists have attempted to modify CEA to account for these deficiencies, while others have been working on alternative methodologies. One group of alternative methodologies can be described as stated preference techniques. These aim to measure both health and non-health outcomes (ie costs and benefits), and include qualitative analysis, conjoint analysis (often referred to as discrete choice analysis/modelling) and willingness to pay (or contingent valuation). This paper provides an overview of stated preference techniques in health economics, with particular focus on their strengths as compared with traditional evaluation methods in health care. The limitations and policy implications of these methods are also discussed.

Attitude to Health↗

PubMed2004

Methodological appraisal of guidelines. The AGREE instrument.

The increasingly important role of clinical practice guidelines as a support tool for clinical decision-making is shown by a growing number of publications in the literature. In fact, it is almost impossible to open a medical journal without coming across one or more guidelines on various subjects. Guidelines serve several objectives: 1) improvement in health care (increasing good and decreasing bad practices); 2) greater availability of and access to medical knowledge; and 3) promotion of cost-effective strategies. The recommended methodology for guideline design and development requires that the recommendations should be evidence-based, i.e., based on selected and critically appraised data, with the final inclusion of evidence that is valid, important and applicable, based on explicit pre-defined criteria. The methodological quality of guidelines varies substantially, raising credibility issues, with subsequent lack of results (in terms of changing medical practice). This has given rise to a series of recent publications on methodological rules for the design and writing of guidelines. This paper presents the first international instrument that can be used as a quality assurance tool for evidence-based clinical guidelines: the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.

Cardiology↗

PubMed2004

Methodology of the youth risk behavior surveillance system.

CDC developed the Youth Risk Behavior Surveillance System (YRBSS) to monitor six categories of priority health-risk behaviors among youth--behaviors that contribute to unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including human immunodeficiency virus (HIV) infection; unhealthy dietary behaviors; and physical inactivity--plus overweight. These risk behaviors contribute markedly to the leading causes of death, disability, and social problems among youth and adults in the United States. YRBSS includes a national school-based survey conducted by CDC as well as state, territorial, and local school-based surveys conducted by education and health agencies. In these surveys, conducted biennially since 1991, representative samples of students in grades 9--12 are drawn. In 2003, a total of 15,214 students completed the national survey, and 32 states and 20 school districts also obtained data representative of their jurisdiction. Although multiple publications have described certain methodologic features of YRBSS, no report has included a comprehensive description of the system and its methodology. This report describes the background and rationale for YRBSS and includes a detailed description of the methodologic features of the system, including its questionnaire; operational procedures; sampling, weighting, and response rates; data-collection protocols; data-processing procedures; reports and publications; and data quality. YRBSS is evolving to meet the needs of CDC and other users of the data.

Adolescent↗

PubMed2004

Computer assisted telephone interviewing (CATI) for health surveys in public health surveillance: methodological issues and challenges ahead.

This article describes methodological issues, challenges, and a vision for using computer assisted telephone interviewing (CATI) in a comprehensive public health surveillance system in the 21st century. Methodological issues include funding of surveys, survey frequency, sample size considerations, response rates, and types of bias to be considered in questionnaire design. Challenges include the recognition of the merits and limitations of CATI, and the potential for greater use in surveillance of public health issues in health regions requiring rapid and regular data. The vision of a CATI survey-based, rapid, flexible, cost-effective public health surveillance system is described. It is concluded that further discussion and views on improvements with regard to CATI methodological and practical issues will help build a better CATI survey-based public health surveillance system for the future.

Canada↗

PubMed2004

[Pharmaceutical care program in HIV patients under antiretroviral treatment: methodology and documentation].

Most hospital pharmacy services in Spain have increased pharmaceutical care activities for HIV-patients under antiretroviral therapy during last years. So, it is necessary the establishment of work methods to secure the best quality of care. The pharmacy service of the general hospital of Castellón has developed a global pharmaceutical care program for these patients characterized by the systematic and individualized strategy or basic pharmaceutical care record which can be completed with additional proceedings. The basic record includes complete drug therapy registry, clinical evolution data and detection of drug related problems (DRP), evaluation and promotion of patient adherence, individualized counselling and nutritional evaluation. Additional proceedings include exhaustive DRP monitoring, additional patient adherence to treatments measurements, SOAP methodology, quality of life and perceived patient satisfaction. Our purpose integrate patient status with pharmaceutical care provided and the expected or obtained outcomes, either clinical or economic as well as activity outcomes, quality of life and satisfaction related results. The main characteristics of the purposed methodology are: clinical orientation, it permits the registry and the establishment of a systematic work methodology, is designed as a cross structure and variables are coded. According to our experience, our model can be considered useful in clinical practice and could be applied in different hospital outpatient units.

Anti-Retroviral Agents↗

PubMed2004

A nitrate biosensor based methodology for monitoring anoxic activated sludge activity.

An improved methodology based on a nitrate biosensor is developed and applied successfully for in-depth monitoring and study of anoxic activated sludge activities. The major advantages of the methodology are its simplicity, reliability and high data quality. The resulting data allowed for the first time to monitor anoxic respiration rate of activated sludge (nitrate uptake rate (NUR)) at a high time resolution making it clearly comparable with high frequency oxygen uptake rate (OUR) measurements obtained under aerobic conditions. Further, the anoxic respiration data resulting from a pulse addition of carbon source to endogenously respiring anoxic activated sludge shows a clear start-up phenomenon and storage tail that is usually also observed in high-frequency OUR measurements. Finally, the improved methodology can be expected to serve as an anoxic respirometer for activated sludge treatment plants where denitrification process occurs in single-step. Further, it can be used for a variety of purposes e.g. for toxicity and activity monitoring, process control and parameter estimation of the activated sludge process, similar to the aerobic respirometers.

Bioreactors↗

PubMed2005

Statistical methodology of the National Immunization Survey, 1994-2002.

OBJECTIVES: Since 1994 the National Immunization Survey (NIS) has monitored progress toward the Healthy People 2000 and 2010 vaccination goals. The NIS collects data in two phases: first, a random-digit-dialing (RDD) telephone survey to identify households with children 19-35 months old and, second, a mail survey to vaccination providers to obtain vaccination histories used to estimate vaccination coverage rates. This report reviews the methodologies used in the 1994-2002 NIS to obtain official estimates of vaccination coverage and describes the methodology used for the first three topical modules of the NIS. METHODS: From 1994 to 1997 the NIS used a variation of a two-phase estimator to compensate for missing provider-reported vaccination histories. Between 1998 and 2001 a weighting-class estimator was used. In 2002 and thereafter the weighting-class approach was refined to account for households that do not have telephones and for unvaccinated children. To collect data on immunization-related topics, the NIS sample was randomized among three topical modules: health insurance and ability to pay for vaccinations (HIM); parental knowledge and experiences about vaccinations (PKM); and daycare attendance, breastfeeding practices, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (DCM). RESULTS: In 2001 among children with completed RDD interviews, 0.3 percent were entirely unvaccinated. Together, the new nontelephone adjustment and the refinement for unvaccinated children yielded revised estimates that were within 1.5 percentage points of the original estimates obtained using the 1998-2001 methodology. Over the six quarters during which the first three topical modules were fielded (from mid-2001 through 2002), 21,163 children were randomized to the HIM, 3576 to the PKM, and 3511 to the DCM.

Adolescent↗

PubMed2005

A benchmark methodology for managing uncertainties in urban runoff quality models.

In this paper we present a benchmarking methodology, which aims at comparing urban runoff quality models, based on the Bayesian theory. After choosing the different configurations of models to be tested, this methodology uses the Metropolis algorithm, a general MCMC sampling method, to estimate the posterior distributions of the models' parameters. The analysis of these posterior distributions allows a quantitative assessment of the parameters' uncertainties and their interaction structure, and provides information about the sensitivity of the probability distribution of the model output to parameters. The effectiveness and efficiency of this methodology are illustrated in the context of 4 configurations of pollutants' accumulation/erosion models, tested on 4 street subcatchments. Calibration results demonstrate that the Metropolis algorithm produces reliable inferences of parameters thus, helping on the improvement of the mathematical concept of model equations.

Algorithms↗

PubMed2005

A successful trial utilizing the Leuzinger-Bohleber methodology for evaluation of psychoanalytic treatment: preliminary report.

Utilizing audio-recorded psychoanalytic interviews of both patients and their analysts, group discussions of these interviews, and the application of questionnaires commonly used in psychotherapy research, the authors investigate the potential use of the Leuzinger-Bohleber methodology as an objective evaluative instrument to assess the quality of psychoanalytic treatment. Preliminary study results were obtained through interviews conducted with seven analysts and their respective patients, three of whom were treated with psychoanalysis (three or more sessions per week, for a duration of no less than one year) and four with psychotherapy (one or two sessions per week, for a duration of no less than one year). Patients were found to be eager to participate, and no adverse experiences were reported by analysts, patients or the research team. In addition to the interviews, further data were obtained through review of mailed-in questionnaires completed by 21 patients. The authors present both preliminary observations regarding the methodology as a whole, as well as the detailed results of one specific case subject treated with psychotherapy. Review of study findings supports the utilization of this methodology as an evaluative instrument which may ultimately advance current knowledge of the process and outcome of psychoanalytic treatment.

Female↗