123 resultados para Quality Evaluation
Resumo:
Aim:
Methods:
A draft was generated using a standardized forward and back translation protocol with independent translators and consensus meetings. Pilot testing included cognitive interviews (n = 12) resulting in question refinements. To explore psychometric properties, 250 participants aged between 40 and 64 years (retest = 116) completed the Japanese version of the heiQ (heiQ-J) and comparator scales, mental health and vitality scales of the Medical Outcomes Study 36 item Short-Form Health Survey, Sense Of Coherence scale, and Social Support Measurement scale.
Results:
Cognitive interviews revealed that the translation was understood as intended by participants. Internal consistency (α) was good to very good for all scales (0.70–0.88) and test–retest intraclass correlation coefficients were high (≥0.83). Concurrent validity was supported by high correlation with like scales and weak correlation with dissimilar scales.
Conclusion:
The translated and adapted heiQ-J has good face and concurrent validity and is reliable. The heiQ-J is likely to be a useful measure of the quality and impact of the SHC and return valuable data to clinicians and commissioners of health education in Japan.
Resumo:
Objectives:
Methods:
Based on a systematic review on self-management programs, effect sizes derived from reported outcome measures are categorized according to the quality of life appraisal model developed by Schwartz and Rapkin which classifies outcomes from performance-based measures (e.g., clinical outcomes) to evaluation-based measures (e.g., emotional well-being).
Results:
The majority of outcomes assessed in self-management trials are based on evaluation-based methods. Overall, effects on knowledge—the only performance-based measure observed in selected trials—are generally medium to large. In contrast, substantially more inconsistent results are found for both perception- and evaluation-based measures that mostly range between nil and small positive effects.
Conclusions:
Effectiveness of self-management interventions and resulting recommendations for health policy makers are most frequently derived from highly variable evaluation-based measures, that is, types of outcomes that potentially carry a substantial amount of measurement error and/or bias such as response shift. Therefore, decisions regarding the value and efficacy of chronic disease self-management programs need to be interpreted with care. More research, especially qualitative studies, is needed to unravel cognitive processes and the role of response shift bias in the measurement of change.
Resumo:
Background Cost of illness studies show that Parkinson disease (PD) is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries.
Methods This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT). It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group.
Conclusion This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD.
Resumo:
The paper presents the findings of the first year of a nationally funded Australian Learning and Teaching Council (ALTC) project on the quality management of online learning environments by and through distributed leadership. The project is being undertaken by five Australian universities with major commitments to online and distance education. Each university, however, has a distinctive location, history and profile in the sector. The first year of the project has seen the development of a quality management framework with six interrelated elements. The framework is being applied, refined and validated in the second year of the project. Allied with the development of the framework, was the conduct of focus groups at each of the five partner institutions in the middle of the first year. These focus groups composed a range of staff involved collectively in the leadership of the organisation's online learning environment. Prominence was given to the nature and value of strategic planning, due diligence conducted in selecting and mainstreaming technologies, evaluation approaches informing decision making, and the various relationships between different leadership levels and domains. A number of key issues which emerged relating to the elements identified in the framework are examined.
Resumo:
OBJECTIVE:
To determine whether improvements in glycemic control and diabetes-specific quality of life (QoL) scores reported in research studies for the type 1 diabetes structured education program Dose Adjustment For Normal Eating (DAFNE) are also found when the intervention is delivered within routine U.K. health care.
RESEARCH DESIGN AND METHODS:
Before and after evaluation of DAFNE to assess impact on glycemic control and QoL among 262 adults with type 1 diabetes.
RESULTS:
There were significant improvements in HbA1c from baseline to 6 and 12 months (from 9.1 to 8.6 and 8.8%, respectively) in a subgroup with suboptimal control. QoL was significantly improved by 3 months and maintained at both follow-up points.
CONCLUSIONS:
Longer-term improved glycemic control and QoL is achievable among adults with type 1 diabetes through delivery of structured education in routine care, albeit with smaller effect sizes than reported in trials.
Resumo:
Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency threshold on the Cognitive Therapy Scale whilst the control group remained below. Conclusions Social workers can attain significant improvements in competency in delivering cognitive behavioural strategies from undertaking brief face to face training. This is relevant in the context of health reforms that involve social worker delivery of evidence based psychological care. Further research is required to assess how these improvements in competence translate into performance in practice and clinical outcomes for patients.
Resumo:
Background
Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.
Methods
This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.
Results
We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).
Conclusions
Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation.
Resumo:
Objectives:
To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation setting versus an alternative setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes.
Data Sources:
Electronic databases from the earliest possible date until May 2011. All languages were included.
Study Selection
Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation with an alternative. There were 29 included trials with 6746 participants.
Data Extraction
Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation.
Data Synthesis:
Results were synthesized using standardized mean differences (SMDs) and meta-analyses for the primary outcome of cost. The Grading of Recommendations Assessment, Development, and Evaluation was applied to assess for risk of bias across studies for meta-analyses. There was high-quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke (pooled SMD [δ]=−.28; 95% confidence interval [CI], −.47 to −.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients poststroke (δ=.31; 95% CI, .15–.48), with improvement to patient outcomes. These results were not replicated in 2 individual trials with a geriatric and a mixed cohort, where costs did not differ between general acute care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of a stroke or orthopedic population, reported less cost for an intensive inpatient rehabilitation program compared with usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses.
Conclusions:
Based on this systematic review and meta-analyses, a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients, inpatient rehabilitation may be the most cost-effective method of providing rehabilitation; yet, for other patients, rehabilitation in the home or community may be the most cost-effective model of care. To achieve cost-effective outcomes, the ideal combination of rehabilitation services and patient inclusion criteria, as well as further data for nonstroke populations, warrants further research.
Resumo:
This paper examines and analyzes different aggregation algorithms to improve accuracy of forecasts obtained using neural network (NN) ensembles. These algorithms include equal-weights combination of Best NN models, combination of trimmed forecasts, and Bayesian Model Averaging (BMA). The predictive performance of these algorithms are evaluated using Australian electricity demand data. The output of the aggregation algorithms of NN ensembles are compared with a Naive approach. Mean absolute percentage error is applied as the performance index for assessing the quality of aggregated forecasts. Through comprehensive simulations, it is found that the aggregation algorithms can significantly improve the forecasting accuracies. The BMA algorithm also demonstrates the best performance amongst aggregation algorithms investigated in this study.
Resumo:
Background:
Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses require quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based research is available to guide teachers.
Objectives:
To develop, implement and evaluate an evidence-based teaching and learning approach in cross-cultural care and antidiscrimination for undergraduate nursing students.
Design:
A quantitative design using pre- and post-survey measures was used to evaluate the teaching and learning approach.
Settings:
The Bachelor of Nursing program in an Australian university.
Participants:
Academics and second year undergraduate nursing students.
Methods:
A literature review and consultation with academics informed the development of the teaching and learning approach. Thirty-three students completed a survey at pre-measures and following participation in the teaching and learning approach at post-measures about their confidence to practice cross-cultural nursing (Transcultural Self-efficacy Tool) and about their discriminatory attitudes (Quick Discrimination Index).
Results:
The literature review found that educational approaches that solely focus on culture might not be sufficient in addressing discrimination and racism. During consultation, academics emphasised the importance of situating cross-cultural nursing and antidiscrimination as social determinants of health. Therefore, cross-cultural nursing was contextualised within primary health care and emphasised care for culturally diverse communities. Survey findings supported the effectiveness of this strategy in promoting students' confidence regarding knowledge about cross-cultural nursing. There was no reported change in discriminatory attitudes. The teaching and learning approach was modified to include stronger experiential learning and role playing.
Conclusions:
Nursing education should emphasise cross-cultural nursing and antidiscrimination. The study describes an evaluated teaching and learning approach and demonstrates how evaluation research can be used to develop cross-cultural nursing education interventions.
Resumo:
We consider the problem of matching a face in a low resolution query video sequence against a set of higher quality gallery sequences. This problem is of interest in many applications, such as law enforcement. Our main contribution is an extension of the recently proposed Generic Shape-Illumination Manifold (gSIM) framework. Specifically, (i) we show how super-resolution across pose and scale can be achieved implicitly, by off-line learning of subsampling artefacts; (ii) we use this result to propose an extension to the statistical model of the gSIM by compounding it with a hierarchy of subsampling models at multiple scales; and (iii) we describe an extensive empirical evaluation of the method on over 1300 video sequences – we first measure the degradation in performance of the original gSIM algorithm as query sequence resolution is decreased and then show that the proposed extension produces an error reduction in the mean recognition rate of over 50%.
Resumo:
Initiatives to promote children’s nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial has assessed intervention impact using this approach. This research aimed to assess the effect on young children’s dietary patterns of a healthy eating and physical activity intervention. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a health promotion cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-hour recalls post-intervention, at approximately 18 months of age. An Obesity Protective Dietary Index was created, and dietary patterns were also assessed by principal components analysis. These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored significantly higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the Obesity Protective Dietary Index (scores out of 30, p=0.01). Three dietary patterns were identified by principal components analysis, however, scores were not significantly different between intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and in the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets, and the need for further research in this area.
Resumo:
Online learning environments (OLEs) are complex information technology (IT) systems that intersect with many areas of university organisation. Distributed models of leadership have been proposed as appropriate for the good governance of OLEs. Based on theoretical and empirical research, a group of Australian universities proposed a framework for the quality management of OLEs, and sought to validate the model via a survey of Australasian university representatives with OLE leadership responsibility. For the framework elements: Planning and Resourcing were rated most important; Organisational structure was rated least important; Technologies were rated low in importance and high in satisfaction; Resourcing and Evaluation were rated low in satisfaction; and Resourcing had the highest rating of importance coupled with low satisfaction. Considering distributed leadership in their institution, respondents reported that the organisational alignments represented by 'official' reporting and peer relationships were significantly more important and more effective than the organisational alignments linking the formal and informal leaders. From a range of desirable characteristics of distributed leadership, 'continuity and sustainability' received the highest rating of importance and a low rating of 'in evidence' - there are concerns about the sustainability of distributed leadership for the governance of OLEs in universities.
Resumo:
Purpose - This paper evaluates the main elements of building performance namely building function, building impact and building quality in order to promote strategic facilities management in healthcare organisation to improve core (health) business activities. Design/methodology/approach - Based on current available toolkits, a questionnaire is issued to healthcare users (staff) in a public hospital about their level of agreement in relation to these elements. Statistical analysis is conducted to regroup the elements. These regrouped elements and their inter relationships are used to develop a framework for measuring building performance in healthcare buildings. Findings - The analysis helped to clarify the understanding and agreement of users in Australian healthcare organisation with regards to building performance. Based on the survey results, 11 new elements were regrouped into three groups. These new regrouped elements will be used to develop a reliable framework for measuring performance of Australian healthcare buildings. Originality/value - Currently there is no building performance toolkit available for Australian healthcare organisation. The framework developed in this paper will help healthcare organisations with a reliable performance tool for their buildings and this will promote strategic facilities management.