An interactive intervention to impact adherence to antiretroviral treatment among treatment-naive HIV-infected adults in Thailand: A pilot randomized controlled study

Background. Consistent adherence to antiretroviral treatment is necessary for a treatment success. Improving and maintaining adherence rate >95% are challenging for health care professionals. This pilot randomized controlled study aimed to evaluate the impact of the interactive intervention on adherence to GPO-VIR, to describe the feasibility of the interactive intervention in Thailand, and to illustrate the adherence self-efficacy concept among HIV treatment-naïve patients in Thailand who were starting antiretroviral treatment. ^ Methods. The study took place at three HIV clinics located in Phayao, Thailand. Twenty-three patients were randomly assigned into the experimental (n=11) and the control groups (n=12). Each participant in the experimental group and a significant person to the patient received 5 educational sessions with a nurse at the clinics and at their homes. They also received 3 follow-up evaluations during the 6-month period of the study. The participants in the control group received the standard of care provided by HIV clinical personnel plus three follow-up evaluations at the clinic. ^ Results. Seventeen patients (7 in the experimental and 10 in the control group) completed the study. The 4-day recall on the Thai ACTG Adherence Scale demonstrated adherence rate >95% for most participants from both groups. After the first measurement, no experimental group patients reporting missing ART, while one control group participant continuously skipped ART. Participants from both groups had significantly increased CD4 cell counts after the study (F(1, 15) = 29.30, p = .000), but no differences were found between two groups (F(1, 15) = .001, p = .98). Examination of the intervention showed limitations and possibilities to implement it in Thailand. Qualitative data demonstrated self-efficacy expectations, resignation and acceptance as related concepts to improve adherence outcomes. ^ Conclusions. This interactive intervention, after appropriate modifications, is feasible to apply for Thai HIV-treatment naïve patients. Because of limitations the study could not demonstrate whether the interactive intervention improved adherence to ART among HIV-treatment naïve in Thailand. A longitudinal study in a larger sample would be required to test the impact of the intervention. ^ Keyword: antiretroviral treatment, adherence, treatment-naïve, Thailand, randomized controlled study ^

Methodologies for Impact Assessment in the Ex Ante Evaluation of European Rural Development Programmes.

The ex ante quantification of impactsis compulsory when establishing a Rural Development Program (RDP) in the European Union. Thus, the purpose of this paper is to learn how to perform it better. In order to this all of the European 2007-2013 RDPs (a total of 88) and all of their corresponding available ex ante evaluations were analyzed.Results show that less than 50% of all RDPs quantify all the impact indicators and that the most used methodology that allows the quantification of all impact indicators is Input-Output. There are two main difficulties cited for not accomplishing the impact quantification: the heterogeneity of actors and factors involved in the program impacts and the lack of needed information.These difficulties should be addressedby usingnew methods that allow approaching the complexity of the programs and by implementing a better planning that facilitatesgathering the needed information.

Environmental impact indicators estimation in European rural devlopment programs. Limitations of evaluators and financial institutions? Expectatios

The European Commission established Mid-term evaluation for the period 2007-2013 on Rural Development Programs as part of a continuous evaluation system. Mid-term evaluations are important for the Commission because they help measuring the success of a program, as well as giving advice and pointing out good practices for the current and consecutive programming periods. One of the main elements used to achieve these objectives is the impact indicators estimation of the program. This paper will focus on how impact indicators estimation is done for just the environmental indicators. To do this the 88 Mid-term evaluations of Rural Development Programs for 2007-2013 period, were analyzed. This study shows how far the actual methodologies to obtain impact indicators? values are from what the European Commission expects when demanding this task to be done.

Perceptions Surrounding the Implementation of Colorado Senate Bill 10-191's New Teacher Evaluations

In 2013, many public education reform efforts in the United States of America center on testing and accountability. Recent data revealed that teachers have the single greatest in-school impact on student learning; however, the methods to assess teacher effectiveness are widely criticized for not holding teachers accountable and, consequently, are experiencing significant legislative attention. In 2010, Colorado passed Senate Bill 10-191: The Great Teachers and Leaders Act to improve student learning by revising teacher and principal evaluations, including linking them to student learning data, and eradicating tenure. Teachers, administrators, and policymakers hold critical roles in the implementation of this bill, yet little is known about how members of each group perceive their respective roles in the implementation. This explanatory sequential mixed methods study was designed to gather perception data from these three groups, through surveys and interviews. Data revealed that teachers and administrators do not have similar perceptions of many matters related to teacher evaluations, education reform, and the implementation of Senate Bill 10-191 (SB 191). The data also revealed that teachers and administrators expected they would agree on these matters. These collective findings led to multiple recommendations, such as the need for increased dialogue between teachers and administrators about their own perceptions of education reforms.

General methods for remedial operations performance evaluations.

Mode of access: Internet.

Ex ante evaluations of alternate data structures for end user queries: Theory and experimental test

The data structure of an information system can significantly impact the ability of end users to efficiently and effectively retrieve the information they need. This research develops a methodology for evaluating, ex ante, the relative desirability of alternative data structures for end user queries. This research theorizes that the data structure that yields the lowest weighted average complexity for a representative sample of information requests is the most desirable data structure for end user queries. The theory was tested in an experiment that compared queries from two different relational database schemas. As theorized, end users querying the data structure associated with the less complex queries performed better Complexity was measured using three different Halstead metrics. Each of the three metrics provided excellent predictions of end user performance. This research supplies strong evidence that organizations can use complexity metrics to evaluate, ex ante, the desirability of alternate data structures. Organizations can use these evaluations to enhance the efficient and effective retrieval of information by creating data structures that minimize end user query complexity.

The effect of service evaluations on behavioral intentions and quality of life

Understanding the contribution of marketing to economic and social outcomes is fundamental to broadening the focus of marketing. The authors develop a comprehensive model that integrates the impact of service quality and service satisfaction on both economic and societal outcomes. The model is validated using two random samples involving intensive health services. The results indicate that service quality and service satisfaction significantly enhance quality of life and behavioral intentions, highlighting that customer service has social as well as economic outcomes. This is an important finding given the movement toward recognizing social and environmental outcomes, such as emphasized through triple bottom-line reporting. The findings have important implications for managing service processes, for improving the quality of life of customers, and for enhancing customers' behavioral intentions toward the organization.

A comparison of the impact of avoidance cues in hazard avoidance during evaluation of text entry

The research presented in this paper is part of an ongoing investigation into how best to support meaningful lab-based evaluations of mobile technologies. In our previous work, we developed a hazard avoidance system for use during lab evaluations [1]; in the work reported here, we further assess the impact of this system, specifically in terms of the effect of avoidance cue type on speech-based text entry tasks.

An evaluation of the impact upon productivity of ending resale price maintenance on books

Report prepared for the OFT by the Centre for Competition Policy at University of East Anglia. An examination of the ending of RPM aims to improve understanding of how competition interventions affect productivity, provide a methodological framework that could inform future evaluations and provide inputs to the ongoing debate about the effects of RPM.

A comparison of the impact of avoidance cues in hazard avoidance during evaluation of text entry

The research presented in this paper is part of an ongoing investigation into how best to support meaningful lab-based evaluations of mobile technologies. In our previous work, we developed a hazard avoidance system for use during lab evaluations [1]; in the work reported here, we further assess the impact of this system, specifically in terms of the effect of avoidance cue type on speech-based text entry tasks.

Program evaluation primer: A review of three evaluations

Program evaluation—a “tool used to assess the implementation and outcomes of a program, to increase a program’s efficiency and impact over time, and to demonstrate accountability” (MacDonald et. al, 2001, p. 1)—is an essential process to program assessment and improvement. This paper overviews three published program evaluations and considers important aspects of program evaluation more broadly.

The Impact of Student Response Systems on the Learning Experience of Undergraduate Psychology Students

Student response systems (SRS) are hand-held devices or mobile phone polling systems which collate real-time, individual responses to on-screen questions. Previous research examining their role in higher education has highlighted both advantages and disadvantages of their use. This paper explores how different SRS influence the learning experience of psychology students across different levels of their programme. Across two studies, first year students’ experience of using Turningpoint clickers and second year students’ experience of using Poll Everywhere was investigated. Evaluations of both studies revealed that SRS has a number of positive impacts on learning, including enhanced engagement, active learning, peer interaction, and formative feedback. Technical and practical issues emerged as consistent barriers to the use of SRS. Discussion of these findings and the authors’ collective experiences of these technologies are used to provide insight into the way in which SRS can be effectively integrated within undergraduate psychology programmes.

Nutritional status and its impact on time and relocation in postoperative complications of abdominal patients undergoing surgery

Introduction: The nutritional state is the independent factor that most influences the post-operational results in elective surgeries. Objective: to evaluate the influence of the nutritional state on the hospitalization period and on the post-operative complications of patients submitted to abdominal surgery. Methods: prospective study with 99 surgical patients over 18 years of age, submitted to abdominal surgeries in the period from April to October of 2013, in the Instituto de Medicina Integral Professor Fernando Figueira (IMIP). All patients were submitted to anthropometric nutritional evaluations through the body mass Index (BMI), arm circumference (AC) and triceps skinfold thickness (TEST). The biochemical evaluation was carried out from the leukogram and serum albumin results. The identification of candidate patients to nutritional therapy (NT) was carried out through the nutritional risk (NR) evaluation by using the BMI, loss of weight and hypoalbuminemia. The information about post-operational complications, hospitalization period and clinical diagnosis was collected from the medical records. Program SPSS version 13.0 and significance level of 5% were used for the statistical analysis. Results: The malnutrition diagnosed by the AC showed significant positive association with the presence of post-operative complications (p=0.02) and with hospitalization period (p=0.02). The presence of NR was greater when evaluated by hypoalbuminemia (28.9%), however, only 4% of the sample carried out the NT in the pre-operational period. The hospitalization period was greater for patients with malignant neoplasia (p<0.01). Conclusion: The malnutrition diagnosis of patients submitted to abdominal surgeries is associated to greater risk of post-operational complications and longer hospitalization permanence.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Impact of salt reduction on biogenic amines, fatty acids, microbiota, texture and sensory profile in traditional blood dry-cured sausages

Meat industry needs to reduce salt in their products due to health issues. The present study evaluated the effect of salt reduction from 6% to 3% in two Portuguese traditional blood dry-cured sausages. Physicochemical and microbiological parameters, biogenic amines, fatty acids and texture profiles and sensory panel evaluations were considered. Differences due to salt reduction were perceptible in a faint decline of water activity, which slightly favoured microbial growth. Total biogenic amines content ranged from 88.86 to 796.68 mg kg 1 fresh matter, with higher amounts, particularly of cadaverine, histamine and tyramine, in low-salt products. Still, histamine and other vasoactive amines remained at low levels, thus not affecting consumers’ health. Regarding fatty acids, no significant differences were observed due to salt. However, texture profile analysis revealed lower resilience and cohesiveness in low-salt products, although no textural changes were observed by the sensory panel. Nevertheless, low-salt sausages were clearly preferred by panellists.