An official American thoracic society research statement: Comparative effectiveness research in pulmonary, critical care, and sleep medicine

Background: Comparative effectiveness research (CER) is intended to inform decision making in clinical practice, and is central to patientcentered outcomes research (PCOR). Purpose: To summarize key aspects of CER definitions and provide examples highlighting the complementary nature of efficacy and CER studies in pulmonary, critical care, and sleep medicine. Methods: An ad hoc working group of the American Thoracic Society with experience in clinical trials, health services research, quality improvement, and behavioral sciences in pulmonary, critical care, and sleepmedicinewas convened. The group used an iterative consensus process, including a reviewbyAmerican Thoracic Society committees and assemblies. Results: The traditional efficacy paradigm relies on clinical trials with high internal validity to evaluate interventions in narrowly defined populations and in research settings. Efficacy studies address the question, "Can it work in optimal conditions?" The CER paradigm employs a wide range of study designs to understand the effects of interventions in clinical settings. CER studies address the question, "Does it work in practice?" The results of efficacy and CER studies may or may not agree. CER incorporates many attributes of outcomes research and health services research, while placing greater emphasis on meeting the expressed needs of nonresearcher stakeholders (e.g., patients, clinicians, and others). Conclusions: CER complements traditional efficacy research by placing greater emphasis on the effects of interventions in practice, and developing evidence to address the needs of the many stakeholders involved in health care decisions. Stakeholder engagement is an important component of CER. Copyright © 2013 by the American Thoracic Society.

Feasibility study of a single-blind randomised controlled trial of an occupational therapy intervention.

BACKGROUND Several factors facilitate or hinder efficacy research in occupational therapy. Strategies are needed, therefore, to support the successful implementation of trials. AIM To assess the feasibility of conducting a randomised controlled trial (RCT). The main feasibility objectives of this study were to assess the process, resources, management, and scientific basis of a trial RCT. MATERIAL AND METHODS A total of 10 occupational therapists, between the ages of 30 and 55 (M 43.4; SD 8.3) with seven to 26 years' (M 14.3; SD 6.1) experience, participated in this study. Qualitative data collected included minutes of meetings, reports, and field notes. The data were analysed based on the principles of content analysis, using feasibility objectives as the main categories. RESULTS Data analysis revealed strengths in relation to retention and inclusion criteria of participants, the study protocol, study organisation, and the competence of researchers. Weaknesses were found related to recruitment, randomisation, data collection, time for training and communication, commitment, and design. CONCLUSION The findings indicated that there are several factors which had a considerable impact on the implementation of an RCT in practice. However, it was useful to assess methods and procedures of the trial RCT as a basis to refine research plans.

Efficacy of a cognitive and behavioural psychotherapy applied by primary care psychologists in patients with mixed anxiety-depressive disorder: a research protocol

Background: In contrast with the recommendations of clinical practice guidelines, the most common treatment for anxiety and depressive disorders in primary care is pharmacological. The aim of this study is to assess the efficacy of a cognitive-behavioural psychological intervention, delivered by primary care psychologists in patients with mixed anxiety-depressive disorder compared to usual care. Methods/Design: This is an open-label, multicentre, randomized, and controlled study with two parallel groups. A random sample of 246 patients will be recruited with mild-to-moderate mixed anxiety-depressive disorder, from the target population on the lists of 41 primary care doctors. Patients will be randomly assigned to the intervention group, who will receive standardised cognitive-behavioural therapy delivered by psychologists together with usual care, or to a control group, who will receive usual care alone. The cognitive-behavioural therapy intervention is composed of eight individual 60-minute face-to face sessions conducted in eight consecutive weeks. A follow-up session will be conducted over the telephone, for reinforcement or referral as appropriate, 6 months after the intervention, as required. The primary outcome variable will be the change in scores on the Short Form-36 General Health Survey. We will also measure the change in the frequency and intensity of anxiety symptoms (State-Trait Anxiety Inventory) and depression (Beck Depression Inventory) at baseline, and 3, 6 and 12 months later. Additionally, we will collect information on the use of drugs and health care services. Discussion: The aim of this study is to assess the efficacy of a primary care-based cognitive-behavioural psychological intervention in patients with mixed anxiety-depressive disorder. The international scientific evidence has demonstrated the need for psychologists in primary care. However, given the differences between health policies and health services, it is important to test the effect of these psychological interventions in our geographical setting.

Middle years teacher education : new programs and research directions

Teacher education programs focussing on the development of specialist teachers for 'the middle years' have proliferated in Australian universities in recent years. This paper provides some insights into middle years' teacher education programs at the University of Queensland, Edith Cowan and Flinders Universities with regard to their: philosophical underpinnings; specific educational context; scope and nature of the program. In addition, some of the research directions and efficacy strategies utilised in conjunction with the programs will be shared, along with some early findings from a longitudinal study in one of the programs. We propose that the pattern of programmatic growth heralds a new time for teacher education, and we speculate about the production of new kinds of teacher identities as graduates take their place in the profession.

The efficacy of waste management plans in Australian commercial construction refurbishment projects

Renovation and refurbishment of the existing commercial building stock is a growing area of total construction activity and a significant generator of waste sent to landfill in Australia. A written waste management plan (WMP) is a widespread regulatory requirement for commercial office redevelopment projects. There is little evidence, however, that WMPs actually increase the quantity of waste that is ultimately diverted from landfill. Some reports indicate an absence of any formal verification or monitoring process by regulators to assess the efficacy of the plans. In order to gauge the extent of the problem a survey was conducted of twenty four consultants and practitioners involved in commercial office building refurbishment projects to determine the state of current practice with regard to WMPs and to elicit suggestions with regard to ways of making the process more effective. Considerable variation in commitment to recycling policies was encountered indicating a need to revisit waste minimisation practices if the environmental performance of refurbishment projects is to be improved.

Response efficacy : the key to minimizing rejection and maximizing acceptance of emotion-based anti-speeding messages

This study sought to improve understanding of the persuasive process of emotion-based appeals not only in relation to negative, fear-based appeals but also for appeals based upon positive emotions. In particular, the study investigated whether response efficacy, as a cognitive construct, mediated outcome measures of message effectiveness in terms of both acceptance and rejection of negative and positive emotion-based messages. Licensed drivers (N = 406) participated via the completion of an on-line survey. Within the survey, participants received either a negative (fear-based) appeal or one of the two possible positive appeals (pride or humor-based). Overall, the study's findings confirmed the importance of emotional and cognitive components of persuasive health messages and identified response efficacy as a key cognitive construct influencing the effectiveness of not only fear-based messages but also positive emotion-based messages. Interestingly, however, the results suggested that response efficacy's influence on message effectiveness may differ for positive and negative emotion-based appeals such that significant indirect (and mediational) effects were found with both acceptance and rejection of the positive appeals yet only with rejection of the fear-based appeal. As such, the study's findings provide an important extension to extant literature and may inform future advertising message design.

Development of self-efficacy and expectancy measures for benzodiazepines

This study aimed to develop and assess the reliability and validity of a pair of self-report questionnaires to measure self-efficacy and expectancy associated with benzodiazepine use, the Benzodiazepine Refusal Self- Efficacy Questionnaire (BRSEQ) and the Benzodiazepine Expectancy Questionnaire (BEQ). Internal structure of the questionnaireswas established by principal component analysis (PCA) in a sample of 155 respondents, and verified by confirmatory factor analyses (CFA) in a second independent sample (n=139) using structural equation modeling. The PCA of the BRSEQ resulted in a 16-item, 4-factor scale, and the BEQ formed an 18-item, 2-factor scale. Both scales were internally reliable. CFA confirmed these internal structures and reduced the questionnaires to a 14-item self-efficacy scale and a 12-item expectancy scale. Lower self-efficacy and higher expectancy were moderately associated with higher scores on the SDS-B. The scales provide reliable measures for assessing benzodiazepine self-efficacy and expectancies. Future research will examine the utility of the scales in prospective prediction of benzodiazepine cessation.

Mood and self-efficacy : impact of joy and sadness on perceived capabilities

Examined the impact of happy and sad moods on efficacy judgments concerning a variety of activities in 16 undergraduates who scored between 9 and 12 on the Harvard Group Scale of Hypnotic Susceptibility—Form A. The mood was induced by having hypnotized Ss recall and revive their feelings about a romantic success or failure. Changes in efficacy that these memories induced were not restricted to the romantic domain but were also seen on interpersonal, athletic, and other activities remote from romance. Results suggest that emotional states have widespread impact on judgments by making mood-congruent thoughts more available. Implications for self-efficacy theory and practical applications are discussed.

The role of self-efficacy in dental patients’ brushing and flossing: Testing an extended Health Belief Model

Objective: In an effort to examine the decreasing oral health trend of Australian dental patients, the Health Belief Model (HBM) was utilised to understand the beliefs underlying brushing and flossing self-care. The HBM states that perception of severity and susceptibility to inaction and an estimate of the barriers and benefits of behavioural performance influences people’s health behaviours. Self-efficacy, confidence in one’s ability to perform oral self-care, was also examined. Methods: In dental waiting rooms, a community sample (N = 92) of dental patients completed a questionnaire assessing HBM variables and self-efficacy, as well as their performance of the oral hygiene behaviours of brushing and flossing. Results: Partial support only was found for the HBM with barriers emerging as the sole HBM factor influencing brushing and flossing behaviours. Self-efficacy significantly predicted both oral hygiene behaviours also. Conclusion: Support was found for the control factors, specifically a consideration of barriers and self-efficacy, in the context of understanding dental patients’ oral hygiene decisions. Practice implications: Dental professionals should encourage patients’ self-confidence to brush and floss at recommended levels and discuss strategies that combat barriers to performance, rather than emphasising the risks of inaction or the benefits of oral self-care.

Digital design communication : measuring learner technological prowess and self-efficacy in problem resolution

Currently the Bachelor of Design is the generic degree offered to the four disciplines of Architecture, Landscape Architecture, Industrial Design, and Interior Design within the School of Design at the Queensland University of Technology. Regardless of discipline, Digital Communication is a core unit taken by the 600 first year students entering the Bachelor of Design degree. Within the design disciplines the communication of the designer's intentions is achieved primarily through the use of graphic images, with written information being considered as supportive or secondary. As such, Digital Communication attempts to educate learners in the fundamentals of this graphic design communication, using a generic digital or software tool. Past iterations of the unit have not acknowledged the subtle difference in design communication of the different design disciplines involved, and has used a single generic software tool. Following a review of the unit in 2008, it was decided that a single generic software tool was no longer entirely sufficient. This decision was based on the recognition that there was an increasing emergence of discipline specific digital tools, and an expressed student desire and apparent aptitude to learn these discipline specific tools. As a result the unit was reconstructed in 2009 to offer both discipline specific and generic software instruction, if elected by the student. This paper, apart from offering the general context and pedagogy of the existing and restructured units, will more importantly offer research data that validates the changes made to the unit. Most significant of this new data is the results of surveys that authenticate actual student aptitude versus desire in learning discipline specific tools. This is done through an exposure of student self efficacy in problem resolution and technological prowess - generally and specifically within the unit. More traditional means of validation is also presented that includes the results of the generic university-wide Learning Experience Survey of the unit, as well as a comparison between the assessment results of the restructured unit versus the previous year.

Using microteaching to enhance teacher efficacy in pre-service teachers

This study examined pre-service teachers’ efficacy in relation to the utilisation of microteaching as an assessment tool for postgraduate education students in Australia. Three hundred and fifteen pre-service teachers completed the teacher efficacy survey and additional qualitative questions at Time 1 and 208 completed the survey and questions at Time 2. A principal components analysis conducted on the Time 1 survey data revealed teacher efficacy to be comprised of two components: ‘teacher efficacy in classroom management’ and ‘personal teacher efficacy’. Repeated measures ANOVAs conducted on the 208 participants who completed the survey at Time 1 and 2 revealed that efficacy on both components increased significantly over time, and that internet students had higher efficacy levels than internal students. The qualitative data revealed that pre-service teachers enter teaching in order to positively impact on children, yet are concerned about behaviour management in the classroom. In addition, this data highlighted the positive impact that microteaching had on their developing teacher identity.