Assessing postgraduate outcomes of research-intensive nursing science PhD programs: Methods and metrics

BackgroundAcross disciplines and within higher educational systems, assessing postgraduate outcomes is essential for evaluating doctoral programs, including research-intensive nursing science doctoral programs. However, there are limited reports regarding methods and metrics related to postgraduate longitudinal evaluation of research-focused nursing doctoral programs.PurposeThe purpose of this paper is to summarize studies in the area of postgraduate outcome assessment and provide recommendations regarding outcome methods and metrics for evaluating the effectiveness of research-focused nursing doctoral programs.MethodsPubMed/Medline, CINHAL Complete, and Google Scholar databases were searched using key words including PhD program, doctoral program, longitudinal evaluation, evaluation, program evaluation, PhD alumni survey, education outcomes and PhD program outcomes. We excluded non-English and full-text articles that were not available for review.DiscussionBased on a review of the literature, there are few reports on methods and questionnaires for postgraduate outcome assessment. There is a critical need to develop standardized core metrics/questions, longitudinal assessments, and a shared data repository. The latter will allow for comparisons across nursing doctoral programs.ConclusionRobust standardized longitudinal assessment of nursing doctoral programs is a necessary step for comparison across programs and re-envisioning the nursing doctoral education of the future.     

Procedural Pain in the Adult Neurological Intensive Care Unit: A Retrospective Study Examining Arterial Line Insertion

BackgroundThis was a retrospective chart review of procedural pain assessments and interventions during arterial catheter insertion in an adult neurological intensive care unit where patients with impaired consciousness are common. Overall, pain assessment was well documented (100%) by Registered Nurses, but not specific to arterial line insertion. Nurse practitioners commonly placed arterial lines and used local analgesia in over 75% of the documented procedures.AimsThe purpose of this study was to examine healthcare providers’ pain-related practices documented during arterial catheter insertion, one of the most painful procedures in a neurological intensive care unit. Secondary purposes were determining whether patient characteristics, procedure-related factors, or provider licensure were associated with pain assessment or procedural pain interventions.DesignA retrospective records review design was used.Methods120 electronic patient medical records were reviewed during a one-year period.Results100 charts met inclusion criteria. Nurses assessed all pain within 4 hours following the procedure in all charts but procedure-specific pain assessments were documented in 4% of charts. Pain-related interventions for arterial line insertion were local analgesic (76% of charts) and other procedure-specific interventions (10%). Significant associations occurred between procedure specific pain assessments and decreased number of insertion attempts (p = .006) and between pain interventions and number of insertion attempts (p = .003). No provider documented procedural pain assessment regarding arterial line insertion. Associations between patient characteristics and pain interventions were significant for patient ethnicity (F = 8.967, p = .007).ConclusionsOverall pain assessment was documented (100%) but not specific to arterial line insertion. Although arterial line insertion can be extremely painful, patients were rarely assessed for such pain by any clinician; 14% did not receive any preprocedural analgesia.Clinical ImplicationsThe lack of procedural pain assessment in this vulnerable population indicates a need for increased pain management education for clinicians and further investigations to determine whether sufficient analgesia is provided to reduce procedural pain during arterial line insertion.     

A Coaching by Telephone Intervention for Veterans and Care Team Engagement (ACTIVATE): A study protocol for a Hybrid Type I effectiveness-implementation randomized controlled trial

IntroductionA large proportion of deaths and many illnesses can be attributed to three modifiable risk factors: tobacco use, overweight/obesity, and physical inactivity. Health risk assessments (HRAs) are widely available online but have not been consistently used in healthcare systems to activate patients to participate in prevention programs aimed at improving lifestyle behaviors.ObjectivesThe goal of this study is to test whether adding telephone-based coaching to use of a comprehensive HRA increases at-risk patients' activation and enrollment into a prevention program compared to HRA use alone.MethodsParticipants were randomized to either complete an HRA alone or in conjunction with a telephone coaching intervention. To be eligible Veterans had to have at least one modifiable risk factor (current smoker, overweight/obese, or physically inactive). The primary outcome is enrollment and participation in a prevention program by 6 months. Secondary outcomes include change in a Patient Activation Measure and Framingham Risk Score.DiscussionThis study is the first to test a web-based health risk assessment coupled with a health coaching intervention within a large healthcare system. Results from this study will help the Veterans Health Administration (VHA) implement its national plan to include comprehensive health risk assessments as a tool to engage Veterans in prevention. The results will also inform health systems outside VHA who seek to implement Medicare's advisement that health risk assessment become a mandatory component of care under the Affordable Care Act.     

Researching the Appropriateness of Care in the Complementary and Integrative Health Professions Part 3: Designing Instruments With Patient Input

ObjectivesThe purpose of this article is to describe how we designed patient survey instruments to ensure that patient data about preferences and experience could be included in appropriateness decisions. These actions were part of a project that examined the appropriateness of spinal manipulation and mobilization for chronic low back pain and chronic neck pain.MethodsWe conducted focus groups, cognitive interviews, a literature review of measures in prior chiropractic and complementary and integrative health research, and a pilot study to develop questionnaires of patient preferences, experiences, values, and beliefs.ResultsQuestionnaires were administered online to 2024 individuals from 125 chiropractic clinics. The survey included 3 long questionnaires and 5 shorter ones. All were administered online. The baseline items had 2 questionnaires that respondents could complete in different sittings. Respondents completed shorter biweekly follow-ups every 2 weeks and a final questionnaire at 3 months. The 2 initial questionnaires had 81 and 140 items, the 5 biweekly follow-up questionnaires had 37 items each, and the endline questionnaire contained 121 items. Participants generally responded positively to the survey items, and 91% of the patients who completed a baseline questionnaire completed the endpoint survey 3 months later. We used “legacy” measures, and we also adapted measures and developed new measures for this study. Preliminary assessment of reliability and validity for a newly developed scale about coping behaviors indicates that the items work well together in a scale.ConclusionsThis article documents the challenges and the efforts involved in designing data collection tools to facilitate the inclusion of patient data into appropriateness decisions.     

Predictors of Missed Follow-up Visits in the National Traumatic Brain Injury Model Systems Cohort Study

ObjectiveTo identify key variables that could predict risk of loss to follow-up (LTFU) in a nationally funded longitudinal database of persons with traumatic brain injury.DesignSecondary analysis of a prospective longitudinal cohort study.SettingTraumatic Brain Injury Model System (TBIMS) Centers in the US.ParticipantsA total of 17,956 TBIMS participants (N=17,956) with interview status data available were included if eligible for 1-, 2-, 5-, 10-, 15-, or 20-year follow-ups between October 31, 1989, and September 30, 2020.InterventionsNot applicable.Main Outcome MeasuresFollow-up data collection completion status at years 1, 2, 5, 10, 15, and 20.ResultsInformation relevant to participants’ history, injury characteristics, rehabilitation stay, and patterns of follow-up across 20 years were considered using a series of logistic regression models. Overall, LTFU rates were low (consistently <20%). The most robust predictors of LTFU across models were missed earlier follow-ups and demographic factors including Hispanic ethnicity, lower education, and lack of private health insurance.ConclusionsEfforts to retain participants in such social disadvantaged or minority groups are encouraged given their disproportionate rate of LTFU. Repeated attempts to reach participants after a previously missed assessment are beneficial because many participants that missed 1 or more follow-ups were later recovered.     

Prospective changes of the quality of life for patients newly diagnosed with oral cancer during the acute stage

Purpose of the researchOral cancer is a common malignant disease in Taiwan. The purpose of this prospective follow-up study was to identify the changes in quality of life for newly diagnosed oral cancer patients during the acute stage.Methods and sampleSubjects were recruited from the outpatient department (OPD) in a medical center located in the northern part of Taiwan. 22 subjects completed both the EORTC QLQ-C30 and the EORTC QLQ-H&N35 at diagnosis, postoperative discharge, and the first postoperative follow-up. In addition, 91% of the subjects received surgery only as their main treatment.Key resultsDuring the three assessments, as measured by the EORTC QLQ-C30, subjects reported that their physical function was much better at diagnosis than at both postoperative discharge and first postoperative follow-up. Their role functioning was much better at diagnosis than at postoperative discharge. Nevertheless, subjects reported better emotional functioning at the first postoperative follow-up than at the other two points of assessment. Only less financial difficulty was reported in the first postoperative follow-up than at diagnosis and postoperative discharge.For QLQ-H&N35, subjects reported that several symptoms (i.e., swallowing) were more severe at postoperative discharge than at diagnosis. Usage of nutritional supplements at first postoperative follow-up was higher than that at diagnosis.ConclusionNewly diagnosed oral cancer patients reported significant changes in certain domains of both the EORTC QLQ-C30 and QLQ-H&N35. Health professionals need to identify the pattern of changes and to provide supportive care to these new oral cancer patients throughout the treatment process, especially during the planning of discharge.     

Prognostic factors of long-term outcome in cases of severe traumatic brain injury

IntroductionThe purpose of this monocentric study was to assess the long-term outcome of a group of severe traumatic brain-injured patients and explore the prognostic values of some clinical and paraclinical parameters available at the initial stage.MethodologyThe patients included were victims of severe traumatic brain injuries in 2007 or 2008. A standardized assessment was performed for each patient including clinical, radiological, and electrophysiological data collected at the initial stage, The outcomes were assessed at least 2 years after injury. Depending on the patients’ availability and ability to communicate, the assessments included measures of dependency for activities of daily living (ADL), cognitive functions, behaviour, mood, and quality of life.ResultsEighteen patients were included, of whom ten were autonomous for ADL at the time of assessment. Memory complaints, attentional deficits, anxiety, and irritability were the main long-term impairments observed. A correlation analysis showed significant correlations between the dependency level (as rated by the Functional Independence Measure) and each of length of coma, length of the post-traumatic amnesia, and the N100 auditory evoked potentials.DiscussionThese results confirm the uniqueness of each patient regarding the long-term consequences of a traumatic brain injury and the multi-determined nature of each prognosis.     

Retrospective comparison between a two- and three-component ankle arthroplasty: clinical and functional evaluation via gait analysis

BackgroundTotal ankle arthroplasty is intended to restore physiological joint function in case of severe ankle arthritis. However, little is known about the functional outcome associated to different prosthesis designs. The aim of this retrospective study was to compare clinical and functional outcomes via gait analysis of two ankle prostheses designed to preserve ankle ligamentous isometry.MethodsTwo groups of twenty patients who underwent ankle arthroplasty using either a three-component or a two-component prosthesis, were clinically evaluated, both pre-operatively and at minimal 2-year follow-up, by means of the AOFAS score. The spatio-temporal parameters, along with the kinetics and kinematics of the lower limb joints were also assessed at follow-up via gait analysis. The non-parametric Kruskal-Wallis test was used to assess differences in functional data between the two patient groups and with respect to those from a control group of 20 healthy subjects.FindingsAll AOFAS scores significantly improved from pre-operative to post-operative assessment in both patient groups (P < 0.05). Most spatio-temporal and functional parameters in the patients were worse than those in the control group, but no significant differences were observed between the two arthroplasty groups.InterpretationBoth patient groups showed improved clinical outcome at follow-up, with a few differences in gait parameters. However, neither of the two groups achieved normal locomotion patterns. Since both prostheses were designed to preserve ligamentous isometry, the choice of one implant over the other should be due to preferences in the surgical approach and to other patient-specific factors.     

Design and baseline characteristics of the cocoa supplement and multivitamin outcomes study for the Mind: COSMOS-Mind

BackgroundLarge simple trials are potentially efficient and cost-effective approaches to assess interventions to preserve cognitive function in older adults. High-dose cocoa flavanols supplementation is a promising intervention that warrants additional testing. We describe the design, recruitment success, and baseline characteristics of the Cocoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind) trial.MethodsCOSMOS-Mind is an ancillary study to the large-scale and predominantly mail-based COSMOS randomized controlled clinical trial. COSMOS is assessing whether cocoa extract (including 600 mg/d cocoa flavanols) and a multivitamin reduce risks for major cardiovascular events and total invasive cancer. COSMOS-Mind uses telephone-based interviews to assess cognitive function and impairment to determine whether cocoa flavanols benefit cognitive function in adults aged 65 years or older, targeting the enrollment of 2000 participants to provide >90% statistical power across 3 years of annual follow-up.ResultsOf the 3224 COSMOS screenees who expressed interest in COSMOS-Mind, 2350 (76%) successfully completed baseline cognitive assessments and 2262 (96%) geographically diverse, eligible individuals were ultimately enrolled over one year. At baseline, the primary outcome, a composite of cognitive test scores, was inversely associated with age in a manner consistent with assumptions used in projections of statistical power.ConclusionsOlder adults are willing to enroll in large simple trials that include telephone-based cognitive assessments. Embedding these trials in large studies of other health outcomes is efficient and expands the scientific knowledge gained from the research.ClinicalTrials.gov Identifiers: NCT03035201 (COSMOS-Mind); NCT102422745 (parent COSMOS).     

Activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury

Introduction: Aquatic therapy can lead to improved mobility and health in individuals with various conditions. This case report looks at an activity-specific aquatic therapy targeting gait for a patient with incomplete spinal cord injury (iSCI). Case report: The patient participated in an individualized aquatic therapy program two times a week for 6 weeks. Assessment occurred prior to the intervention. There were two follow-up assessments after the intervention. Follow-up assessment 1 was completed within the same week as the final intervention. Follow-up assessment 2 was completed 4 weeks after the first follow-up to assess for carryover. Results: Improvements that met minimal detectable change and minimal clinically important difference were noted in The Walking for Spinal Cord Injury Index-II, Spinal Cord Injury Functional Ambulation Index gait parameters, and gait speed. Discussion: An activity-specific aquatic therapy program improved gait in a patient with iSCI. The properties of water create a practical environment for safe practice of skills. Further studies are warranted in large samples.     

Daily process methodology for measuring earlier antidepressant response

ObjectiveRapid onset of therapeutic action for antidepressant medication represents a major area of unmet medical need, and any such effects have been difficult to detect using standard study designs and measurement strategies. We conducted a randomized, open-label study with blinded raters using daily process assessment vs. standard weekly assessment to answer the following study questions: 1) is it possible to detect an antidepressant response more rapidly with daily assessment than with standard assessment approaches? 2) what is the burden of daily assessment on participants relative to standard clinical assessments? and 3) does the process of completing daily assessments have any effect on clinic-based assessments such as the Hamilton Depression Rating Scale (HAM-D)?MethodSeventy-eight outpatients with major depressive disorder who received open-label fluoxetine were randomized to standard weekly clinic assessment or standard weekly clinic assessment plus daily assessment, and were followed for 28 days. Data were collected between September, 2002 and August, 2003.ResultsDaily assessment appeared to have no effect on 17-item HAM-D or MADRS scores obtained in the clinic. Survival analyses revealed that daily diaries detected therapeutic effects more quickly than did standard weekly clinic assessments, across most endpoints. Perceived burden of study participation was not significantly increased by daily diary completion, nor reflected in higher dropout rates.ConclusionDaily process assessment improves the ability to detect an early antidepressant response.     

A content analysis of peripheral arterial disease patient-reported outcome measures using the International Classification of Functioning,Disability and Health

Background: The purpose of this study was to link, classify and describe the content of peripheral arterial disease (PAD)-specific patient-reported outcome measures using the International Classification of Functioning. The results were then analyzed to determine if these assessments provide clinicians and researchers with a comprehensive understanding of the lived experience of patients with PAD.

Methods: Each meaningful concept in identified PAD assessments was linked to the International Classification of Functioning, Disability and Health to determine included and excluded content areas. An overall perspective was assigned to each assessment item. Inter-rater reliability was established using a kappa statistic.

Results: The body functions component is most frequently addressed overall followed by the activities and participation component. International Classification of Functioning chapter and category distribution vary greatly between assessments and no assessment comprehensively examines community participation and relationships. The majority of the assessment items are of the health status-disability and quality of life perspectives.

Conclusions: The results of this study suggest the need for the development of a comprehensive PAD assessment that includes a more even distribution of International Classification of Functioning topics and subtopics. A more comprehensive assessment would better capture the lived experience of this patient population.

• Implications for Rehabilitation

• A better understanding of the data collected using the current peripheral arterial disease-specific patient-reported outcome measures may contribute to the development of more comprehensive assessment tools that will ultimately lead to improved patient care.

• This study contributes to the preliminary foundation for the development of a peripheral arterial disease International Classification of Functioning, Disability and Health Core Set.

• Clinicians and researchers interested in using peripheral arterial disease-specific patient-reported outcome measures for clinical and research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed.

     

Development of a data collection tool to profile osteopathic practice: Use of a nominal group technique to enhance clinician involvement

IntroductionLittle is known about the profile of osteopathic care in the United Kingdom (UK). To address this, a standardised data collection (SDC) tool was developed to record patient-based data within private practice.MethodsThe development of the SDC tool took place within a national network of research groups (hubs) created by the National Council for Osteopathic Research (NCOR); nominal groups were created from the hub network. A Nominal Group Technique (NGT) was used to promote maximum involvement by clinicians and increase ownership of the process: this approach encouraged generation of ideas around specific topics. Following several rounds of iteration, a draft tool was created, followed by a three stage testing process to identify omissions, unnecessary jargon, ambiguities, and any regional differences.ResultsThe tool developed for a national use by UK osteopaths consisted of 65 items. These were divided into specific sections for patient or clinician completion. The section for patient completion collected data concerning demographic and symptom data. Clinicians provided data concerning treatment provided, advice to promote self-management and avoidance of symptom recurrence, outcome information, service data concerned with waiting times, the number of treatments delivered, and the necessity for referral.ConclusionThe tool development process produced a data collection tool aimed to collect snapshot data across the osteopathic profession. The national pilot of the tool will identify changes required, and any barriers to its use by busy professionals.     

Can ems providers adequately assess trauma patients for cervical spinal injury?

Objective. To determine whether EMS providers can accurately apply the clinical criteria for clearing cervical spines in trauma patients. Methods. EMS providers completed a data form based on their initial assessments of all adult trauma patients for whom the mechanism of injury indicated immobilization. Data collected included the presence or absence of neck pain/tenderness; altered mental status; history of loss of consciousness; drug/alcohol use; neurologic deficit; and other painful/distracting injury. After transport to the ED, emergency physicians (EPs) completed an identical data form based on their assessments. Immobilization was considered to be indicated if any one of the six criteria was present. The El's and EMS providers were blinded to each other's assessments. Agreement between the EP and EMS assessments was analyzed using the kappa statistic. Results. Five-hundred seventy-three patients were included in the study. The El' and EMS assessments matched in 78.7% (n = 451) of the cases. There were 44 (7.7%) patients for whom EP assessment indicated immobilization, but the EMS assessment did not. The kappa for the individual components of the assessments ranged from 0.35 to 0.81, with the kappa for the decision to immobilize being 0.48. The EMS providers' assessments were generally more conservative than the EPs'. Conclusion. EMS and EP assessments to rule out cervical spinal injury have moderate to substantial agreement. However, the authors recommend that systems allowing EMS providers to decide whether to immobilize patients should follow those patients closely to ensure appropriate care and to provide immediate feedback to the EMS providers.     

A randomized trial of diet in men with early stage prostate cancer on active surveillance: Rationale and design of the Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance])

BackgroundDiet may substantially alter prostate cancer initiation and progression. However, large-scale clinical trials of diet modification have yet to be performed for prostate cancer. The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) is investigating the effect of increased vegetable consumption on clinical progression in men with localized prostate cancer.Study designMEAL is a randomized, phase III clinical trial designed to test whether an intervention that increases vegetable intake will decrease the incidence of clinical progression in men with clinically localized prostate cancer on active surveillance. We are randomizing 464 patients to either a validated telephone-based diet counseling intervention or a control condition in which patients receive a published diet guideline. The intervention will continue for two years. The primary outcome variable is clinical progression defined by serum prostate-specific antigen (PSA) and pathological findings on follow-up prostate biopsy. Secondary outcome variables include incidence of surgical and non-surgical treatments for prostate cancer, prostate-cancer related patient anxiety and health-related quality of life.ConclusionThe MEAL Study is assessing the effectiveness of a high-vegetable diet intervention for preventing clinical progression in men with localized prostate cancer on active surveillance.