Evaluating postoperative fever: a focused approach

Postoperative fever should be evaluated with a focused approach rather than in "shotgun" fashion. Most fevers that develop within the first 48 hours after surgery are benign and self-limiting. However, it is critical that physicians who provide postoperative care be able to recognize the minority of fevers that demand immediate attention, based on the patient's history, a targeted physical examination, and further studies if appropriate. Fever that develops after the first 2 days following surgery is more likely to have an infectious cause, but noninfectious causes that require further evaluation and treatment must also be considered. When evaluating postoperative fever, a helpful mnemonic is the "four Ws": wind (pulmonary causes: pneumonia, aspiration, and pulmonary embolism, but not atelectasis), water (urinary tract infection), wound (surgical site infection), "what did we do?" (iatrogenic causes: drug fever, blood product reaction, infections related to intravenous lines).     

Evaluating the patient with diarrhea: a case-based approach

The evaluation of the patient with diarrhea can be complex and the treatment challenging. In this article, the definition of diarrhea and the pathophysiologic mechanisms that lead to diarrhea are reviewed. A simplified 5-step approach to the patient with diarrhea is provided and applied in a case-oriented manner applicable to everyday clinical practice. On completion of this article, you should be able to (1) define diarrhea, (2) outline various pathophysiologic mechanisms of diarrhea, and (3) describe a simplified 5-step approach to facilitate the evaluation of diarrhea.     

Evaluating hospice services for improvement: a manageable approach

Over the past thirty years, hospice services across the United States have been established as a viable alternative for terminally ill patients. As expected, during this period of stabilization, hospice service leaders have invested the majority of their energy in securing funding, developing coalitions, and developing/implementing services. All of this work has occurred to support the primary aim of symptom control for patients through use of pharmacotherapy, as well as provision of ancillary services by interdisciplinary teams consisting of nurses, social workers, pastoral care staff, occupational therapists, and others. Little attention has been given to assessing the effectiveness of this range of services in a holistic way. This paper presents a model of evaluation that is both manageable to implement and suitable to the political environments where hospice providers reside. The article demonstrates an approach that is collaborative and directs the evaluative process towards the improvement of services.     

Evaluating the economic costs of migraine: interest of a comparative approach

The major aim of the paper is to give an epidemiologist's viewpoint on several points related to the evaluation of the costs of migraine and to answer some questions that are important if one wishes to decrease the burden of this disease in the general population. In spite of favourable criteria for the management of migraine, and for epidemiologic and economic studies, the relationship between migraine and cost is not so easy to study. The main reason is that this relation is not determinist, which is a condition for the validity of cost-of-illness studies. Personality of migraineurs, belief in efficacy of the healthcare system, efficacy of the first treatment and attitude of the physician interfere with the relationship between migraine and cost. In our opinion, this fact justifies, in addition to cost-of-illness studies, a comparative approach between migraineurs and non-headache subjects to better appreciate the incremental cost related to migraine     

Qualitative data analysis: the framework approach

Qualitative methods are invaluable for exploring the complexities of health care and patient experiences in particular. Diverse qualitative methods are available that incorporate different ontological and epistemological perspectives. One method of data management that is gaining in popularity among healthcare researchers is the framework approach. We will outline this approach, discuss its relative merits and provide a working example of its application to data management and analysis.     

Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation--part II

Part I of this article presented an examination of the methodology used in previous psychosocial interventions (PSI) research and the rationale for the collaborative, qualitative design used in this study. In this second article the findings from an evaluation of five short PSI training courses are presented. Findings demonstrated that while the training was positively evaluated by participants and seen to be relevant to practice, the actual dissemination of PSI training into practice was a complex and context dependent process. There was difficulty for course participants in using PSI in practice as discrete, formal interventions. Rather the predominant way participants used PSI in practice was via a process of modifying PSI. The course philosophy, content and mode of delivery impacted on how the respondents constructed PSI as an overall approach to care and working relationships. Participants reported other 'hidden' benefits of training, such as reaffirming practice, increasing confidence and perhaps most powerfully, a change in attitude linked to the importance and impact attached to the service user and carer involvement in delivering the courses. Discussion locates the findings within the findings from previous PSI training evaluations and recommendations are made for a reappraisal of approaches to PSI training and research.     

Evaluating the impact of training in psychosocial interventions: a stakeholder approach to evaluation--part I

A range of psychosocial interventions (PSI) have developed as approaches to the treatment and support of people with enduring mental health problems and their carers. The impact of training mental health workers in PSI has also been subject to extensive research and evaluation for the past decade. Most previous research in the PSI and PSI training arenas have tended to adopt quasi-experimental designs and professionally defined outcomes-focused approaches to judging the success of training. This paper offers a critique of such approaches and presents a rationale for the methodology used in a qualitative study that evaluated five short PSI courses. The study emphasized a stakeholder approach to evaluation, involving collaborative activities between service users, carers, lecturers and mental health workers. These activities were intended to define what outcomes should be used to judge the success of training and how these should be examined during the research process. This paper details the processes and findings of these stakeholder activities that suggested, for service users particularly, process rather than outcome issues were the most important determinants of the success of PSI. Additionally, if outcomes were used to judge the success of interventions these should be highly individualized to reflect the aspirations of the person receiving the intervention. On the basis of the findings presented, discussion explores a proposal for a different methodological direction to the evaluation of PSI training. Part II of this paper presents and discusses the findings from the evaluation of the courses.     

Evaluating nursing care of the terminally ill in the community: a case study approach.

A multiple case study approach was used to evaluate the care of terminally ill people in the community of one Health Authority. Nine patients, and their visiting district and continuing care nurses, were interviewed to determine their different perspectives on need identification and resolution, using the Standard on Care of the Dying as a framework. Data were subjected to content analysis and categorized in relation to theory emerging from the literature. Needs were felt to be generally well met by the nurses, and patients indicated no serious areas of omission. However, a number of recurrent problems and issues were highlighted and recommendations put forward to redress them.     

Tests over time: Evaluating the currency of normative data in a complex multilingual environment

Abstract

Background: Assessment of oral language skills is challenging in multilingual environments. With language policies promoting increased use of English and reduction of dialectal varieties of languages, rapid changes in language further confound assessment.

Purpose: This study explores the currency of normative data on an expressive language screening tool in English for English-Mandarin bilingual Singaporean children.

Method: Spoken language samples in English from 101 pre-school children were compared with those from 481 children in the original data collection in 2002. Scores for expressive vocabulary and morphosyntax were compared for the two main language groups.

Result: Results indicate that the normative data for English-dominant children are still current. The data for younger Mandarin-dominant children showed improved test scores, indicating improvement in expressive morphosyntax in English.

Conclusion: English language competency has changed over time for Mandarin-dominant children in Singapore, likely due to the influence of language policy on language use. This is a particular challenge in multilingual environments. Current literature emphasizes the need to develop language assessments specific to populations and language groups for standardized assessments to be valid and reliable. These results demonstrate the need to monitor normative data and characteristics of language over time and to update standardized language assessments accordingly.     

Evaluating the value of screening for hypertension: an evidence-based approach.

No recommendations regarding in-school blood pressure (BP) screening currently exist. The purpose of this project was to use an evidence-based approach to determine whether BP screening should be initiated as part of one school district's standard screening protocols. Pediatric BP measurement, risk factors for hypertension, issues for determining youth at risk for hypertension, and eligibility criteria for determining conditions appropriate for screening are discussed. BPs of 1st, 6th, and 11th graders were evaluated according to standardized criteria. The evidence indicated that BP screening in school appears warranted, although a formalized study is needed before a definitive decision can be made regarding the incorporation of BP screening into school health services.     

Evaluating a two-step approach to sexual risk reduction in a publicly-funded STI clinic: rationale, design, and baseline data from the Health Improvement Project-Rochester (HIP-R)

BackgroundSexually transmitted infection (STI) clinics provide an opportune setting for HIV prevention efforts. This randomized controlled trial evaluated a unique, two-step approach to sexual risk reduction at a publicly-funded STI clinic.MethodsDuring an initial visit, patients completed an audio-computer assisted self-interview (ACASI), were randomized to and received one of two brief interventions, obtained medical care, and completed a post-assessment. Next, two-thirds of the patients were assigned to attend an intensive sexual risk reduction workshop. At 3, 6, and 12 months, patients completed additional ACASIs and provided urine specimens to assess behavior change and incident STIs.ResultsDuring a 28-month interval, 5613 patients were screened, 2691 were eligible, and 1483 consented to participate and were randomized; the modal reason for declining was lack of time (82%). Consenting patients included 688 women and 795 men; 64% of participants were African-American. The sample was low-income, with 57% reporting an annual income of less than $15,000; most participants (62%) had a high school education or less, and 51% were unemployed. Sexual risk behavior was common, as indicated by multiple sexual partners (mean = 32.8, lifetime; mean = 2.8, past 3 months), unprotected sex (mean = 17.3 episodes, past 3 months), and prior STIs (mean = 3.3, lifetime; 23% at baseline). Bivariate analyses confirmed our prediction that HIV-related motivation and behavioral skills would be related to current sexual risk behavior. All patients received a brief intervention; patient satisfaction ratings were uniformly high for both interventions (all means ≥ 3.7 on 4-point scales). Fifty-six percent of invited patients attended the intensive workshop, and attendance did not differ as a function of brief intervention. Patient satisfaction ratings were also uniformly positive for the workshop interventions (all means ≥ 3.6). Return to follow-up assessments exceeded 70%.ConclusionsResults demonstrate that implementing an HIV preventive program in a busy, public clinic is feasible and well-accepted by patients. Ongoing evaluation will determine if the interventions reduce sexual risk behavior and lower incident STIs.     

Evaluating the use of a data base system with community health nursing students

The Data Base Management System for community diagnosis was used during two academic semesters with 80 baccalaureate nursing students. At the end of the two semesters the DBMS was evaluated from feedback obtained through faculty discussions, final student papers and oral presentations. The DBMS met the goals established to evaluate the tool. The clarification of categories for essential data is an ongoing process.     

Tissue characterization using electrical impedance spectroscopy data: a linear algebra approach

In this study, we use a new linear algebra manipulation on electrical impedance spectroscopy measurements to provide real-time information regarding the nature of the tissue surrounding the needle in minimal invasive procedures. Using a Comsol Multiphysics three-dimensional model, a phantom based on ex vivo animal tissue and in vivo animal data, we demonstrate how tissue inhomogeneity can be characterized without any previous knowledge of the electrical properties of the different tissues, except that they should not be linearly dependent on a certain frequency range. This method may have applications in needle biopsies, radiation seeds, or minimally invasive surgery and can reduce the number of computer tomography or magnetic resonance imaging images. We conclude by demonstrating how this mathematical approach can be useful in other applications.