Estimating the effectiveness of a hospital’s interventions in India: impact of the choice of disability weights

ObjectiveTo calculate the effect of using two different sets of disability weights for estimates of disability-adjusted life-years (DALYs) averted by interventions delivered in one hospital in India.MethodsDALYs averted by surgical and non-surgical interventions were estimated for 3445 patients who were admitted to a 106-bed private hospital in a semi-urban area of northern India in 2012–2013. Disability weights were taken from global burden of disease (GBD) studies. We used the GBD 1990 disability weights and then repeated all of our calculations using the corresponding GBD 2010 weights. DALYs averted were estimated for surgical and non-surgical interventions using disability weight, risk of death and/or disability, and effectiveness of treatment.FindingsThe disability weights assigned in the GBD 1990 study to the sequelae of conditions such as cataract, cancer and injuries were substantially different to those assigned in the GBD 2010 study. These differences in weights led to large differences in estimates of DALYs averted. For all surgical interventions delivered to this patient cohort, 11 517 DALYs were averted if we used the GDB 1990 weights and 9401 DALYs were averted if we used the GDB 2010 disability weights. For non-surgical interventions 5168 DALYs were averted using the GDB 1990 disability weights and 5537 DALYS were averted using the GDB 2010 disability weights.ConclusionEstimates of the effectiveness of hospital interventions depend upon the disability weighting used. Researchers and resource allocators need to be very cautious when comparing results from studies that have used different sets of disability weights.     

Home care: the experience of a private hospital in the state of São Paulo

Home care is defined as a group of hospital procedures that can be developed at home, encompassing health actions developed by a multiprofessional team. This study aims at disseminating the experience of a home care service offered by S?o Francisco Hospital, located in the city of Ribeir?o Preto, presenting the results of a 12-month period (from September 2001 to August 2002). During the analyzed period, the service provided care mainly to women (57%), with age between 70 and 80 years (30%), with diagnosis of neurological diseases (27%) and tumors (17%). The sector is coordinated by nurses, who are also responsible for bringing in clients. The work is performed by an interprofessional team that performs procedures of collecting material for lab examinations, dressing, deliver care with catheters and ostomies, as well as home hospitalization.     

What is the evidence of the experience of having a fall across the life course? A qualitative synthesis

BackgroundAlleviating the economic and human impacts of falls and fear of falling are critical health and social care issues. Despite some proven effectiveness of a number of falls prevention intervention programmes, uptake remains low and attrition high. There is a need for greater understanding of social, cultural and individual, life course positioning of falling, actual or perceived.ObjectiveTo address the question: what is the evidence of the experience of having a fall across the life course?MethodA qualitative evidence synthesis with key electronic databases searched from 1990 to 2011 using terms related to the experience of falls and falling. Selected papers presented data from the perspective of the person who had fallen. Synthesis included collaborative coding of ‘incidents’ related to falling, theoretical sampling of studies to challenge emerging theories, and constant comparison of categories to generate explanations.ResultsThe initial focus was to access and assess the evidence for the experiences of a fall across the life course but the authors' systematic search revealed that the vast majority of the published literature focuses on the experience of a fall in later life. Only 2 of the 16 studies included, provided perspectives of falling from a life stage other than that of older adults. However older adults' perceptions of their falls experiences are likely to be influenced by lifelong attitudes and beliefs about falling and older age. Synthesis identified that a falls incident or fear of falling induces explicit or implicit ‘Fear.’ Consequences are related to notions of ‘Control’ and ‘Social standing.’ Recovery work involves ‘Adaptation,’ ‘Implications,’ ‘Social standing’ and ‘Control.’ ‘Explanation’ is sought.ConclusionsHow and why people make sense of falling across the life course should have positive impacts on developing falls intervention programmes that people will want to engage with and adhere to.     

Immediate aftermath of a client’s death: the experience of home health aides

This study investigated Home Health Aides’ (HHAs) experiences in the immediate aftermath of client death. Semi-structured in-person interviews with 80 HHAs explored how notification of death and reassignment to a new client were handled. Only 42.5% of HHAs were notified of the death; 40% had to notify the agency; 17.5% were not notified at all and had a negative experience. Reassignment preferences varied, but HHAs had a better experience when their preferences were taken into consideration. Study findings suggest that more mindful approaches to transitions following client death would be valued by HHAs and could improve their work experience.     

Use of the computer as a tool for the implementation of the nursing process--the experience of the Sâo Paulo/UNIFESP

This article reports the pathway used to build a prototype of a computer nurse's clinical decision making support system, using NANDA, NIC and NOC classifications, as an auxiliary tool in the insertion of nursing data in the computerized patient record of Hospital S?o Paulo/UNIFESP.     

A qualitative study of the experience of parents attending a psychoanalytically informed parent–toddler group

The paper presents the findings of a qualitative study into the experience of seven parents attending a psychoanalytically informed parent–toddler group. Semi‐structured interviews were carried out with each parent, and analysed using Interpretative Phenomenological Analysis. Analysis of the interviews led us to three ‘superordinate themes’, each of which captures a certain aspect of the parents' experiences of attending the toddler groups. These themes were: the setting of the toddler groups; what it was like as a parent coming to these groups; and how parents felt their toddlers experienced coming. Within each theme there were a number of subordinate themes that captured particular aspects of the overall experience, and these are presented in narrative form, with extracts from the interview data to help illustrate the themes. It is argued that service users' views are an important part of evaluation, and that there may be certain features of a psychoanalytically informed parent–toddler group that are distinctive.     

Assessment of the effectiveness of health training courses offered for food handlers in a health care district of Gandía, Valencia

BACKGROUND: Food poisoning is a major Health Care issue. Health training is one of the mechanisms available for preventing these illnesses. The purpose of this study is that of ascertaining whether food handlers improve their knowledge regarding food handling practices by attending the courses which are offered for being awarded the handler card and of analyzing the impact of sociodemographic variables on the degree of knowledge prior to taking the course. METHOD: Pre-Post type assessment study on a sample of 500 handlers who came to the Public Health Center in the town of Gandfa (Valencia) to take a training course in October 1997-February 1998. A self-test questionnaire taken prior to and following the course to gauge knowledge and other variables was used. RESULTS: A significant difference was found between the pre-test and the post-test, except with regard to the subject of personal hygiene. Those handlers having worked at this occupation for a longer number of years or who had prior health training answered correctly more often. CONCLUSIONS: The training courses heighten the degree of knowledge regarding food-handling practices. In training courses, greater emphasis must be placed on the subjects of food preservation, preparation and serving than on those of personal hygiene or facility cleanliness. Nonetheless, it would be of interest to research whether any changes in attitudes occur as an initial approach to assessing the effectiveness of the training and ascertaining whether any intention exists of putting the knowledge acquired into practice.     

Is the diffusion method useful for testing the effectiveness of biocides?

The authors tested the fungicide effect of different biocides by the diffusion method. Its principle involves pipeting samples of the tested fungicide preparations into pits in an agar medium on Petri dishes. The agar is inoculated over the whole surface with spores of fungi. It is incubated at 28 degrees C for 2 to 3 days. The size of the inhibition zones in the increments of fungi round the pits with the preparation are recorded. The authors discuss the suitability of this method for different types of preparations with regard to the results they assembled.     

Threshold analysis in the presence of both the diagnostic and the therapeutic risk

The well-established a priori probability of illness threshold in medical decision making, introduced by Pauker and Kassirer (N Engl J Med 293:229–234, 1975; N Engl J Med 302:1109–1117, 1980), involves the diagnostic risk only. We generalize the threshold analysis by adding the therapeutic risk, i.e., in accounting for the risk that a treatment might sometimes fail. We derive a priori probability of illness threshold as a function of the probability of successful treatment, as well as the inverted function, where the successful treatment probability threshold is a function of the a priori probability of illness. The thresholds in the general model are higher than those in the special cases where one of the two risks is absent. Applications show that the changes in the thresholds can be substantial. Our general model might explain empirical findings of much higher thresholds than the Pauker–Kassirer model suggests.     

Illustrating a “consequential” shift in the study of health inequalities: a decomposition of racial differences in the distribution of body mass

Purpose

We present a conceptual introduction to “distributional inequalities”—differences in distributions of risk factors or other outcomes between social groups—as a consequential shift for research on health inequalities. We also review a companion analytical methodology, “distributional decomposition”, which can assess the population characteristics that explain distributional inequalities.

Optimizing the design of web-based questionnaires – experience from a population-based study among 50,000 women

Background Web-questionnaires are an important tool for future epidemiological research because these allow for rapid and cost-efficient assembly of self-reported information on risk factors and health outcomes. However, to achieve high response rates it is essential to accommodate factors that prevent drop out and so insure validity of future studies. We aim to study how socio-demographic variables as well as design issues such as the ordering and level of difficulty (Easy-to-hard vs. Hard-to-easy) of questions in a web-questionnaire affects the probability of drop out and non-response. Method In 2003 we invited 47,859 women participating in an ongoing prospective study to a follow-up using a web-based mode. Two versions of the questionnaire existed, varying in level of difficulty (Easy-to-hard vs. Hard-to-easy). We report drop out (proportion non-completers) between groups defined by level of difficulty and estimated adjusted risk differences. Results The drop out differs significantly depending on the order of the questions in the web-questionnaire. The socio-demographic pattern among lurkers (participants that enter, start responding to, but do not complete a web-questionnaire) differs from that among completers of web-questionnaires. Conclusions An additional 6% units of completers – persons initiating and completing the questionnaire – can be obtained by considering the ordering of questions. A group uniquely identified in web-surveys,␣as lurkers are potentially easier to persuade to complete an already started web-questionnaire compared to a non-responder. Lurkers thus constitute a unique opportunity of decreasing the drop out rate and therefore merit future research.     

Profile of the foster child likely to experience unstable care: a re‐examination

This research reports the results of a survey exploring characteristics associated with the stability of foster care. The survey was developed from a national profile of the child likely to experience unstable foster care. Findings and implications are discussed.     

Does 'welfare-to-work' work? A systematic review of the effectiveness of the UK's welfare-to-work programmes for people with a disability or chronic illness

Welfare-to-work programmes promoting employment of people with a disability or chronic illness are an expanding aspect of welfare reform in the UK. What evidence is there of impact on employment outcomes? This paper presents a systematic review of the evidence on UK policy initiatives. Both quantitative and qualitative studies were identified: 5399 abstracts were located, from which 16 studies were critically appraised. Overall, each of the five main welfare-to-work strategies operating in the 1990s helped people with disabilities into work, who were previously on benefits. The proportion of participants gaining employment after involvement ranged from 11% to 50%, dependent on characteristics of participants, such as 'job-readiness', as well as wider labour market context. As most studies were uncontrolled, it was difficult to determine if the improved employment chances were due to the effectiveness of the welfare-to-work interventions themselves or to external factors. Wider impact, such as uptake of schemes as a proportion of the total target population, was weak. The qualitative components identified barriers and facilitators concerned with effective implementation, to aid design of future initiatives.     

Is quality of life a suitable measure of patient decision aid effectiveness? Sub-analysis of a Cochrane systematic review

Quality of Life Research - Patient decision-aids (PtDAs) help patients make informed treatment decisions incorporating their values. Health-related quality of life (HRQOL) is sometimes an outcome...