The methodology of HIV/AIDS impact studies: a review of current practices

This review of studies on the socio-economic impact of HIV/AIDS shows that diversity in methodological design, which often is a result of practical considerations and resource constraints rather than of poor design, is the norm. This limits the comparability of research findings. More detailed reporting on method, which is not the norm, can go some way towards facilitating such comparison. Furthermore, the review underlines the importance of exploring intervention issues in more detail. Researchers need to employ results in answering specific policy questions. Scope remains for more impact studies to be conducted in developing countries in general and in certain high prevalence countries in specific, i.e. Southern Africa. Studies that explore the urban/rural dynamics of and clients' perceptions and behavior in seeking care and support are necessary to better understand the epidemic. The role of community-based organizations, non-governmental organizations and other stakeholders in studies of this nature can be expanded. Larger studies generally have more statistical power, but smaller, in-depth studies can be equally valuable. A careful stratification of sample populations can enhance the quality of cross-sectional studies. Qualitative methods should be used to complement the current reliance on survey-based methods of data collection. More longitudinal studies are required to explore the long-term impacts of HIV/AIDS. HIV/AIDS training for fieldworkers should be standard in studies of this nature, while cognizance should be taken of the dangers of employing local people as fieldworkers in studies of such sensitive nature. Scope remains for the further empirical analysis of data from impact studies, which requires these data sets being made accessible to more researchers. In the longer term, an attempt at standardizing core modules in impact studies can help to improve our understanding of the impact of HIV/AIDS in different settings.     

Influence of follow-up methodology and completeness on apparent clinical outcome of fundoplication

BACKGROUND: Outcomes after surgery can be determined by face-to-face interview, interviewing patients by telephone, or by mailing out questionnaires. For reasons of convenience, many clinical research studies use mail survey methods. Mail-out responses, however, are rarely complete, and patients returning mail-out questionnaires might be different from patients who do not return questionnaires. METHODS: We identified a group of 75 patients who were all sent a mail-out questionnaire 5 or more years after a laparoscopic fundoplication. Some of these patients returned questionnaires and some did not. All patients were subsequently interviewed by telephone. The responses to the two different data collection methods were compared as well as the interview responses of patients who returned questionnaires with those of patients who did not to determine the influence of follow-up methodology on apparent clinical outcome. RESULTS: Of the 75 patients interviewed, 49 patients (65%) had previously returned a mail-out questionnaire and 26 patients had not. The mean time difference between mail-out response and telephone interview was 1 month. When mail-out responses were compared with interview responses of the patients who had returned questionnaires, equivalent answers were obtained for all symptoms except for dysphagia, for which a higher incidence and greater scores were reported by patients in their mail-out questionnaire responses. When mail-out nonresponders were compared with responders, the nonresponders had a lower level of overall satisfaction with the outcome of surgery, a higher incidence of dysphagia, and greater levels of heartburn. CONCLUSIONS: The measurement of surgical outcomes using a mail-out questionnaire may not be an accurate method of assessing patient symptoms and satisfaction after surgery, particularly if follow-up is incomplete. In this study, patients not responding to mail-out questionnaires were more likely to have adverse symptoms and a lower level of satisfaction than patients returning questionnaires. This dissatisfaction could make patients less likely to return mail-out questionnaires, and for this reason studies with incomplete follow-up that rely on mail-out questionnaire responses may report erroneously higher surgical success rates.     

Practice development: purpose,methodology, facilitation and evaluation

Different approaches to practice development are associated with different assumptions, and these need to be made explicit if practice development is to be transparent, rigorous and systematic in its intentions and approaches. A practice development methodology underpinned by critical social science is advocated because it focuses on achieving sustainable change through practitioner enlightenment, empowerment and emancipation and an associated culture, rather than focusing only on technical practice development. Implications of different worldviews about practice development for facilitation and outcome evaluation are highlighted. Emancipatory practice development underpinned by critical social science is argued as synonymous to emancipatory action research.     

农村社区卫生服务功能综合评价中的方法学研究

目的 农村社区卫生服务功能评价方法学研究。方法 聚类分析与判别分析相结合；样品聚类与秩和比法相结合；因子分析与判别分析相结合。结果 实现了对未知类别的新事物建立分类标准并准确分类的目的。结论 方法结合运用可以在保留各自优点的同时互相弥补对方的缺点，既使结果很好地符合现实情况，又提高了评价的效率和保证了评价结果的再现性和稳定性。     

'A day in the life': advancing a methodology for the cultural study of development and learning in early childhood

This paper explores the methodology of an ecological investigation of aspects of culture in the interactional construction of early childhood in diverse global communities: Peru, Italy, Canada, Thailand, and the United Kingdom. Regarding culture as a dynamic dimension of the child's socialisation, the approach taken was to film a 'day in the life' of a two-and-a-half-year-old girl in each location. The principal investigators viewed these five 'days' and selected clips were made into a compilation tape, to be interrogated and interpreted by the local investigators and the child's family. These latter reflections were also taped and then applied to a growing appreciation of the child in cultural context. Other inter-researcher techniques were used to elucidate and explore events and values further. Reflexive concerns as to the interplay between aims and methods in interpretive research are critical components of this endeavour to develop new cultural understandings of the girls in context.     

浅议互动教学法及其在解剖学组织胚胎学课堂中的应用

对解剖学组织胚胎学的教学方法进行改进，以互动式教学取代传统的灌输式教学，充分发挥学员学习的积极性和主动性，注重学员实际动手操作能力的培养，对提高学员自学能力以及提高课堂教学效果均能起到积极作用。     

综述写作八法

本文从题法、检法、译法、拼法、句法、段法、章法和封法这八个方面阐述综述的写法。     

Do people match surface reflectance fundamentally differently than they match emitted light?

We compared matches between colours that were both presented on a computer monitor or both as pieces of paper, with matching the colour of a piece of paper with a colour presented on a computer monitor and vice versa. Performance was specifically poor when setting an image on a computer monitor to match the colour of a piece of paper. This cannot be due to any of the individual judgments because subjects readily selected a matching piece of paper to match another piece of paper and set the image on the monitor to match another image on a monitor. We propose that matching the light reaching the eye and matching surface reflectance are fundamentally different judgments and that subjects can sometimes but not always choose which to match.     

Failure to rescue in trauma: Coming to terms with the second term

IntroductionThe failure to rescue (FTR) rate is the probability of death after a major complication and was defined in elective surgical cohorts. In elective surgery, the precedence rate (proportion of deaths preceded by major complications) approaches 100%, but recent studies in trauma report rates of only 20–25%. We hypothesised that use of high quality data would result precedence rates in higher than those derived from national datasets, and we further sought to characterise the nature of those deaths not preceded by major complications.MethodsProspectively collected data from 2006 to 2010 from a single level I trauma centre were used. Patients age >16 years with AIS ≥2 who survived beyond the trauma bay were included. Complications, mortality, FTR, and precedence rates were calculated. Chart abstraction was performed for registry deaths without recorded complications to verify the absence of complications and determine the cause of death, after which outcomes were re-calculated.ResultsA total of 8004 patients were included (median age 41 (IQR 25–75), 71% male, 82% blunt, median ISS 10 (IQR 5–18)). Using registry data the precedence rate was 55%, with 132/293 (45%) deaths occurring without antecedent major complications. On chart abstraction, 11/132 (8%) patients recorded in the registry as having no complication prior to death were found to have major complications. Complication and FTR rates after chart abstraction were statistically significantly different than those derived from registry data alone (complications 16.5% vs. 16.3, FTR 12.3 vs.13, p = 0.001), but this difference was unlikely to be clinically meaningful. Patients dying without complications predominantly (87%) had neurologic causes of demise.ConclusionsUse of data with near-complete ascertainment of complications results in precedence rates much higher than those from national datasets. Patients dying without precedent complications at our centre largely succumbed to progression of neurologic injury. Attempts to use FTR to compare quality between centres should be limited to high quality data.Level of evidenceLevel III.Retrospective cohort studyOutcomes.