Evaluating the effectiveness of interventions: exploration of two statistical methods.

Repeated measures designs are often used to evaluate the effectiveness of interventions. In these designs, the outcomes are measured on several occasions before and after implementation of the intervention. Two statistical methods, the repeated measures analysis of variance (RM-ANOVA) and hierarchical linear models (HLM), can be used to analyze the data. The authors provide an overview of the statistical models underlying RM-ANOVA and HLM and discuss the strengths and limitations of each. They propose that the 2 methods are complementary in determining the effectiveness of interventions.     

Anti-N-Methyl-D-Aspartate Receptor Encephalitis with Favorable Outcome Despite Prolonged Status Epilepticus

Background

To describe a case of auto-immune encephalitis in an adolescent with favorable outcome despite prolonged status epilepticus.

Methods

A 17 year old Asian man without previous medical history developed alteration of consciousness and partial seizures. The diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was confirmed by the detection of specific antibodies in both cerebrospinal fluid and serum.

Results

The clinical course was complicated by prolonged status epilepticus which was refractory to a large number of antiepileptic drugs, including barbiturate coma. Immunomodulatory therapy included steroids, plasma exchanges, and intravenous immunoglobulins. After 86 days of intensive therapy, the patient regained consciousness progressively. Brain magnetic resonance imaging never demonstrated any lesion. Extensive search for a tumor was negative. At 12 month follow-up, the patient had made an excellent recovery.

Conclusion

Auto-immune encephalitis is likely underdiagnosed in adolescents. In their most severe presentation, seizures may be resistant to a large number of anti-epileptic drugs, and the clinical improvement seems to be mainly because of the immunomodulatory therapy. Relapse is possible, as well as the delayed development of a teratoma or other tumor.     

Understanding and measuring patients' assessment of the quality of nursing care

BACKGROUND: Traditionally, patients have been considered incapable of evaluating the quality of care they receive, leading to their minimal involvement. OBJECTIVE: To develop the Patient's Assessment of Quality Scale--Acute Care Version (PAQS-ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive. METHODS: Developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later. RESULTS: After exploratory factor analysis, 45 items remained in five factors, accounting for 54% of the variance. Internal consistency estimates were above.83 for four of the five factors, with the fifth factor being.68. Test-retest reliability ranged from .58 to .71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance. DISCUSSION: Although the PAQS-ACV is a relatively new measure of quality nursing care, it has met many criteria for an adequate measure of quality care. The instrument fills a void in the assessment of quality by including patients in the direct evaluation of the care received.     

Strategies to Recruit Minority persons: A Systematic Review

To identify and describe strategies used to recruit persons of ethnically and culturally diverse backgrounds and to examine their reported effectiveness. Studies (n = 26) reporting on recruitment of persons of different cultural and ethnic backgrounds, published in English between 1995 and 2012, were included in this systematic review. Data on the type of recruitment strategies and overall reported effectiveness of the strategy in recruiting participants were extracted. The vote counting method was used to synthesize the findings on effectiveness. Both proactive (face-to-face) and reactive recruitment strategies (collaboration with key leaders, snowball and word of mouth, printed material, and broadcast media) and providing compensation, being flexible, building rapport and trust, and employing ethnically and culturally diverse research staff were effective in recruiting participants. A list of strategies that are effective in recruiting persons of diverse ethnic and cultural backgrounds were generated. Researchers can select the evidence-based strategies that are most applicable in the context of their study.     

Immune-mediated neurological syndromes in SARS-CoV-2-infected patients

Journal of Neurology - Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore...     

Achieving clinical improvement: an interdisciplinary intervention

This study evaluates whether training health care teams in continuous quality improvement methods results in improvements in the care of and outcomes for patients. Nine of the 25 teams who participated in the study were successful in improving the care/outcomes for patients. Successful teams were more effective at problem solving, engaged in more functional group interactions, and were more likely to have physician participation.     

Hyperbaric oxygen therapy of cerebral ischemia

BACKGROUND: Hyperbaric oxygen (HBO) therapy of cerebral ischemia has been evaluated in a number of human and animal studies; however, there is presently no consensus on its efficacy. METHODS: We present a review of animal and human studies on HBO therapy of cerebral ischemia as well as present potential mechanisms of action of HBO. RESULTS: Animal studies of HBO have shown promise by reducing infarct size and improving neurologic outcome. HBO has also been shown to inhibit inflammation and apoptosis after cerebral ischemia. Early reports in humans also suggested benefit in stroke patients treated with HBO. Recent randomized, controlled human studies, however, have not shown benefit, although all were limited by small sample size. Important differences between animal and human studies suggest HBO might be more effective in stroke within the first few hours and at a pressure of 2-3 ATA. CONCLUSIONS: The clinical usefulness of HBO in the treatment of cerebral ischemia is not yet certain. Attention to emerging pathophysiologic data should be taken into consideration in design of any future clinical trials of HBO in acute ischemic stroke.