550 research outputs found
Changes in Facebook Behavior over Time
Use of social networking sites has led to research concerning online behavior and personality. This study uses a model specifically developed to study the shifts in behavior of five defined types of Facebook users over a 5-year period as they exploit the site201F;s Timeline feature. Analysis revealed a statistically significant difference in activity among Scrapbookers, t(7) = 7.99, p .01 and (M = 9.13, s = 3.23) as well as among Social Butterflies, t(7) = 7.13, p .01 and (M = 7.38, s = 2.92). The t-test found no discernable statistically reliable difference in the Observer category t(7) = 1.53, p .05 and (M = 0.5, s = .93) nor in the Activist category t(7) = 1.69, p .05 and (M = 1.63, s = 2.72), or Entrepreneur category t(7) = 1.53, p .05 and (M = 1.75, s = 3.24)
Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises
© 2017 Sara N. Goldhaber-Fiebert, Carl Macrae How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care
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Estimating the Cost of Cervical Cancer Screening in Five Developing Countries
Background: Cost-effectiveness analyses (CEAs) can provide useful information to policymakers concerned with the broad allocation of resources as well as to local decision makers choosing between different options for reducing the burden from a single disease. For the latter, it is important to use country-specific data when possible and to represent cost differences between countries that might make one strategy more or less attractive than another strategy locally. As part of a CEA of cervical cancer screening in five developing countries, we supplemented limited primary cost data by developing other estimation techniques for direct medical and non-medical costs associated with alternative screening approaches using one of three initial screening tests: simple visual screening, HPV DNA testing, and cervical cytology. Here, we report estimation methods and results for three cost areas in which data were lacking. Methods: To supplement direct medical costs, including staff, supplies, and equipment depreciation using country-specific data, we used alternative techniques to quantify cervical cytology and HPV DNA laboratory sample processing costs. We used a detailed quantity and price approach whose face validity was compared to an adaptation of a US laboratory estimation methodology. This methodology was also used to project annual sample processing capacities for each laboratory type. The cost of sample transport from the clinic to the laboratory was estimated using spatial models. A plausible range of the cost of patient time spent seeking and receiving screening was estimated using only formal sector employment and wages as well as using both formal and informal sector participation and country-specific minimum wages. Data sources included primary data from country-specific studies, international databases, international prices, and expert opinion. Costs were standardized to year 2000 international dollars using inflation adjustment and purchasing power parity. Results: Cervical cytology laboratory processing costs were I1.58–3.02 from the face validation method. HPV DNA processing costs were I0.12–0.64 and I0.42–0.83 and I0.07–4.16, increasing to I0.68–17.74. With the total cost of screening for cytology and HPV DNA testing ranging from I11.30–48.77 respectively, the cost of the laboratory transport, processing, and patient time accounted for 26–66% and 33–65% of the total costs. From a payer perspective, laboratory transport and processing accounted for 18–48% and 25–60% of total direct medical costs of I10.57–28.18 respectively. Conclusion: Cost estimates of laboratory processing, sample transport, and patient time account for a significant proportion of total cervical cancer screening costs in five developing countries and provide important inputs for CEAs of alternative screening modalities
Calculating the Expected Value of Sample Information in Practice: Considerations from Three Case Studies
Investing efficiently in future research to improve policy decisions is an
important goal. Expected Value of Sample Information (EVSI) can be used to
select the specific design and sample size of a proposed study by assessing the
benefit of a range of different studies. Estimating EVSI with the standard
nested Monte Carlo algorithm has a notoriously high computational burden,
especially when using a complex decision model or when optimizing over study
sample sizes and designs. Therefore, a number of more efficient EVSI
approximation methods have been developed. However, these approximation methods
have not been compared and therefore their relative advantages and
disadvantages are not clear. A consortium of EVSI researchers, including the
developers of several approximation methods, compared four EVSI methods using
three previously published health economic models. The examples were chosen to
represent a range of real-world contexts, including situations with multiple
study outcomes, missing data, and data from an observational rather than a
randomized study. The computational speed and accuracy of each method were
compared, and the relative advantages and implementation challenges of the
methods were highlighted. In each example, the approximation methods took
minutes or hours to achieve reasonably accurate EVSI estimates, whereas the
traditional Monte Carlo method took weeks. Specific methods are particularly
suited to problems where we wish to compare multiple proposed sample sizes,
when the proposed sample size is large, or when the health economic model is
computationally expensive. All the evaluated methods gave estimates similar to
those given by traditional Monte Carlo, suggesting that EVSI can now be
efficiently computed with confidence in realistic examples.Comment: 11 pages, 3 figure
Providers' knowledge of diagnosis and treatment of tuberculosis using vignettes:Evidence from rural Bihar, India
BACKGROUND: Almost 25% of all new cases of tuberculosis (TB) worldwide are in India, where drug resistance and low quality of care remain key challenges.
METHODS: We conducted an observational, cross-sectional study of healthcare providers' knowledge of diagnosis and treatment of TB in rural Bihar, India, from June to September 2012. Using data from vignette-based interviews with 395 most commonly visited healthcare providers in study areas, we scored providers' knowledge and used multivariable regression models to examine their relationship to providers' characteristics.
FINDINGS: 80% of 395 providers had no formal medical qualifications. Overall, providers demonstrated low levels of knowledge: 64.9% (95% CI 59.8% to 69.8%) diagnosed correctly, and 21.7% (CI 16.8% to 27.1%) recommended correct treatment. Providers seldom asked diagnostic questions such as fever (31.4%, CI 26.8% to 36.2%) and bloody sputum (11.1%, CI 8.2% to 14.7%), or results from sputum microscopy (20.0%, CI: 16.2% to 24.3%). After controlling for whether providers treat TB, MBBS providers were not significantly different, from unqualified providers or those with alternative medical qualifications, on knowledge score or offering correct treatment. MBBS providers were, however, more likely to recommend referrals relative to complementary medicine and unqualified providers (23.2 and 37.7 percentage points, respectively).
INTERPRETATION: Healthcare providers in rural areas in Bihar, India, have low levels of knowledge regarding TB diagnosis and treatment. Our findings highlight the need for policies to improve training, incentives, task shifting and regulation to improve knowledge and performance of existing providers. Further, more research is needed on the incentives providers face and the role of information on quality to help patients select providers who offer higher quality care
Committing to Exercise: Contract Design for Virtuous Habit Formation
Sedentary lifestyles, obesity, and obesity-related chronic diseases have become increasingly common among U.S. adults, posing a major health policy challenge. While individuals may be interested in exercising more to reduce these health risks, they often have difficultly forming long-term exercise habits. Behavioral economic devices like commitment contracts aid individuals make repeated actions in situations where there are upfront costs and the benefits, though substantial, are delayed. It is not known whether such contracts can help individuals to sustain increased exercise. We conducted a randomized controlled trial to test whether nudges and anchoring could be used to shift the types of exercise commitment contracts people entered into using a web-based contract creation tool. At the time of contract creation, users selected a contract length (duration); number of times a week to exercise (frequency); and a financial penalty for failing to live up to the contract in a given week (stake). We randomly set the default duration shown to users (8 weeks, 12 weeks, or 16 weeks). Outcomes include: contract acceptance; chosen duration, frequency, total exercise sessions; and chosen financial stake. We analyzed the data using multivariable regressions and also developed a theoretical model of active choice in the context of nudges, fitting the model to the data using non-linear optimization. 619 users, age 18-69, were included in the study, of whom 61% accepted/signed an exercise commitment contract. Users who were shown a longer default contract durations were significantly more likely to choose a contract of longer duration. There was no difference in the likelihood of accepting contracts or in the chosen exercise frequency or financial stakes. Our model of active choice suggested that almost 50% of users were highly susceptible to default values for contract duration, with the greatest effect for users interested in exercise contracts with durations nearer to the nudged defaults. This implication of the model was confirmed by quantile regressions (greatest effect of nudges for contract durations between the 40th and 80th percentiles). With changes in default values, individuals can be nudged into longer exercise commitment contracts that obligate them to greater numbers of exercise sessions.
Cost Effectiveness of Fibrosis Assessment Prior to Treatment for Chronic Hepatitis C Patients
Chronic hepatitis C (HCV) is a liver disease affecting over 3 million Americans. Liver biopsy is the gold standard for assessing liver fibrosis and is used as a benchmark for initiating treatment, though it is expensive and carries risks of complications. FibroTest is a non-invasive biomarker assay for fibrosis, proposed as a screening alternative to biopsy.We assessed the cost-effectiveness of FibroTest and liver biopsy used alone or sequentially for six strategies followed by treatment of eligible U.S. patients: FibroTest only; FibroTest with liver biopsy for ambiguous results; FibroTest followed by biopsy to rule in; or to rule out significant fibrosis; biopsy only (recommended practice); and treatment without screening. We developed a Markov model of chronic HCV that tracks fibrosis progression. Outcomes were expressed as expected lifetime costs (2009 USD), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICER).Treatment of chronic HCV without fibrosis screening is preferred for both men and women. For genotype 1 patients treated with pegylated interferon and ribavirin, the ICERs are 6,300/QALY (women) compared to FibroTest only; the ICERs increase to 30,000/QALY (women) with the addition of telaprevir. For genotypes 2 and 3, treatment is more effective and less costly than all alternatives. In clinical settings where testing is required prior to treatment, FibroTest only is more effective and less costly than liver biopsy. These results are robust to multi-way and probabilistic sensitivity analyses.Early treatment of chronic HCV is superior to the other fibrosis screening strategies. In clinical settings where testing is required, FibroTest screening is a cost-effective alternative to liver biopsy
Multi-Country analysis of palm oil consumption and cardiovascular disease mortality for countries at different stages of economic development: 1980-1997
<p>Abstract</p> <p>Background</p> <p>Cardiovascular diseases represent an increasing share of the global disease burden. There is concern that increased consumption of palm oil could exacerbate mortality from ischemic heart disease (IHD) and stroke, particularly in developing countries where it represents a major nutritional source of saturated fat.</p> <p>Methods</p> <p>The study analyzed country-level data from 1980-1997 derived from the World Health Organization's Mortality Database, U.S. Department of Agriculture international estimates, and the World Bank (234 annual observations; 23 countries). Outcomes included mortality from IHD and stroke for adults aged 50 and older. Predictors included per-capita consumption of palm oil and cigarettes and per-capita Gross Domestic Product as well as time trends and an interaction between palm oil consumption and country economic development level. Analyses examined changes in country-level outcomes over time employing linear panel regressions with country-level fixed effects, population weighting, and robust standard errors clustered by country. Sensitivity analyses included further adjustment for other major dietary sources of saturated fat.</p> <p>Results</p> <p>In developing countries, for every additional kilogram of palm oil consumed per-capita annually, IHD mortality rates increased by 68 deaths per 100,000 (95% CI [21-115]), whereas, in similar settings, stroke mortality rates increased by 19 deaths per 100,000 (95% CI [-12-49]) but were not significant. For historically high-income countries, changes in IHD and stroke mortality rates from palm oil consumption were smaller (IHD: 17 deaths per 100,000 (95% CI [5.3-29]); stroke: 5.1 deaths per 100,000 (95% CI [-1.2-11.0])). Inclusion of other major saturated fat sources including beef, pork, chicken, coconut oil, milk cheese, and butter did not substantially change the differentially higher relationship between palm oil and IHD mortality in developing countries.</p> <p>Conclusions</p> <p>Increased palm oil consumption is related to higher IHD mortality rates in developing countries. Palm oil consumption represents a saturated fat source relevant for policies aimed at reducing cardiovascular disease burdens.</p
Cost-effectiveness of a Pharmacogenomic Test for Stratified Isoniazid Dosing in Treatment of Active Tuberculosis
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