Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change

Changes in scores on health status questionnaires are difficult to interpret. Several methods to determine minimally important changes (MICs) have been proposed which can broadly be divided in distribution-based and anchor-based methods. Comparisons of these methods have led to insight into essential differences between these approaches. Some authors have tried to come to a uniform measure for the MIC, such as 0.5 standard deviation and the value of one standard error of measurement (SEM). Others have emphasized the diversity of MIC values, depending on the type of anchor, the definition of minimal importance on the anchor, and characteristics of the disease under study. A closer look makes clear that some distribution-based methods have been merely focused on minimally detectable changes. For assessing minimally important changes, anchor-based methods are preferred, as they include a definition of what is minimally important. Acknowledging the distinction between minimally detectable and minimally important changes is useful, not only to avoid confusion among MIC methods, but also to gain information on two important benchmarks on the scale of a health status measurement instrument. Appreciating the distinction, it becomes possible to judge whether the minimally detectable change of a measurement instrument is sufficiently small to detect minimally important changes

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD

A randomized controlled pilot study of a brief web-based mindfulness training

Background: Mindfulness has been shown to be effective in treating various medical and mental problems. Especially its incorporation in cognitive-behavioural interventions has improved long-term outcomes of those treatments. It has also been shown, that brief mindfulness-based trainings are effective in reducing distress. There have been few web-based interventions incorporating mindfulness techniques in their manual and it remains unclear whether a brief web-based mindfulness intervention is feasible. Methods: Out of 50 adults (different distress levels; exclusion criteria: < 18 years, indication of psychotic or suicidal ideation in screening) who were recruited via e-mail and screened online, 49 were randomized into an immediate 2-weeks-treatment group (N = 28) or a waitlist-control group (N = 21), starting with a 2-week delay. Distress (BSI), perceived stress (PSQ), mindfulness (FMI), as well as mood and emotion regulation (PANAS/SEK-27) were measured at pre-, post- and 3-month follow-up (3MFU). Intention-to-treat analyses using MI for missing data and per-protocol analyses (≥ 50% attendance) were performed. Results: 26 participants of the treatment group completed post-measures. Most measures under ITT-analysis revealed no significant improvement for the treatment group, but trends with medium effect sizes for PSQ (d = 0.46) and PANASneg (d = 0.50) and a small, non-significant effect for FMI (d = 0.29). Per-protocol analyses for persons who participated over 50% of the time revealed significant treatment effects for PSQ (d = 0.72) and PANASneg (d = 0.77). Comparing higher distressed participants with lower distressed participants, highly distressed participants seemed to profit more of the training in terms of distress reduction (GSI, d = 0.85). Real change (RCI) occurred for PSQ in the treatment condition (OR = 9). Results also suggest that participants continued to benefit from the training at 3MFU. Conclusion: This study of a brief web-based mindfulness training indicates that mindfulness can be taught online and may improve distress, perceived stress and negative affect for regular users. Although there were no significant improvements, but trends, for most measures under ITT, feasibility of such a program was demonstrated and also that persons continued to use techniques of the training in daily life

Knowledge transfer in Tehran University of Medical Sciences: an academic example of a developing country

<p>Abstract</p> <p>Background</p> <p>In the past two decades, scientific publications in Iran have considerably increased their medical science content, and the number of articles published in ISI journals has doubled between 1997 and 2001. The aim of the present study was to determine how frequently knowledge transfer strategies were applied in Tehran University of Medical Sciences (TUMS). We were also interested in studying the determining factors leading to the type of strategy selected.</p> <p>Methodology</p> <p>All TUMS research projects that had received grants from inside and outside the university in 2004, and were completed by the end of 2006, were included in the study. In total, 301 projects were examined, and data on each of the projects were collected by the research team using a standardized questionnaire. The projects' principle investigators filled out a second questionnaire. In all, 208 questionnaires were collected.</p> <p>Results</p> <p>Researchers stated being more engaged in the passive strategies of knowledge transfer, especially those publishing in peer-reviewed journals. The mean score for the researchers' performance in passive and active strategies were 22% and 9% of the total score, respectively. Linear regression analysis showed that the passive strategy score decreased with the increase in the number of years working as a professional (p = 0.01) and personal interest as the only reason for choosing the research topic (p = 0.01). Regarding the active strategies of knowledge transfer, health system research studies significantly raised the score (p = 0.02) and 'executive responsibility' significantly lowered it (p = 0.03).</p> <p>Conclusion</p> <p>As a study carried out in a Middle Eastern developing country, we see that, like many other universities in the world, many academicians still do not give priority to active strategies of knowledge transfer. Therefore, if 'linking knowledge to action' is necessary, it may also be necessary to introduce considerable changes in academic procedures and encouragement policies (<it>e.g.</it>, employment and promotion criteria of academic members).</p

Knowledge transfer in Tehran University of Medical Sciences: an academic example of a developing country

<p>Abstract</p> <p>Background</p> <p>In the past two decades, scientific publications in Iran have considerably increased their medical science content, and the number of articles published in ISI journals has doubled between 1997 and 2001. The aim of the present study was to determine how frequently knowledge transfer strategies were applied in Tehran University of Medical Sciences (TUMS). We were also interested in studying the determining factors leading to the type of strategy selected.</p> <p>Methodology</p> <p>All TUMS research projects that had received grants from inside and outside the university in 2004, and were completed by the end of 2006, were included in the study. In total, 301 projects were examined, and data on each of the projects were collected by the research team using a standardized questionnaire. The projects' principle investigators filled out a second questionnaire. In all, 208 questionnaires were collected.</p> <p>Results</p> <p>Researchers stated being more engaged in the passive strategies of knowledge transfer, especially those publishing in peer-reviewed journals. The mean score for the researchers' performance in passive and active strategies were 22% and 9% of the total score, respectively. Linear regression analysis showed that the passive strategy score decreased with the increase in the number of years working as a professional (p = 0.01) and personal interest as the only reason for choosing the research topic (p = 0.01). Regarding the active strategies of knowledge transfer, health system research studies significantly raised the score (p = 0.02) and 'executive responsibility' significantly lowered it (p = 0.03).</p> <p>Conclusion</p> <p>As a study carried out in a Middle Eastern developing country, we see that, like many other universities in the world, many academicians still do not give priority to active strategies of knowledge transfer. Therefore, if 'linking knowledge to action' is necessary, it may also be necessary to introduce considerable changes in academic procedures and encouragement policies (<it>e.g.</it>, employment and promotion criteria of academic members).</p

The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study.

A growing body of literature attests to the existence of therapist effects with little explanation of this phenomenon. This study therefore investigated the role of resilience and mindfulness as factors related to practitioner wellbeing and associated effective practice. Data comprised practitioners (n = 37) and their patient outcome data (n = 4980) conducted within a stepped care model of service delivery. Analyses employed benchmarking and multilevel modeling to identify more and less effective practitioners via yoking of therapist factors and nested patient outcomes. A therapist effect of 6.7 % was identified based on patient depression (PHQ-9) outcome scores. More effective practitioners compared to less effective practitioners displayed significantly higher levels of mindfulness as well as resilience and mindfulness combined. Implications for policy, research and practice are discussed

Stochastic Gravity: Theory and Applications

Whereas semiclassical gravity is based on the semiclassical Einstein equation with sources given by the expectation value of the stress-energy tensor of quantum fields, stochastic semiclassical gravity is based on the Einstein-Langevin equation, which has in addition sources due to the noise kernel. In the first part, we describe the fundamentals of this new theory via two approaches: the axiomatic and the functional. In the second part, we describe three applications of stochastic gravity theory. First, we consider metric perturbations in a Minkowski spacetime, compute the two-point correlation functions of these perturbations and prove that Minkowski spacetime is a stable solution of semiclassical gravity. Second, we discuss structure formation from the stochastic gravity viewpoint. Third, we discuss the backreaction of Hawking radiation in the gravitational background of a black hole and describe the metric fluctuations near the event horizon of an evaporating black holeComment: 100 pages, no figures; an update of the 2003 review in Living Reviews in Relativity gr-qc/0307032 ; it includes new sections on the Validity of Semiclassical Gravity, the Stability of Minkowski Spacetime, and the Metric Fluctuations of an Evaporating Black Hol

Stochastic Gravity: Theory and Applications

Whereas semiclassical gravity is based on the semiclassical Einstein equation with sources given by the expectation value of the stress-energy tensor of quantum fields, stochastic semiclassical gravity is based on the Einstein-Langevin equation, which has in addition sources due to the noise kernel.In the first part, we describe the fundamentals of this new theory via two approaches: the axiomatic and the functional. In the second part, we describe three applications of stochastic gravity theory. First, we consider metric perturbations in a Minkowski spacetime: we compute the two-point correlation functions for the linearized Einstein tensor and for the metric perturbations. Second, we discuss structure formation from the stochastic gravity viewpoint. Third, we discuss the backreaction of Hawking radiation in the gravitational background of a quasi-static black hole.Comment: 75 pages, no figures, submitted to Living Reviews in Relativit

Malaria training for community health workers in the setting of elimination: a qualitative study from China

Background: Continuous training of health workers is a key intervention to maintain their good performance and keep their vigilance during malaria elimination programmes. However, countries progressing toward malaria elimination have a largely decreased malaria disease burden, less frequent exposure of health workers to malaria patients, and new challenges in the epidemiology of the remaining malaria cases. Moreover, competing health priorities and usually a decline in resources and in political commitment also pose challenges to the elimination programme. As a consequence, the acceptability, sustainability, and impact of malaria training and education programmes face challenges. However, little is known of the perceptions and expectations of malaria training and education programmes of health workers being engaged in countries with malaria elimination programmes. Methods: This qualitative study provides information on perceptions and expectations of health workers of malaria training programmes from China, which aims to malaria elimination by the year 2020. This study was embedded into a larger study on the challenges and lessons learned during the malaria surveillance strategy in China, involving 42 interviews with malaria experts, health staff, laboratory practitioners, and village doctors at the provincial, city, county, township, and village levels from Gansu province (northwestern China) and Jiangsu province (southeastern China). Results: In the context of an increasing number of imported malaria cases in China, the majority of respondents emphasized the necessity and importance of such programmes and complained about a decreasing frequency of training courses. Moreover, they called for innovative strategies to improve the implementation and sustainability of the malaria training programmes until the elimination goal has been achieved. Perceptions and expectations of health workers from different health centres were quite different. Health workers from higher-level facilities were more concerned about technical training aspects, while health workers from periphery of the health system expected to receive more training on field work coordination and on specific public health actions with regard to case detection and focus investigation. Conclusions: There is need to guarantee an ongoing good training of health workers in China on malaria aspects until the year 2020 and probably beyond