What Can We Learn From the Existing Evidence of the Business Case for Investments in Nursing Care: Importance of Content, Context, and Policy Environment

Decisions of health care institutions to invest in nursing care are often guided by mixed and conflicting evidence of effects of the investments on organizational function and sustainability. This paper uses new evidence generated through Interdisciplinary Nursing Quality Research Initiative (INQRI)-funded research and published in peer-reviewed journals, to illustrate where the business case for nursing investments stands and to discuss factors that may limit the existing evidence and its transferability into clinical practice. We conclude that there are 3 limiting factors: (1) the existing business case for nursing investments is likely understated due to the inability of most studies to capture spillover and long-run dynamic effects, thus causing organizations to forfeit potentially viable nursing investments that may improve long-term financial stability; (2) studies rarely devote sufficient attention to describing the content and the organization-specific contextual factors, thus limiting generalizability; and (3) fragmentation of the current health care delivery and payment systems often leads to the financial benefits of investments in nursing care accruing outside of the organization incurring the costs, thus making potentially quality-improving and cost-saving interventions financially unattractive from the organization\u27s perspective. The payment reform, with its emphasis on high-quality affordable patient-centered care, is likely to strengthen the business case for investments in nursing care. Methodologically rigorous approaches that focus on broader societal implications of investments in nursing care, combined with a thorough understanding of potential barriers and facilitators of nursing change, should be an integral part of future research and policy efforts

A study on the bending of laminated glass under blast loading

Background: The bending behaviour of laminated glass plays an important role in determining its overall response to blast loading. It is costly and difficult to characterise the bending behaviour by carrying out full-scale blast tests, therefore an alternative method is required. Objective: The objective of this study is to understand the response of laminated glass under high-rate bending in the laboratory at rates representative of blast loading. Methods: In this paper a novel testing method is presented in which laminated glass strips of 700 mm long by 60 mm wide are tested up to speeds of 10 m/s in the laboratory. The laminated glass is accelerated to speeds comparable to blast loading and then brought to rest at its edges to mimic impulsive blast loading conditions. Different interlayer thickness, impact speeds, and boundary conditions were explored. Additionally, modelling methods were used to study the flexural rigidity of post-cracked laminated glass. Results: From the experiments it was found that the interlayer thickness plays a key role in determining whether the dominant failure mechanism is de-bonding of interlayer from the glass or interlayer tearing. In addition, it was found that by allowing the frame to bend under loading, the laminated glass can carry greater loads without failure. Finally, an iterative method was used to quantify the flexural rigidity of post-cracked laminated glass depending on the speed of travel. This is a novel finding as it is usually assumed that laminated glass behaves like a membrane in the post-cracked phase of the response. Conclusion: In modelling and design of laminated glass structures under blast loading, post-crack flexural rigidity must be taken into account. Additionally, having novel frame designs to add further load bearing capacity to the framing members, plays a key role in reducing the load intensity on the laminated glass structure

Temperature effects on laminated glass at high rate

The load bearing capacity of a laminated glass pane changes with temperature. In blast protection, laminated glass panes with a Polyvinyl Butyral (PVB) interlayer are usually employed. The post-crack response of the laminated pane is determined by the interlayer material response and its bond to the glass plies. An experimental study has been performed to determine the effects of temperature on the post cracked response of laminated glass at a test rate of 1 m/s for PVB thicknesses of 0.76 mm, 1.52 mm and 2.28 mm. Tensile tests were carried out on single cracked and randomly cracked samples in a temperature range of 0 °C–60 °C. Photoelasticity observation and high speed video recording were used to capture the delamination in the single cracked tests. Competing mechanisms of PVB compliance and the adhesion between the glass and PVB, were revealed. The adhesion showed an increase at lower temperatures, but the compliance of the PVB interlayer was reduced. Based on the interlayer thickness range tested, the post-crack response of laminated glass is shown to be thickness dependent

Putting theory oriented evaluation into practice

Evaluations of gaming simulations and business games as teaching devices are typically end-state driven. This emphasis fails to detect how the simulation being evaluated does or does not bring about its desired consequences. This paper advances the use of a logic model approach which possesses a holistic perspective that aims at including all elements associated with the situation created by a game. The use of the logic model approach is illustrated as applied to Simgame, a board game created for secondary school level business education in six European Union countries

Identification of complex health interventions suitable for evaluation: development and validation of the 8-step scoping framework

Background: There is extensive literature on the methodology of evaluation research and the development and evaluation of complex interventions but little guidance on the formative stages before evaluation and how to work with partner organizations that wish to have their provision evaluated. It is important to be able to identify suitable projects for evaluation from a range of provision and describe the steps required, often with academic institutions working in partnership with external organizations, in order to set up an evaluation. However, research evaluating programs or interventions rarely discusses these stages. Objective: This study aimed to extend work on evaluability assessment and pre-evaluation planning by proposing an 8-Step Scoping Framework to enable the appraisal of multiple programs in order to identify interventions suitable for evaluation. We aimed to add to the literature on evaluability assessment and more recent evaluation guidance by describing the processes involved in working with partner organizations. Methods: This paper documents the steps required to identify multiple complex interventions suitable for process and outcome evaluation. The steps were developed using an iterative approach by working alongside staff in a local government organization, to build an evidence base to demonstrate which interventions improve children’s outcomes. The process of identifying suitable programs for evaluation, thereby establishing the pre-evaluation steps, was tested using all Flying Start provision. Results: The 8-Step Scoping Framework was described using the example of the local government organization Flying Start to illustrate how each step contributes to finding projects suitable for process and outcome evaluation: (1) formulating overarching key questions that encompass all programs offered by an organization, (2) gaining an in-depth understanding of the work and provision of an organization and engaging staff, (3) completing a data template per project/program offered, (4) assessing the robustness/validity of data across all programs, (5) deciding on projects suitable for evaluation and those requiring additional data, (6) negotiating with chosen project leads, both within and outside the organization, (7) developing individual project evaluation protocols, and (8) applying for ethical approval from the university and partner organization. Conclusions: This paper describes the processes involved in identifying suitable projects for evaluation. It adds to the existing literature on the assessment of specific programs suitable for evaluation and guidance for conducting evaluations by establishing the formative steps required to identify suitable programs from a range of provision. This scoping framework particularly relates to academic partners and organizations tasked with delivering evidence-based services designed to meet local needs. The steps identified have been described in the context of early years provision but can be applied to a range of community-based evaluations, or more generally, to cases where an academic partner is working with external stakeholders to identify projects suitable for academic evaluation

A systematic review of sport-based life skills programs for young people: The quality of design and evaluation methods

Over the past two decades, researchers have reported positive life skills outcomes for young people participating in sport-based lifeskills programs. However, to date, there has been a lack of consideration in the literature regarding the quality of the programs designed and the evaluation methods adopted. Therefore, we conducted a systematic review of the life skills literature to: (a) assess the quality of sport-based life skills program design and evaluation methods; and (b) identify characteristics relating to the quality of sport-based life skills programs where authors had evidenced life skills development and transfer. Using the PRISMA guidelines, we searched six databases for relevant research papers and applied inclusion and exclusion criteria to the papers returned, of which 15 papers met the criteria. We conducted two quality assessment exercises (design and evaluation methods) and found three moderate high quality life skills programs, 11 moderate quality programs, and one low quality program. We present the characteristics (regarding quality) of intervention designs and methods, conclude with recommendations for designing quality sport-based life skills programs, and provide guidelines for researchers to evaluate sport-based life skills programs. Lay summary: Through engaging in sport-based life skills programs, young people can develop transferable skills. However, the quality of these life skills programs is unclear. We assess the quality of the design and evaluation methods of sport-based life skills programs, present the characteristics of moderate-high and moderate quality programs, and offer recommendations for future research and practice

Bronchial artery embolization for management of massive cryptogenic hemoptysis: a case series

<p>Abstract</p> <p>Introduction</p> <p>Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. In cases of idiopathic hemoptysis, in which no underlying pulmonary pathology can be identified, treatment is challenging. We report our experience with bronchial artery embolization in the treatment of massive idiopathic hemoptysis.</p> <p>Cases presentation</p> <p>We report three consecutive cases of acute severe idiopathic hemoptysis. Our patients (two men aged 51 and 56 years and one woman aged 46 years), were of Caucasian ethnicity. We discuss the results and management of the patients, and review the literature. All three patients were treated safely and successfully with transcatheter embolization of the bronchial arteries using tris-acryl gelatin microspheres. Hemoptysis was controlled. All cases were followed up for 12 months, and there was no recurrence of bleeding.</p> <p>Conclusion</p> <p>Bronchial artery embolization is an effective tool for the evaluation and treatment of massive idiopathic hemoptysis.</p

Extent and patterns of community collaboration in local health departments: An exploratory survey

<p>Abstract</p> <p>Background</p> <p>Local public health departments (LHDs) in the United States have been encouraged to collaborate with various other community organizations and individuals. Current research suggests that many forms of active partnering are ongoing, and there are numerous examples of LHD collaboration with a specific organization for a specific purpose or program. However, no existing research has attempted to characterize collaboration, for the defined purpose of setting community health status priorities, between a defined population of local officials and a defined group of alternative partnering organizations. The specific aims of this study were to 1) determine the range of collaborative involvement exhibited by a study population of local public health officials, and, 2) characterize the patterns of the selection of organizations/individuals involved with LHDs in the process of setting community health status priorities.</p> <p>Methods</p> <p>Local health department officials in North Carolina (n = 53) responded to an exploratory survey about their levels of involvement with eight types of possible collaborator organizations and individuals. Descriptive statistics and the stochastic clustering technique of Self-Organizing Maps (SOM) were used to characterize their collaboration.</p> <p>Results</p> <p>Local health officials vary extensively in their level of collaboration with external collaborators. While the range of total involvement varies, the patterns of involvement for this specific function are relatively uniform. That is, regardless of the total level of involvement (low, medium or high), officials maintain similar hierarchical preference rankings with Community Advisory Boards and Local Boards of Health most involved and Experts and Elected Officials least involved.</p> <p>Conclusion</p> <p>The extent and patterns of collaboration among LHDs with other community stakeholders for a specific function can be described and ultimately related to outcome measures of LHD performance.</p

Consumer satisfaction with primary care provider choice and associated trust

BACKGROUND: Development of managed care, characterized by limited provider choice, is believed to undermine trust. Provider choice has been identified as strongly associated with physician trust. Stakeholders in a competitive healthcare market have competing agendas related to choice. The purpose of this study is to analyze variables associated with consumer's satisfaction that they have enough choice when selecting their primary care provider (PCP), and to analyze the importance of these variables on provider trust. METHODS: A 1999 randomized national cross-sectional telephone survey conducted of United States residential households, who had a telephone, had seen a medical professional at least twice in the past two years, and aged ≥ 20 years was selected for secondary data analyses. Among 1,117 households interviewed, 564 were selected as the final sample. Subjects responded to a core set of questions related to provider trust, and a subset of questions related to trust in the insurer. A previously developed conceptual framework was adopted. Linear and logistic regressions were performed based on this framework. RESULTS: Results affirmed 'satisfaction with amount of PCP choice' was significantly (p < .001) associated with provider trust. 'PCP's care being extremely effective' was strongly associated with 'satisfaction with amount of PCP choice' and 'provider trust'. Having sought a second opinion(s) was associated with lower trust. 'Spoke to the PCP outside the medical office,' 'satisfaction with the insurer' and 'insurer charges less if PCP within network' were all variables associated with 'satisfaction with amount of PCP choice' (all p < .05). CONCLUSION: This study confirmed the association of 'satisfaction with amount of PCP choice' with provider trust. Results affirmed 'enough PCP choice' was a strong predictor of provider trust. 'Second opinion on PCP' may indicate distrust in the provider. Data such as 'trust in providers in general' and 'the role of provider performance information' in choice, though import in PCP choice, were not available for analysis and should be explored in future studies. Results have implications for rethinking the relationships among consumer choice, consumer behaviors in making trade-offs in PCP choice, and the role of healthcare experiences in 'satisfaction with amount of PCP choice' or 'provider trust.