摘要:

AbstractA powerful impetus behind the rise of the ‘megatrial’ (a large, simple, usually multi‐centred randomized controlled trial analysed by ‘intention to treat’) has been the desire for ever‐increasing precision in the measurement of therapeutic effectiveness. However, the demand for precision has been allowed to override other and more important methodological considerations. Megatrials have progressively abandoned the pursuit of scientifically rigorous experimentation, valid measurement and optimal epidemiological sampling in favour of recruiting and processing large numbers of subjects. This is a mistaken strategy which leads inevitably to error, because investigators are seeking a primarily statistical, rather than clinically or scientifically relevant, notion of exactness. We are now in a position to describe a clinical research strategy which offers many advantages over a megatrial‐led approach. Research should be planned with an awareness that the validity and applicability of estimates is more important than their numerical precision, and that this requires both an unselected denominator population database ofallincident cases, and maximally controlled randomized trials and other studies. The Population‐Adjusted Clinical Epidemiology (PACE) strategy is suggested as exemplifying the twin principles of clinically useful research: rigorous science and representati

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00040.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractA hand search of the original papers in seven medical journals over 5 years was conducted in order to identify those reporting qualitative research. A total of 210 papers were initially identified, of which 70 used qualitative methods of both data collection and analysis. These papers were evaluated by the researchers using a checklist which specified the criteria of good practice. Overall, 2% of the original papers published in the journals reported qualitative studies. Papers were more frequently positively assessed in terms of having clear aims, reporting research for which a qualitative approach was appropriate and describing their methods of data collection. Papers were less frequently positively assessed in relation to issues of data analysis such as validity, reliability and providing representative supporting evidence. It is concluded that the full potential of qualitative research has yet to be realized in the field of health care.

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00041.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThis paper discusses a series of important methodological issues in developing targeted health‐related quality of life measures in studies of the effects of medical interventions. Such measures cannot be developed unless the evaluator understands the life domains that medical interventions affect. Qualitative discovery methods are needed to obtain this understanding. Once domains are targeted for measurement, careful and systematic laboratory pilot work should be used to select initial scale items. Psychometric evaluation of response patterns in subsequent field tests is needed to assess the measures. Less concern should be directed to internal consistency reliability of scales in the psychometric evaluation and more to the ability of short scales to reproduce total scale variance and to provide precise measurement within the range of the outcome where effects are expected. The paper closes with a discussion of modern methods of item response scaling that can be used to address these issue

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00042.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThis review addresses the uptake and implementation of the principles of audit by community, hospital and health authority pharmacists. The pressures to audit professional services are discussed, as are the barriers to cooperation among pharmacists and between pharmacists and prescribes in primary care. The development of standards of professional practice is then described taking into account the particular difficulty in developing standards for health care workers who are geographically separated from other members of the primary care team and are in commercial competition with each other. The review identifies audit of professional services in both community and hospital pharmacy and of clinical services in the latter. The role of pharmacists employed by health authorities to advise them and general practitioners on the optimum use of the drug budget is described and their potential role for involvement in audit is discussed. The particular advantages that pharmacists in hospital and health authorities have in developing the specific aspect of clinical audit related to medicines usage (drug utilization review) is then described. The potential for pharmacists to contribute to clinical and management audit is discussed.

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00043.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00044.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00045.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThis paper presents an outline of the scope for the application of decision theory to health care. Firstly, the main approaches to and assumptions of decision theory are discussed. Secondly, health care decision making is reviewed. It is noted that decision theory can be applied to either the health care professional or to the lay person. Applications of decision theory to clinical practice, to the management of care and to resourcing are considered. Thirdly, some areas which would repay further research are identified. These include social processes in individual and group decision making, the temporal distribution of outcomes and the development of techniques capable of dealing with the complex and dynamic features of decisions. On the basis of the foregoing, some conclusions are drawn.

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00046.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractThe decisions which health care professionals make are the basis of treatment and care given. In order to evaluate effective care it seems logical to suggest that an awareness of the decisions which health care professionals make and how they make them is needed. This study examines the processes nurses use when making decisions about the health care needs of acutely ill patients. In stage one, 104 qualified nurses were interviewed to identify how they decide health care needs. In stage two, a ‘think aloud’ technique was used with patient simulations to obtain verbal protocols from a further 55 qualified nurses to identify the information strategies they used when making these decisions. The results suggest that nurses base their health care decisions mainly on their assessment of qualitative patient states or conditions. Initial indications are that the processes used differ from those characterized in the diagnostic reasoning model, with the context in which decisions are made being an important influence together with nurses' experience. It is suggested that, in order to develop effective predictive models and clinical guidelines which aid decision making, more research into the nature of health care professionals' decision making is carried

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00047.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractA small‐scale study was undertaken to test the relative predictive power of the Health Belief Model and Subjective Expected Utility Theory for the uptake of a behaviour (pelvic floor exercises) to reduce post‐partum urinary incontinence in primigravida females. A structured questionnaire was used to gather data relevant to both models from a sample of antenatal and postnatal primigravida women. Questions examined the perceived probability of becoming incontinent, the perceived (dis)utility of incontinence, the perceived probability of pelvic floor exercises preventing future urinary incontinence, the costs and benefits of performing pelvic floor exercises and sources of information and knowledge about incontinence. Multiple regression analysis focused on whether or not respondents intended to perform pelvic floor exercises and the factors influencing their decisions. Aggregated data were analysed to compare the Health Belief Model and Subjective Expected Utility Theory direc

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00048.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

AbstractRelatively little is known about how individuals (apart from gay and bisexual men) decide to have an HIV test and how, once they have presented for testing, they make decisions about proceeding through the testing trajectory. This paper reports on a qualitative study in which 55 mainly heterosexual respondents with low HIV risk were interviewed about their experiences of decision making around HIV testing. Reasons for deciding to be tested centred on a desire for reassurance and the circumstances of the respondents' current relationship. The most common relationship reason focused on a desire to confirm HIV status before beginning sexual relations or engaging in unprotected sex with a partner. Although some respondents recognized that other individuals had influenced their decision to be tested, few said that pretest counselling had been influential in this respect. Instead, it was said to have promoted feelings of ‘ownership’ of a decision which had already been taken prior to counselling. The potential effects of HIV testing on HIV risk behaviour were also examined and a non‐significant increase in unprotected sex was reported between the month before the test and the month after. The implications of these findings for the provision of HIV testing services are exp

ISSN:1356-1294    

DOI:10.1111/j.1365-2753.1996.tb00049.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY