Health claims and observational human data: relation between dietary fat and cancer. (1/977)

The US Food and Drug Administration review that provided the basis for authorizing a food-label health claim linking the risk of cancer to dietary fat intake illustrated several considerations in the use of epidemiologic data, and observational data in particular, to support dietary recommendations. The review suggested the need for clear and established criteria for judging the quality of observational human data as well as the importance of making the evaluation process for individual studies transparent and organized. The review, which provided for a claim in the absence of controlled human studies, also suggested that observational data may play a greater role when the nature of the relation to be described by a health-claim statement is broad and general rather than targeted and specific. Of particular importance was the relevance of available data to the questions inherent in showing a diet-disease relation, the need to consider the totality of the evidence, and the key role that existing authoritative reports must play in establishing the basis for relation.  (+info)

Qualitative methods: what are they and why use them? (2/977)

OBJECTIVE: To provide an overview of reasons why qualitative methods have been used and can be used in health services and health policy research, to describe a range of specific methods, and to give examples of their application. DATA SOURCES: Classic and contemporary descriptions of the underpinnings and applications of qualitative research methods and studies that have used such methods to examine important health services and health policy issues. PRINCIPAL FINDINGS: Qualitative research methods are valuable in providing rich descriptions of complex phenomena; tracking unique or unexpected events; illuminating the experience and interpretation of events by actors with widely differing stakes and roles; giving voice to those whose views are rarely heard; conducting initial explorations to develop theories and to generate and even test hypotheses; and moving toward explanations. Qualitative and quantitative methods can be complementary, used in sequence or in tandem. The best qualitative research is systematic and rigorous, and it seeks to reduce bias and error and to identify evidence that disconfirms initial or emergent hypotheses. CONCLUSIONS: Qualitative methods have much to contribute to health services and health policy research, especially as such research deals with rapid change and develops a more fully integrated theory base and research agenda. However, the field must build on the best traditions and techniques of qualitative methods and must recognize that special training and experience are essential to the application of these methods.  (+info)

Should we establish chest pain observation units in the UK? A systematic review and critical appraisal of the literature. (3/977)

OBJECTIVES: The chest pain observation unit (CPOU) has been developed in the United States to allow rigorous assessment of patients presenting with chest pain, thus expediting their discharge if assessment is negative. This review aims to examine the evidence for effectiveness and economic efficiency of the CPOU and to explore whether data from the United States can be extrapolated to the UK. METHOD: Search of the literature using Medline and critical appraisal of the validity of the data. RESULTS: Five studies comparing outcomes of CPOU care with routine practice showed no significant difference in objective measures including mortality or missed pathology. Eleven studies described outcomes of a cohort of CPOU patients. Follow up was comprehensive and demonstrated no clinically significant evidence of missed pathology. Nine studies comparing CPOU costs with routine care demonstrated impressive cost savings that were more modest when randomised comparisons were made. CONCLUSION: CPOU care is safe and costs are well defined. There is no strong evidence that a CPOU will improve outcomes if routine practice is good. Cost savings have been shown when compared with routine care in the United States but may not be reproduced the UK.  (+info)

Representation of actions in rats: the role of cerebellum in learning spatial performances by observation. (4/977)

Experimental evidence demonstrates that cerebellar networks are involved in spatial learning, controlling the acquisition of exploration strategies without blocking motor execution of the task. Action learning by observation has been considered somehow related to motor physiology, because it provides a way of learning performances that is almost as effective as the actual execution of actions. Neuroimaging studies demonstrate that observation of movements performed by others, imagination of actions, and actual execution of motor performances share common neural substrates and that the cerebellum is among these shared areas. The present paper analyzes the effects of observation in learning a spatial task, focusing on the cerebellar role in learning a spatial ability through observation. We allowed normal rats to observe 200 Morris water maze trials performed by companion rats. After this observation training, "observer" rats underwent a hemicerebellectomy and then were tested in the Morris water maze. In spite of the cerebellar lesion, they displayed no spatial defects, exhibiting exploration abilities comparable to controls. When the cerebellar lesion preceded observation training, a complete lack of spatial observational learning was observed. Thus, as demonstrated already for the acquisition of spatial procedures through actual execution, cerebellar circuits appear to play a key role in the acquisition of spatial procedures also through observation. In conclusion, the present results provide strong support for a common neural basis in the observation of actions that are to be reproduced as well as in the actual production of the same actions.  (+info)

Egg brooding by deep-sea octopuses in the North Pacific Ocean. (5/977)

Videotapes made from the submersible Alvin on Baby Bare, a 2600-m-deep North Pacific basalt outcrop, and at two other deep-sea localities document that octopuses of the genera Graneledone and Benthoctopus attach their eggs to hard substrate and apparently brood them through development. The behavior of brooding females was generally similar to that of shallow-water octopuses, but the genera showed apparent differences. In addition to the high density of brooding females observed at Baby Bare, which may relate to the increased availability of exposed hard substrates for egg attachment and of prey, females are suggested to increasingly associate with hard substrates as they mature. The biology of Baby Bare may seem unduly unique because the outcrop is isolated on a sedimented plain and is among the few exposures of hard substrate other than hydrothermal vents that have been explored by submersible. On the sediment-covered ocean floor, the availability of hard substrate may strongly affect the distribution of brooding octopuses. The size and shape of boreholes in 19 of over 400 thyasirid clam shells collected from Baby Bare support the hypothesis that octopuses had preyed upon the clams.  (+info)

Watching anaesthetists work: using the professional judgement of consultants to assess the developing clinical competence of trainees. (6/977)

One of the responsibilities of a consultant is to identify the clinical competence of trainees by observing them at work. The attributes of clinical competence in anaesthesia were defined by interviewing a group of consultants and trainees. Observation of practice was believed to be important in monitoring competence and the supervising consultants all believed that they could recognize competent performance. The account of the structure of observation provided by the anaesthetists is used as the basis of advice on how to conduct an assessment of trainees' developing professionalism by use of the specialist's professional judgement.  (+info)

Teaching basic skills to children with Down syndrome and developmental delays: the relative efficacy of interactive modeling with social rewards for benchmark achievements and passive observation. (7/977)

In interventions attempting to remediate deficiencies in the skills repertoire of developmentally delayed children, no less than in medical interventions, it may be fairly said that less is more. That is, the instructor should intervene as little as possible both from the perspective of efficient instructional practice and from time allotment concerns which modern classrooms face. Evidence from this laboratory has indicated that in skills training for children with severe developmental delays the passive observation of a model demonstrating the target skill is more effective than interactive modeling involving hand-over-hand instruction with verbal prompting. We have considered the role of verbal prompting in interactive modeling and have found that prompts intended to provide typical social reinforcers are counterproductive (e.g., Biederman, Davey, Ryder, & Franchi, 1994). The present study examines the efficacy of hand-over-hand modeling with response-contingent verbal prompts. In such instruction, tasks are divided into identifiable sequential components, and the achievement of each component is marked by the delivery of some form of verbal prompt. In a within-subjects design, children were trained in one skill with response-contingent verbal prompts and in a second skill with simple passive observation. A separate group of children were trained with less rigorous verbal prompting in one skill and with passive observation in a second. Consistent with previous research, we found that passive modeling was overall significantly more effective than hand-over-hand modeling and moreover that passive modeling was significantly more effective than hand-over-hand modeling with response-contingent prompting. Our evidence therefore indicates that current classroom practice in training basic skills to children with severe developmental delays may require reassessment in that simple observation of modeled skills appears to be more effective than more labor-intensive instruction.  (+info)

A participant observation study using actors at 30 publicly funded HIV counseling and testing sites in Pennsylvania. (8/977)

OBJECTIVES: This study was designed to augment an evaluation of Pennsylvania publicly funded HIV counseling and testing sites, particularly of the staff-client interaction. METHODS: Actors were trained as research assistants and sent to 30 randomly chosen sites to be tested and counseled for HIV disease. Instruments based on Centers for Disease Control and Prevention (CDC) guidelines were designed and used to evaluate them. RESULTS: Data were generated that identified the range of compliance with CDC guidelines and state policy. Among the findings were that 10 of 30 sites required signed consents despite a state policy allowing anonymous testing. Only 17% of providers developed a written risk reduction plan, even though 69% of all sites surveyed by mail asserted that such plans were developed. Only 2 of 5 HIV-positive actors were offered partner notification services, even though 100% of sites visited by an interviewer claimed to offer such services. CONCLUSIONS: The findings suggest that although evaluation methods such as mail surveys and site visits are useful for evaluating the existence of appropriate policies and protocols and gathering baseline data, they might not be sufficient for assessing actual staff-client interaction.  (+info)