자연주의적 탐구조사(Naturalistic Inquiry)

Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S2

The goals of the …

/pdf/2013-acc-aha-guideline-on-the-treatment-of-blood-cholesterol-pvngcav7fq.pdf

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

Aim. The aim of this paper is to distinguish the integrative review method from other review methods and to propose methodological strategies specific to the integrative review method to enhance the rigour of the process.

Background.  Recent evidence-based practice initiatives have increased the need for and the production of all types of reviews of the literature (integrative reviews, systematic reviews, meta-analyses, and qualitative reviews). The integrative review method is the only approach that allows for the combination of diverse methodologies (for example, experimental and non-experimental research), and has the potential to play a greater role in evidence-based practice for nursing. With respect to the integrative review method, strategies to enhance data collection and extraction have been developed; however, methods of analysis, synthesis, and conclusion drawing remain poorly formulated.

Discussion.  A modified framework for research reviews is presented to address issues specific to the integrative review method. Issues related to specifying the review purpose, searching the literature, evaluating data from primary sources, analysing data, and presenting the results are discussed. Data analysis methods of qualitative research are proposed as strategies that enhance the rigour of combining diverse methodologies as well as empirical and theoretical sources in an integrative review.

Conclusion.  An updated integrative review method has the potential to allow for diverse primary research methods to become a greater part of evidence-based practice initiatives.

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The integrative review: updated methodology

Background Audit and feedback continues to be widely used as a strategy to improve professional practice. It appears logical that healthcare professionals would be prompted to modify their practice if given feedback that their clinical practice was inconsistent with that of their peers or accepted guidelines. Yet, audit and feedback has not been found to be consistently effective. Objectives To assess the effects of audit and feedback on the practice of healthcare professionals and patient outcomes. Search strategy We searched the Cochrane Effective Practice and Organisation of Care Group's register up to January 2001. This was supplemented with searches of MEDLINE and reference lists, which did not yield additional relevant studies. Selection criteria Randomised trials of audit and feedback (defined as any summary of clinical performance over a specified period of time) that reported objectively measured professional practice in a healthcare setting or healthcare outcomes. Data collection and analysis Two reviewers independently extracted data and assessed study quality. Quantitative (meta-regression), visual and qualitative analyses were undertaken. Main results We included 85 studies, 48 of which have been added to the previous version of this review. There were 52 comparisons of dichotomous outcomes from 47 trials with over 3500 health professionals that compared audit and feedback to no intervention. The adjusted RDs of non-compliance with desired practice varied from 0.09 (a 9% absolute increase in non-compliance) to 0.71 (a 71% decrease in non-compliance) (median = 0.07, inter-quartile range = 0.02 to 0.11). The one factor that appeared to predict the effectiveness of audit and feedback across studies was baseline non-compliance with recommended practice. Reviewer's conclusions Audit and feedback can be effective in improving professional practice. When it is effective, the effects are generally small to moderate. The absolute effects of audit and feedback are more likely to be larger when baseline adherence to recommended practice is low.

Audit and feedback: effects on professional practice and healthcare outcomes

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Resource Manual for Nursing Research: Generating and Assessing Evidence for Nursing Practice

Primary objective: The study aim is to explore the perceptions and expectations of seniors in regard to 'smart home' technology installed and operated in their homes with the purpose of improving their quality of life and/or monitoring their health status. Research design and methods: Three focus group sessions were conducted within this pilot study to assess older adults' perceptions of the technology and ways they believe technology can improve their daily lives. Themes discussed in these groups included participants' perceptions of the usefulness of devices and sensors in health-related issues such as preventing or detecting falls, assisting with visual or hearing impairments, improving mobility, reducing isolation, managing medications, and monitoring of physiological parameters. The audiotapes were transcribed and a content analysis was performed. Results: A total of 15 older adults participated in three focus group sessions. Areas where advanced technologies would benefit older adult residents included emergency help, prevention and detection of falls, monitoring of physiological parameters, etc. Concerns were expressed about the user-friendliness of the devices, lack of human response and the need for training tailored to older learners. Conclusions: All participants had an overall positive attitude towards devices and sensors that can be installed in their homes in order to enhance their lives.

Older adults' attitudes towards and perceptions of ‘smart home’ technologies: a pilot study

Systematic review of studies of staffing and quality in nursing homes.

Objectives: The goal of meeting the desire of older adults to remain independent in their home setting while controlling healthcare costs has led to the conceptualization of “smart homes.” A smart home is a residence equipped with technology that enhances safety of residents and monitors their health conditions. The study aim is to assess older adults’ perceptions of specific smart home technologies (i.e., a bed sensor, gait monitor, stove sensor, motion sensor, and video sensor). Methods: The study setting is TigerPlace, a retirement community designed according to the Aging in Place model. Focus group sessions with fourteen residents were conducted to assess perceived advantages and concerns associated with specific applications, and preferences for recipients of sensor-generated information pertaining to residents’ activity levels, sleep patterns and potential emergencies. Sessions were audio-taped; tapes were transcribed, and a content analysis was performed. Results: A total of fourteen older adults over the age of 65 participated in three focus group sessions Most applications were perceived as useful, and participants would agree to their installation in their own home. Preference for specific sensors related to sensors’ appearance and residents’ own level of frailty and perceived need. Specific concerns about privacy were raised. Conclusions: The findings indicate an overall positive attitude toward sensor technologies for nonobtrusive monitoring. Researchers and practitioners are called upon to address ethical and technical challenges in this emerging domain.

Senior residents' perceived need of and preferences for "smart home" sensor technologies.

Background: In meta-analysis, researchers combine the results of individual studies to arrive at cumulative conclusions. Meta-analysts sometimes include “grey literature” in their evidential base, which includes unpublished studies and studies published outside widely available journals. Because grey literature is a source of data that might not employ peer review, critics have questioned the validity of its data and the results of meta-analyses that include it. Objective: To examine evidence regarding whether grey literature should be included in meta-analyses and strategies to manage grey literature in quantitative synthesis. Methods: This article reviews evidence on whether the results of studies published in peer-reviewed journals are representative of results from broader samplings of research on a topic as a rationale for inclusion of grey literature. Strategies to enhance access to grey literature are addressed. Results: The most consistent and robust difference between published and grey literature is that published research is more likely to contain results that are statistically significant. Effect size estimates of published research are about one-third larger than those of unpublished studies. Unfunded and small sample studies are less likely to be published.Yet, importantly, methodological rigor does not differ between published and grey literature. Conclusions: Meta-analyses that exclude grey literature likely (a) over-represent studies with statistically significant findings, (b) inflate effect size estimates, and (c) provide less precise effect size estimates than meta-analyses including grey literature. Metaanalyses should include grey literature to fully reflect the existing evidential base and should assess the impact of methodological variations through moderator analysis.

Grey literature in meta-analyses.

To address an aging population, we have been investigating sensor networks for monitoring older adults in their homes. In this paper, we report ongoing work in which passive sensor networks have been installed in 17 apartments in an aging in place eldercare facility. The network under development includes simple motion sensors, video sensors, and a bed sensor that captures sleep restlessness and pulse and respiration levels. Data collection has been ongoing for over two years in some apartments. This longevity in sensor data collection is allowing us to study the data and develop algorithms for identifying alert conditions such as falls, as well as extracting typical daily activity patterns for an individual. The goal is to capture patterns representing physical and cognitive health conditions and then recognize when activity patterns begin to deviate from the norm. In doing so, we strive to provide early detection of potential problems which may lead to serious health events if left unattended. We describe the components of the network and show examples of logged sensor data with correlated references to health events. A summary is also included on the challenges encountered and the lessons learned as a result of our experiences in monitoring aging adults in their homes.

Marilyn Rantz

Papers

Older adults' attitudes towards and perceptions of ‘smart home’ technologies: a pilot study

Systematic review of studies of staffing and quality in nursing homes.

Senior residents' perceived need of and preferences for "smart home" sensor technologies.

Grey literature in meta-analyses.

A smart home application to eldercare: Current status and lessons learned