THE DESIGN AND ANALYSIS OF EXPERIMENTS. By Oscar Kempthorne. New York, John Wiley and Sons, Inc., 1952. 631 pp. $8.50. This book by a teacher of statistics (as well as a consultant for \"experimenters\") is a comprehensive study of the philosophical background for the statistical design of experiment. It is necessary to have some facility with algebraic notation and manipulation to be able to use the volume intelligently. The problems are presented from the theoretical point of view, without such practical examples as would be helpful for those not acquainted with mathematics. The mathematical justification for the techniques is given. As a somewhat advanced treatment of the design and analysis of experiments, this volume will be interesting and helpful for many who approach statistics theoretically as well as practically. With emphasis on the \"why,\" and with description given broadly, the author relates the subject matter to the general theory of statistics and to the general problem of experimental inference. MARGARET J. ROBERTSON

The Design and Analysis of Experiments

Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.

According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Out of the Crisis

Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research question which will further develop the knowledge base. However, traditional 'narrative' reviews frequently lack thoroughness, and in many cases are not undertaken as genuine pieces of investigatory science. Consequently they can lack a means for making sense of what the collection of studies is saying. These reviews can be biased by the researcher and often lack rigour. Furthermore, the use of reviews of the available evidence to provide insights and guidance for intervention into operational needs of practitioners and policymakers has largely been of secondary importance. For practitioners, making sense of a mass of often-contradictory evidence has become progressively harder. The quality of evidence underpinning decision-making and action has been questioned, for inadequate or incomplete evidence seriously impedes policy formulation and implementation. In exploring ways in which evidence-informed management reviews might be achieved, the authors evaluate the process of systematic review used in the medical sciences. Over the last fifteen years, medical science has attempted to improve the review process by synthesizing research in a systematic, transparent, and reproducible manner with the twin aims of enhancing the knowledge base and informing policymaking and practice. This paper evaluates the extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research. The paper highlights the challenges in developing an appropriate methodology.

Towards a Methodology for Developing Evidence-Informed Management Knowledge by Means of Systematic Review

Undertaking a review of the literature is an important part of any research project. The researcher both maps and assesses the relevant intellectual territory in order to specify a research question which will further develop the knowledge hase. However, traditional 'narrative' reviews frequently lack thoroughness, and in many cases are not undertaken as genuine pieces of investigatory science. Consequently they can lack a means for making sense of what the collection of studies is saying. These reviews can he hiased by the researcher and often lack rigour. Furthermore, the use of reviews of the available evidence to provide insights and guidance for intervention into operational needs of practitioners and policymakers has largely been of secondary importance. For practitioners, making sense of a mass of often-contrad ictory evidence has hecome progressively harder. The quality of evidence underpinning decision-making and action has heen questioned, for inadequate or incomplete evidence seriously impedes policy formulation and implementation. In exploring ways in which evidence-informed management reviews might be achieved, the authors evaluate the process of systematic review used in the medical sciences. Over the last fifteen years, medical science has attempted to improve the review process hy synthesizing research in a systematic, transparent, and reproducihie manner with the twin aims of enhancing the knowledge hase and informing policymaking and practice. This paper evaluates the extent to which the process of systematic review can be applied to the management field in order to produce a reliable knowledge stock and enhanced practice by developing context-sensitive research. The paper highlights the challenges in developing an appropriate methodology.

The long lag time between medical discovery and when Americans benefit from that discovery has a huge cost in terms of morbidity and mortality. Medicine needs more effective methods for moving discovery to practice. In this article, the authors first offer a critical review of the models of structure and change process gleaned from the physician change literature. Next, they describe the Integrated Systems Model (ISM) that they derive from this review. The ISM has four major components: superstructure, change motivators, change process, and functional interactions. The ISM considers the physician practice to operate as a complex adaptive system requiring diversion of resources from reserves to make a change. In the ISM, resource return is a function of improved quality of care and reimbursement for services. Changes decreasing the resources of the system (parasitic) will be harder to make than those that increase resources (symbiotic) because of resistance to resource loss. The authors extend the ISM to the individual level and describe the need to consider whether individuals within the practice have sufficient reserves to fulfill their part in making the change. Any given change is generally competing with other changes for adoption. Finally, the authors consider the strengths and weaknesses of their model, concluding that by keeping patient welfare, quality care, and finances in the forefront, the ISM provides a more complete picture of forces affecting medical practice change.

Physician practice change I: a critical review and description of an Integrated Systems Model

A model for teaching sophomore medical students the essentials of the male genital-rectal examination.

PURPOSE: To determine whether students' ratings of instruction demonstrate a primary effect, to determine whether the primacy effect relates to the number of response options, and to assess whether the primacy effect relates to how favorably the instructional activity is rated. METHOD: Inf 1995-96 s

The effect of right or left placement of the positive response on Likert-type scales used by medical students for rating instruction

PURPOSE Offices of research in medical education have been in existence since the 1st one was begun by Hale Hamm at Case Western Reserve in 1958. There are now 61 medical schools in North America that have a formal office of medical education (OME) and are part of the Society of Directors of Research in Medical Education (SDRME). The purpose of this study was to report how SDRME and OMEs have contributed to the research in medical education (RIME) efforts. SUMMARY This study reports specific initiatives that have been begun by the SDRME culled from historical documents and business meeting minutes and profiles results of the 2000 biannual membership survey that describe what the individual units are doing in support of their institutions. As an organization, SDRME sponsors literature reviews, 5 of which have been published in peer-reviewed journals. It has also collaborated with the American Medical Association, the National Institutes of Health Bureau of the Health Professions (NIH BHP), and the Association of American Medical Colleges in offering conferences and workshops. SDRME worked with the Macy Foundation on a grant initiative which by November 1993 had established 6 consortia to develop regional centers on clinical competence and with the NIH BHP in the development of a grants program that established centers for RIME. Results from the 2000 membership survey indicate that individual units are heavily tied into evaluation efforts at both the institutional and national levels. Research efforts being engaged by these units have led to a reasonably high, but variable, level of publication activity. The current wave of new curricula being implemented in medical education centers are being heavily supported by these units, with all units being involved in curriculum planning and administration. CONCLUSIONS SDRME has been effective in promoting RIME through sponsoring literature reviews and collaborating with various national organizations. OME units have been effective in serving the needs of their institutions as well as contributing to national research efforts.

Offices of Research in Medical Education: Accomplishments and Added Value Contributions

Because there is an association between the lack of knowledge of normal child development, high and unrealistic expectations for a child's performance, and child abuse, a questionnaire about normal child development, child health maintenance, child discipline aspects of childrearing, and child development was given to a representative sample of high school students in Iowa. Though high school students in Iowa rank high in academic performance, the results of this study indicated that students in grades 9 through 12 had a poor knowledge of child development and child health maintenance. Students whose highest probability of response to a child discipline problem was either to punish or abuse knew less about child development and child health maintenance than their peers. Boys at all grade levels knew less about child development and child health maintenance and were more likely to choose punishment and abuse than girls. Though the causes for child abuse are multifactorial and complex, there is a need to guarantee that all who are at risk for parenthood be informed about child development, child health maintenance, and child discipline to minimize the effects that ignorance of these factors may have on their approaches to discipline and their potential for child abuse. Language: en

Mark A. Albanese

Papers

Physician practice change I: a critical review and description of an Integrated Systems Model

A model for teaching sophomore medical students the essentials of the male genital-rectal examination.

The effect of right or left placement of the positive response on Likert-type scales used by medical students for rating instruction

Offices of Research in Medical Education: Accomplishments and Added Value Contributions

Effect of High School Students' Knowledge of Child Development and Child Health on Approaches to Child Discipline