Preliminary Indicators Research Articles

Cultural Change: Implementation of a Recovery Program in a Veterans Health Administration Medical Center Inpatient Unit.

The Freedom Commission's recommendations, Substance Abuse and Mental Health Services Administration's framework, and policy directives on recovery-oriented services have fueled the recovery transformation. Mental health recovery services have been implemented in a broad range of outpatient settings. However, psychiatric inpatient units remained embedded in the traditional model of care. The purpose of this article is to describe an ongoing quality improvement implementation of recovery services in a Veterans Health Administration acute psychiatric inpatient unit. An interprofessional Partnership for Wellness delivered 4 to 6 hours per day of evidence-based recovery and holistic population-specific health programs. Veteran, system, and program indicators were measured. Preliminary indicators over a 2-year period suggest that Veterans rated group content and relevance high, pre-post psychiatric rehospitalization rates decreased by 46%, and fidelity to recommended strategies was high. The project success reflects strong leadership, a partnership of committed staff, effective training, and an organizational culture exemplifying excellence in Veteran services and innovation.

Evaluating implementation strategies in a community model to facilitate early identification and treatment of developmental and social-emotional problems in young children in out-of-home placement

Young children who have been removed from their homes and placed in the child welfare system due to abuse and neglect are at high risk for a variety of developmental and social-emotional problems. Research and policies highlight the importance of coordinated efforts to identify early developmental and social-emotional needs and actively link children with needs to recommended services for this high risk population. These efforts often require service systems and programs to employ multiple implementation strategies. Characterizing implementation from these community-driven implementation efforts has the potential to generate generalizable knowledge about the utility, relevance and effectiveness of specific strategies used to promote implementation. In a large metropolitan region, the area's pediatric health care center and county child welfare system collaborated to implement complementary strategies and services to support young children, caregivers and birth parents, in addition to providing social workers with timely evaluations to support their decision making and case planning. The purpose of this study is to (1) retrospectively characterize the specific implementation strategies employed to deliver a coordinated set of evidence-based screening and linkage practices to facilitate identification and treatment of early developmental and social-emotion problems; and (2) examine preliminary indicators of the impact of these strategies. Implications for addressing this at-risk clinical population and advancing implementation science are discussed.

Vocational rehabilitation and business relations: Preliminary indicators of state VR agency capacity

Vocational rehabilitation and business relations: Preliminary indicators of state VR agency capacity

Possible climate change implications for Saudi Arabian meteorology station maximum daily rainfall records

Global and local models of climate change indicate that in many parts of the Arabian Peninsula rainfall increments are expected during this century. The Kingdom of Saudi Arabia (KSA) is also subject to rainfall increases especially in the northern and southwestern high mountainous parts with some local increments and decrements in some other parts. Such impacts are very important, because they are bound to affect also the infrastructure in the urban areas and also engineering water structures such as dams, reservoirs, levees, culverts, flood protection canals, groundwater recharge, etc. So far, in almost all water-related application projects, the possible impact of climate change has not been taken into consideration. It is the main purpose of this paper to develop suitable preliminary climate change indicators in terms of trend component technique and expose its applications throughout the historical annual daily maximum rainfall records. Trends in the past records are implementations of future possible tendencies in other words they are helpful as preliminary descriptors of possible trends.

The route of guano and the Aji in the articulating axis of the basin of Sama-Peru, during the late regional development and the Inka occupation: preliminary indicators for the knowledge of its economic interaction at the regional level

The route of guano and the Aji in the articulating axis of the basin of Sama-Peru, during the late regional development and the Inka occupation: preliminary indicators for the knowledge of its economic interaction at the regional level

Construction of emergency management system for emerging infectious diseases

Objective To construct nursing emergency management system of emerging infectious diseases for suiting the new situation of emerging infectious disease management needs. Methods The preliminary indicators of nursing emergency management system of emerging infectious diseases were formulated through the literature review and group discussion. The 3 rounds of Delphi questionnaire consultation were held among 20 experts in the field of infectious diseases. Results The experts′ positive coefficients were 0.91, 1.0 and 1.0, and authority coefficient was 0.82, while coordination coefficients were 0.272, 0.311 and 0.320 (P<0.05) . Variation coefficients of various indicators were 0.09-0.22. Finally, the nursing emergency management system of emerging infectious diseases including 4 first-level indicators, 17 second-level indicators and 66 third-level indicators was constructed. Conclusions The construction of scientific, systematic and standardized nursing emergency management system of emerging infectious diseases can improve the emergency disposition ability of nurses, establish efficient and reasonable human resources system, and improve the nursing management level of emerging infectious diseases. Key words: Communicable diseases; Nursing emergency management system; Construction; Delphi method

Implementing a Psychotherapy Service for Medically Unexplained Symptoms in a Primary Care Setting.

Medically unexplained symptoms (MUS) are known to be costly, complex to manage and inadequately addressed in primary care settings. In many cases, there are unresolved psychological and emotional processes underlying these symptoms, leaving traditional medical approaches insufficient. This paper details the implementation of an evidence-based, emotion-focused psychotherapy service for MUS across two family medicine clinics. The theory and evidence-base for using Intensive Short-Term Dynamic Psychotherapy (ISTDP) with MUS is presented along with the key service components of assessment, treatment, education and research. Preliminary outcome indicators showed diverse benefits. Patients reported significantly decreased somatic symptoms in the Patient Health Questionnaire-15 (d = 0.4). A statistically significant (23%) decrease in family physicians’ visits was found in the 6 months after attending the MUS service compared to the 6 months prior. Both patients and primary care clinicians reported a high degree of satisfaction with the service. Whilst further research is needed, these findings suggest that a direct psychology service maintained within the family practice clinic may assist patient and clinician function while reducing healthcare utilization. Challenges and further service developments are discussed, including the potential benefits of re-branding the service to become a ‘Primary Care Psychological Consultation and Treatment Service’.

Technology-Assisted Parent Training Programs for Children and Adolescents With Disruptive Behaviors: A Systematic Review.

To systematically review digitally assisted parent training programs (DPTs) targeting the treatment of children and adolescents with disruptive behaviors. A search was conducted using PubMed, PsycINFO, and EMBASE databases for peer-reviewed studies published between January 1, 2000, and March 1, 2016. Reference lists of included and review articles were searched manually for additional references. Broad search terms in varying combinations for parent, training, technologies, and disruptive behavior problems were used. We included English-language articles reporting on the effectiveness of DPTs targeting child or adolescent disruptive behaviors (eg, conduct disorder, oppositional defiant disorder). DPTs designed to use digital media or software programs not to be primarily used within a therapy setting (eg, group, face-to-face) were included. Study design, recruitment and sample characteristics, theoretical background, digital program features, user's engagement, and measures of child behavior were extracted. Fourteen intervention studies (n = 2,427, 58% male, 1,500 in DPT conditions, 12 randomized trials) examining 10 programs met inclusion criteria. Interventions included self-directed noninteractive (eg, podcasts; 3 studies) and interactive (eg, online software; 4 studies) DPTs, remotely administered DPTs combined with professional phone-based coaching (2 studies), and a smartphone enhancement of standard treatment. Interventions were delivered over a mean ± SD period of 8.7 ± 4.2 weeks, most (11/14; 78.6%) were remotely administered, and all recruitment procedures included an outreach for parents outside of mental health-care settings. For programs with > 5 sessions, the mean ± SD completion rate of available sessions was 68.6% ± 13.1%. In comparison to no treatment control, self-directed programs yielded significant improvements in child behavior for children (age < 9 years, Cohen d = 0.47-0.80, 4 studies) and adolescents (d = 0.17, 0.20, 2 studies). Overall, reduced professional support combined with DPT was not inferior to full-contact conditions and showed small improvement in comparison to usual care (d = 0.34). Preliminary indicators also suggested that technology enhancements may increase engagement and outcomes of standard treatment. The current review indicates the efficacy of DPT across a range of therapy formats applied in real-world settings demonstrating the potential for increased accessibility of evidence-based treatment for youth with disruptive behaviors. Additional studies are needed to extend these findings and to determine moderating effects of different designs.

Examining implementation and preliminary performance indicators of veterans treatment courts: The Kentucky experience

Veterans’ Treatment Courts (VTCs) are posited as a solution to offer rehabilitation for veterans involved in the criminal justice system. Despite the pervasive implementation of VTCs, there is little research focused specifically on VTC implementation and outcomes, which are based on other problem-solving court models such as drug court. The current study presents qualitative process evaluation data from key stakeholders (n=21) and veteran participants (n=4) to show accomplishments, challenges, and lessons learned during first-year implementation at two VTC sites. Quantitative performance data is also presented on veteran participants (n=19) served during the first year to show: types of services, monitoring, judicial interaction, sanctions/therapeutic responses, and rewards, as well as preliminary data on recidivism. Qualitative data, from both key stakeholders and veteran participants, suggests that offering rehabilitation via various program components, services/referrals, and accountability are critical to the success of the VTC. Data also provides valuable lessons learned for VTC implementation including communication, collaboration, information/protocols, and resources. Performance data shows that a variety of services are utilized and that frequent judicial interaction, drug testing, and sanctions are cornerstones of the VTC. Implications and future directions for research are discussed.

Structure and Level of Religiosity Test

Abstract The aim of the article is to present a new measure of structure and level of religiosity. The cognitive-developmental concept of integral development of religiosity by Czesław Walesa, which distinguishes eight parameters of religiosity: religious awareness, religious feelings, religious decisions, bond with the fellowship of believers, religious practices, religious morality, religious experience and forms of profession of faith served as the theoretical bases for the test. The measure was constructed to fit the specificity of the people of the Christian profession. The preliminary reliability and validity indicators were calculated on 126 participants. Construct validity was established with Centrality of Religiosity Scale (C-15), Scale of Religious Identity, Deconversion Scale for Adolescents. The psychometric indicators were satisfactory, which shows that the test can be used to measure structure and level of style of religiosity.

Quality indicators for the referral process from primary to specialised mental health care: an explorative study in accordance with the RAND appropriateness method

BackgroundCommunication between involved parties is essential to ensure coordinated and safe health care delivery. However, existing literature reveals that the information relayed in the referral process is seen as insufficient by the receivers. It is unknown how this insufficiency affects the quality of care, and valid performance measures to explore it are lacking. The aim of the present study was to develop quality indicators to detect the impact that the quality of referral letters from primary care to specialised mental health care has on the quality of mental health services.MethodsUsing a modified version of the RAND/UCLA appropriateness method, a systematic literature review and focus group interviews were conducted to define quality indicators for mental health care expected to be affected by the quality of referral information. Focus group participants included psychiatrists, psychologists, general practitioners, patient representatives and managers. The existing evidence and suggested indicators were presented to expert panels, who assessed the indicators by their validity, reliability, sensitivity and feasibility.ResultsSixteen preliminary indicators emerged during the focus group interviews and literature review. The expert panels recommended four of the 16 indicators. The recommended indicators measure a) timely access, b) delay in the process of assessing the referral, c) delay in the onset of care and d) the appropriateness of the referral. Adjustment was necessary for five other indicators, and seven indicators were rejected because of expected confounding factors reducing their validity and sensitivity.ConclusionsThe quality of information relayed in the referral process from primary care to specialised mental health care is expected to affect a wide range of dimensions defining high quality care. The expected importance of the referral process for ensuring ‘timely access’-one of the six aims of high-quality health care defined by the Institute of Medicine-is highlighted. Exploring the underlying mechanisms for the potential impact of referral information on patient outcomes is recommended to enhance quality of care.Trial registrationClinicalTrials.gov: NCT01374035 (28 April 2011).

Validation of risk indicators for the constitution of the reader/scribe.

To evaluate risk factors for the constitution of the reader/scribe. This is an exploratory study in which a retrospective questionnaire about the child before entering elementary school, based on preliminary indicators for the constitution of the subject reader/scribe, was applied to a population of 293 parents of elementary school students from a public school in São Paulo. The findings were crossed with the diagnostic survey of writing of students from the 1st to the 5th grade and with the evaluation of text production of students from the 3rd to the 5th grade. Data was statistically analyzed. The questionnaire showed acceptable reliability and the analysis of convergent validity presented positive correlation considered valid, statistically significant with the diagnostic survey of writing, that is, the higher the score the better the performance in the survey questionnaire. There was statistically positive correlation between the questionnaire and the performance of the students on text production in cases where parents had complaints regarding the reading and writing of their children. Exploratory factor analysis validated the proposed construct. The questionnaire is easy to apply and inexpensive, and the results showed acceptance by the respondents -- fundamental characteristics of instruments that serve public health and education. The research allowed validating 8 of 15 risk indicators initially proposed for the constitution of the reader/scribe. This validation confers quality to the construct and opens possibilities for its use in health promotion, prevention and rehabilitation in reading, writing and therapy.

녹색건축 인증제도의 지속가능성 제고를 위한 평가항목 분석

The purpose of this study was to suggest new assessment indicators of G-SEED for sustainability improvement. To do so, current G-SEED was analyzed in sustainable perspective, and compared with the major international certification systems. Preliminary assessment indicators were selected to improve sustainability, and 43 new assessment indicators in three phases were suggested through the specialist survey and the result analysis. The indicators are 25 in phase I, 10 in phase II and 8 in Phase III. Achieved indicators need a further review before acceptance to the current system, and especially, the indicators in phase I were marked highly important by the specialist survey for improving sustainability of the G-SEED. Therefore, additional research and further studies on the acceptance are required in the near future.

Building Scientist Capacity in Knowledge Translation: Development of the Knowledge Translation Planning Template

The last fifteen years have seen a fundamental shift in the importance of knowledge translation in health research and clinical care. Health research funders have incorporated knowledge translation into their missions, strategic directions, and funding opportunities, encouraging knowledge translation and implementation science and requiring knowledge translation practice from researchers working across the health research pillars – basic, clinical, health services, and population health. Healthcare and research organizations have changed their landscape as well, hiring knowledge translation practitioners to bridge research and practice for a range of knowledge users. Universities are shifting criteria for academic promotion to incorporate knowledge translation. Growing attention to knowledge translation in research, practice, and scholarship has created a need for researchers and practitioners to develop knowledge translation skills and competencies related to their research, scholarship, and organizational activities. The Knowledge Translation Planning Template was developed to support knowledge translation planning for scientists in health and other sectors. This article provides an overview of the rationale for its development, introduces the tool components, and describes preliminary indicators of impact.

A Study on Setting up a Database for Maternal Health Care Program in Darbandikhan-Kurdistan

There are around 8.64 million women in Iraq who need to maternal health. While, maternal health program in Iraq is considerably down regulated, the vertical national health program, maternal health, has been not monitored appropriately. The aim of this study was to determine the most essential preliminary indicators for monitoring maternal health program in Kurdistan/ Iraq, and to assess those technical challenges for computerizing the maternal health program of Kurdistan Regional Government. This is interventional hospital based study which was carried out in Darbandikhan district- Kurdistan State. An access database was developed for entering whole records of the maternal health program components data in the 200 mothers’ file. And, we got staff belief about database. The study has shown that antenatal care visit record would be a good indicator for assessing maternal health program, when the program was computerized. And, the staff had a positive attitude to computerize the program. This database could accelerate the monitoring and evaluating the maternal health program in considering to indicators of the program.

Identification of Preliminary Prognostic Indicators for Back Rehabilitation in Patients With Nonspecific Chronic Low Back Pain: A Retrospective Cohort Study.

Retrospective Cohort. Our aim was to identify prognostic indicators for success after a back rehabilitation program (BR) in patients with nonspecific chronic low back pain (CLBP). Exercise therapy is recommended for patients with nonspecific CLBP. Consensus on the type of exercises is lacking, largely due to heterogeneity in the studied patient samples. The identification of subgroups through the identification of prognostic indicators is therefore needed. To our knowledge, no specific prognostic indicators for BR are described in the literature. We retrospectively analyzed the patient files of 49 nonspecific CLBP patients who followed a BR. Patients were selected based on predefined in- and exclusion criteria. All underwent 43 therapy sessions, two times per week. Primary outcome measure and dependent variable was the change in Oswestry Disability Questionnaire (ODI) score. Potential predictive variables were tested for association with the primary outcome and consequently entered in a logistic regression model. In this study, the posthoc calculated power was 91%. Based on the change in ODI scores, 24 patients were considered as therapy success (eight points or 50% improvement on change in ODI score) and 25 as therapy failure. Univariate and multiple regression analysis revealed only one significant prognostic indicator: higher scores on the physical function subscale of the SF36 (PF-SF36) corresponded with high risk of therapy failure (odds ratio of 0.791 (95% CI = .662-0.945); sensitivity of 0.79, and specificity of 0.68). Potentially, the preset exercises of the BR in this study design were not appropriate for the identified subgroup. The results of this study should be replicated in a RCT design that conforms to the necessary methodological steps in the identification of prognostic indicators and clinical prediction rules (CPRs).

Validations of a Model to Estimate Thermal Conductivities of Ceramics

The Effective Medium Theory Model (EMTM) used in this work is based on the assumption that every phase of the matrix is embedded in a homogeneous medium with conductivity <i>k_eff</i> to be determined self-consistently. It is based on dilute spherical inclusions of one phase embedded in a matrix of a second phase. Several Samples of composite ceramics that are mechanically strong, relatively non-porous and anisotropic have been investigated. A comparison between the measured data and the results predicted by EMTM were made to validate the model for these ceramic samples. In particular, we investigate the effect of mineralogy (constituents) in ceramics and their spatial distribution profile to validate the homogeneity conditions of the model. Preliminary indicators of validation were used to check the bulk and surface homogeneities. This can be done either by roughly estimating Wiener bounds or by examining microscopically the surfaces of the samples. It turns out that the EMTM is a suitable one to estimate <i>k_eff</i> provided that the homogeneity conditions are satisfied.

Human dehydrogenase/reductase (SDR family) member 8 (DHRS8): a description and evaluation of its biochemical properties.

Dehydrogenase/reductase (SDR family) member 8 (DHRS8, SDR16C2) belongs to the short-chain dehydrogenase/reductase (SDR) superfamily, one of the largest enzyme groups. In addition to the well-known members which participate in the metabolism of important eobiotics and xenobiotics, this superfamily contains many poorly characterized proteins. DHRS8 is a member of the Multisubstrate NADP(H)-dependent SDR16C family, which generally contains insufficiently described enzymes. Despite the limited knowledge about DHRS8, preliminary indicators have emerged regarding its significant function in the modulation of steroidal activity, at least in the case of 3α-adiol, lipid metabolism and detoxification. The aim of this study was to describe additional biochemical properties of DHRS8 and to unify knowledge about this enzyme. The DHRS8 was prepared in recombinant form and its membrane topology in the endoplasmic reticulum as an integral protein with cytosolic orientation was demonstrated. The enzyme participates in the NAD(+)-dependent oxidation of steroid hormones as β-estradiol and testosterone in vitro; apparent K m and V max values were 39.86µM and 0.80nmol×mg(-1)× min(-1) for β-estradiol and 1207.29µM and 3.45nmol×mg(-1)× min(-1) for testosterone. Moreover, synthetic steroids (methyltestosterone and nandrolone) used as anabolics as well as all-trans-retinol were for the first time identified as substrates of DHRS8. This knowledge of its in vitro activity together with a newly described expression pattern at the protein level in tissues involved in steroidogenesis (adrenal gland and testis) and detoxification (liver, lung, kidney and small intestine) could suggest a potential role of DHRS8 in vivo.

Polysaccharide Constituents of Three Types of Sea Urchin Shells and Their Anti-Inflammatory Activities.

As a source of potent anti-inflammatory traditional medicines, the quantitative chromatographic fingerprints of sea urchin shell polysaccharides were well established via pre-column derivatization high performance liquid chromatography (HPLC) analysis. Based on the quantitative results, the content of fucose and glucose could be used as preliminary distinguishing indicators among three sea urchin shell species. Besides, the anti-inflammatory activities of the polysaccharides from sea urchin shells and their gonads were also determined. The gonad polysaccharide of Anthocidaris crassispina showed the most potent anti-inflammatory activity among all samples tested.

A suggestion for pathological grossing and reporting based on prognostic indicators of malignancies from a pooled analysis of renal epithelioid angiomyolipoma.

Epithelioid angiomyolipoma (EAML) is a rare entity of the kidney. The guideline for grossing and reporting of renal EAML has not been established for Chinese patients. We planned this study to provide some preliminary indicators for draft guidelines of pathological diagnosis among Chinese people. The histopathological characteristics of 11 EAML cases from Cancer Hospital, Chinese Academy of Medical Sciences, were reviewed, and a pooled analysis based on our cases and cases from published articles was performed on the histopathological characteristics and prognosis of 56 Chinese patients with EAML. All the cases met the criteria of the 2004 World Health Organization classification of renal tumors. The ratio of female to male was 1.2:1 with the mean age of 43.4 in the 11 cases. All the 11 cases were sampled following the guideline of renal cell carcinoma. The mean tumor size was 6.5 cm. Four (36.4 %) cases showed necrosis. Six (54.5 %) cases showed invasive borders. Only one case showed metastases. In pooled analysis of the total 56 cases with EAML, 10 cases (17.9 %) showed adverse prognosis. Tumor size, necrosis and invasive edge showed significant difference between favorite and adverse prognostic groups (P < 0.05). The majority of EAML is benign, and true malignant EAML is rare. The sample of EAML should follow the sample guidelines of renal cell carcinoma with some modifications, emphasizing the presence of necrosis and invading edge. The information of tumor size, necrosis and invasive edge should be included in the diagnostic report of each EAML case.