Science topic

Outcome Assessment (Health Care) - Science topic

Research aimed at assessing the quality and effectiveness of health care as measured by the attainment of a specified end result or outcome. Measures include parameters such as improved health, lowered morbidity or mortality, and improvement of abnormal states (such as elevated blood pressure).
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I am doing an MSc dissertation looking at how the health of women experiencing homelessness is affected by a disparate set of international, national and state laws and policies. This is a scoping review to set the stage and demonstrate the complexity, hence I am not analysing a particular policy and its outcomes. It crosses many disciplines and government ministries and is by nature difficult to measure outcomes or attribute causality which is part of what I'm trying to show. I'm struggling to find a theory / framework to use to present this in a coherent manner. Is policy mapping appropriate here? Any more thoughts?
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Framework to Define Structure and Boundaries of Complex Health Intervention Systems: The ALERT Project - PubMed (nih.gov)
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Nowadays, there is no country without a medical trainning program. These programs expect its residents to have a research project as a mandatory part to have its board's certificate.
Hence, there is a need to improve the outcomes of these research projects and maximize the publication rate.
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I guess one of things is to hire research expert unit which can demonstrate the the research importance, through a clear curriculum containing literature reviews, research designs, brain storming proposals, papers critique sessions, and to put that mandatory to get the degree at the end. This is in case we really want to achieve that. thanks
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I have collected data from patient records for a specific outcome measure (outcome X) in a cohort of patients with a specific disease (disease Y). However, not all of the patients with disease Y completed the test to measure outcome X. I am writing up a case series of patients with disease Y who had positive outcome X.
When reporting estimated prevalence of outcome X in patients with disease Y, should I assess prevalence against the whole population with disease Y, or should I only assess prevalence against those patients with disease Y who completed the test to measure outcome X?
Any help much appreciated
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I suggest delete the incomplete test result and assess prevalence against those completed the test to measure outcome.
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SPSS ROC analysis produces average values of consecutive cutoffs, which provides other sensitivity and specificity values than by using the plain formulas for these values. I would like to understand why SPSS produces these average values and I am wondering if other researchers describe these average values in stead of the plain formula values, because it will have consequences for the chosen cutoff and the comparability of different research outcomes? I am working on an article describing the cutoff at the PQ-16, a screener used to detect psychosis in a two step screening procedure with the CAARMS interview.
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Hello Yvonne de Jong. I gather you are concerned by the fact that when the test values are whole numbers, the cut-offs shown in the ROC output are mid-way between two scores--e.g., the cut-off between 7 and 8 is 7.5. Is that what you're talking about? If so, I don't think it is having any adverse effect on the Sensitivity and 1-Specificity values that are shown in that same output. Here is an example you can try. If it does not address your concern, please try to use the same bankloan.sav dataset (which all SPSS users have access to) to illustrate the nature of your problem. HTH.
* Use the bankloan.sav data file that comes with SPSS.
* Modify the path on the next line as needed.
GET FILE='C:\SPSSdata\bankloan.sav'.
* Use age as the test variable and default as the condition/disease.
ROC ANALYSIS age BY default (1)
/MISSING USERMISSING=EXCLUDE
/CRITERIA CUTOFF=INCLUDE TESTPOS=SMALL DISTRIBUTION=FREE CI=95
/DESIGN PAIR=FALSE
/PLOT CURVE=ROC(REFERENCE) MODELQUALITY=FALSE
/PRINT SE=TRUE COORDINATES=ROC CLASSIFIER=FALSE.
* Let's take the cutpoint 34.5 as an example.
* The ROC output says that Age <= 34.5 is considered a positive test.
* So let's compute our own TestPos variable using that cutoff.
COMPUTE TestPos = age LE 34.5.
FORMATS TestPos(F1).
CROSSTABS TestPos BY Default /CELLS=count COLUMN.
* The column percentages in the bottom row should
* match the Sensitivity and 1-Specificity values
* shown in the 46.5 row of the ROC output. Those
* values are Sens=.628 and 1-Spec = .476.
* The column percentages from CROSSTABS show
* Sens = 62.8% and 1-Spec = 47.6%.
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Since education and patient's state of mind, i.e, depression play important role in the outcome of the study, the level of education and the measure of depression being used are both important details that are interesting to know. Understanding the disease process may require some educational background to help maintain some perspective towards recovery. Being depressed due to a severe illness is a common and natural reaction but could also become detrimental and a disease in itself if left untreated.
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Thank you, Dariusz. I agree. The state of mind is indeed very important in maintaining health and even in fighting illness. The mind has a definite role in connection with the body and can even control the body as seen in numerous examples including the placebo effect.
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Hello, I want to perform a GEE analysis for my repeatedly measured outcome. But first in order to specify what variables to include in the analysis, I was wondering if I can first perform chi-square tests (categorical DV & IV) at each timeline then the statistically significant ones to be included in the GEE model?
thank you!
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Hello Nivine,
Is there some compelling reason to exclude variables from your IV set from inclusion in a model a priori? (I couldn't discern one from your query.)
If your goal is to include only variables that show bivariate relationship with the DV, then, yes, you can do this. However, if your goal is to identify the best ensemble of IVs for your DV, this approach will not necessarily accomplish that. As well, potential instances of suppression effect would go undiscovered.
Perhaps if you could elaborate a bit on what your research question is, and what variables (and sample size) you're working with, someone could likely give you a more focused recommendation.
Good luck with your work.
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Research Gate, Citation trackers, and Twitter are all means to promote your research, outcomes, knowledge and future possibilities. But what are novel and transformative means to expand research communities, collaborations, and communication. For example, in this new world after the latest Pandemic, how have unforeseen changes altered the advancement of science?
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Good responses from Alka and Biswajoy. I particularly relate to Biswajoy's notion of making research findings more accessible using wider media forms and formats. Academia is now far more reliant than it has ever been on industry and key community stakeholders - as well as the wider lay public. Adjusting academic language and technical reports so that it is accessible and relevent to non-academic audiences is becoming more and more important.
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Hi all,
I have some difficulties regarding interpretation of categorical variables when some of categories , not all categories are statistically significant in Binary logit model. To explain my question more clearly see the following categorical variable used in my study:
Outcome variable: Enrollment in CBHI scheme( enrolled=1, non-enrolled=0)
Some of categorical variables that I have used are as follows:
1. Age of household head(4 categories)
18-30(reference)
31-40 (odds ratio =0.3512 ; P =0.033**) ** shows signficant at 5%
41-50 (odds ratio= 0.7847; P= 0.604)
above 50 (odds ratio=0.4838; P=0.099)
2. Educational status of household head(5 categories)
illiterate( reference)
read and write( odds ratio=28.68; P=0.000***) *** shows significant at 1%
primary (odds ratio= 3.194408 ; P= 0.040**)
secondary (odds ratio= 5.164823 ; P=0.007***)
tertiary(odds ratio= 1.312708; P=0.677)
In addition to this , which way of interpretation is best( is it interpretating Odds ratio or Marginal effect?) in Logistic regression.
Any answer is appreciated
Regards!
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You need to take into account the actual numbers of subjects at each categorical level as this may influence the odds ratio. Also, please look at the 95% CI of the ORs.
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Do research outcomes final or time and place bound?
In other words, is it machine quality/ validity and reliability bound? And what happens when researchers discover that specific machine/ tool/ was/ was not valid enough as well reliable?
Your kind debates..
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Hello Wael,
Research outcomes most are relative than absolute.
qualitative and quantitative approach are the good method to evaluate.It depends on platform and paradigm of different layer of project management as well.
Regards Mehrabi
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@Witold Bogusz asked a question about "the purpose of research and innovation" in various countries as the starting point is not the same worldwide.
Problems to be resolved in local context (culture, climate, human and natural resources) seem to be different. Maybe except for the academic world, where there is always a temptation to follow most "hot, trendy and sexy" topics, hoping for recognition in "mainstream scientific world". I strongly support the academic freedom of research, as long as it is financed from "non-public" founds. When it comes to publicly financed institutions, I'd prefer to see some positive outcomes for the "sponsor" who can be a poor and still developing community. I truly long for some kind of RIF "Real Impact Factor" that would measure the outcomes of the research for the founding community.
Have you any experience with similar metrics?
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Write more publications from JCR.
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Hi, I am using SEM analysis and my model has 3 latent variables with continuous measured indicators and 1 dichotomous observed outcome.
I wonder if I can use different estimators between measurement and structural models .
Thank you.
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First, there is no problem at all if you use different estimators to evaluate both measurement and structural models provided you can justify your choice of estimator. My advice for you Hyun-Jin Cho is to compare your result with the one you get when you use WLSMV to evaluate your measurement. I guess there will not be any significant difference. If that is the case, then you can use WLSMV for the models.
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It is evident that a large number of research studies get completed and than just get a space on the selves or online in some journal. There are a large number of studies which gave notable output and waiting for the implementation of the same. The same is the case with most of the funded research projects.
What is the main reason behind this? Is this normal or its governments who do not want this?
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I share your concern Sanjeet Singh . Unfortunately, the industry - academia interface is so low. Most academic work is far removed from reality.
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In current era of researcher publishing when economics play a part in the outcome of studies, can systematic reviews be trusted given the fact they answer a defined research question by collecting and summarizing all empirical evidence that fits pre-specified eligibility criteria.
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Sunil Kumar Raina- Thank you for your question. Systematic reviews and meta-analysis represent top evidence. However, not all systematic reviews are at the standards we would like to see. We have now several changes to ensure that published systematic reviews are standardised. For example, most journals ask about the registration number of the submitted reviews (such as PRESPIRO registration), journals ask for PRISMA figure and submission of PRISMA checklist with the submitted manuscript. We also see published reports on "reviews on reviews" to assess what was released a few years ago, or when several reviews on a topic were published with contradictory outcomes. Other actions and innovative ideas are currently taking place to ensure that published systematic reviews are accurate and trusted.
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Commercialization is the processes by which research outcome moves toward practice, idea and new findings develop in the form of new products.
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Early days.I am more interested in Research as a modality to solve healthcare issues faced by common man
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Do you have any potential research outcomes and missing links for Africa to become a net food and agricultural products importer, despite it has vast agricultural potential?
How can Africa use its potential for agro-food industry and Agri-business development?
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Thank you Paul for your key points.
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The study I am working collected data over two testing days. On each testing day subjects ran a total of 4 sprints. 2 sprints per day were ran over concrete and 2 were over artificial turf. Sample size was 12 and the results were normally distributed. The goal of this study is to see whether changing running surface affects sprinting time. A repeated measures ANOVA found no significant differences between the surfaces.
The secondary outcome for the study is to report how reliable the data is from one day to the next. I want to break this down into day 1 concrete vs day 2 concrete, day 1 turf vs day 2 turf, as well as overall reliability of day 1 vs day 2.
To do this, I am trying to calculate the ICC (3,1) for each outcome. Unfortunately on SPSS I am getting either a) very low or b) negative values. The data itself appears to agree quite well - for example all sprint times are <0.3 seconds of each other.
I know that the ICC can be affected when there is a small sample size or when there is low variation between participants. My question is, is the ICC the best test to use with regards to my study, and if not, what could be a better option? And if the ICC is the best, is there something I could be doing wrong to obtain such poor values?
Many thanks for your help! :)
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Has the variance analysis requirement been verified ?.
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I have 20 subjects, all subjects received 2 interventions, and i measured outcome 5 times for each intervention, thus, each subject i will have 10 measurements.
Based on qqplot and shapiro-wilk test, i don't think parametric test would be a safe option. I am not so sure which non-parametric test is a good choice, so i decide to go for most general one: linear regression.
In this case, what are my predictor/input variable, and output variable? I assume all measurements for intervention 1 is the output, and all my measurements for intervention 2 is one of the input variable, what is the other input variable? index for each measurement? In addition, what is the relation between two input variables? confounder or interaction?
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here you can look at our papers with repeated measure if they give you any idea:
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I am conducting a meta-analysis where the binary outcome is presented in a multivariate logistic regression table. Each article tends to measure the outcome the same way, but each table contains slightly different covariates. I have found calculations for partial effect sizes when the table is a multivariate OLS regression, but haven't found anything for logistic regression. Can this be done?
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it can
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To validate our new Arabic language parenting measure we'd like to correlate it with a brief validated measure of mental health. I can't find anything that fits other than the K10, which we are already using in our study as an outcome measure. The SRQ 20 was validated with students in UAE, but this is quite a different population than Syrian refugees.
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I recommend making the same approach I used, search PubMed, Web of Science, and Scopus for studies and reviews on the topic, I am sure you will come with several good related papers, as this topic has been for some times with the refugees from Turkey, Lebanon, Afghanistan, Iraqi, Syrian over the last 40-50 years. I think you may find several Europian, Canadian, and Australian studies. Good luck
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Hello Marianne, last week we met at the NJF in Iceland. I am just wondering when we can expect outcomes of your studies. We are very interested and are curious about the way you recruited women for your studies.
With kind regards,
Esther Feijen-de Jong, the Netherlands
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Hi Esther, thank you getting into touch - it was a pleasure meeting you in Reykjavik, and I'm very happy you attended my presentation. I'm looking forward to hearing more about your exciting new research! Hopefully, I'll have my first article out this coming autumnn - and the others in the new year. Best regards, Marianne
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The neurologic examination is a powerful tool for urgent bedside assessment of ICU patients with neurologic or neurosurgical illnesses. Assessing cranial nerve function is one of the most vital components In this context. Testing the pupillary light reflex evaluates the status of the second and third cranial nerves. Automated pupillometers have been developed that provide objective measures of size of the pupil and the responsiveness of the pupil to light (neuropupillary index). Although few studies reveal diagnostic and prognostic usefulness in critically ill patients, none of the studies correct/adjust for interfer and confounding effects by for example sympathomimetic or parasympathomimetic drug effects, interference from ambient light, previous cataract operation, etc.
Isn‘t it much too early to reliably use automated pupillometry for diagnosis and prognosis in daily clinical practice in ICUs?
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The size of the pupil, and the responsiveness to light is definitely a key procedure in neurological ICU patients (especially concerning intracranial pressure) as many of the other neurological tests require active participation of the patient. However automated pupillometry has not found the way to our ICU and I think that the amount and quality of studies is not sufficient yet. In my opinion, it's a great approach, as manual pupillary examination shows a great variety between the investigators. On the other hand, many critical ill neurological patients have a external ventricular drainage anyway. So I think more and larger studies are needed, if they show positive results, automated pupillometry could assist the examination in future.
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Dear all,
I conducted a beetween-subjects experiment with two different groups which where exposed randomly to two different type of messages (activational or non-activational). The outcome variable was meassured before and after the experimental scenario. Now I need to test additionally, if several moderators (measured once) affected the outcome variable.
How do I proceed here? My hypothesis is formulated as follows:
At same type of message (so activational or no-activational), moderator XY leads to higher values in the outcome variable.
I am very happy for your help on this.
Thank you very much in advance.
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We live in a world of increasing data access and use, recognising that exacting scientific analysis can spur insight, innovations and quality improvement in healthcare. How do we manage the conundrum that clinical analyses such as comparative effectiveness studies of therapeutics and outcomes studies are called research and must undergo lengthy and burdensome research regulatory processes while "Business Intelligence" solutions need not. Yet arguably the effectiveness and outcomes studies are more likely to produce clinically valid results leading to improvements in care than the plethora of 'operational' reports currently being generated.
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in any research study its the "validation" phase that establishes proof of value found in particular work. In such a case, clinical trials are actually something having direct impact on human beings as they are applied on physical bodies.
In case of business intelligence, validation automatically happens in course of implementation and subsequent reports appraisal. Validation comes from fact checking using operational efficiency observed. The business concern wouldn't normally retain an unnecessary overhead in their process.
Finally the research standards and policies that govern them will have structural changes depending on type/context and geographic region.
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I am interested in studies of outcomes from special education as it is implemented normally in public schools. A great deal of data was collected under the NCLB Act but I have not seen publications explaining what that data had to say about the performance of students served in special education. Can anyone point me to such studies? Thanks.
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This paper may help.
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Currently, I am doing a systematic review and I have few questions regarding that.
1. Can I combine results of cross-sectional and cohort studies if the outcome is given as Odds ratio for both of them? If yes then please give me some suggestions about that.
2. Can I combine the results of case-control studies results if some of them are in OR and some in HR?
I will be really thankful if someone can help me out.
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No OR and RR cannot be combined since they are different ratios.
Yes this is appropriate
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So, I recently concluded a study, in which the levels of some heavy metals in the serum of carpenters and non-carpenters, as well as carpenters who are regular smokers, and those who are heavy drinkers. The outcome of the study seem very interesting. It is however with great pleasure that I share this article with you. You can make your criticisms and comments and reading through. Believe me, this criticisms or comments will help in my subsequent study.
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Dear Onengiyeofori Ibama ,
Your work seems interesting and novel.
Congratulations to your achievement.
Wish you every success in your future attempts.
Regards,
Ata
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During clinical consultation doctors and nurses interview patients about their medical history. But, patients are usually not prepared for the clinical consultation. In theory, if patients administer their medical history on a computer/tablet before their appointment with the doctor or nurse, then they should be prompted and prepared for the medical history interview. This is one of the hypothetical advantages of patient-administered computerized history taking systems/automated medical history taking systems. What quantitative and/or qualitative factors measures exist that would assess if patients are prepared for the medical history interview?
I'm actually interested in identifying doctor-patient communication and non-communication measures that would determine if a group of patients who took an electronic medical history questionnaire were more prepared for a clinical consultation compared to a group that didn't take the electronic history questionnaire.
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There isnt any
I am just authoring
How to get the best from your GP practice to try to fill this gap!
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Dear colleagues, 
I am conducting a feasibility clinical trial on a novel health related educational intervention in a clinical sample. As the education material be developed is new, and never been tried before, especially in Nepali culture, I am interested in learning if the novel education material is difficult or easy to understand. 
Thus, I intend to use a valid scale to assess difficulty of understanding health education in our research.
I found an 11-point numerical rating scale; 0= "Extremely difficult" and 10= "Very easy" being used in the literature.  In our culture, people find it difficult to use a numerical scale, so I am searching for a similar scale but in a "verbal rating scale" format, for example 0= "Very difficult"; 1= "Difficult", 2= ........; 5= "Very easy", or so.
I would be thankful if you could share your experience of using such a scale, or if you are aware of use of similar verbal rating scale to assess difficulty of understanding any health related educational interventions. 
Thanking you in advance, 
Saurab
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Hi Saurab - your project does indeed sound interesting and novel - particularly at the cultural level. In my mind, you are talking about the same thing here. You would be using either a Likert or a semantic differential scale. The difference between if it is verbal or non-verbal doesn't really change the nature of the scale. For instance, with a lot of consumer research, data collectors will ask you 'how do you rate a product from 0-10'. You would be doing similar - but based on people's experiences or perceptions of something at the health education level.
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Common Outcome Measures like the PEDI and WeeFIM were developed and validated for American children. I am very much interested in developing a culturally sensitive tool that can be used in Africa
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I am working on a research which aims to develop a risk  score to predict critical /bad outcomes of preterm babies. As there are several  outcomes  but can collectively be called as critical outcomes is it possible for me to develop a single risk score? The risk factors for different outcomes may differ.
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Dear Dimuth Peiris, I am not quite sure I understand your question correctly, but if you aim at developing a model to predict critical oucomes on the basis of several independent risk factors I suggest you take a look at the "Decision Tree" models (e.g. http://www.stat.wisc.edu/~loh/treeprogs/guide/wires11.pdf). Yours, AG
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We are running a study where we measure grip strength to older patients in acute medical wards to flag up those with low levels who might be at risk of poor healthcare outcomes. We know that grip strength vary according to age, gender, and dominant hand, but I am not aware that there is any research on whether the grip strength of a patient vary when it is being tested before and after meals. It would be helpful if anyone can share their experiences or refer me to any useful references. 
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I can't see the relevance of this study. If the client has the motivation to eat and the skills involved - what is the significance of grip strength after meals? How will your study provide information that is meaningful to clients healthcare outcomes? What are the assumptions/hypotheses underpinning your study?
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Focus would be on the Intermediate Care (IC) run mostly by NPOs which are subsidised by government and donations.
Possibility of doing a retrospective or prospective study
 either follow the patient route from hospitalization to intermediate care unit  
or create different strategies: hospitalisation, IC, and current status
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  • Thank you so much 
This is very helpful. Have a great day 
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I need this instument 
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You can contact me directly at nrzanvil@umail.iu.edu - she is my Ph.D. mentor.
Noah
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I need to explore the economics of various countries in context with health related issues. I mean the money being spent for treating/preventing any diseases/disorders. If any one came across such kind of database or websites or institutes, Please let me know.
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You could try with OECD Health at a glance. here the link.
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Should they be denied the benefits of it?
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Thanx
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We conducted a study to estimate the economic burden of ADHD in United States using the Medical Expenditure Panel Survey (national survey by Agency of Healthcare Research and Quality). Our primary objective was to estimate the incremental cost for ADHD compared to the non-ADHD population. We used a two-part model to estimate the incremental cost for ADHD. The variable total cost is the sum of direct and indirect cost categories mentioned in the table attached here. We ran separate models to estimate incremental costs for each category. However, when we add the incremental estimates of each cost category, it does not equal to the incremental estimate of the variable "total cost". We looked for literature that might explain this anomaly but could not find any explanation. Can total cost ever be lower than the sum of individual incremental cost estimates? Did anyone come across a similar situation before. Please share your thoughts on it. I have attached the results table (Title: Cost) for your reference.
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Hi Rakesh,
I have a couple  comments based on your post:
I don't think you used the appropriate model for your estimations. A two-part model starts with estimating the probability of having any costs (>0), and the second part is modeling the costs that are >0. In your data, you are comparing those with and without ADHD, and I am assuming that those in the first part are non-ADHD, and then those in the second part are ADHD? If so, this is not the intent of the two-part model. Moreover, I would argue that there is inherent bias in who has zero costs vs those with >0 costs (regardless of their disease status). In this case, the more appropriate model is a Heckman selection model, which estimates the two parts separately. Moreover, there are model checks to see if indeed the two parts follow different underlying processes.
As for the issue of total costs being lower than the sum of the variable and fixed costs: If those are adjusted costs (ie., you estimated some model and these costs are the predicted values as opposed to the actual values), then yes, I can see how those separately estimated costs may be higher than the actual total costs.
Without any adjustment, does the sum of the various costs add up to the total cost? If not, then there is a problem with the data. Also, the MEPS data is weighted. Did you use that weight in your models?
Ariel   
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I am working on a cost effectiveness analysis linking with survival of patients with cancer. The survival part of the analysis is necessary to estimate the "number of life-years gained". To find this quantity I need to calculate the area under the survival curve. In this specific context of long term survival of cancer patient, i need to choose the parametric function of Gompertz which fit the survival in the best way. I'm working on stata software and I would to know if anyone has already done a Gompertz model in STATA, and how to calculate the area under the curve which is the integration of the Gompertz function. Thank you so much for you suggestions.
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A major difference between KM and Gompertz plus other such models is that KM deals with historical or current data while the others mentioned above also extrapolate. The latter can be interesting but are also more risky since you do not know a priori that the existing data trend will continue. So it all depends on the purpose of your exercise, do you want to present existing data or do you want to present educated guesses/guestimates?
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Which is the role of an effective postoperative pain control in relation to less invasive surgical techniques and also rehabilitation programs in order to reduce hospital stay and improve postoperative convalescence?
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