Evaluation & the health professions
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Numbers needed to treat (NNTs) may be used to present the effects of treatment and are the reciprocal of the absolute difference between treatment and control groups in a randomized controlled trial. NNTs are sensitive to factors that change the baseline risk of trial participants: the outcome considered; characteristics of patients; secular trends in incidence and case-fatality; and clinical setting. ⋯ Meaningful NNTs are obtained by applying the pooled relative risk reductions calculated from meta-analyses or individual trials to the baseline risk relevant to specific patient groups. This process will give a range of NNTs depending on whether patients are at high, low, or intermediate levels of risk, rather than a potentially misleading single number.
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The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs' levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. ⋯ After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.
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The volatility in the U. S. health care system due to unprecedented changes in its organization, financing, and delivery, coupled with a growing physician surplus in certain areas, suggests the need for a research agenda to investigate the impact of these forces on the educational programs of medical schools. This article discusses the potential impact of trends in the health care environment on the following key aspects of undergraduate medical education: admissions, faculty, curriculum, and educational outcomes. A representative set of research questions intended to stimulate inquiry and guide empirical studies in each of the four domains is proposed.
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This study evaluated an 8-month media campaign, implemented in western Washington, to educate people on the basic steps of cardiopulmonary resuscitation (CPR) for cardiac arrest. A telephone survey was conducted with a total of 384 adults randomly selected from two towns, one that had been exposed to the campaign (intervention town) and one that had not been exposed to the campaign (comparison town). ⋯ Respondents who had seen the campaign evaluated it very favorably. There were no differences between respondent groups in self-reported CPR training or intentions to perform CPR, suggesting that the campaign had a greater impact on knowledge and awareness than on intentions and behavior.
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This article reviews the different ways in which quality-of-life assessment has been applied to and has affected health care research and practice. A schema that describes the steps involved in the ongoing challenge of improving health outcomes is used to structure the review. ⋯ The benefit of quality-of-life assessment has been demonstrated in a number of these areas (e.g., in identifying problems and evaluating treatments). Its role in other applications (e.g., in clinical practice to assess patients' needs) shows great promise and requires additional evaluation.