Abstract The aim of this doctoral thesis is to present methods of search, evaluation and analysis of a specific research domain (schizophrenia) from four perspectives: bibliometric analysis of 1) Finnish doctoral theses and 2) Finnish journal articles on schizophrenia, and meta-analysis to determine the prevalence of 3) alcohol use disorders and 4) cannabis use disorders in schizophrenia. Over the years, the number of Finnish articles on schizophrenia has increased, as well as the amount of international collaboration. Bibliometric methods were also found to be feasible in the evaluation of psychiatric research. However, the methods should be used with care. Articles written in collaboration with international organisations seem to receive more citations and are published in journals with higher impact factors, which highlights the importance of developing scientific networks. A considerable proportion (20%) of Finnish scientific schizophrenia articles were published in theses consisting of original papers. The current funding system supports the writing of doctoral thesis consisting of original articles and favours epidemiological and biological research over research into medical treatments. This may affect the research culture in Finland and even slow down the development and improvement of the national treatment system. The reported prevalence of alcohol and cannabis use disorders has differed considerably between studies. No meta-analysis on alcohol or cannabis use disorders in schizophrenia has previously been conducted. In studies (n = 71) on schizophrenia patients, the median prevalence was 15% for current and 26% for lifetime alcohol use disorder, and 16% for current and 27% for lifetime cannabis use disorder. Alcohol use disorders are common in schizophrenia patients, although a declining trend was observed when comparing previous reviews. Cannabis use disorders were found to be more common in younger and first-episode patient samples, as well as in samples with a high proportion of males.

Class of 2015 Abstract / Objectives: To retrieve data from RCTs for lorcaserin and phentermine and topiramate combination on weight loss, BMI reduction, and other factors from the placebo groups and to determine if there is a difference in weight loss between those groups. Methods: Design: Meta-analysis Inclusion criteria: RCTs that compared lorcaserin or phentermine/topiramate to placebo as submitted to the FDA and posted to the FDA website. The studies needed to report weight loss or BMI values at baseline and post-treatment. Measures: The primary dependent variables were weight lost in kilograms, change in BMI, and percent who achieved 5% weight loss in the placebo arm. Data Collection: A standardized data collection form was used to extract data from the selected trials. Data was independently extracted by 3 researchers and discrepancies were resolved by consensus. Data Analysis: Data was analyzed by constructing a forest plot of the amount of weight lost in the placebo arm stratified by type of drug. A funnel plot and Kendall’s tau were used to assess publication bias. Heterogeneity was assessed with I2. The a priori alpha level was 0.05. Results: Statistically significant weight loss was achieved in the placebo arm in all 6 RCTs Weight loss was consistent across type of study Lorcaserin studies, mean = 2.42 kg Phentermine/topiramate studies, mean = 2.14 kg Overall rate of 5% weight loss was 0.32 No data was reported on actual caloric intake or actual quantity of exercise Funnel plot and Kendall’s tau (p = 0.85) indicated there was no publication bias There was heterogeneity in the lorcaserin studies resulting from one study reporting a large effect Conclusions: Participants in the placebo arm lost weight with monthly counseling on calorie intake and exercise, however, actual caloric intake or quantity of exercise that resulted in the weight loss is unknown.

Class of 2015 Abstract / Objectives: To establish the impact pharmacists can have on adult immunization rates by having pharmacists available to provide, administer, and advocate for immunizations. Methods: The following databases were searched from inception to November 2014: NLM PubMed; Ovid/MEDLINE; and Google Scholar. Inclusion criteria were comparative studies reporting pharmacist intervention and their impact on immunization rates. Of 38 publications originally identified, 15 met inclusion criteria. Variables examined included study characteristics, pharmacist intervention, and immunization rates. Results: Of the 15 studies we identified, only ten studies could be analyzed in the meta-analysis. All studies showed increases in immunization rates with pharmacist involvement, but there was high variance. Pharmacist interventions at hospital sites had the greatest benefit for increasing immunization rates (average odds ratio [OR], 10.64, confidence interval [CI] 95%, 5.25-21.49). Pharmacist intervention at one or two community sites had the second highest impact (OR, 2.81; CI 95%, 2.31-3.41). Studies covering multiple sites (more than two) showed the lowest increase in immunization rates (OR 2.26; CI 95%, 1.81-2.81). Conclusions: Pharmacist’s involvement in advocating and administering immunizations directly increases immunization rates in some patient populations. The greatest increases in immunization rates can be seen when pharmacists advocate for immunizations in the hospital setting.

Class of 2013 Abstract / Specific Aims: To assess the impact that exercise-type has on diabetes control through improvement in monitoring parameters such as hemoglobin A1c and fasting blood glucose. Methods: Studies were selected using a study inclusion tool and then data was extracted using the data extraction tool. The primary outcomes assessed were BMI and HbA1c. The standardized mean difference (SMD) was the main summary measure and the I2 statistic ¬¬¬¬¬¬was used to assess variability among the studies. Main Results: Ten studies met inclusion criteria (Total N = 1,787). The age range of patients was 40-66 years old with equal amounts of male and female participants. Aerobic and resistance exercise were effective (p < 0.01) in reducing A1c; Tai Chi was not (p = 0.50). Aerobic exercise did not have a significant effect on BMI (p = 0.07), however Tai Chi and Resistance exercise did (p<0.04). Conclusion: Aerobic and resistance exercise produced a significant reduction in HbA1c, whereas Tai Chi did not. The non-significant impact aerobic exercise had on BMI was probably due to large variation between the studies. No significant differences were found between the different forms of exercise and their overall impact on diabetes control. Based upon the data incorporated in this meta-analysis, it is reasonable for patients with diabetes mellitus type 2 to use aerobic or resistance exercise to improve their HbA1C. However, it remains to be seen whether recommending specific exercise types over others will provide increased benefit.

This is a case study of how Tshwane University of Technology is implementing quality assurance of its academic programmes in accordance with the requirements of the Higher Education Quality Committee. The focus of the study is on the activities of the central quality unit, the Directorate of Quality Promotion (DQP) regarding the evaluation of its programme evaluations. This is akin to a question raised regarding parliamentary procedures, not long ago when the Auditor General appeared before the parliamentary committee on public accounts. The question was ‘Who is auditing the Auditor General?’ Before this question could be asked at TUT, a strategic decision was taken by the current director of the DQP regarding what the directorate needed to do in achieving leadership in this regard. An introductory description is made of the current curriculum development practices within the new educational dispensation. The statutory roles of the Department of Education, the South African Qualifications Authority&the Higher Education Quality Committee in this process are described. This is followed by an explanation of the new programme outlay within outcomes-based education. In offering a theoretical framework for the study various evaluation models are treated, and the CIPP evaluation model is adopted for this study. The research design for the study is allied to a literature-based model by Brinkerhoff, et. al. This is a six step framework for conducting meta-evaluation. The qualitative data analysis takes the form of evaluating the evaluation against thirty International Evaluation Standards of the Joint Committee on Standards for Educational Evaluation. These standards are sub-divided into the following categories, namely, utility, feasibility, propriety and accuracy standards. The study concludes that conducting a meta-evaluation for programme reviews has the potential to expose strengths and weaknesses of quality assurance practice. / Dissertation (MEd (Assessment and Quality Assurance in Education and Training))--University of Pretoria, 2007. / Curriculum Studies / MEd / unrestricted

My study investigated internal consistency estimates of psychometric surveys as an operationalization of the state of measurement precision of constructs in industrial and organizational (I/O) psychology. Analyses were conducted of samples used in research articles published in the Journal of Applied Psychology between 1975 and 2010 in five year intervals (K = 934) from 480 articles yielding 1427 coefficients. Articles and their respective samples were coded for test-taker characteristics (e.g., age, gender, and ethnicity), research settings (e.g., lab and field studies), and actual tests (e.g., number of items and scale anchor points). A reliability and inter-item correlations depository was developed for I/O variables and construct groups. Personality measures had significantly lower inter-item correlations than other construct groups. Also, internal consistency estimates and reporting practices were evaluated over time, demonstrating an improvement in measurement precision and missing data.

Background: Despite several decades of research, the relevance of body fat and body fat distribution to the risk of cardiovascular disease remains unclear. This thesis aims to investigate associations of body-mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) with risk of first-onset cardiovascular disease under a range of different circumstances. Methods: This thesis used individual records from the Emerging Risk Factors Collaboration to calculate risk ratios, and measures of discrimination and reclassification. 118 prospective studies, involving 1,064,541 participants without known history of cardiovascular disease, had information on BMI at baseline examination. 58 of these studies, involving 221,934 participants, had additional information on waist and hip circumference at baseline examination. Serial measurements made in 42,300 participants from 12 studies with concomitant information on these adiposity measures enabled quantification of within-person variability in BMI, WC and WHR. Results: Cross-sectional analyses demonstrated that although the correlations of adiposity measures differed with one another, BMI, WC and WHR were similarly and importantly associated with mediating cardiovascular risk factors, such as blood pressure, fasting glucose and lipids. Within-person variability was lower in BMI (regression dilution ratio: 0.96) than in WC (0.88) and WHR (0.66). The variability of adiposity measures was not materially influenced by several characteristics, although the variability of WHR varied somewhat by sex, diabetes status and baseline WHR values. 1,064,541 individuals with information on BMI recorded 161,903 deaths or non-fatal cardiovascular outcomes during 15.0 million person-years of follow-up. In analyses adjusted for age, sex and smoking status, BMI had positive and nearly loge-linear associations with coronary heart disease and ischaemic stroke (except at BMI values below 20 kg/m2), which were largely explained by the intermediate risk factors noted above. The association between BMI and non-vascular mortality was curvilinear. Data on 221,934 individuals with complete information on weight, height, and waist and hip circumference (14,297 incident cardiovascular outcomes; 1.87 million person-years of follow-up) demonstrated that BMI, WC and WHR were substantially and similarly related to risk of coronary heart disease and ischaemic stroke. For cardiovascular risk prediction, additional information on BMI, WC or WHR to a prediction model containing conventional risk factors did not importantly improve risk discrimination, nor classification of participants to risk categories of predicted 10-year risk. Conclusions: BMI, WC and WHR are similarly associated with risk of cardiovascular disease, with much of the risk explained by intermediate risk factors. These clinical measures of adiposity do not importantly improve cardiovascular risk prediction when additional information is available on blood pressures, history of diabetes and lipids.

With the growing number of older adults in the general population, there is also a concomitant rise in the number of older adults who require mental health services, making the measurement of psychological conditions in later life a priority. However, due to a lack of measures created for older adults, researchers and clinicians must often rely on measures created for younger populations. Three studies were designed to add to the field of evidence-based assessment and determine which anxiety measures possess strong evidence when used with older adults to warrant their use with this specific population. In the first study, I systematically reviewed the literature to identify the anxiety measures most commonly used with older adults. I reviewed each measure to examine its psychometric properties (e.g., internal consistency, test-retest reliability, inter-rater reliability, concurrent and discriminant validity) and the availability of age-appropriate norms in order to evaluate whether the instruments are appropriate for use with older adults. In the second study, I conducted a reliability generalization meta-analysis to estimate the mean reliability of each commonly used anxiety measure identified in the first study. Finally, in the third study, I examined whether the anxiety measures commonly used with an older population can be consistently and accurately categorized as evidence-based. The literature review and the reliability generalization study both revealed that most of the most commonly used measures lacked sufficient evidence to warrant their use with older adults. However, three measures (Beck Anxiety Inventory, Penn State Worry Questionnaire, and Geriatric Mental Status Examination) showed psychometric properties sufficient to justify the use of these instruments when assessing anxiety in older adults. In addition, two measures developed specifically for older adults (Worry Scale and Geriatric Anxiety Inventory) were also found to be appropriate for use with older adults. This suggests that based on their overall level of reliability and previous psychometric evidence, both researchers and clinicians assessing anxiety in a geriatric population should consider these measures as likely to be the best currently available.

Osteoporosis is a growing cause of morbidity and mortality in aging populations worldwide, especially in postmenopausal women. Bisphosphonates are widely prescribed for fracture prevention in osteoporosis. Meta-analyses have been performed for alendronate, risedronate, and etidronate, examining their effectiveness versus placebo in fracture prevention. Total withdrawals and adverse event withdrawals were examined as safety outcomes. Systematic reviews were performed for two other bisphosphonates, ibandronate and zoledronic acid and the results combined with previously obtained data for the other bisphosphonates. Indirect treatment comparisons of the drugs against each other and versus placebo were performed using Bayesian and frequentist methods. Both types of analyses yielded almost identical results: zoledronic acid and alendronate were the most effective bisphosphonates for preventing vertebral fractures. No differences were found regarding withdrawals. Subgroup analyses found that fracture prevention was generally more effective with longer therapy (greater than or longer than 3 years).

The development of competency in clinical supervision is becoming an increasingly important element of training and practice in professional psychology. To assist students in developing supervisory competencies, knowledge of relevant research and effective training methods is required. Three studies were designed to add to the field of supervisor development research. In the first study, I conducted a systematic review to examine the extent to which theoretical models of supervisor development have been used in empirical studies of supervisor development within professional psychology. This study revealed that studies rarely employ theory, and when they do, the Supervisor Complexity Model is the most often used theory, likely because it is the only one with an associated measure, the Psychotherapy Supervisor Development Scale (PSDS; Watkins, Schneider, Haynes, & Nieberding, 1995). Building on the findings of this systematic review, in the second study I conducted a reliability and validity generalization on the PSDS. Reliability and validity generalizations are meta-analytic methods that allow reliability and validity data from a measure to be summarized across studies. Results indicate the PSDS has a history of excellent reliability, and higher scores are found with increased supervisory training and experience, evidence of the scale’s validity. The third study is a meta-analysis of the supervisor development literature, in order to assess the effect sizes of training and experience on supervisory development and self-efficacy. Results indicate that training and experience have significant positive effect sizes, though they do not differ from one another. Based on results from these studies I provide recommendations about: the samples with which the PSDS tool is appropriately used, and how researchers might increase reliability within their own future studies, and evidence based recommendations for competency based education efforts.