BACKGROUND:There is a need for more Comparative Effectiveness Research (CER) to strengthen the evidence base for clinical and policy decision-making. Effectiveness Guidance Documents (EGD) are targeted to clinical researchers. The aim of this EGD is to provide specific recommendations for the design of prospective acupuncture studies to support optimal use of resources for generating evidence that will inform stakeholder decision-making.METHODS:Document development based on multiple systematic consensus procedures (written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders including patients, clinicians and payers were involved.RESULTS:Recommendations focused mainly on randomized studies and were developed for the following areas: overall research strategy, treatment protocol, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication.CONCLUSION:The present EGD, based on an international consensus developed with multiple stakeholder involvement, provides the first systematic methodological guidance for future CER on acupuncture.

Thesis (M.S. in Systems Engineering)--Naval Postgraduate School, March 2007. / Thesis Advisor(s): Thomas D. Fiorino, Tom Huynh. "March 2007." Includes bibliographical references (p. 87-90). Also available in print.

BACKGROUND:There is a need for more Comparative Effectiveness Research (CER) on Chinese medicine (CM) to inform clinical and policy decision-making. This document aims to provide consensus advice for the design of CER trials on CM for researchers. It broadly aims to ensure more adequate design and optimal use of resources in generating evidence for CM to inform stakeholder decision-making.METHODS:The Effectiveness Guidance Document (EGD) development was based on multiple consensus procedures (survey, written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders, including patients, clinicians, researchers and payers were involved in creating this document.RESULTS:Recommendations were developed for "using available data" and "future clinical studies". The recommendations for future trials focus on randomized trials and cover the following areas: designing CER studies, treatments, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication.CONCLUSION:The present EGD provides the first systematic methodological guidance for future CER trials on CM and can be applied to single or multi-component treatments. While CONSORT statements provide guidelines for reporting studies, EGDs provide recommendations for the design of future studies and can contribute to a more strategic use of limited research resources, as well as greater consistency in trial design.

Benchmarking offers community practitioners more systematic judgments about research effectiveness when control groups are not feasible, while also providing a standard for program transportability from clinical to community settings. The purpose of the current study was to outline the necessary decisions, calculations, and strengths and limitations of applying benchmarking methodologies to a behavioral parent training (BPT) program, a field in which benchmarking remains relatively underutilized. The implementation of in-home Parent-Child Interaction Therapy (PCIT), an evidence-based practice shown to be successful in reducing child maltreatment and neglect, was evaluated as a case study of the application of benchmarking. Of those parents that completed in-home PCIT, a significant reduction was seen for pre-post ECBI scores. Six randomized controlled trials (RCTs) were established as benchmarks based on similarity in parent and child demographics as well as use of the ECBI as a primary measure. Effect sizes of each benchmark study were aggregated to create a single benchmark effect size for treatment and control groups, respectively. The effect size of the current study was found to be significantly superior to the control benchmark effect size but not significantly equivalent to the treatment benchmark effect size. Although the current study demonstrates the use of benchmarking in community research, the need for further guidelines is critical for researchers.

Background: Dialectical behavior therapy (DBT), an outpatient intervention, has shown efficacy in reducing suicidality. Less is known about its effectiveness when delivered in usual care (UC), and the resource-intensive nature of the program often results in modifications when implemented in usual care. Methods: A systematic search yielded 83 empirical evaluations of DBT that reported original data on at least one of three suicidality-related outcomes: (a) self-directed violence (SDV), (b) crisis service use (CSU), and (c) suicidal ideation (SI). Using meta-analysis, the current study (1) estimated pooled effect of DBT in UC, (2) compared effects in UC and non-UC settings, and (3) examined predictors of differential outcomes. Results: DBT demonstrated a large effect (g=.81) in reducing SDV and a medium effect in reducing SI (g=.68). The estimated effect on CSU (g=.60) was non-significant after adjusting for publication bias (g=.29). DBT was more effective than control conditions in reducing SDV (g=.50), even after adjusting for publication bias (g=1.63). No differences between UC and non-UC effects were detected. In uncontrolled studies, positive associations emerged between therapist training and SDV reduction, adherence-reporting and CSU reduction, and outpatient and SI reduction. Discussion: Results support DBT’s effectiveness in reducing suicidality-related outcomes in UC, but should be interpreted with caution given the heterogeneity among studies. Potential sources of heterogeneity and the methodological challenges of synthesizing research in UC are discussed. Recommendations for future work are offered. / Psychology

This paper describes and tests a largely ignored but important preliminary step for comparative effectiveness research: retrospective evidence syntheses to first establish a knowledge base of condition-based medical conditions. By aggregating and organizing what is already known about a treatment or system, gaps in knowledge can be identified and future research designed to meet those gaps.An information synthesis process may also discover that few knowledge gaps in the knowledge base yet exist, the gaps are negligible, and / or treatment effectiveness and study quality is stable across many years, but is simply not clinically important. A consistent finding of low effectiveness is evidence against more research, including exclusion of a treatment from future comparative effectiveness studies. Though proponents of weak treatments or systems may choose to proceed with further research, use of public funds or resources that eventually increase costs to the public are unwarranted.By first establishing a treatment or system knowledge base, at least three comparative effectiveness research decisions are conceivable: (1) treatment or system should be included in future comparative effectiveness trials to establish relative effectiveness for a given condition, (2) has promise but requires more research in a prospective CER trial, or (3) the treatment is less effective than others for a given condition, making future research unnecessary. Thus, a "retroactive comparative effectiveness research method," rCER, is proposed here to identify which treatments are worth including in future prospective trials and which are known to have small to modest effect sizes and are not worth the time and expense of a closer look.The rCER method herein showed that for non-surgical low back pain any treatments did not improve greatly upon the normal and natural pain trajectory for acute low back pain. Therefore, any advantage in pain reduction by any treatment of acute low back pain over back pain's normal course of resolution without care, is quite small, and as such, the incremental cost for the marginal improvement over no treatment becomes quite large. While the quality of non-surgical low back pain studies over the past 34 years has steadily increased, the effect size has not, leading to the conclusion that future research on non-surgical low back pain treatment is unwarranted.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

A South African university has obligations to societal stakeholders. One dimension of these obligations is research productivity. The extent to which these societal obligations can be met is a function of how innovative research outputs are, and of the extent to which constraints to research output, or productivity, are known, and can be managed. An extensive body of literature, including the Global Leadership and Organisational Behaviour Effectiveness (GLOBE) studies, have demonstrated the influence of organisational cultural values on organisational outcomes. Hofstede’s cultural values research studies have also demonstrated the influence of societal cultural values on societal outcomes. However, despite this body of literature, there is a lack of knowledge of the influence of organisational culture on the research productivity of academic fields. This research attempts to address this lack of knowledge through a qualitative and a quantitative study of the relationships between organisational culture and research productivity. This analysis is undertaken at the level of the academic field, which is proxied in this study as the level of the academic school. A corresponding analysis is also undertaken at the individual level. The relationship between individual values and research productivity is also investigated, to provide a holistic perspective of the relationships between both organisational cultural, as well as individual values, and research productivity, differentiated by level of analysis. On the basis of the qualitative analysis, a model of context-specific individual-level factors is also derived, which are predicted to influence research productivity. A qualitative study of research-productive academics from the University of the Witwatersrand, the University of Cape Town, the University of Johannesburg, the University of South Africa and the University of KwaZulu-Natal was used to develop theory for testing quantitatively. The quantitative study, which sampled the University of the Witwatersrand, was used to test the theory and the propositions that were developed in the qualitative portion of the study. In the quantitative study, at the level of the academic school, relationships between organisational cultural values and research productivity predicted by GLOBE organisational cultural values theory were tested quantitatively. At the individual level, relationships between individual motivational values theory and research productivity that were predicted by Schwartz’s values theory were also tested quantitatively. The model of factors that were predicted by the qualitative analysis to contribute to research productivity was also tested quantitatively. The iii qualitative and quantitative results of the study are taken to support Kuhn’s argument; that academic research outputs are not necessarily innovative, and do not necessarily represent innovative knowledge creation in this context. Findings also indicate that particular values configurations may constrain research productivity. Specifically, configurations of values associated with lower levels of innovativeness might constrain specific non-peer reviewed forms of research productivity. The results reveal a context dominated by a conflict between two societal needs, one associated with increasing enrolments of students that are not necessarily matched by infrastructure increases, or a process of massification, and the other associated with the need for more research productivity. The conflict between these two needs was found to correspond with differences between individuals that relate to the extent to which they derive their primary job satisfaction from research versus teaching. Teacher-satisfied individuals were found to be signficantly less research productive. On the basis of the research findings, recommendations are made to improve research productivity in this context. On the basis of these and other findings discussed in the main text of the thesis, recommendations for practice and for futher research are made. It is concluded that specific value configurations appear to constrain research productivity in this context and that individuals and the academic institutions for which they work need to take the potential effect of such value configurations into account in their management of research productivity.

The purpose of this study is to investigate if cultural backgrounds affect how staff from Scandinavian international schools view school development. The study is based on the alternative hypothesis that cultural backgrounds affect school development. A survey was sent to seven Scandinavian international schools with questions designed to detect the views respondents have on school development based on the two most prominent school development perspectives; school improvement and school effectiveness. I investigated and analyzed respondents’ views about their own development work at their school today and what they would like it to look like. In addition, I examined what processes and standards they considered important when engaged in school development work. Also, I wanted to see if there were any differences in views depending on where the respondents had had their higher education, were born, or if years spent in Scandinavia had influenced their views. The results indicated that it is not statistically likely that respondents’ cultural backgrounds affect their views on school development. There could be many reasons for this outcome but since these have not been studied, I can only speculate. One reason could be that the majority of the respondents have spent more than ten years in Scandinavia which might have homogenized the respondents’ views on school development.  Another reason could be that the majority of the respondents come or have had their higher education in either an English speaking country or in Scandinavia.

Much health related research depends heavily on the analysis of a rapidly expanding universe of observational data. A challenge in analysis of such data is the lack of sound statistical methods and tools that can address multiple facets of estimating treatment or exposure effects in observational studies with a large number of covariates. We sought to advance methods to improve analysis of large observational datasets with an end goal of understanding the effect of treatments or exposures on health. First we compared existing methods for propensity score (PS) adjustment, specifically Bayesian propensity scores. This concept had previously been introduced (McCandless et al., 2009) but no rigorous evaluation had been done to evaluate the impact of feedback when fitting the joint likelihood for both the PS and outcome models. We determined that unless specific steps were taken to mitigate the impact of feedback, it has the potential to distort estimates of the treatment effect. Next, we developed a method for accounting for uncertainty in confounding adjustment in the context of multiple exposures. Our method allows us to select confounders based on their association with the joint exposure and the outcome while also accounting for the uncertainty in the confounding adjustment. Finally, we developed two methods to combine het- erogenous sources of data for effect estimation, specifically information coming from a primary data source that provides information for treatments, outcomes, and a limited set of measured confounders on a large number of people and smaller supplementary data sources containing a much richer set of covariates. Our methods avoid the need to specify the full joint distribution of all covariates.