Expert panel reviews of research centers: the site visit process

Site visits are used extensively in a variety of settings within the evaluation community. They are especially common in making summative value decisions about the quality and worth of research programs/centers. However, there has been little empirical research and guidance about how to appropriately conduct evaluative site visits of research centers. We review the processes of two site visit examples using an expert panel review: (1) a process to evaluate four university research centers and (2) a process to review a federally sponsored research center. A set of 14 categories describing the expert panel review process was obtained through content analysis and participant observation. Most categories were addressed differently through the two processes highlighting the need for more research about the most effective processes to use within different contexts. Decisions about how to structure site visits appear to depend on the research context, practical considerations, the level at which the review is being conducted and the intended impact of the report. Future research pertaining to the selection of site visitors, the autonomy of the visitors in data collection and report writing, and the amount and type of information provided would be particularly valuable.     

Providing medical information to college health center personnel: a circuit Librarian Service at the University of Illinois

College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at Chicago campus. This partnership led to the adoption of circuit librarianship, a dynamic outreach model, to enhance access to health information for McKinley Health Center personnel. A circuit librarian consults with health center personnel during regularly scheduled on-site visits to the center and its satellite office. Upon returning to the resource library, the circuit librarian conducts research for clinical information on behalf of the center's personnel, then sees that articles, books, and relevant Web sites are identified and delivered to assist in answering questions regarding disease management, drug therapy, wellness, and health administration.     

Providing Medical Information to College Health Center Personnel: A Circuit Librarian Service at the University of Illinois

Abstract

College health center personnel are no different from other health practitioners in their need for medical information. To help meet this need, the McKinley Health Center, University of Illinois Urbana-Champaign, developed a partnership in 1997 with the Library of the Health Sciences-Urbana, a regional site library of the University of Illinois at Chicago campus. This partnership led to the adoption of circuit librarianship, a dynamic outreach model, to enhance access to health information for McKinley Health Center personnel. A circuit librarian consults with health center personnel during regularly scheduled on-site visits to the center and its satellite office. Upon returning to the resource library, the circuit librarian conducts research for clinical information on behalf of the center's personnel, then sees that articles, books, and relevant Web sites are identified and delivered to assist in answering questions regarding disease management, drug therapy, wellness, and health administration.     

Development,Evaluation, and Validation of Environmental Assessment Tools to Evaluate the College Nutrition Environment

Abstract

Objective: To develop, evaluate, and validate 2 nutrition environment assessment tools (surveys), for specific use in combating overweight on college/university campuses. Participants and Methods: Invitations to complete surveys were e-mailed to food service and health center directors at 47 universities, Winter 2008. Overall response rate was 48%. Responses from the 39 individuals who completed tool evaluations at the end of each survey were analyzed. Follow-up interviews and site visits performed through Summer 2008 validated responses. Results: The majority of respondents (64%) indicated tools were effective at assessing their nutrition environments; 78% believed these types of assessment tools to be important to their school. Conclusion: Food service and health center directors support use of nutrition environment assessment tools and found them effective at clarifying existing nutrition programs, policies, and food offerings on their campuses. Conducting assessments using these tools could improve university nutrition environments by identifying areas needing improvement.     

The use of zip coded population data in social area studies of service utilization

Social area analysis (SAA) is a well-established methodology for geographically based analysis of service delivery and other health related outcome measures. However, SAA has been limited in application by the complexities of computerized geocoding and difficulties in obtaining appropriate measures of community characteristics. In this paper we demonstrate that these problems can be overcome by employing zip code as well as the unit of analysis for SAA and obtaining commercially available measures of community characteristics. Regression analyses, using New York City zip code populations as the unit of observation were used to illustrate the role of epidemiologic risk factors in predicting rates of inpatient discharge and ambulatory care visits.     

Harnessing the reliability of outcome measures

A method is presented for engineering the necessary levels of measurement reliability for evaluating ongoing programs. Two studies of levels of client functioning at a community mental health center (CMHC), in which an outcome measure, the Global Assessment Scale (GAS), did not perform as expected, drew attention to the need for better control of outcome measure reliabilities. Drawing from generalizability theory, a study was conducted of three sources of GAS score variance — clients, raters, and training in the use of the scale. Several estimates of reliability (ERs) were developed, depending on the manner in which the GAS ratings were, or would be, obtained in the CMHC. The differences among these ERs clarified why the GAS had lower reliability when used in our setting. Finally, two hypothetical examples are described to illustrate the utility of applying generalizability theory to achieve higher reliabilities for outcome measures.     

Control centers design for ergonomics and safety

This paper shows the general design conditions about ergonomics and safety for control centers in the petrochemical process industry. Some of the topics include guidelines for the optimized workstation design, control room layout, building layout, and lighting, acoustical and environmental design. Also takes into account the safety parameters in the control rooms and centers design. The conditions and parameters shown in this paper come from the standards and global advances on this topic on the most recent publications. And also the work was supplemented by field visits of our team to the control center operations in a petrochemical company, and technical literature search efforts. This guideline will be useful to increase the productivity and improve the working conditions at the control rooms.     

The Impact of High-Profile Sexual Abuse Cases in the Media on a Pediatric Emergency Department

High-profile media cases of sexual abuse may encourage disclosures of abuse from victims of unrelated assaults and also influence parental concerns, leading to increased emergency department visits. In the region of the study authors’ institution, there are two recent high-profile sexual abuse cases with media coverage: Earl Bradley, a Delaware pediatrician, and Jerry Sandusky, a Pennsylvania college football coach. This is a retrospective cohort study of children evaluated for sexual abuse at a pediatric emergency department. Patients were classified as either presenting during a media period or non-media period. The media periods were one-month periods immediately following breaking news reports, when the cases were highly publicized in the media. The non-media periods were the 12-month periods directly preceding the first reports. The median number of emergency department visits per month during a non-media period was 9 visits (interquartile range 6–10). There were 11 visits in the month following the Sandusky case and 13 visits following the Bradley case. There was no statistical difference in number of emergency department visits for sexual abuse between the periods (p = .09). These finding have implications regarding use of resources in pediatric EDs after high-profile sexual abuse cases.     

Providing Student Health Services at Sea: A Survey of Chief Complaints Onboard a Maritime Academy Training Ship

Abstract. Objective: The authors describe the epidemiology of infirmary chief complaints aboard a collegiate maritime training ship. Participants: They assessed patients (N = 646 visits) evaluated by the USTS Enterprise medical department during a 44-day sea term from January to February 2007. Methods: The authors conducted a retrospective chart review of infirmary use and extracted information on age, sex, rank, chief complaints, and frequency of visits. Results: Overall, 646 visits were made. The most common complaints were dermatologic (30.1%): rash, skin infection, laceration, and sunburn. Together, ear, nose, and throat and dermatologic complaints accounted for 57.6% of all visits. Work-related complaints accounted for 12.5% of recorded visits. Compared with the ship population, senior and female cadets had more visits than the average. Port departure days were typically the busiest. Conclusions: Among healthy, college-aged cadets at sea, typical primary care constitute comprise the majority of visits.     

Nursing home administrators' views of volunteers' work in an ombudsman program

This research investigated nursing home administrators' (NHAs) perceptions of visits of volunteers in an ombudsman program in relation to effectiveness and satisfaction. Unlike placements of other volunteers made at the behest of organizations, visits of volunteer advocates, which may be mandated and include evaluative assessments of care, usually do not occur at the invitation of NHAs. Yet, outcomes for administrators are not often studied. Despite research showing stress attributed to interaction with state agencies, questionnaire data from 196 NHAs indicated that more contact between volunteers and NHAs was associated with perceptions of greater effectiveness and satisfaction. Those who found visits infrequent and with little impact rated the work of volunteers as less effective and were less satisfied. Qualitative data describe unexpected benefits of visits that were internal and external to the facilities.     

Clinical and Ethical Considerations for Delivering Couple and Family Therapy via Telehealth

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in‐office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here.     

Pollinating animals in the urban environment

Urban environments contain habitats for flowering plants and their pollinating animal species. It is, however, unclear how the urban matrix influences plant-pollinator processes. We recorded plant diversity, floral abundance, flower visitor diversity and plot visits at 89 plant patches within the city of Zürich. The urban matrix surrounding each site was analyzed for the landscape metrics edge density and the extent of green area up to 200 m radius. The correlation between edge density and bee diversity and visitation frequency varied over the entire spatial range, while the correlation for syrphid diversity and visitation frequency levelled off at 80 m radius. In contrast, the correlations with green area were more consistent, with bee diversity levelling off after 100 m, while syrphid diversity and visits continued to increase. The variation in the correlation of bee visits was partly accounted for by the large contribution of honeybees. Plant diversity significantly affected bee diversity and visits, and syrphid visits. Floral abundance had a positive effect on bee visits and bee diversity. Syrphid diversity had a negative interaction with floral abundance and green area. The extent of green area increased bee diversity and visits, and syrphid visits, while edge density reduced visitation by bees. This study showed that plant diversity and floral abundance in urban environments promote pollinating flower visitors. The extent of green area and edge density are important urban mosaic attributes that affect pollinator abundance and visitation frequency at multiple scales.     

Alcohol-Related Emergency Department Visits Associated With Collegiate Football Games

Abstract

Objective: In 2003, after several post–college football game riots, multiple strategies including strict enforcement of open container laws were instituted by the authors’ city and university. The authors compared alcohol-related visits to the on-campus emergency department (ED) associated with home football games in 2002 and 2006, hypothesizing that alcohol-related visits should decline. Participants: ED patients during home game weekends. Methods: Retrospective cohort study comparing the 2002 and 2006 home games—similar seasons wherein the team went undefeated. Logistic regression assessed the impact of environmental and patient characteristics on the likelihood of an ED visit being alcohol related. Results: In total 2,220 visits in 2002 and 2,146 visits in 2006 were reviewed. Alcohol-related visits increased from 2002 (7.9%) to 2006 (9.5%, p = .06). Despite community interventions, the odds of an ED visit being alcohol related increased (odds ratio [OR] 1.3, 95% confidence interval [CI₉₅] 1.06–1.64). Conclusions: Community measures did not reduce alcohol-related visits to the ED.     

Older patient-physician discussions about exercise

This cross-sectional observational study examined the frequency of older patient-physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician's being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.     

Policy Changes in Medicare Home Health Care: Challenges to Providing Family-Centered,Community-Based Care for Older Adults

The Balanced Budget Act of 1997 (BBA) established new reimbursement systems in the Medicare home health fee-for-service benefit. Reimbursements were reduced to 1993 levels and per-beneficiary capitated limits were introduced for the first time. This article analyzes the impact of these changes on chronically ill older adults and their families. The study combined a secondary analysis of the Provider of Service file (1996, 1999, 2002, and the Medicare Current Beneficiary Survey (1996, 1998) with qualitative interviews of home health agency directors. The greatest decreases in staff and visits were for medical social work and home health aide services. Patients with caregivers saw greater decreases in visits and reimbursements for all visits, skilled nursing, medical social work, and home health aide visits. Agency directors reported that they increased caregiver education, training, and involvement in care in order to discharge patients sooner. Additional research is needed to understand the long-term, adverse impact of these policy changes on chronically ill patients and their families.     

Access visits: Perceptions of child protection workers, foster parents and children who are Crown wards

Objective

To report findings from a study of the perceptions of foster parents, child protection workers and children regarding supervised access visits for children who are permanent wards (Crown wards).

Methods

Interviews were conducted with twenty-four Crown wards having regular supervised access visits. Eight focus groups were conducted with twenty-four foster parents, and twenty-six child protection workers. Interviews and focus groups explored perspectives regarding supervised access visits. Interviews and focus groups were transcribed, coded, and thematically analyzed. Negative case analysis, prolonged engagement, and triangulation contributed to the trustworthiness of the research.

Results

While this study is explorative, findings suggest considerable dissatisfaction regarding access visits among foster parents and workers, inadequate training for workers and foster parents, poor communication and consultation regarding access visits, and confusion regarding the roles of supervisors.

Conclusions

The data suggest several possible explanations for children's distress associated with access visits including lack of communication among access supervisors, workers and foster parents; insufficient training for workers who supervise visits; and a lack of validation of the children's contradictory feelings towards their mothers.

Practice implications

Findings suggest the need for more consultation with and inclusion of foster parents in access visits. More training is required for workers supervising access visits including whether and how it is beneficial for children to express their feelings and address potentially difficult topics regarding their biological family members.     

Postcoital Contraception: Awareness of the Existence of Postcoital Contraception among Students who have had a Therapeutic Abortion

Abstract

A two-semester survey was conducted to obtain information about the underutilization of postcoital contraception (PCC) in terms of fear about using it or ignorance of its existence. Among 437 students attending the women's health clinic at California State University/Fresno, 41% had had a therapeutic abortion. One hundred fifty-two, or 84.9%, of those who had had terminations were not aware of PCC. Some were not aware that they had taken a chance of becoming pregnant. It is concluded that students who have had a therapeutic abortion either were unaware of the existence of PCC or were unaware they were risking pregnancy and therefore unable to utilize PCC to avoid the need for a surgical procedure. It would appear that ignorance about the existence of PCC is a major reason for its underutilization.

“Treatment of First Episodes of Genital Herpes Simples Virus Infection with Oral Acyclovir,” YVONNE J. BRYSON, MARYANNE DILLON, MICHAEL LOVETT, GUILLERMO ACUNA, STEPHEN TAYLOR, JAMES D. CHERRY, B. LAMAR JOHNSON, EDWARD WIESMEIER, WILLIAM GROWDON, TERRI CREAGH-KIRK, RONALD KENNEY. We performed a double-blind placebo-controlled trial of oral acyclovir in the treatment of first episodes of genital herpes simplex virus infections in 48 young adults (31 women and 17 men). Subjects were randomized to receive either placebo or acyclovir (200 mg per dose) five times daily for 10 days; they were examined on at least eight visits until healed and at monthly visits thereafter. Acyclovir treatment, as compared with placebo, significantly reduced virus shedding, new lesion formation after 48 hours, and the duration of genital lesions in both men and women. The total duration and severity of clinical symptoms (such as pain, adenopathy, dysuria, and malaise) were significantly reduced by acyclovir in both men and women by the third and fourth day, respectively (P ≤ 0.025), as compared with placebo. No toxicity was observed. Recurrence rates have so far been similar in placebo and acyclovir recipients. Oral acyclovir treatment of first-episode genital herpes simplex virus infections is clincially effective, but it does not seem to prevent virus latency or associated recurrent disease. (New England Journal of Medicine 1983;308:916–21)

“Cesarean Section: Risk and Benefits for Mother and Fetus,” BEN P. SACHS, BRIAN J. McCARTHY, GEORGE RUBIN, ANTHONY BURTON, JULES TERRY, CARL W. TYLER. We studied the effects of cesarean section on neonatal mortality for breech infants and low-birth weight vertex infants using data from the Georgia neonatal surveillance network on 392,241 singleton deliveries between 1974 and 1978. The risk of neonatal death for breech infants weighing 4,000 g or less delivered vaginally was significantly higher than the risk for those delivered by cesarean section. The lower the birthweight, the higher the risk for a vaginal breech delivery. For breech infants weighing 1,000 to 2,500 g, the risk was almost 2½ times greater for a vaginal delivery v a cesarean delivery. The best outcome for high-risk vertex infants weighing 1,000 to 1,500 g was for those delivered by cesarean section in a tertiary perinatal center. An increase in the cesarean section rate may be associated with increased neonatal survival; however, the benefits must be weighed against the costs of an increased maternal mortality and morbidity. (Journal of the American Medical Association 1983;250:2157–2159)