Medical students' and tutors' experiences of directed and self-directed learning programs in evidence-based medicine: a qualitative evaluation accompanying a randomized controlled trial

This qualitative study aims to interpret the results of a randomized controlled trial comparing two educational programs (directed learning and self-directed learning) in evidence-based medicine (EBM) for medical students at the University of Oslo from 2002 to 2003. There is currently very little comparative educational research in this field. In the trial, no statistically significant differences between the study groups were shown for any outcomes considered (EBM knowledge, skills, and attitudes). Further analysis suggests that main reason for the negative trial results was that the majority of students learned equally effectively, whichever program they received, although implementation of the educational programs was not complete because of varying attendance. This study illustrates a stepwise evaluation model that might be useful in evaluating other socially complex interventions.     

On value-judgements and ethics in health technology assessment

The widespread application of technology in health care has imposed a broad range of challenges. The field of health technology assessment (HTA) is developed in order to face some of these challenges. However, this strategy has not been as successful as one could hope. One of the reasons for this is that social and ethical considerations have not been integrated in the HTA process. Nowadays however, such considerations have been included in many HTAs. Still, the conclusions and recommendations of the HTAs are not followed. The reason for this may be that the methods for integrating ethics for HTA are not sufficiently developed, or that they are not adequate. This article presents a supplementary approach to the ethical inquiry in HTA. It is argued that a value analysis is crucial in order to address the ethical issues of health care technology in a fruitful way and to make viable decisions about such technology.

Conflicting strategic objectives in hospital design

This paper presents a multigoal linear programming model designed to analyse the impact of different strategic objectives in the planning of hospitals. The paper argues that it is necessary to adopt an overall point-of-view in planning; that it is necessary to consider the interactions between the hospital, other social and health institutions and the community at large in order to attain an efficient plan. A simplified cost-benefit analysis is suggested, and it is demonstrated that the opportunity costs of lost working days may be more important than both capital and operating costs from a social point of view.     

Iterative bias reduction: a comparative study

Multivariate nonparametric smoothers, such as kernel based smoothers and thin plate splines smoothers, are adversely impacted by the sparseness of data in high dimension, also known as the curse of dimensionality. Adaptive smoothers, that can exploit the underlying smoothness of the regression function, may partially mitigate this effect. This paper presents a comparative simulation study of a novel adaptive smoother (IBR) with competing multivariate smoothers available as package or function within the R language and environment for statistical computing. Comparison between the methods are made on simulated datasets of moderate size, from 50 to 200 observations, with two, five or 10 potential explanatory variables, and on a real dataset. The results show that the good asymptotic properties of IBR are complemented by a very good behavior on moderate sized datasets, results which are similar to those obtained with Duchon low rank splines.     

Constructions of ‘the ageless’ asylum seekers: An analysis of how age is understood among professionals working within the norwegian immigration authorities

This article explores how professionals within the Norwegian immigration authorities conceptualise age when doing non-medical age assessments. By using social constructivism, which challenges an ethnocentric quantifying understanding of age, we delve into how socially constructed perceptions of childhood and adulthood manifest in assessment practices and the implications of these. By examining how applicants’ physical appearance, body language and life experience are used as an assessment basis, we argue that the ways age is conceptualised relate to Western ideas and ideals while overlooking other social and cultural backgrounds in which age is embedded.