Statistical Power of Alternative Structural Models for Comparative Effectiveness Research: Advantages of Modeling Unreliability

The advantages of modeling the unreliability of outcomes when evaluating the comparative effectiveness of health interventions is illustrated. Adding an action-research intervention component to a regular summer job program for youth was expected to help in preventing risk behaviors. A series of simple two-group alternative structural equation models are compared to test the effect of the intervention on one key attitudinal outcome in terms of model fit and statistical power with Monte Carlo simulations. Some models presuming parameters equal across the intervention and comparison groups were under- powered to detect the intervention effect, yet modeling the unreliability of the outcome measure increased their statistical power and helped in the detection of the hypothesized effect. Comparative Effectiveness Research (CER) could benefit from flexible multi- group alternative structural models organized in decision trees, and modeling unreliability of measures can be of tremendous help for both the fit of statistical models to the data and their statistical power

Supporting Recruitment and Retention of Young African-American and Hispanic Fathers in Community-Based Parenting Interventions Research

Few studies to date have provided strategies for maintaining low rates of attrition when conducting longitudinal, epidemiological, or community-based research with young, minority, urban fathers. This paper highlights lessons learned from a 5-year randomized controlled trial of a fatherhood intervention that designed and implemented state-of-the-art and culturally relevant recruitment and retention methods with 348 young fathers ages 15 to 25. Qualitative findings are drawn from interviews with fathers who had been enrolled in the fatherhood intervention (n=10). While traditional recruitment and retention methods, such as incentives, were employed in this study, non-traditional methods were used as well, such as intensive community outreach, staff relationship development, recruiting specialists, and flexible contact methods. These methods were found to be helpful to young fathers in the study. Future research should incorporate, and further study, such non-traditional methods for recruiting young, minority, urban fathers into studies of parenting programs, including randomized control trials, to improve services for this underserved population

A systematic review of the implementation and impact of asthma protocols

BACKGROUND: Asthma is one of the most common childhood illnesses. Guideline-driven clinical care positively affects patient outcomes for care. There are several asthma guidelines and reminder methods for implementation to help integrate them into clinical workflow. Our goal is to determine the most prevalent method of guideline implementation; establish which methods significantly improved clinical care; and identify the factors most commonly associated with a successful and sustainable implementation. METHODS: PUBMED (MEDLINE), OVID CINAHL, ISI Web of Science, and EMBASE. Study Selection: Studies were included if they evaluated an asthma protocol or prompt, evaluated an intervention, a clinical trial of a protocol implementation, and qualitative studies as part of a protocol intervention. Studies were excluded if they had non-human subjects, were studies on efficacy and effectiveness of drugs, did not include an evaluation component, studied an educational intervention only, or were a case report, survey, editorial, letter to the editor. RESULTS: From 14,478 abstracts, we included 101 full-text articles in the analysis. The most frequent study design was pre-post, followed by prospective, population based case series or consecutive case series, and randomized trials. Paper-based reminders were the most frequent with fully computerized, then computer generated, and other modalities. No study reported a decrease in health care practitioner performance or declining patient outcomes. The most common primary outcome measure was compliance with provided or prescribing guidelines, key clinical indicators such as patient outcomes or quality of life, and length of stay. CONCLUSIONS: Paper-based implementations are by far the most popular approach to implement a guideline or protocol. The number of publications on asthma protocol reminder systems is increasing. The number of computerized and computer-generated studies is also increasing. Asthma guidelines generally improved patient care and practitioner performance regardless of the implementation method

Depression and the Long-Term Risk of Pain, Fatigue, and Disability in Patients with Rheumatoid Arthritis

Objective. To determine whether a previous episode of major depression leaves a “scar” that places previously depressed patients with rheumatoid arthritis (RA) at risk for experiencing high levels of pain, fatigue, and disability. Methods. A cohort of 203 patients with RA was randomly selected from a national panel and interviewed by phone about pain, fatigue, depressive symptoms, disability, and history of major depression. Results. Excluding patients who met the criteria for current major depression, patients with both a history of depression and many depressive symptoms at the time of the interview (dysphoria) reported more pain than those without current dysphoria, irrespective of whether they had a history of depression. Dysphoria alone was not reliably related to pain reports. Conclusion. An episode of major depression, even if it occurs prior to the onset of RA, leaves patients at risk for higher levels of pain when depressive symptoms persist, even years after the depressive episode