Managing Health Resources, Standardization of Management - Article Example

1a. Choose three reasons you think are the most important and post these to the discussion on the WebCT Discussion Board Lecture 1. Remember to justify your choices. Your choice of what is most important will probably depend on your values, experiences and context. Managing health resources: Investing in health resources within a country is as important as investing in trade. However, many countries face shortages when it comes to health resources (Peters, Rao and Fryatt, 2003). This is not a good practice as healthy citizens are the basis of the success of a country’s economy. By doing research and obtaining statistical data both qualitatively and quantitatively, it would allow the country to prioritize which areas of health are in need of more funding and this would directly improve healthcare. Standardization of management: Research would also allow healthcare personnel to have standardized care for all patients via the usage of clinical practice guidelines. This would prevent the problem of using experience as a basis of management procedures as research based outcomes are more easily accepted. At the end of the day, it would also translate to better patient care and less morbidity/mortality rate (Dartnell, Hemming, Collier and Ollenschlaeger, 2007). Gauging the standards of healthcare personnel: It is important that we as healthcare personnel regardless of either being a paramedic, nurse or doctor have to from time to time gauge the level of our service towards our clients which in this case are our patients. With research, we can continuously improve our service as it can tell us via parameters such as anxiety in the wards, healthcare personnel-patient relationship and general feedback whether we are doing a good job (Basch, 1987). 1b What types of research occur in your professional organization? There are many types of research which can be found within the organization. It can be divided into primary and secondary research. Primary research includes original research such as experimental studies, randomized controlled trials, controlled trials, observational studies, cohort studies, case control studies and case reports. Secondary research include studies such as meta-analysis, systematic reviews, decision analysis and consensus reports 1c What types of research would you consider to be most useful to you and why? In my opinion, I would consider randomized controlled trials to be most useful. This is because there would be less bias, predictive factors would be balanced between both groups and randomization would also provide a more valid way to evaluate the advantages/disadvantages of 2 different types of management (Green, 2000). 2a What form of knowledge do you value and why? What is it in your personal history that has led you to value this way of knowing? I value theoretical, practical and evidence based forms of knowledge. Theoretical knowledge would provide the basic understanding: knowing why and how something occurs. Practical knowledge would allow me to apply what I have learnt in real life situations so that not only can I gain experience, I would be able to gain addition knowledge on which method works best for me. Evidence based knowledge would allow me to make decisions based on research and this would further improve my daily practice as a paramedic. Personally, I have had many family members as well as friends who have been admitted to the hospital for different reasons and from what I gather from them, the healthcare personnel who offer them the best treatment usually apply these principles in their practice which leads to a better experience. 2b.In light of your reading, what do you think of the questions I have proposed at the start of this session? Critically analyse them. Can they be supported? Should they be modified or discarded? What other questions should be asked? The questions proposed at the beginning of the session are relevant towards my daily short and long term practice. This is because before I apply research in my work, it is important that I understand what research actually is. It is vital that research is based on a relevant theoretical base because we would be able to dissect the research question and find out which areas are the ones which can be improved on. For example, if we are researching on the effects of a certain drug, by understanding the mechanisms of how the drug works would allow us to predict certain side effects. It is also important for the suitable methodology to be used as it would affect the results of the research. For example, if we are finding out whether a certain drug would benefit a specific population, it is important to obtain samples from that population and of a certain number as well to make the research more reliable. The suitability of the methodology in the context of the research too is important as different forms of research have different outcome with different methodology. At the end of the day, the research has to be carried out without any biases or errors as this would not only waste money but mislead people. These 3 questions do not need to be modified or discarded and should be asked for every research. Other questions which can be asked include: What are the side effects of the research? How many percent of the participants of the research withdrew? What were the p values/confidence intervals? Are there any potential biases? (Rochon, Gurwitz, Sykora, Mamdani, Streiner, Garfinkel, Normand and Anderson, 2005) 2c. Try to develop four research questions, two suitable for quantitative research and two suitable for qualitative research. For each question write a short explanation of why you would like to know this information, where would this research be presented and what values have led you to ask this research question. Quantitative Research: a) What is the infant mortality rate in X town? By knowing mortality rates in infants, I would also be able to find out why it happens and make changes to decrease the rates. This research can be presented at infant mortality rates meetings which are actually a nationwide project. b) What is the average cost for patient who is admitted to the hospital for a week? By knowing the average cost, I would be able to see where the resources of the hospital are spent. This would allow me to present the information to the hospital so that resources can be managed more efficiently. Qualitative Research: a) What is the perception of the general public towards paramedics? By doing this research, I would know whether the general perception of the public towards paramedics are positive. If it isn’t, then I can find out why and make improvements. This would allow the public to have more confidence in paramedics. It can be presented to all paramedics as it applies to our daily practice. b) How does cultural differences among patients affect the way they take their medication? Many countries today have a wide variety of patients of all nationalities and ethnic groups. One’s personal beliefs can affect the outcome of treatment and if we understand there differences, compliance would improve. This can be presented to all members of the healthcare team at the hospital as well as national level. 3a. Write a clear definition of experimental, quasi-experimental, correlational, descriptive, analytical and non-experimental research and post these to the discussion lecture 3 on the WebCT Discussion Board. It should be interesting to see what you come up with as there are many ways to explain these terms. Experimental research is research which observes the behavior of the subject under different conditions with variables which can be controlled and if two groups are tested, they are similar. Quasi-experimental research is similar to experimental research but the two groups being compared may not be similar. Correlational research is when data is collected to determine the relationship between the two or more parameters which are being studied. Descriptive research is a research in which the frequency with which something happens is studied. Analytical research is a form of research where the components of the research are broken down and analyzed individually, especially if parameters to determine the results are difficult to be defined. Non-experimental research is when there are no comparisons between different groups and the role of it is to describe behavior. 3b. Write a clear definition of ethnography, grounded theory, life stories/narratives, evaluation and action research and post these in the discussion lecture 3 on the WebCT Discussion Board. Ethnography is defined as the scientific study of people and their culture/ethnic characters via any qualitative research methodology and it is able to provide a detailed description of what that particular group does in everyday life. Life stories/narratives are an account of the events which make up a person’s life. Evaluation and action research is a form of research where a particular action is carried out followed by the evaluation process in order to note if it was a success or failure, and changes are made accordingly until a desirable outcome is achieved. 4a. Revise the different qualitative and quantitative research approaches from lecture 3 and choose two everyday situations that involved you doing some research. Choose one work-related and one other situation. Write a paragraph on each explaining which research approach you used. Have some fun with this one then post your creative endeavours to the Lecture 4 discussion area on WebCT. Quantitative research Question: Is there a decrease in the time taken for the administration of thrombolytics if it was given by paramedics? In this case, pre-hospital thrombolytics are given in cases of acute myocardial infarction. A prospective observational study can be done in which patients who are suspected to have an acute myocardial infarction and may need thrombolysis are included in the study. Patients with suspected acute myocardial infarction would be recruited and then given thrombolytics and the time taken recorded as well. This would tell us if a shorter time would have a better benefit compared to traditional practice where thrombolysis is done in the hospital. Qualitative research Question: What are the families of patients’ perception regarding the service of the hospital cafeteria? For this, a structured interview or questionnaire research approach would be used. I would obtain either a standardized feedback form or create one of my own which would include parameters of satisfaction towards service and different grades for each of one the parameters. After obtaining the data, I would compile all the data and put them in charts before analyzing them individually. 4b What do you find most interesting in these? Do you know of any other situations in which the ethical considerations have become important or caused problems? (I can’t answer this because I need to know what are the situations) 4d Choose one of the above approaches and match it to a research question relating to your context. Explain how the research would be carried out and then post your work to WebCT. I have chosen the prospective study and as mentioned earlier, Patients with suspected acute myocardial infarction would be recruited and then given thrombolytics and the time taken recorded as well. This would tell us if a shorter time would have a better benefit compared to traditional practice where thrombolysis is done in the hospital. 5a. What are some of the practical constraints that could affect the type of research you could conduct in your context? Post your answer in Lecture 5 on the WebCT Discussion Board. Some of the practical constraints that could affect the type of research I would conduct (in regards to the prospective study) would be issues such as informed consent as it would be difficult to consent to a procedure when one is in pain, the ability to read ECGs as not all paramedics are trained to do so and the interpretation is important for the diagnosis of an acute myocardial infarction as well as whether the hospital authorities would approve of such a study because the end effect could be death (Townend and Doshi, 2005). 5b. Please share your web searching hints, experiences and funny stories in Lecture 5 on the WebCT Discussion Board. Some of my web searching hints include using reliable direct medical websites such as the British Medical Journal (BMJ), the New England Journal of Medicine (NEJM) and the Journal of the American Medical Association (JAMA). I also utilize databases such as PubMed and Cochrane Library. The usage of Google Scholar is also good and I would choose the filetype:PDF as this would increase my chances of obtaining a full paper rather than just the abstract because I would like to critically appraise the paper to see if it is suitable to be quoted. A funny experience which I would like to share would be when I Googled for “breast anatomy” once and some pornographic websites actually came up as part of the search! 6a. Give an example of data which you record that is continuous and an example of data that is discrete. Post your answers in Lecture 6 on the WebCT Discussion Board. An example of data which is continuous would be the time taken from the onset of an acute myocardial infarction to the administration of thrombolytics whereas an example of discrete data would be the cost of a patient’s admission to the hospital for a week. 6b Considering the advantages and disadvantages of different sampling techniques set out in Table 8.1 of the text, what factors do you need to consider in your research design for Assignment 2? Post your ideas to the lecture 6 Discussion on the WebCT Discussion Board. (I can’t answer this because I do not know what is your research design for assignment 2) 6c Do you have any good suggestions for organizing data? Have you used spreedsheets or databases and do you think these could be useful in your own research? I would organize my data with the usage of Microsoft Excel. Not only would my data be more systematic but it would also allow me to export the data for SPSS software analysis. Every time information is updated on the spreadsheet, I would also back up another copy within the hard drive itself, another copy on a portable drive and also burn it on a CD/DVD. In addition to this, all the hard copies of the data would also be sorted out according to color, for example blue for male subjects and red for female subjects. I have used spreadsheets and databases before and it is of very much use for research purposes. 7a. What are some of the advantages and limitations of using questionnaires, observations and interviews? Draw on your own experience to give examples and post this to Lecture 7 on the WebCT Discussion Board. Some of the advantages of questionnaires would be that the responses would be collected in a standardized way and it is a quick method of obtaining data whereas disadvantages include the validity of the questionnaire as it may have not been tested out, it can generate large amounts of unneeded data and some people do not like to answer questionnaires as they are worried about confidentiality. Observations have the advantage of studying large numbers of subjects and the cost of setting it up and carrying it out is relatively cheaper compared to other studies (Feneck, 2007). The disadvantages would be a higher possibility of bias and the lack of randomization. Interviews have the advantage of having a more personal way of obtaining information and the researcher can spend time to explain some of the items to the subjects. However, it is time consuming and many researchers may be needed as well as the possibility of affecting the results as there is human-human interaction. 7b What are the key factors you should consider if you were designing a qualitative research study in your work environment.? What would influence your choice of sample? These are important considerations for Assignment 2 so post up your ideas to Lecture 7 on the WebCT Discussion Board. Remember you will be required to draw on the discussions on WebCT in your assignment. Some of the key factors which I would consider when designing a qualitative research would be the method to collect data which may be from observation or questionnaires, the group of people or sample which is to be studied, the suitability of the parameters which would be studied and if there are ways to actually measure the parameters, the size of the sample as well as the time allocated for the data to be collected. My choice of sample would be influenced by my research question which may change the gender, age group or the place where I obtain my samples, the amount of resources which I would have as well as the time involved and the complexity of the research question. 8a . Post your answers for Problem 3 to Lecture 8 on the WebCT Discussion Board a) Organise the data so the assignments are listed in ascending order (going up from smallest to highest category, ie.1-3). Set up a frequency table as well. Student Assignment 1 Bruce 55 Karen 65 Peter 70 Dianne 75 Sally 80 Carol 80 John 85 Andrew 90 Student Assignment 2 Bruce 50 Karen 60 Peter 65 Dianne 70 Sally 70 Andrew 80 John 85 Carol 90 Frequency table Scores Frequency fx 50 1 50 55 1 55 60 1 60 65 2 130 70 3 210 75 1 75 80 3 240 85 2 170 90 2 180 b) What is the mode, median, mean and range for assignment 1? Mode: 80, Median: 77.5, Mean: 75, Range: 35 c) Calculate the mode, median, mean and range for assignment 2. Mode: 70, Median: 70, Mean: 71.25, Range: 40 d) Write a few lines to explain the conclusions that can be made from these data. Which information do you consider most useful and why? Are there any differences between the two assignments? The results were better from the first assignment compared to the second assignment but the differences were slight. The mean would be the best information for a table like this as it would tell us if results are improving or becoming worse. There may be some differences between the 2 assignments in which the second test could have been more difficult as the lowest mark for the second assignment was lower than that of the first. Calculate the Variance and Standard Deviation of the assignments in Problem 3. Which assignment has the greatest spread in results? First you will need to set up a table like the one above on Excel or on paper. Score (x) Deviation (x-75) Deviation squared 55 -20 400 65 -10 100 70 -5 25 75 0 0 80 5 25 80 5 25 85 10 100 90 15 225 Sum: 900 Variance Assignment 1: 900/7=128.57 Standard Deviation Assignment 1: 11.34 Score (x) Deviation (x-71.25) Deviation squared 50 -21.25 451.56 60 -11.25 126.56 65 -6.25 39.06 70 -1.25 1.56 70 -1.25 1.56 80 8.75 76.56 85 13.75 189.06 90 18.75 351.56 Sum: 1237.48 Variance Assignment 2: 1237.48/7= 176.78 Standard Deviation Assignment 2: 13.3 9a . Post the title, author and reference number of two articles which use statistical terminology to Lecture 9 on the WebCT Discussion Board. Keeling P, Hughes D, Price L, Shaw S and Barton A. (2003) Safety and feasibility of prehospital thrombolysis carried out by paramedics. BMJ;327(7405):27 doi:10.1136/bmj.327.7405.27 Moll E, Bossuyt PM, Korevaar JC, Lambalk CB and van der Veen F. (2006) Effect of clomifene citrate plus metformin and clomifene citrate plus placebo on induction of ovulation in women with newly diagnosed polycystic ovary syndrome: randomised double blind clinical trial. BMJ.38867.631551.55v2 doi:10.1136/bmj.38867.631551.55 9b. For Problem 3, Lecture 8, is there a significant difference between the two data sets? Post your findings to Lecture 9 on the WebCT Discussion Board. There is no significant difference between the two data sets as the two-tailed p value is 0.5536. 10. What do you consider to be good ways to improve the quality of data analysis in qualitative research? For your second assignment, what approach should be taken to analyse your data? Try to relate what you have learnt in this lecture to your own context. Post your thoughts and comments to Lecture 10 on the WebCT Discussion Board. Some of the ways which can be used to improve the quality of data analysis in qualitative research would be to first familiarize oneself with the data. This can be done by studying the notes which were taken before and during the data collection as well as analyzing the basic patterns of the data as well as the parameters. I can also identify all the key issues as well as theories/concepts which are related to the area being studied and this would also help in referencing. Issues which have been outlined in the objectives should be answered systematically so that confusion is minimized. All the data should also be indexed with the usage of numbers and each index should be identified with a basic explanation or theme. Next, analysis of data should also undergo rearrangement where data is arranged according to its areas or similarity. In addition to these methods, I would also like to map and interpret the data with the usage of graphics such as pie charts and graphs so that not only does my understanding increase but my viewers would also understand the information better (Pope, Ziebland and Mays, 2000). I would utilize this approach to analyze my data. 11. Think of an example of research which could involve both a quantitative and qualitative approach. This can be professionally related or may be any area of interest. Please post your example to Lecture 11 on the WebCT Discussion Board. An example of research which could involve both a quantitative and qualitative approach would be “Factors attracting patients with breast cancer to complementary medicine and subsequent mortality rates”. For this study, the quantitative parameters would be the mortality rates as well as the period of remission due to breast cancer. Qualitative parameters would look at why women with breast cancer choose to opt for complementary medicine and its subsequent effects on remission/mortality. A study utilizing both quantitative and qualitative parameters in this context would allow us to see the effects of complementary medicine as a lot of its practices are not scientifically based. It would be interesting to note if there are any psychological benefits which may be translated into physical benefits. 12a. What are some of the ways research can be communicated within your area? Are you aware of any professional conferences or publications? Have you ever presented a paper or presentation at a conference? What was it like? Research in my area can be communicated at various levels. At lower levels such as within the hospital or university, findings from research can be presented at lectures and talks. Simplified versions of these research findings can also be presented at talks aimed at the general public so that they are aware of these issues and would also be able to provide feedback to further improve paramedic services. In addition to this, the research can also be communicated in terms of application in clinical practice guidelines which would enable the implementation of the findings. There are publications such as the Journal of Emergency Medical Services and yearly international conferences on paramedicine/emergency medicine organized by various professional associations throughout the year. Unfortunately, I have not had the opportunity to present a paper at a conference but am looking forward to do so in the near future. 12b. Are you aware of any support and funding available for research within your field? There is the Australian College of Ambulance Professionals, National Association of EMS Educators as well as the Paediatric Emergency Medicine Society of Australia and New Zealand which all offer support for paramedics. Funding can be obtained from universities and the National Health and Medical Research Council (NHMRC). References Basch, C. (1987) Focus Group Interview: An Underutilized Research Technique for Improving Theory and Practice in Health Education. Health Education & Behavior, Vol. 14, No. 4, 411-448 Dartnell J, Hemming M, Collier J, Ollenschlaeger G. (2007). Putting evidence into context: some advice for guideline writers. Evid Based Med. 2007 Oct;12(5):130-2 Feneck, RO. (2007) Clinical research in anaesthesia; randomized controlled trials or observational studies? European Journal of Anaesthesiology. 24: 1–5 Green, S. (2000) What to Look for in a Randomized Controlled Trial. Science Editor. Vol 23.5:157 Peters DH, Rao KS and Fryatt R. (2003) Lumping and splitting: the health policy agenda in India. Health Policy Plann.18: 249-60. Pope C, Ziebland S and Mays N. (2000) Qualitative research in health care. Analysing qualitative data. BMJ.;320:114-6. Rochon PA, Gurwitz JH, Sykora K, Mamdani M, Streiner DL, Garfinkel S, Normand SL, Anderson GM. (2005) Reader's guide to critical appraisal of cohort studies: 1. Role and design. BMJ;330(7496):895-7 Townend JN and Doshi SN. (2005) Reducing mortality in myocardial infarction. BMJ. 330(7496):856-7 Read More