ABSTRACT
To confirm results obtained from local evaluation at investigational centers, many oncology studies utilize blinded independent central review (BICR) to make assessments of the primary endpoint, progression-free survival (PFS). The comparison of data often leads to large discordances between these observations, casting doubt on the reliability of the estimated treatment effects from these trials. Here we propose new statistics to measure discordance and evaluate their utility to detect bias in the local evaluation of progression relative to the standard measures of discordance. A new observational error model is proposed that can be used to describe the discordance in patient assessments between multiple readers.
Subject(s)
Bias , Clinical Trials as Topic/statistics & numerical data , Endpoint Determination/statistics & numerical data , Models, Statistical , Neoplasms/epidemiology , Research Design , Clinical Trials as Topic/methods , Computer Simulation , Disease-Free Survival , Endpoint Determination/methods , False Positive Reactions , Humans , Neoplasms/diagnosis , Neoplasms/drug therapy , Observer Variation , Research Design/standards , Research Design/trends , Single-Blind MethodABSTRACT
The potential of cooperative apartments as an alternative in residential care for former mental patients is only beginning to be explored. Existing programs demonstrate the viability of these apartments as a last stepping-stone to be used by patients as they move toward a completely independent way of life. In contrast to other residential arrangements, such as foster home care or halfway houses, cooperative apartments seem on balance to be less likely to induce patient dependence or to have an aura reminiscent of the hospital to patients. Moreover, they are relatively inexpensive, can be established without attracting untoward attention in the community, and permit their occupants to live more like other people and with comparatively little stigma. As indicated by the variety of sponsoring agencies described in this article, the impetus to establish cooperative apartments can come from many sources. Such diversity is currently necessary. Only through the evaluation of different models and their effectiveness will criteria be established for a national policy regarding residential care.
Subject(s)
Mental Health Services , Residential Facilities , Community Mental Health Services , Costs and Cost Analysis , Female , Government Agencies , Hospitals , Humans , Interpersonal Relations , Length of Stay , Male , Maryland , Massachusetts , Missouri , New York , Social Work, PsychiatricSubject(s)
Adolescent , Community Mental Health Services , Counseling , Ethnicity , Family , Female , Humans , Latin America/ethnology , Male , Maryland , Parents , Perception , Sex Factors , TeachingABSTRACT
Although consultation, as an activity for intervention, has achieved considerable popularity among human service professionals and figures prominently in current federal mental health legislation, a basic question still unanswerable is, "Does it work?" This paper reviews 35 consultation outcome studies reported between 1958 and 1972 in an attempt to provide some answers to this question. Although their quality varies greatly, the evidence seems to lend some support to the effectiveness of consultation as a change method. In 69% of the studies reviewed, positive change was demonstrated on the consultee, client, or system level or at some combination of these. The review also suggests that, despite a need for studies which build cumulatively on earlier ones so as to provide comparable data instead of a conglomerate of isolated findings, progress has been made in the evaluation of consultation.
Subject(s)
Mental Health Services , Referral and Consultation , Achievement , Community Mental Health Services , Decision Making , Goals , Group Processes , Humans , Interpersonal Relations , Leadership , Motivation , Nurses , Religion , Social Behavior , Social Control, Formal , Social Welfare , TeachingSubject(s)
Aftercare , Family , Hospitalization , Mental Disorders/therapy , Social Adjustment , Adolescent , Adult , Communication , Community Mental Health Services , Family Characteristics , Female , Group Structure , Humans , Interpersonal Relations , Interview, Psychological , Male , Mental Disorders/rehabilitation , Middle Aged , Patient Care Planning , Patient Readmission , Recurrence , Sex FactorsSubject(s)
Mental Health , Referral and Consultation , Evaluation Studies as Topic , Family Practice , Humans , Mental Disorders/diagnosis , Organization and Administration , Patient Care Planning , Patient Care Team , Personality , Psychiatry , Psychology/education , Public Health Nursing , Referral and Consultation/education , ResearchSubject(s)
Child Behavior Disorders/epidemiology , Hair , Obsessive-Compulsive Disorder/epidemiology , Adolescent , Age Factors , Child , Child, Preschool , Chlorpromazine/therapeutic use , Family , Female , Humans , Infant , Male , Maternal Deprivation , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/drug therapy , Obsessive-Compulsive Disorder/therapy , Parent-Child Relations , Psychosexual Development , Psychotherapy , Sex FactorsSubject(s)
Child Behavior Disorders , Compulsive Behavior , Hair , Self Mutilation , Adolescent , Anxiety , Child , Child Behavior Disorders/genetics , Child Behavior Disorders/therapy , Child, Preschool , Defense Mechanisms , Ego , Family Characteristics , Female , Humans , Male , Maternal Deprivation , Parent-Child Relations , Personality Development , Referral and Consultation , Stress, PsychologicalABSTRACT
The epidemiological-public health approach is applied to an investigation of school withdrawals from a rural Florida county school system. Operating on the premise that school withdrawals constitute a risk group from a mental health viewpoint, five specific withdrawal groups are identified, and time points at which withdrawal is most likely to occur are located. On the basis of certain background information, it was possible to predict in advance students who were most apt to withdraw and the form the withdrawal would take. Implications for program planning are discussed.