Distinguishing case study as a research method from case reports as a publication type.

The purpose of this editorial is to distinguish between case reports and case studies. In health, case reports are familiar ways of sharing events or efforts of intervening with single patients with previously unreported features. As a qualitative methodology, case study research encompasses a great deal more complexity than a typical case report and often incorporates multiple streams of data combined in creative ways. The depth and richness of case study description helps readers understand the case and whether findings might be applicable beyond that setting.

Stakeholder Participation in System Change: A New Conceptual Model.

BACKGROUND: A recent change in Canada's primary care system led to the introduction of Nurse Practitioner-Led clinics. The literature suggests that stakeholders can influence system change initiatives. However, very little is known about healthcare stakeholder motivations, particularly stakeholders who are seen as resistors to change. AIM: To examine stakeholder participation in the system change process that led to the introduction of the first Nurse Practitioner-Led clinic in Ontario. METHODS: This single case study included two site visits, semistructured individual tape-recorded interviews, and the examination of relevant public documents. Qualitative content analysis was used to analyze the data. RESULTS: Sixteen individuals from different healthcare sectors and professions participated in the interviews and 20 documents were reviewed. Six key themes emerged from the data. Linking Evidence to Action The findings from the study present a new perspective on stakeholder participation that includes both those who supported the proposed change and those who advocated for a different change. The findings identify stakeholder activities used to shape, share, and protect their visions for system change. The conceptual model presented in this study adds to the understanding of challenges and complexities involved in healthcare system change. Understanding why and how stakeholders participate in change can help healthcare leaders in planning activities to enhance stakeholder involvement in healthcare system change.

"Casing" the research case study.

The wide variation in definitions of the research case study can make it difficult for health sciences researchers to see all of the possibilities for this form of inquiry. Case studies are defined here as singular combinations of diverse arrays of methodological approaches directed toward maintaining "empirical intimacy" with the one or more temporally and spatially defined objects researchers construct and target for study. The cases selected for study are made as opposed to found through an iterative and theory-laden process called "casing." Case- as opposed to variable-oriented analysis helps researchers maintain "empirical intimacy" with the cases in their case studies. Case studies may be useful in enhancing programs of research in instrument and intervention development.

Value of case studies in disaster assessment?

Case studies can be useful in assessing and learning lessons from emergency situations. In this paper, different uses for disaster case studies, are explored with identification of potential pitfalls that should be avoided. In addition, ways to improve the rigor and significance of case studies are suggested. Case studies can be used as examples or as a research tool. If conducted properly, they can provide robust and compelling results. It is argued that sharing a common guide to conducting and writing case studies among all disaster risk reduction professionals could improve the quality of case study reports and thereby strengthen their value in advancing the prevention, preparedness, and management of disasters and emergencies.

Training and capacity building evaluation: Maximizing resources and results with Success Case Method.

This article describes the use of Success Case Method (Brinkerhoff, 2003) to evaluate health promotion and public health training programs. The goal of the Office Community Research and Engagement (OCRE) of the Puerto Rico Clinical and Translational Research Consortium (PRCTRC) is to establish a stable and sustainable translational research capacity. Early efforts toward achieving this goal included sponsoring two independent research training programs. A description of the implementation of the five step Success Case Method is presented. Results reveal that SCM would deem both trainings as highly successful, based upon the overall impact of a low number of success cases. However, a traditional summative evaluation would consider this disappointing. Strengths of SCM are discussed. It was concluded that the Success Case Method is a useful and valuable evaluative method for measuring the success of health promotion and public health training initiatives and provides sufficient information for decision-making processes.

Enhancing the quality of case studies in health services research.

OBJECTIVE: To provide guidance on improving the quality of case studies in health services research. DATA SOURCES: Secondary data, drawing from previous case study research. RESEARCH DESIGN: Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (four additional items). PRINCIPAL FINDINGS: The guidance demonstrates that many operational steps can be undertaken to improve the quality of case studies. These steps have been a hallmark of high-quality case studies in related fields but have not necessarily been practiced in health services research. CONCLUSIONS: Given higher-quality case studies, the case study method can become a valuable tool for health services research.

Quantifying data quality for clinical trials using electronic data capture.

BACKGROUND: Historically, only partial assessments of data quality have been performed in clinical trials, for which the most common method of measuring database error rates has been to compare the case report form (CRF) to database entries and count discrepancies. Importantly, errors arising from medical record abstraction and transcription are rarely evaluated as part of such quality assessments. Electronic Data Capture (EDC) technology has had a further impact, as paper CRFs typically leveraged for quality measurement are not used in EDC processes. METHODS AND PRINCIPAL FINDINGS: The National Institute on Drug Abuse Treatment Clinical Trials Network has developed, implemented, and evaluated methodology for holistically assessing data quality on EDC trials. We characterize the average source-to-database error rate (14.3 errors per 10,000 fields) for the first year of use of the new evaluation method. This error rate was significantly lower than the average of published error rates for source-to-database audits, and was similar to CRF-to-database error rates reported in the published literature. We attribute this largely to an absence of medical record abstraction on the trials we examined, and to an outpatient setting characterized by less acute patient conditions. CONCLUSIONS: Historically, medical record abstraction is the most significant source of error by an order of magnitude, and should be measured and managed during the course of clinical trials. Source-to-database error rates are highly dependent on the amount of structured data collection in the clinical setting and on the complexity of the medical record, dependencies that should be considered when developing data quality benchmarks.

Organizational injustice: third parties’ reactions to mistreatment of employee / Injusticia organizacional: reacciones de las terceras partes ante el maltrato al empleado

Background: Research on organizational injustice has mainly focused on the victim’s perspective. This study attempts to contribute to our understanding of third parties’ perspective by empirically testing a model that describes third party reactions to mistreatment of employees. Method: Data were obtained from a sample (N = 334) of Spanish employees from various organizations, nested into 66 work-groups, via a survey regarding their perceptions of organizational mistreatment. Structural equation modeling was used to analyze the data. Results: The proposed model had a limited fit to the data and it was re-specified. Organizational mistreatment, employee performance, and employee organizational commitment explained internal attributions blaming the organization. Moreover, coworkers’ organizational identification showed a positive impact on external attributions of responsibility. Lastly, supportive organizational climate and internal attributions accounted for a large percentage of variance in coworkers’ perceptions of organizational unfairness. Conclusions: The final model explains the perceptions of injustice on the basis of internal attributions of responsibility in the face of organizational mistreatment of employees (AU)

Antecedentes: la investigación sobre la justicia organizacional se ha centrado en la perspectiva de la víctima. En este estudio intenta contribuir en la comprensión de la perspectiva de las terceras partes comprobando empíricamente un modelo que describe las reacciones de la tercera parte ante el maltrato de los empleados. Método: los datos fueron obtenidos de una muestra (N= 334) de empleados españoles de diversas organizaciones, incluidos en 66 grupos de trabajo, a través de una encuesta relativa a sus percepciones maltrato organizacional. Se usó el modelado de ecuaciones estructurales para analizar los datos. Resultados: el modelo propuesto tuvo un ajuste limitado a los datos y fue re-especificado. El maltrato organizacional, el rendimiento del empleado y el compromiso organizacional explicaban las atribuciones culpando a la organización. Más aún, la identificación organizacional del observador influía positivamente sobre la atribución de responsabilidad hacia fuera de la organización. Además el clima organizacional de apoyo y las atribuciones internas daban cuenta de un importante porcentaje de la varianza en las percepciones de los compañeros sobre la injusticia organizacional. Conclusiones: el modelo final explica las percepciones de injusticia a través de las atribuciones internas de responsabilidad en relación con el maltrato organizacional a los empleados (AU)

Percepción de profesionales de la salud sobre las funciones esenciales de salud pública / Perception of health professionals on essential public health functions

Pregunta de investigación: ¿Cual es el cumplimiento de las funciones esenciales de salud pública por el Ministerio de Salud y Deportes?. Objetivo: Medir la opinión de profesionales de la salud sobre el grado de desarrollo de las funciones esenciales de salud pública como responsabilidades del Ministerio de Salud y Deportes. Diseño: Estudio de opiníon, exploratorio, transversal y descriptivo. Método: Encuesta anónima y autoadministrada. Resultados: El valor promedio asignado a cada función esencial está alrededor de 5 sobre 10 puntos, que indica un desempeño regular.

The current infectious waste management system at the University Hospital of the West Indies (UHWI)

Inadequate infectious Waste Management practices pose serious problems in health care facilities. According to Bencko (1993), this is primarily caused by the diversity of the individual components of the waste which constitute a risk to health if inadequately handled. It is evident that economic and technical conditions for both a safe disposal as well as efficient steam sterilization and management practices based on legal regulations consequently will contribute to the protection of both human health and the environment. In a study conducted during the months of January to April 1997 describing the current infectious waste management system at the University Hospital of the West Indies (UHWI). It was found that a spectrum of infectious waste is generated from the UHWI, including blood and blood-splattered materials, bandages, body parts, wastes from the clinical laboratories and "sharps" (the name given to needles and scalpels). The characteristic shared by these wastes is the potential for contamination with infectious agents. The writer concluded that the policies and practices found at the hospital for the management of infectious waste were highly unstructured and informal.(Au)

An investigation into the methods of disposal of certain types of biohazard materials at some hospitals and medical laboratories

Biomedical waste represents a small proportion of the total volume of waste generated by health care facilities. Such waste requires proper handling and disposal because of environmental, aesthetic, and occupational concerns, as well as risks to human health. Improper management of infectious medical waste can trigger notable adverse public health impact. This study focuses on how body parts, limbs and blood are diposed of in Kingston, St. Andrew and St. Catherine and how this differs from the standards set in the "Guidelines for the Management of Biomedical Waste in Canada." It was conducted using the entire population (18) of medical laboratories in the selected parishes along with the entire six public hospitals located there. Permission was granted for four hospitals and sixteen laboratories. At each hospital the head of maintenance (HOM) and the maintenance worker that does the actual disposal of body parts and limbs were interviewed separately. At each medical laboratory the chief medical technologist and the laboratory attendant were also interviewed separately. A different questionnaire was prepared for each group. During the interviews the data was filled in by the sole investigator. 79 percent of the medical laboratory formulated their own policy and procedures and the other followed the CAREC guidelines. 67 percent of the hospitals also formulated their own policies and procedures. Incineration was the main method (75 percent) practised by hospitals for the disposals of body parts and limbs. 50 percent of the lab attendants dispose of the blood by incineration, 44 percent by pouring it down the sink after decontaminating it with either bleach or autoclaving and the other 6 percent by burial. The above results are acceptable according to the gold standards. Despite the fair results of the study, the government needs to formulate policies to structure the management of medical waste. This policy process should start by developing a Procedure Manual. Adherence will then need to be monitored by the relevant authority.(Au)