Browsing by Subject "Effectiveness"
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Item Attitudes toward and training in medications for opioid use disorders: a descriptive analysis among employees in the youth legal system and community mental health centers(Springer Nature, 2024-06-21) O’Reilly, Lauren M.; Schwartz, Katherine; Brown, Steven A.; Dir, Allyson; Gillenwater, Logan; Adams, Zachary; Zapolski, Tamika; Hulvershorn, Leslie A.; Aalsma, Matthew; Pediatrics, School of MedicineBackground: Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. Methods: Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). Results: Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. Conclusions: These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.Item Conflict management styles : a predictor of likability and perceived effectiveness among subordinates(2008-08-13T18:25:49Z) Copley, Rachel D.; White-Mills, Kim D.; Dobris, Catherine A.; Sandwina, Ronald M.As greater numbers of women throughout the past few decades have assumed managerial roles in organizations, the question of whether gender differences exist in the ability to manage effectively has become an important concern. According to Korabik, Baril, and Watson (1993), conflict management skills are a fundamental aspect of leadership effectiveness and “perceptions of how females handle crisis and conflict often are cited as blocks to the female manager’s ascent to the executive suite” (Shockley-Zalabak, 1981, p. 289). Additionally, the importance of likability of supervisors by their subordinates has become of greater importance in the past few years as researchers have discovered that more people leave their job because they do not like their supervisor than for any other reason (Agrusa, Spears, Agrusa, & Tanner, 2006; Joyce, 2006). The purpose of this study was to examine gender differences in supervisor’s conflict management styles and to determine how they relate to both effectiveness and likability among their subordinates. Specifically, research was conducted to reveal a) what differences exist between conflict management styles chosen by women and men leaders, b) if a relationship exists between conflict management styles and likeability among subordinates, c) what influence conflict management styles have upon perceived effectiveness among subordinates, and d) what correlation exists between likability and perceived effectiveness.Item Decline in vaccine-type human papillomavirus prevalence in young men from a Midwest metropolitan area of the United States over the six years after vaccine introduction(Elsevier, 2019-09-30) Widdice, Lea E.; Bernstein, David I.; Franco, Eduardo L.; Ding, Lili; Brown, Darron R.; Ermel, Aaron C.; Higgins, Lisa; Kahn, Jessica A.; Medicine, School of MedicinePurpose: The aim of this study was to determine changes in human papillomavirus (HPV) prevalence among young men from a Midwest metropolitan area over the six years after vaccine introduction, including HPV prevalence in men overall, in vaccinated men to examine vaccine impact and in unvaccinated men to examine herd protection. An exploratory aim was to examine associations between number of vaccine doses and HPV prevalence. Methods: Men aged 14–26 years reporting male-female and/or male-male sexual contact were recruited from a primary care clinic, sexually transmitted disease clinic, and community setting during two waves of data collection: 2013–2014 (N = 400) and 2016–2017 (N = 347). Participants completed a questionnaire and were tested for penile, scrotal and anal HPV. Changes in prevalence of any (≥1 type) and vaccine-type HPV (HPV6, 11, 16, and/or 18) were examined using propensity score weighted logistic regression. Associations between number of doses and HPV infection were determined using chi-square tests and logistic regression. Results: The proportion of men with a history of ≥1 HPV vaccine doses increased from 23% to 44% (p < 0.001) from waves 1 to 2. After propensity score weighting, infection with ≥1 vaccine-type HPV significantly decreased among all men (29% to 20%; 31% decrease; odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44–0.88) and unvaccinated men (32% to 21%; 36% decrease; OR = 0.56, 95%CI = 0.34–0.86); there was a non-significant decrease (21%) among vaccinated men. Associations between number of doses and HPV prevalence were not statistically significant. Conclusions: Prevalence of vaccine-type HPV decreased among all, vaccinated, and unvaccinated men six years after HPV vaccine recommendation, supporting vaccine impact and herd protection. Decreases in vaccine-type HPV in all men appear to be due to decreases in unvaccinated men, suggesting that the full impact of vaccination has yet to be realized. Continued monitoring and efforts to vaccinate men prior to sexual initiation are warranted.Item Implementing risk stratification to the treatment of adolescent substance use among youth involved in the juvenile justice system: protocol of a hybrid type I trial(BioMed Central, 2019-09-06) Aalsma, Matthew C.; Dir, Allyson L.; Zapolski, Tamika C. B.; Hulvershorn, Leslie A.; Monahan, Patrick O.; Saldana, Lisa; Adams, Zachary W.; Pediatrics, School of MedicineBACKGROUND: Youth involved in the juvenile justice system (YIJJ) have high rates of substance use problems; however, rates of YIJJ engagement in substance use services is low. Barriers to service engagement include lack of appropriate screening and connection to services by the juvenile justice system, as well as lack of resources for delivering evidence-based treatment in community-based settings. To address these barriers, this paper describes a protocol for a type 1 hybrid design to (1) implement universal substance use screening for YIJJ; (2) implement and evaluate the feasibility and effectiveness of a brief, three-session substance use interventions based in motivational interviewing for youth with mild/moderate substance use: Teen Intervene (an individual-based intervention); (3) implement ENCOMPASS, an evidence-based substance use intervention based in motivational enhancement and cognitive behavioral therapy for youth with severe substance use; and (4) evaluate facilitators and barriers to implementing these interventions for mild to severe substance use among YIJJ in community mental health centers (CMHC). METHODS/DESIGN: Using a hybrid type 1 clinical effectiveness-implementation design, we will collaborate with CMHCs and juvenile justice in two rural Indiana counties. Guided by the EPIS (exploration, preparation, implementation, sustainability) framework, we will measure factors that affect implementation of substance use screening in juvenile justice and implementation of substance use interventions in CMHCs utilizing self-reports and qualitative interviews with juvenile justice and CMHC staff pre- and post-implementation. YIJJ with mild/moderate substance use will receive a brief interventions and YIJJ with severe substance use will receive ENCOMPASS. We will measure the effectiveness of a brief and comprehensive intervention by assessing changes in substance use across treatment. We anticipate recruiting 160 YIJJ and their caregivers into the study. We will assess intervention outcomes utilizing baseline, 3-, and 6-month assessments. DISCUSSION: Findings have the potential to improve screening and intervention services for YIJJ.Item Ixazomib-lenalidomide-dexamethasone in routine clinical practice: effectiveness in relapsed/refractory multiple myeloma(Taylor & Francis, 2021) Hájek, Roman; Minařík, Jiří; Straub, Jan; Pour, Luděk; Jungova, Alexandra; Berdeja, Jesus G.; Boccadoro, Mario; Brozova, Lucie; Spencer, Andrew; van Rhee, Frits; Vela-Ojeda, Jorge; Thompson, Michael A.; Abonour, Rafat; Chari, Ajai; Cook, Gordon; Costello, Caitlin L.; Davies, Faith E.; Hungria, Vania T. M.; Lee, Hans C.; Leleu, Xavier; Puig, Noemi; Rifkin, Robert M.; Terpos, Evangelos; Usmani, Saad Z.; Weisel, Katja C.; Zonder, Jeffrey A.; Bařinová, Magda; Kuhn, Matyáš; Šilar, Jiří; Čápková, Lenka; Galvez, Kenny; Lu, Jin; Elliott, Jennifer; Stull, Dawn Marie; Ren, Kaili; Maisnar, Vladimír; Medicine, School of MedicineAim: To evaluate the effectiveness and safety of ixazomib-lenalidomide-dexamethasone (IRd) in relapsed/refractory multiple myeloma in routine clinical practice. Patients & methods: Patient-level data from the global, observational INSIGHT MM and the Czech Registry of Monoclonal Gammopathies were integrated and analyzed. Results: At data cut-off, 263 patients from 13 countries were included. Median time from diagnosis to start of IRd was 35.8 months; median duration of follow-up was 14.8 months. Overall response rate was 73%, median progression-free survival, 21.2 months and time-to-next therapy, 33.0 months. Ixazomib/lenalidomide dose reductions were required in 17%/36% of patients; 32%/30% of patients discontinued ixazomib/lenalidomide due to adverse events. Conclusion: The effectiveness and safety of IRd in routine clinical practice are comparable to those reported in TOURMALINE-MM1.Item Modeling of Industrial Air Compressor System Energy Consumption and Effectiveness of Various Energy Saving on the System(2018-12) Ayoub, Abdul Hadi Mahmoud; Razban, Ali; Chen, Jie; Goodman, David W.The purpose of this research is to analyze the overall energy consumption of an industrial compressed air system, and identify the impact of various energy saving of individual subsystem on the overall system. Two parameters are introduced for energy consumption evaluation and potential energy saving: energy efficiency (e) and process effectiveness (n). An analytical energy model for air compression of the overall system was created taking into consideration the modeling of individual sub-system components: air compressor, after-cooler, filter, dryer and receiver. The analytical energy model for each subsystem included energy consumption evolution using the theoretical thermodynamic approach. Furthermore, pressure loss models of individual components along with pipe friction loss were included in the system overall efficiency calculation. The efficiency analysis methods and effectiveness approach discussed in this study were used to optimize energy consumption and quantify energy savings. The method was tested through a case study on a plant of a die-casting manufacturing company. The experimental system efficiency was 76.2% vs. 89.3% theoretical efficiency. This showed model uncertainty at ~15%. The effectiveness of reducing the set pressure increases as the difference in pressure increase. The effectiveness of using outside air for compressors intake is close to the compressors work reduction percentage. However, it becomes more effective when the temperature difference increase. This is mainly due to extra heat loss. There is potential room of improvement of the various component using the efficiency and effectiveness methods. These components include compressor, intercooler and dryer. Temperature is a crucial parameter that determines the energy consumption applied by these components. If optimum temperature can be determined, plenty of energy savings will be realized.Item Physician Compensation Models and Quality of Healthcare Services in the United Arab Emirates(2023) Elrefaey, Mahmoud; Tierney, William Michael; Babich, Suzanne M.; Czabanowska, KatarzynaPhysicians working in different healthcare systems receive financial compensation by means of several structures (e.g., the salaried model, the fee-for-service model, and the revenue-share model) depending on how and where they practice. Most research on the relationships, if any, between physicians' compensation models and the outcomes of healthcare services has been conducted in North America and Europe, but no equivalent research has been conducted in the United Arab Emirates (UAE). The purpose of my exploratory qualitative research study was to address two open-ended research questions: 1) what are the perceptions of hospital stakeholders about the idiographic effects of different physician payment models on quality of healthcare services in the hospital? 2) What changes might be implemented to physician payment models to improve healthcare services in the hospital? I audio-recorded semi-structured interviews with a purposive sample of N = 17 stakeholders at one private sector hospital in UAE. The heterogenous or maximum variation sample included five hospital leaders, two financial or insurance managers, five physicians, two nurses, and three patients. I conducted a qualitative analysis and identified ten primary semantic themes by deductive reasoning to address the first research question. I based four semantic themes on a template extracted from the literature, specifically: 1) Physician Payment Models Implemented at the Hospital; 2) Environmental Context for Payment Models; 3) Stakeholders Affected by Payment Models; 4) Misuse of Payment models. I underpinned six semantic themes by the dimensions of healthcare quality proposed by the Institute of Medicine, specifically: 5) Payment Models and Safe Care; 6) Payment Models and Effectiveness of Care; 7) Payment Models and Patient-Centered Care; 8) Payment Models and Timely Care; 9) Payment Models and Efficiency of Care; 10) and Payment Models and Equity of Care. Subsequently, I synthesized the semantic themes and identified two latent themes by inductive reasoning, specifically: 1) Relationships between Physicians' Compensation Models and Healthcare Services; and 2) Proposed Changes to Physician Compensation Models. I propose innovative changes underpinned by Kotter's Management Change Theory and Roger's Theory of Diffusion of Innovations. I recommend future confirmatory research using a quantitative correlational design to validate these themes.Item Prolonged Use of the Etonogestrel Implant and Levonorgestrel Intrauterine Device - Two Years Beyond FDA-Approved Duration(Elsevier, 2017-06) McNicholas, Colleen; Swor, Erin; Wan, Leping Wan; Peipert, Jeffrey F.; Medicine, School of MedicineThe subdermal contraceptive implant, and the 52mg levonorgestrel intrauterine device (IUD) are currently FDA-approved for three and five years of use respectively. Limited available data has suggested both of these methods are effective beyond that time. Demonstration of prolonged effectiveness will improve the cost-effectiveness of the device, and potentially patient continuation and satisfaction. Objective To evaluate the effectiveness of the contraceptive implant and the 52-mg hormonal intrauterine device (IUD) in women using the method for two years beyond the current FDA-approved duration. Study Design We initiated this ongoing prospective cohort study in January 2012. We are enrolling women using the contraceptive implant or 52-mg levonorgestrel IUD for a minimum of 3 and 5 years, respectively (started IUD in 2007 or later or implant in 2009 or later). Demographic and reproductive health histories, as well as objective body mass index (BMI) were collected. Implant users were offered periodic venipuncture for analysis of serum etonogestrel levels. The primary outcome, unintended pregnancy rates, was calculated per 100 woman-years. We analyzed baseline demographic characteristics using chi-square test and Fisher Exact test, and compared serum ENG levels stratified by body mass index using the Kruskal-Wallis test. Results Implant users (n=291) have contributed 444.0 women-years of follow-up. There have been no documented pregnancies in implant users during the two years of post-expiration follow-up. Calculated failure rates in the fourth and fifth years for the implant are calculated as 0 (one-sided %97.5 confidence interval (CI) 0–1.48) per 100 woman years at four years and 0 (one-sided %97.5 CI 0–2.65) per 100 women years at five years. Among 496 levonorgestrel IUD users, 696.9 women-years of follow-up have been completed. Two pregnancies have been reported. The failure rate in the sixth year of use of the levonorgestrel IUD is calculated as 0.25(%95 CI 0.04–1.42) per 100 women year; failure rate during the seventh year is 0.43 (%95 CI 0.08–2.39) per 100 women years. Among implant users with serum etonogestrel results, the median etonogestrel level at the time of method expiration was 207.7 pg/mL (range 63.8–802.6 pg/mL), 166.1 pg/mL (range 67.9 25.0 – 470.5 pg/mL) at the end of the fourth year, and 153.0 pg/mL (range 72.1–538.8 pg/mL) at the end of the fifth year. Median ENG levels were compared by BMI at each time point and a statistical difference was noted at the end of four years of use with overweight women having the highest serum ENG (195.9 pg/ml: range 25.0–450.5) when compared to normal (178.9 pg/ml: range 87.0–463.7) and obese (137.9 pg/ml: range 66.0–470.5) women (p=0.04). Conclusion This study indicates that the contraceptive implant and 52-mg hormonal IUD continue to be highly effective for at least two additional years of use. Serum etonogestrel evaluation demonstrates median levels remain above the ovulation threshold of 90pg/ml for women of in all BMI classes.