Transcript University of Maryland Dissemination and Implementation

Barbara Resnick, PhD, APRN, FAAN, FAANP
University of Maryland, School of Nursing
Joe Ouslander, MD
University of Maryland, School of Medicine
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The FACTS and only the FACTS
Start off with basic descriptives (means,
medians, standard deviations, frequencies);
Provide more sophisticated within or between
group comparisons;
As relevant illustrate your results using tables
or graphs
◦ try to use tables and graphs - avoid REALLY lengthy
text
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The Results section should be organized
around Tables & Figures that should be
sequenced to present your key findings in a
logical order.
Should highlight the evidence needed to
answer the questions/hypotheses you
investigated.
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The page length of this section is set by the
amount and types of data to be reported.
Thus…use those figures and tables, as
appropriate, to present results most
effectively.
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The purpose of a results section is to present
and illustrate your findings. PERIOD!
Make this section completely objective---all interpretation is for the discussion section.
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Use the text to point the reader to
observations that are most relevant.
Include within the text observations that are
not presented in a formal Figure or Table.
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Present the key results of the experiment
without interpreting their meaning.
DO not include findings that are not related
to your study questions/hypotheses.
Avoid writing out long lists of numbers numbers and measurements should all be
tabulated.
◦ For example, the baseline means of all outcome
variables are shown in Table 1.
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State the results of statistical analyses in this
section, but do not describe every detail of
the analysis.
 Assume the readers know what a null hypothesis is,
a rejection rule, chi-square test, etc.
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Important negative results should be reported
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Report your results so as to provide as much
information as possible to the reader about
the nature of differences or relationships.
◦ it is not sufficient to simply report that "groups A
and B were significantly different".
 How were they different?
 How much were they different?
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Statistical test summaries (test name such as
chi-square, p-value) are usually reported
parenthetically in conjunction with the
biological or psychosocial results they
support.
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If demographics are reported in text no need
for a Table….OR you may highlight some
demographics and refer to the Table for
remaining.
◦ The majority of the DCWs were female (n=95; 99%);
59 (62%) were black, 23 (24%) white, 3 (3%) Asian, 1
(1%) Native Hawaiian, and the remaining 10 (10%)
reported multiple races.
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Baseline descriptions of residents and DCWs have
been previously reported1 and are shown within
Tables 2 and 3. Briefly, at baseline DCWs had
strong self-efficacy with regard to their ability to
provide function focused care to residents,
although they did not believe in the benefits of
providing this type of care. They had fair
knowledge of function focused care on a paper and
pencil test, and fair job satisfaction. Based on
observations they performed function focused care
in 76% (SD=24%, range 0-100%) of all care
interactions.
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Treatment effects for residents are shown in
Table 3. While both treatment and control
groups showed a decline in function over 12
months, the decline was greater between
baseline and 12 months for the control group
versus the treatment group (the control
group declined 6.95 points versus 4.33
points for the treatment group, p=.01).
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From baseline to 12 months, 13 (17%)
residents in the treatment group versus 2
(4%) residents in the control group resumed
walking functional distances versus remaining
wheelchair dependent (Chi square=4.94,
p=.026).
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Use a numeral, with the following exceptions:
◦ You cannot begin a sentence with a numeral.
◦ If the number involves a unit of measure, the unit
must be spelled out.
◦ Revise the sentence so you don't have to begin it
with the number!
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When < 10 use words instead of numerals
Numbers are written as numerals when a
specific value is named, and when associated
with a unit of measure: "270 centuries ago,"
"59 people...", "...47.8 g dry weight...".
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Note that simple findings usually do not need
a visual aid.
Visual aids are used to make complex
findings explained in the text easier to grasp.
There are some simple but crucial findings
and visuals are sometimes created to give
these facts more impact or emphasis.
Any Table or Figure should be
understandable without reading the results
section, i.e., it must be able to stand alone
and be interpretable.
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Tables present lists of numbers or text in
columns, each column having a title or label.
Do not use a Table when you wish to show a
trend or a pattern of relationship between
sets of values - these are better presented in
a Figure.
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the presence of a period after "Table #";
the legend (sometimes called the caption)
goes above the Table;
units are specified in column headings;
lines of demarcation are used to set legend,
headers, data, and footnotes apart.
footnotes are used to clarify points in the
table or to denote statistical differences
among groups.
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Figures are visual presentations of results,
including graphs, diagrams, photos,
drawings, schematics, maps, etc.
Graphs are the most common type of figure
and show trends or patterns of relationship.
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Construct tables and figures before writing
the results section.
Include a summary of each table/figure in the
results section.
􀂾 Be High Resolution. Pixilated images,
fuzzy graphs, and illegible tables are
the bane of a good paper.
 􀂾 Have Neat, Legible Labels. There
should be zero ambiguity about what
the figure or table is illustrating.
 􀂾 Be Simple. Figures and tables that
cram too much information into a
small space obscure their meanings
and defeat their own purpose.
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Be Clearly Formatted.
 Tables should have lines clearly separating it
from other pieces of the manuscript.
 Graphs should have appropriate axes, and
images should have appropriate boxes.
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􀂾 Indicate Error. All tables should have
Standard Deviation information; all graphs
should have error bars.
􀂾 Have Detailed Captions.
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A caption should be clear and succinct, yet detailed.
It should convey all the information needed for a reader to
understand the figure, without reading the whole
manuscript.
For example, a good caption of a graph would tell the
reader what the graph illustrates, what samples were used
and the relationship displayed.
A caption should tell the reader the meaning of the figure
or table. Does the table illustrate a trend that the reader
should be noting? Does this figure illustrate the sample
site, and, if so, what are the features of note at this site?
Captions have a lot of information to relay… but they
shouldn’t be longer than about 10 sentences.
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1. Inappropriate Format  Check journal
guidelines.
2. Redundant Information – do not include
the same information in different places: the
text, figures, and tables.
3. Ugly – watch for blurry, unclear,
unlabeled, pixilated. Shoot for clear,
concise, and professionally laid-out.
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1. No Caption. No more need be said – just
make one unless no more need be said.
2. One-Liner. One sentence is never, ever,
enough for a caption. Give the reader more
information.
3. Regurgitates Figure/Table. A caption that
re-states exactly what the table/figure says
is no good – the caption must explain what
it means and why it is important.
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Is the Figure necessary?
Is the Figure simple, clean, and free of extraneous detail?
Are the data plotted accurately?
Is the grid scale correctly proportioned?
Is the lettering large and dark enough to read? Is the
lettering compatible in size with the rest of the Figure?
Are parallel Figures or equally important Figures prepared
according to the same scale?
Are terms spelled correctly?
Are all abbreviations and symbols explained in a Figure
legend or Figure caption? Are the symbols, abbreviations,
and terminology in the figure consistent with those in the
Figure caption? In other Figures? In the text?
Are the Figures numbered consecutively?
Are all Figures mentioned in the text?
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Do not discuss or interpret your results,
report background information, or attempt to
explain anything.
Never include raw data or intermediate
calculations in a research paper.
Do not present the same data more than
once.
Text should complement any Figures or
Tables, not repeat the same information.
Do not confuse Figures with Tables - there is
a difference.
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Present only the key results, meaning those
results that bear on the question or problem
being addressed.
◦ Generally present means, percentages, standard
deviations, etc.
◦ For comparison studies, statistical significance
MUST be included. NO exceptions.
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Do not add additional data that is NOT
relevant to a research question. A separate
paper is an option!
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As always, use past tense when you refer to
your results, and put everything in a logical
order.
In text, refer to each Figure as “Figure 1,"
“Figure 2," etc. ; number your Tables as well.
Place figures and tables, properly numbered,
in order at the end of the manuscript [of
course follow journal guidelines].
The
survey shows that an overwhelming
percentage of the respondents — 83% — feel
that rewarding nursing staff is not necessary, a
disappointing finding.
OR
The
survey shows that 83% of respondents
indicated that rewarding nursing staff is not
necessary.
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Do results as presented address research ?
Question: “How successful are senior centers
in promoting physical activity?”
◦ A large proportion of the respondents — 74% —
indicated that senior centers do not promote
physical activity.
Here are four possibilities of structurally
appropriate reporting:
● The survey [source] shows that [finding]
● It can be seen [writer’s voice/comment] from
the survey [source] that [finding]
● From the survey [source], it was found that
[finding]
● The majority [finding], as can be seen from
the responses to a question about... [source]
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Figure 1 shows that only 15% of the
respondents...
As Figure 1 shows, only 15% of the
respondents...
As can be seen in Figure 1, only 15% of the
respondents...
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Write with accuracy, brevity and clarity.
Use a good topic sentence for each of your
paragraphs.
Summarize statistical analyses.
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Report the flow of participants through each
aspect of the intervention
◦ Randomization to tx arms;
◦ completion of treatment;
◦ deviations from protocol as relevant
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The presentation of qualitative results is easiest to follow if the
structure is directly linked to the research question, moves in
logical steps according to the theory and method, and
consistently uses the concepts presented earlier in the article.
Present your data in a systematic way in the body of the text, so
that quotations, field notes and other documentations are easily
identifiable.
The reader should know if your are providing direct citations or if
you are analyzing interpretations of what the observed or
interviewed persons said.
The citations or other illustrations must be clearly
contextualised.
If it is observational material, state whether you collected the
data yourself or if you used data collected by someone else.
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Give enough raw data, for instance direct
citations, but not too much.
Avoid very short quotations.
If you run out of space, find out from the editor if
you can use online appendices for additional
material.
Do not report in the results section on data that
you have not indicated you collected in the
methods section -if you state that you are going
to use interviews, do not report observations.
If you use grounded theory, you should be able
to present a theory as a result.
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Use “thick” description - sufficient detail to take
the reader into the setting being described.
Use direct quotations so that respondents are
presented in their own terms and ways of
expressing themselves.
Keep quotations and field incident descriptions in
context.
Assure that interpretations follow from the
qualitative data. Make the basis for judgments
explicit.
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Provide enough information in the results so
readers can determine whether the findings
emerged logically from the data.
Demonstration of links from text to codes to
categories to sub-themes to themes makes it
easier to determine the quality of the work.
The reader needs to be able to confirm that
the findings are grounded in data and not
made up.
Raw data model
 􀂾 The question followed by all
participant comments
Descriptive model
 􀂾 Summary description followed by
illustrative quotes
Interpretative model
 􀂾 Summary description followed by
illustrative quotes and interpretation
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Planning service provision
◦ Reductions in workload, stress from having to
manage appointment crises at short notice, and
reduced pressure from having to support staff
meant that for the practice managers in the study
were able to spend more time planning for the
future.
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"The advantage of the system is that I can plan in
advance. I know exactly how many appointments we
are going to have to offer each day and therefore I
can plan if we need extra cover particularly for
annual leave and training days."
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Theme : Managing emergencies better
Coping with sudden illness or other unforeseen
circumstances was easier and less stressful with
computerized appts than with the previous
appointment booking system as exemplified
below.
 "As there are only a few pre-bookable appointments
each session, it is much easier to rearrange
appointments. Before this computerized system came
in, it was simply hell trying to cancel appointments
because you know that you would be getting a lot of
abuse from the patients”
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The NAs further described some of their
challenging situations related to restorative care
and addressed how they handled those situations
to facilitate restorative care. They described how
they would sneak restorative care in by “tricking”
the resident into it. For example, one NA talked
about a trick she had learned during the study:
 …”I do little things like get them to do the
handshake…the RCN called this the queen! This
resident is still doing her range of motion everyday
whether she wants to or not as we sneak it in through
our special handshake!”
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Self-confidence was another theme that emerged from data. Thirty
five participants emphasized the key role played by self-confidence
in feeling and using power and authority, and a majority of them
considered that as a synonym or a necessary base for power. They
also identified the different factors and dimensions in selfconfidence of the nurses. They believed that:
◦ "Self-confidence provides the nurse with the feeling of power and
ability, and lack of confidence causes someone to feel weak and
unable to use his/her talents," so that she/he would avoid
independent actions.
◦ "Power depends on the individuals. Some people have the selfconfidence to make use of their authority in their duty limits as a
nurse or a nurse manager, while some are weak and unable to do
so.”
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Find your rhythm
Focus on telling the story
Data as star – data exemplars
Centrality of the respondents voice
Be creative – how else might you tell the story
(visual, oral etc.)
Write with your audience in mind-Be open,
explicit, reflexive, and thorough in
representing the story
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As far as possible, the Results section should be
exhaustive in reporting the data. Given restricted
space of a journal paper, decisions have to be
made about what to put in and what to leave out.
By convention 3-4 items/theme are
recommended.
Longer quotes are often better for preserving
context.
Short quotes can often, either be taken out of
context or seem to offer little elaboration of an
idea.
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Appropriate to place this data at the end of
the results section.
Important for explaining significant and nonsignificant results.
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Design of study-control and tx groups
maintained; timing of intervention; theoretical
adherence
Training providers-use of training manuals and
oversight
Delivery of treatment- as intended
Receipt of treatment- was it received or just
provided?
Enactment of treatment skill-performing
expected behaviors in real world settings (e.g,
taking pills, exercising, checking fasting sugars)
Treatment Fidelity Plan
Focus Area
Information Used to Evaluate Treatment
Fidelity
Design
Evidence that groups are separate
No contamination
Training
Training manual
Observation & Checklist
Delivery
Observation
Attendance sheets
Receipt
Paper and pencil test
Enactment
Daily logs
TREATMENT FIDELITY DATA SHOULD NOT BE OUTCOME DATA
Example Treatment Fidelity Plan Res-Care NH Study
Treatment
Fidelity
Description of Treatment Fidelity Indicators
Design
The intervention was developed based on social cognitive theory and the theory of selfefficacy. This was reviewed with experts in cognitive theories and behavior change.
Evaluators were kept blinded from treatment intervention and randomization of sites.
Different interventions provided the training for the treatment versus the control sites.
Training
RCN Training: (a) training of the RCN was based on a training manual; (b) RCNs met
monthly with the principal investigator to discuss intervention process and activities to
assure prevent intervention drift.
NA Training: (a) Each nursing assistant attended the 6 classes or was provided with
written material and one-on-one sessions to review the class content.
Delivery
(a) NA class attendance was recorded as were one-on-one sessions to assure delivery of
the intervention; (b) review of daily logs completed by NAs was done on a monthly basis
to assure delivery of restorative care activities.
Receipt
Each NA completed the Nursing Assistants Theoretical Testing of Restorative Care
Activities pre and post the 6 week training period.
Enactment
(a) Monthly logs recording the NA restorative care activities were reviewed in the
treatment sites to determine daily enactment of restorative care. (b) Direct observation of
restorative care based on the Restorative Care Behavior Checklist was done at 4 and 12
months post intervention as evidence that restorative care activities were completed.
Focus
Delivery
Data Obtained
Environment and policy
assessments
Percentage of nurses exposed to
Component I, Classes 1-4
Goal attainment forms
Patient admission packets
Receipt
Knowledge of FFC Test
Environment and policy
assessments
Goal attainment scale
Enactment
FFC Behavior Checklist Nurses
Delirium, pain, fear of falling
FFC Behavior Checklist Patients
Evidence of Treatment Fidelity
Completion of assessments by Research
FFC Nurse
80% of all nurses working on
participating units within the participating
hospitals (# exposed/total # nurses)
Forms completed on all recruited
patients in treatment hospital
FFC admission information provided to
all consented patients.
Mean score of > 80% after exposure to
Component I, Classes 1-4.
Evidence of change(s) made over the
course of the study
Positive goal attainment scores at
discharge in consented patients
Performance of FFC based on
observations of nurses during
intervention
Decreased delirium, pain and fear
indicate interventions were implemented
Increased participation in FFC activities
by patients admission to discharge
Treatment Fidelity Tabulated Results
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We maintained study design and used different interventionists for the
different arms of the study. As per our intervention protocol, in control
communities DCWs were offered only a formal class for education
related to function focused care and via this approach we reached only a
small percentage of DCWs (12-30%). In FFC-AL communities, multiple
teaching modalities were used and 100% of study participants were
exposed to educational materials. Delivery of all other components of
FFC-AL was done as intended by the FFCN based on documentation and
review of such things as resident goals and ongoing mentoring and
motivating activities. There was some evidence of receipt of these
components based on improved DCWs’ scores on a paper and pencil test
as well as evidence of changes in environments in the treatment
communities to optimize function and physical activity (e.g., chairs for
resting in walking areas; increased number and intensity of exercise
classes) and changes in the wording of Service Plan forms for residents
and community based marketing materials.
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PROVIDE HYPOTHESES / RESEARCH
QUESTIONS WITH YOUR RESULTS SECTION
INCLUDE ALL TABLES AND FIGURES
Homework due Thursday, August 8th. Send to
Erin Vigne at: [email protected]