Learning from the challenges of undertaking an evaluation of a multi-partner housing support initiative delivered within a hospital setting.

Objectives: We present learning from a mixed-methods evaluation of a housing support initiative for hospital inpatients. Study design: A mixed-methods process evaluation. Methods: A social housing provider delivered a housing support service in two hospitals (mental health unit and general hospital). Healthcare providers, the social housing provider and academic researchers designed and undertook a co-produced, mixed-methods process evaluation of the intervention. The evaluation included questionnaires, semi-structured interviews, analysis of routinely collected data and economic analysis. Despite commitment from the partners, the evaluation faced challenges. We reflect on the lessons learnt within our discussion paper. Results: Despite the commitment of the partners, we faced several challenges.We took an iterative approach to the design and processes of the evaluation to respond to arising challenges. Recruitment of service-users was more difficult than anticipated, requiring additional staff resources. Given the small-scale nature of the intervention, and the quality of data recorded in hospital records, the planned economic analysis was not feasible. Positive factors facilitating evaluation included involvement of staff delivering the intervention, as well as managers. Being able to offer payment to partner organisations for staff time also facilitated ongoing engagement. Conclusions: Multi-partner evaluations are useful, however, researchers and partners need to be prepared to take an iterative, resource intensive approach. Both availability and quality of routine data, and the resources required to support data collection, may limit feasibility of specific methods when evaluating small-scale cross-sector initiatives. Thus, this necessitates a flexible approach to design and analysis.

School-based AIDS education for adolescents.

PURPOSE: To describe a program which utilizes medical students and persons with AIDS (PWAs) to provide for adolescents school-based education about acquired immunodeficiency syndrome (AIDS). METHODS: Two 1.5 hour classroom sessions were conducted by medical students and persons with AIDS for seventh and eighth grade students (n = 1,161 students) at two urban middle schools. In addition, a two hour informational session was provided for parents. A 49 question student health survey was used to evaluate adolescents' HIV knowledge, tolerance of persons with AIDS, and intentions to engage in human immunodeficiency virus (HIV) safe behaviors. RESULTS: Significant (p < 0.01) increases in HIV knowledge and tolerance of persons with AIDS were observed, which persisted for three months. A significant (p < 0.01) improvement in intention to engage in HIV-safe behaviors was observed but did not persist for three months. CONCLUSIONS: Medical students and persons with AIDS can provide school-based AIDS education to early adolescents.

Considering individual differences in the design of preventive interventions: HIV primary prevention as an example.

This study examined how individual differences in personality style influenced children's receptivity to HIV primary prevention. Prior to taking part in a HIV prevention program, 123 fifth graders from an ethnically diverse inner city school district were administered the Weinberger Adjustment Inventory (WAI) and scales measuring HIV-related beliefs, attitudes, and knowledge. The HIV scales were readministered at the conclusion of the program. WAI groups (formed by contrasting dimensions of restraint and distress) were found to differ significantly on measures of knowledge about HIV, HIV-related fears, safe behavior attitudes, and risk behavior at pre-test. The intervention's impact, as reflected in scale change scores, did not show significant differences among WAI groups. Although subtle differences were evident among groups, findings suggest that HIV primary prevention programs may be equally effective among children with differing degrees of self-restraint and distress.

Child and adolescent psychiatrists and HIV disease: a survey.

During the spring and summer of 1989, all members of the American Academy of Child and Adolescent Psychiatry in nine states were sent questionnaires to determine the extent of child and adolescent psychiatrists' human immunodeficiency virus (HIV)-related knowledge, experience, comfort in working with HIV patients, and opinions regarding perceived educational needs about HIV. The response rate was 54% (N = 511). Two-thirds of the respondents indicated they had treated or had consulted on an HIV-infected patient. Most psychiatrists indicated reasonable comfort in working with HIV patients. Knowledge about HIV was found to be variable. Results suggest that child psychiatrists are engaging in HIV-related activities in all parts of the country, and further information or education would be welcomed by a majority of Academy members, particularly at nationally sponsored events.

Use of hydrogen peroxide to clear blocked ventilation tubes.

Blocked tympanostomy tubes re-create the problem for which they were initially inserted. Hydrogen peroxide offers a noninvasive alternative to extracting the blocked tube and inserting a new tube. In this article we present the results of a long-term retrospective study of 95 patients (113 ears) who had occluded ventilation tubes following myringotomy. An 85% rate of success in opening the clogged tube with hydrogen peroxide is documented. The ototoxicity of the treatment is also examined. Ninety-nine percent of the patients showed no immediate change in bone conduction thresholds following the use of hydrogen peroxide. We have concluded that hydrogen peroxide is a convenient, noninvasive, and inexpensive treatment for blocked ventilation tubes.

Management of the hearing impaired child with serous otitis media.

The majority of research and informative papers dealing with otitis media with effusion (OME) are concerned with normally hearing children who display a mild conductive hearing loss associated with the infection. In contrast, the target of our manuscript is the child who has a previously documented sensori-neural hearing loss that is complicated by the onset of a middle ear infection. It is our clinical experience that OME in the hearing impaired child must be treated aggressively in order to adequately override the additional loss that accompanies a middle ear infection. A number of our patients are children who have various degrees of sensori-neural hearing loss. A significant number of these children also have experienced bouts of OME. The case studies presented will examine the effect that middle ear effusion has had on these hearing impaired children and discuss the importance of vigorous treatment of OME in hearing impaired children. Our intention is to alert the otologist and the audiologist to the possibility of OME in the hearing impaired child and to demonstrate the need for and the benefit of aggressive medical and/or surgical intervention.

Elevated bone conduction thresholds associated with middle ear fluid in adults.

Longitudinal observations of adult patients with documented cases of otitis media revealed fluctuations in bone conduction thresholds as well as air conduction thresholds. Previous investigations in this area presented conflicting information regarding temporary and permanent effects of serous otitis media on sensori-neural function. We conducted a detailed study, including complete otologic, audiologic, and tympanometric evaluation, of 30 adult patients exhibiting serous otitis media. Myringotomies were performed on all patients after appropriate medical management failed to clear the middle ear fluid and subsequent hearing loss. Pre- and postmyringotomy audiograms support our conclusion that middle ear fluid can produce artifactual shifts in bone conduction thresholds. Although the data presented was collected from a cohort of adults, the clinical implications are applicable to the pediatric population. We have observed a similar shift in bone conduction thresholds in children exhibiting serous otitis media, and we have observed improvement in the thresholds with removal of the fluid either by appropriate medical management or by myringotomy with fluid aspiration.

Myringotomy and tube ventilation in adults.

Otitis media is commonly diagnosed in children and is often successfully treated with myringotomy and tube insertion. It also occurs in adults but is frequently undetected and therefore untreated. Adults with hearing loss are often assumed to need a hearing aid, without consideration of a treatable problem. Physicians should be aware of otitis media in adults and the benefits of prompt medical or surgical intervention.

Sudden hearing loss.

This article describes a patient with documented sudden, severe, unilateral, sensorineural hearing loss occurring four days after audiometric evaluation for nonspecific complaints. He was hospitalized immediately; treatment included I.V. histamine and oral steroid therapy. He noted improvement within two days, and serial audiometry has documented recovery to the initial audiometric levels. We believe that this documentation of recovery to pre-illness levels is unique.