In part 1 of this series, the authors describe the importance of incomplete data in clinical research, and provide a conceptual framework for handling incomplete data by describing typical mechanisms and patterns of censoring, and detailing a variety of relatively simple methods and their limitations. In part 2, the authors will explore multiple imputation (MI), a more sophisticated and valid method for handling incomplete data in clinical research. This article will provide a detailed conceptual framework for MI, comparative examples of MI versus naive methods for handling incomplete data (and how different methods may impact subsequent study results), plus a practical user's guide to implementing MI, including sample statistical software MI code and a deidentified precoded database for use with the sample code.ACADEMIC EMERGENCY MEDICINE 2007; 14:669-678 ª
Background
Residents who live in neighborhoods that are primarily African-American, Latino, or poor are more likely to have an out-of-hospital cardiac arrest (OHCA), less likely to receive cardiopulmonary resuscitation (CPR), and less likely to survive. No prior studies have been conducted to understand the contributing factors that may decrease the likelihood of residents learning and performing CPR in these neighborhoods. The goal of this study was to identify barriers and facilitators to learning and performing CPR in three low-income, “high-risk” predominantly African American, neighborhoods in Columbus, Ohio.
Methods and Results
Community-Based Participatory Research (CBPR) approaches were used to develop and conduct six focus groups in conjunction with community partners in three target high-risk neighborhoods in Columbus, Ohio in January-February 2011. Snowball and purposeful sampling, done by community liaisons, was used to recruit participants. Three reviewers analyzed the data in an iterative process to identify recurrent and unifying themes. Three major barriers to learning CPR were identified and included financial, informational, and motivational factors. Four major barriers were identified for performing CPR and included fear of legal consequences, emotional issues, knowledge, and situational concerns. Participants suggested that family/self-preservation, emotional, and economic factors may serve as potential facilitators in increasing the provision of bystander CPR.
Conclusion
The financial cost of CPR training, lack of information, and the fear of risking one's own life must be addressed when designing a community-based CPR educational program. Using data from the community can facilitate improved design and implementation of CPR programs.
Nontargeted opt-out rapid HIV screening in the ED, vs diagnostic testing, was associated with identification of a modestly increased number of patients with new HIV diagnoses, most of whom were identified late in the course of disease.
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