Delayed outcomes

An advantage of the case-control design for the study of drug-outcome relationships is its efficiency for the study of rare or delayed outcomes. Compared with other strategies, the case-control study is relatively inexpensive. One potential problem with case-control studies is their susceptibility to certain types of bias, including selection bias and information bias. Selection bias refers to systematic differences between those selected for study and those who are not, whereas information bias is systematic differences in the quality of information gathered for study and comparison groups. 

Delayed Outcomes. We often create safety award programs to encourage employees to behave safely. The awards usually provide additional positive outcomes for not getting hurt but are too delayed to be effective consequences. We discussed problems with such programs earlier, yet such programs can be an effective component of a safety process. Figure 21.6 displays a more complete diagram that includes both consequences and outcomes. 

Self-Provided Consequences. The ideal safety program is one that maximizes self-control. The employees know the safety rules and feel good about behaving in ways consistent with those rules, often in spite of built-in consequences. They feel anxiety when they take shortcuts or fail to follow safety rules. People who consistently wear seat belts feel similar discomfort if they ride in an automobile without their seat belt fastened. Such self-control is the goal of added consequences and adding delayed outcomes such as safety awards. The anxiety results from the potential punishment for breaking safety rules and the potential loss of future safety awards, compensation, and advancement opportunities. 

Figure 21.6. Contingency diagram adding delayed outcomes.

Factors Influencing Effectiveness of Consequences. Two factors influence the effectiveness of consequences and delayed outcomes ... 

Finally, the behavioral safety process provides delayed outcomes that also support safety. The observation data can be the basis for both team celebrations and individual recognition. By participating in a formal observation process, managers and supervisors can more accurately evaluate employee safety performance when making decisions regarding compensation and promotions. Thus the process helps the normal organizational contingencies to support safety more effectively. 

In addition, managers and supervisors may be evaluated on how well they implement and maintain the observation and feedback processes. The delayed outcomes (such as the manager s annual performance appraisal) then also support the observational feedback process that has a more direct impact on all employees daily safety practices. 

Delayed Outcomes What delayed outcomes should support the desired behavior (Consider both reinforcement and punishment.) What safety awards should support the safe act What effect does performing the unsafe act have on an employee s compensation or career ... 

Differences exist in primary care between the patterns of prescribing fluoxetine, paroxetine or sertraline, which may influence cost outcomes. Sertraline-treated patients are more likely to have their dose increased (Sclar et al, 1995 Donoghue, 1998), and to drop out of treatment prematurely (Donoghue, 1998). The apparent need to titrate doses upwards with sertraline may require more involvement by the clinician and may delay response to treatment, with resultant increases in direct health costs (Sclar et al, 1995). However, these economic findings are retrospective, may suffer from selection bias, and being derived from HMO patients may not be generalizable to other populations confirmation in further studies is required. 

Parra A, Kreiter KT, Williams S, Sciacca R, Mack WJ, Naidech AM, Commichau CS, Fitzsimmons BF, Janjua N, Mayer SA, Connolly Jr. ES, Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage a matched controlled cohort study. Neurosurgery 2005 56 476 84 [discussion 476 84]. 

Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001 32 63-69. 

The field phase of an LSMBS is critically important. Close monitoring of shoppers by field phase study management personnel is required, especially when a sampling plan includes frequent collections, such as weekly or bimonthly. Missed, delayed, or deficient commodity samples can throw a laboratory off schedule, which in turn can adversely affect both the timeliness and the quality of the analyses. Missed, delayed, or deficient samples can also affect the study outcome and interpretation, because a statistical design typically requires a certain number of data points, each represented by analysis of a commodity sample. 

Oral nimodipine is recommended in subarachnoid hemorrhage to prevent delayed cerebral ischemia. Delayed cerebral ischemia occurs 4 to 14 days after the initial aneurysm rupture and is a common cause of neurologic deficits and death. A meta-analysis of 12 studies was conducted and concluded that oral nimodipine 60 mg every 4 hours for 21 days following aneurysmal SAH reduced the risk of a poor outcome and delayed cerebral ischemia.40... 

CF patients often experience delayed puberty. In females, menarche occurs 18 months later than average, and menstrual irregularity is common. Females also have reduced fertility due to increased viscosity of cervical mucus. Due to increasing life expectancy, pregnancy is becoming more common however, outcomes depend on pre-partum nutritional and pulmonary status. 

Evaluate the clinical outcomes of treatment by using the UPDRS. In addition, periodically ask patients to record the amount of on and off time they have with and without dyskinesias in a diary. There are a variety of scales that can be used to assess QOL, depression, anxiety, and sleep disorders. Patients with PD cannot be cured but treatment can delay the progression of symptoms and improve QOL. Delaying the patient s admission into a nursing home is a good outcome. 

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