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This article addresses the under-theorization of visual techniques for social science research applications through the cultural-historical activity theory (CHAT). The "problem" of "the visual" in research is given an ontological framing by highlighting the ways in which the use of visual techniques as research tools--designed to elicit participant responses--has a bearing upon the types of data that are produced: the "how" to some degree shapes the "what" of research output. CHAT, by drawing our attention to the ways in which the artefacts we use to mediate researcher-participant relationship (our visual research tools) also affects them, alerts us to the meanings that we (inadvertently, reflexively or even deliberately) create in the research process. Three different kinds of visual techniques are explored according to a CHAT-informed typology: diagrams as a means of eliciting technical information, drawings as a means of eliciting interpretations and judgements and fictional characters as a means of eliciting personal identification. In each case, the ontological consequences of the choice of visual technique for the insight produced are discussed to explore the value of CHAT as one approach to deepening our understanding and appreciation of the value of "the visual" in research. (Contains 6 figures.)

Background: Demand for surgery to treat osteoarthritis (OA) of the hip, knee and spine has risen dramatically. Whereas total hip (THA) and total knee arthroplasty (TKA) have been widely accepted as cost-effective, spine surgeries (decompression, decompression with fusion) to treat degenerative conditions remain underfunded compared with other surgeries. Methods: An incremental cost-utility analysis comparing decompression and decompression with fusion to THA and TKA, from the perspective of the provincial health insurance system, was based on an observational matched-cohort study of prospectively collected outcomes and retrospectively collected costs. Patient outcomes were measured using short-form (SF)-36 surveys over a 2-year follow-up period. Utility was modelled over the lifetime, and quality-adjusted life years (QALYs) were determined. We calculated the incremental cost per QALY gained by estimating mean incremental lifetime costs and QALYs of surgery compared with medical management of each diagnosis group after discounting costs and QALYs at 3%. Sensitivity analyses were also conducted. Results: The lifetime incremental cost:utility ratios (ICURs) discounted at 3% were $5321 per QALY for THA, $11 275 per QALY for TKA, $2307 per QALY for spinal decompression and $7153 per QALY for spinal decompression with fusion. The sensitivity analyses did not alter the ranking of the lifetime ICURs. Conclusion: In appropriately selected patients with leg-dominant symptoms secondary to focal lumbar spinal stenosis who have failed medical management, the lifetime ICUR for surgical treatment of lumbar spinal stenosis is similar to those of THA and TKA for the treatment of OA. Contexte : La demande en chirurgie de traitement de l'arthrose de la hanche et du genou a considerablement augmente. Les interventions pour prothese totale de hanche (PTH) et prothese totale du genou (PTG) sont largement reconnues pour leur rapport cout:efficacite, mais les chirurgies de la colonne (decompression, decompression avec arthrodese) pour le traitement des maladies degeneratives restent sousfinancees comparativement aux autres chirurgies. Methodes : Nous avons adopte l'angle du regime d'assurance sante provincial pour effectuer une analyse comparative du rapport cout:utilite differentiel entre la decompression et la decompression avec arthrodese, d'une part, et la PTH et la PTG, d'autre part, a partir des resultats regroupes de facon prospective et des couts regroupes de facon retrospective dans une cohorte d'observation assortie. Les resultats chez les patients ont ete mesures au moyen de questionnaires SF-36 sur une periode de suivi de 2 ans. Le volet utilite a quant a lui ete modelise pour la vie durant et on a calcule le nombre d'annees de vie ajustees en fonction de la qualite (AVAQ). Nous avons aussi calcule le cout differentiel par AVAQ gagnee en estimant les couts differentiels moyens pour la vie durant, et le nombre d'AVAQ associe a la chirurgie par opposition a une prise en charge medicale de chaque diagnostic apres actualisation des couts et des AVAQ a 3 %. Nous avons aussi realise des analyses de sensibilite. Resultats : Les rapports cout:utilite differentiels pour la vie durant actualises a 3 % ont ete de 5 321 $ par AVAQ pour la PTH, de 11 275 $ par AVAQ pour la PTG, de 2 307 $ par AVAQ pour la decompression medullaire et de 7 153 $ par AVAQ pour la decompression medullaire avec arthrodese. Les analyses de sensibilite n'ont pas modifie le classement des rapports cout:utilite differentiels pour la vie durant. Conclusion : Chez certains patients selectionnes ayant des symptomes principalement a une jambe par suite d'une stenose medullaire lombaire focale et pour qui le traitement medical a echoue, l'augmentation du rapport cout:utilite differentiel pour la vie durant avec le traitement chirurgical de la stenose medullaire lombaire est semblable a celui des PTH et PTG pour le traitement de l'arthrose., Osteoarthritis (OA) is the main cause of disability in the elderly population (1) and has a major impact on functional capacity. (2) The prevalence of this degenerative condition is increasing [...]

Background: Most joint-replacement surgeries are currently performed in community hospitals. We sought to determine whether the functional outcomes of joint-replacement surgery differ between academic and community hospitals. Methods: We surveyed 471 patients for demographic data, Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores and Medical Outcomes Study Short Form 36 (SF-36) scores at baseline and at 3-month and 1-year follow-up. We assessed patient satisfaction at 1 year with a single survey question. Results: Community hospital patients (n = 269) were significantly older and had greater comorbidity than academic hospital patients (n = 202; p < 0.05). We found no difference in WOMAC scores, SF-36 scores or in patient satisfaction between hospitals at 1-year follow-up (p > 0.05). Adjusted analysis showed that patients undergoing surgery in an academic or community hospitals have the same functional outcomes. Conclusion: There is no significant difference in the functional outcomes of joint-replacement surgery between academic and community hospitals. Further work will involve evaluating cost of care differences between these types of hospitals. Contexte : La plupart des arthroplasties sont actuellement pratiquees dans des hopitaux communautaires. Nous avons cherche a determiner si les resultats fonctionnels de l&apos;arthroplastie different entre les hopitaux universitaires et les hopitaux communautaires. Methodes : Nous avons sonde 471 patients pour obtenir leurs donnees demographiques, les resultats selon l&apos;indice Western Ontario et McMaster sur l&apos;arthrose (WOMAC) et les resultats du questionnaire abrege 36 (SF-36) de l&apos;etude sur les resultats medicaux au depart et au suivi a 3 mois et a 1 an. Nous avons evalue la satisfaction des patients a 1 an en leur posant une seule question. Resultats : Les patients des hopitaux communautaires (n = 269) etaient beaucoup plus ages et avaient plus de comorbidites que ceux des hopitaux universitaires (n = 202; p < 0,05). Nous n&apos;avons constate aucune difference au niveau des scores WOMAC et SF-36, de meme qu&apos;au niveau de la satisfaction des patients entre les hopitaux au suivi a 1 an (p > 0,05). L&apos;analyse rajustee a montre que les patients qui ont subi leur intervention dans un hopital universitaire ou communautaire ont les memes resultats fonctionnels. Conclusion : Il n&apos;y a pas de differences importantes au niveau des resultats fonctionnels de l&apos;arthroplastie pratiquee dans les hopitaux universitaires et les hopitaux communautaires. Une etude plus poussee consistera a evaluer les differences au niveau du cout des soins entre ces types d&apos;hopitaux., Total joint arthroplasty (TJA) has been shown to be an effective procedure for relieving pain and improving quality of life. (1-3) Literature from both the United States and Canada projects [...]

Abstract Background Decision aids have been developed in a number of health disciplines to support evidence-informed decision making, including patient decision aids and clinical practice guidelines. However, policy contexts differ from clinical contexts in terms of complexity and uncertainty, requiring different approaches for identifying, interpreting, and applying many different types of evidence to support decisions. With few studies in the literature offering decision guidance specifically to health policymakers, the present study aims to facilitate the structured and systematic incorporation of research evidence and, where there is currently very little guidance, values and other non-research-based evidence, into the policy making process. The resulting decision aid is intended to help public sector health policy decision makers who are tasked with making evidence-informed decisions on behalf of populations. The intent is not to develop a decision aid that will yield uniform recommendations across jurisdictions, but rather to facilitate more transparent policy decisions that reflect a balanced consideration of all relevant factors. Methods/design The study comprises three phases: a modified meta-narrative review, the use of focus groups, and the application of a Delphi method. The modified meta-narrative review will inform the initial development of the decision aid by identifying as many policy decision factors as possible and other features of methodological guidance deemed to be desirable in the literatures of all relevant disciplines. The first of two focus groups will then seek to marry these findings with focus group members' own experience and expertise in public sector population-based health policy making and screening decisions. The second focus group will examine issues surrounding the application of the decision aid and act as a sounding board for initial feedback and refinement of the draft decision aid. Finally, the Delphi method will be used to further inform and refine the decision aid with a larger audience of potential end-users. Discussion The product of this research will be a working version of a decision aid to support policy makers in population-based health policy decisions. The decision aid will address the need for more structured and systematic ways of incorporating various evidentiary sources where applicable.

Abstract Background In research, diagrams are most commonly used in the analysis of data and visual presentation of results. However there has been a substantial growth in the use of diagrams in earlier stages of the research process to collect data. Despite this growth, guidance on this technique is often isolated within disciplines. Methods A multidisciplinary systematic review was performed, which included 13 traditional healthcare and non-health-focused indexes, non-indexed searches and contacting experts in the field. English-language articles that used diagrams as a data collection tool and reflected on the process were included in the review, with no restriction on publication date. Results The search identified 2690 documents, of which 80 were included in the final analysis. The choice to use diagrams for data collection is often determined by requirements of the research topic, such as the need to understand research subjects' knowledge or cognitive structure, to overcome cultural and linguistic differences, or to understand highly complex subject matter. How diagrams were used for data collection varied by the degrees of instruction for, and freedom in, diagram creation, the number of diagrams created or edited and the use of diagrams in conjunction with other data collection methods. Depending on how data collection is structured, a variety of options for qualitative and quantitative analysis are available to the researcher. The review identified a number of benefits to using diagrams in data collection, including the ease with which the method can be adapted to complement other data collection methods and its ability to focus discussion. However it is clear that the benefits and challenges of diagramming depend on the nature of its application and the type of diagrams used. Discussion/Conclusion The results of this multidisciplinary systematic review examine the application of diagrams in data collection and the methods for analyzing the unique datasets elicited. Three recommendations are presented. Firstly, the diagrammatic approach should be chosen based on the type of data needed. Secondly, appropriate instructions will depend on the approach chosen. And thirdly, the final results should present examples of original or recreated diagrams. This review also highlighted the need for a standardized terminology of the method and a supporting theoretical framework.