ABSTRACT
2EMHFWLYH7RHYDOXDWHH[SHFWHGRXWFRPHVRI QXUVLQJLQWHUYHQWLRQVWRDGGUHVVWKHQXUVLQJGLDJQRVLVRI IDWLJXH0HWKRGV$FURVVVHFWLRQDO TXDVLH[SHULPHQWDOGHVLJQZDVXVHG7KHVDPSOHFRQVLVWHGRIFRURQDU\FDUHXQLWLQSDWLHQWZLWKFRQJHVWLYHKHDUWIDLOXUHDQGIDWLJXH$ VSHFLILFWRROGHVLJQHGIRUWKLVVWXG\ZDVXVHGWRFROOHFWVSHFLILFGDWDRQRXWFRPHVRIQXUVLQJLQWHUYHQWLRQVWRPDQDJHWKHQXUVLQJGLDJQRVLV RIIDWLJXH5HVXOWV1XUVLQJLQWHUYHQWLRQVWRPDQDJHSDWLHQWV·IDWLJXHKDGSRVLWLYHRXWFRPHV&RQFOXVLRQ7KHXVHRIWKHQXUVLQJSURFHVV WRLGHQWLI\WKHQXUVLQJGLDJQRVLVRIIDWLJXHGHVLJQDQGLPSOHPHQWVSHFLILFQXUVLQJLQWHUYHQWLRQVDQGHYDOXDWHSDWLHQWRXWFRPHVOHDGVWR TXDOLW\QXUVLQJFDUH
.H\ZRUGV+HDUWIDLOXUHFRQJHVWLYH1XUVLQJGLDJQRVLV)DWLJXH3DWLHQWFDUHSODQQLQJ1XUVLQJSURFHVV
RESUMO
2EMHWLYR$YDOLDURVUHVXOWDGRVDOFDQoDGRVDSyVLQWHUYHQo}HVGHHQIHUPDJHPSDUDRGLDJQyVWLFRGHHQIHUPDJHP)DGLJD0pWRGRV(VWXGR TXDVHH[SHULPHQWDOWHPSRVpULHHWUDQVYHUVDOUHDOL]DGRHP+RVSLWDO8QLYHUVLWiULRSRUPHLRGDLPSOHPHQWDomRGHLQWHUYHQo}HVHDYDOLDomR GLiULDGRVUHVXOWDGRVHPSDFLHQWHVFRPGLDJQyVWLFRGHLQVXILFLrQFLDFDUGtDFDHGHHQIHUPDJHPIDGLJDLQWHUQDGRVQD8QLGDGHGH&DUGLRORJLD H87,&RURQiULD)RLHODERUDGRXPLQVWUXPHQWRGHFROHWDGHGDGRVFRPSRVWRSRULQWHUYHQo}HVHUHVXOWDGRVGHHQIHUPDJHP5HVXOWDGRV)RL REVHUYDGD ERD HYROXomR GH WRGRV RV LQGLFDGRUHV DYDOLDGRV $V LQWHUYHQo}HV GH HQIHUPDJHP DWLQJLUDP VDWLVIDWRULDPHQWH RV UHVXOWDGRV HVSHUDGRV&RQFOXVmR$RVLVWHPDWL]DUDDVVLVWrQFLDGHHQIHUPDJHPDOFDQoDPRVUHVXOWDGRVIDYRUiYHLVHPVXDVHYLGrQFLDVFOtQLFDV
'HVFULWRUHV,QVXILFLrQFLDFDUGtDFDFRQJHVWLYD'LDJQyVWLFRGHHQIHUPDJHP)DGLJD3ODQHMDPHQWRGHDVVLVWrQFLDDRSDFLHQWH3URFHVVRVGH HQIHUPDJHP
RESUMEN
2EMHWLYR(YDOXDUORVUHVXOWDGRVDOFDQ]DGRVGHVSXpVGHODVLQWHUYHQFLRQHVGHHQIHUPHUtDSDUDHOGLDJQyVWLFRGHHQIHUPHUtD)DWLJD0pWRGRV
6HWUDWDGHXQHVWXGLRFXDVLH[SHULPHQWDOWLHPSRVHULH\WUDQVYHUVDOUHDOL]DGRHQXQ+RVSLWDO8QLYHUVLWDULRSRUPHGLRGHODLPSOHPHQWDFLyQ GHLQWHUYHQFLRQHV\HYDOXDFLyQGLDULDGHORVUHVXOWDGRVHQSDFLHQWHVFRQGLDJQyVWLFRGHLQVXILFLHQFLDFDUGLDFD\GHHQIHUPHUtDIDWLJD LQWHUQDGRVHQOD8QLGDGGH&DUGLRORJtD\8&,&RURQDULD)XHHODERUDGRXQLQVWUXPHQWRGHUHFROHFFLyQGHGDWRVFRPSXHVWRSRULQWHUYHQFLRQHV \UHVXOWDGRVGHHQIHUPHUtD5HVXOWDGRV)XHREVHUYDGDEXHQDHYROXFLyQGHWRGRVORVLQGLFDGRUHVHYDOXDGRV/DVLQWHUYHQFLRQHVGHHQIHUPHUtD DOFDQ]DURQGHPDQHUDVDWLVIDFWRULDORVUHVXOWDGRVHVSHUDGRV&RQFOXVLyQ$OVLVWHPDWL]DUODDVLVWHQFLDGHHQIHUPHUtDDOFDQ]DPRVUHVXOWDGRV IDYRUDEOHVHQVXVHYLGHQFLDVFOtQLFDV
'HVFULSWRUHV ,QVXILFLHQFLD FDUGLDFD FRQJHVWLYD 'LDJQyVWLFR GH HQIHUPHUtD )DWLJD 3ODQLILFDFLyQ GH DWHQFLyQ DO SDFLHQWH 3URFHVRV GH HQIHUPHUtD
6WXG\FDUULHGRXWDW&DUGLRORJ\,QLWDQG,QWHQVLYH&DUH8QLWRI +RVSLWDO6mR3DXOR
3RVWJUDGXDQGDWWKH)HGHUDO8QLYHUVLW\RI 6DR3DXOR²81,)(63²6DR3DXOR63%UD]LO
)XOO3URIHVVRUDWWKH1XUVLQJ'HSDUWPHQW²)HGHUDO8QLYHUVLW\RI 6DR3DXOR²81,)(63²6DR3DXOR63%UD]LO
3RVWJUDGXDQGDWWKH)HGHUDO8QLYHUVLW\RI 6DR3DXOR²81,)(63²6DR3DXOR63%UD]LO
$XWRU &RUUHVSRQGHQWH&LQWKLD &DOVLQVNL GH $VVLV
$O,UDp$SWR0RHPD6mR3DXOR63
$UWLJR UHFHELGR HP H DSURYDGR HP
Evaluation of expected outcomes of nursing interventions to
address the nursing diagnosis of fatigue among patients with
congestive heart failure*
$YDOLDomRGDVLQWHUYHQo}HVHGRVUHVXOWDGRVHVSHUDGRVSDUDRGLDJQyVWLFRGHHQIHUPDJHP)DGLJDHP SRUWDGRUHVGH,QVXILFLrQFLD&DUGtDFD
(YDOXDFLyQGHODVLQWHUYHQFLRQHV\GHORVUHVXOWDGRVHVSHUDGRVSDUDHOGLDJQyVWLFRGHHQIHUPHUtD )DWLJDHQSDFLHQWHVFRQ,QVXILFLHQFLD&DUGLDFD&RQJHVWLYD
&LQWKLD&DOVLQVNLGH$VVLV$OED/~FLD%RWWXUD/HLWHGH%DUURV0DUFHOD
,1752'8&7,21
&RQJHVWLYHKHDUWIDLOXUHLVGHILQHGDVDFOLQLFDOV\QGURPH LQZKLFKDVWUXFWXUDORUIXQFWLRQDOGLVRUGHURIWKHKHDUW UHVXOWVLQWKHGHFUHDVHRI WKHYHQWULFOH·VFDSDFLW\WRHMHFW EORRGDQGRUEHILOOHGZLWKEORRGLQWKHSK\VLRORJLFDO ILOOLQJ SUHVVXUHV 7KLV GLVRUGHU FDQ KDSSHQ GXH WR D GLPLQLVKHGFDSDFLW\RIP\RFDUGLDOFRQWUDFWLRQRUWRDQ
H[FHVVRISUHVVXUHYROXPHLPSRVHGRQWKHKHDUW
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
0RGHUQQXUVLQJLVDWWHPSWLQJWRFUHDWHLWVRZQERG\ RINQRZOHGJHJUDQWLQJWKHSURIHVVLRQDVFLHQWLILFDFWLRQ SDWWHUQ7KLVDWWHPSWKDVUHVXOWHGLQWKH1XUVLQJ:RUN 3URFHVVZKLFKLVXVHGDVDV\VWHPDWLFFDUHGHOLYHU\PHWKRG DLPHGDWFUHDWLQJFRQGLWLRQVWRKHOSLQDQLQGLYLGXDOL]HG ZD\VXSSRUWLQJJUHDWHULQWHJUDWLRQEHWZHHQQXUVHVDQG SDWLHQWVIDPLOLHVWKHFRPPXQLW\DQGWKHPXOWLSURIHVVLRQDO WHDPIDYRULQJWKHLPSURYHPHQWLQFDUHTXDOLW\
7KHQXUVLQJZRUNSURFHVVKDVEHHQGHILQHGLQ%UD]LO DVWKH´G\QDPLFVRIV\VWHPL]HGDQGLQWHUUHODWHGDFWLRQV DLPLQJDWFDUHGHOLYHU\WRKXPDQEHLQJVµ,QWKLVSURSRVDO WKHSURFHVVZDVGLYLGHGLQKLVWRU\GLDJQRVLVFDUHSODQ SUHVFULSWLRQHYROXWLRQDQGSURJQRVLVRIQXUVLQJZRUN 6LQFHWKDWPRPHQWVHYHUDO%UD]LOLDQDXWKRUVKDYHEHHQ FDOOLQJDWWHQWLRQWRWKHDSSOLFDWLRQRIWKLVSURFHVVDVD PHWKRGWRV\VWHPL]HQXUVLQJFDUHLQKRVSLWDOVDVZHOODV LQRXWSDWLHQWFDUH
1XUVLQJFDUHSODQQLQJLVEDVHGRQQXUVLQJGLDJQRVHV LGHQWLILHGWKURXJKDKLJKOHYHORILQWHOOHFWXDOVNLOOVDQG NQRZOHGJH 7KH\ FRQVWLWXWH WKH EDVLV IRU SODQQLQJ LQWHUYHQWLRQDQGSDWLHQWDVVHVVPHQW
$V KHDUW GLVHDVHV DUH UHVSRQVLEOH IRU WKH KLJKHVW QXPEHURIGHDWKVLQ%UD]LOWKHDPRXQWRISDWLHQWVZLWK WKHQXUVLQJGLDJQRVLVRI´)DWLJXHµLVHTXDOO\VLJQLILFDQW +HQFHHYDOXDWLQJWKHLQWHUYHQWLRQVSURSRVHGLQWKH1,& 1XUVLQJ,QWHUYHQWLRQ&ODVVLILFDWLRQFODVVLILFDWLRQDQG WKH UHVXOWV JURXSHG LQ WKH 12& 1XUVLQJ 2XWFRPHV &ODVVLILFDWLRQZLOOIDYRUFDUHTXDOLW\DVVHVVPHQWWKURXJK REVHUYHG DQG V\VWHPDWLFDOO\ PHDVXUHG UHVXOWV WKXV
FRQWULEXWLQJ WR NQRZOHGJH GHYHORSPHQW DQG VROLGLILFDWLRQLQQXUVLQJVFLHQFH
'XHWRWKHLPSRUWDQFHRIFRQJHVWLYHKHDUWIDLOXUHLWLV EHOLHYHGWKDWWKHFDUHQXUVHVGHOLYHUWRWKHVHSDWLHQWVPXVW EHSODQQHGV\VWHPL]HGDQGEDVHGRQVFLHQWLILFNQRZOHGJH 7KLVNLQGRIDFWLRQDLPVWRGHOLYHUSURSHUQXUVLQJFDUHWR WKHSDWLHQWFRQVWUXFWHGWKURXJKWKHGHWHFWLRQRISUREOHPV DQGVXUYH\RIQXUVLQJGLDJQRVHV7KHSURSHULGHQWLILFDWLRQ RI WKH SUHVHQWHG SUREOHPV SHUPLWV DSSURSULDWH FDUH SODQQLQJDLPLQJWRDFKLHYHWKHH[SHFWHGQXUVLQJUHVXOWV E\LPSOHPHQWLQJWKHQXUVLQJLQWHUYHQWLRQVVHOHFWHGRQWKH EDVLVRIWKHLGHQWLILHGGLDJQRVLV
7KLVDUWLFOHDLPVWRDVVHVVWKHUHVXOWVDFFRUGLQJWRWKH 12& FODVVLILFDWLRQ DIWHU SHUIRUPLQJ LQWHUYHQWLRQV VXJJHVWHGE\WKH1,&IRUWKHQXUVLQJGLDJQRVLV)DWLJXH LQSDWLHQWVZLWKFRQJHVWLYHKHDUWIDLOXUH
0(7+2'6
4XDVLH[SHULPHQWDODQGFURVVVHFWLRQDOWLPHVHULHVVWXG\ FRQGXFWHGDWD8QLYHUVLW\+RVSLWDOZLWKWKHLPSOHPHQWDWLRQ RILQWHUYHQWLRQVDQGGDLO\DVVHVVPHQWRIUHVXOWV
7KH FRQYHQLHQFH VDPSOH GHWHUPLQHG D VWXG\ SRSXODWLRQWKDWFRPSULVHGDOOSDWLHQWVFOLQLFDOO\WUHDWHG EHWZHHQ$SULODQG-XO\Q ZLWKFRQJHVWLYHKHDUW IDLOXUHKRVSLWDOL]HGDWWKH&DUGLRORJ\8QLWDQG,QWHQVLYH &DUH8QLWRIWKHUHVHDUFKLQVWLWXWLRQ
,QFRPSOLDQFHZLWKFXUUHQWUXOHVWKHVWXG\SURSRVDO ZDVDSSURYHGE\WKH5HVHDUFK(WKLFV&RPPLWWHHDWWKH LQVWLWXWLRQEHIRUHWKHEHJLQQLQJRIGDWDFROOHFWLRQ7KH DSSURYDOIRUSDUWLFLSDWLRQE\WKHUHVHDUFKVXEMHFWVZDV IRUPDOL]HG E\ VLJQLQJ WKH IUHH DQG LQIRUPHG FRQVHQW WHUPLQOLQHZLWKOHJDORULHQWDWLRQV
7KHIROORZLQJSDWLHQWVZHUHH[FOXGHGDJHXQGHU VDLGWKDWWKH\GLGQRWZDQWWRSDUWLFLSDWHLQWKHVWXG\ GLVDJUHHGZLWKWKHIUHHDQGLQIRUPHGFRQVHQWWHUPZHUH QRW FRQVLVWHQW RU VHGDWHG ZHUH WUDQVIHUUHG IURP D KRVSLWDOL]DWLRQXQLW
7ZR SDWLHQWV IURP WKH VDPSOH GLHG WKUHH GLG QRW ZDQWWRSDUWLFLSDWHLQWKHVWXG\DQGRQHZDVWUDQVIHUUHG WRDQRWKHUXQLW
%DVHG RQ OLWHUDWXUHZH FKRVH WKH UHVXOWV DQG QXUVLQJ LQWHUYHQWLRQV WKDW ZHUH PRVW SURSHU IRU WKH SDUWLFLSDQWV·SURILOH$IWHUWKLVVHOHFWLRQZHGHVLJQHGD FOLQLFDOHYDOXDWLRQLQVWUXPHQW
)RUWKHQXUVLQJGLDJQRVLVXQGHUDQDO\VLVZHVHOHFWHG WKHQXUVLQJLQWHUYHQWLRQV(QHUJ\&RQWURODQG([HUFLVH 3URPRWLRQ 7KLV VHOHFWLRQ REH\HG WR WKH FULWHULRQ RI JUHDWHULPSRUWDQFHIRUWKHGLDJQRVLV
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
7KHFOLQLFDOHYDOXDWLRQLQVWUXPHQWFRQVLVWHGRIWKHGLDJQRVLV GHILQLWLRQXQGHUGLVFXVVLRQLWVGHILQLQJFKDUDFWHULVWLFVDQGUHODWHG IDFWRUVWKHQXUVLQJDFWLYLWLHVVXJJHVWHGE\WKHLQWHUYHQWLRQVDQG WKHLQGLFDWRUVWREHHYDOXDWHGDVOLVWHGLQWKHUHVXOW
7KHDFWLYLWLHVZHUHSUHVFULEHGDQGSHUIRUPHGE\WKH UHVHDUFKHUGXULQJWKHQLJKWVKLIWDQGE\WKHXQLWQXUVHV DQGRUQXUVLQJDLGVLQWKHPRUQLQJRUDIWHUQRRQSHULRGV )RUSDWLHQWHYDOXDWLRQDVFDOHZDVXVHGWKDWGHVLJQDWHV DQXPHULFYDOXHWRHDFKHYDOXDWHGLWHPDFFRUGLQJWRWKH FRPPLWPHQWGHJUHHDVIROORZV
+LJKO\FRPPLWWHG 6XEVWDQWLDOO\FRPPLWWHG 0LOGO\FRPPLWWHG 6OLJKWO\FRPPLWWHG 1RWFRPPLWWHG
+RZHYHULQVRPHFDVHVGXHWRWKHODFNRIHYDOXDWLRQ LQWKHJUDGHGVFDOHRQHRIWZRYDOXHVZDVVHOHFWHGIRU WKHHYDOXDWHGLWHP
3UHVHQFHRIRUFRPPLWPHQW /DFNRIRUQRQFRPPLWPHQW
)RUWKHUHVXOWDQDO\VLVZHFRPSDUHGWKHPD[LPXP VFRUHIRUHDFKLWHPRQWKHILUVWDQGLQWKHVHYHQWKGD\ RI KRVSLWDOL]DWLRQ :H XVHG WKHVH VHYHQ GD\V RI KRVSLWDOL]DWLRQWRFRPSDUHWKHVFRUHVDVWKLVZDVWKH DULWKPHWLF DYHUDJH RI SDWLHQWV· KRVSLWDOL]DWLRQ WLPH PHDVXUHGLQGD\V
$OOSDWLHQWVUHFHLYHGWKHQXUVLQJDFWLYLWLHVDVWKHVH KDGEHHQSUHVFULEHGDQGZHUHFKHFNHGLQWKHFRQWURO VKHHWRI WKHFRURQDU\,&8DQGRI WKH&DUGLRORJ\:DUG
5(68/76
7ZRVXEMHFWVZHUHEHWZHHQDQG\HDUV ROGWKUHHEHWZHHQDQG\HDUVROG EHWZHHQDQG\HDUVROGDQGVHYHQROGHU WKDQ\HDUV0RVWSDWLHQWVZHUHPHQQ
)RUWKHQDPLQJRIWKHGLDJQRVLV)DWLJXHQLQHGHILQLQJ FKDUDFWHULVWLFV'&ZHUHLGHQWLILHGLQWKHSRSXODWLRQXQGHU DQDO\VLV$OOVXEMHFWVSUHVHQWHGWKH'&QHHGIRUDGGLWLRQDO HQHUJ\SUHVHQWHGLQDELOLW\WRPDLQWDLQURXWLQHVDQG VDLGWKH\ODFNHGHQHUJ\7DEOHGLVSOD\VWKHRFFXUUHQFH DQGGLVWULEXWLRQRIWKH'&VLQWKHVWXG\VXEMHFWV
7DEOH ² 'HILQLQJ FKDUDFWHULVWLFV RI WKH QXUVLQJ GLDJQRVLV)DWLJXHLGHQWLILHGLQSDWLHQWVKRVSLWDOL]HGLQ WKH&DUGLRORJ\8QLWDQG&RURQDU\,&86mR3DXOR
7DEOH²(YROXWLRQRI PD[LPXPVFRUHIRUHDFKLQGLFDWRURI WKH$FWLYLW\7ROHUDQFHUHVXOWRQWKHILUVWDQG VHYHQWKGD\RI KRVSLWDOL]DWLRQ6mR3DXOR
'HILQLQJFKDUDFWHULVWLFV Q
3HUFHLYHGQHHGIRUDGGLWLRQDOHQHUJ\
,QDELOLW\WRPDLQWDLQXVXDOURXWLQHV
9HUEDOL]DWLRQRIODFNRIHQHUJ\
,QFUHDVHLQSK\VLFDOFRPSODLQWV
(PRWLRQDOLQVWDELOLW\LUULWDWLRQ
/HWKDUJLFDQGRUDJLWDWLRQ
&RPSURPLVHGFRQFHQWUDWLRQ
'HFUHDVHGSHUIRUPDQFH
'LVLQWHUHVWLQWURVSHFWLRQ
,QGLFDWRUV 'Q 'Q
7DLORULQJOLIHVW\OHWRWKHHQHUJ\OHYHO
6NLQFRORULQVLGHQRUPDOSDWWHUQV
([HFXWLRQRIGDLO\OLYLQJDFWLYLWLHV
$ELOLW\WRVSHDNGXULQJWKHH[HUFLVH
$FNQRZOHGJLQJHQHUJ\OLPLWDWLRQV
8VLQJHQHUJ\SUHVHUYDWLRQWHFKQLTXHV
.HHSLQJWKHULJKWQXWULWLRQ
6KRZQRUPDODSSHWLWH
6KRZFRQFHQWUDWLRQ
+HDUWEHDWLQUHVSRQVHWRWKHDFWLYLW\
5HVSLUDWRU\IUHTXHQF\DQGUK\WKPLQUHVSRQVHWRDFWLYLW\
7KH PDLQ QXUVLQJ LQWHUYHQWLRQV ZHUH FODVVLILHG DV ´GHSHQGHQW DFWLYLWLHVµ RU VWDUWHG E\ SK\VLFLDQV DQG ´LQGHSHQGHQWDFWLYLWLHVµRUVWDUWHGE\QXUVHV:HQRWLFHG WKDWIRUWKHH[HFXWLRQRI WKHVXJJHVWHGDFWLYLWLHVIRUWKH (QHUJ\3URPRWLRQLQWHUYHQWLRQRI WKHDFWLYLWLHV ZHUHLQGHSHQGHQW)RUWKH(QHUJ\&RQWUROLQWHUYHQWLRQ RIWKHDFWLYLWLHVZHUHLQGHSHQGHQW
$VWRWKHVFRUHVGHVLJQHGWRHDFKLQGLFDWRURIWKHUHVXOW $FWLYLW\7ROHUDQFHDOOHYDOXDWHGLWHPVSUHVHQWHGDQLPSURYHPHQW LQWKHVHFRQGHYDOXDWLRQDVVKRZQLQ7DEOH
',6&866,21
7KHLQGLFDWRUVIRUWKH$FWLYLW\7ROHUDQFHUHVXOWZLOOEH GLVFXVVHG LQGLYLGXDOO\ FRPSDULQJ WKH ILUVW DQG VHYHQWK KRVSLWDOL]DWLRQGD\
7DLORULQJOLIHVW\OHWRWKHHQHUJ\OHYHOVLWXDWLRQLQZKLFK WKHSDWLHQWWDLORUVKLVKHUDFWLYLWLHVWRWKHDYDLODEOHHQHUJ\ OHYHO7DLORULQJPHDQVWRILWRQHWKLQJWRWKHRWKHUVKDSLQJ PDNH SURSHU DQG DGMXVW %\ DQDO\]LQJ WKH SDWLHQW·V VLWXDWLRQGXULQJWKHKRVSLWDOL]DWLRQLWFDQEHFRQFOXGHG WKDWKHVKHQHHGVDGDSWDWLRQLQVHYHUDODVSHFWV2QWKH ILUVW KRVSLWDOL]DWLRQ GD\ QR SDWLHQW SUHVHQWHG WKLV DGDSWDWLRQ +RZHYHU WKURXJK WKH DSSOLFDWLRQ RI WKH SURSRVHGLQWHUYHQWLRQVRQGD\VHYHQRIWKHSDWLHQWV VDLGWKH\ZHUHDGDSWHG
6NLQFRORUZLWKLQWKHQRUPDOSDWWHUQVGHSHQGVRQWKH SLJPHQWV LQ WKH EDVDO OD\HU RI WKH HSLGHUPLV DQG LWV FRQFHQWUDWLRQWKLFNQHVVDQGPLFURFLUFXODWLRQQHWZRUN ,WZDVQRWLFHGWKDWRQWKHILUVWKRVSLWDOL]DWLRQGD\RQO\ RIWKHSDWLHQWVZHUHHYDOXDWHGZLWKVFRUHDJDLQVW RQGD\VHYHQ
([HFXWLRQRI GDLO\OLYLQJDFWLYLWLHVDELOLW\WRSHUIRUP URXWLQHDFWLYLWLHVVXFKDVEUXVKLQJWHHWKEDWKLQJDQGHDWLQJ ,WZDVQRWLFHGWKDWRQWKHILUVWKRVSLWDOL]DWLRQGD\QR SDWLHQWSUHVHQWHGVFRUHDQGSUHVHQWHGVFRUH ZKLFKUHSUHVHQWHGWKHFKDQJHVLQUHVW%\DSSO\LQJWKH SURSRVHGLQWHUYHQWLRQRQGD\VHYHQRIWKHKRVSLWDOL]DWLRQ RQO\RIWKHSDWLHQWVSUHVHQWHGVFRUH
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
$FNQRZOHGJLQJHQHUJ\OLPLWDWLRQVVWDWHLQZKLFKWKH SDWLHQWFDQDFNQRZOHGJHWKHLQWHQVLW\DWZKLFKKHVKHFDQ RUFDQQRWSHUIRUPDQDFWLYLW\7KHGLVSURSRUWLRQEHWZHHQ WKHHQWUDQFHDQGQHHGRIR[\JHQDQGRWKHUQXWULHQWVLQ
WLVVXHVLVRQHRIWKHPDLQFKDUDFWHULVWLFVRIFRQJHVWLYH KHDUWIDLOXUH,QWKHDEVHQFHRIWKHVHHOHPHQWVWKHUHLVD VLJQLILFDQW GURS LQ SDWLHQWV· SK\VLFDO DELOLW\ IURP WKH
VLPSOHVWWRWKHPRVWFRPSOH[7KLVDFNQRZOHGJHPHQW
ZDVGHPRQVWUDWHGE\RIWKHSDWLHQWVRQWKHILUVW GD\RIKRVSLWDOL]DWLRQDQGE\RQGD\VHYHQ
8VLQJHQHUJ\SUHVHUYDWLRQWHFKQLTXHVWKLV'&ZDV RQO\HYDOXDWHGDIWHUSRVVLEOHDFWLRQVKDGEHHQWDXJKWWR WKHSDWLHQWVVXFKDVEUXVKLQJWKHWHHWKVHDWHGRUVLWWLQJ GRZQ WR EDWKH IRU H[DPSOH 2Q WKH ILUVW GD\ RI KRVSLWDOL]DWLRQ QR SDWLHQW NQHZ DERXW WKH HQHUJ\ SUHVHUYDWLRQWHFKQLTXHVZKLOHRQGD\VHYHQRI WKH SDWLHQWVXVHGWKHWHFKQLTXHVWKH\ZHUHWDXJKW
.HHSLQJWKHULJKWQXWULWLRQLWLVWKHLQWDNHRIVHYHUDO QXWULHQWV LQ SURSHU DPRXQWV IRU ERG\ QHHGV VXFK DV YLWDPLQV DQG PLQHUDOV ZLWK D YLHZ WR DSSURSULDWH PHWDEROLFIXQFWLRQLQJ 7KLV LQGLFDWRU ZDV HYDOXDWHG WKURXJKWKHLGHQWLILFDWLRQRIWKHIRRGJURXSVFRQVXPHG E\WKHSDWLHQWVDQGWKHFDOFXODWLRQRIWKHLUERG\PDVV LQGH[%0,2QWKHILUVWGD\RIKRVSLWDOL]DWLRQRI WKHSDWLHQWVSUHVHQWHGVFRUHZKLOHRQGD\VHYHQ SUHVHQWHGVFRUH
6KRZQRUPDODSSHWLWHLWZDVHYDOXDWHGLI WKHDSSHWLWH ZDVQRUPDOIRUWKHLQGLYLGXDOFRPSDULQJKLPKHUZLWK KLPKHUVHOI RQRWKHUGD\VZKHQSRVVLEOH7KHIDPLO\·V KHOSZDVUHTXHVWHGZKHQQHHGHG$QRUH[LDDQGQDXVHD DUHFDXVHGE\WKHFRQJHVWLRQRIEHOO\RUJDQVFDXVLQJD IDOVHIHHOLQJRIVDWLVIDFWLRQRUDEGRPLQDOGLVFRPIRUWDQG WKLVFDQHQGXSFDXVLQJDGHFUHDVHLQWKHGHVLUHWRHDWLQ SDWLHQWVZLWKFRQJHVWLYHKHDUWIDLOXUH2QWKHILUVWGD\ RIKRVSLWDOL]DWLRQRQO\RIWKHSDWLHQWVVKRZHGVFRUH ZKLOHRQGD\VHYHQRIWKHSDWLHQWVSUHVHQWHGWKLV VFRUH
6KRZFRQFHQWUDWLRQEUDLQK\SR[LDFDXVHGE\ORZKHDUW EHDW FDQ RULJLQDWH K\SR[LF HQFHSKDORSDWK\ QRWLFLQJ LUULWDWLRQ ORVV RI DWWHQWLRQ DQGRU FRQFHQWUDWLRQ DQG
DJLWDWLRQ,QWKHHYDOXDWLRQRIWKLVLQGLFDWRURI
WKH SDWLHQWV UHFHLYHG VFRUH RQ WKH ILUVW GD\ RI KRVSLWDOL]DWLRQDJDLQVWRQGD\VHYHQ
+HDUWEHDWLQUHVSRQVHWRWKHDFWLYLW\ZLWKLQQRUPDO SDWWHUQVZHIRXQGRIWKHSDWLHQWVZLWKVFRUHRQ WKHILUVWGD\RIKRVSLWDOL]DWLRQDQGRQGD\VHYHQ
+HDUWEHDWDQGUHVSLUDWRU\UK\WKPLQUHVSRQVHWRWKH DFWLYLW\ ZLWKLQ QRUPDO SDWWHUQV RQ WKH ILUVW GD\ RI KRVSLWDOL]DWLRQ QRQH RI WKH SDWLHQWV UHDFKHG VFRUH DJDLQVWRQGD\VHYHQ
2[\JHQVDWXUDWLRQLQUHVSRQVHWRWKHDFWLYLW\ZLWKLQ QRUPDOSDWWHUQVR[\JHQUHFHSWLRQKDSSHQVSULPDULO\LQ WKH OXQJV FRQVWLWXWLQJ WKH ILUVW VWHS LQ WKH SURFHVV RI RIIHULQJR[\JHQWRWKHWLVVXHV2QFHUHFHLYHGWKHR[\JHQ LVWUDQVSRUWHGLQWKHEORRGGLVVROYHGLQWKHSODVPD
RUFRPELQHGZLWKWKHKHPRJORELQ2QWKHILUVW
LQWHUYHQWLRQVRI WKHPSUHVHQWHGQRUPDOSDWWHUQV RQGD\VHYHQ
$JRRGHYROXWLRQLQDOOHYDOXDWHGLQGLFDWRUVZDVQRWLFHG 1XUVLQJLQWHUYHQWLRQVUHDFKHGWKHH[SHFWHGUHVXOWV
:KHQFRPSDULQJWKHVHVWXG\UHVXOWVZLWKVLPLODUSDSHUV FRQFOXVLRQVDSSHDUWKDWVXSSRUWWKLVUHVHDUFK·VFRQFOXVLRQV ,QDVWXG\DERXWWKHDFWLYLW\WROHUDQFHGLDJQRVLVRQO\RQH SDWLHQWGLGQRWSUHVHQWWKHH[SHFWHGHYROXWLRQUHODWHG WRWKHVFRUHVGD\VRIKRVSLWDOL]DWLRQ,QDQRWKHUUHVHDUFK RQWKHQXUVLQJGLDJQRVLV([FHVVLYHIOXLGYROXPHRQWKH ILUVWGD\RIKRVSLWDOL]DWLRQRIWKHSDWLHQWVUHDFKHG VFRUHDJDLQVWRQGD\VHYHQDOVRGHPRQVWUDWLQJDQ H[SHFWHGHYROXWLRQ
&21&/86,21
3DWLHQWVDUHOLPLWHGE\WKHFOLQLFDOFKDUDFWHULVWLFVRIFRQJHVWLYH KHDUWIDLOXUHVLJQLILFDQWO\GHFUHDVLQJWKHLUTXDOLW\RIOLIH
,WLVREYLRXVWKDWSDWLHQWV·FOLQLFDOLPSURYHPHQWFDQQRW RQO\EHDWWULEXWHGWRWKHSHUIRUPHGQXUVLQJDFWLRQVEHFDXVH WKHLUSRVLWLYHHYROXWLRQUHVXOWVIURPDVHWRIIDFWRUVVXFK DVQXUVLQJDFWLYLWLHVDQGSKDUPDFHXWLFDOWKHUDS\DQGWKH OLPLWDWLRQVRIWKLVVWXG\VKRXOGDOVREHWDNHQLQWRDFFRXQW :H FRQVLGHU WKDW WKH FDUH GHOLYHUHG WR VXEMHFWV KRVSLWDOL]HGIRUFRQJHVWLYHKHDUWIDLOXUHLQYROYHVPXOWLSOH SURIHVVLRQDOVDQGIDFWRUV
$IWHUDQDO\]LQJWKHGDWDDVZHOODVWKHVLPLODULWLHVIRXQG LQRWKHUVWXGLHVWKHLPSURYHPHQWRIQXUVLQJGLDJQRVHV WKURXJK WKH FODVVLILFDWLRQ RI LQWHUYHQWLRQV DQG UHVXOWV EHFRPHVHYLGHQW
:HFDQFRQFOXGHWKDWWKHSURSRVHGQXUVHLQWHUYHQWLRQV VXFFHVVIXOO\OHDGWRWKHUHVXOWVXJJHVWHGIRUWKHGLDJQRVLV XQGHUVWXG\
:KHQWKHSDWLHQWUHFHLYHVDEHWWHUSODQQHGQXUVLQJFDUHEDVHG RQVFLHQWLILFNQRZOHGJHDQGHYLGHQFHDVZHOODVRQQXUVLQJ FODVVLILFDWLRQVWKHHYDOXDWLRQRIWKHLPSURYHPHQWLQWKHREWDLQHG UHVXOWVVKRZVWKHHIILFLHQF\RIWKHSURSRVHGLQWHUYHQWLRQV
:HVXJJHVWWKHFUHDWLRQRI VXJJHVWHGFDUHSURWRFROV IRUWKHSUHYDLOLQJQXUVLQJGLDJQRVLVDWFOLQLFDODQGVXUJLFDO XQLWVWKXVWXUQLQJFDUHV\VWHPL]DWLRQLQWRDIHDVLEOHDQG FOHDUO\HIIHFWLYHWRROLQSDWLHQWFDUH
5()(5(1&(6
)HONHU*0$GDPV.)-U.RQVWDP0$2¶&RQQRU&0 *KHRUJKLDGH 0 7KH SUREOHP RI GHFRPSHQVDWHG KHDUW
IDLOXUHQRPHQFODWXUHFODVVLILFDWLRQDQGULVNVWUDWLILFDWLRQ $P+HDUW-6XSSO6
%UDXQZDOG ( 6REHO %( +HDUW GLVHDVH $ WH[W ERRN RI FDUGLRYDVFXODUPHGLFLQH3KLODGHOSKLD(OVHYLHU6DXQGHUV ,,GLUHWUL]SDUDRGLDJQyVWLFRHWUDWDPHQWRGDLQVXILFLrQFLD
FDUGtDFD$UT%UDVGH&DUGLRO6XSSO %DUURV$/%/27UDEDOKRGRFHQWHDVVLVWHQFLDOGHHQIHUPDJHP
QR+RVSLWDO6mR3DXORGD81,)(63(30>WHVH@6mR3DXOR 8QLYHUVLGDGH )HGHUDO GH 6mR 3DXOR (VFROD 3DXOLVWD GH 0HGLFLQD
+RUWD:$3URFHVVRGHHQIHUPDJHP6mR3DXOR(GLWRUD
3HGDJyJLFDH8QLYHUVLWiULDF
&DPSHGHOOL0&RUJDQL]DGRUD3URFHVVRGHHQIHUPDJHPQD SUiWLFD6mR3DXORÉWLFD
&ODUN - /DQJ 1 1XUVLQJ·V QH[W DGYDQFH DQ LQWHUQDO FODVVLILFDWLRQ IRU QXUVLQJ SUDFWLFH ,QW 1XUV 5HY
%XOHFKHN *0 0F&ORVNH\ -&'HILQLQJ DQG YDOLGDWLQJ
QXUVLQJLQWHUYHQWLRQV1XUV&OLQ1RUWK$P
0F&ORVNH\-&%XOHFKHN*0HGLWRUV1XUVLQJ,QWHUYHQWLRQ &ODVVLILFDWLRQ1,&,RZDLQWHUYHQWLRQSURMHFW6W/RXLV 0RVE\
-RKQVRQ 0 0DDV 0 0RRUKHDG 6HGLWRUV 1XUVLQJ RXWFRPHVFODVVLILFDWLRQ12&6W/RXLV0RVE\ 0LFKHO-/0%DUURV$/%/$XWLOL]DomRGDHQWUHYLVWDHP
JUXSRIRFDOSDUDYDOLGDomRGHFRQWH~GRGHXPLQVWUXPHQWR GHFROHWDGHGDGRVGHHQIHUPDJHP$FWD3DXO(QIHUPDJHP 1(VS3W
1$1'$²1XUVLQJ'LDJQRVHVGHILQLWLRQVDQGFODVVLILFDWLRQ 6W/RXLV1$1'$,QWHUQDWLRQDO %DWHV%+RFNHOPDQ5$3URSHGrXWLFDPpGLFD5LRGH-DQHLUR
*XDQDEDUD.RRJDQ
5DPRV-U-6HPLRWpFQLFDGDREVHUYDomRFOtQLFD6mR3DXOR 6DUYLHU
*X\WRQ$&-RQHV&(&ROHPDQ7*7UDWDGRGHILVLRORJLD PpGLFDDHG6mR3DXOR,QWHUDPHULFDQD
5RGULJXHV )* $QGUDGH )& $YDOLDomR GR UHVXOWDGR GH HQIHUPDJHPWROHUkQFLDjDWLYLGDGH12&HPSDFLHQWHV SRUWDGRUHVGH,&&WLSRIXQFLRQDO,,,H,9DSyVDVDWLYLGDGHV GH HQIHUPDJHP UHDOL]DGDV 1,&,Q &RQJUHVVR GH ,QLFLDomR&LHQWtILFDGD8QLYHUVLGDGH)HGHUDOGH6mR3DXOR