14 results
Exploring symptom clusters in mild cognitive impairment and dementia with the NIH Toolbox
- Callie E. Tyner, Aaron J. Boulton, Jerry Slotkin, Matthew L. Cohen, Sandra Weintraub, Richard C. Gershon, David S. Tulsky
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- Journal:
- Journal of the International Neuropsychological Society , First View
- Published online by Cambridge University Press:
- 16 February 2024, pp. 1-12
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Objective:
Symptom clustering research provides a unique opportunity for understanding complex medical conditions. The objective of this study was to apply a variable-centered analytic approach to understand how symptoms may cluster together, within and across domains of functioning in mild cognitive impairment (MCI) and dementia, to better understand these conditions and potential etiological, prevention, and intervention considerations.
Method:Cognitive, motor, sensory, emotional, and social measures from the NIH Toolbox were analyzed using exploratory factor analysis (EFA) from a dataset of 165 individuals with a research diagnosis of either amnestic MCI or dementia of the Alzheimer’s type.
Results:The six-factor EFA solution described here primarily replicated the intended structure of the NIH Toolbox with a few deviations, notably sensory and motor scores loading onto factors with measures of cognition, emotional, and social health. These findings suggest the presence of cross-domain symptom clusters in these populations. In particular, negative affect, stress, loneliness, and pain formed one unique symptom cluster that bridged the NIH Toolbox domains of physical, social, and emotional health. Olfaction and dexterity formed a second unique cluster with measures of executive functioning, working memory, episodic memory, and processing speed. A third novel cluster was detected for mobility, strength, and vision, which was considered to reflect a physical functioning factor. Somewhat unexpectedly, the hearing test included did not load strongly onto any factor.
Conclusion:This research presents a preliminary effort to detect symptom clusters in amnestic MCI and dementia using an existing dataset of outcome measures from the NIH Toolbox.
Sociome Data Commons: A scalable and sustainable platform for investigating the full social context and determinants of health
- Sandra Tilmon, Sharmilee Nyenhuis, Anthony Solomonides, Bruno Barbarioli, Ankur Bhargava, Suzi Birz, Kathryn Bouzein, Celine Cardenas, Bradley Carlson, Ellen Cohen, Emily Dillon, Brian Furner, Zhong Huang, Julie Johnson, Nivedha Krishnan, Kevin Lazenby, Kaitlyn Li, Sonya Makhni, Doriane Miler, Jonathan Ozik, Carlos Santos, Marc Sleiman, Julian Solway, Sanjay Krishnan, Samuel Volchenboum
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- Journal:
- Journal of Clinical and Translational Science / Volume 7 / Issue 1 / 2023
- Published online by Cambridge University Press:
- 07 November 2023, e255
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Background/Objective:
Non-clinical aspects of life, such as social, environmental, behavioral, psychological, and economic factors, what we call the sociome, play significant roles in shaping patient health and health outcomes. This paper introduces the Sociome Data Commons (SDC), a new research platform that enables large-scale data analysis for investigating such factors.
Methods:This platform focuses on “hyper-local” data, i.e., at the neighborhood or point level, a geospatial scale of data not adequately considered in existing tools and projects. We enumerate key insights gained regarding data quality standards, data governance, and organizational structure for long-term project sustainability. A pilot use case investigating sociome factors associated with asthma exacerbations in children residing on the South Side of Chicago used machine learning and six SDC datasets.
Results:The pilot use case reveals one dominant spatial cluster for asthma exacerbations and important roles of housing conditions and cost, proximity to Superfund pollution sites, urban flooding, violent crime, lack of insurance, and a poverty index.
Conclusion:The SDC has been purposefully designed to support and encourage extension of the platform into new data sets as well as the continued development, refinement, and adoption of standards for dataset quality, dataset inclusion, metadata annotation, and data access/governance. The asthma pilot has served as the first driver use case and demonstrates promise for future investigation into the sociome and clinical outcomes. Additional projects will be selected, in part for their ability to exercise and grow the capacity of the SDC to meet its ambitious goals.
Advocacy at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery
- Bistra Zheleva, Amy Verstappen, David M. Overman, Farhan Ahmad, Sulafa K.M. Ali, Zohair Y. Al Halees, Joumana Ghandour Atallah, Isabella E. Badhwar, Carissa Baker-Smith, Maria Balestrini, Amy Basken, Jonah S. Bassuk, Lee Benson, Horacio Capelli, Santo Carollo, Devyani Chowdhury, M. Sertaç Çiçek, Mitchell I. Cohen, David S. Cooper, John E. Deanfield, Joseph Dearani, Blanca del Valle, Kathryn M. Dodds, Junbao Du, Frank Edwin, Ekanem Ekure, Nurun Nahar Fatema, Anu Gomanju, Babar Hasan, Lewis Henry, Christopher Hugo-Hamman, Krishna S. Iyer, Marcelo B. Jatene, Kathy J. Jenkins, Tara Karamlou, Tom R. Karl, James K. Kirklin, Christián Kreutzer, Raman Krishna Kumar, Keila N. Lopez, Alexis Palacios Macedo, Bradley S. Marino, Eva M. Marwali, Folkert J. Meijboom, Sandra S. Mattos, Hani Najm, Dan Newlin, William M. Novick, Sir Shakeel A. Qureshi, Budi Rahmat, Robert Raylman, Irfan Levent Saltik, Craig Sable, Nestor Sandoval, Anita Saxena, Emma Scanlan, Gary F. Sholler, Jodi Smith, James D. St Louis, Christo I. Tchervenkov, Koh Ghee Tiong, Vladimiro Vida, Susan Vosloo, Douglas J. “DJ” Weinstein, James L. Wilkinson, Liesl Zuhlke, Jeffrey P. Jacobs
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- Journal:
- Cardiology in the Young / Volume 33 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 24 August 2023, pp. 1277-1287
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The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery (WCPCCS) will be held in Washington DC, USA, from Saturday, 26 August, 2023 to Friday, 1 September, 2023, inclusive. The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery will be the largest and most comprehensive scientific meeting dedicated to paediatric and congenital cardiac care ever held. At the time of the writing of this manuscript, The Eighth World Congress of Pediatric Cardiology and Cardiac Surgery has 5,037 registered attendees (and rising) from 117 countries, a truly diverse and international faculty of over 925 individuals from 89 countries, over 2,000 individual abstracts and poster presenters from 101 countries, and a Best Abstract Competition featuring 153 oral abstracts from 34 countries. For information about the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery, please visit the following website: [www.WCPCCS2023.org]. The purpose of this manuscript is to review the activities related to global health and advocacy that will occur at the Eighth World Congress of Pediatric Cardiology and Cardiac Surgery.
Acknowledging the need for urgent change, we wanted to take the opportunity to bring a common voice to the global community and issue the Washington DC WCPCCS Call to Action on Addressing the Global Burden of Pediatric and Congenital Heart Diseases. A copy of this Washington DC WCPCCS Call to Action is provided in the Appendix of this manuscript. This Washington DC WCPCCS Call to Action is an initiative aimed at increasing awareness of the global burden, promoting the development of sustainable care systems, and improving access to high quality and equitable healthcare for children with heart disease as well as adults with congenital heart disease worldwide.
Real-world impact of vaccination on coronavirus disease 2019 (COVID-19) incidence in healthcare personnel at an academic medical center
- Part of
- Sarah E. Waldman, Jason Y. Adams, Timothy E. Albertson, Maya M. Juárez, Sharon L. Myers, Ashish Atreja, Sumeet Batra, Elena E. Foster, Cy V. Huynh, Anna Y. Liu, David A. Lubarsky, Victoria T. Ngo, Christian E. Sandrock, Sandra L. Taylor, Ann M. Tompkins, Stuart H. Cohen
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 43 / Issue 9 / September 2022
- Published online by Cambridge University Press:
- 21 July 2021, pp. 1194-1200
- Print publication:
- September 2022
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Objective:
Coronavirus disease 2019 (COVID-19) vaccination effectiveness in healthcare personnel (HCP) has been established. However, questions remain regarding its performance in high-risk healthcare occupations and work locations. We describe the effect of a COVID-19 HCP vaccination campaign on SARS-CoV-2 infection by timing of vaccination, job type, and work location.
Methods:We conducted a retrospective review of COVID-19 vaccination acceptance, incidence of postvaccination COVID-19, hospitalization, and mortality among 16,156 faculty, students, and staff at a large academic medical center. Data were collected 8 weeks prior to the start of phase 1a vaccination of frontline employees and ended 11 weeks after campaign onset.
Results:The COVID-19 incidence rate among HCP at our institution decreased from 3.2% during the 8 weeks prior to the start of vaccinations to 0.38% by 4 weeks after campaign initiation. COVID-19 risk was reduced among individuals who received a single vaccination (hazard ratio [HR], 0.52; 95% confidence interval [CI], 0.40–0.68; P < .0001) and was further reduced with 2 doses of vaccine (HR, 0.17; 95% CI, 0.09–0.32; P < .0001). By 2 weeks after the second dose, the observed case positivity rate was 0.04%. Among phase 1a HCP, we observed a lower risk of COVID-19 among physicians and a trend toward higher risk for respiratory therapists independent of vaccination status. Rates of infection were similar in a subgroup of nurses when examined by work location.
Conclusions:Our findings show the real-world effectiveness of COVID-19 vaccination in HCP. Despite these encouraging results, unvaccinated HCP remain at an elevated risk of infection, highlighting the need for targeted outreach to combat vaccine hesitancy.
The Prevalence and Incidence of Dementia: a Systematic Review and Meta-analysis
- Kirsten M. Fiest, Nathalie Jetté, Jodie I. Roberts, Colleen J. Maxwell, Eric E. Smith, Sandra E. Black, Laura Blaikie, Adrienne Cohen, Lundy Day, Jayna Holroyd-Leduc, Andrew Kirk, Dawn Pearson, Tamara Pringsheim, Andres Venegas-Torres, David B. Hogan
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 43 / Issue S1 / April 2016
- Published online by Cambridge University Press:
- 16 June 2016, pp. S3-S50
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Introduction
Dementia is a common neurological condition affecting many older individuals that leads to a loss of independence, diminished quality of life, premature mortality, caregiver burden and high levels of healthcare utilization and cost. This is an updated systematic review and meta-analysis of the worldwide prevalence and incidence of dementia.
MethodsThe MEDLINE and EMBASE databases were searched for relevant studies published between 2000 (1985 for Canadian papers) and July of 2012. Papers selected for full-text review were included in the systematic review if they provided an original population-based estimate for the incidence and/or prevalence of dementia. The reference lists of included articles were also searched for additional studies. Two individuals independently performed abstract and full-text review, data extraction, and quality assessment of the papers. Random-effects models and/or meta-regression were used to generate pooled estimates by age, sex, setting (i.e., community, institution, both), diagnostic criteria utilized, location (i.e., continent) and year of data collection.
ResultsOf 16,066 abstracts screened, 707 articles were selected for full-text review. A total of 160 studies met the inclusion criteria. Among individuals 60 and over residing in the community, the pooled point and annual period prevalence estimates of dementia were 48.62 (CI95%: 41.98-56.32) and 69.07 (CI95%: 52.36-91.11) per 1000 persons, respectively. The respective pooled incidence rate (same age and setting) was 17.18 (CI95%: 13.90-21.23) per 1000 person-years, while the annual incidence proportion was 52.85 (CI95%: 33.08-84.42) per 1,000 persons. Increasing participant age was associated with a higher dementia prevalence and incidence. Annual period prevalence was higher in North America than in South America, Europe and Asia (in order of decreasing period prevalence) and higher in institutional compared to community and combined settings. Sex, diagnostic criteria (except for incidence proportion) and year of data collection were not associated with statistically significant different estimates of prevalence or incidence, though estimates were consistently higher for females than males.
ConclusionsDementia is a common neurological condition in older individuals. Significant gaps in knowledge about its epidemiology were identified, particularly with regard to the incidence of dementia in low- and middle-income countries. Accurate estimates of prevalence and incidence of dementia are needed to plan for the health and social services that will be required to deal with an aging population.
Contributors
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- By Syed S. Ali, Nathan Allen, John E. Arbo, Elizabeth Arrington, Ani Aydin, Kenneth R. L. Bernard, Amy Caggiula, Nolan Caldwell, Jennifer L. Carey, Jennifer Carnell, Jayaram Chelluri, Michael N. Cocchi, Cristal Cristia, Vishal Demla, Bram Dolcourt, Andrew Eyre, Shawn Fagan, Brandy Ferguson, Sarah Fisher, Jonathan Friedstat, Brian C. Geyer, Brandon Godbout, Jeremy Gonda, Jeremy Goverman, Ashley L. Greiner, Casey Grover, Carla Haack, Abigail Hankin, John W. Hardin, Katrina L. Harper, Gregory Hayward, Stephen Hendriksen, Daniel Herbert-Cohen, Nadine Himelfarb, Calvin E. Hwang, Jacob D. Isserman, Joshua Jauregui, Joshua W. Joseph, Elena Kapilevich, Feras H. Khan, Sarvotham Kini, Karen A. Kinnaman, Ruth Lamm, Calvin Lee, Jarone Lee, Charles Lei, John Lemos, Daniel J. Lepp, Elisabeth Lessenich, Brandon Maughan, Julie Mayglothling, Kevin McConnell, Laura Medford-Davis, Kamal Medlej, Heather Meissen, Payal Modi, Joel Moll, Jolene H. Nakao, Matthew Nicholls, Lindsay Oelze, Carolyn Maher Overman, Viral Patel, Timothy C. Peck, Jeffrey Pepin, Candace Pettigrew, Byron Pitts, Zubaid Rafique, Chanu Rhee, Jonathan C. Roberts, Daniel Rolston, Steven C. Rougas, Benjamin Schnapp, Kathryn A. Seal, Raghu Seethala, Todd A. Seigel, Navdeep Sekhon, Kaushal Shah, Robert L. Sherwin, Kirill Shishlov, Ashley Shreves, Sebastian Siadecki, Jeffrey N. Siegelman, Liza Gonen Smith, Ted Stettner, Marie Carmelle Tabuteau, Joseph E. Tonna, N. Seth Trueger, Chad Van Ginkel, Bina Vasantharam, Graham Walker, Susan Wilcox, Sandra J. Williams, Matthew L. Wong, Nelson Wong, Samantha Wood, John Woodruff, Benjamin Zabar
- Edited by Kaushal Shah, Jarone Lee, Kamal Medlej, American University of Beirut, Scott D. Weingart
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- Book:
- Practical Emergency Resuscitation and Critical Care
- Published online:
- 05 November 2013
- Print publication:
- 24 October 2013, pp xi-xx
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Contributors
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- By Jennifer L. Allen, Inés Baños, Isabel Boege, Susan M. Bögels, Sam Cartwright-Hatton, Sarah Clark, Judith A. Cohen, Cathy Creswell, Esther I. de Bruin, Jessica Deighton, Helen F. Dodd, Caroline L. Donovan, Nicola Dummett, Sandra Dunsmuir, Melinda Edwards, Lara J. Farrell, Iyabo A. Fatimilehin, Andrew Fugard, Peter Fuggle, Philip Graham, Alice M. Gregory, Amira Hassan, Kevin Hilbert, Jennifer L. Hudson, Georgina C. Krebs, Jennifer Y. F. Lau, Anthony P. Mannarino, Sonja March, Ella L. Milliner, Laura K. Murray, Lynne Murray, Carol Newall, Thomas H. Ollendick, Dennis Ougrin, Ronald M. Rapee, Shirley Reynolds, Natalie Rodriguez, Benjamin C. Schwartzman, Stephen Scott, Susan H. Spence, Paul Stallard, Ellen Trautmann, David Trickey, Cynthia M. Turner, Saskia van der Oord, Beth Watkins, Miranda Wolpert, Jeffrey J. Wood
- Edited by Philip Graham, Shirley Reynolds, University of Reading
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- Book:
- Cognitive Behaviour Therapy for Children and Families
- Published online:
- 05 March 2013
- Print publication:
- 14 March 2013, pp viii-x
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Contributors
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- By Michael P. Alexander, Jean-Marie Annoni, Pascal Auzou, Philippe Azouvi, Sandra Black, Stephan Bohlhalter, Thomas Busigny, Lara Caeiro, Hugues Chabriat, Laurent Cohen, Alexandre Croquelois, Luc Defebvre, Stanislas Dehaene, Sebastian Dieguez, Diane Dupuy, José M. Ferro, Olivier Godefroy, Georg Goldenberg, Vladimir Hachinski, Maree Hackett, Hilde Hénon, Argye E. Hillis, Pierre Krolak-Salmon, Pierre Krystkowiak, Mansur A. Kutlubaev, Jany Lambert, Bernard Lechevalier, Claire Leclercq, Didier Leys, Chun Lim, Marie-Anne Mackowiak, Isabel P. Martins, Eugene Mayer, Gillian E. Mead, José G. Merino, Reto Meuli, Paige Moorhouse, Sylvain Moreau, David Nyenhuis, Florence Pasquier, Anne Peskine, Bertille Périn, Hervé Platel, Abid Qureshi, Marc D. Reichhart, Kenneth Rockwood, Bruno Rossion, Martine Roussel, Arnaud Saj, Donald T. Stuss, Pierre Thomas, Tim Vanbellingen, Fausto Viader, Alain Vighetto, Patrik Vuilleumier
- Edited by Olivier Godefroy
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- Book:
- The Behavioral and Cognitive Neurology of Stroke
- Published online:
- 05 March 2013
- Print publication:
- 28 February 2013, pp vii-x
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Notes on Contributors
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- By Susan F. Beegel, Milton A. Cohen, Nancy R. Comley, Kirk Curnutt, Albert J. DeFazio, Suzanne del Gizzo, David M. Earle, Carl P. Eby, Robert E. Fleming, Stacey Guill, Peter L. Hays, Ryan Hediger, Gary Edward Holcomb, Jill Jividen, Hilary K. Justice, Verna Kale, Jeremy Kaye, J. Gerald Kennedy, Kelli A. Larson, Leonard J. Leff, Nghana tamu Lewis, Kevin Maier, Miriam B. Mandel, James H. Meredith, Peter Messent, Debra A. Moddelmog, Lisa Narbeshuber, Matthew Nickel, Charles M. Oliver, Mark P. Ott, James Plath, Russ Pottle, Ann Putnam, John Raeburn, Gail Sinclair, Sandra Spanier, Amy Strong, Thomas Strychacz, Frederic Svoboda, Robert W. Trogdon, Lisa Tyler, Alex Vernon, Emily O. Wittman, Susan Wrynn
- Edited by Debra A. Moddelmog, Ohio State University, Suzanne del Gizzo
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- Book:
- Ernest Hemingway in Context
- Published online:
- 18 December 2013
- Print publication:
- 17 December 2012, pp xi-xxii
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Notes on Contributors
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- By Thomas M. Achenbach, Marc H. Bornstein, W. Thomas Boyce, Robert H. Bradley, Kelly Bridges, Jeanne Brooks-Gunn, Brenda K. Bryant, Sandra L. Calvert, Scott Coltrane, E. Mark Cummings, Stacey B. Daughters, Cindy DeCoste, Marc de Rosnay, Jacquelynne S. Eccles, Hadas Eidelman, Ruth Feldman, Peter Fonagy, Walter S. Gilliam, Andrea L. Gold, Elena L. Grigorenko, Sara Harkness, Sybil L. Hart, Jessica S. Henry, Erika Hoff, Tom Hollenstein, Stephanie M. Jones, Julia Kim-Cohen, Pamela K. Klebanov, Brett Laursen, Mary J. Levitt, Alicia F. Lieberman, Shoon Lio, Jessica F. Magidson, Ann S. Masten, David L. Molfese, Peter J. Molfese, Lynne Murray, Jelena Obradović, Lauren M. Papp, Ross D. Parke, Yaacov Petscher, Aelesia Pisciella, Aliza W. Pressman, Sarah Rabbitt, Craig T. Ramey, Sharon Landesman Ramey, Jessica M. Richards, Robert W. Roeser, Thomas J. Schofield, Ronald Seifer, Anne Shaffer, Michelle Sleed, Laura Stout Sosinsky, Nancy E. Suchman, Charles M. Super, Louis Tuthill, Patricia Van Horn, Eric Vega, Sarah Ward, Monica Yudron
- Edited by Linda Mayes, Yale University, Connecticut, Michael Lewis
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- Book:
- The Cambridge Handbook of Environment in Human Development
- Published online:
- 05 October 2012
- Print publication:
- 27 August 2012, pp ix-xvi
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MAYFLIES (EPHEMEROPTERA) OF MEXICO AND CENTRAL AMERICA: NEW SPECIES, DESCRIPTIONS, AND RECORDS1
- Richard K. Allen, Sandra D. Cohen
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- Journal:
- The Canadian Entomologist / Volume 109 / Issue 3 / March 1977
- Published online by Cambridge University Press:
- 31 May 2012, pp. 399-414
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Descriptions and figures of five undescribed species are presented: Lachlania talea, L. iops, Epeorus (Iron) packeri, Rhithrogena notialis, and Heptagenia bella. Heptagenia mexicana Ulmer is tentatively transferred to the genus Stenonema, the nymphal stage is described for Isonychia sicca manca Eaton and Homoeoneuria salviniae Eaton, and new collection records extend the known distributional range of Dactylobaetis mexicanus Traver & Edmunds, D. musseri Traver & Edmunds, D. zenobia Traver & Edmunds, Isonychia sicca manca, Homoeoneuria salviniae, Epeorus (Iron) metlacensis Traver, and Stenonema mexicana.
seven - Evaluation, evidence and learning in community-based action research
- Edited by Steve Cropper, Keele University, Alison Porter, Swansea University, Gareth Williams, Cardiff University, Sandra Carlisle, University of Aberdeen, Robert Moore, University of Liverpool, Martin O'Neill, Cardiff University, Chris Roberts, Helen Snooks, Swansea University
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- Book:
- Community Health and Wellbeing
- Published by:
- Bristol University Press
- Published online:
- 15 September 2022
- Print publication:
- 22 October 2007, pp 147-170
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Summary
Introduction
Policy makers, professionals of all kinds and the general public now recognise a wide range of social factors as important determinants of health; if community health interventions can help to address such factors, they can play a valuable role in protecting and improving health and wellbeing (Shediac-Rizkallah and Bone, 1998). Publicly funded approaches that develop community capacity and connectedness may also promote stronger partnerships between communities and service providers, potentially leading to more appropriate forms of service provision. Yet, despite a high volume of research across the UK and elsewhere describing the problem of health inequalities, there is still comparatively little intervention research that helps to identify practical responses. There is also a growing expectation of ‘evidence-based practice’, which exerts great pressure to evaluate the effectiveness of community-level health interventions, although with regard to ‘what works’ at community level, there is a gap between the rhetoric of evidence-based policy and what happens on the ground, which is known to be far more complicated (Coote et al, 2004). There are thus questions about how such interventions should be evaluated and what constitutes ‘evidence’, especially when applied to novel approaches such as action research.
The SHARP initiative has focused on generating learning and evidence from community-based action research that will be of use for policy and practice to address health inequalities. This chapter argues that learning and evidence can take many forms in this type of intervention, so we need to cultivate a broader understanding of what works, for whom, and at what cost. The philosophy, assumptions and principles on which community-level research is based have implications for both methodology and methods, and therefore the evidence produced.
We begin by summarising some challenges in evaluating community-based initiatives to improve health and wellbeing. We then introduce the question of what constitutes evidence and learning in the community setting for action research provided through the Sustainable Health Action Research Programme (SHARP). We describe the different approaches to evaluation and evidence taken by participants in one project, and by the overarching evaluation team whose responsibility it was to draw comparative lessons from all seven. We explain the different purposes and principles underpinning these levels of evaluation, the forms of evaluation questions asked, and the links between these and methodological choices around design, process and conduct.
Looking Backward, Looking Forward: MLA Members Speak
- April Alliston, Elizabeth Ammons, Jean Arnold, Nina Baym, Sandra L. Beckett, Peter G. Beidler, Roger A. Berger, Sandra Bermann, J.J. Wilson, Troy Boone, Alison Booth, Wayne C. Booth, James Phelan, Marie Borroff, Ihab Hassan, Ulrich Weisstein, Zack Bowen, Jill Campbell, Dan Campion, Jay Caplan, Maurice Charney, Beverly Lyon Clark, Robert A. Colby, Thomas C. Coleman III, Nicole Cooley, Richard Dellamora, Morris Dickstein, Terrell Dixon, Emory Elliott, Caryl Emerson, Ann W. Engar, Lars Engle, Kai Hammermeister, N. N. Feltes, Mary Anne Ferguson, Annie Finch, Shelley Fisher Fishkin, Jerry Aline Flieger, Norman Friedman, Rosemarie Garland-Thomson, Sandra M. Gilbert, Laurie Grobman, George Guida, Liselotte Gumpel, R. K. Gupta, Florence Howe, Cathy L. Jrade, Richard A. Kaye, Calhoun Winton, Murray Krieger, Robert Langbaum, Richard A. Lanham, Marilee Lindemann, Paul Michael Lützeler, Thomas J. Lynn, Juliet Flower MacCannell, Michelle A. Massé, Irving Massey, Georges May, Christian W. Hallstein, Gita May, Lucy McDiarmid, Ellen Messer-Davidow, Koritha Mitchell, Robin Smiles, Kenyatta Albeny, George Monteiro, Joel Myerson, Alan Nadel, Ashton Nichols, Jeffrey Nishimura, Neal Oxenhandler, David Palumbo-Liu, Vincent P. Pecora, David Porter, Nancy Potter, Ronald C. Rosbottom, Elias L. Rivers, Gerhard F. Strasser, J. L. Styan, Marianna De Marco Torgovnick, Gary Totten, David van Leer, Asha Varadharajan, Orrin N. C. Wang, Sharon Willis, Louise E. Wright, Donald A. Yates, Takayuki Yokota-Murakami, Richard E. Zeikowitz, Angelika Bammer, Dale Bauer, Karl Beckson, Betsy A. Bowen, Stacey Donohue, Sheila Emerson, Gwendolyn Audrey Foster, Jay L. Halio, Karl Kroeber, Terence Hawkes, William B. Hunter, Mary Jambus, Willard F. King, Nancy K. Miller, Jody Norton, Ann Pellegrini, S. P. Rosenbaum, Lorie Roth, Robert Scholes, Joanne Shattock, Rosemary T. VanArsdel, Alfred Bendixen, Alarma Kathleen Brown, Michael J. Kiskis, Debra A. Castillo, Rey Chow, John F. Crossen, Robert F. Fleissner, Regenia Gagnier, Nicholas Howe, M. Thomas Inge, Frank Mehring, Hyungji Park, Jahan Ramazani, Kenneth M. Roemer, Deborah D. Rogers, A. LaVonne Brown Ruoff, Regina M. Schwartz, John T. Shawcross, Brenda R. Silver, Andrew von Hendy, Virginia Wright Wexman, Britta Zangen, A. Owen Aldridge, Paula R. Backscheider, Roland Bartel, E. M. Forster, Milton Birnbaum, Jonathan Bishop, Crystal Downing, Frank H. Ellis, Roberto Forns-Broggi, James R. Giles, Mary E. Giles, Susan Blair Green, Madelyn Gutwirth, Constance B. Hieatt, Titi Adepitan, Edgar C. Knowlton, Jr., Emanuel Mussman, Sally Todd Nelson, Robert O. Preyer, David Diego Rodriguez, Guy Stern, James Thorpe, Robert J. Wilson, Rebecca S. Beal, Joyce Simutis, Betsy Bowden, Sara Cooper, Wheeler Winston Dixon, Tarek el Ariss, Richard Jewell, John W. Kronik, Wendy Martin, Stuart Y. McDougal, Hugo Méndez-Ramírez, Ivy Schweitzer, Armand E. Singer, G. Thomas Tanselle, Tom Bishop, Mary Ann Caws, Marcel Gutwirth, Christophe Ippolito, Lawrence D. Kritzman, James Longenbach, Tim McCracken, Wolfe S. Molitor, Diane Quantic, Gregory Rabassa, Ellen M. Tsagaris, Anthony C. Yu, Betty Jean Craige, Wendell V. Harris, J. Hillis Miller, Jesse G. Swan, Helene Zimmer-Loew, Peter Berek, James Chandler, Hanna K. Charney, Philip Cohen, Judith Fetterley, Herbert Lindenberger, Julia Reinhard Lupton, Maximillian E. Novak, Richard Ohmann, Marjorie Perloff, Mark Reynolds, James Sledd, Harriet Turner, Marie Umeh, Flavia Aloya, Regina Barreca, Konrad Bieber, Ellis Hanson, William J. Hyde, Holly A. Laird, David Leverenz, Allen Michie, J. Wesley Miller, Marvin Rosenberg, Daniel R. Schwarz, Elizabeth Welt Trahan, Jean Fagan Yellin
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- Journal:
- PMLA / Publications of the Modern Language Association of America / Volume 115 / Issue 7 / December 2000
- Published online by Cambridge University Press:
- 23 October 2020, pp. 1986-2078
- Print publication:
- December 2000
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Study of a Needleless Intermittent Intravenous-Access System for Peripheral Infusions: Analysis of Staff, Patient, and Institutional Outcomes
- Meryl H. Mendelson, Louise J. Short, Clyde B. Schechter, Burt R. Meyers, Margarita Rodriguez, Sandra Cohen, John Lozada, Marvalyn DeCambre, Shalom Z. Hirschman
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 19 / Issue 6 / June 1998
- Published online by Cambridge University Press:
- 02 January 2015, pp. 401-406
- Print publication:
- June 1998
-
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-
OBJECTIVE:
To assess the effect on staff- and patient-related complications of a needleless intermittent intravenous access system with a reflux valve for peripheral infusions.
DESIGN:A 6-month cross-over clinical trial (phase I, 13 weeks; phase II, 12 weeks) of a needleless intermittent intravenous access system (NL; study device) compared to a conventional heparin-lock system (CHL, control device) was performed during 1991 on 16 medical and surgical units. A random selection of patients was assessed for local intravenous-site complications; all patients were assessed for the development of nosocomial bacteremia and device-related complications. Staff were assessed for percutaneous injuries and participated in completion of product evaluations. A cost analysis of the study compared to the control device was performed.
SETTING:A 1,100-bed, teaching, referral medical center.
PATIENTS AND STAFF PARTICIPANTS:594 patients during 602 patient admissions, comprising a random sample of all patients with a study or control device inserted within a previous 24-hour period on study and control units, were assessed for local complications. The 16 units included adult inpatient general medicine, surgical, and subspecialty units. Pediatrics, obstetrics-gynecology, and intensive-care units were excluded. All patients on study and control units were assessed for development of nosocomial bacteremia and device-related complications. All staff who utilized, manipulated, or may have been exposed to sharps on study and control units were assessed for percutaneous injuries. Nursing staff completed product evaluations.
INTERVENTION:The study device, a needleless intermittent intravenous access system with a reflux valve, was compared to the control device, a conventional heparin lock, for peripheral infusions.
RESULTS:During the study, 35 percutaneous injuries were reported. Eight injuries were CHL-related; no NL-related injuries were reported (P=.007). An evaluation of 602 patient admissions, 1,134 intermittent access devices, and 2,268 observed indwelling device days demonstrated more pain at the insertion site for CHL than NL; however, no differences in objective signs of phlebitis were noted. Of 773 episodes of positive blood cultures on study and control units, 6 (0.8%) were device-related (assessed by blinded investigator), with no difference between NL and CHL. Complications, including difficulty with infusion (P<.001) and disconnection of intravenous tubing from device (P<.001), were reported more frequently with CHL than with NL. Of nursing staff responding to a product evaluation survey, 95.2% preferred the study over control device. The projected annual incremental cost to our institution for hospitalwide implementation of NL for intermittent access for peripheral infusions was estimated at $82,845, or $230 per 1,000 patient days.
CONCLUSIONS:A needleless intermittent intravenous access system with a reflux valve for peripheral infusions is effective in reducing percutaneous injuries to staff and is not associated with an increase in either insertion-site complications or nosocomial bacteremia. Institutions should consider these data, available institutional resources, and institution-specific data regarding the frequency and risk of intermittent access-device-related injuries and other types of sharps injuries in their staff when selecting the above or other safety devices.