1,720,985 research outputs found
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Extending the hours of a pediatric emergency department's fast track clinic into night shift did not decrease the aggregate length of stay or the length of stay of high acuity patients on night shift
No full textThesis (Master's)--University of Washington, 2012Objective: This study set out to see if extending the hours of the pediatric fast track clinic through the first half of night shift in a dedicated pediatric emergency department decreased the Length of Stay (LOS) of all the patients seen on night shift (termed aggregate LOS) and of the high acuity patients seen on night shift. Methods: This study was conducted in a pediatric hospital run by Multicare Health System in Tacoma, WA. The study was designed as a pre/post-intervention with a comparison to a similar time period the previous year. The intervention was the extension of the hours of Child Express clinic into night shift that started November 1, 2005. The pre/post intervention periods were from October 1 to October 31 and from November 1 to December 2, 2005, respectively, and for the same periods in the previous comparison year (2004). Linear regression was used to determine whether there were observable differences in mean length of stay adjusting for differential inpatient admit rates between pre and post assessment periods using a historical comparison control. Results: Mean length of stay was found to be 2.1 hours in the post intervention (Child Express) period relative to 2.32 hours in the pre-intervention period. When compared to the 2.2 hours and 2.3 hours in the respective historical periods, the difference in differences was found to be .22 hours, or 7.2 minutes (95% CI 0.84, and 1.1, p = 0.37). Conclusion: Extending the hours of the fast track clinic into night shift was not associated with a difference in aggregate LOS or the LOS of high acuity patients on night shift. This is consistent with previous findings. Additional factors likely influence the throughput of a pediatric emergency department beyond simply reducing the volume of low acuity patients in the main emergency room
Evaluation of a Quality Improvement Intervention for Anesthetic Management of Acute Ischemic Stroke Patients Undergoing Endovascular Therapy
Full text linkThesis (Master's)--University of Washington, 2016-06BACKGROUNDS: For acute ischemic stroke (AIS) cases receiving endovascular therapy (EVT), the use of general anesthesia (GA), physiological perturbations, and delays in the institution of EVT adversely impact the outcomes. In 2012, a quality improvement (QI) intervention utilizing PDSA (Plan-Do-Study-Act) model was implemented at Harborview Medical Center (HMC) aiming at minimizing delays for EVT, encouraging the use of monitored anesthesia care (as opposed to the routine use of general anesthesia) and avoiding physiologic perturbations under anesthesia, to improve neurological outcomes of the patients. The objective of this project is to evaluate the effectiveness of the QI intervention quantitatively. METHODS: This is a retrospective pre-post interventional study. The study period was separated into pre-intervention period (Jan 2008 to May 2012), QI intervention roll-out period (Jun 2012 to Nov 2012, the first six months of implementation), and post-intervention period (Dec 2012 to Aug 15th, 2015.) Patient characteristics, choice of anesthetic technique (general anesthesia or monitored anesthesia care), arterial line placement rate, timeliness indicators, intra-procedural physiological parameters, and clinical outcomes were collected and compared between pre-intervention and post-intervention phases. Multi-level generalized estimating equation models were used to estimate the clinical impacts. RESULTS: Data from 78 patients from pre-intervention phase and 43 patients from post-intervention phase were compared. The use of general anesthesia decreased from 97.4% to 72.1% (p<0.0005). The use of arterial catheter decreased from 75.6% to 39.5% (p<0.0005). The median anesthesia-ready time decreased from 14 to 12 minutes (p=0.007). The median door-to-puncture time decreased from 111 to 82 minutes (p=0.02). The prevalence of intra-procedural relative hypotension (non-invasive SBP below the recommended 140mmHg) decreased from 100% to 90.7% (p=0.006). No significant decreases in respiratory parameters were identified (EtCO2>40 mmHg, EtCO2<30 mmHg, SpO2<92%). The subjects in post-intervention phase had lower in-hospital all-cause mortality, (adjusted OR 0.67 [0.55-0.80]; p<0.0005), higher likelihood of favorable neurologic outcome (mRS≤2, adjusted OR 1.27 [0.42-3.8]; p=0.67) and favorable discharge disposition (adjusted OR 1.57 [0.88-2.8]; p=0.13), shorter hospital stay (adjusted IRR 0.79 [0.51-1.19]; p=0.25) and ICU stay (adjusted IRR 0.61 [0.51-1.19]; p=0.25). DISCUSSION: The QI intervention utilizing interdisciplinary “PDSA” model effectively changed physician decision-making for anesthesia technique choice and was significantly associated with less delay to treatment, less relative hypotension, and better survival
Continuity of care in older adults with multiple chronic conditions
No full textThesis (Ph.D.)--University of Washington, 2016-08Nearly three out of four people over 65 years of age in the United States (U.S.), or greater than 35 million older adults, have two or more chronic conditions. People with multiple chronic conditions (MCCs) pose a significant challenge to the health care system because they are at greater risk for morbidity and mortality, utilize more health care services, and are vulnerable to poor quality care. Despite their considerable needs, this patient population is often excluded from clinical and health services research. Thus, the evidence base for best practices of care for this population is lacking, which contributes to poor outcomes of care. Continuity of care (COC) is an important process of care that prior studies have shown is associated with greater patient satisfaction, fewer emergency department (ED) visits and hospitalizations, a reduced risk of mortality, and lower costs of care in older adults. Studies specifically examining patients with MCCs have also demonstrated associations between higher COC and fewer duplicated medications, fewer ED visits and hospitalizations, and a lower risk of death. Thus, COC is a recommended component of high quality care for patients with MCCs. There are, however, a number of limitations to the current COC literature for older adults with MCCs. Although patients with MCCs would seem to be particularly vulnerable to care fragmentation, the association between morbidity burden and COC has not been explored. Also missing from the literature are studies exploring the relationships between COC and patient-reported measures of health status. Another shortcoming is the limited exploration of provider type in COC studies. Finally, differences in benefits conferred by continuity with an individual provider as compared with a medical practice are unclear. In this dissertation, I aim to fill the gaps in the COC literature by testing: 1) whether there is an association between morbidity burden and COC at the provider and practice-level among older adults who primarily saw a PCP and older adults who primarily saw a specialist for their medical care; 2) whether there is an association between provider and practice-level COC and functional status in a population of older adults with MCCs, and whether any observed associations were moderated by the type of provider the patient primarily saw for their health care visits; and 3) whether there is an association between provider and practice-level COC and health care expenditures in a population of older adults with MCCs, and whether any observed associations were moderated by the type of provider the patient primarily saw for their health care visits. In the first study of this dissertation, I found that multimorbidity is an independent risk factor for lower COC. The magnitude of the association was such that people with high levels of morbidity burden would be expected to experience a decrease in continuity that was clinically meaningful, and could impact their clinical outcomes. In the second study, I found that neither provider nor practice-level continuity was significantly associated with functional status decline. However, in subgroup analyses, I observed that specialty care continuity was significantly associated with a lower odds of functional status decline among patients seeing primarily a specialty care provider. Finally, in the third study, I found a significant association between higher continuity and lower expenditures that was irrespective of provider type and provider or practice levels. Results also suggested the lower costs may have arisen from lower rates of emergency department visits and hospitalizations among those with higher COC. Our findings lend further support for the value of COC, a process of care that should be encouraged, particularly among high morbidity patients who are at risk of greater care fragmentation. They also provide insight into the possible effects of delivery system reform efforts that emphasize COC. Our results suggest that COC may provide benefits in terms of costs and utilization, though not necessarily patient-reported health outcomes. They also suggest that emphases on different levels of continuity might not produce appreciable differences in terms of lowered costs, but differences may arise for patient-reported health outcomes. Finally, they indicate the importance of provider type considerations when thinking about care continuity
Evaluating Caller Experience with a Telephone Health Hotline in Malawi
Full text linkThesis (Master's)--University of Washington, 2017-06Introduction: One application of mobile technology for health (mHealth) is health hotlines, which have been implemented in high-, middle-, and low-income countries to increase timely access to health information. The purpose of this study is to describe the characteristics, experiences, and overall satisfaction level of recent callers to Chipatala Cha Pa Foni, a toll-free hotline in Malawi that residents can call for health advice. Methods: Primary data were collected through a cross-sectional phone survey of recent hotline users who left a callback number. The 30-item survey included mostly Likert scale questions and asked participants about their experience in general and about specific aspects of their most recent call experience. Results: Interviews were completed with 239 of the 421 users who left a callback number (57% response rate). Forty-six percent of respondents were male and nearly 80% of all participants reported living at least a one hour walk from the nearest health facility. Ninety-six percent of respondents stated their questions were “answered completely” by hotline workers, 98% reported trusting the information given by hotline workers “very much,” and 96% were “very comfortable” talking to the hotline workers. Ninety-nine percent of respondents reported being “very satisfied” with the hotline and 96% said they were “very likely” to use the service again in the future. However, nearly one-third of respondents (31%) stated that they had trouble reaching the hotline at some point. Discussion: Callers reported very positive experiences with dimensions of the Chipatala Cha Pa Foni hotline service, and 99% of the callers were “very satisfied” with the service overall. Some respondents experienced their call not being answered for a long time or at all, however, or being disconnected while talking to a hotline worker. Continued attention to the technology for a smooth call experience is needed. Further research employing qualitative methods would further illuminate caller experience with the hotline and indicate any additional areas that may warrant focused attention
Serving South Seattle Drug Users through the Hepatitis Education Project Syringe Services Program: A Formative Program Evaluation and Needs Assessment
No full textThesis (Master's)--University of Washington, 2018Abstract: In July of 2017, the Hepatitis Education Project (HEP) opened a syringe service program (SSP) in South Seattle, providing sterile syringes, injection equipment, safe disposal of syringes, and the overdose reversal drug naloxone for people who inject drugs (PWID) and community members. The SSP aims to serve PWID in South Seattle, with an additional focus on people experiencing homelessness and the Black/African American community. To understand the needs of the population being served and to inform the development of the SSP, a formative evaluation was conducted. The evaluation used a cross-sectional design, employing mixed methods using a quantitative questionnaire and qualitative interviews. A convenience sample (n=50) of self-identified drug users was recruited from the larger pool of program participants between December 2017 and April 2018. The questionnaire focused on drug use patterns, equipment preferences, barriers to access and service needs. Additionally, twelve qualitative interviews were conducted, focusing on secondary exchange, barriers to access, and naloxone access, knowledge and use. Results reveal that respondents most commonly use methamphetamine and heroin and most reported injection drug use. Barriers to SSP participation include distance to SSP, SSP hours, mental health challenges, stigma, and misconceptions about SSPs. Interviews indicated that secondary exchange practices, particularly among participants living in homeless encampments, were highly common. Lastly, many participants reported carrying naloxone and feeling comfortable administering the drug; though many expressed a need for more training, and misconceptions about its use, effects and safety were reported. The results of the evaluation will be used to direct and inform the program activities and future development, enabling HEP to serve the South Seattle community most effectively
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Reducing Child Health Disparities with Health Policies: Is Health Reform Enough?
No full textThesis (Ph.D.)--University of Washington, 2018Understanding whether healthcare policies can narrow and eliminate racial/ethnic disparities in health care access and utilization is an important public health issue. This dissertation examines whether two reforms, the Massachusetts (MA) health care reform law (Chapter 58) and the Patient Protection and Affordable Care Act (ACA), reduced racial/ethnic-related disparities in health care access and utilization between Hispanic and NH-white children. The first aim of this study examined the long-term effects of the MA health reform on disparities in insurance access, utilization of care, and health status among Hispanic children compared to non-Hispanic white children. The second and third aims examined the short-term effects of the ACA on disparities among Hispanic children compared to non-Hispanic white children. The second aim evaluated the impact of the ACA on insurance access and utilization of health care, and the third aim examined ACA impacts on financial burden due to medical costs experienced by the child’s family. Data from the National Survey of Children’s Health and the National Health Interview Survey were evaluated before and after implementation of the MA health reform (aim 1) and the ACA insurance expansion in 2014 (aims 2 & 3). The study subjects were children ages 0 to 17 years old. The impact of insurance expansion through health reform on disparities was evaluated using a triple-difference (difference-in-difference-in-difference, or DDD) analysis, which controlled for events not captured by the covariates that can affect the outcomes. Each aim utilized a nonequivalent pretest/posttest comparison group study design. For the first aim, children living in Massachusetts were the intervention group, and children living in surrounding states (Rhode Island, New Hampshire, and Connecticut) were in the comparison group. For the second and third aim, the intervention group includes children who were not eligible for Medicaid/CHIP before reform and whose family income was <400% of the federal poverty level (FPL). The two comparison groups were composed of children eligible for Medicaid/CHIP before and after reform (the Medicaid/CHIP group), and children whose family income was ≥400% of the FPL (the 400% FPL group). The MA Health Reform did significantly narrow disparities between Hispanic and NH-white children for consistent health insurance coverage; no changes were evident for health outcome measures. The ACA significantly improved insurance coverage by approximately 4-percentage points only among children in the Medicaid/CHIP group for Hispanic and NH-white children. However, insurance coverage disparities between Hispanic and NH-white children did not change significantly after insurance expansion for the intervention and 400% FPL comparison groups. Family financial burden disparities were not evident between Hispanic and NH-white children and their families. However, there was a significant reduction in high financial burden for both racial/ethnic groups in the Medicaid/CHIP comparison group post-ACA insurance reform. This study found that after implementation of both health reforms, Hispanic children continue to fall behind NH-white children in having health insurance coverage and in utilizing preventive health care services. Additional interventions targeted at Hispanic families are needed to improve child health disparities in insurance access. Other reform efforts besides improving insurance access are also needed to improve disparities in preventive care utilization. This study underscores the need for quasi-experimental studies of racial/ethnic disparities in health and health care in the future
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