392 research outputs found
The impact of chest radiography on the diagnosis, clinical management and outcome of acute lower respiratory infections in children
No full textBackground. When available, chest radiography is widely used in acute lower respiratory infections in children. Its impact on clinical outcome is unknown. Methods. A randomised controlled trial was performed of 522 children aged 2 to 59 months who met the World Health Organisation case definition for pneumonia. The main outcome was time to recovery, measured in a subset of 398 participants who offered a telephone number. Subsidiary outcomes included diagnosis, elements of clinical management and subsequent use of health facilities. Findings. There was a marginal improvement in time to recovery, which was not clinically significant. The median time to recovery was seven days in both groups, 95% CI 6-8 days and 6-9 days in the radiograph and control groups respectively (p=0.50, log rank test). The hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). This lack of effect was not modified by clinicians' experience and no sub-groups of children were identified in whom the radiograph had an effect. Pneumonia was diagnosed more often in the radiograph group (14.4% vs. 8.8%, p=0.03) and bronchiolitis less often ( 44% vs. 56%, p=0.005). Antibiotic usage was higher in the radiograph group (60.8% vs. 52.2%, p=0,05). There were no differences in subsequent health facility usage. Interpretation. Despite a net change in diagnosis and an increase in antibiotic usage, chest radiography did not affect clinical outcome in outpatient children with acute lower respiratory infection. This lack of effect was independent of clinicians' experience. There were no clinically identifiable sub-groups of children within the World Health Organisation case definition of pneumonia who benefited from radiography. It is concluded that routine use of chest radiography is not beneficial in ambulatory children over two months of age with acute lower respiratory infection
Elliot Merrick (1905-1997)
No full text... Elliot Merrick, Labrador author and traveler, died on 22 April 1997, less than three weeks before his 92nd birthday. Toward the end of his life, he would joke that he was so old that he\u27d become "historical". In fact, he was one of the last surviving links with pioneer Labrador - a place that makes the present-day Labrador of jet overflights and nickel mines seem like another country. ... Elliot Merrick made no contribution to science; his trips did not result in new maps being drawn up, and he did not make any major or even minor archaeological finds. But his books about Labrador will live on to enthral future generations of readers with the magic of the North
Development and Evaluation of a Tailored Knowledge Translation Intervention to Improve Lay Health Workers Ability to Effectively Support TB Treatment Adherence in Malawi
No full textBackground: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi.
Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify
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aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants.
Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed.Ph
Optimizing Audit and Feedback to Improve Quality in Primary Care
No full textOne of the most consistent findings in health services research relates to gaps between ideal and actual care. Audit and feedback is frequently implemented to help providers identify these gaps and to subsequently improve quality of care, with widely varying results. The overall aim of this thesis was to examine how to optimize audit and feedback interventions provided to family physicians to more reliably result in professional behaviour change that will benefit patients. A systematic review, meta-analysis, and meta-regression was conducted to determine the effect of audit and feedback interventions on quality of care and to identify effect modifiers. The review included 140 trials and found that audit and feedback works best when the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. Based on the latter finding and applying principles from relevant behaviour change theories, a worksheet was developed to guide feedback recipients in setting appropriate goals and action plans in response to identified gaps in care. This worksheet was tested in a pragmatic, cluster-randomized trial including 53 family physicians from 14 practices across Ontario. All participating family physicians received feedback every six months regarding the proportion of patients with diabetes and/or heart disease receiving guideline-recommended care. Family physicians in the intervention group also received the worksheet appended to the feedback reports. After two years, no significant effects differences were found between the groups, in part because of poor uptake of the worksheet. An embedded qualitative evaluation examined the barriers and facilitators to improving quality of care for chronic disease management perceived by family physicians who received the feedback reports. Findings highlighted the importance of matching the targeted behaviour change(s) with the priorities and capabilities of recipients and their organizations.Ph.D
Development and Evaluation of a Tailored Knowledge Translation Intervention to Improve Lay Health Workers Ability to Effectively Support TB Treatment Adherence in Malawi
No full textBackground: Task shifting provision of basic health care services to lay health workers (LHWs) is increasingly employed to combat the global shortage of skilled health workers, particularly in low and middle income countries, where the shortage is greatest. Despite evidence for the effectiveness of LHWs in improving access to basic health services and positively impacting a variety of health outcomes, questions remain as to how recognized weaknesses in training and supervision are best addressed. This thesis employed a sequential-concurrent mixed-methods design and is composed of 3 studies with the objective of designing and rigorously evaluating a knowledge translation (KT) intervention tailored to address identified barriers to LHWs ability to function optimally as TB adherence supporters in Zomba district, Malawi.
Methods & Findings: The first study utilized the qualitative methods of focus groups and interviews conducted with LHWs routinely involved in provision of care to TB patients. Lack of TB knowledge and job-specific training were identified as the key barriers to LHWs in their role as TB adherence supporters. Based on these findings, a KT intervention was developed and tailored to the identified training gaps. The second study, evaluated the effectiveness of the intervention in improving TB treatment adherence in a cluster randomized controlled trial, which showed no evidence for effectiveness of the intervention. The third study, conducted concurrently with the cluster trial, employed qualitative interviews to explore LHWs experiences with the intervention to identify
ii
aspects of the intervention found to be helpful and areas in need of improvement. Study 3 found that the intervention was well received and valued, with reported benefits to LHWs through improved knowledge and skills, and increased confidence. Suggestions for improvement varied considerably, with an anticipated concern with the lack of stipends and conduct of training on-site, raised as an issue by a minority of participants.
Conclusion: This thesis suggests that a multi-component KT strategy tailored to address local barriers, was well received and valued by LHWs, and may represent a cost-effective approach to LHW training. However, given the trend for effectiveness did not reach significance in this underpowered study, further research is needed.Ph
Optimizing Audit and Feedback to Improve Quality in Primary Care
No full textOne of the most consistent findings in health services research relates to gaps between ideal and actual care. Audit and feedback is frequently implemented to help providers identify these gaps and to subsequently improve quality of care, with widely varying results. The overall aim of this thesis was to examine how to optimize audit and feedback interventions provided to family physicians to more reliably result in professional behaviour change that will benefit patients. A systematic review, meta-analysis, and meta-regression was conducted to determine the effect of audit and feedback interventions on quality of care and to identify effect modifiers. The review included 140 trials and found that audit and feedback works best when the source is a supervisor or colleague, it is provided more than once, it is delivered in both verbal and written formats, and when it includes both explicit targets and an action plan. Based on the latter finding and applying principles from relevant behaviour change theories, a worksheet was developed to guide feedback recipients in setting appropriate goals and action plans in response to identified gaps in care. This worksheet was tested in a pragmatic, cluster-randomized trial including 53 family physicians from 14 practices across Ontario. All participating family physicians received feedback every six months regarding the proportion of patients with diabetes and/or heart disease receiving guideline-recommended care. Family physicians in the intervention group also received the worksheet appended to the feedback reports. After two years, no significant effects differences were found between the groups, in part because of poor uptake of the worksheet. An embedded qualitative evaluation examined the barriers and facilitators to improving quality of care for chronic disease management perceived by family physicians who received the feedback reports. Findings highlighted the importance of matching the targeted behaviour change(s) with the priorities and capabilities of recipients and their organizations.Ph.D
sj-pdf-1-cjk-10.1177_20543581211041182 – Supplemental material for MyTEMP: Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial
No full textSupplemental material, sj-pdf-1-cjk-10.1177_20543581211041182 for MyTEMP: Statistical Analysis Plan of a Registry-Based, Cluster-Randomized Clinical Trial by Stephanie N. Dixon, Jessica M. Sontrop, Ahmed Al-Jaishi, Lauren Killin, Christopher W. McIntyre, Sierra Anderson, Amit Bagga, Derek Benjamin, Peter Blake, P. J. Devereaux, Eduard Iliescu, Arsh Jain, Charmaine E. Lok, Gihad Nesrallah, Matthew J. Oliver, Sanjay Pandeya, Manish M. Sood, Paul Tam, Ron Wald, Michael Walsh, Merrick Zwarenstein and Amit X. Garg in Canadian Journal of Kidney Health and Disease</p
Staff training and ambulatory tuberculosis treatment outcomes: a cluster randomized controlled trial in South Africa.
No full textOBJECTIVE: To assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatment in primary care clinics with treatment success rates below 70%. METHODS: A cluster randomized controlled trial was conducted from July 1996 to July 2000 in nurse-managed ambulatory primary care clinics in Cape Town, South Africa. Clinics with successful TB treatment completion rates of less than 70% and annual adult pulmonary TB loads of more than 40 patients per year were randomly assigned to either the intervention (n = 12) or control (n = 12) groups. All clinics completed follow-up. Treatment outcomes were measured in cohorts of adult, pulmonary TB patients before the intervention (n = 1200) and 9 months following the training (n = 1177). The intervention comprised an 18-hour experiential, participatory in-service training programme for clinic staff delivered by nurse facilitators and focusing on patient centredness, critical reflection on practice, and quality improvement. The main outcome measure was successful treatment, defined as patients who were cured and those who had completed tuberculosis treatment. FINDINGS: The estimated effect of the intervention was an increase in successful treatment rates of 4.8% (95% confidence interval (CI): -5.5% to 15.2%) and in bacteriological cure rates of 10.4% (CI: -1.2% to 22%). A treatment effect of 10% was envisaged, based on the views of policy-makers on the minimum effect size for large-scale implementation. CONCLUSION: This is the first evidence from a randomized controlled trial on the effects of experiential, participatory training on TB outcomes in primary care facilities in a developing country. Such training did not appear to improve TB outcomes. However, the results were inconclusive and further studies are required
Snacks 31 -- David Warlick!
No full textIncludes descriptive metadata provided by producer in MP3 file: "Snacks 4 the Brain! - Podcasts - Snacks 31 -- David Warlick!" Scott Merrick interviews David Warlick, a North Carolina educator, educational technology specialist, programmer and author. Podcasting in education, and in particular Warlicks' "Connect Learning" podcast series, are among the topics of discussion, as are science education and the implications of young people's use of MySpace.Vanderbilt University. Medical Cente
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