1
|
Stratospheric water vapor affecting atmospheric circulation. Nat Commun 2023; 14:3925. [PMID: 37400442 DOI: 10.1038/s41467-023-39559-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023] Open
Abstract
Water vapor plays an important role in many aspects of the climate system, by affecting radiation, cloud formation, atmospheric chemistry and dynamics. Even the low stratospheric water vapor content provides an important climate feedback, but current climate models show a substantial moist bias in the lowermost stratosphere. Here we report crucial sensitivity of the atmospheric circulation in the stratosphere and troposphere to the abundance of water vapor in the lowermost stratosphere. We show from a mechanistic climate model experiment and inter-model variability that lowermost stratospheric water vapor decreases local temperatures, and thereby causes an upward and poleward shift of subtropical jets, a strengthening of the stratospheric circulation, a poleward shift of the tropospheric eddy-driven jet and regional climate impacts. The mechanistic model experiment in combination with atmospheric observations further shows that the prevailing moist bias in current models is likely caused by the transport scheme, and can be alleviated by employing a less diffusive Lagrangian scheme. The related effects on atmospheric circulation are of similar magnitude as climate change effects. Hence, lowermost stratospheric water vapor exerts a first order effect on atmospheric circulation and improving its representation in models offers promising prospects for future research.
Collapse
|
2
|
Bronchoscopy in the emergency department. Am J Emerg Med 2022; 58:114-119. [DOI: 10.1016/j.ajem.2022.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 10/18/2022] Open
|
3
|
Building a Taxonomy to Understand Health Care Worker's Response to Workplace 'Pressure' in Complex, Volatile and Emergency Situations. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211043646. [PMID: 34569349 PMCID: PMC8477682 DOI: 10.1177/00469580211043646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This research aims to better understand performance under pressure as experienced by health and emergency staff in the workplace. Three basic questions underpin the work: (1) how do health and emergency workers experience and make sense of the 'pressures' entailed in their jobs? (2) What impacts do these pressures have on their working lives and work performance, both positively and negatively? (3) Can we develop a useful explanatory model for 'working under pressure' in complex, volatile and emergency situations? The present article addresses the first question regarding the nature of pressure; a subsequent article will address the question of its impact on performance. Using detailed interviews with workers in a range of roles and from diverse settings across Ecuador, our analysis aims to better understand the genesis of pressure, how people respond to it and to gain insights into managing it more effectively, especially with a view to reducing workplace errors and staff burnout. Rather than imposing preformulated definitions of either 'pressure' or 'performance', we took an emic approach to gain a fresh understanding of how workers themselves experience, describe and make sense of workplace pressure. This article catalogues a wide range of pressures as experienced by our participants and maps relationships between them. We argue that while individuals are often held responsible for workplace errors, both 'pressure' and 'performance' are multifactorial, involving individuals, teams, case complexity, expertise and organizational systems and these must be considered in order to gain better understandings of performing under pressure.
Collapse
|
4
|
Non-prescription medicines may contribute to non-adherence to prescription medicines in people living with chronic health conditions. Int J Clin Pract 2020; 74:e13489. [PMID: 32083362 DOI: 10.1111/ijcp.13489] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/06/2020] [Accepted: 02/15/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-adherence to prescribed medicines is linked to adverse health outcomes in people living with chronic health conditions (CHCs). Multiple factors are known to contribute to non-adherence to medicines including polypharmacy, demographic features and disease and health systems. Both non-prescription and prescription medicines contribute to polypharmacy; however, there is limited data on the influence of non-prescription medicines to non-adherence. AIM Therefore, the aim of the study was to investigate the influence of non-prescription medicines to non-adherence in an Australian population. METHODS Data from the 2016 National Survey of a random sample of Australian adult residents were utilised in this study to investigate factors associated with non-adherence. Descriptive statistics, χ2 , regression and generalised linear models were used to assess the relationships between variables of interest. Narrative response and comments were used to provide further insight. RESULTS This study recruited 1217 participants to explore factors associated with non-adherence to medicines. Weak but statistically significant correlations were identified showing the number of CHCs, patient's age, number of prescription medicines, number of non-prescription medicines and total number of medicines associated with non-adherence. DISCUSSION The findings suggest that people living with CHCs and taking multiple medicines, including non-prescription medicines, are likely to be non-adherent to prescription medicines. This study shows the possible involvement of non-prescription medicines in contributing to non-adherence in an Australian population and suggests that future studies with a broader demographic are warranted.
Collapse
|
5
|
Spectrum and frequency of critical procedures performed at a Level I adult and pediatric trauma center. Am J Emerg Med 2020; 44:272-276. [PMID: 32317200 DOI: 10.1016/j.ajem.2020.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/31/2020] [Accepted: 04/02/2020] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to provide physician-level data about the frequency of critical procedures at a combined adult and pediatric Level I trauma center, high-acuity, high-volume academic ED. The inspiration for this study question came from a previous study by Mittiga et al. (2013) describing pediatric critical procedure data at a similar high-acuity, high-volume, pediatric-only academic ED. Our secondary objective is to compare our pediatric level procedural spectrum and frequency with those published by Mittiga et al. (2013). METHODS This prospective observational study occurred over eleven consecutive months at an urban, Level I combined adult/pediatric trauma center with 96,000 annual visits (8500 pediatric). We recorded only procedures performed in the resuscitation bays. All data analysis is descriptive. RESULTS Over eleven months, data on 3891 resuscitations were collected (3686 adults and 205 children); 38 faculty physicians supervised 1838 total critical procedures, 64 on children. The mean number of critical procedures per physician per month was 4.42 (0.15 on children). Additionally, ultrasound for intravenous access, extended focused assessment with sonography for trauma (e-FAST), or cardiac ultrasound were performed in 3862 resuscitations (178 pediatric). CONCLUSIONS Emergency medicine faculty physicians at a combined Level I adult and pediatric trauma center performed and/or supervised 4.4 total (0.15 pediatric) critical procedures per month per faculty which is nearly 6 times more critical procedures monthly than faculty at a similar volume pediatric-only trauma center. However, fewer critical procedures were performed on children at the combined facility.
Collapse
|
6
|
Yes to Recreational Drugs and Complementary Medicines But No to Life-Saving Medications: Beliefs Underpinning Treatment Decisions Among PLHIV. AIDS Behav 2019; 23:3396-3410. [PMID: 31388852 DOI: 10.1007/s10461-019-02623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the life-preserving benefits of antiretroviral therapy (ART), some people living with HIV (PLHIV) delay, decline or diverge from recommended treatment while paradoxically being willing to use potentially dangerous substances, such as recreational drugs (RD) and complementary medicines (CM). During 2016 and 2017, interviews were conducted with 40 PLHIV, in Australia to understand drivers underpinning treatment decisions. While many believed ART to be effective, they expressed concerns about long-term effects, frustration over perceived lack of autonomy in treatment decisions and financial, emotional and physical burdens of HIV care. In contrast, they ascribed a sense of self-control over the use of RD and CM, along with multiple professed benefits. The perceived burden of ART emerged as a motivator for deviating from recommended treatment, while positive views towards RD and CM appear to justify use. This study may serve as guidance for the development of future strategies to address barriers to treatment uptake and adherence and subsequently health outcomes for PLHIV in Australia and elsewhere.
Collapse
|
7
|
Effect of Gabapentin vs Pregabalin on Pain Intensity in Adults With Chronic Sciatica: A Randomized Clinical Trial. JAMA Neurol 2019; 76:28-34. [PMID: 30326006 DOI: 10.1001/jamaneurol.2018.3077] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Optimal pharmacologic treatment for chronic sciatica (CS) is currently unclear. While gabapentin (GBP) and pregabalin (PGB) are both used to treat CS, equipoise exists. Nevertheless, pharmaceutical regulation authorities typically subsidize one drug over the other. This hinders interchange wherever the favored drug is either ineffective or ill-tolerated. Objective To assess GBP vs PGB head to head for the treatment of CS. Design, Setting, and Participants A preplanned interim analysis of a randomized, double-blind, double-dummy crossover trial of PGB vs GBP for management of CS at half the estimated final sample size was performed in a single-center, tertiary referral public hospital. A total of 20 patients underwent randomization from March 2016 to March 2018, and 2 were excluded with 1 lost to follow-up and the other requiring urgent surgery unrelated to the study. Patients attending a specialist neurosurgery clinic with unilateral CS were considered for trial recruitment. Chronic sciatica was defined as pain lasting for at least 3 months radiating into 1 leg only to, at, or below the knee level. Imaging (magnetic resonance imaging with or without computed tomography) corroborating a root-level lesion concordant with symptoms and/or signs was determined by the trial clinician. Inclusion criteria included patients who had not used GBP and PGB and were 18 years or older. Analyses were intention to treat and began February 2018. Interventions Randomly assigned participants received GBP (400 mg to 800 mg 3 times a day) then PGB (150 mg to 300 mg twice daily) or vice versa, each taken for 8 weeks. Crossover followed a 1-week washout. Main Outcomes and Measures The primary outcome was pain intensity (10-point visual analog scale) at baseline and 8 weeks. Secondary outcomes included disability (using the Oswestry Disability Index) and severity/frequency of adverse events. Results The total trial population (N = 18) consisted mostly of men (11 [61%]) with a mean (SD) age of 57 (16.5) years. A third of the cohort were smokers (5 [28%]), and more than half consumed alcohol (12 [67%]). Gabapentin was superior to PGB, with fewer and less severe adverse events. Both GBP (mean [SD], 7.54 [1.39] to 5.82 [1.72]; P < .001) and PGB (mean [SD], 7.33 [1.30] to 6.38 [1.88]; P = .002) displayed significant visual analog pain intensity scale reduction and Oswestry Disability Index reduction (mean [SD], 59.22 [16.88] to 48.54 [15.52]; P < .001 for both). Head to head, GBP showed superior visual analog pain intensity scale reduction (mean [SD], GBP: 1.72 [1.17] vs PGB: 0.94 [1.09]; P = .035) irrespective of sequence order; however, Oswestry Disability Index reduction was unchanged. Adverse events for PGB were more frequent (PGB, 31 [81%] vs GBP, 7 [19%]; P = .002) especially when PGB was taken first. Conclusions and Relevance Pregabalin and GBP were both significantly efficacious. However, GBP was superior with fewer and less severe adverse events. Gabapentin should be commenced before PGB to permit optimal crossover of medicines. Trial Registration anzctr.org.au Identifier: ACTRN12613000559718.
Collapse
|
8
|
Decision-making under pressure: medical errors in uncertain and dynamic environments. AUST HEALTH REV 2019; 42:395-402. [PMID: 28578757 DOI: 10.1071/ah16088] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 04/03/2017] [Indexed: 11/23/2022]
Abstract
Objective This paper provides a narrative overview of the literature concerning clinical decision-making processes when staff come under pressure, particularly in uncertain, dynamic and emergency situations. Methods Studies between 1980 and 2015 were analysed using a six-phase thematic analysis framework to achieve an in-depth understanding of the complex origins of medical errors that occur when people and systems are under pressure and how work pressure affects clinical performance and patient outcomes. Literature searches were conducted using a Summons Search Service platform; search criteria included a variety of methodologies, resulting in the identification of 95 papers relevant to the present review. Results Six themes emerged in the present narrative review using thematic analysis: organisational systems, workload, time pressure, teamwork, individual human factors and case complexity. This analysis highlights that clinical outcomes in emergency situations are the result of a variety of interconnecting factors. These factors may affect the ability of clinical staff in emergency situations to provide quality, safe care in a timely manner. Conclusions The challenge for researchers is to build the body of knowledge concerning the safe management of patients, particularly where clinicians are working under pressure. This understanding is important for developing pathways that optimise clinical decision making in uncertain and dynamic environments. What is known about the topic? Emergency departments (EDs) are characterised by high complexity, high throughput and greater uncertainty compared with routine hospital wards or out-patient situations, and the ED is therefore prone to unpredictable workflows and non-replicable conditions when presented with unique and complex cases. What does this paper add? Clinical decision making can be affected by pressures with complex origins, including organisational systems, workload, time constraints, teamwork, human factors and case complexity. Interactions between these factors at different levels of the decision-making process can increase the complexity of problems and the resulting decisions to be made. What are the implications for practitioners? The findings of the present study provide further evidence that consideration of medical errors should be seen primarily from a 'whole-of-system' perspective rather than as being primarily the responsibility of individuals. Although there are strategies in place in healthcare organisations to eliminate errors, they still occur. In order to achieve a better understanding of medical errors in clinical practice in times of uncertainty, it is necessary to identify how diverse pressures can affect clinical decisions, and how these interact to influence clinical outcomes.
Collapse
|
9
|
Alignment and mismatch in role relations at end-of-life: A constructivist grounded theory study. DEATH STUDIES 2019; 45:361-370. [PMID: 31397639 DOI: 10.1080/07481187.2019.1648330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In this Australian, constructivist grounded theory study, we undertook in-depth interviews with 11 dying people and 8 caregivers to examine their perspectives on role relations at end-of-life. We found that situations of role alignment between dying people and their family and friends support positive relational and practical outcomes, whereas role mismatch can cause considerable distress. Factors contributing to role mismatch at end-of-life were: dying people and their caregivers' efforts to shield each other from emotional harm; fear of social exclusion; and unwanted focus on the dying identity. Our findings highlight a need for flexibility and adaptability in end-of-life role relations.
Collapse
|
10
|
Proper or Improper Use of the Crossover Design in Clinical Trials in Chronic Sciatica?-Reply. JAMA Neurol 2019; 76:731-732. [PMID: 31034003 DOI: 10.1001/jamaneurol.2019.0873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
11
|
Molecular Evidence of Drug-Resistant Tuberculosis in the Balimo Region of Papua New Guinea. Trop Med Infect Dis 2019; 4:tropicalmed4010033. [PMID: 30744192 PMCID: PMC6473227 DOI: 10.3390/tropicalmed4010033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/07/2019] [Accepted: 02/08/2019] [Indexed: 12/02/2022] Open
Abstract
Papua New Guinea (PNG) has a high burden of tuberculosis (TB), including drug-resistant TB (DR-TB). DR-TB has been identified in patients in Western Province, although there has been limited study outside the provincial capital of Daru. This study focuses on the Balimo region of Western Province, aiming to identify the proportion of DR-TB, and characterise Mycobacterium tuberculosis (MTB) drug resistance-associated gene mutations. Sputum samples were investigated for MTB infection using published molecular methods. DNA from MTB-positive samples was amplified and sequenced, targeting the rpoB and katG genes to identify mutations associated with rifampicin and isoniazid resistance respectively. A total of 240 sputum samples were collected at Balimo District Hospital (BDH). Of these, 86 were classified as positive based on the results of the molecular assays. For samples where rpoB sequencing was successful, 10.0% (5/50, 95% CI 4.4–21.4%) were considered rifampicin-resistant through detection of drug resistance-associated mutations. We have identified high rates of presumptive DR-TB in the Balimo region of Western Province, PNG. These results emphasise the importance of further surveillance, and strengthening of diagnostic and treatment services at BDH and throughout Western Province, to facilitate detection and treatment of DR-TB, and limit transmission in this setting.
Collapse
|
12
|
Examining the transitions between living and dying roles at end-of-life. DEATH STUDIES 2018; 43:601-610. [PMID: 30285566 DOI: 10.1080/07481187.2018.1504836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/29/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Abstract
Improvements in the diagnosis and disclosure of dying mean that nowadays dying people typically live with an awareness of their status for longer than they have previously. However, little is known regarding how transitions between living and dying roles occur during this time. In this grounded theory study, we investigated role transitions at end-of-life. We found that dying people periodically foreground and background living and dying selfhoods, focus on living day-by-day and goal-by-goal and reframe dying roles with an orientation to living. We argue that with better understanding of role transitions at end-of-life more compassionate and responsive care becomes possible.
Collapse
|
13
|
The epidemiology of tuberculosis in the rural Balimo region of Papua New Guinea. Trop Med Int Health 2018; 23:1022-1032. [DOI: 10.1111/tmi.13118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
14
|
Pregabalin versus gabapentin in the treatment of sciatica: study protocol for a randomised, double-blind, cross-over trial (PAGPROS). Trials 2018; 19:21. [PMID: 29316960 PMCID: PMC5759865 DOI: 10.1186/s13063-017-2400-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/11/2017] [Indexed: 12/04/2022] Open
Abstract
Background There is currently an absence of high-grade evidence regarding the treatment of chronic sciatica (CS). Whilst gabapentin (GBP) and pregabalin (PGB) are both currently used to treat CS, equipoise exists regarding their individual use. In particular, no head-to-head study of GBP and PGB in CS exists. Despite equipoise, most countries’ formulary regulatory authorities typically favour one drug for subsidy over the other. This hinders interchange wherever the favoured drug is either ineffective or not tolerated. The primary aim of this study is to conduct a head-to-head comparison of the efficacy of PGB versus GBP for CS based on outcomes on a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Methods/design We are conducting a prospective, randomised, double-blind, double-dummy cross-over study. Included patients will be over 18 years old and have unilateral CS with radiological confirmation of corresponding neural compression/irritation. Pregnant women, those with major organ disease, or those with creatinine clearance < 60 ml/minute will be excluded. Patients will continue their current pain medication at study onset, conditional upon dosage consistency during the prior 30 days. Each drug will be titrated up to a target dose (GBP 400–800 mg three times daily, PGB 150–300 mg twice daily) and taken for 8 weeks. The first drug will then be ceased; however, cross-over will be deferred pending a 1-week washout period. Drug efficacy will be assessed using the VAS and ODI. Results of the Health Locus of Control Scale and side effect frequency/severity will be used to determine psychological functioning. Assuming the hypothesis that PGB will display a superior effect, the sample size required is n = 38 with 80% power and a 5% type I error rate. Results will be analysed via intention-to-treat methodology. Discussion This study will establish the efficacy of PGB compared with GBP in reducing pain in people with sciatica and lead to greater understanding of the treatment options available. Trial registration Australian and New Zealand Clinical Trials Registry, 12613000559718. Registered on 17 May 2013. Electronic supplementary material The online version of this article (10.1186/s13063-017-2400-y) contains supplementary material, which is available to authorized users.
Collapse
|
15
|
Exploring the Contemporary Stage and Scripts for the Enactment of Dying Roles: A Narrative Review of the Literature. OMEGA-JOURNAL OF DEATH AND DYING 2017; 76:328-350. [PMID: 29284312 DOI: 10.1177/0030222817696541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This narrative review explores the literature regarding the drama of dying from several academic perspectives. Three key themes were identified including "The impact of blurred boundaries on roles and transitions," "The orchestration of death and dying through time," and "Contemporary dying and new machinery of control." This review reveals the manner in which tightly scripted dying roles serve the needs of the living to a greater extent than those of the dying, by ensuring the depiction of both dying and death as phenomena which have been brought under the control of the living, thereby countering death anxiety. An incongruence between the actual experience of dying and contemporary dying scripts is also highlighted. The authors argue that this incongruence is hidden from the broader societal audience through the maintenance of a dying role that demands serenity and acceptance, thus downplaying or even hiding the actual end-of-life experiences of the dying themselves.
Collapse
|
16
|
|
17
|
What’s the attraction? The role of performance enhancement as a driver of recreational drug use. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1394381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
18
|
Formaldehyde in the Tropical Western Pacific: Chemical sources and sinks, convective transport, and representation in CAM-Chem and the CCMI models. JOURNAL OF GEOPHYSICAL RESEARCH. ATMOSPHERES : JGR 2017. [PMID: 29527424 DOI: 10.1002/2017ja024474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Formaldehyde (HCHO) directly affects the atmospheric oxidative capacity through its effects on HOx. In remote marine environments, such as the Tropical Western Pacific (TWP), it is particularly important to understand the processes controlling the abundance of HCHO because model output from these regions is used to correct satellite retrievals of HCHO. Here, we have used observations from the CONTRAST field campaign, conducted during January and February 2014, to evaluate our understanding of the processes controlling the distribution of HCHO in the TWP as well as its representation in chemical transport/climate models. Observed HCHO mixing ratios varied from ~500 pptv near the surface to ~75 pptv in the upper troposphere. Recent convective transport of near surface HCHO and its precursors, acetaldehyde and possibly methyl hydroperoxide, increased upper tropospheric HCHO mixing ratios by ~33% (22 pptv); this air contained roughly 60% less NO than more aged air. Output from the CAM-Chem chemistry transport model (2014 meteorology) as well as nine chemistry climate models from the Chemistry-Climate Model Initiative (free-running meteorology) are found to uniformly underestimate HCHO columns derived from in situ observations by between 4 and 50%. This underestimate of HCHO likely results from a near factor of two underestimate of NO in most models, which strongly suggests errors in NOx emissions inventories and/or in the model chemical mechanisms. Likewise, the lack of oceanic acetaldehyde emissions and potential errors in the model acetaldehyde chemistry lead to additional underestimates in modeled HCHO of up to 75 pptv (~15%) in the lower troposphere.
Collapse
|
19
|
Formaldehyde in the Tropical Western Pacific: Chemical sources and sinks, convective transport, and representation in CAM-Chem and the CCMI models. JOURNAL OF GEOPHYSICAL RESEARCH. ATMOSPHERES : JGR 2017; 122:11201-11226. [PMID: 29527424 PMCID: PMC5839129 DOI: 10.1002/2016jd026121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Formaldehyde (HCHO) directly affects the atmospheric oxidative capacity through its effects on HOx. In remote marine environments, such as the Tropical Western Pacific (TWP), it is particularly important to understand the processes controlling the abundance of HCHO because model output from these regions is used to correct satellite retrievals of HCHO. Here, we have used observations from the CONTRAST field campaign, conducted during January and February 2014, to evaluate our understanding of the processes controlling the distribution of HCHO in the TWP as well as its representation in chemical transport/climate models. Observed HCHO mixing ratios varied from ~500 pptv near the surface to ~75 pptv in the upper troposphere. Recent convective transport of near surface HCHO and its precursors, acetaldehyde and possibly methyl hydroperoxide, increased upper tropospheric HCHO mixing ratios by ~33% (22 pptv); this air contained roughly 60% less NO than more aged air. Output from the CAM-Chem chemistry transport model (2014 meteorology) as well as nine chemistry climate models from the Chemistry-Climate Model Initiative (free-running meteorology) are found to uniformly underestimate HCHO columns derived from in situ observations by between 4 and 50%. This underestimate of HCHO likely results from a near factor of two underestimate of NO in most models, which strongly suggests errors in NOx emissions inventories and/or in the model chemical mechanisms. Likewise, the lack of oceanic acetaldehyde emissions and potential errors in the model acetaldehyde chemistry lead to additional underestimates in modeled HCHO of up to 75 pptv (~15%) in the lower troposphere.
Collapse
|
20
|
Zika virus infection and Commonwealth Games 2018 on the Gold Coast, Australia. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
21
|
Motivations and Barriers to Treatment Uptake and Adherence Among People Living with HIV in Australia: A Mixed-Methods Systematic Review. AIDS Behav 2017; 21:352-385. [PMID: 27826734 DOI: 10.1007/s10461-016-1598-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In Australia, approximately 30% of people diagnosed with HIV are not accessing treatment and 8% of those receiving treatment fail to achieve viral suppression. Barriers limiting effective care warrant further examination. This mixed-methods systematic review accessed health and social sector research databases between November and December 2015 to identify studies that explored the perspective of people living with HIV in Australia. Articles were included for analysis if they described the experiences, knowledge, attitudes and beliefs, in relation to treatment uptake and adherence, published between January 2000 and December 2015. Quality appraisal utilised the Mixed Methods Appraisal Tool Version 2011. Seventy-two studies that met the inclusion criteria were reviewed. The interplay of lack of knowledge, fear, stigma, physical, emotional and social issues were found to negatively impact treatment uptake and adherence. Strategies targeting both the individual and the wider community are needed to address these barriers.
Collapse
|
22
|
The social determinants of tuberculosis treatment adherence in a remote region of Papua New Guinea. BMC Public Health 2017; 17:70. [PMID: 28086845 PMCID: PMC5237215 DOI: 10.1186/s12889-016-3935-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Papua New Guinea (PNG) is a diverse and culturally-rich country with severe infrastructural and health problems. Tuberculosis (TB) is widespread, and the number of cases with drug resistance is rising. Treatment adherence is known to be important for both effective treatment and limiting the emergence of drug resistance. The aim of this study was to construct a matrix of the factors that act as facilitators or barriers to TB treatment adherence in a remote region of PNG. Methods The study was based in the Balimo region of the Western Province. People known to have undergone TB treatment, as well as staff involved in managing people with TB, were asked to participate in an in-depth interview about their experiences. Purposive sampling was used to identify a diverse range of participants, from different geographic locations, social backgrounds, and with successful and unsuccessful treatment outcomes. The interview data was analysed based on grounded theory methodology. Results The study identified a range of factors that influence TB treatment adherence, with these being classified as personal, systems, and sociocultural. These factors are presented along with suggested recommendations for adaptations to DOTS-based treatment in this region. Barriers included the challenges associated with travel to treatment sites, and the difficulties of undertaking treatment alongside the daily need to maintain subsistence food production. However, facilitators were also identified, including the positive influence of religious beliefs, and high confidence in the ability of DOTS-based treatment to cure TB. Conclusions Documenting the wide range of factors that influence treatment adherence in a severely affected remote population will assist in improving TB control. These results provide impetus for further community-based efforts aimed at improving access to TB diagnosis and treatment, and maintaining successful treatment outcomes in the face of emerging drug resistance. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3935-7) contains supplementary material, which is available to authorized users.
Collapse
|
23
|
Grounded theory - a lens to understanding clinical reasoning. MEDEDPUBLISH 2017; 6:2. [PMID: 38406475 PMCID: PMC10885213 DOI: 10.15694/mep.2017.000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Clinical reasoning is fundamental to medical education and clinical practice ( Schmidt & Mamede, 2015). Despite its centrality, clinical reasoning is often regarded as difficult to conceptualise and teach ( Charlin, 2012; Pinnock & Welch, 2014). The pivotal role of clinical reasoning constitutes a compelling case for better understanding, more efficient teaching and practice that is more systematic and evidence-based. Clinical reasoning has been regarded as an art rather than a science ( Braude, 2012) and has attracted less research effort than befits its important function. The authors examined the suitability of grounded theory methodology to provide a more complete understanding of the clinical reasoning process. Grounded theory and clinical reasoning are processes which both qualitatively evaluate and analyse information from an interview subject as well as additional sources and arrive at a robust, defensible theory to explain their findings. Grounded theory offers considerable utility for (i) understanding and modelling clinical reasoning, (ii) researching clinical reasoning and (iii) as a heuristic for teaching clinical reasoning skills. This paper explores the parallels between grounded theory methodology and clinical reasoning, as well as the suitability of grounded theory as a framework for informing and transforming our understanding of clinical reasoning.
Collapse
|
24
|
Tracheal Malplacement of the King LT Airway May Be an Important Cause of Prehospital Device Failure. J Emerg Med 2016; 51:e133-e135. [DOI: 10.1016/j.jemermed.2016.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022]
|
25
|
JET Tokamak, preparation of a safety case for tritium operations. FUSION ENGINEERING AND DESIGN 2016. [DOI: 10.1016/j.fusengdes.2015.12.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Abstract
All patients presenting to an MR Imaging Centre during the periods of study, either in 1988 or 1991, have had their records of signs, symptoms and history prior to scanning reviewed, all abnormal MR images archived and an attempt has been made to follow their subsequent course up to the allocation of a confirmed or working diagnosis by their physicians and surgeons. Using a detailed, menu-driven, computer-based dialogue, abnormal images have been described, blind to all other data, in order to identify image features that may be significant in discriminating between diagnoses. This preliminary study addresses the differential diagnosis of multiple sclerosis from cerebrovascular disease, a problem often confounded by the similar multi-centric, multi-episode clinical presentation. Although the numbers starting with similar clinical presentation, with confirmed or working diagnosis at an acceptable level of certainty, and with completed image descriptions are small (45 Multiple Sclerosis, 6 Cerebrovascular disease), there are strong indications that certain MR image features are more helpful than is generally realised. The association of these features during statistical analysis may improve differential diagnostic certainty. Attention is drawn to the detailed appearances of individual lesions, the prevalence of one or more lesion types in individual patients, the sizes of lesions and the association of lesions affecting arcuate fibres with those affecting grey matter.
Collapse
|
27
|
Becoming a clinician researcher in allied health. AUST HEALTH REV 2016; 40:562-569. [DOI: 10.1071/ah15174] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/12/2015] [Indexed: 11/23/2022]
Abstract
Objective
Combining research with clinical practice has benefits for health services and practitioners. There is limited information available on strategies used by health professionals to balance research with high clinical service demands. The aims of the present study were to examine how research is initiated and to identify the factors that influence the successful integration of research into a clinical work role.
Methods
Semistructured recursive-style interviews were conducted with 15 research-active allied health professionals at regional health services using a combination of criterion and purposive sampling. Interviews were recorded, transcribed and analysed using constant comparative techniques to identify dominant themes, which were integrated to create a conceptual model.
Results
Becoming a clinician researcher involved four phases: (1) a research debut; (2) building momentum; (3) developing a track record; and (4) becoming an established clinician researcher. A research debut was enabled by pre-entry exposure to research or through quality activities, predisposing personal characteristics and research opportunities at work. Quarantined time for research, a research-friendly workplace culture and supportive research relationships enabled a clinician to thrive as a researcher despite the challenges.
Conclusion
The clinician researcher career trajectory contributes to a better understanding of how a research career commences and develops in clinical settings. It may assist to develop strategies to support research capacity building.
What is known about the topic?
There are potential benefits for clinicians and health services that flow from incorporating research into clinical roles. Factors that motivate, enable and constrain allied health research in clinical settings have been identified, but little is known about how a research career is initiated and progresses over time.
What does this paper add?
The present study contributes an important career path understanding to the successful development of research capacity from a clinician perspective. The clinician researcher career trajectory delineates four phases and identifies enabling and constraining factors. The study highlights the combination of factors that can initiate a research debut and lead clinicians to thrive as researchers.
What are the implications for practitioners?
Conducting research can provide an opportunity for a professional challenge and increased job satisfaction. A research-friendly environment, supportive research relationships and quarantined time for research contribute to research output in clinical settings.
Collapse
|
28
|
The effect of future ambient air pollution on human premature mortality to 2100 using output from the ACCMIP model ensemble. ATMOSPHERIC CHEMISTRY AND PHYSICS 2016; 16:9847-9862. [PMID: 29250104 PMCID: PMC5730074 DOI: 10.5194/acp-16-9847-2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Ambient air pollution from ground-level ozone and fine particulate matter (PM2.5) is associated with premature mortality. Future concentrations of these air pollutants will be driven by natural and anthropogenic emissions and by climate change. Using anthropogenic and biomass burning emissions projected in the four Representative Concentration Pathway scenarios (RCPs), the ACCMIP ensemble of chemistry-climate models simulated future concentrations of ozone and PM2.5 at selected decades between 2000 and 2100. We use output from the ACCMIP ensemble, together with projections of future population and baseline mortality rates, to quantify the human premature mortality impacts of future ambient air pollution. Future air pollution-related premature mortality in 2030, 2050 and 2100 is estimated for each scenario and for each model using a health impact function based on changes in concentrations of ozone and PM2.5 relative to 2000 and projected future population and baseline mortality rates. Additionally, the global mortality burden of ozone and PM2.5 in 2000 and each future period is estimated relative to 1850 concentrations, using present-day and future population and baseline mortality rates. The change in future ozone concentrations relative to 2000 is associated with excess global premature mortality in some scenarios/periods, particularly in RCP8.5 in 2100 (316 thousand deaths/year), likely driven by the large increase in methane emissions and by the net effect of climate change projected in this scenario, but it leads to considerable avoided premature mortality for the three other RCPs. However, the global mortality burden of ozone markedly increases from 382,000 (121,000 to 728,000) deaths/year in 2000 to between 1.09 and 2.36 million deaths/year in 2100, across RCPs, mostly due to the effect of increases in population and baseline mortality rates. PM2.5 concentrations decrease relative to 2000 in all scenarios, due to projected reductions in emissions, and are associated with avoided premature mortality, particularly in 2100: between -2.39 and -1.31 million deaths/year for the four RCPs. The global mortality burden of PM2.5 is estimated to decrease from 1.70 (1.30 to 2.10) million deaths/year in 2000 to between 0.95 and 1.55 million deaths/year in 2100 for the four RCPs, due to the combined effect of decreases in PM2.5 concentrations and changes in population and baseline mortality rates. Trends in future air pollution-related mortality vary regionally across scenarios, reflecting assumptions for economic growth and air pollution control specific to each RCP and region. Mortality estimates differ among chemistry-climate models due to differences in simulated pollutant concentrations, which is the greatest contributor to overall mortality uncertainty for most cases assessed here, supporting the use of model ensembles to characterize uncertainty. Increases in exposed population and baseline mortality rates of respiratory diseases magnify the impact on premature mortality of changes in future air pollutant concentrations and explain why the future global mortality burden of air pollution can exceed the current burden, even where air pollutant concentrations decrease.
Collapse
|
29
|
Comparison of research experience and support needs of rural versus regional allied health professionals. Aust J Rural Health 2015; 23:277-85. [PMID: 26381792 DOI: 10.1111/ajr.12234] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We compared the research experience or support needs of allied health professionals in rural versus regional cities to identify if they were the same or different. DESIGN Descriptive study using a cross sectional survey. SETTING This study was carried within Queensland Health's northern six health services. PARTICIPANTS Queensland health staff classified as Health Practitioners. INTERVENTIONS This survey was conducted as part of a research capacity building initiative within Queensland Health to increase AHPs' participation in research in regional cities and rural areas of Queensland. MAIN OUTCOME MEASURES Questions in the survey identified demographics, research experience, need for research support, research knowledge and beliefs about research. Data were compared using Chi-square and t-tests. RESULTS The total response rate was 54.5% with 18% of the HPs located in rural communities of less than 5000 people and the rest from the three major cities in northern Queensland. Rural HPs have less research experience in most research activities than regional city HPs and need more research support. Rural HPs have more qualitative research experience than regional city HPs and research is perceived positively by both. Barriers to conducting research were similar across both groups and included insufficient time, lack of staff and no statistical support. CONCLUSION Rural HPs are younger and have less research experience than their counterparts working in regional cities. Therefore, building rural HP research capacity initiatives may require more access to facilitators such as the Research Fellows.
Collapse
|
30
|
Parents' Experiences of Health Care for Their Children With Cerebral Palsy. QUALITATIVE HEALTH RESEARCH 2015; 25:1139-1154. [PMID: 25711842 DOI: 10.1177/1049732315570122] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Although current health care service delivery approaches for children with cerebral palsy recognize the importance of including parents in the health care of their child, we do not yet understand how parents experience this phenomenon. In this study, we used grounded theory methodology to explore parents' experiences of health care for their children with cerebral palsy living in a regional area of Australia. Our findings indicate that parents experience health care for their child as a cyclical process of "making the most of their body and their life." Important aspects of care include "learning as you go," "navigating the systems," "meeting needs through partnership," "being empowered or disempowered," and "finding a balance." We suggest modifications to health care service delivery practices that might contribute to improved experiences of health care for this population.
Collapse
|
31
|
Delivering healthcare services to children with cerebral palsy and their families: a narrative review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2015; 23:242-251. [PMID: 25175322 DOI: 10.1111/hsc.12121] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
Children with cerebral palsy have complex healthcare needs and often require complex multidisciplinary care. It is important for clinicians to understand which approaches to healthcare service delivery for this population are supported in the literature and how these should be applied in clinical practice. This narrative review aims to identify and review the evidence for current approaches to healthcare service delivery for children with cerebral palsy. Databases were searched using key terms to identify relevant research articles and grey literature from December 2011 to September 2013. Search results were screened and sorted according to inclusion and exclusion criteria. Thirty-two documents were included for evaluation and their content was analysed thematically. Three current approaches to healthcare service delivery for children with cerebral palsy identified in this narrative review were family-centred care, the World Health Organisation's International Classification of Functioning, Disability and Health, and collaborative community-based primary care. However, healthcare services for children with cerebral palsy and their families are inconsistently delivered according to these approaches and the identified guidelines or standards of care for children with cerebral palsy have limited incorporation of these approaches. Future research is required to investigate how these approaches to healthcare service delivery can be integrated into clinical practices to enable clinicians to improve services for this population.
Collapse
|
32
|
|
33
|
|
34
|
|
35
|
Positioning occupational therapy as a discipline on the research continuum: results of a cross-sectional survey of research experience. Aust Occup Ther J 2013; 60:241-51. [PMID: 23888974 DOI: 10.1111/1440-1630.12057] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND/AIM Evidence-based practice and research are beginning and endpoints on a research continuum. Progression along the continuum builds research capacity. Occupational Therapy has a low evidence base, thus, clinicians are not implementing evidence-based practice or publishing research. Barriers to implementing evidence-based practice and engaging in research include a lack of confidence. This research gauged Occupational Therapists' research experience, support needs and barriers, and compared levels of research anxiety between allied health disciplines. METHODS A cross-sectional survey was sent to Health Practitioners in northern Queensland in May-June 2011. Responses about experience, support needs and barriers, between Occupational Therapists, were analysed using Chi-square 'goodness of fit' tests. Multivariate analysis compared responses between disciplines about research anxiety. This paper reports results for the subset of Occupational Therapists. RESULTS The whole population, consisting of 152 Occupational Therapists, was sent a questionnaire, from which 86 responded. More Occupational Therapists than not had experience of evidence-based practice and less support was required, but they had little experience of producing research and required more support. The amount of support required for activities along the research continuum was inversely related to the level of experience in these tasks. Barriers included lack of staff and time. Occupational Therapists were more anxious about research (53 of 79, 67%) than all other Health Practitioner disciplines combined (170 of 438, 39%, P < 0.0001). CONCLUSION A cohesive strategy should focus on consolidating Occupational Therapists' evidence-based practice skills and building confidence. Clinicians wishing to engage in research need access to academic support. Academics and clinicians should work closely to produce clinically relevant research.
Collapse
|
36
|
Randomized clinical trial of the effect of supplemental opioids in procedural sedation with propofol on serum catecholamines. Acad Emerg Med 2013; 20:330-7. [PMID: 23701339 DOI: 10.1111/acem.12110] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/03/2012] [Accepted: 10/05/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The objective was to assess the effect on stress biomarkers of supplemental opioid to a standard propofol dosing protocol for emergency department (ED) procedural sedation (PS). The hypothesis was that there is no difference in the change in serum catecholamines between PS using propofol with or without supplemental alfentanil. METHODS This was a randomized, nonblinded pilot study of adult patients undergoing PS in the ED for the reduction of fractures and dislocations. Patients with pain before the procedure were treated with intravenous (IV) morphine sulfate until their pain was adequately treated for at least 20 minutes before starting the procedure. Patients were randomized to receive either 10 μg/kg alfentanil followed by 1 mg/kg propofol, followed by 0.5 mg/kg every 3 minutes as needed, or propofol only, dosed in similar fashion without supplemental alfentanil. Doses, vital signs, nasal end-tidal CO2 (ETCO2), pulse oximetry, and bispectral electroencephalogram (EEG) analysis scores were recorded. Subclinical respiratory depression was defined as a change in ETCO2 > 10 mm Hg, an oxygen saturation of < 92% at any time, or an absent ETCO2 waveform at any time. Clinical events related to respiratory depression were noted during the procedure, including the addition of or increase in the flow rate of supplemental oxygen, the use of a bag-valve-mask apparatus, airway repositioning, or stimulation to induce breathing. Blood was drawn 1 minute prior to the administration of the medications for PS and again 1 minute after completion of the procedure for which the patient was sedated. Serum was tested for total catecholamines, epinephrine, norepinephrine, and dopamine. Postprocedure, patients were asked to report any pain perceived during the procedure. Data were analyzed using descriptive statistics, Wilcoxon rank sum tests, and chi-square tests, as appropriate. RESULTS Twenty patients were enrolled; 10 received propofol and 10 received propofol with alfentanil. No clinically significant complications were noted. Subclinical respiratory depression was seen in four of 10 (40%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -10%, 95% confidence interval [CI] = -53% to 33%). There was no difference in the rate of clinical signs of respiratory depression between the two groups. Pain during the procedure was reported by two of 10 (20%) patients in the propofol group and five of 10 (50%) patients in the propofol/alfentanil group (effect size = -30%, 95% CI = -70% to 10%). Recall of some part of the procedure was reported by 0 of 10 (0%) patients in the propofol group and five of 10 (50%) of patients in the propofol/alfentanil group (effect size = -50%, 95% CI = -81% to -19%). There was no difference in the baseline or postprocedure catecholamine levels between the groups. CONCLUSIONS No difference in serum catecholamines was detected immediately after PS between patients who receive propofol with and without supplemental opioid in this small pilot study. PS using propofol only without supplemental opioid did not appear to induce markers of physiologic stress in this small pilot study.
Collapse
|
37
|
How countries cope with competing demands and expectations: perspectives of different stakeholders on priority setting and resource allocation for health in the era of HIV and AIDS. BMC Public Health 2012; 12:1071. [PMID: 23231820 PMCID: PMC3549279 DOI: 10.1186/1471-2458-12-1071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 11/13/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health systems have experienced unprecedented stress in recent years, and as yet no consensus has emerged as to how to deal with the multiple burden of disease in the context of HIV and AIDS and other competing health priorities. Priority setting is essential, yet this is a complex, multifaceted process. Drawing on a study conducted in five African countries, this paper explores different stakeholders' perceptions of health priorities, how priorities are defined in practice, the process of resource allocation for HIV and Health and how different stakeholders perceive this. METHODS A sub-analysis was conducted of selected data from a wider qualitative study that explored the interactions between health systems and HIV and AIDS responses in five sub-Saharan countries (Burkina Faso, the Democratic Republic of Congo, Ghana, Madagascar and Malawi). Key background documents were analysed and semi-structured interviews (n = 258) and focus group discussions (n = 45) were held with representatives of communities, health personnel, decision makers, civil society representatives and development partners at both national and district level. RESULTS Health priorities were expressed either in terms of specific health problems and diseases or gaps in service delivery requiring a strengthening of the overall health system. In all five countries study respondents (with the exception of community members in Ghana) identified malaria and HIV as the two top health priorities. Community representatives were more likely to report concerns about accessibility of services and quality of care. National level respondents often referred to wider systemic challenges in relation to achieving the Millennium Development Goals (MDGs). Indeed, actual priority setting was heavily influenced by international agendas (e.g. MDGs) and by the ways in which development partners were supporting national strategic planning processes. At the same time, multi-stakeholder processes were increasingly used to identify priorities and inform sector-wide planning, whereby health service statistics were used to rank the burden of disease. However, many respondents remarked that health system challenges are not captured by such statistics.In all countries funding for health was reported to fall short of requirements and a need for further priority setting to match actual resource availability was identified. Pooled health sector funds have been established to some extent, but development partners' lack of flexibility in the allocation of funds according to country-generated priorities was identified as a major constraint. CONCLUSIONS Although we found consensus on health priorities across all levels in the study countries, current funding falls short of addressing these identified areas. The nature of external funding, as well as programme-specific investment, was found to distort priority setting. There are signs that existing interventions have had limited effects beyond meeting the needs of disease-specific programmes. A need for more comprehensive health system strengthening (HSS) was identified, which requires a strong vision as to what the term means, coupled with a clear strategy and commitment from national and international decision makers in order to achieve stated goals. Prospective studies and action research, accompanied by pilot programmes, are recommended as deliberate strategies for HSS.
Collapse
|
38
|
Complexity and Workload of Cytotoxic Manufacturing at a Regional Hospital: A Comparative Study. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2012. [DOI: 10.1002/j.2055-2335.2012.tb00168.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
39
|
|
40
|
|
41
|
Alfentanil for Procedural Sedation in the Emergency Department. Ann Emerg Med 2011; 57:117-21. [DOI: 10.1016/j.annemergmed.2010.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 07/28/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
|
42
|
Decline and recovery of total column ozone using a multimodel time series analysis. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2010jd013857] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
43
|
Multimodel assessment of the upper troposphere and lower stratosphere: Tropics and global trends. ACTA ACUST UNITED AC 2010. [DOI: 10.1029/2009jd013638] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
44
|
|
45
|
Religious Attitudes, Homophobia, and Professional Counseling. JOURNAL OF LGBTQ ISSUES IN COUNSELING 2010. [DOI: 10.1080/15538605.2010.481961] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Silenced voices: hearing the stories of parents bereaved through the suicide death of a young adult child. HEALTH & SOCIAL CARE IN THE COMMUNITY 2010; 18:241-248. [PMID: 19793388 DOI: 10.1111/j.1365-2524.2009.00886.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The current paper reports findings from a qualitative research project that aimed to explore parents' experiences following the suicide death of their young adult child. Twenty-two Australian parents told of the suicide death of their son or daughter during the data collection period (2003 to late 2004). One narrative theme drawn from the interview data is reported here: the way in which suicide-bereaved parents feel unable to talk about their child's life and death, their experience of suicide and their resultant bereavement. Parents reported being silenced by others and silencing themselves in relation to talking about their bereavement. Parents' private stories are used to explain the difficulties they faced given the contemporary social and cultural context of grief and suicide. Then follows an examination of the impact these difficulties had on their ongoing grief narrative and availability of social support. Implications for health and social care intervention are presented to assist in better preparing support workers in their interactions with parents bereaved in this manner.
Collapse
|
47
|
|
48
|
|
49
|
Method: Factors associated with bulk billing: experience from a general practitioners' survey in New South Wales. Aust N Z J Public Health 2008; 28:135-9. [PMID: 15233352 DOI: 10.1111/j.1467-842x.2004.tb00926.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess whether some demographic and practice characteristics of general practitioners (GPs) are associated with the use of bulk billing. METHODS A cross-sectional postal survey was conducted in late 2002 with a 15% stratified random sample, based on sex and area of practice, of currently practising GPs in New South Wales. Multinomial logistic regression was used to look at GPs' characteristics associated with their self-reported use of bulk billing. RESULTS Of the 494 GPs who participated in the study, 44% bulk billed for all patient consultations, 34% for selective patients, while 22% did not bulk bill for any patient. Multivariate analysis revealed that GPs practising in metropolitan areas were six times more likely to bulk bill for all patients compared with GPs in rural areas (OR 6.7, 95% CI 3.8-11.9). Overseas-trained GPs were twice as likely to bulk bill for all patients compared with locally trained GPs (OR 2.3, 95% CI 1.2-4.3). The likelihood of bulk billing for all patients also increased with an increase in GPs' caseload. CONCLUSIONS This paper discusses some of the policy and programmatic implications of the changing pattern of bulk billing. Special efforts are needed to provide increased practice support for GPs in rural and remote areas in order to ensure affordable and accessible GP services.
Collapse
|
50
|
Abstract
Summary The aims of the present study were to explore aspects of sexually transmissible infections (STI) prevention in general practice and to examine general practitioners' (GPs) perceived barriers to sexual-health promotion. The data from a postal survey of 409 GPs practising in New South Wales, Australia (response rate 45.4%) are analysed to explore the prevention of STI in general practice and to examine practitioners' perceived barriers to sexual-health promotion. About 49% of GPs reported having STI leaflets/pamphlets for patients in their clinic, while 21% had posters on STI displayed in their waiting room. Two-third (67%) of GPs provided STI-specific printed materials/leaflets to patients with STI. Female GPs were more likely to be proactive in STI prevention. Time and funding appear to be the major barriers to sexual-health promotion, followed by inadequate access to counselling. One-fifth (22%) of GPs felt that they had little influence in changing patients' risk behaviour, while about 28% emphasized the need for further preventive care training. The present study identifies inconsistencies in STI-prevention activities in general practice along with barriers to undertake sexual-health promotion. This area warrants further attention if GPs are to contribute fully to the control of STI.
Collapse
|