The effect of umbilical cord cleansing with chlorhexidine on omphalitis and neonatal mortality in community settings in developing countries: a meta-analysis.

BACKGROUND: There is an increased risk of serious neonatal infection arising through exposure of the umbilical cord to invasive pathogen in home and facility births where hygienic practices are difficult to achieve. The World Health Organization currently recommends 'dry cord care' because of insufficient data in favor of or against topical application of an antiseptic. The primary objective of this meta-analysis is to evaluate the effects of application of chlorhexidine (CHX) to the umbilical cord to children born in low income countries on cord infection (omphalitis) and neonatal mortality. Standardized guidelines of Child Health Epidemiology Reference Group (CHERG) were followed to generate estimates of effectiveness of topical chlorhexidine application to umbilical cord for prevention of sepsis specific mortality, for inclusion in the Lives Saved Tool (LiST). METHODS: Systematic review and meta-analysis. Data sources included Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, PubMed, CINHAL and WHO international clinical trials registry. Only randomized trials were included. Studies of children in hospital settings were excluded. The comparison group received no application to the umbilical cord (dry cord care), no intervention, or a non-CHX intervention. Primary outcomes were omphalitis and all-cause neonatal mortality. RESULTS: There were three cluster-randomised community trials (total participants 54,624) conducted in Nepal, Bangladesh and Pakistan that assessed impact of CHX application to the newborn umbilical cord for prevention of cord infection and mortality. Application of any CHX to the umbilical cord of the newborn led to a 23% reduction in all-cause neonatal mortality in the intervention group compared to control [RR 0.77, 95 % CI 0.63, 0.94; random effects model, I2=50 %]. The reduction in omphalitis ranged from 27 % to 56 % compared to control group depending on severity of infection. Based on CHERG rules, effect size for all-cause mortality was used for inclusion to LiST model as a proxy for sepsis specific mortality. CONCLUSIONS: Application of CHX to newborn umbilical cord can significantly reduce incidence of umbilical cord infection and all-cause mortality among home births in community settings. This inexpensive and simple intervention can save a significant number of newborn lives in developing countries

Implementing strategies in consumer and community engagement in health care: Results of a large-scale, scoping meta-review

© 2014 Sarrami-Foroushani et al.; licensee BioMed Central Ltd. Background: There is growing recognition of the importance of the active involvement of consumers and community members in health care. Despite the long history of consumer and community engagement (CCE) research and practice, there is no consensus on the best strategies for CCE. In this paper, we identify various dimensions of CCE-related strategies and offer a practical model to assist policy-makers, practitioners and researchers. Methods: We undertook a large-scale, scoping meta-review and searched six databases using a list of nine medical subject headings (MeSH) and a comprehensive list of 47 phrases. We identified and examined a total of 90 relevant systematic reviews. Results: Identified reviews show that although there is a significant body of research on CCE, the development of the field is hindered by a lack of evidence relating to specific elements of CCE. They also indicate a diverse and growing enterprise, drawing on a wide range of disciplinary, political and philosophical perspectives and a mix of definitions, targets, approaches, strategies and mechanisms. CCE interventions and strategies aim to involve consumers, community members and the public in general, as well as specific sub-groups, including children and people from culturally and linguistically diverse backgrounds. Strategies for CCE vary in terms of their aim and type of proposed activity, as do the methods and tools which have been developed to support them. Methods and tools include shared decision making, use of decision aids, consumer representation, application of electronic and internet-based facilities, and peer support. The success of CCE is dependent on both the approach taken and contextual factors, including structural facilitators such as governmental support, as well as barriers such as costs, organisational culture and population-specific limitations. Conclusions: The diversity of the field indicates the need to measure each component of CCE. This meta-review provides the basis for development of a new eight stage model of consumer and community engagement. This model emphasises the importance of clarity and focus, as well as an extensive evaluation of contextual factors within specific settings, before the implementation of CCE strategies, enabling those involved in CCE to determine potential facilitators and barriers to the process

Knowledge modelling for integrating semantic web services in e-government applications

Service integration and domain interoperability are the basic requirements in the development of current service-oriented e-Government applications. Semantic Web and, in particular, Semantic Web Service (SWS) technology aim to address these issues. However, the integration between e-Government applications and SWS is not an easy task. We argue that a more complex semantic layer needs to be modeled. The aim of our work is to provide an ontological framework that maps such a semantic layer. In this paper, we describe our approach for creating a project-independent and reusable model, and provide a case study that demonstrates its applicability

How to use the International Classification of Functioning, Disability and Health as a reference system for comparative evaluation and standardized reporting of rehabilitation interventions

Rehabilitation aims to optimize functioning of persons experiencing functioning limitations. As such the comparative evaluation of rehabilitation interventions relies on the analysis of the differences between the change in patient functioning after a specific rehabilitation intervention versus the change following another intervention. A robust health information reference system that can facilitate the comparative evaluation of changes in functioning in rehabilitation studies and the standardized reporting of rehabilitation interventions is the International Classification of Functioning, Disability and Health (ICF). The objective of this paper is to present recommendations that Cochrane Rehabilitation could adopt for using the ICF in rehabilitation studies by: 1) defining the functioning categories to be included in a rehabilitation study; 2) specifying selected functioning categories and selecting suitable data collection instruments; 3) examining aspects of functioning that have been documented in a study; 4) reporting functioning data collected with various data collection instruments; and 5) communicating results in an accessible, meaningful and easily understandable way. The authors provide examples of concrete studies that underscore these recommendations, whereby also em-phasizing the need for future research on the implementation of specific recommendations, e.g. in meta-analysis in systematic literature reviews. Furthermore, the paper outlines how the ICF can complement or be integrated in established Cochrane and rehabilitation research structures and methods, e.g. use of standard mean difference to compare cross-study data collected using different measures, in developing core outcome sets for rehabilitation, and the use of the PICO model. © 2019 EDIZIONI MINERVA MEDICA

Transcendental Pragmatics and Hermeneutics

Abstract: In which sense could transcendental pragmatics combined with a hermeneutical approach provide the social sciences with a critical oriented approach? This essay aims at giving an answer to that question by elaborating the critical intent of Apel"s approach to transcendental pragmatics and hermeneutics. Hermeneutics itself is considered to have critical potentials by its explicit focus upon the normative presuppositions of the social sciences. Hermeneutics does not, however, provide the sciences with any clear-cut criterions of critique. Nor does hermeneutics escape from a certain relativistic strain, due to the contextual, i.e.; socio-historically relative basis of the normative presuppositions of any hermeneutic approach. The meta-normative conditions of transcendental pragmatics are counterpoising the relativism as well as lack of normative criterions inherent in hermeneutical thinking. The meta-normative conditions of symmetry and reciprocity are meant to be a meta-normative standard for critique as well as functioning as conditions of a valid consensus within a community of scientists. Thereby, Apel is giving a solution to the validation-problem, as well as a compensation for the lack of criterions of criticism within hermeneutics. I will divide the essay into three main topics, and i) start with explicating the transcendental-pragmatic approach of Apel, ii) continue by dealing with his criticism of as well as positive appropriation of hermeneutical thinking, and iii) work out examples of a critical-hermeneutical approach in the last parts of the essay. The main example used will be from contemporary Norwegian sociology, dealing with the possibility of a unitary critical approach. The closing part (iv) will have clarifying purposes

Mediation of semantic web services in IRS-III

Business applications composed of heterogeneous distributed components or Web services need mediation to resolve data and process mismatches at runtime. This paper describes mediation in IRS-III, a framework and platform for developing WSMO-based Semantic Web Services. We present our approach to mediation within Semantic Web Services and highlight the role of WSMO mediator types when solving mismatches at the semantic level between a service requester and a service provider. We describe the components of our mediation framework and how it can handle data, goal and process mediation during the activities of selection, composition and invocation of Semantic Web Services