35 research outputs found
Randomized Control Trials and Qualitative Evaluations of a Multifaceted Programme for Women in Extreme Poverty: Empirical Findings and Methodological Reflections
This paper sets out to synthesize key lessons from studies using alternative methodologies to impact assessment. Drawing on Senβs capability approach as a conceptual framework, it analyses two pairs of impact assessments which were carried out in West Bengal and Sindh around the same time and within close proximity to each other. Each pair consisted of a randomized control trial and a qualitative assessment of attempts to pilot BRACβs approach to transferring assets to women in extreme poverty. The paper reports on the findings of these studies, their strategies for establishing their claims about causality and the information base they drew on to establish these claims. It finds that not only did the RCTs fail to meet their own criteria for establishing causality, but they also provided very limited explanation for the patterns of outcomes observed. Such information formed the substance of the qualitative studies. The paper concludes that greater use of mixed methods could help to offset some of limitations of RCTs and to place their findings on much firmer ground
New aspects in the pathogenesis, prevention, and treatment of hyponatremic encephalopathy in children
Hyponatremia is the most common electrolyte abnormality encountered in children. In the past decade, new advances have been made in understanding the pathogenesis of hyponatremic encephalopathy and in its prevention and treatment. Recent data have determined that hyponatremia is a more serious condition than previously believed. It is a major comorbidity factor for a variety of illnesses, and subtle neurological findings are common. It has now become apparent that the majority of hospital-acquired hyponatremia in children is iatrogenic and due in large part to the administration of hypotonic fluids to patients with elevated arginine vasopressin levels. Recent prospective studies have demonstrated that administration of 0.9% sodium chloride in maintenance fluids can prevent the development of hyponatremia. Risk factors, such as hypoxia and central nervous system (CNS) involvement, have been identified for the development of hyponatremic encephalopathy, which can lead to neurologic injury at mildly hyponatremic values. It has also become apparent that both children and adult patients are dying from symptomatic hyponatremia due to inadequate therapy. We have proposed the use of intermittent intravenous bolus therapy with 3% sodium chloride, 2Β cc/kg with a maximum of 100Β cc, to rapidly reverse CNS symptoms and at the same time avoid the possibility of overcorrection of hyponatremia. In this review, we discuss how to recognize patients at risk for inadvertent overcorrection of hyponatremia and what measures should taken to prevent this, including the judicious use of 1-desamino-8d-arginine vasopressin (dDAVP)