253 research outputs found
Diagnosing policy dynamics: The birth & evolution of the pharmaceutical subsystem
The rising cost of prescription drugs in the United States has led patients---older populations and the disabled especially, to seek relief through foreign nations, and internet mail-order sites, which are often hosted and condoned by state and local governments. Patients are traveling to Canada and Mexico to purchase affordable prescription drugs. According to the Congressional Budget Office, American seniors alone will spend 1.8 trillion dollars on pharmaceuticals over the next ten years (U.S. Senate 2007, S 251). This research examines the agenda status and change of pharmaceutical regulation by tracing the evolution of the pharmaceutics subsystem. By employing a punctuated equilibrium approach, I seek to understand if periods of agenda access and issue definition have corresponded to changes in the institutional structure of policymaking.;As such, this study is motivated by three questions: (1) how has Congress governed the pharmaceutical policy agenda over the post World War II era, (2) have periods of agenda access led to venue changes in pharmaceutical regulation, (3) has the image of pharmaceutical policies led to positive or negative feedback, and if so, what factors precipitated such change. Understanding how image and agenda access can impact the institutional structure of policymaking will illustrate how ideas influence the strength and weakness of the pharmaceutical policy monopoly. The results of this study are important because they highlight the institutional factors influencing the cost and availability of prescription drugs. Moreover, this research provides insight concerning federal involvement in regulatory policy
Randomised controlled trial of fish oil supplement to treat cancer cachexia
This is the protocol for a review and there is no abstract. The objectives are as follows: Our overall aim is to provide an overview of interventions for preventing falls in older people by summarising the evidence from multiple Cochrane intervention reviews that evaluate the effects (primarily, rate of falls and number of fallers) of these interventions in different populations of older people, such as those defined by setting or by specific medical conditions. Fall prevention interventions will include those in the following categories: supervised or unsupervised exercises; medication; surgery; management of urinary incontinence; fluid or nutrition therapy; psychological; environment and assistive technologies; social environment; knowledge/education interventions and any other interventions that do not fall into one of these categories (Lamb 2007). Interventions tested may belong to one category ('single' intervention), or more than one category ('multiple' and 'multifactorial' interventions)
Sensory environment on health-related outcomes of hospital patients
Background: Hospital environments have recently received renewed interest, with considerable investments into building and renovating healthcare estates. Understanding the effectiveness of environmental interventions is important for resource utilisation and providing quality care. Objectives: To assess the effect of hospital environments on adult patient health-related outcomes. Search methods: We searched: the Cochrane Central Register of Controlled Trials (last searched January 2006); MEDLINE (1902 to December 2006); EMBASE (January 1980 to February 2006); 14 other databases covering health, psychology, and the built environment; reference lists; and organisation websites. This review is currently being updated (MEDLINE last search October 2010), see Studies awaiting classification. Selection criteria: Randomised and non-randomised controlled trials, controlled before-and-after studies, and interrupted times series of environmental interventions in adult hospital patients reporting health-related outcomes. Data collection and analysis: Two review authors independently undertook data extraction and 'Risk of bias' assessment. We contacted authors to obtain missing information. For continuous variables, we calculated a mean difference (MD) or standardized mean difference (SMD), and 95% confidence intervals (CI) for each study. For dichotomous variables, we calculated a risk ratio (RR) with 95% confidence intervals (95% CI). When appropriate, we used a random-effects model of meta-analysis. Heterogeneity was explored qualitatively and quantitatively based on risk of bias, case mix, hospital visit characteristics, and country of study. Main results: Overall, 102 studies have been included in this review. Interventions explored were: 'positive distracters', to include aromas (two studies), audiovisual distractions (five studies), decoration (one study), and music (85 studies); interventions to reduce environmental stressors through physical changes, to include air quality (three studies), bedroom type (one study), flooring (two studies), furniture and furnishings (one study), lighting (one study), and temperature (one study); and multifaceted interventions (two studies). We did not find any studies meeting the inclusion criteria to evaluate: art, access to nature for example, through hospital gardens, atriums, flowers, and plants, ceilings, interventions to reduce hospital noise, patient controls, technologies, way-finding aids, or the provision of windows. Overall, it appears that music may improve patient-reported outcomes such as anxiety; however, the benefit for physiological outcomes, and medication consumption has less support. There are few studies to support or refute the implementation of physical changes, and except for air quality, the included studies demonstrated that physical changes to the hospital environment at least did no harm. Authors' conclusions: Music may improve patient-reported outcomes in certain circumstances, so support for this relatively inexpensive intervention may be justified. For some environmental interventions, well designed research studies have yet to take place
From traditional to modern: easing students transition to problem-based learning.
Letter to the Edito
What is the impact of contraceptive methods and mixes of contraceptive methods on contraceptive prevalence, unmet need for family planning, and unwanted and unintended pregnancies?
Background - In many low-and middle-income countries, there is high maternal, infant and child mortality due in part to low contraceptive use and high unmet need for family planning. The aim of this overview of systematic reviews is to synthesise the findings of systematic reviews conducted in this area to assess the impact of various contraceptive methods and mixes of contraceptive methods on contraceptive prevalence, unwanted and unintended pregnancies, and unmet need (a desire to limit the number of children but not currently using any contraception) for family planning in developing countries/regions.Methods - Eight databases (Bioline international, The Cochrane Library, Latin American and Caribbean Health Sciences Literature - LILACS, Popline, PubMed, Turning Research Into Practice, World Health Organisation Reproductive Health Library and Zetoc) were searched from 28 October 2010 to 08 December 2010. Cochrane and non-Cochrane systematic reviews were included. Eligible reviews included studies whose participants were sexually active women or men from countries classified as âdevelopingâ, âlow-incomeâ or âmiddle-incomeâ. Systematic reviews of any intervention (or combination of interventions) designed to increase contraceptive prevalence, reduce fertility or both were eligible. Data were extracted and synthesised narratively. A Measurement Tool to Assess Systematic Reviews, AMSTAR, was used to evaluate the quality of the included systematic reviews, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to evaluate the quality of the body of evidence for each comparison. To aid the interpretation of the findings for a variety of settings, relevant contextual information was presented where possible.Results - There were 22 systematic reviews included in this overview of reviews. The overview examined a range of contraceptive methods, including modern (terminal and spacing) and traditional methods (such as withdrawal and periodic abstinence which do not require contraceptive substances or devices and also do not require clinical procedures). However, the systematic reviews included did not address all the objectives of the overview.The results of the review are summarised below according to the objectives.Objective 1: To assess the impact of various contraceptive methods and mixes ofcontraceptive methods on contraceptive prevalence in developing countries/regions. There was no systematic review that met this objective.Objective 2: To assess the impact of various contraceptive methods and mixes ofcontraceptive methods on unwanted and unintended pregnancies in developingcountries/regions.The body of evidence for the relative efficacy or effectiveness of a variety ofcontraceptive methods to prevent pregnancy in developing countries was generally rated as of low or moderate quality. There was, however, a number of comparisons (between different derivatives of the same contraceptive methods) for which the evidence was rated as of high or moderate quality. Evidence from systematic reviews is lacking on the acceptability of contraceptive methods and their impact on prevalence and on unmet needs for family planning. The evidence for the relative effectiveness of a variety of contraceptive methods to prevent pregnancy in developing countries is generally of low quality. There is some high-quality evidence comparing different derivatives of the same contraceptive methods, although this is more often evidence of efficacy than evidence of effectiveness.Objective 3: To assess the impact of various contraceptive methods and mixes ofcontraceptive methods on unmet need for family planning in developing countries/regions.There was no systematic review that met this objective
Traditional Gender Roles and Effects of Dementia Caregiving within a South Asian Ethnic Group in England
Background: Despite the integral role that women play in the care of older adults in South Asian families, limited empirical data are available on the impact of migration from South Asia to England. The purpose of this research was to examine caring for a family member with dementia from a gender role perspective. Methods: Data were gathered in two phases: (1) focus groups and (2) semi-structured interviews. Focus groups were held with the general public, and semi-structured interviews were conducted with family carers. Data were audio-recorded and analysed using thematic analysis. The NVivo qualitative software was utilised to simplify the thematic analysis. Results: While traditionally family care for frail older adults has been mainly provided by women in South Asian families, the samples in this study revealed how womenâs attitudes towards caregiving are changing in British societies. Conclusion: There is a dearth of research about socioeconomic transformations in South Asian womenâs migration to Western countries that could contribute to deterring them from providing family care. More research is warranted to understand the ways in which migration shapes gender relations in South Asian families and its impact on care for the frail elderly
Effects of Age of Onset of Tonic-Clonic Seizures on Neuropsychological Performance in Children
Forty-eight children (aged 9 to 15 years) with tonic-clonic seizures were administered a neuropsychological test battery. The children with seizures of early onset (before age 5) were significantly impaired relative to the children with later onset on 8 of the 14 measures in the battery. The deficits were seen on tasks whose requirements included the repetition of a simple motor act, attention and concentration, memory, and complex problem solving. These findings emphasize the need for further research to determine the causal factors of the greater dysfunction seen in the early onset group. RĂSUMĂ Quarante huit enfants ĂgĂs de 9 Ă 15 ans souffrant de crises Ăpileptiques tonico-cloniques ont ĂtĂĂtudiĂs avec une batterie de tests neuropsychologiques. Pour huit des quatorze mesures de cette batterie de tests les enfants dont les cirses avaient dĂbutĂ prĂcocĂment (avant cinq ans) se sont avĂrĂs Ătre signiflcativement dĂtĂriorĂs par rapport Ă ceux dont les crises avaient dĂbutĂ plus tardivement. Les dĂficits se sont manifestĂs pour des tĂches nĂcessitant la rĂpĂtition d'un acte moteur simple, attention et concentration, mĂmoire et capacitĂĂ rĂsoudre des problĂmes complexes. Ces rĂsultats mettent l'accent sur la nĂcessitĂ de poursuivre les recherches afin de dĂterminer les facteurs responsables de la plus grande dysfonction observĂe chez les enfants dont l'Ăpilepsie a dĂbutĂ tĂt dans la vie. RESUMEN Se ha aplicado una bateria de tests neuro-psicolĂgicos a 48 niĂos de 9 a 15 aĂos de edad que padecĂan ataques tonico-clĂnicos. Los niĂos con ataques de comienzo precoz (antes de los 5 aĂos) mostraron incapacidades significativas compareĂndolos con niĂos con comienzos mĂs tardios en 8 de los 14 tests de la bateria. Los defectos fueron detectados en las pruebas cuyos requisitos incluĂan la repeticiĂn de un acto motor simple, atenciĂn y concentraciĂn, memoria y resoluciĂn de problemas complejos. Estos hallazgos indican la necesidad de continuar la inves-tigaciĂn para determinar los factores causales de la mayor disfunciĂn observada en el grupo de comienzo precoz. ZUSAMMENFASSUNG 48 Kinder (9 bis 15 Jahre alt) mit tonisch-klonischen KrĂmpfen wurden mit einer neuropsychologischen Testbatterie untersucht. Die Kinder mit einem FrĂhbeginn der AnfĂlle (vor dem Alter von 5 Jahren) zeigten sich bei 8 von 14 Tests der Serie deutlich beeintrĂchtigt im VerhĂltnis zu Kindern mit spĂterem Anfallsbeginn. Die Defekte traten bei Aufgaben auf, die folgende AnsprĂche stellten: Wiederholung einer einfachen motorischen Handlung, Aufmerksamkeit und Konzentration, GedĂchtnis und komplexes ProblemlĂsen. Diese Befunde deuten auf die Notwendigkeit weiterer Untersuchungen, um die ursĂchlichen Faktoren der grĂĂeren FunktionseinbuĂe zu bestimmen, die bei Patienten mit frĂhem Anfallsbeginn beobachtet wird.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65238/1/j.1528-1157.1981.tb04102.x.pd
Maladaptive behaviors are linked with inefficient sleep in individuals with developmental disabilities
The purpose of the current study was to assess the relations between nightly sleep patterns and the frequency of daily maladaptive behavior. Antecedent and consequential relations between sleep patterns and behavior were evaluated with time series analysis. Sleep efficiency and maladaptive behavior were determined for 20 female residents of an institutional care facility for adults with developmental disabilities. Daily maladaptive behavioral data and nightly sleep/awake logs were collected for 4Â months for each participant. Efficient sleep patterns were significantly associated with lower frequencies of maladaptive behaviors. All lagged cross-correlations 8Â days before and 8Â days after an evening of sleep were significant. These findings suggested that inefficient sleep was associated with increased maladaptive behaviors and that the lagged associations reflected a chronic but not an acute linkage between sleep and behavior
Sleep assessment in a population-based study of chronic fatigue syndrome
BACKGROUND: Chronic fatigue syndrome (CFS) is a disabling condition that affects approximately 800,000 adult Americans. The pathophysiology remains unknown and there are no diagnostic markers or characteristic physical signs or laboratory abnormalities. Most CFS patients complain of unrefreshing sleep and many of the postulated etiologies of CFS affect sleep. Conversely, many sleep disorders present similarly to CFS. Few studies characterizing sleep in unselected CFS subjects have been published and none have been performed in cases identified from population-based studies. METHODS: The study included 339 subjects (mean age 45.8 years, 77% female, 94.1% white) identified through telephone screen in a previously described population-based study of CFS in Wichita, Kansas. They completed questionnaires to assess fatigue and wellness and 2 self-administered sleep questionnaires. Scores for five of the six sleep factors (insomnia/hypersomnia, non-restorative sleep, excessive daytime somnolence, sleep apnea, and restlessness) in the Centre for Sleep and Chronobiology's Sleep Assessment Questionnaire(© )(SAQ(©)) were dichotomized based on threshold. The Epworth Sleepiness Scale score was used as a continuous variable. RESULTS: 81.4% of subjects had an abnormality in at least one SAQ(© )sleep factor. Subjects with sleep factor abnormalities had significantly lower wellness scores but statistically unchanged fatigue severity scores compared to those without SAQ(© )abnormality. CFS subjects had significantly increased risk of abnormal scores in the non-restorative (adjusted odds ratio [OR] = 28.1; 95% confidence interval [CI]= 7.4â107.0) and restlessness (OR = 16.0; 95% CI = 4.2â61.6) SAQ(© )factors compared to non-fatigued, but not for factors of sleep apnea or excessive daytime somnolence. This is consistent with studies finding that, while fatigued, CFS subjects are not sleepy. A strong correlation (0.78) of Epworth score was found only for the excessive daytime somnolence factor. CONCLUSIONS: SAQ(© )factors describe sleep abnormalities associated with CFS and provide more information than the Epworth score. Validation of these promising results will require formal polysomnographic sleep studies
Economic evaluation of pharmacist-led medication reviews in residential aged care facilities
Introduction: Medication reviews is a widely accepted approach known to have a
substantial impact on patientsâ pharmacotherapy and safety. Numerous options to optimise
pharmacotherapy in older people have been reported in literature and they include
medication reviews, computerised decision support systems, management teams, and
educational approaches. Pharmacist-led medication reviews are increasingly being
conducted, aimed at attaining patient safety and medication optimisation. Cost
effectiveness is an essential aspect of a medication review evaluation.
Areas covered: A systematic searching of articles that examined the cost-effectiveness of
medication reviews conducted in aged care facilities was performed using the relevant
databases. Pharmacist-led medication reviews confer many benefits such as attainment of
biomarker targets for improved clinical outcomes, and other clinical parameters, as well as
depict concrete financial advantages in terms of decrement in total medication costs and
associated cost savings.
Expert commentary: The cost-effectiveness of medication reviews are more consequential
than ever before. A critical evaluation of pharmacist-led medication reviews in residential
aged care facilities from an economical aspect is crucial in determining if the time, effort,
and direct and indirect costs involved in the review rationalise the significance of conducting
medication reviews for older people in aged care facilities
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