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71.
Kieran A. Walsh Carol Sinnott Aoife Fleming Jenny Mc Sharry Stephen Byrne John Browne Suzanne Timmons 《Journal of the American Medical Directors Association》2018,19(11):948-958.e12
Objectives
Caution is advised when prescribing antipsychotics to people with dementia. This study explored the determinants of appropriate, evidence-based antipsychotic prescribing behaviors for nursing home residents with dementia, with a view to informing future quality improvement efforts and behavior change interventions.Design
Semistructured qualitative interviews based on the Theoretical Domains Framework (TDF).Setting and Participants
A purposive sample of 27 participants from 4 nursing homes, involved in the care of nursing home residents with dementia (8 nurses, 5 general practitioners, 5 healthcare assistants, 3 family members, 2 pharmacists, 2 consultant geriatricians, and 2 consultant psychiatrists of old age) in a Southern region of Ireland.Measures
Using framework analysis, the predominant TDF domains and determinants influencing these behaviors were identified, and explanatory themes developed.Results
Nine predominant TDF domains were identified as influencing appropriate antipsychotic prescribing behaviors. Participants’ effort to achieve “a fine balance” between the risks and benefits of antipsychotics was identified as the cross-cutting theme that underpinned many of the behavioral determinants. On one hand, neither healthcare workers nor family members wanted to see residents over-sedated and without a quality of life. Conversely, the reality of needing to protect staff, family members, and residents from potentially dangerous behavioral symptoms, in a resource-poor environment, was emphasized. The implementation of best-practice guidelines was illustrated through 3 explanatory themes (“human suffering”; “the interface between resident and nursing home”; and “power and knowledge: complex stakeholder dynamics”), which conceptualize how different nursing homes strike this “fine balance.”Conclusions
Implementing evidence-based antipsychotic prescribing practices for nursing home residents with dementia remains a significant challenge. Greater policy and institutional support is required to help stakeholders strike that “fine balance” and ultimately make better prescribing decisions. This study has generated a deeper understanding of this complex issue and will inform the development of an evidence-based intervention. 相似文献72.
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STUDY OBJECTIVES: This study assesses how often local US hospitals provide smoking cessation information in the following two ways: via hospital Web sites; and via routing incoming phone calls to their hospital switchboards to an in-house smoking cessation clinic. DESIGN: Random survey of US hospitals. SETTING: US hospital Web pages and telephone switchboards. Patients or participants: One hundred two randomly selected US hospitals. INTERVENTIONS: One hundred two hospital Web sites were randomly selected across the United States. The site was searched for the topic of smoking cessation. In the second phase of the survey, the main switchboard number of the same 102 hospitals was anonymously called and the "stop smoking clinic" was asked for. MEASUREMENTS AND RESULTS: The overall results indicate that among the hospital Web sites surveyed, only 30% contained information relating to smoking cessation programs. The phone survey of hospital switchboards showed that 47% had a smoking cessation program available via phone inquiry, while 53% did not. CONCLUSIONS: Of the US hospital Web sites visited, only 30% contained information on smoking cessation. The yield of finding the desired information was increased by the presence of an intrasite search option, which is a low-cost enhancement to any complex Web site. The relatively low cost of promoting healthy behaviors such as smoking cessation on a hospital Web site should be used more widely. Surprisingly, the phone survey of hospitals showed that the lower technology route of providing smoking cessation information to patients via a patient-initiated phone call is only available in 47% of hospitals. Both the Internet and phone-based switchboard referrals could be more widely and effectively used. Joint Commission on Accreditation of Healthcare Organizations guidelines would be one avenue of increasing the availability of smoking cessation information at hospital switchboards and Web sites. 相似文献
76.
Lei Chen Erin M. Bell Marilyn L. Browne Charlotte M. Druschel Paul A. Romitti National Birth Defects Prevention Study 《Maternal and child health journal》2014,18(10):2446-2455
We describe patterns of dietary caffeine consumption before and after pregnancy recognition in a cohort of women who recently gave birth. This study included 8,347 mothers of non-malformed liveborn control infants who participated in the National Birth Defects Prevention Study during 1997–2007. Maternal self-reported consumption of beverages (caffeinated coffee, tea, and soda) and chocolate the year before pregnancy was used to estimate caffeine intake. The proportions of prepregnancy caffeine consumption stratified by maternal characteristics are reported. In addition, patterns of reported change in consumption before and after pregnancy were examined by maternal and pregnancy characteristics. Adjusted prevalence ratios were estimated to assess factors most associated with change in consumption. About 97 % of mothers reported any caffeine consumption (average intake of 129.9 mg/day the year before pregnancy) and soda was the primary source of caffeine. The proportion of mothers reporting dietary caffeine intake of more than 300 mg/day was significantly increased among those who smoked cigarettes or drank alcohol. Most mothers stopped or decreased their caffeinated beverage consumption during pregnancy. Young maternal age and unintended pregnancy were associated with increases in consumption during pregnancy. Dietary caffeine consumption during pregnancy is still common in the US. A high level of caffeine intake was associated with known risk factors for adverse reproductive outcomes. Future studies may improve the maternal caffeine exposure assessment by acquiring additional information regarding the timing and amount of change in caffeine consumption after pregnancy recognition. 相似文献
77.
A systematic review of health service interventions to improve linkage with or retention in HIV care
The importance of early linkage to and continuing retention in HIV care is increasingly recognised, particularly in light of the implications poor linkage and retention rates have for the effectiveness of HIV treatment as prevention strategies. The purpose of this systematic review was to examine the effectiveness of healthcare interventions in improving patient linkage to or retention in HIV care. We systematically searched PubMed (MEDLINE and PubMed-only citations) and EMBASE databases for articles reporting the original results of randomised controlled trials, and used a standard data collection form to extract information on study characteristics and outcome data. Five articles met the inclusion criteria, of which two articles focused on linkage to care and three on retention in care. The methodological quality, both of internal and external validity, of most of the trials was suboptimal. Wide variation in the interventions and outcome measures meant synthesis of the results using meta-analysis was not appropriate. This review shows evidence that interventions based on supporting patient self-management improves linkage to, and possibly retention in, care. Interventions aimed at delivery service design may also be effective, although evidence in this review was limited. It is vital that interventions are developed to improve patient engagement in HIV care. The dearth of research identified by this review highlights the need for well-designed trials of interventions in this area in the future. 相似文献
78.
Paul V. Browne Deane F. Mosher Martin H. Steinberg Robert P. Hebbel 《American journal of hematology》1996,51(4):296-301
Thrombospondin (TSP), a large protein found in platelet α-granules (as TSP-1), mediates adhesion of sickle reticulocytes to cultured vascular endothelium. To further explore the physiologic relevance of this observation, we have measured plasma TSP levels and platelet TSP-1 content in subjects with sickle cell disease. Plasma TSP levels were similar for normal controls (mean 491 ng/ml, range 331–723) and steady-state HbSS patients (mean 536, range 333–1107) and were significantly (P = 0.012) but variably elevated for HbSS patients presenting with acute painful crisis (mean 868, range 442–2780). Some of these elevated plasma TSP levels reached those previously observed to support maximal red cell adhesion to endothelium in vitro. Compared to normals, both steady-state and in-crisis HbSS patients had significantly (P < 0.001) depressed platelet TSP-1 content (82.6 ± 11.9, 47.1 ± 16.0 and 45.9 ± 20.7 ng/109 platelets, respectively, mean ± SD). HbSC disease patients, all examined during steady state, had low-normal plasma levels of TSP and either normal or depressed platelet TSP-1 content. Serial observations on three sickle cell anemia subjects indicated a probable relationship between platelet TSP-1 release, elevated plasma TSP levels, and acute vasoocclusive episodes. These results suggest a state of ongoing release and depletion of TSP-1 from activated platelets in patients with sickle cell disease. © 1996 Wiley-Liss, Inc. 相似文献
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Local delivery of basic fibroblast growth factor increases both angiogenesis and engraftment of hepatocytes in tissue-engineered polymer devices 总被引:12,自引:0,他引:12
Lee H Cusick RA Browne F Ho Kim T Ma PX Utsunomiya H Langer R Vacanti JP 《Transplantation》2002,73(10):1589-1593
BACKGROUND: We investigated heterotopic hepatocyte transplantation on biodegradable polymers as a potential treatment for end-stage liver disease. The primary problem has been insufficient engraftment of transplanted cells partly because of insufficient vascularization. Increasing vascularization through locally delivered angiogenic factors may increase angiogenesis and hepatocyte engraftment. METHODS: We studied the effect of local delivery of basic fibroblast growth factor (bFGF) on angiogenesis and hepatocyte engraftment within tissue-engineered liver constructs. Poly-l-lactic acid discs were fabricated and coated with either a mixture of saline, sucralfate, and Hydron (control group) or bFGF, sucralfate, and Hydron (bFGF group). bFGF release from polymers in vitro was tested using an ELISA. Hepatocytes were isolated from Lewis rats, seeded on control (n=9) or bFGF (n=11) polymers, and implanted into the small bowel mesentery of syngeneic animals. Specimens were harvested after 2 weeks and analyzed for hepatocyte engraftment. Microvascular density was compared between control (n=6) and bFGF groups (n=5). RESULTS: Three hundred twenty-three thousandths of a microgram of bFGF were incorporated per polymer. Greater than 99% of the bFGF was released into solution by 72 hr in vitro. Two weeks after implantation, microvascular density, as measured by capillaries per high-powered field (c/hpf), was significantly greater in the bFGF group (43.8 c/hpf), compared with the control group (30.5 c/hpf; P<0.005). Specimens from the bFGF group (mean engraftment, 61,355 microm2) showed a 2.5-fold increase in hepatocyte engraftment as compared with control (24,197 microm2; P<0.002). CONCLUSIONS: The angiogenic growth factor bFGF can be incorporated into degradable polymers used as delivery devices for hepatocyte transplantation. Implantation of these devices increases angiogenesis into the device and increases hepatocyte engraftment. 相似文献