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An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature124096
Source
Implement Sci. 2012;7:48
Publication Type
Article
Date
2012
Author
Courtney C Kennedy
George Ioannidis
Lora M Giangregorio
Jonathan D Adachi
Lehana Thabane
Suzanne N Morin
Richard G Crilly
Sharon Marr
Robert G Josse
Lynne Lohfeld
Laura E Pickard
Susanne King
Mary-Lou van der Horst
Glenda Campbell
Jackie Stroud
Lisa Dolovich
Anna M Sawka
Ravi Jain
Lynn Nash
Alexandra Papaioannou
Author Affiliation
Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada. kennedyc@hhsc.ca
Source
Implement Sci. 2012;7:48
Date
2012
Language
English
Publication Type
Article
Keywords
Bone Density Conservation Agents - administration & dosage - therapeutic use
Calcium - administration & dosage
Dietary Supplements
Drug Utilization
Fractures, Bone - prevention & control
Homes for the Aged - organization & administration
Humans
Information Dissemination
Inservice training
Leadership
Long-Term Care - organization & administration
Nursing Homes - organization & administration
Ontario
Osteoporosis - prevention & control
Pilot Projects
Reminder Systems
Translational Medical Research - organization & administration
Vitamin D - administration & dosage - therapeutic use
Abstract
Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.
The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed =800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (=800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.
Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
Notes
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PubMed ID
22624776 View in PubMed
Less detail

Are brand-name and generic warfarin interchangeable? A survey of Ontario patients and physicians.

https://arctichealth.org/en/permalink/ahliterature172048
Source
Can J Clin Pharmacol. 2005;12(3):e229-39
Publication Type
Article
Date
2005
Author
Jennifer A Pereira
Anne M Holbrook
Lisa Dolovich
Charles Goldsmith
Lehana Thabane
James D Douketis
Mark Crowther
Shannon M Bates
Jeffrey S Ginsberg
Author Affiliation
Centre for Evaluation of Medicines, St Joseph's Healthcare, Hamilton, ON. j.pereira@utoronto.ca
Source
Can J Clin Pharmacol. 2005;12(3):e229-39
Date
2005
Language
English
Publication Type
Article
Keywords
Anticoagulants - pharmacokinetics
Attitude of Health Personnel
Confidence Intervals
Female
Humans
Male
Medicine
Middle Aged
Ontario
Physician's Practice Patterns
Questionnaires
Specialization
Therapeutic Equivalency
Warfarin - pharmacokinetics
Abstract
The issue of therapeutic equivalence has been a source of controversy in Canada since the approval of generic warfarin products in 2000.
We surveyed Ontario patients and physicians on perceptions of generic warfarin and brand substitution.
Self-administered questionnaires employed 7.0-point Likert scales of agreement. Patient participants were drawn from a thromboembolism clinic in Hamilton, Ontario. Physician participants were from a random sample of 375 Ontario family physicians, internists, cardiologists and hematologists.
Eighty-one patients responded: 52% female, mean age 63.4 years and 63% brand-name warfarin users. Overall, 33% of respondents agreed or strongly agreed that they would feel comfortable taking generic warfarin. However, seventeen percent agreed or strongly agreed that generic warfarin was neither as safe nor as effective as brand-name warfarin, with this view more common amongst patients taking brand-name than those taking generic warfarin. One hundred and ten (29.3%) physicians returned the survey--29% females, mean age 45.3 years, 22% family physicians. Forty-four percent agreed or strongly agreed that they would rather prescribe brand-name than generic warfarin for patients starting warfarin therapy, while 40.7% agreed or strongly agreed that they would not feel comfortable switching from brand-name to generic warfarin. However, only 19.4% of physicians who had switched patients from brand-name to generic warfarin actually reported difficulties in managing the switch.
While most patients and physicians appear to have accepted the principle of therapeutic equivalence of generic and brand-name warfarin, a sizable minority has concerns that could influence prescribing and compliance.
PubMed ID
16278495 View in PubMed
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Attitudes of women who are currently using or recently stopped estrogen replacement therapy with or without progestins: results of the AWARE survey.

https://arctichealth.org/en/permalink/ahliterature177248
Source
J Obstet Gynaecol Can. 2004 Nov;26(11):967-73
Publication Type
Article
Date
Nov-2004
Author
Anna M Sawka
Alice Huh
Lisa Dolovich
Alexandra Papaioannou
Kevin Eva
Lehana Thabane
Amiram Gafni
Amie Cullimore
Mary Macdougall
Meir Steiner
Jonathan D Adachi
Author Affiliation
Department of Endocrinology and Metabolism, McMaster University, Hamilton ON.
Source
J Obstet Gynaecol Can. 2004 Nov;26(11):967-73
Date
Nov-2004
Language
English
Publication Type
Article
Keywords
Estrogen Replacement Therapy - adverse effects - psychology
Female
Health Knowledge, Attitudes, Practice
Health Surveys
Humans
Middle Aged
Ontario
Questionnaires
Women's health
Abstract
To examine the level of awareness of the findings of the Women's Health Initiative (WHI) study among recent users of hormone therapy (HT).
A survey was conducted on Canadian women older than 45 years of age who had used either an oral, topical, or vaginal HT within the preceding 3 years. Questionnaires were mailed to a random sample of 210 eligible women within an academic subspecialty rheumatology/osteoporosis practice between April and June 2003. Questionnaires were also provided upon request to women attending tertiary care multidisciplinary clinics and 6 community pharmacies in Hamilton, Ontario. The 98 questions in the survey were either categorical in nature (yes or no response) or followed by a Likert scale. Using chi-square and Student t tests, the responses of women who used combination estrogen/progestin were compared to those who used estrogen alone.
Of the 161 women who responded to the survey (128 from the osteoporosis practice, 33 from other clinics and pharmacies), 102 (63%) had used HT for more than 5 years. Ninety-one of 159 respondents (57%) discontinued HT, and 63% (57/91) of those stopped using HT after publication of the WHI principal findings. Sixty-four percent (33/52) of women on combination estrogen/progestin discontinued HT, compared to 50% (46/93) who were on estrogen only, and 5 other women who also discontinued HT but did not know what type of preparation they had been taking (P = .04 for the difference in rates between the 3 groups). Knowledge of the findings of the estrogen/progestin arm of the WHI study did not significantly differ among users of different types of hormone preparations. Of the women who indicated that they did not know if HT affected the risk of WHI-studied medical conditions, 44% (69/156) indicated being unaware of HT risks for stroke, 28% (44/157) for hip fracture, 39% (60/155) for myocardial infarction, 25% (39/155) for breast cancer, and 48% (73/152) for blood clots. Women who had recently taken HT generally did not regret their use of HT.
Although many women discontinued HT following the publication of the principal findings of the estrogen/progestin arm of the WHI study, the majority of these women lacked a clear understanding of those findings.
Notes
Comment In: J Obstet Gynaecol Can. 2005 Apr;27(4):321; author reply 32215937602
PubMed ID
15560859 View in PubMed
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Barriers and facilitators to implementing Decision Boxes in primary healthcare teams to facilitate shared decisionmaking: a study protocol.

https://arctichealth.org/en/permalink/ahliterature121904
Source
BMC Med Inform Decis Mak. 2012;12:85
Publication Type
Article
Date
2012
Author
Anik Giguere
Michel Labrecque
Roland Grad
Michel Cauchon
Matthew Greenway
France Légaré
Pierre Pluye
Stephane Turcotte
Lisa Dolovich
R Brian Haynes
Author Affiliation
Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL-139, 1280 Main Street West, Hamilton, ON, L8S 4?K1, Canada. anikgiguere@videotron.ca
Source
BMC Med Inform Decis Mak. 2012;12:85
Date
2012
Language
English
Publication Type
Article
Keywords
Canada
Decision Support Systems, Clinical - organization & administration - utilization
Diffusion of Innovation
Health Knowledge, Attitudes, Practice
Humans
Interviews as Topic
Models, organizational
Organizational Culture
Patient care team
Primary Health Care - manpower
Professional-Patient Relations
Qualitative Research
Questionnaires
Regression Analysis
Social Facilitation
Abstract
Decision Boxes are summaries of the most important benefits and harms of health interventions provided to clinicians before they meet the patient, to prepare them to help patients make informed and value-based decisions. Our objective is to explore the barriers and facilitators to using Decision Boxes in clinical practice, more precisely factors stemming from (1) the Decision Boxes themselves, (2) the primary healthcare team (PHT), and (3) the primary care practice environment.
A two-phase mixed methods study will be conducted. Eight Decision Boxes relevant to primary care, and written in both English and in French, will be hosted on a website together with a tutorial to introduce the Decision Box. The Decision Boxes will be delivered as weekly emails over a span of eight weeks to clinicians of PHTs (family physicians, residents and nurses) in five primary care clinics located across two Canadian provinces. Using a web-questionnaire, clinicians will rate each Decision Box with the Information Assessment Method (cognitive impacts, relevance, usefulness, expected benefits) and with a questionnaire based on the Theory of Planned Behavior to study the determinants of clinicians' intention to use what they learned from that Decision Box in their patient encounter (attitude, social norm, perceived behavioral control). Web-log data will be used to monitor clinicians' access to the website. Following the 8-week intervention, we will conduct semi-structured group interviews with clinicians and individual interviews with clinic administrators to explore contextual factors influencing the use of the Decision Boxes. Data collected from questionnaires, focus groups and individual interviews will be combined to identify factors potentially influencing implementation of Decision Boxes in clinical practice by clinicians of PHTs.
This project will allow tailoring of Decision Boxes and their delivery to overcome the specific barriers identified by clinicians of PHTs to improve the implementation of shared decision making in this setting.
Notes
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PubMed ID
22867107 View in PubMed
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Cardiovascular Health Awareness Program (CHAP): a community cluster-randomised trial among elderly Canadians.

https://arctichealth.org/en/permalink/ahliterature158054
Source
Prev Med. 2008 Jun;46(6):537-44
Publication Type
Article
Date
Jun-2008
Author
Janusz Kaczorowski
Larry W Chambers
Tina Karwalajtys
Lisa Dolovich
Barbara Farrell
Beatrice McDonough
Rolf Sebaldt
Cheryl Levitt
William Hogg
Lehana Thabane
Karen Tu
Ron Goeree
J Michael Paterson
Mamdouh Shubair
Tracy Gierman
Shannon Sullivan
Megan Carter
Author Affiliation
Department of Family Practice, University of British Columbia, Canada. janusz.kaczorowski@familymed.ubc.ca
Source
Prev Med. 2008 Jun;46(6):537-44
Date
Jun-2008
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Awareness
Canada
Cardiovascular Diseases - prevention & control
Cardiovascular System
Cluster analysis
Community Medicine
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - prevention & control
Male
Program Evaluation
Social Marketing
Abstract
High blood pressure is an important and modifiable cardiovascular disease risk factor that remains under-detected and under-treated. Community-level interventions that address high blood pressure and other modifiable risk factors are a promising strategy to improve cardiovascular health in populations. The present study is a community cluster-randomised trial testing the effectiveness of CHAP (Cardiovascular Health Awareness Program) on the cardiovascular health of older adults.
Thirty-nine mid-sized communities in Ontario, Canada were stratified by geographic location and size of the population aged >or=65 years and randomly allocated to receive CHAP or no intervention. In CHAP communities, residents aged >or=65 years were invited to attend cardiovascular risk assessment sessions held in pharmacies over 10 weeks in Fall, 2006. Sessions included blood pressure measurement and feedback to family physicians. Trained volunteers delivered the program with support from pharmacists, community nurses and local organisations.
The primary outcome measure is the relative change in the mean annual rate of hospital admission for acute myocardial infarction, congestive heart failure and stroke (composite end-point) among residents aged >or=65 years in intervention and control communities, using routinely collected, population-based administrative health data.
This paper highlights considerations in design, implementation and evaluation of a large-scale, community-wide cardiovascular health promotion initiative.
PubMed ID
18372036 View in PubMed
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Collaboration between community pharmacists and family physicians: lessons learned from the Seniors Medication Assessment Research Trial.

https://arctichealth.org/en/permalink/ahliterature182758
Source
J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5):566-72
Publication Type
Article
Author
Michelle Howard
Kristina Trim
Christel Woodward
Lisa Dolovich
Connie Sellors
Janusz Kaczorowski
John Sellors
Author Affiliation
Department of Family Medicine, McMaster University, HSC 2V10, Hamilton, Ontario, Canada. mhoward@mcmaster.ca
Source
J Am Pharm Assoc (2003). 2003 Sep-Oct;43(5):566-72
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Family Practice
Geriatrics
Health Services Research
Humans
Interprofessional Relations
Ontario
Pharmacists
Abstract
To learn about the experiences of specially trained expanded role pharmacists (ERPs) and family physicians in a program in which they worked together to optimize drug therapy for elderly patients (aged 65 and older) and to identify shortcomings of the program, obstacles to its implementation, and strategies to overcome these obstacles.
Qualitative opinion analysis.
Six family physicians and six community-based ERPs who had participated in a randomized controlled trial (Seniors Medication Assessment Research Trial [SMART]).
In-depth interviews.
Themes that emerged from the interviews regarding the strengths and weaknesses of and ways to improve the program.
ERPs and physicians differed in their perceptions of appropriate roles for ERPs. ERPs saw the program as an opportunity to take on new professional roles. Physicians appreciated the information they received from ERPs about their patients' adherence and use of nonprescription medications, but they did not want ERPs to directly counsel their patients. Some physicians questioned the value of the program for some patients, since the inclusion criteria for patients were broad and not all patients meeting the criteria needed intense interventions by ERPs. Both ERPs and physicians identified the need to refine the referral process and to work out professional role relationships and ongoing collaboration more fully. If the program were to be implemented as a routine service, physicians were concerned about the demands on their staff and office space and the need for an external compensation mechanism.
Issues to be addressed for future programs include clarification of the roles of pharmacist and physician when the professionals work together, targeting of appropriate patients for the program, identification of a more efficient way to deliver recommendations, and development of an appropriate compensation mechanism.
PubMed ID
14626748 View in PubMed
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A community-based program for cardiovascular health awareness.

https://arctichealth.org/en/permalink/ahliterature169670
Source
Can J Public Health. 2005 Jul-Aug;96(4):294-8
Publication Type
Article
Author
Larry W Chambers
Janusz Kaczorowski
Lisa Dolovich
Tina Karwalajtys
Heather L Hall
Beatrice McDonough
William Hogg
Barbara Farrell
Alexandra Hendriks
Cheryl Levitt
Author Affiliation
Elisabeth Bruyère Research Institute, Ottawa, ON. lchamber@scohs.on.ca
Source
Can J Public Health. 2005 Jul-Aug;96(4):294-8
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Attitude to Health
Cardiovascular Diseases - prevention & control
Community Health Planning - organization & administration
Family Practice - organization & administration
Health Education - organization & administration
Health Knowledge, Attitudes, Practice
Health Promotion - organization & administration
Humans
Ontario
Patient Acceptance of Health Care
Pharmacies - organization & administration
Process Assessment (Health Care)
Abstract
The objective of the Cardiovascular Health Awareness Program (CHAP) is to improve the processes of care related to the cardiovascular health of older adults.
Two Ontario communities including family physicians (FP), pharmacists, public health units and nurses, volunteer peer health educators, older adult patients and community organizations.
Community pharmacies and family physician offices.
CHAP is designed to close a process of care loop around cardiovascular health awareness that originates from, and returns to, the FP. Older patients are invited by their FP to attend pharmacy CHAP sessions. At these sessions, trained volunteer peer health educators (PHEs) assist patients both in recording their blood pressure using a calibrated automated device and in completing a cardiovascular risk profile. This information is relayed to their respective FP via an automated computerized database. Pharmacists and patients receive copies of the results. Based on these cumulative risk profiles, patients are advised to follow-up with their FP.
Of the FPs and pharmacists asked, 47% and 79%, respectively, agreed to participate in the project. 39% of older adult patients invited by their FPs attended the CHAP community pharmacy sessions. Of these, 100% agreed to having their risk profile, including their blood pressure readings, forwarded to their FP. Positive feedback about CHAP was expressed by the volunteer PHEs, the FPs and the pharmacists.
The community-based pharmacy CHAP sessions are a feasible way of improving patient, physician, and pharmacist access to reliable blood pressure measurements and to cardiovascular health information. A randomized trial is in progress that will assess the impact of CHAP on monitoring of blood pressure.
PubMed ID
16625801 View in PubMed
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Community mobilization, participation, and blood pressure status in a Cardiovascular Health Awareness Program in Ontario.

https://arctichealth.org/en/permalink/ahliterature115965
Source
Am J Health Promot. 2013 Mar-Apr;27(4):252-61
Publication Type
Article
Author
Tina Karwalajtys
Janusz Kaczorowski
Larry W Chambers
Heather Hall
Beatrice McDonough
Lisa Dolovich
Rolf Sebaldt
Lynne Lohfeld
Brian Hutchison
Author Affiliation
Department of Family Medicine, Faculty of Health Sciences, McMaster University, Grimsby, Ontario, Canada.
Source
Am J Health Promot. 2013 Mar-Apr;27(4):252-61
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Blood Pressure Determination
Cardiovascular Diseases - prevention & control
Community Networks
Feasibility Studies
Female
Health Knowledge, Attitudes, Practice
Health promotion
Humans
Hypertension - diagnosis - drug therapy
Male
Ontario
Pilot Projects
Risk factors
Abstract
To determine the feasibility of a community-wide approach integrated with primary care (Cardiovascular Health Awareness Program [CHAP]) to promote monitoring of blood pressure (BP) and awareness of cardiovascular disease risk.
Demonstration project.
Two midsized Ontario communities.
Community-dwelling seniors.
CHAP sessions were offered in pharmacies and promoted to seniors using advertising and personalized letters from physicians. Trained volunteers measured BP, completed risk profiles, and provided risk-specific education materials.
We examined the distribution of risk factors among participants and predictors of multiple visits and elevated BP.
Opinion leaders aided recruitment of family physicians (n ?=? 56/63) and pharmacists (n ?=? 18/19). Over 90 volunteers were recruited. Invitations were mailed to 4394 seniors. Over 10 weeks, there were 4165 assessments of 2350 unique participants (approximately 30% of senior residents). 37.5% of attendees had untreated (16%; 360/2247) or uncontrolled (21.5%; 482/2247) high BP. Participants who received a letter (odds ratio [OR] 2.5, 95% confidence interval [CI] 2.1-3.0), had an initial elevated BP (OR 1.2, 95% CI 1.0-1.5), or reported current antihypertensive medication (OR 1.4, 95% CI 1.1-1.6) were more likely to attend multiple sessions (p = .05 for all). Older age (= 70 years; OR 1.5, 95% CI 1.3-1.8), BMI = 30 (OR 1.7, 95% CI 1.4-2.2), current antihypertensive medication (OR 1.6, 95% CI 1.3-1.9), and diabetes (OR 2.4, 95% CI 1.9-3.2) predicted elevated BP (p
PubMed ID
23448415 View in PubMed
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A comparison of self-report and health care provider data to assess surveillance definitions of influenza-like illness in outpatients.

https://arctichealth.org/en/permalink/ahliterature126940
Source
Can J Public Health. 2012 Jan-Feb;103(1):69-75
Publication Type
Article
Author
Angela M Barbara
Mark Loeb
Lisa Dolovich
Kevin Brazil
Margaret L Russell
Author Affiliation
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON. barbara@mcmaster.ca
Source
Can J Public Health. 2012 Jan-Feb;103(1):69-75
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada - epidemiology
Child
Female
Germany - ethnology
Humans
Influenza, Human - diagnosis - ethnology - prevention & control
Logistic Models
Male
Middle Aged
Population Surveillance - methods
Retrospective Studies
Sensitivity and specificity
Abstract
Several surveillance definitions of influenza-like illness (ILI) have been proposed, based on the presence of symptoms. Symptom data can be obtained from patients, medical records, or both. Past research has found that agreements between health record data and self-report are variable depending on the specific symptom. Therefore, we aimed to explore the implications of using data on influenza symptoms extracted from medical records, similar data collected prospectively from outpatients, and the combined data from both sources as predictors of laboratory-confirmed influenza.
Using data from the Hutterite Influenza Prevention Study, we calculated: 1) the sensitivity, specificity and predictive values of individual symptoms within surveillance definitions; 2) how frequently surveillance definitions correlated to laboratory-confirmed influenza; and 3) the predictive value of surveillance definitions.
Of the 176 participants with reports from participants and medical records, 142 (81%) were tested for influenza and 37 (26%) were PCR positive for influenza. Fever (alone) and fever combined with cough and/or sore throat were highly correlated with being PCR positive for influenza for all data sources. ILI surveillance definitions, based on symptom data from medical records only or from both medical records and self-report, were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values.
The choice of data source to determine ILI will depend on the patient population, outcome of interest, availability of data source, and use for clinical decision making, research, or surveillance.
PubMed ID
22338332 View in PubMed
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Defining adverse events in manual therapy: an exploratory qualitative analysis of the patient perspective.

https://arctichealth.org/en/permalink/ahliterature136446
Source
Man Ther. 2011 Oct;16(5):440-6
Publication Type
Article
Date
Oct-2011
Author
Lisa C Carlesso
John Cairney
Lisa Dolovich
Jennifer Hoogenes
Author Affiliation
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. carlesl@mcmaster.ca
Source
Man Ther. 2011 Oct;16(5):440-6
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Female
Humans
Male
Middle Aged
Ontario
Patient Acceptance of Health Care
Patient satisfaction
Patients - psychology
Physical Therapy Modalities - adverse effects - standards
Abstract
Rare, serious, and common, benign adverse events (AE) are associated with MT techniques. A proposed standard for defining AE in manual therapy (MT) practise has been published but it did not include the patient perspective. Research comparing clinician and patient reporting of AE demonstrates that several differences exist; for example, the reporting of objective versus subjective events. The objective of this study was to describe how patients define AE associated with MT techniques. A descriptive qualitative design was employed. Semi-structured interviews were used with a purposive sample of patients (n = 13) receiving MT, from physiotherapy, chiropractic and osteopathic practises in Ontario, Canada. The interview guide was informed by existing evidence and consultation with content and methodological experts. Interviews were audiotaped and transcribed verbatim. Date were analysed by two independent team members using thematic content analysis. A key finding was that patients defined mild, moderate and major AE by pain/symptom severity, functional impact, duration and by ruling out of alternative causes. An overarching theme identified multiple factors that influence how the AE is perceived. These concepts differ from the previously proposed framework for defining AE that did not include the patient perspective. Future processes to create standard definitions or measures should include the patient viewpoint to provide a broader, client-centred foundation.
PubMed ID
21377403 View in PubMed
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