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Application of the development stages of a cluster randomized trial to a framework for valuating complex health interventions.

https://arctichealth.org/en/permalink/ahliterature189408
Source
BMC Health Serv Res. 2002 Jul 11;2(1):13
Publication Type
Article
Date
Jul-11-2002
Author
Mark B Loeb
Author Affiliation
Department of Pathology, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
BMC Health Serv Res. 2002 Jul 11;2(1):13
Date
Jul-11-2002
Language
English
Publication Type
Article
Keywords
Aged
Algorithms
Anti-Bacterial Agents - therapeutic use
Cluster analysis
Critical Pathways
Drug Resistance, Bacterial
Female
Health Services Research - methods
Humans
Intervention Studies
Male
Nursing Homes - standards - statistics & numerical data
Nursing Staff - education
Ontario
Qualitative Research
Randomized Controlled Trials as Topic
Urinary Tract Infections - drug therapy - nursing - urine
Abstract
Trials of complex health interventions often pose difficult methodologic challenges. The objective of this paper is to assess the extent to which the various development steps of a cluster randomized trial to optimize antibiotic use in nursing homes are represented in a recently published framework for the design and evaluation of complex health interventions. In so doing, the utility of the framework for health services researchers is evaluated.
Using the five phases of the framework (theoretical, identification of components of the intervention, definition of trial and intervention design, methodological issues for main trial, promoting effective implementation), corresponding stages in the development of the cluster randomized trial using diagnostic and treatment algorithms to optimize the use of antibiotics in nursing homes are identified and described.
Synthesis of evidence needed to construct the algorithms, survey and qualitative research used to define components of the algorithms, a pilot study to assess the feasibility of delivering the algorithms, methodological issues in the main trial including choice of design, allocation concealment, outcomes, sample size calculation, and analysis are adequately represented using the stages of the framework.
The framework is a useful resource for researchers planning a randomized clinical trial of a complex intervention.
Notes
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PubMed ID
12110157 View in PubMed
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Effects of school closure on incidence of pandemic influenza in Alberta, Canada.

https://arctichealth.org/en/permalink/ahliterature127247
Source
Ann Intern Med. 2012 Feb 7;156(3):173-81
Publication Type
Article
Date
Feb-7-2012
Author
David J D Earn
Daihai He
Mark B Loeb
Kevin Fonseca
Bonita E Lee
Jonathan Dushoff
Author Affiliation
McMaster University, Hamilton, Ontario, Canada. earn@math.mcmaster.ca
Source
Ann Intern Med. 2012 Feb 7;156(3):173-81
Date
Feb-7-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Alberta - epidemiology
Child
Child, Preschool
Female
Humans
Incidence
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology - prevention & control - transmission
Likelihood Functions
Male
Pandemics - prevention & control
Schools
Seasons
Social Isolation
Abstract
Control of pandemic influenza by social-distancing measures, such as school closures, is a controversial aspect of pandemic planning. However, investigations of the extent to which these measures actually affect the progression of a pandemic have been limited.
To examine correlations between the incidence of pandemic H1N1 (pH1N1) influenza in Alberta, Canada, in 2009 and school closures or weather changes, and to estimate the effects of school closures and weather changes on pH1N1 transmission.
Mathematical transmission models were fit to data that compared the pattern of confirmed pH1N1 cases with the school calendar and weather patterns.
Alberta, Canada, from 19 April 2009 to 2 January 2010.
2009 virologic test results, 2006 census data, 2009 daily temperature and humidity data, and 2009 school calendars.
Age-specific daily counts of positive results for pH1N1 from the complete database of 35 510 specimens submitted to the Alberta Provincial Laboratory for Public Health for virologic testing from 19 April 2009 to 2 January 2010.
The ending and restarting of school terms had a major effect in attenuating the first wave and starting the second wave of pandemic influenza cases. Mathematical models suggested that school closure reduced transmission among school-age children by more than 50% and that this was a key factor in interrupting transmission. The models also indicated that seasonal changes in weather had a significant effect on the temporal pattern of the epidemic.
Data probably represent a small sample of all viral infections. The mathematical models make simplifying assumptions in order to make simulations and analysis feasible.
Analysis of data from unrestricted virologic testing during an influenza pandemic provides compelling evidence that closing schools can have dramatic effects on transmission of pandemic influenza. School closure seems to be an effective strategy for slowing the spread of pandemic influenza in countries with social contact networks similar to those in Canada.
Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council of Canada, and Public Health Agency of Canada.
Notes
Comment In: Ann Intern Med. 2012 Feb 7;156(3):238-4022312144
SummaryForPatientsIn: Ann Intern Med. 2012 Feb 7;156(3):I2822312154
PubMed ID
22312137 View in PubMed
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Interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia.

https://arctichealth.org/en/permalink/ahliterature167475
Source
J Am Med Dir Assoc. 2006 Sep;7(7):416-9
Publication Type
Article
Date
Sep-2006
Author
Mark B Loeb
Soo B Chan Carusone
Tom J Marrie
Kevin Brazil
Paul Krueger
Lynne Lohfeld
Andrew E Simor
Stephen D Walter
Author Affiliation
Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
J Am Med Dir Assoc. 2006 Sep;7(7):416-9
Date
Sep-2006
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel
Case-Control Studies
Chest Pain - etiology
Clinical Competence - standards
Cough - etiology
Cross Infection - complications - radiography
Cross-Sectional Studies
Dyspnea - etiology
Female
Fever - etiology
Humans
Male
Medical Staff, Hospital - education - psychology
Nursing Homes
Observer Variation
Ontario
Pleural Effusion - complications - radiography
Pneumonia - complications - radiography
Point-of-Care Systems - standards
Radiography, Thoracic - standards
Radiology - education - standards
Randomized Controlled Trials as Topic
Sputum
Time Factors
Abstract
To determine the interobserver reliability of radiologists' interpretations of mobile chest radiographs for nursing home-acquired pneumonia.
A cross-sectional reliability study.
Nursing homes and an acute care hospital.
Four radiologists reviewed 40 mobile chest radiographs obtained from residents of nursing homes who met a clinical definition of lower respiratory tract infections.
Radiologists were asked to interpret radiographs with respect to the film quality; presence, pattern, and extent of an infiltrate; and the presence of a pleural effusion or adenopathy. Interrater reliability was evaluated using the intraclass correlation coefficient derived from a 2-way random effects model.
On average the radiologists reported that 6 of the 40 films were of very good or excellent quality and 16 of the 40 were of fair or poor quality. When the finding of an infiltrate was dichotomized (0 = no; 1 = possible, probable, or definite) all 4 radiologists agreed on 21 of the 37 chest radiographs. The intraclass correlation coefficient for the presence or absence of infiltrates was 0.54 (95% confidence intervals [CI] 0.38 to 0.69). For the 14 radiographs where infiltrates were observed by all radiologists, intraclass correlation coefficients for the presence of pleural effusions was 0.08 (95% CI -0.10 to 0.41), hilar adenopathy 0.54 (95% CI 0.29 to 0.79), and mediastinal adenopathy 0.49 (95% CI 0.21 to 0.76).
In conclusion, the interrater agreement among radiologists for mobile chest radiographs in establishing the presence or absence of an infiltrate can be judged to be "fair." Treatment decisions need to include clinical findings and should not be made based on radiographic findings alone.
Notes
Comment In: J Am Med Dir Assoc. 2006 Sep;7(7):467-916979094
PubMed ID
16979084 View in PubMed
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Nursing home residents and Enterobacteriaceae resistant to third-generation cephalosporins.

https://arctichealth.org/en/permalink/ahliterature179563
Source
Emerg Infect Dis. 2004 Jun;10(6):1050-5
Publication Type
Article
Date
Jun-2004
Author
Carolyn Sandoval
Stephen D Walter
Allison McGeer
Andrew E Simor
Suzanne F Bradley
Lorraine M Moss
Mark B Loeb
Author Affiliation
McMaster University, Hamilton, Ontario, Canada.
Source
Emerg Infect Dis. 2004 Jun;10(6):1050-5
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - pharmacology
Canada
Case-Control Studies
Cephalosporins - pharmacology
Drug Resistance, Bacterial
Enterobacteriaceae - drug effects - growth & development - isolation & purification
Enterobacteriaceae Infections - drug therapy - microbiology
Humans
Logistic Models
Microbial Sensitivity Tests
Multivariate Analysis
Nursing Homes
Risk factors
United States
Abstract
Limited data identify the risk factors for infection with Enterobacteriaceae resistant to third-generation cephalosporins among residents of long-term-care facilities. Using a nested case-control study design, nursing home residents with clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins were compared to residents with isolates of Enterobacteriaceae susceptible to third-generation cephalosporins. Data were collected on antimicrobial drug exposure 10 weeks before detection of the isolates, facility-level demographics, hygiene facilities, and staffing levels. Logistic regression models were built to adjust for confounding variables. Twenty-seven case-residents were identified and compared to 85 controls. Exposure to any cephalosporin (adjusted odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2 to 13.6) and log percentage of residents using gastrostomy tubes within the nursing home (adjusted OR 3.9, 95% CI 1.3 to 12.0) were associated with having a clinical isolate resistant to third-generation cephalosporins.
Notes
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PubMed ID
15207056 View in PubMed
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Pneumonia and lower respiratory infections in nursing home residents: predictors of hospitalization and mortality.

https://arctichealth.org/en/permalink/ahliterature164809
Source
J Am Geriatr Soc. 2007 Mar;55(3):414-9
Publication Type
Article
Date
Mar-2007
Author
Soo B Chan Carusone
Stephen D Walter
Kevin Brazil
Mark B Loeb
Author Affiliation
Departments of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
Source
J Am Geriatr Soc. 2007 Mar;55(3):414-9
Date
Mar-2007
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - classification
Aged
Aged, 80 and over
Critical Pathways
Female
Geriatric Assessment - statistics & numerical data
Heart Failure - mortality
Homes for the Aged - statistics & numerical data
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Nursing Homes - statistics & numerical data
Ontario
Pneumonia, Bacterial - mortality - therapy
Quality of Life
Risk factors
Statistics as Topic
Survival Analysis
Abstract
To compare predictors of hospitalization and death in nursing home residents with pneumonia and other lower respiratory infections (LRIs).
A nested cohort study.
Nine nursing homes in southern Ontario.
Three hundred fifty-three nursing home residents with LRIs (enrolled in the control arm of a clinical trial).
Comorbidities, vaccination status, age, health-related quality of life, functional status, and vital statistics were evaluated as potential predictors of hospitalization and mortality at 30 days.
Moderate to high disease severity score on a practical severity scale was a strong independent predictor of hospitalization (odds ratio (OR)=7.12, P
PubMed ID
17341245 View in PubMed
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Risk factors for resistance to antimicrobial agents among nursing home residents.

https://arctichealth.org/en/permalink/ahliterature187210
Source
Am J Epidemiol. 2003 Jan 1;157(1):40-7
Publication Type
Article
Date
Jan-1-2003
Author
Mark B Loeb
Sharon Craven
Allison J McGeer
Andrew E Simor
Suzanne F Bradley
Donald E Low
Maxine Armstrong-Evans
Lorraine A Moss
Stephen D Walter
Author Affiliation
Department of Pathology and Molecular Medicine, McMaster University and Hamilton Regional Laboratory Program, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
Am J Epidemiol. 2003 Jan 1;157(1):40-7
Date
Jan-1-2003
Language
English
Publication Type
Article
Keywords
Anti-Bacterial Agents
Bacterial Infections - epidemiology - microbiology - prevention & control
Canada - epidemiology
Cross Infection - epidemiology - microbiology - prevention & control
Drug resistance
Environmental Exposure - adverse effects - analysis
Hand Disinfection - methods - standards
Humans
Infection control - methods - standards
Logistic Models
Microbial Sensitivity Tests
Multivariate Analysis
Nursing Homes - organization & administration
Personnel Staffing and Scheduling - statistics & numerical data
Prospective Studies
Risk factors
Soaps
United States - epidemiology
Abstract
The authors prospectively collected data on exposure to antimicrobial agents and susceptibility patterns among all clinical isolates of bacteria taken from 9,156 residents of 50 nursing homes in Canada and the United States in 1998-1999. Exposure to antimicrobial agents was measured during the 10 weeks prior to detection of targeted resistant bacteria in residents and compared with antibiotic exposure during a 10-week interval in individuals with sensitive organisms. These main effects were adjusted for infection-control and staffing covariates using multiple logistic regression modeling. Increased staffing of nursing homes with registered nurses (adjusted odds ratio (OR) = 0.79 (95% confidence interval (CI): 0.72, 0.87) per registered nurse per 100 resident-days) and use of antibacterial soap (adjusted OR = 0.40, 95% CI: 0.18, 0.90) were associated with reduced risk of methicillin-resistant Staphylococcus aureus in nursing home residents. An increase in the number of hand-washing sinks per 100 residents was shown to reduce the risk of trimethoprim-sulfamethoxazole (TMP/SMX)-resistant Enterobacteriaceae (adjusted OR = 0.94, 95% CI: 0.90, 0.98). Exposure to TMP-SMX and exposure to fluoroquinolones were significant risk factors for isolation of TMP-SMX-resistant Enterobacteriaciae (adjusted OR = 1.14, 95% CI: 1.06, 1.22) and fluoroquinolone-resistant Enterobacteriaciae (adjusted OR = 1.08, 95% CI: 1.04, 1.11), respectively. These findings suggest that increased staffing, more hand-washing sinks, and use of antimicrobial soap may reduce resistance to antimicrobial agents in long-term care facilities.
PubMed ID
12505889 View in PubMed
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Use of a broader determinants of health model for community-acquired pneumonia in seniors.

https://arctichealth.org/en/permalink/ahliterature180242
Source
Clin Infect Dis. 2004 May 1;38(9):1293-7
Publication Type
Article
Date
May-1-2004
Author
Mark B Loeb
Author Affiliation
Department of Pathology, McMaster University, Hamilton, Ontario, Canada. loebm@mcmaster.ca
Source
Clin Infect Dis. 2004 May 1;38(9):1293-7
Date
May-1-2004
Language
English
Publication Type
Article
Keywords
Aged
Air Pollutants
Canada - epidemiology
Community-Acquired Infections - epidemiology
Humans
Pneumonia - epidemiology
Respiratory Tract Infections - epidemiology
Risk factors
Socioeconomic Factors
United States - epidemiology
Abstract
Community-acquired pneumonia in older adults represents an important clinical and public health challenge. This article discusses the role that factors such as socioeconomic status, air pollution, crowding, exposure to tobacco smoke, and nutrition play in predisposing elderly persons to such respiratory infections. It is proposed that a model that addresses these factors is needed for a comprehensive understanding of these infections. Although the causal pathways may be unclear, there are data to suggest a relationship between low socioeconomic status and risk of acquiring respiratory infection. The need for more research in this area is emphasized.
PubMed ID
15127343 View in PubMed
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7 records – page 1 of 1.