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1.
Med Educ ; 56(10): 972-982, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35451106

RESUMO

CONTEXT: Continuing professional development (CPD) activities for healthcare professionals are central to the optimisation of patient safety and person-centred care. Although there is some evidence on the economics of healthcare professionals training, very little is known about the costs and benefits of CPD. METHODS: This study aimed to review the research evidence on economic evaluations of CPD activities for healthcare professionals. CINAHL, MEDLINE/PubMed, Scopus, Econlit and Web of Science databases were used to identify articles published between 2010 and 2021. RESULTS: Of the 6791 titles identified, 119 articles met the inclusion criteria and were included in this scoping review. The majority of articles were partial economic evaluations of CPD programmes (n = 70); half were from the USA. Studies that included multiple professions were most prevalent (n = 54), followed by nurses (n = 34) and doctors (n = 23). Patient outcomes were the most commonly reported outcome (n = 51), followed by change in clinical practice (n = 38) and healthcare professionals' knowledge gain (n = 19). CONCLUSIONS: There is an urgent call for more evidence regarding the economic evaluations of CPD. This is particularly important in view of the rising costs of healthcare globally. The majority of studies included in this review did not provide detailed information on the evaluations and many focused exclusively on the cost of CPD activities rather than outcomes.


Assuntos
Pessoal de Saúde , Médicos , Análise Custo-Benefício , Atenção à Saúde , Pessoal de Saúde/educação , Humanos , Segurança do Paciente
2.
Nurse Educ Today ; 137: 106161, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38493589

RESUMO

OBJECTIVES: To investigate the effectiveness of continuing professional development in residential long-term care. DESIGN: Systematic review. DATA SOURCES: PubMed, Cumulative Index to Nursing & Allied Health (CINAHL), and Web of Science. REVIEW METHODS: Empirical studies published between 2003 and 2023 describing the effectiveness of continuing professional development in long-term care were selected according to PRISMA guidelines. The type, topic, and effectiveness of continuing professional development activities in long-term care were analysed, in addition to facilitators and barriers. The protocol of this review is registered in PROSPERO. RESULTS: A total of 155 studies were selected, including over 17,000 participants the majority of whom were nurses. The most common topics were 'dementia care' (n = 22; 14.2 %), and restraint use (n = 14; 9 %). The impact of continuing professional development was mainly evaluated in terms of 'participant satisfaction with continuing professional development' (n = 5; 3 %), 'staff knowledge' (n = 57; 37 %), 'staff competencies and skills' (n = 35; 23 %), 'resident outcomes' (n = 45; 29 %), and 'staff wellbeing' (n = 12; 8 %). A total of 64 (41 %) studies evaluated if impact of continuing professional development was sustained over time. 'Good organisation', 'a supportive learning environment', 'expressing personal preferences', and 'management support' were described as facilitators of continuing professional development. CONCLUSIONS: Increasing numbers of long-term care residents with complex health conditions require nurses with advanced skills, such as dementia care. To improve the effectiveness of continuing professional development, support from managers, who adopt relational leadership styles, is instrumental to integrate new knowledge and skills into practice. This needs to be linked to career progression, and consequently increase the attractiveness of working in the long-term care sector. This could meet the dual goal of improving outcomes for residents and nurses' job satisfaction.


Assuntos
Demência , Assistência de Longa Duração , Humanos , Motivação , Aprendizagem , Recursos Humanos
3.
J Cyst Fibros ; 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38964978

RESUMO

BACKGROUND: In July 2011, Cystic Fibrosis (CF) was added to the Newborn Bloodspot Screening Programme in Ireland. The Irish Comparative Outcomes Study (ICOS) is a historical cohort study established to compare outcomes between clinically-detected and screen-detected children with CF. Here we present the results of economic analysis comparing direct healthcare costs in the first 2 years of life of children born between mid-2008 and mid-2016, in the pre-CF transmembrane conductance regulator modulator era. METHODS: Healthcare resource use information was obtained from Cystic Fibrosis Registry of Ireland (CFRI), medical records and parental questionnaire. Hospital admissions, emergency department visits, outpatient appointments, antibiotics and maintenance medications were included. Costs were estimated using the Health Service Executive Casemix, Irish Medicines Formulary and hospital pharmacy data, adjusted for inflation using Consumer Price Index data from the Central Statistics Office. A Negative Binomial regression was used, with time in the study as an offset. RESULTS: Overall participation was 93 %. After exclusion of those with meconium ileus, data from 139 patients, with follow-up to 2 years of age, were available. 72 (51.8 %) were from the clinically diagnosed cohort. In the final model (n=105), clinically diagnosed children had 2.62-fold higher costs per annum (p<0.0001), when adjusted for confounders, including homozygous ΔF508 or G511D mutation, socio-demographic factors and time between diagnosis and first CFRI interaction. CONCLUSIONS: There are few studies evaluating economic aspects of newborn screening for CF using routine care data. These results imply that the benefits of newborn screening extend to direct healthcare costs borne by the State.

4.
Nurse Educ Pract ; 70: 103638, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37104926

RESUMO

AIM: To describe the various teaching and learning modalities for the delivery of Continuing Professional Development activities for health care professionals in the long-term care sector. BACKGROUND: Continuing Professional Development is a key activity that organisations undertake to achieve effective workforce planning, recruitment, retention and upskilling strategies in long-term care settings. During the Covid-19 pandemic there was a rapid move to online modalities of Continuous Professional Development, but there is a paucity of evidence in relation to their effectiveness compared with face-to-face, or in-class learning. DESIGN: A rapid synthesis review. METHODS: MEDLINE, CINAHL and HEALTH BUSINESS ELITE databases were used to identify relevant articles that were published between 2016 and 2022. Original studies of any design investigating Continuing Professional Development activities, with or without a comparison between interventions or activities were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed. The Kirkpatrick model was adopted as a globally recognised method for evaluating training programmes. RESULTS: After a full text analysis, 34 papers were included in the review. Face to face was the most common method of delivery followed by online, while blended (a mix of face-to-face and online delivery) was the least common method used. The teaching modalities were not associated with specific learning contents, but were used for a range of content. Most studies obtained positive outcomes following implementation of the educational interventions. Kirkpatrick Level 4 (results) was the most commonly measured outcome. CONCLUSIONS: While blended learning was the least common method of delivery, it was found to be more beneficial for learners than face-to-face or online exclusively. There are now new spaces to learn and new technologies that allow us to 'reimagine' where, when and how we teach. This requires Continuing Professional Development providers to design and tailor their courses according to health professionals' learning needs and the clinical contexts where they work. We recommend that Continuing Professional Development providers involve employers when designing teaching and learning activities for Long Term Care workers, to decide which modalities enable effective knowledge translation.


Assuntos
Pessoal de Saúde , Assistência de Longa Duração , COVID-19 , Pessoal de Saúde/educação , Pandemias , Aprendizagem
5.
Nurse Educ Pract ; 72: 103774, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37677990

RESUMO

AIM: to develop a better understanding of the attitudes and experiences of healthcare workers and managers with face-to-face, online asynchronous (pre-recorded), and online synchronous (live) modalities for Continuing Professional Development (CPD) working in the Long-Term Care (LTC) sector. BACKGROUND: The recent global pandemic significantly interrupted the delivery and organisation of education and training for healthcare professionals internationally. As a result of the restrictions, healthcare professionals' access to CPD was limited, consequentially education and training activities were mostly delivered online. Research into the experiences of healthcare workers with the various teaching and learning modalities in the LTC setting is limited. DESIGN: An explanatory mixed methods study using an exploratory sequential design. METHODS: A two-phase study conducted from January 2022 to September 2022, in the Republic of Ireland. In phase one, researchers conducted four focus groups and in phase two 168 participants completed a survey to explore the results of phase one. RESULTS: From the focus groups interviews five themes emerged regarding participants' experiences, attitudes and preferences with the three modalities of CPD education and training in the field of LTC: 1) Flexibility, 2) Networking, 3) Resources and Support, 4) Engaging and meaningful learning, and 5) Balancing online and face-to-face learning through Blended Learning. Results from the survey found the preferred modality was face to face (n = 54, 32.1%), followed very closely by blended learning (n = 51, 30.4%). Most of the respondents reported that synchronous online CPD education was convenient, flexible, offers the opportunity to interact with peers, and that its quality depends on educators' skills. The majority of respondents (n = 155, 92.3%) declared that they would require support in the workplace to implement their new knowledge and skills. CONCLUSIONS: This study revealed the significance participants place on 'engagement' when taking part in education and training. Engagement was described as a key factor to improve the delivery of CPD in the LTC setting. In addition, regardless of the mode of delivery, participants reported that they need to be supported in the workplace to implement their new knowledge and skills. This requires the support and endorsement of employers and managers, who could ensure more protected time for learning, technical support and championing facilitators and mentors in the workplace to enhance the translation of new knowledge into clinical practice. TWEETABLE ABSTRACT: In LTC settings, face-to-face CPD is the preferred mode of delivery. Although synchronous online CPD is very convenient, educators must be able to engage learners. LTC workers need support by managers to implement their new knowledge and skills in their workplace.

6.
PLoS One ; 18(5): e0284561, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37134118

RESUMO

Historical loss of river and stream habitats due to impassable dams has contributed to the severe decline of many fish species. Anadromous fishes that migrate from the sea to freshwater streams to spawn have been especially impacted as dams restrict these fish from accessing ancestral spawning grounds. In 2018, Bloede Dam was removed from the Patapsco River near Baltimore, Maryland, restoring approximately 100 km of potential habitat for migratory fish. We assessed the response of anadromous river herring, alewife (Alosa pseudoharengus) and blueback herring (Alosa aestivalis), to this dam removal by monitoring environmental DNA (eDNA) and eggs from 2015 to 2021 at locations upstream and downstream of the dam site during their spawning migrations. We additionally assessed the presence of fish by collecting electrofishing samples and tracked the movements of individual adult fish within the river using passive integrated transponder (PIT) tags. No adult river herring, eDNA, or eggs were detected upstream of Bloede Dam in the four years prior to its removal despite the presence of a fish ladder. Our results suggest initial habitat use recovery by spawning river herring in the first year post-removal, although a relatively small proportion of the population in the river used the newly accessible habitat. In the three years post-removal, the likelihood of detecting river herring eDNA upstream of the former dam site increased to 5% for alewife and 13% for blueback herring. Two adult fish were also collected in electrofishing samples upstream of the dam site in 2021. We found no evidence of changes in egg abundance and no tagged fish were detected upstream of the dam site post-removal. While long term monitoring is needed to assess population changes, this study highlights the value of integrating methods for comprehensive understanding of habitat use following dam removal.


Assuntos
Ecossistema , Peixes , Animais , Peixes/genética , Rios , Água Doce , Alimentos Marinhos
7.
J CME ; 12(1): 2160092, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36969484

RESUMO

The European Centre of Excellence (CoE) for Research in Continuing Professional Development (UPGRADE) is a pan-European network of researchers, clinicians, regulators, educators, and professional bodies, established in 2020 through a consensus group of experts, who defined its mission, vision, values, aims and objectives. The Centre's aim is to advance the science of Continuing Professional Development (CPD) for healthcare professionals through research and dissemination of best practices for CPD. Debate among UPGRADE partners and interchange of research data will yield best practices across countries to optimise quality CPD programmes. Collaboration, information exchange and communication among CPD experts will be facilitated through UPGRADE via an online Community of Inquiry (CoI). UPGRADE aims to evolve as a driving force network of academics and health professional leaders in research, education, professional regulation, and clinical practice whose collaborative work ensures quality and safe person-centred care. UPGRADE members are from 22 European countries, represented by strategic leaders in diverse sectors of health, policy, academia, and professional organisations. Three research-working groups constitute the pillars of UPGRADE, which addresses gaps in research, collect and create critical databases, and solidify the effectiveness of CPD.

8.
Am Heart J ; 163(5): 836-43, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22607862

RESUMO

BACKGROUND: Understanding childhood obesity's root causes is critical to the creation of strategies to improve our children's health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity. METHODS: We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income. RESULTS: In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down. CONCLUSIONS: The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.


Assuntos
Índice de Massa Corporal , Comportamento Infantil , Exercício Físico/fisiologia , Estilo de Vida , Obesidade/epidemiologia , Adolescente , Atitude Frente a Saúde , Criança , Estudos Transversais , Dieta , Características da Família , Disparidades nos Níveis de Saúde , Humanos , Renda , Masculino , Programas de Rastreamento/organização & administração , Massachusetts/epidemiologia , Michigan/epidemiologia , Obesidade/diagnóstico , Obesidade Mórbida/diagnóstico , Obesidade Mórbida/epidemiologia , Sobrepeso/diagnóstico , Sobrepeso/epidemiologia , Prevalência , Características de Residência , Medição de Risco , Serviços de Saúde Escolar , Fatores Socioeconômicos
11.
Am Heart J ; 160(6): 1185-9, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21146676

RESUMO

BACKGROUND: Childhood obesity is one of the nation's foremost health challenges. How much of this is due to lifestyle choices? The objective of the study was to determine health behaviors that contribute to obesity in sixth-grade children. METHODS: To assess which health habits contribute to childhood obesity, we studied body mass index, blood pressure, lipid profile, glucose, and heart rate recovery after a 3-minute step test among sixth-grade children enrolled in a school-based intervention study from 2004 to 2009, comparing health behaviors and physiologic markers in obese versus nonobese children. Univariate associations with obesity (P values≤.10) were entered into a stepwise logistic regression to identify independent predictors. RESULTS: Among 1,003 sixth graders (55% white, 15% African American; average age 11.5 years), 150 (15%) were obese. Obese students had higher levels of total cholesterol, low-density lipoprotein cholesterol, triglycerides, blood pressure, and recovery heart rates. They consumed more regular soda and school lunches but were less likely to engage in physical activities. Obese students were more likely to watch TV≥2 hours per day. Independent predictors were watching TV or video games (odds ratio [OR] 1.19, 95% CI 1.06-1.33) and school lunch consumption (OR 1.29, 95% CI 1.02-1.64); moderate exercise was protective (OR 0.89, 95% CI 0.82-0.98). CONCLUSIONS: Obesity is present in 15% of our sixth graders and is associated with major differences in cardiovascular risk factors. Opportunities to improve childhood health should emphasize programs that increase physical activity, reduce recreational screen time, and improve nutritional value of school lunches. Whether genetic or not, childhood obesity can be attacked.


Assuntos
Comportamento Infantil , Comportamentos Relacionados com a Saúde , Nível de Saúde , Obesidade/epidemiologia , Índice de Massa Corporal , Criança , Feminino , Promoção da Saúde , Humanos , Incidência , Masculino , Minnesota/epidemiologia , Obesidade/psicologia , Estudos Retrospectivos
13.
Pediatr Pulmonol ; 55(9): 2323-2329, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32470170

RESUMO

The introduction of NBS in Ireland in July 2011, provided a unique opportunity to investigate clinical outcomes using a comparative historical cohort study. Clinical cohort: children clinically diagnosed with CF born 1 July 2008 to 30 June 2011, and NBS cohort: children diagnosed with CF through NBS born 1 July 2011 to 30 June 2016. Clinical data were collected from the CF Registry of Ireland, medical charts, and data on weight/height before diagnosis from public health nurses and family doctors. SPSS was used for analysis. A total of 232 patients were recruited (response 93%) (93 clinically diagnosed, 139 NBS-detected). Following exclusions of meconium ileus (MI) (40), diagnosis outside Ireland (4), and being designated as CFSPID (2), a total of 77 clinically diagnosed patients and 109 NBS detected children were included in analysis. Over half were homozygous for F508del mutation. Being clinically diagnosed was independently associated with hospitalization for infective exacerbation of CF < 36 months (OR, 2.80; 95%CI 1.24-6.29). Diagnosis to first acquisition of Pseudomonas aeruginosa was significantly longer in NBS than clinically detected; from birth there was no significant difference. Weight and length/height were significantly greater in NBS cohort at 6 and 12 months. We provide evidence of improved growth, reduced hospitalization for acute exacerbations, and delayed P. aeruginosa acquisition (from diagnosis) to age 3 for the NBS cohort. Screening practices likely account for the non-significant difference in P. aeruginosa acquisition from birth.


Assuntos
Fibrose Cística/diagnóstico , Triagem Neonatal/métodos , Infecções por Pseudomonas/diagnóstico , Criança , Pré-Escolar , Estudos de Coortes , Fibrose Cística/genética , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Irlanda , Masculino , Mutação , Infecções por Pseudomonas/genética , Pseudomonas aeruginosa
14.
Ir J Med Sci ; 188(3): 921-923, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30554310

RESUMO

BACKGROUND: There is little known regarding how familiar parents are with the newborn bloodspot screening (NBS) test or how well parents of a child with a screen-detected condition understand that condition initially. AIM: The study aim was to examine parental NBS awareness and conditions screened. METHODS: Two studies were conducted: [1] Parents of children with cystic fibrosis (CF) detected via NBS and subsequently, diagnosed (n = 124) completed a telephone questionnaire regarding information they received at the time of NBS. [2] A cross-sectional study of women (n = 662 (58%) antenatal; n = 480 (42%) postnatal) attending three large maternity hospitals completed a questionnaire addressing NBS awareness. RESULTS: Mothers incorrectly identified diabetes/asthma (35% postnatal; 70% antenatal) and sickle cell disease (26%) as conditions on NBS in Ireland. Phenylketonuria was correctly identified by 48/26%, CF by 82/64%, and congenital hypothyroidism by 35/13% postnatal and antenatal women respectively. Of parents of children screen-detected and subsequently, diagnosed with CF, only half (n = 63; 51%) reported awareness at the time of NBS that CF was included. These results should be used to improve the information provided to expectant mothers and to inform health professionals' initial discussions with parents about their child's diagnosis, building on parents' pre-existing knowledge.


Assuntos
Fibrose Cística/diagnóstico , Triagem Neonatal/métodos , Pais/educação , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Irlanda , Masculino
15.
PLoS One ; 13(11): e0205578, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30383750

RESUMO

Environmental DNA (eDNA) sampling has emerged as a powerful tool to detect and quantify species abundance in aquatic environments. However, relatively few studies have compared the performance of eDNA-based abundance estimates to traditional catch or survey approaches in the field. Here, we have developed and field-tested a qPCR assay to detect eDNA from alewife and blueback herring (collectively known as 'river herring'), comparing eDNA-based presence and abundance data to traditional methods of quantification (ichthyoplankton sampling and adult observations). Overall, the qPCR assay showed very high target specificity in lab trials, and was successful in detecting river herring for 11/12 Chesapeake Bay tributaries in spring 2015 and 2016, with 106 out of 445 samples exhibiting positive eDNA hits. We found a strong correlation between eDNA abundance and ichthyoplankton count data (Spearman's Rho = 0.52), and Phi-tests (correlation of presence/absence data) showed higher correlation between eDNA and ichthyoplankton data (Phi = 0.45) than adult data (Phi = 0.35). Detection probability was significantly lower on western vs. eastern shore tributaries of Chesapeake Bay, and blueback herring and alewife were more likely detected on the western and eastern shores, respectively. Temporal patterns of eDNA abundance over the spring spawning season revealed that alewife were present in high abundances weeks ahead of blueback herring, which aligns with known differences in spawning behavior of the species. In summary, the eDNA abundance data corresponded well to other field methods and has great potential to assist future monitoring efforts of river herring abundance and habitat use.


Assuntos
DNA/genética , Espécies em Perigo de Extinção , Monitoramento Ambiental , Peixes/genética , Animais , Baías , Ecossistema , Rios , Alimentos Marinhos , Estações do Ano
16.
Cancer Invest ; 25(8): 711-4, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18058467

RESUMO

BACKGROUND: Severe 5-FU toxicity in adjuvant therapy of colorectal cancer may require change of therapy. We retrospectively explored the safety and efficacy of adjuvant raltitrexed in patients intolerant of 5-FU. METHODS: Over a 5 year period, patients who received 5-FU and subsequent raltitrexed therapy were identified. RESULTS: There were 44 patients, (39 stage III). Median number of prior 5-FU cycles was 2. Three year relapse free and overall survival proportions for stage III patients were 70.8% and 83.6%, respectively. CONCLUSIONS: Raltitrexed adjuvant therapy can be given safely and effectively in patients where further 5-FU is contraindicated.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Neoplasias Colorretais/tratamento farmacológico , Fluoruracila/uso terapêutico , Quinazolinas/uso terapêutico , Tiofenos/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/mortalidade , Deficiência da Di-Hidropirimidina Desidrogenase/metabolismo , Feminino , Fluoruracila/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Quinazolinas/efeitos adversos , Estudos Retrospectivos , Tiofenos/efeitos adversos
17.
Leuk Lymphoma ; 48(6): 1102-9, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17577773

RESUMO

BCL-2 protein expression correlates with shorter survival in patients with diffuse large B cell lymphoma (DLBCL) who are treated with CHOP chemotherapy. We report a retrospective analysis of the prognostic significance of BCL-2 status in patients who received CHOP with the addition of rituximab (CHOP-R) for DLBCL. Patients over 15 years of age with de novo, HIV negative DLBCL, without CNS involvement, and known BCL-2 protein status were identified from the BCCA Lymphoid Cancer Database. BCL-2 tumour positivity was defined as over 50% of tumour cells with BCL-2 protein expression. 140 patients who received CHOP-R were analysed. The majority (59%) of patients were over 60 years of age. Disease stage distribution was limited (22%) and advanced (78%). BCL-2 protein expression was observed in 90 (64%) cases. IPI score was similar in both BCL-2 positive and negative cases. Median follow-up time for living patients is 40 months. BCL-2 status did not predict for either progression-free or overall survival. IPI score was predictive for progression-free survival but not overall survival. The addition of rituximab to CHOP chemotherapy negates the adverse prognostic influence of BCL-2 protein expression on progression free and overall survival in DLBCL.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Genes bcl-2 , Linfoma de Células B/diagnóstico , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais Murinos , Biomarcadores Tumorais/genética , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Regulação Leucêmica da Expressão Gênica , Humanos , Linfoma de Células B/genética , Linfoma de Células B/mortalidade , Linfoma Difuso de Grandes Células B/genética , Linfoma Difuso de Grandes Células B/mortalidade , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Prognóstico , Estudos Retrospectivos , Rituximab , Análise de Sobrevida , Resultado do Tratamento , Vincristina/uso terapêutico
18.
Midwifery ; 45: 21-27, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27978478

RESUMO

OBJECTIVES: research suggests that information provided to parents about newborn bloodspot screening (NBS) can be inconsistent. The majority of international NBS programmes recommend that parents should receive information about NBS in the antenatal period, however prior studies have mostly focused on postnatal women's knowledge, with no quantitative study of women's knowledge in the antenatal period conducted to date. Thus, the aim of this study was to determine if antenatal women received information about NBS in the antenatal period and to evaluate their knowledge and attitudes about NBS. DESIGN/PARTICIPANTS: we conducted a cross-sectional study among antenatal attendees at three maternity hospitals in Ireland. A total of 662 antenatal women (≥36 weeks gestation) were recruited into the study (279 primiparous, 368 multiparous). Women were asked to complete a self reported knowledge and attitude questionnaire about NBS. FINDINGS: primiparity (OR 2.75; 95% CI 1.65, 4.59) lower educational status (OR 1.79; 95% CI 1.02, 3.15) and not having private health insurance (OR 1.84; 95% CI 1.19, 2.85) were independently associated with poor NBS knowledge. Fourteen per cent of antenatal women recalled receiving an information leaflet about NBS, yet over 87 % reported that they would like more information. Thirty four per cent of women agreed that they understand everything they need to know about NBS. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: the process of providing women with information about NBS in the antenatal period is inconsistent; consequently their awareness about NBS is limited. To make an informed choice about NBS women require information to be provided in a more structured format. There are many missed opportunities in the antenatal period for maternity care providers to provide women with information about NBS. Our study recommends that healthcare providers should have a more formal and structured approach with regard to the provision of information about NBS in the antenatal period. This could be achieved by incorporating NBS education into antenatal education classes or through multimedia while women are waiting in the antenatal clinic. Healthcare providers may need education about the importance and benefits of providing women with information about NBS in the antenatal period.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Triagem Neonatal/psicologia , Gestantes/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Irlanda , Triagem Neonatal/métodos , Gravidez , Inquéritos e Questionários
19.
J Clin Oncol ; 23(22): 5027-33, 2005 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-15955905

RESUMO

PURPOSE: For more than two decades, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been the standard therapy for diffuse large B-cell lymphoma (DLBCL). The addition of rituximab to CHOP has been shown to improve outcome in elderly patients with DLBCL. We conducted a population-based analysis to assess the impact of this combination therapy on adult patients with DLBCL in the province of British Columbia (BC). METHODS: We compared outcomes during a 3-year period; 18 months before (prerituximab) and 18 months after (postrituximab) institution of a policy recommending the combination of CHOP and rituximab for all patients with newly diagnosed advanced-stage (stage III or IV or stage I or II with "B" symptoms or bulky [> 10 cm] disease) DLBCL. RESULTS: A total of 292 patients were evaluated; 140 in the prerituximab group (median follow-up, 42 months) and 152 in the postrituximab group (median follow-up, 24 months). Both progression-free survival (risk ratio, 0.56; 95% CI, 0.39 to 0.81; P = .002) and overall survival (risk ratio, 0.40; 95% CI, 0.27 to 0.61, P < .0001) were significantly improved in the postrituximab group. After controlling for age and International Prognostic Index score, era of treatment remained a strong independent predictor of progression-free survival (risk ratio, 0.59; 95% CI, 0.41 to 0.85; P = .005) and overall survival (risk ratio, 0.43; 95% CI, 0.29 to 0.66; P < .001). The benefit of treatment in the postrituximab era was present regardless of age. CONCLUSION: The addition of rituximab to CHOP chemotherapy has resulted in a dramatic improvement in outcome for DLBCL patients of all ages in the province of BC.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma de Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais Murinos , Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Colúmbia Britânica , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Humanos , Linfoma de Células B/patologia , Linfoma Difuso de Grandes Células B/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prednisona/administração & dosagem , Prognóstico , Estudos Retrospectivos , Rituximab , Resultado do Tratamento , Vincristina/administração & dosagem
20.
Bioresour Technol ; 219: 246-251, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27494106

RESUMO

As a potential biofuel feedstock, the marine microalga, Heterosigma akashiwo, accumulates significant lipids, is capable of long-term growth in outdoor photobioreactors, and is an excellent candidate for the bioremediation of industrial emissions. Here, we evaluated resource partitioning in H. akashiwo growing on a CO2 and NO gas mixture under three light intensities: 160, 560, or 1200µmolquantam(-2)s(-1). Light levels had no effect on growth; however, cultures in high light accumulated 2.3-fold more carbohydrates and 17% fewer lipids. Light levels did not affect the percentage of saturated fatty acids, but mono-unsaturates increased by 6% and poly-unsaturates decreased by 12% in high light. The fatty acid profiles reported here suggest that H. akashiwo is a good candidate for the production of neutral lipids for biodiesel and also omega-3 fatty acids, and that the quality of biodiesel acquired from feedstocks grown under fluctuating light conditions would be relatively stable.


Assuntos
Biocombustíveis , Microalgas/crescimento & desenvolvimento , Fotobiorreatores/microbiologia , Gerenciamento de Resíduos/métodos , Biomassa , Dióxido de Carbono/química , Resíduos Industriais , Luz , Lipídeos/biossíntese , Microalgas/metabolismo , Óxido Nítrico/química
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