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Search Results: 1 - 10 of 4998 matches for " Eva Grunfeld "
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Family physicians' perspectives on practice guidelines related to cancer control
Louise Zitzelsberger, Eva Grunfeld, Ian D Graham
BMC Family Practice , 2004, DOI: 10.1186/1471-2296-5-25
Abstract: Five group interviews were conducted by telephone with FPs from across Ontario, Canada. Transcripts were analyzed inductively. Content analysis identified emergent themes. Themes are illustrated by representative quotes taken from the transcripts.The main areas where FPs felt guidelines were needed most included screening – a traditional area of responsibility for FPs – and treatment and follow-up – areas where they felt they lacked the knowledge to best support patients. Confusion over best practice when faced with conflicting guidelines varied according to disease site. FPs defined good guideline formats; the most often cited forms of presentation were tear-off sheets to use interactively with patients, or a binder. Computer-based dissemination was acknowledged as the best way of widely distributing material that needs frequent updates. However, until computer use is a common aspect of practice, mail was considered the most viable method of dissemination. Guidelines designed for use by patients were supported by FPs.Preferred guideline topics, format, dissemination methods and role of patient guidelines identified by FPs in this study reflect the nature of their practice situations. Guideline developers and those supporting use of evidence-based guidelines (e.g., Canadian Strategy for Cancer Control) have a responsibility to ensure that FPs are provided with the resources they identify as important, and to provide them in a format that will best support their use.Family physicians (FPs) play an important role in cancer control. Their traditional involvement has been primarily focused on opposite ends of the cancer control continuum: prevention, screening and diagnosis at the beginning of the continuum, and provision of palliative care at the other end. Treatment and follow-up have typically been the responsibility of secondary or tertiary care physicians.There are indications that FPs would like their traditional roles to include involvement in treatment and follo
Exploring the interpersonal-, organization-, and system-level factors that influence the implementation and use of an innovation-synoptic reporting-in cancer care
Robin Urquhart, Geoffrey A Porter, Eva Grunfeld, Joan Sargeant
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-12
Abstract: This study involves three initiatives in Nova Scotia, Canada, that have implemented synoptic reporting within their departments/programs. Case study methodology will be used to study these initiatives (the cases) in-depth, explore which factors were barriers or facilitators of implementation and use, examine relationships amongst factors, and uncover which factors appear to be similar and distinct across cases. The cases were selected as they converge and differ with respect to factors that are likely to influence the implementation and use of an innovation in practice. Data will be collected through in-depth interviews, document analysis, observation of training sessions, and examination/use of the synoptic reporting tools. An audit will be performed to determine/quantify use. Analysis will involve production of a case record/history for each case, in-depth analysis of each case, and cross-case analysis, where findings will be compared and contrasted across cases to develop theoretically informed, generalisable knowledge that can be applied to other settings/contexts. Ethical approval was granted for this study.This study will contribute to our knowledge base on the multi-level factors, and the relationships amongst factors in specific contexts, that influence implementation and use of innovations such as synoptic reporting in healthcare. Such knowledge is critical to improving our understanding of implementation processes in clinical settings, and to helping researchers, clinicians, and managers/administrators develop and implement ways to more effectively integrate innovations into routine clinical care.Cancer treatment and management have become increasingly complex over the past two decades, with therapeutic decisions often based on input from a multidisciplinary team that consists of radiologists, surgeons, pathologists, and oncologists [1]. For patients with suspected or confirmed cancer, clear and thorough recording of diagnostic and surgical procedures and
The impact of audit and feedback on nodal harvest in colorectal cancer
Geoffrey A Porter, Robin Urquhart, Jingyu Bu, Paul Johnson, Eva Grunfeld
BMC Cancer , 2011, DOI: 10.1186/1471-2407-11-2
Abstract: This population-based study included all patients undergoing resection for primary colorectal cancer in Nova Scotia, Canada, from 01 January 2001 to 31 December 2005. Linkage of the provincial cancer registry with other databases (hospital discharge, physician claims data, and national census data) provided clinicodemographic, diagnostic, and treatment-event data. Factors associated with adequate nodal harvest were examined using multivariate logistic regression. The specific interaction between year and health district was examined to identify any potential effect of dissemination of the previously-performed audit.Among the 2,322 patients, the median nodal harvest was 8; overall, 719 (31%) had an adequate nodal harvest. On multivariate analysis, audited health district (p < 0.0001), year (p < 0.0001), younger age (p < 0.0001), non-emergent surgery (p < 0.0001), more advanced stage (p = 0.008), and previous cancer history (p = 0.03) were associated with an increased likelihood of an adequate nodal harvest. Interaction between year and audited health district was identified (p = 0.006) such that the increase in adequate nodal harvest over time was significantly greater in the audited health district.Improvements in colorectal cancer nodal harvest did occur over time. A published audit demonstrating suboptimal nodal harvest appeared to be an effective knowledge translation tool, though more so for the audited health district, suggesting a potentially beneficial effect of audit and feedback strategies.In Canada, it is estimated there will be 22,500 new cases of colorectal cancer in 2010. More than 9,100 will die of the disease, making it the second most common cancer-causing death [1]. Survival is clearly related to stage of disease at diagnosis; the status of lymph nodes is a critical discriminator of stage, particularly in discriminating patients with stage II and stage III disease [2]. The use of adjuvant therapies has been clearly shown to improve survival for stag
International Law and International Relations: Norm and reality or viceversa
Fred Grunfeld
Amsterdam Law Forum , 2011,
Abstract: The fields of Public International Law (PIL) and International Relations (IR) share the same research area: international politics.This article focuses on the differences between social scientists (especially political scientists studying International Relations) and legal researchers (specifically in the fields of Public International Law and human rights) in terms of research methods. The focus on methodology will highlight the difference between the researchers of Public International Law on the one hand, and International Relations on the other.
A team approach to improving colorectal cancer services using administrative health data
Geoffrey Porter, Robin Urquhart, Jingyu Bu, Cynthia Kendell, Maureen MacIntyre, Ron Dewar, George Kephart, Yukiko Asada, Eva Grunfeld
Health Research Policy and Systems , 2012, DOI: 10.1186/1478-4505-10-4
Abstract: The objectives of this paper are to: 1) provide a detailed description of the methodologies employed across the various studies being conducted by Team ACCESS; 2) demonstrate how administrative health data can be used to evaluate access and quality in CRC services; and 3) provide an example of an interdisciplinary team approach to addressing health service delivery issues.All patients diagnosed with CRC in NS between 2001 and 2005 were identified through the Nova Scotia Cancer Registry (NSCR) and staged using the Collaborative Stage Data Collection System. Using administrative databases that were linked at the patient level, Team ACCESS created a retrospective longitudinal cohort with comprehensive demographic, clinical, and healthcare utilization data. These data were used to examine access to and quality of CRC services in NS, as well as factors affecting access to and quality of care, at various transition points along the continuum of care. Team ACCESS has also implemented integrated knowledge translation strategies targeting policy- and decision- makers.The development of Team ACCESS represents a unique approach to CRC research. We anticipate that the skills, tools, and knowledge generated from our work will also advance the study of other cancer disease sites in NS. Given the increasing prevalence of cancer, and with national and provincial funding agencies promoting collaborative research through increased funding for research team development, the work carried out by Team ACCESS is important in the Canadian context and exemplifies how a team approach is essential to comprehensively addressing issues surrounding not only cancer, but other chronic diseases in Canada.In Canada, an estimated 22,200 new cases of colorectal cancer (CRC) were diagnosed in 2011, making it the third most commonly diagnosed cancer in both men and women in Canada [1]. Despite a modest decrease in national mortality rates over the last 20 years, CRC mortality still accounts for approxim
Lingüística textual: quo vadis?
Koch, Ingedore Grunfeld Villa?a;
DELTA: Documenta??o de Estudos em Lingüística Teórica e Aplicada , 2001, DOI: 10.1590/S0102-44502001000300002
Abstract: this paper aims to discuss the future ? and the proper survival of textlinguistics this millenium, and the challenges it has to face in order to contribute to the development of human sciences in a new era.
Lingüística textual: retrospecto e perspectivas
Ingedore Grunfeld Villa?a Koch
Alfa : Revista de Linguística , 2001,
Abstract: O objetivo do presente trabalho é apresentar uma retrospectiva critica doque se fez no campo da Lingüística Textual nos últimos trinta anos, bem como apontaras perspectivas que se vêm abrindo na área para desenvolvimentos futuros.
Lingüística textual: quo vadis?
Koch Ingedore Grunfeld Villa?a
DELTA: Documenta??o de Estudos em Lingüística Teórica e Aplicada , 2001,
Abstract: Este artigo tem por objetivo discutir o futuro -- e a própria sobrevivência -- da Lingüística Textual neste milênio e os desafios que terá de enfrentar para contribuir para o desenvolvimento das Ciências Humanas numa nova era.
Critical spectrum of fluctuations for deconfinement at proto-neutron star cores
G. Lugones,A. G. Grunfeld
Physics , 2011, DOI: 10.1103/PhysRevD.84.085003
Abstract: We study the deconfinement of hadronic matter into quark matter in a protoneutron star focusing on the effects of the finite size on the formation of just-deconfined color superconducting quark droplets embedded in the hadronic environment. The hadronic phase is modeled by the non-linear Walecka model at finite temperature including the baryon octet and neutrino trapping. For quark matter we use an $SU(3)_f$ Nambu-Jona-Lasinio model including color superconductivity. The finite size effects on the just deconfined droplets are considered in the frame of the multiple reflection expansion. In addition, we consider that just deconfined quark matter is transitorily out of equilibrium respect to weak interaction, and we impose color neutrality and flavor conservation during the transition. We calculate self-consistently the surface tension and curvature energy density of the quark hadron inter-phase and find that it is larger than the values typically assumed in the literature. The transition density is calculated for drops of different sizes, and at different temperatures and neutrino trapping conditions. Then, we show that energy-density fluctuations are much more relevant for deconfinement than temperature and neutrino density fluctuations. We calculate the critical size spectrum of energy-density fluctuations that allows deconfinement as well as the nucleation rate of each critical bubble. We find that drops with any radii smaller than 800 fm can be formed at a huge rate when matter achieves the bulk transition limit of 5-6 times the nuclear saturation density.
Preimplantation genetic diagnosis for gender selection: You don’t always get what you want  [PDF]
Tanmoy Mukherjee, Eric Flisser, Alan B. Copperman, Lawrence Grunfeld, Benjamin Sandler, Jason Barritt
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.23062
Abstract: Parenting children of opposite genders is a powerful motive for parents to seek “sex-selection” services. Medical beneficence and patient autonomy support making these services available. Our goals in this study included data to permit proper patient education, assess outcome, and evaluation of potential biases in this technology. IVF/PGD cases from August 2004 to December 2009 were studied (n = 122). FISH was used to analyze nuclear DNA of biopsied embryos. The variables analyzed were patient age, Day 3 Fluorescent In Situ Hybridization (FISH), the number of fertilized embryos, the number of embryos biopsied, Preimplantation Genetic Diagnosis (PGD) results, the number of embryos transferred, and the fate of remaining embryos. Female embryos were sought in 84 cycles, and male embryos desired in 38 cycles. Couples seeking female offspring had a reduced likelihood of a female-only transfer vs. those seeking males (p < 0.001). No transfer was performed in 32 cases for lack of normal embryos of desired gender. Clinical pregnancy rate per embryo transfer was 30.4%. PGD success rates for gender variety were lower than expected comparative to traditional IVF. In this report we present our clinical experience with IVF/PGD for gender selection. We attempt to analyze which patients seek this specialized treatment and to provide direct clinical and laboratory outcome data from our completed cycles.
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