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Search Results: 1 - 10 of 2614 matches for " Debra Morgan "
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Breaks in continuity of care and the rural senior transferred for medical care under regionalisation
H. Jay Biem,H. Hadjistavropoulos,Debra Morgan,Henry B. Biem
International Journal of Integrated Care , 2003,
Abstract: Continuity of care, defined as the patient experiencing coherent care over time and place, is challenged when a rural senior with multiple medical problems is transferred to a regional hospital for acute care. From an illustrative case of an older patient with pneumonia and atrial fibrillation, we catalogue potential breaks in continuity of care. Optimal continuity of care is characterised not only by regular contact with the providers who establish collaboration with patients and their caregivers, but also by communication, co-ordination, contingency, convenience, and consistency. Because it is not possible to have the same providers continuously available (relational continuity), for continuity of care, there is a need for integrative system approaches, such as: (1) policy and standards, disease management programs, integrated clinical pathways (management continuity), (2) electronic health information systems and telecommunications technology (communication continuity). The evaluation of these approaches requires measures that account for the multi-faceted nature of continuity of care.
Injury Secondary to Antiretroviral Agents: A Retrospective Analysis of a Regional Poison Center Database
Wheatley, Matthew,Shah, Bijal,Morgan, Brent,Houry, Debra
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: Introduction: Poisoning is an increasingly important cause of injury in the United States. In 2009 poison centers received 2,479,355 exposure reports, underscoring the role of poison centers in intentional and unintentional injury prevention. Antiretroviral (ARV) agents are commonly prescribed drugs known to cause toxicity, yet the frequency of these incidents is unknown. The objectives of this study were to quantify the number of reported cases of toxicity secondary to ARV agents at a regional poison center, and to describe the circumstances and clinical manifestations of these poisonings.Methods: We conducted a retrospective review of poison center records between December 1, 2001, and January 7, 2010.Results: One hundred sixty-two exposures to ARV agents were reported to the poison center, of which 30% were intentional and 70% were unintentional. Three patients developed major toxicity and no deaths occurred. The remaining patients developed moderate and minor effects as defined by poison center guidelines.Conclusion: ARV drug toxicity appears to be infrequently reported to the poison center. Fatal and major toxicities are uncommon, and intentional overdoses are associated with a more serious toxicity. Educational efforts should encourage clinicians to report toxicities related to the use of ARV agents to poison centers in order to better study this problem. [West J Emerg Med. 2011;12(3):293-295.]
Insights into the impact and use of research results in a residential long-term care facility: a case study
Cranley Lisa A,Birdsell Judy M,Norton Peter G,Morgan Debra G
Implementation Science , 2012, DOI: 10.1186/1748-5908-7-90
Abstract: Background Engaging end-users of research in the process of disseminating findings may increase the relevance of findings and their impact for users. We report findings from a case study that explored how involvement with the Translating Research in Elder Care (TREC) study influenced management and staff at one of 36 TREC facilities. We conducted the study at ‘Restwood’ (pseudonym) nursing home because the Director of Care engaged actively in the study and TREC data showed that this site differed on some areas from other nursing homes in the province. The aims of the case study were two-fold: to gain a better understanding of how frontline staff engage with the research process, and to gain a better understanding of how to share more detailed research results with management. Methods We developed an Expanded Feedback Report for use during this study. In it, we presented survey results that compared Restwood to the best performing site on all variables and participating sites in the province. Data were collected regarding the Expanded Feedback Report through interviews with management. Data from staff were collected through interviews and observation. We used content analysis to derive themes to describe key aspects related to the study aims. Results We observed the importance of understanding organizational routines and the impact of key events in the facility’s environment. We gleaned additional information that validated findings from prior feedback mechanisms within TREC. Another predominant theme was the sense that the opportunity to engage in a research process was reaffirming for staff (particularly healthcare aides)—what they did and said mattered, and TREC provided a means of having one’s voice heard. We gained valuable insight from the Director of Care about how to structure and format more detailed findings to assist with interpretation and use of results. Conclusions Four themes emerged regarding staff engagement with the research process: sharing feedback reports from the TREC study; the meaning of TREC to staff; understanding organizational context; and using the study feedback for improvement at Restwood. This study has lessons for researchers on how to share research results with study participants, including management.
Clinical Correlates of Awareness for Balance, Function, and Memory: Evidence for the Modality Specificity of Awareness
Megan E. O'Connell,Vanina Dal Bello-Haas,Margaret Crossley,Debra Morgan
Journal of Aging Research , 2014, DOI: 10.1155/2014/674716
Abstract: Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific. 1. Introduction Unawareness, lack of insight, or anosognosia refers to impaired awareness in persons with dementia [1–7]. Awareness is multifactorial and likely modular [4, 8–10], with each domain separable and potentially unique. Most of the literature on awareness in persons with dementia describes the clinical correlates of one awareness domain (reviews by [1, 4, 11]), but the few studies that have contrasted awareness for different domains have found differential patterns of clinical correlates [12–15]. This paper provides further support for the modality specific nature of awareness in dementia by contrasting the clinical correlates for awareness of balance in addition to more commonly measured awareness of day-to-day function and memory. Awareness quantification remains elusive, and there is no consensus method for measuring awareness (e.g., [4, 9]). Awareness has been measured with clinician ratings [16, 17]; or based on discrepancy between self-report versus clinicians’ impression [10] or versus informant report assessed with interview [10, 18] or questionnaires [7, 12, 14, 19–21]; or discrepancy between self-report and objective performance [21, 22], which, depending on the task, measures self-monitoring or metacognitive abilities [3]. Each assessment method has limitations: Clare et al. [21] detail
Study protocol for the translating research in elder care (TREC): building context through case studies in long-term care project (project two)
Jo Rycroft-Malone, Sue Dopson, Lesley Degner, Alison M Hutchinson, Debra Morgan, Norma Stewart, Carole A Estabrooks
Implementation Science , 2009, DOI: 10.1186/1748-5908-4-53
Abstract: To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities.This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time.An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.In this issue of Implementation Science, we present a series of three study protocols: an overview of the Translating Research in Elder Care (TREC) program [1]; TREC project one (Study Protocol for Translating Research in Elder Care: Building Context – an Organizational Monitori
Translating research in elder care: an introduction to a study protocol series
Carole A Estabrooks, Alison M Hutchinson, Janet E Squires, Judy Birdsell, Greta G Cummings, Lesley Degner, Debra Morgan, Peter G Norton
Implementation Science , 2009, DOI: 10.1186/1748-5908-4-51
Abstract: The aims of this study are: to build knowledge translation theory about the role of organizational context in influencing knowledge use in LTC settings and among regulated and unregulated caregivers, to pilot knowledge translation interventions, and to contribute to enhanced use of new knowledge in LTC.This is a multi-level and longitudinal program of research comprising two main interrelated projects and a series of pilot studies. An integrated mixed method design will be used, including sequential and simultaneous phases to enable the projects to complement and inform one another. Inferences drawn from the quantitative and qualitative analyses will be merged to create meta-inferences.Outcomes will include contributions to (knowledge translation) theory development, progress toward resolution of major conceptual issues in the field, progress toward resolution of methodological problems in the field, and advances in the design of effective knowledge translation strategies. Importantly, a better understanding of the contextual influences on knowledge use in LTC will contribute to improving outcomes for residents and providers in LTC settings.In this issue of Implementation Science we present study protocols for the Translating Research in Elder Care (TREC) program of research. We include an overview of the program (this paper), as well as protocols for the two major interrelated projects within the TREC program which were launched in 2008 and 2009 [1,2].The TREC research program described here is the second phase (2007 to 2012) of a long-term investigation into the determinants and processes of using research knowledge to improve care and management in healthcare organizations. The purpose of this program is to develop a robust theoretical understanding of knowledge translation in action in order to facilitate changes that result in better outcomes for recipients of healthcare. The purpose of the present five-year phase of the program is to address the impact of orga
The care unit in nursing home research: Evidence in support of a definition
Carole A Estabrooks, Debra G Morgan, Janet E Squires, Anne-Marie Bostr?m, Susan E Slaughter, Greta G Cummings, Peter G Norton
BMC Medical Research Methodology , 2011, DOI: 10.1186/1471-2288-11-46
Abstract: An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η2, and ω2), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling.In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels.The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to i
Cardiometabolic Risk Indicators That Distinguish Adults with Psychosis from the General Population, by Age and Gender
Debra L. Foley, Andrew Mackinnon, Gerald F. Watts, Jonathan E. Shaw, Dianna J. Magliano, David J. Castle, John J. McGrath, Anna Waterreus, Vera A. Morgan, Cherrie A. Galletly
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082606
Abstract: Individuals with psychosis are more likely than the general community to develop obesity and to die prematurely from heart disease. Interventions to improve cardiovascular outcomes are best targeted at the earliest indicators of risk, at the age they first emerge. We investigated which cardiometabolic risk indicators distinguished those with psychosis from the general population, by age by gender, and whether obesity explained the pattern of observed differences. Data was analyzed from an epidemiologically representative sample of 1,642 Australians with psychosis aged 18–64 years and a national comparator sample of 8,866 controls aged 25–64 years from the general population. Cubic b-splines were used to compare cross sectional age trends by gender for mean waist circumference, body mass index [BMI], blood pressure, fasting blood glucose, triglycerides, LDL, HDL, and total cholesterol in our psychosis and control samples. At age 25 individuals with psychosis had a significantly higher mean BMI, waist circumference, triglycerides, glucose [women only], and diastolic blood pressure and significantly lower HDL-cholesterol than controls. With the exception of triglycerides at age 60+ in men, and glucose in women at various ages, these differences were present at every age. Differences in BMI and waist circumference between samples, although dramatic, could not explain all differences in diastolic blood pressure, HDL-cholesterol or triglycerides but did explain differences in glucose. Psychosis has the hallmarks of insulin resistance by at least age 25. The entire syndrome, not just weight, should be a focus of intervention to reduce mortality from cardiovascular disease.
Sex Differences in Suicide Incident Characteristics and Circumstances among Older Adults: Surveillance Data from the National Violent Death Reporting System—17 U.S. States, 2007–2009
Debra Karch
International Journal of Environmental Research and Public Health , 2011, DOI: 10.3390/ijerph8083479
Abstract: Each year in the U.S. more than 7,000 adults aged 60 years and older die of suicide and as the population ages, these numbers are expected to increase. While sex is an important predictor of older adult suicide, differences between males and females are often overlooked due to low occurrence, particularly among women. The National Violent Death Reporting System (NVDRS) bridges this gap by providing detailed information on older adult suicide by sex in 17 US states (covering approximately 26% of the U.S. population). NVDRS data for 2007–2009 were used to characterize male (n = 5,004) and female (n = 1,123) suicide decedents aged 60 years and older, including incident characteristics and circumstances precipitating suicide. Stratification of NVDRS data by sex shows significant differences with regard to the presence of antidepressants (19% and 45% respectively), opiates (18%, 37%), and 14 precipitating circumstances concerning mental health, interpersonal problems, life stressors and a history of suicide attempts. No differences were found for alcohol problems, suicide/other death of family or friends, non-criminal legal problems, financial problems, or disclosure of intent to take their own life. The findings of this study demonstrate the value of using comprehensive surveillance data to understand sex-specific suicide circumstances so that opportunities for targeted prevention strategies may be considered.
MUMMIES ON DISPLAY: CONSERVATION CONSIDERATIONS
Meier,Debra;
Chungará (Arica) , 2001, DOI: 10.4067/S0717-73562001000100013
Abstract: for centuries, museums around the world have exhibited human mummified remains. in many instances the remains were placed in the exhibit cases without an initial conservation assessment. over time, the mummified remains decay in their cases without proper maintenance. the end result is total loss of integrity within the materials. often times, museums lack conservation specialists, and exhibition staff not trained in conservation does the maintenance of mummies. these museum personnel need to understand the signs of decomposition so that they can detect early signs of conservation problems for proper maintenance over time. they must also make an initial assessment to prepare and maintain mounts that optimizes the conservation of the material while on display. presented is an overview of a conservation assessment that the exhibition professional should be aware of in exhibiting human mummified remains
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