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Search Results: 1 - 10 of 6167 matches for " MacDonald Susan "
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Roles for Information professionals in patient education: Librarians' perspective
Susan L. MacDonald,Todie Winter,Robert Luke
Partnership : the Canadian Journal of Library and Information Practice and Research , 2010,
Abstract: Through an examination of librarians’ contributions to the PEPTalk research project, this article highlights roles for information professionals at various stages in the design and clinical implementation of an information system that delivers patient education. The Personal Education Plan (PEPTalk) was a collaborative, multi-disciplinary research project (2005-2006) based at the University Health Network’s Princess Margaret Hospital that designed an information system to provide web-based health information resources to both patients and clinicians under a shared umbrella of patient education. This article provides an overview of the PEPTalk project methods and outcomes, and documents the contributions of librarians throughout the design and clinical implementation stages of the project. Librarians brought expertise about information seeking behaviours of both patients and clinicians to the project; liaised across institutional and professional boundaries; developed a classification system for online learning objects, and educated project team about information and health literacies. The contributions of librarians on the PEPTalk project illustrate the need for boundary spanners, information brokers, knowledge translators, and change champions in the design and implementation of patient education delivery systems. There are new roles emergent at the intersections of clinical practice and health information provision. There is a need for the traditional skills and expertise of librarians and other information professionals in tailoring health information. Yet the design and implementation of patient education systems also require the development of new skills and the application of advanced information literacy as it pertains to both clinicians and patients.
Behavioral Consequences of Delta-Opioid Receptor Activation in the Periaqueductal Gray of Morphine Tolerant Rats
Michael M. Morgan,Michelle D. Ashley,Susan L. Ingram,MacDonald J. Christie
Neural Plasticity , 2009, DOI: 10.1155/2009/516328
Abstract: Chronic morphine administration shifts delta-opioid receptors (DORs) from the cytoplasm to the plasma membrane. Given that microinjection of morphine into the PAG produces antinociception, it is hypothesized that the movement of DORs to the membrane will allow antinociception to the DOR agonist deltorphin II as a way to compensate for morphine tolerance. Tolerance was induced by twice daily injections of morphine (5, 10, or 20 mg/kg, subcutaneous) for 3.5 days. Microinjection of deltorphin into the vPAG 6 hours after the last morphine injection produced a mild antinociception that did not vary in a consistent manner across morphine pretreatment doses or nociceptive tests. In contrast, deltorphin caused a decrease in activity in morphine tolerant rats that was associated with lying in the cage. The decrease in activity and change in behavior indicate that chronic morphine administration alters DORs in the vPAG. However, activation of these receptors does not appear to compensate for the decrease in antinociception caused by morphine tolerance.
Relationship between blood pressure measurements recorded on patients' charts in family physicians' offices and subsequent 24 hour ambulatory blood pressure monitoring
Marshall Godwin, Dianne Delva, Rachelle Seguin, Ian Casson, Susan MacDonald, Richard Birtwhistle, Miu Lam
BMC Cardiovascular Disorders , 2004, DOI: 10.1186/1471-2261-4-2
Abstract: The study population consists of 1142 patients who are being assessed for enrolment in two community-based randomized controlled trials. Patients must have essential hypertension, be on antihypertensive medication, and must not have met their blood pressure targets. We are reporting on the proportion of patients who have not achieved target, and the degree to which they have not achieved their target. We also report on the mean daytime blood pressures on 24 hour ABPM and compare these to mean blood pressures found on the patients' charts.We identified 3284 patient charts of patients with hypertension. Of these, 1142 were determined to be "out of control" (did not achieve target) and 436 agreed to undergo 24 hour ABPM for final determination of eligibility. Overwhelmingly (95.8% of the time) it was the systolic blood pressure that was not under control. However, most of the patients who had not achieved target according to our criteria were within 10 mmHg of the recommended targets. Isolated systolic blood pressure was the best predictor of elevated mean daytime blood pressure on 24 hour ABPM.At least 35% of patients had not achieved target blood pressure levels and this is primarily due to lack of control of systolic blood pressure. The best predictor of continuing hypertension on 24 hour ABPM was the mean systolic blood pressure on the patients chart. However, only 69% of patients who were uncontrolled according blood pressures recorded in the chart were uncontrolled according to 24 hour ABPM criteria. This suggests that the white coat effect makes blood pressure measurements in the doctor's offices, at least as currently done, not sufficiently accurate for determining treatment endpoint.Twenty percent of adults in Canada are hypertensive according to the Canada Health Surveys conducted between 1986 and 1992. [1] This constitutes about 4.3 million people. These numbers are similar to other countries where similar population surveys have been done [2] : France 22.1%
Pragmatic controlled clinical trials in primary care: the struggle between external and internal validity
Marshall Godwin, Lucia Ruhland, Ian Casson, Susan MacDonald, Dianne Delva, Richard Birtwhistle, Miu Lam, Rachelle Seguin
BMC Medical Research Methodology , 2003, DOI: 10.1186/1471-2288-3-28
Abstract: External validity is maximized by having few exclusion criteria and by allowing flexibility in the interpretation of the intervention and in management decisions. Internal validity is maximized by decreasing contamination bias through cluster randomization, and decreasing observer and assessment bias, in these non-blinded trials, through baseline data collection prior to randomization, automating the outcomes assessment with 24 hour ambulatory blood pressure monitors, and blinding the data analysis.Clinical trials conducted in community practices present investigators with difficult methodological choices related to maintaining a balance between internal validity (reliability of the results) and external validity (generalizability). The attempt to achieve methodological purity can result in clinically meaningless results, while attempting to achieve full generalizability can result in invalid and unreliable results. Achieving a creative tension between the two is crucial.Controlled clinical trials of health care interventions are either explanatory or pragmatic. [1-8] Explanatory trials test whether an intervention is efficacious; that is, whether it can have a beneficial effect in an ideal situation. These trials are often conducted in large tertiary care, referral-based, health centres on a homogenous group of patients, who have demonstrated compliance, who are likely to remain in the study, and who often have no medical condition other than the one under treatment.Pragmatic trials measure effectiveness; they measure the degree of beneficial effect in real clinical practice. Pragmatic trials are conducted on patients who represent the full spectrum of the population to which the treatment might be applied. These patients may demonstrate variable compliance, have a number of co-morbid conditions, and use other medications. If an intervention is shown to have a significant beneficial effect in a pragmatic trial then it has been shown not only that it can work, but a
Expatriates ill after travel: Results from the Geosentinel Surveillance Network
Lim Poh-Lian,Han Pauline,Chen Lin H,MacDonald Susan
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-386
Abstract: Background Expatriates are a distinct population at unique risk for health problems related to their travel exposure. Methods We analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness. Results Our study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months), and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM) for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis). Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea) compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue) and vaccine-preventable infections (hepatitis A), and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness. Conclusions Ill returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.
A Humanized Monoclonal Antibody Specific for Invariant Natural Killer T (iNKT) Cells for In Vivo Depletion
Felix Scheuplein, Abraham Thariath, Susan Macdonald, Alemseged Truneh, Robert Mashal, Robert Schaub
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0076692
Abstract: Invariant Natural Killer T (iNKT) cells are a subset of T cells recognizing glycolipid antigens presented by CD1d. Human iNKT cells express a conserved T cell receptor (TCR)-α chain (Vα24-Jα18) paired with a specific beta chain, Vβ11. The cells are both innate-like, with rapid cytokine release, and adaptive-like, including thymic positive selection. Over activation of iNKT cells can mediate tissue injury and inflammation in multiple organ systems and play a role in mediating the pathology associated with clinically important inflammatory diseases. At the same time, iNKT cell activation can play a role in protecting against infectious disease and cancer or modulate certain autoimmune diseases through its impact on both the innate and adaptive immune system. This suggests that approaches to cause iNKT cell reduction and/or depletion could treat inflammatory diseases while approaches to promote activation may have therapeutic potential in certain infections, cancer or autoimmune disease. This report summarizes the characterization of a humanized monoclonal depleting antibody (NKTT120) in the cynomolgus macaque. NKTT120 is being developed to treat iNKT mediated inflammation that is associated with chronic inflammatory conditions like sickle cell disease and asthma. NKTT120 binds to human iTCRs and to FCγRI and FCγRIII and has been shown to kill target cells in an ADCC assay at low concentrations consistent with the FCγR binding. iNKT cells were depleted within 24 hours in cynomolgus macaques, but T cell, B cell, and NK cell frequencies were unchanged. iNKT cell recovery was dose and time dependent. T cell dependent antigen responses were not impaired by NKTT120 mediated iNKT depletion as measured by response to KLH challenge. NKTT120 administration did not induce an inflammatory cytokine release at doses up to 10 mg/kg. These data support the use of NKTT120 as an intervention in inflammatory diseases where iNKT reduction or depletion could be beneficial.
Patient, Carer and Professional Perspectives on Barriers and Facilitators to Quality Care in Advanced Heart Failure
Susan Browne, Sara Macdonald, Carl R. May, Una Macleod, Frances S. Mair
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093288
Abstract: Background Those with advanced heart failure (HF) experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. Methods Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30), carers (n = 20), and professionals (n = 65). Data analysed using Normalisation Process Theory (NPT) as the underpinning conceptual framework. Findings Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom. Conclusions Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by simple organisational rather than complex clinical mechanisms.
Emergency Preparedness Nursing Education: Learner and Faculty Perspectives  [PDF]
Geraldine Jody Macdonald
Open Journal of Nursing (OJN) , 2015, DOI: 10.4236/ojn.2015.511108
Abstract: Over the past decade, entry-to-practice emergency preparedness competencies have been identified as an essential component of nursing education. In this paper the author reports upon a small Canadian study which explores the perspective of undergraduate learners and faculty members who participated in and/or facilitated an Emergency Preparedness Simulation (EPS) module during a primary health care praxis course. The central purpose of this study was to explore the related experiences of learners and faculty who participated in or facilitated an Emergency Preparedness Simulation (EPS) module academic year and their perspectives on the effectiveness of the simulation in preparing learners to respond to emergencies in the future. The EPS module included a seminar followed by a mass-casualty simulation experience. The mass-casualty simulation experience included a “Teddy Bear” triage and an “Explosion” triage. The constructivist data analysis identified four related patterns for both the learner and faculty participants: Strengths (S), Objections (O), Suggestions (S), and Feelings (!) [SOS!]. Three themes were identified in each pattern: relevance, design, and engagement. In comparing the learner and faculty perspectives, there is a clear congruence between the strengths identified, the objections identified, and the power of feelings for both learners and faculty who participate in the emergency preparedness scenarios. Learners and faculty had different suggestions. Learners suggested more time on developing skills, particularly around first aid of individual clients, and recommended all students begin with the “Teddy Bear” triage. Faculty suggested a re-thinking of the “Explosion” triage simulation to emphasize community based emergency preparedness and responsiveness. Such re-focusing would support the integration of key primary health care principles and values including equity, social justice, and social determinants of health. Learners and faculty valued the EPS module and recommended it continue to be a learning component of the primary health care course.
Distinct Early Molecular Responses to Mutations Causing vLINCL and JNCL Presage ATP Synthase Subunit C Accumulation in Cerebellar Cells
Yi Cao,John F. Staropoli,Sunita Biswas,Janice A. Espinola,Marcy E. MacDonald,Jong-Min Lee,Susan L. Cotman
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0017118
Abstract: Variant late-infantile neuronal ceroid lipofuscinosis (vLINCL), caused by CLN6 mutation, and juvenile neuronal ceroid lipofuscinosis (JNCL), caused by CLN3 mutation, share clinical and pathological features, including lysosomal accumulation of mitochondrial ATP synthase subunit c, but the unrelated CLN6 and CLN3 genes may initiate disease via similar or distinct cellular processes. To gain insight into the NCL pathways, we established murine wild-type and CbCln6nclf/nclf cerebellar cells and compared them to wild-type and CbCln3Δex7/8/Δex7/8 cerebellar cells. CbCln6nclf/nclf cells and CbCln3Δex7/8/Δex7/8 cells both displayed abnormally elongated mitochondria and reduced cellular ATP levels and, as cells aged to confluence, exhibited accumulation of subunit c protein in Lamp 1-positive organelles. However, at sub-confluence, endoplasmic reticulum PDI immunostain was decreased only in CbCln6nclf/nclf cells, while fluid-phase endocytosis and LysoTracker? labeled vesicles were decreased in both CbCln6nclf/nclf and CbCln3Δex7/8/Δex7/8 cells, though only the latter cells exhibited abnormal vesicle subcellular distribution. Furthermore, unbiased gene expression analyses revealed only partial overlap in the cerebellar cell genes and pathways that were altered by the Cln3Δex7/8 and Cln6nclf mutations. Thus, these data support the hypothesis that CLN6 and CLN3 mutations trigger distinct processes that converge on a shared pathway, which is responsible for proper subunit c protein turnover and neuronal cell survival.
The liberal battlefields of global business regulation
Kate Macdonald,Terry Macdonald
Ethics & Global Politics , 2010, DOI: 10.3402/egp.v3i4.5751
Abstract: The global justice movement has often been associated with opposition to the broad programme of ‘neoliberalism’ and associated patterns of ‘corporate globalisation’, creating a widespread impression that this movement is opposed to liberalism more broadly conceived. Our goal in this article is to challenge this widespread view. By engaging in critical interpretive analysis of the contemporary ‘corporate accountability’ movement, we argue that the corporate accountability agenda is not opposed to the core values of a liberal project. Rather, it is seeking to reconfigure the design of liberal institutions of individual rights-protection, adjusting these for new material conditions associated with economic globalisation, under which powerful corporations alongside states now pose direct and significant threats to individual rights. This activist agenda is, therefore, much less radical in its challenge to the prevailing liberal global order than it may initially appear, since it functions to buttress rather than corrode many core normative commitments underpinning the liberal political project.
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