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McMaster University (mcmaster + university)
Terms modified by McMaster University Selected AbstractsPredictors of disability among Filipinos with knee osteoarthritisINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 3 2008Ester G. Penserga Abstract Aims: This study aims to describe the level of disability of Filipino patients with knee osteoarthritis (OA) in relation to common risk factors. Methodology: This is a cross-sectional analytic study. Patients with knee osteoarthritis diagnosed using the American College of Rheumatology criteria for the classification of knee OA, seen at East Avenue Medical Center, using the Quezon City, Philippines, were entered by convenient sampling. The Western Ontario and McMaster Universities (WOMAC (va) 3.1 Tagalog Version) osteoarthritis index was used. Self-reported disability was measured by the function subscale of the WOMAC OA index and used as the dependent variable. Independent variables assessed as possible risk factors affecting disability were age, sex, weight, height, body mass index (BMI), education (in years), number of comorbidities present, smoking status (pack years), duration of knee OA, pain and stiffness. Categories of disability were identified as high, moderate and low. Analyses of the data were performed using Statistical Package for the Social Sciences (SPSS) version 13. Results: Eighty-five subjects were included in the study. The mean disability score was 674.1 ± 318.81 (moderate disability). Chi-square tests showed that the categories or levels of disability are not significantly dependent on the categorical variables. Significant direct correlations were seen between mean disability and weight (r = 0.260, P = 0.016), pain (r = 0.574, P = 0.000), and stiffness (r = 0.616, P = 0.000). Conclusion: This is the first study analysing the relationship between disability and specific risk factors among Filipino patients with knee OA. Self-reported disability of knee OA in the population studied was strongly related to pain scores, weight and joint stiffness scores. [source] Principles of evidence-based management using stage I,II melanoma as a modelINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 11 2002Tsu-Yi Chuang MD Evidence-Based Medicine (EBM) is the practice of integrating best research evidence with clinical expertise and patent values. 1 The term, Evidence-Based Medicine, was named in 1992 by a group led by Gordon Guyatt at McMaster University in Canada. The practice of EBM arose from the awareness of: 1the daily need for valid information pertinent to clinical practice; 2the inadequacy of traditional sources, like textbooks, for such information; 3the disparity between clinical enhancing skills and declining up-to-date knowledge and eventually, clinical performance; and 4the inability to spend more time in finding and assimilating evidence pertinent to clinical practice. EBM simply emphasizes three As: Access, Appraisal and Application. Access requires refining a clinical question into a searchable term and an answerable question and using search engines to track down the information. Appraisal is using epidemiological principles and methods to critically review evidence for its validity and applicability. Application is integrating the critically appraised evidence with clinical expertise and each patient's unique situation. The outcomes following such practices are then assayed. The last step involves evaluating the effectiveness and efficiency in executing the first two As and seeking ways for improvement. In this article, we describe the concept and steps of practising EBM and utilize melanoma as an example to illustrate how we integrate the best evidence to outline the management plan for stage I-II melanoma. [source] Causality, mathematical models and statistical association: dismantling evidence-based medicineJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2010R. Paul Thompson BA MA PhD Abstract From humble beginnings, largely at the medical school at McMaster University, Canada, the evidence-based medicine (EBM) movement has enjoyed a spectacular rise in international acceptance over the last 25 years. Randomized controlled trials (RCTs) and systematic reviews based on them have pride of place (the gold standard) in EBM's hierarchy of evidence; models and theories are relegated to the bottom of the hierarchy. In the last decade, RCTs have been extensively criticized. I briefly rehearse those criticisms because they are an important backdrop to the criticism of EBM developed in this paper. In essence, the argument developed here is that RCTs use mathematics solely as a tool of analysis rather than as the language of the science and that this fundamentally affects the validity of causal claims. As EBM gives pride of place to RCTs and devalues theoretical models , a devaluation that would be incomprehensible to a physicist or biologist , the validity of EBM's causal claims and knowledge claims are weak and far from a ,gold standard'. [source] Identifying women with severe angiographic coronary diseaseJOURNAL OF INTERNAL MEDICINE, Issue 1 2010C. Kreatsoulas Abstract., Kreatsoulas C, Natarajan MK, Khatun R, Velianou JL, Anand SS (McMaster University; CARING Network, McMaster University; Population Health Research Institute, McMaster University and Hamilton Health Sciences; Interventional Cardiology, Hamilton Health Sciences; Eli Lilly Canada,May Cohen Chair in Women's Health, McMaster University; Michael G. DeGroote-Heart and Stroke Foundation of Ontario Chair in Population Health Research, McMaster University; Population Genomics Program, McMaster University; McMaster University, Hamilton, ON, Canada). Identifying women with severe angiographic coronary disease. J Intern Med 2010; 268:66,74. Objectives., To determine sex/gender differences in the distribution of risk factors according to age and identify factors associated with the presence of severe coronary artery disease (CAD). Design., We analysed 23 771 consecutive patients referred for coronary angiography from 2000 to 2006. Subjects., Patients did not have previously diagnosed CAD and were referred for first diagnostic angiography. Outcome measures., Patients were classified according to angiographic disease severity. Severe CAD was defined as left main stenosis ,50%, three-vessel disease with ,70% stenosis or two-vessel disease including proximal left anterior descending stenosis of ,70%. Univariate and multivariate logistic regression was used to assess the association between risk factors and angina symptoms with severe CAD. Results., Women were less likely to have severe CAD (22.3% vs. 36.5%) compared with men. Women were also significantly older (69.8 ± 10.6 vs. 66.3 ± 10.7 years), had higher rates of diabetes (35.0% vs. 26.6%), hypertension (74.8% vs. 63.3%) and Canadian Cardiovascular Society (CCS) class IV angina symptoms (56.7% vs. 47.8%). Men were more likely to be smokers (56.9% vs. 37.9%). Factors independently associated with severe CAD included age (OR = 1.05; 95% CI 1.05,1.05, P < 0.01), male sex (OR = 2.43; CI 2.26,2.62, P < 0.01), diabetes (OR = 2.00; CI 1.86,2.18, P < 0.01), hyperlipidaemia (OR = 1.50; CI 1.39,1.61, P < 0.01), smoking (OR = 1.10; CI 1.03,1.18, P = 0.06) and CCS class IV symptoms (OR = 1.43; CI 1.34,1.53, P < 0.01). CCS Class IV angina was a stronger predictor of severe CAD amongst women compared with men (women OR = 1.82; CI 1.61,2.04 vs. men OR = 1.28; CI 1.18,1.39, P < 0.01). Conclusions., Women referred for first diagnostic angiography have lower rates of severe CAD compared with men across all ages. Whilst conventional risk factors, age, sex, diabetes, smoking and hyperlipidaemia are primary determinants of CAD amongst women and men, CCS Class IV angina is more likely to be associated with severe CAD in women than men. [source] The evolution of the randomized controlled trial and its role in evidence-based decision makingJOURNAL OF INTERNAL MEDICINE, Issue 2 2003P. J. Devereaux Abstract., Devereaux PJ, Yusuf S (McMaster University, Hamilton, Ontario, Canada). The evolution of the randomized controlled trial and its role in evidence-based decision making (Clinical Trials). J Intern Med 2003; 254: 105,113. The randomized controlled trial has been used in medical research for a little over half a century. This manuscript provides an overview of some of the history and evolution of the randomized controlled trial during this period. There exists hierarchies of evidence for therapeutic, diagnostic and prognostic questions, and the randomized controlled trial is at the top of the therapeutic hierarchy. Despite being at the top of the therapeutic hierarchy randomization in itself does not guarantee the trial results approximate the true effect. Issues that result in systematic and nonsystematic deviations from the truth in randomized controlled trials must also be considered. We present a model for evidence-based decision making that includes the following components: the clinical state, patient preferences, research evidence from a range of studies and clinical expertise. We discuss the role of the randomized controlled trial within evidence-based decision making. [source] Forty-five years in climatology,a personal odysseyTHE CANADIAN GEOGRAPHER/LE GEOGRAPHE CANADIEN, Issue 1 2008WAYNE R. ROUSE This article presents a personal perspective on an academic and research vocation spanning a period of over 45 years. It starts with my early involvement in geography and climatology and terminates with my recent experience in a large interdisciplinary research venture. The presentation highlights, with specific examples, the importance of mentors. Also emphasized is the indispensable input of colleagues and graduate students to successful research endeavours. Most of my career has been centred on McMaster University, and I naturally draw on my experiences there. There have been great changes in the research world over the past few decades. Although the number of faculty and graduate students at McMaster remained relatively constant, the research output per person more than doubled. This is attributed in large part to the accelerating technological advancements in our ability to measure and our ability to process and manipulate data. In the environmental sciences, this has revolutionized the spatial and temporal scope of the scientific questions that can be addressed. Such major changes have stimulated a marked trend towards interdisciplinary research that has evolved from mainly wishful talking to active pursuit in a search to understand complex environmental interactions. Important among these is gaining insights into the processes and feedbacks driving climate change, whether natural or anthropologically induced. Equally important is gaining an understanding of the potential impacts resulting from climate change. My perception of my successes, failures and near misses divides chronologically into three periods that cover research in the early years, research in the central subarctic and research in the Mackenzie River Basin. Quarante-cinq ans en climatologie , une odyssée personnelle Cet article propose un regard personnel sur une carrière universitaire et en recherche échelonnée sur plus de 45 ans, de mes premières contributions à la géographie et la climatologie à mes expériences actuelles au sein d'un projet de recherche interdisciplinaire. L'importance du rôle des mentors est illustrée par des exemples. Le concours indispensable apporté par les collègues et les étudiants des cycles supérieurs au succès des démarches de recherche est également souligné. La majeure partie de mes expériences professionnelles s'est déroulée à l'université McMaster et c'est pourquoi il est naturel pour moi d'y faire référence. De grands changements ont bouleversé le monde de la recherche depuis quelques décennies. Malgré le fait que le nombre de professeurs et d'étudiants des cycles supérieurs soit demeuré relativement stable, la publication de résultats de recherche par personne a plus que doublé. Ceci est attribuable en grande partie au développement rapide des technologies qui nous permettent d'évaluer, de traiter et de manipuler les données. Nous assistons donc à une révolution dans le domaine des sciences environnementales au niveau des dimensions spatiales et temporelles des questions scientifiques que nous pouvons aborder. Ces changements d'envergure alimentent une tendance nette en faveur de la recherche interdisciplinaire qui a évolué d'un v,u pieux à une entreprise active visant à comprendre les interactions environnementales d'un haut niveau de complexité. Il est essentiel de mieux prendre conscience des processus et rétroactions qui interviennent dans les changements climatiques naturels ou d'origine anthropiques. Il est aussi très important de mieux comprendre les effets induits par les changements climatiques. Ma manière de percevoir mes réussites, échecs et quasi-succès se divise chronologiquement en trois époques: les recherches durant les premières années, les recherches menées dans le subarctique, et les recherches sur le bassin du fleuve Mackenzie. [source] PERSPECTIVE: Establishing an NPD Best Practices FrameworkTHE JOURNAL OF PRODUCT INNOVATION MANAGEMENT, Issue 2 2006Kenneth B. Kahn Achieving NPD best practices is a top-of-mind issue for many new product development (NPD) managers and is often an overarching implicit, if not explicit, goal. The question is what does one mean when talking about NPD best practices? And how does a manager move toward achieving these? This article proposes a best practices framework as a starting point for much-needed discussion on this topic. Originally presented during the 2004 Product Development Management Association (PDMA) Research Conference in Chicago, the article and the authors' presentation spurred a significant, expansive discussion that included all conference attendees. Given the interest generated, the decision was made to move forward on a series of rejoinders on the topic of NPD best practice, using the Kahn, Barczak, and Moss framework as a focal launching point for these rejoinders. A total of five rejoinders were received and accompany the best practices framework in this issue of JPIM. Each rejoinder brings out a distinct issue because each of the five authors has a unique perspective. The first rejoinder is written by Dr. Marjorie Adams-Bigelow, director of the PDMA's Comparative Performance Assessment Study (CPAS), PDMA Foundation. Based on her findings during the CPAS study, Adams comments on the proposed framework, suggesting limitations in scope. She particularly points out discrepancies between the proposed framework and the framework offered by PDMA's emerging body of knowledge. Dr. Elko Kleinschmidt, professor of marketing and international business at McMaster University, wrote the second rejoinder. Based on his extensive research with Robert G. Cooper on NPD practices, he points out that best practices really raise more questions than answers. Thomas Kuczmarski, president of Kuczmarski and Associates, is the author of the third rejoinder. Kuczmarski highlights that company mindset and metrics are critical elements needing keen attention. Where do these fit,or should they,in the proposed framework? The fourth rejoinder is written by Richard Notargiacomo, consultant for the integrated product delivery process at Eastman Kodak Company. Notargiacomo compares the proposed framework to a best practices framework Kodak has used for new product commercialization and management since 1998. The distinction of the Kodak framework is the inclusion of a product maturity model component. Dr. Lois Peters, associate professor at Rensselaer Polytechnic Institute (RPI), is the author of the fifth rejoinder. She brings out issues of radical innovation, a natural focal issue of RPI's radical innovation project (RRIP). It is highlighted that radical innovation may require unique, distinctive process characteristics a single framework cannot illustrate. Multiple layers of frameworks may be more appropriate, each corresponding to a level of innovation desired. The overall hope is that the discourse on best practices in this issue of JPIM generates more discussion and debate. Ultimately, the hope is that such discourse will lead to subsequent continued study to help discern what NPD best practice means for our discipline. [source] The Role of Differential Diagnoses in Self-Triage Decision-MakingAPPLIED PSYCHOLOGY: HEALTH AND WELL-BEING, Issue 1 2010Elizabeth C. Hall Self-triage, or the decision if and when to seek medical care is crucial, but also intrinsically difficult. The current study evaluates how the presence of competing diagnoses with differing severities influences participants' likelihood of seeking care. Participants were healthy undergraduate students from McMaster University. In a within-subjects design, participants rated the urgency with which they would seek medical care for a series of hypothetical scenarios. Each scenario included symptoms and either a low-severity diagnosis, a high-severity diagnosis, or a differential diagnosis where both high- and low-severity options were presented. Participants rated low-severity diagnoses as less urgent than high-severity diagnoses, as expected. Critically, when presented with both low- and high-severity options, participants rated scenarios with an intermediate level of urgency. Further analyses showed that participants appeared to base their urgency judgments on the low-severity diagnosis and then adjust their ratings upward when presented with a high-severity alternative. The results demonstrate that even when one of the possible diagnoses presented would require immediate care if accurate, ratings of urgency were significantly decreased if another less serious alternative was also suggested, potentially leading to sub-optimal decision-making. Implications of this observed pattern of self-triage decision-making are discussed. [source] Implementing a problem-based learning curriculum in occupational therapy: A conceptual modelAUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2000Penny Salvatori Problem-based learning in occupational therapy education has enjoyed increasing attention in recent years. Drawing on concepts from general systems theory and organizational theory, this paper presents a conceptual model of an occupational therapy education program as an open and dynamic system that interacts with and is responsive to the external environment. The model is described in the generic context of developing, implementing and evaluating a problem-based learning curriculum. The Bachelor of Health Sciences (Occupational Therapy) program at McMaster University in Canada is used to provide a practical illustration of the various components of the model. The model is considered to be sufficiently generic and adaptable for use by any occupational therapy program in any sociocultural environment in the world, and will be of particular interest to those who are considering problem-based learning as an alternative to traditional educational approaches. [source] Pain, physical functioning and quality of life of individuals awaiting total joint replacement: a longitudinal studyJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2008Gretl A. McHugh PhD MSc Abstract Objectives, To investigate if pain, physical function and the quality of life changed among adults with osteoarthritis while on the waiting list for hip or knee joint replacement. Methods, A longitudinal study of patients listed for primary hip or knee joint replacement. Participants were interviewed at baseline (n = 105) and followed up at 3 (n = 84), 6 (n = 47) and 9 months (n = 24), or until their joint replacement. Measurement tools used were a visual analogue scale (VAS), Western Ontario and McMaster's Universities (WOMAC) Osteoarthritis Index and the Medical Outcomes Study Short Form Health Survey (SF-36). Results, Baseline data indicated high levels of pain as measured by VAS [mean 7.0 (SD 2.2)] and WOMAC pain [mean 11.2 (SD 3.5)]. At baseline, the mean physical function measured by WOMAC was 40.3 (SD 12.1). At the 3-month follow-up, there was significant deterioration in VAS pain scores (0.6; 95% CI mean difference 0.3, 1.0); WOMAC pain scores (1.2; 95% CI mean difference 0.7, 1.8) and WOMAC physical function scores (4.8; 95% CI mean difference 2.8, 6.7) compared with baseline. Conclusion, The often long wait for joint replacement surgery and deterioration in pain and physical function has highlighted the need for active management by health professionals while patients are on the waiting list. [source] | ||||||||||