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Research Assistants (research + assistant)

Distribution by Scientific Domains

Medical Sciences	66%
Humanities and Social Sciences	18%
Psychology	11%

Kinds of Research Assistants

trained research assistant

Selected Abstracts

The creation and consequences of the social world: an interactional analysis of extraversion

EUROPEAN JOURNAL OF PERSONALITY, Issue 5 2003
Leslie G. Eaton
Seventy-six previously unacquainted, opposite-sex pairs of undergraduate participants engaged in a 5,min videotaped interaction, then provided their mutual impressions. Research assistants coded 64 behaviours from the videotapes; these ratings were combined into behavioural factors. Participants provided self-descriptions of personality and were described by two acquaintances. Path analyses indicated that targets extraversion was associated with their behavioural involvement, which in turn was associated with partners subsequent ratings of their personality. Targets interpersonal positive affectivity was associated with their partners extraversion. Similar patterns of behavioural associations were found in relation to self-reported, partner-reported, and acquaintance-reported extraversion. These results demonstrate how extraverts may create a positive social environment through their own positivity and by creating a social press for positivity in return. Copyright © 2003 John Wiley & Sons, Ltd. [source]

Partner violence prevalence among women attending a Maori health provider clinic

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2007
Jane Koziol-McLain
Abstract Objective: To determine partner violence rates among women attending a general practice in Aotearoa, New Zealand. Methods: This descriptive study was conducted in a hauora (Maori health provider general practice clinic) in one South Auckland community. Non-acute, English-speaking women who entered the huaora during 30 randomly selected clinic sessions in a five-week period in 2003 were eligible to participate. Research assistants (RAs) verbally administered a structured, brief questionnaire that included a partner violence screen (past 12 months), assessment of high danger risk, and lifetime prevalence. Of 148 women approached, 109 participated. Participants generally self-identified as Maori (74%) or New Zealand European (18%) and ranged in age from 17 to 82 years (mean 38.8). Results: Twenty-three per cent (95% CI 15,31) of women screened positive for partner violence. Among the 25 women who screened positive, six (24%) had one or more high danger risk factors and 24 (96%) reported one or more children living in the household. Seventy-eight per cent (95% CI 70,86) of women reported a history of partner violence. Conclusions: In this sample of mostly Maori women, direct partner violence questioning in a general practice setting yielded a high disclosure rate. Three out of four women disclosed violence by a partner; nearly one out of four disclosed violence by a partner in the past year. Implications: Healthcare providers have the opportunity to identify and provide services to women and their children experiencing partner violence. Health care providers and the health care system also have a responsibility to join with the community in calling for non-tolerance of family violence. [source]

The "Vertical Response Time": Barriers to Ambulance Response in an Urban Area

ACADEMIC EMERGENCY MEDICINE, Issue 9 2007
Robert A. Silverman MD
Background: Ambulance response time is typically reported as the time interval from call dispatch to arrival on-scene. However, the often unmeasured "vertical response time" from arrival on-scene to arrival at the patient's side may be substantial, particularly in urban areas with high-rise buildings or other barriers to access. Objectives: To measure the time interval from arrival on-scene to the patient in a large metropolitan area and to identify barriers to emergency medical services arrival. Methods: This was a prospective observational study of response times for high-priority call types in the New York City 9-1-1 emergency medical services system. Research assistants riding with paramedics enrolled a convenience sample of calls between 2001 and 2003. Results: A total of 449 paramedic calls were included, with a median time from call dispatch to arrival on-scene of 5.2 minutes. The median on-scene to patient arrival interval was 2.1 minutes, leading to an actual response interval (dispatch to patient) of 7.6 minutes. The median on-scene to patient interval was 2.8 minutes for residential buildings, 2.7 minutes for office complexes, 1.3 minutes for private homes (less than four stories), and 0.5 minutes for outdoor calls. Overall, for all calls, the on-scene to patient interval accounted for 28% of the actual response interval. When an on-scene escort provided assistance in locating and reaching the patient, the on-scene to patient interval decreased from 2.3 to 1.9 minutes. The total dispatch to patient arrival interval was less than 4 minutes in 8.7%, less than 6 minutes in 28.5%, and less than 8 minutes in 55.7% of calls. Conclusions: The time from arrival on-scene to the patient's side is an important component of overall response time in large urban areas, particularly in multistory buildings. [source]

Research Note: The silenced assistant.

ASIA PACIFIC VIEWPOINT, Issue 2 2010
Reflections of invisible interpreters, research assistants
Abstract Given the increased attention in anthropology and human geography to the positionality and reflexivity of researchers completing fieldwork in foreign countries, it is surprising that we still know relatively little about how research assistants and interpreters are positioned in the field and their own concerns, constraints and coping mechanisms. This article, based on in-depth interviews with local interpreters/research assistants in Vietnam and China, working alongside Western doctoral students researching upland ethnic minority populations, provides space for the assistants' voices. While reflecting upon their own time in the field, we see how the positionalities of these individuals can have rather unexpected consequences. Furthermore, the assistants' analyses of particular events, as well as their take on the best way to proceed in specific circumstances can be at odds with that of their employers, and negotiated coping strategies have to be found. The article concludes with advice from these assistants regarding how future assistants can make the best of their position, and what foreign researchers need to consider in fostering constructive working relationships. [source]

Pre-operative screening for excessive alcohol consumption among patients scheduled for elective surgery

DRUG AND ALCOHOL REVIEW, Issue 2 2007
SWATI SHOURIE
Abstract Pre-operative intervention for excessive alcohol consumption among patients scheduled for elective surgery has been shown to reduce complications of surgery. However, successful intervention depends upon an effective and practical screening procedure. This study examines current screening practices for excessive alcohol consumption amongst patients scheduled for elective surgery in general hospitals. It also examines the appropriateness of potential sites and staff for pre-operative screening. Forms used routinely to assess alcohol consumption in the pre-admission clinics (PAC) of eight Sydney hospitals were examined. In addition, the appropriateness of six staff categories (surgeons, surgeons' secretaries, junior medical officer, anaesthetists, nurses and a research assistant) and of two sites (surgeons' office and PAC) in conducting additional screening was assessed at two hospitals. Outcomes included observed advantages and disadvantages of sites and personnel, and number of cases with excessive drinking identified. There was duplication in information collected routinely on alcohol use in the PACs in eight Sydney Hospitals. Questions on alcohol consumption in patient self-completion forms were not validated. The PAC provided for efficient screening but time to surgery was typically too short for successful intervention in many cases. A validated tool and efficient screening procedure is required to detect excessive drinking before elective surgery. Patients often present to the PAC too close to the time of surgery for any change in drinking to reverse alcohol's effects. The role of the referring general practitioner and of printed advice from the surgeon in preparing patients for surgery needs further investigation. [source]

Parents and Practitioners Are Poor Judges of Young Children's Pain Severity

ACADEMIC EMERGENCY MEDICINE, Issue 6 2002
Adam J. Singer MD
Objective: Visual analog pain scales are reliable measures in older children and adults; however, pain studies that include young children often rely on parental or practitioner assessments for measuring pain severity. The authors correlated patient, parental, and practitioner pain assessments for young children with acute pain. Methods: This was a prospective, descriptive study of a convenience sample of 63 emergency department patients aged 4-7 years, with acute pain resulting from acute illness or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all parents/guardians. Children assessed their pain severity using a validated ordinal scale that uses five different faces with varying degrees of frowning (severe pain) or smiling (no pain). Each face was converted to a numeric value from 0 (no pain) to 4 (severe pain). Parents and practitioners independently assessed their child's pain using a validated 100-mm visual analog scale (VAS) marked "most pain" at the high end. Pairwise correlations between child, parent, and practitioner pain assessments were performed using Spearman's or Pearson's test as appropriate. The association between categorical data was assessed using ,2 tests. Results: Sixty-three children ranging in age from 4 to 7 were included. Mean age (±SD) was 5.7 (±1.1); 42% were female. Fifty-seven successfully completed the face scale. The distribution of the children's scores was 0-17%, 1-9%, 2-30%, 3-14%, and 4-30%. Mean parental and practitioner scores (±SD) on the VAS were 61 (±26) mm and 37 (±26) mm, respectively (maximal = 100 mm). Correlation between child and parent scores was 0.47 (p < 0.001). Correlation between child and practitioner scores was 0.08 (p = 0.54). Correlation between parent and practitioner scores was 0.04 (p = 0.001). Conclusions: There is poor agreement between pain ratings by children, parents, and practitioners. It is unclear which assessment best approximates the true degree of pain the child is experiencing. [source]

Ability of Patients to Accurately Recall the Severity of Acute Painful Events

ACADEMIC EMERGENCY MEDICINE, Issue 3 2001
Adam J. Singer MD
Abstract. Objective: Pain studies require prospective patient enrollment to ensure accurate pain assessment. The authors correlated pain assessments of an acute painful episode over a one-week period and determined the accuracy of patient pain severity recall over time. Methods: This was a prospective, descriptive, longitudinal study. Participants were a convenience sample of 50 emergency department patients with acute pain resulting from injuries or painful invasive procedures. A trained research assistant administered a structured pain survey containing demographic and historical features to all patients. Patients sequentially assessed their pain severity using a vertical 100-mm visual analog scale marked "most pain" at the top, a verbal numeric rating scale ranging from 0 to 100 from none to worst (NRS100), and a verbal numeric rating scale ranging from 0 to 10 from none to worst (NRS10). Patients were contacted by phone and asked to reassess their initial pain severity one and seven days later using the two verbal numeric rating scales. Analysis of pain assessments using the various scales at the three time intervals was performed with Pearson's and Spearman's coefficients and repeated-measures analysis of variance (ANOVA). Results: There were 50 patients with a mean age of 41 years. Correlation between initial pain assessments on the three scales ranged from 0.83 to 0.92. Correlations between the initial and 24-hour assessments were NRS100-0.98 and NRS10-0.98. Correlations between the initial and one-week assessments were NRS100-0.96 and NRS10-0.97. Repeated-measures ANOVA showed no significant change in pain assessments over time for both verbal numeric scales. Conclusions: Pain severity assessments of acute painful events one and seven days later were similar and highly correlated with initial assessments using both verbal numeric scales. Patients accurately recall the severity of an acute painful episode for at least one week after its occurrence, which may allow retrospective pain assessments. [source]

Examining item bias in the anxiety subscale of the Hospital Anxiety and Depression Scale in patients with chronic obstructive pulmonary disease

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2008
Wai-Kwong Tang
Abstract The Hospital Anxiety and Depression Scale (HADS) is a widely used screening instrument for depression and anxiety in medically compromised patients. The purpose of this study was to examine the differential item functioning (DIF) of the anxiety subscale of the HADA (HADS-A). A research assistant administered the HADS-A to 166 Chinese patients with chronic obstructive pulmonary disease (COPD) who were consecutively admitted to a rehabilitation hospital. Although the HADS-A was overall uni-dimensional, there were one mute item and two items with borderline misfit. Only one item had a DIF for arterial oxygen saturation. No item had DIF for other indicators of the severity of COPD. In conclusion, this study found that for one item the HADS-A has significant item bias for the severity of disease in patients with COPD. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Why Are You Learning a Second Language?

LANGUAGE LEARNING, Issue S1 2003
Motivational Orientations, Self-Determination Theory
The data for this study were collected in my first year of graduate school for a term paper for a course I was taking from Luc Pelletier. When I began graduate school, Luc also started at the University of Ottawa as a new faculty member, and he taught a course in motivation. I had worked with Richard Clément for a couple of years already as an honors student and as a research assistant and had conducted research on orientations and motivation under his supervision as part of my honors thesis project. Luc was very interested in self-determination theory (SDT) and had worked with Bob Vallerand on an instrument to assess academic motivation from this perspective. Luc and I decided to carry out a study on language learning orientations using SDT and enlisted Richard's and Bob's involvement in the project. As a bilingual institution where all students were required to demonstrate competence in their second language (L2), whether French or English, the University of Ottawa was an ideal setting for this type of research. The project was a first examination of SDT in the language learning context, and to the best of my knowledge it was the only, or at least one of the very few, empirical investigations of intrinsic and extrinsic motivation in the area. It involved the development of a valid and reliable instrument to assess the different subtypes of intrinsic and extrinsic motivation. It also explored the link between these motivational subtypes and various orientations to language learning that had been identified by Clément and Kruidenier (1983), including the travel, friendship, knowledge, and instrumental orientations. The results showed that the instrumental orientation and the SDT external regulation orientation were strongly correlated, and that the travel, friendship, and knowledge orientations were quite highly intercorrelated with identified regulation and intrinsic motivation. Moreover, the instrumental and external regulation orientation scales correlated in similar ways with the hypothesized antecedents of perceived autonomy and competence and the hypothesized consequences of intention to pursue L2 study and anxiety. In addition, the travel, friendship, and knowledge orientations were correlated with the hypothesized antecedents and consequences in a manner similar to intrinsic motivation and identified regulation. These results suggested that Clément and Kruidenier's 4 orientations may be tapping a similar construct as the SDT orientations. My only regret with this study is that I did not include a scale to measure the integrative orientation (Gardner, 1985) to determine its relation with the SDT subtypes. This issue would have to wait until a later study to be addressed. The results of this initial investigation encouraged me to pursue research integrating SDT with other theoretical frameworks of language learning motivation. I believe that the SDT framework has several advantages over some other formulations of learner orientations. SDT offers a parsimonious, internally consistent framework for systematically describing many different orientations in a comprehensive manner. It also offers considerable explanatory power for understanding why certain orientations are better predictors of relevant language learning variables (e.g., effort, persistence, attitudes) than others. Also, by invoking the psychological mechanisms of perceived autonomy, competence, and relatedness, it can account for why certain orientations are evident in some learners and not in others. Moreover, the framework is empirically testable and indeed has stood up well under empirical scrutiny in our studies. Its clear predictions may also be particularly valuable in applying the theory in language teaching and program development. [The present article first appeared in Language Learning, 50 (1), 2000, 57,85] [source]

Knowledge to action: Scholarship for faculty and staff

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2009
FAAPArticle first published online: 13 MAR 200, FRCPC, Savithiri Ratnapalan MBBS
Abstract Introduction: This study was undertaken to evaluate the influence of a continuing education course in facilitating the development and implementation of educational projects of course participants. Methods: This is a case study evaluating a full-year course that consisted of 11 monthly seminars, each 4 hours in length, including practice in a computer laboratory. The class size was limited to 12 participants. Needs-assessment surveys at the beginning of the course, student evaluations, and midterm and final progress reports were analyzed. Results: Seven staff physicians, 3 clinical fellows, a nurse educator, and a research assistant enrolled in the course. Initial needs-assessment surveys indicated that most people had adequate computer skills,11 (90%),but only 2 (17%) were able to type well, 11 (90%) had no statistical knowledge, and 10 (83%) had limited literature-searching skills. The mean score on speaker evaluations for lectures was 4.5 on a scoring scheme of 1,5 where 1 was poor and 5 was outstanding. Ten participants (83%) had a complete proposal for an educational project written by midterm. Nine participants applied for external grants and 2 of them received external funding for their projects. Five participants (42%) completed a publishable educational project by the end of the 11-month course, and submitted it for presentation at scientific meetings. Discussion: Like many adults, health care professionals experience limited time for involvement in formal education. This study shows that a limited-time-commitment course could facilitate health care professionals to develop and successfully implement educational projects translating ideas into action. [source]

ORIGINAL RESEARCH,SURGERY: Surgical Treatment of Vulvar Vestibulitis Syndrome: Outcome Assessment Derived from a Postoperative Questionnaire

THE JOURNAL OF SEXUAL MEDICINE, Issue 5 2006
Andrew T. Goldstein MD
ABSTRACT Introduction., Vulvar vestibulitis syndrome (VVS) is the most common pathology in women with sexual pain. Surgery for VVS was first described in 1981. Despite apparently high surgical success rates, most review articles suggest that surgery should be used only "as a last resort." Risks of complications such as bleeding, scarring, and recurrence of symptoms are often used to justify these cautionary statements. However, there are little data in the peer-reviewed literature to justify this cautionary statement. Aims., To determine patient satisfaction with vulvar vestibulectomy for VVS and the rate of complications with this procedure. Methods., Women who underwent a complete vulvar vestibulectomy with vaginal advancement by one of three different surgeons were contacted via telephone by an independent researcher between 12 and 72 months after surgery. Main Outcome Measures., The primary outcome measurement of surgical success was overall patient satisfaction with surgery. Additional secondary outcome measurements included improvement in dyspareunia, changes in coital frequency, and occurrence of surgical complications. Results., In total, 134 women underwent surgery in a 5-year period. An independent research assistant was able to contact 106 women, and 104 agreed to participate in the study. Mean duration since surgery was 26 months. A total of 97 women (93%) were satisfied, or very satisfied, with the outcome of their surgery. Only three patients (3%) reported persistently worse symptoms after surgery and only seven (7%) reported permanent recurrence of any symptoms after surgery. Prior to surgery, 72% of the women were completely apareunic; however, after surgery, only 11% were unable to have intercourse. Discussion., In this cohort of patients, there was a high degree of satisfaction with surgery for VVS. In addition, the risks of complications with this procedure were low, and most complications were transient and the risk of recurrence after surgery was also found to be low. Goldstein AT, Klingman D, Christopher K, Johnson C, and Marinoff SC. Surgical treatment of vulvar vestibulitis syndrome: Outcome assessment derived from a postoperative questionnaire. J Sex Med 2006;3:923,931. [source]

The reliability of information on work-related injuries available from hospitalisation data in Australia

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 4 2009
Kirsten McKenzie
Abstract Objective: To examine the reliability of work-related activity coding for injury-related hospitalisations in Australia. Method: A random sample of 4,373 injury-related hospital separations from 1 July 2002 to 30 June 2004 were obtained from a stratified random sample of 50 hospitals across four states in Australia. From this sample, cases were identified as work-related if they contained an ICD-10-AM work-related activity code (U73) allocated by either: (i) the original coder; (ii) an independent auditor, blinded to the original code; or (iii) a research assistant, blinded to both the original and auditor codes, who reviewed narrative text extracted from the medical record. The concordance of activity coding and number of cases identified as work-related using each method were compared. Results: Of the 4,373 cases sampled, 318 cases were identified as being work-related using any of the three methods for identification. The original coder identified 217 and the auditor identified 266 work-related cases (68.2% and 83.6% of the total cases identified, respectively). Around 10% of cases were only identified through the text description review. The original coder and auditor agreed on the assignment of work-relatedness for 68.9% of cases. Conclusions and implications: The best estimates of the frequency of hospital admissions for occupational injury underestimate the burden by around 32%. This is a substantial underestimate that has major implications for public policy, and highlights the need for further work on improving the quality and completeness of routine, administrative data sources for a more complete identification of work-related injuries. [source]

Evaluation of a guided compliance procedure to reduce noncompliance among preschool children

BEHAVIORAL INTERVENTIONS, Issue 4 2006
David A. Wilder
The effectiveness of a guided compliance procedure to reduce noncompliance among typically developing preschool children was evaluated. After baseline data on compliance to common demands were collected, a parent, instructional assistant, or graduate research assistant implemented the guided compliance procedure, which involved the delivery of progressively more intrusive prompts contingent upon noncompliance. The effects of the procedure were examined using a nonconcurrent multiple baseline design across participants. The results suggest that the procedure was effective for four of the six children who participated. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Continuous Support for Women During Childbirth

BIRTH, Issue 1 2005
E.D. Hodnett
ABSTRACT Background:, Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. Objectives:, Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. Search strategy:, We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). Selection criteria:, All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. Data collection and analysis:, Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Main results:, Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. Reviewers' conclusions:, All women should have support throughout labour and birth. Citation:, Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. ,,,The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd. [source]

The Effects of Clinical Workload on Teaching in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
Sean P. Kelly MD
Background:Academic emergency physicians have expressed concern that increased clinical workload and overcrowding adversely affect clinical teaching. Objectives:To evaluate the influence of clinical workload and attending physicians' teaching characteristics on clinical teaching in the emergency department (ED). Methods:This was a prospective observational study using learner satisfaction assessment tools to evaluate bedside teaching. On days when a research assistant was available, all ED residents and attending physicians were queried. A total of 335 resident surveys were administered over nine months (89% response). Clinical workload was measured by perception and patient volume. Teaching quality and characteristics were rated on ten-point scales. A linear mixed-effects model was used to obtain adjusted impact estimates of clinical workload and teaching attributes on teaching scores while controlling for individual attending physicians' teaching ability and residents' grading tendencies. Results:No clinical workload parameter had a significant effect on teaching scores: residents' workload perception (, estimate, 0.024; p = 0.55), attending physicians' workload perception (, estimate, ,0.05; p = 0.28), patient volume in patients per hour (, estimate, ,0.010; p = 0.36), and shift type (, estimate, ,0.19; p = 0.28). The individual attending physician effect was significant (p < 0.001) and adjusted in each case. In another model, the attending physicians' learning environment established (, estimate, 0.12; p = 0.005), clinical teaching skills (, estimate, 0.36; p < 0.001), willingness to teach (, estimate, 0.25; p < 0.001), and interpersonal skills (, estimate, 0.19; p < 0.001) affected teaching scores, but the attending physicians' availability to teach had no significant effect (, estimate, 0.007; p = 0.35). Conclusions:Clinical workload and attending physicians' availability had little effect on teaching scores. Attending physicians' clinical teaching skills, willingness to teach, interpersonal skills, and learning environment established were the important determinants of overall scores. Skilled instructors received higher scores, regardless of how busy they were. [source]

Evaluating the accuracy of Malformations Surveillance Program in detecting virilization due to congenital adrenal hyperplasia

CONGENITAL ANOMALIES, Issue 1 2005
Julie Travitz
ABSTRACT Malformations surveillance programs of newborn infants have been developed as a method for identifying serious and relatively common birth defects. The virilization of newborn infants with the classic 21-hydroxylase form of congenital adrenal hyperplasia must be identified early if the associated metabolic crisis in the perinatal period is to be prevented. We compared the detection of virilization associated with 21-hydroxylase congenital adrenal hyperplasia in infants by three methods: an ,active' malformations surveillance of medical records at a large urban hospital; routine medical care by examining physicians; and newborn biochemical screening of blood samples. The experience at a large maternity center in Boston, since 1972, showed that pediatricians often recognized affected females (6/6), but not males (0/2); the state newborn screening program, begun in 1990, identified correctly all affected males and females. The Active Malformations Surveillance Program was the least effective screening method, identifying four of six affected females and neither of the affected males. The low rate of detecting affected females by the Surveillance Program was attributed to a failure to sensitize the research assistants to the importance of physicians' notations regarding the signs and symptoms of virilization. The failure of examining physicians, and thereby, the malformations surveillance program, to detect virilized newborn males was due to the lack of consistent associated physical features. These comparisons between these three methods of detection can be used to design and improve malformations surveillance programs. [source]

Do Diabetic Patients Have Higher In-hospital Complication Rates When Admitted from the Emergency Department for Possible Myocardial Ischemia?

ACADEMIC EMERGENCY MEDICINE, Issue 3 2000
Peter B. Richman MD
Abstract Objective: To compare in-hospital complication rates for diabetic and nondiabetic patients admitted from the emergency department (ED) for possible myocardial ischemia. Methods: This was a prospective, observational study of consecutive consenting patients presenting to a suburban university hospital ED during study hours with typical and atypical symptoms consistent with cardiac ischemia. Demographic, historical, and clinical data were recorded by trained research assistants using a standardized, closed-question, data collection instrument. Inpatient records were reviewed by trained data abstractors to ascertain hospital course and occurrence of complications. Final discharge diagnosis of acute myocardial infarction (AMI) was assigned by World Health Organization criteria. Categorical and continuous data were analyzed by chi-square and t-tests, respectively. All tests were two-tailed with alpha set at 0.05. Results: There were 1,543 patients enrolled who did not have complications at initial presentation; 283 were diabetic. The rule-in rate for AMI was 13.8% for nondiabetic patients and 17.7% for diabetic patients (p = 0.09). Times to presentation were similar for nondiabetic vs diabetic patients [248 minutes (95% CI = 231 to 266) vs 235 minutes (95% CI = 202 to 269); p = 0.32]. Nondiabetic patients tended to be younger [56.6 years (95% CI = 55.8 to 57.4) vs 61.6 years (95% CI = 60.2 to 63.1); p = 0.001] and were less likely to be female (34.3% vs 48.1%; p = 0.001). The two groups had similar prevalences for initial electrocardiograms diagnostic for AMI (5.5% vs 7.4%; p = 0.21). There was no significant difference between nondiabetic and diabetic patients for the occurrence of the following complications after admission to the hospital: congestive heart failure (1.3% vs 1.1%, p = 0.77); nonsustained ventricular tachycardia (VT) (1.3% vs 1.2%, p = 0.93); sustained VT (1.2% vs 1.1%, p = 0.85); supraventricular tachycardia (1.7% vs 3.2%, p = 0.12); bradydysrhythmias (1.9% vs 1.1%, p = 0.33); hypotension necessitating the use of pressors (0.9% vs 1.1%, p = 0.76); cardiopulmonary resuscitation (0.2% vs 0.7%, p = 0.10); and death (0.3% vs 0.7%, p = 0.34). One or more complications occurred with similar frequencies for patients in the two groups (6.3% vs 5.7%; p = 0.70). Conclusions: No statistically significant difference was found in the post-admission complication rates for initially stable diabetic vs nondiabetic patients admitted for possible myocardial ischemia. Based on these results, the presence or absence of diabetes as a comorbid condition does not indicate a need to alter admitting decisions with respect to risk for inpatient complications. [source]

Systematic review of interventions in the management of overweight and obese children which include a dietary component

INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 1 2007
Clare E Collins PhD BSc Dip Nutr Diet Dip Clin Epi APD
Background, The prevalence of overweight and obesity in children and adolescents is increasing at an alarming rate around the world and prevention has become a key public health objective. Treatment and management of those already overweight and obese must be aligned with the best available evidence on effectiveness, if the risk of obesity-related morbidity and mortality is yet be reduced. Diet plays a pivotal role in successful treatment of obesity but to date, there is limited evidence on which to base practice. Objectives, To identify and present the best available evidence on the optimal dietetic treatment and management of children and adolescent who are overweight or obese. Search strategy, Published English language literature was searched using the electronic databases CINAHL, MEDLINE, PRE-MEDLINE, DARE, COCHRANE, EMBASE, AUSTROM, Current Concepts and Dissertation Abstracts. The databases were limited to English Language from 1975 until 2003. Government reports from the UK, USA and Australian were also searched and a hand search performed for the Journal of the Dietitians Association of Australia, International Journal of Obesity and the Journal of Human Nutrition and Dietetics and the bibliographies of retrieved articles. Selection criteria, (i) Interventions that evaluated the effectiveness of nutrition or dietary interventions to treat or manage overweight and obesity; (ii) Children aged less than 18 years; and (iii) Participants were defined as overweight or obese by relative weight or a measure of body weight status, studies that reported body weight per se were excluded. Data collection and analysis, An experienced professional librarian searched the databases, and two trained research assistants independently identified studies for retrieval and assessed each article for inclusion. The included studies were critically appraised for methodological quality by two people independently. Data were extracted from the appropriate articles and when a discrepancy arose, a third party would arbitrate. Main results, There were 116 articles that met the inclusion criteria. While 49 articles described randomised controlled trials, they arose from 37 separate studies. There were 67 non-randomised trials. Meta-analyses were performed on eight studies that included both a dietary intervention component and an adequate control group and on four studies that had follow-up data. There was a high degree of heterogeneity between studies and this made comparisons between studies problematic. Interventions that include diet therapy generally result in significant weight loss, at least in the short term. Many studies were poorly designed and had no or only minimal follow up. The details of the dietary intervention were often inadequately described and dietary outcomes rarely reported, making repetition of the studies difficult. Reviewers' conclusions, There is an urgent need for high quality studies investigating the optimal dietary approach to management of paediatric overweight and obesity. These studies require adequate follow up to ascertain if weight loss can be sustained in the long term. Details of the dietary prescription, adherence to the dietary intervention and diet-specific outcomes need to be reported in order to inform best practice. [source]

Older Women and HIV: How Much Do They Know and Where Are They Getting Their Information?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 9 2004
Susan J. Henderson MD
Objectives: To assess older urban women's knowledge about sexual transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) and to evaluate the relationship between their HIV/AIDS knowledge level and sources of information. Design: Cross-sectional survey conducted between June 2001 and July 2002. Trained research assistants administered a questionnaire in a face-to-face interview. Setting: General medicine clinic in a large public hospital in a high HIV/AIDS incidence area. Participants: Five hundred fourteen women aged 50 and older. Measurements: Nine questions assessing knowledge of risk of HIV sexual transmission with potential scores ranging from 0 to 9 correct answers. Participants identified all sources of HIV information. Results: The mean knowledge score was 3.7 out of a possible 9 correct responses (range 0 (3%) to 8 (1%)). Younger age, employment, and higher educational level were associated with higher knowledge scores, whereas marital status was unrelated. No respondent correctly answered all of the nine questions. The most commonly identified sources of HIV/AIDS information were television (85%), friends (54%), and newspapers (51%). Only 38% of respondents identified health professionals as a source of information about HIV/AIDS. Health professionals, newspapers, and family members were each independently associated with higher knowledge scores (P<.05). Conclusion: Older women in a general medicine clinic had limited knowledge of sexual transmission of HIV. HIV/AIDS education specifically targeted to this subpopulation is warranted, and health professionals may have an important role in disseminating such messages. [source]

An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary study

JOURNAL OF CLINICAL NURSING, Issue 6 2006
Engle Angela Chan PhD
Aim and objective., Like other health-care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS-like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses' efficiency, infection control practices and views of the two models. Design and methods., This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight-hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video-taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t -tests. Textual data were coded and categorized for common meanings. Results., Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional. Relevance to clinical practice., This study findings lay the foundation for clinical trials, which would evaluate the significance of patient-care quality, cost-effectiveness and better human resource management by restructuring current nursing practices. [source]

Comparing the Psychometric Properties of the Checklist of Nonverbal Pain Behaviors (CNPI) and the Pain Assessment in Advanced Dementia (PAIN-AD) Instruments

PAIN MEDICINE, Issue 3 2010
FAAN, Mary Ersek PhD
Abstract Objective., To examine and compare the psychometric properties of two common observational pain assessment tools used in persons with dementia. Design., In a cross-sectional descriptive study nursing home (NH) residents were videotaped at rest and during a structured movement procedure. Following one training session and one practice session, two trained graduate nursing research assistants independently scored the tapes using the two pain observation tools. Setting., Fourteen NHs in Western Washington State participating in a randomized controlled trial of an intervention to enhance pain assessment and management. Participants., Sixty participants with moderate to severe pain were identified by nursing staff or chosen based on the pain items from the most recent Minimum Data Set assessment. Measures., Checklist of Nonverbal Pain Indicators (CNPI) and the Pain Assessment in Advanced Dementia (PAINAD), demographic and pain-related data (Minimum Data Set), nursing assistant reports of participants' usual pain intensity, and Pittsburgh Agitation Scale. Results., Internal consistency for both tools was good except for the CNPI at rest for one rater. Inter-rater reliability for pain presence was fair (K = 0.25 for CNPI with movement; K = 0.31 for PAINAD at rest) to moderate (K = 0.43 for CNPI at rest; K = 0.54 for PAINAD with movement). There were significant differences in mean CNPI and PAINAD scores at rest and during movement, providing support for construct validity. However, both tools demonstrated marked floor effects, particularly when participants were at rest. Conclusions., Despite earlier studies supporting the reliability and validity of the CNPI and the PAINAD, findings from the current study indicate that these measures warrant further study with clinical users, should be used cautiously both in research and clinical settings and only as part of a comprehensive approach to pain assessment. [source]

Fieldwork among the Dong national minority in Guizhou, China: Practicalities, obstacles and challenges

ASIA PACIFIC VIEWPOINT, Issue 2 2010
Candice CornetArticle first published online: 28 JUL 2010
Abstract The People's Republic of China (PRC) is increasingly open to foreigners undertaking social science fieldwork; yet obstacles remain. Working with ethnic minorities adds further complexities because of the sensitive topics such research may raise. Based on recent fieldwork among the Dong in southeast Guizhou, as the first foreign researcher to ask for and gain official permission to work in the region, this article exposes some of the challenges, both practical and methodological, of conducting research in the PRC. Gaining access to my field site was a long trek through the hierarchic maze of Chinese administration. While reflecting upon this process, I detail my negotiations with local authorities. I then examine how I found reliable statistical data, was able to access the voices of peasants, acted to protect the anonymity of dissident informants, and negotiated working with local research assistants once in the field. These aspects, in turn, highlighted the importance of considering positionality in the field. Although each person's experiences and routes to fieldwork are unique, there are recurrent issues that shape the research process in the PRC. I reflect upon a number of these here, in the hope that this can smooth the way for future researchers. [source]

Conducting fieldwork with Tarieng communities in southern Laos: Negotiating discursive spaces between neoliberal dogmas and Lao socialist ideology

ASIA PACIFIC VIEWPOINT, Issue 2 2010
Steeve Daviau
Abstract Based on research with ethnic minorities in Laos aimed at understanding how they cope with and negotiate political and economic ,double domination', this article examines the experiences of prolonged fieldwork in a remote Tarieng area in the Annam Range, southern Laos. After briefly reviewing Lao ethnographical policy and practice regarding ethnic minorities, I introduce the Tarieng people. I detail how I initially gained access to these local communities via long-term engagement with a range of development project initiatives. Then, after eight years of conducting such fieldwork in a Tarieng area ,below the radar of the state', I managed to obtain official authorisations to continue research as a graduate student. In this new position, I accessed the field via different negotiations with central, provincial and local official bureaucracies. After detailing this process, back in the field I reveal my strategies to create a discursive space that has allowed me to access dissident Tarieng voices and agency. Finally, I highlight four central elements that have continued to shape my field research: language proficiency, working with research assistants, awareness of political relations and cultural sensitivity, and ethical concerns. These have emerged while the possibilities and constraints of political engagement with the Tarieng people are explored. [source]

Research Note: The silenced assistant.

Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes

ACADEMIC EMERGENCY MEDICINE, Issue 3 2009
Jin H. Han MD
Abstract Objectives:, Missing delirium in the emergency department (ED) has been described as a medical error, yet this diagnosis is frequently unrecognized by emergency physicians (EPs). Identifying a subset of patients at high risk for delirium may improve delirium screening compliance by EPs. The authors sought to determine how often delirium is missed in the ED and how often these missed cases are detected by admitting hospital physicians at the time of admission, to identify delirium risk factors in older ED patients, and to characterize delirium by psychomotor subtypes in the ED setting. Methods:, This cross-sectional study was a convenience sample of patients conducted at a tertiary care, academic ED. English-speaking patients who were 65 years and older and present in the ED for less than 12 hours at the time of enrollment were included. Patients were excluded if they refused consent, were previously enrolled, had severe dementia, were unarousable to verbal stimuli for all delirium assessments, or had incomplete data. Delirium status was determined by using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) administered by trained research assistants (RAs). Recognition of delirium by emergency and hospital physicians was determined from the medical record, blinded to CAM-ICU status. Multivariable logistic regression was used to identify independent delirium risk factors. The Richmond Agitation and Sedation Scale was used to classify delirium by its psychomotor subtypes. Results:, Inclusion and exclusion criteria were met in 303 patients, and 25 (8.3%) presented to the ED with delirium. The vast majority (92.0%, 95% confidence interval [CI] = 74.0% to 99.0%) of delirious patients had the hypoactive psychomotor subtype. Of the 25 patients with delirium, 19 (76.0%, 95% CI = 54.9% to 90.6%) were not recognized to be delirious by the EP. Of the 16 admitted delirious patients who were undiagnosed by the EPs, 15 (93.8%, 95% CI = 69.8% to 99.8%) remained unrecognized by the hospital physician at the time of admission. Dementia, a Katz Activities of Daily Living (ADL) , 4, and hearing impairment were independently associated with presenting with delirium in the ED. Based on the multivariable model, a delirium risk score was constructed. Dementia, Katz ADL , 4, and hearing impairment were weighed equally. Patients with higher risk scores were more likely to be CAM-ICU positive (area under the receiver operating characteristic [ROC] curve = 0.82). If older ED patients with one or more delirium risk factors were screened for delirium, 165 (54.5%, 95% CI = 48.7% to 60.2%) would have required a delirium assessment at the expense of missing 1 patient with delirium, while screening 141 patients without delirium. Conclusions:, Delirium was a common occurrence in the ED, and the vast majority of delirium in the ED was of the hypoactive subtype. EPs missed delirium in 76% of the cases. Delirium that was missed in the ED was nearly always missed by hospital physicians at the time of admission. Using a delirium risk score has the potential to improve delirium screening efficiency in the ED setting. [source]

Reports of Police Calls for Service as a Risk Indicator for Intimate Partner Violence

ACADEMIC EMERGENCY MEDICINE, Issue 1 2009
Melissa E. Dichter MSW
Abstract Objectives:, The purpose of this study was to evaluate the utility of asking female emergency department (ED) patients about police calls for service as a possible indicator of intimate partner violence (IPV). Methods:, Trained research assistants screened female, adult, English-speaking patients presenting to an urban university ED 7am to midnight, 7 days per week during the 2006,2007 academic year. Patients were asked two commonly used IPV screening questions regarding past-year experience with physical violence or threat by an intimate partner and whether or not the police had been called due to a fight between themselves and a male partner. Results:, Of the 4,984 patients screened, 3.9% screened positive for an IPV-related police call in the past 12 months; more than one-third (37.8%) of those screened negative for IPV on the traditional screening questions. The question about an IPV-related police call for service identified an additional 74 cases of possible IPV, representing 1.5% of the overall sample or a 30.8% increase over those identified with the traditional IPV screening questions. Conclusions:, Adding an additional question regarding police calls to standard IPV screening could alert healthcare providers to possible IPV risk. [source]

Antithrombotic management of ischaemic stroke and transient ischaemic attack in China: A consecutive cross-sectional survey

CLINICAL AND EXPERIMENTAL PHARMACOLOGY AND PHYSIOLOGY, Issue 8 2010
Yi-Long Wang
Summary 1.,Little is known about the prevention of secondary stroke in China. In the present study, we assessed the status of antithrombotic management of stroke patients in clinics across China. 2.,A cross-sectional survey was conducted in 19 urban neurological clinics. All subjects diagnosed with ischaemic stroke (IS) or transient ischaemic attack (TIA) were enrolled consecutively in the study. Face-to-face interviews were conducted by research assistants using questionnaires on the day of enrolment. The data recorded included demographic and clinical characteristics, medication and reasons for not using medication. Independent predictors for the prescription of antiplatelet drugs were determined using multivariate logistic regression models. 3.,Of the 2283 patients with IS or TIA enrolled in the study (34.7% women; mean ( ± SD) age 65.8 ± 11.6 years), 1719 (75.3%) had a prescription for antiplatelet therapy. Of the 108 patients with atrial fibrillation, only 14 (13.0%) were receiving warfarin therapy. The main independent factors significantly associated with being on antiplatelet therapy were having basic health insurance (odds ratio (OR) 1.47; 95% confidence interval (CI) 1.09,1.99), government insurance and labour insurance (OR 1.63; 95% CI 1.03,2.59) and a monthly income of > 500 yuan (US$66.70; OR 2.14; 95% CI 1.51,3.03). Being older (OR 0.70; 95% CI 0.50,0.99) and having a severe disability (OR 0.68; 95% CI 0.49,0.97) were associated with lower odds of receiving antiplatelet therapy. 4.,Based on the survey results, adherence to guidelines for antithrombotic management in neurological clinics in China is poor. The main reasons contributing to the less than optimal management of stroke patients include negative attitudes among neurologists, a lack of medical insurance, a lower income and being elderly and/or severely disabled. [source]