53 results on '"Denise Harrison"'
Search Results
2. Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study
- Author
-
Marsha Campbell-Yeo, Janet Squires, Carole Estabrooks, Denise Harrison, Janet Yamada, Mariana Bueno, Anna Taddio, Bonnie Stevens, Anne R Synnes, Sharyn Gibbins, Marilyn Ballantyne, Carol McNair, Shirine Riahi, and Charles Victor
- Subjects
Pediatrics ,RJ1-570 - Abstract
Introduction Oral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative effect on neurodevelopment. We examined the association between total sucrose volumes administered to preterm neonates for pain mitigation in the NICU and their neurodevelopment at 18 months of corrected age (CA).Methods A prospective longitudinal single-arm observational study that enrolled hospitalised preterm neonates
- Published
- 2024
- Full Text
- View/download PDF
3. Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities
- Author
-
Warren A. Kaplan, Carlotta M. Cellini, Kwesi Eghan, Kevin Pilz, Denise Harrison, and Veronika J. Wirtz
- Subjects
Public–private contracting ,Retail pharmacies ,Essential medicines ,Health system strengthening ,Health system administration ,Low- and middle-income countries ,Therapeutics. Pharmacology ,RM1-950 ,Pharmacy and materia medica ,RS1-441 - Abstract
Abstract Background Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. Methods A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including ‘patient-centered’ pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. Results From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public–private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. Conclusion Public–private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.
- Published
- 2023
- Full Text
- View/download PDF
4. Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures
- Author
-
Denise Harrison and Mariana Bueno
- Subjects
Anesthesiology ,RD78.3-87.3 - Abstract
Abstract. Introduction:. Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. Objectives:. To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. Methods:. This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Results:. Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needle-related procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. Conclusion:. There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.
- Published
- 2023
- Full Text
- View/download PDF
5. The effectiveness of repeated sucrose for procedural pain in neonates in a longitudinal observational study
- Author
-
Mariana Bueno, Marilyn Ballantyne, Marsha Campbell-Yeo, Carole A. Estabrooks, Sharyn Gibbins, Denise Harrison, Carol McNair, Shirine Riahi, Janet Squires, Anne Synnes, Anna Taddio, Charles Victor, Janet Yamada, and Bonnie Stevens
- Subjects
neonate ,pain ,procedural pain ,pain assessment ,sucrose ,effectiveness ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
GoalTo determine the analgesic effectiveness of repeated sucrose administration for skin-breaking (SB) procedures over the Neonatal Intensive Care Unit (NICU) hospitalization of preterm infants.MethodsLongitudinal observational study, conducted in four level III Canadian NICUs. Eligible infants were
- Published
- 2023
- Full Text
- View/download PDF
6. Validating the Implementation Leadership Scale in Chinese nursing context: A cross‐sectional study
- Author
-
Jiale Hu, Wendy Gifford, Hong Ruan, Denise Harrison, Qingge Li, Mark G. Ehrhart, Mary‐Ann Harrison, Nick Barrowman, and Gregory A. Aarons
- Subjects
China ,evidence‐based practice ,health services research ,leadership ,nursing ,psychometrics ,Nursing ,RT1-120 - Abstract
Abstract Aim This study aimed to evaluate the validity, reliability and acceptability of the Implementation Leadership Scale in the Chinese nursing context. Design This study utilized a cross‐sectional design. Methods This study was conducted in one general tertiary hospital with 234 nurses (85.3% response rate) from 35 clinical units in China. Content validity, structural validity, convergent validity, reliability (internal consistency), agreement indices and acceptability were evaluated. The data collection was from December 1st, 2017 to June 30th, 2018. Results Confirmatory factor analysis demonstrated a good model fit to the four‐factor implementation leadership model. The psychometric testing also indicated good convergent validity, high internal consistency and acceptable aggregation. Most participants completed the scale in two minutes or less and agreed or strongly agreed that the questions were relevant to implementation leadership, clear and easy to answer. Conclusions This study demonstrated that the Chinese Implementation Leadership Scale is a valid, reliable and pragmatic tool for measuring strategic leadership for implementing evidence‐based practices.
- Published
- 2021
- Full Text
- View/download PDF
7. Therapeutic hypothermia for neonatal encephalopathy with sepsis: a retrospective cohort study
- Author
-
Kei Lui, Victor Samuel Rajadurai, Malcolm Battin, lex Doyle, Leah Hickey, Srinivas Bolisetty, Peter Schmidt, Andy Gill, Jane Pillow, Jacqueline Stack, Pita Birch, Dan Casalaz, Jim Holberton, Alice Stewart, Lucy Cooke, Lyn Downe, Michael Stewart, Andrew Berry, Rod Hunt, Tony De Paoli, Mary Paradisis, Pieter Koorts, Carl Kuschel, Andrew Numa, Hazel Carlisle, Nadia Badawi, Guan Koh, Jonathan Davis, Melissa Luig, Chad Andersen, Brian Darlow, Liza Edmonds, Mariam Buksh, Georgina Chambers, Clare Collins, David Barker, Denise Harrison, Steven Resnick, Jutta van den Boom, Peter Morris, Rebecca Thomas, Mary Sharp, Naomi Spotswood, M Battin, Scott Morris, Nicola Austin, Michael Stark, Anjali Dhawan, Larissa Korostenski, Karen Nothdurft, Mark Greenhalgh, John Craven, Himanshu Popat, Bevan Headley, Barbara Hammond, Kristina Sibbin, Tara M Crawford, Guy Bloomfield, Callum Gately, and Natalie Merida
- Subjects
Pediatrics ,RJ1-570 - Abstract
Objective Neonatal encephalopathy remains a major cause of infant mortality and neurodevelopmental impairment. Infection may exacerbate brain injury and mitigate the effect of therapeutic hypothermia (TH). Additionally, infants with sepsis treated with TH may be at increased risk of adverse effects. This study aimed to review the clinical characteristics and outcomes for infants with sepsis treated with TH.Design and setting Retrospective cohort study of infants treated with TH within Australia and New Zealand.Patients 1522 infants treated with TH, including 38 with culture-positive sepsis from 2014 to 2018.Intervention Anonymised retrospective review of data from Australian and New Zealand Neonatal Network. Infants with culture-positive sepsis within 48 hours were compared with those without sepsis.Main outcome measures Key outcomes include in-hospital mortality, intensive care support requirements and length of stay.Results Overall the rate of mortality was similar between the groups (13% vs 13%). Infants with sepsis received a higher rate of mechanical ventilation (89% vs 70%, p=0.01), high-frequency oscillatory ventilation (32% vs 13%, p=0.003) and inhaled nitric oxide for persistent pulmonary hypertension (38% vs 16%, p
- Published
- 2022
- Full Text
- View/download PDF
8. 'Be sweet to babies': Use of Facebook as a method of knowledge dissemination and data collection in the reduction of neonatal pain
- Author
-
Ana Claudia G. Vieira, Mariana Bueno, and Denise Harrison
- Subjects
breastfeeding ,newborn ,pain management ,skin‐to‐skin contact ,social media ,sweet solutions ,Pediatrics ,RJ1-570 - Abstract
Abstract The Be Sweet to Babies video demonstrates the analgesic effects of breastfeeding, skin‐to‐skin care, and sweet‐tasting solutions as interventions to reduce pain during blood sampling in newborns. Although effective and safe, these strategies are implemented inconsistently in clinical settings. Given the increasing popularity of social media, there is a potential to disseminate and promote health information through it. The study aim was to evaluate the use of Facebook as a means of disseminating the Be Sweet to Babies video in Portuguese, and to evaluate respondents’ prior knowledge, previous use of the three pain management strategies and intent to use the strategies in the future. We conducted a cross‐sectional study, using the “virtual snowball” sampling method. A Facebook webpage was created, in which the video was posted along with a brief survey. Data analyzed included number of views and visits to the page, number of views of the video, likes, dislikes, and survey responses. One year after posting, the page had 70 753 views and 2199 accesses; there were 1553 “likes”, no dislikes, and 43 positive comments. The survey was completed by 930 respondents (42% response rate based on the page access). Over two thirds of the respondents had previous knowledge about breastfeeding, skin‐to‐skin care, and sweet solutions for pain relief. After watching the video, 87% of the respondents intended to use breastfeeding or skin‐to‐skin care in the future, and 71% intended to use sweet solutions. Almost all viewers rated the video as very useful (n = 917, 99%), easy to understand (n = 926, 99%), and easy to apply in real‐life situations (n = 903, 97%). Using Facebook to deliver and evaluate an intervention is feasible, rapid in obtaining responses, low cost, and it is promising for data collection and knowledge dissemination. Further studies are warranted to evaluate the actual impact of the use of social media in practice change.
- Published
- 2020
- Full Text
- View/download PDF
9. Effectiveness of a parent‐targeted video on neonatal pain management: Nonrandomized pragmatic trial
- Author
-
Ligyana Korki de Candido, Denise Harrison, Maria de La Ó Ramallo Veríssimo, and Mariana Bueno
- Subjects
educational technology ,infant ,neonatal nursing ,newborn ,pain ,parents ,Pediatrics ,RJ1-570 - Abstract
Abstract The “Be sweet to babies” video is a knowledge translation tool targeted at parents on the use of analgesic strategies during painful procedures performed in neonates. This study aimed to evaluate the effectiveness of the Portuguese version of this video on maternal involvement in neonatal pain management during the newborn screening blood test. Nonrandomized, pragmatic clinical trial. The study was conducted in a rooming‐in unit. All mothers received a pamphlet regarding neonatal pain management and were invited to participate in daily education sessions conducted by nurses, which included the video. The intervention group included mothers who voluntarily watched the video, while the control group was comprised of mothers who did not attend the education sessions or left the session before watching the video. Data were collected by interviews conducted by the research team. Descriptive and inferential analysis considered a confidence interval of 95%. A total of 73 mothers were included in the study. Analgesic strategies were used in 14 (40%) of the procedures in the intervention group and 9 (24%) in the control group, a clinically important difference of 16% points between groups, although no statistically significant difference was found (P = .13). Breastfeeding was the most commonly used strategy. Watching the video increased the chance of implementing analgesic strategies by 2.1 times (P = .19), while nurses suggesting the use of analgesia increased this chance by 5.5 times (P = .006). Although no statistical significance was found, the results suggest the clinical significance and feasibility of the “Be sweet to babies” video as a KT tool targeted at parents on neonatal pain management during nonurgent painful procedures. In addition, maternal involvement in pain care significantly increased when pain relief strategies were recommended by nurses, which suggests that nurses have a key role in facilitating parental participation.
- Published
- 2020
- Full Text
- View/download PDF
10. A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol
- Author
-
Mariana Bueno, Bonnie Stevens, Melanie A. Barwick, Shirine Riahi, Shelly-Anne Li, Alexa Lanese, Andrew R. Willan, Anne Synnes, Carole A. Estabrooks, Christine T. Chambers, Denise Harrison, Janet Yamada, Jennifer Stinson, Marsha Campbell-Yeo, Melanie Noel, Sharyn Gibbins, Sylvie LeMay, and Wanrudee Isaranuwatchai
- Subjects
Pain ,Procedural ,Infants ,Assessment ,Management ,Implementation ,Medicine (General) ,R5-920 - Abstract
Abstract Background Hospitalized infants undergo multiple painful procedures daily. Despite the significant evidence, procedural pain assessment and management continues to be suboptimal. Repetitive and untreated pain at this vital developmental juncture is associated with negative behavioral and neurodevelopmental consequences. To address this knowledge to practice gap, we developed the web-based Implementation of Infant Pain Practice Change (ImPaC) Resource to guide change in healthcare professionals’ pain practice behaviors. This protocol describes the evaluation of the intervention effectiveness and implementation of the Resource and how organizational context influences outcomes. Methods An effectiveness-implementation hybrid type 1 design, blending a cluster randomized clinical trial and a mixed-methods implementation study will be used. Eighteen Neonatal Intensive Care Units (NICUs) across Canada will be randomized to intervention (INT) or standard practice (SP) groups. NICUs in the INT group will receive the Resource for six months; those in the SP group will continue with practice as usual and will be offered the Resource after a six-month waiting period. Data analysts will be blinded to group allocation. To address the intervention effectiveness, the INT and SP groups will be compared on clinical outcomes including the proportion of infants who have procedural pain assessed and managed, and the frequency and nature of painful procedures. Data will be collected at baseline (before randomization) and at completion of the intervention (six months). Implementation outcomes (feasibility, fidelity, implementation cost, and reach) will be measured at completion of the intervention. Sustainability will be assessed at six and 12 months following the intervention. Organizational context will be assessed to examine its influence on intervention and implementation outcomes. Discussion This mixed-methods study aims to determine the effectiveness and the implementation of a multifaceted online strategy for changing healthcare professionals’ pain practices for hospitalized infants. Implementation strategies that are easily and effectively implemented are important for sustained change. The results will inform healthcare professionals and decision-makers on how to address the challenges of implementing the Resource within various organizational contexts. Trial registration ClinicalTrials.gov, NCT03825822. Registered 31 January 2019.
- Published
- 2020
- Full Text
- View/download PDF
11. Moving on: Transition experiences of young adults with chronic pain
- Author
-
Andrea Higginson, Paula Forgeron, Denise Harrison, G. Allen Finley, and Bruce D. Dick
- Subjects
transition ,chronic pain ,young adults ,adolescents ,young people ,Medicine (General) ,R5-920 ,Therapeutics. Pharmacology ,RM1-950 - Abstract
Purpose The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.
- Published
- 2019
- Full Text
- View/download PDF
12. Retrospective Assessment of Risk Factors for Head and Neck Cancer Among World Trade Center General Responders
- Author
-
Michelle T. Bover Manderski, Kathleen Black, Iris G. Udasin, Taylor M. Black, Michael B. Steinberg, Anna R. Giuliano, Benjamin J. Luft, Denise Harrison, Michael A. Crane, Jacqueline Moline, Marian R. Passannante, Pamela Ohman Strickland, Christopher R. Dasaro, Roberto G. Lucchini, Andrew C. Todd, and Judith M. Graber
- Subjects
behavioral risk factors ,cancer ,questionnaire ,reliability ,World Trade Center (WTC) ,Public aspects of medicine ,RA1-1270 - Abstract
Objective: To assess the reliability of a questionnaire designed to reconstruct risk factors for head and neck cancer relative to the 9/11 World Trade Center (WTC) response and over the lifetime.Methods: As part of a nested case-control study, 200 WTC Health Program (WTCHP) General Responder Cohort (GRC) members completed a newly-developed study questionnaire via telephone (with a trained interviewer) or online (self-administered). We assessed agreement between measures of tobacco and alcohol use in our questionnaire results and data collected previously during WTCHP-GRC monitoring visits using Cohens Kappa (κ) and intraclass correlation coefficient (ICC) for categorical and continuous measures, respectively. We compared agreement by disease status, survey mode, and year of WTCHP enrollment.Results: We observed high agreement between measures of lifetime, pre-WTC, and post-WTC smoking prevalence (all κ > 0.85) and smoking duration (all ICC > 0.84). There was moderate agreement between measures of smoking frequency (ICC: 0.61–0.73). Agreement between measures of smoking frequency, but not duration, differed by disease status, and agreement between smoking measures was higher for participants who completed our survey by phone than by web. Among cases, there were no differences based on enrollment in the WTCHP before or after diagnosis.Conclusion: Agreement between measures was generally high, although potential reporting bias and a mode effect that should be considered when interpreting analyses of self-reported data in this population; however differential misclassification appears to be minimal. Our questionnaire may be useful for future studies examining similar behavioral risk factors among disaster-exposed populations.
- Published
- 2020
- Full Text
- View/download PDF
13. How to translate scientific knowledge into practice? Concepts, models and application
- Author
-
Ana Cláudia Garcia Vieira, Denise Gastaldo, and Denise Harrison
- Subjects
Knowledge Translation ,Translation ,Information Dissemination ,Diffusion ,Clinical competence ,Nursing ,RT1-120 - Abstract
ABSTRACT Objectives: to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle. Results: we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination. Conclusions: in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders.
- Published
- 2020
- Full Text
- View/download PDF
14. The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial
- Author
-
Bonnie Stevens, Janet Yamada, Marsha Campbell-Yeo, Sharyn Gibbins, Denise Harrison, Kimberley Dionne, Anna Taddio, Carol McNair, Andrew Willan, Marilyn Ballantyne, Kimberley Widger, Souraya Sidani, Carole Estabrooks, Anne Synnes, Janet Squires, Charles Victor, and Shirine Riahi
- Subjects
Adverse event ,Analgesia ,Heel lance ,Neonates ,NICU ,Pain ,Pediatrics ,RJ1-570 - Abstract
Abstract Background Orally administered sucrose is effective and safe in reducing pain intensity during single, tissue-damaging procedures in neonates, and is commonly recommended in neonatal pain guidelines. However, there is wide variability in sucrose doses examined in research, and more than a 20-fold variation across neonatal care settings. The aim of this study was to determine the minimally effective dose of 24% sucrose for reducing pain in hospitalized neonates undergoing a single skin-breaking heel lance procedure. Methods A total of 245 neonates from 4 Canadian tertiary neonatal intensive care units (NICUs), born between 24 and 42 weeks gestational age (GA), were prospectively randomized to receive one of three doses of 24% sucrose, plus non-nutritive sucking/pacifier, 2 min before a routine heel lance: 0.1 ml (Group 1; n = 81), 0.5 ml (Group 2; n = 81), or 1.0 ml (Group 3; n = 83). The primary outcome was pain intensity measured at 30 and 60 s following the heel lance, using the Premature Infant Pain Profile-Revised (PIPP-R). The secondary outcome was the incidence of adverse events. Analysis of covariance models, adjusting for GA and study site examined between group differences in pain intensity across intervention groups. Results There was no difference in mean pain intensity PIPP-R scores between treatment groups at 30 s (P = .97) and 60 s (P = .93); however, pain was not fully eliminated during the heel lance procedure. There were 5 reported adverse events among 5/245 (2.0%) neonates, with no significant differences in the proportion of events by sucrose dose (P = .62). All events resolved spontaneously without medical intervention. Conclusions The minimally effective dose of 24% sucrose required to treat pain associated with a single heel lance in neonates was 0.1 ml. Further evaluation regarding the sustained effectiveness of this dose in reducing pain intensity in neonates for repeated painful procedures is warranted. Trial registration ClinicalTrials.gov: NCT02134873. Date: May 5, 2014 (retrospectively registered).
- Published
- 2018
- Full Text
- View/download PDF
15. Special issue on knowledge mobilization: Pediatric pain
- Author
-
Kathryn A. Birnie and Denise Harrison
- Subjects
Pediatrics ,RJ1-570 - Published
- 2020
- Full Text
- View/download PDF
16. Special issue on knowledge mobilization: Neonatal pain
- Author
-
Denise Harrison and Kathryn Birnie
- Subjects
Pediatrics ,RJ1-570 - Published
- 2020
- Full Text
- View/download PDF
17. Seja Doce com os Bebês: avaliação de vídeo instrucional sobre manejo da dor neonatal por enfermeiros
- Author
-
Hellen Caroline Carneiro de Almeida, Ligyana Korki de Candido, Denise Harrison, and Mariana Bueno
- Subjects
Pain ,Infant, Newborn ,Neonatal Nursing ,Education, Nursing ,Evidence-Based Nursing ,Audiovisual Resources ,Public aspects of medicine ,RA1-1270 ,Nursing ,RT1-120 ,Mental healing ,RZ400-408 ,Education (General) ,L7-991 - Abstract
RESUMO Objetivo: Descrever o perfil de enfermeiros atuantes em unidades que assistem o recém-nascido, verificar seu conhecimento prévio sobre amamentação, contato pele a pele e soluções adocicadas no alívio da dor procedural neonatal, e avaliar sua percepção sobre a viabilidade, a aceitabilidade e a utilidade do vídeo “Seja Doce com os Bebês”. Método: Estudo transversal, realizado em quatro unidades de um hospital universitário de São Paulo. Foram incluídos 45 enfermeiros, que responderam ao questionário de caracterização e assistiram ao vídeo. Posteriormente, 38 avaliaram o vídeo. Estatística descritiva foi utilizada para análise das variáveis, além da análise de conteúdo na questão aberta. Resultados: Participaram do estudo 45 enfermeiros. 97,4% conheciam as estratégias analgésicas e, após assistirem ao vídeo, afirmaram pretender utilizá-las ou incentivar seu uso durante procedimentos dolorosos. Todos recomendariam o vídeo para outros profissionais, sendo o recurso avaliado como útil, fácil de entender e de aplicar em situações reais. Conclusão: Os enfermeiros conhecem as estratégias analgésicas, consideram o vídeo viável, aceitável e útil como ferramenta de tradução do conhecimento para profissionais da saúde, o que também pode favorecer o envolvimento dos pais no manejo da dor de seus filhos.
- Published
- 2018
- Full Text
- View/download PDF
18. A Systematic Review and Meta-Analyses of Nonsucrose Sweet Solutions for Pain Relief in Neonates
- Author
-
Mariana Bueno, Janet Yamada, Denise Harrison, Sobia Khan, Arne Ohlsson, Thomasin Adams-Webber, Joseph Beyene, and Bonnie Stevens
- Subjects
Medicine (General) ,R5-920 - Abstract
BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized.
- Published
- 2013
- Full Text
- View/download PDF
19. Using YouTube to Disseminate Effective Vaccination Pain Treatment for Babies.
- Author
-
Denise Harrison, Jodi Wilding, Amanda Bowman, Ann Fuller, Stuart G Nicholls, Catherine M Pound, Jessica Reszel, and Margaret Sampson
- Subjects
Medicine ,Science - Abstract
BACKGROUND:Infant vaccinations are necessary for public health, but are painful, causing distress to the infant and caregivers. Breastfeeding and sucrose effectively reduce infants' pain during vaccinations, and these strategies are recommended in health care provider (HCP)-targeted education and vaccination pain guidelines. However studies show these strategies are infrequently used. YouTube is a popular medium to publicly share and watch videos, and many consumer posted YouTube videos show distressed infants being vaccinated with no pain treatment. The aims of this study were to evaluate the reach and impact of a consumer-targeted YouTube video demonstrating use of effective pain reduction strategies during infant vaccinations. METHODS:A brief consumer-targeted video showing two infants being vaccinated was posted onto YouTube on October 2013. One infant was breastfed and another infant received sucrose by mouth before and during the injection. A link to a viewer survey was visible on a banner near the end of the video. An intensive strategically planned knowledge dissemination strategy using the media, social media and messages to professional organizations took place to promote the video. Data analysis of the viewer survey, YouTube analytics of the reach of the video in terms of number of views, country of viewers, and comments relating to the video took place 12 months after the video was posted. RESULTS:Twelve months after posting, the video had 65,478views, 68 comments, 245 likes, 17 dislikes, and 90 shares. Average duration of viewer time was 65% of the video. The viewer survey was completed by 156 (0.24%) viewers; 90 (58%) answered as HCPs and 66 (42%) as parents. Survey results showed that the video was persuasive; intent to use or support breastfeeding or sucrose was high in both parents and HCPs after viewing the video. Comments posted were often emotional in nature, and were related to anti-vaccination (n = 26, 38%); effectiveness or positive personal experiences (n = 21, 32%); research team comments or promotion (n = 12, 18%); pro-vaccination (n = 6, 8%) and barriers to using breastfeeding or sucrose during vaccinations (n = 3, 4%). CONCLUSION:The video posted onto YouTube demonstrating effective pain treatment during infant vaccinations was viewed by large numbers of people around the world, however the response rate to the linked survey was extremely low. Using YouTube videos for knowledge dissemination has an extensive reach, however it is difficult to evaluate impact on behaviours and practices.
- Published
- 2016
- Full Text
- View/download PDF
20. Be sweet to toddlers during needles: pilot randomized controlled trial of sucrose compared to placebo
- Author
-
Denise Harrison, Jessica Reszel, Nick Barrowman, Brenda Martelli, Diane Sharp, and Regis Vailancourt
- Subjects
Pain ,painful ,children ,sucrose ,venipuncture. ,Nursing ,RT1-120 - Abstract
Sweet solutions reduce procedural pain in infants but there is uncertainty about effectiveness beyond infancy. A blinded pilot randomized controlled trial (RCT) was conducted to inform a full-scale RCT. Hospitalized children aged 12- 36 months were randomized to 24% sucrose or water prior to and during venipuncture. Primary outcomes were crying time and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Secondary outcomes parental report of child’s pain, parental perception of effectiveness and nurse’s score of child’s compliance with study solution. Twenty-one children were studied. There were no differences in pain outcomes between groups. Median FLACC scores at time of needle insertion were high (8/10), and mean crying time during procedure was 61%. Most parents (n=17) would use the same treatment next time and most (n=17) toddlers were compliant with receiving the solutions. The pilot RCT informed the conduct of a future full scale RCT in terms of feasibility, acceptability, data collection, data analysis and sample size estimation.
- Published
- 2015
- Full Text
- View/download PDF
21. Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week
- Author
-
Denise Harrison, Cynthia Joly, Christine Chretien, Sarah Cochrane, Jacqueline Ellis, Christine Lamontagne, and Vaillancourt Regis
- Subjects
Medicine (General) ,R5-920 - Abstract
BACKGROUND: Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice.
- Published
- 2014
- Full Text
- View/download PDF
22. A systematic review of methods for studying consumer health YouTube videos, with implications for systematic reviews
- Author
-
Margaret Sampson, Jordi Cumber, Claudia Li, Catherine M. Pound, Ann Fuller, and Denise Harrison
- Subjects
Social media ,YouTube ,Consumer health ,Research methods ,Systematic review ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Background. YouTube is an increasingly important medium for consumer health information – with content provided by healthcare professionals, government and non-government organizations, industry, and consumers themselves. It is a rapidly developing area of study for healthcare researchers. We examine the methods used in reviews of YouTube consumer health videos to identify trends and best practices.Methods and Materials. Published reviews of consumer-oriented health-related YouTube videos were identified through PubMed. Data extracted from these studies included type of journal, topic, characteristics of the search, methods of review including number of reviewers and method to achieve consensus between reviewers, inclusion and exclusion criteria, characteristics of the videos reported, ethical oversight, and follow-up.Results. Thirty-three studies were identified. Most were recent and published in specialty journals. Typically, these included more than 100 videos, and were examined by multiple reviewers. Most studies described characteristics of the videos, number of views, and sometime characteristics of the viewers. Accuracy of portrayal of the health issue under consideration was a common focus.Conclusion. Optimal transparency and reproducibility of studies of YouTube health-related videos can be achieved by following guidance designed for systematic review reporting, with attention to several elements specific to the video medium. Particularly when seeking to replicate consumer viewing behavior, investigators should consider the method used to select search terms, and use a snowballing rather than a sequential screening approach. Discontinuation protocols for online screening of relevance ranked search results is an area identified for further development.
- Published
- 2013
- Full Text
- View/download PDF
23. Health Care Professionals’ Pain Narratives in Hospitalized Children’S Medical Records. Part 2: Structure and Content
- Author
-
Judy Rashotte, Denise Harrison, Geraldine Coburn, Janet Yamada, Bonnie J Stevens, and the CIHR Team in Children’s Pain
- Subjects
Medicine (General) ,R5-920 - Abstract
BACKGROUND: Although clinical narratives – described as free-text notations – have been noted to be a source of patient information, no studies have examined the composition of pain narratives in hospitalized children’s medical records.
- Published
- 2013
- Full Text
- View/download PDF
24. Establishing Intra- and Inter-Rater Agreement of the Face, Legs, Activity, Cry, Consolability Scale for Evaluating Pain in Toddlers During Immunization
- Author
-
Rebecca J Gomez, Nick Barrowman, Sonja Elia, Elizabeth Manias, Jenny Royle, and Denise Harrison
- Subjects
Medicine (General) ,R5-920 - Abstract
BACKGROUND: The Face, Legs, Activity, Cry, Consolability (FLACC) scale is a five-item tool that was developed to assess postoperative pain in young children. The tool is frequently used as an outcome measure in studies investigating acute procedural pain in young children; however, there are limited published psychometric data in this context.
- Published
- 2013
- Full Text
- View/download PDF
25. Health Care Professionals’ Pain Narratives in Hospitalized Children’s Medical Records. Part 1: Pain Descriptors
- Author
-
Judy Rashotte, Geraldine Coburn, Denise Harrison, Bonnie J Stevens, Janet Yamada, Laura K Abbott, and the CIHR Team in Children’s Pain
- Subjects
Medicine (General) ,R5-920 - Abstract
BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.
- Published
- 2013
- Full Text
- View/download PDF
26. Nurses' knowledge and practices regarding pain management in newborns
- Author
-
Taine Costa, Lisabelle Mariano Rossato, Mariana Bueno, Izabela Linha Secco, Natália Pinheiro Braga Sposito, Denise Harrison, and Júnia Selma de Freitas
- Subjects
Dolor ,Manejo del Dolor ,Recién Nacido ,Enfermería Neonatal ,Unidades de Cuidado Intensivo Neonatal. ,Public aspects of medicine ,RA1-1270 ,Nursing ,RT1-120 ,Mental healing ,RZ400-408 ,Education (General) ,L7-991 - Abstract
Abstract OBJECTIVE To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units. METHOD A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region. RESULTS For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%). CONCLUSION Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns.
- Full Text
- View/download PDF
27. Validating the Implementation Leadership Scale in Chinese nursing context: A cross‐sectional study
- Author
-
Mary-Ann Harrison, Jiale Hu, Qingge Li, Mark G. Ehrhart, Denise Harrison, Hong Ruan, Nick Barrowman, Gregory A. Aarons, and Wendy Gifford
- Subjects
leadership ,psychometrics ,China ,Data collection ,Psychometrics ,Leadership Scale ,evidence‐based practice ,RT1-120 ,Reproducibility of Results ,Context (language use) ,health services research ,Cross-Sectional Studies ,Convergent validity ,Nursing ,Strategic leadership ,nursing ,Scale (social sciences) ,Surveys and Questionnaires ,Content validity ,Humans ,Psychology ,General Nursing ,Research Articles ,Research Article - Abstract
Author(s): Hu, Jiale; Gifford, Wendy; Ruan, Hong; Harrison, Denise; Li, Qingge; Ehrhart, Mark G; Harrison, Mary-Ann; Barrowman, Nick; Aarons, Gregory A | Abstract: AimThis study aimed to evaluate the validity, reliability and acceptability of the Implementation Leadership Scale in the Chinese nursing context.DesignThis study utilized a cross-sectional design.MethodsThis study was conducted in one general tertiary hospital with 234 nurses (85.3% response rate) from 35 clinical units in China. Content validity, structural validity, convergent validity, reliability (internal consistency), agreement indices and acceptability were evaluated. The data collection was from December 1st, 2017 to June 30th, 2018.ResultsConfirmatory factor analysis demonstrated a good model fit to the four-factor implementation leadership model. The psychometric testing also indicated good convergent validity, high internal consistency and acceptable aggregation. Most participants completed the scale in two minutes or less and agreed or strongly agreed that the questions were relevant to implementation leadership, clear and easy to answer.ConclusionsThis study demonstrated that the Chinese Implementation Leadership Scale is a valid, reliable and pragmatic tool for measuring strategic leadership for implementing evidence-based practices.
- Published
- 2021
28. Comparison of the Psychometric Properties of the FLACC Scale, the MBPS and the Observer Applied Visual Analogue Scale Used to Assess Procedural Pain
- Author
-
Nick Santamaria, Dianne Crellin, Denise Harrison, and Franz E Babl
- Subjects
Pain score ,medicine.medical_specialty ,validity ,reliability ,Visual analogue scale ,business.industry ,infants ,Chronic pain ,Pain scale ,Emergency department ,medicine.disease ,pain measurement ,Procedural Pain ,03 medical and health sciences ,Distress ,0302 clinical medicine ,Anesthesiology and Pain Medicine ,030202 anesthesiology ,FLACC scale ,medicine ,Physical therapy ,Journal of Pain Research ,business ,030217 neurology & neurosurgery ,Original Research - Abstract
Dianne Crellin,1– 3 Denise Harrison,1,2,4 Nick Santamaria,1 Franz E Babl2,3,5 1Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia; 2Murdoch Children’s Research Institute, Melbourne, VIC, Australia; 3Royal Children’s Hospital, Melbourne, VIC, Australia; 4Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, ON, Canada; 5Department of Paediatrics, The University of Melbourne, Melbourne, VIC, AustraliaCorrespondence: Dianne Crellinc/o Emergency Department, Royal Children’s Hospital, Flemington Road Parkville, Melbourne, VIC, 3052, AustraliaTel +61 39345 5331Fax +61 9345 5983Email dianne.crellin@rch.org.auPurpose: The purpose of this study was to compare the psychometric data and feasibility and clinical utility of the Face Legs, Activity, Cry and Consolability scale (FLACC), the Modified Behavioral Pain Scale (MBPS) and the Visual Analogue Scale for observers (VASobs) used to assess procedural pain in infants and young children.Patients and Methods: Twenty-six clinicians assessed videorecorded segments of 100 infants and young children who underwent a painful and/or distressing procedure in the emergency department using the FLACC scale, the MBPS and the VASobs pain and VASobs distress.Results: VASobs pain scores were lowest across all procedures and phases of procedures (p < 0.001). Inter-rater reliability was lowest for VASobs pain scores (ICC 0.55). Sensitivity and specificity were highest for FLACC scores (94.9% and 72.5%, respectively) at the lowest cut-off score (pain score two). Observers changed their MBPS scores more often than they changed FLACC or VASobs scores, but FLACC scores were more often incomplete. Reviewers did not consider any scale of use for procedural pain measurement.Conclusion: The reliability and sensitivity of the FLACC and MBPS were supported by study data but concerns about the capacity of these scales to distinguish between pain- and non-pain-related distress were raised. The VASobs cannot be recommended. Despite its limitations, the FLACC scale may be better suited than other scales for procedural pain measurement.Keywords: pain measurement, infants, validity, reliability
- Published
- 2021
29. Commentary: Does Twitter have a role in improving Family Planning messages and services in Low-and-Middle-Income Countries (LMICs)?
- Author
-
Denise, Harrison, Saumya, RamaRao, Dinesh, Vijeyakumar, James, McKinnon, Kristina, Brown, and Stanley, Mierzwa
- Subjects
Research Article - Abstract
Stakeholders are coming together to develop a vision for increasing access to family planning (FP) by 2030. Of the 923 million women in the developing world who wish to avoid a pregnancy, 218 million women are not using a modern contraceptive (Guttmacher Institute, 2020). In 2016, over 3.4 billion people were using the internet (https://ourworldindata.org/internet 2016). Moreover, internet users in the developing world use social media more frequently than Internet users in the U.S. and Europe. Of the many proposed actions to accelerate progress in family planning, the use of Twitter should be a key component. In this commentary, we describe the use of Twitter in a select group of low-and-middle-income countries that have made commitments to the family planning 2020 initiative (FP2020 countries and have the potential to leverage Twitter with current and potential family planning users. We examine Twitter feeds in eight key FP2020 countries, and we look at the content of Tweets issued by the ministries of health in most of these same countries. Our view is that it is feasible and easy to access Twitter feeds in low-and -middle income countries. We base our view on the types of reproductive health and family planning terms discussed in a public forum such as Twitter by current and potential users and their partners and ministries of health. We highlight two broad considerations that merit discussion among interested stakeholders, including policy makers, program designers, and health advocates. The first relates to the use of Twitter within family planning programs, and the second relates to themes that require more significant research. Data coupled with analytical capacity will help policy makers and program designers to effectively leverage Twitter for expanding the reach of family planning services and influencing social media policy. Our aim is to not only to contribute to the body of knowledge but also to spur greater engagement by program personnel, researchers, health advocates and contraceptive users.
- Published
- 2021
30. Moving on: Transition experiences of young adults with chronic pain
- Author
-
Denise Harrison, Andrea Higginson, G. Allen Finley, Bruce D. Dick, and Paula Forgeron
- Subjects
Gerontology ,young adults ,Medicine (General) ,business.industry ,Pediatric health ,Chronic pain ,transition ,Original Articles ,RM1-950 ,medicine.disease ,young people ,Care setting ,Anesthesiology and Pain Medicine ,R5-920 ,Medicine ,adolescents ,Therapeutics. Pharmacology ,Young adult ,business ,chronic pain ,Adult health ,Research Article - Abstract
Purpose: The purpose of this study was to explore the transition experience of young adults with chronic pain in Canada from the pediatric health care setting to the adult health care setting. Materials and Methods: A qualitative descriptive approach using semistructured interviews was used to capture the transition experiences of young people with chronic pain who have recently transferred from the pediatric setting to the adult health care setting. Participants were recruited from west, central, and the east coast of Canada to situate the findings within the context of Canada. Interviews were transcribed and analyzed using qualitative inductive content analysis. Results: Nine participants were interviewed, three from each part of Canada (west, central, and east). Five common categories were determined to describe the transition experience of young adults with chronic pain which include (1) independence (I can do it, maybe?), (2) pain trajectory (stress and pain along for the ride), (3) social support networks (need a shoulder to lean on), (4) parental support (obviously they are there), and (5) collaborative systems (the bridge). Conclusion: Young people with chronic pain experience unique challenges when faced with transitioning to the adult health care setting. Supporting the young person and his or her family in preparation and readiness and collaboration between the pediatric and adult health care settings are essential to ensure a smooth transition and avoid negative transition outcomes. Further research is needed to determine the best ways to prepare young people for transition and the care activities required in both pediatric and adult health care settings to improve pain-related outcomes posttransition.
- Published
- 2019
31. Pavlov’s Conditioning
- Author
-
Denise Harrison and Denise Harrison
- Abstract
After the exhausting and personally costly aftermath of solving the Darwin Killer case, beautiful and brilliant FBI Supervisory Special Agent Emmie Blanchet was looking forward to a little down time. However, her tranquility is abruptly erased when she is assigned the lead position on an emergency task force created to stop a group of domestic terrorists. With her lover, Joel, the local police captain, and her father at her side, Emmie and her team work feverishly to stop these killers before more innocent lives are lost. When their investigations lead them to the Pavlovian Research Institute, founded by an ex-colleague of Emmie's father, the team discovers that the perpetrators may, in reality, be victims of mind control themselves. As the plot thickens and becomes more complicated, Emmie and Joel's relationship and passion grow to new levels, and the pair realize that they want to spend the rest of their lives together. Will Emmie be able to find the source of these crimes and bring the killers to justice? Or will more lives be lost? Will she be able to survive an unimaginable personal loss and still effectively do her job? Will her training and experience help her survive? Or will it be, as Pavlov theorized, that her conditioned responses will guide her?
- Published
- 2023
32. Como traduzir o conhecimento científico à prática? Conceitos, modelos e aplicação
- Author
-
Ana Cláudia Garcia Vieira, Denise Gastaldo, and Denise Harrison
- Subjects
Traducción ,Sociology of scientific knowledge ,Translation ,Knowledge management ,media_common.quotation_subject ,RT1-120 ,Information Dissemination ,MEDLINE ,Clinical competence ,Context (language use) ,Difusión ,Nursing ,Competencia Clínica ,Translational Research, Biomedical ,Diffusion ,03 medical and health sciences ,0302 clinical medicine ,Translação ,Order (exchange) ,Knowledge Translation ,Knowledge translation ,Diseminación de Información ,Humans ,030212 general & internal medicine ,Sociology ,Competência Clínica ,Traducción del Conocimiento ,Disseminação de Informação ,General Nursing ,media_common ,business.industry ,030503 health policy & services ,Health equity ,Tradução do Conhecimento ,Evidence-Based Practice ,Conceptual model ,Difusão ,0305 other medical science ,business ,Brazil - Abstract
Objectives: to present the concept of Knowledge Translation and Exchange as it has been used in the international literature and in Canada, particularly. Next, to describe a renowned conceptual model to guide its implementation, entitled Knowledge-to-Action Cycle. Results: we described the use of the model in the context of the municipal primary health care system in southern Brazil for the implementation of pain management strategies during vaccination. Conclusions: in this theoretical reflection, we argue that in order to promote health equity and quality of care in the Unified Health System (Brazilian SUS) it is important to translate scientific knowledge to various practice settings and create opportunities for exchange with users of this knowledge, such as health professionals, managers, policy makers, patients, family members and other stakeholders. RESUMEN Objetivos: presentar el concepto de Traducción e Intercambio de Conocimiento tal como se ha utilizado en la literatura internacional y, en particular, en Canadá. A continuación, describir un modelo conceptual reconocido para guiar su implementación, titulado Ciclo del Conocimiento a la Acción. Resultados: ilustramos el uso del modelo en el contexto del sistema municipal de atención primaria de salud en el sur de Brasil para implementar estrategias de manejo del dolor durante la vacunación. Conclusiones: en esta reflexión teórica, argumentamos sobre la importancia de traducir el conocimiento científico a los diversos contextos de práctica y de crear oportunidades de intercambio con los usuarios de este conocimiento, como profesionales sanitarios, gerentes, formuladores de políticas públicas, pacientes, familias y otros grupos de interés para promover la equidad y la calidad de los cuidados en el Sistema Único de Salud. RESUMO Objetivos: apresentar o conceito de Tradução e Intercâmbio do Conhecimento tal como vem sendo utilizado na literatura internacional e, em particular, no Canadá. A seguir, descrever um renomado modelo conceitual para orientar a sua implementação, intitulado Ciclo do Conhecimento à Ação. Resultados: ilustramos a utilização do modelo no contexto do sistema municipal de atenção básica à saúde no sul do Brasil, na implementação de estratégias de manejo da dor durante a vacinação. Conclusões: nesta reflexão teórica, argumentamos sobre a importância de se traduzir o conhecimento científico aos diversos contextos de prática e criar oportunidades de intercâmbio com os usuários desse saber, como profissionais de saúde, gestores, formuladores de políticas públicas, pacientes, familiares e demais grupos de interesse, para promover equidade e qualidade dos cuidados no Sistema Único de Saúde.
- Published
- 2020
33. Darwin Was Right
- Author
-
Denise Harrison and Denise Harrison
- Abstract
Beautiful and brilliant FBI Supervisory Agent Emmanuelle Blanchet, known as Emmie to friends and family, was embroiled in the most difficult and challenging case of her life. She and her dedicated team were rushing against time to find and stop a serial killer before he found his next victim. Making the task even more daunting, evidence was piling up suggesting that these murders were somehow related to a cold case that her father had been involved in, and solved, 30 years ago. When one of the victim's mutilated body is found in the Shenandoah National Park, Emmie encounters National Park Ranger Chief Joel McNeil. The attraction was mutual and intense. But could she risk getting involved in a romance during an investigation? With her focus being primarily on her career, personal relationships were always put on hold. Would she be able to resist her powerful feelings? As Joel and her team work closely with her against time to find the killer, it becomes clear that she herself may be a target. Will they be able to find the killer before it is too late? Or will it be, as Darwin suggested, the survival of the fittest?
- Published
- 2022
34. Allergen Sensitization and Asthma Outcomes among World Trade Center Rescue and Recovery Workers
- Author
-
Erin A. West, Juan P. Wisnivesky, Paula J. Busse, Laura Crowley, Denise Harrison, Steven B. Markowitz, Alex D. Federman, Belen Rojano, and Emily Ferdermann
- Subjects
Male ,Health, Toxicology and Mutagenesis ,lcsh:Medicine ,Cockroaches ,Immunoglobulin E ,indoor allergens sensitization ,immunoglobulin E ,Cohort Studies ,Allergic sensitization ,WTC-related asthma ,0302 clinical medicine ,Risk Factors ,immune system diseases ,Prevalence ,Rescue Work ,asthma morbidity ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Sensitization ,education.field_of_study ,biology ,Pyroglyphidae ,asthma outcomes ,3. Good health ,medicine.anatomical_structure ,Asthma Control Questionnaire ,Health Resources ,Female ,mini asthma quality of life questionnaire ,medicine.medical_specialty ,Population ,complex mixtures ,Article ,03 medical and health sciences ,asthma quality of life ,Internal medicine ,medicine ,Animals ,Humans ,Risk factor ,education ,Asthma ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,Environmental Exposure ,Allergens ,medicine.disease ,World Trade Center ,respiratory tract diseases ,asthma control ,030228 respiratory system ,Quality of Life ,biology.protein ,allergen exposure ,Morbidity ,September 11 Terrorist Attacks ,business - Abstract
A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. Asthma morbidity outcomes included level of control (Asthma Control Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ) and acute resource utilization. The prevalence of sensitization to cat, dog, mouse, dust mite, cockroach, and mold allergens were 33%, 21%, 17%, 40%, 17%, and 17%, respectively. Unadjusted and regression analyses showed no significant relationship between sensitization and increased asthma morbidity (p >, 0.05 for all comparisons), except for sensitization to Aspergillus Fumigatus, cat and mouse epithelium, which were associated with decreased morbidity.
- Published
- 2019
- Full Text
- View/download PDF
35. Severe Obstructive Sleep Apnea Is Associated with Alterations in the Nasal Microbiome and an Increase in Inflammation
- Author
-
Jose M. Marin, Anbang Wang, Jag Sunderram, Akosua Twumasi, Bianca Kapoor, Robert Laumbach, Indu Ayappa, Oanh Le-Hoang, Jose C. Clemente, Patrick Malecha, Imran Sulaiman, Benjamin G. Wu, Alan Perez, Michael Plietz, Kathleen Black, Benjamin D. Scaglione, Cameron Blazoski, Yonghua Li, Eugenio Fernández Vicente, Leopoldo N. Segal, David M. Rapoport, Michael D. Weiden, Shahnaz Alimokhtari, Denise Harrison, Shou-En Lu, Iris Udasin, Jing Wang, Nishay Chitkara, Haley Sanders, and Nan Shen
- Subjects
Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Chronic rhinosinusitis ,Inflammation ,urologic and male genital diseases ,Critical Care and Intensive Care Medicine ,Gastroenterology ,Severity of Illness Index ,03 medical and health sciences ,0302 clinical medicine ,Edema ,Internal medicine ,RNA, Ribosomal, 16S ,medicine ,Humans ,030212 general & internal medicine ,Microbiome ,Sleep Apnea, Obstructive ,business.industry ,Interleukin-6 ,Microbiota ,Interleukin-8 ,Airway inflammation ,Original Articles ,Middle Aged ,medicine.disease ,Nasal Lavage Fluid ,respiratory tract diseases ,Obstructive sleep apnea ,030228 respiratory system ,Female ,medicine.symptom ,Nasal Cavity ,business ,Biomarkers - Abstract
Rationale: Obstructive sleep apnea (OSA) is associated with recurrent obstruction, subepithelial edema, and airway inflammation. The resultant inflammation may influence or be influenced by the nasal microbiome. Objectives: To evaluate whether the composition of the nasal microbiota is associated with obstructive sleep apnea and inflammatory biomarkers. Methods: Two large cohorts were used: 1) a discovery cohort of 472 subjects from the WTCSNORE (Seated, Supine and Post-Decongestion Nasal Resistance in World Trade Center Rescue and Recovery Workers) cohort, and 2) a validation cohort of 93 subjects rom the Zaragoza Sleep cohort. Sleep apnea was diagnosed using home sleep tests. Nasal lavages were obtained from cohort subjects to measure: 1) microbiome composition (based on 16S rRNA gene sequencing), and 2) biomarkers for inflammation (inflammatory cells, IL-8, and IL-6). Longitudinal 3-month samples were obtained in the validation cohort, including after continuous positive airway pressure treatment when indicated. Measurements and Main Results: In both cohorts, we identified that: 1) severity of OSA correlated with differences in microbiome diversity and composition; 2) the nasal microbiome of subjects with severe OSA were enriched with Streptococcus, Prevotella, and Veillonella; and 3) the nasal microbiome differences were associated with inflammatory biomarkers. Network analysis identified clusters of cooccurring microbes that defined communities. Several common oral commensals (e.g., Streptococcus, Rothia, Veillonella, and Fusobacterium) correlated with apnea–hypopnea index. Three months of treatment with continuous positive airway pressure did not change the composition of the nasal microbiota. Conclusions: We demonstrate that the presence of an altered microbiome in severe OSA is associated with inflammatory markers. Further experimental approaches to explore causal links are needed.
- Published
- 2019
36. Assessment of cumulative health risk in the World Trade Center general responder cohort
- Author
-
Julia Kaplan, Benjamin J. Luft, Ghalib Bello, Susan L. Teitelbaum, Andrew C. Todd, Christopher R. Dasaro, Michael Crane, Jacqueline Moline, Iris Udasin, Denise Harrison, Roberto Lucchini, and Moshe Shapiro
- Subjects
Adult ,Male ,medicine.medical_specialty ,Poison control ,030204 cardiovascular system & hematology ,Risk Assessment ,Occupational safety and health ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,9/11 ,Environmental health ,Occupational Exposure ,Injury prevention ,medicine ,Rescue Work ,Health Risk Index ,Humans ,030212 general & internal medicine ,mortality ,physiological dysregulation ,World Trade Center ,Emergency Responders ,Female ,Middle Aged ,Occupational Diseases ,September 11 Terrorist Attacks ,Public Health, Environmental and Occupational Health ,Asthma ,COPD ,business.industry ,Environmental and Occupational Health ,Sleep apnea ,medicine.disease ,Cohort ,Emergency medicine ,Life expectancy ,Public Health ,business - Abstract
Background Multiple comorbidities have been reported among rescue/recovery workers responding to the 9/11/2001 WTC disaster. In this study, we developed an index that quantifies the cumulative physiological burden of comorbidities and predicts life expectancy in this cohort. Methods A machine learning approach (gradient boosting) was used to model the relationship between mortality and several clinical parameters (laboratory test results, blood pressure, pulmonary function measures). This model was used to construct a risk index, which was validated by assessing its association with a number of health outcomes within the WTC general responder cohort. Results The risk index showed significant associations with mortality, self-assessed physical health, and onset of multiple chronic conditions, particularly COPD, hypertension, asthma, and sleep apnea. Conclusion As an aggregate of several clinical parameters, this index serves as a cumulative measure of physiological dysregulation and could be utilized as a prognostic indicator of life expectancy and morbidity risk.
- Published
- 2018
37. The association between body mass index and gastroesophageal reflux disease in the World Trade Center Health Program General Responder Cohort
- Author
-
Nikolina, Icitovic, Lynn C, Onyebeke, Sylvan, Wallenstein, Christopher R, Dasaro, Denise, Harrison, Jieying, Jiang, Julia R, Kaplan, Roberto G, Lucchini, Benjamin J, Luft, Jacqueline M, Moline, Lakshmi, Pendem, Moshe, Shapiro, Iris G, Udasin, Andrew C, Todd, and Susan L, Teitelbaum
- Subjects
Adult ,Male ,Environmental and Occupational Health ,Ideal Body Weight ,GERD ,Middle Aged ,Overweight ,9/11 ,BMI ,World Trade Center ,Public Health, Environmental and Occupational Health ,Body Mass Index ,Occupational Exposure ,Gastroesophageal Reflux ,Humans ,Female ,Obesity ,Public Health ,September 11 Terrorist Attacks ,Proportional Hazards Models - Abstract
There is increasing concern about the obesity epidemic in the United States. Obesity is a potential risk factor for a number of chronic diseases, including gastroesophageal reflux disease (GERD). This analysis examined whether body mass index (BMI) was associated with physician-diagnosed GERD in World Trade Center (WTC) general responders.19,819 WTC general responders were included in the study. Cox proportional hazards regression models were used to compare time to GERD diagnosis among three BMI groups (normal (25 kg/m(2) ), overweight (≥25 and30 kg/m(2) ), and obese (≥30 kg/m(2) )).Among the responders, 43% were overweight and 42% were obese. The hazard ratio for normal versus overweight was 0.81 (95% Confidence Interval (CI), 0.75-0.88); normal versus obese 0.71 (95%CI, 0.66, 0.77); and overweight versus obese 0.88 (95%CI, 0.83-0.92).GERD diagnoses rates were higher in overweight and obese WTC responders. Am. J. Ind. Med. 59:761-766, 2016. © 2016 Wiley Periodicals, Inc.
- Published
- 2016
38. Be sweet to toddlers during needles: pilot randomized controlled trial of sucrose compared to placebo
- Author
-
Jessica Reszel, Denise Harrison, Brenda Martelli, Diane Sharp, Regis Vailancourt, and Nick Barrowman
- Subjects
lcsh:RT1-120 ,Pediatrics ,medicine.medical_specialty ,Venipuncture ,venipuncture ,lcsh:Nursing ,business.industry ,Crying ,Pain ,sucrose ,Placebo ,law.invention ,Procedural Pain ,Randomized controlled trial ,painful ,children ,Sample size determination ,law ,FLACC scale ,Physical therapy ,Medicine ,Parental perception ,medicine.symptom ,business ,General Nursing - Abstract
Sweet solutions reduce procedural pain in infants but there is uncertainty about effectiveness beyond infancy. A blinded pilot randomized controlled trial (RCT) was conducted to inform a full-scale RCT. Hospitalized children aged 12- 36 months were randomized to 24% sucrose or water prior to and during venipuncture. Primary outcomes were crying time and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Secondary outcomes parental report of child’s pain, parental perception of effectiveness and nurse’s score of child’s compliance with study solution. Twenty-one children were studied. There were no differences in pain outcomes between groups. Median FLACC scores at time of needle insertion were high (8/10), and mean crying time during procedure was 61%. Most parents (n=17) would use the same treatment next time and most (n=17) toddlers were compliant with receiving the solutions. The pilot RCT informed the conduct of a future full scale RCT in terms of feasibility, acceptability, data collection, data analysis and sample size estimation.
- Published
- 2015
39. Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study
- Author
-
Laura Boland, Denise Harrison, Bryan Feenstra, Dawn Stacey, and Margaret L. Lawson
- Subjects
Insulin pump ,Parents ,Adult ,Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,education ,Decision Making ,Alternative medicine ,Health Informatics ,Coaching ,Health informatics ,Decision Support Techniques ,Nursing ,Intervention (counseling) ,Medicine ,Humans ,Family ,Decision-making ,Child ,Children ,Type 1 diabetes ,business.industry ,Health Policy ,Diabetes ,Decision-coaching ,Middle Aged ,Patient Acceptance of Health Care ,medicine.disease ,Computer Science Applications ,Patient decision aid ,Diabetes Mellitus, Type 1 ,Feasibility Studies ,Female ,business ,human activities ,Dyad ,Research Article - Abstract
Background Although children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections). Methods Pre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children’s hospital. Parent–child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention. Results Of 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent–child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making. Conclusion Decision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.
- Published
- 2015
40. Pain Prevalence in a Pediatric Hospital: Raising Awareness during Pain Awareness Week
- Author
-
Sarah Cochrane, Jacqueline A. Ellis, Cynthia Joly, Christine Chretien, Régis Vaillancourt, Christine Lamontagne, and Denise Harrison
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Cross-sectional study ,MEDLINE ,Pain ,Pilot Projects ,Pain assessment ,Pediatric hospital ,Prevalence ,Medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Child ,Pain Measurement ,lcsh:R5-920 ,business.industry ,Infant, Newborn ,Infant ,Pain management ,Awareness ,Hospitals, Pediatric ,Clinical Practice ,Anesthesiology and Pain Medicine ,Cross-Sectional Studies ,Neurology ,Child, Preschool ,Physical therapy ,Pain catastrophizing ,Original Article ,Female ,business ,lcsh:Medicine (General) - Abstract
BACKGROUND: Despite the evidence and availability of numerous validated pain assessment tools and pain management strategies for infants and children, their use remains inconsistent in clinical practice.OBJECTIVES: To describe the prevalence of pain, pain assessment and pain management practices at a tertiary pediatric hospital in Canada.METHODS: The cross-sectional study design involved a combination of interviews with children and/or caregivers, and chart audits in five inpatient units. Information regarding pain intensity, painful procedures and pain management strategies was obtained from children and/or caregivers by interview. Patient charts were reviewed for information regarding pain assessment, pain scores, and pharmacological and nonpharmacological interventions.RESULTS: Sixty-two children (four days to 17 years of age) participated. Most children or their caregivers (n=51 [84%]) reported that pain was experienced during their hospitalization, with 40 (66%) reporting their worst pain as moderate or severe. Almost one-half reported analgesics were administered before or during their most recent painful procedure. Nineteen (32%) reported sucrose, topical anesthetics or nonpharmacological interventions were used; however, they were documented in only 17% of charts. Pain scores were documented in 34 (55%) charts in the previous 24 h. The majority of the children or their caregiver (n=44 [71%]) were satisfied with pain management at the study hospital.CONCLUSIONS: Most infants and children had experienced moderate or severe pain during their hospitalization. Analgesics were frequently used, and although nonpharmacological strategies were reported to be used, they were rarely documented. Most parents and children were satisfied with their pain management.
- Published
- 2014
41. Cancer incidence in World Trade Center rescue and recovery workers, 2001-2008
- Author
-
Benjamin J. Luft, Denise Harrison, Samara Solan, Moshe Shapiro, Janice Gabrilove, Julia Kaplan, Xiaoling Niu, Paolo Boffetta, Steven B. Markowitz, F. Noah Biro, Gauri Shukla, Henry S. Sacks, Laura Crowley, Iris Udasin, Amy R. Kahn, Lou Gonsalves, Lori Stevenson, Anne Kochman, Jacqueline Moline, Robin Herbert, Susan L. Teitelbaum, Michael Crane, Roberto Lucchini, Cornelia Dellenbaugh, Philip J. Landrigan, Sylvan Wallenstein, Solan, S., Wallenstein, S., Shapiro, M., Teitelbaum, S.L., Stevenson, L., Kochman, A., Kaplan, J., Dellenbaugh, C., Kahn, A., Noah Biro, F., Crane, M., Crowley, L., Gabrilove, J., Gonsalves, L., Harrison, D., Herbert, R., Luft, B., Markowitz, S.B., Moline, J., Niu, X., Sacks, H., Shukla, G., Udasin, I., Lucchini, R.G., Boffetta, P., and Landrigan, P.J.
- Subjects
Gerontology ,Adult ,Male ,medicine.medical_specialty ,Medical surveillance ,cancer incidence ,Time Factors ,Health, Toxicology and Mutagenesis ,Population ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Neoplasms ,Occupational Exposure ,Epidemiology ,Medicine ,cancer ,cancer registry ,Humans ,030212 general & internal medicine ,Registries ,education ,Thyroid cancer ,Aged ,education.field_of_study ,September 11th ,business.industry ,Incidence (epidemiology) ,Research ,Incidence ,Public Health, Environmental and Occupational Health ,WTC Health Program ,Cancer ,Middle Aged ,medicine.disease ,030210 environmental & occupational health ,World Trade Center ,3. Good health ,Cancer registry ,cancer, cancer incidence, cancer registry, epidemiology, September 11th, World Trade Center, WTC Health Program ,Cohort ,Regression Analysis ,epidemiology ,Female ,September 11 Terrorist Attacks ,business - Abstract
Background: World Trade Center (WTC) rescue and recovery workers were exposed to a complex mix of pollutants and carcinogens. Objective: The purpose of this investigation was to evaluate cancer incidence in responders during the first 7 years after 11 September 2001. Methods: Cancers among 20,984 consented participants in the WTC Health Program were identified through linkage to state tumor registries in New York, New Jersey, Connecticut, and Pennsylvania. Standardized incidence ratios (SIRs) were calculated to compare cancers diagnosed in responders to predicted numbers for the general population. Multivariate regression models were used to estimate associations with degree of exposure. Results: A total of 575 cancers were diagnosed in 552 individuals. Increases above registry-based expectations were noted for all cancer sites combined (SIR = 1.15; 95% CI: 1.06, 1.25), thyroid cancer (SIR = 2.39; 95% CI: 1.70, 3.27), prostate cancer (SIR = 1.21; 95% CI: 1.01, 1.44), combined hematopoietic and lymphoid cancers (SIR = 1.36; 95% CI: 1.07, 1.71), and soft tissue cancers (SIR = 2.26; 95% CI: 1.13, 4.05). When restricted to 302 cancers diagnosed ≥ 6 months after enrollment, the SIR for all cancers decreased to 1.06 (95% CI: 0.94, 1.18), but thyroid and prostate cancer diagnoses remained greater than expected. All cancers combined were increased in very highly exposed responders and among those exposed to significant amounts of dust, compared with responders who reported lower levels of exposure. Conclusion: Estimates should be interpreted with caution given the short follow-up and long latency period for most cancers, the intensive medical surveillance of this cohort, and the small numbers of cancers at specific sites. However, our findings highlight the need for continued follow-up and surveillance of WTC responders.
- Published
- 2013
42. Establishing intra- and inter-rater agreement of the Face, Legs, Activity, Cry, Consolability scale for evaluating pain in toddlers during immunization
- Author
-
Jenny Royle, Sonja Elia, Elizabeth Manias, Nick Barrowman, Rebecca J Gomez, and Denise Harrison
- Subjects
Male ,medicine.medical_specialty ,Psychometrics ,Pain ,Context (language use) ,Crying ,Motor Activity ,Pediatrics ,medicine ,Humans ,Pain Measurement ,Randomized Controlled Trials as Topic ,Observer Variation ,lcsh:R5-920 ,Leg ,Reproducibility of Results ,Procedural Pain ,Inter-rater reliability ,Anesthesiology and Pain Medicine ,Neurology ,Scale (social sciences) ,Child, Preschool ,Face ,FLACC scale ,Physical therapy ,Original Article ,Female ,Immunization ,medicine.symptom ,lcsh:Medicine (General) ,Psychometric data ,Psychology - Abstract
BACKGROUND: The Face, Legs, Activity, Cry, Consolability (FLACC) scale is a five-item tool that was developed to assess postoperative pain in young children. The tool is frequently used as an outcome measure in studies investigating acute procedural pain in young children; however, there are limited published psychometric data in this context.OBJECTIVE: To establish inter-rater and intrarater agreement of the FLACC scale in toddlers during immunization.METHODS: Participants comprised a convenience sample of toddlers recruited from an immunization drop-in service, who were part of a larger pilot randomized controlled trial. Toddlers were video- and audiotaped during immunization procedures. The first rater scored each video twice in random order over a period of three weeks (intrarater agreement), while the second rater scored each video once and was blinded to the first rater’s scores (inter-rater agreement). The FLACC scale was scored at four time-points throughout the procedure. Intraclass correlation coefficients were used to assess agreement of the FLACC scale.RESULTS: Thirty toddlers between 12 and 18 months of age were recruited, and video data were available for 29. Intrarater agreement coefficients were 0.88 at baseline, 0.97 at insertion of first needle, and 0.80 and 0.81 at 15 s and 30 s following the final injection, respectively. Inter-rater coefficients were 0.40 at baseline, 0.95 at insertion of first needle, and 0.81 and 0.78 at 15 s and 30 s following the final injection, respectively.CONCLUSIONS: The FLACC scale has sufficient agreement in assessing pain in toddlers during immunizations, especially during the most painful periods of the procedure.
- Published
- 2013
43. Limitations of WTC Five-Year Assessment
- Author
-
Kristina Metzger, Benjamin J. Luft, Stephen M. Levin, Andrew C. Todd, Jacqueline Moline, Iris Udasin, Gwen Skloot, Sherry Baron, Philip J. Landrigan, Jeanne Mager Stellman, Paul L. Enright, Denise Harrison, Robin Herbert, Diane Stein, and Steven M. Markowitz
- Subjects
Male ,Pediatrics ,Time Factors ,Health, Toxicology and Mutagenesis ,Respiratory Tract Diseases ,Poison control ,Suicide prevention ,Occupational safety and health ,Pulmonary function testing ,Mass Screening ,Lung volumes ,September 11 ,Aged, 80 and over ,medicine.diagnostic_test ,pulmonary function ,World trade center ,Human factors and ergonomics ,Dust ,Middle Aged ,humanities ,Occupational Diseases ,September 11 Terrorist Attacks ,disaster response ,Female ,medicine.symptom ,Perspectives ,Spirometry ,Adult ,medicine.medical_specialty ,Adolescent ,Physical examination ,complex mixtures ,FEV1/FVC ratio ,Environmental health ,Wheeze ,Air Pollution ,Occupational Exposure ,Injury prevention ,Correspondence ,medicine ,Humans ,Mass screening ,Asthma ,Aged ,business.industry ,Research ,Public Health, Environmental and Occupational Health ,medicine.disease ,World Trade Center ,Physical therapy ,business ,occupational lung disease - Abstract
We have learned much about the respiratory disorders since the exposures of responders at the World Trade Center (WTC) site, especially from the publications of Prezant and colleagues about the presentations, follow-up, and impairments of pulmonary function and bronchial reactivity of the fire fighters and emergency medical technicians of the New York City Fire Department (Banauch et al. 2003, 2005, 2006; Prezant et al. 2002). These reports are especially informative because of the availability of preexposure clinical and spirometric data. We appreciate the report of much-awaited results among 9,442 workers from the WTC Worker and Volunteer Medical Screening Program (Herbert et al. 2006). Because of the potential for major illness, the large number of subjects at risk, and the resultant enormous public interest, it is important that the information reported be properly understood. A number of limitations in this report must be pointed out. Although the title identified this report (Herbert et al. 2006) as a 5-year assessment, screening examinations were performed between 16 July 2002 and 16 April 2004, < 1 year through < 3 years after 11 September 2001. There were no follow-up examinations, either at the 5-year or at any other interval. Summary conclusions (Herbert et al. 2006), heavily reported in the media, lump all respiratory symptoms: … 69% reported new or worsened respiratory symptoms while performing WTC work. Symptoms persisted to the time of examination in 59% of these workers. The 69% with “any respiratory symptom” included 23.3% with no “lower respiratory symptoms.” A far smaller percentage of all workers (17.3%) complained of what may be considered the most important respiratory symptom, dyspnea, which was not quantified by any standard scale. Such a reliance on symptoms is subject to recall biases both for symptoms present before 9/11 and for the onset, worsening, and persistence of symptoms after 9/11. Because physical examination and chest radiographs were unrevealing (Herbert et al. 2006), the only objective results were from pulmonary function tests. These were confined to spirometry, which does not provide insight into all aspects of respiratory impairment. The data presented by Herbert et al. (2006) are limited. Mean values for subsets (classified by WTC exposure, previous smoking history, etc.) are not given. Despite the frequency of cough (42.8%), wheeze (15.1%), and chest tightness (15.4%) and the common diagnoses of asthma/reactive airways dysfunction, only 7.6% of all responders showed airway obstruction, defined as a ratio of forced expiratory volume in 1 sec (FEV1) to forced vital capacity (FVC) less than the 5th percentile of the reference population. Unlike virtually all spirometric surveys of a large population (reviewed by Miller et al. 1991), Herbert et al. (2006) found little difference in impairment by smoking status. Most spirometric impairments were classified as restrictive, uncharacteristic of the symptoms and clinical diagnoses. This frequency of low FVC (22.7%) raises several issues: a) the effects of other clinical factors not reported on, such as obesity; b) technical considerations in subject performance or technician monitoring of the FVC maneuver, despite the investigators attention to these; and c) the appropriateness of the reference-predicted values. We await further information and follow-up from these investigators, including results of additional diagnostic procedures not included in routine screening. These include a wider array of pulmonary function tests (full lung volumes, diffusing capacity), measurement of bronchial reactivity, computed tomography scans, and—in appropriate patients—bronchoalveolar lavage and lung biopsies, which would truly elucidate the respiratory disorders following WTC exposure.
- Published
- 2007
44. A comparison of CPAP and CPAPFLEX in the treatment of obstructive sleep apnea in World Trade Center responders: study protocol for a randomized controlled trial
- Author
-
Indu Ayappa, Akosua Twumasi, Kathleen Black, Iris Udasin, Jag Sunderram, Jeffrey L. Carson, David M. Rapoport, Shou-En Lu, and Denise Harrison
- Subjects
Nasal cavity ,Time Factors ,medicine.medical_treatment ,Nasal resistance ,Poison control ,Medicine (miscellaneous) ,Study Protocol ,Airway resistance ,Clinical Protocols ,Medicine ,Pharmacology (medical) ,Continuous positive airway pressure ,education.field_of_study ,Sleep Apnea, Obstructive ,Cross-Over Studies ,medicine.diagnostic_test ,New Jersey ,Sleep apnea ,respiratory system ,3. Good health ,medicine.anatomical_structure ,Treatment Outcome ,Research Design ,Rhinomanometry ,Nasal Cavity ,Nasal Obstruction ,medicine.medical_specialty ,Population ,Double-Blind Method ,Internal medicine ,otorhinolaryngologic diseases ,Humans ,education ,Cflex ,Occupational Health ,business.industry ,Airway Resistance ,Snoring ,Emergency Responders ,medicine.disease ,Obstructive sleep apnea ,World Trade Center ,nervous system diseases ,respiratory tract diseases ,Physical therapy ,CPAPFlex ,Patient Compliance ,New York City ,September 11 Terrorist Attacks ,business - Abstract
Following the World Trade Center disaster, a large number of individuals involved in rescue and recovery activity were exposed to significant amounts of dust, and reported symptoms of chronic nasal and sinus inflammation. An unusually high prevalence of obstructive sleep apnea (OSA) has also been observed in this World Trade Center Responder population. This project aims to examine the relationship between nasal pathology and OSA. Our hypothesis is that increased nasal resistance due to nasal inflammation predisposes to OSA in this population. Continuous Positive Airway Pressure (CPAP) is the standard therapy for OSA but despite its efficacy has poor adherence. Subjects with high nasal resistance may have greater difficulty in tolerating this therapy than those who do not have high nasal resistance. Reduction of excess expiratory positive pressure by the modality known as Cflex™ during Continuous Positive Airway Pressure therapy (CPAPFlex) has been suggested to improve comfort without compromising efficacy. We will compare CPAP to CPAPFlex in subjects with OSA. Subjects with new onset habitual snoring will be screened for OSA using home sleep studies and rhinomanometry will be used to determine nasal resistance. In 400 subjects with OSA we will perform a randomized double blind cross-over study comparing CPAP to CPAPflex, and relate nasal resistance to adherence to CPAP therapy. This is the first multicenter trial designed to test the hypothesis that adherence to CPAP therapy relates to nasal resistance and CPAPFlex will improve adherence to CPAP in those subjects with high nasal resistance. We anticipate the following results from this trial: 1. Increased nasal resistance is associated with decreased adherence to CPAP therapy. 2. Use of CPAPFlex improves adherence with CPAP therapy in subjects with high nasal resistance, but not in those with low nasal resistance. 3. The benefit of CPAPFlex on adherence is greatest when offered at CPAP therapy initiation rather than as a “rescue” therapy in subjects with high nasal resistance. ClinicalTrials.gov Identifier: NCT01753999 , Date: 12 December 2012
- Full Text
- View/download PDF
45. Too many crying babies: a systematic review of pain management practices during immunizations on YouTube
- Author
-
Jordi Cumber, Nick Barrowman, Jessica Reszel, Catherine M. Pound, Margaret Sampson, Claudia Li, Koowsar Abdulla, Stuart G. Nicholls, Denise Harrison, and Ann Fuller
- Subjects
Pediatrics ,medicine.medical_specialty ,Video Recording ,Psychological intervention ,Breastfeeding ,Pain ,Crying ,Injections, Intramuscular ,Health care ,medicine ,Humans ,Pain Management ,Early childhood ,Pediatrics, Perinatology, and Child Health ,Internet ,business.industry ,YouTube ,Vaccination ,digestive, oral, and skin physiology ,Infant, Newborn ,Infant ,medicine.disease ,Fear of needles ,3. Good health ,Distress ,Pediatrics, Perinatology and Child Health ,FLACC scale ,Immunization ,medicine.symptom ,business ,Social Media ,Research Article - Abstract
Background Early childhood immunizations, although vital for preventative health, are painful and too often lead to fear of needles. Effective pain management strategies during infant immunizations include breastfeeding, sweet solutions, and upright front-to-front holding. However, it is unknown how often these strategies are used in clinical practice. We aimed to review the content of YouTube videos showing infants being immunized to ascertain parents’ and health care professionals’ use of pain management strategies, as well as to assess infants’ pain and distress. Methods A systematic review of YouTube videos showing intramuscular injections in infants less than 12 months was completed using the search terms "baby injection" and "baby vaccine" to assess (1) the use of pain management strategies and (2) infant pain and distress. Pain was assessed by crying duration and pain scores using the FLACC (Face, Legs, Activity, Cry, Consolability) tool. Results A total of 142 videos were included and coded by two trained individual viewers. Most infants received one injection (range of one to six). Almost all (94%) infants cried before or during the injections for a median of 33 seconds (IQR = 39), up to 146 seconds. FLACC scores during the immunizations were high, with a median of 10 (IQR = 3). No videos showed breastfeeding or the use of sucrose/sweet solutions during the injection(s), and only four (3%) videos showed the infants being held in a front-to-front position during the injections. Distraction using talking or singing was the most commonly used (66%) pain management strategy. Conclusions YouTube videos of infants being immunized showed that infants were highly distressed during the procedures. There was no use of breastfeeding or sweet solutions and limited use of upright or front-to-front holding during the injections. This systematic review will be used as a baseline to evaluate the impact of future knowledge translation interventions using YouTube to improve pain management practices for infant immunizations.
- Full Text
- View/download PDF
46. Conhecimento e práticas de enfermeiros acerca do manejo da dor em recém-nascidos
- Author
-
Júnia Selma de Freitas, Izabela Linha Secco, Natália Pinheiro Braga Sposito, Mariana Bueno, Taine Costa, Lisabelle Mariano Rossato, and Denise Harrison
- Subjects
Adult ,Male ,Health Knowledge, Attitudes, Practice ,medicine.medical_specialty ,Enfermagem Neonatal ,Nurses knowledge ,Neonatal pain ,Pain ,Fentanyl ,03 medical and health sciences ,0302 clinical medicine ,Recién Nacido ,Pain assessment ,Knowledge translation ,Intensive care ,Neonatal Nursing ,Intensive Care Units, Neonatal ,medicine ,Humans ,Pain Management ,Dor ,030212 general & internal medicine ,Intensive care medicine ,General Nursing ,Enfermería Neonatal ,lcsh:RT1-120 ,Unidades de Terapia Intensiva Neonatal ,Practice Patterns, Nurses' ,030504 nursing ,biology ,lcsh:Nursing ,business.industry ,Infant, Newborn ,Curitiba ,Middle Aged ,Pain management ,biology.organism_classification ,Cross-Sectional Studies ,Manejo del Dolor ,Physical therapy ,Manejo da Dor ,Recém-Nascido ,Female ,Dolor ,0305 other medical science ,business ,Unidades de Cuidado Intensivo Neonatal ,medicine.drug - Abstract
OBJECTIVE To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units. METHOD A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region. RESULTS For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%). CONCLUSION Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns. Resumen OBJETIVO Verificar el conocimiento y las prácticas de los enfermeros sobre el manejo del dolor de recién nacidos admitidos en Unidades de Tratamiento Intensivo Neonatal. MÉTODO Estudio descriptivo y transversal. Los datos fueron recolectados con 51 enfermeros, mediante un cuestionario adaptado que tiene el fin de evaluar el conocimiento y las prácticas acerca del manejo del dolor neonatal, en seis hospitales de Curitiba y Región Metropolitana. RESULTADOS Para la mayoría de los enfermeros (86,0%), los neonatos sienten dolor. Un total del 34,7% afirmaron nunca utilizar escalas de evaluación del dolor. El registro del manejo del dolor fue realizado por el 84,3% de los enfermeros. Las medidas farmacológicas realizadas fueron Paracetamol y Fentanilo (47,1%) y Morfina (17,6%); las no farmacológicas adoptadas fueron solución azucarada (68,6%), succión no nutritiva (58,8%) y posicionamiento (56,9%). CONCLUSIÓN Los enfermeros consideraron el dolor neonatal como un evento real; sin embargo, no realizaban evaluación o tratamiento del dolor en el recién nacido de modo sistematizado. Es necesario implantar estrategias de traducción del conocimiento a fin de perfeccionar el manejo del dolor de recién nacidos. Resumo OBJETIVO Verificar o conhecimento e as práticasdos enfermeiros sobreo manejo da dor de recém-nascidos admitidos em Unidades de Tratamento Intensivo Neonatal. MÉTODO Estudo descritivo e transversal. Os dados foram coletados com 51 enfermeiros, a partir de um questionário adaptado que visa avaliar o conhecimento e as práticas sobre o manejo da dor neonatal, em seis hospitais de Curitiba e Região Metropolitana. RESULTADOS Para a maioria dos enfermeiros(86,0%), os neonatos sentem dor. Um total de 34,7% afirmaramnunca utilizar escalas de avaliaçãoda dor. O registro do manejo da dor foi realizado por 84,3% dos enfermeiros. As medidas farmacológicas realizadas foram Paracetamol e Fentanil (47,1%) e Morfina (17,6%);as não farmacológicas adotadas foram solução adocicada (68,6%), sucção não nutritiva (58,8%) e posicionamento (56,9%). CONCLUSÃO Os enfermeiros consideraram a dor neonatal como um evento real, porém não realizavam avaliação ou tratamento da dor no recém-nascido de modosistematizado. É necessário implementarestratégias de tradução do conhecimento paraaprimorar o manejo da dor de recém-nascidos.
47. A comparative assessment of major international disasters: the need for exposure assessment, systematic emergency preparedness, and lifetime health care
- Author
-
Mazitova Nn, Benjamin J. Luft, Jacqueline Moline, Ken Takahashi, Angela a V. Basanets, Andrey Yu Bushmanov, Koji Mori, Denise Harrison, Iris Udasin, Andrew C. Todd, Alexander Stazharau, Sushma Acquilla, Roberto Lucchini, David J. Prezant, Philip J. Landrigan, William Holden, Pier Alberto Bertazzi, Dana Hashim, Michael Crane, Joan Reibman, Paolo Mocarelli, Dori B. Reissman, and James Melius
- Subjects
medicine.medical_specialty ,Bhopal Accidental Release ,Disaster Planning ,010501 environmental sciences ,01 natural sciences ,History, 21st Century ,Risk Assessment ,Disasters ,03 medical and health sciences ,Disaster epidemiology ,Disaster exposure assessment ,Emergency preparedness ,Epidemiological health surveillance ,Major accidents ,Public Health, Environmental and Occupational Health ,0302 clinical medicine ,Environmental health ,Health care ,medicine ,Humans ,030212 general & internal medicine ,0105 earth and related environmental sciences ,Exposure assessment ,Emergency management ,business.industry ,Public health ,lcsh:Public aspects of medicine ,Environmental and Occupational Health ,Civil Defense ,lcsh:RA1-1270 ,Environmental Exposure ,History, 20th Century ,Pennsylvania ,Mental health ,Seveso Accidental Release ,Outreach ,Preparedness ,Population Surveillance ,Needs assessment ,Public Health ,September 11 Terrorist Attacks ,business ,Radioactive Hazard Release ,Research Article - Abstract
Background The disasters at Seveso, Three Mile Island, Bhopal, Chernobyl, the World Trade Center (WTC) and Fukushima had historic health and economic sequelae for large populations of workers, responders and community members. Methods Comparative data from these events were collected to derive indications for future preparedness. Information from the primary sources and a literature review addressed: i) exposure assessment; ii) exposed populations; iii) health surveillance; iv) follow-up and research outputs; v) observed physical and mental health effects; vi) treatment and benefits; and vii) outreach activities. Results Exposure assessment was conducted in Seveso, Chernobyl and Fukushima, although none benefited from a timely or systematic strategy, yielding immediate and sequential measurements after the disaster. Identification of exposed subjects was overall underestimated. Health surveillance, treatment and follow-up research were implemented in Seveso, Chernobyl, Fukushima, and at the WTC, mostly focusing on the workers and responders, and to a lesser extent on residents. Exposure-related physical and mental health consequences were identified, indicating the need for a long-term health care of the affected populations. Fukushima has generated the largest scientific output so far, followed by the WTCHP and Chernobyl. Benefits programs and active outreach figured prominently in only the WTC Health Program. The analysis of these programs yielded the following lessons: 1) Know who was there; 2) Have public health input to the disaster response; 3) Collect health and needs data rapidly; 4) Take care of the affected; 5) Emergency preparedness; 6) Data driven, needs assessment, advocacy. Conclusions Given the long-lasting health consequences of natural and man-made disasters, health surveillance and treatment programs are critical for management of health conditions, and emergency preparedness plans are needed to prevent or minimize the impact of future threats.
- Full Text
- View/download PDF
48. Interventions to support children’s engagement in health-related decisions: a systematic review
- Author
-
Bryan Feenstra, Denise Harrison, Jennifer Kryworuchko, Laura Boland, Michelle Leblanc, Margaret L. Lawson, and Dawn Stacey
- Subjects
Practice ,medicine.medical_specialty ,Adolescent ,business.industry ,Decision Making ,education ,Psychological intervention ,MEDLINE ,Decision quality ,Social Support ,CINAHL ,PsycINFO ,Cochrane Library ,Social support ,Family medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Patient participation ,Pediatrics, Perinatology, and Child Health ,Child ,Psychiatry ,business ,Research Article - Abstract
Background Children often need support in health decision-making. The objective of this study was to review characteristics and effectiveness of interventions that support health decision-making of children. Methods A systematic review. Electronic databases (PubMed, the Cochrane Library, Web of Science, Scopus, ProQuest Dissertations and Theses, CINAHL, PsycINFO, MEDLINE, and EMBASE) were searched from inception until March 2012. Two independent reviewers screened eligibility: a) intervention studies; b) involved supporting children (≤18 years) considering health-related decision(s); and c) measured decision quality or decision-making process outcomes. Data extraction and quality appraisal were conducted by one author and verified by another using a standardized data extraction form. Quality appraisal was based on the Cochrane Risk of Bias tool. Results Of 4313 citations, 5 studies were eligible. Interventions focused on supporting decisions about risk behaviors (n = 3), psycho-educational services (n = 1), and end of life (n = 1). Two of 5 studies had statistically significant findings: i) compared to attention placebo, decision coaching alone increased values congruence between child and parent, and child satisfaction with decision-making process (lower risk of bias); ii) compared to no intervention, a workshop with weekly assignments increased overall decision-making quality (higher risk of bias). Conclusions Few studies have focused on interventions to support children’s participation in decisions about their health. More research is needed to determine effective methods for supporting children’s health decision-making.
- Full Text
- View/download PDF
49. Pilot Study of Sucrose to Reduce Pain in Sick Babies
- Author
-
University of Ottawa and Denise Harrison, Endowed Chair in Nursing Care of Children, Youth and Families
- Published
- 2020
50. Caring for Babies: A Study of Ontario Maternal-Newborn Hospitals on the Implementation of Parent-targeted Education (ONesiE)
- Author
-
Ontario Child Health Support Unit (OCHSU), Better Outcomes Registry & Network Ontario, Dalhousie University, Ottawa Hospital Research Institute, University of Calgary, McGill University, The Hospital for Sick Children, Headwaters Health Care Centre, Champlain Maternal Newborn Regional Program, St Thomas Elgin General Hospital, Baby Friendly Hospital Initiative, and Denise Harrison, Chair in Nursing Care of Children, Youth and Families
- Published
- 2020
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.