150 results on '"Goodwin N"'
Search Results
2. Programme science in action: lessons from an observational study of HIV prevention programming for key populations in Lusaka, Zambia
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Izukanji Sikazwe, Maurice Musheke, Kanema Chiyenu, Benard Ngosa, Jake M. Pry, Chama Mulubwa, Martin Zimba, Martin Sakala, Mphatso Sakala, Paul Somwe, Goodwin Nyirenda, Theodora Savory, Carolyn Bolton‐Moore, and Michael E. Herce
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programme science ,key populations ,HIV prevention ,pre‐exposure prophylaxis ,PrEP ,Zambia ,Immunologic diseases. Allergy ,RC581-607 - Abstract
Abstract Introduction Optimizing uptake of pre‐exposure prophylaxis (PrEP) for individuals at risk of HIV acquisition has been challenging despite clear scientific evidence and normative guidelines, particularly for key populations (KPs) such as men who have sex with men (MSM), female sex workers (FSWs), transgender (TG) people and persons who inject drugs (PWID). Applying an iterative Programme Science cycle, building on the effective programme coverage framework, we describe the approach used by the Centre for Infectious Disease Research in Zambia (CIDRZ) to scale up PrEP delivery and address inequities in PrEP access for KP in Lusaka, Zambia. Methods In 2019, CIDRZ partnered with 10 local KP civil society organizations (CSOs) and the Ministry of Health (MOH) to offer HIV services within KP‐designated community safe spaces. KP CSO partners led KP mobilization, managed safe spaces and delivered peer support; MOH organized clinicians and clinical commodities; and CIDRZ provided technical oversight. In December 2021, we introduced a community‐based intervention focused on PrEP delivery in venues where KP socialize. We collected routine programme data from September 2019 to June 2023 using programme‐specific tools and the national electronic health record. We estimated the before‐after effects of our intervention on PrEP uptake, continuation and equity for KP using descriptive statistics and interrupted time series regression, and used mixed‐effects regression to estimate marginal probabilities of PrEP continuity. Results Most (25,658) of the 38,307 (67.0%) Key Population Investment Fund beneficiaries were reached with HIV prevention services at community‐based venues. In total, 23,527 (61.4%) received HIV testing services, with 15,508 (65.9%) testing HIV negative and found PrEP eligible, and 15,241 (98.3%) initiating PrEP. Across all programme quarters and KP types, PrEP uptake was >90%. After introducing venue‐based PrEP delivery, PrEP uptake (98.7% after vs. 96.5% before, p
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- 2024
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3. Phase 2 of the Norwich COVID-19 testing initiative: an evaluation
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Berger Gillam, T, primary, Chin, J, additional, Cossey, S, additional, Culley, K, additional, Davidson, R K, additional, Edwards, D R, additional, Gharbi, K, additional, Goodwin, N, additional, Hall, N, additional, Hitchcock, M, additional, Jupp, O J, additional, Lipscombe, J, additional, Parr, G, additional, Shearer, N, additional, Smith, R, additional, and Steel, N, additional
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- 2021
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4. The Fourth Dimension of the Quadruple Aim: Empowering the Workforce to Become Partners in Health and Care
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Stein, K. V., primary, Amelung, V. E., additional, Miller, R., additional, and Goodwin, N., additional
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- 2021
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5. Bispectral Index asymmetry and COMFORT score in paediatric intensive care patients
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Froom, S. R., Malan, C. A., Mecklenburgh, J. S., Price, M., Chawathe, M. S., Hall, J. E., and Goodwin, N.
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- 2008
6. Integrated care for frail older people suffering from dementia and multimorbidity
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Nies, Henk, Minkman, Mirella, van Maar, Corine, Amelung, V., Stein, V., Suter, E., Goodwin, N., Nolte, E., Balicer, R., Organization Sciences, Network Institute, Organization & Processes of Organizing in Society (OPOS), Amelung, V., Stein, V., Suter, E., Goodwin, N., Nolte, E., and Balicer, R.
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Gerontology ,business.industry ,Blessing ,SDG 10 - Reduced Inequalities ,medicine.disease ,Integrated care ,Multi morbidity ,Health care ,medicine ,Life expectancy ,Dementia ,business ,Older people ,Health policy - Abstract
Due to improved living conditions and better health care, life expectancy is expanding very rapidly in many countries (Colombo et al., Help wanted? Providing and paying for long-term care, OECD Health Policy Studies, Paris, 2011). Overall, we consider this as a blessing. But this blessing is to some extent ambiguous. Many people also extend their life with years in which they suffer from multiple chronic diseases, such as dementia, disabilities or frailty.In this chapter we will explore avenues to meeting the multiple health challenges for frail older people, in particular people suffering from dementia and multi-morbidity. We will address how integrated care can be organized for these people. We will apply the construct of the socalled Care Standard and build on principles of person centred care and personalized care. Finally, we will discuss how the organisation of integrated care for frail older people suffering from dementia and/or multiple problems may be built up of similar elements. A community approach combined with a whole person’s point of view is also required.
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- 2017
7. Examining perspectives on telecare: factors influencing adoption, implementation, and usage
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Barrett D, Thorpe J, and Goodwin N
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lcsh:Medical technology ,lcsh:R855-855.5 - Abstract
David Barrett,1 Jonathan Thorpe,2 Nick Goodwin3 1Faculty of Health and Social Care, 2Knowledge Exchange, University of Hull, Hull, 3International Foundation for Integrated Care, Oxford, UK Abstract: Telecare, or the use of remote care technologies to support safe and independent living, offers great potential to mitigate the challenges faced in a time of changing demographics. By supporting people to live for longer in their own home, telecare can enhance quality of life, reduce reliance on institutional care settings, and reduce costs. Despite these potential opportunities, the adoption of telecare has not been as fast or widespread as it might have been. This article discusses some of the factors acting as drivers or barriers, which have influenced adoption and impacted on implementation. The implications of the availability of such a wide range of telecare applications is explored; this diversity of choice allows for services to be tailored to the specific needs of users, but also causes a tangled web of terminology that can lead to confusion and lack of clarity. In terms of the evidence base, although evaluations of telecare services often demonstrate a high level of cost benefit and user satisfaction, primary research findings are not as positive. This paper focuses particularly on the Whole System Demonstrator, a large-scale, randomized controlled trial that raised questions about the value and cost-effectiveness of telecare. The paper also discusses the ethical, governance, and resource issues associated with telecare implementation and the organizational complexities inherent in such exciting but challenging changes to services. The policy perspective is also summarized, highlighting how much of the adoption of telecare to date has been influenced by top-down initiatives. Telecare will continue to evolve as our understanding and the technology continue to develop. This paper provides information and advice for commissioners, providers, and practitioners regarding the factors that will shape the future of telecare. Keywords: telecare, barriers and facilitators, perspectives, assisted living, independent living
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- 2014
8. Large-scale gene-centric analysis identifies novel variants for coronary artery disease
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Butterworth, As, Braund, Ps, Farrall, M, Hardwick, Rj, Saleheen, D, Peden, Jf, Soranzo, N, Chambers, Jc, Sivapalaratnam, S, Kleber, Me, Keating, B, Qasim, A, Klopp, N, Erdmann, J, Assimes, Tl, Ball, Sg, Balmforth, Aj, Barnes, Ta, Basart, H, Baumert, J, Bezzina, Cr, Boerwinkle, E, Boehm, Bo, Brocheton, J, Bugert, P, Cambien, F, Clarke, R, Codd, V, Collins, R, Couper, D, Cupples, La, de Jong JS, Diemert, P, Ejebe, K, Elbers, Cc, Elliott, P, Fornage, M, Franzosi, Mg, Frossard, P, Garner, S, Goel, A, Goodall, Ah, Hengstenberg, C, Hunt, Se, Kastelein, Jj, Klungel, Oh, Klüter, H, Koch, K, König, Ir, Kooner, As, Laaksonen, R, Lathrop, M, Li, M, Liu, K, Mcpherson, R, Musameh, Md, Musani, S, Nelson, Cp, O'Donnell, Cj, Ongen, H, Papanicolaou, G, Peters, A, Peters, Bj, Potter, S, Psaty, Bm, Qu, L, Rader, Dj, Rasheed, A, Rice, C, Scott, J, Seedorf, U, Sehmi, Js, Sotoodehnia, N, Stark, K, Stephens, J, van der Schoot CE, van der Schouw YT, Thorsteinsdottir, U, Tomaszewski, M, van der Harst, P, Vasan, Rs, Wilde, Aa, Willenborg, C, Winkelmann, Br, Zaidi, M, Zhang, W, Ziegler, A, de Bakker PI, Koenig, W, Mätz, W, Trip, Md, Reilly, Mp, Kathiresan, S, Schunkert, H, Hamsten, A, Hall, As, Kooner, Js, Thompson, Sg, Thompson, Jr, Deloukas, P, Ouwehand, Wh, Watkins, H, Danesh, J, Samani, Nj, Barnes, T, Rafelt, S, Bruinsma, N, Dekker, Lr, Henriques, Jp, Koch, Kt, de Winter RJ, Alings, M, Allaart, Cf, Gorgels, Ap, Verheugt, Fw, Mueller, M, Meisinger, C, Derohannessian, S, Mehta, Nn, Ferguson, J, Hakonarson, H, Matthai, W, Wilensky, R, Hopewell, Jc, Parish, S, Linksted, P, Notman, J, Gonzalez, H, Young, A, Ostley, T, Munday, A, Goodwin, N, Verdon, V, Shah, S, Cobb, L, Edwards, C, Mathews, C, Gunter, R, Benham, J, Davies, C, Cobb, M, Crowther, J, Richards, A, Silver, M, Tochlin, S, Mozley, S, Clark, S, Radley, M, Kourellias, K, Silveira, A, Söderholm, B, Olsson, P, Barlera, S, Tognoni, G, Rust, S, Assmann, G, Heath, S, Zelenika, D, Gut, I, Green, F, Peden, J, Aly, A, Anner, K, Björklund, K, Blomgren, G, Cederschiöld, B, Danell Toverud, K, Eriksson, P, Grundstedt, U, Heinonen, M, Hellénius, Ml, van't Hooft, F, Husman, K, Lagercrantz, J, Larsson, A, Larsson, M, Mossfeldt, M, Mälarstig, A, Olsson, G, Sabater Lleal, M, Sennblad, B, Strawbridge, R, Öhrvik, J, Zaman, Ks, Mallick, Nh, Azhar, M, Samad, A, Ishaq, M, Shah, N, Samuel, M, Reilly, M, Holm, H, Preuss, M, Stewart, Af, Barbalic, M, Gieger, C, Absher, D, Aherrahrou, Z, Allayee, H, Altshuler, D, Anand, S, Andersen, K, Anderson, Jl, Ardissino, D, Becker, Lc, Becker, Dm, Berger, K, Bis, Jc, Boekholdt, Sm, Brown, Mj, Burnett, Ms, Buysschaert, I, Carlquist, Jf, Chen, L, Davies, Rw, Dedoussis, G, Dehghan, A, Demissie, S, Devaney, J, Do, R, Doering, A, El Mokhtari NE, Ellis, Sg, Elosua, R, Engert, Jc, Epstein, S, de Faire, U, Fischer, M, Folsom, Ar, Freyer, J, Gigante, B, Girelli, D, Gretarsdottir, S, Gudnason, V, Gulcher, Jr, Tennstedt, S, Halperin, E, Hammond, N, Hazen, Sl, Hofman, A, Horne, Bd, Illig, T, Iribarren, C, Jones, Gt, Jukema, Jw, Kaiser, Ma, Kaplan, Lm, Khaw, Kt, Knowles, Jw, Kolovou, G, Kong, A, Lambrechts, D, Leander, K, Lieb, W, Lettre, G, Loley, C, Lotery, Aj, Mannucci, Pm, Maouche, S, Martinelli, Nicola, Mckeown, Pp, Meitinger, T, Melander, O, Merlini, Pa, Mooser, V, Morgan, T, Mühleisen, Tw, Muhlestein, Jb, Musunuru, K, Nahrstaedt, J, Nöthen, Mm, Olivieri, Oliviero, Peyvandi, F, Patel, Rs, Patterson, Cc, Quyyumi, Aa, Rallidis, Ls, Roosendaal, Fr, Rubin, D, Salomaa, V, Sampietro, Ml, Sandhu, Ms, Schadt, E, Schäfer, A, Schillert, A, Schreiber, S, Schrezenmeir, J, Schwartz, Sm, Siscovick, Ds, Sivananthan, M, Smith, Av, Smith, Tb, Snoep, Jd, Spertus, Ja, Stefansson, K, Stirrups, K, Stoll, M, Tang, Wh, Thorgeirsson, G, Thorleifsson, G, Uitterlinden, Ag, van Rij AM, Voight, Bf, Wareham, Nj, Awells, G, Wichmann, He, Witteman, Jc, Wright, Bj, Ye, S, Quertermous, T, März, W, Blankenberg, S, Roberts, R, Onland Moret NC, van Setten, J, Verschuren, Wm, Boer, Jm, Wijmenga, C, Hofker, Mh, Maitland van der Zee AH, de Boer, A, Grobbee, De, Attwood, T, Belz, S, Braund, P, Cooper, J, Crisp Hihn, A, Foad, N, Gracey, J, Gray, E, Gwilliams, R, Heimerl, S, Jolley, J, Krishnan, U, Lloyd Jones, H, Lugauer, I, Lundmark, P, Moore, Js, Muir, D, Murray, E, Neudert, J, Niblett, D, O'Leary, K, Pollard, H, Rankin, A, Rice, Cm, Sager, H, Sambrook, J, Schmitz, G, Scholz, M, Schroeder, L, Syvannen, Ac, Wallace, C., Cardiologie, RS: CAPHRI School for Public Health and Primary Care, Vascular Medicine, Other departments, ACS - Amsterdam Cardiovascular Sciences, Cardiology, Landsteiner Laboratory, Clinical Haematology, Pulmonology, and Medical Research Council (MRC)
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Male ,Cancer Research ,Candidate gene ,Epidemiology ,Genome-wide association study ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cardiovascular ,0302 clinical medicine ,GENETICS & HEREDITY ,Genetics (clinical) ,Genetics ,0303 health sciences ,Cardiovascular diseases [NCEBP 14] ,Middle Aged ,3. Good health ,CYP17A1 ,Genetic Epidemiology ,Genome-wide association ,Myocardial-infarction ,Susceptibility loci ,Risk ,Atherosclerosis ,Metanalysis ,Lipoprotein ,Medicine ,Female ,Life Sciences & Biomedicine ,Research Article ,Asian Continental Ancestry Group ,Adult ,SUSCEPTIBILITY LOCI ,lcsh:QH426-470 ,European Continental Ancestry Group ,Biology ,Polymorphism, Single Nucleotide ,coronary artery disease ,genetics ,White People ,03 medical and health sciences ,SDG 3 - Good Health and Well-being ,Asian People ,Genetic variation ,Humans ,Genetic Predisposition to Disease ,GENOME-WIDE ASSOCIATION ,Allele ,Molecular Biology ,Gene ,METAANALYSIS ,Ecology, Evolution, Behavior and Systematics ,Genetic Association Studies ,Cardiovascular Disease Epidemiology ,Alleles ,030304 developmental biology ,Aged ,0604 Genetics ,Science & Technology ,Case-control study ,Genetic Variation ,Human Genetics ,Odds ratio ,large-scale gene analysis ,lcsh:Genetics ,LIPOPROTEIN ,MYOCARDIAL-INFARCTION ,ATHEROSCLEROSIS ,Case-Control Studies ,Genetics of Disease ,IBC 50K CAD Consortium ,Developmental Biology ,Genome-Wide Association Study - Abstract
Coronary artery disease (CAD) has a significant genetic contribution that is incompletely characterized. To complement genome-wide association (GWA) studies, we conducted a large and systematic candidate gene study of CAD susceptibility, including analysis of many uncommon and functional variants. We examined 49,094 genetic variants in ∼2,100 genes of cardiovascular relevance, using a customised gene array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin). We attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. Potential mechanisms through which the novel variants could affect CAD risk were explored through association tests with vascular risk factors and gene expression. We confirmed associations of several previously known CAD susceptibility loci (eg, 9p21.3:p, Author Summary Coronary artery disease (CAD) has a strong genetic basis that remains poorly characterised. Using a custom-designed array, we tested the association with CAD of almost 50,000 common and low frequency variants in ∼2,000 genes of known or suspected cardiovascular relevance. We genotyped the array in 15,596 CAD cases and 34,992 controls (11,202 cases and 30,733 controls of European descent; 4,394 cases and 4,259 controls of South Asian origin) and attempted to replicate putative novel associations in an additional 17,121 CAD cases and 40,473 controls. We report the novel association of variants in or near four genes with CAD and in additional studies identify potential mechanisms by which some of these novel variants affect CAD risk. Interestingly, we found that these variants, as well as the majority of previously reported CAD variants, have similar associations in Europeans and South Asians. Contrary to prior expectations, many previously suggested candidate genes did not show evidence of any effect on CAD risk, and neither did we identify any novel low frequency alleles with strong effects amongst the genes tested. Discovery of novel genes associated with heart disease may help to further understand the aetiology of cardiovascular disease and identify new targets for therapeutic interventions.
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- 2016
9. Genetic background influences susceptibility to chemotherapy-induced hematotoxicity
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Gatti, D M, primary, Weber, S N, additional, Goodwin, N C, additional, Lammert, F, additional, and Churchill, G A, additional
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- 2017
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10. OPERATIONAL APPLICATION OF THE LANDSAT TIMESERIES TO ADDRESS LARGE AREA LANDCOVER UNDERSTANDING
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Scarth, P., primary, Armston, J., additional, Flood, N., additional, Denham, R., additional, Collett, L., additional, Watson, F., additional, Trevithick, B., additional, Muir, J., additional, Goodwin, N., additional, Tindall, D., additional, and Phinn, S., additional
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- 2015
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11. Abstract IA20: Linking tumor genomics to patient outcomes through a large-scale patient-derived xenograft (PDX) platform.
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Gandara, David R., primary, Li, T., additional, Lara, P.N., additional, Kelly, K., additional, Cooke, D.T., additional, Gandour-Edwards, R., additional, Yoneda, K., additional, Goodwin, N., additional, Kuslak-Meyer, S., additional, and Mack, P., additional
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- 2014
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12. Genetic background influences susceptibility to chemotherapy-induced hematotoxicity
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Gatti, D M, Weber, S N, Goodwin, N C, Lammert, F, and Churchill, G A
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Hematotoxicity is a life-threatening side effect of many chemotherapy regimens. Although clinical factors influence patient responses, genetic factors may also play an important role. We sought to identify genomic loci that influence chemotherapy-induced hematotoxicity by dosing Diversity Outbred mice with one of three chemotherapy drugs; doxorubicin, cyclophosphamide or docetaxel. We observed that each drug had a distinct effect on both the changes in blood cell subpopulations and the underlying genetic architecture of hematotoxicity. For doxorubicin, we mapped the change in cell counts before and after dosing and found that alleles of ATP-binding cassette B1B (Abcb1b) on chromosome 5 influence all cell populations. For cyclophosphamide and docetaxel, we found that each cell population was influenced by distinct loci, none of which overlapped between drugs. These results suggest that susceptibility to chemotherapy-induced hematotoxicity is influenced by different genes for different chemotherapy drugs.
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- 2018
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13. Midhurst Macmillan community specialist palliative care service delivering end-of-life care in the community
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Goodwin, N., primary, Sonola, L., additional, and Thiel, V., additional
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- 2013
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14. Developing primary care in the new NHS: lessons from total purchasing
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Bevan, Gwyn, Wyke, S., Mays, N., Abbot, S., Goodwin, N., Kilorran, A., Malbon, G., McLeod, H., Posnett, J., Raftery, J., and Robinson, R.
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RA1001 Forensic Medicine. Medical jurisprudence. Legal medicine - Published
- 1999
15. Phase 2 of the Norwich COVID-19 testing initiative: an evaluation.
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Gillam, T Berger, Chin, J, Cossey, S, Culley, K, Davidson, R K, Edwards, D R, Gharbi, K, Goodwin, N, Hall, N, Hitchcock, M, Jupp, O J, Lipscombe, J, Parr, G, Shearer, N, Smith, R, and Steel, N
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COVID-19 ,VIRAL load ,SOCIAL isolation ,COVID-19 testing ,POLYMERASE chain reaction - Abstract
The article presents the discussion on determining uptake of testing and positivity rates by user characteristics and location for assessing compliance with isolation and links between viral load and symptoms.
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- 2021
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16. Legalization of all drugs
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Goodwin, N
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Canada ,Letter ,Illicit Drugs ,Drug and Narcotic Control ,Humans - Published
- 1993
17. Violence: a challenge to the public health community
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Walker, B., Goodwin, N. J., and Warren, R. C.
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Black or African American ,Adolescent ,Social Problems ,Prisons ,Humans ,Community Health Services ,Public Health ,Violence ,Child ,United States ,Research Article - Abstract
In the past 2 years, cities have reported skyrocketing rates of violence, crime, and abusive behavior including intrafamilial homicides. Of the 1838 homicide deaths last year among teenagers between the ages of 15 and 19, 71% involved the use of a firearm. Among black males in the same age group, 82% of the deaths were associated with guns. Since 1968, homicide has been among the leading causes of death for black teenagers. These and large volumes of other data clearly indicate that violence and abusive behavior is a compelling public health problem.
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- 1992
18. OPERATIONAL APPLICATION OF THE LANDSAT TIMESERIES TO ADDRESS LARGE AREA LANDCOVER UNDERSTANDING.
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Watson, F., Trevithick, B., Goodwin, N., Tindall, D., Scarth, P., Armston, J., Flood, N., Denham, R., Collett, L., Muir, J., and Phinn, S.
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LANDSAT satellites ,BIG data - Abstract
State Government agencies in northern and eastern Australia and the University of Queensland, Brisbane, have been collaborating through the Joint Remote Sensing Research Program (JRSRP). This has resulted in a significant acceleration in the development and successful operational application of remote sensing methods for the JRSRP members and the various state and national programs and policies which they support. The JRSRP provides an open and collaborative mechanism and governance structure to successfully bring together a unique combination of expertise in image processing, field data collection, and data integration approaches to deliver accurate, repeatable and robust methods for mapping and monitoring Australia's unique ecosystems. Remote sensing provides spatially- and temporally-comprehensive information about land cover features at a range of scales and often for minimal cost compared to traditional mapping and monitoring approaches. This makes remote sensing a very useful operational mapping and monitoring tool for land managers, particularly in the vast rangelands of Australia. This paper outlines recent developments in remote sensing and modelling products that are being used operationally by JRSRP members to address large area landcover understanding. [ABSTRACT FROM AUTHOR]
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- 2015
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19. Evolutionary transitions in parental care and live bearing in vertebrates
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Reynolds, J. D., primary, Goodwin, N. B., additional, and Freckleton, R. P., additional
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- 2002
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20. Evaluation of total purchasing pilots in England and Scotland and implications for primary care groups in England: personal interviews and analysis of routine data
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Goodwin, N., primary, Mays, N., additional, McLeod, H., additional, Malbon, G., additional, and Raftery, J., additional
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- 1998
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21. What is total purchasing?
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Mays, N., primary, Goodwin, N., additional, Bevan, G., additional, and Wyke, S., additional
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- 1997
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22. Making the internal market work
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Goodwin, N, primary
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- 1994
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23. Productivity in clinical medicine.
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Goodwin, N, primary
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- 1993
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24. Voting on trust status for St Mary's Hospital, London
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Goodwin, N. J, primary
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- 1992
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25. Feelings to watch out for on the brink of love or success.
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Goodwin, N.
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EMOTIONS - Abstract
Outlines advice to women to conquer those unsettling feelings about love or success. Anxiety; Disappointment and disillusionment; Emptiness; Fear; Guilt; Anger; Loneliness.
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- 1990
26. Role of a modified ovitrap in the control of Aedes aegypti in Houston, Texas, USA
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Cheng, Min-Lee, Ho, Beng-Chuan, Bartnett, R. E., and Goodwin, N.
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Dengue ,Mosquito Control ,Aedes ,Research ,Oviposition ,Animals ,Humans ,Female ,Texas - Abstract
A modified ovitrap from which larvae could not escape was employed for one year for the control of Aedes aegypti at Blossom Heights, Houston, Texas. At the end of this period, the Breteau index in the ovitrap area had declined by 36%, in contrast to a sharp increase of nearly 500% in the non-ovitrap area. The premises index in the ovitrap area remained unchanged, while the index in the non-ovitrap area increased by 440%. The problems associated with this control campaign and the use of these "autocidal" ovitraps are discussed.Annual fluctuations in the egg populations of A. aegypti and A. triseriatus were studied by weekly collections of eggs from the ovitrap paddles. The weekly fluctuations of egg numbers, the percentage of ovitraps with eggs of Aedes mosquitos, as well as the ovitrap premises index (i.e., percentage of premises with at least one ovitrap positive) all exhibited a similar fluctuation pattern, with a distinct peak extending from June to October.
- Published
- 1982
27. CCD-driven liquid-crystal spatial light modulators.
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Grinberg, J., Braatz, P., Efron, U., Goodwin, N., Little, M., Nash, G., and Flannery, D.
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- 1981
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28. Asking the right questions: Scoping studies in the commissioning of research on the organisation and delivery of health services
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Peckham Stephen, Allen Pauline, Anderson Stuart, and Goodwin Nick
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Scoping studies have been used across a range of disciplines for a wide variety of purposes. However, their value is increasingly limited by a lack of definition and clarity of purpose. The UK's Service Delivery and Organisation Research Programme (SDO) has extensive experience of commissioning and using such studies; twenty four have now been completed. This review article has four objectives; to describe the nature of the scoping studies that have been commissioned by the SDO Programme; to consider the impact of and uses made of such studies; to provide definitions for the different elements that may constitute a scoping study; and to describe the lessons learnt by the SDO Programme in commissioning scoping studies. Scoping studies are imprecisely defined but usually consist of one or more discrete components; most commonly they are non-systematic reviews of the literature, but other important elements are literature mapping, conceptual mapping and policy mapping. Some scoping studies also involve consultations with stakeholders including the end users of research. Scoping studies have been used for a wide variety of purposes, although a common feature is to identify questions and topics for future research. The reports of scoping studies often have an impact that extends beyond informing research commissioners about future research areas; some have been published in peer reviewed journals, and others have been published in research summaries aimed at a broader audience of health service managers and policymakers. Key lessons from the SDO experience are the need to relate scoping studies to a particular health service context; the need for scoping teams to be multi-disciplinary and to be given enough time to integrate diverse findings; and the need for the research commissioners to be explicit not only about the aims of scoping studies but also about their intended uses. This necessitates regular contact between researchers and commissioners. Scoping studies are an essential element in the portfolio of approaches to research, particularly as a mechanism for helping research commissioners and policy makers to ask the right questions. Their utility will be further enhanced by greater recognition of the individual components, definitions for which are provided.
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- 2008
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29. Diagnostic delays and referral management schemes: how 'integrated' primary care might damage your health.
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Goodwin N
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- 2008
30. Integrated care and the management of chronic illness: reflections on the proceedings of the 8th Annual Integrated Care Conference 2008.
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Goodwin N, Kodner D, Smith J, and Manten E
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- 2008
31. What strategies influence general practitioners to deliver public health programmes? : an example using the National Chlamydia Screening Programme
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Ma, R., Allen, P., and Goodwin, N.
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362.1 - Abstract
General practitioners (GPs) have a role in improving population health through health promotion and disease prevention (HPDP) activities such as immunisations, screening, and lifestyle advice. However, GPs must also respond to the patient’s agenda in a consultation. With limited time in a consultation, it might be difficult for GPs to prioritise HPDP with their patients. My thesis aimed to offer insights into the behavioural determinants of GPs to deliver HPDP. I considered behaviour theories such as Ajzen’s Theory of Planned Behaviour (TPB) to help understand clinician behaviour and how they could be applied to influence their behaviour to deliver HPDP programmes. I conducted an overview of systematic reviews to examine impact of behavioural interventions, directed at GPs, to improve health of their patients. The overview suggested there is insufficient evidence for any type of intervention to be consistently effective in influencing GPs behaviour. The National Chlamydia Screening Programme aims to detect and treat chlamydia infection in young people. Primary Care Trusts used different behaviour interventions to encourage GPs to deliver screening. I interviewed GPs and practice nurses (PNs) in London about their experiences of delivering chlamydia screening and the behavioural interventions, such as those discussed in systematic reviews, to influence their behaviour to deliver other public health programmes. The interview data suggested the constructs of TPB - behavioural beliefs, normative beliefs, and control beliefs – could be used as a conceptual framework to explain why these primary care clinicians might deliver public health care. Strategies used to implement public health programmes need to consider how primary care clinicians might respond to the different constructs of TPB. In addition, organisational factors such as contracts and financial incentives, and perception of intrusion into the patient’s agenda need to be managed carefully as they could either facilitate or impede delivery of public health programmes.
- Published
- 2017
- Full Text
- View/download PDF
32. The challenge of assessing the performance of multilateral development agencies : lessons for WHO programmes in Myanmar and Nepal
- Author
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Santamaria Hergueta, Maria José, Goodwin, N., and Sondorp, E.
- Subjects
362.1 - Abstract
Development organisations have moved from reporting on 'what they do' to addressing 'what difference they make' in an environment that forces them to compete for resources. Thus, measuring their effectiveness has evolved from accountability reporting to results enquiries and to evaluation of the impact of interventions at the end user's level. To adapt to these changes, most development organizations and donors have adhered to results based management and use logical framework approaches for their operations. These approaches and systems have recognised usefulness in project planning, although their utility in project monitoring and organizational performance assessment is more contested. The analysis of recent experiences calls for alternative approaches to assessing performance to improve the effectiveness of development and technical organisations at the country level. This research explores the use of logframes to assess the programmatic performance in a multilateral organization at country level, in the context of an increased focus on results based management. It uses a qualitative methodology to a) assess the comparative advantages and challenges of various assessment tools and systems that WHO uses to measure its performance in EPR in Myanmar and in Nepal; b) address the WHO contribution in terms of results and impact in the area studied; and c) propose options for addressing WHO accountability performance and cooperation effectiveness in EPR at country level. The two case studies uncover the importance of contextual factors, and stakeholders' perceptions and intemctions. They further highlight the role that organisational setting and team profile play in using systems and tools to measure progmmmatic performance. Logframes proved useful for planning and financial accountability, although they confronted major difficulties when assessing the core contribution of the teams to the programme achievements and stakeholders' expectations. The research contributes to the understanding of how routine performance assessment systems work in practice. The comparison of the findings in the two countries raises institutional issues and offers the possibility for organizational learning. Finally, the research proposes alternative options that WHO may adopt to measure its programmatic performance in countries.
- Published
- 2009
- Full Text
- View/download PDF
33. What strategies influence general practitioners to deliver public health programmes? An example using the National Chlamydia Screening Programme
- Author
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Ma, R, Allen, P, and Goodwin, N
- Abstract
General practitioners (GPs) have a role in improving population health through health promotion and disease prevention (HPDP) activities such as immunisations, screening, and lifestyle advice. However, GPs must also respond to the patient’s agenda in a consultation. With limited time in a consultation, it might be difficult for GPs to prioritise HPDP with their patients. My thesis aimed to offer insights into the behavioural determinants of GPs to deliver HPDP.\ud I considered behaviour theories such as Ajzen’s Theory of Planned Behaviour (TPB) to help understand clinician behaviour and how they could be applied to influence their behaviour to deliver HPDP programmes. I conducted an overview of systematic reviews to examine impact of behavioural interventions, directed at GPs, to improve health of their patients. The overview suggested there is insufficient evidence for any type of intervention to be consistently effective in influencing GPs behaviour.\ud The National Chlamydia Screening Programme aims to detect and treat chlamydia infection in young people. Primary Care Trusts used different behaviour interventions to encourage GPs to deliver screening. I interviewed GPs and practice nurses (PNs) in London about their experiences of delivering chlamydia screening and the behavioural interventions, such as those discussed in systematic reviews, to influence their behaviour to deliver other public health programmes.\ud The interview data suggested the constructs of TPB - behavioural beliefs, normative beliefs, and control beliefs – could be used as a conceptual framework to explain why these primary care clinicians might deliver public health care.\ud Strategies used to implement public health programmes need to consider how primary care clinicians might respond to the different constructs of TPB. In addition, organisational factors such as contracts and financial incentives, and perception of intrusion into the patient’s agenda need to be managed carefully as they could either facilitate or impede delivery of public health programmes.
- Published
- 2018
- Full Text
- View/download PDF
34. The Core Dimensions of Integrated Care: A Literature Review to Support the Development of a Comprehensive Framework for Implementing Integrated Care
- Author
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Stefano Calciolari, Nick Goodwin, Laura G. González-Ortiz, Viktoria Stein, Gonzalez-Ortiz, L, Calciolari, S, Goodwin, N, and Stein, V
- Subjects
Health (social science) ,Knowledge management ,Sociology and Political Science ,literature review ,Computer science ,Field (computer science) ,03 medical and health sciences ,0302 clinical medicine ,framework ,benchmarking ,chronic conditions ,implementation science ,integrated care ,030212 general & internal medicine ,Set (psychology) ,Chronic condition ,lcsh:R5-920 ,Data collection ,Research and Theory ,business.industry ,030503 health policy & services ,Health Policy ,Benchmarking ,Grey literature ,3. Good health ,Integrated care ,Identification (information) ,Key (cryptography) ,literature review ,lcsh:Medicine (General) ,0305 other medical science ,business - Abstract
Objective: As part of the EU-funded Project INTEGRATE, the research sought to develop an evidence-based understanding of the key dimensions and items of integrated care associated with successful implementation across varying country contexts and relevant to different chronic and/or long-term conditions. This paper identifies the core dimensions of integrated care based on a review of previous literature on the topic. Methodology: The research reviewed literature evidence from the peer-reviewed and grey literature. It focused on reviewing research articles that had specifically developed frameworks on integrated care and/or set out key elements for successful implementation. The search initially focused on three main scientific journals and was limited to the period from 2006 to 2016. Then, the research snowballed the references from the selected published studies and engaged leading experts in the field to supplement the identification of relevant literature. Two investigators independently reviewed the selected articles using a standard data collection tool to gather the key elements analyzed in each article. Results: A total of 710 articles were screened by title and abstract. Finally, 18 scientific contributions were selected, including studies from grey literature and experts’ suggestions. The analysis identified 175 items grouped in 12 categories. Conclusions: Most of the key factors reported in the literature derive from studies that developed their frameworks in specific contexts and/or for specific types of conditions. The identification and classification of the elements from this literature review provide a basis to develop a comprehensive framework enabling standardized descriptions and benchmarking of integrated care initiatives carried out in different contexts.
- Published
- 2018
35. Great expectations: The implementation of integrated care and its contribution to improved outcomes for people with chronic conditions
- Author
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Busetto, Loraine, Vrijhoef, H.J.M., Luijkx, Katrien, Borgermans, L., Baan, C.A., Schaper, N.C., Wensing, M.J.P., Goodwin, N., and Tranzo, Scientific center for care and wellbeing
- Subjects
education ,information science ,natural sciences - Published
- 2016
36. Rainbow of chaos: A study into the theory and practice of integrated primary care
- Author
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Valentijn, Pim, Vrijhoef, H.J.M., Ruwaard, D., Bruijnzeels, M.A., Meurs, P.L., Nies, H.L.G.R., de Maeseneer, J., de Bakker, D.H., Goodwin, N., and Tranzo, Scientific center for care and wellbeing
- Subjects
ComputingMilieux_LEGALASPECTSOFCOMPUTING - Published
- 2015
37. Hyoid movements measured using three-dimensional motion analysis.
- Author
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Roberts, M., Curtis, E., Mani, M., Goodwin, N., Wilkes, A. R., Zatman, T., and Holt, C.
- Abstract
The act of laryngoscopy is complex and dynamic. A recently proposed model for direct laryngoscopy stated that as well as upper airway axes alignment, a feature that may be important, include the position and movement of the hyoid. Optical motion analysis systems have been widely used in biomechanics for measuring movements, including measuring mandibular kinematics after orthognathic surgical treatment. We aim to assess the use of this technique in measuring the movement of the hyoid. Twenty-five healthy volunteers were recruited. Reflective markers were placed bilaterally over the temperomandibular joints, mastoids, and angle of mandible and over the cricoid, hyoid, and mentum. Five infrared cameras and one video camera were used to capture the position of these markers while the volunteers made three movements-maximum mouth opening, mouth opening and protruding the tongue (Mallampati), and protruding the lower jaw. A three-dimensional motion capture system (Qualysis) was used to measure the distances between the mastoid and hyoid markers at a frequency of 60 Hz. The mastoids were used as fixed points against which the movement of the hyoid could be compared. The maximum and minimum distances between the markers during the three movements was found and the difference calculated to give the maximum lateral (X), horizontal (Y), and vertical (Z) movement of the hyoid relative to the mastoids. Thirteen males and 12 females between the ages of 21 and 61 were studied (median 34 yr). BMI ranged from 19 to 38 (median 25). All were predicted to be easy intubations on clinical examination. The maximum movement of the hyoid marker relative to the mastoid marker in the lateral (X), horizontal (Y), and vertical (Z) planes during the three movements are shown in Table 3. Values have been averaged bilaterally. The lateral (X) movement is likely to be due to the head and neck movement and soft tissue artifact. During mouth opening and Mallampati, the hyoid moved in towards the mastoids (Y) and down (Z). During jaw thrust, the hyoid moved out and up. This pilot study has demonstrated a wide range of hyoid movement. Whether these measurements accurately represent those of the hyoid bone depends on the degree of skin motion artifact, which is difficult to determine at this point. Further studies are needed to assess the accuracy of this device in this setting. Eventually, we aim to assess the movement of the laryngeal structures in the anaesthetized patient during laryngoscopy. [ABSTRACT FROM AUTHOR]
- Published
- 2010
38. A randomized, cross-over study comparing the LMA Supreme™ with the LMA Proseal™ in non-paralysed anaesthetized patients.
- Author
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Roberts, M., Mani, M., Wilkes, A. R., and Goodwin, N.
- Abstract
The LMA Supreme is a new disposable supraglottic airway device which claims to combine the advantages of the conventional LMA ProSeal (gastric tube, high seal cuff pressure, and bite block) with the fixed curved tube of the LMA Fastrach, which facilitates insertion. Its insertion success rate in paralysed, anaesthetized patients has been shown to be similar to that of the LMA ProSeal. In this randomized, cross-over study, we compared the LMA Supreme and LMA ProSeal with respect to first-time and overall success rate of insertion, oropharyngeal leak pressures, time to insertion, and fibreoptically determined laryngeal view in unparalysed adult patients undergoing general anaesthesia. Fifty ASA I-II patients were randomized to receive either the LMA Proseal or the LMA Supreme as the initial airway. I.V. induction consisted of fentanyl 1 µg kg-1 and propofol 2-5 mg kg-1 followed by sevoflurane 8%. Number of attempts at insertion, time to insertion, fibreoptic positioning, and the oropharyngeal leak pressure of the first device were recorded before the process was repeated with the second LMA. The primary outcome was the success rate for insertion on the first attempt. This was a non-inferiority study design, aiming to demonstrate that the first-time insertion rate with the LMA Supreme is no more than 15% less than that for the LMA ProSeal using a 95% confidence interval (CI). The secondary outcomes were overall success rate, insertion time, oropharyngeal leak pressure, and fibreoptic position. Twenty-nine males and 21 females were recruited. First-time insertion success rates of the LMA Supreme and LMA ProSeal were 88% and 94% (Table 4). The 95% CI was 219 to 7% for the difference in first-time insertion success of 26%. Overall success rates were 96% and 98%, respectively. The mean leak pressure was greater with the LMA ProSeal (26 cm H2O) compared with the LMA Supreme (22 cm H2O) (P=0.005). The mean time to insertion for the LMA ProSeal and LMA Supreme were 26 and 23 s, respectively (P= 0.198). The fibreoptic view obtained was equal with the two devices on 28 occasions, better with the LMA ProSeal on 13 occasions and better with the LMA Supreme on six occasions (P=0.086). The lower limit of the 95% CI for the difference in first-time success (219%) is greater in magnitude than the 215% limit chosen to indicate non-inferiority, suggesting inferiority of the LMA Supreme™. However, the true difference may also lie at 0% (non-inferiority). Therefore, we cannot conclude that the LMA Supreme™ is non-inferior to the LMA ProSeal™ in terms of the first time insertion success rate in our population of nonparalysed patients. [ABSTRACT FROM AUTHOR]
- Published
- 2010
39. The challenge of assessing the performance of multilateral development agencies: lessons for WHO programmes in Myanmar and Nepal
- Author
-
Santamaria Hergueta, MJ, Goodwin, N, and Sondorp, E
- Abstract
Development organisations have moved from reporting on 'what they do' to addressing 'what difference they make' in an environment that forces them to compete for resources. Thus, measuring their effectiveness has evolved from accountability reporting to results enquiries and to evaluation of the impact of interventions at the end user's level. To adapt to these changes, most development organizations and donors have adhered to results based management and use logical framework approaches for their operations. These approaches and systems have recognised usefulness in project planning, although their utility in project monitoring and organizational performance assessment is more contested. The analysis of recent experiences calls for alternative approaches to assessing performance to improve the effectiveness of development and technical organisations at the country level. This research explores the use of logframes to assess the programmatic performance in a multilateral organization at country level, in the context of an increased focus on results based management. It uses a qualitative methodology to a) assess the comparative advantages and challenges of various assessment tools and systems that WHO uses to measure its performance in EPR in Myanmar and in Nepal; b) address the WHO contribution in terms of results and impact in the area studied; and c) propose options for addressing WHO accountability performance and cooperation effectiveness in EPR at country level. The two case studies uncover the importance of contextual factors, and stakeholders' perceptions and intemctions. They further highlight the role that organisational setting and team profile play in using systems and tools to measure progmmmatic performance. Logframes proved useful for planning and financial accountability, although they confronted major difficulties when assessing the core contribution of the teams to the programme achievements and stakeholders' expectations. The research contributes to the understanding of how routine performance assessment systems work in practice. The comparison of the findings in the two countries raises institutional issues and offers the possibility for organizational learning. Finally, the research proposes alternative options that WHO may adopt to measure its programmatic performance in countries.
40. Assessing the Strengths and Weaknesses for Implementing a Place-Based Model of Care for Older People on the Central Coast, Australia: Results of a Pilot Project Using the Population Health Management Maturity Index (PHM-MI) Tool.
- Author
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van Ede AFTM, Goodwin N, Bruijnzeels MA, and Stein KV
- Abstract
Introduction: Population health management is increasingly being used to support place-based models of care. This case study provides an account of the use of the Population Health Management - Maturity Index (PHM-MI) tool to inform the future development of a neighbourhood model of care for older people in the Central Coast region of Australia., Description: The PHM-MI tool comprises a set of six evidence-informed elements known to be important in enabling PHM in practice. As part of a joint strategic needs assessment, 17 selected stakeholders from key regional organizations were invited to undertake the PHM-MI tool survey. Three follow-up workshops were held to interpret the results and determine priority actions., Discussion: The PHM-MI scores revealed that the overall maturity of the Central Coast to successfully deliver PHM was low across all six elements, findings that were corroborated through participant workshops. Systemic fragmentations, most pertinently of funding and regulation, incentivised silo-based working. The need to formalise and strengthen regional collaborations, enable data integration, find creative ways to use existing funding streams, and promote community engagement were highlighted as core priorities., Conclusion: Using the PHM-MI tool was enabled by it being embedded within a pre-existing regional strategic process. The results were used to inform future regional priorities. The PHM-MI tool has the potential for use across regional or national contexts., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
41. Feasibility of gamified visual desensitisation for visually-induced dizziness.
- Author
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Goodwin N, Powell G, Loizides F, Derry-Sumner H, Rajenderkumar D, and Sumner P
- Subjects
- Humans, Male, Female, Adult, Vertigo therapy, Vertigo rehabilitation, Middle Aged, Young Adult, Dizziness rehabilitation, Dizziness therapy, Feasibility Studies, Video Games
- Abstract
Visually-induced dizziness (visual vertigo) is a core symptom of Persistent Perceptual Postural Dizziness (PPPD) and occurs in other conditions and general populations. It is difficult to treat and lacks new treatments and research. We incorporated the existing rehabilitation approach of visual desensitisation into an online game environment to enhance control over visual motion and complexity. We report a mixed-methods feasibility trial assessing: Usage and adherence; rehabilitation potential; system usability and enjoyment; relationship with daily dizziness. Participants played online with (intervention, N = 37) or without (control, N = 39) the visual desensitisation component for up to 5-10 min, twice daily for 6 weeks. Dropout was 45%. In the intervention group, N = 17 played for the recommended time while N = 20 played less. Decreases in visual vertigo symptoms, anxiety and depression correlated with playtime for the intervention but not control. System usability was high. Daily symptoms predicted playtime. Qualitative responses broadly supported the gamified approach. The data suggest gamified visual desensitisation is accessible, acceptable and, if adherence challenges can be overcome, could become a useful addition to rehabilitation schedules for visually-induced dizziness and associated anxiety. Further trials are needed., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
42. Women's participation in household decision-making: Qualitative findings from the Shonjibon Trial in rural Bangladesh.
- Author
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Kirkwood EK, Khan J, Hasan MM, Iqbal A, Tahsina T, Huda T, Hoddinott JF, Laba TL, Muthayya S, Goodwin N, Islam M, Kingsley EA, Arifeen SE, Dibley MJ, and Alam NA
- Abstract
A key element of women's empowerment is the ability to participate in household decision-making. This study presents the qualitative results from the Shonjibon Cash and Counselling Trial baseline process evaluation with the aim of exploring the status of women's decision-making at the trial's outset and to facilitate the exploration of any changes in women's empowerment over the course of the trial. Between January and March 2021, we conducted forty-one in-depth interviews with pregnant women in rural Bangladesh. The research team translated, transcribed, coded, and discussed the interviews. We used thematic analysis to examine women's experience and perceptions on household decision-making. The key findings that emerged; women jointly participated in financial decision-making with their husbands; men made the final decision regarding seeking healthcare, and women solely made choices regarding infant and young child feeding. Our findings revealed that women felt that they needed to discuss their plans to go outside the house with their husbands, many perceived a lack of importance in the community towards women's participation in decision-making. This study documents current contextual information on the status of women's involvement in household decision-making and intrahousehold power dynamics at the start of the Shonjibon Cash and Counselling Trial., Competing Interests: The authors report there are no competing interests to declare., (Copyright: © 2024 Kirkwood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2024
- Full Text
- View/download PDF
43. Debriefer cognitive load during Traditional Reflective Debriefing vs. Rapid Cycle Deliberate Practice interdisciplinary team training.
- Author
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Wiltrakis S, Hwu R, Holmes S, Iyer S, Goodwin N, Mathai C, Gillespie S, Hebbar KB, and Colman N
- Abstract
Background: Cognitive load impacts performance of debriefers and learners during simulations, but limited data exists examining debriefer cognitive load. The aim of this study is to compare the cognitive load of the debriefers during simulation-based team training (SbTT) with Rapid Cycle Deliberate Practice (RCDP) debriefing and Traditional Reflective Debriefing (TRD). We hypothesize that cognitive load will be reduced during RCDP compared to TRD., Methods: This study was part of a large-scale, interdisciplinary team training program at Children's Healthcare of Atlanta Egleston Pediatric Emergency Department, with 164 learners (physicians, nurses, medical technicians, paramedics, and respiratory therapists (RTs)). Eight debriefers (main facilitators and discipline-specific coaches) led 28 workshops, which were quasi-randomized to either RCDP or TRD. Each session began with a baseline medical resuscitation scenario and cognitive load measurement using the NASA Task Load Index (TLX), and the NASA TLX was repeated immediately following either TRD or RCDP debriefing. Raw scores of the NASA TLX before and after intervention were compared. ANOVA tests were used to compare differences in NASA TLX scores before and after intervention between the RCDP and TRD groups., Results: For all debriefers, mean NASA TLX scores for physical demands and frustration significantly decreased (- 0.8, p = 0.004 and - 1.3, p = 0.002) in TRD and mean perceived performance success significantly increased (+ 2.4, p < 0.001). For RCDP, perceived performance success increased post-debriefing (+ 3.6, p < 0.001), time demands decreased (- 1.0, p = 0.04), and frustration decreased (- 2.0, p < 0.001). Comparing TRD directly to RCDP, perceived performance success was greater in RCDP than TRD (3.6 vs. 2.4, p = 0.04). Main facilitators had lower effort and mental demand in RCDP and greater perceived success (p < 0.001)., Conclusion: RCDP had greater perceived success than TRD for debriefers. Main facilitators also report reduced effort and baseline mental demand in RCDP. For less experienced debriefers, newer simulation programs, or large team training sessions such as our study, RCDP may be a less mentally demanding debriefing methodology for facilitators., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
44. Deep learning to predict rapid progression of Alzheimer's disease from pooled clinical trials: A retrospective study.
- Author
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Ma X, Shyer M, Harris K, Wang D, Hsu YC, Farrell C, Goodwin N, Anjum S, Bukhbinder AS, Dean S, Khan T, Hunter D, Schulz PE, Jiang X, and Kim Y
- Abstract
The rate of progression of Alzheimer's disease (AD) differs dramatically between patients. Identifying the most is critical because when their numbers differ between treated and control groups, it distorts the outcome, making it impossible to tell whether the treatment was beneficial. Much recent effort, then, has gone into identifying RPs. We pooled de-identified placebo-arm data of three randomized controlled trials (RCTs), EXPEDITION, EXPEDITION 2, and EXPEDITION 3, provided by Eli Lilly and Company. After processing, the data included 1603 mild-to-moderate AD patients with 80 weeks of longitudinal observations on neurocognitive health, brain volumes, and amyloid-beta (Aβ) levels. RPs were defined by changes in four neurocognitive/functional health measures. We built deep learning models using recurrent neural networks with attention mechanisms to predict RPs by week 80 based on varying observation periods from baseline (e.g., 12, 28 weeks). Feature importance scores for RP prediction were computed and temporal feature trajectories were compared between RPs and non-RPs. Our evaluation and analysis focused on models trained with 28 weeks of observation. The models achieved robust internal validation area under the receiver operating characteristic (AUROCs) ranging from 0.80 (95% CI 0.79-0.82) to 0.82 (0.81-0.83), and the area under the precision-recall curve (AUPRCs) from 0.34 (0.32-0.36) to 0.46 (0.44-0.49). External validation AUROCs ranged from 0.75 (0.70-0.81) to 0.83 (0.82-0.84) and AUPRCs from 0.27 (0.25-0.29) to 0.45 (0.43-0.48). Aβ plasma levels, regional brain volumetry, and neurocognitive health emerged as important factors for the model prediction. In addition, the trajectories were stratified between predicted RPs and non-RPs based on factors such as ventricular volumes and neurocognitive domains. Our findings will greatly aid clinical trialists in designing tests for new medications, representing a key step toward identifying effective new AD therapies., Competing Interests: PS is funded by the McCord Family Professorship in Neurology, the Umphrey Family Professorship in Neurodegenerative Disorders, multiple NIH grants and several foundation grants (1R01AG080137-01A1, 1RF1AG072491-01, 1R03AG077191-01, 1U01AG079847-01A1, 5R01AG66749-03, 1R01AG083039-01, 5R01AG067498-03, 1RF1AG055053-0A1, 1R01AG062690-01, 1R01AG059321-01A1, 1R01DE07027, 1R01AG082721-01, 2124789, AGT002985, AGT008724, AGT009122), and contracts with multiple pharmaceutical companies related to the performance of clinical trials (ALZ-80-AD301-AGT005383, AGT004414, AGT003423, AGT003882, AGT006620, AGT005768, AGT004564, AGT009188, AGT006056, AGT006764, AGT008197, AGT010139, AGT011949). He serves as a consultant and speaker for Eli Lilly, and Acadia Pharmaceuticals. No other authors have declarations to disclose., (Copyright: © 2024 Ma et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2024
- Full Text
- View/download PDF
45. Integrated Care in Epilepsy Management: A Scoping Review of the Models and Components of Health and Social Care Delivery.
- Author
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Spanos S, Hutchinson K, Ryder T, Rapport F, Goodwin N, and Zurynski Y
- Abstract
Introduction: Epilepsy is the most common neurological condition globally. Integrating health and social care is fundamental in epilepsy management, but the scope of progress in this area is unclear. This scoping review aimed to capture the range and type of integrated care components and models in epilepsy management., Methods: Four databases were searched for articles published since 2010 that reported on integrated care in epilepsy. Data were extracted and synthesised into components of integrated care that had been implemented or recommended only. Models of integrated care were identified, and their components tabulated., Results: Fifteen common and interrelated components of integrated care emerged that were aligned with four broad areas: healthcare staff and pathways (e.g., epilepsy nurses); tasks and services (e.g., care coordination); education and engagement (e.g., shared decision making); and technology for diagnosis and communication (e.g., telehealth). Twelve models of integrated care were identified; seven were implemented and five were recommended., Discussion: There is a growing evidence-base supporting integrated, person-centred epilepsy care, but implementation is challenged by entrenched silos, underdeveloped pathways for care, and deficits in epilepsy education., Conclusion: Integrating epilepsy care relies on changes to workforce development and policy frameworks to support whole-of-system vision for improving care., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
46. A comparison of rapid cycle deliberate practice and traditional reflective debriefing on interprofessional team performance.
- Author
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Colman N, Wiltrakis SM, Holmes S, Hwu R, Iyer S, Goodwin N, Mathai C, Gillespie S, and Hebbar KB
- Subjects
- Humans, Child, Clinical Competence, Curriculum, Educational Measurement, Simulation Training, Internship and Residency
- Abstract
Background: In simulation-based education, debriefing is necessary to promote knowledge acquisition and skill application. Rapid Cycle Deliberate Practice (RCDP) and Traditional Reflective Debriefing (TRD) are based in learning theories of deliberate practice and reflective learning, respectively. In this study, we compared the effectiveness of TRD versus RCDP on acquisition of conceptual knowledge and teamwork skills among interdisciplinary learners in the pediatric emergency department., Methods: One hundred sixty-four learners including emergency department attending physicians, fellows, nurses, medical technicians, paramedics, and respiratory therapists, participated in 28 in-situ simulation workshops over 2 months. Groups were quasi-randomized to receive RCDP or TRD debriefing. Learners completed a multiple-choice test to assess teamwork knowledge. The TEAM Assessment Tool assessed team performance before and after debriefing. Primary outcomes were teamwork knowledge and team performance., Results: Average pre-intervention baseline knowledge assessment scores were high in both groups (TRD mean 90.5 (SD 12.7), RCDP mean 88.7 (SD 15.5). Post-test scores showed small improvements in both groups (TRD mean 93.2 (SD 12.2), RCDP mean 89.9 (SD 13.8), as indicated by effect sizes (ES = 0.21 and 0.09, for TRD and RCDP, respectively). Assessment of team performance demonstrated a significant improvement in mean scores from pre-assessment to post-assessment for all TEAM Assessment skills in both TRD and RCDP arms, based on p-values (all p < 0.01) and effect sizes (all ES > 0.8). While pre-post improvements in TEAM scores were generally higher in the RCDP group based on effect sizes, analysis did not indicate either debriefing approach as meaningfully improved over the other., Conclusions: Our study did not demonstrate that either TRD versus RCDP was meaningfully better in teamwork knowledge acquisition or improving skill application and performance. As such, we propose Reflective Deliberate Practice as a framework for future study to allow learners to reflect on learning and practice in action., (© 2024. The Author(s).)
- Published
- 2024
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47. Person-centred integrated care for people living with Parkinson's, Huntington's and Multiple Sclerosis: A systematic review.
- Author
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Bartolomeu Pires S, Kunkel D, Kipps C, Goodwin N, and Portillo MC
- Subjects
- Humans, Caregivers psychology, Multiple Sclerosis therapy, Multiple Sclerosis psychology, Huntington Disease therapy, Parkinson Disease therapy, Patient-Centered Care organization & administration, Delivery of Health Care, Integrated organization & administration, Quality of Life
- Abstract
Introduction: People living with long-term neurological conditions (LTNCs) have complex needs that demand intensive care coordination between sectors. This review aimed to establish if integrated care improves outcomes for people, and what characterises successful interventions., Methods: A systematic review of the literature was undertaken evaluating multisectoral integrated care interventions in people living with Parkinson's disease (PD), Multiple Sclerosis (MS) and Huntington's disease (HD). Strength of evidence was rated for the different outcomes., Results: A total of 15 articles were included, reporting on 2095 patients and caregivers, finding that integrated care can improve people's access to resources and reduce patients' depression. UK studies indicated improvements in patients' quality of life, although the international literature was inconclusive. Few programmes considered caregivers' outcomes, reporting no difference or even worsening in depression, burden and quality of life. Overall, the evidence showed a mismatch between people's needs and outcomes measured, with significant outcomes (e.g., self-management, continuity of care, care experience) lacking. Successful programmes were characterised by expert knowledge, multisectoral care coordination, care continuity and a person-centred approach., Conclusions: The impact of integrated care programmes on people living with LTNCs is limited and inconclusive. For a more person-centred approach, future studies need to assess integrated care from a service-user perspective., Patient and Public Contribution: Thirty people living with LTNCs were involved in this review, through defining research questions, validating the importance of the project, and increasing the researchers' understanding on what matters to service users. A patient and public involvement subgroup of representatives with lived experience on PD, MS and HD identified the need for more person-centred integrated care, with specific concerns over care fragmentation, care duplication and care continuity. This was key to data analysis and formulating the characteristics of successful and unsuccessful integrated care programmes from the perspective of service users. The discrepancy between service users' needs and the outcomes assessed in the literature point to user-driven research as the solution to address what matters to patients and caregivers., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)
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- 2024
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48. Improving end-of-life care for people with dementia: a mixed-methods study.
- Author
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Triandafilidis Z, Carr S, Davis D, Jeong SY, Hensby J, Wong D, Attia J, and Goodwin N
- Subjects
- Humans, Australia, Palliative Care, Caregivers, Death, Dementia therapy, Terminal Care
- Abstract
Background: Improving palliative and end-of-life care for people with dementia is a growing priority globally. This study aimed to integrate multiple perspectives on end-of-life care for people with dementia and carers, to identify clinically relevant areas for improvement., Methods: The mixed-methods study involved surveys, interviews, and workshops with two participant groups: healthcare professionals and carers (individuals who provided care and support to a family member or friend). Healthcare professionals were invited to complete an online adapted version of the Australian Commission on Safety and Quality in Health Care, End-of-Life Care Toolkit: Clinician Survey Questions. Carers completed a hard copy or online adapted version of the Views of Informal Carers-Evaluation of Services (Short form) (VOICES-SF) questionnaire. Interview schedules were semi-structured, and workshops followed a co-design format. Findings were integrated narratively using a weaving approach., Results: Five areas in which we can improve care for people with dementia at the end of life, were identified: 1) Timely recognition of end of life; 2) Conversations about palliative care and end of life; 3) Information and support for people with dementia and carers; 4) Person-and-carer-centred care; 5) Accessing quality, coordinated care., Conclusions: There are multiple areas where we can improve the quality of end-of-life care people with dementia receive. The findings demonstrate that the heterogeneous and challenging experiences of living with and caring for people with dementia necessitate a multidisciplinary, multifaceted approach to end-of-life care. The identified solutions, including care coordination, can guide local development of co-designed models of end-of-life care for people with dementia., (© 2024. The Author(s).)
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- 2024
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49. What care do people with dementia receive at the end of life? Lessons from a retrospective clinical audit of deaths in hospital and other settings.
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Triandafilidis Z, Carr S, Davis D, Chiu S, Leigh L, Jeong S, Wong D, Hensby J, Lewis S, Attia J, and Goodwin N
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- Humans, Hospitals, Retrospective Studies, Clinical Audit, Dementia diagnosis, Dementia therapy, Terminal Care
- Abstract
Background: The need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings., Methods: A retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models., Results: The characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase., Conclusion: This study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases., (© 2024. The Author(s).)
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- 2024
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50. From People-Centred to People-Driven Care: Can Integrated Care Achieve its Promise without it?
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Goodwin N, Brown A, Johnson H, Miller R, and Stein KV
- Abstract
Competing Interests: The authors have no competing interests to declare.
- Published
- 2022
- Full Text
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