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302. Clinical practices to promote sleep in the ICU: A multinational survey

Author

Hofhuis, José G.M., primary, Rose, Louise, additional, Blackwood, Bronagh, additional, Akerman, Eva, additional, McGaughey, Jennifer, additional, Egerod, Ingrid, additional, Fossum, Mariann, additional, Foss, Helene, additional, Georgiou, Evanthia, additional, Graff, Heidi J., additional, Kalafati, Maria, additional, Sperlinga, Riccardo, additional, Berardo, Alessandra, additional, Schäfer, Andreas, additional, Wojnicka, Aleksandra Gutysz, additional, and Spronk, Peter E., additional

Published
2018
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304. Transitions to Home Mechanical Ventilation. The Experiences of Canadian Ventilator-assisted Adults and Their Family Caregivers

Author

Dale, Craig M., primary, King, Judy, additional, Nonoyama, Mika, additional, Carbone, Sarah, additional, McKim, Douglas, additional, Road, Jeremy, additional, Rose, Louise, additional, Amin, Reshma, additional, Avendano, Monica, additional, Dial, Sandra, additional, Fan, Eddy, additional, Fraser, Ian, additional, Fowler, Robert, additional, Goldstein, Roger, additional, Katz, Sherri, additional, Leasa, David, additional, Mawdsley, Cathy, additional, and Rubenfeld, Gordon, additional

Published
2018
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305. Healthcare utilisation and costs of home mechanical ventilation

Author

Nonoyama, Mika L, primary, McKim, Douglas A, additional, Road, Jeremy, additional, Guerriere, Denise, additional, Coyte, Peter C, additional, Wasilewski, Marina, additional, Avendano, Monica, additional, Katz, Sherri L, additional, Amin, Reshma, additional, Goldstein, Roger, additional, Zagorski, Brandon, additional, and Rose, Louise, additional

Published
2018
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310. Delirium and exposure to psychoactive medications in critically ill adults: A multi-centre observational study

Author

Burry, Lisa D., primary, Williamson, David R., additional, Mehta, Sangeeta, additional, Perreault, Marc M., additional, Mantas, Ioanna, additional, Mallick, Ranjeeta, additional, Fergusson, Dean A., additional, Smith, Orla, additional, Fan, Eddy, additional, Dupuis, Sebastien, additional, Herridge, Margaret, additional, and Rose, Louise, additional

Published
2017
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313. Development of a menu of recovery goals to facilitate goal setting after critical illness.

Author

Apps, Chloe, Brooks, Kate, Terblanche, Ella, Hart, Nicholas, Meyer, Joel, and Rose, Louise

Abstract

To develop an expert-informed (including end users) recovery goal menu for adults recovering from critical illness applicable to the community/home setting. Stage 1 Item generation: iterative development of domains, sub-domains, and goals in consultation with former intensive care patients, family members and expert clinicians. Stage 2 Content validity assessment: cognitive interviews and the content validity index. Virtual consultation meetings facilitated by the research team at King's College London and Guy's and St Thomas' NHS Foundation Trust. Content validity as assessed by: the Item-Content Validity Index (I-CVI), Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score, the Scale Level-Content Validity Index/Average (S-CVI/Ave) score and Average Content Validity Ratio (CVR). Item generation resulted in a goal menu comprising 4 domains, 22 sub-domains and 95 goals assigned as follows: Self-care: 9 sub-domains with 37 goals, Productivity: 7 sub-domains with 13 goals, Leisure: 3 sub-domains with 25 goals, and Person domain 3 sub-domains with 20 goals. Cognitive interviews resulted in addition of 79 goals and modification of 7, addition of 4 new sub-domains and modification of 4, thus resulting in 4 domains, 26 sub-domains with a total of 174 goals. Twenty-four sub-domains (169 goals) were deemed relevant with Item-Content Validity Index (I-CVI) scores ranging from 0.72 to 1. Two sub-domains (5 goals) did not meet the 0.7 cut-off and were removed. The Scale Level-Content Validity Index/Universal Agreement (S-CVI/UA) score was 0.46; the Scale Level-Content Validity Index/Average (S-CVI/Ave) 0.91. Average Content Validity Ratio (CVR) was 0.93. An expert informed recovery goal menu for former intensive care patients has been developed with excellent content validity. The final goal menu comprises 169 goals within 24 sub-domains grouped under 4 domains. This menu will help patients to set goals and increase our understanding of how individuals recover from critical illness. [ABSTRACT FROM AUTHOR]

Published
2023
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314. Resilience among the Extreme Poor in Bangladesh

Author

Wood, Geoffrey, Maitrot, Mathilde Rose Louise, and Devine, Joseph

Subjects
extreme poverty, resilience, Bangladesh
Abstract

This report focuses on the dynamics of resilience amongst the extreme poor in Bangladesh. It argues that resilience is a more appropriate focus of analysis than graduation in trying to understand extreme poor people's attempts to improve their livelihoods and wellbeing. It offers a conceptual framework to understand resilience and then draws on primary empirical data to test the framework. The report also offers a set of reflections on the usefulness for policy of the concept of resilience and also attempts to identify potential indicators.

Published
2016

315. Core outcome sets in intensive care–what are they and why do we need them? An example for delirium.

Author

Rose, Louise, Burry, Lisa, and Blackwood, Bronagh

Subjects
*EVALUATION of medical care, *INTENSIVE care units, *SERIAL publications, *CRITICALLY ill, *PATIENTS, *DELIRIUM, *CRITICAL care medicine, *QUALITY assurance
Abstract

The authors discuss delirium and its core outcomes in critically ill patients. Other topics include the effectiveness of standardization of interventions like intensive care unit (ICU) liberation in improving patient outcomes, the systematic review by their Delirium Core Outcome Set (COS) team to find effective ways to prevent or treat delirium, and the effectiveness of COS in enhancing homogeneity of outcome selection.

Published
2021
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316. Voice outcomes after radiotherapy treatment for early glottic cancer: Assessment using multidimensional tools

Author

June Corry, Alison Perry, Sue M. Cotton, and Jessica Rose Louise. Bibby

Subjects
Adult, Male, Glottis, medicine.medical_specialty, Speech perception, Voice Quality, medicine.medical_treatment, Speech Acoustics, Quality of life (healthcare), Humans, Medicine, Prospective Studies, Prospective cohort study, Laryngeal Neoplasms, Aged, Aged, 80 and over, business.industry, Middle Aged, Surgery, Radiation therapy, medicine.anatomical_structure, Otorhinolaryngology, Glottic cancer, Carcinoma, Squamous Cell, Quality of Life, Speech Perception, Physical therapy, Female, business, Cohort study
Abstract

Background. This is the first prospective study to use instrumental and both clinician- and client-rated auditory- perceptual measures to examine voice and voice-related quality of life changes in patients after curative radiotherapy for early glottic cancer. Method. Thirty patients undergoing curative radiotherapy treatment for early glottic cancer completed the following: 3 voice tasks for acoustic, aerodynamic, and auditory-perceptual voice measures (therapist-rated); a patient self-report rating of voice quality; and a voice-related quality of life assessment before and 12 months after radiotherapy. Results. Patients' perceptions of their voice quality and their voice-related quality of life significantly improved posttreatment, as did acoustic, aerodynamic, and auditory-perceptual voice measures. Mean speaking fundamental frequency did not change significantly, although breathiness and strain in the voice recordings were demonstrably reduced. Conclusion. In describing postradiotherapy voices in this study, pertinent measures of voice outcomes have been estab- lished, setting the benchmark for comparison in future cohort studies. V

Published
2008

321. Variation in Definition of Prolonged Mechanical Ventilation

Author

Rose, Louise, primary, McGinlay, Michael, additional, Amin, Reshma, additional, Burns, Karen EA, additional, Connolly, Bronwen, additional, Hart, Nicholas, additional, Jouvet, Philippe, additional, Katz, Sherri, additional, Leasa, David, additional, Mawdsley, Cathy, additional, McAuley, Danny F, additional, Schultz, Marcus J, additional, and Blackwood, Bronagh, additional

Published
2017
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322. The intensive care delirium research agenda: a multinational, interprofessional perspective

Author

Pandharipande, Pratik P., primary, Ely, E. Wesley, additional, Arora, Rakesh C., additional, Balas, Michele C., additional, Boustani, Malaz A., additional, La Calle, Gabriel Heras, additional, Cunningham, Colm, additional, Devlin, John W., additional, Elefante, Julius, additional, Han, Jin H., additional, MacLullich, Alasdair M., additional, Maldonado, José R., additional, Morandi, Alessandro, additional, Needham, Dale M., additional, Page, Valerie J., additional, Rose, Louise, additional, Salluh, Jorge I. F., additional, Sharshar, Tarek, additional, Shehabi, Yahya, additional, Skrobik, Yoanna, additional, Slooter, Arjen J. C., additional, and Smith, Heidi A. B., additional

Published
2017
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325. Feasibility of melatonin for prevention of delirium in critically ill patients: a protocol for a multicentre, randomised, placebo-controlled study

Author

Burry, Lisa, primary, Scales, Damon, additional, Williamson, David, additional, Foster, Jennifer, additional, Mehta, Sangeeta, additional, Guenette, Melanie, additional, Fan, Eddy, additional, Detsky, Michael, additional, Azad, Azar, additional, Bernard, Francis, additional, and Rose, Louise, additional

Published
2017
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328. Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach

Author

Webster, Fiona, Christian, Jennifer, Mansfield, Elizabeth, Bhattacharyya, Onil, Hawker, Gillian, Levinson, Wendy, Naglie, Gary, Pham, Thuy-Nga, Rose, Louise, Schull, Michael, Sinha, Samir, Stergiopoulos, Vicky, Upshur, Ross, and Wilson, Lynn

Subjects
Ontario, Delivery of Health Care, Integrated, Research, Professional-Patient Relations, Interviews as Topic, PRIMARY CARE, MENTAL HEALTH, Caregivers, Chronic Disease, Humans, Prospective Studies, Attitude to Health, Qualitative Research
Abstract

Objectives The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions. Setting Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada. Participants We included 62 interviews from 44 patients and 18 non-clinical caregivers. Intervention Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues. Outcome measures This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified. Results We identified 5 broad themes that capture the patients’ experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients’ experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients. Conclusions Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.

Published
2015

333. The RECOVER Program: Disability Risk Groups and 1-Year Outcome after 7 or More Days of Mechanical Ventilation

Author

Herridge, Margaret S., primary, Chu, Leslie M., additional, Matte, Andrea, additional, Tomlinson, George, additional, Chan, Linda, additional, Thomas, Claire, additional, Friedrich, Jan O., additional, Mehta, Sangeeta, additional, Lamontagne, Francois, additional, Levasseur, Melanie, additional, Ferguson, Niall D., additional, Adhikari, Neill K. J., additional, Rudkowski, Jill C., additional, Meggison, Hilary, additional, Skrobik, Yoanna, additional, Flannery, John, additional, Bayley, Mark, additional, Batt, Jane, additional, Santos, Claudia dos, additional, Abbey, Susan E., additional, Tan, Adrienne, additional, Lo, Vincent, additional, Mathur, Sunita, additional, Parotto, Matteo, additional, Morris, Denise, additional, Flockhart, Linda, additional, Fan, Eddy, additional, Lee, Christie M., additional, Wilcox, M. Elizabeth, additional, Ayas, Najib, additional, Choong, Karen, additional, Fowler, Robert, additional, Scales, Damon C., additional, Sinuff, Tasnim, additional, Cuthbertson, Brian H., additional, Rose, Louise, additional, Robles, Priscila, additional, Burns, Stacey, additional, Cypel, Marcelo, additional, Singer, Lianne, additional, Chaparro, Cecelia, additional, Chow, Chung-Wai, additional, Keshavjee, Shaf, additional, Brochard, Laurent, additional, Hebert, Paul, additional, Slutsky, Arthur S., additional, Marshall, John C., additional, Cook, Deborah, additional, and Cameron, Jill I., additional

Published
2016
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334. Content analysis of bowel protocols for the management of constipation in adult critically ill patients

Author

Dionne, Joanna C., Johnstone, Jennie, Smith, Orla, Rose, Louise, Oczkowski, Simon, Arabi, Yaseen, Duan, Erick H., Lauzier, François, Alhazzani, Waleed, Alam, Norine, Zytaruk, Nicole, Campisi, Josie, and Cook, Deborah J.

Abstract

Alterations in bowel habits are common during critical illness, and bowel protocols are gaining acceptance. Our objective was to characterize bowel protocols in a cross-sectional analysis of ICUs.

Published
2020
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335. Barriers to and facilitators for the use of augmentative and alternative communication and voice restorative strategies for adults with an advanced airway in the intensive care unit: A scoping review

Author

Istanboulian, Laura, Rose, Louise, Gorospe, Franklin, Yunusova, Yana, and Dale, Craig M.

Abstract

To identify barriers and facilitators for the use of augmentative and alternative communication (AAC) and voice restorative strategies for adult patients with an advanced airway in the intensive care unit (ICU).

Published
2020
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336. Tracheostomy ventilation outside the intensive care unit: Experience of a tertiary care hospital

Author

Hendin, Ariel, Rose, Louise, and McKim, Douglas A.

Abstract

AbstractINTRODUCTION: Some patients remain dependent on invasive mechanical ventilation after critical illness. In most centers, these patients require Intensive Care Unit (ICU)-level care for ongoing tracheostomy-based mechanical ventilation. Our center has over 22 years of experience providing care for patients who require ventilation via tracheostomy on a medical ward.OBJECTIVE: The objective was to describe a patient cohort, including demographics, length of stay, complications and discharge disposition, who were ventilated via tracheostomy on medical wards.METHODS: A single center, retrospective study was conducted from 1993 to 2015.RESULTS: There were 144 admissions for 50 patients over the 22-year study period. Mean age at first admission was 55.6 years; 32 patients (64%) were male and 42 (84%) were admitted from home. Patients required ventilation for amyotrophic lateral sclerosis (ALS; 36%), spinal cord injury (16%), Guillain-Barre (12%) or another neuromuscular disorder (12%). Mean ICU length of stay on index admission was 46.6 days (range 2–219), and ward stay was an average of 264 days (range, 5–1402). Complications on index admission included 23 episodes of stoma infection, 48 episodes of pneumonia, and a total of 28 ICU transfers. Of the 50 patients, 19 (38%) were discharged home, 18 (36%) were transferred to long-term care and 12 patients (24%) died in hospital including 1 due to a critical incident involving prolonged disconnection from the ventilator.CONCLUSION: The complex care needs of patients requiring mechanical ventilation can safely be provided on medical wards. This opens ICU beds for other patients requiring critical care.

Published
2020
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338. Relaxation for Critically ill Patient Outcomes and Stress-coping Enhancement (REPOSE): a protocol for a pilot randomised trial of an integrative intervention to improve critically ill patients' delirium and related outcomes.

Author

Papathanassoglou, Elizabeth D. E., Skrobik, Yoanna, Hegadoren, Kathleen, Thompson, Patrica, Stelfox, Henry Thomas, Norris, Colleen, Rose, Louise, Bagshaw, Sean M., Meier, Michael, LoCicero, Cheryl, Ashmore, Rhonda, Brulotte, Tiffany Sparrow, Hassan, Imran, Park, Tanya, and Kutsogiannis, Demetrios J.

Abstract

Introduction Delirium is a common complication of critical illness, associated with negative patient outcomes. Preventive or therapeutic interventions are mostly ineffective. Although relaxation-inducing approaches may benefit critically ill patients, no well-designed studies target delirium prevention as a primary outcome. The objective of this study is to assess feasibility and treatment effect estimates of a multimodal integrative intervention incorporating relaxation, guided imagery and moderate pressure touch massage for prevention of critical illness delirium and for related outcomes. Methods and analysis Randomised, controlled, single-blinded trial with two parallel groups (1:1 allocation: intervention and standard care) and stratified randomisation (age (18-64 years and =65 years) and presence of trauma) with blocking, involving 104 patients with Intensive Care Delirium Screening Checklist (ICDSC): 0-3 recruited from two academic intensive care units (ICUs). Intervention group participants receive the intervention in addition to standard care for up to five consecutive days (or until transfer/discharge); control group participants receive standard care and a sham intervention. We will assess predefined feasibility outcomes, that is, recruitment rates and protocol adherence. The primary clinical outcome is incidence of delirium (ICDSC =4). Secondary outcomes include pain scores, inflammatory biomarkers, heart rate variability, stress and quality of life (6 weeks and 4 months) post-ICU discharge. Feasibility measures will be analysed descriptively, and outcomes will be analysed longitudinally. Estimates of effects will be calculated. Ethics and dissemination The study has received approval from the Human Research Ethics Board, University of Alberta. Results will inform the design of a future multicentre trial. [ABSTRACT FROM AUTHOR]

Published
2019
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339. Effect of Protocolized Weaning With Early Extubation to Noninvasive Ventilation vs Invasive Weaning on Time to Liberation From Mechanical Ventilation Among Patients With Respiratory Failure: The Breathe Randomized Clinical Trial.

Author

Perkins, Gavin D., Mistry, Dipesh, Gates, Simon, Gao, Fang, Snelson, Catherine, Hart, Nicholas, Camporota, Luigi, Varley, James, Carle, Coralie, Paramasivam, Elankumaran, Hoddell, Beverley, McAuley, Daniel F., Walsh, Timothy S., Blackwood, Bronagh, Rose, Louise, Lamb, Sarah E., Petrou, Stavros, Young, Duncan, Lall, Ranjit, and Breathe Collaborators

Subjects
RESPIRATORY insufficiency treatment, AIRWAY (Anatomy), ARTIFICIAL respiration, COMPARATIVE studies, INTENSIVE care units, RESEARCH methodology, MEDICAL cooperation, RESEARCH, RESPIRATORY insufficiency, TIME, MECHANICAL ventilators, EVALUATION research, RANDOMIZED controlled trials, HOSPITAL mortality
Abstract

Importance: In adults in whom weaning from invasive mechanical ventilation is difficult, noninvasive ventilation may facilitate early liberation, but there is uncertainty about its effectiveness in a general intensive care patient population.Objective: To investigate among patients with difficulty weaning the effects of protocolized weaning with early extubation to noninvasive ventilation on time to liberation from ventilation compared with protocolized invasive weaning.Design, Setting, and Participants: Randomized, allocation-concealed, open-label, multicenter clinical trial enrolling patients between March 2013 and October 2016 from 41 intensive care units in the UK National Health Service. Follow-up continued until April 2017. Adults who received invasive mechanical ventilation for more than 48 hours and in whom a spontaneous breathing trial failed were enrolled.Interventions: Patients were randomized to receive either protocolized weaning via early extubation to noninvasive ventilation (n = 182) or protocolized standard weaning (continued invasive ventilation until successful spontaneous breathing trial, followed by extubation) (n = 182).Main Outcomes and Measures: Primary outcome was time from randomization to successful liberation from all forms of mechanical ventilation among survivors, measured in days, with the minimal clinically important difference defined as 1 day. Secondary outcomes were duration of invasive and total ventilation (days), reintubation or tracheostomy rates, and survival.Results: Among 364 randomized patients (mean age, 63.1 [SD, 14.8] years; 50.5% male), 319 were evaluable for the primary effectiveness outcome (41 died before liberation, 2 withdrew, and 2 were discharged with ongoing ventilation). The median time to liberation was 4.3 days in the noninvasive group vs 4.5 days in the invasive group (adjusted hazard ratio, 1.1; 95% CI, 0.89-1.40). Competing risk analysis accounting for deaths had a similar result (adjusted hazard ratio, 1.1; 95% CI, 0.86-1.34). The noninvasive group received less invasive ventilation (median, 1 day vs 4 days; incidence rate ratio, 0.6; 95% CI, 0.47-0.87) and fewer total ventilator days (median, 3 days vs 4 days; incidence rate ratio, 0.8; 95% CI, 0.62-1.0). There was no significant difference in reintubation, tracheostomy rates, or survival. Adverse events occurred in 45 patients (24.7%) in the noninvasive group compared with 47 (25.8%) in the invasive group.Conclusions and Relevance: Among patients requiring mechanical ventilation in whom a spontaneous breathing trial had failed, early extubation to noninvasive ventilation did not shorten time to liberation from any ventilation.Trial Registration: ISRCTN Identifier: ISRCTN15635197. [ABSTRACT FROM AUTHOR]

Published
2018
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340. Relationship between D-dimers and dead-space on disease severity and mortality in COVID-19 acute respiratory distress syndrome: A retrospective observational cohort study

Author

Camporota, Luigi, Sanderson, Barnaby, Worrall, Stephanie, Ostermann, Marlies, Barrett, Nicholas A., Retter, Andrew, Busana, Mattia, Collins, Patrick, Romitti, Federica, Hunt, Beverley J., Rose, Louise, Gattinoni, Luciano, and Chiumello, Davide

Abstract

Despite its diagnostic and prognostic importance, physiologic dead space fraction is not included in the current ARDS definition or severity classification. ARDS caused by COVID-19 (C-ARDS) is characterized by increased physiologic dead space fraction and hypoxemia. Our aim was to investigate the relationship between dead space indices, markers of inflammation, immunothrombosis, severity and intensive care unit (ICU) mortality.

Published
2023
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341. List of contributors

Author

Aitken, Leanne, Baldwin, Ian, Bancroft, Jayne, Bell, Catherine, Bench, Suzanne, Bergman, Lina, Buckley, Thomas, Calleja, Pauline, Chaboyer, Wendy, Coombs, Maureen A, Coyer, Fiona, Dennett, Jennifer, Dennis, Malcolm, Dirkes, Susan, Driscoll, Andrea, Dwyer, Trudy, Elliott, Rosalind, Endacott, Ruth, Flodén, Anne, Foran, Paula, Friel, Deb, Graan, Sher Michael, Grealy, Bernadette, Grech, Carol, Greenwood, Melanie, Gullick, Janice, Hodge, Alister, Hutchinson, Anastasia, James, Alison, Johansson, Lotta, Juers, Alison, Kendrick, Tina, Kleinpell, Ruth, Kuzmiuk, Leila, Lin, Frances, Marshall, Andrea P, McGaughey, Jennifer, M<ce:sup loc='post">c</ce:sup>Gloin, Elaine, Mitchell, Marion, Murgo, Margherita, Nilsson, Ulrica, Olson, DaiWai M, Paulus, Frederique, Pollock, Wendy, Ramelet, Anne-Sylvie, Rattray, Janice, Riedlinger, Adam, Ringdal, Mona, Rose, Louise, Sampson, Michael, Sluys, Kerstin Prignits, Smith, Karen, Williams, Ged, Williams, Teresa, and Wilson, Denise

Published
2019
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342. The Social Performance of Microfinance Institutions in Rural Bangladesh

Author

Maitrot, Mathilde Rose Louise, BROCKINGTON, DANIEL D, Hulme, David, and Brockington, Daniel

Subjects
Livelihood, Bangladesh, Microfinance, Micro finance, Social performance, Poverty
Abstract

Microfinance was rapidly hailed as a poverty alleviation tool by development agencies, researchers and practitioners. Despite the increasing capacity of MFIs to manage their financial sustainability, impact studies available report disappointingly low social achievements. Social performance assessment tools available struggle to combat a narrow MFI-centric approach which often overlooks contextual issues and institutional characteristics which can influence MFIs’ poverty reduction potential. This research’s main objective is to identify which and explain how organisational structures and management systems impact on MFIs’ social performance. This work uses a bottom-up research strategy, based on a 10-month extensive fieldwork in Bangladesh, a 490 household data-set, an ethnographic community study in Modhupur and institutional analyses of ASA and PDBF. It analyses the livelihoods, capitals and strategies of rural households in Bangladesh, explores their perceptions and experiences of microfinance and examines the management of socio-financial trade-offs within MFIs at different hierarchical levels.The research’s main findings seriously question the poverty reducing potential of standardised commercialised microfinance in settings characterised by vulnerability, shocks and seasonality, such as rural Bangladesh. It finds that although most MFIs have similar poverty reduction missions it is the way in which their organisational structures, managementsystems and working cultures are arranged that shapes their financial and social achievements. There is strong evidence that commercial MFIs can experience a silent practice drift at the field level in Bangladesh and that the commercialisation of MFIs provides strong incentives for the field staff to prioritise the achievement of their financial targets to the detriment of social performance, discouraging them from reporting low social performance.There are therefore few reasons why MFI senior managers should question their model and policies. This drift can manifest itself through malpractices hard-selling of loans, poor client selection and follow-up procedures, forcing clients into borrowing more and larger loans, using extreme forms of pressure through abusive language and behaviours and micro-collateral. This process usually has longer-term negative impacts on clients, especially the very poor who adopt successive short-term coping tactics to meet inflexible repayment schedules. This thesis concludes that commercial microfinance should not be targeted to the poorest and that more consideration should be given to clientselection and follow-up procedures.This thesis argues that the commercialisation of the global microfinance industry serves the interests of diverse stakeholders who contribute to maintaining the industry’s reputation though the media. This can be deemed an iceberg industry (that shows little of its actual workings and impacts to the public) which is sustained through considerable support from an increasing number of private investors for whom MFIs’ commercial expansion (regardless of its social achievements) serves their financial and political interests.

Published
2014

343. Comparison of sedation strategies for critically ill patients: a protocol for a systematic review incorporating network meta-analyses

Author

Hutton, Brian, primary, Burry, Lisa D., additional, Kanji, Salmaan, additional, Mehta, Sangeeta, additional, Guenette, Melanie, additional, Martin, Claudio M., additional, Fergusson, Dean A., additional, Adhikari, Neill K., additional, Egerod, Ingrid, additional, Williamson, David, additional, Straus, Sharon, additional, Moher, David, additional, Ely, E. Wesley, additional, and Rose, Louise, additional

Published
2016
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349. Prevalence, risk factors, and outcomes associated with physical restraint use in mechanically ventilated adults

Author

Rose, Louise, primary, Burry, Lisa, additional, Mallick, Ranjeeta, additional, Luk, Elena, additional, Cook, Deborah, additional, Fergusson, Dean, additional, Dodek, Peter, additional, Burns, Karen, additional, Granton, John, additional, Ferguson, Niall, additional, Devlin, John W., additional, Steinberg, Marilyn, additional, Keenan, Sean, additional, Reynolds, Stephen, additional, Tanios, Maged, additional, Fowler, Robert A., additional, Jacka, Michael, additional, Olafson, Kendiss, additional, Skrobik, Yoanna, additional, and Mehta, Sangeeta, additional

Published
2016
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