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941.
Claire L. Smith Yan Jin Eyas Raddad Terry A. McNearney Xiao Ni David Monteith Roger Brown Mark A. Deeg Thomas Schnitzer 《Pharmaceutical statistics》2019,18(1):39-53
Development of new pharmacological treatments for osteoarthritis that address unmet medical needs in a competitive market place is challenging. Bayesian approaches to trial design offer advantages in defining treatment benefits by addressing clinically relevant magnitude of effects relative to comparators and in optimizing efficiency in analysis. Such advantages are illustrated by a motivating case study, a proof of concept, and dose finding study in patients with osteoarthritis. Patients with osteoarthritis were randomized to receive placebo, celecoxib, or 1 of 4 doses of galcanezumab. Primary outcome measure was change from baseline WOMAC pain after 8 weeks of treatment. Literature review of clinical trials with targeted comparator therapies quantified treatment effects versus placebo. Two success criteria were defined: one to address superiority to placebo with adequate precision and another to ensure a clinically relevant treatment effect. Trial simulations used a Bayesian dose response and longitudinal model. An interim analysis for futility was incorporated. Simulations indicated the study had ≥85% power to detect a 14‐mm improvement and ≤1% risk for a placebo‐like drug to pass. The addition of the second success criterion substantially reduced the risk of an inadequate, weakly efficacious drug proceeding to future development. The study was terminated at the interim analysis due to inadequate analgesic efficacy. A Bayesian approach using probabilistic statements enables clear understanding of success criteria, leading to informed decisions for study conduct. Incorporating an interim analysis can effectively reduce sample size, save resources, and minimize exposure of patients to an inadequate treatment. 相似文献
942.
Public health policies to prevent disease within populations are giving rise to shifting patterns of healthcare delivery in the late modern era. There is an inherent tension in modern medicine between evidence‐based standardisation, on the one hand, and patient‐centred specificity on the other. This tension manifests in recent policy narratives regarding public health risk (which we have characterised in terms of the epidemiological clinic) and co‐production. Drawing on co‐produced data with health trainers (lay health workers tasked with supporting behavioural change in patients at high risk of cardiovascular disease) in a deprived post‐industrial region of England, our decentred analysis focuses on three extended narratives from this data set. Our analysis builds on and develops emerging theories of risk work, informed by Habermas, and we explore the extent to which elite narratives of public health risk are resisted, absorbed, or bracketed off by client‐facing health workers—emphasising the heterogeneity of responses—and locate these responses within the context of the workers' employment conditions, their embodied experiences, and their wider beliefs and traditions. We argue that co‐production—albeit in a highly constrained form—is possible while delivering public health interventions. However, in the context of a community where health is so adversely affected by wider social problems and where task shifting has drawn lower status healthcare workers into these client‐facing roles, workers must find their own ways to negotiate and attempt to reconcile this context with the risk‐framed practices they are required to carry out. 相似文献
943.
944.
945.
Donna Weetra Karen Glover Roxanne Miller Rikki Wilson Cathy Leane Deanna Stuart-Butler Amanda Mitchell Deirdre Gartland Stephanie Brown 《Women and birth : journal of the Australian College of Midwives》2019,32(1):72-79
Background
Aboriginal women and families are under-represented in Australian research on pregnancy and childbirth. The Aboriginal Families Study aimed to investigate the views and experiences of a representative sample of women giving birth to an Aboriginal baby in South Australia between July 2011 and June 2013, using methods designed to respect Aboriginal culture and communities.Methods
A team of 12 Aboriginal researchers facilitated community engagement and recruitment of Aboriginal and non-Aboriginal mothers of Aboriginal infants in urban, regional and remote areas of South Australia over a two-year period.Results
A total of 344 women took part, around a quarter of all Aboriginal women giving birth in South Australia in the study period (39% urban, 35% regional and 25% from remote areas). Participants were representative in relation to maternal age (mean age of 25 years, range = 15–43 years). Over half of women (56%) first heard about the study via a member of the fieldwork team making contact with them through community connections. Other major sources of recruitment were: Aboriginal health services/programs (20%) and public maternity hospitals (16%). Almost all of the women (95%) recruited via community networks of the fieldwork team completed the questionnaire. In contrast, 51% of women recruited via public hospitals completed the questionnaire (odds ratio = 0.1, 95% confidence interval 0.0–0.1, p < 0.001).Conclusions
Aboriginal researchers’ community knowledge and leadership is critical to the conduct of successful Aboriginal health research. High levels of participation in research by ‘harder to reach’ populations are achievable when researchers take time to build relationships and work in partnership with communities. 相似文献946.
James T. Decker Jodi L. Constantine Brown Wendy Ashley Allen E. Lipscomb 《Social work with groups》2019,42(4):308-322
ABSTRACTThe purpose of this article is to identify and describe a teaching tool that supports social work student success in the classroom and in field placement. The project introduced mindfulness, meditation, and breathing techniques to 2nd-year master of social work (MSW) students in a group classroom setting and engaged students as they applied those techniques in their internship settings with clients. Students were introduced to mindfulness, meditation, and breathing techniques through lecture, experimental exercises, video clips, and case studies and used the group setting to learn to use those tools to add trauma-informed mindfulness interventions to the clinical techniques they concurrently practiced in field placement. Students learned methods to incorporate those interventions into their psychotherapy/counseling sessions with clients and discovered that mindfulness-specific interventions also helped regulate their own autonomic nervous systems, contributing to decreased anxiety. Thus, mindfulness skills taught in social work programs have significant multidimensional benefits; engaging a group classroom setting to learn to utilize mindfulness, meditation and breathing techniques can reduce stress and anxiety for clients and promote adaptive self-care skills for MSW students. 相似文献
947.
We examined patterns of shifting cropland cultivation in the US Great Plains from the dust bowl to the beginning of the twenty-first century, by comparing land-cover data from 400 sample sites across the region from the 1930s, 1950s, 1970s, 1990s and 2000s. The small area land-cover data were nested within 50 target counties across the region. To understand the use of marginal land for cultivation since the Great Depression, we argue, requires consideration of the long term dynamics of demography, technology and policy. We draw on these historical dynamics, and their interactions with programs aimed at reducing environmental impacts of agriculture, to tell the story of how and when marginal lands have been brought into use. In a multilevel panel design, macro- and micro-level covariates were used to predict levels of encroachment on marginal soils. We conclude that land retirement programs (like the Conservation Reserve Program) have had a generally stabilizing effect on the micro-level patterns of land use in recent decades, but that increased levels of encroachment on marginal soils and native grassland remain a problem in areas with higher or increasing population densities. 相似文献
948.
This study is based on the reports of 384 adults who were abused physically, sexually, and/or emotionally in childhood by family members. It describes the survivors' attempts, as children, to get help by disclosing the abuse to someone who might intervene; those who did not disclose explain their reasons. The results indicate that disclosure usually did not bring an end to the abuse, and that little action was taken to control the perpetrator, even after disclosure took place. The responses received by the children to their disclosure are linked to their levels of self-esteem and family functioning as adults. 相似文献
949.
Jenny Brown 《Australian and New Zealand Journal of Family Therapy》1999,20(2):94-103
This paper will give an overview of Murray Bowen's theory of family systems. It will describe the model's development and outline its core clinical components. The practice of therapy will be described as well as recent developments within the model. Some key criticisms will be raised, followed by a case example which highlights the therapeutic focus of Bowen's approach. 相似文献
950.
The Australian Census Longitudinal Dataset: using record linkage to create a longitudinal sample from a series of cross‐sections 下载免费PDF全文
James Chipperfield James J. Brown Nicole Watson 《Australian & New Zealand Journal of Statistics》2017,59(1):1-16
The Australian Bureau of Statistics is creating a longitudinal sample, called the Australian Census Longitudinal Dataset (ACLD), by linking person records across its five‐yearly Census of Population and Housing. This paper proposes a Multi‐Panel framework for selecting and weighting records in the ACLD. This framework can be applied more generally to selecting longitudinal samples from a series of cross‐sectional administrative files. The proposed framework avoids some significant limitations of the popular ‘Top‐Up’ sampling approach to maintaining the cross‐sectional and longitudinal representativeness of a sample over time. 相似文献