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Abelson J.,McMaster University | Li K.,Ontario Ministry of Health and Long Term Care | Wilson G.,Nova Scotia Health Authority | Shields K.,Outreach Services | And 2 more authors.
Health Expectations

Objectives: Only rudimentary tools exist to support health system organizations to evaluate their public and patient engagement (PPE) activities. This study responds to this gap by developing a generic evaluation tool for use in a wide range of organizations. Methods: The evaluation tool was developed through an iterative, collaborative process informed by a review of published and grey literature and with the input of Canadian PPE researchers and practitioners. Over a 3-year period, structured e-mail, telephone and face-to-face exchanges, including a modified Delphi process, were used to produce an evaluation tool that includes core principles of high-quality engagement, expected outcomes for each principle and three unique evaluation questionnaires that were tested and revised with input from 65 end users. Results: The tool is structured around four core principles of ‘quality engagement’: (i) integrity of design and process; (ii) influence and impact; (iii) participatory culture; and (iv) collaboration and common purpose. Three unique questionnaires were developed to assess each of these four evaluation domains from the following perspectives: (i) those who participate in PPE activities; (ii) those who plan, execute or sponsor PPE activities within organizations; and (iii) those who provide the leadership and capacity for PPE within their organizations. Conclusions: This is the first known collaboration of researchers and practitioners in the co-design of a comprehensive PPE evaluation tool aimed at three distinct respondent groups and for use in a wide range of health system organization settings. © 2015 The Authors. Source

Deeks S.L.,Public Health England | Deeks S.L.,University of Toronto | Lim G.H.,Public Health England | Simpson M.A.,Ontario Ministry of Health and Long Term Care | And 7 more authors.
BMC Public Health

Background: The province of Ontario, Canada initiated mass immunization clinics with adjuvanted pandemic H1N1 influenza vaccine in October 2009. Due to the scale of the campaign, temporal associations with Guillain-Barré syndrome (GBS) and vaccination were expected. The objectives of this analysis were to estimate the number of background GBS cases expected to occur in the projected vaccinated population and to estimate the number of additional GBS cases which would be expected if an association with vaccination existed. The number of influenza-associated GBS cases was also determined. Methods. Baseline incidence rates of GBS were determined from published Canadian studies and applied to projected vaccine coverage data to estimate the expected number of GBS cases in the vaccinated population. Assuming an association with vaccine existed, the number of additional cases of GBS expected was determined by applying the rates observed during the 1976 Swine Flu and 1992/1994 seasonal influenza campaigns in the United States. The number of influenza-associated GBS cases expected to occur during the vaccination campaign was determined based on risk estimates of GBS after influenza infection and provincial influenza infection rates using a combination of laboratory-confirmed cases and data from a seroprevalence study. Results: The overall provincial vaccine coverage was estimated to be between 32% and 38%. Assuming 38% coverage, between 6 and 13 background cases of GBS were expected within this projected vaccinated cohort (assuming 32% coverage yielded between 5-11 background cases). An additional 6 or 42 cases would be expected if an association between GBS and influenza vaccine was observed (assuming 32% coverage yielded 5 or 35 additional cases); while up to 31 influenza-associated GBS cases could be expected to occur. In comparison, during the same period, only 7 cases of GBS were reported among vaccinated persons. Conclusions: Our analyses do not suggest an increased number of GBS cases due to the vaccine. Awareness of expected rates of GBS is crucial when assessing adverse events following influenza immunization. Furthermore, since individuals with influenza infection are also at risk of developing GBS, they must be considered in such analyses, particularly if the vaccine campaign and disease are occurring concurrently. © 2011 Deeks et al; licensee BioMed Central Ltd. Source

Gheorghiade M.,Northwestern University | Shah A.N.,Northwestern University | Vaduganathan M.,Harvard University | Butler J.,Emory University | And 7 more authors.
Heart Failure Clinics

Hospitalized heart failure (HHF) is associated with unacceptably high postdischarge mortality and rehospitalization rates. This heterogeneous group of patients, however, is still treated with standard, homogenous therapies that are not preventing their rapid deterioration. The costs associated with HHF have added demands from society, government, and payers to improve outcomes. With coordinated and committed efforts in the development of new therapies, improvements may be seen in outcomes for patients with HHF. This article summarizes concepts in developing therapies for HHF discussed during a multidisciplinary panel at the Heart Failure Society of America's Annual Scientific Meeting, September 2012. © 2013. Source

Clarke P.J.,University of Michigan | Blount V.,Ontario Ministry of Health and Long Term Care | Colantonio A.,Toronto Rehabilitation Institute | Colantonio A.,University of Toronto
Journal of the American Geriatrics Society

Objectives: To investigate the effect of cognitive impairment on fatal and nonfatal incident stroke in older adults. Design: A large, national, prospective, population-based study of a representative cohort of older Canadians followed over a 10-year period. Setting: Secondary analyses were conducted using data from the Canadian Study of Health and Aging, a population-based study of older adults followed prospectively from 1991 to 2001. Participants: Nine thousand four hundred fifty-one adults aged 65 and older who had not previously been diagnosed with stroke at baseline (in 1991). Measurements: In addition to known risk factors, the independent contribution of cognitive function (diagnosed in a clinical examination) was examined as a risk for stroke in older adults. Results: Multinomial logistic regression analyses showed that cognitive impairment was associated with twice the odds of fatal incident stroke, controlling for well-established risk factors. Conclusion: This study provides further evidence for the need to consider cognitive function in relation to stroke risk in older populations. © 2011, The American Geriatrics Society. Source

Hawryluck L.,A+ Network | Bouali R.,University of Ottawa | Meth N.D.,Ontario Ministry of Health and Long Term Care
Journal of Law, Medicine and Ethics

Multiprofessional guidelines for fair access to and use of adult critical care services are desperately needed to define a consistent transparent standard of care: when such therapies have the potential to benefit and help a patient as they journey with illness and when they cannot. © 2011 American Society of Law, Medicine & Ethics, Inc. Source

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