814 resultados para Cochrane Collaboration


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Background: Efforts to prevent the development of overweight and obesity have increasingly focused early in the life course as we recognise that both metabolic and behavioural patterns are often established within the first few years of life. Randomised controlled trials (RCTs) of interventions are even more powerful when, with forethought, they are synthesised into an individual patient data (IPD) prospective meta-analysis (PMA). An IPD PMA is a unique research design where several trials are identified for inclusion in an analysis before any of the individual trial results become known and the data are provided for each randomised patient. This methodology minimises the publication and selection bias often associated with a retrospective meta-analysis by allowing hypotheses, analysis methods and selection criteria to be specified a priori. Methods/Design: The Early Prevention of Obesity in CHildren (EPOCH) Collaboration was formed in 2009. The main objective of the EPOCH Collaboration is to determine if early intervention for childhood obesity impacts on body mass index (BMI) z scores at age 18-24 months. Additional research questions will focus on whether early intervention has an impact on children’s dietary quality, TV viewing time, duration of breastfeeding and parenting styles. This protocol includes the hypotheses, inclusion criteria and outcome measures to be used in the IPD PMA. The sample size of the combined dataset at final outcome assessment (approximately 1800 infants) will allow greater precision when exploring differences in the effect of early intervention with respect to pre-specified participant- and intervention-level characteristics. Discussion: Finalisation of the data collection procedures and analysis plans will be complete by the end of 2010. Data collection and analysis will occur during 2011-2012 and results should be available by 2013. Trial registration number: ACTRN12610000789066

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Aims--Telemonitoring (TM) and structured telephone support (STS) have the potential to deliver specialised management to more patients with chronic heart failure (CHF), but their efficacy is still to be proven. Objectives To review randomised controlled trials (RCTs) of TM or STS on all- cause mortality and all-cause and CHF-related hospitalisations in patients with CHF, as a non-invasive remote model of specialised disease-management intervention.--Methods and Results--Data sources:We searched 15 electronic databases and hand-searched bibliographies of relevant studies, systematic reviews, and meeting abstracts. Two reviewers independently extracted all data. Study eligibility and participants: We included any randomised controlled trials (RCT) comparing TM or STS to usual care of patients with CHF. Studies that included intensified management with additional home or clinic visits were excluded. Synthesis: Primary outcomes (mortality and hospitalisations) were analysed; secondary outcomes (cost, length of stay, quality of life) were tabulated.--Results: Thirty RCTs of STS and TM were identified (25 peer-reviewed publications (n=8,323) and five abstracts (n=1,482)). Of the 25 peer-reviewed studies, 11 evaluated TM (2,710 participants), 16 evaluated STS (5,613 participants) and two tested both interventions. TM reduced all-cause mortality (risk ratio (RR 0•66 [95% CI 0•54-0•81], p<0•0001) and STS showed similar trends (RR 0•88 [95% CI 0•76-1•01], p=0•08). Both TM (RR 0•79 [95% CI 0•67-0•94], p=0•008) and STS (RR 0•77 [95% CI 0•68-0•87], p<0•0001) reduced CHF-related hospitalisations. Both interventions improved quality of life, reduced costs, and were acceptable to patients. Improvements in prescribing, patient-knowledge and self-care, and functional class were observed.--Conclusion: TM and STS both appear effective interventions to improve outcomes in patients with CHF.

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This article describes challenges to effective collaboration encountered by nurse educators as they transformed a unit within a school of nursing in Taiwan. This study introduced collaborative action research as a vehicle for curriculum change. Although the team achieved positive outcomes in transforming a unit, the collaborative process was complex with four major challenges: meaning, time, work culture, and conflicting views. This article provides an overview of the study, and the major challenges posed by working together are expounded and illustrated with excerpts drawn from the study data. Possible reasons for the challenges, how these challenges were overcome, and facilitation of the collaborative process are discussed.

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Technology-mediated collaboration process has been extensively studied for over a decade. Most applications with collaboration concepts reported in the literature focus on enhancing efficiency and effectiveness of the decision-making processes in objective and well-structured workflows. However, relatively few previous studies have investigated the applications of collaboration schemes to problems with subjective and unstructured nature. In this paper, we explore a new intelligent collaboration scheme for fashion design which, by nature, relies heavily on human judgment and creativity. Techniques such as multicriteria decision making, fuzzy logic, and artificial neural network (ANN) models are employed. Industrial data sets are used for the analysis. Our experimental results suggest that the proposed scheme exhibits significant improvement over the traditional method in terms of the time–cost effectiveness, and a company interview with design professionals has confirmed its effectiveness and significance.

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This paper is a summary of a PhD thesis proposal. It will explore how the Web 2.0 platform could be applied to enable and facilitate the large-scale participation, deliberation and collaboration of both governmental and non-governmental actors in an ICT supported policy process. The paper will introduce a new democratic theory and a Web 2.0 based e-democracy platform, and demonstrate how different actors would use the platform to develop and justify policy issues.

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This paper focuses on data exchange relationships and ways to improve collaboration in the supply chain. Initially, the paper examines the information needs and alternatives in supply chain management. In the second part, the paper identifies different sets of factors that are likely to influence information sharing with suppliers, from the manufacturers’ point of view. Results from a Finnish Manufacturing industry survey show that manufacturers provided substantial information on demand data, production schedules, and inventories to their suppliers. Respondents perceived delivery performance measured by the timeliness, accuracy, and defect rate of deliveries as the primary incentives for supplier collaboration. On the other hand, supplier image and the market in which the supplier operates were found to be less relevant in determining the intensity of collaboration.

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Monitoring and assessing environmental health is becoming increasingly important as human activity and climate change place greater pressure on global biodiversity. Acoustic sensors provide the ability to collect data passively, objectively and continuously across large areas for extended periods of time. While these factors make acoustic sensors attractive as autonomous data collectors, there are significant issues associated with large-scale data manipulation and analysis. We present our current research into techniques for analysing large volumes of acoustic data effectively and efficiently. We provide an overview of a novel online acoustic environmental workbench and discuss a number of approaches to scaling analysis of acoustic data; collaboration, manual, automatic and human-in-the loop analysis.

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This article is a study of the arts in early childhood as a way of learning, for both children and their teachers. The author suggests that drawing can be a powerful tool for collaborative approaches to pedagogy. When teachers draw with children, pathways of communication can be opened, and the collaborative exercise can trigger processes of transformation for both adult and child. In order to present challenges to more traditional, hands-off pedagogical practices in arts education, this article is an account of reflexive arts pedagogies, and how they can work to improve communication and understandings between adults and children. Within the educational contexts of Australian preschooling and primary schooling, the author examines the process of collaborative drawing, and how this can enable a process of transformation. Her analysis, and the accompanying examples of reflexive practices, combine complementary lenses, socio-cultural and postmodern, that she sees as working in harmony to produce new possibilities, in arts education in particular, and, more broadly, in early childhood education.

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This volume brings together a number of essays that seek to explore the nature of early modern scholarship, ostensibly with special regard to the themes of interdisciplinarity and collaboration. As one might expect, the essays thus cover a gamut of topics – political manoeuvring, philosophical debates, gift-giving and dramatic performance – and each study is important and useful in its own right. As a whole, however, this collection serves more as a starting point for an exploration of its themes, than as an authoritative overview of the subject at hand.

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Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. The aim of this review was to assess the effects of end-of-life care pathways (EOLCP), compared with usual care (no pathway) or with care guided by a different end-of-life care pathway, across all healthcare settings (e.g. hospitals, residential aged care facilities, community). We searched the Cochrane Register of Controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register, MEDLINE, EMBASE, review articles and reference lists of relevant articles. The search was carried out in September 2009. All randomised controlled trials (RCTs), quasi-randomised trials or high quality controlled before and after studies comparing use versus non-use of an EOLCP in caring for the dying were considered for inclusion. The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. There are now recent concerns regarding the big scale roll-out of EOLCP despite the lack of evidence, nurses should report any safety concerns or adverse effects associated with such pathways.

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There appears no shortage of theorists for preservice teacher education; however many ideas are abandoned without practical applications. Indeed, it can take years for theories to materialise into practice, if they materialise at all. The quality of preservice teacher education is central for enhancing an education system, and mentors’ roles can assist to shape preservice teachers’ development within the school context. Yet mentoring can be haphazard without being underpinned by a theoretical framework. A mentoring model (personal attributes, system requirements, pedagogical knowledge, modelling, and feedback) has emerged from research and the literature to guide mentors’ practices. This qualitative study investigates mentors’ pedagogical knowledge as one factor crucial to the mentoring process. More specifically, this study involves a questionnaire and audio-recorded focus group meetings with experienced mentors (n=14) who deliberated on devising practical applications for mentoring pedagogical knowledge. Findings revealed that these experienced mentors pinpointed practical applications around a mentor’s role for providing pedagogical knowledge to the mentee. These strategies were varied and demonstrated that any one mentoring practice may be approached from a number of different angles. Nevertheless, there were core mentoring practices in pedagogical knowledge such as showing the mentee how to plan for teaching, articulating classroom management approaches, and talking about how to connect learning to assessment. Mentors may require education on current mentoring practices with practical strategies that are linked to theoretical underpinnings.

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Emerging from the challenge to reduce energy consumption in buildings is the need for energy simulation to be used more effectively to support integrated decision making in early design. As a critical response to a Green Star case study, we present DEEPA, a parametric modeling framework that enables architects and engineers to work at the same semantic level to generate shared models for energy simulation. A cloud-based toolkit provides web and data services for parametric design software that automate the process of simulating and tracking design alternatives, by linking building geometry more directly to analysis inputs. Data, semantics, models and simulation results can be shared on the fly. This allows the complex relationships between architecture, building services and energy consumption to be explored in an integrated manner, and decisions to be made collaboratively.