Pamela Claire Snow

Bio: Pamela Claire Snow is an academic researcher from La Trobe University. The author has contributed to research in topics: Poison control & Literacy. The author has an hindex of 36, co-authored 142 publications receiving 4496 citations. Previous affiliations of Pamela Claire Snow include Deakin University & Bethesda Hospital.

Clinical pathways: effects on professional practice, patient outcomes, length of stay and hospital costs

Abstract: Background Clinical pathways are structured multidisciplinary care plans used by health services to detail essential steps in the care of patients with a specific clinical problem. They aim to link evidence to practice and optimise clinical outcomes whilst maximising clinical efficiency. Objectives To assess the effect of clinical pathways on professional practice, patient outcomes, length of stay and hospital costs. Search methods We searched the Database of Abstracts of Reviews of Effectiveness (DARE), the Effective Practice and Organisation of Care (EPOC) Register, the Cochrane Central Register of Controlled Trials (CENTRAL) and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED and Global Health. We also searched the reference lists of relevant articles and contacted relevant professional organisations. Selection criteria Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series studies comparing stand alone clinical pathways with usual care as well as clinical pathways as part of a multifaceted intervention with usual care. Data collection and analysis Two review authors independently screened all titles to assess eligibility and methodological quality. Studies were grouped into those comparing clinical pathways with usual care and those comparing clinical pathways as part of a multifaceted intervention with usual care. Main results Twenty-seven studies involving 11,398 participants met the eligibility and study quality criteria for inclusion. Twenty studies compared stand alone clinical pathways with usual care. These studies indicated a reduction in in-hospital complications (odds ratio (OR) 0.58; 95% confidence interval (CI) 0.36 to 0.94) and improved documentation (OR 11.95: 95%CI 4.72 to 30.30). There was no evidence of differences in readmission to hospital or in-hospital mortality. Length of stay was the most commonly employed outcome measure with most studies reporting significant reductions. A decrease in hospital costs/ charges was also observed, ranging from WMD +261 US$ favouring usual care to WMD -4919 US$ favouring clinical pathways (in US$ dollar standardized to the year 2000). Considerable heterogeneity prevented meta-analysis of length of stay and hospital cost results. An assessment of whether lower hospital costs contributed to cost shifting to another health sector was not undertaken. Seven studies compared clinical pathways as part of a multifaceted intervention with usual care. No evidence of differences were found between intervention and control groups. Authors' conclusions Clinical pathways are associated with reduced in-hospital complications and improved documentation without negatively impacting on length of stay and hospital costs.

What is a clinical pathway? Development of a definition to inform the debate

Abstract: Background Clinical pathways are tools used to guide evidence-based healthcare that have been implemented internationally since the 1980s. However, there is widespread lack of agreement on the impact of clinical pathways on hospital resources and patient outcomes. This can be partially attributed to the confusion for both researchers and healthcare workers regarding what constitutes a clinical pathway. This paper describes efforts made by a team of Cochrane Review authors to develop criteria to assist in the objective identification of clinical pathway studies from the literature.

Traumatic Brain Injury: Rehabilitation for Everyday Adaptive Living, 2nd Edition

Abstract: 1. Mechanisms, recovery and sequelae of traumatic brain injury: a foundation for the real approach 2. Assessing and managing impairment of consciousness following traumatic brain injury 3. Assessment of participation, activity and cognition following traumatic brain injury 4. Managing cognitive problems 5. Communication competence following TBI: assessment and management 6. Assessment and management of behaviour problems 7. Returning to the community 8. Dealing with the impact of traumatic brain injury on psychological adjustment and relationships 9. Working with families 10. Traumatic brain injury in children 11. References

Measuring perception of communicative ability: the development and evaluation of the La Trobe communication questionnaire

Abstract: The La Trobe communication questionnaire (LCQ) was designed to measure perceived communicative ability. It was developed to enable collection of information from various sources including the self-perceptions of individuals as well as the perceptions of close others. In this paper we report the development of the questionnaire, its psychometric properties and normative data for the perceptions of young adults and the comparative perceptions of their close others. Participants in the study were 256 adults comprising 147 primary subjects and 109 close others. Primary subjects ranged in age from 16-39 years with a mean age of 20.6 years. The 30 item questionnaire was structured using a modified Likert-type scale with four possible levels of response: (1) never or rarely; (2) sometimes; (3) often; and (4) usually or always. Internal consistency was high (Cronbach's alpha = 0.8596) and good stability over time for self-report was demonstrated (r = 0.7558). There was a significant difference (p < 0.0001) betwee...

The effects of clinical pathways on professional practice, patient outcomes, length of stay, and hospital costs: Cochrane systematic review and meta-analysis.

Abstract: This paper is a summary version of the previously published Cochrane review. It may increase the reach of the topic to health researchers and practitioners and encourage further discussion. The systematic review aims to summarize the evidence and assess the effect of clinical pathways on professional practice, patient outcomes, length of hospital stay, and hospital costs. The authors searched the Database of Abstracts of Reviews of Effectiveness, the Effective Practice and Organisation of Care Register, the Cochrane Central Register of Controlled Trials and bibliographic databases including MEDLINE, EMBASE, CINAHL, NHS EED, and Global Health. Twenty-seven studies considering a total of 11,398 participants were included for analysis. The main results were a reduction in in-hospital complications (odds ratio 0.58: 95% CI [0.36, 0.94] and improved documentation (odds ratio 11.95: 95% CI [4.72, 30.30]) associated with clinical pathways. Considerable variation in study design and settings prevented statistical pooling of results for length of stay (LOS) and hospital costs. The authors concluded that clinical pathways are associated with reduced in-hospital complications and improved documentation.

Principles of Neural Science

Abstract: I have developed "tennis elbow" from lugging this book around the past four weeks, but it is worth the pain, the effort, and the aspirin. It is also worth the (relatively speaking) bargain price. Including appendixes, this book contains 894 pages of text. The entire panorama of the neural sciences is surveyed and examined, and it is comprehensive in its scope, from genomes to social behaviors. The editors explicitly state that the book is designed as "an introductory text for students of biology, behavior, and medicine," but it is hard to imagine any audience, interested in any fragment of neuroscience at any level of sophistication, that would not enjoy this book. The editors have done a masterful job of weaving together the biologic, the behavioral, and the clinical sciences into a single tapestry in which everyone from the molecular biologist to the practicing psychiatrist can find and appreciate his or

Research methods in social relations

Abstract: This sales letter may not influence you to be smarter, but the book that we offer will evoke you to be smarter. Yeah, at least you'll know more than others who don't. This is what called as the quality life improvisation. Why should this research methods in social relations? It's because this is your favourite theme to read. If you like this theme about, why don't you read the book to enrich your discussion?

Constructing a language: A usage-based theory of language acquisition

Abstract: Child psychiatrists, pediatricians, and other child clinicians need to have a solid understanding of child language development. There are at least four important reasons that make this necessary. First, slowing, arrest, and deviation of language development are highly associated with, and complicate the course of, child psychopathology. Second, language competence plays a crucial role in emotional and mood regulation, evaluation, and therapy. Third, language deficits are the most frequent underpinning of the learning disorders, ubiquitous in our clinical populations. Fourth, clinicians should not confuse the rich linguistic and dialectal diversity of our clinical populations with abnormalities in child language development. The challenge for the clinician becomes, then, how to get immersed in the captivating field of child language acquisition without getting overwhelmed by its conceptual and empirical complexity. In the past 50 years and since the seminal works of Roger Brown, Jerome Bruner, and Catherine Snow, child language researchers (often known as developmental psycholinguists) have produced a remarkable body of knowledge. Linguists such as Chomsky and philosophers such as Grice have strongly influenced the science of child language. One of the major tenets of Chomskian linguistics (known as generative grammar) is that children’s capacity to acquire language is “hardwired” with “universal grammar”—an innate language acquisition device (LAD), a language “instinct”—at its core. This view is in part supported by the assertion that the linguistic input that children receive is relatively dismal and of poor quality relative to the high quantity and quality of output that they manage to produce after age 2 and that only an advanced, innate capacity to decode and organize linguistic input can enable them to “get from here (prelinguistic infant) to there (linguistic child).” In “Constructing a Language,” Tomasello presents a contrasting theory of how the child acquires language: It is not a universal grammar that allows for language development. Rather, human cognition universals of communicative needs and vocal-auditory processing result in some language universals, such as nouns and verbs as expressions of reference and predication (p. 19). The author proposes that two sets of cognitive skills resulting from biological/phylogenetic adaptations are fundamental to the ontogenetic origins of language. These sets of inherited cognitive skills are intentionreading on the one hand and pattern-finding, on the other. Intention-reading skills encompass the prelinguistic infant’s capacities to share attention to outside events with other persons, establishing joint attentional frames, to understand other people’s communicative intentions, and to imitate the adult’s communicative intentions (an intersubjective form of imitation that requires symbolic understanding and perspective-taking). Pattern-finding skills include the ability of infants as young as 7 months old to analyze concepts and percepts (most relevant here, auditory or speech percepts) and create concrete or abstract categories that contain analogous items. Tomasello, a most prominent developmental scientist with research foci on child language acquisition and on social cognition and social learning in children and primates, succinctly and clearly introduces the major points of his theory and his views on the origins of language in the initial chapters. In subsequent chapters, he delves into the details by covering most language acquisition domains, namely, word (lexical) learning, syntax, and morphology and conversation, narrative, and extended discourse. Although one of the remaining domains (pragmatics) is at the core of his theory and permeates the text throughout, the relative paucity of passages explicitly devoted to discussing acquisition and proBOOK REVIEWS