DOCSLIB.ORG

The THISTLE Stepped-Wedge Design Randomised Controlled Trial

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The THISTLE Stepped-Wedge Design Randomised Controlled Trial ORIGINAL RESEARCH BMJ Qual Saf: first published as 10.1136/bmjqs-2018-008625 on 13 July 2019. Downloaded from Effect of hands-on interprofessional simulation training for local emergencies in Scotland: the THISTLE stepped-wedge design randomised controlled trial Erik Lenguerrand, 1 Cathy Winter,2 Dimitrios Siassakos,3 Graeme MacLennan,4 Karen Innes,4 Pauline Lynch,5 Alan Cameron,6 Joanna Crofts,2 Alison McDonald,4 Kirsty McCormack,4 Mark Forrest,4 John Norrie,7 Siladitya Bhattacharya,8 Tim Draycott1,2 5mins ► Additional material is ABSTRACT effect on the rate of Apgar <7 in Scotland during the published online only. To view Objective To assess whether the implementation of study period. Local implementation at scale was found please visit the journal online an intrapartum training package (PROMPT (PRactical to be more difficult than anticipated. Further research (http:// dx. doi. org/ 10. 1136/ Obstetric Multi-Professional Training)) across a health is required to understand why the positive effects bmjqs- 2018- 008625). service reduced the proportion of term babies born with observed in other single-unit studies have not been 5mins For numbered affiliations see Apgar score <7 at 5 min (<7 ). replicated in Scottish maternity units, and how units can end of article. Design Stepped-wedge cluster randomised controlled be best supported to locally implement the intervention trial. authentically and effectively. Correspondence to Setting Twelve randomised maternity units with ≥900 Trial registration number ISRCTN11640515. Dr Erik Lenguerrand, births/year in Scotland. Three additional units were Translational Health Sciences, included in a supplementary analysis to assess the effect University of Bristol, Bristol BS8 across Scotland. The intervention commenced in March 1TH, UK; 2014 with follow-up until September 2016. erik. lenguerrand@ bristol. ac. uk INTRODUCTION http://qualitysafety.bmj.com/ Intervention The PROMPT training package (Second 1–3 Maternity care in the UK could be safer. edition), with subsequent unit-level implementation of Received 23 July 2018 Perinatal outcomes are substantially Revised 19 June 2019 PROMPT courses for all maternity staff. 4 Accepted 24 June 2019 Main outcome measures The primary outcome was worse than in countries of similar GDP the proportion of term babies with Apgar<75mins. and more than 50% of adverse pregnancy Results 87 204 eligible births (99.2% with an Apgar outcomes are considered preventable.5–7 score), of which 1291 infants had an Apgar<75mins were Training for intrapartum emergen- delivered in the 12 randomised maternity units. Two cies has been recommended to improve units did not implement the intervention. The overall 3–6 8–10 5mins care and mandated by litigation Apgar<7 rate observed in the 12 randomised units 11 12 was 1.49%, increasing from 1.32% preintervention to authorities but data regarding effec- on September 26, 2021 by guest. Protected copyright. 1.59% postintervention. Once adjusted for a secular tive intrapartum training are conflicting. time trend, the ’intention-to-treat’ analysis indicated Some training programmes have been a moderate but non-significant reduction in the rate associated with significant safety improve- of term babies with an Apgar scores <75mins following ments,13–18 whereas other initiatives have PROMPT training (OR=0.79 95%CI(0.63 to 1.01)). reported either no change16 19 or a dete- However, some units implemented the intervention rioration in outcomes.15 Observational earlier than their allocated step, whereas others studies of a multiprofessional intra- © Author(s) (or their delayed the intervention. The content and authenticity employer(s)) 2019. Re-use of the implemented intervention varied widely at unit partum emergencies training course for permitted under CC BY-NC. No level. When the actual date of implementation of the local maternity staff—PRactical Obstetric commercial re-use. See rights intervention in each unit was considered in the analysis, Multi-Professional Training—(PROMPT, and permissions. Published by there was no evidence of improvement (OR=1.01 Bristol, UK) have previously demonstrated BMJ. (0.84 to 1.22)). No intervention effect was detected by improved compliance with clinical stan- To cite: Lenguerrand E, broadening the analysis to include all 15 large Scottish dards,13 17 reductions in clinical error14 Winter C, Siassakos D, et al. maternity units. Units with a history of higher rates of 5mins and sustainable improvements in perinatal BMJ Qual Saf Epub ahead of Apgar<7 maintained higher Apgar rates during the 20 print: [please include Day study (OR=2.09 (1.28 to 3.41)) compared with units with outcomes. These positive effects were Month Year]. doi:10.1136/ pre-study rates aligned to the national rate. initially observed in a single maternity unit bmjqs-2018-008625 Conclusions PROMPT training, as implemented, had no but have since been repeated across other Lenguerrand E, et al. BMJ Qual Saf 2019;0:1–13. doi:10.1136/bmjqs-2018-008625 1 Original research BMJ Qual Saf: first published as 10.1136/bmjqs-2018-008625 on 13 July 2019. Downloaded from international settings.21–23 Although these early data are (SW-RCT). This was viewed as the safest, most prag- extremely encouraging, it is important to determine matic and ethical option, with the additional rigour of whether these improvements could be replicated at randomisation. scale across a national health system using a robust study The study comprised a control period when none of design such as a randomised controlled trial (RCT). the units received training, three intervention periods, With over 50 000 births annually,24 Scotland and at least two follow-up periods (figure 1). Four provided an ideal setting to investigate the effect of maternity units were randomised to each interven- implementing PROMPT training at national scale. tion step. Each period lasted 6 months to allow all 12 Only 3 of the 15 Scottish maternity units (≥900 births units to receive their intervention within 18 months. annually—2012) had previously undertaken PROMPT This would reduce potential contamination between training. Moreover, all NHS maternity outcomes trained and untrained units (rotation of trained staff are routinely collated centrally by the Information between units) within the pragmatic funding and time Statistics Division Scotland (ISD), providing a robust constraints. data set for analysis. Finally, the proportion of term Maternity units in NHS Scotland with ≥900 births/ babies with Apgar <7 at 5 min (Apgar<75mins),25 an year (n=15) that had not previously participated in the outcome that has previously been shown to be reduced PROMPT T3 programme were eligible (n=12) and following PROMPT training, was higher in Scotland invited to participate through the Scottish Committee 13 than in other settings (1.19% between 2004 and of the Royal College of Obstetricians and Gynaecolo- 2009, data from ISD Scottish Morbidity Record (SMR gists. The three units that had already been conducting 02). PROMPT training prior to this study were included in The aim of this study was to conduct an RCT to a supplementary preplanned analysis to assess the inter- investigate whether the implementation of an intra- vention at national scale. Units with <900 births/year partum emergencies training package across all large were excluded (<6% of births between 01/01/2000 maternity units within an entire health service could and 30/09/2013), as their staffing structures may have reduce the proportion of term babies with an Apgar differed from the larger units. Babies born preterm, 5mins score <7 . at home, at other hospitals and then transferred to a participating unit were all excluded, as were those METHODS confirmed to have an intrauterine death prior to The protocol for this trial has been published previ- labour. Babies born by elective caesarean section (CS) ously.26 were also excluded as their care was not impacted by Intervention the intrapartum training provided by PROMPT. The The intervention was the PROMPT training package first four participating maternity units attended a T3 http://qualitysafety.bmj.com/ (Second edition), which included a 2 day PROMPT programme in March 2014. The 6-month period Train the Trainers (T3) programme (TIDieR check- preceding the start of the first intervention period list, online supplementary appendix 1), with subse- (‘Intervention 1’) (01/10/2013–01/04/2014) was iden- quent unit-level implementation of local PROMPT tified as the control period (‘Control’). The study courses for all maternity staff. PROMPT courses are ended with the completion of the last follow-up period ‘in-house’, adaptable multiprofessional training days (‘Follow-up period 2’) on the 30/09/2016. which cover the management of core obstetric emer- gencies, including postpartum haemorrhage, sepsis and Randomisation, concealment and blinding shoulder dystocia as well as fetal monitoring in labour on September 26, 2021 by guest. Protected copyright. One eligible maternity unit that had attended and team-working. Each participating maternity unit PROMPT T3 training before the start of the study identified a multiprofessional ‘in-house’ training team but had not commenced ‘in-house’ local PROMPT (recommended: two midwives, one obstetrician and courses, was allocated to period 1 for inclusion in the one anaesthetist) to attend the T3 programme at The study. The remaining participating units were allocated Scottish Clinical Simulation Centre in Larbert, before to an intervention period using the ‘imbalance statistic’ the start of their allocated intervention step. The T3 29 30 programme included a demonstration ‘PROMPT method to balance units by size (small, medium, Course’ and a T3 day to guide ‘in house’ trainers in large annual births). An independent statistician from how to use the PROMPT Course-in-a-Box (Second the Centre for Healthcare Randomised Trials (CHaRT) Edition) and set up local PROMPT courses.27 28 The randomly selected an allocation sequence list from a ‘in-house’ trainers were asked to implement local subset with the most desirable balance properties using PROMPT courses, aiming to train all their maternity computer-generated random numbers.
Load more

Recommended publications
  • The Construction of the Scottish Military Identity
    RUINOUS PRIDE: THE CONSTRUCTION OF THE SCOTTISH MILITARY IDENTITY, 1745-1918 Calum Lister Matheson, B.A. Thesis Prepared for the Degree of MASTER OF ARTS UNIVERSITY OF NORTH TEXAS August 2011 APPROVED: Geoffrey Wawro, Major Professor Guy Chet, Committee Member Michael Leggiere, Committee Member Richard McCaslin, Chair of the Department of History James D. Meernik, Acting Dean of the Toulouse Graduate School Matheson, Calum Lister. Ruinous pride: The construction of the Scottish military identity, 1745-1918. Master of Arts (History), August 2011, 120 pp., bibliography, 138 titles. Following the failed Jacobite Rebellion of 1745-46 many Highlanders fought for the British Army in the Seven Years War and American Revolutionary War. Although these soldiers were primarily motivated by economic considerations, their experiences were romanticized after Waterloo and helped to create a new, unified Scottish martial identity. This militaristic narrative, reinforced throughout the nineteenth century, explains why Scots fought and died in disproportionately large numbers during the First World War. Copyright 2011 by Calum Lister Matheson ii TABLE OF CONTENTS Page CHAPTER I: THE HIGHLAND WARRIOR MYTH ........................................................... 1 CHAPTER II: EIGHTEENTH CENTURY: THE BUTCHER‘S BILL ................................ 10 CHAPTER III: NINETEENTH CENTURY: THE THIN RED STREAK ............................ 44 CHAPTER IV: FIRST WORLD WAR: CULLODEN ON THE SOMME .......................... 68 CHAPTER V: THE GREAT WAR AND SCOTTISH MEMORY ................................... 102 BIBLIOGRAPHY ......................................................................................................... 112 iii CHAPTER I THE HIGHLAND WARRIOR MYTH Looking back over nearly a century, it is tempting to see the First World War as Britain‘s Armageddon. The tranquil peace of the Edwardian age was shattered as armies all over Europe marched into years of hellish destruction.
    [Show full text]
  • Young People, Their Carers and the Unit Cultures Anne Claveirole Phd Thesis NAPIER UNIVERSITY 2005
    Listening to the Voices in Four Scottish Adolescent Mental Health Units: Young People, their Carers and the Unit Cultures Anne Claveirole PhD Thesis NAPIER UNIVERSITY 2005 LISTENING TO THE VOICES IN FOUR SCOTTISH ADOLESCENT MENTAL HEALTH UNITS: YOUNG PEOPLE, THEIR CARERS AND THE UNIT CULTURES Thesis submitted in partfulfilment of the requirements for the degree of DOCTOR OF PIDLOSOPHY at The Faculty of Health and Life Sciences NAPIER UNIVERSITY by ANNE CLAVEIROLE June 2005 DECLARATION I declare that this thesis is my own work and that no material contained in it has been submitted for another academic award ~ Anne Claveirole ACKNOWLEDGEMENTS Many people have helped in the completion of this thesis. I should like to thank Andy Gibbs and the School of Community Health at Napier University. Without the School's financial support this study would not have been possible. I would also like to thank my colleagues in the mental health team and in the School for their patience and encouragement. Thanks are due to the Association for Professionals in Services for Adolescents (APSA) who paid for my travelling expenses during the data collection. I am indebted to the NHS services where my data was collected for their co-operation. My deepest gratitude goes to the young people, their parents and the unit staff who shared their lives and stories with me. I am most indebted to my supervisors Dr Maureen Macmillan and Dr David Lyall for their unfailing encouragement, advice and kindness. Throughout my studies, they have given their time generously and their academic expertise has been a source of inspiration to me.
    [Show full text]
  • A History of 119 Infantry Brigade in the Great War with Special Reference To
    The History of 119 Infantry Brigade in the Great War with Special Reference to the Command of Brigadier-General Frank Percy Crozier by Michael Anthony Taylor A thesis submitted to the University of Birmingham for the degree of DOCTOR OF PHILOSOPHY Department of History School of History and Cultures College of Arts and Law University of Birmingham September 2016 University of Birmingham Research Archive e-theses repository This unpublished thesis/dissertation is copyright of the author and/or third parties. The intellectual property rights of the author or third parties in respect of this work are as defined by The Copyright Designs and Patents Act 1988 or as modified by any successor legislation. Any use made of information contained in this thesis/dissertation must be in accordance with that legislation and must be properly acknowledged. Further distribution or reproduction in any format is prohibited without the permission of the copyright holder. Abstract 119 Brigade, 40th Division, had an unusual origin as a ‘left-over’ brigade of the Welsh Army Corps and was the only completely bantam formation outside 35th Division. This study investigates the formation’s national identity and demonstrates that it was indeed strongly ‘Welsh’ in more than name until 1918. New data on the social background of men and officers is added to that generated by earlier studies. The examination of the brigade’s actions on the Western Front challenges the widely held belief that there was an inherent problem with this and other bantam formations. The original make-up of the brigade is compared with its later forms when new and less efficient units were introduced.
    [Show full text]
  • GGA-Policy-Organization-And-Rules-1957.Pdf
    THE POLICY, ORGANIZATION, AND RULES OF THE GIRL GUIDES ASSOCIATION (Incorporated by Royal Charter) PATRONS HER MAJESTY QUEEN ELIZABETH II HER MAJESTY QUEEN ELIZABETH THE QUEEN MOTHER PRESIDENT HER ROYAL HIGHNESS THE PRINCESS ROYAL 1957 LONDON THE GIRL GUIDES ASSOCIATION Commonwealth Headquarters TWO SHILLINGS First Edition, 1916 Twenty-first Edition, 1936 Twenty-second Edition, 1938 Twenty-third Edition, 1939 Twenty-fourth Edition, 1943 Twenty-fifth Edition, 1947 Twenty-sixth Edition, 1950 Twenty-seventh Edition, 1953 Twenty-eighth Edition, 1957 • THE GIRL GUIDES ASSOCIATION Commonwealth Headquarters P.O. Box 269, 17-19 Buckingham Palace Road, London, S.W.1, England. Telephone: VICtoria 6001 (4 lines) 'GIRL GUIDES' 11.40. MAO. 1111/.. Made and printed in England by STAPLES PRINTERS LIMITED at their Rochester, Kent, establishment CONTENTS PAGE THE FOUNDER'S FOREWORD . IV PROMISE, LAW, AND MOTTO . V EXPLANATIONS, ABBREVIATIONS, AND SYMBOLS Vi GENERAL PRINCIPLES . 1 ORGANIZATION AND ADMINISTRATION 5 OVERSEAS . 15 THE BROWNIE BRANCH 17 THE GUIDE BRANCH • 28 THE RANGER BRANCH • 60 THE CADET SECTION . 95 GUIDING IN SCHOOLS, COLLEGES, AND UNIVERSITIES . 99 THE LONE SECTION . 102 THE EXTENSION SECTION . 105 THE AUXILIARY SECTION . 111 THE TREFOIL GUILD 113 UNIFORM • 116 TRAINING 130 CAMPING 136 INTERNATIONAL RELATIONS • 146 PUBLIC RELATIONS . 149 BOY Scours • 151 TESTING . • 152 BATHING, BOATING, AND AIR SAFETY • 154 THE ASSOCIATION AWARDS 162 MISCELLANEOUS RULES . • 164 BIBLIOGRAPHY: List of Training Handbooks and other useful publications . 166 BRANCH SHOPS . 169 REGISTERED GOODS 170 INDEX 171 iii THE FOUNDER'S FOREWORD MAY I draw your attention to the fact that the following pages contain RULES, not REGULATIONS. There is a world of difference between the two.
    [Show full text]
  • THE POLICY, ORGANIZATION, and RULES of the GIRL GUIDES ASSOCIATION (Incorporated by Royal Charter)
    -- THE POLICY, ORGANIZATION, AND RULES OF THE GIRL GUIDES ASSOCIATION (Incorporated by Royal Charter) JULY 1961 With all amendments brought into effect since the 1960 edition, including those pub- lished in THE GUIDER of 1st July, 1961: all revision of Policy, Organization, or Rules takes effect as from the date of Pub- lication in THE GUIDER of January and July in each year. LONDON THE GIRL GUIDES ASSOCIATION Commonwealth Headquarters Two Shillings and Sixpence © Girl Guides Association First Edition, 1916 Twenty-eighth Edition, 1957 Twenty-ninth Edition, 1960 Thirtieth Edition, 1961 A THE GIRL GUIDES ASSOCIATION Commonwealth Headquarters P.O. Box 269, 17-19 Buckingham Palace Road London, S.W.1, England. Telephone: VICtoria 6001 (4 lines) • GIRL GUIDES H.. TAM" 11A. Made and Printed in England by STAPLES PRINTERS LIMITED at their Rochester, Kent, establishment CONTENTS PAGE THE FOUNDER'S FOREWORD iV PROMISE, LAW, AND MOTTO v EXPLANATIONS, ABBREVIATIONS, AND SYMBOLS Vi GENERAL PRINCIPLES 1 ORGANIZATION AND ADMINISTRATION 5 OVERSEAS 16 THE BROWNIE BRANCH 18 THE GUIDE BRANCH 29 THE SENIOR BRANCH 62 RANGERS . 62 CADETS . 99 GUIDING IN SCHOOLS, COLLEGES, AND UNIVERSITIES 103 THE LONE SECTION . 106 THE EXTENSION SECTION 109 THE TREFOIL GUILD 115 UNIFORM 118 TRAINING . 134 CAMPING 139 INTERNATIONAL RELATIONS 150 PUBLIC RELATIONS 153 BOY SCOUTS . 155 TESTING . 156 BATHING, BOATING, AND Am SAFETY 158 THE ASSOCIATION AWARDS 166 MISCELLANEOUS RULES • 169 BOOK LIST • 171 BRANCH SHOPS • 174 REGISTERED GOODS • 175 INDEX . 176 iii THE FOUNDER'S FOREWORD MAY I draw your attention to the fact that the following pages contain RULES, not REGULATIONS. There is a world of difference between the two.
    [Show full text]
  • 2 Capturing Gradience, Continuous Change, and Quasi-Regularity in Sound, Word, Phrase, and Meaning
    Trim size: 170mm x 244mm MacWhinney c02.tex V1 - 08/18/2014 12:43 A.M. Page 53 2 Capturing Gradience, Continuous Change, and Quasi-Regularity in Sound, Word, Phrase, and Meaning JAMES L. MCCLELLAND 1. Visions of Language One vision of the nature of language holds that a language consists of a set of symbolic unit types, and a set of units of each type, together with a set of grammatical princi- ples that constrain how these units can be used to compose other units, and a system of rules that project structured arrangements of such units onto other structured arrange- ments of units (for example, from syntactic to semantic structure). An alternative vision of the nature of language holds that it is often useful to characterize language as if the above statements were true, but only as a way of approximately notating or summa- rizing aspects of language. In reality, according to this alternative vision, approximate conformity to structured systems of symbolic units and rules arises historically, devel- opmentally, and in the moment, from the processes that operate as users communicate with each other using sound or gesture as their medium of communication. These acts of communication leave residues that can be thought of as storing knowledge in the form of the continuous-valued parameters of a complex dynamical system (i.e. a system characterized by continuous, stochastic, and non-linear differential equations). Greatly influenced by the work of Joan Bybee (1985, 2001) and others who have pointed outsome of its advantages, I am a disciple of this alternative vision (Bybee and McClelland, 2005; McClelland and Bybee, 2007).
    [Show full text]
  • STEM-ED Scotland Building a New Educational Framework to Address the STEM Skills Gap a Fundamental Review from a 21St Century Perspective
    STEM-ED Scotland Building a New Educational Framework to Address the STEM Skills Gap A fundamental review from a 21st century perspective Report by STEM-ED Scotland December 2010 STEM-ED Scotland is a partnership aiming to champion world class education in Science, Technology, Engineering and Mathematics Acknowledgements The work of this report was carried out by STEM-ED Scotland, and the authors would like to thank our funders, the Scottish Funding Council, for providing the support that made this project possible. Thanks are also due to the University of Glasgow, who kindly allow us the use of our office space. Authors Professor John Coggins Pro Vice Principal, the University of Glasgow Professor Alan Roach STEM-ED Scotland, the University of Glasgow Dr Michael Guy STEM-ED Scotland, the University of Glasgow Moira Finlayson STEM-ED Scotland, the University of Glasgow Nigel Akam Skills Development Scotland Copyright © 2010 STEM-ED Scotland STEM-ED Scotland 12a the Square University of Glasgow Glasgow, G12 8QQ Web: http//www.gla.ac.uk/stem Contents Executive summary .................................................................................... v Chapter 1: Introduction .............................................................................. 1 1.1 The new context for education in science, engineering and technology .... 3 1.2 The modern priorities in STEM education ........................................ 5 Chapter 2: International review ..................................................................... 9 2.1 Attitudes to
    [Show full text]
  • Encyclopaedia of Scientific Units, Weights and Measures Their SI Equivalences and Origins
    FrancËois Cardarelli Encyclopaedia of Scientific Units, Weights and Measures Their SI Equivalences and Origins English translation by M.J. Shields, FIInfSc, MITI 13 Contents List of Tables ....................................................... xvii 1 Introduction........................................................ 1 1.1 Why a Conversion Handbook?. .................................... 1 1.2 How to Use This Book . ........................................... 2 2The International System of Units . .................................... 3 2.1 History ........................................................ 3 2.2 The General Conference on Weights and Measures . ..................... 6 2.3 Organization of the SI . .......................................... 10 2.3.1 SI Base Units . .......................................... 10 2.3.2 SI Supplementary Units . ................................... 12 2.3.3 SI Derived Units .......................................... 13 2.3.4 Non-SI and SI Units Used in Combination . .................... 14 2.3.4.1 Commonly Used Legal Non-SI Units . .................... 14 2.3.4.2 Non-SI Units Defined by Experiment................... 14 2.3.4.3 Non-SI Units Temporarily Maintained.................. 15 2.3.4.4 Non-SI Units Which Must be Discontinued . ............. 15 2.4 SI Prefixes . .................................................. 15 3 Other Systems of Units .............................................. 19 3.1 MTS, MKpS, MKSA . .......................................... 19 3.1.1 The MKpS System .......................................
    [Show full text]
  • Scottish Haemodialysis Vascular Access Appraisal Report
    Scottish Haemodialysis Vascular Access Appraisal Report: Relating Variation in Outcomes to Variation in Processes Scottish Renal Registry In conjunction with Darlinda’s Charity for Renal Research and the University of Glasgow November 2015 Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association Scottish Haemodialysis Vascular Access Appraisal Report: Relating Variation in Outcomes to Variation in Processes Scottish Renal Registry In conjunction with Darlinda’s Charity for Renal Research and the University of Glasgow November 2015 Scott W. Oliver1, Jacqueline Campbell2, David B. Kingsmore3, Ram Kasthuri4, Jamie Traynor5, Wendy Metcalfe6, Peter C. Thomson7 Email: [email protected]; [email protected] Twitter: @VAccessScotland 1 Specialty Registrar in Renal Medicine; Clinical Teaching Fellow, NHS Lanarkshire; 2 Senior Information Analyst, Information Services Division, NHS National Services Scotland 3 Consultant Vascular and Renal Transplant Surgeon, NHS Greater Glasgow & Clyde; 4 Consultant Interventional Radiologist, NHS Greater Glasgow & Clyde; 5 Technical Director, Scottish Renal Registry & Consultant Nephrologist, NHS Greater Glasgow & Clyde; 6 Chair, Scottish Renal Registry & Consultant Nephrologist, NHS Lothian; 7 Consultant Nephrologist, NHS Greater Glasgow & Clyde. ii Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association CONTENTS LIST OF ACRONYMS .................................................................................................................. IV ACKNOWLEDGEMENTS ............................................................................................................
    [Show full text]
  • Œgmw Soldier Sfmlemfntiu Moy# Sfooa, 1710Ü775
    Frnm Swnrds fn PImiyhsharM; The Context for ŒgMW Soldier SfMlemfntiu MoY# SfoOa, 1710Ü775 Donald Brian Smith A Thesis submitted in partial fidBlhnent of the degree of Master of Arts (History) Saint Mary's University Halifax, Nova Scotia Copyright by Donald Brian Smith 2003 April 9th, 2003 Examining Committee Dr. Michael E. ^/ance Thesis Advisor , Dr. Jq|k G.jMd V Dr. Ron McDonald National Library Bibliothèque nationale of Canada du Canada Acquisitions and Acquisisitons et Bibliographic Services services bibliographiques 395 Wellington Street 395, rue Wellington Ottawa ON K1A0N4 Ottawa ON K1A0N4 Canada Canada Your file Votre référence ISBN: 0-612-83540-5 Our file Notre référence ISBN: 0-612-83540-5 The author has granted a non­ L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distribute or sell reproduire, prêter, distribuer ou copies of this thesis in microform, vendre des copies de cette thèse sous paper or electronic formats. la forme de microfiche/film, de reproduction sur papier ou sur format électronique. The author retains ownership of theL'auteur conserve la propriété du copyright in this thesis. Neither thedroit d'auteur qui protège cette thèse. thesis nor substantial extracts from Niit la thèse ni des extraits substantiels may be printed or otherwise de celle-ci ne doivent être imprimés reproduced without the author's ou aturement reproduits sans son permission. autorisation. Canada Table of Contents Acknowledgements
    [Show full text]
  • Screening for Colorectal Cancer: an Evidence Update for the U.S
    Evidence Synthesis Number 202 Screening for Colorectal Cancer: An Evidence Update for the U.S. Preventive Services Task Force Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. HHSA-290-2015-00007-I-EPC5, Task Order No. 6 Prepared by: Kaiser Permanente Evidence-based Practice Center Kaiser Permanente Center for Health Research Portland, OR Investigators: Jennifer S. Lin, MD, MCR Leslie A. Perdue, MPH Nora B. Henrikson, PhD, MPH Sarah I. Bean, MPH Paula R. Blasi, MPH AHRQ Publication No. 20-05271-EF-1 May 2021 This report is based on research conducted by the Kaiser Permanente Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2015-00007-I-EPC5, Task Order No. 6). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
    [Show full text]
  • Scottish Regimental History
    Scottish Regimental History Regiment/Division Author Title Number Date Location Number Account of the Scottish Regiments 1808-1861, (An) SRH 355.31 REG 1862 324783 Almanack of Scottish Regiments, (The) SRH 355.31 REG 1912 881502 Almanack of Scottish SRH 355.31 REG 1913 881507, 881692 ANDERSON, Douglas N. Scots in Uniform SRH 355.31 REG/AND 1972 881581 BARNES, Major R. Uniforms and History of Money the Scottish Regiments SRH 355.31 REG /BAR ND 738565 BAYNES, J. Soldiers of Scotland SRH 355.31 REG/ BAY 1988 899682 Scottish Highlanders and BRANDER, Michael their Regiments, (The) SRH 355.31 HIG/ BRA 1971 881593, 899601 Memento of the Great Scottish Volunteer Review before Her Majesty in the Queen's Park, Edinburgh, on the BRUCE, George 7th August 1860 SRH 355.31 VOL/ BRU 1860 102039 Story of the Scottish CALDER, Jenni Soldier, (The) 1600-1914 SRH 355.31 REG/ CAL 1987 899662 Notes on early Highland CAMPBELL, A.L. Regiments SRH 355.31 HIG /CAM 1982 881644, 881647 Scottish Units in the CHAPPELL, Mike World Wars SRH 355.31 SCO /CHA 1994 837267 Hector MacDonald: or the COATES, Thomas P.G. Private who became a SRH 355.31 HIG /MAC 1900 837742 COCHRANE, Peter Scottish Military Dress SRH 355.31 REG /COC 1987 899674 Highland Regiments, CROMB, J. (The) SRH 355.31 HIG /CRO 1886 95763, 241190, 642252 1 Regiment/Division Author Title Number Date Location Number Highland Brigade, (The): CROMB, J. Its Battles and its Heroes SRH 355.31 HIG/ CRO 1902 881633, 216142 Scots Army, (The) 1661- DALTON, Charles 1688 SRH 355.31 REG/ DAL 1909 244905 Scots Army, (The) 1661- DALTON, Charles 1688 SRH 355.31 REG /DAL 1989 899708 DEWAR, John & Sons Ltd.
    [Show full text]