scholarly journals Evaluation of two strategies to implement physical cancer rehabilitation guidelines for survivors of abdominopelvic cavity tumors: a controlled before-and-after study

2021 ◽  
Author(s):  
Charlotte IJsbrandy ◽  
Petronella B. Ottevanger ◽  
Winald R. Gerritsen ◽  
Wim H. van Harten ◽  
Rosella P. M. G. Hermens
Keyword(s):  
Primary Outcome ◽  
Healthcare Professionals ◽  
Patient Empowerment ◽  
Implementation Strategies ◽  
Primary Outcome Measure ◽  
Cancer Rehabilitation ◽  
Systematic Screening ◽  
Before And After ◽  
Before And After Study

Abstract Purpose This study evaluates the effectiveness and feasibility of two strategies to implement physical cancer rehabilitation (PCR) guidelines for patients who have survived abdominopelvic cavity malignancies. Methods We tested and compared two tailored strategies to implement PCR guidelines for survivors of gastrointestinal, female organ and urogenital organ malignancies, in a clustered controlled before-and-after study. A patient-directed (PD) strategy was tested in five cancer centers, aiming to empower survivors. A multifaceted (MF) strategy was tested in four cancer centers, aiming additionally to influence healthcare professionals and the healthcare organization. Data were collected from existing registration systems, patient questionnaires and professional questionnaires. We measured both implementation- and client outcomes. For insight into the effectiveness we measured indicators related to PCR guidelines: (1) screening with the Distress Thermometer (DT) (=primary outcome measure), (2) information provision concerning physical activity (PA) and physical cancer rehabilitation programs (PCRPs), (3) advice to take part in PA and PCRPs, (4) referral to PCRPs, (5) participation in PCRPs, (6) PA uptake (PAU); and patient reported outcomes (PROs) such as (7) quality of life, (8) fatigue, and (9) empowerment. Furthermore, survivor and center determinants were assessed as possible confounders. Multilevel analyses were performed to compare the scores of the indicators of the PD and MF strategies, as well as the differences between the characteristics of these groups. The use of and experiences with both strategies were measured using questionnaires and Google Analytics to assess feasibility. Results In total, 1326 survivors participated in the study, 673 in the before- and 653 in the after-measurement. Regarding our primary outcome measure, we found a significant improvement of screening with the DT between the before- and after-measurement for both strategies, respectively from 34.2 to 43.1% (delta=8.9%; odds ratio (OR)=1.6706; p=0.0072) for the PD strategy and from 41.5 to 56.1% (delta=14.6%; OR=1.7098; p=0.0028) for the MF strategy. For both the primary and secondary outcomes, no statistically significant effect of the MF strategy compared to the PD strategy was observed. We found good use of and positive experiences with both strategies. Conclusion Implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT for survivors of abdominopelvic cavity malignancies. Further research is needed to assess the additional effectiveness of strategies that stimulate compliance among healthcare professionals and healthcare organizations. Implications for Cancer Survivors Using implementation strategies containing tools enhancing patient empowerment seem to be effective in increasing the systematic screening with the DT and might improve the quality of care of patients who have survived abdominopelvic cavity malignancies.

Is this an epic innovation? Electronic health record implementation and healthcare workers’ work characteristics and autonomous motivation – a before-and-after study

2021 ◽  
Author(s):  
Gepke L Veenstra ◽  
Eric F. Rietzschel ◽  
Eric Molleman ◽  
Erik Heineman ◽  
Jan Pols ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Healthcare Professionals ◽  
Work Motivation ◽  
Autonomous Motivation ◽  
Health Record ◽  
Work Characteristics ◽  
Job Autonomy ◽  
Before And After ◽  
Before And After Study

Abstract Background Technological innovation in healthcare is often assumed to contribute to the quality of care. However, the question how technology implementation impacts healthcare workers has received little empirical attention. This study investigates the consequences of Electronic Health Record (EHR) implementation for healthcare workers’ work motivation. The consequences of EHR implementation for healthcare workers’ autonomous work motivation are hypothesized to be mediated by changes in perceived work characteristics (job autonomy and interdependence). Additionally, a moderating effect of profession on the relationship between EHR implementation and work characteristics is explored.Methods A quantitative uncontrolled before-and-after study was performed among employees from a large university medical centre in the Netherlands. Data were analysed following the component approach for testing a first stage moderated mediation model, using Generalized Estimating Equations (GEE). Results A total of 456 healthcare workers (75 physicians, 154 nurses, 145 allied healthcare professionals, and 82 administrative workers) finished both the baseline and the follow-up survey. After EHR implementation, job autonomy decreased, whereas interdependence increased. In line with our hypothesis, job autonomy was positively associated with autonomous motivation. Interdependence showed the same association, which we did not anticipate. Autonomous motivation was stable over the course of EHR implementation. This study did not provide support for a moderating effect of profession, meaning that no differences were observed between the various professions regarding the changes in their experienced job autonomy and interdependence after EHR implementation. Conclusions Our study showed that healthcare professionals’ work characteristics, but not their autonomous motivation, are affected by EHR implementation, and that these experiences were relatively similar for physicians, nurses, allied healthcare professionals. The stability of healthcare workers’ autonomous motivation may be explained by the opposite effects of decreased job autonomy and increased interdependence, and the EHR being in line with healthcare workers’ values. The changes in job autonomy and interdependence may have consequences beyond motivation, for example by affecting clinical decision making, proactive behaviour, and the quality of teamwork. These potential consequences of EHR implementation warrant further research.

scholarly journals Audit of documentation proficiency of emergency department patients who are discharged against medical advice before and after implementation of a checklist

2016 ◽  
Vol 5 (4) ◽  
pp. 28
Author(s):  
Sze Joo Juan ◽  
Ghee Hian Lim ◽  
Beng Leong Lim
Keyword(s):  
Emergency Department ◽  
Primary Outcome ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Documentation Quality ◽  
Before And After ◽  
Discharge Against Medical Advice ◽  
Emergency Department Patients ◽  
A Prospective Study

Objective: Documentation of the discharge against medical advice (AMA) is poorly performed in the emergency department (ED). Little is known about the impacts of a checklist on this. Our study aimed to compare the quality of AMA documentation before and after implementation of a checklist.Methods: A retrospective review was conducted followed by a prospective study; each over three months of AMA interactions in our ED pre and post implementation of a checklist. An 11-point checklist was used to determine documentation quality during these two periods. Quality was assessed based on the number of points fulfilled on this tool. Documentation was classified as “good” (8-11), “average” (4-7) and “poor” (0-3). The primary outcome measured was the proportions of discharged AMA records that showed “good”, “average” and “poor” documentation. Secondary outcomes were compliance rates to each of the categories of the checklist before and after its use.Results: 339 and 309 complete records were retrieved from the retrospective and prospective arms respectively. The proportions of case records in the three grades before and after use of the checklist respectively were: poor, 199/339 (59%) vs. 7/313 (2%); fair, 133/339 (39%) vs. 66/313 (21%) and good 7/339 (2%) vs. 240/313 (77%); all p-values were statistically significant. There were also statistically significant differences in compliance rates to each of the categories of the checklist pre and post checklist implementation.Conclusions: This study shows improvement in quality and compliance rates in the audit categories after the implementation of an AMA checklist.

Implementation of effective, self-sustaining headache services in the Republic of Georgia: Evaluation of their impact on headache-related disability and quality of life of people with headache

Cephalalgia ◽  
2017 ◽  
Vol 38 (4) ◽  
pp. 639-645 ◽  
Author(s):  
Gvantsa Giorgadze ◽  
Maka Mania ◽  
Maka Kukava ◽  
Ana Dzagnidze ◽  
Ekaterine Mirvelashvili ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Episodic Migraine ◽  
Primary Outcome Measure ◽  
Tension Type Headache ◽  
International Standards ◽  
Pharmaceutical Companies ◽  
The Republic ◽  
Type Headache

Background Headache disorders are widespread and disabling. They are common in Georgia, especially headache on ≥15 days/month (HA ≥ 15), but there are no headache services. Objective We established headache services meeting local needs, investigating feasibility, consumer uptake and satisfaction, and cost, with an exit strategy bequeathing effective, self-sustaining services that could be rolled out nationwide. Methods We created headache centres in Tbilisi and Gori offering free expert care for three visits over three months, and affordable medication thereafter. The primary outcome measure was the percentage of patients using the service beyond the free period – a measure of both satisfaction and sustainability. Results Of 1,445 patients (age 43.7 ± 12.4 years; 10.5% male), 49.8% had episodic migraine, 22.5% episodic tension-type headache, 25.7% HA ≥ 15 (24.5% overusing medication) and 2.0% trigeminal autonomic cephalalgias. Only 454 (31.4%) and 51 (3.5%) returned for second and third visits; in these, headache improved and treatment costs decreased. As information about the service spread, five other headache clinics opened in Tbilisi and Kutaisi (western Georgia). Pharmaceutical companies reduced prices (sumatriptan 100 mg from US$7 to US$1). Conclusion The study failed to achieve its primary outcome, but sustainable headache services operating to international standards were successfully implemented nonetheless, with demand increasing.

scholarly journals Quality of Life Comparison in Common Rhinologic Surgeries

2012 ◽  
Vol 3 (1) ◽  
pp. ar.2012.3.0020 ◽  
Author(s):  
Mohsen Naraghi ◽  
Behrooz Amirzargar ◽  
Alipasha Meysamie
Keyword(s):  
Quality Of Life ◽  
Statistical Difference ◽  
Sleep Problems ◽  
Sinus Surgery ◽  
Before And After ◽  
General Feeling ◽  
Related Quality ◽  
Health Related ◽  
Before And After Study

Various questionnaires are used in patients who undergo rhinologic surgeries but a unique comprehensive questionnaire is needed to evaluate quality of life (QOL) in rhinologic surgeries. The purpose of this study was to prepare a comprehensive questionnaire and compare QOL among four common rhinologic surgeries including functional endoscopic sinus surgery, septoplasty, septorhinoplasty, and septoplasty with turbinoplasty preoperatively and 6 months postoperatively. This was a prospective interventional before-and-after study. Preoperative and 6 months postoperative evaluations were performed with a Modified Health-Related Quality of Life (HRQL) questionnaire designed to cover all needed QOL aspects and the 22-item Sino-nasal Outcome Test questionnaire to cover all needed QOL aspects. The Modified HRQL included 33 items in six subgroups (nasal symptoms, sleep problems, headache, nonnasal symptoms, and practical and emotional problems) and general feeling. From 202 patients who completed the questionnaire before the procedures, 146 (72% of all patients) who were interviewed 6 months postoperatively were included in this study. Comparing preoperative data between followed up patients and missed patients showed no statistical difference among surgeries (p = 0.90). Comparison of patient's pre- and postoperative QOL showed a significant improvement in global QOL and in all questionnaire items (p < 0.0001 in all comparisons). Comparison of QOL changes before and after surgery among different surgeries revealed no statistical difference (p = 0.282). Our data showed a significant improvement in each surgery but the amount of improvement in different surgeries was almost constant.

External Qigong for Chronic Pain

2010 ◽  
Vol 38 (04) ◽  
pp. 695-703 ◽  
Author(s):  
Ann Vincent ◽  
Jamia Hill ◽  
Kelly M. Kruk ◽  
Stephen S. Cha ◽  
Brent A. Bauer
Keyword(s):  
Chronic Pain ◽  
Pain Intensity ◽  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Low Back ◽  
Analog Scale ◽  
Experienced Pain ◽  
Before And After ◽  
To Receive

External qigong as a pharmacotherapy adjunct was investigated in 50 subjects with chronic pain (pain lasting > 3 months with pain score of ≥ 3 on 0–10 numeric analog scale) who presented to a qigong healing center. Participants were randomized to receive either external qigong treatment (EQT) or equivalent attention time (EAT) in weekly 30-min sessions for four consecutive weeks. Outcomes were assessed before and after sessions. The primary outcome measure was intensity of pain by a 10-cm visual analog scale used to rate all pain severity measurements. At 8-week follow-up, participants were contacted by telephone and mailed a questionnaire. Most had experienced pain for > 5 years (66%); the rest, for > 3 to 5 years (8%), 1 to 3 years (10%), or < 1 year but > 3 months (10%). The most frequent concomitant diagnoses were multifactorial (26%), osteoarthritis (18%), and low back pain (12%). Most patients were also receiving other treatments (74%); none previously had EQT. Participants were randomly assigned to EQT ( n = 26) or EAT ( n = 24). These groups had no significant differences at baseline except for prior awareness of qigong (EQT 31% vs. EAT 63%; p = 0.025). Compared to the EAT group, EQT participants had a significant decrease in pain intensity in the 2nd ( p = 0.003), 3rd ( p < 0.001), and 4th weeks of treatment ( p = 0.003). At week 8, these differences in overall decreased pain intensity persisted but were not statistically significant.

Vocal Exercise versus Voice Rest following Botulinum Toxin Injections: A Randomized Crossover Trial

2010 ◽  
Vol 119 (11) ◽  
pp. 759-763
Author(s):  
Randal C. Paniello ◽  
Julia D. Edgar ◽  
Joel S. Perlmutter
Keyword(s):  
Botulinum Toxin ◽  
Primary Outcome ◽  
Botulinum Toxin Injection ◽  
Primary Outcome Measure ◽  
Adductor Spasmodic Dysphonia ◽  
Related Quality ◽  
Botulinum Toxin Injections ◽  
The Voice ◽  
Dose Injection

Objectives: The intensity of muscle activity immediately following intramuscular botulinum toxin injection may affect the clinical efficacy of the injection. We tested this effect in patients who underwent botulinum toxin injections for adductor spasmodic dysphonia. Methods: Patients were studied over 3 to 5 injection cycles. Cycle 1 was the baseline control; cycle 2 was randomized between a 1-hour reading aloud task (“exercise”) and a 24-hour period of complete voice rest. For cycle 3, the patient completed the task not performed in cycle 2. Patients who were willing to continue for cycles 4 and 5 repeated the experiment at one half the injection dosage. Efficacy was determined with a battery of voice recordings and clinical outcomes instruments administered via telephone at 2- to 4-week intervals. The primary outcome measure was the result of the Voice-Related Quality of Life (VRQOL) instrument. Results: Nine patients (8 women, 1 man) with a mean age of 60.8 years (range, 42 to 76 years) completed at least 3 injection cycles. The VRQOL results were significantly higher for cycles that followed the exercise task. The patients reported subjectively that these were some of the best injection cycles they had ever experienced. Some achieved equivalent results with the half-dose injection plus exercise. The VRQOL results after voice rest cycles were not significantly different from the patients' baseline cycles. Conclusions: These results support the conclusion that a period of intense vocalization immediately following laryngeal botulinum toxin injections improves the efficacy of the injection. Possible mechanisms are proposed.

scholarly journals Continuing education on child development for primary healthcare professionals: a prospective before-and-after study

2014 ◽  
Vol 132 (4) ◽  
pp. 211-218 ◽  
Author(s):  
Amira Consuêlo Melo Figueiras ◽  
Rosana Fiorini Puccini ◽  
Edina Mariko Koga Silva
Keyword(s):  
Child Development ◽  
Continuing Education ◽  
Education Program ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Before And After ◽  
The Impact ◽  
Children's Development ◽  
Before And After Study ◽  
Children’S Development

CONTEXT AND OBJECTIVE: Children's developmental disorders are often identified late by healthcare professionals working in primary care. The aim of this study was to assess the impact of a continuing education program on child development, on the knowledge and practices of these professionals.DESIGN AND SETTING: Prospective single-cohort study (before-and-after study), conducted in the city of Belém, Pará , Brazil.METHODS: Two hundred and twenty-one professionals working in primary healthcare (82.2%) participated in a continuing education program on child development and were assessed before and after implementation of the program through tests on their knowledge of child development, consisting of 19 questions for physicians and 14 for nurses, and questionnaires on their professional practices.RESULTS: One to three years after the program, the mean number of correct answers in the tests had increased from 11.5 to 14.3 among physicians in the Healthy Family Program (Programa Família Saudável, PFS); 13.0 to 14.3 among physicians in Municipal Health Units (Unidades Municipais de Saúde, UMS); 8.3 to 10.0 among PFS nurses; and 7.8 to 9.4 among UMS nurses. In interviews with mothers attended by these professionals before the program, only 21.7% reported that they were asked about their children's development, 24.7% reported that the professional asked about or observed their children's development and 11.1% received advice on how to stimulate them. After the program, these percentages increased to 34.5%, 54.2% and 30.3%, respectively.CONCLUSIONS: Professionals who participated in the program showed improved performance regarding child development knowledge and practices.

Geriatric day hospital improves quality of life: A before and after study

2013 ◽  
Vol 4 (5) ◽  
pp. 304-309 ◽  
Author(s):  
E. de Jaime ◽  
O. Vázquez ◽  
M.L. Rodríguez ◽  
E. Sevilla ◽  
S. Burcet ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Day Hospital ◽  
Before And After ◽  
Before And After Study
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