A before and after study of medical students' and house staff members' knowledge of ACOVE quality of pharmacologic care standards on an acute care for elders unit

2008 ◽  
Vol 6 (2) ◽  
pp. 82-90 ◽  
Author(s):  
Samantha P. Jellinek ◽  
Victor Cohen ◽  
Marcia Nelson ◽  
Antonios Likourezos ◽  
William Goldman ◽  
...  
Keyword(s):  
Medical Students ◽  
Acute Care ◽  
House Staff ◽  
Staff Members ◽  
Before And After ◽  
Before And After Study

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 An evaluation of Acute Care of at-Risk Newborns (ACoRN), a Canadian education program, in Chinese neonatal nurseries

2019 ◽  
Vol 25 (6) ◽  
pp. 351-357
Author(s):  
Khalid Aziz ◽  
Xiaolu Ma ◽  
Jocelyn Lockyer ◽  
Douglas McMillan ◽  
Xiang Y Ye ◽  
...  
Keyword(s):  
At Risk ◽  
Acute Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Clinical Practices ◽  
Canadian Education ◽  
Before And After ◽  
Evaluation Decision ◽  
Hospital Births ◽  
Before And After Study

Abstract Background The Acute Care of at-Risk Newborns (ACoRN) program was developed in Canada to train health care providers in the identification and management of newborns who are at-risk and/or become unwell after birth. The ACoRN process follows a stepwise framework that enables evaluation, decision, and action irrespective of caregiver experience. This study examined the hypothesis that the ACoRN educational program improved clinical practices and outcomes in China. Methods In a before-and-after study, ACoRN training was provided to physicians, neonatal nurses, and administrators in 16 county hospitals in Zhejiang, PRC. Demographic and clinical data were collected on babies admitted to neonatal units before (May 1, 2008 to March 31, 2009) and after (June 1, 2010 to April 30, 2012) training. Results A total of 4,310 babies (1,865 pre- and 2,445 post-training) from 14 sites were included. There were more in-hospital births (97.8% versus 95.6%, P<0.01) in the post-training epoch, fewer babies needing resuscitation (12.7% versus 16.0%, P=0.02), and more babies finishing their care in hospital (67.4% versus 53.1%, P<0.0001). After training, significantly more babies were evaluated as having respiratory distress at admission (14.2% versus 9.4%, P<0.0001); more babies had saturation, glucose and temperature measured on admission and at discharge; and more babies received intravenous fluids (86.3% versus 72.8%, P<0.0001). No significant improvements were noted in mortality (0.49% [post] versus 0.8% [pre], P=0.19 and adjusted odds ratio 0.54, 95% confidence interval: 0.23 to 1.29). Conclusions ACoRN training significantly increased patient evaluations and changed clinical practices. However, we were unable to ascertain improvement in morbidity or mortality.

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.

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

scholarly journals The quiet revolution: Reporting of health outcomes in general medical journals

1997 ◽  
Vol 20 (1) ◽  
pp. 88
Author(s):  
Janelle Seymour ◽  
David Newell ◽  
Alan Shiell
Keyword(s):  
Health Outcomes ◽  
New England ◽  
Comparison Group ◽  
Statistical Significance ◽  
Health State ◽  
The Past ◽  
Before And After ◽  
Comparison Groups ◽  
Before And After Study

This study reviews the extent of evaluation of health outcomes in three general medicaljournals over the past decade by examining papers published in the original researchsection of the New England Journal of Medicine (NEJM), The Lancet, and theMedical Journal of Australia (MJA) in 1982 and 1992. Evaluations were identifiedand classified according to the type of comparison group and the type of outcomemeasures employed. They were divided into three categories: those employing acomparison group; those employing a before-and-after study design (or owncomparison group); and those with no comparison group. The categories of outcomemeasures were mortality, clinical or intermediate measures of health state, and finaloutcome measures (quality of life). Results show that the proportion of papersevaluating a health services intervention remained stable over the period. However,the MJA published considerably fewer evaluations than the other journals. In theNEJM and The Lancet, 75- per cent of evaluations incorporated comparison groups,in the MJA, less than 40- per cent. Overall, the proportion of papers reporting finaloutcome measures increased significantly between 1982 and 1992 (p = 0.04) butthe change in each journal individually did not reach statistical significance. Thisstudy indicates that the reporting of health outcomes evaluations has remainedconstant but there has been some change in the use of comparison groups and finaloutcome measures over time.

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