IMPACT OF WHELD INTERVENTION ON NEUROPSYCHIATRIC SYMPTOMS, ANTIPSYCHOTIC USE AND QUALITY OF LIFE IN PEOPLE WITH DEMENTIA LIVING IN NURSING HOMES: A CLUSTER-RANDOMIZED TRIAL

Abstract Background Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies. Objectives Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care. Methods This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview. Results Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview. Conclusions Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression. Trial registration The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.

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No impact of an extensive social intervention program on return to work and quality of life after acute cardiac event: a cluster-randomized trial in patients with negative occupational prognosis

International Archives of Occupational and Environmental Health ◽

10.1007/s00420-019-01450-3 ◽

2019 ◽

Vol 92 (8) ◽

pp. 1109-1120 ◽

Cited By ~ 1

Author(s):

Annett Salzwedel ◽

Karl Wegscheider ◽

Claudia Schulz-Behrendt ◽

Gesine Dörr ◽

Rona Reibis ◽

...

Keyword(s):

Quality Of Life ◽

Return To Work ◽

Randomized Trial ◽

Cardiac Event ◽

Intervention Program ◽

Cluster Randomized Trial ◽

Social Intervention ◽

Cluster Randomized ◽

Acute Cardiac Event

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Evaluation of a multi-component, non-pharmacological intervention to prevent and reduce sleep disturbances in people with dementia living in nursing homes (MoNoPol-sleep): study protocol for a cluster-randomized exploratory trial

BMC Geriatrics ◽

10.1186/s12877-020-01997-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Martin N. Dichter ◽

Almuth Berg ◽

Jonas Hylla ◽

Daniela Eggers ◽

Denise Wilfling ◽

...

Keyword(s):

Quality Of Life ◽

Nursing Homes ◽

Nursing Staff ◽

Sleep Problems ◽

West Germany ◽

Pharmacological Intervention ◽

Sleep Study ◽

People With Dementia ◽

Cluster Randomized

Abstract Background Sleep problems are highly prevalent in people with dementia. Nevertheless, there is no “gold standard” intervention to prevent or reduce sleep problems in people with dementia. Existing interventions are characterized by a pronounced heterogeneity as well as insufficient knowledge about the possibilities and challenges of implementation. The aim of this study is to pilot and evaluate the effectiveness of a newly developed complex intervention to prevent and reduce sleep problems in people with dementia living in nursing homes. Methods This study is a parallel group cluster-randomized controlled trial. The intervention consists of six components: (1) the assessment of established sleep-promoting interventions and an appropriate environment in the participating nursing homes, (2) the implementation of two “sleep nurses” as change agents per nursing home, (3) a basic education course for nursing staff: “Sleep problems in dementia”, (4) an advanced education course for nursing staff: “Tailored problem-solving” (two workshops), (5) workshops: “Development of an institutional sleep-promoting concept” (two workshops with nursing management and sleep nurses) and (6) written information and education material (e.g. brochure and “One Minute Wonder” poster). The intervention will be performed over a period of 16 weeks and compared with usual care in the control group. Overall, 24 nursing homes in North, East and West Germany will be included and randomized in a 1:1 ratio. The primary outcome is the prevalence of sleep problems in people with dementia living in nursing homes. Secondary outcomes are quality of life, quality of sleep, daytime sleepiness and agitated behavior of people with dementia, as well as safety parameters like psychotropic medication, falls and physical restraints. The outcomes will be assessed using a mix of instruments based on self- and proxy-rating. A cost analysis and a process evaluation will be performed in conjunction with the study. Conclusions It is expected that the intervention will reduce the prevalence of sleep problems in people with dementia, thus not only improving the quality of life for people with dementia, but also relieving the burden on nursing staff caused by sleep problems. Trial registration Current controlled trials: ISRCTN36015309. Date of registration: 06/11/2020.

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Quality of Life in Palliative Cancer Care: Results From a Cluster Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.18.3884 ◽

2001 ◽

Vol 19 (18) ◽

pp. 3884-3894 ◽

Cited By ~ 164

Author(s):

Marit S. Jordhøy ◽

Peter Fayers ◽

Jon Håvard Loge ◽

Marianne Ahlner-Elmqvist ◽

Stein Kaasa

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Randomized Trial ◽

Cluster Randomized Trial ◽

Life Questionnaire ◽

Eortc Qlq C30 ◽

Cluster Randomized ◽

Eortc Qlq ◽

The Impact

PURPOSE: To assess the impact of comprehensive palliative care on patients’ quality of life. The intervention was based on cooperation between a palliative medicine unit and the community service and was compared with conventional care. PATIENTS AND METHODS: A cluster randomized trial was carried out, with community health care districts defined as the clusters. Patients from these districts who had malignant disease and survival expectancy between 2 to 9 months were entered onto the trial. The main quality-of-life end points were physical and emotional functioning, pain, and psychologic distress assessed monthly by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) questionnaire and Impact of Event scale (IES). In total, 235 intervention patients and 199 controls were included. RESULTS: During the initial 4 months of follow-up, the compliance was good (72%) and comparable among treatment groups. No significant differences on any of the quality-of-life scores were found. At later assessments and for scores that were made within 3 months before death, there was also no consistent tendency in favor of any treatment group on the main outcomes or other EORTC QLQ-C30 scales/items. CONCLUSION: A general program of palliative care may be important to ensure flexibility and to meet the needs of terminally ill patients. However, to achieve improvements on a group level of the various dimensions of quality of life, specific interventions directed toward specific symptoms or problems may have to be defined, evaluated, and included in the program.

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