Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios

Abstract Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance. Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines. Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34–1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01–1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46–2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice. Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.

Download Full-text

Neurofeedback and Motor Imagery are as good as physical training on Dart Throwing

10.31234/osf.io/aqnvu ◽

2019 ◽

Author(s):

Maryam Salehi ◽

Wesley Pyke ◽

Hasan Mohammadzadeh ◽

Mohammad Ali Nazari ◽

Amir-Homayoun Javadi

Keyword(s):

Motor Imagery ◽

Physical Training ◽

Outcome Measure ◽

Control Group ◽

Improve Performance ◽

Experimental Conditions ◽

Visuomotor Task ◽

Dart Throwing ◽

Sensorimotor Rhythms

Objectives This experiment assessed the effectiveness of three interventions; neurofeedback, motor imagery and physical training, on their ability to improve visuomotor accuracy, measured by scores achieved on a dart throwing task. Methods Thirty-two female participants, all with no experience in dart throwing, took part and were assigned to either one of the three experimental conditions, or a control group (eight per condition). Training sessions for neurofeedback (NFB) involved participants encouraging both Theta rhythms and Sensorimotor rhythms (SMR). For Motor Imagery (MI), internal (1st person) imagery was used, where participants had to imagine throwing a dart and for physical training (PT) participants physically practised dart throwing. Measurements were recorded pre-intervention, after two weeks (6 sessions) of training (mid-intervention), after 5 weeks (15 sessions) of training (in total; Outcome Measure 1) and again two weeks after training had finished (Outcome Measure 2). Results from Mid-intervention, Outcome Measure 1 and Outcome Measure 2 were compared to baseline scores achieved pre-intervention and showed all three interventions to significantly increase performance on dart throwing compared to the Control group. Conclusion Our findings show that, as well as traditional physical practise, both motor imagery and neurofeedback can effectively improve performance on a fine visuomotor task.

Download Full-text

Walking and talking therapy: Improving cognitive–motor dual-tasking in neurological illness

Journal of the International Neuropsychological Society ◽

10.1017/s1355617708090152 ◽

2009 ◽

Vol 15 (1) ◽

pp. 112-120 ◽

Cited By ~ 44

Author(s):

JONATHAN J. EVANS ◽

EVE GREENFIELD ◽

BARBARA A. WILSON ◽

ANDREW BATEMAN

Keyword(s):

Training Program ◽

Primary Outcome ◽

Outcome Measure ◽

Daily Practice ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Trial Methodology ◽

Dual Tasking ◽

Questionnaire Measure

AbstractUsing randomized control trial methodology, we evaluated the effectiveness of a 5-week cognitive–motor dual-tasking training program developed to improve performance of a group of people with dual-tasking difficulties arising from acquired brain injury. Training involved twice-daily practice on exercises involving walking being combined with tasks which increased in cognitive demand over the course of the intervention. A treatment group (n = 10) was compared with a control group (n = 9). The primary outcome measure was a task requiring participants to walk and carry out a spoken sentence verification task simultaneously. Secondary outcome measures were measures of dual-tasking involving either two motor tasks or two cognitive tasks. A questionnaire measure relating to activities of daily living requiring dual-tasking was also completed. Compliance with the training program was good. We found evidence of improvement in performance on the primary outcome measure, but little evidence of generalization to other measures. There was some evidence that participants believed that their dual-tasking performance in everyday life was improved after the intervention. The study was limited in terms of sample size, was not blinded and did not control fully for therapist contact time, but has produced valuable data relating to effect sizes associated with this form of intervention. (JINS, 2009, 15, 112–120.)

Download Full-text

Pediatric Residents and Interns in an Italian Hospital Perform Improved Bibliographic Searches when Assisted by a Biomedical Librarian

Evidence Based Library and Information Practice ◽

10.18438/b88321 ◽

2013 ◽

Vol 8 (1) ◽

pp. 76

Author(s):

Mathew Stone

Keyword(s):

Teaching Hospital ◽

Assessment Tool ◽

Controlled Trial ◽

Intervention Group ◽

Real Life ◽

Boolean Logic ◽

Bibliographic Databases ◽

Control Group ◽

Pediatric Residents ◽

Clinical Scenarios

A Review of: Gardois, P., Calabrese, R., Colombi, N., Lingua, C., Longo, F., Villanacci, M., Miniero, R., & Piga, A. (2011). Effectiveness of bibliographic searches performed by paediatric residents and interns assisted by librarian. A randomised controlled trial. Health Information and Libraries Journal, 28(4), 273-284. doi: 10.1111/j.1471-1842.2011.00957.x Objective – To establish whether the assistance of an experienced biomedical librarian delivers an improvement in the searching of bibliographic databases as performed by medical residents and interns. Design – Randomized controlled trial. Setting – The pediatrics department of a large Italian teaching hospital. Subjects – 18 pediatric residents and interns. Methods – 23 residents and interns from the pediatrics department of a large Italian teaching hospital were invited to participate in this study, of which 18 agreed. Subjects were then randomized into two groups and asked to spend between 30 and 90 minutes searching bibliographic databases for evidence to answer a real-life clinical question which was randomly allocated to them. Each member of the intervention group was provided with an experienced biomedical librarian to provide assistance throughout the search session. The control group received no assistance. The outcome of the search was then measured using an assessment tool adapted for the purpose of this study from the Fresno test of competence in evidence based medicine. This adapted assessment tool rated the “global success” of the search and included criteria such as appropriate question formulation, number of PICO terms translated into search terms, use of Boolean logic, use of subject headings, use of filters, use of limits, and the percentage of citations retrieved that matched a gold standard set of citations found in a prior search by two librarians (who were not involved in assisting the subjects) together with an expert clinician. Main Results – The intervention group scored a median average of 73.6 points out of a possible 100, compared with the control group which scored 50.4. The difference of 23.2 points in favour of the librarian assisted group was a statistically significant result (p value = 0.013) with a 95% confidence interval of between 4.8 and 33.2. Conclusion – This study presents credible evidence that assistance provided by an experienced biomedical librarian improves the quality of the bibliographic database searches performed by residents and interns using real-life clinical scenarios.

Download Full-text

ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study

The Journal of Vascular Access ◽

10.1177/11297298211002572 ◽

2021 ◽

pp. 112972982110025

Author(s):

Yu-Xia Yin ◽

Wei Gao ◽

Sheng-Yu Feng ◽

Deng-Xu Wang ◽

Min Wan ◽

...

Keyword(s):

Clinical Study ◽

Daily Practice ◽

Patient Characteristics ◽

Mobile App ◽

High Rate ◽

Exit Site Infection ◽

Increased Risk ◽

Retrospective Clinical Study ◽

Operation Rate ◽

Catheter Tip

Objective: Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. Methods: A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. Results: The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. Conclusions: This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.

Download Full-text

Effect of pelvic laparoscopic implantation of neuroprosthesis in spinal cord injured subjects: a 1-year prospective randomized controlled study

Spinal Cord ◽

10.1038/s41393-021-00693-7 ◽

2021 ◽

Author(s):

Helge Kasch ◽

Uffe Schou Løve ◽

Anette Bach Jønsson ◽

Kaare Eg Severinsen ◽

Marc Possover ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Outcome Measures ◽

Outcome Measure ◽

Secondary Outcome ◽

Controlled Study ◽

Control Group ◽

Walking Ability ◽

Data Set ◽

Cord Injury

Abstract Study design 1-year prospective RCT. Objective Examine the effect of implantable pulse generator and low-frequency stimulation of the pelvic nerves using laparoscopic implantation of neuroprosthesis (LION) compared with neuromuscular electrical stimulation (NMES) in SCI. Methods Inclusion criteria: traumatic spinal cord injury (SCI), age 18–55 years, neurological level-of-injury Th4–L1, time-since-injury >1 year, and AIS-grades A–B. Participants were randomized to (A) LION procedure or (B) control group receiving NMES. Primary outcome measure: Walking Index for Spinal Cord Injury (WISCI-II), which is a SCI specific outcome measure assessing ability to ambulate. Secondary outcome measures: Spinal Cord Independence Measure III (SCIM III), Patient Global Impression of Change (PGIC), Penn Spasm Frequency Scale (PSFS), severity of spasticity measured by Numeric Rating Scale (NRS-11); International Spinal Cord Injury data sets-Quality of Life Basic Data Set (QoLBDS), and Brief Pain Inventory (BPI). Results Seventeen SCI individuals, AIS grade A, neurological level ranging from Th4–L1, were randomized to the study. One individual was excluded prior to intervention. Eight participants (7 males) with a mean age (SD) of 35.5 (12.4) years were allocated to the LION procedure, 8 participants (7 males) with age of 38.8 (15.1) years were allocated to NMES. Significantly, 5 LION group participants gained 1 point on the WISCI II scale, (p < 0.013; Fisher´s exact test). WISCI II scale score did not change in controls. No significant changes were observed in the secondary outcome measures. Conclusion The LION procedure is a promising new treatment for individuals with SCI with significant one-year improvement in walking ability.

Download Full-text

Skill Transference of a Probe-Tube Placement Training Simulator

Journal of the American Academy of Audiology ◽

10.3766/jaaa.18054 ◽

2020 ◽

Vol 31 (01) ◽

pp. 040-049 ◽

Cited By ~ 1

Author(s):

Robert W. Koch ◽

Hasan Saleh ◽

Paula Folkeard ◽

Sheila Moodie ◽

Conner Janeteas ◽

...

Keyword(s):

Mixed Model ◽

Tracking System ◽

Optical Tracking ◽

Tube Placement ◽

Control Group ◽

Educational Settings ◽

Training Simulator ◽

Nonlinear Mixed Model ◽

Optical Tracking System ◽

Clinical Scenarios

AbstractProbe-tube placement is a necessary step in hearing aid verification which needs ample hands-on experience and confidence before performing in clinic. To improve the methods of training in probe-tube placement, a manikin-based training simulator was developed consisting of a 3D-printed head, a flexible silicone ear, and a mounted optical tracking system. The system is designed to provide feedback to the user on the depth and orientation of the probe tube, and the time required to finish the task. Although a previous validation study was performed to determine its realism and teachability with experts, further validation is required before implementation into educational settings.This study aimed to examine the skill transference of a newly updated probe-tube placement training simulator to determine if skills learned on this simulator successfully translate to clinical scenarios.All participants underwent a pretest in which they were evaluated while performing a probe-tube placement and real-ear-to-coupler difference (RECD) measurement on a volunteer. Participants were randomized into one of two groups: the simulator group or the control group. During a two-week training period, all participants practiced their probe-tube placement according to their randomly assigned group. After two weeks, each participant completed a probe-tube placement on the same volunteer as a posttest scenario.Twenty-five novice graduate-level student clinicians.Participants completed a self-efficacy questionnaire and an expert observer completed a questionnaire evaluating each participant’s performance during the pre- and posttest sessions. RECD measurements were taken after placing the probe tube and foam tip in the volunteer’s ear. Questionnaire results were analyzed through nonparametric t-tests and analysis of variance, whereas RECD results were analyzed using a nonlinear mixed model method.Results suggested students in the simulator group were less likely to contact the tympanic membrane when placing a probe tube, appeared more confident, and had better use of the occluding foam tip, resulting in more improved RECD measurements.The improved outcomes for trainees in the simulator group suggest that supplementing traditional training with the simulator provides useful benefits for the trainees, thereby encouraging its usage and implementation in educational settings.

Download Full-text

Bilateral Proprioceptive Evaluation in Individuals With Unilateral Chronic Ankle Instability

Journal of Athletic Training ◽

10.4085/1062-6050-52.2.08 ◽

2017 ◽

Vol 52 (4) ◽

pp. 360-367 ◽

Cited By ~ 11

Author(s):

Andreia S. P. Sousa ◽

João Leite ◽

Bianca Costa ◽

Rubim Santos

Keyword(s):

Outcome Measure ◽

Ankle Instability ◽

Position Sense ◽

Chronic Ankle Instability ◽

Joint Position Sense ◽

Control Group ◽

Injured Limb ◽

History Of ◽

Ankle Proprioception ◽

Force Sense

Context: Despite extensive research on chronic ankle instability, the findings regarding proprioception have been conflicting and focused only on the injured limb. Also, the different components of proprioception have been evaluated in isolation. Objective: To evaluate bilateral ankle proprioception in individuals with unilateral ankle instability. Design: Cohort study. Setting: Research laboratory center in a university. Patients or Other Participants: Twenty-four individuals with a history of unilateral ankle sprain and chronic ankle instability (mechanical ankle instability group, n = 10; functional ankle instability [FAI] group, n = 14) and 20 controls. Main Outcome Measure(s): Ankle active and passive joint position sense, kinesthesia, and force sense. Results: We observed a significant interaction between the effects of limb and group for kinesthesia (F = 3.27, P = .049). Increased error values were observed in the injured limb of the FAI group compared with the control group (P = .031, Cohen d = 0.47). Differences were also evident for force sense (F = 9.31, P < .001): the FAI group demonstrated increased error versus the control group (injured limb: P < .001, Cohen d = 1.28; uninjured limb: P = .009, Cohen d = 0.89) and the mechanical ankle instability group (uninjured limb: P = .023, Cohen d = 0.76). Conclusions: Individuals with unilateral FAI had increased error ipsilaterally (injured limb) for inversion movement detection (kinesthesia) and evertor force sense and increased error contralaterally (uninjured limb) for evertor force sense.

Download Full-text

Effect of anterior capsular polishing on the incidence of YAG capsulotomy

Annals of King Edward Medical University ◽

10.21649/akemu.v11i3.1021 ◽

2016 ◽

Vol 11 (3) ◽

Author(s):

Muhammad A Ahad ◽

Mohammad Rashad Qamar ◽

Sameh K Hindi ◽

Martin N Kid

Keyword(s):

Outcome Measure ◽

Early Postoperative Period ◽

Controlled Study ◽

Control Group ◽

Anterior Capsule ◽

Main Outcome Measure ◽

Group I ◽

Group 2 ◽

One Year ◽

Group 1

Purpose: To study the effect of anterior capsule polishing during phacoemulsification on the incidence of post operative YAG laser capsulotomy. Method: A retrospective controlled study of 159 patients who underwent uncomplicated phacoemulsification with anterior capsular polishing between October 1998 and March 2000. 169 age matched patients who underwent phacoemulsification but without anterior capsule polishing served as controls. Main outcome measure: Incidence of visually significant YAG capsulotomy, which improved the Snellen acuity for more than 1 line or at least 1 line with subjective improvements in symptoms. Results: 2.51 % of patients with anterior capsular polishing (Group 1) had YAG capsulotomy compared to 7.1% of patients in control group at one year. However, after two years, 11.3% of patients in Group I had YAG capsulotomy compared to 12.4% in Group 2. Conclusion: Anterior capsular polishing during cataract surgery may delay the opacification of posterior capsule during the early postoperative period. But does not decrease the incidence of YAG capsulotomy after two years.

Download Full-text

Traditional Versus Objective Structured Clinical Examination on Pediatric Nursing Students’ Performance

Evidence-Based Nursing Research ◽

10.47104/ebnrojs3.v2i1.117 ◽

2020 ◽

Vol 2 (1) ◽

pp. 11

Author(s):

Khadiga M. Said ◽

Safaa F. Draz

Keyword(s):

Nursing Students ◽

Clinical Examination ◽

Clinical Skills ◽

Objective Structured Clinical Examination ◽

Simple Random Sample ◽

Control Group ◽

Pediatric Nursing ◽

Clinical Scenarios ◽

Significant Difference ◽

Nursing Skills

Context: The Objective Structured Clinical Examination (OSCE) method is an effective tool for evaluating the clinical nursing skills of nursing students. OSCE is an assessment technique in which the student demonstrates their competence under a variety of simulated conditions Aim: This study aimed to compare objective structured clinical examinations versus traditional clinical examination on pediatric nursing students' performance. Methods: A quasi-experimental research design (study and control group) was used to conduct this study. The study was conducted in the laboratory of pediatric nursing skills at the faculty of nursing, Benha University. All male and female pediatric nursing students in the 3rd year (n. =228), who were studying in the academic year 2018-2019, first semester, faculty of nursing, Benha University, was recruited. A simple random sample chose to achieve the aim of this study. The odd number was for the OSCE group and the even number for the traditional clinical examination (TCE) group. Four tools were utilized to collect data for the current study. A Structured Questionnaire Sheet, A modified Self-administered Questionnaire, Pediatric Nursing Students' Practice Observational Checklists, and Clinical Scenarios were designed to assess the pediatric nursing student OSCE exam and compare between the traditional method and OSCE method of exams. Results: The current study discovered statistically significant differences were found with a high percentage of agreement responses among pediatric nursing students for related items of OSCE method compared to those in TCE. Additionally, the results clarify a highly statistically significant difference between the studied pediatric nursing students' in TCE and OSCE total performance scores. Conclusion: Objective Structured Clinical Examination (OSCE) was opinioned as a tool for clinical evaluation. This finding appeared in pediatric nursing students' responses, which confirmed their acceptance of OSCE. The OSCE subsequently remains a more objective method of assessment than the traditional clinical forms of the exam that was previously used. OSCE can be used most effectively in undergraduate nursing curricula to assess fair practice. This type of exam provided an accurate measure of clinical skill competencies. Therefore, OSCE should be adopted as a strategy for examining clinical skills for students in all academic years. The current study recommended that Objective Structured Clinical Examination can be used as effective and meaningful assistance to fitness for practice, and OSCE should be adopted as a strategy for examining clinical skills for students in all academic years.

Download Full-text

Implementing a patient-centred outcome measure in daily routine in a specialist palliative care inpatient hospital unit: An observational study

Palliative Medicine ◽

10.1177/0269216316655349 ◽

2016 ◽

Vol 31 (3) ◽

pp. 275-282 ◽

Cited By ~ 5

Author(s):

Alze Pereira dos Santos Tavares ◽

Carolina Paparelli ◽

Carolina Sassaki Kishimoto ◽

Silvia Avo Cortizo ◽

Karen Ebina ◽

...

Keyword(s):

Palliative Care ◽

Quality Of Care ◽

Missing Data ◽

Outcome Measure ◽

Symptom Control ◽

Daily Practice ◽

Daily Routine ◽

Palliative Care Outcome Scale ◽

Care Outcome

Background: Gathering clinical evidence data on patients’ palliative care needs is paramount to identify changes in outcomes over time and maintaining on-going quality improvement. Implementation of patient-centred outcome measures has been widely recommended. The routine use of these instruments in daily practice is challenging and not widespread. Aim: To implement a patient-centred outcome measure in daily practice and fulfil one quality indicator: improve pain during the 72 h after admission, in at least 75% of patients. Design: An observational prospective study. The Palliative care Outcome Scale was used at admission (T0), third day (T1) and weekly. Setting/participants: Hospital palliative care unit with 17 individual rooms. All patients admitted to the unit were included in the study. Results: Preliminary results ( N = 84) revealed inconsistent and missing data (14%). Symptoms were sub-optimally controlled by T1. Processes changed, and only a team member could apply Palliative care Outcome Scale. Doctors were encouraged to grasp the meaning of Palliative care Outcome Scale results for each patient. The post-pilot included 317 patients. No missing data occurred. There was an improvement in most items between T0 and T1: ‘pain’ and ‘other symptoms’ presented statistical significant differences ( p < 0.05). Conclusion: Implementing a patient-centred outcome measure in a hospital palliative care service is feasible and improves quality of care. Controlling high pain at T0 improved (>80%) by T1. Results became more consistent and symptom control was improved overall. Patients are evaluated based on holistic domains by an interdisciplinary team and we have added a much needed measure to help guide improvement of the quality of care provided.

Download Full-text