230 The Impact of a Palliative Care ECHO Programme on Symptom Severity Scores and Phases Score in a Nursing Home Population

Abstract Background In Ireland most deaths occur in acute hospitals however 20% of deaths occur in residential facilities. Less than 30% receive specialist palliative care input. ECHO (extension for community healthcare outcomes) is a palliative care education programme consisting of a 10 part lecture series. Twenty nursing homes and 353 staff participated. A phases score is a 5-point rating scale classifying the status of a palliative care patient ranging from stable to bereaved. Methods Data collected by palliative care professionals from September 2017 to December 2018 was analysed. This included demographic features, a phases score and scores for pain, carer stress, spiritual and psychological need. Nursing homes that attended ≤ 3 ECHO sessions were excluded, 15 participating nursing homes were included. Age matched control subjects were selected from non-participating nursing homes on a 2:1 basis. Data was analysed using the paired T Test and Chi squared was analyzed for frequency data. Results There were 40 patients in the intervention group and 80 in the control group. Mean ages were 83yrs and 82yrs respectively. Palliative care referral numbers did not change significantly between the two groups (111 and 114). The Phases score was significantly reduced in the ECHO group compared to controls (P=< 0.007). There was no significant reduction in the phases score in the ECHO group pre and post intervention (P=0.29). There was no difference in Pain scores between groups (P=0.98) Conclusion The ECHO intervention led to a reduction in the overall phases score in participating nursing homes. This was not the result of increased palliative care referrals. We would infer it is a reflection of better control of symptoms overall. We did not demonstrate a significant reduction in individual symptoms. The phases score is an overall representation of a patient’s status. With the expansion of the ECHO programme on-going analysis will be performed.

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The effect of the implementation of a good medical practice booklet on nursing home residents’ drug prescriptions: a difference-in-differences analysis based on data from electronic pill dispensers (Preprint)

10.2196/preprints.13507 ◽

2019 ◽

Author(s):

Stéphane Sanchez ◽

Cécile Payet ◽

Marie Herr ◽

Anne Dazinieras ◽

Caroline Blochet ◽

...

Keyword(s):

Nursing Homes ◽

Medical Practice ◽

Intervention Group ◽

Medication Use ◽

Nursing Home Residents ◽

Control Group ◽

Multilevel Regression ◽

Difference In Differences ◽

Good Medical Practice ◽

The Impact

BACKGROUND The elderly are particularly exposed to adverse events from medication. Among the various strategies to reduce polypharmacy, educational approaches have shown promising results. OBJECTIVE We aimed to evaluate the impact of the implementation of a good medical practice booklet on polypharmacy in nursing homes. METHODS We identified nursing homes belonging to a geriatric care provider that had launched a policy of proper medication use using a good medical practice booklet delivered to prescribers and pharmacists. Data were derived from electronic pill dispensers. The effect of the intervention on polypharmacy was assessed with multilevel regression models, with a control group to account for natural trends over time. The main outcomes were the average daily number of times when medication was administered and the number of drugs with different presentation identifier codes per resident per month. RESULTS 96,216 residents from 519 nursing homes were included between 1 January 2011 and 31 December 2014. The intervention group and the control group both decreased their average daily use of medication (-0.05 and -0.06). The good medical practice booklet did not have a statistically significant effect (exponentiated difference-in-differences coefficient 1.00, 95% confidence interval 0.99-1.02, P=.45). CONCLUSIONS Although the good medical practice booklet itself did not seem effective in decreasing medication use, our data show the effectiveness of a higher-level policy to decrease polypharmacy.

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Impact of Stress Ulcer Prophylaxis Algorithm Study

Annals of Pharmacotherapy ◽

10.1345/aph.1d129 ◽

2005 ◽

Vol 39 (5) ◽

pp. 810-816 ◽

Cited By ~ 12

Author(s):

Christian J Coursol ◽

Sabrina E Sanzari

Keyword(s):

Intensive Care ◽

Stress Ulcer ◽

Treatment Algorithm ◽

Intervention Group ◽

Stress Ulcer Prophylaxis ◽

Control Group ◽

Post Intervention ◽

Ulcer Prophylaxis ◽

The Cost ◽

The Impact

BACKGROUND: In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route. OBJECTIVE: To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis. METHODS: A quasi-experimental—type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm). RESULTS: After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups. CONCLUSIONS: Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

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Evaluation of the Effect of Atorvastatin Administration on the Outcomes of Patients with Traumatic Brain Injury: A Double-Blinded Randomized Clinical Trial

Anesthesiology and Pain Medicine ◽

10.5812/aapm.117140 ◽

2021 ◽

Vol 11 (4) ◽

Author(s):

Farhad Soltani ◽

Farahzad Janatmakan ◽

Sara Jorairahmadi ◽

Fatemeh Javaherforooshzadeh ◽

Pooyan Alizadeh ◽

...

Keyword(s):

Clinical Trial ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Clinical Trial ◽

Rating Scale ◽

Intervention Group ◽

Control Group ◽

Post Intervention ◽

Disability Rating Scale ◽

Double Blinded

Background: Traumatic brain injury (TBI) is one of the common causes of long-term disabilities and mortality. This study aimed to evaluate the effect of atorvastatin administration on the Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and Disability Rating Scale (DRS) in patients with TBI. Methods: This double-blinded randomized clinical trial included 60 patients with TBI in Golestan Hospital of Ahvaz, Iran. After obtaining an informed consent from all patients, the patients were randomly assigned into two groups. For the intervention group, atorvastatin with a daily dose of 20 mg was used. The control group was administered the same amount of placebo for 10 days. Changes in the level of consciousness were measured using the GCS, and functional recovery rate in patients was measured by GOS and DRS in the third follow-up month. Results: According to the obtained results, compared with the control group, the atorvastatin administration significantly increased the level of GCS and DRS within 2 - 3 months post-intervention and improved GOS since the tenth day after the study (P < 0.05). Conclusions: The results revealed the positive effect of atorvastatin on the improvement of outcomes measurements such as GCS, DRS, and GOS in patients after moderate and severe TBI.

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The impact of a peer-based education on fruits and vegetables intake among housewives

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00278-3 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Roya Sheybani ◽

Zahra Hosseini ◽

Sayed Hossein Davoodi ◽

Teamur Aghamolaei ◽

Amin Ghanbarnejad

Keyword(s):

Self Efficacy ◽

Fruits And Vegetables ◽

Group Discussion ◽

Peer Education ◽

Intervention Group ◽

Control Group ◽

Post Intervention ◽

Significant Difference ◽

Quasi Experimental ◽

The Impact

Abstract Background Evidence indicates the lower intake of fruits and vegetables than the recommended daily amount. Study aimed at determining the effects of peer education intervention on the consumption of fruits and vegetable in housewives. Methods A quasi-experimental was conducted with 130 housewives referring to health care centers in Bandar Abbas, Iran. Sixty-five subjects were recruited in each of the intervention and the control groups. Intervention group were divided into three subgroups each receiving a seven-sessions educational programs (lecturing and group discussion) through peers about the importance of benefits of fruits and vegetables consumption. Participants were followed for two months. Data were collected using a questionnaire in two stages of pre- and post-intervention. Differences in the outcome before and after the intervention were tested using T-test and paired T-test. Results The daily servings of fruits and vegetables in the intervention group increased from 1.73 to 4.20 and in the control group from 1.96 to 2.16; a statistically significant difference was also observed between the groups (P < 0.001). After the intervention benefits and self-efficacy of fruits and vegetables consumption significantly increased and perceived barriers of fruits and vegetables consumption significantly decreased in the intervention group (P < 0.001). Conclusion Peer education improves benefits and self-efficacy, reduces barriers, and increases the daily servings of fruits and vegetables in housewives.

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Evaluating the Impact of Teacher-designed, Wellbeing and Sustainability Play-based Learning Experiences on Young Children's Knowledge Connections: A Randomised Trial

Australasian Journal of Early Childhood ◽

10.23965/ajec.43.4.04 ◽

2018 ◽

Vol 43 (4) ◽

pp. 33-42

Author(s):

Heather Morris ◽

Susan Edwards ◽

Amy Cutter-Mackenzie ◽

Leonie Rutherford ◽

Janet Williams-Smith ◽

...

Keyword(s):

Digital Media ◽

Randomised Trial ◽

Learning Experiences ◽

Intervention Group ◽

Parent Report ◽

Control Group ◽

Post Intervention ◽

Waitlist Control Group ◽

Children's Interests ◽

The Impact

THIS PAPER REPORTS FINDINGS from a randomised investigation into the effect of teacher-designed, play-based learning experiences on preschool-aged children's knowledge connections between healthy eating and active play as wellbeing concepts, and sustainability. The investigation used a ‘ funds of knowledge’ theoretical framework to situate young children's interests in digital media and popular culture, as a site for learning these knowledge connections. The findings suggest that the intervention group children created more wellbeing and sustainability knowledge connections than the waitlist control group children. Additionally, the intervention group children demonstrated an increase in vegetable serves and a decrease in unhealthy food servings post intervention (measured by parent report). The paper suggests that more attention should be paid to early childhood teachers’ capacity for actively building children's knowledge about wellbeing and sustainability concepts through play-based learning, as opposed to top-down approaches towards obesity education and prevention alone.

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Impact of educational programs on nurses’ knowledge and attitude toward pediatric palliative care

Palliative & Supportive Care ◽

10.1017/s1478951521001139 ◽

2021 ◽

pp. 1-10

Author(s):

Sawsan Abuhammad ◽

Ruaa Almasri

Keyword(s):

Palliative Care ◽

Educational Program ◽

Intervention Group ◽

Pediatric Palliative Care ◽

Control Group ◽

Pediatric Nurses ◽

The Mean ◽

Knowledge And Attitude ◽

The Impact ◽

Nurses Knowledge

Abstract Objective This study aims to assess the knowledge and attitude of nurses toward pediatric palliative care (PPC) and examine the impact of an educational program on pediatric nurses’ knowledge and attitude regarding PPC for children facing life-threatening illnesses or chronic diseases in Jordan. Method A quasi-experimental design was used. Exactly 120 pediatric nurses participated in the study, of which 60 were in the intervention group and 60 in the control group. Results The results of the study showed that nurses had a low score in knowledge and attitude toward PPC. The mean knowledge score of PPC for the control group is 6.88 (SD = 2.26), while that of the intervention group was 7.92 (SD = 1.99; p = 0.052). The mean attitude for PPC score for the control group was 95.88 (SD = 7.90), while that of the intervention group was 100 (SD = 10.95; p = 0.009). Also, the educational intervention had a significant positive effect on the knowledge and attitude toward PPC among nurses. Significance of the results Based on the result of this study, the authors found strong evidence of the effectiveness of the PPC educational program when it came to improving the nurses’ knowledge and attitude toward PPC services and offer us an effective educational program.

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Development and Complex Dynamics at School Environment

Complexity ◽

10.1155/2018/3963061 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Miguel Angel Fuentes ◽

Juan Pablo Cárdenas ◽

Natalia Carro ◽

Mariana Lozada

Keyword(s):

Social Interactions ◽

Social Relationships ◽

Behavioral Plasticity ◽

School Context ◽

Intervention Group ◽

Positive Interactions ◽

Control Group ◽

Post Intervention ◽

Quantitative Evidence ◽

The Impact

In this work we use complex systems methodologies to analyze quantitatively the impact of an intervention involving cooperative and self-awareness activities on social interactions in children. The aim of this study is to evaluate behavioral plasticity of social relationships between peers in 6-7 year-olds who participated in the intervention conducted in a school context. The intervention consisted of 8 one-hour long sessions comprising mindfulness-based practices, collaborative activities that required cooperation, and perspective-taking instances in which children shared feelings, perceptions, and needs felt during the activities. We used complex network and game theory to evaluate pre-post-intervention variations. Social relationship was analyzed with a sociogram in both the intervention group and a control group which continued with regular classes. By means of the sociometric questionnaire we asked each child to mention which classmates he/she would choose as playmates and which he/she would not. Changes in the number of peers selected and rejected reflected changes in the pattern of social relationships pre-post-intervention. Our findings show that participating in the intervention positively modulated social interactions since we found an increase in the diversity and quality of positive links and a reduction in negative ones; a higher level of integration, indicated by enhanced positive networks where children with many positive connections tended to connect with those with few links; and more positive interactions between genders. These findings were not observed in the control group. Through the use of the mentioned methodologies, the current investigation provides new quantitative evidence of social network plasticity in children, an important topic which, to our knowledge, has been little studied. Results from this work indicate that positive transformations in social relationships can be fostered through the performance of this kind of intervention.

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Physical activity and prenatal depression: going beyond statistical significance by assessing the impact of reliable and clinical significant change

Psychological Medicine ◽

10.1017/s0033291719003714 ◽

2020 ◽

pp. 1-6

Author(s):

Marina Vargas-Terrones ◽

Taniya S. Nagpal ◽

Maria Perales ◽

Harry Prapavessis ◽

Michelle F. Mottola ◽

...

Keyword(s):

At Risk ◽

Exercise Intervention ◽

Statistical Significance ◽

Intervention Group ◽

Prenatal Depression ◽

Control Group ◽

Post Intervention ◽

Point Change ◽

Significant Change ◽

The Impact

Abstract Background Previous literature supports exercise as a preventative agent for prenatal depression; however, treatment effects for women at risk for prenatal depression remain unexplored. The purpose of the study was to examine whether exercise can lower depressive symptoms among women who began pregnancy at risk for depression using both a statistical significance and reliable and clinically significant change criteria. Methods This study is a secondary analysis of two randomized controlled trials that followed the same exercise protocol. Pregnant women were allocated to an exercise intervention group (IG) or control group (CG). All participants completed the Center for Epidemiological Depression (CES-D) scale at gestational week 9–16 and 36–38. Women with a baseline score ⩾16 were included. A clinically reliable cut-off was calculated as a 7-point change in scores from pre- to post-intervention. Results Thirty-six women in the IG and 25 women in the CG scored ⩾16 on the CES-D at baseline. At week 36–38 the IG had a statistically significant lower CES-D score (14.4 ± 8.6) than the CG (19.4 ± 11.1; p < 0.05). Twenty-two women in the IG (61%) had a clinically reliable decrease in their post-intervention score compared to eight women in the CG (32%; p < 0.05). Among the women who met the reliable change criteria, 18 (81%) in the IG and 7 (88%) in the CG had a score <16 post-intervention, with no difference between groups (p > 0.05). Conclusions A structured exercise program might be a useful treatment option for women at risk for prenatal depression.

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Effect of early palliative care for patients with glioblastoma (EPCOG): a randomised phase III clinical trial protocol

BMJ Open ◽

10.1136/bmjopen-2019-034378 ◽

2020 ◽

Vol 10 (1) ◽

pp. e034378 ◽

Cited By ~ 1

Author(s):

Heidrun Golla ◽

Charlotte Nettekoven ◽

Claudia Bausewein ◽

Jörg-Christian Tonn ◽

Niklas Thon ◽

...

Keyword(s):

Palliative Care ◽

Caregiver Burden ◽

Intervention Group ◽

International Standards ◽

Phase Iii ◽

Control Group ◽

Care Needs ◽

Multicenter Rct ◽

The Impact ◽

Positive Effect

IntroductionRandomised controlled trials (RCTs) have shown a positive effect of early integration of palliative care (EIPC) in various advanced cancer entities regarding patients’ quality of life (QoL), survival, mood, caregiver burden and reduction of aggressiveness of treatment near the end of life. However, RCTs investigating the positive effect of EIPC for patients suffering from glioblastoma multiforme (GBM) are lacking. After modelling work identifying the specific needs of GBM patients and their caregivers, the aim of this study is to investigate the impact of EIPC in this particular patient group.Methods and analysisThe recruitment period of this multicenter RCT started in May 2019. GBM patients (n=214) and their caregivers will be randomly assigned to either the intervention group (receiving proactive EIPC on a monthly basis) or the control group (receiving treatment according to international standards and additional, regular assessment of QoL (‘optimised’ standard care)).The primary outcome is QoL assessed by subscales of the Functional Assessment of Cancer Therapy for brain tumour (FACT-Br) from baseline to 6 months of treatment. Secondary outcomes are changes in QoL after 12 (end of intervention), 18 and 24 months (end of follow-up), the full FACT-Br scale, patients’ palliative care needs, depression/anxiety, cognitive impairment, caregiver burden, healthcare use, cost-effectiveness and overall survival.Ethics and disseminationThe study will be conducted in accordance with the Declaration of Helsinki and has been approved by the local ethics committees of the University Clinics of Cologne, Aachen, Bonn, Freiburg and Munich (LMU). Results of the trial will be submitted for publication in a peer-reviewed, open access journal and disseminated through presentations at conferences.Trial registration numberGerman Register for Clinical Studies (DRKS) (DRKS00016066); Pre-results.

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The Impact of Patient Education on the Quality of Inpatient Bowel Preparation for Colonoscopy

Canadian Journal of Gastroenterology ◽

10.1155/2010/718628 ◽

2010 ◽

Vol 24 (9) ◽

pp. 543-546 ◽

Cited By ~ 48

Author(s):

Greg Rosenfeld ◽

Darin Krygier ◽

Robert A Enns ◽

Janakie Singham ◽

Holly Wiesinger ◽

...

Keyword(s):

Patient Education ◽

Bowel Preparation ◽

Rating Scale ◽

Tertiary Care ◽

Intervention Group ◽

Control Group ◽

Inpatient Setting ◽

Care Hospital ◽

Patient Counselling ◽

The Impact

BACKGROUND: For patients requiring colonoscopy while admitted to hospital, achieving adequate cleansing of the colon is often difficult.OBJECTIVES: To assess the impact of patient education, in the form of both counselling and written instructions, on bowel cleanliness at colonoscopy.METHODS: A total of 38 inpatients at a tertiary care hospital in Vancouver, British Columbia, who were referred to the gastroenterology service for colonoscopy were enrolled in the present study. Sixteen patients were randomly assigned to the intervention group, while 22 patients comprised the control group. Both groups received a clear liquid diet and 4 L of a commercially available bowel preparation. The intervention group also received a brief counselling session and written instructions outlining the methods and rationale for bowel preparation before colonoscopy. Bowel cleanliness was assessed by the endoscopist using a five-point rating scale.RESULTS: The two groups were similar with respect to demographics, the indication for colonoscopy and findings at colonoscopy. The median bowel cleanliness scores in the control group and the enhanced-instruction group were 3.0 and 2.0, respectively (P=0.001).CONCLUSION: Patient counselling and written instructions are inexpensive, safe and simple interventions. Such interventions are an effective means of optimizing colonoscopy preparation in the inpatient setting.

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