A multifaceted stewardship intervention helps curb steroid overprescribing in hospitalized patients with acute exacerbations of COPD

2021 ◽  
Author(s):  
Jennifer L Cole ◽  
Sarah E Smith
Keyword(s):  
Length Of Stay ◽  
Intervention Strategy ◽  
Audit And Feedback ◽  
Face To Face ◽  
Duration Of Therapy ◽  
Significant Difference ◽  
Acute Exacerbations ◽  
Before And After ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Abstract Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Corticosteroid overprescribing is well documented in real-world practice. There is currently no evidence to guide best practices for steroid stewardship. The aim of this study was to assess the effects of a 3-part stewardship intervention strategy on inpatient steroid prescribing in patients with acute exacerbations of COPD (AECOPD). Summary Investigators implemented a 3-part stewardship initiative consisting of (1) an anonymous survey for providers on steroid prescribing in a simplified case of AECOPD, (2) face-to-face education and review of survey results, and (3) prospective audit and feedback from a clinical pharmacist. This was a quasi-experimental before-and-after study evaluating hospitalized adults diagnosed with AECOPD in two 12-month study periods before (April 2019-March 2020) and after (May 2020-April 2021) implementation. The primary outcome was mean inpatient steroid dosing. Secondary outcomes were duration of therapy, length of stay (LOS), 30-day readmissions, 30-day mortality, and incidence of hyperglycemia. Per power analysis, there were 27 patients per cohort. The interventions resulted in a significant reduction in prednisone equivalents during hospitalization: 118 mg vs 53 mg (P = 0.0003). This decrease was similar in ICU (160 mg vs 61 mg, P = 0.008) and non-ICU (102 mg vs 49 mg, P = 0.004) locations. There was no significant difference in duration of therapy (8 days vs 7 days, P = 0.44), length of stay (3.3 days vs 3.9 days, P = 0.21), 30-day mortality (4% vs 7%, P = 0.55), 30-day readmissions (15% vs 7%, P = 0.39), or rate of hyperglycemia (48% vs 44%, P = 0.78). Conclusion A multifaceted stewardship intervention significantly reduced steroid dosing in hospitalized AECOPD patients. This reduction was not associated with known deleterious effects.

The effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women: A controlled quasi-experimental study

2021 ◽  
pp. 1357633X2110241
Author(s):  
Zari Doaltabadi ◽  
Leila Amiri-Farahani ◽  
Seyedeh Batool Hasanpoor-Azghady ◽  
Shima Haghani
Keyword(s):  
Prenatal Care ◽  
Fear Of Childbirth ◽  
Virtual Training ◽  
Face To Face ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Care Training ◽  
The Mean ◽  
And Control ◽  
Primiparous Women

Introduction The spouse has a special role in promoting the health of mothers and infants during pregnancy, childbirth, and postpartum. Women's health during pregnancy requires the participation and cooperation of their spouses. Therefore, this study was conducted to determine the effect of face-to-face and virtual prenatal care training of spouses on the pregnancy experience and fear of childbirth of primiparous women. Methods This is a quasi-experimental clinical trial that was conducted on primiparous pregnant women referring to three prenatal clinics in Tehran, Iran. Sampling was done by available method and pregnant women were divided into three groups of face-to-face training ( n = 35), virtual training ( n = 35), and control ( n = 33). The content of training program in the virtual and face-to-face groups was similar and included; nutrition during pregnancy, emotional support, fetal growth and development, advantages and disadvantages of vaginal delivery, planning for delivery, infant care, and danger signs for infants, which were presented in four sessions. The samples in the control group did not receive any training. In the 18th and 20th weeks of pregnancy, the demographic information form, pregnancy experience scale, and version A of the Wijma delivery expectancy/experience questionnaires were completed, and once again in the 37th and 38th weeks of pregnancy, the pregnancy experience scale and version A of the Wijma delivery expectancy/experience questionnaires were completed. Results There was a statistically significant difference in the mean score of pregnancy experience after the intervention between the face-to-face training and control groups ( p = 0.001). There was a statistically significant difference in the mean score of uplifts between the two groups of face-to-face training and control ( p = 0.01), and also between virtual training and control groups ( p = 0.02). There was a statistically significant difference between the two groups of face-to-face training and control in terms of and hassles score after the intervention ( p = 0.04). There was a statistically significant difference between the two groups of face-to-face training and control ( p = 0.02) and also between virtual training and control ( p = 0.04) in terms of the mean score of fear of childbirth after the intervention. Conclusion The results of this study showed that teaching prenatal care to spouses of primiparous women by face-to-face and virtual methods can be a useful intervention in improving the pregnancy experience and reducing the fear of childbirth among primiparous women.

scholarly journals The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

2019 ◽  
Vol 3 (4) ◽  
pp. 545-552
Author(s):  
Nathalia De Oro ◽  
Maria E Gauthreaux ◽  
Julie Lamoureux ◽  
Joseph Scott
Keyword(s):  
Lactic Acid ◽  
Length Of Stay ◽  
Community Hospital ◽  
Unit Length ◽  
Hospital Setting ◽  
Control Group ◽  
Before And After ◽  
Quasi Experimental ◽  
Current Cutoff ◽  
The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

scholarly journals The difference in saliva pH before and after brushing with fluoride containing toothpaste and without toothpaste

2008 ◽  
Vol 20 (3) ◽  
Author(s):  
Samuel Setiawan ◽  
Edeh Rolleta Haroen ◽  
Dede Hadidjah
Keyword(s):  
Drinking Water ◽  
Research Method ◽  
Control Group ◽  
Research Subjects ◽  
Male And Female ◽  
Significant Difference ◽  
Salivary Ph ◽  
Before And After ◽  
Quasi Experimental ◽  
The Difference

In administering fluoride through drinking water there is the risk of overdose, higher cost and inadequate availability of drinking water containing fluoride in developing countries like Indonesia. A safe fluoride source is contained in toothpaste. The purpose of this research was to obtain data concerning difference in saliva pH before and after brushing with toothpaste containing fluoride and without toothpaste. The research method used was the quasi-experimental method. Samples were collected by the way of purposive sampling, conducted on 43 male and female research subjects. The data were analyzed by statistical analysis using the t test at 95% confidence level. In this research a control group consisting of 43 people was used. Research results indicated that the average saliva pH before brushing was 7.174; after brushing with fluoride containing toothpaste salivary pH was 7.593. Result research of brushing without toothpaste showed an average saliva of 7.163 before brushing and 7.379 after brushing without toothpaste. The average changes in saliva pH before and after brushing using fluoride containing toothpaste was 0.216. The conclusion of this research was that there was significant difference in saliva pH before and after brushing with toothpaste containing fluoride; there was significant difference in saliva pH before and after brushing without toothpaste, and there was significant difference in saliva pH before and after brushing with toothpaste containing fluoride and without toothpaste.

scholarly journals The Effect of Resource-Based Instructions on Pre-service Biology Teachers’ Attitudes towards Learning Biology

2021 ◽  
Vol 20 (8) ◽  
pp. 262-277
Author(s):  
Josiane Mukagihana ◽  
Catherine M Aurah ◽  
Florien Nsanganwimana
Keyword(s):  
Negative Attitude ◽  
Control Group ◽  
Biology Teachers ◽  
Lecture Method ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Based Instruction ◽  
Teachers Attitudes ◽  
Attitudes Towards Learning

A positive attitude correlates to successful learning; while a negative attitude leads to poor learning. The present study aimed to compare the pre-service biology teachers’ attitudes towards learning biology and assessing their attitudinal change before and after being taught by resource-based instructions (RBI) in Rwanda. A survey-research design was used, in combination with a quasi-experimental control group, and the equivalent time-series designs. Pre-service biology teachers were taught at a public university in three separate groups, with one control group and two experimental groups. Each group received a pre-attitude and a post-attitude assessment. In contrast, at a private university, they were taught as a single group, in a series of instructions, starting with the lecture method, followed by animation-based instruction and small- group laboratory activities, in which at each stage, the pre-service biology teachers received the same assessment. The biology Attitudinal Scale showed a Cronbach alpha reliability of 0.625 before its use. The data were analyzed quantitatively; and the results revealed no statistically significant difference between the public and the private pre-service teachers’ attitudes before learning microbiology. After the teaching interventions, the results revealed that both the traditional and the resource-based instructions improved the pre-service biology teachers’ attitudes towards learning biology, as a result of their improved maturity and their anticipated future teaching career.

scholarly journals USING JUMBLED LETTERS TO IMPROVE STUDENTS VOCABULARY MASTERY

2019 ◽  
Vol 1 (2) ◽  
pp. 55-61
Author(s):  
Sri Wahyuni ◽  
Ali Wira Rahman
Keyword(s):  
Total Sample ◽  
Crossword Puzzle ◽  
Significant Difference ◽  
Before And After ◽  
Tenth Grade ◽  
Post Test ◽  
Quasi Experimental ◽  
And Control ◽  
Listening And Speaking ◽  
Academic Year

Vocabulary considered one of the important things to learn for students, the vocabulary is basic thing that students must be mastered in foreign language lessons, especially in English. Without vocabulary students will have difficulty in mastering skills in English such as writing, reading, listening and speaking.  Therefore, it is very important to find out the solution to enhance students’ vocabulary. The objective of the research is to find out whether or not using Jumbled letters can improve the students vocabulary of the tenth grade students in MAN 2 Barru and to find out whether or not using Crossword puzzle can improve the students vocabulary of the tenth grade students in MAN 2 Barru. This research applied quasi-experimental group design with two groups experimental and control class. The population of this research was the tenth grade students of MAN 2 Barru in academic year 2018/2019. The Total sample of the research was taken by using clustering random sampling which consisted of 141 students. From two classes taken from the population of the tenth grade students of MAN 2 Barru, X MIA 1 as the experimental class consisted 29 students and X MIA 3 as the control class that consisted 29 students. The result of the data analysis showed that there was a significant difference of students’ vocabulary before and after teaching vocabulary through jumbled word letters. The value of t-test pre-test 2.09 was higher than t-table 2.000, and the value of post-test 4.62 was higher than t-table 2.000, at the level significance a =0.05 and degree of freedom (df) = 56. It can be concluded that jumbled word letters can enhance the vocabulary of the tenth grade students’ of MAN 2 Barru

scholarly journals THE EFFECT OF THREE PHASE TECHNIQUE ON STUDENTS’ READING COMPREHENSION

2019 ◽  
Vol 4 (3) ◽  
pp. 303
Author(s):  
Eko Saputra Nurdiansa
Keyword(s):  
Reading Comprehension ◽  
Sampling Technique ◽  
Significant Degree ◽  
Study Program ◽  
Three Phase ◽  
Reading Technique ◽  
Significant Difference ◽  
Before And After ◽  
Sample Test ◽  
Quasi Experimental

The objective of the study is to know whether or not three phase technique   has   significant   effect   on   students’ reading comprehension. The design of this study was quasi experimental research. The population of the study were students who were taking Reading 1 class in English study program at Halu Oleo University in academic year of  2016-2017.  By  employing  purposive  sampling technique the researcher chose class A as the sample of this study. Instrument of study was reading comprehension test in form of multiple choices questions. The result of this study confirmed that the teaching reading  by  using  three  phase  reading  technique  could give significant effect on the students’ reading comprehension. Based on the Paired Sample Test, it was found that there was a significant difference of students’ reading comprehension score before and after they were given treatment by using three phase reading technique procedure in Reading 1 class with the significant degree of 0.013. Furthermore, there was also significant improvement in students' mean score (79.78). Therefore, the proposed hypothesis which stated “three phase reading technique has significant effect on students’ reading comprehension” was accepted. Keywords: Three Phase Technique, Reading Comprehension

scholarly journals Efficacy of standard- vs reduced-dose insulin for treatment of hyperkalemia: A quasi-experiment

2021 ◽  
Author(s):  
Sara Catherine Pearson ◽  
Kristin O’Connor ◽  
Kimberly Keller ◽  
T J Hodge ◽  
Ross Nesbit
Keyword(s):  
Glucose Level ◽  
Standard Dose ◽  
Additional Treatment ◽  
Treatment Pathway ◽  
Reduced Dose ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Stage Renal Disease ◽  
The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hyperkalemia more commonly affects patients with a glomerular filtration rate of less than 60 mL/min. Using intravenous (IV) insulin to shift potassium intracellularly may cause hypoglycemia, requiring additional treatment or longer hospitalization. Literature on insulin dosing in this context is limited, with one previous study indicating that 5 units of IV insulin might be as effective and result in less hypoglycemia than the standard dose of 10 units of IV insulin. The hyperkalemia treatment pathway at our institution was revised in May 2018 to include a reduced-dose option (5 units of insulin) for patients with end-stage renal disease. This study aimed to compare the prevalence of hypoglycemia between patients who received standard-dose vs reduced-dose IV insulin. Methods This single-center, retrospective, quasi-experimental study evaluated the impact of revision of the hyperkalemia treatment pathway by assessing rates of hypoglycemia during the 6 months before and after implementation of the revised pathway. The primary endpoint was prevalence of hypoglycemia, defined as a blood glucose level of less than or equal to 70 mg/dL. Results There was no statistically significant difference in the occurrence of hypoglycemia when comparing the pre- and postimplementation groups (36 [17.7%] patients vs 34 [18.7%] patients; P = 0.7924). The postimplementation group had a statistically significant lower reduction in potassium levels after treatment than the preimplementation group (mean [interquartile range], –0.9 [–1.3, –0.5] mEq/L vs –0.6 [–1.2, –0.2] mEq/L; P = 0.0095). Baseline potassium levels were similar between the groups. Conclusion Administration of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia. When accounting for potential confounders, the only variable that was associated with hypoglycemia was pretreatment glucose level.

scholarly journals Peningkatan Status Perkembangan Anak Prasekolah dengan Stimulasi Perkembangan

JKEP ◽  
2020 ◽  
Vol 5 (2) ◽  
pp. 150-160
Author(s):  
Santun Setiawati ◽  
Agus Citra Dermawan ◽  
Raden Siti Maryam
Keyword(s):  
Univariate Analysis ◽  
Wilcoxon Test ◽  
Good Growth ◽  
Frequency Distributions ◽  
Growth Status ◽  
Development Status ◽  
Significant Difference ◽  
Before And After ◽  
Quasi Experimental ◽  
Children Development

The children are not small adults, but have unique characteristics that are always growing and evolving since their conception until the end of adolescence. Good growth and development of children requires appropriate stimulation and accordance with the age such as developmental stimulation. The aim of this study was to determine the influence development simulations towards pre-school children’s growth status. This research was using the quasi-experimental design without control. The numbers of respondents were 30 children (with aged 60-72 month). The children with dubious developmental status had performed the development stimulations for 2 weeks for 3-4 housr a day and evaluated the development status. Developmental Pre-Screening Questionnaire (KPSP) instrument used in this research. The data analysis was using univariate analysis (frequency distributions), bivariate (Wilcoxon test) and multivariate (ANCOVA test). There was a significant difference in the children’s development status before and after development stimulation interventions (p= 0.000), but there was no children and mothers’ characteristic factors that affect the children development status. Stimulation associated with the value of child development, where the high category of stimulation is not found in children whose development category is slow. So it takes stimulation of children from an early age. Growth stimulations can be done routinely as a part of efforts to improve the children development status.

scholarly journals Good, bad or indifferent: a longitudinal multi-methods study comparing four modes of training for healthcare professionals in one Australian state

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e021264 ◽  
Author(s):  
Priya Martin ◽  
Saravana Kumar ◽  
LuJuana Abernathy ◽  
Matthew Browne
Keyword(s):  
Healthcare Professionals ◽  
Longitudinal Design ◽  
Mode Of Delivery ◽  
Face To Face ◽  
Supervision Training ◽  
Australian State ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Training Delivery

ObjectivesThe aim of the study was to compare the differences in learning outcomes for supervision training of healthcare professionals across four modes namely face-to-face, videoconference, online and blended modes. Furthermore, changes sustained at 3 months were examined.Design/methodsA multimethods quasi-experimental longitudinal design was used. Data were collected at three points—before training, immediately after training and at 3 months post-training. Quantitative and qualitative data were collected through anonymous surveys and reflective summaries, respectively.ResultsParticipants reported an increase in supervision knowledge and confidence immediately after training that was sustained at 3 months with all four modalities of training. Using analysis of variance, we found these changes were sustained at 3 months postcompletion (confidence p<0.01 and knowledge p<0.01). However, there was no statistically significant difference in outcomes between the four modes of training delivery (confidence, p=0.22 or knowledge, p=0.39). Reflective summary data highlighted the differences in terminology used by participant to describe their experiences across the different modes, the key role of the facilitator in training delivery and the merits and risks associated with online training.ConclusionsWhen designed and delivered carefully, training can achieve comparable outcomes across all four modes of delivery. Regardless of the mode of delivery, the facilitator in training delivery is critical in ensuring positive outcomes.

Teaching English Grammar in a Hybrid Academic ESL Course

2018 ◽  
pp. 149-169
Author(s):  
Tülay Dixon ◽  
MaryAnn Christison
Keyword(s):  
Hybrid Design ◽  
Hybrid Instruction ◽  
Hybrid Course ◽  
Face To Face ◽  
Course Effectiveness ◽  
English Grammar ◽  
Significant Difference ◽  
Quasi Experimental ◽  
Learner Perceptions ◽  
Positive Effect

This study investigates whether hybrid instruction has a positive effect on the development of students' knowledge of English grammar and editing skills, as well as whether learners have positive perceptions of the hybrid design. The study was conducted in two sections of an English grammar and editing skills class. One section was designed as a hybrid course, while the other was a traditional face-to-face (f2f) class. To determine the effectiveness of hybrid instruction, a quasi-experimental design with a pre- and posttest was employed. To investigate learner perceptions of the hybrid design, learners completed a questionnaire and participated in a focus group. The results indicate that there was no significant difference between the two groups in terms of their knowledge of English grammar and editing skills after the treatment. The learners had positive perceptions of the hybrid design and also offered some suggestions for improving course effectiveness.

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