P1557EFFECTIVENESS OF INTERVENTION FOR SAFETY CONFIRMATION OF HEMODIALYSIS PREPARATION PROCESS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Yasunori Higashitsuji ◽  
Itoko Tobita ◽  
Takashi Kano ◽  
Kumiko Shima ◽  
Masako Sasaki ◽  
...  
Keyword(s):  
Registered Nurses ◽  
Intervention Program ◽  
Healthcare Professionals ◽  
Video Feedback ◽  
Clinical Engineering ◽  
Adherence Rate ◽  
Preparation Process ◽  
Initial Stage ◽  
Final Confirmation

Abstract Background and Aims It has been determined that more than half of the medical errors related to haemodialysis treatment are due to the preparation process at the initial stage of treatment, and that the errors are mainly caused by insufficient confirmation behaviour of healthcare professionals. Pointing confirmation and double check have been proven effective as safety treatments, but no specific strategy has been established to verify these insufficient confirmation behaviours. This study clarified the actual behaviour of healthcare professionals engaged in haemodialysis during the preparation process at the initial stage of treatment and defined the confirmation behaviour necessary to start safe haemodialysis based on the results. Moreover, the aim was to assess the effectiveness of an intervention program for enhancing adherence to confirmation practice. Method A first study was conducted to investigate the actual state of behaviour, and a second study to verify the effectiveness of an intervention program. In the first study, we monitored and analysed the actual behaviours of 23 clinical engineering technicians and 14 registered nurses at a dialysis centre during the preparation process (218 steps) at the initial stage of treatment, and calculated their adherence rates. In the second study, the final confirmation process at the initial stage of treatment was determined (13 steps), and an intervention program aimed at adherence was devised. To verify its effectiveness, 18 clinical engineering technicians and 8 registered nurses were randomly divided into an experimental group (E) and a control group (C). The intervention program for Group E comprised baseline without intervention, intervention 1 (verbal explanation of confirmatory behaviour), intervention 2 (adding graphic feedback), intervention 3 (adding video feedback), and follow-up without intervention. That of Group C comprised only baseline and intervention 1. The adherence rate to the final confirmation process in both groups was calculated. Results In the first study, the adherence rate to the preparation process at the initial stage of treatment was 67.2%, and the adherence rate in the confirmation process immediately after the start of dialysis was 21.0%, which was remarkably low. In the second study, the adherence rate to the final confirmation process in Group E was 17.1% at baseline, 45.5% after intervention 1, 65.5% after intervention 2, 90.4% after intervention 3, and 93.9% at follow-up. In contrast, the adherence rate in Group C was 8.6% at baseline and 50.4% after intervention 1. Conclusion The adherence rate to the preparation process at the initial stage of treatment was less than 70%. Furthermore, the intervention program using graphic feedback and video feedback increased the adherence rate to the final confirmation process. Intervention programs aimed at the behaviour modification of healthcare professionals involved in haemodialysis have increased the adherence rate to confirmation actions in the final confirmation step of haemodialysis, and it has become clear that verbal teaching and visualized feedback are effective.

The Mindfulness-Based Stress Reduction Program (MBSR) Reduces Stress-Related Psychological Distress in Healthcare Professionals

2010 ◽  
Vol 13 (2) ◽  
pp. 897-905 ◽  
Author(s):  
Andrés Martín-Asuero ◽  
Gloria García-Banda
Keyword(s):  
Experimental Study ◽  
Psychological Distress ◽  
Stress Reduction ◽  
Health Professionals ◽  
Healthcare Professionals ◽  
Training Programs ◽  
The Other ◽  
Reduction Program ◽  
Mindfulness Based Stress Reduction

This semi-experimental study examines how Mindfulness facilitates a distress reduction in a group of health professionals. The sample comprises 29 professionals seeking stress reduction who undertook an 8 weeks psico-educative intervention, involving 28 hours of class, based on a program called Mindfulness-based Stress Reduction or MBSR. Results show a 35% reduction of distress, from percentile 75 to 45, combined with a 30% reduction in rumination and a 20% decrease in negative affect. These benefits lasted during the 3 months of the follow up period. The correlation analysis indicates that the decrease in distress is significantly related to the other two variables. These results confirm the effectiveness of MBSR to decrease distress and its applicability in training programs for health professionals.

Remote Follow-up of Self-isolating COVID-19 Patients with a Patient Portal: Protocol for a Mixed-method Pilot Study (The Opal-COVID Study) (Preprint)

2021 ◽  
Author(s):  
David Lessard ◽  
Kim Engler ◽  
Yuanchao Ma ◽  
Adriana Rodriguez Cruz ◽  
Serge Vicente ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Mixed Method ◽  
Healthcare Professionals ◽  
Qualitative Interviews ◽  
Sociodemographic Characteristics ◽  
Patient Portal ◽  
Implementation Outcomes ◽  
Service Outcomes ◽  
Qualitative Analyses

BACKGROUND Individuals diagnosed with COVID-19 are instructed to self-isolate at home. However, during self-isolation, they may experience anxiety and insufficient care. Some patient portals can allow patients to self-monitor and share their health status with healthcare professionals for remote follow-up, but little data is available on the feasibility of their use. OBJECTIVE This manuscript presents the protocol of the Opal-COVID Study which has four objectives: 1) assess the implementation of using the Opal patient portal for distance monitoring of COVID-19 patients self-isolating at home; 2) identify influences on the intervention’s implementation; and describe 3) service and 4) patient outcomes of this intervention. METHODS This mixed-method pilot study aims to recruit 50 COVID-19 patient participants tested at the McGill University Health Centre (MUHC, Montreal, Canada) for 14 days of remote follow-up. With access to questionnaires through the Opal patient portal smartphone app, configured for this study, patients will complete a daily self-assessment of symptoms, vital signs, and mental health, monitored by a nurse, and receive subsequent teleconsultations, as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden) and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, recruitment/retention rates and fidelity, as well as on the frequency and nature of contacts with healthcare professionals via Opal. The statistical analyses for Objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For Objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As to the qualitative analyses, for Objective 2 (influences on implementation), semi-structured qualitative interviews will be conducted with four groups of stakeholders (i.e., patient participants, healthcare professionals, technology developers and study administrators) and submitted to content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers and facilitators of implementation. For Objective 3 (service outcomes), reasons for contacting healthcare professionals through Opal will also be submitted to content analysis. RESULTS Between December 2020 and March 2021, 51 patient-participants were recruited. Qualitative interviews were conducted with 39 involved stakeholders, from April to September 2021. Delays in the study process were experienced due to implemented measures at the MUHC to address COVID-19 but the quantitative and qualitative analyses are currently underway. CONCLUSIONS This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. CLINICALTRIAL ClinicalTrials.gov identifier NCT04978233.

scholarly journals Determining the variables associated to clean intermittent self-catheterization adherence rate: one-year follow-up study

2011 ◽  
Vol 37 (6) ◽  
pp. 766-772 ◽  
Author(s):  
Marcia Eli Girotti ◽  
Sarita MacCornick ◽  
Humberto Perissé ◽  
Nelson S Batezini ◽  
Fernando G. Almeida
Keyword(s):  
Adherence Rate ◽  
Follow Up Study ◽  
One Year

scholarly journals Impact of 5-Year Endoscopic Surveillance Intervals with Biopsy following Endoscopic Papillectomy for Ampullary Adenoma

2022 ◽  
Vol 12 (1) ◽  
pp. 51
Author(s):  
Hoonsub So ◽  
Sung Woo Ko ◽  
Seung Hwan Shin ◽  
Eun Ha Kim ◽  
Do Hyun Park
Keyword(s):  
Patient Adherence ◽  
Diagnostic Yield ◽  
Endoscopic Biopsy ◽  
Endoscopic Surveillance ◽  
Adherence Rate ◽  
Low Grade ◽  
Ampullary Adenoma ◽  
Endoscopic Papillectomy ◽  
Routine Biopsy

Background: Endoscopic snare papillectomy (ESP) has been established as a safe and effective treatment for ampullary adenomas. However, little is known about the optimal post-procedure follow-up period and the role of routine endoscopic surveillance biopsy following ESP. We aimed to evaluate patient adherence to a 5-year endoscopic surveillance and routine biopsy protocol after ESP of ampullary adenoma. Methods: We reviewed our prospectively collected database (n = 98), all members of which underwent ESP for ampullary lesions from January 2011 to December 2016, for the evaluation of long-term outcomes. The primary outcome was the rate of patient adherence to 5-year endoscopic surveillance following ESP. The secondary outcomes were the diagnostic yield of routine endoscopic biopsy, recurrence rate, and adverse events after endoscopic surveillance in the 5-year follow-up (3-month, 6-month, and every 1 year). Results: A total of 19 patients (19.4%) experienced recurrence during follow-up, all of these patients experienced recurrence within 3 years of the procedure (median 217 days, range 69–1083). The adherence rate for patients with sporadic ampullary adenoma were 100%, 93.5%, and 33.6% at 1, 3, and 5 years after ESP, respectively. The diagnostic yield of routine endoscopic biopsy without macroscopic abnormality was 0.54%. Pancreatitis occurred in four patients (4%, 3 mild, 1 moderate) after surveillance endoscopic biopsy without macroscopic abnormality. Conclusions: Given the low 5-year adherence rate and diagnostic yield of routine endoscopic biopsy with risk of pancreatitis, optimal surveillance intervals according to risk stratification (low grade vs. high grade adenoma/intramucosal adenocarcinoma) may be required to improve patient adherence, and routine biopsy without macroscopic abnormality may not be recommended.

scholarly journals Lipid Lowering Treatment and Follow Up in Recent Post Acute Coronary Syndrome Patients: Real-World Evidence from the Multicenter Observational Prospective - Post Acute Coronary Syndrome Italian Study (PACSI)

2020 ◽  
Vol 19 ◽  
Author(s):  
Pompilio Faggiano ◽  
Giuseppe Patti ◽  
Stefania Cercone ◽  
Laura Canullo ◽  
Roberta Rossini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Recurrent Events ◽  
Real Life ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Adherence Rate ◽  
Prospective Clinical Study ◽  
Target Attainment ◽  
Coronary Syndrome

PURPOSE: Patients suffering from an acute coronary syndrome are at very high risk for recurrent events. Early targeted pharmacological intervention primarily aimed at controlling plasma LDL-cholesterol (LDL-C) levels can result in the reduction of recurrent cardiovascular events. This study aimed to evaluate real-life evidence from the Italian setting to document current practice of secondary prevention in patients after acute coronary syndrome (ACS), specifically assessing: (i) the rate of LDL-C target (<70 mg/dl) achievement after 6-10 weeks from index event and at later follow-up, (ii) the distance from LDL-C target during follow up, (iii) adherence rate and visit attendance. METHODS Multicenter observational prospective clinical study ACS patients, evaluating target attainment rate at 6 weeks (V0) and 18 months (V2). RESULTS Approximately 97.4% patients enrolled (N=524) received statin-based therapy, and 3.6% received ezetimibe at discharge; mean LDL-C values decreased from 113.0±44.7 mg/dL at discharge to 71.3±26.5 mg/dl at V0. Among patients with known LDL-C for main time-points, 51.7% achieved target LDL-C at V0, 45.8% at V2. Among patients not reaching the target, the mean distance from target was 23.5±20.7 mg/dL. Attainment of target LDL-C was similar in patients receiving intensive or low-moderate statin-based treatment (approximately 50%). LDL-C target attainment was associated with lower LDL-C value at discharge and smoking status. Adherence to statin treatment was high (96.2%) throughout, similarly to medical appointment attendance at V2 (84.7%). CONCLUSION Despite most ACS patients receiving intensive statin-based regimens, only approximately half achieved LDL-C target, suggesting the need for further optimizing drug selection, combination and dosage. 

scholarly journals Pharmacovigilance of suspected or confirmed therapeutic ineffectiveness of artemisinin-based combination therapies: extent, associated factors, challenges and solutions to reporting

2020 ◽  
Author(s):  
Ronald Kiguba ◽  
Helen Byomire Ndagije ◽  
Victoria Nambasa ◽  
Leonard Manirakiza ◽  
Elijah Kirabira ◽  
...  
Keyword(s):  
Associated Factors ◽  
Healthcare Professionals ◽  
Pharmacovigilance Centre ◽  
Combination Therapies ◽  
Public And Private ◽  
Factors Associated ◽  
Adr Reporting ◽  
National Pharmacovigilance Centre ◽  
Reporting Procedures

Abstract Background: This study aimed to determine the extent and associated factors of past 6-month reporting of artemisinin-based combination therapy (ACT)-failure by healthcare professionals (HCPs); and difficulties and solutions to the pharmacovigilance (PV) of ACT therapeutic ineffectiveness.Methods: Survey of 685 HCPs from June to July 2018 in purposively selected public and private health facilities in Uganda.Results: One in five [20%, 137/685; 95% confidence intervals (CI) 17% to 23%] HCPs reported ACT-failure to any authority in the previous 6-months. HCPs commonly reported ACT-failure to immediate supervisors (72%, 106/147), mostly verbally only (80%, 109/137); none had ever reported a written ACT-failure to Uganda’s National Pharmacovigilance Centre. Common difficulties to reporting ACT-failure were; unavailability of reporting procedures (31%, 129/421), poor follow-up of treated patients (22%, 93/421) and absence of reporting tools (16%, 68/421). Factors associated with reporting ACT-failure in past 6-months were: hospital-status (vs other; OR = 2.4, 95% CI, 1.41 to 4.21), HCPs aged under 25 years (OR = 2.2, 95% CI, 1.29 to 3.76), suspicion of ACT-failure in past 4-weeks (OR = 2.3, 95% CI, 1.29 to 3.92), receipt of patient-complaint(s) of ACT-failure in past 4-weeks (OR = 2.9, 95% CI, 1.62 to 5.12) and HCPs from northern (vs central; OR = 0.5, 95% CI, 0.28 to 0.93) and western (vs central; OR = 0.4, 95% CI, 0.17 to 0.77) parts of Uganda.Conclusion: One in five HCPs reported ACT-failure, mostly verbally to supervisors. The existing ADR-reporting infrastructure should be leveraged to promote the PV of ACT therapeutic ineffectiveness.

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