scholarly journals Improving surgical informed consent in obstetric and gynaecologic surgeries in a teaching hospital in Ethiopia: A before and after study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023408 ◽  
Author(s):  
Million Teshome ◽  
Zenebe Wolde ◽  
Abel Gedefaw ◽  
Anteneh Asefa
Keyword(s):  
Informed Consent ◽  
Elective Surgery ◽  
Post Intervention ◽  
Sustained Improvement ◽  
Poisson Regression Analysis ◽  
Specialized Hospital ◽  
Need To Evaluate ◽  
Before And After ◽  
Before And After Study ◽  
Hawassa University

ObjectivesEven though surgical informed consent (SIC) has marked benefits, in many settings the information is not provided appropriately. In Ethiopia, minimal attention is given to SIC. This study assesses whether an intervention designed to improve SIC in obstetric and gynaecologic surgeries is associated with receipt of SIC components.DesignPre-intervention and post-intervention surveys were conducted at Hawassa University Comprehensive Specialized Hospital among women who underwent obstetric or gynaecologic surgeries. The intervention consisted of a 3-day training on standard counselling for surgical procedures offered to health professionals. A total of 457 women were surveyed (230 pre-intervention, 227 post-intervention). An adjusted Poisson regression analysis was used to identify the association between the intervention and the number of SIC components received.ResultsThe majority of participants were 25–34 years of age in both the pre-intervention and post-intervention groups (p=0.66). 45.7% of the pre-intervention and 51.5% of the post-intervention survey participants underwent elective surgery (p=0.21). Additionally, 70.4% of pre-intervention survey participants received counselling immediately before surgery, compared with 62.4% of post-intervention participants (p<0.001). 5.7% of pre-intervention and 6.6% of post-intervention participants reported the belief that SIC consists entirely of signing on a piece of paper (p=0.66). After controlling for effects of potential confounders, the number of SIC components reported by post-intervention survey participants was 16% higher than what is received by pre-intervention ones (adjusted coefficient=1.16 (1.06–1.28)). Having elective versus emergency surgery was not associated with the number of components received by participants in either group (adjusted coefficient=0.98 (0.88–1.09)).ConclusionTraining on the delivery of standard SIC is associated with receipt of a higher number of standard counselling components. However, there is a need to evaluate whether a one-time intervention leads to sustained improvement. A system-wide study of factors that promote SIC is required.

scholarly journals Clinical practice guideline on the prevention and management of neonatal extravasation injury: a before-and-after study design

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kam Ming Chan ◽  
Janita Pak Chun Chau ◽  
Kai Chow Choi ◽  
Genevieve Po Gee Fung ◽  
Wai Wa Lui ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Central Line ◽  
Evidence Based ◽  
Post Intervention ◽  
Before And After ◽  
Level Of Knowledge ◽  
Intravenous Catheters ◽  
Before And After Study

Abstract Background Extravasation injury resulting from intravenous therapies delivered via peripheral intravenous catheters or umbilical and peripherally inserted central venous catheters is a common iatrogenic complication occurring in neonatal intensive care units. This study aimed to evaluate the effectiveness of an evidence-based clinical practice guideline in the prevention and management of neonatal extravasation injury by nurses. Methods A controlled before-and-after study was conducted in a neonatal unit. The clinical practice guideline was developed, and a multifaceted educational program was delivered to nurses. Neonatal outcomes, including the rates of peripheral intravenous extravasation and extravasation from a central line, were collected at the pre- and post-intervention periods. Post-intervention data for nurses, including the nurses’ level of knowledge and adherence, were collected at six months after the program. Results 104 and 109 neonates were recruited in the pre-intervention period (control) and the post-intervention period (intervention), respectively. The extravasation rate before and after the intervention was 14.04 and 2.90 per 1,000 peripheral intravenous catheters days, respectively. The adjusted odds ratio of peripheral intravenous extravasation post-intervention compared with that of pre-intervention was 0.20 (95% confidence interval: 0.05–0.74; p = 0.02) after adjusting for peripheral intravenous catheter days. The extravasation from a central line rate of the control and intervention groups post-intervention was 4.94 and zero per 1,000 central venous catheter days, respectively. Fifty-nine registered nurses were recruited. At six months post-program, there were significant improvements in the nurses’ level of knowledge and adherence. Conclusions These findings suggest that the implementation of an evidence-based clinical practice guideline significantly reduced the rate of peripheral intravenous extravasation and extravasation from a central line in neonates. However, to maintain nurses’ knowledge and adherence to the evidence-based practice, the educational program will have to be conducted periodically and incorporated into the nurses’ induction program. Trial registration ClinicalTrials.gov, Identifiers: NCT04321447. Registered 20 March 2020 - Retrospectively registered.

scholarly journals Improving retention in care of HIV+ women through behavioural change interventions aimed at their male partners: A prospective, controlled before-and-after study protocol (WeMen) (Preprint)

2020 ◽  
Author(s):  
Stefano Orlando ◽  
Ilaria Palla ◽  
Fausto Ciccacci ◽  
Isotta Triulzi ◽  
Darlington Thole ◽  
...  
Keyword(s):  
Adult Population ◽  
Retention In Care ◽  
Hiv Positive ◽  
Male Partners ◽  
Post Intervention ◽  
Intervention Phase ◽  
The World ◽  
Before And After ◽  
Living With Hiv ◽  
Before And After Study

BACKGROUND According to the World Health Organization (WHO), in 2018, 37.9 million people were living with HIV (PLWHIV) worldwide. More than two-thirds of PLWHIV reside in Sub-Saharan Africa (SSA), where the HIV prevalence in the adult population (aged 15-49) is 3.9%. This includes 1.3 million pregnant women living with HIV, of whom 82% received Antiretroviral Therapy (ART) for Prevention of HIV Mother-To-Child Transmission (PMTCT). In these countries, one of the main challenges is an insufficient level of treatment adherence, particularly in HIV positive pregnant women. Among the causes, the lack of male partner involvement represents a significant contributor to the problem. This issue emerges strongly in Malawi, one of the countries with the highest HIV prevalence in the world: 9.2% of its adult population lived with HIV in 2018. OBJECTIVE The objective of the study is to assess three different interventions aimed at improving ART adherence and retention among HIV positive women through engagement with their male partners in four Malawian healthcare centres. METHODS The prospective, controlled before-and-after study is articulated in three phases (total duration of 24 months): pre-intervention, intervention and post-intervention analyses. The number of selected clusters (clinical centres) is limited to four, one for each intervention plus a cluster where no intervention will be performed (control arm). The interventions are 1) opening the facility on one Saturday per month, only for men, defined as a "special day"; 2) testing peer-to-peer counselling among men, "male champions"; 3) providing a non-economic incentive to all women who are accompanied by their partners to the facility, "nudge". The primary outcome of the study is to evaluate differences in retention in care and adherence among women to therapeutic protocols; the intermediate outcome is the assessment of differences in Male Involvement (MI). The level of MI in the health of their female partners (intermediate outcome) will be evaluated through a dedicated questionnaire administered at baseline and in the post-intervention phase. Data will be collected at the clinical centres and stored in two electronic databases managed through two different types of software. RESULTS Analysis of data collected in the four centres during the pre-intervention phase is ongoing as enrolment ceased on March 31, 2020. The total number of patients enrolled was 452 (Namandanje: 133, Kapeni: 78, Kapire: 75, Balaka: 166). Meanwhile several meetings have taken placeat the centres to organize the intervention phase. CONCLUSIONS The study will identify the best intervention which enhances involvement of male partners in womens health, using an approach that takes into consideration a broad spectrum of behaviours. An important aspect will the use of educational tools focused on messages initiating a reflective discussion of stereotypes and false beliefs related to the idea of masculinity present in Malawian culture. CLINICALTRIAL Clinicaltrials.gov NCT04356157 https://clinicaltrials.gov/show/NCT04356157

Only problem gamblers spend less money when loot boxes are removed from a game: A before and after study of Heroes of the Storm

2019 ◽  
Author(s):  
David Zendle
Keyword(s):  
Video Games ◽  
Problem Gambling ◽  
Video Game ◽  
Real World ◽  
Complex Pattern ◽  
Problem Gamblers ◽  
Before And After ◽  
Gambling Severity ◽  
Reliable Correlation ◽  
Before And After Study

Loot boxes are items in video games that may be paid for with real-world money, but which contain randomised contents. There is a reliable correlation between loot box spending and problem gambling severity: The more money gamers spend on loot boxes, the more severe their problem gambling tends to be. However, it is unclear whether this link represents a case in which loot box spending causes problem gambling; a case in which the gambling-like nature of loot boxes cause problem gamblers to spend more money; or whether it simply represents a case in which there is a general dysregulation in in-game spending amongst problem gamblers, nonspecific to loot boxes.The multiplayer video game Heroes of the Storm recently removed loot boxes. In order to better understand links between loot boxes and problem gambling, we conducted an analysis of players of Heroes of the Storm (n=112) both before and after the removal of loot boxes.There were a complex pattern of results. In general, when loot boxes were removed from Heroes of the Storm, problem gamblers appeared to spend significantly less money in-game in contrast to other groups. These results suggest that the presence of loot boxes in a game may lead to problem gamblers spending more money in-game. It therefore seems possible that links between loot box spending and problem gambling are not due to a general dysregulation in in-game spending amongst problem gamblers, but rather are to do with specific features of loot boxes themselves.

INTERVENSI PELATIHAN PENILAIAN KINERJA PADA ATASAN UNTUK MENINGKATKAN PERCEIVED ORGANIZATIONAL SUPPORT & EMPLOYEE ENGAGEMENT

2017 ◽  
Vol 2 (2) ◽  
pp. 1-8
Author(s):  
Holy Greata
Keyword(s):  
Performance Appraisal ◽  
Employee Engagement ◽  
Study Design ◽  
Work Engagement ◽  
Organizational Support ◽  
Perceived Organizational Support ◽  
Paired Sample ◽  
Utrecht Work Engagement Scale ◽  
Before And After ◽  
Before And After Study

This study aims to look at the effectiveness of performance appraisal training programs to improve perceived organizational support and employee engagement among employees at YPTK educational institutions. This research uses a quantitative approach, with the before-and-after study design research design. The strength of this program is the ability to measure the impact of an intervention. Measuring devices perceived organizational support is an adaptation of the survey of perceived organizational support, while measuring instruments employee engagement is an adaptation of the Utrecht work engagement scale. The results of this study indicate the influence of perceived organizational support on employee engagement of 0.168 (p = 0.016 significant at l.o.s 0.05). Paired sample t-test results showed significant differences in perceived organizational support and employee engagement scores before and after the training and outreach of performance appraisal. Keywords: Perceived Organizational Suppor; Employee Engagement, Performance assessment   Penelitian ini bertujuan melihat efektifitas program pelatihan penilaian kinerja untuk meningkatkan perceived organizational support dan employee engagement pada karyawan di lembaga pendidikan YPTK. Penelitian ini menggunakan pendekatan kuantitatif, dengan design penelitian the before-and-after study design. Kelebihan dari program ini adalah kemampuan untuk mengukur dampak dari sebuah intervensi. Alat ukur perceived organizational support merupakan adaptasi dari survey of perceived organizational support, sedangkan alat ukur employee engagement merupakan adaptasi dari Utrecht work engagement scale. Hasil penelitian ini menunjukkan adanya pengaruh perceived organizational support terhadap employee engagement sebesar 0.168 (p=0.016 signifikan pada l.o.s 0.05). Hasil uji paired sample t-test menunjukkan adanya perbedaan skor perceived organizational support dan employee engagement yang signifikan sebelum dan sesudah dilakukan pelatihan dan sosialisasi penilaian kinerja.   Kata Kunci: Perceived Organizational Suppor; Employee Engagement, Penilaian Kinerja.

scholarly journals Robust Inferences from a Before-and-After Study with Multiple Unaffected Control Groups

2013 ◽  
Vol 1 (2) ◽  
pp. 209-234 ◽  
Author(s):  
Pengyuan Wang ◽  
Mikhail Traskin ◽  
Dylan S. Small
Keyword(s):  
Sensitivity Analysis ◽  
Control Groups ◽  
Two Stage ◽  
Time Effects ◽  
Unaffected Control ◽  
Group Time ◽  
Before And After ◽  
Group Variation ◽  
The Impact ◽  
Before And After Study

AbstractThe before-and-after study with multiple unaffected control groups is widely applied to study treatment effects. The current methods usually assume that the control groups’ differences between the before and after periods, i.e. the group time effects, follow a normal distribution. However, there is usually no strong a priori evidence for the normality assumption, and there are not enough control groups to check the assumption. We propose to use a flexible skew-t distribution family to model group time effects, and consider a range of plausible skew-t distributions. Based on the skew-t distribution assumption, we propose a robust-t method to guarantee nominal significance level under a wide range of skew-t distributions, and hence make the inference robust to misspecification of the distribution of group time effects. We also propose a two-stage approach, which has lower power compared to the robust-t method, but provides an opportunity to conduct sensitivity analysis. Hence, the overall method of analysis is to use the robust-t method to test for the overall hypothesized range of shapes of group variation; if the test fails to reject, use the two-stage method to conduct a sensitivity analysis to see if there is a subset of group variation parameters for which we can be confident that there is a treatment effect. We apply the proposed methods to two datasets. One dataset is from the Current Population Survey (CPS) to study the impact of the Mariel Boatlift on Miami unemployment rates between 1979 and 1982.The other dataset contains the student enrollment and grade repeating data in West Germany in the 1960s with which we study the impact of the short school year in 1966–1967 on grade repeating rates.

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