Implementing bedside rounds to improve patient-centred outcomes: a systematic review

2018 ◽  
Vol 28 (4) ◽  
pp. 317-326 ◽  
Author(s):  
John T Ratelle ◽  
Adam P Sawatsky ◽  
Deanne T Kashiwagi ◽  
Will M Schouten ◽  
Patricia J Erwin ◽  
...  
Keyword(s):  
Patient Experience ◽  
Experimental Studies ◽  
Selective Reporting ◽  
Patient Knowledge ◽  
Adult Care ◽  
Cohen’S D ◽  
Bedside Rounds ◽  
Central Registry ◽  
Patient Reported ◽  
Cohen's D

BackgroundBedside rounds (BR) have been proposed as an ideal method to promote patient-centred hospital care, but there is substantial variation in their implementation and effects. Our objectives were to describe the implementation of BR in hospital settings and determine their effect on patient-centred outcomes.MethodsData sources included Ovid MEDLINE, Ovid Embase, Scopus and Ovid Cochrane Central Registry of Clinical Trials from database inception through 28 July 2017. We included experimental studies comparing BR to another form of rounds in a hospital-based setting (ie, medical/surgical unit, intensive care unit (ICU)) and reporting a quantitative patient-reported or objectively measured clinical outcome. We used random effects models to calculate pooled Cohen's d effect size estimates for the patient knowledge and patient experience outcome domains.ResultsTwenty-nine studies met inclusion criteria, including 20 from adult care (17 non-ICU, 3 ICU), and nine from paediatrics (5 non-ICU, 4 ICU), the majority of which (n=23) were conducted in the USA. Thirteen studies implemented BR with cointerventions as part of a ‘bundle’. Studies most commonly reported outcomes in the domains of patient experience (n=24) and patient knowledge (n=10). We found a small, statistically significant improvement in patient experience with BR (summary Cohen’s d=0.09, 95% CI 0.04 to 0.14, p<0.001, I2=56%), but no significant association between BR and patient knowledge (Cohen’s d=0.21, 95% CI −0.004 to –0.43, p=0.054, I2=92%). Risk of bias was moderate to high, with methodological limitations most often relating to selective reporting, low adherence rates and missing data.ConclusionsBR have been implemented in a variety of hospital settings, often ‘bundled’ with cointerventions. However, BR have demonstrated limited effect on patient-centred outcomes.

scholarly journals Statistical Power and Precision of Experimental Studies Originated in the Republic of Turkey from 2010 to 2020: Current Practices and Some Recommendations

2020 ◽  
Author(s):  
Metin Bulus ◽  
Ilhan Koyuncu
Keyword(s):  
Power Analysis ◽  
Statistical Power ◽  
Experimental Studies ◽  
Small Scale ◽  
Cohen’S D ◽  
Ex Ante ◽  
The Republic ◽  
Cohen's D ◽  
Republic Of Turkey ◽  
Education Field

This study systematically reviews randomly selected 155 experimental studies in education field originated in the Republic of Turkey between 2010 and 2020. Indiscriminate choice of sample size in recent publications prompted us to evaluate their statistical power and precision. First, above and beyond our review, we could not identify any large-scale experiments such as cluster-randomized or multisite randomized trials, which overcome shortcomings of small-scale experiments, better suit to the organizational structure of the education field, nevertheless require far greater effort and financial resources. Second, none of the small-scale experiments has reported or conducted ex-ante power analysis. Third, results indicate that studies are sufficiently powered to detect medium to large effects (0.50 &lt; Cohen’s d &lt; 0.80), however they are underpowered to detect small effects (Cohen’s d ≤ 0.20). In other words, they are precise enough to detect medium effects and above (MDES ≥ .50). Finally, trends in the past ten years indicate precision remained unchanged. Findings should be interpreted in light of minimum effects in education that are relevant to education policy and practice. We emphasize the importance of conducting ex-ante power analysis, and encourage the reporting of standardized variance parameters and attrition rates to inform future studies of similar kind.

scholarly journals Remotely supervised transcranial direct current stimulation for the treatment of fatigue in multiple sclerosis: Results from a randomized, sham-controlled trial

2017 ◽  
Vol 24 (13) ◽  
pp. 1760-1769 ◽  
Author(s):  
Leigh E Charvet ◽  
Bryan Dobbs ◽  
Michael T Shaw ◽  
Marom Bikson ◽  
Abhishek Datta ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Training ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Short Form ◽  
Active Group ◽  
Direct Current Stimulation ◽  
Cohen’S D ◽  
Patient Reported ◽  
Cohen's D

Background: Fatigue is a common and debilitating feature of multiple sclerosis (MS) that remains without reliably effective treatment. Transcranial direct current stimulation (tDCS) is a promising option for fatigue reduction. We developed a telerehabilitation protocol that delivers tDCS to participants at home using specially designed equipment and real-time supervision (remotely supervised transcranial direct current stimulation (RS-tDCS)). Objective: To evaluate whether tDCS can reduce fatigue in individuals with MS. Methods: Dorsolateral prefrontal cortex left anodal tDCS was administered using a RS-tDCS protocol, paired with 20 minutes of cognitive training. Here, two studies are considered. Study 1 delivered 10 open-label tDCS treatments (1.5 mA; n = 15) compared to a cognitive training only condition ( n = 20). Study 2 was a randomized trial of active (2.0 mA, n = 15) or sham ( n = 12) delivered for 20 sessions. Fatigue was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS)—Fatigue Short Form. Results and conclusion: In Study 1, there was modest fatigue reduction in the active group (−2.5 ± 7.4 vs −0.2 ± 5.3, p = 0.30, Cohen’s d = −0.35). However, in Study 2 there was statistically significant reduction for the active group (−5.6 ± 8.9 vs 0.9 ± 1.9, p = 0.02, Cohen’s d = −0.71). tDCS is a potential treatment for MS-related fatigue.

Phonologische Verarbeitung bei Grundschulkindern mit schwacher Lesefähigkeit

2013 ◽  
Vol 2 (4) ◽  
pp. 199-215 ◽  
Author(s):  
Maria Klatte ◽  
Claudia Steinbrink ◽  
Kirstin Bergström ◽  
Thomas Lachmann
Keyword(s):  
Cohen’S D ◽  
Phonologische Verarbeitung ◽  
Cohen's D

Defizite in der phonologischen Informationsverarbeitung werden heute als Kernsymptom der Lese-Rechtschreibstörung betrachtet. In Trainingsstudien mit betroffenen Kindern erwiesen sich Phonemwahrnehmungsfähigkeiten als trainierbar, und Programme, in denen Aufgaben zur phonologischen Bewusstheit mit der systematischen Vermittlung von Phonem-Graphem-Zuordnungen kombiniert wurden, zeigten Transfereffekte auf Lese- und Rechtschreibleistungen. Ausgehend von diesen Erkenntnissen wurde ein computerbasiertes Trainingsprogramm zur Förderung der Phonemwahrnehmung, der phonologischen Bewusstheit und der Graphem-Phonem-Zuordnungen für deutschsprachige Grundschulkinder mit Lese-Rechtschreibstörung entwickelt. Aufgrund der besonderen Relevanz der Vokallänge für die deutsche Orthographie enthält das Programm neben Aufgaben, die auf Konsonanten fokussieren, auch Vokallängenaufgaben. Bei der Konzipierung des Programms wurden etablierte, ursprünglich für andere Sprachen entwickelte Aufgaben an die deutsche Phonologie angepasst und in ein computerbasiertes Format übersetzt. Im Rahmen der vorliegenden Studie sollte überprüft werden, ob die konstruierten Trainingsaufgaben die spezifischen Defizite von Kindern mit Lese-Rechtschreibstörung wie intendiert abbilden. Hierzu wurden leseschwache Dritt- und Viertklässler (n = 35) mit mindestens durchschnittlichen Lesern derselben Klassenstufen (n = 75; Kontrollgruppe) hinsichtlich ihrer Leistungen in den Aufgaben verglichen. Die leseschwachen Kinder zeigten in allen Aufgaben schlechtere Leistungen als die Kontrollgruppe. Die Effektstärken der Gruppenunterschiede (Cohen's d) lagen im mittleren bis hohen Bereich (0.50 – 2.19). Die Ergebnisse bestätigen, dass die Aufgaben des Trainingsprogramms die spezifischen Defizite leseschwacher Kinder abbilden. Ein Training mit diesen Aufgaben erscheint daher grundsätzlich sinnvoll. Die Wirkungen eines solchen Trainings auf die schriftsprachlichen Leistungen von Kindern mit Lese-Rechtschreibstörung werden in zukünftigen Studien überprüft.

Political Inclusion Reduces Political Prejudice

2019 ◽  
Author(s):  
Jan G. Voelkel ◽  
Dongning Ren ◽  
Mark John Brandt
Keyword(s):  
The Political ◽  
Political Discussion ◽  
Total N ◽  
Cohen’S D ◽  
Promising Strategy ◽  
Political Inclusion ◽  
Cohen's D ◽  
Political Divide ◽  
Scenario Study ◽  
Fair Chance

The political divide is characterized by liberals and conservatives who hold strong prejudice against each other. Here we introduce one possible strategy for reducing political prejudice: political inclusion. We define political inclusion as receiving a fair chance to voice one’s opinions in a discussion of political topics with political outgroup members. This strategy may reduce political prejudice by inducing perceptions of the political outgroup as fair and respectful; however, such a strategy may also highlight conflicting attitudes and worldviews, thereby further exacerbating prejudice. In three preregistered studies (total N = 799), we test if political inclusion reduces or increases prejudice toward the political outgroup. Specifically, political inclusion was manipulated with either an imagined scenario (Study 1) or a concurrent experience in an ostensible online political discussion (Studies 2 &amp; 3). Across all studies, participants who were politically included by political outgroup members reported reduced prejudice toward their outgroup compared to participants in a neutral control condition (Cohen’s d [-0.27, -0.50]). This effect was mediated by perceptions of the political outgroup as fairer and less dissimilar in their worldviews. Our results indicate that political discussions that are politically inclusive do not cause additional prejudice via worldview conflict, but instead give others a feeling of being heard. It is a promising strategy to reduce political prejudice.

scholarly journals Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

2019 ◽  
Vol 8 (4) ◽  
pp. 555 ◽  
Author(s):  
Cátia Caneiras ◽  
Cristina Jácome ◽  
Sagrario Mayoralas-Alises ◽  
José Ramon Calvo ◽  
João Almeida Fonseca ◽  
...  
Keyword(s):  
Clinical Research ◽  
Patient Experience ◽  
Clinical Care ◽  
Research Priorities ◽  
Specific Patient ◽  
Quality Healthcare ◽  
Body Of Knowledge ◽  
Number Of Patients ◽  
Patient Reported ◽  
System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

scholarly journals Lower Extremity Rehabilitation in Patients with Post-Stroke Sequelae through Virtual Reality Associated with Mirror Therapy

2021 ◽  
Vol 18 (5) ◽  
pp. 2654
Author(s):  
Roxana Steliana Miclaus ◽  
Nadinne Roman ◽  
Ramona Henter ◽  
Silviu Caloian
Keyword(s):  
Virtual Reality ◽  
Muscle Strength ◽  
Lower Extremity ◽  
Range Of Motion ◽  
Control Group ◽  
Mirror Therapy ◽  
Cohen’S D ◽  
Cohen's D ◽  
Experimental Group ◽  
Post Therapy

More innovative technologies are used worldwide in patient’s rehabilitation after stroke, as it represents a significant cause of disability. The majority of the studies use a single type of therapy in therapeutic protocols. We aimed to identify if the association of virtual reality (VR) therapy and mirror therapy (MT) exercises have better outcomes in lower extremity rehabilitation in post-stroke patients compared to standard physiotherapy. Fifty-nine inpatients from 76 initially identified were included in the research. One experimental group (n = 31) received VR therapy and MT, while the control group (n = 28) received standard physiotherapy. Each group performed seventy minutes of therapy per day for ten days. Statistical analysis was performed with nonparametric tests. Wilcoxon Signed-Rank test showed that both groups registered significant differences between pre-and post-therapy clinical status for the range of motion and muscle strength (p < 0.001 and Cohen’s d between 0.324 and 0.645). Motor Fugl Meyer Lower Extremity Assessment also suggested significant differences pre-and post-therapy for both groups (p < 0.05 and Cohen’s d 0.254 for the control group and 0.685 for the experimental group). Mann-Whitney results suggested that VR and MT as a therapeutic intervention have better outcomes than standard physiotherapy in range of motion (p < 0.05, Cohen’s d 0.693), muscle strength (p < 0.05, Cohen’s d 0.924), lower extremity functionality (p < 0.05, Cohen’s d 0.984) and postural balance (p < 0.05, Cohen’s d 0.936). Our research suggests that VR therapy associated with MT may successfully substitute classic physiotherapy in lower extremity rehabilitation after stroke.

Development of a multimedia intervention to improve pneumoconiosis prevention in construction workers using RE-AIM framework

2021 ◽  
Author(s):  
Jieling Chen ◽  
Cho Lee Wong ◽  
Bernard Man Hin Law ◽  
Winnie Kwok Wei So ◽  
Doris Yin Ping Leung ◽  
...  
Keyword(s):  
South Asian ◽  
Educational Intervention ◽  
Self Efficacy ◽  
Intervention Mapping ◽  
Intervention Development ◽  
Educational Interventions ◽  
Construction Workers ◽  
Post Intervention ◽  
Cohen’S D ◽  
Cohen's D

Summary Pneumoconiosis is a common occupational lung disease among construction workers. Educational interventions targeting specific ethnic groups of construction workers are of benefit for pneumoconiosis prevention. The aim of this study was to develop a multimedia educational intervention for pneumoconiosis prevention for South Asian construction workers, and to evaluate its feasibility, acceptability and effectiveness in increasing knowledge of pneumoconiosis, modifying beliefs about pneumoconiosis, and enhancing intention to implement measures for its prevention among the workers. This evaluation was performed using the Reach-Effectiveness-Adoption-Implementation-Maintenance framework. A one-group design was adopted and intervention mapping was used to guide the process of intervention development, while the Health Belief Model guided the development of intervention content. The intervention was delivered at construction sites, ethnic minority associations and South Asian community centres. Data were collected via surveys completed at pre-intervention, post-intervention and 3 months after the intervention. A total of 1002 South Asian construction workers participated in the intervention. The participants reported a moderate-to-large increase in knowledge, perceived susceptibility, perceived severity, perceived benefits, cues to action and self-efficacy (Cohen’s d: 0.37–0.89), a small reduction in perceived barriers (Cohen’s d = 0.12) and a moderate improvement in attitudes and intention to practice (Cohen’s d: 0.45, 0.51) at post-intervention. A follow-up survey of 121 participants found that the implementation of preventive measures appeared to increase. Overall, the findings demonstrate that the implementation of a culturally adapted multimedia educational intervention could be an effective approach to improving knowledge, self-efficacy and intention regarding pneumoconiosis prevention among South Asian construction workers.

scholarly journals Explainable AI enables clinical trial patient selection to retrospectively improve treatment effects in schizophrenia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monika S. Mellem ◽  
Matt Kollada ◽  
Jane Tiller ◽  
Thomas Lauritzen
Keyword(s):  
Clinical Trial ◽  
Patient Selection ◽  
Treatment Effect ◽  
Controlled Clinical Trial ◽  
Learning Approaches ◽  
Full Sample ◽  
Cohen’S D ◽  
Explainable Ai ◽  
Cohen's D ◽  
Analytical Approaches

Abstract Background Heterogeneity among patients’ responses to treatment is prevalent in psychiatric disorders. Personalized medicine approaches—which involve parsing patients into subgroups better indicated for a particular treatment—could therefore improve patient outcomes and serve as a powerful tool in patient selection within clinical trials. Machine learning approaches can identify patient subgroups but are often not “explainable” due to the use of complex algorithms that do not mirror clinicians’ natural decision-making processes. Methods Here we combine two analytical approaches—Personalized Advantage Index and Bayesian Rule Lists—to identify paliperidone-indicated schizophrenia patients in a way that emphasizes model explainability. We apply these approaches retrospectively to randomized, placebo-controlled clinical trial data to identify a paliperidone-indicated subgroup of schizophrenia patients who demonstrate a larger treatment effect (outcome on treatment superior than on placebo) than that of the full randomized sample as assessed with Cohen’s d. For this study, the outcome corresponded to a reduction in the Positive and Negative Syndrome Scale (PANSS) total score which measures positive (e.g., hallucinations, delusions), negative (e.g., blunted affect, emotional withdrawal), and general psychopathological (e.g., disturbance of volition, uncooperativeness) symptoms in schizophrenia. Results Using our combined explainable AI approach to identify a subgroup more responsive to paliperidone than placebo, the treatment effect increased significantly over that of the full sample (p < 0.0001 for a one-sample t-test comparing the full sample Cohen’s d = 0.82 and a generated distribution of subgroup Cohen’s d’s with mean d = 1.22, std d = 0.09). In addition, our modeling approach produces simple logical statements (if–then-else), termed a “rule list”, to ease interpretability for clinicians. A majority of the rule lists generated from cross-validation found two general psychopathology symptoms, disturbance of volition and uncooperativeness, to predict membership in the paliperidone-indicated subgroup. Conclusions These results help to technically validate our explainable AI approach to patient selection for a clinical trial by identifying a subgroup with an improved treatment effect. With these data, the explainable rule lists also suggest that paliperidone may provide an improved therapeutic benefit for the treatment of schizophrenia patients with either of the symptoms of high disturbance of volition or high uncooperativeness. Trial Registration: clincialtrials.gov identifier: NCT 00,083,668; prospectively registered May 28, 2004

scholarly journals Louisiana Geriatric Workforce Enhancement Program: Analysis of Learning Outcomes From Dementia Training

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 58-58
Author(s):  
Katherine Kirsch ◽  
Catherine Lemieux ◽  
Laura Ainsworth ◽  
Sarah Choate ◽  
Ashleigh Borgmeyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Analysis ◽  
Training Session ◽  
Cohen’S D ◽  
Response Formats ◽  
Cohen's D ◽  
Item Knowledge ◽  
South Louisiana ◽  
Severe Shortage ◽  
Primary Care Professionals

Abstract A recent Alzheimer’s Association report noted that by year 2050, the number of Americans diagnosed with Alzheimer’s disease and related dementias (ADRD) will triple to over 15 million. The report referred to primary care as the front line for meeting this demand, yet the nation faces a severe shortage of ADRD trained, primary care professionals (PCPs). Louisiana Geriatric Workforce Enhancement Program (LA-GWEP) addresses this demand. The purpose of this study was to examine preliminary data respective to LA-GWEP effectiveness with interdisciplinary education and training seminars, primarily aimed at medical, nursing, and social work PCPs. Three seminars were conducted in south Louisiana: Seminars 1 and 2 addressed effective communication, verbal and nonverbal, among persons with ADRD and caregivers; Seminar 3 offered basic overview of dementia symptomology, stages, and behaviors. Pre- and post-training session data were collected on-site. Participants completed questionnaires that included a 10-item knowledge assessment and 20-item Dementia Attitudes Scale (DAS). These measures contained Likert response formats; higher scores indicating greater levels of ADRD knowledge, in patient and caregiver contexts. Paired sample t-tests were conducted to observe any significant pre-to-post improvement, Cohen’s d for effect size. Seminar 1 revealed no significant pre-to-post difference: t = -1.019, p = 0.320. Adjusting content from audience feedback, Seminar 2 revealed significant pre-to-post difference: t = -7.516, p &lt; .001, Cohen’s d = 1.2. Seminar 3 yielded significant improvement on DAS scores: t = -2.96, p &lt; .01, Cohen’s d = 0.34. Implications for seminars in future years of LA-GWEP are discussed.

scholarly journals Understanding the patient experience in hepatocellular carcinoma: a qualitative patient interview study

2021 ◽  
Author(s):  
Nikunj Patel ◽  
Joshua Maher ◽  
Xandra Lie ◽  
Chad Gwaltney ◽  
Afsaneh Barzi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Drug Development ◽  
Conceptual Model ◽  
Patient Experience ◽  
Outcome Measurement ◽  
Qualitative Interviews ◽  
Patient Reported Outcome ◽  
Weight Changes ◽  
Patient Reported ◽  
Pro Instruments

Abstract Purpose This study aimed to elucidate the patient experience of hepatocellular carcinoma (HCC) to guide patient-centered outcome measurement in drug development. Methods Patients with HCC participated in qualitative interviews to elicit disease-related signs/symptoms and impacts, using discussion guides developed from literature searches and discussions with oncologists. Interview participants rated the disturbance of their experiences (0–10 scale). A conceptual model was developed and mapped against patient-reported outcome (PRO) instruments identified from database reviews. Results Interviews were conducted with 25 individuals with HCC (68% were men; median age: 63 years; 12% Barcelona clinic liver cancer (BCLC) stage A; 32% stage B; and 56% stage C) in the USA. Fifty-one HCC-related concepts were identified from the interviews and were grouped into eight sign/symptom categories (eating behavior/weight changes; extremities [arms, legs]; fatigue and strength; gastrointestinal; pain; sensory; skin; other) and four impact categories (emotional; physical; cognitive function; other) for the conceptual model. The most prevalent and disturbing experiences across the disease stages were fatigue/lack of energy and emotional impacts such as frustration, fear, and depression. Abdominal pain and skin-related issues were particularly common and disturbing in individuals with HCC stage C. The EORTC QLQ-C30 and HCC18 were identified as commonly used PRO instruments in HCC studies and captured the relevant signs/symptoms associated with the patient experience. Conclusion Patients with HCC reported a range of signs/symptoms and impacts that negatively affect daily functioning and quality of life. Including PRO measures in HCC clinical trials can provide meaningful patient perspectives during drug development.

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