Changing Clinicians’ Behavior: a Randomized Controlled Trial of Fees and Education

2008 ◽  
Vol 87 (7) ◽  
pp. 640-644 ◽  
Author(s):  
J.E. Clarkson ◽  
S. Turner ◽  
J.M. Grimshaw ◽  
C.R. Ramsay ◽  
M. Johnston ◽  
...  
Keyword(s):  
Evidence Based Practice ◽  
Controlled Trial ◽  
Implementation Strategies ◽  
Cost Effective ◽  
Evidence Based ◽  
Permanent Molars ◽  
Primary Hypothesis ◽  
And Control ◽  
Treatment Education ◽  
Fissure Sealing

The fissure-sealing of newly erupted molars is an effective caries prevention treatment, but remains underutilized. Two plausible reasons are the financial disincentive produced by the dental remuneration system, and dentists’ lack of awareness of evidence-based practice. The primary hypothesis was that implementation strategies based on remuneration or training in evidence-based healthcare would produce a higher proportion of children receiving sealed second permanent molars than standard care. The four study arms were: fee per sealant treatment, education in evidence-based practice, fee plus education, and control. A cost-effectiveness analysis was conducted. Analysis was based on 133 dentists and 2833 children. After adjustment for baseline differences, the primary outcome was 9.8% higher when a fee was offered. The education intervention had no statistically significant effect. ‘Fee only’ was the most cost-effective intervention. The study contributes to the incentives in health care provision debate, and led to the introduction of a direct fee for this treatment.

scholarly journals Reducing Assaults Against Staff Using Body-Worn Cameras (BWCs) in Railway Stations

2018 ◽  
Vol 44 (1) ◽  
pp. 76-93 ◽  
Author(s):  
Barak Ariel ◽  
Mark Newton ◽  
Lorna McEwan ◽  
Garry A. Ashbridge ◽  
Cristobal Weinborn ◽  
...  
Keyword(s):  
Workplace Violence ◽  
Physical Violence ◽  
Controlled Trial ◽  
Health And Safety ◽  
Cost Effective ◽  
Railway Stations ◽  
Major Health ◽  
Diffusion Of Benefits ◽  
And Control ◽  
Official Records

Workplace violence is a major health and safety phenomenon. We investigate whether body-worn cameras (BWCs) can achieve a cost-effective reduction of assaults. We conducted a randomized controlled trial with train stations exposed to the highest recorded assault rates against staff in England and Wales. Treatment members of staff were equipped with BWCs and control staff were unexposed to BWCs. Official records of assaults against treatment and control staff as well as against any employee at the station complexes are used as outcome measures. Results suggest 47% significant overall reduction in the odds of assaults against BWCs-equipped staff at treatment versus controls locations—or approximately two versus four assaults, on average, per station. In addition, we found a 26% significant reduction in assaults against all employees in the treatment versus control station complexes—9 versus 12 assaults, on average, per station—suggesting that BWCs have a spatial diffusion of benefits effects. We estimate that BWCs can reduce at least 3,000 working days per year lost because of physical violence at work. We conclude that BWCs provide substantial benefits for staff health and safety to those who are equipped with the devices as well as to staff in the vicinity of BWC-equipped employees.

scholarly journals Prevalence of Vitamin D Deficiency and Its Relationship with Clinical Outcomes in Patients with Fibromyalgia: a Systematic Review of the Literature

2022 ◽  
Vol 4 (1) ◽  
Author(s):  
Omar M. E. Ali
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Patient Flow ◽  
Controlled Trial ◽  
Cost Effective ◽  
Therapeutic Benefit ◽  
Vitamin D Supplementation ◽  
Effective Interventions ◽  
Randomised Controlled ◽  
And Control

Abstract Fibromyalgia is a debilitating chronic condition which poses a therapeutic challenge to the clinician. With a large backlog in patient flow subsequent to the COVID-19 pandemic and rising numbers of patients with post-acute sequelae of COVID-19 (PASC) presenting with fibromyalgia-like clinical features, there is an increasingly pressing need to identify broad cost-effective interventions. Low levels of vitamin D have previously been reported in patients with fibromyalgia, though any causative link has been difficult to establish. A systematic literature review on the association between vitamin D deficiency and fibromyalgia was performed examining retrospective evidence both for and against an association between vitamin D deficiency (VDD) and fibromyalgia and evaluating the therapeutic benefit from supplementation. A group of six studies were selected based on relevance, use of controls, quality of research and citations. Four primary studies assessing the prevalence of VDD in fibromyalgia patients versus controls were evaluated with a total 3,496 subjects. Three included females only and one larger study assessed males. Two (n = 313) concluded the presence of a statistically significant association, and two (n = 161) found none. Two randomised controlled trials assessing the effect of vitamin D supplementation in a total of 80 subjects found conflicting results, with pain reduction in one and none in the other. It is likely there exists an association between VDD deficiency and fibromyalgia in a large subset of patients, although establishing primary causation is difficult. There is a need for larger randomised controlled trial designs with more effective comparison with healthy subjects and control for confounding factors. Given VDD is a major problem in the general population, we recommend supplementation be recommended by healthcare professionals to fibromyalgia patients for the purpose of maintaining bone health given their potentially increased susceptibility to developing deficiency and its sequelae.

Evidence-based Practice Implementation Strategies: Results of a Qualitative Study

2007 ◽  
Vol 44 (3) ◽  
pp. 213-224 ◽  
Author(s):  
Charles A. Rapp ◽  
Diane Etzel-Wise ◽  
Doug Marty ◽  
Melinda Coffman ◽  
Linda Carlson ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Evidence Based Practice ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Practice Implementation

scholarly journals Communication Intervention to Improve Informed Choice at Childbirth: A Randomized Controlled Trial Protocol Using Digital Technology in the Context of the Covid-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Carmen Simone Grilo Diniz ◽  
Ana Carolina Arruda Franzon ◽  
Beatriz Fioretti-Foschi ◽  
Denise Yoshie Niy ◽  
Livia Pedrilio ◽  
...  
Keyword(s):  
Information Needs ◽  
Controlled Trial ◽  
Informed Choice ◽  
Smartphone Application ◽  
Communication Strategy ◽  
Evidence Based ◽  
Trial Protocol ◽  
Randomized Controlled ◽  
Childbirth Experience ◽  
And Control

BACKGROUND In Brazil, and in other low-and-middle-income countries, the excess of interventions in childbirth has been associated with an increase in preterm and early term births, contributing to stagnant morbidity and mortality of mothers and babies. The fact that women often report a negative experience in vaginal childbirth, with physical pain and feelings of unsafety, neglect or abuse, may explain the high acceptability of elective cesarean sections. The recognition of the information needs and of the right to informed choice in childbirth can contribute to change this reality. The internet has been the main source of health information, but its quality is highly variable. OBJECTIVE Develop and evaluate an information/communication strategy through a smartphone application about childbirth, to facilitate informed choice for access to safer and evidence-based care, in the context of the Covid-19 pandemic. METHODS Randomized-controlled trial, with two arms (intervention and control), blind, parallel, to be conducted in a smartphone application, with women in reproductive age. After completing an entry questionnaire to verify the eligibility criteria and ethical consent, around 20,000 participants will be randomly allocated between the intervention and control groups in a 1: 1 ratio. Participants allocated to the intervention group will be invited to engage in an online information and communication strategy, designed to expand evidence-based knowledge on the advantages and disadvantages of options in labor and birth, and safety of care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience, and are updated to include the new challenges and disruptions in maternity care within the Covid-19 pandemic. The control group will receive information about disposable and reusable diapers as placebo intervention. The groups will be compared in their responses on a mission to prepare the birth plan, as well as in the entry and exit questionnaires, regarding answers less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. RESULTS The digital trial will start recruiting participants in late October 2020 and data collection is projected to finish by December 2020. CONCLUSIONS This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, so that they can make better choices and ensure their rights during the pandemic. CLINICALTRIAL Brazilian Registry of Clinical Trials – ReBEC (http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/). WHO’s Unique Trial Number (UTN U1111-1255-8683). This is the first version of the trial protocol.

The Terrain

2016 ◽  
pp. 3-25
Author(s):  
Daniel B. Fishman ◽  
David J.A. Edwards
Keyword(s):  
Quantitative Methods ◽  
Evidence Based Practice ◽  
Controlled Trial ◽  
Government Support ◽  
Evidence Based ◽  
Qualitative And Quantitative Methods ◽  
Empirically Supported ◽  
Recent Developments ◽  
Evidence Model

Although much has been written about the basic incompatibility of the dominant quantitative research model in psychotherapy and the qualitative preferences of the practitioner community, the recent developments detailed in this chapter have resulted in a growing rapprochement on both sides in the service of pragmatically improving the effectiveness of psychotherapy. Examples of these developments include (a) the growing mixed-methods movement; (b) the creation of the American Psychological Association’s evidence-based practice in psychology and evidence-based relationships models, to complement traditional empirically supported treatments; (c) the growth of the “practice-based evidence” model to complement evidence-based practice; (d) the organization of the case study field into a coherent whole with a variety of types of complementary approaches; (e) the emergence of “theory-building” case studies; (f) the development of case-study-based thinking within the cognitive-behavioral therapy movement; and (g) government support of initiatives that link traditional randomized controlled trial research to approaches that emphasize both qualitative and quantitative methods.

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