scholarly journals The impact of removing financial incentives and/or audit and feedback on chlamydia testing in general practice: A cluster randomised controlled trial (ACCEPt-able)

PLoS Medicine ◽  
2022 ◽  
Vol 19 (1) ◽  
pp. e1003858
Author(s):  
Jane S. Hocking ◽  
Anna Wood ◽  
Meredith Temple-Smith ◽  
Sabine Braat ◽  
Matthew Law ◽  
...  
Keyword(s):  
General Practice ◽  
Financial Incentives ◽  
Controlled Trial ◽  
Absolute Difference ◽  
Cluster Rct ◽  
Chlamydia Testing ◽  
Group A ◽  
Group B ◽  
Randomised Controlled ◽  
Group D

Background Financial incentives and audit/feedback are widely used in primary care to influence clinician behaviour and increase quality of care. While observational data suggest a decline in quality when these interventions are stopped, their removal has not been evaluated in a randomised controlled trial (RCT), to our knowledge. This trial aimed to determine whether chlamydia testing in general practice is sustained when financial incentives and/or audit/feedback are removed. Methods and findings We undertook a 2 × 2 factorial cluster RCT in 60 general practices in 4 Australian states targeting 49,525 patients aged 16–29 years for annual chlamydia testing. Clinics were recruited between July 2014 and September 2015 and were followed for up to 2 years or until 31 December 2016. Clinics were eligible if they were in the intervention group of a previous cluster RCT where general practitioners (GPs) received financial incentives (AU$5–AU$8) for each chlamydia test and quarterly audit/feedback reports of their chlamydia testing rates. Clinics were randomised into 1 of 4 groups: incentives removed but audit/feedback retained (group A), audit/feedback removed but incentives retained (group B), both removed (group C), or both retained (group D). The primary outcome was the annual chlamydia testing rate among 16- to 29-year-old patients, where the numerator was the number who had at least 1 chlamydia test within 12 months and the denominator was the number who had at least 1 consultation during the same 12 months. We undertook a factorial analysis in which we investigated the effects of removal versus retention of incentives (groups A + C versus groups B + D) and the effects of removal versus retention of audit/feedback (group B + C versus groups A + D) separately. Of 60 clinics, 59 were randomised and 55 (91.7%) provided data (group A: 15 clinics, 11,196 patients; group B: 14, 11,944; group C: 13, 11,566; group D: 13, 14,819). Annual testing decreased from 20.2% to 11.7% (difference −8.8%; 95% CI −10.5% to −7.0%) in clinics with incentives removed and decreased from 20.6% to 14.3% (difference −7.1%; 95% CI −9.6% to −4.7%) where incentives were retained. The adjusted absolute difference in treatment effect was −0.9% (95% CI −3.5% to 1.7%; p = 0.2267). Annual testing decreased from 21.0% to 11.6% (difference −9.5%; 95% CI −11.7% to −7.4%) in clinics where audit/feedback was removed and decreased from 19.9% to 14.5% (difference −6.4%; 95% CI −8.6% to −4.2%) where audit/feedback was retained. The adjusted absolute difference in treatment effect was −2.6% (95% CI −5.4% to −0.1%; p = 0.0336). Study limitations included an unexpected reduction in testing across all groups impacting statistical power, loss of 4 clinics after randomisation, and inclusion of rural clinics only. Conclusions Audit/feedback is more effective than financial incentives of AU$5–AU$8 per chlamydia test at sustaining GP chlamydia testing practices over time in Australian general practice. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12614000595617

scholarly journals A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Pengyi Li ◽  
Lianbing Gu ◽  
Jing Tan ◽  
Zhenghuan Song ◽  
Qingming Bian ◽  
...  
Keyword(s):  
Prostaglandin E1 ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Inflammatory Factors ◽  
Pulmonary Shunt ◽  
One Lung Ventilation ◽  
Reference Concentration ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Abstract Background Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO2 one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO2 OLV and provide a reference concentration of PGE1. Methods Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO2 and 0.1 µg/kg PGE1), Group B (40% FiO2 and 0.1 µg/kg PGE1), and Group C (40% FiO2, 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV. Results During OLV, patients in Group C and B had lower levels of PaO2, SaO2, SpO2, MAP, and Qs/Qt than those in Group A (P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO2/FiO2 than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores. Conclusion The concentration of FiO2 could be reduced from 60 to 40% to maintain oxygenation. 40% FiO2 + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors. Trial registration: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.

scholarly journals Gamification as an entrepreneur well-being intervention: A study protocol for a single-blinded randomised controlled trial

2021 ◽  
Author(s):  
Waqar M. Naqvi
Keyword(s):  
Controlled Trial ◽  
Life Quality ◽  
Well Being ◽  
Likert Scale ◽  
Control Group ◽  
Group A ◽  
Measuring Scale ◽  
Group B ◽  
Randomised Controlled

Abstract Entrepreneurs usually work for long hours resulting in exhaustion, stress, and burnout. The prevalent symptoms of burnout are reduced levels of physical and mental energy, reduced job efficiency and diminished productivity. Therefore, it is important to improve the health of entrepreneurs. Gamification has a positive relationship with improvements in health and well-being as it influences positive experiences and satisfaction. This trial aims to study how 30-minutes of virtual reality game use via Kinect Azure and Oculus platforms 3-times per week, for 4 weeks, relates to differences in entrepreneur stress, burnout, subjective life quality, and downstream firm performance. We will recruit entrepreneurs over the age of 18 for the gamification analysis. Analysis of previous power using G*Power will determine the sample size. We will divide the participants into 3 groups, wherein Group A will undergo gamification on the Kinect platform, Group B will undergo the Oculus Quest intervention, and Group C will be the control group. We will conduct the study at two sites, one at the HuMen research. The outcome measures include a five-point Likert scale for measuring entrepreneurial stress, burnout-measuring scale (BMS) for burnout, five-point Likert scale for performance and SF-12 for Quality of life. Since current strains pave ways to future accomplishment, entrepreneurs' eudemonic well-being might particularly relate to forward-looking challenge stressors and burnouts. The results will provide an insight into how gamification could help entrepreneurs to deal with work stress and maintain high well-being.

scholarly journals P045 Is chlamydia testing in general practice sustained when financial incentives or audit + feedback are removed: a cluster RCT

2019 ◽  
Author(s):  
Jane Hocking ◽  
Anna Wood ◽  
Sabine Braat ◽  
Callum Jones ◽  
Meredith Temple-Smith ◽  
...  
Keyword(s):  
General Practice ◽  
Financial Incentives ◽  
Cluster Rct ◽  
Chlamydia Testing

A Randomised, Controlled Clinical Study on Total Hip Arthroplasty Using 4 Different Bearings: Results after 10 Years

2016 ◽  
Vol 27 (1) ◽  
pp. 96-103
Author(s):  
Arne Borgwardt ◽  
Bo Zerahn ◽  
Sandra D. Fabricius ◽  
Tine H. Bertelsen ◽  
Henrik Daugaard ◽  
...  
Keyword(s):  
Clinical Study ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Metal On Metal ◽  
Group A ◽  
Group B ◽  
Randomised Controlled ◽  
Group D ◽  
Controlled Clinical Study

Purpose To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. Methods 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia-on-polyethylene (group A), metal-on-metal (group B), zirconia-on-polyethylene with the liner moulded into the shell (group C), or alumina-on-alumina (group D). In the individual case the surgeon could choose other implants if indicated. Results 299 patients were operated with the allocated prosthesis. The estimated cumulated prosthesis survival percentages and 95% confidence interval after 10 years were: group A 84.6 (75.8-93.4); group B 95.0 (89.5-100); group C 93.2 (86.7-99.7); group D 66.1 (54.5-77.7). The patients' physical function was significantly improved and remained equally good in all 4 groups, however slightly declining with ageing. The luxation rate was initially high, and equal between the groups, but was reduced by improving the surgical procedure introducing capsule repair by reinsertion of the short external hip rotators. Conclusions The metal-on-metal or zirconia-on-polyethylene prostheses had high 10-year survival percentages. The longevity of these bearing couples by themselves was not related to the combination of materials. The zirconia-on-polyethylene prosthesis with the liner mounted peroperatively possibly exhibited cases of backside wear which the corresponding bearing couple with moulded polyethylene (Asian) did not. The alumina-on-alumina bearing performed poorly - it was redesigned after our study initiation and later withdrawn from the market.

scholarly journals Dexmedetomidine and Fentanyl for Postoperative Analgesia in Patients Undergoing Abdominal Surgery: Randomised Controlled Trial

2021 ◽  
Author(s):  
Prashant Sachan ◽  
Prem Raj Singh ◽  
Sateesh Verma ◽  
Brij Bihari Kushwaha
Keyword(s):  
Postoperative Pain ◽  
Randomised Controlled Trial ◽  
Abdominal Surgery ◽  
Postoperative Analgesia ◽  
Pain Control ◽  
Controlled Trial ◽  
Haemodynamic Stability ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Introduction: Pain control is an important factor for postoperative recovery. Many drugs have been studied for effectiveness of postoperative analgesia. Fentanyl is a conventional drug and dexmedetomidine is one of the emerging drugs used for analgesia and postoperative pain control. Aim: To compare the effect of fentanyl and dexmedetomidine on pain control and haemodynamic stability. Materials and Methods: A randomised controlled trial was conducted on 60 patients (30 each group) undergoing for abdominal surgery, between January 2019 to January 2020. Group A received fentanyl loading dose 2 μg/kg I.V. followed by 0.5 μg/kg/hr infusion and group B received dexmedetomidine loading 1 μg/kg over 10 minutes followed by maintenance 0.5 μg/kg/hr infusion. Infusion was continued up to four hours during surgery and till eight hours of postoperative in both groups. Haemodynamic parameters {Heart Rate (HR), Mean Arterial Pressure (MAP)} were recorded after start of study drug infusion, after intubation, then every 15 minutes till 1 hour, then every 30 minutes till end of surgery and after extubation. In postoperative period, HR and MAP were recorded at interval of one hour till eight hours after extubation and postoperative analgesia was assessed by Visual Analogue Scale (VAS) at interval of one hour till eight hours. Present study used descriptive statistical analysis for data analysis. Analysis of variance (ANOVA) was used to compare data between two groups. Chi-square test was used to find the significance of difference on categorical scale between two groups. Results: This study showed that group-B had significantly less VAS score most of time in recovery period as compared to group-A (1.97±0.18 vs 2.10±0.31 at eight hours postoperative). HR, MAP was found significantly less all the time during surgery and most of the time postoperatively in group-B (p-value <0.05). Conclusion: Intravenous infusion of dexmedetomidine can be better for controlling postoperative pain and perioperative haemodynamic stability as compared to infusion of fentanyl in patients undergoing abdominal surgeries.

scholarly journals TP8.2.19 Virtual versus In-Person Education Research (VIPER) in Surgical Skills Teaching: A crossover randomised controlled trial

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jih Dar Yau ◽  
Radheswari Measuria ◽  
Professor Mahmoud Loubani
Keyword(s):  
Controlled Trial ◽  
Training Needs ◽  
Surgical Skills ◽  
Student Feedback ◽  
Written Feedback ◽  
Initial Experience ◽  
Knot Tying ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Abstract Aims To compare effectiveness of virtual versus in-person teaching of one-handed reef knot to medical students. Methodology 20 students were randomised into 2 groups of 10, to learn to tie one-handed reef knot. Group A attended a 15-minute virtual session followed by a 15-minute in-person session; vice versa for Group B simultaneously. For the virtual session, trainer and students used online platform, Zoom, on an overhead webcam-laptop workstation in separate rooms. For the in-person session, trainer and students were in one room. Anonymous written feedback was collected from all students. Results 50% of the students had previous experience in knot-tying. On average, the instruction clarity and support received during the virtual session were reported to be less by Group A than Group B. 30% reported non-inferiority in the virtual method to in-person in fulfilling their training needs to learn this skill. 80% said they could have benefited from more time during the virtual session when compared to learning the same skill in-person. During the virtual sessions, 60% encountered technical difficulties relating to internet (20%), Zoom (25%), trainer availability (10%), and hardware (5%). 35% felt that a fully virtual session is suitable for learning one-handed reef knot. 30% stated they would attend a fully virtual basic surgical skills course whilst 40% would attend a partially virtual one. Conclusion Initial experience with virtual surgical skills teaching revealed promising potential based on student feedback. Further focused studies with targeted optimisation are warranted for it to be a viable alternative to traditional in-person teaching.

scholarly journals The effects of transcranial direct current stimulation compared to standard bupropion for the treatment of tobacco dependence: A randomized sham-controlled trial

2019 ◽  
Vol 60 ◽  
pp. 41-48 ◽  
Author(s):  
Shahram Ghorbani Behnam ◽  
Seyed Abbas Mousavi ◽  
Mohammad Hassan Emamian
Keyword(s):  
Smoking Cessation ◽  
Direct Current ◽  
Transcranial Direct Current Stimulation ◽  
Repeated Measures ◽  
Controlled Trial ◽  
Direct Current Stimulation ◽  
Salivary Cotinine ◽  
Group A ◽  
Group B ◽  
Group D

AbstractBackground:Current treatments for smoking cessation are not effective for most smokers. This study aims to examine the effectiveness of transcranial Direct Current Stimulation (tDCS) on smoking cessation.Methods:In this randomized, sham-controlled trial study, tobacco-dependent (by DSM-5) male participants were recruited from the general public invitation. Participants were randomly allocated to 5 groups; (A), treatment with 300mg bupropion for 8 weeks; (B), active tDCS (20 sessions for 4 weeks); (C), sham for group B ; (D), active tDCS (20 sessions for 12 weeks), and (E), sham for group D. The electrode montage was anode F3 and cathode F4. Study outcomes include salivary cotinine, Fagerstrom test for nicotine dependence, and smoked cigarette per day, were examined on three time points. Repeated-measures analysis of variances and the generalized estimation equation (GEE) model were employed for data analysis.Results:Among 210 volunteers, 170 participants completed the study. Mean age of participants was 42.9 years, ranging from 21 to 64 years. The 6-month point abstinence rates in groups A, B and D were 20%, 7% and 25.7%, and in C, D sham groups were 3.1% and 3% respectively. Results of the GEE model showed that although group D was not different from group A in abstinence rate, i.e., salivary cotinine >4 (p = 0.266), nicotine dependency by Fagerstrom test was lower in this group compared to group A (p = 0.019).Conclusions:The 12-week tDCS had a clinically good therapeutic effect on smoking cessation and its dependency. It may be a substitute for bupropion treatment.

A Pilot Study of Acupuncture for Tension Headache, Using a Novel Placebo

1996 ◽  
Vol 14 (1) ◽  
pp. 11-15 ◽  
Author(s):  
AR White ◽  
C Eddleston ◽  
R Hardie ◽  
KL Resch ◽  
E Ernst
Keyword(s):  
Controlled Trial ◽  
Tension Headache ◽  
Tension Type Headache ◽  
Guide Tube ◽  
Test Procedures ◽  
Trial Duration ◽  
Before And After ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

Tension headache is common, and treatment with acupuncture is frequently recommended, although the evidence of its effectiveness is contradictory. This small, randomised, controlled trial was designed as a pilot to test procedures in preparation for a multi-centre trial investigating the effect of acupuncture as a treatment for tension headache. Ten volunteers suffering from episodic, tension-type headache were recruited by local newspaper articles. Patients were randomised to receive either brief needling to tender areas or selected traditional points (Group A), or pressure from a cocktail stick supported within a guide tube to defined, non-tender and non-acupuncture areas (Group B). The patients’ view of the treatment sites was obstructed so that no indication could be gained as to which form of treatment was being given. Throughout the period of the trial, duration, frequency and intensity of headaches were recorded, from which the mean weekly headache index was calculated. There was no difference between the changes in weekly headache index in the two groups, comparing scores before and after treatment. However, Group A experienced a considerably higher number of headache-free weeks than Group B. The credibility of the two procedures was tested using a standard credibility questionnaire and a “final verdict”. One subject in Group B concluded that she had not received genuine acupuncture, but overall there was no statistical difference between the credibility of treatment in the two groups.

scholarly journals An intervention for improving the lifestyle habits of kindergarten children in Israel: a cluster-randomised controlled trial investigation

2014 ◽  
Vol 18 (9) ◽  
pp. 1537-1544 ◽  
Author(s):  
Liat Lerner-Geva ◽  
Elinor Bar-Zvi ◽  
Gila Levitan ◽  
Valentina Boyko ◽  
Brian Reichman ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Intervention Group ◽  
Cluster Randomised Controlled Trial ◽  
Nutritional Knowledge ◽  
Intervention Programme ◽  
Cluster Randomised ◽  
Daily Energy ◽  
Group A ◽  
Group B ◽  
Randomised Controlled

AbstractObjectiveTo assess the effectiveness of an intervention programme to improve kindergarten children's eating and leisure habits in Israel.DesignA cluster-randomised controlled trial.SettingSix full-day kindergartens in Israel were randomly divided into three groups. Group A received the full intervention programme, which included lessons on good eating habits and daily physical exercise. Group B received a partial intervention of lessons only. Group C, the reference group, did not receive any intervention.SubjectsChildren aged 4–6 years (n 204) were recruited for the study.MethodsObjective data for weight and height were collected to calculate BMI Z-scores. Activity, sedentary time, sleeping hours and daily energy intake were assessed via a parental questionnaire. Nutritional knowledge was assessed by a single dietitian using a questionnaire addressed to the children. Assessments were done at baseline and at the end of the intervention.ResultsAfter adjustment for baseline levels we observed a significant reduction in daily energy intake for the full intervention group A (P = 0·03). A positive intervention effect was demonstrated on nutritional knowledge in the partial intervention group B (P = 0·03), although no significant change was demonstrated for BMI Z-score.ConclusionsThe study supports the incorporation of education on healthy lifestyle habits and physical activity into the curricula of kindergartens.

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