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Silvera-Tawil D, Cameron J, Li J, Varnfield M, Allan LP, Harris M, Lannin NA, Redd C, Cadilhac DA. Multicomponent Support Program for Secondary Prevention of Stroke Using Digital Health Technology: Co-Design Study With People Living With Stroke or Transient Ischemic Attack. J Med Internet Res 2024; 26:e54604. [PMID: 39172512 PMCID: PMC11377903 DOI: 10.2196/54604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 04/23/2024] [Accepted: 06/14/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Few individuals (<2%) who experience a stroke or transient ischemic attack (TIA) participate in secondary prevention lifestyle programs. Novel approaches that leverage digital health technology may provide a viable alternative to traditional interventions that support secondary prevention in people living with stroke or TIA. To be successful, these strategies should focus on user needs and preferences and be acceptable to clinicians and people living with stroke or TIA. OBJECTIVE This study aims to co-design, with people with lived experience of stroke or TIA (referred to as consumers) and clinicians, a multicomponent digital technology support program for secondary prevention of stroke. METHODS A consumer user needs survey (108 items) was distributed through the Australian Stroke Clinical Registry and the Stroke Association of Victoria. An invitation to a user needs survey (135 items) for clinicians was circulated via web-based professional forums and national organizations (eg, the Stroke Telehealth Community of Practice Microsoft Teams Channel) and the authors' research networks using Twitter (subsequently rebranded X, X Corp) and LinkedIn (LinkedIn Corp). Following the surveys, 2 rounds of user experience workshops (design and usability testing workshops) were completed with representatives from each end user group (consumers and clinicians). Feedback gathered after each round informed the final design of the digital health program. RESULTS Overall, 112 consumers (male individuals: n=63, 56.3%) and 54 clinicians (female individuals: n=43, 80%) responded to the survey; all items were completed by 75.8% (n=85) of consumers and 78% (n=42) of clinicians. Most clinicians (46/49, 94%) indicated the importance of monitoring health and lifestyle measures more frequently than current practice, particularly physical activity, weight, and sleep. Most consumers (87/96, 90%) and clinicians (41/49, 84%) agreed that providing alerts about potential deterioration in an individual's condition were important functions for a digital program. Intention to use a digital program for stroke prevention and discussing the data collected during face-to-face consultations was high (consumers: 79/99, 80%; clinicians 36/42, 86%). In addition, 7 consumers (male individuals: n=5, 71%) and 9 clinicians (female individuals: n=6, 67%) took part in the user experience workshops. Participants endorsed using a digital health program to help consumers manage stroke or TIA and discussed preferred functions and health measures in a digital solution for secondary prevention of stroke. They also noted the need for a mobile app that is easy to use. Clinician feedback highlighted the need for a customizable clinician portal that captures individual consumer goals. CONCLUSIONS Following an iterative co-design process, supported by evidence from user needs surveys and user experience workshops, a consumer-facing app that integrates wearable activity trackers and a clinician web portal were designed and developed to support secondary prevention of stroke. Feasibility testing is currently in progress to assess acceptability and use.
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Affiliation(s)
- David Silvera-Tawil
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
| | - Jan Cameron
- Department of Medicine, Monash University, Melbourne, Australia
- Australian Centre for Heart Health, Melbourne, Australia
| | - Jane Li
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
| | - Marlien Varnfield
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
| | - Liam P Allan
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
- Department of Medicine, Monash University, Melbourne, Australia
| | - Mitch Harris
- Data 61, Commonwealth Scientific and Industrial Research Organisation, Melbourne, Australia
| | - Natasha A Lannin
- Australian Centre for Heart Health, Melbourne, Australia
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Christian Redd
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Sydney, Australia
| | - Dominique A Cadilhac
- Department of Medicine, Monash University, Melbourne, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Australia
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Baker A, Cornwell P, Gustafsson L, Lannin NA. Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation. Disabil Rehabil 2024; 46:3116-3127. [PMID: 37551867 DOI: 10.1080/09638288.2023.2243589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation. MATERIALS AND METHODS This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months. RESULTS Environmental context and resources, the clinician's social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals' capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation. CONCLUSIONS A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting.
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Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane, Australia
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
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Cheema K, Dunn T, Chapman C, Rockwood K, Howlett SE, Sevinc G. A systematic review of goal attainment scaling implementation practices by caregivers in randomized controlled trials. J Patient Rep Outcomes 2024; 8:37. [PMID: 38530578 PMCID: PMC10965877 DOI: 10.1186/s41687-024-00716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Goal attainment scaling (GAS), an established individualized, patient-centred outcome measure, is used to capture the patient's voice. Although first introduced ~60 years ago, there are few published guidelines for implementing GAS, and almost none for its use when caregivers GAS is implemented with caregiver input. We conducted a systematic review of studies that implemented GAS with caregiver input; and examined variations in GAS implementation, analysis, and reporting. METHODS Literature was retrieved from Medline, Embase, Cochrane, PsycInfo and CINAHL databases. We included randomized controlled trials (published between 1968 and November 2022) that used GAS as an outcome measure and involved caregiver input during goal setting. RESULTS Of the 2610 studies imported for screening, 21 met the inclusion criteria. Most studies employed GAS as a primary outcome. The majority (76%) had children as study participants. The most common disorders represented were cerebral palsy, developmental disorders, and dementia/Alzheimer's disease. The traditional five-point GAS scale, with levels from -2 to +2, was most often implemented, with -1 level typically being the baseline. However, most studies omitted essential GAS details from their reports including the number of goals set, number of attainment levels and whether any training was given to GAS facilitators. CONCLUSIONS GAS with caregiver input has been used in a limited number of randomized controlled trials, primarily in pediatric patients and adults with dementia. There is a variability in GAS implementation and many crucial details related to the specifics of GAS implementation are omitted from reports, which may limit reproducibility. Here we propose catalog that may be utilized when reporting research results pertaining to GAS with caregivers to enhance the application of this patient-centered outcome measure.
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Affiliation(s)
- Kulpreet Cheema
- Ardea Outcomes, Halifax, NS, Canada
- Neuroscience and Mental Health Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | - Kenneth Rockwood
- Ardea Outcomes, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
- Geriatric Medicine Research Unit, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Susan E Howlett
- Ardea Outcomes, Halifax, NS, Canada
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
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Stewart V, McMillan SS, Hu J, Collins JC, El-Den S, O’Reilly CL, Wheeler AJ. Are SMART goals fit-for-purpose? Goal planning with mental health service-users in Australian community pharmacies. Int J Qual Health Care 2024; 36:mzae009. [PMID: 38381655 PMCID: PMC10880889 DOI: 10.1093/intqhc/mzae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/15/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
Goal planning is an important element in brief health interventions provided in primary healthcare settings, with specific, measurable, achievable, realistic/relevant, and timed (SMART) goals recommended as best practice. This study examined the use of SMART goals by Australian community pharmacists providing a brief goal-oriented wellbeing intervention with service-users experiencing severe and persistent mental illnesses (SPMIs), in particular, which aspects of SMART goal planning were incorporated into the documented goals. Goal data from the PharMIbridge Randomized Controlled Trial (RCT) were used to investigate how community pharmacists operationalized SMART goals, goal quality, and which SMART goal planning format aspects were most utilized. Goals were evaluated using the SMART Goal Evaluation Method (SMART-GEM) tool to determine how closely each documented goal met the SMART criteria. Goals were also categorized into five domains describing their content or purpose. Descriptive analysis was used to describe the SMART-GEM evaluation results, and the Kruskal-Wallis H test was used to compare the evaluation results across the goal domains. All goals (n = 512) co-designed with service-users (n = 156) were classified as poor quality when assessed against the SMART guidelines for goal statements, although most goals contained information regarding a specific behaviour and/or action (71.3% and 86.3%, respectively). Less than 25% of goals identified how goal achievement would be measured, with those related to lifestyle and wellbeing behaviours most likely to include measurement information. Additionally, the majority (93.5%) of goals lacked details regarding monitoring goal progress. Study findings raise questions regarding the applicability of the SMART goal format in brief health interventions provided in primary healthcare settings, particularly for service-users experiencing SPMIs. Further research is recommended to identify which elements of SMART goals are most relevant for brief interventions. Additionally, further investigation is needed regarding the impact of SMART goal training or support tools on goal quality.
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Affiliation(s)
- Victoria Stewart
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Sara S McMillan
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jie Hu
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
| | - Jack C Collins
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Sarira El-Den
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Claire L O’Reilly
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Amanda J Wheeler
- Centre for Mental Health, Griffith University, Mt Gravatt, QLD 4122, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD 4222, Australia
- Faculty of Health and Behavioural Sciences, University of Auckland, Auckland 1142, New Zealand
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Tharakan A, Desai DP, Gupta R, Wambugu V, Biola HR, Granger BB. Applying the RE-AIM framework to evaluate an educational model to "close the gap" and improve health equity in uncontrolled hypertension. PATIENT EDUCATION AND COUNSELING 2024; 119:108053. [PMID: 37976672 DOI: 10.1016/j.pec.2023.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To use the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to evaluate an educational model addressing self-management of uncontrolled hypertension. METHODS We used a pre-post single cohort design to identify minoritized patients with uncontrolled hypertension (systolic > 160 mmHg and/or diastolic > 100 mmHg). Trained Ambassadors provided telephone outreach, skill-based blood pressure (BP) monitoring, and goal-setting for 4 months. Follow-up occurred at 7 months. We evaluated the initiative using the RE-AIM framework and quantitative analysis for process and outcome measures post-intervention. RESULTS Among Black patients (n = 345), the average age was 55.4 years (8.7), half identified as male (n = 173, 50.1 %); many were uninsured (n = 159, 46.1 %). Engagement in calls occurred for 67.8 % (n = 234) of the cohort; monitor distribution was 22.9 % (n = 79); and goal setting occurred for 64 patients. BP improved for 40 % of the cohort (mean pre: 168/98 mmHg, mean post: 150/89 mmHg; p < 0.0001) and 40 % of patients' last known BP was < 140/90. CONCLUSIONS RE-AIM evaluation of the Closing the Gap initiative suggests that the model is associated with BP reduction in high-risk Black patients. PRACTICE IMPLICATIONS An educational model for patient-centered hypertension management in low-income populations is feasible and addresses self-monitoring barriers.
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Affiliation(s)
- Anna Tharakan
- Duke University, Durham, USA; Duke-Margolis Center for Health Policy, Durham, USA.
| | - Devan P Desai
- Duke University, Durham, USA; Duke-Margolis Center for Health Policy, Durham, USA.
| | - Rohan Gupta
- Duke University, Durham, USA; Duke-Margolis Center for Health Policy, Durham, USA.
| | - Vivien Wambugu
- Duke University, Durham, USA; Duke-Margolis Center for Health Policy, Durham, USA.
| | | | - Bradi B Granger
- Duke-Margolis Center for Health Policy, Durham, USA; Duke University School of Nursing, Durham, USA.
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Wolken MJ, Larson S, Raney EC, Pogge EK, Afolabi TM, Storjohann T, Fairman KA, Davis LE. Finding our Voice: Evaluation of Goal Setting Using the Habits of Preceptors Rubric in Terms of Focus, "SMARTness," and Impact. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00101. [PMID: 37937957 DOI: 10.1097/ceh.0000000000000540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
INTRODUCTION Effective leadership propels teams from effectiveness to greatness and is accomplished when everyone achieves and contributes their full potential, or "voice." The Clinician Educators Program Teaching and Learning Curriculum fosters preceptor development using the Habits of Preceptors Rubric (HOP-R) to guide participants in finding their precepting "voice." After the HOP-R self-assessment, participants select a habit of focus (HOF) and craft a SMART (specific/measurable/achievable/relevant/time-bound) goal. This report describes a pilot rubric, SMART-EP (emotional intelligence(EI)/professionalism), exploring goal "SMARTness" alongside change (impact) in participants' perceived precepting capabilities. METHODS HOP-R self-ratings (2018-2020) and HOF/SMART goals (2019-2020) were retrospectively reviewed by two raters. Perceived preceptor capabilities were measured by analyzing the change in self-assessed habit level ratings between the first/fourth-quarter surveys. SMART goals were categorized by HOF and inclusion of SMART-EP components. Participants were guided in the inclusion of SMART, but not -EP, components. RESULTS In aggregate, 120 participants completed HOP-R surveys (2018-2020). Within-subject changes across all 11 habits were significant ( P < .001). For the SMART-EP rubric analysis (2019-2020), 71 participants had an average "SMARTness" score of 3.92 (of 5) with corresponding interrater reliability of 0.91. Goals included 2.77 (of 4) EI traits and 1.72 (of 3) professionalism components. DISCUSSION The SMART-EP rubric provided insights into preceptor development opportunities among participants. Beyond SMART components, participants often included elements of EI and professionalism. Ratings confirm and support the consistency of the HOP-R as a tool to assess precepting habits.
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Affiliation(s)
- Maura J Wolken
- Dr. Wolken: Clinical Pharmacist, Ambulatory Care, Covenant Medical Group, Knoxville, TN. Dr. Larson: Director, Office of Experiential Education, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Raney: Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Pogge: Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Afolabi: Associate Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Storjohann: Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Fairman: Associate Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ. Dr. Davis: Cardiology Director, Internal Medicine Field Medical Group, Pfizer Medical Affairs, New York, NY, and Adjunct Professor, Department of Pharmacy Practice, Midwestern University College of Pharmacy, Glendale Campus, Glendale, AZ
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Baker A, Cornwell P, Gustafsson L, Stewart C, Lannin NA. Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study. J Rehabil Med 2023; 55:jrm4471. [PMID: 37548542 PMCID: PMC10424097 DOI: 10.2340/jrm.v55.4471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/05/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. DESIGN This study followed a participatory action research approach guided by the Knowledge to Action framework. METHODS Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. RESULTS Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. CONCLUSION Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes.
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Affiliation(s)
- Amanda Baker
- School of Health Sciences and Social Work, Griffith University, Brisbane; Statewide Rehabilitation Clinical Network, Clinical Excellence Division, Queensland Health, Brisbane; Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast.
| | - Petrea Cornwell
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane; The Hopkins Centre, Menzies Health Institute Queensland, Brisbane
| | - Claire Stewart
- Allied Health, Physiotherapy Department, Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia; Alfred Health, Melbourne, Australia
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Winkel AF, Chang LY, McGlone P, Gillespie C, Triola M. SMARTer Goalsetting: A Pilot Innovation for Coaches During the Transition to Residency. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:585-589. [PMID: 36652456 DOI: 10.1097/acm.0000000000005153] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
PROBLEM Ability to set goals and work with coaches can support individualized, self-directed learning. Understanding the focus and quality of graduating medical student and first-year resident goals and the influence of coaching on goal-setting can inform efforts to support learners through the transition from medical school to residency. APPROACH This observational study examined goal-setting among graduating medical students and first-year residents from April 2021 to March 2022. The medical students set goals while participating in a Transition to Residency elective. The residents in internal medicine, obstetrics and gynecology, emergency medicine, orthopedics, and pathology set goals through meeting 1:1 with coaches. Raters assessed goals using a 3-point rubric on domains of specific, measurable, attainable, relevant, and timely (i.e., SMART goal framework) and analyzed descriptive statistics, Mann-Whitney U tests, and linear regressions. OUTCOMES Among 48 medical students, 30 (62.5%) set 108 goals for early residency. Among 134 residents, 62 (46.3%) entered goals. Residents met with coaches 2.8 times on average (range 0-8 meetings, median = 3). Goal quality was higher in residents than medical students (average score for S: 2.71 vs 2.06, P < .001; M: 2.38 vs 1.66, P < .001; A: 2.92 vs 2.64, P < .001; R: 2.94 vs 2.86, P = .002; T: 1.71 vs 1.31, P < .001). The number of coaching meetings was associated with more specific, measurable goals (specific: F [1, 1.02] = 6.56, P = .01, R2 = .10; measurable: F [1, 1.49] = 4.74, P = .03, R2 = .07). NEXT STEPS Learners set realistic, attainable goals through the transition to residency, but the goals could be more specific, measurable, and timely. The residents set SMARTer goals, with coaching improving goal quality. Understanding how best to scaffold coaching and support goal-setting through this transition may improve trainees' self-directed learning and well-being.
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Affiliation(s)
- Abigail Ford Winkel
- A.F. Winkel is professor, Department of Obstetrics & Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Lucy Y Chang
- L.Y. Chang is clinical associate professor, Department of Pediatrics, New York University Grossman School of Medicine, New York, New York
| | - Pauline McGlone
- P. McGlone is program manager, Office of Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Colleen Gillespie
- C. Gillespie is director, Division of Education Quality, Institute for Innovations in Medical Education, New York University Grossman School of Medicine, New York, New York
| | - Marc Triola
- M. Triola is associate dean for educational informatics, director, Institute for Innovations in Medical Educationassociate professor, Department of Medicine, New York University Grossman School of Medicine, New York, New York
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Cameron J, Lannin NA, Harris D, Andrew NE, Kilkenny MF, Purvis T, Thrift AG, Thayabaranathan T, Ellery F, Sookram G, Hackett M, Kneebone I, Drummond A, Cadilhac DA. A mixed-methods feasibility study of a new digital health support package for people after stroke: the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) intervention. Pilot Feasibility Stud 2022; 8:241. [PMID: 36401336 PMCID: PMC9675218 DOI: 10.1186/s40814-022-01197-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/31/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Evidence for digital health programmes to support people living with stroke is growing. We assessed the feasibility of a protocol and procedures for the Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS) trial. METHODS We conducted a mixed-method feasibility study. Participants with acute stroke were recruited from three hospitals (Melbourne, Australia). Eligibility: Adults with stroke discharged from hospital to home within 10 days, modified Rankin Score 0-4 and prior use of Short Message System (SMS)/email. While in hospital, recruited participants contributed to structured person-centred goal setting and completed baseline surveys including self-management skills and health-related quality of life. Participants were randomised 7-14 days after discharge via REDCap® (1:1 allocation). Following randomisation, the intervention group received a 12-week programme of personalised electronic support messages (average 66 messages sent by SMS or email) aligned with their goals. The control group received six electronic administrative messages. Feasibility outcomes included the following: number of patients screened and recruited, study retainment, completion of outcome measures and acceptability of the ReCAPS intervention and trial procedures (e.g. participant satisfaction survey, clinician interviews). Protocol fidelity outcomes included number of goals developed (and quality), electronic messages delivered, stop messages received and engagement with messages. We undertook inductive thematic analysis of interview/open-text survey data and descriptive analysis of closed survey questions. RESULTS Between November 2018 and October 2019, 312 patients were screened; 37/105 (35%) eligible patients provided consent (mean age 61 years; 32% female); 33 were randomised (17 to intervention). Overall, 29 (88%) participants completed the12-week outcome assessments with 12 (41%) completed assessments in the allocated timeframe and 16 also completing the satisfaction survey (intervention=10). Overall, trial participants felt that the study was worthwhile and most would recommend it to others. Six clinicians participated in one of three focus group interviews; while they reported that the trial and the process of goal setting were acceptable, they raised concerns regarding the additional time required to personalise goals. CONCLUSION The study protocol and procedures were feasible with acceptable retention of participants. Consent and goal personalisation procedures should be centralised for the phase III trial to reduce the burden on hospital clinicians. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry, ACTRN12618001468213 (date 31/08/2018); Universal Trial Number: U1111-1206-7237.
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Affiliation(s)
- Janette Cameron
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Natasha A Lannin
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Dawn Harris
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Nadine E Andrew
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Tara Purvis
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Tharshanah Thayabaranathan
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Fiona Ellery
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Garveeta Sookram
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3 Hudson Institute Building, 27-31 Wright Street, Clayton, VIC, 3168, Australia.
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.
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Arora VM, Klein A, Coe A, Patel A, Albert D, Blanchard A. Implementation and evaluation of IGNITE (Improving GME Nursing Interprofessional Team Experiences) to improve care in an academic health system. Healthcare (Basel) 2022; 10:100642. [DOI: 10.1016/j.hjdsi.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/22/2022] [Accepted: 07/02/2022] [Indexed: 11/04/2022] Open
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Taverno Ross SE, Liang HW, Cheng J, Fox A, Documet PI. Effectiveness of a Promotores Network to Improve Health in an Emerging Latino Community. HEALTH EDUCATION & BEHAVIOR 2022; 49:455-467. [PMID: 35473431 DOI: 10.1177/10901981221090161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Latinos living in emerging communities (i.e., nontraditional destinations with a small but growing population) face obstacles to their mental and physical health. This study evaluated the effectiveness of a 6-month, promotor-led intervention on access to care, physical activity, dietary practices, and perceived social support among Latino adults living in an emerging community, compared with a nonrandomly assigned control group. METHOD Participants (n = 81 intervention; n = 86 control) were drawn from Allegheny county, Pennsylvania. Promotores used an intervention tool offering nondirective social support to assist participants in developing SMART goals to address their life concerns in eight domains (e.g., social, diet, and exercise/recreation); the control group received printed materials. Participants completed a survey in Spanish at baseline and follow-up to assess outcomes and had their height and weight measured. Adjusted linear mixed effects models compared change in outcomes over time. RESULTS There was a marginally significant improvement in dietary practices in the intervention group at follow-up, and no change in access to care. Both groups experienced an improvement in social support. There was a significant intervention-by-time interaction such that the intervention group increased physical activity by 259 minutes/week compared with the control group. CONCLUSION This study demonstrates the potential effectiveness of a promotores network in assisting individuals living in an emerging Latino community to address their life concerns and improve health behaviors. Future studies should include objective and more rigorous measures with a larger sample to replicate these results.
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Affiliation(s)
| | | | | | - Andrea Fox
- University of Pittsburgh, Pittsburgh, PA, USA
- Squirrel Hill Health Center, Pittsburgh, PA, USA
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Baumann H, Fiedler J, Wunsch K, Woll A, Wollesen B. mHealth Interventions to Reduce Physical Inactivity and Sedentary Behavior in Children and Adolescents: Systematic Review and Meta-analysis of Randomized Controlled Trials. JMIR Mhealth Uhealth 2022; 10:e35920. [PMID: 35544294 PMCID: PMC9133983 DOI: 10.2196/35920] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 12/29/2022] Open
Abstract
Background
Children and adolescents increasingly do not meet physical activity (PA) recommendations. Hence, insufficient PA (IPA) and sedentary behavior (SB) among children and adolescents are relevant behavior change domains for using individualized mobile health (mHealth) interventions.
Objective
This review and meta-analysis investigated the effectiveness of mHealth interventions on IPA and SB, with a special focus on the age and level of individualization.
Methods
PubMed, Scopus, Web of Science, SPORTDiscus, and Cochrane Library were searched for randomized controlled trials published between January 2000 and March 2021. mHealth interventions for primary prevention in children and adolescents addressing behavior change related to IPA and SB were included. Included studies were compared for content characteristics and methodological quality and summarized narratively. In addition, a meta-analysis with a subsequent exploratory meta-regression examining the moderating effects of age and individualization on overall effectiveness was performed.
Results
On the basis of the inclusion criteria, 1.3% (11/828) of the preliminary identified studies were included in the qualitative synthesis, and 1.2% (10/828) were included in the meta-analysis. Trials included a total of 1515 participants (mean age (11.69, SD 0.788 years; 65% male and 35% female) self-reported (3/11, 27%) or device-measured (8/11, 73%) health data on the duration of SB and IPA for an average of 9.3 (SD 5.6) weeks. Studies with high levels of individualization significantly decreased insufficient PA levels (Cohen d=0.33; 95% CI 0.08-0.58; Z=2.55; P=.01), whereas those with low levels of individualization (Cohen d=−0.06; 95% CI −0.32 to 0.20; Z=0.48; P=.63) or targeting SB (Cohen d=−0.11; 95% CI −0.01 to 0.23; Z=1.73; P=.08) indicated no overall significant effect. The heterogeneity of the studies was moderate to low, and significant subgroup differences were found between trials with high and low levels of individualization (χ21=4.0; P=.04; I2=75.2%). Age as a moderator variable showed a small effect; however, the results were not significant, which might have been because of being underpowered.
Conclusions
Evidence suggests that mHealth interventions for children and adolescents can foster moderate reductions in IPA but not SB. Moreover, individualized mHealth interventions to reduce IPA seem to be more effective for adolescents than for children. Although, to date, only a few mHealth studies have addressed inactive and sedentary young people, and their quality of evidence is moderate, these findings indicate the relevance of individualization on the one hand and the difficulties in reducing SB using mHealth interventions on the other.
Trial Registration
PROSPERO CRD42020209417; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209417
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Affiliation(s)
- Hannes Baumann
- Department of Human Movement, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
- Department of Biological Psychology and Neuroergonomics, Institute for Psychology and Occupational Science, Technical University Berlin, Berlin, Germany
- Department of Performance, Neuroscience, Therapy and Health, Faculty of Health Sciences, Medical School Hamburg, Hamburg, Germany
| | - Janis Fiedler
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Kathrin Wunsch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Bettina Wollesen
- Department of Human Movement, Faculty of Psychology and Human Movement Science, University of Hamburg, Hamburg, Germany
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Howard MC, Davis MM. A meta-analysis and systematic literature review of mixed reality rehabilitation programs: Investigating design characteristics of augmented reality and augmented virtuality. COMPUTERS IN HUMAN BEHAVIOR 2022. [DOI: 10.1016/j.chb.2022.107197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Intervenções para promover função física de crianças e jovens com paralisia cerebral: diretriz internacional de prática clínica. Dev Med Child Neurol 2022; 64:e15-e29. [PMID: 35729722 DOI: 10.1111/dmcn.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
ResumoOBJETIVOFornecer recomendações de intervenções para promoção da função física de crianças e jovens com paralisia cerebral.MÉTODOUm painel de especialistas priorizou perguntas e desfechos importantes para o paciente. Usando o Grading of Recommendations Assessment, Development and Evaluation (GRADE), o painel avaliou a certeza das evidências e fez recomendações, com consultoria de especialistas internacionais e consumidores.RESULTADOSA diretriz compreende 13 recomendações (informadas por três revisões sistemáticas, 30 estudos randomizados e cinco estudos pré‐pós). Para alcance de objetivos funcionais, recomenda‐se que a intervenção inclua objetivos escolhidos pelo cliente, prática completa da tarefa em ambientes da vida real, suporte para empoderar as famílias e uma abordagem em equipe. Idade, habilidade e preferências da criança/família precisam ser consideradas. Para melhora da habilidade da marcha, recomenda‐se marcha no solo, que pode ser complementada com treinamento em esteira. Várias abordagens podem facilitar os objetivos relacionados ao uso das mãos: terapia bimanual, terapia de contensão induzida, treino direcionado a objetivos e abordagens cognitivas. Para auto‐cuidado, prática da tarefa completa, combinada com recursos assistivos podem aumentar a independência e reduzir a sobrecarga do cuidador. A participação em objetivos de lazer pode combinar prática da tarefa completa com estratégias direcionadas para barreiras ambientais, pessoais e sociais.INTERPRETAÇÃOIntervenção para promoção da função de crianças e jovens com paralisia cerebral precisa incluir objetivos escolhidos pelo cliente e a prática da tarefa completa dos objetivos. Os clínicos devem considerar as preferências da criança/família, idade e habilidade ao selecionarem intervenções específicas.
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Affiliation(s)
- Michelle Jackman
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
- John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Leanne Sakzewski
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Roslyn N Boyd
- The University of Queensland, Child Health Research Centre, Faculty of Medicine, Brisbane, QLD, Australia
| | - Sue E Brennan
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Rachel A M Toovey
- Physiotherapy Department, University of Melbourne, Melbourne, VIC, Australia
| | - Sue Greaves
- Occupational Therapy Department, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Brisbane, QLD, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan SE, Langdon K, Toovey RAM, Greaves S, Thorley M, Novak I. Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Dev Med Child Neurol 2022; 64:536-549. [PMID: 34549424 DOI: 10.1111/dmcn.15055] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 01/08/2023]
Abstract
AIM To provide recommendations for interventions to improve physical function for children and young people with cerebral palsy. METHOD An expert panel prioritized questions and patient-important outcomes. Using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods, the panel assessed the certainty of evidence and made recommendations, with international expert and consumer consultation. RESULTS The guideline comprises 13 recommendations (informed by three systematic reviews, 30 randomized trials, and five before-after studies). To achieve functional goals, it is recommended that intervention includes client-chosen goals, whole-task practice within real-life settings, support to empower families, and a team approach. Age, ability, and child/family preferences need to be considered. To improve walking ability, overground walking is recommended and can be supplemented with treadmill training. Various approaches can facilitate hand use goals: bimanual therapy, constraint-induced movement therapy, goal-directed training, and cognitive approaches. For self-care, whole-task practice combined with assistive devices can increase independence and reduce caregiver burden. Participation in leisure goals can combine whole-task practice with strategies to address environmental, personal, and social barriers. INTERPRETATION Intervention to improve function for children and young people with cerebral palsy needs to include client-chosen goals and whole-task practice of goals. Clinicians should consider child/family preferences, age, and ability when selecting specific interventions.
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Affiliation(s)
- Michelle Jackman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Catherine Morgan
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sue E Brennan
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Rachel A M Toovey
- Physiotherapy Department, University of Melbourne, Melbourne, Victoria, Australia
| | - Susan Greaves
- Occupational Therapy Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Brisbane, Queensland, Australia
| | - Iona Novak
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Cerebral Palsy Alliance Research Institute, The University of Sydney, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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16
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Win H, Russell S, Wertheim BC, Maizes V, Crocker R, Brooks AJ, Mesa R, Huberty J, Geyer H, Eckert R, Larsen A, Gowin K. Mobile App Intervention on Reducing the Myeloproliferative Neoplasm Symptom Burden: Pilot Feasibility and Acceptability Study. JMIR Form Res 2022; 6:e33581. [PMID: 35357315 PMCID: PMC9015738 DOI: 10.2196/33581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/12/2022] Open
Abstract
Background Myeloproliferative neoplasms (MPNs) are a group of myeloid malignancies associated with significant symptom burden. Despite pharmacological advances in therapies, inadequate management of MPN symptoms results in reduced quality of life. Objective This study aims to determine the feasibility of a 12-week global wellness mobile app intervention in decreasing MPN symptom burden. The University of Arizona Andrew Weil Center for Integrative Medicine’s global wellness mobile app, My Wellness Coach (MWC), guides patients to improve their health and well-being through facilitating behavior changes. Methods Of the 30 patients enrolled in a 12-week intervention, 16 (53%) were retained through the final assessment. Feasibility was assessed by the ease of recruitment, participant adherence, and mobile app acceptability. App acceptability was measured using the user version of the Mobile Application Rating Scale. MPN symptom burden was measured at baseline and 12 weeks after the intervention. Results Recruitment was efficient, with the participant goal reached within a 60-day period, suggestive of a demand for such an intervention. Adherence was less than the target within study design (75%), although similar to mobile device app use in other studies (53%). The app was deemed acceptable based on the mean user version of the Mobile Application Rating Scale 3-star rating by participants. Finally, there were statistically significant improvements in several MPN symptoms, quality of life, and total score on the Myeloproliferative Neoplasm Symptom Assessment Form surveys. Conclusions Our 12-week intervention with the MWC app was feasible and was associated with a decrease in MPN symptom burden. Further investigation of the MWC app for use as a self-management strategy to reduce the symptom burden in patients with MPN is warranted.
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Affiliation(s)
- Hninyee Win
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Samantha Russell
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | | | - Victoria Maizes
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Robert Crocker
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Audrey J Brooks
- Andrew Weil Center for Integrative Medicine, University of Arizona, Tucson, AZ, United States
| | - Ruben Mesa
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Jennifer Huberty
- Department of Hematology, University of Arizona, Tucson, AZ, United States
| | - Holly Geyer
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ryan Eckert
- Mays Cancer Center, University of Texas, San Antonio, TX, United States
| | - Ashley Larsen
- Department of Medicine, University of Arizona, Tucson, AZ, United States
| | - Krisstina Gowin
- Department of Hematology, University of Arizona, Tucson, AZ, United States
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Barnden R, Cadilhac DA, Lannin NA, Kneebone I, Hersh D, Godecke E, Stolwyk R, Purvis T, Nicks R, Farquhar M, Gleeson S, Gore C, Herrmann K, Andrew NE. Development and field testing of a standardised goal setting package for person-centred discharge care planning in stroke. PEC INNOVATION 2021; 1:100008. [PMCID: PMC10194112 DOI: 10.1016/j.pecinn.2021.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 06/17/2023]
Abstract
Objective Develop and test a person-centred goal-setting package for discharge care planning in acute and rehabilitation stroke units. Methods A multidisciplinary, expert working group (n = 15), and consumer group (n = 4) was convened. A multistage iterative approach was used to develop and test the package. Stages included: (i) contextual understanding, (ii) package development, and (iii) clinician training and field-testing in acute and rehabilitation settings. Observational field notes were taken and clinicians' perspectives captured using semi-structured focus groups post-testing. Results The final package included a 34-item menu aligned with a manual containing: guideline summaries; common goals; goal metrics based on the SMART Goal Evaluation Method (SMART-GEM); evidence-based strategies; and worked examples. Twenty-three clinicians attended training. Clinician observations (n = 5) indicated that: the package could be incorporated into practice; a range of person-centred goals were set; and opportunities provided to raise additional issues. Clinician feedback (n = 8) suggested the package was useful and facilitated person-centred goal-setting. Enablers included potential for incorporation into existing processes and beliefs that it promoted person-centred care. Barriers included additional time. Conclusion The package demonstrated potential to facilitate comprehensive person-centred goal-setting for patients with stroke. Innovation We developed an innovative approach to support structured person-centred goal setting in clinical and research settings.
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Affiliation(s)
- Rebecca Barnden
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Natasha A. Lannin
- School of Allied Health, Health Sciences Building 1, La Trobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia
- Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ian Kneebone
- Graduate School of Health, Building 20, University of Technology Sydney, 100 Broadway, Ultimo, NSW 2007, Australia
| | - Deborah Hersh
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Erin Godecke
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Dr, Joondalup, WA 6027, Australia
| | - Rene Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton Campus, Wellington Rd, Clayton, VIC 3800, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Level 3, Hudson Institute Building, 27-31 Wright Street, Clayton, VIC 3168, Australia
| | - Rebecca Nicks
- Occupational Therapy Department, Eastern Health, 5 Arnold St, Box Hill, Melbourne, VIC 3128, Australia
| | | | - Stephanie Gleeson
- Occupational Therapy Department, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Carol Gore
- Subacute Care Services, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
| | - Kelsie Herrmann
- Lung Foundation Australia, 11 Finchley St, Milton, QLD 4064, Australia
| | - Nadine E. Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, PO Box 52, Frankston, VIC 3199, Australia
- Academic Unit, Peninsula Health, PO Box 52, Frankston, VIC 3199, Australia
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Whitehead L, Glass C, Coppell K. The effectiveness of goal setting on glycaemic control for people with type 2 diabetes and prediabetes: A systematic review and meta-analysis. J Adv Nurs 2021; 78:1212-1227. [PMID: 34716594 DOI: 10.1111/jan.15084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 08/24/2021] [Accepted: 10/16/2021] [Indexed: 11/29/2022]
Abstract
AIM This review assessed the effectiveness of interventions using a goal-setting approach on glycaemic control for people diagnosed with prediabetes or type 2 diabetes. DESIGN A systematic review guided by the Joanna Briggs Institute methodology for conducting systematic reviews of primary research studies was conducted. DATA SOURCES Randomized controlled trials and experimental studies with a minimum follow-up period of 6 months were considered for inclusion. The primary outcome was change in glycaemic control as measured by glycated haemoglobin (%) and/or fasting plasma glucose (mg/dl). A systematic search of seven electronic databases was completed in October 2020. REVIEW METHODS Papers meeting the inclusion criteria were critically appraised using the Joanna Briggs Institute tools for critical appraisal followed by data extraction. A Grading of Recommendations Assessment, Development and Evaluation assessment was conducted to assess the overall certainty of the evidence. Fixed-effect meta-analyses were completed to demonstrate the mean effect for each outcome of interest. RESULTS Twenty one studies were included in this review. Goal setting was more effective than usual care for glycaemic control in prediabetes at 6 months and at 12 months for fasting plasma glucose (mg/dl) and glycated haemoglobin (%). Goal setting was more effective than usual care for glycaemic control in type 2 diabetes for fasting plasma glucose (mg/dl) at 6 months, fasting plasma glucose (mg/dl) at 12 months, glycated haemoglobin (%) at 6 months and glycated haemoglobin (%) at 12 months. CONCLUSION The evidence suggests goal setting is effective in supporting people to achieve glycaemic targets in prediabetes and type 2 diabetes.
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Affiliation(s)
- Lisa Whitehead
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Courtney Glass
- Edith Cowan University, Joondalup, Western Australia, Australia
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Kvale G, Frisk B, Jürgensen M, Børtveit T, Ødegaard-Olsen ØT, Wilhelmsen-Langeland A, Aarli BB, Sandnes K, Rykken S, Haugstvedt A, Hystad SW, Søfteland E. Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study. JMIR Res Protoc 2021; 10:e32216. [PMID: 34505838 PMCID: PMC8500350 DOI: 10.2196/32216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. OBJECTIVE We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. METHODS The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes. RESULTS Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. CONCLUSIONS If successful, this study may have a substantial impact on the treatment of low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/32216.
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Affiliation(s)
- Gerd Kvale
- Helse i Hardanger, Øystese, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Bente Frisk
- Helse i Hardanger, Øystese, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Marte Jürgensen
- Helse i Hardanger, Øystese, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | | | - Øystein Theodor Ødegaard-Olsen
- Helse i Hardanger, Øystese, Norway
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Ane Wilhelmsen-Langeland
- Helse i Hardanger, Øystese, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Bernt Bøgvald Aarli
- Helse i Hardanger, Øystese, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | | | - Anne Haugstvedt
- Helse i Hardanger, Øystese, Norway
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Eirik Søfteland
- Helse i Hardanger, Øystese, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Beristain Iraola A, Álvarez Sánchez R, Hors-Fraile S, Petsani D, Timoleon M, Díaz-Orueta U, Carroll J, Hopper L, Epelde G, Kerexeta J, Bamidis PD, Konstantinidis EI. User Centered Virtual Coaching for Older Adults at Home Using SMART Goal Plans and I-Change Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136868. [PMID: 34206808 PMCID: PMC8297101 DOI: 10.3390/ijerph18136868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022]
Abstract
Preventive care and telemedicine are expected to play an important role in reducing the impact of an increasingly aging global population while increasing the number of healthy years. Virtual coaching is a promising research area to support this process. This paper presents a user-centered virtual coach for older adults at home to promote active and healthy aging and independent living. It supports behavior change processes for improving on cognitive, physical, social interaction and nutrition areas using specific, measurable, achievable, relevant, and time-limited (SMART) goal plans, following the I-Change behavioral change model. Older adults select and personalize which goal plans to join from a catalog designed by domain experts. Intervention delivery adapts to user preferences and minimizes intrusiveness in the user’s daily living using a combination of a deterministic algorithm and incremental machine learning model. The home becomes an augmented reality environment, using a combination of projectors, cameras, microphones and support sensors, where common objects are used for projection and sensed. Older adults interact with this virtual coach in their home in a natural way using speech and body gestures on projected user interfaces with common objects at home. This paper presents the concept from the older adult and the caregiver perspectives. Then, it focuses on the older adult view, describing the tools and processes available to foster a positive behavior change process, including a discussion about the limitations of the current implementation.
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Affiliation(s)
- Andoni Beristain Iraola
- Digital Health & Biomedical Technologies Department, Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), Mikeletegi 57, 20009 San Sebastián, Spain; (R.Á.S.); (G.E.); (J.K.)
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
- Correspondence:
| | - Roberto Álvarez Sánchez
- Digital Health & Biomedical Technologies Department, Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), Mikeletegi 57, 20009 San Sebastián, Spain; (R.Á.S.); (G.E.); (J.K.)
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
| | - Santiago Hors-Fraile
- Salumedia Labs, Research Division of Adhera Health, Inc., Palo Alto, CA 94304, USA;
| | - Despoina Petsani
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.P.); (M.T.); (P.D.B.); (E.I.K.)
| | - Michail Timoleon
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.P.); (M.T.); (P.D.B.); (E.I.K.)
| | - Unai Díaz-Orueta
- Department of Psychology, Maynooth University, Maynooth W23 F2H6, Co. Kildare R51, Ireland;
| | - Joanne Carroll
- School of Psychology, Dublin City University, Dublin 9, Ireland; (J.C.); (L.H.)
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin 9, Ireland; (J.C.); (L.H.)
| | - Gorka Epelde
- Digital Health & Biomedical Technologies Department, Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), Mikeletegi 57, 20009 San Sebastián, Spain; (R.Á.S.); (G.E.); (J.K.)
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
| | - Jon Kerexeta
- Digital Health & Biomedical Technologies Department, Vicomtech Foundation, Basque Research and Technology Alliance (BRTA), Mikeletegi 57, 20009 San Sebastián, Spain; (R.Á.S.); (G.E.); (J.K.)
- e-Health Department, Biodonostia Health Research Institute, Paseo Dr Begiristain s/n, 20014 San Sebastián, Spain
| | - Panagiotis D. Bamidis
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.P.); (M.T.); (P.D.B.); (E.I.K.)
| | - Evdokimos I. Konstantinidis
- Lab of Medical Physics and Digital Innovation, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (D.P.); (M.T.); (P.D.B.); (E.I.K.)
- WITA SRL, 38123 Trento, Italy
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21
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Cadilhac DA, Cameron J, Kilkenny MF, Andrew NE, Harris D, Ellery F, Thrift AG, Purvis T, Kneebone I, Dewey H, Drummond A, Hackett M, Grimley R, Middleton S, Thijs V, Cloud G, Carey M, Butler E, Ma H, Churilov L, Hankey GJ, English C, Lannin NA. Protocol of a randomized controlled trial investigating the effectiveness of Recovery-focused Community support to Avoid readmissions and improve Participation after Stroke (ReCAPS). Int J Stroke 2021; 17:236-241. [PMID: 34037468 DOI: 10.1177/17474930211022678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
RATIONALE To address unmet needs, electronic messages to support person-centered goal attainment and secondary prevention may avoid hospital presentations/readmissions after stroke, but evidence is limited. HYPOTHESIS Compared to control participants, there will be a 10% lower proportion of intervention participants who represent to hospital (emergency/admission) within 90 days of randomization. METHODS AND DESIGN Multicenter, double-blind, randomized controlled trial with intention-to-treat analysis. The intervention group receives 12 weeks of personalized, goal-centered, and administrative electronic messages, while the control group only receive administrative messages. The trial includes a process evaluation, assessment of treatment fidelity, and an economic evaluation. Participants: Confirmed stroke (modified Rankin Score: 0-4), aged ≥18 years with internet/mobile phone access, discharged directly home from hospital. Randomization: 1:1 computer-generated, stratified by age and baseline disability. Outcomes assessments: Collected at 90 days and 12 months following randomization. OUTCOMES Primary outcomes include hospital emergency presentations/admissions within 90 days of randomization. Secondary outcomes include goal attainment, self-efficacy, mood, unmet needs, disability, quality-of-life, recurrent stroke/cardiovascular events/deaths at 90 days and 12 months, and death and cost-effectiveness at 12 months. Sample size: To test our primary hypothesis, we estimated a sample size of 890 participants (445 per group) with 80% power and two-tailed significance threshold of α = 0.05. Given uncertainty for the effect size of this novel intervention, the sample size will be adaptively re-estimated when outcomes for n = 668 are obtained, with maximum sample capped at 1100. DISCUSSION We will provide new evidence on the potential effectiveness, implementation, and cost-effectiveness of a tailored eHealth intervention for survivors of stroke.
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Affiliation(s)
- Dominique A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Jan Cameron
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Monique F Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Clayton, Australia.,Professorial Academic Unit, Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Dawn Harris
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Fiona Ellery
- Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Tara Purvis
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Ian Kneebone
- Graduate School of Health, University of Technology Sydney, Ultimo, Australia
| | - Helen Dewey
- Eastern Health Clinical School, Monash University, Clayton, Australia.,Department of Neurosciences, Eastern Health, Box Hill, Australia
| | - Avril Drummond
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Maree Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia.,Sunshine Coast Clinical School, Griffith University, Birtinya, Australia
| | - Sandy Middleton
- Nursing Research Institute, St Vincent's Health Network, Sydney, Australia.,Nursing Research Institute, Australian Catholic University, Sydney, Australia
| | - Vincent Thijs
- Stroke theme, Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia.,Department of Neurology, Austin Health, Heidelberg, Australia
| | - Geoffrey Cloud
- Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Mariko Carey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Ernest Butler
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Frankston, Australia
| | - Henry Ma
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Leonid Churilov
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Graeme J Hankey
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
| | - Coralie English
- School of Health Science and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Callaghan, Australia
| | - Natasha A Lannin
- Department of Neurology, Alfred Health, Melbourne, Australia.,Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
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22
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Ahlich E, Verzijl CL, Cunning A, Wright E, Rancourt D. Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study. Surg Obes Relat Dis 2021; 17:1591-1602. [PMID: 34134941 DOI: 10.1016/j.soard.2021.05.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Existing research has primarily focused on weight as the outcome of interest for bariatric surgery; however, patients frequently report other lifestyle and interpersonal surgery motivations and goals. Understanding the spectrum of bariatric surgery goals and motivations has important implications for enhancing patient-centered care and surgery outcomes. OBJECTIVES The current study characterized the nature of bariatric patient motivations and goals for surgery, described the extent to which motivations matched goals, and examined whether men and women differed in the specific motivations/goals described. SETTING Teaching hospital, United States METHODS: Data were obtained via retrospective chart review of bariatric patient responses to the clinic's standard open-ended questions about motivations and goals for bariatric surgery. A mixed method approach was used, including content analysis, to identify themes and χ2/t test analyses to test gender differences. RESULTS Surgery motivations and outcome goals were reflected by 8 overarching and overlapping themes. The most common motivations were related to general health and quality of life. The most common goals were to improve health/longevity and mobility. Over a quarter of patients showed no overlap between motivations and goals. Few gender differences were observed. CONCLUSION Findings underscore the importance of goals beyond weight loss, as well as the utility of helping patients shape their goals in accordance with goal-setting theories.
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Affiliation(s)
- Erica Ahlich
- Department of Psychology, University of South Florida, Tampa, Florida.
| | | | - Allison Cunning
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Erin Wright
- Department of Psychology, University of South Florida, Tampa, Florida
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, Florida
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23
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Chun JY, Bharadwaz A, Kyaw Tun J, Bilhim T, Gonzalez-Junyent C, Kawa B. CIRSE Standards of Practice on Conducting Meetings on Morbidity and Mortality. Cardiovasc Intervent Radiol 2021; 44:1157-1164. [PMID: 34018022 DOI: 10.1007/s00270-021-02860-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
This CIRSE Standards of Practice document is developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It aims to assist Interventional Radiologists in their daily practice by providing best practices for conducting meetings on morbidity and mortality.
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Affiliation(s)
- Joo-Young Chun
- Department of Radiology, St George's Hospital, London, UK.
| | - Arindam Bharadwaz
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jimmy Kyaw Tun
- Department of Interventional Radiology, Barts Health NHS Trust, London, UK
| | - Tiago Bilhim
- Interventional Radiology Unit, Centro Hospitalar Universitário de Lisboa Central, Saint Louis and CUF Hospital, Lisbon, Portugal
- Nova Medical School, Lisbon, Portugal
| | | | - Bhavin Kawa
- Department of Radiology, St George's Hospital, London, UK
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24
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Lessons Learned Using Logic Models to Design and Guide DNP Projects. Nurse Educ 2021; 46:E127-E131. [PMID: 33988533 DOI: 10.1097/nne.0000000000001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A final culminating project that is derived from a practice immersion experience is a critical part of a doctor of nursing practice (DNP) program. PROBLEM Many schools use well-designed quality improvement (QI) projects to meet this requirement, but there is no consensus on which QI methods and tools are the most effective for DNP students to demonstrate before graduation. APPROACH One Mid-Atlantic public university began using QI process models, one of which was a logic model, to guide their DNP projects. This led to subsequent changes in the curriculum, faculty preparation, and practice partner responsibilities. OUTCOME Many benefits and challenges were identified during the logic model implementation that may benefit other schools seeking to increase consistency and rigor. Although the learning process for students and faculty may be challenging, the outcomes included improved project conceptualization, clarity, concision, and feasibility of goal attainment. CONCLUSIONS Use of logic models expands DNP students' skills to develop and implement a successful project and supports clinical scholarship.
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25
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Sulaiman AH, Ahmad Sabki Z, Jaafa MJ, Francis B, Razali KA, Juares Rizal A, Mokhtar NH, Juhari JA, Zainal S, Ng CG. Development of a Remote Psychological First Aid Protocol for Healthcare Workers Following the COVID-19 Pandemic in a University Teaching Hospital, Malaysia. Healthcare (Basel) 2020; 8:E228. [PMID: 32722042 PMCID: PMC7551586 DOI: 10.3390/healthcare8030228] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/17/2022] Open
Abstract
The purpose of this article is to discuss the importance of addressing the psychological impact of coronavirus disease 2019 (COVID-19) on healthcare workers (HCWs) who are frontliners directly involved in mitigating the spread of the disease. This paper focuses on the utilization of a clinical practice protocol for identifying HCWs who are COVID-19-positive or under investigation and surveillance for suspected infection, in a tertiary, university teaching hospital of Malaysia. The protocol for Psychological First Aid (PFA), which is applied remotely via a mobile application and phone calls, outlines the work process in stages, with expected immediate, intermediate, and long-term goals within a "Specific, Measurable, Attainable, Relevant, and Realistic Timeframe" (SMART). This protocol is developed to provide a guideline for psychological crisis interventions that promote safety, calm, and hope in HCWs, allowing them to return to psychological functioning without being stigmatized. The unprecedented remote PFA protocol may serve as a platform for further research on the application of a goal-directed approach in a healthcare organization.
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Affiliation(s)
- Ahmad Hatim Sulaiman
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (Z.A.S.); (A.J.R.); (J.A.J.); (C.G.N.)
| | - Zuraida Ahmad Sabki
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (Z.A.S.); (A.J.R.); (J.A.J.); (C.G.N.)
| | - Mohd Johari Jaafa
- Psychology and Counselling Management Unit, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (M.J.J.); (S.Z.)
| | - Benedict Francis
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (B.F.); (K.A.R.); (N.H.M.)
| | - Khairul Arif Razali
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (B.F.); (K.A.R.); (N.H.M.)
| | - Aliaa Juares Rizal
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (Z.A.S.); (A.J.R.); (J.A.J.); (C.G.N.)
| | - Nor Hazwani Mokhtar
- Department of Psychological Medicine, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (B.F.); (K.A.R.); (N.H.M.)
| | - Johan Arif Juhari
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (Z.A.S.); (A.J.R.); (J.A.J.); (C.G.N.)
| | - Suhaila Zainal
- Psychology and Counselling Management Unit, University Malaya Medical Centre, Kuala Lumpur 59100, Malaysia; (M.J.J.); (S.Z.)
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia; (Z.A.S.); (A.J.R.); (J.A.J.); (C.G.N.)
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26
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Occupational Therapy Goal Achievement for People with Stroke: A Retrospective Study. Occup Ther Int 2020; 2020:8587908. [PMID: 32410926 PMCID: PMC7206877 DOI: 10.1155/2020/8587908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 08/06/2019] [Accepted: 04/02/2020] [Indexed: 11/17/2022] Open
Abstract
Methods A cross-sectional retrospective study design was used. People with stroke receiving rehabilitation services at King Abdulaziz Medical City (KAMC) were the target of this study. Data about the extent of achieving occupational therapy goals were collected using the Goal Attainment Scaling (GAS). Results Of the 100 medical records of people with stroke included in this study, only 30% of the goals were functional. Only 54% of the goals were achieved. No association was found between the number of achieved goals and variables such as age, gender, type of stroke, and stroke hemisphere/side. Conclusion People with stroke included in this study have not shown significant progress toward achieving their therapy goals. As for clinical practice, this study could guide therapists in the future to improve the process of achieving their patients' goals.
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27
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Sibley C, Ayers C, King B, Browning T, Kwon JK. Decreasing Patient Dwell Times for Outpatient Cardiac Nuclear Medicine Studies: The Benefits of SMART Goals, Scope Limitations, and Society Guidelines in Quality Improvement. Curr Probl Diagn Radiol 2020; 49:333-336. [PMID: 32321661 DOI: 10.1067/j.cpradiol.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 02/03/2020] [Accepted: 02/25/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND We describe a quality improvement project to improve patient dwell times for outpatient cardiac nuclear medicine exams. Preliminary data indicated that the mean patient dwell time was about 270 minutes. Our specific, measurable, achievable, relevant, and time-bound goal was to reduce patient dwell times for outpatient pharmacologically stressed cardiac nuclear medicine exams by 60 minutes over the course of 2 months. METHODS An interdisciplinary team was formed which used staff interviews and workflow observation to create a cause and effect diagram as well as a process map. Review of the national guidelines for cardiac nuclear medicine exams identified rest and stress intervals as intervention targets. A new protocol was designed and implemented. RESULTS The mean patient dwell time was improved from 270 to 184 minutes. CONCLUSIONS Overall, we found that a clear specific, measurable, achievable, relevant, and time-bound goal, limited scope, and national guideline review allowed for a successful quality improvement project.
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Affiliation(s)
- Carson Sibley
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX.
| | - Camara Ayers
- UT Southwestern Department of Radiology, Dallas, TX
| | - Brent King
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
| | - Travis Browning
- UT Southwestern Department of Radiology, Dallas, TX; Parkland Health and Hospital System, Dallas, TX
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28
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Mohammed J, Smith SR, Burns L, Basak G, Aljurf M, Savani BN, Schoemans H, Peric Z, Chaudhri NA, Chigbo N, Alfred A, Bakhsh H, Salooja N, Chris Chim A, Hashmi SK. Role of Physical Therapy before and after Hematopoietic Stem Cell Transplantation: White Paper Report. Biol Blood Marrow Transplant 2019; 25:e191-e198. [DOI: 10.1016/j.bbmt.2019.01.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
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29
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Schultz CM, Krassa TJ, Doran RJ. Using Elementary Schools for Pediatric Practicum: An Alternative Approach. J Prof Nurs 2019; 35:224-227. [PMID: 31126400 DOI: 10.1016/j.profnurs.2018.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/16/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
Securing clinical sites that facilitate achievement of nursing skills to competently care for children is often challenging for nursing faculty. An additional challenge is helping nursing students learn the importance of conceptually driven practice and its application in the delivery of high quality care. This manuscript describes an alternative pedagogical approach that utilizes elementary schools for pediatric practicum, which is framed by the Whole School, Whole Community, Whole Child Model. Our model driven approach not only provides a framework by which baccalaureate nursing students gain the skills necessary to interact with, educate, and care for children, but also one in which they can gain a greater understanding of how the home, school and community influence the overall health and well-being of children. Subsequently, this pedagogy serves as an exemplar of how an alternative site can be utilized to successfully educate nursing students regarding the care of children.
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Affiliation(s)
- Celeste M Schultz
- University of Illinois at Chicago College of Nursing, Urbana-Champaign Campus, 625 South Wright Street, Suite 201, Champaign, IL 61820, United States of America.
| | - Teresa J Krassa
- University of Illinois at Chicago College of Nursing, Urbana-Champaign Campus, 625 South Wright Street, Suite 201, Champaign, IL 61820, United States of America
| | - Rebecca J Doran
- Illinois State Board of Education, Springfield, IL 62777, United States of America
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30
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Snoek JA, Eijsvogels TMH, VAN 't Hof AWJ, Prescott E, Hopman MT, Kolkman E, DE Kluiver EDP. Impact of a Graded Exercise Program on V˙O2peak and Survival in Heart Failure Patients. Med Sci Sports Exerc 2019; 50:2185-2191. [PMID: 29933343 DOI: 10.1249/mss.0000000000001688] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Although exercise therapy has the potential to improve health outcomes of patients with chronic heart failure (CHF), less than 50% of patients adhere to prescribed physical activity guidelines 1 yr after cardiac rehabilitation. We aimed to assess the effects of an extended cardiac rehabilitation program with 12 months of graded exercise therapy (GET) and resistance exercise training (RT) on exercise capacity and long-term survival in patients with CHF. METHODS This prospective cohort study included 60 CHF patients between 2009 and 2010. The GET-RT program consisted of exercise sessions at 6 d·wk. Total training time of aerobic exercises increased incrementally every other week without changing exercise intensity. Resistance exercise training consisted of 8 exercises with a durable resistance band. Guidance consisted of a step-down approach from in-hospital to home-based training. Cardiopulmonary exercise tests were performed at baseline, 3, 6, and 12 months. Subsequently, patients were propensity score matched on a 1:2 ratio with controls (n = 117) from a CHF registry of patients from the same clinic receiving usual out-patient care and the incidence of all-cause mortality was compared between both groups. RESULTS Baseline V˙O2 peak was 15.0 mL·min·kg and significantly elevated at 3 months (+1.1 mL·min·kg (95% CI, 0.4-1.8), 6 months (+2.9 mL·min·kg (95% CI, 1.1-2.9) and 12 months (+2.6 mL·min·kg (95% CI, 1.4-3.8). During 8 yr of follow-up 23 (38.3%) patients of the GET-RT program died versus 63 (53.8%) patients of the control group (P = 0.063). CONCLUSIONS The 12-month GET-RT program was associated with an improved fitness during 1-yr follow-up, whereas a tendency toward better survival rates was observed during long-term follow-up.
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Affiliation(s)
- Johan A Snoek
- Sports Medicine Department, Isala, Zwolle, THE NETHERLANDS.,Isala Heart Centre, Zwolle, THE NETHERLANDS
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Centre, Nijmegen, THE NETHERLANDS
| | - Arnoud W J VAN 't Hof
- Isala Heart Centre, Zwolle, THE NETHERLANDS.,Maastricht UMC, Maastricht, THE NETHERLANDS
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, DENMARK
| | - Maria T Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Centre, Nijmegen, THE NETHERLANDS
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31
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McNally GA, Hrnicek AK, Barr H. Clinical Trial Amendments: Development of a Process for Consistent Implementation
. Clin J Oncol Nurs 2018; 21:627-628. [PMID: 28945727 DOI: 10.1188/17.cjon.627-628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical trials are responsible for the advancements made in cancer care. An interdepartmental work group at a major academic cancer hospital developed a process for the consistent communication and implementation of clinical trial amendments. This process ensures improved patient safety, as well as high-quality research.
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Affiliation(s)
- Gretchen A McNally
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Amanda K Hrnicek
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Hallie Barr
- Ohio State University Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Abstract
Scientific education and a clinical background allow orthopaedic surgeons to perform leading research. Several resources, skills and techniques may be developed to maximize their research potential.Surgeon-researchers should develop Specific, Measurable, Achievable, Realistic, and Time-defined (SMART) goals. It is critical to define a timeline - which can be 1 year, 3 years, 5 years - to re-evaluate goals and to plan and identify potential obstacles.Physician-scientists are a product of training, funding, resources, practice setting, context, environment, and infrastructure. Although orthopaedic surgery has difficulty in recruiting surgeon-scientists, these are essential for the promotion of advances in technologies and treatment, as they have unique abilities to raise questions from the bedside and the operating room.The most critical personal traits necessary to succeed as a surgeon-scientist are persistence, resilience, and passion for research. These traits may be innate or acquired through mentorship and from role models.Mentors can improve mentees' research efficiency and help them to persevere.Clinical researchers and surgeon-scientists should focus their research interests and efforts in their areas of clinical expertise.For surgeon-researchers to succeed they must have passion for research, persistence in working toward a goal, collaboration/teamwork skills, resilience, research training/experience, a track record of publications, clear goals and expectations, and a defined research plan as well as being clinically excellent. A formal research degree is desirable.Having non-clinician scientists in the team brings added expertise and value.Funding and protected research time are important. To provide outstanding clinical care and improve the quality of the care delivered, surgeons must be leaders in innovation and research. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170065.
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Affiliation(s)
- Cristina Alves
- Department of Pediatric Orthopaedics, Hospital Pediátrico – CHUC, EPE, Portugal
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33
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Wolfe ES, Madden KJ. Evidence-Based Considerations and Recommendations for Athletic Trainers Caring for Patients With Attention-Deficit/Hyperactivity Disorder. J Athl Train 2016; 51:813-820. [PMID: 27834506 DOI: 10.4085/1062-6050-51.12.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Patients with attention-deficit/hyperactivity disorder (ADHD) can be noncompliant, impulsive, and disruptive in an athletic training or physical rehabilitation facility. Athletic trainers (ATs) are valuable and essential health care providers for active patients with ADHD. However, for a patient with ADHD to have a successful outcome in a busy athletic training environment, the AT or health care provider must tailor the treatment setting to the patient's needs. OBJECTIVE To educate and raise awareness among ATs about patients with ADHD and to provide ATs with strategies and tools that will allow them to treat patients with ADHD more effectively. DATA SOURCES We retrieved and reviewed articles from PubMed, PsychINFO, and Ovid without date restrictions. Search words were attention deficit hyperactivity disorder plus 1 of the following topics or search words: athletic training, athletics, coaching, sport, or sport psychology. STUDY SELECTION Any ADHD articles that were not applicable or translatable in good faith to athletic training, physical rehabilitation, or sport and exercise were excluded. DATA EXTRACTION Nonpharmacologic interventions were reviewed and amassed into categories from which the recommendations were created. No statistical analyses were conducted for this review. DATA SYNTHESIS We identified 1241 articles, and 86 met the inclusion criteria. Five groups of evidence were observed: (1) goal setting and coaching, (2) reinforcements and outcomes, (3) routines and treatment timing, (4) simplified feedback and instructions, and (5) environmental control. Reliable evidence suggests that these techniques can be translated and applied within an athletic training and physical rehabilitation setting. CONCLUSIONS Athletic trainers are a vital component in providing health care for patients with ADHD. Using goal contagion creates a structured environment and positive reinforcements that accommodate patients with ADHD. Furthermore, ATs may use the evidence-based recommendations in this review to create a treatment and physical rehabilitation program and space that are tailored to the needs of the ADHD patient to increase the chance of a successful outcome.
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Giesbrecht V, Au S. Morbidity and Mortality Conferences: A Narrative Review of Strategies to Prioritize Quality Improvement. Jt Comm J Qual Patient Saf 2016; 42:516-527. [PMID: 28266920 DOI: 10.1016/s1553-7250(16)42094-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The morbidity and mortality conference (MMC) provides a valuable opportunity to review patient care processes and safety concerns, aligning with a growing quality improvement (QI) mandate. Yet the structure, processes, and aims of many MMCs are often ill-defined. This review summarizes strategies employed by medical, surgical, and critical care departments in the development of patient safety-centered MMCs. METHODS A structured narrative review of literature was conducted using combinations of the search terms "morbidity and mortality conference(s)," "morbidity and mortality meetings," or "morbidity and mortality round(s)." The titles and abstracts of 250 returned articles were screened; 76 articles were reviewed in full, with 32 meeting the full inclusion criteria. RESULTS The literature review elicited a number of methods used by medical, surgical, and critical care MMCs to emphasize QI and patient safety outcomes. A list of actionable changes made in each article was compiled. Five themes common to QI-centered MMCs were identified: (1) defining the role of the MMC, (2) involving stakeholders, (3) detecting and selecting appropriate cases for presentation, (4) structuring goal-directed discussion, and (5) forming recommendations and assigning follow-up. Innovative methods to pair adverse event screening with MMCs were superior to nonstructured voluntary reporting and case selection for overall morbidity detection. Structured case review, discussion, and follow-up were more likely to lead to implementing systems-based change, and interdisciplinary MMCs were associated with a greater likelihood of forming an action item. CONCLUSION The modern patient safety-centered MMC shares common themes of practices that can be adopted by institutions looking to create a venue for analysis of care processes, a platform to launch QI initiatives, and a culture of safety.
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Affiliation(s)
| | - Selena Au
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine
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Peter WF, Hurkmans EJ, van der Wees PJ, Hendriks EJM, van Bodegom-Vos L, Vliet Vlieland TPM. Healthcare Quality Indicators for Physiotherapy Management in Hip and Knee Osteoarthritis and Rheumatoid Arthritis: A Delphi Study. Musculoskeletal Care 2016; 14:219-232. [PMID: 26799718 DOI: 10.1002/msc.1133] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The aim of the present study was to develop healthcare quality indicators (HCQIs) for the physiotherapy (PT) management of patients with hip or knee osteoarthritis (HKOA) or rheumatoid arthritis (RA) in the Netherlands. METHODS Two multidisciplinary expert panels, including patients, were instituted. A draft HCQI set was derived from recommendations included in two existing Dutch PT guidelines for HKOA and RA. The panels suggested additional topics, after which a Delphi procedure was performed. All propositions were scored for their potential to represent good-quality PT care (score range 0-9). Based on predefined rules, the Delphi panel HCQIs were discussed and selected. Lastly, every indicator was rephrased, resulting in its output consisting of a numerator and denominator, to facilitate comparisons within and among practices. RESULTS After two Delphi rounds, two final sets of 17 HCQI - one for HKOA and one for RA - were composed, both containing 16 process indicators (regarding initial assessment, treatment and evaluation) and one outcome indicator. CONCLUSIONS Two sets of HCQIs for PT management in HKOA and RA were developed for measuring the quality of PT care in daily clinical practice. Each indicator was formulated in a measurable way. Future research should focus on the feasibility of both indicator sets for daily clinical practice.
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Affiliation(s)
- W F Peter
- Department of Orthopaedics, Leiden University Medical Center, Leiden, and the Amsterdam Rehabilitation Research Centre
- Reade, Amsterdam, the Netherlands
| | - E J Hurkmans
- Section of Physical Therapy, University of Applied Sciences, FH Campus Wien, Vienna, Austria
| | - P J van der Wees
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, and Centre for Evidence Based Physical therapy, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - E J M Hendriks
- Centre for Evidence Based Physical therapy, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - L van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - T P M Vliet Vlieland
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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