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Ohene-Agyei P, Tran T, Harding JE, Crowther CA. Do glycaemic treatment targets affect the perinatal mental health status of women with gestational diabetes? - Data from the TARGET Trial. BMC Pregnancy Childbirth 2023; 23:869. [PMID: 38104076 PMCID: PMC10724999 DOI: 10.1186/s12884-023-06190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus is associated with perinatal mental disorders. Effective management may reduce this risk, but there is little evidence on effects of different glycaemic treatment targets. We assessed whether tight glycaemic treatment targets compared with less-tight targets reduce the risk of poor mental health outcomes in women with gestational diabetes. METHODS This was a secondary analysis of data from women who consented to complete perinatal mental health questionnaires as participants in the TARGET Trial, a stepped-wedge cluster randomized trial in 10 hospitals in New Zealand. All hospitals initially used less tight glycaemic targets for management of gestational diabetes and were sequentially randomized, in clusters of two at 4-monthly intervals, to using tighter glycaemic targets. Data were collected from 414 participants on anxiety (6-item Spielberger State Anxiety scale), depression (Edinburgh Postnatal Depression Scale), and health-related quality of life (36-Item Short-Form General Health Survey) at the time of diagnosis (baseline), 36 weeks of gestation, and 6 months postpartum. The primary outcome was composite poor mental health (any of anxiety, vulnerability to depression, or poor mental health-related quality of life). Generalized linear mixed models were used to determine the main treatment effect with 95% confidence intervals using an intention-to-treat approach. RESULTS We found no differences between randomised glycaemic target groups in the primary outcome at 36 weeks' (relative risk (RR): 1.07; 95% confidence interval 0.58, 1.95) and 6 months postpartum (RR: 1.03; 0.58, 1.81). There were similarly no differences in the components of the primary outcome at 36 weeks' [anxiety (RR: 0.85; 0.44, 1.62), vulnerability to depression (RR: 1.10; 0.43, 2.83), or poor mental health-related quality of life (RR: 1.05; 0.50, 2.20)] or at 6 months postpartum [anxiety (RR:1.21; 0.59, 2.48), vulnerability to depression (RR:1.41; 0.53, 3.79), poor mental health-related quality of life (RR: 1.11; 0.59, 2.08)]. CONCLUSION We found no evidence that adoption of tighter glycaemic treatment targets in women with gestational diabetes alters their mental health status at 36 weeks' gestation and at 6 months postpartum. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583 (ANZCTR-Registration). Date of registration: 25 March 2015.
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Affiliation(s)
| | - Thach Tran
- School of Biomedical Engineering, University of Technology Sydney, Sydney, Australia
| | - Jane E Harding
- Liggins Institute, University of Auckland, Auckland, New Zealand
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Sha Y, Li C, Xiong Y, Hazra A, Lio J, Jiang I, Huang H, Kerman J, Molina J, Li L, Liang K, Gong D, Li Q, Wu S, Sherer R, Tucker JD, Tang W. Co-creation using crowdsourcing to promote PrEP adherence in China: study protocol for a stepped-wedge randomized controlled trial. BMC Public Health 2022; 22:1697. [PMID: 36071401 PMCID: PMC9449927 DOI: 10.1186/s12889-022-14117-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 09/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background Adherent pre-exposure prophylaxis (PrEP) uptake can prevent HIV infections. Despite the high HIV incidence, Chinese key populations have low PrEP uptake and adherence. New interventions are needed to increase PrEP adherence among key populations in China. Co-creation methods are helpful to solicit ideas from the community to solve public health problems. The study protocol aims to describe the design of a stepped-wedge trial and to evaluate the efficacy of co-created interventions to facilitate PrEP adherence among key populations in China. Methods The study will develop intervention packages to facilitate PrEP adherence among Chinese key populations using co-creation methods. The study will then evaluate the efficacy of the co-created intervention packages using a stepped-wedge randomized controlled trial. This four-phased closed cohort stepped-wedge design will have four clusters. Each cluster will start intervention at three-month intervals. Seven hundred participants who initiated PrEP will be recruited. Participants will be randomized to the clusters using block randomization. The intervention condition includes receiving co-created interventions in addition to standard of care. The control condition is the standard of care that includes routine clinical assessment every 3 months. All participants will also receive an online follow-up survey every 3 months to record medication adherence and will be encouraged to use a WeChat mini-app for sexual and mental health education throughout the study. The primary outcomes are PrEP adherence and retention in PrEP care throughout the study period. We will examine a hypothesis that a co-created intervention can facilitate PrEP adherence. Generalized linear mixed models will be used for the primary outcome analysis. Discussion Developing PrEP adherence interventions in China faces barriers including suboptimal PrEP uptake among key populations, the lack of effective PrEP service delivery models, and insufficient community engagement in PrEP initiatives. Our study design addresses these obstacles by using co-creation to generate social media-based intervention materials and embedding the study design in the local healthcare system. The study outcomes may have implications for policy and intervention practices among CBOs and the medical system to facilitate PrEP adherence among key populations. Trial registration The study is registered in Clinical Trial databases in China (ChiCTR2100048981, July 19, 2021) and the US (NCT04754139, February 11, 2021). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14117-5.
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Affiliation(s)
- Yongjie Sha
- University of North Carolina at Chapel Hill Project-China, 7 Lujing Road, Guangzhou, 510091, Guangdong Province, China
| | - Chunyan Li
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yuan Xiong
- University of North Carolina at Chapel Hill Project-China, 7 Lujing Road, Guangzhou, 510091, Guangdong Province, China
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Jonathan Lio
- Section of Infectious Diseases and Global Health, Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Ivy Jiang
- Section of Infectious Diseases and Global Health, Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | | | - Jared Kerman
- Section of Infectious Diseases and Global Health, Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | | | - Linghua Li
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Dandan Gong
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Quanmin Li
- Department of Infectious Diseases, Guangzhou Number Eight People's Hospital, Guangzhou, China
| | - Songjie Wu
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Renslow Sherer
- Section of Infectious Diseases and Global Health, Department of Medicine, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| | - Joseph D Tucker
- University of North Carolina at Chapel Hill Project-China, 7 Lujing Road, Guangzhou, 510091, Guangdong Province, China. .,Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. .,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, 7 Lujing Road, Guangzhou, 510091, Guangdong Province, China. .,Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Marchand A, Caille A, Gissot V, Giraudeau B, Lengelle C, Bourgoin H, Largeau B, Leducq S, Maruani A. Topical sirolimus solution for lingual microcystic lymphatic malformations in children and adults (TOPGUN): study protocol for a multicenter, randomized, assessor-blinded, controlled, stepped-wedge clinical trial. Trials 2022; 23:557. [PMID: 35804404 PMCID: PMC9270761 DOI: 10.1186/s13063-022-06365-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 04/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Lingual microcystic lymphatic malformations (LMLMs) are rare congenital vascular malformations presenting as clusters of cysts filled with lymph fluid or blood. Even small well-limited lesions can be responsible for a heavy burden, inducing pain, aesthetic prejudice, or oozing, bleeding, infections. The natural history of LMLMs is progressive worsening punctuated by acute flares. Therapeutic options include surgery, laser excision, and radiofrequency ablation but all are potentially detrimental and expose to local relapse. Therefore, the management frequently relies on a “watchful waiting” approach. In complicated LMLMs, treatment with oral sirolimus, a mammalian target of rapamycin (mTOR) inhibitor, is often used. Topical applications of sirolimus on the buccal mucosae have been reported in other oral diseases with good tolerance and none to slight detectable blood sirolimus concentrations. We aim to evaluate the efficacy and safety of a 1 mg/mL sirolimus solution applied once daily on LMLM of any stage in children and adults after 4, 8, 12, 16, 20, and 24 weeks of treatment compared to usual care (no treatment). Methods This is a randomized, multicentric study using an individually randomized stepped-wedge design over 24 weeks to evaluate topical application of a 1 mg/mL sirolimus solution once daily, on LMLM, versus usual care (no treatment), the control condition. Participants begin with an observational period and later switch to the intervention at a randomized time (week 0, 4, 8, or 12). Visits occur every 4 weeks, either in the study center or by teleconsulting. The primary outcome will be the evaluation of global severity of the LMLM on monthly standardized photographs by 3 independent blinded experts using the physical global assessment (PGA) 0 to 5 scale. Secondary outcomes will include lesion size measurement and quality of life assessment, investigator, and patient-assessed global disease and specific symptoms (oozing, bleeding, sialorrhea, eating impairment, taste modification, aesthetic impairment, pain, and global discomfort) assessment. A biological monitoring will be performed including residual blood sirolimus concentration and usual laboratory parameters. Discussion Given the disappointing state of current treatment options in LMLMs, topical sirolimus could become firstline therapy in treating LMLMs if its efficacy and safety were to be demonstrated. Trial registration ClinicalTrials.gov NCT04128722. Registered on 24 September 2019. EudraCT: EUCTR2019-001530-33-FR Sponsor (University Hospital Center of Tours – CHRU Tours): DR190041-TOPGUN French regulatory authorities: ID RCB: 2019-001530-33 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06365-y.
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Affiliation(s)
- A Marchand
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France.
| | - A Caille
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - V Gissot
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - B Giraudeau
- Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - C Lengelle
- Pharmacovigilance Regional Centre (CRPV), CHRU Tours, 37000, Tours, France
| | - H Bourgoin
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - B Largeau
- Department of Pharmacy, University Hospital Center of Tours, 37000, Tours, France
| | - S Leducq
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France.,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France.,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France
| | - A Maruani
- Department of Dermatology and Reference Center for Rare Diseases and Vascular Malformations (MAGEC), CHRU Tours, Avenue de la République, 37044, Tours, Cedex 9, France. .,Clinical Investigation Center, INSERM 1415, CHRU Tours, 37000, Tours, France. .,INSERM U1246 -SPHERE « MethodS in Patients-centered outcomes and HEalth REsearch », University of Nantes, University of Tours, 37000, Tours, France.
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Ouyang Y, Li F, Preisser JS, Taljaard M. Sample size calculators for planning stepped-wedge cluster randomized trials: a review and comparison. Int J Epidemiol 2022; 51:2000-2013. [PMID: 35679584 PMCID: PMC9749719 DOI: 10.1093/ije/dyac123] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/17/2022] [Indexed: 01/21/2023] Open
Abstract
Recent years have seen a surge of interest in stepped-wedge cluster randomized trials (SW-CRTs). SW-CRTs include several design variations and methodology is rapidly developing. Accordingly, a variety of power and sample size calculation software for SW-CRTs has been developed. However, each calculator may support only a selected set of design features and may not be appropriate for all scenarios. Currently, there is no resource to assist researchers in selecting the most appropriate calculator for planning their trials. In this paper, we review and classify 18 existing calculators that can be implemented in major platforms, such as R, SAS, Stata, Microsoft Excel, PASS and nQuery. After reviewing the main sample size considerations for SW-CRTs, we summarize the features supported by the available calculators, including the types of designs, outcomes, correlation structures and treatment effects; whether incomplete designs, cluster-size variation or secular trends are accommodated; and the analytical approach used. We then discuss in more detail four main calculators and identify their strengths and limitations. We illustrate how to use these four calculators to compute power for two real SW-CRTs with a continuous and binary outcome and compare the results. We show that the choice of calculator can make a substantial difference in the calculated power and explain these differences. Finally, we make recommendations for implementing sample size or power calculations using the available calculators. An R Shiny app is available for users to select the calculator that meets their requirements (https://douyang.shinyapps.io/swcrtcalculator/).
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Affiliation(s)
- Yongdong Ouyang
- Corresponding author. Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON K1Y 4E9, Canada. E-mail:
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA,Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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5
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Quezada-Sánchez AD, Fuentes-Rivera E, García-Martínez A, Del Carmen Hernández-Chávez M, Pineda-Antúnez C, Martínez MR, García-Guerra A, García-Feregrino R, Madrigal-Ramírez A, Santiago-Angelino T, Olvera-Flores F, Schnaas L, Pérez-Escamilla R, Serván-Mori E. Assessing the effect of an educational intervention on early childhood development among Mexican preschool children in the state of Oaxaca: a study protocol of a cluster randomized stepped-wedge trial. Trials 2022; 23:126. [PMID: 35130939 PMCID: PMC8821775 DOI: 10.1186/s13063-022-06024-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early childhood development (ECD) is essential in human capacity building and a critical element in the intergenerational process of human development. In some countries, social programs targeted at improving ECD have proven to be successful. Oaxaca is one of the States with the greatest social inequities in Mexico. Therefore, children in Oaxaca are at a high risk of suboptimal ECD. In 2014, the non-governmental organization (NGO) Un Kilo de Ayuda started to implement the Neurological and Psycho-affective Early Childhood Development Program in eighty marginalized communities of Oaxaca. In this article, we present the impact evaluation design to estimate the effect of this program on ECD. Methods We will use a cluster randomized stepped-wedge design with an allocation ratio of 1:1. Communities will be randomly assigned to each study group: four groups of twenty communities each. We expect that children from intervened communities will show better ECD outcomes. Discussion This study is one of the few rigorous assessments of the effect of an ECD program on the neurodevelopment of Mexican children recruited in their first 3 years of life from communities of high social vulnerability. Our study design is recommended when the way in which outcomes are measured and assessed depends on age, self-selection is present, and assignment is performed at an aggregate level. Implementation research will be conducted prior to study launch and quality control measures will be in place to maximize the fidelity of study design implementation. Trial registration ClinicalTrials.gov NCT04210362
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Affiliation(s)
- Amado D Quezada-Sánchez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Evelyn Fuentes-Rivera
- Center for Demographic, Urban and Environmental Studies, College of Mexico A.C., Mexico City, Mexico
| | | | | | - Carlos Pineda-Antúnez
- Center for Health Systems Research, National Institute of Public Health, Universidad Av, 655, Cuernavaca, Mexico
| | - Martín Romero Martínez
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Armando García-Guerra
- Center for Research in Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico
| | - Raquel García-Feregrino
- Center for Evaluation and Surveys Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Abby Madrigal-Ramírez
- Center for Health Systems Research, National Institute of Public Health, Universidad Av, 655, Cuernavaca, Mexico
| | - Tania Santiago-Angelino
- Center for Health Systems Research, National Institute of Public Health, Universidad Av, 655, Cuernavaca, Mexico
| | | | - Lourdes Schnaas
- National Institute of Perinatology Isidro Espinosa de los Reyes, Mexico City, Mexico
| | - Rafael Pérez-Escamilla
- Department of Social & Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, USA
| | - Edson Serván-Mori
- Center for Health Systems Research, National Institute of Public Health, Universidad Av, 655, Cuernavaca, Mexico.
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Talal AH, Markatou M, Sofikitou EM, Brown LS, Perumalswami P, Dinani A, Tobin JN. Patient-centered HCV care via telemedicine for individuals on medication for opioid use disorder: Telemedicine for Evaluation, Adherence and Medication for Hepatitis C (TEAM-C). Contemp Clin Trials 2021; 112:106632. [PMID: 34813962 DOI: 10.1016/j.cct.2021.106632] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Telemedicine has the potential to increase healthcare access especially for vulnerable populations. Telemedicine for Evaluation, Adherence, and Medication for Hepatitis C (TEAM-C) is comparing telemedicine access to specialty medical care to usual care for management of hepatitis C virus (HCV) infection among persons with opioid use disorder (PWOUD). PWOUD have the highest hepatitis C virus (HCV) prevalence and incidence, yet they infrequently receive HCV care. The study objectives are to compare access to specialty care via telemedicine to offsite specialty referral (usual care) on 1) treatment initiation, completion, and sustained virological response, 2) patient satisfaction with health care delivery, and 3) HCV reinfection after successful HCV cure. METHODS TEAM-C is a multi-site, non-blinded, randomized pragmatic clinical trial conducted at 12 opioid treatment programs (OTP) throughout New York State that utilizes the stepped-wedge design. The unit of randomization is the OTP with a total sample size of 624 participants. HCV-infected PWOUD were treated via telemedicine or referral. Telemedicine encounters are conducted onsite in the OTP with co-administration of direct acting antivirals for HCV with medications for opioid use disorder. The primary outcome is undetectable HCV RNA obtained 12 weeks post-treatment cessation. We also follow participants for two years to assess for reinfection. CONCLUSIONS The study utilizes a rigorous study design to evaluate the effectiveness and implementation of virtual treatment for HCV integrated into behavioral treatment. We demonstrate the feasibility, engagement principles and lessons learned from the initial prospective randomized trial of telemedicine targeted to a vulnerable population.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology, and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicot Street, Suite 6090, Buffalo, NY 14203, USA.
| | - Marianthi Markatou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Elisavet M Sofikitou
- Department of Biostatistics, University at Buffalo, 726 Kimball Tower, Buffalo, NY 14214, USA.
| | - Lawrence S Brown
- START Treatment & Recovery Centers, 22 Chapel Street, Brooklyn, NY 11201, USA.
| | - Ponni Perumalswami
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Amreen Dinani
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, 17 East 102nd Street 8th Floor, New York, NY 10029, USA.
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, USA; The Rockefeller University, 5 West 37th Street, 10(th) floor, New York, NY 10018, USA.
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Emond Y, Wolff A, Bloo G, Damen J, Westert G, Wollersheim H, Calsbeek H. Complexity and involvement as implementation challenges: results from a process analysis. BMC Health Serv Res 2021; 21:1149. [PMID: 34688287 PMCID: PMC8542304 DOI: 10.1186/s12913-021-07090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The study objective was to analyse the implementation challenges experienced in carrying out the IMPROVE programme. This programme was designed to implement checklist-related improvement initiatives based on the national perioperative guidelines using a stepped-wedge trial design. A process analysis was carried out to investigate the involvement in the implementation activities. Methods An involvement rating measure was developed to express the extent to which the implementation programme was carried out in the hospitals. This measure reflects the number of IMPROVE-implementation activities executed and the estimated participation in these activities in all nine participating hospitals. These data were compared with prospectively collected field notes. Results Considerable variation between the hospitals was found with involvement ratings ranging from 0 to 6 (mean per measurement = 1.83 on a scale of 0–11). Major implementation challenges were respectively the study design (fixed design, time planning, long duration, repeated measurements, and data availability); the selection process of hospitals, departments and key contact person(s) (inadequately covering the entire perioperative team and stand-alone surgeons); the implementation programme (programme size and scope, tailoring, multicentre, lack of mandate, co-interventions by the Inspectorate, local intervention initiatives, intervention fatigue); and competitive events such as hospital mergers or the introduction of new IT systems, all reducing involvement. Conclusions The process analysis approach helped to explain the limited and delayed execution of the IMPROVE-implementation programme. This turned out to be very heterogeneous between hospitals, with variation in the number and content of implementation activities carried out. The identified implementation challenges reflect a high complexity with regard to the implementation programme, study design and setting. The involvement of the target professionals was put under pressure by many factors. We mostly encountered challenges, but at the same time we provide solutions for addressing them. A less complex implementation programme, a less fixed study design, a better thought-out selection of contact persons, as well as more commitment of the hospital management and surgeons would likely have contributed to better implementation results. Trial registration Dutch Trial Registry: NTR3568, retrospectively registered on 2 August 2012. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07090-z.
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Affiliation(s)
- Yvette Emond
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands. .,Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands.
| | - André Wolff
- Department of Anesthesiology, Pain Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerrit Bloo
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands.,Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Johan Damen
- Department of Anesthesiology, Pain and Palliative Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Gert Westert
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
| | - Hub Wollersheim
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
| | - Hiske Calsbeek
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud university medical center, PO Box 9101, 114 IQ healthcare, 6500 HB, Nijmegen, The Netherlands
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Abstract
Background In a cross-sectional stepped-wedge cluster randomized trial comparing usual care to a new intervention, treatment allocation and time are correlated by design because participants enrolled early in the trial predominantly receive usual care while those enrolled late in the trial predominantly receive the new intervention. Current guidelines recommend adjustment for time effects when analyzing stepped-wedge cluster randomized trials to remove the confounding bias induced by this correlation. However, adjustment for time effects impacts study power. Within the Frequentist framework, adopting a sample size calculation that includes time effects would ensure the trial having adequate power regardless of the magnitude of the effect of time on the outcome. But if in fact time effects were negligible, this would overestimate the required sample size and could lead to the trial being deemed infeasible due to cost or unavailability of the required numbers of clusters or participants. In this study, we explore the use of prior information on time effects to potentially reduce the required sample size of the trial. Methods We applied a Bayesian approach to incorporate the prior information on the time effects into cluster-level statistical models (for continuous, binary, or count outcomes) for the stepped-wedge cluster randomized trial. We conducted simulations to illustrate how the bias in the intervention effect estimate and the trial power vary as a function of the prior precision and the mis-specification of the prior means of the time effects in an example scenario. Results When a nearly flat prior for the time effects was used, the power or sample size calculated using the Bayesian approach matched the result obtained using the Frequentist approach with time effects included. When a highly precise prior for the time effects (with accurately specified prior means) was used, the Bayesian result matched the Frequentist result obtained with time effects excluded. When the prior means of the time effects were nearly correctly specified, including this information improved the efficiency of the trial with little bias introduced into the intervention effect estimate. When the prior means of the time effects were greatly mis-specified and a precise prior was used, this bias was substantial. Conclusion Including prior information on time effects using a Bayesian approach may substantially reduce the required sample size. When the prior can be justified, results from applying this approach could support the conduct of a trial, which would be deemed infeasible if based on the larger sample size obtained using a Frequentist calculation. Caution is warranted as biased intervention effect estimates may arise when the prior distribution for the time effects is concentrated far from their true values.
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Affiliation(s)
- Denghuang Zhan
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Yongdong Ouyang
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Liang Xu
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada.,Centre for Health Evaluation and Outcomes Sciences, St Paul's Hospital, Vancouver, BC, Canada
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9
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Battaglia TA, Freund KM, Haas JS, Casanova N, Bak S, Cabral H, Freedman RA, White KB, Lemon SC. Translating research into practice: Protocol for a community-engaged, stepped wedge randomized trial to reduce disparities in breast cancer treatment through a regional patient navigation collaborative. Contemp Clin Trials 2020; 93:106007. [PMID: 32305457 PMCID: PMC7884078 DOI: 10.1016/j.cct.2020.106007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/10/2020] [Accepted: 04/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Racial and socioeconomic disparities in breast cancer mortality persist. In Boston, MA, Black, Non-Hispanic women and Medicaid-insured individuals are 2-3 times more likely to have delays in treatment compared to White or privately insured women. While evidence-based care coordination strategies for reducing delays exist, they are not systematically implemented across healthcare settings. METHODS Translating Research Into Practice (TRIP) utilizes community engaged research methods to address breast cancer care delivery disparities. Four Massachusetts Clinical and Translational Science Institute (CTSI) hubs collaborated with the Boston Breast Cancer Equity Coalition (The Coalition) to implement an evidence-based care coordination intervention for Boston residents at risk for delays in breast cancer care. The Coalition used a community-driven process to define the problem of care delivery disparities, identify the target population, and develop a rigorous pragmatic approach. We chose a cluster-randomized, stepped-wedge hybrid type I effectiveness-implementation study design. The intervention implements three evidence-based strategies: patient navigation services, a shared patient registry for use across academic medical centers, and a web-based social determinants of health platform to identify and address barriers to care. Primary clinical outcomes include time to first treatment and receipt of guideline-concordant treatment, which are captured through electronic health records abstraction. We will use mixed methods to collect the secondary implementation outcomes of acceptability, adoption/penetration, fidelity, sustainability and cost. CONCLUSION TRIP utilizes an innovative community-driven research strategy, focused on interdisciplinary collaborations, to design and implement a translational science study that aims to more efficiently integrate proven health services interventions into clinical practice.
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Affiliation(s)
- Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America.
| | - Karen M Freund
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, United States of America; Division of Internal Medicine and Primary Care, Department of Medicine, Tufts Medical Center, Boston, MA, United States of America; Tufts University School of Medicine, Boston, MA, United States of America
| | - Jennifer S Haas
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Nicole Casanova
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America
| | - Sharon Bak
- Women's Health Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, United States of America; Boston University School of Medicine, Boston, MA, United States of America
| | - Howard Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
| | - Rachel A Freedman
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, MA, United States of America
| | - Karen Burns White
- Initiative to Eliminate Cancer Disparities, Dana Farber/Harvard Cancer Center, Boston, MA, United States of America
| | - Stephenie C Lemon
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, United States of America
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10
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Fan S, Liu Z, Luo Z, Yu M, Ouyang L, Gong H, Ding Y, Li P, Yuan T, Zhou Y, Wu G, Zou H. Effect of availability of HIV self-testing on HIV testing frequency among men who have sex with men attending university in China (UniTest): protocol of a stepped-wedge randomized controlled trial. BMC Infect Dis 2020; 20:149. [PMID: 32070297 PMCID: PMC7029612 DOI: 10.1186/s12879-020-4807-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background HIV testing plays a central role in the combat against HIV. We aimed to determine if the availability of HIV self-testing (HIVST) would increase the frequency of testing among men who have sex with men (MSM) attending university in China. Methods A stepped wedge randomized controlled trial will be conducted in 4 provinces in China: Chongqing, Guangdong, Shandong, and Tianjin. Eligibility assessment will include (1) male, aged 16 years or older, (2) university student (technical diploma and undergraduate students), (3) MSM (sexual behaviors including mutual masturbation, oral sex, and anal sex), (4) HIV negative, and (5) willing to provide informed consent. Participants will be randomly allocated to HIV self-testing intervention with free HIVST kits in every 30 days according to the intervention waiting lists with a computer-generated randomized sequence. All participants will complete a self-administrated online questionnaire onsite at baseline and 12-month follow-up and complete an online questionnaire at 4- and 8-month. The primary outcome is the effect of HIVST on HIV testing frequency. Secondary outcomes include the change in sexual behaviors and HIV incidence. Discussion No previous study had measured the effect of social media based HIVST intervention on the change in HIV testing behaviors, sexual behaviors and incident HIV infection among MSM attending university in China. Findings from this study will provide evidence for further interventional practice promotions and prevention strategies scale-up, including HIV testing, pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP), and sexual partner serosorting. Trial registration Chinese Clinical Trial Registry: ChiCTR1900020645. Registered 11 January 2019.
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Affiliation(s)
- Song Fan
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China.,School of Public Health, Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhongquan Liu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhenzhou Luo
- Nanshan District Center for Chronic Disease Control, Shenzhen, 518000, China
| | - Maohe Yu
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Lin Ouyang
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Hui Gong
- Department of AIDS/STD Control and Prevention, Tianjin Center for Disease Control and Prevention, Tianjin, 300011, China
| | - Yi Ding
- Nanshan District Center for Chronic Disease Control, Shenzhen, 518000, China
| | - Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Tanwei Yuan
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 510006, Guangdong, China
| | - Yepeng Zhou
- Foshan Pengyou AIDS Prevention Care Center, Foshan, 528000, Guangdong, China
| | - Guohui Wu
- Department of AIDS/STD Control and Prevention, Chongqing Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, 510006, Guangdong, China. .,Kirby Institute, University of New South Wales, Sydney, Australia. .,School of Public Health, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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11
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Li J, Zhang Y, Myers LJ, Bravata DM. Power calculation in stepped-wedge cluster randomized trial with reduced intervention sustainability effect. J Biopharm Stat 2019; 29:663-674. [PMID: 31317805 DOI: 10.1080/10543406.2019.1633658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The stepped-wedge design for pragmatic clinical trials has received increased attention in health service-related research seeking to evaluate the effect of interventions. Compared with the parallel design, the stepped-wedge design is preferred when there is prior knowledge supporting the effectiveness and harmlessness of the intervention, and/or when practical or financial constraints exist such that the intervention can only be implemented sequentially on a fraction of clusters. In some health service studies, the study period may consist of two parts: an active implementation followed by a sustainability phase, where the intervention effect is possibly reduced. There is a gap in current literature of the stepped-wedge design for cluster randomization trials for dealing with this specific scenario. We aim to provide an analytical formula for power analysis under this situation to aid the stepped-wedge design of an ongoing PREVENT trial.
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Affiliation(s)
- Jing Li
- a Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University , Indianapolis , IN , USA
| | - Ying Zhang
- b Department of Biostatistics, College of Public Health, University of Nebraska Medical Center , Omaha , NE , USA
| | - Laura J Myers
- c Health Services Research Service, Richard L. Roudebush VA Medical Center , Indianapolis , IN , USA.,d Department of Internal Medicine, Indiana University School of Medicine , Indianapolis , IN , USA
| | - Dawn M Bravata
- c Health Services Research Service, Richard L. Roudebush VA Medical Center , Indianapolis , IN , USA.,d Department of Internal Medicine, Indiana University School of Medicine , Indianapolis , IN , USA.,e Center for Health Services Research, Regenstrief Institute , Indianapolis , IN , USA
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12
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Tesky VA, Schall A, Schulze U, Stangier U, Oswald F, Knopf M, König J, Blettner M, Arens E, Pantel J. Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project). Trials 2019; 20:424. [PMID: 31296264 PMCID: PMC6625077 DOI: 10.1186/s13063-019-3534-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates. Methods The aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design. Discussion Our main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression. Trial registration DRKS, DRKS00015686, Oct. 10, 2018.
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Affiliation(s)
- Valentina A Tesky
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. .,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.
| | - Arthur Schall
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.,Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Ulrike Schulze
- Hessian Institute of Nursing Research (HessIP), Frankfurt University of Applied Sciences (Frankfurt UAS), Nibelungenplatz 3, Frankfurt am Main, 60318, Germany
| | - Ulrich Stangier
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Frank Oswald
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany.,Interdisciplinary Ageing Research, Faculty of Educational Sciences, Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Monika Knopf
- Frankfurt Forum for Interdisciplinary Ageing Research (FFIA), Goethe University Frankfurt, Theodor-W.-Adorno-Platz 6, Frankfurt am Main, 60323, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Johannes Gutenberg University of Mainz, Langenbeckstraße 1, Mainz, 55131, Germany
| | - Elisabeth Arens
- Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Varrentrappstraße 40-42, Frankfurt am Main, 60486, Germany
| | - Johannes Pantel
- Department of Geriatric Medicine, Institute of General Practice, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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13
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Karra M, Pearson E, Pradhan E, de Silva R, Samarasekera A, Canning D, Shah I, Weerasekera D, Senanayake H. The effect of a postpartum IUD intervention on counseling and choice: Evidence from a cluster-randomized stepped-wedge trial in Sri Lanka. Trials 2019; 20:407. [PMID: 31287021 PMCID: PMC6615190 DOI: 10.1186/s13063-019-3473-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this study, we evaluate the effect of the FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge trial. METHODS/DESIGN Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD. RESULTS We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054). CONCLUSIONS This study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention's effectiveness can be improved to be able to meet the demand for postpartum family planning of women. TRIAL REGISTRATION ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).
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Affiliation(s)
- Mahesh Karra
- Frederick S. Pardee School of Global Studies, Boston University, 121 Bay State Road, Boston, MA, 02215, USA. .,Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Erin Pearson
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,Ipas, Chapel Hill, NC, 27515, USA
| | - Elina Pradhan
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,World Bank Group, Washington, DC, 20006, USA
| | - Ranjith de Silva
- Sri Lanka College of Obstetricians and Gynaecologists, Colombo, 08, Sri Lanka
| | | | - David Canning
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Iqbal Shah
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Deepal Weerasekera
- Sri Lanka College of Obstetricians and Gynaecologists, Colombo, 08, Sri Lanka
| | - Hemantha Senanayake
- Sri Lanka College of Obstetricians and Gynaecologists, Colombo, 08, Sri Lanka
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14
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Wong H, Ouyang Y, Karim ME. The randomization-induced risk of a trial failing to attain its target power: assessment and mitigation. Trials 2019; 20:360. [PMID: 31208463 PMCID: PMC6580524 DOI: 10.1186/s13063-019-3471-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
Health researchers are familiar with the concept of trial power, a number that prior to the start of a trial is intended to describe the probability that the results of the trial will correctly conclude that the intervention has an effect. Trial power, as calculated using standard software, is an expected power that arises from averaging hypothetical trial results over all possible treatment allocations that could be generated by the randomization algorithm. However, in the trial that ultimately is conducted, only one treatment allocation will occur, and the corresponding attained power (conditional on the allocation that occurred) is not guaranteed to be equal to the expected power and may be substantially lower. We provide examples illustrating this issue, discuss some circumstances when this issue is a concern, define and advocate the examination of the pre-randomization power distribution for evaluating the risk of obtaining unacceptably low attained power, and suggest the use of randomization restrictions to reduce this risk. In trials that randomize only a modest number of units, we recommend that trial designers evaluate the risk of getting low attained power and, if warranted, modify the randomization algorithm to reduce this risk.
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Affiliation(s)
- Hubert Wong
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Yongdong Ouyang
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Mohammad Ehsanul Karim
- School of Population & Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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15
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Ibañez LV, Stoep AV, Myers K, Zhou C, Dorsey S, Steinman KJ, Stone WL. Promoting early autism detection and intervention in underserved communities: study protocol for a pragmatic trial using a stepped-wedge design. BMC Psychiatry 2019; 19:169. [PMID: 31174514 PMCID: PMC6556010 DOI: 10.1186/s12888-019-2150-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/20/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the known benefits of early, specialized intervention for toddlers with Autism Spectrum Disorder (ASD), access to such intervention remains limited. This pragmatic trial examines a novel healthcare delivery model (Screen-Refer-Treat [SRT]), which capitalizes upon existing health care and early intervention (EI) infrastructure to increase community capacity for ASD detection and treatment before age 3, when it is likely to have the greatest impact. This model comprises three components: (1) universal use of Stage 1 ASD screening by primary care providers (PCPs) at 18-month well-child visits (i.e., Screen); (2) immediate referral of positive screens to a community-based EI program (i.e., Refer); and (3) provision of an inexpensive, evidence-based ASD-specialized treatment by EI providers, after verifying ASD risk with a Stage 2 screen (i.e., Treat). This paper describes our research design and the initial successes, challenges, and adaptations made during the early implementation phase. METHOD/DESIGN A stepped-wedge cluster RCT was used to implement the SRT model sequentially in four diverse Washington State counties ("clusters"). Counties are randomly assigned to the time of receipt of the SRT intervention, which comprises training workshops and technical assistance focused on the use of evidence-based ASD screening and intervention tools. Separate cohorts of families with toddlers (16-35 months old) with and without ASD concerns are recruited before and after the SRT intervention from participating PCP practices and EI programs. PCPs and EI providers complete measures on their screening, referral, and intervention practices before and after the SRT intervention. Each family cohort completes surveys about their well-being, parenting efficacy, health care satisfaction, and toddler's social-communicative behaviors. CONCLUSION This trial is the first of its kind to work simultaneously with two service delivery systems with the goal of improving early detection and treatment for ASD. Our approach was successful in attaining buy-in from PCPs and EI providers, building and maintaining partnerships with providers, and achieving high levels of retention and survey completion. Fostering provider engagement and problem-solving issues together as partners were integral to overcoming the main challenges. Numerous lessons have been learned thus far, which have applicability for implementation researchers in ASD and those in other fields. TRIAL REGISTRATION The registration number for this trial is NCT02409303 and it was posted on ClinicalTrials.gov on April 6, 2015.
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Affiliation(s)
- Lisa V. Ibañez
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
| | - Ann Vander Stoep
- 0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, Department of Epidemiology, University of Washington, Seattle, WA 98195 USA
| | - Kathleen Myers
- 0000000122986657grid.34477.33Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 USA
| | - Chuan Zhou
- 0000000122986657grid.34477.33Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA 98195 USA ,0000 0000 9026 4165grid.240741.4Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, WA 98145 USA
| | - Shannon Dorsey
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
| | - Kyle J. Steinman
- 0000000122986657grid.34477.33Departments of Neurology, Psychiatry & Behavioral Sciences, and Pediatrics, University of Washington, Seattle, WA 98195 USA ,0000 0000 9026 4165grid.240741.4Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, WA 98101 USA
| | - Wendy L. Stone
- 0000000122986657grid.34477.33Department of Psychology, University of Washington, CHDD, Box 357920, Seattle, WA 98195 USA
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Owen RR, Woodward EN, Drummond KL, Deen TL, Oliver KA, Petersen NJ, Meit SS, Fortney JC, Kirchner JE. Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design. Implement Sci 2019; 14:33. [PMID: 30898129 PMCID: PMC6429823 DOI: 10.1186/s13012-019-0875-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background Integrating mental health providers into primary care clinics improves access to and outcomes of mental health care. In the Veterans Health Administration (VA) Primary Care Mental Health Integration (PCMHI) program, mental health providers are co-located in primary care clinics, but the implementation of this model is challenging outside large VA medical centers, especially for rural clinics without full mental health staffing. Long wait times for mental health care, little collaboration between mental health and primary care providers, and sub-optimal outcomes for rural veterans could result. Telehealth could be used to provide PCMHI to rural clinics; however, the clinical effectiveness of the tele-PCMHI model has not been tested. Based on evidence that implementation facilitation is an effective implementation strategy to increase uptake of PCMHI when delivered on-site at larger VA clinics, it is hypothesized that this strategy may also be effective with regard to ensuring adequate uptake of the tele-PCMHI model at rural VA clinics. Methods This study is a hybrid type 2 pragmatic effectiveness-implementation trial of tele-PCMHI in six sites over 24 months. Tele-PCMHI, which will be delivered by clinical staff available in routine care settings, will be compared to usual care. Fidelity to the care model will be monitored but not controlled. We will use the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework to evaluate the patient-level clinical effectiveness of tele-PCMHI in rural VA clinics and also to evaluate the fidelity to and outcomes of the implementation strategy, implementation facilitation. The proposed study will employ a stepped-wedge design in which study sites sequentially begin implementation in three steps at 6-month intervals. Each step will include (1) a 6-month period of implementation planning, followed by (2) a 6-month period of active implementation, and (3) a final period of stepped-down implementation facilitation. Discussion This study will evaluate the effectiveness of PCMHI in a novel setting and via a novel method (clinical video telehealth). We will test the feasibility of using implementation facilitation as an implementation strategy to deploy tele-PCMHI in rural VA clinics. Trial registration ClinicalTrials.gov registration number NCT02713217. Registered on 18 March 2016 Electronic supplementary material The online version of this article (10.1186/s13012-019-0875-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Richard R Owen
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA. .,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, USA.
| | - Eva N Woodward
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, USA.,Center for Implementation Research, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, USA
| | - Karen L Drummond
- VA Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA.,Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, USA
| | - Tisha L Deen
- Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA
| | - Karen Anderson Oliver
- William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, USA
| | - Nancy J Petersen
- VA HSR&D Center for Innovations in Quality Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA.,Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Scott S Meit
- Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, USA
| | - John C Fortney
- Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, 1660 S. Columbian Way, Seattle, WA, S-152, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, USA
| | - JoAnn E Kirchner
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR, USA.,Department of Veterans Affairs, VA Quality Enhancement Research Initiative (QUERI) Program for Team-Based Behavioral Health, 2200 Fort Roots Drive, North Little Rock, AR, USA
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Cockcroft A, Omer K, Gidado Y, Gamawa AI, Andersson N. Impact of universal home visits on maternal and infant outcomes in Bauchi state, Nigeria: protocol of a cluster randomized controlled trial. BMC Health Serv Res 2018; 18:510. [PMID: 29970071 PMCID: PMC6029180 DOI: 10.1186/s12913-018-3319-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality in Nigeria is one of the highest in the world. Access to antenatal care is limited and the quality of services is poor in much of the country. Previous research in Bauchi State found associations between maternal morbidity and domestic violence, heavy work in pregnancy, lack of knowledge about danger signs, and lack of spousal communication about pregnancy and childbirth. This cluster randomized controlled stepped-wedge trial will test the impact of universal home visits to pregnant women and their partners, and the added value of video edutainment. METHODS The trial will take place in six wards of Toro Local Government Area in Bauchi State, Nigeria, randomly allocated into three waves of two wards each. Home visits will begin in wave 1 wards immediately; in wave 2 wards after one year; and in wave 3 wards after a further year. In each wave, one ward, randomly allocated, will receive video edutainment during the home visits. Female home visitors will contact all households in their catchment areas of about 300 households, register all pregnant women, and visit them every two months during pregnancy, after delivery and one year later. They will use android handsets to collect information on pregnancy progress, send this to a central server, and discuss with the women the evidence about household factors associated with higher maternal risks, using video clips in the edutainment wards. Male home visitors will contact the partners of the pregnant women and discuss with them the same evidence. We will compare outcomes between wave 1 and wave 2 wards at about one year, between wave 2 and wave 3 wards at about two years, and finally between wards with and without added edutainment. Primary outcomes will be complications in pregnancy and delivery, and child health at one year. Secondary outcomes include knowledge and attitudes, use of health services, knowledge of danger signs, and household care of pregnant women. DISCUSSION Demonstrating an impact of home visits and understanding potential mechanisms could have important implications for reducing maternal morbidity and mortality in other settings with poor access to quality antenatal care services. TRIAL REGISTRATION Registration number: ISRCTN82954580 . Registry: ISRCTN. Date of registration: 11 August 2017. Retrospectively registered.
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Affiliation(s)
- Anne Cockcroft
- CIET/PRAM, Department of Family Medicine, McGill University, 5858 Cote des Neiges, Montreal, Canada.
| | - Khalid Omer
- CIET in Nigeria, Federal Low Cost, Near Police Station, Bauchi, Bauchi State, Nigeria
| | - Yagana Gidado
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi Chapter, FOMWAN Nursery/Pri/Sec. Schools, AllahiruBatarwa Street, G.R.A., PO Box 2539, Bauchi, Bauchi State, Nigeria
| | - Adamu Ibrahim Gamawa
- Bauchi State Primary Health Care Development Agency, Ministry of Health, Bank Road, Bauchi, Bauchi State, Nigeria
| | - Neil Andersson
- CIET/PRAM, Department of Family Medicine, McGill University, 5858 Cote des Neiges, Montreal, Canada.,Centro de Investigaciones de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero, Acapulco, Guerrero, Mexico
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18
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Ferm L, Rasmussen CDN, Jørgensen MB. Operationalizing a model to quantify implementation of a multi-component intervention in a stepped-wedge trial. Implement Sci 2018; 13:26. [PMID: 29422080 PMCID: PMC5806452 DOI: 10.1186/s13012-018-0720-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 01/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is challenging to interpret the results of multifaceted interventions due to complex program theories that are difficult to measure in a quantifiable manner. The aims of this paper were, first, to develop a model for a comprehensive quantitative implementation evaluation and, second, to operationalize it in the process evaluation of the stepped-wedge cluster randomized controlled trial: "Prevention of low back pain and its consequences among nurses' aides in elderly care" to investigate if implementation differed across intervention components, steps, and settings (workplaces). METHODS Operationalization of a quantifiable measure of implementation requires three steps: (1) development of a program logic and intervention protocol, (2) description of a complete and acceptable delivery of the intervention, and (3) description of what determines the receipt of the intervention. Program logic from a previously developed multifaceted stepped-wedge intervention was used. The optimal delivery of the intervention was defined as the deliverers' full understanding and following of the intervention protocol and that they performed their best and contributed to the participants' attention and motivation (fidelity). The optimal receipt of the intervention was defined as participants being fully present at all intervention activities (participation), being motivated and satisfied, and having a good social support (responsiveness). Measurements of the fidelity, participation, and responsiveness were obtained from logbooks and questionnaires. Fidelity was multiplied by participation to measure exposure of the intervention to the individual. The implementation was determined from optimal delivery and optimal receipt on a scale from 0 (no implementation) to 100 (full implementation) on individual and organizational level. RESULTS Out of 753 sessions, 95% were delivered. The sessions were delivered with 91% success (fidelity) across the organization. Average participation, fidelity, exposure, and responsiveness were 50, 93, 48, and 89% across all participants. The implementation of the intervention was uniform across steps (p = 0.252) and workplaces (p = 0.125) but not for intervention components (p = 0.000). However, participation, fidelity, exposure, and responsiveness varied between workplaces. CONCLUSIONS This study developed a quantifiable implementation evaluation measuring participation, fidelity, exposure, and responsiveness. The quantifiable implementation evaluation was suitable for comparing implementation across steps, components, and settings and can be applied in the analyses on the impact of implementation of complex interventions.
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Affiliation(s)
- Linnea Ferm
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark
| | | | - Marie Birk Jørgensen
- National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100, Copenhagen, Denmark.
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19
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Graham HR, Ayede AI, Bakare AA, Oyewole OB, Peel D, Gray A, McPake B, Neal E, Qazi S, Izadnegahdar R, Falade AG, Duke T. Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial. Trials 2017; 18:502. [PMID: 29078810 PMCID: PMC5659007 DOI: 10.1186/s13063-017-2241-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 10/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity. METHODS/DESIGN This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018. DISCUSSION Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.
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Affiliation(s)
- Hamish R Graham
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia. .,Department of Paediatrics, University College Hospital, Ibadan, Nigeria.
| | - Adejumoke I Ayede
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Ayobami A Bakare
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Oladapo B Oyewole
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | | | - Amy Gray
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eleanor Neal
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Shamim Qazi
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | | | - Adegoke G Falade
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria.,Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Level 2 East, 50 Flemington Road, Parkville, VIC, 3052, Australia
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Murphy J, Goldsmith CH, Jones W, Oanh PT, Nguyen VC. The effectiveness of a Supported Self-management task-shifting intervention for adult depression in Vietnam communities: study protocol for a randomized controlled trial. Trials 2017; 18:209. [PMID: 28476148 PMCID: PMC5418759 DOI: 10.1186/s13063-017-1924-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 11/13/2022] Open
Abstract
Background Depressive disorders are one of the leading causes of disease and disability worldwide. In Vietnam, although epidemiological evidence suggests that depression rates are on par with global averages, services for depression are very limited. In a feasibility study that was implemented from 2013 to 2015, we found that a Supported Self-management (SSM) intervention showed promising results for adults with depression in the community in Vietnam. This paper describes the Mental Health in Adults and Children: Frugal Innovations (MAC-FI) trial protocol that will assess the effectiveness of the SSM intervention, delivered by primary care and social workers, to community-based populations of adults with depression in eight Vietnamese provinces. Methods/design The MAC-FI program will be assessed using a stepped-wedge, randomized controlled trial. Study participants are adults aged 18 years and over in eight provinces of Vietnam. Study participants will be screened at primary care centres and in the community by health and social workers using the Self-reporting Questionnaire-20 (SRQ-20). Patients scoring >7, indicating depression caseness, will be invited to participate in the study in either the SSM intervention group or the enhanced treatment as usual control group. Recruited participants will be further assessed using the World Health Organization’s Disability Assessment Scale (WHODAS 2.0) and the Cut-down, Annoyed, Guilty, Eye-opener (CAGE) Questionnaire for alcohol misuse. Intervention-group participants will receive the SSM intervention, delivered with the support of a social worker or social collaborator, for a period of 2 months. Control- group participants will receive treatment as usual and a leaflet with information about depression. SRQ-20, WHODAS 2.0 and CAGE scores will be taken by blinded outcome assessors at baseline, after 1 month and after 2 months. The primary analysis method will be intention-to-treat. Discussion This study has the potential to add to the knowledge base about the effectiveness of a SSM intervention for adult depression that has been validated for the Vietnamese context. This trial will also contribute to the growing body of evidence about the effectiveness of low-cost, task-shifting interventions for use in low-resource settings, where specialist mental health services are often limited. Trial registration Retrospectively registered at ClinicalTrials.gov, identifier: NCT03001063. Registered on 20 December 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1924-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jill Murphy
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada.
| | - Charles H Goldsmith
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Wayne Jones
- Centre for Applied Research in Mental Health and Addictions, Simon Fraser University, Suite 2400, 515 W. Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Pham Thi Oanh
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
| | - Vu Cong Nguyen
- Institute of Population, Health and Development, 18 Lane 132, Hoa Bang, Yen Hoa, Hanoi, 122667, Vietnam
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21
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Heo M, Kim N, Rinke ML, Wylie-Rosett J. Sample size determinations for stepped-wedge clinical trials from a three-level data hierarchy perspective. Stat Methods Med Res 2016; 27:480-489. [PMID: 26988927 DOI: 10.1177/0962280216632564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stepped-wedge (SW) designs have been steadily implemented in a variety of trials. A SW design typically assumes a three-level hierarchical data structure where participants are nested within times or periods which are in turn nested within clusters. Therefore, statistical models for analysis of SW trial data need to consider two correlations, the first and second level correlations. Existing power functions and sample size determination formulas had been derived based on statistical models for two-level data structures. Consequently, the second-level correlation has not been incorporated in conventional power analyses. In this paper, we derived a closed-form explicit power function based on a statistical model for three-level continuous outcome data. The power function is based on a pooled overall estimate of stratified cluster-specific estimates of an intervention effect. The sampling distribution of the pooled estimate is derived by applying a fixed-effect meta-analytic approach. Simulation studies verified that the derived power function is unbiased and can be applicable to varying number of participants per period per cluster. In addition, when data structures are assumed to have two levels, we compare three types of power functions by conducting additional simulation studies under a two-level statistical model. In this case, the power function based on a sampling distribution of a marginal, as opposed to pooled, estimate of the intervention effect performed the best. Extensions of power functions to binary outcomes are also suggested.
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Affiliation(s)
- Moonseong Heo
- 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Namhee Kim
- 2 Department of Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael L Rinke
- 3 Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Judith Wylie-Rosett
- 1 Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.,4 Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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