Journal articles on the topic 'Self-Efficacy Scale for Clinical Nurse Leaders'
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Nanyonga, Rose Clarke, Edna N. Bosire, David J. Heller, Elizabeth Bradley, and Nancy R. Reynolds. "Predictors of nursing leadership in Uganda: a cross-sectional study." Health Policy and Planning 35, Supplement_1 (November 1, 2020): i51—i64. http://dx.doi.org/10.1093/heapol/czaa100.
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Abstract Evidence regarding the role of nurses-in-leadership and how to engage nurses in policy decisions is minimal in sub-Saharan Africa. The purpose of this study was: (1) to assess the leadership practices of nurses-in-leadership in Uganda (by self-report) and from the perspective of ‘followers’ (direct-report, peers, co-workers, other); and (2) to determine factors (positively) associated with leadership practices. We surveyed 480 nurses, 120 in leadership roles (Response Rate 57%) and 360 ‘followers’ (Response Rate 60%), who were recruited from five hospitals in Kampala, Uganda. We used the Leadership Practice Inventory (Self and Observer), a project-specific demographic questionnaire and Denison’s Organizational Culture Survey (DOCS). Sixty-three per cent of the respondents held a registered nursing certificate; 79% had received formal leadership training; 47% were based in private for-profit (PFP) hospitals, 28% in private not-for-profit (PNFP) and 25% in public hospitals. Among the five leadership practices, nurses-in-leadership used the practice of Model the Way (M = 8.27, SD = 1.30), Challenge the Process (M = 8.12, SD = 1.30) and Encourage the Heart (M = 8.04, SD = 1.51) more frequently (on a 10-point Likert Scale). Inspire a Shared Vision (M = 7.82, SD = 1.57) and Enable Others to Act (M = 7.62, SD = 1.66) practices were used less frequently. The same rank order was true for leadership scores from the perception of followers. However, leadership scores by followers were significantly lower (P < 0.01) than the nurse leader self-reported scores across all sub-scales. Leadership practice scores were higher in public than private hospitals (P < 0.0001). Organizational culture (OC) was associated (P < 0.001) with leadership practices. Although overall leadership practice scores were generally high, the less frequent use of Inspire and Enable practices suggests opportunities for targeted improvement. Moreover, differences between self-reported and leadership scores by followers suggest perception gaps between leaders and their followers. The positive relationship between public hospital settings and self-reported leadership practices among nurses-in-leadership suggests that important nursing leadership practices are possible even in a low-resource clinical setting.
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Kennedy, L., S. Bejarano, E. P. Larochelle, and G. J. Tsongalis. "An Organized Approach to Multi-Organ Screening in Rural Honduras." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 48s. http://dx.doi.org/10.1200/jgo.18.31100.
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Background: Poverty, poor healthcare infrastructure and geographic location contribute to a total lack of cancer screening for most residents of rural Honduras. Three projects built upon each other to develop, with local leaders, multiorgan screening events that mitigated barriers to screening-based early detection of cancers. Targeted barriers included transportation, cost, community perception and convenience. Aim: To test a novel system of multiorgan screening for feasibility, acceptability and effectiveness. Methods: Leveraging well-known brigade-style medical outreach methods, two large-scale weekend programs for women and one for men over four years in the same rural location screened women for cancers of the cervix, breast, oral cavity, thyroid; and men for cancers of the testes, oral cavity, skin, prostate and colon; and connected participants with follow-up care at a Honduran cancer center. Screening methods ranged from simple throat palpation for thyroid lesions to molecular screening for high risk HPV. Generally, screening began with low-tech methods onsite to triage the participants and identify those at high-risk for cancer who should have more technical follow-up at an equipped clinic. Well-trained Honduran medical students provided screening capacity and community leaders were solely responsible for promoting the screening opportunities. Masking was not possible onsite, but data analysis in the U.S. was anonymized. Results: Participants were accrued to each program's capacity (n=400) in 2013 and 2016 and near capacity in 2017 with high levels of participants completing the screening programs, community engagement with the process, and compliance with referrals for clinical follow-up at a collaborating cancer center located three hours away. Participants identified at the screenings for clinical follow-up included for women: breast 2.7% (2013) and 4.2% (2016), thyroid 1.7% (2016), cervix/positive for high risk HPV 8.2% (2013) and 11.8% (2016); and for men all in 2017: skin 0%, testes 7%, colorectal 1%, oropharynx 1 participant, and prostate 6.7%. The dominant local narrative predicted men would not participate in screening, yet 326 participated and of that group, 239 self-identified as having possible colorectal symptoms based on seeing an advertising flyer with questions about symptoms of constipation, bloody stools, or unintended weight loss. That self-identified subset took the initiative to see the local nurse in advance, obtain a colorectal sample kit, collect three days of stool samples, and bring them to the screening event. Conclusion: With community engagement and attention to planning for organized and rapid throughput, large-scale multiorgan cancer screening may be feasible in low-income rural communities. Funding: The Jornada studies were funded by Norris Cotton Cancer Center at Dartmouth's Geisel School of Medicine and a special grant from Geisel's Munck-Pfefferkorn Fund.
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Bulgin, Dominique, Paula Tanabe, Asnani Monika, and Christian Douglas. "Health Related Stigma and Quality of Life in Adults with Sickle Cell Disease in Jamaica." Blood 132, Supplement 1 (November 29, 2018): 2285. http://dx.doi.org/10.1182/blood-2018-99-113263.
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Abstract Introduction Sickle cell disease (SCD) is the most common inherited blood disorder in Jamaica. SCD is associated with significantly shortened lifespans globally. SCD has serious health complications and individuals with SCD often experience poor quality of life (QoL) and high levels of perceived stigma as a result. Stigma acts as a barrier to self-management, and affects morbidity, mortality, and QoL in individuals with SCD. Sources and perceptions of stigma depend largely on culture, society, and environment. The purpose of this study is to describe health-related QoL, perceived stigma, and measure the relationships between these concepts in adults with SCD in Jamaica. Methods Inclusion criteria were >18 years of age and self-reported diagnosis of a SCD genotype. Participants were recruited from the Sickle Cell Unit at The University of the West Indies in Kingston, Jamaica. Participants (n=50) completed interviewer-administered surveys including demographic/clinical characteristics; SCD Health Related Stigma Scale (SCD-HRSS) subscales: family, general public, doctors, nurses (scores range 10-60, total 40-240); the Measure of Sickle Cell Stigma (MoSCS) subscales: disclosure concerns, expected discrimination, social exclusion, internalized stigma (scores range 3-18, 2-12, 3-18, 3-18 respectively; total 11-66); and the Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me) subscales: Emotional Impact, Sleep Impact, Social Functioning Impact, Stiffness Impact, Pain Impact, and Pain Episode Frequency and Severity. ASCQ-Me uses a T-score metric where 50 is the mean of the reference population and 10 is the standard deviation. The value of 50 indicates the health score of the average field test respondent during testing of the ASCQ-Me in the United States. Higher scores indicate healthier status for all subscales except pain episode frequency and severity. Scores were determined by using the online scoring system at Healthmeasures.net as recommended. The MoSCS and SCD-HRSS are both scored by obtaining summing the mean score of the subscales; higher scores indicate higher perceived stigma. Descriptive statistics were used to report scores per subscale. To identify a relationships between QoL and stigma a set of Spearman point-biserial correlation analyses were performed. Results Fifty individuals (average age 34.4 +/- 11.4; 94% Black) were recruited, 22 (44%) males and 28 (56%) females. The majority of the sample reported low disease severity. Participants reported average to healthier status on the ASCQ-Me domain in comparison to the normative United States population. Low to moderate levels of stigma were reported. See Table I for ASCQ-Me, SCD-HRSS, and MoSCS results. There were weak but significant relationships identified between the QoL measures and the stigma scales, according to the lenient p ≤0.10 significance level that was used for this exploratory study. A positive correlation was identified between pain frequency and stigma (SCD-HRSS: r=0.303, p: 0.043; MoSCS: r=0.379 p: 0.008), indicating that individuals who report experiencing more frequent pain may also report higher stigma. Negative correlations were identified between stigma and both emotional impact (SCD-HRSS: r=-0.335, p=0.025; MoSCS: -0.331, p=0.021) and social functioning (MoSCS: r=-0.397; p=0.005); suggesting that individuals who report less emotional impact, as a result of having SCD, and better social functioning also experience less perceived stigma. Conclusion It is important to note that while participants in this Jamaican sample of adults with SCD reported average to healthier status on the QoL measures than the normative population of individuals with SCD, this does not signify better QoL than the general population. A previous study found that in comparison to the general population, individuals with SCD reported QoL levels most similar to those undergoing hemodialysis. Our sample reported low levels of stigma, which is also consistent with also having lower disease severity. Correlational analysis revealed relationships that indicate that greater disease severity (pain frequency) could result in higher stigma levels, while experiencing less psychosocial (social functioning and emotional) impacts could result in lower stigma levels. Disclosures Bulgin: NIH NINR: Research Funding; Jonas Nurse Leaders Scholar Program: Other: Education Funding ; Duke Global Health Institute Field Work Grant: Research Funding. Tanabe:Alliant Health: Consultancy; NIH and AHRQ: Research Funding; Duke University: Employment.
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Javidan, A., A. Nathens, H. Tien, and L. da Luz. "P079: Clinical handover from emergency medical services to the trauma team: A gap analysis." CJEM 22, S1 (May 2020): S92—S93. http://dx.doi.org/10.1017/cem.2020.285.
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Background: Clinical handover between emergency medical services (EMS) and the hospital trauma team can be subject to errors that may negatively affect patient care. Thus far, there has been limited evaluation of the quality of EMS handover. As such, we sought to characterize handover practices from EMS to the trauma team, identify areas for improvement, and determine if there is a need for standardization of current handover practices. Aim Statement: Identify areas for improvement in handover from EMS to the trauma team, specifically examining handover content, structure, and discordances between different team members regarding handover expectations. Measures & Design: Data were prospectively collected over a nine week period by a trained observer at Canada's largest level one trauma centre. A randomized scheduled was used to capture a representative breadth of handovers. Data collected included outcome measures such as duration of handover, structure of the handover, and information shared, process measures such as questions and interruptions from the trauma team, and perceptions of the handover from nurses, trauma team leaders (TTLs) and EMS according to a bidirectional Likert scale. Evaluation/Results: Of 410 trauma team activations, 79 verbal handovers were observed. Information was often missing regarding airway (present 22%), breathing (54%), medications (59%), and allergies (54%). Handover structure lacked consistency beyond the order of identification and mechanism of injury. Only 28% of handovers had a dedicated question and answer period. Of all questions asked, 35% were questioning previously given information. EMS returned to categories of information unprompted in 84% of handovers. The majority of handovers (61%) involved parallel conversations between team members while EMS was speaking, which was associated with a greater number of interrupting questions from the trauma team (3.15 vs. 1.82, p =.001). There was a statistically significant disparity between the self-evaluation of EMS handovers and the perceived quality determined by nurses and trauma team leaders. Discussion/Impact: At our trauma centre, we have identified the need for handover standardization due to poor information content, a lack of structure and active listening, significant information repetition, and discordant expectations between EMS, nurses, and TTLs. We intend to use our results to guide the development of a co-constructed framework integrating the perspectives of all team members on the trauma team.
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Cho, Youngmi, Jung-Min Joo, Seyoon Kim, and Sohyune Sok. "Effects of Meridian Acupressure on Stress, Fatigue, Anxiety, and Self-Efficacy of Shiftwork Nurses in South Korea." International Journal of Environmental Research and Public Health 18, no. 8 (April 15, 2021): 4199. http://dx.doi.org/10.3390/ijerph18084199.
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Shiftwork nurses experience physical and psychological health problems related to shift work. This study aimed to examine the effects of Meridian acupressure on stress, fatigue, anxiety, and self-efficacy of shiftwork nurses in South Korea. A quasi-experimental pretest-posttest control group design was employed. Study participants were a total of 59 shiftwork nurses (intervention group: n = 29, control group: n = 30) in S hospital, Seoul, South Korea. The study was conducted at nurse stations in S hospital. Meridian acupressure as intervention was conducted for a total of 15 min on six Meridian acupressure points (GV 20, GB 12, GB 21, LI 11, SI 3, KI 1), 2 min 30 s (10 times for 15 s at a time) on each Meridian point. Measures were the stress scale, fatigue scale, State Anxiety Inventory, and self-efficacy scale, in Korean. Data were collected from July to August 2018. There were significant differences in the degrees of stress, fatigue, and anxiety of shiftwork nurses between the two groups. Meridian acupressure significantly decreased stress, fatigue, and anxiety of shiftwork nurses. This study provides preliminary evidence that Meridian acupressure was an effective intervention. Meridian acupressure could be applied to shiftwork nurses in various clinical situations.
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Banerjee, Smita C., Jessica M. Staley, Koshy Alexander, Patricia A. Parker, Kelly S. Havil, Aimee Moreno, and Chasity B. Walters. "Sexual and Gender Minority Communication Skills (SGM Comskil) Training for Oncology Clinicians: Development, Implementation, and Preliminary Efficacy." Annals of LGBTQ Public and Population Health 2, no. 1 (March 1, 2021): 35–52. http://dx.doi.org/10.1891/lgbtq-2020-0016.
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Enhancing communicative competence of healthcare providers (HCPs) is a critical initiative for improving the healthcare experience of sexual and gender minority (SGM) cancer patients. This study presents the development, implementation, and preliminary efficacy of a new training curriculum for improving oncology HCPs’ skills in providing a safe and welcoming environment for SGM cancer patients (SGM Comskil training). Thirty-three (N = 33) oncology HCPs including nurses, nurse leaders, and nurse practitioners participated in a 4.25-hour SGM Comskil Training between July and August 2019. Overall, participants reported highly favorable evaluations of the training, with more than 80% of the participants reacting positively to 12 of the 15 evaluation items assessing engagement and reflectiveness for experiential role-plays with lesbian, gay, bisexual (LGB) and transgender standardized patients (SPs), respectively. Participants also demonstrated significant improvements in SGM healthcare knowledge, self-efficacy, beliefs toward LGB and transgender persons, and SGM-sensitive language use skills following the training. Encouraged by the feasibility of conducting this experiential training with busy cancer care HCPs and the initial favorable participant evaluation of the SGM Comskil training, results clearly indicate that this training can be rolled out into clinical settings to ensure its translational potential. The next steps should assess observable changes in communication skills and SGM-sensitive language skills with SGM patients and improvements in SGM patients’ healthcare experience.
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Aladah, Rawan A. M., Nahed M. A. Morsi, and Shadia A. Yousf. "Job Stress and Self-Efficacy Among Nurses Working in Al-Amal Psychiatric and Addiction Hospital." Evidence-Based Nursing Research 2, no. 2 (April 29, 2020): 11. http://dx.doi.org/10.47104/ebnrojs3.v2i2.122.
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Context: Nurses act as patients' first caregivers who help them manage their physical needs, control, and treat health conditions through their early nursing interventions and critical decision-making. The critical factor for nurses that help to raise their feeling of confidence is self-efficacy. Psychiatric nurses as long as they are protected, they will become more productive, creative, and supported.
Aim: This study aimed to identify the relation between job stress and self- efficacy among nurses working in psychiatric and addiction hospital.
Methods: A descriptive-correlational design was utilized. The study was conducted at Al-Amal Psychiatric and Addiction Hospital in Jeddah, Saudi Arabia. A convenience sample of 133 nurses voluntarily participated. Data were collected by using two tools; psychiatric nurse job stress scale used to assess nurses' socio-demographic data and clinical experiences, besides, to measure psychiatry nurses' job stress. General self-efficacy scale to assess self-beliefs to cope with stressful life events and capture individuals' general beliefs about their capabilities to handle different situations.
Results: The results showed that about half of the participants (47%) have high job stress, and approximately three-quarters of participants (74.44%) have high self-efficacy. Middle-aged nurses had less job stress than young nurses. It was found that non-Saudi were experience job stress less than Saudi.
Conclusion: The analysis of the collected data revealed that there is a statistically significant negative relationship between overall job stress and self-efficacy. Nurses need to be trained in coping strategies to deal with job stress. Workshops regarding stress management, communication skills are a must for those nurses working in a psychiatric hospital. Develop training programs on self-efficacy to help nurses heighten their stress management capability and also increase their job achievements.
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Bennett, Michael I., Matthew R. Mulvey, Natasha Campling, Sue Latter, Alison Richardson, Hilary Bekker, Alison Blenkinsopp, et al. "Self-management toolkit and delivery strategy for end-of-life pain: the mixed-methods feasibility study." Health Technology Assessment 21, no. 76 (December 2017): 1–292. http://dx.doi.org/10.3310/hta21760.
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BackgroundPain affects most people approaching the end of life and can be severe for some. Opioid analgesia is effective, but evidence is needed about how best to support patients in managing these medicines.ObjectivesTo develop a self-management support toolkit (SMST) and delivery strategy and to test the feasibility of evaluating this intervention in a future definitive trial.DesignPhase I – evidence synthesis and qualitative interviews with patients and carers. Phase II – qualitative semistructured focus groups and interviews with patients, carers and specialist palliative care health professionals. Phase III – multicentre mixed-methods single-arm pre–post observational feasibility study.ParticipantsPhase I – six patients and carers. Phase II – 15 patients, four carers and 19 professionals. Phase III – 19 patients recruited to intervention that experienced pain, living at home and were treated with strong opioid analgesia. Process evaluation interviews with 13 patients, seven carers and 11 study nurses.InterventionSelf-Management of Analgesia and Related Treatments at the end of life (SMART) intervention comprising a SMST and a four-step educational delivery approach by clinical nurse specialists in palliative care over 6 weeks.Main outcome measuresRecruitment rate, treatment fidelity, treatment acceptability, patient-reported outcomes (such as scores on the Brief Pain Inventory, Self-Efficacy for Managing Chronic Disease Scale, Edmonton Symptom Assessment Scale, EuroQol-5 Dimensions, Satisfaction with Information about Medicines Scale, and feasibility of collecting data on health-care resource use for economic evaluation).ResultsPhase I – key themes on supported self-management were identified from evidence synthesis and qualitative interviews. Phase II – the SMST was developed and refined. The delivery approach was nested within a nurse–patient consultation. Phase III – intervention was delivered to 17 (89%) patients, follow-up data at 6 weeks were available on 15 patients. Overall, the intervention was viewed as acceptable and valued. Descriptive analysis of patient-reported outcomes suggested that interference from pain and self-efficacy were likely to be candidates for primary outcomes in a future trial. No adverse events related to the intervention were reported. The health economic analysis suggested that SMART could be cost-effective. We identified key limitations and considerations for a future trial: improve recruitment through widening eligibility criteria, refine the SMST resources content, enhance fidelity of intervention delivery, secure research nurse support at recruiting sites, refine trial procedures (including withdrawal process and data collection frequency), and consider a cluster randomised design with nurse as cluster unit.Limitations(1) The recruitment rate was lower than anticipated. (2) The content of the intervention was focused on strong opioids only. (3) The fidelity of intervention delivery was limited by the need for ongoing training and support. (4) Recruitment sites where clinical research nurse support was not secured had lower recruitment rates. (5) The process for recording withdrawal was not sufficiently detailed. (6) The number of follow-up visits was considered burdensome for some participants. (7) The feasibility trial did not have a control arm or assess randomisation processes.ConclusionsA future randomised controlled trial is feasible and acceptable.Study and trial registrationThis study is registered as PROSPERO CRD42014013572; Current Controlled Trials ISRCTN35327119; and National Institute for Health Research (NIHR) Portfolio registration 162114.FundingThe NIHR Health Technology Assessment programme.
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Gülnar, Emel, and Nurcan Çalişkan. "The Development and Effectiveness of a Care Protocol Using the Stevens Star Model of Knowledge Transformation in Female Patients With Stress Incontinence: An Experimental Study." Wound Management & Prevention 67, no. 3 (March 10, 2021): 36–47. http://dx.doi.org/10.25270/wmp.2021.3.3647.
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BACKGROUND: Nurse-led pelvic floor muscle exercise and lifestyle education programs are effective first-line interventions for women with stress incontinence (SI). PURPOSE: To develop an evidence-based stress incontinence care protocol (SICP) using the Stevens Star Model of Knowledge Transformation and evaluate its effect on the frequency and quantity of urinary incontinence, quality of life, pelvic muscle self-efficacy levels, and lifestyle variables of women with SI. METHODS: An SICP was developed on the basis of the Star model. The views of an expert were consulted for testing the content validity of the protocol. Using a pretest-posttest experimental design, 68 women with SI who visited an outpatient clinical at a hospital in Turkey were prospectively enrolled in the intervention (n = 34) and control (n = 34) groups. After obtaining baseline demographic and health history information, participants completed the King’s Health Questionnaire, the Broome Pelvic Muscle Exercise Self-Efficacy Scale, a 3-day voiding diary, and a 1-hour pad test. The intervention group received an 8-week program of care according to the Star model-derived SICP, and follow-up assessments were completed by both groups after 8 and 12 weeks. RESULTS: The content validity index for the SICP was 91.9%. The intervention group had a reduced quantity and frequency of urinary leakage, reduced King’s Health Questionnaire scores, and increased Broome Pelvic Muscle Exercise Self-Efficacy Scale scores (P < .05). CONCLUSION: Care provided according to the Star model-derived SICP reduced the quantity and frequency of SI and improved the perceived pelvic muscle exercise self-efficacy and quality of life of the participants.
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Ndosi, M., D. Johnson, T. Young, B. Hardware, J. Hill, C. Hale, J. Maxwell, E. Roussou, and A. Adebajo. "Effects of needs-based patient education on self-efficacy and health outcomes in people with rheumatoid arthritis: a multicentre, single blind, randomised controlled trial." Annals of the Rheumatic Diseases 75, no. 6 (July 10, 2015): 1126–32. http://dx.doi.org/10.1136/annrheumdis-2014-207171.
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ObjectivesThe Educational Needs Assessment Tool (ENAT) is a self-completed questionnaire, which allows patients with arthritis to prioritise their educational needs. The aim of this study was to evaluate the effects of needs-based patient education on self-efficacy, health outcomes and patient knowledge in people with rheumatoid arthritis (RA).MethodsPatients with RA were enrolled into this multicentre, single-blind, parallel-group, pragmatic randomised controlled trial. Patients were randomised to either the intervention group (IG) where patients completed ENAT, responses of which were used by the clinical nurse specialist to guide patient education; or control group (CG) in which they received patient education without the use of ENAT. Patients were seen at weeks 0, 16 and 32. The primary outcome was self-efficacy (Arthritis Self Efficacy Scale (ASES)-Pain and ASES-Other symptoms). Secondary outcomes were health status (short form of Arthritis Impact Measurement Scale 2, AIMS2-SF) and patient knowledge questionnaire-RA. We investigated between-group differences using analysis of covariance, adjusting for baseline variables.ResultsA total of 132 patients were recruited (IG=70 and CG=62). Their mean (SD) age was 54 (12.3) years, 56 (13.3) years and disease duration 5.2 (4.9) years, 6.7 (8.9) years for IG and CG, respectively. There were significant between-group differences, in favour of IG at week 32 in the primary outcomes, ASES-Pain, mean difference (95% CI) −4.36 (1.17 to 7.55), t=−2.72, p=0.008 and ASES-Other symptoms, mean difference (95% CI) −5.84 (2.07 to 9.62), t=−3.07, p=0.003. In secondary outcomes, the between-group differences favoured IG in AIMS2-SF Symptoms and AIMS2-SF Affect. There were no between-group differences in other secondary outcomes.ConclusionsThe results suggest that needs-based education helps improve patients’ self-efficacy and some aspects of health status.Trial registration numberISRCTN51523281.
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Bell, D. Stewart, W. Mark Shipman, Mario A. Cleves, and Jill Siegelman. "Which Drug For Which Patient? Is There a Fluoxetine Responding Versus a Bupropion Responding Personality Profile?" Clinical Practice & Epidemiology in Mental Health 9, no. 1 (July 12, 2013): 142–47. http://dx.doi.org/10.2174/1745017901309010142.
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This paper proposes that a certain premorbid personality type – that of hard driving, achievement-oriented, often exercise-oriented individuals – correlates with bupropion response; conversely, patients without these premorbid traits and whose depression is marked by mood swings, irritability and rumination are likely fluoxetine responders. The authors developed the Fluoxetine Bupropion Assessment Scale (FBAS), a 10-question, self-administered rating scale, to assess these traits and hypothesized that its use would improve outcomes. A Marriage and Family Therapist (MFT) and a Registered Nurse/Nurse Practitioner (RN/NP) retrospectively reviewed 72 charts from one psychiatrist’s office for two time periods: before and after the psychiatrist utilized the questionnaire to guide antidepressant selection (33 charts before and 39 charts after). Raters were blinded to the theory and to the treatment time period. On the basis of clinical information in the charts, they formulated Clinical Global Impression assessments of treatment response in patients with Beck Depression Inventory scores ≥17 who were not on either drug at the time of intake, and who were prescribed either fluoxetine or bupropion. The data were in the direction of better results in the FBAS-guided group, particularly after adjusting for age, gender and marital status (efficacy p = 0.087). When global improvement data were combined into three groups describing treatment response (improved, minimal to no improvement, and worse) there were statistically significant better results (p = 0.047) in the FBAS-guided treatment group. Revision and validation of the questionnaire and a larger, randomized study seem indicated.
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Walling, Anne Margaret, Christopher Pietras, Kauser Ahmed, Anne Coscarelli, Sara A. Hurvitz, Wendy Simon, Peter Phung, et al. "Engaging oncologists toward integrating a shared mental model for palliative oncology within a large academic oncology practice." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 105. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.105.
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105 Background: We aimed to engage oncologists to disseminate a successful pilot-tested shared mental model (SMM) for the integration of early advance care planning (ACP) and identification of palliative care (PC) needs across a health system’s oncologic practice. Methods: Our Oncology Communication Collaborative Team (OCCT) had oncology leadership support and included a multidisciplinary team representing leaders in oncology, ACP, PC, psycho-social oncology and quality. To communicate the SMM developed by our team, the OCCT developed an interactive Saturday session (1-hr didactic, 3-hr small group role-play) that focused on early ACP and the cognitive and emotional aspects of communication. Before and after the training, we asked participants to rate their ability to communicate with patients as well as their readiness, self-efficacy, and need for help to improve communication regarding prognosis, ACP, end of life care and symptom management using a previously validated survey. We computed means and compared matched pairs of pre and post surveys using a paired t-test. We also surveyed participants about whether they would recommend the course to others and planned changes to practice. Results: All but one oncologist (52/53), 3/4 invited fellows, and 12/14 oncology nurse practitioners participated and 90% of attendees completed pre and post surveys. Participants rated their communication ability higher (6.7 v. 7.6, p < 0.01) on a 10-point scale after the training. Readiness to improve communication in this domain (9.1 v. 9.2, p = 0.35) was similar before and after the training. Self-efficacy (1.5 v. 1.5, p = 0.70) and needing help to improve (1.6 v. 1.7, p = 0.37) were rated highly (1 = A lot and 4 = Not at all) but did not change with training. All but one participant reported they would recommend the course to others and free text responses about changes they planned to make to their practice based on the training included: having earlier ACP discussions, focusing on patient goals/priorities and asking open-ended questions. Conclusions: Conducting a training to disseminate a SMM of oncology and PC is feasible, valuable, and can be the first step for partnered continuous quality improvement.
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Bott, Nicholas, Sharon Wexler, Lin Drury, Chava Pollak, Victor Wang, Kathleen Scher, and Sharon Narducci. "A Protocol-Driven, Bedside Digital Conversational Agent to Support Nurse Teams and Mitigate Risks of Hospitalization in Older Adults: Case Control Pre-Post Study." Journal of Medical Internet Research 21, no. 10 (October 17, 2019): e13440. http://dx.doi.org/10.2196/13440.
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Background Hospitalized older adults often experience isolation and disorientation while receiving care, placing them at risk for many inpatient complications, including loneliness, depression, delirium, and falls. Embodied conversational agents (ECAs) are technological entities that can interact with people through spoken conversation. Some ECAs are also relational agents, which build and maintain socioemotional relationships with people across multiple interactions. This study utilized a novel form of relational ECA, provided by Care Coach (care.coach, inc): an animated animal avatar on a tablet device, monitored and controlled by live health advocates. The ECA implemented algorithm-based clinical protocols for hospitalized older adults, such as reorienting patients to mitigate delirium risk, eliciting toileting needs to prevent falls, and engaging patients in social interaction to facilitate social engagement. Previous pilot studies of the Care Coach avatar have demonstrated the ECA’s usability and efficacy in home-dwelling older adults. Further study among hospitalized older adults in a larger experimental trial is needed to demonstrate its effectiveness. Objective The aim of the study was to examine the effect of a human-in-the-loop, protocol-driven relational ECA on loneliness, depression, delirium, and falls among diverse hospitalized older adults. Methods This was a clinical trial of 95 adults over the age of 65 years, hospitalized at an inner-city community hospital. Intervention participants received an avatar for the duration of their hospital stay; participants on a control unit received a daily 15-min visit from a nursing student. Measures of loneliness (3-item University of California, Los Angeles Loneliness Scale), depression (15-item Geriatric Depression Scale), and delirium (confusion assessment method) were administered upon study enrollment and before discharge. Results Participants who received the avatar during hospitalization had lower frequency of delirium at discharge (P<.001), reported fewer symptoms of loneliness (P=.01), and experienced fewer falls than control participants. There were no significant differences in self-reported depressive symptoms. Conclusions The study findings validate the use of human-in-the-loop, relational ECAs among diverse hospitalized older adults.
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Hinman, Rana S., Penny K. Campbell, Belinda J. Lawford, Andrew M. Briggs, Janette Gale, Caroline Bills, Jessica Kasza, et al. "Does telephone-delivered exercise advice and support by physiotherapists improve pain and/or function in people with knee osteoarthritis? Telecare randomised controlled trial." British Journal of Sports Medicine 54, no. 13 (November 20, 2019): 790–97. http://dx.doi.org/10.1136/bjsports-2019-101183.
Abstract:
ObjectiveEvaluate a physiotherapist-led telephone-delivered exercise advice and support intervention for people with knee osteoarthritis.MethodsParticipant-blinded, assessor-blinded randomised controlled trial. 175 people were randomly allocated to (1) existing telephone service (≥1 nurse consultation for self-management advice) or (2) exercise advice and support (5–10 consultations with a physiotherapist trained in behaviour change for a personalised strengthening and physical activity programme) plus the existing service. Primary outcomes were overall knee pain (Numerical Rating Scale, range 0–10) and physical function (Western Ontario and McMaster Universities Osteoarthritis Index, range 0–68) at 6 months. Secondary outcomes, cost-effectiveness and 12-month follow-up were included.Results165 (94%) and 158 (90%) participants were retained at 6 and 12 months, respectively. At 6 months, exercise advice and support resulted in greater improvement in function (mean difference 4.7 (95% CI 1.0 to 8.4)), but not overall pain (0.7, 0.0 to 1.4). Eight of 14 secondary outcomes favoured exercise advice and support at 6 months, including pain on daily activities, walking pain, pain self-efficacy, global improvements across multiple domains (overall improvement, improved pain, improved function and improved physical activity) and satisfaction. By 12 months, most outcomes were similar between groups. Exercise advice and support cost $A514/participant and did not save other health service resources.ConclusionTelephone-delivered physiotherapist-led exercise advice and support modestly improved physical function but not the co-primary outcome of knee pain at 6 months. Functional benefits were not sustained at 12 months. The clinical significance of this effect is uncertain.Trial registration numberAustralian New Zealand Clinical Trials Registry (#12616000054415).
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MacDonald, James John, Jennifer S. Temel, Elene Viscosi, Jeanne Griffin Vaughn, Lara Traeger, Theresa Margaret McDonnell, William F. Pirl, and Joseph A. Greer. "Improving management of breathlessness in lung cancer." Journal of Clinical Oncology 32, no. 31_suppl (November 1, 2014): 220. http://dx.doi.org/10.1200/jco.2014.32.31_suppl.220.
Abstract:
220 Background: Dyspnea is a common and debilitating symptom of advanced lung cancer that interferes with quality of life (QOL). Though few evidence-based treatments for dyspnea exist, there is support for non-pharmacological interventions that include elements of cognitive-behavioral therapy (CBT). The purpose of this study was to pilot a brief nurse-delivered CBT intervention for dyspnea in patients with lung cancer, assessing feasibility and effect. Methods: For this single-group, nonrandomized pilot trial, 20 patients receiving outpatient chemotherapy for advanced lung cancer (ECOG Performance Status 0-2) and reporting dyspnea participated in a two-session CBT intervention. We enrolled a convenience sample of patients referred by their medical oncologists based on self-reported dyspnea. Two nurse practitioners taught the participants breathing and relaxation techniques within the infusion clinic and encouraged home practice. Patients completed measures of dyspnea (Modified Medical Research Council Dyspnea Scale [MMRCDS]), QOL (Functional Assessment of Cancer Therapy-Lung [FACT-L] and Trial Outcome Index [TOI]), and depression symptoms (Hospital Anxiety and Depression Scale depression subscale [HADS-D]) at baseline and within 6 weeks after enrollment. We used dependent-samples t-tests to analyze treatment effect on dyspnea and QOL and sign test to analyze depressions symptoms. Results: Of the 20 patients (50% Female; Mean Age=64.80 years) enrolled in the study, 85% (17) completed post-assessment. We observed significant improvement in MMRCDS (p=.001), FACT –L (p=.029), and FACT-TOI (p=.008) scores from baseline to post-assessment. The proportion of patients reporting depression symptoms (e.g. HADS-D >7) decreased from 50% (n=10/20) to 12 % (n=2/17) (p=.016). Conclusions: In this sample of patients with advanced lung cancer and dyspnea, we observed a high completion rate for the 2-session CBT intervention. Patients also showed improvements in dyspnea, QOL, and mood. Follow-up randomized controlled trials are needed to examine the efficacy of brief CBT interventions for dyspnea. Clinical trial information: NCT01937637.
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Dualé, Christian. "The Dose-Dependent Effects of Ketoprofen on Dynamic Pain after Open Heart Surgery." september 2017 6, no. 20;6 (September 11, 2017): 509–20. http://dx.doi.org/10.36076/ppj.20.509.
Abstract:
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) can reduce postoperative pain, in both static (i.e., at rest) and dynamic contexts (e.g., during coughing or mobilization), and reduced doses could improve their efficacy/tolerance balance. Objectives: To test this hypothesis of efficacy after open heart surgery, in which NSAIDs are poorly used, particularly for safety concerns. Study Design: Randomized, double-blind trial. Setting: Single-center, French university hospital. Methods: Patients. One hundred patients at low risk of postoperative complications undergoing scheduled open heart surgery (97 analyzed). Intervention. We tested intravenous ketoprofen, at a dose of 0.5 mg/kg-1 every 6 hours during the 48 hours following the end of sedation, after surgery. This standard protocol was compared to a similar one in which half doses were administered, to one with quarter doses, as well as to a placebo group. Analgesia was supplemented by acetaminophen plus self- and nurse-administered intravenous morphine. Measurement. The primary outcome was the intensity of dynamic pain, assessed over 48 hours on an 11-point numerical rating scale (NRS). Results: Only the full-dose ketoprofen group showed reduced dynamic and static postoperative pain vs. placebo (P < 0.00001 for both). The evolution of dynamic pain suggested a delayed and therefore non-significant effect with the low doses. Ketoprofen did not affect either the postoperative morphine consumption or the tolerance outcomes, such as the volumes of chest tube drainage and the renal function. Limitations: This pilot trial was undersized to test major tolerance outcomes. Conclusions: Although we failed to demonstrate any analgesic effects with low doses of ketoprofen, we confirmed the good efficacy/tolerance balance with this propionic NSAID of intermediate COX2 -selectivity. Lower doses of NSAIDs, potentiated by a loading dose, should be tested in the future. IRB approval: CPP Sud-Est VI (Clermont-Ferrand, France), on 12/23/2013. Clinical trial registry: EudraCT (2013-003878-27); ClinicalTrials.gov (NCT02180087)
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Asgary, Ramin, and Karen Jacobson. "Comprehensive On-site Medical and Public Health Training for Local Medical Practitioners in a Refugee Setting." Disaster Medicine and Public Health Preparedness 7, no. 1 (February 2013): 82–88. http://dx.doi.org/10.1017/dmp.2013.2.
Abstract:
AbstractObjectivesIn refugee settings, local medical personnel manage a broad range of health problems but commonly lack proper skills and training, which contributes to inefficient use of resources. To fill that gap, we designed, implemented, and evaluated a curriculum for a comprehensive on-site training for medical providers.MethodsThe comprehensive teaching curriculum provided ongoing on-site training for medical providers (4 physicians, 7 medical officers, 15 nurses and nurse aids, and 30 community health workers) in a sub-Saharan refugee camp. The curriculum included didactic sessions, inpatient and outpatient practice-based teaching, and case-based discussions, which included clinical topics, refugee public health, and organizational skills. The usefulness and efficacy of the training were evaluated through pretraining and posttraining tests, anonymous self-assessment surveys, focus group discussions, and direct clinical observation.ResultsPhysicians had a 50% (95% CI 17%-82%; range, 25%-75%) improvement in knowledge and skills. They rated the quality and usefulness of lectures 4.75 and practice-based teaching 5.0 on a 5-point scale (1=poor to 5=excellent). Evaluation of medical officers’ knowledge revealed improvements in (1) overall test scores (52% [SD 8%] to 80% [SD 5%]; P < .0001); (2) pediatric infectious diseases (44% [SD 9%] to 79% [SD 7%]; P < .001); and (3) noninfectious diseases (57% [SD 16%] to 81% [SD 10%] P < .01). Main barriers to effective learning were lack of training prioritization, time constraints, and limited ancillary support.ConclusionsA long-term, ongoing training curriculum for medical providers initiated by aid agencies but integrated into horizontal peer-to-peer education is feasible and effective in refugee settings. Such programs need prioritizing, practice and system-based personnel training, and a comprehensive curriculum to improve clinical decision making.(Disaster Med Public Health Preparedness. 2013;7:82-88)
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Lin, Rongbo, Jinfeng Zhu, Shuitu Feng, Sunzhi Lin, Jianqian Fu, Yongzhi Yao, Lixia Hong, et al. "Patient controlled analgesia (PCA) versus non-PCA intravenous hydromorphone titration for severe cancer pain: A randomized, controlled, multicenter, phase III trial, HMORCT09-1." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): TPS11635. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.tps11635.
Abstract:
TPS11635 Background: The opioid dose for an individual with cancer pain to provide adequate relief of pain with an acceptable degree of side effects is variable. Opioid titration is a process to obtain the tailored dose. Conventional titration is administered by a clinician or nurse. PCA is that patients control cancer pain by self-administration of intravenous opioids using programmable pump. The aim of our study is to evaluate the efficacy of PCA titration versus conventional titration intravenously for severe cancer pain (10-point numerical rating scale, NRS ≥ 7). Injectable Hydromorphone was selected as pharmaceutical analgesics, which works as well as morphine and oxycodone and had similar side effects. Methods: This is currently enrolling patients (n=230) with severe cancer pain during previous 24 hours. Patients are randomized 1:1 and stratified by opioid intolerance or opioid tolerance into PCA or non-PCA titration. PCA titration using programmable pump: bolus hydromorphone at 0.5mg (for opioid intolerance) or hydromorphone dose equivalent to 10% to 20% of the total opioid taken in the previous 24 hours with a lockout time 15 minutes (for opioid tolerance) was administered by the patients educated. No basal infusion was set in the pump. Non-PCA titration administered by a nurse or clinician: Initial hydromorphone doses were same with PCA titration. Reassess pain at 15 minutes. Increased dose of hydromorphone by 50%-100% if pain unchanged or increased, or repeat same dose if pain decreased to NRS 4-6, or continue at current effective dose as needed over initial 24 hours. The primary endpoint is the time needed to successful titration was defined the time from the first dose of hydromorphone after randomization to achieve satisfied pain control. The satisfied pain control was defined NRS pain score ≤ 3 at rest in at least 2 consecutive assessment (15 minutes interval). The time needed to successful titration was extended to achieve satisfied pain control again if NRS pain score ≥ 7 after satisfied pain control within 24 hours. The failure of successful titration was defined that satisfied pain control does not achieve within 24 hours. Secondary endpoints include the percentage of patients titrated successfully, the mean NRS pain score of 24 hours, the total dose of hydromorphone titrated, and adverse events. Clinical trial information: NCT03375515.
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Hewlett, Sarah, Celia Almeida, Nicholas Ambler, Peter S. Blair, Ernest Choy, Emma Dures, Alison Hammond, et al. "Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations." Health Technology Assessment 23, no. 57 (October 2019): 1–130. http://dx.doi.org/10.3310/hta23570.
Abstract:
Background Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive–behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. Objectives To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive–behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors’ experiences of the RAFT programme. Design A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. Setting Seven hospital rheumatology units in England and Wales. Participants Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. Interventions RAFT – group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care – brief discussion of a RA fatigue self-management booklet with the research nurse. Main outcome measures Primary – fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary – fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. Results A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (–1.36 units; p < 0.001) and the control interventions (–0.88 units; p < 0.004). Regression analysis showed a difference between treatment arms in favour of the RAFT programme [adjusted mean difference –0.59 units, 95% confidence interval (CI) –1.11 to –0.06 units; p = 0.03, effect size 0.36], and this was sustained over 2 years (–0.49 units, 95% CI –0.83 to –0.14 units; p = 0.01). At 26 weeks, further fatigue differences favoured the RAFT programme (BRAF-MDQ fatigue impact: adjusted mean difference –3.42 units, 95% CI –6.44 to – 0.39 units, p = 0.03; living with fatigue: adjusted mean difference –1.19 units, 95% CI –2.17 to –0.21 units, p = 0.02; and emotional fatigue: adjusted mean difference –0.91 units, 95% CI –1.58 to –0.23 units, p = 0.01), and these fatigue differences were sustained over 2 years. Self-efficacy favoured the RAFT programme at 26 weeks (Rheumatoid Arthritis Self-Efficacy Scale: adjusted mean difference 3.05 units, 95% CI 0.43 to 5.6 units; p = 0.02), as did BRAF-NRS coping over 2 years (adjusted mean difference 0.42 units, 95% CI 0.08 to 0.77 units; p = 0.02). Fatigue severity and other clinical outcomes were not different between trial arms and no harms were reported. Satisfaction with the RAFT programme was high, with 89% of patients scoring ≥ 8 out of 10, compared with 54% of patients in the control arm rating the booklet (p < 0.0001); and 96% of patients and 68% of patients recommending the RAFT programme and the booklet, respectively, to others (p < 0.001). There was no significant difference between arms for total societal costs including the RAFT programme training and delivery (mean difference £434, 95% CI –£389 to £1258), nor QALYs gained (mean difference 0.008, 95% CI –0.008 to 0.023). The probability of the RAFT programme being cost-effective was 28–35% at the National Institute for Health and Care Excellence’s thresholds of £20,000–30,000 per QALY. Tutors felt that the RAFT programme’s CB approaches challenged their usual problem-solving style, helped patients make life changes and improved tutors’ wider clinical practice. Limitations Primary outcome data were missing for 25 patients; the EQ-5D-5L might not capture fatigue change; and 30% of the 2-year economic data were missing. Conclusions The RAFT programme improves RA fatigue impact beyond usual care alone; this was sustained for 2 years with high patient satisfaction, enhanced team skills and no harms. The RAFT programme is < 50% likely to be cost-effective; however, NHS costs were similar between treatment arms. Future work Given the paucity of RA fatigue interventions, rheumatology teams might investigate the pragmatic implementation of the RAFT programme, which is low cost. Trial registration Current Controlled Trials ISRCTN52709998. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 57. See the NIHR Journals Library website for further project information.
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Uhlig, T., L. F. Karoliussen, T. K. Kvien, E. A. Haavardsholm, and H. Berner Hammer. "THU0446 SUCCESSFUL TREATMENT OF GOUT IS FREQUENT IN CLINICAL PRACTICE WHEN APPLYING A TREAT-TO-TARGET STRATEGY: RESULTS FROM THE NOR-GOUT STUDY." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 460.2–460. http://dx.doi.org/10.1136/annrheumdis-2020-eular.5571.
Abstract:
Background:International EULAR and ACR recommendations support lifestyle changes, diet and urate lowering therapy (ULT) in gout. Treat-to-target ULT is often not performed, resulting in insufficient treatment of gout. We studied how many patients achieved the recommended treatment target of <360 µmol/l for serum urate (SUA) when a treat-to-target approach was applied in clinical practice, and which factors predicted reaching this target.Objectives:We studied how many patients achieved the recommended treatment target of <360 µmol/l for serum urate (SUA) when a treat-to-target approach was applied in clinical practice, and which factors predicted reaching this target.Methods:211 patients with crystal proven gout were included into the prospective, observational NOR-Gout study if they recently had a gout flare as well as insufficiently treated serum urate SUA >360 µmol/l).The intervention consisted of individual verbal information on lifestyle, including factors related to physical activity, diet and the importance of drug adherence. ULT (mainly allopurinol) was initiated and escalated monthly according to EULAR recommendations. Patients were during the first year seen by physician and nurse every three months with additional visits after month 1 and month 2, with further visits monthly as necessary until the treatment target of SUA <360 µmol/l (or <300 if tophi) was met.Baseline age was 53.6 (SD 12.2) years, disease duration 7.8 years (SD 7.6), BMI 28.8 (SD 4.5) kg/m2, 95.3% were males. Baseline SUA was 500 (77) µmol/l and 16.6% had subcutaneous tophi. Assessments included questions on frequency of alcohol use, and application of the self-efficacy scales for symptoms (SES, range 10-100) as well as the beliefs in medicines questionnaire (BMQ), which included a scale for general overuse of medicines (range 4-16).186/211 (88.2%) patients completed the visit for the primary SUA endpoint at 12 months.Results:SUA continuously declined over 12 months and the frequency of responders increased (table 1):Table 1Responders and SUA levels during the treat-to-target interventionMonthMonth 01236912%n RespondersSUA<36000/21121.3 43/20248.794/19369.3131/18986.7151/18781.9136/16685.5159/186SUA µmol/l (mean, SD)500 (78)413 (77)371 (64)341 (61)327 (59)316 (56)311 (49)At 12 months 87.6% (163/186) of patients used allopurinol and 13.4% (23/186) febuxostat with mean daily doses of 289 mg (range 100-900) and 59 (20-120) mg, respectively.Reaching the treatment target of SUA after 12 months was bivariately related to work status, alcohol use, and beliefs in general overuse of medicines. In multivariable analyses in the final model also adjusted for baseline SUA, several variables predicted reaching the SUA target of <360 µmol/l: age (per 10 years) (OR 1.5; 95% CI 1.06 – 1.96, p=0.026), alcohol use no more than monthly vs. at least weekly (OR 6.9, 95% CI 1.90 – 25.2, p=0.003), self-efficacy for symptoms (per 10 units) (OR1.31; 95% CI 1.00 – 1.63; p=0.05), and low belief that medicines are generally overused (per decreasing unit) (OR 1.30; 1.04 – 1.62, p=0.019).Conclusion:Most patients (85.5%) with recent gout flare und increased SUA reached the target SUA after 12 months. A good treatment result was predicted by increasing age,less frequent alcohol use, when patients believed they could cope with symptoms and when they did not believe that drugs are generally overused.Disclosure of Interests: :Till Uhlig Consultant of: Lilly, Pfizer, Speakers bureau: Grünenthal, Novartis, Lars Fridtjof Karoliussen: None declared, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Espen A Haavardsholm Grant/research support from: AbbVie, UCB Pharma, Pfizer Inc, MSD Norway, Roche Norway, Consultant of: Pfizer, AbbVie, Janssen-Cilag, Gilead, UCB Pharma, Celgene, Lilly, Paid instructor for: UCB Pharma, Speakers bureau: Pfizer, AbbVie, UCB Pharma, Celgene, Lilly, Roche, MSD, Hilde Berner Hammer: None declared
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Gage, Heather, Linda Grainger, Sharlene Ting, Peter Williams, Christina Chorley, Gillian Carey, Neville Borg, et al. "Specialist rehabilitation for people with Parkinson’s disease in the community: a randomised controlled trial." Health Services and Delivery Research 2, no. 51 (December 2014): 1–376. http://dx.doi.org/10.3310/hsdr02510.
Abstract:
BackgroundMultidisciplinary rehabilitation is recommended for Parkinson’s disease, but evidence suggests that benefit is not sustained.Objectives(1) Implement a specialist domiciliary rehabilitation service for people with Parkinson’s and carers. (2) Provide continuing support from trained care assistants to half receiving the rehabilitation. (3) Evaluate the clinical effectiveness of the service, and the value added by the care assistants, compared with usual care. (4) Assess the costs of the interventions. (5) Investigate the acceptability of the service. (6) Deliver guidance for commissioners.DesignPragmatic three-parallel group randomised controlled trial.SettingCommunity, county of Surrey, England, 2010–11.ParticipantsPeople with Parkinson’s, at all stages of the disease, and live-in carers.InterventionsGroups A and B received specialist rehabilitation from a multidisciplinary team (MDT) – comprising Parkinson’s nurse specialists, physiotherapists, occupational therapists, and speech and language therapists – delivered at home, tailored to individual needs, over 6 weeks (about 9 hours’ individual therapy per patient). In addition to the MDT, participants in group B received ongoing support for a further 4 months from a care assistant trained in Parkinson’s (PCA), embedded in the MDT (1 hour per week per patient). Participants in control group (C) received care as usual (no co-ordinated MDT or ongoing support).Main outcome measuresFollow-up assessments were conducted in participants’ homes at 6, 24 and 36 weeks after baseline. Primary outcomes: Self-Assessment Parkinson’s Disease Disability Scale (patients); the Modified Caregiver Strain Index (carers). Secondary outcomes included: for patients, disease-specific and generic health-related quality of life, psychological well-being, self-efficacy, mobility, falls and speech; for carers, strain, stress, health-related quality of life, psychological well-being and functioning.ResultsA total of 306 people with Parkinson’s (and 182 live-in carers) were randomised [group A,n = 102 (n = 61); group B,n = 101 (n = 60); group C,n = 103 (n = 61)], of whom 269 (155) were analysed at baseline, pilot cohort excluded. Attrition occurred at all stages. A per-protocol analysis [people with Parkinson’s,n = 227 (live-in carers,n = 125)] [group A,n = 75 (n = 45); group B,n = 69 (n = 37); group C,n = 83 (n = 43)] showed that, at the end of the MDT intervention, people with Parkinson’s in groups A and B, compared with group C, had reduced anxiety (p = 0.02); their carers had improved psychological well-being (p = 0.02). People with Parkinson’s in groups A and B also had marginally reduced disability (primary outcome,p = 0.09), and improved non-motor symptoms (p = 0.06) and health-related quality of life (p = 0.07), compared with C. There were significant differences in change scores between week 6 (end of MDT) and week 24 (end of PCA for group B) in favour of group B, owing to worsening in group A (no PCA support) in posture (p = 0.001); non-motor symptoms (p = 0.05); health-related quality of life (p = 0.07); and self-efficacy (p = 0.09). Carers in group B (vs. group A) reported a tendency for reduced strain (p = 0.06). At 36 weeks post recruitment, 3 months after the end of PCA support for group B, there were few differences between the groups. Participants reported learning about Parkinson’s, and valued individual attention. The MDT cost £833; PCA support was £600 extra, per patient (2011 Great British pounds).ConclusionsFurther research is needed into ways of sustaining benefits from rehabilitation including the use of care assistants.Study registrationCurrent Controlled Trials: ISRCTN44577970.FundingThis project was funded by the National Institute for Health Research Health Services and Delivery Research programme and the South East Coast Dementias and Neurodegenerative Disease Research Network (DeNDRoN), and the NHS South East Coast. The report will be published in full inHealth Services and Delivery Research; Vol. 2, No. 51. See the NIHR Journals Library website for further project information.
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Araújo, Fátima, Maria Nilza Nogueira, Joana Silva, and Sílvia Rego. "A Technological-Based Platform for Risk Assessment, Detection, and Prevention of Falls Among Home-Dwelling Older Adults: Protocol for a Quasi-Experimental Study." JMIR Research Protocols 10, no. 8 (August 12, 2021): e25781. http://dx.doi.org/10.2196/25781.
Abstract:
Background According to the United Nations, it is estimated that by 2050, the number of people aged 80 years and older will have increased by 3 times. Increased longevity is often accompanied by structural and functional changes that occur throughout an individual’s lifespan. These changes are often aggravated by chronic comorbidities, adopted behaviors or lifestyles, and environmental exposure, among other factors. Some of the related outcomes are loss of muscle strength, decreased balance control, and mobility impairments, which are strongly associated with the occurrence of falls in the elderly. Despite the continued undervaluation of the importance of knowledge on fall prevention among the elderly population by primary care health professionals, several evidence-based (single or multifaceted) fall prevention programs such as the Otago Exercise Program (OEP) have demonstrated a significant reduction in the risk of falls and fall-related injuries in the elderly within community settings. Recent studies have strived to integrate technology into physical exercise programs, which is effective for adherence and overcoming barriers to exercise, as well as improving physical functioning. Objective This study aims to assess the impact of the OEP on the functionality of home-dwelling elderly using a common technological platform. Particularly, the impact on muscle strength, balance, mobility, risk of falling, the perception of fear of falling, and the perception of the elderly regarding the ease of use of technology are being examined in this study. Methods A quasi-experimental study (before and after; single group) will be conducted with male and female participants aged 65 years or older living at home in the district of Porto. Participants will be recruited through the network COLABORAR, with a minimum of 30 participants meeting the study inclusion and exclusion criteria. All participants will sign informed consent forms. The data collection instrument consists of sociodemographic and clinical variables (self-reported), functional evaluation variables, and environmental risk variables. The data collection tool integrates primary and secondary outcome variables. The primary outcome is gait (timed-up and go test; normal step). The secondary outcome variables are lower limb strength and muscle resistance (30-second chair stand test), balance (4-stage balance test), frequency of falls, functional capacity (Lawton and Brody - Portuguese version), fear of falling (Falls Efficacy Scale International - Portuguese version), usability of the technology (System Usability Scale - Portuguese version), and environmental risk variables (home fall prevention checklist for older adults). Technological solutions, such as the FallSensing Home application and Kallisto wearable device, will be used, which will allow the detection and prevention of falls. The intervention is characterized by conducting the OEP through a common technological platform 3 times a week for 8 weeks. Throughout these weeks, the participants will be followed up in person or by telephone contact by the rehabilitation nurse. Considering the COVID-19 outbreak, all guidelines from the National Health Service will be followed. The project was funded by InnoStars, in collaboration with the Local EIT Health Regional Innovation Scheme Hub of the University of Porto. Results This study was approved on October 9, 2020 by the Ethics Committee of Escola Superior de Enfermagem do Porto (ESEP). The recruitment process was meant to start in October, but due to the COVID-19 pandemic, it was suspended. We expect to restart the study by the beginning of the third quarter of 2021. Conclusions The findings of this study protocol will contribute to the design and development of future robust studies for technological tests in a clinical context. Trial Registration ISRCTN 15895163; https://www.isrctn.com/ISRCTN15895163 International Registered Report Identifier (IRRID) PRR1-10.2196/25781
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Azizi, Maryam, Najmeh Javan, Seyed Mohammad Mousavi Mirzaei, and Seyyed Abolfazl Vagharseyyedin. "The Efficacy of a Peer-Led Versus Nurse-Led Self-Management on the Subjective Well-Being of Patients with Multiple Sclerosis: A Randomized Clinical Trial." Jundishapur Journal of Chronic Disease Care 9, no. 3 (August 18, 2020). http://dx.doi.org/10.5812/jjcdc.103036.
Abstract:
Background: Subjective well-being (SWB) can be a buffer against mental health problems. Patients with multiple sclerosis (MS) tend to experience low levels of subjective well-being. Objectives: The two objectives were (1) to examine whether peer-led and nurse-led self-management training can improve SWB of patients with MS and (2) to compare the effect of these two interventions on SWB of patients with MS. Methods: In this trial, 81 patients were randomly assigned to either nurse-led (n = 41) or peer-led (n = 40) groups. Both groups participated in six weekly-based 1.5‐hr self-management sessions. The cognitive and affective components of SWB were evaluated using the Satisfaction with Life Scale and the Scale for Positive and Negative Experience, respectively. Results: Life satisfaction increased in both groups over time (P < 0.001), although it was not significantly different between the two groups (P > 0.05). Positive and negative experiences increased in both groups over time (P < 0.05), but the increase in positive experience in the peer-led group was significantly larger than those in the nurse-led group (P < 0.05). Conclusions: Peer-led and nurse-led self-management training, are feasible tools to enhance the cognitive component of SWB, i.e., life satisfaction. Considering the affective component of SWB, positive experience in the peer-led group improved better than in the nurse-led group over time. Therefore, if healthcare providers improve the SWB of patients with relapsing-remitting MS, the self-management intervention led by peers is preferred than nurse-led self-management training.
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Baernholdt, Marianne, Terry L. Jones, Colleen V. Anusiewicz, Caitlin Marley Campbell, Aoyjai Montgomery, and Patricia A. Patrician. "Development and Testing of the Quality Improvement Self-efficacy Inventory." Western Journal of Nursing Research, March 20, 2021, 019394592199415. http://dx.doi.org/10.1177/0193945921994158.
Abstract:
Quality improvement is paramount for patient safety. Leading change for quality improvement requires nurses with knowledge and skills beyond the clinical management of patients. In this study, staff nurses working in hospitals throughout Alabama were asked via an online survey to rate their quality improvement knowledge and skills using the new 10-item Quality Improvement Self-Efficacy Inventory (QISEI) and their perceptions of the nursing work environment using the Practice Environment Scale of the Nursing Work Index. Nurses ( N = 886) rated the basic quality improvement items higher than the more advanced items. Several nurse characteristics and the nursing work environment were associated with nurses’ ratings of their quality improvement knowledge and skills. Educators and administrators in health care organizations can use QISEI to gauge their nurses’ knowledge and skills and then develop continuous professional development opportunities aimed at improving quality and safety competencies.
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Prosen, Mirko, Andreja Kvas, Sandra Bošković, and Sabina Ličen. "Cross-cultural adaptation and psychometric evaluation of the Slovenian version of the nurse professional competence scale." BMC Nursing 20, no. 1 (August 11, 2021). http://dx.doi.org/10.1186/s12912-021-00664-6.
Abstract:
Abstract Background The competency-based approach to the assessment of nursing practice has been adopted as a key policy in the developed world. The continual self-assessment of competence gives nurses the opportunity to reflect on their competencies and has a significant impact on the quality of nursing practice and patient safety. The study was designed to describe the process of cross-cultural adaptation and to assess the psychometric properties of the Slovenian version of a short form of the Nurse Professional Competence scale (NPC-SF) and to evaluate the efficacy of this instrument in a sample of registered nurses. Methods A cross-sectional and validation study was conducted in 425 registered nurses to test the psychometric properties of the Slovenian version of a short form of the scale and to evaluate nurses’ professional competence. A multilevel approach was used: Translation, back-translation, language validity, face and content validity, construct validity, and reliability of the Slovenian version of the scale were analysed respectively. Participants completed an online survey, with the data being collected between April and July 2020. Results Factor analysis showed that the Slovenian version of the scale could be used in four dimensions explained with 65 % of the variance. Cronbach’s α was 0.972. The four-factor model fit the data (RMSEA = 0.083, CFI = 0.731). Self-reported competence was high and rated higher by nurses employed at the tertiary level of healthcare, followed by nurses employed at the secondary and primary, and from social care institutions. Nurses with more years of experience assessed their competence higher. Conclusions The NPC-SF helps understand and identify nurses’ self-reported core competencies in clinical settings, thereby providing an important predictor of the professional development of nursing. The Slovenian version of the scale demonstrated acceptable psychometric properties and may be used in research and clinical practice to evaluate nurses’ professional competence.
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Breen, Joan C., Jeanne Andrusin, Julie DiCarlo, Julia Keenan, Paula Fortuna, Juliette Rodriguez, and Hannah Garth. "Abstract WP188: Community-Based Outpatient Stroke Rehabilitation Program Achieves Excellent Outcomes Including Return to Work, Driving, Stroke Knowledge, and Other Rehabilitation Outcomes." Stroke 51, Suppl_1 (February 2020). http://dx.doi.org/10.1161/str.51.suppl_1.wp188.
Abstract:
Background: Return to driving and employment are goals for many stroke survivors. There are few reports of patient centered outcomes including return to employment, driving, self-efficacy, functional outcomes, stroke knowledge or characteristics of survivors who achieve these goals. Methods: Prospective observational study of stroke patients treated in an interdisciplinary outpatient rehabilitation program addressing physical, cognitive, communicative, risk factor/stroke knowledge, self-efficacy, psychosocial, driving and vocational issues. Results: 190 consecutive patients(117 men, 73 women, average age 62(18-90), 66 aphasic) with baseline modified Rankin Scores of 5(1%); 4(25%); 3(56%); 2(15%); 1(3%), and average NIHSS score of 6(range 0-18) were treated between 12/2011-7/2019. 136 Patients suffered ischemic strokes and 54 had hemorrhages. Locations were: 65 left, 69 right, 26 bilateral hemisphere, 30 brainstem. 41% had MCA territory strokes. Of 104 patients working pre-stroke, 50% returned to work and an additional 7% were work capable upon completion of program. 95% of patients driving pre-stroke could not drive on admission. After training, 43%(67/157) returned to driving. Patients had improvements in all 9 domains of Stroke Impact Scale with SIS total score improving an average of 23%. Patients received an average of 33 physical therapy visits with average percent improvement of 72% and 41% on 6” walk and Berg Balance scores. Average percent improvement in Stroke Self Efficacy Scores was 29%. After individualized cardiovascular risk, stroke and medication education sessions with the Nurse Practitioner based on AHA guidelines and Life’s Simple 7’s curriculum, stroke and risk factor knowledge quiz scores improved an average of 29%. Average length of stay was 5(range .5-24) months. Multiple other demographic and outcome measures are collected. Conclusions: Outcome data show a community-based team rehabilitation program can successfully combine CV/stroke education with rehabilitation services to maximize patient centered outcomes including return to work, driving, overall stroke recovery, physical functioning, stroke knowledge, and self-efficacy for many types of stroke survivors with moderate to severe disability.
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Ward, Kathleen, and David Rivera. "Abstract 398: A New Paradigm in Resuscitation Education: “Does Frequency Matter?”." Circulation 140, Suppl_2 (November 19, 2019). http://dx.doi.org/10.1161/circ.140.suppl_2.398.
Abstract:
Introduction: Survival of in-house cardiac arrests (IHCA) is dependent upon high quality cardiopulmonary resuscitation (CPR). While current BLS and ACLS training occur biannually, studies demonstrate that skills and knowledge diminish over time. Although Self Efficacy (SE) correlates with CPR skills and knowledge, one’s SE can be strengthened through mastery experiences. The RQI training program increases the frequency of training. This study questioned Resuscitation Quality Improvement (RQI), a new quarterly training program, and its influence on self-efficacy and skill decay Methods: The study used a quantitative, quasi-experimental design with a convenience sample derived from 3 medical-surgical (MS) units. Registered nurses (RNs) completed the Basic Resuscitation Skills Self-Efficacy Scale (BRS-SES) survey. Two units were enrolled in traditional life support training, an intervention unit completed the RQI program. Performance data was obtained from program mannequins. Data analysis used Chi-square statistic and ANOVA; p-value 0.05 determined statistical significance. Data sets were inclusive of BRS-SES and performance reports from RQI. Results: SE increased on the intervention unit baseline to 1 year (1512.4±226 to 1600±164, p=0.068); SE improved for safe use of automated external defibrillator (AED)/Defibrillator (627.2±91 to 661.8±71, p=0.034); CPR Skill (350±52 to 374.6±65, p=0.117); recognition (535.2±91 to 563.6±55, p=0.173). RNs < 40 years of age demonstrated an increased SE compared to their peers. Performance was measured by average attempts to pass (ATTP) and mean score with the RQI: compression (2.3 to 1, 79 to 95.4); ventilation (1.6 to 1, 81.1 to 94.9). Conclusions: The RQI training program was associated with increased SE and decreased skill decay. Age appears to influence the degree of success in nurse training using this new methodology. Data suggests an association between RQI and clinical outcomes. Multi-site studies are recommended for future study.
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Hurt, Emily, and Alison McLoughlin. "Facilitating research amongst radiographers through information literacy workshops." Journal of the Medical Library Association 109, no. 1 (January 7, 2021). http://dx.doi.org/10.5195/jmla.2021.842.
Abstract:
Background: Despite a strong research presence in Lancashire Teaching Hospitals National Health Service (NHS) Foundation Trust (LTHTR), allied health professionals from the organization are underrepresented in developing and publicizing research that is inspired by day-to-day clinical practice and staff experiences. Two LTHTR departments, Library and Knowledge Services (LKS) and Research and Innovation (R&I), came together to enable a group of staff to develop the knowledge and skills that they needed to access information and create new “home grown” research.Case Presentation: A clinical librarian and an academic research nurse created a research engagement program in the diagnostic radiography department at LTHTR, which included the development, delivery, and evaluation of 6 workshops. Sixteen individuals took part in these workshops, and data were collected on library usage, self-efficacy in information literacy, and research output before and after their delivery. Library membership increased by 50% among diagnostic radiography staff, literature search requests from this department increased by 133%, and all participants who attended at least 1 workshop reported an increased Information Literacy Self Efficacy Scale (ILSES) score. An increase in research activity and outputs was also attributed to the program.Conclusions: This project has resulted in a set of freely available workshop plans and support resources that can be customized for other health care professionals and has won several awards for its innovative use of departmental collaboration. Through the evaluation of the program from workshop attendees and non-attenders, we have identified impacts, outputs, and barriers to engagement in order to continue to deliver this content to other departments and embed a home grown research culture at LTHTR.