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stepped wedge design

Justin W L Keogh, Tim Henwood, Paul Gardiner, Anthony Tuckett, Brent Hodgkinson, Kevin Rouse
Progressive resistance plus balance training (PRBT) has been demonstrated as effective in reducing later life physical disability, falls risk and poor health, even among those with complex health care needs. However, few studies have examined the influence of PRBT on health service utilisation, cognitive wellbeing and training modality acceptance or undertaken a cost benefit analysis. This project will investigate the broad scope benefits of PRBT participation among community-dwelling older Australians receiving Government supported aged care packages for their complex health care needs...
October 6, 2016: Archives of Gerontology and Geriatrics
Natalie Ingraham, Dawn Harbatkin, Jennifer Lorvick, Marj Plumb, Alexandra M Minnis
INTRODUCTION: Lesbian and bisexual (LB) women have higher body weight than heterosexual women. Interventions focused on health and well-being versus weight loss may be more likely to succeed among LB women. This article describes effects of Women's Health and Mindfulness, a 12-week pilot intervention addressing mindfulness, healthy eating, and physical activity, on outcomes associated with chronic disease risk among overweight and obese LB women older than 40 years. METHOD: Eighty women were randomized, using a stepped-wedge design, to either an immediate- or a delayed-start intervention group; the delayed-start group served as the control...
October 2, 2016: Health Promotion Practice
Miao Zhang, Nan Qin, Xun Jia, Wei J Zou, Atif Khan, Ning J Yue
This work investigated the possibility of using proton beam for total body irradia-tion (TBI). We hypothesized the broad-slow-rising entrance dose from a monoen-ergetic proton beam can deliver a uniform dose to patient with varied thickness. Comparing to photon-based TBI, it would not require any patient-specific com-pensator or beam spoiler. The hypothesis was first tested by simulating 250 MeV, 275 MeV, and 300 MeV protons irradiating a wedge-shaped water phantom in a paired opposing arrangement using Monte Carlo (MC) method...
2016: Journal of Applied Clinical Medical Physics
Myrta Kohler, Jürg Schwarz, Melanie Burgstaller, Susi Saxer
BACKGROUND: Up to 90 % of nursing home residents with dementia suffer from urinary incontinence with adverse effects on the quality of life. Nurses are often insufficiently prepared for incontinence management and their knowledge is incomplete. Urinary incontinence management for people with dementia is complex due to the multifactorial nature of the disease and cognitive impairment. OBJECTIVE: This study explored the effects of an educational program and subsequent nursing case conferences on urinary incontinence and quality of life of nursing home residents with dementia...
September 6, 2016: Zeitschrift Für Gerontologie und Geriatrie
Catherine Deri Armstrong, Monica Taljaard, William Hogg, Amy E Mark, Clare Liddy
BACKGROUND: Practice facilitation (PF), a multifaceted approach in which facilitators (external health care professionals) help family physicians to improve their adoption of best practices, has been highly successful. Improved Delivery of Cardiovascular Care (IDOCC) was an innovative PF trial designed to improve evidence-based care for people who have, or are at risk of, cardiovascular disease (CVD). The intervention was found to be ineffective as assessed by a patient-level composite score based on chart reviews from a subsample of patients (N = 5292)...
2016: Trials
Karen A Bonuck, Arthur Blank, Barbara True-Felt, Ronald Chervin
Inadequate or poor quality sleep in early childhood impairs social-emotional and cognitive function via effects on the developing brain and increases obesity risk via hormonal and endocrine effects. The prevalence of short sleep duration, behavioral sleep problems, and sleep-disordered breathing among children aged 3 to 5 years is 20% to 50%. Healthy sleep habits increase sleep duration and prevent behavioral sleep problems. Awareness of sleep-disordered breathing symptoms leads to its timely treatment. We designed a study that aims to empower families whose children are in early childhood programs with the knowledge and skills needed to obtain healthy sleep and to recognize a sleep problem...
2016: Preventing Chronic Disease
Renée J Zwanenburg, Gianni Bocca, Selma A J Ruiter, Jan H Dillingh, Boudien C T Flapper, Edwin R van den Heuvel, Conny M A van Ravenswaaij-Arts
Phelan-McDermid syndrome (PMS) or 22q13.3 deletion syndrome is a rare neurodevelopmental disorder with at least 60 children and 35 adults diagnosed in the Netherlands. Clinical features are moderate to severe intellectual disability and behavioural problems in the autism spectrum. Other researchers had observed a beneficial effect of intranasal insulin on development and behaviour in a pilot study in six children with PMS. To validate this effect, we conducted a randomized, double-blind, placebo-controlled clinical trial using a stepped-wedge design...
August 31, 2016: European Journal of Human Genetics: EJHG
Alireza Jeddian, Karla Hemming, Antje Lindenmeyer, Arash Rashidian, Leila Sayadi, Nazila Jafari, Reza Malekzadeh, Tom Marshall
PURPOSE: This trial evaluates implementation of critical care outreach in a middle-income country. MATERIALS AND METHODS: Critical care outreach delivered by a team of intensive care nurses was implemented across general hospital wards in an Iranian university hospital. The order of implementation was randomized with wards stratified by predicted mortality rates. Effectiveness was evaluated using a stepped wedge cluster randomized controlled trial design, comparing outcomes between patients admitted before and after implementation...
July 26, 2016: Journal of Critical Care
Ibrahim Diakite, Eric Q Mooring, Gustavo E Velásquez, Megan B Murray
BACKGROUND: During the 2014 Ebola virus disease (EVD) outbreak, policy-makers were confronted with difficult decisions on how best to test the efficacy of EVD vaccines. On one hand, many were reluctant to withhold a vaccine that might prevent a fatal disease from study participants randomized to a control arm. On the other, regulatory bodies called for rigorous placebo-controlled trials to permit direct measurement of vaccine efficacy prior to approval of the products. A stepped-wedge cluster study (SWCT) was proposed as an alternative to a more traditional randomized controlled vaccine trial to address these concerns...
August 2016: PLoS Neglected Tropical Diseases
Katherine E Harding, Jennifer J Watts, Leila Karimi, Mary O'Reilly, Bridie Kent, Michelle Kotis, Sandra G Leggat, Jackie Kearney, Nicholas F Taylor
BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care...
2016: BMC Health Services Research
Katy Town, Cliodna A M McNulty, Ellie J Ricketts, Thomas Hartney, Anthony Nardone, Kate A Folkard, Andre Charlett, J Kevin Dunbar
BACKGROUND: Providing sexual health services in primary care is an essential step towards universal provision. However they are not offered consistently. We conducted a national pilot of an educational intervention to improve staff's skills and confidence to increase chlamydia testing rates and provide condoms with contraceptive information plus HIV testing according to national guidelines, known as 3Cs&HIV. The effectiveness of the pilot on chlamydia testing and diagnosis rates in general practice was evaluated...
2016: BMC Public Health
Alex Thabane, Brittany B Dennis, Olga Gajic-Veljanoski, James Paul, Lehana Thabane
BACKGROUND: Stepped wedge design (SWD) is a cluster randomized controlled trial (RCT) design that sequentially rolls out intervention to all clusters at varying time points. Being a relatively new design method, reporting quality has yet to be explored, and this review will seek to fill this gap in knowledge. OBJECTIVES: The objectives of this review are: 1) to assess the quality of SWD trial reports based on the CONSORT guidelines or CONSORT extension to cluster RCTs; 2) to assess the completeness of reporting of SWD trial abstracts using the CONSORT extension for abstracts; 3) to assess the reporting of sample size details in SWD trial reports or protocols; 4) to assess the completeness of reporting of SWD trial protocols according to SPIRIT guidelines; 5) to assess the consistency between the trial registration information and final SWD trial reports; and 6) to assess the consistency of what is reported in the abstracts and main text of the SWD trial reports...
2016: Clinical Epidemiology
Alexandra Hiscox, Tobias Homan, Collins K Mweresa, Nicolas Maire, Aurelio Di Pasquale, Daniel Masiga, Prisca A Oria, Jane Alaii, Cees Leeuwis, Wolfgang R Mukabana, Willem Takken, Thomas A Smith
BACKGROUND: Increasing levels of insecticide resistance as well as outdoor, residual transmission of malaria threaten the efficacy of existing vector control tools used against malaria mosquitoes. The development of odour-baited mosquito traps has led to the possibility of controlling malaria through mass trapping of malaria vectors. Through daily removal trapping against a background of continued bed net use it is anticipated that vector populations could be suppressed to a level where continued transmission of malaria will no longer be possible...
2016: Trials
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No abstract text is available yet for this article.
2016: Trials
Hannah Spring, Saugato Datta, Sabitri Sapkota
Despite the provision of free and subsidized family planning services and clients' demonstrated intentions to delay pregnancies, family planning uptake among women who receive abortion and postabortion services at Sunaulo Parivar Nepal (SPN), one of Nepal's largest non-governmental sexual and reproductive health (SRH) providers, remains low. Through meetings, interviews, and observations with SPN's stakeholders, service providers, and clients at its 36 SRH centers, we developed hypotheses about client- and provider-side barriers that may inhibit postabortion family planning (PAFP) uptake...
2016: Frontiers in Public Health
Kristen M Cunanan, Bradley P Carlin, Kevin A Peterson
BACKGROUND: Many clinical trial designs are impractical for community-based clinical intervention trials. Stepped wedge trial designs provide practical advantages, but few descriptions exist of their clinical implementational features, statistical design efficiencies, and limitations. OBJECTIVES: Enhance efficiency of stepped wedge trial designs by evaluating the impact of design characteristics on statistical power for the British Columbia Telehealth Trial. METHODS: The British Columbia Telehealth Trial is a community-based, cluster-randomized, controlled clinical trial in rural and urban British Columbia...
July 17, 2016: Clinical Trials: Journal of the Society for Clinical Trials
Anita Romijn, Martine C de Bruijne, Pim W Teunissen, Christianne J M de Groot, Cordula Wagner
INTRODUCTION: In obstetrics, patients often experience referral situations between different care professionals. In these multidisciplinary teams, a focus on communication and interprofessional collaboration is needed to ensure care of high quality. Crew resource management team training is increasingly being applied in healthcare settings to improve team performance and coordination. Efforts to improve communication also include tools for standardisation such as SBAR (situation, background, assessment, recommendation)...
2016: BMJ Open
Yirui Hu, Donald R Hoover
Randomized stepped-wedge (R-SW) designs are increasingly used to evaluate interventions targeting continuous longitudinal outcomes measured at T-fixed time points. Typically, all units start out untreated, and randomly chosen units switch to intervention at sequential time points until all receive intervention. As randomization is not always feasible, non-randomized stepped-wedge (NR-SW) designs (units switching to intervention are not randomly chosen) have attracted researchers. We develop an orthogonlized generalized least squares framework for both R-SW and NR-SW designs...
July 10, 2016: Statistical Methods in Medical Research
Loredana Tirlea, Helen Truby, Terry P Haines
PURPOSE: To test the effectiveness of an intervention delivered by health professionals outside the school environment to girls identified with issues such as poor body image, low self-esteem, low self-confidence, nonparticipation in sports, or being overweight or underweight. DESIGN: The study's design was a stepped-wedge randomized controlled trial to test the efficacy of an intervention on self-esteem, impairment induced by eating disorders, self-efficacy, body satisfaction, and dieting behaviors...
March 2016: American Journal of Health Promotion: AJHP
Jakob Søgaard Juul, Flemming Bro, Nete Hornung, Berit Sanne Andersen, Søren Laurberg, Frede Olesen, Peter Vedsted
BACKGROUND: Colorectal cancer is a common malignancy and a leading cause of cancer-related death. Half of patients with colorectal cancer initially present with non-specific or vague symptoms. In the need for a safe low-cost test, the immunochemical faecal occult blood test (iFOBT) may be part of the evaluation of such patients in primary care. Currently, Danish general practitioners have limited access to this test. The aim of this article is to describe a study that will assess the uptake and clinical use of iFOBT in general practice...
2016: BMC Cancer
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