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2.
J Addict Med ; 14(5): e139-e141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32826619

RESUMO

: The COVID-19 pandemic has created an urgent need to expand access to substance use disorder (SUD) treatment through telehealth. A more permanent adoption of tele-SUD treatment options could positively alter the future of SUD treatment. We identify four steps that will help to ensure a broader transition to telehealth will be successful in improving the health outcomes of patients with SUDs. These steps are: (1) investing in telehealth infrastructure to enable health care providers and patients to use telehealth; (2) training and equipping providers to provide SUD treatment through telehealth; (3) providing patients with the financial and social support, hardware, and training necessary to use telehealth; (4) making temporary changes to telehealth law and regulation permanent. We believe these 4 steps will be critical to initiating SUD treatment for many persons that have yet to receive it, and for preserving SUD treatment continuity for millions of other patients both during and after the pandemic.


Assuntos
Infecções por Coronavirus , Pandemias , Pneumonia Viral , Desenvolvimento de Programas/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Telemedicina , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
4.
Pediatr Clin North Am ; 67(4): 675-682, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32650866

RESUMO

Telehealth and telemedicine services can be a solution for improving accessibility and reducing the cost of health care. Challenges remain in designing, implementing, and sustainably scaling telehealth solutions. Research is lacking on the health impacts and cost-effectiveness of telehealth; more data are needed in the evaluation of telehealth programs, adjusting for potential participant bias and extending the time frame of evaluating impact. In addition, rethinking and addressing the economic incentives and payment for telehealth services, as well as the medical-legal framework for provider competition across geographic regions (and jurisdictions), are needed for greater adoption of telehealth services.


Assuntos
Desenvolvimento de Programas/métodos , Telemedicina/organização & administração , Segurança Computacional , Análise Custo-Benefício , Acesso aos Serviços de Saúde , Humanos , Registro Médico Coordenado , Telemedicina/economia , Telemedicina/instrumentação
5.
Neurology ; 95(7): 305-311, 2020 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-32611634

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has rapidly moved telemedicine from discretionary to necessary. Here, we describe how the Stanford Neurology Department (1) rapidly adapted to the COVID-19 pandemic, resulting in over 1,000 video visits within 4 weeks, and (2) accelerated an existing quality improvement plan of a tiered roll out of video visits for ambulatory neurology to a full-scale roll out. Key issues we encountered and addressed were related to equipment/software, provider engagement, workflow/triage, and training. On reflection, the key drivers of our success were provider engagement and dedicated support from a physician champion, who plays a critical role understanding stakeholder needs. Before COVID-19, physician interest in telemedicine was mixed. However, in response to county and state stay-at-home orders related to COVID-19, physician engagement changed completely; all providers wanted to convert a majority of visits to video visits as quickly as possible. Rapid deployment of neurology video visits across all its subspecialties is feasible. Our experience and lessons learned can facilitate broader utilization, acceptance, and normalization of video visits for neurology patients in the present as well as the much anticipated postpandemic era.


Assuntos
Infecções por Coronavirus/terapia , Neurologia/métodos , Pneumonia Viral/terapia , Telemedicina/métodos , Comunicação por Videoconferência/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Atitude do Pessoal de Saúde , Betacoronavirus , Humanos , Pandemias , Desenvolvimento de Programas/métodos
6.
Bull Cancer ; 107(5): 556-564, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32414536

RESUMO

As the benefits of physical activity (PA) in oncology field continue to be demonstrated, multiple structures (sports clubs, associations…) develop PA programs and activities to offer cancer patients survivors the opportunity to continue adapted physical activity. Promoted in the 2014-2019 cancer plan as complementary supportive care, the practice of physical activity is legitimized by the 2016 Health Act of the Ministry of Social Affairs and Health, including the amendment 'prescription health sport', by giving it a legislative framework. In this context of development of new PA offers for cancer patients, it seems necessary to determine and evaluate the structures on their capacities to supervise physical activities for this population with specific needs. This article presents the methodological development and validation process of a tool used to characterize the different structures offering physical activity programs for people who have had cancer, and seeks to define the quality criteria that a structure should meet in the current state of knowledge. Ten of these criteria were selected according to a qualitative methodology and the final tool therefore facilitates the identification of quality programs in post-cancer PA, and could be used systematically by both users and professionals as part of the post-cancer care pathway, as well as by the sport-health platforms themselves in the current dynamics of their deployment throughout the national territory.


Assuntos
Sobreviventes de Câncer , Exercício Físico , Promoção da Saúde , Desenvolvimento de Programas , Certificação , Contraindicações , Exercício Físico/fisiologia , França , Promoção da Saúde/legislação & jurisprudência , Promoção da Saúde/métodos , Humanos , Desenvolvimento de Programas/métodos , Esportes
7.
Workplace Health Saf ; 68(6): 263-271, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32421473

RESUMO

Background: A drug-free workplace program (DFWP) has been shown to be effective in reducing workers' drug misuse. The purpose of this project was to determine the need and capacity for a new or enhanced DFWP in a large health system. If determined to be needed, the next step would be to develop, implement, and evaluate a toolkit to assist occupational health nurses to promote a new or enhanced DFWP. Methods: A strategic prevention framework was used to assess the need and capacity for a toolkit to prepare occupational health nurses to promote a new or enhanced DFWP. The project was conducted in the occupational health services department at a large health system in the Midwest U.S. occupational health nurses and employee assistance counselors in the hospital system completed a survey assessing the need and capacity for a new or enhanced DFWP. Findings: A gap was identified in the perceived effectiveness of training about DFWP and current DFWP components. The findings reflect the need and capacity for a DFWP toolkit. Optimally, a DFWP toolkit would include evidence-based drug and alcohol screening tools. We found that a toolkit for occupational health nurses to promote a new or enhanced DFWP in the project site was warranted. Conclusion/Application to practice: A DFWP can be an effective method of promoting workplace health and safety. Occupational health nurses can contact state and national representatives to encourage monitoring of drug-related work injuries to provide evidence to influence health policies to support effective DFWPs.


Assuntos
Serviços de Saúde do Trabalhador/métodos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Promoção da Saúde/métodos , Humanos , Enfermagem do Trabalho/métodos , Enfermagem do Trabalho/tendências , Desenvolvimento de Programas/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/terapia , Local de Trabalho/psicologia , Local de Trabalho/normas
8.
Health Psychol ; 39(8): 667-678, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32406728

RESUMO

OBJECTIVE: Due to global urbanization, technological advancements, and increasing convenience in daily activities, reduced energy expenditure in all aspects of life has become a major public health concern. A positive physical activity (PPA) intervention was developed to promote physical activity and fitness among Hong Kong families. PPA utilizes positive affective attitudes to circumvent barriers to health behavior change by helping families associate feelings of enjoyment with physical activity. Zero-Time Exercise (ZTEx) was introduced and promoted as a foot-in-the-door approach. METHOD: Using a community-based collaborative approach, the research team worked with social service organizations, a government department, and schools to implement a cluster randomized controlled crossover trial at a citywide scale. A total of 1,983 eligible participants from 1,467 families were recruited from all 18 districts in Hong Kong. Data were collected using structured questionnaires and physical fitness assessments at preintervention and 1-month and 3-month follow-up. RESULTS: PPA was effective in increasing ZTEx and ZTEx with family members at 1-month and 3-month follow-up and in improving balance and endurance at 3-month follow-up. Semistructured focus groups provided further support for the intervention effectiveness and added in-depth insights into the participants' motivational, interpersonal, and affective experiences. CONCLUSION: The results not only shed light on the intervention's effectiveness for physical activity and fitness but also demonstrated that the community-based collaborative approach was successful in engaging relevant stakeholders in an active and fruitful partnership with effective capacity building for program development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Exercício Físico/psicologia , Comportamentos Relacionados com a Saúde/fisiologia , Promoção da Saúde/métodos , Desenvolvimento de Programas/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física/psicologia , Adulto Jovem
9.
Emerg Med Australas ; 32(3): 511-514, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-143068

RESUMO

OBJECTIVES: There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes. METHODS: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID-19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. RESULTS: Outcomes measured include being COVID-19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. CONCLUSION: This project will support EDs during this pandemic.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus , Registros Eletrônicos de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas/métodos , Vigilância em Saúde Pública/métodos , Melhoria de Qualidade , Sistema de Registros , Betacoronavirus , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Saúde Pública , Qualidade da Assistência à Saúde , Triagem/métodos
10.
Emerg Med Australas ; 32(3): 511-514, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-38612

RESUMO

OBJECTIVES: There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes. METHODS: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID-19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. RESULTS: Outcomes measured include being COVID-19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. CONCLUSION: This project will support EDs during this pandemic.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus , Registros Eletrônicos de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas/métodos , Vigilância em Saúde Pública/métodos , Melhoria de Qualidade , Sistema de Registros , Betacoronavirus , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Saúde Pública , Qualidade da Assistência à Saúde , Triagem/métodos
11.
Emerg Med Australas ; 32(3): 511-514, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32255567

RESUMO

OBJECTIVES: There is an urgency to support Australian ED clinicians with real-time tools as the COVID-19 pandemic evolves. The COVID-19 Emergency Department (COVED) Quality Improvement Project has commenced and will provide flexible and responsive clinical tools to determine the predictors of key ED-relevant clinical outcomes. METHODS: The COVED Project includes all adult patients presenting to a participating ED and meeting contemporary testing criteria for COVID-19. The dataset has been embedded in the electronic medical record and the COVED Registry has been developed. RESULTS: Outcomes measured include being COVID-19 positive and requiring intensive respiratory support. Regression methodology will be used to generate clinical prediction tools. CONCLUSION: This project will support EDs during this pandemic.


Assuntos
Infecções por Coronavirus/diagnóstico , Coronavirus , Registros Eletrônicos de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Desenvolvimento de Programas/métodos , Vigilância em Saúde Pública/métodos , Melhoria de Qualidade , Sistema de Registros , Betacoronavirus , Coronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças/prevenção & controle , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Saúde Pública , Qualidade da Assistência à Saúde , Triagem/métodos
12.
Support Care Cancer ; 28(9): 4005-4017, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32296982

RESUMO

BACKGROUND: The literature reflects considerable heterogeneity in what constitutes home-based exercise interventions. The variability for where and what "home-based" exercise can represent challenges interpretation of findings and appropriate advocacy, referral, or development of these models of care. Therefore, the objective of this review was to provide a comprehensive summary of how home-based exercise is defined and reported in the literature and summarize the range of supportive elements utilized in home-based exercise trials. METHODS: We followed methodology for scoping reviews. Relevant research databases were searched from inception to March 2019. Two reviewers independently screened articles to determine eligibility and extracted terminology used to describe home-based exercise and intervention details for intervention delivery. RESULTS: Of the 9432 records identified, 229 articles met inclusion criteria. Across the literature, exercise interventions were described as home-based if they were completed at-home, outdoors in the neighbourhood, and in community facilities; or in self-selected environments; or if they were unsupervised. Supportive elements for home-based models ranged with respect to the amount of supervision and resources utilized, including the provision of print materials, exercise equipment, telephone support, home visits, and technology. CONCLUSIONS: This review provides a comprehensive summary of strategies previously utilized to deliver home-based exercise interventions in oncology, along with the various definitions of the home-based environment for exercise reported by researchers. Specific recommendations to improve the prescription and reporting of home-based exercise interventions are provided in order to facilitate the delivery, evaluation, and translation of findings into clinical practice.


Assuntos
Desenvolvimento de Programas/métodos , Terapia por Exercício/métodos , Humanos , Oncologia/métodos
13.
GMS J Med Educ ; 37(1): Doc9, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32270023

RESUMO

Objective: Increasingly, intensive care units (ICU) are operated by teams of physicians and nurses with specialist training in anaesthesia and intensive care. The aims of our study were to evaluate any prior experience, expectations and the requisites for interprofessional ICU simulation-based training (SBT), and to evaluate a newly designed training course incorporating these findings. Methods: The study was laid out as a cross-sectional study and is projected in three steps. First, questionnaires were sent out to ICU nurses and physicians from 15 different hospitals in a greater metropolitan area (> million citizens). Based upon this survey a one-day ICU simulator course designed for 12 participants (6 nurses and 6 physicians) was developed, with evaluation data from four subsequent courses being analysed. Results: In the survey 40% of nurses and 57% of the physicians had had prior exposure to SBT. Various course formats were explored with respect to duration, day of the week, and group composition. After completing the course, the majority deemed a full working day in interprofessional setting to be most appropriate (p<0.001). The scenarios were considered relevant and had a positive impact on communication, workflow and coping with stress. Conclusion: Currently SBT is not a mainstream tool used by German ICU teams for further education, and this lack of familiarity must be taken into consideration when preparing SBT courses for them. We developed a nontechnical skills training course for ICU teams which was undertaken in the setting of simulated clinical scenarios (pertinent to their work environment). The participants found the course's content to be relevant for their daily work, rated the course's impact on their workplace practices as being good and advocated for longer training sessions.


Assuntos
Unidades de Terapia Intensiva/tendências , Relações Interprofissionais , Treinamento por Simulação/métodos , Adulto , Estudos Transversais , Alemanha , Humanos , Unidades de Terapia Intensiva/organização & administração , Desenvolvimento de Programas/métodos , Treinamento por Simulação/tendências
14.
PLoS One ; 15(3): e0229249, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32196520

RESUMO

BACKGROUND: The development of trustworthy guidelines requires substantial investment of resources and time. This highlights the need to prioritize topics for guideline development and update. OBJECTIVE: To systematically identify and describe prioritization exercises that have been conducted for the purpose of the de novo development, update or adaptation of health practice guidelines. METHODS: We searched Medline and CINAHL electronic databases from inception to July 2019, supplemented by hand-searching Google Scholar and the reference lists of relevant studies. We included studies describing prioritization exercises that have been conducted during the de novo development, update or adaptation of guidelines addressing clinical, public health or health systems topics. Two reviewers worked independently and in duplicate to complete study selection and data extraction. We consolidated findings in a semi-quantitative and narrative way. RESULTS: Out of 33,339 identified citations, twelve studies met the eligibility criteria. All included studies focused on prioritizing topics; none on questions or outcomes. While three exercises focused on updating guidelines, nine were on de novo development. All included studies addressed clinical topics. We adopted a framework that categorizes prioritization into 11 steps clustered in three phases (pre-prioritization, prioritization and post-prioritization). Four studies covered more than half of the 11 prioritization steps across the three phases. The most frequently reported steps for generating initial list of topics were stakeholders' input (n = 8) and literature review (n = 7). The application of criteria to determine research priorities was used in eight studies. We used and updated a common framework of 22 prioritization criteria, clustered in 6 domains. The most frequently reported criteria related to the health burden of disease (n = 9) and potential impact of the intervention on health outcomes (n = 5). All the studies involved health care providers in the prioritization exercises. Only one study involved patients. There was a variation in the number and type of the prioritization exercises' outputs. CONCLUSIONS: This review included 12 prioritization exercises that addressed different aspects of priority setting for guideline development and update that can guide the work of researchers, funders, and other stakeholders seeking to prioritize guideline topics.


Assuntos
Terapia por Exercício/métodos , Desenvolvimento de Programas/métodos , Guias como Assunto , Promoção da Saúde , Humanos , Saúde Pública
15.
BMC Public Health ; 20(1): 343, 2020 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-32183758

RESUMO

BACKGROUND: Rural Nigeria has one of the greatest burdens of low back pain but there are no effective evidence-based interventions to manage it in this population. This paper presents the application of the intervention mapping (IM) approach in the development of a complex behavior change intervention - The Good Back program, aimed at reducing non-specific chronic low back pain (CLBP) disability in rural Nigeria. METHODS: The first four steps of IM were applied. A critical review of the literature, 2 qualitative studies and a population-based cross-sectional study in rural Nigeria helped to identify two key program objectives in order to reduce CLBP disability in this population: reduce the impact of illness perceptions, fear avoidance beliefs, catastrophising, anxiety and depression by targeting maladaptive illness perceptions about CLBP; and facilitate the adoption of exercises and good posture to limit disability. A systematic review plus these studies, identified the personal and environmental determinants of the performance objectives including health literacy, self-awareness, self-efficacy, personal preference, health professional skills, health facility structure and family/community support. The theory, techniques and strategies for modifying personal and environmental determinants were also identified from these studies. Intervention components and materials were then produced for practical application. The initial developed intervention was described. RESULTS: The feasibility and acceptability of the developed program was then tested using a small pragmatic non-randomised controlled study incorporating qualitative exit feedback interviews in a rural Nigerian primary health care centre. The program appeared feasible and acceptable when delivered by a highly trained physiotherapist. There were promising clinical outcomes in disability, pain intensity, illness perceptions, fear avoidance beliefs and pain medication use. Suggestions for program improvement included shorter but ongoing sessions, video demonstration of exercises/good posture, spacious exercise/demonstration rooms, and community legitimisation of exercise as treatment for back pain. Subsequent modifications to program content and delivery were then described. Theoretical modification included the addition of aspects of the social cognitive theory to the Leventhal's self-regulatory model of illness cognitions. CONCLUSIONS: IM appears to be a suitable framework for designing complex behavior change interventions in rural Nigeria. The need for further testing of the intervention was highlighted.


Assuntos
Terapia Comportamental/métodos , Dor Lombar/terapia , Atenção Primária à Saúde/métodos , Desenvolvimento de Programas/métodos , Autogestão/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pesquisa Qualitativa , Projetos de Pesquisa , População Rural
16.
Health Secur ; 18(S1): S53-S63, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32004126

RESUMO

Multiple costing tools have been developed to understand the resources required to build and sustain implementation of the International Health Regulations (IHR), including a detailed costing tool developed by WHO ("WHO Costing Tool") and 2 action-based costing tools, Georgetown University's IHR Costing Tool and CDC's Priority Actions Costing Tool (PACT). The relative performance of these tools is unknown. Nigeria costed its National Action Plan for Health Security (NAPHS) using the WHO Costing Tool. We conducted a desktop review, using the other tools to compare the cost estimates generated using different costing approaches. Technical working groups developed activity plans and estimated component costs using the WHO Costing Tool during a weeklong workshop with approximately 60 participants from various ministries, departments, and federal agencies. We retrospectively applied the IHR Costing Tool and PACT to generate rapid cost estimates required to achieve a Joint External Evaluation (JEE) score of "demonstrated capacity" (level 4). The tools generated similar activities for implementation. Cost estimates varied based on the anticipated procurement and human resources requirements and by the level of implementation (eg, health facility-level versus local government area-level procurement). The desktop IHR Costing Tool and PACT tools required approximately 2 and 8 person-hours to complete, respectively. A strategic costing approach, wherein governments select from a menu of recommended and costed actions following the JEE to develop a NAPHS, could accelerate implementation of plans. Major cost drivers, including procurement and human resources, should be prioritized based on anticipated resource availability and countries' priorities.


Assuntos
Política de Saúde/economia , Regulamento Sanitário Internacional/economia , Saúde Pública/economia , Surtos de Doenças/prevenção & controle , Saúde Global , Órgãos Governamentais/economia , Humanos , Nigéria , Desenvolvimento de Programas/economia , Desenvolvimento de Programas/métodos , Saúde Pública/legislação & jurisprudência , Organização Mundial da Saúde
17.
Health Info Libr J ; 37(1): 83-88, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32096587

RESUMO

This feature is part of a series about medical library services in various countries. It gives an overview of the state of and selected current developments of medical library services to support research, education and clinical practice in Germany. Findings from an online survey and issues of access to health information are discussed in relation to the German health care system.J.M.


Assuntos
Bibliotecas Médicas/provisão & distribução , Alemanha , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Internet , Bibliotecas Médicas/normas , Bibliotecas Médicas/estatística & dados numéricos , Desenvolvimento de Programas/métodos , Desenvolvimento de Programas/estatística & dados numéricos , Inquéritos e Questionários , Universidades/organização & administração , Universidades/estatística & dados numéricos
18.
Am J Nurs ; 120(2): 44-48, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31977418

RESUMO

This is the sixth article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series features exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.


Assuntos
Prática Clínica Baseada em Evidências/normas , Desenvolvimento de Programas/métodos , Bolsas de Estudo , Humanos
20.
BMC Palliat Care ; 19(1): 5, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915000

RESUMO

BACKGROUND: Research has highlighted the need for improving the implementation of advance care planning (ACP) in nursing homes. We developed a theory-based multicomponent ACP intervention (the ACP+ programme) aimed at supporting nursing home staff with the implementation of ACP into routine nursing home care. We describe here the protocol of a cluster randomised controlled trial (RCT) that aims to evaluate the effects of ACP+ on nursing home staff and volunteer level outcomes and its underlying processes of change. METHODS: We will conduct a cluster RCT in Flanders, Belgium. Fourteen eligible nursing homes will be pair-matched and one from each pair will be randomised to either continue care and education as usual or to receive the ACP+ programme (a multicomponent programme which is delivered stepwise over an eight-month period with the help of an external trainer). Primary outcomes are: nursing home care staff's knowledge of, and self-efficacy regarding ACP. Secondary outcomes are: 1) nursing home care staff's attitudes towards ACP and ACP practices; 2) support staff's and volunteer's ACP practices and 3) support staff's and volunteers' self-efficacy. Measurements will be performed at baseline and eight months post-measurement, using structured self-reported questionnaires. A process evaluation will accompany the outcome evaluation in the intervention group, with measurements throughout and post-intervention to assess implementation, mechanisms of impact and context and will be carried out using a mixed-methods design. DISCUSSION: There is little high-quality evidence regarding the effectiveness and underlying processes of change of ACP in nursing homes. This combined outcome and process evaluation of the ACP+ programme aims to contribute to building the necessary evidence to improve ACP and its uptake for nursing home residents and their family. TRIAL REGISTRATION: The study is registered at ClinicalTrials.gov (no. NCT03521206). Registration date: May 10, 2018. Inclusion of nursing homes started March, 2018. Hence, the trial was retrospectively registered but before end of data collection and analyses.


Assuntos
Planejamento Antecipado de Cuidados/tendências , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Bélgica , Protocolos Clínicos , Análise por Conglomerados , Humanos , Casas de Saúde/organização & administração , Desenvolvimento de Programas/métodos , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Inquéritos e Questionários
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