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1.
JASA Express Lett ; 4(7)2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38984970

RESUMO

This article presents a different experiment examining the impact of feedback timing on its perception. Dialog sequences, featuring a main speaker's utterance followed by a listener's feedback, were extracted from spontaneous conversations. The original feedback instances were manipulated to be produced earlier, up to 1.5 s in advance, or to be delayed, up to 2 s later. Participants evaluated the feedback acceptability and engagement level of the listener. The findings reveal that 76% of the time feedback remains acceptable regardless of the delay. However, engagement decreases after a 1-s delay while no consistent effect is observed for feedback anticipation.


Assuntos
Comunicação , Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Retroalimentação , Fatores de Tempo , Percepção da Fala/fisiologia
3.
JAMA Netw Open ; 7(7): e2420218, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38985474

RESUMO

Importance: Handheld phone use while driving is a major factor in vehicle crashes. Scalable interventions are needed to encourage drivers not to use their phones. Objective: To test whether interventions involving social comparison feedback and/or financial incentives can reduce drivers' handheld phone use. Design, Setting, and Participants: In a randomized clinical trial, interventions were administered nationwide in the US via a mobile application in the context of a usage-based insurance program (Snapshot Mobile application). Customers were eligible to be invited to participate in the study if enrolled in the usage-based insurance program for 30 to 70 days. The study was conducted from May 13 to June 30, 2019. Analysis was completed December 22, 2023. Interventions: Participants were randomly assigned to 1 of 6 trial arms for a 7-week intervention period: (1) control; (2) feedback, with weekly push notification about their handheld phone use compared with that of similar others; (3) standard incentive, with a maximum $50 award at the end of the intervention based on how their handheld phone use compared with similar others; (4) standard incentive plus feedback, combining interventions of arms 2 and 3; (5) reframed incentive plus feedback, with a maximum $7.15 award each week, framed as participant's to lose; and (6) doubled reframed incentive plus feedback, a maximum $14.29 weekly loss-framed award. Main Outcome and Measure: Proportion of drive time engaged in handheld phone use in seconds per hour (s/h) of driving. Analyses were conducted with the intention-to-treat approach. Results: Of 17 663 customers invited by email to participate, 2109 opted in and were randomized. A total of 2020 drivers finished the intervention period (68.0% female; median age, 30 [IQR, 25-39] years). Median baseline handheld phone use was 216 (IQR, 72-480) s/h. Relative to control, feedback and standard incentive participants did not reduce their handheld phone use. Standard incentive plus feedback participants reduced their use by -38 (95% CI, -69 to -8) s/h (P = .045); reframed incentive plus feedback participants reduced their use by -56 (95% CI, -87 to -26) s/h (P < .001); and doubled reframed incentive plus feedback participants reduced their use by -42 s/h (95% CI, -72 to -13 s/h; P = .007). The 5 active treatment arms did not differ significantly from each other. Conclusions and Relevance: In this randomized clinical trial, providing social comparison feedback plus incentives reduced handheld phone use while individuals were driving. Trial Registration: ClinicalTrials.gov Identifier: NCT03833219.


Assuntos
Condução de Veículo , Motivação , Humanos , Feminino , Masculino , Adulto , Condução de Veículo/psicologia , Condução de Veículo/estatística & dados numéricos , Pessoa de Meia-Idade , Uso do Telefone Celular/estatística & dados numéricos , Aplicativos Móveis , Retroalimentação , Estados Unidos
4.
BMC Med Educ ; 24(1): 779, 2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-39030534

RESUMO

BACKGROUND: Effective cardiopulmonary resuscitation (CPR) training for nursing students is crucial for improving patient outcomes in cardiac arrest scenarios. This study assesses the impact of infographic versus video feedback on enhancing nursing students' clinical skills in Basic Life Support (BLS). METHODS: In a randomized controlled setting, 76 nursing students at Torbat Heydariyeh University of Medical Sciences were divided into two groups: one received infographic-based education and the other video feedback training. Pre- and post-intervention assessments measured knowledge and skill retention using validated questionnaires. RESULTS: Post-training, the infographic group showed significantly higher knowledge scores, while the video feedback group exhibited greater improvement in CPR skill performance. No significant differences were noted in pre-training assessment scores between the groups. CONCLUSION: Infographic-based education enhances BLS knowledge retention, and video feedback improves practical CPR skills. This suggests potential benefits of a combined infographic and video feedback approach for optimizing CPR training outcomes, addressing a critical need in medical education.


Assuntos
Reanimação Cardiopulmonar , Competência Clínica , Estudantes de Enfermagem , Humanos , Reanimação Cardiopulmonar/educação , Feminino , Masculino , Gravação em Vídeo , Avaliação Educacional , Adulto Jovem , Adulto , Retroalimentação , Bacharelado em Enfermagem/métodos
5.
J Nurs Adm ; 54(7-8): 427-432, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39016612

RESUMO

OBJECTIVE: To propose practical hypotheses on audit and feedback that support the effectiveness with nurses. BACKGROUND: Audit and feedback interventions have been mainly studied with physicians; however, the processes have been practiced by nurses for years. Nurses' response may differ from that of physicians and other healthcare disciplines because of their roles, power, and the configuration of nursing activities. METHODS: A comparative analysis of the Clinical Performance Feedback Intervention Theory was conducted using nursing-specific empirical data from: 1) a mixed-methods systematic review and 2) a pilot study of audit and feedback with a team of primary care nurses. RESULTS: Researchers hypothesize that audit and feedback interventions are more effective when: 1) feedback emphasizes how it relates to the relational aspect of nursing; 2) indicators are measured and reported at team level; and 3) feedback is provided in a way that highlights benefits to nurses' practice, such as the potential to reduce workload. CONCLUSION: These proposed hypotheses provide concrete guidance to researchers and managers for an effective use of audit and feedback as a quality improvement strategy with nurses.


Assuntos
Retroalimentação , Humanos , Projetos Piloto , Melhoria de Qualidade , Pesquisa Qualitativa , Auditoria de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/psicologia
6.
BMC Med Ethics ; 25(1): 67, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38849807

RESUMO

BACKGROUND: Genetic research can yield information that is unrelated to the study's objectives but may be of clinical or personal interest to study participants. There is an emerging but controversial responsibility to return some genetic research results, however there is little evidence available about the views of genomic researchers and others on the African continent. METHODS: We conducted a continental survey to solicit perspectives of researchers, science policy makers and research ethics committee members on the feedback of individual genetic research findings in African genomics research. RESULTS: A total of 110 persons participated in the survey with 51 complete and 59 incomplete surveys received. Data was summarised using descriptive analysis. Overall, our respondents believed that individual genetic research results that are clinically actionable should be returned to study participants apparently because participants have a right to know things about their health, and it might also be a means for research participation to be recognized. Nonetheless, there is a need for development of precise guidance on how to return individual genetic research findings in African genomics research. DISCUSSION: Participants should receive information that could promote a healthier lifestyle; only clinically actionable findings should be returned, and participants should receive all important information that is directly relevant to their health. Nevertheless, detailed guidelines should inform what ought to be returned. H3Africa guidelines stipulate that it is generally considered good practice for researchers to feedback general study results, but there is no consensus about whether individual genomic study results should also be fed back. The decision on what individual results to feedback, if any, is very challenging and the specific context is important to make an appropriate determination.


Assuntos
Comitês de Ética em Pesquisa , Pesquisa em Genética , Genômica , Pesquisadores , Humanos , Pesquisadores/ética , Genômica/ética , Pesquisa em Genética/ética , África , Masculino , Feminino , Inquéritos e Questionários , Pessoal Administrativo/ética , Adulto , Retroalimentação , Pessoa de Meia-Idade , População Negra/genética
7.
Opt Express ; 32(11): 20370-20384, 2024 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-38859150

RESUMO

The rapid advancement of photonic technologies has facilitated the development of photonic neurons that emulate neuronal functionalities akin to those observed in the human brain. Neuronal bursts frequently occur in behaviors where information is encoded and transmitted. Here, we present the demonstration of the bursting response activated by an artificial photonic neuron. This neuron utilizes a single vertical-cavity surface-emitting laser (VCSEL) and encodes multiple stimuli effectively by varying the spike count during a burst based on the polarization competition in the VCSEL. By virtue of the modulated optical injection in the VCSEL employed to trigger the spiking response, we activate bursts output in the VCSEL with a feedback structure in this scheme. The bursting response activated by the VCSEL-neuron exhibits neural signal characteristics, promising an excitation threshold and the refractory period. Significantly, this marks the inaugural implementation of a controllable integrated encoding scheme predicated on bursts within photonic neurons. There are two remarkable merits; on the one hand, the interspike interval of bursts is distinctly diminished, amounting to merely one twenty-fourth compared to that observed in optoelectronic oscillators. Moreover, the interspike period of bursts is about 70.8% shorter than the period of spikes activated by a VCSEL neuron without optical feedback. Our results may shed light on the analogy between optical and biological neurons and open the door to fast burst encoding-based optical systems with a speed several orders of magnitude faster than their biological counterparts.


Assuntos
Lasers , Neurônios , Neurônios/fisiologia , Humanos , Potenciais de Ação/fisiologia , Retroalimentação , Modelos Neurológicos
8.
Can Med Educ J ; 15(2): 14-26, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38827914

RESUMO

Purpose: Competency-based medical education relies on feedback from workplace-based assessment (WBA) to direct learning. Unfortunately, WBAs often lack rich narrative feedback and show bias towards Medical Expert aspects of care. Building on research examining interactive assessment approaches, the Queen's University Internal Medicine residency program introduced a facilitated, team-based assessment initiative ("Feedback Fridays") in July 2017, aimed at improving holistic assessment of resident performance on the inpatient medicine teaching units. In this study, we aim to explore how Feedback Fridays contributed to formative assessment of Internal Medicine residents within our current model of competency-based training. Method: A total of 53 residents participated in facilitated, biweekly group assessment sessions during the 2017 and 2018 academic year. Each session was a 30-minute facilitated assessment discussion done with one inpatient team, which included medical students, residents, and their supervising attending. Feedback from the discussion was collected, summarized, and documented in narrative form in electronic WBA forms by the program's assessment officer for the residents. For research purposes, verbatim transcripts of feedback sessions were analyzed thematically. Results: The researchers identified four major themes for feedback: communication, intra- and inter-personal awareness, leadership and teamwork, and learning opportunities. Although feedback related to a broad range of activities, it showed strong emphasis on competencies within the intrinsic CanMEDS roles. Additionally, a clear formative focus in the feedback was another important finding. Conclusions: The introduction of facilitated team-based assessment in the Queen's Internal Medicine program filled an important gap in WBA by providing learners with detailed feedback across all CanMEDS roles and by providing constructive recommendations for identified areas for improvement.


Objectif: La formation médicale fondée sur les compétences s'appuie sur la rétroaction faite lors de l'évaluation des apprentissages par observation directe dans le milieu de travail. Malheureusement, les évaluations dans le milieu de travail omettent souvent de fournir une rétroaction narrative exhaustive et privilégient les aspects des soins relevant de l'expertise médicale. En se basant sur la recherche ayant étudié les approches d'évaluation interactive, le programme de résidence en médecine interne de l'Université Queen's a introduit en juillet 2017 une initiative d'évaluation facilitée et en équipe (« Les vendredis rétroaction ¼), visant à améliorer l'évaluation holistique du rendement des résidents dans les unités d'enseignement clinique en médecine interne. Dans cette étude, nous visons à explorer comment ces « vendredis rétroaction ¼ ont contribué à l'évaluation formative des résidents en médecine interne dans le cadre de notre modèle actuel de formation axée sur les compétences. Méthode: Au total, 53 résidents ont participé à des séances d'évaluation de groupe facilitées et bi-hebdomadaires au cours de l'année universitaire 2017-2018. Chaque séance consistait en une discussion d'évaluation facilitée de 30 minutes menée avec une équipe de l'unité de soins, qui comprenait des étudiants en médecine, des résidents et le médecin superviseur. Les commentaires issus de la discussion ont été recueillis, résumés et documentés sous forme narrative dans des formulaires électroniques d'observation directe dans le milieu de travail par le responsable de l'évaluation du programme de résidence. À des fins de recherche, les transcriptions verbatim des séances de rétroaction ont été analysées de façon thématique. Résultats: Les chercheurs ont identifié quatre thèmes principaux pour les commentaires : la communication, la conscience intra- et interpersonnelle, le leadership et le travail d'équipe, et les occasions d'apprentissage. Bien que la rétroaction concerne un large éventail d'activités, elle met fortement l'accent sur les compétences liées aux rôles intrinsèques de CanMEDS. De plus, le fait que la rétroaction avait un rôle clairement formatif est une autre constatation importante. Conclusions: L'introduction de l'évaluation en équipe facilitée dans le programme de médecine interne à Queen's a comblé une lacune importante dans l'apprentissage par observation directe dans le milieu de travail en fournissant aux apprenants une rétroaction détaillée sur tous les rôles CanMEDS et en formulant des recommandations constructives sur les domaines à améliorer.


Assuntos
Competência Clínica , Medicina Interna , Internato e Residência , Pesquisa Qualitativa , Medicina Interna/educação , Humanos , Educação Baseada em Competências/métodos , Feedback Formativo , Liderança , Retroalimentação , Avaliação Educacional/métodos , Comunicação
9.
PLoS One ; 19(6): e0300001, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38837994

RESUMO

BACKGROUND: Up to 30% of diagnostic imaging (DI) tests may be unnecessary, leading to increased healthcare costs and the possibility of patient harm. The primary objective of this systematic review was to assess the effect of audit and feedback (AF) interventions directed at healthcare providers on reducing image ordering. The secondary objective was to examine the effect of AF on the appropriateness of DI ordering. METHODS: Studies were identified using MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov registry on December 22nd, 2022. Studies were included if they were randomized control trials (RCTs), targeted healthcare professionals, and studied AF as the sole intervention or as the core component of a multi-faceted intervention. Risk of bias for each study was evaluated using the Cochrane risk of bias tool. Meta-analyses were completed using RevMan software and results were displayed in forest plots. RESULTS: Eleven RCTs enrolling 4311 clinicians or practices were included. AF interventions resulted in 1.5 fewer image test orders per 1000 patients seen than control interventions (95% confidence interval (CI) for the difference -2.6 to -0.4, p-value = 0.009). The effect of AF on appropriateness was not statistically significant, with a 3.2% (95% CI -1.5 to 7.7%, p-value = 0.18) greater likelihood of test orders being considered appropriate with AF vs control interventions. The strength of evidence was rated as moderate for the primary objective but was very low for the appropriateness outcome because of risk of bias, inconsistency in findings, indirectness, and imprecision. CONCLUSION: AF interventions are associated with a modest reduction in total DI ordering with moderate certainty, suggesting some benefit of AF. Individual studies document effects of AF on image order appropriateness ranging from a non-significant trend toward worsening to a highly significant improvement, but the weighted average effect size from the meta-analysis is not statistically significant with very low certainty.


Assuntos
Diagnóstico por Imagem , Humanos , Diagnóstico por Imagem/métodos , Retroalimentação , Padrões de Prática Médica , Ensaios Clínicos Controlados Aleatórios como Assunto , Auditoria Médica
10.
Int J Qual Health Care ; 36(2)2024 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-38907579

RESUMO

Near Real-Time Feedback (NRTF) on the patient's experience with care, coupled with data relay to providers, can inform quality-of-care improvements, including at the point of care. The objective is to systematically review contemporary literature on the impact of the use of NRTF and data relay to providers on standardized patient experience measures. Six scientific databases and five specialty journals were searched supplemented by snowballing search strategies, according to the registered study protocol. Eligibility included studies in English (2015-2023) assessing the impact of NRTF and data relay on standardized patient-reported experience measures as a primary outcome. Eligibility and quality appraisals were performed by two independent reviewers. An expert former patient (Patient and Family Advisory Council and communication sciences background) helped interpret the results. Eight papers met review eligibility criteria, including three randomized controlled trials (RCTs) and one non-randomized study. Three of these studies involved in-person NRTF prior to data relay (patient-level data for immediate corrective action or aggregated and peer-compared) and led to significantly better results in all or some of the experience measures. In turn, a kiosk-based NRTF achieved no better experience results. The remaining studies were pre-post designs with mixed or neutral results and greater risks of bias. In-person NRTF on the patient experience followed by rapid data relay to their providers, either patient-level or provider-level as peer-compared, can improve the patient experience of care. Reviewed kiosk-based or self-reported approaches combined with data relay were not effective. Further research should determine which approach (e.g. who conducts the in-person NRTF) will provide better, more efficient improvements and under which circumstances.


Assuntos
Retroalimentação , Satisfação do Paciente , Humanos , Melhoria de Qualidade , Qualidade da Assistência à Saúde
11.
J Nurses Prof Dev ; 40(4): 195-200, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38842449

RESUMO

Nurse preceptors are key to the successful transition of graduate nurses to practice and experienced nurses to a new organization. Providing ongoing preceptor development is essential to support nurses in this vital role. The evidence-based R2C2 (relationship, reaction, content, coach) feedback and coaching model was implemented to facilitate the delivery of constructive feedback from nurse preceptors to their orientees. Post-intervention survey results suggest an overall positive response to the use of the feedback model in practice.


Assuntos
Preceptoria , Preceptoria/métodos , Humanos , Inquéritos e Questionários , Retroalimentação , Papel do Profissional de Enfermagem , Tutoria/métodos , Desenvolvimento de Pessoal/métodos
12.
Age Ageing ; 53(6)2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38851216

RESUMO

OBJECTIVES: To investigate if a prospective feedback loop that flags older patients at risk of death can reduce non-beneficial treatment at end of life. DESIGN: Prospective stepped-wedge cluster randomised trial with usual care and intervention phases. SETTING: Three large tertiary public hospitals in south-east Queensland, Australia. PARTICIPANTS: 14 clinical teams were recruited across the three hospitals. Teams were recruited based on a consistent history of admitting patients aged 75+ years, and needed a nominated lead specialist consultant. Under the care of these teams, there were 4,268 patients (median age 84 years) who were potentially near the end of life and flagged at risk of non-beneficial treatment. INTERVENTION: The intervention notified clinicians of patients under their care determined as at-risk of non-beneficial treatment. There were two notification flags: a real-time notification and an email sent to clinicians about the at-risk patients at the end of each screening day. The nudge intervention ran for 16-35 weeks across the three hospitals. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients with one or more intensive care unit (ICU) admissions. The secondary outcomes examined times from patients being flagged at-risk. RESULTS: There was no improvement in the primary outcome of reduced ICU admissions (mean probability difference [intervention minus usual care] = -0.01, 95% confidence interval -0.08 to 0.01). There were no differences for the times to death, discharge, or medical emergency call. There was a reduction in the probability of re-admission to hospital during the intervention phase (mean probability difference -0.08, 95% confidence interval -0.13 to -0.03). CONCLUSIONS: This nudge intervention was not sufficient to reduce the trial's non-beneficial treatment outcomes in older hospital patients. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry, ACTRN12619000675123 (registered 6 May 2019).


Assuntos
Assistência Terminal , Humanos , Masculino , Idoso de 80 Anos ou mais , Feminino , Idoso , Assistência Terminal/métodos , Estudos Prospectivos , Queensland , Unidades de Terapia Intensiva , Futilidade Médica , Retroalimentação , Admissão do Paciente , Fatores Etários , Medição de Risco
13.
Health Informatics J ; 30(2): 14604582241262707, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38871668

RESUMO

Objective: This study sought to assess the impact of a novel electronic audit and feedback (e-A&F) system on patient outcomes. Methods: The e-A&F intervention was implemented in a tertiary hospital and involved near real-time feedback via web-based dashboards. We used a segmented regression analysis of interrupted time series. We modelled the pre-post change in outcomes for the (1) announcement of this priority list, and (2) implementation of the e-A&F intervention to have affected patient outcomes. Results: Across the study period there were 222,792 episodes of inpatient care, of which 13,904 episodes were found to contain one or more HACs, a risk of 6.24%. From the point of the first intervention until the end of the study the overall risk of a HAC reduced from 8.57% to 4.12% - a 51.93% reduction. Of this reduction the proportion attributed to each of these interventions was found to be 29.99% for the announcement of the priority list and 21.93% for the implementation of the e-A&F intervention. Discussion: Our findings lend evidence to a mechanism that the announcement of a measurement framework, at a national level, can lead to local strategies, such as e-A&F, that lead to significant continued improvements over time.


Assuntos
Retroalimentação , Segurança do Paciente , Centros de Atenção Terciária , Humanos , Centros de Atenção Terciária/organização & administração , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Estudos Longitudinais , Auditoria Médica/métodos , Análise de Séries Temporais Interrompida/métodos
14.
Appl Ergon ; 119: 104323, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-38824829

RESUMO

In 2015, the VIRTUS helmet was introduced to UK Armed Forces and will ultimately replace the Mark 7 combat helmet. The VIRTUS helmet has a reduced trimline compared to the Mark 7 helmet and can incorporate attachments such as a visor, mandible guard and nape protection. An anonymous questionnaire was provided to 200 UK Armed Forces personnel deployed to four locations on Operation TORAL in Afghanistan between September and October 2019. This is the first User feedback survey assessing the VIRTUS helmet in an operational environment. Users were measured to ascertain the fit of their helmet and asked to rate perceived helmet mass and comfort using a 5-point Likert scale. Users were also asked whether the VIRTUS helmet was better than previous helmets and about their use of the nape protection. The VIRTUS helmet was perceived to be an improvement over previously issued UK combat helmets in terms of both comfort and mass.


Assuntos
Dispositivos de Proteção da Cabeça , Militares , Humanos , Reino Unido , Militares/psicologia , Inquéritos e Questionários , Masculino , Adulto , Desenho de Equipamento , Campanha Afegã de 2001- , Feminino , Afeganistão , Adulto Jovem , Comportamento do Consumidor , Retroalimentação
15.
Lancet Digit Health ; 6(7): e446-e457, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38906611

RESUMO

BACKGROUND: Despite the availability of effective treatments, most depressive disorders remain undetected and untreated. Internet-based depression screening combined with automated feedback of screening results could reach people with depression and lead to evidence-based care. We aimed to test the efficacy of two versions of automated feedback after internet-based screening on depression severity compared with no feedback. METHODS: DISCOVER was an observer-masked, three-armed, randomised controlled trial in Germany. We recruited individuals (aged ≥18 years) who were undiagnosed with depression and screened positive for depression on an internet-based self-report depression rating scale (Patient Health Questionnaire-9 [PHQ-9] ≥10 points). Participants were randomly assigned 1:1:1 to automatically receive no feedback, non-tailored feedback, or tailored feedback on the depression screening result. Randomisation was stratified by depression severity (moderate: PHQ-9 score 10-14 points; severe: PHQ-9 score ≥15 points). Participants could not be masked but were kept unaware of trial hypotheses to minimise expectancy bias. The non-tailored feedback included the depression screening result, a recommendation to seek professional diagnostic advice, and brief general information about depression and its treatment. The tailored feedback included the same basic information but individually framed according to the participants' symptom profiles, treatment preferences, causal symptom attributions, health insurance, and local residence. Research staff were masked to group allocation and outcome assessment as these were done using online questionnaires. The primary outcome was change in depression severity, defined as change in PHQ-9 score 6 months after random assignment. Analyses were conducted following the intention-to-treat principle for participants with at least one follow-up visit. This trial was registered at ClinicalTrials.gov, NCT04633096. FINDINGS: Between Jan 12, 2021, and Jan 31, 2022, 4878 individuals completed the internet-based screening. Of these, 1178 (24%) screened positive for depression (mean age 37·1 [SD 14·2] years; 824 [70%] woman, 344 [29%] men, and 10 [1%] other gender identity). 6 months after random assignment, depression severity decreased by 3·4 PHQ-9 points in the no feedback group (95% CI 2·9-4·0; within-group d 0·67; 325 participants), by 3·5 points in the non-tailored feedback group (3·0-4·0; within-group d 0·74; 319 participants), and by 3·7 points in the tailored feedback group (3·2-4·3; within-group d 0·71; 321 participants), with no significant differences among the three groups (p=0·72). The number of participants seeking help for depression or initiating psychotherapy or antidepressant treatment did not differ among study groups. The results remained consistent when adjusted for fulfilling the DSM-5-based criteria for major depressive disorder or subjective belief of having a depressive disorder. Negative effects were reported by less than 1% of the total sample 6 months after random assignment. INTERPRETATION: Automated feedback following internet-based depression screening did not reduce depression severity or prompt sufficient depression care in individuals previously undiagnosed with but affected by depression. FUNDING: German Research Foundation.


Assuntos
Depressão , Internet , Programas de Rastreamento , Humanos , Masculino , Feminino , Alemanha , Adulto , Pessoa de Meia-Idade , Depressão/diagnóstico , Programas de Rastreamento/métodos , Retroalimentação , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/terapia , Inquéritos e Questionários
16.
J Grad Med Educ ; 16(3): 286-295, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38882423

RESUMO

Background The integration of entrustable professional activities (EPAs) within objective structured clinical examinations (OSCEs) has yielded a valuable avenue for delivering timely feedback to residents. However, concerns about feedback quality persist. Objective This study aimed to assess the quality and content alignment of verbal feedback provided by examiners during an entrustment-based OSCE. Methods We conducted a progress test OSCE for internal medicine residents in 2022, assessing 7 EPAs. The immediate 2-minute feedback provided by examiners was recorded and analyzed using the Quality of Assessment of Learning (QuAL) score. We also analyzed the degree of alignment with EPA learning objectives: competency milestones and task-specific abilities. In a randomized crossover experiment, we compared the impact of 2 scoring methods used to assess residents' clinical performance (3-point entrustability scales vs task-specific checklists) on feedback quality and alignment. Results Twenty-one examiners provided feedback to 67 residents. The feedback demonstrated high quality (mean QuAL score 4.3 of 5) and significant alignment with the learning objectives of the EPAs. On average, examiners addressed in their feedback 2.5 milestones (61%) and 1.2 task-specific abilities (46%). The scoring methods used had no significant impact on QuAL scores (95% CI -0.3, 0.1, P=.28), alignment with competency milestones (95% CI -0.4, 0.1, P=.13), or alignment with task-specific abilities (95% CI -0.3, 0.1, P=.29). Conclusions In our entrustment-based OSCE, examiners consistently offered valuable feedback aligned with intended learning outcomes. Notably, we explored high-quality feedback and alignment as separate dimensions, finding no significant impact from our 2 scoring methods on either aspect.


Assuntos
Competência Clínica , Educação Baseada em Competências , Avaliação Educacional , Medicina Interna , Internato e Residência , Humanos , Competência Clínica/normas , Avaliação Educacional/métodos , Medicina Interna/educação , Educação Baseada em Competências/métodos , Retroalimentação , Educação de Pós-Graduação em Medicina/métodos , Feedback Formativo , Estudos Cross-Over , Lista de Checagem
18.
J Public Health Manag Pract ; 30: S96-S99, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38870366

RESUMO

Cardiovascular disease (CVD) disproportionately affects people of color and those with lower household income. Improving blood pressure (BP) and cholesterol management for those with or at risk for CVD can improve health outcomes. The New York City Department of Health implemented clinical performance feedback with practice facilitation (PF) in 134 small primary care practices serving on average over 84% persons of color. Facilitators reviewed BP and cholesterol management data on performance dashboards and guided practices to identify and outreach to patients with suboptimal BP and cholesterol management. Despite disruptions from the COVID-19 pandemic, practices demonstrated significant improvements in BP (68%-75%, P < .001) and cholesterol management (72%-78%, P = .01). Prioritizing high-need neighborhoods for impactful resource investment, such as PF and data sharing, may be a promising approach to reducing CVD and hypertension inequities in areas heavily impacted by structural racism.


Assuntos
COVID-19 , Colesterol , Registros Eletrônicos de Saúde , Atenção Primária à Saúde , Humanos , Cidade de Nova Iorque/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , COVID-19/epidemiologia , Colesterol/sangue , SARS-CoV-2 , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Pressão Sanguínea/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/epidemiologia , Feminino , Masculino , Melhoria de Qualidade , Pessoa de Meia-Idade , Retroalimentação
19.
Bull Math Biol ; 86(7): 84, 2024 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-38847946

RESUMO

Recent developments of eco-evolutionary models have shown that evolving feedbacks between behavioral strategies and the environment of game interactions, leading to changes in the underlying payoff matrix, can impact the underlying population dynamics in various manners. We propose and analyze an eco-evolutionary game dynamics model on a network with two communities such that players interact with other players in the same community and those in the opposite community at different rates. In our model, we consider two-person matrix games with pairwise interactions occurring on individual edges and assume that the environmental state depends on edges rather than on nodes or being globally shared in the population. We analytically determine the equilibria and their stability under a symmetric population structure assumption, and we also numerically study the replicator dynamics of the general model. The model shows rich dynamical behavior, such as multiple transcritical bifurcations, multistability, and anti-synchronous oscillations. Our work offers insights into understanding how the presence of community structure impacts the eco-evolutionary dynamics within and between niches.


Assuntos
Evolução Biológica , Teoria dos Jogos , Conceitos Matemáticos , Dinâmica Populacional , Dinâmica Populacional/estatística & dados numéricos , Humanos , Modelos Biológicos , Ecossistema , Simulação por Computador , Retroalimentação , Animais , Meio Ambiente
20.
Water Sci Technol ; 89(11): 3147-3162, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38877636

RESUMO

Real-time and model-predictive control promises to make urban drainage systems (UDS) adaptive, coordinated, and dynamically optimal. Though early implementations are promising, existing control algorithms have drawbacks in computational expense, trust, system-level coordination, and labor cost. Linear feedback control has distinct advantages in computational expense, interpretation, and coordination. However, current methods for building linear feedback controllers require calibrated software models. Here we present an automated method for generating tunable linear feedback controllers that require only system response data. The controller design consists of three main steps: (1) estimating the network connectivity using tools for causal inference, (2) identifying a linear, time-invariant (LTI) dynamical system which approximates the network, and (3) designing and tuning a feedback controller based on the LTI urban drainage system approximation. The flooding safety, erosion prevention, and water treatment performance of the method are evaluated across 190 design storms on a separated sewer model. Strong results suggest that the system knowledge required for generating effective, safe, and tunable controllers for UDS is surprisingly basic. This method allows near-turnkey synthesis of controllers solely from sensor data or reduction of process-based models.


Assuntos
Drenagem Sanitária , Modelos Teóricos , Cidades , Retroalimentação
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