Practice-based Intervention Research Articles

Factors impacting breast cancer survivors' performance of annual follow-up mammograms: A nationally representative study.

ObjectiveGuided by the PRECEDE-PROCEDE model, this study explores the factors associated with completing an annual screening mammogram among breast cancer survivors (BCS). MethodsWe used multiple cycles of survey data from the Health Information National Trends Survey (HINTS) (2017–2020). Logistic regression analyses were conducted to examine the correlates of past year mammograms among breast cancer survivors. ResultsWe included a sample of 909 breast cancer survivors in the study. Seventy percent of the sample reported at least one mammography screening in the prior 12 months. The more time since diagnosis, the fewer participants performed screening. Consistent with the PRECEDE-PROCEDE Model, annual screening was associated with enabling factors (having health insurance), reinforcing factors (trust in doctors, patient-centered communication), and predisposing factors (cancer-related worry and quality of care). ConclusionsFindings suggest that thirty percent of BCS may experience barriers to receipt of follow-up mammograms. Additional research is needed to identify strategies that address demographic, enabling, reinforcing, and predisposing factors with the ultimate goal of improving access to follow-up mammography and ensuring the well-being of breast cancer survivors.Practice ImplicationsCancer surveillance among BCS is vital to improving health outcomes. Provider and practice-based interventions can potentially increase access and engagement with annual screening recommendations.

A pediatric primary care practice-based obesity intervention to support families: a cluster-randomized clinical trial.

The American Academy of Pediatrics recommends that pediatric practices help families make lifestyle changes to improve BMI, but provider time and access to treatment are limited. This study compared the effectiveness of two pediatric practice-based referral interventions in reducing BMI. In this cluster-randomized clinical trial, 20 pediatric primary care practices were randomized to telephonic coaching (Fitline Coaching) or mailed workbook (Fitline Workbook). Parents and their 8- to 12-year-old children with BMI ≥ 85th percentile completed assessments at baseline and at6 and 12 months post baseline. Primary outcomes were 12-month BMI percentile and z score. A total of 501 children and their parents received Fitline Coaching (n = 243) or Fitline Workbook (n = 258); 26.8% had overweight, 55.4% had obesity, and 17.8% had severe obesity. Mean (SD) age was 10.5 (1.4), and 47.5% were female. BMI percentile improved in both groups; 12-month decline in continuous BMI z score was not statistically significant in either group. However, 20.8% of telephonic coaching participants and 12.4% of workbook participants achieved a clinically significant reduction of at least 0.25 in BMI z score, a significant between-group difference (p = 0.0415). Both low-intensity interventions were acceptable and produced modest improvements in BMI percentile. One in five children in the telephonic coaching condition achieved clinically meaningful BMI z score improvements. However, more research is needed before such a program could be recommended for pediatric primary care practice.

An exploratory randomised trial investigating feasibility, potential impact and cost effectiveness of link workers for people living with multimorbidity attending general practices in deprived urban communities

BackgroundSocial prescribing link workers are non-health or social care professionals who connect people with psychosocial needs to non-clinical community supports. They are being implemented widely, but there is limited evidence for appropriate target populations or cost effectiveness.This study aimed to explore the feasibility, potential impact on health outcomes and cost effectiveness of practice-based link workers for people with multimorbidity living in deprived urban communities.MethodsA pragmatic exploratory randomised trial with wait-list usual care control and blinding at analysis was conducted during the COVID 19 pandemic (July 2020 to January 2021). Participants had two or more ongoing health conditions, attended a general practitioner (GP) serving a deprived urban community who felt they may benefit from a one-month practice-based social prescribing link worker intervention.. Feasibility measures were recruitment and retention of participants, practices and link workers, and completion of outcome data. Primary outcomes at one month were health-related quality of life (EQ-5D-5L) and mental health (HADS). Potential cost effectiveness from the health service perspective was evaluated using quality adjusted life years (QALYs), based on conversion of the EQ-5D-5L and ICECAP-A capability index to utility scoring.ResultsFrom a target of 600, 251 patients were recruited across 13 general practices. Randomisation to intervention (n = 123) and control (n = 117) was after baseline data collection. Participant retention at one month was 80%. All practices and link workers (n = 10) were retained for the trial period. Data completion for primary outcomes was 75%. There were no significant differences identified using mixed effects regression analysis in EQ-5D-5L (MD 0.01, 95% CI -0.07 to 0.09) or HADS (MD 0.05, 95% CI -0.63 to 0.73), and no cost effectiveness advantages. A sensitivity analysis that considered link workers operating at full capacity in a non-pandemic setting, indicated the probability of effectiveness at the €45,000 ICER threshold value for Ireland was 0.787 using the ICECAP-A capability index.ConclusionsWhile the trial under-recruited participants mainly due to COVID-19 restrictions, it demonstrates that robust evaluations and cost utility analyses are possible. Further evaluations are required to establish cost effectiveness and should consider using the ICE-CAP-A wellbeing measure for cost utility analysis.RegistrationThis trial is registered on ISRCTN.Title: Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas.Trial ID: ISRCTN10287737.Date registered 10/12/2019.Link: https://www.isrctn.com/ISRCTN10287737

'ThinkCancer!': randomised feasibility trial of a novel practice-based early cancer diagnosis intervention.

UK cancer deaths remain high; primary care is key for earlier cancer diagnosis as half of avoidable delays occur here. Improvement is possible through lower referral thresholds, better guideline adherence, and better safety-netting systems. Few interventions target whole practice teams. We developed a novel whole-practice team intervention to address this. To test the feasibility and acceptability of a novel, complex behavioural intervention, 'ThinkCancer!', for assessment in a subsequent Phase III trial. Pragmatic, superiority pilot randomised controlled trial (RCT) with an embedded process evaluation and feasibility economic analysis in Welsh general practices. Clinical outcome data were collected from practices (the unit of randomisation). Practice characteristics and cancer safety-netting systems were assessed. Individual practice staff completed evaluation and feedback forms and qualitative interviews. The intervention was adapted and refined. Trial recruitment and workshop deliveries took place between March 2020 and May 2021. Trial progression criteria for recruitment, intervention fidelity, and routine data collection were met. Staff-level fidelity, retention, and individual level data collection processes were reviewed and amended. Interviews highlighted positive participant views on all aspects of the intervention. All practices set out to liberalise referral thresholds appropriately, implement guidelines, and address safety-netting plans in detail. 'ThinkCancer!' appears feasible and acceptable. The new iteration of the workshops was completed and the Phase III trial has been funded to assess the effectiveness and cost-effectiveness of this novel professional behaviour change intervention. Delivery at scale to multiple practices will likely improve fidelity and reach.

Improving mental health in chronic care in general practice: study protocol for a cluster-randomised controlled trial of the Healthy Mind intervention

BackgroundMental health issues are common among patients with chronic physical conditions, affecting approximately one in five patients. Poor mental health is associated with worse disease outcomes and increased mortality. Problem-solving therapy (PST) may be a suitable treatment for targeting poor mental health in these patients. This study protocol describes a randomised controlled trial of the Healthy Mind intervention, a general practice-based intervention offering PST to patients with type 2 diabetes and/or ischaemic heart disease and poor mental well-being.MethodsA stepped-wedge cluster-randomised controlled trial with 1-year follow-up will be conducted in Danish general practice. At the annual chronic care consultation, patients with type 2 diabetes and/or chronic ischaemic heart disease will be screened for poor mental well-being. Patients in the control group will be offered usual care while patients in the intervention group will be offered treatment with PST provided by general practitioners (GPs) or general practice staff, such as nurses, who will undergo a 2-day PST course before transitioning from the control to the intervention group. The primary outcome is change in depressive symptoms after 6 and 12 months. Secondary outcomes include change in mental well-being, anxiety, and diabetes distress (patients with type 2 diabetes) after 6 and 12 months as well as change in total cholesterol levels, low-density lipoprotein (LDL) levels, and blood glucose levels (patients with diabetes) after 12 months. Process outcomes include measures of implementation and mechanisms of impact. We aim to include a total of 188 patients, corresponding to approximately 14 average-sized general practices.DiscussionThe Healthy Mind trial investigates the impact of PST treatment for patients with chronic disease and poor mental well-being in general practice. This will be the first randomised controlled trial determining the effect of PST treatment for patients with chronic diseases in general practice. The results of this study will provide relevant insights to aid GPs, and general practice staff manage patients with poor mental well-being.Trial registrationClinicalTrials.gov NCT05611112. Registered on October 28, 2022.

Using an App-Based Mindfulness Intervention: A Mixed Methods Approach

Mindfulness-based practices are often utilized and substantial research supports the continued use of these practices as effective interventions. Mindfulness interventions that utilize focused breathing, app-based guidance, and brief duration may present mental health benefits. However, examining individuals’ unique experiences from continued engagement in brief app-based mindfulness interventions over time, as well as identifying potential barriers preventing the use, is understudied. The current study utilized a longitudinal mixed method design to understand the experiences of individuals using a widely available app-based (i.e., Apple Watch) mindfulness breathing intervention over a 2-week period by identifying the thematic patterns common among the individuals and how this affected their levels of depression, anxiety, and coping skills over time. Qualitative analysis revealed a general positive experience among the participants, as well as the importance of personalization related to mindfulness interventions. Quantitative findings indicated a significant increase in coping skills, but no substantial change in their levels of depression or anxiety after 2 weeks. Researchers should continue examining interventions that include the core aspects of mindfulness, while exploring variations of mindfulness duration, frequency, total length, and breath rate to determine maximum efficacy. Practice-based interventions should focus on the effective ways to implement app-based self-guided mindfulness interventions, such as being short in duration, personalized for daily use, and aligning the practice with key components of mindfulness.

The Effects of Applied Behavior Analysis on Verbal Behavior With Autistic Individuals Using the Verbal Behavior Milestones Assessment and Placement Program (VBMAPP) and the Assessment of Basic Language and Learning Skills (ABLLS).

Introduction Applied behavior analysis (ABA) is a fundamental practice-based intervention for treating autism spectrum disorder (ASD). Few studies have directly measured and evaluated the effects of ABA on verbal behaviors, mainly using the Verbal Behavior Milestones Assessment and Placement Program (VBMAPP) and the Assessment of Basic Language and Learning Skills (ABLLS) as outcome measures. This study aims to fill this gap by examining the relationship between ABA interventions and the enhancement of verbal skills, as measured by the VBMAPP and the ABLLS, in a convenience sample of individuals with ASD. Materials and methods At The Oxford Centers (TOCs) in Brighton and Troy, Michigan, USA, 33 individuals with autism received treatment from January 2018 to July 2021, spanning 43 months. A pretest-posttest design was employed to retrospectively examine any impacts between ABA interventions and alterations in verbal scores among individuals with ASD. Depending on developmental age, all subjects underwent two verbal assessments with a six-month interval in-between. Twelve children were administered the VBMAPP, while 21 were given the ABLLS. Results Paired t-tests for pretest and posttest VBMAPP subscales resulted in statistically significant effects (p<0.05) for (VBMAPP - Mand), (VBMAPP - Tact), (VBMAPP - Listener Responding), (VBMAPP - Visual Perceptual Skills and Matching-to-Sample), (VBMAPP -Independent Play), (VBMAPP - Social Play), (VBMAPP - Motor Imitation), (VBMAPP - Spontaneous Vocalization), (VBMAPP - Intraverbal), (VBMAPP - Group Behavior), and (VBMAPP - Linguistic Structure). As measured by Cohen's d, effect sizes were moderate to mostly high (-0.623to -1.688). There were non-significant results (p>0.05) for (VBMAPP - Listener Responding by Feature, Function, and Class) and (VBMAPP - Echoic). Paired t-tests for pretest and posttest ABLLS subscales resulted in statistically significant effects (p<.05) for all ABLLS scales: (ABLLS - Receptive Language), (ABLLS - Requests), (ABLLS - Labeling), (ABLLS - Intraverbals), (ABLLS - Spontaneous Vocalizations), (ABLLS - Syntax Grammar), (ABLLS - Social Interactions), and (ABLLS - Generalized Responding).As measured by Cohen's d, effect sizes were moderate to mostly high (-0.656 to -1.372). Conclusions The administration of ABA treatments had a noteworthy influence, with statistically significant impacts on improving verbal behaviors on 11 of the 13 VBMAPP scales and all of the ABLLS scales. As measured by Cohen's d, effect sizes were moderate to high for both scales. These findings underscore the importance and effectiveness of ABA interventions in enhancing verbal skills in children with ASD. However, it's crucial to note that further confirmatory studies are required to verify the reliability of these original findings, emphasizing the ongoing need for research in this field.

Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review.

To provide a systematic synthesis of primary care practice-based interventions and their effect on participation in population-based cancer screening programs. Globally, population-based cancer screening programs (bowel, breast, and cervical) have sub-optimal participation rates. Primary healthcare workers (PHCWs) have an important role in facilitating a patient's decision to screen; however, barriers exist to their engagement. It remains unclear how to best optimize the role of PHCWs to increase screening participation. A comprehensive search was conducted from January 2010 until November 2023 in the following databases: Medline (OVID), EMBASE, and CINAHL. Data extraction, quality assessment, and synthesis were conducted. Studies were separated by whether they assessed the effect of a single-component or multi-component intervention and study type. Forty-nine studies were identified, of which 36 originated from the USA. Fifteen studies were investigations of single-component interventions, and 34 studies were of multi-component interventions. Interventions with a positive effect on screening participation were predominantly multi-component, and most included combinations of audit and feedback, provider reminders, practice-facilitated assessment and improvement, and patient education across all screening programs. Regarding bowel screening, provision of screening kits at point-of-care was an effective strategy to increase participation. Taking a 'whole-of-practice approach' and identifying a 'practice champion' were found to be contextual factors of effective interventions.The findings suggest that complex interventions comprised of practitioner-focused and patient-focused components are required to increase cancer screening participation in primary care settings. This study provides novel understanding as to what components and contextual factors should be included in primary care practice-based interventions.

In what context does goal-oriented care thrive? A qualitative study investigating how contextual factors influence implementation efforts for goal-oriented care.

This study aims to explore how the concept of goal-oriented care is being picked up and adopted in Flanders, Belgium. Looking at the meso- and macro-level context: what drives the implementation process of goal-oriented care forward and what might hinder its uptake? This research helps individuals and organizations who want to introduce an innovation such as goal-oriented care inside their organization or in the broader primary care landscape by offering insights into an implementation process, in particular on how contextual elements influence implementation efforts. &#x0D; We conducted qualitative research, performing in-depth interviews with n=23 respondents who are involved with the implementation of goal-oriented care within their professional function, either on project level or strategic/policy level. This way, we learned about the perspectives and lived experiences of a wide range of actors working for governmental institutions, non profit organizations, provider organizations, patient organizations, health or social care organizations and care councils. Data were collected using a semi-structured interview guide, audio recorded, and analyzed first inductively and then deductively using a categorization of constructs into structural, organizational, provider, patient, and innovation level factors, as described by Chaudoir et al. (2013). &#x0D; Our preliminary findings suggest that facilitators for the implementation of goal-oriented care are mainly found on an organizational, provider and innovation level. Active commitment, overall recognition of goal-oriented care as quality of care and setting up a form of coordination are key. Most prominent barriers are found on a structural level, which shows that for goal-oriented care to be actually embedded in primary care the meso- and macro context structures and preconditions should be further shaped. &#x0D; Our findings can contribute to further translate the concept of goal-oriented care into a practice-based intervention. It gives insight in how to perform a context scan for a primary care intervention and highlights the dynamics between contextual factors and implementation efforts. The next step is to define implementation strategies for goal-oriented care that come forward out of the identified barriers and facilitators.

Is the practice of autonomy support the missing element in teacher training at university? A study on the effects of an intervention based on self-determination theory on biology preservice teachers' knowledge, beliefs, and intentions.

Teacher education at universities often lacks practice although preservice teachers should be equipped with effective teaching methods. We conducted an intervention to convey and practice autonomy-supportive teaching behavior (ASTB) with 63 preservice teachers. The first control group (n = 76) did not receive any information on ASTB. A second control group (n = 54) had their regular seminar on ASTB without practicing what they had learned. Significant differences in the participants’ (Mage = 24.18 ± 3.26 years; Msemester = 7.61 ± 1.84; 63% female) knowledge, beliefs, and intentions were found. Participants of the intervention had higher theoretical and practical knowledge regarding ASTB and a higher level of perception that ASTB is easy to implement than a seminar without information on ASTB (first control group) and the regular seminar (second control group). That is, their knowledge acquisition and their belief about the ease of implementation were positively affected by the intervention in comparison to both control groups. Although no significant differences were found, preservice teachers in the intervention group also showed the highest level of agreement with the belief about the effectiveness of ASTB and the most pronounced intention to implement ASTB. The results of our study show that the developed intervention based on self-determination theory had a positive impact on preservice teachers’ knowledge and beliefs about ASTB as well as their intention to apply it in the future. Since teacher education at university often lacks practice, the development of such effective theory- and practice-based interventions for preservice teachers is especially important. The practical skills acquired in our study are of particular importance for one central challenge teachers face in their profession: the need to counteract the decreasing trend of student motivation during secondary schooling.

"Everyone's struggling right now": Impact of COVID-19 on addressing food insecurity in rural primary care.

Primary care practices can address food insecurity (FI) through routine screening, practice-based food programmes, and referrals to community resources. The COVID-19 pandemic had disproportionate impacts on health outcomes for food-insecure households. To describe the impact of the COVID-19 pandemic on FI screening and interventions in rural primary care practices in northern New England. We conducted semi-structured interviews with thirteen providers and staff regarding changes to FI screening and interventions, community resources and partnerships, and patient food needs during the pandemic. Themes and exemplar quotations were identified through iterative discussion. Practices reported more frequent informal discussions with patients about FI during the pandemic. Despite limitations in site operations, practices created programmes to distribute food at practice locations or through food deliveries. The adoption of telemedicine had variable impacts on FI screening, creating challenges for some while facilitating screening outside of scheduled visits for others. Practices reported increased food availability due to new or expanded community programmes, but lack of transportation and delivery availability were challenges. New and stronger connections formed between practices and community partners. Increased awareness of FI among both patients and practice staff resulted in decreased stigma. Screening for and addressing FI was a priority for rural primary care practices during the pandemic. The implementation of practice-based FI interventions was supported by stronger practice-community connections and a decrease in stigma. The experiences of providers and staff during the pandemic provide insight into best practices for engaging primary care practices in reducing FI.

The development and feasibility evaluation of a program to identify and manage apathy in people with dementia: the SABA program

Objectives To develop and evaluate feasibility of a program for family and professional caregivers to identify and manage apathy in people with dementia: the Shared Action for Breaking through Apathy program (SABA). Methods A theory- and practice-based intervention was developed and tested among ten persons with apathy and dementia in two Dutch nursing homes from 2019 to 2021. Feasibility was evaluated with interviews with family caregivers (n = 7) and professional caregivers (n = 4) and two multidisciplinary focus groups with professional caregivers (n = 5 and n = 6). Results SABA was found feasible for identifying and managing apathy. Caregivers mentioned increased knowledge and awareness regarding recognizing apathy and its impact on their relationship with the person with apathy. They experienced increased skills to manage apathy, a greater focus on small-scale activities and increased appreciation of small moments of success. The content, form and accessibility of the program’s materials were considered facilitating by all stakeholders, as was the compatibility of the procedures with the usual way of working. The expertise and involvement of stakeholders, staff stability and the support of an ambassador and/or manager were facilitating, while insufficient collaboration was a barrier. Organizational and external aspects like not prioritizing apathy, staff discontinuity, and the Covid-19 pandemic were perceived as barriers. A stimulating physical environment with small-scale living rooms, and access to supplies for activities were considered facilitating. Conclusions SABA empowers family and professional caregivers to successfully identify and manage apathy. For implementation, it is important to take into account the facilitators and barriers resulting from our study.

Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting – results from a qualitative sub-study of the PICTURE trial

BackgroundThe results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study.MethodsQualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories.ResultsThe study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention.ConclusionThe primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach.Trial registrationThe main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.

MP54-13 A PRACTICE-BASED INTERVENTION TO IMPROVE THE CARE OF WOMEN WITH URINARY INCONTINENCE: PROTOCOL FOR A CLUSTER RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023MP54-13 A PRACTICE-BASED INTERVENTION TO IMPROVE THE CARE OF WOMEN WITH URINARY INCONTINENCE: PROTOCOL FOR A CLUSTER RANDOMIZED CONTROLLED TRIAL Kyle Okamuro, Catherine Bresee, Isabella Dolendo, Karyn Eilber, Ramy Eskander, Tamara Grisales, Jejo Koola, Allison Mays, Carmen Mendez, Marlene Millen, Teryl Nuckols, Joshua Pevnick, David Reuben, Jennifer Singer, Ming Tai-Seale, Florin Vaida, Katherine Ward, Neil Wenger, Tajnoos Yazdany, Xi Zhu, and Jennifer Anger Kyle OkamuroKyle Okamuro More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Isabella DolendoIsabella Dolendo More articles by this author , Karyn EilberKaryn Eilber More articles by this author , Ramy EskanderRamy Eskander More articles by this author , Tamara GrisalesTamara Grisales More articles by this author , Jejo KoolaJejo Koola More articles by this author , Allison MaysAllison Mays More articles by this author , Carmen MendezCarmen Mendez More articles by this author , Marlene MillenMarlene Millen More articles by this author , Teryl NuckolsTeryl Nuckols More articles by this author , Joshua PevnickJoshua Pevnick More articles by this author , David ReubenDavid Reuben More articles by this author , Jennifer SingerJennifer Singer More articles by this author , Ming Tai-SealeMing Tai-Seale More articles by this author , Florin VaidaFlorin Vaida More articles by this author , Katherine WardKatherine Ward More articles by this author , Neil WengerNeil Wenger More articles by this author , Tajnoos YazdanyTajnoos Yazdany More articles by this author , Xi ZhuXi Zhu More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence (UI) presents an immense human and financial burden to American women. The impact of this condition will only continue to rise as the population ages, yet primary care for UI has been inadequate to date. The primary objective of this study is to improve the quality of UI care provided to women through a controlled practice-based intervention for primary care providers. Secondary objectives include evaluating the effect of the intervention on referral rates to specialists, improving patient-centered outcomes, reducing disparities in care, and disseminating findings to a diverse population of patients and providers. METHODS: Sixty offices across 4 Southern California medical institutions will be randomized to receive a four-pronged practice-based incontinence intervention vs. routine care. The intervention involves academic detailing (physician education and individual performance feedback), clinical decision support (note templates, order sets, and best practice advisory), co-management with a dedicated advanced practice provider, and implementation of an electronic consult referral service in which inappropriate referrals are returned with recommendations. RESULTS: The quality of care, as measured by compliance with a set of 12 quality indicators, will be measured across the arms after implementation of the intervention. Patient-reported outcomes and utilization of specialists will also be compared. After the initial intervention phase, there will be a validation phase in which the control group will cross over and receive the intervention. CONCLUSIONS: The potential reach of this pragmatic practice-based trial in Southern California is vast—with 900 patients, 225 providers, 60 offices, and 4 medical institutions directly impacted. The results of the study will also contribute to the translation of patient-centered outcomes research into clinical practice, impacting women locally and nationally. Source of Funding: Funded by the Agency for Healthcare Research and Quality. Project 1U18HS028740 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e758 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Okamuro More articles by this author Catherine Bresee More articles by this author Isabella Dolendo More articles by this author Karyn Eilber More articles by this author Ramy Eskander More articles by this author Tamara Grisales More articles by this author Jejo Koola More articles by this author Allison Mays More articles by this author Carmen Mendez More articles by this author Marlene Millen More articles by this author Teryl Nuckols More articles by this author Joshua Pevnick More articles by this author David Reuben More articles by this author Jennifer Singer More articles by this author Ming Tai-Seale More articles by this author Florin Vaida More articles by this author Katherine Ward More articles by this author Neil Wenger More articles by this author Tajnoos Yazdany More articles by this author Xi Zhu More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF downloadLoading ...

MP72-06 IMPORTANCE OF PRIMARY CARE LEADERSHIP INVOLVEMENT: RECRUITMENT LESSONS FROM AN OFFICE-BASED URINARY INCONTINENCE INTERVENTION

You have accessJournal of UrologyCME1 Apr 2023MP72-06 IMPORTANCE OF PRIMARY CARE LEADERSHIP INVOLVEMENT: RECRUITMENT LESSONS FROM AN OFFICE-BASED URINARY INCONTINENCE INTERVENTION Kyle Okamuro, Catherine Bresee, Isabella Dolendo, Karyn Eilber, Ramy Eskander, Tamara Grisales, Jejo Koola, Allison Mays, Carmen Mendez, Marlene Millen, Teryl Nuckols, Joshua Pevnick, David Reuben, Jennifer Singer, Ming Tai-Seale, Florin Vaida, Katherine Ward, Neil Wenger, Tajnoos Yazdany, Xi Zhu, and Jennifer Anger Kyle OkamuroKyle Okamuro More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Isabella DolendoIsabella Dolendo More articles by this author , Karyn EilberKaryn Eilber More articles by this author , Ramy EskanderRamy Eskander More articles by this author , Tamara GrisalesTamara Grisales More articles by this author , Jejo KoolaJejo Koola More articles by this author , Allison MaysAllison Mays More articles by this author , Carmen MendezCarmen Mendez More articles by this author , Marlene MillenMarlene Millen More articles by this author , Teryl NuckolsTeryl Nuckols More articles by this author , Joshua PevnickJoshua Pevnick More articles by this author , David ReubenDavid Reuben More articles by this author , Jennifer SingerJennifer Singer More articles by this author , Ming Tai-SealeMing Tai-Seale More articles by this author , Florin VaidaFlorin Vaida More articles by this author , Katherine WardKatherine Ward More articles by this author , Neil WengerNeil Wenger More articles by this author , Tajnoos YazdanyTajnoos Yazdany More articles by this author , Xi ZhuXi Zhu More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003340.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Low rates of recruitment pose significant barriers to the success of trials and can lead to incomplete trials, insufficient power, and inconclusive results. There is limited literature on strategies to recruit providers for studies evaluating practice-based interventions. We sought to identify barriers to recruitment of primary care (PC) providers and improve enrollment for an office-based urinary incontinence (UI) intervention. METHODS: The intervention consists of a combination of academic detailing, clinical decision support, co-management with a dedicated advanced practice provider, and implementation of an e-consult referral service, in which referrals lacking appropriate primary UI care are returned. The recruitment goal of the study is to enroll 225 providers, across 60 primary care offices within 4 Southern California medical groups. Recruitment barriers were identified based on clinician and PC leadership feedback. RESULTS: Between February and October 2022, meetings were held between study investigators and PC leadership at each site to identify eligible PC offices. Offices were excluded for intrinsic and extrinsic factors incompatible with the study design including lack of integration with the electronic medical record environment and transitioning clinical leadership. Eligible offices were contacted and asked to participate. Providers cited time constraints, prioritization of other medical issues during the visit, discomfort providing UI counsel or initiating UI medications, and concerns of increased clinic burden as barriers to enrollment. Strategies that improved provider buy-in included PC leadership emphasizing the implementation of Medicare 5 Star metrics for UI as the future of standard clinical care, investigators integrating provider feedback into the design of the intervention, and emphasizing study interventions that could reduce clinical burden. With these strategies, 61 offices across the 4 sites agreed to participate. CONCLUSIONS: Lower than expected recruitment rates threaten the success of a clinical trial. Early identification of potential barriers and involvement of PC leadership in intervention design and office selection can improve recruitment rates and lead to high-quality practice-based intervention trials. Source of Funding: Funded by the Agency of Healthcare Research and Quality. Project 1U18HS028740 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1026 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Okamuro More articles by this author Catherine Bresee More articles by this author Isabella Dolendo More articles by this author Karyn Eilber More articles by this author Ramy Eskander More articles by this author Tamara Grisales More articles by this author Jejo Koola More articles by this author Allison Mays More articles by this author Carmen Mendez More articles by this author Marlene Millen More articles by this author Teryl Nuckols More articles by this author Joshua Pevnick More articles by this author David Reuben More articles by this author Jennifer Singer More articles by this author Ming Tai-Seale More articles by this author Florin Vaida More articles by this author Katherine Ward More articles by this author Neil Wenger More articles by this author Tajnoos Yazdany More articles by this author Xi Zhu More articles by this author Jennifer Anger More articles by this author Expand All Advertisement PDF downloadLoading ...

Supporting chaplains on the frontlines of the COVID-19 pandemic: A mixed-method practice-based pilot intervention study.

During the coronavirus disease 2019 (COVID-19) pandemic, chaplains have played a pivotal role in patient, family member, and staff care. However, little empirical attention has been given to (a) the potential toll of frontline spiritual care on chaplains' mental health and occupational functioning as well as (b) the development of interventions that can help ameliorate these risks and promote resilience. Using a mixed-method practice-based design, we conducted a pilot study (n = 77) to evaluate a novel spiritually integrated support group intervention for chaplains across multiple industries, which consisted of five Zoom-based sessions cofacilitated by psychotherapists. Participants completed pre- and postintervention measures of traumatic stress, burnout, spiritual/moral struggles, flourishing, resilience, and overall experience in the group. Qualitative findings elucidated the salience of peer support, therapeutic group processes, and key intervention components that warrant further study. Quantitative results indicated significant (a) decreases in burnout and spiritual/moral struggles from pre- to postintervention as well as (b) increases in sense of resilience and flourishing. Findings of this pilot study offer preliminary evidence for the use of a spiritually integrated group model to decrease isolation, address moral and spiritual distress, and promote resilience among chaplains. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

STRONGER MEMORY: EXPERIENCES OF OLDER ADULTS AND CAREGIVERS IN AN INTERVENTION PROGRAM FOR COGNITIVE PERFORMANCE

Abstract Subjective cognitive decline (SCD), defined as self-reported memory issues that have worsened over the past year, can be one of the first indications of Alzheimer’s disease and related dementias. SCD affects nearly 9% of Virginians aged 45 or older, and 31% of these individuals live alone. A practice-based intervention is essential to addressing the challenges associated with cognitive impairment. This study examined the effect of StrongerMemory program, which involves a series of cognitive exercises. The StrongerMemory program provides a 12-week curriculum designed to stimulate the brain’s prefrontal cortex, which governs the ability to retrieve memories. Participants are encouraged to spend 20 to 30 minutes a day reading aloud, writing or journaling and completing simple math problems. The Mason Gerontology Research Team investigated the pre- and post-cognitive outcomes among 43 participants who participated in the StrongerMemory program to determine the effectiveness of the program. The cognitive outcomes were evaluated using the Mini Montreal Cognitive Assessment 2.1 (Mini MoCA). The mean (SD) scores in Mini MoCA evaluated in the participants were 12.60 ± 2.1 (pre-test) and 13.53 ± 1.9 (post-test). The mean difference was statistically significant. Our results indicate that the StrongerMemory program is beneficial for cognition. The premise around the StrongerMemory program is that prior to a diagnosis or even with a diagnosis of mild cognitive impairment, a decline can be slowed and possibly prevented by participating in a program like StrongerMemory. The Mason Gerontology Research Team continues to evaluate the StrongerMemory program to examine its impact on SCD.

Measuring changes in nursing students' workplace performance following feedback encounters: A quasi-experimental study

BackgroundWork-integrated learning and performance is intimately linked with assessment and feedback; however, empirical evidence concerning the impact of feedback on student performance in workplace settings is limited. A novel practice-based feedback intervention—the REMARK (nuRse fEedback iMplementAtion frameworRK) program—was developed and implemented. Sustainable feedback processes that involve both learners and learning partners can ultimately maximise learning outcomes, optimise self-regulation, and impact performance. ObjectivesTo determine the impact of implementing an educational intervention based on best practice principles of feedback on undergraduate nursing student performance during clinical placements in acute healthcare settings. MethodsA non-equivalent, quasi-experimental design was used. A pre- and post-assessment strategy for both control and intervention groups was employed. The REMARK program was based on known attributes of effective feedback critiqued in the literature that foster interactions between a learner and learning partner and, hence, support dialogic feedback. ResultsClinical assessment data of 214 final-year nursing students collected at three time points were analysed. Using multivariate modelling, the results indicated that students participating in the REMARK programme (intervention group) had statistically higher performance scores than students in the control group when time and placement setting were controlled. ConclusionsThis research provides evidence that engagement with an intervention based on attributes of effective feedback improves nursing students' workplace performance during clinical placement. To achieve the greatest advantage, incorporating strategies that encourage students to adopt an active role in feedback conversations that relate to the student's learning goals are recommended.

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

David O. Warner, M.D., Recipient of the 2022 Excellence in Research Award

Kindness as Ethics-in-Practice in the business curriculum

This research explores the pedagogic potential of kindness as a taught construct within a business ethics programme. Kindness in the curriculum is a topic often taught in early years’ education (Kindness Curriculum, 2020) but seldom at tertiary level and this research will investigate the intrinsic and extrinsic reasons for this context (Caldwell &amp; Bird, 2015). Business studies can provide students with the knowledge and skills essential to leading and managing people and resources. Inter alia, business ethics teaches the fundamentals of refraining from corruption and unfair competition. Furthermore, business ethics programmes might eschew traditional ethical theory, promoting instead such constructs as Triple Bottom Line (TBL) thinking (Giddings, 2002), Corporate Social Responsibility (CSR) and Corporate Citizenship. This research considers the taught benefits of modelling philanthropy (kindness delivered at the corporate level) as one positive aspect of business ethicality. Instilling dispositions towards ethical behaviour (‘virtues’) at both the individual and company level remains a key goal of business ethics education. The ‘humane’ virtues as conceptualised within the modern Positive Psychology movement (Banicki, 2014; Peterson &amp; Seligman, 2004) provide a theoretical underpinning for understanding kindness as a behavioural disposition, a tendency to ‘tend and befriend’ (Peterson &amp; Seligman, 2004) that reliably generates ethical businesses grounded in ethical employees (Sternberg, 2001). This research argues that, for a business ethics course, business viewed through the lens of kindness should not be seen through the eyes of the student or the practitioner as an extracurricular activity but deconstructed as ethics-in-practice. The practice-based research intervention is in the form of a one-day student enrichment activity. The enrichment activity takes the form of a case study which looks at kindness through the lens of philanthropy. Students analyse a new case study exploring business philanthropy intervention, then complete a survey to review their opinion on key aspects of ethicality in business. Students evaluated the interconnectedness between ethics and how positive psychology is embedded in business. Thematic analysis was used to determine (a) ways of measuring values in action by doing good, and (b) changes in students’ understanding of the role of ethics in business upon completion of the intervention. However, in summary our research suggests that kindness embedded in the business curriculum and academics have a key role in facilitating this improvement.