Pretest-posttest Intervention Study Research Articles

Impact of the ´Alforja Educativa’ on Ecuadorian schoolchildren’s knowledge of bacteria, antibiotics, and antibiotic resistance, a pretest-posttest study

BackgroundWidespread use of antibiotics disrupts the balance in the microbial world and promotes development and spread of antibiotic resistant bacteria. Educational initiatives are important as part of strategies to mitigate antibiotic resistance. The Alforja Educativa is an innovative educational program developed in Ecuador with the aim to teach schoolchildren about antibiotic use and antibiotic resistance. The program places antibiotic resistance within a broader frame of health, well-being, and ecological awareness, highlighting the importance to maintain balance in the microbial world. The objective of this study was to evaluate the effect of the Alforja Educativa on knowledge about bacteria, antibiotics and antibiotic resistance amongst fifth and sixth grade Ecuadorian schoolchildren.MethodsThis pretest-posttest intervention study was conducted between April and June 2017 and comprised fifth and sixth grade schoolchildren from 20 schools in Cuenca, Ecuador, recruited by purposeful sampling. The Alforja Educativa was implemented over twelve 80-minute sessions by trained university students. Schoolchildren’s knowledge was assessed before and after participation in the educational program using a structured questionnaire. A mean total score, the proportion of correct responses for each individual knowledge-based question, as well as correct responses for each of the multiple-choice options of the knowledge-based questions were calculated for the pretest and posttest.ResultsA total of 1,257 schoolchildren participated in the Alforja Educativa program, of which 980 (78%) completed both the pretest and posttest. Overall, the mean total knowledge score increased from pretest to posttest (2.58/7.00 vs. 3.85/7.00; CI = 0.5, p < 0.001). After participation in the program, the proportion of schoolchildren that correctly identified that bacteria can be both good and bad increased from 35.0 to 84.3%. In addition, scores increased for correctly identifying the meaning of antibiotic resistance (37.4–72.0%); how to prevent antibiotic resistance (63.2–74.6%); and for identifying the meaning of self-medication (46.3–54.3%).ConclusionThe Alforja Educativa was effective in improving the knowledge of participating schoolchildren about concepts related to bacteria, antibiotics and antibiotic resistance. The holistic perspective taken to explain the complex relationship between humans and bacteria, as well as the effect of antibiotics on the microbial world, may help provide a foundation for more sustainable antibiotic use.

Implementation of a Frailty Care Bundle (FCB) Targeting Mobilisation, Nutrition and Cognitive Engagement to Reduce Hospital Associated Decline in Older Orthopaedic Trauma Patients: Pretest-Posttest Intervention Study.

To implement and evaluate a Frailty Care Bundle (FCB) targeting mobilisation, nutrition, and cognition in older trauma patients to reduce hospital associated decline. We used a two group, pretest-posttest design. The FCB intervention was delivered on two orthopaedic wards and two rehabilitation wards, guided by behaviour change theory (COM-B) to implement changes in ward routines (patient mobility goals, nurse assisted mobilisation, mealtimes, communication). Primary outcomes were patient participants' return to pre-trauma functional capability (modified Barthel Index - mBI) at 6-8 weeks post-hospital discharge and average hospital daily step-count. Statistical analysis compared pre versus post FCB group differences using ordinal regression and log-linear models. We recruited 120 patients (pre n=60 and post n=60), and 74 (pre n=43, post n=36) were retained at follow-up. Median age was 78 years and 83% were female. There was a non-significant trend for higher mBI scores (improved function) in the post compared to pre FCB group (OR 2.29, 95% CI 0.98-5.36), associated with an average 11% increase in step-count. It was feasible, during the Covid-19 pandemic, for multidisciplinary teams to implement elements of the FCB. Clinical facilitation supported teams to prioritise fundamental care above competing demands, but sustainability requires ongoing attention. ISRCTN registry: ISRCTN15145850 (https://doi.org/10.1186/ISRCTN15145850).

Improving Clinician Communication through Action Research.

There are many challenges to interdisciplinary communication in home care. Management often takes a top-down approach, instructing home care clinicians on methods to improve communication. In this pretest-posttest intervention study, a bottom-up approach was taken using a focus group to allow home care clinicians to identify, develop, and implement strategies to share critical clinical and social information. The participants in the intervention group were compared with a control group who did not participate in the focus group. We found that empowering home care clinicians to develop strategies to improve interdisciplinary communication was beneficial in improving interdisciplinary collaboration. Actively involving home care clinicians in identifying issues and developing solutions may lead to improved collaboration.

Effects of combined exercises on shoulder mobility and strength of the upper extremities in breast cancer rehabilitation: a 3-week randomized controlled trial

PurposeThe aim of this study was to analyze the effects of mobility training with FIVE® devices in combination with device-supported strength exercises for shoulder mobility and strength of the upper extremities in women with breast cancer.MethodsWe conducted a pretest-posttest intervention study with female breast cancer patients (n = 41) who were randomly assigned to two groups by lot during their stationary follow-up treatment at a rehabilitation clinic in the south of Germany between February and March 2020. As part of exercise therapy, the intervention group (n = 24) performed a mobility training with FIVE® devices combined with device-supported strength training, whereas the control group (n = 17) completed device-supported strength training. Before and after the 3-week intervention (3 training sessions/week), shoulder mobility and isokinetic maximal strength were tested.ResultsBoth groups achieved significant improvements in shoulder mobility in the frontal and sagittal plane (between 3.8 and 15.35%; p < 0.05) and in strength performance (31.36% [IG] vs. 51.24% [CG]; p < 0.001). However, no robust evidence could be determined about potential interaction effects.ConclusionA combined device-supported strength and mobility training (FIVE®) showed no advantages. Therefore, a variety of exercise methods is possible in exercise therapy of breast cancer patients.Clinical trial registration numberSince the University of Education Weingarten does not assign clinical trial registration numbers or ethical approval numbers, none could be assigned for this study.

The impact of a cognitive impairment support program on patients in an acute care setting: a pre-test post-test intervention study

BackgroundPatients with cognitive impairment are at greater risk of hospital acquired complications, longer hospital stays, and poor health outcomes compared to patients without cognitive impairment. The Cognitive Impairment Support Program is a multi-disciplinary approach to improve screening rates and awareness of patients with cognitive impairment and guide clinician response and communication during their hospitalisation to improve health outcomes.ObjectiveThis study evaluated the impact of implementing the Cognitive Impairment Support Program on patient hospital acquired complications, patient reported quality of life and staff satisfaction in an outer metropolitan hospital.DesignA pre-test post-test design was used to collect data in two 6-month time periods between March 2020 and November 2021.ParticipantsPatients aged ≥ 65 years, admitted to a participating ward for > 24 h.InterventionThe Cognitive Impairment Support Program consisted of four components: cognitive impairment screening, initiation of a Cognitive Impairment Care Plan, use of a Cognitive Impairment Identifier and associated staff education.MeasuresThe primary outcome was hospital acquired complications experienced by patients with cognitive impairment identified using clinical coding data. Secondary outcomes were patient quality of life and a staff confidence and perceived organisational support to care for patients with cognitive impairment.ResultsHospital acquired complication rates did not vary significantly between the two data collection periods for patients experiencing cognitive impairment with a 0.2% (95% confidence interval: -5.7–6.1%) reduction in admissions with at least one hospital acquired complication. Patients in the post intervention period demonstrated statistically significant improvements in many items in two of the Dementia Quality of Life Measure domains: memory and everyday life. The staff survey indicated statistically significant improvement in clinical staff confidence to care for patients with cognitive impairment (p = 0.003), satisfaction with organisational support for patients (p = 0.004) and job satisfaction (p ≤ 0.001).ConclusionThis study provides evidence that a multicomponent Cognitive Impairment Support Program had a positive impact on staff confidence and satisfaction and patient quality of life. Broader implementation with further evaluation of the multicomponent cognitive impairment intervention across a range of settings using varied patient outcomes is recommended.

On-site communication skills education increases client-centered communication in four companion animal practices.

To evaluate veterinarian-client communication before and after a 15-month on-site communication skills training intervention. Multipractice, pretest-posttest intervention study. A convenience sample of 4 companion animal practices owned by a single practice group in Austin, Texas (n = 9 veterinarians; 170 audio recordings). After intervention, visits were 8 minutes longer (P = .005), and veterinarians' client-centered scores increased significantly (2.30 vs 2.72; P = .006). Veterinarians' biomedical questions decreased by nearly a third (P = .0007), while veterinarians' facilitation (ie, partnership-building) statements were 1.15 times as great (P = .04) after intervention due to an increase in asking for the client's opinion (P = .03) and use of back-channel statements (P = .01). Agenda-setting skills, including agenda-setting questions (P = .009), summary of the client's agenda (P = < .0001), and a check for remaining concerns (P = .013), increased significantly after intervention. Clients asked 1.9 times as many lifestyle-social related questions (P = .02) and provided 1.3 times as much lifestyle-social information (P = .0004) after the intervention. Additionally, clients offered 1.4 times as many emotion-handling statements (P = .0001), including showing concern (P = .03) and optimism, reassurance, or encouragement (P < .0001), after intervention. Paraverbally, clients presented as more anxious/nervous (P = .03) and emotionally distressed/upset (P = .02) after the intervention. Results suggest that client-centered communication skills increased after intervention. This study builds upon previous case-based studies examining practice-based communication training, emphasizing that long-term interventions positively enhance veterinarian-client communication, which is likely to have a positive impact on client and patient care.

Perceptions of interprofessional collaboration at the intersection of child welfare and child and adolescent psychiatry in Germany

In Germany (and other countries) a significant proportion of children and young people in contact with the child welfare system do not receive adequate mental health care. Fragmented service delivery has been partially attributed to a lack of interprofessional collaboration between the child welfare system and providers of child mental health services. Child and adolescent psychiatric (CAP) clinics provide the majority of child mental health care for the child welfare population in Germany. In this paper, we present the first wave of data collected in a nonrandomized pretest–posttest intervention study, in which we examined the collaboration between child welfare services and CAP clinics in Northern Germany with a sample of N = 204 professionals in total, from both organizations. We used two standardized measurements. The general quality of collaboration was measured using an established tool, the “Perceptions of Interprofessional Collaboration Model – Questionnaire” (PINCOM-Q). Perceptions of collaboration around children with complex care needs were measured with a newly developed scale, the “Perceptions of Interprofessional Collaboration Scale for Children with Multiple and Complex Needs” (PICOCC). The results show that perceptions of interprofessional collaboration differed based on organizational and professional affiliation. Frontline workers employed in the child welfare system compared to those working in CAP clinics had a more negative perception of collaboration in general, and felt their organization provided less support for collaboration. Social workers in both CAP and child welfare services perceived less organizational support for collaboration compared to mental health professionals. In the overall group of social workers, those working in the child welfare system felt their organization supported collaboration the least. Mental health professionals working in CAP clinics, however, had a more negative perception of collaboration around children with complex needs. This suggests that attention should be paid to perceptions of interprofessional collaboration as an important process variable, which may impact on frontline workers’ responsiveness to organizational change.

Drill; A Solution to Reduce Mistriage in Prehospital Emergency Setting

Background: Triage is used as one of the main concepts in the emergency medicine to differentiate between critically ill patients or patients in a non-emergency situation. Miss-triage occurs if the prioritization of patients or injured is not done correctly for any reason. Miss-triage occurs in two forms of over and under triage. According to studies, the incidence of miss-triage is high worldwide. Exercising is one of the ways to reduce the amount of miss-triage. Objectives:. This two-group pretest post-test intervention study aimed to investigate the effect of drilling on the miss-triage of emergency medical service personnel. Methods: The tools used in this study included: demographic information form questionnaire, Triage Decision Making Inventory (TDMI), and designed START/jump START triage scenarios. After collecting the required data, these data were analyzed by appropriate parametric and non-parametric statistical tests, including mean and standard deviation, independent t-test, paired t-test, K-square. Results: Results showed that the Miss-triage rate decreased from (34.1%) before the intervention to (9.1%) after the intervention in the experimental group. Moreover, after drill, the score of triage decision-making power increased from (121) to (136.91). However, in the control group, no statistically significant change was observed in the amount of miss-triage and triage decision-making power in emergency medical service personnel at the end of the study (p&gt;.05). Conclusion: The findings of the present study revealed the effectiveness of this exercise method in reducing miss-triage in participants. Thus, this method could be used in emergency medical service personnel training and preparation programs.

Nurse-led eHealth transition care program for adolescents with spina bifida: A feasibility and acceptability study

PurposeThis study aimed to evaluate the feasibility and acceptability of a nurse-led eHealth transition care program for adolescents with spina bifida. Design and methodsThis study used a single-arm, pretest-posttest intervention study. Adolescents with spina bifida, aged 12–15 years, and their parents participated in the program. A 6-week program was delivered through an online platform in real-time by nurses. We evaluated feasibility and acceptability using criteria such as the completion rate, program satisfaction, changes in transition readiness, social support, career preparation behavior, sexual knowledge, and sexual worries at three time points from July to September 2021. ResultsThirteen adolescents completed all sessions and surveys (13/14, 92.9%). All adolescents expressed high satisfaction with both the content and delivery methods of the program. Significant benefits in transition readiness, career preparation behavior, and sexual knowledge were identified over the study period. However, the evaluation of social support and sexual worries did not demonstrate any significant improvements. Additionally, through family counseling, adolescents benefited from experiences such as reflecting on their current transition readiness, setting and achieving individualized goals and plans using a self-checklist with their parents and nursing professionals. ConclusionThis nurse-led eHealth intervention was feasible and acceptable for adolescents with spina bifida. Furthermore, our results highlight the practicability and the potential for strategic dissemination of using this eHealth program in transitional care during the COVID-19 pandemic. Practice implicationsThe eHealth transition care program contributes to broadening existing nursing interventions not only in medical areas but also in daily life areas.

364 Improving hairdressers’ knowledge and identification of hair loss disorders with use of an educational video

Hair loss, regardless of cause, can have a significant impact on self-esteem, mental health, and quality of life. Early detection and treatment help to improve outcomes and lessen the emotional burden on patients. Lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), and central centrifugal cicatricial alopecia (CCCA) are forms of scarring alopecia that primarily affect women. Haircare professionals are often the first to note signs and symptoms of hair loss in their clients. However, the signs of hair loss, especially cicatricial alopecia (CA), for which early intervention is paramount, are not well known by hair stylists. We conducted a single-group, pretest-posttest intervention study to assess the use of an educational video in training hairdressers to identify signs of CA. Subjects included 40 hairdressers with a mean age of 44.1 and a mean of 20.3 years’ experience in haircare. Subjects completed a pre- and post-video questionnaire that assessed the subjects’ ability to identify clinical signs of scarring alopecia. Subjects showed increased knowledge about signs of CA after watching the video, with significantly more hair stylists correctly identifying perifollicular scale and redness as a sign of CA after watching the educational video compared to before (90% vs 50%, p<.001). Subjects also had increased ability to correctly identify photographs of persons with CA after watching the video (82.5% vs 57.5%, p=.003). Our data demonstrate that the education of hair stylists using a video can be effective in improving hairdressers’ ability to identify signs of CA. These results echo previous studies that have shown the effectiveness of videos in training hairdressers to detect melanoma. This intervention could lead to recommendations to seek dermatologic care and earlier treatment, improving patient outcomes.

Anesthcalc™ is Associated with Superior Accuracy and Faster Accomplishment in Simulation-based Anesthesia Drugs Dosage Calculation

Abstract Background: Medication error is one of the barriers to achieving sustainable patient safety. We aim to determine the efficacy and reliability of a smartphone dosage calculator application (AnesthCalc™) when compared with the manual calculation of various anesthetic drugs to prevent medication error. Materials and Methods: This is a pre-test–post-test intervention study. There are 52 participants who included residents in anesthesiology, which is divided into two groups. Each group performed two simulation cases in which they had to calculate drugs dosage in anesthesia settings. One set of cases was performed with the app and the other set was performed manually. The order of drugs and simulation patients was randomized. The accuracy and the deviation of administered drug doses were recorded. Accuracy of dosage was categorized as either accurate (80–100% of target dose) or inaccurate (less than 80%), whereas the deviation of dosage was categorized as either deviant (&lt;50% or &gt;200% of target dose) or safe (between the range). Results: There is a significant increase in the accuracy of calculation between the manual group and that using the app group (from 46% to 92%, a mean increase of 18.29%, P &lt; 0.005). There is a significant decrease in the duration of calculation between without using the app group and with using the app group (from 32.92 to 18.79 s, a mean decrease of 30.55 s, P = 0.001). Conclusion: AnesthCalc™ is a valid and reliable instrument as it increases users’ accuracy and shortens calculating time. AnesthCalc™ may be the potential to reduce calculation errors and may increase patients’ safety.

Cardio-pulmonary-resuscitation for people who use a wheelchair and/or have an atypical chest shape: an educational intervention

Purpose To determine the impact of the addition of information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes on staff confidence to respond to emergency scenarios with these populations. Materials and methods A pre-test post-test intervention study was conducted with staff from one of the largest disability organisations in Tasmania, Australia. Supplemented CPR and BLS classes were presented to participants. A purpose-designed questionnaire was completed pre, post, and six-months post after the training. Results A significant rise in confidence post-training was demonstrated, and this was retained at the six-month time point. Time spent in the disability sector before the supplemented training or attendance at previous standard CPR classes did not have a significant effect on confidence levels before the supplemented training. Conclusions Confidence is closely linked to willingness to act during emergency situations. Improved confidence may therefore result in improved willingness to act for people with disability, atypical chest shapes, and wheelchair users, thus improving health outcomes for these populations and providing this cohort with access to more equitable healthcare. IMPLICATIONS FOR REHABILITATION Guidelines for undertaking CPR and BLS on people with atypical chest shapes and/or in a wheelchair are not currently available. Including information specific to people with atypical chest shapes and/or in a wheelchair during mandatory CPR classes increases staff confidence to respond to such situations. Supplementary disability-specific information can be successfully incorporated into existing CPR and BLS training.

Effectiveness of training in increasing awareness about managing pressure injuries in emergency departments

IntroductionEmergency room conditions and the characteristics of the patients followed up pose a risk for pressure injury. AimThis study was conducted as a pilot study to assess the effectiveness of a training program in increasing the awareness of healthcare professionals working in an emergency department about how to manage pressure injuries. MethodsThe study was a prospective, pre-test post-test intervention study without a control group. The study included 595 patients who were hospitalized in the emergency room for more than two hours and voluntarily agreed to participate, as well as 11 physicians and 17 nurses working in the emergency department between 15 April and 19 June 2019 2019. It was carried out in three stages. In the first stage, the 30-day pressure injury incidence rate in the emergency department was evaluated using the “Emergency Department Patients Information and Pressure Injury Assessment Form” and “The Braden Scale for Predicting Pressure Injury Risk”. In the second stage, the healthcare professionals were given training about pressure injuries. The knowledge levels of healthcare professionals before and after the training were evaluated using “The Descriptive Characteristics Form for Emergency Department Personnel (doctors and nurses)” and “The Questionnaire for Identifying and Preventing Pressure Injury”. In the third stage, the 30-day pressure injury incidence rate in the was re-evaluated after the training using the same two scales as before. The SPSS 25 package program was used to evaluate the data in terms of frequency, percentage, mean and standard deviation, and the Mann-Whitney U Test for independent groups, the t-test, the correlated sample t-test, the Wilcoxon Signed Rank test, Pearson Chi-square test, Yates Chi-square test and Fisher’s Exact Chi-square test were also used. ResultsThe mean knowledge test score of the healthcare professionals working in the emergency department was determined as X¯±SD = 53.71 ± 14.70 before the training and X¯±SD = 58.57 ± 11.83 after the training. The average score on the prevention dimension of the Questionnaire for Identifying and Preventing Pressure Injury was found to be statistically significantly higher than before the training (p < 0.05). The pressure injury incidence in the emergency department was 12.5% before the training and 8.8% afterwards. ConclusionIt was observed that the knowledge of healthcare professionals about pressure injury was insufficient and that training given on this topic both increased their knowledge and decreased the incidence of pressure injury. However, the difference was not statistically significant. Training about pressure injuries is important for preventing pressure injury, identifying the injury early, treating the injury appropriately and increasing the awareness of healthcare professionals.

Feasibility of a virtual hybrid resistance and balance training program for older patients with cancer and its preliminary effects on lower body strength and balance.

12002 Background: Falls are a major issue among older patients with cancer and can lead to interruption in cancer treatment. Ample evidence shows resistance and balance training can prevent falls in older adults; however, there is a paucity of evidence regarding exercise on fall prevention in the older cancer population, who often have unique risk factors for falls. Given the new reality of the COVID-19 pandemic, minimizing group gatherings and its associated risks is imperative for older patients, who are a vulnerable population. This study sought to investigate the feasibility of an 8-week, virtual exercise program and its preliminary effects on lower body strength and balance in community-dwelling cancer patients. Methods: Study participants were recruited for this pretest-posttest intervention study using consecutive sampling over a one-year period from the Cross Cancer Institute in Edmonton, Alberta. The intervention entailed leg muscle strengthening and balance training exercises that progressed in difficulty as outlined by the Otago program, and involved a virtual component (facilitated live by a certified exercise physiologist via Zoom meeting platform once a week) and independent at-home training component (twice a week). Lower body strength and balance were assessed using the 5-times chair-stand and the 4-stage balance test, respectively, and were analyzed using the Wilcoxon Signed Rank test. Results: Twenty-seven older patients (mean age 70.1, range 65-76) participated. The most common cancer sites were breast (48%) and prostate (41%). One participant withdrew due to personal reasons unrelated to the program. The remaining 26 participants completed the intervention. Attendance rate for the virtual component was 97.6% and independent component 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). At baseline, 33% (n = 9) ≥1 fall over the past 6 months. A statistically significant improvement in lower body strength was detected post-intervention ( p =.001), whereas no difference was detected in balance ( p =.059). Conclusions: This virtual, hybrid resistance and balance training program was feasible, overwhelmingly accepted by our older participants, and appeared effective in improving lower body strength. Findings from this study may have potential to inform design of a larger, randomized multi-site study.

The effectiveness of a recurrent fall prevention program applied to elderly people undergoing fracture treatment

BackgroundWorldwide 30–40% of people aged of 65 and over fall each year. It is important to develop preventive interventions for falls in the elderly to prevent injuries leading to mortality and morbidity. ObjectivesThis study evaluated the effectiveness of a recurrent fall prevention program in elderly individuals undergoing fracture treatment. MethodsA pretest-posttest intervention study. A recurrent fall prevention program including assessment of fall risk factors, education on falls and home modifications was developed for elderly people undergoing fracture treatment for 52 patients. ResultsIn the first evaluation before the delivery of the recurrent fall prevention program, the number of risk factors was 17.63 ± 3.40 as mean ± standart deviation. Following implementation of the fall prevention program, the number of risk factors decreased to 15.73 ± 3.19 in the first follow-up and decreased to 14.92 ± 3.06 in the second follow-up. Knowledge scores increased to 6.09 ± 1.65 in the first follow-up and to 6.71 ± 1.53 in the second follow-up, while it was 5.50 ± 1.54 in first evaluation. The differences between follow-ups were statistically significant. During the 3-month study period, 15.4% of participants experienced fall. ConclusionThe recurrent fall prevention program was effective in reducing fall-related risk factors and increase fall knowledge. Health care professionals should assess older people for fall risk factors and increase their awareness for falls.

Outcome of Carer-Assisted Care for Stroke Survivors with Severe Disability: Preliminary Findings

Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings. DOI : http://dx.doi.org/10.17576/JSKM-2019-17SI-08

Outcome of Carer-Assisted Care for Stroke Survivors with Severe Disability: Preliminary Findings

Involvement of informal carer in post-stroke care is important to prevent development of secondary complications particularly among stroke survivors with severe disability. However, to date, evidence on the benefit of stroke care training and involving carer to assist in the care for this group of stroke survivors is still limited. In this study, we evaluated the outcome of a carer-assisted care program for stroke survivors with severe disability who live at home. Sixteen stroke survivors with severe disability and 16 primary carers participated in this pre-test post-test intervention study. Carers were trained using a stroke care module which was developed by a group of multidisciplinary researchers from Universiti Kebangsaan Malaysia, prior to implementing the daily care for 8 weeks. Outcome of care on stroke survivors was assessed in term of change in disability level and quality of life using Modified Barthel Index (MBI) and EuroQol health-state measure (EQ-5D and EQ-VAS), respectively. While outcome of stroke care training on carer was determined using Modified Caregiver Strain Index (MCSI). Significant improvement is shown in the stroke survivors’ EQ-VAS component of EuroQol health state measure (average increase by 12%, t = 2.86, p = 0.01) following the care. Although not statistically significant (t = 0.97; p = 0.35), the mean score of MCSI reduced by 14%. No significant change was found in the MBI of the stroke survivors at completion of the program. Carer-assisted care is useful in improving quality of life of stroke survivors and can potentially reduce stress level among carers. Larger study may assist in establishing these preliminary findings.

A Web-Based and Print-Delivered Computer-Tailored Physical Activity Intervention for Older Adults: Pretest-Posttest Intervention Study Comparing Delivery Mode Preference and Attrition.

BackgroundWeb-based interventions can play an important role in promoting physical activity (PA) behavior among older adults. Although the effectiveness of these interventions is promising, they are often characterized by low reach and high attrition, which considerably hampers their potential impact on public health.ObjectiveThe aim of this study was to identify the participant characteristics associated with the preference for a Web-based or a printed delivery mode and to determine whether an association exists between delivery modes or participant characteristics and attrition in an intervention. This knowledge may enhance implementation, sustainability of participation, and effectiveness of future interventions for older adults.MethodsA real-life pretest-posttest intervention study was performed (N=409) among community-living single adults who were older than 65 years, with physical impairments caused by chronic diseases. Measurements were taken at baseline and 3 months after the start of the intervention. Hierarchical logistic regression was used to assess demographic and behavioral characteristics (age, gender, body mass index, educational attainment, degree of loneliness, and PA level), as well as psychosocial characteristics (social support for PA, modeling, self-efficacy, attitude, and intention) related to delivery mode preference at baseline and attrition after 3 months.ResultsThe printed delivery mode achieved higher participation (58.9%, 241/409) than the Web-based delivery mode (41.1%, 168/409). Participation in the Web-based delivery mode was associated with younger age (B=–0.10; SE 0.02; Exp (B)=0.91; P<.001) and higher levels of social support for PA (B=0.38; SE 0.14; Exp (B)=1.46; P=.01); attrition was associated with participation in the Web-based delivery mode (B=1.28; SE 0.28; Exp (B)=3.58; P<.001) and low educational attainment (B=–0.53; SE 0.28; Exp (B)=0.59; P=.049).ConclusionsA total of 41% of the participants chose the Web-based delivery mode, thus demonstrating a potential interest of single older adults with physical impairments in Web-based delivered interventions. However, attrition was demonstrated to be higher in the Web-based delivery mode, and lower educational attainment was found to be a predictor for attrition. Characteristics predicting a preference for the printed delivery mode included being older and receiving less social support. Although Web-based delivery modes are generally less expensive and easier to distribute, it may be advisable to offer a printed delivery mode alongside a Web-based delivery mode to prevent exclusion of a large part of the target population.Trial RegistrationNetherlands Trial Register NTR2297; https://www.trialregister.nl/trial/2173International Registered Report Identifier (IRRID)RR2-DOI: 10.2196/resprot.8093

Using Variable Priority Training to Examine Video Game-Related Gains in Cognition.

Identify mechanisms associated with video-game-related gains in cognitive functioning. Seventy-nine older adults (Mean age = 72.72, SD = 7.16) participated in a pretest-posttest intervention study. A video game that required four cognitive abilities was developed. The game had two modes: (1) variable priority training (VPT) and (2) single priority training (SPT). After a pretest session, participants completed a battery of cognitive tasks and 'were randomly assigned to either the VPT (n = 42) or the SPT mode (n = 37) for an average of 15.94 (SD = 2.15) one-hour game play sessions. Post-testing was administrated within one week after completion of training. Time (pretest/posttest) by game mode (VPT/SPT) interactions were examined using Multivariate Repeated Measure ANOVAs. No significant multivariate training effects were observed. Results suggest that VPT may not be the underlying mechanism responsible for video-game-related gains in cognition. Our results also cast doubts on whether playing video games could lead to cognitive enhancements in older adults.

Influence of Palliative Care Training on Last-Year Nursing Department Students' Perception on Regarding Spirituality and Spiritual Care: A Single-Group Pretest-Posttest Intervention Study.

Spiritual care is a part of integrated care and should not be considered as a separate aspect of palliative care. Spirituality is seen as a requirement that must be met for all patients. The aim of this study is to determine the influence of palliative care on the perception levels of student nurses regarding spirituality and spiritual care. The research was carried out as a single-group pretest-posttest intervention study.The study was conducted with 70 student nurses. Data were collected via personal information form and spirituality and spiritual care grading scale (SSCGS). Frequency, percentage, average, standard deviation, paired sample t-test and Wilcoxon test were used to analyze the data. 55.7% of the students who participated in research stated that they had never heard of spiritual care, and 81.4% of the students stated that they had not obtained any information regarding spiritual care. The point average of the student nurses related to SSCGS was found to be 3.27 ± 0.21 before training and 3.35 ± 0.22 after training. The difference between the total point averages of the student nurses pre- and posttraining was found to be statistically significant (p < 0.05).As a result of the research, the perception of the student nurses regarding spirituality and spiritual support was found to be above the middle and increased significantly after the training. In accordance with these results, it is suggested that spiritual care training should be included more into nursing education.