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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 109 records · Page 6Linked to original sources
PubMed1999

Addressing barriers to change: an RCT of practice-based education to improve the management of hypertension in the elderly.

BACKGROUND: In the future, primary care groups (PCGs) will have to consider how best to apply audit and education to fulfil their commitment to clinical governance and to facilitate the implementation of research findings. AIM: To establish whether an exploration of 'barriers to change' can enhance the effectiveness of an educational intervention designed to improve the management of hypertension in the elderly. METHOD: A parallel-arm, randomized, single-blind, controlled trial of practice-based educational visits in 18 practices. These practices had previously taken part in a multipractice audit of the management of hypertension in the elderly. Both groups received outreach visits in their own practice, during which they received the results of the previous audit. The nine 'intervention' practices were encouraged to explore barriers that would prevent them from implementing pertinent research findings. The control group was not encouraged to do this. The main outcome measure of the trial was determined in advance as 'the stated management of systolic hypertension in patients aged 70 to 79'. A secondary endpoint was the stated management of a specific patient scenario. The endpoints were tested by questionnaire before and after the educational intervention. RESULTS: For the primary endpoint, there was a statistically significant difference in the stated threshold for treating systolic hypertension between intervention and control groups after the visits (161.8 mmHg versus 167.2 mmHg; P = 0.007). For the secondary endpoint, there was also a statistically significant difference between the two groups, after the visits, in their willingness to treat a 70-year-old male with mild hypertension (89% of doctors would treat in the intervention group versus 57% in the control group; P = 0.047). CONCLUSION: The effectiveness of an educational intervention is significantly improved by addressing the barriers preventing practitioners from implementing the findings of research.

Aged↗
PubMed1999

A RCT of three training and support strategies to encourage implementation of screening and brief alcohol intervention by general practitioners.

BACKGROUND: Providing doctors with new research findings or clinical guidelines is rarely sufficient to promote changes in clinical practice. An implementation strategy is required to provide clinicians with the skills and encouragement needed to alter established routines. AIM: To evaluate the effectiveness and cost-effectiveness of different training and support strategies in promoting implementation of screening and brief alcohol intervention (SBI) by general practitioners (GPs). METHOD: Subjects were 128 GPs, one per practice, from the former Northern and Yorkshire Regional Health Authority, who agreed to use the 'Drink-Less' SBI programme in an earlier dissemination trial. GPs were stratified by previous marketing conditions and randomly allocated to three intensities of training and support: controls (n = 43) received the programme with written guidelines only, trained GPs (n = 43) received the programme plus practice-based training in programme usage, trained and supported GPs (n = 42) received the programme plus practice-based training and a support telephone call every two weeks. GPs were requested to use the programme for three months. Outcome measures included proportions of GPs implementing the programme and numbers of patients screened and intervened with. RESULTS: Seventy-three (57%) GPs implemented the programme and screened 11,007 patients for risk drinking. Trained and supported GPs were significantly more likely to implement the programme (71%) than controls (44%) or trained GPs (56%); they also screened, and intervened with, significantly more patients. Costs per patient screened were: trained and supported GPs, 1.05 Pounds; trained GPs, 1.08 Pounds; and controls, 1.47 Pounds. Costs per patient intervened with were: trained and supported GPs, 5.43 Pounds; trained GPs, 6.02 Pounds; and controls, 8.19 Pounds. CONCLUSION: Practice-based training plus support telephone calls was the most effective and cost-effective strategy to encourage implementation of SBI by GPs.

Alcohol Drinking↗
PubMedDate not supplied

Evaluation of DOWNSTAGING as leading concept in sphincter-saving surgery for rectal cancer after preoperative radio-chemotherapy (Preop RCT).

AIM: To evaluate the downstaging of rectal cancer after preop R +/- CT. METHODS: 392 patients (pts) with rectal cancer were observed. Only 172 pts (58%) with II and III stage cancer of middle and lower third were examined. Enrol-led pts were 168: 52 of them received preop R +/- CT (32 RT, 20 R + CT). Preop R +/- CT group included 14 middle third cancers (73%), 38 lower third (17%). In this group, tumor stage was as follows: 44 T3 stage tumors (86.4%), 8 (15.4%) T4. Mean age of this group was 57 years (range 42-67). Patients received 45 Gy for 5 weeks in 25 fractions and continuous administration of 5-FU (300-500 mg/m2/die). Surgery was performed 6 weeks +/- 7 days after the therapy. RESULTS: Downstaging, at least of 1 T-stage level, was detected in 45 patients (86%) (8 middle third; 32 lower third), in 5 (9.6%) (4 middle third, 1 lower third), tumor decreased to pT0N0, while in 7 (13.5%) (2 middle third, 5 lower third), there was no response. An Anterior Resection (AR) was performed in 40 patients (77%) [4 Downstaged to pT0N0 middle third cancers; 36 downstaged but with residual disease (8 middle third, 28 lower third)]; APR was performed in 12 (23%) (7 No responders patients, 1 Downstaged to pT0N0 lower third cancer, 4 downstaged but with residual disease of lower third). CONCLUSIONS: Preop R +/- CT is effective in obtaining a significative downstaging to allow sphincter saving surgery, without compromising oncological results.

Adult↗
PubMedDate not supplied

An RCT into calculating insulin start dose in type 2 diabetes.

AIMS: This trial compares to methods used to find the insulin dose when starting insulin in people with type 2 diabetes in whom maximal tolerated oral hypoglycaemic agents have failed to control glycaemia. One method of initiating insulin (based on height, weight, and fasting blood plasma glucose and insulin resistance) was compared with a conventional method of initiating 10 units of isophane insulin twice daily. METHOD: Sixty subjects were randomised to calculated (CALC) or conventional (C). Follow-up was at three, six and 12 months with diabetes specialist nurse (DSN) support. The outcomes that were compared were glycated haemoglobin levels (HbA1c), hypoglycaemia, weight gain, insulin dose, quality of life, treatment satisfaction, blood pressure, and frequency of DSN contact. RESULTS: HbA1c levels values were reduced significantly in the CALC group during the first three months after starting insulin (p = 0.0001) and improved by one per cent overall during 12 months (p = 0.03). No difference was found in rates of hypoglycaemia, blood pressure, quality of life, and treatment satisfaction. Weight gain was seen in both groups but was significantly higher in the CALC group. People in the CALC group needed significantly less DSN time (p = 0.01). CONCLUSIONS: HbA1c target values were achieved more quickly and with less DSN contact using the CALC method. The difference in weight gain with the CALC method needs further investigation.

Adult↗
PubMedDate not supplied

A retrospective analysis of the registered care technologist (RCT) proposal.

This article reviews, in retrospect, the Registered Care Technologist proposal previously advanced by the American Medical Association. It argues that an analysis of this proposal is a useful way of understanding interest group theory. Further, it makes a case for nurses in general and Black nurses in particular to understand this theory from an economic perspective. Finally, it urges all nurses to continue to collectively utilize power.

Allied Health Personnel↗