Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial

Background Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. Method A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients' symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants' health-related quality of life, their satisfaction with the intervention, and an economic valuation. Discussion This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system

Provider Adherence to Practice Guidelines in Overcoming Hypothermia in the Postoperative Period

Background: The implementation of a standardized warming protocol aims to prevent hypothermia in the postoperative period. Hypothermia in the postoperative period can result in inadvertent adverse outcomes for patients undergoing surgical procedures. In 2011, The Joint Commission (TJC) and Center for Medicare and Medicaid (CMS) issued the Surgical Care Improvement Project (SCIP) Inf-10 guidelines, known as the body temperature management guidelines, to decrease morbidity and mortality in surgical patients undergoing general anesthesia. These guidelines recommend using an active warming system, such as the 3MTM Bair Hugger TM System to warm patients intraoperatively. Review of Literature: Randomized control trials (RCTs) and meta-analysis were included as part of the literature review with the use of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration and Medline databases. Purpose: In this study, the research aims to evaluate the effectiveness of preventing hypothermia in a hospital that adopted the evidence-based body temperature management guidelines. Methods: The author retrospectively analyzed a total of 243 medical records, which included 158 paper medical records and 85 electronic medical records using the hospital’s information management system. As part of the study, two groups, each consisting of 50 patient medical records meeting inclusion criteria, were analyzed. A total of 108 paper medical records and 85 electronic medical records were excluded from the study for not meeting criteria. Results: Patients were randomized and divided into two groups. Group A (n=50) consisting of patients who did not receive active warming in 2010, and Group B (n=50) consisting of patients who received the active warming intervention in 2020. Group B revealed a mean body temperature that was 0.1° Celsius higher than Group A. At the end of surgery, Group A demonstrated nearly a 15% higher incidence of hypothermia when compared to Group B. Descriptive statistics were analyzed using an independent sample t-test, assuming unequal variance for the two groups. There was a statistically significant difference between the two groups (P \u3c 0.028). The study’s results support the use of forced air warming (FAW) in the intraoperative period as an effective way of preventing postoperative hypothermia in the Post Anesthesia Care Unit (PACU). Implications/Conclusion: This study assessed the effectiveness of SCIP Inf-10 guidelines in preventing hypothermia in patients undergoing surgical procedures. Prior to 2011, there were no recommendations issued by TJC or CMS to actively warm patients. Active warming, as characterized by the 3MTM Bair Hugger TM System warming system has been shown to be decrease morbidity and mortality, surgical site infections and other complications. Group B, which consisted of patients having undergone surgical procedures in 2020, were actively warmed and experienced a 0% incidence of hypothermia. Group A, which consisted of patients having undergone surgery before the release of SCIP Inf-10 guidelines, experienced nearly a 15% incidence of hypothermia. It is reasonable to conclude that the utilization of body temperature management guidelines is effective in preventing hypothermia in patients undergoing surgical procedures

Decision support systems in forest management: requirements from a participatory planning perspective

Participatory approaches and computerised tools such as decision support systems (DSS) represent conflicting tendencies in state-of the-art sustainable forest management. As a result, there may be considerable tension between these two developments in practice. The objective of this paper is to explore how participatory approaches and DSS could be brought together to improve planning processes and to explore how DSS could be adapted in their use or combined with other tools to enable successful participatory planning. From a review of the literature, we identified criteria related to successful participatory planning. From these criteria, we selected those a DSS can influence and created a short list of the criteria that could be used to evaluate participatory processes where DSS are applied. The evaluation criteria with particular relevance for DSS that we identified are as follows: fairness, opportunity to influence outcome, quality and selection of information, cost-effectiveness, challenging status quo and fostering creative thinking, structured decision-making process, transparency, and independence and neutrality of process. We also scrutinised existing forest DSS and identified features that may enable DSS to address these criteria. The features of DSS we identified that may support participatory processes are as follows: group decision support, possibilities to include other values than timber production, flexibility of system to include non-traditional forest data and management options, and multi-criteria decision analysis tools. We argue that the DSS to be used should be assessed to clarify, how it can be used in the specific planning situation and how it should be complemented with other available and non-computerised tool

The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study: study protocol for a randomized trial

Abstract Background Diabetes shared medical appointments (SMAs) and reciprocal peer support programs have been found in efficacy trials to help adults with diabetes improve their self-management and achieve short-term gains in clinical and patient-centered outcomes. In order to translate this evidence to system-level interventions, there is a need for large-scale, pragmatic trials that examine the effectiveness, implementation, and costs of SMAs and reciprocal peer support across diverse settings. Methods The Shared Health Appointments and Reciprocal Enhanced Support (SHARES) study is a multisite, cluster randomized trial that is evaluating the effectiveness and implementation of SMAs with and without an additional reciprocal Peer-to-Peer (P2P) support program, when compared to usual care. The P2P program comprises periodic peer support group sessions and telephone contact between SMA participant pairs to promote more effective diabetes self-management. We will examine outcomes across three different treatment groups: (1) SMAs, (2) SMAs plus P2P, and (3) usual care. We will collect and analyze data over a 2.5-year implementation period at five geographically diverse Veterans Affairs (VA) health systems. The primary outcome is the relative change in hemoglobin A1c over time. Secondary outcomes are changes in systolic blood pressure, antihypertensive medication use, statin use, and insulin initiation over the study period. The unit of analysis is the individual, adjusted by the individual’s SMA group (the cluster). We will use mixed methods to rigorously evaluate processes and costs of implementing these programs in each of the clinic settings. Discussion We hypothesize that patients will experience improved outcomes immediately following participation in SMAs and that augmenting SMAs with reciprocal peer support will help to maintain these gains over time. The results of this study will be among the first to examine the effects of diabetes SMAs alone and in conjunction with P2P in a range of real-life clinical settings. In addition, the study will provide important information on contextual factors associated with successful program implementation. Trial registration ClinicalTrials.gov, ID: NCT02132676 . Registered on 21 August 2013.https://deepblue.lib.umich.edu/bitstream/2027.42/136794/1/13063_2017_Article_1959.pd

Development and Usability Evaluation of a Nursing Graduate Information Management System (GSMIS) Based on User Experience

[Research Background] Recent years, the rapid development of information technology in colleges and universities and the continuous expansion of graduate students have not only increased the pressure of graduate student management in the School of Nursing of Fudan University, but also accelerated the pace of information technology construction in the college, and the School of Nursing urgently needs to use the existing good platform to realize the information technology of nursing graduate student management in combination with the actual situation of the college, so as to realize the communication between graduate student supervisors, graduate students and management, and also to build an objective and scientific clinical competence assessment system in line with It is also important to provide material for the construction of an objective and scientific clinical competence assessment and evaluation system that is in line with the postgraduate nursing education, which is important to achieve the cultivation goals and improve the quality of nursing graduate training. [Research Purpose] Based on the theory of user experience and the concept of "User-Centered Design", this project develops the information management system for graduate students in the School of Nursing by studying the actual needs of teachers and graduate students in the School of Nursing, which can be divided into the following contents: (1) Construction of the framework content of a Nursing GSMIS (2) Development and testing of a Nursing GSMIS (3) Usability evaluation of the a Nursing GSMIS [Research Methods] 1. Demand analysis of the Nursing GSMIS (1) Preliminary framework: Using target sampling method and maximum variation method, semi- structured interviews were conducted with both faculty and student users of the School of Nursing to build the preliminary framework of the system. (2) Final framework: Expert focus group interviews were used to revise and adjust the required content such as interface design, business functions and performance, and to determine the final framework of the system. 2. Development and testing of Nursing GSMIS The “Rapid Prototype Interaction” model was used to develop the system. After the prototype was developed, the Shanghai Institute of Comprehensive Application of Network Technology was contacted for professional system testing, and then the system was modified and adjusted until it met the research requirements. 3. Usability evaluation of Nursing GSMIS A mixed evaluation method of usability test, questionnaire and qualitative interview was used to conduct a more comprehensive and objective usability evaluation of the GSMIS successfully developed in the early stage. It was used to understand the users' feelings and experiences of the system, analyze the advantages and shortcomings of the system, and explore its actual usability.[Research Results] 1. Demand analysis of Nursing GSMIS (1) Preliminary framework of the system: The faculty and student users interviewed expressed that information management is an important step in the progress of the college and the nursing discipline, and expressed strong support and need for the construction of our information system. Based on the literature review and the needs of faculty and students, the framework was initially formulated as four modules: basic information of admission, cultivation process, research results, and clinical cases. (2)The final framework of Nursing GSMIS: It is built from modules and functions, performance, interface, text, color, etc.; Modules include: basic information module for admission, training process module, scientific research achievement module, clinical case library module, employment information module, graduation tracking module; functions include password setting and retrieval, user log-in, user management, data maintenance, custom query, audit and message notification; Performance can be summarized as follows: data structure is clear, complete, with real-time, expansion, operation and stability; Interface Design is friendly and beautiful, simple and easy to use; Layout should highlight the key points; text design is easy to recognize and read, color design reflects the connotation and characteristics of the college. The performance can be summarized as: clear data structure, complete, real-time, scalability, operability and stability; friendly and beautiful interface design, simple and easy to use, layout to highlight the key points; text design is easy to identify, easy to read, color design reflects the connotation and characteristics of the college. 2. Development and testing of Nursing GSMIS Based on the requirements, the engineers used the “Rapid Prototype Interaction Model” to develop the system. After the prototype was developed, the Shanghai Institute of Comprehensive Application of Network Technology was contacted for professional system testing, and then after many rounds of software discussions and corrections between the software engineers and researchers, the GSMIS finally had the registration and log-in page, the informed consent notification page, the information notification page and six main modules. 3. Usability evaluation of Nursing GSMIS (1) Usability Test: Based on the usability test theory, the target sampling method was used, and five graduate students users were selected to participate in the test is sufficient, and the results are as follows. 1) Quantitative results: The effectiveness was mostly at 100%, and the efficiency was 56.2min/s, 72.2min/s, 53min/s, 225.2min/s, 75.8min/s, 33min/s, and 5.5min/s; The overall score of the post-scene questionnaire (ASQ) was 1.24. The evaluation indexes all indicated that the users rated the system highly. 2) Qualitative results: The test subjects all easily completed and highly praised the system during the test, indicating that the operation was not difficult and satisfied the interaction needs of users. (2) SUS Questionnaire: A total of 40 users completed the SUS using the convenience sampling method and the maximum variance method, and the Mean±SD was 70.23±7.7. Among them, the mean score of the Usability sub-scale was 71.59±8.93 , and the mean score of the ease of Learning sub-scale was 64.77±7.53, with scores ranging from 60 to 70. (3) Qualitative interviews: Using target sampling method and maximum variation method, a total of 10 people were interviewed, including 5 students and 5 staff users, and the number of interviews was 3, with no repeated interviews or secondary interviews. The maximum interview time was 46 minutes, the minimum was 25 minutes, and the average was 35.5 minutes. The results can be summarized into three aspects: general evaluation, content and function evaluation, and shortcomings and improvement. This study combines qualitative and quantitative results, reflecting the good usability of the system, but there are also shortcomings and improvements. [Conclusion] This study used various research methods such as literature review, qualitative interview, and focus group interview to construct a system framework based on user experience, completed the development of the graduate student information management system in the School of Nursing, and used mixed methods such as out-of-sound thinking method, usability testing method, questionnaire survey method, and qualitative interview to evaluate the usability of the system, and the results showed that the system has high acceptance, ease of use, and usability

The effectiveness of a facilitated group decision support system (decision conferencing): A UK/US field study.

The increasingly complex and turbulent business environments of these days frequently require greater specialised knowledge pertaining to the issues, which are usually beyond that of any individual. Therefore, group meetings are becoming more complex, more frequent, and more important. As part of the transition into this new environment together with recent advancements in computers, telecommunications and management science techniques, organisational researchers have made serious efforts to use advanced technologies to improve group meetings. An example of such attempts is the development of a Group Decision Support System (GDSS), an application of information technology to support the work of groups. One common example of GDSSs is the Decision Conferencing (DC), which combines the use of decision analytic softwares to incorporate the differing perspectives of the participants with group facilitation techniques. This thesis systematically reviews the existing case, field, and laboratory decision room type GDSS studies. It, then, explores the plausible factors for the inconsistent findings across studies. Main objective of the thesis, however, is to investigate the effectiveness of a DC in aiding group work with regard to decision processes, overall user attitudes, and decision quality, and to identify variables associated with differences in perceived effectiveness. Three theories were employed to build a conceptual framework with criteria by which to describe and evaluate the effectiveness of decision making in GDSS settings: Competing Values Approach, Stratified Systems Theory, and Human Information Processing Model. It was shown that these three approaches share common theoretical assumptions. Then, quantitative data were collected through a mailed questionnaire of participants in 22 conferences, hosted by the Decision Conferences Inc. in the U.S.A., Decision Analysis Unit at London School of Economics, and International Computers Ltd. in the U.K. Overall, a DC was perceived better than a conventional meeting for all of the evaluation criteria. The effectiveness of a DC, however, was perceived differently according to various factors: participants' levels in the executive hierarchy, differences in the culture and style of the organisation, task differences in terms of the degree of threat, group size, variety of facilitators, and careers of the participants. Of greater interest is the finding that independent of the numerous variables above, a DC was perceived highly effective in terms of user attitudes, improved decision quality, adaptable process, goal-centred process, and efficiency of decision; and relatively less effective with regard to implementation, and accountability of decision

Conservation science in NOAA’s National Marine Sanctuaries: description and recent accomplishments

This report describes cases relating to the management of national marine sanctuaries in which certain scientific information was required so managers could make decisions that effectively protected trust resources. The cases presented represent only a fraction of difficult issues that marine sanctuary managers deal with daily. They include, among others, problems related to wildlife disturbance, vessel routing, marine reserve placement, watershed management, oil spill response, and habitat restoration. Scientific approaches to address these problems vary significantly, and include literature surveys, data mining, field studies (monitoring, mapping, observations, and measurement), geospatial and biogeographic analysis, and modeling. In most cases there is also an element of expert consultation and collaboration among multiple partners, agencies with resource protection responsibilities, and other users and stakeholders. The resulting management responses may involve direct intervention (e.g., for spill response or habitat restoration issues), proposal of boundary alternatives for marine sanctuaries or reserves, changes in agency policy or regulations, making recommendations to other agencies with resource protection responsibilities, proposing changes to international or domestic shipping rules, or development of new education or outreach programs. (PDF contains 37 pages.

The GUIDES checklist: development of a tool to improve the successful use of guideline-based computerised clinical decision support

Background: Computerised decision support (CDS) based on trustworthy clinical guidelines is a key component of a learning healthcare system. Research shows that the effectiveness of CDS is mixed. Multifaceted context, system, recommendation and implementation factors may potentially affect the success of CDS interventions. This paper describes the development of a checklist that is intended to support professionals to implement CDS successfully. Methods: We developed the checklist through an iterative process that involved a systematic review of evidence and frameworks, a synthesis of the success factors identified in the review, feedback from an international expert panel that evaluated the checklist in relation to a list of desirable framework attributes, consultations with patients and healthcare consumers and pilot testing of the checklist. Results: We screened 5347 papers and selected 71 papers with relevant information on success factors for guideline-based CDS. From the selected papers, we developed a 16-factor checklist that is divided in four domains, i.e. the CDS context, content, system and implementation domains. The panel of experts evaluated the checklist positively as an instrument that could support people implementing guideline-based CDS across a wide range of settings globally. Patients and healthcare consumers identified guideline-based CDS as an important quality improvement intervention and perceived the GUIDES checklist as a suitable and useful strategy. Conclusions: The GUIDES checklist can support professionals in considering the factors that affect the success of CDS interventions. It may facilitate a deeper and more accurate understanding of the factors shaping CDS effectiveness. Relying on a structured approach may prevent that important factors are missed

Does it work? evaluating a new pay system

This report focuses on the evaluation of the impact of new pay systems in large, unionised multi-site organisations by the organisations themselves. Evaluation of the effectiveness of a pay system, however, does not take place in a vacuum and relates to the aims and objectives of the pay system concerned. Moreover, evaluation is not an end in itself. It is, therefore, relevant to consider if any further steps were taken as a result of evaluation. Accordingly our research questions were: • What were the aims and objectives of organisations when introducing new pay arrangements? • What data did organisations collect and review to inform their evaluation? • What steps have organisations taken as a result of their evaluation? We re-appraised our data from 10 NHS trusts in England which had introduced some innovations in pay and grading in the 1990s. Additionally, we looked at seven multi-site unionised organisations outside the NHS in both the public and private sectors, which had recently made changes to their reward systems, carrying out interviews and inspecting documents. The main output is a template for the evaluation of Agenda for Change by NHS organisations