5 research outputs found
Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters
This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe
MULTICAGE CAD-4 for behavioral addiction screening: Structural validity after inclusion of a scale on smartphone abuse
Los comportamientos adictivos no se limitan al uso de drogas,
sino que también incluyen ciertos comportamientos diarios que pueden
causar gratificación. Su progresión a patrones patológicos más severos con-
lleva graves consecuencias para el individuo, incluidas múltiples manifesta-
ciones psicopatológicas. La detección temprana de este tipo de comporta-
miento es de interés para la atención primaria de salud. Por lo tanto, para
detectar riesgos en etapas tempranas, las herramientas confiables y válidas
para la práctica diaria son esenciales. El cuestionario MULTICAGE CAD-
4 es una herramienta de detección para detectar simultáneamente conduc-
tas adictivas. Este estudio incluye una nueva escala para la detección del
abuso de teléfonos inteligentes. El objetivo es evaluar la adecuación de sus
propiedades psicométricas. Una muestra de 2.074 sujetos reclutados en
centros de atención primaria de Madrid (España) completó el cuestionario
MULTICAGE CAD-4. Se realizó un análisis factorial confirmatorio, utili-
zando el método de mínimos cuadrados no ponderados. La prueba mostró
una buena consistencia interna tanto a nivel del ítem como de las escalas.
La estructura del cuestionario fue consistente con las expectativas teóricas.
El MULTICAGE CAD-4, incluida la nueva escala para teléfonos inteligen-
tes, es una herramienta robusta y confiable con una estructura válida para
evaluar la presencia de comportamientos disfuncionales o potencialmente
adictivos, y especialmente útil en servicios de atención primaria de salud.Addictive behaviors are not limited to drugs use, but also in-
clude certain daily behaviors that can cause gratification. Their progression
to more severe pathological patterns entails grave consequences for the
individual, including multiple psychopathological manifestations. The early
detection of this type of behavior is of concern to primary health care.
Therefore, in order to detect risk at early stages, reliable and valid tools for
daily practice are essential. The MULTICAGE CAD-4 questionnaire is a
screening tool for simultaneously detecting addictive behaviors. This study
includes a new scale for the detection of smartphone abuse. The objective
is to evaluate the adequacy of its psychometric properties. A sample of
2,074 subjects that were recruited from primary care centers of Madrid
(Spain) completed the MULTICAGE CAD-4 questionnaire. A confirma-
tory factor analysis, using unweighted least squares method, was per-
formed. The test showed good internal consistency both at item and scale
levels. The questionnaire structure was consistent with theoretical expecta-
tions. The MULTICAGE CAD-4, including the new smartphone scale, is
a robust, reliable tool with a valid structure for assessing the presence of
dysfunctional or potentially addictive behaviors, and especially useful in
primary health care services
Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12)
Abstract Background The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. Methods/design The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. Discussion The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment. Trial registration This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.</p