Journal of evaluation in clinical practice
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This paper addresses the challenge of investigating fidelity in the implementation of a complex rehabilitation intervention designed to increase the level of independence in personal activities of daily living of stroke patients living in UK care homes. A programme theory of intervention fidelity was constructed to underpin a process evaluation running alongside a cluster randomized trial of the rehabilitation intervention. ⋯ These findings characterize the real-world nature of fidelity within intervention research, and specifically the negotiated nature of implementation within clinical settings, including individual patients' needs. This research adds to the evidence base because current frameworks for fidelity neglect the importance of learning over time of individuals and across the time span of a trial.
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Poor medication adherence is a major global public health challenge. A valid, reliable, cost-effective tool for measuring medication adherence would lead to a better understanding of non-adherence and lay the groundwork for interventions aimed at facilitating adherence to therapies. The aim of this study was to translate and evaluate the psychometric properties of the Chinese version of the 8-item Morisky medication adherence scale (C-MMAS-8) in Chinese myocardial infarction (MI) patients. ⋯ The psychometric properties of the C-MMAS-8 are satisfactory.
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This study aimed to apply the 'systems approach' to patient safety in order to identify causes for delays and errors in lung cancer diagnoses following an abnormal chest radiograph. ⋯ Both reporting radiologists and referring clinicians have a responsibility to ensure appropriate action following an abnormal chest radiograph. The main error lies in communication between the referring clinicians and the radiologists. Direct electronic communication is potentially a more robust method to overcome this.
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Population level data on colorectal cancer (CRC) management in Australia are lacking. This study assessed broad level patterns of care and concordance with guidelines for CRC management at the population level using linked administrative data from both the private and public health sectors across South Australia. Disparities in CRC treatment were also explored. ⋯ Greater emphasis should be given to ensure CRC patients who may benefit from neo-adjuvant/adjuvant therapies have access to these treatments.
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Classification of patients with back pain in order to inform treatments is a long-standing aim in medicine. We used latent class analysis (LCA) to classify patients with low back pain and investigate whether different classes responded differently to a cognitive behavioural intervention. The objective was to provide additional guidance on the use of cognitive behavioural therapy to both patients and clinicians. ⋯ We were able to classify the trial participants based on psychosocial baseline scores relevant to the intervention. An association between class membership and outcome was identified for those people receiving the intervention, but not those in the control group. However, we were not able to identify outcome associations for individual classes and so predict outcome in order to aid clinical decision making. For this cohort of patients, the STarT system was as successful, but not superior.