Articles: checklist.
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Randomized Controlled Trial Pragmatic Clinical Trial
Learning before leaping: integration of an adaptive study design process prior to initiation of BetterBirth, a large-scale randomized controlled trial in Uttar Pradesh, India.
Pragmatic and adaptive trial designs are increasingly used in quality improvement (QI) interventions to provide the strongest evidence for effective implementation and impact prior to broader scale-up. We previously showed that an on-site coaching intervention focused on the World Health Organization Safe Childbirth Checklist (SCC) improved performance of essential birth practices (EBPs) in one facility in Karnataka, India. We report on the process and outcomes of adapting the intervention prior to larger-scale implementation in a randomized controlled trial in Uttar Pradesh (UP), India. ⋯ The adaptive study design of implementation, evaluation, and feedback drove iterative redesign and successfully developed a SCC-focused coaching intervention that improved EBPs in UP facilities. This work was critical to develop a replicable BetterBirth package tailored to the local context. The multi-center pragmatic trial is underway measuring impact of the BetterBirth program on EBP and maternal-neonatal morbidity and mortality.
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The use of printed or electronic checklists and other cognitive aids has gained increasing interest from anesthesia providers and professional societies. While these aids are not currently considered standard of care, the perceptions of the clinician might have an impact on their adoption. ⋯ Providers at our large academic institution generally embrace the concept of checklists and other cognitive aids. This was true for all providers for checklists for procedural time outs, anesthesia crisis situations and those for routine procedures that providers rarely perform. Only very experienced and very junior providers appreciated the use of checklists for routine care. There remains a discrepancy between these claims and provider's perception on their clinical competency based on memory alone.
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Fear, anxiety, and emotional upset are common experiences for hospitalized children. To identify and treat children's emotional reactions, health care professionals must be able to differentiate emotional reactions from pain and other symptoms. Clinical assessment of emotions requires the use of valid and reliable instruments in acute care settings. ⋯ Internal consistency was better supported for the recalled unpleasant experience (α = 0.77) than for the pleasant experience (α = 0.60). Results supported construct and concurrent validity and beginning internal consistency reliability for the ERC in an acute care setting. Further research is required to establish feasibility of repeated use with ill children.
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To compare procedure-specific checklists and a global rating scale in assessing technical competence. ⋯ Assessment using a global rating scale may be superior to assessment using a checklist for evaluation of technical competence. Traditional standard-setting methods may establish checklist cut scores with too-low specificity: High checklist scores did not rule out incompetence. The role of clinically significant errors in determining procedural competence should be further evaluated.