scholarly journals Effects of a clinician referral and exercise program for men who have completed active treatment for prostate cancer: A multicenter cluster randomized controlled trial ( ENGAGE )

Cancer ◽  
2015 ◽  
Vol 121 (15) ◽  
pp. 2646-2654 ◽  
Author(s):  
Patricia M. Livingston ◽  
Melinda J. Craike ◽  
Jo Salmon ◽  
Kerry S. Courneya ◽  
Cadeyrn J. Gaskin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
Active Treatment ◽  
Controlled Trial ◽  
Exercise Program ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Cluster Randomized

Effects of an Individualized Exercise Program Plus Behavioral Change Enhancement Strategies for Managing Fatigue in Older People Who Are Frail: Protocol for a Cluster Randomized Controlled Trial

2019 ◽  
Vol 99 (12) ◽  
pp. 1616-1627
Author(s):  
Justina Y W Liu ◽  
Patrick P K Kor ◽  
Paul L Lee ◽  
Wai T Chien ◽  
Parco M Siu ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Exercise Training ◽  
Older People ◽  
Behavioral Change ◽  
Controlled Trial ◽  
Exercise Program ◽  
Cluster Randomized Controlled Trial ◽  
Randomized Controlled ◽  
General Fatigue ◽  
Cluster Randomized

Abstract Background Although the evidence suggests that general fatigue is a strong indicator of rapid aging, frailty, and disability, general fatigue is undertreated in gerontological care. Objective The aim of this study is to investigate whether an individualized exercise program with and without behavioral change enhancement (BCE) strategies for older people who are frail and have general fatigue will reduce their fatigue and symptoms of frailty. Design A 3-arm, single-blind, cluster randomized controlled trial registered with ClinicalTrials.gov (NCT03394495) will be conducted. Setting The study will be conducted in a community setting. Participants Two hundred eighty-five community-dwelling older people with general fatigue will be recruited from 12 district community health centers. Intervention People from each center will be randomized to one of three groups. The combined group will receive a 16-week combined intervention consisting of individualized exercise training and the BCE program, plus two booster sessions at 2 and 6 months after the program. The exercise group will receive exercise training and health talks only. The control group will receive health talks only. Measurements Outcome measures will be collected at baseline, at the midpoint (week 8) of the program, and then at 1 week, 6 months, and 12 months after the end of the program. The primary outcome---level of fatigue---will be measured using the Multidimensional Fatigue Inventory. Secondary outcomes will include the participants’ frailty status, strength, mobility, exercise self-efficacy, and habitual physical activity. Limitations A self-reported level of fatigue will be used. Conclusions The effect of exercise and BCE strategies on general fatigue among older people who are frail is not known. This study will be a pioneering interventional study on how general fatigue among older people who are frail can be managed and how fatigue-related frailty can be prevented or minimized.

scholarly journals Electronic Trigger-Based Intervention to Reduce Delays in Diagnostic Evaluation for Cancer: A Cluster Randomized Controlled Trial

2015 ◽  
Vol 33 (31) ◽  
pp. 3560-3567 ◽  
Author(s):  
Daniel R. Murphy ◽  
Louis Wu ◽  
Eric J. Thomas ◽  
Samuel N. Forjuoh ◽  
Ashley N.D. Meyer ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Randomized Controlled Trial ◽  
Electronic Health Record ◽  
Controlled Trial ◽  
Cluster Randomized Controlled Trial ◽  
Diagnostic Evaluation ◽  
Health Record ◽  
Randomized Controlled ◽  
Cluster Randomized

Purpose We tested whether prospective use of electronic health record-based trigger algorithms to identify patients at risk of diagnostic delays could prevent delays in diagnostic evaluation for cancer. Methods We performed a cluster randomized controlled trial of primary care providers (PCPs) at two sites to test whether triggers that prospectively identify patients with potential delays in diagnostic evaluation for lung, colorectal, or prostate cancer can reduce time to follow-up diagnostic evaluation. Intervention steps included queries of the electronic health record repository for patients with abnormal findings and lack of associated follow-up actions, manual review of triggered records, and communication of this information to PCPs via secure e-mail and, if needed, phone calls to ensure message receipt. We compared times to diagnostic evaluation and proportions of patients followed up between intervention and control cohorts based on final review at 7 months. Results We recruited 72 PCPs (36 in the intervention group and 36 in the control group) and applied the trigger to all patients under their care from April 20, 2011, to July 19, 2012. Of 10,673 patients with abnormal findings, the trigger flagged 1,256 patients (11.8%) as high risk for delayed diagnostic evaluation. Times to diagnostic evaluation were significantly lower in intervention patients compared with control patients flagged by the colorectal trigger (median, 104 v 200 days, respectively; n = 557; P < .001) and prostate trigger (40% received evaluation at 144 v 192 days, respectively; n = 157; P < .001) but not the lung trigger (median, 65 v 93 days, respectively; n = 19; P = .59). More intervention patients than control patients received diagnostic evaluation by final review (73.4% v 52.2%, respectively; relative risk, 1.41; 95% CI, 1.25 to 1.58). Conclusion Electronic trigger-based interventions seem to be effective in reducing time to diagnostic evaluation of colorectal and prostate cancer as well as improving the proportion of patients who receive follow-up. Similar interventions could improve timeliness of diagnosis of other serious conditions.

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