scholarly journals Promoting Early Presentation of Breast Cancer in Older Women: Implementing an Evidence-Based Intervention in Routine Clinical Practice

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Lindsay J. L. Forbes ◽  
Alice S. Forster ◽  
Rachael H. Dodd ◽  
Lorraine Tucker ◽  
Rachel Laming ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Clinical Practice ◽  
Randomised Controlled Trial ◽  
Older Women ◽  
Breast Screening ◽  
Controlled Trial ◽  
Routine Clinical Practice ◽  
Cancer Awareness ◽  
Breast Cancer Awareness ◽  
Randomised Controlled

Background. Women over 70 with breast cancer have poorer one-year survival and present at a more advanced stage than younger women. Promoting early symptomatic presentation in older women may reduce stage cost effectively and is unlikely to lead to overdiagnosis. After examining efficacy in a randomised controlled trial, we piloted a brief health professional-delivered intervention to equip women to present promptly with breast symptoms, as an integral part of the final invited mammogram at age~70, in the English National Health Service Breast Screening Programme.Methods. We trained mammographers, who then offered the intervention to older women in four breast screening services. We examined breast cancer awareness at baseline and one month in women receiving the intervention, and also in a service where the intervention was not offered.Results. We trained 27 mammographers to deliver the intervention confidently to a high standard. Breast cancer awareness increased 7-fold at one month in women receiving the intervention compared with 2-fold in the comparison service (odds ratio 15.2, 95% confidence interval 10.0 to 23.2).Conclusions. The PEP Intervention can be implemented in routine clinical practice with a potency similar to that achieved in a randomised controlled trial. It has the potential to reduce delay in diagnosis for breast cancer in older women.

Integrating routine clinical interventions with single-case methodology: Parallels, differences and bridging strategies

2019 ◽  
Vol 21 (1) ◽  
pp. 99-109
Author(s):  
Robyn L. Tate ◽  
Michael Perdices ◽  
Donna Wakim
Keyword(s):  
Clinical Practice ◽  
Randomised Controlled Trial ◽  
Treatment Effectiveness ◽  
Single Case ◽  
Controlled Trial ◽  
Routine Clinical Practice ◽  
Case Methods ◽  
Case Methodology ◽  
Randomised Controlled ◽  
Building Practice

AbstractClinical practice offers the opportunity for the clinician to be a scientist-practitioner in the workplace. This, in turn, facilitates building practice-based evidence. But this can only occur if the effects of the interventions are objectively and systematically evaluated. To this end, single-case methodology is a valuable tool to implement an intervention in a scientifically rigorous manner and gather data on treatment effectiveness. It is possible to incorporate single-case methods into routine clinical practice by using a few simple strategies. This paper examines the ways in which single-case methodology departs from (a) routine clinical practice and (b) the familiar between-groups research design, such as the randomised controlled trial. It presents five practical strategies that will bridge the gap between routine clinical practice and single-case methodology. The Model for Assessing Treatment Effect is described as providing context for and a framework to self-evaluate the scientific rigour in clinical practice and benchmark service delivery.

scholarly journals Thresholds for clinically important deterioration versus improvement in COPD health status: results from a randomised controlled trial in pulmonary rehabilitation and an observational study during routine clinical practice

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025776 ◽  
Author(s):  
Harma Johanna Alma ◽  
Corina de Jong ◽  
Danijel Jelusic ◽  
Michael Wittmann ◽  
Michael Schuler ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Status ◽  
Randomised Controlled Trial ◽  
Pulmonary Rehabilitation ◽  
Controlled Trial ◽  
Routine Clinical Practice ◽  
Observational Research ◽  
Chronic Obstructive ◽  
Global Rating ◽  
Randomised Controlled

ObjectivesChronic Obstructive Pulmonary Disease (COPD) is a progressive disease. Preventing deterioration of health status is therefore an important therapy goal. (Minimal) Clinically Important Differences ((M)CIDs) are used to interpret changes observed. It remains unclear whether (M)CIDs are similar for both deterioration and improvement in health status. This study investigates and compares these clinical thresholds for three widely-used questionnaires.Design and settingData were retrospectively analysed from an inhouse 3-week pulmonary rehabilitation (PR) randomised controlled trial in the German Klinik Bad Reichenhall (study 1), and observational research in Dutch primary and secondary routine clinical practice (RCP) (study 2).ParticipantsPatients with COPD aged ≥18 years (study 1) and aged ≥40 years (study 2) without respiratory comorbidities were included for analysis.Primary outcomesThe COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ) and St George’s Respiratory Questionnaire (SGRQ) were completed at baseline and at 3, 6 and 12 months. A Global Rating of Change scale was added at follow-up. Anchor-based and distribution-based methods were used to determine clinically relevant thresholds.ResultsIn total, 451 patients were included from PR and 207 from RCP. MCIDs for deterioration ranged from 1.30 to 4.21 (CAT), from 0.19 to 0.66 (CCQ), and from 2.75 to 7.53 (SGRQ). MCIDs for improvement ranged from −3.78 to −1.53 (CAT), from −0.50 to −0.19 (CCQ), and from −9.20 to −2.76 (SGRQ). Thresholds for moderate improvement versus deterioration ranged from −5.02 to −3.29 vs 3.89 to 8.14 (CAT), from −0.90 to −0.72 vs 0.42 to 1.23 (CCQ), and from −15.85 to −13.63 vs 7.46 to 9.30 (SGRQ).ConclusionsMCID ranges for improvement and deterioration on the CAT, CCQ and SGRQ were somewhat similar. However, estimates for moderate and large change varied and were inconsistent. Thresholds differed between study settings.Trial registration numberRoutine Inspiratory Muscle Training within COPD Rehabilitation trial: #DRKS00004609; MCID study: #UMCG201500447.

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