STUDY PROTOCOL Open Access
A multi-component cognitive behavioural
intervention for the treatment of fear of
falling after hip fracture (FIT-HIP): protocol
of a randomised controlled trial
Maaike N. Scheffers-Barnhoorn1*, Jolanda C. M. van Haastregt2, Jos M. G. A. Schols2, Gertrudis I. J. M. Kempen2,
Romke van Balen1,3, Jan H. M. Visschedijk1, Wilbert B. van den Hout4, Eve M. Dumas5, Wilco P. Achterberg1
and Monica van Eijk1
Abstract
Background: Hip fracture is a common injury in the geriatric population. Despite surgical repair and subsequent
rehabilitation programmes, functional recovery is often limited, particularly in individuals with multi-morbidity. This
leads to high care dependency and subsequent use of healthcare services. Fear of falling has a negative influence
on recovery after hip fracture, due to avoidance of activity and subsequent restriction in mobility. Although fear of
falling is highly prevalent after hip fracture, no structured treatment programme is currently available. This trial will
evaluate whether targeted treatment of fear of falling in geriatric rehabilitation after hip fracture using a
multi-component cognitive behavioural intervention (FIT-HIP), is feasible and (cost) effective in reducing fear of
falling and associated activity restriction and thereby improves physical functioning.
Methods/design: This multicentre cluster randomised controlled trial will be conducted among older patients with
hip fracture and fear of falling who are admitted to a multidisciplinary inpatient geriatric rehabilitation programme
in eleven post-acute geriatric rehabilitation units. Fifteen participants will be recruited from each site. Recruitment
sites will be allocated by computer randomisation to either the control group, receiving usual care, or to the
intervention group receiving the FIT-HIP intervention in addition to usual care. The FIT-HIP intervention is
conducted by physiotherapists and will be embedded in usual care. It consists of various elements of cognitive
behavioural therapy, including guided exposure to feared activities (that are avoided by the participants).
Participants and outcome assessors are blinded to group allocation. Follow-up measurements will be performed at
3 and 6 months after discharge from geriatric rehabilitation. (Cost)-effectiveness and feasibility of the intervention
will be evaluated. Primary outcome measures are fear of falling and mobility.
Discussion: Targeted treatment of fear of falling may improve recovery and physical and social functioning after
hip fracture, thereby offering benefits for patients and reducing healthcare costs. Results of this study will provide
insight into whether fear of falling is modifiable in the (geriatric) rehabilitation after hip fracture and whether the
intervention is feasible.
Trial registration: Netherlands Trial Register: NTR 5695.
Keywords: Fear of falling, Hip fracture, Geriatric rehabilitation, Randomised controlled trial, Cognitive behavioural ...
Reflection Journal 10Assessment DescriptionStudents are requir.docxcargillfilberto
Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2
Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In so.
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
Safe and Steady Fall Prevention among Senior Citizens.pptxHenrySaya1
Health awareness for fall prevention among elderly / senior citizens. By prioritizing fall prevention, we can ensure the safety, independence, and well-being of older adults while also minimizing healthcare costs and enhancing the overall quality of life for our aging population. Raising awareness among older adults about fall risks is crucial for empowering them, promoting proactive behaviors, and reducing the incidence of falls. By increasing knowledge and understanding, we can create a culture of safety, support healthy aging, and ultimately improve the quality of life for older adults.
Reflection Journal 10Assessment DescriptionStudents are requir.docxcargillfilberto
Reflection Journal 10
Assessment Description
Students are required to maintain weekly reflective narratives throughout the course to combine into one course-long reflective journal that integrates leadership and inquiry into current practice as it applies to the Professional Capstone and Practicum course.
In your journal, you will reflect on the personal knowledge and skills gained throughout this course. The journal should address a variable combination of the following, depending on your specific practice immersion clinical experiences:
Please focus on the topic: Fall Prevention in Outpatient Radiology Clinic
New practice approaches
Intra-professional collaboration
Healthcare delivery and clinical systems
Ethical considerations in health care
Population health concerns
The role of technology in improving health care outcomes
Health policy
Leadership and economic models
Health disparities
Students will outline what they have discovered about their professional practice, personal strengths and weaknesses that surfaced, additional resources and abilities that could be introduced to a given situation to influence optimal outcomes, and finally, how the student met the competencies aligned to this course.
While APA style is not required for the body of this assignment, solid academic writing is expected, and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.
Benchmark Information
This benchmark assignment assesses the following programmatic competencies:
RN to BSN
1.3: Understand and value the processes of critical thinking, ethical reasoning, and decision making.
2.6: Promote interprofessional collaborative communication with health care teams to provide safe and effective care.
3.2: Utilize patient care technology and information management systems.
4.2: Preserve the integrity and human dignity in the care of all patients.
5.5: Provide culturally sensitive care.
20XXKRONA HOSPITAL OPERATING BUDGET FOR 20XXRevenuesInpatient $ 25,000,000Outpatient15,000,000Emergency Room10,000,000Laboratory5,000,000Pharmacy1,500,000Home Health and Hospice1,500,000Ambulance Services950,000Substance Abuse250,000Other850,000Subtotal$ 60,050,000Less Chartiy Care18,000,000Net Revenues$ 42,050,000ExpensesPayroll (including nursing salaries)$ 12,500,000Benefits3,000,000Contract Labor100,000Insurance300,000General Services (laundary, security, etc)3,000,000Depreciation 1,500,000Interest Expense300,000Professional Services10,000,000Total Operating Expenses$ 30,700,000Net Income$ 11,350,000
Sheet2
Sheet3
Benchmark - Capstone Project Change Proposal
Mananita Gerochi-Caparas
Grand Canyon University
NRS-493-O503 Professional Capstone and Practicum
Davida Murphy Smith
October 23, 2022
Benchmark - Capstone Project Change Proposal
Background
Falling incidences are prevalent among older patients. In so.
Abstract
Background: Physiotherapy is multi-dimensional and can treat a vast variety of conditions, ranging from musculoskeletal aches, arthritis, joints problems, paraplegia, hemiplegic, sports injuries and frozen shoulder etc. Apart from culture competency and core medical knowledge a physiotherapist must be competent enough in all physiotherapist medical conditions where physical therapy plays a vital role. This study aims to identify the frequency of common clinical conditions among client presented at Habib Physiotherapy Complex (HPC), Hayatabad during 2010.
Methodology: This was a descriptive study; the data were retrieved from record register of HPC (Indoor and Outdoor patients) recording their presenting complaints and known diagnoses. Data was collected on a structure grid. Data was analyzed using SPSS version 15 and presented in term of frequency and percentages.
Result: The majority of clients (1280 (29%)) were suffering from low back pain. The second common condition 891(20%) was osteoarthritis of the knee joint and cerebrovascular accidents 824(18.4%), while cervical pain accounted for 734(16.4%). The rest of clinical conditions included; frozen shoulder, pelvic inflammation, cerebral palsy, polio effected and paraplegia.
Conclusion: The Study reveals the occurrence of Osteoarthritis (Low Back, Cervical Pain, and Knee Joints Pain) were the most common condition which deteriorated the performance of common individuals in our society.
Safe and Steady Fall Prevention among Senior Citizens.pptxHenrySaya1
Health awareness for fall prevention among elderly / senior citizens. By prioritizing fall prevention, we can ensure the safety, independence, and well-being of older adults while also minimizing healthcare costs and enhancing the overall quality of life for our aging population. Raising awareness among older adults about fall risks is crucial for empowering them, promoting proactive behaviors, and reducing the incidence of falls. By increasing knowledge and understanding, we can create a culture of safety, support healthy aging, and ultimately improve the quality of life for older adults.
Living University of Postural Care - Living Local Postural Care Project Evalu...Sarah Clayton
This project was commissioned in the aftermath of Winterbourne View.
This is one of five projects within the ‘Living Local’ Programme and part of the East Midlands Joint Children and Adults Services Efficiency Strategy. This Programme is within both Health and Social Care which is targeted at delivering better and more personalised outcomes for young adults (aged 14-25) and adults with complex health needs to enable them to live closer to home and have better, more fulfilling lives. This evaluation will outline the background to the project, how the work was carried out and the key findings and recommendations of those involved.
Running head EXERCISE PROGRAMS TO PREVENT FALLS .docxcowinhelen
Running head: EXERCISE PROGRAMS TO PREVENT FALLS 1
EXERCISE PROGRAMS TO PREVENT FALLS 5
Exercise Programs to Prevent
Fall Related Injuries in Older Adults
Student
Student
Gwynedd Mercy University
Abstract
The implementation of exercise programs was evaluated to identify best-practice in fall-related injury prevention. This paper incorporates information from four different studies to identify the evidence that suggests best-practice protocol. Evidence of these studies suggests that implementing exercise programs helps to prevent fall-related injuries in long-term care facilities for older adults. Incorporating exercise programs increases patient safety, prevents further injury, and promotes communication between patients and staff. By implementing these programs, patients’ overall health improves and they’re more satisfied by their ability to perform activities of daily living on a more independent level.
Exercise Programs to Prevent Fall Related Injuries in Older Adults
As individuals age through life, the risk for falls increase immensely. This is due to the lack of strength as well as a lack of balance in the human body. It is important for nurses to take l precautions to help stop patient falls because in many instances, falls are preventable (Ambutas, Lamb, & Quigley, 2017). Fall prevention includes important interventions that stop subsequent injuries from happening to patients. Everyday, nurses take precautions to prevent falls but additional actions could be taken in order to make these interventions more effective. Every patient is at risk of falling, especially older adults because they lose muscle mass and balance as they age (Taylor, Lillis, & Lynn, 2015, p. 142). After performing fall-risk assessments on each patient, nurses implement suggested best practice protocols for low-risk, moderate-risk, and high-risk patients. Best practice includes educating patients and families on fall risk, using bed or chair alarms, lowering the beds, encouraging regular toileting and other precautions (Taylor, et al., p. 145). Exercise programs act as another important measure that nurses could implement, in order to help patients improve their balance, strength and mobility while performing activities of daily living, and reduce risk for falls (Ambutas, Lamb & Quigley).
The following clinical question will be used to identify best practice related to exercise programs in order to prevent falls in older adults:
P: Older adults living in long-term care facilities
I: Exercise programs
C: (none)
O: Prevent fall-related injuries
T: (None)
In long-term care facilities for older adults, how do exercise programs help prevent fall-related injuries?
Review of Literature
Dal Bello-Haas, Thorpe, Lix, Scudds, and Hadjistavropoulos (2012) completed a quantitative research study that focused on the implementation of a walking program in long-term care facilities, in order to prevent falls. Ris ...
Linking clinical workforce skill mix planning to health and health care dynamicsIme Asangansi, MD, PhD
Current health workforce planning methods are inadequate for the complexity of the task. Most approaches treat the workforce supply of individual health professions in isolation and avoid quantifying the impact of changes in skills mix, either planned or unplanned. The causes and consequences of task delegation and task substitution between or within health professions is particularly important in handling workforce shortages in developing countries and understanding and planning possible responses to both rapid catastrophic health demands and slower background trends in their social and political environment. As well as the contextual environment, interactions and delays in supplying and balancing health resources and configuring clinical services are required to address the geographic, profession-specific and quality imbalances. These supply side resources include knowledge and research, skills and attitudes of clinicians, buildings and equipment, medications and medical technologies, information and communications technologies and any other methods and models to improve the provision of clinical services. The interaction between demand
and supply could adjust for feedbacks of health services outcomes, policies and governance on population expectations, funding, political and social supports and explicitly link these to clinical workforce supply in a useful, rigorous and relevant tool. The challenge is capture the relevant essence of the dynamic complexity of health and healthcare for this purpose.
The fragility of health systems has never been of greater interest—or importance—than at this moment, in the aftermath of the worst Ebola virus disease epidemic to date. The loss of life, massive social disruption, and collapse of even the most basic health-care services shows what happens when a crisis hits and health systems are not prepared. This did not happen only in west Africa—we saw it in Texas too: the struggle to provide a coherent response and manage public sentiment (which often manifests as fear) in a way that ensures that disease does not spread while also allowing day-to-day life to continue.
In other words, we saw an absence of resilience.
This Viewpoint puts forth a proposed framework for resilient health systems and the characteristics that define them, informed by insights from other fields that have embraced resilience as a practice.
Η διαχείριση των μειζόνων συμπεριφορικών παραγόντων κινδύνου στην ΠΦΥEvangelos Fragkoulis
Παρουσίαση μου στα πλαίσια του Consensus Meeting: "Η διαχείριση και ο έλεγχος των Μείζονων Συμπεριφορικών Παραγόντων Κινδύνου για την Υγεία: η συμβολή νέων "εργαλείων" για την αντιμετώπιση τους", Ελληνική Επιστημονική Εταιρεία Οικονομίας και Πολιτικής της Υγείας, Ξυλόκαστρο 6-8 Ιουλίου 2018
Perceived benefits and barriers to exercise for recently treated patients wit...Enrique Moreno Gonzalez
Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.
Print, complete, and score the following scales. .docxVannaJoy20
Print, complete, and score the following scales. Do not read how to score a scale until after you have completed it.
1. Stressed Out
2. Susceptibility to Stress (SUS)
3. Response to Stress Scale
4. Are you a Type A or Type B?
5. Coping with Stress
6. Multidimensional Health Locus of Control
7. Locus of Control
8. Life Orientation Test
Identify at Least 5 of Your Personal Stressors and 5 Daily Hassles
Using the information gathered in A and B, write a 3-5 page self-reflection paper that includes the following sections:
. Discuss your scores on each of the above scales and write a couple of brief statements about what that score means for you. Were you surprised by the score(s)? Did the results of the scales resonate with your perception of your stress level?
Incorporating information from your text and other academic sources, provide a summary of your stressors and life hassles.
3. Incorporating information from your text and other academic sources, provide a summary of what you might do to reduce your stress.
4. Discuss the issue of personal stress as it relates to psychological well-being. Relate your own results and thoughts about your experience with these scales to the information provided in the text and other academic sources (journal articles, books, .gov, .edu, or .org websites)
PERSPECTIVE
published: 25 February 2022
doi: 10.3389/fpsyt.2022.846244
Frontiers in Psychiatry | www.frontiersin.org 1 February 2022 | Volume 13 | Article 846244
Edited by:
Kairi Kõlves,
Griffith University, Australia
Reviewed by:
Jacinta Hawgood,
Griffith University, Australia
Jennifer Muehlenkamp,
University of Wisconsin–Eau Claire,
United States
*Correspondence:
M. David Rudd
[email protected]
Specialty section:
This article was submitted to
Psychopathology,
a section of the journal
Frontiers in Psychiatry
Received: 30 December 2021
Accepted: 02 February 2022
Published: 25 February 2022
Citation:
Rudd MD and Bryan CJ (2022)
Finding Effective and Efficient Ways to
Integrate Research Advances Into the
Clinical Suicide Risk Assessment
Interview.
Front. Psychiatry 13:846244.
doi: 10.3389/fpsyt.2022.846244
Finding Effective and Efficient Ways
to Integrate Research Advances Into
the Clinical Suicide Risk Assessment
Interview
M. David Rudd 1* and Craig J. Bryan 2
1Department of Psychology, University of Memphis, Memphis, TN, United States, 2Department of Psychiatry and Behavioral
Science, The Ohio State University Wexner Medical Center, Columbus, OH, United States
Research in clinical suicidology continues to rapidly expand, much of it with implications
for day-to-day clinical practice. Clinicians routinely wrestle with how best to integrate
recent advances into practice and how to do so in efficient and effective fashion. This
article identifies five critical domains of recent research findings and offers examples
of simple questions that can easily be integ.
More Related Content
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Living University of Postural Care - Living Local Postural Care Project Evalu...Sarah Clayton
This project was commissioned in the aftermath of Winterbourne View.
This is one of five projects within the ‘Living Local’ Programme and part of the East Midlands Joint Children and Adults Services Efficiency Strategy. This Programme is within both Health and Social Care which is targeted at delivering better and more personalised outcomes for young adults (aged 14-25) and adults with complex health needs to enable them to live closer to home and have better, more fulfilling lives. This evaluation will outline the background to the project, how the work was carried out and the key findings and recommendations of those involved.
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EXERCISE PROGRAMS TO PREVENT FALLS 5
Exercise Programs to Prevent
Fall Related Injuries in Older Adults
Student
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Gwynedd Mercy University
Abstract
The implementation of exercise programs was evaluated to identify best-practice in fall-related injury prevention. This paper incorporates information from four different studies to identify the evidence that suggests best-practice protocol. Evidence of these studies suggests that implementing exercise programs helps to prevent fall-related injuries in long-term care facilities for older adults. Incorporating exercise programs increases patient safety, prevents further injury, and promotes communication between patients and staff. By implementing these programs, patients’ overall health improves and they’re more satisfied by their ability to perform activities of daily living on a more independent level.
Exercise Programs to Prevent Fall Related Injuries in Older Adults
As individuals age through life, the risk for falls increase immensely. This is due to the lack of strength as well as a lack of balance in the human body. It is important for nurses to take l precautions to help stop patient falls because in many instances, falls are preventable (Ambutas, Lamb, & Quigley, 2017). Fall prevention includes important interventions that stop subsequent injuries from happening to patients. Everyday, nurses take precautions to prevent falls but additional actions could be taken in order to make these interventions more effective. Every patient is at risk of falling, especially older adults because they lose muscle mass and balance as they age (Taylor, Lillis, & Lynn, 2015, p. 142). After performing fall-risk assessments on each patient, nurses implement suggested best practice protocols for low-risk, moderate-risk, and high-risk patients. Best practice includes educating patients and families on fall risk, using bed or chair alarms, lowering the beds, encouraging regular toileting and other precautions (Taylor, et al., p. 145). Exercise programs act as another important measure that nurses could implement, in order to help patients improve their balance, strength and mobility while performing activities of daily living, and reduce risk for falls (Ambutas, Lamb & Quigley).
The following clinical question will be used to identify best practice related to exercise programs in order to prevent falls in older adults:
P: Older adults living in long-term care facilities
I: Exercise programs
C: (none)
O: Prevent fall-related injuries
T: (None)
In long-term care facilities for older adults, how do exercise programs help prevent fall-related injuries?
Review of Literature
Dal Bello-Haas, Thorpe, Lix, Scudds, and Hadjistavropoulos (2012) completed a quantitative research study that focused on the implementation of a walking program in long-term care facilities, in order to prevent falls. Ris ...
Linking clinical workforce skill mix planning to health and health care dynamicsIme Asangansi, MD, PhD
Current health workforce planning methods are inadequate for the complexity of the task. Most approaches treat the workforce supply of individual health professions in isolation and avoid quantifying the impact of changes in skills mix, either planned or unplanned. The causes and consequences of task delegation and task substitution between or within health professions is particularly important in handling workforce shortages in developing countries and understanding and planning possible responses to both rapid catastrophic health demands and slower background trends in their social and political environment. As well as the contextual environment, interactions and delays in supplying and balancing health resources and configuring clinical services are required to address the geographic, profession-specific and quality imbalances. These supply side resources include knowledge and research, skills and attitudes of clinicians, buildings and equipment, medications and medical technologies, information and communications technologies and any other methods and models to improve the provision of clinical services. The interaction between demand
and supply could adjust for feedbacks of health services outcomes, policies and governance on population expectations, funding, political and social supports and explicitly link these to clinical workforce supply in a useful, rigorous and relevant tool. The challenge is capture the relevant essence of the dynamic complexity of health and healthcare for this purpose.
The fragility of health systems has never been of greater interest—or importance—than at this moment, in the aftermath of the worst Ebola virus disease epidemic to date. The loss of life, massive social disruption, and collapse of even the most basic health-care services shows what happens when a crisis hits and health systems are not prepared. This did not happen only in west Africa—we saw it in Texas too: the struggle to provide a coherent response and manage public sentiment (which often manifests as fear) in a way that ensures that disease does not spread while also allowing day-to-day life to continue.
In other words, we saw an absence of resilience.
This Viewpoint puts forth a proposed framework for resilient health systems and the characteristics that define them, informed by insights from other fields that have embraced resilience as a practice.
Η διαχείριση των μειζόνων συμπεριφορικών παραγόντων κινδύνου στην ΠΦΥEvangelos Fragkoulis
Παρουσίαση μου στα πλαίσια του Consensus Meeting: "Η διαχείριση και ο έλεγχος των Μείζονων Συμπεριφορικών Παραγόντων Κινδύνου για την Υγεία: η συμβολή νέων "εργαλείων" για την αντιμετώπιση τους", Ελληνική Επιστημονική Εταιρεία Οικονομίας και Πολιτικής της Υγείας, Ξυλόκαστρο 6-8 Ιουλίου 2018
Perceived benefits and barriers to exercise for recently treated patients wit...Enrique Moreno Gonzalez
Understanding the physical activity experiences of patients with multiple myeloma (MM) is essential to inform the development of evidence-based interventions and to quantify the benefits of physical activity. The aim of this study was to gain an in-depth understanding of the physical activity experiences and perceived benefits and barriers to physical activity for patients with MM.
Similar to STUDY PROTOCOL Open AccessA multi-component cognitive beha (20)
Print, complete, and score the following scales. .docxVannaJoy20
Print, complete, and score the following scales. Do not read how to score a scale until after you have completed it.
1. Stressed Out
2. Susceptibility to Stress (SUS)
3. Response to Stress Scale
4. Are you a Type A or Type B?
5. Coping with Stress
6. Multidimensional Health Locus of Control
7. Locus of Control
8. Life Orientation Test
Identify at Least 5 of Your Personal Stressors and 5 Daily Hassles
Using the information gathered in A and B, write a 3-5 page self-reflection paper that includes the following sections:
. Discuss your scores on each of the above scales and write a couple of brief statements about what that score means for you. Were you surprised by the score(s)? Did the results of the scales resonate with your perception of your stress level?
Incorporating information from your text and other academic sources, provide a summary of your stressors and life hassles.
3. Incorporating information from your text and other academic sources, provide a summary of what you might do to reduce your stress.
4. Discuss the issue of personal stress as it relates to psychological well-being. Relate your own results and thoughts about your experience with these scales to the information provided in the text and other academic sources (journal articles, books, .gov, .edu, or .org websites)
PERSPECTIVE
published: 25 February 2022
doi: 10.3389/fpsyt.2022.846244
Frontiers in Psychiatry | www.frontiersin.org 1 February 2022 | Volume 13 | Article 846244
Edited by:
Kairi Kõlves,
Griffith University, Australia
Reviewed by:
Jacinta Hawgood,
Griffith University, Australia
Jennifer Muehlenkamp,
University of Wisconsin–Eau Claire,
United States
*Correspondence:
M. David Rudd
[email protected]
Specialty section:
This article was submitted to
Psychopathology,
a section of the journal
Frontiers in Psychiatry
Received: 30 December 2021
Accepted: 02 February 2022
Published: 25 February 2022
Citation:
Rudd MD and Bryan CJ (2022)
Finding Effective and Efficient Ways to
Integrate Research Advances Into the
Clinical Suicide Risk Assessment
Interview.
Front. Psychiatry 13:846244.
doi: 10.3389/fpsyt.2022.846244
Finding Effective and Efficient Ways
to Integrate Research Advances Into
the Clinical Suicide Risk Assessment
Interview
M. David Rudd 1* and Craig J. Bryan 2
1Department of Psychology, University of Memphis, Memphis, TN, United States, 2Department of Psychiatry and Behavioral
Science, The Ohio State University Wexner Medical Center, Columbus, OH, United States
Research in clinical suicidology continues to rapidly expand, much of it with implications
for day-to-day clinical practice. Clinicians routinely wrestle with how best to integrate
recent advances into practice and how to do so in efficient and effective fashion. This
article identifies five critical domains of recent research findings and offers examples
of simple questions that can easily be integ.
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Consequentialist theory
Focuses on consequences of actions
Hard Universalist/Absolutist theory
The theory that one ought to maximize happiness and
minimize the unhappiness of as many people as
possible
Epicurus (341-270 B.C.E.) Greek philosopher who
advocated a life free of pain
Coined the term utilitarianism
Believed that it is good for an action to have a utility
(to make people happy)
Developed Hume’s theory of utility into a moral theory
to reform the British legal system
Believed that all humans are hedonists
Developed Hedonistic Calculus
Calculates probable consequences of actions
Produces a rational solution to any problem
Rediscovered the paradox of hedonism
The more you search for pleasure, the more it will elude
you
Refined Bentham’s theory
Higher and lower pleasures
Harm Principle
The only purpose of interfering with the life of someone
is to prevent harm to others
Act Utilitarianism
Always do whatever act
that will create the
greatest happiness for
the greatest number of
people
Only focuses on
consequences of present
decision
Always do whatever type
of act (based on a rule)
that will create the
greatest happiness for
the greatest number of
people
Focuses on consequences
of others applying that
same rule
Rule Utilitarianism
CemeteryAnalysis
Massachusetts has a unique archaeological resource in its many colonial graveyards. These contain a large number of precisely dated “artifacts” in the form of headstones and provide an opportunity for studies of the ways in which different aspects of British colonial and Euro- American culture have changed over time. For this assignment, you will visit a local cemetery of your choosing and use the headstones and other associated material culture to address questions aimed at understanding demographic, social, symbolic, or technological issues in the past. This assignment does not require any archaeological excavation, and your instructor and federal, state, and local laws expressly forbid you from doing any! The project also does not require you to do any additional background research, although you are welcome to do so. Please
respect these cemeteries, the individuals buried therein, and any visitors you may encounter during your study.
You must follow these steps:
1)
Chooseagraveyardwithheadstonesdatingtothe1600s,1700s,or1800s. There are several good graveyards in downtown Boston and many more scattered around the city and suburbs. The downtown locations have been studied at length as they are all regularly served by the MBTA. Several “off-the-beaten-track” locations, such as the Tollgate Cemetery in Forest Hills, is also served by transit and has not been visited by my students in the past. While everyone has their own time pressures, I encourage to think .
The theory that states that people look after their .docxVannaJoy20
The theory that states that people look
after their own self interest
An absolutist theory
Does not consider other options
A descriptive theory
Does not make a judgment
A British philosopher (1588-1679)
Agreed with Glaucon that:
Humans choose to live in a society with rules
because it benefits us
Any show of concern for others only hides a
true concern for ourselves
It is foolish to not look after ourselves
Believed that humans feel pity for others
because we fear something similar happening to
us
A theory that says people ought to act in their
own self interest
An absolutist theory
A normative theory
Makes a judgment or prescription about
behavior
A consequentialist theory
Focuses on consequences of actions
Russian-born American (1905-1982)
Believed that egoism benefits society
People should not feel guilty for seeking their own
happiness
People should not feel obligated to help those who are
“moochers and leeches.”
Everyone should give up his or her own self-interest
for others
Normative theory
Consequentialist theory
.
This is a graded discussion 30 points possibledue -.docxVannaJoy20
This is a graded discussion: 30 points possible
due -
Discussion 2 (Complete by
Sunday, Nov. 6)
20 20
This discussion aligns with Learning Outcomes 1, 2, and 4
Democracy, at its core, is centered on the idea that individuals can, in fact,
rule themselves. This concept is enshrined in the U.S. Constitution as we
know it today. However, early on the American Constitution was not a sound,
democratic document. In particular, the idea of popular sovereignty; that is,
the will of the people, was not extended to everyone. For example, as you
read this week, the framers, for a time, chose to retain slavery in the new
Republic. In addition to slavery, in what other areas was the Constitution of
1788 less than democratic? In what ways has the Constitution, since then,
become more democratic? Be sure to provide examples to support your
claims.
Submission
Our discussions are a valuable opportunity to have thoughtful conversations
regarding a specific topic. You are required to provide a comprehensive
initial post with 3-4 well-developed paragraphs that include a topic
sentence and at least 3-5 supporting sentences with additional details,
11/4/22, 1:30 AM
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Reply
explanations, and examples. In addition, you are required to respond
substantively to the initial posts of at least two other classmates on two
different days. All posts should be reflective and well written, meaning free
of errors in grammar, sentence structure, and other mechanics.
Grading
This discussion is worth 30 points toward your final grade and will be
graded using the Discussion Rubric. Please use it as a guide toward
successful completion of this discussion. For information on how to view the
rubric, refer to this Canvas Community Guide
(https://community.canvaslms.com/docs/DOC-10577-4212540120) .
Unread Subscribe
(https://canvas.fscj.edu/courses/65283/users/135004)
Sarkis Boyajian (https://canvas.fscj.edu/courses/65283/users/135004)
Tuesday
11/4/22, 1:30 AM
Page 2 of 29
Reply
The Constitution of 1788 lacked democracy because it did not protect
the people’s beliefs. Religion influences people’s morality. And morality is
a key component of personal convictions. People’s convictions influence
how they want to be governed and how they vote. The first amendment to
the Constitution provided protection to the people’s beliefs by restricting
Congress from making laws respective to an establishment of religion or
prohibiting the free exercise thereof.
The Constitution of 1788 lacked democracy because it did not protect
the people’s expression. Speech is the cornerstone of sharing thoughts
and ideas. The sharing of thoughts and ideas influences people’s
opinions. People’s opinions influence how they want to be governed and
how they vote. The first amendment to the Constitution provided
protection to people’s expression by restricting Congress from making
laws respective to ab.
· Please include the following to create your Argumentative Essay .docxVannaJoy20
· Please include the following to create your Argumentative Essay Presentation Plan:
· Presentation author and title of the presentation (Essay)
· Purpose: What do you want your audience to obtain or support after the discussion?
· Audience: What phrases will you adapt-without diverting from the purpose of the essay- as you select a medium to include on the slides?
· Keywords: As you break down your essay into keywords, which themes and concepts arise?
· Introduction: What does the outline of the presentation include?
· Body: Think about the body of your essay. Which specific details are necessary to get your points across?
· Conclusion: Why is your essay and analysis important?
· How did you get to that conclusion?
· Since you will communicate with the audience through more than one sense, what media do you intend to use?
· Which presentation software program do you intend to use to prepare the presentation?
· As you prepare your presentation and deepen your understanding, what do you notice that you hadn’t seen before?
· You must present your writing double-spaced, in a Times New Roman, Arial or Courier New font, with a font size of 12.
· Pay attention to grammar rules (spelling and syntax).
· Your work must be original and must not contain material copied from books or the internet.
· When citing the work of other authors, include citations and references using APA style to respect their intellectual property and avoid plagiarism.
· Remember that your writing must have a header or a cover page that includes the name of the institution, the program, the course code, the title of the activity, your name and student number, and the assignment's due date.
.
• FINISH IVF• NATURAL FAMILY PLANNING• Preimplanta.docxVannaJoy20
• FINISH IVF
• NATURAL FAMILY PLANNING
• Preimplantation Genetic Diagnosis (PGD)
• Surrogate motherhood
• “snowflake babies”
• Artificial Insemination (AI)
Preimplantation Genetic Diagnosis (PGD)
ZYGOTE
M
O
RU
LA
COMPACTION
BLASTOMERES
MALE &
FEMALE
PRONUCLEI
Surrogate motherhood
https://en.wikipedia.org/wiki/2014_Thai_surrogacy_controversy
INTRINSIC BIOETHICAL EVIL/WRONG:
NATURAL RIGHT TO BE GESTATED BY BIOLOGICAL MOTHER
“snowflake babies” = ivf embryo transfer
http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html
Artificial Insemination (AI)
NATURAL FAMILY PLANNING (NFP)
1.OVULATION SYMPTOMS
2.BIOETHICAL EVALUATION
NATURAL FAMILY PLANNING (NFP)
1.OVULATION SYMPTOMS
a) 3 PRIMARY
b) 7 SECONDARY
PRIMARY OVULATION SYMPTOMS:
1) BASAL BODY TEMPERATURE (BBT)
2) CERVIX ACTIVITY
3) CERVICAL MUCUS
SECONDARY OVULATION SYMPTOMS:
1) MITTELSCHMERZ
2) SPOTTING
3) SWOLLEN VAGINA AND/OR VULVA
4) INCREASED LIBIDO
5) BREAST TENDERNESS
6) GENERAL BLOATING
7) FERNING
SOME MAJOR PROTOCOLS AND METHODS:
• CREIGHTON MODEL (NaPro Technology)
• COUPLE TO COUPLE (CCL)
• SYMPTO-THERMAL METHOD
• BILLINGS METHOD
• FAMILY OF THE AMERICAS (BASED ON BILLINGS)
ACTIVITY OF THE CERVIX AND CERIVCAL OS DURING MENSTRUAL CYCLE
INFERTILEFERTILE
1 DAY BEFORE OVULATION:
OS OPEN, CERVIX HIGH,
SOFT AND CENTRAL,
EGGWHITE FLUID
INFERTILE PHASE: OS CLOSED,
CERVIX FIRM,
ANGLED SLIGHTLY,
TACKY FLUID
Examples of cervical mucus
during various days of the
menstrual cycle.
Transparent and elastic
is fertile.
Opaque and tacky
is infertile.
WHAT ABOUT THE HUSBAND?
• DISCIPLINE, RESPECT, COMMUNICATION, SACRIFICIAL LOVE
• OPENNESS TO THE PRESENCE OF GOD IN THEIR DAILY LIFE
2. BIOETHICAL EVALUATION OF NFP:
a) AS A MEANS
b) AS AN END / GOAL / OBJECTIVE
a) AS A MEANS:
• NO SEPARATION ÷ UNITIVE / PROCREATIVE
DIMENSIONS
• RESPECTFUL OF HUMAN NATURE
• MARRITAL INTIMACY = UNION OF
BODY AND SOUL
b) AS AN END:
HUMANAE VITAE 16b:
“If therefore there are well-grounded
reasons for spacing births, arising from the
physical or psychological condition
of husband or wife,
or from external circumstances…
then take advantage
of the natural cycles immanent
in the reproductive system…”
b) AS AN END:
THEREFORE, TO BE AVOIDED IS A
CONTRACEPTIVE MENTALITY,
WHEREBY PREGNANCY / CHILDREN
ARE SEEN AS AN EVIL,
TO BE AVOIDED BY ANY MEANS.
INSTEAD, A FUNDAMENTAL OPENNESS TO LIFE,
COLLABORATING WITH GOD’S PLAN
TO BE CO-CREATORS
OF A UNIQUE HUMAN LIFE.
Slide Number 1Slide Number 2Slide Number 3Slide Number 4Slide Number 5Slide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14Slide Number 15Slide Number 16Slide Number 17Slide Number 18Slide Number 19
See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/220672617
.
Use the information presented in the module folder along with your.docxVannaJoy20
Use the information presented in the module folder along with your readings from the textbook to answer thefollowing questions.1. Differentiate between bacterial infection and bacterial intoxication.
2. Discuss the importance of E. coli as part of our intestinal flora.
3. Describe three (3) different types of gastrointestinal diseases caused by bacteria. Besure to give the name of the specific organism that causes each, describe somecommon signs and symptoms and discuss treatment for each disease:
4. Define meningitis. Compare and contrast between bacterial and viral meningitisincluding treatment for each.
5. What is a prion? Describe the impact prions have on the human brain and discuss twoprion-associated diseases in humans:
6. What is a vector-borne (vector transmitted) disease? Give an example of a vectorborne disease and the vector responsible for causing it.
.
• Ryanairs operations have been consistently plagued with emp.docxVannaJoy20
• Ryanair's operations have been consistently plagued with employee
discontent and protests (Temming, 2017). Communication between Line
Managers and employees has been tensed, and performance has suffered as a
result. The Company would benefit from the strategic positioning and
interpersonal skills of the Human Resource Business Partner.
• As an employee advocate, he or she would engage employees in dialogue and
ensure that whatever findings are made are brought to the attention of the line
manager promptly to be addressed.
• Also, as a collaborative partner, he would assist in channeling the needs of the
line manager in a way that will be understood and well received by
subordinates.
• Effective communication would eventually lead to mutual understanding and
benefit for all parties.
• It would go a long way in developing a strong company culture where
individuals are not afraid to express their thoughts and ideas. and would shift
focus away from conflict towards meeting Organizational goals.
01 CONSTRUCTIVE COMMUNICATION
BETWEEN MANAGEMENT AND STAFF
02 EFFECTIVE CHANGE
MANAGEMENT
• The Greek Philosopher, Heraclitus stated that “Change is the only
constant of life” (Rothwell et al., 2015). This statement is pertinent to the
rapidly changing business climate (Lauer, 2019, p3) in which Ryanair
finds itself.
• A company’s readiness and reaction to change are important in
determining success. From our current state analysis, we discovered
that several tasks may be expedited and optimized with the introduction
of new technology.
• However, this must be introduced strategically to prevent resistance.
The role of the Human Resources Business Partner is essential in this
regard.
• He or She would determine the need for change and ensure reception of
the change by employing effective communication strategies
(McCracken et al., 2017).
• Apart from a change in technology, other elements that may undergo
transformation include processes, policies, personnel, amongst others.
It is important that these changes are taken in stride so that they do not
forestall operations.
03 FOCUSED TRAINING AND
CAPACITY BUILDING
• The Business Partner would be instrumental in identifying
areas requiring competency improvements (Onen, 2013) in
Ryanair.
• Through a series of activities such as performance reviews
and data analysis, as well as knowledge of the business, and
interactions with staff, the business partner would tailor
training programmers to drive outcomes that matter and meet
the company's needs and vision.
• Doing so would be of benefit not only to employees but to
Ryanair, who would see improved performances and save
costs that would have gone into retraining because of an
inefficient programme.
EFFECTIVE STRATEGY
DEVELOPMENT
• Ryanair would benefit from the HRBP's skills and
knowledge in developing strategic plans that create value
for future business successes.
• He or she would ensure that plans align with the needs and
expectations .
· Your initial post should be at least 500 words, formatted and ci.docxVannaJoy20
· Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
· All replies must be constructive and use literature where possible.
#1
Lisa Wright
St. Thomas University
NUR 417: Aging and End of Life
Yedelis Diaz
November 01, 2022
Pathological Conditions in Older Adults
As one goes through the natural aging process, the body's capacity to defend itself against infections diminishes. The immune system's ability to offer protection is reduced, and the individual becomes susceptible to conditions that affect them more than other age groups (Haynes, 2020). This population also experiences other symptoms impairing other aspects of their lives as time passes. For instance, their skin and bones lose their integrity and become more prone to abrasions and breakage. This assignment module will examine the pathological conditions that affect the sexual response in older adults and how and why nutritional and psychological factors, drugs, and other alternative and complementary medications affect the immune system of the populations.
Pathological Conditions that Affect Sexual Response in Older Adults
Sexuality is an essential aspect of life, irrespective of the age group one is in—the older population and the younger generation alike need to explore sexuality to maintain health and well-being. Exploring sexuality is also a mixture of biological, psychological, social, and religious factors, all of which have plenty to do with aging. Among the pathological conditions that affect sexual response in the elderly include
Genitourinary Syndrome of Menopause
These are the changes experienced in the genitourinary pathway as one age. The individual can feel a burning sensation, dryness, or irritation. This can lead to painful sexual encounters, which can, in turn, reduce their desire to engage and their response.
Dementia
This is a degenerative disorder of the mental faculties, predominantly among the elderly (National Institute on Aging, n.d.). Their judgment diminishes, making them disinterested or utterly unaware of their sexual experiences. Some forms of the condition have been shown to increase sex or closeness, but the individual may fail to recognize what is appropriate and what is not.
Diabetes
As a chronic condition experienced mainly by this population, it can lead to yeast generation, leading to itchiness around the sex organs, making sex unpalatable. The situation can, however, be addressed with medication.
Incontinence
This is a condition where one experiences bladder leakage caused by poor control (National Institute on Aging, n.d.). It is most prevalent among the population an.
• ALFRED CIOFFI• CATHOLIC PRIEST, ARCHDIOCESE OF MIAMI.docxVannaJoy20
• ALFRED CIOFFI
• CATHOLIC PRIEST, ARCHDIOCESE OF MIAMI
• DOCTORATE IN MORAL THEOLOGY, GREGORIAN UNIVERSITY, ROME, ITALY
• DOCTORATE IN GENETICS, PURDUE UNIVERSITY, INDIANA
• ASSOCIATE PROFESSOR, BIOLOGY AND BIOETHICS
• DIRECTOR, INSTITUTE FOR BIOETHICS
BIOMEDICAL ETHICS
Introduction
• PRESENTATIONS
• THINK
• RESPECT
• HONOR CODE
• ON TIME
• QUIZZES
• TAKE NOTES
• AVERAGE
CANVAS
HUMAN BIO-ETHICS: evidence-based
• BEGINNING OF LIFE
• HEALTHCARE
• END OF LIFE
BIO-ETHICS
PRINCIPLED
UTILITARIAN
or…
• SEXUAL REPRODUCTION
• EARLY EMBRYONIC DEVELOPMENT
• ONTOLOGICAL STATUS OF HUMAN EMBRYO
SEXUAL REPRODUCTION: INVOLVES FERTILIZATION
FERTILIZATION: INVOLVES FUSION OF GAMETES
AT FERTILIZATION THE DIPLOID NUMBER (2n) IS RESTORED
GAMETES = SEX CELLS (SPERM & OVA), PRODUCED BY MEIOSIS
FIRST, A REVIEW OF MITOSIS
b
d
c
a
chromatin
2n
2n
b
d
c
a
chromatin
2n
2n
X
X
X
X
2b
1a
1b
2a
chromatin
2n
2n
2b1b
1a
2a
2b1b
1a
2a
1a 1b
2b
2a
2b1b
1a
2a
2a 2b
1b
1a
DNA REPLICATION
SISTER CHROMATIDS
Temporary “4n” stage
2b1b
1a
2a
CELL CYCLE
G = GAP
S = SYNTHESIS
2n
2n
2n
MEIOSIS:
DOUBLE CELLULAR SPLIT: ONE CELL -> -> 4 CELLS
• RECOMBINATION (CROSSING OVER)
• FROM DIPLOID NUMBER (2n) -> HAPLOID NUMBER (n) = CHROMATIC REDUCTION
2a
2b
1a
1b
2a
2b
1a
1b
2a2b
1a1b
DNA RECOMBINATION = CROSSING OVER
MEIOSIS = FORMATION OF GAMETES (SEX CELLS), HAPLOID
SPERMATOGENESIS -> SPERM (n)
GAMETOGENESIS
OOGENESIS -> OVUM (n)
Primary spermatocyte (2n)
Primary oocyte (2n)
Polar
bodies
H. sapiens # OF CHROMOSOMES = 46 = 23 "PAIRS" ONLY IDENTICAL IN FEMALE (XX)
• 22 PAIRS = AUTOSOMES
• 1 PAIR = SEX CHROMOSOMES
THEREFORE, IN HUMANS:
• n = 23 (gametes)
• 2n = 46 (somatic cells)
Seminiferous
tubules
Ovarian
follicles
VIDEOS OF HUMAN EMBRYONIC AND FETAL DEVELOPMENT
From fertilization to birth 6 minutes
https://www.youtube.com/watch?v=7kC6p1twkXk
https://www.youtube.com/watch?v=7kC6p1twkXk
EGG + SPERM = ZYGOTE
ZYGON (GK) = YOKED OR LINKED
ZYGOTE DNA:
• 50% OF THE GENETIC MATERIAL COMES FROM THE MOTHER
• 50% FROM THE FATHER
0.1 mm 0.005 mm
0.05 mm
= SYNGAMY
Ampulla
DAY 1
DAY 7
Endometrium
ZYGOTE
M
O
RU
LA
COMPACTION
BLASTOMERES
MALE &
FEMALE
PRONUCLEI
FIRST CELLULAR DIFFERENTIATION = 2 CELL LAYERS
(INNER CELL MASS)
1 2 3
4 5 6
IMPLANTATION
FURTHER CELLULAR DIFFERENTIATION: 3 GERM LAYERS
( ICM )
GASTRULATION
THIRD WEEK OF EMBRYONIC DEVELOPMNET:
GASTRULA
LONGITUDINAL VIEW CROSS SECTION
NEURAL GROOVE
~ 1 inch
EIGHT WEEKS
EMBRYO FETUS
FETUS
VIDEOS OF HUMAN EMBRYONIC AND FETAL DEVELOPMENT
Conception to birth -- visualized | Alexander Tsiaras 10 minutes
https://www.youtube.com/watch?v=fKyljukBE70
https://www.youtube.com/watch?v=fKyljukBE70
THEREFORE, REGARDING EMBRYONIC DEVELOPMENT:
CONTINUOUS DEVELOPMENT OF TISSUES, ORGANS AND SYSTEMS
FROM THE ZYGOTE, THROUGH 9 MONTHS, UP .
· Reflect on the four peer-reviewed articles you critically apprai.docxVannaJoy20
· Reflect on the four peer-reviewed articles you critically appraised in Module 4, related to your clinical topic of interest and PICOT.
· Reflect on your current healthcare organization and think about potential opportunities for evidence-based change, using your topic of interest and PICOT as the basis for your reflection.
· Consider the best method of disseminating the results of your presentation to an audience.
The Assignment: (Evidence-Based Project)
Part 4: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide
narrated PowerPoint presentation in which you do the following:
· Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
· Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
· Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
· Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
· Explain how you would disseminate the results of your project to an audience. Provide a rationale for why you selected this dissemination strategy.
· Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
· Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
· Add a lessons learned section that includes the following:
· A summary of the critical appraisal of the peer-reviewed articles you previously submitted
· An explanation about what you learned from completing the Evaluation Table within the Critical Appraisal Tool Worksheet Template (1-3 slides)
Zeinab Hazime
Nurs 6052
10/16/2022
Evaluation Table
Use this document to complete the
evaluation table requirement of the Module 4 Assessment,
Evidence-Based Project, Part 3A: Critical Appraisal of Research
Full
APA formatted citation of selected article.
Article #1
Article #2
Article #3
Article #4
Abraham, J., Kitsiou, S., Meng, A., Burton, S., Vatani, H., & Kannampallil, T.
(2020). Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews.
BMJ Quality & Safety, 29(10), 1-2.
Alanazi, A. (2020). The effect of computerized physician order entry on mortality rates in pediatric and neonatal care setting: Meta-analysis.
Informatics in Medicine
Unlocked, 19, 100308. https.
· Choose a B2B company of your choice (please note that your chose.docxVannaJoy20
· Choose a B2B company of your choice (please note that your chosen company will also be used for your final assignment).
· Across your two assignment you will develop an Industrial marketing plan.
· For assignment 1 you are required to develop the first part of the marketing plan and assignment 2 the final part.
· Perform a situation analysis identifying the following:
1. Product mix:
i. Current product mix, product lines and individual products
2. Market analysis:
i. Who are their current competitors
ii. PESTEL
3. Market segmentation
i. Identify the segments that that they target (including the characteristics of each market segment).
4. Value proposition:
i. Identify the value that the company aims to provide to each segment (which products are aimed at each segment and what the benefits
are to that segment)
5. Positioning:
i. How do they position themselves in the market (and if relevant to each segment). How do they differentiate themselves through this
positioning from their competitors?
· Your Marketing Plan Part 1 should be uploaded in PDF format.
· Your table of contents should include:
1. Introduction/Background
2. Product Mix
3. Market analysis
4. Market segmentation
5. Value proposition
6. Positioning
7. References
Formalities:
· Wordcount: 1500
· Cover, Table of Contents, References and Appendix are excluded of the total wordcount.
· Font: Arial 11 pts.
· Text alignment: Left.
· The in-text References and the Bibliography must be in Harvard’s citation style.
Dido and Aeneas
Music composed by Henry Purcell
Libretto by Nahum Tate
Date of composition: 1689
DIDO AND AENEAS
An opera perform'd at Mr. Josias Priest's Boarding School
at Chelsey by Young Gentlewomen.
The words made by Mr. NAHUM TATE
The music composed by Mr. HENRY PURCELL
Dramatis Personae
DIDO
BELINDA
TWO WOMEN
AENEAS
SORCERESS
ENCHANTRESSES
SPIRIT of the Sorceress (Mercury)
Dido's train, Aeneas' train, Fairies, Sailors
OVERTURE
ACT THE FIRST
Scene [I]: The Palace [enter Dido, Belinda and train]
BELINDA
Shake the cloud from off your brow,
Fate your wishes does allow;
Empire growing,
Pleasures flowing,
Fortune smiles and so should you.
CHORUS
Banish sorrow, banish care,
Grief should ne'er approach the fair.
DIDO
Ah! Belinda, I am prest
With torment not to be Confest,
Peace and I are strangers grown.
I languish till my grief is known,
Yet would not have it guest.
BELINDA
Grief increases by concealing,
DIDO
Mine admits of no revealing.
BELINDA
Then let me speak; the Trojan guest
Into your tender thoughts has prest;
The greatest blessing Fate can give
Our Carthage to secure and Troy revive.
CHORUS
When monarchs unite, how happy their state,
They triumph at once o'er their foes and t.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
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STUDY PROTOCOL Open AccessA multi-component cognitive beha
1. STUDY PROTOCOL Open Access
A multi-component cognitive behavioural
intervention for the treatment of fear of
falling after hip fracture (FIT-HIP): protocol
of a randomised controlled trial
Maaike N. Scheffers-Barnhoorn1*, Jolanda C. M. van
Haastregt2, Jos M. G. A. Schols2, Gertrudis I. J. M. Kempen2,
Romke van Balen1,3, Jan H. M. Visschedijk1, Wilbert B. van
den Hout4, Eve M. Dumas5, Wilco P. Achterberg1
and Monica van Eijk1
Abstract
Background: Hip fracture is a common injury in the geriatric
population. Despite surgical repair and subsequent
rehabilitation programmes, functional recovery is often limited,
particularly in individuals with multi-morbidity. This
leads to high care dependency and subsequent use of healthcare
services. Fear of falling has a negative influence
on recovery after hip fracture, due to avoidance of activity and
subsequent restriction in mobility. Although fear of
falling is highly prevalent after hip fracture, no structured
treatment programme is currently available. This trial will
evaluate whether targeted treatment of fear of falling in
geriatric rehabilitation after hip fracture using a
multi-component cognitive behavioural intervention (FIT-HIP),
is feasible and (cost) effective in reducing fear of
falling and associated activity restriction and thereby improves
physical functioning.
2. Methods/design: This multicentre cluster randomised controlled
trial will be conducted among older patients with
hip fracture and fear of falling who are admitted to a
multidisciplinary inpatient geriatric rehabilitation programme
in eleven post-acute geriatric rehabilitation units. Fifteen
participants will be recruited from each site. Recruitment
sites will be allocated by computer randomisation to either the
control group, receiving usual care, or to the
intervention group receiving the FIT-HIP intervention in
addition to usual care. The FIT-HIP intervention is
conducted by physiotherapists and will be embedded in usual
care. It consists of various elements of cognitive
behavioural therapy, including guided exposure to feared
activities (that are avoided by the participants).
Participants and outcome assessors are blinded to group
allocation. Follow-up measurements will be performed at
3 and 6 months after discharge from geriatric rehabilitation.
(Cost)-effectiveness and feasibility of the intervention
will be evaluated. Primary outcome measures are fear of falling
and mobility.
Discussion: Targeted treatment of fear of falling may improve
recovery and physical and social functioni ng after
hip fracture, thereby offering benefits for patients and reducing
healthcare costs. Results of this study will provide
insight into whether fear of falling is modifiable in the
(geriatric) rehabilitation after hip fracture and whether the
intervention is feasible.
Trial registration: Netherlands Trial Register: NTR 5695.
Keywords: Fear of falling, Hip fracture, Geriatric rehabilitation,
Randomised controlled trial, Cognitive behavioural
therapy
* Correspondence: [email protected]
4. million in 2050 [1]. Despite the diversity of experienced
health in older age, many older adults often face numer-
ous health conditions affecting their physical and mental
capacity, independence, autonomy and overall well-being
and quality of life. At present there is no evidence that
the current generation of older adults is in better health
in their older years compared with the previous gener-
ation [2]. Due to the relative increase of elderly in the
global population, medical and formal care consumption
is increasing, placing a burden on healthcare systems
and caregivers worldwide. Therefore, healthcare strat-
egies should be aimed at optimising the older adult’s
functional ability and supporting their independence.
Falls and fall-related injuries, specifically hip fractures,
are a major health problem for older adults, threatening
physical and functional ability [3–5]. Annually 1.6 mil-
lion older adults worldwide sustain a hip fracture and
this number is expected to reach 4.5 million in 2050 [2].
A hip fracture in older adults is associated with poor
functional outcome, with a 1-year mortality rate of
approximately 30% [3, 4, 6, 7]. Despite surgery and sub-
sequent rehabilitation programmes, many older hip frac-
ture patients experience permanent functional disability
as a result of the fracture, with only 40–60% recovering
to their pre-fracture level of mobility within 1 year after
fracture. 6 months after a fracture, about 42–71% have
regained their pre-fracture level of functioning in basic
activities in daily living (ADL) [3–5, 8]. Approximately
10–20% are unable to return to their prior residence [5].
The degree of disability may be even greater for frail
older adults in need of extensive rehabilitation within an
inpatient setting. Therefore, interventions aimed at opti -
mising functional recovery after hip fracture and
decreasing future fall risk are important to improve out-
come for individual patients, and to reduce the burden
5. on (in)formal care and therefore society.
Social demographic factors (age, gender), pre-fracture
physical condition and functioning (walking ability, level
of independence in ADL, co-morbidity, hand grip
strength), psychological factors (cognitive functioning,
depression, fear of falling), pain and anaemia influence
functional outcome after hip fracture [4, 9–12]. How-
ever, only a few of these factors are potentially modifi -
able and thus eligible to be targeted in an intervention
strategy to improve functional outcome. In this context,
fear of falling is of specific interest as it has an even
greater impact on recovery after hip fracture than does
cognitive state, depressive symptoms, or level of per-
ceived pain [11]. In addition, fear of falling is important
as it is highly prevalent in both community-dwelling
older adults (54%) [13, 14] and in patients who have
sustained a hip fracture (50–65%) [15, 16].
Fear of falling is defined by Tinetti et al. as: ‘a lasting
concern about falling that leads to an individual avoid-
ing activities that he/she remains capable of performing’
[17]. Consequences of fear of falling (and activity avoid-
ance due to fear of falling) are increased risk of falls,
decreased mobility/balance performance, loss of inde-
pendence, lower social participation, and lower health-
related quality of life [13, 18]. Therefore, it not only
affects physical functioning, but also psychosocial func-
tioning. Specifically, after a hip fracture, fear of falling is
associated with a reduction in time spent on exercise
during rehabilitation [15] which, in turn, impedes func-
tional performance.
In the Netherlands, about 25–30% of elderly hip fracture
patients receive inpatient multidisciplinary rehabilitation
6. care following surgery, due to the acute decrease in their
physical functioning and associated dependency in ADL.
This vulnerable patient group is discharged from hospital
to ‘geriatric rehabilitation’ (GR), a multidisciplinary
inpatient rehabilitation programme within post-acute GR
units in nursing homes. The rehabilitation programme,
which is led by an elderly care physician, includes physical
- and occupational therapy, and treatment of comorbidi-
ties. In GR, fear of falling is highly prevalent among
patients with hip fracture (63%) [16].
Targeted treatment of fear of falling during rehabilitation
after hip fracture could lead to reduction of fear of falling
and the associated activity restriction and, therefore, to im-
proved mobilisation, functional recovery and a higher level
of independence. To our knowledge, no treatment pro-
grammes are currently available for the treatment of fear of
falling among this specific patient population [15, 19].
However, several programmes are available for the treat-
ment of fear of falling for community-dwelling older adults.
For example, the Netherlands has an adapted Dutch
version of ‘A Matter of Balance’ [20, 21]. This multicompo-
nent cognitive behavioural group programme has proven
cost-effective in treating fear of falling and has been imple-
mented nationally [22–24]. Recently a home-based version
of ‘A Matter of Balance’ was developed and this latter
programme also proved (cost)effective in reducing fear of
falling and associated activity restriction, disability and in-
door falls [25, 26].
Partially based on the Dutch version of ‘A Matter of
Balance’, and specifically developed for the multidiscip-
linary GR setting, the multi-component cognitive behav-
ioural FIT-HIP intervention has been developed. It is
directed at reducing fear of falling and the associated
avoidance of activities and increasing self-efficacy and
7. Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 2
of 13
daily functioning among hip fracture patients admitted
to GR. This multicentre cluster randomised controlled
trial (RCT) will examine whether the FIT-HIP interven-
tion is feasible and (cost)effective in reducing fear of fall-
ing and, therefore, improving functional outcome in hip
fracture patients in GR. In addition, it will assess
whether the intervention is feasible for patients and
healthcare professionals.
Primary objective
In hip fracture patients admitted to multidisciplinary in-
patient GR, to compare the effect of the FIT-HIP inter-
vention with usual care in GR, with respect to reducing
fear of falling (measured with the Falls Efficacy Scale-
International) and improving gait and balance (measured
with the Performance-Oriented Mobility Assessment).
Secondary objectives
� To compare the effect of the FIT-HIP intervention
with usual care with respect to improving the degree
of independence in ADL (Barthel index), ambulation
ability (Functional Ambulation Categories) and
walking speed.
� To compare the number of fall incidents, mortality,
hospital (re)admission and psychosocial functioning
(social participation after discharge from GR,
measured by the Utrecht Scale for Evaluation of
Rehabilitation-subscale Participation; and quality of
8. life, measured by the EuroQol 5D) between the
FIT-HIP intervention and usual care.
� To examine the feasibility of the FIT-HIP intervention
for participants and therapists conducting the
FIT-HIP intervention.
� To perform an economic evaluation, consisting of a
cost analysis and cost-utility analysis, comparing the
FIT-HIP intervention with usual care. Costs will be
measured from a healthcare perspective.
Methods/design
Study design
This multicentre cluster RCT will be conducted among
165 patients with hip fracture and fear of falling, who
are admitted to a multidisciplinary inpatient GR
programme in post-acute GR units in Dutch nursing
homes. For these hip fracture patients in GR, this RCT
compares usual care (control group) with an interven-
tion group that includes the addition of the FIT-HIP
intervention to the usual care. The FIT-HIP intervention
is aimed at reducing fear of falling. Figure 1 presents an
overview of the study design. Simultaneously, a process
evaluation will be performed to assess the feasibility of
the programme.
This study protocol was approved by the Ethics
Committee of the Leiden University Medical Center (9
September 2015; P15.212). In addition, the Board of
Directors and (if applicable) the research committees of
the participating recruitment sites (post-acute GR units
of nursing homes) provided consent to participate in the
FIT-HIP intervention study.
Prior to baseline assessments and to starting the FIT-
9. HIP treatment (in the intervention group), written
consent will be obtained from participants.
Setting
The department of Public Health and Primary Care
(PHEG) of the Leiden University Medical Center will co-
ordinate the FIT-HIP study. Eleven post-acute GR units
from nursing homes in the province South Holland are
included in this study, most of which work in close col-
laboration with the PHEG through the University Net-
work for the Care-sector South Holland (UNC-ZH).
Annually, the eligible post-acute GR units each have ≥50
patients admitted for GR after orthopaedic events (e.g.
trauma, elective surgery or amputation).
Participants (and eligibility criteria)
Study participants are patients aged ≥65 years, admitted
to one of the 11 participating post-acute GR units for a
geriatric rehabilitation programme following surgical
repair of a hip fracture, and concerned to fall. Fear of
falling is assessed within the first week of admission to
GR, using the 1-item fear of falling question (‘Are you
concerned to fall?’). This question has five answer cat-
egories (never – almost never – sometimes – often – very
often). Patients are eligible to participate if they answer
this question with ‘sometimes, often, or very often’
An exclusion criterion for this trial is any condition
interfering with learnability, e.g. a diagnosis of dementia,
major psychiatric disease, or a score of > 1 on the
Hetero-anamnesis List Cognition (HAC) [27]. The HAC
is derived from the Mini Mental State Examination
(MMSE) and is used to explore the presence of premor-
bid cognitive disabilities. A relative/informal caregiver is
asked if there were problems concerning orientation,
language, memory, planning and execution of activities,
10. and to which degree the patient needed assistance or
professional therapy for these problems. A score of > 1 is
suggestive for premorbid cognitive problems. Other
exclusion criteria for this trial are a limited life expect-
ancy (<3 months), the presence of a pathological hip
fracture, a pre-fracture Barthel index score of < 15, and
insufficient mastery of the Dutch language.
Randomisation (and allocation)
Of the 11 post-acute GR units, six will be randomly allo-
cated by computer-generated randomisation to conduct
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 3
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the FIT-HIP intervention and five are allocated to the
control group (usual care). Hip fracture patients will be
screened for eligibility for the FIT-HIP study on admis-
sion to these post-acute GR units. For this trial, each
post-acute GR unit will include a maximum of 15 partic-
ipants (in order of succession in which patients are
admitted to GR, eligible, and willing to participate). Par -
ticipants will receive treatment (usual care, or the
addition of FIT-HIP intervention to usual care) accord-
ing to the randomisation of the post-acute GR unit to
which they are admitted.
Usual care (control group)
Usual care consists of an inpatient multidisciplinary re-
habilitation programme (GR) for patients with a hip
fracture. This rehabilitation programme is led by an eld-
erly care physician. It comprises physical therapy ses-
sions focussing on balance and gait exercises, and
11. improving muscle strength. The nursing staff and an
occupational therapist are also involved in coaching
patients in performing ADL, e.g. going to the toilet, and
self-care. Each participating post-acute GR unit employs
a care-pathway GR, containing formalised agreements
on the contents of the multidisciplinary rehabilitation
process, such as therapy intensity and assessments
during rehabilitation. In general, a patient will receive
5-6 sessions of physiotherapy per week.
The FIT-HIP intervention
The FIT-HIP intervention is a multi-component cogni-
tive behavioural intervention aimed at reducing fear of
falling in hip fracture patients in GR. It is an individua-
lised treatment programme, tailored to the individual
needs, preferences and capacities of the participant. It is
coordinated and primarily conducted by physiothera-
pists. The programme is combined with regular exercise
Fig. 1 Procedures of the FIT-HIP clustered randomised
controlled trial. GR = geriatric rehabilitation (multidisciplinary
inpatient
rehabilitation programme)
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 4
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training during the physiotherapy sessions in GR (usual
care). The physiotherapists are part of the multidisciplin-
ary GR healthcare team of the participating post-acute
GR unit and have experience in the field of (orthopaedic)
rehabilitation of frail older adults. Prior to participant re -
cruitment, two physiotherapists per intervention post-
acute GR unit will be trained to conduct the FIT-HIP
12. intervention. Also, for each intervention post-acute GR
unit, one psychologist (who is part of healthcare team
concerned), will be briefed on the intervention and will
participate in part of the training.
The psychologists are trained to function as a coach
for the physiotherapists, assisting them with cognitive
restructuring when they need advice on this subject. If
required, they also assist in the additional treatment of
participants, e.g. for more complex psychiatric problems
such as generalised anxiety disorder or post-traumatic
stress disorder (in the event that this only became appar-
ent during admission and could not have been consid-
ered an exclusion criterion).
All elements of the FIT-HIP intervention are described
in more detail below. The guided exposure to mobility-
related activities is the core element of the intervention
and is also applied by the nursing staff in the process of
mobilisation during GR. The nursing staff was trained in
the concepts of guided exposure and instructed how to
administer this. The treatment plan for the mobilisation
process (guided exposure) is made by the physiothera-
pists. Based on the existing communication procedures
for each post-acute GR unit, communication protocols
will be drafted on how the physiotherapists keep the
nursing staff updated on the current status of treatment
plans for the individual participants.
Guided exposure
Guided exposure to the situations that participants fear
is the core element of the FIT-HIP intervention. In the
case of fear of falling, the feared situation will be a form
of activity and therefore the exposure to that situation
will be practical training of an activity. These fearful
situations are assessed for each patient individually dur-
13. ing the intake to GR. In rehabilitation after hip fracture
the feared situations may be basic (but fundamental) for
the mobilisation process and performing ADL. Examples
of assessed situations are: standing, transfer (from bed to
chair and vice versa), toilet use, walking inside/outside,
and staircase walking. In the intervention, it is also
important to focus on participation activities. Therefore,
the physiotherapist also assesses which (more complex)
activities in daily living the participant considers import-
ant or desirable to able to perform, and which of these
may lead to fear of falling, e.g. cycling or using public
transport.
For each of these feared situations, guided exposure
will be conducted by means of a separate fear hierarchy.
In the FIT-HIP intervention the fear hierarchy is repre-
sented in a ‘fear ladder’. Each ‘fear ladder’ contains six
steps, each step representing a goal. Goals for exposure
are ranked according to the intensity of fear of falling it
gives rise to, and edited in such a manner that there is
an increasing intensity of concern/fear. Goals are formu-
lated in accordance with the Goal Attainment Scaling
(GAS) method [28, 29]. The GAS is a technique for
developing individualised, scaled descriptions of treat-
ment goals. It is a method to evaluate the (rehabilitation)
therapy. Goals are formulated in a SMART manner (spe-
cific, measurable, acceptable, realistic and defined in
time), in collaboration with the patient in order to relate
to the personal interests and social environment of the
patient. The goals are scaled from −3 to +2, with −3 be-
ing deterioration in function, −2 the starting point
(current situation when starting the therapy) and 0 being
the primary goal. At −1 there is improvement in func-
tion but the primary goal in not yet achieved, and at +1
and +2 the function is better than the primary goal. All
treatment goals are formulated as functional goals of im-
14. provement of mobility. They are not formulated as goals
to (primarily) decrease fear. The fear ladders are evalu-
ated with the participant every week and adjusted if ne-
cessary. Figure 2 is an example of a FIT-HIP fear ladder.
The fear ladders are incorporated in the individual
FIT-HIP therapy plan. This therapy plan forms a guiding
principle for applying the guided exposure in the process
of mobilisation. The exposure takes place gradually, with
increasing intensity, in a predictable and controllable
manner, and under supervision of the physiotherapist.
Due to this repeated graded exposure to the feared situ-
ation, the fear is expected to initially increase in the
presence of the physiotherapist, but to lessen and grad-
ually fade out during the experience of the activity.
Guided exposure will be performed during each physio-
therapy session during GR (combined with other phys-
ical exercises, such as strength/balance). Participants are
also encouraged to practise exposure outside of the ther -
apy sessions (homework). The nursing staff will have a
supporting function in this process. The nursing staff is
regularly briefed by the physiotherapist to engage in the
current principles of the guided exposure for the individ-
ual patient.
Cognitive restructuring
This is based on the principles of cognitive behavioural
therapy whereby the combination of applied behaviour
and effectively recognising and managing negative/un-
realistic thoughts and learning to apply realistic thoughts
are the key components. Physiotherapists are trained to
apply these principles during the therapy sessions. Also,
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 5
of 13
15. at least once during the rehabilitation, a worksheet is
filled in to structure this process (describing the event,
thoughts, feeling, behaviour, consequence) and helping
the participant to formulate realistic thoughts. The pa-
tient learns to examine his/her thoughts and beliefs, and
the effect this has on behaviour and feeling (anxiety).
This principle is also incorporated in the relapse preven-
tion plan.
Psycho-education
During the initial phase of rehabilitation, shortly after
admission to GR, information is given to the participant
on anxiety, fear of falling, consequences of fear of falling
and self-help possibilities. The rationale and background
of guided exposure will be explained. Also, the influence
of thoughts/beliefs on emotion and behaviour will be
explained (background of the cognitive restructuring).
In the final phase of rehabilitation, when a patient is in
preparation of discharge (home), the psycho-education
will focus on home safety. This will be processed in the
relapse prevention plan.
Relapse prevention plan
In preparation of discharge from GR to the home situ-
ation, a relapse prevention plan for fear of falling will be
made. The purpose of this plan is to assess situations/
circumstances (in the home situation) in which the pa-
tient is at risk of a relapse. By means of this plan, the
physiotherapist prepares the participant to anticipate
these situations and to prevent falling back into old
habits in potential fearful situations.
The relapse prevention plan will be worked out and
16. given to the patient as a ‘Staying Active Plan’. It consists
of three elements: 1) General home safety and fall pre-
vention; 2) Individual advice for safe ambulation and
staying active. Individual advice for use of walking aids/
assistance is given, with precautions if necessary. Also,
two individualised physical exercises are described that
are recommended for the patient to stay active and in
condition in the home situation. Also, if necessary with
precautions. The therapist will also discuss that it can be
useful to have a buddy to do these exercises with, and
who that may be for the patient; 3 (Preventing) a relapse.
Information is given about preventing and recognising a
relapse, and advice as to what is helpful when a relapse
occurs.
Telephonic booster
Six weeks after discharge from GR the physiotherapist
conducts a telephonic booster intervention. The purpose
of this booster is to evaluate the fear of falling in the first
weeks after discharge, discuss difficulties concerning fear
of falling and activity restriction, discuss the use of the
relapse prevention plan and, if necessary, give new
advice for dealing with or preventing fear of falling.
Motivational interviewing
Physiotherapists will also be trained to use motivational
interviewing techniques for the guidance of their pa-
tients. Motivational interviewing is a client-centred,
goal-oriented counselling technique that is used to
explore and reinforce the patient’s internal motivation
for behavioural change. By exploring and resolving am-
bivalence, it aims at evoking behavioural change [30]. In
the FIT-HIP intervention, the motivational interviewing
techniques can assist the physiotherapist to explore
which (rehabilitation) goals are important for the indi-
17. vidual participant, in order to personalise the treatment
goals.
Duration of the FIT-HIP intervention
The FIT-HIP intervention, integrated in the usual care,
will be conducted during the entire period that the par-
ticipant is admitted to GR. The duration of the inpatient
Fig. 2 Example of a FIT-HIP fear ladder (walking inside)
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 6
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GR is determined for each participant individually, and
is therefore variable. On average, the duration of admis-
sion to GR for rehabilitation after hip fracture is 6 weeks.
During the trial, the following is registered: i) total dur-
ation of GR in days, ii) number of therapy sessions dur-
ing GR, iii) duration of therapy sessions, and iv) (in the
intervention group) performance of the individual com-
ponents of the FIT-HIP intervention; all these elements
can be used as confounding variables in the final out-
come analyses.
Blinding
Both the participants and the independent research as-
sistants assessing the outcome measurements are
blinded to the group allocation. They are not aware of
what usual care is/should be and what the addition of
the FIT-HIP intervention is. Healthcare professionals
working at the recruitment sites are aware of the alloca-
tion status, as the intervention group has been specific-
ally trained to perform the intervention. They are
instructed not to inform the participants, family mem-
18. bers and the research assistants assessing outcome mea-
sures about the allocation status. The main researcher
(MSB) was involved in providing the training for the
intervention and therefore cannot be blinded in the ini -
tial phase of this trial. For data analysis, the database will
be processed to blind data to the initial allocation.
To warrant the blinding of participants in the control
group (who receive usual care with possibly no specific
treatment for or notice of the fear of falling) a dummy
intervention is given in both the control and intervention
group. The dummy intervention is an information bro-
chure containing information about fear of falling, its con-
sequences, and possibilities for seeking medical attention
or help for this problem. This is regarded as an appropri -
ate dummy intervention, as healthcare strategies directed
at reducing risk of falling in older adults that use educa-
tional interventions alone, have not proven effective [31].
Therefore, we do not expect this information brochure to
have a significant effect on the fear of falling.
Effect evaluation
Primary outcome
1. Mean difference in the Tinetti Performance Oriented
Mobility Assessment (POMA) score [32, 33] at discharge
from GR (or at a maximum of 3 months after admit-
tance to GR), compared between FIT-HIP intervention
and usual care. The POMA is a measure of mobility
function (gait and balance).
2. Mean difference in the Falls Efficacy Scale Inter-
national (FES-I) score [34–36] at discharge from GR (or
at a maximum of 3 months after admittance to GR),
compared between FIT-HIP intervention and usual care.
The FES-I is a measure of fear of falling.
19. Secondary outcomes
Table 1 gives an overview of the secondary outcome
measures in the effect evaluation. For these outcome mea-
sures, at discharge from GR, mean differences between
the intervention and control group will be assessed.
Additional variables
Table 2 gives an overview of the additional variables
assessed in this trial.
Process evaluation
To determine the feasibility of the FIT-HIP intervention, a
process evaluation will be conducted in accordance with
the theory of Saunders et al. [37] Using a mixed-method
approach, information about reach, fidelity, exposure, sat-
isfaction and barriers for applying the programme will be
assessed. Table 3 gives an overview of the measurement
instruments used to collect these data.
Therapist data
In the intervention arm of this trial, physiotherapists will
register per session which elements of the intervention
were conducted, reasons for deviating from the individ-
ual FIT-HIP therapy plan and the duration of the ther-
apy sessions, using weekly calendars as session logs.
Also, for each therapy session, the Pittsburgh Rehabilita-
tion Participation Scale is filled in as a measure of the
extent of active engagement of the participant in the
therapy. At the end of the study, the physiotherapists
and psychologists conducting the intervention will be in-
vited to take part in qualitative group interviews to dis-
cuss in detail their satisfaction with the (components of
the) intervention, experienced barriers applying the
intervention and suggestions for improvement. Also,
matters concerning participant recruitment and main-
taining participant engagement will be discussed.
20. Other members of the GR team (the elderly physician and
nursing staff) will be approached to fill in a short evaluation
questionnaire about their general opinion of the intervention
and to assess to what extent the individual FIT-HIP therapy
plans were routinely discussed in the GR team.
Participant data
All participants in the intervention arm of this trial will
receive evaluation questionnaires at discharge from GR
and at follow-up (3 and 6 months after discharge from
GR). In these questionnaires, information on experi-
enced benefits and burden of the intervention, and sug-
gestions for improvement of the intervention, will be
assessed. In addition, qualitative interviews will be held
with a (random) subgroup of the participants, to gain
more insight into these matters.
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 7
of 13
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Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 8
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Economic evaluation
The economic evaluation consists of a cost analysis and
a cost-utility analysis, both with a 6-month time horizon
after discharge from GR. Costs will be measured from a
healthcare perspective. In the cost-utility analysis, the
difference in healthcare costs between the strategies will
be compared to the difference in Quality-Adjusted Life
Years (QALYs, calculated using the 3-level Dutch EQ-
5D tariff [38] and the visual analogue scale for health).
Estimated healthcare costs will include the costs of the
66. FIT-HIP intervention (estimated from the study registra-
tion) and other healthcare utilisation (estimated using
quarterly questionnaires filled in by the patients). Other
healthcare utilisation will include care provided by gen-
eral practitioners, consultations of medical specialists
and paramedics, home care, informal care, hospitalisa-
tion, and residential care. A cost-price analysis will be
performed for the FIT-HIP intervention; other health-
care items will be valued using standard prices.
Sample size
This study tests the null hypothesis that there is no dif-
ference in POMA score between the intervention and
control group at discharge from GR. The criterion for
significance (alpha) was set at 0.050. The test is 2-tailed,
which means that an effect in either direction will be
interpreted. With a sample size of 40 in both groups, the
study will have power of 80% to yield a statistically sig-
nificant result. Based on our previous research, the min-
imal clinical relevant difference (mean difference of the
POMA at discharge measurement) was set at -3.8, with
the common within-group standard deviation at 6.0.
The corresponding means are 17.0 vs. 20.8. This effect
was selected as the smallest effect that would be
Table 2 Additional variables assessed in the FIT-HIP trial
Domain Assessment Description Time point(s)
Socio-demographics Age, gender, marital status, type of
residence
prior to hip fracture
BA
67. General health and
physical functioning
Functional comorbidity index (weighed) [46] Assesses 18
comorbid conditions and their effect
on physical functioning.
BA
Medication use Number and type of medication used by
participants.
Assessed by ECP (questionnaire).
BA, DA
Assistive walking device Type of assistive walking aid, used for
indoor and
outdoor usage. Assessed by questionnaire.
BA
Use of formal care (home care) and informal
care (given by relatives/volunteers)
Assessed by questionnaire. BA, FU1, FU2
Previous fall frequency Number of falls in 6 months prior to hip
fracture. BA
Handheld grip strength Evaluated with dynamometer. BA
Nutritional status: Body Mass Index Calculated by dividing
bodyweight in kilograms by
length in meters squared.
BA, DA
68. Numeric Pain Rating Scale (NPRS) [47] Assesses intensity of
pain on an 11-point scale (0 –10). BA, DA, FU1, FU2
Hip fracture (related)
characteristics
Type of fracture, operation, weight-bearing
capacity
Assessed by ECP (questionnaire). BA
Duration of hospital admission due to hip
fracture
Number of days in hospital. BA
Complications during hospital admission
due to hip fracture
Number and type of complications. Assessed by ECP
(questionnaire).
BA
Neuropsychological
factors
Mini Mental State Examination (MMSE)
[48, 49]
Screens for cognitive disorders and dementia BA
Geriatric Depression Scale, 8-item (GDS-8)
[50]
69. Short adapted version of the GDS-30. Developed to
screen depression in nursing home population.
BA
Hospital anxiety and depression scale –
subscale anxiety (HADS-A) [51]
Screens for anxiety. BA
Utrecht Coping List; subscales active and
passive coping. (UCL) [52]
Assesses coping mechanism. Questionnaire assesses how
a person deals with problematic situations in general.
BA
Pittsburgh Rehabilitation Participation
Scale [53]
Participation/motivation for physiotherapy (PT)
during GR.
During every session
of PT until discharge
BA baseline assessment (pre-intervention), DA discharge
assessment (post-intervention), FU1 follow-up 1 assessment, 3
months after discharge from GR, FU2
follow-up 2 assessment, 6 months after discharge from GR, ECP
elderly care physician, NPRS numeric pain rating scale, MMSE
mini mental state examination,
GDS-8 geriatric depression scale, 8-item, HADS-A hospital
anxiety and depression scale – subscale anxiety, UCL Utrecht’s
coping list, PT physiotherapy
70. Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page 9
of 13
important to detect, in the sense that any smaller effect
would not be of clinical or substantive significance. It is
also assumed that this effect size is reasonable, in the
sense that an effect of this magnitude could be antici-
pated in this field of research.
Compensation for design effect and possible loss to
follow-up was taken into account in the choice of sam-
ple size. For the design effect (cluster randomisation),
the intraclass correlation coefficient (ICC) for the out-
come measure POMA is expected to be 0.05 because of
clustering of data and because there may be inequality
of the numbers within clusters. For the possible loss to
follow-up, specifically death in the 3-month rehabilita-
tion phase is not expected be ≥10%. Instead of the 40
patients calculated with the power analysis, we will in-
clude 75 patients per group.
As 11 post-acute GR units were interested in participat-
ing, we decided to include one additional intervention
post-acute GR unit, in case of unsuspected drop-out of
one intervention location. Thus, we aim to include a total
of 165 participants.
Data analyses
Differences between the intervention and control group
in characteristics of participants at baseline will be tested
with chi-square tests for categorical variables, Mann-
Whitney U-test for continuous variables with skewed
71. distributions, and one-way ANOVA for normally distrib-
uted continuous variables. Given the hierarchical data
structure, multilevel analyses will be used for continuous
outcomes, and logistic Generalized Estimated Equation
(GEE) analyses for dichotomous outcomes. Logistic GEE
is preferred to logistic multilevel analyses because of the
instability of the latter. Analyses will be based on an
intention-to-treat principle and the level of significance
will be set at p < 0.05. Missing data will be handled as
Table 3 Outcome measures of the FIT-HIP process evaluation
Component and definition Operationalisation Measurement
instruments
SLog QpD QpF1 QpF2 Ip It Qt BLog Sq D
Reach
Proportion of the intended target population
that participated in the programme
Refusal and dropout rate. Reasons for
withdrawal
+ +
Fidelity
Extent to which the elements of the
intervention were implemented as planned
Per therapy session: registration of which
intervention components were performed
+
72. Per therapy session: reasons for deviation from
individual FIT-HIP therapy plan
+
Reasons for deviation from protocol +
Dose received - Exposure
Extent of participants’ active engagement in
and receptiveness to the programme
Per therapy session: extent of active
engagement in therapy
+
In general: use of relapse prevention plan
(Staying Active Plan)
+ + +
Dose received - Satisfaction
Satisfaction of participants and therapists
with the programme
Overall opinion about the intervention + + + + + +
Opinion about the value of the intervention + + + + + +
Opinion about the value of the main
elements of the intervention
+ + + + +
73. Experienced burden + + +
Barriers
The extent to which problems were
encountered while applying the programme
Barriers in applying the (individual
components of the) intervention.
+
Suggestions for improvement + + + + + +
Recruitment procedures + +
Maintaining participant engagement + +
SLog physiotherapist session log, QpD evaluation questionnaire
filled in by participant at discharge from GR, QpF1 evaluation
questionnaire filled in by participant
at follow-up 1 (3 months after discharge from GR), QpF2
evaluation questionnaire filled in by participant at follow -up 2
(6 months after discharge from GR), Ip
Interview with participant, It interview with physiotherapist and
psychologist, Qt evaluation questionnaire filled in by GR team
members: elderly care physician,
nursing staff and psychologist, BLog booster log, registration of
telephonic booster, Sq screening questionnaire filled in at
admission to GR, D data recorded by
research assistants during study period
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page
10 of 13
74. missing (no imputation). Multilevel analyses will be per-
formed with MLwiN. All other analyses will be per-
formed with IBM SPSS statistics.
With regard to the qualitative data (assessed for the
process evaluation), these will be analysed by means of
coding techniques based on transcriptions of the qualita-
tive interviews. In the economic evaluation, group aver-
ages will be compared using unequal-variance t-tests,
according to the intention-to-treat principle. Costs will
be compared to QALYs using net-benefit analysis. Mul-
tiple imputation will be used to account for missing
values. Sensitivity analysis will be performed on the time
horizon (base case 6 months vs. 12 months) and the util -
ity measure (base case Dutch EQ-5D tariff vs. visual
analogue scale for health).
Discussion
At present, the functional recovery after a hip fracture in
frail older adults is limited, resulting in a considerable
amount of long-term disability. Therefore, a hip fracture
has major consequences for individual patients, as well
as for society, due to the costs of healthcare and the bur -
den on caregivers. Based on the current literature, only a
few factors influencing functional recovery after hip frac-
ture could prove to be modifiable. As fear of falling is
highly prevalent in hip fracture patients and leads to
avoidance of activity, it is probably a significant factor
contributing to limited recovery after hip fracture. To
our knowledge this is the first RCT to evaluate the effect
of treatment of fear of falling in this population. This
multicentre cluster RCT will provide insight into
whether targeted treatment of fear of falling during geri -
atric rehabilitation after hip fracture, using the FIT-HIP
75. intervention, is effective in reducing fear of falling and
associated avoidance of activities and, therefore, improv-
ing functional outcome after hip fracture.
The key component in this trial, guided exposure, is
based on the principles of cognitive behavioural therapy.
It encourages the systematic confrontation of feared
stimuli (situations), in a graded approach. It is the pre-
ferred treatment in various types of anxiety disorders, in-
cluding phobias. In the FIT-HIP programme, the guided
exposure is used in conjunction with psycho-education
and cognitive restructuring. The programme has been
developed together with experts that developed a treat-
ment programme on fear of falling in community-
dwelling older adults, which was shown to effectively re-
duce the fear of falling [21–26].
Because the FIT-HIP programme is integrated in usual
care, the additional costs are expected to be limited. In
an earlier phase we conducted a small pilot study, aimed
at testing the FIT-HIP training and the feasibility of the
intervention for healthcare professionals and partici -
pants. The additional time spent on therapy for the
purpose of this intervention appeared to be limited in
the pilot, but will become clear after the evaluation of
the intervention. Also, guided exposure was easily inte-
grated in the usual care. Although the principles of
guided exposure are often practiced in usual care, they
are not generally as structured and intentional as in this
intervention.
A strength of this study is that the feasibility for
healthcare professionals and patients will be evaluated
through a process evaluation. Cost effectiveness will also
be assessed. If this intervention proves to be (cost)effec-
76. tive in improving functional outcome after hip fracture
and is feasible, it could offer major benefits for individ-
ual patients, their (family) caregivers and for society.
This study also has some challenges. Cluster random-
isation was chosen as the study design, as the risk of
contamination of the FIT-HIP intervention on usual care
would be too substantial in view of the complex nature
of the intervention. All participating recruitment sites
(post-acute GR units) employ a standardised care path-
way for patients with hip fracture. This care pathway
contains formalised agreements on the content of the
multidisciplinary rehabilitation process [39]. As the post-
acute GR units are all part of different Dutch care orga-
nisations, there could be subtle differences in the usual
care for hip fracture patients. These differences (quantity
and quality of the received therapy) will be assessed in
the process evaluation.
A second challenge in this study, is the blinding. As
the FIT-HIP intervention is compared to ‘care as
usual’, blinding is only partially possible. Generally,
participants should not be aware of what usual care is
and what the addition of the FIT-HIP intervention
could be. If, however, the usual care does not take
note of the fear of falling, the participant could
suspect being allocated to the control group. To limit
this effect, all participants receive an information bro-
chure on fear of falling and self-help possibilities.
Educational interventions alone, aimed at increasing
knowledge about fall prevention, have not proven to
be effective in fall prevention and we therefore do
not expect that this will contaminate the effect of the
intervention [31]. The healthcare professionals (phys-
iotherapists, psychologist and nursing staff ) receive
specific training for conducting the FIT-HIP treat-
77. ment and are therefore aware of allocation; however,
they are instructed not to inform the participants,
family or research assistants. Outcome assessors
(research assistants) are blinded to allocation.
In conclusion, this study will provide insight into
whether fear of falling is modifiable in the rehabilitation
process after hip fracture. The results of this trial will be
disseminated in peer-reviewed journals and via profes-
sional and scientific conferences.
Scheffers-Barnhoorn et al. BMC Geriatrics (2017) 17:71 Page
11 of 13
Abbreviations
ADL: Activities of daily living; ECP: Elderly care physician;
EQ-5D: EuroQol 5D;
FES-I: Falls efficacy scale-international; FIT-HIP trial: Fear of
falling intervention
in hip fracture geriatric rehabilitation; GAS: Goal attainment
Scaling;
GDS: Geriatric depression scale; GR: Geriatric rehabilitation
(multidisciplinary
inpatient rehabilitation programme); HAC: Hetero-anamnesis
list cognition;
HADS-A: Hospital anxiety and depression scale – subscale
anxiety;
LUMC: Leiden University Medical Center; MMSE: Mini mental
state
examination; NPRS: Numeric pain rating scale; PHEG:
Department of public
health and primary care; POMA: The tinetti performance
oriented mobility
assessment; PT: Physiotherapy; QALY: Quality-adjusted life
78. years;
RCT: Randomised controlled trial; UCL: Utrecht’s coping list;
UNC-ZH: University
Network for the Care-sector South Holland; USER-P: Utrecht
Scale for the
Evaluation of Rehabilitation-Participation.
Acknowledgements
The authors thank Monique Caljouw and Jacobijn Gussekloo for
their
assistance in the development of the primary study design and
Eva van der
Ploeg for her support with the intervention. In particular, we
express our
gratitude to Bart Beck for his assistance in developing the
intervention
(material) and providing the training for the intervention group.
Frans van
Wijngaarden (physiotherapist) trained the research assistants to
perform the
POMA, the 10-m walking test and the handheld grip strength,
we thank him
for his assistance. We also thank the participating healthcare
organisations
(post-acute GR units) for their participation in this study and,
specifically, their
healthcare professionals who conducted the intervention and
those assisting
with the screening of possible participants.
Funding
This study is funded by ZONMw (The Netherlands Organisation
for Health
Research and Development), research grant number 839120004.
This study is
also supported by the SBOH (employer of elderly care medicine
79. trainees)
and the Leiden University Medical Center (training center for
Elderly Care
Medicine). This research is conducted independently of the
funding body.
Availability of data and materials
Not applicable.
Authors’ contributions
WPA, MvE, JCMvH, GIJMK, JMGAS, RvB, JHMV and EMD
designed the primary
study and first version of the intervention. WvdH is involved
for the
economic evaluation in this trial. WPA and MvE led the grant
application.
MSB was involved in the further development of the
intervention, together
with WPA, MvE, JCMvH, GIJMK, JMGAS and Bart Beck
(nursing home
psychologist, and teacher at LUMC). MSB was involved in the
recruitment of
post-acute GR units and provided training of the intervention
post-acute GR
units, together with Bart Beck. The manuscript was drafted by
MSB, in collab-
oration with all other authors. All authors read and approved the
final
manuscript.
Competing interests
The authors declare that they have no competing interests.
Consent for publication
Not applicable.
80. Ethics approval and consent to participate
This study protocol was reviewed and approved by the Ethics
Committee of
the Leiden University Medical Center (The Netherlands)
(reference number:
P15.212). Written consent will be obtained from all participants
prior to
participation in this trial.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional
claims in
published maps and institutional affiliations.
Author details
1Department of Public Health and Primary Care, Leiden
University Medical
Center, Postbox 9600, Leiden 2300 RC, The Netherlands.
2Department of
Health Services Research and Care and Public Health Research
Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences,
Maastricht University,
Maastricht, The Netherlands. 3Geriatric Center and Nursing
Home Antonius
Binnenweg, Laurens, Rotterdam, The Netherlands. 4Department
of Medical
Decision Making and Quality of Care, Leiden University
Medical Center,
Postbox 9600, Leiden 2300 RC, The Netherlands. 5Medical
Psychology
department, The Tjongerschans Hospital, Postbox 105008440
MA
Heerenveen, The Netherlands.
81. Received: 6 December 2016 Accepted: 14 March 2017
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http://www.euroqol.org/AbstractBackgroundMethods/designDis
cussionTrial registrationBackgroundPrimary objectiveSecondary
objectivesMethods/designStudy designSettingParticipants (and
eligibility criteria)Randomisation (and allocation)Usual care
(control group)The FIT-HIP interventionGuided
exposureCognitive restructuringPsycho-educationRelapse
prevention planTelephonic boosterMotivational
interviewingDuration of the FIT-HIP interventionBlindingEffect
evaluationPrimary outcomeSecondary outcomesAdditional
variablesProcess evaluationTherapist dataParticipant
dataEconomic evaluationSample sizeData
analysesDiscussionAbbreviationsAcknowledgementsFundingAv
ailability of data and materialsAuthors’ contributionsCompeting
interestsConsent for publicationEthics approval and consent to
92. participatePublisher’s NoteAuthor detailsReferences
CONSORT 2010 checklist of information to include when
reporting a randomised trial*
Section/Topic
Item No
Checklist item
Reported on page No
Title and abstract
1a
Identification as a randomised trial in the title
1b
Structured summary of trial design, methods, results, and
conclusions (for specific guidance see CONSORT for abstracts)
Introduction
Background and objectives
2a
Scientific background and explanation of rationale
2b
Specific objectives or hypotheses
Methods
Trial design
3a
Description of trial design (such as parallel, factorial) including
allocation ratio
3b
93. Important changes to methods after trial commencement (such
as eligibility criteria), with reasons
Participants
4a
Eligibility criteria for participants
4b
Settings and locations where the data were collected
Interventions
5
The interventions for each group with sufficient details to allow
replication, including how and when they were actually
administered
Outcomes
6a
Completely defined pre-specified primary and secondary
outcome measures, including how and when they were assessed
6b
Any changes to trial outcomes after the trial commenced, with
reasons
Sample size
7a
How sample size was determined
7b
When applicable, explanation of any interim analyses and
stopping guidelines
94. Randomisation:
Sequence generation
8a
Method used to generate the random allocation sequence
8b
Type of randomisation; details of any restriction (such as
blocking and block size)
Allocation concealment mechanism
9
Mechanism used to implement the random allocation sequence
(such as sequentially numbered containers), describing any
steps taken to conceal the sequence until interventions were
assigned
Implementation
10
Who generated the random allocation sequence, who enrolled
participants, and who assigned participants to interventions
Blinding
11a
If done, who was blinded after assignment to interventions (for
example, participants, care providers, those assessing outcomes)
and how
11b
If relevant, description of the similarity of interventions
Statistical methods
95. 12a
Statistical methods used to compare groups for primary and
secondary outcomes
12b
Methods for additional analyses, such as subgroup analyses and
adjusted analyses
Results
Participant flow (a diagram is strongly recommended)
13a
For each group, the numbers of participants who were randomly
assigned, received intended treatment, and were analysed for
the primary outcome
13b
For each group, losses and exclusions after randomisati on,
together with reasons
Recruitment
14a
Dates defining the periods of recruitment and follow -up
14b
Why the trial ended or was stopped
Baseline data
15
A table showing baseline demographic and clinical
characteristics for each group
Numbers analysed
16
96. For each group, number of participants (denominator) included
in each analysis and whether the analysis was by original
assigned groups
Outcomes and estimation
17a
For each primary and secondary outcome, results for each
group, and the estimated effect size and its precision (such as
95% confidence interval)
17b
For binary outcomes, presentation of both absolute and relative
effect sizes is recommended
Ancillary analyses
18
Results of any other analyses performed, including subgroup
analyses and adjusted analyses, distinguishing pre-specified
from exploratory
Harms
19
All important harms or unintended effects in each group (for
specific guidance see CONSORT for harms)
Discussion
Limitations
20
Trial limitations, addressing sources of potential bias,
imprecision, and, if relevant, multiplicity of analyses
Generalisability
21
Generalisability (external validity, applicability) of the trial
findings
97. Interpretation
22
Interpretation consistent with results, balancing benefits and
harms, and considering other relevant evidence
Other information
Registration
23
Registration number and name of trial registry
Protocol
24
Where the full trial protocol can be accessed, if available
Funding
25
Sources of funding and other support (such as supply of drugs),
role of funders
*We strongly recommend reading this statement in conjunction
with the CONSORT 2010 Explanation and Elaboration for
important clarifications on all the items. If relevant, we also
recommend reading CONSORT extensions for cluster
randomised trials, non-inferiority and equivalence trials, non-
pharmacological treatments, herbal interventions, and pragmatic
trials. Additional extensions are forthcoming: for those and for
up to date references relevant to this checklist, see
www.consort-statement.org.
PAGE
98. CONSORT 2010 checklist
Page 1
1
Running Head: CONSORT OF RANDOMIZED CLINICAL
TRIAL
2
CONSORT OF RANDOMIZED CLINICAL TRIAL
Application of the CONSORT Statement to a Randomized Trial
of Low-Dose Aspirin in Preventing Cardiovascular Disease in
Women
Author
School
Exemplar of CONSORT Assignment
99. Analysis of Strengths and Weaknesses
Introduction
The following analysis relates to the article by Ridker, Cook,
Lee, Gordon, Gaziano, Manson, Hennekens, Buring (2005). The
purpose of this Randomized Clinical Trial (RCT) was to
determine if low-dose aspirin should be recommended as a
strategy for prevention of cardiovascular disease for women age
45 or greater.
Overall Strengths and Weaknesses
There was a decrease in Cardiovascular events for women who
received the aspirin as compared to women who received the
placebo. In addition, the ischemic stroke risk decreased by
30%. The method of randomization was unclear, as well as the
method for blinding (Author, 2016).
Reliability and Validity
The statistics used compared aspirin and placebo groups using
the Relative Risk, P values, cumulative incidence rates, and
95% confidence intervals. There was no explanation of how the
authors selected these methods in terms of time, e.g. pre-
specified or commencement after the initiation of the trial
(Author, 2018). This is a Level II trial, which is at a higher
level of evidence if the researchers follow the protocols for a
Level II trial, and overall these researchers did. The RCT had
randomization, intervention and control groups, as well as
manipulation of the independent variable, which provides
strength in studying the cause-effect relationship. Following
these Level II design requirements reduces the threats to
internal and external validity LoBiondo-Wood & Haber, 2018).
Ethics
The Institutional Review Board did monitor the study, and
informed consent was signed by those participating as subjects
in this study .
Topic, Summary
This is an important topic and the need to determine whether
100. low-dose aspirin should be utilized needs to be analyzed. Since
this study was completed in 2005, much new information is
available that renders the findings of this study lacking for
generalization of the clinical applications to women in this age
group.
References
American Psychological Association. (2009). Publication
manual of the American
Psychological Association (6th ed.). Washington, DC: Author.
Author, (n.d
.) Application of CONSORT statement for a randomized
trial of low-dose aspirin inpreventing cardiovascular disease in
women. (Unpublished Doctoral Assignment). School
LoBiondo-Wood, G. & Haber, J. (2018).
Nursing research: Methods and critical appraisal for
evidence-based practice. St. Louis, MO: Elsevier.
Ridker, P.M., Cook, N.R., Lee, I., Gordon, D., Gazianao, J.M.,
Manson, J.E.,. . . Buring, J.E. (2005). A randomized trial
of low-dose aspirin in the primary prevention of cardiovascular
101. disease in women.
New England Journal of Medicine, 352(13), 1293-1304.
Doi: 10.1956/nejmoa050613.
Note: CONSORT Checklist was completed for this Exemplar