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Background: The objective of the STREAM Trial was to evaluate the effect of simulation training on process times in acute stroke care.
Methods: The multicenter prospective interventional STREAM Trial was conducted between 10/2017 and 04/2019 at seven tertiary care neurocenters in Germany with a pre- and post-interventional observation phase. We recorded patient characteristics, acute stroke care process times, stroke team composition and simulation experience for consecutive direct-to-center patients receiving intravenous thrombolysis (IVT) and/or endovascular therapy (EVT). The intervention consisted of a composite intervention centered around stroke-specific in situ simulation training. Primary outcome measure was the ‘door-to-needle’ time (DTN) for IVT. Secondary outcome measures included process times of EVT and measures taken to streamline the pre-existing treatment algorithm.
Results: The effect of the STREAM intervention on the process times of all acute stroke operations was neutral. However, secondary analyses showed a DTN reduction of 5 min from 38 min pre-intervention (interquartile range [IQR] 25–43 min) to 33 min (IQR 23–39 min, p = 0.03) post-intervention achieved by simulation-experienced stroke teams. Concerning EVT, we found significantly shorter door-to-groin times in patients who were treated by teams with simulation experience as compared to simulation-naive teams in the post-interventional phase (−21 min, simulation-naive: 95 min, IQR 69–111 vs. simulation-experienced: 74 min, IQR 51–92, p = 0.04).
Conclusion: An intervention combining workflow refinement and simulation-based stroke team training has the potential to improve process times in acute stroke care.
Over the last decade, the prospect of improving or maintaining cognitive functioning has provoked a steadily increasing number of cognitive training studies. Central target populations are individuals at risk for a disadvantageous development, such as older adults exhibiting cognitive decline or children with learning impairments. They rely on cognitive resources to meet the challenges of an independent life in old age or requirements at school.
To support daily cognitive functioning, training outcomes need to generalize to other cognitive abilities. Such transfer effects are, however, highly discussed. For example, recent meta-analyses on working memory training differed in the conclusion on the presence (Au et al., 2015; Karbach and Verhaeghen, 2014) or absence of transfer effects (Melby-Lervåg and Hulme, 2013). Usually training-specific design factors such as type, intensity, duration, and feedback routines are discussed as reasons for such inconsistent findings. However, even individuals participating in exactly the same training regime highly differ in their training outcomes. We argue that it is time to study the individual development during trainings to understand these differential outcomes. It is time to have a closer look at the intraindividual training data.
Previous studies used a text-fading procedure as a training tool with the goal to increase silent reading fluency (i.e., proficient reading rate and comprehension). In recently published studies, this procedure resulted in lasting reading enhancements for adult and adolescent research samples. However, studies working with children reported mixed results. While reading rate improvements were observable for Dutch reading children in a text-fading training study, reading fluency improvements in standardized reading tests post-training attributable to the fading manipulation were not detectable. These results raise the question of whether text-fading training is not effective for children or whether research design issues have concealed possible transfer effects. Hence, the present study sought to investigate possible transfer effects resulting from a text-fading based reading training program, using a modified research design. Over a period of 3 weeks, two groups of German third-graders read sentences either with an adaptive text-fading procedure or at their self-paced reading rate. A standardized test measuring reading fluency at the word, sentence, and text level was conducted pre- and post-training. Text level reading fluency improved for both groups equally. Post-training gains at the word level were found for the text-fading group, however, no significant interaction between groups was revealed for word reading fluency. Sentence level reading fluency gains were found for the text-fading group, which significantly differed from the group of children reading at their self-paced reading routine. These findings provide evidence for the efficacy of text-fading as a training method for sentence reading fluency improvement also for children.
Background: Among cancer care providers (CCPs), lack of knowledge constitutes an important barrier to the discussion of complementary and alternative medicine (CAM) use with patients. This study assessed CCPs’ needs and preferences regarding CAM information and training (I&T).
Methods: An online survey was completed by 209 general practitioners, 437 medical specialists, 159 oncology nurses and medical assistants, and 244 psychologists and social workers engaged in cancer care. Latent class analysis (LCA) was used to identify subgroups of individuals with distinct preference patterns regarding I&T content.
Results: CCPs prefer CAM I&T to be provided as lectures, information platforms on the internet, workshops, and e-mail newsletters. Concerning subject matters, many CCPs considered CAM therapy options for the treatment of a variety of cancer disease- and therapy-related symptoms to be very important (75%-72% of the sample); the same applies to an "overview of different CAM therapies" (74%). LCA identified 5 latent classes (LCs) of CCPs. All of them attached considerable importance to "medical indication," "potential side effects," and "tips for usage." LCs differed, however, in terms of overall importance ratings, the perceived importance of "patients’ reasons" for using specific CAM therapies, "case examples," and "scientific evidence." Notably, the 5 LCs were clearly present in all 4 occupational groups.
Conclusions: CAM I&T should provide CCPs with an overview of different CAM therapies and show how CAM might help in treating symptoms cancer patients frequently demonstrate (eg, fatigue). Moreover, I&T programs should be flexible and take into account that individual information needs vary even within the same occupational group.
We estimate a semiparametric single-risk discrete-time duration model to assess the effect of vocational training on the duration of unemployment spells. The data basis used in this study is the German Socio-Economic-Panel (GSOEP) for West Germany for the period from 1986 to 1994. To take into account a possible selection bias actual participation in vocational training is instrumented using estimates of a randomeffects probit model for the participation in qualification measures. Our main results show that training does have a significant short term effect of reducing unemployment duration but that this effect does not persist in the long run. JEL classifications: C41, J20, J64