16 Clinical Trials for Various Conditions
The primary objective of the proposed study will be to determine if a multi-modality teaching curriculum utilizing high-fidelity simulation and didactic lecture will result in sustained improvement by internal medicine residents in written knowledge and clinical performance when compared to residents receiving a curriculum utilizing only didactic lecture. The investigators hypothesis is that the addition of high-fidelity simulation to a traditional didactic lecture curriculum will result in sustained and superior written knowledge and practical performance when compared to a group receiving only didactic lecture on the same topic. Specifically, the investigators will be assessing internal medicine resident knowledge and performance in the area of sepsis in the hospitalized patient, and will shape the investigators teaching curriculum around this focus.
The preclinical curriculum related to firearm violence and safety counseling at the UCLA David Geffen School of Medicine (DGSOM) has been expanded for the Class of 2027, informed by the results and conclusions of an initial study of firearm safety counseling by medical students (ClinicalTrials.gov ID: NCT05242627), which was conducted by the present study team. The 1-hour firearm safety counseling training session used in that study will be taught again to first-year medical students in the Class of 2027, but training will be augmented with additional instruction; the Class will receive additional comprehensive instruction on suicide risk assessment and will participate in small group breakout sessions, to facilitate the opportunity for students to discuss issues related to firearm violence as a public health issue and to practice firearm safety counseling with standardized patient actors (SPs). Assessment of access to firearms and firearm safety counseling will be added as a standard component of the Social History that students are taught to obtain from patients during clinical examinations. The goal of the expanded training is to increase the prevalence of medical student counseling when they are conducting a history and physical examination in a simulated patient encounter with an SP 6 months after the initial training session, when compared to results from the initial study. The scenario provided to the SP will be identical to that used in the initial study and is a situation in which firearm safety counseling is warranted. Students will participate in a survey to ascertain their knowledge of firearm violence and their attitudes about physician counseling about firearm safety, prior to formal instruction. Informed consent will be obtained from students to use their responses in educational research. Following the didactic and small group sessions, students will be asked to complete a post-training survey that is similar to the original survey, as a means of assessing knowledge gained and any change in attitudes about physician counseling. The simulated patient encounter will occur approximately 6 months later, after which students will complete another survey to determine retention of knowledge and their experience during the simulated patient encounter. Students will not be told before the encounter that they will be evaluated regarding firearm safety counseling. The SP will identify which students did and did not raise the issue of firearm safety. Videos recorded of each students' sessions (routinely obtained for grading purposes) will be viewed by investigators for those students who provide informed consent, to determine the quality of counseling, if it was conducted. Results from this follow-up study will be compared to the results of the initial study as a historical control, to determine whether augmentation of firearm safety counseling training above a 1-hour didactic session increases firearm safety counseling by medical students in a clinical setting and whether it improves retention of knowledge about firearm violence.
1. Briefly describe the purpose of this protocol: This study is designed to evaluate the effectiveness of an educational training video on the topic of health literacy for medical students. 2. Briefly summarize how participants are recruited: OHSU medical students attending mandatory trainings on the topic of health literacy during the 1st and 2nd years of medical school will be invited to participate in the study. 3. Briefly describe the procedures subjects will undergo: Completion of a short self-administered anonymous survey before and after viewing a 23-minute video about health literacy. 4. If applicable, briefly describe survey/interview instruments used: A 12-item pre-test questionnaire and 13-item post-test questionnaire designed to assess individuals' knowledge about health literacy, and intended clinical practices with respect to health literacy. 5. If this is a clinical trial using an experimental drug and/or device, or an approved drug and/or device used for an unapproved purpose, briefly describe the drug and/or device: n/a 6. Briefly describe how the data will be analyzed to address the purpose of the protocol: Demographics and responses to individual items will be reported as frequencies and percentages within the sample. The investigators will use a chi-square analysis to stratify responses by demographic groups and t-tests to measure possible changes over time.
The goal of this clinical trial is to compare whether videos help teens better understand medical topics. The main questions answered in this trial are: 1. whether videos can improve teen knowledge about electronic medical record portals 2. whether videos can improve teen knowledge about general health issues Participants will answer surveys and watch videos as part of this study.
In the United States, nearly one in every three households contains at least one firearm, and roughly 20-25% of American adults personally own a firearm. Such easy access to firearms is a major contributor to the uniquely high levels of firearm-related violent death in the United States compared with other high-income nations. American physicians are intimately aware of this burden and are positioned to help modify the risks that firearms pose to the health and safety of their patients. Accordingly, it is imperative that physicians learn both how to screen their patients for exposure to firearms and how they can effectively counsel those who are at an increased risk for firearm-related injury on how they might reduce that risk. Until the 2021-2022 academic year, the David Geffen School of Medicine (DGSOM) at the University of California, Los Angeles (UCLA) did not include in its medical school curriculum a firearm-safety counseling module; the only information pertaining to firearms had been a narrow-in-scope "Clinical Pearl," which gave statistics on the increased risk for fatal injury that firearms pose in the setting of domestic violence. Beginning with the incoming Class of 2025, DGSOM will implement a new curriculum, and the Curriculum Re-design Committee has incorporated a module offering instruction on how to screen for exposure to firearms and counsel patients on firearm-safety. This inclusion follows a pilot module on firearm safety counseling that was presented to the Class of 2023. The current trial will take advantage of these unique circumstances to evaluate the effects of introducing such a module on medical students' attitudes, beliefs, and behaviors related to firearm-safety counseling in the clinical setting. The performance of students in the Class of 2023, who did not receive training, will be compared to that of students in the Class of 2024, who did receive training, during a standardized patient encounter. The high prevalence of firearms in the US demands that physicians have a working knowledge of how to screen patients for exposure to firearms, and an ability to counsel those who have such exposure on firearm-safety. While physicians believe they should have an active role in screening for risk factors of firearm violence and counsel on firearm safety, experience indicates that they fail to do either routinely. Importantly, physicians cite a lack of training and self-confidence as the major factors preventing them from screening for, and counseling on, firearm safety. A recent study of third-year medical students showed that those who completed a brief (20 minute) module on firearm injury prevention (compared with those who did not) were more likely to report increased self-perceived ability to counsel patients on firearm injury prevention, both immediately and 6 months post intervention; however, the study failed to demonstrate a difference in long-term clinical behavior, suggesting more rigorous training methods are warranted. The investigators hope that educational modules supplemented with simulated patient interactions designed to allow students the opportunity to practice firearm-safety counseling will increase their propensity for engaging in these conversations in the future. The first innovative aspect of our proposal is that it is introducing an educational module which combines didactic lectures, interactive case-based discussions, and interviews with standardized patients. On a computerized literature search, the investigators found no evidence that such a comprehensive module has been studied. Furthermore, unlike previous studies which have either focused on immediate self-reported confidence or self-reported clinical encounters, the investigators' proposal intends to assess long-term retention of the module content by observing students' clinical practices in an OSCE 6 months after the module is taught. The investigators hypothesize that an educational module will significantly increase both the proportion of second-year medical year students who screen for firearms and the quality of firearm safety counseling.
This trial evaluates the impact of a systemic social work driven approach on medical power of attorney documentation, knowledge, attitudes, and beliefs in participants with stage I-IV gynecological cancers. Social work counseling and education may help increase the number of participants who complete medical power of attorney documents. Counseling and education may also affect attitudes about decision-making and willingness to take part in these conversations in participants with stage I-IV gynecological cancers and their family members and/or caregivers.
This observational study consists of two parts. In part one, case scenario focus groups with hemophilia A patients and healthcare providers (HCPs) will be held. This parts aims to identify potential use scenarios of a point of care (POC) in vitro medical for patients with hemophilia A. The main questions it aims to answer are: * How is coagulation lab testing for patients with hemophilia A currently organized? * What is the interest and what are desired alternatives of a POC in-vitro diagnostic medical device for patients with hemophilia A? Part two of the study consists of a use scenario study in which patients with hemophilia A and HCPs will evaluate two types of non-functional mock-ups of a POC in vitro medical device. The main goal of this part is to evaluate the usability of the current prototypes of the POC device.
The goal of this clinical trial is to compare two health system-based approaches for offering kidney failure treatment options to older patients with kidney failure, specifically, to ensure patients are actively involved in a shared decision making (SDM) process covering a full range of treatment choices and have meaningful access to that full range of choices. These include standard in-center or home dialysis as well as alternative treatment plans (ATPs): active medical care without dialysis, time-limited trial of dialysis, palliative dialysis, and deciding not to decide. Approach 1 - Educate and Engage: Nephrology practices encourage their patients to a) participate in a kidney disease education program providing a balanced presentation of all options including ATPs, b) use evidence-based patient decision aids that include ATPs, and c) engage in SDM with staff trained in communication skills and best practices. Approach 2 - Educate and Engage Plus Kidney Supportive Care Program: Nephrology practices add a primary palliative care program to support patients who choose ATPs and their families. The program provides care coordination, symptom management, advance care planning, and psychosocial support to supplement usual care from their nephrologist. To compare the two approaches, the investigators will conduct a repeated, cross-sectional stepped wedge cluster randomized trial involving 20-25 chronic kidney disease clinics at 8 practice organizations around the United States. Aim 1: Compare the effectiveness of Approaches 1 and 2 in a) increasing proportion of patients choosing ATP and b) reducing patient-reported decisional conflict about treatment. Aim 2: Compare the patient and family experience of ATP care between Approaches 1 and 2 in terms of quality of life, services used, and end of life (EOL) experience. Aim 2a will focus on experience while patients are receiving an ATP. Aim 2b will describe the EOL experience. Aim 3: Evaluate implementation of each approach through a mixed-methods design based on the expanded RE-AIM framework. For Aims 1 and 2, researchers will collect information by chart review and surveys with patients and caregivers. For Aim 3, information will be reported by site managers as part of monthly progress reports. Clinic administrators, clinical providers, and staff will complete surveys before and after implementation of each approach.
This study aims to identify the unmet psychoeducational needs of parents of children 8-12 years of age using insulin pump and CGM for pediatric T1D management and to leverage that information to develop an innovative app-based psychoeducational intervention to optimize use of these technologies and improve T1D outcomes.
The purpose of this randomized controlled trial is to evaluate the impact of patient and provider facing educational materials and peer comparison on medical testing conversations during annual physicals. The investigators hypothesize that education materials and peer comparison will improve conversation quality about medical testing decisions.
This is a study to compare patient knowledge about the indications of their medications between two sites. Regions Hospital has a population of patients that receive the medication indication on the label for any new or changed medications at the time of patient discharge. Brigham Women's Health follows a standard policy of discharge medication labels including the name of the medication and instructions for use without any indication of what the medication is intended to treat. Consented patient will receive a phone call where researchers will ask about which medications they are taking and other questions about those medications. The study population will be patients recently discharged from the hospital with 1 or more new or changed medications
The purpose of this study is to identify existing cost knowledge of Emergency Medicine (EM) physicians and patients and investigates its reported impacts on medical compliance. A cross-sectional survey will be administered electronically to Emergency Medicine physicians at the University of Utah Hospital and the Emergency Physician Integrated Care, LLC (EPIC) who staff ten-community hospital Emergency Departments (ED) in order to investigate physician knowledge and attitudes regarding cost and perceived patient compliance. In addition, a cross-sectional survey will be administered to a convenience sample of patients presenting to the University of Utah Emergency Department to obtain information about their cost knowledge and reported compliance. All ED patients will complete a follow-up phone survey to measure compliance with recommendations made during the ED visits. Following administration of the baseline survey physicians will be provided the prices of the test and procedures and will be re-surveyed 30-days later as a post intervention test to measure changes in knowledge and attitudes.
The purpose of this study is to compare an adaptive Web-based learning system to a non-adaptive system for teaching physicians-in-training about ambulatory medicine.
This study is designed to test the impact of a new curriculum, called Provider Awareness Cultural Dexterity Toolkit for Surgeons (PACTS), on surgical residents' cross-cultural knowledge, attitudes, and skills surrounding the care of patients from diverse cultural backgrounds, as well as clinical and patient-reported health outcomes for patients treated by surgical residents undergoing this training.
The Master Preceptor Fellowship Pilot Study is a prospective cohort study that is being conducted to measure changes in participant knowledge, teaching efficacy, leadership skills, job satisfaction and quality of life.
Medical imaging is one of the fastest growing sectors in health care and increases in utilization underscore the need to ensure imaging technology is developed and used effectively. Evaluation of the clinical and economic impact of such imaging lags behind the technology development. Heart failure (HF) represents the final common pathway for most forms of heart disease and morbidity and mortality remain high. There is a need to identify imaging approaches that have a positive impact on therapy decisions, patient outcomes and costs. As well as standard methods to evaluate new and emerging techniques to better test their potential in a clinical management setting. PRIMARY OBJECTIVES: to compare the effect of HF imaging strategies on the composite clinical endpoint of cardiac death, MI, resuscitated cardiac arrest and cardiac re-hospitalization (WHF, ACS, arrhythmia). Patients with an ischemic heart disease (IHD) etiology will follow HF imaging strategy algorithms according to the question(s) asked by the physicians (is there ischemia and/or viability), in agreement with their local practices for standard and alternative imaging. SECONDARY OBJECTIVES: 1. To evaluate the effect of imaging modalities within and between the imaging subgroups (advanced (CMR and PET), PET, MRI and standard (SPECT)) on the primary and secondary outcomes in patients being evaluated either for viability and/or ischemia. 2. To evaluate the impact of adherence to recommendations between modalities on outcomes in patients being evaluated for either viability or ischemia. 3. To compare the effect of HF imaging strategies on: 1. The incidence of revascularization procedures (PCI, CABG, none) and the interaction of the imaging strategy and types of revascularization on outcomes 2. LV remodeling: LV volumes, LVEF, 3. HF symptoms, NYHA class 4. QOL (MLHFQ, the EQ5D) 5. The evolution of serum prognostic markers in HF (e.g. BNP, RDW, hs-cTnT, hs-CRP, ST2) 6. Health economics: Costs estimated through regression analysis and cost effectiveness assessed through decision modeling. 7. The safety of imaging tests measured by cumulative radiation, adverse reactions to imaging contrast agents and stress testing agents will also be determined. 8. The evolution of renal function (eGFR) and LV remodeling-associated biomarkers (e.g. PIIINP, OPN). 9. Event rates of each component of the composite endpoint as well as the combined endpoint of CV death and HF hospitalization 10. All-cause mortality