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Sökning: WFRF:(Deluca Paolo)

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1.
  • Anderson, Peter, et al. (författare)
  • Delivery of Brief Interventions for Heavy Drinking in Primary Care: Outcomes of the ODHIN 5-Country Cluster Randomized Trial
  • 2017
  • Ingår i: Annals of Family Medicine. - : ANNALS FAMILY MEDICINE. - 1544-1709 .- 1544-1717. ; 15:4, s. 335-340
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE We aimed to test whether 3 strategies-training and support, financial reimbursement, and an option to direct screen-positive patients to an Internet-based method of giving brief advice-have a longer-term effect on primary care clinicians delivery of screening and advice to heavy drinkers operationalized with the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) tool. METHODS We undertook a cluster randomized factorial trial with a 12-week implementation period in 120 primary health care units throughout Catalonia, England, Netherlands, Poland, and Sweden. Units were randomized to 8 groups: care as usual (control); training and support alone; financial reimbursement alone; electronic brief advice alone; paired combinations of these conditions; and all 3 combined. The primary outcome was the proportion of consulting adult patients (aged 18 years and older) receiving intervention-screening and, if screen-positive, advice-at 9 months. RESULTS Based on the factorial design, the ratio of the log of the proportion of patients given intervention at the 9-month follow-up was 1.39 (95% CI, 1.03-1.88) in units that received training and support as compared with units that did not. Neither financial reimbursement nor directing screen-positive patients to electronic brief advice led to a higher proportion of patients receiving intervention. CONCLUSIONS Training and support of primary health care units has a lasting, albeit small, impact on the proportion of adult patients given an alcohol intervention at 9 months.
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2.
  • Anderson, Peter, et al. (författare)
  • Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial
  • 2017
  • Ingår i: European Journal of General Practice. - : TAYLOR & FRANCIS LTD. - 1381-4788 .- 1751-1402. ; 23:1, s. 241-245
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. Objectives: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. Methods: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. Results: Nurses tended to screen more patients than doctors (OR = 3.1; 95% CI: 1.9, 4.9). Screenpositive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95% CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95% CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. Conclusions: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised.
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3.
  • De Pontieu, Bart, et al. (författare)
  • Probing the Physics of the Solar Atmosphere with the Multi-slit Solar Explorer (MUSE). I. Coronal Heating
  • 2022
  • Ingår i: Astrophysical Journal. - : American Astronomical Society. - 0004-637X .- 1538-4357. ; 926:1
  • Tidskriftsartikel (refereegranskat)abstract
    • The Multi-slit Solar Explorer (MUSE) is a proposed mission composed of a multislit extreme ultraviolet (EUV) spectrograph (in three spectral bands around 171 Å, 284 Å, and 108 Å) and an EUV context imager (in two passbands around 195 Å and 304 Å). MUSE will provide unprecedented spectral and imaging diagnostics of the solar corona at high spatial (≤05) and temporal resolution (down to ∼0.5 s for sit-and-stare observations), thanks to its innovative multislit design. By obtaining spectra in four bright EUV lines (Fe ix 171 Å, Fe xv 284 Å, Fe xix–Fe xxi 108 Å) covering a wide range of transition regions and coronal temperatures along 37 slits simultaneously, MUSE will, for the first time, "freeze" (at a cadence as short as 10 s) with a spectroscopic raster the evolution of the dynamic coronal plasma over a wide range of scales: from the spatial scales on which energy is released (≤05) to the large-scale (∼170'' × 170'') atmospheric response. We use numerical modeling to showcase how MUSE will constrain the properties of the solar atmosphere on spatiotemporal scales (≤05, ≤20 s) and the large field of view on which state-of-the-art models of the physical processes that drive coronal heating, flares, and coronal mass ejections (CMEs) make distinguishing and testable predictions. We describe the synergy between MUSE, the single-slit, high-resolution Solar-C EUVST spectrograph, and ground-based observatories (DKIST and others), and the critical role MUSE plays because of the multiscale nature of the physical processes involved. In this first paper, we focus on coronal heating mechanisms. An accompanying paper focuses on flares and CMEs.
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4.
  • Keurhorst, Myrna N., et al. (författare)
  • Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN) : study protocol for a cluster randomized factorial trial
  • 2013
  • Ingår i: Implementation Science. - : BioMed Central. - 1748-5908. ; 8
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe European level of alcohol consumption, and the subsequent burden of disease, is high compared to the rest of the world. While screening and brief interventions in primary healthcare are cost-effective, in most countries they have hardly been implemented in routine primary healthcare. In this study, we aim to examine the effectiveness and efficiency of three implementation interventions that have been chosen to address key barriers for improvement: training and support to address lack of knowledge and motivation in healthcare providers; financial reimbursement to compensate the time investment; and internet-based counselling to reduce workload for primary care providers.Methods/designIn a cluster randomized factorial trial, data from Catalan, English, Netherlands, Polish, and Swedish primary healthcare units will be collected on screening and brief advice rates for hazardous and harmful alcohol consumption. The three implementation strategies will be provided separately and in combination in a total of seven intervention groups and compared with a treatment as usual control group. Screening and brief intervention activities will be measured at baseline, during 12 weeks and after six months. Process measures include health professionals’ role security and therapeutic commitment of the participating providers (SAAPPQ questionnaire). A total of 120 primary healthcare units will be included, equally distributed over the five countries. Both intention to treat and per protocol analyses are planned to determine intervention effectiveness, using random coefficient regression modelling.DiscussionEffective interventions to implement screening and brief interventions for hazardous alcohol use are urgently required. This international multi-centre trial will provide evidence to guide decision makers.
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