Siripanth Nippita

A randomized controlled trial of daily text messages versus monthly paper diaries to collect bleeding data after intrauterine device insertion.

OBJECTIVEnBleeding data in contraceptive trials are often collected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection.nnnSTUDY DESIGNnThis trial randomized participants 1:1 to use text messages or paper diaries to report on bleeding experienced during the 90 days after intrauterine device (IUD) insertion. Participants chose either the copper T380A or the 52-mg levonorgestrel IUD. Our primary outcome was number of days of reported bleeding data. We hypothesized that data gathered with daily text messages would have fewer missing values than paper diaries. Intention to treat analyses used the rank-sum test to compare medians.nnnRESULTSnTwo hundred thirty women enrolled, and randomization yielded groups similar in baseline characteristics. Twenty percent of participants provided no bleeding data; of these, 77% were assigned to paper diaries. With 90 days of reporting, approximately 20% in each group provided complete bleeding data. The text group reported a median of 82 days [interquartile range (IQR) 40-89] and the paper group reported a median of 36 days (IQR 0-88) (p≤.001). The number of responses received decreased gradually over the 90-day period but was always higher in the text group. Women who had attained higher levels of education did well regardless of data collection modality, while response rates of text messages were greater among those with a high school education or less (p<.01).nnnCONCLUSIONSnParticipants reporting bleeding via text messages provided more complete data than women using paper diaries.nnnIMPLICATIONSnDepending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.

Impact of teamwork improvement training on communication and teamwork climate in ambulatory reproductive health care

BACKGROUNDnWhile team training is associated with improved hospital-based team climate, less is known about effects in the ambulatory setting.nnnSTUDY DESIGNnIn 2014 and 2015, we enrolled 20 organizations, each operating various health centers, into this ongoing study. Evaluation tools include a communication behaviors assessment (CBA) and Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS® ) Teamwork Perceptions Questionnaire (T-TPQ), which staff completes at baseline, 6 months, and 1xa0year, and the Patients Insights and Views of Teamwork (PIVOT) survey, which patients complete at baseline and 1xa0year. We also assessed patient satisfaction. We analyzed T-TPQs paired at the individual level and CBAs and PIVOTs paired at the health center level. We also conducted key informant interviews with the first cohort.nnnRESULTSnCBAs showed that TeamSTEPPS tools and strategies were utilized, with 50% or more of centers reporting increases in all behaviors at 1xa0year; key informant interviews confirmed this. T-TPQ findings indicated that TeamSTEPPS implementation was associated with improved staff perceptions of teamwork at 6 months; lesser improvements were seen at 1xa0year. The PIVOT survey demonstrated significant improvements in select patient ratings of teamwork. Patient satisfaction improved at 1xa0year.nnnCONCLUSIONSnTeamSTEPPS has positive effects in the ambulatory reproductive health care environment. Improvements persisted at 1xa0year.

Randomized trial of high- and low-fidelity simulation to teach intrauterine contraception placement

Background High‐fidelity simulation creates conditions that resemble real circumstances, and can help teach procedures such as intrauterine contraception placement. Its impact on skill retention has not been studied. Objective We sought to evaluate novice learners’ skills, attitudes, and knowledge on placement of intrauterine contraception when trained using a high‐fidelity commercially available simulator compared with a low‐fidelity simulator. Study Design We recruited senior nurse practitioner students and interns in obstetrics and gynecology and family medicine inexperienced with intrauterine contraception placement. In this unblinded, randomized controlled trial, participants were assigned to practice within a high‐fidelity simulator group or a coasterlike model group. We evaluated intrauterine contraception placement skills, self‐perceived comfort and competence, and knowledge before and after simulation, as well as at 3 months. Our primary outcome was the change in scores for intrauterine contraception placement skills before and after practice. Assuming a standard deviation of 15 points, we needed 10 participants per group to detect a 20‐point difference in scores with 80% power. Results From June through July 2014, 60 participants enrolled; 59 completed the initial study visit and 1 withdrew. In all, 48 (80%) completed the second study visit at 3 months. Demographic characteristics were similar for the randomization groups. We observed an improvement in intrauterine contraception placement skills for both groups following practice on simulators (P < .01); the proportion that improved was similar (20% for the high‐fidelity simulator group and 15% for the coaster group, P = .55). Increases in self‐perceived comfort and competence with placing copper, levonorgestrel 52‐mg, and levonorgestrel 13.5‐mg devices were similar (all P ≥ .11). Knowledge assessment scores were comparable between the 2 groups postsimulation (73% for the high‐fidelity simulator group and 80% for the coaster group, P = .29) and at 3 months (87% for both groups, P = 1.0). Conclusion Trainees’ knowledge, intrauterine contraception placement skills, and self‐perceived comfort and competence were comparable whether they used high‐ or low‐fidelity simulators.

Comfort and Competency With Intrauterine Contraception Insertion: A Randomized Controlled Trial [226].

INTRODUCTION: Different simulators are available to teach intrauterine contraception insertion. We compared self-perceived competence and comfort with intrauterine contraception insertions after practice on a high-fidelity simulator compared with a low-fidelity model. METHODS: In this randomized controlled trial, participants were assigned to practice intrauterine contraception insertions on the ARMS PelvicSim high-fidelity simulator or a coaster-like model. We enrolled family medicine interns, obstetrics and gynecology interns, and nurse practitioner students inexperienced with intrauterine contraception insertion (defined as having inserted less than five intrauterine contraception devices). Participants viewed a didactic module and intrauterine contraception insertion training videos before practicing on their assigned models. Before and after practicing they rated their comfort and competency with intrauterine contraception insertion. RESULTS: We enrolled 60 participants; 59 completed their study visit and one withdrew. Twenty-nine participants practiced on the ARMS PelvicSim and 30 on the coaster. Participants included 20 interns and 39 nurse practitioner students. Median age was 27.0 years (range 26.0–30.0 years) and 53 (89.8%) were female. After the training, both groups were similarly more comfortable with the steps of intrauterine contraception insertion (P=.24) as well as inserting the Mirena (P=.23), Skyla (P=.11), and ParaGard (P=.47). Self-perceived competency with these procedures improved for both groups regardless of simulator used (P>.05 for all). Twenty-six (92.7%) participants who used the ARMS PelvicSim thought their model was valuable compared with 17 (56.7%) who used the coaster (P=.007). CONCLUSION: Although participants who used the PelvicSim felt it was more valuable, the type of model used to practice intrauterine contraception insertion did not affect self-reported competency and comfort among trainees inexperienced with intrauterine contraception insertion.

Text Messages Compared With Monthly Paper Diaries: Collecting Bleeding Data After Intrauterine Device Insertion

INTRODUCTION: Short-term bleeding patterns after intrauterine device (IUD) insertion are poorly characterized. Most young women text message daily. We aimed to assess success of collecting 90 days bleeding data after IUD insertion by method of data collection (text message compared with traditional paper diaries). METHODS: We enrolled women with cell phones initiating the copper T380A IUD or levonorgestrel intrauterine system and randomized participants (one-to-one) to record bleeding through daily text messages or monthly paper calendars. Women in the text group received automated daily prompts. The groups received equal compensation for completing the diaries. RESULTS: We enrolled 230 participants. The groups were similar in baseline characteristics, including age, parity, ethnicity, and education. Twenty percent of participants provided no bleeding data; of these, 76% were in the paper group; only 20% in each group provided complete 90-day data. The median diary completion was 82 days for the text group (interquartile range 40–89) and 36 days in the paper group (interquartile range 0–88). Those with 30 or fewer responses were less educated and more likely to self-identify as Hispanic than those providing more than 60 responses. CONCLUSIONS: Women providing bleeding data electronically by daily text message gave more complete data than women using traditional paper diaries; however, bleeding data were incomplete in both groups. For future studies of contraception and bleeding patterns, use of text may be superior to paper diaries.