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Stepped wedge trials are increasingly adopted because practical constraints necessitate staggered roll-out. While a complete design requires clusters to collect data in all periods, resource and patient-centered considerations may call for an incomplete stepped wedge design to minimize data collection burden. To study incomplete designs, we expand the metric of information content to discrete outcomes. We operate under a marginal model with general link and variance functions, and derive information content expressions when data elements (cells, sequences, periods) are omitted. We show that the centrosymmetric patterns of information content can hold for discrete outcomes with the variance-stabilizing link function. We perform numerical studies under the canonical link function, and find that while the patterns of information content for cells are approximately centrosymmetric for all examined underlying secular trends, the patterns of information content for sequences or periods are more sensitive to the secular trend, and may be far from centrosymmetric.
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http://dx.doi.org/10.1111/sjos.12615 | DOI Listing |
JAMA Pediatr
September 2025
Department of Pediatrics and Emergency Medicine, Children's National Hospital, George Washington University, Washington, DC.
Importance: Adolescents account for almost half of the 2.5 million diagnosed sexually transmitted infections in the US annually, and the emergency department functions as the primary source of health care for many adolescents. No recommendations exist for emergency department gonorrhea and chlamydia screening.
View Article and Find Full Text PDFJCO Oncol Pract
September 2025
Dana-Farber Cancer Institute, Boston, MA.
Purpose: We assessed the perspectives of staff from six health systems to understand how electronic Symptom Management (eSyM), an eSyM program that supports patients during chemotherapy and after surgery, is normalized and sustained.
Methods: Starting in 2019, we integrated eSyM into routine clinical practice and assessed its effectiveness using a cluster randomized stepped-wedge trial design. At least 1 year after implementation, we administered cross-sectional surveys to elicit the perspectives of physicians, nurses, advanced practice providers (APPs), hospital administrators, information technology, and research staff using the Normalization MeAsure Development (NoMAD) and the Clinical Sustainability Assessment Tool (CSAT).
JAMA Netw Open
September 2025
Division of Cardiovascular Diseases and Hypertension, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Importance: The association of cardiopulmonary point-of-care ultrasonography (POCUS) with length of stay (LOS) and hospitalization costs for patients admitted to internal medicine wards remains uncertain.
Objective: To evaluate a collaborative implementation model involving hospitalists, sonographers, and a remote cardiologist for integrating cardiopulmonary POCUS into the assessment of adult patients (≥18 years) hospitalized with undifferentiated dyspnea, and to assess its association with LOS and hospitalization costs.
Design, Setting, And Participants: This quality improvement study employed a type 1 effectiveness-implementation hybrid design using a 6-month stepped-wedge cluster randomized approach, conducted at a tertiary care hospital in the US between December 7, 2023, and July 2, 2024, to compare the standard-of-care (control) with the intervention group.
Front Neurol
August 2025
Department of Medicine (Division of Neurology), Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
Background: The translation of standard-of-care in acute ischemic stroke reperfusion interventions into practice is well established, but multifactorial obstacles exist in complete adoption, which has led to inequities in access and delivery of services. The objective of this study was to improve access and efficiency of ischemic stroke treatment across four Atlantic Canadian Provinces.
Methods: A stepped-wedge cluster trial was conducted over 30 months with 3 clusters covering 34 sites.
Isr J Health Policy Res
September 2025
Gray Faculty of Medical & Health Sciences, Tel Aviv University, Ramat Aviv, Israel.
Background: Prolonged shifts in residency contribute to physician fatigue, cognitive decline, and increased medical errors. This systematic review and meta-analysis evaluate how reducing shift length affects patient-physician safety, physician well-being, and residency training, addressing the ongoing challenge of balancing resident welfare, patient outcomes, and educational standards across varied implementation settings.
Methods: A comprehensive search of PubMed, EMBASE, The Cochrane Library, Google Scholar, and opengrey.