Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement

The effect of the Patient Health Engagement model-based care strategy on improving patient-ventilator synchrony in patients with respiratory failure: a quasi-experimental study

BACKGROUND

Non-invasive positive pressure ventilation (NPPV) is a crucial method for treating acute and chronic respiratory failure. The effectiveness of NPPV treatment heavily depends on the active participation of patients. However, research on strategies to enhance patient engagement during NPPV therapy is still lacking.

AIM

To evaluate the effect of nursing interventions based on the Patient Health Engagement (PHE) model in enhancing patient-ventilator synchrony and improving outcomes of NPPV in patients with respiratory failure.

STUDY DESIGN

This quasi-experimental study employed a pre-post design with non-equivalent control group. Convenience sampling was used to select patients with respiratory failure receiving NPPV at Zhongshan Hospital, Fudan University. A total of 104 participants entered the data analysis phase. The control group (n = 52) received routine NPPV care, while the intervention group (n = 52) received care based on the PHE model.

RESULTS

The intervention group showed decreased patient-ventilator asynchrony index {Δ [95% confidence interval (95% CI)] = -2.82 (-4.02, -1.62), p < 0.001} and NPPV non-adherence score [Δ (95% CI) = -1.08 (-1.42, -0.74), p < 0.001] within 48 h compared to the control group. The dyspnoea score in the intervention group decreased more rapidly after NPPV and was lower than that in the control group at 4 h [Δ (95% CI) = -1.27 (-2.03, -0.51), p = 0.001]. Additionally, the intervention group had higher comfort scores [Δ (95% CI) = 2.26 (1.56, 2.96), p < 0.001] and shorter ICU stays [Δ (95% CI) = -0.95 (-1.89, -0.01), p = 0.049].

CONCLUSION

Interventions based on the PHE model enhance comfort, synchrony, and adherence during NPPV in patients with respiratory failure, leading to improved respiratory and oxygenation outcomes, and reduced ICU stays.

RELEVANCE TO CLINICAL PRACTICE

Patient engagement is essential for optimizing NPPV outcomes in critical care. This study provides recommendations on cognitive, behavioural, and emotional aspects of NPPV care, offering a reference for intensive care managers to enhance nursing processes, standards, and the integration of humanistic care in the critical care setting.

Quality of reporting of pre-recorded music interventions in surgical patients - A systematic review

BACKGROUND

Perioperative music interventions are promising, with substantial beneficial effects on patients. However, adequate reporting is crucial for interpreting the outcomes and implementing the interventions. Our objective is to analyze the reporting quality of perioperative music interventions and to provide recommendations and a research agenda for future trials.

MATERIAL AND METHODS

This study utilized data from a systematic review, that was conducted as part of a separate previous analysis by Geensen, Dirven et al. For this analysis, a PROSPERO registration (CRD42023427138) was formalized. The Template for intervention Description and Replication (TiDieR) checklist was adapted and used. Nineteen intervention items were assessed, categorized in the aim, the core and the implementation.

RESULTS

Due to narrowed inclusion criteria, ten music intervention studies were included. None of the studies completely reported all intervention items. The reporting of core intervention items were poorly described. Complete description of implementation items, such as fidelity and modifications, was scarce.

CONCLUSIONS

Perioperative music studies often lack the complete reporting of essential intervention items. This hinders replicability, generalization of the results and might contribute to research waste. We recommend adequate reporting in future studies to avoid these problems, by using our adapted TIDieR checklist.

The Effects of Pursed Lip Breathing Exercises on Patients' Post-Bronchoscopy Recovery Parameters: A Nurse-Led Quasi-Experimental Study

Pursed-lip breathing (PLB) exercises are used as a nursing intervention among post-bronchoscopy patients. However, there is limited evidence of their effectiveness in improving post-bronchoscopy recovery status. This study investigated the effect of the PLB exercise program on patients' post-bronchoscopy recovery parameters. A nurse-led quasi-experimental research involving study and control groups involving 60 adult participants who were randomly divided into two equal groups. A three-part questionnaire was used for data collection from October 2022 to April 2023. Shapiro-Wilk test, chi-square test, Fisher's exact test, Cochran's test, post hoc test (Dunn's), student's t-test, and Friedman test were employed for data analyses. There were significant improvements in temperature, pulse, respiration, blood pressure, oxygen saturation, chest pain, and peak expiratory flow in the study group, with statistically significant difference after 30 min. PLB exercises enhanced the clinical outcomes of the study group participants compared to the control group in improving respiratory and cardiac status post-bronchoscopy. Nursing service units may conduct in-service training programs for nursing staff about applying PLB techniques and endorse this as a part of routine care to improve patients' clinical outcomes post-bronchoscopy.

Clinical Relevance of an Online Self-Management Intervention in Haemodialysis: A Secondary Data Analysis of the 'Connected We St@nd' Programme

BACKGROUND

The 'Connected We St@nd' programme is an Internet-mediated self-management intervention that combines health education with psychosocial support, with evidenced feasibility and acceptability in haemodialysis.

OBJECTIVES

To evaluate the clinical relevance of the programme and to better understand which intervention outcomes/health-related self-report measures are most sensitive to reflect changes between pre- and post-intervention assessments.

DESIGN

This study followed a pre-post quasi-experimental design.

PARTICIPANTS

Twenty-six individuals (16 people on haemodialysis and 10 family caregivers) completed the intervention.

MEASUREMENTS

Participants filled out a web-based assessment protocol before and after the intervention. To determine the clinical relevance of within-group pre-post changes, effect sizes, minimal clinically important differences, and reliable change indexes were calculated.

RESULTS

Clinically meaningful results were found on outcome measures with reasonable sensitivity to detect pre-post changes in the positive affect dimension of subjective well-being, purpose in life, overall quality of life, and psychological health. The latter was the variable that obtained the greatest number of respondents with reliable post-intervention improvements.

CONCLUSIONS

Participation in the programme led to clinically important and reliable improvements in several intervention outcomes, hinting that this evidence-informed intervention has the potential to be a valuable resource for promoting successful psychosocial adjustment among this population. Suggestions were made to fine-tune the evaluation and implementation of a large-scale trial to, in due course, encourage the integration of this technology-assisted interdisciplinary initiative into existing kidney care services.

Survival and Complication Rates of Feldspathic, Leucite-Reinforced, Lithium Disilicate and Zirconia Ceramic Laminate Veneers: A Systematic Review and Meta-Analysis

OBJECTIVES

To analyze survival and complication rates for anterior and premolar laminate-veneers out of different ceramic materials (feldspathic, leucite-reinforced glass-ceramic [LRGC], lithium-disilicate [LDS] and zirconia).

MATERIAL AND METHODS

A systematic literature search was conducted across multiple databases for clinical studies on ceramic laminate-veneers with a minimum-follow-up of ≥ 1 year. The date of last search was on February 19, 2024. Survival, technical, esthetic and biological events were assessed for different laminate-veneer materials at three observation periods (short- [1-3 years], mid- [4-6 years] and long-term [≥ 7 years]).

RESULTS

Twenty-nine studies were included. Meta-analysis revealed a pooled survival-rate of 96.13% for feldspathic, 93.70% for LRGC and 96.81% for LDS at 10.4 years. No difference was found between materials. Complication rates (technical/esthetic/biological) were as follows: Feldspathic: 41.48%/19.64%/6.51%; LRGC: 29.87%/17.89%/4.4%; LDS: 6.1%/1.9%/0.45% at 10.4 years. Zirconia showed a 100% survival-rate with no complications at 2.6 years. No long-term data was available for zirconia.

CONCLUSIONS

Feldspathic, LRGC and LDS laminate-veneers showed high survival-rates at long-term observation. LDS slightly outperforms feldspathic and LRGC laminate-veneers with lower long-term complication rates. More studies providing long-term data on zirconia laminate-veneers are needed.

CLINICAL SIGNIFICANCE

Ceramic laminate-veneers are a reliable treatment option. LDS may be preferred as a restorative material for long-term success.

Management of Postpartum Preeclampsia and Hypertensive Disorders (MOPP): Postpartum Tight vs Standard Blood Pressure Control

BACKGROUND

It is unknown whether tightly controlled blood pressure in the postpartum period will improve outcomes.

OBJECTIVES

The purpose of this study was to assess the effect of a lower treatment threshold (≥130/80 mm Hg) for initiating and titrating antihypertensive medication on reducing emergency department visits in postpartum patients with hypertension.

METHODS

A prospective cohort of postpartum patients was recruited in a multicenter study between March 2023 and March 2024 and treated to maintain blood pressure <130/80 mm Hg using remote blood pressure monitoring. These patients were compared to a propensity score-matched retrospective cohort from February 2021 to February 2023 who were treated to maintain blood pressures <150/100 mm Hg. Eligible patients were 18 or older with a diagnosis of hypertensive disorder. The primary outcome was an emergency department visit for hypertension.

RESULTS

There were 392 patients enrolled in the interventional cohort and 1,204 patients identified in the retrospective cohort. After the propensity score match, 276 and 429 patients remained in the prospective and retrospective groups, respectively. Emergency department visits for hypertensive disorders occurred in 10 patients (3.6%) in the intervention and 36 patients (8.4%) in the retrospective cohort (risk difference -4.8; 95% CI: -8.2 to -1.3; doubly robust OR: 0.32; 95% CI: 0.10-1.01). At 6 weeks postpartum, compared to the retrospective group, the intervention group had systolic and diastolic blood pressure that was 4.4 mm Hg (95% CI: -6.8 to -2.0) and 3.1 mm Hg (95% CI: -4.9 to -1.2) lower, respectively.

CONCLUSIONS

Tighter blood pressure control was associated with reduced postpartum emergency department visits for hypertensive disorders.

Multicomponent Deimplementation Strategy to Reduce Low-Value Preoperative Testing

Importance

Routine preoperative blood tests and electrocardiograms before low-risk surgery do not prevent adverse events or change management but waste resources and can cause patient harm. Given this, multispecialty organizations recommend against routine testing before low-risk surgery.

Objective

To determine whether a multicomponent deimplementation strategy (the intervention) would reduce low-value preoperative testing before low-risk general surgery operations.

Design, Setting, and Participants

This study had a pre-post quality improvement interventional design using interrupted time series and difference-in-difference analytic approaches. The setting was a single academic, quaternary referral hospital with 2 freestanding ambulatory surgery centers and a central preoperative clinic. Included in the study were adult patients undergoing nonurgent outpatient inguinal hernia repairs, lumpectomy, or laparoscopic cholecystectomy between June 2022 and August 2023. Eligible clinicians included those treating at least 1 patient during both the preintervention and postintervention periods.

Interventions

All clinicians were exposed to the multicomponent deimplementation intervention, and their testing practices were compared before and after the intervention. The strategy components were evidenced-based decisional support, multidisciplinary stakeholder engagement, educational sessions, and consensus building with surgeons and physician assistants staffing a preoperative clinic.

Main Outcomes and Measures

The primary end point of the trial was the rate of unnecessary preoperative tests across each trial period.

Results

A total of 1143 patients (mean [SD] age, 58.7 [15.5] years; 643 female [56.3%]) underwent 261 operations (23%) in the preintervention period, 510 (45%) in the intervention period, and 372 (33%) in the postintervention period. Unnecessary testing rates decreased over each period (intervention testing rate, -16%; 95% CI, -4% to -27%; P = .01; postintervention testing rate, -27%; 95% CI, -17% to -38%; P = .003) and within each test category. The decrease in overall testing was not observed at other hospitals in the state on adjusted difference-in-difference analysis.

Conclusions and Relevance

In this quality improvement study, a multicomponent deimplementation strategy was associated with a reduction in unnecessary preoperative testing before low-risk general surgery operations. The resulting changes in testing practice patterns were not associated with temporal trends within or outside the study hospital. Results suggest that this intervention was effective, applicable to common general surgery operations, and adaptable for expansion into appropriate clinical settings.

Evaluation of landmine risk education programs: a scoping review

Through a scoping review, we aimed to assess the effectiveness and impact of health education programs on landmines, known as mine risk education programs, on reducing risk-taking behaviour and injuries. Mine risk education evaluative studies were identified by searching electronic databases and publication lists of relevant humanitarian organizations. The review identified nine relevant mine risk education evaluative studies representing eight countries. These studies used different quantitative and/or qualitative methods, focusing on change in knowledge, risk-taking behaviour, and/or injuries. Three studies compared mine risk education in targeted and non-targeted groups. The review showed that mine risk education increases awareness among beneficiary communities, but the effect on decreasing landmine injury is still unknown. Due to the limited availability of rigorous evaluative studies of mine risk education programs, there still needs to be solid evidence of their effectiveness. Better-designed and resourced studies are needed to assess their effect on risk-taking behaviour and injuries.

Vaccine microarray patch self-administration: A preliminary study in adults 50 years of age and over

INTRODUCTION

We assessed the safety, performance, acceptability, and usability of the High-Density Microarray Patch (HD-MAP) for vaccination in adults aged 50 and over.

METHODS

This study was a single-centre, open-label, single-arm intervention in healthy adults aged 50+. HD-MAPs (vaccine-free) were applied by a trained user and self-administered. Participants received one excipient-coated HD-MAP to the volar forearm (FA) and the upper arm (UA) administered by a trained user. Participants then self-administered a HD-MAP to the FA and UA. Application sites were compared for skin response. Participants completed an online survey and participated in a semi-structured interview on acceptability and usability. Analyses were undertaken using descriptive statistics. Interviews were coded in NVivo 12 and subject to thematic analysis. The study occurred from 8 September 2021 to 15 February 2022 in Brisbane, Australia.

RESULTS

Of 44 participants, 43 % (n = 19) were male, and 57 % (n = 25) female. The HD-MAP was well-tolerated, with no treatment-related serious adverse events. The increase in transepidermal water loss following self-administration was similar to that observed for trained user administration (UA: 7.5 fold vs 6-fold, FA: 6.1-fold vs 6.6 fold). Fluorescent dermatoscopy confirmed that HD-MAPs engaged with the skin surface and that self and trained user administrations were similar. All participants found the HD-MAP applicator easy to use. 82 % of participants preferred "vaccination" by HD-MAP should its efficacy be proven equivalent to intramuscular injection (IM). Participants reported high acceptance of the resulting transient marks on the skin (82 %). 98 % of participants agreed that self-administration of the HD-MAP at home, without supervision, was highly preferable for its convenience.

CONCLUSION

HD-MAPs were safe in adults 50+ years, and performance was effective, regardless of administrator. Participants preferred the HD-MAP for its ease of use and convenience in self-administration. This vaccine delivery method shows promise for future implementation for this population.

Effects of Exercise on Bone Marrow Adipose Tissue in Children With Overweight/Obesity: Role of Liver Fat

CONTEXT

Exercise reduces adiposity, but its influence on bone marrow fat fraction (BMFF) is unknown; nor is it known whether a reduction in liver fat content mediates this reduction.

OBJECTIVES

This work aimed to determine whether incorporating exercise into a lifestyle program reduces the lumbar spine (LS) BMFF and to investigate whether changes in liver fat mediate any such effect.

METHODS

Ancillary analysis of a 2-arm, parallel, nonrandomized clinical trial was conducted at primary care centers in Vitoria-Gasteiz, Spain. A total of 116 children with overweight/obesity were assigned to a 22-week family-based lifestyle program (control group [n = 57]) or the same program plus an exercise intervention (exercise group [n = 59]). The compared interventions consisted of a family-based lifestyle program (two 90-minute sessions/month) and the same program plus supervised exercise (three 90-minute sessions/week). The primary outcome examined was the change in LS-BMFF between baseline and 22 weeks, as estimated by magnetic resonance imaging. The effect of changes in hepatic fat on LS-BMFF were also recorded.

RESULTS

Mean weight loss difference between groups was 1.4 ± 0.5 kg in favor of the exercise group. Only the children in the exercise group experienced a reduction in LS-BMFF (effect size [Cohen d] -0.42; CI, -0.86 to -0.01). Importantly, 40.9% of the reductions in LS-BMFF were mediated by changes in percentage hepatic fat (indirect effect: β=-0.104; 95% CI, -0.213 to -0.019). The effect of changes in hepatic fat on LS-BMFF was independent of weight loss.

CONCLUSION

The addition of exercise to a family-based lifestyle program designed to reduce cardiometabolic risk improves bone health by reducing LS-BMFF in children with overweight or obesity. This beneficial effect on bone marrow appears to be mediated by reductions in liver fat.

Staff's Knowledge and Self-Confidence in Difficult Communication: Evaluation of a Short Experiential-Based Training Program

Background: Most of the communication training programs developed over the past two decades were monodisciplinary, relied on traditional teaching methods, and targeted the hospital context. Objectives: The aim of this study is to assess the impact of a short, interdisciplinary, experiential-based communication program (Teach-to-Communicate program) targeted at nursing home (NH) personnel with regard to short-term, staff-related outcomes. Methods: This study is part of a larger quality improvement project based on a pre-post single-arm intervention design. We focused on a 6 h residential program involving 30 participants with different scopes of practice working in an NH. Traditional and experiential learning methods were used, including lectures, small group discussions, brainstorming sessions, videos on successful and failed communication, role play, and storytelling based on real cases. The primary outcome was the acquired knowledge of communication strategies and protocols (pre- and post-test quiz). Secondary outcomes were self-reported knowledge, preparedness, confidence, and satisfaction with training (5-point Likert questions). Results: A statistically significant improvement in acquired knowledge with a large size effect (0.7, p < 0.001) was observed. Self-reported preparedness and confidence ameliorated for all measured communication skills and topics, with the highest effect size registered for self-reported preparedness and confidence in engaging in difficult communication (both 0.7, p < 0.001). Participants were highly satisfied with the training, and particularly with the use of video cases (mean 4.6, SD 0.6) and the relevance to clinical practice (mean 4.7, SD 0.5). Conclusions: The Teach-to-Communicate program holds promise for improving knowledge and self-confidence regarding difficult communication among NH staff, and highlights the utility of video cases in communication skills training.

Outcomes Following a Mental Health Care Intervention for Children in the Emergency Department: A Nonrandomized Clinical Trial

Importance

The emergency department (ED) is an important safety net for children experiencing mental and behavioral health crises and can serve as a navigational hub for families seeking support for these concerns.

Objectives

To evaluate the outcomes of a novel mental health care bundle on child well-being, satisfaction with care, and health system metrics.

Design, Setting, and Participants

Nonrandomized trial of 2 pediatric EDs in Alberta, Canada. Children younger than 18 years with mental and behavioral health presentations were enrolled before implementation (preimplementation: January 2020 to January 2021), at implementation onset (run-in: February 2021 to June 2021), and during bundle delivery (implementation: July 2021 to June 2022).

Intervention

The bundle involved risk stratification, standardized mental health assessments, and provision of an urgent follow-up appointment after the visit, if required.

Main Outcomes and Measures

The primary outcome, child well-being 30 days after the ED visit, was assessed using the Stirling Children's Wellbeing Scale (children aged <14 years) or Warwick-Edinburgh Mental Wellbeing Scale (children aged 14-17 years). Change in well-being between the preimplementation and implementation periods was examined using interrupted time-series analysis and multivariable modeling. Changes in health system metrics (hospitalization, ED length of stay [LOS], and revisits) and care satisfaction were also examined.

Results

A total of 1412 patients (median [IQR] age, 13 [11-15] years), with 715 enrolled preimplementation (390 [54.5%] female; 55 [7.7%] First Nations, Inuit, or Métis; 46 [6.4%] South, Southcentral, or Southeast Asian; and 501 [70.1%] White) and 697 enrolled at implementation (357 [51.2%] female; 51 [7.3%] First Nations, Inuit, or Métis; 39 [5.6%] South, Southcentral, or Southeast Asian; and 511 [73.3%] White) were included in the analysis. There were no differences between study periods in well-being. Reduced well-being z scores were associated with mood disorder diagnosis (standardized mean difference, -0.14; 95% CI, -0.26 to -0.02) and nonbinary gender identity (standardized mean difference, -0.41; 95% CI, -0.62 to -0.19). The implementation period involved fewer hospitalizations (difference in hospitalizations, -6.9; 95% CI, -10.4 to -3.4) and longer ED LOS (1.1 hours; 95% CI, 0.7 to 1.4 hours). There were no differences between study periods in ED revisits or care satisfaction.

Conclusions and Relevance

In this study, the delivery of a care bundle was not associated with higher child well-being 30 days after an ED visit. Hospitalizations did decrease during bundle delivery, but ED LOS did not. These health system findings may have been affected by broader changes in patient volumes and flow processes that occurred during the COVID-19 pandemic, which took place as the study was conducted.

Trial Registration

ClinicalTrials.gov Identifier: NCT04292379.

Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo: A Nonrandomized Clinical Trial

Importance

Dizziness symptoms account for nearly 2 million annual emergency department (ED) visits and present a diagnostic challenge for clinicians. Most dizziness research has focused on improving guideline-concordant care among clinicians, with little focus on developing patient-centered interventions to improve dizziness-related disability.

Objective

To examine the feasibility of ED vestibular rehabilitation therapy (ED-VeRT) using a protocolized diagnostic classification algorithm and collection of longitudinal patient-reported outcomes.

Design, Setting, and Participants

A pilot nonrandomized clinical trial of ED-VeRT vs usual care for patients presenting to the ED with dizziness at a single urban US ED was conducted from November 16, 2021, to February 6, 2023, with collection of 3-month outcomes through May 1, 2023. Patients were allocated to ED-VeRT or usual care at the discretion of the treating physician.

Interventions

Use of ED-VeRT was delivered by an ED physical therapist via a protocolized diagnostic classification and treatment algorithm based on a diagnosis of benign paroxysmal positional vertigo, triggered undifferentiated dizziness, spontaneous undifferentiated dizziness, or unilateral peripheral hypofunction.

Main Outcomes and Measures

Feasibility outcomes included participant screening, enrollment, and retention rates to inform the design of a future randomized clinical trial; retention was defined as completing any of 4 follow-up surveys over 3 months. The primary efficacy outcome was change in the Dizziness Handicap Inventory score; the secondary efficacy outcome was change in the Vestibular Activities Avoidance Inventory-9 score.

Results

Of 366 patients screened, 125 participants were enrolled (median age, 52 [IQR, 40-66] years, 73 [58%] female, 61 [49%] White), and 105 retained (84.0%) in longitudinal data collection. Sixty-three participants (50.4%) received ED vestibular therapy and were assigned to primary diagnostic classifications of benign paroxysmal positional vertigo (23 [37.1%]), triggered undifferentiated dizziness (14 [22.6%]), spontaneous undifferentiated dizziness (14 [22.6%]), or unilateral peripheral hypofunction (9 [14.5%]). Despite having higher Dizziness Handicap Inventory and Vestibular Activities Avoidance Inventory scores at baseline, ED-VeRT participants reported lower dizziness handicap (difference: -1.68; 95% CI, -11.30 to 7.90) and vestibular activities avoidance (difference: -2.27; 95% CI, -8.40 to 3.86) at 3 months, although these differences were not statistically significant.

Conclusions and Relevance

In this nonrandomized clinical trial, ED vestibular therapy was feasibly delivered to patients presenting to the ED with undifferentiated dizziness symptoms. For participants receiving vestibular therapy the findings for dizziness-related disability over 3 months were not statistically significant, pointing to the need for a fully powered randomized clinical trial.

Trial Registration

ClinicalTrials.gov Identifier: NCT05122663.

Service Users' Participation in Mental Health Nursing Education: Quasi-Experimental Design With Blended Learning Model

Nursing students' negative perceptions of and reduced interest in individuals experiencing mental health challenges could lead to problems such as deteriorating quality of mental health nursing and lack of competent, qualified mental health nurses. Promoting changes and developments in mental health nursing education for greater effectiveness is pivotal. This study aimed to develop, introduce and validate a blended learning service user involvement programme for mental health nursing education-the first of its kind in South Korea. This study is reported according to TREND guidelines. The experimental group's scores for attitudes and empathy with individuals experiencing mental health challenges increased significantly after taking the 6-week service user involvement class. The experimental group achieved higher scores for knowledge of mental health nursing, satisfaction, and confidence in performance than the control group, which attended a traditional-style class. However, no significant difference was found between groups in changes in attitudes towards and empathy with individuals experiencing mental health challenges. The service user involvement class could improve some students' knowledge of mental health nursing and confidence, but providing the course in a single semester is not sufficient to improve students' attitudes towards and empathy with individuals experiencing mental health challenges. Therefore, an appropriate approach to more systematic long-term planning should be developed, and public perception should be improved. Additionally, long-term studies should evaluate the sustainability and progression of changes in attitudes and empathy over time. We recommend developing mental health nursing education programmes with diverse designs and structures.

Short-term outcome of personalized theory-based pharmaceutical care service on the medication administration problems of family caregivers: a pre-post intervention study

BACKGROUND

Family caregivers face many problems during administration of medications. Pharmacists are reliable and accessible healthcare providers in addressing family caregivers' medication related inquiries in primary care.

AIM

This study aimed to evaluate the short-term outcome of a personalized theory-based pharmaceutical care service on the medication administration problems of family caregivers.

METHOD

This pre-post intervention study was carried out among family caregivers at a community pharmacy in Istanbul, Türkiye from May through December 2022. The service was developed by mapping problems using the Theoretical Domains Framework and selecting related behavioural change techniques. The primary outcome was the change in the scores on the Turkish version of the Family Caregiver Medication Administration Hassles Scale (FCMAHS-TR) from baseline to the one-month follow-up assessment. Secondary outcomes were their ability to read health related materials, care burden, and satisfaction.

RESULTS

Among family caregivers (n = 100), total score of FCMAHS-TR was significantly reduced after receiving theory based pharmaceutical care service (median [IQR] 23.0 [17.0-27.0] vs 17.0 [10.3-20.0]; p < 0.001). The proportion of family caregivers with high ability to read health related materials was significantly increased (34.0% vs 48.0%; p < 0.05) with non-significant change in the proportion of family caregiver with high burden (97.0% vs 94.0%; p > 0.05). Younger family caregivers had significantly higher scores on the Turkish version of Patient-Oriented Pharmacy Services Questionnaire (PSPSQ) 2.0 when compared with the older ones (≥ 65 y) (p < 0.05).

CONCLUSION

Family caregivers' medication administration problems were reduced after receiving the theory based pharmaceutical care service. Long term impact and national implementation of this service should be assessed in the further studies.

Behavioral Design Strategies Improve Healthy Food Sales in a Military Cafeteria

PURPOSE

This study examined the use of behavioral design strategies to improve healthier food sales.

DESIGN

A quasi-experimental, one-group, repeated measures design examined changes in food sales following behavioral design adjustments.

SETTING

United States military base hospital dining facility.

SUBJECTS

U.S. military service members, retirees, and civilian employees.

INTERVENTION

Behavioral design changes included placement, layout, messaging, default healthy bundling, a stoplight rating system, strategic positioning of healthy items on menu boards, and an increase in healthier snacks.

MEASURES

Food sales were assessed by point-of-sales data.

ANALYSIS

T-tests examined total sales of each food adjusted weekly between baseline and intervention and intervention and post-intervention. 16 food items targeted by the intervention were examined. Weekly food sales were calculated for the 18-week baseline, 18-week intervention, and 9-week post-intervention. Further, analysis estimated negative binomial models for food item sales.

RESULTS

The hospital dining facility served 600 to 900 meals per day. Weekly foods sales decreased during the intervention for desserts, cooked starches, hummus, and yogurt (P < 0.01). Sales increased during the intervention for fruit cups, cooked vegetables, vegetable and turkey burgers, grilled chicken, packaged salads, French fries, hamburgers, and hot dogs (P < 0.02).

CONCLUSION

This study demonstrates that a mixture of behavioral design strategies can be operationalized with reasonable fidelity and can lead to increases in the sales of some healthy foods in military worksites.

Nurses' Knowledge and Attitudes About Pain Management in Pediatric Surgical Wards: An Educational Intervention Study

BACKGROUND

Pediatric pain management is a constantly developing field. Despite extensive research, several studies have concluded that children's pain is still underestimated and undertreated. Nurses working with children have an important professional and ethical responsibility to possess up-to-date knowledge of pediatric pain management.

PURPOSE

The purpose of this study was to identify nurses' knowledge and attitudes regarding pain management in pediatric surgical wards and to investigate the short- and long-term effects of a tailored educational intervention.

METHODS

This study has a quasi-experimental design without a control group and uses a previously validated questionnaire, the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain-Norwegian version (PNKAS-N). Nurses in four pediatric surgical wards in one university hospital in Norway answered the survey once before and three times after a tailored educational intervention.

RESULTS

Eighty-three nurses answered the PNKAS-N at baseline (response rate of 75%). The nurse's total PNKAS-N mean score was 27.8 (77.3%) at baseline. We identified knowledge and attitude deficits regarding items related to opioid doses, the risk of drug addiction, the risk of respiratory depression, and the choice of pain medication for children. The total PNKAS-N mean score was statistically significantly increased after the intervention, at T2 (85.2%), as compared to baseline, and this improvement was sustained at T3 (83.8%) and T4 (81.4%).

CONCLUSION

The tailored educational intervention had a significant effect on nurses' knowledge and attitudes about pediatric pain management.

The Association Between Selective Serotonin Reuptake Inhibitors and the Incidence of Delirium in Critically Ill Patients: A Systematic Review

OBJECTIVES

To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.

DATA SOURCES

PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.

STUDY SELECTION

Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.

DATA EXTRACTION

Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.

DATA SYNTHESIS

Two reviewers analyzed the studies' risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.

CONCLUSIONS

The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.

Assessing Theoretical Considerations of Effects Within a Behavioural Obesity Treatment in Women: Implications for Medical Professional Referral

RATIONALE

Obesity is an increasing medical issue not responding well to behavioural treatments beyond their initial weeks/months.

AIMS AND OBJECTIVES

Before suggesting surgical or pharmacological interventions, medical professionals might consider referrals to cost-effective, community-based behavioural treatments if stronger theoretical/empirical bases were demonstrated. Thus, evaluation of such is warranted.

METHOD

Women with obesity were randomly assigned to 6-month treatments emphasizing either behavioural theory-based methods focused on exercise-associated psychological changes generalizing to dietary changes (n = 101), or typical instruction in weight-control methods (n = 53). Theory-driven psychosocial, behavioural and weight changes were assessed over 12 months.

RESULTS

Improvements in all measured variables were significantly greater in the behavioural theory group. In the evaluation of hypothesized theory-based relationships-which have overarching bases in social cognitive theory-(1) self-efficacy theory was supported by self-regulation-associated increases in self-efficacy predicting later positive changes in exercise and the diet; (2) coaction theory was reinforced by the identified transfer of changes in self-regulation of exercise to self-regulation of eating; (3) the mood-behaviour model was sustained by improved mood predicting exercise and dietary improvements through (mediated by) self-regulation changes; (4) self-regulation theory was bolstered through early improvements in self-regulation supporting its longer-term increase, especially under conditions of self-regulatory skills practice and (5) operant conditioning theory was supported through results indicating a reinforcing effect from exercise-associated mood improvement to reduced emotional eating. Across the theories, relationships among tested variables were generally stronger in the behavioural theory group. Improvements in exercise and dietary behaviours were significant independent predictors of reduced weight.

CONCLUSION

Findings support the addressed behavioural theories within a community-based obesity treatment model that emphasized exercise for its psychosocial impacts on dietary behaviours and sustained weight loss. Based on the present empirical supports, medical professionals should consider referral to such approaches before (or in combination with) surgical or pharmacological methods.

Is respiratory sinus arrhythmia a modifiable index of symptom change in cognitive behavioral therapy for youth? A pooled-data analysis of a randomized trial

OBJECTIVE

We evaluated whether respiratory sinus arrhythmia (RSA) reactivity and resting RSA-physiological markers reflecting the increase in heart rate with inspiration and decrease during expiration related to parasympathetic influence on the heart-are modifiable and predict symptom change during youth psychotherapy. Methods: Diverse youth (N = 158; ages 7-15; 48.1% female) received the Modular Approach to Therapy for Children and completed pre-treatment (pre), post-treatment (post), and 18-months postbaseline (18Mo) assessments. We measured resting RSA, RSA reactivity during stress induction, and psychopathology symptoms. Results: Pre-to-post and pre-to-18Mo, reactivity decreased, and resting RSA increased. Changes in reactivity and resting RSA, separately, did not predict reduced psychopathology. Yet, decreased reactivity combined with increased resting RSA predicted reduced psychopathology over time, suggesting that observed RSA changes were beneficial for some. Higher dosage of a module utilizing slow-breathing, muscle-relaxation, and imagery predicted greater pre-to-18Mo changes in reactivity and resting RSA, whereas a similar module with less emphasis on slow-breathing did not. Conclusions: Findings raise the possibility that youth reactivity and resting RSA could be modifiable during cognitive behavioral therapy and contribute to the amelioration of psychopathology. More studies are needed to determine whether resting RSA and RSA reactivity are modifiable indices of symptom change in slow-breathing practices and psychotherapy.

CLINICALTRIALS.GOV IDENTIFIER

NCT03153904, registered May 15, 2017.

'I Can't See Myself Seeking Help': The Influence of Clinical Placements on Nursing Students' Stigmatising Beliefs and Intentions to Seek Help for Their Own Mental Health Issues: A Prospective Cohort Study

Mental health conditions such as anxiety, depression and psychosis represent a global health challenge. Stigma surrounding mental health continues to hinder help-seeking behaviours for people with mental illness and as this study demonstrates, nursing students as well. However, if student nurses are reluctant to seek help for mental health issues, how can others be expected to do so? This reluctance poses challenges in mental health nursing, impacting both care provision and nursing education. The present study seeks to explore the influence of traditional versus non-traditional mental health clinical placements on second-year nursing students' stigmatising beliefs and intentions to seek help for mental health issues. Employing a prospective cohort design using the TREND checklist, the study sampled second-year nursing students assigned to either traditional hospital-based or non-traditional recovery-focused mental health clinical placements. Using validated scales, stigmatising beliefs and help-seeking intentions were measured before and after the placements. Statistical analyses were conducted to assess changes in these variables over time and across placement settings. A significant impact of placement setting on help-seeking intentions was observed, with students in non-traditional placements showing an increased willingness to seek help. Additionally, non-traditional placements were found to significantly reduce stigmatising beliefs in all measured domains, suggesting that these settings may provide a more conducive environment for fostering positive attitudes towards mental health. Recovery-focused placements appear to offer experiences that can diminish stigma and encourage more positive perceptions and intentions related to mental health support.

Predicting Extent of Opioid Use Following Cardiac Surgery: A Pilot Study

OBJECTIVES

This study was designed to test whether a negative affect phenotype reflecting depression, anxiety, anger, and pain catastrophizing predicts inpatient and outpatient opioid use outcomes following cardiac surgery.

DESIGN

In a single-center prospective observational pilot study, the authors obtained validated measures of negative affect and opioid-related phenotype preoperatively and collected opioid use and opioid misuse-related outcomes at 30-day postoperative follow-up.

SETTING

Quaternary medical center.

PARTICIPANTS

The final dataset included 30 adult patients undergoing elective cardiac surgery procedures between August 19, 2022, and August 29, 2023.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Opioid outcomes included: (1) total inpatient postoperative opioid use (in milligram morphine equivalents), (2) self-reported number of days that prescribed outpatient opioids were used during the 30-day follow-up period (Timeline Followback method), and (3) number of opioid misuse-related behaviors (Current Opioid Misuse Measure-9) at 30-day follow-up. Generalized linear model analyses using a Poisson distribution indicated that greater preoperative depression, anxiety, anger, pain catastrophizing, and opioid misuse risk (indexed by the Screener and Opioid Assessment for Patients with Pain- Revised) were all significantly (p < 0.002) associated with greater inpatient and outpatient postoperative opioid use, as well as more opioid misuse-related behaviors at 30-day follow-up (p < 0.001).

CONCLUSIONS

Patients with higher preoperative levels of negative affect (depression, anxiety, anger, and pain catastrophizing) use more inpatient and outpatient opioid analgesics following cardiac surgery, a pattern similar to noncardiac surgery populations. Results support further study of patient-specific approaches to opioid prescribing to reduce the risk for opioid use disorder post-cardiac surgery.

Nurse management of minor problems in primary care emergencies: a non-randomized controlled trial

BACKGROUND

Health systems must implement strategies to adapt to the high demand in primary care caused by social changes. Since 2009, the Catalan Institute of Health has been expanding the Nurse Demand Management programme through which nursing autonomously addresses minor health problems. This study aims to analyse whether this programme is a factor in improving the efficiency and quality of care in a primary care emergency centre. The results come from a non-randomised controlled experimental study that tested the implementation of the programme applied to an experimental group treated by nurses versus a control group treated by doctors. The study was approved on 14 July 2022 by the Research Ethics Committee of the Jordi Gol University Institute following the guidelines of the TREND statement.

RESULTS

A total of 312 patients were included in the study, all of whom came to the emergency centre with five types of minor problems. Exactly half (156) were seen by nurses and half were seen by doctors. The experimental group had an average waiting time of 15.1 min and the control group 33.25 min. There was no significant difference in the assessment of the quality of care received and there were no differences in the total number of consultations for the same problem. There were fewer prescriptions given out by nurses, with an average of 1.79 medicines per participant versus 2.26 medicines prescribed by doctors. The results of the study suggest that the Nurse Demand Management programme was a factor in improving the efficiency and in the emergency centre. Nurse resolution capacity, after applying algorithms, offered quality care, with fewer prescriptions and good patient satisfaction without increasing the total number of consultations due to the same problem.

TRIAL REGISTRATION

The protocol for the current study was registered at Clinicaltrials.gov, with identification NCT06298240, retrospectively registered February 29, 2024.

High-fidelity simulation training for improving nursing professional values acquisition

BACKGROUND

Nursing professional values form the basis of nursing interventions and serve as a guide for professional practice, reflecting in all interactions with patients and other healthcare professionals. As nursing professional values constitute powerful influencers in nursing practice, a strong commitment to these values is essential for nursing students to provide high-quality care.

AIM

To evaluate the impact of high-fidelity simulation training on first-year nursing students' nursing professional values acquisition.

RESEARCH DESIGN

Quasi-experimental study using a longitudinal design with a single group pre- and post-intervention evaluation.

PARTICIPANTS AND RESEARCH CONTEXT

202 first-year nursing students at the Complutense University of Madrid (Spain) participated in the study between September 2023 and May 2024. Their nursing professional values were compared at baseline and after the simulation experience using the "Nurses Professional Values Scale-Revised" (NVPS-R). The acquisition of these values was also evaluated using a verification list during simulation sessions. Five simulated scenarios recreated ethics dilemmas, where students should manage conflictive situations with a standardized patient.

ETHICAL CONSIDERATIONS

The study was approved by the Research Ethics Committee from the Complutense University of Madrid (reference code: CE_20231116_18_SAL).

RESULTS

Most of the students (84.87%) acquired the nursing professional values needed to manage adequately simulated ethical dilemmas. Nursing students significantly improved their nursing professional values after the simulation sessions. The effect size was medium for the "professional expertise" and "professional mastery" dimensions, and the total score of NVPS-R, whereas the obtained effect size was small for the "ethics" dimension.

CONCLUSION

High-fidelity simulation training using standardized patients allows first-year nursing students to acquire and improve nursing professional values. The inclusion of simulation training programs in nursing study plans to foster nursing professional values is needed to train undergraduate nursing students, providing them with the necessary ethical concepts and principles for their future clinical practice and ensuring high-quality care.

Outcomes Following Close Collaboration With Parents Intervention in Neonatal Intensive Care Units: A Nonrandomized Clinical Trial

Importance

Family-centered care (FCC) in neonatal intensive care units (NICUs) is critical for parental involvement and infant well-being, yet few studies have evaluated the impact of FCC interventions on practice or examined how implementation fidelity may affect these outcomes.

Objectives

To evaluate the association between the Close Collaboration With Parents intervention and FCC practices and how implementation fidelity may modify these outcomes.

Design, Setting, and Participants

This nonrandomized clinical trial had a before-and-after design. It was conducted between March 2021 and June 2023 at 6 NICUs in Estonia and included the parents of all newborns and all staff.

Intervention

Close Collaboration With Parents is an educational intervention for multiprofessional NICU staff including e-learning and bedside practices combined with reflection sessions. It aims to improve FCC culture by developing staff skills in communication and collaboration with parents and parenting support.

Main Outcomes and Measures

The quality of FCC was assessed using a 1-time questionnaire for the parents with 9 questions from the Digi Family-Centered Care-Parent version tool, and daily questions for the staff using Digi Family-Centered Care-Nurse version tool. The association between implementation fidelity, defined as the proportion of staff who completed the full education, and the quality of FCC was also analyzed.

Results

A total of 186 infants (with responses from 186 mothers and 22 fathers) were included in the preintervention period. The median (IQR) gestational age was 37.4 (34.0-39.9) weeks, 94 infants (50.5%) were male, and the median (IQR) parental age was 32 (28-36) years. A total of 208 infants (with responses from 208 mothers and 55 fathers) were included in the postintervention period. The median (IQR) gestational age was 38.1 (35.4-39.9) weeks, 114 infants (55.1%) were male, and median (IQR) parental age was 32 (27-35) years. From the staff, 7448 and 6717 daily responses were analyzed in the preintervention and postintervention periods, respectively. The total rating was significantly higher after the intervention than before, by both the parents (r = 0.07; P < .001) and the staff (r = 0.10; P < .001). The median ratings did not, however, change: the parents' median (IQR) overall rating before and after was 7.0 (6.0-7.0), and the staff's median (IQR) overall rating was 6.0 (5.0-7.0) before and 6.0 (6.0-7.0) after. Implementation fidelity ranged from 4 of 30 health care professionals (13.3%) to 37 of 45 (82.2%) at the NICUs. The NICUs with high fidelity, as opposed to low fidelity, had significantly greater improvement in FCC ratings by the staff after the intervention (β = 2.1 [95% CI, 0.8-3.4]; P = .002).

Conclusions and Relevance

In this nonrandomized clinical trial, FCC practices were rated higher by the staff and parents after the Close Collaboration With Parents intervention. Implementation fidelity was identified as an important factor.

Trial Registration

ClinicalTrials.gov Identifier: NCT06258655.

Day-to-day dynamics of fetal heart rate variability to detect chorioamnionitis in preterm premature rupture of membranes

BACKGROUND

Chorioamnionitis is recognized as a major consequence of preterm premature rupture of membranes (PPROM), and a frequent cause of neonatal morbidity and mortality. The association between fetal heart rate (FHR) and chorioamnionitis remains unclear.

OBJECTIVES

The aim of this study was to evaluate the dynamics of FHR in a PPROM population at the approach of delivery according to the presence or absence of chorioamnionitis.

MATERIALS & METHODS

120 pregnant women with PPROM between 26 and 34 weeks' gestation were enrolled in this multicenter prospective unblinded study. All participants were fully informed of the study's objectives. 39 of the 120 patients were included in the analysis of FHR recordings. The analysis consisted of extracting features from computerized FHR analysis (cFHR) and fetal heart rate variability analysis (FHRV) in the temporal, frequency and nonlinear domains. Then, each set of features was analyzed separately using the multiple factor analysis, where three groups were defined as the feature set for days 0, -1 and -2 prior to birth. The distances between the global projection and the projections for each day were computed and used in the ROC analysis to distinguish chorioamnionitis from non-chorioamnionitis group.

RESULTS

The results showed that there were significant differences in certain features between populations with and without chorioamnionitis. The distinction between the two populations reached an area under the curve (AUC) of only 37% [34-40] for cFHR features and 63% [59-66] for time-domain FHRV features when comparing all stages of chorioamnionitis to non-chorioamnionitis subjects. When only stage 3 chorioamnionitis was compared to non-chorioamnionitis patients, the AUC reached 90% [88-93] for nonlinear-domain and 84% [82-87] for time-domain FHRV features, whereas it was limited to 71% [68-74] using cFHR features.

CONCLUSION

The present study suggests that the HRV features are more reliable for diagnosing chorioamnionitis than cFHR, and that the assessment of features dynamics over several days is an interesting tool for detecting chorioamnionitis. Further study should be carried out on a larger sample to confirm these findings, improve the diagnostic performance of chorioamnionitis and help clinicians decide on delivery criteria.

Starting a surgical prehabilitation program: results from a pragmatic nonrandomized feasibility study

PURPOSE

We sought to assess the feasibility and estimate the effects on outcomes of a multimodal prehabilitation service implemented as an ancillary surgical service.

METHODS

We conducted a pragmatic, nonrandomized feasibility study of surgical prehabilitation. Patients were eligible if they were ≥ 18 yr of age, fluent in English, and referred by a health professional for prehabilitation. Participants received an individualized program of preoperative exercise, nutrition, psychological, and/or smoking cessation support. The primary outcome was operational feasibility, including referral volume, enrolment rate, prehabilitation window, engagement, completion rate, and safety. Secondary outcomes included surgical complications, length of hospital stay, readmission, quality of life, and physical and mental health. Qualitative data related to intervention feasibility and acceptability. We compared intervention participants with patients who were referred for, but declined, prehabilitation.

RESULTS

One hundred and sixteen patients were referred for prehabilitation. The mean age of referred patients was 71 yr and 55% were male. Over 90% of referrals were from surgical oncology, and the most common indication for referral was frailty (46%). Of the 116 referred patients, 83 consented to participate in the study. Patient-reported and objectively measured outcomes improved by a clinically important margin from baseline to presurgery, and returned to presurgery levels by 90 days postoperatively. Qualitative findings suggest that the prehabilitation intervention was well received.

CONCLUSION

Multimodal surgical prehabilitation is feasible as an integrated clinical service and may be effective for improving physical and psychological outcomes. Further evaluations of clinically integrated prehabilitation programs in Canada are needed to confirm these findings.

[IQWiG evidence report on psychological consequences of abortion]

The Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Ministry of Health to provide support for the further development of the S2k guideline on first-trimester abortion into an S3 guideline. To this end, the responsible guideline group formulated research questions that were answered in IQWiG evidence reports. One of the questions to be addressed was the evidence regarding the psychological consequences of an abortion in the first trimester compared to no abortion in the first trimester in pregnant women who wish to have an abortion. A systematic search identified one relevant prospective comparative cohort study that reported results on the outcomes of clinically diagnosed depression and clinically diagnosed anxiety disorders. The evidence was evaluated in accordance with the methodological requirements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group, as specified by the IQWiG methods. No significant differences were observed between the study groups with regard to the outcomes mentioned. The certainty of the evidence was rated as very low and downgraded due to study limitations and imprecision of the effects. Prospective comparative cohort studies that approach the research question under investigation should, inter alia, have adequate control for relevant confounders, a sufficient number of participants, and a carefully planned collection of data on relevant outcomes.

Effectiveness, usability, and patient satisfaction of an mHealth application with an integrated ePRO system following lumbar degenerative spinal surgery: A quasi-experimental study

Introduction

There is a lack of comprehensive clinical research to assess potential benefits of mHealth solutions in post discharge follow-up care after spinal surgery.

Purpose

This quasi-experimental study evaluated the effectiveness, usability, and patient satisfaction of an mHealth pathway with an electronic Patient-Reported Outcome (ePRO)-based post-discharge nurse-led intervention for patients undergoing surgery for lumbar spine degenerative disorders, compared to standard care.

Methods

Conducted at a Danish tertiary spine center, this study represents the final stage of a three-phase participatory design. The primary outcome was patient quality of recovery, measured by the Quality of Recovery-15 (QoR-15) questionnaire. Secondary outcomes included patient-perceived usability, assessed with the Danish System Usability Scale (SUS). To capture additional patient insights, an open-ended feedback question was included at the end of the survey.

Results

Data from 150 patients (77 women and 73 men) were analyzed, with 104 in the intervention group and 46 in the comparison group. Both groups showed significant improvement over time, but no significant difference between groups. Of 154 potential SUS respondents, 110 participated. Analysis revealed 48 statements, categorized into five themes: (1) Usability and functionality of the mHealth solution, (2) Feedback on the QoR-15 questionnaire, (3) Safety and support, (4) Missing functions and suggestions for improvements, and (5) Patient satisfaction.

Conclusion

No significant differences in effectiveness between the mHealth pathway and standard care were found for post-surgery recovery in lumbar spine patients. Usability and patient satisfaction were generally high, though suggestions for improvements were noted. The study highlighted the importance of post-discharge support, suggesting that the intervention provided crucial security and support, potentially demonstrating compassion through nurse-led care.

Implementation effectiveness of an antenatal lifestyle intervention to optimize gestational weight gain in women with obesity

OBJECTIVE

The objective of this study was to evaluate a lifestyle intervention implemented into routine antenatal care to optimize gestational weight gain (GWG) and outcomes using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework.

METHODS

This study was an embedded pragmatic behavioral intervention delivered by a health coach and supported by a physician over five sessions for women with a prepregnancy BMI between 25 and 43 kg/m2 who were <23 weeks' gestation in an Australian maternity service. Both intervention and standard care received routine antenatal care. The primary outcome was effectiveness in reducing excess GWG, and the secondary outcomes were reach, adoption, implementation, and maintenance and maternal and neonatal outcomes using the RE-AIM framework.

RESULTS

For the "Reach" aspect, 90% of eligible women were included (N = 404; n = 202 intervention and n = 202 standard care). For the "Efficacy" aspect, there were no differences in proportion exceeding GWG recommendations or mean GWG between groups. Secondary analysis excluding women with gestational diabetes showed that a lower proportion of women in the intervention group had GWG above recommendations (β coefficient 0.51, 95% CI: 0.27 to 0.97; p = 0.04), with less GWG (β coefficient -1.93 kg, 95% CI: -3.63 to -0.24; p = 0.03). For the "Adoption" aspect, qualitative analysis of staff/participants demonstrated strong support for service. For the "Implementation" aspect, strong fidelity (implementation according to study plan) and staff/participant acceptability were observed. Finally, for the "Maintenance" aspect, the program has continued for 4 years with plans/funding for scale-up.

CONCLUSIONS

Lifestyle intervention did not alter the overall proportion with excess GWG or total GWG. Secondary analysis, excluding women with gestational diabetes mellitus, showed less GWG. This demonstrates implementation and maintenance of the intervention in routine antenatal care, generating new knowledge within the RE-AIM framework.

The effect of instructional therapeutic play on acceptance behavior of nasal lavage in hospitalized children

PURPOSE

To evaluate the effect of instructional therapeutic play on acceptance of nasal lavage in children hospitalized for respiratory conditions.

DESIGN AND METHODS

This quasi-experimental study was conducted at a teaching hospital. For the therapeutic play session, disposable gloves filled with compressed air and designed to resemble a human face, syringes, and saline solution ampoules were used. Children's acceptance behaviors were assessed before, immediately after, and 6 h after the therapeutic play session. The data were subjected to descriptive and inferential statistical analyses.

RESULTS

Children (N = 42) aged 3-6 years, 50 % female, with a hospitalization duration of 0.2-9 days, showed increased acceptance of nasal lavage (p = 0.01), with the child self-administering the saline solution (p = 0.01), and with reduction of all resistance behaviors to nasal lavage (p < 0.05).

CONCLUSIONS

Instructional therapeutic play was effective as an educational intervention for the acceptance of nasal lavage in hospitalized children.

PRACTICE IMPLICATIONS

This study demonstrates the potential of using instructional therapeutic play, innovating the field of pediatric nursing, and expanding the international knowledge frontier of this subject. In the future, there is a need for clinical trials with control groups, larger and more heterogeneous samples, and implementation studies.

Evaluating professionals' adaptations before and after a decision support intervention "the Adaptation and Fidelity Tool" (A-FiT)-A longitudinal within-person intervention design

Background

Implementing evidence-based interventions (EBIs) in practice requires balancing fidelity and adaptation to suit new contexts. Careful considerations are needed to maintain the core elements for effectiveness while ensuring fit with new contexts. The Adaptation and Fidelity Tool (A-FiT) intervention addresses this challenge by providing support for professionals using EBIs in the sustainment phase of implementation. This study evaluates the A-FiT intervention and examines how professionals delivering an EBI manage fidelity and adaptation during the sustainment phase of implementation, before and after the intervention. Method Short, structured interviews were repeatedly conducted with 14 professionals delivering an EBI (n = 127). Data was analyzed using deductive content analysis focusing on adaptation types, planning, intentionality, and fidelity consistency. The adaptations were counted and compared before versus after the A-FiT intervention using a chi2-test.

Results

The professionals made about the same number of adaptations before and after the A-FiT intervention. However, after the intervention, significant changes in the type and intentionality of the adaptations were observed. Changes in type consisted of fewer "removing," "substituting," and "integrating another framework" adaptations and more "loosening structure" and "departing from the intervention" adaptations. Regarding intentionality, fewer planned adaptations with the intention of improving the EBI effects were made, while adaptations made for practical reasons, both planned and unplanned, increased after the A-FiT intervention. No statistical change was found regarding fidelity consistency.

Conclusions

The findings indicate increased awareness about fidelity and adaptation among the group leaders, resulting in fewer planned adaptations to enhance program effects and more practical adaptations to address context challenges. The A-FiT intervention appears to help professionals in their management of fidelity and adaptations when delivering EBIs. The study underscores the importance of understanding adaptations in their context, purpose, and impact (intended and unintended) on the outcome/value.

Adaptation, Validation, and Feasibility Evaluation of Mindful Standing Yoga Combined with Baduanjin for Older Patients with Primary Osteoporosis

OBJECTIVE

This study aimed to adapt, validate, and evaluate the feasibility of a mindful exercise program (Mindful Standing Yoga combined with Baduanjin) for older patients with primary osteoporosis.

METHODS

The study was conducted in 3 stages. Stage 1 involved a qualitative focus group discussion with 6 experts to gather perspectives on modifying the exercise program. Stage 2 used a Delphi approach with another 6 experts to validate the program. In Stage 3, a feasibility study was conducted with 20 eligible patients (out of 23 initially enrolled) at a traditional Chinese medicine hospital, using a single-group pre- and posttest design. The strenuousness of the adapted exercise was assessed through heart rate (HR) and rating of perceived exertion (RPE). Its effects were measured using the Global Pain Scale (GPS), the Five Facets Mindfulness Questionnaire-Short Form (FFMQ-SF), the Tampa Kinesiophobia-11 Scale, and the Timed Up and Go test. Patient satisfaction and feedback were also collected.

RESULTS

The modified program, consisting of 9 movements and taking 30 min to complete, was validated by experts as suitable, safe, and effective for practice. HR and RPE measurements confirmed it as a low-intensity exercise and not strenuous for the study population. The program significantly improved back pain and mindfulness in the feasibility study, with most participants expressing satisfaction with the protocol.

CONCLUSION

Experts and participants affirmed that the program was appropriate and satisfactory for older patients with primary osteoporosis, particularly those with back pain. Further high-quality randomized controlled trials are needed to validate its effectiveness.

The Effect of a Biofeedback-Based Integrated Program on Improving Orthostatic Hypotension in Community-Dwelling Older Adults: A Pilot Study

BACKGROUND

Orthostatic hypotension (OH) is prevalent among community-dwelling older adults and is associated with multiple negative health outcomes. Older adults are susceptible to developing OH because aging alters autonomic nervous system function. Biofeedback is a noninvasive, nonpharmacological intervention that can modulate autonomic nervous system dysfunction in older adults.

OBJECTIVES

Our aim in this study was to examine the effect of a biofeedback-based integrated program on community-dwelling older adults with OH.

METHODS

We conducted a controlled pilot study. Community-dwelling older adults 65 years or older who had nonneurogenic OH were eligible. Data from 51 participants, comprising 27 in the intervention group and 24 in the control group, were analyzed. Weekly biofeedback-based integrated program consisting of biofeedback training along with group education about behavioral modification, physical activities, and telephone counseling was provided for 12 weeks. Orthostatic hypotension was evaluated by measuring the drop in systolic and diastolic blood pressure after postural changes. Autonomic nervous system function was measured using heart rate variability.

RESULTS

Among the indicators of heart rate variability, total power ( P = .037) and low frequency ( P = .017) increased significantly, suggesting that autonomic function improved. Severity of orthostatic symptoms ( P < .001) and drops in systolic ( P = .003) and diastolic ( P = .012) blood pressure after postural changes decreased significantly in the intervention group.

CONCLUSION

Biofeedback-based integrated program was effective in improving autonomic nervous system function and alleviated OH. Therefore, biofeedback-based integrated program should be tested in a larger randomized controlled study with long-term follow-up.

Compliance Behaviour After a Coronary Ischaemic Event: A Quasi-Experimental Study of Adherence to a Protocolised Follow-Up in Primary Care

Following a coronary ischaemic event, it is essential to promote empowerment in self-care decision making. Primary care nursing is crucial for intensive follow-up to promote adherence to the therapeutic regimen. Objective: To ascertain whether adherence to a protocolised follow-up programme, with the support of a patient notebook, improves compliance behaviours in terms of physical activity, prescribed diet and medication. This is a quasi-experimental multicentre pre/post study. Population: Individuals aged 40-70 years, diagnosed with cardiac ischaemia in the last 18 months with a follow-up from March 2017 to January 2019, were included in a protocolised follow-up programme consisting of 11 visits over 12 months. A total of 194 patients started the programme and 132 completed it. Of these, 67.4% exhibited good adherence to follow-up, 31.8% exhibited medium adherence, and 0.8% exhibited poor adherence. Therefore, the patients were recoded into two variables: Medium-Low Adherence and High. The Nursing Outcomes Classification variables were significantly different between the Poor-Medium and Good Adherence groups and were always higher in the Good Adherence group (p-values < 0.05 t-student). There was a significant relationship between level of adherence and compliance behaviour. Good adherence to a follow-up plan led by primary care nurses improves compliance behaviours in terms of prescribed diet, physical activity, and medication. Early, intensive and protocolised follow-up by primary care nurses is essential to improve adherence to the therapeutic regimen and compliance behaviour among individuals with cardiac ischaemia. The use of a cardiovascular self-care notebook promotes adherence.

Outcomes and management of invasive procedures in participants with hemophilia A post gene therapy: a post hoc analysis of the GENEr8-1 phase III trial

Background

Hemophilia A is caused by coagulation factor VIII (FVIII) deficiency and increases bleeding risk during invasive procedures.

Objectives

To investigate FVIII concentrate use and bleeding outcomes for invasive procedures after valoctocogene roxaparvovec gene transfer.

Design

This manuscript presents post hoc analysis of the phase III GENEr8-1 trial.

Methods

A post hoc analysis was performed for GENEr8-1, a global, single-arm, open-label, phase III trial that enrolled 134 adults with severe hemophilia A. FVIII activity and bleeding were evaluated after 2 years of follow-up. Invasive procedures were reviewed and categorized as major or minor. FVIII activity was measured with a chromogenic assay. Bleeding was self-reported by participants. Principal investigators completed questionnaires about perioperative management.

Results

In total, 111 invasive procedures were performed in 65 participants during GENEr8-1 as of the data cut. Procedures performed with FVIII treatment included 33 minor and 11 major procedures. The remaining 67 invasive procedures were minor and performed without FVIII treatment. When considering these 67 minor procedures, 43/46 investigators completing the questionnaires reported that the gene-therapy-derived FVIII activity was sufficient for the type of procedure. Minor procedures performed without FVIII treatment were associated with participants' higher mean endogenous FVIII activity (50.5 IU/dL) compared with major procedures (14.2 IU/dL) or minor procedures (16.4 IU/dL) performed with concomitant FVIII. Fourteen participants experienced 18 procedure-related bleeds (13 co-occurring with FVIII use). Participants who received FVIII treatment for procedure-related bleeds had numerically lower mean endogenous FVIII activity than those who did not receive FVIII treatment.

Conclusion

Invasive procedures were safely performed in participants following treatment with valoctocogene roxaparvovec. The questionnaire responses from investigators generally suggest they used endogenous FVIII activity derived from valoctocogene roxaparvovec to inform clinical decisions in a manner comparable to exogenously administered FVIII, and more commonly prescribed supplementary FVIII concentrate in the peri-procedural period for participants with lower FVIII activity levels.

Situational leadership theory in nursing management: a scoping review

AIM

To provide a comprehensive overview of situational leadership theory as applied to nursing management, outlining its relevant measurement tools, intervention modalities, and reporting gaps.

DESIGN

A scoping review of the literature was conducted according to the JBI guidelines.

DATA SOURCES

Eight databases were used including PubMed, Embase, CINHAL, Web of Science, CNKI, WanFang, Cqvip, SinoMed. References of included studies were also searched. All literature published up to 9 September 2024 was included.

REVIEW METHODS

According to the PCC framework, the search formula was developed and a three-stage integrated search strategy was employed to search the literature. The titles, abstracts, and full texts were assessed by the reviewers followed by the data extraction and synthetization of results.

RESULTS

Nineteen articles were included in this study, including five cross-sectional studies, thirteen quasi-experimental studies, and one mixed study. The research identified that situational leadership theory has multiple applications in nursing management and plays an important role in the development of nurses' leadership and maturity. However, the studies were reported with low transparency and did not adhere to the relevant reporting guidelines. In addition, further validation of the relevant measuring instruments is needed.

CONCLUSION

Situational leadership is a follower-centred leadership skill that enables leaders to adapt their leadership style to achieve optimal management results, facilitate the achievement of organizational goals, and increase follower satisfaction and growth. Further research is needed to develop standardized intervention protocols to apply this theory effectively and enhance the reporting quality of relevant studies.

IMPACT

The situational leadership theory emphasizes the necessity for nursing managers to use different leadership styles depending on their nurses' maturity. However, the study suggests that it is necessary to further differentiate between different situational leadership models and to explore relevant research tools and interventions further. This could lead to a more standardized and effective clinical application of the theory.

A physiotherapist-led biopsychosocial education and exercise programme for patients with chronic low back pain in Ghana: a mixed-methods feasibility study

BACKGROUND

Low back pain is a common musculoskeletal condition which causes substantial disability globally. The biopsychosocial model of management has been recommended in national and international guidelines for the management of patients with chronic low back pain (CLBP). However, biopsychosocial approaches are predominantly delivered in high income countries (HICs), although the prevalence of LBP is substantially higher in low- and middle-income countries (LMICs) especially in Africa (39%; 95% CI 30-47). Understanding the effectiveness of BPS interventions in LMICs especially in Africa is underexplored, with substantial inequity between research from HICs and LMICs. Ghana is a LMIC where the effectiveness of biopsychosocial interventions has been underexplored. Therefore, the aim of this study was to explore the feasibility of delivering a physiotherapist-led BPS programme for the management of patients with CLBP in Ghana.

METHODS

This was a mixed-methods, sequential, pretest-posttest feasibility study. Participants involved thirty patients with CLBP. The biopsychosocial intervention involved an exercise and patient education programme based on principles of cognitive behavioural strategies with emphasis on self-management. The biopsychosocial intervention was delivered for six weeks for each participant. Feasibility outcomes regarding management and processes were captured pre-intervention, post-intervention, and three-months post intervention. Semi-structured interviews were conducted post-intervention to explore participants' experiences with the biopsychosocial intervention. Patients' demographics were collected at baseline. Patient reported outcome measures such as intensity of pain, disability, pain catastrophising, kinesiophobia, self-efficacy, and general quality of life, were collected pre-intervention, post-intervention and at three-months follow-up. Qualitative analysis explored participants' experiences regarding the acceptability of the biopsychosocial intervention.

RESULTS

The results of this feasibility study demonstrated that the training programme was acceptable to physiotherapists. Recruitment rate (5 patient participants per week - 100% recruitment met), retention rate post-intervention (90%), data completion rate post-intervention (99.8%) and intervention fidelity (83.1%), all met feasibility thresholds. There were no adverse events. Qualitative data also demonstrated that the biopsychosocial intervention was acceptable to participants.

CONCLUSION

This study has established the potential to deliver a biopsychosocial intervention programme in a Ghanaian hospital setting. This biopsychosocial intervention therefore shows promise, and the result of the study provides a platform to develop future clinical studies.

Impact of Occupation-Based Groups on Occupational Performance and Satisfaction Outcomes: Pilot Study

Occupation-based groups can be used to improve occupational performance outcomes in the inpatient rehabilitation setting. It remains unclear whether they offer comparable outcomes to occupation-based interventions delivered individually. This study aims to pilot an occupation-based group intervention and compare occupational performance, satisfaction, and goal attainment outcomes with usual care. Twenty-one participants (15 women, 6 men, aged 34-85) were allocated to control (n = 11) and intervention (n = 10) groups. The control group received usual care (individual occupation-based interventions), while the intervention group received usual care plus an occupation-based group intervention. The method used a pilot quasi-experimental pre- to post-intervention design with a nonequivalent control group. The primary outcome measures were the Canadian Occupational Performance Measure (COPM) and the Goal Attainment Scale (GAS). No significant between-group differences were found; both groups reported statistically significant improvements with medium to large effect sizes. Pilot data suggests that occupation-based groups offered comparable outcomes to individual treatment; a larger sample size is required to draw conclusions on their impact. Australian New Zealand Clinical Trials Registry (https://uat.anzctr.org.au/Default.aspx) was accessed on November 20, 2023. Registration number: ACTRN12623001196639.

Effectiveness of a Nurse-Led Telecare Programme in the Postoperative Follow-Up of Bariatric Surgery Patients: A Quasi-Experimental Study

BACKGROUND/OBJECTIVES

Obesity is a growing public health challenge due to its high prevalence and associated comorbidities. Bariatric surgery is the most effective treatment for achieving sustained weight reduction when more conservative treatments have failed. This study evaluates the impact of a nurse-led telecare follow-up programme in the immediate postoperative period for patients who have undergone bariatric surgery.

METHODS

A quasi-experimental study was carried out in two hospitals in southern Spain. We included 161 patients who met the inclusion criteria: a body mass index (BMI) ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 with associated comorbidities, and the failure of non-surgical treatments. Patients were divided into two groups: the intervention group (IG), which received follow-up telephone calls from a specialised nurse during the first 30 days post-surgery, and the control group (CG), which received standard care. The nurse, who was available 24 h a day, answered questions and dealt with queries over the phone or referred patients to the emergency department if necessary. Several variables were recorded, including the number of telephone consultations, reasons for consultation, number of emergency visits, readmissions, and surgical reinterventions.

RESULTS AND CONCLUSIONS

The IG showed a significant reduction in ED visits (4.9% vs. 30% in CG), and consultations were mainly related to diet and drainage. The nurse telecare intervention significantly improved postoperative recovery by reducing complications and optimising the safety and quality of postoperative care. These results reinforce the importance of personalised follow-up in improving clinical outcomes in bariatric patients.

Psychosocial and vocational impact of an internship program for people diagnosed with severe mental illnesses

PURPOSE

Unemployment is an obstacle in recovery for people with severe mental illnesses (SMI), both in reducing psychopathological symptoms and in achieving a high quality of life. The aim of this study was to explore the impact of an internship program for people diagnosed with SMI on psychosocial variables using a pre-test and post-test design.

METHOD

Four scales were administered to a sample of 127 study participants, all of whom were diagnosed with SMI. The results of standard and sheltered employment outcomes were obtained by comparing the number and type of contracts gained by participants up to one year after program completion. A repeated measures ANOVA analysis was carried out with intervention being an independent intra-subject variable and type of participant diagnosis being a between-subjects variable.

RESULTS

A limited increase in social functioning was found, as well as a significant decrease in psychiatric distress for users diagnosed with personality disorders. Participants in the internship program obtained a greater number of employment contracts than their peers who did not participate in the program, albeit with a low effect size.

CONCLUSIONS

Though results were positive, extension of internship length and provision of more intensive counselling for participants may be useful.

Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands

BACKGROUND

The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care.

OBJECTIVES

This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands.

METHODS

The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients' activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately.

RESULTS

We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089-0.687; p = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A.

CONCLUSION

Use of the ABCC-tool has a positive effect on perceived quality of care and patients' activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.Trial registration number: ClinicalTrials.gov Registry (NCT04127383).

A scoping review of studies exploring physical activity and cognition among persons with cancer

PURPOSE

This scoping review aimed to identify and synthesize published studies on physical activity (PA) and cognition among persons with cancer and elucidate knowledge gaps.

METHODS

Articles were identified through electronic and manual searches (02/21 and 03/22) using the following inclusion criteria: (1) empirical, peer-reviewed publication in English, (2) sample comprised persons with cancer, and (3) reported at least one statistical association between PA and cognition. Multiple reviewers independently performed study selection and data extraction, and results were mapped in tabular and narrative form.

RESULTS

Ninety-seven articles were eligible; these were largely published from 2017 to 2022 (54.6%), conducted in high-income countries (96.9%), and presented (quasi-)experimental studies (73.2%). Samples predominantly comprised women with breast cancer (48.5%), and recruitment often occurred post-treatment (63.9%). PA interventions included: aerobic (32.3%), resistance (4.8%), combined aerobic/resistance (38.7%), mind-body (19.4%), or other PA (4.8%). Most (66%) articles reported inconclusive findings; 32% were positive (in support of PA promoting cognition or vice versa), and 2.1% were negative. Diverse samples and studies with long-term follow-up were scarce.

CONCLUSIONS

The state of knowledge is insufficient and more rigorous, large-scale studies are required to provide definitive conclusions about the cognitive benefits of PA among persons with cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer-related cognitive impairment (CRCI) thwarts quality of life. This review summarizes what is known about the association between PA and cognition among persons with cancer and concludes that the evidence is currently equivocal. Hence, it remains uncertain if PA interventions can reduce CRCI, and large-scale PA intervention trials explicitly designed to promote cognition are greatly needed.

The impact of oral health promotion on the quality of life of children with bleeding disorders: fighting misconceptions

BACKGROUND

Understanding the disease-specific risks and patient-related barriers of children with bleeding disorders is necessary for primary oral health promotion. Our goal was to assess the oral health status and the impact of oral health promotion among patients with bleeding disorders.

RESEARCH DESIGN AND METHODS

At baseline, 70 patients with inherited and acquired bleeding disorders had a complete intraoral examination, completed the oral health-related quality of life (OHRQoL) questionnaires, and an oral health education was given. After 6 months, the effectiveness of the oral hygiene promotion was evaluated clinically and through the OHRQoL questionnaires.

RESULTS

Our cohort included 33 patients with chronic immune thrombocytopenia (cITP), 27 hemophilia A patients, and 10 with inherited thrombasthenia. Forty patients (57.1%) had dental caries, 90.0% showed fair oral hygiene status with variable degrees of gingivitis. The baseline self-image score was significantly inferior among patients with inherited bleeding disorders, while the psychological domain for family was greatly affected among cITP patients. After 6 months, there was a significant reduction in the oral debris, the modified gingival indexes, the percentages of cases with oral bleeding, and a significantly improved mean OHRQoL total score.

CONCLUSIONS

After the oral health education, the OHRQoL scores had significantly improved, and oral hygiene status were acceptable among patients with bleeding disorders.

Enhancing orthopaedic surgery research: developing manuscripts using systematic checklists

BACKGROUND AND CHALLENGES

Writing and publishing research is important in the fields of orthopaedic surgery, and medicine in general. In recent years, the number of orthopaedic publications has significantly increased, highlighting the value of possessing the ability to write and publish a paper. However, publishing research is not an easy task, especially if English is not a native language. Non-native English speakers have been reported to experience barriers to writing and publishing research in English, the dominant language of scientific publication. This affects not only individual researchers, but also the scientific community in general. To improve reporting in scientific manuscripts, many peer-reviewed guidelines have been published for a variety of study designs and study types. These guidelines are made available through the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network and have associated checklists that guide authors in the synthesis of their research manuscript.

PURPOSE

Whether you are a non-native English speaker or a novice research writer, these checklists can ameliorate the process of building your manuscript. The purpose of this paper is to empower orthopaedic researchers, and researchers in general, through an easy-to-follow framework for writing a research manuscript using available checklists and general research knowledge.

Impact of a health literacy sensitive model of care in outpatient nephrology dietetic clinics

BACKGROUND

Inadequate health literacy in people with chronic kidney disease is associated with poorer disease management and greater complications. Adherence to the renal diet is known to be suboptimal and patient feedback about the renal diet suggests that patients leave nephrology clinics feeling confused. The present study aimed to evaluate the impact of a health literacy sensitive model of care (MOC) in outpatient nephrology dietetic clinics.

METHODS

This quasi-experimental non-randomised pre-post study recruited adults attending three renal dietitian clinics. The revised MOC consisted of a renal diet question prompt sheet, teachback, and plain language materials and instructions. Outcomes assessed included clinical, dietary, patient-reported satisfaction and quality of life. Differences between and within groups were analysed using paired t-tests, independent sample t-tests (or non-parametric equivalent), chi-squared and McNemar's tests. Linear mixed models evaluated change in total diet quality score, fruit, vegetable, protein and dairy intake with time as a fixed effect and a random subject specific effect.

RESULTS

Fail to attend rates at the initial appointments were lower in the revised MOC (21.5% vs. 9.1%). The revised MOC was associated with significantly improved fruit (p = 0.03) and vegetable (p = 0.003) intake and an improved proportion with adequate diet quality (p = 0.03). These impacts were of moderate effect size (d = 0.5, 95% confidence interval = 0.0-1.0). The revised MOC was also associated with greater satisfaction at baseline (p = 0.04) and higher acceptability scores for all questions at the review appointments. Quality of life improved clinically but not significantly in the revised MOC (p = 0.92).

CONCLUSIONS

This low-cost health literacy sensitive intervention is a promising strategy to improve fruit and vegetable intake in adults attending renal dietitian clinics. Further research to determine fidelity of teachback use and cost utility analysis would be beneficial. Larger scale trials powered to detect changes in quality of life would also be informative.

Effectiveness of a Nutrition Counseling Intervention on Food Consumption, According to the Degree of Processing: A Community-Based Non-Randomized Trial of Quilombola Communities in South Brazil

Objectives

To evaluate the effectiveness of a nutrition counseling intervention on food consumption according to the Nova classification that reflects levels of food processing.

Methods

Controlled community trial was conducted in quilombola communities in the South of Brazil. Four communities were allocated to the control group (CG) and the intervention group (IG), two communities comprised each group. A total of 158 individuals (CG = 87; IG = 68) were included in the study. The intervention consisted of six theoretical and practical workshops on food and nutrition education, conducted over a 4-month period. We used a 24-hour recall at baseline and another post-intervention.

Results

There was an increase in the consumption of traditional quilombola food as an effect of the intervention (from 14.5% to 20.7% in the IG, and from 12.7% to 16.0% in the CG, p = 0.05). There was no significant variation in the other Nova food groups according to time and intervention.

Conclusion

An increase in traditional quilombola food indicates a resumption of traditional food intake and appreciation of local culture as an effect of this intervention at the community level. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT02489149.

Improving Child and Adolescent Mental Health: A Bibliometric Analysis of Related Intervention Studies

In response to the increase in adolescent mental health problems, related intervention research has flourished. This study examined 2258 mental health intervention studies captured by the Web of Science, focusing on their distribution, interdisciplinary collaboration, and emerging trends, using bibliometric analysis. Our findings revealed a rise in studies and enhanced collaboration across disciplines, with studies from the United States, Australia, and the United Kingdom showing high academic output, intellectual impact, and strong scientific partnerships. However, there is a noticeable Western-centrism in the research. Identifying current trends and key areas of focus offers valuable insights for future practices in child and adolescent mental health.

The importance of combined use of spacing and testing effects for complex skills training: A quasi-experimental study

INTRODUCTION

A major challenge is retention of complex clinical skills. Spacing training and testing have been demonstrated to increase knowledge and skill retention but the combination has not been previously investigated in complex clinical skills. The aim of our study was to compare the effectiveness of combined spacing and testing for Basic Life Support (BLS) and Advance Life Support (ALS) simulation training in one group (intervention group), with combined spacing and testing, and another group (control) that received simulation training in a single-session simulation training without testing.

METHODS

A quasi-experimental study.

RESULTS

Thirteen nursing students were in the intervention group and 18 in the control group. After three months, there was no significant reduction in retention of BLS knowledge (p > 0.05) or BLS skills (p < 0.05) in the intervention group, but there was a significant reduction in both (p < 0.05) in the control group. We found no significant reduction in retention of ALS knowledge in the control group (p > 0.05), but there was a significant reduction in the intervention group (p < 0.05). There was no significant decay of ALS skills in both groups (p < 0.05).

DISCUSSION

This is the first study to demonstrate that combined spacing and testing could be highly effective for complex skills simulation training to increase retention after three months.

Exploring the influence of tooth, ceramic, and resin luting agent variations on laminate veneer optical characteristics: a prospective clinical investigation

OBJECTIVE

This study evaluated the influence of tooth shade, resin-based luting agent shade values, and ceramic thickness on the optical properties of CLVs.

MATERIALS AND METHODS

The study involved 16 participants who received 95 CLVs. CIE L*, a*, b* color coordinates were assessed with a clinical spectrophotometer. Variables considered were: luting agent value in three levels (high, medium, low); tooth shade before and after preparation in two levels (lighter and darker shades); and CLV thickness in two levels (< 1 mm, ≥ 1 mm). The color difference (ΔE00) was analyzed under four scenarios, utilizing statistical methods suitable for non-normal distributions.

RESULTS

Ninety-five CLVs (n = 95) were analyzed, ceramic thicknesses mean (SD) values were 0.70 (± 0.15) for < 1 mm group and 1.19 (0.20) for ≥ 1 mm group. ΔE00 values ranging from 2.93 to 9.72, all exceeding the thresholds of perceptibility and acceptability. Significant variations were observed in optical outcomes based on the clinical variables studied, particularly showing that high-value luting agents are more effective over darker substrates (p = 0.043). Thicker ceramics significantly improved masking capabilities, demonstrating their critical role in esthetic treatments (p = 0.024). No significant differences were found regarding the tooth shade after preparation (p = 0.215).

CONCLUSION

The study confirmed that luting agent shade values and ceramic thickness, critically influence the final optical properties of CLVs. High-value luting agents and thicker ceramics effectively achieved acceptable color differences, especially over darker tooth substrates. These findings underscore the importance of carefully selecting materials and techniques to optimize optical outcomes in CLV restorations.

CLINICAL SIGNIFICANCE

Luting agent's value and ceramic thickness plays a critical role in achieving natural-looking ceramic laminate veneers, especially on darker tooth substrates. These factors significantly impact the final color matching and esthetic outcome.