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

Outcome and process evaluation of a social norms approach intervention on nonmedical use of prescription stimulants for study performance among Flemish university students: a quasi-experimental study

BACKGROUND

Students are increasingly engaging in the nonmedical use of prescription stimulants (NMUPS) to enhance their study performance. However, little research has been conducted on the effectiveness of interventions to reduce NMUPS. This study assessed the effect of a social norms approach (SNA) intervention on NMUPS and the perception of NMUPS for study performance among Flemish students. Additionally, a process evaluation of the intervention was performed.

METHODS

A social media campaign, containing social norm messages based on data from 'Head in the Clouds?' (HITC) survey edition 2021, ran from December 2022 to April 2023 at the University of Antwerp. Data from the HITC survey was also used as baseline measurement (Antwerp: n = 2,963, Ghent: n = 8,598). Afterward, a post-intervention survey was conducted among the students of the University of Antwerp (n = 1,827) and Ghent University (n = 3,333), the latter serving as the control group. A quantitative process evaluation among the intervention group was conducted according to the guidance of the Medical Research Council for process evaluation of complex interventions.

RESULTS

A difference-in-difference approach showed that students of the intervention group at endline estimated NMUPS for study performance among peers significantly lower (P < .0001; Est. = -3.792; SE = 0.805)-and thus closer to the real social norm. There was no significant influence (P = 0.421; OR = 1.10; 95% CI = 0.87 to -1.39) of the intervention on NMUPS for study performance. The process analysis showed that 18.7% of the intervention group had seen the campaign. Most of them found the campaign credible (83.6%) and clear (website: 90.8%; videos 94.7%; images: 92.4%). The overall satisfaction was 6.38 (SD 1.68) out of 10. Very few students (3.1%) had seen the campaign via TikTok, compared to Facebook (64.0%) and Instagram (53.3%), although 35.7% of the total budget had been spent on TikTok.

CONCLUSIONS

The results of this study confirm that an SNA intervention could reduce the misperceptions of NMUPS among students. However, the hypothesis that the behavior of NMUPS for study performance would be reduced subsequently could not be demonstrated. Follow-up research is needed to investigate long-term effects. The implementation of the intervention might be improved by making more optimal use of the campaign budget.

Relationships between intergroup contact and student nurses' stigma toward people living with mental illness at a mental health clinical placement: A prospective cohort study

AIM

The aim of the present study was twofold. Firstly, to investigate the impact of social contact quantity and quality on stigmatising attitudes for pre-registration nursing students during a mental health clinical placement. Secondly, to compare these measures between students attending a traditional (i.e. hospital-based) and non-traditional (i.e. recovery-focused) mental health clinical placement.

METHODS

A prospective cohort design was used to compare student nurses' quantity and quality of contact with individuals living with mental illness. Pre-registration nurses attended a traditional (i.e. hospital-based) (N = 97) or non-traditional (i.e. recovery-focussed) (N = 184) mental health clinical placement. Scores were collected at two timepoints (pre, post) on the General Intergroup Contact Quantity and Quality Scale (QICQCQ) and the Opening Minds Stigma Scale for Healthcare Providers (OMS-HC). Responses were compared between clinical placement types over timepoints via a repeated-measures multivariate analysis of variance. Pearson correlations were performed to determine the nature and strength of relationships between intergroup contact and student nurses' stigmatising attitudes. The TREND reporting method was adhered to.

RESULTS

A significant increase in contact quantity was identified after attending a non-traditional clinical placement (p = .009). The quality of intergroup contact reported during a non-traditional placement was significantly higher in Equality, Intimacy, Pleasantness, and Collaborativeness. No changes in intergroup contact quantity or quality were observed during the hospital-based placement (all p > .05). Correlational analyses showed that increases in these types of contact quality were significantly associated with lower stigmatising attitudes, lower desire to social distance, and lower stigma surrounding disclosure/help-seeking.

CONCLUSION

The study highlights a significant association between high-quality intergroup contact and reduced stigmatising attitudes. Increases in contact quality were linked to lower levels of stigma, reduced social distancing, and a more supportive attitude toward disclosure and help-seeking. Results underscore the effectiveness of non-traditional mental health placements in fostering more meaningful and positive interactions between pre-registration student nurses and individuals with mental illness. This, in turn, contributes to a decrease in stigmatising attitudes among future healthcare professionals.

Effects of the Nudge Theory-Based Multifaceted Intervention on Reducing Inappropriate Proton Pump Inhibitors Use for Prophylaxis in Hospitalized Patients: A Non-Randomized Controlled Study

BACKGROUND

Inappropriate use of proton pump inhibitors (PPIs) for prophylaxis among hospitalized patients continues to be a significant issue. Previous interventions have often been ineffective and lack evaluation of their longer-term impacts.

AIM

This study aims to assess the clinical and economic effects of a nudge theory-based multifaceted intervention on reducing inappropriate PPI prophylaxis in hospitalized patients.

METHODS

This non-randomized controlled study was carried out in a teaching hospital's wards from January 2021 to June 2023, with a 12-month pre-intervention period, a 12-month intervention period (including the first and second stages of intervention), and a post-intervention period with 6-month follow-up. The intervention, based on nudge theory, was implemented among 114 doctors across 10 wards, sequentially involved peer comparison, information provision, and face-to-face feedback. The outcomes were assessed by randomly selecting cases of adult patients who received at least one PPI treatment during hospitalization, and the statistical analysis included univariate analysis, and multivariate and subgroup analyses.

RESULTS

The study included 1782 patients, with a median age of 61 years. During and after intervention, the rate of appropriate PPI use significantly increased by 2.83- to 5.47-fold, rising from 23.82% (147/617) to 46.96% (139/296) after the first stage, to 63.13% (202/320) after the second stage, and remained at 53.01% (291/549) later on. The rate of PPI injections decreased from 92.54 to 74.13-84.12%, the median defined daily doses from 16 to 7-12, and PPI-related expenditures from 484.80 to 156.00-262.99 CNY per-patient. The cost associated with inappropriate PPI use dropped from 161.60 to 0-45.58 CNY per-patient. Subgroup analyses supported these findings.

CONCLUSION

A nudge theory-based multifaceted intervention led to increased appropriate PPI use, decreased PPI injections, and cost savings, with benefits lasting at least 6 months post-intervention.

The relationship between radiological OA severity or body weight and outcomes following a structured education and exercise therapy program (GLA:D®) for people with knee osteoarthritis

BACKGROUND

Clinicians may presume people with higher bodyweight or greater OA severity do not respond to exercise therapy for knee osteoarthritis (OA), but few studies have examined this.

OBJECTIVE

To examine the relationship between radiographical OA severity or bodyweight and pain and functional outcomes following a structured education and exercise therapy program (Good Life with OsteoArthritis from Denmark: GLA:D®).

METHODS

33 participants with knee OA were assessed at baseline and week 8 following GLA:D®. Outcomes were pain (Visual analogue scale (VAS) 0-100), Knee Injury and Osteoarthritis Outcome Score-12 (KOOS-12 total), 40 m-fast-paced walk and 30-s chair stand. Multilevel models were used to define the severity of OA in medial, lateral and patellofemoral compartments using the Kellgren-Lawrence (KL) system and to examine the relationship between compartment severity, bodyweight and outcomes.

RESULTS

No meaningful relationships between bodyweight and response to GLA:D® were found for any outcome measures. Greater medial OA compartment severity was related to less improvement in pain, KOOS-12 and chair stand repetitions. However, all levels of lateral compartment severity had similar improvements, and greater patellofemoral compartment severity was related to more improvement for KOOS-12 and pain.

CONCLUSION

Bodyweight may have little influence on a person's response to a structured education and exercise therapy program. While people with greater medial compartment severity were less likely to improve following the program, OA severity in the PF and lateral compartments was not a barrier to improvement.

Protective effects of elastic band training-detraining on Fall risk, power, body composition, and cognition in older adults with mild cognitive impairment: A 40-week trial

BACKGROUND

Physical inactivity exacerbates muscle function and mass loss, increasing the risk of falls in older adults. Regular exercise can prevent muscle loss, cognitive decline, and comorbidities, potentially reducing fall risk. Given the multifactorial nature of fall risk, a comprehensive assessment is required.

OBJECTIVE

To investigate the effects of a 40-week intervention, including a long-term exercise program (16-weeks), detraining (8-weeks), and retraining (16-weeks), on fall risk and cognitive status in older adults with mild cognitive impairment.

METHODS

Participants (≥70 years old) were divided into two groups: Elastic Band Resistance Training (EBRT, n = 22) and a control group with no treatment (n = 20). Cognitive profile, body composition, muscle power, and multifactorial fall risk assessments (Timed Up-and-Go Test (TUG), Falls Efficacy Scale (FES), Fall Risk Assessment Tool (FRAT), and sensorimotor platform) were evaluated at four time points.

RESULTS

Significant correlations between muscle power, fat-free mass, and cognitive status with fall risk assessments were observed at baseline. Both phases of the exercise intervention improved muscle power, body composition, cognitive profile, and fall risk status. The EBRT group showed significant improvements in muscle power (p ≤ 0.01), fall risk (FRAT, p ≤ 0.01), FES (p ≤ 0.05), sensorimotor performance (p ≤ 0.001), TUG (p ≤ 0.001), and cognitive status (MoCA, p ≤ 0.05). Protective effects persisted during the detraining phase.

CONCLUSION

This study highlights significant improvements in fall risk assessment induced by EBRT, demonstrating its protective effects. The findings suggest that EBRT can enhance aspects related to fall risk, offering promising avenues for improving independence and quality of life in older adults prone to falls.

Effectiveness of a Nursing Intervention to Improve Basic and Psychological First Aid Knowledge Among Adolescents. A Quasi-Experimental Study

Basic first aid (FA) knowledge is important for in-school adolescents to save lives in emergency situations. The study aimed to evaluate the change in basic and psychological FA knowledge levels after developing an educational intervention. A quasi-experimental study with a pre and posttest design and no control group was conducted. The intervention consisted of sessions on basic and psychological first aid for students in six schools. A knowledge test was administered to the students prior to the start of the intervention. At the end, a posttest was administered with the same questions used in the pretest. A change in the knowledge level of 185 students was evaluated. The mean difference between the pretest and posttest for knowledge level was significant (3.11 95% CI: 2.68-3.54). Airway management, poisoning, FA basics, and psychological FA all increased by more than 10 points in the posttest. The study showed that the intervention improves the level of knowledge of basic and psychological FA in adolescents. The results demonstrate that health education in the school setting can have a significant impact.

Impact of Alarm Management Training on Adult ICU Nurses' Knowledge, Behaviour, and Fatigue: A Quasi-Experimental Study

OBJECTIVE

Teaching effective alarm management behaviours to intensive care nurses and preventing alarm fatigue is essential for patient safety. In this context, demonstrating the effectiveness of training activities for nurses on effective alarm management can significantly contribute to ensuring patient safety. However, studies demonstrating the effectiveness of alarm management training activities are limited. Therefore, there is an emerging need to examine the effects of training interventions that can help nurses gain effective alarm management behaviours. The study aimed to assess the effect of alarm management training on the knowledge, behaviours and fatigue levels of ICU nurses.

METHODS

This is a pretest- posttest, single-group, quasi-experimental study. The sample size was 19 nurses from two ICUs in a state hospital. Data were collected between 1 November 2021 and 20 March 2022 with the "Nurse Information Form," "Monitor Alarms Management Monitoring Form," "Monitor Alarm Management Knowledge Test," and "Alarm Fatigue Scale." Monitor alarm management training was given by presentation, case studies and reminder cards. The researcher monitored 322 alarms in the pretest and 199 in the posttest.

RESULTS

At post- training, nurses' alarm response times (p = 0.008) and crisis alarms (p = 0.032) decreased statistically significantly compared to the pre-training. Post-training, nurses' customization of alarm ranges based on patients' clinical condition (p = 0.001) and performing skin cleaning (p = 0.001) increased statistically significantly compared to pre-training. The inappropriate behaviour of "silencing and muting the alarm" was never exhibited post-training. "No response to the alarm" behaviour decreased statistically significantly, and the rate of effective alarm management behaviours increased statistically significantly (p = 0.016). Nurses' monitor alarm management knowledge increased significantly (p < 0.001), while alarm fatigue scores decreased statistically significantly at posttest (p < 0.001).

CONCLUSIONS

The alarm management training intervention was significantly increased nurses' knowledge regarding effective alarm management, improved their behaviours and alarm fatigue scores, and patients' monitor alarm outputs. In conclusion, it can be suggested that training activities be focused on to teach intensive care nurses effective alarm management behaviours and reduce their alarm fatigue.

A bundle to prevent postinduction hypotension in high-risk noncardiac surgery patients: the ZERO-HYPOTENSION single-arm interventional proof-of-concept study

Background

Postinduction hypotension is common and associated with organ injury but might be largely preventable by careful anaesthetic management. We thus aimed to quantify the severity and duration of postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle.

Methods

In this prospective single-arm interventional proof-of-concept study, 107 high-risk noncardiac surgery patients were treated with a hypotension prevention bundle. The bundle included continuous intra-arterial blood pressure monitoring, a hypotension alarm set at a mean arterial pressure (MAP) of 75 mm Hg, careful administration of anaesthetic drugs, and continuous administration of norepinephrine when MAP decreased below 75 mm Hg. The primary endpoint, AUC65, was derived from a plot of MAP over time for the first 15 min after induction of general anaesthesia as the area of the plot under a MAP of 65 mm Hg .

Results

Of 107 patients, 55 (51%) had at least one MAP reading <65 mm Hg, but only 16/107 patients (15%) had a MAP <65 mm Hg for at least one continuous minute. Patients had a MAP <65 mm Hg for a median (25% percentile, 75% percentile; minimum-maximum) of 0.2 min (0.0, 0.8; 0.0-5.2 min). The median AUC65 was 0.1 mm Hg . min (0.0, 4.1; 0.0-40.6 mm Hg min).

Conclusions

We observed minimal postinduction hypotension in high-risk noncardiac surgery patients treated with a hypotension prevention bundle. However, randomised trials are needed to confirm that using the hypotension prevention bundle helps reduce postinduction hypotension.

Effect of Routine Opt-Out HIV Screening on Emergency Department Operational Metrics: Results From the Pragmatic Randomized HIV TESTED Trial

STUDY OBJECTIVE

To assess the effect of routine opt-out HIV screening on emergency department (ED) patient throughput.

METHODS

We performed a multicenter, prospective, pragmatic 3-arm, parallel-group, randomized clinical trial to evaluate the effectiveness of 3 triage-driven, opt-out HIV screening strategies-nontargeted, enhanced targeted, and traditional targeted screening-when fully integrated into usual ED practices. As the 3 screening approaches were performed concurrently, the trial was nested in an equivalent time samples quasi-experiment to allow for the evaluation of HIV screening on ED operational metrics. Hierarchical multivariable linear and log binomial regression were performed to estimate associations between opt-out HIV screening and patient wait time, length of stay, boarding time, door-to-door time, and left before treatment was complete.

RESULTS

From January 19, 2014, through July 7, 2016, a total of 377,392 patient visits were included, 125,743 (33.3%) of which were included from intervention periods. Among these visits, 65,093 (51.8%) were randomized into the HIV TESTED (HIV Testing Using Enhanced Screening Techniques in Emergency Departments) trial with 39,720 (61.0%) ultimately offered opt-out HIV testing. Of those offered HIV testing, 17,485 (44.0%) did not decline testing and 13,314 (33.5%) tests were completed. HIV screening was associated with an increase, on average, in wait time of 1.4 (95% confidence interval [CI] 0.3 to 2.6) minutes when adjusted for mode of arrival, acuity, overall crowding, time of day, and day of the week. HIV screening was negatively associated with length of stay for admitted patients (-18 [95% CI -30 to -4] minutes) and door-to-door time (-18 [95% CI -24 to -6] minutes), whereas HIV screening was not associated with length of stay for nonadmitted patients (-6 [95% CI -12 to 6] minutes) and boarding time (-6 [95% CI -42 to 24] minutes). Finally, HIV screening was associated with an increased prevalence of left before treatment was complete (prevalence ratio: 1.10, 95% CI 1.06 to 1.15) when adjusted for the same covariates.

CONCLUSIONS

When fully integrated into clinical ED care, routine opt-out HIV screening was associated with small but nonclinically meaningful increases in wait time and left before treatment was complete and no significant change in length of stay, boarding time, or door-to-door time.

Effects of a theory driven and culturally tailored educational program on promoting cervical cancer screening in rural populations

Urban-rural disparities in the uptake rate of cervical cancer screening are significant, while one major barrier to rural populations completing the screening is a lack of knowledge. Therefore, implementing health education targeted towards rural populations is crucial. This study aimed to investigate the impact of a theory-driven, culture-tailored educational program on promoting cervical cancer screening among rural Chinese women. The study, a two-arm parallel, non-randomized controlled trial, was conducted in 10 villages. A total of 362 rural women aged 25-64 years (Mean = 45.18, SD = 9.11) were recruited and assigned to the intervention arm or the control arm, with 181 participants in each. Both groups received routine local health education on cervical cancer screening, while the intervention arm also participated in a five-session nurse-led educational program based on social cognitive theory and adapted to the rural Chinese sociocultural context. The primary outcome measured was the cervical cancer screening uptake rate, with secondary outcomes including self-efficacy and knowledge of cervical cancer screening. Data analysis was performed using Chi-square and generalized estimating equation (GEE) models. Results indicated that the intervention arm demonstrated significantly greater improvements in self-efficacy and knowledge than the control arm immediately after the intervention and at three months post-intervention (p < 0.001). At six months post-intervention, the screening uptake rate in the intervention arm was significantly higher (p < 0.001). Furthermore, 18 months post-intervention, the self-efficacy and knowledge of the intervention arm remained at relatively high levels (p < 0.001). The study findings demonstrated that the educational program had a positive impact on increasing participation in cervical cancer screening within rural communities. As a result, the theory-driven and culture-tailored educational program could be incorporated into cancer prevention promotion strategies in rural areas. However, further high-quality randomized control trials are necessary to assess and generalize this educational approach more widely.Trial registration Chinese Clinical Trial Registry, ChiCTR2200055954. Registered 29 January 2022, https://www.chictr.org.cn/showprojEN.html?proj=150955 .

Examining the impact of 28-week multicomponent and strength exercises on brain health, salivary stress, and mental well-being in frail older women: A controlled trial analysis

BACKGROUND

In recent years, the efficacy of various physical exercise programs in enhancing functional fitness among frail older adults has gained recognition. However, limited research has concurrently explored the long-term effects of exercise on brain health, stress biomarkers, and mental well-being. This study aimed to investigate the impact of two distinct chair-based exercise programs on salivary stress hormones and psychological well-being in frail older women over a 28-week period.

METHODS

A total of 140 individuals participated in the enrollment phase, with 84 eligible participants randomly assigned to three groups. Following the intervention, data from 60 participants were analyzed across the multicomponent exercise (MCE, n = 23), elastic band muscle-strength exercise (ESE, n=19), and non-exercise control (CG n=18) groups. Salivary biomarkers of alpha-amylase (α-AMY) Cortisol (COR), alpha-amylase/cortisol ratio, psychological indicators and physical frailty (PF) and functional fitness were assessed pre- and post-intervention.

RESULTS

Salivary COR levels exhibited a significant time × group interaction, with a moderate increase in MCE, a small decrease in ESE, and a substantial increase in CGne. Salivary α-AMY levels varied significantly over time and by group, with a small decrease in both exercise groups and a moderate increase in CGne. The α-AMY /COR ratio also displayed a significant interaction effect. Additionally, significant improvements were observed in PF compound scores, general self-efficacy, attitudes toward aging, and reductions in perceived stress and depressive symptoms (p < 0.05).

CONCLUSIONS

Notably, the MCE program demonstrated greater benefits than ESE. The observed associations between changes in α-AMY levels, mental well-being, and functional fitness indicators contribute novel evidence on the psychophysiological adaptations to long-term exercise. Importantly, reductions in PF scores correlated with improvements in self-efficacy, attitudes toward aging, and handgrip strength, reinforcing the link between functional fitness, stress regulation, and psychological well-being. These findings emphasize the need for tailored exercise interventions to enhance both physiological resilience and mental health in frail older populations.

Scoping review of deep learning research illuminates artificial intelligence chasm in otolaryngology-head and neck surgery

Clinical validation studies are important to translate artificial intelligence (AI) technology in healthcare but may be underperformed in Otolaryngology - Head & Neck Surgery (OHNS). This scoping review examined deep learning publications in OHNS between 1996 and 2023. Searches on MEDLINE, EMBASE, and Web of Science databases identified 3236 articles of which 444 met inclusion criteria. Publications increased exponentially from 2012-2022 across 48 countries and were most concentrated in otology and neurotology (28%), most targeted extending health care provider capabilities (56%), and most used image input data (55%) and convolutional neural network models (63%). Strikingly, nearly all studies (99.3%) were in silico, proof of concept early-stage studies. Three (0.7%) studies conducted offline validation and zero (0%) clinical validation, illuminating the "AI chasm" in OHNS. Recommendations to cross this chasm include focusing on low complexity and low risk tasks, adhering to reporting guidelines, and prioritizing clinical translation studies.

Comprehensive comparison of technical performance, surgical outcomes, and oncologic prognosis between remnant gastric cancer and primary upper-third gastric cancer in the era of minimally invasive surgery: A pooled analysis of 3 prospective trials

BACKGROUND AND OBJECTIVE

To compare the technical performances and short- and long-term outcomes of laparoscopic total gastrectomy for remnant gastric cancer and primary upper gastric cancer.

METHODS

This prospective study (FUGES-004 study) enrolled 50 remnant gastric cancer patients who underwent laparoscopic total gastrectomy at Fujian Medical University Union Hospital between June 2016 and June 2020 (ClinicalTrials.gov identifier: NCT02792881). Propensity score matching (1:2) was used to select upper gastric cancer patients who underwent laparoscopic total gastrectomy in the FUGES-001 and FUGES-002 studies. Technical performance was assessed using the General Error Reporting Tool, Objective Structured Assessment of Technical Skills (OSATS), and Intraoperative Complication Classification.

RESULTS

After matching, 46 remnant gastric cancer and 92 upper gastric cancer patients were included in the final analysis. Abdominal adhesions in the epigastrium, central abdomen, and bowel-to-bowel regions were more severe in the remnant gastric cancer group (P < .001). The remnant gastric cancer group had more technical errors and intraoperative adverse events (especially grade I bleeding) during surgery (P < .05). However, the Objective Structured Assessment of Technical Skills scores were comparable between the remnant gastric cancer and upper gastric cancer groups (30.8 vs 31.0, P = .799). Although the severe postoperative complication rates were similar between the 2 groups (P = .333), the postoperative complication rate was significantly higher in the remnant gastric cancer group (28.3% vs 7.6%, P = .001). Additionally, the long-term oncologic outcomes (including 3-year disease-free survival, overall survival, and recurrence pattern) were comparable between the remnant gastric cancer and upper gastric cancer groups (log-rank P > .05).

CONCLUSIONS

Although the long-term oncologic outcomes were comparable between the groups, the remnant gastric cancer group had more intraoperative errors and adverse events and higher postoperative complication rates than the upper gastric cancer group. For complex remnant gastric cancer cases, laparoscopic total gastrectomy may serve as an effective therapeutic option. However, experienced surgeons at high-volume centers should exercise caution when performing laparoscopic total gastrectomy and implement more rigorous perioperative management strategies.

Effectiveness and Implementation Outcomes of an mHealth App Aimed at Promoting Physical Activity and Improving Psychological Distress in the Workplace Setting: Cluster-Level Nonrandomized Controlled Trial

Background

Encouraging physical activity improves mental health and is recommended in workplace mental health guidelines. Although mobile health (mHealth) interventions are promising for physical activity promotion, their impact on mental health outcomes is inconsistent. Furthermore, poor user retention rates of mHealth apps pose a major challenge.

Objective

This study aimed to examine the effectiveness and implementation outcomes of the smartphone app ASHARE in Japanese workplace settings, leveraging a deep learning model to monitor depression and anxiety through physical activity.

Methods

This hybrid effectiveness-implementation trial was a 3-month nonrandomized controlled trial conducted from October 2023 to September 2024. Work units and employees were recruited and allocated to the intervention or active control group based on preference. The intervention group installed the ASHARE app, whereas the control group participated in an existing multicomponent workplace program promoting physical activity. Changes in physical activity and psychological distress levels were compared between the groups. User retention rates, participation rates, acceptability, appropriateness, feasibility, satisfaction, and potential harm were also assessed.

Results

A total of 84 employees from 7 work units participated (67 from 5 units in the intervention group and 17 from 2 units in the control group). In total, 78 employees completed the 3-month follow-up survey (follow-up rate: 93%). Both groups showed increased physical activity, and the intervention group showed reduced psychological distress; however, the differences between groups were not statistically significant (P=.20; P=.36). In a sensitivity analysis of protocol-compliant employees (n=21), psychological distress levels were significantly reduced in the intervention group compared with the control group (coefficient=-3.68, SE 1.65; P=.03). The app's 3-month user retention rate was 20% (12/61), which was lower than the participation rate in each component of the control programs. Implementation outcomes evaluated by employees were less favorable in the intervention group than in the control group, whereas health promotion managers found them to be similar.

Conclusions

The ASHARE app did not show superior effectiveness compared with an existing multicomponent workplace program for promoting physical activity. An implementation gap may exist between health promotion managers and employees, possibly contributing to the app's low user retention rate. Future research should focus on examining the effectiveness of strategies to get engagement from managers and from segments of employees with favorable responses in the workplace at an early stage.

Pawsitive Care: Canine-Assisted Intervention for Anxiety in ICU Patients and Family Members: A Single-Center, Single-Arm Study

OBJECTIVES

To investigate the effect of canine-assisted intervention (CAI) on anxiety symptoms among intensive care patients and their family members.

DESIGN

Prospective, single-center, single-arm, nonrandomized, within-subject study design.

SETTING

Tertiary hospital ICU.

PATIENTS/SUBJECTS

Adult (≥ 16 yr) ICU patients and their family members.

INTERVENTIONS

Individual CAI (therapy dog) sessions, lasting at least 15 minutes.

MEASUREMENTS AND MAIN RESULTS

Primary outcome: change in Visual Analog Scale for Anxiety (VAS-A) among patients and family members; secondary outcomes (patient cohort): change in: 1) Numeric Pain Rating Scale, 2) physiologic vital signs, and 3) intervention-related adverse events. A total of 141 participants (70 patients and 71 family members) were recruited. The median (interquartile range [IQR]) age (yr) was 63 (49-71) for patients, and 51 (36-61) for family members. There was a significant reduction in anxiety scores after the intervention, with median (IQR) VAS-A scores changing from 5 (1-7) to 0 (0-4 [p < 0.001]) for the patient cohort and from 6 (5-8) to 3 (1-5 [p < 0.001]) for the family cohort. Majority of patients (56/70 [62%]) and family members (63/68 [93%]) demonstrated a greater than or equal to 2-point reduction in VAS-A scores. In terms of pain, median (IQR) scores among the patient cohort were also lower post-intervention (0 [0-5] vs. 0 [0-2]; p < 0.001). There were no statistically significant changes in physiologic vital signs (heart rate, respiratory rate, and systolic blood pressure) among patients following the intervention. Additionally, there were no reported dog bites, scratches, or other adverse events during CAI.

CONCLUSIONS

CAI offers immediate therapeutic benefits in reducing anxiety symptoms in ICU patients and their family members with no observed adverse effects. It may also have a potential role as an adjunctive therapy for pain management in ICU patients. Further research should explore the influence on longer-term psychologic outcomes for ICU patients and family members.

Emergency department-initiated oral naltrexone for patients with moderate to severe alcohol use disorder: A pilot feasibility study

OBJECTIVES

Alcohol use disorder (AUD) is the most common substance use disorder in the United States. Despite availability of four FDA-approved medications, fewer than 10% of patients are prescribed medication. This study aimed to evaluate the impact and feasibility of emergency department (ED)-initiated oral naltrexone in patients with moderate to severe AUD.

METHODS

This was a prospective, single-arm, open-label, nonrandomized clinical trial conducted a single ED. Consenting participants were adults with moderate to severe AUD who were provided a single 50-mg dose of oral naltrexone, a 14-day starter pack of naltrexone, and referral for treatment. Follow-up was conducted at 14 and 30 days post-ED visit. The primary outcome was engagement in formal addiction treatment. Secondary outcomes included alcohol consumption, craving, quality-of-life measures, satisfaction, and safety.

RESULTS

Of 761 patients screened, 21 enrolled and received at least one dose of naltrexone. At 14 days, 29% were engaged in treatment, increasing to 33% at 30 days. There was a decrease in the mean (±SD) number of drinks per day from 5.20 (±4.67) at baseline to 2.23 (±4.35) during the follow-up period (p = 0.078). There was a decrease in alcohol craving scores, with median scores dropping from 19 at baseline to 8.27 during the follow-up period (p < 0.001). Quality-of-life measures improved, with a statistically significant increase in the reported number of healthy days (p = 0.006) and decrease in depressive symptoms (p < 0.001). Reported side effects were mild and satisfaction with the screening process was high.

CONCLUSIONS

ED-initiated oral naltrexone is feasible and acceptable for patients with moderate to severe AUD. While engagement in treatment was moderate, significant reductions in alcohol craving and improvements in quality of life suggest potential benefits. Further research is warranted to confirm these findings.

Effect of Climate Change and Health Course on Global Warming Knowledge and Attitudes, Environmental Literacy, and Eco-Anxiety Level of Nursing Students: A Quasi-Experimental Study

BACKGROUND

Climate change is the most important problem that threatens the health of individuals, public health, and health systems on a global scale. The International Council of Nurses emphasizes that nurses should strive to reduce the effects of climate change and help individuals and systems adapt. In addition, it is stated that climate change should be integrated into nursing education curricula and nursing students, who are future healthcare providers, should be prepared to reduce the effects of climate change and promote a healthier environment.

AIM

The aim of this study is to examine the effect of the Climate Change and Health course on global warming knowledge and attitude, environmental literacy, and eco-anxiety levels in nursing students.

DESIGN AND METHODS

In this study, a pretest-posttest comparative quasi-experimental design type was used. The research was conducted with 117 students taking the "Climate Change and Health" course added to the curriculum at the Nursing Department of a private university in Istanbul between February 2023 and June 2023. Data were collected before and after the intervention using the Descriptive Characteristics Form, Global Warming Knowledge Questionnaire, Global Warming Attitude Scale, Environmental Literacy Scale for Adults, and Eco-Anxiety Scale.

RESULTS

After taking the Climate Change and Health course, nursing students' global warming knowledge and attitude total scores increased, and a statistically significant increase was detected in the eco anxiety total and behavioral symptoms subscale mean scores. There was no statistically significant change in the Environmental Literacy Scale total and subscale mean scores.

CONCLUSIONS

It can be stated that the Climate Change and Health course positively improved nursing students' knowledge and attitudes toward global warming and increased their sensitivity about climate change. Nurses, who constitute the most important part of the healthcare workforce worldwide, have an important role in creating a healthy and safe environment and in combating the effects of global warming and climate change. For this reason, in order to train knowledgeable and equipped health professionals on this subject, it is recommended that courses on the effects of climate change, adaptation, and coping with it be added to the nursing curriculum and integrated into all subjects every year to ensure continuity.

Effects of humanistic care digital storytelling programme on the humanistic qualities of intensive care unit nursing students: A mixed-methods study

AIM

To explore the effects of a humanistic care digital storytelling programme on the humanistic care ability, empathy, emotional intelligence and clinical communication ability.

BACKGROUND

Humanistic qualities are vital for patient satisfaction and nursing quality. However, traditional nursing curricula may impede their development, especially in intensive care unit settings. Digital storytelling shows promise, but its effectiveness in enhancing humanistic qualities remains unclear.

DESIGN

A quasi-experimental design with repeated measures, using a convergent parallel mixed-methods approach.

METHODS

In a tertiary hospital in Changsha, China, 37 nursing students participated in the intervention group and 40 in the control group. The four-week intervention included educational sessions, reflective diaries and discussion groups. Humanistic qualities were assessed quantitatively at baseline, post-intervention and one-month follow-up using repeated measures ANOVA. Qualitative data from diaries and interviews were analyzed using reflective thematic analysis.

RESULTS

The intervention group demonstrated significantly improved humanistic care ability and empathy scores compared with controls (p < 0.05). Interaction effects were significant for both humanistic care ability (p < 0.05) and emotional intelligence (p < 0.001). The intervention group also showed statistically significant improvements in humanistic care ability and emotional intelligence at both post-intervention and follow-up (p < 0.05). Qualitative analysis revealed four themes: Infectious fusion and Educational Significance, Balancing Enjoyment and Reflection, Complementary Relationship between the Teaching Curriculum and Clinical Practice and Recommendations for Improving the Teaching curriculum.

CONCLUSION

The digital storytelling programme effectively enhances humanistic qualities among intensive care unit nursing students, supporting its integration into nursing education for improved outcomes.

Effect of COVID-19 pandemic on smoking, alcohol consumption, and substance use in persons aged 15 years and older in Uganda

In Uganda, the effect of the COVID-19 pandemic on substance and drug use at the national level has not been studied. Our study evaluated the effect of the COVID-19 pandemic on the frequency of smoking, alcohol consumption, and substance use among Ugandans aged ≥ 15 years based on a large, nationally representative survey. This quasi-experimental study used the Uganda National Household Survey data collected between June 2019 and November 2020, with the COVID-19 pandemic as the primary exposure and outcomes as smoking, alcohol consumption, and substance use frequency before and during the COVID-19 pandemic, measured on an ordered scale (none, less than daily, and daily). We used propensity score weighting to balance the exposed and unexposed groups, and analyzed the effect of COVID-19 on the outcomes using ordered logistic regression, adjusting for the propensity score weights. Sub-group analysis was conducted based on sex, residence, and age groups. We analyzed data on 34,312 participants (18,270 exposed vs. 16,042 unexposed) aged ≥ 15 years, with 53.8% male and 54.3% aged 25-59 years. Frequency of smoking (weighted proportional odds ratio [pOR] 0.13, 95% confidence interval [CI] 0.07-0.25), alcohol consumption (weighted pOR 0.36, 95% CI 0.26-0.48), and substance use (weighted pOR 0.04, 95% CI 0.01-0.29) were significantly lower during the COVID-19 pandemic compared to the pre-pandemic levels. In sex-stratified analysis, smoking, alcohol consumption, and substance use were lower during the COVID-19 pandemic compared to the pre-pandemic period. In rural areas, substance use was higher, but smoking and alcohol consumption were lower. In urban settings, the reductions in smoking, alcohol consumption, and substance use remained consistent with the pre-pandemic levels. In Uganda, the frequency of smoking, alcohol consumption, and substance use during the COVID-19 pandemic was lower compared to the pre-pandemic levels. Future studies should examine if the reductions were sustained after the pandemic and whether modified restrictions can reduce alcohol consumption.

Healthy Pills: A Physical Activity and Meditation Program to Enhance Mental Health and Well-Being in Spanish University Students

(1) Background: University students' mental health (MH) is in crisis due to academic stress, lack of physical activity (PA), and low self-esteem. This study evaluated a 12-week PA and meditation intervention to enhance psychological well-being in Spanish university students. (2) Methods: A quasi-experimental design was used, with a non-randomized control group and pretest-posttest assessments. The study lasted 14 weeks (12 weeks of intervention and two for evaluations). Initially, 149 students were recruited, but the final sample included 136 (82 intervention, 54 control) due to attrition. Participants were selected through convenience sampling, respecting university-established groups. The intervention consisted of six PA sessions (aerobic, cardiovascular, and strength exercises) and six meditation sessions (yoga and mindfulness). Validated questionnaires assessed resilience, psychological distress, self-esteem, mood, personality traits, sedentary behavior, PA levels, and sleep duration. (3) Results: Significant improvements were found in resilience (p < 0.001), depression (p < 0.01), and sleep duration (p < 0.05), with greater mood benefits in men. No major changes were observed in other variables. (4) Conclusions: PA- and meditation-based interventions can improve students' MH, particularly in key psychological aspects. Further research should explore long-term effects and refine strategies by distinguishing between preventive and therapeutic approaches.

Knowledge and awareness of the use of reporting guidelines in specialist dentists: a cross-sectional study

BACKGROUND

Reporting guidelines are guidelines developed to standardize the reporting of scientific studies, to ensure that it is transparent, accurate, and complete, and to improve the quality of the study. Their use is very important in terms of literature. This study aimed to evaluate the level of knowledge and awareness of specialist dentists about the reporting guidelines of scientific research.

METHODS

This study was conducted on 240 specialist dentists and research assistants continuing their specialty education in Turkey. A questionnaire on sociodemographic characteristics and respondents' level of knowledge about the Enhancing Quality and Transparency of Health Research (EQUATOR) Network and reporting guidelines was prepared. Data were collected through this questionnaire. Data obtained from the questionnaire were analyzed with IBM SPSS v23. Pearson's Chi-square test, Yates Correction, and Fisher's Exact tests were used to analyze the association between categorical variables(p < 0.050).

RESULTS

80.8% of the participants were female,19.2% were male and 48.8% were aged between 30 and 35 years.13.8% of the participants had heard the term EQUATOR Network before. Of these, 10.4% learned it from journal websites, and the rest from congresses and seminars. In scientific papers, 32.9% have served as reviewers, but only 7% have used the reporting guidelines. The title group with the best knowledge of the EQUATOR network was the Associate Professor Prof group with a rate of 44.4%. The most recognized reporting guidelines were CONSORT (17.5%), PRISMA (16.3%), and STROBE (%12.1). 82.5% of the participants would like to be informed about the guidelines.

CONCLUSIONS

Specialist dentists' awareness and use of scientific research reporting guidelines and the EQUATOR Network are insufficient. However, they would like to have information on this subject. With the conclusion of this study, a great deal of awareness has been created among the participants. In addition, detailed training on reporting guidelines may increase their utilization.

CLINICAL TRIAL NUMBER

Not applicable.

Reduction of High Emotional Eating via Increased Physical Activity: Assessing a Path Informed by Multiple Behavioral Theories Within Community-Based Obesity Interventions

Emotional eating (EE; eating in response to negative emotions) is a considerable problem in adults with obesity. Recent meta-analyses of behavioral treatments for those with elevated body mass index (BMI) have demonstrated inconsistent, but generally minimal, effects for dealing with EE. This might largely be due to inappropriate sampling, cross-sectional research designs, and a lack of understanding of theory-driven psychosocial mechanisms of EE change. This study aimed to inform mental health, medical, and health behavior-change professionals on methods to address EE within obesity treatments. Within the present field-based research, women with high EE participated in 6-month community-based obesity treatments emphasizing either weight-management education + attention on EE (n = 34), self-regulatory skills-no attention on EE (n = 43), or self-regulatory skills + attention on EE (n = 42). Each condition incorporated physical activity for its mood-change potentials. Significant improvements in physical activity, mood, eating-related self-regulation and self-efficacy, EE, and weight were found in all groups, with greater advances occurring in the self-regulation vs. educationally focused conditions. Incorporating aggregated data, significant theory- and previous research-derived paths from changes in physical activity → mood → self-regulation → self-efficacy → EE change over 6 months, and over 12 months, were identified. Reductions in EE over 6 and 12 months predicted weight loss over 6, 12, and 24 months. Findings supported tenets of social cognitive theory, self-regulation theory, the mood-behavior model, and self-efficacy theory, and informed future behavioral obesity treatments on evidence-driven methods to better-address EE within scalable settings.

Osimertinib plus anlotinib for advanced NSCLC with acquired EGFR T790M mutation: results from a multicenter phase II study with ctDNA analysis

BACKGROUND

Osimertinib is a standard treatment for first- or second-line therapy in patients with non-small cell lung cancer (NSCLC) harboring mutations in the epidermal growth factor receptor (EGFR). However, options are limited for patients with acquired EGFR T790M mutations resistant to first- or second-generation EGFR-tyrosine kinase inhibitors (TKIs). This study assessed the efficacy and safety of combining osimertinib with anlotinib in this patient population and explored circulating tumor DNA (ctDNA) as a biomarker of treatment outcomes.

METHODS

In this prospective, single-arm, phase II trial, 31 patients with advanced NSCLC resistant to prior first- or second-generation EGFR-TKIs therapy received osimertinib (80 mg daily) and anlotinib (12 mg daily on days 1-14 of each 21-day cycle). Efficacy endpoints included progression-free survival (PFS) and overall survival (OS). ctDNA was analyzed using next-generation sequencing (NGS) to monitor mutation status and treatment response.

RESULTS

The median PFS was 16.2 months (95% confidence interval [CI] 9.8-23.6, 90% CI 14.2-20.9), and the median OS was 31.4 months (95% CI 27.3-not reached). The objective response rate (ORR) was 45.2% (95% CI 30.6-66.6%), with a disease control rate (DCR) of 96.8% (95% CI 86.3-100.0%). ctDNA analysis showed that activating EGFR mutation clearance after two treatment cycles correlated with significantly longer PFS and OS. The regimen was well-tolerated, with no grade 4 or higher adverse events observed.

CONCLUSIONS

Osimertinib combined with anlotinib demonstrates promising long-term efficacy and manageable safety in EGFR T790M-positive NSCLC. Clearance of ctDNA, particularly of EGFR mutations, could serve as a valuable predictive biomarker, supporting the implementation of personalized treatment strategies.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT04029350.

Enhancing beliefs and implementation of evidence-based practice among undergraduate nurses using a multi-component educational programme: a pre-post study

BACKGROUND

Using evidence-based practice (EBP) is one of the core skills that students should have acquired by the end of their Bachelor of Science in Nursing (BSN). However, little is known about how their beliefs about EBP and their frequency of implementation relate to multi-component educational programmes on this topic. This study aims to investigate the impact of a multi-component educational programme on nursing students' beliefs about EBP and their frequency of implementation at the School of Health Sciences, HES-SO Valais.

METHODS

This quantitative, pre-post-design study compared undergraduate nursing students' beliefs about EBP and their frequency of implementation before and after completing a multi-component educational programme on EBP. The programme included integrative workshops based on the steps of EBP held during their clinical internships throughout their three-year curriculum. The study occurred between September 2017 and June 2020: the start and end of their studies. The programme's impact was measured using Melnyk et al.'s self-reported EBP Beliefs and Implementation Scales. Descriptive, comparative, correlational and regression statistics were computed to evaluate nurses' responses and scores.

RESULTS

Ninety-five eligible first-year undergraduate nursing students were invited to participate in this EBP study and 81 completed the pre- and post-test questionnaires. Mean EBP scores improved significantly versus baseline on both the Beliefs (49.1 vs. 53.3; p < 0.001) and Implementation (1.7 vs. 9.0; p < 0.001) scales. Cronbach alphas for the EBP Beliefs scale were 0.799 pre-test (95% CI: 0.729, 0.858) and 0.869 post-test (95% CI: 0.823, 0.907). Cronbach's alphas for the EBP Implementation scale were 0.804 pre-test (95% CI: 0.736, 0.861) and 0.939 post-test (95% CI: 0.918, 0.957). There were significant correlations between EBP Beliefs and Implementation scores (p < 0.001). Linear regression analysis showed that the programme's theory-based component contributed significantly more than clinical internships to raising EBP Beliefs and Implementation scores.

CONCLUSIONS

The multi-component educational programme on EBP improved undergraduate nursing students' EBP Beliefs and Implementation scores. Future research should investigate means of optimally integrating EBP into undergraduate nursing curricula and explore nursing students' intentions to implement EBP in clinical practice.

Brazil nut consumption within an energy-restricted diet improved cardiometabolic risk markers in women: a quasi-experimental, controlled study (Brazilian Nuts Study)

Consuming functional foods alongside the energy-restricted diet can be a great ally in weight loss and improving cardiometabolic risk factors. Whether Brazil nut (BN) consumption in the context of energy restriction affects them remains to be answered. We aimed to evaluate the effect of BN within an energy-restricted diet on cardiometabolic risk markers among women. This is an eight-week, quasi-experimental, controlled nutritional intervention study. The women were allocated into two energy-restricted (-500 kcal/d) groups: a control free of BN (n=29) and a BN-group (BNG) (n=27) with 2 units/day of BN (~ 347 µg of selenium). Both groups had similar weight loss, but in the BNG, the serum selenium increased by 276.7% and apolipoprotein A1 increased by 27.4%. In addition, BNG had a more pronounced reduction in liver enzymes, and presented the most preserved percentages of lean and fat-free mass in relation to the control group. Consuming 2 units/day of BN in an 8-week weight loss intervention improved cardiometabolic risk markers in women. Our results suggest that regular consumption of BN during energy-restricted diets may be a strategy to minimize adiposity, preserve lean mass, improve serum selenium status, lipid, and liver metabolism markers, and, consequently, help obesity management and its comorbidities.

Online training improves motivational counseling in health insurance practitioners: a pre-post analysis of return-to-work conversations

PURPOSE

Health insurance practitioners need to evaluate sick-listed workers, motivate them for return-to-work (RTW), and guide them in doing so. This study evaluates the effectiveness of a 10-h, online and interactive training in "motivational counseling," on practitioners' communication behaviors. The training is based on Motivational Interviewing (MI) and Self-Determination Theory (SDT)'s basic psychological need support for autonomy, relatedness, and competence.

MATERIALS AND METHODS

We observed and rated video recordings of online patient encounters, simulated by experienced actors enacting fictive scenarios. Two-tailed Wilcoxon signed-rank tests compared pre- and post-training outcomes of 31 practitioners using observational instruments based on MI and SDT.

RESULTS

After training, the practitioners showed significantly more technical (e.g., using reflections) and relational (i.e., seeking collaboration and taking perspective) MI behaviors. Autonomy- and competence-supportive behaviors increased (e.g., providing rationales or feedback) while autonomy-thwarting behaviors decreased (e.g., using controlling language).

CONCLUSIONS

The training in motivational counseling effectively promoted motivating communication behaviors among health insurance practitioners, in line with SDT and MI. The online format makes the training practically more feasible for RTW stakeholders operating in time-restrained contexts. More research is needed on training transfer and implementation barriers, as on the impact on sick-listed workers' motivational processes and RTW trajectories.

Experimentation Without Randomised Controls

BACKGROUND

In an experimental study, researchers often have the ability to assign different treatments. This is often done with randomisation. There are many settings; however, where it is not desirable to use randomisation. It is unclear how to best design an experimental study without randomisation while still providing persuasive evidence.

OBJECTIVES

The aim of this study was to outline several approaches, broadly classified as quasiexperimental studies, where researchers can use methodologically sound alternatives to randomisation.

RESULTS

The interrupted time series, phased inventions, withdrawal design, waiting list control group, stepped wedge design and regression discontinuity all represent approaches where careful nonrandom allocation to treatment groups can produce high-quality research findings.

CONCLUSION

Quasiexperimental studies can produce rigorous research findings. The allocation to treatment groups and the times of evaluation need to be carefully designed. Proper use of these quasiexperimental approaches can enhance research options in settings where the research team has control of allocation but finds randomisation to be problematic.

Tauroursodeoxycholic Acid (TUDCA) Reduces ER Stress and Lessens Disease Activity in Ulcerative Colitis

Background and Aims

In inflammatory bowel disease, protein misfolding in the endoplasmic reticulum (ER) potentiates epithelial barrier dysfunction and impairs mucosal healing. Tauroursodeoxycholic acid (TUDCA), a naturally occurring bile acid, acts as a chemical chaperone to reduce protein aggregation and colitis severity in preclinical models. We conducted an open label trial evaluating oral TUDCA as therapy in patients with active ulcerative colitis (UC).

Methods

Patients with moderate-to-severely active UC (Mayo score ≥6, endoscopic subscore ≥1) received oral TUDCA at 1.75 or 2 g/day for 6 weeks. Exclusion criteria included known hepatic disorders or change in UC therapy within 60 days. Clinical disease activity questionnaires, endoscopy with biopsy, blood, and stool were collected at enrollment and after 6 weeks. The primary outcome measure was change in ER stress markers while safety, tolerability and change in UC disease activity were secondary outcomes.

Results

Thirteen participants completed the study with eleven evaluable for clinical response. TUDCA was well-tolerated with transient dyspepsia being the most common side effect. Mucosal biopsies revealed significant reductions in ER stress and inflammation as well as an increase in markers of epithelial restitution. Clinical, endoscopic, and histologic disease activity were significantly improved at week 6 (mean total Mayo Score: 9 to 4.5, p<0.001).

Conclusions

Six weeks of oral TUDCA treatment was well-tolerated in patients with active ulcerative colitis and promoted mucosal healing, lessened ER stress, and reduced clinical disease activity. A randomized controlled trial of adjunctive TUDCA therapy in patients with UC is warranted.

Trial registration

ClinicalTrials.gov (NCT04114292).

Efficacy of probiotic, prebiotic, synbiotic and postbiotic supplementation on gastrointestinal health in cats: systematic review and meta-analysis

OBJECTIVES

The clinical efficacy of the use of probiotics, prebiotics, synbiotics and postbiotics (biotics) in cats is unknown, despite their use in daily practice. The objectives of the study is to evaluate the effectiveness of biotic supplementation in treating and preventing gastroenteropathies, and in reducing gastrointestinal signs associated with antibiotics in cats.

MATERIALS AND METHODS

A systematic review was conducted by searching four databases for publications before August 2, 2024, following a pre-registered protocol. Eligible publications were trials involving healthy cats or those with gastroenteropathies, supplemented with biotics (and an inactive control), studying outcomes such as faecal consistency, faecal microbiota or vomiting. Risk of bias and quality of reports were assessed. Effects were synthesised by meta-analyses and vote counting based on direction of effect. Certainty of evidence was rated using GRADE approach.

RESULTS

Twenty reports were included, presenting unclear or low risk of bias. The evidence did not permit a high-confidence evaluation of the effectiveness of biotics, although five of the seven probiotic trials showed beneficial effects on faecal consistency. Synbiotics presented no clinically relevant effect in reducing antibiotics-associated vomiting, with very low certainty, in a meta-analysis including 32 adult cats. Probiotics significantly reduce the Bacillota/Actinomycetota ratio, with low certainty, in a meta-analysis involving 34 healthy young-adult cats. Following vote counting, probiotics improved immune profile in young cats, and increased butyric acid concentration in healthy cats.

CLINICAL SIGNIFICANCE

Current data highlight the need for further research, especially focused on at-risk groups and sick cats, before advocating the use of biotic supplementation.

A pre-, peri- and postoperative rehabilitation pathway for lumbar fusion surgery (REACT): a nonrandomized controlled clinical trial

PURPOSE

To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care.

METHODS

A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.

RESULTS

Participants in the REACT group demonstrated significantly greater improvements in disability (p = 0.003), back pain intensity (p = 0.007), and return-to-work rates (88% vs 56%, p = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (p = 0.038), pain catastrophizing (p < 0.001), combined negative emotional states (p = 0.007), sit-to-stand performance (p = 0.021), and reduced analgesic use (p = 0.001). No significant differences were observed in leg pain intensity (p = 0.042), length of hospital stay (p = 0.095) or adverse events (p = 1.00).

CONCLUSION

The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group.

Effects of an App-Based Visitation Program for Mothers of High-Risk Infants in the Neonatal Intensive Care Unit: A Quasi-Experimental Study

PURPOSE

This study established an app-based visitation program for mothers of infants admitted to the neonatal intensive care unit (NICU)-constrained by COVID-19 visitation restrictions-and assessed its impact on neonatal perception, maternal-infant attachment, and parental stress.

BACKGROUND

High-risk infants in the NICU encounter heightened challenges, exacerbated by COVID-19 restrictions, leading to heightened maternal stress, impaired neonatal perception, and hindered mother-infant attachment.

METHODS

A quasi-experimental study was conducted with 40 mothers (20 in the experimental group and 20 in the control group) unable to visit the NICU of a tertiary general hospital in South Korea. The experimental group utilized the Dodam-Dodam smartphone application, while the control group received neonatal information through telephone calls and text messages. Data collection occurred in July 2022 (control) and September 2022 (experimental) using research instruments (parent's neonatal perception, maternal-infant attachment, and parental stressor scale: NICU, visiting program satisfaction). Descriptive statistics and tests (χ 2 , Fisher's exact, Shapiro-Wilk, parametric independent t and paired t tests, and nonparametric tests: Mann-Whitney and Wilcoxon's signed-rank) were employed for analysis.

RESULTS

The Dodam-Dodam application significantly impacted maternal-infant attachment parental stress scores and program satisfaction in the experimental group, except for neonatal perception.

CONCLUSIONS

The Dodam-Dodam application was more efficacious than traditional visiting programs in enhancing maternal-infant attachment, increasing maternal satisfaction and reducing parental stress within NICU settings amid restricted visitation.

IMPLICATIONS FOR PRACTICE AND RESEARCH

Recommendations include app-based NICU visitation, exploring app variations, studying diverse populations, and providing optimal information provision.

A Mixed-Methods Evaluation of a Peer Group Intervention to Promote Wellbeing in Mental Health Nurses

The work mental health nurses undertake is widely acknowledged as being challenging. Stressors encountered in the workplace can negatively impact nurses' psychological wellbeing and contribute to issues with retaining nurses in the profession. There is limited interventional research that focuses on external factors that foster nurse wellbeing. This study aimed to evaluate a peer group intervention to promote nurse wellbeing. A longitudinal mixed-methods study with an equal status concurrent design was undertaken. Qualitative and quantitative data were collected via semi-structured interviews and surveys across three timepoints, baseline, mid-intervention, and post-intervention. Qualitative data were collected to explore interviewees' experiences of participating in the intervention, and quantitative data were obtained to assess for any measurable effect on wellbeing outcomes. Fifteen peer group participants completed semi-structured interviews. There were n = 28 responses to the baseline survey, n = 27 returned the mid-intervention survey, and n = 25 responded to the post-intervention survey. Qualitative data analysis identified four main themes: Attending Peer Group, Participating in Peer Group, Impact on the Individual, and Unrelated Workplace Change. Wellbeing scores were found to be significantly modified by the number of peer group sessions attended for depression (p = 0.006), stress (p = 0.004), and emotional exhaustion (p = 0.02) By the post-intervention survey, more favourable scores were significantly associated with higher attendance levels for all three measures. Integration of the qualitative findings and quantitative results demonstrated potential benefits of peer groups for nurse wellbeing. Given that greater exposure to the intervention was associated with better outcomes, facilitating attendance is essential to realise the benefits of peer groups.

Impact of High-Fidelity Simulation on the Acquisition of Spiritual Competencies in a Nursing Degree in Spain: An Experimental Pre-Post Study

High-fidelity simulation is an educational technique that utilizes advanced technology and realistic clinical scenarios to replicate real-life situations, offering students a safe and immersive environment to practice and enhance their skills. A quantitative experimental study with a pretest-posttest single-group design was conducted, where 143 first-year undergraduate nursing students (n = 143) participated in a simulation program focusing on spiritual care. The response rate was 49.5%, calculated as the number of students who completed the questionnaire (143) divided by the total number of students approached (289). The pretest and posttest were conducted one month apart. The Spirituality and Spiritual Care Rating Scale (SSCRS-Sp) was used to assess changes in students' spiritual competencies before and after the simulation. Results indicated significant improvements in students' perceptions of spiritual care, suggesting that simulation is an effective method for enhancing spiritual competencies.

The effectiveness of new urban trail infrastructure on physical activity and active transportation: a systematic review and meta-analysis of natural experiments

BACKGROUND

Cities in Western countries are investing billions of dollars in new cycling infrastructure (urban trails) to support active transportation (AT) and leisure-type physical activity (PA). Little empirical evidence exists on the effectiveness of urban trails on changes in AT or PA.

DESIGN AND METHODS

We searched CINAHL, OVID, SPORTDiscus, Transport Research International Documentation (TRID), Web of Science Core Collection and Google Scholar for articles published from 2010 to 2023. We included controlled experimental studies that reported PA, AT or trail counts as outcome measures before and after construction of an urban trail. A modified risk of bias tool was employed to assess the methodological quality of each selected study (Prospero ID: CRD42023438891).

RESULTS

Three independent reviewers screened abstracts from 3936 articles identified in the original search and identified 24 articles that met inclusion criteria: 11 studies (n = 11,464) that measured changes in PA, 8 studies (n = 92,001) that measured changes in cycling traffic and 5 studies (n = 4,958,203) that measured changes in rates of AT/cycling. Meta-analysis revealed that new trails increased PA levels among individuals in proximity to one, compared to those living in control areas (SMD = 0.12; 95% CI: 0.04, 0.20; I2 = 73%; n = 11,464). This effect was marginally stronger when data were restricted to individuals living in closest proximity to trails (SMD = 0.14; 96% CI: 0.06 to 0.25, I2 = 74%; n = 8234). Meta-analyses were not possible for measures of AT and cycling counts. All studies were at high risk of bias due to a failure to adhere to reporting guidelines for quasi-experimental studies.

CONCLUSIONS

There is limited but intriguing evidence that the addition of protected urban trails increases daily PA for individuals living in neighbourhoods that receive them. The strength of this evidence could be enhanced with the application of and adherence to principles of causal inference and increased diversity of individuals included in study designs.

Effects of psychosocial interventions on wellbeing in individuals with severe mental illness: a systematic review

Introduction

Wellbeing, encompassing hedonic and/or eudaimonic components, provides a two-dimensional framework for evaluating the effects of psychosocial interventions for individuals with severe mental illness (SMI). This study investigates how this conceptualization of wellbeing is reflected in existing research on psychosocial interventions for people with SMI. This is the first systematic review to assess the effects of psychosocial interventions on wellbeing as a purely positive phenomenon in this population. The study was registered in PROSPERO (CRD42024598954).

Method

A systematic review was conducted on intervention studies involving adults with SMI receiving psychosocial interventions in an out-patient setting, with a control condition and a wellbeing outcome aligned with a wellbeing framework. Five databases were searched, supplemented by manual searches, yielding 2,842 potential studies. Due to considerable heterogeneity (I 2 = 94%), interventions were analyzed independently, with results summarized based on the proportion of studies reporting significant effects. The study followed PRISMA guidelines.

Results

Seventeen studies met the inclusion criteria. Only one study (6%) provided a full rationale for using a wellbeing measure as the primary outcome. Over 70% reported a significant positive effect on wellbeing. In 13 studies effect size could be calculated, 29% in reference to all 17 studies demonstrated a positive effect (ranging from small to large). Clinical implications of the wellbeing construct were discussed in 47% of the studies, including an increased emphasis on positive functioning. Fewer than 50% received a high-quality rating, and only three studies reporting significant effects used Intention-To-Treat (ITT) data.

Conclusion

Research on two-dimensional wellbeing is a promising yet underprioritized field, providing a renewed focus on abilities and generating significant clinical implications. Wellbeing ought to be a prioritized outcome in out-patient treatment policies, but today no recommendation as to which interventions are most effective are possible due to insufficient data. The implications of detecting changes in wellbeing in individuals with SMI, along with recommendations for future research, are discussed.

Effects of a CrossFit Training Program on Body Composition and Physical Fitness in Novice and Advanced Practitioners: An Inter-Individual Analysis

Background: CrossFit® has become a popular and effective training methodology. This study aimed to compare the effects of a four-week CrossFit training program and analyze the inter-individual variability on body composition (fat mass and fat-free mass) and physical fitness (push-ups, military press, back squat, deadlift, countermovement jump (CMJ), sit-ups, and 30 m sprint speed) in novice and advanced practitioners. Methods: A quasi-experimental design was used, with single-blinded (evaluators) and 2 parallel groups: novices (n = 10; age = 22.30 ± 0.81) and advanced practitioners (n = 11; age = 22.80 ± 1.41). The intervention consisted of 3 weekly 75 min sessions (4 weeks), with pre- and post-assessments. A two-factor mixed ANOVA and inter-individual analyses to classify responders (Rs) and non-responders (NRs) were performed. Results: No significant interaction effects were found. However, the novice group significantly improved back squat performance (p = 0.031). Inter-individual analysis showed higher proportions of Rs in the novice group for back squat (40%), deadlift (20%), military press (10%), CMJ (10%), sit-ups (30%), push-ups (30%), and 30 m sprint speed (10%) compared to the advanced group. Conclusions: CrossFit program did not significantly affect body composition, but novices exhibited significant back squat improvements. Considering experience levels can enhance training outcomes.

The effect of recreational games on happiness, life satisfaction, loneliness, and somatisation in elderly individuals: a non-randomized controlled trial

BACKGROUND

Participation in recreational activities supports continuity of activity and psychological well-being in old age. Games are one of these recreational activities. This study aims to measure the influence of recreational games on somatisation, loneliness, happiness and life satisfaction among elderly individuals.

METHODS

This non-randomized quasi-experimental study involved 80 individuals from two nursing homes, allocated to intervention (n = 40) and control (n = 40) groups. Participants, aged 65 or older, met cognitive eligibility criteria based on the Standardized Mini-Mental State Examination. The intervention group selected 4 games (hot-and-cold, word challenge, bingo, matching pairs) from a set of 15 and played twice weekly for two months in smaller groups. The control group maintained their usual leisure activities. Data were collected using the Oxford Happiness Questionnaire Short Form, Satisfaction with Life Scale, De Jong Gierveld Loneliness Scale, and Symptom Checklist-90-Revised Somatization Subscale at baseline, 1 week, and 1 month post-intervention.

RESULTS

The intervention group (IG) showed significant improvements compared to the control group (CG). Happiness (η² = 0.93) and life satisfaction (η² = 0.92) increased significantly in the IG (p < 0.0001), with higher scores than the CG in both the post-test (r ≈ -0.246 to -0.212, p < 0.05) and follow-up (r ≈ -0.273 to -0.309, p < 0.01). Loneliness, including emotional and social loneliness, decreased significantly in the IG (η² = 0.94, p < 0.0001), with greater reductions than the CG in the post-test and follow-up (r ≈ -0.503 to -0.593, p < 0.0001). Somatization did not change significantly within the IG but showed a reduction compared to the CG in the post-test and follow-up (r ≈ -0.226 to -0.280, p < 0.05).

CONCLUSIONS

Recreational games may give psychological benefits to older adults. Yet, results of the study need to be interpreted with caution and need to be replicated.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT06505070 (retrospectively registered, Protocol ID: Duzce-U-merve0003, Last Update Posted: 2024-08-02). https://ctv.veeva.com/study/the-effect-of-recreational-games-on-happiness-life-satisfaction-loneliness-and-somatisation-in-el?comeFrom=study-search .

Sustainable Implementation of Digital Assistive Technologies in Health Care Through a Simplified Interaction and Control Platform: Protocol for a Cocreative Feasibility Study

BACKGROUND

With the expected increase in the number of people needing care and the increasing shortage of skilled care workers, new care concepts are required. Therefore, digital assistive technologies (DATs), especially robotics, can improve the situation of people with different needs and create opportunities for participation. For a human-technology interaction to have a high level of usability, DAT's meaningfulness and effectiveness must be accessible to end users. Significant barriers to the use of DATs in health care are the lack of controllability and adaptivity, as well as control functions that are too complex.

OBJECTIVE

The objective of this paper is to develop an interaction and control platform that is understandable to a layperson and has a programming interface for DAT interactions. The innovation consists of the expansion of usage and interaction options for carers of existing DAT in a more individual manner. This is to be achieved by combining modern interactive media, a modular software architecture, and already available DAT.

METHODS

The project is planned as a mixed methods study with a longitudinal design, with multiple user involvements and measurement times in collaboration with 3 care facilities in Germany. When assessing technologies, the satisfaction of the basic human needs of competence, connection, and autonomy plays an important role in the actual use of the technology. These needs can be measured in the form of usability (System Usability Scale), intention to use (Technology Usage Inventory), and satisfaction with the carers' needs (Technology-Based Experience of Need Satisfaction). In the qualitative assessment, user experience is recorded using the think-aloud method and focus groups in order to obtain information about potential improvements of the platform.

RESULTS

The EduXBot (Educational Exploration Robot Application Platform) project was initiated in January 2023 and is scheduled to conclude in December 2025, at which point the project's final results are expected to be available. The initial results were attained in the summer of 2024 when the final concept for the platform prototype was developed. In November 2024, an initial prototype of a functional platform for the simplified interaction and control of DAT was evaluated.

CONCLUSIONS

It is expected that the open DAT system architecture enables caregivers without any previous technical knowledge to assemble their individual DAT functional portfolio. The results of the project will provide low-threshold access to interaction options for existing DAT as well as expand the usage of such technologies in an individual and patient-centered way.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien DRKS00034195; https://drks.de/search/de/trial/DRKS00034195.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/63089.

Segregation and Recycling in the Operating Room. An Intervention to Accelerate the Decarbonisation Process in the Health Sector

AIM

To evaluate the impact of a multilevel intervention in a surgical department on the segregation of non-hazardous healthcare waste (plastic and paper) during the perioperative period as well as its effect on the carbon footprint of the healthcare organisation.

METHODS

A prospective before-after interventional study without a control group was carried out in the operating room of the Universitary Hospital Mútua Terrassa in Catalonia (Spain). A multilevel programme to improve the segregation process during the surgical interventions was implemented in several phases from May 2023 to December 2024. Data collection was conducted in each phase of the study through questionnaires addressed to the professionals along with calculations of the carbon footprint and the volume of waste segregation. The study is framed within the socio-ecological model and employs a collaborative design. The study population included all professionals working in the operating room (n = 320).

RESULTS

A multidisciplinary team was formed with consideration for all stakeholders. The project phases were implemented consecutively. A total of 141 professionals (44.4%) completed the baseline questionnaire. As a result of the project's development, the carbon footprint has been reduced to 79.1 kg CO2 eq/week, representing an 85% reduction in emissions.

CONCLUSION

The implementation of the recycling project has led to significant reductions in the amount of waste generated and it has been positively evaluated by the professionals. The benefits of fostering a behavioural change among the professionals, coupled with the implementation of a well-designed segregation and recycling system, lead to significant benefits for the institution in carbon footprint.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses can lead this type of project with a clear impact on both the institution and the environment.

IMPACT

Reduction of the carbon footprint in the operating room increased satisfaction among professionals for contributing to environmental improvement.

REPORTING METHOD

The reporting of intervention evaluation studies using nonrandomized designs: the TREND statement Des Jarlais et al. (2004) was used to evaluate the quality of the study.

PATIENT OR PUBLIC CONTRIBUTION

N/A. Only professionals are involved in this study.

Effect of active teaching strategies on interprofessional clinical judgment: a quasi-experiment

OBJECTIVES

to assess the effect of active teaching strategies on clinical judgment for cardiopulmonary arrest care of patients with COVID-19 in in-hospital settings by an interprofessional team.

METHODS

quasi-experimental study without a comparison group. A total of 85 professionals were selected by non-probabilistic sampling. The educational intervention consisted of a class combined with skills training. The significance level was 5%.

RESULTS

most professionals were categorized as "proficiency" on a clinical judgment scale (52.9%). The "exemplary" category accounted for 31.8% of the total. Only 2.4% of participants were categorized as "beginning" and 12.9% were "developing" post-intervention.

CONCLUSIONS

an active strategy based on a dialogued lecture combined with skills training had a positive impact on clinical judgment improvement. Thus, participatory educational actions, based on an active teaching method, developed, in most nurses, the "proficiency" and "exemplary" levels, while, in the medical and physiotherapy team, the "exemplary" level predominated.

Respiratory muscle training reduces painful swallowing and opioid use during radiation therapy for head and neck cancer: a matched pair analysis

BACKGROUND

Patients with head and neck cancer (HNC) receiving radiation therapy (RT) are at increased risk for symptoms of oral mucositis (OM), opioid use, and declines in physical function, outcomes that contribute to increased morbidity and mortality. The study objective was to determine the effects of respiratory muscle training (RMT) on OM and opioid use, as well as functional performance in patients with HNC receiving RT with or without concurrent chemotherapy (CCRT).

METHODS

Patients aged ≥ 18 years of age with stage I to IV HNC being treated with RT or CCRT receiving a home-based respiratory muscle training (RMT) (n = 20) were compared to a 5:1 matched historical group (n = 100) who did not receive RMT. RMT was delivered using the commercially available Power Lung AireStream device (Houston, TX) via a standardized home-based inspiratory and expiratory muscle-training program requiring ~ 20-30 min/day, five days per week, with a progressively increasing workload. Primary endpoints collected from all patients included changes in OM symptoms and use of opioids for pain control following start of RT. Secondary outcomes collected on RMT patients included respiratory muscle strength and functional performance (Six-Minute Walk Test, 6MWT; Short Physical Performance Battery, SPPB). All measures were assessed before and within 1-2 weeks following a standard 7-week RT regimen.

RESULTS

RMT reduced the impact of self-reported swallowing soreness (p = 0.032), eating soreness (p = 0.036), and opioid use (p = 0.015). RMT maintained inspiratory muscle strength (+ 0.6 ± 18 cmH2O, p = 0.87), expiratory muscle strength (+ 0.7 ± 12.7 cmH2O, p = 0.197), and improved the 6MWT (+ 20 ± 39.9 m, p = 0.025), with no change in the SPPB total score (p = 0.262).

CONCLUSIONS

RMT is a low-cost intervention that is easy to perform among patients undergoing RT/RTCC for HNC and is likely to reduce OM pain/symptoms and opioid, as well as to preserve respiratory muscle strength and physical function during cancer treatment.

TRIAL REGISTRATION

Not applicable. This was a matched retrospective cohort study not registered as it was a nonrandomized trial with a historical control group.

Exploring the impact of home-based Vojta therapy on gait performance in individuals with Down syndrome: a preliminary feasibility study

Background

Vojta therapy (VT) enhances postural control and improves gait abilities. However, there is limited evidence regarding the impact of home-based VT on individuals with Down syndrome (DS).

Objective

This study aimed to assess the feasibility and preliminary effects of a two-week home-based VT program on spatiotemporal gait parameters in individuals with DS.

Methods

Sixteen individuals with DS (mean age = 17.88 ± 4.57 years, 8 females) participated in a two-week home-based VT program. Feasibility was measured through adherence rates and the occurrence of adverse events. Spatiotemporal gait parameters were evaluated before and after the intervention using the Vicon motion capture system.

Results

All participants (100%) successfully completed the home-based VT program with no reported adverse events. Significant improvements were observed in walking speed, cadence, step time (left and right), stride time (left and right), step length (left and right), stride length (left and right), and single support (left and right) (p < 0.05).

Conclusion

This preliminary study suggests that home-based VT is a feasible approach and can lead to meaningful improvements in spatiotemporal gait parameters for individuals with DS. Further research with larger sample sizes, more robust designs, and extended follow-up periods is recommended.

Can (dynamic) social norms encourage plant-based food purchases? a quasi-experimental study in real-world Dutch supermarkets

BACKGROUND

Communicating (dynamic) social norms is considered a promising tool to stimulate healthy and sustainable food choices. The aim of the present study was to evaluate to what extent a (dynamic) social norm intervention in real-world supermarkets could increase sales (grams per week) of meat alternatives (i.e. meat substitutes and legumes).

METHODS

A quasi-experimental study, including three intervention and three control supermarkets, was conducted during a 12-week period. The intervention supermarkets communicated dynamic norms textually on stickers and banners at different in-store locations (e.g. at the entrance, meat aisles). Moreover, the prominence of meat substitutes was (optically) increased and legumes were conveniently placed near the meat and meat substitutes section. Weekly sales data over a period of 75 weeks were obtained, 62 pre-intervention and 13 during intervention. Comparative interrupted time series analyses were conducted to analyse changes in meat alternative sales (in grams) during the intervention period in the intervention supermarkets compared to pre-intervention sales trends and to control supermarkets. Secondary outcomes included meat sales in grams per week and the ratio of protein content of meat alternatives to protein content of meat sales.

RESULTS

Average meat alternative sales in weekly grams before the intervention were M = 371,931.2 (SD = 113,055.3) in the control supermarkets and M = 299,012.5 (SD = 91,722.8) in the intervention supermarkets. The intervention did not change meat alternative sales in intervention supermarkets compared to pre-implementation sales trends and to control supermarkets (B = - 685.92, 95% CI [- 9904.8; 8525.7]). Sales of meats were also unaffected (B = - 130.91, 95% CI [- 27,127.50; 26,858.33]), as well as the ratio of protein content of meat alternatives to protein content of meat in grams sold per week (B = - 670.54, 95% CI [- 8990.6; 7644.4]).

CONCLUSIONS

Communicating (dynamic) social norms via textual and environmental cues (i.e. increasing the prominence of meat alternatives in supermarkets) did not increase meat alternative sales nor reduce meat sales. With supermarkets playing an important role in modulating sustainable food choices, more substantial effort or changes are needed to increase plant-based food purchases and lower meat purchases.

Training healthcare professionals in hypnosis-derived communication to mitigate procedural pain in children

How professionals communicate during medical procedures may have a significant impact on children and adolescents' pain. Rel@x is a manualized training program designed to develop hypnosis-derived communication skills to mitigate childhood pain and distress. The study aimed to evaluate if this training was associated with an improvement and maintenance in communication skills over time, and measure associations between changes and participants' characteristics. A 9-hour training in hypnosis-derived communication was offered to 78 volunteer healthcare professionals from a tertiary pediatric hospital, and 58 participated in the evaluative study. Participants were evaluated at baseline, immediately after training, and 5 months later (39 ± 10 yrs, 52 women, 54 nurses). We used a video-recorded standardized simulation protocol of blood draw and coded the participants' interactions with the pre-validated Sainte-Justine Hypnotic Communication Assessment Scale (SJ-HCAS) assessing relational, technical, and total skills. We modeled pre-post-follow-up changes over time with latent growth curve models. Satisfaction with Rel@x was consistently excellent (97%). Across the 3 domains, we observed significant improvements of total (+ 61%, 95% CI 53-69%), relational (+ 27%, 95% CI 20-34%), and technical skills (+ 124%, 95% CI 08-140%). Post-training competence levels were 73-91% across domains. A large proportion of acquired skills were maintained at 5 months (55-75%) suggesting a significant effect of the training. Sensitivity analyses confirmed these results (best-case/worst-case skill maintenance ratio: 59-79%/49-73%). Larger improvements in technical skills were associated with younger age and lower baseline skills of participants. The Rel@x training is associated with improved skills in hypnotic communication post-training and at follow-up. This simulation study paves the way for future efficacy studies to examine the effect of hypnotic communication on real patients' pain and distress.

Prehabilitation Program for Lung and Esophageal Cancers (Boosting Recovery and Activity Through Early Wellness): Protocol for a Nonrandomized Trial

BACKGROUND

Cancer is the leading cause of death in Canada, responsible for 28.2% of all deaths. Based on surgical candidacy and disease status, both lung and esophageal cancer are treated through surgical resection by a thoracic surgeon. Although surgery contributes to improved outcomes, the 30-day postoperative mortality risks are as high as 10% and 2.8%, respectively. Evidence has shown that prehabilitation is a way in which patients can have improved postoperative outcomes. Prehabilitation is multimodal, often including some form of movement, nutrition, stress management, and smoking cessation. Given the complexity of the health care system, pragmatic trials are important methodological tools to assess internal validity and improve current practice under real-world conditions. Concurrently, using community resources is imperative to keep people active in their community and create sustainable programming.

OBJECTIVE

The Boosting Recovery and Activity Through Early Wellness (BREATHE WELL) study aims to explore the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation health coaching program. This includes nutrition, smoking cessation, sleep hygiene, and movement for individuals scheduled to undergo surgery for lung or esophageal cancer.

METHODS

This is a pilot, nonrandomized, pragmatic, repeated measures, mixed methods trial. We will recruit 32 participants diagnosed with lung or esophageal cancer and are scheduled to undergo surgical resection into the prehabilitation program, with 32 additional participants who decline participation to act as a control group. Participants who agree will then go through an 8-week tailored prehabilitation program (in person or virtual), covering movement, nutrition, stress management, nutrition, goal setting, and smoking cessation. They will complete 6 sessions prior to surgery and then have 4 sessions, 1×/week following surgery. Following the completion of the program, they will have 3 booster sessions via phone or Zoom (Zoom Video Communications). The primary outcome is feasibility: (1) recruitment feasibility-recruitment rate (the number of participants referred per month), enrollment rate (the number of enrolled participants divided by the number of referred participants), reasons for declining, and prehabilitation window (time between consent and surgery); and (2) intervention feasibility-adherence to the movement intervention, attrition, safety, study completion rate, and adverse events. Secondary outcomes include measures of preliminary effectiveness including patient-reported outcomes, such as well-being, fatigue, and functional measures. All measures will be assessed before, during, and after the prehabilitation program.

RESULTS

Enrollment has begun in January 2025, with 2 participants enrolled in the health coaching program. The full study is expected to be completed in approximately 3 years and be published in winter 2027.

CONCLUSIONS

This study will inform the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation program in Nova Scotia, Canada, for people scheduled to undergo curative intent surgery for lung and esophageal cancer.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06354959; https://clinicaltrials.gov/study/NCT06354959.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/60791.

The effect of DECO-MOM mobile application for a prenatal environmental health program on environmental health behaviors: a pilot test

BACKGROUND

The DECO-MOM mobile program was developed to enhance prenatal environmental health behaviors among pregnant women, addressing the challenges of climate change and environmental pollution. This pilot study aimed to assess the feasibility and preliminary impacts of the DECO-MOM app on personal and community health behaviors, quality of life, subjective health status, depression, anxiety, and e-learning satisfaction, guided by the revised protection motivation theory.

METHODS/DESIGN

This non-randomized controlled study employed a pre-post-test design with experimental and control groups. The study analyzed data from 31 participants in the experimental group and 34 in the control group after a four-week mobile application intervention conducted from September 26 to October 24, 2023, in three cities in South Korea.

RESULTS

The experimental group demonstrated significant improvements in personal environmental health behaviors (p = .003), community environmental health behaviors (p = .001), quality of life (p = .043), and e-learning satisfaction (p = .005) compared to the control group. Significant increases were observed in subcategories such as lifestyle (p = .005), dust (p < .001), reduction (p = .011), involvement (p = .007), recycling (p = .005), reuse (p = .035), content (p < .001), and communication (p = .039). However, no significant increases were found in subjective health status, depression, or anxiety.

DISCUSSION

The DECO-MOM app demonstrated feasibility and potential as a mobile health tool to promote environmental health behaviors among pregnant women. Future studies should explore the long-term effects, scalability, and integration of psychological support features to optimize outcomes.

TRIAL REGISTRATION

Trial registration Number: KCT0007725, Registered September 22, 2022. Prospectively registered.

Peer-led digital health lifestyle intervention for a low-income community at risk for cardiovascular diseases (MYCardio-PEER): a quasi-experimental study protocol

BACKGROUND

Cardiovascular disease (CVD) poses a substantial global health burden, necessitating effective and scalable interventions for primary prevention. Despite the increasing recognition of peer-based interventions in managing chronic diseases, their application in CVD prevention still needs to be explored.

AIMS

We describe the protocol of a quasi-experiment to evaluate the effectiveness of a peer-led digital health lifestyle intervention, MYCardio-PEER, for a low-income community at risk for CVD. This study aims to assess the effectiveness of MYCardio-PEER in improving the participants' knowledge, lifestyle behaviours and biomarkers related to CVD. Secondarily, we aim to assess the adherence and satisfaction of participants towards MYCardio-PEER.

METHODS

A minimum total sample of 68 low-income community members at risk for CVD will be recruited and allocated either to the control group or the intervention group. Participants in the control group will receive standard lifestyle advice and printed materials for CVD prevention, while the intervention group will participate in the 8-week MYCardio-PEER intervention program. The participants will be assessed at Week 0 (baseline), Week 8 (post-intervention) and Week 20 (post-follow-up).

DISCUSSION

We anticipate a net improvement in CVD risk score, besides investigating the effectiveness of the intervention program on CVD-related knowledge, biomarkers, and diet and lifestyle behaviours. The successful outcome of this study is essential for various healthcare professionals and stakeholders to implement population-based, cost-effective, and accessible interventions in reducing CVD prevalence in the country.Trial registration: ClinicalTrials.gov (NCT06408493).

The Effect of the Flipped Classroom in a Nursing Informatics Course on Nursing Students' Knowledge and Readiness Levels, System Usability

The flipped classroom method to be used in the nursing informatics course can increase nursing students' engagement and learning outcomes. This study aimed to evaluate the effect of flipped classroom education on nursing students' readiness for the flipped classroom model of education, as well as the usability of the flipped classroom and how this model impacts the level of students' knowledge in a nurse informatics course. The nursing students received 6 weeks of classic education and 6 weeks of flipped classroom education in the nursing informatics course. A personal information form, the System Usability Scale, and the Flipped Learning Readiness Scale were used. The study was conducted with 84 students; the students were at an average age of 21.26 years with an average background of 7 years of using technology. An increase in the students' technology self-efficacy and readiness was observed after the implementation of the flipped classrooms. Students who received flipped classroom education rated system usability and technology self-efficacy more positively. The students' engagement in the course had a positive effect on their readiness scores. It was discovered that the factors influencing student achievement include motivation, engagement in the course, and home Internet connection. Flipped classrooms can be used to increase students' ability to use technology both in courses and in hospital clinics.

Artificial Intelligence-Based Chatbots in Chronic Disease Management: A Systematic Review of Applications and Challenges

Artificial intelligence (AI) is being used by an increasing number of conversational agents, sometimes known as chatbots. In applications related to health care, such as those that educate and assist patients with chronic illnesses, which are among the main causes of mortality in the 21st century, they are becoming more and more common. Chatbots powered by AI allows for more frequent and efficient engagement with these patients. This systematic review aimed to examine the traits, medical conditions, and AI architectures of conversational agents that are based on artificial intelligence and are specifically made for chronic illnesses. We searched four databases (Scopus, Web of Science, PubMed, and Cumulative Index to Nursing and Allied Health Literature [CINAHL]) to search for relevant studies using specific inclusion and exclusion criteria. Among these databases, we found 386 studies that were screened for duplicates and then assessed by inclusion and exclusion criteria. We included the 10 most relevant studies in this systemic review. There is a dearth of research on AI-based interactive agents for chronic illnesses, and what little is available is primarily quasi-experimental studies, including chatbots in prototype stages that employ natural language processing (NLP) and enable multimodal user engagement. Future studies could benefit from comparing and evaluating AI-based conversational bots within and between various chronic health disorders using evidence-based methodology. In addition to improving comparability, more structured development and standardized evaluation procedures could improve the caliber of chatbots created for certain chronic diseases and their subsequent effects on the target patients.

Using natural experiments to evaluate population health interventions: a framework for producers and users of evidence

Background

There has been a substantial increase in the conduct of natural experimental evaluations in the last 10 years. This has been driven by advances in methodology, greater availability of large routinely collected datasets, and a rise in demand for evidence about the impacts of upstream population health interventions. It is important that researchers, practitioners, commissioners, and users of intervention research are aware of the recent developments. This new framework updates and extends existing Medical Research Council guidance for using natural experiments to evaluate population health interventions.

Methods

The framework was developed with input from three international workshops and an online consultation with researchers, journal editors, funding representatives, and individuals with experience of using and commissioning natural experimental evaluations. The project team comprised researchers with expertise in natural experimental evaluations. The project had a funder-assigned oversight group and an advisory group of independent experts.

Results

The framework defines key concepts and provides an overview of recent advances in designing and planning evaluations of natural experiments, including the relevance of a systems perspective, mixed methods and stakeholder involvement throughout the process. It provides an overview of the strengths, weaknesses, applicability and limitations of the range of methods now available, identifies issues of infrastructure and data governance, and provides good practice considerations.

Limitations

The framework does not provide detailed information for the substantial volume of themes and material covered, rather an overview of key issues to help the conduct and use of natural experimental evaluations.

Conclusion

This updated and extended framework provides an integrated guide to the use of natural experimental methods to evaluate population health interventions. The framework provides a range of tools to support its use and detailed, evidence-informed recommendations for researchers, funders, publishers, and users of evidence.

Study registration

This methodological project was not registered.

Funding

This project was jointly funded by the Medical Research Council (MRC) and National Institute for Health and Care Research (NIHR), with project reference MC_PC_21009. The work is published in full in Public Health Research; Vol. 13, No. 3.