Study designs: Part 4 - Interventional studies

Culturally Adapted STAR-Caregivers Virtual Training and Follow-Up for Latino Caregivers of People Living With Dementia: Single-Arm Pre-Post Mixed Methods Study

Background

Latino caregivers are at an increased risk of negative health outcomes due to the responsibilities of caring for someone with dementia. Although interventions exist to address caregiver burden, they often do not meet the cultural needs of Latino caregivers.

Objective

This study aimed to pilot test the cultural adaptation of the STAR-Caregivers Virtual Training and Follow-Up (STAR-VTF) intervention. The intervention is an evidence-based training program designed to teach family caregivers strategies to manage behavioral and psychological symptoms of dementia (BPSD). Our research team has conducted past studies to identify and perform culturally relevant adaptations to the training modules of STAR-VTF, and this study aimed to pilot these culturally adapted modules with a sample of Latino caregivers.

Methods

Data on feasibility, usability, and acceptability were collected from a pilot test in which Latino caregivers (n=16) used the training modules of the STAR-VTF intervention over a 7-week period. Participants completed usability surveys following the completion of each module, and acceptability was assessed through semistructured interviews (n=14) postintervention. Preliminary outcome measures were also collected, and a descriptive analysis was conducted. The primary outcomes were the Revised Memory and Behavior Problem Checklist (RMBPC) and the Preparedness for Caregiving Scale.

Results

The pilot study results suggest that it is feasible to deliver the culturally adapted STAR-VTF intervention to Latino caregivers, with 94% (15/16) of participants maintaining enrollment through intervention completion. The intervention's usability was found to be "good" based on an average System Usability Score of 76.7 out of 100 across all training modules. Caregivers were generally satisfied with the training modules. In addition, preliminary outcome results demonstrated a trend of decreased BPSD pre- versus postintervention (RMBPC subscale score: 28.24 to 21.34). Findings also demonstrated decreased caregiver reaction to BPSD pre- versus postintervention (RMBPC subscale score: 40.40 to 37.21) and increased caregiver preparedness based on pre- and postintervention (Preparedness Caregiving Scale score: 1.98 to 2.43).

Conclusions

The pilot study demonstrated that the culturally adapted STAR-VTF intervention is feasible and perceived as easy to use by a small sample of Latino caregivers. We aim to refine the cultural adaptations of the STAR-VTF intervention further based on feedback from study participants. Future studies are necessary to test the efficacy of the intervention and support the broad dissemination of the culturally adapted intervention.

Evaluating the Impact of the Vulvar Quality of Life Index for New Patient Dermatology Assessments

BACKGROUND

The prevalence of vulvar diseases has a significant impact on quality of life (QoL). Measurement may not be consistently collected during assessments. Incorporating a QoL measurement tool may help optimize patient-centred care.

OBJECTIVE

To determine the impact of the validated Vulvar Quality of Life Index (VQLI) questionnaire during consultation assessments.

METHODS

A randomized controlled trial from a single dermatology centre was completed over 10 months. The intervention group completed the VQLI at the baseline/initial appointment, and both the intervention and control groups completed the questionnaire at follow-up, with these scores compared. Secondary outcomes compared scores within the intervention group; analyzed treatment adherence; and surveyed self-reported symptom improvement, whether patient health-related concerns were addressed, and well-being. Data were analyzed descriptively, with significance between means and proportions assessed using t-tests and Fisher's exact tests, respectively.

RESULTS

Forty-two patients participated. Scores within the intervention group, baseline (18) versus follow-up (8.3), were statistically significant. Follow-up VQLI scores in the intervention group (n = 23), 8.3, trended lower than the control (n = 19), 12.8, but were not statistically significant (P = .1529). Although treatment adherence (P = .428), symptom improvement (P = .684), and feeling of whether health-related concerns were addressed (P = .391) were similar, improvement in well-being (P = .017) in the intervention group was statistically significant.

CONCLUSIONS

In addition to the use of VQLI in vulvar dermatology assessments as an aid in identifying the impact of vulvar conditions on QoL, we recommend its use to improve the patients' sense of well-being.

Taking a Strengths-Based Approach to Mental Health in Rural Communities: What Is the Evidence for Harnessing Strengths?

OBJECTIVE

This study aimed to determine if rural community strengths identified in the literature have been causally linked to improved mental health and whether these strengths have been harnessed in interventions.

METHODS

A secondary analysis of a systematic review of literature from Australia, Canada and the USA identified 28 studies that proposed a conceptual relationship to improved mental health. Studies were categorised, their distribution across a socioecological framework was assessed, and evidence of causality was evaluated.

RESULTS

Among 28 studies, 24 were analytical and focused mainly on community strengths, with four interventional studies that addressed both personnel and community strengths. None established a causal relationship, including those that harnessed strengths in interventions.

CONCLUSIONS

Although rural strengths have been associated with improved mental health, evidence on causality, effectiveness and mechanisms for harnessing remains limited. Strengthening the evidence base is critical to justify incorporating rural strengths into mental health commissioning.

Commonly Held Beliefs About Myopia That Lack a Robust Evidence Base: 2025 Update

PURPOSE

To subject a number of areas of contention in the myopia field to evidence-based scrutiny.

METHOD

The 10 topics from our previous review were revisited, and nine new topics were also critiqued with emphasis on the recent peer-reviewed literature.

RESULTS

The following observations were made: 0.01% atropine should not be considered a frontline myopia control treatment; the role of relative peripheral hyperopia in myopia development and progression remains unclear; undercorrection probably does not slow myopia progression; treatment efficacy diminishes with time; percentage is a misleading metric of efficacy; handheld digital devices have not been proven to be myopiagenic; more time outdoors may slow myopic shift to a similar extent in children with and without myopia; daylight is responsible for only part of the impact of outdoor time; all myopia, not just high myopia, carries the risk of visually threatening complications; premyopia is a real condition. Furthermore, myopia may be considered a disease; accommodation lag may be a measurement artifact; adult myopia progression is significant; past progression is a flawed indicator to initiate myopia control; fast progression does not mean nonresponse to treatment; single vision soft contact lenses are not myopiagenic; red light therapy may not be safe; contact lens wear in children may be considered safe; rebound cannot be assessed by comparing progression during and following treatment.

CONCLUSIONS

The myopia field continues to evolve with some conflicts resolved, ongoing areas of confusion, and new uncertainties emerging.

Advancing Maternal Pain Management After Cesarean Delivery in a Rural Tanzanian Hospital Through Hybrid Global Health Education

BACKGROUND

Focused anesthesia education may be beneficial for resource-constrained settings where inadequate training along with lack of infrastructure, staff, and supplies can contribute to high anesthetic morbidity and mortality rates. Some medical outreach efforts have transitioned from short-term and service-focused "missions" to education-focused global health interventions to build health care capacity. The Stanford Anesthesiology Division of Global Health Equity partnered with Foundation for African Medicine and Education (FAME), a hospital in Karatu, Tanzania, to introduce regional anesthesia through virtual workshops and in-person bidirectional exchange. This study aimed to assess the translation of hybrid global health education in regional anesthesia to improvements on maternal post-cesarean delivery pain.

METHODS

From 2020 to 2023, the FAME team was trained in regional and acute pain techniques via virtual biannual 2-week workshops. The FAME head nurse anesthetist visited Stanford for a 5-week observership in October 2023, then a Stanford team traveled to Tanzania in January 2024 for 4 weeks of hands-on regional anesthesia training. The nurse anesthetists identified obstetric anesthesia as an area for application. Postsurgical pain management pathways were developed, introducing numerical pain scores and multimodal analgesia including transversus abdominis plane (TAP) blocks. Primary outcomes included maximum pain scores reported for the first 12 hours, pain scores at 12 hours and at 24 hours after C-section. Secondary outcomes included postoperative analgesic prescriptions, side effects, and hospital length of stay.

RESULTS

Mean maximum pain scores after C-section were significantly decreased (preintervention: 7.6 ± 1.9 [mean ± standard deviation {SD}] versus postintervention: 4.5 ± 1.6, P < .001). Smaller decreases in pain scores were observed at 12 hours (2.5 ± 1.3 vs 2.2 ± 1.1, P < .05) and 24 hours (1.1 ± 0.9 vs 0.7 ± 0.9, P < .01). Multimodal analgesia was utilized with reduction in scheduled tramadol (97.9% vs 69.9%, P < .001) and reduced side effect profiles (dizziness [29.3% vs 16.8%, P < .05] and nausea/vomiting [24.3% vs 8.8%, P < .001]).

CONCLUSIONS

This study demonstrates the impact of global health educational interventions, including virtual workshops and bidirectional exchange, on maternal pain outcomes in a Tanzanian hospital. Preintervention data collection fostered heightened awareness among the FAME nurse anesthetists of the severity of post-cesarean pain. The introduction of TAP blocks further improved their existing multimodal analgesic strategy with a clinically significant reduction in maximum pain scores. This educational strategy aims to advance global anesthesia goals, including building longitudinal partnership, thereby enhancing access to safe anesthesia education and promoting sustainable capacity building.

Preliminary evaluation of a gamified smartphone intervention (O2O-PEP) for enhancing HIV post-exposure prophylaxis uptake in men who have sex with men: pilot feasibility study

BACKGROUND

Addressing the burden of human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) has become a major priority. Over the years, post-exposure prophylaxis (PEP) has proven efficacy in preventing HIV transmission. However, the widespread underutilization of PEP undermines its protective potential. To address this issue, we developed an innovative, gamified mini-app embedded in WeChat, known as O2O-PEP (online-to-offline collaborative model for HIV postexposure prophylaxis), that targets PEP uptake.

OBJECTIVE

We aimed to conduct a pilot feasibility study to assess the feasibility, acceptability, and preliminary efficacy of O2O-PEP in promoting PEP uptake among Chinese MSM.

METHODS

A single-arm, pre-post feasibility study combing quantitative and qualitative methods for data collection was performed in Qingdao, China. Eligible MSM were invited to use the O2O-PEP for 2 weeks. The mini-app provides an online-to-offline service model, enabling MSM to access PEP-related character-based narratives, share on moments, sexual transmitted disease picture test quizzes, e-Consultation, and referrals to offline PEP service providers. Additionally, gamification features, such as reward-based engagement and social support, are incorporated to enhance user motivation. Intervention feasibility was tested by looking at participant engagement data. The acceptability of the intervention was explored with System Usability Scale (SUS) and in-depth interviews. Preliminary efficacy was measured by assessing HIV PEP knowledge and HIV PEP uptake.

RESULTS

A total of twenty Chinese MSM were successfully enrolled. All participants completed baseline outcome measures, and 19 (19/20, 95%) completed outcome measures at 2 weeks. Participants had a mean age of 29.65 years (SD 9.17). PEP knowledge scores increased from 7.79 (SD 1.69) at baseline to 9.68 (SD 2.86) at the two-week follow-up, reflecting a large Cohen's d effect size of 0.8. One participant successfully accessed PEP within 12 h after engaging in condomless anal sex with a stranger during the intervention period. On average, participants spent 35.84 min using the mini-app over a two-week period, though app usage declined over the study period. Acceptability ratings ranged from moderate to extreme across several dimensions, including satisfaction, usability, recommendation of the mini-app to others, and user-friendliness. Ratings for the difficulty of using O2O-PEP was somewhat lower. Regarding the SUS score, 89.5% of participants rated the mini-app within the acceptable usability range (≥ 50), indicating that the majority found the mini-app to be user-friendly. Qualitative analysis of follow-up assessments identified areas where O2O-PEP needed to be improved to enhance user engagement, including a desire to additional functions of psychological and sexual transmitted diseases counseling.

CONCLUSIONS

This study pioneers the application of gamification to PEP uptake, demonstrating the feasibility and acceptability of O2O-PEP. A further efficacy trial is currently underway.

TRIAL REGISTRATION

This study was prospectively registered at the Chinese Clinical Trial Registry (No. ChiCTR2200062538) on 11 Augst, 2022.

Supporting women undergoing radiotherapy for cervical cancer: A pilot intervention

Background

Cervical cancer is the second most common cancer among women in South Africa. Treatment is tailored but external beam radiation and brachytherapy with or without concomitant chemotherapy are commonly used.

Aim

This study aimed to pilot test a support programme for women receiving curative radiotherapy for cervical cancer.

Setting

The Radiation Oncology Department at an academic hospital in the Gauteng province.

Methods

An intervention design and pre-test post-test approach was used. The primary outcome was perceived social support and the secondary outcome was quality of life (QoL). Census sampling entered 56 women in the programme but only 15 completed it. The Berlin Social Support Scale (BSSS) and EORTC QOQ-CX24 served as data collection instruments. Descriptive statistics were used to analyse the data using a completer only approach.

Results

The majority of both the pre-intervention (n = 56) and post-intervention (n = 15) groups were older than 40 years (62.5%, n = 35 and 73.4%, n = 11, respectively). Most of the support categories except for 'support seeking' showed statistical significant differences before and after the programme. Symptom experience had the highest mean score of the symptoms scales both before and after the programme (M = 50.7 and 41.8, respectively).

Conclusion

Positive results were obtained in terms of support, but QoL did not show the same trend. However, it would be feasible to refine the programme and conduct a second pilot test.

Contribution

Our study seems to be the first of its kind and illustrates the positive influence a support programme can have on the lives of women receiving radiotherapy for cervical cancer.

Influence of Resistance Training Variables and the Nordic Hamstring Exercise on Biceps Femoris Architectural Adaptations in Soccer Players: A Systematic Review

CONTEXT

Manipulation of resistance training variables influences the structural and functional adaptations of muscle, having a great impact on sport performance and hamstring injury prevention.

OBJECTIVE

To analyze how the main resistance training variables affect the biceps femoris long head architecture in soccer players.

DATA SOURCES

Five databases were searched from inception to January 2024.

STUDY SELECTION

Studies that included training intervention groups and measured muscle architecture adaptations before and after the training program in soccer players were included.

STUDY DESIGN

Systematic review with meta-analysis.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

Muscle thickness, fascicle length, and pennation angle were extracted from included studies as main outcomes.

RESULTS

Six studies and 12 training groups (168 participants) were analyzed. The effects of Nordic hamstring exercise (NHE) against soccer interventions, volume of training, and frequency of training as independent variables were analyzed. NHE significantly improved biceps femoris long head fascicle length (P = 0.01). Training twice a week did not show significant differences compared with training once a week. Higher volumes of training (ie, >290 repetitions) in a period of 6 to 12 weeks with 57 repetitions per week demonstrated significant effects.

CONCLUSION

NHE lengthens the fascicle, especially if a sufficient volume (ie, >290 repetitions) and 2 days per week are performed. It is still unknown how the programming of some fundamental variables such as intensity, degree of effort, or exercise selection affects the muscle architecture of the biceps femoris long head.

An Expert Consensus Statement on Biomarkers of Aging for Use in Intervention Studies

Biomarkers of aging serve as important outcome measures in longevity-promoting interventions. However, there is limited consensus on which specific biomarkers are most appropriate for human intervention studies. This work aimed to address this need by establishing an expert consensus on biomarkers of aging for use in intervention studies via the Delphi method. A 3-round Delphi study was conducted using an online platform. In Round 1, expert panel members provided suggestions for candidate biomarkers of aging. In Rounds 2 and 3, they voted on 500 initial statements (yes/no) relating to 20 biomarkers of aging. Panel members could abstain from voting on biomarkers outside their expertise. Consensus was reached when there was ≥70% agreement on a statement/biomarker. Of the 460 international panel members invited to participate, 116 completed Round 1, 87 completed Round 2, and 60 completed Round 3. Across the 3 rounds, 14 biomarkers met consensus that spanned physiological (eg, insulin-like growth factor 1, growth-differentiating factor-15), inflammatory (eg, high sensitivity C-reactive protein, interleukin-6), functional (eg, muscle mass, muscle strength, hand grip strength, Timed-Up-and-Go, gait speed, standing balance test, frailty index, cognitive health, blood pressure), and epigenetic (eg, DNA methylation/epigenetic clocks) domains. Expert consensus identified 14 potential biomarkers of aging which may be used as outcome measures in intervention studies. Future aging research should identify which combination of these biomarkers has the greatest utility.

Impact of physical activity on semen quality: a review of current evidence

A growing global trend indicates a decline in semen quality, with a lack of physical activity identified as one of the contributing factors. Exercise is medication, and numerous studies have explored its effects on semen quality. However, there is no consensus on the most effective type and intensity of exercise for improving semen quality, owing to inconsistent findings across studies. These discrepancies may be attributable to variations in study populations (e.g., healthy versus infertile individuals) and research methodologies (e.g., observational versus interventional studies). This paper reviews the existing literature from the databases PubMed, Web of Science, and Google Scholar, reclassifying articles on their subject and research designs to delineate the relationship between exercise and semen quality. It also summarizes the mechanisms through which exercise influences semen quality, including hormonal regulation, oxidative stress, and inflammatory factors.

Exercise medicine for individuals diagnosed with Lung Cancer: A systematic review and meta-analysis of health outcomes

Consensus exists regarding the need to provide exercise interventions to individuals diagnosed with lung cancer (LC). Exercise interventions for this populations usually include multidisciplinary approaches, making the attempt to understand the effects of exercise a real challenge. Therefore, we designed a systematic review to identify the effects of exercise interventions among individuals with a LC diagnosis. Following the PRISMA guidelines, studies across 5 different databases were systematically screened. Eligible studies were randomised and non-randomised trials, including individuals with a LC diagnosis, administering exercise-only interventions. Three-level meta-analyses were performed for cardiorespiratory fitness, strength, physical function, anxiety, depression, and health-related quality of life. Differences between exercise types were also explored. The Cochrane Risk of Bias (RoB) II tool for randomised controlled trials and the RoB in non-randomised studies - of interventions were used to assess study quality. A total of 36,304 records were screened and 13 studies, including 547 LC survivors, were considered eligible. Randomised and non-randomised trials were mainly judged as "some concern" and at "serious" RoB, respectively. Meta-analyses reported significant improvements on physical function among exercise groups compared to control (ES = 0.62; 95 % CI: 0.10 to 1.15; p = 0.03), and no significant changes for all other variables. There is moderate evidence that exercise interventions appear to be an effective tool to improve physical function among individuals diagnosed with LC. Further studies are still needed to determine exercise prescription effectiveness on health outcomes, differences across exercise types and enhance individualized interventions.

Pathway mapping of exhaled volatile organic compounds associated with blood and ruminal fluid metabolites to describe the nutritional and metabolic status of lactating dairy cows

Exhaled breath offers an interesting matrix for low invasive sampling of potentially relevant information about the organism's metabolism in the form of volatile organic compounds (VOC). The VOC can be exhaled by the ructus or pass the blood-lung barrier for expiration through the lungs. In this work, we consider exhaled breath as a mixture of VOC derived from the lungs and from the upper gastrointestinal tract. However, the informative value of exhaled breath in ruminants remains largely unstudied. The aim of this study was to identify exhaled VOC that could be used to assess the nutritional and metabolic status of dairy cows. To do so, we performed untargeted analysis of exhaled VOC from dairy cows, investigated their correlations with commonly analyzed blood and ruminal fluid metabolites and the calculated energy balance (EB), and explored the underlying pathways of correlated exhaled VOC. This was done as part of a feeding experiment in which 32 lactating Holstein dairy cows were assigned to 2 basal diets for 12 wk. Half of the cows were fed a hay-based diet, and the other half were fed a silage-based diet. During experimental wk 1 through 8, half of the cows in each basal diet group were supplemented with a control concentrate, and the other half received an experimental concentrate containing essential oils. During experimental wk 9 through 12, all cows received the control concentrate. Exhaled breath, blood, and ruminal fluid samples were collected every 4 experimental weeks (wk 4, 8, and 12) on 3 consecutive sampling days. Exhaled breath was analyzed for VOC, ruminal fluid for VFA and ammonia, and serum samples for albumin, total protein, urea, glucose, cholesterol, BHB, and nonesterified fatty acid (NEFA) concentrations. Pearson correlations were calculated to assess the associations between exhaled VOC and concentrations of blood and ruminal fluid metabolites and the calculated EB. Fifteen correlations were found between exhaled VOC (tetradecanal and γ-hydroxybutyrate [GHB], 3-penten-2-one, 4-hydroxy-4-methylpentan-2-one, 2-ethylhexanal, 2-ethylhexan-1-ol, p-cymene) and ruminal fluid (acetate, butyrate, valerate, and ammonia) and blood metabolite concentrations (BHB, NEFA, glucose, urea, and cholesterol) across the cow groups. The underlying pathways of 3-penten-2-one, GHB, and tetradecanal were mainly related to fat and protein catabolism and therefore to the actual animal metabolism. The correlations with the other 4 exhaled VOC, 4-hydroxy-4-methylpentan-2-one, p-cymene, 2-ethyl-hexan-1-ol, and 2-ethylhexanal, were diet- or time-related, specifically due to differences in feed ingredients. The results demonstrate the associations of single exhaled VOC with the nutritional and metabolic status of healthy dairy cows. Their potential as new biomarkers should be further investigated in cows in various nutritional and metabolic states.

Impact of a Novel Virtual Rounding Queue Software on Nurse and Family Presence for Rounds in the Neonatal Intensive Care Unit: A Pilot Study

OBJECTIVE

Coordination to get everyone in the room at the same time for family-centered rounds (FCR) is challenging. The objective of this study was to determine if using a virtual queue that notifies nurses and families in real time when to expect the rounding team could impact their presence on rounds.

METHODS

We observed rounds on two neonatal intensive care unit (NICU) teams for 6 weeks before and after implementation of a novel rounding software, Q-rounds, that shares real-time updates on when the team will arrive and allows families to répondez s'il vous plaît (RSVP) to join remotely when they cannot be there in person. Observers collected metrics pertinent to FCR including nurse and family presence (in-person or remotely) and duration of rounds and used Chi-square and two group t-tests for analysis.

RESULTS

Rounds were observed for 165 patient encounters pre-implementation and 179 patient encounters post-implementation, with an average rounding duration of 10.3 minutes (SD 6.5) and 10.4 minutes (SD 6.3) per patient respectively (P = 0.91). The proportion of nurses who were present for the entirety of the rounding discussion increased from 18.8% to 58.2% (P < 0.001). Family presence on rounds increased from 20.0% (95% CI, 13.9-26.1) to 43.0% (95% CI, 35.8-50.3; P < 0.001). The percentage of families that participated in rounds remotely increased from 15.2% to 55.8% (P < 0.001).

CONCLUSIONS

This observational study showed that the use of a novel rounding software was associated with a significant increase in family presence for rounds and nurse presence for the entirety of rounds without increasing rounding duration.

A scoping review of communication outcomes measures in augmentative and alternative communication

Although outcomes are a critical component of evidence-based practice, measuring augmentative and alternative communication (AAC) outcomes remains problematic. This is, in part, because there is no consensus on how to operationally define AAC communication outcomes. To gain greater insight into AAC communication outcomes, we used the communicative competence framework to determine which areas of AAC intervention have received the greatest attention and how these outcomes are being measured. The following data were charted from the 77 studies that met the inclusion criteria for the scoping review: study design, study participants, study communication target (e.g., language, word learning, etc.), and communication outcome measurements. Across the included studies, researchers used a variety of standardized and non-standardized measures to assess outcomes. Seventy-seven percent of the studies assessed social skills and 62% assessed linguistic skills. A limited number of studies measured operational (14%), strategic (4%), and psychosocial (18%) skills. Using the communicative competence framework enabled us to identify gaps in the research that has been conducted to date.

A Bibliometric Analysis of Healthcare Intervention-Related Studies Reporting Patient and Public Involvement and Engagement

BACKGROUND/OBJECTIVES

Patient and public involvement and engagement (PPIE) has gained global recognition as an innovative healthcare research practice. PPIE engages end-users throughout the research process, improving intervention effectiveness, resource efficiency, and user satisfaction. Despite its increasing inclusion in studies, comprehensive bibliometric reviews of healthcare intervention-related studies reporting PPIE are scarce. This study aims to conduct a bibliometric analysis of healthcare intervention-related studies reporting PPIE in recent decades to identify key worldwide bibliometric features, themes, and trends.

METHODS

The analysis includes 10,624 relevant English articles published in the Web of Science (WoS) Core Collection up to 26 November 2024. Search terms were selected based on PPIE conceptualization, interventional types, and related healthcare terms. Using WoS descriptive analysis and CiteSpace, we examined bibliometric features and identified major international themes and trends.

RESULTS

There has been a significant increase in the number of healthcare intervention-related studies reporting PPIE over the past five years, especially from the United States and the United Kingdom, with a recent rise in Asia. However, cross-national collaboration remains limited. Key research themes identified include "community participation", "health equity", "coronary heart disease", "web-based patient empowerment", "mental illness", and "obesity prevention", with growing interest in "mobile health" and "digital health".

CONCLUSIONS

This study provides a comprehensive and up-to-date overview of the bibliometric characteristics and evolving trends in healthcare intervention-related studies reporting PPIE. It highlights global regions with limited PPIE implementation, suggests pathways for further development, and identifies key research themes. The study offers researchers and practitioners valuable insights into tracking PPIE trends in healthcare interventions and fostering collaborations on evidence-based PPIE studies with leading scholars and institutions worldwide. Additionally, the findings drive innovations aimed at improving patient and public healthcare outcomes.

Feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing intervention among men in two Ugandan fishing communities, 2022

BACKGROUND

Social network-based interventions can improve uptake of health interventions. However, limited evidence exists on their feasibility and acceptability in fishing community settings. We assessed the feasibility, acceptability and preliminary effects of a social network-based, peer-led HIV self-testing (HIVST) intervention among men in Uganda.

METHODS

The PEer-led HIVST intervention for MEN (PEST4MEN) is a pilot intervention conducted among men in Kalangala and Buvuma districts. Baseline data were collected in July 2022 and follow-up data in September 2022. The intervention was implemented through 22 trained lay men ("peer-leaders") who received training in HIVST use and distribution processes and requested to refer at least 20 male members from their social networks for study eligibility screening. To be eligible, men had to be aged 15 years or older with unknown or HIV-negative status. After the baseline interview, men were requested to pick two oral fluid-based HIVST kits from their peer-leaders. The intervention was deemed feasible if peer-leaders gave-out > 80% of the kits and acceptable if > 80% of the kits' recipients used them to self-test for HIV. At the follow-up interview, newly diagnosed HIV-positive men were asked if they had linked to HIV care. Data were descriptively analyzed using STATA version 16.0.

RESULTS

Of 475 screened men, 400 (84.2%) met the eligibility criteria and completed the baseline interview. Of these, 56.7% (n = 227) were engaged in fishing or fishing-related activities. At follow-up, 361 men (90.2%) were interviewed; 98.3% (n = 355) received at least one kit from their peer-leaders. Nearly all (99.1%, n = 352) kits' recipients used them to self-test for HIV. Of the 352 HIV self-testers, 51 men (14.5%) had reactive (positive) HIV self-test results. Nearly one-third of the HIV self-tested men (31.4%, n = 16) were first-time HIV-positive testers. Of these, 87.5% (n = 14) went for confirmatory HIV testing, 50.0% (n = 7) were confirmed as HIV-positive and 71.4% (n = 5) were linked to HIV care.

CONCLUSION

Our peer-led HIVST intervention was feasible and acceptable and identified newly diagnosed HIV-positive men who were linked to HIV care. However, while these results are promising, we recommend additional research in a randomized controlled trial prior to the eventual roll-out of this intervention.

TRIAL REGISTRATION

ClinicalTrials.Gov: NCT05685498 (retrospectively registered on January 17, 2023).

Novel trial designs: Master protocol trials

Conventional trial designs are resource and time-intensive. To accelerate the process of testing new interventions, we now have several novel research trial designs. This article focuses on master protocol trials, which allow several therapies to be tested within a single larger trial.

The effect of computer-based Stress Inoculation Training (SIT) approach on the pelvic pain, depression, and anxiety in students with primary dysmenorrhea: a clinical trial study

BACKGROUND

Primary dysmenorrhea (PD) is one of the most common pains experienced by women. Stress Inoculation Training (SIT) is a cognitive-behavioral technique that immunizes them against future periods of stress. The purpose of this research is to investigate the effectiveness of a computer-based stress inoculation approach on pelvic pain, depression, and anxiety symptoms in students with PD.

METHODS

The present study is a clinical trial conducted on 100 students with PD. The SIT intervention consisted of eight consecutive sessions. The content of the sessions was created as multimedia on a computer platform of a site. In each session, several interactive questions were asked about the topics of that session, and participants answered them, with responses recorded in the system. Then, each individual session, lasting about 50 min, was sent as a link (offline) to a participant. Data collection tools included the demographics Checklist, McGill Pain Questionnaire (MPQ), Moos Menstrual Distress Questionnaire (MMDQ), Hospital Anxiety and Depression Scale (HADS), Pain Self-Efficacy Questionnaire (PSEQ), and Perceived Stress Scale (PSS-14), which were completed on the second menstrual day of the cycle before the study and for three consecutive cycles after the intervention by each student. The data were analyzed using chi-square, generalized linear mixed models (GLMM), and multiple linear regression tests. The significance level was set at P < 0.05.

RESULTS

The results of the GLMM test showed that the SIT intervention decreased depression (p = 0.002), anxiety (p = 0.001), menstrual distress (p = 0.001), pain intensity (p = 0.003), and perceived stress (p = 0.002), while it increased pain self-efficacy (p = 0.001). Based on multiple linear regression analysis, the main predictors of depression were the student's age and residence in a dormitory (β=-0.255, p = 0.047 and β=-0.376, p = 0.005, respectively). The factors influencing pain self-efficacy were birth rank and the type of university admission (β=-0.351, p = 0.027 and β=-0.249, p = 0.030, respectively). In the presence of confounding variables, increasing age and living in a dormitory were risk factors that increased depression, while studying with tuition fees and a higher birth rank were associated with decreased self-efficacy.

CONCLUSION

The computer-based SIT was effective in reducing pelvic pain, and psychological factors, and in increasing pain self-efficacy in students with primary dysmenorrhea. Therefore, it can be used as a useful solution to manage complications associated with primary dysmenorrhea.

TRIAL REGISTRATION

IRCT20230130057274N5 Date of registration: 2024-04-29 Retrospectively registered.

Comparison of the effectiveness of botulinum toxin, dry needling, pharmacological treatment, and manual therapy for bruxism-induced myalgia: a prospective randomized study

Bruxism is a significant phenomenon that should not be underestimated, given its prevalence and consequences. The major symptoms associated with bruxism include myalgia, decreased quality of life, and limited mandibular movements. This study aimed to evaluate and compare the effectiveness of four treatment methods for managing bruxism-related symptoms: botulinum toxin (BoNT-A), dry needling (DN), pharmacological therapy (PT), and manual therapy (MT). Eighty patients with bruxism (44 female, 36 male) were randomly assigned to four groups of 20 patients each. All therapies were administered by the same maxillofacial surgeon. Measurements were recorded at baseline (pre-treatment) and at 2, 4 and 12 weeks post-treatment. The metrics assessed included the visual analog scale (VAS) for pain, maximum painless mouth opening (MMO), and the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Statistical analysis was performed using a mixed-design repeated measures two-way analysis of variance (ANOVA) to compare changes within and among the groups over time. Tukey's multiple comparison test was applied for further analysis. The results indicated that both objective and subjective clinical outcomes were similar across all treatment groups. Considering their competitive efficiency, non-invasiveness or minimal invasiveness, and cost-effectiveness, DN, MT and PT appear to be promising alternatives for managing bruxism and its symptoms, especially in the early stages. ClinicalTrials ID: NCT06583551.

Switching Mediterranean Consumers to Mediterranean Sustainable Healthy Dietary Patterns (SWITCHtoHEALTHY): Study Protocol of a Multicentric and Multi-Cultural Family-Based Nutritional Intervention Study

BACKGROUND/OBJECTIVES

Populations in Mediterranean countries are abandoning the traditional Mediterranean diet (MD) and lifestyle, shifting towards unhealthier habits due to profound cultural and socioeconomic changes. The SWITCHtoHEALTHY project aims to demonstrate the effectiveness of a multi-component nutritional intervention to improve the adherence of families to the MD in three Mediterranean countries, thus prompting a dietary behavior change.

METHODS

A parallel, randomized, single-blinded, and controlled multicentric nutritional intervention study will be conducted over 3 months in 480 families with children and adolescents aged 3-17 years from Spain, Morocco, and Turkey. The multi-component intervention will combine digital interactive tools, hands-on educational materials, and easy-to-eat healthy snacks developed for this study. Through the developed SWITCHtoHEALTHY app, families will receive personalized weekly meal plans, which also consider what children eat at school. The engagement of all family members will be prompted by using a life simulation game. In addition, a set of activities and educational materials for adolescents based on a learning-through-playing approach will be codesigned. Innovative and sustainable plant-based snacks will be developed and introduced into the children's dietary plan as healthy alternatives for between meals. By using a full-factorial design, families will be randomized into eight groups (one control and seven interventions) to test the independent and combined effects of each component (application and/or educational materials and/or snacks). The impact of the intervention on diet quality, economy, and the environment, as well as on classical anthropometric parameters and vital signs, will be assessed in three different visits. The COM-B behavioral model will be used to assess essential factors driving the behavior change. The main outcome will be adherence to the MD assessed through MEDAS in adults and KIDMED in children and adolescents.

CONCLUSIONS

SWITCHtoHEALTHY will provide new insights into the use of sustained models for inducing dietary and lifestyle behavior changes in the family setting. It will facilitate generating, boosting, and maintaining the switch to a healthier MD dietary pattern across the Mediterranean area. Registered Trial, National Institutes of Health, ClinicalTrials.gov (NCT06057324).

Research designs for cardiothoracic surgeons: part 1 - a primer for evidence-based practice

Understanding research designs is crucial for cardiothoracic surgeons to enhance their clinical practice and decision-making. This article provides a comprehensive overview of different research study types, including observational and experimental studies, and their relevance to cardiothoracic surgery. Detailed explanations of cohort, case-control, and cross-sectional studies, as well as various types of randomized controlled trials, are presented. Key terms and concepts like bias, validity, and reliability are discussed. Practical case examples from the literature illustrate the application of these research designs, aiding clinicians in selecting the appropriate study design for their research questions.

"This Is Me" an Awareness-Raising and Anti-Stigma Program for Undergraduate Nursing Students: A Pre-Post Intervention Study

BACKGROUND

Stigma education for nursing students has focused solely on stigma reduction, with studies showing temporary improvements in attitudes. However, nursing education research should also emphasize the importance of critical reflection and self-reflection to enhance attitudes, beliefs, topic comprehension, and learning satisfaction. This study aimed to evaluate the effectiveness of the "This is me" intervention regarding knowledge, attitudes, and communication skills of senior undergraduate nursing students in responding to mental illness-related stigma.

METHODS

This study employed a psychoeducational intervention for reducing mental illness stigma, using a questionnaire survey to assess pre- and post-intervention effects, with 37 eligible nursing students undergoing clinical training in psychiatric services between 16 May and 15 July 2022. Instruments included sociodemographic and health questions, the MICA-4 scale to evaluate students' attitudes toward mental illness, the MAKS to measure mental health knowledge, the Empathy Scale (JSPE-S), the Intergroup Anxiety Scale (SS-12), and the Attribution Questionnaire (AQ-27).

RESULTS

Most students were female (73.0%) and single (70.3%), with a mean age of around 29 years. After implementing the psychoeducational program, there was a statistically significant increase in overall stigma-related knowledge (MAKS: Z = -1.99, p < 0.05), a decrease in intergroup anxiety (IAS: Z = -3.42, p < 0.05), and reductions in the perceptions of patients as dangerous (AQ27-Dangerousness: Z = -2.399, p < 0.05) and fear (AQ27-Fear: Z = -2.415, p < 0.05). Additionally, there was an improvement in empathy, specifically in Perspective Taking (JSPE: Z = -2.555, p < 0.05).

CONCLUSIONS

This program may contribute to mental health literacy related to stigma, positively impacting therapeutic relationships and communication with people with mental illness and resulting in more effective care practices.

Statistical tools and packages for data collection, management, and analysis - A brief guide for health and biomedical researchers

Previous articles in this series have looked at various aspects of planning, designing, conducting and interpreting biomedical research. In this article, we offer an overview of some tools and resources available to health and biomedical researchers, to help them with their research.

The educational game SonoQz improves diagnostic performance in ultrasound assessment of ovarian tumors

INTRODUCTION

Our objective was to determine whether the educational game SonoQz can improve diagnostic performance in ultrasound assessment of ovarian tumors.

MATERIAL AND METHODS

The SonoQz mobile application was developed as an educational tool for medical doctors to practice ultrasound assessment, based on still images of ovarian tumors. The game comprises images from 324 ovarian tumors, examined by an ultrasound expert prior to surgery. A training phase, where the participants assessed at least 200 cases in the SonoQz app, was preceded by a pretraining test, and followed by a posttraining test. Two equal tests (A and B), each consisting of 20 cases, were used as pre- and posttraining tests. Half the users took test A first, B second, and the remaining took the tests in the opposite order. Users were asked to classify the tumors (1) according to International Ovarian Tumor Analysis (IOTA) Simple Rules, (2) as benign or malignant, and (3) suggest a specific histological diagnosis. Logistic mixed models with fixed effects for pre- and posttraining tests, and crossed random effects for participants and cases, were used to determine any improvement in test scores, sensitivity, and specificity.

RESULTS

Fifty-eight doctors from 19 medical centers participated. Comparing the pre- and posttraining test, the median of correctly classified cases, in Simple Rules assessment increased from 72% to 83%, p < 0.001; in classifying the lesion as benign or malignant tumors from 86% to 95%, p < 0.001; and in making a specific diagnosis from 43% to 63%, p < 0.001. When classifying tumors as benign or malignant, at an unchanged level of sensitivity (98% vs. 97%, p = 0.157), the specificity increased from 70% to 89%, p < 0.001.

CONCLUSIONS

Our results indicate that the educational game SonoQz is an effective tool that may improve diagnostic performance in assessing ovarian tumors, specifically by reducing the number of false positives while maintaining high sensitivity.

Evaluation of the Impact of a Less-Invasive Trunk and Pelvic Trauma Protocol on Mortality in Patients with Severe Injury by Interrupted Time-Series Analysis

Background and Objectives: Minimally invasive trauma management, including interventional radiology and non-operative approaches, has proven effective. Consequently, our hospital established a trauma IVR protocol called "Ohta Nishinouchi Hospital trauma protocol (ONH trauma protocol) in 2013, mainly for trunk trauma. However, the efficacy of the ONH trauma protocol has remained unverified. We aimed to assess the protocol's impact using interrupted time-series analysis (ITSA). Materials and Methods: This retrospective cohort study was conducted at Ohta Nishinouchi hospital, a tertiary emergency hospital, from January 2004 to December 2019. We included patients aged ≥ 18 years who presented to our institution due to severe trauma characterized by an Abbreviated Injury Scale of ≥3 in any region. The primary outcome was the incidence of in-hospital deaths per 100 transported patients with trauma. Multivariable logistic regression analysis was conducted with in-hospital mortality as the outcome, with no exposure before protocol implementation and with exposure after protocol implementation. Results: Overall, 4558 patients were included in the analysis. The ITSA showed no significant change in in-hospital deaths after protocol induction (level change -1.49, 95% confidence interval (CI) -4.82 to 1.84, p = 0.39; trend change -0.044, 95% CI -0.22 to 0.14, p = 0.63). However, the logistic regression analysis revealed a reduced mortality effect following protocol induction (odds ratio: 0.50, 95% CI: 0.37 to 0.66, p < 0.01, average marginal effects: -3.2%, 95% CI: -4.5 to -2.0, p < 0.01). Conclusions: The ITSA showed no association between the protocol and mortality. However, before-and-after testing revealed a positive impact on mortality. A comprehensive analysis, including ITSA, is recommended over before-and-after comparisons to assess the impact of the protocol.

Sample size calculation in clinical research

Calculation of sample size is an essential part of research study design since it affects the reliability and feasibility of the research study. In this article, we look at the principles of sample size calculation for different types of research studies.

Impact of Promotional Videos on Public Perception of Pharmacy Services

Background: Promotional videos are an effective means of marketing products or services in this era of social media. However, little is known if such videos can be a useful tool to promote pharmacy services. Objective: To assess the impact of promotional videos on public awareness of the health services provided by New Zealand pharmacists. Methods: This experimental study used an online questionnaire and promotional videos developed by the Pharmaceutical Society of New Zealand as an intervention to assess the public's perspectives about pharmacy services before and after the intervention. The survey was sent out to 1 127 randomly selected members of the public aged 18 and above from all over New Zealand. Data were analysed using descriptive statistics and thematic analysis. Results: A total of 313 participants completed the survey. The majority (95.8%) had not heard of the promotional videos before. However, 84.3% found the videos informative and nearly three-quarters (74.1%) reported a change in their perception of pharmacy services after watching the video. Similarly, 63.2% reported that they or a family member would be more likely to visit a pharmacy in the future after watching the promotional video. Less than half (40%) of the participants reported that the videos were too long and only 11.5% found them boring. Conclusion: The PSNZ videos were found to be an effective tool for educating New Zealanders on different pharmacy services and the pharmacy profession, however, there is a need to choose the advertising platform carefully so as to enhance the coverage.

Efficacy and safety of corticosteroids and ACTH in epileptic syndromes beyond Infantile Epileptic Spasms Syndrome (IESS): A systematic review and meta-analysis

We conducted a systematic review investigating the efficacy and tolerability of adrenocorticotropic hormone (ACTH) and corticosteroids in children with epilepsies other than infantile epileptic spasm syndrome (IESS) that are resistant to anti-seizure medication (ASM). We included retrospective and prospective studies reporting on more than five patients and with clear case definitions and descriptions of treatment and outcome measures. We searched multiple databases and registries, and we assessed the risk of bias in the selected studies using a questionnaire based on published templates. Results were summarized with meta-analyses that pooled logit-transformed proportions or rates. Subgroup analyses and univariable and multivariable meta-regressions were performed to examine the influence of covariates. We included 38 studies (2 controlled and 5 uncontrolled prospective; 31 retrospective) involving 1152 patients. Meta-analysis of aggregate data for the primary outcomes of seizure response and reduction of electroencephalography (EEG) spikes at the end of treatment yielded pooled proportions (PPs) of 0.60 (95% confidence interval [CI] 0.52-0.67) and 0.56 (95% CI 0.43-0.68). The relapse rate was high (PP 0.33, 95% CI 0.27-0.40). Group analyses and meta-regression showed a small benefit of ACTH and no difference between all other corticosteroids, a slightly better effect in electric status epilepticus in slow sleep (ESES) and a weaker effect in patients with cognitive impairment and "symptomatic" etiology. Obesity and Cushing's syndrome were the most common adverse effects, occurring more frequently in trials addressing continuous ACTH (PP 0.73, 95% CI 0.48-0.89) or corticosteroids (PP 0.72, 95% CI 0.54-0.85) than intermittent intravenous or oral corticosteroid administration (PP 0.05, 95% CI 0.02-0.10). The validity of these results is limited by the high risk of bias in most included studies and large heterogeneity among study results. This report was registered under International Prospective Register of Systematic Reviews (PROSPERO) number CRD42022313846. We received no financial support.

Exploiting integrative metabolomics to study host-parasite interactions in Plasmodium infections

Despite years of research, malaria remains a significant global health burden, with poor diagnostic tests and increasing antimalarial drug resistance challenging diagnosis and treatment. While 'single-omics'-based approaches have been instrumental in gaining insight into the biology and pathogenicity of the Plasmodium parasite and its interaction with the human host, a more comprehensive understanding of malaria pathogenesis can be achieved through 'multi-omics' approaches. Integrative methods, which combine metabolomics, lipidomics, transcriptomics, and genomics datasets, offer a holistic systems biology approach to studying malaria. This review highlights recent advances, future directions, and challenges involved in using integrative metabolomics approaches to interrogate the interactions between Plasmodium and the human host, paving the way towards targeted antimalaria therapeutics and control intervention methods.

Complexity reduction of oxygen saturation variability signals in COVID-19 patients: Implications for cardiorespiratory control

BACKGROUND

Coronavirus disease 2019 (COVID-19) is a respiratory illness that leads to severe acute respiratory syndrome and various cardiorespiratory complications, contributing to morbidity and mortality. Entropy analysis has demonstrated its ability to monitor physiological states and system dynamics during health and disease. The main objective of the study is to extract information about cardiorespiratory control by conducting a complexity analysis of OSV signals using scale-based entropy measures following a two-month timeframe after recovery.

METHODS

This prospective study collected data from subjects meeting specific criteria, using a Beurer PO-80 pulse oximeter to measure oxygen saturation (SpO2) and pulse rate. Excluding individuals with a history of pulmonary/cardiovascular issues, the study analyzed 88 recordings from 44 subjects (26 men, 18 women, mean age 45.34 ± 14.40) during COVID-19 and two months post-recovery. Data preprocessing and scale-based entropy analysis were applied to assess OSV signals.

RESULTS

The study found a significant difference in mean OSV during illness (95.08 ± 0.15) compared to post-recovery (95.59 ± 1.03), indicating reduced cardiorespiratory dynamism during COVID-19. Multiscale entropy analyses (MSE, MPE, MFE) confirmed lower entropy values during illness across all time scales, particularly at higher scales. Notably, the maximum distinction between illness and recovery phases was seen at specific time scales and similarity criteria for each entropy measure, showing statistically significant differences.

CONCLUSIONS

The study demonstrates that the loss of complexity in OSV signals, quantified using scale-based entropy measures, has the potential to detect malfunctioning of cardiorespiratory control in COVID-19 patients. This finding suggests that OSV signals could serve as a valuable indicator for assessing the cardiorespiratory status of COVID-19 patients and monitoring their recovery progress.

Implementation considerations of deprescribing interventions: A scoping review

Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.

Interventions addressing challenging behaviours in Arab children and adults with intellectual disabilities and/or autism: A systematic review

BACKGROUND

Arabs with intellectual disabilities and/or autism may exhibit challenging behaviour that affects them and their caregivers. Early, appropriate intervention may reduce these effects. This review synthesised and critically appraised challenging behaviour intervention research for this population.

METHODS

All published empirical research on challenging behaviour interventions for Arabs with intellectual disabilities and/or autism was included. In September 2022, 15 English and Arabic databases yielded 5282 search records. Studies were appraised using the MMAT. Review findings were narratively synthesised.

RESULTS

The 79 included studies (n = 1243 participants) varied in design, intervention, and evaluation method. Only 12.6% of interventions were well-designed and reported. Arab interventions primarily targeted children, were applied collectively on small samples, lacked individualised assessment, and were based on an inconsistent understanding of challenging behaviour.

CONCLUSION

The evidence base on interventions for Arabs with intellectual disabilities and/or autism and challenging behaviour needs strengthening. Attention should be given to culturally relevant adaptations.

Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022

OBJECTIVE

Helicopter emergency medical services (HEMS) is widely used for prehospital and interfacility transport, but there is a paucity of HEMS outcomes data from studies using randomized controlled trial designs. In the absence of robust randomized controlled trial evidence, judgments regarding HEMS potential benefit must be informed by observational data. Within the study design set of observational analyses, the natural experiment (NE) is notable for its high potential methodologic quality; NE designs are occasionally denoted "quasi-experimental." The aim of this study is to examine all NE outcomes studies in the HEMS literature and to discern what lessons can be learned from these potentially high-quality observational data.

METHODS

HEMS NE studies were identified during the development of a new HEMS Outcomes Assessment Research Database (HOARD). HOARD was constructed using a broad-ranging search of published and gray literature resources (eg, PubMed, Embase, and Google Scholar) that used variations of the terms "helicopter EMS," "air ambulance," and "air medical transport." Among the 221 studies ultimately included in HOARD, 16 NE publications describing 13 sets of observational data comprising myriad diagnostic groups were identified. Of these 16 HEMS NEs, 4 HEMS NE studies assessing trauma outcomes were used in a meta-analysis. A meta-analysis was also performed of 4 HEMS NE studies.

RESULTS

Although the disparity of studies (in terms of both case mix and end points) precluded the generation of a pooled effect estimate of an adjusted mortality benefit of HEMs versus ground emergency medical services, HEMS was found to be associated with outcomes improvement in 8 of the 13 cohorts.

CONCLUSION

The weight of the NE evidence supports a conclusion of some form of HEMS-mediated outcomes improvement in a variety of patient types. Meta-analysis of 4 HEMS NE studies assessing trauma outcomes generated a model with acceptable heterogeneity (I2 = 43%, Q test: P = .16), which significantly (P < .01) favored HEMS use with a pooled HEMS survival odd ratio estimate of 1.66 (95% confidence interval, 1.23-2.22).

Patient values in patient-provider communication about participation in early phase clinical cancer trials: a qualitative analysis before and after implementation of an online value clarification tool intervention

BACKGROUND

Patients with advanced cancer who no longer have standard treatment options available may decide to participate in early phase clinical trials (i.e. experimental treatments with uncertain outcomes). Shared decision-making (SDM) models help to understand considerations that influence patients' decision. Discussion of patient values is essential to SDM, but such communication is often limited in this context and may require new interventions. The OnVaCT intervention, consisting of a preparatory online value clarification tool (OnVaCT) for patients and communication training for oncologists, was previously developed to support SDM. This study aimed to qualitatively explore associations between patient values that are discussed between patients and oncologists during consultations about potential participation in early phase clinical trials before and after implementation of the OnVaCT intervention.

METHODS

This study is part of a prospective multicentre nonrandomized controlled clinical trial and had a between-subjects design: pre-intervention patients received usual care, while post-intervention patients additionally received the OnVaCT. Oncologists participated in the communication training between study phases. Patients' initial consultation on potential early phase clinical trial participation was recorded and transcribed verbatim. Applying a directed approach, two independent coders analysed the transcripts using an initial codebook based on previous studies. Steps of continuous evaluation and revision were repeated until data saturation was reached.

RESULTS

Data saturation was reached after 32 patient-oncologist consultations (i.e. 17 pre-intervention and 15 post-intervention). The analysis revealed the values: hope, perseverance, quality or quantity of life, risk tolerance, trust in the healthcare system/professionals, autonomy, social adherence, altruism, corporeality, acceptance of one's fate, and humanity. Patients in the pre-intervention phase tended to express values briefly and spontaneously. Oncologists acknowledged the importance of patients' values, but generally only gave 'contrasting' examples of why some accept and others refuse to participate in trials. In the post-intervention phase, many oncologists referred to the OnVaCT and/or asked follow-up questions, while patients used longer phrases that combined multiple values, sometimes clearly indicating their weighing.

CONCLUSIONS

While all values were recognized in both study phases, our results have highlighted the different communication patterns around patient values in SDM for potential early phase clinical trial participation before and after implementation of the OnVaCT intervention. This study therefore provides a first (qualitative) indication that the OnVaCT intervention may support patients and oncologists in discussing their values.

TRIAL REGISTRATION

Netherlands Trial Registry: NL7335, registered on July 17, 2018.

Association between mouth rinse use and changes in blood pressure: A systematic review and meta-analysis with trial sequential analysis

INTRODUCTION

Previous randomized controlled trials have shown that the use of antiseptic mouth rinses not only eradicates oral bacteria but also disrupts their ability to convert nitrate to nitrite, which is the key molecule in regulating blood pressure (BP).

OBJECTIVE

This study aimed to evaluate the association between the use of mouth rinses and changes in BP.

METHODS

The PubMed, Web of Science, EMBASE, Scopus, and Cochrane Library databases were systematically searched from their respective inception dates to 18th December 2022 to identify potential interventional studies with information on the association between the use of mouth rinse and changes in BP. Five trials using a controlled, crossover design were identified for data analysis.

RESULTS

The weighted mean difference was pooled using a random-effects model. The pooled results of five trials together showed that the use of mouth rinses did not result in a statistically or clinically significant increase in the systolic BP (SBP) (1.59 mmHg; 95% confidence interval [CI], -0.15 to 3.33) or diastolic BP (DBP) (0.46 mmHg; 95% CI, -0.72 to 1.64). The trial sequential analysis did not present conclusive evidence supporting the association between mouth rinse use and BP elevation.

CONCLUSION

Within the limits of the available evidence, our review and meta-analysis showed that mouth rinse use did not result in a statistically significant increase in the SBP, DBP, or mean arterial pressure (MAP). Nevertheless, the results should be interpreted cautiously due to the high degree of inconsistency across the studies.

A framework for multi-scale intervention modeling: virtual cohorts, virtual clinical trials, and model-to-model comparisons

Computational models of disease progression have been constructed for a myriad of pathologies. Typically, the conceptual implementation for pathology-related in-silico intervention studies has been ad-hoc and similar in design to experimental studies. We introduce a multi-scale interventional design (MID) framework toward two key goals: tracking of disease dynamics from within-body to patient to population scale; and tracking impact(s) of interventions across these same spatial scales. Our MID framework prioritizes investigation of impact on individual patients within virtual pre-clinical trials, instead of replicating the design of experimental studies. We apply a MID framework to develop, organize, and analyze a cohort of virtual patients for the study of tuberculosis (TB) as an example disease. For this study, we use HostSim: our next-generation whole patient-scale computational model of individuals infected with Mycobacterium tuberculosis. HostSim captures infection within lungs by tracking multiple granulomas, together with dynamics occurring with blood and lymph node compartments, the compartments involved during pulmonary TB. We extend HostSim to include a simple drug intervention as an example of our approach and use our MID framework to quantify the impact of treatment at cellular and tissue (granuloma), patient (lungs, lymph nodes and blood), and population scales. Sensitivity analyses allow us to determine which features of virtual patients are the strongest predictors of intervention efficacy across scales. These insights allow us to identify patient-heterogeneous mechanisms that drive outcomes across scales.

Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review

BACKGROUND

Electronic health records are a significant contributing factor in clinician burnout, which negatively impacts patient care.

OBJECTIVES

To identify and appraise published solutions that aim to reduce EHR-related burnout in clinicians.

METHODS

A literature search strategy was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six databases were searched for articles published between January 1950 and March 2023. The inclusion criteria were peer-reviewed, full-text, English language articles that described interventions targeting EHR-related burnout in any type of clinician, with reported outcomes related to burnout, wellness, EHR satisfaction, or documentation workload. Studies describing interventions without an explicit focus on reducing burnout or enhancing EHR-related satisfaction were excluded.

RESULTS

We identified 44 articles describing interventions to reduce EHR-related burnout. These interventions included the use of scribes, EHR training, and EHR modifications. These interventions were generally well received by the clinicians and patients, with subjective improvements in documentation time and EHR satisfaction, although objective data were limited.

CONCLUSION

The findings of this review underscore the potential benefits of interventions to reduce EHR-related burnout as well as the need for further research with more robust study designs involving randomized trials, control groups, longer study durations, and validated, objective outcome measurements.

New Infiltration Technique in the Treatment of the Plantar Fascia Syndrome Based on Platelet-Rich Plasma

Pain in the attachment of the plantar fascia in the calcaneus represents 10% of all sports injuries, affects 10% of foot runners, and will affect around 20% of the world population. There is no effective conservative treatment for it. This paper justifies a new definition and name for this pathology, Plantar Fascia Syndrome (PFS), presents a methodology for its diagnosis, and presents the clinical and functional effectiveness of a new conservative treatment based on platelet-rich plasma (PRP). In total, 25 patients (from an initial sample of 260) diagnosed with recalcitrant PFS lasting for more than 12 months were treated with a single infiltration of 2 mL of PRP, according to a new technic proposed. The study was approved by the ethical committee for clinical research of the reference hospital. The patients were controlled after 15, 30, 90, and 180 days, reviewing on each occasion pain, thickness of the plantar fascia, and active extension of the ankle joint. A total of 15 days after infiltration, 85% of patients had no clinical signs requiring treatment. After 90 days of infiltration, no patients showed clinical signs. This improvement in the patients' condition lasted for 180 days. All patients after treatment can fully resume normal activity with no pain.

Urine concentrating ability in cats with hyperthyroidism: Influence of radioiodine treatment, masked azotemia, and iatrogenic hypothyroidism

BACKGROUND

Hyperthyroid cats often have urine specific gravity (USG) values <1.035. It remains unclear how USG changes after treatment, if USG can be used to predict azotemia after treatment, or how iatrogenic hypothyroidism influences USG values.

OBJECTIVES

To determine the proportion of hyperthyroid cats with USG <1.035 vs ≥1.035; if USG changes after treatment; and whether USG <1.035 correlated with unmasking of azotemia or hypothyroidism.

ANIMALS

Six hundred fifty-five hyperthyroid cats treated with radioiodine; 190 clinically normal cats.

METHODS

Prospective, before-and-after study. Hyperthyroid cats had serum thyroxine, thyroid-stimulating hormone, and creatinine concentrations, and USG measured before and 6 months after successful treatment with radioiodine.

RESULTS

Of untreated hyperthyroid cats, USG was ≥1.035 in 346 (52.8%) and <1.035 in 309 (47.2%). After treatment, 279/346 (80.6%) maintained USG ≥1.035, whereas 67/346 (19.4%) became <1.035; 272/309 (88%) maintained USG <1.035, whereas 37/309 (12%) became ≥1.035. Only 22/346 (6.4%) with USG ≥1.035 developed azotemia after treatment, compared with 136/309 (44%) with <1.035 (P < .001). Of cats remaining nonazotemic, 38% had USG <1.035, compared with 20% of normal cats (P < .001). The 137 cats with iatrogenic hypothyroidism had lower USG after treatment than did 508 euthyroid cats (1.024 vs 1.035), but USGs did not change after levothyroxine supplementation. USG <1.035 had high sensitivity (86.1%) but moderate specificity (65.2%) in predicting azotemia after treatment.

CONCLUSIONS AND CLINICAL IMPORTANCE

Hyperthyroidism appears not to affect USG in cats. However, cats with evidence of sub-optimal concentrating ability before radioiodine treatment (USG < 1.035) are more likely to develop azotemia and unmask previously occult chronic kidney disease. Iatrogenic hypothyroidism itself did not appear to affect USG values.

A remote monitoring-enabled home exercise prescription for patients with interstitial lung disease at risk for exercise-induced desaturation

RATIONALE

Alternatives to center-based pulmonary rehabilitation are needed to improve patient access to this important therapy. A critical challenge to overcome is how to maximize safety of unsupervised exercise for at-risk patients. We investigated if a novel remote monitoring-enabled mobile health (mHealth) program is safe, feasible, and effective for patients who experience exercise-induced hemoglobin desaturation.

METHODS

An interstitial lung disease (ILD) commonly associated with pronounced exercise desaturation was investigated - the rare, female-predominant ILD lymphangioleiomyomatosis (LAM). Over a 12-week program, hemoglobin saturation (SpO2) was continuously recorded during all home exercise sessions. Intervention effects were assessed with 6-min walk test (6MWT), maximal cardiopulmonary exercise test (CPET), lower extremity computerized dynamometry, pulmonary function tests, and health-related quality of life (QoL) surveys. Safety was assessed by blood biomarkers of systemic inflammation and cardiac wall stress, and incidence of adverse events.

RESULTS

Fifteen LAM patients enrolled and 14 completed the intervention, with high adherence to aerobic (87 ± 15%) and strength (87 ± 12%) training components. An innovative characterization of exercise training SpO2 revealed that while mild-to-moderate desaturation was common during home workouts, participants were able to self-adjust exercise intensity and supplemental oxygen levels to maintain recommended exercise parameters. Significant improvements included 6MWT distance (+36 ± 34 m, p = 0.003), CPET time (p = 0.04), muscular endurance (p = 0.008), QoL (p = 0.009 to 0.03), and fatigue (p = 0.001 to 0.03). Patient acceptability and satisfaction indicators were high, blood biomarkers remained stable (p > 0.05), and no study-related adverse events occurred.

CONCLUSION

A remote monitoring-enabled home exercise program is a safe, feasible, and effective approach even for patients who experience exercise desaturation.

Interventions to change antimicrobial use in livestock: A scoping review and an impact pathway analysis of what works, how, for whom and why

Antimicrobial resistance (AMR) is a public health threat responsible for 700,000 deaths per year worldwide. Antimicrobial use (AMU) in livestock contributes to AMR in animal and public health. Therefore, it is essential to implement effective interventions towards better AMU in livestock. However, there is a lack of evidence to inform decision-makers of what works, how, for whom and why and how effective interventions can be adapted to different contexts. We conducted a scoping review and an impact pathway analysis to systematically map the research done in this area and to inform evidence-based and context-appropriate policies. We followed the PRISMA-ScR requirements and searched Web of Science, PubMed and Scopus databases to identify studies in English or French languages, in open access and published between 2000 and 2022. We selected thirty references addressing twenty-eight different interventions that were successful in changing AMU in livestock. We used an impact pathway logic model as an analytic framework to guide the technical aspects of the scoping review process and to identify the complex relationships between outputs, outcomes, impacts and contextual factors. A majority of interventions managed to improve AMU by changing herd and health management practices (ni=18). We identified intermediate outcomes including change in the veterinarian-farmer relationship (ni=7), in knowledge and perception (ni=6), and in motivation and confidence (ni=1). Twenty-two studies recorded positive impacts on animal health and welfare (ni=11), technical performances (ni=9), economic performances (ni=4) and AMR reduction (ni=4). Interventions implemented different strategies including herd and health management support (ni=20), norms and standards (ni=11), informational and educational measures (ni=10), economic support (ni=5). Studies were mainly in European countries and in pig and large ruminants farming. Most interventions targeted farmers or veterinarians but we identified other major and influential actors including authority and governmental organizations, academics and research, organization of producers or veterinarians, herd advisors and technicians, laboratories, and public opinion. Key success factors were knowledge and perception (ni=14), social factors (ni=13), intervention characteristics (ni=11), trajectory and ecosystem of change (ni=11), economic factors (ni=9), herd and health status (ni=8), data access and monitoring (ni=4). This review describes a paucity of impact assessment of interventions towards better AMU in livestock. There is no one-size-fits-all transition pathway but we inform decision-makers about the most successful interventions that work, how, for whom and why. The impact pathway analysis provided a holistic view of the successful change processes and the complex relationships between outputs, outcomes, impacts and contexts.

The association of a critical care electronic prescribing system with the quality of patient care provided by clinical pharmacists - a prospective, observational cohort study

BACKGROUND

Despite the strong face validity of electronic prescribing (EP), the empiric data in support of improved patient safety is sparse. The objective of this study was to compare the clinical significance of pharmacist contributions between an established EP and paper-based prescribing (PBP) system in the intensive care unit (ICU) to understand the EP impact on the quality of patient care.

MATERIALS AND METHODS

We conducted a prospective longitudinal study in two 18-bed ICUs; one with EP and the other, PBP. Pharmacist contributions were analysed over three months. Demographic, clinical and adjunctive intervention data were also collected. A multilevel ordinal logistic regression model was used and patients were followed up for 28 days. The primary outcome was the distribution of clinical significance levels of pharmacist contributions.

RESULTS

There were 303 patients admitted to the ICU between April 1st and June 30th 2018. EP was used in 171 patients and PBP in 132 patients. 1658 contributions were analysed. There were 14.9% highly clinically significant contributions with EP compared to 44.6% with PBP. The EP group had lower odds (OR 0.05, 95% CI 0.02-0.12) for a higher clinical significance contribution compared to the PBP group, but this changed over the admission and differed between groups, with decreasing odds of a higher-level clinical contribution for each additional admission day with PBP (OR 0.57, 95%CI 0.42-0.78).

CONCLUSION

This study showed a significant difference in the distribution of pharmacist contributions made over time, with clinical significance levels remaining stable in the EP group at low severity, as opposed to PBP which were initially high and then gradually decreased in severity over time. This contemporaneous controlled study found that the EP system required less significant input both in the severity and frequency of pharmacist contributions to maintain patient safety.

Public Mental Health Approaches to Online Radicalisation: An Empty Systematic Review

This systematic review seeks to position online radicalisation within whole system frameworks incorporating individual, family, community and wider structural influences whilst reporting evidence of public mental health approaches for individuals engaging in radical online content.

METHODS

the authors searched Medline (via Ovid), PsycInfo (via Ebscohost) and Web of Science (Core Collection) with the use of Boolean operators across "extremism", "online content" and "intervention".

RESULTS

Following full-text assessments, all retrieved papers were excluded. No publications fulfilled the primary objective of reporting public mental health interventions specifically addressing online radicalisation. However, six publications fulfilled the secondary objective of identifying theoretical and conceptual relationships amongst elements in the three inclusion criteria (online extremism, psychological outcomes and intervention strategy) that could inform interventions within public mental health frameworks. These publications were quality assessed and discussed following the Cochrane Effective Practice and Organisation of Care guide for reporting empty reviews.

CONCLUSIONS

there is an immediate need for further research in this field given the increase in different factions of radicalised beliefs resulting from online, particularly social media, usage.

Efficiency Improvement Strategies for Public Health Systems: Developing and Evaluating a Taxonomy in the Australian Healthcare System

INTRODUCTION

As demand for healthcare continues to grow, public health systems are increasingly required to drive efficiency improvement (EI) to address public service funding challenges. Despite this requirement, evidence of EI strategies that have been successful applied at the whole-of-system level is limited. This study reports the development, implementation and evaluation of a novel taxonomy of EI strategies used in public health systems to inform systemwide EI models.

MATERIALS AND METHODS

The public health system in New South Wales, Australia, operates a centralised EI model statewide and was the setting for this study. An audit of EI strategies implemented in the NSW Health system between July 2016 and June 2019 was used to identify all available EI strategies within the study timeframe. A content management approach was applied to audit the strategies, with each strategy coded to an EI focus area. Codes were clustered according to similarity, and category names were assigned to each cluster to form a preliminary taxonomy. Each category was defined and examples were provided. The resulting taxonomy was distributed and evaluated by user feedback survey and pre-post study to assess the impact on EI strategy distribution.

RESULTS

A total of 1127 EI strategies were identified and coded into 263 unique strategies, which were clustered into nine categories to form the taxonomy of EI strategies. Categories included the following: non-clinical contracts and supplies; avoided and preventable activity; clinical service delivery and patient outcomes; finance and operations; recruitment, vacancies and FTE; staffing models; leave management; staff engagement and development; premium staffing; and clinical contracts and supplies. Evaluative findings revealed a perceived reduction in the duplication of EI work, improved access to EI knowledge and improved engagement with EI processes when using the taxonomy. The taxonomy was also associated with wider use of EI strategies.

CONCLUSIONS

Whole-of-system EI is an increasing requirement. Using a taxonomy to guide systemwide practice appears to be advanta-geous in reducing duplication and guiding practice, with implications for use in health systems internationally.

Training interventions to reduce the risk of injury to the lower extremity joints during landing movements in adult athletes: a systematic review and meta-analysis

Objective

Aim of this systematic review was to summarise training interventions designed to reduce biomechanical risk factors associated with increased risk of lower extremity landing injuries and to evaluate their practical implications in amateur sports.

Design

Systematic review and meta-analysis.

Data sources

MEDLINE, Scopus and SPORTDiscus.

Eligibility criteria

Training intervention(s) aimed at reducing biomechanical risk factors and/or injury rates included the following: (1) prospective or (non-)randomised controlled study design; (2) risk factors that were measured with valid two-dimensional or three-dimensional motion analysis systems or Landing Error Scoring System during jump landings. In addition, meta-analyses were performed, and the risk of bias was assessed.

Results

Thirty-one studies met all inclusion criteria, capturing 11 different training interventions (eg, feedback and plyometrics) and 974 participants. A significantly medium effect of technique training (both instruction and feedback) and dynamic strengthening (ie, plyometrics with/without strengthening) on knee flexion angle (g=0.77; 95% CI 0.33 to 1.21) was shown. Only one-third of the studies had training interventions that required minimal training setup and additional coaching educations.

Conclusion

This systematic review highlights that amateur coaches can decrease relevant biomechanical risk factors by means of minimal training setup, for example, instructing to focus on a soft landing, even within only one training session of simple technique training. The meta-analysis emphasises implementing technique training as stand-alone or combined with dynamic strengthening into amateur sport training routine.

Effect of periodontal therapy on insulin resistance in adults with dysglycemia and periodontitis: a systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to address whether non-surgical periodontal therapy (NSPT) can affect insulin resistance, estimated by the homeostasis model assessment (HOMA), in adults with prediabetes or type 2 diabetes mellitus and periodontitis.

MATERIALS AND METHODS

Six electronic databases and the gray literature were systematically searched for interventional studies reporting NSPT effect on insulin resistance. Seven studies met the eligibility criteria to be synthesized in the qualitative analysis, six reporting change in HOMA-IR, three reporting change in HOMA-%S, and two in HOMA-β. Among them, four were pooled in a meta-analysis of standardized mean difference (SMD) of HOMA-IR; comparing pre- and post-intervention values, three were pooled considering HOMA-%S as outcome, and two studies were summarized considering SMD of HOMA-%S between intervention and control groups. HOMA-β results were qualitatively synthetized.

RESULTS

With low level of certainty, NSPT significantly reduced HOMA-IR, when compared with pre-intervention data (SMD, -0.35, 95% CI -0.63 to 0.07, p=0.02). There were no significant changes in HOMA-%S or in HOMA-β scores. The level of certainty was very low and moderate, respectively.

CONCLUSIONS

Assertions about a causal link between NSPT and insulin resistance are weak and conflicting, although our more robust results point out to the absence of effect. .

CLINICAL RELEVANCE

Because further high-quality studies assessing the relationship between periodontitis and insulin resistance are need, the findings of the current systematic review are limited to give recommendations for clinicians. However, while identifying a lack of research in humans with T2D concerning periodontitis and insulin resistance, this study reinforces the need of multicenter well-designed randomized clinical trials.

Symptoms of post-traumatic stress disorder in parents of preterm newborns: A systematic review of interventions and prevention strategies

Background

Preterm birth and subsequent NICU admission can be a traumatic experience for parents who may subsequently develop post-traumatic stress (PTS) disorder (PTSD). Given that developmental issues are common among children of parents with PTSD, interventions for prevention and treatment are essential.

Objective

To assess the most effective non-pharmacological interventions to prevent and/or treat PTS symptoms in parents of preterm newborns.

Methods

Systematic review performed in accordance with the PRISMA statements. Eligible articles in English language were searched in MEDLINE, Scopus, and ISI Web of Science databases using the following medical subject headings and terms: “stress disorder, post-traumatic,” “parents,” “mothers,” “fathers,” “infant, newborn,” “intensive care units, neonatal,” and “premature birth.” The terms “preterm birth” and “preterm delivery” were also used. Unpublished data were searched in ClinicalTrials.gov website. All intervention studies published until September 9th, 2022 and including parents of newborns with gestational age at birth (GAb) &lt;37 weeks which underwent ≥1 non-pharmaceutical interventions for prevention and/or treatment of PTS symptoms related to preterm birth were included. Subgroup analyses were conducted by type of intervention. The quality assessment was performed according to the criteria from the RoB-2 and the “NIH Quality Assessment Tool for Before-After studies.”

Results

Sixteen thousand six hundred twenty-eight records were identified; finally, 15 articles (1,009 mothers, 44 fathers of infants with GAb ≤ 366/7 weeks) were included for review. A good standard of NICU care (effective as sole intervention: 2/3 studies) and education about PTSD (effective in association with other interventions: 7/8 studies) could be offered to all parents of preterm newborns. The 6-session Treatment Manual is a complex intervention which revealed itself to be effective in one study with low risk of bias. However, the effectiveness of interventions still remains to be definitively established. Interventions could start within 4 weeks after birth and last 2–4 weeks.

Conclusion

There is a wide range of interventions targeting PTS symptoms after preterm birth. However, further studies of good quality are needed to better define the effectiveness of each intervention.

The "Next Day" Effects of Cannabis Use: A Systematic Review

Background: Δ9-Tetrahydrocannabinol (THC), the main intoxicating component of cannabis, can cause cognitive and psychomotor impairment. Whether this impairment is still present many hours or even days after THC use requires clarification. Possible "next day" effects are of major significance in safety-sensitive workplaces. We therefore conducted a systematic review of studies investigating the "next day" effects of THC. Methods: Studies that measured performance on safety-sensitive tasks (e.g., driving, flying) and/or neuropsychological tests >8 h after THC (or cannabis) use using interventional designs were identified by searching two online databases from inception until March 28, 2022. Risk of bias (RoB) was evaluated using the relevant Cochrane tools. Results were described in terms of whether THC had a significant effect on performance relative to the primary comparator (i.e., placebo or baseline, as appropriate). Results: Twenty studies (n=458) involving 345 performance tests were reviewed. Most studies administered a single dose of THC (median [interquartile range]: 16 [11-26] mg) and assessed performance between >12 and 24 h post-treatment. N=209/345 tests conducted across 16 published studies showed no "next day" effects of THC. Nine of these 16 studies used randomized, double-blind, placebo-controlled designs. Half (N=8) had "some" RoB, and half (N=8) had a "high" RoB. Notably, N=88 of these 209 tests failed to demonstrate "acute" (i.e., <8 h post-treatment) THC-induced impairment. N=12/345 tests conducted across five published studies indicated negative (i.e., impairing) "next day" effects of THC. None of these five studies used randomized, double-blind, placebo-controlled designs and all were published >18 years ago (four, >30 years ago). Three had "some" RoB, and two had a "high" RoB. A further N=121/345 tests indicated "unclear" "next day" effects of THC with insufficient information provided to assess outcomes. The remaining N=3/345 tests indicated positive (i.e., enhancing) "next day" effects of THC. Conclusions: Some lower quality studies have reported "next day" effects of THC on cognitive function and safety-sensitive tasks. However, most studies, including some of higher quality, have found no such effect. Overall, it appears that there is limited scientific evidence to support the assertion that cannabis use impairs "next day" performance. Further studies involving improved methodologies are required to better address this issue.

How "age-friendly" are deprescribing interventions? A scoping review of deprescribing trials

OBJECTIVE

To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing-a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms-"Medication", "Mentation", "Mobility", and "What Matters Most" to the person-can be used to guide assessment of age-friendliness of deprescribing trials.

DATA SOURCE

Published literature.

STUDY DESIGN

Scoping review.

DATA EXTRACTION METHODS

The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms.

PRINCIPAL FINDINGS

Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: "Medication" was considered in the intervention design of all trials; "Mentation" was considered in eight trials; "Mobility" (n = 2) and "What Matters Most" (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions.

OUTCOME ASSESSMENT

"Medication" was the most commonly assessed outcome (n = 33), followed by "Mobility" (n = 13) and "Mentation" (n = 10) outcomes, with no study examining "What Matters Most" outcomes.

CONCLUSIONS

"Mentation" and "Mobility", and "What Matters Most" have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.