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Sample records for intervention improved referral

  1. Interventions to improve outpatient referrals from primary care to secondary care.

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    Akbari, Ayub; Mayhew, Alain; Al-Alawi, Manal Alawi; Grimshaw, Jeremy; Winkens, Ron; Glidewell, Elizabeth; Pritchard, Chanie; Thomas, Ruth; Fraser, Cynthia

    2008-10-08

    The primary care specialist interface is a key organisational feature of many health care systems. Patients are referred to specialist care when investigation or therapeutic options are exhausted in primary care and more specialised care is needed. Referral has considerable implications for patients, the health care system and health care costs. There is considerable evidence that the referral processes can be improved. To estimate the effectiveness and efficiency of interventions to change outpatient referral rates or improve outpatient referral appropriateness. We conducted electronic searches of the Cochrane Effective Practice and Organisation of Care (EPOC) group specialised register (developed through extensive searches of MEDLINE, EMBASE, Healthstar and the Cochrane Library) (February 2002) and the National Research Register. Updated searches were conducted in MEDLINE and the EPOC specialised register up to October 2007. Randomised controlled trials, controlled clinical trials, controlled before and after studies and interrupted time series of interventions to change or improve outpatient referrals. Participants were primary care physicians. The outcomes were objectively measured provider performance or health outcomes. A minimum of two reviewers independently extracted data and assessed study quality. Seventeen studies involving 23 separate comparisons were included. Nine studies (14 comparisons) evaluated professional educational interventions. Ineffective strategies included: passive dissemination of local referral guidelines (two studies), feedback of referral rates (one study) and discussion with an independent medical adviser (one study). Generally effective strategies included dissemination of guidelines with structured referral sheets (four out of five studies) and involvement of consultants in educational activities (two out of three studies). Four studies evaluated organisational interventions (patient management by family physicians compared to

  2. Small-Group Standardized Patient Encounter Improves Athletic Training Students' Psychosocial Intervention and Referral Skills

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    Walker, Stacy E.; Weidner, Thomas G.; Thrasher, Ashley B.

    2016-01-01

    Context: Athletic trainers provide psychological support, counseling, intervention, and referral to patients during clinical practice. However, students are rarely exposed to real-life opportunities to develop these skills. Objective: To determine if a small-group standardized patient (SP) encounter improved athletic training students'…

  3. Reading Intervention and Special Education Referrals

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    Polcyn, Dawn M.; Levine-Donnerstein, Deborah; Perfect, Michelle M.; Obrzut, John E.

    2014-01-01

    This study examined whether consistently implementing reading fluency interventions prior to referring students for a special education evaluation led to fewer overall special education referrals, as well as more accurate special education referrals. Results indicated that the implementation of a peer-mediated reading fluency intervention…

  4. Abused women's experiences of a primary care identification and referral intervention: a case study analysis.

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    Bradbury-Jones, Caroline; Clark, Maria; Taylor, Julie

    2017-01-10

    The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care. Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England. Qualitative study with a case study design. In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016. Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health. Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important. © 2017 John Wiley & Sons Ltd.

  5. A multifaceted approach to improving the quality of ENT Emergency Clinic referrals

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    Swords, Chloe; Leach, Laura; Kasbekar, Anand; Jani, Piyush

    2017-01-01

    It is imperative that primary care referrals are directed to the appropriate secondary care service. Patients presenting to a primary care physician with ENT conditions may require review in an Emergency Clinic. The latter clinics provide patients with rapid access to secondary care, for urgent, yet non-life-threatening conditions. In our department, we noticed that patients with conditions inappropriate to the capabilities of the Clinic were being booked in or reviewed too late; thus causing wasted journeys for the patient. We conducted a Quality Improvement Project to improve the efficiency of the referral process. A prospective evaluation of referrals was collected continuously over a two-month period. Overall, 5 domains were deemed crucial to enable timely and accurate booking of patients to clinic: booking date, urgency, legibility, patient identification and appropriateness. Our proposed standard set for this project was 100% compliance over the 5 domains. Three separate interventions were instigated following the first cycle. The main components of the intervention were the phased development of an electronic referral system and an educational initiative for junior doctors. 20 referral forms were analysed during the initial 3-week period. No referrals met the recommended overall compliance standard of 100% (mean number of domains achieved: 3.38; standard deviation (SD): 0.637). Legibility and patient information were included in 21% and 30% of referrals, respectively. There was a trend of improvement following initiation of interventions. The mean number of domains achieved was 4.27 (SD 0.647; n=13) in the second data collection period, 4.53 (SD 0.514; n=16) in the third, and 4.75 (SD 0.452; n=24) in the fourth. Using linear regression, this change demonstrates a statistically significant improvement (psystem represents a safe and efficient communication technology. When implementing policy change, it is crucial to acquire managerial and consultant support

  6. Conducting an audit to improve the facilitation of emergency maternal and newborn referral in northern Ghana.

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    Awoonor-Williams, John Koku; Bailey, Patricia E; Yeji, Francis; Adongo, Ayire Emmanuel; Baffoe, Peter; Williams, Afua; Mercer, Sarah

    2015-10-01

    Ghana Health Service conducted an audit to strengthen the referral system for pregnant or recently pregnant women and newborns in northern Ghana. The audit took place in 16 facilities with two 3-month cycles of data collection in 2011. Midwife-led teams tracked 446 referred women until they received definitive treatment. Between the two audit cycles, teams identified and implemented interventions to address gaps in referral services. During this time period, we observed important increases in facilitating referral mechanisms, including a decrease in the dependence on taxis in favour of national or facility ambulances/vehicles; an increase in health workers escorting referrals to the appropriate receiving facility; greater use of referral slips and calling ahead to alert receiving facilities and higher feedback rates. As referral systems require attention from multiple levels of engagement, on the provider end we found that regional managers increasingly resolved staffing shortages; district management addressed the costliness and lack of transport and increased midwives' ability to communicate with pregnant women and drivers; and that facility staff increasingly adhered to guidelines and facilitating mechanisms. By conducting an audit of maternal and newborn referrals, the Ghana Health Service identified areas for improvement that service providers and management at multiple levels addressed, demonstrating a platform for problem solving that could be a model elsewhere.

  7. A theory-based educational intervention to pediatricians in order to improve identification and referral of maternal depression: a quasi-experimental study

    OpenAIRE

    Agapidaki, Eirini; Souliotis, Kyriakos; Christogiorgos, Stylianos; Zervas, lannis; Leonardou, Angeliki; Kolaitis, Gerasimos; Giannakopoulos, George; Dimitrakaki, Christina; Tountas, Yannis

    2013-01-01

    Background Maternal depression has a negative impact on both the mother and child's physical and mental health, as well as impairs parenting skills and pediatric health care utilization. The pediatricians' role in identification and management of maternal depression is well established. Although it can be successfully and easily treated, maternal depression remains under-recognized and under-treated. Despite the heightened emphasis, there is lack of interventions to pediatricians in order to ...

  8. Can adding web-based support to UK primary care exercise referral schemes improve patients’ physical activity levels? Intervention development for the e-coachER study.

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    Adrian Taylor

    2015-10-01

    Aims: This presentation will provide details on the intervention development and data to be captured to inform a process evaluation. Methods: An initial version of e-coachER was produced, building on experiences from obesity and diabetes self-management interventions using the Lifeguide platform, and beta tested over 7 months. Co-applicants and researchers then provided feedback on a time-truncated version, and ERS patients on a real-time version, for 5 months before it was locked for the RCT. Within the trial, after participants are screened, provide consent and complete baseline assessments, they are randomised to receive usual ERS at each site or usual ERS plus a mailed Welcome Pack (including a user friendly guide to register for e-coachER access in-line, a free pedometer and a fridge magnet with daily recording strips for step counts or minutes of MVPA. Contact details for an e-coachER facilitator are provided for additional technical support. Results: At the core of the intervention are ‘7 Steps to Health’ aimed to last 5-10 mins each, to encourage patients to think about the benefits of PA, seek support from an ERS practitioner (and friends/family, and the web, to self-monitor PA with a pedometer and upload steps or minutes of MVPA, set progressive goals, build confidence, autonomy and relatedness (from Self-Determination Theory, find ways to increase sustainable PA more broadly, and deal with setbacks. An avatar (to avoid having to represent a range of individual characteristics such as age, gender, and ethnicity and brief narratives are used throughout to normalise and support behaviour change and encourage e-coachER use. Automatic or patient chosen e-mails from the Lifeguide system promote on-going use of functions such as recording weekly PA and goal setting. For each site, participants are able to access links to reputable generic websites for further information about chronic conditions and lifestyle, links to other sites and apps for self

  9. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

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    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  10. The Effects of Implementing a Positive Behavior Intervention Support Program on Office Discipline Referrals

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    Thomas, Cheryl Denise

    2015-01-01

    The purpose of this study was to determine if the implementation of PBIS (Positive Behavioral Intervention Support) program had a positive significant effect in decreasing office discipline referrals in a local elementary school. A sample independent t-Test was used to examine data on the school's average office discipline referrals for two years…

  11. Management of common ailments requiring referral in the pharmacy: a mystery shopping intervention study.

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    Collins, Jack Charles; Schneider, Carl Richard; Faraj, Renee; Wilson, Frances; de Almeida Neto, Abilio Cesar; Moles, Rebekah Jane

    2017-08-01

    Background Pharmacists can play a key role in managing ailments through their primary roles of supplying over-the-counter (non-prescription) medicines and advice-giving. It must be ensured that pharmacy staff practise in an evidence-based, guideline-compliant manner. To achieve this, mystery shopping can be used as an intervention to assess and train pharmacy staff. Objective To determine if repeated student pharmacist mystery shopping with immediate feedback affected the outcome of scenarios requiring referral to a medical practitioner. To determine what, if any, factors may influence whether referral occurred. Setting Thirteen community pharmacies across metropolitan Sydney, Australia. Methods Sixty-one student pharmacist mystery shoppers visited 13 community pharmacies across metropolitan Sydney once weekly over nine weeks between March-October 2015 to conduct audio-recorded mystery shopping visits with assigned scenarios (asthma, dyspepsia, diarrhoea). Students returned to the pharmacy immediately to provide staff members with feedback. Pharmacy staff were scored by mystery shoppers according to a standardised scoresheet. Score data and other characteristics, such as the assigned scenario, were analysed via correlation and logistic regression modelling. Main outcome measure Whether a student mystery shopper was appropriately referred to a medical practitioner based on the presenting symptoms. Results 158 visits were eligible for analysis. Referral to a medical practitioner was appropriately made in 66% of visits. The regression model provided an R2 value of 0.73; the questioning score of the interaction and if a pharmacist was involved in the interaction were significant predictor of appropriate outcome (p 0.05). Conclusions Mystery shopping with feedback did not improve pharmacy staff performance over time. Increased questioning and involvement of a pharmacist in the interaction were significant predictors of referral to a medical practitioner occurring.

  12. Promoting Early Intervention Referral through a Randomized Controlled Home-Visiting Program

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    Schwarz, Donald F.; O'Sullivan, Ann L.; Guinn, Judith; Mautone, Jennifer A.; Carlson, Elyse C.; Zhao, Huaqing; Zhang, Xuemei; Esposito, Tara L.; Askew, Megan; Radcliffe, Jerilynn

    2012-01-01

    The MOM Program is a randomized, controlled trial of an intervention to promote mothers' care for the health and development of their children, including accessing early intervention (EI) services. Study aims were to determine whether, relative to controls, this intervention increased receipt of and referral to EI services. Mothers (N = 302)…

  13. Improving the psychological evaluation of exercise referral: Psychometric properties of the Exercise Referral Quality of Life Scale

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    Charlotte Hilton

    2015-07-01

    Full Text Available There is a growing need to assess the psychological outcomes of exercise referral and the National Institute of Health and Care Excellence has called for the routine assessment of life-quality. However, a quality of life scale specific to the requirements of exercise referral is currently unavailable. Therefore, the aim of this study was to produce a quality of life measure for this purpose. The Exercise Referral Quality of Life Scale is a 22-item measure comprising three domains: mental and physical health, injury pain and illness and physical activity facilitators. Exploratory factor analysis determined the initial factor structure and was subsequently confirmed by confirmatory factor analysis. Additional scale properties were also assessed. The scale contributes to the global need for improved consistent psychological outcome assessment of exercise referral.

  14. Improving Appropriate Access to Care With Central Referral and Triage in Rheumatology.

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    Hazlewood, Glen S; Barr, Susan G; Lopatina, Elena; Marshall, Deborah A; Lupton, Terri L; Fritzler, Marvin J; Mosher, Dianne P; Steber, Whitney A; Martin, Liam

    2016-10-01

    To evaluate the short-term and long-term impact of a centralized system for the intake and triage of rheumatology referrals on access to care and referral quality. An innovative central referral process, the Central Referral and Triage in Rheumatology (CReATe Rheum) program, was implemented in 2006, serving a referral base of 2 million people. Referrals are received in a central office, triaged by trained nurses, and assigned to the next available appointment on a prioritized basis. To evaluate the short-term impact, we compared wait times, duplicate referrals, and no-shows from a pre-implementation practice audit to a 2-year post-implementation evaluation (January 2007 to December 2008). Rheumatologists also assessed the quality and completeness of the referral information and accuracy of the urgency category assigned during triage. We evaluated the long-term impact by tracking referral volume, wait times, and rheumatologist manpower each year until December, 2013. During the first 2 years, wait-time variability between rheumatologists decreased, and wait times were reduced for moderate and urgent referrals. CReATe Rheum improved the quality of referral information and eliminated duplicate referrals. The urgency of the referral was assigned correctly in 90% of referrals. Over the long term, CReATe Rheum maintained short wait times for more urgent patients despite a growing number of referrals and a stable number of rheumatologists. A centralized system for the intake and triage of rheumatology referrals improved referral quality, reduced system inefficiencies, and effectively managed wait times on a prioritized basis for a large referral population. © 2016, American College of Rheumatology.

  15. Changes in Teacher Stress through Participation in Pre-Referral Intervention Teams

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    Lhospital, Ann Shargo; Gregory, Anne

    2009-01-01

    Teachers today face high stress that can compromise their well-being, longevity in the profession, and the quality of their interactions with students. Pre-referral interventions, which address individual student difficulties before consideration for special education, may help buffer teacher stress through student interventions and team support.…

  16. The role of screening, brief intervention, and referral to treatment in the perinatal period.

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    Wright, Tricia E; Terplan, Mishka; Ondersma, Steven J; Boyce, Cheryl; Yonkers, Kimberly; Chang, Grace; Creanga, Andreea A

    2016-11-01

    Substance use during pregnancy is at least as common as many of the medical conditions screened for and managed during pregnancy. While harmful and costly, it is often ignored or managed poorly. Screening, brief intervention, and referral to treatment is an evidence-based approach to manage substance use. In September 2012, the US Centers for Disease Control and Prevention convened an Expert Meeting on Perinatal Illicit Drug Abuse to help address key issues around drug use in pregnancy in the United States. This article reflects the formal conclusions of the expert panel that discussed the use of screening, brief intervention, and referral to treatment during pregnancy. Screening for substance use during pregnancy should be universal. It allows stratification of women into zones of risk given their pattern of use. Low-risk women should receive brief advice, those classified as moderate risk should receive a brief intervention, whereas those who are high risk need referral to specialty care. A brief intervention is a patient-centered form of counseling using the principles of motivational interviewing. Screening, brief intervention, and referral to treatment has the potential to reduce the burden of substance use in pregnancy and should be integrated into prenatal care. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. [Screening, Brief Intervention, Referral to Treatment(SBIRT) model for alcohol use disorder in Japan].

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    Isono, Hiroki; Yoshimoto, Hisashi

    2015-09-01

    The prevalence of alcohol dependence in Japan was 0.9% in 2013, but up to 16% adults drink alcohol at levels of unhealthy use. Primary care physicians play an important role in recognizing alcohol use disorder, helping patients change their behavior, and preventing its medical complications. The Screening, Brief Intervention, Referral to Treatment (SBIRT) model is an evidence-based, cost-effective intervention implemented worldwide to reduce alcohol use disorder.

  18. Screening, Brief Intervention and Referral to Treatment: implications of SAMHSA's SBIRT initiative for substance abuse policy and practice.

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    Babor, Thomas F; Del Boca, Frances; Bray, Jeremy W

    2017-02-01

    management of substance use disorders into primary care and general medicine. Screening, Brief Intervention and Referral to Treatment implementation was associated with improvements in treatment system equity, efficiency and economy. © 2017 Society for the Study of Addiction.

  19. Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions.

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    Baxter, Susan K; Blank, Lindsay; Woods, Helen Buckley; Payne, Nick; Rimmer, Melanie; Goyder, Elizabeth

    2014-05-10

    There is increasing interest in innovative methods to carry out systematic reviews of complex interventions. Theory-based approaches, such as logic models, have been suggested as a means of providing additional insights beyond that obtained via conventional review methods. This paper reports the use of an innovative method which combines systematic review processes with logic model techniques to synthesise a broad range of literature. The potential value of the model produced was explored with stakeholders. The review identified 295 papers that met the inclusion criteria. The papers consisted of 141 intervention studies and 154 non-intervention quantitative and qualitative articles. A logic model was systematically built from these studies. The model outlines interventions, short term outcomes, moderating and mediating factors and long term demand management outcomes and impacts. Interventions were grouped into typologies of practitioner education, process change, system change, and patient intervention. Short-term outcomes identified that may result from these interventions were changed physician or patient knowledge, beliefs or attitudes and also interventions related to changed doctor-patient interaction. A range of factors which may influence whether these outcomes lead to long term change were detailed. Demand management outcomes and intended impacts included content of referral, rate of referral, and doctor or patient satisfaction. The logic model details evidence and assumptions underpinning the complex pathway from interventions to demand management impact. The method offers a useful addition to systematic review methodologies. PROSPERO registration number: CRD42013004037.

  20. After-hours equine emergency admissions at a university referral hospital (1998 - 2007 : causes and interventions

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    A. Viljoen

    2009-05-01

    Full Text Available Medical records of equine after-hours admissions from 1998 to 2007 are reviewed. Data extracted from the medical records included signalment, reason for admission, pre-admission treatment, clinical presentation, procedures performed, final diagnoses, complications occurring in hospital, length of stay and outcome. Eight hundred and twenty after-hours admissions were available of which 75 % were classified as emergencies. Most horses originated from Gauteng province (82 %, with Thoroughbred, Arabian, and Warmbloods representing 46 %, 10 % and 7 % of horses. Horses had a median age of 7 years and were predominantly male (60 %. Gastrointestinal (64 % and musculoskeletal (19 % disorders were the primary reasons for admission. Anti-inflammatories, sedation and antibiotics were given in 51 %, 20 % and 15 % of cases respectively prior to referral. On admission, 23 % of horses had surgical intervention. Intravenous catheterisation (64 %, rectal examination (61 %, nasogastric intubation (56 %, abdominocentesis (33 % and ultrasonography (19 % were the procedures performed most frequently. Surgical and medical colics constituted 28 % and 27 % respectively of the overall diagnoses, while piroplasmosis was diagnosed in 5 % of horses. Post-admission complications occurred in <2 % of horses. The median length of stay was 4 days (95 % CI: 1 to 21 days. Overall survival to discharge was 74 %. This study demonstrates that the majority of after-hours equine admissions to a university referral hospital required medical intervention and were mostly due to gastrointestinal disorders. Information obtained from this study can be used in emergency referral planning.

  1. Improving the effectiveness of electronic health record-based referral processes.

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    Esquivel, Adol; Sittig, Dean F; Murphy, Daniel R; Singh, Hardeep

    2012-09-13

    Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted "socio-technical" approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication.

  2. Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria

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    Uzochukwu Benjamin SC

    2009-11-01

    Full Text Available Abstract Background Malaria remains a major cause of morbidity and mortality among children under five years of age in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with anti-malarials bought over-the-counter (OTC from untrained drug vendors. Self-medication through drug vendors can be ineffective, with increased risks of drug toxicity and development of drug resistance. Global malaria control initiatives highlights the potential role of drug vendors to improve access to early effective malaria treatment, which underscores the need for interventions to improve treatment obtained from these outlets. This study aimed to determine the feasibility and impact of training rural drug vendors on community-based malaria treatment and advice with referral of severe cases to a health facility. Methods A drug vendor-training programme was carried out between 2003 and 2005 in Ugwuogo-Nike, a rural community in south-east Nigeria. A total of 16 drug vendors were trained and monitored for eight months. The programme was evaluated to measure changes in drug vendor practice and knowledge using exit interviews. In addition, home visits were conducted to measure compliance with referral. Results The intervention achieved major improvements in drug selling and referral practices and knowledge. Exit interviews confirmed significant increases in appropriate anti-malarial drug dispensing, correct history questions asked and advice given. Improvements in malaria knowledge was established and 80% compliance with referred cases was observed during the study period, Conclusion The remarkable change in knowledge and practices observed indicates that training of drug vendors, as a means of communication in the community, is feasible and strongly supports their inclusion in control strategies aimed at improving prompt effective treatment of malaria with referral of severe cases.

  3. Screening, brief intervention, and referral to treatment (SBIRT) as an integral part of nursing practice.

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    Finnell, Deborah S; Nowzari, Shahrzad; Reimann, Brie; Fischer, Leigh; Pace, Elizabeth; Goplerud, Eric

    2014-01-01

    ABSTRACT. Substance use screening, brief intervention, and referral to treatment (SBIRT) should be an integral part of the scope of nursing practice. This commentary is an appeal for nurses to advance their knowledge and competencies related to SBIRT. The question of how to move SBIRT into the mainstream of nursing practice was posed to several leaders of federal agencies, health care and nursing organizations, nurse educators, and nurse leaders. The authors provide recommendations for moving this set of clinical strategies (i.e., SBIRT) into day-to-day nursing practice.

  4. Criteria-based audit to improve a district referral system in Malawi: A pilot study

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    Mlava Grace

    2008-09-01

    Full Text Available Abstract Background To study the feasibility of using criteria-based audit to improve a district referral system. Methods A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases. Results There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001; delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014; clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001 and feedback given to the referring health centres (1.7% vs 91.9%; p 95% in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Conclusion Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

  5. An Overview of Cancer Rehabilitation and Exercise in the Literature: Promoting Increased Referrals to Improve Oncology Outcomes

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    Leslie J. Waltke

    2014-08-01

    Full Text Available Medical management for malignant neoplastic diseases includes surgery, chemotherapy, radiation, and hormonal and biological therapies. Each of these antineoplastic interventions has unique impacts on physiological, musculoskeletal and functional performance. Cancer rehabilitation is the area of physical medicine responsible for addressing impairments associated with cancer treatment and survivorship, advanced disease and end of life. Although it is expected that more than one-half of persons being treated for cancer will suffer moderate pain and physical and functional decline, and that most will describe fatigue, referrals to rehabilitation are traditionally low. Evidence suggests that referrals to rehabilitation before, during and after treatment for neoplastic disease may improve physiological and functional performance, quality of life and survival outcomes. Oncology practitioners are encouraged to refer patients undergoing cancer treatment to a rehabilitation professional at the peridiagnosis period.

  6. A Pilot Study of Screening, Brief Intervention, and Referral for Treatment (SBIRT) in Non-Treatment Seeking Smokers with HIV

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    Cropsey, Karen L.; Hendricks, Peter S.; Jardin, Bianca; Clark, C. Brendan; Katiyar, Nandan; Willig, James; Mugavero, Michael; Raper, James L.; Saag, Michael; Carpenter, Matthew J.

    2013-01-01

    Introduction PLHIV have higher rates of smoking and lower motivation to quit smoking; thus to impact smoking rates, cessation interventions need to be acceptable to a wider range of PLHIV smokers as well as feasible to implement in a busy clinical setting. The purpose of this study was to evaluate the acceptability, feasibility, and effects of a Screening, Brief Intervention, and Referral for Treatment (SBIRT) model in an HIV/AIDS clinic among a sample of PLHIV. Methods PLHIV smokers (N = 40) were randomized at baseline, irrespective of their self-reported discrete smoking cessation motivation status, to receive either 8-weeks of combination nicotine replacement therapy (NRT) in conjunction with brief counseling (SBIRT framework) (n = 23) or usual care (n = 17). Smoking outcome measures included cigarettes smoked per day, nicotine dependence, smoking urge, and smoking withdrawal symptoms. Results The SBIRT intervention appeared to be acceptable and feasible, and produced medium to large reductions in cigarettes smoked per day, physical nicotine dependence, smoking urge, and smoking withdrawal symptoms, even for smokers not ready to quit within 6 months. Conclusions Findings provide preliminary support for the integration of an SBIRT model in an HIV/AIDS clinic setting to screen and provide active treatment to all smokers, regardless of readiness to quit smoking. Given the high prevalence and incredible health burden of continued smoking in this population, identifying brief and effective interventions that are easily translated into clinical practice represents an enormous challenge that if met, will yield significant improvements to overall patient outcomes. PMID:23787030

  7. Screening, brief intervention, and referral to treatment for opioid and other substance use during infertility treatment.

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    Wright, Tricia E

    2017-08-01

    Opioid use and misuse have reached epidemic proportions in the United States, especially in women of childbearing age, some of whom seek infertility treatments. Substance use is much more common than many of the conditions routinely screened for during the preconception period, and it can have devastating consequences for the woman and her family. Substance use can worsen infertility, complicate pregnancy, increase medical problems, and lead to psychosocial difficulties for the woman and her family. The reproductive endocrinologist thus has an ethical and medical duty to screen for substance use, provide initial counseling, and refer to specialized treatment as needed. This article provides an overview of screening, brief intervention, and referral to treatment (SBIRT), a public health approach shown to be effective in ameliorating the harms of substance use. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  8. The Relationship between Reading Fluency Intervention and the Need for Special Education Referrals

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    Polcyn, Dawn M.

    2012-01-01

    Students are often referred for special education evaluations following teacher generated referrals. These referrals indicate observable poor academic progress, although often there is no indication of the cause of the poor performance as well as no indication of remediation attempts prior to a special education referral. Students who demonstrate…

  9. Pediatric Neurosurgical Outcomes Following a Neurosurgery Health System Intervention at Mulago National Referral Hospital in Uganda.

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    Fuller, Anthony T; Haglund, Michael M; Lim, Stephanie; Mukasa, John; Muhumuza, Michael; Kiryabwire, Joel; Ssenyonjo, Hussein; Smith, Emily R

    2016-11-01

    Pediatric neurosurgical cases have been identified as an important target for impacting health disparities in Uganda, with over 50% of the population being less than 15 years of age. The objective of the present study was to evaluate the effects of the Duke-Mulago collaboration on pediatric neurosurgical outcomes in Mulago National Referral Hospital. We performed retrospective analysis of all pediatric neurosurgical cases who presented at Mulago National Referral Hospital in Kampala, Uganda, to examine overall, preprogram (2005-2007), and postprogram (2008-2013) outcomes. We analyzed mortality, presurgical infections, postsurgical infections, length of stay, types of procedures, and significant predictors of mortality. Data on neurosurgical cases was collected from surgical logbooks, patient charts, and Mulago National Referral Hospital's yearly death registry. Of 820 pediatric neurosurgical cases, outcome data were complete for 374 children. Among children who died within 30 days of a surgical procedure, the largest group was less than a year old (45%). Postinitiation of the Duke-Mulago collaboration, we identified an overall increase in procedures, with the greatest increase in cases with complex diagnoses. Although children ages 6-18 years of age were 6.66 times more likely to die than their younger counterparts preprogram, age was no longer a predictive variable postprogram. When comparing pre- and postprogram outcomes, mortality among pediatric patients within 30 days after a neurosurgical procedure increased from 4.3% to 10.0%, mortality after 30 days increased slightly from 4.9% to 5.0%, presurgical infections decreased by 4.6%, and postsurgery infections decreased slightly by 0.7%. Our data show the provision of more complex neurological procedures does not necessitate improved outcomes. Rather, combining these higher-level procedures with essential pre- and postoperative care and continued efforts in health system strengthening for pediatric neurosurgical

  10. The Impact of Staff Initiated Referral and Intervention Protocols on Symptoms of Depression in People with Mild Intellectual Disability

    Science.gov (United States)

    McGillivray, Jane A.; Kershaw, Mavis M.

    2013-01-01

    It has been estimated that people with ID experience the same and possibly higher levels of depression than the general population. Referral to a General Medical Practitioner (GP) for primary care is recommended practice for people with depression and cognitive behavioural (CB) therapy is now an accepted evidence based intervention. A growing body…

  11. Screening, Brief Intervention, and Referral to Treatment in a rural Ryan White Part C HIV clinic.

    Science.gov (United States)

    Graham, Lucy J; Davis, Amy L; Cook, Paul F; Weber, Mary

    2016-01-01

    About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. Over this time period, 37-49% of encounters per year were notable for tobacco use, 8-21% for alcohol use, 6-16% for marijuana use, 3-9% for amphetamine use, and 0-2% for illicit opioid use. Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

  12. The cost-effectiveness of brief intervention versus brief treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States.

    Science.gov (United States)

    Barbosa, Carolina; Cowell, Alexander; Dowd, William; Landwehr, Justin; Aldridge, Arnie; Bray, Jeremy

    2017-02-01

    To conduct a cost-effectiveness analysis (CEA) comparing the delivery of brief intervention (BI) with brief treatment (BT) within Screening, Brief Intervention and Referral to Treatment (SBIRT) programs. Quasi-experimental differences in observed baseline characteristics between BI and BT patients were adjusted using propensity score techniques. Incremental comparison of costs and health outcomes associated with BI and BT. Health-care settings in four US states participating in Substance Abuse and Mental Health Services Administration SBIRT grant programs. Ninety patients who received BT and 878 who received BI. Per-patient cost of SBIRT, patient demographics and six measures of substance use: proportion using alcohol, proportion using alcohol to intoxication, days of alcohol use, days of alcohol use to intoxication, proportion using drugs and days using drugs. BI and BT were associated with better outcomes. The cost of SBIRT was significantly higher for BT patients ($75.54 versus 16.32, 95% confidence interval, P brief treatment if the goal is to abstain from alcohol. However, the higher effectiveness of brief treatment for this outcome is associated with considerable uncertainty and, because both brief intervention and brief treatment improve all outcomes, brief treatment does not appear to be a good use of resources. © 2017 Society for the Study of Addiction.

  13. Study protocol: a multi-professional team intervention of physical activity referrals in primary care patients with cardiovascular risk factors—the Dalby lifestyle intervention cohort (DALICO study

    Directory of Open Access Journals (Sweden)

    Stenman Emelie

    2012-06-01

    Full Text Available Abstract Background The present study protocol describes the trial design of a primary care intervention cohort study, which examines whether an extended, multi-professional physical activity referral (PAR intervention is more effective in enhancing and maintaining self-reported physical activity than physical activity prescription in usual care. The study targets patients with newly diagnosed hypertension and/or type 2 diabetes. Secondary outcomes include: need of pharmacological therapy; blood pressure/plasma glucose; physical fitness and anthropometric variables; mental health; health related quality of life; and cost-effectiveness. Methods/Design The study is designed as a long-term intervention. Three primary care centres are involved in the study, each constituting one of three treatment groups: 1 Intervention group (IG: multi-professional team intervention with PAR, 2 Control group A (CA: physical activity prescription in usual care and 3 Control group B: treatment as usual (retrospective data collection. The intervention is based on self-determination theory and follows the principles of motivational interviewing. The primary outcome, physical activity, is measured with the International Physical Activity Questionnaire (IPAQ and expressed as metabolic equivalent of task (MET-minutes per week. Physical fitness is estimated with the 6-minute walk test in IG only. Variables such as health behaviours; health-related quality of life; motivation to change; mental health; demographics and socioeconomic characteristics are assessed with an electronic study questionnaire that submits all data to a patient database, which automatically provides feed-back to the health-care providers on the patients’ health status. Cost-effectiveness of the intervention is evaluated continuously and the intermediate outcomes of the intervention are extrapolated by economic modelling. Discussions By helping patients to overcome practical, social and cultural

  14. Scheduled Follow-Up Referrals and Simple Prevention Kits Including Counseling to Improve Post-Discharge Outcomes Among Children in Uganda: A Proof-of-Concept Study

    Science.gov (United States)

    Wiens, Matthew O; Kumbakumba, Elias; Larson, Charles P; Moschovis, Peter P; Barigye, Celestine; Kabakyenga, Jerome; Ndamira, Andrew; English, Lacey; Kissoon, Niranjan; Zhou, Guohai; Ansermino, J Mark

    2016-01-01

    ABSTRACT Background: Recurrent illness following hospital discharge is a major contributor to childhood mortality in resource-poor countries. Yet post-discharge care is largely ignored by health care workers and policy makers due to a lack of resources to identify children with recurrent illness and a lack of cohesive systems to provide care. The purpose of this proof-of-concept study was to evaluate the effectiveness of a bundle of interventions at discharge to improve health outcomes during the vulnerable post-discharge period. Methods: The study was conducted between December 2014 and April 2015. Eligible children were between ages 6 months and 5 years who were admitted with a suspected or proven infectious disease to one of two hospitals in Mbarara, Uganda. A bundle of interventions was provided at the time of discharge. This bundle included post-discharge referrals for follow-up visits and a discharge kit. The post-discharge referral was to ensure follow-up with a nearby health care provider on days 2, 7, and 14 following discharge. The discharge kit included brief educational counseling along with simple preventive items as incentives (soap, a mosquito net, and oral rehydration salts) to reinforce the education. The primary study outcome was the number of post-discharge referral visits completed. Secondary study outcomes included satisfaction with the intervention, rates of readmission after 60 days, and post-discharge mortality rates. In addition, outcomes were compared with a historical control group, enrolled using the same inclusion criteria and outcome-ascertainment methods. Results: During the study, 216 children were admitted, of whom 14 died during hospitalization. Of the 202 children discharged, 85% completed at least 1 of the 3 follow-up referral visits, with 48% completing all 3 visits. Within 60 days after discharge, 22 children were readmitted at least once and 5 children (2.5%) died. Twelve (43%) readmissions occurred during a scheduled follow

  15. Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians

    OpenAIRE

    Salvalaggio, Ginetta; Dong, Kathryn; Vandenberghe, Christine; Kirkland, Scott; Mramor, Kelsey; Brown, Taryn; Taylor, Marliss; McKim, Robert; Cummings, Greta G.; Wild, T. Cameron

    2013-01-01

    Background Screening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of pat...

  16. MEASURES TO IMPROVE THE OUTCOME OF ABRUPTIO PLACENTA IN A TERTIARY REFERRAL CENTRE

    Directory of Open Access Journals (Sweden)

    Vijaya

    2015-12-01

    Full Text Available AIM To analyze the outcome of 135 patients admitted with Abruptio Placenta during a period of 9 months managed at Tertiary Referral Centre, Modern Govt. Maternity Hospital, Petalburz, Hyderabad, Telangana State. MATERIALS AND METHODS A study of 135 cases of Abruptio Placenta over a period of 9 months at a tertiary level referral centre. They were analyzed regarding age, parity, socio economic status, period of gestation, antenatal care, management of Abruption and maternal and fetal outcome, and the measures to improve the condition were analyzed. RESULTS Abruptio placenta is a dreadful threat to maternal and fetal life. In our study unbooked cases were 110(81.48%, Hypertension is the main risk factor almost in 90(66.66% cases, 65% of them were between 28-36 weeks of GA, and 6 were grandmultis, 6 cases ended up with HELLP syndrome with DIC. All these 6 cases were near misses, 5 unbooked cases had eclampsia. One case of unbooked eclampsia had abruption DIC and could not be saved as it was the late referral. Total number of vaginal deliveries were 66(48.88% and total no. of abdominal deliveries were 67(49.62% in this LSCS 66 and one hysterotomy. IUD at the time of admission total were 100(74%. CONCLUSION To improve the outcome in Abruptio Placentae Good antenatal care, Educating the patient, Strengthening the Primary Health Centers in identifying the risk factors like Pre-eclampsia thereby avoiding eclampsia. Regular antenatal checkups timely delivery and availability of blood and blood products with good Neonatal care unit will help in improving the outcome of Abruptio.

  17. Enhancing screening, brief intervention, and referral to treatment among socioeconomically disadvantaged patients: study protocol for a knowledge exchange intervention involving patients and physicians.

    Science.gov (United States)

    Salvalaggio, Ginetta; Dong, Kathryn; Vandenberghe, Christine; Kirkland, Scott; Mramor, Kelsey; Brown, Taryn; Taylor, Marliss; McKim, Robert; Cummings, Greta G; Wild, T Cameron

    2013-03-22

    Screening, Brief Intervention, and Referral for Treatment (SBIRT) is an effective approach for managing alcohol and other drug misuse in primary care; however, uptake into routine care has been limited. Uptake of SBIRT by healthcare providers may be particularly problematic for disadvantaged populations exhibiting alcohol and other drug problems, and requires creative approaches to enhance patient engagement. This knowledge translation project developed and evaluated a group of patient and health care provider resources designed to enhance the capacity of health care providers to use SBIRT and improve patient engagement with health care. A nonrandomized, two-group, pre-post, quasi-experimental intervention design was used, with baseline, 6-, and 12-month follow-ups. Low income patients using alcohol and other drugs and who sought care in family medicine and emergency medicine settings in Edmonton, Canada, along with physicians providing care in these settings, were recruited. Patients and physicians were allocated to the intervention or control condition by geographic location of care. Intervention patients received a health care navigation booklet developed by inner city community members and also had access to an experienced community member for consultation on health service navigation. Intervention physicians had access to online educational modules, accompanying presentations, point of care resources, addiction medicine champions, and orientations to the inner city. Resource development was informed by a literature review, needs assessment, and iterative consultation with an advisory board and other content experts. Participants completed baseline and follow-up questionnaires (6 months for patients, 6 and 12 months for physicians) and administrative health service data were also retrieved for consenting patients. Control participants were provided access to all resources after follow-up data collection was completed. The primary outcome measure was patient

  18. A time and motion study of Screening, Brief Intervention, and Referral to Treatment implementation in health-care settings.

    Science.gov (United States)

    Cowell, Alexander J; Dowd, William N; Landwehr, Justin; Barbosa, Carolina; Bray, Jeremy W

    2017-02-01

    Screening and brief intervention for harmful substance use in medical settings is being promoted heavily in the United States. To justify service provision fiscally, the field needs accurate estimates of the number and type of staff required to provide services, and thus the time taken to perform activities used to deliver services. This study analyzed the time spent in activities for the component services of the substance misuse Screening, Brief Intervention and Referral to Treatment (SBIRT) program implemented in emergency departments, in-patient units and ambulatory clinics. Observers timed activities according to 18 distinct codes among SBIRT practitioners. Twenty-six US sites within four grantees. Five hundred and one practitioner-patient interactions; 63 SBIRT practitioners. Timing of practitioner activities. Delivery of component services of SBIRT. The mean (standard error) time to deliver services was 1:19 (0:06) for a pre-screen (n = 210), 4:28 (0:24) for a screen (n = 97) and 6:51 (0:38) for a brief intervention (n = 66). Estimates of service duration varied by setting. Overall, practitioners spent 40% of their time supporting SBIRT delivery to patients and 13% of their time delivering services. In the United States, support activities (e.g. reviewing the patient's chart, locating the patient, writing case-notes) for substance abuse Screening, Brief Intervention and Referral to Treatment require more staff time than delivery of services. Support time for screens and brief interventions in the emergency department/trauma setting was high compared with the out-patient setting. © 2017 Society for the Study of Addiction.

  19. Impact of UK NICE Clinical Guidelines 168 and social deprivation on access to interventional treatment for symptomatic varicose vein and specialist referral for leg ulceration.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Bate, Gareth; Kelly, Lisa; Koutsoumpelis, Andreas; Bradbury, Andrew W

    2017-09-01

    Background UK National Institute for Health and Care Excellence (NICE) clinical guidelines (CG) 168, published in July 2013, aimed to improve the management of lower limb venous disease by newly recommending interventional treatment for all people affected by symptomatic varicose veins (VV) and specialist vascular referral for all people suffering from a leg ulcer (LU) that had been present for ≥2 weeks. This study aims to determine if CG168 has increased access to vascular services, particularly for the socially deprived, who might be expected to have greater need for such services. Methods The study was performed in a highly multi-cultural, socio-economically diverse, mixed urban/suburban population of approximately 1.2 million people living in and around East Birmingham, UK. Index of multiple deprivation quintile (IMD-Q) was used as a measure of social deprivation to compare levels of social deprivation of people undergoing interventions for symptomatic VV or referred with an LU during 18-month periods before and after the publication of CG168. The referring general practitioner practices (GPPs) were also recorded. Results There was no change in overall IMD-Q distribution before and after CG168 in terms of VV interventions. However, there was a non-significant increase in proportions of people classified as IMD-Q5 (the most deprived quintile). After CG168, fewer IMD-Q5 people with LU were referred, with a shift in referrals towards those from less socially deprived areas. More GPP referred people with both VV and LU after CG168, and those that referred patients before and after CG168 tended to refer more after CG168. Conclusions CG168 has increased VV interventions as well as the number referred with LU. However, this improvement in access to treatment and referral may have disproportionately favoured the more socio-economic privileged. Professional and public education is required to ensure that the beneficial impact of the CG168 recommendations are maximised

  20. Using Interactive Web-Based Screening, Brief Intervention and Referral to Treatment in an Urban, Safety-Net HIV Clinic.

    Science.gov (United States)

    Dawson Rose, Carol; Cuca, Yvette P; Kamitani, Emiko; Eng, Shannon; Zepf, Roland; Draughon, Jessica; Lum, Paula

    2015-06-01

    Substance use among people living with HIV is high, and screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based approach to addressing the issue. We examined whether patients would participate in a technology-based SBIRT program in an urban HIV clinic. An SBIRT intervention was programmed into the clinic's web-based patient portal linked to their personal health record. We examined: demographic, health, HIV, and substance use characteristics of participants who completed the web-based intervention compared to those who did not. Fewer than half of the 96 participants assigned to the web-based SBIRT completed it (n = 39; 41 %). Participants who completed the web-based intervention had significantly higher amphetamine SSIS scores than those who did not complete the intervention. Participants whose substance use is more harmful may be more motivated to seek help from a variety of sources. In addition, it is important that technology-based approaches to behavioral interventions in clinics take into consideration feasibility, client knowledge, and comfort using technology.

  1. Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial.

    Science.gov (United States)

    Döpp, Carola M E; Graff, Maud J L; Teerenstra, Steven; Nijhuis-van der Sanden, Maria W G; Olde Rikkert, Marcel G M; Vernooij-Dassen, Myrra J F J

    2013-05-30

    To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat. At 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t -2,55 / 43 / 0,02) differed significantly at 12 months. Passive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to

  2. Improving availability of EmOC services in Rwanda--CARE's experiences and lessons learned at Kabgayi Referral Hospital.

    Science.gov (United States)

    Kayongo, M; Butera, J; Mboninyibuka, D; Nyiransabimana, B; Ntezimana, A; Mukangamuje, V

    2006-03-01

    CARE's work in Rwanda was designed to improve the functional capacity of health facilities for the delivery of EmOC services. The project supported a comprehensive package of focused interventions that included hospital renovations, provision of essential equipment, training of staff and improvement of management systems at the Kabgayi regional referral hospital. There was an increased level of preparedness for emergencies and ability to manage common obstetric complications according to evidence-based practices. These changes ultimately led to increased availability, quality and use of services as demonstrated by an increase in the demand for care of obstetric complications at the facility. The met need increased from 16% at the start of the project (2001) to 25% in 2004, while the cesarean rate remained essentially the same (1.9% and 3.2%) over the same time period. There were progressive declines in the case fatality rates from 2.2% in 2001 to 1.2% in 2004. CARE's experience indicates that progress towards reducing maternal mortality requires specific efforts that support and strengthen existing health systems to provide skilled care that can save women's lives.

  3. Strengthening referral of sick children from the private health sector and its impact on referral uptake in Uganda: a cluster randomized controlled trial protocol

    OpenAIRE

    Buregyeya, Esther; Rutebemberwa, Elizeus; LaRussa, Philip; Mbonye, Anthony

    2016-01-01

    Background Uganda’s under-five mortality is high, currently estimated at 66/1000 live births. Poor referral of sick children that seek care from the private sector is one of the contributory factors. The proposed intervention aims to improve referral and uptake of referral advice for children that seek care from private facilities (registered drug shops/private clinics). Methods/Design A cluster randomized design will be applied to test the intervention in Mukono District, central Uganda. A s...

  4. Education improves referral of patients suspected of having spondyloarthritis by general practitioners: a study with unannounced standardised patients in daily practice

    Science.gov (United States)

    van Onna, Marloes; Gorter, Simone; Maiburg, Bas; Waagenaar, Gerrie; van Tubergen, Astrid

    2015-01-01

    Objectives To evaluate the practice performance of general practitioners (GPs) and GP residents in recognising and referring patients suspected for having axial or peripheral spondyloarthritis (SpA), and to investigate the influence of education on this performance. Methods GP (residents) were visited in two rounds by standardised patients (SPs) simulating axial SpA, peripheral SpA or carpal tunnel syndrome (CTS) with in between an educational intervention on SpA for part of the participants. Participants were unaware of the nature of the medical problem and study purpose. CTS was included as diversionary tactic. The primary outcome was ≥40% improvement in (considering) referral of the SPs with SpA to the rheumatologist after education. Secondary outcomes included ordering additional diagnostic tests, correct recognition of SpA and identification of variables contributing to this. Results 68 participants (30 GPs and 38 GP residents) were included, of which 19 received education. The primary outcome was met. A significantly higher proportion of GP (residents) from the intervention group referred patients to the rheumatologist compared with the control group after education (change scores, axial SpA +71% vs +15% (p<0.01); peripheral SpA +48% vs 0% (p<0.001)). Participants who received education, more frequently correctly recognised SpA compared with controls (change scores, axial SpA +50% vs −5% (p<0.001); peripheral SpA +21% vs 0% (p=0.01). Conclusions Recognition and referral of patients suspected for having SpA by GP (residents) is low, but targeted education markedly improved this. This supports the development of educational initiatives to improve recognition of SpA and hence referral to a rheumatologist. PMID:26535152

  5. The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol

    Directory of Open Access Journals (Sweden)

    Ford Daniel E

    2010-11-01

    Full Text Available Abstract Background Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group. Methods The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates and patient participation (proportion referred who go to the website. We will then compare the effectiveness of the standard and augmented patient websites. Discussion Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login and patient outcomes (six-month smoking cessation. Trial Registration Web-delivered Provider Intervention for

  6. Repatriation to referral hospital after reperfusion of STEMI patients transferred for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Ting, Rudee; Tejpal, Ambika; Finken, Laura

    2016-01-01

    BACKGROUND: In regional systems of ST-segment elevation myocardial infarction (STEMI) care, patients presenting to hospitals without percutaneous coronary intervention (PCI) are transferred to PCI-capable hospitals for primary PCI. Repatriation, a practice whereby such patients are transferred ba...

  7. Effect of Depression on Risky Drinking and Response to a Screening, Brief Intervention, and Referral to Treatment Intervention.

    Science.gov (United States)

    Montag, Annika C; Brodine, Stephanie K; Alcaraz, John E; Clapp, John D; Allison, Matthew A; Calac, Dan J; Hull, Andrew D; Gorman, Jessica R; Jones, Kenneth Lyons; Chambers, Christina D

    2015-08-01

    We assessed alcohol consumption and depression in 234 American Indian/Alaska Native women (aged 18-45 years) in Southern California. Women were randomized to intervention or assessment alone and followed for 6 months (2011-2013). Depression was associated with risk factors for alcohol-exposed pregnancy (AEP). Both treatment groups reduced drinking (P < .001). Depressed, but not nondepressed, women reduced drinking in response to SBIRT above the reduction in response to assessment alone. Screening for depression may assist in allocating women to specific AEP prevention interventions.

  8. Can a self-referral system help improve access to psychological treatments?

    Science.gov (United States)

    Brown, June S L; Boardman, Jed; Whittinger, Naureen; Ashworth, Mark

    2010-05-01

    Referrals for psychological treatment have been problematic for many years. Even though GPs have attempted to limit access into the small psychological treatment services, long waiting lists have developed which have deterred referrals and deferred psychological care. GPs have understandably been frustrated. In addition, the consultation rate for psychological problems is low when compared with the rate of identified mental health problems in population surveys. Possible reasons include patients' failure to recognise the problem as psychological and thus not consulting one's GP, and/or the problem not being detected by the GP. While a self-referral system may be seen as a way of trying to allow non-consulters to receive treatment, this has been viewed with some scepticism since it may allow the 'worried well' to access already limited services. However, a study has shown that those self-referring to advertised psychological workshops had high levels of psychological morbidity and also were more representative of the population, in terms of ethnicity, than GP referrals. The government has set up the Increasing Access to Psychological Therapies (IAPT) programme to address some of the service shortfalls by expanding the provision of psychological therapists. Notably, the IAPT programme is allowing self-referrals such that any member of the public can access the service directly, bypassing general practice. Although not available at all the sites, this represents a radical shift from the present system in which access to talking therapy is generally only available through direct referral by the GP. The implications of this new development are discussed.

  9. Using a screening tool to improve timely referral of patients from acute oncology-haematology to palliative care services.

    Science.gov (United States)

    Begum, Akhtari

    2013-01-01

    This project was done at specialist cancer hospital in Qatar. At a haematology-oncology inpatient department most patients were not getting access to palliative care unless they were at the very end stages of life. Data collected from 2008-2011 showed significant numbers of patients were dying within one month of their transfer to palliative care. There was no standard measure to identify the prospective palliative care patients. A multidisciplinary team developed a Palliative care referral screening tool based on the National Cancer Care Network guideline. Retrospective medical record review done from January to April 2012 showed a mean of 68% of patients who scored more than five were not consulted, 32% of patients who scored more than seven were not transferred to palliative care and seven percent died without any referral. The team used various kinds of quality planning, analysis and improvement tools in the form of process mapping, value analysis, Fish Bone diagrams, stakeholders' analysis and communication, physician survey, "Pareto's principal" (80 / 20 rule, the law of vital few) and other data collection tools. The palliative care referral process was standardised by preparing and implementing an objective scoring tool based on international best practice. It changed the referral culture and helped manage the psychological barriers of patients, families and caregivers. Extensive orientation and education of all key stakeholders was implemented. Monthly auditing of patient records was carried out. The aim has been achieved, exceeded and sustained, and we reduced the percentage of patients who scored more than five without palliative consultation from a mean of 68% to 16% and those who scored more than seven without palliative care transfer from a mean of thirty two percent to three percent, after four months of the project's implementation. Standardising the referral process and creating an objective referral tool is needed to facilitate safe, collaborative

  10. Improving timeliness and efficiency in the referral process for safety net providers: application of the Lean Six Sigma methodology.

    Science.gov (United States)

    Deckard, Gloria J; Borkowski, Nancy; Diaz, Deisell; Sanchez, Carlos; Boisette, Serge A

    2010-01-01

    Designated primary care clinics largely serve low-income and uninsured patients who present a disproportionate number of chronic illnesses and face great difficulty in obtaining the medical care they need, particularly the access to specialty physicians. With limited capacity for providing specialty care, these primary care clinics generally refer patients to safety net hospitals' specialty ambulatory care clinics. A large public safety net health system successfully improved the effectiveness and efficiency of the specialty clinic referral process through application of Lean Six Sigma, an advanced process-improvement methodology and set of tools driven by statistics and engineering concepts.

  11. Family Perspectives on High-Quality Pediatric Subspecialty Referrals.

    Science.gov (United States)

    Ray, Kristin N; Ashcraft, Laura Ellen; Kahn, Jeremy M; Mehrotra, Ateev; Miller, Elizabeth

    2016-08-01

    Although children are frequently referred to subspecialist physicians, many inadequacies in referral processes have been identified from physician and system perspectives. Little is known, however, about how to comprehensively measure or improve the quality of the referral systems from a family-centered perspective. To foster family-centered improvements to pediatric subspecialty referrals, we sought to develop a framework for high-quality, patient-centered referrals from the perspectives of patients and their families. We used stakeholder-informed qualitative analysis of parent, caregiver, and patient interviews to identify outcomes, processes, and structures of high-quality pediatric subspecialty referrals as perceived by patients and their family members. We interviewed 21 informants. Informants identified 5 desired outcomes of subspecialty referrals: improved functional status or symptoms; improved long-term outcomes; improved knowledge of their disease; informed expectations; and reduced anxiety about the child's health status. Processes that informants identified as supporting these outcomes centered around 6 key steps in subspecialty referrals, including the referral decision, previsit information transfer, appointment scheduling, subspecialist visit, postvisit information transfer, and ongoing care integration and communication. Health care delivery structures identified by informants as supporting these processes included physical infrastructure, human resources, and information technology systems. We identified family-centered outcomes, processes, and structures of high-quality pediatric subspecialty referrals. These domains can be used not only to improve measurement of the quality of existing referral systems but also to inform future interventions to improve patient-centered outcomes for children in need of specialty care. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  12. Does a pre-hospital emergency pathway improve early diagnosis and referral in suspected stroke patients? – Study protocol of a cluster randomised trial [ISRCTN41456865

    Directory of Open Access Journals (Sweden)

    Lori Giuliano

    2005-10-01

    Full Text Available Abstract Background Early interventions proved to be able to improve prognosis in acute stroke patients. Prompt identification of symptoms, organised timely and efficient transportation towards appropriate facilities, become essential part of effective treatment. The implementation of an evidence based pre-hospital stroke care pathway may be a method for achieving the organizational standards required to grant appropriate care. We performed a systematic search for studies evaluating the effect of pre-hospital and emergency interventions for suspected stroke patients and we found that there seems to be only a few studies on the emergency field and none about implementation of clinical pathways. We will test the hypothesis that the adoption of emergency clinical pathway improves early diagnosis and referral in suspected stroke patients. We designed a cluster randomised controlled trial (C-RCT, the most powerful study design to assess the impact of complex interventions. The study was registered in the Current Controlled Trials Register: ISRCTN41456865 – Implementation of pre-hospital emergency pathway for stroke – a cluster randomised trial. Methods/design Two-arm cluster-randomised trial (C-RCT. 16 emergency services and 14 emergency rooms were randomised either to arm 1 (comprising a training module and administration of the guideline, or to arm 2 (no intervention, current practice. Arm 1 participants (152 physicians, 280 nurses, 50 drivers attended an interactive two sessions course with continuous medical education CME credits on the contents of the clinical pathway. We estimated that around 750 patients will be met by the services in the 6 months of observation. This duration allows recruiting a sample of patients sufficient to observe a 30% improvement in the proportion of appropriate diagnoses. Data collection will be performed using current information systems. Process outcomes will be measured at the cluster level six months after the

  13. A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol.

    Science.gov (United States)

    Satre, Derek D; Ly, Khanh; Wamsley, Maria; Curtis, Alexa; Satterfield, Jason

    2017-04-18

    Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged. The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application. Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT. Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement

  14. Demographic data, referral patterns and interventions used for children and adolescents with tinnitus and hyperacusis in Denmark

    DEFF Research Database (Denmark)

    Rosing, Susanne Nemholt; Kapandais, Anestis; Schmidt, Jesper Hvass

    2016-01-01

    OBJECTIVES: To investigate whether children and adolescents with tinnitus and/or hyperacusis are seen in Ear-Nose-Throat (ENT) clinics and to report the clinical data, treatment and referral patterns of these children. To describe the population of children and adolescents with tinnitus and...... to February 2015. All children with a primary complaint of tinnitus and/or hyperacusis was reported. No changes in daily practice regarding diagnostics, treatment or referral were made. A retrospective case review was undertaken during a five-year period from 01/01/2009 to 31/12/2013 in each Danish.......5%) had been diagnosed with tinnitus as a primary complaint. Hyperacusis was the primary complaint in 9 cases (12.8%), and both tinnitus and hyperacusis were reported in 11 cases (15.7%). The findings of this study indicate that a majority of children with tinnitus and/or hyperacusis are seen in settings...

  15. Can adding web-based support to UK primary care exercise referral schemes improve patients’ physical activity levels? Findings from an internal pilot study.

    Directory of Open Access Journals (Sweden)

    Adrian Taylor

    2015-10-01

    Full Text Available Background: Promoting physical activity (PA via primary care exercise referral schemes (ERS is common but there is no rigorous evidence for long term changes in PA (Pavey et al, 2011 among those with chronic conditions. From July 2015, for 15 months, the e-coachER trial began to recruit 1400 patients (in SW England, Birmingham and Glasgow with one or more chronic conditions including diabetes, obesity, hypertension, osteoarthritis, or depression, who are eligible and about to attend an ERS. The two-arm parallel RCT is powered to determine if the addition of a web-based, interactive, theory-driven and evidence-based support system called e-coachER (hosted on the ‘LifeGuide’ platform will result in at least 10% more patients who do 150 mins or more per week of accelerometer assessed moderate or vigorous physical activity (MVPA at 12 months. Recruitment into the trial is within primary care, using both mail-merged patient invitations and opportunistic GP invitations (and exercise referrals. Within the trial, after participants are screened, provide consent and complete baseline assessments, they are randomised to receive usual ERS at each site or usual ERS plus a mailed Welcome Pack with registration details to access e-coachER on-line. Inclusion criteria for entering the trial are: (1 Aged 16-74 years; (2 with one or more of the following: obesity (BMI 30-35, hypertension (SBP 140-179 or DBP 90-109, type 2 diabetes, lower limb osteoarthritis, recent history of treatment for depression; (3 Participants who are in the two lowest (of four groups using the GP Physical Activity Questionnaire; (4 have an e-mail address and access to the internet; (5 Eligible for an ERS. The intervention rationale, design and content are reported in another presentation. Aims: This presentation will provide initial findings from a 3 month internal pilot phase with a focus on trial recruitment and initial intervention engagement. We will present data on the

  16. Improving diabetes medication adherence: successful, scalable interventions

    Directory of Open Access Journals (Sweden)

    Zullig LL

    2015-01-01

    Full Text Available Leah L Zullig,1,2 Walid F Gellad,3,4 Jivan Moaddeb,2,5 Matthew J Crowley,1,2 William Shrank,6 Bradi B Granger,7 Christopher B Granger,8 Troy Trygstad,9 Larry Z Liu,10 Hayden B Bosworth1,2,7,11 1Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 2Department of Medicine, Duke University, Durham, NC, USA; 3Center for Health Equity Research and Promotion, Pittsburgh Veterans Affairs Medical Center, Pittsburgh, PA, USA; 4Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; 5Institute for Genome Sciences and Policy, Duke University, Durham, NC, USA; 6CVS Caremark Corporation; 7School of Nursing, Duke University, Durham, NC, USA; 8Department of Medicine, Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; 9North Carolina Community Care Networks, Raleigh, NC, USA; 10Pfizer, Inc., and Weill Medical College of Cornell University, New York, NY, USA; 11Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA Abstract: Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US healthcare system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population. We identify key characteristics that make these interventions effective and scalable. This information is intended to inform healthcare systems seeking proven, low resource, cost-effective solutions to improve medication adherence. Keywords: medication adherence, diabetes mellitus, chronic disease, dissemination research

  17. Using Electronic Health Records Data for Substance Use Screening, Brief Intervention, and Referral to Treatment among Adults with Type 2 Diabetes: Design of a National Drug Abuse Treatment Clinical Trials Network Study

    Science.gov (United States)

    Wu, Li-Tzy; Brady, Kathleen T.; Spratt, Susan E.; Dunham, Ashley A.; Heidenfelder, Brooke; Batch, Bryan C.; Lindblad, Robert; VanVeldhuisen, Paul; Rusincovitch, Shelley A.; Killeen, Therese K.; Ghitza, Udi E.

    2015-01-01

    Background The Affordable Care Act encourages healthcare systems to integrate behavioral and medical healthcare, as well as to employ electronic health records (EHRs) for health information exchange and quality improvement. Pragmatic research paradigms that employ EHRs in research are needed to produce clinical evidence in real-world medical settings for informing learning healthcare systems. Adults with comorbid diabetes and substance use disorders (SUDs) tend to use costly inpatient treatments; however, there is a lack of empirical data on implementing behavioral healthcare to reduce health risk in adults with high-risk diabetes. Given the complexity of high-risk patients' medical problems and the cost of conducting randomized trials, a feasibility project is warranted to guide practical study designs. Methods We describe the study design, which explores the feasibility of implementing substance use Screening, Brief Intervention, and Referral to Treatment (SBIRT) among adults with high-risk type 2 diabetes mellitus (T2DM) within a home-based primary care setting. Our study includes the development of an integrated EHR datamart to identify eligible patients and collect diabetes healthcare data, and the use of a geographic health information system to understand the social context in patients' communities. Analysis will examine recruitment, proportion of patients receiving brief intervention and/or referrals, substance use, SUD treatment use, diabetes outcomes, and retention. Discussion By capitalizing on an existing T2DM project that uses home-based primary care, our study results will provide timely clinical information to inform the designs and implementation of future SBIRT studies among adults with multiple medical conditions. PMID:26563446

  18. A Novel Semantically-Time-Referrer based Approach of Web Usage Mining for Improved Sessionization in Pre-Processing of Web Log

    Directory of Open Access Journals (Sweden)

    Navjot Kaur

    2017-01-01

    Full Text Available Web usage mining(WUM , also known as Web Log Mining is the application of Data Mining techniques, which are applied on large volume of data to extract useful and interesting user behaviour patterns from web logs, in order to improve web based applications. This paper aims to improve the data discovery by mining the usage data from log files. In this paper the work is done in three phases. First and second phase0 which are data cleaning and user identification respectively are completed using traditional methods. The third phase, session identification is done using three different methods. The main focus of this paper is on sessionization of log file which is a critical step for extracting usage patterns. The proposed referrer-time and Semantically-time-referrer methods overcome the limitations of traditional methods. The main advantage of pre-processing model presented in this paper over other methods is that it can process text or excel log file of any format. The experiments are performed on three different log files which indicate that the proposed semantically-time-referrer based heuristic approach achieves better results than the traditional time and Referrer-time based methods. The proposed methods are not complex to use. Web log file is collected from different servers and contains the public information of visitors. In addition, this paper also discusses different types of web log formats.

  19. Mental Health in Sport (MHS): Improving the Early Intervention Knowledge and Confidence of Elite Sport Staff.

    Science.gov (United States)

    Sebbens, Joshua; Hassmén, Peter; Crisp, Dimity; Wensley, Kate

    2016-01-01

    Mental illnesses are as prevalent among elite athletes as in the general population. Despite this, there is little research examining how to enhance mental health literacy or helping behaviors in elite sport environments. A Mental Health in Sport (MHS) workshop was therefore developed and its effects on mental health literacy and confidence studied in 166 coaches and support staff working with elite athletes and teams in Australia. Results indicated that participants increased their knowledge of the signs and symptoms of common mental illnesses and were more confident in helping someone who may be experiencing a mental health problem. We conclude that even a very brief intervention can be effective in improving the mental health literacy and confidence of key persons in elite sport environments, and may promote early intervention and timely referral of elite athletes with mental health concerns to appropriate professionals.

  20. Successful implementation of the World Health Organization hand hygiene improvement strategy in a referral hospital in Mali, Africa.

    Science.gov (United States)

    Allegranzi, Benedetta; Sax, Hugo; Bengaly, Loséni; Richet, Hervé; Minta, Daouda K; Chraiti, Marie-Noelle; Sokona, Fatoumata Maiga; Gayet-Ageron, Angèle; Bonnabry, Pascal; Pittet, Didier

    2010-02-01

    To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country. A before-and-after study from December 2006 through June 2008, with a 6-month baseline evaluation period and a follow-up period of 8 months from the beginning of the intervention. University Hospital, Bamako, Mali. Participants. Two hundred twenty-four healthcare workers. The intervention consisted of introducing a locally produced, alcohol-based handrub; monitoring hand hygiene compliance; providing performance feedback; educating staff; posting reminders in the workplace; and promoting an institutional safety climate according to the World Health Organization multimodal hand hygiene improvement strategy. Hand hygiene infrastructure, compliance, healthcare workers' knowledge and perceptions, and handrub consumption were evaluated at baseline and at follow-up. Severe deficiencies in the infrastructure for hand hygiene were identified before the intervention. Local handrub production and quality control proved to be feasible, affordable, and satisfactory. At follow-up, handrubbing was the quasi-exclusive hand hygiene technique (93.3%). Compliance increased from 8.0% at baseline to 21.8% at follow-up (P hygiene promotion is feasible and effective in a low-income country. Access to handrub was critical for its success. These findings motivated the government of Mali to expand the intervention nationwide. This experience represents a significant advancement for patient safety in developing countries.

  1. High compliance with newborn community-to-facility referral in eastern Uganda:.an opportunity to improve newborn survival.

    Directory of Open Access Journals (Sweden)

    Christine Kayemba Nalwadda

    Full Text Available BACKGROUND: Seventy-five percent of newborn deaths happen in the first-week of life, with the highest risk of death in the first 24-hours after birth.WHO and UNICEF recommend home-visits for babies in the first-week of life to assess for danger-signs and counsel caretakers for immediate referral of sick newborns. We assessed timely compliance with newborn referrals made by community-health workers (CHWs, and its determinants in Iganga and Mayuge Districts in rural eastern Uganda. METHODS: A historical cohort study design was used to retrospectively follow up newborns referred to health facilities between September 2009 and August 2011. Timely compliance was defined as caretakers of newborns complying with CHWs' referral advice within 24-hours. RESULTS: A total of 724 newborns were referred by CHWs of whom 700 were successfully traced. Of the 700 newborns, 373 (53% were referred for immunization and postnatal-care, and 327 (47% because of a danger-sign. Overall, 439 (63% complied, and of the 327 sick newborns, 243 (74% caretakers complied with the referrals. Predictors of referral compliance were; the newborn being sick at the time of referral- Adjusted Odds Ratio (AOR = 2.3, and 95% Confidence-Interval (CI of [1.6 - 3.5], the CHW making a reminder visit to the referred newborn shortly after referral (AOR =1.7; 95% CI: [1.2 -2.7]; and age of mother (25-29 and (30-34 years, (AOR =0.4; 95% CI: [0.2 - 0.8] and (AOR = 0.4; 95% CI: [0.2 - 0.8] respectively. CONCLUSION: Caretakers' newborn referral compliance was high in this setting. The newborn being sick, being born to a younger mother and a reminder visit by the CHW to a referred newborn were predictors of newborn referral compliance. Integration of CHWs into maternal and newborn care programs has the potential to increase care seeking for newborns, which may contribute to reduction of newborn mortality.

  2. Surdez: da suspeita ao encaminhamento Sordera: de la sospecha al encaminamiento Deafness: from suspicion to referral for intervention

    Directory of Open Access Journals (Sweden)

    Angélica Bronzatto P. Silva

    2012-06-01

    frecuentaban atención especializada en Centro de Estudios e Investigaciones en Rehabilitación, en la provincia de São Paulo, hace como mínimo dos años. Se realizó entrevista semiestructurada con las madres y se hizo análisis del habla de las participantes, buscando comprender el sentido que las madres dieron a su comunicación. RESULTADOS: A pesar del diagnóstico de seis niños haber sido realizado antes de un año de edad y teniendo en cuenta los múltiples sentimientos de las madres frente a la sordera de los hijos, se observó que en algunos casos el diagnóstico podría haber ocurrido antes si el habla de las madres fuera valorada. Se percibió la dificultad de «escucha» de los profesionales de la salud respecto a las dudas, quejas y cuestionamientos de las madres. Se constató que, en algunos casos, aun cuando tuvo lugar la selección auditiva neonatal o el diagnóstico oportuno, se retardó la atención al niño porque no se hicieron encaminamientos adecuados para locales que trabajan en el área de la sordera. En el momento del diagnóstico, la forma como se comunicó la sordera a la familia necesitaría tener en cuenta las condiciones sociales, culturales y emocionales de las madres. CONCLUSIONES: Se subraya la importancia de la cualificación y atención de los profesionales de salud, para hacer posible el diagnóstico temprano, el apoyo a los padres y el encaminamiento y seguimiento adecuados para los casos de sordera.OBJECTIVE: To investigate the experiences of mothers concerning the suspicion of deafness, the diagnosis and the referral to rehabilitation, as well as their perception about how the diagnosis was presented and explained. METHODS: Qualitative study with ten hearing mothers of deaf children who attended specialized treatment at São Paulo State, Brazil, for at least two years. A semi-structured interview with the mothers was performed and data were analyzed by examining of participants speeches, seeking to understand the meaning that mothers

  3. The impact of informational interventions about cognitive behavioral therapy for chronic fatigue syndrome on GPs referral behavior.

    NARCIS (Netherlands)

    Scheeres, K.; Wensing, M.J.P.; Mes, C.; Bleijenberg, G.

    2007-01-01

    OBJECTIVE: This study investigated the impact of an informational intervention among general practitioners (GPs) about a new treatment with cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). The outcome measures concerned GPs knowledge and attitude

  4. Effectiveness of an intervention to facilitate prompt referral to memory clinics in the United Kingdom: Cluster randomised controlled trial.

    Directory of Open Access Journals (Sweden)

    Gill Livingston

    2017-03-01

    Full Text Available Most people with dementia do not receive timely diagnosis, preventing them from making informed plans about their future and accessing services. Many countries have a policy to increase timely diagnosis, but trials aimed at changing general practitioner (GP practice have been unsuccessful. We aimed to assess whether a GP's personal letter, with an evidence-based leaflet about overcoming barriers to accessing help for memory problems-aimed at empowering patients and families-increases timely dementia diagnosis and patient presentation to general practice.Multicentre, cluster-randomised controlled trial with raters masked to an online computer-generated randomisation system assessing 1 y outcome. We recruited 22 general practices (August 2013-September 2014 and 13 corresponding secondary care memory services in London, Hertfordshire, and Essex, United Kingdom. Eligible patients were aged ≥70 y, without a known diagnosis of dementia, living in their own homes. There were 6,387 such patients in 11 intervention practices and 8,171 in the control practices. The primary outcome was cognitive severity on Mini Mental State Examination (MMSE. Main secondary outcomes were proportion of patients consulting their GP with suspected memory disorders and proportion of those referred to memory clinics. There was no between-group difference in cognitive severity at diagnosis (99 intervention, mean MMSE = 22.04, 95% confidence intervals (CIs = 20.95 to 23.13; 124 control, mean MMSE = 22.59, 95% CI = 21.58 to 23.6; p = 0.48. GP consultations with patients with suspected memory disorders increased in intervention versus control group (odds ratio = 1.41; 95% CI = 1.28, 1.54. There was no between-group difference in the proportions of patients referred to memory clinics (166, 2.5%; 220, 2.7%; p = .077 respectively. The study was limited as we do not know whether the additional patients presenting to GPs had objective as well as subjective memory problems and

  5. Referral for psychological therapy of people with long term conditions improves adherence to antidepressants and reduces emergency department attendance: Controlled before and after study

    Science.gov (United States)

    de Lusignan, Simon; Chan, Tom; Tejerina Arreal, Maria C.; Parry, Glenys; Dent-Brown, Kim; Kendrick, Tony

    2013-01-01

    Background Referral to psychological therapies is recommended for people with common mental health problems (CMHP) however its impact on healthcare utilisation in people with long term conditions (LTCs) is not known. Method Routinely collected primary care, psychological therapy clinic and hospital data were extracted for the registered population of 20 practices (N = 121199). These data were linked using the SAPREL (Secure and Private Record Linkage) method. We linked the 1118 people referred to psychological therapies with 6711 controls, matched for age, gender and practice. We compared utilisation of healthcare resources by people with LTCs, 6 months before and after referral, and conducted a controlled before and after study to compare health utilisation with controls. We made the assumption that collection of a greater number of repeat prescriptions for antidepressants was associated with greater adherence. Results Overall 21.8% of people with an LTC had CMHP vs. 18.8% without (p < 0.001). People with LTCs before referral were more likely to use health care resources (2-tailed t-test p < 0.001). Cases with LTCs showed referral to the psychological therapies clinic was associated with increased antidepressant medication prescribing (mean differences 0.62, p < 0.001) and less use of emergency department than controls (mean difference −0.21, p = 0.003). Conclusions Referral to improved access to psychological therapies (IAPT) services appears of value to people with LTC. It is associated with the issue of a greater number of prescriptions for anti-depressant medicines and less use of emergency services. Further studies are needed to explore bed occupancy and outpatient attendance. PMID:23639304

  6. [e-Health interventions and improvement in treatment adherence].

    Science.gov (United States)

    Sieben, Angelien; Bredie, S J H Bas; van Laarhoven, C J H M Kees; Schoonhoven, Lisette; Burger, David M; van Onzenoort, Hein A W

    2014-01-01

    Poor adherence to medication is one of the most important determinants in the treatment of patients with chronic disorders. e-Health-based interventions may be able to improve treatment adherence. This article gives an overview of the available e-Health interventions and the extent to which they can improve adherence. We searched in the PubMed, Cinahl, PsycInfo, and Embase databases for e-Health interventions that aimed at improving adherence to treatment. Of the 16 included studies, 15 used a website and one used an app. Ten studies showed a significant improvement in treatment adherence by using the intervention. e-Health interventions were generally complex. Simple interventions were the most successful in improving treatment adherence.

  7. Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices.

    Science.gov (United States)

    Kennelly, S; Kennedy, N P; Corish, C A; Flanagan-Rughoobur, G; Glennon-Slattery, C; Sugrue, S

    2011-10-01

    Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals' nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at 'high risk' of malnutrition than before (88% versus 37%; P dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

  8. Improvement of knowledge, attitude and perception of healthcare workers about ADR, a pre- and post-clinical pharmacists' interventional study

    Science.gov (United States)

    Mohebbi, Niayesh; Hendoiee, Narjes; Keshtkar, Abbas-Ali; Dashti-Khavidaki, Simin

    2012-01-01

    Purpose Healthcare workers have a main role in detection, assessment and spontaneous reporting of adverse drug reactions (ADRs), and improvement of their related knowledge, attitude and perception is essential. The goal of this study was evaluation of clinical pharmacists' interventions in improvement of knowledge, attitude and perception of healthcare workers about ADRs in a teaching referral hospital, Tehran, Iran. Method Changes in knowledge, attitude and perception of healthcare workers of Imam teaching hospital about ADRs were evaluated before and after clinical pharmacists' interventions including workshops, meetings and presentations. Results From the 100 participated subjects, 82 of them completed the study. 51% of the health workers have been aware of the Iranian Pharmacovigilance Center at the ministry of health before intervention and after that all the participants knew this centre. About awareness and detection of ADRs in patients, 69 (84.1%) healthcare workers recognised at least one, and following interventions, it was improved to 73 (89%). Only seven (8.5%) subjects have reported ADRs in before intervention phase that were increased significantly to 18 (22%) after intervention. Conclusion Clinical pharmacists' interventions were successful in improvement of healthcare workers' knowledge, attitude and perception about ADRs and spontaneous reporting in our hospital. PMID:22246555

  9. Music Education Intervention Improves Vocal Emotion Recognition

    Science.gov (United States)

    Mualem, Orit; Lavidor, Michal

    2015-01-01

    The current study is an interdisciplinary examination of the interplay among music, language, and emotions. It consisted of two experiments designed to investigate the relationship between musical abilities and vocal emotional recognition. In experiment 1 (N = 24), we compared the influence of two short-term intervention programs--music and…

  10. Music Education Intervention Improves Vocal Emotion Recognition

    Science.gov (United States)

    Mualem, Orit; Lavidor, Michal

    2015-01-01

    The current study is an interdisciplinary examination of the interplay among music, language, and emotions. It consisted of two experiments designed to investigate the relationship between musical abilities and vocal emotional recognition. In experiment 1 (N = 24), we compared the influence of two short-term intervention programs--music and…

  11. Web-based remote psychological intervention improves cancer treatment.

    Science.gov (United States)

    Wang, Ping; Yu, Tao; Yang, Lin

    2017-08-01

    Web-based-remote (WBR) intervention is a new approach that incorporates smart control technology and modern medicine to monitor patient compliance. It is based on computer control and communication technology. This study is to explore the benefits of WBR psychological intervention for cancer treatment. 128 patients diagnosed with cancer by Pathology Department of our hospital between 1 February 2013 and 1 August 2013 were included. Patients were randomly assigned to intervention and control group (n = 64). The Questionnaire-Core 30 (QLQ-C30) was used for the survey. Intervention group received WBR psychological intervention in addition to regular clinical follow-up care. Control group only received regular clinical follow-up care. The QLQ-C30 score was significantly better in the intervention group than the control group when the intervention and control groups were followed for three months. In conclusion, WBR psychological intervention substantially improves the quality of life in patients during cancer treatment.

  12. Improving Surgical and Anaesthesia Practice: Review of the Use of the WHO Safe Surgery Checklist in Felege Hiwot Referral Hospital, Ethiopia

    Science.gov (United States)

    Ellis, Ryan; Izzuddin Mohamad Nor, Ahmad; Pimentil, Iona; Bitew, Zebenaye; Moore, Jolene

    2017-01-01

    Development of surgical and anaesthetic care globally has been consistently reported as being inadequate. The Lancet Commission on Global Surgery highlights the need for action to address this deficit. One such action to improve global surgical safety is the introduction of the WHO Surgical Checklist to Operating Rooms (OR) around the world. The checklist has a growing body of evidence supporting its ability to assist in the delivery of safe anaesthesia and surgical care. Here we report the introduction of the Checklist to a major Ethiopian referral hospital and low-resource setting and highlight the success and challenges of its implementation over a one year period. This project was conducted between July 2015 and August 2016, within a wider partnership between Felege Hiwot Hospital and The University of Aberdeen. The WHO Surgical Checklist was modified for appropriate and locally specific use within the OR of Felege Hiwot. The modified Checklist was introduced to all OR's and staff instructed on its use by local surgical leaders. Assessment of use of the Checklist was performed for General Surgical OR in three phases and Obstetric OR in two phases via observational study and case note review. Training was conduct between each phase to address challenges and promote use. Checklist utilisation in the general OR increased between Phase I and 2 from 50% to 97% and remained high at 94% in Phase 3. Between Phase I and 2 partial completion rose from 27% to 77%, whereas full completion remained unchanged (23% to 20%). Phase 3 resulted in an increase in full completion from 20% to 60%. After 1 year the least completed section was “Sign In” (53%) and “Time Out” was most completed (87%). The most poorly checked item was “Site Marked” (60%). Use of the checklist in Obstetrics OR increased between Phase I and Phase II from 50% to 100% with some improvement in partial completion (50% to 60%) and a notable increase in full completion (0% to 40%). The least

  13. Why economic analysis of health system improvement interventions matters

    Directory of Open Access Journals (Sweden)

    Edward Ivor Broughton

    2016-10-01

    Full Text Available There is little evidence to direct health systems toward providing efficient interventions to address medical errors, defined as an unintended act of omission or commission or one not executed as intended that may or may not cause harm to the patient but does not achieve its intended outcome. We believe that lack of guidance on what is the most efficient way to reduce adverse events and improve the quality of health care limits the scale-up of health system improvement interventions. Challenges to economic evaluation of these interventions include defining and implementing improvement interventions in different settings with high fidelity, capturing all of the positive and negative effects of the intervention, using process measures of effectiveness rather than health outcomes, and determining the full cost of the intervention and all economic consequences its effects. However, health system improvement interventions should be treated similarly to individual medical interventions and undergo rigorous economic evaluation to provide actionable evidence to guide policy-makers in decisions of resources allocation for improvement activities among other competing demands for health care resources.

  14. Why Economic Analysis of Health System Improvement Interventions Matters

    Science.gov (United States)

    Broughton, Edward Ivor; Marquez, Lani

    2016-01-01

    There is little evidence to direct health systems toward providing efficient interventions to address medical errors, defined as an unintended act of omission or commission or one not executed as intended that may or may not cause harm to the patient but does not achieve its intended outcome. We believe that lack of guidance on what is the most efficient way to reduce medical errors and improve the quality of health-care limits the scale-up of health system improvement interventions. Challenges to economic evaluation of these interventions include defining and implementing improvement interventions in different settings with high fidelity, capturing all of the positive and negative effects of the intervention, using process measures of effectiveness rather than health outcomes, and determining the full cost of the intervention and all economic consequences of its effects. However, health system improvement interventions should be treated similarly to individual medical interventions and undergo rigorous economic evaluation to provide actionable evidence to guide policy-makers in decisions of resource allocation for improvement activities among other competing demands for health-care resources.

  15. Do multiple micronutrient interventions improve child health, growth, and development?

    Science.gov (United States)

    Ramakrishnan, Usha; Goldenberg, Tamar; Allen, Lindsay H

    2011-11-01

    Micronutrient deficiencies are common and often co-occur in many developing countries. Several studies have examined the benefits of providing multiple micronutrient (MMN) interventions during pregnancy and childhood, but the implications for programs remain unclear. The key objective of this review is to summarize what is known about the efficacy of MMN interventions during early childhood on functional outcomes, namely, child health, survival, growth, and development, to guide policy and identify gaps for future research. We identified review articles including meta-analyses and intervention studies that evaluated the benefits of MMN interventions (3 or more micronutrients) in children (child morbidity, anemia, and growth. Two studies found no effects on child mortality. The findings for respiratory illness and diarrhea are mixed, although suggestive of benefit when provided as fortified foods. There is evidence from several controlled trials (>25) and 2 meta-analyses that MMN interventions improve hemoglobin concentrations and reduce anemia, but the effects were small compared to providing only iron or iron with folic acid. Two recent meta-analyses and several intervention trials also indicated that MMN interventions improve linear growth compared to providing a placebo or single nutrients. Much less is known about the effects on MMN interventions during early childhood on motor and mental development. In summary, MMN interventions may result in improved outcomes for children in settings where micronutrient deficiencies are widespread.

  16. Are We There Yet? A Review of Screening, Brief Intervention, and Referral to Treatment (SBIRT) Implementation Fidelity Tools and Proficiency Checklists.

    Science.gov (United States)

    Reho, Kaitlyn; Agley, Jon; DeSalle, Mallori; Gassman, Ruth A

    2016-08-01

    Screening and brief intervention (SBI) for alcohol is an evidence-based prevention practice designed to reduce frequency and severity of alcohol misuse. Many studies have validated the effectiveness of SBI for reducing levels of alcohol misuse, especially in primary medical care. Additional research continues to be conducted in terms of the effectiveness of including referral to treatment (SBIRT) and addressing illicit drug use and prescription drug abuse. Importantly, cross-comparison among SBIRT programs is difficult because evaluative processes vary widely between programs, which themselves often are substantively different. In this brief report, we utilized cross-comparison techniques to elucidate similarities and differences among SBIRT fidelity tools and proficiency checklists. In early 2014, researchers completed a systematic review of SBIRT fidelity tools and proficiency checklists published or made available from 2004 through April 2014; in total, eleven instruments were located and assessed. The analytic methodology consisted of creating a matrix with key SBIRT components identified from the literature prior to assessment. Three researchers populated the matrix with the identified fidelity tools and proficiency checklists before assessing each tool for the presence or absence of each component. The level of agreement between the researchers was checked for inter-rater reliability using free-marginal Kappa statistics. The results of the matrix analysis suggested heterogeneity among existing SBIRT fidelity tools and proficiency checklists. Importantly, it was not the case that this lack of concordance reflected poorly on any given fidelity tool. Rather, it emphasized the multi-partite and variable nature of SBIRT programs. It was not evident that a single standardized SBIRT fidelity tool or proficiency checklist could appropriately determine the level of fidelity to SBIRT for all programs. Suggestions for next steps in SBIRT fidelity research are provided

  17. Determining the potential scalability of transport interventions for improving maternal, child, and newborn health in Pakistan.

    Science.gov (United States)

    uddin Mian, Naeem; Malik, Mariam Zahid; Iqbal, Sarosh; Alvi, Muhammad Adeel; Memon, Zahid; Chaudhry, Muhammad Ashraf; Majrooh, Ashraf; Awan, Shehzad Hussain

    2015-11-25

    Pakistan is far behind in achieving the Millennium Development Goals regarding the reduction of child and maternal mortality. Amongst other factors, transport barriers make the requisite obstetric care inaccessible for women during pregnancy and at birth, when complications may become life threatening for mother and child. The significance of efficient transport in maternal and neonatal health calls for identifying which currently implemented transport interventions have potential for scalability. A qualitative appraisal of data and information about selected transport interventions generated primarily by beneficiaries, coordinators, and heads of organizations working with maternal, child, and newborn health programs was conducted against the CORRECT criteria of Credibility, Observability, Relevance, Relative Advantage, Easy-Transferability, Compatibility and Testability. Qualitative comparative analysis (QCA) techniques were used to analyse seven interventions against operational indicators. Logical inference was drawn to assess the implications of each intervention. QCA was used to determine simplifying and complicating factors to measure potential for scaling up of the selected transport intervention. Despite challenges like deficient in-journey care and need for greater community involvement, community-based ambulance services were managed with the support of the community and had a relatively simple model, and therefore had high scalability potential. Other interventions, including facility-based services, public-sector emergency services, and transport voucher schemes, had limitations of governance, long-term sustainability, large capital expenditures, and need for management agencies that adversely affected their scalability potential. To reduce maternal and child morbidity and mortality and increase accessibility of health facilities, it is important to build effective referral linkages through efficient transport systems. Effective linkages between

  18. Interventional tools to improve medication adherence: review of literature

    Science.gov (United States)

    Costa, Elísio; Giardini, Anna; Savin, Magda; Menditto, Enrica; Lehane, Elaine; Laosa, Olga; Pecorelli, Sergio; Monaco, Alessandro; Marengoni, Alessandra

    2015-01-01

    Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we review the most frequent interventions employed to increase the degree of medication adherence, the measured outcomes, and the improvements achieved, as well as the main limitations of the available studies on adherence, with a particular focus on older persons. PMID:26396502

  19. What's the Right Referral Rate? Specialty Referral Patterns and Curricula Across I3 Collaborative Primary Care Residencies.

    Science.gov (United States)

    Gwynne, Mark; Page, Cristen; Reid, Alfred; Donahue, Katrina; Newton, Warren

    2017-02-01

    Specialty physician visits account for a significant portion of ambulatory visits nationally, contribute significantly to cost of care, and are increasing over the past decade. Marked variability in referral rates exists among primary care practices without obvious causality. We present data describing the referral process and specialty referral curriculum within the I3 collaborative. Residency directors were surveyed about residency characteristics related to referrals. Specialty physician referral rates were obtained from each program and then correlated to program characteristics referral rates in four domains: presence and type of referral curriculum, process of referral review, faculty preceptor characteristics, and use of referral data for administrative processes. The survey response rate was 87%; 10 programs submitted complete referral data. Three programs (23%) reported a formal curriculum addressing the process of making a referral, and four programs (31%) reported a curriculum on appropriateness of subspecialty referrals. Specialty referral rates varied from 7%-31% of active residency patients, with no relationship to age, payor status, or race. Marked variability in referral rates and patterns exist within primary care residency training programs. Specialty referral practices are a key driver of total cost of care yet few curricula exist that address appropriateness, quantity, or process of specialty referrals. Practice patterns often develop during residency training, therefore an opportunity exists to improve training and practice around referrals.

  20. Will Interventions Targeting Conscientiousness Improve Aging Outcomes?

    Science.gov (United States)

    English, Tammy; Carstensen, Laura L.

    2014-01-01

    The articles appearing in this special section discuss the role that conscientiousness may play in healthy aging. Growing evidence suggests that conscientious individuals live longer and healthier lives. However, the question remains whether this personality trait can be leveraged to improve long-term health outcomes. We argue that even though it…

  1. A cluster randomized trial of an organizational process improvement intervention for improving the assessment and case planning of offenders: a Study Protocol.

    Science.gov (United States)

    Shafer, Michael S; Prendergast, Michael; Melnick, Gerald; Stein, Lynda A; Welsh, Wayne N

    2014-01-01

    The Organizational Process Improvement Intervention (OPII), conducted by the NIDA-funded Criminal Justice Drug Abuse Treatment Studies consortium of nine research centers, examined an organizational intervention to improve the processes used in correctional settings to assess substance abusing offenders, develop case plans, transfer this information to community-based treatment agencies, and monitor the services provided by these community based treatment agencies. A multi-site cluster randomized design was used to evaluate an inter-agency organizational process improvement intervention among dyads of correctional agencies and community based treatment agencies. Linked correctional and community based agencies were clustered among nine (9) research centers and randomly assigned to an early or delayed intervention condition. Participants included administrators, managers, and line staff from the participating agencies; some participants served on interagency change teams while other participants performed agency tasks related to offender services. A manualized organizational intervention that includes the use of external organizational coaches was applied to create and support interagency change teams that proceeded through a four-step process over a planned intervention period of 12 months. The primary outcome of the process improvement intervention was to improve processes associated with the assessment, case planning, service referral and service provision processes within the linked organizations. Providing substance abuse offenders with coordinated treatment and access to community-based services is critical to reducing offender recidivism. Results from this study protocol will provide new and critical information on strategies and processes that improve the assessment and case planning for such offenders as they transition between correctional and community based systems and settings. Further, this study extends current knowledge of and methods for, the study

  2. Improving Breastfeeding Behaviors: Evidence from Two Decades of Intervention Research.

    Science.gov (United States)

    Green, Cynthia P.

    This report summarizes research on interventions intended to improve four key breastfeeding behaviors: early initiation of breastfeeding, feeding of colostrum to newborns, exclusive breastfeeding for the first 0-6 months, and continued breastfeeding through the second year and beyond. It clarifies what is known about improving these practices in…

  3. Mobile phone-based interventions for improving contraception use.

    Science.gov (United States)

    Smith, Chris; Gold, Judy; Ngo, Thoai D; Sumpter, Colin; Free, Caroline

    2015-06-26

    Contraception provides significant benefits for women's and children's health, yet an estimated 225 million women had an unmet need for modern contraceptive methods in 2014. Interventions delivered by mobile phone have been demonstrated to be effective in other health areas, but their effects on use of contraception have not been established. To assess the effects of mobile phone-based interventions for improving contraception use. We searched for randomised controlled trials (RCTs) of client-provider interventions delivered by mobile phone to improve contraception use compared with standard care or another intervention. We searched the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Global Health, PsycINFO, POPLINE, Africa-Wide Information and Latin American Caribbean Health Sciences Literature (LILACS) from January 1993 to October 2014, as well as clinical trials registries, online mHealth resources and abstracts from key conferences. Randomised controlled trials of mobile phone-based interventions to improve any form of contraception use amongst users or potential users of contraception. Outcome measures included uptake of contraception, measures of adherence, pregnancy and abortion. Two review authors independently screened titles and abstracts of studies retrieved using the search strategy and extracted data from the included studies. We calculated the Mantel-Haenszel risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, together with 95% confidence intervals (CIs). Differences in interventions and outcome measures did not permit us to undertake meta-analysis. Five RCTs met our inclusion criteria. Three trials aimed to improve adherence to a specific method of contraception amongst existing or new contraception users by comparing automated text message interventions versus standard care. Two trials aimed to improve both uptake and adherence, not limited to one method, in

  4. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Brown, Erwin; Charani, Esmita; Fenelon, Lynda; Gould, Ian M; Holmes, Alison; Ramsay, Craig R; Wiffen, Philip J; Wilcox, Mark

    2013-04-30

    included any professional or structural interventions as defined by EPOC. The intervention had to include a component that aimed to improve antibiotic prescribing to hospital inpatients, either by increasing effective treatment or by reducing unnecessary treatment. The results had to include interpretable data about the effect of the intervention on antibiotic prescribing or microbial outcomes or relevant clinical outcomes. Two authors extracted data and assessed quality. We performed meta-regression of ITS studies to compare the results of persuasive and restrictive interventions. Persuasive interventions advised physicians about how to prescribe or gave them feedback about how they prescribed. Restrictive interventions put a limit on how they prescribed; for example, physicians had to have approval from an infection specialist in order to prescribe an antibiotic. We standardized the results of some ITS studies so that they are on the same scale (percent change in outcome), thereby facilitating comparisons of different interventions. To do this, we used the change in level and change in slope to estimate the effect size with increasing time after the intervention (one month, six months, one year, etc) as the percent change in level at each time point. We did not extrapolate beyond the end of data collection after the intervention. The meta-regression was performed using standard weighted linear regression with the standard errors of the coefficients adjusted where necessary. For this update we included 89 studies that reported 95 interventions. Of the 89 studies, 56 were ITSs (of which 4 were controlled ITSs), 25 were RCT (of which 5 were cluster-RCTs), 5 were CBAs and 3 were CCTs (of which 1 was a cluster-CCT).Most (80/95, 84%) of the interventions targeted the antibiotic prescribed (choice of antibiotic, timing of first dose and route of administration). The remaining 15 interventions aimed to change exposure of patients to antibiotics by targeting the decision to treat

  5. A multifaceted education intervention for improving family physicians' case management.

    Science.gov (United States)

    Reyes-Morales, Hortensia; Flores-Hernández, Sergio; Tomé-Sandoval, Patricia; Pérez-Cuevas, Ricardo

    2009-04-01

    The Mexican Institute of Social Security (IMSS) is the largest public health care system in Mexico. IMSS family physicians' management of clinical problems is frequently not consistent with published evidence. This study aimed to evaluate the effects of a multifaceted educational intervention to improve management of acute respiratory infections (ARI) by IMSS family physicians. A non-randomized pre-post intervention with comparison group design was conducted in eight IMSS family medicine clinics in which 106 family physicians practiced. An evidence-based clinical guideline for ARI management was developed, and clinical tutors were trained. The three-stage intervention comprised interactive workshops, individual tutorials, and round-table peer-review sessions. The main outcome was appropriate ARI case management. The intervention effect was calculated by using the differences-in-differences model, adjusting for cluster of physicians. In the intervention group, the difference in mean proportion of improvement compared with baseline evaluation was 22.6% (95% confidence interval [CI]=10.3 to 34.9) for appropriate prescription of antibiotics, 29.8% (95% CI=17.2 to 42.4) for indication of worsening signs, and 19.6% (95% CI=11.2 to 28.0) for overall appropriate case management. The comparison group showed no significant changes. The educational intervention improved ARI management. Further studies are needed to analyze organizational implications, cost, sustainability, and effects on health outcomes.

  6. Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial

    NARCIS (Netherlands)

    Dopp, C.M.E.; Graff, M.J.L.; Teerenstra, S.; Sanden, M.W.; Olde Rikkert, M.G.M.; Vernooij-Dassen, M.J.F.J.

    2013-01-01

    BACKGROUND: To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS: A cluster randomized controlled trial with 28 experimental and 17 control clusters was

  7. Reasons for Referral, Intervention Approaches and Demographic Characteristics of Clients with Intellectual Disability Attending Adult Psychiatric Outpatient Services in the Kingdom of Bahrain

    Science.gov (United States)

    Grey, I.; Al-Saihati, B. A.; Al-Haddad, M.; McClean, B.

    2015-01-01

    Background: Relatively little information is available regarding the use of psychiatric services by individuals with intellectual disability (ID) in Arab countries. The current study aimed to identify (1) the reasons for referral; (2) demographic characteristics of individuals referred; (3) previous contact with child psychiatric services; (4)…

  8. Malnourished patients on hemodialysis improve after receiving a nutritional intervention

    Directory of Open Access Journals (Sweden)

    Adaiane Calegari

    2011-12-01

    Full Text Available INTRODUCTION: Malnutrition is multifactorial and may be modified by nutritional intervention. We aimed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non-industrialized nutritional supplement. METHODS: 18 patients were studied, they were selected from a previous nutritional assessment where nutritional risk was defined as: subjective global assessment > 15 plus one criterion for malnutrition. The following variables were assessed: anthropometric parameters, subjective global assessment, dietary intake, six-minute walking test, quality of life (SF-36, and biochemical tests. Patients were randomized to either Control or Intervention Groups. The Intervention Group received a dietetic supplement during dialysis containing 355 kcal, prepared from simple ingredients. After three months, subjects from the Control Group and other patients also considered at nutritional risk underwent the same intervention. The study groups were compared after three months, and all patients were analyzed before and after the intervention. RESULTS: Fifteen men and three women, aged 56.4 ± 15.6 years-old, nine in each group, were studied. The Intervention Group showed an improvement in the subjective global assessment (p = 0.04. There were differences in role physical and bodily pain domains of SF-36, with improvement in the Intervention Group and worsening in the Control Group (p = 0.034 and p = 0.021. Comparisons before and after intervention for all patients showed improvement in the subjective global assessment (16.18 ± 4.27 versus 14.37 ± 4.20, p = 0.04, and in the six-minute walking test (496.60 ± 132.59 versus 547.80 ± 132.48 m; p = 0.036. The nutritional supplement was well tolerated by all patients, and it did not cause side effects. CONCLUSIONS: The nutritional intervention improved the subjective global assessment and quality of life of hemodialysis patients at short-term. A

  9. Cluster sampling with referral to improve the efficiency of estimating unmet needs among pregnant and postpartum women after disasters.

    Science.gov (United States)

    Horney, Jennifer; Zotti, Marianne E; Williams, Amy; Hsia, Jason

    2012-01-01

    Women of reproductive age, in particular women who are pregnant or fewer than 6 months postpartum, are uniquely vulnerable to the effects of natural disasters, which may create stressors for caregivers, limit access to prenatal/postpartum care, or interrupt contraception. Traditional approaches (e.g., newborn records, community surveys) to survey women of reproductive age about unmet needs may not be practical after disasters. Finding pregnant or postpartum women is especially challenging because fewer than 5% of women of reproductive age are pregnant or postpartum at any time. From 2009 to 2011, we conducted three pilots of a sampling strategy that aimed to increase the proportion of pregnant and postpartum women of reproductive age who were included in postdisaster reproductive health assessments in Johnston County, North Carolina, after tornadoes, Cobb/Douglas Counties, Georgia, after flooding, and Bertie County, North Carolina, after hurricane-related flooding. Using this method, the percentage of pregnant and postpartum women interviewed in each pilot increased from 0.06% to 21%, 8% to 19%, and 9% to 17%, respectively. Two-stage cluster sampling with referral can be used to increase the proportion of pregnant and postpartum women included in a postdisaster assessment. This strategy may be a promising way to assess unmet needs of pregnant and postpartum women in disaster-affected communities. Published by Elsevier Inc.

  10. Outpatient nephrology referral rates after acute kidney injury.

    Science.gov (United States)

    Siew, Edward D; Peterson, Josh F; Eden, Svetlana K; Hung, Adriana M; Speroff, Theodore; Ikizler, T Alp; Matheny, Michael E

    2012-02-01

    AKI associates with an increased risk for the development and progression of CKD and mortality. Processes of care after an episode of AKI are not well described. Here, we examined the likelihood of nephrology referral among survivors of AKI at risk for subsequent decline in kidney function in a US Department of Veterans Affairs database. We identified 3929 survivors of AKI hospitalized between January 2003 and December 2008 who had an estimated GFR (eGFR) <60 ml/min per 1.73 m(2) 30 days after peak injury. We analyzed time to referral considering improvement in kidney function (eGFR ≥60 ml/min per 1.73 m(2)), dialysis initiation, and death as competing risks over a 12-month surveillance period. Median age was 73 years (interquartile range, 62-79 years) and the prevalence of preadmission kidney dysfunction (baseline eGFR <60 ml/min per 1.73 m(2)) was 60%. Overall mortality during the surveillance period was 22%. The cumulative incidence of nephrology referral before dying, initiating dialysis, or experiencing an improvement in kidney function was 8.5% (95% confidence interval, 7.6-9.4). Severity of AKI did not affect referral rates. These data demonstrate that a minority of at-risk survivors are referred for nephrology care after an episode of AKI. Determining how to best identify survivors of AKI who are at highest risk for complications and progression of CKD could facilitate early nephrology-based interventions.

  11. Failure of a patient-centered intervention to substantially increase the identification and referral for-treatment of ambulatory emergency department patients with occult psychiatric conditions: a randomized trial [ISRCTN61514736

    Directory of Open Access Journals (Sweden)

    Nezami Wais A

    2005-05-01

    Full Text Available Abstract Background We previously demonstrated that a computerized psychiatric screening interview (the PRIME-MD can be used in the Emergency Department (ED waiting room to identify patients with mental illness. In that trial, however, informing the ED physician of the PRIME-MD results did not increase the frequency of psychiatric diagnosis, consultation or referral. We conducted this study to determine whether telling the patient and physician the PRIME-MD result would result in the majority of PRIME-MD-diagnosed patients being directed toward treatment for their mental illness. Methods In this single-site RCT, consenting patients with non-specific somatic chief complaints (e.g., fatigue, back pain, etc. completed the computerized PRIME-MD in the waiting room and were randomly assigned to one of three groups: patient and physician told PRIME-MD results, patient told PRIME-MD results, and neither told PRIME-MD results. The main outcome measure was the percentage of patients with a PRIME-MD diagnosis who received a psychiatric consultation or referral from the ED. Results 183 (5% of all ED patients were approached. 123 eligible patients consented to participate, completed the PRIME-MD and were randomized. 95 patients had outcomes recorded. 51 (54% had a PRIME-MD diagnosis and 8 (16% of them were given a psychiatric consultation or referral in the ED. While the frequency of consultation or referral increased as the intervention's intensity increased (tell neither = 11% (1/9, tell patient 15% (3/20, tell patient and physician 18% (4/22, no group came close to the 50% threshold we sought. For this reason, we stopped the trial after an interim analysis. Conclusion Patients willingly completed the PRIME-MD and 54% had a PRIME-MD diagnosis. Unfortunately, at our institution, informing the patient (and physician of the PRIME-MD results infrequently led to the patient being directed toward care for their psychiatric condition.

  12. Effectiveness of knowledge translation interventions to improve cancer pain management.

    Science.gov (United States)

    Cummings, Greta G; Olivo, Susan Armijo; Biondo, Patricia D; Stiles, Carla R; Yurtseven, Ozden; Fainsinger, Robin L; Hagen, Neil A

    2011-05-01

    Cancer pain is prevalent, yet patients do not receive best care despite widely available evidence. Although national cancer control policies call for education, effectiveness of such programs is unclear and best practices are not well defined. To examine existing evidence on whether knowledge translation (KT) interventions targeting health care providers, patients, and caregivers improve cancer pain outcomes. A systematic review and meta-analysis were undertaken to evaluate primary studies that examined effects of KT interventions on providers and patients. Twenty-six studies met the inclusion criteria. Five studies reported interventions targeting health care providers, four focused on patients or their families, one study examined patients and their significant others, and 16 studies examined patients only. Seven quantitative comparisons measured the statistical effects of interventions. A significant difference favoring the treatment group in least pain intensity (95% confidence interval [CI]: 0.44, 1.42) and in usual pain/average pain (95% CI: 0.13, 0.74) was observed. No other statistical differences were observed. However, most studies were assessed as having high risk of bias and failed to report sufficient information about the intervention dose, quality of educational material, fidelity, and other key factors required to evaluate effectiveness of intervention design. Trials that used a higher dose of KT intervention (characterized by extensive follow-up, comprehensive educational program, and higher resource allocation) were significantly more likely to have positive results than trials that did not use this approach. Further attention to methodological issues to improve educational interventions and research to clarify factors that lead to better pain control are urgently needed. Crown Copyright © 2011. Published by Elsevier Inc. All rights reserved.

  13. Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial.

    Science.gov (United States)

    Mullen, Patricia Dolan; Savas, Lara S; Bundy, Łucja T; Haardörfer, Regine; Hovell, Mel; Fernández, Maria E; Monroy, Jo Ann A; Williams, Rebecca S; Kreuter, Matthew W; Jobe, David; Kegler, Michelle C

    2016-10-01

    Replication of intervention research is reported infrequently, limiting what we know about external validity and generalisability. The Smoke Free Homes Program, a minimal intervention, increased home smoking bans by United Way 2-1-1 callers in randomised controlled trials in Atlanta, Georgia and North Carolina. Test the programme's generalisability-external validity in a different context. A randomised controlled trial (n=508) of English-speaking callers from smoking-discordant households (≥1 smoker and ≥1 non-smoker). 2-1-1 Texas/United Way HELPLINE call specialists serving the Texas Gulf Coast recruited callers and delivered three mailings and one coaching call, supported by an online tracking system. Data collectors, blind to study assignment, conducted telephone interviews 3 and 6 months postbaseline. At 3 months, more intervention households reported a smoke-free home (46.6% vs 25.4%, pspeaking Latinos, support programme generalisability and convey evidence of external validity. Our recruitment experience indicates that site-specific adjustments might improve recruitment efficiency and reach. NCT02097914, Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Radiologists' responses to inadequate referrals

    Energy Technology Data Exchange (ETDEWEB)

    Lysdahl, Kristin Bakke [Oslo University College, Faculty of Health Sciences, Oslo (Norway); University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Hofmann, Bjoern Morten [University of Oslo, Section for Medical Ethics, Faculty of Medicine, P.O. Box 1130, Blindern, Oslo (Norway); Gjoevik University College, Faculty of Health Care and Nursing, Gjoevik (Norway); Espeland, Ansgar [Haukeland University Hospital, Department of Radiology, Bergen (Norway); University of Bergen, Section for Radiology, Department of Surgical Sciences, Bergen (Norway)

    2010-05-15

    To investigate radiologists' responses to inadequate imaging referrals. A survey was mailed to Norwegian radiologists; 69% responded. They graded the frequencies of actions related to referrals with ambiguous indications or inappropriate examination choices and the contribution of factors preventing and not preventing an examination of doubtful usefulness from being performed as requested. Ninety-five percent (344/361) reported daily or weekly actions related to inadequate referrals. Actions differed among subspecialties. The most frequent were contacting the referrer to clarify the clinical problem and checking test results/information in the medical records. Both actions were more frequent among registrars than specialists and among hospital radiologists than institute radiologists. Institute radiologists were more likely to ask the patient for additional information and to examine the patient clinically. Factors rated as contributing most to prevent doubtful examinations were high risk of serious complications/side effects, high radiation dose and low patient age. Factors facilitating doubtful examinations included respect for the referrer's judgment, patient/next-of-kin wants the examination, patient has arrived, unreachable referrer, and time pressure. In summary, radiologists facing inadequate referrals considered patient safety and sought more information. Vetting referrals on arrival, easier access to referring clinicians, and time for radiologists to handle inadequate referrals may contribute to improved use of imaging. (orig.)

  15. Effective Interventions on Service Quality Improvement in a Physiotherapy Clinic

    Directory of Open Access Journals (Sweden)

    Farid Gharibi

    2014-07-01

    Full Text Available Background: Service quality is considered as a main domain of quality associated with non-clinical aspect of healthcare. This study aimed to survey and improves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. Methods: A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reliable researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. Results: In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001. Conclusion: Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

  16. Can worksite nutritional interventions improve productivity and firm profitability?

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård

    2011-01-01

    ’ nutritional knowledge, food intake and health and on the firm’s profitability, mainly in terms of reduced absenteeism and presenteeism. Conclusions: Well-targeted and efficiently implemented diet-related worksite health promotion interventions may improve labour productivity by 1%–2%. On larger worksites...

  17. Effective interventions on service quality improvement in a physiotherapy clinic.

    Science.gov (United States)

    Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

    2014-01-01

    Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (PService quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

  18. Baduanjin Mind-Body Intervention Improves the Executive Control Function

    Science.gov (United States)

    Chen, Tingting; Yue, Guang H.; Tian, Yingxue; Jiang, Changhao

    2017-01-01

    This study aims at comparing the effects of the Baduanjin mind-body (BMB) intervention with a conventional relaxation training program on enhancing the executive function. The study also attempts to explore the neural substrates underlying the cognitive effect of BMB intervention using near-infrared spectroscopy (NIRS) technique. Forty-two healthy college students were randomly allocated into either the Baduanjin intervention group or relaxation training (control) group. Training lasted for 8 weeks (90 min/day, 5 days/week). Each participant was administered the shortened Profile of Mood States to evaluate their mood status and the flanker task to evaluate executive function before and after training. While performing the flanker task, the NIRS data were collected from each participant. After training, individuals who have participated in BMB exercise showed a significant reduction in depressive mood compared with the same measure before the intervention. However, participants in the control group showed no such reduction. The before vs. after measurement difference in the flanker task incongruent trails was significant only for the Baduanjin intervention group. Interestingly, an increase in oxygenated hemoglobin in the left prefrontal cortex was observed during the Incongruent Trails test only after the BMB exercise intervention. These findings implicate that Baduanjin is an effective and easy-to-administering mind-body exercise for improving executive function and perhaps brain self-regulation in a young and healthy population. PMID:28133453

  19. An educational intervention to improve pain assessment in preverbal children.

    Science.gov (United States)

    Vael, Aimee; Whitted, Kelli

    2014-01-01

    Pediatric nurses often use an inappropriate tool to assess pain in children younger than 36 months of age. This intervention intended to improve the nursing practice of assessing pain in preverbal (less than 36 months of age) children. Pain assessment frequency and use of a pain assessment pediatric tool use was evaluated pre- and post-intervention via a retrospective chart review and a survey of pediatric nurses. Parametric and non-parametric statistical tests were used to determine significant differences between pre- and post-intervention data for both approaches. The chart review data showed a significant increase in the number of times pain was assessed and documented post-educational intervention. Similarly, the survey data analysis showed a significant post-intervention increase in the use of a pain assessment tool and that most nurses used the FLACC pain assessment tool when assessing pain in preverbal children. Educating staff nurses about the use of an appropriate pain assessment scale altered practice and improved the frequency of pain assessment of preverbal children.

  20. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan

    2017-02-09

    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  1. Lifestyle intervention according to general recommendations improves glucose tolerance.

    Science.gov (United States)

    Mensink, Marco; Blaak, Ellen E; Corpeleijn, Eefje; Saris, Wim H; de Bruin, Tjerk W; Feskens, Edith J

    2003-12-01

    Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes. However, it needs to be assessed whether moderate interventions, in agreement with current guidelines for the general population, are effective. We evaluated the impact of a 2-year combined diet and physical activity intervention program on glucose tolerance in Dutch subjects at increased risk for developing diabetes. Subjects with glucose intolerance were randomly assigned to either the lifestyle intervention group (INT) or control group (CON). The INT received regular dietary advice and was stimulated to increase their physical activity. The CON received a brief leaflet about healthy diet and increased physical activity. Primary outcome measure was the change in glucose tolerance. In total, 88 subjects completed 2 years of intervention (40 subjects in the INT, 48 subjects in the CON, mean BMI 29.4 kg/m2). Subjects in the INT reduced their body weight, waist circumference, and (saturated) fat intake and improved their aerobic capacity. Two-hour plasma glucose concentration declined from 8.7 to 8.0 mM in the INT and rose from 8.6 to 9.4 mM in the CON (p general recommendations improves glucose tolerance, even in a less obese and more physical active population. Furthermore, our results underscore the importance of combining diet and physical activity to improve glucose tolerance and insulin resistance.

  2. Brief educational intervention improves content of intern handovers.

    Science.gov (United States)

    Shaughnessy, Erin E; Ginsbach, Kimberly; Groeschl, Nicole; Bragg, Dawn; Weisgerber, Michael

    2013-03-01

    The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills. We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills. Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters. All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.

  3. Veterans' Perspectives on Interventions to Improve Retention in HIV Care.

    Directory of Open Access Journals (Sweden)

    Sophie G Minick

    Full Text Available Poor retention in HIV medical care is associated with increased mortality among patients with HIV/AIDS. Developing new interventions to improve retention in HIV primary care is needed. The Department of Veteran Affairs (VA is the largest single provider of HIV care in the US. We sought to understand what veterans would want in an intervention to improve retention in VA HIV care. We conducted 18 one-on-one interviews and 15 outpatient focus groups with 46 patients living with HIV infection from the Michael E. DeBakey VAMC (MEDVAMC. Analysis identified three focus areas for improving retention in care: developing an HIV friendly clinic environment, providing mental health and substance use treatment concurrent with HIV care and encouraging peer support from other Veterans with HIV.

  4. Creative Learning Through the Use of Simulation to Teach Nursing Students Screening, Brief Intervention, and Referral to Treatment for Alcohol and Other Drug Use in a Culturally Competent Manner.

    Science.gov (United States)

    Fioravanti, Marie A; Hagle, Holly; Puskar, Kathy; Knapp, Emily; Kane, Irene; Lindsay, Dawn; Terhorst, Lauren; Mitchell, Ann M

    2017-08-01

    Cultural competency is an integral component in undergraduate nursing education to provide patient-centered care and addressing patients' cultural differences. Students need to consider the prevalence of alcohol and other drug use/misuse in patients from all cultures. This project combines cultural competency education, simulation, and educating students to use screening, brief intervention, and referral to treatment for alcohol and other drug use. Culturally diverse simulation scenarios were developed and used in the simulation lab with students to reduce stigma surrounding other cultures while learning an evidence-based practice to screen and intervene with patients who use/misuse substances. Results show students value simulation and 91% of the students felt that they were able to apply culturally competent knowledge after the simulation experience. Cultural competency principles can be embedded in teaching the broader evidence-based practice of screening, brief intervention, and referral to treatment with undergraduate students. This is a replicable teaching methodology that could be adapted in other schools of nursing.

  5. Can worksite nutritional interventions improve productivity and firm profitability?

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård

    2011-01-01

    Aims: This paper investigates whether and how worksite nutrition policies can improve employee productivity. Methods: The questions are pursued through a literature review, including a systematic search of literature – combined with literature identified from backward references – on randomized...... controlled or quasi-experimental worksite intervention trials and observational cross-sectional studies. Studies were selected on the basis of topic relevance, according to publication title and subsequently according to abstract content. A quality appraisal of the studies was based on study design...... and clarity in definition of interventions, as well as environmental and outcome variables. Results: The search identified 2,358 publications, 30 of which were found suitable for the review. Several of the reviewed studies suggest that diet-related worksite interventions have positive impacts on employees...

  6. Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions

    Directory of Open Access Journals (Sweden)

    Ferreira Isabel

    2005-04-01

    Full Text Available Abstract Background The present paper intends to contribute to the debate on the usefulness and barriers in applying theories in diet and physical activity behavior-change interventions. Discussion Since behavior theory is a reflection of the compiled evidence of behavior research, theory is the only foothold we have for the development of behavioral nutrition and physical activity interventions. Application of theory should improve the effectiveness of interventions. However, some of the theories we use lack a strong empirical foundation, and the available theories are not always used in the most effective way. Furthermore, many of the commonly-used theories provide at best information on what needs to be changed to promote healthy behavior, but not on how changes can be induced. Finally, many theories explain behavioral intentions or motivation rather well, but are less well-suited to explaining or predicting actual behavior or behavior change. For more effective interventions, behavior change theory needs to be further developed in stronger research designs and such change-theory should especially focus on how to promote action rather than mere motivation. Since voluntary behavior change requires motivation, ability as well as the opportunity to change, further development of behavior change theory should incorporate environmental change strategies. Conclusion Intervention Mapping may help to further improve the application of theories in nutrition and physical activity behavior change.

  7. Can theoretical intervention improve hand hygiene behavior among nurses?

    Directory of Open Access Journals (Sweden)

    Baghaei R

    2016-06-01

    Full Text Available Rahim Baghaei,1 Elham Sharifian,1 Aziz Kamran2 1Inpatient Safety Research Center, Nursing and Midwifery School, Urmia University of Medical Sciences, Urmia, 2Public Health Department, Khalkhal Faculty of Medical Sciences, Ardabil University of Medical Sciences, Ardabil, IranBackground: Hand washing is the best strategy to prevent known nosocomial infections but the nurses' hand hygiene is estimated to be poor in Iran.Objective: This study aimed to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors model on hand hygiene adherence education.Methods: This controlled quasi-experimental study was conducted on 70 hemodialysis unit nurses (35 case and 35 control in the health and educational centers of the University of Medical Sciences of Urmia, Iran. To collect the data, a six-part validated and reliable questionnaire was used. The data were analyzed using SPSS version18, using Wilcoxon, Mann–Whitney, chi-square, and Fisher's exact tests. The significance level was considered P<0.05.Results: The mean age was 38.4±8.1 years for the intervention group and 40.2±8.0 years for the control group. There was no significant difference between the two groups for any demographic variables. Also, before the intervention, there was no significant difference between the two groups for any components of the BASNEF model. Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P<0.001, but hand hygiene behavior did not show any significant change in the intervention group (P=0.16.Conclusion: Despite the improving attitudes and intention, the intervention had no significant effect on hand hygiene behavior among the studied nurses.Keywords: hand hygiene, adherence, education nurse, behavior

  8. Hypertension Improvement Project (HIP) Latino: results of a pilot study of lifestyle intervention for lowering blood pressure in Latino adults

    Science.gov (United States)

    del Pilar Rocha-Goldberg, María; Corsino, Leonor; Batch, Bryan; Voils, Corrine I.; Thorpe, Carolyn T.; Bosworth, Hayden B.; Svetkey, Laura P.

    2010-01-01

    Objectives To assess the feasibility of a culturally tailored behavioral intervention for improving hypertension-related health behaviors in Hispanic/Latino adults. Design Feasibility pilot study in a community health center and a Latino organization in Durham, North Carolina (NC). Intervention The culturally adapted behavioral intervention consisted of 6 weekly group sessions incorporating motivational interviewing techniques. Goals included weight loss if overweight, adoption of the Dietary Approaches to Stop Hypertension (DASH) dietary pattern, and increased physical activity. Participants were also encouraged to monitor their daily intake of fruits, vegetables, dairy and fat, and to record physical activity. Cultural adaptations included conducting the study in familiar places, using Spanish-speaking interventionist, culturally-appropriate food choices, and physical activity. Main outcomes Systolic blood pressure, weight, body mass index (BMI), exercise, and dietary pattern were measured at baseline and at 6 weeks follow-up. Qualitative evaluations of the recruitment process and the intervention were also conducted. Results There were 64 potential participants identified via health care provider referrals (33%), printed media (23%), and direct contact (44%). Seventeen participants completed the intervention and had main outcome data available. Participants “strongly agreed/ agreed” that the group sessions provided them with the tools they needed to achieve weight loss, blood pressure control, and the possibility of sustaining the lifestyle changes after completing the intervention. At the end of the intervention, all physiological, diet, and exercise outcomes were more favorable, with the exception of fat. After 6 weeks, systolic blood pressure decreased an average of −10.4 ± 10.6 mmHg, weight decreased 1.5 ± 3.2 lbs, BMI decreased 0.3 ± 0.5, and physical activity increased 40 minutes per week. Conclusion Our findings suggest that lifestyle

  9. Training interventions for improving telephone consultation skills in clinicians.

    Science.gov (United States)

    Vaona, Alberto; Pappas, Yannis; Grewal, Rumant S; Ajaz, Mubasshir; Majeed, Azeem; Car, Josip

    2017-01-05

    Since 1879, the year of the first documented medical telephone consultation, the ability to consult by telephone has become an integral part of modern patient-centred healthcare systems. Nowadays, upwards of a quarter of all care consultations are conducted by telephone. Studies have quantified the impact of medical telephone consultation on clinicians' workload and detected the need for quality improvement. While doctors routinely receive training in communication and consultation skills, this does not necessarily include the specificities of telephone communication and consultation. Several studies assessed the short-term effect of interventions aimed at improving clinicians' telephone consultation skills, but there is no systematic review reporting patient-oriented outcomes or outcomes of interest to clinicians. To assess the effects of training interventions for clinicians' telephone consultation skills and patient outcomes. We searched CENTRAL, MEDLINE, Embase, five other electronic databases and two trial registers up to 19 May 2016, and we handsearched references, checked citations and contacted study authors to identify additional studies and data. We considered randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted time series studies evaluating training interventions compared with any control intervention, including no intervention, for improving clinicians' telephone consultation skills with patients and their impact on patient outcomes. Two review authors independently selected studies for inclusion, extracted data and assessed the risk of bias of eligible studies using standard Cochrane and EPOC guidance and the certainty of evidence using GRADE. We contacted study authors where additional information was needed. We used standard methodological procedures expected by Cochrane for data analysis. We identified one very small controlled before-after study performed in 1989: this study used a

  10. Qualitative study on maternal referrals in rural Tanzania: decision making and acceptance of referral advice.

    Science.gov (United States)

    Pembe, Andrea B; Urassa, David P; Darj, Elisabeth; Carlsted, Anders; Olsson, Pia

    2008-08-01

    The aim of this study was to describe perceptions of maternal referrals in a rural district in Tanzania. Focus group discussions (FGDs) with health workers and community members, stratified by age and gender, were conducted. The FGDs revealed that husbands and relatives are the decision makers in maternal referrals, whereas the women had limited influence, especially on emergency referrals. The process in deciding to seek referral care is envisaged within community perception of seriousness of the condition, difficulty to access and cost involved in transport, living expenses at the hospital, and perceived quality of care at facility level. The hospitals were seen as providing acceptable quality of care, whereas, the health centres had lower quality than expected. To improve maternal referral compliance and reduce perinatal and maternal morbidity and mortality, community views of existing referral guidelines, poverty reduction, women's empowerment and male involvement in maternal care are necessary.

  11. Improving decision making in multidisciplinary tumor boards: prospective longitudinal evaluation of a multicomponent intervention for 1,421 patients.

    Science.gov (United States)

    Lamb, Benjamin W; Green, James S A; Benn, Jonathan; Brown, Katrina F; Vincent, Charles A; Sevdalis, Nick

    2013-09-01

    Due to its complexity, cancer care is increasingly being delivered by multidisciplinary tumor boards (MTBs). Few studies have investigated how best to organize and run MTBs to optimize clinical decision making. We developed and evaluated a multicomponent intervention designed to improve the MTB's ability to reach treatment decisions. We conducted a prospective longitudinal study during 16 months that evaluated MTB decision making for urological cancer patients at a university hospital in London, UK. After a baseline period, MTB improvement interventions (eg, MTBs checklist, MTB team training, and written guidance) were delivered sequentially. Outcomes measures were the MTB's ability to reach a decision, the quality of information presentation, and the quality of teamwork (as assessed by trained assessors using a previously validated observational assessment tool). The efficacy of the intervention was evaluated using multivariate analyses. There were 1,421 patients studied between December 2009 and April 2, 2011. All outcomes improved considerably between baseline and intervention implementation: the MTB's ability to reach a decision rose from 82.2% to 92.7%, quality of information presentation rose from 29.6% to 38.3%, and quality of teamwork rose from 37.8% to 43.0%. The MTB's ability to reach a treatment decision was related to the quality of available information (r = 0.298; p < 0.05) and quality of teamwork within the MTB (r = 0.348; p < 0.05). The most common barriers to reaching clinical decisions were inadequate radiologic information (n = 77), inadequate pathologic information (n = 51), and inappropriate patient referrals (n = 21). Multidisciplinary tumor board-delivered treatment is becoming the standard for cancer care worldwide. Our intervention is efficacious and applicable to MTBs and can improve decision making and expedite cancer care. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  12. An ambulance referral network improves access to emergency obstetric and neonatal care in a district of rural Burundi with high maternal mortality.

    Science.gov (United States)

    Tayler-Smith, K; Zachariah, R; Manzi, M; Van den Boogaard, W; Nyandwi, G; Reid, T; De Plecker, E; Lambert, V; Nicolai, M; Goetghebuer, S; Christiaens, B; Ndelema, B; Kabangu, A; Manirampa, J; Harries, A D

    2013-08-01

    In 2006, Médecins sans Frontières (MSF) established an emergency obstetric and neonatal care (EmONC) referral facility linked to an ambulance referral system for the transfer of women with obstetric complications from peripheral maternity units in Kabezi district, rural Burundi. This study aimed to (i) describe the communication and ambulance service together with the cost; (ii) examine the association between referral times and maternal and early neonatal deaths; and (iii) assess the impact of the referral service on coverage of complicated obstetric cases and caesarean sections. Data were collected for the period January to December 2011, using ambulance log books, patient registers and logistics records. In 2011, there were 1478 ambulance call-outs. The median referral time (time from maternity calling for an ambulance to the time the patient arrived at the MSF referral facility) was 78 min (interquartile range, 52-130 min). The total annual cost of the referral system (comprising 1.6 ambulances linked with nine maternity units) was € 85 586 (€ 61/obstetric case transferred or € 0.43/capita/year). Referral times exceeding 3 h were associated with a significantly higher risk of early neonatal deaths (OR, 1.9; 95% CI, 1.1-3.2). MSF coverage of complicated obstetric cases and caesarean sections was estimated to be 80% and 92%, respectively. This study demonstrates that it is possible to implement an effective communication and transport system to ensure access to EmONC and also highlights some of the important operational factors to consider, particularly in relation to minimising referral delays. © 2013 John Wiley & Sons Ltd.

  13. Interventions to improve water quality for preventing diarrhoea

    Science.gov (United States)

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  14. The nutrition intervention improved adult human capital and economic productivity.

    Science.gov (United States)

    Martorell, Reynaldo; Melgar, Paul; Maluccio, John A; Stein, Aryeh D; Rivera, Juan A

    2010-02-01

    This article reviews key findings about the long-term impact of a nutrition intervention carried out by the Institute of Nutrition of Central America and Panama from 1969 to 1977. Results from follow-up studies in 1988-89 and 2002-04 show substantial impact on adult human capital and economic productivity. The 1988-89 study showed that adult body size and work capacity increased for those provided improved nutrition through age 3 y, whereas the 2002-04 follow-up showed that schooling was increased for women and reading comprehension and intelligence increased in both men and women. Participants were 26-42 y of age at the time of the 2002-04 follow-up, facilitating the assessment of economic productivity. Wages of men increased by 46% in those provided with improved nutrition through age 2 y. Findings for cardiovascular disease risk factors were heterogeneous; however, they suggest that improved nutrition in early life is unlikely to increase cardiovascular disease risk later in life and may indeed lower risk. In conclusion, the substantial improvement in adult human capital and economic productivity resulting from the nutrition intervention provides a powerful argument for promoting improvements in nutrition in pregnant women and young children.

  15. The South Asian Heart Lifestyle Intervention (SAHELI) study to improve cardiovascular risk factors in a community setting: design and methods.

    Science.gov (United States)

    Kandula, Namratha R; Patel, Yasin; Dave, Swapna; Seguil, Paola; Kumar, Santosh; Baker, David W; Spring, Bonnie; Siddique, Juned

    2013-11-01

    Disseminating and implementing evidence-based, cardiovascular disease (CVD) prevention lifestyle interventions in community settings and in ethnic minority populations is a challenge. We describe the design and methods for the South Asian Heart Lifestyle Intervention (SAHELI) study, a pilot study designed to determine the feasibility and initial efficacy of a culturally-targeted, community-based lifestyle intervention to improve physical activity and diet behaviors among medically underserved South Asians (SAs). Participants with at least one CVD risk factor will be randomized to either a lifestyle intervention or a control group. Participants in both groups will be screened in a community setting and receive a primary care referral after randomization. Intervention participants will receive 6weeks of group classes, followed by 12weeks of individual telephone support where they will be encouraged to initiate and maintain a healthy lifestyle goal. Control participants will receive their screening results and monthly mailings on CVD prevention. Primary outcomes will be changes in moderate/vigorous physical activity and saturated fat intake between baseline, 3-, and 6-month follow-up. Secondary outcomes will be changes in weight, clinical risk factors, primary care visits, self-efficacy, and social support. This study will be one of the first to pilot-test a lifestyle intervention for SAs, one of the fastest growing racial/ethnic groups in the U.S. and one with disparate CVD risk. Results of this pilot study will provide preliminary data about the efficacy of a lifestyle intervention on CVD risk in SAs and inform community-engaged CVD prevention efforts in an increasingly diverse U.S. population.

  16. Referral patterns and the referral system for oral surgery care. Part 2: The referral system and telemedicine.

    Science.gov (United States)

    Coulthard, P; Kazakou, I; Koran, R; Worthington, H V

    2000-04-08

    To investigate GDP opinions of the current referral system and to investigate the need and demand for telemedicine in oral surgery referrals. Postal questionnaire. 400 GDPs in Greater Manchester. 84% participation rate. 48% were not satisfied overall with the service of their current specialist oral surgery referral site. The principal reason was the length of the waiting time for consultation and treatment. Distance for patients to travel to the specialist unit was also of concern, even though most patients (89%) travelled short distances (return journey of twelve miles or less). 23% of respondents wished to improve their ability to communicate with the oral surgeon and 70% wanted involvement in the patient consultation. Both of these requirements were more likely in younger practitioners. There is a need and demand for change in the referral system for oral surgery specialist care. Telemedicine could conceivably be one way to improve access to specialist oral surgery care.

  17. Interventions for improving sit-to-stand ability following stroke.

    Science.gov (United States)

    Pollock, Alex; Gray, Charla; Culham, Elsie; Durward, Brian R; Langhorne, Peter

    2014-05-26

    Standing up from a seated position is one of the most frequently performed functional tasks, is an essential pre-requisite to walking and is important for independent living and preventing falls. Following stroke, patients can experience a number of problems relating to the ability to sit-to-stand independently. To review the evidence of effectiveness of interventions aimed at improving sit-to-stand ability after stroke. The primary objectives were to determine (1) the effect of interventions that alter the starting posture (including chair height, foot position, hand rests) on ability to sit-to-stand independently; and (2) the effect of rehabilitation interventions (such as repetitive practice and exercise programmes) on ability to sit-to-stand independently. The secondary objectives were to determine the effects of interventions aimed at improving ability to sit-to-stand on: (1) time taken to sit-to-stand; (2) symmetry of weight distribution during sit-to-stand; (3) peak vertical ground reaction forces during sit-to-stand; (4) lateral movement of centre of pressure during sit-to-stand; and (5) incidence of falls. We searched the Cochrane Stroke Group Trials Register (June 2013), CENTRAL (2013, Issue 5), MEDLINE (1950 to June 2013), EMBASE (1980 to June 2013), CINAHL (1982 to June 2013), AMED (1985 to June 2013) and six additional databases. We also searched reference lists and trials registers and contacted experts. Randomised trials in adults after stroke where: the intervention aimed to affect the ability to sit-to-stand by altering the posture of the patient, or the design of the chair; stated that the aim of the intervention was to improve the ability to sit-to-stand; or the intervention involved exercises that included repeated practice of the movement of sit-to-stand (task-specific practice of rising to stand).The primary outcome of interest was the ability to sit-to-stand independently. Secondary outcomes included time taken to sit-to-stand, measures of

  18. Interventions to improve return to work in depressed people.

    Science.gov (United States)

    Nieuwenhuijsen, Karen; Faber, Babs; Verbeek, Jos H; Neumeyer-Gromen, Angela; Hees, Hiske L; Verhoeven, Arco C; van der Feltz-Cornelis, Christina M; Bültmann, Ute

    2014-12-03

    inhibitor (SNRI) medication on reducing sickness absence and yielded highly inconsistent results. Clinical interventions, psychological We found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care (SMD -0.23; 95% CI -0.45 to -0.01). Clinical interventions, psychological combined with antidepressant medication We found low quality evidence based on two studies that enhanced primary care did not substantially decrease sickness absence in the medium term (4 to 12 months) (SMD -0.02; 95% CI -0.15 to 0.12). A third study found no substantial effect on sickness absence in favour of this intervention in the long term (24 months).We found high quality evidence, based on one study, that a structured telephone outreach and care management program was more effective in reducing sickness absence than usual care (SMD - 0.21; 95% CI -0.37 to -0.05). Clinical interventions, exercise We found low quality evidence based on one study that supervised strength exercise reduced sickness absence compared to relaxation (SMD -1.11; 95% CI -1.68 to -0.54). We found moderate quality evidence based on two studies that aerobic exercise was no more effective in reducing sickness absence than relaxation or stretching (SMD -0.06; 95% CI -0.36 to 0.24). We found moderate quality evidence that adding a work-directed intervention to a clinical intervention reduced the number of days on sick leave compared to a clinical intervention alone. We also found moderate quality evidence that enhancing primary or occupational care with cognitive behavioural therapy reduced sick leave compared to the usual care. A structured telephone outreach and care management program that included medication reduced sickness absence compared to usual care. However, enhancing primary care with a quality improvement program did not have a considerable effect on sickness absence. There was no evidence

  19. A Multimodal Intervention Improves Postanesthesia Care Unit Handovers.

    Science.gov (United States)

    Weinger, Matthew B; Slagle, Jason M; Kuntz, Audrey H; Schildcrout, Jonathan S; Banerjee, Arna; Mercaldo, Nathaniel D; Bills, James L; Wallston, Kenneth A; Speroff, Theodore; Patterson, Emily S; France, Daniel J

    2015-10-01

    Failures of communication are a major contributor to perioperative adverse events. Transitions of care may be particularly vulnerable. We sought to improve postoperative handovers. We introduced a multimodal intervention in an adult and a pediatric postanesthesia care unit (PACU) to improve postoperative handovers between anesthesia providers (APs) and PACU registered nurses (RNs). The intervention included a standardized electronic handover report form, a didactic webinar, mandatory simulation training focused on improving interprofessional communication, and post-training performance feedback. Trained, blinded nurse observers scored PACU handovers during 17 months using a structured tool consisting of 8 subscales and a global score (1-5 scale). Multivariate logistic regression assessed the effect of the intervention on the proportion of observed handovers receiving a global effectiveness rating of ≥3. Four hundred fifty-two clinicians received the simulation-based training, and 981 handovers were observed and rated. In the adult PACU, the estimated percentages of acceptable handovers (global ratings ≥3) among AP-RN pairs, where neither received simulation-based training (untrained dyads), was 3% (95% confidence interval, 1%-11%) at day 0, 10% (5%-19%) at training initiation (day 40), and 57% (33%-78%) at 1-year post-training initiation (day 405). For AP-RN pairs where at least one received the simulation-based training (trained dyads), these percentages were estimated to be 18% (11%-28%) and 68% (57%-76%) on days 40 and 405, respectively. The percentage of acceptable handovers was significantly greater on day 405 than it was on day 40 for both untrained (P 3 years later.

  20. Facilitating Help Seeking Behavior and Referrals for Mental Health Difficulties in School Aged Boys and Girls: A School-Based Intervention

    Science.gov (United States)

    Santor, Darcy A.; Poulin, Christiane; LeBlanc, John C.; Kusumakar, Vivek

    2007-01-01

    Although the need for early intervention for mental health difficulties is widely acknowledged, few studies have attempted to explicitly increase actual help seeking behavior for mental health difficulties. Students in intervention classrooms received two one-hour, in-class workshops on distress and help seeking and were compared to students in…

  1. Ergonomic interventions to improve work environment in garment manufacturing units

    Directory of Open Access Journals (Sweden)

    Parimalam Parimalam

    2006-01-01

    Full Text Available The work environment in the garment manufacturing units is unhealthy and unsafe for the workers, resulting in several health problems. Analysis of garment manufacturing units using a combination of techniques revealed that the congested work area, improper ventilation, dust, unergonomic workstations, excessive noise and non-use of personal protective equipment were the major constraints faced by the workers in these units. Based on the study, interventions to improve the work environment, safety aspects and work methods have been suggested which could be adopted on a wider scale.

  2. Multi-modal intervention improved oral intake in hospitalized patients

    DEFF Research Database (Denmark)

    Holst, M; Beermann, T; Mortensen, M N

    2015-01-01

    : A 12-months observational multi-modal intervention study was done, using the top-down and bottom-up principle. All hospitalized patients (>3 days) were included. Setting: A university hospital with 758 beds and all specialities. Measurements: Record audit of GNP, energy- and protein-intake by 24-h......BACKGROUND: Good nutritional practice (GNP) includes screening, nutrition plan and monitoring, and is mandatory for targeted treatment of malnourished patients in hospital. AIMS: To optimize energy- and protein-intake in patients at nutritional risk and to improve GNP in a hospital setting. METHODS...

  3. Interventional tools to improve medication adherence: review of literature

    Directory of Open Access Journals (Sweden)

    Costa E

    2015-09-01

    Full Text Available Elísio Costa,1 Anna Giardini,2 Magda Savin,3 Enrica Menditto,4 Elaine Lehane,5 Olga Laosa,6 Sergio Pecorelli,7,8 Alessandro Monaco,7 Alessandra Marengoni9On behalf of the A1 Action group “Prescription and Adherence to Medical Plans”, European Innovation Partnership on Active and Healthy Ageing1UCIBIO, REQUIMTE, Faculty of Pharmacy, University of Porto, Porto, Portugal; 2Psychology Unit, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Montescano (PV, Pavia, Italy; 3European Association of Pharmaceutical Full-line Wholesalers, Brussels, Belgium; 4CIRFF/Center of Pharmacoeconomics, School of Pharmacy, University of Naples FedericoII, Nápoles, Italy; 5Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, Ireland; 6Centro de Investigación Clínica del Anciano Fundación para la Investigación Biomédica, Hospital Universitario de Getafe, Madrid, Spain; 7Italian Medicines Agency – AIFA, Rome, Italy; 8University of Brescia, Brescia, Italy; 9Department of Clinical and Experimental Science, University of Brescia, Brescia, Italy Abstract: Medication adherence and persistence is recognized as a worldwide public health problem, particularly important in the management of chronic diseases. Nonadherence to medical plans affects every level of the population, but particularly older adults due to the high number of coexisting diseases they are affected by and the consequent polypharmacy. Chronic disease management requires a continuous psychological adaptation and behavioral reorganization. In literature, many interventions to improve medication adherence have been described for different clinical conditions, however, most interventions seem to fail in their aims. Moreover, most interventions associated with adherence improvements are not associated with improvements in other outcomes. Indeed, in the last decades, the degree of nonadherence remained unchanged. In this work, we

  4. Community Based Screening, Brief-Intervention and Referral for Treatment (SBIRT for unhealthy tobacco use: single arm study experience and Implementation Success in rural and semi-rural settings, South-West Nigeria

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    Victor Olufolahan Lasebikan

    2016-08-01

    Full Text Available Objective: To determine whether Screening, Brief Intervention and Referral to Treatment (SBIRT can reduce the prevalence of tobacco use in rural and semi-rural settings. Method: Design and participants: A non-randomized clinical trial with assessments at baseline and post-intervention assessments at 3 and 6 months was conducted in a rural and semi-rural district in South-West of Nigeria. A representative sample of 1203 persons consented to the study and had ASSIST administered to them by trained community healthcare extension workers between October, 2010 and April, 2011. Follow-up participation was more than 99% at all points. Intervention: Participants received a single ASSIST linked brief intervention (BI and referral for treatment (RT at entry, and a booster ASSIST BI and RT at 3 months.Main outcomes and measures: The primary outcome was self-reported scores on ASSIST. Results: At baseline, out of 1203 respondents, lifetime prevalence and current prevalence of any tobacco products was 405 (33.7% and 248 (20.6% respectively. Of the current users, on the ASSIST, 79 (31.9% scored 0-3 (low health risk, 130 (52.4% scored 4-26 (moderate risk, 39 (15.7% scored 27+ (high risk. At 3 months, out of 1199 respondents, prevalence of current users was 199 (16.5% and out of 1195 respondents, was 169 (14.1% at 6 months. Prevalence of tobacco use reduced significantly at 3 months Z = -3.1, p = 0.01 and at 6 months when compared with baseline Z = 4.2, p = 0.001, but not at 6 months compared with at 3 months, Z = 2.1, p = 0.09. Multivariate analysis revealed that age at initiation of tobacco use, gender, marital status, setting of dwelling and socioeconomic status were the only variables that were associated with current tobacco use at baseline, 3 months and 6 months.Conclusion: A one-time BI with a booster at 3 months had a significant effect on tobacco use in persons living in community settings. This finding suggests a need for promoting the adoption of

  5. Improving Self-Regulated Learning With a Retrieval Practice Intervention.

    Science.gov (United States)

    Ariel, Robert; Karpicke, Jeffrey D

    2017-06-12

    Repeated retrieval practice is a powerful learning tool for promoting long-term retention, but students use this tool ineffectively when regulating their learning. The current experiments evaluated the efficacy of a minimal intervention aimed at improving students' self-regulated use of repeated retrieval practice. Across 2 experiments, students made decisions about when to study, engage in retrieval practice, or stop learning a set of foreign language word pairs. Some students received direct instruction about how to use repeated retrieval practice. These instructions emphasized the mnemonic benefits of retrieval practice over a less effective strategy (restudying) and told students how to use repeated retrieval practice to maximize their performance-specifically, that they should recall a translation correctly 3 times during learning. This minimal intervention promoted more effective self-regulated use of retrieval practice and better retention of the translations compared to a control group that received no instruction. Students who experienced this intervention also showed potential for long-term changes in self-regulated learning: They spontaneously used repeated retrieval practice 1 week later to learn new materials. These results provide a promising first step for developing guidelines for teaching students how to regulate their learning more effectively using repeated retrieval practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  6. Developing At-Risk Referral Procedures for Rural Areas.

    Science.gov (United States)

    Olson, Jennifer; Bostick, Mary

    1986-01-01

    A screening and referral procedure for rural, at-risk infants was developed by a three-step process that: (1) identified key professionals; (2) educated rural medical personnel regarding benefits and strategies of early intervention; and (3) implemented a screening and referral system with low temporal and monetary costs for hospital personnel.…

  7. A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: a cluster randomised trial.

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    Philip Ayieko

    2011-04-01

    Full Text Available BACKGROUND: In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. METHODS AND FINDINGS: This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n  =  4 and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n  =  4. Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both groups performance improved from baseline. Completion of admission assessment tasks was higher in intervention sites at 18 months (mean  =  0.94 versus 0.65, adjusted difference 0.54 [95% confidence interval 0.05-0.29]. Uptake of guideline recommended therapeutic practices was also higher within intervention hospitals: adoption of once daily gentamicin (89.2% versus 74.4%; 17.1% [8.04%-26.1%]; loading dose quinine (91.9% versus 66.7%, 26.3% [-3.66% to 56.3%]; and adequate prescriptions of intravenous fluids for severe dehydration (67.2% versus 40.6%; 29.9% [10.9%-48.9%]. The proportion of children receiving inappropriate doses of drugs in intervention hospitals was lower (quinine dose >40 mg/kg/day; 1.0% versus 7.5%; -6.5% [-12.9% to 0.20%], and inadequate gentamicin dose (2.2% versus 9.0%; -6.8% [-11.9% to -1.6%]. CONCLUSIONS: Specific efforts are needed to improve hospital care in developing countries. A full, multifaceted intervention was associated

  8. Electronic referrals: what matters to the users.

    Science.gov (United States)

    Warren, Jim; Gu, Yulong; Day, Karen; White, Sue; Pollock, Malcolm

    2012-01-01

    Between September 2010 and May 2011 we evaluated three implementations of electronic referral (eReferral) systems at Hutt Valley, Northland and Canterbury District Health Boards in New Zealand. Qualitative and quantitative data were gathered through project documentation, database records and stakeholder interviews. This paper reports on the user perspectives based on interviews with 78 clinical, management and operational stakeholders in the three regions. Themes that emerge across the regions are compared and synthesised. Interviews focused on pre-planned domains including quality of referral, ease of use and patient safety, but agendas were adapted progressively to elaborate and triangulate on themes emerging from earlier interviews and to clarify indications from analysis of database records. The eReferral users, including general practitioners, specialists and administrative staff, report benefits in the areas of: (1) availability and transparency of referral-related data; (2) work transformation; (3) improved data quality and (4) the convenience of auto-population from the practice management system into the referral forms. eReferral provides enhanced visibility of referral data and status within the limits of the implementation (which only goes to the hospital door in some cases). Users in all projects indicated the desire to further exploit IT to enhance two-way communication between community and hospital. Reduced administrative handling is a clear work transformation benefit with mixed feedback regarding clinical workload impact. Innovations such as GP eReferral triaging teams illustrate the further potential for workflow transformation. Consistent structure in eReferrals, as well as simple legibility, enhances data quality. Efficiency and completeness is provided by auto-population of forms from system data, but opens issues around data accuracy. All three projects highlight the importance of user involvement in design, implementation and refinement. In

  9. Improving patient access to an interventional US clinic.

    Science.gov (United States)

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014.

  10. Physician Referral Patterns

    Data.gov (United States)

    U.S. Department of Health & Human Services — The physician referral data was initially provided as a response to a Freedom of Information (FOIA) request. These files represent data from 2009 through June 2013...

  11. Improvements in Unmarried African American Parents' Rapport, Communication, and Problem-Solving Following a Prenatal Coparenting Intervention.

    Science.gov (United States)

    McHale, James P; Salman-Engin, Selin; Coovert, Michael D

    2015-12-01

    This report examines effects of a coparenting intervention designed for and delivered to expectant unmarried African American mothers and fathers on observed interaction dynamics known to predict relationship adjustment. Twenty families took part in the six-session "Figuring It Out for the Child" (FIOC) dyadic intervention offered in a faith-based human services agency during the third trimester of the mother's pregnancy, and completed a postpartum booster session 1 month after the baby's arrival. Parent referrals for the FIOC program were received from a county Health Department and from OBGYNs and Pregnancy Centers in the targeted community. All intervention sessions were delivered by a trained male-female paraprofessional team whose fidelity to the FIOC manualized curriculum was independently evaluated by a team of trained analysts. At both the point of intake ("PRE") and again at an exit evaluation completed 3 months postpartum ("POST"), the mothers and fathers were videotaped as they completed two standardized "revealed differences" conflict discussions. Blinded videotapes of these sessions were evaluated using the System for Coding Interactions in Dyads. Analyses documented statistically significant improvements on 8 of 12 variables examined, with effect sizes ranging from moderate to large. Overall, 14 families demonstrated beneficial outcomes, 3 did not improve, and 3 showed some signs of decline from the point of intake. For most interaction processes, PRE to POST improvements were unrelated to degree of adherence the paraprofessional interventionists showed to the curriculum. However, better interventionist competence was related to decreases in partners' Coerciveness and Negativity and Conflict, and to smaller increases in partner Withdrawal. Implications of the work for development and delivery of community-based coparenting interventions for unmarried parents are discussed.

  12. Quality Improvement Intervention for Reduction of Redundant Testing

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    Alan M. Ducatman MD, MS

    2017-05-01

    Full Text Available Laboratory data are critical to analyzing and improving clinical quality. In the setting of residual use of creatine kinase M and B isoenzyme testing for myocardial infarction, we assessed disease outcomes of discordant creatine kinase M and B isoenzyme +/troponin I (− test pairs in order to address anticipated clinician concerns about potential loss of case-finding sensitivity following proposed discontinuation of routine creatine kinase and creatine kinase M and B isoenzyme testing. Time-sequenced interventions were introduced. The main outcome was the percentage of cardiac marker studies performed within guidelines. Nonguideline orders dominated at baseline. Creatine kinase M and B isoenzyme testing in 7496 order sets failed to detect additional myocardial infarctions but was associated with 42 potentially preventable admissions/quarter. Interruptive computerized soft stops improved guideline compliance from 32.3% to 58% ( P 80% ( P < .001 with peer leadership that featured dashboard feedback about test order performance. This successful experience was recapitulated in interrupted time series within 2 additional services within facility 1 and then in 2 external hospitals (including a critical access facility. Improvements have been sustained postintervention. Laboratory cost savings at the academic facility were estimated to be ≥US$635 000 per year. National collaborative data indicated that facility 1 improved its order patterns from fourth to first quartile compared to peer norms and imply that nonguideline orders persist elsewhere. This example illustrates how pathologists can provide leadership in assisting clinicians in changing laboratory ordering practices. We found that clinicians respond to local laboratory data about their own test performance and that evidence suggesting harm is more compelling to clinicians than evidence of cost savings. Our experience indicates that interventions done at an academic facility can be readily

  13. Prenatal interventions for congenital diaphragmatic hernia for improving outcomes.

    Science.gov (United States)

    Grivell, Rosalie M; Andersen, Chad; Dodd, Jodie M

    2015-11-27

    Congenital diaphragmatic hernia (CDH), is an uncommon but severe condition in which there is a developmental defect in the fetal diaphragm, resulting in liver and bowel migrating to the chest cavity and impairing lung development and function for the neonate. This condition can be diagnosed during pregnancy and as such, is potentially amenable to in-utero prenatal intervention. Neonatal surgical repair is possible, but even with early surgical repair and improving neonatal management, neonatal morbidity and mortality is high. Prenatal interventions described to date have included maternal antenatal corticosteroid administration and fetal tracheal occlusion, with both methods aiming to improve lung growth and maturity. However surgical procedures have potential maternal complications, as the uterus and amniotic sac are breached in order to gain access to the fetus. To compare the effects of prenatal versus postnatal interventions for CDH on perinatal mortality and morbidity, longer-term infant outcomes and maternal morbidity, and to compare the effects of different prenatal interventions with each other. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of retrieved studies. All published (including those published in abstract form), unpublished, and ongoing randomised controlled trials comparing prenatal and postnatal interventions for fetuses with CDH. Quasi-RCTs were eligible for inclusion but none were identified. Trials using a cross-over design are not eligible for inclusion. Two review authors evaluated trials for inclusion and methodological quality without consideration of their results according to the stated eligibility criteria and extracted data independently. Data were checked for accuracy. We identified 11 studies for potential inclusion. Of those, we included three studies involving 97 women. Two additional studies are ongoing.Two trials examined in-utero fetal tracheal occlusion with

  14. Referral Criteria from Community Clinics to Pediatric Emergency Departments

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    Jacob Urkin

    2008-01-01

    Full Text Available Referral of patients to a pediatric emergency department (PED should be medically justified and the need for referral well communicated. The objectives of this paper were (1 to create a list of criteria for referral from the community to the PED, (2 to describe how community physicians categorize their need for referral, and (3 to determine agreement between the physician's referral letter and the selected criteria. We present a descriptive study of referrals to the PED of Soroka University Medical Center, Beer-Sheva, Israel, during February to April 2003. A list of 22 criteria for referral was created, using the Delphi method for reaching consensus. One or more criteria could be selected from this list for each referral, by the referring community physicians and, independently, based on the physicians' referral letters, by two consultants, and compared. There were 140 referrals included in the study. A total of 262 criteria for referral were selected by the referring community physicians. The criteria most frequently selected were: “Need for same-day consultation/laboratory/imaging result not available in the community” (32.1%, “Suspected life- or organ-threatening infection” (16.4%, and “Need for hospitalization” (15.7%. Rates of agreement regarding criteria for referral between the referring physicians and the two consultants, and a senior community pediatrician and a senior PED pediatrician, were 57.9 and 48.6%, respectively. We conclude that the standard referral letter does not convey in full the level of need for referral to the PED. A list of criteria for referral could augment efficient utilization of emergency department services and improve communication between community physicians and the PED.

  15. Telephone referral education, and evidence of retention and transfer after six-months

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    Marshall Stuart D

    2012-06-01

    Full Text Available Abstract Background Effective communication between clinicians is essential for safe, efficient healthcare. We undertook a study to determine the longer-term effectiveness of an education session employing a structured method to teach referral-making skills to medical students. Methods All final year medical students received a forty-five minute education intervention consisting: discussion of effective telephone referrals; video viewing and critique; explanation, demonstration and practice using ISBAR; provision of a memory aid for use in their clinical work. Audio recordings were taken during a subsequent standardised simulation scenario and blindly assessed using a validated scoring system. Recordings were taken immediately before (control, several hours after (intervention, and at approximately six months after the education. Retention of the acronym and self-reports of transfer to the clinical environment were measured with a questionnaire at eight months. Results Referral clarity at six months was significantly improved from pre-intervention, and referral content showed a trend towards improvement. Both measures were lower than the immediate post-education test. The ISBAR acronym was remembered by 59.4% (n = 95/160 and used by the vast majority of the respondents who had made a clinical telephone referral (n = 135/143; 94.4%. Conclusions A brief education session improved telephone communication in a simulated environment above baseline for over six months, achieved functional retention of the acronym over a seven to eight month period and resulted in self reports of transfer of the learning into practice.

  16. Ergonomic intervention for improving work postures during notebook computer operation.

    Science.gov (United States)

    Jamjumrus, Nuchrawee; Nanthavanij, Suebsak

    2008-06-01

    This paper discusses the application of analytical algorithms to determine necessary adjustments for operating notebook computers (NBCs) and workstations so that NBC users can assume correct work postures during NBC operation. Twenty-two NBC users (eleven males and eleven females) were asked to operate their NBCs according to their normal work practice. Photographs of their work postures were taken and analyzed using the Rapid Upper Limb Assessment (RULA) technique. The algorithms were then employed to determine recommended adjustments for their NBCs and workstations. After implementing the necessary adjustments, the NBC users were then re-seated at their workstations, and photographs of their work postures were re-taken, to perform the posture analysis. The results show that the NBC users' work postures are improved when their NBCs and workstations are adjusted according to the recommendations. The effectiveness of ergonomic intervention is verified both visually and objectively.

  17. Lung Cancer Survival Improvement through Surgical Intervention in PUMCH Hospital

    Institute of Scientific and Technical Information of China (English)

    GUO Feng; ZHANG Zhiyong; CUI Yushang; LI Shanqing; LI Li; XU Xiaohui; GE Feng; GUO Huiqin; LI Zejian

    2006-01-01

    Objective: To investigate and evaluate improvement of lung cancer survival after surgical intervention in PUMC hospital during the last 15 years. Methods: From January 1989 to December 2003, 1574 lung cancer cases underwent surgical treatment and followed up. All cases in this series were divided into two groups according to time period: group A (1999-2003) and group B (1989-1998). The difference in the survival rate between groups A and B was compared. Results: The morbidity and mortality in group A was decreased significantly in comparison to group B (11.2% vs. 19.2%, 1.06% vs. 1.93%, respectively).However, the 3-year and 5-year survival rate was increased from 42.35% to 56.07%, and from 28.46% to38.99%, respectively. A significant improvement in survival was observed in patients with stage Ⅰ, Ⅱ and ⅢA, but not in those with stage ⅢB and Ⅳ. Also, patients with lobectomy had more satisfactory results than those receiving exploratory thoracotomy, limited resection, pneumonectomy and sleeve resection. Conclusion: Lobectomy plus systematic mediastinal lymph nodes dissection has become the standard mode for resectable lung cancer. Combination of complete resection along with lymph nodal dissection, and postoperative adjuvant chemotherapy based on platinum/3rd generation chemotherapy medicine, has preliminarily been justified, proving an important approach for effective improvement in long-term survival of non-small cell lung carcinoma.

  18. Improving adherence to venous thromoembolism prophylaxis using multiple interventions

    Directory of Open Access Journals (Sweden)

    Al-Tawfiq Jaffar

    2011-01-01

    Full Text Available Objective : In hospital, deep vein thrombosis (DVT increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE. However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients. Methods : The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs. Results : During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91% patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22 and increased to an overall rate of 100% (39 of 39 (P = 0.002. Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT. Conclusion : In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.

  19. Project WINGS (Women Initiating New Goals of Safety): A randomised controlled trial of a screening, brief intervention and referral to treatment (SBIRT) service to identify and address intimate partner violence victimisation among substance-using women receiving community supervision.

    Science.gov (United States)

    Gilbert, Louisa; Shaw, Stacey A; Goddard-Eckrich, Dawn; Chang, Mingway; Rowe, Jessica; McCrimmon, Tara; Almonte, Maria; Goodwin, Sharun; Epperson, Matthew

    2015-12-10

    The high rate of intimate partner violence (IPV) victimisation found among substance-using women receiving community supervision underscores the need for effective IPV victimisation screening, brief intervention and referral to treatment services (SBIRT) for this population. This randomised controlled trial (RCT) aims to assess the feasibility, safety and efficacy of a single-session computerised self-paced IPV SBIRT (Computerised WINGS) in identifying IPV victimisation among women under community supervision and increasing access to IPV services, compared to the same IPV SBIRT service delivered by a case manager (Case Manager WINGS). This RCT was conducted with 191 substance-using women in probation and community court sites in New York City. No significant differences were found between Computerised and Case Manager WINGS arms on any outcomes. Both arms reported identical high rates of any physical, sexual or psychological IPV victimisation in the past year (77% for both arms) during the intervention. Both arms experienced significant increases from baseline to the 3-month follow-up in receipt of IPV services, social support, IPV self-efficacy and abstinence from drug use. Findings suggest that both modalities of WINGS show promise in identifying and addressing IPV victimisation among substance-using women receiving community supervision. Copyright © 2015 John Wiley & Sons, Ltd.

  20. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention

    Directory of Open Access Journals (Sweden)

    Julie Ambia

    2016-04-01

    Full Text Available Introduction: The success of prevention of mother-to-child transmission of HIV (PMTCT is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Methods: Selected databases were searched for studies published in English (up to September 2015. Outcomes of interest included antiretroviral (ARV drugs or antiretroviral therapy (ART initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Results: Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs, mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I2=83% in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I2=0% in four studies (one randomized. Four studies (three randomized that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I2=69% in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I2=45%. The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Conclusions: Our findings indicate that mobile

  1. A systematic review of interventions to improve prevention of mother-to-child HIV transmission service delivery and promote retention.

    Science.gov (United States)

    Ambia, Julie; Mandala, Justin

    2016-01-01

    The success of prevention of mother-to-child transmission of HIV (PMTCT) is dependent upon high retention of mother-infant pairs within these programmes. This is a systematic review to evaluate the effectiveness of interventions that aim to improve PMTCT service delivery and promote retention throughout the PMTCT steps. Selected databases were searched for studies published in English (up to September 2015). Outcomes of interest included antiretroviral (ARV) drugs or antiretroviral therapy (ART) initiation among HIV-positive pregnant and/or breastfeeding women and their infants, retention into PMTCT programs, the uptake of early infant diagnosis (EID) of HIV and infant HIV status. Risk ratios and random-effect meta-analysis were used in the analysis. Interventions assessed in the 34 identified studies included male partner involvement in PMTCT, peer mentoring, the use of community health workers (CHWs), mobile phone-based reminders, conditional cash transfer, training of midwives, integration of PMTCT services and enhanced referral. Five studies (two randomized) that evaluated mobile phone-based interventions showed a statistically significant increase (pooled RR 1.18; 95% CI 1.05 to 1.32, I(2)=83%) in uptake of EID of HIV at around six weeks postpartum. Male partner involvement in PMTCT was associated with reductions in infant HIV transmission (pooled RR 0.61; 95% CI 0.39 to 0.94, I(2)=0%) in four studies (one randomized). Four studies (three randomized) that were grounded on psychological interventions reported non-significant results (pooled RR 1.01; 95% CI 0.93 to 1.09, I(2)=69%) in increasing ARV/ART uptake among HIV-positive pregnant and/or breastfeeding women and infant HIV testing (pooled RR 1.00; 95% CI 0.94 to 1.07, I(2)=45%). The effect of the other interventions on the effectiveness of improving PMTCT uptake was unclear. Heterogeneity of interventions limits these findings. Our findings indicate that mobile phone-based reminders may increase the uptake

  2. Management of patients with Graves' orbitopathy: initial assessment, management outside specialised centres and referral pathways.

    Science.gov (United States)

    Perros, Petros; Dayan, Colin M; Dickinson, A Jane; Ezra, Daniel; Estcourt, Stephanie; Foley, Peter; Hickey, Janis; Lazarus, John H; MacEwen, Caroline J; McLaren, Julie; Rose, Geoffrey E; Uddin, Jimmy; Vaidya, Bijay

    2015-04-01

    Graves' orbitopathy (GO) is uncommon, but responsible for considerable morbidity. A coordinated approach between healthcare professionals is required in order to meet the needs of patients. Early diagnosis can be achieved by a simple clinical assessment. Low-cost effective interventions can be initiated by generalists, which may improve outcomes. Moderate-to-severe GO should be referred to specialised centres. Recommendations for clinical diagnosis, initial management and referral pathways are highlighted.

  3. Interventions to improve teamwork and communications among healthcare staff.

    Science.gov (United States)

    McCulloch, P; Rathbone, J; Catchpole, K

    2011-04-01

    Concern over the frequency of unintended harm to patients has focused attention on the importance of teamwork and communication in avoiding errors. This has led to experiments with teamwork training programmes for clinical staff, mostly based on aviation models. These are widely assumed to be effective in improving patient safety, but the extent to which this assumption is justified by evidence remains unclear. A systematic literature review on the effects of teamwork training for clinical staff was performed. Information was sought on outcomes including staff attitudes, teamwork skills, technical performance, efficiency and clinical outcomes. Of 1036 relevant abstracts identified, 14 articles were analysed in detail: four randomized trials and ten non-randomized studies. Overall study quality was poor, with particular problems over blinding, subjective measures and Hawthorne effects. Few studies reported on every outcome category. Most reported improved staff attitudes, and six of eight reported significantly better teamwork after training. Five of eight studies reported improved technical performance, improved efficiency or reduced errors. Three studies reported evidence of clinical benefit, but this was modest or of borderline significance in each case. Studies with a stronger intervention were more likely to report benefits than those providing less training. None of the randomized trials found evidence of technical or clinical benefit. The evidence for technical or clinical benefit from teamwork training in medicine is weak. There is some evidence of benefit from studies with more intensive training programmes, but better quality research and cost-benefit analysis are needed. Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  4. Improving hand hygiene behaviour among adolescents by a planning intervention.

    Science.gov (United States)

    Zhou, Guangyu; Jiang, Tingting; Knoll, Nina; Schwarzer, Ralf

    2015-01-01

    To improve regular hand hygiene in adolescents, educational messages based on medical information have not been very successful. Therefore, a theory-guided self-regulatory intervention has been designed with a particular focus on planning strategies. A randomised controlled trial with 307 adolescents, aged 12-18 years, was conducted in high schools. The control group received educational hand hygiene leaflets, whereas the experimental group received a self-regulatory treatment which required them to generate specific action plans and coping plans. Three times during one month, both groups received verbal reminder messages about planning to wash their hands properly. At one-month follow-up, hand hygiene behaviour as well as planning to practise hand hygiene were higher in the self-regulation than in the education group (p planning levels operated as a mediator between experimental conditions and changes in behavioural outcomes. Teaching self-regulatory planning strategies may constitute a superior approach than educational messages to improve regular hand hygiene practice in adolescents.

  5. [Intervention to improve hand hygiene compliance in Catalonia, Spain].

    Science.gov (United States)

    Sobrequés, Jordi; Espuñes, Jordi; Bañeres, Joaquim

    2014-07-01

    Hand hygiene (HM) is the single most important measure and effective in reducing the risk of Healthcare acquired infections (IRAS). Although HM is an effective, simple and cheap measure, it is usual to find results of low compliance among health professionals. The main objective of this strategy has been to give new force to the promotion of HM in hospitals and educate professionals about the importance of this single action. The strategy was planned as a multicenter intervention study to promote HM in health centers of Catalonia in 2009-2010. The intervention is based on 4 main areas: a survey of barriers and facilitators, distribution of graphic material, training at different levels and measure of quality indicators. With this strategy a total of 57% of the number of acute beds in the concerted public and private network of hospitals were reached. The survey revealed that training was perceived as the main facilitator of the HM action. 15,376 professionals registered to the on-line training. The overall compliance with HM indications (based on "five moments for HM") was 56.45% in the acute areas. The campaigns and programs to promote HM carried out in the last four years in Catalonia has helped to achieve an increasing number of hospitals associated to the strategy of the Alliance for Patient Safety in Catalonia. The on-line curse acceptance was very high and seems a powerful tool to improve hand hygiene knowledge and compliance among health professionals. The compliance of HM seems to increase in the hospitals of Catalonia evaluated. Copyright © 2014. Published by Elsevier Espana.

  6. Lean intervention improves patient discharge times, improves emergency department throughput and reduces congestion.

    Science.gov (United States)

    Beck, Michael J; Okerblom, Davin; Kumar, Anika; Bandyopadhyay, Subhankar; Scalzi, Lisabeth V

    2016-12-01

    To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient's bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day's discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.

  7. Implementing electronic handover: interventions to improve efficiency, safety and sustainability.

    Science.gov (United States)

    Alhamid, Sharifah Munirah; Lee, Desmond Xue-Yuan; Wong, Hei Man; Chuah, Matthew Bingfeng; Wong, Yu Jun; Narasimhalu, Kaavya; Tan, Thuan Tong; Low, Su Ying

    2016-10-01

    Effective handovers are critical for patient care and safety. Electronic handover tools are increasingly used today to provide an effective and standardized platform for information exchange. The implementation of an electronic handover system in tertiary hospitals can be a major challenge. Previous efforts in implementing an electronic handover tool failed due to poor compliance and buy-in from end-users. A new electronic handover tool was developed and incorporated into the existing electronic medical records (EMRs) for medical patients in Singapore General Hospital (SGH). There was poor compliance by on-call doctors in acknowledging electronic handovers, and lack of adherence to safety rules, raising concerns about the safety and efficiency of the electronic handover tool. Urgent measures were needed to ensure its safe and sustained use. A quality improvement group comprising stakeholders, including end-users, developed multi-faceted interventions using rapid PDSA (P-Plan, D-Do, S-Study, A-Act ) cycles to address these issues. Innovative solutions using media and online software provided cost-efficient measures to improve compliance. The percentage of unacknowledged handovers per day was used as the main outcome measure throughout all PDSA cycles. Doctors were also assessed for improvement in their knowledge of safety rules and their perception of the electronic handover tool. An electronic handover tool complementing daily clinical practice can be successfully implemented using solutions devised through close collaboration with end-users supported by the senior leadership. A combined 'bottom-up' and 'top-down' approach with regular process evaluations is crucial for its long-term sustainability. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Nursing interventions for improving nutritional status and outcomes of stroke patients: descriptive reviews of processes and outcomes.

    Science.gov (United States)

    Perry, Lin; Hamilton, Sharon; Williams, Jane; Jones, Susan

    2013-02-01

    Stroke produces many effects that impact eating. Nutrition is fundamental for recovery and rehabilitation, but the nursing nutritional role and associated outcomes have not been delineated. (1) To identify nursing interventions intended to improve nutritional status and related outcomes of stroke survivors, and (2) To examine the outcomes of identified nursing interventions on nutrition-related outcomes, including dietary intake, functional status, complications, activities of daily living, mortality, and quality of life for stroke survivors. A modified version of Cochrane literature searching and review methods was used to identify studies that described and evaluated nursing nutritional interventions for adult stroke patients in hospital and community settings. A minimum of 10 years content of seven databases and nine journals was searched to March 2011. Findings were presented descriptively. In total 27 papers from 26 studies were included: 5 randomized controlled trials, 5 clinical trials, 6 quasi-experiments, 4 case studies, and 6 qualitative/observational studies. Stroke nursing nutritional care encompassed screening of nutritional status and swallowing function; assessment of nutritional characteristics and preferences; referral; mealtime organization, supervision and monitoring; mealtime assistance and feeding skills. Nurses individualized care, coordinated or managed meal delivery and enteral feeding systems, were responsible for the dining environment and conduct of mealtimes; they taught staff, patients, and carers. There was little indication of integrated or psychosocial nursing nutritional care, or concepts, theories or models of nursing nutritional care. Many interventions were described but not evaluated. Little high quality evidence was of available. This review indicated the parameters of nursing nutritional care, and provided a framework for future research. A functional, supportive, and educational nursing nutritional role was described but

  9. Acute Care Referral Systems in Liberia: Transfer and Referral Capabilities in a Low-Income Country.

    Science.gov (United States)

    Kim, Jimin; Barreix, Maria; Babcock, Christine; Bills, Corey B

    2017-07-27

    Introduction Following two decades of armed conflict in Liberia, over 95% of health care facilities were partially or completely destroyed. Although the Liberian health system has undergone significant rehabilitation, one particular weakness is the lack of organized systems for referral and prehospital care. Acute care referral systems are a critical component of effective health care delivery and have led to improved quality of care and patient outcomes. Problem This study aimed to characterize the referral and transfer systems in the largest county of Liberia. A cross-sectional, health referral survey of a representative sample of health facilities in Montserrado County, Liberia was performed. A systematic random sample of all primary health care (PHC) clinics, fraction proportional to district population size, and all secondary and tertiary health facilities were included in the study sample. Collected data included baseline information about the health facility, patient flow, and qualitative and quantitative data regarding referral practices. A total of 62 health facilities-41 PHC clinics, 11 health centers (HCs), and 10 referral hospitals (RHs)-were surveyed during the 6-week study period. In sum, three percent of patients were referred to a higher-level of care. Communication between health facilities was largely unsystematic, with lack of specific protocols (n=3; 5.0%) and standardized documentation (n=26; 44.0%) for referral. While most health facilities reported walking as the primary means by which patients presented to initial health facilities (n=50; 81.0%), private vehicles, including commercial taxis (n=37; 60.0%), were the primary transport mechanism for referral of patients between health facilities. This study identified several weaknesses in acute care referral systems in Liberia, including lack of systematic care protocols for transfer, documentation, communication, and transport. However, several informal, well-functioning mechanisms for

  10. Straight-to-test colonoscopy for 2-week-wait referrals improves time to diagnosis of colorectal cancer and is feasible in a high-volume unit.

    Science.gov (United States)

    Banerjea, A; Voll, J; Chowdhury, A; Siddika, A; Thomson, S; Briggs, R; Humes, D J

    2017-09-01

    We have introduced 'straight-to-test' (STT) colonoscopy as part of our 2-week-wait (2WW) pathway to address increasing numbers of urgent referrals for colorectal cancer (CRC) within the National Health Service. In this study we evaluated the ability of this initiative to shorten the time to diagnosis of CRC. We amended our 2WW referral form to include performance status and comorbidities. General practitioners were asked to provide data on estimated glomerular filtration rate and full blood count/ferritin. Our 2WW referrals were screened by a colorectal consultant and a nurse specialist. Those deemed unsuitable for STT were offered outpatient assessment (OPA). Of 553 2WW referrals screened, 352 were considered suitable, 65 of whom failed a telephone assessment or were uncontactable, and accordingly 287 were offered the STT pathway. The STT group was significantly younger than the OPA group (median 65.9 years vs 78.7 years; P STT colonoscopy significantly reduced the time to first test (13 days vs 22 days; P STT pathway were managed with 'best supportive care only' compared with patients attending OPA (one of 15 vs six of 22, respectively). STT colonoscopy obviated the need for clinic attendance before testing in 287 patients, representing a potential net cost benefit of at least £48 500 in 4 months. STT colonoscopy was safe and effective for selecting out a group of symptomatic patients who could proceed straight to endoscopic examination and receive a diagnosis more rapidly. Colorectal Disease © 2017 The Association of Coloproctology of Great Britain and Ireland.

  11. Optimization of burn referrals

    DEFF Research Database (Denmark)

    Reiband, Hanna K; Lundin, Kira; Alsbjørn, Bjarne

    2014-01-01

    INTRODUCTION: Correct estimation of the severity of burns is important to obtain the right treatment of the patient and to avoid over- and undertriage. In this study we aimed to assess how often the guidelines for referral of burn injured patients are met at the national burn centre (NBC), Denmar...

  12. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Borgstein, Alexander Berend-Jan; Sondaal, Stephanie FV; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

    2016-01-01

    Background Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. Objective We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. Methods The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. Results A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. Conclusions mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to

  13. Effectiveness of mHealth Interventions Targeting Health Care Workers to Improve Pregnancy Outcomes in Low- and Middle-Income Countries: A Systematic Review.

    Science.gov (United States)

    Amoakoh-Coleman, Mary; Borgstein, Alexander Berend-Jan; Sondaal, Stephanie Fv; Grobbee, Diederick E; Miltenburg, Andrea Solnes; Verwijs, Mirjam; Ansah, Evelyn K; Browne, Joyce L; Klipstein-Grobusch, Kerstin

    2016-08-19

    Low- and middle-income countries (LMICs) face the highest burden of maternal and neonatal deaths. Concurrently, they have the lowest number of physicians. Innovative methods such as the exchange of health-related information using mobile devices (mHealth) may support health care workers in the provision of antenatal, delivery, and postnatal care to improve maternal and neonatal outcomes in LMICs. We conducted a systematic review evaluating the effectiveness of mHealth interventions targeting health care workers to improve maternal and neonatal outcomes in LMIC. The Cochrane Library, PubMed, EMBASE, Global Health Library, and Popline were searched using predetermined search and indexing terms. Quality assessment was performed using an adapted Cochrane Risk of Bias Tool. A strength, weakness, opportunity, and threat analysis was performed for each included paper. A total of 19 studies were included for this systematic review, 10 intervention and 9 descriptive studies. mHealth interventions were used as communication, data collection, or educational tool by health care providers primarily at the community level in the provision of antenatal, delivery, and postnatal care. Interventions were used to track pregnant women to improve antenatal and delivery care, as well as facilitate referrals. None of the studies directly assessed the effect of mHealth on maternal and neonatal mortality. Challenges of mHealth interventions to assist health care workers consisted mainly of technical problems, such as mobile network coverage, internet access, electricity access, and maintenance of mobile phones. mHealth interventions targeting health care workers have the potential to improve maternal and neonatal health services in LMICs. However, there is a gap in the knowledge whether mHealth interventions directly affect maternal and neonatal outcomes and future research should employ experimental designs with relevant outcome measures to address this gap.

  14. Interventions to improve hand hygiene compliance in patient care.

    Science.gov (United States)

    Gould, Dinah J; Moralejo, Donna; Drey, Nicholas; Chudleigh, Jane H

    2010-09-08

    Health care-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as an effective preventive measure. To update the review done in 2007, to assess the short and longer-term success of strategies to improve hand hygiene compliance and to determine whether a sustained increase in hand hygiene compliance can reduce rates of health care-associated infection. We conducted electronic searches of: the Cochrane Central Register of Controlled Trials; the Cochrane Effective Practice and Organisation of Care Group specialised register of trials; MEDLINE; PubMed; EMBASE; CINAHL; and the BNI. Originally searched to July 2006, for the update databases were searched from August 2006 until November 2009. Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses meeting explicit entry and quality criteria used by the Cochrane Effective Practice and Organisation of Care Group were eligible for inclusion. Studies reporting indicators of hand hygiene compliance and proxy indicators such as product use were considered. Self-reported data were not considered a valid measure of compliance. Studies to promote hand hygiene compliance as part of a care bundle approach were included, providing data relating specifically to hand hygiene were presented separately. Studies were excluded if hand hygiene was assessed in simulations, non-clinical settings or the operating theatre setting. Two reviewers independently extracted data and assessed data quality. Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the

  15. Randomised controlled trial of tailored interventions to improve the management of anxiety and depressive disorders in primary care

    Directory of Open Access Journals (Sweden)

    Terluin Berend

    2011-07-01

    Full Text Available Abstract Background Anxiety and depressive disorders are highly prevalent disorders and are mostly treated in primary care. The management of these disorders by general practitioners is not always consistent with prevailing guidelines because of a variety of factors. Designing implementation strategies tailored to prospectively identified barriers could lead to more guideline-recommended care. Although tailoring of implementation strategies is promoted in practice, little is known about the effect on improving the quality of care for the early recognition, diagnosis, and stepped care treatment allocation in patients with anxiety or depressive disorders in general practice. This study examines whether the tailored strategy supplemented with training and feedback is more effective than providing training and feedback alone. Methods In this cluster randomised controlled trial, a total of 22 general practices will be assigned to one of two conditions: (1 training, feedback, and tailored interventions and (2 training and feedback. The primary outcome measure is the proportion of patients who have been recognised to have anxiety and/or depressive disorder. The secondary outcome measures in patients are severity of anxiety and depressive symptoms, level of functioning, expectation towards and experience with care, quality of life, and economic costs. Measures are taken after the start of the intervention at baseline and at three- and six-month follow-ups. Secondary outcome measures in general practitioners are adherence to guideline-recommended care in care that has been delivered, the proportion of antidepressant prescriptions, and number of referrals to specialised mental healthcare facilities. Data will be gathered from the electronic medical patient records from the patients included in the study. In a process evaluation, the identification of barriers to change and the relations between prospectively identified barriers and improvement

  16. Referral patterns of community health workers diagnosing and treating malaria

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal;

    2016-01-01

    Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria...... (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral inpatient registers...... more distant from health centers were more likely to be referred (low transmission only). CHWs using mRDTs and ACTs increased referral compared with CHWs using a presumptive diagnosis. To address these concerns, referral training should be emphasized in CHW programs as they are scaled-up....

  17. Effective Referral of Low-Income Women at Risk for Hereditary Breast and Ovarian Cancer to Genetic Counseling: A Randomized Delayed Intervention Control Trial.

    Science.gov (United States)

    Pasick, Rena J; Joseph, Galen; Stewart, Susan; Kaplan, Celia; Lee, Robin; Luce, Judith; Davis, Sharon; Marquez, Titas; Nguyen, Tung; Guerra, Claudia

    2016-10-01

    To determine the effectiveness of a statewide telephone service in identifying low-income women at risk for hereditary breast and ovarian cancer and referring them to free genetic counseling. From June 2010 through August 2011, eligible callers to California's toll-free breast and cervical cancer telephone service were screened for their family histories of breast and ovarian cancer. High-risk women were identified and called for a baseline survey and randomization to an immediate offer of genetic counseling or a mailed brochure on how to obtain counseling. Clinic records were used to assess receipt of genetic counseling after 2 months. Among 1212 eligible callers, 709 (58.5%) agreed to answer family history questions; 102 (14%) were at high risk (25% Hispanic, 46% White, 10% Black, 16% Asian, 3% of other racial/ethnic backgrounds). Of the high-risk women offered an immediate appointment, 39% received counseling during the intervention period, as compared with 4.5% of those receiving the brochure. A public health approach to the rare but serious risk of hereditary breast and ovarian cancer can be successful when integrated into the efforts of existing safety net organizations.

  18. An Intervention to Improve the Comfort And Satisfaction of Nurses in the Telephone Triage of Child Maltreatment Calls.

    Science.gov (United States)

    Hunter, Julie

    2015-01-01

    Nurses are mandated reporters of actual or suspected child maltreatment or the threat thereof. The purpose of this quality improvement project was to determine the knowledge and comfort of nurses in telephone triage in pediatric clinics when dealing with suspected or actual child abuse calls. Nurses (N = 17) from three pediatric primary care clinics and one specialty care orthopedic clinic were surveyed. Based on results of the survey showing a lack of knowledge and adequate referral resources perceived by the nursing staff, resources and staff education were developed, along with a script for guiding maltreatment calls toward standardization of care. Following the intervention, nurses reported an increased comfort level when doing telephone triage for child maltreatment calls, an increase in knowledge of risk factors for county resources. Further, they reported a substantial shift in opinion about the need for a standardized script when responding to child maltreatment telephone calls. Nurses undertaking telephone triage of high-risk child maltreatment calls can improve their comfort and knowledge through a survey of their needs and directed education and resource development for the management of child maltreatment telephone triage.

  19. Evaluation of a tailored intervention to improve management of overweight and obesity in primary care: study protocol of a cluster randomised controlled trial.

    Science.gov (United States)

    Krause, Jane; Agarwal, Shona; Bodicoat, Danielle H; Ring, Arne; Shepherd, David; Rogers, Stephen; Wensing, Michel; Baker, Richard

    2014-03-19

    In the UK around 22% of men and 24% of women are obese, and there are varying but worrying levels in other European countries. Obesity is a chronic condition that carries an important health risk. National guidelines, for use in England, on the management of people who are overweight or obese have been published by the National Institute for Health and Clinical Excellence (NICE, 2006). NICE recommendations for primary care teams are: determine the degree of overweight and obesity; assess lifestyle, comorbidities and willingness to change; offer multicomponent management of overweight and obesity; referral to external services when appropriate. This study investigates a tailored intervention to improve the implementation of these recommendations by primary care teams. The study is a cluster randomised controlled trial. Primary care teams will be recruited from the East Midlands of England, and randomised into two study arms: 1) the study group, in which primary care teams are offered a set of tailored interventions to help implement the NICE guidelines for overweight and obesity; or 2) the control group in which primary care teams continue to practice usual care. The primary outcome is the proportion of overweight or obese patients for whom the primary care team adheres to the NICE guidelines. Secondary outcomes include the proportion of patients with a record of lifestyle assessment, referral to external weight loss services, the proportion of obese patients who lose weight during the intervention period, and the mean weight change over the same period. Although often recommended, the methods of tailoring implementation interventions to account for the determinants of practice are not well developed. This study is part of a programme of studies seeking to develop the methods of tailored implementation. Current Controlled Trials ISRCTN07457585. Registered 09/08/2013. Randomisation commenced 30/08/2013.

  20. Cost-Effectiveness Analysis in Practice: Interventions to Improve High School Completion

    Science.gov (United States)

    Hollands, Fiona; Bowden, A. Brooks; Belfield, Clive; Levin, Henry M.; Cheng, Henan; Shand, Robert; Pan, Yilin; Hanisch-Cerda, Barbara

    2014-01-01

    In this article, we perform cost-effectiveness analysis on interventions that improve the rate of high school completion. Using the What Works Clearinghouse to select effective interventions, we calculate cost-effectiveness ratios for five youth interventions. We document wide variation in cost-effectiveness ratios between programs and between…

  1. Evaluating student discipline practices in a public school through behavioral assessment of office referrals.

    Science.gov (United States)

    Putnam, Robert F; Luiselli, James K; Handler, Marcie W; Jefferson, Gretchen L

    2003-09-01

    Office discipline referrals are a common practice in public schools to address students' problem behaviors. The authors report two descriptive studies in a public elementary-middle school to illustrate frequency of office referrals as an evaluative data source. Study I was a behavioral assessment of office referrals to determine the types of discipline problems confronting school personnel and the distribution of referrals among teachers, students, and grade level. In Study II, a fifth-grade class that had the most office referrals in the school received whole-class and individual-student interventions that produced a decrease in the number of referrals. These findings support use of office referrals as a readily available index by which to identify school discipline problems, design interventions, and evaluate outcome.

  2. Testing an intervention to improve functional capability in advanced cardiopulmonary illness.

    Science.gov (United States)

    Dougherty, Cynthia M; Steele, Bonnie G; Hunziker, Jim

    2011-01-01

    The development of a conceptually driven exercise and self-management intervention for improving functional capability and reducing health care costs using social cognitive theory is described. The intervention has 2 components: a 1-month outpatient exercise intervention followed by a home component, lasting 5 months. The intervention is expected to have significant impact on daily function, quality of life, gait/balance, self-efficacy, and health care utilization in persons with advanced heart failure or chronic obstructive pulmonary disease. We report preliminary results related to process-related variables, including feasibility, safety, and intervention adherence. Intervention outcomes are currently under study and will be reported when available.

  3. Enhancing Documentation of Pressure Ulcer Prevention Interventions: A Quality Improvement Strategy to Reduce Pressure Ulcers.

    Science.gov (United States)

    Jacobson, Therese M; Thompson, Susan L; Halvorson, Anna M; Zeitler, Kristine

    2016-01-01

    Prevention of hospital-acquired pressure ulcers requires the implementation of evidence-based interventions. A quality improvement project was conducted to provide nurses with data on the frequency with which pressure ulcer prevention interventions were performed as measured by documentation. Documentation reports provided feedback to stakeholders, triggering reminders and reeducation. Intervention reports and modifications to the documentation system were effective both in increasing the documentation of pressure ulcer prevention interventions and in decreasing the number of avoidable hospital-acquired pressure ulcers.

  4. Reading intervention with a growth mindset approach improves children's skills.

    Science.gov (United States)

    Andersen, Simon Calmar; Nielsen, Helena Skyt

    2016-10-25

    Laboratory experiments have shown that parents who believe their child's abilities are fixed engage with their child in unconstructive, performance-oriented ways. We show that children of parents with such "fixed mindsets" have lower reading skills, even after controlling for the child's previous abilities and the parents' socioeconomic status. In a large-scale randomized field trial (Nclassrooms = 72; Nchildren = 1,587) conducted by public authorities, parents receiving a reading intervention were told about the malleability of their child's reading abilities and how to support their child by praising his/her effort rather than his/her performance. This low-cost intervention increased the reading and writing achievements of all participating children-not least immigrant children with non-Western backgrounds and children with low-educated mothers. As expected, effects were even bigger for parents who before the intervention had a fixed mindset.

  5. Early intervention to improve hand function in hemiplegic cerebral palsy

    Directory of Open Access Journals (Sweden)

    Anna Purna Basu

    2015-01-01

    Full Text Available Children with hemiplegic cerebral palsy often have marked hand involvement with excessive thumb adduction and flexion and limited active wrist extension from infancy. Post-lesional aberrant plasticity can lead to progressive abnormalities of the developing motor system. Disturbances of somatosensory and visual function and developmental disregard contribute to difficulties with hand use. Progressive soft tissue and bony changes may occur, leading to contractures which further limit function in a vicious cycle. Early intervention might help to break this cycle: however, the precise nature and appropriateness of the intervention must be carefully considered. Traditional approaches to the hemiplegic upper limb include medications and botulinum toxin injections to manage abnormalities of tone, and surgical interventions. Therapist input, including provision of orthoses, remains a mainstay although many therapies have not been well evaluated. There has been a recent increase in interventions for the hemiplegic upper limb, mostly aimed outside the period of infancy. These include trials of constraint-induced movement therapy and bimanual therapy as well as the use of virtual reality and robot-assisted therapy. In future, non-invasive brain stimulation may be combined with therapy. Interventions under investigation in the infant age group include modified constraint-induced movement therapy and action observation therapy. A further approach which may be suited to the infant with thumb-in-palm deformity, but which requires evaluation, is the use of elastic taping. Enhanced cutaneous feedback through mechanical stimulation to the skin provided by the tape during movement has been postulated to modulate ongoing muscle activity. If effective, this would represent a low-cost, safe, widely applicable early intervention.

  6. Factors influencing accuracy of referral and the likelihood of false positive referral by optometrists in Bradford, United Kingdom.

    Science.gov (United States)

    Davey, Christopher James; Scally, Andrew J; Green, Clare; Mitchell, Edwin S; Elliott, David B

    2016-01-01

    Levels of false positive referral to ophthalmology departments can be high. This study aimed to evaluate commonality between false positive referrals in order to find the factors which may influence referral accuracy. In 2007/08, a sample of 431 new Ophthalmology referrals from the catchment area of Bradford Royal Infirmary were retrospectively analysed. The proportion of false positive referrals generated by optometrists decreases with experience at a rate of 6.2% per year since registration (p<0.0001). Community services which involved further investigation done by the optometrist before directly referring to the hospital were 2.7 times less likely to refer false positively than other referral formats (p=0.007). Male optometrists were about half as likely to generate a false positive referral than females (OR=0.51, p=0.008) and as multiple/corporate practices in the Bradford area employ less experienced and more female staff, independent practices generate about half the number of false positive referrals (OR=0.52, p=0.005). Clinician experience has the greatest effect on referral accuracy although there is also a significant effect of gender with women tending to refer more false positives. This may be due to a different approach to patient care and possibly a greater sensitivity to litigation. The improved accuracy of community services (which often refer directly after further investigation) supports further growth of these schemes. Copyright © 2015 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  7. Interventions to improve the management of pain in emergency departments: systematic review and narrative synthesis.

    Science.gov (United States)

    Sampson, F C; Goodacre, S W; O'Cathain, A

    2014-10-01

    Pain management in emergency departments (ED) is often inadequate despite the availability of effective analgesia, with many patients receiving insufficient and untimely analgesia. We conducted a systematic literature review to identify interventions that could improve pain management in the ED. We systematically searched seven databases for studies reporting pain management outcomes after intervention to change professional practice to improve pain management in the ED, compared with pain management before or without intervention. Data was synthesised using principles of narrative synthesis. We identified 43 relevant studies, including 40 uncontrolled before-and-after studies. Interventions included implementation of guidelines and protocols, educational interventions, pain scoring tools and changes in nursing roles, with many multifaceted interventions incorporating two or more of these elements. Interventions aimed to improve assessment and documentation of pain, knowledge and awareness of pain management and reduce time to analgesia. Due to the high probability of bias in study design and significant variation between studies, it was not possible to estimate the overall effectiveness of interventions, or identify which had the greatest impact. Intervention to improve pain management was reported to have some positive impact in most studies, but these findings may be explained by limitations in study design. Many interventions reported improvements in pain management, but current evidence is insufficient to recommend any for widespread adoption. In order to improve pain management we need to understand more about the theory underlying interventions, the context in which interventions work, and develop interventions based on this stronger theoretical understanding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Lifestyle intervention according to general recommendations improves glucose tolerance

    NARCIS (Netherlands)

    Mensink, M.R.; Blaak, E.E.; Corpeleijn, E.; Saris, W.H.M.; Bruin, T.W.; Feskens, E.J.M.

    2003-01-01

    Objective: Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes. However, it needs to be assessed whether moderate interventions, in agreement with current guidelines for the general population, are effective. We evaluated the

  9. Using Teacher Impression Journals to Improve Intervention Effectiveness

    Science.gov (United States)

    Yu, SeonYeong; Ostrosky, Michaelene M.; Meyer, Lori E.; Favazza, Paddy C.; Mouzourou, Chryso; van Luling, Lisa

    2016-01-01

    This article describes the use of "Teacher Impression Journals" during a larger study that examined the efficacy of an intervention program designed to promote kindergarteners' positive attitudes toward peers with disabilities (i.e., the "Special Friends" program). The journals were designed to gather information about…

  10. Interventions to improve return to work in depressed people

    NARCIS (Netherlands)

    Nieuwenhuijsen, Karen; Faber, Babs; Verbeek, Jos H.; Neumeyer-Gromen, Angela; Hees, Hiske L.; Verhoeven, Arco C.; van der Feltz-Cornelis, Christina M.; Bultmann, Ute

    2014-01-01

    Background Work disability such as sickness absence is common in people with depression. Objectives To evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders. Search methods We searched CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CIN

  11. Lifestyle intervention according to general recommendations improves glucose tolerance

    NARCIS (Netherlands)

    Mensink, M; Blaak, EE; Corpeleijn, E; Saris, WH; de Bruin, TW; Feskens, EJ

    2003-01-01

    Objective: Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes. However, it needs to be assessed whether moderate interventions, in agreement with current guidelines for the general population, are effective. We evaluated the impa

  12. Lifestyle intervention according to general recommendations improves glucose tolerance

    NARCIS (Netherlands)

    Mensink, M; Blaak, EE; Corpeleijn, E; Saris, WH; de Bruin, TW; Feskens, EJ

    2003-01-01

    Objective: Changing dietary and physical activity habits has the potential to postpone or prevent the development of type 2 diabetes. However, it needs to be assessed whether moderate interventions, in agreement with current guidelines for the general population, are effective. We evaluated the impa

  13. An intervention to improve the timing of vancomycin levels.

    Science.gov (United States)

    Melanson, Stacy E F; Mijailovic, Aleksandar S; Wright, Aileen P M; Szumita, Paul M; Bates, David W; Tanasijevic, Milenko J

    2013-12-01

    Blood samples for vancomycin levels are often drawn too early, leading to potential misinterpretation of results. However, only a few studies describe interventions to reduce mistimed vancomycin levels. We implemented an information technology (IT)-based intervention that provided educational instructions to nurses and determined the percentage of levels drawn too early for 27 months before (n = 6,291) and 14 months after (n = 3,608) the intervention. In addition, we conducted nurse interviews (n = 40) and dataset analysis to assess the root causes of mistimed levels. The percentage of vancomycin timing errors decreased from 39% (2,438/6,291) to 32% (1,137/3,608), though in a time series analysis this decrease was not statistically significant (P = .64). Four common causes of mistimed levels were found: (1) unclear provider orders, (2) scheduling levels to be drawn with morning laboratory tests, (3) lack of communication between providers, and (4) failure to adjust the blood draw in relation to the previous dose. A real-time, IT-based intervention that links the timing of levels with medication administration might have a more substantial impact.

  14. Interventions to improve occupational health in depressed people

    NARCIS (Netherlands)

    Nieuwenhuijsen, K.; Bultmann, U.; Neumeyer-Gromen, A.; Verhoeven, A.C.; Verbeek, J.H.; van der Feltz-Cornelis, C.M.

    2008-01-01

    BACKGROUND: Work disability such as sickness absence is common in people with depression. OBJECTIVES: To evaluate the effectiveness of interventions aimed at reducing work disability in depressed workers. SEARCH STRATEGY: We searched the CCDANCTR-Studies and CCDANCTR-References on 2/8/2006, Cochrane

  15. Cold Plasma: an emerging antimicrobial intervention to improve food safety

    Science.gov (United States)

    Contamination of fresh and fresh-cut fruits and vegetables by foodborne pathogens has prompted research into novel interventions. Cold plasma is a nonthermal food processing technology which uses energetic, reactive gases to inactivate contaminating microbes. This flexible sanitizing method uses ele...

  16. Self-referral to chest pain units: results of the German CPU-registry.

    Science.gov (United States)

    Nowak, Bernd; Giannitsis, Evangelos; Riemer, Thomas; Münzel, Thomas; Haude, Michael; Maier, Lars S; Schmitt, Claus; Schumacher, Burghard; Mudra, Harald; Hamm, Christian; Senges, Jochen; Voigtländer, Thomas

    2012-12-01

    Chest pain units (CPUs) are increasingly established in emergency cardiology services. With improved visibility of CPUs in the population, patients may refer themselves directly to these units, obviating emergency medical services (EMS). Little is known about characteristics and outcomes of self-referred patients, as compared with those referred by EMS. Therefore, we described self-referral patients enrolled in the CPU-registry of the German Cardiac Society and compared them with those referred by EMS. From 2008 until 2010, the prospective CPU-registry enrolled 11,581 consecutive patients. Of those 3789 (32.7%) were self-referrals (SRs), while 7792 (67.3%) were referred by EMS. SR-patients were significantly younger (63.6 vs. 70.1 years), had less prior myocardial infarction or coronary artery bypass surgery, but more previous percutaneous coronary interventions (PCIs). Acute coronary syndromes were diagnosed less frequently in the SR-patients (30.3 vs. 46.9%; pCPU as a self-referral are younger, less severely ill and have more non-coronary problems than those calling an emergency medical service. Nevertheless, 30% of self-referral patients had an acute coronary syndrome.

  17. Implementing a fax referral program for quitline smoking cessation services in urban health centers: a qualitative study

    Directory of Open Access Journals (Sweden)

    Cantrell Jennifer

    2009-12-01

    Full Text Available Abstract Background Fax referral services that connect smokers to state quitlines have been implemented in 49 U.S. states and territories and promoted as a simple solution to improving smoker assistance in medical practice. This study is an in-depth examination of the systems-level changes needed to implement and sustain a fax referral program in primary care. Methods The study involved implementation of a fax referral system paired with a chart stamp prompting providers to identify smoking patients, provide advice to quit and refer interested smokers to a state-based fax quitline. Three focus groups (n = 26 and eight key informant interviews were conducted with staff and physicians at two clinics after the intervention. We used the Chronic Care Model as a framework to analyze the data, examining how well the systems changes were implemented and the impact of these changes on care processes, and to develop recommendations for improvement. Results Physicians and staff described numerous benefits of the fax referral program for providers and patients but pointed out significant barriers to full implementation, including the time-consuming process of referring patients to the Quitline, substantial patient resistance, and limitations in information and care delivery systems for referring and tracking smokers. Respondents identified several strategies for improving integration, including simplification of the referral form, enhanced teamwork, formal assignment of responsibility for referrals, ongoing staff training and patient education. Improvements in Quitline feedback were needed to compensate for clinics' limited internal information systems for tracking smokers. Conclusions Establishing sustainable linkages to quitline services in clinical sites requires knowledge of existing patterns of care and tailored organizational changes to ensure new systems are prioritized, easily integrated into current office routines, formally assigned to specific

  18. Improving uptake and engagement with child body image interventions delivered to mothers: Understanding mother and daughter preferences for intervention content.

    Science.gov (United States)

    Garbett, Kirsty M; Diedrichs, Phillippa C

    2016-12-01

    Mothers are a key influence on adolescent girls' body image. This study aimed to improve understanding of mothers' and daughters' preferences for content in body image interventions designed to assist mothers to promote positive body image among their daughters. British mother-daughter dyads (N=190) viewed descriptions of five evidence-based influences on body image (family, friends, and relationships; appearance-based teasing; media and celebrities; appearance conversations; body acceptance and care). Mothers and daughters each selected the two most important influences to learn about in these interventions. Overall, both mothers and daughters most frequently opted for family, friends, and relationships and body acceptance and care, whereas media and celebrities was their least preferred topic. While the overall sample of mothers and daughters agreed on preferences, Fisher's exact tests showed that within-dyad agreement was low. Recommendations for improving parent and child engagement with, and effectiveness of, child body image interventions delivered to parents are discussed.

  19. Knowledge Translation Interventions to Improve the Timing of Dialysis Initiation

    Science.gov (United States)

    Chau, Elaine M. T.; Manns, Braden J.; Garg, Amit X.; Sood, Manish M.; Kim, S. Joseph; Naimark, David; Nesrallah, Gihad E.; Soroka, Steven D.; Beaulieu, Monica; Dixon, Stephanie; Alam, Ahsan; Tangri, Navdeep

    2016-01-01

    Background: Early initiation of chronic dialysis (starting dialysis with higher vs lower kidney function) has risen rapidly in the past 2 decades in Canada and internationally, despite absence of established health benefits and higher costs. In 2014, a Canadian guideline on the timing of dialysis initiation, recommending an intent-to-defer approach, was published. Objective: The objective of this study is to evaluate the efficacy and safety of a knowledge translation intervention to promote the intent-to-defer approach in clinical practice. Design: This study is a multicenter, 2-arm parallel, cluster randomized trial. Setting: The study involves 55 advanced chronic kidney disease clinics across Canada. Patients: Patients older than 18 years who are managed by nephrologists for more than 3 months, and initiate dialysis in the follow-up period are included in the study. Measurements: Outcomes will be measured at the patient-level and enumerated within a cluster. Data on characteristics of each dialysis start will be determined by linkages with the Canadian Organ Replacement Register. Primary outcomes include the proportion of patients who start dialysis early with an estimated glomerular filtration rate greater than 10.5 mL/min/1.73 m2 and start dialysis in hospital as inpatients or in an emergency room setting. Secondary outcomes include the rate of change in early dialysis starts; rates of hospitalizations, deaths, and cost of predialysis care (wherever available); quarterly proportion of new starts; and acceptability of the knowledge translation materials. Methods: We randomized 55 multidisciplinary chronic disease clinics (clusters) in Canada to receive either an active knowledge translation intervention or no intervention for the uptake of the guideline on the timing of dialysis initiation. The active knowledge translation intervention consists of audit and feedback as well as patient- and provider-directed educational tools delivered at a comprehensive in

  20. Interventions to improve adherence to first-line antibiotics in respiratory tract infections

    DEFF Research Database (Denmark)

    Llor, Carl; Monedero, María José; García, Guillermo

    2015-01-01

    Background: Many interventions aimed at improving the quality of antibiotic prescribing have been investigated, but more knowledge is needed regarding the impact of different intensity interventions. Objectives: To compare the effect of two interventions, a basic intervention (BI) and intensive....... In the group of GPs following the BI, first-line antibiotics accounted for 23.8% of antibiotics before the intervention and 29.4% after (increase 5.6%, 95% confidence interval (CI): 1.2-10%), while in the group of GPs following the II these figures were 26.2% and 48.6% (increase 22.4%, 95% CI: 18...

  1. Practices and attitudes of doctors and patients to downward referral in Shanghai, China

    Science.gov (United States)

    Yu, Wenya; Li, Meina; Nong, Xin; Ding, Tao; Ye, Feng; Liu, Jiazhen; Dai, Zhixing; Zhang, Lulu

    2017-01-01

    conduct universal publicity for downward referral. Doctors and patients should promote understandings of downward referral. Hospitals should realise the necessity of downward referral, effectively reduce workloads and provide continuing education for doctors. Increasing monetary reimbursement is urgent, as is improving the medical insurance system. PMID:28373247

  2. Effectiveness of an electronic health record-based intervention to improve follow-up of abnormal pathology results: a retrospective record analysis.

    Science.gov (United States)

    Laxmisan, Archana; Sittig, Dean F; Pietz, Kenneth; Espadas, Donna; Krishnan, Bhuvaneswari; Singh, Hardeep

    2012-10-01

    On March 11, 2009, the Veterans Health Administration (VA) implemented an electronic health record (EHR)-based intervention that required all pathology results to be transmitted to ordering providers by mandatory automated notifications. We examined the impact of this intervention on improving follow-up of abnormal outpatient pathology results. We extracted pathology reports from the EHR of 2 VA sites. From 16,738 preintervention and 17,305 postintervention reports between 09/01/2008 and 09/30/2009, we randomly selected about 5% and evaluated follow-up outcomes using a standardized chart review instrument. Documented responses to the alerted report (eg, ordering follow-up tests or referrals, notifying patients, and prescribing/changing treatment) were recorded. Primary outcome measures included proportion of timely follow-up responses (within 30 d) and median time to direct response for abnormal reports. Of 816 preintervention and 798 postintervention reports reviewed, 666 (81.6%) and 688 (86.2%) were abnormal. Overall, there was no apparent intervention effect on timely follow-up (69% vs. 67.1%; P=0.4) or median time to direct response (8 vs. 8 d; P=0.7). However, logistic regression uncovered a significant intervention effect (preintervention odds ratio, 0.7; 95% confidence interval, 0.5-1.0) after accounting for site-specific differences in follow-up, with a lower likelihood of timely follow-up at one site (odds ratio, 0.4; 95% confidence interval, 0.2-0.7). An electronic intervention to improve test result follow-up at 2 VA institutions using the same EHR was found effective only after accounting for certain local contextual factors. Aggregating the effect of EHR interventions across different institutions and EHRs without controlling for contextual factors might underestimate their potential benefits.

  3. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada.

    Science.gov (United States)

    Markle-Reid, Maureen; Browne, Gina; Gafni, Amiram

    2013-02-01

    This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (≥65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions. The nurse-led HPDP interventions were 6- or 12-month multi-component and evidence-based strategies targeting known risk factors for functional decline and frailty. Across the three studies, a common approach was used to measure the change in health-related quality of life (HRQOL) (SF-36) and the costs of use of health services (Health and Social Services Utilization Inventory) from baseline to the end of the intervention. The main lesson learned from the three studies is that nurse-led HPDP interventions for frail older home care clients provide greater improvements in HRQOL compared with usual home care. Such approaches are highly acceptable to this population and can be implemented using existing home care resources. Nurse-led HPDP interventions should include multiple home visits, multidimensional screening and assessment, multi-component evidence-based HPDP strategies, intensive case management, inter-professional collaboration, providers with geriatric training and experience, referral to and coordination of community services, and theory use. The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings. © 2011 Blackwell Publishing Ltd.

  4. Using efficiency analysis and targeted intervention to improve operational performance and achieve cost savings in the endoscopy center.

    Science.gov (United States)

    Kaushal, Neal K; Chang, Kenneth; Lee, John G; Muthusamy, V Raman

    2014-04-01

    With an increasing demand for endoscopy services, there is a greater need for efficiency within the endoscopy center. A validated methodology is important for evaluating efficiency in the endoscopy unit. To use the principles of operations management to establish a validated methodology for evaluating and enhancing operational performance in the endoscopy center. Biphasic prospective study with pre-intervention and post-intervention efficiency data and analysis. Tertiary-care referral teaching hospital. Scheduled outpatients undergoing endoscopy. Determination of the rate-limiting step, or bottleneck, of the endoscopy unit and reducing inefficiencies. Staffing costs and a novel performance metric, True Completion Time (TCT). Data were prospectively recorded for 2248 patients undergoing a total of 2713 procedures (phase I: 255 EGD, 305 colonoscopy, 91 EGD/colonoscopy, 375 EUS, 44 ERCP, 75 EUS/ERCP; phase II: 243 EGD, 328 colonoscopy, 99 EGD/colonoscopy, 335 EUS, 38 ERCP, 109 EUS/ERCP). The bottleneck of the operation was identified as the 10-bed communal pre-procedure/recovery room. On-time procedure starts increased by 51% (P costs were reduced by 30%, whereas full-time employee staff was reduced by 0.85. Annual cost savings were calculated as $312,618 or 11.02% of total operating expenses. This study is not directly tied to quality outcomes, and inpatient procedures transported to the endoscopy unit were not directly studied. Room turnover time and room-to-endoscopist ratio are not necessarily the driving parameters behind endoscopy unit efficiency. A focus on developing a methodology for identifying factors constraining operational efficiency can improve performance and reduce costs in the endoscopy center. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  5. Theory, evidence and Intervention Mapping to improve behavior nutrition and physical activity interventions.

    NARCIS (Netherlands)

    J. Brug (Hans); A. Oenema (Anke); A. Ferreira (Isabel)

    2005-01-01

    textabstractBACKGROUND: The present paper intends to contribute to the debate on the usefulness and barriers in applying theories in diet and physical activity behavior-change interventions. DISCUSSION: Since behavior theory is a reflection of the compiled evidence of behavior research, theory is th

  6. Subliminal strengthening: improving older individuals' physical function over time with an implicit-age-stereotype intervention.

    Science.gov (United States)

    Levy, Becca R; Pilver, Corey; Chung, Pil H; Slade, Martin D

    2014-12-01

    Negative age stereotypes that older individuals assimilate from their culture predict detrimental outcomes, including worse physical function. We examined, for the first time, whether positive age stereotypes, presented subliminally across multiple sessions in the community, would lead to improved outcomes. Each of 100 older individuals (age=61-99 years, M=81) was randomly assigned to an implicit-positive-age-stereotype-intervention group, an explicit-positive-age-stereotype-intervention group, a combined implicit- and explicit-positive-age-stereotype-intervention group, or a control group. Interventions occurred at four 1-week intervals. The implicit intervention strengthened positive age stereotypes, which strengthened positive self-perceptions of aging, which, in turn, improved physical function. The improvement in these outcomes continued for 3 weeks after the last intervention session. Further, negative age stereotypes and negative self-perceptions of aging were weakened. For all outcomes, the implicit intervention's impact was greater than the explicit intervention's impact. The physical-function effect of the implicit intervention surpassed a previous study's 6-month-exercise-intervention's effect with participants of similar ages. The current study's findings demonstrate the potential of directing implicit processes toward physical-function enhancement over time.

  7. A Meta-Analytic Review of Stand-Alone Interventions to Improve Body Image.

    Directory of Open Access Journals (Sweden)

    Jessica M Alleva

    Full Text Available Numerous stand-alone interventions to improve body image have been developed. The present review used meta-analysis to estimate the effectiveness of such interventions, and to identify the specific change techniques that lead to improvement in body image.The inclusion criteria were that (a the intervention was stand-alone (i.e., solely focused on improving body image, (b a control group was used, (c participants were randomly assigned to conditions, and (d at least one pretest and one posttest measure of body image was taken. Effect sizes were meta-analysed and moderator analyses were conducted. A taxonomy of 48 change techniques used in interventions targeted at body image was developed; all interventions were coded using this taxonomy.The literature search identified 62 tests of interventions (N = 3,846. Interventions produced a small-to-medium improvement in body image (d+ = 0.38, a small-to-medium reduction in beauty ideal internalisation (d+ = -0.37, and a large reduction in social comparison tendencies (d+ = -0.72. However, the effect size for body image was inflated by bias both within and across studies, and was reliable but of small magnitude once corrections for bias were applied. Effect sizes for the other outcomes were no longer reliable once corrections for bias were applied. Several features of the sample, intervention, and methodology moderated intervention effects. Twelve change techniques were associated with improvements in body image, and three techniques were contra-indicated.The findings show that interventions engender only small improvements in body image, and underline the need for large-scale, high-quality trials in this area. The review identifies effective techniques that could be deployed in future interventions.

  8. Open-access ultrasound referrals from general practice.

    LENUS (Irish Health Repository)

    Hughes, P

    2015-03-01

    Direct access referral for radiological investigations from General Practice (GP) provides an indispensable diagnostic tool and avoids the inherently long waiting time that referral through a hospital based specialty would entail. Improving access to hospital based radiology services is one of Health Information and Quality Authority\\'s key recommendations in its report on patient referrals from general practice. This study aimed to review all GP referrals for ultrasound investigations to a tertiary referral teaching hospital over a seven month period with respect to their demographics, waiting times and diagnostic outcomes. 1,090 ultrasounds originating in general practice were carried out during the study period. Positive findings were recorded in 332 (30.46%) examinations. The median waiting time from receipt of referral to the diagnostic investigation was 56 days (range 16 - 91 years). 71 (6.5%) patients had follow-up imaging investigations while recommendation for hospital based specialty referral was made in 35 cases (3.2%). Significant findings included abdominal aortic aneurysms, metastatic disease and lymphoma. Direct access to ultrasound for general practitioners allows the referring physician to make an informed decision with regard to the need for specialist referral. We believe these findings help support the case for national direct access to diagnostic ultrasound for general practitioners.

  9. A Brief Educational Intervention Improves Medication Safety Knowledge in Grandparents of Young Children

    Directory of Open Access Journals (Sweden)

    Maneesha Agarwal

    2015-03-01

    Full Text Available Background and Objectives: Increasing grandparent-grandchild interactions have not been targeted as a potential contributing factor to the recent surge in pediatric poisonings. We hypothesized that in grandparents with a young grandchild, a single educational intervention based on the PROTECT “Up & Away” campaign will improve safe medication knowledge and storage at follow-up from baseline. Methods: This prospective cohort study validated the educational intervention and survey via cognitive debriefing followed by evaluation of the educational intervention in increasing safe medication storage. Participants had to read and speak English and have annual contact with one grandchild ≤ 5-years-old. Participants were recruited from a convenience sample of employees in a regional healthcare system. They completed a pre-intervention survey querying baseline demographics, poisoning prevention knowledge, and medication storage, followed by the educational intervention and post-intervention survey. Participants completed a delayed post-intervention survey 50–90 days later assessing medication storage and poisoning prevention knowledge. Storage sites were classified as safe or unsafe a priori|a panel classified handwritten responses. Results: 120 participants were enrolled|95 (79% completed the delayed post-intervention survey. Participants were predominantly female (93% and white (76%|50% had a clinical degree. Participants averaged 1.9 grandchildren. Initially, 23% of participants reported safe medication storage|this improved to 48% after the intervention (OR 6.4|95% CI = 2.5–21.0. 78% of participants made at least one improvement in their medication storage after the intervention even if they did not meet all criteria for safe storage. Participants also demonstrated retention of poisoning prevention knowledge. Conclusions: This brief educational intervention improved safe medication storage and poisoning prevention knowledge in grandparents

  10. Towards successful coordination of electronic health record based-referrals: a qualitative analysis

    Directory of Open Access Journals (Sweden)

    Paul Lindsey A

    2011-07-01

    Full Text Available Abstract Background Successful subspecialty referrals require considerable coordination and interactive communication among the primary care provider (PCP, the subspecialist, and the patient, which may be challenging in the outpatient setting. Even when referrals are facilitated by electronic health records (EHRs (i.e., e-referrals, lapses in patient follow-up might occur. Although compelling reasons exist why referral coordination should be improved, little is known about which elements of the complex referral coordination process should be targeted for improvement. Using Okhuysen & Bechky's coordination framework, this paper aims to understand the barriers, facilitators, and suggestions for improving communication and coordination of EHR-based referrals in an integrated healthcare system. Methods We conducted a qualitative study to understand coordination breakdowns related to e-referrals in an integrated healthcare system and examined work-system factors that affect the timely receipt of subspecialty care. We conducted interviews with seven subject matter experts and six focus groups with a total of 30 PCPs and subspecialists at two tertiary care Department of Veterans Affairs (VA medical centers. Using techniques from grounded theory and content analysis, we identified organizational themes that affected the referral process. Results Four themes emerged: lack of an institutional referral policy, lack of standardization in certain referral procedures, ambiguity in roles and responsibilities, and inadequate resources to adapt and respond to referral requests effectively. Marked differences in PCPs' and subspecialists' communication styles and individual mental models of the referral processes likely precluded the development of a shared mental model to facilitate coordination and successful referral completion. Notably, very few barriers related to the EHR were reported. Conclusions Despite facilitating information transfer between PCPs and

  11. An occupation-based video feedback intervention for improving self-awareness: protocol and rationale.

    Science.gov (United States)

    Schmidt, Julia; Fleming, Jennifer; Ownsworth, Tamara; Lannin, Natasha A

    2015-02-01

    Impaired self-awareness can limit rehabilitation outcomes for people with traumatic brain injury (TBI). Video feedback on occupational performance has been found to improve self-awareness after TBI when delivered according to specific principles. The purpose of this article is to describe an occupation-based video feedback intervention found to be effective in a randomized controlled trial to assist with translation into clinical practice. The intervention uses therapist-mediated video feedback on clients' occupational performance, aiming to facilitate self-reflection on performance and improve self-awareness. This paper describes the theoretical background, intervention principles, and protocol of the intervention. Therapists can use video feedback intervention, incorporating the principles in this article, to improve people's intellectual awareness and ability to recognize and correct errors during task performance after TBI without a negative impact on emotional status.

  12. Referral patterns of community health workers diagnosing and treating malaria

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal

    2016-01-01

    Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria...... rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy...... (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral inpatient registers...

  13. [A Paediatric Orthopaedic outpatient clinic referral patterns].

    Science.gov (United States)

    Moraleda, L; Castellote, M

    2015-08-01

    The aim of this study was to identify the commonest referrals to a paediatric orthopaedic outpatient clinic and, therefore, to be able to improve the paediatric residency program in managing musculoskeletal problems. Demographic data, referrals and final diagnosis were collected prospectively on all patients that were evaluated in a paediatric orthopaedic outpatient clinic. The majority of referrals were to evaluate musculoskeletal pain (37%), foot deformity (20%), spine deformity (15%), walking pattern (11%), alignment of the lower limbs (4%), and development of the hip (4%). A normal physical examination or a normal variation was observed in 42% of patients. A mild condition was observed in 17% of patients that should have only been referred to a paediatric orthopaedic clinic after failing to resolve pain with anti-inflammatories or physiotherapy. A mild deformity that only needed treatment if it became symptomatic was seen in 8% of patients. The majority of referrals were due to a normal variation or mild conditions that only required symptomatic treatment. Paediatric residency programs do not reflect the prevalence of musculoskeletal conditions in clinical practice. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  14. How Can We Improve Preventive and Educational Interventions for Intimate Relationships?

    Science.gov (United States)

    Bradbury, Thomas N.; Lavner, Justin A.

    2012-01-01

    Improving intimate relationships with preventive and educational interventions has proven to be more difficult than originally conceived, and earlier models and approaches may be reaching their limits. Basic concerns remain about the long-term effectiveness of these interventions, whether they are reaching and benefiting couples most likely to…

  15. The Influence of National and Organizational Culture on the Use of Performance Improvement Interventions

    Science.gov (United States)

    Vadivelu, Ramaswamy N.; Klein, James D.

    2011-01-01

    This exploratory study examined the influence of national and organizational culture on the use of various performance improvement interventions. Data on intervention use were collected from practitioners in the United States and South Asia. Results revealed that orientation programs, organizational communication, instructor-led training, and…

  16. Parental involvement in interventions to improve child dietary intake: A systematic review

    Science.gov (United States)

    Interventions that aim to improve child dietary quality and reduce disease risk often involve parents. The most effective methods to engage parents remain unclear. A systematic review of interventions designed to change child and adolescent dietary behavior was conducted to answer whether parent inv...

  17. Family Ties to Health Program: A Randomized Intervention to Improve Vegetable Intake in Children

    Science.gov (United States)

    Tabak, Rachel G.; Tate, Deborah F.; Stevens, June; Siega-Riz, Anna Maria; Ward, Dianne S.

    2012-01-01

    Objective: Evaluate a home-based intervention targeted toward parents to improve vegetable intake in preschool-aged children. Methods: Four-month feasibility study of home-based intervention consisting of 4 tailored newsletters and 2 motivational phone calls compared to control; 4 children's books for the control group; and measured pre and post…

  18. Improving Students' Representational Flexibility in Linear-Function Problems: An Intervention

    Science.gov (United States)

    Acevedo Nistal, A.; Van Dooren, W.; Verschaffel, L.

    2014-01-01

    This study evaluates the effects of an intervention aimed at improving representational flexibility in linear-function problems. Forty-nine students aged 13-16 participated in the study. A pretest-intervention-posttest design with an experimental and control group was used. At pretest, both groups solved a choice test, where they could freely…

  19. Using instructional design process to improve design and development of Internet interventions.

    Science.gov (United States)

    Hilgart, Michelle M; Ritterband, Lee M; Thorndike, Frances P; Kinzie, Mable B

    2012-06-28

    Given the wide reach and extensive capabilities of the Internet, it is increasingly being used to deliver comprehensive behavioral and mental health intervention and prevention programs. Their goals are to change user behavior, reduce unwanted complications or symptoms, and improve health status and health-related quality of life. Internet interventions have been found efficacious in addressing a wide range of behavioral and mental health problems, including insomnia, nicotine dependence, obesity, diabetes, depression, and anxiety. Despite the existence of many Internet-based interventions, there is little research to inform their design and development. A model for behavior change in Internet interventions has been published to help guide future Internet intervention development and to help predict and explain behavior changes and symptom improvement outcomes through the use of Internet interventions. An argument is made for grounding the development of Internet interventions within a scientific framework. To that end, the model highlights a multitude of design-related components, areas, and elements, including user characteristics, environment, intervention content, level of intervention support, and targeted outcomes. However, more discussion is needed regarding how the design of the program should be developed to address these issues. While there is little research on the design and development of Internet interventions, there is a rich, related literature in the field of instructional design (ID) that can be used to inform Internet intervention development. ID models are prescriptive models that describe a set of activities involved in the planning, implementation, and evaluation of instructional programs. Using ID process models has been shown to increase the effectiveness of learning programs in a broad range of contexts. ID models specify a systematic method for assessing the needs of learners (intervention users) to determine the gaps between current

  20. Economic evaluation of mobile phone text message interventions to improve adherence to HIV therapy in Kenya

    Science.gov (United States)

    Patel, Anik R.; Kessler, Jason; Braithwaite, R. Scott; Nucifora, Kimberly A.; Thirumurthy, Harsha; Zhou, Qinlian; Lester, Richard T.; Marra, Carlo A.

    2017-01-01

    Abstract Background: A surge in mobile phone availability has fueled low cost short messaging service (SMS) adherence interventions. Multiple systematic reviews have concluded that some SMS-based interventions are effective at improving antiretroviral therapy (ART) adherence, and they are hypothesized to improve retention in care. The objective of this study was to evaluate the cost-effectiveness of SMS-based adherence interventions and explore the added value of retention benefits. Methods: We evaluated the cost-effectiveness of weekly SMS interventions compared to standard care among HIV+ individuals initiating ART for the first time in Kenya. We used an individual level micro-simulation model populated with data from two SMS-intervention trials, an East-African HIV+ cohort and published literature. We estimated average quality adjusted life years (QALY) and lifetime HIV-related costs from a healthcare perspective. We explored a wide range of scenarios and assumptions in one-way and multivariate sensitivity analyses. Results: We found that SMS-based adherence interventions were cost-effective by WHO standards, with an incremental cost-effectiveness ratio (ICER) of $1,037/QALY. In the secondary analysis, potential retention benefits improved the cost-effectiveness of SMS intervention (ICER = $864/QALY). In multivariate sensitivity analyses, the interventions remained cost-effective in most analyses, but the ICER was highly sensitive to intervention costs, effectiveness and average cohort CD4 count at ART initiation. SMS interventions remained cost-effective in a test and treat scenario where individuals were assumed to initiate ART upon HIV detection. Conclusions: Effective SMS interventions would likely increase the efficiency of ART programs by improving HIV treatment outcomes at relatively low costs, and they could facilitate achievement of the UNAIDS goal of 90% viral suppression among those on ART by 2020. PMID:28207516

  1. Interventions aimed at improving the nursing work environment: a systematic review

    Directory of Open Access Journals (Sweden)

    Hollands Louk

    2010-04-01

    Full Text Available Abstract Background Nursing work environments (NWEs in Canada and other Western countries have increasingly received attention following years of restructuring and reported high workloads, high absenteeism, and shortages of nursing staff. Despite numerous efforts to improve NWEs, little is known about the effectiveness of interventions to improve NWEs. The aim of this study was to review systematically the scientific literature on implemented interventions aimed at improving the NWE and their effectiveness. Methods An online search of the databases CINAHL, Medline, Scopus, ABI, Academic Search Complete, HEALTHstar, ERIC, Psychinfo, and Embase, and a manual search of Emerald and Longwoods was conducted. (Quasi- experimental studies with pre/post measures of interventions aimed at improving the NWE, study populations of nurses, and quantitative outcome measures of the nursing work environment were required for inclusion. Each study was assessed for methodological strength using a quality assessment and validity tool for intervention studies. A taxonomy of NWE characteristics was developed that would allow us to identify on which part of the NWE an intervention targeted for improvement, after which the effects of the interventions were examined. Results Over 9,000 titles and abstracts were screened. Eleven controlled intervention studies met the inclusion criteria, of which eight used a quasi-experimental design and three an experimental design. In total, nine different interventions were reported in the included studies. The most effective interventions at improving the NWE were: primary nursing (two studies, the educational toolbox (one study, the individualized care and clinical supervision (one study, and the violence prevention intervention (one study. Conclusions Little is known about the effectiveness of interventions aimed at improving the NWE, and published studies on this topic show weaknesses in their design. To advance the field, we

  2. A quality improvement study using fishbone analysis and an electronic medical records intervention to improve care for children with asthma.

    Science.gov (United States)

    Gold, Jonathan; Reyes-Gastelum, David; Turner, Jane; Davies, H Dele

    2014-01-01

    Despite expert guidelines, gaps persist in quality of care for children with asthma. This study sought to identify barriers and potential interventions to improve compliance to national asthma prevention guidelines at a single academic pediatric primary care clinic. Using the plan-do-check-act (PDCA) quality improvement framework and fishbone analysis, several barriers to consistent asthma processes and possible interventions were identified by a group of key stakeholders. Two interventions were implemented using the electronic medical record (EMR). Physician documentation of asthma quality measures were analyzed before intervention and during 2 subsequent time points over 16 months. Documentation of asthma action plans (core group P asthma care in a pediatric primary care setting.

  3. Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance

    NARCIS (Netherlands)

    Berkel, J. van; Boot, C.R.L.; Proper, K.I.; Bongers, P.M.; Beek, A.J. van der

    2013-01-01

    OBJECTIVE:: To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. METHODS:: Process measures were assessed using a combination of quantitative and qualitative

  4. Changing physician behavior: interventions to improve prescription writing practices in a secondary level hospital in Delhi

    Directory of Open Access Journals (Sweden)

    Dipanweeta Routray

    2014-10-01

    Conclusion: Combining different intervention seems a noble approach to improve the prescription writing practices with respect to completeness and inclusion of generic drugs, drugs from EDL. [Int J Basic Clin Pharmacol 2014; 3(5.000: 840-844

  5. Improving the uptake of systematic reviews: a systematic review of intervention effectiveness and relevance.

    LENUS (Irish Health Repository)

    Wallace, John

    2014-01-01

    Little is known about the barriers, facilitators and interventions that impact on systematic review uptake. The objective of this study was to identify how uptake of systematic reviews can be improved.

  6. Improvement interventions: To what extent are they manifestations of social defences?

    Directory of Open Access Journals (Sweden)

    Jeremias J. de Klerk

    2012-01-01

    Full Text Available Orientation: The statistical record of change and improvement interventions to deliver on expectations is notoriously poor. Yet, new interventions are started constantly.Research purpose: The aim is to provide an explanation to the lure behind interventions and to contribute to building a theory on plausible systems psychodynamic drivers and mechanisms of recurrent change interventions.Motivation for the study: This study provides insights into social defences in ways that did not receive much attention previously; specifically how defence mechanisms act as drivers for new change and improvement interventions.Research design, approach and method: A literature study, consisting of a literature review and a phenomenological analysis. The study was conducted from the systems psychodynamic approach.Main findings: Improvement interventions often represent defences that serve to contain anxieties or maintain fantasies. Four specific themes emerged: interventions defend the perception of being in control, they maintain the fantasy that one is busy with worthy actions to overcome challenges, they are defences against boredom or contain anxieties about incompetence, and they maintain the fantasy of being heroic leaders.Practical/managerial implications: The findings can assist leaders to understand their own defences in order to avoid embarking on non-essential interventions. This can free up much time, energy and effort to spend on other priorities, assisting organisations to achieve better results.Contribution/value-add: The study refutes the notion that improvement interventions are always rational coping mechanisms and highlights the role of improvement interventions as defences to reduce anxiety, even though they may contribute little to organisational survival in real terms.

  7. Factors that influence improvement in numeracy, reading and comprehension in the context of a numeracy intervention.

    Directory of Open Access Journals (Sweden)

    Ann Dowker

    2016-12-01

    Full Text Available In a randomized controlled trial 104 primary school children, who received an individualized numeracy intervention, Catch Up Numeracy, were compared with 100 children, who received matched-time teaching, and 107, who received business-as-usual teaching. They were assessed before and after intervention, on the Number Screening Test and on both the reading and comprehension components of the Salford Sentence Reading Test. Those who received the intervention improved significantly more than the controls in numeracy but not in reading or comprehension. Numeracy, reading and comprehension scores were significantly correlated. Both reading and numeracy predicted improvement in comprehension, but only comprehension predicted improvement in reading, and neither literacy measure predicted improvement in numeracy. Children eligible for free school meals scored lower than others on all pretests and post-tests, but did not differ in their levels of improvement. Age negatively predicted improvement in reading and comprehension, but not numeracy. Gender affected comprehension but not reading or numeracy.

  8. New Directions in Social Psychological Interventions to Improve Academic Achievement

    Science.gov (United States)

    Wilson, Timothy D.; Buttrick, Nicholas R.

    2016-01-01

    Attempts to improve student achievement typically focus on changing the educational environment (e.g., better schools, better teachers) or on personal characteristics of students (e.g., intelligence, self-control). The 6 articles in this special issue showcase an additional approach, emanating from social psychology, which focuses on students'…

  9. Improving General Intelligence with a Nutrient-Based Pharmacological Intervention

    Science.gov (United States)

    Stough, Con; Camfield, David; Kure, Christina; Tarasuik, Joanne; Downey, Luke; Lloyd, Jenny; Zangara, Andrea; Scholey, Andrew; Reynolds, Josh

    2011-01-01

    Cognitive enhancing substances such as amphetamine and modafinil have become popular in recent years to improve acute cognitive performance particularly in environments in which enhanced cognition or intelligence is required. Nutraceutical nootropics, which are natural substances that have the ability to bring about acute or chronic changes in…

  10. Improving General Intelligence with a Nutrient-Based Pharmacological Intervention

    Science.gov (United States)

    Stough, Con; Camfield, David; Kure, Christina; Tarasuik, Joanne; Downey, Luke; Lloyd, Jenny; Zangara, Andrea; Scholey, Andrew; Reynolds, Josh

    2011-01-01

    Cognitive enhancing substances such as amphetamine and modafinil have become popular in recent years to improve acute cognitive performance particularly in environments in which enhanced cognition or intelligence is required. Nutraceutical nootropics, which are natural substances that have the ability to bring about acute or chronic changes in…

  11. Evaluating the effectiveness of health belief model interventions in improving adherence: a systematic review.

    Science.gov (United States)

    Jones, Christina Jane; Smith, Helen; Llewellyn, Carrie

    2014-01-01

    Lack of adherence to health-promoting advice challenges the successful prevention and management of many conditions. The Health Belief Model (HBM) was developed in 1966 to predict health-promoting behaviour and has been used in patients with wide variety of disease. The HBM has also been used to inform the development of interventions to improve health behaviours. Several reviews have documented the HBM's performance in predicting behaviour, but no review has addressed its utility in the design of interventions or the efficacy of these interventions. A systematic review was conducted to identify interventional studies which use the HBM as the theoretical basis for intervention design. The HBM has been used continuously in the development of behaviour change interventions for 40 years. Of 18 eligible studies, 14 (78%) reported significant improvements in adherence, with 7 (39%) showing moderate to large effects. However, only six studies used the HBM in its entirety and five different studies measured health beliefs as outcomes. Intervention success appeared to be unrelated to HBM construct addressed challenging the utility of this model as the theoretical basis for adherence-enhancing interventions. Interventions need to be described in full to allow for the identification of effective components and replication of studies.

  12. Internet Interventions for Improving Psychological Well-Being in Psycho-Oncology: Review and Recommendations

    Science.gov (United States)

    Leykin, Yan; Thekdi, Seema M.; Shumay, Dianne M.; Muñoz, Ricardo F.; Riba, Michelle; Dunn, Laura B.

    2011-01-01

    Objective Too few cancer patients and survivors receive evidence-based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients. Methods The authors examined available literature regarding Internet interventions tailored to cancer patients’ mental health needs, and reviewed elements of Internet interventions for mental health relevant to advancing psycho-oncology Internet intervention research. Recommendations for research methods for Internet interventions are described. Results Relatively few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventions—including intervention structure, customization, provider interaction, and privacy and confidentiality issues—are discussed. These guidelines are offered as a step toward establishing a set of “best practices” for Internet interventions in psycho-oncology, and to generate further discussion regarding the goals of such interventions and their place in cancer care. Conclusions Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. PMID:21608075

  13. Improvements in Child Behavior and Family Mealtime Environment After an Intensive Behavioral Feeding Intervention.

    Science.gov (United States)

    Seiverling, Laura; Hendy, Helen M; Yusupova, Stella

    2016-08-31

    The present study examined changes in child and family mealtime patterns before and after intensive behavioral feeding intervention at a multidisciplinary hospital-based program for 50 children. At preintervention and postintervention, caregivers completed surveys to report child feeding goals and the About Your Child's Eating scale (AYCE). In addition, at postintervention, each caregiver rated intervention effectiveness for his or her child's feeding goals identified at preintervention and provided intervention satisfaction ratings. Results revealed that caregivers perceived all three AYCE family mealtime patterns to improve from preintervention to postintervention, the majority of caregivers rated intervention as being effective for improving the specific child feeding goals identified at preintervention, and caregivers gave high satisfaction ratings for the intervention.

  14. Teachers' Perspectives on a Professional Development Intervention to Improve Science Instruction Among English Language Learners

    Science.gov (United States)

    Lee, Okhee; Adamson, Karen; Maerten-Rivera, Jaime; Lewis, Scott; Thornton, Constance; Leroy, Kathryn

    2008-02-01

    Our 5-year professional development intervention is designed to promote elementary teachers’ knowledge, beliefs, and practices in teaching science, along with English language and mathematics for English Language Learning (ELL) students in urban schools. In this study, we used an end-of-year questionnaire as a primary data source to seek teachers’ perspectives on our intervention during the first year of implementation. Teachers believed that the intervention, including curriculum materials and teacher workshops, effectively promoted students’ science learning, along with English language development and mathematics learning. Teachers highlighted strengths and areas needing improvement in the intervention. Teachers’ perspectives have been incorporated into our on-going intervention efforts and offer insights into features of effective professional development initiatives in improving science achievement for all students.

  15. [Multimodal surgical intervention to improve outcome after colon cancer].

    Science.gov (United States)

    Hohenberger, Werner; O'Connell, Ronan; Iversen, Lene Hjerrild

    2011-04-04

    Surgeons have focused their efforts towards improving outcome following surgical treatment of rectal cancer by implementation of the total mesorectal excision technique, among others. Great progress has been made, and in Denmark and Sweden survival rates for rectal cancer now exceed those for colon cancer. Recently, the significance of complete mesocolic excision in colonic cancer has been acknowledged. Treatment of colon cancer is challenging in patients with locally advanced disease, peritoneal carcinomatosis, and emergency presentation, all of which are described.

  16. Community health workers adherence to referral guidelines

    DEFF Research Database (Denmark)

    Lal, Sham; Ndyomugenyi, Richard; Paintain, Lucy;

    2016-01-01

    Background Many malaria-endemic countries have implemented national community health worker (CHW) programmes to serve remote populations that have poor access to malaria diagnosis and treatment. Despite mounting evidence of CHWs’ ability to adhere to malaria rapid diagnostic tests (RDTs...... artemisinin-based combination therapy (ACT) and recognize symptoms in children that required immediate referral to the nearest health centre. Intervention arm CHWs had additional training on how to conduct an RDT; CHWs in the control arm used a presumptive diagnosis for malaria using clinical signs...

  17. An Internet-Based Physical Activity Intervention to Improve Quality of Life of Inactive Older Adults

    DEFF Research Database (Denmark)

    Broekhuizen, Karen; de Gelder, Jelle; Wijsman, Carolien A

    2016-01-01

    BACKGROUND: Increasing physical activity is a viable strategy for improving both the health and quality of life of older adults. OBJECTIVE: The aim of this study was to assess if an Internet-based intervention aimed to increase physical activity was effective in improving quality of life...... of inactive older adults. In addition, we analyzed the effect of the intervention on quality of life among those participants who successfully reached their individually targeted increase in daily physical activity as indicated by the intervention program, as well as the dose-response effect of increasing......-worn triaxial accelerometer, respectively. RESULTS: After 3 months, a significant improvement in quality of life was seen in the intervention group compared to the control group for RAND-36 subscales on emotional and mental health (2.52 vs -0.72, respectively; P=.03) and health change (8.99 vs 2...

  18. Improving surgical site infection prevention practices through a multifaceted educational intervention.

    LENUS (Irish Health Repository)

    Owens, P

    2015-03-01

    As part of the National Clinical Programme on healthcare-associated infection prevention, a Royal College of Surgeons in Ireland (RCSI) and Royal College of Physicians of Ireland (RCPI) working group developed a quality improvement tool for prevention of surgical site infection (SS). We aimed to validate the effectiveness of an educational campaign, which utilises this quality improvement tool to prevent SSI in a tertiary hospital. Prior to the SSI educational campaign, surgical patients were prospectively audited and details of antibiotic administration recorded. Prophylactic antibiotic administration recommendations were delivered via poster and educational presentations. Post-intervention, the audit was repeated. 50 patients were audited pre-intervention, 45 post-intervention. Post-intervention, prophylaxis within 60 minutes prior to incision increased from 54% to 68% (p = 0.266). Appropriate postoperative prescribing improved from 71% to 92% (p = 0.075). A multifaceted educational program may be effective in changing SSI prevention practices.

  19. Are parenting interventions effective in improving the relationship between mothers and their preterm infants?

    Science.gov (United States)

    Evans, Tracey; Whittingham, Koa; Sanders, Matthew; Colditz, Paul; Boyd, Roslyn N

    2014-05-01

    To systematically review the efficacy of parenting interventions in improving the quality of the relationship between mothers and preterm infants. Randomized or quasi-randomized controlled trials (RCT) of parenting interventions for mothers of preterm infants where mother-infant relationship quality outcomes were reported. Databases searched: The Cochrane Library, PubMed, CINAHL, PsycINFO and Web of Science. Seventeen studies met the inclusion criteria, 14 with strong methodological quality. Eight parenting interventions were found to improve the quality of the mother-preterm infant relationship. Heterogeneity of the interventions calls for an integrated new parenting program focusing on cue-based, responsive care from the mother to her preterm infant to improve the quality of the relationship for these mother-preterm infant dyads. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. [Recruiting and Personal Development in Surgical Departments of Large Referral Centers - Current Practice and Options for Improvement from Industry and Service Business].

    Science.gov (United States)

    Homayounfar, K; König, S; Rabe, C; Beck-Broichsitter, B; Lützen, U; Ghadimi, M B; Schmidt, C

    2016-06-23

    Background: Cut-throat competition, cost pressure, generation Y, shortage of qualified staff and feminisation influence human resources management in visceral surgery. The assessment of the current situation by chief surgeons (CS) as well as proof of transferability of strategies from industry and service business (ISB) have not yet been investigated. Material and Methods: The CS of university hospitals and large referral centres (> 800 beds) were interviewed (n = 100) on the basis of a standardised questionnaire including 43 items. Closed questions were designed with a 5-point Likert scale and their analysis was presented as means (MW) and standard deviations (±). Ten human resources manager (HMR) of ISB were invited to participate in 45-minute telephone interviews. Results: Thirty-seven CS participated in the survey, 15 of whom were full professors. Unsolicited applications (100 %), job advertisements (78 %) and direct approaches to final year students (78 %) were the most common ways of recruitment. Only 17 % of CS used a standardised form for preparation. Professional expertise (MW 2.2 ± 0.9), social skills (MW 1.9 ± 0.6) and excellent German language skills (MW 1.8 ± 0.8) were named as important qualifications for employment, while references and certificates were regarded as being less important (MW 3.2 ± 0.9). Personal development was regarded as important (MW 1.1 ± 0.2), but a defined period for residency was not guaranteed (MW 3.0 ± 1.5). Transparent selection criteria for career opportunities (MW 2.5 ± 1.1) and different career models (MW 2.7 ± 1.2) were only rarely available. Six HRM participated in the interviews. Active head-hunting (75 %), Internet platforms (75 %), presentations at conferences (75 %), as well as hiring trainees (50 %), job advertisements (50 %) and social media (50 %) were established options to find qualified employees. Professional and management careers were often

  1. Teamwork, communication and safety climate: a systematic review of interventions to improve surgical culture.

    Science.gov (United States)

    Sacks, Greg D; Shannon, Evan M; Dawes, Aaron J; Rollo, Johnathon C; Nguyen, David K; Russell, Marcia M; Ko, Clifford Y; Maggard-Gibbons, Melinda A

    2015-07-01

    To define the target domains of culture-improvement interventions, to assess the impact of these interventions on surgical culture and to determine whether culture improvements lead to better patient outcomes and improved healthcare efficiency. Healthcare systems are investing considerable resources in improving workplace culture. It remains unclear whether these interventions, when aimed at surgical care, are successful and whether they are associated with changes in patient outcomes. PubMed, Cochrane, Web of Science and Scopus databases were searched from January 1980 to January 2015. We included studies on interventions that aimed to improve surgical culture, defined as the interpersonal, social and organisational factors that affect the healthcare environment and patient care. The quality of studies was assessed using an adapted tool to focus the review on higher-quality studies. Due to study heterogeneity, findings were narratively reviewed. The 47 studies meeting inclusion criteria (4 randomised trials and 10 moderate-quality observational studies) reported on interventions that targeted three domains of culture: teamwork (n=28), communication (n=26) and safety climate (n=19); several targeted more than one domain. All moderate-quality studies showed improvements in at least one of these domains. Two studies also demonstrated improvements in patient outcomes, such as reduced postoperative complications and even reduced postoperative mortality (absolute risk reduction 1.7%). Two studies reported improvements in healthcare efficiency, including fewer operating room delays. These findings were supported by similar results from low-quality studies. The literature provides promising evidence for various strategies to improve surgical culture, although these approaches differ in terms of the interventions employed as well as the techniques used to measure culture. Nevertheless, culture improvement appears to be associated with other positive effects, including

  2. Evaluation of Effectiveness of Integrated Intervention Program in Improving Drug Addicts' Psychological Health1

    Institute of Scientific and Technical Information of China (English)

    YA-QIONG YAN; YONG-YOU LIU; YUE-FENG ZENG; YI-WEI CUI; JI-WEI LEI; ZENG-ZHEN WANG

    2008-01-01

    Objective To investigate the social mental state of drug addicts in a compulsive drug abuse treatment center;evaluate the effectiveness of integrated program for the prevention of abuse relapse and improvement of drug addicts' psychological health.Methods The study subjects were addicts from the Wuhan Compulsive Drug Abuse Treatment Center between October 2003 and June 2004,who satisfied the inclusion criteria.A non-randomized control-intervention study design was adopted.Volunteers willing to take part in intervention were put into the intervention group with their full awareness and willingness to prevent drug abuse relapse.The control group was composed of the addicts who were willing to prevent relapse and to be followed up after their discharge. Results The effectiveness of the integrated intervention program in promoting addicts' psychological health:before the intervention,the scores of Self-Rating Anxiety Scale(SAS),the positive and negative dimensionalities of Simple Coping Style Questionnaire(SCSQ)and Chinese Perceived Stress Scales(CPSS)had no significant differences between the intervention group and the control group.After the intervention,exccpt that the SCSQ's positive dimensionality in the intervention group was significantly higher than that in the control group,other indices in the intervention group were lower.Before and after the intervention.the psychological health level in both the groups was lower than that in the normal population;there were significant differences between addicts and normal subjects in regards with all of the indices above. Conclusion Drug abuse was associated closely with addicts' social mental factors.The integrated intervention program can alleviate anxiety and stress,reduce co-morbid mental disorders and effectively improve their coping style.In conclusion,the program can promote addicts' psychological health significantly.

  3. Implementing referral guidelines: lessons from a negative outcome cluster randomised factorial trial in general practice

    Directory of Open Access Journals (Sweden)

    Shaw Lindsey

    2006-11-01

    Full Text Available Abstract Background Few patients with lower bowel symptoms who consult their general practitioner need a specialist opinion. However data from referred patients suggest that those who are referred would benefit from detailed assessment before referral. Methods A cluster randomised factorial trial. 44 general practices in North Trent, UK. Practices were offered either an electronic interactive referral pro forma, an educational outreach visit by a local colorectal surgeon, both or neither. The main outcome measure was the proportion of cases with severe diverticular disease, cancer or precancerous lesions and inflammatory bowel disease in those referred by each group. A secondary outcome was a referral letter quality score. Semi-structured interviews were conducted to identify key themes relating to the use of the software Results From 150 invitations, 44 practices were recruited with a total list size of 265,707. There were 716 consecutive referrals recorded over a six-month period, for which a diagnosis was available for 514. In the combined software arms 14% (37/261 had significant pathology, compared with 19% (49/253 in the non-software arms, relative risk 0.73 (95% CI: 0.46 to 1.15. In the combined educational outreach arms 15% (38/258 had significant pathology compared with 19% (48/256 in the non-educational arms, relative risk 0.79 (95% CI: 0.50 to 1.24. Pro forma practices documented better assessment of patients at referral. Conclusion There was a lack of evidence that either intervention increased the proportion of patients with organic pathology among those referred. The interactive software did improve the amount of information relayed in referral letters although we were unable to confirm if this made a significant difference to patients or their health care providers. The potential value of either intervention may have been diminished by their limited uptake within the context of a cluster randomised clinical trial. A number of

  4. Does an educational intervention improve parents' knowledge about immunization? Experience from Malaysia.

    Science.gov (United States)

    Awadh, Ammar Ihsan; Hassali, Mohamed Azmi; Al-Lela, Omer Qutaiba; Bux, Siti Halimah; Elkalmi, Ramadan M; Hadi, Hazrina

    2014-10-06

    Parents' knowledge about immunization is an important predictor factor for their children's immunization status. The aims of this study were to assess parents' knowledge and to evaluate the effect of a short educational intervention on improving parents' knowledge of childhood immunization. A cross-sectional study using a pre- and post-test intervention survey of a single group was conducted among Malaysian parents. Changes in total knowledge score before and after the intervention were measured using a validated questionnaire. The intervention consisted of an animated movie and lecture using simple understandable language. Wilcoxon signed ranks test and the McNemar x2 test were applied to compare the differences in knowledge before and after the intervention. Seventy-three parents were enrolled in this study; the majority were mothers (n = 64, 87.7%). Parents' knowledge about childhood immunization increased significantly after the intervention compared to the baseline results (p educational level and monthly income (p educational intervention designed for parents had a positive effect on their knowledge about immunization. Educational interventions targeting parents with low levels of education and income are needed. Further studies investigating the actual effectiveness of such interventions on immunization rates and statuses are required.

  5. A brief social-belonging intervention improves academic and health outcomes of minority students.

    Science.gov (United States)

    Walton, Gregory M; Cohen, Geoffrey L

    2011-03-18

    A brief intervention aimed at buttressing college freshmen's sense of social belonging in school was tested in a randomized controlled trial (N = 92), and its academic and health-related consequences over 3 years are reported. The intervention aimed to lessen psychological perceptions of threat on campus by framing social adversity as common and transient. It used subtle attitude-change strategies to lead participants to self-generate the intervention message. The intervention was expected to be particularly beneficial to African-American students (N = 49), a stereotyped and socially marginalized group in academics, and less so to European-American students (N = 43). Consistent with these expectations, over the 3-year observation period the intervention raised African Americans' grade-point average (GPA) relative to multiple control groups and halved the minority achievement gap. This performance boost was mediated by the effect of the intervention on subjective construal: It prevented students from seeing adversity on campus as an indictment of their belonging. Additionally, the intervention improved African Americans' self-reported health and well-being and reduced their reported number of doctor visits 3 years postintervention. Senior-year surveys indicated no awareness among participants of the intervention's impact. The results suggest that social belonging is a psychological lever where targeted intervention can have broad consequences that lessen inequalities in achievement and health.

  6. Improving Care for Patients With or at Risk for Chronic Kidney Disease Using Electronic Medical Record Interventions: A Pragmatic Cluster-Randomized Trial Protocol

    Directory of Open Access Journals (Sweden)

    Danielle M. Nash

    2017-04-01

    Full Text Available Background: Many patients with or at risk for chronic kidney disease (CKD in the primary care setting are not receiving recommended care. Objective: The objective of this study is to determine whether a multifaceted, low-cost intervention compared with usual care improves the care of patients with or at risk for CKD in the primary care setting. Design: A pragmatic cluster-randomized trial, with an embedded qualitative process evaluation, will be conducted. Setting: The study population comes from the Electronic Medical Record Administrative data Linked Database®, which includes clinical data for more than 140 000 rostered adults cared for by 194 family physicians in 34 clinics across Ontario, Canada. The 34 primary care clinics will be randomized to the intervention or control group. Intervention: The intervention group will receive resources from the “CKD toolkit” to help improve care including practice audit and feedback, printed educational materials for physicians and patients, electronic decision support and reminders, and implementation support. Measurements: Patients with or at risk for CKD within participating clinics will be identified using laboratory data in the electronic medical records. Outcomes will be assessed after dissemination of the CKD tools and after 2 rounds of feedback on performance on quality indicators have been sent to the physicians using information from the electronic medical records. The primary outcome is the proportion of patients aged 50 to 80 years with nondialysis-dependent CKD who are on a statin. Secondary outcomes include process of care measures such as screening tests, CKD recognition, monitoring tests, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker prescriptions, blood pressure targets met, and nephrologist referral. Hierarchical analytic modeling will be performed to account for clustering. Semistructured interviews will be conducted with a random purposeful sample of

  7. Evaluation of the ACT intervention to improve nurses' cardiac triage decisions.

    Science.gov (United States)

    Arslanian-Engoren, Cynthia; Hagerty, Bonnie; Eagle, Kim A

    2010-10-01

    Emergency department (ED) nurses are in a key position to initiate life-saving recommendations for myocardial infarction, which include a physician-read electrocardiogram (ECG) within 10 min of ED arrival. Using a quasi-experimental, one-group pretest-posttest design, the authors evaluated the preliminary effectiveness of the Aid to Cardiac Triage (ACT) intervention to improve ED nurses' cardiac triage decisions. Charts of all women who received an ED ECG 3 months before ( n = 171) and after (n = 184) the intervention and who were at least 18 years of age were reviewed. A 1-hr educational session was conducted to improve nurses' (n = 23) cardiac triage decisions. Postintervention, the proportion of women receiving an ECG within 10 min of ED arrival improved, as did the odds of women receiving a timely ECG. Preliminary evaluation of the ACT intervention indicates its effectiveness at improving ED nurses' cardiac triage decisions and obtaining a 10-min physician-read ECG.

  8. Nurse's Desk: food bank-based outreach and screening to decrease unmet referral needs.

    Science.gov (United States)

    Larsson, Laura S; Kuster, Emilie

    2013-01-01

    The Nurse's Desk health screening project used the Intervention Wheel model to conduct outreach, screening, education, and referral for food bank clients (n = 506). Blood glucose, blood pressure, health care utilization, and unmet referral needs were assessed. Screening results identified 318 clients (62.8%) with 1 or more unmet referral needs, including 6 clients (3.16%) with capillary blood glucose more than 199 mg/dL and 132 (31.9%) with hypertension. Clients had higher-than-average systolic and diastolic blood pressures and undiagnosed diabetes than in the general population. A client-approved method for tracking completed referrals is needed for this potentially high-risk population.

  9. Do ergonomics improvements increase computer workers' productivity?: an intervention study in a call centre.

    Science.gov (United States)

    Smith, Michael J; Bayehi, Antoinette Derjani

    2003-01-15

    This paper examines whether improving physical ergonomics working conditions affects worker productivity in a call centre with computer-intensive work. A field study was conducted at a catalogue retail service organization to explore the impact of ergonomics improvements on worker production. There were three levels of ergonomics interventions, each adding incrementally to the previous one. The first level was ergonomics training for all computer users accompanied by workstation ergonomics analysis leading to specific customized adjustments to better fit each worker (Group C). The second level added specific workstation accessories to improve the worker fit if the ergonomics analysis indicated a need for them (Group B). The third level met Group B requirements plus an improved chair (Group A). Productivity data was gathered from 72 volunteer participants who received ergonomics improvements to their workstations and 370 control subjects working in the same departments. Daily company records of production outputs for each worker were taken before ergonomics intervention (baseline) and 12 months after ergonomics intervention. Productivity improvement from baseline to 12 months post-intervention was examined across all ergonomics conditions combined, and also compared to the control group. The findings showed that worker performance increased for 50% of the ergonomics improvement participants and decreased for 50%. Overall, there was a 4.87% output increase for the ergonomics improvement group as compared to a 3.46% output decrease for the control group. The level of productivity increase varied by the type of the ergonomics improvements with Group C showing the best improvement (9.43%). Even though the average production improved, caution must be used in interpreting the findings since the ergonomics interventions were not successful for one-half of the participants.

  10. Direct interventions for improving the performance of individuals with Alzheimer's disease.

    Science.gov (United States)

    Mahendra, N

    2001-11-01

    Direct interventions are being used increasingly to maintain and improve the communicative and cognitive functioning of patients with Alzheimer's dementia. Speech-language pathologists can play an integral role in maximizing the functioning of dementia patients by selecting appropriate direct interventions that capitalize on spared neuropsychological abilities to compensate for impaired abilities. Successful direct interventions use techniques that facilitate learning and retention of information and skills. In this article, direct intervention techniques-repeated exposure via spaced retrieval training and quizzes; errorless learning; multisensory stimulation using music, toys, pets, and memory wallets; and other approaches to cognitive-linguistic stimulation such as the use of personal computers; the Montessori method; and activity programming-are reviewed. The rationale for use of these direct interventions and available efficacy data with Alzheimer's patients also are presented.

  11. How to design and evaluate interventions to improve outcomes for patients with multimorbidity

    Directory of Open Access Journals (Sweden)

    Susan M. Smith

    2013-10-01

    Full Text Available Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems.

  12. Diabetes patient at risk score - a novel system for triaging appropriate referrals of inpatients with diabetes to the diabetes team.

    Science.gov (United States)

    Rajendran, Rajesh; Round, Rachael-Marie; Kerry, Christopher; Barker, Sarah; Rayman, Gerry

    2015-06-01

    The acceptability, uptake and effectiveness of a new referral tool - the diabetes patient at risk (DPAR) score - were evaluated and the timeliness of review of referred inpatients by the diabetes team was measured. For this, a snapshot survey of ward healthcare professionals (HCPs) and a review of all DPAR referrals to the diabetes team between 1 September 2013 and 31 January 2014 were undertaken. All referrals in November 2013 were audited for timeliness of review. 77% of HCPs agreed/strongly agreed that the tool improved access to the diabetes team. 76% of referrals were from nurses. 80% of who should have been referred were referred; the remaining had already been reviewed by the diabetes team and therefore did not require referral. Only 11% of referrals were inappropriate. All DPAR referrals were reviewed within the stipulated time period in November 2013. Overall, the DPAR system was well accepted, successfully identified appropriate referrals and facilitated referrals in a timely manner to the diabetes team.

  13. The current state of electronic consultation and electronic referral systems in Canada: an environmental scan.

    Science.gov (United States)

    Liddy, Clare; Hogel, Matthew; Blazkho, Valerie; Keely, Erin

    2015-01-01

    Access to specialist care is a point of concern for patients, primary care providers, and specialists in Canada. Innovative e-health platforms such as electronic consultation (eConsultation) and referral (eReferral) can improve access to specialist care. These systems allow physicians to communicate asynchronously and could reduce the number of unnecessary referrals that clog wait lists, provide a record of the patient's journey through the referral system, and lead to more efficient visits. Little is known about the current state of eConsultation and eReferral in Canada. The purpose of this work was to identify current systems and gain insight into the design and implementation process of existing systems. An environmental scan approach was used, consisting of a systematic and grey literature review, and targeted semi-structured key informant interviews. Only three eConsultation/eReferral systems are currently in operation in Canada. Four themes emerged from the interviews: eReferral is an end goal for those provinces without an active eReferral system, re-organization of the referral process is a necessity prior to automation, engaging the end-user is essential, and technological incompatibilities are major impediments to progress. Despite the acknowledged need to improve the referral system and increase government spending on health information technology, eConsultation and eReferral systems remain scarce as Canada lags behind the rest of the developed world.

  14. Effectiveness of training intervention to improve medical student's information literacy skills.

    Science.gov (United States)

    Abdekhoda, Mohammadhiwa; Dehnad, Afsaneh; Yousefi, Mahmood

    2016-12-01

    This study aimed to assess the efficiency of delivering a 4-month course of "effective literature search" among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students' attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student's attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students' familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students' competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students' ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student's information literacy skills.

  15. Effectiveness of training intervention to improve medical student’s information literacy skills

    Science.gov (United States)

    2016-01-01

    This study aimed to assess the efficiency of delivering a 4-month course of “effective literature search” among medical postgraduate students for improving information literacy skills. This was a cross-sectional study in which 90 postgraduate students were randomly selected and participated in 12 training sessions. Effective search strategies were presented and the students’ attitude and competency concerning online search were measured by a pre- and post-questionnaires and skill tests. Data were analyzed by SPSS version 16 using t-test. There was a significant improvement (p=0.00), in student’s attitude. The mean (standard deviation [SD]) was 2.9 (0.8) before intervention versus the mean (SD) 3.9 (0.7) after intervention. Students’ familiarity with medical resources and databases improved significantly. The data showed a significant increase (p=0.03), in students’ competency score concerning search strategy design and conducting a search. The mean (SD) was 2.04 (0.7) before intervention versus the mean (SD) 3.07 (0.8) after intervention. Also, students’ ability in applying search and meta search engine improved significantly. This study clearly acknowledges that the training intervention provides considerable opportunity to improve medical student’s information literacy skills. PMID:27907985

  16. Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review

    Science.gov (United States)

    LaMantia, Michael A.; Scheunemann, Leslie P.; Viera, Anthony J.; Busby-Whitehead, Jan; Hanson, Laura C.

    2015-01-01

    Transitions between health care settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. We conducted a systematic review to identify and evaluate interventions which seek to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. We searched MEDLINE, ISI Web, and EBSCO Host (from inception to June 2008) for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives; two described interventions that improved communication of medication lists; and one intervention addressed both goals. One study was a randomized controlled trial, while remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists, and pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. While preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high quality transitional care. PMID:20398162

  17. FTO Genotype Interacts with Improvement in Aerobic Fitness on Body Weight Loss During Lifestyle Intervention

    Directory of Open Access Journals (Sweden)

    Corinna Sailer

    2016-06-01

    Full Text Available Objective: Not every participant responds with a comparable body weight loss to lifestyle intervention, despite the same compliance. Genetic factors may explain parts of this difference. Variation in fat mass and obesity-associated gene (FTO is the strongest common genetic determinant of body weight. The aim of the present study was to evaluate the impact of FTO genotype differences in the link between improvement of fitness and reduction of body weight during a lifestyle intervention. Methods: We genotyped 292 healthy subjects for FTO rs8050136. Participants underwent a 9-month lifestyle intervention. Before and after intervention, aerobic fitness was tested by bicycle (VO2max and treadmill spiroergometry (individual anaerobic threshold (IAT, subgroup of N = 192. Results: Participants lost body weight (p FTO genotype (p = 0.5. There was a significant correlation between improvement in VO2max and decrease in body weight (p FTO genotype interacted with this relationship (p = 0.0042 for VO2max, p = 0.0049 for IAT. When stratifying the cohort according to their improvement in VO2max, FTO obesity-risk A-allele carriers in the higher quartiles of improvement in fitness lost significantly less body weight. Conclusions: Our data reveal that genetic variation in FTO impacts on body weight reduction during lifestyle intervention only in subjects with marked improvement in aerobic fitness.

  18. Early signaling, referral, and treatment of adolescent chronic pain: a study protocol

    Directory of Open Access Journals (Sweden)

    Voerman Jessica S

    2012-06-01

    Full Text Available Abstract Background Chronic pain is prevalent among young people and negatively influences their quality of life. Furthermore, chronic pain in adolescence may persist into adulthood. Therefore, it is important early on to promote the self-management skills of adolescents with chronic pain by improving signaling, referral, and treatment of these youngsters. In this study protocol we describe the designs of two complementary studies: a signaling study and an intervention study. Methods and design The signaling study evaluates the Pain Barometer, a self-assessed signaling instrument for chronic pain in adolescents. To evaluate the feasibility of the Pain Barometer, the experiences of youth-health care nurses will be evaluated in semi-structured interviews. Also, we will explore the frequencies of referral per health-care provider. The intervention study evaluates Move It Now, a guided self-help intervention via the Internet for teenagers with chronic pain. This intervention uses cognitive behavioural techniques, including relaxation exercises and positive thinking. The objective of the intervention is to improve the ability of adolescents to cope with pain. The efficacy of Move It Now will be examined in a randomized controlled trial, in which 60 adolescents will be randomly assigned to an experimental condition or a waiting list control condition. Discussion If the Pain Barometer is proven to be feasible and Move It Now appears to be efficacious, a health care pathway can be created to provide the best tailored treatment promptly to adolescents with chronic pain. Move It Now can be easily implemented throughout the Netherlands, as the intervention is Internet based. Trial registration Dutch Trial Register NTR1926

  19. Effectiveness of pharmacy interventions in improving availability of essential medicines at the primary healthcare level.

    Science.gov (United States)

    Nunan, Michael; Duke, Trevor

    2011-05-01

    To assess the effectiveness of pharmaceutical systems interventions in improving the availability of essential medicines at the primary care level. Literature search for examples of pharmaceutical systems interventions in low and middle income countries that evaluated the impact of specific interventions on medicines' availability. Qualitative and quantitative studies were included. Seventeen studies were included, on privatisation of drug distribution, user-fees, revolving drug funds (RDFs), supervisory visitation programmes, staff training initiatives, community-directed interventions (CDIs) and disease-specific drug programmes. We found no studies on non-monetary staff incentives or the use of national pharmacy standards. Generally, the quantity and quality of evidence was low; evidence was strongest for supervisory visitation programmes and CDIs. Several interventions have the potential for improving medicines' availability without requiring large-scale international cooperation or global policy change. The absence of evidence in this field does not prove lack of effect. There is a need for more systematic studies of multi-faceted pharmaceutical interventions to improve drug availability in the context of difficult health systems, such as structured supervision of remote health facilities, CDIs, staff training, integration of disease-specific programmes, implementation of national pharmacy standards, non-monetary staff incentives and measures to ensure cost is not a barrier to access. A standardised approach to measuring the availability of essential medicines is needed. © 2011 Blackwell Publishing Ltd.

  20. Emergency department-based interventions for women suffering domestic abuse: a critical literature review.

    Science.gov (United States)

    Ansari, Sereena; Boyle, Adrian

    2017-02-01

    Domestic abuse represents a serious public health and human rights concern. Interventions to reduce the risk of abuse include staff training and standardized documentation improving detection and adherence to referral pathways. Interventional studies have been conducted in primary care, maternity and outpatient settings. Women disclosing abuse in emergency departments differ from women attending other healthcare settings, and it is unclear whether these interventions can be transferred to the emergency care setting. This review examines interventional studies to evaluate the effectiveness of emergency department-based interventions in reducing domestic abuse-related morbidity. Medline, EMBASE, CINAHL, PsycINFO and Cochrane Library were searched, according to prespecified selection criteria. Study quality was assessed using the Jadad scale. Of 273 search results, nine were eligible for review. Interventions involving staff training demonstrated benefits in subjective measures, such as staff knowledge regarding abuse, but no changes in clinical practice, based on detection and referral rates. When staff training was implemented in conjunction with supporting system changes - for example, standardized documentation for assessment and referral - clinically relevant improvements were noted. Interventions centred around staff training are insufficient to bring about improvements in the management and, thus, outcome of patients suffering abuse. Instead, system changes, such as standardized documentation and referral pathways, supported by training, may bring about beneficial changes. It remains uncertain whether surrogate outcomes employed by most studies translate to changes in abuse-related morbidity: the ultimate goal.

  1. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis.

    Science.gov (United States)

    Lee, Jennifer E; Bisht, Babita; Hall, Michael J; Rubenstein, Linda M; Louison, Rebecca; Klein, Danielle T; Wahls, Terry L

    2017-01-01

    The objective of this study was to examine whether participation in a 12-month multimodal intervention would improve mood and cognitive function in adults with progressive multiple sclerosis (MS). In this one-arm, open-label feasibility trial, participants were prescribed a home-based multimodal intervention, including (1) a modified Paleolithic diet; (2) an exercise program (stretching and strengthening of the trunk and lower limb muscles); (3) neuromuscular electrical stimulation (EStim) of trunk and lower limb muscles; and (4) stress management (meditation and self-massage). Individuals completed measures of mood (Beck Anxiety and Depression Inventories) and cognitive (Cognitive Stability Index, Cognitive Screening Test, Delis-Kaplan Executive Function System) and executive function (Wechsler Adult Intelligence Scale) at baseline and 3, 6, 9, and 12 months after the start of the intervention. Dosage of the multimodal intervention was assessed at 3, 6, 9, and 12 months. The more individuals participated in the intervention activities, the greater improvements they had from baseline to 12 months on self-report measures of anxiety (Beck Anxiety Inventory [BAI]; ps = 0.001 to 0.02), depression (Beck Depression Inventory [BDI]; ps = Paleolithic diet than to exercise and stress management dosage. Anxiety and depression changes were evident after just a few months, whereas changes in cognitive function were generally not observed until later in the intervention period. Mood and cognitive function changes from baseline to 12 months were significantly associated with fatigue improvements (ps = Paleolithic diet, exercise, EStim, and stress management intervention like this one has the potential to improve the mood and cognitive symptoms that can lead to considerable suffering in people with MS, potentially improving quality of life and function for people with progressive MS.

  2. Efficacy of interventions to improve sleep quality among patients with breast cancer : a systematic review

    OpenAIRE

    Li, Xueqi; 李雪琪

    2015-01-01

    Introduction: Breast cancer is the most common cancer in women. While advances in therapeutic approaches have improved the survival of breast cancer patients, it is important to improve the quality of life among the cancer survivors. Sleep disturbance is one of the most important problems for breast cancer patients that substantially reduced their quality of life. Many interventions have been developed for improving sleep quality for breast cancer patients. The aim of this review is firstly t...

  3. Health system and community level interventions for improving antenatal care coverage and health outcomes

    Science.gov (United States)

    Mbuagbaw, Lawrence; Medley, Nancy; Darzi, Andrea J; Richardson, Marty; Habiba Garga, Kesso; Ongolo-Zogo, Pierre

    2015-01-01

    Background The World Health Organization (WHO) recommends at least four antenatal care (ANC) visits for all pregnant women. Almost half of pregnant women worldwide, and especially in developing countries do not receive this amount of care. Poor attendance of ANC is associated with delivery of low birthweight babies and more neonatal deaths. ANC may include education on nutrition, potential problems with pregnancy or childbirth, child care and prevention or detection of disease during pregnancy. This review focused on community-based interventions and health systems-related interventions. Objectives To assess the effects of health system and community interventions for improving coverage of antenatal care and other perinatal health outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (7 June 2015) and reference lists of retrieved studies. Selection criteria We included randomised controlled trials (RCTs), quasi-randomised trials and cluster-randomised trials. Trials of any interventions to improve ANC coverage were eligible for inclusion. Trials were also eligible if they targeted specific and related outcomes, such as maternal or perinatal death, but also reported ANC coverage. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Main results We included 34 trials involving approximately 400,000 women. Some trials tested community-based interventions to improve uptake of antenatal care (media campaigns, education or financial incentives for pregnant women), while other trials looked at health systems interventions (home visits for pregnant women or equipment for clinics). Most trials took place in low- and middle-income countries, and 29 of the 34 trials used a cluster-randomised design. We assessed 30 of the 34 trials as of low or unclear overall risk of bias. Comparison 1: One intervention versus no intervention We

  4. Improving safety culture on adult medical units through multidisciplinary teamwork and communication interventions: the TOPS Project.

    Science.gov (United States)

    Blegen, M A; Sehgal, N L; Alldredge, B K; Gearhart, S; Auerbach, A A; Wachter, R M

    2010-08-01

    The goal of this project was to improve unit-based safety culture through implementation of a multidisciplinary (pharmacy, nursing, medicine) teamwork and communication intervention. The Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture was used to determine the impact of the training with a before-after design. Surveys were returned from 454 healthcare staff before the training and 368 staff 1 year later. Five of eleven safety culture subscales showed significant improvement. Nurses perceived a stronger safety culture than physicians or pharmacists. While it is difficult to isolate the effects of the team training intervention from other events occurring during the year between training and postevaluation, overall the intervention seems to have improved the safety culture on these medical units.

  5. Evaluating the Effectiveness of an Educational Intervention to Improve the Patient Safety Attitudes of Intern Pharmacists

    Science.gov (United States)

    Fois, Romano A.; McLachlan, Andrew J.; Chen, Timothy F.

    2017-01-01

    Objective. To evaluate the effectiveness of a face-to-face educational intervention in improving the patient safety attitudes of intern pharmacists. Methods. A patient safety education program was delivered to intern pharmacists undertaking The University of Sydney Intern Training Program in 2014. Their patient safety attitudes were evaluated immediately prior to, immediately after, and three-months post-intervention. Underlying attitudinal factors were identified using exploratory factor analysis. Changes in factor scores were examined using analysis of variance. Results. Of the 120 interns enrolled, 95 (78.7%) completed all three surveys. Four underlying attitudinal factors were identified: attitudes towards addressing errors, questioning behaviors, blaming individuals, and reporting errors. Improvements in all attitudinal factors were evident immediately after the intervention. However, only improvements in attitudes towards blaming individuals involved in errors were sustained at three months post-intervention. Conclusion. The educational intervention was associated with short-term improvements in pharmacist interns’ patient safety attitudes. However, other factors likely influenced their attitudes in the longer term. PMID:28289295

  6. [An intervention program to improve the quality of the medical records in an Internal Medicine Department].

    Science.gov (United States)

    Wikman, A; Safont, P; Merino, J; Martínez Baltanás, A; Matarranz Del Amo, M; López Calleja, E

    2009-09-01

    The medical records are key documents for the patient's diagnosis, treatment and follow-up. Thus, the clinical histories must be made with high technical quality. Although some studies relate the quality of the clinical history with better control of a disease, as far as we know, there are few that evaluate the quality of the medical record itself. This study aims to analyze the quality of the clinical histories of our Internal Medicine Department and then evaluate the improvement achieved. A descriptive and intervention study with a before and after design was conducted. It included 186 medical records elaborated by the physicians of our Internal Medicine Department. A 16-item Likert-like scale was designed for the evaluation. The items were analyzed item by item and a score combining them was elaborated. A baseline analysis and a second analysis 3 months after making several interventions were made. Weak points were detected in the baseline analysis (described) and after the interventions. There was an improvement in almost all the items, this being very significant in the recording of allergies and habits. The global score also improved significantly. CONCLUSION. The study has allowed us to learn our weak points in the elaboration of the medical records. We have improved their quality with the interventions. We estimate that this intervention has also been useful for the training of internal medicine physicians, residents and students.

  7. Evaluating the Effectiveness of an Educational Intervention to Improve the Patient Safety Attitudes of Intern Pharmacists.

    Science.gov (United States)

    Walpola, Ramesh L; Fois, Romano A; McLachlan, Andrew J; Chen, Timothy F

    2017-02-25

    Objective. To evaluate the effectiveness of a face-to-face educational intervention in improving the patient safety attitudes of intern pharmacists. Methods. A patient safety education program was delivered to intern pharmacists undertaking The University of Sydney Intern Training Program in 2014. Their patient safety attitudes were evaluated immediately prior to, immediately after, and three-months post-intervention. Underlying attitudinal factors were identified using exploratory factor analysis. Changes in factor scores were examined using analysis of variance. Results. Of the 120 interns enrolled, 95 (78.7%) completed all three surveys. Four underlying attitudinal factors were identified: attitudes towards addressing errors, questioning behaviors, blaming individuals, and reporting errors. Improvements in all attitudinal factors were evident immediately after the intervention. However, only improvements in attitudes towards blaming individuals involved in errors were sustained at three months post-intervention. Conclusion. The educational intervention was associated with short-term improvements in pharmacist interns' patient safety attitudes. However, other factors likely influenced their attitudes in the longer term.

  8. Improving self-esteem in women diagnosed with Turner syndrome: results of a pilot intervention.

    Science.gov (United States)

    Chadwick, Paul M; Smyth, Arlene; Liao, Lih-Mei

    2014-06-01

    To evaluate a brief intervention to improve the self esteem of women diagnosed with Turner syndrome (TS). Prospective observational study. Turner Syndrome Support Society, UK. 30 women aged 18-60 years. A 1-day psychology workshop targeting problems of self-esteem in women diagnosed with TS. The workshop drew on cognitive-behavioral therapy and narrative therapy skills and emphasized increased self-awareness of interpersonal difficulties and improved capacity for self-management. Rosenberg Self-esteem Scale (RSS); Hospital Anxiety and Depression Scale (HADS); bespoke user experiences questionnaire. All 30 women provided baseline data, 27/30 provided immediate post-intervention data and 22/30 provided follow-up data at 3 months. The intervention improved RSS and HADS scores at 3 months. Generic skills-based psychological interventions have the potential to be adapted to provide brief and low-cost interventions to improve self-esteem and reduce psychological distress in women diagnosed with TS. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  9. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.

    Science.gov (United States)

    McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken

    2010-11-02

    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. Interrupted time series. The emergency general surgery ward of a university hospital in the United Kingdom. Seven safety relevant care processes. A Lean intervention targeting five of the seven care processes relevant to patient safety. 969 patients were admitted during the four month study period before the introduction of the Lean intervention (May to August 2007), and 1114 were admitted during the four month period after completion of the intervention (May to August 2008). Compliance with the five process measures targeted for Lean intervention (but not the two that were not) improved significantly (relative improvement 28% to 149%; PLean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.

  10. Evaluation of a practice-based intervention to improve the management of pediatric asthma.

    Science.gov (United States)

    Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

    2011-02-01

    Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

  11. Exercise interventions improve postural control in children with cerebral palsy: a systematic review.

    Science.gov (United States)

    Dewar, Rosalee; Love, Sarah; Johnston, Leanne Marie

    2015-06-01

    The aim of this study was to evaluate the efficacy and effectiveness of exercise interventions that may improve postural control in children with cerebral palsy (CP). A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Six databases were searched using the following keywords: ('cerebral palsy' OR 'brain injury'); AND ('postur*' OR 'balance' OR 'postural balance' [MeSH]); AND ('intervention' OR 'therapy' OR 'exercise' OR 'treatment'). Articles were evaluated based on their level of evidence and conduct. Searches yielded 45 studies reporting 13 exercise interventions with postural control outcomes for children with CP. Five interventions were supported by a moderate level of evidence: gross motor task training, hippotherapy, treadmill training with no body weight support (no-BWS), trunk-targeted training, and reactive balance training. Six of the interventions had weak or conflicting evidence: functional electrical stimulation (FES), hippotherapy simulators, neurodevelopmental therapy (NDT), treadmill training with body weight support, virtual reality, and visual biofeedback. Progressive resistance exercise was an ineffective intervention, and upper limb interventions lacked high-level evidence. The use of exercise-based treatments to improve postural control in children with CP has increased significantly in the last decade. Improved study design provides more clarity regarding broad treatment efficacy. Research is required to establish links between postural control impairments, treatment options, and outcome measures. Low-burden, low-cost, child-engaging, and mainstream interventions also need to be explored. © 2014 Mac Keith Press.

  12. Lung cancer physicians' referral practices for palliative care consultation.

    Science.gov (United States)

    Smith, C B; Nelson, J E; Berman, A R; Powell, C A; Fleischman, J; Salazar-Schicchi, J; Wisnivesky, J P

    2012-02-01

    Integration of palliative care with standard oncologic care improves quality of life and survival of lung cancer patients. We surveyed physicians to identify factors influencing their decisions for referral to palliative care. We provided a self-administered questionnaire to physicians caring for lung cancer patients at five medical centers. The questionnaire asked about practices and views with respect to palliative care referral. We used multiple regression analysis to identify predictors of low referral rates (consultation. Multivariate analysis, controlling for provider characteristics, found that low referral rates were associated with physicians' concerns that palliative care referral would alarm patients and families [odds ratio (OR) 0.45, 95% confidence interval (CI) 0.21-0.98], while the belief that palliative care specialists have more time to discuss complex issues (OR 3.07, 95% CI 1.56-6.02) was associated with higher rates of referral. Although palliative care consultation is increasingly available and recommended throughout the trajectory of lung cancer, our data indicate it is underutilized. Understanding factors influencing decisions to refer can be used to improve integration of palliative care as part of lung cancer management.

  13. The 'radiographer-referrer game': image interpretation dynamics in rural practice.

    Science.gov (United States)

    Squibb, Kathryn; Smith, Anthony; Dalton, Lisa; Bull, Rosalind M

    2016-03-01

    Effective interprofessional communication is intrinsic to safe health care. Despite the identified positive impact of collaborative radiographic interpretation between rural radiographers and referrers, communication difficulties still exist. This article describes the strategies that Australian rural radiographers use for communication of their radiographic opinion to the referring doctor. In a two-phase interpretive doctoral study completed in 2012, data were collected from radiographers working in rural New South Wales, Western Australia and Tasmania using a paper based questionnaire followed by in-depth semistructured interviews. Data were analysed thematically in order to identify, analyse and report the emergent themes. The overarching theme was Patient Advocacy, where in the interest of patient care radiographers took measures to ensure that a referring doctor did not miss radiographic abnormalities. Strong interprofessional relationships enabled direct communication pathways. Interprofessional boundaries shaped by historical hierarchical relationships, together with a lack of confidence and educational preparation for radiographic interpretation result in barriers to direct communication pathways. These barriers prompted radiographers to pursue indirect communication pathways, such as side-stepping and hint and hope. A lack of formal communication pathways and educational preparation for this role has resulted in radiographers playing the radiographer-referrer game to overtly or covertly assist referrers in reaching a radiographic diagnosis. The findings from this study may be used to plan interventions for strengthening interprofessional communication pathways and improve quality of healthcare for patients.

  14. Improving the quality of obstetric care for women with obstructed labour in the national referral hospital in Uganda: lessons learnt from criteria based audit.

    Science.gov (United States)

    Kayiga, Herbert; Ajeani, Judith; Kiondo, Paul; Kaye, Dan K

    2016-07-11

    Obstructed labour remains a major cause of maternal morbidity and mortality whose complications can be reduced with improved quality of obstetric care. The objective was to assess whether criteria-based audit improves quality of obstetric care provided to women with obstructed labour in Mulago hospital, Uganda. Using criteria-based audit, management of obstructed labour was analyzed prospectively in two audits. Six standards of care were compared. An initial audit of 180 patients was conducted in September/October 2013. The Audit results were shared with key stakeholders. Gaps in patient management were identified and recommendations for improving obstetric care initiated. Six standards of care (intravenous fluids, intravenous antibiotics, monitoring of maternal vital signs, bladder catheterization, delivery within two hours, and blood grouping and cross matching) were implemented. A re-audit of 180 patients with obstructed labour was conducted four months later to evaluate the impact of these recommendations. The results of the two audits were compared. In-depth interviews and focus group discussions were conducted among healthcare providers to identify factors that could have influenced the audit results. There was improvement in two standards of care (intravenous fluids and intravenous antibiotic administration) 58.9 % vs. 86.1 %; p motivation), facility factors (poor supervision, stock-outs of essential supplies, absence of protocols) and patient factors (high patient load, poor compliance to instructions) contributed to poor quality of care. Introduction of criteria based audit in the management of obstructed labour led to measurable improvements in only two out of six standards of care. The extent to which criteria based audit may improve quality of obstetric care depends on having basic effective healthcare systems in place.

  15. Medical and surgical interventions to improve outcomes in obese women planning for pregnancy.

    Science.gov (United States)

    Sharma, Anu; Bahadursingh, Sarasvati; Ramsewak, Samuel; Teelucksingh, Surujpal

    2015-05-01

    Obesity is a known risk factor for infertility in women. The exact mechanism through which obesity is linked to infertility is still not fully understood. Hyperleptinaemia, hyperinsulinaemia and resultant hyperandrogenism are all thought to play a role. Various medical and surgical interventions have been attempted to improve fertility rates in obese women. Encouraging evidence for pharmacotherapy, bariatric surgery and assisted reproduction are yet to be seen. In this chapter, we review the hormonal changes in obesity and the evidence behind medical and surgical interventions to improve fertility in obese women.

  16. Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions.

    Science.gov (United States)

    Salam, Rehana A; Faqqah, Anadil; Sajjad, Nida; Lassi, Zohra S; Das, Jai K; Kaufman, Miriam; Bhutta, Zulfiqar A

    2016-10-01

    Adolescents have special sexual and reproductive health needs (whether or not they are sexually active or married). This review assesses the impact of interventions to improve adolescent sexual and reproductive health (including the interventions to prevent female genital mutilation/cutting [FGM/C]) and to prevent intimate violence. Our review findings suggest that sexual and reproductive health education, counseling, and contraceptive provision are effective in increasing sexual knowledge, contraceptive use, and decreasing adolescent pregnancy. Among interventions to prevent FGM/C, community mobilization and female empowerment strategies have the potential to raise awareness of the adverse health consequences of FGM/C and reduce its prevalence; however, there is a need to conduct methodologically rigorous intervention evaluations. There was limited and inconclusive evidence for the effectiveness of interventions to prevent intimate partner violence. Further studies with rigorous designs, longer term follow-up, and standardized and validated measurement instruments are required to maximize comparability of results. Future efforts should be directed toward scaling-up evidence-based interventions to improve adolescent sexual and reproductive health in low- and middle-income countries, sustain the impacts over time, and ensure equitable outcomes. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. A Chinese Chan-based lifestyle intervention improves memory of older adults

    Directory of Open Access Journals (Sweden)

    Agnes S. eChan

    2014-03-01

    Full Text Available This study aims to explore the potential benefits of a Chinese Chan-based lifestyle intervention on enhancing memory in older people with lower memory function. Forty-four aged 60 to 83 adults with various level of memory ability participated in the study. Their memories (including verbal and visual components were assessed before and after a 3-month intervention. The intervention consisted of 12 sessions, with one 90-minute session per week. The intervention involved components of adopting a special vegetarian diet, practicing a type of mind-body exercises and learning self-realization. Elderly with lower memory function at the baseline (i.e., their performance on standardized memory tests was within 25th percentile showed a significant memory improvement after the intervention. Their verbal and visual memory performance has showed 50% and 49% enhancement respectively. In addition, their improvement can be considered as a reliable and clinically significant change as reflected by their significant pre-post differences and reliable change indices. Such robust treatment effect was found to be specific to memory functions, but less influencing on the other cognitive functions. These preliminary encouraging results have shed some light on the potential applicability of the Chinese Chan-based lifestyle intervention as a method for enhancing memory in the elderly population.

  18. Using Primary Care Parenting Interventions to Improve Outcomes in Children with Developmental Disabilities: A Case Report

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    Cassandra L. Tellegen

    2012-01-01

    Full Text Available Parenting is central to the health and well-being of children. Children with developmental disabilities have been shown to be at increased risk of developing emotional and behavioral problems. Parent training programs are effective interventions for improving child behavior and family functioning. This paper describes the outcomes of a brief 4-session parenting intervention (Primary Care Stepping Stones Triple P targeting compliance and cooperative play skills in an 8-year-old girl with Asperger’s disorder and ADHD combined type. The intervention was associated with decreases in child behavior problems, increases in parenting confidence, and decreases in dysfunctional parenting styles. This paper demonstrates that low-intensity parenting interventions can lead to significant improvements in child behavior and family functioning. Such brief interventions are cost effective, can be widely disseminated, and have been designed to be delivered within primary health care settings. Pediatricians can play a key role in identifying parents in need of assistance and in helping them access evidence-based parenting interventions.

  19. Group-Based Intervention to Improve Socio-Emotional Health in Vulnerable Children

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    Tony Cassidy

    2014-12-01

    Full Text Available Internalizing and externalizing problems present as difficulties in socio-emotional competence and predispose to a wide range of mental and physical health outcomes. This study examines the efficacy of an intervention (Pyramid Plus in strengthening children’s socio-emotional competencies. Participants (294 11 year old children attending schools in Northern Ireland were screened for socio-emotional difficulties using the Strengths and Difficulties Questionnaire (SDQ and before being allocated to attend a Pyramid Club intervention (n = 162, and a waiting list control (n = 122. A 3 × 2 mixed-model design was used: group (intervention group vs. waiting list control × 3 time points (pre- vs. post-intervention vs. 12 weeks follow up to investigate the impact of the Pyramid Plus intervention. Teachers and children completed the SDQ-11-16 years, and children completed the TEIQue-CSF ant all 3 times. SDQ total difficult, internalizing and externalizing scores were reduced significantly, and prosocial and emotional intelligence scores were increased significantly compared to waiting list controls post intervention and at follow up. The Pyramid Plus intervention improves the socio-emotional health of vulnerable children through promoting positive outcomes as well as reducing socio- emotional deficits.

  20. Assessment of Fidelity in Interventions to Improve Hand Hygiene of Healthcare Workers: A Systematic Review

    Science.gov (United States)

    Musuuza, Jackson S.; Barker, Anna; Ngam, Caitlyn; Vellardita, Lia; Safdar, Nasia

    2016-01-01

    OBJECTIVE Compliance with hand hygiene in healthcare workers is fundamental to infection prevention yet remains a challenge to sustain. We examined fidelity reporting in interventions to improve hand hygiene compliance, and we assessed 5 measures of intervention fidelity: (1) adherence, (2) exposure or dose, (3) quality of intervention delivery, (4) participant responsiveness, and (5) program differentiation. DESIGN Systematic review METHODS A librarian performed searches of the literature in PubMed, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Library, and Web of Science of material published prior to June 19, 2015. The review protocol was registered in PROSPERO International Prospective Register of Systematic Reviews, and assessment of study quality was conducted for each study reviewed. RESULTS A total of 100 studies met the inclusion criteria. Only 8 of these 100 studies reported all 5 measures of intervention fidelity. In addition, 39 of 100 (39%) failed to include at least 3 fidelity measures; 20 of 100 (20%) failed to include 4 measures; 17 of 100 (17%) failed to include 2 measures, while 16 of 100 (16%) of the studies failed to include at least 1 measure of fidelity. Participant responsiveness and adherence to the intervention were the most frequently unreported fidelity measures, while quality of the delivery was the most frequently reported measure. CONCLUSIONS Almost all hand hygiene intervention studies failed to report at least 1 fidelity measurement. To facilitate replication and effective implementation, reporting fidelity should be standard practice when describing results of complex behavioral interventions such as hand hygiene. PMID:26861117

  1. Improving Student Outcomes in Higher Education: The Science of Targeted Intervention.

    Science.gov (United States)

    Harackiewicz, Judith M; Priniski, Stacy J

    2017-09-20

    Many theoretically based interventions have been developed over the past two decades to improve educational outcomes in higher education. Based in social-psychological and motivation theories, well-crafted interventions have proven remarkably effective because they target specific educational problems and the processes that underlie them. In this review, we evaluate the current state of the literature on targeted interventions in higher education with an eye to emerging theoretical and conceptual questions about intervention science. We review three types of interventions, which focus on the value students perceive in academic tasks, their framing of academic challenges, and their personal values, respectively. We consider interventions that (a) target academic outcomes (e.g., grades, major or career plans, course taking, retention) in higher education, as well as the pipeline to college, and (b) have been evaluated in at least two studies. Finally, we discuss implications for intervention science moving forward. Expected final online publication date for the Annual Review of Psychology Volume 69 is January 4, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

  2. Improving adherence to antiretroviral treatment in Uganda with a low-resource facility-based intervention

    Directory of Open Access Journals (Sweden)

    Celestino Obua

    2014-06-01

    Full Text Available Objective: To assess the effects of facility-based interventions using existing resources to improve overall patient attendance and adherence to antiretroviral therapy (ART at ART-providing facilities in Uganda. Methods: This was an interventional study which tracked attendance and treatment adherence of two distinct cohorts: experienced patients who had been on treatment for at least 12 months prior to the intervention and patients newly initiated on ART before or during the intervention. The interventions included instituting appointment system, fast-tracking, and giving longer prescriptions to experienced stable patients. Mixed-effects models were used to examine intervention effects on the experienced patients, while Cox proportional hazards models were used to determine the intervention effects on time until newly treated patients experienced gaps in medication availability. Results: In all, 1481 patients’ files were selected for follow-up from six facilities – 720 into the experienced cohort, and 761 into the newly treated cohort. Among patients in the experienced cohort, the interventions were associated with a significant reduction from 24.4 to 20.3% of missed appointments (adjusted odds ratio (AOR: 0.67; 95% confidence interval (CI: 0.59–0.77; a significant decrease from 20.2 to 18.4% in the medication gaps of three or more days (AOR: 0.69; 95% CI: 0.60–0.79; and a significant increase from 4.3 to 9.3% in the proportion of patients receiving more than 30 days of dispensed medication (AOR: 2.35; 95% CI: 1.91–2.89. Among newly treated patients, the interventions were associated with significant reductions of 44% (adjusted hazard rate (AHR: 0.56, 95% CI: 0.42–0.74 and 38% (AHR: 0.62; 95% CI: 0.45–0.85 in the hazards of experiencing a medication gap of 7 and 14 days or more, respectively. Conclusions: Patients’ adherence was improved with low-cost and easily implemented interventions using existing health facilities

  3. The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD in primary care

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    du Bois Elizabeth

    2009-07-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small

  4. Improving blood pressure control in end stage renal disease through a supportive educative nursing intervention.

    Science.gov (United States)

    Kauric-Klein, Zorica

    2012-01-01

    Hypertension in patients on hemodialysis (HD) contributes significantly to their morbidity and mortality. This study examined whether a supportive nursing intervention incorporating monitoring, goal setting, and reinforcement can improve blood pressure (BP) control in a chronic HD population. A randomized controlled design was used and 118 participants were recruited from six HD units in the Detroit metro area. The intervention consisted of (1) BP education sessions; (2) a 12-week intervention, including monitoring, goal setting, and reinforcement; and (3) a 30-day post-intervention follow-up period. Participants in the treatment were asked to monitor their BP, sodium, and fluid intake weekly for 12 weeks in weekly logs. BP, fluid and sodium logs were reviewed weekly with the researcher to determine if goals were met or not met. Reinforcement was given for goals met and problem solving offered when goals were not met. The control group received standard care. Both systolic and diastolic BPs were significantly decreased in the treatment group.

  5. Using kaizen to improve employee well-being: Results from two organizational intervention studies.

    Science.gov (United States)

    von Thiele Schwarz, Ulrica; Nielsen, Karina M; Stenfors-Hayes, Terese; Hasson, Henna

    2017-08-01

    Participatory intervention approaches that are embedded in existing organizational structures may improve the efficiency and effectiveness of organizational interventions, but concrete tools are lacking. In the present article, we use a realist evaluation approach to explore the role of kaizen, a lean tool for participatory continuous improvement, in improving employee well-being in two cluster-randomized, controlled participatory intervention studies. Case 1 is from the Danish Postal Service, where kaizen boards were used to implement action plans. The results of multi-group structural equation modeling showed that kaizen served as a mechanism that increased the level of awareness of and capacity to manage psychosocial issues, which, in turn, predicted increased job satisfaction and mental health. Case 2 is from a regional hospital in Sweden that integrated occupational health processes with a pre-existing kaizen system. Multi-group structural equation modeling revealed that, in the intervention group, kaizen work predicted better integration of organizational and employee objectives after 12 months, which, in turn, predicted increased job satisfaction and decreased discomfort at 24 months. The findings suggest that participatory and structured problem-solving approaches that are familiar and visual to employees can facilitate organizational interventions.

  6. An intervention to improve nurse-physician communication in depression care.

    Science.gov (United States)

    Brown, Ellen L; Raue, Patrick J; Klimstra, Sibel; Mlodzianowski, Amy E; Greenberg, Rebecca L; Bruce, Martha L

    2010-06-01

    Depression in older adult home care recipients is frequently undetected and inadequately treated. Failed communication between home healthcare personnel and the patient's physician has been identified as a barrier for depression care. The purpose of this pilot intervention study was to improve nurse competency for communicating depression-related information to the physician. A single group pre-post experimental design. Two Medicare-certified home healthcare agencies serving an urban and suburban area in New York. Twenty-eight home care nurses, all female Registered Nurses. Two-hour skills training workshop. To evaluate the intervention, pre-post changes in effective nurse communication using Objective Structured Clinical Examinations and nurse survey reports. The intervention significantly improved the ability of the home care nurse to perform a case presentation in a complete and standard organized format pre versus postintervention. The intervention also increased nurse-reported certainty to communicate depression-related information to the physician. Our findings provide support for the ability of a brief, depression-focused communication skills training intervention to improve home care nurse competency for effectively communicating depression-related information to the physician.

  7. Improving breast cancer survivors’ knowledge using a patient-centered intervention

    Science.gov (United States)

    Ulloa, Jesus G.; Hemmelgarn, Marian; Viveros, Lori; Odele, Patience; Feldman, Nancy R.; Ganz, Patricia A.; Maggard-Gibbons, Melinda

    2016-01-01

    Background Low-income, minority women with breast cancer experience a range of barriers to receiving survivorship information. Our objective was to test a novel, patient-centered intervention aimed at improving communication about survivorship care. Methods We developed a wallet card to provide oncologic and follow-up care survivorship information to breast cancer patients. We used a prospective, pre–post design to assess the intervention at a safety net hospital. The intervention was given by a patient navigator or community health worker. Results Patient knowledge (n = 130) of personal cancer history improved from baseline pretest to 1 week after the intervention for stage (66–93%; P < .05), treatment (79–92%; P < .05), and symptoms of recurrence (48–89%; P <.05), which was retained at 3 months. The intervention reduced the number of patients who were unsure when their mammogram was due (15–5% at 1 week and 6%at 3 months; P <.05). Nearly 90% reported they would be likely to share their survivorship card with their providers. Conclusion A patient-centered survivorship card improved short-term recall of key survivorship care knowledge and seems to be effective at reducing communication barriers for this population. Further studies are warranted to assess long-term retention and the impact on receipt of appropriate survivorship follow-up care. PMID:26032819

  8. Simple interventions to improve healthy eating behaviors in the school cafeteria

    Science.gov (United States)

    2016-01-01

    The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peer-reviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now. PMID:26874753

  9. Simple interventions to improve healthy eating behaviors in the school cafeteria.

    Science.gov (United States)

    Kessler, Holly S

    2016-03-01

    The National School Lunch Program in the United States provides an important opportunity to improve nutrition for the 30 million children who participate every school day. The purpose of this narrative review is to present and evaluate simple, evidence-based strategies to improve healthy eating behaviors at school. Healthy eating behaviors are defined as increased selection/consumption of fruits and/or vegetables, increased selection of nutrient-dense foods, or decreased selection of low-nutrient, energy-dense foods. Data were collected from sales records, 24-hour food recalls, direct observation, and estimation of plate waste. The review is limited to simple, discrete interventions that are easy to implement. Sixteen original, peer-reviewed articles are included. Interventions are divided into 5 categories: modification of choice, behavior modification, marketing strategies, time-efficiency strategies, and fruit slicing. All interventions resulted in improved eating behaviors, but not all interventions are applicable or feasible in all settings. Because these studies were performed prior to the implementation of the new federally mandated school meal standards, it is unknown if these interventions would yield similar results if repeated now.

  10. Improved status following behavioural intervention in a case of severe dysarthria with stroke aetiology.

    Science.gov (United States)

    Mackenzie, Catherine; Lowit, Anja

    2012-08-01

    There is little published intervention outcome literature concerning dysarthria acquired from stroke. Single case studies have potential for more detailed specification and interpretation than is generally possible in larger studies so are informative for clinicians dealing with similar cases. Such research also contributes to planning of larger scale investigations. Behavioural intervention is described which was carried out between 7-9 months after stroke with a 69-year-old man with severe dysarthria. Pre-intervention stability between 5-7 months contrasted with post-intervention gains. Significant improvement was demonstrated using randomized, blinded assessment by 10 judges on measures of word and reading intelligibility and communication effectiveness in conversation. A range of speech analyses were undertaken (rate, pause, and intonation characteristics in connected speech and single word phonetic transcription), with the aim of identifying speech components which might explain the listeners' perceptions of improvement. Changes were detected mainly in parameters related to utterance segmentation and intonation. The basis of post-intervention improvement in dysarthria is complex, both in terms of the active therapeutic dimensions and also the specific speech alterations which account for changes to intelligibility and effectiveness.

  11. Let's talk about sleep: a systematic review of psychological interventions to improve sleep in college students.

    Science.gov (United States)

    Friedrich, Anja; Schlarb, Angelika A

    2017-06-15

    Sleep problems are a common occurrence in college students. Insomnia, nightmares and impaired sleep quality lead to several mental health issues, as well as impaired academic performance. Although different sleep programmes exist, a systematic overview comparing their effectiveness is still missing. This systematic review aims to provide an overview of psychological interventions to improve sleep in college students. Seven databases were searched from November to December 2016 (MEDLINE, EMBASE, PsycINFO, Cinahl, Cochrane Library, PubMed, OpenSigle). The search string included search terms from three different topics: sleep, intervention and college students. Outcome measures included subjective as well as objective measures and focused on sleep, sleep-related and mental health variables. Twenty-seven studies met the inclusion criteria. They were assigned to four intervention categories: (1) sleep hygiene, (2) cognitive-behavioural therapy (CBT), (3) relaxation, mindfulness and hypnotherapy and (4) other psychotherapeutic interventions. Fifteen studies were randomized controlled trials. While sleep hygiene interventions provided small to medium effects, the CBTs showed large effects. The variability of the effect sizes was especially large in the relaxation category, ranging from very small to very large effect sizes. Other psychotherapeutic interventions showed medium effects. CBT approaches provided the best effects for the improvement of different sleep variables in college students. Five studies included insomnia patients. The other three intervention categories also showed promising results with overall medium effects. In the future, CBT should be combined with relaxation techniques, mindfulness and hypnotherapy. Furthermore, the interventions should broaden their target group and include more sleep disorders. © 2017 European Sleep Research Society.

  12. Effects of a randomized intervention to improve workplace social capital in community health centers in China.

    Science.gov (United States)

    Sun, Xiaojie; Zhang, Nan; Liu, Kun; Li, Wen; Oksanen, Tuula; Shi, Lizheng

    2014-01-01

    To examine whether workplace social capital improved after implementing a workplace social capital intervention in community health centers in China. This study was conducted in 20 community health centers of similar size in Jinan of China during 2012-2013. Using the stratified site randomization, 10 centers were randomized into the intervention group; one center was excluded due to leadership change in final analyses. The baseline survey including 447 staff (response rate: 93.1%) was conducted in 2012, and followed by a six-month workplace social capital intervention, including team building courses for directors of community health centers, voluntarily public services, group psychological consultation, and outdoor training. The follow-up survey in July 2013 was responded to by 390 staff members (response rate: 86.9%). Workplace social capital was assessed with the translated and culturally adapted scale, divided into vertical and horizontal dimensions. The facility-level intervention effects were based on all baseline (n = 427) and follow-up (n = 377) respondents, except for Weibei respondents. We conducted a bivariate Difference-in-Difference analysis to estimate the facility-level intervention effects. No statistically significant intervention effects were observed at the center level; the intervention increased the facility-level workplace social capital, and its horizontal and vertical dimensions by 1.0 (p = 0.24), 0.4 (p = 0.46) and 0.8 (p = 0.16), respectively. The comprehensive intervention seemed to slightly improve workplace social capital in community health centers of urban China at the center level. High attrition rate limits any causal interpretation of the results. Further studies are warranted to test these findings.

  13. [Effectiveness of interventions for improving drug prescribing in Primary Health Care].

    Science.gov (United States)

    Zavala-González, Marco Antonio; Cabrera-Pivaral, Carlos Enrique; Orozco-Valerio, María de Jesús; Ramos-Herrera, Igor Martín

    2017-01-01

    To determine the effectiveness of interventions for improving drug prescribing in Primary Health Care units. Systematic review and meta-analysis. Searches were made in MedLine(©), ScienceDirect(©), Springer(©), SciELO(©), Dialnet(©), RedALyC(©) and Imbiomed(©), in Spanish, English and Portuguese, using keywords "drug prescribing", "intervention studies" and "primary health care", indexed in each data base up to August 2014. Experimental and quasi-experimental studies were included that had a CASP-score>5 and that evaluated effect of any type intervention on the quality of drug prescription in Primary Health Care. A total of 522 articles were found, and an analysis was performed on 12 that reported 17 interventions: 64.7% educational, 23.5% incorporating pharmacists into the health team, and 11.8% on the use of computer applications. The strong "intervention/improvement" associations were educational interventions OR=2.47 (95% CI; 2.28 - 2.69), incorporation of pharmacists OR=3.28 (95% CI; 2.58 4.18), and use of computer applications OR=10.16 (95% CI; 8.81 -11.71). The use of interventions with computer applications showed to be more effective than educational interventions and incorporation pharmacists into the health team. Future studies are required that include economic variables such as, implementation costs, drug costs and other expenses associated with health care and treatment of diseases. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. Behind the scenes of the PRIME intervention: designing a complex intervention to improve malaria care at public health centres in Uganda

    Directory of Open Access Journals (Sweden)

    Deborah D. DiLiberto

    2015-10-01

    Full Text Available Background: In Uganda, health system challenges limit access to good quality healthcare and contribute to slow progress on malaria control. We developed a complex intervention (PRIME, which was designed to improve quality of care for malaria at public health centres. Objective: Responding to calls for increased transparency, we describe the PRIME intervention's design process, rationale, and final content and reflect on the choices and challenges encountered during the design of this complex intervention. Design: To develop the intervention, we followed a multistep approach, including the following: 1 formative research to identify intervention target areas and objectives; 2 prioritization of intervention components; 3 review of relevant evidence; 4 development of intervention components; 5 piloting and refinement of workshop modules; and 6 consolidation of the PRIME intervention theories of change to articulate why and how the intervention was hypothesized to produce desired outcomes. We aimed to develop an intervention that was evidence-based, grounded in theory, and appropriate for the study context; could be evaluated within a randomized controlled trial; and had the potential to be scaled up sustainably. Results: The process of developing the PRIME intervention package was lengthy and dynamic. The final intervention package consisted of four components: 1 training in fever case management and use of rapid diagnostic tests for malaria (mRDTs; 2 workshops in health centre management; 3 workshops in patient-centred services; and 4 provision of mRDTs and antimalarials when stocks ran low. Conclusions: The slow and iterative process of intervention design contrasted with the continually shifting study context. We highlight the considerations and choices made at each design stage, discussing elements we included and why, as well as those that were ultimately excluded. Reflection on and reporting of ‘behind the scenes’ accounts of intervention

  15. Referrals from general practitioners to a social services department.

    Science.gov (United States)

    Sheppard, M G

    1983-01-01

    One year's referrals from general practitioners to a social services department were studied. There was a low referral rate and a bias towards women, the elderly and the less affluent. The referrals were predominantly made for practical help with problems of ill health. A high proportion of clients were allocated to non-social work staff, and the social service intervention, generally of short duration, showed a sympathetic response to the practical requests of general practitioners. The limited use of social workers by doctors is considered to be the result of ignorance or scepticism about psychodynamic social work skills. Closer liaison between general practitioners and social workers, and a clearer presentation by social workers of their professional skills, are suggested solutions to this problem.

  16. Interventions to improve chronic cyclosporine A nephrotoxicity through inhibiting renal cell apoptosis: a systematic review

    Institute of Scientific and Technical Information of China (English)

    XIAO Zheng; LI Cheng-wen; SHAN Juan; LUO Lei; FENG Li; LU Jun; LI Sheng-fu

    2013-01-01

    Objective To reveal interventions for chronic cyclosporine A nephrotoxicity (CCN) and provide new targets for further studies,we analyzed all relevant studies about interventions in renal cell apoptosis.Data sources We collected all relevant studies about interventions for cyclosporine A (CsA)-induced renal cell apoptosis in Medline (1966 to July 2010),Embase (1980 to July 2010) and ISI (1986 to July 2010),evaluated their quality,extracted data following PICOS principles and synthesized the data.Study selection We included all relevant studies about interventions in CsA-induced renal cell apoptosis no limitation of research design and language) and excluded the duplicated articles,meeting abstracts and reviews without specific data.Results There were three kinds of intervention,include anti-oxidant (sulfated polysaccharides,tea polyphenols,apigenin,curcumin,spirulina,etc),biologics (recombinant human erythropoietin (rhEPO),a murine pan-specific transforming growth factor (TGF)-beta-neutralizing monoclonal antibody1D11,cartilage oligomeric matrix protein (COMP)-angiopoietin-1 and hepatocyte growth factor (HGF) gene),and other drugs (spironolactone,rosiglitazone,pirfenidone and colchicine).These interventions significantly improved the CCN,renal cell apoptosis and renal dysfunction through intervening in four apoptotic pathways in animals or protected renal cells from apoptosis induced by CsA and increased cell survival through respectively four pathways in vitro.Conclusions There are three group interventions for CCN.Especially anti-oxidant drugs can significantly improve CCN,renal cell apoptosis and renal dysfunction.Many drugs can improve CCN through intervening in Fas/Fas ligand or mitochondrial pathway with sufficient evidences.Angiotensin Ⅱ,nitric oxide (NO) and endoplasmic reticulum (ER) pathways will be new targets for CCN.

  17. Intervention to improve the quality of antimicrobial prescribing for urinary tract infection: a cluster randomized trial.

    Science.gov (United States)

    Vellinga, Akke; Galvin, Sandra; Duane, Sinead; Callan, Aoife; Bennett, Kathleen; Cormican, Martin; Domegan, Christine; Murphy, Andrew W

    2016-02-02

    Overuse of antimicrobial therapy in the community adds to the global spread of antimicrobial resistance, which is jeopardizing the treatment of common infections. We designed a cluster randomized complex intervention to improve antimicrobial prescribing for urinary tract infection in Irish general practice. During a 3-month baseline period, all practices received a workshop to promote consultation coding for urinary tract infections. Practices in intervention arms A and B received a second workshop with information on antimicrobial prescribing guidelines and a practice audit report (baseline data). Practices in intervention arm B received additional evidence on delayed prescribing of antimicrobials for suspected urinary tract infection. A reminder integrated into the patient management software suggested first-line treatment and, for practices in arm B, delayed prescribing. Over the 6-month intervention, practices in arms A and B received monthly audit reports of antimicrobial prescribing. The proportion of antimicrobial prescribing according to guidelines for urinary tract infection increased in arms A and B relative to control (adjusted overall odds ratio [OR] 2.3, 95% confidence interval [CI] 1.7 to 3.2; arm A adjusted OR 2.7, 95% CI 1.8 to 4.1; arm B adjusted OR 2.0, 95% CI 1.3 to 3.0). An unintended increase in antimicrobial prescribing was observed in the intervention arms relative to control (arm A adjusted OR 2.2, 95% CI 1.2 to 4.0; arm B adjusted OR 1.4, 95% CI 0.9 to 2.1). Improvements in guideline-based prescribing were sustained at 5 months after the intervention. A complex intervention, including audit reports and reminders, improved the quality of prescribing for urinary tract infection in Irish general practice. ClinicalTrials.gov, no. NCT01913860. © 2016 Canadian Medical Association or its licensors.

  18. A systematic review of the effectiveness of remediation interventions to improve NCLEX-RN pass rates.

    Science.gov (United States)

    Pennington, Tracy D; Spurlock, Darrell

    2010-09-01

    First-time NCLEX-RN pass rates are important measures of educational quality in prelicensure nursing education programs. Licensure pass rate problems has been the subject of countless nursing education articles and studies over the past several decades. To improve NCLEX-RN pass rates, remediation is often prescribed for students who have academic performance deficits. This article presents a systematic review of studies on remediation interventions and their effects on NCLEX-RN pass rates. Most studies of remediation and its effects on licensure pass rates are descriptive program evaluation reports. The overall quality of studies included in this review is uneven but generally low. Nursing education researchers should focus on conducting higher quality intervention studies in which the fidelity of remediation interventions can be examined. Viewing licensure pass rates from a process improvement perspective and accounting for pass rate variations could also change the nature of scholarship on this topic.

  19. Improving communication after ended adjuvant treatment - experiences of a coaching intervention

    DEFF Research Database (Denmark)

    Timmermann, Connie; Ammentorp, Jette; Birkelund, Regner

    illness. To improve the conditions for cancer survivors the objective of this study was to develop and evaluate a coaching intervention aimed to improve the communication with the patients. Methods & Materials: Three nurses participated in a two-day training program focusing on coaching methods. A total...... of 10 patients were included in the study after completion of their adjuvant treatment and approximately three month ahead. The intervention consisted of two personal conversations succeeded by two follow-up phone calls carried out by the specially trained nurses. The patients´ experiences...... of participating in the intervention were collected through qualitative interviews. Data were analyzed in accordance with the phenomenological-hermeneutic tradition. Results: The patients described a comprehensive process of regaining mental as well as physical strength and well-being after ended treatment...

  20. [Interventions to improve the management of diabetes mellitus in primary health care and outpatient community settings].

    Science.gov (United States)

    Hansen, Lars Jørgen; Drivsholm, Thomas B

    2002-01-28

    This review should be cited as: Renders CM, Valk GD, Griffin S. Wagner EH, Eijk JThM van, Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings (Cochrane Review). In: The Cochrane Library, Issue 2, 2001. Oxford: Update Software. A substantive amendment to this systematic review was last made on 29 June 2000. Cochrane reviews are regularly checked and updated if necessary. Diabetes is a common chronic disease that is increasingly managed in primary care. Different systems have been proposed to manage diabetes care. To assess the effects of different interventions, targeted at health professionals or the structure in which they deliver care, on the management of patients with diabetes in primary care, outpatient and community settings. We searched the Cochrane Effective Practice and Organisation of Care Group specialised register, the Cochrane Controlled Trials Register (Issue 4 1999), MEDLINE (1966-1999), EMBASE (1980-1999), Cinahl (1982-1999), and reference lists of articles. Randomised trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series (ITS) analyses of professional, financial and organisational strategies aimed at improving care for people with Type 1 or Type 2 diabetes. The participants were health care professionals, including physicians, nurses and pharmacists. The outcomes included objectively measured health professional performance or patient outcomes, and self-report measures with known validity and reliability. Two reviewers independently extracted data and assessed study quality. Forty-one studies were included involving more than 200 practices and 48,000 patients. Twenty-seven studies were RCTs, 12 were CBAs, and two were ITS. The studies were heterogeneous in terms of interventions, participants, settings and outcomes. The methodological quality of the studies was often poor. In all studies the intervention

  1. Effectiveness of an Intervention Program for Improving School Atmosphere: Some Results

    Science.gov (United States)

    Sanchez, A. M.; Rivas, M. T.; Trianes, M. V.

    2006-01-01

    This work describes the results of the "Programa de Desarrollo Social y Afectivo" [Social and Affective Development Program] (Trianes & Munoz, 1994; Trianes, 1996), under way during four years at a public school in a disadvantaged area Malaga, earmarked for special educational resources. The intervention is meant to improve classroom…

  2. Process evaluation of a workplace health promotion intervention aimed at improving work engagement and energy balance

    NARCIS (Netherlands)

    Berkel, J. van; Boot, C.R.L.; Proper, K.I.; Bongers, P.M.; Beek, A.J. van der

    2013-01-01

    OBJECTIVE:: To evaluate the process of the implementation of an intervention aimed at improving work engagement and energy balance, and to explore associations between process measures and compliance. METHODS:: Process measures were assessed using a combination of quantitative and qualitative method

  3. Improving the governance of patient safety in emergency care: a systematic review of interventions

    NARCIS (Netherlands)

    Hesselink, G.J.; Berben, S.A.; Beune, T.; Schoonhoven, L.

    2016-01-01

    OBJECTIVES: To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. DESIGN: A systematic review of the literature. METHODS: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health

  4. Interventions for improving the adoption of shared decision making by healthcare professionals

    NARCIS (Netherlands)

    Legare, F.; Stacey, D.; Turcotte, S.; Cossi, M.J.; Kryworuchko, J.; Graham, I.D.; Lyddiatt, A.; Politi, M.C.; Thomson, R.; Elwyn, G.; Donner-Banzhoff, N.

    2014-01-01

    BACKGROUND: Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice. OBJECTIVES: To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM.

  5. Characteristics of Effective Interventions in Improving Young People's Sexual Health: A Review of Reviews

    Science.gov (United States)

    Poobalan, Amudha S.; Pitchforth, Emma; Imamura, Mari; Tucker, Janet S.; Philip, Kate; Spratt, Jenny; Mandava, Lakshmi; van Teijlingen, Edwin

    2009-01-01

    The purpose of this paper is to conduct a review of reviews to identify characteristics of effective sex and relationship education (SRE) interventions and/or programmes in young people to improve sexual health and identify barriers and facilitators for implementation. Six bibliographic databases were searched from 1986 to 2006 for systematic…

  6. Interventions to improve patient hand hygiene: a systematic review.

    Science.gov (United States)

    Srigley, J A; Furness, C D; Gardam, M

    2016-09-01

    Nosocomial pathogens may be acquired by patients via their own unclean hands, but there has been relatively little emphasis on patient hand hygiene as a tool for preventing healthcare-associated infections (HCAIs). The aim of this systematic review was to determine the efficacy of patient hand hygiene interventions in reducing HCAIs and improving patient hand hygiene rates compared to usual care. Electronic databases and grey literature were searched to August 2014. Experimental and quasi-experimental studies were included if they evaluated a patient hand hygiene intervention conducted in an acute or chronic healthcare facility and included HCAI incidence and/or patient hand hygiene rates as an outcome. All steps were performed independently by two investigators. Ten studies were included, most of which were uncontrolled before-after studies (N=8). The majority of interventions (N=7) were multi-modal, with components similar to healthcare worker hand hygiene programmes, including education, reminders, audit and feedback, and provision of hand hygiene products. Six studies reported HCAI outcomes and four studies assessed patient hand hygiene rates; all demonstrated improvements but were at moderate to high risk of bias. In conclusion, interventions to improve patient hand hygiene may reduce the incidence of HCAIs and improve hand hygiene rates, but the quality of evidence is low. Future studies should use stronger designs and be more selective in their choice of outcomes.

  7. A multifaceted intervention model can give a lasting improvement of older peoples' nutritional status.

    Science.gov (United States)

    Lorefält, B; Wilhelmsson, S

    2012-04-01

    The purpose of this study was with a multifaceted intervention model improve the nutritional status of elderly people living in residential homes to increase their energy intake and to maintain improvements over time. Three different municipal residential homes in the south-east of Sweden. The study population consisted of 67 elderly people. A within-subjects design was used which means that the participants were their own controls. A multifaceted intervention model was chosen, which included education on both theoretical and practical issues, training and support for staff, and individualized snacks to the residents. Nutritional status was measured by Mini Nutritional Assessment (MNA), the consumption of food was recorded by the staff using a food record method for 3 consecutive days. The length of night-time fasting has been calculated from the food records. Nutritional status improved after 3 months of intervention and was maintained after 9 months. Weight increased during the whole study period. Night-time fasting decreased but not to the recommended level. This study shows that it is possible by a multifaceted intervention model to increase energy intake including expanding snacks and thereby improve and maintain nutritional status over a longer period in the elderly living in residential homes. This result was possible to achieve because staff received education and training in nutritional issues and by provision of support during a period when new routines were introduced.

  8. Intervention to Improve Expository Reading Comprehension Skills in Older Children and Adolescents with Language Disorders

    Science.gov (United States)

    Ward-Lonergan, Jeannene M.; Duthie, Jill K.

    2016-01-01

    With the recent renewed emphasis on the importance of providing instruction to improve expository discourse comprehension and production skills, speech-language pathologists need to be prepared to implement effective intervention to meet this critical need in older children and adolescents with language disorders. The purpose of this review…

  9. Efficacy of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP) Primary Version

    Science.gov (United States)

    DiPerna, James Clyde; Lei, Puiwa; Bellinger, Jillian; Cheng, Weiyi

    2015-01-01

    A multisite cluster randomized trial was conducted to examine the effects of the Social Skills Improvement System Classwide Intervention Program (SSIS-CIP; Elliott & Gresham, 2007) on students' classroom social behavior. The final sample included 432 students across 38 second grade classrooms. Social skills and problem behaviors were measured…

  10. Can a Brief Educational Intervention Improve Parents' Knowledge of Healthy Children's Sleep? A Pilot-Test

    Science.gov (United States)

    Jones, Caroline H. D.; Owens, Judith A.; Pham, Brian

    2013-01-01

    Objective: Insufficient and poor quality sleep is prevalent in children, and is a significant public health concern due to the negative consequences for health. Certain sleep-related behaviours are associated with improved sleep, and sleep behaviours are amenable to efforts targeted towards behaviour change. Parental educational interventions have…

  11. Parental involvement in interventions to improve child diet and prevent disease

    Science.gov (United States)

    Parents influence children's dietary intake in part through general parenting styles, feeding styles, and/or food parenting practices. Interventions aimed at improving child diet often include parent components. A systematic review was conducted to assess the effect of targeting parenting styles and...

  12. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    Science.gov (United States)

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series,…

  13. Interventions to Improve Responses of Helping Professionals to Intimate Partner Violence: A Quick Scoping Review

    Science.gov (United States)

    Choi, Y. Joon; An, Soonok

    2016-01-01

    Objective: The purpose of the study is to systematically review the available evidence on the effectiveness of interventions to improve the response of various helping professionals who come into contact with female victims of intimate partner violence (IPV). Methods: Several databases were searched, and N = 38 studies met the inclusion criteria…

  14. Using Action Research Interventions to Improve the Effectiveness of an Executive Team

    Science.gov (United States)

    McCarty, Timothy

    2010-01-01

    Purpose: The purpose of this study was to conduct an in-depth investigation of an executive team, to determine which internal and external factors impacted the team and to determine in what ways action research interventions improved the team's effectiveness. Methodology: The subjects in this study were seven members of a school district…

  15. Community based lifestyle intervention improves body weight, anthropometric, and fitness parameters

    Science.gov (United States)

    Lifestyle modification of nutrition, physical activity and behavior is a proven methodology for weight loss and health improvement. We examined a community based lifestyle intervention (CBLI) program on anthropometric, fitness and biologic outcomes in 41 (2 men, 39 women) overweight and obese (BMI =...

  16. Intervention to Improve Expository Reading Comprehension Skills in Older Children and Adolescents with Language Disorders

    Science.gov (United States)

    Ward-Lonergan, Jeannene M.; Duthie, Jill K.

    2016-01-01

    With the recent renewed emphasis on the importance of providing instruction to improve expository discourse comprehension and production skills, speech-language pathologists need to be prepared to implement effective intervention to meet this critical need in older children and adolescents with language disorders. The purpose of this review…

  17. Evaluation of an Intervention to Help Students Avoid Unintentional Plagiarism by Improving Their Authorial Identity

    Science.gov (United States)

    Elander, James; Pittam, Gail; Lusher, Joanne; Fox, Pauline; Payne, Nicola

    2010-01-01

    Students with poorly developed authorial identity may be at risk of unintentional plagiarism. An instructional intervention designed specifically to improve authorial identity was delivered to 364 psychology students at three post-1992 universities in London, UK, and evaluated with before-and-after measures of beliefs and attitudes about academic…

  18. Beyond Grand Rounds: A Comprehensive and Sequential Intervention to Improve Identification of Delirium

    Science.gov (United States)

    Ramaswamy, Ravishankar; Dix, Edward F.; Drew, Janet E.; Diamond, James J.; Inouye, Sharon K.; Roehl, Barbara J. O.

    2011-01-01

    Purpose of the Study: Delirium is a widespread concern for hospitalized seniors, yet is often unrecognized. A comprehensive and sequential intervention (CSI) aiming to effect change in clinician behavior by improving knowledge about delirium was tested. Design and Methods: A 2-day CSI program that consisted of progressive 4-part didactic series,…

  19. Improving sleep quality interventions among menopausal women with sleep disturbances in Taiwan: a preliminary study.

    Science.gov (United States)

    Hsu, Hsiu-Chin; Tsao, Lee-Ing; Lin, Mei-Hsiang

    2015-11-01

    The aim of this study was to evaluate the effectiveness of improving sleep quality interventions in menopausal women with sleep disturbance. Sleep disturbances are an extensive and common problem among menopausal women. There is an increased trend in the use of non-pharmacological methods to alleviate sleep disturbances. Studies that have implemented two or more non-pharmacological strategies for menopausal women are scant. A repeat measurement with a randomized assignment was conducted. A total of 59 menopausal women with sleep disturbance were recruited and randomly assigned to experimental (n = 29) and control (n = 30) groups. Participants in the experimental group received four 2-hour improving sleep quality activities, whereas the control group received regular greeting calls. Sleep quality was measured prior to intervention, and on the 5th and 8th weeks by using the Pittsburg's Sleep Quality Index, and Actiwatch was worn before and during the 8 weeks of intervention. Generalized estimating equation was used to analyze data. The results revealed that subjective sleep quality had significant main effect in group and time. The findings of the objective measurement showed that participants in the experimental group had significantly shorter frequency of awakening time and increased sleep efficiency. The improving sleep quality intervention is a healthy and cost-effective method to improve sleep quality in community-dwelling menopausal women with sleep disturbance. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Identifying quality improvement intervention publications - A comparison of electronic search strategies

    Directory of Open Access Journals (Sweden)

    Rubenstein Lisa V

    2011-08-01

    Full Text Available Abstract Background The evidence base for quality improvement (QI interventions is expanding rapidly. The diversity of the initiatives and the inconsistency in labeling these as QI interventions makes it challenging for researchers, policymakers, and QI practitioners to access the literature systematically and to identify relevant publications. Methods We evaluated search strategies developed for MEDLINE (Ovid and PubMed based on free text words, Medical subject headings (MeSH, QI intervention components, continuous quality improvement (CQI methods, and combinations of the strategies. Three sets of pertinent QI intervention publications were used for validation. Two independent expert reviewers screened publications for relevance. We compared the yield, recall rate, and precision of the search strategies for the identification of QI publications and for a subset of empirical studies on effects of QI interventions. Results The search yields ranged from 2,221 to 216,167 publications. Mean recall rates for reference publications ranged from 5% to 53% for strategies with yields of 50,000 publications or fewer. The 'best case' strategy, a simple text word search with high face validity ('quality' AND 'improv*' AND 'intervention*' identified 44%, 24%, and 62% of influential intervention articles selected by Agency for Healthcare Research and Quality (AHRQ experts, a set of exemplar articles provided by members of the Standards for Quality Improvement Reporting Excellence (SQUIRE group, and a sample from the Cochrane Effective Practice and Organization of Care Group (EPOC register of studies, respectively. We applied the search strategy to a PubMed search for articles published in 10 pertinent journals in a three-year period which retrieved 183 publications. Among these, 67% were deemed relevant to QI by at least one of two independent raters. Forty percent were classified as empirical studies reporting on a QI intervention. Conclusions The presented

  1. Beyond clinical engagement: a pragmatic model for quality improvement interventions, aligning clinical and managerial priorities.

    Science.gov (United States)

    Pannick, Samuel; Sevdalis, Nick; Athanasiou, Thanos

    2016-09-01

    Despite taking advantage of established learning from other industries, quality improvement initiatives in healthcare may struggle to outperform secular trends. The reasons for this are rarely explored in detail, and are often attributed merely to difficulties in engaging clinicians in quality improvement work. In a narrative review of the literature, we argue that this focus on clinicians, at the relative expense of managerial staff, has proven counterproductive. Clinical engagement is not a universal challenge; moreover, there is evidence that managers-particularly middle managers-also have a role to play in quality improvement. Yet managerial participation in quality improvement interventions is often assumed, rather than proven. We identify specific factors that influence the coordination of front-line staff and managers in quality improvement, and integrate these factors into a novel model: the model of alignment. We use this model to explore the implementation of an interdisciplinary intervention in a recent trial, describing different participation incentives and barriers for different staff groups. The extent to which clinical and managerial interests align may be an important determinant of the ultimate success of quality improvement interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Asthma disease management-Australian pharmacists' interventions improve patients' asthma knowledge and this is sustained.

    Science.gov (United States)

    Saini, Bandana; LeMay, Kate; Emmerton, Lynne; Krass, Ines; Smith, Lorraine; Bosnic-Anticevich, Sinthia; Stewart, Kay; Burton, Deborah; Armour, Carol

    2011-06-01

    To assess any improvements in knowledge of asthma patients after a tailored education program delivered by pharmacists and measure the sustainability of any improvements. To ascertain patients' perceptions about any changes in their knowledge. Ninety-six specially trained pharmacists recruited patients based on their risk of poor asthma control. A tailored intervention was delivered to patients based on individual needs and goals, and was conducted at three or four time points over six months. Asthma knowledge was assessed at the beginning and end of the service, and six and 12 months after it had ended. Patients' perceptions of the impact of the service on their knowledge were explored qualitatively in interviews. The 96 pharmacists recruited 570 patients, 398 (70%) finished. Asthma knowledge significantly improved as a result of the service (7.65 ± 2.36, n=561, to 8.78 ± 2.14, n=393). This improvement was retained for at least 12 months after the service. Patients reported how the knowledge and skills gained had led to a change in the way they managed their asthma. Improvements in knowledge are achievable and sustainable if pharmacists used targeted educational interventions. Pharmacist educational interventions are an efficient way to improve asthma knowledge in the community. Crown Copyright © 2011. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Improving maternal care with a continuous quality improvement strategy: a report from the Interventions to Minimize Preterm and Low Birth Weight Infants through Continuous Improvement Techniques (IMPLICIT) Network.

    Science.gov (United States)

    Bennett, Ian M; Coco, Andrew; Anderson, Janice; Horst, Michael; Gambler, Angela S; Barr, Wendy Brooks; Ratcliffe, Stephen

    2009-01-01

    Maternal medical care (prenatal and postpartum) involves a set of clinical interventions addressing risk factors associated with important maternal and infant outcomes. Programs to increase the rate of delivery of these interventions in clinical practice have not been widely implemented. A practice-based research network focused on developing continuous quality improvement (CQI) processes for maternal care among 10 family medicine residency training sites in the northeastern United States (the IMPLICIT Network) from January 2003 through September 2007. Documented delivery of 5 standard maternal care interventions was assessed before and after initiating a program to increase their frequency. Proportion chart analyses were conducted comparing the period before and after implementation of the CQI interventions. Data were available for 3936 pregnancies during the course of the study period. Results varied across the clinical interventions. Significant improvement in care processes was seen for 3 screening activities: (1) prenatal depression symptomatology (by 15 weeks' gestation); (2) screening for smoking at 30 weeks' gestation; (3) and postpartum contraception planning. Screening for smoking by 15 weeks' gestation and testing for asymptomatic bacteriuria were already conducted >90% of the time during the baseline period and did not increase significantly after initiating the CQI program. Screening for postpartum depression symptomatology was recorded in 50% to 60% of women before the CQI program and did not increase significantly. A practice-based research network of family medicine residency practices focused on CQI outcomes was successful in increasing the delivery of some maternal care interventions.

  4. Doctors admitted to a Physicians’ Health Program: a comparison of self-referrals versus directed referrals

    Science.gov (United States)

    Braquehais, María Dolores; Valero, Sergi; Bel, Miquel Jordi; Navarro, María Cecilia; Matalí, Josep Lluís; Nasillo, Viviana; Padrós, Jaume; Arteman, Antoni; Bruguera, Eugeni; Casas, Miquel

    2014-01-01

    Objective To compare the profile of doctors with mental disorders admitted to a Physicians’ Health Program (PHP) depending on their type of referral. Design Retrospective chart review. Method We analysed 1545 medical records of doctors admitted to the Barcelona PHP (PAIMM) from 1 February 1998 to 31 December 2012. Results Most doctors (83.2%) were self-referred to the programme. Patients non-self-referred were older (=55 vs =49.6 years; t=6.96, p<0.01) than those self-referred and there were more men (68.3%) than women (45.8%; OR=0.39; 95% CI 0.29 to 0.52). Self-referrals were more frequent among patients with non-addictive disorders (84.6% vs 15.4%; OR=4.52; 95% CI 3.23 to 28.45). Self-referred patients needed less inpatient admissions (16.8% vs30.9%; OR=2.22; 95% CI 1.63 to 3.01) and the length of their treatment episodes was shorter (=24.3 vs  = 32.4 months; t=3.34; p<0.01). Logistic regression showed a significant model (χ2=67.52; df=3; p<0.001). Age, gender and diagnosis were statistically associated with type of referral to the programme. Conclusions Type of referral to a PHP may be influenced not only by sick doctors’ personal traits but also by each programme's design and how it is perceived by service users. Our findings should be taken into account when designing treatment and preventive interventions for this professional group. PMID:24993767

  5. Effectiveness of a participatory ergonomics intervention in improving communication and psychosocial exposures.

    Science.gov (United States)

    Laing, A C; Cole, D C; Theberge, N; Wells, R P; Kerr, M S; Frazer, M B

    2007-07-01

    A participatory ergonomics programme was implemented in an automotive parts manufacturing factory in which an ergonomics change team was formed, composed of members from management, the organized labour union and the research team. It was hypothesized that the participatory nature of this change process would result in enhanced worker perceptions of workplace communication dynamics, decision latitude and influence, which in conjunction with anticipated mechanical exposure reductions would lead to reduced worker pain severity. Utilizing a sister plant in the corporation as a referent group, a quasi-experimental design was employed with a longitudinal, repeat questionnaire approach to document pre-post intervention changes. Nine participatory activities (psychosocial interventions) were implemented as part of the process. Communication dynamics regarding ergonomics were significantly enhanced at the intervention plant compared to the referent plant. However, there were no significantly different changes in worker perceptions of decision latitude or influence between the two plants, nor did pain severity change. Possible explanations for these results include limited intervention intensity, context and co-intervention differences between the two plants, high plant turnover reducing the statistical power of the study and lack of sensitivity and specificity in the psychosocial measures used. Further research should include the development of psychosocial tools more specific to participatory ergonomic interventions and the assessment of the extent of change in psychosocial factors that might be associated with improvements in pain.

  6. Identifying Interventions for Improving Letter Formation: A Brief Experimental Analysis of Students with Intellectual Disabilities

    Directory of Open Access Journals (Sweden)

    E. Rüya ÖZMEN

    2016-09-01

    Full Text Available As a group, students with intellectual disabilities display difficulties in a wide range of academic skills, including the acquisition of basic academic skills such as literacy. Early writing and reading skills must be supported to prepare students with intellectual disabilities to learn to read and write. The goal of this study was to replicate and extend the current research on Brief Experimental Analysis with letter formation. Three students with intellectual disabilities participated in the study. A brief multi-element design was used to test effectiveness of four interventions on letter formation. These interventions included goal setting plus contingent reinforcement, graphical feedback, error correction and modeling. For one student, modeling was effective; for the two remaining students, goal setting plus contingent reinforcement was effective. The results of this study extend the BEA literature by investigating the effects of interventions for improving letter formation in students with intellectual disabilities. The study findings suggest that using BEA to assess the relative contribution of each intervention can identify the most effective interventions for improving letter formation in students with intellectual disabilities.

  7. An educational intervention to improve nurses' knowledge, attitude, and practice toward reporting of adverse drug reactions.

    Science.gov (United States)

    Hanafi, Somayeh; Torkamandi, Hassan; Hayatshahi, Alireza; Gholami, Kheirollah; Shahmirzadi, Nikinaz Ashrafi; Javadi, Mohammad Reza

    2014-01-01

    The reporting of adverse drug reactions (ADRs) by nurses in hospitals is very important. This study was aimed at investigating the impact of an educational intervention to improve ADR reporting and whether trained nurses had better knowledge, attitude, and practice toward ADR reporting. A total of 300 nurses in a tertiary care teaching hospital in Tehran, Iran were evaluated with a knowledge, attitude, and practice (KAP) questionnaire regarding ADR reporting in March 2010. After this, an educational program about ADR was provided to nurses. Then the nurses were re-evaluated by the same questionnaire. Comparisons were made of the attitude and knowledge within nurses, before and after education. Data were analyzed using SPSS software. P < 0.05 was considered as significant level. Independent-sample t-test was used to measure the intervention effect. The response rate was 61.3% (N = 184). Knowledge of nurses before the intervention was significantly less than the knowledge after the intervention (P = 0.001). Also, there was a significant effect on attitude (P = 0.002). During the follow-up period of 4 months after the intervention, 26 spontaneous reports were received. Continuous ADR educational program, training, and integration of ADRs' reporting into the activities of the nurses would likely improve ADR reporting.

  8. Evaluating an educational intervention to improve the accuracy of death certification among trainees from various specialties

    Directory of Open Access Journals (Sweden)

    Villar Jesús

    2007-11-01

    Full Text Available Abstract Background The inaccuracy of death certification can lead to the misallocation of resources in health care programs and research. We evaluated the rate of errors in the completion of death certificates among medical residents from various specialties, before and after an educational intervention which was designed to improve the accuracy in the certification of the cause of death. Methods A 90-min seminar was delivered to seven mixed groups of medical trainees (n = 166 from several health care institutions in Spain. Physicians were asked to read and anonymously complete a same case-scenario of death certification before and after the seminar. We compared the rates of errors and the impact of the educational intervention before and after the seminar. Results A total of 332 death certificates (166 completed before and 166 completed after the intervention were audited. Death certificates were completed with errors by 71.1% of the physicians before the educational intervention. Following the seminar, the proportion of death certificates with errors decreased to 9% (p Conclusion Major errors in the completion of the correct cause of death on death certificates are common among medical residents. A simple educational intervention can dramatically improve the accuracy in the completion of death certificates by physicians.

  9. A Multifaceted Prospective Memory Intervention to Improve Medication Adherence: Design of a Randomized Control Trial

    Science.gov (United States)

    Insel, Kathie C.; Einstein, Gilles O.; Morrow, Daniel G.; Hepworth, Joseph T.

    2012-01-01

    Adherence to prescribed antihypertensive agents is critical because control of elevated blood pressure is the single most important way to prevent stroke and other end organ damage. Unfortunately, nonadherence remains a significant problem. Previous interventions designed to improve adherence have demonstrated only small benefits of strategies that target single facets such as understanding medication directions. The intervention described here is informed by prospective memory theory and performance of older adults in laboratory-based paradigms and uses a comprehensive, multifaceted approach to improve adherence. It incorporates multiple strategies designed to support key components of prospective remembering involved in taking medication. The intervention is delivered by nurses in the home with an education control group for comparison. Differences between groups in overall adherence following the intervention and 6 months later will be tested. Systolic and diastolic blood pressure levels also will be examined between groups and as it relates to adherence. Intra-individual regression is planned to examine change in adherence over time and its predictors. Finally, we will examine the association between executive function/working memory and adherence, predicting that adherence will be related to executive/working memory in the control group but not in the intervention group. PMID:23010608

  10. FTO Genotype Interacts with Improvement in Aerobic Fitness on Body Weight Loss During Lifestyle Intervention.

    Science.gov (United States)

    Sailer, Corinna; Schmid, Vera; Fritsche, Louise; Gerter, Tsvetelina; Machicao, Fausto; Niess, Andreas; Häring, Hans-Ulrich; Stefan, Norbert; Fritsche, Andreas; Heni, Martin

    2016-01-01

    Not every participant responds with a comparable body weight loss to lifestyle intervention, despite the same compliance. Genetic factors may explain parts of this difference. Variation in fat mass and obesity-associated gene (FTO) is the strongest common genetic determinant of body weight. The aim of the present study was to evaluate the impact of FTO genotype differences in the link between improvement of fitness and reduction of body weight during a lifestyle intervention. We genotyped 292 healthy subjects for FTO rs8050136. Participants underwent a 9-month lifestyle intervention. Before and after intervention, aerobic fitness was tested by bicycle (VO2max) and treadmill spiroergometry (individual anaerobic threshold (IAT), subgroup of N = 192). Participants lost body weight (p fitness lost significantly less body weight. Our data reveal that genetic variation in FTO impacts on body weight reduction during lifestyle intervention only in subjects with marked improvement in aerobic fitness. © 2016 The Author(s) Published by S. Karger GmbH, Freiburg.

  11. A culturally appropriate intervention to improve health behaviors in Hispanic mother-child dyads.

    Science.gov (United States)

    Bender, Melinda S; Nader, Philip R; Kennedy, Christine; Gahagan, Sheila

    2013-04-01

    Obesity interventions targeting Hispanic preschool children are still nascent, and few are culturally appropriate. We evaluated the feasibility of a culturally relevant 9-month intervention program to improve health behaviors in low-income Mexican mothers with 3- to 5-year-old children. A community engagement approach was used to culturally and linguistically tailor an intervention program that was pilot tested with 33 mother-child dyads enrolled from a large California urban health center. A one-group, pretest-posttest design assessed changes in children's consumption of sugar-sweetened beverages (SSB), mothers' pedometer steps, and BMI. Data were collected at baseline, postintervention and at 6 months postintervention. At postintervention, SSB consumption had significantly decreased for soda and other sugary drinks with a modest reduction for 100% juice. Consumption of water had significantly increased, whereas milk had an increased trend. Maternal step counts significantly increased for weekdays by 69% and weekend days by 49%. Overall, maternal BMI decreased while children's BMI% remained stable. At 6 months postintervention, children's soda and juice consumption reverted toward baseline levels, as did maternal step counts, but children's consumption of sugary drinks remained lower, while water and milk remained higher. Findings suggest that a culturally relevant intervention was feasible for improving target health behaviors in a low-income Mexican community. Future work should assess an enhanced intervention including a maintenance phase for long-term adherence to health behavior changes and influence on maternal and child BMI.

  12. Improving Physical Activity and Metabolic Syndrome Indicators in Women: A Transtheoretical Model-Based Intervention

    Science.gov (United States)

    Mostafavi, Firoozeh; Ghofranipour, Fazllolah; Feizi, Awat; Pirzadeh, Asiyeh

    2015-01-01

    Background: This study aimed at investigating the impact of an educational intervention based on transtheoretical model to increase physical activity and improve metabolic syndrome indicators in women. Methods: In this quasi-experimental study, 142 women with metabolic syndrome were randomly assigned to the case and control group (each group 71 participants). SECQ (Marcus), processes of change (Marcus), decisional balance (Bandura) and self-efficacy (Nigg) questionnaires and International Physical Activities Standard Questionnaire in preintervention, 3 and 6 months after intervention were completed. Furthermore, abdominal obesity, triglycerides (TG), and high-density lipoprotein (HDL) were measured. Physical activity intervention based on transtheoretical model (TTM) was performed in the case group. Finally, data were analyzed by SPSS (16) (SPSS Inc., Chicago, IL, USA) and repeated measure ANOVA, independent t-test and Freidman was used. A two-tailed P value, lower than 0.05, was considered to be statistically significant. Results: After the intervention, physical activity level increased in the intervention group, and they also progressed in stages of change, but the people in the control group had regressed. All changes in TTM constructs were significant in the intervention group during the time and differences in pros and cons were not significant in the control group. Abdominal obesity and TG has significantly reduced, and HDL has increased in the intervention group. In the control group, there was a significant increase in TGs and a decrease in HDL. Conclusions: Physical activity training based on TTM can improve physical activity and metabolic syndrome indicators in women. PMID:25949778

  13. NARRATIVE AND META-ANALYTIC REVIEW OF INTERVENTIONS AIMING TO IMPROVE MATERNAL-CHILD ATTACHMENT SECURITY.

    Science.gov (United States)

    Letourneau, Nicole; Tryphonopoulos, Panagiota; Giesbrecht, Gerald; Dennis, Cindy-Lee; Bhogal, Sanjit; Watson, Barry

    2015-01-01

    Early secure maternal-child attachment relationships lay the foundation for children's healthy social and mental development. Interventions targeting maternal sensitivity and maternal reflective function during the first year of infant life may be the key to promoting secure attachment. We conducted a narrative systematic review and meta-analysis to examine the effectiveness of interventions aimed at promoting maternal sensitivity and reflective function on maternal-child attachment security, as measured by the gold standard Strange Situation (M. Ainsworth, M. Blehar, B. Waters, & S. Wall, 1978) and Q-set (E. Waters & K. Deane, 1985). Studies were identified from electronic database searches and included randomized or quasi-randomized controlled parallel-group designs. Participants were mothers and their infants who were followed up to 36 months' postpartum. Ten trials, involving 1,628 mother-infant pairs, were included. Examination of the trials that provided sufficient data for combination in meta-analysis revealed that interventions of both types increased the odds of secure maternal-child attachment, as compared with no intervention or standard intervention (n = 7 trials; odds ratio: 2.77; 95% confidence interval: 1.69, 4.53, n = 965). Of the three trials not included in the meta-analyses, two improved the likelihood of secure attachment. We conclude that interventions aimed at improving maternal sensitivity alone or in combination with maternal reflection, implemented in the first year of infants' lives, are effective in promoting secure maternal-child attachments. Intervention aimed at the highest risk families produced the most beneficial effects.

  14. Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Bate, Gareth; Kelly, Lisa; Darvall, Katy; Bradbury, Andrew W

    2017-01-01

    Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in

  15. Economic analysis of interventions to improve village chicken production in Myanmar.

    Science.gov (United States)

    Henning, J; Morton, J; Pym, R; Hla, T; Sunn, K; Meers, J

    2013-07-01

    A cost-benefit analysis using deterministic and stochastic modelling was conducted to identify the net benefits for households that adopt (1) vaccination of individual birds against Newcastle disease (ND) or (2) improved management of chick rearing by providing coops for the protection of chicks from predation and chick starter feed inside a creep feeder to support chicks' nutrition in village chicken flocks in Myanmar. Partial budgeting was used to assess the additional costs and benefits associated with each of the two interventions tested relative to neither strategy. In the deterministic model, over the first 3 years after the introduction of the interventions, the cumulative sum of the net differences from neither strategy was 13,189Kyat for ND vaccination and 77,645Kyat for improved chick management (effective exchange rate in 2005: 1000Kyat=1$US). Both interventions were also profitable after discounting over a 10-year period; Net Present Values for ND vaccination and improved chick management were 30,791 and 167,825Kyat, respectively. The Benefit-Cost Ratio for ND vaccination was very high (28.8). This was lower for improved chick management, due to greater costs of the intervention, but still favourable at 4.7. Using both interventions concurrently yielded a Net Present Value of 470,543Kyat and a Benefit-Cost Ratio of 11.2 over the 10-year period in the deterministic model. Using the stochastic model, for the first 3 years following the introduction of the interventions, the mean cumulative sums of the net difference were similar to those values obtained from the deterministic model. Sensitivity analysis indicated that the cumulative net differences were strongly influenced by grower bird sale income, particularly under improved chick management. The effects of the strategies on odds of households selling and consuming birds after 7 months, and numbers of birds being sold or consumed after this period also influenced profitability. Cost variations for

  16. Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

    Directory of Open Access Journals (Sweden)

    Rogers William H

    2008-01-01

    Full Text Available Abstract Background Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any should be deferred to a subsequent visit. Methods Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores. Results There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02 and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08 compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group. Conclusion A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality

  17. Challenges in improving fitness: results of a community-based, randomized, controlled lifestyle change intervention.

    Science.gov (United States)

    Yancey, Antronette K; McCarthy, William J; Harrison, Gail G; Wong, Weng Kee; Siegel, Judith M; Leslie, Joanne

    2006-05-01

    This study tested the efficacy of an 8-week culturally targeted nutrition and physical activity intervention on body composition. A randomized, attention-controlled, two-group trial was conducted in a blackowned commercial gym with a sample of 366 predominantly healthy, obese African American women. A free 1-year membership to the study site gym was provided to participants in both groups. Data were collected at baseline, 2, 6, and 12 months. Sample retention at 1 year was 71%. Between-group longitudinal analysis including only participants with complete data revealed a trend toward weight stability in the intervention group at 2 months compared with controls (+0.05 kg/m(2), p = 0.75; +0.32 kg/m(2), p = 0.08, respectively), disappearing at 12 months (+1.37 kg/m(2), p = 0.0001; +1.02 kg/m(2), p = 0.001, respectively). Within-group analysis demonstrated that intervention and control participants' fitness (1-mile run-walk) improved by 1.9 minutes (p = 0.0001) and 2.3 minutes (p = 0.0001), respectively, at 12 months. Mixed model regression analyses demonstrated a significant main effect of the intervention on fitness (p = 0.0185) and a marginally significant effect on body mass index (BMI) (p = 0.057), at 2 months, disappearing by 6 months. By 12 months, however, the controls exhibited a significant advantage in waist circumference stability compared with intervention participants (+1.1 cm, p = 0.2763; +2.1 cm, p = 0.0002, respectively). The intervention produced modest short-term improvements in body composition, but the economic incentive of a free 1-year gym membership provided to all participants was a more potent intervention than the education and social support intervention tested. However, longer-term fitness enhancement remains elusive and demands research and policy attention. These findings have policy implications in that employer-/insurer-subsidized gym memberships may require interventions targeting other levels of change (e.g., physical or social

  18. Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique.

    Science.gov (United States)

    Sutton, Roberta; Lahuerta, Maria; Abacassamo, Fatima; Ahoua, Laurence; Tomo, Maria; Lamb, Matthew R; Elul, Batya

    2017-01-01

    Challenges to ensuring timely linkage to and retention in HIV care are well documented. Combination intervention strategies can be effective in improving the HIV care continuum. Data on feasibility and acceptability of intervention types within intervention packages are limited. The Engage4Health study assessed the effectiveness of a combination intervention strategy to increase linkage and retention among adults newly diagnosed with HIV in Mozambique. The study included 2 health communication interventions-modified delivery of pre-antiretroviral therapy (pre-ART) counseling sessions and SMS reminders-and 3 structural interventions-point-of-care CD4 testing after diagnosis, accelerated ART initiation, and noncash financial incentives. We used a process evaluation framework to assess dose delivered-extent each intervention was delivered as planned-and dose received-participant acceptability-of health communication versus structural interventions in the effectiveness study to understand associated benefits and challenges. Data sources included study records, participant interviews, and clinical data. For dose delivered of health communication interventions, 98% of eligible clients received pre-ART counseling and 90% of participants received at least one SMS reminder. For structural interventions, 74% of clients received CD4 testing and 53% of eligible participants initiated ART within 1 month. Challenges for structural interventions included facility-level barriers, staffing limitations, and machine malfunctions. For dose received, participants reported pre-ART counseling and CD4 testing as the most useful interventions for linkage and financial incentives as the least useful for linkage and retention. Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies.

  19. The impact of structural interventions to improve physical fitness among adolescents

    DEFF Research Database (Denmark)

    Breum, Lars; Toftager, Mette; Troelsen, Jens

    and organization of the after school fitness program was implemented in only two local areas. A process analysis showed that a multicomponent intervention generates synergy but there is an upper limit related to feasibility and external validity of the intervention. Based on two-year follow-up data physical tests...... did not show significant effect in regard to physical fitness, handgrip strength and waist circumference. On average boys improved their running distance with 59 m, increased their handgrip strength with 11 kg and gained 6.3 cm in waist circumference. For girls the change was 0 m, 5.2 kg and 6.1 cm...

  20. A pragmatic approach to measuring, monitoring and evaluating interventions for improved tuberculosis case detection.

    Science.gov (United States)

    Blok, Lucie; Creswell, Jacob; Stevens, Robert; Brouwer, Miranda; Ramis, Oriol; Weil, Olivier; Klatser, Paul; Sahu, Suvanand; Bakker, Mirjam I

    2014-09-01

    The inability to detect all individuals with active tuberculosis has led to a growing interest in new approaches to improve case detection. Policy makers and program staff face important challenges measuring effectiveness of newly introduced interventions and reviewing feasibility of scaling-up successful approaches. While robust research will continue to be needed to document impact and influence policy, it may not always be feasible for all interventions and programmatic evidence is also critical to understand what can be expected in routine settings. The effects of interventions on early and improved tuberculosis detection can be documented through well-designed program evaluations. We present a pragmatic framework for evaluating and measuring the effect of improved case detection strategies using systematically collected intervention data in combination with routine tuberculosis notification data applying historical and contemporary controls. Standardized process evaluation and systematic documentation of program implementation design, cost and context will contribute to explaining observed levels of success and may help to identify conditions needed for success. Findings can then guide decisions on scale-up and replication in different target populations and settings. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

  1. Do evidence based interventions for chronic fatigue syndrome improve sleep? A systematic review and narrative synthesis.

    Science.gov (United States)

    Russell, Charlotte; Kyle, Simon D; Wearden, Alison J

    2017-06-01

    Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) are recommended evidence based treatments for chronic fatigue syndrome (CFS), with research supporting their effectiveness in reducing fatigue and functional impairment. However, little research has focussed on the effect of these treatments on sleep, despite high reported sleep disturbance in CFS. Using a narrative synthesis approach, we aimed to 1) systematically identify and summarise the current evidence for the effectiveness of CBT and GET in improving sleep; 2) consider factors influencing treatment effectiveness, including incorporation of sleep management techniques; and 3) consider the appropriateness of sleep outcome measures used within evaluations. Studies evaluating CBT and/or GET for CFS, and including a sleep outcome were eligible for inclusion. Eight studies were identified. We found that GET interventions can improve sleep but this effect is inconsistent across studies. For CBT the evidence is limited with only one of two evaluations demonstrating sleep-related improvements. We conclude from existing research that we know little about the effects of including sleep management components within CBT and GET interventions. We suggest that future research should explore the effectiveness of sleep components within interventions, and sleep specific interventions, using comprehensive outcome measures that fully capture the range of sleep difficulties experienced in CFS. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Wireless Mobile Technology to Improve Workflow and Feasibility of MR-Guided Percutaneous Interventions

    Science.gov (United States)

    Rube, Martin A.; Holbrook, Andrew B.; Cox, Benjamin F.; Buciuc, Razvan; Melzer, Andreas

    2015-01-01

    Purpose A wireless interactive display and control device combined with a platform-independent web-based User Interface (UI) was developed to improve the workflow for interventional Magnetic Resonance Imaging (iMRI). Methods The iMRI-UI enables image acquisition of up to three independent slices using various pulse sequences with different contrast weighting. Pulse sequence, scan geometry and related parameters can be changed on the fly via the iMRI-UI using a tablet computer for improved lesion detection and interventional device targeting. The iMRI-UI was validated for core biopsies with a liver phantom (n=40) and Thiel soft-embalmed human cadavers (n=24) in a clinical 1.5T MRI scanner. Results The iMRI-UI components and setup were tested and found conditionally MRI-safe to use according to current ASTM standards. Despite minor temporary touchscreen interference at a close distance to the bore (<20 cm), no other issues regarding quality or imaging artefacts were observed. The 3D root-mean-square distance error was 2.8±1.0 (phantom) / 2.9±0.8 mm (cadaver) and overall procedure times ranged between 12–22 (phantom) / 20–55 minutes (cadaver). Conclusions The wireless iMRI-UI control setup enabled fast and accurate interventional biopsy needle placements along complex trajectories and improved the workflow for percutaneous interventions under MRI guidance in a preclinical trial. PMID:25179151

  3. Interventions to improve the appropriate use of polypharmacy for older people.

    Science.gov (United States)

    Patterson, Susan M; Cadogan, Cathal A; Kerse, Ngaire; Cardwell, Chris R; Bradley, Marie C; Ryan, Cristin; Hughes, Carmel

    2014-10-07

    Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. This review sought to determine which interventions, alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people. In November 2013, for this first update, a range of literature databases including MEDLINE and EMBASE were searched, and handsearching of reference lists was performed. Search terms included 'polypharmacy', 'medication appropriateness' and 'inappropriate prescribing'. A range of study designs were eligible. Eligible studies described interventions affecting prescribing aimed at improving appropriate polypharmacy in people 65 years of age and older in which a validated measure of appropriateness was used (e.g. Beers criteria, Medication Appropriateness Index (MAI)). Two review authors independently reviewed abstracts of eligible studies, extracted data and assessed risk of bias of included studies. Study-specific estimates were pooled, and a random-effects model was used to yield summary estimates of effect and 95% confidence intervals (CIs). The GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach was used to assess the overall quality of evidence for each pooled outcome. Two studies were added to this review to bring the total number of included studies to 12. One intervention consisted of computerised decision support; 11 complex, multi-faceted pharmaceutical approaches to interventions were provided in a variety of settings. Interventions were delivered by healthcare professionals, such as prescribers and pharmacists. Appropriateness of prescribing was measured using validated tools, including the MAI score

  4. Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation

    NARCIS (Netherlands)

    Noben, C.; Evers, S.; Genabeek, J.V.; Nijhuis, F.; Rijk, A. de

    2016-01-01

    Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness

  5. Rationale for Percutaneous Intervention of CTO.

    Science.gov (United States)

    Waram, Kethes C; Willis, Nicholas P; Girotra, Sudhakar; Shaker, Rimon L; Pershad, Ashish

    2012-07-01

    Chronic total occlusion accounts for 15% of cases during diagnostic angiography with higher referral rate to surgical revascularization. With contemporary strategies and techniques, the success rate with experienced operators can exceed 90%. Currently available observational studies in carefully selected patient populations show evidence of a trend toward symptom relief; improvement in quality of life, left ventricular function, and mortality; and improved tolerance toward future ischemic events. Lack of randomized controlled trials comparing current optimal medical management with percutaneous coronary intervention for chronic total occlusion is a major barrier to widespread adaptation of this advanced complex interventional technique. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda

    National Research Council Canada - National Science Library

    Leerlooijer, J.N; Kok, G; Weyusya, J; Bos, A.E.R; Ruiter, R.A.C; Rijsdijk, E; Nshakira, N; Bartholomew, L.K

    2014-01-01

    .... This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried teenage mothers in rural Uganda...

  7. Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

    Science.gov (United States)

    Mosnaim, Giselle S.; Pappalardo, Andrea A.; Resnick, Scott E.; Codispoti, Christopher D.; Bandi, Sindhura; Nackers, Lisa; Malik, Rabia N.; Vijayaraghavan, Vimala; Lynch, Elizabeth B.; Powell, Lynda H.

    2015-01-01

    Background Factors at multiple ecological levels, including the child, family, home, medical care, and community, impact adolescent asthma outcomes. Objective This systematic review characterizes behavioral interventions at the child, family, home, medical system, and community level to improve asthma management among adolescents. Methods A systematic search of PubMed, SCOPUS, OVID, PsycINFO, CINAHL, and reference review databases was conducted from January 1, 2000 through August 10, 2014. Articles were included if the title or abstract included asthma AND intervention AND (Education OR self-management OR behavioral OR technology OR trigger reduction); and the mean/median age of participants was between eleven and sixteen years. We compared populations, intervention characteristics, study designs, outcomes, settings, and intervention levels across studies to evaluate behavioral interventions to improve asthma management for adolescents. Results Of 1230 articles identified and reviewed, 24 articles (21 unique studies) met inclusion criteria. Promising approaches to improving adherence to daily controller medications include: objective monitoring of inhaled corticosteroid adherence with allergist/immunologist feedback on medication taking behavior and school nurse directly observed therapy. Efficacy at increasing asthma self-management skills was demonstrated using group interactive learning in the school setting. This systematic review is not a meta-analysis, thus limiting its quantitative assessment of studies. Publication bias may also limit our findings. Conclusions Novel strategies to objectively increase controller medication adherence for adolescents include allergist/immunologist feedback and school nurse directly observed therapy. Schools, the most common setting across studies in this review, provide the opportunity for group interactive learning to improve asthma knowledge and self-management skills. PMID:26563672

  8. Effect of interventions to improve health care services for ethnic minority populations

    Directory of Open Access Journals (Sweden)

    Louise Forsetlund

    2011-03-01

    Full Text Available Objectives: Since the early 1990s there has been an increasing awareness of social and ethnic inequity in health and for the last few years there has also been an increasing focus on disparities in the quality of health services to ethnic minority groups. The aim of this review was to collect and summarise in a systematic and transparent manner the effect of interventions to improve health care services for ethnic minorities.Methods: We searched several medical databases for systematic reviews and randomised controlled trials. Two researchers independently screened for and selected studies, assessed risk of bias, extracted data and graded the quality of the evidence for each outcome in the included studies. The analysis was done qualitatively by describing studies and presenting them in tables.Results: We included 19 primary studies. The interventions were targeted at reducing clinical, structural and organisational barriers against good quality health care services. Eight studies examined the effect of educational interventions in improving outcomes within cross-cultural communication, smoking cessation, asthma care, cancer screening and mental health care. In six comparisons the effect of reminders for improving health care services and patient outcomes within cancer screening and diabetes care was examined. Two studies compared professional remote interpretation services to traditional interpretation services, two studies compared ethnic matching of client and therapist and two studies examined the effect of providing additional support in the form of more personnel in the treatment of diabetes and kidney transplant patients. Most patients were African-Americans and Latin-Americans and all ages were represented.Conclusions: Educational interventions and electronic reminders to physicians may in some contexts improve health care and health outcomes for minority patients. The quality of the evidence varied from low to very low. The quality of

  9. Culturally adaptive storytelling intervention versus didactic intervention to improve hypertension control in Vietnam: a cluster-randomized controlled feasibility trial

    National Research Council Canada - National Science Library

    Hoa L Nguyen; Jeroan J Allison; Duc A Ha; German Chiriboga; Ha N Ly; Hanh T Tran; Cuong K Nguyen; Diem M Dang; Ngoc T Phan; Nguyen C Vu; Quang P Nguyen; Robert J Goldberg

    2017-01-01

    ...,” and a didactic intervention. Methods The storytelling intervention included stories about strategies for coping with hypertension, with patients speaking in their own words, and didactic content about the importance of healthy...

  10. Can a school physical activity intervention improve physical self-perception and enjoyment?

    DEFF Research Database (Denmark)

    Lund-Cramer, Pernille; Christiansen, Lars Breum Skov; Smedegaard, Søren

    2016-01-01

    Purpose Physical activity at school can improve mental health of all children – especially if it is targeted to children’s needs and executed in a positive social climate. The purpose of the present study was to examine the effect of a multicomponent school-based physical activity intervention......-perception, and HRQoL) was collected prior to intervention and after 9 months. Results At baseline 2.892 children (92%) completed the survey. Mean physical self-perceptions [1-4] were generally high; Athletic Competence: 2.95, Body Attractiveness: 2.75, Physical Self-Worth: 3.12. However, a large minority had low self......-perceptions. Mean Physical Activity Enjoyment [7-35] was 28.7. After collection of follow-up data in June 2016, multivariate multilevel analysis will be used to determine post intervention differences in physical self-perception and enjoyment of physical activity. Results will be available for the conference...

  11. Can a school physical activity intervention improve physical self-perception and enjoyment?

    DEFF Research Database (Denmark)

    Lund-Cramer, Pernille; Christiansen, Lars Breum Skov; Smedegaard, Søren

    2016-01-01

    Purpose Physical activity at school can improve mental health of all children – especially if it is targeted to children’s needs and executed in a positive social climate. The purpose of the present study was to examine the effect of a multicomponent school-based physical activity intervention......-perceptions. Mean Physical Activity Enjoyment [7-35] was 28.7. After collection of follow-up data in June 2016, multivariate multilevel analysis will be used to determine post intervention differences in physical self-perception and enjoyment of physical activity. Results will be available for the conference...... on physical self-perception and enjoyment of physical activity among children aged 10-13 years. Methods An intervention based on Self-Determination Theory was developed and pilot tested in close co-operation with schools and targeted 1) physical education lessons, 2) in-class activity, and 3) physical...

  12. Analysis of the Efficacy of an Intervention to Improve Parent-Adolescent Problem Solving.

    Science.gov (United States)

    Semeniuk, Yulia Yuriyivna; Brown, Roger L; Riesch, Susan K

    2016-07-01

    We conducted a two-group longitudinal partially nested randomized controlled trial to examine whether young adolescent youth-parent dyads participating in Mission Possible: Parents and Kids Who Listen, in contrast to a comparison group, would demonstrate improved problem-solving skill. The intervention is based on the Circumplex Model and Social Problem-Solving Theory. The Circumplex Model posits that families who are balanced, that is characterized by high cohesion and flexibility and open communication, function best. Social Problem-Solving Theory informs the process and skills of problem solving. The Conditional Latent Growth Modeling analysis revealed no statistically significant differences in problem solving among the final sample of 127 dyads in the intervention and comparison groups. Analyses of effect sizes indicated large magnitude group effects for selected scales for youth and dyads portraying a potential for efficacy and identifying for whom the intervention may be efficacious if study limitations and lessons learned were addressed.

  13. Referrals between Public Sector Health Institutions for Women with Obstetric High Risk, Complications, or Emergencies in India - A Systematic Review.

    Science.gov (United States)

    Singh, Samiksha; Doyle, Pat; Campbell, Oona M; Mathew, Manu; Murthy, G V S

    2016-01-01

    Emergency obstetric care (EmOC) within primary health care systems requires a linked referral system to be effective in reducing maternal death. This systematic review aimed to summarize evidence on the proportion of referrals between institutions during pregnancy and delivery, and the factors affecting referrals, in India. We searched 6 electronic databases, reviewed four regional databases and repositories, and relevant program reports from India published between 1994 and 2013. All types of study or reports (except editorials, comments and letters) which reported on institution-referrals (out-referral or in-referral) for obstetric care were included. Results were synthesized on the proportion and the reasons for referral, and factors affecting referrals. Of the 11,346 articles identified by the search, we included 232 articles in the full text review and extracted data from 16 studies that met our inclusion criteria Of the 16, one was RCT, seven intervention cohort (without controls), six cross-sectional, and three qualitative studies. Bias and quality of studies were reported. Between 25% and 52% of all pregnancies were referred from Sub-centres for antenatal high-risk, 14% to 36% from nurse run delivery or basic EmOC centres for complications or emergencies, and 2 to 7% were referred from doctor run basic EmOC centres for specialist care at comprehensive EmOC centres. Problems identified with referrals from peripheral health centres included low skills and confidence of staff, reluctance to induce labour, confusion over the clinical criteria for referral, non-uniform standards of care at referral institutions, a tendency to by-pass middle level institutions, a lack of referral communication and supervision, and poor compliance. The high proportion of referrals from peripheral health centers reflects the lack of appropriate clinical guidelines, processes, and skills for obstetric care and referral in India. This, combined with inadequate referral communication

  14. Lifestyle intervention reduces body weight and improves cardiometabolic risk factors in worksites.

    Science.gov (United States)

    Salinardi, Taylor C; Batra, Payal; Roberts, Susan B; Urban, Lorien E; Robinson, Lisa M; Pittas, Anastassios G; Lichtenstein, Alice H; Deckersbach, Thilo; Saltzman, Edward; Das, Sai Krupa

    2013-04-01

    Worksites are potentially effective locations for obesity control because they provide opportunities for group intervention and social support. Studies are needed to identify effective interventions in these settings. We examined the effects of a multicomponent lifestyle intervention on weight loss and prevention of regain in 4 worksites (2 intervention and 2 control sites). Overweight and obese employees (n = 133) enrolled in this pilot worksite-randomized controlled trial with a 0-6-mo weight-loss phase and a 6-12-mo structured weight-maintenance phase. The intervention combined recommendations to consume a reduced-energy, low-glycemic load, high-fiber diet with behavioral change education. Outcome measurements included changes in body weight and cardiometabolic risk factors. The mean ± SEM weight loss was substantial in intervention participants, whereas control subjects gained weight (-8.0 ± 0.7 compared with +0.9 ± 0.5 kg, respectively; P weight-loss phase. Intervention effects were not significant at the 0.05 level but would have been at the 0.10 level (P = 0.08) in a mixed model in which the worksite nested within group was a random factor. There were also significant improvements in cardiometabolic risk factors in intervention compared with control subjects regarding fasting total cholesterol, glucose, systolic blood pressure, and diastolic blood pressure (P ≤ 0.02 for each). No significant weight regain was observed in participants who enrolled in the structured weight-maintenance program (0.5 ± 0.7 kg; P = 0.65), and overweight and obese employees in intervention worksites who were not enrolled in the weight-loss program lost weight compared with subjects in control worksites (-1.3 ± 0.5 compared with +0.7 ± 0.2 kg, respectively; P = 0.02). Worksites can be effective for achieving clinically important reductions in body weight and improved cardiometabolic risk factors. This trial was registered at clinicaltrials.gov as NCT01470222.

  15. "The Friendly Clergy": Characteristics and Referral.

    Science.gov (United States)

    Faiver, Christopher M.; O'Brien, Eugene M.; McNally, Christopher J.

    1998-01-01

    Among the recommendations possible in assessment of clients' religious beliefs is that of referral to the "friendly clergy." Delineates guidelines for referral as well as ideal characteristics of that spiritual profession. (Author)

  16. Improvement of Interoceptive Processes after an 8-Week Body Scan Intervention

    Directory of Open Access Journals (Sweden)

    Dana Fischer

    2017-09-01

    Full Text Available Objective: Interoceptive processes are defined as ability to detect sensations arising within the body. There is a growing body of research investigating ways of improving interoceptive processes. One promising approach increasing the attention to bodily sensations is the body scan (BS, a method stemming from mindfulness-based stress reduction. Research so far revealed only heterogenous findings of meditational practice and mindfulness-based stress reduction on interoceptive processes. Even more importantly, there is no study considering the effect of an 8-week BS intervention on interoceptive processes and the distinguishable subdomains of interoception. Therefore, the main objective of this research is to examine the effects of a BS intervention on different interoceptive subdomains over 8 weeks of training in two different samples.Methods: In study 1, healthy participants executed a 20 min standardized audiotaped BS in the BS intervention group (n = 25 each day over 8 weeks. The control group (n = 24 listened to an audio book for the same amount of time. In study 2, the BS group (n = 18 was compared to an inactive control group (n = 18. In both studies, three measurement points were realized and interoceptive accuracy (IAc – using a heartbeat perception task – as well as interoceptive sensibility (IS – using confidence ratings for the heartbeat perception task and the subscale ‘interoceptive awareness’ of the Eating Disorder Inventory-2 (EDI-2 – were assessed.Results: In study 1, we found, as a descriptive trend, IAc and confidence ratings to be increased irrespective of the condition. However, post hoc analysis revealed a significant improvement of IAc between T1 and T3 in the BS intervention only. IS revealed to be unaffected by the interventions. In study 2, we observed a significant positive effect of the BS intervention on IAc and confidence ratings compared to the inactive controls. As in study 1, IS (EDI-2 was unaffected by

  17. A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Ong Ken K

    2010-03-01

    Full Text Available Abstract Background Improving nutrition knowledge among children may help them to make healthier food choices. The aim of this study was to assess the effectiveness and acceptability of a novel educational intervention to increase nutrition knowledge among primary school children. Methods We developed a card game 'Top Grub' and a 'healthy eating' curriculum for use in primary schools. Thirty-eight state primary schools comprising 2519 children in years 5 and 6 (aged 9-11 years were recruited in a pragmatic cluster randomised controlled trial. The main outcome measures were change in nutrition knowledge scores, attitudes to healthy eating and acceptability of the intervention by children and teachers. Results Twelve intervention and 13 control schools (comprising 1133 children completed the trial. The main reason for non-completion was time pressure of the school curriculum. Mean total nutrition knowledge score increased by 1.1 in intervention (baseline to follow-up: 28.3 to 29.2 and 0.3 in control schools (27.3 to 27.6. Total nutrition knowledge score at follow-up, adjusted for baseline score, deprivation, and school size, was higher in intervention than in control schools (mean difference = 1.1; 95% CI: 0.05 to 2.16; p = 0.042. At follow-up, more children in the intervention schools said they 'are currently eating a healthy diet' (39.6% or 'would try to eat a healthy diet' (35.7% than in control schools (34.4% and 31.7% respectively; chi-square test p Conclusions The 'Top Grub' card game facilitated the enjoyable delivery of nutrition education in a sample of UK primary school age children. Further studies should determine whether improvements in nutrition knowledge are sustained and lead to changes in dietary behaviour.

  18. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions.

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.

  19. Improving clean-catch contamination rates: A prospective interventional cohort study.

    Science.gov (United States)

    Teo, Sharon; Cheek, John A; Craig, Simon

    2016-12-01

    The clean-catch method of urine collection carries a high contamination rate. This study aims to evaluate the effects on contamination rate of providing a parent handout and pre-made urine collection pack for clean-catch urine collection. We conducted a single-centre prospective cohort interventional study in a tertiary paediatric ED. All children younger than 24 months who presented from April 2013 to June 2014 requiring a urine sample to be obtained were included. The intervention was provision of a pre-made urine collection pack including a standardised information handout. The primary outcome measure was the difference in proportion of urine contamination in samples obtained via a clean-catch pre- and post-intervention. The total number of urine specimens included was 288 in the pre-intervention group and 333 in the post-intervention group. Contamination rates were 14.9% in the pre-intervention group and 11.4% in the post-intervention group. There was no statistically significant reduction in contamination (P = 0.19). The contamination rates appeared to be associated with gender, with (pooled) female contamination rates being 16.4% (44/269) and male contamination rates being 10.5% (37/352). Most specimens of urine were collected via the clean-catch method (81.2%), followed by catheter urine specimen (13.7%) and suprapubic aspirate (5.1%). The contamination rate in our study for clean-catch urine collectively was 13%, catheter urine specimen 3.8% and suprapubic aspirate 0%. The contamination rate of clean-catch urine did not improve with the implementation of a pre-made urine collection pack including standardised written instructions. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    Science.gov (United States)

    Légaré, France; Robitaille, Hubert; Gane, Claire; Hébert, Jessica; Labrecque, Michel; Rousseau, François

    2016-01-01

    Background Knowledge translation (KT) interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties. Objective We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing. Methods We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153) published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC) and Consumers and Communication. Results We retrieved 2473 unique trials of which we retained only 28 (1%). Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1) and educational outreach (n = 1). Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15), communication of DNA-based disease risk estimates (n = 7), personalized risk communication (n = 3) and mobile phone messaging (n = 1). Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective. Conclusions More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations. PMID:26938633

  1. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions.

    Directory of Open Access Journals (Sweden)

    France Légaré

    Full Text Available Knowledge translation (KT interventions are attempts to change behavior in keeping with scientific evidence. While genetic tests are increasingly available to healthcare consumers in the clinic, evidence about their benefits is unclear and decisions about genetic testing are thus difficult for all parties.We sought to identify KT interventions that involved decisions about genetic testing in the clinical context and to assess their effectiveness for improving decision making in terms of behavior change, increased knowledge and wellbeing.We searched for trials assessing KT interventions in the context of genetic testing up to March 2014 in all systematic reviews (n = 153 published by two Cochrane review groups: Effective Practice and Organisation of Care (EPOC and Consumers and Communication.We retrieved 2473 unique trials of which we retained only 28 (1%. Two EPOC reviews yielded two trials of KT interventions: audit and feedback (n = 1 and educational outreach (n = 1. Both targeted health professionals and the KT intervention they assessed was found to be effective. Four Consumers and Communication reviews yielded 26 trials: decision aids (n = 15, communication of DNA-based disease risk estimates (n = 7, personalized risk communication (n = 3 and mobile phone messaging (n = 1. Among these, 25 trials targeted only health consumers or patients and the KT interventions were found to be effective in four trials, partly effective in seven, and ineffective in four. Lastly, only one trial targeted both physicians and patients and was found to be effective.More research on the effectiveness of KT interventions regarding genetic testing in the clinical context may contribute to patients making informed value-based decisions and drawing the maximum benefit from clinical applications of genetic and genomic innovations.

  2. Electronic consultation as an alternative to hospital referral for patients with chronic kidney disease: a novel application for networked electronic health records to improve the accessibility and efficiency of healthcare.

    Science.gov (United States)

    Stoves, John; Connolly, John; Cheung, Chee Kay; Grange, Angela; Rhodes, Penny; O'Donoghue, Donal; Wright, John

    2010-10-01

    Chronic kidney disease is increasingly recognised in the UK, leading to a greater demand for specialist services. Traditional means of meeting this demand rely on GP referral of patients to see a nephrologist. Hospital assessment may be inconvenient for patients and inefficient for health services. 17 general practices and a secondary care nephrology service in Bradford, UK. A before and after evaluation comparing nephrology referrals from implementation and non-implementation practices following the introduction of electronic consultations (e-consultations) for chronic kidney disease. The number, appropriateness and quality of new referrals (paper and electronic) from primary care, the timeliness of responses and the satisfaction of patients and health professionals with the new service. Strategies for change Electronic sharing of primary care electronic health records with the nephrology service was introduced to implementation practices. Participating GPs attended education workshops and received paper and e-guidance about the new service. There was a significant reduction in paper referrals from implementation practices. E-consultation provided nephrologists with access to more clinical information. GPs reported that the service was convenient, provided timely and helpful advice, and avoided outpatient referrals. Specialist recommendations were well followed, and GPs felt more confident about managing chronic kidney disease in the community. E-consultation promotes effective management of patients with mild-to-moderate chronic kidney disease in primary care, allowing specialist resources to be directed towards supporting patients with more complex needs. There is a potential role for e-consultation in other chronic disease specialties.

  3. The effectiveness of a bundled intervention to improve resident progress notes in an electronic health record.

    Science.gov (United States)

    Dean, Shannon M; Eickhoff, Jens C; Bakel, Leigh Anne

    2015-02-01

    Providers nationally have observed a decline in the quality of documentation after implementing electronic health records (EHRs). In this pilot study, we examined the effectiveness of an intervention bundle designed to improve resident progress notes written in an EHR and to establish the reliability of an audit tool used to evaluate notes. The bundle consisted of establishing note-writing guidelines, developing an aligned note template, and educating interns about the guidelines and using the template. Twenty-five progress notes written by pediatric interns before and after this intervention were examined using an audit tool. Reliability of the tool was evaluated using the intraclass correlation coefficient (ICC). The total score of the audit tool was summarized in terms of means and standard deviation. Individual item responses were summarized using percentages and compared between the pre- and postintervention assessment using the Fisher exact test. The ICC for the audit tool was 0.96 (95% confidence interval: 0.91-0.98). A significant improvement in the total note score and in questions related to note clutter was seen. No significant improvement was seen for questions related to copy-paste. The study suggests that an intervention bundle can lead to some improvements in note writing.

  4. Study protocol: can a school gardening intervention improve children’s diets?

    Directory of Open Access Journals (Sweden)

    Christian Meaghan S

    2012-04-01

    Full Text Available Abstract Background The current academic literature suggests there is a potential for using gardening as a tool to improve children’s fruit and vegetable intake. This study is two parallel randomised controlled trials (RCT devised to evaluate the school gardening programme of the Royal Horticultural Society (RHS Campaign for School Gardening, to determine if it has an effect on children’s fruit and vegetable intake. Method/Design Trial One will consist of 26 schools; these schools will be randomised into two groups, one to receive the intensive intervention as “Partner Schools” and the other to receive the less intensive intervention as “Associate Schools”. Trial Two will consist of 32 schools; these schools will be randomised into either the less intensive intervention “Associate Schools” or a comparison group with delayed intervention. Baseline data collection will be collected using a 24-hour food diary (CADET to collect data on dietary intake and a questionnaire exploring children’s knowledge and attitudes towards fruit and vegetables. A process measures questionnaire will be used to assess each school’s gardening activities. Discussion The results from these trials will provide information on the impact of the RHS Campaign for School Gardening on children’s fruit and vegetable intake. The evaluation will provide valuable information for designing future research in primary school children’s diets and school based interventions. Trial registration ISRCTN11396528

  5. [Impact of an intervention to improve indwelling urinary catheter use and reduce urinary tract infections].

    Science.gov (United States)

    Smithson, A; Bosch, L; Ramos, X; Martínez-Santana, V

    2016-01-01

    To evaluate the impact of an intervention regarding the adequate use and improvement in the care of indwelling urinary catheters (IUC) and the frequency of catheter-associated urinary tract infections (CAUTI) in hospitalised patients. A quasi-experimental study was performed. Basic data on the use of IUC were recorded before and after the intervention, which consisted of training on IUC use and the implementation of reminders for their removal. There were 197 patients in the pre-intervention period and 194 in the post-intervention period. There was a non-significant decrease in the prevalence (17.3% versus 15.3%) and days with IUC (4.8±5.8 versus 4.3±4.2). There was an increase in adequately prescribed (41.1% versus 61.9%; P<.001) and attached IUC (0% vs 38.1%; P<.001), and a decrease in the urine collection bags on the floor (26.4% vs 6,2%; P<.001). The increase in the appropriate indications for IUC (86.8% vs 92.3%) and the decrease in CAUTI incidence density (2.1 vs 1.2 episodes/1,000 catheter days) were not significant, although above the standards. After the intervention there was a significant increase in the number of adequately prescribed and attached IUC, and a decrease in the number of urine collection bags on the floor. Improvement in IUC indication and frequency of CAUTI reached the quality standards. Educational activities and the use of reminders improve safety of hospitalised patients with IUC. Copyright © 2015 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Cholesterol-lowering interventions and stroke: Insights from IMPROVE-IT.

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    De Caterina, Raffaele; Salvatore, Tanya; Marchioli, Roberto

    2016-05-01

    The relationship of cholesterol with stroke is much less clear than its relationship with myocardial infarction, thus confounding the interpretation of results with cholesterol-lowering trials. Because for long time the only lipid-lowering intervention reducing stroke was statins, it has been actually argued that reduction in stroke found in statin trials is not due to statins' ability to reduce LDL cholesterol, but to other "pleiotropic" effects, unrelated to cholesterol lowering. In re-analyzing the relationship of cholesterol lowering versus changes in the risk of stroke in a meta-regression of all cholesterol-lowering interventions, including also non-statin interventions, we had previously reached the opposite conclusion: that some reduction in stroke has to be expected proportional to cholesterol reduction. We had predicted that a 1% reduction of total cholesterol-no matter by what intervention produced-was associated with a 0.8% relative risk reduction of stroke. Data from the recently published Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) now offer a clear proof of this concept, demonstrating that pure cholesterol lowering, as obtained with ezetimibe, plays an important role in reducing stroke. IMPROVE-IT data, showing a 13.3% reduction in total cholesterol at one year in association with a hazard ratio (HR) of 0.86 for total stroke during the trial, are very closely aligned with the relative risk of 0.90 predicted on the basis of the totality of lipid lowering interventions. These data are important to predict stroke outcomes in currently ongoing trials now testing PCSK9 or cholesterol ester transfer protein inhibitors.

  7. A ventilation intervention study in classrooms to improve indoor air quality: the FRESH study.

    Science.gov (United States)

    Rosbach, Jeannette T M; Vonk, Machiel; Duijm, Frans; van Ginkel, Jan T; Gehring, Ulrike; Brunekreef, Bert

    2013-12-17

    Classroom ventilation rates often do not meet building standards, although it is considered to be important to improve indoor air quality. Poor indoor air quality is thought to influence both children's health and performance. Poor ventilation in The Netherlands most often occurs in the heating season. To improve classroom ventilation a tailor made mechanical ventilation device was developed to improve outdoor air supply. This paper studies the effect of this intervention. The FRESH study (Forced-ventilation Related Environmental School Health) was designed to investigate the effect of a CO2 controlled mechanical ventilation intervention on classroom CO2 levels using a longitudinal cross-over design. Target CO2 concentrations were 800 and 1200 parts per million (ppm), respectively. The study included 18 classrooms from 17 schools from the north-eastern part of The Netherlands, 12 experimental classrooms and 6 control classrooms. Data on indoor levels of CO2, temperature and relative humidity were collected during three consecutive weeks per school during the heating seasons of 2010-2012. Associations between the intervention and weekly average indoor CO2 levels, classroom temperature and relative humidity were assessed by means of mixed models with random school-effects. At baseline, mean CO2 concentration for all schools was 1335 ppm (range: 763-2000 ppm). The intervention was able to significantly decrease CO2 levels in the intervention classrooms (F (2,10) = 17.59, p < 0.001), with a mean decrease of 491 ppm. With the target set at 800 ppm, mean CO2 was 841 ppm (range: 743-925 ppm); with the target set at 1200 ppm, mean CO2 was 975 ppm (range: 887-1077 ppm). Although the device was not capable of precisely achieving the two predefined levels of CO2, our study showed that classroom CO2 levels can be reduced by intervening on classroom ventilation using a CO2 controlled mechanical ventilation system.

  8. Gender differences in effectiveness of the Complete Health Improvement Program (CHIP) lifestyle intervention: an Australasian study.

    Science.gov (United States)

    Kent, Lillian M; Morton, Darren P; Rankin, Paul M; Mitchell, Brett G; Chang, Esther; Diehl, Hans

    2014-12-01

    Complete Health Improvement Program (CHIP) is a lifestyle modification program that promotes healthy diet, physical activity and stress management techniques. Among US CHIP participants, differences in gender responsiveness to improvements in chronic disease risk factors were demonstrated. This study examined gender differences in outcomes to the CHIP intervention in Australasia. Changes in body weight, blood pressure (BP), blood lipid profile and fasting plasma glucose (FPG) were assessed in 925 participants (34.3% men, mean age=56.0±12.5 years; 65.7% women, mean age=54.4±13.5 years) 30 days after program commencement. Significant reductions (Pdisease risk factors among men than women. All participants, but particularly men, entering the program with the greatest risk achieved the largest reductions. Possible physiological or behavioural factors include food preferences, making commitments and differential support modes. SO WHAT?: Developers of lifestyle intervention programs should consider gender differences in physiological and behavioural factors when planning interventions. In particular, developers should manage expectations of people entering lifestyle interventions to increase awareness that men tend to respond better than women. In addition, this is a call for further research to identify the underlying mechanisms responsible for the disproportionate responsiveness of males.

  9. The Comparison of Educational Intervention Effect Using BASNEF and Classic Models on Improving Assertion Skill Level.

    Science.gov (United States)

    Hazavehei, Smm; Sharifirad, Ghr; Kargar, M

    2008-06-28

    To compare the effectiveness of BASNEF and Classic educational models to improve the assertion skill level of high school boy students. The 60 high school male students from Shiraz City, Fars Province Iran, were participated in this study. They were randomly divided in two groups (groups A and B). The group A attended in designed educational planning based on BASNEF model and group B attended in classic educational program. The both groups had participated in six session educational activity (2 hours each session) during the four weeks. The data collected using questionnaire before and after one-month intervention. The mean score of knowledge, attitude, enabling factors, social norms, and Rathus Assertion Test were not significant statistically between two groups before and after intervention. However, the mean scores of all mentioned variables in group A and only knowledge and assertion variables in group B changed significantly after intervention. In addition, the comparison of the mean scores and the means of scores difference of all variables changed significantly between two groups after intervention. Performing BASNEF educational model, in accordance with its main parts (knowledge, attitude, social norms, and enabling factors) is more effective than performing classic educational model to improve high school boy students' assertion.

  10. A framework for scaling up health interventions: lessons from large-scale improvement initiatives in Africa.

    Science.gov (United States)

    Barker, Pierre M; Reid, Amy; Schall, Marie W

    2016-01-29

    Scaling up complex health interventions to large populations is not a straightforward task. Without intentional, guided efforts to scale up, it can take many years for a new evidence-based intervention to be broadly implemented. For the past decade, researchers and implementers have developed models of scale-up that move beyond earlier paradigms that assumed ideas and practices would successfully spread through a combination of publication, policy, training, and example. Drawing from the previously reported frameworks for scaling up health interventions and our experience in the USA and abroad, we describe a framework for taking health interventions to full scale, and we use two large-scale improvement initiatives in Africa to illustrate the framework in action. We first identified other scale-up approaches for comparison and analysis of common constructs by searching for systematic reviews of scale-up in health care, reviewing those bibliographies, speaking with experts, and reviewing common research databases (PubMed, Google Scholar) for papers in English from peer-reviewed and "gray" sources that discussed models, frameworks, or theories for scale-up from 2000 to 2014. We then analyzed the results of this external review in the context of the models and frameworks developed over the past 20 years by Associates in Process Improvement (API) and the Institute for Healthcare improvement (IHI). Finally, we reflected on two national-scale improvement initiatives that IHI had undertaken in Ghana and South Africa that were testing grounds for early iterations of the framework presented in this paper. The framework describes three core components: a sequence of activities that are required to get a program of work to full scale, the mechanisms that are required to facilitate the adoption of interventions, and the underlying factors and support systems required for successful scale-up. The four steps in the sequence include (1) Set-up, which prepares the ground for

  11. A Population Intervention to Improve Outcomes in Children With Medical Complexity.

    Science.gov (United States)

    Noritz, Garey; Madden, Melissa; Roldan, Dina; Wheeler, T Arthur; Conkol, Kimberly; Brilli, Richard J; Barnard, John; Gleeson, Sean

    2017-01-01

    Children with medical complexity experience frequent interactions with the medical system and often receive care that is costly, duplicative, and inefficient. The growth of value-based contracting creates incentives for systems to improve their care. This project was designed to improve the health, health care value, and utilization for a population-based cohort of children with neurologic impairment and feeding tubes. A freestanding children's hospital and affiliated accountable care organization jointly developed a quality improvement initiative. Children with a percutaneous feeding tube, a neurologic diagnosis, and Medicaid, were targeted for intervention within a catchment area of >300 000 children receiving Medicaid. Initiatives included standardizing feeding tube management, improving family education, and implementing a care coordination program. Between January 2011 and December 2014, there was an 18.0% decrease (P organization, can be part of the solution for improving outcomes and health care value for children with medical complexity. Copyright © 2017 by the American Academy of Pediatrics.

  12. A novel approach to improve digital signal performance by placement and routing with manual intervention

    Science.gov (United States)

    Cheng, Guimei; Wu, Songbo; Wan, Min; Bao, Bin; Duan, Jing

    2015-04-01

    This paper describes how placement and routing with manual intervention to improve the digital signal performance. According to studying and analyzing the features of Field Programmable Gate Array (FPGA) devices which include chip architecture and timing characteristics, a new approach is presented that some key logic modules can be relocated reasonably with manual intervention after completing successful place-and-route automatically. An example is given to illustrate this method. In this example, in order to improve remote sensing Charge Coupled Device (CCD) camera performance, signal-skew and delays among CCD driving timing signals must be controlled accurately and easily. This method can make CCD driving timing signals obtain the zero-skew which means tCO (clock to out) values for all these signals are equal, and finally hardware tests are carried out and experiment results are measured precisely by oscilloscope.

  13. A Preliminary Investigation Examining the Use of Minor Discipline Referral Data to Identify Students at Risk for Behavioral Difficulties: Observations within Systems of Schoolwide Positive Behavior Interventions and Supports

    Science.gov (United States)

    Cavanaugh, Brian

    2016-01-01

    Within multitiered behavioral frameworks such as schoolwide positive behavior interventions and supports (SWPBIS), it is recommended that schools use multiple sources of data to identify students at risk who may benefit from additional intervention. To date, much of the research in this area has focused on examining either systematic screening…

  14. Improving Pupil Referral Unit Outcomes: Pupil Perspectives

    Science.gov (United States)

    Michael, Siobhan; Frederickson, Norah

    2013-01-01

    Concern has been expressed about the quality of alternative provision for young people with social, emotional and behavioural difficulties, and the poor academic and social outcomes many experience. Little research has sought the views of the young people themselves regarding the enablers and barriers to positive outcomes they have encountered. A…

  15. A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes.

    Science.gov (United States)

    Nkonki, L; Tugendhaft, A; Hofman, K

    2017-02-28

    Evidence of the cost-effectiveness of community health worker interventions is pertinent for decision-makers and programme planners who are turning to community services in order to strengthen health systems in the context of the momentum generated by strategies to support universal health care, the post-2015 Sustainable Development Goal agenda.We conducted a systematic review of published economic evaluation studies of community health worker interventions aimed at improving child health outcomes. Four public health and economic evaluation databases were searched for studies that met the inclusion criteria: National Health Service Economic Evaluation Database (NHS EED), Cochrane, Paediatric Economic Evaluation Database (PEED), and PubMed. The search strategy was tailored to each database.The 19 studies that met the inclusion criteria were conducted in either high income countries (HIC), low- income countries (LIC) and/or middle-income countries (MIC). The economic evaluations covered a wide range of interventions. Studies were grouped together by intended outcome or objective of each study. The data varied in quality. We found evidence of cost-effectiveness of community health worker (CHW) interventions in reducing malaria and asthma, decreasing mortality of neonates and children, improving maternal health, increasing exclusive breastfeeding and improving malnutrition, and positively impacting physical health and psychomotor development amongst children.Studies measured varied outcomes, due to the heterogeneous nature of studies included; a meta-analysis was not conducted. Outcomes included disease- or condition -specific outcomes, morbidity, mortality, and generic measures (e.g. disability-adjusted life years (DALYs)). Nonetheless, all 19 interventions were found to be either cost-effective or highly cost-effective at a threshold specific to their respective countries.There is a growing body of economic evaluation literature on cost-effectiveness of CHW

  16. Interventions to improve the appropriate use of polypharmacy in older people: a Cochrane systematic review.

    Science.gov (United States)

    Cooper, Janine A; Cadogan, Cathal A; Patterson, Susan M; Kerse, Ngaire; Bradley, Marie C; Ryan, Cristín; Hughes, Carmel M

    2015-12-09

    To summarise the findings of an updated Cochrane review of interventions aimed at improving the appropriate use of polypharmacy in older people. Cochrane systematic review. Multiple electronic databases were searched including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (from inception to November 2013). Hand searching of references was also performed. Randomised controlled trials (RCTs), controlled clinical trials, controlled before-and-after studies and interrupted time series analyses reporting on interventions targeting appropriate polypharmacy in older people in any healthcare setting were included if they used a validated measure of prescribing appropriateness. Evidence quality was assessed using the Cochrane risk of bias tool and GRADE (Grades of Recommendation, Assessment, Development and Evaluation). All healthcare settings. Older people (≥ 65 years) with ≥ 1 long-term condition who were receiving polypharmacy (≥ 4 regular medicines). Primary outcomes were the change in prevalence of appropriate polypharmacy and hospital admissions. Medication-related problems (eg, adverse drug reactions), medication adherence and quality of life were included as secondary outcomes. 12 studies were included: 8 RCTs, 2 cluster RCTs and 2 controlled before-and-after studies. 1 study involved computerised decision support and 11 comprised pharmaceutical care approaches across various settings. Appropriateness was measured using validated tools, including the Medication Appropriateness Index, Beers' criteria and Screening Tool of Older Person's Prescriptions (STOPP)/ Screening Tool to Alert doctors to Right Treatment (START). The interventions demonstrated a reduction in inappropriate prescribing. Evidence of effect on hospital admissions and medication-related problems was conflicting. No differences in health-related quality of life were reported. The included interventions demonstrated improvements in appropriate polypharmacy based on

  17. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

    Directory of Open Access Journals (Sweden)

    Pascal Geldsetzer

    2016-04-01

    Full Text Available Introduction: The World Health Organization recommends lifelong antiretroviral therapy (ART for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1 retention within prevention of mother-to-child HIV transmission (PMTCT programmes after birth, (2 transitioning from PMTCT to general ART programmes in the postpartum period, and (3 retention of postpartum women in general ART programmes. Methods: We searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria. Results and Discussion: After screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way. Conclusions: Overall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum.

  18. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

    OpenAIRE

    Pascal Geldsetzer; H Manisha N Yapa; Maria Vaikath; Osondu Ogbuoji; Fox, Matthew P; Essajee, Shaffiq M; Negussie, Eyerusalem K; Till Bärnighausen

    2016-01-01

    Introduction: The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) pr...

  19. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

    OpenAIRE

    Geldsetzer, Pascal; H Manisha N Yapa; Vaikath, Maria; Ogbuoji, Osondu; Fox, Matthew P; Essajee, Shaffiq M; Negussie, Eyerusalem K; Bärnighausen, Till

    2016-01-01

    Introduction The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) pro...

  20. Interventions for improving coverage of childhood immunisation in low- and middle-income countries

    OpenAIRE

    Oyo-ita, Angela; Wiysonge, Charles S; Oringanje, Chioma; Nwachukwu, Chukwuemeka E; Oduwole, Olabisi; Meremikwu, Martin M

    2016-01-01

    Background Immunisation is a powerful public health strategy for improving child survival, not only by directly combating key diseases that kill children but also by providing a platform for other health services. However, each year millions of children worldwide, mostly from low- and middle-income countries (LMICs), do not receive the full series of vaccines on their national routine immunisation schedule. This is an update of the Cochrane review published in 2011 and focuses on intervention...

  1. Health Blief Model-based intervention to improve nutritional behavior among elderly women

    OpenAIRE

    Iranagh, Jamileh Amirzadeh; Rahman, Hejar Abdul; Motalebi, Seyedeh Ameneh

    2016-01-01

    BACKGROUND/OBJECTIVES Nutrition is a determinant factor of health in elderly people. Independent living in elderly people can be maintained or enhanced by improvement of nutritional behavior. Hence, the present study was conducted to determine the impact of Health Belief Model (HBM)-based intervention on the nutritional behavior of elderly women. SUBJECTS/METHODS Cluster-random sampling was used to assess the sample of this clinical trial study. The participants of this study attended a 12-we...

  2. Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial

    Science.gov (United States)

    Doyle, Orla; Delaney, Liam; O’Farrelly, Christine; Fitzpatrick, Nick; Daly, Michael

    2017-01-01

    Objective This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children’s school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems. Methods Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing. Results The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday. Conclusion The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments. PMID:28095505

  3. [Surface Cleaning and Disinfection in the Hospital. Improvement by Objective Monitoring and Intervention].

    Science.gov (United States)

    Woltering, R; Hoffmann, G; Isermann, J; Heudorf, U

    2016-11-01

    Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11-67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2-48.3; pdisinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures. © Georg Thieme Verlag KG Stuttgart · New York.

  4. A repeated short educational intervention improves asthma control and quality of life.

    Science.gov (United States)

    Plaza, Vicente; Peiró, Meritxell; Torrejón, Montserrat; Fletcher, Monica; López-Viña, Antolín; Ignacio, José María; Quintano, José Antonio; Bardagí, Santiago; Gich, Ignasi

    2015-11-01

    We assessed the effectiveness of an asthma educational programme based on a repeated short intervention (AEP-RSI) to improve asthma control (symptom control and future risk) and quality of life. A total of 230 adults with mild-to-moderate persistent uncontrolled asthma participated in a 1-year cluster randomised controlled multicentre study. The AEP-RSI was given in four face-to-face sessions at 3-month intervals, and included administration of a written personalised action plan and training on inhaler technique. Centres were randomised to the AEP-RSI (intervention) group or usual clinical practice group. Specialised centres using a standard educational programme were the gold standard group. A significant improvement in the Asthma Control Test score was observed in all three groups (pimprovements were higher in the intervention and gold standard groups than in the usual clinical practice group (p=0.042), which also showed fewer exacerbations (mean±sd; 1.20±2.02 and 0.56±1.5 versus 2.04±2.72, respectively) and greater increases in the Mini Asthma Quality of Life Questionnaire scores (0.95±1.04 and 0.89±0.84 versus 0.52±0.97, respectively). The AEP-RSI was effective in improving asthma symptom control, future risk and quality of life.

  5. A MOTIVATIONAL MUSIC AND VIDEO INTERVENTION IMPROVES HIGH-INTENSITY EXERCISE PERFORMANCE

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    Martin J. Barwood

    2009-09-01

    Full Text Available Music and video are utilised by recreational gym users to enhance their exercise experience. Music and video have not been investigated for their combined ergogenic effect during high intensity exercise. To induce fatigue, this study was performed in warm (~26°C, moist conditions (~50%RH. Six, non-acclimated, male participants took part in the study. Each participant completed three 30-minute exercise bouts on a motorised treadmill under three counterbalanced conditions on separate days: control (CON, motivational music plus video intervention (M, non-motivational intervention (NM. They completed a warm-up (5 km·h-1 [5 minutes], 9km·h-1 [10 minutes] followed by a maximal effort run (15 minutes. Participants did not receive any feedback of time elapsed, distance run or speed. Measures: Distance covered (metres, heart rate, blood lactate accumulation (Blac and ratings of perceived exertion (RPE. Participants in the M condition ran significantly further than in the NM (M: 3524 [388]metres; NM: 3110 [561]metres; CON: 3273 [458]metres and CON conditions, accumulated more Blac, but did not increase their peak RPE rating (p < 0.05. The M intervention improved tolerance of high intensity exercise in warm conditions. It was proposed that a change in attentional processing from internal (physical sensations to external perspective (music and video may have facilitated this improvement. These findings have strong implications for improving health, fitness and engagement in gym-based exercise programs

  6. Organisational interventions for improving wellbeing and reducing work-related stress in teachers.

    Science.gov (United States)

    Naghieh, Ali; Montgomery, Paul; Bonell, Christopher P; Thompson, Marc; Aber, J Lawrence

    2015-04-08

    The teaching profession is an occupation with a high prevalence of work-related stress. This may lead to sustained physical and mental health problems in teachers. It can also negatively affect the health, wellbeing and educational attainment of children, and impose a financial burden on the public budget in terms of teacher turnover and sickness absence. Most evaluated interventions for the wellbeing of teachers are directed at the individual level, and so do not tackle the causes of stress in the workplace. Organisational-level interventions are a potential avenue in this regard. To evaluate the effectiveness of organisational interventions for improving wellbeing and reducing work-related stress in teachers. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ASSIA, AEI, BEI, BiblioMap, DARE, DER, ERIC, IBSS, SSCI, Sociological Abstracts, a number of specialist occupational health databases, and a number of trial registers and grey literature sources from the inception of each database until January 2015. Randomised controlled trials (RCTs), cluster-RCTs, and controlled before-and-after studies of organisational-level interventions for the wellbeing of teachers. We used standard methodological procedures expected by Cochrane. Four studies met the inclusion criteria. They were three cluster-randomised controlled trials and one with a stepped-wedge design.Changing task characteristicsOne study with 961 teachers in eight schools compared a task-based organisational change intervention along with stress management training to no intervention. It found a small reduction at 12 months in 10 out of 14 of the subscales in the Occupational Stress Inventory, with a mean difference (MD) varying from -3.84 to 0.13, and a small increase in the Work Ability Index (MD 2.27; 95% confidence interval (CI) 1.64 to 2.90; 708 participants, low-quality evidence).Changing organisational characteristicsTwo studies compared teacher

  7. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

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    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  8. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study.

    Science.gov (United States)

    Kampf, Günter; Reise, Gesche; James, Claudia; Gittelbauer, Kirsten; Gosch, Jutta; Alpers, Birgit

    2013-01-01

    Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps. The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI) including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology). A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback), followed by a second observation period. During the last observation week, participants evaluated the intervention. In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test). Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after). Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68.6% when three of five steps were done; p<0.001). The

  9. Limited intervention improves technical skill in focus assessed transthoracic echocardiography among novice examiners

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    Frederiksen Christian

    2012-08-01

    Full Text Available Abstract Background Previous studies addressing teaching and learning in point-of-care ultrasound have primarily focussed on image interpretation and not on the technical quality of the images. We hypothesized that a limited intervention of 10 supervised examinations would improve the technical skills in Focus Assessed Transthoracic Echocardiography (FATE and that physicians with no experience in FATE would quickly adopt technical skills allowing for image quality suitable for interpretation. Methods Twenty-one physicians with no previous training in FATE or echocardiography (Novices participated in the study and a reference group of three examiners with more than 10 years of experience in echocardiography (Experts was included. Novices received an initial theoretical and practical introduction (2 hours, after which baseline examinations were performed on two healthy volunteers. Subsequently all physicians were scheduled to a separate intervention day comprising ten supervised FATE examinations. For effect measurement a second examination (evaluation of the same two healthy volunteers from the baseline examination was performed. Results At baseline 86% of images obtained by novices were suitable for interpretation, on evaluation this was 93% (p = 0.005. 100% of images obtained by experts were suitable for interpretation. Mean global image rating on baseline examinations was 70.2 (CI 68.0-72.4 and mean global image rating after intervention was 75.0 (CI 72.9-77.0, p = 0.0002. In comparison, mean global image rating in the expert group was 89.8 (CI 88.8-90.9. Conclusions Improvement of technical skills in FATE can be achieved with a limited intervention and upon completion of intervention 93% of images achieved are suitable for clinical interpretation.

  10. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care.

    Science.gov (United States)

    MacPherson, Peter; Munthali, Chigomezgo; Ferguson, Jane; Armstrong, Alice; Kranzer, Katharina; Ferrand, Rashida A; Ross, David A

    2015-08-01

    Adolescents living with HIV face substantial difficulties in accessing HIV care services and have worse treatment outcomes than other age groups. The objective of this review was to evaluate the effectiveness of service delivery interventions to improve adolescents' linkage from HIV diagnosis to antiretroviral therapy (ART) initiation, retention in HIV care and adherence to ART. We systematically searched the Medline, SCOPUS and Web of Sciences databases and conference abstracts from the International AIDS Conference and International Conference on AIDS and STIs in Africa (ICASA). Studies published in English between 1st January 2001 and 9th June 2014 were included. Two authors independently evaluated reports for eligibility, extracted data and assessed methodological quality using the Cochrane risk of bias tool and Newcastle-Ottawa Scale. Eleven studies from nine countries were eligible for review. Three studies were randomised controlled trials. Interventions assessed included individual and group counselling and education; peer support; directly observed therapy; financial incentives; and interventions to improve the adolescent-friendliness of clinics. Most studies were of low to moderate methodological quality. This review identified limited evidence on the effectiveness of service delivery interventions to support adolescents' linkage from HIV diagnosis to ART initiation, retention on ART and adherence to ART. Although recommendations are qualified because of the small numbers of studies and limited methodological quality, offering individual and group education and counselling, financial incentives, increasing clinic accessibility and provision of specific adolescent-tailored services appear promising interventions and warrant further investigation. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  11. Self-care Improvement After a Pharmaceutical Intervention in Elderly Type 2 Diabetic Patients.

    Science.gov (United States)

    Nascimentoa, Tania; Braz, Nídia; Gomes, Eurico; Fernandez-Arche, Angeles; De La Puerta, Rocio

    2015-01-01

    Diabetes mellitus involves long-term complications that affect diabetic patients' quality of life. The best way to prevent these complications is that patients achieve good metabolic control. In order to reach this goal, patients are requested to acquire daily behaviours (self-care). Such behaviours are sometimes hard to adhere, because they require changes in habits acquired over time. The aim of the present study is to evaluate the improvement on self-care after a pharmaceutical intervention on home regime patients. We performed a controlled experimental comparative study with a follow up of 6 months, on 87 patients, randomized in control group (n=43) and intervention group (n=44). We accessed sociodemographic and clinical data (glycaemic profile), as well as adherence to drug therapy and self-assessed care (before/after). In the intervention group, mean age was 74.2±5.4 years, and the median time of T2DM diagnosis was 14.7±8.5 years. At the end of study, the decrease in fasting blood glucose was higher in the intervention group patients than that observed in the control group (50.2mg/dL), with statistically significant difference (pnutrition and physical exercise dimensions became evident, with an increase in the number of days of adherence. On medication adherence statistically significant alterations (p<0.05) were also recorded. We can conclude that an individualized pharmaceutical intervention can improve self-care behaviours, as well as medication adherence, contributing to better metabolic control.

  12. Active educational intervention as a tool to improve safe and appropriate use of antibiotics

    Directory of Open Access Journals (Sweden)

    Mayadah B. Shehadeh

    2016-09-01

    It is concluded that using tailored education material targeting antibiotic need and use with a major aim of improving the public knowledge about antibiotics can be an effective and feasible strategy. This pilot study could be considered as the starting point for a wider scale public educational intervention study and national antibiotic campaign. However, the improvement in participant’s knowledge might not reflect an actual change in antibiotics–seeking behaviour or future retention of knowledge. Future research should seek to assess the impact of education on participant’s behaviour.

  13. Multifaceted intervention to improve obstetric practices: The OPERA cluster-randomized controlled trial.

    Science.gov (United States)

    Dupont, Corinne; Winer, Norbert; Rabilloud, Muriel; Touzet, Sandrine; Branger, Bernard; Lansac, Jacques; Gaucher, Laurent; Duclos, Antoine; Huissoud, Cyril; Boutitie, Florent; Rudigoz, René-Charles; Colin, Cyrille

    2017-08-01

    Suboptimal care contributes to perinatal morbidity and mortality. We investigated the effects of a multifaceted program designed to improve obstetric practices and outcomes. A cluster-randomized trial was conducted from October 2008 to November 2010 in 95 French maternity units randomized either to receive an information intervention about published guidelines or left to apply them freely. The intervention combined an outreach visit with a morbidity/mortality conference (MMC) to review perinatal morbidity/mortality cases. Within the intervention group, the units were randomized to have MMCs with or without clinical psychologists. The primary outcome was the rate of suboptimal care among perinatal morbidity/mortality cases. The secondary outcomes included the rate of suboptimal care among cases of morbidity, the rate of suboptimal care among cases of mortality, the rate of avoidable morbidity and/or mortality cases, and the incidence of, morbidity and/or mortality. A mixed logistic regression model with random intercept was used to quantify the effect of the intervention on the main outcome. The study reviewed 2459 cases of morbidity or mortality among 165,353 births. The rate of suboptimal care among morbidity plus mortality cases was not significantly lower in the intervention than in the control group (8.1% vs. 10.6%, OR [95% CI]: 0.75 [0.50-1.12], p=0.15. However, the cases of suboptimal care among morbidity cases were significantly lower in the intervention group (7.6% vs. 11.5%, 0.62 [0.40-0.94], p=0.02); the incidence of perinatal morbidity was also lower (7.0 vs. 8.1‰, p=0.01). No differences were found between psychologist-backed and the other units. The intervention reduced the rate of suboptimal care mainly in morbidity cases and the incidence of morbidity but did not succeed in improving morbidity plus mortality combined. More clear-cut results regarding mortality require a longer study period and the inclusion of structures that intervene before and

  14. Swedish emergency department triage and interventions for improved patient flows: a national update

    Directory of Open Access Journals (Sweden)

    Farrokhnia Nasim

    2011-12-01

    Full Text Available Abstract Background In Scandinavia, emergency department triage and patient flow processes, are under development. In Sweden, the triage development has resulted in two new triage scales, the Adaptive Process Triage and the Medical Emergency Triage and Treatment System. Both these scales have logistic components, aiming to improve patient flows. The aim of this study was to report the development and current status of emergency department triage and patient flow processes in Sweden. Methods In 2009 and 2010 the Swedish Council on Health Technology Assessment sent out a questionnaire to the ED managers in all (74 Swedish hospital emergency departments. The questionnaire comprised questions about triage and interventions to improve patient flows. Results Nearly all (97% EDs in Sweden employed a triage scale in 2010, which was an increase from 2009 (73%. Further, the Medical Emergency Triage and Treatment System was the triage scale most commonly implemented across the country. The implementation of flow-related interventions was not as common, but more than half (59% of the EDs have implemented or plan to implement nurse requested X-ray. Conclusions There has been an increase in the use of triage scales in Swedish EDs during the last few years, with acceleration for the past two years. Most EDs have come to use the Medical Emergency Triage and Treatment System, which also indicates regional co-operation. The implementation of different interventions for improved patient flows in EDs most likely is explained by the problem of crowding. Generally, more studies are needed to investigate the economical aspects of these interventions.

  15. Interventions to improve cultural competency in healthcare: a systematic review of reviews

    Science.gov (United States)

    2014-01-01

    Background Cultural competency is a recognized and popular approach to improving the provision of health care to racial/ethnic minority groups in the community with the aim of reducing racial/ethnic health disparities. The aim of this systematic review of reviews is to gather and synthesize existing reviews of studies in the field to form a comprehensive understanding of the current evidence base that can guide future interventions and research in the area. Methods A systematic review of review articles published between January 2000 and June 2012 was conducted. Electronic databases (including Medline, Cinahl and PsycINFO), reference lists of articles, and key websites were searched. Reviews of cultural competency in health settings only were included. Each review was critically appraised by two authors using a study appraisal tool and were given a quality assessment rating of weak, moderate or strong. Results Nineteen published reviews were identified. Reviews consisted of between 5 and 38 studies, included a variety of health care settings/contexts and a range of study types. There were three main categories of study outcomes: patient-related outcomes, provider-related outcomes, and health service access and utilization outcomes. The majority of reviews found moderate evidence of improvement in provider outcomes and health care access and utilization outcomes but weaker evidence for improvements in patient/client outcomes. Conclusion This review of reviews indicates that there is some evidence that interventions to improve cultural competency can improve patient/client health outcomes. However, a lack of methodological rigor is common amongst the studies included in reviews and many of the studies rely on self-report, which is subject to a range of biases, while objective evidence of intervention effectiveness was rare. Future research should measure both healthcare provider and patient/client health outcomes, consider organizational factors, and utilize more

  16. The Stress Gym: An Online Intervention to Improve Stress and Depressive Symptoms in Adults.

    Science.gov (United States)

    Hinkle, Julie F

    2015-01-01

    Finding methods to facilitate efficient assimilation of relevant health care information is important for quality outcomes, including promoting maximal wellness and optimal patient outcomes in vulnerable populations. The Internet is a promising information resource that can be used to reach those suffering from depression, but evidence of its efficacy in this population is lacking. This study was designed to examine The Stress Gym intervention, a web-enhanced behavioral self-management program (WEB-SM) consisting of nine modules focused on the management of stress and depression. The effect of the Stress Gym intervention on depressive symptoms, stress, and attention was examined, from pre- to post-intervention, in participants with stress and in participants who were experiencing both stress and depressive symptoms. A statistically significant decrease in depressive symptoms and stress was observed and there was a statistically significant increase in attention after the Stress Gym intervention, on average, for all participants. This study supports the efficacy of Stress Gym as a tool to reduce depressive symptoms, stress, and attentional difficulties. There were significant improvements in participants overall and for participants when they were segregated into two groups, those with stress only and those with depressive symptoms and stress. With many patients choosing to explore health concerns online, it is important to have evidence-based programs available online that can help them manage their symptoms.

  17. An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

    Directory of Open Access Journals (Sweden)

    Opondo Charles

    2009-07-01

    Full Text Available Abstract Background It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Methods Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Results Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors

  18. Efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour: a systematic review.

    Science.gov (United States)

    Schoeppe, Stephanie; Alley, Stephanie; Van Lippevelde, Wendy; Bray, Nicola A; Williams, Susan L; Duncan, Mitch J; Vandelanotte, Corneel

    2016-12-07

    Health and fitness applications (apps) have gained popularity in interventions to improve diet, physical activity and sedentary behaviours but their efficacy is unclear. This systematic review examined the efficacy of interventions that use apps to improve diet, physical activity and sedentary behaviour in children and adults. Systematic literature searches were conducted in five databases to identify papers published between 2006 and 2016. Studies were included if they used a smartphone app in an intervention to improve diet, physical activity and/or sedentary behaviour for prevention. Interventions could be stand-alone interventions using an app only, or multi-component interventions including an app as one of several intervention components. Outcomes measured were changes in the health behaviours and related health outcomes (i.e., fitness, body weight, blood pressure, glucose, cholesterol, quality of life). Study inclusion and methodological quality were independently assessed by two reviewers. Twenty-seven studies were included, most were randomised controlled trials (n = 19; 70%). Twenty-three studies targeted adults (17 showed significant health improvements) and four studies targeted children (two demonstrated significant health improvements). Twenty-one studies targeted physical activity (14 showed significant health improvements), 13 studies targeted diet (seven showed significant health improvements) and five studies targeted sedentary behaviour (two showed significant health improvements). More studies (n = 12; 63%) of those reporting significant effects detected between-group improvements in the health behaviour or related health outcomes, whilst fewer studies (n = 8; 42%) reported significant within-group improvements. A larger proportion of multi-component interventions (8 out of 13; 62%) showed significant between-group improvements compared to stand-alone app interventions (5 out of 14; 36%). Eleven studies reported app usage statistics

  19. Evaluation and Referral for Child Maltreatment in Pediatric Poisoning Victims

    Science.gov (United States)

    Wood, Joanne N.; Pecker, Lydia H.; Russo, Michael E.; Henretig, Fred; Christian, Cindy W.

    2012-01-01

    Objective: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine…

  20. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

    Science.gov (United States)

    Smith, Susan M; Wallace, Emma; O'Dowd, Tom; Fortin, Martin

    2016-03-14

    Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. Two review authors independently

  1. Designing Cognitive Intervention to Improve the Awareness Index of the Residents in the Landslide Area

    Science.gov (United States)

    Susanto, N.; Putranto, T. T.; Ulfa, E. A.

    2017-02-01

    Considering Semarang as a city with a high potential of landslides occurrences in its almost area, human as the part of the system should be played as a centre of the disaster management system to reduce the natural disaster risk. The study area is located in Manyaran district (the west of Semarang) which is categorised as a vulnerable of landslide area. This study aims at establishing a cognitive intervention based on a cause analysis (Fault Tree Analysis/FTA) to find the cause of low value and improve the awareness index of residents as the implementation of human-based disaster management model. The FTA result was then combined with the demographical data to generate the design of the cognitive intervention. The FTA result conducted that the preparedness of emergency planning had the lowest value (18.2%) which was caused by the lack individual preparation including lack of residents knowledge, and the absence of observation facilities as well as the lack of evacuation planning. Analysis of demographical data resulted in a situation of lack socialisation and knowledge of the residents regarding the landslide occurrence. The model of cognitive intervention then utilised some tools such as video, module and discussion to improve the awareness index.

  2. Effects of a primary care intervention to improve the quality of zolpidem prescriptions in elderly patients.

    Science.gov (United States)

    López-Sepúlveda, Rocío; García Lirola, María Ángeles; Espínola García, Esther; Martín Sances, Salvadora; Anaya Ordóñez, Sonia; Jurado Martínez, José María; Cabeza Barrera, José

    2017-04-01

    The objective of this study was to measure the impact of an intervention on the prescription habits of general practitioners (GPs) in order to improve the quality of zolpidem prescriptions in patients aged 75 or older. A prospective multicentric non-randomized trial was performed in the Metropolitan Granada Primary Healthcare Area (Andalusian Public Healthcare Service, Spain), which serves a total population of approximately 675,000 inhabitants. All health centers volunteering to participate in the trial were included. The intervention consisted of training sessions, individualized feedback, clinical information, and financial incentives. A daily dose over 5 mg was considered non-safe. Reduction in non-safe prescriptions of zolpidem in the elderly population became a quality prescribing indicator in a pay-for-performance scheme. Statistically significant differences versus baseline were found between the intervention and control groups in mean zolpidem prescription prevalence (28.5 vs. 37.5‰, respectively; p = 0.008) and mean non-safe zolpidem prescription prevalence (16.5 vs. 34.2‰, respectively; p safe prescriptions was 1309, 35% lower versus baseline, with a significant difference of p GPs who receive no financial incentive are required to evaluate the relative importance of an economic reward in achieving this improvement.

  3. Immunological changes associated with clinical improvement of asthmatic children subjected to psychosocial intervention.

    Science.gov (United States)

    Castés, M; Hagel, I; Palenque, M; Canelones, P; Corao, A; Lynch, N R

    1999-03-01

    In the present study we evaluated the impact of a program of psychosocial intervention (PSI) on the immunological status and the clinical management of a group of asthmatic children of an island population in Venezuela. We studied a total of 35 asthmatic children who belonged to either a PSI group (19 patients) or a control group (16 patients), both of which received conventional antiasthmatic treatment. The PSI group received, in addition, a 6-month psychosocial intervention program which included relaxation, guided imagery, and self-esteem workshops. During the PSI period, the number of asthmatic episodes and the use of bronchodilator medication were significantly reduced, and pulmonary function was significantly improved, compared to the 6 months before intervention. There was also a significant reduction in the specific IgE responses against the most important allergen in these children, the intestinal parasite Ascaris lumbricoides. PSI resulted in a significant increase of NK cells, an augmented expression of the T-cell receptor for IL-2, and a significant decrease of leukocytes with low affinity receptors for IgE. In fact, these surface markers became similar to those of nonasthmatic children from both Coche Island and the mainland. None of these clinical or immunological changes were seen in the control group of asthmatics who did not undergo PSI. These results are consistent with the possibility that PSI induces immunological alterations that are responsible for the clinical and physiological improvements observed in the study group. Copyright 1999 Academic Press.

  4. Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions

    Science.gov (United States)

    Pickhardt, Perry J.; Schumacher, Jessica R.; Potvien, Aaron; Kim, David H.; Pfau, Patrick R.; Jacobs, Elizabeth A.; Smith, Maureen A.

    2017-01-01

    Aims. Colorectal cancer (CRC) screening is underutilized. Increasing CRC screening rates requires interventions targeting multiple barriers at each level of the healthcare organization (patient, provider, and system). We examined groups of primary care providers (PCPs) based on perceptions of screening barriers and the relationship to CRC screening rates to inform approaches for conducting barrier assessments prior to designing and implementing quality improvement interventions. Methods. We conducted a retrospective cohort study linking EHR and survey data. PCPs with complete survey responses for questions addressing CRC screening barriers were included (N = 166 PCPs; 39,430 patients eligible for CRC screening). Cluster analysis identified groups of PCPs. Multivariate logistic regression estimated odds ratios and 95% confidence intervals for predictors of membership in one of the PCP groups. Results. We found two distinct groups: (1) PCPs identifying multiple barriers to CRC screening at patient, provider, and system levels (N = 75) and (2) PCPs identifying no major barriers to screening (N = 91). PCPs in the top half of CRC screening performance were more likely to identify multiple barriers than the bottom performers (OR, 4.14; 95% CI, 2.43–7.08). Conclusions. High-performing PCPs can more effectively identify CRC screening barriers. Targeting high-performers when conducting a barrier assessment is a novel approach to assist in designing quality improvement interventions for CRC screening.

  5. Interdepartmental Dermatology: Characteristics and Impact of Dermatology Inpatient Referrals at a Teaching Hospital in Eastern India

    Science.gov (United States)

    Chowdhury, Satyendra Nath; Podder, Indrasish; Saha, Abanti; Bandyopadhyay, Debabrata

    2017-01-01

    Background: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management. Materials and Methods: We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses. PMID:28216722

  6. Transition of care: A set of pharmaceutical interventions improves hospital discharge prescriptions from an internal medicine ward.

    Science.gov (United States)

    Neeman, Marine; Dobrinas, Maria; Maurer, Sophie; Tagan, Damien; Sautebin, Annelore; Blanc, Anne-Laure; Widmer, Nicolas

    2017-03-01

    Continuity of care between hospitals and community pharmacies needs to be improved to ensure medication safety. This study aimed to evaluate whether a set of pharmaceutical interventions to prepare hospital discharge facilitates the transition of care. This study took place in the internal medicine ward and in surrounding community pharmacies. The intervention group's patients underwent a set of pharmaceutical interventions during their hospital stay: medication reconciliation at admission, medication review, and discharge planning. The two groups were compared with regards to: number of community pharmacist interventions, time spent on discharge prescriptions, and number of treatment changes. Comparison between the groups showed a much lower (77% lower) number of community pharmacist interventions per discharge prescription in the intervention (n=54 patients) compared to the control group (n=64 patients): 6.9 versus 1.6 interventions, respectively (phospital physician. The number of medication changes at different steps was also significantly lower in the intervention group: 40% fewer (phospital admission and discharge, 66% fewer (phospital discharge and community pharmacy care, and 25% fewer (p=0.002) between community pharmacy care and care by a general practitioner. An intervention group underwent significantly fewer medication changes in subsequent steps in the transition of care after a set of interventions performed during their hospital stay. Community pharmacists had to perform fewer interventions on discharge prescriptions. Altogether, this improves continuity of care. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  7. Interventions to improve or facilitate linkage to or retention in pre-ART (HIV care and initiation of ART in low- and middle-income settings – a systematic review

    Directory of Open Access Journals (Sweden)

    Darshini Govindasamy

    2014-08-01

    Full Text Available Introduction: Several approaches have been taken to reduce pre-antiretroviral therapy (ART losses between HIV testing and ART initiation in low- and middle-income countries, but a systematic assessment of the evidence has not yet been undertaken. The aim of this systematic review is to assess the potential for interventions to improve or facilitate linkage to or retention in pre-ART care and initiation of ART in low- and middle-income settings. Methods: An electronic search was conducted on Medline, Embase, Global Health, Web of Science and conference databases to identify studies describing interventions aimed at improving linkage to or retention in pre-ART care or initiation of ART. Additional searches were conducted to identify on-going trials on this topic, and experts in the field were contacted. An assessment of the risk of bias was conducted. Interventions were categorized according to key domains in the existing literature. Results: A total of 11,129 potentially relevant citations were identified, of which 24 were eligible for inclusion, with the majority (n=21 from sub-Saharan Africa. In addition, 15 on-going trials were identified. The most common interventions described under key domains included: health system interventions (i.e. integration in the setting of antenatal care; patient convenience and accessibility (i.e. point-of-care CD4 count (POC testing with immediate results, home-based ART initiation; behaviour interventions and peer support (i.e. improved communication, patient referral and education and incentives (i.e. food support. Several interventions showed favourable outcomes: integration of care and peer supporters increased enrolment into HIV care, medical incentives increased pre-ART retention, POC CD4 testing and food incentives increased completion of ART eligibility screening and ART initiation. Most studies focused on the general adult patient population or pregnant women. The majority of published studies were

  8. Smartphone-based psychotherapeutic micro-interventions to improve mood in a real-world setting

    Directory of Open Access Journals (Sweden)

    Gunther Meinlschmidt

    2016-07-01

    Full Text Available Background: Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes.Method: As part of a larger neurofeedback study, all subjects – after being randomly assigned to an experimental or control neurofeedback condition – underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good–bad, GB; awake–tired, AT; and calm–nervous, CN. Results: Twenty-seven men participated on at least eleven days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13% and contemplative repetition (68 sessions, 20.30% being the most frequently applied techniques. Mixed models indicated that subjects showed better mood (GB: b=0.464, 95%confidence interval (CI [0.068, 0.860], t(613.3=2.298, p=0.022 and became more awake (AT: b=0.514, 95%CI [0.103, 0.925], t(612.4=2.456, p=0.014 and calmer (CN: b=0.685, 95%CI [0.360, 1.010], t(612.3=4.137, p<0.001 from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the first day until the last day with regard to GB mood (r=0.614, 95%CI [0.297, 0.809], p<0.001, but not AT mood (r=0.279, 95%CI [-0.122, 0.602], p=0.167 and CN mood (r=0.277, 95

  9. Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting

    Science.gov (United States)

    Meinlschmidt, Gunther; Lee, Jong-Hwan; Stalujanis, Esther; Belardi, Angelo; Oh, Minkyung; Jung, Eun Kyung; Kim, Hyun-Chul; Alfano, Janine; Yoo, Seung-Schik; Tegethoff, Marion

    2016-01-01

    Background: Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes. Method: As part of a larger neurofeedback study, all subjects—after being randomly assigned to an experimental or control neurofeedback condition—underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good–bad, GB; awake–tired, AT; and calm–nervous, CN). Results: Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t(613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t(612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t(612.3) = 4.137, p < 0.001] from pre- to post-micro-intervention. These mood improvements from pre- to post-micro-intervention were associated with changes in mood from the 1st day until the last day with regard to GB mood (r = 0.614, 95%CI [0.297, 0.809], p < 0.001), but not AT mood (r = 0.279, 95%CI [−0.122, 0.602], p = 0.167) and CN mood (r

  10. Development and evaluation of an interprofessional communication intervention to improve family outcomes in the ICU.

    Science.gov (United States)

    Curtis, J Randall; Ciechanowski, Paul S; Downey, Lois; Gold, Julia; Nielsen, Elizabeth L; Shannon, Sarah E; Treece, Patsy D; Young, Jessica P; Engelberg, Ruth A

    2012-11-01

    The intensive care unit (ICU), where death is common and even survivors of an ICU stay face the risk of long-term morbidity and re-admissions to the ICU, represents an important setting for improving communication about palliative and end-of-life care. Communication about the goals of care in this setting should be a high priority since studies suggest that the current quality of ICU communication is often poor and is associated with psychological distress among family members of critically ill patients. This paper describes the development and evaluation of an intervention designed to improve the quality of care in the ICU by improving communication among the ICU team and with family members of critically ill patients. We developed a multi-faceted, interprofessional intervention based on self-efficacy theory. The intervention involves a "communication facilitator" - a nurse or social worker - trained to facilitate communication among the interprofessional ICU team and with the critically ill patient's family. The facilitators are trained using three specific content areas: a) evidence-based approaches to improving clinician-family communication in the ICU, b) attachment theory allowing clinicians to adapt communication to meet individual family member's communication needs, and c) mediation to facilitate identification and resolution of conflict including clinician-family, clinician-clinician, and intra-family conflict. The outcomes assessed in this randomized trial focus on psychological distress among family members including anxiety, depression, and post-traumatic stress disorder at 3 and 6 months after the ICU stay. This manuscript also reports some of the lessons that we have learned early in this study.

  11. Morphological Awareness Intervention: Improving Spelling, Vocabulary, and Reading Comprehension for Adult Learners.

    Science.gov (United States)

    Bangs, Kathryn E; Binder, Katherine S

    2016-01-01

    Adult Basic Education programs are under pressure to develop and deliver instruction that promotes rapid and sustained literacy development. We describe a novel approach to a literacy intervention that focuses on morphemes, which are the smallest meaningful units contained in words. We argue that if you teach learners that big words are comprised of smaller components (i.e., morphemes), you will provide those students with the skills to figure out the meanings of new words. Research with children has demonstrated that teaching them about morphemes improves word recognition, spelling, vocabulary, and comprehension (Bowers & Kirby, 2009; Kirk & Gillon, 2009; Nunes, Bryant, & Olsson, 2003). Our hope is that this type of intervention will be successful with adult learners, too.

  12. Randomized trial of a DVD intervention to improve readiness to self-manage joint pain.

    Science.gov (United States)

    Elander, James; Robinson, Georgina; Morris, John

    2011-10-01

    A DVD (digital video disk) intervention to increase readiness to self-manage joint pain secondary to hemophilia was informed by a 2-phase, motivational-volitional model of readiness to self-manage pain, and featured the personal experiences of individuals with hemophilia. The DVD was evaluated in a randomized controlled trial in which 108 men with hemophilia completed measures of readiness to self-manage pain (Pain Stages of Change Questionnaire) before and 6 months after receiving the DVD plus information booklet (n=57) or just the booklet (n=51). The effect of the DVD was assessed by comparing changes in Pain Stages of Change Questionnaire scores (precontemplation, contemplation, and action/maintenance) between groups. The impact on pain coping, pain acceptance, and health-related quality of life was tested in secondary analyses. Repeated-measures analysis of variance, including all those with complete baseline and follow-up data regardless of use of the intervention, showed a significant, medium-sized, group×time effect on precontemplation, with reductions among the DVD group but not the booklet group. Significant use×time effects showed that benefits in terms of contemplation and action/maintenance were restricted to those who used the interventions at least once. The results show that low-intensity interventions in DVD format can improve the motivational impact of written information, and could be used to help prepare people with chronic pain for more intensive self-management interventions. The findings are consistent with a 2-phase, motivational-volitional model of pain self-management, and provide the first insights to our knowledge of readiness to self-manage pain in hemophilia.

  13. Outcomes of a randomised controlled trial of a complex genetic counselling intervention to improve family communication.

    Science.gov (United States)

    Hodgson, Jan; Metcalfe, Sylvia; Gaff, Clara; Donath, Susan; Delatycki, Martin B; Winship, Ingrid; Skene, Loane; Aitken, MaryAnne; Halliday, Jane

    2016-03-01

    When an inherited genetic condition is diagnosed in an individual it has implications for other family members. Privacy legislation and ethical considerations can restrict health professionals from communicating directly with other family members, and so it is frequently the responsibility of the first person in a family to receive the diagnosis (the proband) to share this news. Communication of genetic information is challenging and many at-risk family members remain unaware of important information that may be relevant to their or their children's health. We conducted a randomised controlled trial in six public hospitals to assess whether a specifically designed telephone counselling intervention improved family communication about a new genetic diagnosis. Ninety-five probands/parents of probands were recruited from genetics clinics and randomised to the intervention or control group. The primary outcome measure was the difference between the proportion of at-risk relatives who contacted genetics services for information and/or genetic testing. Audit of the family genetic file after 18 months revealed that 25.6% of intervention group relatives compared with 20.9% of control group relatives made contact with genetic services (adjusted odds ratio (OR) 1.30, 95% confidence interval 0.70-2.42, P=0.40). Although no major difference was detected overall between the intervention and control groups, there was more contact in the intervention group where the genetic condition conferred a high risk to offspring (adjusted OR 24.0, 95% confidence interval 3.4-168.5, P=0.001). The increasing sophistication and scope of genetic testing makes it imperative for health professionals to consider additional ways of supporting families in communicating genetic information.

  14. Improving medication adherence with a targeted, technology-driven disease management intervention.

    Science.gov (United States)

    Lawrence, David B; Allison, Wanda; Chen, Joyce C; Demand, Michael

    2008-06-01

    Treatment adherence is critical in managing chronic disease, but achieving it remains an elusive goal across many prevalent conditions. As part of its care management strategy, BlueCross BlueShield of South Carolina (BCBSSC) implemented the Longitudinal Adherence Treatment Evaluation program, a behavioral intervention to improve medication adherence among members with cardiovascular disease and/or diabetes. The objectives of this study were to 1) assess the effectiveness of telephonic intervention in influencing reinitiation of medication therapy, and 2) evaluate the rate and timing of medication reinitiation. BCBSSC applied algorithms against pharmacy claims data to identify patients prescribed targeted medications who were 60 or more days overdue for refills. This information was provided to care managers to address during their next patient contact. Care managers received focused training on techniques for medication behavior change, readiness to change, motivational interviewing, and active listening. Training also addressed common barriers to adherence and available resources, including side effect management, mail order benefits, drug assistance programs, medication organizers, and reminder systems. Overdue refills were tracked for 12 months, with medication reinitiation followed for an additional 3 months. In the intervention group, 94 patients were identified with 123 instances of late medication refills. In the age- and gender-matched comparison group, 61 patients were identified with 76 late refills. The intervention group had a significantly higher rate of medication reinitiation (59.3%) than the control group (42.1%; P management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a period of nonadherence and decreased the time from nonadherence to adherence.

  15. Portland Identification and Early Referral: A Community-Based System for Identifying and Treating Youths at High Risk of Psychosis

    Science.gov (United States)

    McFarlane, William R.; Cook, William L.; Downing, Donna; Verdi, Mary B.; Woodberry, Kristen A.; Ruff, Anita

    2010-01-01

    Objective The Portland [Maine] Identification and Early Referral (PIER) Program was established in 2001 as a prevention system for identifying and treating youths at high risk of an initial psychotic episode. Methods During six years, 7,270 professionals from the educational, general medical, and mental health sectors were provided information on prodromal symptoms and means for rapid referral of at-risk youth, which resulted in referral of 780 youths who met eligibility criteria. Results After screening, 37% of the community referrals were found to be at high risk of psychosis, and another 20% had untreated psychosis, yielding an efficiency ratio of 57%. Prodromal cases identified were 46% of the expected incidence of psychosis in the catchment area. Community educational presentations were significantly associated with referrals six months later; half of referrals were from outside the mental health system. Conclusions Community-based identification is an efficient public health strategy, offering the opportunity for preventive intervention. PMID:20439374

  16. Improving the Dictation in Attention Deficit Hyperactivity Disorder by Using Computer Based Interventions: A Clinical Trial

    Directory of Open Access Journals (Sweden)

    Mahdi Tehranidoost

    2006-07-01

    Full Text Available Objective: The aim of the current study was to assess the impact of computer games and computer-assisted type instruction on dictation scores of elementary school children with attention deficit – hyperactivity disorder (ADHD. Method: In this single-blind clinical trial, 37 elementary school children with ADHD, selected by convenience sampling and divided into group I (n=17 and group II (n=20, underwent eight one-hour sessions (3 sessions per week of intervention by computer games versus computer-assisted type instruction, respectively. 12 school dictation scores were considered: 4 scores preintervention, 4 scores during interventions, and 4 scores post-intervention. Dictation test was taken during each session. Data was analyzed using repeated measure ANOVA. Results: Two groups were matched for age, gender, school grade, medication, IQ, parent’s and teacher’s Conners’ scale scores, having computer at home, history of working with computer, and mean dictation scores. There was no significant difference in dictation scores before and after interventions and also between the study groups. The improvement in school dictation scores had no significant correlation with age, gender, Ritalin use, owning a computer at home and past history of computer work, baseline dictation scores, Ritalin dose, educational status, IQ, and the total score of parent’s and teacher’s Conners’ rating scale. Conclusion: Absence of significant improvement in dictation scores in study groups may be due to the confounding effect of other variables with known impact on dictation scores. Further studies in this field should also assess the change of attention and memory.

  17. Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting.

    Science.gov (United States)

    Meinlschmidt, Gunther; Lee, Jong-Hwan; Stalujanis, Esther; Belardi, Angelo; Oh, Minkyung; Jung, Eun Kyung; Kim, Hyun-Chul; Alfano, Janine; Yoo, Seung-Schik; Tegethoff, Marion

    2016-01-01

    Using mobile communication technology as new personalized approach to treat mental disorders or to more generally improve quality of life is highly promising. Knowledge about intervention components that target key psychopathological processes in terms of transdiagnostic psychotherapy approaches is urgently needed. We explored the use of smartphone-based micro-interventions based on psychotherapeutic techniques, guided by short video-clips, to elicit mood changes. As part of a larger neurofeedback study, all subjects-after being randomly assigned to an experimental or control neurofeedback condition-underwent daily smartphone-based micro-interventions for 13 consecutive days. They were free to choose out of provided techniques, including viscerosensory attention, emotional imagery, facial expression, and contemplative repetition. Changes in mood were assessed in real world using the Multidimensional Mood State Questionnaire (scales: good-bad, GB; awake-tired, AT; and calm-nervous, CN). Twenty-seven men participated on at least 11 days and were thus included in the analyses. Altogether, they underwent 335, generally well-tolerated, micro-intervention sessions, with viscerosensory attention (178 sessions, 53.13%) and contemplative repetition (68 sessions, 20.30%) being the most frequently applied techniques. Mixed models indicated that subjects showed better mood [GB: b = 0.464, 95%confidence interval (CI) [0.068, 0.860], t (613.3) = 2.298, p = 0.022] and became more awake [AT: b = 0.514, 95%CI [0.103, 0.925], t (612.4) = 2.456, p = 0.014] and calmer [CN: b = 0.685, 95%CI [0.360, 1.010], t (612.3) = 4.137, p mindfulness-based psychotherapy, transcendental meditation, and other contemplative therapies. The results encourage exploring these techniques' capability to improve mood in randomized controlled studies and patients. Smartphone-based micro-interventions are promising to modify mood in real-world settings, complementing other psychotherapeutic interventions, in

  18. Vision for improvement: Expressive writing as an intervention for people with Stargardt's disease, a rare eye disease.

    Science.gov (United States)

    Bryan, Jennifer L; Lu, Qian

    2016-05-01

    This study implemented and evaluated the effectiveness of an expressive writing intervention among patients with Stargardt's disease, a rare disease due to macular degeneration. Participants were randomly assigned to either an expressive writing intervention or a neutral writing condition. Participants completed measures at three time points: baseline, 3 weeks, and 6 weeks post-intervention. Psychological health outcomes improved at the 3-week follow-up for the intervention condition compared to control. Self-reported physical health improved at the 6-week follow-up in the intervention condition compared to control. These results suggest that expressive writing may be an effective, practical, and low-cost intervention for those with Stargardt's disease.

  19. Neighborhood-Level Interventions to Improve Childhood Opportunity and Lift Children Out of Poverty.

    Science.gov (United States)

    Sandel, Megan; Faugno, Elena; Mingo, Angela; Cannon, Jessie; Byrd, Kymberly; Garcia, Dolores Acevedo; Collier, Sheena; McClure, Elizabeth; Jarrett, Renée Boynton

    2016-04-01

    Population health is associated with the socioeconomic characteristics of neighborhoods. There is considerable scientific and policy interest in community-level interventions to alleviate child poverty. Intergenerational poverty is associated with inequitable access to opportunities. Improving opportunity structures within neighborhoods may contribute to improved child health and development. Neighborhood-level efforts to alleviate poverty for all children require alignment of cross-sector efforts, community engagement, and multifactorial approaches that consider the role of people as well as place. We highlight several accessible tools and strategies that health practitioners can engage to improve regional and local systems that influence child opportunity. The Child Opportunity Index is a population-level surveillance tool to describe community-level resources and inequities in US metropolitan areas. The case studies reviewed outline strategies for creating higher opportunity neighborhoods for pediatricians interested in working across sectors to address the impact of neighborhood opportunity on child health and well-being.

  20. A Chinese Chan-Based Mind-Body Intervention Improves Sleep on Patients with Depression: A Randomized Controlled Trial

    OpenAIRE

    Chan, Agnes S.; Wong, Queenie Y.; Sze, Sophia L.; Kwong, Patrick P. K.; Han, Yvonne M. Y.; Mei-chun Cheung

    2012-01-01

    Sleep disturbance is a common problem associated with depression, and cognitive-behavioral therapy (CBT) is a more common behavioral intervention for sleep problems. The present study compares the effect of a newly developed Chinese Chan-based intervention, namely Dejian mind-body intervention (DMBI), with the CBT on improving sleep problems of patients with depression. Seventy-five participants diagnosed with major depressive disorder were randomly assigned to receive 10 weekly sessions of C...

  1. Dejian Mind-Body Intervention Improves the Cognitive Functions of a Child with Autism

    Directory of Open Access Journals (Sweden)

    Agnes S. Chan

    2011-01-01

    Full Text Available There has been increasing empirical evidence for the enhancing effects of Dejian Mind-Body Intervention (DMBI, a traditional Chinese Shaolin healing approach, on human frontal brain activity/functions, including patients with autism who are well documented to have frontal lobe problems. This study aims to compare the effects of DMBI with a conventional behavioural/cognitive intervention (CI on enhancing the executive functions and memory of a nine-year-old boy with low-functioning autism (KY and to explore possible underlying neural mechanism using EEG theta cordance. At post-one-month DMBI, KY's inhibitory control, cognitive flexibility, and memory functioning have significantly improved from “severely-to-moderately impaired” to “within-normal” range. This improvement was not observed from previous 12-month CI. Furthermore, KY showed increased cordance gradually extending from the anterior to the posterior brain region, suggesting possible neural mechanism underlying his cognitive improvement. These findings have implicated potential applicability of DMBI as a rehabilitation program for patients with severe frontal lobe and/or memory disorders.

  2. Evaluation of an intervention to improve blood culture practices: a cluster randomised trial.

    Science.gov (United States)

    Pavese, P; Maillet, M; Vitrat-Hincky, V; Recule, C; Vittoz, J-P; Guyomard, A; Seigneurin, A; François, P

    2014-12-01

    This study aimed to evaluate an intervention to improve blood culture practices. A cluster randomised trial in two parallel groups was performed at the Grenoble University Hospital, France. In October 2009, the results of a practices audit and the guidelines for the optimal use of blood cultures were disseminated to clinical departments. We compared two types of information dissemination: simple presentation or presentation associated with an infectious diseases (ID) specialist intervention. The principal endpoint was blood culture performance measured by the rate of patients having one positive blood culture and the rate of positive blood cultures. The cases of 130 patients in the "ID" group and 119 patients in the "simple presentation" group were audited during the second audit in April 2010. The rate of patients with one positive blood culture increased in both groups (13.62 % vs 9.89 % for the ID group, p = 0.002, 15.90 % vs 13.47 % for the simple presentation group, p = 0.009). The rate of positive blood cultures improved in both groups (6.68 % vs 5.96 % for the ID group, p = 0.003, 6.52 % vs 6.21 % for the simple presentation group, p = 0.017). The blood culture indication was significantly less often specified in the request form in the simple presentation group, while it remained stable in the ID group (p = 0.04). The rate of positive blood cultures and the rate of patients having one positive blood culture improved in both groups. The ID specialist intervention did not have more of an impact on practices than a simple presentation of audit feedback and guidelines.

  3. Continuous Non-Invasive Arterial Pressure Technique Improves Patient Monitoring during Interventional Endoscopy

    Directory of Open Access Journals (Sweden)

    Sylvia Siebig, Felix Rockmann, Karl Sabel, Ina Zuber-Jerger, Christine Dierkes, Tanja Brünnler, Christian E. Wrede

    2009-01-01

    Full Text Available Introduction: Close monitoring of arterial blood pressure (BP is a central part of cardiovascular surveillance of patients at risk for hypotension. Therefore, patients undergoing diagnostic and therapeutic procedures with the use of sedating agents are monitored by discontinuous non-invasive BP measurement (NIBP. Continuous non-invasive BP monitoring based on vascular unloading technique (CNAP®, CN Systems, Graz may improve patient safety in those settings. We investigated if this new technique improved monitoring of patients undergoing interventional endoscopy. Methods: 40 patients undergoing interventional endoscopy between April and December 2007 were prospectively studied with CNAP® in addition to standard monitoring (NIBP, ECG and oxygen saturation. All monitoring values were extracted from the surveillance network at one-second intervals, and clinical parameters were documented. The variance of CNAP® values were calculated for every interval between two NIBP measurements. Results: 2660 minutes of monitoring were recorded (mean 60.1±34.4 min/patient. All patients were analgosedated with midazolam and pethidine, and 24/40 had propofol infusion (mean 90.9±70.3 mg. The mean arterial pressure for CNAP® was 102.4±21.2 mmHg and 106.8±24.8 mmHg for NIBP. Based on the first NIBP value in an interval between two NIBP measurements, BP values determined by CNAP® showed a maximum increase of 30.8±21.7% and a maximum decrease of 22.4±28.3% (mean of all intervals. Discussion: Conventional intermittent blood pressure monitoring of patients receiving sedating agents failed to detect fast changes in BP. The new technique CNAP® improved the detection of rapid BP changes, and may contribute to a better patient safety for those undergoing interventional procedures.

  4. A Perceptual Motor Intervention Improves Play Behavior In Children With Moderate To Severe Cerebral Palsy

    Directory of Open Access Journals (Sweden)

    Brigette Oliver Ryalls

    2016-05-01

    Full Text Available For children with moderate or severe cerebral palsy (CP, a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 seconds were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM, and the Play Assessment of Children with Motor Impairment (PACMI play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System (PIECES. Significant improvements in GMFM sitting scores (p<0.001 and marginally significant improvement in play assessment scores (p=0.067 were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.

  5. A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy

    Science.gov (United States)

    Ryalls, Brigette O.; Harbourne, Regina; Kelly-Vance, Lisa; Wickstrom, Jordan; Stergiou, Nick; Kyvelidou, Anastasia

    2016-01-01

    For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p < 0.001) and marginally significant improvement in play assessment scores (p = 0.067) were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment. PMID:27199868

  6. Predictors of acceptance of offered care management intervention services in a quality improvement trial for dementia.

    Science.gov (United States)

    Kaisey, Marwa; Mittman, Brian; Pearson, Marjorie; Connor, Karen I; Chodosh, Joshua; Vassar, Stefanie D; Nguyen, France T; Vickrey, Barbara G

    2012-10-01

    Care management approaches have been proven to improve outcomes for patients with dementia and their family caregivers (dyads). However, acceptance of services in these programs is incomplete, impacting effectiveness. Acceptance may be related to dyad as well as healthcare system characteristics, but knowledge about factors associated with program acceptance is lacking. This study investigates patient, caregiver, and healthcare system characteristics associated with acceptance of offered care management services. This study analyzed data from the intervention arm of a cluster randomized controlled trial of a comprehensive dementia care management intervention. There were 408 patient-caregiver dyads enrolled in the study, of which 238 dyads were randomized to the intervention. Caregiver, patient, and health system factors associated with participation in offered care management services were assessed through bivariate and multivariate regression analyses. Out of the 238 dyads, 9 were ineligible for this analysis, leaving data of 229 dyads in this sample. Of these, 185 dyads accepted offered care management services, and 44 dyads did not. Multivariate analyses showed that higher likelihood of acceptance of care management services was uniquely associated with cohabitation of caregiver and patient (p dementia (p = 0.03), and higher patient comorbidity (p = 0.03); it also varied across healthcare organization sites. Understanding factors that influence care management participation could result in increased adoption of successful programs to improve quality of care. Using these factors to revise both program design as well as program promotion may also benefit external validity of future quality improvement research trials. Copyright © 2011 John Wiley & Sons, Ltd.

  7. A Low-Glycemic Diet Lifestyle Intervention Improves Fat Utilization during Exercise in Older Obese Humans

    DEFF Research Database (Denmark)

    Solomon, Thomas; Haus, Jacob M; Cook, Marc A

    2013-01-01

    lipid was reduced (P foods for reversing metabolic defects in obesity.......Objective: To determine the influence of dietary glycemic index on exercise training-induced adaptations in substrate oxidation in obesity. Design and Methods: Twenty older, obese individuals undertook 3 months of fully supervised aerobic exercise and were randomized to low- (LoGIX) or high....... Results: Weight loss (-8.6 ± 1.1%) and improvements (P fasting lipemia, and metabolic flexibility were similar for both LoGIX and HiGIX groups. During submaximal exercise, energy expenditure was higher following the intervention (P

  8. Does an Exercise Intervention Improving Aerobic Capacity Among Construction Workers Also Improve Musculoskeletal Pain, Work Ability, Productivity, Perceived Physical Exertion, and Sick Leave?

    DEFF Research Database (Denmark)

    Gram, Bibi; Holtermann, Andreas; Bültmann, Ute;

    2012-01-01

    OBJECTIVE:: To investigate whether an exercise intervention shown to increase aerobic capacity, would also lead to less musculoskeletal pain; improved work ability, productivity, and perceived physical exertion; and less sick leave. METHODS:: Sixty-seven construction workers were randomized...... into an exercise group training 3 × 20 minutes per week and a control group. Questionnaires and text messages were completed before and after the 12-week intervention. RESULTS:: No significant changes were found in musculoskeletal pain, work ability, productivity, perceived physical exertion, and sick leave...... with the intervention. Questionnaires and text messages provided similar results of pain and work ability. CONCLUSIONS:: Although the intervention improved aerobic capacity, it was not successful in improving musculoskeletal pain and other work-related factors. A detectable improvement presumably requires a more...

  9. A social autopsy of neonatal mortality suggests needed improvements in maternal and neonatal interventions in Balaka and Salima districts of Malawi

    Directory of Open Access Journals (Sweden)

    Alain K. Koffi

    2015-06-01

    ANC visits, and ensure urine screening for all pregnant women. Early recognition and referrals of women with obstetric complications and interventions to promote maternal recognition of neonatal illnesses and care–seeking before the child becomes severely ill are also needed to improve newborn survival in Balaka and Salima districts of Malawi.

  10. Interventions to improve professional adherence to guidelines for prevention of device-related infections.

    Science.gov (United States)

    Flodgren, Gerd; Conterno, Lucieni O; Mayhew, Alain; Omar, Omar; Pereira, Cresio Romeu; Shepperd, Sasha

    2013-03-28

    Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators), and poor staff adherence to infection prevention practices during insertion and care for the devices when in place. There are specific risk profiles for each device, but in general, the breakdown of aseptic technique during insertion and care for the device, as well as the duration of device use, are important factors for the development of these serious and costly infections. To assess the effectiveness of different interventions, alone or in combination, which target healthcare professionals or healthcare organisations to improve professional adherence to infection control guidelines on device-related infection rates and measures of adherence. We searched the following electronic databases for primary studies up to June 2012: the Cochrane Effective Paractice and Organisation of Care (EPOC) Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and CINAHL. We searched reference lists and contacted authors of included studies. We also searched the Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effectiveness (DARE) for related reviews. We included randomised controlled trials (RCTs), non-randomised controlled trials (NRCTs), controlled before-after (CBA) studies and interrupted time series (ITS) studies that complied with the Cochrane EPOC Group methodological criteria, and that evaluated interventions to improve professional adherence to guidelines for the prevention of device-related infections. Two review authors independently extracted data and assessed the risk of bias of each included study using the Cochrane EPOC 'Risk of bias' tool. We contacted authors of original papers to obtain

  11. Intervention studies for improving global health and health care: An important arena for epidemiologists

    Directory of Open Access Journals (Sweden)

    Gunnar Kvåle

    2009-10-01

    Full Text Available Marginalised populations in many low- and middle-income countries experience an increasing burden of disease, in sub-Saharan Africa to a large extent due to faltering health systems and serious HIV epidemics. Also other poverty related diseases (PRDs are prevalent, especially respiratory and diarrhoeal diseases in children, malnutrition, maternal and perinatal health problems, tuberculosis and malaria. Daily, nearly 30,000 children under the age of 5 die, most from preventable causes, and 8,000 people die from HIV infections. In spite of the availability of powerful preventive and therapeutic tools for combating these PRDs, their implementation, especially in terms of equitable delivery, leaves much to be desired. The research community must address this tragic gap between knowledge and implementation. Epidemiologists have a very important role to play in conducting studies on diseases that account for the largest share of the global disease burden. A shift of focus of epidemiologic research towards intervention studies addressing health problems of major public health importance for disadvantaged population groups is needed. There is a need to generate an evidence-base for interventions that can be implemented on a large scale; this can result in increased funding of health promotion programs as well as enable rational prioritization and integration between different health interventions. This will require close and synergetic teamwork between epidemiologists and other professions across disciplines and sectors. In this way epidemiologists can contribute significantly to improve health and optimise health care delivery for marginalized populations.

  12. Systematic review of public-targeted communication interventions to improve antibiotic use.

    Science.gov (United States)

    Cross, Elizabeth Louise Anne; Tolfree, Robert; Kipping, Ruth

    2017-04-01

    Excessive use of antibiotics accelerates the acquisition/spread of antimicrobial resistance. A systematic review was conducted to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. The databases MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library were searched. Search terms were related to the population (public, community), intervention (campaign, mass media) and outcomes (antibiotic, antimicrobial resistance). References were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied and only articles in the English language were considered. Studies had to have a control group or be an interrupted time-series. Outcomes had to measure change in antibiotic-related prescribing/consumption and/or the public's knowledge, attitudes or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Fourteen studies were included with an estimated 74-75 million participants. Most studies were conducted in the United States or Europe and targeted both the general public and clinicians. Twelve of the studies measured changes in antibiotic prescribing. There was quite strong ( P  antibiotic prescribing; the majority of these studies reported reductions of greater than -14% with the largest effect size reaching -30%. Multi-faceted communication interventions that target both the general public and clinicians can reduce antibiotic prescribing in high-income countries but the sustainability of reductions in antibiotic prescribing is unclear.

  13. Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis.

    Science.gov (United States)

    Mercier, Joanie; Savard, Josée; Bernard, Paquito

    2016-11-10

    Exercise leads to several positive outcomes in oncology. However, the question as to whether exercise is a valuable option for improving patients' sleep, which is frequently disturbed in cancer patients, remains unanswered. The aims of this study were to conduct a systematic review and meta-analysis of randomized and non-randomized clinical trials that have investigated the effect of exercise on sleep outcomes, assessed subjectively and objectively. Relevant studies, published before May 2016, were traced through a systematic search of PubMed, Embase, PsycINFO, SportDiscus and Cochrane library databases. The review looked at twenty one trials, including 17 randomized controlled trials. Most interventions were home-based aerobic walking programs and breast cancer patients were the subgroup most represented. Sleep variables were most commonly used as secondary outcomes in the reviewed studies. Studies were highly heterogeneous in terms of methodology. The qualitative review of available evidence suggested a beneficial effect of exercise interventions on sleep in several studies (48%). However, the meta-analysis conducted on RCTs revealed no significant effect either on subjective or on objective sleep measures. This lack of significant effect could be due, at least in part, to a floor effect. More rigorous studies are needed to assess the effect of exercise interventions in cancer patients, in particular randomized controlled trials conducted in patients with clinically significant sleep disturbances at baseline.

  14. Improving knowledge, assessment, and attitudes related to pain management: evaluation of an intervention.

    Science.gov (United States)

    Schreiber, Judith A; Cantrell, Donita; Moe, Krista A; Hench, Jeanine; McKinney, Emily; Preston Lewis, C; Weir, Amy; Brockopp, Dorothy

    2014-06-01

    Pain control in the acute care setting is repeatedly described in the literature as problematic. The purpose of this clinical research project was to evaluate an educational intervention designed to improve the management of pain in an acute care setting. A quasi-experimental pre- and post-intervention design was used. Three hundred and forty-one medical-surgical and critical care nurses completed the Brockopp-Warden Pain Knowledge/Bias Questionnaire (2004) (203 pre, 138 post). Data were collected before the intervention and 3 months following the educational experience. Sixty patients (30 pre, 30 post) recorded numerical assessments of their pain every 2 hours in a pain diary. Patient charts were reviewed to compare patients' pain assessments with nurses' documentation. A 50% decrease in the mean difference between patients' assessment of pain and nurses' documentation (p keeping with earlier research on bias regarding pain management, patients with non-physiological conditions were not attended to as well as patients who had clearly defined physical problems. Results of this project have precipitated major changes regarding the management of pain in this institution. A pain steering committee has been formed and additional unit-based projects have been conducted. The challenge of finding the most effective method for changing biases toward specific patient populations and increasing knowledge regarding pain management remains.

  15. Impact of Water, Sanitation, and Hygiene Interventions on Improving Health Outcomes among School Children

    Directory of Open Access Journals (Sweden)

    Ashish Joshi

    2013-01-01

    Full Text Available Purpose. This review was done to explore the impact of water treatment, hygiene, and sanitary interventions on improving child health outcomes such as absenteeism, infections, knowledge, attitudes, and practices and adoption of point-of-use water treatment. Methods. A literature search was conducted using the databases PubMed and Google scholar for studies published between 2009 and 2012 and focusing on the effects of access to safe water, hand washing facilities, and hygiene education among school-age children. Studies included were those that documented the provision of water and sanitation in schools for children less than 18 years of age, interventions which assessed WASH practices, and English-language, full-text peer reviewed papers. Results. Fifteen studies were included in the final analysis. 73% (n=11 of the studies were conducted in developing countries and were rural based (53%, n=8. The child's age, gender, grade level, socioeconomic index, access to hygiene and sanitary facilities, and prior knowledge of hygiene practices were significantly associated with the outcomes. Nutrition practices which are key factors associated with the outcomes were rarely assessed. Conclusion. Further research is required to assess the long-term impact of such interventions in different settings.

  16. Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomnia

    NARCIS (Netherlands)

    Niet, G.J. De; Tiemens, B.G.; Kloos, M.W.; Hutschemaekers, G.J.M.

    2009-01-01

    Background Insomnia is a very common condition in various populations. Non-pharmacological interventions might offer (safe) alternatives for hypnotics. Aim To evaluate the evidence for efficacy from systematic reviews about non-pharmacological interventions to improve sleep quality in insomnia by a

  17. Implementation examined in a health center-delivered, educational intervention that improved infant growth in Trujillo, Peru: successes and challenges.

    Science.gov (United States)

    Robert, Rebecca C; Gittelsohn, Joel; Creed-Kanashiro, Hilary M; Penny, Mary E; Caulfield, Laura E; Narro, M Rocio; Steckler, Allan; Black, Robert E

    2007-06-01

    Process evaluation was used to examine the implementation of a randomized, controlled trial of an education intervention that improved infant growth in Trujillo, Peru. Health personnel delivered the multi-component intervention as part of usual care in the government health centers. Quantitative and qualitative methods were used to examine process indicators, which included the extent of delivery (dose), fidelity to intervention protocol, barriers to implementation and context. Results demonstrated that most intervention components were delivered at a level of 50-90% of expectations. Fidelity to intervention protocol, where measured, was lower (28-70% of expectations). However, when compared with existing nutrition education, as represented by the control centers, significant improvements were demonstrated. This included both improved delivery of existing educational activities as well as delivery of new intervention components to strengthen overall nutrition education. Barriers to, and facilitators of, implementation were explored with health personnel and helped to explain results. This study demonstrates the importance of examining actual versus planned implementation in order to improve our understanding of how interventions succeed. The information gained from this study will inform future evaluation designs, and lead to the development and implementation of more effective intervention programs for child health.

  18. Use of Computer-Based Interventions to Improve Literacy Skills in Students with Autism Spectrum Disorders: A Systematic Review

    Science.gov (United States)

    Ramdoss, Sathiyaprakash; Mulloy, Austin; Lang, Russell; O'Reilly, Mark; Sigafoos, Jeff; Lancioni, Giulio; Didden, Robert; El Zein, Farah

    2011-01-01

    The purpose of this review is to provide a systematic analysis of studies investigating computer-based interventions (CBI) to improve literacy skills (e.g., reading, writing, and vocabulary) in students with autism spectrum disorders (ASD). This review synthesizes intervention outcomes, appraises the certainty of evidence, and describes software…

  19. Use of computer-based interventions to improve literacy skills in students with autism spectrum disorders: A systematic review

    NARCIS (Netherlands)

    Ramdoss, S.; Mulloy, A.; Lang, R.; O'Reilly, M.F.; Sigafoos, J.; Lancioni, G.E.; Didden, H.C.M.; El Zein, F.

    2011-01-01

    The purpose of this review is to provide a systematic analysis of studies investigating computer-based interventions (CBI) to improve literacy skills (e.g., reading, writing, and vocabulary) in students with autism spectrum disorders (ASD). This review synthesizes intervention outcomes, appraises th

  20. Review of systematic reviews about the efficacy of non-pharmacological interventions to improve sleep quality in insomnia

    NARCIS (Netherlands)

    Niet, G.J. De; Tiemens, B.G.; Kloos, M.W.; Hutschemaekers, G.J.M.

    2009-01-01

    Background Insomnia is a very common condition in various populations. Non-pharmacological interventions might offer (safe) alternatives for hypnotics. Aim To evaluate the evidence for efficacy from systematic reviews about non-pharmacological interventions to improve sleep quality in insomnia by a

  1. The Effectiveness of Using a Social Story Intervention to Improve Social Interaction Skills of Students with Autism

    Science.gov (United States)

    Al zyoudi, Mohammed; Al Murhairi, Oshua; Sartaiwi, AbedAlziz; Olimat, Enas; Al zyoudi, Abedsalm

    2016-01-01

    The aim of this study was to evaluate the effectiveness of using a social story intervention to improve social interaction skills in three students with autism aged between 7-8 years. A multiple-baseline-across participants design was used. To achieve the purpose of the study, the social stories were implemented. The intervention included reading…

  2. Skin conditions in primary care: an analysis of referral demand.

    Science.gov (United States)

    Castillo-Arenas, E; Garrido, V; Serrano-Ortega, S

    2014-04-01

    Skin conditions are among the main reasons for seeking primary health care. Primary care physicians (PCPs) must diagnose skin conditions and determine their impact, and must therefore incorporate the relevant knowledge and skills into their education. The present study analyzes the reasons for primary care referral to dermatology (referral demand) as well as diagnostic agreement between PCPs and dermatologists informed by pathology where appropriate. Data were collected for 755 patients and 882 initial dermatology appointments from February 1, 2012 through April 30, 2012 following primary care referral. Data obtained included age, sex, occupation, reason for referral, primary care diagnosis, and dermatologic diagnosis. Statistical analysis of the data for each diagnosed condition identified frequency, reasons for referral, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the κ statistic for diagnostic agreement. The most common diagnoses were seborrheic keratosis, melanocytic nevus, actinic keratosis, and acne. The main reason for referral was diagnostic assessment (52.5%). For skin tumors, sensitivity of primary care diagnosis was 22.4%, specificity 94.7%, PPV 40.7%, and NPV 88.3%, with a κ of 0.211. For the more common diagnoses, primary care sensitivity was generally low and specificity high. According to our results, primary care physicians are better qualified to rule out a given skin condition in a patient (high specificity) than to establish an accurate clinical diagnosis (poor sensitivity). This suggests that knowledge and skills training should be organized for primary care physicians to improve management of skin conditions-especially skin cancer, because of its impact. A more responsive system would ensue, with shorter waiting lists and better health care. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

  3. Behavioral interventions for improving contraceptive use among women living with HIV.

    Science.gov (United States)

    Lopez, Laureen M; Hilgenberg, Deborah; Chen, Mario; Denison, Julie; Stuart, Gretchen

    2013-01-31

    Contraception services can help meet the family planning goals of women living with HIV as well as prevent mother-to-child transmission. Due to the increased availability of antiretroviral therapy, survival has improved for people living with HIV, and more HIV-positive women may desire to have a child or another child. This review examines behavioral interventions to improve contraceptive use, for family planning, among women who are HIV-positive. We systematically reviewed studies that examined behavioral interventions for HIV-positive women that were intended to inform contraceptive choice, encourage contraceptive use, or promote adherence to a contraceptive regimen. Through October 2012, we searched MEDLINE, CENTRAL, POPLINE, EMBASE, CINAHL, PsycINFO, ClinicalTrials.gov and ICTRP. For other relevant papers, we examined reference lists and unpublished project reports, and contacted investigators in the field. Studies evaluated a behavioral intervention for improving contraceptive use for contraception. The comparison could be another behavioral intervention, usual care, or no intervention. We also considered studies that compared HIV-positive women versus HIV-negative women. We included nonrandomized (observational) studies as well as randomized trials.Primary outcomes were pregnancy and contraception use, e.g., uptake of a new method, improved use or continuation of current method. Secondary outcomes were knowledge of contraceptive effectiveness and attitude about contraception in general or about a specific contraceptive method. Two authors independently extracted the data. One author entered the data into RevMan and a second verified accuracy. We examined the quality of evidence using the Newcastle-Ottawa Quality Assessment Scale.Given the need to control for confounding factors in observational studies, we used adjusted estimates from the models when available. Where we did not have adjusted analyses, we calculated the odds ratio (OR) with 95% confidence

  4. A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study.

    Science.gov (United States)

    Gagnon, Pierre; Fillion, Lise; Robitaille, Marie-Anik; Girard, Michèle; Tardif, François; Cochrane, Jean-Philippe; Le Moignan Moreau, Joanie; Breitbart, William

    2015-08-01

    We developed a specific cognitive-existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures. Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire. All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively). This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.

  5. A cognitive–existential intervention to improve existential and global quality of life in cancer patients: A pilot study

    Science.gov (United States)

    GAGNON, PIERRE; FILLION, LISE; ROBITAILLE, MARIE-ANIK; GIRARD, MICHÈLE; TARDIF, FRANÇOIS; COCHRANE, JEAN-PHILIPPE; LE MOIGNAN MOREAU, JOANIE; BREITBART, WILLIAM

    2017-01-01

    Objective We developed a specific cognitive–existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures. Method Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire. Results All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively). Significance of results This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study. PMID:25050872

  6. A systematic review of triage-related interventions to improve patient flow in emergency departments

    Directory of Open Access Journals (Sweden)

    Asplund Kjell

    2011-07-01

    Full Text Available Abstract Background Overcrowding in emergency departments is a worldwide problem. A systematic literature review was undertaken to scientifically explore which interventions improve patient flow in emergency departments. Methods A systematic literature search for flow processes in emergency departments was followed by assessment of relevance and methodological quality of each individual study fulfilling the inclusion criteria. Studies were excluded if they did not present data on waiting time, length of stay, patients leaving the emergency department without being seen or other flow parameters based on a nonselected material of patients. Only studies with a control group, either in a randomized controlled trial or in an observational study with historical controls, were included. For each intervention, the level of scientific evidence was rated according to the GRADE system, launched by a WHO-supported working group. Results The interventions were grouped into streaming, fast track, team triage, point-of-care testing (performing laboratory analysis in the emergency department, and nurse-requested x-ray. Thirty-three studies, including over 800,000 patients in total, were included. Scientific evidence on the effect of fast track on waiting time, length of stay, and left without being seen was moderately strong. The effect of team triage on left without being seen was relatively strong, but the evidence for all other interventions was limited or insufficient. Conclusions Introducing fast track for patients with less severe symptoms results in shorter waiting time, shorter length of stay, and fewer patients leaving without being seen. Team triage, with a physician in the team, will probably result in shorter waiting time and shorter length of stay and most likely in fewer patients leaving without being seen. There is only limited scientific evidence that streaming of patients into different tracks, performing laboratory analysis in the emergency

  7. Music interventions for improving psychological and physical outcomes in cancer patients.

    Science.gov (United States)

    Bradt, Joke; Dileo, Cheryl; Magill, Lucanne; Teague, Aaron

    2016-08-15

    Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in cancer patients. To assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/ and the National Research Register. We searched all databases, except for the last two, from their inception to January 2016; the other two are no longer functional, so we searched them until their termination date. We handsearched music therapy journals, reviewed reference lists and contacted experts. There was no language restriction. We included all randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adult and pediatric patients with cancer. We excluded participants undergoing biopsy and aspiration for diagnostic purposes. Two review authors independently extracted the data and assessed the risk of bias. Where possible, we presented results in meta-analyses using mean differences and standardized mean differences. We used post-test scores. In cases of significant baseline difference, we used change scores. We identified 22 new trials for inclusion in this update. In total, the evidence of this review rests on 52 trials with a total of 3731 participants. We included music therapy interventions offered by trained music therapists, as well as music medicine interventions, which are defined as listening to pre-recorded music, offered by medical staff. We categorized 23 trials as music therapy trials and 29 as music medicine trials

  8. Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

    Directory of Open Access Journals (Sweden)

    Qingyan Ma

    2016-10-01

    Full Text Available Introduction: Qualitative research on antiretroviral therapy (ART adherence interventions can provide a deeper understanding of intervention facilitators and barriers. This systematic review aims to synthesize qualitative evidence of interventions for improving ART adherence and to inform patient-centred policymaking. Methods: We searched 19 databases to identify studies presenting primary qualitative data on the experiences, attitudes and acceptability of interventions to improve ART adherence among PLHIV and treatment providers. We used thematic synthesis to synthesize qualitative evidence and the CERQual (Confidence in the Evidence from Reviews of Qualitative Research approach to assess the confidence of review findings. Results: Of 2982 references identified, a total of 31 studies from 17 countries were included. Twelve studies were conducted in high-income countries, 13 in middle-income countries and six in low-income countries. Study populations focused on adults living with HIV (21 studies, n=1025, children living with HIV (two studies, n=46, adolescents living with HIV (four studies, n=70 and pregnant women living with HIV (one study, n=79. Twenty-three studies examined PLHIV perspectives and 13 studies examined healthcare provider perspectives. We identified six themes related to types of interventions, including task shifting, education, mobile phone text messaging, directly observed therapy, medical professional outreach and complex interventions. We also identified five cross-cutting themes, including strengthening social relationships, ensuring confidentiality, empowerment of PLHIV, compensation and integrating religious beliefs into interventions. Our qualitative evidence suggests that strengthening PLHIV social relationships, PLHIV empowerment and developing culturally appropriate interventions may facilitate adherence interventions. Our study indicates that potential barriers are inadequate training and compensation for lay

  9. eHealth Technologies as an Intervention to Improve Adherence to Topical Antipsoriatics

    DEFF Research Database (Denmark)

    Svendsen, Mathias Tiedemann; Andersen, Flemming; Andersen, Klaus Ejner

    2017-01-01

    Health interventions designed to improve adherence to topical antipsoriatics and to review applications for smartphones (apps) incorporating the word psoriasis. MATERIAL AND METHODS: Literature review: Medline, Embase, Cochrane, PsycINFO, and Web of Science were searched using search terms for eHealth, psoriasis...... and topical antipsoriatics. General analysis of apps: The operating systems (OS) for smartphones, iOS, Google Play, Microsoft Store, Symbian OS and Blackberry OS were searched for apps containing the word psoriasis. RESULTS: Literature review: Only one RCT was included, reporting on psoriasis patients......' internet-reporting their status of psoriasis over a 12-month period. The rate of adherence was measured by Medication Event Monitoring System (MEMS®). An improvement in medical adherence and reduction of severity of psoriasis were reported. General analysis of apps: 184 apps contained the word psoriasis...

  10. Health benefits from improved outdoor air quality and intervention in China.

    Science.gov (United States)

    Li, Shanshan; Williams, Gail; Guo, Yuming

    2016-07-01

    China is at its most critical stage of outdoor air quality management. In order to prevent further deterioration of air quality and to protect human health, the Chinese government has made a series of attempts to reduce ambient air pollution. Unlike previous literature reviews on the widespread hazards of air pollution on health, this review article firstly summarized the existing evidence of human health benefits from intermittently improved outdoor air quality and intervention in China. Contents of this paper provide concrete and direct clue that improvement in outdoor air quality generates various health benefits in China, and confirm from a new perspective that it is worthwhile for China to shift its development strategy from economic growth to environmental economic sustainability. Greater emphasis on sustainable environment design, consistently strict regulatory enforcement, and specific monitoring actions should be regarded in China to decrease the health risks and to avoid long-term environmental threats.

  11. Interventions to Improve Asthma Management of the School-Age Child.

    Science.gov (United States)

    Friend, Mary; Morrison, Amber

    2015-06-01

    Improvement of medication adherence in the school-age child can lead to improvement in quality of life, decreased morbidity, and a potential decreased risk of deferred academic, social, and emotional development. The objective of this article is to review barriers to asthma medication adherence and identify evidence-based techniques that improve medication management of the asthmatic child 5 to 12 years of age. A literature review was performed and articles were obtained through database searches within Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PubMed. Research indicates that barriers to the adherence of medication regimens required for asthmatic children include poor understanding of the medication regimen, substandard education on symptom recognition and environmental triggers, rejection of the diagnosis, and a lack of support or understanding within the community. Researched techniques aimed to improve medication management in 5- to 12-year-olds include: computer-based education; workshops for parents, teachers, and children; incorporation of asthma education into classroom lessons; use of case managers; the introduction of a nurse practitioner in the school to provide care, including medication prescriptions for the asthmatic child; and assessment and evaluation of environmental and emotional triggers in the home and school. Collaboration of current data may help lead to a successful interventional model that can improve asthma management in this population.

  12. Improved scores for observed teamwork in the clinical environment following a multidisciplinary operating room simulation intervention.

    Science.gov (United States)

    Weller, Jennifer M; Cumin, David; Civil, Ian D; Torrie, Jane; Garden, Alexander; MacCormick, Andrew D; Gurusinghe, Nishanthi; Boyd, Matthew J; Frampton, Christopher; Cokorilo, Martina; Tranvik, Magnus; Carlsson, Lisa; Lee, Tracey; Ng, Wai Leap; Crossan, Michael; Merry, Alan F

    2016-08-05

    We ran a Multidisciplinary Operating Room Simulation (MORSim) course for 20 complete general surgical teams from two large metropolitan hospitals. Our goal was to improve teamwork and communication in the operating room (OR). We hypothesised that scores for teamwork and communication in the OR would improve back in the workplace following MORSim. We used an extended Behavioural Marker Risk Index (BMRI) to measure teamwork and communication, because a relationship has previously been documented between BMRI scores and surgical patient outcomes. Trained observers scored general surgical teams in the OR at the two study hospitals before and after MORSim, using the BMRI. Analysis of BMRI scores for the 224 general surgical cases before and 213 cases after MORSim showed BMRI scores improved by more than 20% (0.41 v 0.32, pteamwork score would translate into a clinically important reduction in complications and mortality in surgical patients. We demonstrated an improvement in scores for teamwork and communication in general surgical ORs following our intervention. These results support the use of simulation-based multidisciplinary team training for OR staff to promote better teamwork and communication, and potentially improve outcomes for general surgical patients.

  13. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study.

    Science.gov (United States)

    Wade, Alexandra T; Davis, Courtney R; Dyer, Kathryn A; Hodgson, Jonathan M; Woodman, Richard J; Keage, Hannah A D; Murphy, Karen J

    2017-02-16

    The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines.

  14. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study

    Science.gov (United States)

    Wade, Alexandra T.; Davis, Courtney R.; Dyer, Kathryn A.; Hodgson, Jonathan M.; Woodman, Richard J.; Keage, Hannah A. D.; Murphy, Karen J.

    2017-01-01

    The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines. PMID:28212320

  15. A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy.

    Science.gov (United States)

    Ryalls, Brigette O; Harbourne, Regina; Kelly-Vance, Lisa; Wickstrom, Jordan; Stergiou, Nick; Kyvelidou, Anastasia

    2016-01-01

    For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.

  16. Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review.

    OpenAIRE

    van der Wilt Gert Jan; Gerretsen Barend; Dieleman Marjolein

    2009-01-01

    Abstract Background Improving health workers' performance is vital for achieving the Millennium Development Goals. In the literature on human resource management (HRM) interventions to improve health workers' performance in Low and Middle Income Countries (LMIC), hardly any attention has been paid to the question how HRM interventions might bring about outcomes and in which contexts. Such information is, however, critical to assess the transferability of results. Our aim was to explore if rea...

  17. Impact of interventions to improve the quality of peer review of biomedical journals: a systematic review and meta-analysis

    OpenAIRE

    Bruce, Rachel; Chauvin, Anthony; Trinquart, Ludovic; Ravaud, Philippe; Boutron, Isabelle

    2016-01-01

    Background The peer review process is a cornerstone of biomedical research. We aimed to evaluate the impact of interventions to improve the quality of peer review for biomedical publications. Methods We performed a systematic review and meta-analysis. We searched CENTRAL, MEDLINE (PubMed), Embase, Cochrane Database of Systematic Reviews, and WHO ICTRP databases, for all randomized controlled trials (RCTs) evaluating the impact of interventions to improve the quality of peer review for biomedi...

  18. Improving Financial Management via Contemplation: Novel Interventions and Findings in Laboratory and Applied Settings.

    Science.gov (United States)

    Harkin, Ben

    2017-01-01

    The present research tackles two main areas of financial mismanagement, namely avoiding debt-related information and underestimating expenditure. We draw upon research which has shown that inviting people to think about reasons for avoiding something actually serves to reduce the likelihood that they will then avoid it, and potentially improves what they know about it. Therefore, in three studies we investigated if prompting participants to contemplate their debt (Studies 1 and 2) and expenditure (Study 3) would decrease avoidance of debt-related information and improve estimates of expenditure, respectively. Conform to our expectations prompting contemplation via questionnaire (Study 1) and video (Study 2) reduced avoidance of debt-related information. In other words, contemplation reduced the likelihood that people would avoid viewing their risk of debt. The success of prompting contemplation via video offers a new and important addition to the literature on contemplation, which has previously focused on using the traditional questionnaire format. In Study 3 we observed that contemplation improved the estimates of expenditure that loan applicants at a credit union provided. Specifically, contemplation resulted in participants providing larger and more detailed accounts of their expenditure, and increased the agreement between staff and clients for the number of expenditure items provided by the clients. In sum, these findings suggest that contemplation in the context of the above financial decision-making is a robust intervention, as it was effective for different types of interventions (questionnaire and video), behaviors (avoidance of debt-related information and improving estimates of expenditure), and samples (students and university staff; Studies 1 and 2 and loan applicants at a credit union; Study 3). We discuss the theoretical, policy and applied impact of these findings, and highlight limitations and considerations for future research.

  19. Improving Financial Management via Contemplation: Novel Interventions and Findings in Laboratory and Applied Settings

    Science.gov (United States)

    Harkin, Ben

    2017-01-01

    The present research tackles two main areas of financial mismanagement, namely avoiding debt-related information and underestimating expenditure. We draw upon research which has shown that inviting people to think about reasons for avoiding something actually serves to reduce the likelihood that they will then avoid it, and potentially improves what they know about it. Therefore, in three studies we investigated if prompting participants to contemplate their debt (Studies 1 and 2) and expenditure (Study 3) would decrease avoidance of debt-related information and improve estimates of expenditure, respectively. Conform to our expectations prompting contemplation via questionnaire (Study 1) and video (Study 2) reduced avoidance of debt-related information. In other words, contemplation reduced the likelihood that people would avoid viewing their risk of debt. The success of prompting contemplation via video offers a new and important addition to the literature on contemplation, which has previously focused on using the traditional questionnaire format. In Study 3 we observed that contemplation improved the estimates of expenditure that loan applicants at a credit union provided. Specifically, contemplation resulted in participants providing larger and more detailed accounts of their expenditure, and increased the agreement between staff and clients for the number of expenditure items provided by the clients. In sum, these findings suggest that contemplation in the context of the above financial decision-making is a robust intervention, as it was effective for different types of interventions (questionnaire and video), behaviors (avoidance of debt-related information and improving estimates of expenditure), and samples (students and university staff; Studies 1 and 2 and loan applicants at a credit union; Study 3). We discuss the theoretical, policy and applied impact of these findings, and highlight limitations and considerations for future research. PMID:28326053

  20. Analysis of a vibrating interventional device to improve 3-D colormark tracking.

    Science.gov (United States)

    Fronheiser, Matthew P; Smith, Stephen W

    2007-08-01

    Ultrasound guidance of interventional devices during minimally invasive surgical procedures has been investigated by many researchers. Previously, we extended the methods used by the Colormark tracking system to several interventional devices using a real-time, three-dimensional (3-D) ultrasound system. These results showed that we needed to improve the efficiency and reliability of the tracking. In this paper, we describe an analytical model to predict the transverse vibrations along the length of an atrial septal puncture needle to enable design improvements of the tracking system. We assume the needle can be modeled as a hollow bar with a circular cross section with a fixed proximal end and a free distal end that is suspended vertically to ignore gravity effects. The initial results show an ability to predict the natural nodes and antinodes along the needle using the characteristic equation for free vibrations. Simulations show that applying a forcing function to the device at a natural antinode yields an order of magnitude larger vibration than when driving the device at a node. Pulsed wave spectral Doppler data was acquired along the distal portion of the needle in a water tank using a 2-D matrix array transesophageal echocardiography probe. This data was compared to simulations of forced vibrations from the model. These initial results suggest that the model is a good first order approximation of the vibrating device in a water tank. It is our belief that knowing the location of the natural nodes and antinodes will improve our ability to drive the device to ensure the vibrations at the proximal end will reach the tip of the device, which in turn should improve our ability to track the device in vivo.

  1. Impact of an Educational Intervention to Improve Physician Adherence to Bronchiolitis Clinical Practice Guidelines: A Pre-Post Intervention Study.

    Science.gov (United States)

    Genies, Marquita C; Kim, Julia M; Pyclik, Kristina; Rossi, Suzanne; Spicyn, Natalie; Serwint, Janet R

    2017-04-01

    Bronchiolitis is the leading cause of infant hospitalizations in the United States. Despite clinical practice guidelines discouraging the utilization of non-evidence-based therapies, there continues to be wide variation in care and resource utilization. A pre-post physician focused educational intervention was conducted with the aims to reduce the use of non-evidence-based medical therapies, including bronchodilators, among patients admitted for bronchiolitis. Among patients meeting inclusion criteria (pre: n = 45; post: n = 47), bronchodilator use decreased by 50% ( P educational intervention highlighting American Academy of Pediatrics clinical practice guidelines resulted in reduced utilization of bronchodilators.

  2. Educational interventions to improve inhaler techniques and their impact on asthma and COPD control: a pilot effectiveness-implementation trial

    Directory of Open Access Journals (Sweden)

    Tiago Maricoto

    Full Text Available ABSTRACT To assess the impact that educational interventions to improve inhaler techniques have on the clinical and functional control of asthma and COPD, we evaluated 44 participants before and after such an intervention. There was a significant decrease in the number of errors, and 20 patients (46% significantly improved their technique regarding prior exhalation and breath hold. In the asthma group, there were significant improvements in the mean FEV1, FVC, and PEF (of 6.4%, 8.6%, and 8.3% respectively. Those improvements were accompanied by improvements in Control of Allergic Rhinitis and Asthma Test scores but not in Asthma Control Test scores. In the COPD group, there were no significant variations. In asthma patients, educational interventions appear to improve inhaler technique, clinical control, and functional control.

  3. Does educational intervention improve doctors’ knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia

    Science.gov (United States)

    Wong, Zhi Yen; Alrasheedy, Alian A.; Saleem, Fahad; Mohamad Yahaya, Abdul Haniff; Aljadhey, Hisham

    2014-01-01

    Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name) prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively). In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05). Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05). Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines. PMID:26770747

  4. Does educational intervention improve doctors’ knowledge and perceptions of generic medicines and their generic prescribing rate? A study from Malaysia

    Directory of Open Access Journals (Sweden)

    Mohamed Azmi Hassali

    2014-11-01

    Full Text Available Objectives: To investigate the impact of an educational intervention on doctors’ knowledge and perceptions towards generic medicines and their generic (international non-proprietary name prescribing practice. Methods: This is a single-cohort pre-/post-intervention pilot study. The study was conducted in a tertiary care hospital in Perak, Malaysia. All doctors from the internal medicine department were invited to participate in the educational intervention. The intervention consisted of an interactive lecture, an educational booklet and a drug list. Doctors’ knowledge and perceptions were assessed by using a validated questionnaire, while the international non-proprietary name prescribing practice was assessed by screening the prescription before and after the intervention. Results: The intervention was effective in improving doctors’ knowledge towards bioequivalence, similarity of generic medicines and safety standards required for generic medicine registration (p = 0.034, p = 0.034 and p = 0.022, respectively. In terms of perceptions towards generic medicines, no significant changes were noted (p > 0.05. Similarly, no impact on international non-proprietary name prescribing practice was observed after the intervention (p > 0.05. Conclusion: Doctors had inadequate knowledge and misconceptions about generic medicines before the intervention. Moreover, international non-proprietary name prescribing was not a common practice. However, the educational intervention was only effective in improving doctors’ knowledge of generic medicines.

  5. Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda

    NARCIS (Netherlands)

    Leerlooijer, J.N.; Kok, G.; Weyusya, J.; Bos, A.E.R.; Ruiter, R.A.C.; Rijsdijk, E.; Nshakira, N.; Bartholomew, L.K.

    2014-01-01

    Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve

  6. Applying Intervention Mapping to Develop a Community-Based Intervention Aimed at Improved Psychological and Social Well-Being of Unmarried Teenage Mothers in Uganda

    Science.gov (United States)

    Leerlooijer, Joanne N.; Kok, Gerjo; Weyusya, Joseph; Bos, Arjan E. R.; Ruiter, Robert A. C.; Rijsdijk, Liesbeth E.; Nshakira, Nathan; Bartholomew, Leona K.

    2014-01-01

    Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psychological and social well-being of unmarried…

  7. Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda

    NARCIS (Netherlands)

    Leerlooijer, J.N.; Kok, G.; Weyusya, J.; Bos, A.E.R.; Ruiter, R.A.C.; Rijsdijk, E.; Nshakira, N.; Bartholomew, L.K.

    2014-01-01

    Out-of-wedlock pregnancy among adolescents in sub-Saharan Africa is a major concern, because of its association with health, social, psychological, economic and demographic factors. This article describes the development of the Teenage Mothers Project, a community-based intervention to improve psych

  8. Effectiveness of interventions to improve occupational performance of people with cognitive impairments after stroke: an evidence-based review.

    Science.gov (United States)

    Gillen, Glen; Nilsen, Dawn M; Attridge, Jessica; Banakos, Erasmia; Morgan, Marie; Winterbottom, Lauren; York, Wesley

    2015-01-01

    This evidence-based review was conducted to determine which interventions are effective in improving occupational performance after stroke. Forty-six articles met the inclusion criteria and were examined. Interventions for the following impairments were reviewed: general cognitive deficits, executive dysfunction, apraxia, memory loss, attention deficits, visual field deficits (included because of their close relationship with neglect), and unilateral neglect. Evidence is available from a variety of clinical trials to guide interventions regarding general cognition, apraxia, and neglect. The evidence regarding interventions for executive dysfunction and memory loss is limited. There is insufficient evidence regarding impairments of attention and mixed evidence regarding interventions for visual field deficits. The effective interventions have some commonalities, including being performance focused, involving strategy training, and using a compensatory as opposed to a remediation approach. The implications of the findings for practice, research, and education are discussed.

  9. The effect of referral for cardiac rehabilitation on survival following acute myocardial infarction

    DEFF Research Database (Denmark)

    Lewinter, Christian; Bland, John M; Crouch, Simon

    2014-01-01

    BACKGROUND: International guidelines recommend referral for cardiac rehabilitation (CR) after acute myocardial infarction (AMI). However, the impact on long-term survival after CR referral has not been adjusted by time-variance. We compared the effects of CR referral after hospitalization for AMI......% CI, 0.66 to 0.96, p = 0.02 in 2003) when patients entered the model at three months after discharge and had a common exit at 90 months. Significant positive and negative predictors for CR referral were beta-blocker prescription (+), reperfusion (+) and age (-) in 1995, and reperfusion...... (+), revascularization (+), heart failure (HF) (+), antiplatelets (+), angiotensin-converting-enzyme inhibitor (ACE-I) (+), statins (+), diabetes (-), and the modified Global Registry of Acute Cardiac Events (GRACE) risk score (-) in 2003. CONCLUSIONS: CR referral was associated with improved survival in 2003...

  10. Interventions for improving the research literacy of nurses: a systematic review.

    Science.gov (United States)

    Hines, Sonia; Ramsbotham, Joanne; Coyer, Fiona

    2016-02-01

    Despite the importance of research literacy for nurses, many nurses report feeling unable to effectively read and understand research, which in turn results in lower research utilization in practice. Nurses themselves identify poor experiences with trying to understand and use research as factors that contribute to a reluctance to utilize research. This reluctance often leads nurses to seek other sources of information, such as colleagues, instead. The objective of this review was to identify the effectiveness of research literacy interventions on the research literacy of registered nurses. Registered nurses.Interventions of interest were those that evaluated the effectiveness of workplace educational programs or interventions conducted in a healthcare organization or tertiary-level educational facility aiming to improve or increase registered nurses' understanding of research literature.Outcomes of interest were research literacy, measured explicitly or as research knowledge, research understanding, use of research evidence in practice, and/or ability to critically appraise research.We considered experimental study designs such as randomized controlled trials, nonrandomized controlled trials, quasi-experimental, and before and after studies. A wide range of databases were searched in order to provide the most complete possible review of the evidence. Initial keywords used were: "research litera*", "research education", "research knowledge", "evidence-based practice education". Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data were extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI. Quantitative data would have been, if possible, pooled in statistical meta

  11. The Relative Contribution of Subjective Office Referrals to Racial Disproportionality in School Discipline.

    Science.gov (United States)

    Girvan, Erik J; Gion, Cody; McIntosh, Kent; Smolkowski, Keith

    2016-10-13

    To improve our understanding of where to target interventions, the study examined the extent to which school discipline disproportionality between African American and White students was attributable to racial disparities in teachers' discretionary versus nondiscretionary decisions. The sample consisted of office discipline referral (ODR) records for 1,154,686 students enrolled in 1,824 U.S. schools. Analyses compared the relative contributions of disproportionality in ODRs for subjectively and objectively defined behaviors to overall disproportionality, controlling for relevant school characteristics. Results showed that disproportionality in subjective ODRs explained the vast majority of variance in total disproportionality. These findings suggest that providing educators with strategies to neutralize the effects of implicit bias, which is known to influence discretionary decisions and interpretations of ambiguous behaviors, may be a promising avenue for achieving equity in school discipline. (PsycINFO Database Record

  12. Improving the psychosocial work environment at multi-ethnic workplaces: a multi-component intervention strategy in the cleaning industry.

    Science.gov (United States