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Sample records for interventions improve poor

  1. Evaluating a Large-Scale Community-Based Intervention to Improve Pregnancy and Newborn Health Among the Rural Poor in India

    PubMed Central

    Lalwani, Tanya; Dutta, Rahul; Rajaratnam, Julie Knoll; Ruducha, Jenny; Varkey, Leila Caleb; Wunnava, Sita; Menezes, Lysander; Taylor, Catharine; Bernson, Jeff

    2015-01-01

    Objectives. We evaluated the effectiveness of the Sure Start project, which was implemented in 7 districts of Uttar Pradesh, India, to improve maternal and newborn health. Methods. Interventions were implemented at 2 randomly assigned levels of intensity. Forty percent of the areas received a more intense intervention, including community-level meetings with expectant mothers. A baseline survey consisted of 12 000 women who completed pregnancy in 2007; a follow-up survey was conducted for women in 2010 in the same villages. Our quantitative analyses provide an account of the project’s impact. Results. We observed significant health improvements in both intervention areas over time; in the more intensive intervention areas, we found greater improvements in care-seeking and healthy behaviors. The more intensive intervention areas did not experience a significantly greater decline in neonatal mortality. Conclusions. This study demonstrates that community-based efforts, especially mothers’ group meetings designed to increase care-seeking and healthy behaviors, are effective and can be implemented at large scale. PMID:25393175

  2. US Intervention in Failed States: Bad Assumptions=Poor Outcomes

    DTIC Science & Technology

    2002-01-01

    NATIONAL DEFENSE UNIVERSITY NATIONAL WAR COLLEGE STRATEGIC LOGIC ESSAY US INTERVENTION IN FAILED STATES: BAD ASSUMPTIONS = POOR ...2002 2. REPORT TYPE 3. DATES COVERED 00-00-2002 to 00-00-2002 4. TITLE AND SUBTITLE US Intervention in Failed States: Bad Assumptions= Poor ...country remains in the grip of poverty , natural disasters, and stagnation. Rwanda Rwanda, another small African country, is populated principally

  3. Surviving Performance Improvement "Solutions": Aligning Performance Improvement Interventions

    ERIC Educational Resources Information Center

    Bernardez, Mariano L.

    2009-01-01

    How can organizations avoid the negative, sometimes chaotic, effects of multiple, poorly coordinated performance improvement interventions? How can we avoid punishing our external clients or staff with the side effects of solutions that might benefit our bottom line or internal efficiency at the expense of the value received or perceived by…

  4. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh

    PubMed Central

    Iqbal, Afrin; Hoque, D. M. Emdadul; Moinuddin, Md.; Zaman, Sojib Bin; Rahman, Qazi Sadeq-ur; Begum, Tahmina; Chowdhury, Atique Iqbal; Haider, Rafiqul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.

    2017-01-01

    Introduction Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled ‘Interrupting Pathways to Sepsis Initiative’ (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Materials and Method Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite ‘Program Coaches’, facilitating triage and rapid transfer of patients through ‘Welcoming Persons’ and enabling rapid treatment through ‘Task Shifting’ from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. Results From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of

  5. Differences in brain function and changes with intervention in children with poor spelling and reading abilities.

    PubMed

    Gebauer, Daniela; Fink, Andreas; Kargl, Reinhard; Reishofer, Gernot; Koschutnig, Karl; Purgstaller, Christian; Fazekas, Franz; Enzinger, Christian

    2012-01-01

    Previous fMRI studies in English-speaking samples suggested that specific interventions may alter brain function in language-relevant networks in children with reading and spelling difficulties, but this research strongly focused on reading impaired individuals. Only few studies so far investigated characteristics of brain activation associated with poor spelling ability and whether a specific spelling intervention may also be associated with distinct changes in brain activity patterns. We here investigated such effects of a morpheme-based spelling intervention on brain function in 20 children with comparatively poor spelling and reading abilities using repeated fMRI. Relative to 10 matched controls, children with comparatively poor spelling and reading abilities showed increased activation in frontal medial and right hemispheric regions and decreased activation in left occipito-temporal regions prior to the intervention, during processing of a lexical decision task. After five weeks of intervention, spelling and reading comprehension significantly improved in the training group, along with increased activation in the left temporal, parahippocampal and hippocampal regions. Conversely, the waiting group showed increases in right posterior regions. Our findings could indicate an increased left temporal activation associated with the recollection of the new learnt morpheme-based strategy related to successful training.

  6. Effect of Wii-intervention on balance of children with poor motor performance.

    PubMed

    Mombarg, Remo; Jelsma, Dorothee; Hartman, Esther

    2013-09-01

    The purpose of this study was to investigate the effects of training with the Wii-balance board on balance and balance-related skills of children with poor motor performance. Twenty-nine children (23 boys, 6 girls; aged 7-12 years) participated in this study and were randomly assigned to an experimental and control group. All children scored below the 16th percentile on a standardized test of motor ability and balance skills (Movement Assessment Battery for children (M-ABC-2)). Before and after a six-week Wii-intervention (M=8h, 22 min, SD=53 min), the balance skills of the experimental group and control group were measured with the M-ABC-2 and the Bruininks-Oseretsky test of motor proficiency (BOT-2). Both groups improved on all tests. The M-ABC-2 and the BOT-2 total balance-scores of the experimental group improved significantly from pre to post intervention, whereas those of the control group showed no significant progress. This resulted in significant interaction-effects, favoring the experimental children. No transfer-effects of the intervention on balance-related skills were demonstrated. Our findings showed that the Wii-balance board is an effective intervention for children with poor balance control. Further development and investigation of the intervention could be directed toward the implementation of the newly acquired balance-skills in daily life.

  7. Estimating the impact on health of poor reliability of drinking water interventions in developing countries.

    PubMed

    Hunter, Paul R; Zmirou-Navier, Denis; Hartemann, Philippe

    2009-04-01

    Recent evidence suggests that many improved drinking water supplies suffer from poor reliability. This study investigates what impact poor reliability may have on achieving health improvement targets. A Quantitative Microbiological Risk Assessment was conducted of the impact of interruptions in water supplies that forced people to revert to drinking raw water. Data from the literature were used to construct models on three waterborne pathogens common in Africa: Rotavirus, Cryptosporidium and Enterotoxigenic E. coli. Risk of infection by the target pathogens is substantially greater on days that people revert to raw water consumption. Over the course of a few days raw water consumption, the annual health benefits attributed to consumption of water from an improved supply will be almost all lost. Furthermore, risk of illness on days drinking raw water will fall substantially on very young children who have the highest risk of death following infection. Agencies responsible for implementing improved drinking water provision will not make meaningful contributions to public health targets if those systems are subject to poor reliability. Funders of water quality interventions in developing countries should put more effort into auditing whether interventions are sustainable and whether the health benefits are being achieved.

  8. Improving Latin America's School Quality: Which Special Interventions Work?

    ERIC Educational Resources Information Center

    Anderson, Joan B.

    2005-01-01

    This article presents new findings, first, regarding the effectiveness of compensatory interventions in improving language and math achievement, and in increasing the probability of promotion. A second question addressed in this research is whether a particular intervention is equally effective in poor and nonpoor environments. A third important…

  9. Reading Comprehension: A Computerized Intervention with Primary-age Poor Readers.

    PubMed

    Horne, Joanna Kathryn

    2017-01-09

    The current study investigates the effectiveness of a computerized reading comprehension programme on the reading accuracy, reading comprehension and reading rate of primary-age poor readers. There is little published literature relating to computerized reading interventions in UK primary schools, and no previous studies have investigated the Comprehension Booster programme. Thirty-eight children (26 boys and 12 girls; aged 6:7 to 11:0) from two schools in East Yorkshire, UK, took part. Half of the participants (the intervention group) undertook the Comprehension Booster programme for a 6-week period, whilst the other half (the control group) continued with their usual teaching. Significant effects of the intervention were found, with increases in reading accuracy and reading comprehension for the intervention group. It is concluded that computerized reading programmes can be effective in improving reading skills, and these are particularly useful for pupils with reading difficulties in disadvantaged areas, where resources are limited and family support in reading is lower. However, such programmes are not a replacement for good teaching, and regular monitoring of children with reading difficulties is required. Further research is necessary to compare the programme used here to other conventional and computerized intervention programmes, using a larger sample. Copyright © 2017 John Wiley & Sons, Ltd.

  10. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence

    PubMed Central

    Newman-Casey, Paula Anne; Weizer, Jennifer S.; Heisler, Michele; Lee, Paul P.; Stein, Joshua D.

    2014-01-01

    Adherence to prescribed glaucoma medications is often poor, and proper adherence can be challenging for patients. We systematically reviewed the literature and identified eight studies using educational interventions to improve glaucoma medication adherence. Overall, five of the eight studies found that educational interventions lead to a significant improvement in medication adherence, and the remaining studies found a trend towards improvement. Using information from this systematic review and Health Behavior Theory, we constructed a conceptual framework to illustrate how counseling and education can improve glaucoma medication adherence. More rigorous studies grounded in Health Behavior Theory with adequately powered samples and longer follow-up are needed. PMID:23697623

  11. CMS proposal for interventional pain management by nurse anesthetists: evidence by proclamation with poor prognosis.

    PubMed

    Manchikanti, Laxmaiah; Caraway, David L; Falco, Frank J E; Benyamin, Ramsin M; Hansen, Hans; Hirsch, Joshua A

    2012-01-01

    and training qualifications for CRNAs to offer interventional techniques, the FTC issued their opinion and CMS proposed to expand these practice patterns with a policy of improved access and reduced cost. However, in reality, the opposite will happen and will increase fraud, reduce access due to inappropriate procedures, and increase complications, all as a result of privileges by legislation without education. The CMS proposal for interventional pain management by nurse anesthetists is a proclamation with a poor prognosis.

  12. Poor Sleep Quality in Patients after Coronary Artery Bypass Graft Surgery: An Intervention Study Using the PRECEDE-PROCEED Model

    PubMed Central

    Ranjbaran, Soheila; Dehdari, Tahereh; Sadeghniiat-Haghighi, Khosro; Majdabadi, Mahmood Mahmoodi

    2015-01-01

    Abstract Background: Poor sleep quality (SQ) is common among patients after coronary artery bypass graft surgery (CABG). This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG. Methods: This study was a randomized clinical trial. The study sample, including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center, was assigned either to the intervention (recipient of exercise and lifestyle training plus designed intervention based on the PRECEDE-PROCEED model) or to the control group (recipient of exercise and lifestyle training). Eight training sessions over 8 weeks were conducted for the intervention group. Predisposing, enabling, and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points. Results: The mean age of the patients in the intervention (24% women) and control (24% women) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years, respectively. The results showed that the mean scores of SQ (p value < 0.001), knowledge (p value < 0.001), beliefs (p value < 0.001), sleep self-efficacy (p value < 0.001), enabling factors (p value < 0.001), reinforcing factors (p value < 0.001), and social support (p value < 0.001) were significantly different between the intervention and control groups after the intervention. Conclusion: Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients. PMID:26157457

  13. Telemedicine Intervention Improves ICU Outcomes

    PubMed Central

    Sadaka, Farid; Palagiri, Ashok; Trottier, Steven; Deibert, Wendy; Gudmestad, Donna; Sommer, Steven E.; Veremakis, Christopher

    2013-01-01

    Telemedicine for the intensive care unit (Tele-ICU) was founded as a means of delivering the clinical expertise of intensivists located remotely to hospitals with inadequate access to intensive care specialists. This was a retrospective pre- and postintervention study of adult patients admitted to a community hospital ICU. The patients in the preintervention period (n = 630) and during the Tele-ICU period (n = 2193) were controlled for baseline characteristics, acute physiologic scores (APS), and acute physiologic and health evaluation (APACHE IV) scores. Mean APS scores were 37.1 (SD, 22.8) and 37.7 (SD, 19.4) (P = 0.56), and mean APACHE IV scores were 49.7 (SD, 24.8) and 50.4 (SD, 21.0) (P = 0.53), respectively. ICU mortality was 7.9% during the preintervention period compared with 3.8% during the Tele-ICU period (odds ratio (OR) = 0.46, 95% confidence interval (CI), 0.32–0.66, P < 0.0001). ICU LOS in days was 2.7 (SD, 4.1) compared with 2.2 (SD, 3.4), respectively (hazard ratio (HR) = 1.16, 95% CI, 1.00–1.40, P = 0.01). Implementation of Tele-ICU intervention was associated with reduced ICU mortality and ICU LOS. This suggests that there are benefits of a closed Tele-ICU intervention beyond what is provided by daytime bedside physicians. PMID:23365729

  14. Pilot Study of a Web-Delivered Multicomponent Intervention for Rural Teens with Poorly Controlled Type 1 Diabetes

    PubMed Central

    Christiano, Ann S.; Casella, Samuel J.

    2016-01-01

    Objective. The purpose of this study was to examine the feasibility and effectiveness of a web-delivered multicomponent behavioral and family-based intervention targeting self-regulation and self-monitoring of blood glucose levels (SMBG) and glycemic control (HbA1c) in teens with type 1 diabetes (T1DM) living in rural US. Methods. 15 teens with poorly controlled T1DM participated in a 25-week web-delivered intervention with two phases, active treatment (weekly treatment sessions and working memory training program) and maintenance treatment (fading of treatment sessions). Results. Almost all (13 of 15) participants completed at least 14 of 15 treatment sessions and at least 20 of 25 working memory training sessions. SMBG was increased significantly at end of active and maintenance treatment, and HbA1c was decreased at end of active treatment (p's ≤ 0.05). Executive functioning improved at end of maintenance treatment: performance on working memory and inhibitory control tasks significantly improved (p's ≤ 0.02) and parents reported fewer problems with executive functioning (p = 0.05). Improvement in inhibitory control was correlated with increases in SMBG and decreases in HbA1c. Conclusions. An innovative web-delivered and multicomponent intervention was feasible for teens with poorly controlled T1DM and their families living in rural US and associated with significant improvements in SMBG and HbA1c. PMID:27610391

  15. Improved simulation of poorly drained forests using Biome-BGC.

    PubMed

    Bond-Lamberty, Ben; Gower, Stith T; Ahl, Douglas E

    2007-05-01

    Forested wetlands and peatlands are important in boreal and terrestrial biogeochemical cycling, but most general-purpose forest process models are designed and parameterized for upland systems. We describe changes made to Biome-BGC, an ecophysiological process model, that improve its ability to simulate poorly drained forests. Model changes allowed for: (1) lateral water inflow from a surrounding watershed, and variable surface and subsurface drainage; (2) adverse effects of anoxic soil on decomposition and nutrient mineralization; (3) closure of leaf stomata in flooded soils; and (4) growth of nonvascular plants (i.e., bryophytes). Bryophytes were treated as ectohydric broadleaf evergreen plants with zero stomatal conductance, whose cuticular conductance to CO(2) was dependent on plant water content. Individual model changes were parameterized with published data, and ecosystem-level model performance was assessed by comparing simulated output to field data from the northern BOREAS site in Manitoba, Canada. The simulation of the poorly drained forest model exhibited reduced decomposition and vascular plant growth (-90%) compared with that of the well-drained forest model; the integrated bryophyte photosynthetic response accorded well with published data. Simulated net primary production, biomass and soil carbon accumulation broadly agreed with field measurements, although simulated net primary production was higher than observed data in well-drained stands. Simulated net primary production in the poorly drained forest was most sensitive to oxygen restriction on soil processes, and secondarily to stomatal closure in flooded conditions. The modified Biome-BGC remains unable to simulate true wetlands that are subject to prolonged flooding, because it does not track organic soil formation, water table changes, soil redox potential or anaerobic processes.

  16. A Rhythmic Musical Intervention for Poor Readers: A Comparison of Efficacy with a Letter-Based Intervention

    ERIC Educational Resources Information Center

    Bhide, Adeetee; Power, Alan; Goswami, Usha

    2013-01-01

    There is growing evidence that children with reading difficulties show impaired auditory rhythm perception and impairments in musical beat perception tasks. Rhythmic musical interventions with poorer readers may thus improve rhythmic entrainment and consequently improve reading and phonological skills. Here we compare the effects of a musical…

  17. Veterans’ Perspectives on Interventions to Improve Retention in HIV Care

    PubMed Central

    Kertz, Barbara L.; Cully, Jeffery A.; Stanley, Melinda A.; Davila, Jessica A.; Dang, Bich N.; Rodriguez-Barradas, Maria C.; Giordano, Thomas P.

    2016-01-01

    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. PMID:26829641

  18. Missouri School Improvement Program: Support and Intervention

    ERIC Educational Resources Information Center

    Missouri Department of Elementary and Secondary Education, 2016

    2016-01-01

    The Missouri State Board of Education and the Department of Elementary and Secondary Education are dedicated to ensuring that all children have access to good schools that prepare them for college and career success. The Missouri School Improvement Program: Support and Intervention Plan takes a differentiated approach to state support based on…

  19. Text message program improves outcomes, decreases ED utilization among ED patients with poorly controlled diabetes.

    PubMed

    2014-02-01

    Diabetic patients who lack access to primary care tend to frequent the ED, often with complications from their disease that could have been prevented with proper management and education. To get around the problem of access, researchers tested an automated program that continuously delivered educational messaging via text to a group of patients who presented to the ED with poorly controlled diabetes. After six months, researchers noted improvements in Hb A1c levels, self-reported medication adherence, and ED utilization when compared with a control group. And the impact was particularly noteworthy among Latinos, according to the researchers. The text messaging program, dubbed TExT-Med, was developed by four physicians and two diabetes educators. The messages were delivered daily, and contained educational as well motivational content derived from the National Diabetes Education Program.There were also medication reminders, healthy living challenges, and trivia questions about diabetes. At six months, Hb A1c levels decreased by 1.05% in the intervention group, compared to 0.60% in the control group, and self-reported medication adherence improved from 4.5 to 5.4 (as measured on an 8 point scale) in the intervention group versus a decrease of 0.1 in the control group. During the six-month study period, 35.9% of patients in the intervention group presented to the ED for care, as compared to 51.6% of patients in the control group.

  20. Will interventions targeting conscientiousness improve aging outcomes?

    PubMed

    English, Tammy; Carstensen, Laura L

    2014-05-01

    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 may be possible to design therapeutic interventions that increase conscientiousness, there may be more effective and efficient ways to improve population health. We ask for evidence that a focus on conscientiousness improves behavior change efforts that target specific health-related behaviors or large-scale environmental modification.

  1. Cell Phone Intervention to Improve Adherence

    PubMed Central

    Marciel, Kristen K.; Saiman, Lisa; Quittell, Lynne M.; Dawkins, Kevin; Quittner, Alexandra L.

    2010-01-01

    Summary Background Treatment regimens for patients with cystic fibrosis (CF) are time-consuming and complex, resulting in consistently low adherence rates. To date, few studies have evaluated innovative technologies to improve adherence in this population. Current infection control guidelines for patients with CF seek to minimize patient-to-patient transmission of potential pathogens. Thus, interventions must avoid face-to-face contact and be delivered individually, limiting opportunities for peer support. This study aimed to develop and assess a web-enabled cell phone, CFFONE™, designed to provide CF information and social support to improve adherence in adolescents with CF. Methods The acceptability, feasibility, and utility of CFFONE™ were evaluated with health care professionals (n = 17) adolescents with CF aged 11–18 years old (n = 12), adults with CF aged 21–36 years old (n = 6), parents of adolescents with CF (n = 12), and technology experts (n = 8). Adolescents also tested a prototype of CFFONE™ (n = 9). Qualitative and quantitative data were collected. Results Focus group data with health care = professionals indicated a need for this intervention, and indicated that CFFONE™ would be likely to improve knowledge and social support, and somewhat likely to improve adherence. Adolescent, adults, and parents all rated CFFONE™ as likely to improve adherence. Technology experts rated the prototype design and format as appropriate. Conclusions The current study provided some support from key stakeholders for this intervention to improve adherence in adolescents with CF. Next steps include a multi-center trial of the efficacy and safety of CFFONE™. PMID:20054860

  2. Why Continuous Improvement Is a Poor Substitute for School Choice

    ERIC Educational Resources Information Center

    Rose, David C.; Rochester, J. Martin

    2008-01-01

    Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

  3. Educational interventions to improve recognition of delirium: a systematic review.

    PubMed

    Yanamadala, Mamata; Wieland, Darryl; Heflin, Mitchell T

    2013-11-01

    Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium.

  4. Perceptions of Health, Health Care and Community-Oriented Health Interventions in Poor Urban Communities of Kinshasa, Democratic Republic of Congo

    PubMed Central

    Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

    2013-01-01

    In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city’s major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and

  5. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

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

    2015-01-01

    quality interventions might prevent diarrhoea? Diarrhoea is a major cause of death and disease, especially among young children in low-income countries where the most common causes are faecally contaminated water and food, or poor hygiene practices. In remote and low-income settings, source-based water quality improvement may include providing protected groundwater (springs, wells, and bore holes) or harvested rainwater as an alternative to surface sources (rivers and lakes). Alternatively water may be treated at the point-of-use in people's homes by boiling, chlorination, flocculation, filtration, or solar disinfection. These point-of-use interventions have the potential to overcome both contaminated sources and recontamination of safe water in the home. What the research says There is currently insufficient evidence to know if source-based improvements in water supplies, such as protected wells and communal tap stands or treatment of communal supplies, consistently reduce diarrhoea in low-income settings (very low quality evidence). We found no trials evaluating reliable piped-in water supplies to people's homes. On average, distributing disinfection products for use in the home may reduce diarrhoea by around one quarter in the case of chlorine products (low quality evidence), and around a third in the case of flocculation and disinfection sachets (moderate quality evidence). Water filtration at home probably reduces diarrhoea by around a half (moderate quality evidence), and effects were consistently seen with ceramic filters (moderate quality evidence), biosand systems (moderate quality evidence) and LifeStraw® filters (low quality evidence). Plumbed-in filtration has only been evaluated in high-income settings (low quality evidence). In low-income settings, distributing plastic bottles with instructions to leave filled bottles in direct sunlight for at least six hours before drinking probably reduces diarrhoea by around a third (moderate quality evidence). Research

  6. Percutaneous coronary intervention for poor coronary microcirculation reperfusion of patients with stable angina pectoris.

    PubMed

    Li, J S; Zhao, X J; Ma, B X; Wang, Z

    2016-01-01

    Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant

  7. Effects of simulated interventions to improve school entry academic skills on socioeconomic inequalities in educational achievement.

    PubMed

    Chittleborough, Catherine R; Mittinty, Murthy N; Lawlor, Debbie A; Lynch, John W

    2014-01-01

    Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764, imputed), simulated effects of plausible interventions to improve school entry academic skills on socioeconomic inequality in educational achievement at age 16 were examined. Progressive universal interventions (i.e., more intense intervention for those with greater need) to improve school entry academic skills could raise population levels of educational achievement by 5% and reduce absolute socioeconomic inequality in poor educational achievement by 15%.

  8. Effects of Simulated Interventions to Improve School Entry Academic Skills on Socioeconomic Inequalities in Educational Achievement

    PubMed Central

    Chittleborough, Catherine R; Mittinty, Murthy N; Lawlor, Debbie A; Lynch, John W

    2014-01-01

    Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764, imputed), simulated effects of plausible interventions to improve school entry academic skills on socioeconomic inequality in educational achievement at age 16 were examined. Progressive universal interventions (i.e., more intense intervention for those with greater need) to improve school entry academic skills could raise population levels of educational achievement by 5% and reduce absolute socioeconomic inequality in poor educational achievement by 15%. PMID:25327718

  9. Modeling Determinants of Medication Attitudes and Poor Adherence in Early Nonaffective Psychosis: Implications for Intervention

    PubMed Central

    Drake, Richard J.; Nordentoft, Merete; Haddock, Gillian; Arango, Celso; Fleischhacker, W. Wolfgang; Glenthøj, Birte; Leboyer, Marion; Leucht, Stefan; Leweke, Markus; McGuire, Phillip; Meyer-Lindenberg, Andreas; Rujescu, Dan; Sommer, Iris E.; Kahn, René S.; Lewis, Shon W.

    2015-01-01

    We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from “insight,” correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures’ and DAI’s predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate. PMID:25750247

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

    ERIC Educational Resources Information Center

    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. Recovery interventions and strategies for improved tennis performance

    PubMed Central

    Kovacs, Mark S; Baker, Lindsay B

    2014-01-01

    Improving the recovery capabilities of the tennis athlete is receiving more emphasis in the research communities, and also by practitioners (coaches, physical trainers, tennis performance specialists, physical therapists, etc). The purpose of this article was to review areas of recovery to limit the severity of fatigue and/or speed recovery from fatigue. This review will cover four broad recovery techniques commonly used in tennis with the belief that the interventions may improve athlete recovery and therefore improve adaptation and future performance. The four areas covered are: (1) temperature-based interventions, (2) compressive clothing, (3) electronic interventions and (4) nutritional interventions. PMID:24668374

  12. Interventions to improve communication in autism.

    PubMed

    Paul, Rhea

    2008-10-01

    Children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these methods in maintenance and generalization of skills suggests that many children with autism will need to have these methods supplemented with less adult-directed activities to increase communicative initiation and carry over learned skills to new settings and communication partners. Providing opportunities for mediated peer interactions with trained peers in natural settings seems to be especially important in maximizing the effects of this intervention.

  13. [Improving health care practices and organization: methodology for intervention studies].

    PubMed

    Zaugg, Vincent; Savoldelli, Virginie; Sabatier, Brigitte; Durieux, Pierre

    2014-01-01

    Interventions designed to improve professional practices and healthcare organization are regularly implemented in all health systems. Their effectiveness on quality of care should be properly evaluated prior to their widespread implementation. Intervention studies can be conducted for this purpose according to a rigorous methodology in order to provide results with a good level of evidence. This article describes the main phases of an intervention study, including definition of the intervention, choice of study design, outcomes assessment, and writing of the report. It also addresses methodological issues of intervention studies designed to improve quality of care, such as cluster-randomization or the use of quasi-experimental designs. One of the specific features of these studies is that professionals are the targets, while patients are the beneficiaries of the intervention. A good knowledge of the specific features of studies designed to improve quality of care is essential to conduct research, or to evaluate the quality of the evidence from published studies.

  14. An Intervention to Improve Motivation for Homework

    ERIC Educational Resources Information Center

    Akioka, Elisabeth; Gilmore, Linda

    2013-01-01

    A repeated measures design, with randomly assigned intervention and control groups and multiple sources of information on each participant, was used to examine whether changing the method of delivery of a school's homework program in order to better meet the students' needs for autonomy, relatedness and competence would lead to more positive…

  15. Music Education Intervention Improves Vocal Emotion Recognition

    ERIC Educational Resources Information Center

    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…

  16. Improving Student Reading through Early Intervention.

    ERIC Educational Resources Information Center

    Saratore, Katherine K.; Walsh, Mary Ann

    A study examined an early reading intervention program designed to lead children, identified with low reading readiness at the start of first grade, to an appropriate reading level by the end of a 6-month period. Subjects were students entering first grade in a middle class community in northern Illinois. The problems of low reading readiness were…

  17. 76 FR 12969 - Campaign To Improve Poor Medication Adherence (U18)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-09

    ... HUMAN SERVICES Food and Drug Administration Campaign To Improve Poor Medication Adherence (U18) AGENCY... ] importance of good medication adherence, a vital first step toward improved adherence behavior and better...' awareness of the importance of good medication adherence and provide tools to prescribers to help...

  18. Video Educational Intervention Improves Reporting of Concussion and Symptom Recognition

    ERIC Educational Resources Information Center

    Hunt, Tamerah N.

    2015-01-01

    Context: Concussion management is potentially complicated by the lack of reporting due to poor educational intervention in youth athletics. Objective: Determine if a concussion-education video developed for high school athletes will increase the reporting of concussive injuries and symptom recognition in this group. Design: Cross-sectional,…

  19. Transvaginal ovarian trauma, poor responders and improvement of success rates in IVF: anecdotal data and a hypothesis.

    PubMed

    Siristatidis, Charalampos; Vogiatzi, Paraskevi; Bettocchi, Stefano; Basios, George; Mastorakos, George; Vrachnis, Nikos

    2014-08-01

    In this report, we propose an intervention capable of improving IVF outcomes in subfertile women with poor ovarian response. This intervention derives from anecdotal data and observations in our daily practice, but most importantly from trials on experimental models and subfertile women with Polycystic Ovarian Syndrome (PCOS). Our hypothesis suggests that transvaginal induction of trauma to the ovary in the cycle preceding IVF should benefit poor ovarian responders and their lowered pregnancy rates by increasing - at least - the number of retrieved oocytes during oocyte retrieval. Up-to-the minute data show that, via this means, there is a unique response of the ovarian surface epithelium and stroma to the induced trauma. The potential pathways of this beneficial response involve an improvement of the raised gonadotrophins to act either through the mechanical reduction of the size of the ovary or through alterations of the hormonal profile by lowering LH, inhibin and local androgen concentrations through hypothalamic-pituitary axis feedbacks, the induction of increased blood flow to the ovaries, a differentiated local immune reaction and a non-elucidated as yet role of reactive oxygen species. In this report, we also describe the technique and the associated possible negative points while we try to point out the needed research steps to ensure its efficiency before it enters daily clinical practice.

  20. Why Economic Analysis of Health System Improvement Interventions Matters.

    PubMed

    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.

  1. Morphological awareness assessment and intervention to improve language and literacy.

    PubMed

    Wolter, Julie A; Gibson, Frances E

    2015-02-01

    Morphological awareness positively influences language and literacy development and may be an ideal intervention focus for improving vocabulary, sight word reading, reading decoding, and reading comprehension in students with and without language and literacy deficits. This article will provide supporting theory, research, and strategies for implementing morphological awareness intervention with students with language and literacy deficits. Additionally, functional connections are explored through the incorporation and application of morphological awareness intervention in academic literacy contexts linked to Common Core State Standards.

  2. Using the template for intervention description and replication (TIDieR) as a tool for improving the design and reporting of manual therapy interventions.

    PubMed

    Alvarez, Gerard; Cerritelli, Francesco; Urrutia, Gerard

    2016-08-01

    The detailed reporting of any research intervention is crucial to evaluate its applicability into a routinely practice-based context. However, it has been estimated that, especially in non-pharmacological interventions, the published literature typically includes incomplete intervention details. In the field of manual medicine, where interventions are delivered with a high degree of individualization and variability, poorly reported studies could compromise internal and external validity of the results. Among the various initiatives that have been undertaken to improve the intervention description, the Template for Intervention Description and Replication (TIDieR) has to be highlighted as the most promising. TIDieR offers both to researchers and clinicians a helpful and comprehensive guidance on how manual therapy interventions have to be designed and reported, taking into account the clinical complexity of manual therapy and the need to satisfy research gold standards.

  3. An Intervention to Improve School and Student Performance

    ERIC Educational Resources Information Center

    Shaver, Becky

    2008-01-01

    Georgia Leadership Institute for School Improvement (GLISI) used ISPI's 10 Standards of Performance Technology to share the design, development, and implementation of an intervention striving to help Georgia districts and schools share their success stories in a clear and concise format. This intervention took the form of a PowerPoint…

  4. The Cost-Effectiveness of Education Interventions in Poor Countries. Policy Insight, Volume 2, Issue 4

    ERIC Educational Resources Information Center

    Evans, David K.; Ghosh, Arkadipta

    2008-01-01

    Poor countries need development programs that are both effective and cost-effective. To assess effectiveness, researchers are increasingly using randomized trials (or quasi-experimental methods that imitate randomized trials), which provide a clear picture of which outcomes are attributable to the program being evaluated. This "Policy Insight"…

  5. Efficacy of a brief multifactorial adherence-based intervention on reducing the blood pressure of patients with poor adherence: protocol for a randomized clinical trial

    PubMed Central

    2010-01-01

    Background Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug. Methods/Design The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen. Measurement The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost. Discussion The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI). Trial registration Current controlled trials ISRCTN21229328 PMID:20868531

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

    PubMed Central

    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

  7. Assessing resources for implementing a community directed intervention (CDI) strategy in delivering multiple health interventions in urban poor communities in Southwestern Nigeria: a qualitative study

    PubMed Central

    2013-01-01

    Background Many simple, affordable and effective disease control measures have had limited impact due to poor access especially by the poorer populations (urban and rural) and inadequate community participation. A proven strategy to address the problem of access to health interventions is the Community Directed Interventions (CDI) approach, which has been used successfully in rural areas. This study was carried out to assess resources for the use of a CDI strategy in delivering health interventions in poorly-served urban communities in Ibadan, Nigeria. Methods A formative study was carried out in eight urban poor communities in the Ibadan metropolis in the Oyo State. Qualitative methods comprising 12 focus group discussions (FGDs) with community members and 73 key informant interviews (KIIs) with community leaders, programme managers, community-based organisations (CBOs), non-government organisations (NGOs) and other stakeholders at federal, state and local government levels were used to collect data to determine prevalent diseases and healthcare delivery services, as well as to explore the potential resources for a CDI strategy. All interviews were audio recorded. Content analysis was used to analyse the data. Results Malaria, upper respiratory tract infection, diarrhoea and measles were found to be prevalent in children, while hypertension and diabetes topped the list of diseases among adults. Healthcare was financed mainly by out-of-pocket expenses. Cost and location were identified as hindrances to utilisation of health facilities; informal cooperatives (esusu) were available to support those who could not pay for care. Immunisation, nutrition, reproductive health, tuberculosis (TB) and leprosy, environmental health, malaria and HIV/AIDs control programmes were the ongoing interventions. Delivery strategies included house-to-house, home-based treatment, health education and campaigns. Community participation in the planning, implementation and monitoring of

  8. Multifaceted Prospective Memory Intervention to Improve Medication Adherence

    PubMed Central

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

    2015-01-01

    Background/Objectives Older adults do not take medication as prescribed, diminishing the benefits of treatment and increasing costs to individuals and society. A multifaceted prospective memory intervention for improving adherence to antihypertensive medication was tested and assessed if executive function/working memory processes moderated intervention effects. Design A two group longitudinal randomized control trial was used. Setting and Participants and Measurements The sample consisted of community-based older adults (≥ 65 years of age) without signs of dementia or symptoms of severe depression who were self-managing prescribed medication. Following four weeks of initial adherence monitoring using a medication event monitoring system (MEMS®), individuals with 90% or less adherence were randomly assigned to groups. Intervention The prospective memory intervention was designed to provide strategies that switch older adults from relying on executive function/working memory processes (that show effects of cognitive aging) to mostly automatic associative processes (that are relatively spared with normal aging) for remembering to take one’s medications. Strategies included establishing a routine, establishing cues strongly associated with medication taking actions, performing the action immediately upon thinking about it, using a medication organizer, and imagining medication taking to enhance encoding and improve cuing. Results There was significant improvement in adherence for the intervention group (57% at baseline to 78% post intervention), but most of these gains were lost after 5 months. The control condition started at 68%, was stable during the intervention, but dropped to 62%. Executive function/working memory moderated the intervention effect, with the intervention producing greater benefit for those with lower executive function/working memory. Conclusion The intervention improved adherence, but the benefits were not sustained. Further research is

  9. Targeted interventions of ultra-poor women in rural Rangpur, Bangladesh: do they make a difference to appropriate cooking practices, food habits and sanitation?

    PubMed

    Yeasmin, Lubna; Akter, Shamima; Shahidul Islam, A M; Mizanur Rahman, Md; Akashi, Hidechika; Jesmin, Subrina

    2014-07-01

    This study aimed to assess whether teaching good cooking practices, food habits and sanitation to ultra-poor rural women in four rural communities of Rangpur district, Bangladesh, with a high density of extremely poor households, would improve the overall health of the community. The sample size was 200 respondents combined from the target and control areas. In the target area, twelve in-depth interviews and four focus group discussions were undertaken for knowledge dissemination. Descriptive and mixed-model analyses were performed. The results show that washing hands with soap was 1.35 times more likely in the target than the control group (p<0.01). Further, after intervention, there was a significant improvement in hand-washing behaviour: before cutting vegetables, preparing food, feeding a child and eating, and after defecating and cleaning a baby (p<0.05). Also, the target group was more likely to moderately and briefly boil their vegetables and were 19% less likely to use maximum heat when cooking vegetables than the control group (p<0.01). Improved knowledge and skills training of ultra-poor women reduces the loss of nutrients during food preparation and increases their hygiene through hand-washing in every-day life.

  10. Nutrition interventions need improved operational capacity

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The Lancet's Child Survival Series was a galvanising manifesto: it focused action plans to improve the well-being of children worldwide. However, the authors did not address in detail the importance of nutrition in child survival, and thus the current Undernutrition Series was born. This welcome n...

  11. Will Interventions Targeting Conscientiousness Improve Aging Outcomes?

    ERIC Educational Resources Information Center

    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…

  12. Improving Student Achievement through Behavior Intervention.

    ERIC Educational Resources Information Center

    Berry, Gina; And Others

    This report describes a program that was designed to identify and modify disruptive student behavior and improve academic performance. The targeted fifth grade class had been noted for inappropriate behavior and sporadic academic success, with problems documented by teacher observation surveys and self-reporting by students. Probable causes…

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

    PubMed

    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 (<5 y of age) using Pubmed and EMBASE. Several controlled trials (n = 45) and meta-analyses (n = 6) have evaluated the effects of MMN interventions primarily for 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.

  14. Effectiveness of a structured educational intervention using psychological delivery methods in children and adolescents with poorly controlled type 1 diabetes: a cluster-randomized controlled trial of the CASCADE intervention

    PubMed Central

    Christie, Deborah; Thompson, Rebecca; Sawtell, Mary; Allen, Elizabeth; Cairns, John; Smith, Felicity; Jamieson, Elizabeth; Hargreaves, Katrina; Ingold, Anne; Brooks, Lucy; Wiggins, Meg; Oliver, Sandy; Jones, Rebecca; Elbourne, Diana; Santos, Andreia; Wong, Ian C K; O'Neil, Simon; Strange, Vicki; Hindmarsh, Peter; Annan, Francesca; Viner, Russell M

    2016-01-01

    Introduction Type 1 diabetes (T1D) in children and adolescents is increasing worldwide with a particular increase in children <5 years. Fewer than 1 in 6 children and adolescents achieve recommended glycated hemoglobin (HbA1c) values. Methods A pragmatic, cluster-randomized controlled trial assessed the efficacy of a clinic-based structured educational group incorporating psychological approaches to improve long-term glycemic control, quality of life and psychosocial functioning in children and adolescents with T1D. 28 pediatric diabetes services were randomized to deliver the intervention or standard care. 362 children (8–16 years) with HbA1c≥8.5% were recruited. Outcomes were HbA1c at 12 and 24 months, hypoglycemia, admissions, self-management skills, intervention compliance, emotional and behavioral adjustment, and quality of life. A process evaluation collected data from key stakeholder groups in order to evaluate the feasibility of delivering the intervention. Results 298/362 patients (82.3%) provided HbA1c at 12 months and 284/362 (78.5%) at 24 months. The intervention did not improve HbA1c at 12 months (intervention effect 0.11, 95% CI −0.28 to 0.50, p=0.584), or 24 months (intervention effect 0.03, 95% CI −0.36 to 0.41, p=0.891). There were no significant changes in remaining outcomes. 96/180 (53%) families in the intervention arm attended at least 1 module. The number of modules attended did not affect outcome. Reasons for low uptake included difficulties organizing groups and work and school commitments. Those with highest HbA1cs were less likely to attend. Mean cost of the intervention was £683 per child. Conclusions Significant challenges in the delivery of a structured education intervention using psychological techniques to enhance engagement and behavior change delivered by diabetes nurses and dietitians in routine clinical practice were found. The intervention did not improve HbA1c in children and adolescents with poor control

  15. Improving resistance and resiliency through crisis intervention training.

    PubMed

    Chan, Angelina O M; Chan, Yiong Huak; Kee, Jass P C

    2012-01-01

    To our knowledge no research has been done on the impact of crisis intervention training programs on resistance and resiliency. This paper describes the use of a localized crisis intervention course and its impact on resistance and resiliency in the participants after 2 days of training. Participants attending the localized version of ICISF Individual Crisis Intervention and Peer Support courses participated in a pre-course quiz and a post-course quiz. The overall resistance and resiliency scores improved at the end of the localized 2-Day Individual Crisis Intervention and Peer Support course. Organizations should view the training of employees in mental health and crisis intervention as contributing to the overall resiliency of the organization, in addition to providing services that facilitate the resilience and recovery of employees affected by personal or workplace stress or critical incidents.

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

    ERIC Educational Resources Information Center

    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…

  17. Interventions to Improve Adherence in Patients with Immune-Mediated Inflammatory Disorders: A Systematic Review

    PubMed Central

    Depont, Fanny; Berenbaum, Francis; Filippi, Jérome; Le Maitre, Michel; Nataf, Henri; Paul, Carle; Peyrin-Biroulet, Laurent; Thibout, Emmanuel

    2015-01-01

    Background In patients with immune-mediated inflammatory disorders, poor adherence to medication is associated with increased healthcare costs, decreased patient satisfaction, reduced quality of life and unfavorable treatment outcomes. Objective To determine the impact of different interventions on medication adherence in patients with immune-mediated inflammatory disorders. Design Systematic review. Data sources MEDLINE, EMBASE and Cochrane Library. Study eligibility criteria for selecting studies Included studies were clinical trials and observational studies in adult outpatients treated for psoriasis, Crohn’s disease, ulcerative colitis, rheumatoid arthritis, spondyloarthritis, psoriatic arthritis or multiple sclerosis. Study appraisal and synthesis methods Intervention approaches were classified into four categories: educational, behavioral, cognitive behavioral, and multicomponent interventions. The risk of bias/study limitations of each study was assessed using the GRADE system. Results Fifteen studies (14 clinical trials and one observational study) met eligibility criteria and enrolled a total of 1958 patients. Forty percent of the studies (6/15) was conducted in patients with inflammatory bowel disease, half (7/15) in rheumatoid arthritis patients, one in psoriasis patients and one in multiple sclerosis patients. Seven out of 15 interventions were classified as multicomponent, four as educational, two as behavioral and two as cognitive behavioral. Nine studies, of which five were multicomponent interventions, had no serious limitations according to GRADE criteria. Nine out of 15 interventions showed an improvement of adherence: three multicomponent interventions in inflammatory bowel disease; one intervention of each category in rheumatoid arthritis; one multicomponent in psoriasis and one multicomponent in multiple sclerosis. Conclusion The assessment of interventions designed for increasing medication adherence in IMID is rare in the literature and

  18. Development of the Community Health Improvement Navigator Database of Interventions

    PubMed Central

    Roy, Brita; Stanojevich, Joel; Stange, Paul; Jiwani, Nafisa; King, Raymond; Koo, Denise

    2016-01-01

    Summary With the passage of the Patient Protection and Affordable Care Act, the requirements for hospitals to achieve tax-exempt status include performing a triennial community health needs assessment and developing a plan to address identified needs. To address community health needs, multisector collaborative efforts to improve both health care and non–health care determinants of health outcomes have been the most effective and sustainable. In 2015, CDC released the Community Health Improvement Navigator to facilitate the development of these efforts. This report describes the development of the database of interventions included in the Community Health Improvement Navigator. The database of interventions allows the user to easily search for multisector, collaborative, evidence-based interventions to address the underlying causes of the greatest morbidity and mortality in the United States: tobacco use and exposure, physical inactivity, unhealthy diet, high cholesterol, high blood pressure, diabetes, and obesity. PMID:26917110

  19. Improvement of dissolution property of poorly water-soluble drug by supercritical freeze granulation.

    PubMed

    Sonoda, Ryoichi; Hara, Yuko; Iwasaki, Tomohiro; Watano, Satoru

    2009-10-01

    The dissolution property of the poorly water-soluble drug, flurbiprofen (FP) was improved by a novel supercritical freeze granulation using supercritical carbon dioxide. Supercritical freeze granulation was defined as a production method of the granulated substances by using the dry ice to generate intentionally for the rapid atomization of the supercritical carbon dioxide to the atmospheric pressure. This process utilized a rapid expansion of supercritical solutions (RESS) process with the mixture of the drug and lactose. In the supercritical freeze granulation, needle-like FP fine particles were obtained which adhered to the surface of lactose particles, which did not dissolve in supercritical carbon dioxide. The number of FP particles that adhered to the surface of particles decreased with an increase in the ratio of lactose added, leading to markedly improve the dissolution rate. This improvement was caused not only by the increase in the specific surface area but also the improvement of the dispersibility of FP in water. It is thus concluded that the supercritical freeze granulation is a useful technique to improve the dissolution property of the poorly water-soluble flurbiprofen.

  20. Eggs: the uncracked potential for improving maternal and young child nutrition among the world's poor.

    PubMed

    Iannotti, Lora L; Lutter, Chessa K; Bunn, David A; Stewart, Christine P

    2014-06-01

    Eggs have been consumed throughout human history, though the full potential of this nutritionally complete food has yet to be realized in many resource-poor settings around the world. Eggs provide essential fatty acids, proteins, choline, vitamins A and B12 , selenium, and other critical nutrients at levels above or comparable to those found in other animal-source foods, but they are relatively more affordable. Cultural beliefs about the digestibility and cleanliness of eggs, as well as environmental concerns arising from hygiene practices and toxin exposures, remain as barriers to widespread egg consumption. There is also regional variability in egg intake levels. In Latin American countries, on average, greater proportions of young children consume eggs than in Asian or African countries. In China and Indonesia, nutrition education and social marketing have been associated with greater amounts of eggs in the diets of young children, though generally, evidence from interventions is minimal. Homestead chicken-and-egg production with appropriate vaccination, extension service, and other supports can simultaneously address poverty and nutrition in very poor rural households. With undernutrition remaining a significant problem in many parts of the world, eggs may be an uncracked part of the solution.

  1. Developing, implementing, and evaluating a multifaceted quality improvement intervention to promote sleep in an ICU.

    PubMed

    Kamdar, Biren B; Yang, Jessica; King, Lauren M; Neufeld, Karin J; Bienvenu, O Joseph; Rowden, Annette M; Brower, Roy G; Collop, Nancy A; Needham, Dale M

    2014-01-01

    Critically ill patients commonly experience poor sleep quality in the intensive care unit (ICU) because of various modifiable factors. To address this issue, an ICU-wide, multifaceted quality improvement (QI) project was undertaken to promote sleep in the Johns Hopkins Hospital Medical ICU (MICU). To supplement previously published results of this QI intervention, the present article describes the specific QI framework used to develop and implement this intervention, which consists of 4 steps: (a) summarizing the evidence to create a list of sleep-promoting interventions, (b) identifying and addressing local barriers to implementation, (c) selecting performance measures to assess intervention adherence and patient outcomes, and (d) ensuring that all patients receive the interventions through staff engagement and education and regular project evaluation. Measures of performance included daily completion rates of daytime and nighttime sleep improvement checklists and completion rates of individual interventions. Although long-term adherence and sustainability pose ongoing challenges, this model provides a foundation for future ICU sleep promotion initiatives.

  2. Encapsulation of poorly water-soluble drugs into organic nanotubes for improving drug dissolution.

    PubMed

    Moribe, Kunikazu; Makishima, Takashi; Higashi, Kenjirou; Liu, Nan; Limwikrant, Waree; Ding, Wuxiao; Masuda, Mitsutoshi; Shimizu, Toshimi; Yamamoto, Keiji

    2014-07-20

    Hydrocortisone (HC), a poorly water-soluble drug, was encapsulated within organic nanotubes (ONTs), which were formed via the self-assembly of N-{12-[(2-α,β-d-glucopyranosyl) carbamoyl]dodecanyl}-glycylglycylglycine acid. The stability of the ONTs was evaluated in ten organic solvents, of differing polarities, by field emission transmission electron microscopy. The ONTs maintained their stable tubular structure in the highly polar solvents, such as ethanol and acetone. Furthermore, solution-state (1)H-NMR spectroscopy confirmed that they were practically insoluble in acetone at 25°C (0.015 mg/mL). HC-loaded ONTs were prepared by solvent evaporation using acetone. A sample with a 3/7 weight ratio of HC/ONT was analyzed by powder X-ray diffraction, which confirmed the presence of a halo pattern and the absence of any crystalline HC peak. HC peak broadening, observed by solid-state (13)C-NMR measurements of the evaporated sample, indicated the absence of HC crystals. These results indicated that HC was successfully encapsulated in ONT as an amorphous state. Improvements of the HC dissolution rate were clearly observed in aqueous media at both pH 1.2 and 6.8, probably due to HC amorphization in the ONTs. Phenytoin, another poorly water-soluble drug, also showed significant dissolution improvement upon ONT encapsulation. Therefore, ONTs can serve as an alternative pharmaceutical excipient to enhance the bioavailability of poorly water-soluble drugs.

  3. Educational interventions to improve prescribing competency: a systematic review

    PubMed Central

    Kamarudin, Gritta; Penm, Jonathan; Chaar, Betty; Moles, Rebekah

    2013-01-01

    Objective To review the literature on educational interventions to improve prescribing and identify educational methods that improve prescribing competency in both medical and non-medical prescribers. Design A systematic review was conducted. The databases Medline, International Pharmaceutical Abstracts (IPA), EMBASE and CINAHL were searched for articles in English published between January 1990 and July 2013. Setting Primary and secondary care. Participants Medical and non-medical prescribers. Intervention Education-based interventions to aid improvement in prescribing competency. Primary outcome Improvements in prescribing competency (knows how) or performance (shows how) as defined by Miller's competency model. This was primarily demonstrated through prescribing examinations, changes in prescribing habits or adherence to guidelines. Results A total of 47 studies met the inclusion criteria and were included in the systematic review. Studies were categorised by their method of assessment, with 20 studies assessing prescribing competence and 27 assessing prescribing performance. A wide variety of educational interventions were employed, with different outcome measures and methods of assessments. In particular, six studies demonstrated that specific prescribing training using the WHO Guide to Good Prescribing increased prescribing competency in a wide variety of settings. Continuing medical education in the form of academic detailing and personalised prescriber feedback also yielded positive results. Only four studies evaluated educational interventions targeted at non-medical prescribers, highlighting that further research is needed in this area. Conclusions A broad range of educational interventions have been conducted to improve prescribing competency. The WHO Guide to Good Prescribing has the largest body of evidence to support its use and is a promising model for the design of targeted prescribing courses. There is a need for further development and evaluation

  4. A Model of Intervention at a Psychoanalytic Parent/Child Drop-In Group in a Poor District of Lima, Peru

    ERIC Educational Resources Information Center

    Holmes, Joshua

    2012-01-01

    The psychoanalytically informed work of a team of workers at a drop-in centre for families in a poor district of Lima is described. Interventions involve: accepting, connecting, playing and empowering. Clinical vignettes are used to illustrate the ways in which these interventions aim to help families. The acceptance of difficult feelings provides…

  5. Interventions to improve cortisol regulation in children: a systematic review.

    PubMed

    Slopen, Natalie; McLaughlin, Katie A; Shonkoff, Jack P

    2014-02-01

    Childhood adversity is associated with physiologic dysregulation across multiple biological systems; however, relatively little is known about whether these changes are reversible with intervention. The objective of this review was to examine evidence for the effectiveness of interventions to promote healthy cortisol regulation in children. We selected articles from English-language publications in PubMed and EBSCO databases through 2012. Two independent reviewers assessed articles against eligibility criteria. Eligible studies were randomized controlled or quasi-experimental studies designed to improve relationships, environments, or psychosocial functioning in children and examined cortisol as an outcome. We identified 19 articles. There was substantial heterogeneity across studies with regard to age, selection criteria, intervention design, cortisol assessment, and follow-up duration. Eighteen of the 19 articles reported at least 1 difference in baseline cortisol, diurnal cortisol, or cortisol responsivity between intervention and control participants. Importantly, however, there was remarkable inconsistency with regard to how the interventions influenced cortisol. Therefore, studies that included a low-risk comparison group (n = 8) provided critical insight, and each found some evidence that postintervention cortisol levels in the intervention group approximated the low-risk comparison group and differed from children receiving usual care. In conclusion, existing studies show that cortisol activity can be altered by psychosocial interventions. These findings are promising, not only because they indicate physiologic plasticity that can be leveraged by interventions but also because they suggest it may be possible to repair regulatory systems after childhood adversity, which could inform strategies for reducing health disparities and promoting lasting improvements in health.

  6. Interventions to Improve Cortisol Regulation in Children: A Systematic Review

    PubMed Central

    McLaughlin, Katie A.; Shonkoff, Jack P.

    2014-01-01

    Childhood adversity is associated with physiologic dysregulation across multiple biological systems; however, relatively little is known about whether these changes are reversible with intervention. The objective of this review was to examine evidence for the effectiveness of interventions to promote healthy cortisol regulation in children. We selected articles from English-language publications in PubMed and EBSCO databases through 2012. Two independent reviewers assessed articles against eligibility criteria. Eligible studies were randomized controlled or quasi-experimental studies designed to improve relationships, environments, or psychosocial functioning in children and examined cortisol as an outcome. We identified 19 articles. There was substantial heterogeneity across studies with regard to age, selection criteria, intervention design, cortisol assessment, and follow-up duration. Eighteen of the 19 articles reported at least 1 difference in baseline cortisol, diurnal cortisol, or cortisol responsivity between intervention and control participants. Importantly, however, there was remarkable inconsistency with regard to how the interventions influenced cortisol. Therefore, studies that included a low-risk comparison group (n = 8) provided critical insight, and each found some evidence that postintervention cortisol levels in the intervention group approximated the low-risk comparison group and differed from children receiving usual care. In conclusion, existing studies show that cortisol activity can be altered by psychosocial interventions. These findings are promising, not only because they indicate physiologic plasticity that can be leveraged by interventions but also because they suggest it may be possible to repair regulatory systems after childhood adversity, which could inform strategies for reducing health disparities and promoting lasting improvements in health. PMID:24420810

  7. Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

    PubMed

    Kakyo, Tracy Alexis; Xiao, Lily Dongxia

    2017-03-09

    Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention.

  8. Multi-sensory intervention for preterm infants improves sucking organization

    PubMed Central

    Medoff-Cooper, Barbara; Rankin, Kristin; Li, Zhuoying; Liu, Li; White-Traut, Rosemary

    2015-01-01

    Objective The aim of this RCT was to evaluate sucking organization in premature infants following a preterm infant multi-sensory intervention, the Auditory, Tactile, Visual, and Vestibular (ATVV). Study Design A convenience sample of 183 healthy premature infants born 29 - 34 weeks post-menstrual age (PMA) enrolled. Sucking organization was measured at baseline, then weekly assessments, during the infant's hospital stay. Results A quadratic trend was observed for number of sucks, sucks per burst, and maturity index, with the intervention group increasing significantly faster by day 7 (Model estimates for group*day: β = 13.69, p < 0.01; β = 1.16, p < 0.01; and β = 0.12, p < 0.05, respectively). Sucking pressure increased linearly over time, with significant between-group differences at day 14 (β = 45.66, p < 0.01). Conclusion ATVV infants exhibited improved sucking organization during hospitalization, suggestive that ATVV intervention improves oral feeding. PMID:25822519

  9. Integrated Morphological Awareness Intervention as a Tool for Improving Literacy

    ERIC Educational Resources Information Center

    Kirk, Cecilia; Gillon, Gail T.

    2009-01-01

    Purpose: This study evaluated the effects of an intervention program aimed to improve reading and spelling ability through instruction in morphological awareness together with other forms of linguistic awareness, including knowledge of phonology, orthography, syntax, and semantics. Method: Sixteen children aged between 8;07 (years;months) and…

  10. Improving Student Writing Ability through the Use of Teacher Interventions.

    ERIC Educational Resources Information Center

    Gouty, Jackie; Lid, Sandy

    This report described a program to improve student writing ability. The targeted population consisted of first and third grade students in a middle class community, located in the Midwest. The problem of inadequate writing and the results of the interventions were documented. Analysis of probable cause data revealed that students lacked positive…

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

    PubMed Central

    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

  12. [Improvement of intestinal absorption of poorly absorbable drugs by various sugar esters].

    PubMed

    Yamamoto, Akira; Katsumi, Hidemasa; Kusamori, Kosuke; Sakane, Toshiyasu

    2014-01-01

    Effects of sucrose fatty acid esters (sugar esters) on the intestinal absorption of poorly absorbable drugs were examined by an in situ closed loop method in rats. 5(6)-Carboxyfluorescein (CF) and fluorescein isothiocyanate-dextrans (FDs) with various molecular weights were used as model drugs of poorly absorbable drugs. The absorption of CF from the rat small intestine was significantly enhanced in the presence of various sugar esters and a maximal absorption enhancing effect was observed in the presence of 0.5%(w/v) S-1670. The absorption enhancing effect of S-1670 in the small intestine decreased as the molecular weights of drugs increased. Moreover, we evaluated the intestinal membrane damage with or without various sugar esters. These sugar esters (0.5%(w/v)) did not increase the activities of lactate dehydrogenase (LDH), suggesting that these sugar esters did not cause serious membrane damage to the intestinal epithelium. Furthermore, these sugar esters increased membrane fluidity of lipid layers of the intestinal brush border membranes and decreased the transepithelial electrical resistance (TEER) of Caco-2 cells. Therefore, these findings suggested that these sugar esters might improve the intestinal absorption of poorly absorbable drugs via a transcellular and a paracellular pathways.

  13. Superoxide dismutase and taurine supplementation improves in vitro blastocyst yield from poor-quality feline oocytes.

    PubMed

    Ochota, Małgorzata; Pasieka, Anna; Niżański, Wojciech

    2016-03-15

    Blastocyst production in vitro seems to be crucial part of assisted reproduction techniques in feline species. However, the results of cats' oocyte maturation and embryo development are still lower than those in other species. The aim of this study was to evaluate whether the supplementation with superoxide dismutase (SOD) and taurine during maturation or culture would improve the blastocyst yield obtained from lower grades of oocytes, that are usually discarded, as not suitable for further in vitro purposes. To investigate the effect of antioxidants' addition, the good- and poor-quality oocytes, were cultured with the addition of 10-mmol taurine and 600 UI/mL SOD. The nuclear maturity, embryo development, and blastocyst quality were subsequently assessed. In control group, without antioxidant supplementation, significantly less poor-quality oocytes matured (42% vs. 62%) and more degenerated (35% vs. 20%), comparing to the experimental group supplemented with SOD and taurine. The amount of obtained blastocyst was much higher, when poor quality oocytes were supplemented with SOD and taurine (supplementation to IVM-4%; supplementation to IVC-5.5%; supplementation to IVM and IVC-5.9% of blastocyst), comparing to not supplemented control group (1.3%). The best blastocysts were obtained when poor oocytes had antioxidants added only during embryo culture (185 ± 13.4 blastomeres vs. 100 ± 1.5 in control). In the present study, we reported that the lower grades of oocytes can better mature and form significantly more blastocysts with better quality, when cultured with addition of SOD and taurine.

  14. Adaptation of a Motivational Interviewing Intervention to Improve Antidepressant Adherence among Latinos

    PubMed Central

    Interian, Alejandro; Martinez, Igda; Rios, Lisbeth Iglesias; Krejci, Jonathan; Guarnaccia, Peter J.

    2009-01-01

    Poor antidepressant adherence is a significant issue in depression treatment that adversely affects treatment outcomes. While being a common problem, it tends to be more common among Latinos. To address this problem, the current study adapted a Motivational Interviewing (MI) intervention to improve adherence among Latinos with depression. The adaptation process included six focus groups that elicited participants’ perspectives (N = 30), applying the intervention with test cases (N = 7) to fine tune the intervention, and eliciting feedback on the intervention (N = 5). The findings generated from these adaptation phases are described, along with a case example. Examples of adaptations to the MI included reframing antidepressant adherence as a way to luchar (struggle) against problems, focusing on motivation for improving depression and not just medication, refining methods for imparting antidepressant information, and inclusion of personalized visual feedback on dose-taking. The findings provide a description of the antidepressant issues experienced by a group of Latinos, as well as considerations for applying MI with this population. The intervention remained grounded in MI principles, but was contextualized for this Latino group. PMID:20438160

  15. Interventions to improve delivery of isoniazid preventive therapy: an overview of systematic reviews

    PubMed Central

    2014-01-01

    Background Uptake of isoniazid preventive therapy (IPT) to prevent tuberculosis has been poor, particularly in the highest risk populations. Interventions to improve IPT delivery could promote implementation. The large number of existing systematic reviews on treatment adherence has made drawing conclusions a challenge. To provide decision makers with the evidence they need, we performed an overview of systematic reviews to compare different organizational interventions to improve IPT delivery as measured by treatment completion among those at highest risk for the development of TB disease, namely child contacts or HIV-infected individuals. Methods We searched the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects (DARE), and MEDLINE up to August 15, 2012. Two authors used a standardized data extraction form and the AMSTAR instrument to independently assess each review. Results Six reviews met inclusion criteria. Interventions included changes in the setting/site of IPT delivery, use of quality monitoring mechanisms (e.g., directly observed therapy), IPT delivery integration into other healthcare services, and use of lay health workers. Most reviews reported a combination of outcomes related to IPT adherence and treatment completion rate but without a baseline or comparison rate. Generally, we found limited evidence to demonstrate that the studied interventions improved treatment completion. Conclusions While most of the interventions were not shown to improve IPT completion, integration of tuberculosis and HIV services yielded high treatment completion rates in some settings. The lack of data from high burden TB settings limits applicability. Further research to assess different IPT delivery interventions, including those that address barriers to care in at-risk populations, is urgently needed to identify the most effective practices for IPT delivery and TB control in high TB burden settings. PMID:24886159

  16. Poor Health Literacy in Nigeria: Causes, Consequences and Measures to improve it.

    PubMed

    Adekoya-Cole, T O; Akinmokun, O I; Enweluzo, G O; Badmus, O O; Alabi, E O

    2015-01-01

    Health literacy is the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make an appropriate decisions concerning their health. It is one of the link by which the health status of individual and the health indices and statistics of our country can be improved upon. Factors influencing health literacy in Nigeria include the culture and belief system, poor and ineffective communication, lack of education and low educational level, and low socioeconomic status Low health literacy predisposes to poorer health status, poorer disease outcome, lack of understanding in the use of preventive services, frequent hospital visitations amongst others. Factors influencing health literacy must be identified and modified to help improve the health literacy level of the populace. This will invariably improve the health status of the populace with a resultant improvement in the health indices of our country. This is a call for the Government and Health Care Professionals to acknowledge low health literacy as a problem and, therefore, be willing to play their roles in tackling this problem to achieve a healthy Nation

  17. The Work Compatibility Improvement Framework: theory and application of improvement action and intervention strategies.

    PubMed

    Genaidy, Ash M; Rinder, Magda M; Sequeira, Reynold; A-Rehim, Amal D

    2009-05-01

    Challenges facing management of manufacturing firms can be transformed into asset gains by giving careful consideration to the worker-work environment interface. The benefits of a 'healthy' interface may lead to sizable reductions in rising health care costs and retention of highly qualified workers. This paper presents a novel approach for the 'improve' phase of the Work Compatibility Improvement Framework. The work tasks of this research consisted of: (a) fundamentals of cognitive-based improvement action and intervention; (b) design concepts and process of improvement action/intervention generation; (c) assessment model of estimated gains in company's assets; (d) application demonstration in the manufacturing sector. The process of improvement action/intervention generation is described, preceded by a description of the fundamentals of cognitive-based improvement action and intervention and system architecture. This is followed by a documentation of estimated asset gains as a result of the improvement plan. The results showed that expert workers were, on average, 78% in agreement with the algorithm-identified improvement actions. Their knowledge was used to update the recommended actions as well as to detail the multiple strategies required to address the improvement actions. As a result, an integrated improvement plan was developed resulting in estimated asset gains of $1.6 million, which was validated by the general manager. The research reported herein documented the theory and application of the 'improve' phase of the Work Compatibility Improvement Framework. The economic assessment of the suggested improvement is also reported and this has proved to be an important driver to secure the firm collaboration of manufacturing enterprise management. An integrated improvement solution plan backed by a detailed economic assessment of suggested improvements is essential to demonstrate the full potential of workplace micro- and macro-ergonomic interventions.

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

    PubMed Central

    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

  19. Interventions to Improve Parental Communication About Sex: A Systematic Review

    PubMed Central

    Holland, Cynthia L.; Bost, James

    2011-01-01

    CONTEXT: The relative effectiveness of interventions to improve parental communication with adolescents about sex is not known. OBJECTIVE: To compare the effectiveness and methodologic quality of interventions for improving parental communication with adolescents about sex. METHODS: We searched 6 databases: OVID/Medline, PsychInfo, ERIC, Cochrane Review, Communication and Mass Media, and the Cumulative Index to Nursing and Allied Health Literature. We included studies published between 1980 and July 2010 in peer-reviewed English-language journals that targeted US parents of adolescents aged 11 to 18 years, used an experimental or quasi-experimental design, included a control group, and had a pretest/posttest design. We abstracted data on multiple communication outcomes defined by the integrative conceptual model (communication frequency, content, skills, intentions, self-efficacy, perceived environmental barriers/facilitators, perceived social norms, attitudes, outcome expectations, knowledge, and beliefs). Methodologic quality was assessed using the 11-item methodologic quality score. RESULTS: Twelve studies met inclusion criteria. Compared with controls, parents who participated in these interventions experienced improvements in multiple communication domains including the frequency, quality, intentions, comfort, and self-efficacy for communicating. We noted no effects on parental attitudes toward communicating or the outcomes they expected to occur as a result of communicating. Four studies were of high quality, 7 were of medium quality, and 1 was of lower quality. CONCLUSIONS: Our review was limited by the lack of standardized measures for assessing parental communication. Still, interventions for improving parent-adolescent sex communication are well designed and have some targeted effects. Wider dissemination could augment efforts by schools, clinicians, and health educators. PMID:21321027

  20. Transient improvement of urticaria induces poor adherence as assessed by Morisky Medication Adherence Scale-8.

    PubMed

    Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Furue, Masutaka; Onozuka, Daisuke; Takeuchi, Satoshi; Murota, Hiroyuki; Sugaya, Makoto; Saeki, Hidehisa; Shintani, Yoichi; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Kitami, Yuki; Tanioka, Miki; Imafuku, Shinichi; Abe, Masatoshi; Hagihara, Akihito; Morisky, Donald E; Katoh, Norito

    2015-11-01

    Poor adherence to medication is a major public health challenge. Here, we aimed to determine the adherence to oral and topical medications and to analyze underlying associated factors using the translated Japanese version of Morisky Medication Adherence Scale-8 regarding urticaria treatment. Web-based questionnaires were performed for 3096 registered dermatological patients, along with a subanalysis of 751 registered urticaria patients in this study. The adherence to oral medication was significantly associated with the frequency of hospital visits. Variables that affected the adherence to topical medication included age and experience of drug effectiveness. The rate of responses that "It felt like the symptoms had improved" varied significantly among the dermatological diseases treated with oral medications. Dermatologists should be aware that adherence to the treatment of urticaria is quite low. Regular visits and active education for patients with urticaria are mandatory in order to achieve a good therapeutic outcome by increasing the adherence.

  1. Performance improvement of GPS single frequency, single epoch attitude determination with poor satellite visibility

    NASA Astrophysics Data System (ADS)

    Chen, Wantong; Sun, Xingli

    2016-07-01

    Similar to global positioning system (GPS) positioning in urban canyons, a fast and successful attitude determination with limited satellite visibility is very significant. For land vehicles, the possible attitude candidates can be treated as a spherical zone with the center at the reference antenna and the baseline as the radius. This provides an important constraint, which can be exploited to improve the reliability of GPS single frequency and single epoch attitude determination in the case of poor satellite reception. First, we fully integrate the spherical zone constraint into the estimation procedure of ambiguity resolution, but not in the validation procedure. Combining both the coordinate domain search and the ambiguity domain search, allows development of a global minimizer of the fixed ambiguity objective function. This scheme also improves the precision of the float ambiguity solution, thus avoiding the problem of search halting. The performance of the new ambiguity resolution method was analyzed by means of several experimental tests, using simulated as well as actual GPS data in urban environments. The experimental results showed that this new, proposed method can utilize a priori spherical zone knowledge to improve the reliability of ambiguity resolution in difficult environments.

  2. Improving psychotherapy research: The example of mindfulness based interventions

    PubMed Central

    Chiesa, Alberto

    2011-01-01

    The increasing number and sophistication of available psychotherapies suggests that a critical appraisal of the methodological issues of psychotherapy studies is highly needed. Several key questions regarding the efficacy of a given intervention, the understanding of whether positive effects observed following the delivery of a psychotherapeutic intervention are specifically attributable to the intervention itself or to other “non specific” factors, such as benefit expectations, therapist attention and support, and the possibility of improving psychotherapy research need an answer. This, in turn, could provide clinicians with more rigorous information about psychotherapy outcomes and could properly address several shortcomings that are frequently observed in current psychotherapy studies. Accordingly, in this editorial I will highlight some of the most important critical issues that a well designed psychotherapy study should take into account, including the need for appropriate control groups, appropriate randomization and blinding procedures, and the importance of performing appropriately powered studies that include a sufficiently long follow-up period. Finally, I will build on my expertise in the field of mindfulness based interventions, in particular mindfulness based stress reduction and mindfulness based cognitive therapy, to show how such issues have been and can be successfully implemented in the design of future psychotherapy studies. PMID:25237607

  3. Compliance therapy: an intervention to improve inpatients' attitudes toward treatment.

    PubMed

    Tay, Sim-Eng Clara

    2007-06-01

    Nonadherence to prescription medication is the leading cause of relapse or recurrence of psychotic illness. Literature has shown that compliance therapy, a brief intervention based on motivational interviewing and cognitive approaches, can lead to improved attitudes, adherence to treatment, and insight. This descriptive study aimed to examine the effectiveness of compliance therapy on treatment adherence. The 69 participants were patients of the same ward, either referred for patient education by the psychiatrist or selected from a convenience sample of patients on the clinical pathway of relapsed schizophrenia or major depression. Compliance therapy was conducted individually or in small groups of 2 to 3 patients. The shortened version of the Drug Attitude Inventory (DAI-10), along with a rating scale adapted from another study, was used to measure attitude and the rate of adherence before and after therapy. Patients in both individual and group sessions showed significant improvements in attitude. Those with six or more admissions had slightly less significant improvement, and those with personality disorder or substance abuse showed no significant improvement. Compliance therapy benefits patients and improves their attitude toward treatment. Psychiatric nurses could be trained in this clinical intervention to enable them to conduct compliance therapy in the hospital or in the community.

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

    PubMed

    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.

  5. Improving oxygen prescribing rates by tailoring interventions for specific healthcare professional groups

    PubMed Central

    Helliar, Sebastian

    2016-01-01

    Oxygen prescription remains a nationwide problem. The dangers associated with unregulated oxygen administration are well described in the literature with the potential for serious harm in patients with chronic hypercapnia, as well as potentially delaying discharge in patients who are administered it without a prescription. This project identifies poor compliance with regional and national standards and sets out to improve the frequency of oxygen prescribing on a cardiology ward. By studying the problem at a Somerset district general hospital we identified two main groups of professionals responsible for the poor compliance, nursing staff (who administer the oxygen) and junior doctors (who should prescribe it). A series of interventions was designed to firstly raise awareness of the problem within these two groups before going on to target each group with a further intervention over 24 weeks. At baseline we found only 11.3% of patients receiving oxygen had it prescribed. At the end of the project this had improved to 69.6%. We also found that following raised awareness in the nursing staff and introduction of a bedside warning the number of patients receiving oxygen on the ward fell by 35%. In conclusion, this project outlines a strategy for improving oxygen prescribing rates on a medical ward. By targeting different populations we had hoped to see a cumulative improvement after each improvement cycle, however, some resistance from junior doctors in engaging with our third intervention was reflected with a slight decrease in prescribing rates. Further work should address this issue and look to apply this strategy across a wider clinical area with a greater sample size to see if the results are replicable on a larger scale. PMID:28074129

  6. Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD.

    PubMed

    Jones, Arwel W; Taylor, Abigail; Gowler, Holly; O'Kelly, Noel; Ghosh, Sudip; Bridle, Christopher

    2017-01-01

    Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD.

  7. Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD

    PubMed Central

    Jones, Arwel W.; Taylor, Abigail; Gowler, Holly; O'Kelly, Noel; Ghosh, Sudip; Bridle, Christopher

    2017-01-01

    Pulmonary rehabilitation is considered a key management strategy for chronic obstructive pulmonary disease (COPD), but its effectiveness is undermined by poor patient uptake and completion. The aim of this review was to identify, select and synthesise the available evidence on interventions for improving uptake and completion of pulmonary rehabilitation in COPD. Electronic databases and trial registers were searched for randomised trials evaluating the effect of an intervention compared with a concurrent control group on patient uptake and completion. The primary outcomes were the number of participants who attended a baseline assessment and at least one session of pulmonary rehabilitation (uptake), and the number of participants who received a discharge assessment (completion). Only one quasi-randomised study (n=115) (of 2468 records identified) met the review inclusion criteria and was assessed as having a high risk of bias. The point estimate of effect did, however, indicate greater programme completion and attendance rates in participants allocated to pulmonary rehabilitation plus a tablet computer (enabled with support for exercise training) compared with controls (pulmonary rehabilitation only). There is insufficient evidence to guide clinical practice on interventions for improving patient uptake and completion of pulmonary rehabilitation in COPD. Despite increasing awareness of patient barriers to pulmonary rehabilitation, our review highlights the existing under-appreciation of interventional trials in this area. This knowledge gap should be viewed as an area of research priority due to its likely impact in undermining wider implementation of pulmonary rehabilitation and restricting patient access to a treatment considered the cornerstone of COPD. PMID:28154821

  8. Exercise and nutritional interventions for improving aging muscle health.

    PubMed

    Forbes, Scott C; Little, Jonathan P; Candow, Darren G

    2012-08-01

    Skeletal muscle mass declines with age (i.e., sarcopenia) resulting in muscle weakness and functional limitations. Sarcopenia has been associated with physiological changes in muscle morphology, protein and hormonal kinetics, insulin resistance, inflammation, and oxidative stress. The purpose of this review is to highlight how exercise and nutritional intervention strategies may benefit aging muscle. It is well known that resistance exercise training increases muscle strength and size and evidence also suggests that resistance training can increase mitochondrial content and decrease oxidative stress in older adults. Recent findings suggest that fast-velocity resistance exercise may be an effective intervention for older adults to enhance muscle power and functional capacity. Aerobic exercise training may also benefit aging skeletal muscle by enhancing mitochondrial bioenergetics, improving insulin sensitivity, and/or decreasing oxidative stress. In addition to exercise, creatine monohydrate, milk-based proteins, and essential fatty acids all have biological effects which could enhance some of the physiological adaptations from exercise training in older adults. Additional research is needed to determine whether skeletal muscle adaptations to increased activity in older adults are further enhanced with effective nutritional interventions and whether this is due to enhanced muscle protein synthesis, improved mitochondrial function, and/or a reduced inflammatory response.

  9. Methods to improve routine bioassay monitoring for freshly separated, poorly transported plutonium

    SciTech Connect

    Bihl, D.E.; Lynch, T.P.; Carbaugh, E.H.; Sula, M.J.

    1988-09-01

    Several human cases involving inhalation of plutonium oxide at Hanford have shown clearance half-times from the lung that are much longer than the 500-day half-time recommended for class Y plutonium in Publication 30 of the International Commission on Radiological Protection(ICRP). The more tenaciously retained material is referred to as super class Y plutonium. The ability to detect super class Y plutonium by current routine bioassay measurements is shown to be poor. Pacific Northwest Laboratory staff involved in the Hanford Internal Dosimetry Program investigated four methods to se if improvements in routine monitoring of workers for fresh super class Y plutonium are feasible. The methods were lung counting, urine sampling, fecal sampling, and use of diethylenetriaminepentaacetate (DTPA) to enhance urinary excretion. Use of DTPA was determined to be not feasible. Routine fecal sampling was found to be feasible but not recommended. Recommendations were made to improve the detection level for routine annual urinalysis and routine annual lung counting. 12 refs., 9 figs., 7 tabs.

  10. [Improvement of physical fitness as anti-aging intervention].

    PubMed

    Castillo Garzón, Manuel J; Ortega Porcel, Francisco B; Ruiz Ruiz, Jonatan

    2005-02-05

    Several recent important studies have clearly shown that a low physical fitness represents a potent risk factor and even a predictor of both cardiovascular and all-causes morbidity and mortality. As a consequence, physical fitness assessment should be performed at the clinical level since, when properly assessed, it is a highly valuable health and life expectancy indicator. Based on the results of fitness assessment in a particular person and knowing his/her life style and daily physical activity, an individually adapted training program can be prescribed. This training program will allow that person to develop his/her maximal physical potential while improving his/her physical and mental health and attenuating the deleterious consequences of aging. In fact, physical exercise is today proposed as a highly effective means to treat and prevent major morbidity and mortality causes in industrialized countries. Most of these causes are associated with the aging process. In order to be effective, this type of intervention should be directed to improve the aerobic capacity and strength. In addition, it should be complemented with work directed to improve the general coordination and flexibility. Finally, diet optimization and use of nutritional supplements and legal ergogenic aids are key elements to improve the functional capacity and health, all of which is synonymous of anti-aging interventions.

  11. The Feasibility of Health Trainer Improved Patient Self-Management in Patients with Low Health Literacy and Poorly Controlled Diabetes: A Pilot Randomised Controlled Trial

    PubMed Central

    Rathod, Trishna; Rowlands, Gillian; Richardson, Gerry; Reeves, David

    2016-01-01

    Type 2 diabetes mellitus is most prevalent in deprived communities and patients with low health literacy have worse glycaemic control and higher rates of diabetic complications. However, recruitment from this patient population into intervention trials is highly challenging. We conducted a study to explore the feasibility of recruitment and to assess the effect of a lay health trainer intervention, in patients with low health literacy and poorly controlled diabetes from a socioeconomically disadvantaged population, compared with usual care. Methods. A pilot RCT comparing the LHT intervention with usual care. Patients with HbA1c > 7.5 (58 mmol/mol) were recruited. Baseline and 7-month outcome data were entered directly onto a laptop to reduce patient burden. Results. 76 patients were recruited; 60.5% had low health literacy and 75% were from the most deprived areas of England. Participants in the LHT arm had significantly improved mental health (p = 0.049) and illness perception (p = 0.040). The intervention was associated with lower resource use, better patient self-care management, and better QALY profile at 7-month follow-up. Conclusion. This study describes successful recruitment strategies for hard-to-reach populations. Further research is warranted for this cost-effective, relatively low-cost intervention for a population currently suffering a disproportionate burden of diabetes, to demonstrate its sustained impact on treatment effects, health, and health inequalities. PMID:27833922

  12. Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods*

    PubMed Central

    Devendra, C.

    2013-01-01

    The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which

  13. Investments on Pro-poor Development Projects on Goats: Ensuring Success for Improved Livelihoods.

    PubMed

    Devendra, C

    2013-01-01

    The elements that determine the success of development projects on goats and the prerequisites for ensuring this are discussed in the context of the bewildering diversity of goat genetic resources, production systems, multifunctionality, and opportunities for responding to constraints for productivity enhancement. Key determinants for the success of pro-poor projects are the imperatives of realistic project design, resolution of priorities and positive impacts to increase investments and spur agricultural growth, and appropriate policy. Throughout the developing world, there exist 97% of the total world population of 921 million goats across all agro-ecological zones (AEZs), including 570 breeds and 64% share of the breeds. They occupy a very important biological and socio-economic niche in farming systems making significant multifunctional contributions especially to food, nutrition and financial security, stability of farm households, and survival of the poor in the rural areas. Definitions are given of successful and failed projects. The analyses highlighted in successful projects the value of strong participatory efforts with farmers and climate change. Climate change effects on goats are inevitable and are mediated through heat stress, type of AEZ, water availability, quantity and quality of the available feed resources and type of production system. Within the prevailing production systems, improved integrated tree crops - ruminant systems are underestimated and are an important pathway to enhance C sequestration. Key development strategies and opportunities for research and development (R and D) are enormous, and include inter alia defining a policy framework, resolution of priority constraints using systems perspectives and community-based participatory activities, application of yield-enhancing technologies, intensification, scaling up, and impacts. The priority for development concerns the rainfed areas with large concentrations of ruminants in which

  14. Effects of Individualised and Small-Group Guided Oral Reading Interventions on Reading Skills and Reading Attitude of Poor Readers in Grades 2-4

    ERIC Educational Resources Information Center

    Oostdam, Ron; Blok, Henk; Boendermaker, Conny

    2015-01-01

    To assess the efficacy of guided oral reading as a remedy for low-achieving readers, two experiments were conducted in the early grades of primary school. In the first, poor-reading students were randomly divided between two treatment groups and a control group. In treatment groups, the intervention was delivered one-to-one, either in a repeated…

  15. Improved biochemical outcome with adjuvant radiotherapy after radical prostatectomy for prostate cancer with poor pathologic features

    SciTech Connect

    Vargas, Carlos; Kestin, Larry L. . E-mail: lkestin@beaumont.edu; Weed, Dan W.; Krauss, Daniel; Vicini, Frank A.; Martinez, Alvaro A.

    2005-03-01

    5-year BC rate was 52% for RP+RT vs. 30% for RP (p < 0.01). The 5-year BC rate for patients with seminal vesicle invasion was 60% for RP+RT vs. 18% for RP (p < 0.01). For those with positive margins, the 5-year BC rate was 64% for RP+RT vs. 27% for RP (p < 0.01). The use of adjuvant RT remained statistically significant on multivariate analysis when applying either biochemical failure definition. Adjuvant RT also remained statistically significant when including the postoperative PSA level (>30 days after surgery) in the multivariate analyses. In addition, 99 (17%) of the 583 RP patients required salvage prostatic fossa RT (median dose, 59.4 Gy) at a median interval of 1.3 years after surgery (range, 0.1-8.4) for a palpable recurrence (n = 10) or a detectable/rising postoperative PSA level (n = 89). The median PSA level before salvage RT was 0.8 ng/mL (mean, 3.2 ng/mL). The 5-year and 8-year BC rate, using the PSA < 0.1 ng/mL definition, from the date of salvage RT was 41% and 35%, respectively. The 5-year and 8-year BC rate, using the PSA < 0.3 ng/mL definition, was 46% and 36%, respectively. The 8-year local recurrence rate after salvage RT was 4%. Conclusion: Adjuvant RT demonstrated improved efficacy against prostate cancer. For patients with poor pathologic features (extracapsular extension, seminal vesicle invasion, positive margins), adjuvant RT improved the biochemical outcome independent of other prognostic factors.

  16. Improving clinical interventions through successful outreach using Six Sigma quality improvement.

    PubMed

    Beard, Gary

    2008-01-01

    Interventions involving outreach to members via telephone are dependent on the success of reaching the member and engaging him or her in a discussion about treatment. This article describes a successful process improvement at a managed behavioral health organization aimed at increasing the percentage of times staff was able to reach a member by telephone. Using Six Sigma methodology, the project team was able to achieve statistically significant improvement in the rate of successful outreach for the organization.

  17. A ventilation intervention study in classrooms to improve indoor air quality: the FRESH study

    PubMed Central

    2013-01-01

    Background 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. Methods 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. Results 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). Conclusions 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

  18. Identification of Risk Factors for Poor Feeding in Infants with Congenital Heart Disease and a Novel Approach to Improve Oral Feeding.

    PubMed

    Indramohan, Gitanjali; Pedigo, Tiffany P; Rostoker, Nicole; Cambare, Mae; Grogan, Tristan; Federman, Myke D

    2017-02-03

    Many infants with complex congenital heart disease (CHD) do not develop the skills to feed orally and are discharged home on gastrostomy tube or nasogastric feeds. We aimed to identify risk factors for failure to achieve full oral feeding and evaluate the efficacy of oral motor intervention for increasing the rate of discharge on full oral feeds by performing a prospective study in the neonatal and cardiac intensive care units of a tertiary children's hospital. 23 neonates born at ≥37weeks gestation and diagnosed with single-ventricle physiology requiring a surgical shunt were prospectively enrolled and received oral motor intervention therapy. 40 historical controls were identified. Mean length of stay was 53.7days for the control group and 40.9days for the study group (p=0.668). 13/23 patients who received oral motor intervention therapy (56.5%) and 18/40 (45.0%) controls were on full oral feeds at discharge, a difference of 11.5% (95% CI -13.9% to 37.0%, p=0.378). Diagnosis of hypoplastic left heart syndrome, longer intubation and duration of withholding enteral feeds, and presence of gastroesophageal reflux disease were predictors of poor oral feeding on univariate analysis. Although we did not detect a statistically significant impact of oral motor intervention, we found clinically meaningful differences in hospital length of stay and feeding tube requirement. Further research should be undertaken to evaluate methods for improving oral feeding in these at-risk infants.

  19. [Evidence-based and promising interventions to prevent infectious diseases among youth as a result of poor hand hygiene in schools: a literature review].

    PubMed

    Malherbe, Hélène; Nugier, Angélique; Clément, Juliette; Lamboy, Béatrice

    2013-01-01

    Infectious diseases remain a major cause of death among young people throughout the world. This paper reviews the current knowledge of empirically validated and promising interventions aimed at preventing infectious diseases among children caused by poor hand hygiene in schools. The study used a standard protocol to identify and review the literature and to classify the selected interventions. Approximately ten interventions were found to have a beneficial effect by promoting hand washing and hand hygiene in schools. The study also found that most of the interventions were implemented at elementary school. However, some interventions were also implemented at kindergarten or in child care centers, while others were aimed at university students. Most of the interventions were implemented by teachers, peers and/or external professionals. The study found that hand hygiene is effective regardless of the type of cleaning product used (i.e. antibacterial or plain soap, alcohol-based or alcohol-free hand sanitizer). This study aims to contribute to the understanding of empirically validated and promising interventions and to promote reflection on professional practice in France.

  20. Development of a complex intervention to improve health literacy skills

    PubMed Central

    Austvoll-Dahlgren, Astrid; Danielsen, Stein; Opheim, Elin; Bjørndal, Arild; Reinar, Liv Merete; Flottorp, Signe; Oxman, Andrew David; Helseth, Sølvi

    2013-01-01

    Background Providing insight into the developmental processes involved in building interventions is an important way to ensure methodological transparency and inform future research efforts. The objective of this study was to describe the development of a web portal designed to improve health literacy skills among the public. Methods The web portal was tailored to address three key barriers to obtaining information, using the conceptual frameworks of shared decision-making and evidence-based practice and based on explicit criteria for selecting the content and form of the intervention. Results The web portal targeted the general public and took the form of structured sets of tools. Content included: an introduction to research methods, help on how to find evidence-based health information efficiently based on the steps of evidence-based practice, an introduction to critical appraisal, information about patient participation rights in decision-making, and a decision aid for consultations. Conclusions The web portal was designed in a systematic and transparent way and address key barriers to obtaining and acting upon reliable health information. The web portal provides open access to the tools and can be used independently by health care users, or during consultations with health professionals. PMID:24251890

  1. Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta-analysis.

    PubMed

    Burgess, E; Hassmén, P; Welvaert, M; Pumpa, K L

    2017-04-01

    Poor adherence to lifestyle intervention remains a key factor hindering treatment effectiveness and health outcomes for adults with obesity. The aim of this systematic review and meta-analysis is to determine if behavioural treatment strategies (e.g. goal setting, motivational interviewing, relapse prevention, cognitive restructuring etc.) improve adherence to lifestyle intervention programmes in adults with obesity. Randomized controlled trials that investigated the use of behavioural treatment strategies in obesity management were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from their inception to August 2016. This meta-analysis shows that behavioural treatment interventions have a significant positive effect on session attendance (percentage) and physical activity (total min/week) in adults with obesity (M = 17.63 (95% confidence interval (CI) = 10.77, 24.50), z =5.0337, P < 0.0001 and M = 105.98 (95% CI = 58.64, 153.32), z =4.3878, P < 0.0001, respectively). This meta-analysis of randomized controlled trials provides evidence that behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity. These strategies should be routinely incorporated into lifestyle intervention, obesity management and weight loss programmes with the aim of improving engagement and adherence. If adherence were improved, treatment effectiveness, health outcomes and the ultimate burden of chronic disease could also be improved.

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

    PubMed

    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.

  3. Improved Cumulative Survival in Fistulas Requiring Surgical Interventions to Promote Fistula Maturation Compared to Endovascular Interventions

    PubMed Central

    Lee, Timmy; Tindni, Arshdeep; Roy-Chaudhury, Prabir

    2014-01-01

    Due to high non-maturation rates, arteriovenous fistulas (AVF) frequently require intervention(s) to promote maturation. Endovascular or surgical interventions are often undertaken to salvage non-maturing AVFs. The objective of this study was to compare the impact of surgical versus endovascular interventions to promote AVF maturation on cumulative AVF survival. We evaluated 89 patients with new AVF placement from a Veterans Affairs population over a 5-year period. Of these, 46 (52%) required intervention(s) to achieve successful maturation for dialysis. 31 patients had surgical revisions and 15 patients had endovascular repairs. We compared cumulative survival between AVFs requiring no intervention, surgical revision, and endovascular intervention to promote AVF maturation. Cumulative survival was longer in AVFs receiving surgical intervention compared to angioplasty to promote AVF maturation (p=0.05). One year cumulative survival was 86% vs 83% vs 40% for no intervention vs. surgery vs. angioplasty, respectively. In AVFs that required interventions to promote maturation, AVFs with surgical intervention had longer cumulative survival compared to those AVFs with endovascular intervention. AVFs with surgical intervention to promote maturation had similar one-year cumulative survival to those AVFs that did not require intervention to promote maturation. PMID:22404567

  4. Improved cumulative survival in fistulas requiring surgical interventions to promote fistula maturation compared with endovascular interventions.

    PubMed

    Lee, Timmy; Tindni, Arshdeep; Roy-Chaudhury, Prabir

    2013-01-01

    Due to high nonmaturation rates, arteriovenous fistulas (AVF) frequently require intervention(s) to promote maturation. Endovascular or surgical interventions are often undertaken to salvage nonmaturing AVFs. The objective of this study was to compare the impact of surgical versus endovascular interventions to promote AVF maturation on cumulative AVF survival. We evaluated 89 patients with new AVF placement from a Veterans Affairs population over a 5-year period. Of these, 46 (52%) required intervention(s) to achieve successful maturation for dialysis: 31 patients had surgical revisions and 15 patients had endovascular repairs. We compared cumulative survival between AVFs requiring no intervention, surgical revision, and endovascular intervention to promote AVF maturation. Cumulative survival was longer in AVFs receiving surgical intervention compared with angioplasty to promote AVF maturation (p = 0.05). One-year cumulative survival was 86% vs. 83% vs. 40% for no intervention vs. surgery vs. angioplasty, respectively. In AVFs that required interventions to promote maturation, AVFs with surgical intervention had longer cumulative survival compared with those AVFs with endovascular intervention. AVFs with surgical intervention to promote maturation had similar 1-year cumulative survival to those AVFs that did not require intervention to promote maturation.

  5. Key principles to improve programmes and interventions in complementary feeding.

    PubMed

    Lutter, Chessa K; Iannotti, Lora; Creed-Kanashiro, Hilary; Guyon, Agnes; Daelmans, Bernadette; Robert, Rebecca; Haider, Rukhsana

    2013-09-01

    Although there are some examples of successful complementary feeding programmes to promote healthy growth and prevent stunting at the community level, to date there are few, if any, examples of successful programmes at scale. A lack of systematic process and impact evaluations on pilot projects to generate lessons learned has precluded scaling up of effective programmes. Programmes to effect positive change in nutrition rarely follow systematic planning, implementation, and evaluation (PIE) processes to enhance effectiveness over the long term. As a result a set of programme-oriented key principles to promote healthy growth remains elusive. The purpose of this paper is to fill this gap by proposing a set of principles to improve programmes and interventions to promote healthy growth and development. Identifying such principles for programme success has three requirements: rethinking traditional paradigms used to promote improved infant and young child feeding; ensuring better linkages to delivery platforms; and, improving programming. Following the PIE model for programmes and learning from experiences from four relatively large-scale programmes described in this paper, 10 key principles are identified in the areas of programme planning, programme implementation, programme evaluation, and dissemination, replication, and scaling up. Nonetheless, numerous operational research questions remain, some of which are highlighted in this paper.

  6. Cinnamon Converts Poor Learning Mice to Good Learners: Implications for Memory Improvement.

    PubMed

    Modi, Khushbu K; Rangasamy, Suresh B; Dasarathi, Sridevi; Roy, Avik; Pahan, Kalipada

    2016-12-01

    This study underlines the importance of cinnamon, a commonly used natural spice and flavoring material, and its metabolite sodium benzoate (NaB) in converting poor learning mice to good learning ones. NaB, but not sodium formate, was found to upregulate plasticity-related molecules, stimulate NMDA- and AMPA-sensitive calcium influx and increase of spine density in cultured hippocampal neurons. NaB induced the activation of CREB in hippocampal neurons via protein kinase A (PKA), which was responsible for the upregulation of plasticity-related molecules. Finally, spatial memory consolidation-induced activation of CREB and expression of different plasticity-related molecules were less in the hippocampus of poor learning mice as compared to good learning ones. However, oral treatment of cinnamon and NaB increased spatial memory consolidation-induced activation of CREB and expression of plasticity-related molecules in the hippocampus of poor-learning mice and converted poor learners into good learners. These results describe a novel property of cinnamon in switching poor learners to good learners via stimulating hippocampal plasticity.

  7. Improvement of primary health care of patients with poorly regulated diabetes mellitus type 2 using shared decision-making – the DEBATE trial

    PubMed Central

    2012-01-01

    Background Since 2004, a national Disease Management Program (DMP) has been implemented in Germany, which includes educational measures aimed at patients with type-2 diabetes (T2D). However, about 15-20% of T2D patients remain in poor metabolic control. Qualitative research shows that one reason for this might be an increasing frustration of general practitioners (GPs) with the management of their poorly regulated T2D patients over time. We aim at approaching this problem by improving the GP-patient-communication and fostering shared decision-making. Methods/Design An educative intervention will be tested within a multi-centred cluster-randomized controlled trial (RCT) in Germany. We include 20 GPs in three regions. Each of the 60 GPs will recruit about 13 patients meeting the inclusion criteria (total of 780 patients). GPs allocated to the intervention group will receive a peer-visit from a specifically trained GP-colleague who will motivate them to apply patient-centred communication techniques including patient-centred decision aids. GPs allocated to the control group will not take part in any intervention program, but will provide care as usual to their patients. The primary inclusion criterion for patients at the time of the recruitment is an HbA1c-level of over 8.0. Primary outcome is the change of HbA1c at 6, 12, 18, and 24 months compared to HbA1c at baseline. Secondary outcomes include patient’s participation in the process of shared decision-making and quality of life. Discussion If this intervention proves to be effective it may be integrated into the existing Disease Management Program for T2D in Germany. PMID:22913642

  8. Multisystemic Therapy Improves the Patient-Provider Relationship in Families of Adolescents with Poorly Controlled Insulin Dependent Diabetes

    PubMed Central

    Carcone, April Idalski; Ellis, Deborah A.; Chen, Xinguang; Naar-King, Sylvie; Cunningham, Phillippe B.; Moltz, Kathleen

    2015-01-01

    Objective The purpose of this study was to determine if Multisystemic Therapy (MST), an intensive, home and community-based family treatment, significantly improved patient-provider relationships in families where youth had chronic poor glycemic control. Methods One hundred forty-six adolescents with type 1 or 2 diabetes in chronic poor glycemic control (HbA1c ≥ 8%) and their primary caregivers were randomly assigned to MST or a telephone support condition. Caregiver perceptions of their relationship with the diabetes multidisciplinary medical team were assessed at baseline and treatment termination with the Measure of Process of Care-20. Results At treatment termination, MST families reported significant improvement on the Coordinated and Comprehensive Care scale and marginally significant improvement on the Respectful and Supportive Care scale. Improvements on the Enabling and Partnership and Providing Specific Information scales were not significant. Conclusions Results suggest MST improves the ability of the families and the diabetes treatment providers to work together. PMID:25940767

  9. Pharmaceutical solid dispersion technology: a strategy to improve dissolution of poorly water-soluble drugs.

    PubMed

    Kumar, Shobhit; Gupta, Satish K

    2013-08-01

    Oral bioavailability is the major problem when a poorly water-soluble active agent is delivered via oral route. To overcome such problems, solid dispersion systems have been demonstrated in literature to enhance the dissolution property of poorly water-soluble drugs. In the present review, the important aspects to be considered during preparation of solid dispersion systems viz., properties of polymer and preparation techniques of solid dispersion which affect the dissolution rate are discussed. Formulation and evaluation techniques for solid dispersions have been described. The final section of article highlights the recent patents and studies related to solid dispersion systems.

  10. Motor Skill Interventions to Improve Fundamental Movement Skills of Preschoolers with Developmental Delay

    ERIC Educational Resources Information Center

    Kirk, Megan A.; Rhodes, Ryan E.

    2011-01-01

    Preschoolers with developmental delay (DD) are at risk for poor fundamental movement skills (FMS), but a paucity of early FMS interventions exist. The purpose of this review was to critically appraise the existing interventions to establish direction for future trials targeting preschoolers with DD. A total of 11 studies met the inclusion…

  11. Repackaging exemptions under National Health Insurance in Ghana: how can access to care for the poor be improved?

    PubMed

    Kanchebe Derbile, Emmanuel; van der Geest, Sjaak

    2013-09-01

    For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new 'National Health Insurance Scheme' (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities' own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions.

  12. Media Reporting of Health Interventions: Signs of Improvement, but Major Problems Persist

    PubMed Central

    Wilson, Amanda; Bonevski, Billie; Jones, Alison; Henry, David

    2009-01-01

    Background Studies have persistently shown deficiencies in medical reporting by the mainstream media. We have been monitoring the accuracy and comprehensiveness of medical news reporting in Australia since mid 2004. This analysis of more than 1200 stories in the Australian media compares different types of media outlets and examines reporting trends over time. Methods and Findings Between March 2004 and June 2008 1230 news stories were rated on a national medical news monitoring web site, Media Doctor Australia. These covered a variety of health interventions ranging from drugs, diagnostic tests and surgery to dietary and complementary therapies. Each story was independently assessed by two reviewers using ten criteria. Scores were expressed as percentages of total assessable items deemed satisfactory according to a coding guide. Analysis of variance was used to compare mean scores and Fishers exact test to compare proportions. Trends over time were analysed using un-weighted linear regression analysis. Broadsheet newspapers had the highest average satisfactory scores: 58% (95% CI 56–60%), compared with tabloid newspapers and online news outlets, 48% (95% CI 44–52) and 48% (95% CI 46–50) respectively. The lowest scores were assigned to stories broadcast by human interest/current affairs television programmes (average score 33% (95% CI 28–38)). While there was a non- significant increase in average scores for all outlets, a significant improvement was seen in the online news media: a rise of 5.1% (95%CI 1.32, 8.97; P 0.009). Statistically significant improvements were seen in coverage of the potential harms of interventions, the availability of treatment or diagnostic options, and accurate quantification of benefits. Conclusion Although the overall quality of medical reporting in the general media remains poor, this study showed modest improvements in some areas. However, the most striking finding was the continuing very poor coverage of health news by

  13. Improving Educational Outcomes for Poor Children. Discussion Paper No. 1352-08

    ERIC Educational Resources Information Center

    Jacob, Brian A.; Ludwig, Jens

    2008-01-01

    One of the best ways to avoid being poor as an adult is to obtain a good education. Individuals with higher academic achievement and more years of schooling earn more than those with lower levels of human capital. This is not surprising given that we believe that schooling makes people more productive, allowing them to command higher wages in the…

  14. Improving flood prediction by the assimilation of satellite soil moisture in poorly monitored catchments

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Flood prediction in poorly monitored catchments is among the greatest challenges faced by hydrologists. To address this challenge, an increasing number of studies in the last decade have explored methods to integrate various existing observations from ground and satellites. One approach in particula...

  15. Interventions for improving adherence to iron chelation therapy in people with sickle cell disease or thalassaemia

    PubMed Central

    Fortin, Patricia M; Madgwick, Karen V; Trivella, Marialena; Hopewell, Sally; Doree, Carolyn; Estcourt, Lise J

    2016-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: To identify and assess the effectiveness of interventions to improve adherence to iron chelation therapy compared to standard care in people with SCD or thalassaemia including: identifying and assessing the effectiveness of different types of interventions (psychological and psychosocial, educational, medication interventions, or multi-component interventions);identifying and assessing the effectiveness of interventions specific to different age groups (children, adolescents, adults). PMID:27713668

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

    PubMed

    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 < .01). Moreover, changes in 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.

  17. Mindfulness-based Intervention for Perinatal Grief Education and Reduction among Poor Women in Chhattisgarh, India: a Pilot Study

    PubMed Central

    Roberts, Lisa; Montgomery, Susanne

    2017-01-01

    Introduction Stillbirth is a significant public health problem in low-to-middle-income countries and results in perinatal grief, often with negative psychosocial impact. In low-resource settings, such as Chhattisgarh, India, where needs are high, it is imperative to utilize low-cost, effective interventions. Mindfulness-based stress reduction (MBSR) is an empirically sound intervention that has been utilized for a broad range of physical and mental health problems, and is adaptable to specific populations. The main objective of this pilot study was to explore the feasibility and effectiveness of a shortened, culturally adapted mindfulness-based intervention to address complex grief after stillbirth. Methods We used an observational, pre-post-6-week post study design. The study instrument was made up of descriptive demographic questions and validated scales and was administered as a structured interview due to low literacy rates. We used a community participatory approach to culturally adapt the five-week mindfulness-based intervention and delivered it through two trained local nurses. Quantitative and qualitative data analyses explored study outcomes as well as acceptability and feasibility of the intervention. Results 29 women with a history of stillbirth enrolled, completed the pretest and began the intervention; 26 completed the five-week intervention and post-test (89.7%), and 23 completed the six-week follow-up assessment (88.5%). Pretest results included elevated psychological symptoms and high levels of perinatal grief, including the active grief, difficulty coping, and despair subscales. General linear modeling repeated measures was used to explore posttest and six-week follow up changes from baseline, controlling for significantly correlated demographic variables. These longitudinal results included significant reduction in psychological symptoms; four of the five facets of mindfulness changed in the desired direction, two significantly; as well as

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

    PubMed

    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.

  19. A Metacognitive Program for Improving the Word Identification and Reading Comprehension Skills of Upper Primary Poor Readers.

    ERIC Educational Resources Information Center

    Bruce, Merle E.; Robinson, Gregory L.

    This paper reports on a series of three studies designed to assess the effectiveness of a metacognitive approach to teaching word identification and reading comprehension skills to upper primary poor readers, and to investigate effective methods for implementing the metacognitive program in the regular classroom. To improve word identification…

  20. Exercise interventions in polypathological aging patients that coexist with diabetes mellitus: improving functional status and quality of life.

    PubMed

    Cadore, Eduardo Lusa; Izquierdo, Mikel

    2015-06-01

    In elderly populations, diabetes is associated with reduced muscle strength, poor muscle quality, and accelerated loss of muscle mass. In addition, diabetes mellitus increases risk for accelerated aging and for the development of frailty syndrome. This disease is also associated with a polypathological condition, and its complications progressively affect quality of life and survival. Exercise interventions, including resistance training, represent the cornerstones of diabetes management, especially in patients at severe functional decline. This review manuscript aimed to describe the beneficial effects of different exercise interventions on the functional capacity of elderly diabetics, including those at polypathological condition. The SciELO, Science Citation Index, MEDLINE, Scopus, SPORTDiscus, and ScienceDirect databases were searched from 1980 to 2015 for articles published from original scientific investigations. In addition to the beneficial effects of exercise interventions on glycemic control, and on the cardiovascular risk factors associated with diabetes, physical exercise is an effective intervention to improve muscle strength, power output, and aerobic power and functional capacity in elderly diabetic patients. Thus, a combination of resistance and endurance training is the most effective exercise intervention to promote overall physical fitness in these patients. In addition, in diabetic patients with frailty and severe functional decline, a multicomponent exercise program including strength and power training, balance exercises, and gait retraining may be an effective intervention to reduce falls and improve functional capacity and quality of life in these patients.

  1. Accelerating Decoding-Related Skills in Poor Readers Learning a Foreign Language: A Computer-Based Intervention

    ERIC Educational Resources Information Center

    Björn, Piia Maria; Leppänen, Paavo H. T.

    2013-01-01

    The results of Fast ForWord® training on English decoding-related skills were examined. Finnish fifth-grade students were identified as having reading fluency problems and poor skills in English as a foreign language learned at school and were randomly assigned to either a training group (TRG) or a control group. The TRG ("n"?=?13)…

  2. Intervention Learning Plan to Address the Issue of Poor Writing Skills among Students of Al Ittihad Model School

    ERIC Educational Resources Information Center

    Sarsar, Nasreddine Mohamed

    2008-01-01

    Students in UAE Model Schools exhibit poor writing skills. Samples of some of the essays they came up with bear clear evidence of the problems they have with writing in particular and place them at an increased risk for literacy failure. The data I gathered by means of questionnaires and interviews with teachers and students alike suggest that the…

  3. Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa

    PubMed Central

    Houweling, Tanja A J; Morrison, Joanna; Alcock, Glyn; Azad, Kishwar; Das, Sushmita; Hossen, Munir; Kuddus, Abdul; Lewycka, Sonia; Looman, Caspar W; Magar, Bharat Budhathoki; Manandhar, Dharma S; Akter, Mahfuza; Dube, Albert Lazarous Nkhata; Rath, Shibanand; Saville, Naomi; Sen, Aman; Tripathy, Prasanta; Costello, Anthony

    2016-01-01

    Background Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa. Methods We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70 574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results. Results Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them. Conclusions Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants’ convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos. PMID:26246540

  4. Food Environment Interventions to Improve the Dietary Behavior of Young Adults in Tertiary Education Settings: A Systematic Literature Review.

    PubMed

    Roy, Rajshri; Kelly, Bridget; Rangan, Anna; Allman-Farinelli, Margaret

    2015-10-01

    The current obesity-promoting food environment, typified by highly accessible unhealthy foods and drinks, may lead to an increased risk of chronic disease, particularly within young adults. A number of university-based intervention trials have been conducted in the United States and Europe to improve the food environment in this setting. However, there are no systematic reviews focusing on these interventions conducted exclusively in tertiary education settings. Our objective was to conduct a systematic literature review evaluating food environment interventions targeting dietary behavior in young adults in college and university settings. Eight databases were searched for randomized controlled trials, pre- and postintervention studies, quasiexperimental studies, cross-sectional studies, and other nonexperimental studies from 1998 to December 2014 that were conducted in tertiary education settings (ie, colleges and universities). Studies that evaluated a food environment intervention and reported healthier food choices, reductions in unhealthy food choices, nutrition knowledge, and/or food and drink sales as primary outcomes were included. Fifteen studies of high (n=5), medium (n=7), and poor quality (n=3) met the inclusion criteria, 13 of which showed positive improvements in outcome measures. Information relating to healthy foods through signage and nutrition labels (n=10) showed improvements in outcomes of interest. Increasing the availability of healthy foods (n=1) and decreasing the portion size of unhealthy foods (n=2) improved dietary intake. Price incentives and increased availability of healthy foods combined with nutrition information to increase purchases of healthy foods (n=2) were identified as having a positive effect on nutrition-related outcomes. Potentially useful interventions in tertiary education settings were nutrition messages/nutrient labeling, providing healthy options, and portion size control of unhealthy foods. Price decreases for and

  5. Improved delivery of poorly soluble compounds using nanoparticle technology: a review.

    PubMed

    Kalepu, Sandeep; Nekkanti, Vijaykumar

    2016-06-01

    Although a large number of new drug molecules with varied therapeutic potentials have been discovered in the recent decade, yet most of them are still in developmental process. This can be attributed to the limited aqueous solubility which governs the bioavailability of such drug molecules. Hence, there is a requisite for a technology-based product (formulation) in order to overcome such issues without compromising on the therapeutic response. The purpose of this review is to provide an insight to the formulation of drug nanoparticles for enhancing solubility and dissolution velocity with concomitant enhancement in bioavailability. In the recent decade, nanonization has evolved from a concept to reality owing to its versatile applications, especially in the development of drugs having poor solubility. In this review, a relatively simple and scalable approach for the manufacture of drug nanoparticles and latest characterization techniques utilized to evaluate the drug nanoparticles are discussed. The drug nanoparticulate approach described herein provides a general applicability of the platform technology in designing a formulation for drugs associated with poor aqueous solubility.

  6. Improvement of drug delivery with a breath actuated pressurised aerosol for patients with poor inhaler technique.

    PubMed Central

    Newman, S P; Weisz, A W; Talaee, N; Clarke, S W

    1991-01-01

    BACKGROUND The metered dose inhaler is difficult to use correctly, synchronising actuation with inhalation being the most important problem. A breath actuated pressurised inhaler, designed to help patients with poor inhaler technique, was compared with a conventional metered dose inhaler in terms of aerosol deposition and bronchodilator response. METHODS Radioaerosol deposition and bronchodilator response to 100 micrograms salbutamol were measured in 18 asthmatic patients, who inhaled from a conventional metered dose inhaler by their own chosen metered dose inhaler technique, from a conventional metered dose inhaler by a taught metered dose inhaler technique, and from a breath actuated pressured inhaler (Autohaler). RESULTS In the 10 patients who could coordinate actuation and inhalation of the inhaler on their own deposition of aerosol in the lungs and bronchodilator response were equivalent on the three study days. By contrast, in the eight patients who could not coordinate the mean (SEM) percentage of the dose deposited in the lungs with their own inhaler technique (7.2% (3.4%] was substantial lower than those attained by the taught metered dose inhaler technique (22.8% (2.5%] and by Autohaler (20.8% (1.7%]. CONCLUSION Although of little additional benefit to asthmatic patients with good coordination, the Autohaler is potentially a valuable aid to those with poor coordination, and should be considered in preference to a conventional metered dose inhaler in any patient whose inhaler technique is not known to be satisfactory. Images PMID:1750017

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

    ERIC Educational Resources Information Center

    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…

  8. Oral Motor Intervention Improved the Oral Feeding in Preterm Infants

    PubMed Central

    Tian, Xu; Yi, Li-Juan; Zhang, Lei; Zhou, Jian-Guo; Ma, Li; Ou, Yang-Xiang; Shuai, Ting; Zeng, Zi; Song, Guo-Min

    2015-01-01

    Abstract Oral feeding for preterm infants has been a thorny problem worldwide. To improve the efficacy of oral feeding in preterm infants, oral motor intervention (OMI), which consists of nonnutritive sucking, oral stimulation, and oral support, was developed. Published studies demonstrated that OMI may be as an alternative treatment to solve this problem; however, these results remain controversial. We conducted a meta-analysis with trial sequential analysis (TSA) to objectively evaluate the potential of OMI for improving the current status of oral feeding in preterm infants. A search of PubMed, EMBASE, Web of Science, the Cochrane Library, and China National Knowledge Infrastructure was performed to capture relevant citations until at the end of October, 2014. Lists of references of eligible studies and reviews were also hand-checked to include any latent studies. Two independent investigators screened literature, extracted data, and assessed the methodology, and then a meta-analysis and TSA was performed by using Reviewer Manager (RevMan) 5.3 and TSA 0.9 beta, respectively. A total of 11 randomized controlled trials (RCTs), which included 855 participants, were incorporated into our meta-analysis. The meta-analyses suggested that OMI is associated with the reduced transition time (ie, the time needed from tube feeding to totally oral feeding) (mean difference [MD], −4.03; 95% confidence interval [CI], −5.22 to −2.84), shorten hospital stays (MD, −3.64; 95% CI, −5.57 to −1.71), increased feeding efficiency (MD, 0.08; 95% CI, 0.36–1.27), and intake of milk (MD, 0.14; 95% CI, 0.06–0.21) rather than weight gain. Results of TSA for each outcomes of interest confirmed these pooled results. With present evidences, OMI can be as an alternative to improve the condition of transition time, length of hospital stays, feeding efficiency, and intake of milk in preterm infants. However, the pooled results may be impaired due to low quality included, and thus

  9. A Checklist to Improve Patient Safety in Interventional Radiology

    SciTech Connect

    Koetser, Inge C. J.; Vries, Eefje N. de; Delden, Otto M. van; Smorenburg, Susanne M.; Boermeester, Marja A.; Lienden, Krijn P. van

    2013-04-15

    To develop a specific RADiological Patient Safety System (RADPASS) checklist for interventional radiology and to assess the effect of this checklist on health care processes of radiological interventions. On the basis of available literature and expert opinion, a prototype checklist was developed. The checklist was adapted on the basis of observation of daily practice in a tertiary referral centre and evaluation by users. To assess the effect of RADPASS, in a series of radiological interventions, all deviations from optimal care were registered before and after implementation of the checklist. In addition, the checklist and its use were evaluated by interviewing all users. The RADPASS checklist has two parts: A (Planning and Preparation) and B (Procedure). The latter part comprises checks just before starting a procedure (B1) and checks concerning the postprocedural care immediately after completion of the procedure (B2). Two cohorts of, respectively, 94 and 101 radiological interventions were observed; the mean percentage of deviations of the optimal process per intervention decreased from 24 % before implementation to 5 % after implementation (p < 0.001). Postponements and cancellations of interventions decreased from 10 % before implementation to 0 % after implementation. Most users agreed that the checklist was user-friendly and increased patient safety awareness and efficiency. The first validated patient safety checklist for interventional radiology was developed. The use of the RADPASS checklist reduced deviations from the optimal process by three quarters and was associated with less procedure postponements.

  10. Improving Intervention Implementation and Fidelity in Evidence-Based Practice: Integrating Teacher Preference into Intervention Selection

    ERIC Educational Resources Information Center

    Wehby, Joseph H.; Maggin, Daniel M.; Johnson, LeAnne; Symons, Frank J.

    2010-01-01

    The purpose of the present study was to examine the effect that teacher choice of intervention has on their level of procedural implementation and quality of implementation. The following research questions helped to guide the study: (1) Do teachers randomly assigned to the intervention "choice" group have higher ratings of procedural fidelity…

  11. Eliminating Poor Performers: The Catalyst to Improve Quality in the U.S. Army

    DTIC Science & Technology

    2012-05-01

    eventually improve job satisfaction by increasing the quality of leaders. Changing the parameters of success to be more qualitative by allowing unit...will initially increase quality of units and will eventually improve job satisfaction by increasing the quality of leaders. Changing the parameters ...satisfaction by increasing the quality of leaders. Changing the parameters of success to be more qualitative by allowing unit commanders to decrease to an

  12. User perceptions of gaming interventions for improving upper extremity motor function in persons with chronic stroke.

    PubMed

    Finley, Margaret; Combs, Stephanie

    2013-04-01

    Finding ways to engage patients with stroke in repetitive intervention protocols long-term is poorly understood, particularly from the patients' perspective. Limited information exists that combines clinical expertise as well as user feedback on improving gaming interaction. The purpose of this study was to utilize input from focus groups of gaming intervention users with chronic stroke to identify characteristics of gaming that influence user/patient engagement in the activity. Two focus groups (n = 10) were conducted with each group participant playing two different gaming systems. Following exposure to the two systems, guided group interview sessions occurred that consisted of open-ended questions encompassing areas of overall gaming system preference, aspects that were liked or disliked, background appearance, music options, feedback provided, as well as recommendations for change. Findings revealed that participants enjoyed playing the gaming systems. Three primary themes emerged differentiating the systems: (1) musical encouragement; (2) focus and attention; and (3) motivation provided by performance feedback. It was concluded that when selecting a gaming system for upper extremity rehabilitation, a clinician should select a system that provides user-relevant music options with a modifiable background appearance for progression from basic to more challenging, providing appropriate feedback in an effort to encompass to a variety of user performance levels.

  13. Mathematical literacy in Plant Physiology undergraduates: results of interventions aimed at improving students' performance

    NASA Astrophysics Data System (ADS)

    Vila, Francisca; Sanz, Amparo

    2013-09-01

    The importance of mathematical literacy in any scientific career is widely recognized. However, various studies report lack of numeracy and mathematical literacy in students from various countries. In the present work, we present a detailed study of the mathematical literacy of Spanish undergraduate students of Biology enrolled in a Plant Physiology course. We have performed individual analyses of results obtained during the period 2000-2011, for questions in the examinations requiring and not requiring mathematical skills. Additionally, we present the outcome of two interventions introduced with the aim of helping students improve their prospects for success in the course. Our results confirm previous research showing students' deficiencies in mathematical skills. However, the scores obtained for mathematical questions in the examinations are good predictors of the final grades attained in Plant Physiology, as there are strong correlations at the individual level between results for questions requiring and not requiring mathematical skills. The introduction of a laboratory session devoted to strengthening the application of students' previously acquired mathematical knowledge did not change significantly the results obtained for mathematical questions. Since mathematical abilities of students entering university have declined in recent years, this intervention may have helped to maintain students' performance to a level comparable to that of previous years. The outcome of self-assessment online tests indicates that although Mathematics anxiety is lower than during examinations, the poor results obtained for questions requiring mathematical skills are, at least in part, due to a lack of self-efficacy.

  14. Improvement of time in therapeutic range with warfarin by pharmaceutical intervention.

    PubMed

    Víquez-Jaikel, Alvaro; Victoria Hall-Ramírez; Ramos-Esquivel, Allan

    2017-02-01

    Background Anticoagulation therapy with warfarin is highly effective for prevention and treatment of thromboembolic disorders. Nevertheless, its management is challenging especially in developing countries, where the medical access is difficult and patient education is poor. Objective To determine the effect of pharmaceutical intervention (PI) on the time in therapeutic range (TTR) of a group of anticoagulated patients from our referral center. Method A group of consecutive outpatients previously treated by usual medical care underwent PI. The intervention consisted in the identification and avoidance of food and drug interactions, the confection of medication schedule charts and education to patients regarding side effects and drug monitoring. Mean TTR before and after PI was compared through the Wilcoxon test for repeated measures. Regression analyses were performed to assess the relationship between a TTR level under 65% and potential explanatory variables. Results Mean TTR before PI was 37.4 ± 23.5% and after PI it raised to 67.0 ± 24.9%. Mean change in TTR was +29.5% (95% CI 14.5-44.6; p < 0.001). Before PI only 4 patients had TTR values above 65%, in contrast to 18 patients after PI. Conclusion Our findings support the efficacy of PI to improve TTR values in patients treated with warfarin.

  15. Pharmacological interventions to improve sleep in hospitalised adults: a systematic review

    PubMed Central

    Kanji, Salmaan; Mera, Alexandru; Hutton, Brian; Burry, Lisa; Rosenberg, Erin; MacDonald, Erika; Luks, Vanessa

    2016-01-01

    Objectives Patients often suffer from disturbed sleep in hospital. Poor-quality sleep in hospitalised patients has been associated with significant morbidity and pharmacological sleep aids are often prescribed. The objective of this systematic review is to evaluate the comparative efficacy and safety of pharmacological interventions used for sleep in hospitalised patients. Setting/participants We searched MEDLINE, Embase, the Cochrane database and grey literature for prospective studies that evaluated sleep in hospitalised adults after a pharmacological intervention. Primary and secondary outcome measures Two reviewers assessed studies for inclusion and extracted data for efficacy outcomes, including sleep efficiency, sleep latency, sleep fragmentation and objectively measured sleep stage distribution. Risk of bias was assessed and meta-analyses were planned contingent upon homogeneity of the included studies. Results After screening 1920 citations, 15 studies involving 861 patients were included. Medications studied included benzodiazepines, nonbenzodiazepine sedatives, melatonin, propofol and dexmedetomidine. Five studies were deemed to be of high quality. Heterogeneity and variable outcome reporting precluded meta-analysis in most cases. No consistent trends with respect to sleep efficiency, quality or interruptions were observed identifying a drug or drug class as superior to another or no treatment. Benzodiazepines appeared to be better than no treatment with respect to sleep latency, but this was not consistently demonstrated across all studies. Sleep stage distribution shows that sleep in hospital is dominated by stages N1 and N2. Conclusions There is insufficient evidence to suggest that pharmacotherapy improves the quality or quantity of sleep in hospitalised patients suffering from poor sleep. No drug class or specific drug was identified as superior even when compared to placebo or no treatment. Although 15 studies were included, the quality of evidence

  16. Front-office staff can improve clinical tobacco intervention

    PubMed Central

    Bass, Frederic; Naish, Brigham; Buwembo, Isaac

    2013-01-01

    Abstract Objective To learn whether front-line personnel in primary care practices can increase delivery of clinical tobacco interventions and also help smokers address physical inactivity, at-risk alcohol use, and depression. Design Uncontrolled before-and-after design. Setting Vancouver, BC, area (4 practices); northern British Columbia (2 practices). Participants Six practices, with 1 staff person per practice serving as a “health coordinator” who tracked and, after the baseline period, delivered preventive interventions to all patients who smoked. To assess delivery of preventive interventions, each practice was to sample 300 consecutive patient records, both at baseline and at follow-up 15 months later. Interventions Front-office staff were recruited, trained, paid, and given ongoing support to provide preventive care. Clinicians supplemented this care with advice and guided the use of medication. Main outcome measures Effectiveness of the intervention was based on comparison, at baseline and at follow-up, of the proportion of patients with any of the following 6 proven intervention components documented in their medical records: chart reminder, advice received, self-management plan, target quit date, referral, and follow-up date (as they applied to tobacco, physical inactivity, at-risk alcohol use, and depression). A Tobacco Intervention Flow Sheet cued preventive care, and its data were entered into a spreadsheet (which served as a smokers’ registry). Qualitative appraisal data were noted. Results For tobacco, substantial increases occurred after the intervention period in the proportion of patients with each of the intervention components noted in their charts: chart reminder (20% vs 94%); provision of advice (34% vs 79%); self-management plan (14% vs 57%); target quit date (5% vs 11%); referral (6% vs 11%); and follow-up date (7% vs 42%). Interventions for physical inactivity and depression showed some gains, but there were no gains for at

  17. Impact of extension interventions in improving livelihood of dairy farmers of Nadia district of West Bengal, India.

    PubMed

    Garai, Suman; Garai, Sanchita; Maiti, Sanjit; Meena, B S; Ghosh, M K; Bhakat, Champak; Dutta, T K

    2017-03-01

    Livestock is a one of the major sources of livelihood for most of the small and marginal farmers in India, particularly for rural households who live in below poverty line. Extension interventions have long been seen as a key element for enabling farmers to obtain information and technologies that can improve their livelihoods. It is also recognized that extension is an important factor in promoting dairy development. Ex-post-facto cause to effect research design was applied in this study to trace out the impact of extension interventions in improving knowledge, attitude, adoption towards scientific dairy farming practices and improvement in milk production of dairy animal and income from dairying which will be resulted into improved livelihood of rural poor in Nadia district of West Bengal, India. Therefore, 60 dairy farmers of experimental villages who were considered as beneficiaries and 60 dairy farmers of control villages who were considered as non-beneficiaries were selected as sample for the study. It was found that beneficiaries had significantly higher score in all the five components of livelihood improvement with its all sub components, i.e., knowledge, attitude, adoption of scientific dairy farming practices, milk production per household per day and monthly income from dairying except disease control, and marketing component of adoption. Hence, it may be concluded that extension interventions had a significant impact on improving livelihood of rural dairy farmers in Nadia district of West Bengal, India.

  18. Time for action-Improving the design and reporting of behaviour change interventions for antimicrobial stewardship in hospitals: Early findings from a systematic review.

    PubMed

    Davey, Peter; Peden, Claire; Charani, Esmita; Marwick, Charis; Michie, Susan

    2015-03-01

    There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information. We identified 116 studies reporting 123 interventions. Reporting of BCTs was poor, with little detail of BCT characteristics. Feedback was only reported for 17 (13.8%) of the interventions, and self-monitoring was used in only 1 intervention. Goals were reported for all interventions but were poorly specified, with only three of the nine characteristics reported for ≥50% of interventions. A goal threshold and timescale were specified for just 1 of the 123 interventions. Only 29 authors (25.0%) responded to the request for additional information. In conclusion, both the content and reporting of interventions for antimicrobial stewardship fell short of scientific principles and practices. There is a strong evidence base regarding BCTs in other contexts that should be applied to antimicrobial stewardship now if we are to further our understanding of what works, for whom, why and in what contexts.

  19. Taking action on the social determinants of health: improving health access for the urban poor in Mongolia

    PubMed Central

    2012-01-01

    Introduction In recent years, the country of Mongolia (population 2.8 million) has experienced rapid social changes associated with economic growth, persisting socio-economic inequities and internal migration. In order to improve health access for the urban poor, the Ministry of Health developed a "Reaching Every District" strategy (RED strategy) to deliver an integrated package of key health and social services. The aim of this article is to present findings of an assessment of the implementation of the RED strategy, and, on the basis of this assessment, articulate lessons learned for equitable urban health planning. Methods Principal methods for data collection and analysis included literature review, barrier analysis of health access and in-depth interviews and group discussions with health managers and providers. Findings The main barriers to health access for the urban poor relate to interacting effects of poverty, unhealthy daily living environments, social vulnerability and isolation. Implementation of the RED strategy has resulted in increased health access for the urban poor, as demonstrated by health staff having reached new clients with immunization, family planning and ante-natal care services, and increased civil registrations which enable social service provision. Organizational effects have included improved partnerships for health and increased motivation of the health workforce. Important lessons learned from the early implementation of the RED strategy include the need to form strong partnerships among stakeholders at each level of the health system and in the community, as well as the need to develop a specific financing strategy to address the needs of the very poor. The diverse social context for health in an urban poor setting calls for a decentralized planning and partnership strategy, but with central level commitment towards policy guidance and financing of pro-poor urban health strategies. Conclusions Lessons from Mongolia mirror other

  20. Evaluating the ready biodegradability of two poorly water-soluble substances: comparative approach of bioavailability improvement methods (BIMs).

    PubMed

    Sweetlove, Cyril; Chenèble, Jean-Charles; Barthel, Yves; Boualam, Marc; L'Haridon, Jacques; Thouand, Gérald

    2016-09-01

    Difficulties encountered in estimating the biodegradation of poorly water-soluble substances are often linked to their limited bioavailability to microorganisms. Many original bioavailability improvement methods (BIMs) have been described, but no global approach was proposed for a standardized comparison of these. The latter would be a valuable tool as part of a wider strategy for evaluating poorly water-soluble substances. The purpose of this study was to define an evaluation strategy following the assessment of different BIMs adapted to poorly water-soluble substances with ready biodegradability tests. The study was performed with two poorly water-soluble chemicals-a solid, anthraquinone, and a liquid, isodecyl neopentanoate-and five BIMs were compared to the direct addition method (reference method), i.e., (i) ultrasonic dispersion, (ii) adsorption onto silica gel, (iii) dispersion using an emulsifier, (iv) dispersion with silicone oil, and (v) dispersion with emulsifier and silicone oil. A two-phase evaluation strategy of solid and liquid chemicals was developed involving the selection of the most relevant BIMs for enhancing the biodegradability of tested substances. A description is given of a BIM classification ratio (R BIM), which enables a comparison to be made between the different test chemical sample preparation methods used in the various tests. Thereby, using this comparison, the BIMs giving rise to the greatest biodegradability were ultrasonic dispersion and dispersion with silicone oil or with silicone oil and emulsifier for the tested solid chemical, adsorption onto silica gel, and ultrasonic dispersion for the liquid one.

  1. Improving lifestyle interventions for people with serious mental illnesses: Qualitative results from the STRIDE study

    PubMed Central

    Yarborough, Bobbi Jo H.; Stumbo, Scott P.; Yarborough, Micah T.; Young, Thomas J.; Green, Carla A.

    2015-01-01

    Objective Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes. Methods A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%) or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes. Results Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes. Conclusions and implications for practice Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly. PMID:26214184

  2. Improving antibiotic prescribing for children in the resource-poor setting.

    PubMed

    Le Doare, Kirsty; Barker, Charlotte I S; Irwin, Adam; Sharland, Mike

    2015-03-01

    Antibiotics are a critically important part of paediatric medical care in low- and middle-income countries (LMICs), where infectious diseases are the leading cause of child mortality. The World Health Organization estimates that >50% of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients do not take their medicines correctly. Given the rising prevalence of antimicrobial resistance globally, inappropriate antibiotic use is of international concern, and countries struggle to implement basic policies promoting rational antibiotic use. Many barriers to rational paediatric prescribing in LMICs persist. The World Health Organization initiatives, such as 'Make medicines child size', the Model List of Essential Medicines for Children and the Model Formulary for Children, have been significant steps forward. Continued strategies to improve access to appropriate drugs and formulations, in conjunction with improved evidence-based clinical guidelines and dosing recommendations, are essential to the success of such initiatives on both a national and an international level. This paper provides an overview of these issues and considers future developments that may improve LMIC antibiotic prescribing.

  3. Improving antibiotic prescribing for children in the resource-poor setting

    PubMed Central

    Le Doare, Kirsty; Barker, Charlotte I S; Irwin, Adam; Sharland, Mike

    2015-01-01

    Antibiotics are a critically important part of paediatric medical care in low- and middle-income countries (LMICs), where infectious diseases are the leading cause of child mortality. The World Health Organization estimates that >50% of all medicines are prescribed, dispensed or sold inappropriately and that half of all patients do not take their medicines correctly. Given the rising prevalence of antimicrobial resistance globally, inappropriate antibiotic use is of international concern, and countries struggle to implement basic policies promoting rational antibiotic use. Many barriers to rational paediatric prescribing in LMICs persist. The World Health Organization initiatives, such as ‘Make medicines child size’, the Model List of Essential Medicines for Children and the Model Formulary for Children, have been significant steps forward. Continued strategies to improve access to appropriate drugs and formulations, in conjunction with improved evidence-based clinical guidelines and dosing recommendations, are essential to the success of such initiatives on both a national and an international level. This paper provides an overview of these issues and considers future developments that may improve LMIC antibiotic prescribing. PMID:24433393

  4. Feasibility and Acceptability of the TALK Social Worker Intervention to Improve Live Kidney Transplantation

    ERIC Educational Resources Information Center

    DePasquale, Nicole; Hill-Briggs, Felicia; Darrell, Linda; Boyer, LaPricia Lewis; Ephraim, Patti; Boulware, L. Ebony

    2012-01-01

    Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with…

  5. An injectable hybrid nanoparticle-in-oil-in-water submicron emulsion for improved delivery of poorly soluble drugs

    NASA Astrophysics Data System (ADS)

    Wang, Shuo; Wang, Hua; Liang, Wenquan; Huang, Yongzhuo

    2012-04-01

    Poor drugability problems are commonly seen in a class of chemical entities with poor solubility in water and oil, and moreover, physicochemical instability of these compounds poses extra challenges in design of dosage forms. Such problems contribute a significant high failure rate in new drug development. A hybrid nanoparicle-in-oil-in-water (N/O/W) submicron emulsion was proposed for improved delivery of poorly soluble and unstable drugs (e.g., dihydroartemisinin (DHA)). DHA is known for its potent antimalarial effect and antitumor activity. However, its insolubility and instability impose big challenges for formulations, and so far, no injectable dosage forms are clinically available yet. Therefore, an injectable DHA N/O/W system was developed. Unlike other widely-explored systems (e.g., liposomes, micelles, and emulsions), in which low drug load and only short-term storage are often found, the hybrid submicron emulsion possesses three-fold higher drug-loading capacity than the conventional O/W emulsion. Of note, it can be manufactured into a freeze-drying form and can render its storage up to 6 months even in room temperature. The in vivo studies demonstrated that the PK profiles were significantly improved, and this injectable system was effective in suppressing tumor growth. The strategy provides a useful solution to effective delivery of such a class of drugs.

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

    PubMed

    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 < .001, noncore group P = .004) and medication counseling (core group P < .001, noncore group P < .001) improved substantially by the third time point. A systematic approach to quality improvement using PDCA and fishbone analysis in conjunction with embedded EMR tools can improve asthma care in a pediatric primary care setting.

  7. Simulation Improves Resident Performance in Catheter-Based Intervention

    PubMed Central

    Chaer, Rabih A.; DeRubertis, Brian G.; Lin, Stephanie C.; Bush, Harry L.; Karwowski, John K.; Birk, Daniel; Morrissey, Nicholas J.; Faries, Peter L.; McKinsey, James F.; Kent, K Craig

    2006-01-01

    Objectives: Surgical simulation has been shown to enhance the training of general surgery residents. Since catheter-based techniques have become an important part of the vascular surgeon's armamentarium, we explored whether simulation might impact the acquisition of catheter skills by surgical residents. Methods: Twenty general surgery residents received didactic training in the techniques of catheter intervention. Residents were then randomized with 10 receiving additional training with the Procedicus, computer-based, haptic simulator. All 20 residents then participated in 2 consecutive mentored catheter-based interventions for lower extremity occlusive disease in an OR/angiography suite. Resident performance was graded by attending surgeons blinded to the resident's training status, using 18 procedural steps as well as a global rating scale. Results: There were no differences between the 2 resident groups with regard to demographics or scores on a visuospatial test administered at study outset. Overall, residents exposed to simulation scored higher than controls during the first angio/OR intervention: procedural steps (simulation/control) (50 ± 6 vs. 33 ± 9, P = 0.0015); global rating scale (30 ± 7 vs. 19 ± 5, P = 0.0052). The advantage provided by simulator training persisted with the second intervention (53 ± 6 vs. 36 ± 7, P = 0.0006); global rating scale (33 ± 6 vs. 21 ± 6, P = 0.0015). Moreover, simulation training, particularly for the second intervention, led to enhancement in almost all of the individual measures of performance. Conclusion: Simulation is a valid tool for instructing surgical residents and fellows in basic endovascular techniques and should be incorporated into surgical training programs. Moreover, simulators may also benefit the large number of vascular surgeons who seek retraining in catheter-based intervention. PMID:16926560

  8. Early Intervention to Improve Hand Function in Hemiplegic Cerebral Palsy

    PubMed Central

    Basu, Anna Purna; Pearse, Janice; Kelly, Susan; Wisher, Vicki; Kisler, Jill

    2015-01-01

    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 (CIMT) 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 CIMT 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. PMID:25610423

  9. Text Messaging to Improve Hypertension Medication Adherence in African Americans: BPMED Intervention Development and Study Protocol

    PubMed Central

    Artinian, Nancy T; Schwiebert, Loren; Yarandi, Hossein; Levy, Phillip D

    2015-01-01

    Background Hypertension (HTN) is a major public health concern in the United States, with almost 78 million Americans age 20 years and over suffering from the condition. Moreover, HTN is a key risk factor for health disease and stroke. African Americans disproportionately shoulder the burdens of HTN, with greater prevalence, disease severity, earlier onset, and more HTN-related complications than age-matched whites. Medication adherence for the treatment of HTN is poor, with estimates indicating that only about half of hypertensive patients are adherent to prescribed medication regimens. Although no single intervention for improving medication adherence has emerged as superior to others, text message medication reminders have the potential to help improve medication adherence in African Americans with uncontrolled HTN as mobile phone adoption is very high in this population. Objective The purpose of this two-phased study was to develop (Phase I) and test in a randomized controlled trial (RCT) (Phase II) a text message system, BPMED, to improve the quality of medication management through increasing medication adherence in African Americans with uncontrolled HTN. Methods In Phase I, we recruited 16 target end-users from a primary care clinic, to assist in the development of BPMED through participating in one of three focus groups. Focus groups sought to gain patient perspectives on HTN, medication adherence, mobile phone use, and the use of text messaging to support medication adherence. Potential intervention designs were presented to participants, and feedback on the designs was solicited. In Phase II, we conducted two pilot RCTs to determine the feasibility, acceptability, and preliminary efficacy of BPMED in primary care and emergency department settings. Both pilot studies recruited approximately 60 participants, who were randomized equally between usual care and the BPMED intervention. Results Although data collection is now complete, data analysis from the

  10. Improving parental stress levels among mothers living with HIV: a randomized control group intervention study.

    PubMed

    Johnson, Erica R; Davies, Susan L; Aban, Inmaculada; Mugavero, Michael J; Shrestha, Sadeep; Kempf, Mirjam-Colette

    2015-04-01

    Limited knowledge exists regarding parenting efficacy interventions for mothers living with HIV (MLH). This study evaluated the impact of a supportive group intervention on lowering parenting stress among MLH. Eighty MLH were randomized to a parenting (N=34) or health focused (control) (N=46) group intervention. Pre- and post-intervention stress levels were assessed using the Parental Stress Index-Short Form (PSI/SF). Differences in PSI/SF scores were examined using ANOVA, and predictors of PSI/SF scores were evaluated using multivariable linear regression. Findings indicate that both groups experienced significant decreases in parenting stress from baseline to post-intervention (p=0.0001), with no significant differences between interventions. At baseline, 41% of participants were identified as highly stressed and 30% as clinically stressed, with PSI/SF scores above the 85(th) and 90(th) percentile, respectively. Amongst the highly stressed subpopulation, significant improvements in PSI/SF scores for Parental Distress PSI/SF (p=0.039), Difficult Child PSI/SF (p=0.048), and total PSI/SF (p=0.036) were seen, with greater improvements in the parenting intervention. Among the clinically stressed subpopulation, significant improvements in total post-intervention PSI/SF scores were seen (p=0.049), with greater improvements in the parenting intervention. Results indicate that screening for high levels of stress should be considered in clinical practice to effectively implement stress-reducing interventions among MLH.

  11. Improving Parental Stress Levels Among Mothers Living with HIV: A Randomized Control Group Intervention Study

    PubMed Central

    Johnson, Erica R.; Davies, Susan L.; Aban, Inmaculada; Mugavero, Michael J.; Shrestha, Sadeep

    2015-01-01

    Abstract Limited knowledge exists regarding parenting efficacy interventions for mothers living with HIV (MLH). This study evaluated the impact of a supportive group intervention on lowering parenting stress among MLH. Eighty MLH were randomized to a parenting (N=34) or health focused (control) (N=46) group intervention. Pre- and post-intervention stress levels were assessed using the Parental Stress Index-Short Form (PSI/SF). Differences in PSI/SF scores were examined using ANOVA, and predictors of PSI/SF scores were evaluated using multivariable linear regression. Findings indicate that both groups experienced significant decreases in parenting stress from baseline to post-intervention (p=0.0001), with no significant differences between interventions. At baseline, 41% of participants were identified as highly stressed and 30% as clinically stressed, with PSI/SF scores above the 85th and 90th percentile, respectively. Amongst the highly stressed subpopulation, significant improvements in PSI/SF scores for Parental Distress PSI/SF (p=0.039), Difficult Child PSI/SF (p=0.048), and total PSI/SF (p=0.036) were seen, with greater improvements in the parenting intervention. Among the clinically stressed subpopulation, significant improvements in total post-intervention PSI/SF scores were seen (p=0.049), with greater improvements in the parenting intervention. Results indicate that screening for high levels of stress should be considered in clinical practice to effectively implement stress-reducing interventions among MLH. PMID:25734870

  12. Particle size reduction to the nanometer range: a promising approach to improve buccal absorption of poorly water-soluble drugs

    PubMed Central

    Rao, Shasha; Song, Yunmei; Peddie, Frank; Evans, Allan M

    2011-01-01

    Poorly water-soluble drugs, such as phenylephrine, offer challenging problems for buccal drug delivery. In order to overcome these problems, particle size reduction (to the nanometer range) and cyclodextrin complexation were investigated for permeability enhancement. The apparent solubility in water and the buccal permeation of the original phenylephrine coarse powder, a phenylephrine–cyclodextrin complex and phenylephrine nanosuspensions were characterized. The particle size and particle surface properties of phenylephrine nanosuspensions were used to optimize the size reduction process. The optimized phenylephrine nanosuspension was then freeze dried and incorporated into a multi-layered buccal patch, consisting of a small tablet adhered to a mucoadhesive film, yielding a phenylephrine buccal product with good dosage accuracy and improved mucosal permeability. The design of the buccal patch allows for drug incorporation without the need to change the mucoadhesive component, and is potentially suited to a range of poorly water-soluble compounds. PMID:21753876

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

    PubMed

    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.

  14. Improved oral bioavailability of poorly water-soluble glimepiride by utilizing microemulsion technique

    PubMed Central

    Li, Haiying; Pan, Tingting; Cui, Ying; Li, Xiaxia; Gao, Jiefang; Yang, Wenzhi; Shen, Shigang

    2016-01-01

    The objective of this work was to prepare an oil/water glimepiride (GM) microemulsion (ME) for oral administration to improve its solubility and enhance its bioavailability. Based on a solubility study, pseudoternary phase diagrams, and Box–Behnken design, the oil/water GMME formulation was optimized and prepared. GMME was characterized by dynamic laser light scattering, zeta potential, transmission electron microscopy, and viscosity. The in vitro drug release, storage stability, pharmacodynamics, and pharmacokinetics of GMME were investigated. The optimized GMME was composed of Capryol 90 (oil), Cremophor RH40 (surfactant), and Transcutol (cosurfactant), and increased GM solubility up to 544.6±4.91 µg/mL. The GMME was spherical in shape. The particle size and its polydispersity index were 38.9±17.46 nm and 0.266±0.057, respectively. Meanwhile, the GMME was physicochemically stable at 4°C for at least 3 months. The short-term efficacy in diabetic mice provided the proof that blood glucose had a consistent and significant reduction at a dose of 375 µg/kg whether via IP injection or IG administration of GMME. Compared with the glimepiride suspensions or glimepiride-meglumine complex solution, the pharmacokinetics of GMME in Wistar rats via IG administration exhibited higher plasma drug concentration, larger area under the curve, and more enhanced oral bioavailability. There was a good correlation of GMME between the in vitro release values and the in vivo oral absorption. ME could be an effective oral drug delivery system to improve bioavailability of GM. PMID:27540291

  15. Commentary--Enlarging Concepts, Refining Methods, Improving Interventions

    ERIC Educational Resources Information Center

    Palacios, Jesús

    2015-01-01

    As illustrated by the articles in this special issue, the research into ethnic identity in adoption is making significant progress. At the same time, it faces new challenges in the definition of concepts, the use of appropriate methods of study, and the consideration of implications for professional interventions. This commentary offers additional…

  16. Improving Fine Motor Skills in Young Children: An Intervention Study

    ERIC Educational Resources Information Center

    Brown, Carol G.

    2010-01-01

    The aim of this study was to evaluate the effect of the Primary Movement programme on the fine motor skills of children in an early years setting in an area of high social disadvantage. Primary Movement is a programme which can be used as an early intervention technique to help children inhibit persistent primary reflexes that have been shown to…

  17. Evaluation of Interventions to Improve Solar Protection in Primary Schools.

    ERIC Educational Resources Information Center

    Girgis, Afaf; And Others

    1993-01-01

    An intensive intervention group (n=247) of 9-11 year olds were exposed to SKIN SAFE, a curriculum about sun protection. A standard group (n=180) received a lecture about skin cancer; control group numbered 185. The intensive group were significantly more likely to use high levels of protection; no differences were apparent between the standard and…

  18. An Intervention and Assessment to Improve Information Literacy

    ERIC Educational Resources Information Center

    Scharf, Davida

    2013-01-01

    Purpose: The goal of the study was to test an intervention using a brief essay as an instrument for evaluating higher-order information literacy skills in college students, while accounting for prior conditions such as socioeconomic status and prior academic achievement, and identify other predictors of information literacy through an evaluation…

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  20. Active educational intervention as a tool to improve safe and appropriate use of antibiotics.

    PubMed

    Shehadeh, Mayadah B; Suaifan, Ghadeer A R Y; Hammad, Eman A

    2016-09-01

    Misconception about antibiotics use among the public has been widely outlined to be a main reason for inappropriate use of antibiotics including failure to complete treatment, skipping of doses, re-use of leftover medicines and overuse of antibiotics. The study was devised to evaluate whether education might be a potential strategy to promote safer use of antibiotics and reducing self-medication. Two hundred seventy one adults were asked to complete two questionnaires; a pre and posteducation. The questionnaires comprised of three parts consisting of 17 statements assessing the knowledge on: appropriate use, safe use and resistance of antibiotics. Knowledge score was estimated by calculating the percentage of correct responses. The mean (SD) knowledge score pre-education was 59.4% (20.3). However, posteducation the score was 65.9% (17.9), p < 0.001(t-test). Knowledge scores were classified as poor, adequate and good. Posteducation, participants within poor and adequate knowledge categories were significantly shifted to the good category describing better knowledge, McNemar-χ2 = 28.7, df = 3, p < 0.001. 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.

  1. Cryptococcal meningitis: improving access to essential antifungal medicines in resource-poor countries.

    PubMed

    Loyse, Angela; Thangaraj, Harry; Easterbrook, Philippa; Ford, Nathan; Roy, Monika; Chiller, Tom; Govender, Nelesh; Harrison, Thomas S; Bicanic, Tihana

    2013-07-01

    Cryptococcal meningitis is the leading cause of adult meningitis in sub-Saharan Africa, and contributes up to 20% of AIDS-related mortality in low-income and middle-income countries every year. Antifungal treatment for cryptococcal meningitis relies on three old, off-patent antifungal drugs: amphotericin B deoxycholate, flucytosine, and fluconazole. Widely accepted treatment guidelines recommend amphotericin B and flucytosine as first-line induction treatment for cryptococcal meningitis. However, flucytosine is unavailable in Africa and most of Asia, and safe amphotericin B administration requires patient hospitalisation and careful laboratory monitoring to identify and treat common side-effects. Therefore, fluconazole monotherapy is widely used in low-income and middle-income countries for induction therapy, but treatment is associated with significantly increased rates of mortality. We review the antifungal drugs used to treat cryptococcal meningitis with respect to clinical effectiveness and access issues specific to low-income and middle-income countries. Each drug poses unique access challenges: amphotericin B through cost, toxic effects, and insufficiently coordinated distribution; flucytosine through cost and scarcity of registration; and fluconazole through challenges in maintenance of local stocks--eg, sustainability of donations or insufficient generic supplies. We advocate ten steps that need to be taken to improve access to safe and effective antifungal therapy for cryptococcal meningitis.

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

    PubMed

    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.

  3. A Monte Carlo approach for improved estimation of groundwater level spatial variability in poorly gauged basins

    NASA Astrophysics Data System (ADS)

    Varouchakis, Emmanouil; Hristopulos, Dionissios

    2013-04-01

    Groundwater level is an important source of information in hydrological modelling. In many aquifers the boreholes monitored are scarce and/or sparse in space. In both cases, geostatistical methods can help to visualize the free surface of an aquifer, whereas the use of auxiliary information improves the accuracy of level estimates and maximizes the information gain for the quantification of groundwater level spatial variability. In addition, they allow the exploitation of datasets that cannot otherwise be efficiently used in catchment models. In this presentation, we demonstrate an approach for incorporating auxiliary information in interpolation approaches using a specific case study. In particular, the study area is located on the island of Crete (Greece). The available data consist of 70 hydraulic head measurements for the wet period of the hydrological year 2002-2003, the average pumping rates at the 70 wells, and 10 piezometer readings measured in the preceding hydrological year. We present a groundwater level trend model based on the generalized Thiem's equation for multiple wells. We use the drift term to incorporate secondary information in Residual Kriging (RK) (Varouchakis and Hristopulos 2013). The residuals are then interpolated using Ordinary Kriging and then are added to the drift model. Thiem's equation describes the relationship between the steady-state radial inflow into a pumping well and the drawdown. The generalized form of the equation includes the influence of a number of pumping wells. It incorporates the estimated hydraulic head, the initial hydraulic head before abstraction, the number of wells, the pumping rate, the distance of the estimation point from each well, and the well's radius of influence. We assume that the initial hydraulic head follows a linear trend, which we model based on the preceding hydrological year measurements. The hydraulic conductivity in the study basin varies between 0.0014 and 0.00014 m/s according to geological

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

    PubMed Central

    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

  5. Challenging logics of complex intervention trials: community perspectives of a health care improvement intervention in rural Uganda.

    PubMed

    Okwaro, Ferdinand M; Chandler, Clare I R; Hutchinson, Eleanor; Nabirye, Christine; Taaka, Lilian; Kayendeke, Miriam; Nayiga, Susan; Staedke, Sarah G

    2015-04-01

    Health systems in many African countries are failing to provide populations with access to good quality health care. Morbidity and mortality from curable diseases such as malaria remain high. The PRIME trial in Tororo, rural Uganda, designed and tested an intervention to improve care at health centres, with the aim of reducing ill-health due to malaria in surrounding communities. This paper presents the impact and context of this trial from the perspective of community members in the study area. Fieldwork was carried out for a year from the start of the intervention in June 2011, and involved informal observation and discussions as well as 13 focus group discussions with community members, 10 in-depth interviews with local stakeholders, and 162 context descriptions recorded through quarterly interviews with community members, health workers and district officials. Community members observed a small improvement in quality of care at most, but not all, intervention health centres. However, this was diluted by other shortfalls in health services beyond the scope of the intervention. Patients continued to seek care at health centres they considered inadequate as well as positioning themselves and their children to access care through other sources such as research and nongovernmental organization (NGO) projects. These findings point to challenges of designing and delivering interventions within a paradigm that requires factorial (reduced to predictable factors) problem definition with easily actionable and evaluable solutions by small-scale projects. Such requirements mean that interventions often work on the periphery of a health system rather than tackling the murky political and economic realities that shape access to care but are harder to change or evaluate with randomized controlled trials. Highly projectified settings further reduce the ability to genuinely 'control' for different health care access scenarios. We argue for a raised consciousness of how

  6. Effectiveness of complementary food supplements and dietary counselling on anaemia and stunting in children aged 6–23 months in poor areas of Qinghai Province, China: a controlled interventional study

    PubMed Central

    Zhang, Yanfeng; Wu, Qiong; Wang, Wei; van Velthoven, Michelle Helena; Chang, Suying; Han, Huijun; Xing, Min; Chen, Li; Scherpbier, Robert W.

    2016-01-01

    combined with dietary counselling can improve feeding practices and reduce anaemia prevalence. Future studies should use longer follow-up to assess the effects on stunting. Strengths and limitations We included a large number of participants and assessed a combined complementary food supplements and dietary counselling intervention in a poor rural area in China with high anaemia prevalence. Although the study took place in only one intervention county and one control county, we conducted an analysis that controlled for differences between the two counties. Also, although we made significant efforts to train village doctors, their education was not systematically assessed after training and thus their delivery of the interventions may have been variable. Trial registration number ChiCTRPRC12002444; Pre-results. PMID:27799239

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

    PubMed Central

    Alleva, Jessica M.; Sheeran, Paschal; Webb, Thomas L.; Martijn, Carolien; Miles, Eleanor

    2015-01-01

    Objective 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. Methods 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. Results 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. Conclusions 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. PMID:26418470

  8. An Informatics-supported Intervention Improves Diabetes Control in a Primary Care Setting

    PubMed Central

    Ziemer, David C.; Tsui, Circe; Caudle, Jane; Barnes, Catherine S.; Dames, Faye; Phillips, Lawrence S.

    2006-01-01

    Although research has shown that proper management of diabetes can improve outcomes, glucose control is worsening. This partly reflects the failure of providers to intensify diabetes therapy when indicated, termed clinical inertia. Our intervention used (a) decision support reminders which provided patient specific recommendations for management at each visit, and (b) computer generated provider specific feedback on performance. This intervention improved the frequency with which providers intensified the therapy and improved glycemic control. PMID:17238779

  9. Does a Quality Improvement Intervention for Anxiety Result in Differential Outcomes for Lower Income Patients?

    PubMed Central

    Sullivan, Greer; Sherbourne, Cathy; Chavira, Denise A.; Craske, Michelle G.; Gollineli, Daniela; Han, Xiaotong; Rose, Raphael D.; Bystritsky, Alexander; Stein, Murray B.; Roy-Byrne, Peter

    2013-01-01

    Objective This study examined the effects of a collaborative care intervention for anxiety disorders in primary care on lower income participants relative to those with higher incomes. The authors hypothesized that lower income patients might show less improvement or improve at a lower rate given that they experience greater economic stress over the treatment course. Alternatively, lower income patients could improve at a higher rate because the intervention facilitates access to evidence-based treatment, which typically is less available to persons with lower incomes. Method The authors compared baseline demographic and clinical characteristics of patients with lower (n=287) and higher (n=717) income using t-tests and chi-square tests for continuous and categorical variables respectively. For the longitudinal analysis of intervention effects by income group, the authors jointly modeled the outcomes at the four assessment times by study site; income; time; intervention; time and intervention; income and time; income and intervention; and time, intervention and income. Results Although lower-income participants were more ill and disabled at baseline than those in the higher income group, the two income groups were very similar in their clinical response. The lower income participants experienced a comparable degree of clinical improvement, despite receiving fewer treatment sessions, less relapse prevention, and less continuous care. Conclusions These findings contribute to the ongoing discussion as to whether or not, and to what extent, quality improvement interventions work equally well across income groups or require tailoring for specific vulnerable populations. PMID:23377641

  10. Polyamidoamine dendrimers as novel potential absorption enhancers for improving the small intestinal absorption of poorly absorbable drugs in rats.

    PubMed

    Lin, Yulian; Fujimori, Takeo; Kawaguchi, Naoko; Tsujimoto, Yuiko; Nishimi, Mariko; Dong, Zhengqi; Katsumi, Hidemasa; Sakane, Toshiyasu; Yamamoto, Akira

    2011-01-05

    Effects of polyamidoamine (PAMAM) dendrimers on the intestinal absorption of poorly absorbable drugs were examined by an in situ closed loop method in rats. 5(6)-Carboxyfluorescein (CF), fluorescein isothiocyanate-dextrans (FDs) with various molecular weights, calcitonin and insulin were used as model drugs of poorly absorbable drugs. The absorption of CF, FD4 and calcitonin from the rat small intestine was significantly enhanced in the presence of PAMAM dendrimers. The absorption-enhancing effects of PAMAM dendrimers for improving the small intestinal absorption of CF were concentration and generation dependent and a maximal absorption-enhancing effect was observed in the presence of 0.5% (w/v) G2 PAMAM dendrimer. However, G2 PAMAM dendrimer had almost no absorption-enhancing effect on the small intestinal absorption of macromolecular drugs including FD10 and insulin. Overall, the absorption-enhancing effects of G2 PAMAM dendrimer in the small intestine decreased as the molecular weights of drug increased. However, G2 PAMAM dendrimer did not enhance the intestinal absorption of these drugs with different molecular weights in the large intestine. Furthermore, we evaluated the intestinal membrane damage with or without G2 PAMAM dendrimer. G2 PAMAM dendrimer (0.5% (w/v)) significantly increased the activities of lactate dehydrogenase (LDH) and the amounts of protein released from the intestinal membranes, but the activities and amounts of these toxic markers were less than those in the presence of 3% Triton X-100 used as a positive control. Moreover, G2 PAMAM dendrimer at concentrations of 0.05% (w/v) and 0.1% (w/v) did not increase the activities and amounts of these toxic markers. These findings suggested that PAMAM dendrimers at lower concentrations might be potential and safe absorption enhancers for improving absorption of poorly absorbable drugs from the small intestine.

  11. Carboxylated mesoporous carbon microparticles as new approach to improve the oral bioavailability of poorly water-soluble carvedilol.

    PubMed

    Zhang, Yanzhuo; Zhi, Zhizhuang; Li, Xue; Gao, Jian; Song, Yaling

    2013-09-15

    The main objective of this study was to develop carboxylated ordered mesoporous carbon microparticles (c-MCMs) loaded with a poorly water-soluble drug, intended to be orally administered, able to enhance the drug loading capacity and improve the oral bioavailability. A model drug, carvedilol (CAR), was loaded onto c-MCMs via a procedure involving a combination of adsorption equilibrium and solvent evaporation. The physicochemical properties of the drug-loaded composites were systematically studied using scanning electron microscopy (SEM), transmission electron microscopy (TEM), nitrogen adsorption, powder X-ray diffraction (PXRD), differential scanning calorimetry (DSC) and HPLC. It was found that c-MCM has a high drug loading level up to 41.6%, and higher than that of the mesoporous silica template. Incorporation of CAR in both drug carriers enhanced the solubility and dissolution rate of the drug, compared to the pure crystalline drug. After loading CAR into c-MCMs, its oral bioavailability was compared with the marketed product in dogs. The results showed that the bioavailability of CAR was improved 179.3% compared with that of the commercial product when c-MCM was used as the drug carrier. We believe that the present study will help in the design of oral drug delivery systems for enhanced oral bioavailability of poorly water-soluble drugs.

  12. Melt dispersion granules: formulation and evaluation to improve oral delivery of poorly soluble drugs - a case study with valsartan.

    PubMed

    Chella, Naveen; Tadikonda, Ramarao

    2015-06-01

    Solid dispersion (SD) technique is a promising strategy to improve the solubility and dissolution of BCS class II drugs. However, only few products are marketed till today based on SD technology due to poor flow properties and stability. The present work was intended to solve these problems by using combination approach, melt dispersion and surface adsorption technologies. The main aim of the present work is to improve the absorption in the stomach (at lower pH) where the absorption window exists for the drug by improving the dissolution, resulting in the enhancement of oral bioavailability of poorly soluble, weakly acidic drug with pH dependant solubility, i.e. valsartan. Melt dispersion granules were prepared in different ratios using different carriers (Gelucire 50/13, PEG 8000 and Pluronic F-68) and lactose as an adsorbent. Similarly, physical mixtures were also prepared at corresponding ratios. The prepared dispersion granules and physical mixtures were characterized by FTIR, DSC and in vitro dissolution studies. DSC studies revealed reduction in the crystallinity with a possibility of presence of amorphous character of drug in the dispersion granules. From dissolution studies, valsartan Gelucire dispersion (GSD4; 1:4 ratio) showed complete drug release in 30 min against the plain drug which showed only 11.31% of drug release in 30 min. Pharmacokinetic studies of optimized formulation in male Wistar rats showed 2.65-fold higher bioavailability and 1.47-fold higher Cmax compared to pure drug. The melt dispersion technology has the potential to improve dissolution and the bioavailability of BCS class II drugs.

  13. The Usability of Diabetes MAP: A Web-delivered Intervention for Improving Medication Adherence

    PubMed Central

    Nelson, Lyndsay A; Bethune, Magaela C; Lagotte, Andrea E

    2016-01-01

    Background Web-delivered interventions are a feasible approach to health promotion. However, if a website is poorly designed, difficult to navigate, and has technical bugs, it will not be used as intended. Usability testing prior to evaluating a website’s benefits can identify barriers to user engagement and maximize future use. Objective We developed a Web-delivered intervention called Diabetes Medication Adherence Promotion (Diabetes MAP) and used a mixed-methods approach to test its usability prior to evaluating its efficacy on medication adherence and glycemic control in a randomized controlled trial. Methods We recruited English-speaking adults with type 2 diabetes mellitus (T2DM) from an academic medical center who were prescribed diabetes medications. A trained research assistant administered a baseline survey, collected medical record information, and instructed participants on how to access Diabetes MAP. Participants were asked to use the site independently for 2 weeks and to provide survey and/or focus group feedback on their experience. We analyzed survey data descriptively and qualitative data thematically to identify participants’ favorable and unfavorable experiences, characterize usability concerns, and solicit recommendations for improving Diabetes MAP. Results Enrolled participants (N=32) were an average of 51.7 ± 11.8 years old, 66% (21/32) female, 60% (19/32) non-Hispanic White, 88% (28/32) had more than 12 years of education, half had household incomes over $50,000, and 78% (25/32) were privately insured. Average duration of diagnosed diabetes was 7.8 ± 6.3 years, average A1c was 7.4 ± 2.0, and 38% (12/32) were prescribed insulin. Of enrolled participants, 91% (29/32) provided survey and/or focus group feedback about Diabetes MAP. On the survey, participants agreed website information was clear and easy to understand, but in focus groups they reported navigational challenges and difficulty overcoming user errors (eg, entering data in an

  14. Identifying continuous quality improvement publications: what makes an improvement intervention ‘CQI’?

    PubMed Central

    Hempel, Susanne; Lim, Yee-Wei; Danz, Marjorie S; Foy, Robbie; Suttorp, Marika J; Shekelle, Paul G; Rubenstein, Lisa V

    2011-01-01

    Background The term continuous quality improvement (CQI) is often used to refer to a method for improving care, but no consensus statement exists on the definition of CQI. Evidence reviews are critical for advancing science, and depend on reliable definitions for article selection. Methods As a preliminary step towards improving CQI evidence reviews, this study aimed to use expert panel methods to identify key CQI definitional features and develop and test a screening instrument for reliably identifying articles with the key features. We used a previously published method to identify 106 articles meeting the general definition of a quality improvement intervention (QII) from 9427 electronically identified articles from PubMed. Two raters then applied a six-item CQI screen to the 106 articles. Results Per cent agreement ranged from 55.7% to 75.5% for the six items, and reviewer-adjusted intra-class correlation ranged from 0.43 to 0.62. ‘Feedback of systematically collected data’ was the most common feature (64%), followed by being at least ‘somewhat’ adapted to local conditions (61%), feedback at meetings involving participant leaders (46%), using an iterative development process (40%), being at least ‘somewhat’ data driven (34%), and using a recognised change method (28%). All six features were present in 14.2% of QII articles. Conclusions We conclude that CQI features can be extracted from QII articles with reasonable reliability, but only a small proportion of QII articles include all features. Further consensus development is needed to support meaningful use of the term CQI for scientific communication. PMID:21727199

  15. Using Instructional Design Process to Improve Design and Development of Internet Interventions

    PubMed Central

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

    2012-01-01

    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

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

    ERIC Educational Resources Information Center

    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…

  17. Improving Inappropriate Social Behavior of Autistic Students Using the LISTEN Intervention Strategy

    ERIC Educational Resources Information Center

    Al-Shammari, Zaid; Daniel, Cathy; Faulkner, Paula; Yawkey, Thomas D.

    2010-01-01

    A case study was conducted on the development of the LISTEN intervention strategy for use with autistic students to improve inappropriate social behaviors. The study was conducted in a special education classroom in an autism school in Kuwait. Examination of LISTEN Intervention Strategy applications included: duration of targeted behavior; methods…

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

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

    ERIC Educational Resources Information Center

    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…

  20. Effects of Simulated Interventions to Improve School Entry Academic Skills on Socioeconomic Inequalities in Educational Achievement

    ERIC Educational Resources Information Center

    Chittleborough, Catherine R.; Mittinty, Murthy N.; Lawlor, Debbie A.; Lynch, John W.

    2014-01-01

    Randomized controlled trial evidence shows that interventions before age 5 can improve skills necessary for educational success; the effect of these interventions on socioeconomic inequalities is unknown. Using trial effect estimates, and marginal structural models with data from the Avon Longitudinal Study of Parents and Children (n = 11,764,…

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

    ERIC Educational Resources Information Center

    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…

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

    PubMed Central

    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

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

    PubMed

    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.

  4. Quantifying accessibility and use of improved sanitation: towards a comprehensive indicator of the need for sanitation interventions

    PubMed Central

    Park, M. J.; Clements, A. C. A.; Gray, D. J.; Sadler, R.; Laksono, B.; Stewart, D. E.

    2016-01-01

    To prevent diseases associated with inadequate sanitation and poor hygiene, people needing latrines and behavioural interventions must be identified. We compared two indicators that could be used to identify those people. Indicator 1 of household latrine coverage was a simple Yes/No response to the question “Does your household have a latrine?” Indicator 2 was more comprehensive, combining questions about defecation behaviour with observations of latrine conditions. Using a standardized procedure and questionnaire, trained research assistants collected data from 6,599 residents of 16 rural villages in Indonesia. Indicator 1 identified 30.3% as not having a household latrine, while Indicator 2 identified 56.0% as using unimproved sanitation. Indicator 2 thus identified an additional 1,710 people who were missed by Indicator 1. Those 1,710 people were of lower socioeconomic status (p < 0.001), and a smaller percentage practiced appropriate hand-washing (p < 0.02). These results show how a good indicator of need for sanitation and hygiene interventions can combine evidences of both access and use, from self-reports and objective observation. Such an indicator can inform decisions about sanitation-related interventions and about scaling deworming programmes up or down. Further, a comprehensive and locally relevant indicator allows improved targeting to those most in need of a hygiene-behaviour intervention. PMID:27452598

  5. Improving Prospective Teachers' Knowledge about Scientific Models and Modelling: Design and evaluation of a teacher education intervention

    NASA Astrophysics Data System (ADS)

    Danusso, Luciana; Testa, Italo; Vicentini, Matilde

    2010-05-01

    Evidence of the role of models in the teaching/learning process in science education is well documented in literature. A crucial role in this process is played by teachers. It is therefore important to design teacher education intervention focused on models and modelling. Although recognized as important by many authors, few attempts have been carried out and with a limited success. This paper reports of a three-year-long study whose aims can be summarized as follows: to investigate the knowledge of scientific models and modelling of physics, mathematics, and engineering prospective teachers; to explore the effectiveness of a research-based teacher education intervention aimed at improving knowledge about scientific models and modelling; to inspect the effects of a refinement process of the intervention based on a design-trial-redesign cycle. About 400 prospective teachers from two Italian universities were involved in the study. The results show that the knowledge about models and modelling of prospective teachers after the four- or five-year degree diploma is still rather poor and confused. On the other hand, the implementation results support the effectiveness of the designed intervention and of the refinement process. Implications which may give a contribution to more general research problems related to models and modelling in science education are also discussed.

  6. A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults

    PubMed Central

    Sikkema, Kathleen J.; Hansen, Nathan; Kochman, Arlene; Heh, Victor; Neufeld, Sharon

    2011-01-01

    This research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms. PMID:20857188

  7. A randomized clinical trial of a coping improvement group intervention for HIV-infected older adults.

    PubMed

    Heckman, Timothy G; Sikkema, Kathleen J; Hansen, Nathan; Kochman, Arlene; Heh, Victor; Neufeld, Sharon

    2011-04-01

    This research tested if a 12-session coping improvement group intervention (n = 104) reduced depressive symptoms in HIV-infected older adults compared to an interpersonal support group intervention (n = 105) and an individual therapy upon request (ITUR) control condition (n = 86). Participants were 295 HIV-infected men and women 50-plus years of age living in New York City, Cincinnati, OH, and Columbus, OH. Using A-CASI assessment methodology, participants provided data on their depressive symptoms using the Geriatric Depression Screening Scale (GDS) at pre-intervention, post-intervention, and 4- and 8-month follow-up. Whether conducted with all participants (N = 295) or only a subset of participants diagnosed with mild, moderate, or severe depressive symptoms (N = 171), mixed models analyses of repeated measures found that both coping improvement and interpersonal support group intervention participants reported fewer depressive symptoms than ITUR controls at post-intervention, 4-month follow-up, and 8-month follow-up. The effect sizes of the differences between the two active interventions and the control group were greater when outcome analyses were limited to those participants with mild, moderate, or severe depressive symptoms. At no assessment period did coping improvement and interpersonal support group intervention participants differ in depressive symptoms.

  8. An educational intervention to increase "speaking-up" behaviors in nurses and improve patient safety.

    PubMed

    Sayre, Michelle M; McNeese-Smith, Donna; Leach, Linda Searle; Phillips, Linda R

    2012-01-01

    "Speaking up" is a critical component in improving patient safety. Studies indicate, though, that most registered nurses prefer using behaviors of avoidance or accommodation in conflict situations. The purpose of this quasi-experimental study was to determine whether an educational intervention using scenarios, personal reflection, and peer support in small groups could improve speaking-up behaviors in registered nurses. Results showed a significant difference in speaking-up behaviors and scores in the intervention group (P < .001).

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

    NASA Astrophysics Data System (ADS)

    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.

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

    PubMed

    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.

  11. Telehealth for improved glycaemic control in patients with poorly controlled diabetes after acute hospitalization - a preliminary study in Singapore.

    PubMed

    Wai Leng, Chow; Jundong, Jiang; Li Wei, Cho; Joo Pin, Foo; Kwong Ming, Fock; Chen, Richard

    2014-09-01

    We evaluated a disease management and education programme delivered via telephone support (TS) to patients with poorly controlled diabetes (HbA1c >7%). All eligible patients were invited to participate in the programme, which involved education on lifestyle modification and disease management delivered via three scheduled monthly calls by trained nurses. Patients who declined or could not be contacted acted as the controls (usual care, UC). A per protocol analysis was conducted using a mixed effect model for two subgroups with different baseline HbA1c levels (i.e. baseline HbA1c <8.0% and HbA1c ≥8.0%). A total of 2646 patients with diabetes were eligible for enrolment. Of these, 1391 participants had HbA1c measurements available. The study comprised 633 patients (46%) who completed the programme (TS), 598 (43%) who were not contactable or refused to participate at the first telephone call (UC) and 160 patients who dropped out. In the patients with HbA1c ≥8%, TS reduced the adjusted mean HbA1c by 0.38% (P = 0.022) but the reduction in diabetes-related admissions (4.2% lower adjusted mean admission rate) was not significant. In patients with HbA1c <8%, TS had no additional effect on glycaemic control or diabetes-related admission. Telephone support appeared effective in improving glycaemic control in patients with poor diabetes control.

  12. Improvement of health care for the poor in Split (southern Croatia) during the first half of the 19th century.

    PubMed

    Brisky, Livia; Brisky, Tibor

    2011-12-01

    The aim of this study was to investigate the health care available for the poor citizens of Split during the first half of the 19th century. Soon after being constructed in 1797, the Civic Hospital in Split founded by the Ergovac brothers for the needs of the poor was transformed into a military hospital. Consequently, caring for this social stratum was taken over by two inadequate shelters and later by a small civic hospital situated in the Split suburb of Dobri. The year of the application of Petar Ergovac to the supreme ruler for the transformation of the hospital building established by his family from a military to a civil institution was found, as well as the correct data regarding its return to initial idea in 1821. On the basis of the archival documents kept in the Archaeological Museum in Split and in the State Archives in Zadar, the work organization of the Civic Hospital in Split and the first stage of its change from a charitable to a public health hospital institution were presented. This study revealed the aspiration of the authorities in the first half of the 19th century to improve the health system of the city of Split.

  13. Factors That Influence Improvement in Numeracy, Reading, and Comprehension in the Context of a Numeracy Intervention

    PubMed Central

    Dowker, Ann

    2016-01-01

    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 pre-tests 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. PMID:28066278

  14. Nanosuspension for improving the bioavailability of a poorly soluble drug and screening of stabilizing agents to inhibit crystal growth.

    PubMed

    Ghosh, Indrajit; Bose, Sonali; Vippagunta, Radha; Harmon, Ferris

    2011-05-16

    The purpose of this study was to develop a nanosuspension of a poorly soluble drug by nanomilling process using wet media milling to achieve superior in vitro dissolution and high in vivo exposure in pharmacokinetic studies. A promising nanosuspension was developed with Vitamin E TPGS based formulation with particle size in the nano range. Although the formulation showed significant improvement during in vitro dissolution and in vivo plasma level, probably due to the strong hydrophobic interaction between Vitamin TPGS and the drug molecule, crystal growth was observed during stability studies. A systematic study was done with different combinations of solubilizer/stabilizer system in order to obtain a more stable nanosuspension. Hydroxypropyl methylcellulose (HPMC 3 cps) was found to stabilize the nanosuspension by better surface coverage due to stronger interaction with the drug as compared to other stabilizers used in this study.

  15. Improving management of type 2 diabetes in South Asian patients: a systematic review of intervention studies

    PubMed Central

    Bhurji, N; Javer, J; Gasevic, D; Khan, N A

    2016-01-01

    Objectives Optimal control of type 2 diabetes is challenging in many patient populations including in South Asian patients. We systematically reviewed studies on the effect of diabetes management interventions targeted at South Asian patients with type 2 diabetes on glycaemic control. Design Systematic review of MEDLINE, EMBASE and CINAHL databases for randomised controlled trials (RCTs) and pre-post-test studies (January 1990 to February 2014). Studies were stratified by where interventions were conducted (South Asia vs Western countries). Participants Patients originating from Pakistan, Bangladesh or India with type 2 diabetes. Primary outcome Change in glycated haemoglobin (HbA1c). Secondary end points included change in blood pressure, lipid levels, anthropomorphics and knowledge. Results 23 studies (15 RCTs) met criteria for analysis with 7 from Western countries (n=2532) and 16 from South Asia (n=1081). Interventions in Western countries included translated diabetes education, additional clinical care, written materials, visual aids, and bilingual community-based peers and/or health professionals. Interventions conducted in South Asia included yoga, meditation or exercise, community-based peers, health professionals and dietary education (cooking exercises). Among RCTs in India (5 trials; n=390), 4 demonstrated significant reductions in HbA1c in the intervention group compared with usual care (yoga and exercise interventions). Among the 4 RCTs conducted in Europe (n=2161), only 1 study, an education intervention of 113 patients, reported a significant reduction in HbA1c with the intervention. Lipids, blood pressure and knowledge improved in both groups with studies from India more often reporting reductions in body mass index and waist circumference. Conclusions Overall, there was little improvement in HbA1c level in diabetes management interventions targeted at South Asians living in Europe compared with usual care, although other outcomes did improve. The

  16. Systematic Review of Educational Interventions to Improve Glaucoma Medication Adherence: an update in 2015

    PubMed Central

    Newman-Casey, Paula Anne; Dayno, Megan; Robin, Alan L.

    2016-01-01

    Purpose To evaluate the current state of the research on educational interventions whose aim is to improve glaucoma medication adherence. Methods A systematic review of Pubmed, Embase and CINAHL was conducted to identify research studies evaluating educational interventions to improve glaucoma medication adherence. Studies were included if the intervention was described, the outcomes assessed glaucoma medication adherence, and the focus of the research was on adults with glaucoma. The search was conducted on June 2, 2015. Results Seventeen studies were identified that met the inclusion criteria. These included nine randomized controlled trials and eight observational studies. Eight of the studies demonstrated an impact on glaucoma medication adherence, though their outcome measures were too heterogeneous to estimate a pooled effect size.. Conclusion The interventions that successfully improved glaucoma medication adherence used an adequate dose of face-to-face counseling to overcome barriers to health behavior change alongside education about glaucoma. PMID:27134639

  17. A motivational intervention can improve retention in PCIT for low-motivation child welfare clients.

    PubMed

    Chaffin, Mark; Valle, Linda Anne; Funderburk, Beverly; Gurwitch, Robin; Silovsky, Jane; Bard, David; McCoy, Carol; Kees, Michelle

    2009-11-01

    A motivational orientation intervention designed to improve parenting program retention was field tested versus standard orientation across two parenting programs, Parent-Child Interaction Therapy (PCIT) and a standard didactic parent training group. Both interventions were implemented within a frontline child welfare parenting center by center staff. Participants had an average of six prior child welfare referrals, primarily for neglect. A double-randomized design was used to test main and interaction effects. The motivational intervention improved retention only when combined with PCIT (cumulative survival = 85% vs. around 61% for the three other design cells). Benefits were robust across demographic characteristics and participation barriers but were concentrated among participants whose initial level of motivation was low to moderate. There were negative effects for participants with relatively high initial motivation. The findings suggest that using a motivational intervention combined with PCIT can improve retention when used selectively with relatively low to moderately motivated child welfare clients.

  18. A Systematic Review of Community Interventions to Improve Aboriginal Child Passenger Safety

    PubMed Central

    Oudie, Eugenia; Desapriya, Ediriweera; Turcotte, Kate; Pike, Ian

    2014-01-01

    We evaluated evidence of community interventions to improve Aboriginal child passenger safety (CPS) in terms of its scientific merit and cultural relevance. We included studies if they reported interventions to improve CPS in Aboriginal communities, compared at least pre- and postintervention conditions, and evaluated rates and severity of child passenger injuries, child restraint use, or knowledge of CPS. We also appraised quality and cultural relevance of studies. Study quality was associated with community participation and cultural relevance. Strong evidence showed that multicomponent interventions tailored to each community improves CPS. Interventions in Aboriginal communities should incorporate Aboriginal views of health, involve the community, and be multicomponent and tailored to the community’s circumstances and culture. PMID:24754652

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

    ERIC Educational Resources Information Center

    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…

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

    ERIC Educational Resources Information Center

    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'…

  1. Improving general practitioner clinical records with a quality assurance minimal intervention.

    PubMed Central

    Del Mar, C B; Lowe, J B; Adkins, P; Arnold, E; Baade, P

    1998-01-01

    BACKGROUND: Although good medical records have been associated with good care, there is considerable room for their improvement in general practice. AIM: To improve the quality of general practice medical records at minimal cost. METHOD: A total of 150 randomly sampled general practitioners (GPs) in suburban Brisbane, Australia, were randomized in a controlled trial to receive or not receive an intervention. The intervention consisted of 6 to 12 one-hour monthly meetings when the pairs of GPs assessed samples of each other's medical records using a 12-item instrument. This was developed previously by a process of consensus of general practice teachers. Mean scores of 10 medical records selected at random from before the intervention started and one year later were compared. RESULTS: After the intervention, the increase in the total score (for which the maximum possible was 18) for the intervention GPs (from a baseline of 11.5 to 12.3) was not significantly greater than for the controls (from 11.4 to 11.7). Legibility and being able to determine the doctor's assessment of the consultation were significantly improved. The post-intervention increase of 1.06 (9.3%) of the total scores of the 47% of intervention GPs who complied with the intervention was significantly greater than that for the controls. CONCLUSION: The quality assurance activity improved some components of the quality of GPs' clinical records. However, the improvement was small, and the search for activities for Australian GPs that demonstrate an improvement in the quality of their practice must continue. Images p1311-a PMID:9747547

  2. Improving Executive Function and its Neurobiological Mechanisms through a Mindfulness-Based Intervention: Advances within the Field of Developmental Neuroscience.

    PubMed

    Tang, Yi-Yuan; Yang, Lizhu; Leve, Leslie D; Harold, Gordon T

    2012-12-01

    Poor executive function (EF) has been associated with a host of short- and long-term problems across the lifespan, including elevated rates of attention deficit hyperactivity disorder, depression, drug abuse, and antisocial behavior. Mindfulness-based interventions that focus on increasing awareness of one's thoughts, emotions, and actions have been shown to improve specific aspects of EF, including attention, cognitive control, and emotion regulation. In this article, we apply a developmental neuroscience perspective to review research relevant to one specific mindfulness-based intervention, Integrative Body-Mind Training (IBMT). Randomized controlled trials of IBMT indicate improvements in specific EF components, and uniquely highlight the role of neural circuitry specific to the anterior cingulate cortex (ACC) and the autonomic nervous system (ANS) as two brain-based mechanisms that underlie IBMT-related improvements. The relevance of improving specific dimensions of EF through short-term IBMT to prevent a cascade of risk behaviors for children and adolescents is described and future research directions are proposed.

  3. An Integrated Review of Interventions to Improve Psychological Outcomes In Caregivers of Patients with Heart Failure

    PubMed Central

    Evangelista, Lorraine S.; Strömberg, Anna; Dionne-Odom, J. Nicholas

    2016-01-01

    Purpose of the Review To examine interventions aimed at improving psychological outcomes (e.g., caregiver burden, quality of life, anxiety, depression, perceived control, stress mastery, caregiver confidence and preparedness, and caregiver mastery) in family caregivers of patients with heart failure (HF). Recent Findings Eight studies meeting the inclusion criteria were included in the review. The most common intervention involved psychoeducation facilitated by a nurse (6/8) and supplemented with a combination of follow-up face-to-face sessions (2/6), home visits (2/6), telephone calls (3/6), and telemonitoring (3/6). Two studies used a support group intervention of 4–6 sessions. Half of the interventions reported a significant effect on one or more primary outcomes, including caregiver burden (n=4), depressive symptoms (n=1), stress mastery (n=1), caregiver confidence and preparedness (n=1), and caregiver mastery (n=1). Summary Compared to dementia and cancer family caregiving, few interventions have been evaluated in caregivers of patients with HF. Of the existing interventions identified in this review, considerable variability was observed in aims, intervention content, delivery methods, duration, intensity, methodological rigor, outcomes, and effects. Given this current state of the science, direct comparison of HF caregiver interventions and recommendations for clinical practice are premature. Thus, research priority is strongly warranted for intervention development and testing to enhance HF caregiver support and education. PMID:26716392

  4. Assessing Interventions To Improve Influenza Vaccine Uptake Among Health Care Workers.

    PubMed

    Rashid, Harunor; Yin, Jiehui Kevin; Ward, Kirsten; King, Catherine; Seale, Holly; Booy, Robert

    2016-02-01

    Despite official recommendations for health care workers to receive the influenza vaccine, uptake remains low. This systematic review of randomized controlled trials was conducted to understand the evidence about interventions to improve influenza vaccine uptake among health care workers. We identified twelve randomized controlled trials that, collectively, assessed six major categories of interventions involving 193,924 health care workers in high-income countries. The categories were educational materials and training sessions, improved access to the vaccine, rewards following vaccination, organized efforts to raise vaccine awareness, reminders to get vaccinated, and the use of lead advocates for vaccination. Only one of the four studies that evaluated the effect of a single intervention in isolation demonstrated a significantly higher vaccine uptake rate in the intervention group, compared to controls. However, five of the eight studies that evaluated a combination of strategies showed significantly higher vaccine uptake. Despite the low quality of the studies identified, the data suggest that combined interventions can moderately increase vaccine uptake among health care workers. Further methodologically appropriate trials of combined interventions tailored to individual health care settings and incorporating less-studied strategies would enhance the evidence about interventions to improve immunization uptake among health care workers.

  5. Role of Pharmacogenetics in Improving the Safety of Psychiatric Care by Predicting the Potential Risks of Mania in CYP2D6 Poor Metabolizers Diagnosed With Bipolar Disorder.

    PubMed

    Sánchez-Iglesias, Santiago; García-Solaesa, Virginia; García-Berrocal, Belén; Sanchez-Martín, Almudena; Lorenzo-Romo, Carolina; Martín-Pinto, Tomás; Gaedigk, Andrea; González-Buitrago, José Manuel; Isidoro-García, María

    2016-02-01

    One of the main concerns in psychiatric care is safety related to drug management. Pharmacogenetics provides an important tool to assess causes that may have contributed the adverse events during psychiatric therapy. This study illustrates the potential of pharmacogenetics to identify those patients for which pharmacogenetic-guided therapy could be appropriate. It aimed to investigate CYP2D6 genotype in our psychiatric population to assess the value of introducing pharmacogenetics as a primary improvement for predicting side effects.A broad series of 224 psychiatric patients comprising psychotic disorders, depressive disturbances, bipolar disorders, and anxiety disorders was included. The patients were genotyped with the AmpliChip CYP450 Test to analyzing 33 allelic variants of the CYP2D6 gene.All bipolar patients with poor metabolizer status showed maniac switching when CYP2D6 substrates such as selective serotonin reuptake inhibitors were prescribed. No specific patterns were identified for adverse events for other disorders.We propose to utilize pharmacogenetic testing as an intervention to aid in the identification of patients who are at risk of developing affective switching in bipolar disorder treated with selective serotonin reuptake inhibitors, CYP2D6 substrates, and inhibitors.

  6. Role of Pharmacogenetics in Improving the Safety of Psychiatric Care by Predicting the Potential Risks of Mania in CYP2D6 Poor Metabolizers Diagnosed With Bipolar Disorder

    PubMed Central

    Sánchez-Iglesias, Santiago; García-Solaesa, Virginia; García-Berrocal, Belén; Sanchez-Martín, Almudena; Lorenzo-Romo, Carolina; Martín-Pinto, Tomás; Gaedigk, Andrea; González-Buitrago, José Manuel; Isidoro-García, María

    2016-01-01

    Abstract One of the main concerns in psychiatric care is safety related to drug management. Pharmacogenetics provides an important tool to assess causes that may have contributed the adverse events during psychiatric therapy. This study illustrates the potential of pharmacogenetics to identify those patients for which pharmacogenetic-guided therapy could be appropriate. It aimed to investigate CYP2D6 genotype in our psychiatric population to assess the value of introducing pharmacogenetics as a primary improvement for predicting side effects. A broad series of 224 psychiatric patients comprising psychotic disorders, depressive disturbances, bipolar disorders, and anxiety disorders was included. The patients were genotyped with the AmpliChip CYP450 Test to analyzing 33 allelic variants of the CYP2D6 gene. All bipolar patients with poor metabolizer status showed maniac switching when CYP2D6 substrates such as selective serotonin reuptake inhibitors were prescribed. No specific patterns were identified for adverse events for other disorders. We propose to utilize pharmacogenetic testing as an intervention to aid in the identification of patients who are at risk of developing affective switching in bipolar disorder treated with selective serotonin reuptake inhibitors, CYP2D6 substrates, and inhibitors. PMID:26871771

  7. Improving the dissolution rate of poorly water soluble drug by solid dispersion and solid solution: pros and cons.

    PubMed

    Chokshi, Rina J; Zia, Hossein; Sandhu, Harpreet K; Shah, Navnit H; Malick, Waseem A

    2007-01-01

    The solid dispersions with poloxamer 188 (P188) and solid solutions with polyvinylpyrrolidone K30 (PVPK30) were evaluated and compared in an effort to improve aqueous solubility and bioavailability of a model hydrophobic drug. All preparations were characterized by differential scanning calorimetry, powder X-ray diffraction, intrinsic dissolution rates, and contact angle measurements. Accelerated stability studies also were conducted to determine the effects of aging on the stability of various formulations. The selected solid dispersion and solid solution formulations were further evaluated in beagle dogs for in vivo testing. Solid dispersions were characterized to show that the drug retains its crystallinity and forms a two-phase system. Solid solutions were characterized to be an amorphous monophasic system with transition of crystalline drug to amorphous state. The evaluation of the intrinsic dissolution rates of various preparations indicated that the solid solutions have higher initial dissolution rates compared with solid dispersions. However, after storage at accelerated conditions, the dissolution rates of solid solutions were lower due to partial reversion to crystalline form. The drug in solid dispersion showed better bioavailability in comparison to solid solution. Therefore, considering physical stability and in vivo study results, the solid dispersion was the most suitable choice to improve dissolution rates and hence the bioavailability of the poorly water soluble drug.

  8. Improving pig husbandry in tropical resource-poor communities and its potential to reduce risk of porcine cysticercosis.

    PubMed

    Lekule, Faustin P; Kyvsgaard, Niels C

    2003-06-01

    improvement of pig husbandry in tropical resource-poor countries.

  9. Pluronic-Functionalized Silica-Lipid Hybrid Microparticles: Improving the Oral Delivery of Poorly Water-Soluble Weak Bases.

    PubMed

    Rao, Shasha; Richter, Katharina; Nguyen, Tri-Hung; Boyd, Ben J; Porter, Christopher J H; Tan, Angel; Prestidge, Clive A

    2015-12-07

    A Pluronic-functionalized silica-lipid hybrid (Plu-SLH) microparticle system for the oral delivery of poorly water-soluble, weak base drugs is reported for the first time. A highly effective Plu-SLH microparticle system was composed of Labrasol as the lipid phase, Pluronic F127 as the polymeric precipitation inhibitor (PPI), and silica nanoparticles as the solid carrier. For the model drug cinnarizine (CIN), the Plu-SLH delivery system was shown to offer significant biopharmaceutical advantages in comparison with unformulated drug and drug in the silica-lipid hybrid (SLH) system. In vitro two-phase dissolution studies illustrated significantly reduced pH provoked CIN precipitation and an 8- to 14-fold improvement in the extent of dissolution in intestinal conditions. In addition, under simulated intestinal digesting conditions, the Plu-SLH provided approximately three times more drug solubilization than the SLH. Oral administration in rats resulted in superior bioavailability for Plu-SLH microparticles, i.e., 1.6- and 2.1-fold greater than the SLH and the unformulated CIN, respectively. A physical mixture of Pluronic and SLH (Plu&SLH), having the same composition as Plu-SLH, was also evaluated, but showed no significant increase in CIN absorption when compared to unmodified CIN or SLH. This work represents the first study where different methods of incorporating PPI to formulate solid-state lipid-based formulations were compared for the impact on the biopharmaceutical performance. The data suggest that the novel physicochemical properties and structure of the fabricated Plu-SLH microparticle delivery system play an important role in facilitating the synergistic advantage of Labrasol and Pluronic F127 in preventing drug precipitation, and the Plu-SLH provides efficient oral delivery of poorly water-soluble weak bases.

  10. Interventions to improve patient access to and utilisation of genetic and genomic counselling services

    PubMed Central

    Benjamin, Caroline M; Thomas, Lois H; Skirton, Heather; Gustafson, Shanna; Coupe, Jacqueline; Patch, Christine; Belk, Rachel; Tishkovskaya, Svetlana; Calzone, Kathleen; Payne, Katherine

    2015-01-01

    This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective The primary objective is to assess the effectiveness of interventions to improve patient identification, access to and utilisation of genetic and genomic counselling services when compared to: No intervention; Usual or current practice; and Other active intervention. Secondary objective The secondary objective is to explore the resource use and costs associated with interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. We will report on factors that may explain variation in the effectiveness of interventions aimed at improving patient identification, access to and utilisation of genetic and genomic counselling services from studies meeting the eligibility criteria. Another secondary objective is to explore how interventions which target improved patient identification, access to and utilisation of genetic and genomic counselling services affect the subsequent appropriate use of health services for the prevention or early detection of disease. It is also possible that the genetic counselling interaction itself will contribute to the possible use of preventative services. PMID:26989348

  11. Improving Process Evaluations of Health Behavior Interventions: Learning From the Social Sciences.

    PubMed

    Morgan-Trimmer, Sarah

    2015-09-01

    This article reflects on the current state of process evaluations of health behavior interventions and argues that evaluation practice in this area could be improved by drawing on the social science literature to a greater degree. While process evaluations of health behavior interventions have increasingly engaged with the social world and sociological aspects of interventions, there has been a lag in applying relevant and potentially useful approaches from the social sciences. This has limited the scope for health behavior process evaluations to address pertinent contextual issues and methodological challenges. Three aspects of process evaluations are discussed: the incorporation of contexts of interventions; engagement with the concept of "process" in process evaluation; and working with theory to understand interventions. Following on from this, the article also comments on the need for new methodologies and on the implications for addressing health inequalities.

  12. Response to Intervention: Does It Improve Literacy Skills for At-Risk Students?

    ERIC Educational Resources Information Center

    Vatakis, Tiffany

    2016-01-01

    Response to Intervention (RTI) has been used in the public school system to improve student achievement in areas of weakness and identify students who may need further resources. The local goal is to improve the retention rate and identify those students that may need additional support systems. The overall goal is to decrease the number of…

  13. Improving mental health literacy as a strategy to facilitate early intervention for mental disorders.

    PubMed

    Kelly, Claire M; Jorm, Anthony F; Wright, Annemarie

    2007-10-01

    Good mental health literacy in young people and their key helpers may lead to better outcomes for those with mental disorders, either by facilitating early help-seeking by young people themselves, or by helping adults to identify early signs of mental disorders and seek help on their behalf. Few interventions to improve mental health literacy of young people and their helpers have been evaluated, and even fewer have been well evaluated. There are four categories of interventions to improve mental health literacy: whole-of-community campaigns; community campaigns aimed at a youth audience; school-based interventions teaching help-seeking skills, mental health literacy, or resilience; and programs training individuals to better intervene in a mental health crisis. The effectiveness of future interventions could be enhanced by using specific health promotion models to guide their development.

  14. A systematic review of eHealth interventions to improve health literacy.

    PubMed

    Jacobs, Robin J; Lou, Jennie Q; Ownby, Raymond L; Caballero, Joshua

    2016-06-01

    Implementation of eHealth is now considered an effective way to address concerns about the health status of health care consumers. The purpose of this study was to review empirically based eHealth intervention strategies designed to improve health literacy among consumers in a variety of settings. A computerized search of 16 databases of abstracts (e.g. Biomedical Reference Collection, Cochrane Central Register of Controlled Trials, Computers & Applied Sciences Complete, Health Technology Assessments, MEDLINE) were explored in a systematic fashion to assess the presence of eHealth applications targeting health literacy. Compared to control interventions, the interventions using technology reported significant outcomes or showed promise for future positive outcomes regarding health literacy in a variety of settings, for different diseases, and with diverse samples. This review has indicated that it is feasible to deliver eHealth interventions specifically designed to improve health literacy skills for people with different health conditions, risk factors, and socioeconomic backgrounds.

  15. Ofatumumab in poor-prognosis chronic lymphocytic leukemia: a Phase IV, non-interventional, observational study from the European Research Initiative on Chronic Lymphocytic Leukemia

    PubMed Central

    Moreno, Carol; Montillo, Marco; Panayiotidis, Panayiotis; Dimou, Maria; Bloor, Adrian; Dupuis, Jehan; Schuh, Anna; Norin, Stefan; Geisler, Christian; Hillmen, Peter; Doubek, Michael; Trněný, Marek; Obrtlikova, Petra; Laurenti, Luca; Stilgenbauer, Stephan; Smolej, Lukas; Ghia, Paolo; Cymbalista, Florence; Jaeger, Ulrich; Stamatopoulos, Kostas; Stavroyianni, Niki; Carrington, Patrick; Zouabi, Hamadi; Leblond, Veronique; Gomez-Garcia, Juan C.; Rubio, Martin; Marasca, Roberto; Musuraca, Gerardo; Rigacci, Luigi; Farina, Lucia; Paolini, Rossella; Pospisilova, Sarka; Kimby, Eva; Bradley, Colm; Montserrat, Emili

    2015-01-01

    We report the largest retrospective, phase IV non-interventional, observational study of ofatumumab therapy in heavily pre-treated patients with poor-prognosis chronic lymphocytic leukemia. Total number of patients was 103; median age was 65 years (range 39–85). Median number of prior lines of therapy was 4 (range 1–13), including, in most cases, rituximab-, fludarabine- and alemtuzumab-based regimens; 13 patients had been allografted. Of 113 adverse events, 28 (29%) were considered to be directly related to ofatumumab. Grade 3–4 toxicities included neutropenia (10%), thrombocytopenia (5%), anemia (3%), pneumonia (17%), and fever (3%). Two heavily pre-treated patients developed progressive multifocal leukoencephalopathy. On an intention-to-treat analysis, the overall response rate was 22% (3 complete response, 1 incomplete complete response). Median progression-free and overall survival times were 5 and 11 months, respectively. This study confirms in a daily-life setting the feasibility and acceptable toxicity of ofatumumab treatment in advanced chronic lymphocytic leukemia. The complete response rate, however, was low. Therefore, treatment with ofatumumab should be moved to earlier phases of the disease. Ideally, this should be done in combination with other agents, as recently approved for ofatumumab plus chlorambucil as front-line treatment for patients unfit for fludarabine. This study is registered at clinicaltrials.gov identifier:01453062. PMID:25596264

  16. Psychological Intervention for Improving Cognitive Function in Cancer Survivors: A Literature Review and Randomized Controlled Trial

    PubMed Central

    King, Summer; Green, Heather Joy

    2015-01-01

    Although the impact of cancer and associated treatments on cognitive functioning is becoming an increasingly recognized problem, there are few published studies that have investigated psychological interventions to address this issue. A waitlist randomized controlled trial methodology was used to assess the efficacy of a group cognitive rehabilitation intervention (“ReCog”) that successfully targeted cancer-related cognitive decline in previously published pilot research. Participants were 29 cancer survivors who were randomly allocated to either the intervention group or a waitlist group who received the intervention at a later date, and 16 demographically matched community volunteers with no history of cancer (trial registration ACTRN12615000009516, available at http://www.ANZCTR.org.au/ACTRN12615000009516.aspx). The study was the first to include an adapted version of the Traumatic Brain Injury Self-Efficacy Scale to assess cognitive self-efficacy (CSE) in people who have experienced cancer. Results revealed participating in the intervention was associated with significantly faster performance on one objective cognitive task that measures processing speed and visual scanning. Significantly larger improvements for the intervention group were also found on measures of perceived cognitive impairments and CSE. There was some evidence to support the roles of CSE and illness perceptions as potential mechanisms of change for the intervention. Overall, the study provided additional evidence of feasibility and efficacy of group psychological intervention for targeting cancer-related cognitive decline. PMID:25859431

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

    PubMed

    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.

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

    PubMed Central

    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

  19. Efficacy of an Intervention Program to Improve Employability of University Students.

    PubMed

    Hernández-Fernaud, Estefanía; Ruiz-de la Rosa, Carmen Inés; Negrín, Fátima; Ramos-Sapena, Yeray; Hernández, Bernardo

    2017-01-19

    In the current socioeconomic situation, the need to improve employability of potential workers is especially relevant. The aim of this study was to evaluate the efficacy of an intervention program focusing on improving employability of university students. To do this, a two-group study was designed: one group undertook the intervention program and the other group were used for comparison. Two measurements were taken at different times (pre-intervention and post-intervention). The sample consisted of 271 university students. The results show that the group that underwent the intervention program improved their perceived employability F(1, 269) = 17.49, p < .001; η2 = .06, openness to learning F(1, 269) = 4.24, p < .05; η2 = .02, self-efficacy for labor market insertion F(1, 269) = 75.70, p < .001; η2 = .22 and for teamwork F(1, 269) = 39.43, p < .001; η2 = .13, and their knowledge of employment resources F(1, 269) = 512.89, p < .001; η2 = .66 compared to the group that did not. Furthermore, there was a high level of satisfaction of participants with the intervention program.

  20. An educational intervention to improve internal medicine interns' awareness of hazards of hospitalization in acutely ill older adults.

    PubMed

    Wilkerson, Loren M; Iwata, Isao; Wilkerson, Matthew D; Heflin, Mitchell T

    2014-04-01

    Hospitalized older adults are susceptible to complications termed "hazards of hospitalization" (HOH), which collectively result in poor patient outcomes. Previous research has shown that residents are not aware of their patients' risk factors for HOH. This study investigated the effect of an educational intervention to increase internal medicine interns' knowledge and self-efficacy of HOH and to improve their care of hospitalized older adults as measured by their documentation of HOH. Targeted learners were internal medicine interns on their geriatrics rotation at a large academic hospital in 2011 to 2012. The intervention covered 10 specific HOH: delirium, pressure ulcers, urinary incontinence and retention, functional decline, falls, suboptimal prescribing, dehydration and malnutrition, infection, depression, and inappropriate interventions. Knowledge and self-efficacy were measured before and after training. HOH documentation rates of interns who did and did not complete the training were compared over a preset 8-week period. Forty-two of 43 eligible interns completed the curriculum. After training, knowledge was significantly greater (approximately 1 more correct question out of 3, P < .001). Self-reported confidence in managing each hazard also significantly increased (13 questions on two 5-point Likert scales, P < .001). Trained interns had significantly more-frequent documentation of patients' activities of daily living, gait, and plan for functional decline prevention than interns who were not trained (P < .05). Conversely, documentation of instrumental activities of daily living was more frequent among interns who were not trained (P < .01). Implementation of an educational intervention was successful in improving educational and behavior change outcomes regarding HOH.

  1. Do Web-Based Interventions Improve Well-Being in Type 2 Diabetes? A Systematic Review and Meta-Analysis

    PubMed Central

    Byrne, Jo; Bodicoat, Danielle H; Robertson, Noelle; Eborall, Helen; Khunti, Kamlesh; Davies, Melanie J

    2016-01-01

    Background Poor diabetes self-care can have a negative impact on psychological well-being and quality of life. Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs, Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions. However, there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes. Objective This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes. Methods Searches were carried out in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library. Reference lists were hand-searched. A meta-analysis was conducted for depression and distress outcomes. Results A total of 16 randomized controlled studies met the inclusion criteria for the systematic review and 9 were included in the meta-analyses. Theories were applied to the majority of the interventions. The most common behavior change techniques were “General information” and “Tracking/monitoring.” Interventions with a duration of 2-6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes. The pooled mean (95% confidence interval) difference between the intervention and control arms at follow-up on depression score was -0.31 (-0.73 to 0.11). The pooled mean difference on distress scores at follow-up was -0.11 (-0.38 to 0.16). No significant improvements in depression (P=.15) or distress (P=.43) were found following meta-analyses. Conclusions While the meta-analyses demonstrated nonsignificant results for depression and distress scores, this review has shown that there is a potential for Web-based interventions to improve

  2. Piloting Lead with Love: a film-based intervention to improve parents' responses to their lesbian, gay, and bisexual children.

    PubMed

    Huebner, David M; Rullo, Jordan E; Thoma, Brian C; McGarrity, Larissa A; Mackenzie, Jenny

    2013-10-01

    Lesbian, gay, and bisexual youth are at increased risk for a variety of poor health outcomes, relative to their heterosexual counterparts, and recent research implicates family responses to a child's sexual orientation as an important predictor of these health difficulties. Lead with Love is a 35-min documentary-style preventive intervention created to improve parents' behaviors toward their lesbian, gay, and bisexual (LGB) children, by providing parents with support, information, and concrete behavioral guidance. The film was made available free online, and was promoted widely with a multi-media marketing campaign. In this paper we describe the theoretical and empirical rationale for the intervention, and report findings from pilot data collected in the first year after the film's release. Specifically, we gathered data to examine the feasibility of reaching parents of LGB youth with this intervention, to determine whether it was acceptable, and to provide preliminary indicators of its potential efficacy. In the first 12 months after launch, 10,949 individuals viewed the film online. The film successfully reached parents of LGB youth (n=1,865), including the hardest to reach parents: 21% had only learned about their child's sexual orientation in the past month, 36% reported having an LGB child was "very" or "extremely" hard for them, and 86% had never obtained any other formal support for having an LGB child. Parents who completed a follow-up assessment immediately after the film reported significant pre- to post-film increases in self-efficacy for parenting an LGB child.

  3. Improving Early Language and Literacy Skills: Differential Effects of an Oral Language versus a Phonology with Reading Intervention

    ERIC Educational Resources Information Center

    Bowyer-Crane, Claudine; Snowling, Margaret J.; Duff, Fiona J.; Fieldsend, Elizabeth; Carroll, Julia M.; Miles, Jeremy; Gotz, Kristina; Hulme, Charles

    2008-01-01

    Background: This study compares the efficacy of two school-based intervention programmes (Phonology with Reading (P + R) and Oral Language (OL)) for children with poor oral language at school entry. Methods: Following screening of 960 children, 152 children (mean age 4;09) were selected from 19 schools on the basis of poor vocabulary and verbal…

  4. A Metaanalysis of Interventions to Improve Adherence to Lipid-Lowering Medication

    PubMed Central

    Deichmann, Richard E.; Morledge, Michael D.; Ulep, Robin; Shaffer, Johnathon P.; Davies, Philippa; van Driel, Mieke L.

    2016-01-01

    Background: Inadequate patient adherence to a medication regimen is a major factor in the lack of success in treating hyperlipidemia. Improved adherence rates may result in significantly improved cardiovascular outcomes in populations treated with lipid-lowering therapy. The purpose of this metaanalysis was to evaluate the effectiveness of interventions aimed at improving adherence to lipid-lowering drugs, focusing on measures of adherence and clinical outcomes. Methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, PsycINFO, and the Cumulative Index to Nursing and Allied Health Literature databases through January 14, 2015, and also used the results from previous Cochrane reviews of this title. Randomized controlled trials of adherence-enhancing interventions for lipid-lowering medication in adults in an ambulatory setting with measurable outcomes were evaluated with criteria outlined by the Cochrane Handbook for Systematic Reviews of Interventions. Results: Twenty-seven studies randomly assigning 899,068 participants to a variety of interventions were analyzed. One group of interventions categorized as intensified patient care showed significant improvement in adherence rates when compared to usual care (odds ratio 1.93; 95% confidence interval [CI] 1.29-2.88). Additionally, after <6 months of follow-up, total cholesterol decreased by a mean of 17.15 mg/dL (95% CI 1.17-33.14), while after >6 months total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95-20.19). Conclusion: Healthcare systems that can implement team-based intensified patient care interventions, such as electronic reminders, pharmacist-led interventions, and healthcare professional education of patients, may be successful in improving adherence rates to lipid-lowering medicines. PMID:27660570

  5. How Efficacious Are Patient Education Interventions to Improve Bowel Preparation for Colonoscopy? A Systematic Review

    PubMed Central

    Kurlander, Jacob E.; Sondhi, Arjun R.; Waljee, Akbar K.; Menees, Stacy B.; Connell, Cathleen M.; Schoenfeld, Philip S.; Saini, Sameer D.

    2016-01-01

    Background Bowel preparation is inadequate in a large proportion of colonoscopies, leading to multiple clinical and economic harms. While most patients receive some form of education before colonoscopy, there is no consensus on the best approach. Aims This systematic review aimed to evaluate the efficacy of patient education interventions to improve bowel preparation. Methods We searched the Cochrane Database, CINAHL, EMBASE, Ovid, and Web of Science. Inclusion criteria were: (1) a patient education intervention; (2) a primary aim of improving bowel preparation; (3) a validated bowel preparation scale; (4) a prospective design; (5) a concurrent control group; and, (6) adult participants. Study validity was assessed using a modified Downs and Black scale. Results 1,080 abstracts were screened. Seven full text studies met inclusion criteria, including 2,660 patients. These studies evaluated multiple delivery platforms, including paper-based interventions (three studies), videos (two studies), re-education telephone calls the day before colonoscopy (one study), and in-person education by physicians (one study). Bowel preparation significantly improved with the intervention in all but one study. All but one study were done in a single center. Validity scores ranged from 13 to 24 (maximum 27). Four of five abstracts and research letters that met inclusion criteria also showed improvements in bowel preparation. Statistical and clinical heterogeneity precluded meta-analysis. Conclusion Compared to usual care, patient education interventions appear efficacious in improving the quality of bowel preparation. However, because of the small scale of the studies and individualized nature of the interventions, results of these studies may not be generalizable to other settings. Healthcare practices should consider systematically evaluating their current bowel preparation education methods before undertaking new interventions. PMID:27741260

  6. Improving fragmentation of poorly fragmenting peptides and phosphopeptides during collision-induced dissociation by malondialdehyde modification of arginine residues.

    PubMed

    Leitner, Alexander; Foettinger, Alexandra; Lindner, Wolfgang

    2007-07-01

    Despite significant technological and methodological advancements in peptide sequencing by mass spectrometry, analyzing peptides that exhibit only poor fragmentation upon collision-induced dissociation (CID) remains a challenge. A major cause for unfavorable fragmentation is insufficient proton 'mobility' due to charge localization at strongly basic sites, in particular, the guanidine group of arginine. We have recently demonstrated that the conversion of the guanidine group of the arginine side chain by malondialdehyde (MDA) is a convenient tool to reduce the basicity of arginine residues and can have beneficial effects for peptide fragmentation. In the present work, we have focused on peptides that typically yield incomplete sequence information in CID-MS/MS experiments. Energy-resolved tandem MS experiments were carried out on angiotensins and arginine-containing phosphopeptides to study in detail the influence of the modification step on the fragmentation process. MDA modification dramatically improved the fragmentation behavior of peptides that exhibited only one or two dominant cleavages in their unmodified form. Neutral loss of phosphoric acid from phosphopeptides carrying phosphoserine and threonine residues was significantly reduced in favor of a higher abundance of fragment ions. Complementary experiments were carried out on three different instrumental platforms (triple-quadrupole, 3D ion trap, quadrupole-linear ion trap hybrid) to ascertain that the observation is a general effect.

  7. Factors contributing to the poor bulk behavior of meat and bone meal and methods for improving these behaviors.

    PubMed

    Garcia, R A; Flores, R A; Mazenko, C E

    2007-11-01

    Meat and bone meal (MBM), a product of the rendering industry, is a potential feedstock for numerous bio-based applications. Design of processing equipment for MBM is difficult due to MBM's bulk behaviors; it flows less easily than many other granular materials, and it tends to foul the surfaces of processing equipment. This study examines the major factors contributing to MBM's poor bulk behavior, including moisture content, fat content, particle size distribution and temperature, and the relative importance of these factors. Potential methods for improving MBM's bulk properties, including use of an anti-caking agent, dehydration, fat extraction, milling and refrigeration are also studied. The effects of these factors were determined by a standard laboratory measurement, the Hausner ratio, as well as by the rate of surface-fouling and dust generation using a pilot-scale aspirator. In contrast to past studies with other granular materials, moisture content was shown to have an insignificant effect on MBM's bulk behavior. The results, however, show that MBM fat content is a major determinant of the bulk behavior of the MBM. Reduction of fat content resulted in major changes in MBM's bulk behavior, by all measures used. Less dramatic changes were achieved through refrigeration to solidify the fat and/or treatment with an anti-caking agent.

  8. Novel polyvinylpyrrolidones to improve delivery of poorly water-soluble drugs: from design to synthesis and evaluation.

    PubMed

    Niemczyk, Anna I; Williams, Adrian C; Rawlinson-Malone, Clare F; Hayes, Wayne; Greenland, Barnaby W; Chappell, David; Khutoryanskaya, Olga; Timmins, Peter

    2012-08-06

    Polyvinylpyrrolidone is widely used in tablet formulations with the linear form acting as a wetting agent and disintegrant, whereas the cross-linked form is a superdisintegrant. We have previously reported that simply mixing the commercial cross-linked polymer with ibuprofen disrupted drug crystallinity with consequent improvements in drug dissolution behavior. In this study, we have designed and synthesized novel cross-linking agents containing a range of oligoether moieties that have then been polymerized with vinylpyrrolidone to generate a suite of novel excipients with enhanced hydrogen-bonding capabilities. The polymers have a porous surface and swell in the most common solvents and in water, properties that suggest their value as disintegrants. The polymers were evaluated in simple physical mixtures with ibuprofen as a model poorly water-soluble drug. The results show that the novel PVPs induce the drug to become "X-ray amorphous", which increased dissolution to a greater extent than that seen with commercial cross-linked PVP. The polymers stabilize the amorphous drug with no evidence for recrystallization seen after 20 weeks of storage.

  9. Psychotherapy and pharmacotherapy interventions to reduce distress or improve well-being in people with amyotrophic lateral sclerosis: A systematic review.

    PubMed

    Gould, Rebecca L; Coulson, Mark C; Brown, Richard G; Goldstein, Laura H; Al-Chalabi, Ammar; Howard, Robert J

    2015-01-01

    Our objective was to systematically review and critically evaluate the evidence for psychotherapy and pharmacotherapy interventions for reducing distress or improving well-being in people with amyotrophic lateral sclerosis (pwALS). Online bibliographic databases and clinical trial registers were searched and an assessment of study quality was conducted. Seven thousand two hundred and twenty-three studies were identified, of which five met inclusion criteria (four completed and one in progress). All studies examined psychotherapeutic interventions, and no studies investigated pharmacotherapy. Two studies adopted a randomized controlled trial design, one a controlled trial design and two a cohort design. Sample sizes were small in all studies (overall n = 145). The quality of completed studies was generally poor, with evidence that all were at potential risk of bias in numerous areas. Improvements in well-being were found with expressive disclosure (compared to no disclosure), cognitive behavioural therapy/counselling (compared to non-randomized pharmacotherapy) and hypnosis in the short term only, while no improvements were seen with a life review intervention. In conclusion, there is currently insufficient evidence to recommend the use of specific psychotherapy interventions for reducing distress or improving well-being in pwALS, and no evidence to support pharmacotherapy interventions. Research is urgently needed to address these significant gaps in the literature.

  10. Behavioral intervention to improve calorie intake of children with cystic fibrosis: treatment versus wait list control.

    PubMed

    Stark, L J; Mulvihill, M M; Powers, S W; Jelalian, E; Keating, K; Creveling, S; Byrnes-Collins, B; Harwood, I; Passero, M A; Light, M; Miller, D L; Hovell, M F

    1996-04-01

    Changes in calorie intake and weight gain were evaluated in five children with cystic fibrosis (CF) who received behavioral intervention and four children with CF who served as wait list controls. The behavioral intervention was a 6-week group treatment that provided nutritional education plus management strategies aimed at mealtime behaviors that parents find most problematic. The control group was identified prospectively and was evaluated on all dependent measures at the same points in time pre- and posttreatment as the intervention group. Difference scores on calorie intake and weight gain from pre- to posttreatment were compared between groups using t tests for independent samples. The behavioral intervention group increased their calorie intake by 1,032 calories per day, while the control group's intake increased only 244 calories per day from pre- to posttreatment [t(6) = 2.826, p = 0.03]. The intervention group also gained significantly more weight (1.7 kg) than the control group (0 kg) over the 6 weeks of treatment [t(7) = 2.588, p = 0.03] and demonstrated catchup growth for weight, as indicated by improved weight Z scores (-1.18 to -0.738). The control group showed a decline in weight Z scores over this same time period (-1.715 to -1.76). One month posttreatment, the intervention was replicated with two of the four children from the control group. Improved calorie intake and weight gain pre- to posttreatment were again found in these children. At 3- and 6-month follow-up study of children receiving intervention, maintenance of calorie intake and weight gain was confirmed. No changes were found on pulmonary functioning, resting energy expenditure, or activity level pre- to posttreatment. This form of early intervention appears to be promising in improving nutritional status and needs to be investigated over a longer period of time to evaluate the effects of treatment gains on the disease process.

  11. Multiple interventions improve analgesic treatment of supracondylar fractures in a pediatric emergency department

    PubMed Central

    Porter, Robert N; Chafe, Roger E; Newhook, Leigh A; Murnaghan, Kyle D

    2015-01-01

    BACKGROUND: Provision of appropriate and timely treatment for pain in the pediatric population has been challenging. Children with painful conditions commonly present to emergency departments (EDs), a setting in which it may be particularly difficult to consistently provide timely analgesic interventions. OBJECTIVES: To measure the effectiveness of a set of interventions in improving the rate and timeliness of analgesic medication administration, as well as appropriate backslab immobilization (application of a moldable plaster or fiberglass splint), in a pediatric ED. METHODS: Data regarding pain management were collected on a consecutive sample of cases of supracondylar fracture over a 13-month period. This followed the implementation of a formal triage pain assessment and treatment medical directive, supplemented with relevant education of nursing and house staff, and posters in the ED. These data were compared with data previously collected from a similar cohort of cases, which presented before the interventions. RESULTS: Postintervention, the proportion of patients treated with an analgesic within 60 min of triage increased from 15% to 54% (P<0.001), and the median time to administration of an analgesic decreased from 72.5 min to 11 min (P<0.001). Rates for backslab application before radiography were similar before and after the intervention (29% and 33%, respectively; P=0.646). CONCLUSIONS: A multifaceted approach to improving early analgesic interventions was associated with considerably improved rates of early analgesic treatments for supracondylar fracture; however, no improvement in early immobilization was observed. PMID:26125193

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

    PubMed Central

    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

  13. Increased Needle Nitrogen Contents Did Not Improve Shoot Photosynthetic Performance of Mature Nitrogen-Poor Scots Pine Trees

    PubMed Central

    Tarvainen, Lasse; Lutz, Martina; Räntfors, Mats; Näsholm, Torgny; Wallin, Göran

    2016-01-01

    Numerous studies have shown that temperate and boreal forests are limited by nitrogen (N) availability. However, few studies have provided a detailed account of how carbon (C) acquisition of such forests reacts to increasing N supply. We combined measurements of needle-scale biochemical photosynthetic capacities and continuous observations of shoot-scale photosynthetic performance from several canopy positions with simple mechanistic modeling to evaluate the photosynthetic responses of mature N-poor boreal Pinus sylvestris to N fertilization. The measurements were carried out in August 2013 on 90-year-old pine trees growing at Rosinedalsheden research site in northern Sweden. In spite of a nearly doubling of needle N content in response to the fertilization, no effect on the long-term shoot-scale C uptake was recorded. This lack of N-effect was due to strong light limitation of photosynthesis in all investigated canopy positions. The effect of greater N availability on needle photosynthetic capacities was also constrained by development of foliar phosphorus (P) deficiency following N addition. Thus, P deficiency and accumulation of N in arginine appeared to contribute toward lower shoot-scale nitrogen-use efficiency in the fertilized trees, thereby additionally constraining tree-scale responses to increasing N availability. On the whole our study suggests that the C uptake response of the studied N-poor boreal P. sylvestris stand to enhanced N availability is constrained by the efficiency with which the additional N is utilized. This efficiency, in turn, depends on the ability of the trees to use the greater N availability for additional light capture. For stands that have not reached canopy closure, increase in leaf area following N fertilization would be the most effective way for improving light capture and C uptake while for mature stands an increased leaf area may have a rather limited effect on light capture owing to increased self-shading. This raises the

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

    PubMed Central

    DiLiberto, Deborah D.; Staedke, Sarah G.; Nankya, Florence; Maiteki-Sebuguzi, Catherine; Taaka, Lilian; Nayiga, Susan; Kamya, Moses R.; Haaland, Ane; Chandler, Clare I. R.

    2015-01-01

    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 design may

  15. Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review

    PubMed Central

    2016-01-01

    Background People who are homeless encounter barriers to primary care despite having greater needs for health care, on average, than people who are not homeless. We evaluated the effectiveness of interventions to improve access to primary care for people who are homeless. Methods We performed a systematic review to identify studies in English published between January 1, 1995, and July 8, 2015, comparing interventions to improve access to a primary care provider with usual care among people who are homeless. The outcome of interest was access to a primary care provider. The risk of bias in the studies was evaluated, and the quality of the evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. Results From a total of 4,047 citations, we identified five eligible studies (one randomized controlled trial and four observational studies). With the exception of the randomized trial, the risk of bias was considered high in the remaining studies. In the randomized trial, people who were homeless, without serious mental illness, and who received either an outreach intervention plus clinic orientation or clinic orientation alone, had improved access to a primary care provider compared with those receiving usual care. An observational study that compared integration of primary care and other services for people who are homeless with usual care did not observe any difference in access to a primary care provider between the two groups. A small observational study showed improvement among participants with a primary care provider after receiving an intervention consisting of housing and supportive services compared with the period before the intervention. The quality of the evidence was considered moderate for both the outreach plus clinic orientation and clinic orientation alone, and low to very low for the other interventions. Despite limitations, the literature identified reports of

  16. [Cost-benefit analysis of an intervention to improve udder health in Swiss dairy farms].

    PubMed

    Heiniger, D; van den Borne, B H P; Lechner, I; Tschopp, A; Strabel, D; Steiner, A; Meier, H

    2014-10-01

    The objective of this study was to calculate the national costs associated with udder health in Switzerland and to estimate the cost effectiveness of an udder health intervention program. In 49 farms, yearly mastitis associated costs before and during an intervention were collected at herd level. Costs were calculated for each lactating cow being present in the herd. At the beginning of the intervention, 24 farms received a report with recommendations to improve the udder health. In the following year, those herds were followed-up by their veterinarian at a monthly basis. The other 25 farms were used as a negative control group and neither received any recommendations nor any follow-up. In the first year of analysis (2010), the median udder health associated costs were 209.- Swiss Francs for each lactating cow, regardless of the intervention group. During the intervention period (2012), mastitis associated costs were 191.- Swiss Francs for control farms and 396.- Swiss Francs for farms with veterinary intervention on a monthly basis. The median additional costs for herds with intervention were 159.- Swiss Francs per lactating cow. At the national level, mastitis associated costs were estimated at 129.4 millions of Swiss Francs per year. The cost effectiveness of future mastitis control programs can be evaluated with the help of the deterministic model developed during this study.

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

    PubMed Central

    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

  18. Economic analysis of a randomized trial of academic detailing interventions to improve use of antihypertensive medications.

    PubMed

    Simon, Steven R; Rodriguez, Hector P; Majumdar, Sumit R; Kleinman, Ken; Warner, Cheryl; Salem-Schatz, Susanne; Miroshnik, Irina; Soumerai, Stephen B; Prosser, Lisa A

    2007-01-01

    The authors estimated the costs and cost savings of implementing a program of mailed practice guidelines and single-visit individual and group academic detailing interventions in a randomized controlled trial to improve the use of antihypertensive medications. Analyses took the perspective of the payer. The total costs of the mailed guideline, group detailing, and individual detailing interventions were estimated at 1000 dollars, 5500 dollars, and 7200 dollars, respectively, corresponding to changes in the average daily per person drug costs of -0.0558 dollars (95% confidence interval, -0.1365 dollars to 0.0250 dollars) in the individual detailing intervention and -0.0001 dollars (95% confidence interval, -0.0803 dollars to 0.0801 dollars) in the group detailing intervention, compared with the mailed intervention. For all patients with incident hypertension in the individual detailing arm, the annual total drug cost savings were estimated at 21,711 dollars (95% confidence interval, 53,131 dollars savings to 9709 dollars cost increase). Information on costs of academic detailing could assist with health plan decision making in developing interventions to improve prescribing.

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

    PubMed Central

    Tellegen, Cassandra L.; Sanders, Matthew R.

    2012-01-01

    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. PMID:22928141

  20. Designing AAC Research and Intervention to Improve Outcomes for Individuals with Complex Communication Needs.

    PubMed

    Light, Janice; Mcnaughton, David

    2015-06-01

    There is a rapidly growing body of research that demonstrates the positive effects of augmentative and alternative communication (AAC) intervention on the communication of children and adults with complex communication needs. Despite the positive impact of many AAC interventions, however, many individuals with complex communication needs continue to experience serious challenges participating in educational, vocational, healthcare, and community environments. In this paper, we apply the framework proposed by the International Classification of Functioning, Disability and Health (ICF) to illustrate the need to re-think AAC intervention to improve outcomes for individuals with complex communication needs, and to foster a new generation of intervention research that will provide a solid foundation for improved services. Specifically, the paper emphasizes the need to take a more holistic view of communication intervention and highlights the following key principles to guide AAC intervention and research: (a) build on the individual's strengths and focus on the integration of skills to maximize communication, (b) focus on the individual's participation in real-world contexts,

  1. Systematic Review and Meta-Analysis of Behavioral Interventions to Improve Child Pedestrian Safety

    PubMed Central

    Barton, Benjamin K.; Shen, Jiabin; Wells, Hayley L.; Bogar, Ashley; Heath, Gretchen; McCullough, David

    2014-01-01

    Objective Pedestrian injuries represent a pediatric public health challenge. This systematic review/meta-analysis evaluated behavioral interventions to teach children pedestrian safety. Methods Multiple strategies derived eligible manuscripts (published before April 1, 2013, randomized design, evaluated behavioral child pedestrian safety interventions). Screening 1,951 abstracts yielded 125 full-text retrievals. 25 were retained for data extraction, and 6 were later omitted due to insufficient data. In all, 19 articles reporting 25 studies were included. Risk of bias and quality of evidence were assessed. Results Behavioral interventions generally improve children’s pedestrian safety, both immediately after training and at follow-up several months later. Quality of the evidence was low to moderate. Available evidence suggested interventions targeting dash-out prevention, crossing at parked cars, and selecting safe routes across intersections were effective. Individualized/small-group training for children was the most effective training strategy based on available evidence. Conclusions Behaviorally based interventions improve children’s pedestrian safety. Efforts should continue to develop creative, cost-efficient, and effective interventions. PMID:24864275

  2. A Brief Intervention Designed to Improve Social Awareness and Skills to Improve Latino College Student Retention

    ERIC Educational Resources Information Center

    Cerezo, Alison; McWhirter, Benedict T.

    2012-01-01

    The purpose of this study was to examine the effectiveness of the Latino Educational Equity Project (LEEP), a brief intervention designed to enhance college retention by increasing social awareness and skills for Latino students at three, predominately White universities in the Pacific Northwest. Participants were 40 students who completed the…

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

    PubMed

    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.

  4. Targeted Interventions Improve Shared Agreement of Daily Goals in the Pediatric Intensive Care Unit

    PubMed Central

    Rehder, Kyle J; Uhl, Tammy L; Meliones, Jon N; Turner, David A; Smith, P Brian; Mistry, Kshitij P

    2011-01-01

    Objective To improve communication during daily rounds using sequential interventions. Design Prospective cohort study Setting Multidisciplinary pediatric intensive care unit in a university hospital. Subjects The multidisciplinary rounding team in the pediatric intensive care unit, including attending physicians, physician trainees, and nurses. Interventions Daily rounds on 736 patients were observed over a nine month period. Sequential interventions were timed 8–12 weeks apart: (1) Implementing a new resident daily progress note format, (2) creating a performance improvement `dashboard,' and (3) documenting patients' daily goals on bedside whiteboards. Measurements and Main Results Following all interventions, team agreement with the attending physician's stated daily goals increased from 56.9% to 82.7% (p < 0.0001). Mean agreement increased for each provider category: 65.2% to 88.8% for fellows (p < 0.0001), 55.0% to 83.8% for residents (p < 0.0001), and 54.1% to 77.4% for nurses (p < 0.0001). In addition, significant improvements were noted in provider behaviors following interventions. Barriers to communication (bedside nurse multitasking during rounds, interruptions during patient presentations, and group disassociation) were reduced, and the use of communication facilitators (review of the prior day's goals, inclusion of bedside nurse input, and order read back) increased. The percentage of providers reporting being `very satisfied' or `satisfied' with rounds increased from 42.6% to 78.3%, (p < 0.0001). Conclusions Shared agreement of patients' daily goals among key healthcare providers can be increased through process-oriented interventions. Improved agreement will potentially lead to improved quality of patient care and reduced medical errors. PMID:21478796

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

    PubMed

    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.

  6. Tai chi intervention improves dynamic postural control during gait initiation in older adults: a pilot study.

    PubMed

    Vallabhajosula, Srikant; Roberts, Beverly L; Hass, Chris J

    2014-12-01

    Tai Chi intervention has been shown to be beneficial for balance improvement. The current study examined the effectiveness of Tai Chi to improve the dynamic postural control among older adults with mobility disability. Six sedentary older adults with mobility disability participated in a 16-week Tai Chi intervention consisting of one hour sessions three times a week. Dynamic postural control was assessed pre- and post intervention as participants initiated gait in four stepping conditions: forward; 45° medially, with the stepping leg crossing over the other leg; 45° and 90° laterally. The center of pressure (CoP) displacement, velocity, and its maximum separation distance from the center of mass in the anteroposterior, mediolateral, and resultant directions were analyzed. Results showed that in the postural phase, Tai Chi increased the CoP mediolateral excursions in the medial (13%) and forward (28%) conditions, and resultant CoP center of mass distance in the medial (9%) and forward (19%) conditions. In the locomotion phase, the CoP mediolateral displacement and velocity significantly increased after the Tai Chi intervention (both by > 100% in the two lateral conditions). These results suggest that through alteration in CoP movement characteristics, Tai Chi intervention might improve the dynamic postural control during gait initiation among older adults.

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

    PubMed Central

    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

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

    PubMed

    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.

  9. Nanocomposite formation between alpha-glucosyl stevia and surfactant improves the dissolution profile of poorly water-soluble drug.

    PubMed

    Uchiyama, Hiromasa; Tozuka, Yuichi; Nishikawa, Masahiro; Takeuchi, Hirofumi

    2012-05-30

    The formation of a hybrid-nanocomposite using α-glucosyl stevia (Stevia-G) and surfactant was explored to improve the dissolution of flurbiprofen (FP). As reported previously, the dissolution amount of FP was enhanced in the presence of Stevia-G, induced by the formation of an FP and Stevia-G-associated nanostructure. When a small amount of sodium dodecyl sulfate (SDS) was present with Stevia-G, the amount of dissolved FP was extremely enhanced. This dissolution-enhancement effect was also observed with the cationic surfactant of dodecyl trimethyl ammonium bromide, but not with the non-ionic surfactant of n-octyl-β-D-maltopyranoside. To investigate the dissolution-enhancement effect of Stevia-G/SDS mixture, the pyrene I(1)/I(3) ratio was plotted versus the Stevia-G concentration. The pyrene I(1)/I(3) ratio of Stevia-G/SDS mixture had a sigmoidal curve at lower Stevia-G concentrations compared to the Stevia-G solution alone. These results indicate that the Stevia-G/SDS mixture provides a hydrophobic core around pyrene molecules at lower Stevia-G concentrations, leading to nanocomposite formation between Stevia-G and SDS. The nanocomposite of Stevia-G/SDS showed no cytotoxicity to Caco-2 cells at a mixture of 0.1% SDS and 1% Stevia-G solution, whereas 0.1% SDS solution showed high toxicity. These results suggest that the nanocomposite formation of Stevia-G/SDS may be useful way to enhance the dissolution of poorly water-soluble drugs without special treatment.

  10. Impact of Baltimore Healthy Eating Zones: an environmental intervention to improve diet among African American youth.

    PubMed

    Shin, Ahyoung; Surkan, Pamela J; Coutinho, Anastasia J; Suratkar, Sonali R; Campbell, Rebecca K; Rowan, Megan; Sharma, Sangita; Dennisuk, Lauren A; Karlsen, Micaela; Gass, Anthony; Gittelsohn, Joel

    2015-04-01

    This study assessed the impact of a youth-targeted multilevel nutrition intervention in Baltimore City. The study used a clustered randomized design in which 7 recreation centers and 21 corner stores received interventions and 7 additional recreation centers served as comparison. The 8-month intervention aimed to increase availability and selection of healthful foods through nutrition promotion and education using point-of purchase materials such as posters and flyers in stores and interactive sessions such as taste test and cooking demonstrations. Two hundred forty-two youth-caregiver dyads residing in low-income areas of Baltimore City recruited from recreation centers were surveyed at baseline using detailed instruments that contained questions about food-related psychosocial indicators (behavioral intentions, self-efficacy, outcome expectancies, and knowledge), healthful food purchasing and preparation methods, and anthropometric measures (height and weight). The Baltimore Healthy Eating Zones intervention was associated with reductions in youth body mass index percentile (p = .04). In subgroup analyses among overweight and obese girls, body mass index for age percentile decreased significantly in girls assigned to the intervention group (p = .03) and in girls with high exposure to the intervention (p = .013), as opposed to those in comparison or lower exposure groups. Intervention youth significantly improved food-related outcome expectancies (p = .02) and knowledge (p < .001). The study results suggest that the Baltimore Healthy Eating Zones multilevel intervention had a modest impact in reducing overweight or obesity among already overweight low-income African American youth living in an environment where healthful foods are less available. Additional studies are needed to determine the relative impact of health communications and environmental interventions in this population, both alone and in combination.

  11. Preventing stroke: a narrative review of community interventions for improving hypertension control in black adults.

    PubMed

    Connell, Patricia; Wolfe, Charles; McKevitt, Christopher

    2008-03-01

    Incidence rates for stroke and hypertension are higher in black ethnic groups of African descent in the USA and UK than in white groups, suggesting a need for targeted intervention. We conduct a narrative review of published research evidence on community interventions to manage hypertension among black ethnic groups, and explore the concept of cultural sensitivity in these interventions. Data sources comprised computer-aided searches of published studies over the years 1981 to March 2006, on community strategies for improving hypertension control targeting black groups, and further references from these articles. Twenty-seven relevant studies were identified. Health education was associated with improvements in knowledge about hypertension, while education combined with individualised support for patients to self-manage hypertension, including goal setting and monitoring to enhance patient self-management of hypertension, and family support in managing hypertension were associated with reductions in blood pressure levels and improvements in blood pressure control. Collaboration with black communities, using local or minority ethnic staff, conducting preliminary research with target groups to investigate perceptions and canvass ideas for the intervention design were common methods assumed to achieve cultural sensitivity. Studies, however, provided insufficient robust evidence of the effectiveness of these strategies in terms of quantifiable outcomes, although this criterion is contested, with social justice arguments being offered instead. Implicit assumptions about homogeneity and shared interests within the 'community', and representation of 'community' views have implications for the effectiveness of interventions. These findings highlight areas for the future development of interventions to reduce hypertension rates in black groups, and factors that need to be robustly investigated and explicitly addressed in intervention design.

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

    PubMed

    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.

  13. USING SOCIAL NETWORK INTERVENTIONS TO IMPROVE MENTALLY ILL CLIENTS’ WELL-BEING

    PubMed Central

    Pinto, Rogério Meireles

    2009-01-01

    This paper reviews empirical evidence showing that the structures of the social networks of mentally ill clients influence both their well-being and their use of mental health services. Network interventions that might help clients better address network-related problems, and might help their families improve relationships and prevent caretaker’s burn-out are presented. A case illustration will demonstrate how practitioners can assess a client’s social network, involve the client’s family in treatment, evaluate that treatment, and select tailored interventions. This case will emphasize both how practitioners can help a client restructure her network, and the complementary roles of formal and informal networks. The author shows practitioners how to match clients’ initial network structures to interventions and desired outcomes. Practitioners can thus help clients modify their social networks, increase the use of preventive services, and improve their well-being. PMID:20098662

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

    PubMed Central

    2011-01-01

    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 search terms and

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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. Leveraging Technology to Improve Developmental Mathematics Course Completion: Evaluation of a Large-Scale Intervention

    ERIC Educational Resources Information Center

    Wladis, Claire; Offenholley, Kathleen; George, Michael

    2014-01-01

    This study hypothesizes that course passing rates in remedial mathematics classes can be improved through early identification of at-risk students using a department-wide midterm, followed by a mandated set of online intervention assignments incorporating immediate and elaborate feedback for all students identified as "at-risk" by their…

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

    ERIC Educational Resources Information Center

    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…

  18. An Evaluation of a Community Health Intervention Programme Aimed at Improving Health and Wellbeing

    ERIC Educational Resources Information Center

    Strachan, G.; Wright, G. D.; Hancock, E.

    2007-01-01

    Objective: The objective of this evaluation was to examine the extent to which participants in the Tailor Made Leisure Package programme experienced any improvement in their health and wellbeing. Design: A quantitative survey. Setting: The Healthy Living Centre initiative is an example of a community-based intervention which was formalized as part…

  19. Virtual Intervention to Improve Storytelling Ability among Deaf and Hard-of-Hearing Children

    ERIC Educational Resources Information Center

    Eden, Sigal

    2014-01-01

    Deaf and hard-of-hearing (D/HH) children reveal considerable difficulty in producing an organised and complete narrative. The current study conducted a three-month intervention to improve D/HH children's storytelling ability through training in arranging episodes of temporal scripts, and telling the stories they created. We examined 65 D/HH…

  20. Use of a Social Story intervention to improve mealtime skills of an adolescent with Asperger syndrome.

    PubMed

    Bledsoe, Rebecca; Myles, Brenda Smith; Simpson, Richard L

    2003-09-01

    This study assessed the utility of a Social Story intervention to improve the lunchtime eating behaviors of an adolescent diagnosed with Asperger syndrome. Using an ABAB design, the Social Story program appeared to result in a decrease in the number of food and drink spills and an increase in the frequency of appropriate mouth-wiping during lunch at school.

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

    ERIC Educational Resources Information Center

    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…

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

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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...

  3. An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital.

    PubMed

    Chen, Lu; Xu, YingJun; Zhang, Fengxia; Yang, Qingfeng; Yuan, Juxiang

    2016-11-01

    Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.

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

    ERIC Educational Resources Information Center

    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'…

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

    PubMed

    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.

  6. Improving Instructor Response to Student E-Mails Using Template and Reminder Interventions

    ERIC Educational Resources Information Center

    Elbeck, Matthew; Song, Minjung

    2011-01-01

    Student e-mails without the student's name, message, file attachment, and other identifying information may impede a timely and thorough instructor response. To help resolve this issue, we apply template and reminder interventions to improve student e-mail format defined as the degree of agreement between a student's e-mail format and an…

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

    ERIC Educational Resources Information Center

    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…

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

    ERIC Educational Resources Information Center

    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,…

  9. Three Essays on Estimating the Effects of School and Student Improvement Interventions

    ERIC Educational Resources Information Center

    Saw, Guan

    2016-01-01

    This dissertation consists of three chapters that examine the effects of school and students improvement interventions. The first chapter investigates whether, for whom, and under which conditions high school mathematics and science course graduation requirements (CGRs) affect student achievement and educational attainment. Drawing on data from…

  10. Impact of an intervention to improve middle school student breakfast participation rates

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Breakfast consumption is related to healthy weight. The goal of this study was to improve school breakfast (SB) participation among low-income middle school students. The study schools were primarily Hispanic, and >75% of the students were eligible for free/reduced price meals. The intervention incl...

  11. Attributional Retraining and Elaborative Learning: Improving Academic Development through Writing-Based Interventions

    ERIC Educational Resources Information Center

    Hall, Nathan C.; Perry, Raymond P.; Goetz, Thomas; Ruthig, Joelle C.; Stupnisky, Robert H.; Newall, Nancy E.

    2007-01-01

    Attributional retraining (AR) is a motivational intervention that consistently produces improved performance by encouraging controllable failure attributions. Research suggests that cognitively engaging AR methods are ideal for high-elaborating students, whereas affect-oriented techniques are better for low-elaborating students. College students'…

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

    ERIC Educational Resources Information Center

    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…

  13. An Evaluation of Collaborative Interventions to Improve Chronic Illness Care: Framework and Study Design

    ERIC Educational Resources Information Center

    Cretin, Shan; Shortell, Stephen M.; Keeler, Emmett B.

    2004-01-01

    The authors' dual-purpose evaluation assesses the effectiveness of formal collaboratives in stimulating organizational changes to improve chronic illness care (the chronic care model or CCM). Intervention and comparison sites are compared before and after introduction of the CCM. Multiple data sources are used to measure the degree of…

  14. A Peer-Delivered Educational Intervention to Improve Nursing Student Cyberprofessionalism.

    PubMed

    Marnocha, Suzanne; Marnocha, Mark; Cleveland, Rebecca; Lambie, Christina; Limberg, Cassandra Y; Wnuk, Jacqueline

    2017-03-01

    Previous research documents online unprofessionalism among nursing students. The current study assessed the effects of a peer-facilitated social media education session on changes in attitudes and knowledge among recently admitted prelicensure nursing students. Uncertain or incorrect attitudes and knowledge showed significant improvements after the session. Such interventions may enhance cyberprofessionalism in future student cohorts and warrant further exploration.

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

    ERIC Educational Resources Information Center

    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…

  16. Reducing Test Anxiety and Improving Academic Performance in Fourth Grade Students: Exploring an Intervention

    ERIC Educational Resources Information Center

    Donato, Jeanne M.

    2009-01-01

    This quantitative study investigated the effectiveness of a teacher-implemented intervention of eight sessions integrated into an existing curriculum to reduce test anxiety and improve academic performance in fourth grade students. The experimental group, n=23 was drawn from a sample of 64 students in a southwestern Rhode Island public school…

  17. The influence of health literacy level on an educational intervention to improve glaucoma medication adherence

    PubMed Central

    Muir, Kelly W.; Ventura, Alice; Stinnett, Sandra S.; Enfiedjian, Abraham; Allingham, R. Rand; Lee, Paul P.

    2013-01-01

    Objective To test an educational intervention targeted to health literacy level with the goal of improving glaucoma medication adherence. Methods One hundred and twenty-seven veterans with glaucoma were randomized to glaucoma education or standard care. The intervention included a video scripted at a 4th, 7th, or 10th grade level, depending on the subject’s literacy level. After six months, the number of days without glaucoma medicine (DWM) according to pharmacy records for the intervention and control groups was compared. Results The number of DWM in the six months following enrollment was similar for control and intervention groups (intervention, n = 67, DWM = 63 ± 198; standard care, n = 60, DWM = 65 ± 198; p = 0.708). For each subgroup of literacy (adequate, marginal, inadequate), subjects in the intervention group experienced less mean DWM than subjects in the control group and the effect size (ES) increased as literacy decreased: adequate literacy, ES 0.069; marginal, ES 0.183, inadequate, ES 0.363. Decreasing health literacy skills were associated with decreasing self-reported satisfaction with care (slope = 0.017, SE = 0.005, p = 0.002). Conclusions Patients with decreased health literacy skills may benefit from educational efforts tailored to address their health literacy level and learning style. Practice implications Providers should consider health literacy skills when engaging in glaucoma education. PMID:22000272

  18. Improvement in metabolic effects by dietary intervention is dependent on the precise nature of the developmental programming challenge.

    PubMed

    Bautista, C J; Guzmán, C; Rodríguez-González, G L; Zambrano, E

    2015-08-01

    Predisposition to offspring metabolic dysfunction due to poor maternal nutrition differs with the developmental stage at exposure. Post-weaning nutrition also influences offspring phenotype in either adverse or beneficial ways. We studied a well-established rat maternal protein-restriction model to determine whether post-weaning dietary intervention improves adverse outcomes produced by a deficient maternal nutritional environment in pregnancy. Pregnant rats were fed a controlled diet (C, 20% casein) during pregnancy and lactation (CC) or were fed a restricted diet (R, 10% casein isocaloric diet) during pregnancy and C diet during lactation (RC). After weaning, the offspring were fed the C diet. At postnatal day (PND) 70 (young adulthood), female offspring either continued with the C diet (CCC and RCC) or were fed commercial Chow Purina 5001 (I) to further divide the animals into dietary intervention groups CCI and RCI. Another group of mothers and offspring were fed I throughout (III). Offspring food intake was averaged between PND 95-110 and 235-250 and carcass and liver compositions were measured at PND 25 and 250. Leptin (PND 110 and 250) and serum glucose, triglycerides and cholesterol (PND 250) levels were measured. Statistical analysis was carried out using ANOVA. At PND 25, body and liver weights were similar between groups; however, CCC and RCC carcass protein:fat ratios were lower compared with III diet. At PND 110 and 250, offspring CCC and RCC had higher body weight, food intake and serum leptin compared with CCI and RCI. CCI had lower carcass fat and increased protein compared with CCC and improved fasting glucose and triglycerides. Adult dietary intervention partially overcomes adverse effects of programming. Further studies are needed to determine the mechanisms involved.

  19. The Health Impacts of Housing Improvement: A Systematic Review of Intervention Studies From 1887 to 2007

    PubMed Central

    Thomas, Sian; Sellstrom, Eva; Petticrew, Mark

    2009-01-01

    Objectives. We conducted a systematic review of the health impacts of housing improvement. Methods. Forty-two bibliographic databases were searched for housing intervention studies from 1887 to 2007. Studies were appraised independently by H. T. and S. T. or E. S. for sources of bias. The data were tabulated and synthesized narratively, taking into account study quality. Results. Forty-five relevant studies were identified. Improvements in general, respiratory, and mental health were reported following warmth improvement measures, but these health improvements varied across studies. Varied health impacts were reported following housing-led neighborhood renewal. Studies from the developing world suggest that provision of basic housing amenities may lead to reduced illness. There were few reports of adverse health impacts following housing improvement. Some studies reported that the housing improvement was associated with positive impacts on socioeconomic determinants of health. Conclusions. Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts. PMID:19890174

  20. A multifaceted prospective memory intervention to improve medication adherence: design of a randomized control trial.

    PubMed

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

    2013-01-01

    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 they relate 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.

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

    PubMed

    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.

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

    PubMed Central

    Athanasiou, Thanos

    2016-01-01

    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. PMID:26647411

  3. Improving Colorectal Cancer Screening in Asian Americans: Results of a Randomized Intervention Study

    PubMed Central

    Carney, Patricia A.; Lin, Frances Lee; Mongoue-Tchokote, Solange; Mori, Motomi; Leung, Holden; Lau, Christine; Le, TD; Lieberman, David A.

    2014-01-01

    Objective To test, using a randomized controlled trial design, the impact of an educational intervention delivered by specially trained community health workers among Chinese, Korean and Vietnamese participants aged 50–75 on knowledge, attitudes, beliefs and intention regarding colorectal cancer screening. Methods We collected baseline data on participants’ baseline demographic characteristics, knowledge, attitudes, beliefs about cancer, its risk factors and intention to keep up-to-date on cancer screening in the future. Fifteen intervention sessions were held between April and June of 2011. Follow-up surveys were administered in the post-test period to both intervention and control participants. Those randomized to the control group received educational pamphlets in their native language. Results The intervention had the greatest influence on the Chinese subgroup, which had improved scores relative to the control group for Perceived Behavior Control and Intentions (pre- vs. post- change in control group −0.16; change in intervention group 0.11, p=0.004), Behavioral Beliefs on Cancer Screening (pre- vs. post- change in control group −0.06; change in intervention group 0.24, p=0.0001), and for Attitudes Toward Behavior (pre- vs. post- change in control group −0.24; change in intervention group 0.35, p=<0.0001). The intervention had no effect on Behavioral Beliefs on Cancer, Control Beliefs, and Perceived Behavioral Control (Reliance on Family). Though intention to stay up-to-date for cancer screening increased in two study groups (Chinese and Vietnamese), these were not significant. Conclusions An educational program delivered by culturally specific community health educators using culturally appropriate language influences some knowledge, attitude and behavioral beliefs but not others. PMID:24595714

  4. Efficacy and safety of a multifactor intervention to improve therapeutic adherence in patients with chronic obstructive pulmonary disease (COPD): protocol for the ICEPOC study

    PubMed Central

    2011-01-01

    Background Low therapeutic adherence to medication is very common. Clinical effectiveness is related to dose rate and route of administration and so poor therapeutic adherence can reduce the clinical benefit of treatment. The therapeutic adherence of patients with chronic obstructive pulmonary disease (COPD) is extremely poor according to most studies. The research about COPD adherence has mainly focussed on quantifying its effect, and few studies have researched factors that affect non-adherence. Our study will evaluate the effectiveness of a multifactor intervention to improve the therapeutic adherence of COPD patients. Methods/Design A randomized controlled clinical trial with 140 COPD diagnosed patients selected by a non-probabilistic method of sampling. Subjects will be randomly allocated into two groups, using the block randomization technique. Every patient in each group will be visited four times during the year of the study. Intervention: Motivational aspects related to adherence (beliefs and behaviour): group and individual interviews; cognitive aspects: information about illness; skills: inhaled technique training. Reinforcement of the cognitive-emotional aspects and inhaled technique training will be carried out in all visits of the intervention group. Discussion Adherence to a prescribed treatment involves a behavioural change. Cognitive, emotional and motivational aspects influence this change and so we consider the best intervention procedure to improve adherence would be a cognitive and emotional strategy which could be applied in daily clinical practice. Our hypothesis is that the application of a multifactor intervention (COPD information, dose reminders and reinforcing audiovisual material, motivational aspects and inhalation technique training) to COPD patients taking inhaled treatment will give a 25% increase in the number of patients showing therapeutic adherence in this group compared to the control group. We will evaluate the effectiveness

  5. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice.

    PubMed Central

    Oxman, A D; Thomson, M A; Davis, D A; Haynes, R B

    1995-01-01

    OBJECTIVE: To determine the effectiveness of different types of interventions in improving health professional performance and health outcomes. DATA SOURCES: MEDLINE, SCISEARCH, CINAHL and the Research and Development Resource Base in CME were searched for trials of educational interventions in the health care professions published between 1970 and 1993 inclusive. STUDY SELECTION: Studies were selected if they provided objective measurements of health professional performance or health outcomes and employed random or quasi-random allocation methods in their study designs to assign individual subjects or groups. Interventions included such activities as conferences, outreach visits, the use of local opinion leaders, audit and feedback, and reminder systems. DATA EXTRACTION: Details extracted from the studies included the study design; the unit of allocation (e.g., patient, provider, practice, hospital); the characteristics of the targeted health care professionals, educational interventions and patients (when appropriate); and the main outcome measure. DATA SYNTHESIS: The inclusion criteria were met by 102 trials. Areas of behaviour change included general patient management, preventive services, prescribing practices, treatment of specific conditions such as hypertension or diabetes, and diagnostic service or hospital utilization. Dissemination-only strategies, such as conferences or the mailing of unsolicited materials, demonstrated little or no changes in health professional behaviour or health outcome when used alone. More complex interventions, such as the use of outreach visits or local opinion leaders, ranged from ineffective to highly effective but were most often moderately effective (resulting in reductions of 20% to 50% in the incidence of inappropriate performance). CONCLUSION: There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important

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

    PubMed

    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

  7. A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia)

    PubMed Central

    Vallès-Fernandez, Roser; Rosell-Murphy, Magdalena; Correcher-Aventin, Olga; Mengual-Martínez, Lucas; Aznar-Martínez, Núria; Prieto-De Lamo, Gemma; Franzi-Sisó, Alícia; Puig-Manresa, Jordi; Ma Bonet-Simó, Josep

    2009-01-01

    Background Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. Methods and design Design: multicentric study quasi-experimental before – after with control group. The non-randomised allocation of the intervention will be done at PHCT level. Setting: 18 PHCT in the Barcelona province (Spain). Sample: all patients with a diagnosis of hypertension (population based study). Exclusion criteria: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. Intervention: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. Measurements: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. Analysis: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables

  8. A pragmatic approach to measuring, monitoring and evaluating interventions for improved tuberculosis case detection.

    PubMed

    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.

  9. Wireless Mobile Technology to Improve Workflow and Feasibility of MR-Guided Percutaneous Interventions

    PubMed Central

    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

  10. A pragmatic approach to measuring, monitoring and evaluating interventions for improved tuberculosis case detection

    PubMed Central

    Blok, Lucie; Creswell, Jacob; Stevens, Robert; Brouwer, Miranda; Ramis, Oriol; Weil, Olivier; Klatser, Paul; Sahu, Suvanand; Bakker, Mirjam I.

    2014-01-01

    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. PMID:25100402

  11. A Description and Qualitative Assessment of a 4-Year Intervention to Improve Patient Counseling by Improving Medical Student Health

    PubMed Central

    Frank, Erica; Smith, Donna; Fitzmaurice, Dorothy

    2005-01-01

    Background To test whether promoting medical student health could efficiently improve patient counseling, we developed and implemented a 4-year-long curricular and extracurricular intervention to promote healthy behaviors among students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia. Methods We asked students: (1) “What did you think about these [listed intervention components]”; (2) “did any of these interventions influence your personal health habits/attitudes toward your personal health”; and (3) “did any of these interventions influence your behavior or attitudes regarding current or future clinical practices, including history taking or counseling? If so, how? If not, why not?” Students evaluated the effectiveness of these formats and proposed changes in our intervention. The focus groups were transcribed and analyzed with QSR N5. Results Several major themes emerged from the focus groups: Listen to the students early, often, substantively, and noticeably;Incorporate many faculty and student leaders;Quietly integrate the curricular activities into the regular curriculum;Provide a strong, science-based, pragmatic prevention curriculum to complement the personal health promotion;Don't just use lectures to teach;Offer plentiful, nonrequired, fun extracurriculars;Don't nag;Have achievable interventions and recommendations;Provide collective data, but don't overexpose the students to it, and don't assume that collective data apply to every student, especially if it's unpleasant news;Provide personalized data where possible; andUncouple evaluations from the intervention, and keep evaluations brief. Conclusions Some students seemed pleased to have their medical school be attentive to their health, and believed that the project positively influenced their personal health practices and clinical practices (which was our goal). The students enjoyed many components of the intervention, especially the extracurricular activities

  12. Behavioral Interventions to Improve Asthma Outcomes for Adolescents: A Systematic Review

    PubMed Central

    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

  13. Tier 2 Supports to Improve Motivation and Performance of Elementary Students with Behavioral Challenges and Poor Work Completion

    ERIC Educational Resources Information Center

    Oakes, Wendy Peia; Lane, Kathleen Lynne; Cox, Meredith; Magrane, Ashley; Jenkins, Abbie; Hankins, Katy

    2012-01-01

    We offer a methodological illustration for researchers and practitioners of how to conduct a development study consistent with the parameters delineated by the Institute of Education Sciences (IES; U.S. Department of Education [USDE], 2010) to explore the utility of an existing Tier 1 intervention applied as a Tier 2 support within a three-tiered…

  14. Analysis of the Efficacy of an Intervention to Improve Parent-Adolescent Problem Solving.

    PubMed

    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.

  15. Analysis of the Efficacy of an Intervention to Improve Parent-Adolescent Problem Solving

    PubMed Central

    Semeniuk, Yulia Yuriyivna; Brown, Roger L.; Riesch, Susan K.

    2016-01-01

    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. PMID:26936844

  16. Research on culturally tailored interventions aimed at improving chronic disease risk factors and management.

    PubMed

    Dorrejo, Xiomara M; Wilson, Paula

    2012-10-01

    High blood pressure (HBP) is a worldwide epidemic with health and economic consequences. Although there is a growing body of knowledge, treatment options, and clinical guidelines, a small percentage of people with hypertension (HTN) achieve optimal control. In addition, HBP disproportionately affects racial and ethnic minorities. Strategies to address the management of HTN among specific populations remain scarce. Evidence shows that successful management of HTN requires pharmacological, educational, and self-care approaches. The first 3 summaries here profile research addressing this issue. The research focuses on the tailoring of interventions for racial and ethnic minority groups, specifically African Americans and Korean Americans. The fourth summary profiles an intervention targeted at a low-literacy group to improve diet. Readers are encouraged to access the full articles to learn more details about the intervention strategies and outcomes of these initiatives.

  17. Pro-Poor PRIMR: Improving Early Literacy Skills for Children from Low-Income Families in Kenya

    ERIC Educational Resources Information Center

    Piper, Benjamin; Jepkemei, Evelyn; Kibukho, Kennedy

    2015-01-01

    Children from low-income families are at risk of learning outcome difficulties, particularly in literacy. Various studies link poor literacy results with performance later in primary and secondary school, and suggest that poverty, literacy skills and weak instructional methods combine to drastically limit the educational opportunities for many…

  18. Building BRIDGES: A Design Experiment to Improve Reading and United States History Knowledge of Poor Readers in Eighth Grade

    ERIC Educational Resources Information Center

    O'Connor, Rollanda E.; Beach, Kristen D.; Sanchez, Victoria M.; Bocian, Kathleen M.; Flynn, Lindsay J.

    2015-01-01

    We tested the effects of teaching reading skills through U.S. history content for 38 eighth-grade poor readers whose reading ability ranged from second-to fourth-grade levels. Half of the students received special education services, and half of the students were English language learners. Students were taught to decode multisyllabic words, learn…

  19. Interventions to improve the use of antimalarials in south-east Asia: an overview.

    PubMed Central

    Gomes, M.; Wayling, S.; Pang, L.

    1998-01-01

    There are few drugs for malaria, and those which are available for use are subject to rapid development of resistance. Curiously, little effort has been made to improve drug use in malaria-endemic countries and to assess the benefits of such improvements. Advances can be made in public understanding of the value of ingesting a full regimen of antimalarials, in order to achieve complete cure, and in improving simple technologies (blister packaging) to achieve the same result. Better efforts can be made to reduce the availability of fake or substandard drugs in the marketplace. In this article, we describe the outcome of a concerted effort to improve drug compliance and drug quality in an area of multidrug resistance for malaria. These research efforts, guided by the Task Force for Improved Use of Antimalarials, characterized the problems in drug compliance in South-East Asia, and developed interventions to improve drug use in the various countries. Interventions involved drug packaging, public information campaigns, and assessments of drug quality. Results show that blister packaging worked best to improve drug compliance and that the increased cost of packaged medication did not limit its use. Drug quality was a major problem in unregulated countries and should be improved. PMID:9763718

  20. Interventions to Improve Neonatal Health and Later Survival: An Overview of Systematic Reviews

    PubMed Central

    Lassi, Zohra S.; Middleton, Philippa F.; Crowther, Caroline; Bhutta, Zulfiqar A.

    2015-01-01

    Background Evidence-based interventions and strategies are needed to improve child survival in countries with a high burden of neonatal and child mortality. An overview of systematic reviews can focus implementation on the most effective ways to increase child survival. Methods In this overview we included published Cochrane and other systematic reviews of experimental and observational studies on antenatal, childbirth, postnatal and child health interventions aiming to prevent perinatal/neonatal and child mortality using the WHO list of essential interventions. We assessed the methodological quality of the reviews using the AMSTAR criteria and assessed the quality of the outcomes using the GRADE approach. Based on the findings from GRADE criteria, interventions were summarized as effective, promising or ineffective. Findings The overview identified 148 Cochrane and other systematic reviews on 61 reproductive, maternal, newborn and child health interventions. Of these, only 57 reviews reported mortality outcomes. Using the GRADE approach, antenatal corticosteroids for preventing neonatal respiratory distress syndrome in preterm infants; early initiation of breastfeeding; hygienic cord care; kangaroo care for preterm infants; provision and promotion of use of insecticide treated bed nets (ITNs) for children; and vitamin A supplementation for infants from six months of age, were identified as clearly effective interventions for reducing neonatal, infant or child mortality. Antenatal care, tetanus immunization in pregnancy, prophylactic antimalarials during pregnancy, induction of labour for prolonged pregnancy, case management of neonatal sepsis, meningitis and pneumonia, prophylactic and therapeutic use of surfactant, continuous positive airway pressure for neonatal resuscitation, case management of childhood malaria and pneumonia, vitamin A as part of treatment for measles associated pneumonia for children above 6 months, and home visits across the continuum of

  1. Intervention to improve social and family support for caregivers of dependent patients: ICIAS study protocol

    PubMed Central

    2014-01-01

    Background Despite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver. Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life. Methods/design Design: Controlled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT). Study area: Primary Health Care network (9 PHCTs). Study participants: Primary informal caregivers of patients receiving home health care from participating PHCTs. Sample: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group. Intervention: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support. Control: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request. Data analysis Dependent variables: Caregiver burden (short-form Zarit test), caregivers’ social support (Medical Outcomes Study), and

  2. Feasibility and Acceptability of Health Communication Interventions Within a Combination Intervention Strategy for Improving Linkage and Retention in HIV Care in Mozambique

    PubMed Central

    Lahuerta, Maria; Abacassamo, Fatima; Ahoua, Laurence; Tomo, Maria; Lamb, Matthew R.; Elul, Batya

    2017-01-01

    Background: 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. Methods: 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. Results: 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. Discussion: Findings demonstrate that health communication interventions can be feasibly and acceptably integrated with structural interventions to create combination intervention strategies. PMID:27930609

  3. Community Interventions to Improve Glycemic Control in African Americans With Type 2 Diabetes: A Systemic Review

    PubMed Central

    Smalls, Brittany L.; Walker, Rebekah J.; Bonilha, Heather S.; Campbell, Jennifer A.; Egede, Leonard E.

    2015-01-01

    Purpose: The purpose of this study was to conduct a systematic review of published community interventions to evaluate different components of community interventions and their ability to positively impact glycemic control in African Americans with T2DM. Methods: Medline, PsychInfo, and CINAHL were searched for potentially eligible studies published from January 2000 through January 2012. The following inclusion criteria were established for publications: (1) describe a community intervention, not prevention; (2) specifically indicate, in data analysis and results, the impact of the community intervention on African American adults, 18 years and older; (3) measure glycemic control (HbA1C) as an outcome measure; and (4) involve patients in a community setting, which excludes hospitals and hospital clinics. Results: Thirteen studies out of 9,233 articles identified in the search met the predetermined inclusion criteria. There were 5 randomized control trials and 3 reported improved glycemic control in the intervention group compared to the control group at the completion of the study. Of the 8 studies that were not randomized control trials, 6 showed a statistically significant change in HbA1C. Conclusion: In general, the community interventions assessed led to significant reductions in HbA1C in African Americans with type 2 diabetes. Community health workers did not have a greater impact on glycemic control in this sample. The findings of this study provides insight for designing community-based interventions in the future, such as including use of multiple delivery methods, consideration of mobile device software, nutritionist educator, and curriculum-based approaches. PMID:26156923

  4. "PHE in Action": Development and Modeling of an Intervention to Improve Patient Engagement among Older Adults.

    PubMed

    Menichetti, Julia; Graffigna, Guendalina

    2016-01-01

    The increasing prevalence of chronic conditions among older adults constitutes a major public health problem. Thus, changes in lifestyles are required to prevent secondary conditions and sustain good care practices. While patient engagement received great attention in the last years as key strategy to solve this issue, to date no interventions exist to sustain the engagement of older chronic patients toward their health management. This study describes the design, development, and optimization of PHEinAction, a theoretically-driven intervention program to increase patient engagement in older chronic populations and consequently to foster healthy changes that can help reduce risks of health problems. The development process followed the UK Medical Research Council's (MRC) guidelines and involved selecting the theoretical base for the intervention, identifying the relevant evidence-based literature, and conducting exploratory research to qualitatively evaluate program's feasibility, acceptability, and comprehension. The result was a user-endorsed intervention designed to improve older patients' engagement in health management based on the theoretical framework of the Patient Health Engagement (PHE) model. The intervention program, which emerged from this process, consisted of 2 monthly face-to-face 1-h sessions delivered by a trained facilitator and one brief telephonic consultation, and aimed to facilitate a range of changes for patient engagement (e.g., motivation to change, health information seeking and use, emotional adjustment, health behaviors planning). PHEinAction is the first example of a theoretically-based patient engagement intervention designed for older chronic targets. The intervention program is based on psychological theory and evidence; it facilitates emotional, psychological, and behavioral processes to support patient engagement and lifestyle change and maintenance. It provides estimates of the extent to which it could help high-risk groups

  5. Improving Decision Making about Genetic Testing in the Clinic: An Overview of Effective Knowledge Translation Interventions

    PubMed Central

    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

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

    PubMed Central

    Villar, Jesús; Pérez-Méndez, Lina

    2007-01-01

    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 < 0.0001). The most common error in the completion of death certificates was the listing of the mechanism of death instead of the cause of death. Before the seminar, 56.8% listed respiratory or cardiac arrest as the immediate cause of death. None of the participants listed any mechanism of death after the educational intervention (p < 0.0001). 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. PMID:18005414

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

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    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 Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an

  8. A novel school-based intervention to improve nutrition knowledge in children: cluster randomised controlled trial

    PubMed Central

    2010-01-01

    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 < 0.001). Most children (75.5%) enjoyed playing the game and teachers considered it a useful resource. 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. PMID:20219104

  9. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand

    PubMed Central

    Bhutta, Zulfiqar A; Darmstadt, Gary L; Haws, Rachel A; Yakoob, Mohammad Yawar; Lawn, Joy E

    2009-01-01

    Background Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. Methods We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. Results In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the

  10. Study protocol for a randomized controlled trial to assess the feasibility of an open label intervention to improve hydroxyurea adherence in youth with sickle cell disease

    PubMed Central

    Smaldone, Arlene; Findley, Sally; Bakken, Suzanne; Matiz, L. Adriana; Rosenthal, Susan L.; Jia, Haomiao; Matos, Sergio; Manwani, Deepa; Green, Nancy S.

    2016-01-01

    Background Community health workers (CHW) are increasingly recognized as a strategy to improve health outcomes for the underserved with chronic diseases but has not been formally explored in adolescents with sickle cell disease (SCD). SCD primarily affects African American, Hispanic and other traditionally underserved populations. Hydroxyurea (HU), an oral, once-daily medication, is the only approved therapeutic drug for sickle cell disease and markedly reduces symptoms, morbidity and mortality and improves quality of life largely by increasing hemoglobin F blood levels. This paper presents the rationale, study design and protocol for an open label randomized controlled trial to improve parent-youth partnerships in self-management and medication adherence to HU in adolescents with SCD. Methods/Design A CHW intervention augmented by text messaging was designed for adolescents with SCD ages 10–18 years and their parents to improve daily HU adherence. Thirty adolescent parent dyads will be randomized with 2:1 intervention group allocation. Intervention dyads will establish a relationship with a culturally aligned CHW to identify barriers to HU use, identify cues to build a habit, and develop a dyad partnership to improve daily HU adherence and achieve their individualized “personal best” hemoglobin F target. Intervention feasibility, acceptability and efficacy will be assessed via a 2-site trial. Outcomes of interest are HU adherence, dyad self-management communication, quality of life, and resource use. Discussion Despite known benefits, poor HU adherence is common. If feasible and acceptable, the proposed intervention may improve health of underserved adolescents with SCD by enhancing long-term HU adherence. PMID:27327779

  11. The effectiveness of a bundled intervention to improve resident progress notes in an electronic health record.

    PubMed

    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.

  12. A repeated short educational intervention improves asthma control and quality of life.

    PubMed

    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 (p<0.001), but improvements 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.

  13. Cholesterol-lowering interventions and stroke: Insights from IMPROVE-IT.

    PubMed

    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.

  14. Essential pre-pregnancy and pregnancy interventions for improved maternal, newborn and child health

    PubMed Central

    2014-01-01

    The statistics related to pregnancy and its outcomes are staggering: annually, an estimated 250000-280000 women die during childbirth. Unfortunately, a large number of women receive little or no care during or before pregnancy. At a period of critical vulnerability, interventions can be effectively delivered to improve the health of women and their newborns and also to make their pregnancy safe. This paper reviews the interventions that are most effective during preconception and pregnancy period and synergistically improve maternal and neonatal outcomes. Among pre-pregnancy interventions, family planning and advocating pregnancies at appropriate intervals; prevention and management of sexually transmitted infections including HIV; and peri-conceptual folic-acid supplementation have shown significant impact on reducing maternal and neonatal morbidity and mortality. During pregnancy, interventions including antenatal care visit model; iron and folic acid supplementation; tetanus Immunisation; prevention and management of malaria; prevention and management of HIV and PMTCT; calcium for hypertension; anti-Platelet agents (low dose aspirin) for prevention of Pre-eclampsia; anti-hypertensives for treating severe hypertension; management of pregnancy-induced hypertension/eclampsia; external cephalic version for breech presentation at term (>36 weeks); management of preterm, premature rupture of membranes; management of unintended pregnancy; and home visits for women and children across the continuum of care have shown maximum impact on reducing the burden of maternal and newborn morbidity and mortality. All of the interventions summarized in this paper have the potential to improve maternal mortality rates and also contribute to better health care practices during preconception and periconception period. PMID:25178042

  15. Interventions to improve care coordination between primary healthcare and oncology care providers: a systematic review

    PubMed Central

    Tomasone, Jennifer R; Brouwers, Melissa C; Vukmirovic, Marija; Grunfeld, Eva; O'Brien, Mary Ann; Urquhart, Robin; Walker, Melanie; Webster, Fiona; Fitch, Margaret

    2016-01-01

    Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. Trial registration number CRD42015025006. PMID:27843639

  16. Effectiveness of a Barber-Based Intervention for Improving Hypertension Control in Black Men

    PubMed Central

    Victor, Ronald G.; Ravenell, Joseph E.; Freeman, Anne; Leonard, David; Bhat, Deepa G.; Shafiq, Moiz; Knowles, Patricia; Storm, Joy S.; Adhikari, Emily; Bibbins-Domingo, Kirsten; Coxson, Pamela G.; Pletcher, Mark J.; Hannan, Peter; Haley, Robert W.

    2012-01-01

    Context Barbershop-based hypertension (HTN) outreach programs for black men are becoming increasingly common, but whether they are an effective approach for improving HTN control remains uncertain. Objective To evaluate whether a continuous high blood pressure (BP) monitoring and referral program conducted by barbers will motivate male patrons with elevated BP to pursue physician follow-up, leading to improved HTN control. Design, Setting, and Participants Cluster randomized trial (Barber-Assisted Reduction in Blood Pressure in Ethnic Residents [BARBER-1]) of HTN control among black male patrons of 17 black-owned barbershops in Dallas County, Texas (March 2006-December 2008). Intervention Black male patrons of participating barbershops underwent 10-week baseline BP screening. Study sites were then randomized to a comparison group (8 shops, 77 hypertensives/shop) that received standard BP pamphlets or an intervention group (9 shops, 75 hypertensives/shop) in which barbers continually offered BP checks with haircuts and promoted physician follow-up with gender-specific peer-based health messaging. After 10 months, follow-up data were obtained. Primary Outcome Measure Change in HTN control rate for each barbershop. Results The HTN control rate increased more in intervention-arm barbershops than in comparison-arm barbershops (absolute group difference, 8.8%; 95% confidence interval [CI], 0.8 to 16.9%; P=0.036); the intervention effect persisted after adjustment for covariates (P=0.031). A marginal intervention effect was found for systolic BP change (absolute group difference: −2.5 mmHg; 95% CI, −5.3 to 0.3 mmHg; P=0.08). Conclusion The effect of BP screening on HTN control among black male barbershop patrons was improved when barbers were enabled to become health educators, monitor BP, and promote physician referral. Further research is warranted. Trial registration clinicalTrials.gov Identifier NCT00325533 PMID:20975012

  17. Feasibility and acceptability of the TALK social worker intervention to improve live kidney transplantation.

    PubMed

    DePasquale, Nicole; Hill-Briggs, Felicia; Darrell, Linda; Boyér, LaPricia Lewis; Ephraim, Patti; Boulware, L Ebony

    2012-11-01

    Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with progressive chronic kidney disease in a recent randomized controlled trial: Patients and their families were invited to meet twice with a social worker to discuss their self-identified barriers to seeking LKT and to identify solutions to barriers. The authors audio recorded and transcribed all social worker visits to assess implementation of the TALK SWI and its acceptability to patients and families. The study social worker adhered to the TALK SWI protocol more than 90 percent of the time. Patients and families discussed medical (for example, long-term risks of transplant), psychological (for example, patients' denial of the severity of their disease), and economic (for example, impact of donation on family finances) concerns regarding LKT. Most patients and families felt that the intervention was helpful. Consistently high adherence to the TALK SWI protocol and acceptability of the intervention among patients and families suggest that the TALK SWI can be feasibly implemented in clinical practice.

  18. Piloting Lead with Love: A film-based intervention to improve parents’ responses to their lesbian, gay, and bisexual children

    PubMed Central

    Huebner, David M.; Rullo, Jordan E.; Thoma, Brian C.; McGarrity, Larissa; Mackenzie, Jenny

    2013-01-01

    Lesbian, gay, and bisexual youth are at increased risk for a variety of poor health outcomes, relative to their heterosexual counterparts, and recent research implicates family responses to a child’s sexual orientation as an important predictor of these health difficulties. Lead with Love is a 35-minute documentary-style preventive intervention created to improve parents’ behaviors toward their lesbian, gay, and bisexual (LGB) children, by providing parents with support, information, and concrete behavioral guidance. The film was made available free online, and was promoted widely with a multi-media marketing campaign. In this paper we describe the theoretical and empirical rationale for the intervention, and report findings from pilot data collected in the first year after the film’s release. Specifically, we gathered data to examine the feasibility of reaching parents of LGB youth with this intervention, to determine whether it was acceptable, and to provide preliminary indicators of its potential efficacy. In the first 12 months after launch, 10,949 individuals viewed the film online. The film successfully reached parents of LGB youth (n = 1,865), including the hardest to reach parents: 21% had only learned about their child’s sexual orientation in the past month, 36% reported having an LGB child was “very” or “extremely” hard for them, and 86% had never obtained any other formal support for having an LGB child. Parents who completed a follow-up assessment immediately after the film reported significant pre- to post-film increases in self-efficacy for parenting an LGB child. PMID:23943135

  19. Rationale and study design of a patient-centered intervention to improve health status in chronic heart failure: The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) randomized trial.

    PubMed

    Bekelman, David B; Allen, Larry A; Peterson, Jamie; Hattler, Brack; Havranek, Edward P; Fairclough, Diane L; McBryde, Connor F; Meek, Paula M

    2016-11-01

    While contemporary heart failure management has led to some improvements in morbidity and mortality, patients continue to report poor health status (i.e., burdensome symptoms, impaired function, and poor quality of life). The Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) trial is a NIH-funded, three-site, randomized clinical trial that examines the effect of the CASA intervention compared to usual care on the primary outcome of patient-reported health status at 6months in patients with heart failure and poor health status. The CASA intervention involves a nurse who works with patients to treat symptoms (e.g., shortness of breath, fatigue, pain) using disease-specific and palliative approaches, and a social worker who provides psychosocial care targeting depression and adjustment to illness. The intervention uses a collaborative care team model of health care delivery and is structured and primarily phone-based to enhance reproducibility and scalability. This article describes the rationale and design of the CASA trial, including several decision points: (1) how to design a patient-centered intervention to improve health status; (2) how to structure the intervention so that it is reproducible and scalable; and (3) how to systematically identify outpatients with heart failure most likely to need and benefit from the intervention. The results should provide valuable information to providers and health systems about the use of team care to manage symptoms and provide psychosocial care in chronic illness.

  20. The links between agriculture and health: an intersectoral opportunity to improve the health and livelihoods of the poor.

    PubMed Central

    Hawkes, Corinna; Ruel, Marie

    2006-01-01

    Agriculture and health are linked in many ways. First, agriculture is essential for good health: it produces the world's food, fibre and materials for shelter; in many countries it is also an important source of livelihood among the poor. At the same time, agriculture can be linked with poor health, including malnutrition, malaria, foodborne illnesses, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), livestock-related diseases, chronic diseases and occupational ill-health. Health also affects agriculture: people's health status influences the demand for agricultural outputs, and in agricultural communities, poor health reduces work performance, reducing income and productivity and perpetuating a downward spiral into ill-health. This paper presents an overview of the bidirectional links between agriculture and health with a focus on the developing world. It develops a conceptual framework that brings together the various links between agriculture and health into a single broad framework. The framework comprises the core components of the agricultural supply chain (producers, systems and outputs), key health concerns and the mechanisms of common interaction between the agricultural and health components: income, labour, environment and access -- all key social determinants of health. These links between agriculture and health present an opportunity for the two sectors to work together to find solutions to each other's problems. Yet the health and agricultural sectors remain poorly coordinated. Leadership from global health and agricultural institutions is needed to build policies and good governance to facilitate integration, while capacity building is needed at all levels to help translate the conceptual links into comprehensive action on the ground. Health and agricultural researchers likewise need to work more closely together to achieve common goals. PMID:17242835

  1. The links between agriculture and health: an intersectoral opportunity to improve the health and livelihoods of the poor.

    PubMed

    Hawkes, Corinna; Ruel, Marie

    2006-12-01

    Agriculture and health are linked in many ways. First, agriculture is essential for good health: it produces the world's food, fibre and materials for shelter; in many countries it is also an important source of livelihood among the poor. At the same time, agriculture can be linked with poor health, including malnutrition, malaria, foodborne illnesses, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), livestock-related diseases, chronic diseases and occupational ill-health. Health also affects agriculture: people's health status influences the demand for agricultural outputs, and in agricultural communities, poor health reduces work performance, reducing income and productivity and perpetuating a downward spiral into ill-health. This paper presents an overview of the bidirectional links between agriculture and health with a focus on the developing world. It develops a conceptual framework that brings together the various links between agriculture and health into a single broad framework. The framework comprises the core components of the agricultural supply chain (producers, systems and outputs), key health concerns and the mechanisms of common interaction between the agricultural and health components: income, labour, environment and access -- all key social determinants of health. These links between agriculture and health present an opportunity for the two sectors to work together to find solutions to each other's problems. Yet the health and agricultural sectors remain poorly coordinated. Leadership from global health and agricultural institutions is needed to build policies and good governance to facilitate integration, while capacity building is needed at all levels to help translate the conceptual links into comprehensive action on the ground. Health and agricultural researchers likewise need to work more closely together to achieve common goals.

  2. Towards improved solubility of poorly water-soluble drugs: cryogenic co-grinding of piroxicam with carrier polymers.

    PubMed

    Penkina, Anna; Semjonov, Kristian; Hakola, Maija; Vuorinen, Sirpa; Repo, Timo; Yliruusi, Jouko; Aruväli, Jaan; Kogermann, Karin; Veski, Peep; Heinämäki, Jyrki

    2016-01-01

    Amorphous solid dispersions (SDs) open up exciting opportunities in formulating poorly water-soluble active pharmaceutical ingredients (APIs). In the present study, novel catalytic pretreated softwood cellulose (CPSC) and polyvinylpyrrolidone (PVP) were investigated as carrier polymers for preparing and stabilizing cryogenic co-ground SDs of poorly water-soluble piroxicam (PRX). CPSC was isolated from pine wood (Pinus sylvestris). Raman and Fourier transform infrared (FTIR) spectroscopy, X-ray powder diffraction (XRPD) and differential scanning calorimetry (DSC) were used for characterizing the solid-state changes and drug-polymer interactions. High-resolution scanning electron microscope (SEM) was used to analyze the particle size and surface morphology of starting materials and final cryogenic co-ground SDs. In addition, the molecular aspects of drug-polymer interactions and stabilization mechanisms are presented. The results showed that the carrier polymer influenced both the degree of amorphization of PRX and stabilization against crystallization. The cryogenic co-ground SDs prepared from PVP showed an enhanced dissolution rate of PRX, while the corresponding SDs prepared from CPSC exhibited a clear sustained release behavior. In conclusion, cryogenic co-grinding provides a versatile method for preparing amorphous SDs of poorly water-soluble APIs. The solid-state stability and dissolution behavior of such co-ground SDs are to a great extent dependent on the carrier polymer used.

  3. The novel formulation design of O/W microemulsion for improving the gastrointestinal absorption of poorly water soluble compounds.

    PubMed

    Araya, Hiroshi; Tomita, Mikio; Hayashi, Masahiro

    2005-11-23

    The design of the novel O/W microemulsion formulation, which enhances the oral bioavailability by raising the solubility of poorly water soluble compounds was examined. Using medium chain fatty acid triglyceride (MCT), diglyceryl monooleate (DGMO-C), polyoxyethylene hydrogenated castor oil 40 (HCO-40), ethanol and PBS (pH 6.8) as an oil phase, a lipophilic surfactant, a hydrophilic surfactant, a solubilizer and an aqueous phase, at the mixture ratio of 5%/1%/9%/5%/80% (w/w), respectively, the O/W microemulsion with an average particle diameter of 20 nm or less was prepared. Moreover, for nine kinds of poorly water soluble compounds, such as Ibuprofen, Ketoprofen, Tamoxifen, Testosterone, Tolbutamide and other new compounds, the solubility to water was increased from 60 to 20,000 times by this O/W microemulsion formulation. The AUCs in plasma concentration of Ibuprofen and a new compound, ER-1039, following single oral administration of these compounds as the O/W microemulsion to fasted rats were equivalent to that of solution administration or increased by nine and two times that of suspension administration, respectively. Accordingly, this novel O/W microemulsion is a useful formulation, which enhances the oral bioavailability by raising the solubility of poorly water soluble compounds.

  4. The intelligence of observation: improving high school students' spatial ability by means of intervention unit

    NASA Astrophysics Data System (ADS)

    Patkin, Dorit; Dayan, Ester

    2013-03-01

    This case study of one class versus a control group focused on the impact of an intervention unit, which is not part of the regular curriculum, on the improvement of spatial ability of high school students (forty-six 12th-graders, aged 17-18, both boys and girls) in general as well as from a gender perspective. The study explored three sub-abilities: mental rotation (MR), spatial visualization (VS) and spatial orientation (SO). Findings indicated that the spatial orientation of the experimental group students had considerably improved. The findings also illustrated a significant gender-based advantage in favour of the boys in some of the spatial abilities even before the implementation of the intervention unit. The hypothesis relating to the reduction of the gender differences was not corroborated.

  5. Considering context in quality improvement interventions and implementation: concepts, frameworks, and application.

    PubMed

    McDonald, Kathryn M

    2013-01-01

    Growing consensus within the health care field suggests that context matters and needs more concerted study for helping those who implement and conduct research on quality improvement interventions. Health care delivery system decision makers require information about whether an intervention tested in one context will work in another with some differences from the original site. We aimed to define key terms, enumerate candidate domains for the study of context, provide examples from the pediatric quality improvement literature, and identify potential measures for selected contexts. Key sources include the organizational literature, broad evaluation frameworks, and a recent project in the patient safety area on context sensitivity. The article concludes with limitations and next steps for developments in this area.

  6. Evaluation of an intervention aimed at improving voluntary incident reporting in hospitals

    PubMed Central

    Evans, Sue M; Smith, Brian J; Esterman, Adrian; Runciman, William B; Maddern, Guy; Stead, Karen; Selim, Pam; O'Shaughnessy, Jane; Muecke, Sandy; Jones, Sue

    2007-01-01

    Objectives To assess the effectiveness of an intervention package comprising intense education, a range of reporting options, changes in report management and enhanced feedback, in order to improve incident‐reporting rates and change the types of incidents reported. Design, setting and participants Non‐equivalent group controlled clinical trial involving medical and nursing staff working in 10 intervention and 10 control units in four major cities and two regional hospitals in South Australia. Main outcome measures Comparison of reporting rates by type of unit, profession, location of hospital, type of incident reported and reporting mechanism between baseline and study periods in control and intervention units. Results The intervention resulted in significant improvement in reporting in inpatient areas (additional 60.3 reports/10 000 occupied bed days (OBDs); 95% CI 23.8 to 96.8, p<0.001) and in emergency departments (EDs) (additional 39.5 reports/10 000 ED attendances; 95% CI 17.0 to 62.0, p<0.001). More reports were generated (a) by doctors in EDs (additional 9.5 reports/10 000 ED attendances; 95% CI 2.2 to 16.8, p = 0.001); (b) by nurses in inpatient areas (additional 59.0 reports/10 000 OBDs; 95% CI 23.9 to 94.1, p<0.001) and (c) anonymously (additional 20.2 reports/10 000 OBDs and ED attendances combined; 95% CI 12.6 to 27.8, p<0.001). Compared with control units, the study resulted in more documentation, clinical management and aggression‐related incidents in intervention units. In intervention units, more reports were submitted on one‐page forms than via the call centre (1005 vs 264 reports, respectively). Conclusions A greater variety and number of incidents were reported by the intervention units during the study, with improved reporting by doctors from a low baseline. However, there was considerable heterogeneity between reporting rates in different types of units. PMID:17545341

  7. A systematic review of economic evaluations of CHW interventions aimed at improving child health outcomes.

    PubMed

    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

  8. Nursing peer review of late deceleration recognition and intervention to improve patient safety.

    PubMed

    Davis, Jocelyn; Kenny, Tiffany H; Doyle, Jennifer L; McCarroll, Michele; von Gruenigen, Vivian E

    2013-01-01

    We describe a nurse peer-review process to improve late deceleration recognition and intervention on one labor and delivery unit. Monthly chart audits (n = 721) met the goal of 75% reviewer agreement after the 4th month of implementation and have been maintained to date. Nurses recognized for excellence were more likely to be certified, work day shift, or be a member of the Perinatal Safety Team. Institutional support, a dedicated review team, and education contributed to success.

  9. Interventions with potential to improve the mental health and wellbeing of UK veterinary surgeons.

    PubMed

    Bartram, D J; Sinclair, J M A; Baldwin, D S

    2010-04-24

    The proportion of UK veterinary surgeons who die by suicide as opposed to other causes is approximately four times that of the general population, and around twice that of other healthcare professionals. Recent research suggests that veterinary surgeons report high levels of psychological distress. This paper proposes a portfolio of evidence-based interventions, for both organisations and individuals, which have the potential to improve mental health and wellbeing in the veterinary profession.

  10. Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial

    PubMed Central

    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

  11. A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

    PubMed Central

    Geldsetzer, Pascal; Yapa, H Manisha N; 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) 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. PMID:27118443

  12. Safety and Impact of Chlorhexidine Antisepsis Interventions for Improving Neonatal Health in Developing Countries

    PubMed Central

    Mullany, Luke C.; Darmstadt, Gary L.; Tielsch, James M.

    2008-01-01

    Affordable, efficacious, and safe interventions to prevent infections and improve neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-spectrum antiseptic that has been used extensively for many decades in hospital and other clinical settings. It has also been given as maternal vaginal lavage, full-body newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates. Recent evidence suggests that these chlorhexidine interventions may have significant public health impact on the burden of neonatal infection and mortality in developing countries. This review examines the available data from randomized and nonrandomized studies of chlorhexidine cleansing, with a primary focus on potential uses in low-resource settings. Safety issues related to chlorhexidine use in newborns are reviewed, and future research priorities for chlorhexidine interventions for neonatal health in developing countries are discussed. We conclude that maternal vaginal cleansing combined with newborn skin cleansing could reduce neonatal infections and mortality in hospitals of sub-Saharan Africa, but the individual impact of these interventions must be determined, particularly in community settings. There is evidence for a protective benefit of newborn skin and umbilical cord cleansing with chlorhexidine in the community in south Asia. Effectiveness trials in that region are required to address the feasibility of community-based delivery methods such as incorporating these interventions into clean birth kits or training programs for minimally skilled delivery assistants or family members. Efficacy trials for all chlorhexidine interventions are needed in low-resource settings in Africa, and the benefit of maternal vaginal cleansing beyond that provided by newborn skin cleansing needs to be determined. PMID:16874163

  13. Improving medication adherence with a targeted, technology-driven disease management intervention.

    PubMed

    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 < 0.05). Time to reinitiation was significantly shorter in the intervention group, 59.5 (+/- 69.0) days vs. 107.4 (+/- 109) days for the control group (P < 0.05). This initiative demonstrated that a targeted disease management intervention promoting patient behavior change increased the number of patients who reinitiated therapy after a

  14. A theory-based intervention to improve breast cancer awareness and screening in Jamaica.

    PubMed

    Anakwenze, Chidinma P; Coronado-Interis, Evelyn; Aung, Maung; Jolly, Pauline E

    2015-05-01

    Despite declines in breast cancer mortality rates in developed countries, mortality rates remain high in Jamaica due to low levels of screening and lack of early detection. We hypothesized that a theory-based health educational intervention would increase awareness of breast cancer and intention to screen among women in Western Jamaica. Two hundred and forty six women attending hospitals or clinics were enrolled in an educational intervention consisting of a pretest, breast cancer presentation, and posttest if they had never been screened or had not been screened in 5 years or more. The questionnaires assessed attitudes and knowledge of risk factors and symptoms related to breast cancer. Participants were followed approximately 6 months after the intervention to determine whether they accessed breast cancer screening. There were statistically significant increases (p < 0.0001) in the percentage of correct knowledge responses and in participants' intention to screen from pretest to posttest. The greatest posttest improvements were among items measuring knowledge of breast cancer screening tests and risk factors. Of the 134 women who were reached by phone for post-intervention follow-up, 30 women (22.4 %) were screened for breast cancer and 104 women (77.6 %) had not been screened. The use of a theory-based educational intervention positively influenced knowledge of breast cancer risk factors, symptoms, and types of screening and increased screening rates in screening-naïve women. This theory-based educational intervention may be replicated to promote awareness of breast cancer and further increase screening rates in other areas of Jamaica and other developing countries.

  15. Self-care Improvement After a Pharmaceutical Intervention in Elderly Type 2 Diabetic Patients.

    PubMed

    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 (p<0.05), as well as the decrease verified in HbA1c. In self-care adherence, alterations in the levels of adherence of the general nutrition 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.

  16. Development of a Health Empowerment Programme to improve the health of working poor families: protocol for a prospective cohort study in Hong Kong

    PubMed Central

    Fung, Colman Siu Cheung; Yu, Esther Yee Tak; Guo, Vivian Yawei; Kung, Kenny; Ho, Sin Yi; Lam, Lai Ying; Ip, Patrick; Fong, Daniel Yee Tak; Lam, David Chi Leung; Wong, William Chi Wai; Tsang, Sandra Kit Man; Tiwari, Agnes Fung Yee; Lam, Cindy Lo Kuen

    2016-01-01

    Introduction People from working poor families are at high risk of poor health partly due to limited healthcare access. Health empowerment, a process by which people can gain greater control over the decisions affecting their lives and health through education and motivation, can be an effective way to enhance health, health-related quality of life (HRQOL), health awareness and health-seeking behaviours of these people. A new cohort study will be launched to explore the potential for a Health Empowerment Programme to enable these families by enhancing their health status and modifying their attitudes towards health-related issues. If proven effective, similar empowerment programme models could be tested and further disseminated in collaborations with healthcare providers and policymakers. Method and analysis A prospective cohort study with 200 intervention families will be launched and followed up for 5 years. The following inclusion criteria will be used at the time of recruitment: (1) Having at least one working family member; (2) Having at least one child studying in grades 1–3; and (3) Having a monthly household income that is less than 75% of the median monthly household income of Hong Kong families. The Health Empowerment Programme that will be offered to intervention families will comprise four components: health assessment, health literacy, self-care enablement and health ambassador. Their health status, HRQOL, lifestyle and health service utilisation will be assessed and compared with 200 control families with matching characteristics but will not receive the health empowerment intervention. Ethics and dissemination This project was approved by the University of Hong Kong—the Hospital Authority Hong Kong West Cluster IRB, Reference number: UW 12-517. The study findings will be disseminated through a series of peer-reviewed publications and conference presentations, as well as a yearly report to the philanthropic funding body–Kerry Group Kuok

  17. A Multifaceted Nurse- and Web-Based Intervention for Improving Adherence to Treatment in Patients With Cardiovascular Disease: Rationale and Design of the MIRROR Trial

    PubMed Central

    2016-01-01

    Background Poor adherence to medication is one of the limitations in the treatment of cardiovascular diseases, thereby increasing the risk of premature death, hospital admissions, and related costs. There is a need for simple and easy-to-implement interventions that are based on patients’ perspectives, beliefs, and perceptions of their illness and medication. Objective The objective is to test the effectivity of this intervention to improve medication adherence in patients with established cardiovascular disease, that is, in secondary prevention. Methods In this study the effect of a personalized visualization of cardiovascular risk levels through a website aiming at supporting self management in combination with a group consultation and communication intervention by a nurse on adherence to treatment in 600 patients with manifest cardiovascular diseases will be assessed. The health belief model was chosen as main theoretical model for the intervention. Results Primary outcome is adherence to treatment calculated by refill data. Secondary outcomes include the Beliefs about Medication Questionnaire and the Modified Morisky Scale. Patients are followed for one year. Results are expected by 2015. Conclusions This study assesses adherence to treatment in a high-risk cardiovascular population by applying an intervention that addresses patients’ capacity and practical barriers as well as patients’ beliefs and perceptions of their illness and medication. ClinicalTrial ClinicalTrials.gov NCT01449695; https://clinicaltrials.gov/ct2/show/NCT01449695 (Archived by WebCite at http://www.webcitation.org/6kCzkIKH3) PMID:27624877

  18. A group intervention to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS.

    PubMed

    Feldman, Matthew B; Torino, Jenny A; Swift, Margaret

    2011-01-01

    A healthy diet is essential to maintaining a strong immune system for people living with HIV and AIDS. Prior studies have shown that HIV-positive gay and bisexual men are more susceptible to poor body image, which can negatively impact dietary habits. Interventions that simultaneously address body image and nutrition are therefore critical for this population. This paper describes the curriculum for a 14-week group designed to improve body image satisfaction and dietary habits in gay and bisexual men living with HIV/AIDS.

  19. The Stress Gym: An Online Intervention to Improve Stress and Depressive Symptoms in Adults.

    PubMed

    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.

  20. A new self-microemulsifying mouth dissolving film to improve the oral bioavailability of poorly water soluble drugs.

    PubMed

    Xiao, Lu; Yi, Tao; Liu, Ying

    2013-09-01

    A new self-microemulsifying mouth dissolving film (SMMDF) for poorly water-soluble drugs such as indomethacin was developed by incorporating self-microemulsifying components with solid carriers mainly containing microcrystalline cellulose, low-substituted hydroxypropyl cellulose and hypromellose. The uniformity of dosage units of the preparation was acceptable according to the criteria of Chinese Pharmacopoeia 2010. The SMMDF was disintegrated within 20 s after immersion into water, released completely at 5 min in the dissolution medium and achieved microemulsion particle size of 28.81 ± 3.26 nm, which was similar to that of liquid self- microemulsifying drug delivery system (SMEDDS). Solid state characterization of the SMMDF was performed by SEM, DSC and X-ray powder diffraction. Results demonstrated that indomethacin in the SMMDF was in the amorphous state, which might be due to self-microemulsifying ingredients. Pharmacokinetic parameters in rats including T(max), C(max), AUC were similar between the SMMDF and liquid SMEDDS. AUC and C(max) from the SMMDF were significantly higher than those from the common mouth dissolving film or the conventional tablet, and Tmax from SMMDF group was also significantly decreased. These findings suggest that the SMMDF is a new promising dosage form, showing notable characteristics of convenience, quick onset of action and enhanced oral bioavailability of poorly water-soluble drugs.

  1. Formulation Strategies to Improve the Bioavailability of Poorly Absorbed Drugs with Special Emphasis on Self-Emulsifying Systems

    PubMed Central

    Gupta, Shweta; Kesarla, Rajesh

    2013-01-01

    Poorly water-soluble drug candidates are becoming more prevalent. It has been estimated that approximately 60–70% of the drug molecules are insufficiently soluble in aqueous media and/or have very low permeability to allow for their adequate and reproducible absorption from the gastrointestinal tract (GIT) following oral administration. Formulation scientists have to adopt various strategies to enhance their absorption. Lipidic formulations are found to be a promising approach to combat the challenges. In this review article, potential advantages and drawbacks of various conventional techniques and the newer approaches specifically the self-emulsifying systems are discussed. Various components of the self-emulsifying systems and their selection criteria are critically reviewed. The attempts of various scientists to transform the liquid self-emulsifying drug delivery systems (SEDDS) to solid-SEDDS by adsorption, spray drying, lyophilization, melt granulation, extrusion, and so forth to formulate various dosage forms like self emulsifying capsules, tablets, controlled release pellets, beads, microspheres, nanoparticles, suppositories, implants, and so forth have also been included. Formulation of SEDDS is a potential strategy to deliver new drug molecules with enhanced bioavailability mostly exhibiting poor aqueous solubility. The self-emulsifying system offers various advantages over other drug delivery systems having potential to solve various problems associated with drugs of all the classes of biopharmaceutical classification system (BCS). PMID:24459591

  2. Interventions to improve cultural competency in healthcare: a systematic review of reviews

    PubMed Central

    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

  3. Current smoking is associated with a poor visual acuity improvement after intravitreal ranibizumab therapy in patients with exudative age-related macular degeneration.

    PubMed

    Lee, Sangmoon; Song, Su Jeong; Yu, Hyeong Gon

    2013-05-01

    In this study, the risk factors that may influence visual improvement after intravitreal ranibizumab (IVR) treatment for exudative age-related macular degeneration (AMD) were examined. From 2008 to 2012, 420 patients (448 eyes) with exudative AMD were prospectively registered at Seoul National University Hospital. From this group of patients, 125 eyes were included in this study. All patients were treated with 3 consecutive IVR injections. The visual acuity (VA) was evaluated at baseline and 1 month after the third ranibizumab injection. To evaluate the risk factors associated with VA improvement after IVR, patient demographic data and systemic risk factors were analyzed. Patients were divided into a poor VA improvement group and a good VA improvement group, with reference to the median visual improvement in all eyes. Among 125 eyes, 66 eyes (52.8%) were included in the responder group and 59 eyes (47.2%) in the non-responder group. The median VA improvement after 3 monthly ranibizumab injections was -0.05 logMAR. Multivariate analyses revealed that current smoking (adjusted OR, 7.540; 95% CI, 1.732-32.823) was independently associated with poor VA improvement after IVR treatment for exudative AMD. In conclusion, cigarette smoking is an independent risk factor for lower VA gains with IVR treatment for exudative AMD.

  4. Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions

    PubMed Central

    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. PMID:28163715

  5. Primary Care Provider Perceptions of Colorectal Cancer Screening Barriers: Implications for Designing Quality Improvement Interventions.

    PubMed

    Weiss, Jennifer M; 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.

  6. Literature review: pharmacists' interventions to improve control and management in type 2 diabetes mellitus.

    PubMed

    Hassali, Mohamed Azmi Ahmad; Nazir, Saeed Ur Rashid; Saleem, Fahad; Masood, Imran

    2015-01-01

    Diabetes mellitus (DM) is a common disease in which excessive levels of blood glucose (sugar) occur. In simple terms, diabetes is generally due to failure in the effective functioning of insulin. Common types of diabetes include type 1 and type 2, which have different treatment options. In the general population, type 2 diabetes is more prevalent than type 1, and type 2 accounts for more than 90% of all known cases of diabetes. The current review examines the contributions of pharmacists to the more positive, long-term prognosis of patients with DM through improvements in its control and management. The authors conducted a systematic literature search. Twenty-seven studies were identified that demonstrated the effects of a pharmacist's intervention on glycated hemoglobin (HbA1c). In all cases, it was reported that the intervention was successful in reducing HbA1c in patients with DM. Pharmacist interventions have also proven successful in improving patient lipid profiles, cardiovascular outcomes, and body mass indexes (BMIs), and in reducing other complications associated with the disease. It was also reported that economic advantages were associated with a pharmacist's management of DM.

  7. Designing Cognitive Intervention to Improve the Awareness Index of the Residents in the Landslide Area

    NASA Astrophysics Data System (ADS)

    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.

  8. Smartphone-Based Psychotherapeutic Micro-Interventions to Improve Mood in a Real-World Setting

    PubMed Central

    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

  9. Randomized trial of a DVD intervention to improve readiness to self-manage joint pain.

    PubMed

    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.

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

    PubMed Central

    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. PMID:27445887

  11. Adolescent development and risk of injury: Using developmental science to improve interventions

    PubMed Central

    Johnson, Sara B.; Jones, Vanya C.

    2015-01-01

    In adolescence, there is a complex interaction among physical, cognitive, and psychosocial developmental processes, culminating in greater risk-taking and novelty-seeking. Concurrently, adolescents face an increasingly demanding environment, which results in heightened vulnerability to injury. In this paper, we provide an overview of developmental considerations for adolescent injury interventions based on developmental science including findings from behavioral neuroscience and psychology. We examine the role that typical developmental processes play in the way adolescents perceive and respond to risk and how this integrated body of developmental research adds to our understanding of how to do injury prevention with adolescents. We then highlight strategies to improve the translation of developmental research into adolescent injury prevention practice, calling on examples of existing interventions including graduated driver licensing. PMID:20876765

  12. Morphological Awareness Intervention: Improving Spelling, Vocabulary, and Reading Comprehension for Adult Learners.

    PubMed

    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.

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

    PubMed

    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.

  14. A cost-effectiveness analysis of provider and community interventions to improve the treatment of uncomplicated malaria in Nigeria: study protocol for a randomized controlled trial

    PubMed Central

    2012-01-01

    Background There is mounting evidence of poor adherence by health service personnel to clinical guidelines for malaria following a symptomatic diagnosis. In response to this, the World Health Organization (WHO) recommends that in all settings clinical suspicion of malaria should be confirmed by parasitological diagnosis using microscopy or Rapid Diagnostic Test (RDT). The Government of Nigeria plans to introduce RDTs in public health facilities over the coming year. In this context, we will evaluate the effectiveness and cost-effectiveness of two interventions designed to support the roll-out of RDTs and improve the rational use of ACTs. It is feared that without supporting interventions, non-adherence will remain a serious impediment to implementing malaria treatment guidelines. Methods/design A three-arm stratified cluster randomized trial is used to compare the effectiveness and cost-effectiveness of: (1) provider malaria training intervention versus expected standard practice in malaria diagnosis and treatment; (2) provider malaria training intervention plus school-based intervention versus expected standard practice; and (3) the combined provider plus school-based intervention versus provider intervention alone. RDTs will be introduced in all arms of the trial. The primary outcome is the proportion of patients attending facilities that report a fever or suspected malaria and receive treatment according to malaria guidelines. This will be measured by surveying patients (or caregivers) as they exit primary health centers, pharmacies, and patent medicine dealers. Cost-effectiveness will be presented in terms of the primary outcome and a range of secondary outcomes, including changes in provider and community knowledge. Costs will be estimated from both a societal and provider perspective using standard economic evaluation methodologies. Trial registration Clinicaltrials.gov NCT01350752 PMID:22682276

  15. Lidocaine self-sacrificially improves the skin permeation of the acidic and poorly water-soluble drug etodolac via its transformation into an ionic liquid.

    PubMed

    Miwa, Yasushi; Hamamoto, Hidetoshi; Ishida, Tatsuhiro

    2016-05-01

    Poor transdermal penetration of active pharmaceutical ingredients (APIs) impairs both bioavailability and therapeutic benefits and is a major challenge in the development of transdermal drug delivery systems. Here, we transformed a poorly water-soluble drug, etodolac, into an ionic liquid in order to improve its hydrophobicity, hydrophilicity and skin permeability. The ionic liquid was prepared by mixing etodolac with lidocaine (1:1, mol/mol). Both the free drug and the transformed ionic liquid were characterized by differential scanning colorimetry (DSC), infrared spectroscopy (IR), and saturation concentration measurements. In addition, in vitro skin-permeation testing was carried out via an ionic liquid-containing patch (Etoreat patch). The lidocaine and etodolac in ionic liquid form led to a relatively lower melting point than either lidocaine or etodolac alone, and this improved the lipophilicity/hydrophilicity of etodolac. In vitro skin-permeation testing demonstrated that the Etoreat patch significantly increased the skin permeation of etodolac (9.3-fold) compared with an etodolac alone patch, although an Etoreat patch did not increase the skin permeation of lidocaine, which was consistent with the results when using a lidocaine alone patch. Lidocaine appeared to self-sacrificially improve the skin permeation of etodolac via its transformation into an ionic liquid. The data suggest that ionic liquids composed of approved drugs may substantially expand the formulation preparation method to meet the challenges of drugs which are characterized by poor rates of transdermal absorption.

  16. Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

    PubMed

    Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

    2016-06-01

    Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.

  17. Neighborhood-Level Interventions to Improve Childhood Opportunity and Lift Children Out of Poverty.

    PubMed

    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.

  18. Using Literacy-Based Behavioral Interventions and Social Stories to Improve Work Behavior in Employees with Developmental Disabilities

    ERIC Educational Resources Information Center

    Bucholz, Jessica L.; Brady, Michael P.; Duffy, Mary Lou; Scott, Jack; Kontosh, Larry G.

    2008-01-01

    This study was designed to examine the effects of Literacy-Based Behavioral Interventions and social stories to improve the work behavior of employees with developmental disabilities. Two experiments were conducted. In the first experiment a multiple baseline across subjects was used to examine the effects of the intervention on employees'…

  19. The Role of Need for Contraception in the Evaluation of Interventions to Improve Access to Family-Planning Methods

    ERIC Educational Resources Information Center

    Leon, Federico R.; Lundgren, Rebecka; Sinai, Irit; Jennings, Victoria

    2011-01-01

    A nonrandomized experiment carried out in Jharkhand, India, shows how the effects of interventions designed to improve access to family-planning methods can be erroneously regarded as trivial when contraceptive use is utilized as dependent variable, ignoring women's need for contraception. Significant effects of the intervention were observed on…

  20. The Effectiveness of Using a Social Story Intervention to Improve Social Interaction Skills of Students with Autism

    ERIC Educational Resources Information Center

    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…

  1. Use of Computer-Based Interventions to Improve Literacy Skills in Students with Autism Spectrum Disorders: A Systematic Review

    ERIC Educational Resources Information Center

    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…

  2. Comparative Cost-Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction

    PubMed Central

    Ito, Kouta; Shrank, William H; Avorn, Jerry; Patrick, Amanda R; Brennan, Troyen A; Antman, Elliot M; Choudhry, Niteesh K

    2012-01-01

    Objective To evaluate the comparative cost-effectiveness of interventions to improve adherence to evidence-based medications among postmyocardial infarction (MI) patients. Data Sources/Study Setting Cost-effectiveness analysis. Study Design We developed a Markov model simulating a hypothetical cohort of 65-year-old post-MI patients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost-effectiveness ratio (ICER) as measured by cost per quality-adjusted life year (QALY) gained. Data Collection/Extraction Methods Model inputs were extracted from published literature. Principal Findings Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 per QALY gained, respectively. In an incremental analysis, only mailed education had an ICER of less than $100,000 per QALY and was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month. Conclusions Mailed education and a polypill, once available, may be the cost-saving strategies for improving post-MI medication adherence. PMID:22998129

  3. Dejian Mind-Body Intervention Improves the Cognitive Functions of a Child with Autism

    PubMed Central

    Chan, Agnes S.; Sze, Sophia L.; Cheung, Mei-Chun; Han, Yvonne M. Y.; Leung, Winnie W. M.; Shi, Dejian

    2011-01-01

    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. PMID:21584249

  4. A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy

    PubMed Central

    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

  5. Evaluation of an intervention to improve blood culture practices: a cluster randomised trial.

    PubMed

    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.

  6. Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

    PubMed Central

    Ma, Qingyan; Tso, Lai Sze; Rich, Zachary C; Hall, Brian J; Beanland, Rachel; Li, Haochu; Lackey, Mellanye; Hu, Fengyu; Cai, Weiping; Doherty, Meg; Tucker, Joseph D

    2016-01-01

    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 health workers and

  7. Highlighting the evidence gap: how cost-effective are interventions to improve early childhood nutrition and development?

    PubMed

    Batura, Neha; Hill, Zelee; Haghparast-Bidgoli, Hassan; Lingam, Raghu; Colbourn, Timothy; Kim, Sungwook; Sikander, Siham; Pulkki-Brannstrom, Anni-Maria; Rahman, Atif; Kirkwood, Betty; Skordis-Worrall, Jolene

    2015-07-01

    There is growing evidence of the effectiveness of early childhood interventions to improve the growth and development of children. Although, historically, nutrition and stimulation interventions may have been delivered separately, they are increasingly being tested as a package of early childhood interventions that synergistically improve outcomes over the life course. However, implementation at scale is seldom possible without first considering the relative cost and cost-effectiveness of these interventions. An evidence gap in this area may deter large-scale implementation, particularly in low- and middle-income countries. We conduct a literature review to establish what is known about the cost-effectiveness of early childhood nutrition and development interventions. A set of predefined search terms and exclusion criteria standardized the search across five databases. The search identified 15 relevant articles. Of these, nine were from studies set in high-income countries and six in low- and middle-income countries. The articles either calculated the cost-effectiveness of nutrition-specific interventions (n = 8) aimed at improving child growth, or parenting interventions (stimulation) to improve early childhood development (n = 7). No articles estimated the cost-effectiveness of combined interventions. Comparing results within nutrition or stimulation interventions, or between nutrition and stimulation interventions was largely prevented by the variety of outcome measures used in these analyses. This article highlights the need for further evidence relevant to low- and middle-income countries. To facilitate comparison of cost-effectiveness between studies, and between contexts where appropriate, a move towards a common outcome measure such as the cost per disability-adjusted life years averted is advocated. Finally, given the increasing number of combined nutrition and stimulation interventions being tested, there is a significant need for evidence of cost

  8. Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis.

    PubMed

    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.

  9. A brief educational intervention to improve healthcare providers' awareness of child passenger safety.

    PubMed

    Ekundayo, O James; Jones, Gennifer; Brown, Angela; Aliyu, Muktar; Levine, Robert; Goldzweig, Irwin

    2013-01-01

    Introduction. Motor vehicle crashes are the leading cause of death among US children aged 4-14 years. In theory, health provider counseling about Child Passenger Safety (CPS) could be a useful deterrent. The data about the effectiveness of CPS dissemination is sparse, but existing results suggest that providers are not well informed. Moreover, there is insufficient evidence to determine whether provider counseling about CPS is effective. Methods. We therefore assessed CPS best practice knowledge among 217 healthcare workers at hospitals in seven cities throughout the USA and evaluated the impact of a brief, lunch and learn educational intervention with a five-item questionnaire. Attendees were comprised of physicians, nurses, social workers, pediatric residents, and pediatric trauma response teams. Results. Pre-post survey completion was nearly 100% (216 of 217 attendees). Participation was fairly evenly distributed according to age (18-29, 30-44, and 45+ years). More than 80% of attendees were women. Before intervention, only 4% of respondents (9/216) answered all five questions correctly; this rose to 77% (167/216) (P < 0.001, using a Wilcoxon signed-rank test) after intervention. Conclusion. Future research should consider implementation and controlled testing of comparable educational programs to determine if they improve dissemination of CPS best practice recommendations in the long term.

  10. A Food Service Intervention Improves Whole Grain Access at Lunch in Rural Elementary Schools

    PubMed Central

    Cohen, Juliana F. W.; Rimm, Eric B.; Austin, S. Bryn; Hyatt, Raymond R.; Kraak, Vivica I.; Economos, Christina D.

    2015-01-01

    Background Whole grain (WG) options are often limited in schools, which may impact rural, low-income students who rely on school meals for a substantial portion of their food intake. This study examined the changes in the availability and quantity of WG and refined grain foods offered in schools participating in the Creating Healthy, Active and Nurturing Growing-up Environments (CHANGE) study, a randomized, controlled intervention among rural communities (4 intervention and 4 control). Methods Foods were assessed using production records, recipes, and nutrition labels from breakfast and lunch over 1week during fall 2008 and spring 2009. Key informant interviews were conducted with school food service directors in the spring 2009. Results The CHANGE intervention schools significantly increased the average percent of school days WGs were offered (p =.047) and the amount of WGs offered/food item (ounces) at lunch compared with control schools (p = .02). There was a significant decrease in the percent of students with access to refined grains at lunch compared with control schools (p =.049), although there were no significant differences in WG availability during breakfast. Conclusions The CHANGE schools improved WG availability, enabling student's WG consumption to be closer to national recommendations. PMID:24443783

  11. Does an education intervention improve physician signature legibility? Pilot study of a prospective chart review.

    PubMed

    Glisson, James K; Morton, Mary E; Bond, Allyn H; Griswold, Michael

    2011-01-01

    Illegible physician signatures in patient records can lead to inaccurate documentation, improper billing, and potential legal issues. Many studies in the current literature address legibility of prescriptions and medication orders; however, few focus on legibility of physicians' signatures. The purpose of the present quality improvement survey was to evaluate physician signature legibility on patient charts at the University of Mississippi Medical Center's Adult Internal Medicine Clinic. At the time of the study, the clinic was known as the University of Mississippi Medical Center (UMMC) Adult Internal Medicine Clinic. Effective July 1, 2009, UMMC entered into a collaboration with Jackson-Hinds Comprehensive Health Center (JHCHC), a federally qualified health center. The clinic is now known as the Federally Qualified Health Center at the Jackson Medical Mall. In this pilot study, we examined clinic notes and billing sheets for legible physician signatures over a three-month period. Midway through the study, an intervention group was given name stamps and a standardized discussion on the importance of signature legibility and proper name stamp usage. Legibility of resident signatures in the intervention group increased from 26 percent to 60 percent. Legibility of attending signatures in the intervention group increased from 1.4 percent to 86 percent. Results suggest the significant impact of resident education on changing practice behavior.

  12. Impact of Water, Sanitation, and Hygiene Interventions on Improving Health Outcomes among School Children

    PubMed Central

    Joshi, Ashish

    2013-01-01

    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. PMID:24454415

  13. How Can Childbirth Care for the Rural Poor Be Improved? A Contribution from Spatial Modelling in Rural Tanzania

    PubMed Central

    Fogliati, Piera; Straneo, Manuela; Brogi, Cosimo; Fantozzi, Pier Lorenzo; Salim, Robert Mahimbo; Msengi, Hamis Mwendo; Azzimonti, Gaetano; Putoto, Giovanni

    2015-01-01

    Introduction Maternal and perinatal mortality remain a challenge in resource-limited countries, particularly among the rural poor. To save lives at birth health facility delivery is recommended. However, increasing coverage of institutional deliveries may not translate into mortality reduction if shortage of qualified staff and lack of enabling working conditions affect quality of services. In Tanzania childbirth care is available in all facilities; yet maternal and newborn mortality are high. The study aimed to assess in a high facility density rural context whether a health system organization with fewer delivery sites is feasible in terms of population access. Methods Data on health facilities’ location, staffing and delivery caseload were examined in Ludewa and Iringa Districts, Southern Tanzania. Geospatial raster and network analysis were performed to estimate access to obstetric services in walking time. The present geographical accessibility was compared to a theoretical scenario with a 40% reduction of delivery sites. Results About half of first-line health facilities had insufficient staff to offer full-time obstetric services (45.7% in Iringa and 78.8% in Ludewa District). Yearly delivery caseload at first-line health facilities was low, with less than 100 deliveries in 48/70 and 43/52 facilities in Iringa and Ludewa District respectively. Wide geographical overlaps of facility catchment areas were observed. In Iringa 54% of the population was within 1-hour walking distance from the nearest facility and 87.8% within 2 hours, in Ludewa, the percentages were 39.9% and 82.3%. With a 40% reduction of delivery sites, approximately 80% of population will still be within 2 hours’ walking time. Conclusions Our findings from spatial modelling in a high facility density context indicate that reducing delivery sites by 40% will decrease population access within 2 hours by 7%. Focused efforts on fewer delivery sites might assist strengthening delivery services

  14. A lifestyle intervention reduces body weight and improves cardiometabolic risk factors in worksites

    Technology Transfer Automated Retrieval System (TEKTRAN)

    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 ...

  15. [Improved quality of coronary diagnostics and interventions by virtual reality simulation].

    PubMed

    Voelker, W; Maier, S; Lengenfelder, B; Schöbel, W; Petersen, J; Bonz, A; Ertl, G

    2011-08-01

    Currently, more than 800,000 diagnostic procedures and 300,000 percutaneous coronary interventions are performed annually in 556 catheter laboratories in Germany. These numbers document the importance of training programs in interventional cardiology. However, this need is in sharp contrast to the time constraints for continuing medical education in Germany due to personnel and financial restrictions. A possible solution for this dilemma could be new training programs which partially supplement conventional clinical training by simulation-based medical education. Currently five virtual reality simulators for diagnostic procedures and percutaneous coronary interventions are available. These simulators provide a realistic hands-on training comparable to flight simulation in aviation.The simulator of choice for a defined training program depending on the underlying learning objectives could either be a simple mechanical model (for puncture training) or even a combination of virtual reality simulator and a full-scale mannequin (for team training and crisis resource management). For the selection of the adequate training program the basic skills of the trainee, the learning objectives and the underlying curriculum have to be taken into account. Absolutely mandatory for the success of simulation-based training is a dedicated teacher providing feedback and guidance. This teacher should be an experienced interventional cardiologist who knows both the simulator and the selected training cases which serve as a vehicle for transferring knowledge and skills.In this paper the potential of virtual reality simulation in cardiology will be discussed and the conditions which must be fulfilled to achieve quality improvement by simulation-based training will be defined.

  16. Intervention to reduce heat stress and improve efficiency among sugarcane workers in El Salvador: Phase 1

    PubMed Central

    Bodin, T; García-Trabanino, R; Weiss, I; Jarquín, E; Glaser, J; Jakobsson, K; Lucas, R A I; Wesseling, C; Hogstedt, C; Wegman, D H

    2016-01-01

    Background Chronic heat stress and dehydration from strenuous work in hot environments is considered an essential component of the epidemic of chronic kidney disease in Central America. Objective (1) To assess feasibility of providing an intervention modelled on OSHA's Water.Rest.Shade programme (WRS) during sugarcane cutting and (2) to prevent heat stress and dehydration without decreasing productivity. Methods Midway through the 6-month harvest, the intervention introduced WRS practices. A 60-person cutting group was provided water supplied in individual backpacks, mobile shaded rest areas and scheduled rest periods. Ergonomically improved machetes and efficiency strategies were also implemented. Health data (anthropometric, blood, urine, questionnaires) were collected preharvest, preintervention, mid-intervention and at the end of harvest. A subsample participated in focus group discussions. Daily wet bulb globe temperatures (WBGT) were recorded. The employer provided individual production records. Results Over the harvest WBGT was >26°C from 9:00 onwards reaching average maximum of 29.3±1.7°C, around 13:00. Postintervention self-reported water consumption increased 25%. Symptoms associated with heat stress and with dehydration decreased. Individual daily production increased from 5.1 to a high of 7.3 tons/person/day postintervention. This increase was greater than in other cutting groups at the company. Focus groups reported a positive perception of components of the WRS, and the new machete and cutting programmes. Conclusions A WRS intervention is feasible in sugarcane fields, and appears to markedly reduce the impact of the heat stress conditions for the workforce. With proper attention to work practices, production can be maintained with less impact on worker health. PMID:27073211

  17. A systematic review of triage-related interventions to improve patient flow in emergency departments

    PubMed Central

    2011-01-01

    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 department or having nurses to

  18. Improving the de-agglomeration and dissolution of a poorly water soluble drug by decreasing the agglomerate strength of the cohesive powder.

    PubMed

    Allahham, Ayman; Stewart, Peter J; Das, Shyamal C

    2013-11-30

    Influence of ternary, poorly water-soluble components on the agglomerate strength of cohesive indomethacin mixtures during dissolution was studied to explore the relationship between agglomerate strength and extent of de-agglomeration and dissolution of indomethacin (Ind). Dissolution profiles of Ind from 20% Ind-lactose binary mixtures, and ternary mixtures containing additional dibasic calcium phosphate (1% or 10%; DCP), calcium sulphate (10%) and talc (10%) were determined. Agglomerate strength distributions were estimated by Monte Carlo simulation of particle size, work of cohesion and packing fraction distributions. The agglomerate strength of Ind decreased from 1.19 MPa for the binary Ind mixture to 0.84 MPa for 1DCP:20Ind mixture and to 0.42 MPa for 1DCP:2Ind mixture. Both extent of de-agglomeration, demonstrated by the concentration of the dispersed indomethacin distribution, and extent of dispersion, demonstrated by the particle size of the dispersed indomethacin, were in descending order of 1DCP:2Ind>1DCP:20Ind>binary Ind. The addition of calcium sulphate dihydrate and talc also reduced the agglomerate strength and improved de-agglomeration and dispersion of indomethacin. While not definitively causal, the improved de-agglomeration and dispersion of a poorly water soluble drug by poorly water soluble components was related to the agglomerate strength of the cohesive matrix during dissolution.

  19. Evidence-based and occupational perspective of effective interventions for older clients that remediate or support improved driving performance.

    PubMed

    Hunt, Linda A; Arbesman, Marian

    2008-01-01

    To assess the effectiveness of person-related interventions on driving ability in older adults, this literature review was completed as a part of the Evidence-Based Literature Review Project of the American Occupational Therapy Association. Nineteen articles were incorporated into the systematic review and include interventions in the following areas: visual, cognitive, and motor; educational; passengers; and medical. The results provide inconclusive evidence for the use of interventions such as the Useful Field of View training, home exercise programs, and passenger interactions. Conclusive evidence shows that older adults respond positively to programs stressing self-awareness of driving skills and that some medical interventions affect the ability to drive. Despite limitations, the studies reviewed provide useful information that deserves further exploration. Reading the literature provides therapists with knowledge that might improve client care. Learning about cutting-edge interventions and educating peers and students about evidence-based interventions may lead to safer community mobility for older adults.

  20. Applying Intervention Mapping to Develop a Community-Based Intervention Aimed at Improved Psychological and Social Well-Being of Unmarried Teenage Mothers in Uganda

    ERIC Educational Resources Information Center

    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…

  1. Educational interventions to improve inhaler techniques and their impact on asthma and COPD control: a pilot effectiveness-implementation trial

    PubMed Central

    Maricoto, Tiago; Madanelo, Sofia; Rodrigues, Luís; Teixeira, Gilberto; Valente, Carla; Andrade, Lília; Saraiva, Alcina

    2016-01-01

    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. PMID:28117475

  2. Applying Intervention Mapping to develop a community-based intervention aimed at improved psychological and social well-being of unmarried teenage mothers in Uganda.

    PubMed

    Leerlooijer, Joanne N; Kok, Gerjo; Weyusya, Joseph; Bos, Arjan E R; Ruiter, Robert A C; Rijsdijk, Liesbeth E; Nshakira, Nathan; Bartholomew, Leona K

    2014-08-01

    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 teenage mothers in rural Uganda. We used Intervention Mapping (IM) for systematically developing a theory and evidence-based comprehensive health promotion programme. A planning group consisting of community leaders, teenage mothers, staff of a community-based organization and a health promotion professional was involved in the six steps of IM: needs assessment, programme objectives, methods and applications, intervention design, planning for adoption and implementation and planning for evaluation. The programme includes five intervention components: community awareness raising, teenage mother support groups, formal education and income generation, counselling, and advocacy. The intervention components are based on a variety of theoretical methods, including entertainment education, persuasive communication, mobilization of social networks and social action. In conclusion, IM facilitated the planning group to structure the iterative, bottom-up, participatory design of the project in a real-life setting and to use evidence and theory. The article provides suggestions for the planning of support interventions for unmarried teenage mothers.

  3. Prioritizing policy interventions to improve diets? Will it work, can it happen, will it do harm?

    PubMed Central

    Snowdon, W.; Potter, J.-L.; Swinburn, B.; Schultz, J.; Lawrence, M.

    2010-01-01

    Policies from non-health sectors have considerable impacts on the food environment and in turn on population nutrition. Health impact assessment (HIA) methods have been developed to identify the potential health effects of non-health policies; however, they are underused both within and outside the health sector. HIA and other assessment methods and tools can be used more extensively in health promotion to assist with the identification of the best policy options to pursue to improve and protect health. A participatory process is presented in this paper which combines HIAs with feasibility and effectiveness assessments. The intention is to enable health promoters to more accurately identify which policy change options would be most likely to improve diets, considering both impact and likelihood of implementation. The process was successfully used in Fiji and Tonga and provided a more systematic way of understanding which policy interventions showed the most promise. PMID:20167827

  4. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study.

    PubMed

    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.

  5. Adherence to medication in the community: audit cycle of interventions to improve the assessment of adherence

    PubMed Central

    Farooq, Saeed; Choudry, Abid

    2017-01-01

    Aims and method To investigate whether medication adherence is monitored during follow-up in out-patient reviews. A retrospective audit was carried out with a sample of 50 follow-up patients with a diagnosis of schizophrenia or schizoaffective disorder. Following this, interventions were made prior to the re-audit (including text messaging clinicians and prompt sheets in the out-patient department to encourage adherence discussions). Results There was an improvement on all the standards set for this audit following the interventions. More doctors had discussed medication adherence (62% second cycle v. 50% first cycle) with their patient and there was increased discussion and documentation regarding medication side-effects (60% second cycle v. 30% first cycle). More clinicians discussed the response to medication (60% second cycle v. 46% first cycle). Clinical implications Treatment adherence is not regularly monitored or recorded in clinical notes in routine psychiatric out-patient appointments. This highlights the need for regular training to improve practice. PMID:28184317

  6. A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study

    PubMed Central

    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

  7. Improving the Psychosocial Work Environment at Multi-Ethnic Workplaces: A Multi-Component Intervention Strategy in the Cleaning Industry

    PubMed Central

    Smith, Louise Hardman; Hviid, Kirsten; Frydendall, Karen Bo; Flyvholm, Mari-Ann

    2013-01-01

    Global labour migration has increased in recent years and immigrant workers are often recruited into low status and low paid jobs such as cleaning. Research in a Danish context shows that immigrants working in the cleaning industry often form social networks based on shared languages and backgrounds, and that conflict between different ethnic groups may occur. This paper evaluates the impact of a multi-component intervention on the psychosocial work environment at a multi-ethnic Danish workplace in the cleaning sector. The intervention included Danish lessons, vocational training courses, and activities to improve collaboration across different groups of cleaners. Interviews about the outcome of the intervention were conducted with the cleaners and their supervisor. The Copenhagen Psychosocial Questionnaire was used as a supplement to the interviews. The results suggest that the psychosocial work environment had improved after the intervention. According to the interviews with the cleaners, the intervention had led to improved communication, trust, and collaboration. These findings are supported by the questionnaire where social support from supervisor and colleagues, social community, trust, and teamwork seem to have improved together with meaning of work, rewards, and emotional demands. The design of the intervention may provide inspiration for future psychosocial work environment interventions at multi-ethnic work places. PMID:24129115

  8. Improving the psychosocial work environment at multi-ethnic workplaces: a multi-component intervention strategy in the cleaning industry.

    PubMed

    Smith, Louise Hardman; Hviid, Kirsten; Frydendall, Karen Bo; Flyvholm, Mari-Ann

    2013-10-14

    Global labour migration has increased in recent years and immigrant workers are often recruited into low status and low paid jobs such as cleaning. Research in a Danish context shows that immigrants working in the cleaning industry often form social networks based on shared languages and backgrounds, and that conflict between different ethnic groups may occur. This paper evaluates the impact of a multi-component intervention on the psychosocial work environment at a multi-ethnic Danish workplace in the cleaning sector. The intervention included Danish lessons, vocational training courses, and activities to improve collaboration across different groups of cleaners. Interviews about the outcome of the intervention were conducted with the cleaners and their supervisor. The Copenhagen Psychosocial Questionnaire was used as a supplement to the interviews. The results suggest that the psychosocial work environment had improved after the intervention. According to the interviews with the cleaners, the intervention had led to improved communication, trust, and collaboration. These findings are supported by the questionnaire where social support from supervisor and colleagues, social community, trust, and teamwork seem to have improved together with meaning of work, rewards, and emotional demands. The design of the intervention may provide inspiration for future psychosocial work environment interventions at multi-ethnic work places.

  9. Close Collaboration with Parents™ intervention to improve parents' psychological well-being and child development: Description of the intervention and study protocol.

    PubMed

    Ahlqvist-Björkroth, Sari; Boukydis, Zack; Axelin, Anna Margareta; Lehtonen, Liisa

    2016-10-12

    Parents of preterm infants commonly experience separation from their infant or exclusion from their role as primary caregivers during the hospital care of their infant, which may impair parent-infant bonding and parents' psychological well-being. Therefore, we developed the Close Collaboration with Parents™ intervention to improve staff skills in communicating and collaborating with parents in neonatal intensive care units (NICU), to increase parents' presence and participation into infant care, and to improve parent-infant bonding and, thereby, parents' psychological well-being and later child development. The Close Collaboration with Parents™ intervention was developed and carried out at Turku University Hospital. The intervention was based on developmental theories about early parenthood and parent-infant attachment. The training was targeted at both doctors and nurses. The goals of the training included understanding individual behaviors and responses of infants and the uniqueness of families, using receptive listening skills in communication with parents and making decisions collaboratively with them. By increasing the sensitivity of the staff to the individual needs of infants and parents and by increasing staff-parent collaboration in daily care, the intervention supported parents' presence and parents' participation in the care of their infant. The effectiveness of the intervention is being evaluated in a prospective study comparing the post-intervention cohort (n=113) to the baseline cohort (n=232). The outcomes include bonding, long-term psychological well-being of both mothers and fathers and child development up to 5 years of age. The Close Collaboration with Parents™ intervention potentially offers a preventive and salutogenic model to integrate parents and parenting in neonatal hospital care.

  10. Improving Financial Management via Contemplation: Novel Interventions and Findings in Laboratory and Applied Settings

    PubMed Central

    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

  11. Improving Financial Management via Contemplation: Novel Interventions and Findings in Laboratory and Applied Settings.

    PubMed

    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.

  12. Effectiveness of interventions that apply new media to improve vaccine uptake and vaccine coverage

    PubMed Central

    Odone, Anna; Ferrari, Antonio; Spagnoli, Francesca; Visciarelli, Sara; Shefer, Abigail; Pasquarella, Cesira; Signorelli, Carlo

    2014-01-01

    %), software for physicians and health professionals (n.4, 21%), and email communication (n.1, 5%). There is some evidence that text messaging, accessing immunization campaign websites, using patient-held web-based portals and computerized reminders increase immunization coverage rates. Insufficient evidence is available on the use of social networks, email communication and smartphone applications. Conclusion Although there is great potential for improving vaccine uptake and vaccine coverage by implementing programs and interventions that apply new media, scant data are available and further rigorous research - including cost-effectiveness assessments - is needed. PMID:25483518

  13. Effectiveness of the behavior change intervention to improve harm reduction self-efficacy among people who inject drugs in Thailand

    PubMed Central

    Pawa, Duangta; Areesantichai, Chitlada

    2016-01-01

    Background People who inject drugs (PWID) in Thailand reported unsafe injection practices resulting in injection-related health consequences. Harm reduction self-efficacy plays an important role and could be improved to reduce harm associated with injecting drugs. Evidence-based interventions targeting PWID are needed. This study sought to evaluate the effectiveness of the behavior change intervention within the PWID population. Methods The behavior change intervention, Triple-S, was designed to improve harm reduction self-efficacy among PWID. This quasi-experimental study was a pre- and post-comparison with a control group design. Participants were PWID, aged 18–45 years, and located in Bangkok. Changes in harm reduction self-efficacy of the intervention group were compared with the control group using paired and independent t-test. Results Most of PWID were male (84%), had a secondary school and lower education (71%), were single, and had a mean age of 41 years. They had been injecting drugs for an average of 20 years, and the median of drug injections per week was ten times in the past month. Pre- and post-intervention effects were measured and results showed that the intervention group reported improvement in harm reduction self-efficacy in negative emotional conditions (P=0.048). Conclusion Our findings suggest that Triple-S intervention can significantly improve harm reduction self-efficacy in negative emotional conditions. The results may suggest the importance of behavior change intervention, especially when integrated with services provided by drop-in centers. The intervention can be further developed to cover other harm reduction behaviors and improve harm reduction self-efficacy. PMID:27660503

  14. Process evaluation of a multi-component intervention to reduce infectious diseases and improve hygiene and well-being among school children: the Hi Five study.

    PubMed

    Bonnesen, C T; Plauborg, R; Denbæk, A M; Due, P; Johansen, A

    2015-06-01

    The Hi Five study was a three-armed cluster randomized controlled trial designed to reduce infections and improve hygiene and well-being among pupils. Participating schools (n = 43) were randomized into either control (n = 15) or one of two intervention groups (n = 28). The intervention consisted of three components: (i) a curriculum (ii) mandatory daily hand washing before lunch (iii) extra cleaning of school toilets. The aim of this study was to evaluate the implementation and to identify challenges to program implementation. Several data sources were used, including observations of school toilets, semi-structured interviews with school coordinators (n = 4), focus groups with pupils (n = 6) and teachers (n = 5), and questionnaires among pupils (n = 5440), teachers (n = 387) and school coordinators (n = 28). This study indicates that the curriculum was successfully implemented at most schools, and that teachers and pupils reacted positively to this part of the intervention. However, daily hand washing before lunch seems to be difficult to implement. Overall, the implementation process was affected by several factors such as poor sanitary facilities, lack of time and prioritization and objections against the increasing tendency to place the responsibility for child-rearing tasks on schools. This study reveals the strong and weak parts of the Hi Five study and can guide program improvement.

  15. Back pain outcomes in primary care following a practice improvement intervention:- a prospective cohort study

    PubMed Central

    2011-01-01

    Background Back pain is one of the UK's costliest and least understood health problems, whose prevalence still seems to be increasing. Educational interventions for general practitioners on back pain appear to have had little impact on practice, but these did not include quality improvement learning, involve patients in the learning, record costs or document practice activities as well as patient outcomes. Methods We assessed the outcome of providing information about quality improvement techniques and evidence-based practice for back pain using the Clinical Value Compass. This included clinical outcomes (Roland and Morris Disability Questionnaire), functional outcomes, costs of care and patient satisfaction. We provided workshops which used an action learning approach and collected before and after data on routine practice activity from practice electronic databases. In parallel, we studied outcomes in a separate cohort of patients with acute and sub-acute non-specific back pain recruited from the same practices over the same time period. Patient data were analysed as a prospective, split-cohort study with assessments at baseline and eight weeks following the first consultation. Results Data for 1014 patients were recorded in the practice database study, and 101 patients in the prospective cohort study. We found that practice activities, costs and patient outcomes changed little after the intervention. However, the intervention was associated with a small, but statistically significant reduction in disability in female patients. Additionally, baseline disability, downheartedness, self-rated health and leg pain had small but statistically significant effects (p < 0.05) on follow-up disability scores in some subgroups. Conclusions GP education for back pain that both includes health improvement methodologies and involves patients may yield additional benefits for some patients without large changes in patterns of practice activity. The effects in this study were

  16. A racket-sport intervention improves behavioral and cognitive performance in children with attention-deficit/hyperactivity disorder.

    PubMed

    Pan, Chien-Yu; Chu, Chia-Hua; Tsai, Chia-Liang; Lo, Shen-Yu; Cheng, Yun-Wen; Liu, Yu-Jen

    2016-10-01

    The present study assessed the effects of a 12-week table tennis exercise on motor skills, social behaviors, and executive functions in children with attention deficit hyperactivity disorder (ADHD). In the first 12-week phase, 16 children (group I) received the intervention, whereas 16 children (group II) did not. A second 12-week phase immediately followed with the treatments reversed. Improvements were observed in executive functions in both groups after the intervention. After the first 12-week phase, some motor and behavioral functions improved in group I. After the second 12-week phase, similar improvements were noted for group II, and the intervention effects achieved in the first phase were persisted in group I. The racket-sport intervention is valuable in promoting motor skills, social behaviors, and executive functions and should be included within the standard-of-care treatment for children with ADHD.

  17. What are the most effective ways of improving population health through transport interventions? Evidence from systematic reviews

    PubMed Central

    Morrison, D; Petticrew, M; Thomson, H

    2003-01-01

    Methods: Systematic review methodology was used to evaluate published and unpublished systematic reviews in any language that described the measured health effects of any mode of transport intervention. Main results: 28 systematic reviews were identified. The highest quality reviews indicate that the most effective transport interventions to improve health are health promotion campaigns (to prevent childhood injuries, to increase bicycle and motorcycle helmet use, and to promote children's car seat and seatbelt use), traffic calming, and specific legislation against drink driving. Driver improvement and education courses are associated with increases in crash involvement and violations. Conclusions: Systematic reviews are able to provide evidence about effective ways of improving health through transport related interventions and also identify well intentioned but harmful interventions. Valuable additional information may exist in primary studies and systematic reviews have a role in evaluating and synthesising their findings. PMID:12700214

  18. Clinical improvements in adopted children with fetal alcohol spectrum disorders through neurodevelopmentally informed clinical intervention: A pilot study.

    PubMed

    Zarnegar, Zohreh; Hambrick, Erin P; Perry, Bruce D; Azen, Stanley P; Peterson, Cassandra

    2016-10-01

    Research on early intervention for young children (infants and toddlers) with fetal alcohol spectrum disorders (FASD), particularly children with comorbid maltreatment experiences, is limited. Existing research has primarily focused on structuring environments to be responsive to the needs experienced by children with FASD rather than improving their functioning. The purpose of this study is to present outcomes from an early psychosocial intervention with 10 adopted, maltreated young children diagnosed with FASD, aged 10-53 months (M = 35 months), and their adoptive parents. The potential for early, targeted interventions to improve developmental outcomes for children with prenatal alcohol exposure was examined, as well as improving the skills of and reducing stress experienced by their adoptive parents. Based on the outcomes of a neurodevelopmentally informed assessment protocol, the 10 children whose data are presented were recommended to receive a range of regulatory, somatosensory, relational, and cognitive enrichments. As part of their treatment, children and caregivers received Child-Parent Psychotherapy (CPP), and caregivers (here, adoptive parents) also received Mindful Parenting Education (MPE). Related-samples Wilcoxon signed-rank tests indicated that scores of several measures of child developmental functioning improved from pre- to post-intervention and that parents' caregiving skills improved while their caregiving stress decreased. Reliable change analyses indicated that change observed from pre- to post-intervention was reliable. The promise of using neurodevelopmentally informed assessment strategies to sequence interventions for young children with diverse neurodevelopmental insults is discussed.

  19. pH-sensitive polymeric nanoparticles to improve oral bioavailability of peptide/protein drugs and poorly water-soluble drugs.

    PubMed

    Wang, Xue-Qing; Zhang, Qiang

    2012-10-01

    pH-sensitive polymeric nanoparticles are promising for oral drug delivery, especially for peptide/protein drugs and poorly water-soluble medicines. This review describes current status of pH-sensitive polymeric nanoparticles for oral drug delivery and introduces the mechanisms of drug release from them as well as possible reasons for absorption improvement, with emphasis on our contribution to this field. pH-sensitive polymeric nanoparticles are prepared mainly with polyanions, polycations, their mixtures or cross-linked polymers. The mechanisms of drug release are the result of carriers' dissolution, swelling or both of them at specific pH. The possible reasons for improvement of oral bioavailability include the following: improve drug stability, enhance mucoadhesion, prolong resident time in GI tract, ameliorate intestinal permeability and increase saturation solubility and dissolution rate for poorly water-soluble drugs. As for the advantages of pH-sensitive nanoparticles over conventional nanoparticles, we conclude that (1) most carriers used are enteric-coating materials and their safety has been approved. (2) The rapid dissolution or swelling of carriers at specific pH results in quick drug release and high drug concentration gradient, which is helpful for absorption. (3) At the specific pH carriers dissolve or swell, and the bioadhesion of carriers to mucosa becomes high because nanoparticles turn from solid to gel, which can facilitate drug absorption.

  20. Improvement in the bioavailability of poorly absorbed glycyrrhizin via various non-vascular administration routes in rats.

    PubMed

    Sasaki, Kazuhiro; Yonebayashi, Shingo; Yoshida, Motoyuki; Shimizu, Kenji; Aotsuka, Tomaji; Takayama, Kozo

    2003-10-20

    The purpose of this study was to examine the improvement of the bioavailability of glycyrrhizin (GL) via extra-vascular, i.e. oral, rectal, and nasal routes with or without the aid of an absorption enhancer in place of the vascular intravenous route in rats. Pharmacokinetic behavior following administration via vascular routes, i.e. the intravenous and portal-venous routes was examined in rats. The area under the plasma concentration-time curve (AUC) after administration of GL via the portal vein was decreased slightly, suggesting that the first elimination of GL in the liver may be one of the factors contributing to the low bioavailability after administration via the oral route. When GL was administered orally as a solution (30 mg/kg), the plasma concentration of GL was extremely low. However, after rectal or nasal administration of GL solution (30 mg/kg) with or without sodium caprate, the mean AUC value was remarkably increased compared with oral administration. In particular, the absolute bioavailability of GL after nasal administration was estimated to be approximately 20%, which was approximately 80-fold greater compared with after oral administration despite of the absence of an enhancer. Furthermore, the fatty acids co-administered orally with GL produced an increase in GL absorption in the following order: sodium caprate>sodiumlaurate>sodiumcaprylate>sodium oleate. These results indicate that the rectum and nasal cavity are useful administration routes for systemic delivery of GL. It was also found that the fatty acids were enhancers for the absorption of GL.

  1. Group Music Intervention Reduces Aggression and Improves Self-esteem in Children with Highly Aggressive Behavior: A Pilot Controlled Trial

    PubMed Central

    Lee, Myeong Soo; Lee, Jung-Sook

    2010-01-01

    We investigated the effects of group music intervention on aggression and self-esteem in children with highly aggressive behavior. Forty-eight children were allocated to either a music intervention group or an untreated control group. The music intervention group received 50 min of music intervention twice weekly for 15 consecutive weeks. The outcome measures were Child Behavior Checklist Aggression Problems Scale (Parents), Child Aggression Assessment Inventory (Teachers) and Rosenberg Self-esteem Scale. After 15 weeks, the music intervention group showed significant reduction of aggression and improvement of self-esteem compared with the control group. All outcome measures were significantly lower in the music intervention group than prior to treatment, while there was no change in the control group. These findings suggest that music can reduce aggressive behavior and improve self-esteem in children with highly aggressive behavior. Music intervention is an easily accessible therapy for children and as such may be an effective intervention for aggressive behavior. Further more, objective and replicable measures are required from a randomized controlled trial with a larger sample size and active comparable control. PMID:18955314

  2. A 10 year (2000–2010) systematic review of interventions to improve quality of care in hospitals

    PubMed Central

    2012-01-01

    Background Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000–2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions. Methods Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria. Results Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n = 11) or interpersonal (n = 9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care. Conclusions The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of

  3. Improved Reproductive Health Equity Between the Poor and the Rich: An Analysis of Trends in 46 Low- and Middle-Income Countries

    PubMed Central

    2015-01-01

    While several indicators for reproductive health have improved for entire populations, few analyses are available for trends over time in the gaps between the poor and the rich. This paper tracks improvements in the equitable distribution of reproductive health indicators according to wealth quintiles, especially for contraceptive use, in 46 low- and middle-income countries based on national population-based surveys conducted between 1990 and 2013. It focuses on the gaps between the poorest and richest quintiles in the earliest and latest survey rounds across a number of reproductive health indicators related to family planning, fertility desires, antenatal care, and infant and child mortality, as well as on improvements in the absolute levels of contraceptive use by the poorest quintile. Gap changes were decomposed to show how the gaps can either diminish or grow due to either the bottom or top quintile, or both. In addition, bivariate correlation analysis was conducted to examine the relationship of the gaps, and of contraceptive use by the poor, to national family planning program efforts. Overall, the gaps between the poorest and richest have narrowed, due primarily to faster improvements among the poor than the rich. For example, the gap between the richest and poorest in the modern contraceptive prevalence rate has declined by 25%, from a 20.4 percentage point difference to a 15.4 point difference. And the gap has decreased more where family planning programs have been stronger. Across most of 18 other reproductive health indicators, the gaps have also been narrowing. For instance, the poor-rich gap for antenatal care decreased by over a third, from a difference of 30.7 percentage points to 19.6 percentage points. Gaps in infant and child mortality also have declined by about one-third. The pattern for contraceptive use in sub-Saharan Africa, however, has been mixed, with the gap actually increasing in some countries with strong programs. This disparity may

  4. Do telemedical interventions improve quality of life in patients with COPD? A systematic review

    PubMed Central

    Gregersen, Thorbjørn L; Green, Allan; Frausing, Ejvind; Ringbæk, Thomas; Brøndum, Eva; Suppli Ulrik, Charlotte

    2016-01-01

    Objective Telehealth is an approach to disease management, which may hold the potential of improving some of the features associated with COPD, including positive impact on disease progression, and thus possibly limiting further reduction in quality of life (QoL). Our objective was, therefore, to summarize studies addressing the impact of telehealth on QoL in patients with COPD. Design Systematic review. Methods A series of systematic searches were carried out using the following databases: PubMed, EMBASE, Cochrane Controlled Trials Register, and ClinicalTrials.gov (last updated November 2015). A predefined search algorithm was utilized with the intention to capture all results related to COPD, QoL, and telehealth published since year 2000. Outcome measures Primary outcome was QoL, assessed by validated measures. Results Out of the 18 studies fulfilling the criteria for inclusion in this review, three studies found statistically significant improvements in QoL for patients allocated to telemedical interventions. However, all of the other included studies found no statistically significant differences between control and telemedical intervention groups in terms of QoL. Conclusion Telehealth does not make a strong case for itself when exclusively looking at QoL as an outcome, since statistically significant improvements relative to control groups have been observed only in few of the available studies. Nonetheless, this does not only rule out the possibility that telehealth is superior to standard care with regard to other outcomes but also seems to call for more research, not least in large-scale controlled trials. PMID:27143872

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

    PubMed Central

    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, including evidence-based reviews of delirium recognition, prevention, and management, interspersed with interactive small group sessions and practical case conferences was conceptualized in consultation with a leading expert on delirium. Pretest and posttest instruments were designed to test the attendees on their knowledge and confidence around delirium identification. Results: An average of 71 people attended each didactic session. Among all responses, 50 pretests and posttests were matched based on numeric coding (6 MD/DOs, 34 RNs, and 10 others). Mean pretest and posttest scores were 7.9 and 10.8 points, respectively (maximum: 17), showing a positive change in knowledge scores after the intervention (2.9 points, p < .001). Improvement in knowledge scores was higher in the cohort attending 2 or more lectures (3.8 points, p < .001) compared with those attending only 1 lecture (1.3 points, p < .12). Confidence in identifying patients with delirium increased by 28% (p < .001), and self-assessed capacity to correctly administer the Confusion Assessment Method increased by 36% (p < .001). Implications: A novel CSI increased clinician knowledge about delirium identification and management and improved confidence and self-assessed capacity to identify delirium in the hospitalized elderly patients. This strategy, which incorporates multiple reinforcing modes of education, may ultimately be more effective in influencing clinician behavior when compared with traditional grand rounds. PMID:20855818

  6. Does subjective sleep quality improve by a walking intervention? A real-world study in a Japanese workplace

    PubMed Central

    Hori, Hikaru; Ikenouchi-Sugita, Atsuko; Yoshimura, Reiji; Nakamura, Jun

    2016-01-01

    Objectives The purpose of this study was to evaluate the impact of a 4-week walking intervention on subjective sleep quality. Design A prospective open-label study. Participants A total of 490 healthy workers were included in the study. The 490 participants were divided into a group of 214 participants with exercise habits (exercising group, EG) and a group of 276 participants without exercise habits (non-EG). Interventions A walking intervention with a target of walking 10 000 steps daily for 4 weeks. Outcome measures The Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered twice (before the start and after the end of the study). Results Overall, the walking intervention improved the participants’ PSQI global score, sleep latency (minutes), sleep duration (hours), perceived sleep quality factor and daily disturbance factor. Among the EG participants, the walking intervention significantly improved the PSQI global score and perceived sleep quality. Among the non-EG participants, the walking intervention significantly improved the PSQI global score, sleep latency, sleep duration and perceived sleep quality. Conclusions A walking intervention might reduce the sleep latency and increase total sleep duration in working persons without exercise habits. PMID:27797982

  7. Information Technology-Based Interventions to Improve Drug-Drug Interaction Outcomes: A Systematic Review on Features and Effects.

    PubMed

    Nabovati, Ehsan; Vakili-Arki, Hasan; Taherzadeh, Zhila; Saberi, Mohammad Reza; Medlock, Stephanie; Abu-Hanna, Ameen; Eslami, Saeid

    2017-01-01

    The purpose of this systematic review was to identify features and effects of information technology (IT)-based interventions on outcomes related to drug-drug interactions (DDI outcomes). A literature search was conducted in Medline, EMBASE, and the Cochrane Library for published English-language studies. Studies were included if a main outcome was related to DDIs, the intervention involved an IT-based system, and the study design was experimental or observational with controls. Study characteristics, including features and effects of IT-based interventions, were extracted. Nineteen studies comprising five randomized controlled trials (RCT), five non-randomized controlled trials (NRCT) and nine observational studies with controls (OWC) were included. Sixty-four percent of prescriber-directed interventions, and all non-prescriber interventions, were effective. Each of the following characteristics corresponded to groups of studies of which a majority were effective: automatic provision of recommendations within the providers' workflow, intervention at the time of decision-making, integration into other systems, and requiring the reason for not following the recommendations. Only two studies measured clinical outcomes: an RCT that showed no significant improvement and an OWC that showed improvement, but did not statistically assess the effect. Most studies that measured surrogate outcomes (e.g. potential DDIs) and other outcomes (e.g. adherence to alerts) showed improvements. IT-based interventions improve surrogate clinical outcomes and adherence to DDI alerts. However, there is lack of robust evidence about their effectiveness on clinical outcomes. It is recommended that researchers consider the identified features of effective interventions in the design of interventions and evaluate the effectiveness on DDI outcomes, particularly clinical outcomes.

  8. Efficacy of interventions to improve physical activity levels in individuals with stroke: a systematic review protocol

    PubMed Central

    Aguiar, Larissa Tavares; Martins, Júlia Caetano; Nadeau, Sylvie; Britto, Raquel Rodrigues; Teixeira-Salmela, Luci F; Faria, Christina D C M

    2017-01-01

    Introduction Stroke is a leading health problem worldwide and an important cause of disability. Stroke survivors show low levels of physical activity, and increases in physical activity levels may improve function and health status. Therefore, the aims are to identify which interventions that have been employed to increase physical activity levels with stroke survivors, to verify their efficacy and to identify the gaps in the literature. Methods and analysis A systematic review of randomised controlled trials that investigated the efficacy of interventions aiming at increasing physical activity levels of stroke survivors will be conducted. Electronic searches will be performed in the MEDLINE, Physiotherapy Evidence Database (PEDro), Excerpta Medica (EMBASE), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) and Scientific Electronic Library Online (SCIELO) databases. Hand searches of the reference lists of the included studies or relevant reviews will also be employed. Two independent reviewers will screen all the retrieved titles, abstracts and full texts. A third reviewer will be referred to solve any disagreements. The quality of the included studies will be assessed by the PEDro Rating Scale. This systematic review will also include a qualitative synthesis. Meta-analyses will be performed, if the studies are sufficiently homogeneous. This review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The quality of the evidence regarding physical activity will be assessed, according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Discussion This systematic review will provide information on which interventions are effective for increasing physical activity levels of stroke survivors. This evidence may be important for clinical decision-making and will allow the identification of gaps in the literature that may be useful for the definition of future research

  9. Improving Depression Treatment for Women: Integrating a Collaborative Care Depression Intervention into OB-GYN Care

    PubMed Central

    LaRocco-Cockburn, Anna; Reed, Susan D.; Melville, Jennifer; Croicu, Carmen; Russo, Joan; Inspektor, Michal; Edmondson, Eddie; Katon, Wayne

    2013-01-01

    Background Women have higher rates of depression and often experience depression symptoms during critical reproductive periods, including adolescence, pregnancy, postpartum, and menopause. Collaborative care intervention models for mood disorders in patients receiving care in an OB-GYN clinic setting have not been evaluated. Study design and methodology for a randomized, controlled trial of collaborative care depression management versus usual care in OB-GYN clinics and the details of the adapted collaborative care intervention and model implementation are described in this paper. Methods Women over age 18 years with clinically significant symptoms of depression, as measured by a Patient Health Questionnaire-9 (PHQ-9) score ≥10 and a clinical diagnosis of major depression or dysthymia, were randomized to the study intervention or to usual care and were followed for 18 months. The primary outcome assessed was change over time in the SCL-20 depression scale between baseline and 12 months. Baseline Results 205 women were randomized: 57% white, 20% African American, 9% Asian or Pacific Islander, 7% Hispanic, and 6% Native American. Mean age was 39 years. 4.6% were pregnant and 7.5% were within 12 months postpartum. The majority were single, (52%), and 95% had at least the equivalent of a high school diploma. Almost all patients met DSM IV criteria for major depression (99%) and approximately 33% met criteria for dysthymia. Conclusions An OB-GYN collaborative care team including a social worker, psychiatrist and OB-GYN physician who met weekly and used an electronic tracking system for patients were essential elements of the proposed depression care treatment model described here. Further study of models that improve quality of depression care that are adapted to the unique OB-GYN setting are needed. PMID:23939510

  10. Do cognitive interventions improve general cognition in dementia? A meta-analysis and meta-regression

    PubMed Central

    Huntley, J D; Gould, R L; Liu, K; Smith, M; Howard, R J

    2015-01-01

    Objectives To review the efficacy of cognitive interventions on improving general cognition in dementia. Method Online literature databases and trial registers, previous systematic reviews and leading journals were searched for relevant randomised controlled trials. A systematic review, random-effects meta-analyses and meta-regression were conducted. Cognitive interventions were categorised as: cognitive stimulation (CS), involving a range of social and cognitive activities to stimulate multiple cognitive domains; cognitive training (CT), involving repeated practice of standardised tasks targeting a specific cognitive function; cognitive rehabilitation (CR), which takes a person-centred approach to target impaired function; or mixed  CT and stimulation (MCTS). Separate analyses were conducted for general cognitive outcome measures and for studies using ‘active’ (designed to control for non-specific therapeutic effects) and non-active (minimal or no intervention) control groups. Results 33 studies were included. Significant positive effect sizes (Hedges’ g) were found for CS with the mini-mental state examination (MMSE) (g=0.51, 95% CI 0.29 to 0.69; p<0.001) compared to non-active controls and (g=0.35, 95% CI 0.06 to 0.65; p=0.019) compared to active controls. Significant benefit was also seen with the Alzheimer's disease Assessment Scale-Cognition (ADAS-Cog) (g=−0.26, 95% CI −0.445 to −0.08; p=0.005). There was no evidence that CT or MCTS produced significant improvements on general cognition outcomes and not enough CR studies for meta-analysis. The lowest accepted minimum clinically important difference was reached in 11/17 CS studies for the MMSE, but only 2/9 studies for the ADAS-Cog. Additionally, 95% prediction intervals suggested that although statistically significant, CS may not lead to benefits on the ADAS-Cog in all clinical settings. Conclusions CS improves scores on MMSE and ADAS-Cog in dementia, but benefits on the ADAS-Cog are generally

  11. An improved technique for gaining radial artery access in endovascular interventions.

    PubMed

    Rigatelli, Gianluca; Magro, Beatrice; Maronati, Lorenza; Tranquillo, Milan; Oliva, Laura; Panin, Stefano; Bedendo, Emiliano

    2006-01-01

    We present a simple technique to avoid time loss and potential dangerous maneuvers for catheterization of the radial artery in endovascular interventions. If any difficulties are encountered when advancing the guide wire after the arterial puncture using standard transradial kits, we found it useful to routinely use a 60-mm polyethylene radial pressure line catheter like the Leader Cath (Vygon, Ecquen, France), which is more flexible and less traumatic than short catheters and are usually available in the standard hydrophilic transradial kit. With the 20-gauge needle within the arterial lumen, it is sufficient to advance the guide wire 3 or 4 cm, followed by the insertion of the radial pressure line catheter for administering a vasodilator cocktail. The contrast injection through the catheter is safer than through the needle, and visualization of the underling problems may avoid any time loss and complications. The standard sheath insertion is facilitated by the pressure line catheter that acts as a dilator. This technique, especially when performing coronary or peripheral interventions in which large introducers are needed, may avoid potentially dangerous vascular complications and improve the success rate.

  12. Epi-fingerprinting and epi-interventions for improved crop production and food quality

    PubMed Central

    Rodríguez López, Carlos M.; Wilkinson, Mike J.

    2015-01-01

    Increasing crop production at a time of rapid climate change represents the greatest challenge facing contemporary agricultural research. Our understanding of the genetic control of yield derives from controlled field experiments designed to minimize environmental variance. In spite of these efforts there is substantial residual variability among plants attributable to Genotype × Environment interactions. Recent advances in the field of epigenetics have revealed a plethora of gene control mechanisms that could account for much of this unassigned variation. These systems act as a regulatory interface between the perception of the environment and associated alterations in gene expression. Direct intervention of epigenetic control systems hold the enticing promise of creating new sources of variability that could enhance crop performance. Equally, understanding the relationship between various epigenetic states and responses of the crop to specific aspects of the growing environment (epigenetic fingerprinting) could allow for a more tailored approach to plant agronomy. In this review, we explore the many ways in which epigenetic interventions and epigenetic fingerprinting can be deployed for the improvement of crop production and quality. PMID:26097484

  13. Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners

    PubMed Central

    Segrin, Chris; Figueredo, Aurelio J.; Harrington, Joanne; Sheppard, Kate; Passalacqua, Stacey; Pasvogel, Alice; Bishop, Maria

    2011-01-01

    Purpose The primary purpose was to test the effectiveness of two telephone-delivered psychosocial interventions for maintaining and improving quality of life (QOL) (psychological, physical, social, and spiritual well-being) among 71 prostate cancer survivors and the 70 intimate or family partners who were supporting them in their recovery. Methods This study used a three-wave repeated measures experimental design. Both the interpersonal counseling intervention (TIP-C) and health education attention condition (HEAC) were delivered using the telephone. Results Improvements in depression, negative affect, stress, fatigue, and spiritual well-being were significantly higher for survivors in the HEAC than for those in the TIP-C condition. Partners in the HEAC condition showed significantly greater improvements in depression, fatigue, social support from family members, social well-being, and spiritual well-being compared to partners in the TIP-C condition. The results revealed superior outcomes for those assigned to the HEAC intervention. Conclusions The psychosocial interventions in this study were effective in maintaining or improving the QOL for prostate cancer survivors and their partners. Both the survivor and their intimate partner or family member benefitted from the interventions. Future research is needed to determine the optimal timing and client characteristics for each intervention. PMID:21170682

  14. Using Design Thinking to Improve Psychological Interventions: The Case of the Growth Mindset During the Transition to High School

    PubMed Central

    Yeager, David S.; Romero, Carissa; Paunesku, Dave; Hulleman, Christopher S.; Schneider, Barbara; Hinojosa, Cintia; Lee, Hae Yeon; O’Brien, Joseph; Flint, Kate; Roberts, Alice; Trott, Jill; Greene, Daniel; Walton, Gregory M.; Dweck, Carol S.

    2016-01-01

    There are many promising psychological interventions on the horizon, but there is no clear methodology for preparing them to be scaled up. Drawing on design thinking, the present research formalizes a methodology for redesigning and tailoring initial interventions. We test the methodology using the case of fixed versus growth mindsets during the transition to high school. Qualitative inquiry and rapid, iterative, randomized “A/B” experiments were conducted with ~3,000 participants to inform intervention revisions for this population. Next, two experimental evaluations showed that the revised growth mindset intervention was an improvement over previous versions in terms of short-term proxy outcomes (Study 1, N=7,501), and it improved 9th grade core-course GPA and reduced D/F GPAs for lower achieving students when delivered via the Internet under routine conditions with ~95% of students at 10 schools (Study 2, N=3,676). Although the intervention could still be improved even further, the current research provides a model for how to improve and scale interventions that begin to address pressing educational problems. It also provides insight into how to teach a growth mindset more effectively. PMID:27524832

  15. Moving from theory to research to practice. Implementing an effective dyadic intervention to improve antiretroviral adherence for clinic patients.

    PubMed

    Remien, Robert H; Stirratt, Michael J; Dognin, Joanna; Day, Emily; El-Bassel, Nabila; Warne, Patricia

    2006-12-01

    There is a dearth of evidence on the relative efficacy of intervention modalities to improve and maintain patient adherence to antiretroviral medications. Although empiric findings from research on HIV/AIDS, other diseases, and chronic medical conditions consistently demonstrate that social support plays an important role in facilitating adherence, few HIV/AIDS interventions have directly targeted this factor. Ewart's social action theory emphasizes the role of social relationships in behavior change and provides a comprehensive and useful guide to the development of interventions for adherence. We describe the development, content, and testing of SMART Couples, an effective antiretroviral adherence intervention that is grounded in social action theory and designed to enhance social support for ART adherence. Finally, we discuss some of the challenges of translating findings from the randomized clinical trial of this intervention into clinical practice and offer recommendations for integration of lessons learned into ongoing clinical care.

  16. Interventions for improving coverage of childhood immunisation in low- and middle-income countries

    PubMed Central

    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 interventions for improving childhood immunisation coverage in LMICs. Objectives To evaluate the effectiveness of intervention strategies to boost and sustain high childhood immunisation coverage in LMICs. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) 2016, Issue 4, part of The Cochrane Library. www.cochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 12 May 2016); MEDLINE In-Process and Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 12 May 2016); CINAHL 1981 to present, EbscoHost (searched 12 May 2016); Embase 1980 to 2014 Week 34, OvidSP (searched 2 September 2014); LILACS, VHL (searched 2 September 2014); Sociological Abstracts 1952 - current, ProQuest (searched 2 September 2014). We did a citation search for all included studies in Science Citation Index and Social Sciences Citation Index, 1975 to present; Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 2 July 2016). We also searched the two Trials Registries: ICTRP and ClinicalTrials.gov (searched 5 July 2016) Selection criteria Eligible studies were randomised controlled trials (RCT), non-RCTs, controlled before-after studies, and interrupted time series conducted in LMICs involving children aged from birth to four years, caregivers, and healthcare providers. Data collection and analysis We independently screened the search output, reviewed

  17. Lessons learned from a quality improvement intervention with homeless veteran services.

    PubMed

    Chinman, Matthew; Hannah, Gordon; McCarthy, Sharon

    2012-08-01

    Homeless veterans are a vulnerable population, with high mortality and morbidity rates. Evidence-based practices for homelessness have been challenging to implement. This study engaged staff members from three VA homeless programs to improve their quality using Getting-To-Outcomes (GTO), a model and intervention of trainings and technical assistance that builds practitioner capacity to plan, implement, and self-evaluate evidence-based practices. Primarily used in community-based, non-VA settings, this study piloted GTO in VA by creating a GTO project within each homeless program and one across all three. The feasibility and acceptability of GTO in VA is examined using the results of the projects, time spent on GTO, and data from focus groups and interviews. With staff members averaging 33 minutes per week on GTO, each team made significant programmatic changes. Homeless staff stated GTO was helpful, and that high levels of communication, staff member commitment to the program, and technical assistance were critical.

  18. Dose-dispensing service as an intervention to improve adherence to polymedication.

    PubMed

    Hersberger, Kurt E; Boeni, Fabienne; Arnet, Isabelle

    2013-07-01

    Given the importance of high adherence to long-term pharmacotherapy and the growing need to improve medication adherence, choosing the best intervention represents a challenge for healthcare providers. A dose-dispensing service is defined as the repackaging of solid oral medication into dose-dispensing aids by a healthcare provider, mostly in a community pharmacy or hospital pharmacy, in order to assist patients in the management of their polymedication. The personalized dose-dispensing aid organizes individual oral doses according to their prescribed intake schedule throughout the day and the week. This review aims to describe the pros and cons of different dose-dispensing services and technologies, summarizes current evidence and addresses research gaps.

  19. Working memory training with tDCS improves behavioral and neurophysiological symptoms in pilot group with post-traumatic stress disorder (PTSD) and with poor working memory.

    PubMed

    Saunders, Nerida; Downham, Russell; Turman, Bulent; Kropotov, Juri; Clark, Richard; Yumash, Rustam; Szatmary, Arielle

    2015-01-01

    This pilot study investigated the feasibility of treating people suffering from both post-traumatic stress disorder (PTSD) and poor working memory by employing a combination of computerized working memory training and transcranial direct current stimulation (tDCS). After treatment, all four participants showed clinically significant improvements on a range of cognitive and emotional performance measures. Moreover, these improvements were accompanied by theoretically significant neurophysiological changes between pre- and post-treatment electroencephalographic (EEG) recordings. Specifically, the P3a component of participants' event related potentials (ERP) in response to novelty stimuli, characteristically abnormal in this clinical population, shifted significantly toward database norms. So, participants' initially slow alpha peak frequency (APF), theorized to underlie impaired cognitive processing abilities, also increased in both frequency and amplitude as a result of treatment. On the basis of these promising results, more extensive controlled studies are warranted.

  20. Development of a Novel Milling System Using Supercritical Carbon Dioxide for Improvement of Dissolution Characteristics of Water-Poorly Soluble Drugs.

    PubMed

    Fern, Jennifer Chia Wee; Nakamura, Hideya; Watano, Satoru

    2016-01-01

    The aim of this study is to develop a novel milling system using supercritical carbon dioxide (SC-CO2) for the improvement of dissolution characteristics of water-poorly soluble drugs. SC-CO2 possesses high potential in the application of nanotechnology, due to the attractive properties of SC-CO2 fluid such as cheap, inert and non-polluting. In addition, SC-CO2 has density comparable to a liquid, viscosity similar to a gas, and high diffusion capacity. Most of all, carbon dioxide exists as gas in room temperature and pressure, which enables the removal of fluid instantaneously. In this study, a novel method of milling using SC-CO2 was proposed to produce fine-drug particles. SC-CO2 milling was conducted and its performance was compared with the ones by various milling methods such as jet milling, dry milling and wet milling. A comparison on the effect of each milling medium on its milling performance, drug size distribution, and particle morphology was conducted. Operating variables of the SC-CO2 milling system were also investigated to clarify the factors affecting the milling properties and to improve drug release characteristics of water-poorly soluble drugs.

  1. A cognitive training intervention improves modality-specific attention in a randomized controlled trial of healthy older adults

    PubMed Central

    Long, Ashley B.; Morgan, Ashley R.; Rawley-Payne, Melissa; Laurienti, Paul J.

    2009-01-01

    Age-related deficits in cognitive and sensory function can result in increased distraction from background sensory stimuli. This randomized controlled trial investigated the effects of a cognitive training intervention aimed at helping healthy older adults suppress irrelevant auditory and visual stimuli. Sixty-six participants received 8 weeks of either the modality-specific attention training program or an educational lecture control program. Participants who completed the intervention program had larger improvements in modality-specific selective attention following training than controls. These improvements also correlated with reductions in bimodal integration during selective attention. Further, the intervention group showed larger improvements than the control group in non-trained domains such as processing speed and dual-task completion, demonstrating the utility of modality-specific attention training for improving cognitive function in healthy older adults. PMID:19428142

  2. Do Family Interventions Improve Outcomes in Early Psychosis? A Systematic Review and Meta-Analysis

    PubMed Central

    Claxton, Melanie; Onwumere, Juliana; Fornells-Ambrojo, Miriam

    2017-01-01

    Family interventions for psychosis (FIp) are effective in reducing service user relapse and carer distress in people with schizophrenia-spectrum conditions. Several treatment and best practice guidelines recommend FIp for all people with schizophrenia. However, outcome findings in relation to early psychosis groups have been inconsistent. The current paper reports a systematic review and meta-analyses of articles that evaluated FIp in early psychosis with a clearly defined comparison group. A combination of electronic database searches (using PsychINFO, Medline, and CENTRAL), citation searches and hand searches of key journals and reviews was conducted. Peer-reviewed articles published in English from database inception to June 2016 were included. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool (EPHPP). Seventeen papers from 14 studies met inclusion criteria for review, the overall quality of which was moderate. Meta-analytic synthesis showed that FIp improved service user functioning and reduced the likelihood of relapse by the end of treatment. Psychotic symptoms were significantly reduced in the FIp group at follow up, but this was not evident at end of treatment. In terms of FIp target mechanisms, carers receiving FIp were more likely to shift from high to low expressed emotion and less likely to report patient focused criticism or engage in conflict communication than carers randomized to standard care. Carer burden and well-being were improved by the end of treatment but gains were not sustained at follow up. FIp had no impact on carer emotional over-involvement. The findings indicate that FIp is an effective intervention for early psychosis service users and their relatives. However, further research is required to establish which key therapeutic components of FIp are most effective for whom, in addition to understanding the mechanisms by which FIp might affect positive change.

  3. Computer assisted electromagnetic navigation improves accuracy in computed tomography guided interventions: A prospective randomized clinical trial

    PubMed Central

    2017-01-01

    Purpose To assess the accuracy and usability of an electromagnetic navigation system designed to assist Computed Tomography (CT) guided interventions. Materials and methods 120 patients requiring a percutaneous CT intervention (drainage, biopsy, tumor ablation, infiltration, sympathicolysis) were included in this prospective randomized trial. Nineteen radiologists participated. Conventional procedures (CT group) were compared with procedures assisted by a navigation system prototype using an electromagnetic localizer to track the position and orientation of a needle holder (NAV group). The navigation system displays the needle path in real-time on 2D reconstructed CT images extracted from the 3D CT volume. The regional ethics committee approved this study and all patients gave written informed consent. The main outcome was the distance between the planned trajectory and the achieved needle trajectory calculated from the initial needle placement. Results 120 patients were analyzable in intention-to-treat (NAV: 60; CT: 60). Accuracy improved when the navigation system was used: distance error (in millimeters: median[P25%; P75%]) with NAV = 4.1[2.7; 9.1], vs. with CT = 8.9[4.9; 15.1] (p<0.001). After the initial needle placement and first control CT, fewer subsequent CT acquisitions were necessary to reach the target using the navigation system: NAV = 2[2; 3]; CT = 3[2; 4] (p = 0.01). Conclusion The tested system was usable in a standard clinical setting and provided significant improvement in accuracy; furthermore, with the help of navigation, targets could be reached with fewer CT control acquisitions. PMID:28296957

  4. Video-based educational intervention associated with improved stroke literacy, self-efficacy, and patient satisfaction

    PubMed Central

    Vahidy, Farhaan; Vu, Kim Y. T.; Sharrief, Anjail Z.; Savitz, Sean I.

    2017-01-01

    Background and purpose Interventions are needed to improve stroke literacy among recent stroke survivors. We developed an educational video for patients hospitalized with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). Methods A 5-minute stroke education video was shown to our AIS and ICH patients admitted from March to June 2015. Demographics and a 5-minute protocol Montreal Cognitive Assessment were also collected. Questions related to stroke knowledge, self-efficacy, and patient satisfaction were answered before, immediately after, and 30 days after the video. Results Among 250 screened, 102 patients consented, and 93 completed the video intervention. There was a significant difference between pre-video median knowledge score of 6 (IQR 4–7) and the post-video score of 7 (IQR 6–8; p<0.001) and between pre-video and the 30 day score of 7 (IQR 5–8; p = 0.04). There was a significant difference between the proportion of patients who were very certain in recognizing symptoms of a stroke pre- and post-video, which was maintained at 30-days (35.5% vs. 53.5%, p = 0.01; 35.5% vs. 54.4%, p = 0.02). The proportion who were “very satisfied” with their education post-video (74.2%) was significantly higher than pre-video (49.5%, p<0.01), and this was maintained at 30 days (75.4%, p<0.01). There was no association between MoCA scores and stroke knowledge acquisition or retention. There was no association between stroke knowledge acquisition and rates of home blood pressure monitoring or primary care provider follow-up. Conclusions An educational video was associated with improved stroke knowledge, self-efficacy in recognizing stroke symptoms, and satisfaction with education in hospitalized stroke patients, which was maintained at 30 days after discharge. PMID:28333925

  5. Randomized Trial of the Availability, Responsiveness and Continuity (ARC) Organizational Intervention for Improving Youth Outcomes in Community Mental Health Programs

    ERIC Educational Resources Information Center

    Glisson, Charles; Hemmelgarn, Anthony; Green, Philip; Williams, Nathaniel J.

    2013-01-01

    Objectives: The primary objective of the study was to assess whether the Availability, Responsiveness and Continuity (ARC) organizational intervention improved youth outcomes in community based mental health programs. The second objective was to assess whether programs with more improved organizational social contexts following the 18-month ARC…

  6. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lifestyle interventions causing weight loss or improved physical fitness in obese individuals may lead to improved physical function. This study involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this study we...

  7. Intensive lifestyle intervention improves physical function among obese adults with knee pain: Findings from the Look AHEAD Trial

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at basel...

  8. A Study of the Effectiveness of a School Improvement Intervention (Success in Sight). Final Report. NCEE 2012-4014

    ERIC Educational Resources Information Center

    Wilkerson, Stephanie B.; Shannon, Lisa C.; Styers, Mary K.; Grant, Billie-Jo

    2012-01-01

    Success in Sight focuses on the interrelated parts of an education system. This systemic school improvement intervention is designed to address schools' specific needs while building their capacities to plan, implement, and evaluate school improvement practices. It is intended to help schools, leadership teams, and teachers systemically engage in…

  9. Effect of a classroom-based behavioral intervention package on the improvement of children's sitting posture in Japan.

    PubMed

    Noda, Wataru; Tanaka-Matsumi, Junko

    2009-03-01

    The present study evaluates the effect of a classroom-based behavioral intervention package to improve Japanese elementary school children's sitting posture in regular classrooms (N=68). This study uses a multiple-baseline design across two classrooms with a modified repeated reversal within each class. The article defines appropriate sitting posture as behavior composed of four components (feet, buttocks, back, and a whole body). The intervention package includes modeling, correspondence training, prompt, and reinforcement, among others. The authors counted the number of children with appropriate sitting posture in each classroom across all 28 sessions throughout the study. Interobserver agreement of appropriate sitting posture ranged from 80% to 100%. As a result of the intervention, the mean proportion of children with appropriate posture increased from approximately 20% to 90%. In addition, their academic writing productivity increased with the improved sitting posture. Teachers' acceptance of the intervention program proved to be excellent.

  10. Carers’ education improves oral health of older people suffering from dementia – results of an intervention study

    PubMed Central

    Zenthöfer, Andreas; Meyer-Kühling, Inga; Hufeland, Anna-Luisa; Schröder, Johannes; Cabrera, Tomas; Baumgart, Dominik; Rammelsberg, Peter; Hassel, Alexander J

    2016-01-01

    Aim The aim of this study was to evaluate the effectiveness of carers’ education on improvements in oral health and denture hygiene of care-dependent and cognitively impaired older people in nursing homes compared to those without intervention. Methods A total of 219 seniors living in 14 nursing homes in southwest Germany (intervention: n=144; control: n=75) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI) and Community Periodontal Index of Treatment Needs (CPITN) were assessed at baseline and six months following the interventions. In addition, demographic parameters such as age, sex, chronic diseases, permanent medications, level of dependency and cognitive state were recorded. In the intervention homes, education for caregivers was provided and ultrasound baths for denture cleaning were implemented. Changes in the dental target variables PCR, GBI, CPITN and DHI during the six-month study period were compared between subjects in the intervention and the control groups as well as between subjects with and without dementia. Additionally, multivariate models were compiled for each dental index to evaluate possible confounders. Results In the intervention group, PCR and DHI significantly improved during the study period (P<0.001). Oral health and denture hygiene improved likewise in subjects with and without dementia. In the control group, no significant improvements were observed (P>0.05). Conclusion Carers’ education improves oral health of people in nursing homes over a clinically relevant period of time. Implementation of ultrasound baths is a simple and effective measure to improve denture hygiene of both institutionalized elderly people and seniors with dementia and in severe need of care. From a clinical standpoint, it is noteworthy that the respective interventions can be easily implemented in everyday care routine. PMID:27942206

  11. Challenges of implementation and implementation research: Learning from an intervention study designed to improve tumor registry reporting

    PubMed Central

    McAlearney, Ann Scheck; Walker, Daniel M; Livaudais-Toman, Jennifer; Parides, Michael; Bickell, Nina A

    2016-01-01

    Objectives: Implementation of interventions designed to improve the quality of medical care often proceeds differently from what is planned. Improving existing conceptual models to better understand the sources of these differences can help future projects avoid these pitfalls and achieve desired effectiveness. To inform an adaptation of an existing theoretical model, we examined unanticipated changes that occurred in an intervention designed to improve reporting of adjuvant therapies for breast cancer patients at a large, urban academic medical center. Methods: Guided by the complex innovation implementation conceptual framework, our study team observed and evaluated the implementation of an intervention designed to improve reporting to a tumor registry. Findings were assessed against the conceptual framework to identify boundary conditions and modifications that could improve implementation effectiveness. Results: The intervention successfully increased identification of the managing medical oncologist and treatment reporting. During implementation, however, unexpected external challenges including hospital acquisitions of community practices and practices’ responses to government incentives to purchase electronic medical record systems led to unanticipated changes and associated threats to implementation. We present a revised conceptual model that incorporates the sources of these unanticipated challenges. Conclusion: This report of our experience highlights the importance of monitoring implementation over time and accounting for changes that affect both implementation and measurement of intervention impact. In this article, we use our study to examine the challenges of implementation research in health care, and our experience can help future implementation efforts. PMID:27635248

  12. Improving the well-being of couples facing cancer: a review of couples-based psychosocial interventions.

    PubMed

    Baik, Ok Mi; Adams, Kathryn Betts

    2011-04-01

    The purpose of this review article is to assess the available scientific evidence on the effects of couples-based psychosocial interventions for couples when one spouse faces cancer. For the present study, we conducted an extensive search of three electronic databases using a comprehensive search strategy. The literature search identified 14 studies evaluating couples intervention where one partner is facing cancer. Among them, eight studies concluded there was overall improvement for patients and eight studies reported overall improvement for partners, whereas an additional five studies showed partial improvement for patients and three demonstrated partial improvements for partners. Taken in the aggregate, these studies illustrated partial effectiveness--most had some positive results--but with clear limitations in terms of how many aspects of psychosocial well-being changed, lack of equal effectiveness for both patients and their partners, or limited maintenance of improvements over time, a common concern with brief psychosocial interventions. Although couples-based interventions may facilitate emotional support and dyadic coping, how these psychosocial interventions should be delivered, at what point in the illness and treatment they should be delivered, and how long they should continue remain as future challenges.

  13. Exposure to Large-Scale Social and Behavior Change Communication Interventions Is Associated with Improvements in Infant and Young Child Feeding Practices in Ethiopia

    PubMed Central

    Rawat, Rahul; Mwangi, Edina M.; Tesfaye, Roman; Abebe, Yewelsew; Baker, Jean; Frongillo, Edward A.; Ruel, Marie T.; Menon, Purnima

    2016-01-01

    Optimal breastfeeding (BF) practices in Ethiopia are far below the government’s targets, and complementary feeding practices are poor. The Alive & Thrive initiative aimed to improve infant and young child feeding (IYCF) practices through large-scale implementation of social and behavior change communication interventions in four regions of Ethiopia. The study assessed the effects of the interventions on IYCF practices and anthropometry over time in two regions–Southern Nations, Nationalities and Peoples Region and Tigray. A pre- and post-intervention adequacy evaluation design was used; repeated cross-sectional surveys of households with children aged 0–23.9 mo (n = 1481 and n = 1494) and with children aged 24–59.9 mo (n = 1481 and n = 1475) were conducted at baseline (2010) and endline (2014), respectively. Differences in outcomes over time were estimated using regression models, accounting for clustering and covariates. Plausibility analyses included tracing recall of key messages and promoted foods and dose-response analyses. We observed improvements in most WHO-recommended IYCF indicators. Early BF initiation and exclusive BF increased by 13.7 and 9.4 percentage points (pp), respectively. Differences for timely introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD), and consumption of iron-rich foods were 22.2, 3.3, 26.2, 3.5, and 2.7 pp, respectively. Timely introduction and intake of foods promoted by the interventions improved significantly, but anthropometric outcomes did not. We also observed a dose-response association between health post visits and early initiation of BF (OR: 1.8); higher numbers of home visits by community volunteers and key messages recalled were associated with 1.8–4.4 times greater odds of achieving MDD, MMF, and MAD, and higher numbers of radio spots heard were associated with 3 times greater odds of achieving MDD and MAD. The interventions were

  14. Impact of Baltimore Healthy Eating Zones: An Environmental Intervention to Improve Diet among African American Youth

    ERIC Educational Resources Information Center

    Shin, Ahyoung; Surkan, Pamela J.; Coutinho, Anastasia J.; Suratkar, Sonali R.; Campbell, Rebecca K.; Rowan, Megan; Sharma, Sangita; Dennisuk, Lauren A.; Karlsen, Micaela; Gass, Anthony; Gittelsohn, Joel

    2015-01-01

    This study assessed the impact of a youth-targeted multilevel nutrition intervention in Baltimore City. The study used a clustered randomized design in which 7 recreation centers and 21 corner stores received interventions and 7 additional recreation centers served as comparison. The 8-month intervention aimed to increase availability and…

  15. Cost-Effectiveness of Interventions to Improve Moderate Physical Activity: A Study in Nine UK Sites

    ERIC Educational Resources Information Center

    Pringle, Andy; Cooke, Carlton; Gilson, Nicholas; Marsh, Kevin; McKenna, Jim

    2010-01-01

    Objective: With growing concerns to establish the value for returns on public health investment, there is a need to identify cost-effective physical activity interventions. This study measured change in moderate physical activity (MPA) in seven community-based intervention types, costs and cost-effectiveness of the interventions, and possible…

  16. A Longitudinal Evaluation of "QuickSmart": An Effective Australian Intervention to Improve Numeracy

    ERIC Educational Resources Information Center

    Graham, Lorraine; Pegg, John

    2010-01-01

    This paper reports data from the evaluation of the numeracy component of a long-running educational intervention, covering the period from 2001 to 2008. "QuickSmart" is both an intervention and research project operating in Australian schools. It is a structured intervention program designed for middle-school students (ages 10 to 13…

  17. A Systematic Review of Health Economic Analyses of Housing Improvement Interventions and Insecticide-Treated Bednets in the Home

    PubMed Central

    Pega, Frank; Wilson, Nick

    2016-01-01

    Background Housing improvements have considerable potential for improving health. So does the provision of insecticide-treated bednets for malaria prevention. Therefore we aimed to conduct updated systematic reviews of health economic analyses in both these intervention domains. Methods and findings The search strategy included economic analyses of housing improvement interventions and use of insecticide-treated bednets for community-dwelling, healthy populations (published between 1 January 2000 and 15 April 2014). We searched the Cochrane Database of Systematic Reviews, MEDLINE, PubMed, EMBASE, and three health economics databases. Thirty-five economic analyses of seven types of intervention fulfilled the inclusion criteria. Most included studies adopted a health sector perspective and were cost-effectiveness analyses using decision analytic modeling or conducted alongside trials. The overall quality of the studies was generally likely to be adequate for informing policy-making (albeit with limitations in some areas). There was fairly consistent evidence for the cost-effectiveness/favorable cost-benefit of removing indoor lead to prevent lead poisoning and sequelae, and retrofitting insulation to prevent lung disease. But the value of assessing and improving home safety and providing smoke alarms to prevent injuries was more mixed and the economic evidence was inconclusive or insufficient for: home ventilation to prevent lung disease, installing heaters to prevent lung disease and regulating tap water temperatures to prevent scalding. Few studies (n = 4) considered health equity. The 12 studies of providing insecticide-treated bednets or hammocks to prevent malaria found these interventions to be moderately to highly cost-effective. Conclusions This systematic review provides updated evidence that several housing improvement interventions (such as removing indoor lead and retrofitting insulation) and also the provision of insecticide-treated bednets are cost

  18. Control of Tungiasis through Intermittent Application of a Plant-Based Repellent: An Intervention Study in a Resource-Poor Community in Brazil

    PubMed Central

    Buckendahl, John; Heukelbach, Jörg; Ariza, Liana; Kehr, Judith Dorothea; Seidenschwang, Martin; Feldmeier, Hermann

    2010-01-01

    Background Tungiasis, an ectoparasitosis caused by the female sand flea Tunga penetrans, is an important health problem in many impoverished communities in the tropics. Sand flea disease is associated with a broad spectrum of clinical pathology and severe sequels are frequent. Treatment options are limited. Methodology/Principal Findings We assessed the effectiveness of the intermittent application of the plant-based repellent Zanzarin to reduce infestation intensity and tungiasis-associated morbidity in a resource-poor community in Brazil, characterized by a very high attack rate. The study population was randomized into three cohorts. Initially, during a period of four weeks, the repellent was applied twice daily to the feet of all cohort members. This reduced the number of embedded sandfleas to 0 in 98% of the participants. Thereafter members of cohort A applied the repellent every second week twice daily for one week, members of cohort B every fourth week for one week, and members of cohort C served as controls. Infestation intensity and tungiasis-associated morbidity were monitored during five months. The intermittent application of Zanzarin for one week every second week significantly reduced infestation intensity from a median 4 lesions (IQR 1–9) during the whole transmission season. In contrast, in cohort B (application of the repellent every fourth week) the infestation intensity remained twice as high (median 8 lesions, IQR 9–16; p = 0.0035), and in the control cohort C 3.5 times as high (median 14 lesions; IQR 7–26; p = 0.004 during the transmission season). Tungiasis-related acute pathology remained very low in cohort A (median severity score 2; IQR 1–4) as compared to cohort B (median severity score 5; IQR 3–7; p<0.001), and control cohort C (median severity score 6.5; IQR 4–8; p<0.001). Conclusions/Significance Our study shows that in a setting with intense transmission, tungiasis-associated morbidity can be minimized through the

  19. Rationalizing the selection of oral lipid based drug delivery systems by an in vitro dynamic lipolysis model for improved oral bioavailability of poorly water soluble drugs.

    PubMed

    Dahan, Arik; Hoffman, Amnon

    2008-07-02

    As a consequence of modern drug discovery techniques, there has been a consistent increase in the number of new pharmacologically active lipophilic compounds that are poorly water soluble. A great challenge facing the pharmaceutical scientist is making these molecules into orally administered medications with sufficient bioavailability. One of the most popular approaches to improve the oral bioavailability of these molecules is the utilization of a lipid based drug delivery system. Unfortunately, current development strategies in the area of lipid based delivery systems are mostly empirical. Hence, there is a need for a simplified in vitro method to guide the selection of a suitable lipidic vehicle composition and to rationalize the delivery system design. To address this need, a dynamic in vitro lipolysis model, which provides a very good simulation of the in vivo lipid digestion process, has been developed over the past few years. This model has been extensively used for in vitro assessment of different lipid based delivery systems, leading to enhanced understanding of the suitability of different lipids and surfactants as a delivery system for a given poorly water soluble drug candidate. A key goal in the development of the dynamic in vitro lipolysis model has been correlating the in vitro data of various drug-lipidic delivery system combinations to the resultant in vivo drug profile. In this paper, we discuss and review the need for this model, its underlying theory, practice and limitations, and the available data accumulated in the literature. Overall, the dynamic in vitro lipolysis model seems to provide highly useful initial guidelines in the development process of oral lipid based drug delivery systems for poorly water soluble drugs, and it predicts phenomena that occur in the pre-enterocyte stages of the intestinal absorption cascade.

  20. A Review of Interventions and System Changes to Improve Time to Reperfusion for ST-Segment Elevation Myocardial Infarction

    PubMed Central

    McDermott, Kelly A.; Helfrich, Christian D.; Rumsfeld, John S.; Ho, P. Michael; Fihn, Stephan D.

    2008-01-01

    Objective Identify and describe interventions to reduce time to reperfusion for patients with ST-segment elevation myocardial infarction (STEMI). Data Source Key word searches of five research databases: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Web of Science, and Cochrane Clinical Trials Registry. Interventions We included controlled and uncontrolled studies of interventions to reduce time to reperfusion. One researcher reviewed abstracts and 2 reviewed full text articles. Articles were subsequently abstracted into structured data tables, which included study design, setting, intervention, and outcome variables. We inductively developed intervention categories from the articles. A second researcher reviewed data abstraction for accuracy. Measurements and Main Results We identified 666 articles, 42 of which met inclusion criteria. We identified 11 intervention categories and classified them as either process specific (e.g., emergency department administration of thrombolytic therapy, activation of the catheterization laboratory by emergency department personnel) or system level (e.g., continuous quality improvement, critical pathways). A majority of studies (59%) were single-site pre/post design, and nearly half (47%) had sample sizes less than 100 patients. Thirty-two studies (76%) reported significantly lower door to reperfusion times associated with an intervention, 12 (29%) of which met or exceeded guideline recommended times. Relative decreases in times to reperfusion ranged from 15 to 82% for door to needle and 13–64% for door to balloon. Conclusions We identified an array of process and system-based quality improvement interventions associated with significant improvements in door to reperfusion time. However, weak study designs and inadequate information about implementation limit the usefulness of this literature. Electronic supplementary materials The online version of this article (doi:10.1007/s11606

  1. Recommendations and Improvements for the Evaluation of Integrated Community-Wide Interventions Approaches

    PubMed Central

    Spierings, Eline J. M.; Westerman, Marjan J.; Seidell, Jacob C.; Schuit, Albertine J.

    2016-01-01

    Background. Integrated community-wide intervention approaches (ICIAs) are implemented to prevent childhood obesity. Programme evaluation improves these ICIAs, but professionals involved often struggle with performance. Evaluation tools have been developed to support Dutch professionals involved in ICIAs. It is unclear how useful these tools are to intended users. We therefore researched the facilitators of and barriers to ICIA programme evaluation as perceived by professionals and their experiences of the evaluation tools. Methods. Focus groups and interviews with 33 public health professionals. Data were analysed using a thematic content approach. Findings. Evaluation is hampered by insufficient time, budget, and experience with ICIAs, lack of leadership, and limited advocacy for evaluation. Epidemiologists are regarded as responsible for evaluation but feel incompetent to perform evaluation or advocate its need in a political environment. Managers did not prioritise process evaluations, involvement of stakeholders, and capacity building. The evaluation tools are perceived as valuable but too comprehensive considering limited resources. Conclusion. Evaluating ICIAs is important but most professionals are unfamiliar with it and management does not prioritise process evaluation nor incentivize professionals to evaluate. To optimise programme evaluation, more resources and coaching are required to improve professionals' evaluation capabilities and specifically the use of evaluation. PMID:28116149

  2. All cholesterol-lowering interventions are expected to reduce stroke: Confirmatory data from IMPROVE-IT

    PubMed Central

    De Caterina, Raffaele; Salvatore, Tanya; Marchioli, Roberto

    2016-01-01

    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 (Di Napoli et al., 2002) [1], (De Caterina et al., 2010) [2]). IMPROVE-IT data ((Cannon et al. 2015) [3]), showing a 13.3% reduction in total cholesterol at one year in association with a hazard ratio (HR) of 0.i86 for total stroke during the trial, are very closely aligned with the relative risk of 0.90 predicted based on the totality of lipid lowering interventions ((De Caterina et al., 2016) [4]). We here provide the data from the original trials used to construct this meta-analysis, with the now added additional data from IMPROVE-IT, well-fitting the previously found meta-regression line. These data are important to predict stroke outcomes in currently ongoing trials now testing PCSK9 or cholesterol ester transfer protein inhibitors. PMID:27222850

  3. Enhancing C3 photosynthesis: an outlook on feasible interventions for crop improvement.

    PubMed

    Singh, Jitender; Pandey, Prachi; James, Donald; Chandrasekhar, Kottakota; Achary, V Mohan Murali; Kaul, Tanushri; Tripathy, Baishnab C; Reddy, Malireddy K

    2014-12-01

    Despite the declarations and collective measures taken to eradicate hunger at World Food Summits, food security remains one of the biggest issues that we are faced with. The current scenario could worsen due to the alarming increase in world population, further compounded by adverse climatic conditions, such as increase in atmospheric temperature, unforeseen droughts and decreasing soil moisture, which will decrease crop yield even further. Furthermore, the projected increase in yields of C3 crops as a result of increasing atmospheric CO2 concentrations is much less than anticipated. Thus, there is an urgent need to increase crop productivity beyond existing yield potentials to address the challenge of food security. One of the domains of plant biology that promises hope in overcoming this problem is study of C3 photosynthesis. In this review, we have examined the potential bottlenecks of C3 photosynthesis and the strategies undertaken to overcome them. The targets considered for possible intervention include RuBisCO, RuBisCO activase, Calvin-Benson-Bassham cycle enzymes, CO2 and carbohydrate transport, and light reactions among many others. In addition, other areas which promise scope for improvement of C3 photosynthesis, such as mining natural genetic variations, mathematical modelling for identifying new targets, installing efficient carbon fixation and carbon concentrating mechanisms have been touched upon. Briefly, this review intends to shed light on the recent advances in enhancing C3 photosynthesis for crop improvement.

  4. Improving women's nutrition imperative for rapid reduction of childhood stunting in South Asia: coupling of nutrition specific interventions with nutrition sensitive measures essential

    PubMed Central

    2016-01-01

    Abstract The implications of direct nutrition interventions on women's nutrition, birth outcome and stunting rates in children in South Asia are indisputable and well documented. In the last decade, a number of studies present evidence of the role of non‐nutritional factors impacting on women's nutrition, birth outcome, caring practices and nutritional status of children. The implications of various dimensions of women's empowerment and gender inequality on child stunting is being increasingly recognised. Evidence reveals the crucial role of early age of marriage and conception, poor secondary education, domestic violence, inadequate decision‐making power, poor control over resources, strenuous agriculture activities, and increasing employment of women and of interventions such as cash transfer scheme and microfinance programme on undernutrition in children. Analysis of the nutrition situation of women and children in South Asia and programme findings emphasise the significance of reaching women during adolescence, pre‐conception and pregnancy stage. Ensuring women enter pregnancy with adequate height and weight and free from being anemic is crucial. Combining nutrition‐specific interventions with measures for empowerment of women is essential. Improvement in dietary intake and health services of women, prevention of early age marriage and conception, completion of secondary education, enhancement in purchasing power of women, reduction of work drudgery and elimination of domestic violence deserve special attention. A range of programme platforms dealing with health, education and empowerment of women could be strategically used for effectively reaching women prior to and during pregnancy to accelerate reduction in stunting rates in children in South Asia. PMID:27187909

  5. Organizational interventions improving access to community-based primary health care for vulnerable populations: a scoping review.

    PubMed

    Khanassov, Vladimir; Pluye, Pierre; Descoteaux, Sarah; Haggerty, Jeannie L; Russell, Grant; Gunn, Jane; Levesque, Jean-Frederic

    2016-10-10

    Access to community-based primary health care (hereafter, 'primary care') is a priority in many countries. Health care systems have emphasized policies that help the community 'get the right service in the right place at the right time'. However, little is known about organizational interventions in primary care that are aimed to improve access for populations in situations of vulnerability (e.g., socioeconomically disadvantaged) and how successful they are. The purpose of this scoping review was to map the existing evidence on organizational interventions that improve access to primary care services for vulnerable populations. Scoping review followed an iterative process. Eligibility criteria: organizational interventions in Organisation for Economic Cooperation and Development (OECD) countries; aiming to improve access to primary care for vulnerable populations; all study designs; published from 2000 in English or French; reporting at least one outcome (avoidable hospitalization, emergency department admission, or unmet health care needs).

  6. A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

    PubMed Central

    2013-01-01

    Background Racial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care. Methods Using a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions. Discussion As a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have

  7. Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment

    PubMed Central

    Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N

    2016-01-01

    Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month

  8. Improving quinolone use in hospitals by using a bundle of interventions in an interrupted time series analysis.

    PubMed

    Willemsen, Ina; Cooper, Ben; van Buitenen, Carin; Winters, Marjolein; Andriesse, Gunnar; Kluytmans, Jan

    2010-09-01

    The objectives of the present study were to determine the effects of multiple targeted interventions on the level of use of quinolones and the observed rates of resistance to quinolones in Escherichia coli isolates from hospitalized patients. A bundle consisting of four interventions to improve the use of quinolones was implemented. The outcome was measured from the monthly levels of use of intravenous (i.v.) and oral quinolones and the susceptibility patterns for E. coli isolates from hospitalized patients. Statistical analyses were performed using segmented regression analysis and segmented Poisson regression models. Before the bundle was implemented, the annual use of quinolones was 2.7 defined daily doses (DDDs)/100 patient days. After the interventions, in 2007, this was reduced to 1.7 DDDs/100 patient days. The first intervention, a switch from i.v. to oral medication, was associated with a stepwise reduction in i.v. quinolone use of 71 prescribed daily doses (PDDs) per month (95% confidence interval [CI] = 47 to 95 PDDs/month, P < 0.001). Intervention 2, introduction of a new antibiotic guideline and education program, was associated with a stepwise reduction in the overall use of quinolones (reduction, 107 PDDs/month [95% CI = 58 to 156 PDDs/month). Before the interventions the quinolone resistance rate was increasing, on average, by 4.6% (95% CI = 2.6 to 6.1%) per year. This increase leveled off, which was associated with intervention 2 and intervention 4, active monitoring of prescriptions and feedback. Trends in resistance to other antimicrobial agents did not change. This study showed that the hospital-wide use of quinolones can be significantly reduced by an active policy consisting of multiple interventions. There was also a stepwise reduction in the rate of quinolone resistance associated with the bundle of interventions.

  9. Simple Interventions Improve the Quality of a Missed Lab Appointment Process.

    PubMed

    Mookadam, Martina; Grover, Michael; Pullins, Chris; Winscott, Mary; Pierce, Susan

    2016-01-01

    Simple interventions resolve the problem of missed lab appointments. It is essential that patients complete ordered laboratory studies. This maintains clinical quality and, potentially, keeps patients safe from harm. In our academic family medicine practice, baseline data demonstrated patients completed 94.7% of labs as ordered (26850/28348 patients per year) while 1498 (5.3%) did not. Our baseline patient reminder process, a mail or portal based generic letter, resulted in only 449 (30%) of patients ultimately completing them (1049 [70%] did not). Our baseline system was 96.3 % reliable. This process did not allow for provider review or input, and was not personalized for patients. We designed a quality improvement project involving three PDSA (Plan, Do, Study, and Act) cycles of about two months each. Desk staff created weekly reports of unresolved lab orders. A message in the electronic medical record (EMR) solicited provider input. Providers could elect to cancel studies (if already completed, reordered, or no longer clinically indicated) or have the patient receive a personalized reminder, including provider name and associated diagnoses. This reminder was sent by patient portal secure messaging (if an account existed) or with a mailed letter. These interventions resulted in 98.8 % process reliability. The frequency of unresolved lab orders decreased from 70% at baseline to 25%. In the second PDSA cycle, we contacted patients by the portal only if there was evidence of an active account. Otherwise, they were contacted by telephone. Patients without a portal account continued to receive a letter by mail. These modified processes resulted in an overall reliability rate of 99.2%. The frequency of unresolved lab orders decreased to 17%. A final PDSA cycle utilized only telephone contact with patients with unresolved lab orders. Schedulers offered patients a choice of appointment dates if they spoke personally. Otherwise, they were left messages with a future lab

  10. Intervention to Improve Follow-up for Abnormal Papanicolaou Tests: A Randomized Clinical Trial

    PubMed Central

    Breitkopf, Carmen Radecki; Dawson, Lauren; Grady, James J.; Breitkopf, Daniel M.; Nelson-Becker, Carolyn; Snyder, Russell R.

    2014-01-01

    Objective To evaluate the effect of a theory-based, culturally-targeted intervention on adherence to follow-up among low-income and minority women who experience an abnormal Pap test. Methods 5,049 women were enrolled and underwent Pap testing. Of these, 378 had an abnormal result and 341 (90%) were randomized to 1 of 3 groups to receive their results: Intervention (I): culturally-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; Active Control (AC): non-targeted behavioral and normative beliefs + knowledge/skills + salience + environmental constraints/barriers counseling; or Standard Care Only (SCO). The primary outcome was attendance at the initial follow-up appointment. Secondary outcomes included delay in care, completion of care at 18 months, state anxiety (STAI Y-6), depressive symptoms (CES-D), and distress (CDDQ). Anxiety was assessed at enrollment, notification of results, and 7–14 days later with the CDDQ and CES-D. Results 299 women were included in intent-to-treat analyses. Adherence rates were 60% (I), 54% (AC), and 58% (SCO), p=0.73. Completion rates were 39% (I) and 35% in the AC and SCO groups, p=0.77. Delay in care (in days) was (M ±SD): 58 ±75 (I), 69 ±72 (AC), and 54 ±75 (SCO), p=0.75. Adherence was associated with higher anxiety at notification, p<0.01 while delay <90 days (vs. 90+) was associated with greater perceived personal responsibility, p<0.05. Women not completing their care (vs. those who did) had higher CES-D scores at enrollment, p<0.05. Conclusions A theory-based, culturally-targeted message was not more effective than a non-targeted message or standard care in improving behavior. PMID:23730719

  11. Feasibility of a Brief Yoga Intervention for Improving Acute Pain and Distress Post Gynecologic Surgery

    PubMed Central

    Sohl, Stephanie J.; Avis, Nancy E.; Stanbery, Kimberly; Tooze, Janet A.; Moormann, Kelly; Danhauer, Suzanne C.

    2016-01-01

    Background Women undergoing surgical procedures for suspected gynecologic malignancies frequently experience pain and psychological distress related to surgery. Yoga may reduce these negative surgical outcomes. The primary objective of this pilot study was to assess the feasibility of evaluating a perioperative brief Yoga Skills Training (YST) in this population. Secondary objectives were to (1) assess the immediate effects of the YST on pain and psychological distress; and (2) provide preliminary data for future studies. Method Adult women scheduled to undergo an exploratory laparotomy for a suspected gynecologic malignancy were recruited to this one-arm feasibility study. Each woman received the YST, which consisted of three 15-minute sessions, one before and two after surgery. The following constructs were assessed: feasibility (rates of accrual, intervention adherence, measure completion, retention, and level of satisfaction), immediate effects of the YST (visual analogue scale ratings of pain and distress immediately before and after each session), and descriptive statistics for measures to be used in future studies. Results Of the 33 eligible women, 18 were approached and 10 agreed to participate (mean age = 54.7 years; 90% White). Two women discontinued the study prior to starting the YST sessions. Of the eight participants who received the YST, five completed the pre-surgery session (63%) and seven completed (88%) both post-surgical sessions; one woman withdrew after one YST session. Participants reported high satisfaction with the YST. Acute pain and distress decreased from before to immediately after the YST session with moderate to large effects: pain, d’s = −0.67 to −0.95; distress, d’s = −0.66 to −1.08. Conclusions This study demonstrated reasonable indicators of feasibility. In addition, patients showed short-term reductions in pain and distress. Next steps include attention to improving staff availability and intervention implementation

  12. Improved Outcomes Following a Single Session Web-Based Intervention for Problem Gambling.

    PubMed

    Rodda, S N; Lubman, D I; Jackson, A C; Dowling, N A

    2017-03-01

    Research suggests online interventions can have instant impact, however this is yet to be tested with help-seeking adults and in particular those with problem gambling. This study seeks to determine the immediate impact of a single session web-based intervention for problem gambling, and to examine whether sessions evaluated positively by clients are associated with greater improvement. The current study involved 229 participants classified as problem gamblers who agreed to participate after accessing Gambling Help Online between November 2010 and February 2012. Almost half were aged under 35 years of age (45 %), male (57 %) as well as first time treatment seekers (62 %). Participants completed measures of readiness to change and distress both prior to and post-counselling. Following the provision of a single-session of counselling, participants completed ratings of the character of the session (i.e., degree of depth and smoothness) post-counselling. A significant increase in confidence to resist and urge to gamble and a significant decrease in distress (moderate effect size; d = .56 and .63 respectively) was observed after receiving online counselling. A hierarchical regression indicated the character of the session was a significant predictor of change in confidence, however only the sub-scale smoothness was a significant predictor of change in distress. This was the case even after controlling for pre-session distress, session word count and client characteristics (gender, age, preferred gambling activity, preferred mode of gambling, gambling severity, and preferred mode of help-seeking). These findings suggest that single session web-based counselling for problem gambling can have immediate benefits, although further research is required to examine the impact on longer-term outcomes.

  13. Improvement of dissolution behavior for poorly water-soluble drug by application of cyclodextrin in extrusion process: comparison between melt extrusion and wet extrusion.

    PubMed

    Yano, Hideki; Kleinebudde, Peter

    2010-06-01

    The purpose of this study was to improve dissolution behavior of poorly water-soluble drugs by application of cyclodextrin in extrusion processes, which were melt extrusion process and wet extrusion process. Indomethacin (IM) was employed as a model drug. Extrudates containing IM and 2-hydroxypropyl-beta-cyclodextrin (HP-beta-CyD) in 1:1 w/w ratio were manufactured by both melt extrusion process and wet extrusion process. In vitro drug release properties of IM from extrudates and physiochemical properties of extrudates were investigated. The dissolution rates of IM from extrudates manufactured by melt extrusion and wet extrusion with HP-beta-CyD were significantly higher than that of the physical mixture of IM and HP-beta-CyD. In extrudate manufactured by melt extrusion, gamma-form of IM changed to amorphous completely during melt extrusion due to heating above melting point of IM. On the other hand, in extrudate manufactured by wet extrusion, gamma-form of IM changed to amorphous partially due to interaction between IM and HP-beta-CyD and mechanical agitating force during process. Application of HP-beta-CyD in extrusion process is useful for the enhancement of dissolution rate for poorly water-soluble drugs.

  14. Improving a web-based employability intervention for work-disabled employees: results of a pilot economic evaluation.

    PubMed

    Noben, Cindy; Evers, Silvia; Genabeek, Joost van; Nijhuis, Frans; de Rijk, Angelique

    2016-01-23

    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, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and

  15. Improving Maternal Health in Pakistan: Toward a Deeper Understanding of the Social Determinants of Poor Women’s Access to Maternal Health Services

    PubMed Central

    Salway, Sarah; Bhatti, Afshan; Shanner, Laura; Zaman, Shakila; Laing, Lory; Ellison, George T. H.

    2014-01-01

    Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010–February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan. PMID:24354817

  16. Improving maternal health in Pakistan: toward a deeper understanding of the social determinants of poor women's access to maternal health services.

    PubMed

    Mumtaz, Zubia; Salway, Sarah; Bhatti, Afshan; Shanner, Laura; Zaman, Shakila; Laing, Lory; Ellison, George T H

    2014-02-01

    Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.

  17. Quantifying parental preferences for interventions designed to improve home food preparation and home food environments during early childhood.

    PubMed

    Virudachalam, Senbagam; Chung, Paul J; Faerber, Jennifer A; Pian, Timothy M; Thomas, Karen; Feudtner, Chris

    2016-03-01

    Though preparing healthy food at home is a critical health promotion