6-month Intervention Research Articles

Efficacy of a mountain craft training in improving resilience and psychological well-being and reducing fatigue in childhood cancer survivors.

TPS167 Background: This pilot study aims to determine the feasibility, acceptability, and preliminary efficacy of mountain craft training in improving resilience and quality of life and reducing fatigue and depressive symptoms in childhood cancer survivors (CCS). Methods: A randomised controlled trial. A sample of 40 CCS, aged 10 to 16, will be invited to participate in this study. Resilience scale, Center for epidemiologic studies depression scale; Paediatric Quality of Life Inventory; and Fatigue Scale – Child will be used to assess resilience, depressive symptoms, health-related quality of life and levels of fatigue, respectively. Participants in the intervention group will receive two 30-45 mins lectures on resilience, physical exercise, knowledge and skills in mountain craft; and a 4-day hiking programme on weekends over a 3-month period. Participants in the control group will participate in 4 day of leisure activities on weekends over a 3-month period. The main outcome measure: The participants’ level of resilience at 6-month post intervention The Statistical Package for Social Sciences (SPSS) software (version 26.0) will be used to analyse the quantitative data. Pearson chi-square test or Fisher’s exact test for categorical variables, and the independent sample t-test for continuous variables. The Generalised Estimating Equation (GEE) will be employed to determine the changes between the intervention and placebo control groups, the within-group (time) effects, and the interaction effects.

Efficacy of a Web-Based Home Blood Pressure Monitoring Program in Improving Predialysis Blood Pressure Control Among Patients Undergoing Hemodialysis: Randomized Controlled Trial.

Hypertension is highly prevalent among patients undergoing hemodialysis, with a significant proportion experiencing poorly controlled blood pressure (BP). Digital BP management in this population has been underused. This study aimed to explore the efficacy of a web-based home BP monitoring (HBPM) program in improving predialysis BP control and enhancing knowledge, perception, and adherence to HBPM among patients with hypertension undergoing hemodialysis. A multicenter, open-label, randomized controlled trial was conducted at 2 hemodialysis units. Patients were randomly allocated in a 1:1 ratio to either the web-based HBPM program as the intervention group or to usual care as the control group over a 6-month period. The primary outcomes were the predialysis BP control rate, defined as less than 140/90 mm Hg, and the predialysis systolic and diastolic BP, assessed from baseline to the 6-month follow-up. Secondary outcomes included patient knowledge, perception, and adherence to HBPM, evaluated using the HBPM Knowledge Questionnaire, HBPM Perception Scale, and HBPM Adherence Scale, respectively. A generalized estimating equations analysis was used to analyze the primary outcomes in the intention-to-treat analysis. Of the 165 patients enrolled in the program (n=84, 50.9% in the web-based HBPM group and n=81, 49.1% in the control group), 145 (87.9%) completed the follow-up assessment. During the follow-up period, 11 instances of hypotension occurred in 9 patients in the web-based HBPM group, compared to 15 instances in 14 patients in the control group. The predialysis BP control rate increased from 30% (25/84) to 48% (40/84) in the web-based HBPM group after the 6-month intervention, whereas in the control group, it decreased from 37% (30/81) to 25% (20/81; χ22=16.82, P<.001; odds ratio 5.11, 95% CI 2.14-12.23, P<.001). The web-based HBPM group demonstrated a significant reduction after the 6-month intervention in the predialysis systolic BP (t163=2.46, P=.02; β=-6.09, 95 % CI -10.94 to -1.24, P=.01) and the predialysis diastolic BP (t163=3.20, P=.002; β=-4.93, 95% CI -7.93 to -1.93, P=.001). Scores on the HBPM Knowledge Questionnaire (t163=-9.18, P<.001), HBPM Perception Scale (t163=-10.65, P<.001), and HBPM Adherence Scale (t163=-8.04, P<.001) were significantly higher after 6 months of intervention. The implementation of a web-based HBPM program can enhance predialysis BP control and the knowledge, perception, and adherence to HBPM among patients undergoing hemodialysis. This web-based HBPM program should be promoted in appropriate clinical settings.

Strengthening the Chain: A Continuing Medical Education Program for Test Results Follow-up.

The Canadian Medical Protective Association (CMPA)'s Commitment to Change in Test-Results Follow-Up (CTC-TRFU) program aims to provide physicians with resources to enhance their test results follow-up systems for improved patient safety. Framed around the Transtheoretical Model, the program involves a 6-month multimodal educational intervention involving individual and group coaching sessions, action planning, and reflection surveys. This study evaluates the CTC-TRFU program's impact by analyzing survey responses and course documents, focusing on three main outcomes: physicians' perceived barriers and challenges, changes in their confidence and commitment, and implemented practice changes with perceived impact on patient safety. Participants were Canadian physicians who enrolled through the CMPA's open-access registration, with a particular emphasis on those facing challenges in test result follow-up. One hundred two physicians have enrolled in the program. Of these physicians, 34 (33.3%) have successfully completed the program and 28 (27.5%) are actively enrolled. Among the 34 physicians who successfully completed the program, an overwhelming majority of 97.1% (n = 33) expressed their belief that the improvements made to their test follow-up system significantly enhance patient safety within their practice. We observed a significant increase in confidence in the robustness of the physician's follow-up system from program registration to completion (P < .001). Physicians reported catching specific missed test results (55.9%, n = 19), including various laboratory reports and diagnostic imaging like abnormal mammograms or missing MRI/CT results. Physicians who participated in the CTC-TRFU program reported meaningful practice changes, which we believe underscores the value of comprehensive, longitudinal continuing patient safety CPD initiatives. These findings indicate the potential for future studies to explore the long-term impact of similar programs and their scalability.

Protective Assets Reinforced With Integrated Care and Technology (PARITY): Protocol for a Randomized Controlled Trial.

Black women are significantly more likely to experience severe maternal morbidity and are 3 times as likely to die from pregnancy-related causes compared to White women. Using a strengths-based wellness approach within an integrated supportive care program provided by a community doula could offer pragmatic solutions for Black maternal disparities. The Protective Assets Reinforced with Integrated Care and Technology (PARITY) program consists of a wellness technology platform, including informational links to wellness content and reinforcing motivational SMS text messages, as well as community-based doula support delivered both in person and through the technology platform to improve Black maternal wellness. This pilot randomized controlled trial (RCT) and mixed methods evaluation aims to (1) determine the feasibility and acceptability of the PARITY intervention; (2) investigate the preliminary efficacy of the PARITY intervention on clinical outcomes (maternal blood pressure, gestational weight gain, and cesarean birth); and (3) investigate changes to wellness behavioral outcomes (nutrition, physical activity, sleep, and health care adherence) and empowered strengths (self-efficacy, social support, motivation, resilience, problem-solving, and self-regulation) in the intervention group compared to a control group. A 2-arm RCT and mixed methods evaluation will be conducted. Overall, 60 Black pregnant individuals will be randomized in a ratio of 1:1 to either the intervention or informational control group. Participants in the intervention group will receive access to the technology platform over a 12-week period that ends before birth. Intervention participants will be assigned a doula interventionist, who will meet with them 4 times during the intervention. All participants (intervention and control) will receive a referral for a birth doula at no cost, printed materials about having a healthy pregnancy, and community resources. Feasibility and acceptability will be assessed at the end of the program. Measures will be obtained at baseline (20-28 weeks), the 36th week of pregnancy, birth, and 6-12 weeks post partum. Summary statistics and distribution plots will be used to describe measured variables at each time point. A generalized linear mixed model with a shared random component will be used to analyze the effects of PARITY on clinical, wellness behavioral, and empowered strength outcomes, including baseline nutrition, physical activity, and sleep measures as covariates. For significant effects, post hoc contrasts will be adjusted using the Holm method to maintain comparison-wise error at or <.05. Missing data will be addressed using a pattern-mixture model. The National Institute of Nursing Research funded this pilot RCT. Recruitment, enrollment, and data collection are ongoing, and the estimated study completion date is October 2024. The expected results of this study will provide the feasibility and preliminary efficacy of the PARITY intervention, to be used in a larger trial with a 12-month PARITY program intervention. ClinicalTrials.gov NCT05802615; https://clinicaltrials.gov/study/NCT05802615. DERR1-10.2196/58580.

Prebiotics improve frailty status in community-dwelling older individuals in a double-blind, randomized, controlled trial.

BACKGROUNDFrailty significantly affects morbidity and mortality rates in the older population (age >65 years). Age-related degenerative diseases are influenced by the intestinal microbiota. However, limited research exists on alterations in the intestinal microbiota in frail older individuals, and the effectiveness of prebiotic intervention for treating frailty remains uncertain.OBJECTIVEWe sought to examine the biological characteristics of the intestinal microbiome in frail older individuals and assess changes in both frailty status and gut microbiota following intervention with a prebiotic blend consisting of inulin and oligofructose.METHODSThe study consisted of 3 components: an observational analysis with a sample size of 1,693, a cross-sectional analysis (n = 300), and a multicenter double-blind, randomized, placebo-controlled trial (n = 200). Body composition, commonly used scales, biochemical markers, intestinal microbiota, and metabolites were examined in 3 groups of older individuals (nonfrail, prefrail, and frail). Subsequently, changes in these indicators were reevaluated after a 3-month intervention using the prebiotic mixture for the prefrail and frail groups.RESULTSThe intervention utilizing a combination of prebiotics significantly improved frailty and renal function among the older population, leading to notable increases in protein levels, body fat percentage, walking speed, and grip strength. Additionally, it stimulated an elevation in gut probiotic count and induced alterations in microbial metabolite expression levels as well as corresponding metabolic pathways.CONCLUSIONSThe findings suggest a potential link between changes in the gut microbiota and frailty in older adults. Prebiotics have the potential to modify the gut microbiota and metabolome, resulting in improved frailty status and prevention of its occurrence.TRIAL REGISTRATIONClinicalTrials.gov NCT03995342.

Early findings from the NHS Type 2 Diabetes Path to Remission Programme: a prospective evaluation of real-world implementation

Randomised controlled trials have shown that total diet replacement (TDR) can lead to remission of type 2 diabetes. In 2019, the English National Health Service (NHS) committed to establishing a TDR-based interventional programme delivered at scale within real-world environments; development followed of the NHS Type 2 Diabetes Path to Remission (T2DR) programme, a 12-month behavioural intervention to support weight loss involving an initial 3-month period of TDR. We assessed remission of type 2 diabetes for programme participants. In this national prospective service evaluation of programme implementation, people in England aged 18-65 years and diagnosed with type 2 diabetes in the last 6 years were referred to the programme between programme launch on Sept 1, 2020, and Dec 31, 2022. Programme data were linked to the National Diabetes Audit to ascertain HbA1c measurements and glucose-lowering medication prescriptions. The primary outcome was remission of type 2 diabetes at 1 year, defined as two HbA1c measurements of less than 48 mmol/mol recorded at least 3 months apart with no glucose-lowering medications prescribed from 3 months before the first HbA1c measurement, and the second HbA1c measurement recorded 11-15 months after the programme start date. Outcomes were assessed in two ways: for all participants who started TDR on the 12-month programme before January, 2022, for whom there were no missing data; and for all participants who started TDR on the 12-month programme before January, 2022, and had completed the programme (ie, had a valid weight recorded at month 12) by Dec 31, 2022, for whom there were no missing data. Between Sept 1, 2020, and Dec 31, 2022, 7540 people were referred to the programme; of those, 1740 started TDR before January, 2022, and therefore had a full 12-month opportunity to undertake the programme by the time of data extraction at the end of December, 2022. Of those who started TDR before January, 2022, 960 (55%) completed the programme (defined as having a weight recorded at 12 months). The mean weight loss for the 1710 participants who started the programme before January, 2022 and had no missing data was 8·3% (95% CI 7·9-8·6) or 9·4 kg (8·9-9·8), and the mean weight loss for the 945 participants who completed the programme and had no missing data was 9·3% (8·8-9·8) or 10·3 kg (9·7-10·9). For the subgroup of 710 (42%) of 1710 participants who started the programme before January, 2022, and also had two HbA1c measurements recorded, 190 (27%) had remission, with mean weight loss of 13·4% (12·3-14·5) or 14·8 kg (13·4-16·3). Of the 945 participants who completed the programme, 450 (48%) had two HbA1c measurements recorded; of these, 145 (32%) had remission, with mean weight loss of 14·4% (13·2-15·5) or 15·9 kg (14·3-17·4). Findings from the NHS T2DR programme show that remission of type 2 diabetes is possible outside of research settings, through at-scale service delivery. However, the rate of remission achieved is lower and the ascertainment of data is more limited with implementation in the real world than in randomised controlled trial settings. None.

Meditation training and enduring changes in psychological functioning: a 7-year longitudinal study

ABSTRACT Considerable research has now documented the beneficial effects of mindfulness-based practices on psychological functioning. Less is known about the long-term durability of such changes following formal meditation training. In a sample of adults (N = 67, 52% female, ages 22–70 years), we examined changes in 16 measures of psychological adaptive functioning across a 3-month residential meditation intervention and across a subsequent 7-year period. We observed general training-related improvements followed by multi-year returns toward pre-training levels. However, beneficial changes in two personality attributes (agreeableness and neuroticism) were of moderate effect size (d = 0.51 and d = 0.45, respectively) and were retained across the 7-year follow-up. We further found that individual variation in changes was represented by three latent attributes: (Changes related to) Mindful Well-being, Resilient Extraversion, and Self-Compassionate Openness. These results suggest that intensive meditation training is associated with improved adaptive functioning and enduring changes in aspects of personality.

Protein Network Alterations in G-CSF Treated Severe Congenital Neutropenia Patients and Beneficial Effects of Oral Health Intervention.

Severe congenital neutropenia (SCN) is a raredisorder characterized by diminished neutrophil levels. Despite granulocytecolony-stimulating factor (G-CSF) treatment, SCN patients remain still prone tosevere infections, including periodontal disease-a significant oral healthrisk. This study investigates the host proteome and metaproteome in saliva andgingival crevicular fluid (GCF) of G-CSF-treated patients. We used label-free quantitative proteomics on saliva and GCF samples from SCN patients before (n=10, mean age: 10.7±6.6 years) and after a 6-month oral hygiene intervention (n=9,mean age: 11.6±5.27 years), and from 12 healthy controls. We quantified 894 proteins in saliva (648 human,246 bacterial) and 756 proteins in GCF (493 human, 263 bacterial). Predominant bacterial genera included Streptococcus, Veillonella, Selenomonas, Corynebacterium, Porphyromonas, and Prevotella. SCN patients showed reduced antimicrobial peptides (AMPs) and elevated complement proteins compared tohealthy controls. Oral hygiene intervention improved oral epithelial conditionsand reduced both AMPs and complement proteins. SCN patients have aunique proteomic profile with reduced AMPs and increased complement proteins, contributing to infection susceptibility. Oral hygiene intervention not onlyimproved oral health in SCN patients but also offers potential overall therapeuticbenefits.

Navigating formative assessment as professional development in digital contexts: insights from teachers’ experiences

ABSTRACT As digital technology transforms education, investigating shifts in teachers’ formative assessment practices within digital contexts becomes essential. This study explores upper secondary school teachers’ experiences in an 18-month professional development intervention focused on formative assessment in digital contexts. Data from a baseline survey (n = 26) and reflection logs (n = 12) were analysed using descriptive statistics and thematic analysis. Teachers exhibited a preference to provide digital feedback for student learning but expressed uncertainty about its effectiveness. Thematic analysis revealed four main themes: the importance of a shared language for formative assessment; challenges tied to real-time distance learning; the paradoxical nature of digital feedback in fostering dialogue; and strategies for seeking and improving digital feedback. The professional development intervention enhanced teachers’ understanding of formative assessment, including its timing and impact on student learning. The study contributes to the discourse on digital formative assessment, offering insights for educational practices and research.

Effects of a 6-month physical activity behavioral intervention in patients following metabolic bariatric surgery: a randomized controlled trial

BackgroundPromoting habitual physical activity (PA) among bariatric patients is crucial for long-term surgery success, yet it poses a significant challenge for healthcare practitioners. ObjectivesThis randomized controlled trial (RCT) aimed to examine the effectiveness of a theory-based behavioral intervention on PA level in post-metabolic bariatric surgery (MBS) patients. SettingUniversity Hospital, Israel MethodsForty-four patients undergoing MBS were randomized to the intervention (n = 22) or control group (n = 22). The intervention group received a 6-month PA counseling program based on self-determination theory (SDT) and the 5 A’s framework, while the control group received usual care. PA level and self-efficacy for exercise (SEE) were assessed pre- (baseline, preintervention) and postoperatively (14 and 28 weeks follow-ups). Anthropometrics, physical function, cardiovascular, and biochemical outcomes were measured at all time points. ResultsThe intervention group showed greater increases in PA levels across time compared to the control group. A significant increase in step counts from baseline to 14 weeks was observed (P = .003). Significant differences favoring the intervention group were observed in self-reported PA changes from baseline to 14- and 28-week follow-ups (P = .020 and P = .024, respectively). Additionally, Physical function, as assessed by the 6-minute walk test (6MWT) and the 5 sit-to-stand (5STS) test, significantly improved in the intervention group throughout the follow-up period (P < .05 for all), However, no between-group differences were observed in SEE, anthropometrics, cardiovascular, or biochemical parameters. ConclusionsA 6-month behavioral intervention post-MBS significantly enhanced patients' PA levels and physical function. Given its theory-based approach and structured protocol, this intervention could be disseminated to support MBS clinicians and centers. Further research with longer follow-up period is warranted to confirm these findings and assess the long-term effects.

KArAT (Knee Arthroplasty Activity Trial): rationale and design features of a multicenter randomized controlled trial

BackgroundTotal knee arthroplasty (TKA) is commonly performed to relieve pain in persons with severe knee osteoarthritis. Despite substantial pain reduction and functional improvements, physical activity (PA) does not necessarily increase post TKA. The premise for this randomized trial is that a behavioral intervention invoking internal and external motivators could lead to improvement in PA uptake post TKA. MethodsKArAT (the Knee Arthroplasty Activity Trial) is a three-arm multi-center randomized controlled trial designed to establish the efficacy and sustainability of a personalized behavioral intervention in improving PA among TKA recipients with a primary diagnosis of knee osteoarthritis. The three arms include: 1) usual care, 2) attention control with Fitbit activity trackers, and 3) health coaching and financial incentives for reaching personalized PA goals. The primary outcome is defined as the proportion of participants engaged in at least 150 minutes of moderate-to-vigorous physical activity over a given week after the 6-month intervention. We also plan to conduct a cost-effectiveness analysis to establish the value and affordability of the KArAT interventions. DiscussionThis paper aims to outline the rationale, study design, and implementation of KArAT. Trial RegistrationClinicaltrials.gov NCT04107649

Impact of Dialectical Behavioral Therapy on Anxiety Levels Among African American Adolescents.

Anxiety and depression among adolescents in the United States has steadily increased. In addition, significant disparities in access to mental health care exist for African Americans. The purpose of the current project was to support the mental health of African American adolescents involved in faith-based youth groups through implementation of dialectical behavioral therapy (DBT). The community partner was an African American church in Southwest Georgia. Mindfulness training modules are offered in monthly sessions. Pre- and post-intervention surveys and the Generalized Anxiety Disorder-7 (GAD-7) were analyzed, comparing mean GAD-7 scores before and after participation. Nurse-led quality improvement initiatives support adolescent mental health and provide sustainable resources for mental health in rural areas. Results of the quality improvement project reveal improvement in self-reported anxiety symptoms among participants after the 4-month DBT intervention. [Journal of Psychosocial Nursing and Mental Health Services, 62(8), 7-10.].

Workplace Health Promotion in Italian University Employees: Effects on Body Composition and Mediterranean Diet Adherence.

As Workplace Health Promotion is spreading among several working environments, the university context seems to be one of the best to apply primary prevention activities. Working in this direction, the University of Torino led the Wellness@Work for UniTo Project (W@W), with the aim of promoting employees' health. Internal university professionals assessed body composition and adherence to the Mediterranean diet (MD), giving on-target advice for improving lifestyle. The aim of this paper is to evaluate the effectiveness of the W@W Project after a 4-month intervention period. This project was addressed to university employees, who could participate on a voluntary basis. Researchers assessed (T1) socio-demographic information and collected anthropometric variables. Body composition was evaluated through Classic and Specific Bioelectrical impedance Vector Analysis (BIVA). Adherence to the MD was assessed through the Medi-Lite questionnaire. After the assessments, participants were given 5-min counselling from internal professionals. After about 4 months, participants were supposed to undergo same assessments (T2). Overall, 479 workers joined the project, and of those, 246 came back for the T2 assessment. Globally, either anthropometric, body composition, or MD variables improved significantly after 4 months, both for male and female samples, suggesting how an easy-to-apply WHP intervention could help to improve workers' health.

Feasibility and acceptability of an online multicomponent very low-carbohydrate intervention in young adult women with obesity: a pilot study

BackgroundApproximately one-third of US young adults (18–25 years) have obesity, and there are calls to help young adults lose weight to prevent weight-related chronic conditions. This pilot trial tested the feasibility and acceptability of a very low-carbohydrate (VLC) eating pattern, with supportive positive affect and mindful eating skills, for weight management among young females with obesity.MethodsIn a single-arm trial, women (N = 17), aged 19–23, with obesity participated in a 4-month diet and lifestyle intervention. Participants were taught how to follow a VLC eating pattern with the help of a coach and 16 weekly web-based sessions. We assessed feasibility and acceptability through session participation, outcome collection, intervention satisfaction, and adverse events.ResultsSeventeen participants enrolled and 14 (82%) reported body weight at 4 months. Fifteen participants (94% of those beginning the intervention) viewed at least one session, and 8/15 (53%) of these participants were active in the intervention, viewing at least half of the sessions. Among the nine participants who provided 4-month self-report information, intervention satisfaction was high (mean 5.89/7, 95% CI 4.59 to 7.19). Among participants with a 4-month body weight, 7/14 (50%) lost ≥ 5% of their body weight, and of those who were also active in the intervention, 6/7 (86%) lost ≥ 5% of their body weight. There were no serious adverse events.ConclusionsThe results of this pilot study suggest that a VLC eating pattern may be a feasible and acceptable approach for weight loss in some young women with obesity.Trial registrationThis trial was registered with ClinicalTrials.gov on August 18, 2021. The trial number is NCT05010083.

The impact of a digital guideline version on schizophrenia guideline knowledge: results from a multicenter cluster-randomized controlled trial

BackgroundClinical practice guidelines are crucial for enhancing healthcare quality and patient outcomes. Yet, their implementation remains inconsistent across various professions and disciplines. Previous findings on the implementation of the German guideline for schizophrenia (2019) revealed low adherence rates among healthcare professionals. Barriers to guideline adherence are multifaceted, influenced by individual, contextual, and guideline-related factors. This study aims to investigate the effectiveness of a digital guideline version compared to print/PDF formats in enhancing guideline adherence.MethodsA multicenter, cluster-randomized controlled trial was conducted in South Bavaria, Germany, involving psychologists and physicians. Participants were divided into two groups: implementation of the guideline using a digital online version via the MAGICapp platform and the other using the traditional print/PDF version. The study included a baseline assessment and a post-intervention assessment following a 6-month intervention phase. The primary outcome was guideline knowledge, which was assessed using a guideline knowledge questionnaire.ResultsThe study included 217 participants at baseline and 120 at post-intervention. Both groups showed significant improvements in guideline knowledge; however, no notable difference was found between both study groups regarding guideline knowledge at either time points. At baseline, 43.6% in the control group (CG) and 52.5% of the interventional group (IG) met the criterion. There was no significant difference in the primary outcome between the two groups at either time point (T0: Chi2(1) = 1.65, p = 0.199, T1: Chi2(1) = 0.34, p = 0.561). At post-intervention, both groups improved, with 58.2% in the CG and 63.5% in the IG meeting this criterion.ConclusionsWhile the study did not include a control group without any implementation strategy, the overall improvement in guideline knowledge following an implementation strategy, independent of the format, was confirmed. The digital guideline version, while not superior in enhancing knowledge, showed potential benefits in shared decision-making skills. However, familiarity with traditional formats and various barriers to digital application may have influenced these results. The study highlights the importance of tailored implementation strategies, especially for younger healthcare providers.Trial registrationhttps://drks.de/search/de/trial/DRKS00028895

Study on needle stick injuries during surgery and blunt needle use for reducing occupational exposure and hygiene benefits.

The conventional round suture needle poses a significant risk of needle stick injuries among surgical physicians, identified as a global occupational hazard by the World Health Organization, increasing hospital costs and exposure to bloodborne pathogens. While novel blunt suture needles have shown promise in reducing these risks, their adoption is limited domestically, prompting a study to compare their efficacy against traditional sharp needles in reducing needle stick injuries among surgical physicians. To investigate suture needle stick injuries among surgical doctors during operations and assess the application effectiveness of a novel blunt suture needle. A total of 106 surgical department physicians from March 2021 to February 2023 participated in the study. After completing a questionnaire survey on suture needle injuries during surgery, the participants were divided into two groups. Over a 6-month intervention period, the control group used regular round needles while the study group utilized novel blunt suture needles. Subsequently, suture needle injury incidence rates and economic hygiene benefits were compared between the two groups. The suture needle injury questionnaire survey showed that over the past 6 months, among 106 surgical department physicians, 20 needle stick injuries occurred, yielding an incidence rate of 18.87%. The highest incidence (65.00%) was during suturing incisions longer than 10 cm, primarily when visibility was poor (70.00%). Surgeons linked most injuries (60.00%) to prolonged surgical duration causing fatigue. Although 85.00% detected injuries within 1 minute, only 40.00% were reported, often due to perceived reporting complexity. Following intervention, the study group had significantly fewer injuries per surgery and lower occupational exposure costs compared to the control group (p< 0.05). Surgical department physicians commonly sustain suture needle injuries while suturing incisions of 5-10 cm length under poor visibility, exacerbated by prolonged surgical duration. Despite detecting most injuries within 1 minute, only 40% are reported. The implementation of novel blunt suture needles significantly decreases injury rates, resulting in reduced occupational exposure costs and favorable safety and economic hygiene outcomes.

Efficacy of an mHealth-delivered behavioral intervention on weight loss and cardiometabolic risk in African American postpartum people with overweight or obesity: the SnapBack randomized controlled trial.

The objective of this study was to evaluate the efficacy of a mobile health (mHealth)-delivered behavioral intervention on changes in postpartum weight and cardiometabolic risk factors (blood pressure [BP], lipids, and hemoglobin A1c) over 12 months. A randomized controlled trial of 300 African American postpartum peoplewith overweight and obesity enrolled in Philadelphia Women, Infants, and Children (WIC) clinics was conducted. Participants were randomized to usual WIC care (n = 151) or a 12-month mHealth-delivered intervention (n = 149) comprising behavior change goals, interactive self-monitoring text messages, and counseling support. Intervention and usual-care participants did not significantly differ in 12-month mean postpartum weight change (1.1 vs. 1.6 kg, p = 0.5; difference -0.6 kg, 95% CI: -2.3 to 1.2). However, high intervention engagement led to weight loss compared with weight gain among those who were less engaged (-0.6 vs. 2.4 kg, p = 0.01; difference -3.0 kg, 95% CI: -5.4 to -0.6). The intervention reduced systolic BP relative to usual care (-1.6 vs. 2.4 mm Hg, p = 0.02; difference -4.0 mm Hg, 95% CI: -7.5 to -0.5), but this effect did not extend to other cardiometabolic risk factors. Among African American postpartum people enrolled in WIC, an mHealth-delivered intervention reduced systolic BP but not additional cardiometabolic risk factors or weight. Intervention participants with high engagement had significantly better postpartum weight outcomes, and thus, next steps include addressing barriers to engagement.

An adapted white-coat and warm-heart intervention on nurses' knowledge, general stigmatizing attitudes, and work avoidance behaviors towards HIV: a quasi-experimental study.

To determine the effect of an adapted white-coat and warm-heart intervention (AWWI) among nurses. HIV discrimination among the medical staff hinders the progress in HIV prevention. Seven hundred seventy-nine nurses were randomized into intervention and control groups. The intervention group was provided AWWI training. The control group did not receive AWWI training. HIV-related knowledge, attitudes, and behaviors of participants were assessed. Participants in the intervention group had better HIV-related knowledge and less stigmatizing attitudes and work avoidance behavior levels than participants in the control group after the 1-, 3-, and 6-month interventions (P<0.05). The main effects of group and time factors were highly significant in the intervention group. There were significant interaction effects in group and time factors. AWWI effectively improved the level of HIV-related knowledge and reduced general stigmatizing attitudes and work avoidance behaviors among nurses based on self-reported data in a tertiary hospital of China during a 6-month period.

Opening Pandora’s box - key facilitators of practice change in detecting and responding to childhood adversity - a practitioner perspective

BackgroundChildhood adversities worsen physical and mental health across the lifespan. Health and social care practitioners play a key role in identifying and responding to childhood adversity, however, may be reluctant to do so due to a perceived lack of services to refer to, time pressures and a deficit of training and confidence. We aimed to (1) quantify changes in practitioner comfort and confidence to identify and respond to childhood adversity following a multimodal intervention within an integrated child and family health and social care hub and (2) to understand barriers and facilitators of practice change.MethodsHub practitioners were surveyed about their competence and comfort to directly ask about and confidence to respond to adversity at baseline and then at six and twelve months post training. Interviews were undertaken to explore practitioner barriers and enablers of practice change. Interviews were recorded, transcribed verbatim, and analysed using reflexive thematic analysis. The theoretical domains framework was used to identify the key drivers of practice change.ResultsFifteen of 18 practitioners completed all three surveys and 70% reported increased competence and comfort to directly ask, and confidence to respond across a range of adversities over the 12-month intervention. Twenty-one practitioners completed interviews. Six themes were identified as either facilitators or barriers to practice change. Facilitator themes included (1) connection matters, (2) knowledge provides assurance, (3) confidence in ability and (4) choosing change. Barrier themes were (1) never enough time and (2) opening Pandora’s box. Following analysis, key drivers of practice change were ‘social influence’, ‘belief in capability’, ‘knowledge’ and ‘behaviour regulation’ while barriers to practice change were ‘environmental context and resources’ and ‘emotion’.ConclusionsPractitioners reported improved confidence in identifying and responding to adversity through a multimodal intervention delivered in an integrated Child and Family Hub. Changing practice requires more than just education and training. Opportunities for social connection and coaching to improve self-confidence and perceived competence are needed to overcome the fear of opening Pandora’s box.

The evolution of subjective cognition after meditation training in older people: a secondary analysis of the three-arm age-well randomized controlled trial

ABSTRACT Aging is associated with cognitive changes, even in the absence of brain pathology. This study aimed to determine if meditation training, by comparison to active and passive control groups, is linked to changes in the perception of cognitive functioning in older adults. One hundred thirty-four healthy older participants from the Age-Well Randomized Clinical Trial were included: 45 followed a meditation training, 45 a non-native language training and 44 had no intervention. Subjective cognition was assessed at baseline and following the 18-month intervention period. Perception of attentional efficiency was assessed using internal and external Attentional Style Questionnaire (ASQ) subscale scores. Perception of global cognitive capacities was measured via the total score of Cognitive Difficulties Scale (CDS). Deltas ([posttest minus pretest scores]/standard deviation at pretest) were calculated for the analyses. Generalized mixed effects models controlling for age, sex, education and baseline scores revealed that meditation training decreased the vulnerability score toward external distractors measured by the ASQ compared to non-native language training. However, no between-groups differences on ASQ internal or CDS total scores were observed. Results suggest a beneficial effect of meditation practice on perceived management of external distracting information in daily life. Meditation training may cultivate the ability to focus on specific information (e.g., breath) and ignore stimulation from other kinds of stimuli (e.g., noise).