6-week Postintervention Research Articles

Effectiveness of recruitment and retention strategies in a pregnant adolescent nutrition intervention study.

To report the methodological strategies used to recruit and retain pregnant adolescents into a nutrition-focused intervention study. An important step to meeting the developmental and healthcare needs of pregnant adolescents is to conduct high-quality research studies that generate reliable and accurate data. However, recruitment and retention of pregnant adolescents into research are challenging and time intensive. A quasi-experimental, one-group, pre, post, 6-week postintervention repeated measures study was conducted among inner-city pregnant adolescents. Study participants' nutrition knowledge, eating habits, and personal self-efficacy were measured prior to pregnant adolescents' participation in the workshop, immediately after the intervention and 6-weeks following the intervention. A total of four workshops were conducted over 14months from 2014-2015. Gatekeepers were influential in recruitment efforts due to trusting relationship they had with study participants. The use of texting reminders and pregnant adolescent-related incentives that included gift bags and baby items were also effective recruitment and retention strategies. Despite designing the recruitment strategies and using a developmentally tailored workshop, based on empirical evidence gleaned from pregnant adolescents that was modified to meet study participant's schedules, an adequate sample was unable to be recruited and retained for this study. High-quality research studies that generate reliable and accurate data are essential in meeting the developmental and healthcare needs of pregnant adolescents. A major barrier in developing evidence-based care practices to promote the health of these young mothers and their children involves recruiting and retaining them in research studies.

Adherence to Mediterranean and low-fat diets among heart and lung transplant recipients: a randomized feasibility study

BackgroundHeart and lung transplant recipients are at a substantially increased risk of cardiovascular disease (CVD). Since both low-fat and Mediterranean diets can reduce CVD in immunocompetent people at high risk, we assessed adherence among thoracic transplant recipients allocated to one or other of these diets for 12 months.MethodsForty-one transplant recipients (20 heart; 21 lung) randomized to a Mediterranean or a low-fat diet for 12 months received diet-specific education at baseline. Adherence was primarily assessed by questionnaire: 14-point Mediterranean diet (score 0–14) and 9-point low-fat diet (score 0–16) respectively, high scores indicating greater adherence. Median scores at baseline, 6 months, 12 months, and 6-weeks post-intervention were compared by dietary group. We further assessed changes in weight, body mass index (BMI) and serum triglycerides from baseline to 12 months as an additional indicator of adherence.ResultsIn those randomized to a Mediterranean diet, median scores increased from 4 (range 1–9) at baseline, to 10 (range 6–14) at 6-months and were maintained at 12 months, and also at 6-weeks post-intervention (median 10, range 6–14). Body weight, BMI and serum triglycerides decreased over the 12-month intervention period (mean weight − 1.8 kg, BMI –0.5 kg/m2, triglycerides − 0.17 mmol/L). In the low-fat diet group, median scores were 11 (range 9–14) at baseline; slightly increased to 12 (range 9–16) at 6 months, and maintained at 12 months and 6 weeks post-intervention (median 12, range 8–15). Mean changes in weight, BMI and triglycerides were − 0.2 kg, 0.0 kg/m2 and − 0.44 mmol/L, respectively.ConclusionsThoracic transplant recipients adhered to Mediterranean and low-fat dietary interventions. The change from baseline eating habits was notable at 6 months; and this change was maintained at 12 months and 6 weeks post-intervention in both Mediterranean diet and low-fat diet groups. Dietary interventions based on comprehensive, well-supported education sessions targeted to both patients and their family members are crucial to success. Such nutritional strategies can help in the management of their substantial CVD risk.Trial registrationThe IRAS trial registry (ISRCTN63500150). Date of registration 27 July 2016. Retrospectively registered.

A self-care, problem-solving and mindfulness intervention for informal caregivers of people with motor neurone disease: A pilot study

Background: Informal caregivers of people with motor neurone disease (MND) take on an extensive role. Caregivers are at increased risk of experiencing psychological distress and burden, yet, there is a lack of intervention programmes to support them. Aim: The aim of this study was to investigate the feasibility and acceptability of a therapeutic group intervention promoting self-care, problem-solving and mindfulness to informal caregivers of people with MND. Design: Pilot study that utilised a one-arm pre- and post-design. Acceptability of the intervention was assessed 2 weeks post intervention with a questionnaire designed specifically for this study. Feasibility was assessed with consent, adherence and reasons for non-participation, refusal and attrition. Participants completed baseline and follow-up (6-week post intervention) questionnaires for psychological morbidity, burden, problem-solving, mindfulness and preparedness. Settings/participants: Caregivers of people with a diagnosis of MND within the past 12 months who were 18 years or older; who could speak, read and write in English and who were attending a progressive neurological diseases clinic were eligible. Results: A total of 13 caregivers participated in one of three group intervention sessions which were focused on self-care, problem-solving and mindfulness. The intervention appeared to be feasible and acceptable. All participants stated that they would recommend the intervention to others. The group format appeared to be highly valued. There was no significant change in measures between pre-intervention and 6 weeks post intervention. Conclusion: This pilot serves as an initial step for examining interventions for MND caregivers, with the hope of identifying effective, efficient and sustainable strategies to best support this group.

A Preliminary Study on the Efficacy of a Community-Based Physical Activity Intervention on Physical Function-Related Risk Factors for Falls Among Breast Cancer Survivors.

The aim of this study was to examine the effects of a 6-week community-based physical activity (PA) intervention on physical function-related risk factors for falls among 56 breast cancer survivors (BCS) who had completed treatments. This was a single-group longitudinal study. The multimodal PA intervention included aerobic, strengthening, and balance components. Physical function outcomes based on the 4-meter walk, chair stand, one-leg stance, tandem walk, and dynamic muscular endurance tests were assessed at 6-week pre-intervention (T1), baseline (T2), and post-intervention (T3). T1 to T2 and T2 to T3 were the control and intervention periods, respectively. All outcomes, except the tandem walk test, significantly improved after the intervention period (P < 0.05), with no change detected after the control period (P > 0.05). Based on the falls risk criterion in the one-leg stance test, the proportion at risk for falls was significantly lower after the intervention period (P = 0.04), but not after the control period. A community-based multimodal PA intervention for BCS may be efficacious in improving physical function-related risk factors for falls, and lowering the proportion of BCS at risk for falls based on specific physical function-related falls criteria. Further larger trials are needed to confirm these preliminary findings.

The Efficacy of an Intervention for the Management of Postpartum Fatigue

To assess the efficacy of a psychoeducational intervention, Wide Awake Parenting (WAP), to decrease symptoms of postnatal fatigue. A randomized controlled trial. Local government areas within the Australian state of Victoria. Two hundred and two mothers were randomly allocated to either the professionally-led telephone support intervention (n=63), self-directed written intervention (n=67), or waitlist control (n=72). The professionally-led group received a workbook, home visit, and three telephone support calls. The self-directed written group received the workbook only, and the control group received usual health care services. Primary outcomes were symptoms of fatigue, depression, anxiety and stress, and health care beliefs and behaviors. Mothers were followed up at 2- and 6-weeks postintervention. Mothers in the professionally-led group reported fewer symptoms of fatigue than mothers in the control condition at 6 weeks postintervention. Mothers in either intervention had more positive attitudes toward their health- and self-care behaviors at postintervention and follow-up. Mothers in the professionally-led intervention reported fewer symptoms of depression, anxiety, and stress than mothers in the other conditions at postintervention. Wide Awake Parenting is effective in promoting mothers' self-efficacy to prioritize, plan for, and engage in health and self-care behaviors to promote mental health and manage fatigue. Implications and future opportunities for WAP are discussed.

Effectiveness of a Self-Guided Web-Based Cannabis Treatment Program: Randomized Controlled Trial

BackgroundSelf-help strategies offer a promising way to address problems with access to and stigma associated with face-to-face drug and alcohol treatment, and the Internet provides an excellent delivery mode for such strategies. To date, no study has tested the effectiveness of a fully self-guided web-based treatment for cannabis use and related problems.ObjectivesThe current study was a two-armed randomized controlled trial aimed at testing the effectiveness of Reduce Your Use, a fully self-guided web-based treatment program for cannabis use disorder consisting of 6 modules based on cognitive, motivational, and behavioral principles.Methods225 individuals who wanted to cease or reduce their cannabis use were recruited using both online and offline advertising methods and were randomly assigned to receive: (1) the web-based intervention, or (2) a control condition consisting of 6 modules of web-based educational information on cannabis. Assessments of cannabis use, dependence symptoms, and abuse symptoms were conducted through online questionnaires at baseline, and at 6-week and 3-month follow-ups. Two sets of data analyses were undertaken—complier average causal effect (CACE) modeling and intention to treat (ITT).ResultsTwo thirds (149) of the participants completed the 6-week postintervention assessment, while 122 (54%) completed the 3-month follow-up assessment. Participants in the intervention group completed an average of 3.5 of the 6 modules. The CACE analysis revealed that at 6 weeks, the experimental group reported significantly fewer days of cannabis use during the past month (P=.02), significantly lower past-month quantity of cannabis use (P=.01), and significantly fewer symptoms of cannabis abuse (P=.047) relative to controls. Cannabis dependence symptoms (number and severity) and past-month abstinence did not differ significantly between groups (Ps>.05). Findings at 3 months were similar, except that the experimental group reported significantly fewer and less severe cannabis dependence symptoms (Ps<.05), and past-month quantity of cannabis consumed no longer differed significantly between groups (P=.16). ITT analyses yielded similar outcomes.ConclusionFindings suggest that web-based interventions may be an effective means of treating uncomplicated cannabis use and related problems and reducing the public health burden of cannabis use disorders.Trial registrationACTRN12609000856213, Australian New Zealand Clinical Trials Registry.

Patient Safety

FigureThis month’s continuing education article on “Hand Dermatitis” prompts us to consider that, in addition to the high risk of hand dermatitis among wound care practitioners, it is our hands that are the major transmitters of potentially harmful bacteria. Therefore, we must increase patient safety by improving our hand hygiene (HH). Hand Washing: The Need for Evidence In 1847, Hungarian physician Ignaz Philipp Semmelweis advanced the theory that hand washing with chlorinated lime solutions was a way to reduce nosocomial infection.1 Puerperal fever was common in mid–19th-century hospitals with a mortality of 10% to 35%. Despite evidence indicating hand washing reduced mortality to less than 1%, Semmelweis’ observations were rejected by the medical establishment.1 Some physicians were offended at the suggestion that they should wash their hands. Semmelweis’ practice earned widespread acceptance only years after his death, when Louis Pasteur confirmed the germ theory and Joseph Lister operated, using hygienic methods, with great success.1 Later, during the Crimean War (1853–1856), Florence Nightingale’s legendary triumphs in patient safety during this conflict have been well documented. She encouraged surgeons to practice HH and demonstrated that safe food and water and a clean environment could decrease death rates in military hospitals. Hand-Washing Patient-Centered Research Currently, the Centers for Disease Control and Prevention, The Joint Commission, and the World Health Organization (WHO) recommend several strategies to improve HH with interventional, observational, and other measurement techniques. Any interventional program must include a continuous quality improvement program based in advancing and learning from the organization’s efforts in HH and patient safety. When utilizing the principle of observation to measure or improve HH, privacy is always a consideration. The Just Clean Your Hands program of Public Health Ontario Canada is an evidence-based program established in 2008 to improve compliance with HH in healthcare settings to prevent healthcare-associated infections (HCAIs) and promote patient safety. The HH program’s instructions state, “The observer must conduct observations openly, without interfering with the ongoing work, and keep the identity of the healthcare providers confidential.” There are no identifiers or names recorded on the observer tool.2 A recent study on bacterial contamination of hands by medical care specialty found the highest bacterial contamination on the hands of healthcare workers was from rehabilitation units. A 6-week preintervention and postintervention study, with a 3-month follow-up using a patient education model, was conducted in a 24-bed inpatient rehabilitation unit located in an acute care hospital. Thirty-five patients were enrolled in the intervention phase of the study after agreeing to ask all healthcare workers who had direct contact with them, “Did you wash/sanitize your hands?” Compliance with the program was measured through soap/sanitizer usage per resident—the day before, during, and after the intervention. As a result of this intervention, usage increased from 5 HH per patient-day during the preintervention to 9.7 HH per resident-day during the intervention (P < .001), 6.7 HH per resident-day after intervention (6 weeks) (P < .001), and 7.0 HH per resident-day at 3 months (P < .001). This study indicated that patient education increased HH compliance in an inpatient rehabilitation unit by 94% during the 6-week intervention, 34% during the 6-week postintervention, and 40% at 3-month follow-up.3 An observational study by Japanese researchers wanted to measure compliance to a unit-based “rule” that HH was mandatory prior to entering the intensive care unit (ICU). The tool for the observations was a ceiling-mounted video camera connected to a time-lapse videocassette recorder to document each person’s actions when he/she entered the ICU during a 7-day period. Hand hygiene compliance was assessed for 3 different categories: ICU personnel, non-ICU personnel, and patient visitors. In 1030 entries to the ICU, HH compliance results were as follows: ICU personnel, 71%; non-ICU, 74%; and patient visitors, 94%. Hand-washing compliance by patient visitors was significantly higher than hospital personnel (P < .001).4 Globally, millions of patients annually succumb to HCAIs. Most HCAIs are preventable through good HH. The WHO guidelines on HH in healthcare support HH promotion and improvement in healthcare facilities worldwide.5 Hand hygiene is the single most important intervention for reducing HCAIs and preventing the spread of antimicrobial resistance.FigureRichard “Sal” Salcido, MD

Effect of a six‐week walking program on work place activity limitations among adults with arthritis

To conduct an exploratory evaluation of the impact of the Arthritis Foundation's evidence-based Walk With Ease (WWE) program on work place activity limitations of adults with self-reported or doctor-diagnosed arthritis. WWE participants who were self-identified as "employed" completed the Workplace Activity Limitation Scale (WALS) at 6-week (postintervention; n = 94) and 1-year followup (n = 69). Paired t-tests were used to determine whether reduced work place limitations were reported at 6 weeks and maintained at 1-year followup. Participants were on average age 55 years, 88% women, and 61% white. The mean body mass index was 32 kg/m2 , and 81% had more than a high school education. Overall WALS scores improved significantly from a mean ± SD of 6.7 ± 3.99 at baseline to 5.5 ± 4.20 at 6-week followup (P < 0.001, effect size 0.30). Improvements were maintained at 1-year followup, i.e., no change from 6-week followup (P = 0.87). Work place activities reported by participants as "some" or "a lot" of difficulty at baseline, i.e., "crouch/bend/kneel/work in awkward positions," "stand for long periods," and "lift/carry/move objects," showed some of the highest improvements at 6 weeks. "Concentrate/keep your mind on the job" also improved significantly, although it was not rated as a substantial difficulty at baseline. Our study provides encouraging evidence that WWE, a brief, low-cost, and easy-to-do community-based walking program, may provide both immediate and sustained benefits for people with self-reported arthritis who also report a range of work place limitations related to their arthritis symptoms.

A Natural S-Equol Supplement Alleviates Hot Flushes and Other Menopausal Symptoms in Equol Nonproducing Postmenopausal Japanese Women

The objective of this clinical trial was to examine the efficacy of a supplement containing natural S-(-)equol, a daidzein metabolite, in reducing menopausal symptoms. In this multicenter, double-blind placebo-controlled trial, 160 equol nonproducing, postmenopausal Japanese women who experienced at least 1 hot flush/day were randomly assigned to consume 10 mg/day S-(-)equol (n=77 women) or placebo (n=83 women) for 12 weeks. Participants completed a standardized menopausal symptom checklist and rated five common menopause symptoms by a visual analog scale at baseline, week 12, and week 18 (6-week postintervention). Physical, blood, and urine examinations were conducted. One hundred twenty-six women completed the study. At baseline, daily hot flush frequency was 2.9±2.1 for the S-(-)equol group and 3.2±2.4 for the placebo group. After the 12-week intervention, the S-(-)equol group had a greater decrease from baseline in hot flush frequency compared with the placebo group (-1.9±1.8/day, -58.7%, vs. -1.0±2.0/day, -34.5%, p=0.009). The severity of hot flushes and neck or shoulder muscle stiffness significantly decreased in the S-(-)equol group compared with the placebo group. No changes in clinical parameters or serious adverse effects were reported. This is the first trial to show beneficial effects of a 10-mg natural S-(-)equol supplement consumed daily for 12 weeks on major menopausal symptoms, specifically, hot flushes and neck or shoulder muscle stiffness, in postmenopausal Japanese women. This supplement offers a promising alternative for management of menopausal symptoms.

Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters

To investigate prevalence and severity of symptoms and symptom clustering in breast cancer survivors who attended MBSR(BC). Women were randomly assigned into MBSR(BC) or Usual Care (UC). Eligible women were≥21years, had been diagnosed with breast cancer and completed treatment within 18months of enrollment. Symptoms and interference with daily living were measured pre- and post-MBSR(BC) using the M.D. Anderson Symptom Inventory. Symptoms were reported as highly prevalent but severity was low. Fatigue was the most frequently reported and severe symptom among groups. Symptoms clustered into 3 groups and improved in both groups. At baseline, both MBSR(BC) and the control groups showed similar mean symptom severity and interference; however, after the 6-week post-intervention, the MBSR(BC) group showed statistically-significant reduction for fatigue and disturbed sleep (P<0.01) and improved symptom interference items, compared to the control group. For the between-group comparisons, 11 of 13 symptoms and 5 of 6 interference items had lower means in the MBSR(BC) condition than the control condition. These results suggest that MBSR(BC) modestly decreases fatigue and sleep disturbances, but has a greater effect on the degree to which symptoms interfere with many facets of life. Although these results are preliminary, MBSR intervention post-treatment may effectively reduce fatigue and related interference in QOL of breast cancer survivors.

Distal embolic protection during renal artery angioplasty and stenting

Percutaneous renal artery angioplasty and/or stenting (RA-PTAS) is increasingly being used as an alternative to surgery for renal artery revascularization. Unfortunately, renal function responses after RA-PTAS appear to be inferior to those observed after surgical revascularization both in terms of improving and preventing deterioration of renal function postintervention. Atheroembolism during RA-PTAS has been postulated as a potential cause for the disparate results. Strategies to limit the occurrence of atheroembolism, such as the use of distal embolic protection (DEP) systems, may result in improved outcomes after RA-PTAS. All RA-PTAS procedures performed with DEP (using a commercially available temporary balloon occlusion and aspiration catheter) between October 2003 and July 2005 were reviewed. Glomerular filtration rate (eGFR) was estimated preintervention and 4 to 6 weeks postintervention using the abbreviated Modification of Diet in Renal Disease formula. Renal function and hypertension response rates as well as procedural data were classified and reported according to American Heart Association guidelines. Renal function improvement and deterioration were defined as a 20% increase and decrease in eGFR, respectively, compared with preoperative values. Continuous and categoric data were analyzed using paired t tests and repeated measures linear models. DEP was used in 32 RA-PTAS procedures in 15 women and 11 men with a mean age of 71 years. All patients were hypertensive, 24 (92%) had renal insufficiency, and the mean preintervention degree of renal artery stenosis was 79%. Immediate technical success was achieved in 100% of RA-PTAS cases. Mean pre- and postintervention serum creatinine and eGFR values were 1.9 vs 1.6 mg/dL (P < .001) and 37 vs 43 mL/min/1.73 m(2) (P < .001), respectively. Renal function was defined as improved after 17 (53%) of 32 procedures and worsened in none (0%). RA-PTAS using DEP resulted in 4- to 6-week postintervention renal function results approximating those of surgical revascularization. These data suggest that DEP use may prevent renal function harm during RA-PTAS as a result of atheroembolism and warrant further investigation.