Application Of Such Interventions Research Articles

Advancing understanding of the linkages between local land policy interventions and the responsiveness of housing supply: Intervention mechanisms in the Finnish context

Land policy interventions are important ways for municipalities to implement their spatial development objectives. Such interventions may, however, generate both intended and unintended effects to housing supply and its responsiveness. It is therefore essential to better understand how and through what kind of mechanisms local land policy interventions can influence the quantity of housing supply. This paper addresses these questions. First, we develop a conceptual classification of so-called intervention mechanisms that describes the linkages between local land policy interventions and the quantity and responsiveness of housing supply. The intervention mechanisms build on a review of the urban economics literature and are further developed empirically using extensive expert interview data on local land policy interventions and practices in 30 Finnish municipalities. Based on the understanding that such intervention primarily influences housing supply through either direct or indirect costs on development, we conceptualize seven intervention mechanisms in the Finnish land policy context. Second, we demonstrate the variation in the application of land policy interventions that contribute to the (in)responsiveness of housing supply at the municipal level. Our findings highlight significant variation in the application of such interventions, potentially leading to different outcomes in housing supply restrictiveness. The findings contribute to a deeper understanding of the mechanisms by which land policy interventions operate to affect the (in)responsiveness of housing supply.

Revisiting Post-ICU Admission Fluid Balance Across Pediatric Sepsis Mortality Risk Strata: A Secondary Analysis of a Prospective Observational Cohort Study.

Post-ICU admission cumulative positive fluid balance (PFB) is associated with increased mortality among critically ill patients. We sought to test whether this risk varied across biomarker-based risk strata upon adjusting for illness severity, presence of severe acute kidney injury (acute kidney injury), and use of continuous renal replacement therapy (CRRT) in pediatric septic shock. Ongoing multicenter prospective observational cohort. Thirteen PICUs in the United States (2003-2023). Six hundred and eighty-one children with septic shock. None. Cumulative percent PFB between days 1 and 7 (days 1-7 %PFB) was determined. Primary outcome of interest was complicated course defined as death or persistence of greater than or equal to two organ dysfunctions by day 7. Pediatric Sepsis Biomarker Risk Model (PERSEVERE)-II biomarkers were used to assign mortality probability and categorize patients into high mortality (n = 91), intermediate mortality (n = 134), and low mortality (n = 456) risk strata. Cox proportional hazard regression models with adjustment for PERSEVERE-II mortality probability, presence of sepsis-associated acute kidney injury on day 3, and use of CRRT, demonstrated that time-dependent variable days 1-7%PFB was independently associated with an increased hazard of complicated course. Risk-stratified analyses revealed that each 10% increase in days 1-7 %PFB was associated with increased hazard of complicated course only among patients with high mortality risk strata (adjusted hazard ratio 1.24 (95% CI, 1.08-1.43), p = 0.003). However, this association was not causally mediated by PERSEVERE-II biomarkers. Our data demonstrate the influence of cumulative %PFB on the risk of complicated course in pediatric septic shock. Contrary to our previous report, this risk was largely driven by patients categorized as having a high mortality risk based on PERSEVERE-II biomarkers. Incorporation of such prognostic enrichment tools in randomized trials of restrictive fluid management or early initiation of de-escalation strategies may inform targeted application of such interventions among at-risk patients.

Use of School-Based Interventions for ADHD, Professional Support, and Burnout Symptoms among Teachers in Iceland

Objective: Effective school-based interventions for youth with ADHD are critical to their success. We examined whether teacher application of such interventions and perceptions of professional support related to greater well-being, including fewer burnout symptoms. Method: Teachers in primary schools in Iceland were invited to participate in an online survey, including questions about professional support and the Maslach Burnout Inventory (MBI). The sample comprised N = 592 (88.5% female) participants. Results: Regression analyses indicated that use of recommended ADHD interventions was positively associated with MBI-Personal Achievement (PA). Greater satisfaction with professional support related to lower MBI-Emotional Exhaustion and MBI-Depersonalization, and higher MBI-PA. Level of professional support was positively associated with use of recommended interventions. Conclusion: Effective interventions and support for students with ADHD may enhance teacher well-being. Icelandic teachers require further training and professional support in best practices for ADHD, to help promote teacher and student success.

The acceptability and feasibility of a cognitive behavioural therapy managing emotions group on a male psychiatric intensive care unit: a mixed methods evaluation

Research suggests that the provision of psychological interventions within acute inpatient settings is effective and important for improving clinical outcomes. There remains limited research on the application of such interventions for individuals admitted to psychiatric intensive care units (PICU), and notablynone for male-only PICU environments specifically. Two published protocols have been evaluated in female and mixed gender PICU settings, one a cognitive behavioural therapy (CBT) anger management group and one dialectical behaviour therapy (DBT) skills group. No studies have reported on a general CBT-based group in a male PICU. This study aimed to assess the acceptability and feasibility of a CBT-based managing emotions skills group, delivered in brief 30-minute sessions, within a 7-bed male PICU. All individuals admitted to the PICU during the study period were invited to attend a five-session group. A mixed methods design was used incorporating measuring attendance andretention, a pre–post quasi-experimental design and a qualitative component. Pre- and post-group self-report outcome measures of calmness, anxiety, recovery, and qualitative feedback were gathered and analysed. Pre- and post-outcome measures demonstrate significant improvements in calmness and reduction in anxiety following attendance. Attendance, retention and qualitative feedback data suggests that the group was acceptable and feasible for the participants. Initial findings suggest that adapted CBT skills group-based interventions tailored to the male PICU population are acceptable, feasible, and beneficial to participants. The clinical and research implications are discussed.

[Justification of nurses' interventions for skin cleansing and skincare: Qualitative results of the SKINCARE-Pilot study].

Justification of nurses' interventions for skin cleansing and skincare: Qualitative results of the SKINCARE-Pilot study Abstract. Background: Skin care interventions are core tasks of nursing. Various factors influence the implementation of evidence-based care. Aims: To explore the perspectives of nursing staff on the relevance of skin care interventions in long-term care settings and the justification of clinical decisions about the application of such interventions. Methods: Qualitative part of a mixed methods study in three long-term-care facilities, consisting of short interviews with nursing staff members directly after nursing assistance with personal hygiene, focus group discussions with nursing staff members, and semi-structured interviews with nursing managers. The data were analyzed by means of content analysis. Results: The sample (N = 30) comprises 10 short interviews, 3 focus groups (n = 17), and 3 individual interviews. Nurses predominantly assigned a high relevance to nursing support in personal hygiene. As a basis for their decision-making, residents' needs and preferences, nurses' personal knowledge as well as own experiences and preferences were reported. Evidence-based sources of knowledge were hardly mentioned. The availability of skin cleansing and skin care products, staff and time resources, and nurse-physician cooperation were identified as influencing factors. Conclusions: Decisions about nursing support in personal hygiene seem poorly informed by evidence-based sources for clinical decision-making. Evidence-based decision support could facilitate the use of appropriate nursing interventions.

Improving compliance of risk assessment and nonpharmacological interventions for deep venous thrombosis prevention in a respiratory ICU: a best practice implementation project.

To increase the compliance with deep venous thrombosis (DVT) nonpharmacologic prophylaxis best practice recommendations while ensuring appropriate and structured nonpharmacologic prophylaxis for patients in the respiratory ICU. DVT is a major problem for patients, with those who are critically ill representing a high-risk population for developing the condition. Nonpharmacologic prophylaxis is considered an effective intervention. However, the application of such interventions in practice has not been optimal to date. The current project was conducted in a respiratory ICU of a tertiary hospital. Audit criteria were developed on the basis of an evidence summary developed by the Joanna Briggs Institute, whereby the institute's Practical Application of Clinical Evidence System program to facilitate an audit and feedback cycle was utilized as an implementation framework. Baseline and follow-up audits on nonpharmacological DVT prophylaxis were conducted for 35 patients against five evidence-based recommendations. In addition, the nurses' knowledge and attitude regarding DVT prophylaxis were investigated both prior to and postimplementation. In the baseline audit, compliance with the five evidence-based audit criteria was less than 15%. After the implementation of strategies including education, person-centered care, financial and human-resource support, there was a significant improvement in all the audit criteria. In addition, improvements in the nurses' knowledge and attitude regarding DVT prophylaxis were reported. The rate of discharged patients due to a deterioration of their condition decreased from 31.4 to 5.7% in the follow-up cycle. One DVT patient occurred in the baseline data, whereas no new incidences of DVT were found in the follow-up data. The project not only improved nurses' knowledge and attitude regarding DVT prevention, but also remarkably improved the implementation of nonpharmacological DVT prophylaxis. The application of evidence-based nonpharmacological DVT prophylaxis may improve patients' outcomes in the ICU.

Cognitive Tele-Enhancement in Healthy Older Adults and Subjects With Subjective Memory Complaints: A Review.

Background: In recent years, emphasis has been placed on cognitive enhancement to stimulate cognitive abilities and prevent functional decline. Considering that traditional face-to-face interventions can be very expensive and are not accessible to all individuals, the need to transfer care from the clinic to the patient's home is evident. In this regard, cognitive tele-enhancement interventions have received increased attention.Aim: The aim of this review was to provide an overview of protocols that apply remotely controlled cognitive training with individualized feedback on performance by the therapist in healthy older adults or participants with subjective memory complaints.Methods: Out of 35 articles assessed for eligibility, eight studies were identified. Of the selected studies, five included cognitively healthy older adults, while three included participants with subjective memory complaints.Results: Most of the reviewed studies showed beneficial effects of cognitive tele-enhancement interventions, reporting improvements in memory, sustained attention, working memory, executive functions, and language abilities. Moreover, reductions in anxiety and depression symptomatology levels, as well as in subjective memory difficulties, were described in some of the studies.Conclusions: Cognitive tele-enhancement treatment could be a good alternative to face-to-face intervention. This literature review highlights the importance of applying preventive cognitive interventions to subjects with initial subjective memory complaints. Remote modalities seem to facilitate the application of such interventions.

Species-Specific Variations in the Metabolomic Profiles of Acropora hyacinthus and Acropora millepora Mask Acute Temperature Stress Effects in Adult Coral Colonies

Coral reefs are suffering unprecedented declines in health state on a global scale. Some have suggested that human assisted evolution or assisted gene flow may now be necessary to effectively restore reefs and pre-condition them for future climate change. An understanding of the key metabolic processes in corals, including under stressed conditions, would greatly facilitate the effective application of such interventions. To date, however, there has been little research on corals at this level, particularly regarding studies of the metabolome of Scleractinian corals. Here, the metabolomic profiles [measured using 1H nuclear magnetic resonance spectroscopy (1H NMR) and ultra-high-performance liquid chromatography-mass spectrometry (LC-MS)] of two dominant reef building corals, Acropora hyacinthus and A. millepora, from two distinct geographical locations (Australia and Singapore) were characterized. We assessed how an acute temperature stress (an increase of 3.25°C ± 0.28 from ambient control levels over 8 days), shifted the corals’ baseline metabolomic profiles. Regardless of the profiling method utilized, metabolomic signatures of coral colonies were significantly distinct between coral species, a result supporting previous work. However, this strong species-specific metabolomic signature appeared to mask any changes resulting from the acute heat stress. On closer examination, we were able to discriminate between control and temperature stressed groups using a partial least squares discriminant analysis classification model (PLSDA). However, in all cases “late” components needed to be selected (i.e., 7 and 8 instead of 1 and 2), suggesting any treatment effect was small, relative to other sources of variation. This highlights the importance of pre-characterizing the coral colony metabolomes, and of factoring that knowledge into any experimental design that seeks to understand the apparently subtle metabolic effects of acute heat stress on adult corals. Further research is therefore needed to decouple these apparent individual and species-level metabolomic responses to climate change in corals.

Investigating the Relevance of Nursing Caring Interventions Delivered to Patients with Coronary Artery Disease at a Teaching Hospital in China: A Retrospective Study.

Objective: Coronary artery disease (CAD) remains the leading cause of morbidity and mortality worldwide. Previous systematic reviews and meta-analysis of randomized controlled trials concluded that nursing caring interventions (NCIs) are beneficial for coronary artery patients. However, most of those interventions were conducted in outpatient or home-based settings or through the telephone. Due to its multiple benefits, the authors recommended the application of such interventions to hospitalized coronary artery patients. Currently, little is known on the status of application of such evidence-based interventions in the actual clinical setting for hospitalized coronary artery patients. Similar studies conducted in China were also inadequate. Therefore, this study aimed to investigate the kinds of NCIs delivered to hospitalized coronary artery patients and their consistent relationship with risk factors of CAD found in the clinical records of patients. Results of this study were expected to alert nurses to consider such risk factors when caring for coronary artery patients as well as appraising their caring efforts in improving the patient’s wellbeing for the reduction of morbidity and mortality from a CAD sequel. This report also disseminates some cardiovascular knowledge and health tips to the readers.Methods: A descriptive, cross-sectional, retrospective design using clinical case notes was employed; the study was undertaken in coronary care wards at the teaching hospital in China from November 2017 to September 2018. A total of 300 coronary artery case notes were randomly selected from 700 eligible cardiovascular patients files by using a simple random technique of simple random numbers through Microsoft office excel sheet. Chi-square (χ2) test and multivariate logistic regression analysis for adjusted odds ratio with 95% confidence interval (CI) within its range were used to compare the relationship among independent (patient's demographic and clinical risk factors of CAD) and dependent variables (NCIs implemented to such patients).Results: A total of 300 coronary artery patients’ case notes were audited with a mean age of 63±11.2 years. Of these 175 (58.3%) were males, 126 (42%) were smokers and 224 (74.7%) were hypertensive. NCIs such as “administer coronary artery medication and their instructions” was mostly delivered to 291 (97%) patients. The delivery of three out of eight gathered NCIs were significantly influenced by three or all of these CAD risk factors (age, smoking, hypertension, and diabetes) (p < 0.05 and/or < 0.01) with an adjusted odds ratio (95% CI) within their significant ranges. Patients with diabetes mellitus were five times more likely to influence the delivery of “administer medication and their instructions” than the rest of patients with coronary artery risk factors (p < 0.01; AOR (95% CI) 5.02(2.059-7.207).Conclusion: This study reveals that nurses delivered beneficial evidence-based interventions to patients with CAD. The interventions were significantly consistent with age as an unmodifiable risk factor and smoking, hypertension, and diabetes as modifiable risk factors of CAD. However, the management of stress in these patients was low; and since stress may trigger CAD, it should be assessed and managed appropriately.

Attitude towards Bike Use in Rende, a Small Town in South Italy

The bike can contribute to the development of sustainable mobility. This requires interventions to promote bike use, such as increasing the cyclist safety, construction of bikeways, and provision of ancillary services and bike sharing activities. In the literature many studies focus on bike use and agree with the application of such interventions. However, these studies are often related to specific urban areas that are very different; the transferability of results and models has not been adequately analyzed. This work investigates the attitudes towards cycling in Rende, a small town in Southern Italy. The aim is to determine in what conditions the users would be willing to use bicycles in relation to the trip purpose, the presence or absence of cycle paths, and the availability of bike sharing services. Different factors, such as age, gender, and occupation, are taken into account. The results show that the bike use could be incentivized by enlarging the existent bike network, adopting bike sharing systems, and promoting specific policies oriented to sustainable transport modes. Furthermore, two aspects emerged from the analysis: the importance of studying the propensity to use bikes by different groups of users and the importance of focusing interventions on market segments with greater willingness to bike.

Interventions for acute stroke management in Africa: a systematic review of the evidence

BackgroundThe past decades have witnessed a rapid evolution of research on evidence-based acute stroke care interventions worldwide. Nonetheless, the evidence-to-practice gap in acute stroke care remains variable with slow and inconsistent uptake in low-middle income countries (LMICs). This review aims to identify and compare evidence-based acute stroke management interventions with alternative care on overall patient mortality and morbidity outcomes, functional independence, and length of hospital stay across Africa.MethodsThis review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. An electronic search was conducted in six databases comprising MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Academic Search Complete and Cochrane Library for experimental and non-experimental studies. Eligible studies were abstracted into evidence tables and their methodological quality appraised using the Joanna Briggs Institute checklist. Data were analysed and presented narratively with reference to observed differences in patient outcomes, reporting p values and confidence intervals for any possible relationship.ResultsInitially, 1896 articles were identified and 37 fully screened. Four non-experimental studies (three cohort and one case series studies) were included in the final review. One study focused on the clinical efficacy of a stroke unit whilst the remaining three reported on thrombolytic therapy. The results demonstrated a reduction in patient deaths attributed to stroke unit care and thrombolytic therapy. Thrombolytic therapy was also associated with reductions in symptomatic intracerebral haemorrhage (SICH). However, the limited eligible studies and methodological limitations compromised definitive conclusions on the extent of and level of efficacy of evidence-based acute stroke care interventions across Africa.ConclusionEvidence from this review confirms the widespread assertion of low applicability and uptake of evidence-based acute stroke care in LMICs. Despite the limited eligible studies, the overall positive patient outcomes following such interventions demonstrate the applicability and value of evidence-based acute stroke care interventions in Africa. Health policy attention is thus required to ensure widespread applicability of such interventions for improved patients’ outcomes. The review findings also emphasises the need for further research to unravel the reasons for low uptake.Systematic review registrationPROSPERO CRD42016051566

Brief Interventions for Cannabis Use Disorders: A Review

Background: Cannabis use and abuse is an important health hazard which has several harmful consequences on person’s physical and psychological well-being. Although cannabis use disorder is a common problem across various countries, the effective medications for treatment are still limited. Because of this, the major focus of interventions for cannabis use disorder has been on psychological modalities. One such intervention is a brief intervention, which targets mainly those persons with less severe cannabis use problems. The current narrative review aims at providing an overview of the role and relevance of brief intervention in cannabis use disorders and discusses the relevant methodological issues. Subjects and Methods: We reviewed multiple scientific search engines including Google Scholar, PubMed, and PubMed Central. Search terms used includes but are not limited to, “brief intervention,” “cannabis use disorders treatment,” “cannabis abuse treatment,” “brief interventions for cannabis,” etc. Studies assessing efficacy/effectiveness of brief intervention in cannabis use disorders were included in this review. Results: The majority of studies points toward the effectiveness of brief intervention in reducing the cannabis use and/or associated consequences in cannabis use disorders. However, the studies should be interpreted cautiously given the variation in the type, theoretical construct, duration, and outcome measures for brief intervention and the therapist attributes. Conclusions: Brief interventions might be useful for mild to moderate cannabis users for reducing cannabis use and/or associated consequences. Future studies, especially in developing countries are required to look for applicability of such interventions in different populations.

Tools for Practical Psychotherapy: A Transtheoretical Collection (or Interventions Which Have, At Least, Worked for Us).

Regardless of their historical and theoretical roots, strategies, tactics, and techniques used in everyday psychotherapy across diverse theoretical schools contain common factors and methods from other specific psychotherapeutic modalities that contribute substantially to psychotherapy outcomes. Common factors include alliance, empathy, goal consensus/collaboration, positive regard/affirmation, and congruence/genuineness, among others. All therapies also recognize that factors specific to therapists impact treatment. Starting with these common factors, we add psychotherapeutic methods from many theoretical orientations to create a collection of clinical tools. We then provide concrete suggestions for enacting psychotherapy interventions, which constitute a transtheoretical collection. We begin with observations made by earlier scholars, our combined clinical and teaching experiences, and oral traditions and clinical pearls passed down from our own supervisors and mentors. We have compiled a list of tools for students with foundational knowledge in the basic forms of psychotherapy, which may expand their use of additional interventions for practicing effective psychotherapy. Our toolbox is organized into 4 categories: Relating; Exploring; Explaining; and Intervening. We note how these tools correspond to items previously published in a list of core psychotherapy competencies. In our view, the toolbox can be used most judiciously by students and practitioners schooled and grounded in frameworks for conducting established psychotherapies. Although they are still a work in progress, these tools can authorize and guide trainees and practitioners to enact specific approaches to psychotherapy utilizing other frameworks. We believe that psychotherapy education and training might benefit from explicitly focusing on the application of such interventions.

Effects of Charitable Versus Monetary Incentives on the Acceptance of and Adherence to a Pedometer-Based Health Intervention: Study Protocol and Baseline Characteristics of a Cluster-Randomized Controlled Trial.

BackgroundResearch has so far benefited from the use of pedometers in physical activity interventions. However, when public health institutions (eg, insurance companies) implement pedometer-based interventions in practice, people may refrain from participating due to privacy concerns. This might greatly limit the applicability of such interventions. Financial incentives have been successfully used to influence both health behavior and privacy concerns, and may thus have a beneficial effect on the acceptance of pedometer-based interventions.ObjectiveThis paper presents the design and baseline characteristics of a cluster-randomized controlled trial that seeks to examine the effect of financial incentives on the acceptance of and adherence to a pedometer-based physical activity intervention offered by a health insurance company.MethodsMore than 18,000 customers of a large Swiss health insurance company were allocated to a financial incentive, a charitable incentive, or a control group and invited to participate in a health prevention program. Participants used a pedometer to track their daily physical activity over the course of 6 months. A Web-based questionnaire was administered at the beginning and at the end of the intervention and additional data was provided by the insurance company. The primary outcome of the study will be the participation rate, secondary outcomes will be adherence to the prevention program, physical activity, and health status of the participants among others.ResultsBaseline characteristics indicate that residence of participants, baseline physical activity, and subjective health should be used as covariates in the statistical analysis of the secondary outcomes of the study.ConclusionsThis is the first study in western cultures testing the effectiveness of financial incentives with regard to a pedometer-based health intervention offered by a large health insurer to their customers. Given that the incentives prove to be effective, this study provides the basis for powerful health prevention programs of public health institutions that are easy to implement and can reach large numbers of people in need.

Emergence of Transdiagnostic Treatments for PTSD and Posttraumatic Distress.

Both theoretical and empirical findings have demonstrated similarities across diagnoses, leading to a growing interest in transdiagnostic interventions. Most of the evidence supporting transdiagnostic treatment has accumulated for depression, anxiety, and eating disorders, with minimal attention given to posttraumatic stress disorder and other reactions to traumatic stressors. Although single-diagnosis protocols are effective for posttraumatic stress disorder (PTSD) and other trauma-related disorders, in principle, transdiagnostic approaches may have beneficial applications within a traumatized population. This paper defines different types of transdiagnostic treatments, reviews transdiagnostic approaches used in related disorders, and discusses their applicability to PTSD. Examples are drawn from existing transdiagnostic treatments in order to provide a framework for the application of such interventions to the field of traumatic stress. Implications for implementation and dissemination are also discussed.

Rehabilitation outcomes following autologous human stem cell transplantation in a chronic complete C4 tetraplegic - the first 12 months: A case report

Autologous Human Stem Cell Transplantation (AHESC) is emerging as one of several promising new cell-based treatments for chronic spinal cord injury (SCI). Since chronic SCI is generally deemed irreversible, treatment paradigms for post-intervention rehabilitation after many years of disability are limited, and a description of the impact of such intervention on the patients is hard to find. Here we describe, for the first time, the multi-disciplinary post-operative rehabilitation and outcome of a patient with chronic cervical SCI after autologous human embryonic stem cell transplant. We include the anatomical, physiological, functional and quality of life outcomes. METHODS: A 33 year old male, American Spinal cord Injury Association (ASIA) Grade A, C4 chronic SCI patient received glial scar resection and Autologous Human Embryonic Stem Cell (AHESC) transplant, 6 years after injury, and thereafter had intensive interdisciplinary rehabilitation comprising occupational, biokinetic and physiotherapy, for an average of 17 hours per week over the course of 12 months. Outcomes were measured with standardised outcome measures of physiological improvement, increased independence, and a questionnaire was designed to gain understanding of the changes in quality of life and well-being of the patient, from his perspective RESULTS: The patient progressed from ASIA Grade A to ASIA Grade C, over the first 12 post-operative months. Sensory recovery comprised awareness of deep pressure and light touch in all dermatomes, with accurate localisation to L1. Motor activation was restored to all major muscle groups of the right upper limb, and to a lesser extent in the left upper limb, with some recovery in thoracic, abdominal and spinal muscles. Gains have been made in areas of motor, sensory and vascular function, self-care, wheelchair use and safety, and leisure participation. The patient has found these changes meaningful in terms of quality of life CONCLUSION: Regenerative medicine approaches may create rehabilitation potential where none formerly existed, presenting unprecedented challenges to rehabilitation therapists. Our experience demonstrates the value of intensive multi-disciplinary rehabilitation programmes in this setting, and provides a template for functional restoration and retraining after many years of chronic disability. It also emphasises the need to debate the ethical questions surrounding the application of such interventions and highlights the impact that participation in rehabilitation can have on a patient's perception of quality of life and health status. Key words: Human therapeutic cloning, autologous human embryonic stem cells, spinal cord, spinal cord injury, quadriplegia, motor rehabilitation, motor retraining, mirror therapy, quality of life

Narrative-based educational nursing intervention for managing hospitalized older adults at risk for delirium: Field testing and qualitative evaluation

Though delirium is a common complication among hospitalized older adults and the nursing care required in these situations is complex, the subject has received little attention in the literature on continuing nursing education. A study was undertaken to field test and qualitatively evaluate a narrative-based educational intervention for nurses in hospital units with a high incidence of delirium. Triangulated data collection allowed carrying out a qualitative evaluation of the intervention process and outcomes. Process evaluation showed that the intervention was facilitated by the participants' attitudes and diversity of experience, as well as by the use of real care situations, which allowed integrating theory and practice. Outcome evaluation brought to light numerous elements of empirical, ethical and esthetic knowledge expressed by the participants. Study results evidence the applicability of such interventions as part of continuing nursing education and their contribution to knowledge development.

The Efficacy of Clinic-Based Interventions Aimed at Increasing Screening for Bacterial Sexually Transmitted Infections Among Men Who Have Sex With Men

In many countries, the prevalence of bacterial sexually transmitted infections (STIs) among men who have sex with men (MSM) is high. We undertook a systematic review to identify clinic-based strategies for increasing screening and detection of bacterial STIs among MSM. We reviewed studies that compared screening for or detection of gonorrhea, chlamydia, and syphilis in the presence and the absence of an intervention. The primary end points were STI screening, rescreening, or detection rates. Of 1809 studies identified, 8 fulfilled the inclusion criteria; of these, 4 studies demonstrated significant increases in screening rates for gonorrhea and chlamydia using different strategies (odds ratio range, 1.4-1.9). These included the following: use of a computer alert on an electronic medical record; the introduction of clinic guidelines on STI screening; and short text messaging reminders for repeat STI screening. A further 4 studies demonstrated increases in syphilis testing (odds ratio range, 2.3-21.4), with increased detection of asymptomatic early syphilis in 2 studies. Strategies used included regular serological screening for syphilis during routine human immunodeficiency virus (HIV) care, syphilis serology included with blood tests performed as part of HIV monitoring, use of a computer alert on an electronic medical record, and an electronic medical record system to enhance syphilis retesting after syphilis treatment. A range of interventions has been used, including the application of newer technologies targeting clinicians and patients that appear to be efficacious at increasing screening of MSM for bacterial STIs. Wider application of such interventions could improve STI screening and control in this high-risk population.

Telefonisches Compliance–Monitoring und Bonusprogramme – Zwei neue Möglichkeiten zur Compliance–Verbesserung in der Behandlung psychiatrischer Patienten?

Aufgrund noch immer unbefriedigender Behandlungsergebnisse in der Therapie von psychisch kranken Menschen sind weitere Maßnahmen zur Verbesserung der Compliance von großem Interesse. Eine Möglichkeit ist der Einsatz von Telefoninterventionen und Bonusprogrammen, die in verschiedenen Studien positive Effekt auf die Compliance von Patienten mit unterschiedlichen Erkrankungen zeigten. Eine Anwendung dieser Interventionen im Bereich der Psychiatrie erscheint vielversprechend, allerdings sind die Daten – vor allem zu Bonusprogrammen – hier noch unzureichend. Weitere, methodisch fundierte Studien sind deshalb dringend indiziert.

A Review of Weight Loss Programs Delivered Via the Internet

The escalating obesity epidemic has prompted healthcare professionals to seek interventions that can reach large numbers of individuals in a timely and cost-effective manner. The Internet, with its growing audience, seems an obvious solution. Commercial weight loss programs already abound on the Internet. The purpose of this review is to describe the efficacy of weight loss programs delivered via the Internet in the United States. A search for clinical trials evaluating weight loss via Internet programs was conducted using PubMed, CINAHL, Cochrane Library, Academic Search Premier, the National Institutes of Health Clinical Trials Database, and the Internet as well as a cross-check of reference lists. Eight published studies that met the inclusion criteria were reviewed. Data were extracted on study design, sample characteristics, attrition, weight loss, duration of treatment, and maintenance of weight loss. Of the 8 studies, 3 evaluated the Internet as a means to maintain long-term weight loss. All studies examining weight loss via Internet programs reported positive results, except for one investigating a commercial program. Results from the 3 weight loss maintenance programs conducted on the Internet were equivocal. Because the subjects of all these studies were predominately white, educated women, generalization of findings is limited. Data from the reviewed studies suggest that the Internet may be an alternative to traditional face-to-face weight loss programs. Questions still remain as to the efficacy of using the Internet for long-term weight loss maintenance. Findings from these studies provide beginning guidelines for healthcare providers who may choose to use Internet-based weight loss interventions. Future research is still needed to determine the applicability of such interventions in diverse age, ethnic, and socioeconomic groups.