Assess Intervention Effects Research Articles

Effective dietary interventions during pregnancy: a systematic review and meta-analysis of behavior change techniques to promote healthy eating

Improving dietary intake during pregnancy can mitigate adverse consequences for women and their children. The effective techniques and features for supporting and sustaining dietary change during pregnancy and postpartum are minimally reported. The primary aims of this systematic review and meta-analysis were to summarise the effectiveness of dietary interventions for pregnant woman, identify which behaviour change techniques (BCTs) and intervention features were most frequently used and determine which were most effective at improving dietary intake. Six databases were searched to identify randomised control trials (RCTs) reporting on dietary intake in pregnant women over the age of sixteen, with an active intervention group compared to a control group receiving usual care or less intensive interventions. The Cochrane Risk of Bias Tool 1 was used to assess study validity. BCTs were coded by two authors using Michie et al.’s BCT taxonomy V1. A random effect model assessed intervention effects on indices of dietary quality and food groups (fruit, vegetables, grains and cereals, meat, and dairy) in relation to the use of BCTs and intervention features. Thirty- seven RCTs met the inclusion criteria. High heterogeneity was observed across intervention characteristics and measures of fidelity. Only half of the available BCTs were used, with eleven used once. The BCT category Reward and threat was successful in improving dietary quality and vegetable intake, whilst 'Action planning’ (1.4) from the category Goals and planning significantly improved dietary quality. Interventions delivered by a nutrition professional and those that included group sessions improved dietary quality more than those delivered by other health professionals, research staff, or application-delivered interventions and delivered via other modalities. Future dietary interventions during pregnancy should incorporate and report on BCTs used in the intervention. Successful design elements for improving antenatal dietary intake may include multimodal interventions delivered by nutrition professionals and the use of Rewards and Goal setting.

Construction of the digital intelligence-enabled intervention model for learning engagement

Academic English writing is a crucial component of undergraduate English education. However, undergraduates commonly face challenges such as unclear topic selection, imprecise language expression, and a lack of depth and logical coherence in analysis and argumentation. This study, grounded in AGIL theory (Adaption, Goal Attainment, Integration, Latency Pattern Maintenance), integrates generative artificial intelligence with instant feedback to develop a “Human-Computer Dual-Instructor” model for learning engagement intervention. The model consists of four subsystems: the objective system, the environmental system, the operational system, and the response system for learning engagement intervention. Through an iterative intervention response mechanism, this model is capable of dynamically assessing intervention effects and ensuring the orderly flow of data among the subsystems. Using an academic English writing course as an example, this model is applied to the design of teaching interventions, aiming to enhance students’ learning engagement and academic writing skills.

Development and evaluation of an intervention designed to increase the prioritisation of health by professionals working in the private sector of urban development: study protocol

ABSTRACT The built environment is known to have a significant influence on population and planetary health, including the incidence of non-communicable disease, but evidence suggests that professionals in the land and development industries struggle to prioritise health and health equity when making urban development decisions amidst challenging structures and competing priorities. The aim of this study is to use a mixed-methods approach to develop, deliver, optimise, and evaluate an intervention for professionals working in the private sector of urban development to increase their intention to act on health and health equity where possible. This protocol describes four planned research activities that constitute this intervention’s development, delivery, and evaluation: 1) Intervention development using an iterative co-production process with non-academic industry partners using the Person-Based Approach and following Medical Research Council guidelines on the development of complex interventions; 2) Development of survey questions to assess intervention effectiveness; 3) Delivery and mixed-methods longitudinal evaluation of the intervention; and 4) Evaluation of the impact of co-production and delivery of the intervention with the project’s industry partners.

Digital symptom management interventions for people with chronic kidney disease: a scoping review based on the UK Medical Research Council Framework

BackgroundChronic Kidney Disease (CKD) is a growing global health issue with a complex symptom phenotype. It negatively impacts patients’ health-related quality of life and increases healthcare utilization. While digital health interventions offer promising avenues for improving symptom management in CKD, understanding their development, validation, and effectiveness is crucial for clinical application.ObjectiveTo comprehensively map the existing literature on digital health interventions designed to manage symptoms in patients with Chronic Kidney Disease (CKD), using the UK Medical Research Council’s complex intervention framework as a guiding lens. This scoping review aims to: (1) catalogue digital health interventions utilized in CKD symptom management; (2) detail the range of outcome measures assessing intervention effectiveness, including clinical efficacy, patient adherence, and quality of life; (3) examine the methodologies and frameworks employed in the creation of these interventions; (4) assess the pilot testing and effectiveness evaluations; and (5) categorize and analyze the barriers to implementation.MethodsA scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Databases searched included PubMed, Scopus, Embase, and others, covering literature up to December 2023. Studies were selected based on predefined eligibility criteria for digital health interventions for CKD symptom management.ResultsThe search yielded 31 studies, with a mix of development and validation studies, predominantly from developed countries. The review highlights the potential of digital interventions in enhancing symptom management, quality of life, and patient engagement in CKD care. However, gaps were identified as follows: (1) Iterative refinement cycles involving multidisciplinary stakeholders enhanced intervention acceptability and usability should be guaranteed, (2) Theory-driven and evidence-based approaches were underutilized in current intervention development, (3) Long-term implementation outcomes and process evaluations were rarely assessed. This review maps an evolving landscape where digital health interventions offer patient-centric solutions for CKD symptom management while highlighting opportunities for methodological advancements.ConclusionDigital health interventions hold promise for improving symptom management in CKD, yet more research is needed to overcome current limitations and fully realize their potential. Future studies should focus on patient-centred designs, comprehensive validation processes, exploring the underlying mechanism using process evaluation and the integration of these technologies into routine clinical practice.

Reducing Disparities in Access to Kidney Transplantation Regional Study: A Randomized Trial in the Southeastern United States.

The Southeastern United States (US) has among the lowest rates of kidney transplantation nationally and has documented racial and socioeconomic disparities in transplant access. We assessed the effectiveness and implementation of a multi-component intervention aimed at increasing access and reducing disparities in access to early transplant steps in Georgia (GA), North Carolina (NC), and South Carolina (SC). The Reducing Disparities in Access to Kidney Transplantation (RaDIANT) Regional Study randomized 440 dialysis facilities in GA, NC, and SC to receive the RaDIANT Regional educational and quality intervention or standard of care in 2018. The primary outcome was a change in dialysis facility-level transplant referral within one year of dialysis start post-intervention, with secondary outcomes examining changes in evaluation start within six months of referral and waitlisting within one year of evaluation start. A process evaluation included a post-implementation survey (N=220) and semi-structured interviews of staff (N=4). Generalized linear mixed-effects models assessed intervention effectiveness overall and in race subgroups. Among the 25,586 patients with ESKD treated in 440 dialysis facilities, referral rates decreased across both intervention arms one-year post-intervention; however, a greater decrease in referrals was observed among control (11.2% to 9.2%) vs. intervention (11.2% to 10.5%) facilities. We observed no significant difference in the likelihood of referral among Black patients in intervention versus control facilities post-intervention (adjusted odds ratio [OR]: 1.12, 95% confidence interval [CI]: 0.94-1.33); however, a significant increase in referral was observed among White patients in intervention facilities post-intervention (OR: 1.24, 95% CI: 1.02-1.51). Interviews highlighted the importance of tailored interventions, federal mandates, and implementation challenges for large pragmatic trials. Post-intervention declines in referral mirror national trends; however, these declines were less for some groups receiving the intervention, warranting long-term follow-up. These findings provide important context for future modification and scale-up of multi-level, multicomponent interventions in dialysis settings.

A Review of Sensor-Based Interventions for Supporting Patient Adherence to Inhalation Therapy.

This review aims to provide a comprehensive overview of sensor technologies employed in interventions to enhance patient adherence to inhalation therapy for chronic respiratory diseases, with a particular emphasis on human factors. Sensor-based interventions offer opportunities to improve adherence through monitoring and feedback; however, a deeper understanding of how these technologies interact with patients is essential. We conducted a systematic review by searching online databases, including PubMed, Scopus, Web of Science, Science Direct, and ACM Digital Library, spanning the timeframe from January 2014 to December 2023. Our inclusion criteria focused on studies that employed sensor-based technologies to enhance patient adherence to inhalation therapy. The initial search yielded 1563 results. After a thorough screening process, we selected 37 relevant studies. These sensor-based interventions were organized within a comprehensive HFE framework, including data collection, data processing, system feedback, and system feasibility. The data collection phase comprised person-related, task-related, and physical environment-related data. Various approaches to data processing were employed, encompassing applications for assessing intervention effectiveness, monitoring patient behaviour, and identifying disease risks, while system feedback included reminders and alerts, data visualization, and persuasive features. System feasibility was evaluated based on patient acceptance, usability, and device cost considerations. Sensor-based interventions hold significant promise for improving adherence to inhalation therapy. This review highlights the necessity of an integrated "person-task-physical environment" system to advance future sensor technologies. By capturing comprehensive data on patient health, device usage patterns, and environmental conditions, this approach enables more personalized and effective adherence support. Key recommendations include standardizing data integration protocols, employing advanced algorithms for insights generation, enhancing interactive visual features for accessibility, integrating persuasive design elements to boost engagement, exploring the advantages of conversational agents, and optimizing experience to increase patient acceptance.

Quality of studies submitted for incorporation of non-pharmaceutical technologies

Introdução Hospitals employing Health Technology Assessment (HTA) methodologies to support technology incorporation decisions commonly require the presentation of clinical studies as a basis for the request for incorporation by the relevant professional or department. Various factors influence the selection of presented studies, including conflicts of interest, confirmation bias, and whether systematic methods were used in evidence retrieval. This study aims to evaluate the quality of studies presented to support the incorporation of non-pharmaceutical technologies. Métodos We conducted a review of submissions made by the clinical staff of a university hospital between 2018 and 2023. Information regarding the submitted studies, complementary searches conducted by the Health Technology Assessment Unit (HTAU), and their application in the issued recommendations were collected. The collected data were organized into tables and analyzed descriptively. Resultados A total of 36 non-pharmaceutical technologies related to incorporation were identified, including medical equipment, devices, orthoses, prostheses, and special materials. The average number of studies attached per request was 3.0 (±2.6). Sixteen submissions (44.4%) were based on controlled clinical trials (intervention) studies, with 8 systematic literature reviews (SLR) of clinical trials, 03 randomized clinical trials (RCT), 02 systematic literature reviews of diagnostic accuracy and 03 quasi-experimental studies (QE). Among the technologies that were based on experimental studies, 06 had a favorable recommendation and 10 unfavorable. Of the 20 technologies supported by observational studies, 09 contained RSL, 04 single-arm studies, 06 comparative studies and 01 case series only. Of the technologies that were based on observational studies, 10 obtained a favorable recommendation and 7 unfavorable. Discussão e conclusões According to the GRADE approach, the randomized clinical trial (RCT) is the most appropriate study design to assess intervention effectiveness, providing greater reliability and bias control. The quality of scientific evidence is a critical factor underpinning incorporation decisions. Our results indicate that, among intervention- -based technologies, only a limited number received favorable recommendations, primarily supported by high-quality RCTs or SLRs of these trials. Observational studies also played a significant role, provided they were well-conducted. However, it is important to acknowledge the higher potential for bias in these studies. Familiarity with HTA principles is essential for technology stakeholders and decision-makers to optimize the process of requesting and incorporating non-pharmaceutical technologies in the hospital context.

Nationwide analysis of air pollution hotspots across India: A spatiotemporal PM2.5 trend analysis (2008–2019)

IntroductionIndia experiences high levels of air pollution as measured by fine particulate matter <2.5 μm (PM2.5) across the country. With limited resources, it is imperative to identify the most impacted areas. We aimed to identify air pollution hotspots in India and analyze temporal trends. MethodsWe conducted a geospatial analysis using Getis-Ord Gi statistics on gridded-annual levels of PM2.5 disaggregated for every state/UT and three largest cities [Delhi, Kolkata & Mumbai] of India from 2008 to 2019. The annual average PM2.5 was derived from a validated and robust nationwide spatiotemporal model(1kmx1km). Hotspots were identified annually using Gi∗ score and p-value and temporal trends across 2 periods [T1:2008–2013 & T2:2014–2019] for each spatial unit. We classified temporal trends based on the number of occurrences of hotspots in T1 and in T2 as consistent (similar in T1 & T2), declining (decreasing in T2) and emerging (increasing in T2) hotspots. ResultsWe identified consistent hotspots in 9.9% followed by emerging hotspots in 2.6% of the country where 16% and 4.9% people live. In addition, we identified declining hotspots in 2.6% area with 3.4% of the population. Rajasthan had largest share of area identified as consistent hotspots while Uttar Pradesh had densely populated consistent hotspots. Maharashtra had both higher number of areas identified as emerging and declining hotspots. Among the largest cities, Kolkata had highest proportion of consistent hotspots. We identified 170 additional cities with either consistent or emerging hotspots beyond the non-attainment cities as defined by the National Clean Air Programme. ConclusionIndia continues to have large areas of consistent and emerging hotspots of air pollution where close to a fifth of India's population live. Identifying hotspots can inform strategic approach for targeted action in air quality management, appropriate resource allocation and a baseline for assessing intervention effectiveness and future programs and policies, including health.

A Prospective Cohort Study on Metamorphosis of Peptic Ulcer Dynamics: Insights into High Risk Paramedical Students Transformed Knowledge, Lifestyle and Symptoms Pattern

Background: This study explores the epidemiology of Peptic Ulcer Disease (PUD) among resident students in Komarapalayam, India, with the aim of increasing awareness, identifying influential lifestyle factors, and assessing intervention effectiveness. Methods: A comprehensive nine-month prospective cohort study involving 404 paramedical students aged 17-28 was rigorously conducted. Data collection included a meticulously validated questionnaire, high-risk subgroup identification, and the implementation of educational interventions. Statistical analyses maintained a significance threshold at p ≤ 0.05. Results: The study findings revealed a striking contrast. While the actual incidence of Peptic Ulcer Disease was lower than anticipated, the prevalence of prodromal symptoms was surprisingly high. This underscores the critical need for early symptom identification. Tailored educational interventions exhibited great promise in improving PUD comprehension. Lifestyle choices played a substantial role in susceptibility, with hostellers experiencing the highest PUD prevalence at 10.3%— the efficacy of symptom-based assessments extended beyond healthcare domains. Conclusion: This investigation underscores the urgency of early symptom recognition, personalized education, and proactive health-oriented choices to mitigate the onset of Peptic Ulcer Disease. It highlights the merit of symptom- based assessments and emphasizes the essential role of health education within tertiary institutions. This research catalyzes future initiatives aimed at enhancing the well-being of students in the context of Peptic Ulcer Disease.

Epidemiological Insights into Diabetes, Hypertension, and Cardiovascular Diseases: Implications for Public Health Nutrition

This review examines the epidemiological understanding of diabetes, hypertension, and cardiovascular diseases as interconnected nutritional disorders. These conditions, sharing common dietary and lifestyle risk factors, collectively represent significant global public health challenges that require integrated investigation and intervention approaches. Epidemiological approaches, including descriptive, analytical, and interventional designs, emphasizing their strengths and limitations in investigating disease prevalence, risk factors, and potential interventions. It scrutinizes the utilisation of routine population data and surveillance systems in estimating disease burden and assessing intervention effectiveness, focusing on large-scale population-based studies and national surveys. Advanced statistical analyses enhance data interpretation while accounting for demographic variables, ensuring precise comparative analyses across populations. The application of standardization techniques and robust statistical methods strengthens epidemiological findings and minimizes potential biases. A coordinated, multidisciplinary approach is essential for translating epidemiological evidence into effective public health interventions, emphasizing collaboration between epidemiologists, healthcare practitioners, and policymakers. This analysis provides insights for researchers, public health professionals, and policymakers engaged in addressing nutrition-related chronic diseases through epidemiological approaches, highlighting the field's potential to mitigate the escalating burden of these conditions while acknowledging its limitations.

Cracking the Wealth Puzzle: Investigating the Interplay of Personal Finance, Expenditure Behavior, and Financial Management

This paper investigated the wealth puzzle by examining the relationships among personal finance (PF), expenditure behavior (EB), and financial management (FM). Data from a diverse sample of 2000 individuals across regions such as Kosovo, Ghana, Kenya, Nigeria, Turkey, Pakistan, Nepal, Uganda, Cameroon, Ethiopia, India, Indonesia, Albania, Oman, and Egypt were collected through an online questionnaire from 2023 to 2024, and processed through exploratory and confirmatory factor analyses using AMOS and SPSS programs. Results revealed the robust relationships among PF, EB, and FM, indicating their resilience and strong internal consistency, and underscoring their pivotal role in shaping individuals’ financial stability and well-being. Notably, EB emerged as a crucial determinant, highlighting the importance of aligning spending habits with family priorities, moderating excesses, and consistently reviewing for improvements. Moreover, critical variables within PF and FM underscored the necessity for strategic financial planning, efficient spending optimization, and the cultivation of resilience against unforeseen financial obstacles. This research has significantly advanced the understanding of wealth dynamics and provided practical insights for policymakers and educators to design targeted financial education initiatives that can improve financial well-being and long-term prosperity. Future research should concentrate on understanding underlying mechanisms and assessing intervention effectiveness across more variables and countries.

Dementia and Cognitive Decline: A HEALM Approach.

Dementia and cognitive decline pose significant global public health challenges, with prevalence expected to rise in the coming decades. Lifestyle medicine offers a promising approach to mitigating cognitive issues through six key interventions: diet, physical activity, restorative sleep, social connections, stress management, and avoiding risky substances. Traditional methods like randomized controlled trials (RCTs) have limitations in capturing the long-term impacts of these interventions. To overcome these challenges, the American College of Lifestyle Medicine (ACLM) and the True Health Initiative (THI) developed the Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM) framework, informed by the Evidence Threshold Pathway Mapping (ETPM) approach. This framework integrates diverse evidence sources to assess intervention effects over time. Applying HEALM, this review evaluates lifestyle factors' impact on dementia and cognitive decline. It finds strong evidence supporting plant-based nutrition, physical activity, restorative sleep, and avoiding risky substances in promoting cognitive health. Social connections may mitigate cognitive decline, while stress management requires further investigation due to inconclusive findings. Integrating these findings into public health strategies could effectively address the growing dementia burden and enhance overall well-being in aging populations, underscoring the need for continued research in cognitive health.

The Role of a Biothesiometer in Early Detection and Management of Diabetic Neuropathy.

Diabetic foot ulcers (DFUs)have become a common and serious outcome of diabetes mellitus (DM). Diabetic peripheral neuropathy (DPN) is often underdiagnosed, which impairs the capacity to prevent foot ulceration. The clinical manifestations typically include sensory complaints, which leavepatients vulnerable to increased risk of injury without their awareness. The current study aims to assess the viability of VPT (vibration perception threshold) testing using a biothesiometer as an early diagnostic tool for detecting diabetic neuropathy and reducing the burden of diabetic foot disease. This prospective study was conducted in Dr. D. Y. Patil Medical College, Pimpri, Pune from August 2022 to July 2024 among 50 patients with DFUs. Ethical approval was taken from the Institutional Ethical Committee. An informed consent was obtained from all the study participants. VPT testing using a biothesiometer was done to assess the neurological status of the patient's limbs. A significant difference between the symptomatic and asymptomatic cases was also calculated to evaluate the co-relation of symptoms compared to VPT. The largest age group among those surveyed is 41-50 with a mean age of 50.72. Males form a slightly larger proportionthan females. A total of 22 (44%) ulcers are present over the plantar aspect of the foot. Out of the entire study, 37 (74%)individuals reported Grade II or III neuropathy, and 29 (58%)individuals reported no symptoms of diabetic neuropathy. The majority portion ofindividuals in the study had an HbA1c ranging from 6.5% to 8%. After an intervention, 44 (88%) patients did not experience a change in their VPT grading after six months. The chi-square test results suggest that the onset period of diabetes in years or the type of treatment history for diabetes does not significantly influence VPT grading among the surveyed individuals. However, individuals with higher HbA1c levels tend to exhibit more severe VPT impairments. Regular monitoring of VPT grading is crucial for early diagnosis of neuropathy, tracking disease progression, and assessing intervention effectiveness. Hence, we recommend all diabetic patientsregularly undergo biothesiometry as part of their routine diabetic check-ups to help prevent disease progressionand complications like amputations and improve their overall quality of life.

Effectiveness of Providing Cash Incentives and Training To Community Health Workers on Active Case Finding for Tuberculosis In Nigeria: A Cluster-Randomized Control Trial

Background Case detection for Tuberculosis remains low in high-burden communities. Community Health Workers (CHWs) are the first point of contact for many rural Nigerians and have been useful in active case finding. This study assessed the effectiveness of cash incentives and training on tuberculosis case detection by CHWs in six Local Government Areas in Nigeria. Materials and Methods A cluster randomized control trial with three arms was conducted. Arm A received cash incentives and training, Arm B received only training, and the control arm (C) received neither. CHWs already working in the communities participated. TB case notification and number of community outreaches held were used to assess intervention effects. Data were analyzed using STATA (v.13) and GraphPad Prism (v.8). Effect sizes were calculated using odds ratios and 95% confidence intervals. Associations were tested using Chi-square (χ²) tests, with significance set at P=0.05. Results Arm A had a 14.4% increase in case notification, Arm B showed a 7.4% increase, and the control arm showed a 39.7% increase from the previous year. Arms A and B had lower odds of TB case notification post-intervention, compared to the control (OR = 0.819 and 0.769, respectively), with no significant difference between them. Arm A also saw a 144.8% increase in community outreaches, compared to 46.7% in Arm B and 22.7% in Control Arm C. Arms A and B had higher odds of carrying out community outreaches post-intervention compared to the control (OR = 1.995 and 1.195, respectively), but no significant differences were found between the groups regarding community outreach. Conclusion While the interventions resulted in an increased number of community outreaches compared to the control, case notification improved more in the control arm than in the intervention arms. Nevertheless, the findings highlight the potential of combining cash incentives with training to improve TB control efforts at the community level. Further exploration of the implementation process may shed light on the observed outcomes and guide future intervention strategies.

Neck muscle vibration and prism adaptation fail to improve balance disturbances after stroke: A multicentre randomised controlled study

BackgroundPilot studies suggest potential effects of neck muscle vibration (NMV) and prism adaptation (PA) on postural balance disturbances related to spatial cognition. ObjectivesTo evaluate the effect of 10 sessions of NMV and/or PA on ML deviation. We used the mediolateral centre of pressure position (ML deviation) as a biomarker for spatial cognition perturbation, hypothesising that PA and NMV would improve ML deviation, with a potential synergistic impact when used together. MethodsWe conducted a multicentre, single-blind, randomised controlled study. Participants within 9 months of a right-hemisphere supratentorial stroke and with less than 40% body weight supported on the paretic side in standing were randomised into 4 groups (PA, NMV, PA+NMV, or control). Primary outcomeML deviation at Day 14. Secondary outcomes: force platform data, balance abilities, autonomy, and ML deviation, measured just after the first session (Day 1), at Day 90, and Day 180. A generalised linear mixed model (GLMM) assessed intervention effects on these outcomes, adjusting for initial ML deviation and incorporating other relevant factors. Results89 participants were randomised and data from 80 participants, mean (SD) age 59.2 (10.2) years, mean time since stroke 94 (61) days were analysed. At Day 14, a weak time x group interaction (P = .001, omega-squared = 0.08) was found, with no significant between-group differences in ML deviation (P = .12) or in secondary outcomes (P = .08). Between-group differences were found on Day 1 (P = .03), Day 90 (P = .001) and Day 180 (P < .0001) regardless of age and stroke-related data. On Day 1, ML deviation improved in both the PA and NMV groups (P = .03 and P = .01). In contrast, ML deviation deteriorated in the NMV+PA group on Day 90 and Day 180 (P = .01 and P = .01). ConclusionsThe study found no evidence of any beneficial effects of repeated unimodal or combined sessions of NMV and/or PA on ML deviation after stroke. Trial registrationClinicalTrials.gov identifier NCT01677091

Pharmacist-led primary care interventions to promote medicines optimisation and reduce overprescribing: a systematic review of UK studies and initiatives

ObjectivesTo systematically review and synthesise evidence on the effectiveness and implementation barriers/facilitators of pharmacist-led interventions to promote medicines optimisation and reduce overprescribing in UK primary care.DesignSystematic review.SettingUK primary care.MethodsWe searched...

Academic and Behavioral Strategies in Inclusive Settings for Students With EBD: A Meta Analysis

More students with emotional and behavioral disorders (EBD) than ever before spend most of their time in general education. To increase their academic and behavioral success, students with EBD need access to empirically supported interventions and services. The purpose of this systematic review and meta-analysis was to evaluate strategy effectiveness for students with EBD in K–12 inclusive settings. Identified studies were assessed with two approaches for evaluating methodological quality and multiple methods for assessing intervention effects. Results indicated that there is a dearth of empirical support for strategies implemented in general education classrooms for students with EBD though most of the studied reviewed were of high quality with moderate-to-large effects. In addition to the practical findings, the research team compared review methods with findings indicating agreement between expert visual analysis and more structured approaches for visual analysis. For the quantitative metrics, results indicated variable agreement across methods. Implications for research and practice are discussed.

Learning health system research as a catalyst for promoting physician wellness: EHR InBasket Spring cleaning and team-based compassion practice.

Addressing physician burnout is critical for healthcare systems. As electronic health record (EHR) workload and teamwork have been identified as major contributing factors to physician well-being, we aimed to mitigate burnout through EHR-based interventions and a compassion team practice (CTP), targeting EHR workload and team cohesion. A modified stepped wedge-clustered randomized trial was conducted, involving specialties with heavy InBasket workloads. EHR interventions included quick-action shortcuts and recommended practice for secure chats. The CTP comprised 30-s practice between physicians and their dyad partners. Survey and EHR data were collected over four assessment periods. Linear and generalized mixed-effects models assessed intervention effects, accounting for covariates. Forty-four physicians participated (20% participation rate). While burnout prevalence decreased from 58.5% at baseline to 50.0% at the end of the study, burnout reduction was not statistically significant after EHR (OR 0.43, 95% CI 0.12 to 1.61, p = 0.21) or EHR + CTP (OR 0.60, 95% CI 0.17 to 2.10, p = 0.42) interventions. Statistically significant greater perceived ease of EHR work resulted from both the EHR intervention (coefficient 0.76, 95% CI 0.22 to 1.29, p = 0.01) and EHR + CTP intervention (coefficient 0.80, 95% CI 0.26 to 1.35, p < 0.01). EHR + CTP increased perceived workplace supportiveness (coefficient 0.61, 95% CI -0.04 to 1.26, p = 0.07). Total number of InBasket messages/week increased significantly after EHR interventions (coefficient = 27.4, 95% CI 6.69 to 48.1, p = 0.011) and increased after EHR + CTP (18.5, 95% CI -3.15 to 40.2, p = 0.097). While burnout reduction was not statistically significant, EHR interventions positively impacted workload perceptions. CTP showed potential for improving perceived workplace supportiveness. Further research is needed to explore the efficacy of CTP with more participants. The interventions gained interest beyond our institution and prompted consideration for broader implementation.

Applying enhanced recovery principles to emergency laparotomy in penetrating abdominal trauma: a case-matched study.

The implementation of enhanced recovery after surgery programs (ERPs) has significantly improved outcomes within various surgical specialties. However, the suitability of ERPs in trauma surgery remains unclear. This study aimed to (1) design and implement an ERP for trauma laparotomy patients; (2) assess its safety, feasibility, and efficacy; and (3) compare the outcomes of the proposed ERP with conventional practices. This case-matched study prospectively enrolled hemodynamically stable patients undergoing emergency laparotomy after penetrating trauma. Patients receiving the proposed ERP were compared to historical controls who had received conventional treatment from two to eight years prior to protocol implementation. Cases were matched for age, sex, injury mechanism, extra-abdominal injuries, and trauma scores. Assessment of intervention effects were modelled using regression analysis for outcome measures, including length of hospital stay (LOS), postoperative complications, and functional recovery parameters. Thirty-six consecutive patients were enrolled in the proposed ERP and matched to their 36 historical counterparts, totaling 72 participants. A statistically significant decrease in LOS, representing a 39% improvement in average LOS was observed. There was no difference in the incidence of postoperative complications. Opioid consumption was considerably lower in the ERP group (p < 0.010). Time to resumption of oral liquid and solid intake, as well as to the removal of nasogastric tubes, urinary catheters, and abdominal drains was significantly earlier among ERP patients (p < 0.001). The implementation of a standardized ERP for the perioperative care of penetrating abdominal trauma patients yielded a significant reduction in LOS without increasing postoperative complications. These findings demonstrate that ERPs principles can be safely applied to selected trauma patients.

Modeling approaches for assessing device-based measures of energy expenditure in school-based studies of body weight status

BackgroundObesity has become an important threat to children’s health, with physical and psychological impacts that extend into adulthood. Limited physical activity and sedentary behavior are associated with increased obesity risk. Because children spend approximately 6 h each day in school, researchers increasingly study how obesity is influenced by school-day physical activity and energy expenditure (EE) patterns among school-aged children by using wearable devices that collect data at frequent intervals and generate complex, high-dimensional data. Although clinicians typically define obesity in children as having an age-and sex-adjusted body mass index (BMI) value in the high percentiles, the relationships between school-based physical activity interventions and BMI are analyzed using traditional linear regression models, which are designed to assess the effects of interventions among children with average BMI, limiting insight regarding the effects of interventions among children categorized as overweight or obese.MethodsWe investigate the association between wearable device–based EE measures and age-and sex-adjusted BMI values in data from a cluster-randomized, school-based study. We express and analyze EE levels as both a scalar-valued variable and as a continuous, high-dimensional, functional predictor variable. We investigate the relationship between school-day EE (SDEE) and BMI using four models: a linear mixed-effects model (LMEM), a quantile mixed-effects model (QMEM), a functional mixed-effects model (FMEM), and a functional quantile mixed-effects model (FQMEM). The LMEM and QMEM include SDEE as a summary measure, whereas the FMEM and FQMEM allow for the modeling of SDEE as a high-dimensional covariate. The FMEM and FQMEM allow the influence of the time of day at which physical activity is performed to be assessed, which is not possible using the LMEM or the QMEM. The FMEM assesses how frequently collected SDEE data influences mean BMI, whereas the FQMEM assesses the effects on quantile levels of BMI.ResultsThe LMEM and QMEM detected a statistically significant effect of overall mean SDEE on log (BMI) (the natural logarithm of BMI) after adjusting for intervention, age, race, and sex. The FMEM and FQMEM provided evidence for statistically significant associations between SDEE and log (BMI) for only a short time interval. Being a boy or being assigned a stand-biased desk is associated with a lower log (BMI) than being a girl or being assigned a traditional desk. Across our models, age was not a statistically significant covariate, and white students had significantly lower log (BMI) than non-white students in quantile models, but this significant effect was observed for only the 10th and 50th quantile levels of BMI. The functional regression models allow for additional interpretations of the influence of EE patterns on age-and sex-adjusted BMI, whereas the quantile regression models enable the influence of EE patterns to be assessed across the entire BMI distribution.ConclusionThe FQMEM is recommended when interest lies in assessing how device-monitored SDEE patterns affect children of all body types, as this model is robust and able to assess intervention effects across the full BMI distribution. However, the sample size must be sufficiently large to adequately power determinations of covariate effects across the entire BMI distribution, including the tails.