Best-practice Interventions Research Articles

Prevention of falls: applying AACN's healthy work environment standards to a fall campaign.

Efforts leading to the reduction and elimination of falls within acute and long-term clinical care settings are one of the top priorities of health care organizations nationwide. Falls often lead to serious life-threatening conditions and long-term consequences for our patients, their families, and health systems, while also contributing to astonishing costs for health care facilities. In 2010, the direct medical cost related to falls (adjusted for inflation) was $30 billion, and by the year 2020, the annual direct cost related to falls is expected to be near $54.9 billion. 1 With the 2008 change in payment rule by the Centers for Medicare and Medicaid Services (CMS), hospitals no longer receive payment for costs required to treating injuries that are acquired during hospitalizations as a result of falling. 2 The latest recommendations from the guidelines for prevention of falls from the Institute of Clinical Systems Improvement (ICSI) provide health care organizations with evidence-based, best-practice interventions for the implementation of a successful program to reduce the number of falls. 3 Our unit-based team used many of the interventions and practices identified within the guidelines. Second, by committing and applying the American Association of Critical-Care Nurses (AACN) healthy work environments standards, our team developed and implemented a unified approach in our strategy to reduce and eliminate falls within our progressive care unit (PCU).

SY03-2-6 * WHO-ISAM FELLOWSHIP TREATMENTS IN ASIA AND PHENOMENOLOGICAL ANALYSIS OF THE LIVED EXPERIENCE OF RECOVERING GAMBLERS IN MALAYSIA

The development of intervention and prevention programs for gambling disorder among Asian populations is constantly evolving. This symposium will highlight current best practices for treatment among Asian gamblers (Raylu, Loo & Oei, 2013) and provide a platform for further development and assessment of treatment effectiveness in Malaysian samples. Recent prevalence research in Malaysia highlighted that 4.4% of Malaysians were identified to be problem gamblers (Loo & Ang, 2013). As research on gambling addiction in Malaysia is still at its infancy, this symposium will employ a mixed methods approach in understanding the factors implicated in the recovery process. Results of the analyses will provide an understanding of the lived experience of recovering Malaysian gamblers (Choong, Loo & Ng, 2014) and examine factors that predict problem gambling among this sample. Implications and suggestions for research among Asian problem gamblers and more specifically among Malaysian problem gamblers will be discussed. References . Raylu, N., Loo, J. M. Y., & Oei, T. P. S. (2013). Treatment of gambling problems in Asia: Comprehensive review and implications for Asian problem gamblers. Journal of Cognitive Psychotherapy, 27 (3), 297–322. Research funded by the Malaysian Health Promotion Board and conducted as part of the initiative of the National Committee on Problem Gambling, Malaysia. Research collaborator: Dr. Ang Kim Teng from the Malaysian Mental Health Association. a. Loo, J. M. Y., & Ang, K. T. (2013). Prevalence of problem gambling in Selangor urban areas. Kuala Lumpur: Monash University & Malaysian Mental Health Association. Choong, L. L., Loo, J. M. Y., & Ng, W. S. (2014). The experience of recovering gamblers in Malaysia: A phenomenological study. Asian Journal of Gambling Issues and Public Health (Special issue: Impacts of problem gambling on families and significant others), 4 (1). doi: 10.1186/2195-3007-4-1

SY26-2 * TREATMENTS IN ASIA AND PHENOMENOLOGICAL ANALYSIS OF THE LIVED EXPERIENCE OF RECOVERING GAMBLERS IN MALAYSIA

The development of intervention and prevention programs for gambling disorder among Asian populations is constantly evolving. This symposium will highlight current best practices for treatment among Asian gamblers (Raylu, Loo & Oei, 2013) and provide a platform for further development and assessment of treatment effectiveness in Malaysian samples. Recent prevalence research in Malaysia highlighted that 4.4% of Malaysians were identified to be problem gamblers (Loo & Ang, 2013). As research on gambling addiction in Malaysia is still developing, this symposium will employ a mixed methods approach in understanding the factors implicated in the recovery process. Results of the analyses will provide an understanding of the lived experience of recovering Malaysian gamblers (Choong, Loo & Ng, 2014) and examine factors that predict problem gambling among this sample. Implications and suggestions for research among Asian problem gamblers and more specifically among Malaysian problem gamblers will be discussed.

A national multidisciplinary healthcare network for treatment of hepatitis C in people who inject drugs in Slovenia.

A national multidisciplinary healthcare network for treatment of hepatitis C in people who inject drugs in Slovenia.

The challenge of change – improving services for women involved in prostitution and substance use

Purpose – Against Violence & Abuse (AVA) and DrugScope undertook research into good practice interventions for supporting women involved in street-based prostitution and substance use. The purpose of this paper is to report on the findings of a survey of service providers and interviews with both service users and providers about women's involvement in prostitution and substance use, their associated support needs and how these can be met by services. Design/methodology/approach – As part of a mixed methods study, this paper focuses on the findings of interviews with 19 women involved in prostitution and of a survey of and interviews with 64 services that support women involved in prostitution. Findings – Generic substance misuse services are more likely to associate women's involvement in prostitution with funding their own or their partner's substance use. By comparison, specialist sex work projects are more likely to report women using substances to manage the emotional and physical pain of selling sex. These beliefs impact on the interventions delivered, with specialist services offering a more diverse package of care than generic services. Research limitations/implications – This study covered predominantly two English regions. A more systematic study of service provision across the UK would be welcomed and could be used to inform guidance for national and local policymakers. Originality/value – This paper adds to the existing evidence base of “what works” in supporting women involved in prostitution. It is novel in its focus on women involved in prostitution who also use substances and in offering a detailed picture of the types of support currently available in England.

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

Pneumonia is the eighth leading cause of death in Canada. Use of guideline-concordant therapy tempers the development of resistance, decreases health care costs, and reduces morbidity and mortality. The purpose of this study was to optimize the treatment of patients with pneumonia under hospitalist care by focusing on best practice and local antibiogram data. The objectives were to collaborate with a hospitalist representative to optimize in-hospital treatment of patients with community-acquired, hospital-acquired, and health care-associated pneumonia; to complete a baseline audit to determine the proportion of antibiotic orders adhering to the strategy; to present the strategy and baseline audit findings to the hospitalists; to perform a post-intervention audit, with comparison to baseline, and to present results to the hospitalists; to expedite de-escalation to a narrower-spectrum antibiotic; to expedite parenteral-to-oral step-down therapy and promote appropriate duration of therapy; and to determine if a pneumonia scoring system was used. An audit and feedback intervention focusing on pre- and post-intervention retrospective chart audits was completed. Review of pneumonia guidelines and the local antibiogram assisted in identifying the study strategy. A presentation to the hospitalists outlined antimicrobial stewardship principles and described the findings of the baseline audit. Pre- and post-intervention audit results were compared. Local best-practice treatment algorithms were developed for community-acquired pneumonia and for hospital-acquired and health care-associated pneumonia. The pre-intervention audit covered the period December 2011 to January 2012, with subsequent education and audit results presented to the hospitalists in November 2012. The post-intervention audit covered the period December 2012 to January 2013. Adherence to the treatment algorithms increased from 10% (2/21) in the pre-intervention audit to 38% (5/13) in the post-intervention audit. There was a trend to reduced duration of therapy in the post-intervention group. An audit and feedback intervention related to hospitalists' prescribing for pneumonia increased adherence to local best practice.

Who qualifies for deep brain stimulation for OCD? Data from a naturalistic clinical sample.

A few patients with obsessive-compulsive disorder (OCD) remain severely impaired despite exhausting best-practice treatments. For them, neurosurgery (stereotactic ablation or deep brain stimulation) might be considered. The authors investigated the proportion of treatment-seeking OCD patients, in a naturalistic clinical sample, who met contemporary neurosurgery selection criteria. Using comprehensive baseline data on diagnosis, severity, and treatment history for adult patients from the NIMH-supported Brown Longitudinal OCD Study, only 2 of 325 patients met screening criteria for neurosurgery. This finding prompts consideration of new models for clinical trials with limited samples as well as methods of refining entry criteria for such invasive treatments.

Educational interventions to raise men's awareness of bladder and bowel health

Urinary incontinence is a common health problem that carries with it a significant burden. Nearly twice as many men suffer from this problem than women, and studies have demonstrated that help-seeking behavior is more challenging for men. This information sheet is based on a systematic review and focuses on the best-available evidence regarding educational interventions to raise men's awareness of bladder and bowel health. It also provides recommendations for practice.

Health information technology and its impact on the quality and cost of healthcare delivery

The impact of health information technologies (HIT) on the quality of healthcare delivery is a topic of significant importance and recent research has yielded mixed evidence. We use archival data on HIT usage in combination with data on quality of care processes to conduct a three-year longitudinal study of a large panel of U.S. hospitals. Our analysis extends earlier research on the association between HIT and healthcare quality among healthcare providers that have previously focused on outcomes associated with cost reduction. We study the impact of HIT applications, not only on hospital operating expenses, but also on the process quality associated with evidence-based measures for treatment of four major health conditions. Our results indicate a positive association between usage of clinical information systems and patient scheduling applications and conformance with best practices for treatment of heart attacks, heart failures, and pneumonia. Our results also suggest that usage of financial management systems is associated with lower hospital operating expenses. Furthermore, we find that not-for-profits and urban hospitals are more likely to exhibit greater conformance with process quality metrics, while for-profits exhibit lower operational expenses. Our results have important policy implications for investments in health IT and studying their cost and quality implications.

Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria

BackgroundMalaria in pregnancy (MIP) is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives.MethodsThe study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses) providing ante-natal care (ANC) services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP). The data was collected from May to June 2010.ResultsNot many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p < 0.05). It was found that 50 % of private sector providers and 25 % of public sector providers prescribed chemoprophylaxis using pyrimethamine, chloroquine and proguanil to pregnant women.ConclusionsThere is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers’ knowledge and practices with regards to management of MIP.

Best practices for treatment of retinal vein occlusion

Retinal vein occlusion (RVO) is a sight-threatening retinal vascular disorder associated with macular edema and neovascularization. Until recently, the standard of care for branch RVO-associated macular edema was grid laser photocoagulation and observation for central RVO-associated macular edema. Neovascularization was treated with scatter laser photocoagulation. The purpose of this article is to review recent findings that have changed our treatments of RVO. The recent development of intravitreal pharmacotherapy has demonstrated benefit with anti-vascular endothelial growth factor (VEGF) agents and corticosteroids for the treatment of RVO-associated macular edema. The intravitreal use of FDA-approved ranibizumab (Lucentis) and a sustained release dexamethasone implant (Ozurdex), along with off-label bevacizumab (Avastin) and preservative-free triamcinolone, has significantly expanded our treatment options and replaced standard of care for treatment of RVO-associated macular edema. Whereas anti-VEGF agents can also induce rapid regression of neovascularization, scatter laser photocoagulation remains the standard of care to prevent neovascular complications. Intravitreal pharmacotherapy has revolutionized our treatment of retinal vascular diseases, including RVO. Although these intravitreal agents are effective, our understanding of their specific indications and long-term roles is still evolving. Furthermore, until the underlying occlusive pathophysiology of RVO can be addressed, our treatments will be limited to temporizing therapies against a chronic disease.

The Health Literacy of Adults With Severe Mental Illness

The Health Literacy of Adults With Severe Mental Illness

Resolving the Human Remains Crisis in British Archaeology: A reply

General confusion concerning the proper treatment of human remains of archaeological significance prompted the Church of England and English Heritage to co-ordinate a working group which produced a document called ‘Guidance for best practice for treatment of human remains excavated from Christian burial grounds in England’, published in 2005. This established best practice for dealing within the current secular and ecclesiastical legislation with Christian burials, but also with wider application. It also led to the eventual formation of the Advisory Panel on the Archaeology of Burials in England (APABE, see http://www.britarch.ac.uk/ apabe/). At this time the Home Office (later the Ministry of Justice) was working on revision of the secular legislation. During this process, concerns were raised that the current system of granting licences might not be lawful, and in 2008 an interim system was introduced whereby licences could be granted to archaeologists to hold human remains for two years, which could then be renewed on application. It was intended that these two years would allow time for the legislation to be amended. There is no doubt that this interim arrangement caused a certain amount of confusion and disquiet, with some people referring erroneously to a “Burial Act 2008”. No such piece of legislation exists. However, this planned legislative overhaul was dropped by the government in 2010, causing more concern among archaeologists. Following pressure from various organisations including EH, the IFA, ALGAO and APABE, the Ministry of Justice introduced a new licencing system in the summer of 2011, which allowed for the retention of human remains by archaeologists, putting the responsibility for justification and control for such retention on the local authority. This is a good resolution, which archaeologists should be happy to support.1

Management of heart conditions in older rural and urban Australian women

Cardiovascular disease death rates are higher among Australians from regional and remote areas than those from major cities. To investigate the causes of excess mortality from heart disease in rural compared to urban Australian women aged over 75 years. In 2004, 944 older urban and rural participants in the Australian Longitudinal Study on Women's Health aged 77-83 years with self-reported ischaemic heart disease (IHD), heart failure or atrial fibrillation took part in a nested cross-sectional substudy. We used clinical guidelines to determine key management issues for these conditions. Using logistic regression we calculated odds ratios (OR) and 95% confidence intervals (CI) to assess the relationship between management and area of residence. These older Australian women often did not receive recommended management for their heart conditions. Only 30% reported having had an echocardiogram. Reported use of statins and beta-blockers was low among women with IHD (58% and 41% respectively) and only 32% of women reporting heart failure were taking angiotensin-converting enzyme inhibitors. Women from regional/remote areas had greater odds of reporting never having seen a cardiologist (OR = 3.88, 95% CI 1.72-8.72) and never having had an echocardiogram than women from major cities (OR = 2.86, 95% CI 1.42-5.75). Medication use was similar for rural and urban women. Our results suggest that best-practice treatments for heart conditions are suboptimally provided to older women. In addition, they suggest differential use of some health services, which might help explain higher cardiovascular mortality among rural compared with urban women.

A 9-year infection-control surveillance program in Sydney-based residential aged-care facilities

There are very limited Australian data on the incidence of infections in the residential aged-care setting. The objective of this study was to undertake a program of surveillance to establish a baseline rate of infection within the high-care residential facilities of the Columbia Aged Care Services Group in Sydney, Australia. Further, this baseline rate would be used as a benchmark to prompt subsequent process monitoring for infection control with the aim of decreasing infection rates. Data were collected using a surveillance form compliant with the internationally recognised McGeer (1991) definitions for infection surveillance in long-term care facilities. The data were initially collected across five facilities from March 2001 to December 2005 and the data were reviewed during this period. The audit continued from January 2006 to December 2009 to monitor the success of ongoing surveillance and best-practice interventions. The rate of infection calculated over the first 5-year period established the baseline at 3.1 infections per 1000 occupied-bed days (95% CI, 3.0–3.3). For respiratory infections and for all facilities, a monthly seasonal trend was detected using time series analysis, with the majority of infections occurring during the months of May to September and peaking in July. After intervention, the July peak diminished during the second period, although it still exceeded the baseline rate. Infection rates were relatively constant over time for most facilities throughout the surveillance period. Control chart analysis identified several spikes in infection rates that were recorded as a result of outbreaks. This comprehensive long-term surveillance programhas provided a valuable baseline rate of infection for comparison. It has also facilitated a proactive approach to infection prevention and control, such that problem areas and ‘high-risk’ periods can now be identified and managed. The application of this approach should be considered in other high-care residential settings – perhaps nationally, given the absence of uniform systematic surveillance systems in any Australian state or territory. However, there is a need to reviewand validate the 20-year-old American definitions of McGeer et al . for the contemporary Australian context.

Bridging the Gap between Family-Based Treatment and Family-Based Research in Childhood Obesity.

The treatment of pediatric obesity has been greatly informed by research as well as by expert opinion.1 The challenge remains to discover novel treatment approaches and translate these findings into clinical care. As with compassionate use of therapeutics in oncology, there is an urgent need to provide best-practice treatment to the millions of children presently struggling with obesity, particularly at the most advanced stages.2 In 2007, Wake Forest University School of Medicine and Brenner Children's Hospital founded Brenner FIT (Families In Training), a multidisciplinary, family-based pediatric weight management program. From the outset, Brenner FIT integrated quality healthcare principles into program development activities. From this, three innovative programs have been developed. In a somewhat reverse direction of traditional translational research, these three successful clinical programs have informed a larger research initiative and have led to the establishment of a unique and promising research center.

Behavioral Health Conditions Among Military Personnel and Veterans: Prevalence and Best Practices for Treatment

The Department of Defense and the Department of Veterans Affairs place a high priority on behavioral health assessment, treatment, and research. We present the national and regional prevalence of the most-common behavioral health problems experienced by Operation Enduring Freedom and Operation Iraqi Freedom veterans and offer resources for best practices for treatment.

Best practice interventions: Short-term impact and long-term outcomes

This paper uses empirical field research to examine whether short-term best practice interventions (BPIs) can lead to improvements that are sustained in the long term. In addition, this research investigates the implied conflict between striving for short-term results and achieving long-term development of capabilities. It also examines the tension between the lack of resources of the typical small and medium sized enterprise (SME) users of BPIs and the time required to develop a critical mass of capability. A longitudinal case-based study of eight SME contexts examined BPI outcomes and factors leading to short- and long-term success and sustaining best practices. The research identifies factors related to the intervention context, implementation and change-agent approach. The data indicate that in resource-limited SMEs BPIs are limited in their ability to develop adequate capability for long-term change.

Borderline Personality Disorder, PTSD, and Suicide

Borderline Personality Disorder, PTSD, and Suicide

Best practice for prevention and treatment of cardiovascular disease through an equity lens: a review

Despite declining rates of cardiovascular disease (CVD) mortality in developed countries, lower socioeconomic groups continue to experience a greater burden of the disease. There are now many evidence-based treatments and prevention strategies for the management of CVD and it is essential that their impact on the more disadvantaged group is understood if socioeconomic inequalities in CVD are to be reduced. To determine whether key interventions for CVD prevention and treatment are effective among lower socioeconomic groups, to describe barriers to their effectiveness and the potential or actual impact of these interventions on the socioeconomic gradient in CVD. Interventions were selected from four stages of the CVD continuum. These included smoking reduction strategies, absolute risk assessment, cardiac rehabilitation, secondary prevention medications, and heart failure self-management programmes. Electronic searches were conducted using terms for each intervention combined with terms for socioeconomic status (SES). Only limited evidence was found for the effectiveness of the selected interventions among lower SES groups and there was little exploration of socioeconomic-related barriers to their uptake. Some broad themes and key messages were identified. In the majority of findings examined, it was clear that the underlying material, social and environmental factors associated with disadvantage are a significant barrier to the effectiveness of interventions. Opportunities to reduce socioeconomic inequalities occur at all stages of the CVD continuum. Despite this, current treatment and prevention strategies may be contributing to the widening socioeconomic-CVD gradient. Further research into the impact of best-practice interventions for CVD upon lower SES groups is required.