Common Intervention Research Articles

QOL-03. CAREGIVER PROGRAM IN NEURO-ONCOLOGY: UCSF EXPERIENCE CARING FOR MORE THAN 4,000 CAREGIVERS OVER THE LAST 10 YEARS

Abstract BACKGROUND Caregivers of patients with primary brain tumors are at high risk for distress as they navigate caring for their loved one with both a cancer diagnosis and neurologic disorder. The UCSF Gordon Murray Neuro-Oncology Program, the first of its kind, addresses caregiver needs and is fully integrated into clinical care, providing personalized care and programming to address common challenges and foster resilience. The Program includes a nurse, administrator, and social worker. Referrals occur at the initial clinic appointment; from clinical staff; and caregivers of patients with GBM receive proactive outreach. Dedicated programming provides educational materials around common concerns and building community through support groups, annual retreats and family camp. We report our practical experience of the Program serving over 4,000 caregivers. METHODS Total number of individual caregivers were included from 01/2014 – 12/2023. Detailed demographics were extrapolated during clinical interviews from a subset. Caregiver concerns and interventions were extracted from the medical records between 01/2017 – 12/2023. RESULTS The Program serves an average of 400 caregivers and 800 encounters annually. Demographics revealed 66% females; 77% between 41-64 years of age; 60% spouse; 89% working full time; and 30% with children at home. The most common concerns were informational (42%), followed by emotional (25%), and practical (23%). Examples of informational concerns included desire for resources, understanding treatment plan/side effects, and patient behavioral changes. Emotionally, they feel overwhelmed, uncertain, and sad. Practical concerns included physically caring for patients and issues around medical insurance, disability, and finances. Most common intervention was providing emotional support (40%). CONCLUSIONS Caregivers of patients with primary brain tumors are at high risk of distress and have unique needs. Our practical 10 year experience of a dedicated, fully integrated, caregiver program highlights real world concerns of caregivers and identifies opportunities to develop tailored interventions to address these needs.

A stepped wedge randomised controlled trial assessing the efficacy and patient acceptability of virtual clinical pharmacy in rural and remote Australian hospitals

Abstract Background Despite medication being the most common healthcare intervention and medication-related incidents being common in hospitals, many rural and remote hospitals in Australia lack onsite pharmacy services due to resource constraints. A Virtual Clinical Pharmacy Service (VCPS) staffed by two senior, rural generalist hospital pharmacists assigned to four hospitals each was implemented in rural and remote facilities to determine whether the VCPS increased adherence to National Safety and Quality Health Service Standards (NSQHS). Methods A stepped-wedge randomised controlled trial was employed to sequentially implement a telehealth pharmacy service at one-month intervals in eight hospitals. The primary outcomes were patient-level medication reconciliation completion rates on admission and discharge. Secondary measures evaluated compliance with other NSQHS standards (including Best Possible Medication History, Medication Reconciliation and venous thromboembolism risk assessment), patient outcomes (including representation within 48 h, readmission within 28 days and length of stay), and detection of potential medication-related harms (including pharmacist identified medication related problems, reported medication errors and falls). Patients were invited to complete a patient-reported experience questionnaire. Data were collected from electronic medical records and analysed using mixed logistic regression models to estimate the effectiveness of the VCPS. Antimicrobial usage, falls, and medication errors were analysed at the facility level, while other data were analysed at the patient level. Results Compared to control (n = 535), patients in the intervention period (n = 527) were more likely to have an admission medication reconciliation completed (Odds Ratio (OR) 11.16, 95% confidence interval (CI) 5.59–22.30, p < 0.001) in models adjusted for the study period. A similar improvement was observed for discharge medication reconciliation completion (OR 4.07, CI 2.38–6.95, p < 0.001), whereas a 33-fold improvement was seen in Best Possible Medication History completion (OR 33.27, CI 17.53–63.14, p < 0.001). The VCPS documented 879 medication related problems, with 61% of patients having at least one medication-related problem documented by a pharmacist. There was no change in length of stay, falls, readmission rates or reported medication error rates; however, the study was not powered to detect these changes. Patient feedback was positive and comparable to in-person care, with 95% (179/189) reporting their overall experience as ‘good’ or ‘very good.’ No unintended harms were reported. Conclusions The VCPS improved compliance with national standards for medication safety, had high patient acceptability and resulted in the detection of clinically relevant medication-related issues in rural and remote settings. The applicability of virtual pharmacy should be explored in further rural and remote locations in addition to other settings such as metropolitan locations with no onsite clinical pharmacists. Ethics number GWHREC 2019/ETH13355. Trial registration ANZCTR registration number ACTRN12619001757101. Registered on 11/12/2019. Published trial protocol: A stepped wedge trial of efficacy and scalability of a virtual clinical pharmacy service (VCPS) in rural and remote NSW health facilities.

Assessment of the relevance of a prescribing competency framework in Kuwait – An e-Delphi study

Abstract Introduction Prescribing is the most common intervention used to manage patients. Globally, prescribing competency frameworks have been developed to standardize prescribing practice across all healthcare disciplines1. Research on prescribing practice in different chronic diseases in Kuwait has shown some inconsistencies in the quality of care delivered to patients. Aim This study assesses the relevance of the National Pharmaceutical Society (NPS) MedicineWise Prescribing Competency Framework statements amongst physicians, dentists, and pharmacists in Kuwait as a first step in developing a National Prescribing Competency Framework for Kuwait. Methods Ethical approval was granted by Kuwait’s Ministry of Health (MOH) for this project. A 4-phase adopt and adapt approach was planned to develop the Prescribing Competency Framework for Kuwait. This study covers phases 1 and 2 of this approach. Phase one involved translating the Framework into Arabic using parallel translation. Phase two utilised the e-Delphi method to reach consensus on the relevance of 48 statements (divided into 7 Competency Areas) for prescribing in Kuwait. For this phase, a survey, with a 4-point Likert scale, was developed using Google Forms and distributed to experts participating in the e-Delphi process. Purposive and snowballing method was used to recruit the experts, targeting all doctors, dentists, and pharmacists working in MOH. Participants were asked to rate their agreement with the relevance of the statements to Kuwait and allowed to leave comments. Statements achieving a consensus level ≥90%, with no answer as strongly disagree, were deemed relevant. Statements not reaching consensus will be reevaluated in Round 2 of the e-Delphi process (planned for July-September 2024). Results The translation phase yielded a bilingual framework that could be utilised by prescribers in Kuwait. Round 1 of the e-Delphi included 36 experts (22 doctors, 8 dentists, and 6 pharmacists). Out of the seven Competency Areas in the NPS framework, four Competency Areas reached 100% consensus (Areas 1, 4, 5, and 6). 90% of the statements in Competency Area 2 reached consensus, while only 40% of the statements in Competency Area 3, and 85.7% of the statements in Competency Area 7 reached consensus. Competency statements that did not reach consensus will be re-assessed in Round 2 of the e-Delphi process. Conclusion To our knowledge, this is the first study conducted to initiate the process of adopting and adapting a Prescribing Competency Framework in Kuwait. Competency statements involving patient engagement in their management plan seemed to gain the least consensus in Round 1 of our study, which will be explored further in Round 2 of our e-Delphi process. This is consistent with current published literature in the Middle Eastern and North African regions which shows that there is no clear understanding by healthcare professionals of how to apply patient-centred care2,3. Limited comments on disagreed statements in Round 1 require further clarification. There is a need to standardize the prescribing process due to the complexity of choosing the right medication, the imperative to optimize medication use, a change in the patient's care models, and the possibility of other healthcare professionals taking on prescribing roles.

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

EFFECTIVENESS OF EPLEY MANEUVER AND GANS REPOSITIONING MANEUVER ON DIZZINESS, BALANCE AND KINESIOPHOBIA IN PATIENTS WITH POSTERIOR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO

Background: Benign paroxysmal positional vertigo (BPPV) is the most prevalent type of peripheral vestibular vertigo, typically affecting the posterior semi-circular canal. Objective: The objective of study was to compare the effectiveness of Epley maneuver and Gans repositioning maneuver on dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Methods: 30 BPPV patients were selected and assigned into two groups based on the selection criteria. Group-A (N=15), received Epley maneuver and 15 were assigned to Group-B, undergone Gans repositioning maneuver, for 20 minutes per session, 3 session (alternate days) per week for 3 weeks. Cawthorne and Cooksey Exercises were given to both the group as common intervention. Dizziness, balance and kinesiophobia were assessed both before and after the 3-week intervention program using Dizziness Handicap Inventory (DHI) scale, Timed-Up and Go (TUG) test and Tampa Scale of Kinesiophobia (TSK), respectively. The collected data were subsequently tabulated and analyzed using appropriate statistical tools. Results: The unpaired ‘t’ test analysis of dizziness and balance revealed statistically significant scores in DHI(t=2.2259) and TUG(t=2.2547), respectively, at a 95% confidence interval. Consequently, Group A demonstrated significant reduction in dizziness and balance improvement in patients with posterior canal BPPV. The scores of Kinesiophobia for both the groups were (A, Mean=31.6; B, Mean= 32.2), which showed no significant difference(t=1.074), that means the group showed the improvement from baseline. Conclusion: The study concluded that a 3-week intervention combining the Epley maneuver with Cawthorne-Cooksey exercises was effective in treating dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Implication: The Epley and Gans maneuvers effectively reduce dizziness and improve balance in patients with posterior canal BPPV. They also may alleviate kinesiophobia, enhancing patient confidence in movement. These interventions highlight the importance of targeted therapy in managing vestibular disorders, promoting functional recovery and quality of life.

A Comparison of Open Ventral Hernia Repair Risk Stratification Systems: A Call for Consensus

Background/Objectives: Ventral hernia repair (VHR) is a common surgical intervention linked to specific surgical site complications. In such occurrences, the related morbidity is often substantial. Although known risk factors have long been recognized, their systematic inclusion in risk stratification systems lacks universal validation. This study evaluates the effectiveness and correspondence of three risk assessment tools—CeDAR, VHWG, and the modified VHWG—in predicting postoperative wound complications in VHR patients. Methods: We analyzed data from 203 patients who underwent VHR for incisional midline or lateral wall hernia across two surgical departments between 2019 and 2023. Each patient was scored using CeDAR, VHWG, and the modified VHWG systems. Outcomes were assessed based on surgical site occurrences (SSOs) such as seroma formation, wound infections, and recurrences. Results: The incidence of SSOs was 8.9%, with two recorded deaths (0.89%). CeDAR scores showed a statistically significant relationship with SSOs but failed to accurately predict complication rates across subgroups. The VHWG grading system effectively predicted higher complication rates for grades III and IV compared to grades I and II, though its modified version did not show significant predictive improvements. Secondary outcomes indicated a higher SSO rate in patients requiring posterior component separation (TAR) and those with larger hernia defects, though the differences were not statistically significant. Major preoperative risk factors, including smoking, diabetes, and obesity, did not show significant correlations with SSO rates in this study. Conclusions: Current risk estimation tools inadequately predict SSOs in VHR. Enhancing prediction accuracy will require incorporating both patient-specific and surgical factors, potentially through advanced algorithms and large-scale studies.

Epidemiology and outcomes of critically ill patients in the emergency department of a tertiary teaching hospital in Rwanda.

The introduction of Emergency Medicine in Rwanda in 2015 has been associated with a mortality reduction in patients presenting to Kigali University Teaching Hospital (KUTH). In the context of increasing numbers of critically ill patients presenting to Emergency Departments (ED) globally, the aim of this study was to describe the characteristics of critically ill patients, the critical care interventions performed, and the outcomes of critically ill patients presenting to the KUTH ED with the goal of informing future research into the root causes of mortality of critically ill ED patients and of identifying high yield topics for didactic and procedural training. A descriptive observational prospective cohort pilot study analyzed all patients ≥15 years who presented to KUTH between April and June 2022 with modified South African Triage Scores of Red with alarm, Red without alarm, and Orange. Of 320 patients, 66.9% were male and median age was 40 years. Patients were triaged as Orange (65.3%), Red without alarm (22.8%), and Red with alarm (11.9%). Presentations were categorized as: medical emergencies (48.0%), traumatic injury (44.5%), and surgical emergencies (7.6%). Median length of stay was 31h (IQR 28, 56) and boarding was 23h (IQR 8, 48). Overall mortality was 12.2% and highest among medical emergencies (16.5%, p = 0.048) and increased significantly with triage color: Red with alarm (47.4%), Red without alarm (16.4%), and Orange (4.3%, p < 0.0001). Cardiopulmonary resuscitation (CPR) (10.3%), endotracheal intubation (8.8%), and vasopressor administration (3.1%) were the most frequent critical interventions performed. Survival after cardiac arrest was 9.1% and 32.1% after intubation. Mortality was associated with the following interventions: CPR, intubation, and use of vasopressors (p < 0.05). This pilot study identified the most common critical care interventions performed and a high mortality among patients who required these interventions in the ED of a tertiary teaching hospital in Rwanda. These findings will inform didactics and procedural training for emergency care providers. Future research should focus on the root causes of mortality in these specific patient populations and identify areas of system strengthening to reduce mortality.

Interventions to Reduce Imaging in Children With Minor Traumatic Head Injury: A Systematic Review.

Reducing unnecessary imaging in emergency departments (EDs) for children with minor traumatic brain injuries (mTBIs) has been encouraged. Our objective was to systematically review the effectiveness of interventions to decrease imaging in this population. Eight electronic databases and the gray literature were searched. Comparative studies assessing ED interventions to reduce imaging in children with mTBIs were eligible. Two independent reviewers screened studies, completed a quality assessment, and extracted data. The median of relative risks with interquartile range (IQR) are reported. A multivariable metaregression identified predictors of relative change in imaging. Twenty-eight studies were included, and most (79%) used before-after designs. The Pediatric Emergency Care Applied Research Network (PECARN) rule was the most common intervention (71%); most studies (75%) used multifaceted interventions (median components: 3; IQR: 1.75 to 4). Before-after studies assessing multi-faceted PECARN interventions reported decreased computed tomography (CT) head imaging (relative risk = 0.73; IQR: 0.60 to 0.89). Higher baseline imagine (P < .001) and additional intervention components (P = .008) were associated with larger imaging decreases. The limitations of this study include the inconsistent reporting of important outcomes and that the results are based on non-randomized studies. Implementing interventions in EDs with high baseline CT ordering using complex interventions was more likely to reduce head imaging in children with mTBIs. Including the PECARN decision rule in the intervention strategy decreased orders by a median of 27%. Further research could provide insight into which specific factors influence successful implementation and sustained effects.

Understanding the features and effectiveness of randomized controlled trials in reducing COVID-19 misinformation: a systematic review.

This systematic review aimed to assess the features and effectiveness of individual-level randomized controlled trials targeting COVID-19 misinformation. The selection process included rigorous criteria, resulting in the inclusion of 24 individual studies from 21 papers. The majority of studies were conducted in high-income countries, with the accuracy/credibility of information as the primary outcome. Debunking and boosting interventions were the most common interventions while nudging and content labeling interventions were examined in a few studies. This study highlights that further research is needed to enhance the effectiveness of boosting strategies and to explore the impact of combined interventions. Addressing bias concerns and standardizing intervention assessment measures will contribute to the development of evidence-based approaches in this critical area.

Evaluating the Impact of a Clinical Pharmacist in Patients Receiving New Chemotherapy for Breast Cancer: Analysis of a Pilot Study

Purpose: Breast cancer treatment may include chemotherapy, which is associated with significant toxicities. At the Sidney Kimmel Cancer Center at Jefferson Health, a pilot program was developed to add an oncology clinical pharmacist to the breast cancer clinic. The purpose of this study is to identify the impact of the clinical pharmacist in supportive care management, add to existing literature discussing the impact of the clinical pharmacist in ambulatory oncology settings, and justify future, permanent ambulatory oncology pharmacist positions within the institution. Methods: This single-center retrospective chart review assesses interventions made by the clinical pharmacist in patients with any stage of breast cancer who presented to the breast clinic for new chemotherapy treatment between September 1, 2020, and February 28, 2021. The primary outcome was to describe clinical pharmacist interventions at the first follow-up encounter after chemotherapy initiation. Secondary outcomes included classifying and quantifying total interventions and comparing intervention details between total and included patients within the 6-month timeframe. Results: Of 44 included patients, 29 had a follow-up encounter. The clinical pharmacist directly managed 33% of the 58 patient-reported adverse drug effects. In 6 months, the clinical pharmacist made 1,068 interventions spanning 189.6 documented hours. The most common interventions were coordination of care, education, and supportive care pharmacotherapy interventions. Conclusion: This study identified the pharmacist’s role in supportive care management and reports the successful integration of a clinical pharmacist into a breast cancer clinic. Future directions include conducting prospective studies to further explore the impact of the clinical pharmacist on treatment outcomes.

Airway management in infants with Robin sequence in the United Kingdom and Ireland: A prospective population-based study.

There is currently no consensus about managing upper airway obstruction (UAO) in infants with Robin sequence (RS), in terms of treatment efficacy or clinical outcomes. This study describes UAO management in UK/Ireland, and explores relationships between patient characteristics, UAO management, and clinical outcomes in the first 2 years of life. Active surveillance of RS throughout UK/Ireland via the British Paediatric Surveillance Unit and nationally commissioned cleft services. Clinical data were collected at initial notification and 12-month follow-up. 173 infants with RS were identified, of which 47% had additional congenital anomalies or an underlying syndrome (non-isolated RS). Two-thirds (n = 119) required an airway intervention other than prone positioning: non-surgical in 84% and surgical (tracheostomy) in 16%. Nasopharyngeal airway (NPA) was the most common intervention, used in 83% (n = 99) for median 90 days (IQR 136). Surgical UAO management was associated with prolonged hospital admission, higher prevalence of neurodevelopmental delay (NDD), lower weight-for-age z-scores, and delayed oral feeding. These findings were not attributable to a higher prevalence of non-isolated RS in this group. Although more commonly associated with non-isolated RS, growth faltering was also identified in 48%, and NDD in 18%, of cases of isolated RS. In UK/Ireland, most infants with RS are managed with NPA, and tracheostomy is reserved for refractory severe UAO. Clinical outcomes and duration of use indicate that NPA is a safe and feasible first-line approach to UAO. Longitudinal assessment of neurodevelopment and growth is imperative, including in children with isolated RS. Current variations in practice reinforce the need for evidence-based treatment guidelines.

Electronic screening and brief interventions promoting healthy diet and physical activity among adult patients in medical settings: A systematic review

Background & AimsElectronic screening and brief interventions (eSBIs) are promising health promoting approaches but their utilization towards nutrition outcomes has been little documented so far. The aim of this systematic review is to examine the nature and findings of eSBIs targeting diet and/or physical activity (PA) among adult patients in healthcare settings since smartphone technologies emerged. MethodsThree systematic searches in PubMed, ScienceDirect and PsycINFO were conducted from January 2010 to May 2023. We include all studies assessing eSBI towards lifestyle habits (dietary habits and/or PA at least), implemented in healthcare settings and targeting adult participants. ResultsOf 1981 articles identified, 15 studies met inclusion criteria. Most of them documented eSBIs implemented in primary care (n=11), targeting PA (n=11) and diet (n=9) alone or combined (n=5). Some eSBIs targeted additional behaviors (e.g. smoking, drinking). Delivery modes included computer (n=8), printed documents (n=8) or phone (n=2) but only four eSBIs were interactive (or partially automated). In addition to personalized feedback, most common behavior change techniques were “information about social and environmental consequences” (n=9), “goal setting” (n=7), and “information about health consequences” (n=7). Most studies assessing behavior change had a control group (8 in 10), and eight studies found positive changes in behavior. ConclusionsAlthough implementing eSBIs towards PA/diet among adult patients in medical settings seems promising for primary, secondary and tertiary prevention, common conceptual framework, intervention and outcomes are severely lacking, and the extent to which they follow existing SBI guidelines remains unclear. Demonstrating their effectiveness requires fixing these issues before conducting prospective assessment studies in medical settings.

Revisiting Therapeutic Facet Joint Injections for Chronic Spinal Pain: A Case Series

Facet joint injections with steroids are a common therapeutic intervention for chronic pain management, particularly in patients with lumbar spondylosis and facet arthropathy. However, many insurance companies do not provide coverage for this helpful intervention. This case series presents four patients who experienced significant and sustained pain relief following therapeutic facet joint injections. The aim of this case series is to highlight the efficacy of facet joint injections with steroids in managing chronic spinal pain and to discuss the potential benefits of this treatment modality in patients who may not be interested in pursuing lumbar radiofrequency neurotomy.

Rehabilitation delivery models to foster healthy ageing - a scoping review

Abstract Background Rehabilitation is crucial for healthy ageing among older adults, who face heightened risks of non-communicable diseases, infections, injuries, and mental health issues. Yet, understanding tailored rehabilitation for this demographic remains limited. To fill this gap, we conducted a scoping review to identify rehabilitation delivery models targeting older adults’ functioning and healthy ageing. Methods We systematically searched Medline and Embase (January 2015 to May 2022) for English-language studies on rehabilitation approaches for older adults. Three authors independently screened records for eligibility and synthesized findings through quantitative and qualitative analysis. Results Among 6,933 records, we assessed 585 articles, identifying 283 studies with 69,257 participants. Six main rehabilitation delivery models emerged, with outpatient (24%) and telerehabilitation (22%) being predominant. Multidisciplinary teams (31.5%) often followed integrated care principles (30.4%). However, most studies adopted a disease-centric approach (59.0%), neglecting prevalent issues like pain, sensory impairments, incontinence, and sexual dysfunctions. Therapeutic exercises (54.1%) and self-management education (40.1%) were common interventions. Conclusions Our scoping review outlines diverse rehabilitation delivery models for older adults, highlighting gaps in addressing prevalent issues and emphasizing evidence-based strategies to promote healthy ageing. It underscores the need for systematic functional assessment and expansion of rehabilitation programs to cover prevalent health concerns. While limitations include reliance on published research and not assessing model effectiveness, this review lays groundwork for future research and innovation in rehabilitation and healthy ageing. Key messages • The scoping review identifies six rehabilitation delivery models for older adults. • The scoping review advocates for evidence-based strategies for enhancing healthy ageing through rehabilitation.

Equal, equitable or exacerbating inequalities: patterns and predictors of social prescribing referrals in 160 128 UK patients.

Social prescribing is growing rapidly globally as a way to tackle social determinants of health. However, whom it is reaching and how effectively it is being implemented remains unclear. To gain a comprehensive picture of social prescribing in the UK, from referral routes, reasons, to contacts with link workers and prescribed interventions. This study undertook the first analyses of a large database of administrative data from over 160 000 individuals referred to social prescribing across the UK. Data were analysed using descriptive analyses and regression modelling, including logistic regression for binary outcomes and negative binomial regression for count variables. Mental health was the most common referral reason and mental health interventions were the most common interventions prescribed. Between 72% and 85% of social prescribing referrals were from medical routes (primary or secondary healthcare). Although these referrals demonstrated equality in reaching across sociodemographic groups, individuals from more deprived areas, younger adults, men, and ethnic minority groups were reached more equitably via non-medical routes (e.g. self-referral, school, charity). Despite 90% of referrals leading to contact with a link worker, only 38% resulted in any intervention being received. A shortage of provision of community activities - especially ones relevant to mental health, practical support and social relationships - was evident. There was also substantial heterogeneity in how social prescribing is implemented across UK nations. Mental health is the leading reason for social prescribing referrals, demonstrating its relevance to psychiatrists. But there are inequalities in referrals. Non-medical referral routes could play an important role in addressing inequality in accessing social prescribing and therefore should be prioritised. Additionally, more financial and infrastructural resource and strategic planning are needed to address low intervention rates. Further investment into large-scale data platforms and staff training are needed to continue monitoring the development and distribution of social prescribing.

Same term, but unequal understanding: differences in digital public health intervention features

Abstract Digital technologies have transformed healthcare delivery and public health, with many countries integrating interventions such as online consultations, electronic health records, and telemedicine to improve population health and healthcare accessibility. Multinational assessments for benchmarking system maturity ask for the degree of implementation of such tools. However, are these interventions as comparable as they claim to be? This talk presents a qualitative analysis of 179 digital public health (DiPH) interventions described in scientific articles. We categorized interventions based on their implementation stages, public health functions, and reported and non-technical features. Telemedicine, health apps, and electronic health record interventions dominated the diverse landscape. While these technology groups already differed greatly in their functions, we identified equally significant differences in the reported intervention characteristics within the groups. For example, telemedicine was not only used in healthcare settings for patients and health professionals but also in primary prevention and research for researchers, policymakers, and healthy individuals. Different interventions reported varying functions, such as remote monitoring, self-monitoring, alarm systems, patient motivation, and user empowerment modules. So, is there one common telemedical intervention? No. Instead, all individual technologies differed to varying degrees. The analysis underscored the diversity of DiPH interventions among and within intervention groups and highlighted the importance of precise terminology for effective planning and evaluation. Instead of using broad classifications like ‘telemedicine,’ interventions should be defined and communicated based on specific technological functions, non-technical characteristics, use cases, and user groups. This approach will promote cross-disciplinary collaboration and foster international comparability across DiPH systems.

Trends in Korean intervention studies on complementary and alternative therapies in rehabilitation nursing.

In nursing, complementary and alternative therapies (CATs) can be provided alongside, or as alternatives, to conventional medical treatments to maximize therapeutic effects, accelerate rehabilitation, and enhance patient satisfaction. Fostering the correct knowledge and attitudes toward CATs is crucial not only for theoretical development but also for practical application. To gain a comprehensive understanding of recent domestic research trends, this study conducted an integrative review to analyze different types of CAT-related intervention studies in rehabilitation nursing in South Korea. A literature search of relevant databases suggested 14 papers. The review revealed that most studies focused on older adult patients, with manipulative and body-based therapies being the most common CAT interventions, followed by energy therapies, mind-body therapies, and others. The efficacy analysis of the CATs used in the selected studies indicated that their effects varied depending on participant characteristics and outcome measures, even when the same CAT was employed. To advance the field of rehabilitation nursing, effective CATs that are proven to be safe for older adult patients need to be developed and actively utilized. Additionally, specialized nurse training programs and clinical and community-based applications for rehabilitation patients requiring interventions need to be developed.

Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry.

To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS. Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022). UK NHS hospitals treating RRP patients. Children and adults diagnosed with RRP and managed in an NHS hospital. Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death). Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period. This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time. NCT03465280, ISRCTN36100560.

Randomized controlled trial parallel-group on optimizing community pharmacist's care for the elderly: The influence of WhatsApp-Email delivered clinical case scenarios.

Drug-related problems (DRPs) significantly threaten the safety of the elderly. In order to improve pharmacists' ability to minimize these events, novel educational interventions that consider the current challenges in clinical practice are crucial. The primary objective is to assess the impact of two unique educational interventions on pharmacists' ability to identify DRPs. A total of 127 community pharmacies in the United Arab Emirates (UAE) were recruited and randomly allocated to one of three arms using a 1:1:1 allocation ratio. While a series of clinical case scenarios (N = 24) related to elderly care were established and validated and sent to pharmacists in Active Group A over a 3-month period, lengthy research articles focused on medication safety in elderly were emailed to pharmacists in Active Group B. The control group pharmacist received no intervention. Then, pharmacists self-reported the number, categories, and severity of DRPs and pharmacist recommendations. The incidence of DRPs identified by pharmacists was 10.8% in Active Group A, 2.0% in the Control Group (p = 0.011), and 3.8% in Active Group B (p = 0.014). A significant difference was observed in the proportion of DRP types between Active Group A and the Control Group. The most common DRPs in Active Group A were avoidable medication (14.7%) and untreated disease (9.2%). Pharmacists in Active Group A (37.2%) and Active Group B (32.3%) most commonly intervened by recommending the cessation of medication, while the most common intervention in the Control Group was recommending a decrease in dose (29.8%). The mean cost reduction per patient was highest in Active Group A (31.3 ±11.8 $), followed by Active Group B (20.8 ±8.6 $) and the Control Group (19.6 ±9.5 $). The mean time needed to resolve a DRP was shortest in Active Group A (7.3 ±3.5 minutes), followed by Active Group B (9.8 ±4.2 minutes) and the Control Group (9.8 ±5.7 minutes). Using WhatsApp to deliver clinical scenarios was effective in improving pharmacists' ability to identify and address DRPs in elderly patients, resulting in faster resolution and higher cost savings.

Prescribing by level of deprivation in Wales: an investigation of selected medicine groups

BackgroundPrescribing is the most common intervention made by healthcare professionals. Our study aimed to compare prescribing between general practitioner (GP) practices with the highest and lowest levels of deprivation.MethodsThe deprivation...