Core Intervention Research Articles

638. Using NHSN Annual Self-Reported Dialysis Data to Understand Infection Prevention and Control Practices and their Association with Bloodstream Infections in Dialysis Facilities

Abstract Background Hemodialysis (HD) patients are at increased risk of bloodstream infection (BSI). Although BSI events are surveilled by the National Healthcare Safety Network (NHSN), studies correlating dialysis facilities’ self-reported infection control (IC) practices with BSI events are lacking.Figure 1.Seven Areas of Least Compliance by Facilities A total of 34 facilities were included. Best practices were selected based on adherence by less than 2/3 of dialysis centers. Methods We used 2022 NHSN Annual Outpatient Dialysis Center Practices Survey data for Nebraska facilities to identify 44 questions pertaining to IC practices. These questions were included into a scoring system and dichotomized to adherent (1) or non-adherent (0), leading up to a “best practice (BP) score” for each facility. Questions related to attending IC training initiatives were coded as yes (1) or no (0). Self-reported adherence to CDC Dialysis Safety Core Interventions (DSCI) were coded as following all (1) or some/none (0). We extracted BSI standardized infection ratios (SIR) from NHSN Dialysis Events Surveillance data. Descriptive statistics was used to evaluate facility characteristics and scores. Multivariate regression, using a Poisson model, generated rate ratios (RR) to understand association of trainings/guidelines with BP scores and BSI SIR. Pearson correlation was used to assess association between BSI SIR and BP scores.Figure 2.BSI SIR and Overall Facility Performance Score Distributions Results A total of 34 facilities yielded a mean BP score of 36/44 (82%). The top 3 least reported BP strategies included: ointment application to HD catheter during dressing change (adhered by 2 of 34), medications drawn into syringes outside the patient room (adhered by 12 of 34), and patient education on showering with HD catheters (adhered by 15 of 34). Overall, facilities following all DSCI were associated with higher BP scores (RR: 1.11, 95% CI: 1.06, 1.16) and lower BSI SIR (RR: 0.33, 95% CI: 0.13, 0.83) compared to those who followed some or none. Similarly, facilities participating in infection prevention initiatives were associated with lower BSI SIR (RR: 0.39, 95% CI: 0.16, 0.96) compared to those who did not. An inverse association was found between BSI SIR and BP score (p=0.001). Conclusion Adherence to DSCI and participation in IC initiatives likely help HD facilities in preventing BSI events and need to be further explored. NHSN annual outpatient dialysis data provides important information about areas where further improvement is needed. Disclosures Muhammad Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support

Comparing Synchronous and Asynchronous Remotely Delivered Lifestyle Interventions: Protocol for a Randomized Noninferiority Trial.

Remotely delivered lifestyle interventions have emerged to increase the reach and accessibility of traditional interventions that involve numerous in-person visits. Remote interventions can be delivered synchronously via videoconference software or phone or asynchronously via online platforms. Asynchronously delivered interventions are convenient and flexible in that they allow people to participate at any time and as such, they may be more sustainable. Evidence for asynchronous interventions is needed given their potential for convenience and sustainability, which may have implications for weight loss maintenance. This is a randomized noninferiority trial comparing 2 remotely delivered lifestyle interventions: one that is delivered synchronously via videoconference meetings and one that is delivered asynchronously through private Facebook (Meta) groups. We hypothesize that the percent weight loss difference between conditions at 6 and 12 months will be less than 2% and that the asynchronous condition will cost less to deliver per pound lost. We also hypothesize that engagement will be higher in the asynchronous condition at 12, 18, and 24 months and that the asynchronous condition will have greater weight loss at 24 months. We will randomize 328 participants with overweight or obesity to a remotely delivered lifestyle intervention that is delivered either synchronously or asynchronously. Delivery of the synchronous lifestyle intervention will be via videoconference group sessions, whereas the delivery of the asynchronous lifestyle intervention will be via private Facebook groups. The lifestyle intervention in both conditions is based on the Diabetes Prevention Program. The intervention goals are to lose 5%-10% of baseline weight and to work toward 300 minutes per week of moderate intensity physical activity. The core intervention will last for 12 months and be led by counselors in each group. This will be followed by a 12-month maintenance phase to be led by participant volunteers from each group. Participant engagement and weight loss maintenance will be assessed during this phase. The primary outcome is mean percent weight loss at 6 and 12 months. The noninferiority margin for differences in weight loss between conditions is 2% at both 6 and 12 months. We will model percent weight loss at 6 and 12 months using general linear regression models with the intent-to-treat sample. Secondary outcomes include engagement, collective efficacy, cost, and weight loss at 18 and 24 months. The funding period began on August 17, 2023, and the study was approved by the University of Connecticut Institutional Review Board on August 17, 2023. Participant recruitment will begin December 2024 and the intervention will begin February 2024. If hypotheses are confirmed, this work will provide evidence that asynchronously delivered remote interventions are as efficacious as synchronously delivered ones and more sustainable such that people will engage in them longer and retain more weight loss for less cost. ClinicalTrials.gov NCT06393725; https://tinyurl.com/4kzzwkc9. PRR1-10.2196/65323.

Assessing motivational interviewing integrity in the Toddler Oral Health Intervention study.

The Toddler Oral Health Intervention (TOHI) was launched in 2017 to promote oral health prevention at well-baby clinics, with a focus on parents with children aged 6-48 months. This study aims to evaluate the integrity of motivational interviewing (MI) as one of the core intervention pillars in the TOHI study. The TOHI study was conducted at nine well-baby clinics in the central and southern regions of the Netherlands, with 11 trained oral health coaches (OHCs) delivering a tailored individual counselling programme. Audio recordings of counselling sessions were uploaded by the OHCs into an online portal for feedback and integrity evaluation purposes. A trained independent assessor evaluated MI integrity using the MITI 4.2.1 coding scale. IBM SPSS Statistics was used to analyse the data, with ratings on technical and relational components and behavior counts computed by adding up the scores and categorizing them into six key MI skills. Descriptive statistics, including frequencies, percentages and median scores with interquartile ranges, were calculated. The median ratings on the technical and relational components were 2.5 (IQR 2.0-3.5) and 3.5 (IQR 3.0-4.0) out of a maximum of 5, with 45% and 58% of recordings showing fair or good MI integrity, respectively. A median of 38% (IQR 25-55%) of complex reflections and a reflection-to-question ratio of 0.7 (IQR 0.4-1.0), with 47% and 24% of recordings showing fair or good MI integrity, respectively. Median counts of MI-adherent and non-adherent statements were 3.0 (IQR 2.0-5.0) and 0.0 (IQR 0.0-1.0), respectively. The duration of recordings and MI integrity varied among oral health coaches. Overall, this study revealed that, while intensive training was provided, not all OHCs in the TOHI study met fair thresholds for MI integrity. These findings emphasize the necessity of ongoing training, reflection and support to achieve and maintain a fair or good level of MI integrity in clinical practice.

Improving medication safety for intensive care patients transitioning to a hospital ward: development of a theory-informed intervention package.

Care of critically ill patients is complex, requiring effective collaboration co-ordination and communication across care teams and professions. Medicines are a fundamental component of the acute interventions intensive care unit (ICU) patients receive, requiring frequent review and optimisation according to patient needs. ICU patients recovering to transfer to a hospital ward are at risk of medication transition errors, contributing to poorer patient and health-system outcomes. We aimed to develop of a theory-informed intervention package to improve medication safety for ICU patients transferring to a hospital ward. We conducted a qualitative study comprising two UK face-to-face focus group meetings in April and May 2022. There were ten participants in each meeting (7-8 healthcare professionals and 2-3 patient and public representatives). Each meeting had four foci: (i) What needs to change (intervention targets)? (ii) What are the core intervention components? (iii) What will the intervention components change and how (mechanisms of action), and what key outcomes will the changes impact on? (iv) What are the barriers and facilitators to intervention delivery? A background to the problem and previous intervention development work was provided. Meetings were digitally recorded and transcribed verbatim. Iterative analyses, informed by the Behaviour Change Wheel framework, were conducted to provide a behavioural diagnosis, identify key behaviour change techniques and outline the mechanisms of action through which the intervention might impact on key outcome. We identified what needs to change to improve medication safety for UK ICU patients on this care transition. A theory-informed intervention package was developed, based on seven core intervention components (e.g., medication review (targeted), task organisation and prioritisation). For each intervention component the mechanism of action, targeted change, and key outcomes were identified (e.g., medication review (targeted); action planning; decreases problematic polypharmacy; decreased preventable adverse drug events). Barriers and facilitators to intervention component delivery were described. We developed a theory-informed core intervention package to address the limitations in medication safety for ICU patients transferring to a hospital ward. Understanding what needs to change, and the accompanying facilitators provides a basis for intervention feasibility testing and refinement prior to future evaluation of effectiveness.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

Psychologists' experiences of working with fear of childbirth: implications and advice for care providers.

Fear of childbirth is a common problem that affects women's health and wellbeing. A variety of interventions have been used in research and clinical settings, but it remains unclear how interventions should be designed to be as effective and acceptable as possible. Additionally, the experiences of psychologists working to support women fearing childbirth are sparsely documented and therefore unavailable for researchers and clinicians. This qualitative study aimed to bridge this gap by exploring and describing the experiences of perinatal psychologists working clinically with women suffering from fear of childbirth. Focus group interviews with eleven psychologists, analysed with reflexive thematic analysis with an inductive and semantic approach. We identified four main themes, with three to four subthemes each. It was described as essential to meet the woman where she stands: to listen, validate, explore, and tailor interventions. Depending on the needs of each woman, the psychologists had a smorgasbord of core interventions to offer. They also described how they could help the woman and her partner or support person to prepare for childbirth. Finally, they addressed the importance of multiprofessional engagement and cooperation. A list of recommendations based on the findings is presented. The findings add to the existing literature on how to treat and support women with fear of childbirth and should be considered as one of many sources of information guiding the development of future interventions, care strategies, and clinical pathways for women fearing childbirth.

An Integrative Review of Psychosocial Intervention Programs for Children and Adolescents who Experienced Traumatic Events

Background: This integrative review study aims to analyze the core components, intervention strategies, and effects of psychosocial intervention programs conducted for children and adolescents in Korea who have experienced traumatic events.Methods: The integrative review involved a search of major domestic databases using key terms such as 'children’, 'adolescents’, 'trauma’, 'post-traumatic stress’, 'intervention’, and 'education’. A total of 10 studies were selected for analysis based on predefined criteria.Results: The 10 selected studies were categorized into three types of interventions based on the environment and structure of the intervention delivery: individual-based interventions targeting only children and adolescents, family-based interventions involving family members, and school-based interventions conducted within schools. These interventions were found to be effective in addressing mental health issues caused by trauma in children and adolescents.Conclusions: Despite the serious nature of traumatic experiences among children and adolescents, this integrative review found that domestic research on psychosocial interventions for this population lacks rigorous study design and is limited in the selection of participants and trauma events. Therefore, the study suggests the need for the development and dissemination of more proactive psychosocial interventions for children and adolescents. The findings of this study are expected to serve as foundational data for the development of trauma managing programs for this population.

In-person and online mixed method non-randomised studies exploring feasibility and acceptability of HEADS: UP, an adapted Mindfulness-Based Stress Reduction programme for stroke survivors experiencing symptoms of anxiety and depression

BackgroundDepression and anxiety are prevalent after stroke and associated with poor outcomes. We previously co-developed a stroke-specific self-management intervention, HEADS: UP (Helping Ease Anxiety and Depression after Stroke). The two studies reported here aimed to test the feasibility and acceptability of the HEADS: UP course and supporting materials, and research processes ahead of a definitive trial.MethodsWe recruited community-dwelling stroke survivors (SS) ≥ 3 months post-stroke, with symptoms of mood disorder (Hospital Anxiety and Depression Scale ≥ 8). Participants could ‘enrol’ a family member/ ‘other’ to take part with them, if desired. Study 1 tested HEADS: UP delivered in-person, and informed optimisation of research processes and intervention delivery and materials. In a pragmatic response to Covid-related socialising restrictions, HEADS: UP was then adapted for online delivery, tested in Study 2. The primary outcome (both studies) was the feasibility (acceptability, fidelity) of the intervention and of research processes. Quantitative data (including patient-reported outcome measures (PROMs) assessing mood and quality of life) and qualitative data were collected pre-/post-intervention. Descriptive statistics were used to analyse quantitative data; a thematic framework approach was used to analyse qualitative data. Both studies received ethical approval prior to commencement.ResultsStudy 1Feasibility: 13 (59.1%) of 22 potentially eligible stroke survivors consented; aged 66 (median, interquartile range (IQR) 14); male (n = 9; 69%); 28 (IQR 34) months post-stroke. Of these, n = 10 (76.9%) completed PROMS pre-intervention; n = 6 (46.2%) post-intervention.Acceptability: Nine (69.2%) of the 13 participants attended ≥ 4 core intervention sessions. Aspects of screening and data collection were found to be burdensome.Study 2Feasibility: SS n = 9 (41%) of 22 potentially eligible stroke survivors consented; aged 58 years (median; IQR 12); male (n = 4; 44.4%); 23 (IQR 34) months post-stroke. Of these, n = 5 (55.6%) completed PROMS pre-intervention; n = 5 (55.6%) post-intervention.Acceptability: Five (55.6%) of the 9 participants attended ≥ 4 core sessions. They found online screening and data collection processes straightforward.

It Starts With a Story: A Four-Step Narrative-Based Framework for Serious Illness Conversations.

Background: As a key component of advance care planning, serious illness conversations form a core intervention in palliative care. To achieve effective serious illness conversations, acknowledgment and inclusion of patient sense of self and identity are critical. However, no framework exists to describe how goals, values, and choices relate to patient identity. This conceptual gap hinders the advancement of palliative care education and practice. Objective: This philosophical investigation aimed to explicate two items: first, a novel conceptual framework for serious illness conversations; second, a structured approach to optimize these conversations within the palliative care clinical context. Methods: A philosophical and theoretical analysis was performed within an interdisciplinary context, by scholars in palliative care, medical humanities, philosophy, and bioethics. Key literature in psychology, qualitative research on the experience of serious illness, medical ethics, and choice architecture in medical decision-making were reviewed, and a structured conceptual and narrative analysis was performed. Results: An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). Discussion: By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.

Increasing Effective Primary Care Screenings in the U.S. Virgin Islands Department of Health Community Clinic.

Background: In 2019, 1.8 million new cancer cases occurred, and 500,000 cancer deaths were expected in the United States, costing $21 billion. Regular primary care screenings have correlated with early cancer detection, treatment, health promotion, and reduced costs. Objectives: The aim was to increase effective primary care screenings in adults in St. Thomas U.S. Virgin Islands Department of Health Community Clinic to 75% within 8 weeks. Methods: This quality improvement initiative used four Plan-Do-Study-Act cycles over 8 weeks. Two core interventions, each with four tests of change, were implemented. Interventions: Core interventions included screening utilizing a checklist for body mass index, depression, and colorectal, lung, breast, cervical, uterine, and prostate cancer and engagement utilizing a checklist for correlated screening-related education, interventions, shared decision-making, and referral. Results: Primary care screenings increased from 55% to 96%, and patient engagement increased from 6% to 82%. Effective primary care screenings increased to 89%, exceeding the aim. Conclusions: This project improved primary care screening and engagement and effectively applied patient-centered care. Achievements were made through standardized screening and engagement. Implications for Nursing: This quality improvement project may be spread to other clinics to improve patient health outcomes.

Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting.

End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning. This project aimed to increase patient-centered care for ESRD patients to 80% in 90 days. The project utilized the Plan-Do-Study-Act quality improvement model in four 2-week rapid cycles with 2 focus improvement areas. The 2 core interventions were patient screening for preferences and values and providing the right care for palliative management utilizing a checklist. At the end of the project, patient-centered right care for ESRD increased from a baseline of 24% to 94%. Patient engagement scores increased from a baseline of 3.2 to 4.9 on a 5-point Likert scale, with 5 being the highest supporting a shared decision model of care in improving patient-centered right care.

A latent profile analysis and network analysis of anxiety and depression symptoms in Chinese widowed elderly

Widowhood, as a traumatic event in the aging process, may lead to adverse psychological consequences such as anxiety and depression. However, the heterogeneity of anxiety and depression comorbidity patterns in widowed elderly and the interrelationships between symptoms have not been adequately studied. 10,239 elderly aged 65years and older were screened from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017-2018), to assess depression and anxiety using the Center for Epidemiologic Studies Depression Scale (CESD) and the 7-item Generalized Anxiety Disorder Questionnaire (GAD). The subgroups of widowed elderly with similar patterns of symptoms were identified by latent profile analysis (LPA). The structure of anxiety-depressive comorbidity network was characterized using "bridge expected influence" as centrality indices. Network stability was tested using a case drop bootstrap program. A network comparison test (NCT) was performed to examine the differences in network characteristics across LPA subgroups. LPA identified dichotomous profiles: low comorbid (n=4457) and high comorbid (n=692). NCT revealed a significant difference in the global strength between networks (S=0.631, p < 0.001). GAD1 (Nervousness or anxiety) is the common bridging symptom for both networks, while the bridging symptom for the high comorbidity network also includes GAD3 (Generalized worry). Cross-sectional methods are unable to verify causal relationships, and further randomized controlled trials are warranted. Anxiety-depressive pattern in Chinese widowed elderly can be categorized into a low comorbid or a high comorbid group. GAD3 (Generalized worry) can be used as the core intervention target during intervention.

Weaning-associated interventions for ventilated intensive care patients: A scoping review.

Mechanical ventilation is a core intervention in critical care, but may also lead to negative consequences. Therefore, ventilator weaning is crucial for patient recovery. Numerous weaning interventions have been investigated, but an overview of interventions to evaluate different foci on weaning research is still missing. To provide an overview of interventions associated with ventilator weaning. We conducted a scoping review. A systematic search of the Medline, CINAHL and Cochrane Library databases was carried out in May 2023. Interventions from studies or reviews that aimed to extubate or decannulate mechanically ventilated patients in intensive care units were included. Studies concerning children, outpatients or non-invasive ventilation were excluded. Screening and data extraction were conducted independently by three reviewers. Identified interventions were thematically analysed and clustered. Of the 7175 records identified, 193 studies were included. A total of six clusters were formed: entitled enteral nutrition (three studies), tracheostomy (17 studies), physical treatment (13 studies), ventilation modes and settings (47 studies), intervention bundles (42 studies), and pharmacological interventions including analgesic agents (8 studies), sedative agents (53 studies) and other agents (15 studies). Ventilator weaning is widely researched with a special focus on ventilation modes and pharmacological agents. Some aspects remain poorly researched or unaddressed (e.g. nutrition, delirium treatment, sleep promotion). This review compiles studies on ventilator weaning interventions in thematic clusters, highlighting the need for multidisciplinary care and consideration of various interventions. Future research should combine different interventions and investigate their interconnection.

Impact of Positive Resection Margins on Recurrence and Survival Following Resection and Adjuvant Chemotherapy in Pancreatic Cancer: Results of the PRODIGE 24-CCTG PA-6 Randomized Controlled Trial.

This study investigated the correlation between positive resection margins and outcomes in patients with pancreatic ductal adenocarcinoma who underwent surgery and adjuvant chemotherapy according to the pivotal trial PRODIGE 24-CCTG PA-6. The primary focus is on elucidating the prognostic significance of specific resection margins, including those associated with the superior-mesenteric vein (SMV), medial, and posterior pancreas. The analysis involved 400 patients across multiple centers in France and Canada. Surgical resection and subsequent adjuvant chemotherapy were core interventions. This study assessed the prognostic impact of resection margins, highlighting the significance of standardized pathology assessments. Additionally, the influence of chemotherapy regimen choice, comparing gemcitabine to mFOLFIRINOX, on the implications of positive resection margins was examined. Only three margins, SMV (HR=1.48 95% CI [1.11;1.96], P<.001), medial (HR=1.92 95% CI [1.36;2.73], P<.001) and posterior (HR=1.65 95% CI [1.21;2.24], P=.002), had a significant prognostic impact on disease-free survival and were sufficient compared with the seven recommended margins (Kappa=0.90 95% CI [0.87; 0.94]). R1 status was significant independent prognostic factor for poorer survival in gemcitabine-treasted patients (HR=1.97 95% CI [1.23;3.16], P=.005) but lost its significance with mFOLFIRINOX (HR=1.46 95% CI [0.91;2.35], P=.114). All efforts should be made to evaluate the three margins of the highest prognostic value, with the others being secondary. A key finding of this study is the likely effect of mFOLFIRINOX on local invasion in operated patients, which seems to correct the impairment related to margin involvement, probably explaining the improvements in DFS and OS.

Physiotherapists’ Use of Outcome Measure Tools in the Assessment of Neuro-Musculoskeletal Injuries for Short-Term Functional Rehabilitation Domains to Minimize Impairments and Disability following Commercial Motorcycle Road-Related Accident, Eldoret, Kenya

Bed immobilization remains a core intervention to stabilize neuro-musculoskeletal injuries following commercial motorcycle-related road traffic accidents. Despite timely operative and conservative management, most patients remain handicapped, requiring short- and long-term physical therapy. That calls for physiotherapists to assess and make use of outcome measure tools to determine the level of impairments and disability and make informed decisions when developing management goals. The objective of the study was to determine short-term functional rehabilitation domains, the use of outcome measure tools, and physiotherapy interventions used to minimize impairments and disability following a commercial motorcycle road-related accident in Eldoret, Kenya. Biopsychosocial theory guided the study. A prospective cohort study was adopted. Purposive sampling was used for the selection of 79 participants for 6 months between March 2021 and July 2021 in level 5 hospitals in Eldoret, Kenya. The target population included post-operative patients in both male and female orthopedics wards, physiotherapists, and social workers in the orthopedic department of Moi Teaching and Referral Hospital. The study population was 150 patients. A self-administered, structured questionnaire was used. The data collected was entered and analyzed with SPSS 20. The findings of this study revealed that forty-four percent (44%) of total participants were bedridden for fracture immobilization and spinal cord injuries for more than 3 days before and after orthopedic and neurological surgery. The majority (100%) of the participants had been referred for physiotherapy rehabilitation. All 100 participants were assessed with different outcome measure tools for neuro-musculoskeletal injuries to determine the level of physical function. Forty-three percent (43%) had lost functional abilities of the upper extremity (19 males, 15 females). Fifty-one-point nine percent (51.9%) had lost physical function due to lower extremity fractures (39% (26 males, 15 females) and 24% (15 males, 4 females) with spinal cord injuries. Four participants (5%) reported lost days to school, and 94.9% reported lost days to income-generating activities (27 females, 48 males). The majority (100%) of the participants pre- and post-operatively were assessed with standardized outcome measure tools that remain significant for prompt best evidence-based physiotherapy practices. Pain (100%) and impaired physical functions (100%) were the main rehabilitation domains that posed the biggest challenge to patients’ post-trauma. Multicomponent physiotherapy interventions ranging from stretching, strengthening, breathing exercises, bed positioning, mobility and transfers, balance and coordination, and gait training tailored to patients’ physical function levels, prevention of muscle atrophy and strength, and joint stiffness were core. This study recommended short-term physiotherapy rehabilitation on early bed mobilization and ambulation for patients, which remains core for the restoration of physical functional levels and a return formula to socioeconomic status.

Using co-design methods to develop new personalised support for people living with Long Covid: The 'LISTEN' intervention.

Many Covid-19 survivors are living with unresolved, relapsingand remitting symptoms and no 'one size' of treatment is likely to be effective for everyone. Supported self-management for the varied symptoms of Long Covid (LC) is recommended by the National Institute for Health and Care Excellence in the United Kingdom. We aimed to develop a new personalised support intervention for people living with LC using a structured co-design framework to guide replication and evaluation. We used the improvement methodology, Experience-Based Co-Design, in an accelerated form to harness the collective experiences of people with LC. Incorporating evidence from 'Bridges Self-Management' (Bridges) an approach in which healthcare professionals (HCPs)are trained to support knowledge, confidence and skills of individuals living with long term conditions. Co-designed resources are also central to Bridges. Adults who self-identified as living with or recovered from LC, from England or Wales, aged 18 years and over were recruited, and HCPs, with experience of supporting people with LC. Participants took part in a series of small co-design group meetings and larger mixed meetings to agree priorities, core principles and generate resources and intervention content. People with LC (n = 28), and HCPs (n = 9) supported co-design of a book (hard-copy and digital form) to be used in 1:1 support sessions with a trained HCP. Co-design stages prioritised stories about physical symptoms first, and psychological and social challenges which followed, nonlinear journeys and reconceptualising stability as progress, rich descriptions of strategiesand links to reputable advice and support for navigating healthcare services. Co-design enabled formulation of eight core intervention principles which underpinned the training and language used by HCPs and fidelity assessments. We have developed a new personalised support intervention, with core principles to be used in one-to-one sessions delivered by trained HCPs, with a new co-designed book as a prompt to build personalised strategies and plans using narratives, ideas, and solutions from other people with LC. Effectiveness and cost effectiveness of the 'LISTEN' intervention will be evaluated in a randomised controlled trial set within the context of the updated Framework for Developing and Evaluating Complex Interventions. The LISTEN Public and Patient Involvement (PPI) group comprised seven people living with LC. They all contributed to the design of this study and five members were part of a larger co-design community described in this paper. They have contributed to this paper by interpreting stages of intervention design and analysis of results. Three members of our PPI group are co-authors of this paper.

CYP2C19 and CYP2J2 genotypes predict praziquantel plasma exposure among Ethiopian school-aged children

Metabolism of praziquantel (PZQ), a racemic mixture and the only drug approved to treat S. mansoni infection, is mediated by genetically polymorphic enzymes. Periodic school-based mass drug administration (MDA) with PZQ is the core intervention to control schistosomiasis. However data on the impact of pharmacogenetic variation, nutrition, and infection status on plasma PZQ exposure is scarce. We investigated genetic and non-genetic factors influencing PZQ plasma concentration and its metabolic ratios (trans-4-OH-PZQ/PZQ and cis-4-OH-PZQ/PZQ). Four hundred forty-six school children aged 7–15 years from four primary schools in southern Ethiopia who received albendazole and PZQ preventive chemotherapy through MDA campaign were enrolled. Genotyping for common functional variants of CYP3A4 (*1B), CYP3A5 (*3, *6), CYP2C19 (*2, *3, *17), CYP2C9 (*2, *3), and CYP2J2*7 was performed. Plasma concentrations of PZQ, trans-4-OH-PZQ, and cis-4-OH-PZQ were quantified using UPLCMS/MS. Carriers of CYP2C19 defective variant alleles (*2 and *3) had significantly higher mean PZQ plasma concentration than CYP2C19*1/*1 or *17 carriers (p = 0.005). CYP2C19*1/*1 and CYP2C19*17 carriers had higher trans-4-OH-PZQ/PZQ and cis-4-OH-PZQ/PZQ metabolic ratios compared with CYP2C19*2 or *3 carriers (p < 0.001). CYP2J2*7 carriers had lower mean PZQ plasma concentration (p = 0.05) and higher trans-4-OH-PZQ/PZQ and cis-4-OH-PZQ/PZQ metabolic ratios. Male participants had significantly higher PZQ concentration (p = 0.006) and lower metabolic ratios (p = 0.001) than females. There was no significant effect of stunting, wasting, S. mansoni or soil-transmitted helminth infections, CYP3A4, CYP3A5, or CYP2C9 genotypes on plasma PZQ or its metabolic ratios. In conclusion, sex, CYP2C19 and CYP2J2 genotypes significantly predict PZQ plasma exposure among Ethiopian children. The impact of CYP2C19 and CYP2J2 genotypes on praziquantel treatment outcomes requires further investigation.

Optimizing the physical activity intervention for older adults with mild cognitive impairment: a factorial randomized trial.

Physical activity (PA) intervention is one of the most effective interventions to promote cognitive function of older adults with mild cognitive impairment (MCI). However, the level of PA remains low. Based on the two core interventions (X-CircuiT and health education), this study aimed to examine the effect of three implementation strategies (viz., role modeling, goal-setting, and reminding) on the PA level among older adults with MCI using the multiphase optimization strategy (MOST). Participants were randomized into one of eight conditions in a factorial design involving three factors with two levels: (i) role modeling (on vs. off); (ii) goal-setting (on vs. off); and (iii) reminding (on vs. off). The primary outcome was PA level at 12 weeks. The secondary outcomes were cognitive function, self-efficacy, and cost-effectiveness at 12 weeks. The intention-to-treat (ITT) analysis was performed as the main analysis and the per-protocol (PP) analysis as the sensitivity analysis. A total of 107 participants were included and randomly assigned into three groups, each receiving different implementation strategies. The results of the multivariate regression analysis showed that the three implementation strategies, namely, reminding (B = 0.31, p < 0.01), role modeling (B = 0.21, p < 0.01), and goal-setting (B = 0.19, p < 0.01), could significantly improve PA level. Specifically, it was found that role modeling (B = 0.68, p = 0.03) could significantly improve cognitive function. There were no significant interactions among the three implementation strategies. Role modeling was the most cost-effective strategy, costing 93.41 RMB for one unit of PA. Role modeling was likely to be the best implementation strategy. The value-based and cost-effective PA intervention package could include the core intervention (X-CircuiT and health education) and implementation strategy (role modeling). https://www.chictr.org.cn, The study was retrospectively registered on 30 June 2022 (ChiCTR2200061693).

Process Evaluation of a Problem-Solving Approach for Analyzing Literacy Practices within a Multi-Tiered System of Supports Framework

A Multi-Tiered System of Supports (MTSS) framework features a structured problem-solving process and the use of assessment data to develop, identify, and evaluate the impact of instruction and intervention to meet the needs of all students proactively. The purpose of this process evaluation was to examine the implementation of a novel problem-solving approach for analyzing literacy practices across the tiers of an MTSS framework (i.e., core instruction, strategic intervention). The aim of the initiative was to build the capacity of teachers to provide effective instruction based on the science of reading in two elementary schools. The findings from this process evaluation study provide evidence that a problem-solving approach for analyzing literacy practices resulted in improvements in the core curriculum, instruction, and intervention supports. Implications for improvement efforts at the school district and state department of education levels are discussed.

Compliance to prenatal care among pregnant women at Panglima Estino, Province of Sulu: an assessment

This study assessed the extent of compliance to prenatal care among pregnant women in Panglima Estino, Province of Sulu in terms of Awareness to Prenatal Care, Family Tradition, Cultural Belief and Practices, Availability to Health Care Facilities, Financial Constraints and Accessibility, and Language and Communication Barriers. With 100 samples taken through non-probability sampling method via purposive sampling, and with the use of weighted mean, standard deviation, t-test for independent samples, One-way ANOVA, and Pearson’s r, this study reveals the following findings: 1) Most of the respondents are within the age range of 31-40 years old, all are married, mostly are unemployed with 5,000 &amp;amp; below monthly income, and have secondary level of education; 2) On the average, there is a moderate extent of compliance of pregnant women to prenatal care; 3) Generally, variables age, civil status, occupation, average monthly income, and educational attainment indeed significantly mediate in ways how pregnant women assessed the extent of compliance of pregnant women to prenatal care; 4) Generally, the group of respondents who perceived the extent of compliance to prenatal care among pregnant women in Panglima Estino, Province of Sulu in terms of Awareness to Prenatal Care as Agree or with High Extent may not necessarily be the same group of respondents who perceived Family Tradition, Cultural Belief and Practices, Availability to Health Care Facilities, Financial Constraints and Accessibility, and Language and Communication Barriers as Moderately Agree or with Moderate Extent, respectively; and 5) This study supports the principle forwarded by Mosammet Khaleda Akter which espouses that, to reduce the ratio of maternal and infant mortality and to improve overall birth outcomes, adequate prenatal care is recommended. Adequate prenatal care is one of the core interventions for improving maternal and fetal outcomes where evidence suggests that access to adequate prenatal care is strongly associated with substantial reductions in mortality and morbidity for both mother and newborn.