Different Types Of Interventions Research Articles

Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients.

Interventions for increasing immunosuppressant medication adherence in solid organ transplant recipients.

Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback.

IntroductionIn the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful. The objective of this project was to evaluate a similar multicomponent intervention aimed at ED physician ordering, with the primary goal of reducing the number of monthly BUN tests ordered per ED visit.MethodsA pre post intervention design was conducted over 12-months. The first intervention component was an educational presentation conducted by physician leaders. Second, a regularly used order panel within the ED electronic order system was modified, removing the BUN test. The third component involved audit and feedback; the total monthly BUN test ordered for the ED department post intervention start was shared with all ED physicians twice (at 5 and 12 months).An interrupted time series analysis was completed to evaluate the multicomponent intervention effect.ResultsThe total monthly ordered BUN test declined from an average of 1905 pre-intervention to 448 post-intervention, and the total monthly BUN test to total ED visit ratio declined from 0.46 to 0.1. These results were a statistically significant reduction in physician BUN test ordering.ConclusionsTargeted education, order panel design and data feedback interventions can impact physician ordering behaviour in the emergent healthcare context, where diagnostic tests are often over used.Supplementary InformationThe online version contains supplementary material available at 10.1007/s43678-022-00333-w.

Effectiveness of interventions to improve medication adherence in adults with depressive disorders: a meta-analysis

BackgroundNon-adherence to medication is a major obstacle in the treatment of depressive disorders. We systematically reviewed the literature to evaluate the effectiveness of interventions aimed at improving adherence to medication among adults with depressive disorders with emphasis on initiation and implementation phase.MethodsWe searched Medline, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Social Science Citation Index and Science Citation Index for randomized or non-randomized controlled trials up to January 2022. Risk of bias was assessed using the criteria of the Cochrane Collaboration. Meta-analyses, cumulative and meta-regression analyses for adherence were conducted.ResultsForty-six trials (n = 24,324) were included. Pooled estimate indicates an increase in the probability of adherence to antidepressants at 6 months with the different types of interventions (OR 1.33; 95% CI: 1.09 to 1.62). The improvement in adherence is obtained from 3 months (OR 1.62, 95% CI: 1.25 to 2.10) but it is attenuated at 12 months (OR 1.25, 95% CI: 1.02 to 1.53). Selected articles show methodological differences, mainly the diversity of both the severity of the depressive disorder and intervention procedures. In the samples of these studies, patients with depression and anxiety seem to benefit most from intervention (OR 2.77, 95% CI: 1.74 to 4.42) and collaborative care is the most effective intervention to improve adherence (OR 1.88, 95% CI: 1.40 to 2.54).ConclusionsOur findings indicate that interventions aimed at improving adherence to medication among adults with depressive disorders are effective up to six months. However, the evidence on the effectiveness of long-term adherence is insufficient and supports the need for further research efforts.Trial registrationInternational Prospective Register for Systematic Reviews (PROSPERO) number: CRD42017065723.

Financing of complex replacement surgery

In addition to the surgical demands of hip revision arthroplasty, the reimbursement of the different types of interventions represents amajor economic challenge for orthopaedic hospitals. With complex revision endoprostheses such as, for example, modular systems or custom-made implants, the flat-rate DRG is usually not sufficient to cover the costs generated and assure sufficient revenue. In Germany, the reimbursement of various replacement interventions in hip revision surgery has been differentiated and reduced in recent years and mostly not in favour of orthopaedic surgeons. Recently, the isolated cup exchange was substantially downgraded from the significantly better rated DRG I46B to the clearly lower rated DRG I47A. Isolated stem exchanges or complete exchanges of the entire endoprosthesis are sometimes only economically affordable for hospitals with supportive reimbursement by means of additional fees. An additional burden for hospitals in recent years has been the repeated deletion of additional OPS codes by insurance companies, which has led to the triggering of an additional fee. In summary, hip revision arthroplasty is an economically difficult terrain, in which cost coverage with appropriate reimbursement can only be achieved under the prerequisite of high case numbers, great experience and negotiation of adequate additional fees.

Comparing the Impacts on Team Behaviors Between Artificial Intelligence and Human Process Management in Interdisciplinary Design Teams

Abstract This brief extends prior research by the authors on studying the impacts of interventions provided by either a human or an artificial intelligence (AI) process manager on team behaviors. Our earlier research found that a created AI process manager matched the capabilities of human process management. Here, these data are studied further to identify the impact of different types of interventions on team behaviors and outcomes. This deeper dive is done via two unique perspectives: comparing teams’ problem-solving processes before and after interventions are provided, and through a regression analysis between intervention counts and performance. Results show overall mixed adherence to the provided interventions, and that this adherence also depends on the intervention type. The most significant impact on the team process arises from the communication frequency interventions. Furthermore, a regression analysis identifies the interventions with the greatest correlation with team performance, indicating a better selection of interventions from the AI process manager. Paired together, the results show the feasibility of automated process management via AI and shed light on the effective implementation of intervention strategies for future development and deployment.

Standard of care for COVID-19 in randomized clinical trials registered in trial registries and published in preprint servers and scholarly journals: a cross-sectional study

BackgroundThe concept of standard of care (SoC) treatment is commonly utilized in clinical trials. However, in a setting of an emergent disease, such as COVID-19, where there is no established effective treatment, it is unclear what the investigators considered as the SoC in early clinical trials. The aim of this study was to analyze and classify SoC reported in randomized controlled trial (RCT) registrations and RCTs published in scholarly journals and on preprint servers about treatment interventions for COVID-19.MethodsWe conducted a cross-sectional study. We included RCTs registered in a trial registry, and/or published in a scholarly journal, and/or published on preprint servers medRxiv and bioRxiv (any phase; any recruitment status; any language) that aim to compare treatment interventions related to COVID-19 and SoC, available from January 1, 2020, to October 8, 2020. Studies using „standard“ treatment were eligible for inclusion if they reported they used standard, usual, conventional, or routine treatment. When we found such multiple reports of an RCT, we treated those multiple sources as one unit of analysis.ResultsAmong 737 unique trials included in the analysis, 152 (21%) reported that SoC was proposed by the institutional or national authority. There were 129 (18%) trials that reported component(s) of SoC; the remaining trials simply reported that they used SoC, with no further detail. Among those 129 trials, the number of components of SoC ranged from 1 to 10. The most commonly used groups of interventions in the SoC were antiparasitics (62% of the trials), antivirals (57%), antibiotics (31%), oxygen (17%), antithrombotics/anticoagulants (14%), vitamins (13%), immunomodulatory agents (13%), corticosteroids (12%), analgesics/antipyretics (12%). Various combinations of those interventions were used in the SoC, with up to 7 different types of interventions combined. Posology, timing, and method of administration were frequently not reported for SoC components.ConclusionMost RCTs (82%) about treatment for COVID-19 that were registered or published in the first 9 months of the pandemic did not describe the “standard of care” they used. Many of those interventions have, by now, been shown as ineffective or even detrimental.

Manuscript and/or Cursive: The Contribution of Research Conducted Since 2012 on Handwriting Instruction

ABSTRACT Learning how to trace out letters constitutes an important technical element in the mastery of writing. Teaching students how to do so requires decision-making: either teaching manuscript writing, cursive writing or both and choosing which instructional practices to favor. This synthesis aims to take stock of the knowledge that comes from the research that can allow us to shed light on these choices. In the footsteps of a synthesis published in 2012, we found 41 scholarly writings published between 2012 and 2021. These articles confirm and specify some elements of this synthesis through a snapshot of choices made according to country: learning prerequisites for handwriting acquisition and the effect of different types of intervention on the handwriting acquisition. These scientific papers also highlight new knowledge that concerns learning how to handwrite in general and the consequences of choices made on the learning of reading and writing.

Interventions to improve immigrant women's mental health: Asystematic review.

To identify the effectiveness of interventions for improving immigrant women's mental health and explore the role of these interventions in nursing practice. Immigrant women rearing children and living in a foreign country experience many mental health problems during pregnancy, child-rearing, and acculturation. Mental health problems can be controlled or modified through effective practices. Few studies have examined the role of different types of interventions in alleviating these mental health issues in immigrant women in the perinatal period, and it is unclear whether such interventions are effective. This systematic review used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. Studies form December 1948-August 2021 were retrieved from four databases: MEDLINE, CINAHL, EMBASE, and Cochrane Library. This systematic review's protocol was registered at PROSPERO (CRD42020210845). The data were summarised using narrative analysis. Eight studies met the inclusion criteria and were included in the final analyses. There were few mental health improvement interventions for immigrant women. The interventions included home visit programmes, asset-building mental health interventions, cognitive-behavioural interventions, nursing interventions, perinatal education interventions, and mindfulness interventions. Home visit programmes and asset-building mental health interventions have reported positive outcomes in improving depressive symptoms and mental health. There are few interventions for improving immigrant women's mental health. Most existing interventions are conducted through group education, but there are no explicit significant effects. Home visits may be an effective approach for conducting interventions to improve immigrant women's mental health. An effective nursing intervention should be developed, and more research is needed in improving immigrant women's mental health. This review provides evidence for nurses and midwives to practice appropriate and effective approaches and strategies for improving immigrant women's mental health. We suggest possible future interventions for this cohort of immigrant women in the perinatal period.

Depression in Adolescents with Asperger’s Syndrome: Long-Term Outcome

IntroductionAsperger Syndrome (AS) exhibits a particular set of difficulties, the foremost of them being the impairment in social interaction. Furthermore, adolescence by itself is a period burdened with many social challenges and distress. The attempt to adjust to them while having AS is much harder, thus it may constitute the premise for the onset of internalizing symptomatology, in particular depression.ObjectivesThis study aimed to observe what factors either improved or hindered the long-term outcome. It was analyzed how the different types of interventions influenced the outcome of these individuals in terms of academic performance, social functioning, psychiatric relapses and quality of life.MethodsOur lot was represented by 16 patients diagnosed with Asperger Syndrome and Major Depressive Disorder (MDD), followed up on a period between 1 to 10 years. The lot was divided into two groups, each with a different therapeutic plan. The main instruments used were clinical observation and parents’ assessments.ResultsIn the first group, the adolescents, treated with a complex intervention which included also a psychotherapeutic component, were found to have a positive outcome, 71,42% of them having no other psychiatric comorbidity than Major Depressive Disorder. The adolescents in the second group, who were treated only with pharmacological treatment, were found to have a negative outcome.ConclusionsThe factors that were found to have the most important impact on the long-term outcome were: the integration in a psychotherapy programme, having family support, compliance with the pharmacological treatment and having MDD as the only psychiatric comorbidity.DisclosureNo significant relationships.

Developing a New Neuromodulation Treatment Pathway for the Treatment of Depression

AimsTo ensure an appropriate treatment pathway is available to patients diagnosed with Depression a STEPPED care model where different types of intervention are offered depending on the patient's experienced severity of Depression. However, a great percentage of patients continue to experience disabling symptoms and fall into the Treatment Resistant Depression (TRD) category. There was a need to review the options available within local Mental Health Services (MHS) for the treatment of patients with depression and TRD.MethodsA new clinical pathway was designed to provide access to patients to emerging treatments, such as EsKetamine, Vagal Nerve Stimulation (VNS) and repetitive Transcranial Magnetic Stimulation (rTMS). After calculating the local impact of depression to patients, trust resources and society we extrapolated our calculations to neighbouring Trusts covering the South West. A newly developed business plan demonstrating the need for new treatment options and the benefits, financial and otherwise, was presented and underwent various approvals levels by the Trust Governance and Executive Committees and local commissioning groups, before being able to proceed. Within the original business plan, rTMS and VNS were offered in addition to the existing ECT as parts of a new treatment pathway. We are now in the process of incorporating EsKetamine and Transcranial Direct Current Stimulation (tDCS). The clinic was set up in March 2020, just at the beginning of the pandemic, which halted operations for quite a few months before being able to resume recentlyResultsWe have managed to treat patients with both VNS and rTMS from our Trust, as well from surrounding areas. Patients have already experienced benefits in the recovery from symptoms. The new service has provided another line of support for colleagues in offering bespoke treatment plans to their patients and patients have appreciated having access to new non-traditional treatment options.ConclusionAlthough there has been a primary result in improving patient care, income generation is also possible by positioning the Trust in the forefront of new therapeutics and allowing the provision of service to expand to neighbouring Trusts and private patients. Other benefits are associated with the Trust's reputations and kudos being enhanced and include the forging of new pathways within the developing alliance with General Hospitals, increased ‘visibility’ for training and research opportunities, improved patient satisfaction and improved CQC standing.

POS0380 EFFECTIVENESS OF REMOTE CARE INTERVENTIONS: A SYSTEMATIC REVIEW INFORMING THE 2022 EULAR POINTS TO CONSIDER FOR REMOTE CARE IN RHEUMATIC AND MUSCULOSKELETAL DISEASES

BackgroundWhile the number of patients with rheumatic musculoskeletal diseases (RMDs) is increasing worldwide, there is no adequate increment in the number of health care professionals, leading to the urgent need for new forms of care to take pressure from health care systems.1 2 Telehealth comprises a number of different types of interventions with the scope of performing certain steps of care, ranging from diagnostics to follow-up visits, in a remote manner. The use of remote care is heterogenous and guidance is needed to optimize the combination with conventional face-to-face (F2F) visits.ObjectivesTo perform a systematic literature review (SLR) on different outcomes of remote care compared to F2F care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the European Alliance of Associations for Rheumatology (EULAR) Points to Consider for remote care in RMDs.MethodsProspective, retrospective, and qualitative studies testing different types of remote care in patients with RMDs were included. Medline, Embase and the Cochrane Library were searched through February 28th, 2021. Two reviewers independently performed standardized data extraction, synthesis, and risk of bias assessment.ResultsA total of 2,240 references were identified. Forty-seven studies, consisting of 26 randomized controlled trials, 8 prospective cohort studies, 8 cross sectional studies, and 5 qualitative studies were included.Fifty-one percent of the studies involved patients with inflammatory RMDs, including rheumatoid arthritis, and spondyloarthritis, while 49% were on patients with non-inflammatory conditions, such as osteoarthritis and fibromyalgia. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Thirty-four studies investigated outcomes of remote care in comparison to F2F care. The most frequently assessed outcomes concerned efficacy and user perception of remote care, with 34% and 21% of studies, respectively, reporting superior results for the remote care intervention.Time savings and flexibility were reported as major drivers, while inadequate technical knowledge and concerns in data security were the main barriers to implementing remote care. Implementation of remote care methods into clinical practice was not reported by the included studies. The main limitations were the heterogeneity of outcomes and interventions, and the substantial risk of bias (50% of studies with high risk of bias).ConclusionStudies on remote care reported similar to partially better results compared to F2F care concerning efficacy, and user perception outcomes, with the limitation of heterogeneity and considerable risk of bias.

Why Antibias Interventions (Need Not) Fail

There is a critical disconnect between scientific knowledge about the nature of bias and how this knowledge gets translated into organizational debiasing efforts. Conceptual confusion around what implicit bias is contributes to misunderstanding. Bridging these gaps is the key to understanding when and why antibias interventions will succeed or fail. Notably, there are multiple distinct pathways to biased behavior, each of which requires different types of interventions. To bridge the gap between public understanding and psychological research, we introduce a visual typology of bias that summarizes the process by which group-relevant cognitions are expressed as biased behavior. Our typology spotlights cognitive, motivational, and situational variables that affect the expression and inhibition of biases while aiming to reduce the ambiguity of what constitutes implicit bias. We also address how norms modulate how biases unfold and are perceived by targets. Using this typology as a framework, we identify theoretically distinct entry points for antibias interventions. A key insight is that changing associations, increasing motivation, raising awareness, and changing norms are distinct goals that require different types of interventions targeting individual, interpersonal, and institutional structures. We close with recommendations for antibias training grounded in the science of prejudice and stereotyping.

A Systematic Review of Interventions Used to Reduce University Students’ Speaking Anxiety

Despite a growing body of research, Speaking Anxiety (SA) reduction has been a prominent issue in Second/Foreign Language (S/FL) learning, especially among undergraduate students. The complexity and variety of features of Speaking Anxiety Interventions (SAI) make the synthesis and application of their findings in practice challenging. This study systematically reviews the existing evidence on SAI between January 2015 and mid-June 2021 to summarize and clarify the field’s current state and offer directions for future research in the context of undergraduate learners. Seven established inclusion criteria were used to select studies. The study identified 2280 potentially eligible studies through Scopus, WOS, and Science Direct, 16 of which were eventually included. The studies applied a range of methodological designs and different types of interventions with various durations. This systematic review resulted in two main categories of SAI, namely direct and indirect, according to the mechanism used to intervene with SA. In addition to exploring innovative methods to promote effective SAI, future research should examine the cause of SA and learners’ speaking English proficiency levels before selecting or applying any SA reduction approach that may significantly impact the success or failure of SAI.

Differential Gateways, Facilitators, and Barriers to Substance Use Disorder Treatment for Pregnant Women and Mothers: A Scoping Systematic Review.

Access to substance use disorder (SUD) treatment is complex, and more so for pregnant women and mothers who experience unique barriers. This scoping systematic review aimed to summarize contemporary findings on gateways, facilitators, and barriers to treatment for pregnant women and mothers with SUD. We used the scoping review methodology and a systematic search strategy via MEDLINE/PubMed and Google Scholar. The search was augmented by the similar article lists for sources identified in PubMed. Scholarly and peer-reviewed articles that were published in English from 1996 to 2019 were included. A thematic analysis of the selected studies was used to summarize pathways to SUD treatment and to identify research gaps. The analysis included 41 articles. Multiple gateway institutions were identified: health care settings, social service agencies, criminal justice settings, community organizations, and employers. Some of the identified facilitators and barriers to SUD treatment were unique to pregnant women and mothers (eg, fear of incarceration for child abuse). Both personal (emotional support and social support) and child-related factors (loss of children, suspension or termination of parental rights, the anticipation of reuniting with children) motivated women to seek treatment. Major access barriers included fear, stigma, charges of child abuse, inconvenience, and financial hardship. There has been progress in implementing different types of interventions and treatments for that were attentive to pregnant women and mothers' needs. We developed a conceptual model that characterized women's pathways to treatment by deciphering women's potential engagement in gateway settings.

The role of blue green infrastructure in the urban thermal environment across seasons and local climate zones in East Africa

Rapid urbanisation and climate change are two major trends in Africa in need of further investigation. In this paper, the urban thermal environment and vegetation abundance in four East African cities (Khartoum, Addis Ababa, Kampala and Dar es Salaam) were characterised, providing new insights into the role and potentials of blue green infrastructure in differing climate regions. The Local Climate Zone (LCZ) framework was employed to detect the seasonal Land Surface Temperature (LST) and Enhanced Vegetation Index (EVI) derived from Landsat-8 data. Significant LST differences between LCZs in dry and rainy seasons were confirmed using a Welch's T test. The LCZs were found to offer potentially new approaches to investigating issues pertaining to urban heating in data-scarce regions. Greater surface urban heat island (SUHI) intensity during the rainy season was apparent in Khartoum and Addis Ababa, emphasising the importance of seasonality in urban thermal studies. Spatial correlations between EVI and LST within each LCZ were analysed through Moran's I and further illustrated the complex relationships of vegetation and thermal behaviour in urban areas. Despite these complexities, urban blue green infrastructure was found to moderate the SUHI, with different types of intervention required across different LCZs.

The Role of Prehabilitation in Modern Esophagogastric Cancer Surgery: A Comprehensive Review.

Simple SummarySurgery is the only potentially curative treatment option for esophagogastric cancer. Although esophagectomy/gastrectomy remains associated with major surgical trauma and significant morbidity. Prehabilitation has emerged as a novel strategy to improve postoperative outcomes by preparing patients for a surgery-associated physiological challenge. We discuss current knowledge and the results of studies on the role of prehabilitation in esophagogastric cancer surgery.Esophagogastric cancer is among the most common malignancies worldwide. Surgery with or without neoadjuvant therapy is the only potentially curative treatment option. Although esophagogastric resections remain associated with major surgical trauma and significant postoperative morbidity. Prehabilitation has emerged as a novel strategy to improve clinical outcomes by optimizing physical and psychological status before major surgery through exercise and nutritional and psychological interventions. Current prehabilitation programs may be unimodal, including only one intervention, or multimodal, combining the benefits of different types of interventions. However, it still is an investigational treatment option mostly limited to clinical trials. In this comprehensive review, we summarize the current evidence for the role of prehabilitation in modern esophagogastric cancer surgery. The available studies are very heterogeneous in design, type of interventions, and measured outcomes. Yet, all of them confirm at least some positive effects of prehabilitation in terms of improved physical performance, nutritional status, quality of life, or even reduced postoperative morbidity. However, the optimal interventions for prehabilitation remain unclear; thus, they cannot be standardized and widely adopted. Future studies on multimodal prehabilitation are necessary to develop optimal programs for patients with esophagogastric cancer.

The effect of interventions in alleviating fear of childbirth in pregnant women: a systematic review

ABSTRACT Background The Fear of Childbirth (FOC) is regarded as a general problem, which affects women’s health and well-being, justifying demanding caesarean section. Several primary studies have been performed in relation to the interventions performed to reduce the fear of childbirth, which show contradictions between the results of these studies. Objective This review aims to provide a comprehensive review of the different types of interventions used to reduce the fear of childbirth in pregnant mothers. Methods In this study, systematic review of study information related to the effect of different therapies on reducing the fear of childbirth using subject-related keywords and validated with MeSH in SID, MagIran, IranMedex, IranDoc, Embase, ProQuest, Scopus, PubMed, Web of Science (ISI) databases and Google Scholar Search Engine were extracted without any time limit until February 2021. Results After removing duplicates and irrelevant works from among the 5396 articles found, 63 articles remained in the study. The participants in these 63 articles were 5415 cases and 5770 controls. In addition, three studies were on epidural anesthesia, 33 on the effects of psychotherapy, 19 on the effects of education, and eight on the influence of other interventions on alleviating FOC. As shown by the results, psychotherapy intervention and education decreased FOC significantly. Conclusion According to the results of this study, to prevent the fear of childbirth, pregnancy training and prenatal preparation courses are recommended to empower pregnant women. It also seems beneficial to use psychotherapy approaches for women who are afraid of childbirth.

Clinical interventions to improve adherence to urate-lowering therapy in patients with gout: a systematic review.

The aim of this study was to systematically review and compare the quantitative effect of clinical interventions designed to improve adherence to urate-lowering therapy. MEDLINE, Embase, CINAHL, Scopus and Web of Science were searched for interventional studies reporting quantitative adherence to urate-lowering therapy information as an endpoint. Intervention details, quantitative adherence information, clinical outcome and cost-effectiveness data were extracted. Risk of bias was assessed. From 4721 records, 11 studies (3 randomised and 8 observational) met the inclusion criteria. Pharmacist- and nurse-led interventions were described, involving a mixture of patient education, telephone or mobile texting reminders, and medication blister packing. Quantitative adherence information was obtained using methods such as patient self-reporting and pharmacy-dispensing data. Most studies had a moderate-to-high risk of bias. Two of the three randomised studies reported improvement in adherence between the intervention and control groups, including a 13% increase in the mean proportion of days covered >0.8 [341/681 participants (50%) versus 289/782 participants (37%)] and an 88% increase in achieving a high Medicine Taking Behaviour questionnaire score [37/42 participants (88.1%) versus 0/40 participants (0%)]. Four of the eight observational studies reported improved adherence from baseline (ranging from 33% to 91% based on the longitudinal change in adherence metrics reported). A comparison of the different types of interventions was not feasible due to the heterogeneity between study designs and adherence metrics used. These findings support the need for more interventional studies to be conducted to aid adherence management.

Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe: development of the SAFEGUARDING-BZRAs toolkit using a co-design approach

Abstract Introduction Long-term benzodiazepine receptor agonist (BZRA) use (>3 months) persists worldwide and poses risks of harm. Effective interventions are needed to address this issue. Aim To develop an intervention to support discontinuation of long-term benzodiazepine receptor agonist (BZRA) use. Methods The intervention development process built on previous qualitative work that used the Theoretical Domains Framework (TDF) to explore perceived barriers and facilitators to discontinuing long-term BZRA use (1). A co-design approach was used whereby lay individuals and professionals worked as equals during the research process based on principles of authentic participation and collaboration (2). The co-design team included five ‘experts by lived experience’ with experience of long-term BZRA use who previously provided input on other related work as patient and public involvement representatives or responded to an expression of interest call on social media. Two online co-design team meetings were held. During the first meeting, a summary of previous findings was presented together with a long-list of behaviour change techniques (BCTs) generated using established mapping matrices in which BCTs were reliably allocated to the TDF. Each team member independently documented their decision as to whether each BCT should be included in a short-list for potential inclusion in the final intervention using online polling software. The a priori decision rule was that 70% of team members had to agree regarding the inclusion/exclusion of a BCT. All other BCTs were then discussed at a follow-up meeting. A finalised list of BCTs for inclusion in the intervention was agreed at the second meeting using a consensus-based approach involving the same decision rule. Potential ways in which BCTs could be operationalised were then discussed. Results Thirty BCTs were discussed and six BCTs were excluded. For example, team members recommended avoiding ‘Social comparison’ as individual circumstances and experiences of discontinuation and associated withdrawal symptoms are unique and not directly comparable. Given the number of included BCTs, the co-design team recommended presenting them as a toolkit. The SAFEGUARDING-BZRAs (Supporting sAFE and GradUAl ReDuctIon of loNG-term BenzodiaZepine Receptor Agonist uSe) toolkit comprises 24 BCTs: ‘Goal setting (behaviour)’, ‘Review behaviour goal(s)’, ‘Review outcome goal(s)’, ‘Feedback on behaviour’, ‘Self-monitoring of behaviour’, ‘Social support (practical)’, ‘Social support (emotional)’, ‘Information about health consequences’, ‘Monitoring of emotional consequences’, ‘Information about emotional consequences’, ‘Prompts/cues’, ‘Habit reversal’, ‘Graded tasks’, ‘Pros and cons’, ‘Comparative imagining of future outcomes’, ‘Social reward’, ‘Self-reward’, ‘Reduce negative emotions’, ‘Distraction’, ‘Adding objects to the environment’, ‘Body changes’, ‘Verbal persuasion about capability’, ‘Focus on past success’ and ‘Credible source’. The toolkit includes recommendations targeted at primary care-based clinicians for operationalising each BCT to support BZRA discontinuation. Conclusion The SAFEGUARDING-BZRAs toolkit has been developed using a systematic, theory-based approach that addresses identified limitations of previous research (e.g. lack of detailed intervention description). In terms of limitations, it is possible that a different group of individuals may have developed a different type of intervention. To overcome this, a priori decision rules were used for decision making. Further research is needed to assess the toolkit’s usability and acceptability by service users and clinicians. References (1) Lynch et al. Health Expect. [in press] DOI: 10.1111/hex.13392. (2) O’Donnell et al. BMC Health Serv Res. 2019;19(1):797

Palliative Care for Patients With Heart Failure: An Integrative Review.

Palliative care should be integrated into routine disease management for all patients with serious illness, regardless of settings or prognosis. The purposes of this integrative review were to identify the features of randomized controlled trials for adult patients with heart failure and to provide basic references for the development of future trials. Using Whittemore and Knafl's integrative literature review method, comprehensive searches of the PubMed, Cochrane Library, CINAHL, EMBASE, and Korean databases were conducted, integrating keywords about heart failure and palliative care interventions. Quality appraisal was assessed using Cochrane risk-of-bias tools. In total, there were 6 trials providing palliative care interventions integrating team-based approaches between palliative care specialists and nonpalliative clinicians, such as a cardiologist, cardiac nurse, and advanced practice nurse across inpatient and outpatient settings. The different types of interventions included home visits, symptom management via phone calls or referral to a specialist team, and the establishment of treatment planning. Patient-reported outcome measures included positive effects of palliative interventions on symptom burden and quality of life. Given that most of the selected studies were conducted in Western countries, palliative care should be culturally tailored to assist heart failure patients worldwide.