Different Types Of Interventions Research Articles

Interventions for preventing haemodialysis dysequilibrium syndrome.

Dialysis dysequilibrium syndrome (DDS) refers to neurological symptoms usually seen during or after new initiation or following reinitiation of haemodialysis (HD) after missing multiple sessions. DDS is associated with death and morbidity. We studied interventions aimed at preventing DDS. To evaluate the benefits and harms of different types of interventions for preventing DDS. We contacted the information specialist and searched the Cochrane Kidney and Transplant Register of Studies up to 8 May 2024 using search terms relevant to this review. Studies in the Register were identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Registry Platform (ICTRP) Search Portal, and ClinicalTrials.gov. We included randomised controlled trials (RCTs) that compared any intervention against standard care, including individuals initiated on HD, regardless of age. Two authors independently determined study eligibility, assessed quality and extracted data. Data were collected on methods, interventions, participants, and outcomes (DDS incidence, severe DDS, death, adverse events). Risk ratios (RR) and confidence intervals (CI) were calculated. Study quality was assessed using the Cochrane Risk of Bias 2 (ROB2) tool. Confidence in the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. We included two RCTs, enrolling 32 adult participants. Interventions included were slow dialysis, sodium modelling, standard sodium dialysate, and high sodium dialysate. The risk of bias was of some concern to high risk of bias in both studies. Slow dialysis compared to sodium modelling (1 study, 15 participants) may result in little to no difference in DDS, severe DDS, and death (low certainty evidence) and has uncertain effects on adverse events (RR 1.33, 95% CI 0.15 to 11.64; very low certainty evidence). Standard sodium dialysate compared to high sodium dialysate (1 study, 17 participants) has uncertain effects on the incidence of DDS (RR 0.07, 95% CI 0.00 to 1.12), severe DDS (RR 0.47, 95% CI 0.02 to 10.32), and adverse events (RR 0.29, 95% CI 0.08 to 1.02) (very low certainty evidence). In HD patients, sodium modelling, compared to slow dialysis, may result in little to no difference in DDS and death (low certainty evidence) and has uncertain effects on adverse events (very low certainty evidence). The evidence is very uncertain for the effect of high-sodium dialysate and standard sodium dialysate on DDS, death and adverse events (very low certainty evidence).

Network meta-analysis of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults.

To compare the outcomes associated with the use of probiotics, prebiotics, and synbiotics for the treatment of chronic constipation in adults. We searched eight electronic databases from database inception to July 11, 2023, to identify randomized controlled trials (RCTs) that report efficacy and safety for the treatment of chronic constipation. The risk of bias in the included RCTs was evaluated according to the Cochrane tool, and the certainty of the evidence was assessed using the Confidence in Network Meta-Analysis framework. The analysis was conducted using R version 4.3.0. Out of the 37 RCTs, a total of 21 different types of interventions were reported, involving 3,903 patients. This NMA demonstrated that both prebiotics and synbiotics resulted in an increase in frequency of stool movements per week. Compared to placebo, lactulose (Mean difference [MD] = 3.39, 95% Confdence interval [CI] [1.13, 5.65], moderate certainty), mix2 (consisting of Lactulose and Bacillus coagulans) (MD = 3.63, 95% CI [1.37, 5.89], moderate certainty), mix6 (consisting of Lactulose and Bifidobacterium coagulans) (MD = 4.30, 95% CI [1.04, 7.54], low certainty), and mix7 (consisting of Lactulose, Bifidobacterium subtilis, and Enterococcus faecium) (MD = 4.58, 95% CI [1.35, 7.78], moderate certainty) exhibited a significant effect. Notably, mix7 demonstrated the highest probability of being the most effective intervention (94.8%). Furthermore, when compared to L. plantarum, four probiotics and two synbiotics showed significant advantages in the Patient Assessment of Constipation Symptoms (PAC-SYM) score. L. reuteri (MD = -13.74, 95% CI [-22.20, -4.66], very low certainty) exhibited a significant effect in improving the Patient Assessment of Constipation Quality of Life (PAC-QoL) score. In terms of safety, there were no statistically significant differences between the intervention and control groups in all adverse event analyses. Moderate to very low evidence supports the use of lactulose and synbiotics to increase the number of weekly stool movements in patients, particularly highlighting the significant impact of synbiotics in increasing the number of weekly stool movements in patients with constipation. The use of L. paracasei showed improvements in PAC-SYM scores, while L. reuteri demonstrated enhancements in PAC-QoL scores.

Combined Aerobic Exercise with Intermittent Fasting Is Effective for Reducing mTOR and Bcl-2 Levels in Obese Females.

The integration of combined aerobic exercise and intermittent fasting (IF) has emerged as a strategy for the prevention and management of obesity, including its associated health issues such as age-related metabolic diseases. This study aimed to examine the potential of combined aerobic exercise and IF as a preventative strategy against cellular senescence by targeting mTOR and Bcl-2 levels in obese females. A total of 30 obese women, aged 23.56 ± 1.83 years, body fat percentage (FAT) 45.21 ± 3.73% (very high category), BMI 30.09 ± 3.74 kg/m2 were recruited and participated in three different types of interventions: intermittent fasting (IF), exercise (EXG), and a combination of intermittent fasting and exercise (IFEXG). The intervention program was carried out 5x/week for 2 weeks. We examined mTOR and Bcl-2 levels using ELISA kits. Statistical analysis used the one-way ANOVA test and continued with Tukey's HSD post hoc test, with a significance level of 5%. The study results showed that a combination of aerobic exercise and IF significantly decreased mTOR levels (-1.26 ± 0.79 ng/mL) compared to the control group (-0.08 ± 1.33 ng/mL; p ≤ 0.05). However, combined aerobic exercise and IF did not affect Bcl-2 levels significantly (-0.07 ± 0.09 ng/mL) compared to the control group (0.01 ± 0.17 ng/mL, p ≥ 0.05). The IF-only group, exercise-only group, and combined group all showed a significant decrease in body weight and fat mass compared to the control group (p ≤ 0.05). However, the combined aerobic exercise and IF program had a significant effect in reducing the total percentage of body fat and fat mass compared to the IF-only group (p ≤ 0.05). Therefore, it was concluded that the combined intermittent fasting and exercise group (IFEXG) undertook the most effective intervention of the three in terms of preventing cellular senescence, as demonstrated by decreases in the mTOR level, body weight, and fat mass. However, the IFEXG did not present reduced Bcl-2 levels.

Retaining Black Women in Computing: A Comparative Analysis of Interventions for Computing Persistence

Black women remain severely underrepresented in computing despite ongoing efforts to diversify the field. Given that Black women exist at the intersection of both racial and gendered identities, tailored approaches are necessary to address the unique barriers Black women face in computing. However, it is difficult to quantitatively evaluate the efficacy of interventions designed to retain Black women in computing, since samples of computing students typically contain too few Black women for robust statistical analysis. Using about a decade of student survey responses from an National Science Foundation–funded Broadening Participation in Computing alliance, we use regression analyses to quantitatively examine the connection between different types of interventions and Black women’s intentions to persist in computing and how this compares to other students (specifically, Black men, white women, and white men). This comparison allows us to quantitatively explore how Black women’s needs are both distinct from—and similar to—other students. We find that career awareness and faculty mentorship are the two interventions that have a statistically significant, positive correlation with Black women’s computing persistence intentions. No evidence was found that increasing confidence or developing skills/knowledge was correlated with Black women’s computing persistence intentions, which we posit is because Black women must be highly committed and confident to pursue computing in college. Last, our results suggest that many efforts to increase the number of women in computing are focused on meeting the needs of white women. While further analyses are needed to fully understand the impact of complex intersectional identities in computing, this large-scale quantitative analysis contributes to our understanding of the nuances of Black women’s needs in computing.

Effects of Two Online Mindfulness-Based Interventions for Early Adolescents for Attentional, Emotional, and Behavioral Self-Regulation.

(1) Background: Mindfulness-based interventions (MBIs) have shown interesting preliminary effects on self-regulation processes in early adolescence. However, programs have typically combined different types of interventions with no understanding of the specific effect of each intervention type on attentional, emotional, and behavioral regulation. The objective of this research was to evaluate the effect of two MBIs-one focused on classic attentional practices and another focused on the recognition and expression of emotions-on attentional, emotional, and behavioral self-regulation in early adolescents. (2) Method: An experimental paradigm was used. A sample of 74 children aged between 8 and 12 years old were randomly assigned to three experimental conditions: (1) an MBI with a focus on attentional practices, (2) an MBI with a focus on recognition and expression of emotions, and (3) a control group. The interventions lasted 8 weeks, with a weekly, 1 h online synchronous session plus home practices. Children were evaluated before starting the intervention and at the end of the 8-week period. The assessed outcomes were (1) mindfulness; (2) emotional regulation; (3) attentional regulation, and (4) behavioral regulation. (3) Results: Children who participated in both intervention programs increased their mindfulness and emotional and behavioral regulation scores. Only children who participated in the MBI with a focus on attention showed significant changes in their ability to self-regulate attention. (4) Conclusions: The use of online MBIs, with attention to external and internal stimuli practices, can be a good strategy to strengthen self-regulation skills for attention, emotions, and behavior in early adolescence.

Non-pharmacological interventions on quality of life in stroke survivors: A systematic review and meta-analysis.

Non-pharmacological interventions have been used in the rehabilitation of stroke survivors, but their effects on stroke survivors' quality of life (QoL) are unknown. This review aimed to summarize the existing evidence regarding non-pharmacological interventions for QoL in stroke survivors and to evaluate the effectiveness of different types of interventions. We systematically searched databases including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese BioMedical Literature Database, China Science and Technology Journal Database, and Wanfang data from the earliest available records to March 2023. Randomized controlled trials which explored the effects of non-pharmacological interventions on QoL in stroke patients were included. The meta-analysis was conducted to evaluate the effectiveness of different interventions on QoL. The Review Manager 5.3 was used to conduct the meta-analysis and the revised Cochrane risk-of-bias tool was used to assess the methodological quality of trials. A total of 93,245 records were identified, and 34 articles were reviewed and summarized, of which 20 articles were included in the meta-analysis. The summary of the findings of the included studies revealed fitness training, constraint-induced movement therapy (CIMT), physical exercise, music therapy (MT), and art-based interventions may have positive effects on QoL. The fitness training improved total QoL, especially in physical domains including physical functioning (mean difference [MD] = 10.90; 95% CI [7.20, 14.59]), role physical (MD = 10.63; 95% CI [6.71, 14.55]), and global health (MD = 8.76; 95% CI [5.14, 12.38]). The CIMT had a slight effect on general QoL (standardized mean difference [SMD] = 0.48, 95% CI [0.16, 0.80]), whereas significantly improved strength (MD = 8.84; 95% CI [1.31, 16.38]), activities of daily living/instrumental activities of daily living (ADL/IADL; MD = 10.42; 95% CI [2.98, 17.87]), and mobility (MD = 8.02; 95% CI [1.21, 14.83]). MT had a positive effect on the mental health domain (SMD = 0.54; 95% CI [0.14, 0.94]). Our findings suggest that fitness training and CIMThave a significant effect on improving physical QoL, while MThas a positive effect on improving psychological QoL. Future studies may use comprehensive and multicomponent interventions to simultaneously improve the patients' physical, psychological, and social QoL.

Best supportive care in advanced pancreas cancer: a systematic review to define a patient-care bundle.

The majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics. A systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned. Forty-four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health-related quality of life necessitates optimisation by involving family, carers and multi-disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required. This is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.

Is Acute Lower Back Pain Associated with Heart Rate Variability Changes? A Protocol for Systematic Reviews

Acute lower back pain (ALBP) is an extremely common musculoskeletal problem. ALBP consists of a sudden onset of short-duration pain in the lower back. However, repeated attacks can make the pain chronic. It can be measured through a self-report scale as well as through physical and physiological evaluations. Heart Rate Variability (HRV) has been used to evaluate the body’s response to pain. However, to the best of our knowledge, no clear consensus has been reached regarding the relationship between both variables and on an optimal protocol for ALBP evaluation based on HRV. The objective of this review is to analyze the relationship and effectiveness of HRV as an instrument for measuring ALBP. Furthermore, we consider the influence of different types of interventions in this relationship. The protocol of this review was previously recorded in the International Prospective Register of Systematic Reviews (number CRD42023437160). The PRISMA guidelines for systematic reviews and PubMed, WOS and Scopus databases are employed. Studies with samples of adults with ALBP are included. This study sets out a systematic review protocol to help identify the relationship between HRV and ALBP. Understanding this relationship could help in designing early detection or action protocols that alleviate ALBP.

Effects of the mental health promotion seminar ‘Coping with stress’ in the undergraduate medical curriculum of the Medical University of Vienna

BackgroundHigh prevalence rates of distress and burnout in medical students are well-documented in mental health literature. Different types of interventions have been developed in the past in order to reduce stress in medical undergraduate students and promote better coping skills. There is, however, a paucity of studies that have tested the effectiveness of these interventions. This study aimed to examine the effect of different versions of the seminar ‘Coping with stress’, which was implemented in the first year of the undergraduate curriculum of the Medical University of Vienna in the summer semester of 2018, on students’ mental health.MethodsInvitations to participate in the study were sent via email to six cohorts of students from the Medical University of Vienna. Two cohorts participated in the onsite version of the seminar ‘Coping with stress’, whereas two cohorts participated in the online version of the seminar, and two cohorts received no intervention (control group). Data on burnout risk, life satisfaction, stress, and knowledge about available help resources were collected via online questionnaires from n = 137 students before and after the curriculum module that contained the seminar.ResultsMedical students who participated in the onsite seminar reported a reduction of some aspects of burnout, a decrease in stress, and an increase in knowledge about available help resources. No such effect was seen in the control group. Participants of the online seminar experienced a similar increase in knowledge about available help resources, but no changes in other outcomes.ConclusionsThe findings support the notion that the onsite seminar of ‘Coping with stress’ had a positive impact on medical students’ mental health and is a useful addition to the medical curriculum by promoting mental health literacy.Trial registrationThis research has been registered in the German Clinical Trial Registry with the registration number DRKS00018981 and the registration date 14/11/2019.

HIV Prevention among Young People in Sub-Saharan Africa

Purpose: The commitment to getting to epidemic control by 2030, places the prevention of Human Immune Virus at the center of the response. With the disease affecting young people disproportionately, reducing HIV infections among this group is vital. This paper seeks to review data on the different types of interventions used in the prevention of HIV amongst young people in Sub-Saharan Africa. Method: Data search was done by reviewing journals through PubMed and Google scholar. Findings: Reviews found that school based approach improved on knowledge, attitude and reduced risky sexual behaviors among young people. Adolescent-responsive strategy was seen to be effective, sustainable and scalable. The percentage of condom use increased from 32% to 45% for females (p<.05) and from 44% to 61% for males (p<.01) with regular partners among Cameroonian youths. Condom use among sexually active students decreased from 61% in 2009 to 54% in 2019.HIV testing had low rates among young people. Oral PrEP demonstrated over 90% risk reduction of HIV. Circumcised men had a 60% HIV protection effect and cash transfers reduced HIV risk significantly among adolescent girls and young women with positive behavioral outcomes. Conclusion: HIV prevention approaches when integrated can achieve maximum effectiveness, but it’s important for these interventions to be tailored towards meeting the needs of young people. Knowing that they have unique developmental needs and challenges, prevention programs should be contextualized depending on the geographical location and environment to meet specific needs.

Non-pharmacological interventions for the reduction and maintenance of blood pressure in people with prehypertension: a systematic review protocol

IntroductionPrehypertension is defined as blood pressure that is above the normal range but not high enough to be classed as hypertension. Prehypertension is a warning of development of hypertension as...

Intervenções da Fonoaudiologia nas áreas de respiração, mastigação, deglutição e fala: uma revisão de escopo

ABSTRACT There are several types of approaches that can be used to achieve therapeutic goals in disorders related to the functions of mastication, swallowing, speech, and breathing. However, the literature lacks evidence to support their use in speech-language clinical practice. The objective of this review was to map the syntheses of evidence on speech-language pathology intervention in the areas of breathing, mastication, swallowing and speech in adults and the elderly. Only studies classified by their authors as a systematic review, studies that addressed therapy for orofacial disorders in individuals over 18 years of age were included. The procedures performed included: electronic and manual search; selection of studies; data extraction; evaluation of the quality of studies and data analysis. It was possible to observe different types of interventions mainly aimed at the swallowing function, ranging from traditional therapy to the use of devices. However, due to the limitations of the studies, the data must be interpreted with caution.

Implementing and embedding Social Prescribing successfully: what works, for whom and in which context?

Background: Integrating healthcare and social care is necessary because a substantial proportion of primary care clients receive unnecessary healthcare (not tailored to their social needs) which can lead to undesirable costs. Social prescribing is an innovative approach for more holistic person-centered care and aims to address clients’ social determinants of health. Often social prescribing services include link workers who support primary care patients to access community and voluntary care services. The aim is to replace the medical approach with a social approach to address patients’ needs. Previous literature has provided basic insights into how social prescribing can be implemented, especially in the early stages of implementation. Though little is known about how social prescribing can be fully embedded. This study provides guiding principles by which social prescribing can be implemented and embedded successfully and identifies which contextual factors and mechanisms influence these guiding principles.
 Methods: We conducted a Rapid Realist Review to understand what works, for whom in which context. This review consisted of three steps. The first step was to align the research questions with those of health/cure and care organizations. A local reference panel consisting of national organizations gave advice on the research questions and search strategy. Then, based on these questions a systematic search of the international peer-reviewed literature was conducted. Finally, a panel discussion was organized, engaging Dutch health care professionals working with social prescribing, to discuss what the international insights mean for their local contexts. This input helped to refine the literature review’s findings.
 Results: Preliminary results provided insight into what is needed for implementing and embedding social prescribing after a pilot phase. For example, investing in a change of culture mindset, enabling trust between health/cure and care professionals, creating facilitative conditions for professionals to work with social prescribing in daily practice. In this paper more detailed insights will be presented on the facilitators and barriers mechanisms for implementing and embedding social prescribing in healthcare and how they operate in different contexts. 
 Discussion: Internationally, social prescribing has gained more and more attention, and first implementation best practices have been identified. However, we found that different types of social prescribing interventions were implemented. We will reflect on how the guiding principles relate to the implementation and embedding of these different types of interventions. 
 
 Conclusion: Implementation and embedding of social prescribing is experienced as challenging, because of local differences in context, such as different populations and the way in which care is organized. The retrieved insights demonstrate which principles can be followed for implementation and embedding of social prescribing, for whom and in which context.
 Lessons Learned: We developed guiding principles for the embedding of social prescribing, and we provided insight into what this means for the context in the Netherlands.
 Suggestions for future research: Despite the increase in implementation, there is little knowledge on the effectiveness of social prescribing on health and wellbeing outcomes of patients, and changes in healthcare use. Future research should focus on gaining insight into the effectiveness and impact of social prescribing.
 
 
 

Interventions for gender equality in STEM education: A meta‐analysis

AbstractBackgroundAlthough gender inequality in education is gaining increasing attention, female underrepresentation remains pervasive in STEM fields. Many studies have applied various interventions to narrow the gender gap in STEM education.ObjectivesIn this study, we conducted a systematic meta‐analysis to examine the effectiveness of various interventions for gender equality in STEM education and tested the influence of moderator variables.MethodsTen databases—ERIC, IEEE, JSTOR, ProQuest‐Education, SAGE Journals, Scopus, Springer Link, Taylor & Francis, Web of Science, and Wiley Online Library—and seven high‐quality journals in related fields were selected as literature resources. The Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) process was used to identify eligible articles for the random‐effects meta‐analysis.Results and ConclusionsThe overall effect size (Hedges' g) was 0.434, indicating that the interventions promoting gender equality in STEM education had a near‐medium positive effect. There were significant differences by the type of intervention, but not by the type of intervention outcome. The results of the moderator analysis showed a significant difference in moderator variables, including country, educational level, form of experiment, intervention level, and different measurement methods, whereas there was no significant difference in the moderator variables, including economic development level and sample size.ImplicationsThis study examined the effectiveness of gender equality interventions and the impact on it of different types of intervention, intervention outcomes, and moderator variables. These results have implications for the design of gender equality interventions in STEM education.

Clinical effectiveness of treatments for the management of anxiety in community dwelling people living with dementia: a systematic review and meta‐analysis

AbstractBackgroundPeople living with dementia commonly experience distress or behavioural and psychological symptoms, such as anxiety, which are associated with worse outcomes in this population. Symptoms of anxiety can be challenging to manage, as there is limited evidence supporting the prescription of psychotropic medications and it is unclear if conventional psychological treatments, such as cognitive behavioural therapy, are effective. The aim of this systematic review and meta‐analysis was therefore to investigate the effectiveness of pharmacological and non‐pharmacological treatments for the management of anxiety in community dwelling people living with dementia.MethodA systematic review and meta‐analysis was conducted of randomised controlled trials until January 2022, searching EMBASE, CINAHL, MEDLINE and PsycInfo. This is currently being updated to Jan 2023. Standardised mean differences were estimated at follow‐up between treatments and pooled across studies using random‐effects models. The Cochrane risk‐of‐bias tool for randomized trials assessed risk of bias and meta‐analysis was performed if three or more studies of a treatment group were available.ResultTwenty‐seven studies (comprising 2517 participants) were included. We categorised these as pharmacological interventions (n = 8), non‐pharmacological group interventions (n = 8) and non‐pharmacological individual interventions (n = 11). Pharmacological interventions with evidence of potential effectiveness included olanzapine, loxapine, citalopram, buspirone and risperidone; and those with no evidence of effectiveness were thioridazine and haloperidol. Meta‐analyses was not performed due to study heterogeneity.Some non‐pharmacological treatments were found to be effective in reducing anxiety in people living with dementia, compared to usual care or active controls. For interventions aimed at individuals the pooled standardised mean difference was ‐0.41 (CI: ‐0.71, ‐0.11) and for those aimed at groups it was ‐0.44 (CI: ‐0.79, ‐0.09). When examining different type of intervention, results suggest music therapy and muscular approaches (e,g, relaxing massage) were effective in reducing anxiety symptoms, while cognitive approaches and sensory stimulation were not. We will present additional findings from updated searches.ConclusionResults suggest non‐pharmacological interventions can be effective in reducing anxiety in community‐dwelling people living with dementia. This supports the development and use of more group‐based non‐pharmacological interventions to help reduce anxiety among people living with dementia in the community and their carers.

Comparison of the effectiveness of lifestyle interventions and multi-interventional therapy on biochemical parameters of metabolic syndrome among women.

Metabolic syndrome is one of the emerging health issues in developing countries. It includes diabetes, high blood pressure, obesity, and elevated blood cholesterol. This study aimed to compare the effects of two different types of interventions: multi-interventional therapy (MIT) and lifestyle interventions (LIs) on high-density lipoprotein (HDL), triglycerides, and fasting blood sugar (FBS) among women with metabolic syndrome. The study used a quasi-experimental nonequivalent control group design with two experimental groups and one control group. This study was conducted among self-help group women from nine area development societies (ADS) in a selected area in South India from March 1, 2019, to February 28, 2020. Women (aged between 35 and 55 years) with metabolic syndrome were recruited by multistage sampling (N = 220) and randomly assigned into three groups: (a) control, (b) MIT (intervention 1), and (c) LIs (intervention 2). Reflexology foot massage, dietary modification, moderate-intensity exercise, and structured education were given to the MIT group and dietary modification, moderate-intensity exercise, and structured education were given to the LI group for 12 weeks. The control group received routine care. A demographic and clinical data sheet is used to collect the basic information. Biochemical variables (HDL, triglycerides, and FBS) were assessed before and after the intervention. The data obtained from the study were computed using a frequency distribution to describe the demographic characteristics, and a Chi-square (x2) test was conducted to find the homogeneity. Both parametric and nonparametric tests were conducted for the comparison of the effectiveness of different methods of interventions on biochemical parameters of metabolic syndrome. Women who received MIT and LI had significantly lower values of HDL, triglycerides, and FBS after the treatment from baseline and compared with the control group. The study found a significant improvement in the biochemical parameters in the MIT group as compared to the control group and the LI group (<0.001). Paired t-test shows significant improvement in HDL, triglycerides, and FBS (P < 0.001) in both the LI and MIT groups. In case of triglycerides, MIT was found to be more effective (P < 0.001). Both MIT and LIs can be considered interventions for reducing triglycerides and FBS and increasing HDL.

Component-Specific Effects of Team Case Management on Adult Sickle Cell Utilization in Moderate to Low Utilizers

Background: Utilization in adult sickle cell disease (SCD) patients is driven by a large array of biopsychosocial predictors which are often dominated by social determinants of health. We have previously demonstrated that disease management in an Adult Sickle Cell Medical Home may curb avoidable ED visits and hospitalizations, particularly in high utilizers (Blood).[i] However, further analysis is needed to determine the relative “doses” of components, and component-specific effects, of such team interventions as medical care for biological determinants; behavioral health counseling for behavioral determinants; case management for social determinants, and; administrative/reimbursement management for administrative determinants. And further analysis is needed to determine how the latter three, non-biological, components affected total utilization and subtypes of care utilization among moderate to low utilizers within the Medical Home. We examined the latter question for this analysis. The analysis was correlational and non-causal since interventions and outcomes occurred in the same time period. Method: We excluded data available during the “Pre-CoVID” years (2017-2019), in order to isolate impact apart from the COVID phenomenon. We also excluded the 50 Highest utilizers, defined as those with &amp;gt;$200,000 in annual medical charges in a given year and high utilization of the hospital, because they were already assigned specific case managers. Thus, our sample, unlike high-utilization patients, was not assigned specific case managers. We counted and empirically weighted any contact with any member of the Medical Home during a particular year as an intervention. We stacked counts of interventions-multiple visits were weighed more heavily than a single visit. Interventions could have included behavioral health counseling by a licensed clinical social worker. The number of these visits was counted. Case management by Community Health Workers called Patient Navigators (PNs) could have included three types of visits: inpatient, outpatient, and telephone. PN visit weights were obtained by measuring the number of each type of visit, and the time of each visit. Last, prior authorization case management by a reimbursement specialist who was a licensed pharmacy tech each intervention was counted. Thus, the maximum intervention score for any patient in any year was not capped. We calculated charges due to all ambulatory, ED, and hospital utilization separately, and we also calculated combined charges for all utilization. Statistics include Spearman's Correlations, comparing the annual intervention score to charges for each utilization outcome, recognizing that charges would reflect charges for ambulatory medical and behavioral interventions. Results: The sample included N=466 distinct individuals in 2020, 499 in 2021, and 522 in 2022, the “CoVID Years.” Correlations between the annual intervention scores and ambulatory, ED, hospital, and total utilization charges during each corresponding year are shown in Table 1. High PN contact (doses) correlated with more ambulatory visits. More PN contact (dose) was correlated with more inpatient discharges and either more ED visits, or insignificant reductions in ED visits. Conclusion: The case management components of an ambulatory case management program, where patients were not assigned case managers, were inconsistently associated with annual utilization costs for ambulatory care. Because these data were measured essentially simultaneously, we cannot draw causal inferences between management dose and utilization. Perhaps the most significant finding was determining a system of empiric weights for different types of interventions, and summary scores of all interventions may represent a new method to measure team interventions for case management in SCD. [i] Intensive Case Management in an Adult Sickle Cell Medical Home: Annual Effects on Utilization Efficiency Using Community Health Workers; Shirley Johnson, BA, LSW1*, Daniel M Sop, BS, MS2, Yue May Zhang, MS3*,Benjamin Jaworowski, BS 1*and Wally R Smith, MD4

Non-agency interventions for causal mediation in the presence of intermediate confounding

Abstract Recent approaches to causal inference have focused on causal effects defined as contrasts between the distribution of counterfactual outcomes under hypothetical interventions on the nodes of a graphical model. In this article, we develop theory for causal effects defined with respect to a different type of intervention, one which alters the information propagated through the edges of the graph. These information transfer interventions may be more useful than node interventions in settings in which causes are non-manipulable, for example when considering race or genetics as a causes. Furthermore, information transfer interventions allow us to define path-specific decompositions which are identified in the presence of treatment-induced mediator-outcome confounding, a practical problem whose general solution remains elusive. We prove that the proposed effects provide valid statistical tests of mechanisms, unlike popular methods based on randomised interventions on the mediator. We propose efficient non-parametric estimators for a covariance version of the proposed effects, using data-adaptive regression coupled with semi-parametric efficiency theory to address model misspecification bias while retaining n-consistency and asymptotic normality. We illustrate the use of our methods in two examples using publicly available data.

Abstract 16479: The Effects of Pulmonary Artery Catheter Usage and Treatment Intensity on Mortality in Patients With Cardiogenic Shock by Etiology

Background: The routine usage of pulmonary artery catheter (PAC) in the management of cardiogenic shock (CS) by etiology remains controversial. Objectives: We sought to study the prognostic effects of PAC usage and the escalation of care in a large CS cohort. Methods: Multicenter, retrospective, observational study from the Cardiogenic Shock Working Group registry (CSWG) registry. The baseline characteristics, hospital course, and outcome of patients (pts) with acute decompensated heart failure-CS (ADHF) and acute myocardial infarction-CS (AMI) who had PAC during hospitalization were obtained. Different types of interventions were analyzed and compared between survival and non-survival by etiology. Results: The registry had 3524 pts (58% ADHF, 28% AMI). The overall mortality rate was significantly higher in the AMI group (41 vs 29%, p &lt;0.0001). There was no difference in PAC usage (68 vs 62%). In ADHF, the mortality was significantly lower when PAC was used (22 vs 35%, P&lt;0.0001). However, in AMI, there was no significant mortality difference with PAC usage (40 vs 46%, P=0.052).Pts who had PAC (n=2260, 71% male, 2/3 ADHF) were then analyzed. ADHF had longer duration of PAC (6.3 vs 4.7 days). ADHF pts had more comorbidities (CKD, DM, AF) and better admission and max SCAI stage. However, AMI pts were older (60±14 vs 66±12 year p&lt;0001), more HTN and higher transfer rate. During hospitalization, the effect of treatment intensity with mechanical circulatory support (MCS) and drugs usage on mortality is summarized in fig.1 (a,b). Conclusions: In a large CS registry, we identified that ADHF is more common with much better prognosis than AMI despite similar PAC and drugs usage, and less MCS usage. This can be explained by the difference in baseline characteristic and the shock severity. PAC usage did correlate with better survival only in ADHF group. Multiple MCS and multiple drugs usage were associated with higher mortality in both groups. IABP, when used alone, had better survival.

Overdiagnosis in malignant melanoma: a scoping review

ObjectivesWe aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different...