Different Types Of Interventions Research Articles

Sleep disorders and effectiveness of various methods of insomnia therapy in pregnant women (Literature review)

Sleep disorders (dyssomnia) during pregnancy are of high prevalence and may be associated with negative peri- and postnatal outcomes. However, these conditions are often not effectively diagnosed and treated. In this review a systematic evaluation of the effectiveness of different methods of therapy to improve the quality of sleep and in the presence of insomnia during pregnancy was conducted.Systematic search in PubMed, Psycinfo and Medline databases was conducted without limiting the publication date till November 3, 2022. The relevant studies included pregnant women of any age and gestation; they included the clinical intervention schemes aimed at improving sleep quality; the data before and after treatment for one or more sleep-related results were reported. 16 studies were selected with a total of 988 pregnant women. According to the results of researches the effectiveness of different types of interventions was established: cognitive-behavioral therapy for sleep disorders, pharmacotherapy, acupuncture, yoga, relaxation and phytotherapy. The recent publications have determined that sleep disorders have a connection with the adverse pregnancy outcomes, including fetal growth restriction, premature births, weakness of uterine labor activity and high delivery frequency of caesarean section.There is an extremely high relevance and need for high-quality randomized controlled studies about sleep disorders during pregnancy and implementation of effective standard obstetric care programs. There is a necessity to improve psychological care and sleep care during pregnancy to maintain a positive pregnancy course, childbirth and postpartum period. Future clinical studies should be randomized and include a sufficient number of women for statistical efficacy, including checking the effectiveness of cognitive-behavioral insomnia therapy to prevent pregnancy/childbirth complications and somatic diseases in the long-term period.

Are we measuring loneliness in the same way in men and women in the general population and in the older population? Two studies of measurement equivalence.

High levels of loneliness are associated with negative health outcomes and there are several different types of interventions targeted at reducing feelings of loneliness. It is therefore important to accurately measure loneliness. A key unresolved debate in the conceptualisation and measurement of loneliness is whether it has a unidimensional or multidimensional structure. The aim of this study was to examine the dimensional structure of the widely used UCLA Loneliness Scale and establish whether this factorial structure is equivalent in men and women. Two online UK-based samples were recruited using Prolific. The participants in Study 1 were 492 adults, selected to be nationally representative by age and gender, whilst the participants in Study 2 were 290 older adults aged over 64. In both studies, participants completed the UCLA Loneliness Scale (Version 3) as part of a larger project. In both studies, the best fitting model was one with three factors corresponding to 'Isolation,' 'Relational Connectedness,' and 'Collective Connectedness.' A unidimensional single factor model was a substantially worse fit in both studies. In both studies, there were no meaningful differences between men and women in any of the three factors, suggesting measurement invariance across genders. These results are consistent with previous research in supporting a multidimensional, three factor structure to the UCLA scale, rather than a unidimensional structure. Further, the measurement invariance across genders suggests that the UCLA scale can be used to compare levels of loneliness across men and women. Overall the results suggest that loneliness has different facets and thus future research should consider treating the UCLA loneliness scale as a multidimensional scale, or using other scales which are designed to measure the different aspects of loneliness.

Body-oriented therapy in the prevention of eating disorders. A systematic review

Aim
 Despite the growing significance of body-oriented therapy and the broad applicability of psychotherapeutic methods that focus on the body, there is a general scarcity of systematic reviews analyzing the effectiveness of this therapeutic approach in addressing body image problems in persons with anorexia or at risk of anorexia. The above constitutes a barrier for practitioners, theoreticians who investigate the mechanisms underpinning therapeutic interventions, as well as educators who implement health promotion programs. The aim of this article was to review research studies analyzing the effects of different body-oriented interventions on body image perception in persons suffering from or at risk of eating disorders such as anorexia.
 Methods
 The review was conducted according to the PRISMA guidelines. Digital databases (ProQuest, PsychINFO, PubMed, ScienceDirect, Scopus, Web of Science) were searched for randomized control trials (RCT). A total of 425 records, including 69 full-length research articles, were critically analyzed. Fifteen trials that met all inclusion criteria were ultimately included in the analysis.
 Results 
 The review revealed that body-oriented therapeutic programs are more effective in reducing risk factors and reinforcing protective factors in comparison with the control groups, and that the inclusion of body-oriented therapy in standard therapeutic practice could substantially minimize the symptoms of eating disorders.
 Conclusions
 Further research is needed to directly compare the effects of different types of interventions on risk factors and protective factors.

Identifying Drug-Drug Interactions in Diabetic Patients with Chronic Kidney Disease: Pharmacist’s Interventions

Drug-drug interactions (DDIs) can negatively affect patients ‘therapeutic outcomes. Therefore, our aim was to evaluate DDIs among diabetic patients with chronic kidney disease (CKD). To achieve this aim, our objectives were to identify DDIs in diabetic patients with CKD admitted to the Medicine Department of the tertiary care hospital and to evaluate pharmacist’s interventions in managing DDIs among these patients. A prospective observational study was conducted over 6 months. The pharmacist performed a medication chart review, and DDIs were identified by using Lexicomp® drug interaction. The pharmacist informed prescribers regarding the occurrence of DDIs, and all pharmacist`s interventions were classified according to Pharmaceutical Care Network Europe. Overall 307 DDIs were identified among a total of 119 study patients with an average of 2.6 DDIs per patient. The most of identified DDIs (205, 66.7%) belonged to the interaction risk-rating category of C, which indicates that DDIs required close monitoring of patients’ therapy to avoid any potential adverse outcome. DDIs that needed to be managed by considering therapy modification (risk-rating category of D) and avoiding drug combination (risk-rating category of X) were accounted for 19.2% and 14.0% of all detected interactions, respectively. Interactions between Furosemide–Insulin (43, 14.0%), Amlodipine–Calcium carbonate/vitamin D3 (35, 11.4%) were found to be among most commonly identified DDIs. The pharmacist delivered different types of interventions to prescribers, which ranged from monitoring of therapy outcome to stopping DDIs. A great proportion of delivered pharmacist’s interventions (87%) were accepted by prescribers. Clinically significant DDIs occurred commonly in hospitalized diabetic patients with CKD. The pharmacist delivered important interventions in timely identifying DDIs.

Platelet components and bacterial contamination: hospital perspective 2022

Bacterial contamination of platelet units has been one of the most common transfusion-transmitted infections. Approximately 4 to 7 fatalities are being reported to the US Food and Drug Administration (FDA) annually, which cites bacterially contaminated platelet units as the cause. Over the past 3 decades, different mitigation strategies have been introduced to minimize the risk of morbidity and mortality related to contaminated platelet units. The process of platelet collection and manufacturing as well as storage at 20°C to 24°C contributes to higher prevalence of contaminated units. The risk of transfusing bacterially contaminated platelets can be lowered using different types of interventions. Prevention of bacterial contamination can be done by strict adherence to techniques that minimize contamination during unit collection. The detection of bacteria in platelet products can be improved with a combination of rapid testing and bacterial cultures that involve large volume and delayed sampling. Finally, pathogen reduction can inactivate bacteria or other pathogens present in the unit. This article describes different strategies that blood centers and transfusion services have undertaken since October 2021 to meet FDA guidance requirements. Market forces as well as feasibility of different FDA-proposed approaches have limited the number of practical solutions to just a few. In addition, the blood product availability required hospitals to adopt more progressive strategies to provide patients with needed platelet products.

Consumer-oriented interventions to extend smartphones’ service lifetime

A promising strategy to reduce smartphones' environmental footprint is to increase their service lifetime, thereby reducing the demand for resource-intensive production of new devices. Most of the existing literature focuses on production-oriented measures, such as improving repairability, but what remains missing is a systematic overview of consumer-oriented interventions to extend smartphones' service lifetime. In this study, we applied the consumer intervention mapping approach by systematically identifying consumer decision situations along the smartphone life cycle and interventions that encourage consumers to make smartphone lifetime-extending decisions. We identify two main mechanisms to achieve lifetime extension: retention by increasing the time during which a user keeps a device, and recirculation by passing on a device to an additional user. Altogether, we identified 26 different types of interventions to induce consumers to make smartphone lifetime-extending decisions and structure these according to consumer-influence techniques, e.g., informing consumers about retention/recirculation options and environmental impacts caused throughout device life cycles, persuading consumers by creating emotional attachment, nudging consumers through product labels for secondhand devices, simplifying execution of lifetime-extending decision options through take-back programs, and incentivizing lifetime-extension through buy-back programs. These interventions' success in achieving lifetime extensions and reducing environmental impacts in practice depends on the degree to which they actually extend smartphones' service lifetime and reduce production of new devices (displacement rate), induction and re-spending effects associated with the interventions, and the interventions’ implementation feasibility, which conflicts of interest in the smartphone ecosystem often challenge. • Overview of consumer decision situations that impact smartphones' service lifetime. • Specification of consumer-oriented interventions for smartphone lifetime extension. • Discussion of environmental implications of lifetime-extending interventions.

Telemedicine as a Tool to Improve Medicine Adherence in Patients with Affective Disorders - A Systematic Literature Review.

Affective disorders are a common psychological impairment. A major problem with respect to treatment is medication non-adherence. eHealth interventions are already widely used in the treatment of patients living with affective disorders. The aim of this systematic literature review is to obtain the current scientific evidence to eHealth as a tool to improve medication adherence in patients with affective disorders. A systematic search was performed across PubMed, Cochrane Library, Web of Science and PsycInfo. Studies in English and German published between 2007 and 2020 were included. The review followed the PRISMA guidelines and were performed with the CADIMA online tool. A total of 17 articles were included in this review. Eleven studies were randomized controlled trials, two were controlled clinical trials, and four had a pre-/post-design. Three different types of interventions could be identified: internet-based self-management programs (n=4), multi-faceted interventions addressing different dimensions of medication adherence (n=4), and single-faceted interventions (n=9) comprising four mobile interventions and five telehealth interventions. Eleven interventions addressed patients with (comorbid) depressions and six addressed patients with bipolar disorders. Six interventions showed a statistically significant positive effect on medication adherence. None of the studies showed a statistically significant negative effect. All interventions which had a statistically significant positive effect on medication adherence involved personal contacts between therapists and patients. All included eHealth interventions are at least as effective as control conditions and seems to be effective for patients with depression as well as with bipolar disorders. Personal contacts seem to improve the effectiveness of eHealth interventions. eHealth interventions are an effective way to improve medication adherence in patients with affective disorders. In rural or underserved regions, eHealth can supplement usual care interventions on medication adherence by expanding access. More analyses are needed in order to understand determinants for the effectiveness of eHealth interventions on medication adherence enhancement.

Rhythm-Based and Tonal-Based Music Interventions on Upper Extremity in Parkinson's Disease: A Scoping Review

<h3>Objective(s)</h3> To compare the effects of rhythmic-based and tonal-based music interventions on upper extremity (UE) outcomes in individuals with Parkinson's Disease (PD). Rhythmic-cueing utilizes external beats to influence motor execution of rhythmic movements (e.g., walking); tonal-based interventions incorporate melody and harmony to motivate and affect movement performance. However, the majority of the PD studies exclusively focused on rhythmic cueing for gait, which is a naturally paced movement. As the upper extremity (UE) movements are more varied and may be less rhythmed (e.g., dressing, handwriting), we wonder whether different types of intervention may provide distinct benefits in UE. <h3>Data Sources</h3> Five electronic databases (Cochrane, PubMed, Medline, CINAHL, and Embase) were used, with keyword combinations of Parkinson, rhythm/music, and upper extremity. All the searches were completed in August 2021. <h3>Study Selection</h3> Two pairs of two reviewers split the potential 1560 articles from the literature search and independently reviewed the article titles and abstracts for inclusion. Forty-six English-written full-text articles were further examined by two independent reviewers from either pair, resulting in a total of 22 studies included. <h3>Data Extraction</h3> All four independent reviewers extracted the descriptive data related to the intervention, the outcome measures, and the results. <h3>Data Synthesis</h3> The four reviewers classified the studies into three groups based on the intervention type: Rhythm-Only (n=12), Music-No-Beats (n=7), and Music-With-Beats (n=4) interventions. <h3>Conclusions</h3> Regardless of the intervention types, PD participants demonstrated consistent improvements in non-functional, rhythmed tasks (e.g., finger tapping) after training. However, no studies of Rhythm-Only interventions examined UE functions (e.g., dressing). Although 4 studies of Music-No-Beats interventions assessed UE functions (e.g., eating), none showed significant improvements. Further analysis suggests that interventions using familiar melodies could be distracting and deteriorate PD patients' performance. All the Music-With-Beats studies demonstrated significant results, but only one measured and showed functional benefits (in handwriting). Overall, only limited PD studies examined UE functional outcomes. More studies are needed to understand the unique effects of each intervention type for better clinical applications in PD. <h3>Author(s) Disclosures</h3> No conflict of interest.

A systematic scoping review on contextual factors associated with communicative participation among children with developmental language disorder.

Variations in communicative participation of children with developmental language disorder (DLD) cannot be wholly explained by their language difficulties alone and may be influenced by contextual factors. Contextual factors may support or hinder communicative participation in children, which makes their identification clinically relevant. To investigate which contextual (environmental and personal) factors in early childhood are protective, risk or neutral factors for communicative participation among school-aged children with DLD, and to identify possible gaps in knowledge about this subject. A scoping review was conducted based on a systematic search of studies published from January 2007 to March 2022 in Pubmed, Embase (without MEDLINE), CINAHL and PsycINFO. In total, 8802 studies were reviewed using predefined eligibility criteria, of which 32 studies were included for data extraction and critically appraised using the Critical Appraisal Skills Programme (2021) tools. The methodological quality of included studies was adequate to strong. Personal protective factors identified are being a preschool girl, reaching school age and being prosocial, while personal risk factors are becoming a teenager or adolescent, having low socio-cognitive skills and experiencing comorbid mobility impairment or behavioural problems. Gender after the preschool years and non-verbal abilities were not found to be of influence, and the role of socio-emotional skills is inconclusive. Receiving therapy is an environmental protective factor, while the association between socio-economical family characteristics with communicative participation is inconclusive. Limited research has been conducted on which risk and protective factors present in early childhood are associated with later communicative participation of children with DLD. The influence of co-occurring health conditions, social background variables, individual psychological assets, interpersonal relationships and attitudes of other people represent knowledge gaps. In addition, knowledge about the comparative effectiveness of different types of interventions and service delivery models, and the impact of administrative control, organizational mechanisms and standards established by governments on children's communicative participation is lacking. More longitudinal research is needed focusing on the identification of relevant personal and environmental factors and the interactions between them in relation to communicative participation outcomes. What is already known on this subject Children with DLD experience varying degrees of communicative participation restrictions. Insight into contextual factors that influence communicative participation can help to identify children at risk and inform family and child-centred therapy. Systematic research on contextual factors that facilitate or hinder communicative participation in children with DLD is currently lacking. What this paper adds to existing knowledge Knowledge of protective factors can guide the development of interventions for children and young people with DLD that boost resilience and facilitate communicative participation, while insight into the risk factors can help professionals identify the most vulnerable children and develop interventions that can lift or neutralize barriers present in the life of these children. Specific groups potentially at risk are young boys, children with co-morbid mobility impairment, children with conduct problems, and children reaching adolescence. In contrast, potentially protective factors are reaching school age and being prosocial. In addition, the development of socio-cognitive skills may be beneficial for the communicative participation of children with DLD. What are the potential or actual clinical implications of this work? To support communicative participation, it is important that professionals who work with children with DLD understand which groups are at risk for communicative participation restrictions, and which factors can foster resilience. In the absence of evidence-based instruments for the systematic assessment of personal and environmental factors, consulting parents and children on the contextual factors that they perceive as important remains critical.

Empirical evidence of study design biases in nutrition randomised controlled trials: a meta-epidemiological study

BackgroundInstruments to critically appraise randomised controlled trials (RCTs) are based on evidence from meta-epidemiological studies. We aim to conduct a meta-epidemiological study on the average bias associated with reported methodological trial characteristics such as random sequence generation, allocation concealment, blinding, incomplete outcome data, selective reporting, and compliance of RCTs in nutrition research.MethodsWe searched the Cochrane Database of Systematic Reviews, for systematic reviews of RCTs, published between 01 January 2010 and 31 December 2019. We combined the estimates of the average bias (e.g. ratio of risk ratios [RRR] or differences in standardised mean differences) in meta-analyses using the random-effects model. Subgroup analyses were conducted to investigate the potential differences among the RCTs with low versus high/unclear risk of bias with respect to the different types of interventions (e.g. micronutrients, fatty acids, dietary approach), outcomes (e.g. mortality, pregnancy outcomes), and type of outcome (objective, subjective). Heterogeneity was assessed through I2 and τ2, and prediction intervals were calculated.ResultsWe included 27 Cochrane nutrition reviews with 77 meta-analyses (n = 927 RCTs). The available evidence suggests that intervention effect estimates may not be exaggerated in RCTs with high/unclear risk of bias (versus low) judgement for sequence generation (RRR 0.97, 95% CI 0.93 to 1.02; I2 = 28%; τ2 = 0.002), allocation concealment (RRR 1.00, 95% CI 0.96 to 1.04; I2 = 27%; τ2 = 0.001), blinding of participants and personnel (RRR 0.95, 95% CI 0.91 to 1.00; I2 = 23%; τ2 = 0), selective reporting (RRR 0.97, 95% CI 0.92 to 1.02; I2 = 24%; τ2 = 0), and compliance (RRR 0.95, 95% CI 0.89 to 1.02; I2 = 0%; τ2 = 0). Intervention effect estimates seemed to be exaggerated in RCTs with a high/unclear risk of bias judgement for blinding of outcome assessment (RRR 0.81, 95% CI 0.70 to 0.94; I2 = 26%; τ2 = 0.03), which was predominately driven by subjective outcomes, and incomplete outcome data (RRR 0.92, 95% CI 0.88 to 0.97; I2 = 22%; τ2 = 0.001). For continuous outcomes, no differences were observed, except for selective reporting.ConclusionsOn average, most characteristics of nutrition RCTs may not exaggerate intervention effect estimates, but the average bias appears to be greatest in trials of subjective outcomes. Replication of this study is suggested in this field to keep this conclusion updated.

Supporting Human Dignity in a Collapsing Field: Gestalt Approach in the Social and Political Contexts

Supporting Human Dignity in a Collapsing Field: Gestalt Approach in the Social and Political Contexts

Crisis interventions for adults with borderline personality disorder.

People diagnosed with borderline personality disorder (BPD) frequently present to healthcare services in crisis, often with suicidal thoughts or actions. Despite this, little is known about what constitutes effective management of acute crises in this population and what type of interventions are helpful at times of crisis. In this review, we will examine the efficacy of crisis interventions, defined as an immediate response by one or more individuals to the acute distress experienced by another individual, designed to ensure safety and recovery and lasting no longer than one month. This review is an update of a previous Cochrane Review examining the evidence for the effects of crisis interventions in adults diagnosed with BPD. To assess the effects of crisis interventions in adults diagnosed with BPD in any setting. We searched CENTRAL, MEDLINE, Embase, nine other databases and three trials registers up to January 2022. We also checked reference lists, handsearched relevant journal archives andcontacted experts in the field to identify any unpublished or ongoing studies. Randomised controlled trials (RCTs) comparing crisis interventions with usual care, no intervention or waiting list, in adults of any age diagnosed with BPD. We used standard methodological procedures expected by Cochrane. We included two studies with 213 participants. One study (88 participants) was a feasibility RCT conducted in the UK that examined the effects of joint crisis plans (JCPs) plus treatment as usual (TAU) compared to TAU alone in people diagnosed with BPD. The primary outcome was self-harm. Participants had an average age of 36 years, and 81% were women. Government research councils funded the study. Risk of bias was unclear for blinding, but low in the other domains assessed. Evidence from this study suggested that there may be no difference between JCPs and TAU on deaths (risk ratio (RR) 0.91, 95% confidence interval (CI) 0.06 to 14.14; 88 participants; low-certainty evidence); mean number of self-harm episodes (mean difference (MD) 0.30, 95% CI -36.27 to 36.87; 72 participants; low-certainty evidence), number of inpatient mental health nights (MD 1.80, 95% CI -5.06 to 8.66; 73 participants; low-certainty evidence), or quality of life measured using the EuroQol five-dimension questionnaire (EQ-5D; MD -6.10, 95% CI -15.52 to 3.32; 72 participants; very low-certainty evidence). The study authors calculated an Incremental Cost Effectiveness Ratio of GBP -32,358 per quality-adjusted life year (QALY), favouring JCPs, but they described this result as "hypothesis-generating only" and we rated this as very low-certainty evidence. The other study (125 participants) was an RCT conducted in Sweden of brief admission to psychiatric hospital by self-referral (BA) compared to TAU, in people with self-harm or suicidal behaviour and three or more diagnostic criteria for BPD. The primary outcome was use of inpatient mental health services. Participants had an average age of 32 years, and 85% were women. Government research councils and non-profit foundations funded the study. Risk of bias was unclear for blinding and baseline imbalances, but low in the other domains assessed. The evidence suggested that there is no clear difference between BA and TAU on deaths (RR 0.49, 95% CI 0.05 to 5.29; 125 participants; low-certainty evidence), mean number of self-harm episodes (MD -0.03, 95% CI -2.26 to 2.20; 125 participants; low-certainty evidence), violence perpetration (RR 2.95, 95% CI 0.12 to 71.13; 125 participants; low-certainty evidence), or days of inpatient mental health care (MD 0.70, 95% CI -14.32 to 15.72; 125 participants; low-certainty evidence). The study suggested that BA may have little or no effect on the mean number of suicide attempts (MD 0.00, 95% CI -0.06 to 0.06; 125 participants; very low-certainty evidence). We also identified three ongoing RCTs that met our inclusion criteria. The results will be incorporated into future updates of this review. A comprehensive search of the literature revealed very little RCT-based evidence to inform the management of acute crises in people diagnosed with BPD. We included two studies of two very different types of intervention (JCP and BA). We found no clear evidence of a benefit over TAU in any of our main outcomes. We are very uncertain about the true effects of either intervention, as the evidence was judged low- and very low-certainty, and there was only a single study of each intervention. There is an urgent need for high-quality, large-scale, adequately powered RCTs on crisis interventions for people diagnosed with BPD, in addition to development of new crisis interventions.

Seasonal influenza vaccine uptake among healthcare workers in tertiary care hospitals, Bangladesh: Study protocol for influenza vaccine supply and awareness intervention

BackgroundHealthcare workers (HCWs), such as doctors, nurses, and support staffs involved in direct or indirect patient care, are at increased risk of influenza virus infections due to occupational exposures. Vaccination is the most effective way to prevent influenza. Despite the World Health Organization (WHO) recommendations, Bangladesh lacks a seasonal influenza vaccination policy for HCWs, and thus vaccination rates remain low. The current project aims to investigate the effect of interventions on influenza vaccine awareness and availability of vaccine supply, explore HCWs’ knowledge and perceptions about influenza vaccination, understand the barriers and motivators for influenza vaccine uptake, and understand policymakers' views on the practicality of influenza vaccination among HCWs.MethodWe will conduct the study at four tertiary care teaching hospitals in Bangladesh, using a cluster randomized controlled trial approach, with the hospital as the unit of randomization and intervention. The study population will include all types of HCWs.The four different types of intervention will be randomly allocated and implemented in four study hospitals separately. The four interventions will be: i) ensuring the availability of influenza vaccine supply; ii) developing influenza vaccine awareness; iii) both ensuring influenza vaccine supply and developing influenza vaccine awareness and iv) control arm with no intervention. Both quantitative and qualitative approaches will be applied to assess the intervention effect. We will estimate the Difference in Differences (DID) with 95% CI of the proportion of vaccine uptake between each intervention and control (non-intervention) arm, adjusting for the clustering effect. The qualitative data will be summarised using a framework matrix method.DiscussionThe results of this study will inform the development and implementation of a context-specific strategy to enhance influenza vaccination rates among Bangladeshi HCWs.Trial registrationClinicaltrials.gov NCT05521763. Version 2.0 was registered in September 2022, and the first participant enrolled in March 2022. Retrospectively registered.

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.