Effectiveness Of Interventions Research Articles

Effect of an online training intervention on evidence-based practice in clinical nurses. #Evidencer Project.

Online learning is becoming increasingly essential for health professionals, and it is necessary to understand how this modality affects clinical nurses' learning of Evidence-Based Practice (EBP). For this reason, the present study sought to assess the effectiveness of an online training program in improving nurses' EBP competence. A quasi-experimental study with a pretest-posttest design was conducted with a control group and without randomization for a period of 6months. The intervention was an online self-learning course based on Melnyk's seven steps of Evidence-Based Practice (EBP). The course was structured into sequential modules requiring 72h of work, with task completions and tests necessary for progression. Participants had three months to complete the course. EBP competence was measured with the EBP-COQ Prof© questionnaire. Data analysis included percentages, means, standard deviations, chi-square tests, student's t-tests, and a two-way repeated measuresanalysis of covariance (ANCOVA). The analysis of the changes observed in each dimension and the overall EBP competence between the intervention group (IG) and the control group (CG) showed a significant group*time interaction in three of the four dimensions of the questionnaire. The results indicated that the online Evidence-Based Practice (EBP) course significantly improved knowledge, skills, and utilization three months after its completion. In the IG, the mean score was 44.04 (standard deviation (SD) = 7), compared to 37.83 (SD = 8.5) in the CG (p < 0.001). Regarding skills, the IG had a mean score of 24.24 (SD = 3.8), while the CG scored 23.01 (SD = 3.1) (p = 0.008). For utilization, the mean score in the IG was 36.77 (SD = 6.8), and the CG was 33.12 (SD = 6.3) (p = 0.005). Overall competence also showed a statistically significant difference, with the IG achieving a mean score of 141.22 (SD = 20.0) compared to the CG with a mean score of 130.34 (SD = 16.7) (p < 0.001). Training through an online education platform for three months (72h) is an effective tool for improving the competence in Evidence-Based Practice (EBP) of clinical nurses. A significant increase was observed in knowledge and moderate improvements in skills and the application of EBP. These online courses, adapted to the needs of professionals, can be an efficient way to prepare nurses and improve their application of EBP in a clinical setting.

A Gaussian Process Regression and Wavelet Transform Time Series approaches to modeling Influenza A.

The global spread of Influenza A viruses is worsening economic and social challenges. Various mechanistic models have been developed to understand the virus's spread and evaluate intervention effectiveness. This study aimed to model the temporal dynamics of Influenza A using Gaussian Process Regression (GPR) and wavelet transform approaches. The study employed Continuous Wavelet Transform (CWT), Discrete Wavelet Transform (DWT) and Wavelet Power Spectrum to analyze time-series data from 2009 to 2023. The GPR model, known for its non-parametric Bayesian nature, effectively captured non-linear trends in the Influenza A data, while wavelet transforms provided insights into frequency and time-localized characteristics. The integration of GPR with DWT denoising techniques demonstrated superior performance in forecasting Influenza A cases compared to traditional models like Auto Regressive Integrated Moving Averages (ARIMA) and Exponential Smoothing (ETS) using Holt-Winter method. The study identified significant anomalies in Influenza A cases, corresponding to known pandemic events and seasonal variations. These findings highlight the effectiveness of combining wavelet transform analysis with GPR in understanding and predicting infectious disease patterns, offering valuable insights for public health planning and intervention strategies. The research recommends extending this approach to other respiratory viruses to assess its broader applicability.

Effectiveness of HIV prevention interventions targeting long-distance truck drivers: protocol for a systematic review and meta-analysis of global evidence

IntroductionGlobally, long-distance truck drivers’ (LDTDs) risk of exposure to HIV infections is higher compared with other populations in transit. Thus, several HIV prevention interventions have been implemented, though to a...

Transition from Virtual Reality to Metaverse: Students’ Experiences Regarding the Future of Nursing Education

The study was aimed at determining the effect of educational intervention on nursing students’ awareness of virtual reality (VR), augmented reality (AR), and metaverse in nursing education, both on their level of virtual presence, and their knowledge of, attitudes towards, and awareness of metaverse. A quasi-experimental study with a single-group pretest–posttest design study was conducted at a university. Ninety-three nursing students participated in the present study. Descriptive statistics, independent t-tests, and Pearson’s correlation analysis were used for data analysis. Of all the participants, 60.2% had heard of metaverse, 50.5% had VR experience, and 62.4% said that metaverse could be used in nursing education in the future. The participating nursing students’ experiences regarding their transition from VR to metaverse revealed that their level of readiness for e-learning and knowledge and awareness of metaverse was high. It was concluded that metaverse could be used in nursing education within the possibilities provided by today’s technology.

Health Literacy in Fall Prevention Strategy: A Scoping Review.

Although the significance of health literacy (HL) in fall prevention strategies is growing, limited knowledge is available regarding the relationship, impact, and role of HL in falls. This scoping review aimed to explore and synthesize the current evidence regarding the role of HL in enhancing fall prevention in hospital and community settings. We adhered to the Joanna Briggs Institute manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for scoping reviews. PubMed, CINAHL, EMBASE, and the Cochrane Library were searched until November 2023 using Medical Subject Headings and text words. Studies related to HL and falls, regardless of study design, were considered eligible. We screened 99,249 records, of which 27 were included: 12 interventional studies, seven observational studies, four qualitative studies, and four mixed methods studies. Two-thirds of the studies were conducted in community-based settings. Four observational studies reported that HL was associated with fall-related outcome including fall incidence. Although intervention studies did not encompass all elements of HL based on the Health Literacy Framework, eight out of 12 intervention studies reported effect of HL-embedded fall prevention interventions, and HL was effective in fall-related outcomes including fall incidence in six studies. Three of 14 studies reported the measurement properties of fall-related HL. While HL can be increased through tailored information, verbal debriefing, interactive communication, and culturally adapted interventions, low HL impedes the understanding of education, engaging interventions, and using technological devices in implementing fall prevention interventions in qualitative and mixed methods studies. This scoping review suggests that nurses need to recognize and assess patients' HL as a potential risk factor for falls and implement fall prevention interventions based on the HL level of participants. Further research is required to develop culturally adapted and fall-relevant HL measures applicable to various vulnerable populations and settings.

(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol.

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!. In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group's needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one's daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3). This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI. ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.

Using social media for agricultural information dissemination: the role of informant-recipient homogeneity

ABSTRACT This study uses a randomised experiment targeting wheat producers in Ethiopia to examine the impact of providing market price information through Facebook on farmers’ sales behaviour. To identify the effect of informant homogeneity, we distinguished the informants’ nationality as either Ethiopian or foreign. Our findings reveal that when wheat selling prices were provided immediately after the harvest – when prices are typically at their lowest – only the information provided by Ethiopian informants led to a reduction in sales decisions and sales volume during that period. This information did not affect selling prices during the low-price period. However, analysis of data collected six months post-harvest shows that the selling price of wheat increased by approximately 14% due to information from Ethiopian informants. This suggests that farmers used the price information to delay sales until prices were higher, rather than negotiating with traders during the low-price period. Additionally, our heterogeneity analysis reveals that older, poorer, more socially isolated, and female farmers benefited more from domestic informant information, likely due to their previously limited access to information. These findings demonstrate the potential of social media for efficiently disseminating price information and highlight the importance of informant homogeneity in the effectiveness of such interventions.

Effectiveness of a three-component intervention supporting unemployed individuals with mental health issues in their job search and mental health recovery (3for1): study protocol of a non-randomized controlled study.

There is a vicious cycle between unemployment and mental health issues. Unemployed individuals with mental health issues require individualized support at multiple levels in order to promote their mental health, and obtain and retain employment. The 3for1-intervention program aims to provide such support with three components (short-term psychotherapy, job coaching based on the Individual Placement and Support approach, and peer support). This study protocol outlines how the effectiveness of this three-component intervention program in terms of re-employment, mental health, and psychosocial outcomes will be evaluated. The 3for1-intervention program will be evaluated with a non-randomized controlled trial design in a multi-center study. 500 eligible participants aged between 18 and 60 years from six job centers in Southern Germany will be allocated to a control group or an intervention group. Allocation is time-based, with the control group being recruited first, followed by recruitment of the intervention group. The control group will receive treatment as usual, whereas the intervention group will receive treatment as usual as well as access to the three intervention components over a period of 12 months. Assessment will be conducted at baseline (t0), and 12 (t1) and 18 (t3) months later. The primary outcome will be the proportion of participants who are in employment subject to social insurance contributions at t1. Differences between control and intervention group will be tested with logistic regression analysis, controlling for relevant covariates. Analyses of secondary outcomes will relate to group differences regarding re-employment, health and well-being, social integration, help-seeking, and self-stigma at t1 and t2, applying logistic regression analysis or analysis of covariance. Additionally, usage of health services will be measured to evaluate the intervention program's cost effectiveness. The 3for1-intervention aims to improve employability and mental health outcomes of a vulnerable population with high need for assistance. Improvements for this population would benefit the German welfare state as well. This study could provide valuable insights into the feasibility, implementation, and sustainability of this individualized, multi-level support program within German job centers. This trial is registered with the German Clinical Trials Register: DRKS00029002 (registered on 11 May 2022).

Evaluation of a meaning in life intervention applied to work: A randomized clinical trial.

Meaning-based interventions have demonstrated promising outcomes in enhancing meaning in life. However, understanding their efficacy in diverse contexts requires further research. This study aims to investigate the effectiveness of a meaning-based intervention in a military sample and the impact of incorporating an additional emotion regulation module into the intervention. We conducted a randomized three-group parallel trial with active-duty military personnel: a waitlist control group (n= 21), a meaning-based intervention group (n= 42), and a meaning-based intervention with emotion regulation group (n= 43). Both intervention groups received six 2-hour sessions and a follow-up session 4 months later. Meaning in life and work-related variables, as well as well-being, depression, emotion regulation, and work-related factors, were assessed using a mixed-factorial analysis of variance (ANOVA). The results showed that only the meaning-based intervention with an emotion regulation component significantly increased the presence of meaning in life. We also observed a trend toward improved well-being scores over time that did not emerge for the other intervention. This study provides initial support for the efficacy of meaning-based interventions within the military context when supplemented with emotion regulation skills.

"Instead of Building More Buildings, They Should Plant More Trees", a Photovoice Study of Determinants of Happiness and Sadness Among East London Adolescents.

Globally, mental health problems in adolescents, alongside associated morbidity and mortality, have never been higher. Local living, working and environmental conditions, socio-economics, and intra-individual and inter-individual processes impact mental health. The risk of developing mental health problems is higher in certain areas, including East London. However, limited research explores East London adolescents' experiences of mental health. An in-depth and locally situated understanding of determinants shaping East London adolescents' happiness and sadness is needed. This study used Photovoice, a qualitative method within a community-based participatory research methodology, to generate photographic and textual data, which was analyzed using reflexive thematic analysis. This method allows participants to be part of knowledge production and authors to present the data. Our findings underscore the bidirectional interplay between environmental factors and adolescents' happiness and sadness. Gratitude for nature was described as increasing happiness: adolescents connected to nature to memories, appreciation, and leisure opportunities. Adolescents were concerned about the fragility of nature in response to urban development. The urban environment was perceived as imposing, inspiring, and offering therapeutic benefits blighted by pollution. Beautiful areas were described as paradisical and lacking, revealing urban development and economic productivity disparities. Our research documents the voices of an under-researched group, revealing novel insights while empowering adolescents as co-producers of mental health research. This study indicates participatory research is valuable for granting adolescents autonomy and addressing misrepresentation. The findings implicate multiple stakeholders, including "Health in All Policies." By deepening our understanding of adolescent mental health in East London, our study can be leveraged to bolster the effectiveness and relevance of interventions for East London adolescents.

Effects of social support interventions on LGBTQ+ survivor-victims of Intimate Partner Violence: a systematic review

Intimate Partner Violence (IPV) is a significant global health concern associated with poor physical and mental health outcomes and overall mortality. IPV is highly prevalent in LGBTQ+ individuals, but interventions targeting LGBTQ+ survivor-victims of IPV remain scarce. Although interventions using a social support approach have a well-documented positive effect on cisgender heterosexual survivor-victims, relatively little is known about how these interventions impact LGBTQ+ survivor-victims. This systematic review synthesizes literature on effects of social support interventions on LGBTQ+ survivor-victims of IPV. Using a comprehensive search strategy, one quantitative and six qualitative studies were identified and included. Observed themes include connection, mentorship, representation, discrimination, safety, service access, and service utilization. Findings highlight that, while interventions can have numerous benefits, there are also notable adverse impacts, including safety risks and discrimination. Services that are specialized for LGBTQ+ survivor-victims or are community-focused were most beneficial. Overall, this review is evidence that much more research is needed to continue understanding the effects of social support interventions and to optimize the support provided for LGBTQ+ survivor-victims of IPV.

The effectiveness of telemedicine applications in mental health services: a meta-analysis study.

This study was conducted to reveal the effectiveness of telemedicine applications in mental health services. For this meta-analysis study, data were obtained by searching PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center databases for the last 5years in September-December 2023. After the review, 24 studies were included. In this meta-analysis, it was found that telemedicine interventions in mental health services decreased the depression level of individuals (SMD - 0.168, 95% CI - 0.315 to - 0.021; Z = - 2.243; p < .05). In addition, it was determined that the duration of the intervention played a role in the effectiveness of telemedicine interventions applied to individuals. In addition, it was determined that the type of intervention, the country where the research was conducted, and the patient group did not play a role in the effectiveness of telemedicine interventions applied to individuals. Telemedicine applications in mental health services can play an effective role in reducing the burden of chronic mental illness and improving patient outcomes.

About Distress in Chronic Pain Conditions: A Pre–Post Study on the Effectiveness of a Mindfulness-Based Intervention for Fibromyalgia and Low Back Pain Patients

Chronic pain (CP) affects about 30% of the global population and poses significant challenges to individuals and healthcare systems worldwide. The interactions between physiological, psychological, and social factors are crucial in the onset and development of CP conditions. This study aimed to evaluate the effectiveness of mindfulness-based intervention, examining its impact on perceived stress (PSS), depression and anxiety (BDI-II, PGWBI/DEP, SAS, STAI Y), sleep quality (PSQI), and mindfulness abilities (MAAS) in individuals with CP. Participants (N = 89, 84.3% female) underwent one of two diagnoses [fibromyalgia (FM) or low back pain (LBP)] and took part in an MBSR intervention. The mindfulness program proved effective in reducing PSQI scores (F = 11.97; p &lt; 0.01) over time, independently of the type of diagnosis. There was also a marginal increase in trait mindfulness as measured by MAAS (F = 3.25; p = 0.07) in both groups. A significant difference between the two groups was found for the effect on PSS: F (1,87) = 6.46; p &lt; 0.05. Mindfulness practice also reduced anxiety in FM and depressive symptoms in LBP, indicating a reduction in psychological distress among participants. Our findings suggest that mindfulness-based interventions may offer promising avenues for personalized pain management in clinical settings.

Intention to use short messaging services for promoting drug adherence among individuals with diabetes in Addis Ababa, Ethiopia

Background Suboptimal medication adherence among individuals with diabetes presents a significant challenge in low-income nations. Growing evidence demonstrates the effectiveness of text messaging interventions to enhance medication adherence. This study assesses the intention to use Short Messaging Service (SMS) based reminder services in promoting drug adherence among diabetic patients and associated factors in Addis Ababa, Ethiopia. Methods An institution-based cross-sectional study was conducted from February 06, 2023, to March 27, 2023, in Addis Ababa, Ethiopia. A sample of 351 patients was selected using systematic random sampling. Structured questionnaires were used for data collection. Binary and multivariable logistic regression models were used to analyze the association between intention to use SMS reminders to promote drug adherence among individuals with diabetes and related factors. Results A total of 333 respondents, with a 94.87% response rate, were interviewed for this study. The majority of respondents, 66.4 % (95% CI [61.9–71.2]), expressed an intention to use SMS-based reminder services to promote their drug adherence. Age &lt; 45 years (AOR = 5.73, 95% CI [2.07–15.73]), higher educational level (AOR = 3.03, 95% CI [1.16–7.90]), type of diabetes (AOR = 3.71, 95% CI [1.16–7.90]), oral medication users (AOR = 2.99, 95% CI [1.42–6.32]), SMS as a preferred medium for communication (AOR = 2.86, 95% CI [1.17–7.00]) were deemed to be important variables linked to intention to use SMS reminders to promote drug adherence among individuals with diabetes. Conclusion The findings suggest the majority of individuals with diabetes have intention to use SMS reminders to enhance adherence. This result indicates the potential for utilization of SMS reminders to enhance adherence to diabetic medications. Furthermore, the findings highlight the importance of tailored interventions that take into account patient characteristics and preferences as factors that influence intention when designing such an intervention.

A07 - EDI&amp;S Outputs of appointing a Trainee Executive Group in delivering a multi-centre randomized controlled surgical trial: Lessons learnt from The Sunflower Study

Abstract Background Randomised controlled trials (RCTs) are widely accepted as the ‘gold standard’ for evaluating the effectiveness of health interventions. Trial recruitment is notoriously difficult, with approximately 57% of publicly funded RCTs not meeting recruitment target sample sizes. Trainee involvement can be crucial for large scale clinical studies. However, there remains limited knowledge about methods in which trainee collaboration can assist studies in achieving their aims. The Sunflower Study is the UKs largest surgical RCT and is unique in piloting the establishment of a Trainee Executive Group (TEG). Here we explore the outputs of the TEG and its impact on the study. Method The TEG consists of five trainee representatives of different training grades and research backgrounds, all appointed via national selection. The TEG held regular virtual meetings seeking to understand trainee perspectives on RCTs recruitment, champion and disseminate examples of good recruitment, indentify recruitment barriers, optimise The Sunflower Study's social media presence and update digital resources via a trainee section on its website. The TEG also established a network of regional representatives with the purpose of connecting neighbouring recruitment sites with one another, disseminating knowledge at a local level, sharing recruitment tips and encouraging local/national competition. All of these strategies aimed to ultimately boost patient recruitment. Results The regional representative network assisted with setting up a new recruitment site, who have since remained a top recruiter. The TEGs establishment saw the highest number of trainees attend the study's yearly ‘Investigators' Meeting’. The TEGs engagement with the study’s social media led to an increase in follower numbers and consistently maintained high tweet impressions. The Sunflower Study is affiliated with the NIHR API scheme and has 165 collaborators registered with the scheme - the highest of any UK study. Through this, trainees are able to develop leadership, communication and research skills; as well as gain competencies required for CCT. Conclusion The implementation of the TEG illustrates how innovative strategies can be utilised to actively involve trainees in research. Following the establishment of the TEG, new sites participated in the study, the study's social media impact increased and trainee engagement was optimised. The TEG also encouraged trainees' future involvement with research through the API scheme. In the post-COVID-19 era, collaborative studies have proven their role in providing high impact quality research. Future studies could foster the TEG model, with an appointed trainee leadership team focusing on maximising trainee output, providing benefits not only for the trainees themselves, but also recruitment sites and studies overall.

Support for parents and families after stillbirth and neonatal death.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To identify and assess the effect of support interventions focused on psychological, social, and emotional outcomes for bereaved parents (including birth and non-birthing mothers, fathers, partners) and family members of parents (e.g. grandparents; siblings) who have experienced stillbirth or neonatal death.

MitoQ enhances CYP19A1 expression to stimulate WNT/β-catenin signaling pathway for promoting hair growth in androgenetic alopecia.

Increased sensitivity to androgens and androgen receptors is the underlying cause of androgenetic alopecia (AGA), a hereditary disease. Our study investigated the preventive effects of MitoQ on dihydrotestosterone (DHT)-induced mitochondrial dysfunction and subsequent hair loss from three perspectives: in vivo, in vitro, and network pharmacology. A mouse model of AGA was used to assess the effectiveness of MitoQ intervention. Seventy-five drug targets and 367 disease targets were identified through network pharmacology analysis. Molecular docking analysis revealed that the androgen receptor (AR) and CYP19A1, which are key targets of MitoQ, may play a role in AGA treatment. CYP19A1 expression was downregulated in lesions from patients with AGA compared to healthy scalp tissue, while AR expression was upregulated. Cellular tests of human dermal papilla cells (DPCs) treated with MitoQ revealed that the mRNA and protein expression of AR remained unchanged, but the mRNA expression of CYP19A1 was upregulated. Our experiments also confirmed that CYP19A1 overexpression prevented DHT-induced apoptosis and upregulated the expression levels of WNT3A and β-catenin, whereas increased apoptosis levels and the downregulation of WNT3A and β-catenin due to CYP19A1 knockdown were reduced by MitoQ. We verified that MitoQ enhanced hair growth in DHT-induced hair loss model mice and reversed DHT-induced apoptosis by enhancing the expression of CYP19A1 in DPCs and that MitoQ may act by mediating the WNT/β-catenin pathway. These findings indicate that MitoQ could be a promising intervention for AGA and that CYP19A1 may serve as a valuable therapeutic target for AGA.

Acute effects of motor imagery interventions and physical exercise on tongue strength and pain in healthy adults: a randomized, crossover trial

Abstract Background Motor imagery (MI) has increasingly been used in physiotherapy. Oral rehabilitation may be a potential application area for MI. The aim of this study is to investigate the acute effects of orofacial and tongue muscle strengthening exercises in the form of physical exercise and motor imagery on pain and tongue strength in healthy adults. Thirty asymptomatic adults were included in this trial. MI skills were evaluated using the Movement Imagery Questionnaire-Revised and the mental chronometer. The pain and strength were assessed using an algometer and a tongue pressure device. Following the baseline evaluations, three interventions: physical exercise, kinesthetic motor imagery, and visual motor imagery, were applied randomly on different days. Pain and tongue strength were re-evaluated immediately after the interventions. Results The physical exercise program did not significantly improve pain and tongue strength (p &gt; 0.05). Following the kinesthetic MI training, a significant increase was detected (p = 0.016, d = 0.51) in the left masseter muscle pain threshold. Visual MI training resulted in improvements in anterior tongue strength (p = 0.002, d = 0.66) and left masseter muscle pain (p = 0.024, d = 0.40). Conclusions The present study suggests that different motor imagery strategies may have different effects on tongue muscle strength and pain threshold in healthy adults.

Effects of clowning on anxiety, stress, pain, and hormonal markers in paediatric patients.

Clowning has been used in many hospitals, particularly for children. Studies suggest the effectiveness of this methodology, but more evidence is needed. The aim of this study was to evaluate the impact of a humour therapy intervention on biological markers, pain and anxiety levels in paediatric patients. Three different clinical contexts were chosen to assess the effect of clowning interventions: patients who were subjected to venepuncture (group 1), patients undergoing general anesthesia for any cause (group 2)and patients hospitalized in the pediatric ward without distinction of their disease (group 3). Groups 1 and 2 were divided into control (C) and intervention (I) subgroups. A saliva sample was taken from all the children to measure oxytocin and cortisol levels by ELISAs. Validated scales and crying time were used to determine pain, stress, and anxiety levels. Children in group 3 were assessed before and after the intervention, employing the same methods. A total of 272 patients were included. The children in group 1 (n = 125) were 7.7 ± 3.2 years old, and 53.6% were females. 48% were in the I group, which showed decreased cortisol levels and increased oxytocin levels. The I group exhibited a decrease in perceived pain and crying time. The children in group 2 (n = 69) were aged 7.1 ± 3.5 years, and 36% were females. 51% were in the I group, which showed increased oxytocin levels and decreased cortisol levels, acute stress levels, perceived pain, and crying time. The children in group 3 (n = 78) were 8.6 ± 3.3 years old, and 54% of the children were females. There was an increase in oxytocin levels and a decrease in cortisol levels, stress levels and perceived pain following the intervention. This study suggested that an intervention based on clowning is an effective strategy for decreasing pain, stress, and anxiety levels in paediatric patients in different clinical contexts. These findings support the implementation of humour therapy programs in paediatric units.

Alignment of Audiologists' Values With Best-Practice Standards: Insights From a National Survey.

Previous research documented the values of audiology through a qualitative content analysis of documents representing traditional, best-practice hearing health care. The primary objective of this study was to validate the existing list of audiology values. Through a nationwide survey, this study aimed to elicit the values of practicing audiologists, with a specific focus on the prescription and dispensing of amplification devices, to ensure a comprehensive understanding of their priorities. Additionally, this study sought to identify any values missing from the original list and determine the rank order importance of these values, comparing this to the prioritization of values found in best-practice audiology documents. This comparison aimed to assess the alignment of recommended guidelines and real-world practices in hearing health care. An online survey was distributed to audiologists to elicit the prioritization of values from hearing health care providers. Participants were tasked with sorting and ranking 18 items, each representing a specific value in hearing health care, based on importance. Respondents were encouraged to suggest and rank the importance of additional values not included in the list. Audiologists were recruited from professional association mailing lists and direct contact. Respondent demographics were representative of U.S. audiologists. Qualitative content analysis was used to interpret values suggested by audiologists. Kendall's rank distance test was used to compare values prioritization between audiologists and best-practice audiology documents. After filtering out incomplete or disqualifying responses, data from 289 audiologists across 46 states were analyzed. Additional values suggested by respondents aligned with existing values from best-practice documents; thus, no new values were added as a result of this study. A ranked list of values based on mean order of importance was elicited from U.S.-based audiologists. There was substantial agreement between survey results and the rank order of values found in best-practice audiology documents. A demographic subgroup analysis revealed a broad agreement among audiologists in the rank order of values. This study validated a comprehensive list of values in audiology and identified the rank order of values among a nationally representative sample of audiologists. The findings provide a foundation for future investigations into how these values influence decision-making processes for individuals with hearing difficulty. Addressing values conflicts as potential barriers to hearing health care usage can lead to solutions aligned with values of specific populations, ultimately improving the adoption and effectiveness of hearing health care interventions. https://doi.org/10.23641/asha.27478149.