Efficacy Of Initiative Research Articles

Evaluating the Efficacy of Social Innovation Programming at Advancing Rural Development in the Context of Exogenous Shocks

In this paper, we design and deploy an experimental approach to evaluate the efficacy of a social innovation initiative implemented in rural communities situated in the highlands of Peru, which confronted the challenges posed by the COVID-19 pandemic in the midst of its implementation. Using three rounds of information collected before, during, and after participation, we examine the efficacy of the social innovation economic development approach at increasing household livelihoods. We present robust, statistically significant improvements in household economic well-being, food security satisfaction, and community outlook for participating households compared to non-participating households following program engagement. The results presented in this study suggest that the social innovation program facilitated a notable restructuring of the portfolio of household income and livelihood activities towards more lucrative and value-added pursuits. This transition manifested in increased involvement in entrepreneurial ventures and specialized labor associated with both agricultural and non-agricultural sectors while distancing from traditional agricultural and livestock-related endeavors. The income gains stemming from self-employment activities and wage labor outweigh the losses incurred from reduced agricultural and livestock earnings. Furthermore, our analysis underscores the resilience of innovative income-generating pathways in the face of the COVID-19 pandemic, outperforming traditional agrarian value chains. These findings highlight the efficacy of social innovation programming in facilitating economic development and also shed light on sustainable strategies for economic resilience amidst unforeseen challenges such as the recent global health crisis.

Multimodal Quality Initiatives in Sepsis Care: Assessing Impact on Core Measures and Outcomes.

Providing timely and effective care for patients with sepsis is challenging due to delays in recognition and intervention. The Surviving Sepsis Campaign has developed bundles that have been shown to reduce sepsis mortality. However, hospitals have not consistently adhered to these bundles, resulting in suboptimal outcomes. To address this, a multimodal quality improvement sepsis program was implemented from 2017 to 2022 in a large urban tertiary hospital. The aim of this program was to enhance the Severe Sepsis and Septic Shock Management Bundle compliance and reduce sepsis mortality. At baseline, the Severe Sepsis and Septic Shock Management Bundle compliance rates were low, at 25%, with a sepsis observed/expected mortality ratio of 1.14. Our interventions included the formation of a multidisciplinary committee, the appointment of sepsis champions, the implementation of sepsis alerts and order sets, the formation of a Code Sepsis team, real-time audits, and peer-to-peer education. By 2022, compliance rose to 62%, and the observed/expected mortality ratio decreased to 0.73. Our approach led to improved outcomes and hospital rankings. These findings underscore the efficacy of a comprehensive sepsis care initiative, emphasizing the importance of interdisciplinary collaboration. A multimodal hospital-wide sepsis performance program is feasible and can contribute to improved outcomes. However, further research is necessary to determine the specific impact of individual strategies on sepsis outcomes.

An Investigation Of The Effectiveness Of Biofeedback-Based Stress Management Training For College Going Students

Exploring the efficacy of a biofeedback-driven stress management initiative for college students, particularly those grappling with heightened stress and anxiety in their initial semesters, this comprehensive paper delves into an intricate study involving thirty randomly assigned first-year students segregated into biofeedback intervention and control groups. The biofeedback cohort immersed themselves in an extensive five-week training regimen, harnessing biofeedback for adept stress and anxiety management, whereas the control group remained devoid of specific training. Remarkable revelations surfaced: the biofeedback ensemble maintained a commendable stability in stress levels, adeptly countering the control group’s palpable surge. Moreover, the biofeedback faction showcased a marked reduction in anxiety, sharply juxtaposed with the control group’s moderately escalating levels. Conclusively, the study vehemently posits the resounding efficacy of biofeedback-centric stress management in alleviating anxiety and steadying stress levels amidst a myriad of first-year college students across diverse fields. This groundbreaking intervention holds immense potential in amplifying academic prowess, nurturing holistic well-being, and furnishing students with indispensable stress management tools for their intricate academic and professional journeys.

Tingkat Partisipasi Masyarakat Akan Kebijakan Pelaksanaan Vaksinasi Covid-19 Di Kota Batam

The objective of this study is to assess the extent of community engagement in the execution of the Covid-19 vaccination strategy within Batam City. The administration of Covid-19 vaccines plays a pivotal role in surmounting a worldwide pandemic, with active engagement from the community serving as a significant determinant of the efficacy of a vaccination initiative. The present study employs a qualitative methodology for data collection. A survey utilizing a structured questionnaire will be administered to assess the degree of community engagement in the Covid-19 vaccination process. Furthermore, a comprehensive analysis will be undertaken through conducting in-depth interviews with a carefully selected group of respondents. This approach aims to acquire a more profound comprehension of the various factors that exert influence on their level of participation. The anticipated outcomes of this research endeavor aim to offer a comprehensive assessment of the extent of community engagement in the execution of the Covid-19 vaccination program within Batam City. The aforementioned findings will offer significant insights to authorities and healthcare providers, enabling them to formulate enhanced communication and outreach strategies aimed at augmenting public engagement in vaccination programs.

Encounters with police drug detection dogs at music festivals amongst people who regularly use ecstasy and/or other illicit stimulants in Australia.

Despite increasing evidence challenging the effectiveness and legality of police drug dog operations, these strategies remain common. We aimed to describe drug dog encounters at music festivals, behavioural adaptations taken in anticipation of their presence and consequences of encounters amongst a sample of people who regularly use MDMA/ecstasy. Data were collected via interviewer-administered questionnaires in April-June 2019. Australians aged 16 years or older who used MDMA/ecstasy and/or other stimulants monthly in the last 6 months were recruited from capital cities via social media and word-of-mouth (n=797). Participants reported recent drug dog encounters, encounter settings and actions taken in anticipation of and in response to encounters. In this sample, encounters with drug dogs at festivals were common (60%), with most participants (92%) reporting anticipating the encounter. Most (86%) of this group reported behavioural adaptations to avoid a detection, with concealing drugs well (57%) and consuming prior to entering the festival (20%) most reported. Only 4% of those who expected drug dog presence chose not to carry or consume drugs. One-quarter (26%) of those who reported an encounter were stopped by police and 4% were searched (bodily/bag search). Most participants anticipated drug dog presence at festivals, however, were not deterred from carrying or consuming drugs. Some reported adaptations to avoid detection may increase drug-related health, social and legal harms. Our study suggests drug dog presence at festivals does not deter carriage/use of illegal drugs, and echoes concerns regarding the efficacy and appropriateness of this policing initiative.

Adapting to a Pandemic: Web-Based Residency Training and Script Concordance Testing in Emergency Medicine During COVID-19.

The coronavirus disease (COVID-19) pandemic necessitated alternative methods to ensure the continuity of medical education. Our study explores the efficacy and acceptability of a digital continuous medical education initiative for medical residents during this challenging period. From September to December 2020, 47 out of 60 enrolled trainee doctors participated in this innovative digital Continuous Medical Education (CME) approach. We utilized the Script Concordance Test to bolster clinical reasoning skills. Three simulation scenarios, namely Advanced Trauma Life Support (ATLS), Advanced Life Support (ALS), and European Paediatric Life Support (EPLS), were transformed into interactive online sessions via Zoom™. Participant feedback was also collected through a survey. Consistent Script Concordance Testing (SCT) scores among participants indicated the effectiveness of the online training module. Feedback suggested a broad acceptance of this novel training approach. However, discrepancies observed between formative SCT scores, and summative Multiple-Choice Questions (MCQ) assessments highlighted areas for potential refinement. Our findings showcase the resilience and adaptability of medical education amidst challenges like the global pandemic. The success of methodologies such as SCT, endorsed by prestigious bodies like the European Resuscitation Council and the American Heart Association, suggests their potential in preparing health care professionals for emergent situations. This research offers valuable insights for shaping future online CME strategies.

Efficacy of Global Leadership Initiative on Malnutrition as potential cachexia screening tool for patients with solid cancer

PurposeCachexia has a very high prevalence in patients with cancer, and lacks effective screening tools yet. Global Leadership Initiative on Malnutrition (GLIM) is a novel malnutrition assessment tool, with increased important roles in malnutrition diagnosis for patients with cancer. However, whether GLIM can be used as an effective screening tool remains unknown.MethodsWe performed a multicenter cohort study including 8,478 solid tumor patients from 40 clinical centers throughout China. Cachexia was diagnosed based on the 2011 international cancer cachexia consensus. The receiver operating characteristic curves (ROC) and decision curve analysis (DCA) were developed to determine the efficacy and clinical net benefit of GLIM and Patient-Generated Subjective Global Assessment (PG-SGA) in the detection of cancer cachexia, respectively.ResultsAccording to the consensus guidelines, 1,441 (17.0%) cancer patients were diagnosed with cachexia among 8,478 patients in the present study. The sensitivity of one-step GLIM and two-step GLIM for detecting cachexia were 100 and 88.8%, respectively, while that of PG-SGA was 86.2%. The accuracies of one-step GLIM and two-step GLIM reached 67.4 and 91.3%, which were higher than that of PG-SGA (63.1%). The area under the curves (AUCs) of one-step GLIM (0.835) and two-step GLIM (0.910) were higher than PG-SGA (0.778) in patients with cancer. The DCA also revealed that two-step GLIM had better clinical effect than PG-SGA between 20-50% threshold probabilities.ConclusionGLIM could be used as an effective tool in screening cancer cachexia, two-step GLIM criteria show more accurate while one-step GLIM criteria is more sensitive.Trial registrationChiCTR1800020329.

Bringing Sickle Cell Disease Care Closer to Home: Feasibility and Efficacy of a Quality Improvement Initiative at a Community Hospital

Comprehensive care for patients with sickle cell disease has been shown to improve morbidity. However, few studies have focused on community hospitals where the burden of disease is highest. From 2017 to 2019, a series of quality improvement interventions was implemented in Brampton, Toronto, ON, Canada, directed toward pediatric and adult sickle cell disease populations. This included a new adult clinic and education directed at patients and healthcare providers. There were 206 visits from 88 unique patients at the clinic and hydroxyurea (HU) uptake increased from 41.0 to 60.0% over that time (p < 0.001). The annual admission rate by adult patients before and after intervention was 90.0 and 75.0% respectively (p = 0.010). The length of stay of pediatric patients decreased from 3.5 to 2.9 days (p = 0.039). These interventions resulted in significant improvements in acute care utilization and HU use by sickle cell disease patients locally, but larger studies are required to confirm these findings.

Provider education program on the Khorana score to promote venous thromboembolism chemoprophylaxis in patients with gynecologic cancer

ObjectiveTo evaluate the efficacy of a healthcare improvement initiative to improve provider compliance with the American Society of Clinical Oncology (ASCO) guidelines for venous thromboembolism chemoprophylaxis in patients with gynecologic...

Strengthening lower-income families: Lessons learned from policy responses to the COVID-19 pandemic.

Families are navigating an unstable economy due to COVID‐19. Financial stressors have the potential to strain intimate relationships and exacerbate prior inequities across lower‐income families. Notably, the economic impact of COVID‐19 disproportionately influenced Black and Latinx families. As a response to families' economic adversity during the pandemic, the federal government initiated the CARES Act. This type of federal response to lower‐income families, however, is not new. The purpose of this paper is to contextualize and historicize previous and current efforts to mitigate the consequences of financial hardship on families by comparing the assumptions and efficacy of the Healthy Marriages Initiative and the CARES act. We conclude with four recommendations to promote well‐being in lower‐income families: (1) acknowledging and reducing inequities that disproportionally impact families racialized as Black or Latinx; (2) intervening to mitigate stressors surrounding families; (3) using innovative methods to deliver relationship education; and (4) considering prevention versus intervention strategies.

Obstacles to Promoting Growth Mindset in a Streamed Mathematics Course: “It’s like Confirming They Can’t Make the Cut”

ABSTRACT In this study, we consider the experiences of a professional learning community (PLC) who focused on fostering growth mindset to improve learning in a lower-stream grade 9 mathematics course. Using a sociocultural theoretical lens and drawing on data from a two-year case study, we summarize the ways that PLC members fostered growth mindset and then more deeply explore the obstacles they encountered. Participants found that shifting from a fixed mindset to a growth mindset required changes to the ways they taught mathematics. Even with these changes, shifting mindsets about mathematics learning proved more challenging than they expected. PLC members shared the view that the process was impeded by: students’ ingrained fixed mindsets, views of mathematics as a right or wrong subject, assessment practices focused on grading, the need to overcome their own fixed mindsets, and the streamed nature of the course. Through sustained collaboration, they found ways to begin to address these obstacles, with the notable exception of streaming. This study provides evidence of the ways streaming can inhibit the efficacy of a growth mindset initiative and offers suggestions for teachers, schools, and divisions planning to implement a growth mindset initiative to improve mathematics learning in similar contexts.

The Women's Health Network: An Evaluation of a Community-Based Initiative

This study is an evaluation of the Women's Health Network (WHN) program initiative. The WHN is a grant funded project aimed at creating and maintaining health equity for women in the state of Kansas in the United States. This qualitative study explores the efficacy of a community-based initiative to build trust among community members. The WHN gathered a group of professionals and community members to serve as the board of directors.

Comparison of the Efficacy of the Global Leadership Initiative on Malnutrition Criteria, Subjective Global Assessment, and Nutrition Risk Screening 2002 in Diagnosing Malnutrition and Predicting 5-Year Mortality in Patients Hospitalized for Acute Illnesses.

The Global Leadership Initiative on Malnutrition (GLIM) has developed new criteria for diagnosing patients with malnutrition. The aims of this study were to investigate the prevalence of malnutrition according to the GLIM criteria, Subjective Global Assessment (SGA), and Nutrition Risk Screening 2002 (NRS-2002) and their association with long-term mortality in patients hospitalized for acute illnesses. A retrospective analysis was performed in a sample of 231 patients with different comorbidities hospitalized for acute illnesses in medical or surgical wards. Nutrition status was retrospectively assessed with GLIM criteria using patients' records at admission in addition to SGA and NRS-2002. The agreement between the tools was calculated using κ statistics, and the association of malnutrition according to each tool and mortality were analyzed using Cox regression analysis. The mean age of the patients was 62.2 ± 18.2 years, and 56.7% were women. The prevalence of malnutrition was 35.9% with GLIM criteria, 37.2% with SGA, and 38% with NRS-2002. The agreement between tools was good (GLIM-SGA, κ = 0.804; GLIM-NRS-2002, κ = 0.784). During a median follow-up period of 63.2 months, 79 deaths occurred. The sensitivity in predicting 5-year mortality was 59.49%, 58.23%, and 58.23%, and specificity was 76.32%, 73.68%, and 72.37% for GLIM criteria, SGA, and NRS-2002, respectively. After adjusting for confounders, GLIM criteria best predicted 5-year mortality (hazard ratio, 3.09; 95% CI, 1.96-4.86; P < .001). Our findings support the effectiveness of GLIM in diagnosing malnutrition and predicting all-cause mortality among patients hospitalized for acute illnesses.

Reducing post-operative opioids in children undergoing outpatient urologic surgery: A quality improvement initiative

Opioid prescriptions have been implicated as one of the proximate causes of the national opioid epidemic. Children and adolescents and their families are at risk for increased opioid exposure through prescriptions after surgery. In pediatric urologic surgery, indications for postoperative opioids can vary widely and a focus on opioid stewardship is important to reduce potential harms. To measure the efficacy of a quality improvement initiative aimed to reduce post-operative opioids for pain management in a large pediatric surgical cohort. Patients undergoing ambulatory pediatric urologic surgery at a tertiary children's hospital between July 2016 to June 2019 were analyzed. Structured physician peer-to-peer comparisons, electronic health record redesign and a standardized pain management protocol were implemented. Rate of opioid prescriptions per month, utilization of non-opioid analgesia, unplanned encounters in the emergency department and/or office during implementation were aggregated. Opioid doses and prescribed opioid days before and after protocol implementation were analyzed. A subcohort, from October-December 2018 was administered a patient-reported outcome questionnaire focused on pain management and return to baseline activity. A total of 6684 consecutive outpatient urologic cases were included (median age=3.3 years old (IQR 0.9-9.2) and 92.3% male). Comparing 6 months pre-intervention and the post-intervention latest 6 month intervals, opioid prescription rate decreased from 43.9% to 2.3% (p<0.001). Additionally, non-opioid analgesia with ketorolac increased from 30.7% to 50.6% (p<0.001). Concurrently, no differences in the rate of office visits within 5 days, overall ED visits, ED visits for pain or for bleeding within 30 days after implementation were identified. Between October to December 2018, 373 cases were performed and a Patient-Reported Outcome (PRO) questionnaire was completed for 128 of those patients (34%). Families reported a low patient pain score of 3.7 (SD 2.4) and a rapid postoperative recovery time of a median 2 (IQR 1-4) days to full resumption of pre-operative level of activity. High satisfaction with opioid reduction in post-operative pain management was reported (median score of 10 (IQR 8-10)). Opioid prescriptions and utilization may be minimized without increasing unplanned encounters or adversely affecting quality of life. The QI framework utilized in this process can be implemented to reduce opioid exposure in other surgical patient populations.

Relational Practices for Boundary Work: Complexity, Liminality, and Knowledge Arbitrage

In this article, we investigate to role of frontline workers who are responsible for enabling the delivery of primary care within a marginalized tribal community in Northwestern India. Our ethnographic study of these frontline medic counsellors helps to illuminate how these entrepreneurial agents actively create, negotiate and manage activities between multiple boundary conditions including those of primary healthcare facilities and the local community, social and gender boundaries within the community, and professional boundaries within the clinical domain. Our findings reveal how this female corps of medic counsellors have engaged configurational boundary work to improve the efficacy of a community health initiative. In so doing, they have also gained significant influence within the professional clinical domain and also within their respective communities. This configurational boundary work can be understood as a set of relational practices by which boundary of the community is drawn into the highly institutionalized domain of the clinic, and the boundary of the clinic is drawn into the social and cultural domain of the community. These relational practices identified through our analysis are: a) empathizing, b) buffering, c) facilitating, d) co-opting and e) improvising. Our resulting conceptual model contributes to extant knowledge across a number of dimensions, particularly research on: i) the practices of agents working within and across multiple intersectional conditions; ii) research on how configurational (as opposed to competitive or collaborative) boundary work can be used towards common goals, and iii) middle-status groups can expand jurisdictional authority and enhance legitimacy and status by drawing upon and leveraging knowledge from different domains.

Challenges Assessing the Impact of Project-Based Learning on Critical Thinking Skills

ABSTRACT The lack of a precise definition for critical thinking makes it difficult for educators to agree on specifically how critical thinking should be assessed. This study assesses the efficacy of an innovative university initiative designed to promote critical thinking through project-based learning (PBL). Over 400 students participated in a 2 × 2 factorial experiment including critical thinking items from both a widely used inventory as well as a new assessment designed to assess critical thinking in a more practical fashion. The authors’ novel critical thinking assessment breaks down critical thinking into construction and critique components, with results indicating that critique is more challenging for students, regardless of experimental condition. However, students specifically prompted for critique demonstrated more attempts at critique than their counterparts who did not receive a critique prompt. The results indicate a paucity of critical thought in general, suggesting multiple challenges for both the teaching and assessment of critical thinking skills.

P40 Smart Snacks in College: How Do They Match Up to Popular Alternatives?

Background Snacking has been increasing for decades, and snacks are often high in solid fats and added sugars. College campuses provide numerous and overwhelming snacking options that may factor into college weight gain such as vending machines. The Social Cognitive Theory postulates that many factors drive health behaviors. The food environment can strongly influence snacking behaviors of students. Objective The goal of this study was to evaluate the nutritional impact of a healthy snack intervention on a southern college campus. Study Design, Settings, Participants This quasi-experimental study took place in a southern college campus and is part of a larger study evaluating the efficacy of a healthy snack initiative in four residential halls. Half of vending snacks were substituted with snacks complying with federal Smart Snacks in School nutrition standards for K-12 schools. Smart Snacks must meet caloric, fat, sodium, and sugar guidelines. Measurable Outcome/Analysis Data collected in fall 2017 included sales, waste, and stock of snacks in 12 vending machines. Descriptive statistics were computed from the sales data and nutrition information collected through manufacturer's websites.. Results Average sales per week were 427 Smart Snacks and 775 standard non-compliant snacks. On average, each Smart Snack sold offered a reduction of 122 calories, 135.7 mg of sodium, 3.4 g saturated fat, and 8.6 grams of sugar and an increase of 1.1 grams of fiber. Despite overall lower sales of Smart Snacks relative to non-compliant counterparts, 14.9 caloric pounds, calculated from calorie differences, were saved each week in vending sales over a semester-long 50% Smart Snacks intervention. Conclusion The potential nutritional benefit with even a 50% Smart Snack replacement is promising. There are many comparable snacks for vendors to consider that mimic the mouthfeel, taste, and appearance of their original full-fat, full-sodium, and full-sugar counterparts. A vending machine snack adaptation to healthier snack choices may be a viable option for universities to transform the campus eating environment. Funding None.

From intention to participation: Exploring the moderating role of a voucher-based event leveraging initiative

The purpose of this study was to explore relationships between intentions to try a sport after watching an elite sport event and post-event participation, and explore the role exposure to a post-event leveraging initiative plays in facilitating behavior. A field experiment design was employed to test the efficacy of the leveraging initiative among experimental and control condition groups. Data were collected through a questionnaire following an international track cycling competition from spectators (N = 338) who had no prior experience participating in the sport, and then were matched with participation data collected directly from the sport facility. Results demonstrate that post-event intentions were a significant positive predictor of participation. Results also demonstrate that exposure to a leveraging initiative can increase participation in a new sport. Notably, the voucher stimulated participation for spectators with both low intentions and high intentions to participate post-event. Results provide support for the use of leveraging tactics as a means of stimulating sport participation in the context of hosting novel sport events.

Choosing Wisely: Decreasing the incidence of perioperative blood transfusions in gynecologic oncology

ObjectiveTo evaluate the efficacy and economic impact of a transfusion reduction initiative for patients undergoing gynecologic surgery. MethodsWe conducted a prospective healthcare improvement study to align transfusion practices with the American Society of Hematology's Choosing Wisely® campaign. Baseline transfusion rates were determined retrospectively for all major gynecologic surgical cases from 3/1/14 to 6/30/14. Data for the post-intervention period from 5/15/15 to 5/16/16 were captured prospectively. The primary outcome was transfusion within 72 h of surgery. Secondary outcomes included perioperative morbidity, mortality, number of units ordered per transfusion episode and cost. ResultsWe identified 1281 surgical cases, 334 in the baseline and 947 in the post-implementation cohort. The baseline cohort was noted to have a higher median estimated blood loss (100 v. 75 mL, P < 0.01). Otherwise, there were no differences in clinical or perioperative characteristics between the two cohorts. The perioperative transfusion rate decreased from 24% to 11% (adjusted OR 0.27, 95% CI 0.16 to 0.45; P < 0.001). The perioperative laparotomy transfusion rate decreased from 48% to 23% (adjusted OR 0.21, 95% CI 0.12, 0.37; P < 0.001). The number of occurrences in which more than one unit of blood was ordered at a time decreased from 65% to 23%, P < 0.001. The incidence of surgical site infections declined in the post-intervention group, otherwise there were no differences in 30-day mortality, cardiac, venous thromboembolism or readmission rates between the groups. The projected cost savings was $161,112 over the 12-month intervention period. ConclusionsImplementation of an educational based transfusion reduction program was associated with substantial reductions in perioperative transfusions and cost without significant changes in morbidity or mortality.

Employee Engagement as Administrative Reform: Testing the Efficacy of the OPM's Employee Engagement Initiative

AbstractResearchers have long recognized administrative reform as a constant feature of American public administration. The employee engagement initiative of the U.S. Office of Personnel Management (OPM) has become one of the most prominent administrative reforms underway in the federal government. Like many reforms, the veracity of claims about this reform have gone untested. This article addresses this gap by testing the relationship between the OPM's employee engagement initiative and agency performance. After establishing the psychometric validity of the OPM's Employment Engagement Index, the authors use a five‐year panel data set of federal agencies and two‐way fixed‐effects regression to test the efficacy of this prominent reform. The analysis shows that efforts to encourage employee engagement generally have the expected relationship with performance, but the relationship varies according to the components that make up the index and the organizational level at which these efforts are expended.