Entire Intervention Research Articles

An Evaluation of the Mindless to Mindful (M2M) Intervention on Exercise Self-Regulation and Fat Mass Loss: A Case Study.

To evaluate the impact of the Mindless to Mindful intervention on fat mass loss in adults. This was a single-group case study. A fitness center delivered by certified fitness professionals. 222 adults who participated in M2M as a team or as individuals, and 195 completed the entire intervention (attrition rate = 12.16%). M2M was an 8-week behavior change intervention with tailored coaching, group moderate-to-vigorous exercise (MVE) and self-regulation techniques. Participants completed a demographic questionnaire, the Jackson-Pollock 4-site body fat measure, brief self-control scale, self-compassion scale, and a daily exercise log. Paired sample t-tests were used to determine differences within groups and a one-way ANOVA was used to determine the differences between groups (P-value <.05). Participants engaged in an average of 4.88h (SD = 2.04) of MVE per week. There was a significant decrease in fat mass (M = £7.65; P < .001) and increase in self-control (t = 6.248, P < .001, d = .300) and self-compassion (t = 4.314, P < .001, d = .165). Self-monitoring, group exercise, and individualized coaching can promote self-regulation and fat mass loss.

BIM IMPLEMENTATION FOR HERITAGE RENOVATION THROUGHOUT PROJECT LIFECYCLE: CURRENT USE, BENEFITS, AND BARRIERS

Introduction: Building Information Modeling (BIM) has garnered significant attention due to advancements in sophisticated technologies and methods. However, a comprehensive review of the existing literature indicates a lack of research exploring the application of BIM in managing the entire intervention design and renovation processes from a broader system perspective. The purpose of the study was to fill this gap by identifying and evaluating the current utilization, benefits, and barriers associated with implementing BIM in the lifecycle of renovation projects. The study methodology is based on conducting 31 structured interviews with experienced professionals who have employed BIM in their project deliveries. The results reveal that the primary benefits of BIM adoption, in descending order of importance, pertain to improved collective understanding of design intent, lower risk and better predictability of outcomes, better-designed and performing buildings, more accurate project documentation, and increased accuracy of the cost estimate. However, there are several prominent barriers: project budget, complexity of modeling historic structures, cost to hire BIM professionals, and the lack of BIM knowledge. The findings will advance BIM adoption for heritage renovation and enable project stakeholders to focus on realizing the benefits and potential uses of lifecycle BIM, while also addressing the critical challenges discussed in this study.

Effect of extracorporeal shock wave combined with autologous platelet-rich plasma injection on rotator cuff calcific tendinitis: study protocol for a randomized controlled trial

BackgroundRotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear.MethodsThis study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas.DiscussionThis study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options.Trial registrationClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1.

The effect of dexmedetomidine on hemodynamic parameters during neuro-oncological surgery

Introduction. The use of alpha 2-adrenoagonist dexmedetomidine, as an adjuvant for anesthesiological aid in neuro-oncological surgery, allows to create and maintain stable hemodynamics throughout the entire surgical intervention. The observed hemodynamic effects depend on the dose of dexmedetomidine.The objective was to evaluate the effect of the highly selective alpha2-adrenoagonist dexmedetomidine on hemodynamic parameters during anesthesia in surgeries for the removal of a brain tumor.Materials and methods. The study included 92 patients operated on for a brain tumor. The division into groups was carried out depending on the dosage of dexmedetomidine and the position on the operating table. In group 1 (n = 58), dexmedetomidine was used, which was administered during the first 30–40 minutes at a rate of 1.4 ± 0.4 mkg/kg/h, and after introductory anesthesia at a maintenance dosage of 0.4 ± 0.2 mkg/kg/h. In group 2 (n = 34), dexmedetomidine was administered during the first 30–40 minutes at a rate of 0.7 ± 0.1 mkg/kg/h, and after induction of anesthesia with a maintenance dosage of 0.2 ± 0.1 mkg/kg/h. Subgroup A – patients operated in a sitting position, subgroup B – patients operated in a lying position.Results. More stable hemodynamics and mild parasympathicotonia were noted at all stages of surgery when dexmedetomidine was used at an initial dose of 0.7 ± 0.1 mkg/kg/h and a maintenance dose of 0.2 ± 0.1 mkg/kg/h. Conclusion. The study revealed that the optimal dosage of dexmedtomidine to achieve a central sympathomodulating effect is 0.7 ± 0.1 mkg/kg/h in the initial stages and 0.2 ± 0.1 mkg/kg/h in the maintenance.

Evaluation of a specialist nurse-led structured self-management training for peer supporters with type 2 diabetes mellitus with or without comorbid hypertension in Slovenia

BackgroundThe training of peer supporters is critical because the success of the entire peer support intervention depends on the knowledge and experience that peer supporters can share with other patients. The objective of this study was to evaluate the pilot implementation of a specialist nurse-led self-management training programme for peer supporters with type 2 diabetes mellitus (T2DM) with or without comorbid hypertension (HTN) at the primary healthcare level in Slovenia, in terms of feasibility, acceptability, and effectiveness.MethodsA prospective pre-post interventional pilot study was conducted in two Community Health Centres (CHC) in Slovenia from May 2021 to August 2022. Purposive sampling was employed to recruit approximately 40 eligible volunteers to become trained peer supporters. A specialist nurse-led structured training lasting 15 h over a 2-month period was delivered, comprising four group and two individual sessions. The comprehensive curriculum was based on interactive verbal and visual learning experience, utilising the Diabetes Conversation Maps™. Data were collected from medical records, by clinical measurements, and using questionnaires on sociodemographic and clinical data, the Theoretical Framework of Acceptability, knowledge of T2DM and HTN, and the Appraisal of Diabetes Scale, and evaluation forms.ResultsOf the 36 participants, 31 became trained peer supporters (retention rate of 86.1%). Among them, 21 (67.7%) were women, with a mean age of 63.9 years (SD 8.9). The training was evaluated as satisfactory and highly acceptable. There was a significant improvement in knowledge of T2DM (p < 0.001) and HTN (p = 0.024) among peer supporters compared to baseline. Six months post-training, there was no significant improvement in the quality of life (p = 0.066), but there was a significant decrease in body mass index (BMI) (p = 0.020) from 30.4 (SD 6.2) at baseline to 29.8 (SD 6.2).ConclusionThe pilot implementation of a specialist nurse-led self-management training for peer supporters was found to be feasible, acceptable, and effective (in the study group). It led to improvements in knowledge, maintained disease control, and promoted positive self-management behaviours among peer supporters, as evidenced by a decrease in their BMI over six months. The study emphasises the need for effective recruitment, training, and retention strategies.Trial registrationThe research is part of the international research project SCUBY: Scale up diabetes and hypertension care for vulnerable people in Cambodia, Slovenia and Belgium, which is registered in ISRCTN registry (https://www.isrctn.com/ISRCTN41932064).

Alcohol Interventions on Online Grocery Shopping Platforms

Introduction &amp; BackgroundThere is opportunity to engage light to moderate drinkers in alcohol reduction interventions as a preventative measure. In the space of online grocery shopping there is an added challenge in intervention development in the form of deceptive patterns, which influence consumer behaviour in unhealthy ways including automating behaviour and encouraging overconsumption. Objectives &amp; ApproachThe objectives of this study are to: 1) identify deceptive patterns in the online grocery shopping context, 2) develop interventions which support healthier decision making in this context, 3) apply those interventions to appropriate product categories. The method utilised in the first objective is heuristic analysis which was conducted across eleven major online grocery shopping platforms. The interventions were then developed using the Rapid Iterative Testing and Evaluation (RITE) method, which involved interviewing participants and iterating upon the inventions after every interview. Each interview was analysed using content analysis. When incorporating the interventions into the online grocery shopping environment, interviews were conducted to gain insight into drinking and purchasing habits of consumers. These final interviews were then analysed with inductive thematic analysis. Relevance to Digital FootprintsDigital Footprints underpin the entire intervention development space. The background of the project is built upon human shopping and interaction behaviour online when encountering deceptive patterns. These deceptive patterns have been established using mobile gaming micro-transaction data, online grocery shopping log-in and rewards data, among other data sources. Digital Footprints data can further support the findings from the thematic analysis by further showing cultural and social trends around drinking (e.g., increased purchasing of seasonal beers and ciders in the summer and during sporting tournaments). The purpose of the drinking identified through those social and cultural trends gauge the appropriateness of proposed alcohol interventions. Beyond this, digital footprints data around engagement with health and wellness promoting applications (e.g., active users and app downloads) provides greater insight into the types of health messaging that garner attention and can be used to further inform how to approach those currently outside the health-engaged group. Digital footprints serve to attach larger societal trends to the smaller-scaled interviews and thematic analysis conducted as part of the study. ResultsInitial findings have shown opportunities for nudging light to moderate drinkers who primarily consume beer, wine, or cider. Spirits have been identified as difficult to substitute due to a lack of substitution options in the low alcohol spirit category that are widely available on the consumer market via online grocery retailers. Conclusions &amp; ImplicationsWithout significant change, costs to the National Health Service (NHS) in alcohol related harm are set to rise by over 1 billion GBP. Alcohol consumption is a public health risk and there are opportunities to utilise digital footprint informed interventions to engage the public in preventative interventions.

Acceptance and commitment therapy adapted for women with infertility: a pilot study of the Infertility ACTion program

BackgroundApproximately one in six couples are currently infertile, defined as unable to achieve pregnancy despite 12 or more months of active attempts to conceive. Experiencing infertility has been disproportionately associated with an array of psychological difficulties, particularly in women. However, currently available psychological interventions have had minimal benefits for distress, anxiety, or depression related to infertility.MethodsA one-arm pilot study was conducted to test the acceptability of a newly created acceptance and commitment therapy-based self-guided program—Infertility ACTion. Twenty women, located in Canada, completed the program and completed measures assessing expectancy of improvement, treatment credibility, participant satisfaction, treatment completion and retention, psychological flexibility, fertility quality of life, depression, and anxiety. Participants were also asked to provide feedback on how the researchers could improve the intervention. Paired sample t-tests were conducted to compare pre- and post-intervention outcomes.ResultsSixteen out of 20 participants completed the entire intervention. Reported treatment expectancy, credibility and satisfaction were favorable. Eighty-one percent of participants reported that they would recommend the program to a friend and 88% thought the program was worth their time. Medium increases in psychological flexibility and fertility quality of life were observed. Improvements in anxious and depressive symptoms were in the small to medium range but were not significant. Participants had several recommendations for program improvement.ConclusionsThis acceptance and commitment therapy-based self-guided program proved to be an acceptable treatment for infertility-related distress. Participant feedback will be used to adjust the current intervention in preparation for a more rigorous randomized-controlled trial testing this program.

Virtual reality-based cognitive–behavioural therapy for the treatment of anxiety in patients with acute myocardial infarction: a randomised clinical trial

BackgroundThe presence of mental health conditions is pervasive in patients who experienced acute myocardial infarction (AMI), significantly disrupting their recovery. Providing timely and easily accessible psychological interventions using virtual reality-based...

Preparing practice-ready family nurse practitioners using technology-based, high-fidelity pediatric telehealth simulations: A curricular quality improvement initiative

BackgroundThe SARS-CoV-2 pandemic accelerated the change in delivery of pediatric primary care services from in-person to telehealth to curb the spread of the SARS-CoV-2 virus, creating an urgent need to prepare competent, practice-ready Family Nurse Practitioner (FNP) graduates able to deliver high-quality pediatric telehealth services. The aim of this curricular quality improvement initiative was to develop preclinical telehealth competence through implementation of an innovative, technology-based, high-fidelity pediatric telehealth simulation educational intervention. The initiative was set in a private, urban university with a state-of-the art simulation center. Participants included FNP students, FNP faculty, and simulation faculty. MethodsThe Evidence Based Practice Improvement (EBPI) Model is the framework that was used for this initiative. A curricular gap analysis was conducted by faculty, results guiding the development of a high-fidelity, pediatric telehealth simulation educational intervention. Baseline measurements included student demographics, knowledge of essential pediatric telehealth concepts, and perceptions of self-efficacy in conducting telehealth visits. Knowledge assessment and self-efficacy were again measured after completion of a pre-briefing, pediatric telehealth asynchronous learning module, and self-efficacy for a third time after completion of the entire simulation intervention. Written, semi-structured qualitative questionnaires were also completed at the end of the intervention. ResultsKnowledge assessment scores significantly increased from baseline after completion of the asynchronous learning module (P < 0.001). Pediatric telehealth self-efficacy scores also showed significant improvements from baseline after completion of the asynchronous learning module (P < 0.001) and again after completion of the simulation intervention (P < 0.001). Qualitative themes supported quantitative findings. ConclusionHigh-fidelity, pediatric telehealth simulation is an effective educational intervention to develop pre-clinical, telehealth competence in FNP students prior to pediatric clinical rotations and provide them with the skills to be practice-ready upon graduation.

Are populations of postpartum women differentially served by community health worker programs: an observational cohort study from Zanzibar, Tanzania

BackgroundAlthough community health worker (CHW) programs focus on improving access to healthcare, some individuals may not receive the intended quality or quantity of an intervention. The objective of this research was to examine if certain populations of pregnant women differentially experience the implementation of a community health worker-led maternal health intervention in Zanzibar.MethodsWe included pregnant women enrolled in the Safer Deliveries (Uzazi Salama) program, which operated in 10 of 11 districts in Zanzibar, Tanzania between January 1, 2017, and June 19, 2019 (N = 33,914). The outcomes of interest were receipt of the entire postpartum intervention (three CHW visits) and time to first postpartum CHW visit (days). Visits by CHWs were done at the women’s home, however, a telehealth option existed for women who were unable to be reached in-person. We conducted statistical tests to investigate the bivariate associations between our outcomes and each demographic and health characteristic. We used multivariate logistic regression to estimate the relationships between covariates and the outcomes and multivariate linear regression to estimate the association between covariates and the average time until first postpartum visit.ResultsHigher parity (OR = 0.85; P = 0.014; 95%CI: 0.75–0.97), unknown or unreported HIV status (OR = 0.64; p < 0.001; 95%CI: 0.53–0.78), and receipt of phone consultations (OR = 0.77; p < 0.001; 95%CI: 0.69–0.87) were associated with a lower odds of receiving all postpartum visits. Similarly, women with an unknown or unreported HIV status (estimated mean difference of 1.81 days; p < 0.001; 95%CI: 1.03–2.59) and those who received a phone consultation (estimated mean difference of 0.83 days; p < 0.001; 95%CI: 0.43–1.23), on average, experienced delays to first visit. In addition, current delivery at a referral hospital was associated with lower odds of receiving a postpartum visit and longer time to first visit compared to delivery at home, cottage hospital, PHCU + , or district hospital. Women from all other districts received their first visit earlier than women from Kaskazini B. There were no differences in the odds of receiving the entire postpartum intervention by sociodemographic variables, including age, education, and poverty assessment indicators.ConclusionThe results indicate no differences in intervention contact across wealth and education levels, suggesting that the program is effectively reaching women regardless of SES. However, women with other characteristics (e.g., higher parity, unknown or unreported HIV status) had lower odds of receiving the complete intervention. Overall, this work generates knowledge on existing disparities in intervention coverage and enables future programs to develop approaches to achieve equity in health care utilization and outcomes.

Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity

People with Parkinson’s disease (PwPD) can benefit from progressive high-intensity exercise facilitated with a lower-extremity exoskeleton, but the mechanisms explaining these benefits are unknown. We explored the relationship between exercise intensity progression and memory and gait outcomes in PwPD who performed 8 weeks (2 × per week) of progressive exercise with and without a lower-extremity powered exoskeleton, as the planned exploratory endpoint analysis of an open-label, parallel, pilot randomized controlled trial. Adults 50–85 years old with a confirmed diagnosis of PD participated. Twenty-seven participants randomized to exercise with (Exo = 13) or without (Nxo = 14) the exoskeleton were included in this exploratory endpoint analysis. Detailed exercise logs were kept and actigraphy was used to measure activity count*min−1 (ACPM) during all exercise sessions. Only the Exo group were able to progressively increase their ACPM over the entire 8-week intervention, whereas the Nxo group plateaued after 4 weeks. Exercise intensity progression correlated with change in the memory sub-scale of the SCOPA-COG and change in gait endurance from the 6MWT, consistent with the prevailing hypotheses linking high-intensity interval exercise to improved muscle and brain function via angiogenic and neurotrophic mechanisms. Facilitating high-intensity exercise with advanced rehabilitation technology is warranted for improving memory and gait endurance in PwPD.Registration: ClinicalTrials.gov, NCT 03583879 (7/10/2018).

Technical and Clinical Outcome of Low-Milliampere CT Fluoroscopy-Guided Percutaneous Drainage Placement in Abdominal Fluid Collections after Liver Transplantation: A 16-Year Retrospective Analysis of 50 Consecutive Patients.

Evaluation of the effectiveness of CT-guided drainage (CTD) placement in managing symptomatic postoperative fluid collections in liver transplant patients. The assessment included technical success, clinical outcomes, and the occurrence of complications during the peri-interventional period. Analysis spanned the years 2005 to 2020 and involved 91 drain placement sessions in 50 patients using percutaneous transabdominal or transhepatic access. Criteria for technical success (TS) included (a) achieving adequate drainage of the fluid collection and (b) the absence of peri-interventional complications necessitating minor or prolonged hospitalization. Clinical success (CS) was characterized by (a) a reduction or normalization of inflammatory blood parameters within 30 days after CTD placement and (b) the absence of a need for surgical revision within 60 days after the intervention. Inflammatory markers in terms of C-reactive protein (CRP), leukocyte count and interleukin-6, were evaluated. The dose length product (DLP) for various intervention steps was calculated. The TS rate was 93.4%. CS rates were 64.3% for CRP, 77.8% for leukocytes, and 54.5% for interleukin-6. Median time until successful decrease was 5.0 days for CRP and 3.0 days for leukocytes and interleukin-6. Surgical revision was not necessary in 94.0% of the cases. During the second half of the observation period, there was a trend (p = 0.328) towards a lower DLP for the entire intervention procedure (median: years 2013 to 2020: 623.0 mGy·cm vs. years 2005 to 2012: 811.5 mGy·cm). DLP for the CT fluoroscopy component was significantly (p = 0.001) lower in the later period (median: years 2013 to 2020: 31.0 mGy·cm vs. years 2005 to 2012: 80.5 mGy·cm). The TS rate of CT-guided drainage (CTD) placement was notably high. The CS rate ranged from fair to good. The reduction in radiation exposure over time can be attributed to advancements in CT technology and the growing expertise of interventional radiologists.

The effects of osteopathic manipulative treatment on pain and disability in patients with chronic low back pain: a single-blinded randomized controlled trial.

The evidence for the efficacy of osteopathic manipulative treatment (OMT) in the management of low back pain (LBP) is considered weak by systematic reviews, because it is generally based on low-quality studies. Consequently, there is a need for more randomized controlled trials (RCTs) with a low risk of bias. The objective of this study is to evaluate the efficacy of an OMT intervention for reducing pain and disability in patients with chronic LBP. A single-blinded, crossover, RCT was conducted at a university-based health system. Participants were adults, 21-65 years old, with nonspecific LBP. Eligible participants (n=80) were randomized to two trial arms: an immediate OMT intervention group and a delayed OMT (waiting period) group. The intervention consisted of three to four OMT sessions over 4-6weeks, after which the participants switched (crossed-over) groups. The primary clinical outcomes were average pain, current pain, Patient-Reported Outcomes Measurement Information System (PROMIS)29 v1.0 pain interference and physical function, and modified Oswestry Disability Index (ODI). Secondary outcomes included the remaining PROMIS health domains and the Fear Avoidance Beliefs Questionnaire (FABQ). These measures were taken at baseline (T0), after one OMT session (T1), at the crossover point (T2), and at the end of the trial (T3). Due to the carryover effects of OMT intervention, only the outcomes obtained prior to T2 were evaluated utilizing mixed-effects models and after adjusting for baseline values. Totals of 35 and 36 participants with chronic LBP were available for the analysis at T1 in the immediate OMT and waiting period groups, respectively, whereas 31 and 33 participants were available for the analysis at T2 in the immediate OMT and waiting period groups, respectively. After one session of OMT (T1), the analysis showed a significant reduction in the secondary outcomes of sleep disturbance and anxiety compared to the waiting period group. Following the entire intervention period (T2), the immediate OMT group demonstrated a significantly better average pain outcome. The effect size was a 0.8 standard deviation (SD), rendering the reduction in pain clinically significant. Further, the improvement in anxiety remained statistically significant. No study-related serious adverse events (AEs) were reported. OMT intervention is safe and effective in reducing pain along with improving sleep and anxiety profiles in patients with chronic LBP.

Qualitative realist evaluation of an occupational therapy intervention programme (ABLE), addressing ability to perform activities of daily living among persons with chronic conditions

BackgroundChronic conditions are associated with problems related to performance of activities of daily living (ADL) stressing a need to develop and evaluate intervention programmes addressing such problems. Hence, the ABLE programme was developed, and its feasibility evaluated. Implementing intervention programmes in community-based rehabilitation settings requires understanding of how the programme works in various contexts. Applying a realist evaluation approach, the aim of this study was to identify and evaluate interactions between contexts, mechanisms, and outcomes in the ABLE 2.0, to confirm, refine, or reject aspects of the initial programme theory.MethodsRealist evaluation using qualitative data collected in the ABLE 2.0 randomised controlled trial (n = 78). Based on the ABLE 2.0 initial programme theory, qualitative realist interviews were conducted among receivers (n = 8) and deliverers (n = 3) of the ABLE 2.0 in a Danish municipality. Transcripts were coded, and context-mechanism-outcome configurations were extracted and grouped into contiguous themes. Results were then held up against the initial programme theory.ResultsFour contiguous themes were identified including a total of n = 28 context-mechanism-outcome configurations: building a foundation for the entire intervention; establishing the focus for further intervention; identifying and implementing relevant compensatory solutions; and re-evaluating ADL ability to finalise intervention. Overall, the ABLE 2.0 initial programme theory was confirmed. The evaluation added information on core facilitating mechanisms including active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using compensatory solutions. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client’s home, skilled occupational therapists, and clients feeling ready for making changes.ConclusionsThe ABLE 2.0 represents a coherent problem-solving occupational therapy process, applicable across sex, age, and diagnoses with the potential to enhance ADL ability among persons with chronic conditions, when delivered as part of community-based rehabilitation services. Knowledge about the interactions between contextual factors, mechanisms, and outcomes in the ABLE 2.0 is central in case of future implementation of the programme in community-based rehabilitation settings.Trial registrationThe trial was prospectively registered on www.ClinicalTrials.gov (registration date: 05/03/2020; identifier: NCT04295837) prior to data collection that occurred between August 2020 and October 2021.

Effect of Simulation-Based Ventilator Alarm Management Training on Nurse’s Knowledge and Practices in a Tertiary Care Hospital

This study aimed to evaluate the effectiveness of simulation-based ventilator alarm management training on knowledge and practice among nurses. It was conducted among 50 nurses of neurosurgery department AIIMS, New Delhi. Assessment of knowledge and practice regarding ventilator alarm management was done using researcher-developed knowledge questionnaire and observational checklist. Didactic teaching of 15- 20 minutes was done regarding various ventilator alarms following the baseline assessment. Hence, simulationbased teaching on managing ventilator alarm was conducted in a group of 3-4 participants which consisted of pre-brief (3-5 min explanation regarding the situation the participant was to experience), scenario run (7-10 min where the response and measures of managing different ventilator alarms are performed) and debrief (15-20 min of discussing the positive and right performance of participants followed by different areas requiring improvement). A low tech manikin (half body Laerdal manikin) was used for the simulation and the simulation was conducted in neuro ward of AIIMS, New Delhi. The entire intervention lasts for 40-45 min after which immediate post-test was done for knowledge and skill. Retention of knowledge was assessed 7 days after the intervention. Nurse’s knowledge range regarding mechanical ventilator alarm management in pre-test was 11 (8, 15) MED (IQR), post-test 1 was 15 (13, 17) MED (IQR), post-test 2 range was 15 (13.16) MED (IQR). Thus, there was significant improvement in the knowledge level of nurses regarding the ventilator alarm management after the intervention (p &lt;0.001). The pre-practice score of nurse’s skill in managing mechanical ventilator alarm management was 3.5 (2, 5) MED (IQR) and postpractice score minimum maximum range was 10.5 (2, 14) MED (IQR). There was significant improvement in the skill level of nurses regarding the ventilator alarm management after the intervention (p &lt;0.01). Simulation-based education improves nurse’s knowledge and practice in recognising and managing the ventilator alarms.

Uso do método de Pontos para a Reestruturação de Objetivos Fonéticos e Oro-Musculares (PROMPT) no Transtorno do Espectro Autista: um estudo de caso

ABSTRACT Autism Spectrum Disorder (ASD) is classified by Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a neurodevelopmental disorder, whose characteristics are mainly deficits in social communication and a restricted range of interests. There are several studies about autism, speech, and language in the literature, but few correlate speech and autism. This study aims to carry out a case study that will address autism, speech, and PROMPT (Restructuring Oral Muscular Phonetic Targets) and also to describe the speech improvement in the participant with autism using the method. The target words were defined for the entire intervention according to the System Analysis Observation (SAO) and Motor Speech Hierarchy (MSH), which are parts of the PROMPT evaluation. After the evaluation, the participant was attended for 16 sessions, once weekly, with the objective of improving their speech. After analyzing the data, it was possible to observe improvement in all aspects outlined according to the pre-treatment evaluation of the method such as phonatory control, mandibular control, lip-facial control and lingual control as well as in the sequenced movement although this was not the aim outlined in the evaluation. It was also possible to measure the improvement of an adequate number of words, an adequate number of phonemes, percentages of correct consonants – revised (PCC-R), and intelligibility.

Effects of a multilevel intervention of resistance training with or without beta-hydroxy-beta-methylbutyrate in medical ICU patients during entire hospitalisation: a four-arm multicentre randomised controlled trial

BackgroundIntensive care unit-acquired weakness (ICU-AW) is a prevalent and severe issue among ICU patients. Resistance training and beta-hydroxy-beta-methylbutyrate (HMB) intervention have demonstrated the potential to enhance muscle function in patients with sarcopenia and in older adults. The purpose of this study was to determine whether resistance training and/or HMB administration would improve physical function, muscle strength, and quality of life in medical ICU patients.MethodsIn this multicentre, four-arm, single-blind randomised control trial, a total of 112 adult patients with internal medical diagnoses admitted to the ICU were enrolled. These participants were then randomly assigned to one of four treatment groups: the resistance training group received protocol-based multilevel resistance exercise, the HMB group received 3 g/day of HMBCa, combination group and control groups received standard care, from the ICU to the general ward until discharge. The primary outcomes assessed at discharge included six-minute walking distance (6MWD) and short physical performance battery (SPPB). Secondary outcomes measured included muscle mass, MRC score, grip strength, and health reports quality of life at different time points. Data analysis was performed using a generalised linear mixed model, adhering to the principles of intention-to-treat analysis.ResultsResistance training and combination treatment groups exhibited significant increases in SPPB scores (3.848 and 2.832 points, respectively) compared to the control group and substantial improvements in 6WMD (99.768 and 88.577 m, respectively) (all with P < 0.01). However, no significant changes were observed in the HMB group. Muscle strength, as indicated by MRC and grip strength tests conducted at both ICU and hospital discharge, showed statistically significant improvements in the resistance training and combination groups (P < 0.05). Nevertheless, no significant differences were found between the treatment groups and usual care in terms of 60-day mortality, prevalence of ICU-AW, muscle mass, quality of life, or other functional aspects.ConclusionsResistance training with or without beta-hydroxy-beta-methylbutyrate during the entire hospitalisation intervention improves physical function and muscle strength in medical ICU patients, but muscle mass, quality of life, and 60-day mortality were unaffected.Trial registrationChiCTR2200057685 was registered on March 15th, 2022.

Effects of Green Tea Leaf Extract on Viability, Apoptosis, and Expression of Interleukin-6 in Keloid Fibroblasts

Green tea leaf (Camellia sinensis) extract contains polyphenols, anti-inflammatory and anti-carcinogenic agents that may effectively to as keloid therapy. This study aims to examine the effect of green tea leaf extract on viability, apoptosis, and interleukin-6 expression in keloid fibroblasts. Keloid fibroblast cultures were divided into groups that were cultivated with green tea extract at dosages of 100, 200, 400, and 800 μg/mL, negative control (10% Fetal Bovine Serum/FBS), and positive control (100 μM dexamethasone). This study used post-test-only control group design. The highest mean IL-6 expression was in the GTE 200 (275,942.7 pg/mL), while the lowest was in the GTE 800 ( -2,890.6 pg/mL). The viability and apoptosis was analized by using one-way ANOVA, continued with Least Significant Difference (LSD) with a significance of p 0.05 in the GTE 800 treatment group compared to the entire intervention group. Kruskal-Wallis followed by a Mann-Whitney was carried out for interleukin-6 (IL-6) with a significance of p 0.05 in the extract therapy group at dosages of 200, 400, 800 μg/ml and 100 μM dexamethasone. In conclusion, green tea leaf extract at 800 μg/ml could reduce viability interleukin-6 expression and increase apoptotic caspase-3 expression in keloid fibroblast cells.

Digital support for quality assurance in 24-hour caregiving at home: a randomized controlled trial investigating the effects on quality of life and professional skills of paid 24h-caregivers

BackgroundRegarding the care of older adults, 24-h home-care represents a cornerstone, with > 32,000 service users in Austria. Our research project 24hQuAALity aimed to develop and evaluate a distributed client-server software solution for the support and quality assurance of this home-care service. In this trial, we investigated the effects of this intervention on the quality of life and professional skills of paid 24h-caregivers in Austria.MethodsThe application used in our study comprises an e-learning platform, an integrated emergency management, networking opportunities, and an electronic care documentation system in the native language of the 24h-caregivers. The trial was conducted using a parallel three-arm study design to evaluate (i) a control group, which performed usual home care, (ii) a partial intervention group, which used the e-learning and networking platforms, and (iii) a full intervention group, which used the entire intervention (e-learning platform, networking platform, and digital care documentation). Primary self-reported outcomes were the standardized ASCOT for Carers score and a score based on responses to project-specific efficacy questions.ResultsAmong the 110 24h-caregivers who were randomly classified into the three groups, ASCOT for Carers score data were available for 57 and 35 24h-caregivers at 5- and 9-month follow-up examinations, respectively. At 9 months, 24h-caregivers receiving any intervention rated the ASCOT for Carers score (not significantly) better than the controls (p = 0.05, ηp2 = 0.15), mainly in the domain “feeling encouraged and supported”. At 9 months, 24h-caregivers receiving any intervention rated the project-specific Efficacy score significantly better than the controls (p = 0.02, ηp2 = 0.20), mainly due to better ratings in the subitems “satisfaction with current docu”, “docu supports doing my job”, “ I’m well prepared for emergencies”, “my professional skills are adequate for doing my job”, and “communication with contacts”.ConclusionsProviding e-learning and e-documentation devices to 24h-caregivers improved their care-related quality of life, mainly because they felt more encouraged and supported. Moreover, these interventions improved their self-perceived professional skills. As an extrapolation of findings, we found that these interventions could empower 24h-caregivers and improve the quality of home-care services provided by them.Trial registrationDigital Support for Quality Assurance in 24-h Caregiving at Home was registered and posted on the ClinicalTrials.gov public website (ClinicalTrials.gov Identifier: NCT04581538).

Text messaging intervention for fatigue self-management in people with stroke, spinal cord injury, and multiple sclerosis: A pilot study

BackgroundFatigue negatively impacts the function and quality of life of people with disabilities (PwD). Mobile health (mHealth) platforms are recognized as effective and accessible approaches to delivering health interventions and may show higher satisfaction by tailoring the information toward personalized needs for PwD. ObjectiveTo evaluate the acceptability, feasibility, and participant engagement with a Short Message Service (SMS) text messaging intervention for fatigue self-management and to explore the pre- and post-score health changes in PwD. MethodsA total of 27 PwD (multiple sclerosis = 9, spinal cord injury = 9, or stroke = 9) experiencing fatigue in their daily lives participated in a 12-week self-management text messaging intervention. Participants completed a demographic survey and health outcome measures, including patient activation, self-efficacy for managing symptoms, fatigue, sleep, and satisfaction with participation in social roles before and after the intervention. Participants also completed a client satisfaction questionnaire after the intervention. We also tracked the program retention and SMS response rates over the 12-week intervention period. ResultsTwenty-five participants completed the entire intervention (93% retention rate), and the overall SMS response rate was 84.67%, indicating high acceptability and adherence to the intervention. The mean satisfaction score was 3.18, indicating high satisfaction with the intervention. Despite finding a negligible effect on patient activation, we found a small intervention effect on self-efficacy for managing symptoms (η2 = 0.04) and moderate effects on fatigue (η2 = 0.06-0.12), sleep (η2 = 0.11), and satisfaction with participation in social roles (η2 = 0.08). ConclusionsThis study provides initial feasibility and health outcome change evidence to support an SMS text messaging intervention to manage fatigue in PwD.