Feedback-based Intervention Research Articles

An assessment of adaptation and fidelity in the implementation of an audit and feedback-based intervention to improve transition to adult type 1 diabetes care in Ontario, Canada

BackgroundThe fit between an intervention and its local context may affect its implementation and effectiveness. Researchers have stated that both fidelity (the degree to which an intervention is delivered, enacted, and received as intended) and adaptation to the local context are necessary for high-quality implementation. This study describes the implementation of an audit and feedback (AF)-based intervention to improve transition to type 1 diabetes adult care, at five sites, in terms of adaptation and fidelity.MethodsAn audit and feedback (AF)-based intervention for healthcare teams to improve transition to adult care for patients with type 1 diabetes was studied at five pediatric sites. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to document the adaptations made during the study. Fidelity was determined on three different levels: delivery, enactment, and receipt.ResultsFidelity of delivery, receipt, and enactment were preserved during the implementation of the intervention. Of the five sites, three changed their chosen quality improvement initiative, however, within the parameters of the study protocol; therefore, fidelity was preserved while still enabling participants to adapt accordingly.ConclusionsWe describe implementing a multi-center AF-based intervention across five sites in Ontario to improve the transition from pediatric to adult diabetes care for youth with type 1 diabetes. This intervention adopted a balanced approach considering both adaptation and fidelity to foster a community of practice to facilitate implementing quality improvement initiatives for improving transition to adult diabetes care. This approach may be adapted for improving transition care for youth with other chronic conditions and to other complex AF-based interventions.Trial registrationClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Comparing Rationale for Opioid Prescribing Decisions after Surgery with Subsequent Patient Consumption: A Survey of the Highest Quartile of Prescribers.

Opioid prescribing patterns, including those after surgery, have been implicated as a significant contributor to the US opioid crisis. A plethora of interventions-from nudges to reminders-have been deployed to improve prescribing behavior, but reasons for persistent outlier behavior are often unknown. Our institution employs multiple prescribing resources and a near real-time, feedback-based intervention to promote appropriate opioid prescribing. Since 2019, an automated system has emailed providers when a prescription exceeds the 75th percentile of typical opioid consumption for a given procedure-as defined by institutional data collection. Emails include population consumption metrics and an optional survey on rationale for prescribing. Responses were analyzed to understand why providers choose to prescribe atypically large discharge opioid prescriptions. We then compared provider prescriptions against patient consumption. During the study period, 10,672 eligible postsurgical patients were discharged; 2,013 prescriptions (29.4% of opioid prescriptions) exceeded our institutional guideline. Surveys were completed by outlier prescribers for 414 (20.6%) encounters. Among patients where both consumption data and prescribing rationale surveys were available, 35.2% did not consume any opioids after discharge and 21.5% consumed <50% of their prescription. Only 93 (39.9%) patients receiving outlier prescriptions were outlier consumers. Most common reasons for prescribing outlier amounts were attending preference (34%) and prescriber analysis of patient characteristics (34%). The top quartile of opioid prescriptions did not align with, and often far exceeded, patient postdischarge opioid consumption. Providers cite assessment of patient characteristics as a common driver of decision-making, but this did not align with patient usage for approximately 50% of patients.

The mazing race: Effects of interruptions and benefits of interruption lags in a novel maze-like decision-making paradigm.

Interruptions are an inevitable, and often negative, part of everyday life that increase both errors and the time needed to complete even menial tasks. However, existing research suggests that being given time to prepare for a pending interruption-a lag time-can mitigate some of the interruption costs. To understand better why interruption lags are effective, we present a series of three experiments in which we develop and test a novel sequential decision-making paradigm, the mazing race. We find that interruption lags were only beneficial when participants had a clear strategy for how to complete the task, allowing them to avoid specific errors. In the final experiment, we attempted to use what we learned about the kinds of errors introduced by interruptions to develop a feedback-based intervention, aimed at dealing with situations in which interruption lags are not possible. We found that feedback was, only in certain situations, an effective replacement for an interruption lag. Overall, however, because the usefulness of interruption lags depend on the specific strategy a participant adopts, developing generic interventions to replace interruption lags is likely to be difficult. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Abstract WP63: Somatosensory Evoked Potentials As A Measure Of Sensorimotor Impairment In Hemiparetic Stroke

Introduction: Stroke is the leading cause of serious, long-term disability. Previous neuroimaging studies have demonstrated that the cortical motor system might be reorganized following a stroke, with an increasing recruitment of the contralesional hemisphere. The control of movement requires sensory feedback; however, it is unknown if there is a similar hemispheric shift in the somatosensory system to adapt to the change in the motor system and if this is related to the impairment. Hypothesis: Cortical somatosensory reorganization occurs post stroke and is related to sensory and motor impairment. Methods: This proof-of-concept study assessed early phase cortical somatosensory processing in chronic hemiparetic stroke participants (n=9) using electroencephalograph (EEG). Components P50 and N100 of sensory evoked potentials (SEPs) were extracted and compared to motor and sensory impairments. Results: Pearson correlation analysis found that the amplitude of SEP component P50 is negatively correlated with Fugl-Meyer Upper Extremity (FM-UE) Motor Score in stroke (R=-0.630, P=0.047) and the amplitude of SEP component N100 is positively correlated with the Erasmus modifications to the Nottingham Sensory Assessment (EmNSA) (R=0.705, p=0.025). Conclusion: This information potentially helps predict the severity of motor and sensory impairments based on SEP measures. This is clinically significant, because if an assessment for sensorimotor impairments could be done from a “pure” sensory perspective using SEP, this would improve assessments in those with severe impairments or after an acute stroke in those with limited functional movements. Additionally, it may provide clinicians with enhanced sensory feedback-based interventions for rehabilitation post stroke.

Why Doesn’t Opioid Prescribing Change? Surveying Surgical Providers Resistant to a Feedback Intervention Bundle

INTRODUCTION: Opioid prescribing patterns, including those after operation, have been implicated as significant contributors to the US opioid crisis. Our institution employs multiple prescribing resources and a near real-time, feedback-based intervention to promote appropriate postoperative opioid prescribing. METHODS: We assessed the rationale of providers who did not respond to our interventions. Since 2019, an automated system emails outlier providers whose prescription sizes exceed the 75th percentile of patient opioid consumption for that procedure. Emails include procedure-specific consumption data for patients at our institution and an option to complete a survey on rationale for over-prescribing. RESULTS: During the study period, 10,672 eligible postoperative patients have been discharged from our institution. A total of 2,013 prescriptions (29.4% of opioid prescriptions) exceeded our institutional guideline. Surveys were completed for 414 (20.6%) outlier prescriptions. Of patients receiving outlier quantities, 35% did not consume any opioids after discharge and an additional 21.5% consumed less than 50% of their prescription. Only 39.9% of patients receiving outlier prescriptions were outlier consumers. The most common reasons for prescribing outlier amounts were attending preference (34%) and prescriber analysis of patient characteristics (34%); 68.0% of outlier providers did not follow our institution-specific prescribing dashboard (Table). CONCLUSION: Among providers who remained outliers in prescribing despite feedback, prescriptions did not align with, and often far exceeded, patient’s post-discharge consumption. Providers cite assessment of patient attributes as a main driver of decision-making, but this does not align with patient usage. Table. - Responses for “Other” Were Thematically Classified by Two Authors Determinant of prescribing decision Resident (N = 266) APP (N = 113) Fellow (N = 11) Attending (N = 23) Attending preference 127 (47.7%) 8 (7.1%) 6 (54.6%) 0 (0%) Analysis of patient characteristics 75 (28.2%) 51 (45.1%) 3 (27.3%) 12 (52.0%) Patient preference 13 (4.9%) 1 (0.9%) 0 (0%) 1 (4.0%) “The amount that I have always prescribed” 2 (0.8%) 8 (7.1%) 0 (0%) 0 (0%) Online prescribing dashboard 6 (2.3%) 0 (0%) 0 (0%) 0 (0%) Department or national guidelines 2 (0.8%) 2 (1.8%) 0 (0%) 1 (4.0%) Other (free response) 41 (15.4%) 43 (38.1%) 2 (18.2%) 9 (39.0%) APP, advanced practice provider.

Effectiveness of the Mobility Rehab System for Mobility Training in Older Adults: A Pragmatic Clinical Trial.

Introduction: Mobility impairments are among the main causes of falls in older adults and patients with neurological diseases, leading to functional dependence and substantial health care costs. Feedback-based interventions applied in controlled, laboratory environments have shown promising results for mobility rehabilitation, enhancing the benefits of standard therapy. However, the effectiveness of sensor-based feedback to improve gait in actual outpatient physical therapy settings is unknown. The proposed trial examines the effectiveness of a physical therapist-assisted, visual feedback system using wearable inertial sensors, Mobility Rehab, for mobility training in older adults with gait disturbances in an outpatient clinic.Methods: The study is a single site, pragmatic clinical trial in older adults with gait disturbances. Two hundred patients undergoing their outpatient rehabilitation program are assigned, by an independent assistant, for screening by one of four therapists, and assigned to either a standard physical therapy or therapist-assisted feedback therapy. Both groups train twice a week for 6 weeks. Four physical therapists were randomized and stratified by years of experience to deliver standard therapy or therapist-assisted feedback rehabilitation. Each session is 45 min long. Gait is trained for 30 min. The additional 15 min include exercises for endurance, strength, and static and dynamic balance in functional tasks. Mobility Rehab uses unobtrusive, inertial sensors on the feet and belt with real-time algorithms to provide real-time feedback on gait metrics (i.e., gait speed, double support time, foot clearance, angle at foot strike, and arm swing), which are displayed on a hand-held monitor. Blinded assessments are carried out before and after the intervention. The primary outcome measure is subjects' perception of balance as measured by the Activities-specific Balance Confidence scale. Gait speed, as measured with wearable inertial sensors during walking, is the secondary outcome measure.Discussion: We hypothesize that therapist-assisted feedback rehabilitation will be more effective than standard rehabilitation for gait. Feedback of motor performance plays a crucial role in rehabilitation and objective characterization of gait impairments by Mobility Rehab has the potential to improve the accuracy of patient-specific gait feedback.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03869879.

An Evaluation of Feedback-Based Interventions on Promoting Use of Personal Protective Equipment in a School

ABSTRACT Employees working in human services are more likely to receive injuries on the job than in many other industries. Human service organizations that serve individuals who engage in dangerous behavior often require employees to adhere to safety guidelines, including utilizing protective equipment to minimize the risk of injuries. Despite protective equipment being prescribed in students’ treatment plans at a private day school, employees were often observed working with students without the prescribed protective equipment. Results from a Performance Diagnostic Checklist-Safety assessment varied across three classrooms. Therefore, individualized treatment packages were implemented in each classroom. Results indicated increased use of prescribed protective equipment across all three classrooms and an overall decrease in staff injuries sustained by student contact.

Policy Note: Digital Feedback-Based Interventions for Water Conservation

Progress in water conservation is dependent as much on human behavior as on the promise of new technologies. Digital feedback-based interventions present an opportunity to bring these two factors together, as increasingly sophisticated technologies can help change behaviors rather than simply solving problems caused by those behaviors. This paper explores the various options and opportunities for adopting feedback-based interventions — those that communicate information for the purpose of encouraging individuals to alter water consumption habits. Lessons proposed are applicable to any realm in which individual human behavior contributes to a collective environmental or social problem. Focusing on five determinants of success (design, delivery, content, integration, and commitment), this paper presents findings of related studies and fashions them into a suite of recommendations that serves as a template for practice and agenda for future research. The underlying theme — that technology is no absolute substitute for behavioral change but can be one catalyst for it — contributes to broader discussions about the relationship between human systems and the environment.

Communication Skills and Communicative Autonomy of Prelinguistic Deaf and Hard-of-Hearing Children: Application of a Video Feedback Intervention.

Background and AimEvidence on the efficacy of parenting interventions to support communication development in deaf and hard-of-hearing children is emerging. In previous research, we showed that parental participation in a video feedback–based intervention enhanced parental self-esteem and emotional availability to their deaf and hard-of-hearing children. This paper investigates the impact of the intervention on the development of the children’s prelingual communication skills and autonomy. Evidence on the efficacy of parenting interventions to support communication development is warranted.MethodsSixteen hearing parents with a prelingual deaf and hard-of-hearing child (Mage = 2.05 years, SD = 1.77) were recruited by self-selection from pediatric audiological services and randomly stratified into intervention-first and waiting-list groups. Families completed three sessions of Video Interaction Guidance in their homes. Designed for maximal inclusion, the sample comprised children with complex developmental and social needs. The primary inclusion criterion was the child’s prelingual status (<50 signed/spoken words), which was established using speech and language therapy reports. Child communicative autonomy was assessed from a 20 min free-play video recording using a gold standard measure for deaf and hard-of-hearing children (Tait) before and after the intervention.ResultsA Mann–Whitney U test indicated no significant difference between the two groups. The groups were collated, and a Wilcoxon signed-rank test with time (pre-/post-intervention) as a repeating variable was run. A significant increase in children’s communicative autonomy (Z = −3.517, p < 0.0001, d = 0.62) and decrease in children’s no-responses (Z = −3.111, p < 0.005, d = 0.55) were seen. There was no significant difference in the overall number of turn-taking between the parent and child, indicating differences in the quality of the parent–child interactions, not the quantity.ConclusionThis study adds to the emerging evidence for parenting interventions with deaf and hard-of-hearing children. We hypothesize that the video feedback intervention with its focus on emotional availability created space for the children to show increased communicative autonomy during parent–child interactions. Communicative autonomy is a long-term predictor of communication and linguistic development in deaf and hard-of-hearing children, and its conceptual underpinning makes it a good early measure of relational agency. Results can inform wider interventions that focus on the quantity of the parent–child communication.

Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group

BackgroundWhen young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care.MethodsThis is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results.DiscussionThere is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings.Trial registrationClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

2067. Improving Outpatient Antimicrobial Prescribing for Respiratory Tract Infections

BackgroundAntimicrobial stewardship often focuses on inpatients, yet inappropriate antimicrobial use is common in the outpatient setting. We performed a prospective, stepped wedge interventional study to assess the impact of an educational and feedback-based intervention on prescribing practices for respiratory tract infections (RTIs) in the adult primary care ambulatory setting.MethodsFamily and internal medicine practices were randomly placed into 6 cohorts, which received the intervention in a stepped wedge fashion at monthly intervals. The study period was July 1, 2016 to October 31, 2018, with the intervention occurring from October 1, 2017 to October 31, 2018. The intervention consisted of a 20-minute in-person educational session on appropriate antimicrobial prescribing for RTIs followed by monthly feedback to individual providers on their proportion of antibiotic prescriptions in comparison to their peers for (1) visits with a primary diagnosis of any RTI and (2) visits with a primary diagnosis of an RTI for which an antibiotic should rarely be prescribed (tier 3 diagnoses). The outcome of interest was whether an antibiotic was prescribed in RTI visits. Chi squared testing and logistic regression were used for analysis.ResultsThirty-two practices participated, with 197,814 unique visits with a primary RTI diagnosis. Of these, 141,888 (71.7%) were physician visits and 55,926 (28.3%) were advanced practitioner visits (Figure 1). The proportion of visits with antibiotic prescriptions dropped from 37.2% to 24.0% following the intervention (P < 0.0001). Antibiotic prescriptions were significantly reduced for all primary RTI visits, OR 0.53 (95% CI 0.52 to 0.54), as well as for visits with tier 3 RTI diagnoses, OR 0.64 (95% CI 0.60 to 0.68). The proportion of visits with antibiotic prescriptions also exhibited a marked seasonal variation, another finding of the study (Figure 2).ConclusionAn educational intervention with provider feedback successfully reduced antibiotic prescribing for RTIs in the ambulatory setting. Additional study is necessary to assess the sustainability of response over time after discontinuation of the monthly feedback. Disclosures All authors: No reported disclosures.

Effectiveness of intervention due to feedback on errors arising from inappropriate transportation and storage of blood bags in hospitals: a quasi-experimental study.

BackgroundThe limited supply of red blood cells (RBCs) for transfusion has clinical implications, and can lead to the introduction of different approaches in decreasing blood wastage and the safe and effective delivery of blood products.ObjectiveTo identify the influences of feedback-based intervention on inappropriate temperatures during transportation and storage of blood bags.MethodsThis was a quasi-experimental pretest-posttest design with a non-equivalent control group that was carried out on 200 RBC. The study was conducted in a teaching hospital in Mashhad, Iran, and in two periods during the same season: winter of 2015 (pre-intervention period) and winter of 2016 (post-intervention period). Staff of the blood bank department, as the intervention group, received the intervention including feedback regarding the inappropriate temperature in the blood bank during the pre-intervention period. The control group included personnel and nurses from the OR, CSICU, and transportation department, who did not receive any feedback. The effect of the intervention on the RBCs’ temperature was evaluated by comparing the percentage of inappropriate temperature of RBC bags before and after the implementation of the intervention.ResultsInappropriate temperature in the blood bank decreased from 30% to 12% after the intervention was implemented (relative reduction of 60%). Meanwhile, there was even an increase in inappropriate temperature in the control group including OR (from 6.5% to 20.5%), CSICU (from 1% to 2.5%) and transportation (from 0.6% to 16.6%).ConclusionThe implementation of a feedback-based intervention to increase the awareness of the staff of critical conditions can improve conditions of blood storage and transport. The use of various interventions along with this type of intervention seems necessary to increase effectiveness.FundingThis research was part of the first author’s MSc thesis which was supported by a grant from Mashhad University of Medical Science Research Council (Ref. no.: 950116; Date: September 7, 2016).

The influence of context in the subjective evaluation of "negative" alcohol-related consequences.

College students may subjectively evaluate the consequences of drinking in unexpected ways, rating "negative" consequences as neutral or even positive experiences. We previously gathered qualitative evidence for several contextual factors that may influence one's subjective evaluations (e.g., social influences, intoxication level, concurrent positive consequences). The purpose of the present study was to quantitatively investigate whether student evaluations of consequences differ by various contextual factors. We administered an anonymous online survey to 214 college students (76% female, 69% drinkers, 48% heavy drinkers) in return for academic credit, on which they reported how positively or negatively they would evaluate 6 alcohol-related consequences (e.g., vomiting, being rude, blacking out) under different conditions. Paired samples t tests were used to compare evaluation ratings, averaged across consequences, under different hypothetical contextual conditions (e.g., among friends vs. strangers). Out of 16 contextual comparisons, all but one (first-time vs. repeated consequence) revealed significant differences in subjective evaluations; the pattern held in reduced samples of just drinkers or just heavy drinkers. Examples include that consequences were viewed more negatively (a) if occurring at either a party or bar versus alone in one's home/dorm, (b) if friends express concern versus find it funny, (c) if the consequence was expected versus unexpected, and (d) if there are lasting consequences versus none. When using recent consequences in feedback-based interventions to build motivation to change, it may be useful to discuss the context of a consequence and how this influences the perceived aversiveness of that consequence. (PsycINFO Database Record

"Personalized feedback interventions for college alcohol misuse: An update of Walters &amp; Neighbors (2005)": Correction to Miller et al. (2012).

Reports an error in Feedback Interventions for College Alcohol Misuse: An Update of Walters & Neighbors (2005) by Mary Beth Miller, Thad Leffingwell, Kasey Claborn, Ellen Meier, Scott Walters and Clayton Neighbors (Psychology of Addictive Behaviors, Advanced Online Publication, Dec 31, 2012, np). There was an error in the coding of content components in a few studies. The Carey et al. (2009, 2011), Juarez et al. (2006), Walters (2000), and Walters et al. (2000) studies did not include decisional balance content. As a result of this, the article included an error in the calculation of effect size comparisons for this intervention component. In light of these corrections, there is no significant difference between the short-term effect sizes of written interventions that included or excluded the decisional balance component. Conclusions regarding the relative efficacy of decisional balance as a component of PFI content in the article are unfounded and should be disregarded. There were also a few errors in the tables; the corrected tables appear in the correction. (The following abstract of the original article appeared in record 2012-35005-001.) Personalized drinking feedback is an evidence-based and increasingly common way of intervening with high-risk college drinking. This article extends an earlier review by Walters and Neighbors (S. T. Walters & C. Neighbors, 2005, Feedback interventions for college alcohol misuse: What, why, and for whom? Addictive Behaviors, 30, 1168-1182) by reviewing the literature of published studies using personalized feedback as an intervention for heavy drinking among college students. This article updates and extends the original review with a more comprehensive and recent set of 41 studies, most of which were not included in the original article. This article also examines within-subject effect sizes for personalized feedback interventions (PFIs) for high-risk alcohol use and examines the content of PFIs more closely to provide insight on the most essential components that will guide the future development of feedback-based interventions. In general, PFIs appear to be reliably effective at reducing harmful alcohol misuse among college students. Some components are almost universally included (i.e., drinking profile and normative comparison), precluding inferences regarding their unique contribution. Significantly larger effect sizes were observed for interventions that included decisional balance, practical costs, and strategies to limit risks. The present research provides an important empirical foundation for determining the relative contribution of individual components and facets in the efficacy of PFIs. (PsycINFO Database Record (c) 2013 APA, all rights reserved). Language: en

Personalized feedback interventions for college alcohol misuse: An update of Walters &amp; Neighbors (2005).

Personalized drinking feedback is an evidence-based and increasingly common way of intervening with high-risk college drinking. This article extends an earlier review by Walters and Neighbors (S. T. Walters & C. Neighbors, 2005, Feedback interventions for college alcohol misuse: What, why, and for whom? Addictive Behaviors, 30, 1168-1182) by reviewing the literature of published studies using personalized feedback as an intervention for heavy drinking among college students. This article updates and extends the original review with a more comprehensive and recent set of 41 studies, most of which were not included in the original article. This article also examines within-subject effect sizes for personalized feedback interventions (PFIs) for high-risk alcohol use and examines the content of PFIs more closely to provide insight on the most essential components that will guide the future development of feedback-based interventions. In general, PFIs appear to be reliably effective at reducing harmful alcohol misuse among college students. Some components are almost universally included (i.e., drinking profile and normative comparison), precluding inferences regarding their unique contribution. Significantly larger effect sizes were observed for interventions that included decisional balance, practical costs, and strategies to limit risks. The present research provides an important empirical foundation for determining the relative contribution of individual components and facets in the efficacy of PFIs.

Abstract P178: Pedometer Feedback Intervention Increases Time Spent in Moderate-to-Vigorous Physical Activity in Cardiac Rehabilitation Patients

Introduction: Pedometer feedback with step goals has previously been demonstrated to be effective in increasing daily steps in cardiac rehabilitation patients. These monitors allow the individual to track steps taken during a day, which may influence the frequency or duration of structured physical activity that is intended to achieve a step goal. However, it is not known whether an increase in step counts by pedometer feedback with step goals also increases time spent in recommended intensity levels for improved health, specifically moderate-to vigorous physical activity (MVPA), in cardiac rehabilitation patients. Hypothesis: Pedometer feedback with weekly step goals will increase time spent in MVPA, mediated by an increase in step counts in cardiac rehabilitation patients. Methods: A total of 31 (22 men and 9 women, age 62 ± 9 years) patients participated in a 12-week maintenance cardiac rehabilitation, pedometer based step goal intervention. Prior to the intervention, each subject’s one week baseline average daily step count was measured and 10% of this value was used to increase step goals during the intervention. Each week the step goal was met, the following week’s goal was appropriately increased. However, if the step goal for the week was not achieved, the step goal would not increase until the goal was fulfilled. Additionally, daily step counts and time spent in MVPA and light physical activity were assessed at baseline (without pedometer feedback) and for each intervention week (with pedometer feedback) using a Kenz Lifecorder PLUS monitor (Nagoya, Japan). Average time spent in light physical activity (activity level of 1-2) and MVPA (activity levels ≥3), were determined according to activity intensity level defined by the manufacturer’s analyses program. Results: The average step count for the baseline week was 5546 ± 2679 steps/day which significantly increased to 8348± 3613 steps/day by week 12 (p&lt;0.01). The average time spent in MVPA also significantly increased (p&lt;0.01) from 19 ± 16 min/day at baseline to 38 ± 23 min/day at week 12. In addition, there was a significant increase (p&lt;0.05) in time spent in light physical activity from baseline (42 ± 18 min/day) to week 12 (51 ± 24 min/day). Conclusion: Findings of this study demonstrate that a 12-week pedometer feedback-based intervention was effective in increasing time spent in MVPA in maintenance cardiac rehabilitation patients. Cardiac rehabilitation facilities can utilize pedometer feedback and goal setting to promote increases in time spent in recommended activity levels previously associated with improved health outcomes.

Drinking on campus. What Do we know about reducing alcohol use among college students?

Drinking and related problems on the college campus have reached near epidemic levels. In order to address this trend, many colleges have launched alcohol prevention and intervention programs for college students. Unfortunately, most such programs are either not empirically validated or are plainly based on models that have shown poor efficacy. This overview of the college treatment literature describes the kinds of interventions that have shown the best success and offers directions for future studies. In general, educational and abstinence-based approaches show the least efficacy, while other types of skills, attitudinal and feedback-based interventions based on aspects of the social learning model appear to be more successful. In addition to employing those approaches that have shown empirical success, a re-examination of the role that alcohol plays in the larger campus culture is crucial.