Intervention Characteristics Research Articles

Assessing interventions promoting the uptake of cancer-related genomic services within the Latino community: A scoping review using the RE-AIM framework.

Cancer genomic services (CGS) can support genetic risk-stratified cancer prevention and treatment. Racial/ethnic minority groups are less likely to access and utilize CGS compared with non-Hispanic Whites. Little research has described characteristics of interventions targeted at CGS among Latinos. This scoping review aimed to (1) describe interventions promoting uptake of CGS among Latinos in the United States and Latin America, (2) describe intervention adaptations for Latino participants, and (3) summarize intervention implementation factors suggested by reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. We conducted a search in English and Spanish of literature published between 2005 and 2022 across PubMed and Latin American and Caribbean Health Sciences Literature databases. Sixteen of 2344 papers met the inclusion criteria of the analysis. Efforts to promote CGS among Latino communities were limited in the US and lower in Latin America. This review highlights the need for in-depth exploration of acculturation-informed interventions and better reporting on implementation factors to enhance their scalability across diverse settings.

Pharmacist initiated interventions using RxChange message communication with prescribers for electronic prescriptions: A retrospective descriptive study

BackgroundRxChange messages improve patient medication management by enhancing pharmacist-prescriber communication, but their usage patterns in the United States are not well-documented. ObjectiveTo determine intervention characteristics by pharmacists and prescribers using RxChange messages. MethodsA retrospective analysis of electronic prescription and RxChange messages from 2022 to 2023, using data from Surescripts, LLC, was conducted. This included NewRx messages and RxChange Responses, categorized by 7 RxChange use cases and Anatomical Therapeutic Chemical level 4 medication classes. Descriptive statistics and nonparametric tests were used for statistical analysis. ResultsThe study analyzed 1,361,528 RxChange messages. Therapeutic interchange was the predominant use case (76.14%). Direct approvals accounted for 10.44% of requests, approvals with changes for 42.55%, and denials for 47.01%. Script clarification had the highest approval rate (64.21%), while prior authorization faced the most frequent denials (73.38%). The top denial reason was "Request addressed through alternate methods such as phone or fax (41.50%).” The most frequent drug classes observed in the data were selective beta-2 adrenoreceptor agonists, extended-spectrum penicillins, selective serotonin reuptake inhibitors, and glucagon-like peptide 1 analogues. Time from new e-prescription issuance to RxChange request submission was longer than from request to response, with a significant statistical difference (median 1.57 vs 0.27 days, P-value < 0.05). ConclusionThis study highlights interventions pharmacists make using RxChange with electronic prescriptions to improve patient care and medication safety. It underlined the need for improved RxChange message content and data on the effectiveness of RxChange messages in improving medication use.

Characteristics and outcomes of community-based perinatal peer support: Protocol for a systematic review.

Mental health issues and parenting difficulties in the perinatal period are common, and have significant negative impacts on individuals, families, and broader society. Community-based peer support programs might be an effective adjunct to standard mental health interventions in perinatal mental health issues, specifically where low-cost interventions are required, or access to professional care is limited. A systematic review will be undertaken. Searches will be conducted on four electronic databases (Pubmed, Embase, Cinahl, and PsycINFO), using terms related to perinatal mental health and peer support. Literature will be screened by title and abstract and then by full text. Selected studies will be evaluated using the Quality Assessment with Diverse Studies (QuADS) tool. Data relevant to community-based perinatal peer support intervention characteristics and outcomes will be extracted, and synthesised narratively. This review will contribute to the existing evidence about perinatal mental health peer support, by synthesising information about community-based interventions specifically. The findings will be used to inform the design, implementation, and evaluation of a community-based perinatal mental health peer support program in urban and rural/remote hospital and health services in Australia. Systematic review registration: CRD42023451568.

Online Interventions to Improve Mental Health of K-12 Teachers: A Scoping Review

Purpose: To explore mental health interventions using online technologies for school teachers and identify characteristics and effects on teachers’ mental health improvement.Methods: The method of Arksey and O’Malley was referenced. Two researchers independently searched seven electronic databases. Eleven experimental studies of online mental health interventions for K-12 teachers were analyzed for publication information, intervention characteristics, and summaries of outcome evaluations.Results: Publication years ranged from 2014 to 2023. Most studies were conducted in Europe. Teleconferencing was the most frequently used. Virtual reality has seen recent development. Cognitive factors were frequently evaluated to ensure the program’s effectiveness, including mental health awareness and coping skills. Thus, cognitive behavior therapy was the most significant component of interventions to improve teachers’ health.Conclusion: Our scoping review illustrates recent trends of online interventions to improve teachers’ mental health. Due to very limited information on Korean teachers, it is necessary to adopt available online interventions considering educational systems and teachers’ characteristics. Highly accessible modality, person-centered contents of mental health concern, and careful protection of teachers’ privacy are recommended for promoting mental health of teachers.

Simultaneous ST-elevation in lead augmented vector right (aVR) and III in non-ST-elevation acute coronary syndromes.

The value of ST-elevation in lead augmented vector right (aVR) remains controversial in clinical practice. This study aimed to investigate the association of simultaneous ST-elevation in lead aVR and III with angiographic findings and clinical outcomes in patients with non-ST-elevation acute coronary syndromes (NSTEACS). In this observational study, patients who had been diagnosed with NSTEACS and presented with ST-elevation in lead aVR and without ST-elevation in any other two contiguous leads were enrolled from January 2018 to June 2019. Demographic, baseline clinical, angiographic and interventional characteristics as well as clinical outcomes were collected and recorded on standardized case report forms. A total of 157 patients meeting the criteria were finally enrolled in this study and classified into two groups according to the presence of ST-elevation in lead III. Patients in the two groups were similar in average age and previous history of hypertension, diabetes mellitus, hyperlipidemia, chronic kidney disease, stroke, and peripheral vascular diseases (all P>0.05). Patients with ST-elevation in lead III tended to present with myocardial hypertrophy in the echocardiography (P=0.02). The cases with ST-elevation in lead III showed higher high sensitivity troponin T (hs-TnT; P=0.08) and creatinine kinase MB isoenzyme (CK-MB; P<0.01) whereas those without ST-elevation in lead III showed higher N-terminal pro brain natriuretic peptide (NT-proBNP; P=0.02). Of note, patients with ST-elevation in lead III presented with more ST-depression in multiple leads [especially in lead I, augmented vector left (aVL), V3-V6] as well as higher degree of ST-depression (all P<0.05) and were more likely to develop multi-vessel and left main trunk (LM) lesions (P=0.04), with 20% of the cases having a LM lesion and 60% having triple vessel lesions. Patients with ST-elevation in lead III were at increased risk of 3-year major adverse cardiovascular events (MACEs), despite no significant statistical difference between the two groups (hazard ratio =1.29; P=0.26). The NSTEACS cases with simultaneous ST-elevation in lead III and aVR tended to present with more multiple leads with ST-depression, higher degree of ST-depression, and more LM or multi-vessel lesions, suggesting a broader range of severe myocardial ischemia. The concurrent presentation of ST-elevation in lead III and aVR may play a vital role in the diagnosis, risk-stratification, and prediction of poor prognosis during the management of NSTEACS patients.

Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial

BackgroundSocial isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as “the interest in establishing and guiding the next generation,” can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU? intervention.MethodsIn this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention.DiscussionWe hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U? intervention. We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL.Trial registrationClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.

Peer and lay health work for people experiencing homelessness: A scoping review.

Homelessness poses complex health obstacles for individuals and communities. Peer and lay health worker programs aim to increase access to health care and improve health outcomes for PEH by building trust and empowering community-based workers. The scope and breadth of peer and lay health worker programs among PEH has not been synthesized. The primary objective of this scoping review is to understand the context (setting, community, condition or disease) encompassing peer and lay health worker programs within the homelessness sector. The secondary objective is to examine the factors that either facilitate or hinder the effectiveness of peer and lay health worker programs when applied to people experiencing homelessness (PEH). We searched CINHAL, Cochrane, Web of Science Core Collection, PsycINFO, Google Scholar and MEDLINE. We conducted independent and duplicate screening of titles and abstracts, and extracted information from eligible studies including study and intervention characteristics, peer personnel characteristics, outcome measures, and the inhibitors and enablers of effective programs. We discuss how peer and lay health work programs have successfully been implemented in various contexts including substance use, chronic disease management, harm reduction, and mental health among people experiencing homelessness. These programs reported four themes of enablers (shared experiences, trust and rapport, strong knowledge base, and flexibility of role) and five themes of barriers and inhibitors (lack of support and clear scope of role, poor attendance, precarious work and high turnover, safety, and mental well-being and relational boundaries). Organizations seeking to implement these interventions should anticipate and plan around the enablers and barriers to promote program success. Further investigation is needed to understand how peer and lay health work programs are implemented, the mechanisms and processes that drive effective peer and lay health work among PEH, and to establish best practices for these programs.

Designing the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability.

People with intellectual disability have diverse needs and experience higher rates of diet-related chronic disease such as type 2 diabetes compared to people without disability. However, they are infrequently included in development and implementation of interventions to address diet-related chronic disease. The present study describes the process to plan, develop and refine the Food and Lifestyle Information Program (FLIP) culinary nutrition intervention for adults with mild-to-moderate intellectual disability. The project was initiated by a disability service provider and was guided by the Cook-Ed™ model and inclusive research principles. Initially the disability service provider and academic research team members co-designed pre-program consultation and pilot studies, and draft program resources. Pre-program consultation explored paid disability support worker (n = 10) perceptions of cooking and food skills, nutrition priorities and optimal program format, which guided further program drafting. Program resources and pilot study design were further developed and refined with co-researchers with lived experience of intellectual disability who attended a pre-pilot and then pilot study sessions as remunerated co-facilitators. Key characteristics of the FLIP intervention arising from pre-program consultation included providing cooking task instruction in small steps, enabling participant choice in program activities, promoting an inclusive and social atmosphere, and providing paper-based resources. FLIP intervention co-design was enabled through ongoing input from the disability service provider and people with lived experience of intellectual disability. Evaluation of FLIP feasibility, acceptability and preliminary effectiveness to improve diet-related health is underway.

The effect of computation interventions for students with autism spectrum disorder: A meta‐analysis and systematic review

AbstractComputation is foundational to learning many mathematics concepts, as well as a functional skill in everyday life. Yet students with autism spectrum disorder (ASD) often have challenges in learning computation skills. The current study aimed to provide quantitative and descriptive analyses of single‐case experimental studies on computation interventions for students with ASD. Our systematic search and screening procedures yielded a total of 16 eligible studies for the final analyses. An analysis of publication bias indicated an absence of publication bias in the included studies. Tau‐U was used to calculate the overall intervention effect, resulting in an omnibus effect of 0.90 (95% CI [0.81, 1.00]), indicating a medium effect. Moderator analyses showed that variables such as study design, participant characteristics, intervention characteristics, and target skills did not moderate intervention effects. However, some evidence‐based practices were identified to significantly moderate maintenance effects. Implications for researchers and practitioners are discussed.

Uncovering Complexities in Reducing Aggression, Conflict and Restrictive Practices in Acute Mental Healthcare Settings: An Overview of Reviews.

Aggression, conflict and restrictive practices present complexities in acute mental health services, as do implementing service changes to reduce them. Existing published literature needs to offer more high-level guidance on the effectiveness of these service changes and their associated implementation factors. As a result, an overview of systematic reviews was undertaken to identify (i) nonpharmacological interventions to reduce conflict, aggression and restrictive practices in acute mental health settings, and (ii) their effects across different clinical outcomes. A parallel re-extraction from primary studies was then utilised (iii) to identify factors influencing successful intervention implementation. Of 124 articles sourced from nine databases and registries, four reviews were retained for the final analysis, using the direction of effect and tabular and narrative summaries. These reviews included programmes or interventions focused on inpatient adolescent, adult and older adult populations. They reported on alternative containment strategies, risk assessments, Safewards, sensory rooms and equipment, Six Core Strategy-based interventions and staff training. The overview found that a combination of interventions intended to improve relationships and reduce interpersonal conflict may help reduce aggression, conflict and restrictive practices. At the same time, stand-alone staff training and sensory rooms and equipment may have mixed effects. The quality of the evidence linking these interventions to reductions in aggression, conflict and restrictive practices is limited. Successful implementation hinges on multiple factors: intervention characteristics, preparation and planning, evaluation and monitoring, outcome interpretation, stakeholder involvement/investment, staff-related factors and contextual factors. Any implementation initiative may benefit from using pragmatic and complexity-informed research methodologies, including integrating meaningful involvement with service users, peer workers and culturally diverse groups.

Comparison of pre-hospital management of out-of-hospital cardiac arrest and its outcomes between the COVID-19 and pre-COVID-19 periods

Out-of-hospital cardiac arrest (OHCA) is a time-sensitive medical emergency that needs immediate interventions. COVID-19 affected the performance of the emergency medical service (EMS) system in pre-hospital care, including the management of cardiac arrest. This study aimed to identify the impact of the COVID-19 pandemic on pre-hospital management of out-of-hospital cardiac arrest and its outcome in Qom City, Iran. In this descriptive-analytical study, the data were collected from the electronic registration system of the EMS center in Qom, Iran. All OHCA patients who received resuscitation during COVID-19 and before COVID-19 were enrolled in the study. Data consisted of the characteristics of OHCA patients, EMS interventions and response times, and the outcome of OHCA. A P-value of <0.05 was deemed statistically significant. 630 OHCA patients in the COVID-19 period and 524 OHCA patients in the pre-COVID-19 period were included in the study. Endotracheal intubation and defibrillation were done more in the COVID-19 period than in the pre-COVID-19 period (50.2 % vs. 17 %, p<0.001 %, and 40.1 % vs. 22.5 %, p < 0.001, respectively). The EMS response time was longer during the COVID-19 pandemic (9.1 ± 3.9 min vs. 7.6 ± 1.4 min, p < 0.001). The rate of pre-hospital return of spontaneous circulation (ROSC) was lower in the COVID-19 period (15.6 % vs. 8.4 %, p < 0.001). According to univariate analysis, ROSC was predicted by COVID-19 (p < 0.001). However, COVID-19 was not the statistically significant independent predictor after multivariate analysis (p < 0.67). The COVID-19 pandemic period influenced OHCA and ROSC. Also, it affected pre-hospital management in the OHCA situation. The negative impact of COVID-19 on the EMS response reflected the need to know and remove barriers to managing crises such as COVID-19.

Interventions that have potential to help older adults living with social frailty: a systematic scoping review

BackgroundThe impact of social frailty on older adults is profound including mortality risk, functional decline, falls, and disability. However, effective strategies that respond to the needs of socially frail older adults are lacking and few studies have unpacked how social determinants operate or how interventions can be adapted during periods requiring social distancing and isolation such as the COVID-19 pandemic. To address these gaps, we conducted a scoping review using JBI methodology to identify interventions that have the best potential to help socially frail older adults (age ≥65 years).MethodsWe searched MEDLINE, CINAHL (EPSCO), EMBASE and COVID-19 databases and the grey literature. Eligibility criteria were developed using the PICOS framework. Our results were summarized descriptively according to study, patient, intervention and outcome characteristics. Data synthesis involved charting and categorizing identified interventions using a social frailty framework. ResultsOf 263 included studies, we identified 495 interventions involving ~124,498 older adults who were mostly female. The largest proportion of older adults (40.5%) had a mean age range of 70-79 years. The 495 interventions were spread across four social frailty domains: social resource (40%), self-management (32%), social behavioural activity (28%), and general resource (0.4%). Of these, 189 interventions were effective for improving loneliness, social and health and wellbeing outcomes across psychological self-management, self-management education, leisure activity, physical activity, Information Communication Technology and socially assistive robot interventions. Sixty-three interventions were identified as feasible to be adapted during infectious disease outbreaks (e.g., COVID-19, flu) to help socially frail older adults.ConclusionsOur scoping review identified promising interventions with the best potential to help older adults living with social frailty.

Neuropsychological and Anatomical-Functional Effects of Transcranial Magnetic Stimulation in Post-Stroke Patients with Cognitive Impairment and Aphasia: A Systematic Review.

Transcranial magnetic stimulation (TMS) has been found to be promising in the neurorehabilitation of post-stroke patients. Aphasia and cognitive impairment (CI) are prevalent post-stroke; however, there is still a lack of consensus about the characteristics of interventions based on TMS and its neuropsychological and anatomical-functional benefits. Therefore, studies that contribute to creating TMS protocols for these neurological conditions are necessary.To analyze the evidence of the neuropsychological and anatomical-functional TMS effects in post-stroke patients with CI and aphasia and determine the characteristics of the most used TMS in research practice.The present study followed the PRISMA guidelines and included articles from PubMed, Scopus, Web of Science, ScienceDirect, and EMBASE databases, published between January 2010 and March 2023.In the 15 articles reviewed, it was found that attention, memory, executive function, language comprehension, naming, and verbal fluency (semantic and phonological) are the neuropsychological domains that improved post-TMS. Moreover, TMS in aphasia and post-stroke CI contribute to greater frontal activation (in the inferior frontal gyrus, pars triangularis, and opercularis). Temporoparietal effects were also found. The observed effects occur when TMS is implemented in repetitive modality, at a frequency of 1Hz, in sessions of 30min, and that last more than 2 weeks in duration.The use of TMS contributes to the neurorehabilitation process in post-stroke patients with CI and aphasia. However, it is still necessary to standardize future intervention protocols based on accurate TMS characteristics.

Identifying and characterising digital behaviour change interventions to improve fruit and vegetable intake in low-socioeconomic status primary school children: a systematic review

BackgroundDigital behaviour change interventions aiming to improve dietary intakes; specifically fruit and vegetable intake, in low-socioeconomic children are being developed and tested. However there is currently no synthesis of the characteristics or reported effectiveness of these interventions. This systematic review aims to: (1) identify existing digital interventions targeting fruit and vegetable intake in low-socioeconomic status children, (2) identify and synthesise characteristics and reported effectiveness of these interventions using the Behaviour Change Intervention Ontology.MethodCINAHL, ERIC, PubMed, Cochrane Library, ACM Digital Library and Scopus were searched in December 2021 – February 2022 and in February–March 2024. Inclusion criteria for studies were: 1) children of low-SES families, aged between 5–11 years old; 2) Digital intervention to improve fruit and vegetable intake; 3) Comparison groups could be digital or non-digital; 4) Outcome measures were fruit and vegetable intake and antecedents to diet behaviours; 5) Randomised controlled trials (cluster and parallel designs). Characteristics of identified studies were coded using the Behaviour Change Techniques Taxonomy and Modes of Delivery, Setting and Source ontologies of the Behaviour Change Intervention Ontology.ResultsFive studies met all inclusion criteria, with majority reporting significant effects of interventions on improving fruit and vegetable intake. Most common Behaviour Change Techniques found were Goal Setting (k = 4), Problem Solving (k = 3), Instruction on how to perform a Behaviour (k = 3), and Prompts and Cues (k = 3). Characteristics relating to intervention source were unclear.ConclusionsDigital interventions had positive outcomes in fruit and vegetable intake in children; particularly more for fruit than vegetable intake. Characteristics in digital interventions which have direct effects on child fruit and vegetable intake in low-socioeconomic families should be further investigated. Furthermore, clearer reporting on intervention characteristics is needed.

Recovery of adults with autism spectrum disorder during intensive inpatient treatment: a qualitative study.

Although some adults with autism spectrum disorder (ASD) require intensive and specialized ASD treatment, there is little research on how these adults experience the recovery process. Recovery is defined as the significant improvement in general functioning compared to the situation prior to treatment. This qualitative study describes the recovery process from the perspective of adults on the autism spectrum during intensive inpatient treatment. Semi-structured interviews (n = 15) were carried out and analyzed according to the principles of grounded theory. Our results indicate that, given the specific characteristics of autism, therapeutic interventions and goal-oriented work cannot be carried out successfully, and the recovery process cannot begin, if no good working relationship has been established, and if care is not organized in ways that a person on the autism spectrum finds clear and predictable.

Effects of Visual Art Therapy on Positive Symptoms, Negative Symptoms, and Emotions in Individuals with Schizophrenia: A Systematic Review and Meta-Analysis.

Schizophrenia is characterized by psychiatric symptoms and emotional issues. While pharmacological treatments have limitations, non-pharmacological interventions are essential. Art therapy has the potential to enhance emotional expression, communication, and health; however, the effectiveness of visual art therapy remains uncertain. This systematic review and meta-analysis synthesizes the findings of randomized controlled trials (RCTs) of visual art therapy on positive symptoms, negative symptoms, and emotions in patients with schizophrenia. This study reviews RCTs published prior to February, 2024. The PubMed, Embase, Cochrane Library, CEPS, CNKI, Wanfang, and Yiigle databases were searched, and three independent researchers screened the studies. In this meta-analysis, standardized mean difference (SMD) was employed as a measure to calculate effect sizes for continuous variables using a random effects model, while the meta-regression and subgroup analyses were performed with patient and intervention characteristics. A total of 31 studies revealed visual art therapy had a significant small-to-moderate effect on positive symptoms (SMD = 0.407, 95% CI 0.233 to 0.581), a moderate effect on negative symptoms (SMD = 0.697, 95% CI 0.514 to 0.880), a moderate effect on depression (SMD = 0.610, 95% CI 0.398 to 0.821), and a large effect on anxiety (SMD = 0.909, 95% CI 0.386 to 1.433). The subgroup analysis revealed painting and handcrafts had significant effects on positive symptoms, negative symptoms, and emotions. Combined Chinese calligraphy and painting had significant effects on positive symptoms, depression, and anxiety. Better improvement was noted among the Asian population, and a longer weekly treatment duration was associated with better improvement in positive symptoms. Female participants tended to have more improvements in negative symptoms and anxiety through visual art therapy. The results indicate that visual art therapy has positive effects on the psychiatric symptoms and emotions of individuals with schizophrenia. We recommend future research further investigate art therapy modalities and durations.

The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews

BackgroundAs the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.MethodsA scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.ResultsThirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.ConclusionThe findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.

Deprescribing: An umbrella review.

This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.

Effectiveness of complex behaviour change interventions tested in randomised controlled trials for people with multiple long-term conditions (M-LTCs): systematic review with meta-analysis

IntroductionThe prevalence of multiple long-term conditions (M-LTCs) increases as adults age and impacts quality of life and health outcomes. To help people manage these conditions, complex behaviour change interventions are...

A systematic review of student outcomes as a function of behavioral skills training of teachers

Problem behavior of students in school settings have negative effects on several areas of functioning in children. Empirical research has provided conclusive evidence regarding lifetime repercussions when problematic behavior is not treated. Despite evidence of the effectiveness of applied behavior analysis interventions to improve student’s behavior, access to these services remains a major challenge. Training teachers and staff in these procedures has been shown to be an effective alternative to achieve a greater reach; however, little attention has been paid to the effect of teacher training on student’s outcomes. The current systematic review aims to provide a synthesis of the evidence of teacher’s behavioral skills training intended to modify student’s behavior. Fifty-three empirical studies were collected from eight databases and eight specialized journals. Overall, we found the studies provide evidence of the effectiveness of teacher training on student’s outcomes. We also describe the main characteristics of the study interventions and discuss potential considerations related to training components that can be used to provide more effective training, especially for diverse contexts and communities with fewer resources. Needs for future research are discussed.