Intervention Group Research Articles

How do patients and healthcare professionals experience foot examinations in diabetes care? - A randomised controlled study of digital foot examinations versus traditional foot examinations.

Digital solutions in healthcare can facilitate and improve care. However, the experiences and the usefulness of using either digital foot examinations or traditional foot examinations need to be evaluated. The aims of the study were to evaluate: 1) The differences in patient experiences, having their foot examined supported by the Clinical Decision Support System as compared with having their foot examined in traditional practice, 2) How healthcare professionals, by using the digital tool, experienced the routine compared with performing the foot examination as in traditional practice. Of a total of 141 patients, 100 patients with diabetes were single-blind digitally randomised to one of two parallel arms: having their foot examined by a healthcare professional using a digital tool (n = 47) or having their foot examined as in traditional practice (n = 53) at the Department of Prosthetics and Orthotics at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients filled in a modified version of the National Patient Survey and the Orthotics and Prosthetics Users' Survey at study end. Two healthcare professionals, working at a Department of Prosthetics and Orthotics, answered surveys regarding the interaction between the patient and the certified prosthetist and orthotist. Patients, aged 66 ± 13 years, perceived a high level of satisfaction with the service at the department, regardless of the method used. No significant differences between groups were found when evaluated by 27 questions in the National Patient Survey or by the Orthotics and Prosthetics Users' Survey, with scores of 67.17 ± 12.18 vs. 66.35 ± 16.52 (p = 0.78) for the intervention and control group respectively. For the same patient that healthcare professionals foot examined, the risk class was fully obtained when the risk to develop foot ulcers was assessed by using the digital tool, whereas only 2% of the patients were classified when foot assessed in traditional practice. Regardless of the method used for the foot examination, patients perceived a high level of satisfaction with the services at the Department of Prosthetics and Orthotics. All the patients were risk classified in the intervention group. The healthcare professionals found that, by using the Clinical Decision Support System, the foot examination was structured and followed clinical guidelines. Furthermore, the documentation in the electronic health record was thorough, even though further improvements, such as integration with co-existing health record systems, were requested. Clinical Trials NCT03088566 , Registered 23 March 2017.

The effectiveness of multimedia mental health self-care program based on cyber space on the mental health of infertile women: a randomized controlled trial.

So far, some training interventions have been carried out to improve the mental health in women with infertility, but designing the need and evidence-based, as well as multimedia mental health self-care interventions based on cyber space has received less attention. Due to the spread of the internet and the role of self-care in improving mental disorders, this study was conducted to evaluate the effectiveness of the multimedia mental health self-care program on mental health and to assess the users' satisfaction. This study is a randomized controlled trial with pretest-posttest follow-up design. The sample was selected using a convenience sampling method (n = 90). The random number function was used to assign random numbers. The research instruments include a demographic, psychological Well-being, depression, anxiety, perceived stress, fertility problems and satisfaction with training questionnaire. Six weeks of intervention was conducted following the pre-test and the link of each session's content was sent to the participants, based on the training schedule, through Eitaa Messenger. The post-test and follow-up were conducted 1week and 1month post intervention. The data were analyzed using independent t-test and repeated measures ANOVA. A statistically significant difference was observed between the intervention and control group in the mean score of psychological well-being, perceived stress and infertility stress 1week and 1month post intervention and in the mean score of depression and anxiety 1month post intervention. The intervention group scored higher than the control in psychological well-being but lower in perceived stress, depression, anxiety and infertility stress. The intervention had a positive effect and reduced the score of perceived stress, depression, anxiety and infertility in the intervention group over time. The score reduction continued until the follow-up stage. No significant time-interaction effect was observed on psychological well-being and on the control group. Satisfaction with the program and subscales was desirable. This program could significantly reduce the depression, anxiety, perceived stress and infertility stress and desirable satisfaction with the program was observed among users. This program can be used in designing the experimental and therapeutic interventions to improve mental-health self-care behaviors. RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20210526051410N1; Registration date: 2022-11-06. Last update: 2023-01-28 https://irct.behdasht.gov.ir/trial/57874.

Abstract 4137479: Integrating Ambulatory Care Pharmacists into Value-Based Primary Care: A Scalable Model for Addressing Cardiometabolic Disease

Background: Chronic disease is common, costly, and complicated. In the shift to value-based payment models, interventions to engage patients and improve disease control are necessary to reduce morbidity, mortality, and cost. The use of ambulatory pharmacists has demonstrated improved management of chronic diseases. Traditionally, ambulatory pharmacists are employed by healthcare systems. In this study, we test if integrating ambulatory pharmacists hired, trained, and managed by a retail pharmacy into value-based primary care (VBPC) clinics improves care. Hypothesis: Integrating a Walgreens pharmacist empowered by collaborative drug therapy management agreements (CDTM) into Village Medical (VMD) clinics will improve indicators of chronic disease control. Aims: Improve hemoglobin A1c (HbA1c) in patients with type 2 diabetes (T2D) and systolic blood pressure (SBP) and diastolic blood pressure (DBP) measurements in patients with hypertension (HTN). Methods: An ambulatory pharmacist was embedded into VMD clinics in Phoenix, Arizona under the supervision of VMD primary care providers via a CDTM. The pharmacist provided education, coaching, and medication management by prescribing and titrating therapies for treating T2D and HTN - enabled by access to pharmacy dispensing data. β was generated from difference-in-differences (DID) analyses with propensity score matched controls. Results: 125 patients had T2D, and 43 patients had HTN in the intervention group with 250 and 86 in the matched control group, respectively. The mean age was 65 years, 54% were female, 2% non-English speaking, and 29% racial/ethnic minorities. The average baseline HbA1c was 9% in the intervention group and 10% in the matched cohort. The average baseline SBP was 146 mmHg in the intervention group and 142 mmHg in the matched cohort. The β in the T2D group was -1.61% (p<0.001) while the β in the HTN group was -10.2 mmHg (p<0.01) for SBP and -2.0 mmHg (p=0.42) for DBP. Conclusion: We saw significant reductions in SBP and HbA1c in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into VBPC clinics may improve measures of chronic disease known to be associated with morbidity and mortality.

Evaluation of an Epidemiological Skills Laboratory Course Using a Direct Teaching and Online Flipped Classroom Method in Iran: An Interventional Study

Background and aims: The epidemiological skills laboratory (ESL) course has been incorporated into the curriculum for Master of Science students in epidemiology. However, it has not been implemented and evaluated in Iran so far. The present study was conducted to compare two teaching methods and the implementation of an ESL lesson. Methods: All MSc students (N=9) in epidemiology at Shahrekord University of Medical Sciences were included in the study during two academic semesters in 2019-2020 using a census sampling method. Three levels of Kirkpatrick’s pyramid were used to evaluate direct teaching and electronic flipped classroom (FC) groups. The Chi-square test, Fisher’s exact test, paired t-test, and independent t-test were used in Stata software with a significance level<0.05. Results: The means±standard deviations (SD) of scores of pre- and post-instructional interventions were 42.1±8.4 and 96.6±2.1 in the intervention group with the FC method and 41.3±3.2 and 77.3±4.7 in the direct teaching group. The means±SDs of satisfaction scores of pre- and post-instructional interventions were 67.8±1.6 and 97.6±5.6 in the intervention group with the FC method and 45.3±5 and 87.3±4.5 in the direct teaching group. Conclusion: Under the conditions of the coronavirus disease 2019 epidemic, mainly the virtualization of students’ education and easy access to virtual education systems to convey instructional content, it is a pleasurable opportunity to use the electronic FC method to teach students. The FC method could improve the students’ epidemiological skills and increase their satisfaction.

Based -evidence, an intervention study to improve sleep quality in awake adult ICU patients: a prospective, single-blind, clustered controlled trial.

Evidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients. We conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size. From September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects. Evidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day. ChiCTR2300075763, Registered 14 September 2023-Retrospectively registered, https://www.chictr.org.cn/bin/userProject.

Nutritional education on health beliefs, metabolic profiles, and quality of life among high-risk pregnant women for gestational diabetes mellitus: a randomized controlled trial.

In recent years, nutrition has become increasingly important in treating and managing gestational diabetes mellitus. The Health Belief Model (HBM) is a conceptual framework in health behavior research used in some medical research. The present study aimed to evaluate the effect of glycemic index training based on the HBM on metabolic indicators and pregnant women's health-related quality of life. In this open-label, parallel-controlled randomized trial, 90 pregnant women from primary health centers in Iran were recruited and randomly assigned to either the intervention group or the control group, using a block randomization method with a block size of six. The intervention group underwent 12 weeks of nutritional education on the glycemic index and load of foodstuff. The control group only received routine health care. Valid and reliable questionnaires included demographic and prenatal information, physical activity, three days of food records, quality of life (SF-12), and HBM constructs. Fasting blood samples were taken at baseline and end of the study, to assess fasting blood glucose (FBS), fasting insulin, hs-CRP, and lipids. Eighty-four pregnant women with an age mean of 30.12 ± 4.35 completed 12 weeks of intervention. At baseline, there were no significant differences between groups in the HBM subscales (P > 0.05). However, within the intervention group, there was an increase in perceived susceptibilities (mean change 1.45 ± 4.21; P = 0.03) and cue to action (mean change: 1.22 ± 3.38; P = 0.02). In the adjusted model, the General Health subscale of Quality of Life showed a significant increase in the comparison between groups (mean change 13.69 ± 29.83 vs. 0.00 ± 29.58; P = 0.04). Additionally, the adjusted model revealed a notable difference between the groups in serum hs-CRP level, (mean change -0.877 ± 3.47 vs. -0.067 ± 3.40; P = 0.01) and triglyceride level (mean change - 55.24 ± 111.21 vs. 40.92 ± 142.01; P = 0.001). However, in the adjusted model, the total cholesterol levels increased between groups (mean change 22.75 ± 66.17 vs. 30.12 ± 61.33; P = 0.01) at the end of the study. There was no significant difference in glycemic indices (P > 0.05). Participation in a nutrition education program might positively impact nutritional beliefs, behaviors, and some biochemical indicators among pregnant women. Future studies with larger sample sizes and longer follow-ups are warranted.Trial registration number: IRCTID: IRCT20190227042858N1. Registration date: 2019-07-18.

Effects of Nurse-Led Intervention for Mother-Infant Dyads on Breastfeeding, Infant Health Outcomes.

This study aimed to investigate the efficacy of nurse-led interventions in enhancing breastfeeding women's knowledge and practices and in preventing diarrhea among their infants. The study was conducted in rural areas of Haryana, India, and used the survey design and pre-experimental research design in Phase I and Phase II, respectively. Mothers who had recently delivered a baby were identified using the birth register at the panchayat office, and 200 mothers who met the inclusion criteria were chosen using purposive sampling technique. The data were collected by interview approach using the knowledge questionnaire on breastfeeding, observational checklist on practice of breastfeeding, diarrhea assessment tool, and the duration of data collection was between May to August 2022. In Phase I, exclusive and non-exclusive breastfeeding mothers were surveyed regarding the occurrence of diarrhea among infants. In Phase II, non-exclusive breastfeeding mothers' knowledge and practice were assessed, and then nurseled intervention on breastfeeding was administrated and on 30th, 60th, and 90th days, post-test was done. The study's findings demonstrate that the knowledge and practice scores varied significantly across different tests, from pre-test 1 (6.73 ± 1.94) to post-test 3 (16.19 ± 3.04), (F=294.11, p < .000) for knowledge, and for practice pre-test 1 (23.41 ± 8.90) to post-test 3 (101.81 ± 22.4), (F=535.98, p < .000) in the intervention group. Further, in the intervention group, there was decrease in diarrhea occurrence among various observations (Q=60.609, p < .000). The nurse-led intervention of breastfeeding is an effective teaching technique to improve the knowledge and practice of mothers, as well as it helps to reduce the occurrence of diarrhea among infants, there by it can contribute to reducing the infant mortality rate.

Abstract 4116558: Navigator-driven Recommendations for Palliative Care Consults for Patients with Heart Failure and High Predicted Mortality

Background: Palliative care (PC) engagement can improve quality of life, reduce hospital costs, and enhance symptom control for individuals with heart failure (HF). For certain HF patients, PC can address symptoms and improve quality of life. However, referrals to PC often occur late, delaying benefits. Hypothesis: We hypothesize that a standardized recommendation for inpatient PC consultation will increase PC consultation rates and improve 30-day readmission without an impact on 30-day mortality rates. Methods: This interrupted time series study focused on high-risk HF patients at Atrium Health Wake Forest Baptist. The cohort included patients in the Golden Hearts Program, which is a local program to identify HF patients at elevated risk for 30-day readmissions and to accelerate resources to support their transitions. Baseline data were from patients 5 months before September 1, 2023, and the intervention group were from patients 5 months afterward. A standardized message recommending inpatient PC consultation was sent to attending physicians for patients with ESCAPE scores ≥4. Recommendations were also discussed at multidisciplinary rounds with senior residents. The primary outcomes were inpatient palliative care consultation and discharge to Hospice. Secondary outcomes were 30-day readmissions and 30-day mortality. Outcome measures were assessed post-discharge using Chi-square and T-test analyses. Results: The baseline group had 203 patients; the intervention group had 213. Post-intervention, PC consultation rates decreased from 12.3% to 8% (p=0.19), Discharge to hospice decreased from 2% to 0.9% (p=0.05), 30-day mortality decreased (8.4% vs 7%, p=0.74), and 30-day readmission dropped from 23.6% to 15% (p=0.04). The average length of stay remained 5.7 days in both groups. Limitations included provider buy-in and a limited time period. Conclusion: Though the intervention aimed at targeted PC consult recommendations for advanced HF patients led to reduced 30-day readmissions, there was a not a statistically significant impact on palliative care consultation or mortality.

Mindfulness Meditation Improves Mental Health in Flood Survivors and Disaster Volunteers: A Randomized Wait-List Controlled Trial

Abstract Objectives Being affected by a natural disaster or helping victims can impact mental health. This study aimed to examine whether a digital mindfulness intervention positively affects self-compassion, life satisfaction, and positive affect, and alleviates negative affect, perceived stress, and pathological symptoms in victims and volunteers of the flood disaster in Germany in July 2021. Method Participants were 146 people affected by the flood (via house, n = 88; friends, n = 100; workplace, n = 54) and/or volunteered after the disaster (n = 86). After the randomized assignment, 74 received a 6-week application-based mindfulness intervention, and 72 were allocated to the wait-control condition. The control group received the same intervention 6 weeks later. Before (T1) and after (T2) the intervention of the first group and after the intervention of the control group (T3), participants filled out questionnaires regarding different aspects of mental health. Results We found significant interaction effects of time and intervention for all variables (self-compassion, life satisfaction, positive and negative affect, perceived stress, and pathological symptoms), indicating effectiveness of the digital mindfulness intervention. No deterioration were found between T2 and T3 in the intervention group for any of the variables. Conclusions The 6-week digital mindfulness program positively affected the mental health of both disaster victims and volunteers. Therefore, a digital mindfulness intervention could be a good alternative in situations where group programs or face-to-face meetings are infeasible.

Reducing ACL injury risk: A meta-analysis of prevention programme effectiveness.

The aim of this study was to conduct a meta-analysis of the literature regarding anterior cruciate ligament (ACL) injury prevention programmes (IPPs) in order to assess the effectiveness of ACL prevention programmes based on current high-quality studies. The hypothesis was that the implementation of ACL IPPs significantly reduces the incidence of ACL ruptures compared to standard practice. A meta-analysis of the literature was conducted using the databases PubMed, EMBASE, MEDLINE, CINHAL and Cochrane Central Register of Controlled Trials. The search terms utilized were ACL, injury, knee, control and prevention. The collected data and reported clinical outcomes were independently gathered by three different individuals. After evaluating the heterogeneity of the studies, the DerSimonian-Laird random effects models were employed to determine the pooled risk ratios (RRs) and the risk differences (RDs) regarding ACL Injuries. The RD was utilized to ascertain the number needed to treat. The search strategy identified 743 studies, of which 11 met all inclusion and quality criteria for pooled analysis. The total number of study participants was 16,316. The overall RR of sustaining an ACL injury in the intervention group was 0.36 (95% confidence interval [CI]: 0.23 to 0.57) of the control group, showing a significant reduction in the ACL injury risk of the intervention group (p < 0.001). We identified an RD of -1.4% (95% CI: -2.4% to -0.4%) in favour of the intervention group. The number needed to treat in preventing one ACL rupture was 71. In conclusion, the study clearly demonstrates a significant positive preventive effect of training programmes concerning ACL injuries (p < 0.001). The pooled estimates indicate that such programmes result in a significant reduction of ACL injury risks (p < 0.001). Despite the moderate quality of the included literature, the results exhibit robustness. However, based on the literature examined, no definitive superior training programme could be identified. II.

Improving Outcomes for Patients With Tracheostomy Through Implementation of AARC Clinical Practice Guidelines.

The COVID-19 global pandemic dramatically increased our institution's tracheostomy census. Comparing our existing protocols with American Association for Respiratory Care (AARC) January 2021 clinical practice guideline (CPG) relevant to caring for adult patients with tracheostomy in the acute care setting revealed numerous opportunities for improving our care of those patients. We assembled an interdisciplinary tracheostomy team to implement AARC CPG recommendations and manage all patients with tracheostomy in our hospital. We examined the effect our interdisciplinary team approach and implementation of AARC CPG recommendations had on the following metrics: average patient length of stay (LOS); ICU LOS; percentage of ventilator days; percentage of tracheostomy mask days; tracheostomy tube changes; decannulations; average time to decannulation; mortality; 30-d readmissions; and consultations for speech-language pathology (SLP), one-way speaking valves, physical therapy, and occupational therapy. A total of 203 subjects with tracheostomy were followed in a quality improvement study from June 2019-June 2023 (94 in the pre-intervention group, 109 in the post group). There were significant increases between before and after intervention groups in percentage of decannulations in acutely patients with tracheostomy/not present on admission, non-COVID subjects who survived hospitalization (11.8% vs 33.3%, P = .043), percentage of SLP consults (53.2% vs 89.0%, P < .001), and percentage of one-way speaking valve consults (17.0% vs 32.1%, P = .02). Establishment of an interdisciplinary tracheostomy team and implementation of AARC CPG recommendations for care of adult patients with tracheostomy in the acute care setting resulted in positive, statistically significant outcomes.

Effectiveness of an Executive Functions Parental Program in ADHD Children

Attention/Deficit Hyperactivity Disorder (ADHD) is one of the most prevalent disorders in the child population. Evidence suggests that children with this disorder usually present impairments in executive functions (EF). This study aims to evaluate the effects of a home-based intervention applied by parents (Flii, A Space Adventure) on the EF of Brazilian children with ADHD. Sixteen children with ADHD aged 7 to 12 participated in this study. A battery of neuropsychological tests and questionnaires was applied as assessment. Afterwards, children’ received Flii programa applied at home by the parents. A relevant improvement in visuospatial working memory in the Flii group after the intervention (T2) compared to the control group. The results of the intragroup analyzes suggest that the intervention group had gains in processing speed, cognitive flexibility, verbal and visuospatial working memory. These results suggest that Flii was effective in promoting some changes in the children’ executive functioning.

Abstract 4135178: Short Term Outcomes Of Transcatheter Tricuspid Valve Interventions On Post-Procedural Length Of Hospital Stay, Readmissions For Heart Failure And Procedure Success If An Intracardiac Device Is Present: A Systematic Review And Meta-Analysis In A New Era Of Tricuspid Interventions

Background: Tricuspid regurgitation (TR) is no longer considered forgotten. Transcatheter tricuspid valve repair/replacement (TVRR) has become widely accepted as gauged by clinical outcomes. FDA approved two tricuspid valve devices for the purpose of improving quality of life and not necessarily to improve TR severity. We aim to support evidence-based use of TVRR, by summarizing the latest evidence on the clinical effectiveness in terms of post-procedural length of hospital stay, readmissions for heart failure and procedure success if an Intracardiac device is present. Methods: We searched Pubmed, Embase and Cochrane databases and performed a meta-analysis of the included cohort studies using a fixed-effects model. Studies were excluded if they did not present an outcome in each intervention group or did not have enough information required for continuous data comparison. We performed a meta-analysis of hazard ratio (HR) for two outcomes and odds ratio (OR) for one outcome using the random effects model to remove inconsistency and compared the results with fixed effects model. The compared findings of both methods were similar. The variables used for analysis were number of events in exposure group and total amount of events. All data analyses were performed using MedCalc® Statistical Software version 22.023. Results: Of 161 potentially relevant studies, 8 retrospective studies with a total of 1,717 patients were included in the meta-analysis. Procedure (TVRR) success was associated with fewer readmissions for heart failure in all three studies included in the analysis of pooled HR (HR = 0.46, 95% confidence interval [CI]: 0.33 - 0.63, p&lt;0.001). Procedure success was also associated with shorter length of hospitalization post-procedure in all three studies included in the analysis of pooled HR (HR = 0.48, 95% CI: 0.33 - 0.72, p&lt;0.001). There was no significant association between procedure success and having an intra-cardiac device in all three studies included in the analysis of pooled OR (OR = 0.79, 95% CI: 0.56 - 1.12, p=0.18). Conclusion: Our meta-analysis showed that successful TVRR for high risk patients with severe TR is associated with significant positive outcomes on post-procedural length of hospital stay and readmissions for heart failure, regardless of presence of an intracardiac device. With emerging improvements in device technology and procedural performance, TVRR should be considered in severe and functional TR, to improve clinical prognosis.

Mindfulness-based stress reduction (MBSR) for improving hope and happiness in men with visual impairment

Hope and happiness are positive emotions that affect an individual’s thoughts, feelings, and behavior. These two variables also affect different aspects of an individual’s life such as physical health, lifespan, academic performance, socialization process, creative thinking, problem-solving ability, and mental health. This study seeks to examine the effectiveness of mindfulness-based stress reduction (MBSR) in improving hope and happiness in visually impaired people. Employing a quasi-experimental pre-test–post-test design with a control group, this study sought to examine the degree of the effectiveness of MBSR therapy in improving hope and happiness in visually impaired people. The participants were selected from all visually impaired men aged 20 and 40 living in Tehran in 2023, who were supported by the State Welfare Organization of Iran and were members of the White Cane Society. A total of 40 visually impaired people were selected as the participants and randomly assigned to intervention and control groups (each with 20 members). The data were collected using Snyder’s Adult Hope Scale (1991) and Oxford Happiness Questionnaire (OHQ; 1990). The participants in the intervention group attended eight 90-min MBSR intervention sessions once a week. One-way analysis of covariance (ANCOVA) was used to analyze the data. The mean hope scores in the pre-intervention and post-intervention stages were 20 ± 3.28 and 25.53 ± 3.138, respectively. The mean happiness scores in the pre-intervention and post-intervention stages were 66.86 ± 5.91 and 75.93 ± 4.47, respectively (mean difference = 75.93 – 66.86). The findings showed that MBSR was effective in improving hope ( F = 32.7; p = .01) and happiness ( F = 45.86; p &lt; .001) in men with visual impairment. As a result, MBSR can be considered an effective intervention to enhance happiness and hope while reducing the psychological complications associated with visual impairment in affected individuals.

Abstract 4140111: Impact of Digital Health Tools on Patients Undergoing Cardiac Rehabilitation

Digital health apps are novel tools that have the potential to enhance patient care. However, their benefits in the context of cardiac rehabilitation (CR) are not well studied. This study aims to examine an app’s effectiveness in enhancing exercise performance. The app (KardioPAC) connects to both Bluetooth and cellular-enabled BP devices, which allows providers to monitor and communicate with patients remotely. We aim to assess the app’s impact on functional capacity (metabolic equivalents /METs) compared to standard of care (SOC) CR. This study took place at UC San Diego. Participants were recruited from CR, and randomized in a 1:1 ratio to the two study arms (KardioPAC+CR vs SOC CR). The intervention group was requested to take BP at home and upload via KardioPAC. They additionally received a BP reminder daily and got an intra-app call from the care team at least every 1-2 weeks and when needed. All patients, including SOC arm, were asked to complete a pre- and post-CR visit. In each visit, several measurements (including blood pressure, METs, and quality of life questionnaires) were recorded. The study was approved by the UCSD IRB. All statistical analyses were performed on Python 3.11.8. From Jan 2023 to Mar 2024, 43 patients were enrolled. Table 1 shows their demographics. The mean METs changes are 3.68 vs 2.97 (Intervention vs Control, p=0.052). The mean METs percent changes are 104.39% vs 81.22% (Intervention vs Control, p=0.042), as plotted in Figure 1. Our study found that digital tools significantly enhance CR patients’ performance, even with a small sample size. Furthermore, we found positive signals of digital tools in reducing patients’ blood pressure and improving their quality of life. Patients’ behavior could be changed by incorporating digital tools into daily practice. Our study warrants large-scale studies to investigate the underlying mechanisms and verify the broader benefits of digital tools, including physical, mental, and social improvements.

Ultrasound-guided suprascapular nerve block with lidocaine vs. saline combined with physical exercises for the rehabilitation of supraspinatus tendinitis: a randomized double-blind controlled trial

IntroductionShoulder pain is the third leading cause of musculoskeletal complaints in primary care clinics. Its prevalence varies from 14% to 34%. Among all the structures that can cause shoulder pain, the most vulnerable to injury is the tendon of the supraspinatus muscle. The ideal management protocol is still unknown. To date, little is known in the literature about the use of ultrasound-guided suprascapular nerve block as a treatment for supraspinatus muscle tendinitis. Our objective was to assess the effects of the association of a single ultrasound-guided suprascapular nerve block combined with home-based rotator cuff exercises to reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis.MethodsWe evaluated the effect of a single ultrasound-guided suprascapular nerve block on pain and functioning of people with supraspinatus tendinitis. Diagnosis was performed using the positive Jobe test. Due to large disparity between clinical and radiological findings, only clinical diagnostic criteria were used to select patients. This was a double-blind, randomized, controlled, clinical study in which patients in the intervention group (n = 42) received a single injection of 5 ml of 2% lidocaine, while in the control group (n = 41) patients underwent the same procedure receiving saline solution 0.9%. All patients received face to face instructions by an experienced physiotherapist and a leaflet explaining home-based exercises. Pain and functioning were assessed using the Shoulder Pain and Disability Index (SPADI) questionnaire before the procedure, one week and 12 weeks after the procedure.ResultsPatients in both groups improved significantly since the initial evaluation until the 12th week. Intervention group SPADI (pre, 1 week, 12 weeks): 75.80 ± 18.96, 56.25 ± 31.37, 46.31 ± 31.41 (p &amp;lt; 0.001); Control group SPADI: 75.49 ± 16.67, 50.51 ± 27.58, 49.37 ± 30.90 (p &amp;lt; 0.001). However, there were no significant differences between groups (p = 0.291).Discussion/conclusionWe concluded that both lidocaine and saline ultrasound-guided suprascapular nerve blocks reduce pain and improve shoulder functioning in patients with supraspinatus tendinitis. Unexpectedly, the same block performed with saline showed similar results and effects. Clinical Trial RegistrationClinicalTrials.gov, identifier [NCT02495818].

Abstract 4117856: Effects of a Nurse-led Common-sense Model of Self-regulation-Based Heart Failure Self-care Program on Patient Outcomes: A Randomized Controlled Trial

Introduction: Guidelines have recognized the critical role of self-care in heart failure (HF), but people with HF do not adequately practice self-care. The Common-Sense Model (CSM) of Self-Regulation is a widely used theoretical framework for promoting behavior change and improving disease prognosis among patients. However, studies on the effects of the application of this model among people with HF are limited and present mixed results. Aims: To examine the effects of a nurse-led CSM of Self-Regulation-based self-care intervention on illness perceptions, self-care behaviors, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, anxiety, symptom burden, sleep quality, healthcare service utilization, and mortality among people with HF. Methods: A randomized controlled trial was conducted. Participants were recruited from a university-affiliated hospital and randomized at a 1:1 ratio into the intervention or the control groups. Participants in the intervention group received a 6-week nurse-led CSM of Self-Regulation-based self-care program and usual care. Control group participants only received the usual care. Outcomes of interest were measured at baseline, 6 weeks (T1), and 3 months (T2) after enrollment. The generalized estimating equations model and Mann-Whitney U test were used to examine the intervention effects on the study outcomes. Results: 138 subjects were enrolled in the study between March and May 2023. Participants in the intervention showed statistically greater improvements in illness perceptions, self-care self-efficacy, self-care behaviors, health-related quality of life, depression, symptom burden, and sleep quality compared with the controls at T1 and T2. We also observed a statistically significant reduction in the number of HF-related unscheduled outpatient department visits in the intervention group compared to the control group at T2. However, no significant differences were found in anxiety, number of HF-related hospital readmissions, length of HF-related hospital stays, number of HF-related emergency department visits, or HF-related mortality between the study groups at T1 and T2. Conclusion: Our program generates favorable effects on promoting behavior change and improving health outcomes among people with HF. It also fills the knowledge gaps around the application of CSM of Self-Regulation in people with HF and provides more empirical evidence supporting the effectiveness of nurse-led interventions.

The Effectiveness of the Moyamoya Healthy Youth Application for the Salutogenesis of Adolescents With Moyamoya Disease: A Randomized Controlled Trial.

Adolescents with moyamoya disease can experience unexpected transient ischemic attacks, significantly impacting their daily lives. This study aimed to examine the effectiveness of the Moyamoya Healthy Youth application for adolescents with moyamoya disease. The research employed a parallel, two-group randomized controlled trial with a repeated measures design. A total of 64 adolescents with moyamoya disease were participated. The intervention group applied the application, whereas the wait-list group received their usual care from an outpatient clinic. The outcome variables were assessed three times during the study, from July 2021 to March 2022. Repeated measures ANOVA and Friedman test were used to analyze results. The intervention group exhibited significant improvements in stress and health behavior. No statistically significant improvement was observed in moyamoya disease knowledge, social support, sense of coherence, depression, cortisol, and symptoms. This mobile-based strategy empowered adolescents to monitor their health behaviors and cope with stress. This intervention is a promising strategy for health care providers to enhance self-management skills and achieve better quality of life in such adolescents. Trial Registration: Korea Clinical Trial Registry KCT0006451. https://cris.nih.go.kr/cris/search/detailSearch.do/21925.

Abstract 4135780: Predictors of Engagement in a Coaching Intervention for Heart Failure Caregivers

Background: Even the best intervention will not be effective without engagement in the experience. We developed and tested a virtual health coaching intervention ("ViCCY”, Virtual Caregiver Coach for You) for informal caregivers of patients with HF in a RCT. Of the 125 caregivers in the intervention group, completion rates varied (mean 6 ± 4 sessions, median 9; 21% no sessions). The aim of this study was to identify factors associated with intervention engagement defined as receipt of ≥8 of 10 intervention sessions over a 6-month period based on core intervention content. Methods: This explanatory sequential mixed methods study was conducted in two phases. First quantitative data were analyzed with respect to number of completed sessions, sociodemographics, and the Credibility-Expectancy Questionnaire measuring expectations regarding intervention effectiveness. We used multivariable logistic regression to quantitatively identify salient predictors of caregivers’ intervention engagement. Then, based on the number of sessions completed, 24 caregivers assigned to ViCCY were interviewed to explore individual, family, community, and societal factors associated with intervention engagement. Transcribed interviews were coded using content analysis. Results: Each one hour increase in hours caregiving was associated with reduced odds of completing ≥8 sessions. Race other than White and income insufficient to make ends meet were associated with reduced odds of completing ≥8 sessions. Each unit increase in intervention credibility was associated with increased odds of completing ≥8 sessions. Interviews with participants who completed some sessions revealed common challenges such as the patient’s HF progression and life events including caregiver health issues, balancing multiple responsibilities, and interpersonal issues. Reluctance to accept help from an unfamiliar individual through a virtual network and perceiving additional resources as burdensome also hindered participation. Practical issues such as finding a suitable space for virtual meetings and scheduling conflicts interfered. In those who did not complete any sessions, the main reason for non-engagement was misunderstanding of what to expect in the intervention. Conclusions: The daily lives of HF caregivers are influenced by caregiving demands exacerbated by social determinants of health. These issues may reduce the capacity of caregivers to accept help and ultimately act as a barrier to program engagement.

Post-discharge tobacco abstinence in a Mumbai hospital after implementation of tobacco cessation counseling: A pragmatic evaluation of the LifeFirst program.

Hospitalization provides a key opportunity to address tobacco use. Few studies have examined cessation treatment in hospitals in low- and middle-income countries (LMIC). We aimed to measure tobacco abstinence among individuals discharged from a Mumbai hospital after the implementation of cessation counseling compared to abstinence among those discharged pre-implementation. Pre-post intervention study in the Prince Aly Khan Hospital, Mumbai pre- (11/2015-10/2016) and post-implementation (02/2018-02/2020) of LifeFirst counseling. LifeFirst is multi-session (up to six sessions) counseling extending from hospitalization up to six months post-discharge. Primary analyses compare self-reported 6-month continuous abstinence among hospitalized individuals post-implementation (intervention) with pre-implementation (comparator) using an intent-to-treat approach that includes all participants offered LifeFirst post-implementation in the intervention group. Secondary analyses compare those who received ≥ 1 LifeFirst session with the pre-implementation group. We enrolled n = 437 individuals pre-implementation (8.7% dual use, 57.7% smokeless tobacco, 33.6% smoking) and n = 561 post-implementation (8.6% dual use, 64.3% smokeless tobacco, 27.1% smoking). Post-implementation, 490 patients (87.3%) accepted ≥ 1 counseling session. Continuous abstinence 6-months post-discharge was higher post-implementation (post: 41.6% vs. pre: 20.0%; adjusted odds ratio [aOR]: 2.86, 95% confidence interval [CI] 1.94-4.21). Those who received LifeFirst had higher odds of continuous abstinence compared to pre-implementation (aOR: 2.95, 95% CI 1.98-4.40). Post-discharge abstinence was more common after implementation of a multi-session tobacco counseling program for hospitalized patients compared to abstinence among patients hospitalized before implementation. These findings represent observational evidence of a promising association between post-discharge abstinence and a hospital-based tobacco cessation program implemented within routine practice in an LMIC setting.