Interventions In Health Care Settings Research Articles

The Effectiveness of ACT and DBT-Based Interventions with and without Exercise on Pain Outcomes and Desire for Treatment in Substance-Dependent Patients with Chronic Pain

Background: Managing chronic pain outcomes and addressing the desire for addiction treatment can be crucial for recovery from substance dependence and chronic pain. Objectives: This study aimed to control pain outcomes and enhance the desire for treatment using interventions based on acceptance and commitment therapy (ACT), Dialectical Behavior Therapy (DBT), and physical exercise. Methods: This quasi-experimental study employed a pre-test-post-test design with a two-month follow-up period and included a control group. Seventy-five voluntary patients undergoing addiction treatment in 2021 at Taban, Hayate Pak, and Omid addiction treatment centers in Zahedan with chronic pain participated. Participants were selected through purposive sampling and randomly assigned to five groups (ACT and DBT groups with and without exercise, and a control group). Data were collected using the Pain Outcomes Questionnaire-VA (POQ-VA) (Clark, Gironda, & Young, 2003) and the Stages of Change Readiness and Treatment Eagerness scale (SOCRATES) (Miller & Tonigan, 1996). Acceptance and Commitment Therapy intervention (eight sessions), DBT intervention (eight sessions), and aerobic exercise (24 sessions) were conducted only for the intervention groups over two months. Data were analyzed using repeated measures analysis of variance (ANOVA) and Bonferroni's post hoc test with SPSS-26 software at a significance level of 0.05 (P < 0.05). Results: Repeated measures ANOVA revealed significant changes for ACT and DBT interventions with and without exercise in the intragroup effect (time) for pain outcomes and the desire for treatment across the pre-intervention, post-intervention, and follow-up stages (P ≤ 0.001), as well as for time-group interaction (P ≤ 0.001). Furthermore, the three groups exhibited significant differences in pain outcomes and the desire for treatment across the three evaluation stages (P ≤ 0.01). Notably, compared to other interventions, ACT intervention with exercise was more effective in managing pain outcomes and enhancing the desire for treatment (P ≤ 0.001). Conclusions: The findings suggest that ACT intervention with exercise, while controlling pain outcomes and increasing the desire for treatment, can contribute to successful addiction cessation and serve as an effective intervention in healthcare settings.

The Impact of Integrated Patient Education on Short-Term Revisit Rates in Healthcare Settings: A Quality Improvement Project.

Patient education plays a critical role in healthcare, influencing outcomes and resource utilization. However, effectively integrating patient education into clinical practice remains challenging due to time constraints and inconsistencies in information delivery. Enhancements in Electronic Health Records (EHR) offer potential solutions by facilitating customized, quality education delivery. This study investigates the impact of an EHR-enhanced patient education intervention on short-term revisit rates to healthcare facilities. A quasi-experimental, pre-test/post-test design without a control group was employed at the International Medical Center in Riffa, Bahrain. The intervention consisted of modifications to the EHR system to support patient education, along with staff training on effective education delivery. Patient revisit rates within seven days post-consultation were compared before and after the intervention using chi-square tests and logistic regression, adjusting for potential confounders. A total of 1,239 patients participated in the study, which was divided into two groups: 754 patients in the pre-intervention group and 485 patients in the post-intervention group. A significant change was observed in the patient revisit rates: in the pre-intervention group, 53.32% of patients (402 out of 754) returned within seven days, compared to 41.44% of patients (201 out of 485) in the post-intervention group, with a p-value < 0.01. Enhancements to EHR systems, combined with comprehensive staff education on patient education, can lead to significant reductions in short-term patient revisits. This underscores the importance of integrating technological and educational interventions in healthcare settings to improve patient outcomes and efficiency.

Linking patient-centered communication with cancer information avoidance: The mediating roles of patient trust and literacy

ObjectivesThis study, drawing on the pathway mediation model developed by Street and his colleagues (2009) that links communication to health outcomes, explores how patient-centered communication affects cancer information avoidance. MethodsData was gathered through online access panel surveys, utilizing stratified sampling across Germany, Switzerland, the Netherlands, and Austria. The final sample included 4910 non-cancer and 414 cancer patients, all receiving healthcare from clinicians within the past year. ResultsThe results demonstrated that patient-centered communication is directly associated with reduced cancer information avoidance, especially among cancer patients. Additionally, this association is indirectly mediated through patient trust and healthcare literacy. ConclusionThe findings provide empirical evidence that reveals the underlying mechanism linking clinician-patient communication to patient health information behavior. Practice implicationsThe potential of clinician-patient communication in addressing health information avoidance is highlighted by these findings. Future interventions in healthcare settings should consider adopting patient-centered communication strategies. Additionally, improving patient trust and literacy levels could be effective in reducing cancer information avoidance.

Associations between muscle dysmorphia symptomatology and sleep duration and difficulty in the Canadian Study of Adolescent Health Behaviors

ObjectivesPrior research has shown links between mental health symptomatology and poor sleep. However, associations between muscle dysmorphia symptomatology and poor sleep remain unknown, which was the aim of this study. MethodsData from the Canadian Study of Adolescent Health Behaviors (2021-2022) were analyzed (N = 912). Multinomial logistic regression analyses and logistic regression analyses were used to determine the association between muscle dysmorphia symptomatology and average sleep duration (5 hours or less, 6 hours, 7 hours, and 8 or more hours) and difficulty falling or staying asleep over a 2-week period. ResultsFindings indicated significant associations between muscle dysmorphia symptomatology and shorter sleep duration and greater sleep difficulty in both cross-sectional and prospective analyses. ConclusionsThe findings from this study underscore poor sleep as a correlate of muscle dysmorphia symptomatology among adolescents and young adults, emphasizing the need for screening and interventions in healthcare settings.

A multilevel intervention in pediatric primary care for youth tobacco control: Outcomes of implementing an Ask, Advise, and Connect model.

Multilevel interventions in healthcare settings (e.g. Ask, Advise, and Connect; AAC) can reduce tobacco product use among adult patients: their effectiveness in pediatric practice is largely unknown. We implemented an AAC model in pediatric primary care to deter children's tobacco use, and evaluated its effectiveness in a single-arm trial. At wellness visits, young patients (ages 12-17) completed a tablet-based assessment (Ask) of lifetime and current tobacco use. These data were made available within the electronic health record to pediatric primary care providers for preventive counseling (Advise). Providers then referred patients to an e-health evidence-based tobacco control intervention (Connect). Tobacco control outcomes were examined in the clinic population (N = 2219) and in a sample of patients (N = 388, 62% female, 39% non-White, M age = 15) over time, along with intervention engagement. Population use of tobacco products decreased following introduction of AAC (more than 2-fold). At the patient level, most children (80.9%) engaged with the intervention: those who were Black or African American, who never used tobacco products/were not susceptible to use, and who used fewer non-cigarette tobacco products were more likely to engage, but only after multiple prompts versus a single prompt. Engagement was positively associated with lowering children's susceptibility to using tobacco at follow-up. A pediatric AAC model holds promise in deterring youth tobacco use, including among historically marginalized populations who may require additional support.

Construct Validity and Test-Retest Reliability of Questionnaires to Assess Workplace Violence Risk Factors (QAWRF): A Tripartite Perspective of Worksite-Specific Determinants in Healthcare Settings.

Among available workplace violence (WPV) interventions, only data-driven, worksite-based, and risk-based approach WPV interventions had moderate evidence for effectiveness in decreasing the risk of WPV. The Questionnaires to Assess Workplace Violence Risk Factors (QAWRF) had been previously developed to determine the level of WPV risk factors in each healthcare setting based on the tripartite perspective of key stakeholders to enable effective WPV interventions. This study aimed to determine the construct validity and test-retest validity of QAWRF. QAWRF, a three-component instrument consisting of QAWRF-Administrators, QAWRF-Workers, and QAWRF-Clients, had previously undergone content validation, face validation, and internal consistency reliability testing. 965 respondents were recruited to examine the construct validity of QAWRF, and a subset of these (n = 90) were retested again at an interval of three weeks to assess its test-retest reliability. Confirmatory factor analysis (CFA) was performed, and fitness indices, average variance extracted, correlation coefficient, composite reliability, and intraclass correlation coefficient were determined. QAWRF-Administrator, QAWRF-Worker, and QAWRF-Client had acceptable factor loadings (≥0.6), absolute fit (Root Mean Square Error of Approximation > 0.1), incremental fit (Confirmatory Fit Index and Tucker Lewis Index > 0.9), parsimonious fit (Chi-square/degree of freedom < 5), correlation coefficient between construct (≤0.85), discriminant validity index, and construct reliability (≥0.6). CFA supported a four-factor model for QAWRF-Administrator and QAWRF-Worker, and a two-factor model for QAWRF-Client. QAWRF holds good construct validity and test-retest reliability. By using QAWRF, healthcare managers can identify specific WPV risk factors that are perceived by stakeholders as prevalent at a particular workplace, and these findings can contribute towards data-driven, worksite-specific, and targeted WPV interventions in healthcare settings that are expected to be resource-efficient and more effective than general WPV interventions.

Estimating the return on investment of selected infection prevention and control interventions in healthcare settings for preparing against novel respiratory viruses: modelling the experience from SARS-CoV-2 among health workers

Insufficient infection prevention and control (IPC) practices in healthcare settings increase the SARS-CoV-2 infection risk among health workers. This study aimed to examine the level of preparedness for future outbreaks. We modelled the experience from the COVID-19 pandemic and assessed the return on investment on a global scale of three IPC interventions to prevent SARS-CoV-2 infections among health workers: enhancing hand hygiene; increasing access to personal protective equipment (PPE); and combining PPE, with a scale-up of IPC training and education (PPE+). Our analysis covered seven geographic regions, representing a combination of World Health Organization (WHO) regions and the Organisation for Economic Co-operation and Development (OECD) countries. Across all regions, we focused on the first 180 days of the pandemic in 2020 between January 1st and June 30th. We used an extended version of a susceptible-infectious-recovered compartmental model to measure the level of IPC preparedness. Data were sourced from the WHO COVID-19 Detailed Surveillance Database. In all regions, the PPE+intervention would have averted the highest number of new SARS-CoV-2 infections compared to the other two interventions, ranging from 6562 (95% CI 4873-8779) to 38,170 (95% CI 33,853-41,901) new infections per 100,000 health workers in OECD countries and in the South-East Asia region, respectively. Countries in the South-East Asia region and non-OECD countries in the Western Pacific region were poised to achieve the highest level of savings by scaling up the PPE+intervention. Our results not only support efforts to make an economic case for continuing investments in IPC interventions to halt the COVID-19 pandemic and protect health workers, but could also contribute to efforts to improve preparedness for future outbreaks. This work was funded by WHO, with support by the German Federal Ministry of Health for the WHOResearch and Development Blueprint for COVID-19.

Development and implementation of the Specialist Palliative Care in Aged Care (SPACE) Project across Queensland.

There is an urgent and unmet need for specialist palliative care services in residential aged care. The Specialist Palliative Care in Aged Care (SPACE) Project aimed to improve palliative and end-of-life care for older people living in residential aged care facilities in Queensland. A representative working group developed a series of service principles around palliative care practice in aged care (comprehensive resident-focused care, streamlined service, and capacity building). Funding was allocated by population to the health services in Queensland to adapt and implement models of care aligned with these principles. SPACE successfully implemented a variety of decentralised models of care across Queensland. The critical elements for the success of SPACE were the use of an expert working group to define the core innovation, networking and implementation support from the central project team and community of practice, and adaptable models of care led by local facilitators. Lessons learned from this real-world case study could be adopted to guide and ensure the successful implementation and sustainability of future complex interventions in healthcare settings, both nationally and internationally.

Navigating Cultural Entropy: Leadership Strategies and Organizational Dynamics in Higher Education Institutions

This study aims to explore cultural entropy in higher education institutions, with a focus on understanding its impact on employee performance and organizational dynamics. The research investigates factors influencing cultural entropy, the relationship with leadership, and parallels with healthcare settings. Conducted as a systematic literature review, this research employs a bottom-up approach, reviewing articles from Scopus, Emerald, and Google Scholar (2010-2023). The analysis includes factors contributing to cultural entropy, leadership styles, and the impact on organizational performance in higher education. The findings reveal that cultural entropy in higher education is influenced by factors such as bureaucratic excess, unclear communication, and limited employee engagement. Transformational leadership emerges as a crucial factor in addressing cultural entropy, emphasizing the need for leaders who can instigate positive change and foster a culture of continuous learning. The research is limited by the relatively small body of literature on cultural entropy in higher education. Further research is needed to explore tailored approaches for diverse academic contexts and to develop specific interventions for mitigating cultural entropy in educational settings. The study underscores the importance of proactive leadership in managing cultural entropy. Higher education institutions can benefit from strategies inspired by successful interventions in healthcare settings. Implementing policies and supports to address employee stress and cultural entropy can contribute to a more balanced and sustainable work environment. This study contributes to the limited body of literature on cultural entropy within educational institutions, shedding light on its unique manifestations and challenges. The exploration of parallels between healthcare and academia provides a novel perspective, emphasizing the distinct dynamics at play in educational settings. The study encourages further investigation into tailored approaches for addressing cultural entropy in diverse academic contexts.

Implementation and Impact of Health Care Gardens: A Systematic Scoping Review.

Background: In community and school settings, gardens and garden interventions have been shown to confer several psychosocial, physiological, and nutritional benefits. However, little is known about the implementation and impact of health care gardens on patients, visitors, and staff health and well-being. The primary aim of this review is to identify and describe the types of gardens and common design elements implemented in health care settings and the impact these gardens have on the health and well-being of patients, visitors, and staff. A secondary aim is to assess the quality of available evidence. Methods: PubMed, CINAHL, EMBASE, and PsycINFO were systematically searched on October 28, 2022. Primary qualitative and quantitative studies (excluding case reports and studies) were eligible for inclusion if they described the types of gardens and common design elements implemented in health care settings (hospitals, aged care, rehabilitation facilities, and medical centers) and/or assessed the impact of garden interventions on the health and well-being of patients, visitors, and staff. Review, selection, and data extraction were conducted by two independent researchers, with findings synthesized and presented in narrative form. Articles were critically appraised using the mixed methods appraisal tool (MMAT). Results: Eighteen articles were included. Eight studies provided detailed descriptions of the types of gardens implemented in health care settings (healing [n = 3], therapeutic [n = 2], sensory [n = 2], children's fairy gardens [n = 1], and enriched [n = 1] gardens). Studies examining the psychosocial impacts of gardens were most frequently reported (n = 16), followed by physical (n = 4) and nutritional (n = 2). A wide range of positive outcomes, predominantly relating to patients (n = 12), were reported, including improvements in stress, quality of life (QOL), cognitive function, physical activity, and fruit and vegetable intake. The evidence was heterogeneous and low-medium quality. Conclusions: The findings suggest that implementing gardens and garden interventions in health care settings may positively impact the health and well-being of patients, visitors, and staff. Most studies related to the impact of gardens on patients' mental health and QOL, indicating the need for further research to explore physical and nutritional outcomes, as well as health outcomes of staff and visitors. Findings also suggest the need for high-quality study designs (e.g., cluster control trials) and standardized measurement tools.

Abstract P348: Utilizing A Whatsapp Community To Enhance Hypertension Control And Address Misconceptions Among Patients With High Blood Pressure

A prospective intervention study was conducted, involving patients diagnosed with hypertension and exhibiting misconceptions regarding the condition. The study explored the impact of a WhatsApp community in promoting knowledge exchange, peer support, and adherence to hypertension management strategies. A total of 3000 patients were enrolled in the study, all of whom had been diagnosed with high blood pressure and displayed misconceptions surrounding hypertension. The WhatsApp community provided a platform for these patients to interact, share experiences, and receive guidance from healthcare professionals. The community facilitated the exchange of accurate information regarding hypertension, its causes, risk factors, and effective management strategies. Among the population, 30% were below 40 years of age and predominantly male (70%). About 18% were not on active treatment and a further 12% had switched themselves onto alternative medicines for fear of prescription medicines. Through active participation in the WhatsApp community, patients gained a deeper understanding of hypertension (formative assessment through quizzes), dispelled misconceptions (direct question and answer sessions), and received valuable support from peers facing similar challenges. This real-time communication fostered a sense of empowerment and accountability among the patients. These findings highlight the potential of utilizing technology-based platforms, such as WhatsApp communities, as effective tools for improving hypertension control and addressing misconceptions among patients. Implementing similar interventions in healthcare settings can lead to enhanced patient education, improved adherence, and ultimately better health outcomes for individuals with hypertension.

The Restorative and Contingent Value of Biophilic Indoor Environments in Healthcare Settings

During the COVID-19 pandemic, individuals undergoing healthcare-related quarantine often experience heightened anxiety and stress. While biophilic indoor environments have shown potential in reducing stress, their effectiveness within healthcare quarantine settings remains uncertain. Additionally, the economic value associated with implementing biophilic interventions in healthcare environments remains largely unknown. This study aimed to explore the effects of biophilic interventions in indoor quarantine environments on the perceived outcomes of individuals (such as preference, perceived restorativeness, and satisfaction) and their willingness-to-pay (WTP). Participants were asked to imagine themselves in quarantine and were subsequently assigned to one of four indoor rooms, each featuring a different level of biophilic intervention (non-biophilic, low, medium, and high indoor green). Their perceived outcomes and WTP were then evaluated. The findings consistently demonstrated that incorporating biophilic interventions had a significantly positive impact on perceived outcomes and WTP compared with non-biophilic interventions within healthcare quarantine settings. Among the three levels of biophilic intervention, high indoor green spaces had the highest influence, while low indoor green spaces had the lowest. Moreover, perceived restorativeness consistently played a role in influencing WTP across all three biophilic indoor rooms. Further analysis indicated that a medium level of biophilic intervention would be more advantageous and practical in the design of healthcare indoor environments. This study offers valuable insights into both the monetary and nonmonetary values of biophilic interventions in healthcare settings, aiding designers in selecting appropriate biophilic designs to create enhanced restorative indoor environments.

Smartphone Ownership and Usage Among Pregnant Women Living With HIV in South Africa: Secondary Analysis of CareConekta Trial Data.

Mobile health (mHealth) initiatives are increasingly common in low-resource settings, but the appropriateness of smartphone interventions in health care settings is uncertain. More research is needed to establish the appropriateness and feasibility of integrating new mHealth modalities (novel apps and social media apps) in the South African context. In this study, to inform future mHealth interventions, we describe smartphone ownership, preferences, and usage patterns among pregnant women living with HIV in Gugulethu, South Africa. We screened pregnant women living with HIV from December 2019 to February 2021 for the CareConekta trial. To be enrolled in the trial, respondents were required to be 18 years of age or older, living with HIV, ≥28 weeks pregnant, and own a smartphone that met the technical requirements of the CareConekta app. In this secondary analysis, we describe mobile phone ownership and sociodemographic characteristics of all women screened for eligibility (n=639), and smartphone use patterns among those enrolled in the trial (n=193). Overall, median age was 31 (IQR 27-35) years. Of the 582 women who owned smartphones, 580 responded to the question about whether or not it was a smartphone, 2 did not. Among those with smartphones, 92% (421/458) of them used the Android operating system of version 5.0 or above, 98% (497/506) of phones had a GPS, and 96% (485/506) of individuals charged their phones less than twice a day. Among women who were enrolled in the trial, nearly all (99%, 190/193) owned the smartphone themselves; however, 14% (26/193) shared their smartphone with someone. In this case, 96% (25/26) reported possessing the phone most of the day. Median duration of ownership of the smartphone was 12 (IQR 5-24) months, median duration with current phone number use was 25 (IQR 12-60) months, and median number of cell phone numbers owned 2 years prior to enrollment in the trial was 2 (IQR 1-2). Receiving (192/193, 99.5%) and making (190/193, 99%) phone calls were among the most common smartphone uses. The least used features were GPS (106/193, 55%) and email (91/193, 47%). WhatsApp was most frequently reported as a favorite app (181/193, 94%). Smartphone ownership is very common among pregnant women living with HIV in this low-resource, periurban setting. Phone sharing was uncommon, nearly all used the Android system, and phones retained sufficient battery life. These results are encouraging to the development of mHealth interventions. Existing messaging platforms-particularly WhatsApp-are exceedingly popular and could be leveraged for interventions. Findings of moderate smartphone ownership turnover and phone number turnover are considerations for mHealth interventions in similar settings. ClinicalTrials.gov NCT03836625; https://clinicaltrials.gov/ct2/show/NCT03836625?term=NCT03836625.

Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Protocol for a Scoping Review

With the increased adoption of technology, the use of digital health interventions in health care settings has increased. Patient-clinician digital health interventions have the potential to improve patient care, especially during important transitions between hospital and home. Digital health interventions can provide support to patients during these transitions, thereby leading to better patient outcomes. This scoping review aims to explore the available literature, specifically (1) to examine the impact of platform-based digital health interventions focused on care transitions on patient outcomes, and (2) to identify the barriers to and enablers for the uptake and implementation of these digital health interventions. This protocol was developed based on Arksey and O'Malley's, Levac and colleagues', and JBI scoping review methodologies, and it has been reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews) format. The search strategies were developed for 4 databases: MEDLINE, CINAHL, EMBASE, and the Cochrane Central Register of Controlled Trials by using key words such as "hospital to home transition" and "platform-based digital health." Studies involving patients 16 years or older that used a platform-based digital health intervention during their hospital to home transition will be included in this review. Two reviewers will independently screen articles for eligibility by using a 2-stage process (ie, title and abstract screening and full-text screening). We expect to refine the eligibility criteria during the title and abstract screening process as we anticipate retrieving a significant number of articles. In addition, we will also perform a targeted search of the grey literature, as well as data extraction. Data analysis will consist of a narrative and descriptive synthesis. The review is expected to identify research gaps that will inform the development of future patient-clinician digital health interventions. We have identified a total of 8333 articles. Screening began in September 2022, and data extraction is expected to commence in February 2023 and end by April 2023. Data analyses and final results will be submitted to a peer-reviewed journal in August 2023. We expect to find a wide variety of postcare interventions, some gaps in the quality of research evidence, as well as a lack of detailed information on digital health interventions. PRR1-10.2196/42056.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

A glycemic diet improves the understanding of glycemic control in diabetes patients during their follow-up.

Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research.

Food insecurity, the insufficient or uncertain access to enough food, affected 14.8% of US households with children in 2020 and is associated with adverse physical, mental, and behavioral health across the lifecourse. 1 Coleman-Jensen A Rabbit MP Gregory CA et al. Household Food Insecurity in the United States in 2020, ERR-298. U.S. Department of Agriculture Economic Research Service, 2021 Google Scholar National healthcare organizations have recommended that clinicians screen patients for food insecurity and other social risk factors (Figure). In our study, “Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic,” we evaluated a natural experiment that occurred at one clinic that converted from clinicians verbally asking a 2-item food insecurity questionnaire to parents/caregivers responding on a written form. 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar We found that changing from a verbal to written screen resulted in an immediate and significant increase in the proportion of families who reported food insecurity (10.4% vs 16.3%). 2 Palakshappa D Goodpasture M Albertini L et al. Written versus verbal food insecurity screening in one primary care clinic. Acad Pediatr. 2020; 20: 203-207https://doi.org/10.1016/j.acap.2019.10.001 Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar In this progress report, we consider our results in light of the published literature since we submitted our manuscript in May 2019 and discuss the increased focus on social inequities, growing investment in integrating social care, areas for future research, and potential challenges with social risk screening.

Effectiveness and Safety of Acupuncture to Treat Sleep Difficulties in Women on Hormone Replacement Therapy for the Treatment of Breast Cancer: A Randomized Controlled Trial

Sleep difficulties are commonly reported by cancer patients as consequences of cancer or its treatments. Aim of this study was to measure the effectiveness and safety of acupuncture to treat sleep difficulties in breast cancer women on hormone replacement therapy. Methods: 58 breast cancer women were randomized to once weekly acupuncture session for 8 weeks (acupuncture group) or to a standard care session once a week, for 8 weeks (control group). The primary endpoint was change in sleep difficulties and insomnia, as measured by the Insomnia Severity Index (ISI), administered at baseline and 8 weeks later. Results: Random assignment produced equivalent groups regarding demographic and clinical characteristics at baseline. After 8 weeks, the changes in sleep quality and quantity were significantly different in the two groups. In the acupuncture group 43.33% go into complete remission (absence of insomnia), but none in the control group, and the mean ISI score decreased from 15.87 (standard deviation, SD= 3.95) to 9.80 (SD= 6.22), in the acupuncture group versus 17.46 to 15.39. No patient reported any problems or discomfort associated with acupuncture. Conclusion: A weekly session of acupuncture may have beneficial effects on quality and quantity of sleep among breast cancer women on hormone replacement therapy, after 8 weeks. The results could have important implications for Public Health to prioritize promotion of healthy sleep and acupuncture may be considered as alternative intervention in healthcare setting to ameliorate cancer patients’ sleep and quality of life.

Implementing a text-messaging intervention for unhealthy alcohol use in emergency departments: protocol for implementation strategy development and a pilot cluster randomized implementation trial

BackgroundUnhealthy alcohol use (UAU) is a leading cause of premature mortality among adults in the USA. Emergency departments (EDs) are key intervention settings for UAU but often have limited time and resources. One low-burden, scalable approach to address UAU is text-messaging interventions. Despite strong research support and promise for scalability, there is little research on how to implement such interventions in healthcare settings. The process of providers making them available to patients in an efficient way within already busy and overburdened ED workflows and patients adopting them remains a new area of research. The purpose of this three-phase study is to develop and test an implementation strategy for UAU text-messaging interventions in EDs.MethodOur first aim is to examine barriers and facilitators to staff offering and patients accepting a text-messaging intervention in the ED using an explanatory, sequential mixed methods approach. We will examine alcohol screening data in the electronic health records of 17 EDs within a large integrated health system in the Northeast and conduct surveys among chairpersons in each. This data will be used to purposively sample 4 EDs for semi-structured interviews among 20 clinical staff, 20 patients, and 4 chairpersons. Our second aim is to conduct a stakeholder-engaged intervention mapping process to develop a multi-component implementation strategy for EDs. Our third aim is to conduct a mixed method 2-arm cluster randomized pilot study in 4 EDs that serve ~11,000 UAU patients per year to assess the feasibility, acceptability, and preliminary effectiveness of the implementation strategy. The Integrated Promoting Action on Research Implementation in Health Services framework will guide study activities.DiscussionLow-burden technology, like text messaging, along with targeted implementation support and strategies driven by identified barriers and facilitators could sustain large-scale ED-based alcohol screening programs and provide much needed support to patients who screen positive while reducing burden on EDs. The proposed study would be the first to develop and test this targeted implementation strategy and will prepare for a larger, fully powered hybrid effectiveness-implementation trial. Findings may also be broadly applicable to implementation of patient-facing mobile health technologies.Trial registrationThis study was registered at ClinicalTrials.gov (NCT05350878) on 4/28/2022.

Healthcare-Based Interventions to Improve Parenting Outcomes in LMICs: A Systematic Review and Meta-Analysis.

Although a number of early childhood development (ECD) interventions in healthcare settings in low- and middle-income countries (LMICs) have been developed to improve parent-directed outcomes and support ECD, their impact have yet to be established. This review assesses the effectiveness of healthcare-based ECD interventions in LMICs on the following key evidence-informed parenting outcomes affecting ECD: (1) responsive caregiving (2) cognitive stimulation and (3) parental mental health. Impacts on parental knowledge regarding ECD and parenting stress were also assessed. PubMed, PsycINFO, Scopus, CINAHL and Embase were searched. We included randomized controlled trials reporting effects of healthcare-based ECD interventions in LMICs on parent-directed outcomes in the first five years of life. Data extraction included study characteristics, design, sample size, participant characteristics, settings, intervention descriptions, and outcomes. Meta-analyses were conducted using random effects models. 8 articles were included. Summary standardized mean differences demonstrated significant benefits of healthcare-based interventions in LMICs for improving: (1) cognitive stimulation (n = 4; SMD = 0.32; 95% CI: 0.08 to 0.56) and (2) ECD knowledge (n = 4; SMD = 0.44; 95% CI: 0.27 to 0.60). No significant effects were seen on maternal depression and parenting stress; only one study assessed parent-child interactions in the context of responsiveness. Limitations included small number of studies for moderation analysis, high heterogeneity, variability in measures used for outcomes and timing of assessments. Our results demonstrate statistically significant effects of healthcare-based interventions in LMICs on improving key evidence-based parenting outcomes and offers one promising strategy to support children reach their full developmental potential.

Intimate partner violence and mental health: lessons from the COVID-19 pandemic.

Intimate partner violence and mental health: lessons from the COVID-19 pandemic.