Intervention Outcomes Research Articles

Place-based approach to support children’s development towards sustainable development goals: A scoping review of current effort and future agenda

In 2015, the Sustainable Development Goals (SDGs) were announced with the agreement of 190 world leaders aiming for ending extreme poverty, fighting inequality and injustice by 2030. Among different approaches, investments in future generations’ capacities to thrive are key to attaining these goals. Promoting children’s thriving, however, is not a simple matter because child development is not a single state and is not determined by a single force. Promoting children’s development and capacities necessitates a multifaceted approach, and place-based interventions stand out as a promising strategy. This paper reviewed current evidence on the outcomes of place-based interventions aimed at improving children’s capacities to thrive. We found that 22 published texts that met our inclusion criteria, exhibiting a range of program effects. The review also highlighted several challenges related to implementation and evaluation. Additionally, we discussed how place-based interventions adapt in the digital age.

Understanding parental hurdles in accessing strabismus treatment

PurposeTo explore the parental factors that impede early intervention for strabismus and thus identify strategies for improving access to specialized care. MethodsThis hospital-based cross-sectional study included 110 parents of children under 19 years with strabismus receiving treatment at the squint clinic of a tertiary health care center in north India. A pre-validated survey questionnaire was administered to the participants, that had a section about the socio-demographics of the participants, another section addressed the parental knowledge about strabismus about diagnosis, and the need for an eye examination. It also sought information about referral source, the felt need for squint examination, and reasons for not seeking treatment. ResultsA total of 110 parents/guardians of strabismus patients (59 exotropes and 51 esotropes) were interviewed using a survey questionnaire. Parents themselves identified 80% of cases, and a substantial link (P ​< ​0.0001) was found between the education status of parents and the age of identification of strabismus. Fear of surgical outcomes (41.79%) was a significant barrier to timely surgery with a higher percentage of parents expressing fear of surgical outcomes (P ​= ​0.025). The cost of surgery (34.33%) and the non-availability of facilities (23.88%) also delayed the intervention. ConclusionsIt is essential to educate parents about the importance of strabismus therapy at an appropriate time, stressing its reconstructive rather than merely cosmetic nature, as there are notable gaps in their knowledge. Also, we need to do away with the fear of surgical outcomes of surgical interventions for strabismus.

Physical activity in adult users of inpatient mental health services: A scoping review.

People with severe mental illness engage in considerably less physical activity than those without. They also experience premature mortality of around 10-25 years. A large proportion of these premature deaths are attributed to modifiable behaviours, including physical activity. The inpatient environment provides an opportunity to support people to become more physically active; however, there is limited evidence on which interventions are most successful and what contextual factors affect their delivery. A scoping review was conducted to help understand the extent and type of evidence in this area and identify research gaps. We included studies of physical activity correlates and interventions in adult inpatient mental health services published in peer-reviewed journals. Reviews, meta-analyses, and papers focusing on eating disorder populations were excluded. We searched the MEDLINE, CINAHL, PsycINFO, ASSIA and Web of Science databases for relevant studies published in English. We extracted data on study design, participant characteristics, intervention and control conditions, key findings, and research recommendations. We used a descriptive analytical approach and results are presented in tables and figures. Of 27,286 unique records screened, 210 reports from 182 studies were included. Sixty-one studies reported on correlates of physical activity, and 139 studies reported on physical activity interventions. Most intervention studies used a single-group, pre-post design (40%) and included fewer than 100 participants (86%). Ninety percent of interventions delivered physical activity directly to participants, and 50% included group-based sessions. The duration, type, frequency and intensity of sessions varied. Mental health was the most commonly reported outcome (64%), whereas physical activity was rarely an outcome (13%). Overall, there is a modest but growing body of research on physical activity in adult users of inpatient mental health services. More high-quality trials are needed to advance the field, and future research should target neglected intervention types, outcomes, populations and settings.

Design Considerations for Virtual Reality Intervention for People with Intellectual and Developmental Disabilities: A Systematic Review.

This systematic review aims to explore virtual reality (VR) applications for rehabilitation purposes among people with intellectual and developmental disabilities (IDD), identify their effects on rehabilitation outcomes, explore themes to consider in VR intervention design, and provide guidance for designers and researchers in creating therapeutic environments using VR technology. VR has gained increasing attention in healthcare settings to assist in achieving rehabilitation goals for people with IDD. VR is particularly advantageous since it simulates the real world while providing controllable, safe, and versatile environments. It is necessary to expand the current body of knowledge on VR intervention's outcomes by synthesizing further information on VR application characteristics as well as identifying design considerations regarding feasibility, usability, safety, and other aspects that will benefit future VR intervention design and research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framed the current review. Multiple databases were searched to identify studies published between 2001 and 2023. The review qualitatively organized VR environment design considerations according to three themes: feasibility, usability, and safety. This review included 27 articles and included 868 participants. The overall findings indicated that VR interventions are promising in enhancing rehabilitation outcomes among people with IDD, such as physical, cognitive, emotional, and functional independence domains. This review provides design recommendations to create effective, usable, and safe VR interventions for individuals with IDD. The suggested design implications should be applied with the awareness that VR is a relatively emerging technology with rapidly evolving features.

55. Sarcopenic obesity: an underrated phenomenon impacting adult spinal deformity intervention outcomes

55. Sarcopenic obesity: an underrated phenomenon impacting adult spinal deformity intervention outcomes

Efficacy of interventions for cutaneous squamous cell carcinoma insitu (Bowen's disease): A systematic review and meta-analysis of proportions.

Cutaneous squamous cell carcinoma insitu (Bowen's disease) is a precancerous condition confined to the epidermis of the skin. Despite the critical need for effective interventions to halt its progression, there remains a notable shortage of comprehensive data comparing the efficacy of various therapeutic approaches. This systematic review and meta-analysis endeavour to compare the different efficacies of interventions by investigating and synthesizing data from numerous trials. A pre-defined protocol was registered in PROSPERO (CRD42021242224, registration date: 16 April 2021). Systematic searches in Medline, Embase and Central, along with manual trial register searches, identified studies reporting lesion clearance rates (LCR), participant clearance rates (PCR) or recurrence rates (date of last search: 12 June 2024). Quality assessment followed guidelines from the National Heart, Lung, and Blood Institute (NHLBI). After the study arms were categorized into treatment groups and groups of study quality, the proportions were pooled using the generalized linear mixed model (GLMM) as meta-analytical method. A comprehensive inclusion of 71 studies facilitated an evaluation of 3783 lesions for LCR, 1225 patients for PCR, 4073 lesions for lesion recurrence rates (LRR) and 740 patients for participant recurrence rates (PRR). Surgery demonstrated the highest LCR and PCR (0.97, 95% confidence interval (CI): 0.90-0.99) and the lowest LRR (0.04, 95% CI: 0.02-0.07). This study provides a thorough overview of reported efficacy outcomes for practice-relevant interventions for Bowen's disease. Surgery outperformed other treatments for Bowen's disease. For the other intervention groups, it was not possible to show clear differences in effectiveness: LCR, PCR, LRR and PRR showed various treatment rankings, and the comparability was restricted by different numbers of studies between treatment groups and outcome measures, methodical and clinical heterogeneity. Further high-quality studies are needed to investigate practice-relevant interventions for Bowen's disease.

Characterization of the components in plasma EVs unveiling the link between EVs-derived complement C3 with the severity and initial treatment response of profound sudden sensorineural hearing loss

BackgroundSudden sensorineural hearing loss (SSNHL) is characterized by rapid, unexplained loss of hearing within a 72-hour period and exhibits a high incidence globally. Despite this, the outcomes of therapeutic interventions remain largely unpredictable, especially for those with profound hearing loss. Extracellular vesicles (EVs), nano-sized entities containing biological materials, are implicated in the development of numerous diseases. The specific relationship between EVs and both the severity and treatment effectiveness of SSNHL, however, is not well understood. MethodsThis study involved the analysis of medical records from the Department of Otolaryngology (September 1, 2020 − December 31, 2022) of patients diagnosed with SSNHL according to the 2015 Guidelines for Diagnosis and Treatment of Sudden Deafness in China. Peripheral blood samples from patients with various types of SSNHL before and after treatment were collected, alongside samples from healthy volunteers serving as controls. Plasma EVs were isolated using gel rejection chromatography and analyzed for concentration, marker presence, and morphology using Nanosight, Western blot, and transmission electron microscopy (TEM), respectively. Proteomics and miRNA assessments were conducted to identify differentially expressed proteins and miRNAs in the plasma EVs of SSNHL patients and healthy volunteers. Key proteins were further validated through Western blot analysis. Enzyme-linked immunosorbent assay (ELISA) was utilized to determine the levels of complement C3 in plasma EVs, and correlation analyses were performed with audiological data pre- and post-treatment. ResultsPlasma from SSNHL patients of varying types was collected and their EVs were successfully isolated and characterized. Proteomic analysis revealed that complement C3 levels in the plasma EVs of patients with profound SSNHL were significantly higher compared to healthy controls. Differential expression of miRNAs in plasma EVs and their related functions were also identified. The study found that the level of complement C3 in plasma EVs, but not the total plasma complement C3, positively correlated with the severity of SSNHL in patients exhibiting positive therapeutic responses, particularly in those with initially lower levels of EV-associated complement C3. After treatment, complement C3 level was decreased in patients with initially higher levels of EV-associated complement C3. No significant correlation was observed between changes in plasma EV-derived complement C3 levels and the degree of hearing loss in either responders or non-responders among patients with profound SSNHL. ConclusionDifferential profiles of proteins and miRNAs were identified in patients with profound SSNHL. Notably, plasma EV-derived complement C3 was linked to both the severity and early treatment effectiveness of patients with profound SSNHL.

An implementation evaluation of a sports-based health intervention for underrepresented middle school youth in Philadelphia.

Multicomponent, community-based programs aiming to improve health behaviors in youth are needed but can be challenging to implement. Research is needed to better understand the factors that facilitate and inhibit effective implementation of these programs especially for youth at increased risk of health disparities. This study aimed to identify and explore the implementation determinants and outcomes of a multicomponent health intervention conducted from 2021 to 2022 for middle school students living in underserved communities in Philadelphia, PA, USA. Mixed methods approaches, including self-report surveys and semi-structured qualitative interviews, were administered to 18 members of the implementation staff at the end of the program, including coaches (n = 7), assistant coaches (n = 2), school champions (n = 6), administrative leaders (n = 2), and a school district administrator (n = 1). Survey and interview questions were guided by the Consolidated Framework for Implementation Research (CFIR), and interviews were thematically coded following transcription based on 26 CFIR constructs. Innovation source, evidence strength and quality, cosmopolitanism, and the personal attributes of individuals were key constructs associated with implementation effectiveness. Data revealed three multidimensional themes that highlighted broader challenges influencing implementation: (i) broad consensus, different interpretations, (ii) staffing challenges, and (iii) continuity is key. The need for the program was clearly recognized and overall belief in the purpose of the intervention was strong among key program staff and administration. However, issues including limited engagement with training, staffing turnover, and the rotational programming design hindered implementation. Future projects aiming to implement multicomponent after-school time interventions must ensure a consistent vision among partners and continuity in program delivery.

Implementation of the Acute InpatientMedicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) in rural Veterans Health Administration hospitals: A mixed methods evaluation protocol.

Few rural hospital medicine programs include workforce development training that provides social and professional support for interdisciplinary teams. Even fewer include training that creates supportive learning environments that result in higher staff satisfaction, lower burnout, and reduced turnover. The Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) aims to create supportive learning environments in Veterans Health Administration (VA) rural hospital medicine teams. AIM-HI is a type II hybrid implementation study utilizing a convergent mixed methods approach to evaluate the Relational Playbook, a workforce development intervention, and three implementation strategies: behavioral nudges, learning and leadership collaboratives, and leadership coaching. AIM-HI implementation will occur in waves, enrolling additional hospitals every 12 months. In the first wave, AIM-HI will be implemented at three tertiary VA hospitals that treat at least 1000 rural Veterans annually and have an active inpatient hospital medicine program. The primary outcomes in year 1 will be the acceptability, appropriateness, and feasibility of AIM-HI assessed through participant surveys and interviews. In subsequent years, trends in the learning environment, job satisfaction, burnout, and turnover scores will be assessed using a linear mixed-effect model. The anticipated impact of AIM-HI is to evaluate the utility of the implementation strategies and assess trends in Playbook intervention outcomes. The Playbook has strong face validity; however, before large-scale adoption across the VA enterprise, it is essential to establish the acceptability, appropriateness, and feasibility of the Playbook and implementation strategies, as well as to gather data on AIM-HI effectiveness.

The Impact of Laparoscopic Surgery on Fertility Outcomes in Patients with Minimal/Mild Endometriosis.

Minimal/mild endometriosis (MME) is independently associated with reduced fecundity rates. In this review article, we discuss the role of laparoscopic surgery in enhancing the fertility outcomes of patients with MME. Laparoscopic management of MME enhances fecundity and increases the chances of spontaneous conception in appropriately selected cases. However, laparoscopy cannot be routinely recommended in asymptomatic patients with the sole purpose of diagnosing and treating potentially present MME. Equally, and based on existing information, the laparoscopic management of MME cannot be routinely recommended prior to in vitro fertilisation (IVF) attempts due to the lack of robust and beneficial evidence. Because an overlap between unexplained infertility and MME cases likely exists, the development of reliable, widely available, non-invasive tests for the diagnosis of MME may revolutionise the management of cases currently classified as unexplained infertility. In a disease as diverse as endometriosis, management decisions should be based on a multitude of factors. Future studies should focus on reporting the outcomes of interventions for MME on fertility and obstetric outcomes, clearly differentiating between disease stages and phenotypes.

Provider care segregation and hospital-region racial disparities for carotid interventions in the USA

BackgroundReasons for racial disparities in the utilization and outcomes of carotid interventions (carotid endarterectomy (CEA) and carotid artery stenting (CAS)) are not well understood, especially segregation of care associated with...

Altered states of consciousness in Danish healthy volunteers and recreational users of psilocybin and the possible impact of setting and intention: Danish validation of the five-dimensional altered states of consciousness questionnaire.

Psychedelic substances reliably induce marked altered states of consciousness (ASC), which may be important for lasting effects and clinical outcomes of psychedelic intervention. Several instruments are available to measure the acute psychedelic experience, of which the Five Dimensional Altered States of Consciousness Questionnaire (5D-ASC) is commonly used. The questionnaire can be scored and analyzed as having five dimensions or 11 subscales, but the two have not been evaluated with comparable factor analysis methods. The Danish translation of the 5D-ASC was completed by one sample of healthy volunteers receiving psilocybin in a laboratory setting (N = 47) and one sample of recreative users5D-ASC of psychedelics (N = 550), who reported retrospectively through an online survey based on their most recent experience with psilocybin. We calculated internal consistency measures of Cronbach's alpha and McDonald's omega, conducted a confirmatory factor analysis of the previously suggested factor structures, and tested for possible associations between the 5D-ASC total scores and dose, setting, and intention. For the 11 subscales, we reported omega-sem (composite reliability) using the parameters of the fitted confirmatory factor analyses model. Confirmatory factor analysis showed that the 11 subscales had a good fit to data and showed a better fit compared to the originally proposed five-dimensional solution and good internal consistencies. We further found that the 5D-ASC total scores correlated positively with the dose in the recreative sample. We found no correlations between 5D-ASC total scores and intention or setting. We find the Danish 5D-ASC to be a valid tool for measuring ASC among Danish-speaking individuals.

Outcomes of Different Surgical Interventions for Treating Trigeminal Neuralgia: A Review.

Trigeminal neuralgia (TN) is a debilitating condition characterized by severe facial pain. Various surgical interventions are employed to manage this condition, including microvascular decompression (MVD), percutaneous radiofrequency rhizotomy (PRR), glycerol rhizotomy, percutaneous balloon compression (PBC), and stereotactic radiosurgery such as Gamma Knife radiosurgery (GKRS). This review synthesizes the outcomes of these interventions to provide an understanding of their efficacy and associated risks. MVD, known for its high initial relief rates, shows substantial long-term effectiveness, with recurrence rates varying based on patient demographics and comorbidities. GKRS offers significant pain relief with a favorable adverse event profile; however, recurrence rates increase over time, necessitating repeat procedures for sustained efficacy. PBC demonstrates high initial success, but pain recurrence is common, especially in patients with atypical TN. PRR provides immediate relief with a manageable recurrence rate and is particularly suitable for elderly patients and those with comorbidities. Glycerol rhizotomy, a cost-effective procedure, yields comparable outcomes to other interventions but requires careful patient selection. This review highlights the importance of tailored treatment approaches based on individual patient profiles, emphasizing the need for precise diagnostic criteria and careful patient selection to optimize outcomes. Long-term follow-up and the potential for repeat interventions are critical considerations in managing TN surgically.

E-Health Interventions to Improve Health Outcomes in Patients with Systemic Lupus Erythematosus: A Systematic Review.

Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease that involves damage to one or more organs and systems. E-Health technologies have been used to improve the quality of care and to minimize the cost of rehabilitation services. This study aimed to provide the most recent and convincing evidence on the rehabilitation effects of e-Health interventions compared to conventional treatments. A systematic review was conducted. Inclusion criteria were defined following PICO recommendations (i.e., populations, intervention, comparison and outcome measures). Methodological quality and risk-of-bias were assessed for each study. Six studies met the inclusion criteria, providing data on 743 individuals with SLE. Results indicated that e-Health interventions improved health outcomes, such as disease management or emotional status. Methodological quality was moderate and low risk-of-bias was found in the majority of the studies included. For patients with SLE, e-Health interventions are a safe rehabilitation intervention to improve health outcomes. However, more high-quality studies with large samples are needed, with a focus on the long-term outcomes of e-Health interventions for patients with SLE.

The beneficial impact of ketogenic diets on chemically-induced colitis in mice depends on the diet's lipid composition

Previously, we showed that restrictive diets, including ketogenic diet (KD), have an anti-inflammatory impact on the healthy gastrointestinal tract of mice. Afterward, we found that energy-restricting diets mitigate inflammation in the dextran sodium sulfate (DSS) colitis mouse model. The current study aimed to verify the impact of KD on DSS colitis and assess if the diet's fat composition influences the outcomes of the intervention.Mice with mild chronic colitis were fed control chow, KD composed of long-chain triglycerides (KD LCT) or a KD containing a mix of LCT and medium-chain triglycerides (KD LCT/MCT).KDs did not reverse DSS-enhanced gut permeability and shortening of the colon. Both KDs had a similar impact on liver, cecum, and spleen weight, villi and colon length, the thickness of muscularis externa, and expression of ZO-1 and occludin. On the contrary, body weight, glutathione (GSH) and taurine-GSH levels, GSH-S transferase (GST), and myeloperoxidase (MPO) activity, as well as an abundance of several fecal bacteria, all were differentially affected by the two types of KDs. When compared to the DSS control diet, reduction in colon mucosa cytokines expression was stronger in KD LCT than in the KD LCT/MCT group.We conclude that the outcomes of the KD interventions in terms of potential therapeutical applications depend on lipid composition. KD LCT showed a strong positive impact on gut inflammation. A potential contribution of GSH to KD outcomes and a correlation between MPO activity and microbiota composition was identified.

Mediators of a Mindfulness-Based Intervention for Younger Breast Cancer Survivors: Effects on Depressive Symptoms.

Depression is associated with poor outcomes in breast cancer patients, with higher prevalence among younger women. Although mindfulness-based interventions (MBIs) have demonstrated therapeutic effects, the mechanisms of intervention effects are poorly understood. We investigated whether rumination, self-kindness, intrusive thoughts about cancer, cancer-related worry, or a sense of meaning and peace mediated the intervention effects of an MBI, Mindful Awareness Practices (MAPs), on depressive symptoms. Additionally, we explored the same variables as mediators of a psychoeducation program, Survivorship Education (SE). Women diagnosed with stage 0-III breast cancer at age <50 years were randomized to 6 weeks of MAPs ( n = 85), SE ( n = 81), or wait-list control (WLC; n = 81). During preintervention, postintervention, and 6-month follow-up (FU), we assessed depressive symptoms, rumination, self-kindness, intrusive thoughts, worry, and meaning and peace. MAPs and SE significantly reduced depressive symptoms at postintervention, and reductions remained through 6-month FU for MAPs. Models revealed that reductions in rumination ( β = -0.68, 95% confidence interval [CI] = -1.64 to -0.07) and intrusive thoughts ( β = 1.17, 95% CI = -2.17 to -0.37) and improvements in self-kindness ( β = -1.09, 95% CI = -2.37 to -0.28) and meaning and peace ( β = -1.09, 95% CI = -3.16 to -0.56) mediated MAPs' effects at all time points. Reductions in worry ( β = -1.34, 95% CI = -2.47 to -0.45]) mediated effects at postintervention only. Worry and intrusive thoughts mediated SE effects at postintervention and 6-month FU, respectively. Findings identified depression-relevant mediators of MAPs' effects, expanding the understanding of MBI mechanisms. Results highlight pathways that could be leveraged to optimize intervention outcomes. ClinicalTrials.gov identifier: NCT03025139 .

Retinitis Pigmentosa and Therapeutic Approaches: A Systematic Review.

Background: Retinitis pigmentosa (RP) is a group of hereditary retinal dystrophies characterized by progressive degeneration of photoreceptor cells, which results in debilitating visual impairment. This systematic review aims to evaluate the efficacy and safety of emerging treatment modalities for RP, including gene therapy, mesenchymal-cell-based approaches, and supplementary interventions. Methods: A comprehensive search of electronic databases was conducted to identify relevant studies published up to February 2024. Studies reporting outcomes of treatment interventions for RP, including randomized controlled trials, non-randomized studies, and case series, were included. Data extraction and synthesis were performed according to predefined criteria, focusing on assessing the quality of evidence and summarizing key findings. Results: The search yielded 13 studies meeting inclusion criteria, encompassing diverse treatment modalities and study designs. Gene therapy emerged as a promising therapeutic approach, with several studies reporting favorable outcomes regarding visual function preservation and disease stabilization. Mesenchymal-cell-based therapies also demonstrated potential benefits, although evidence remains limited and heterogeneous. Supplementary interventions, including nutritional supplements and neuroprotective agents, exhibited variable efficacy, with conflicting findings across studies. Conclusions: Despite the lack of definitive curative treatments, emerging therapeutic modalities promise to slow disease progression and preserve visual function in individuals with RP. However, substantial gaps in evidence and heterogeneity in study methodologies underscore the need for further research to elucidate optimal treatment strategies, refine patient selection criteria, and enhance long-term outcomes. This systematic review provides a comprehensive synthesis of current evidence and highlights directions for future research to advance the care and management of individuals with RP.

Personalized care for complex lives: initial outcomes of a behaviorally-informed complex care intervention

Background5% of patients account for the majority of healthcare spend, but standardized interventions for this complex population struggle to generate return on investment. The aim of this study is the development and proof of concept of an adaptive intervention to reduce cost and risk of readmission for medically high-risk individuals with any behavioral health diagnosis.MethodsA behaviorally-oriented, personalized care service was delivered using a consultative, team-based approach including a physician, counselor, dietitian and social worker in collaboration with nurse care coordinators. Iterative re-conceptualizations informed tailored treatment approaches to prevent acute decompensation while retraining behaviors that impeded recovery. This service was offered to a small set of members of the employee health plan at University Hospitals Cleveland with an existing behavioral health disorder from November of 2020 to March of 2023. 26 members receiving the service were identified and matched with 26 controls using a risk algorithm. Members and controls were then classified as high utilizers (n = 14) or standard utilizers (n = 38) based on utilization claims data.ResultsPrimary outcomes of this study included medical expenditures (delineated as planned and unplanned spend) and readmission risk scores. Compared to risk-matched controls, both planned and unplanned health care expenditures significantly decreased (p < .05) for 7 high utilizers, and unplanned spend only significantly decreased for 19 standard utilizers (p < .05). Risk scores, which predict future spend, decreased significantly for standard utilizers (p < .05), but not for high utilizers.DiscussionThe value of a behaviorally-oriented personalized care intervention for medically high-risk patients in a commercial insurance population was demonstrated through decreased spend for high utilizers and decreased risk for standard utilizers. Further expansion, refinement, evaluation and scaling are warranted.

Factors Associated With Unplanned Readmissions and Prolonged Length of Stay in Patients Undergoing Primary Fusion for Congenital Scoliosis.

Approximately 50% of patients with congenital scoliosis will require surgical treatment to prevent further progression. Outcomes following congenital scoliosis are sparse in the literature. The purpose of this study was to identify independent risk factors associated with unplanned readmission and prolonged length of stay (LOS) in patients undergoing primary surgical treatment for congenital scoliosis. The National Surgical Quality Improvement Database-Pediatric was queried for database years 2016-2018 to identify patients with congenital scoliosis who underwent primary posterior fusion of the spine. Patient demographics, comorbidities, and operative variables, such as the number of levels fused and the American Society of Anesthesiologists (ASA) classificaiton, were collected. Univariate and multivariate analyses of patient factors were performed to test for association with readmission within 30 days and prolonged LOS (>4 days). Eight hundred sixteen patients were identified. The average age was 11.3 ± 4.02 years, and the mean postoperative LOS was 4.64 ± 3.71 days. Forty-three patients (5.40%) were readmitted, and 73 patients (8.96%) had prolonged LOS. Independent risk factors associated with prolonged LOS included chronic lung disease (P < 0.001), presence of a tracheostomy (P < 0.001), structural central nervous system abnormality (P = 0.039), oxygen support (P < 0.001), and number of levels fused (P = 0.008). The factors independently associated with unplanned readmission were fusion to the pelvis (P = 0.004) and LOS >4 days (P = 0.008). Prolonged LOS and readmission are widely being used as quality and performance metrics for hospitals. Congenital scoliosis, which often progresses rapidly resulting in significant deformity, frequently requires surgery at an earlier age than idiopathic and neuromuscular deformity. Nevertheless, 30-day outcomes for surgical intervention have not been thoroughly studied. The present study identifies risk factors for prolonged LOS and readmission, which can facilitate preoperative planning, patient/family counseling, and postoperative care. Congenital scoliosis management poses certain challenges that may be mitigated by understanding the risk factors for adverse outcomes following primary fusion surgery.

An evaluation of education videos for women experiencing domestic and family violence in healthcare settings: protocol for a mixed methods systematic review

BackgroundDomestic and family violence (DFV) is a significant public health issue that poses a high risk to women, globally. Women experiencing DFV have higher rates of healthcare utilisation than women not experiencing DFV. Healthcare services are therefore well placed to address DFV and deliver education and awareness interventions to women. Video interventions are a strategy to deliver education to women, while overcoming barriers such as language, literacy, lack of rapport with clinician, or unwillingness to disclose. The current review will aim to further understand the characteristics, methods of evaluation, and outcomes of DFV video education interventions for perinatal women.MethodsThe review will be reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A systematic search will be conducted of the following databases: Medline, Embase, PsycINFO, PsycArticles, Scopus, and Web of Science Core Collection. Two independent reviewers will screen titles and abstracts against the inclusion criteria, followed by a full text screening of eligible articles. A third reviewer will resolve discrepancies. All study types will be included. Only studies published in English will be included. Risk of bias will be assessed using the Quality Assessment with Diverse Studies (QuADS) tool. Data will undergo an aggregate mixed method synthesis informed by The Joanna Briggs Institute, before being analysed using a thematic approach.DiscussionThis systematic review will provide evidence on best practice for the creation, delivery, and evaluation of DFV video interventions for women in the peripartum.Systematic review registrationPROSPERO registration number CRD42023475338.