Intervention Practices Research Articles

A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention.

Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol. We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team. Ethical approval was obtained from NHS North West-Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.

Impact of Custom Foot Orthosis on Dynamic Balance in Sports Enthusiasts with Flat Feet

Background: Custom foot orthoses (CFOs) have been extensively studied for their effectiveness in redistributing plantar pressure, aligning foot structure, and enhancing stability in individuals with flatfoot (Desmyttere et al., 2019; Xu et al., 2020). Flatfoot, characterized by reduced or absent arches, often leads to overpronation and compromised musculoskeletal alignment, impacting dynamic balance and elevating injury risk during physical activity (Hawke et al., 2015). This study examines the impact of CFOs on dynamic balance specifically in sports-active individuals with flatfoot, where optimal balance is critical due to rapid directional changes and stability demands. By providing customized support, CFOs may serve as a practical intervention to improve stability and support safe sports participation. Methods: This quantitative, experimental study used a one-group pre-test and post-test design with purposive sampling. Twelve subjects participated, and dynamic balance was measured using the Modified Bass Dynamic Balance Test. Results: Statistical analysis with a paired-sample t-test yielded a p-value of 0.002, indicating a significant positive effect of CFOs on dynamic balance (p < 0.005). Conclusion: The findings indicate a positive effect of CFOs on dynamic balance in flatfoot individuals engaged in sports. It is recommended that individuals with flatfoot, particularly those involved in sports, consider CFOs to improve balance and reduce injury risk. Regular assessments by healthcare professionals may further optimize orthotic benefits for enhanced performance and stability.

Nanomedicine in cardiology: Precision drug delivery for enhanced patient outcomes.

Cardiovascular diseases as a primary driver of global morbidity and mortality. Despite the array of therapeutic avenues in clinical practice, predominantly pharmaceutical and surgical interventions, they often fall short of fully addressing the clinical exigencies of cardiovascular patients. In recent years, nanocarriers have shown great potential in the treatment and diagnose of cardiovascular diseases. They can enhance drug targeting and bioavailability while reducing side effects. Additionally, by improving imaging and detection technologies, they enhance early diagnosis and disease monitoring capabilities. These advancements in technology offer new solutions for precision medicine in cardiovascular diseases, advancing treatment efficacy and disease management. Crafted from biomaterials, metals, or their amalgamations, these nanocarriers approximate the dimensions of biologically active molecules like proteins and DNA. Cardiovascular nanomedicine, in its infancy, has only recently burgeoned. Yet, with continual refinement in nanocarrier architecture, drug delivery mechanisms, and therapeutic outcomes, the potential of nanomedical technologies in clinical contexts becomes increasingly evident. This review aims to consolidate the strides made in nanocarrier research concerning the treatment and diagnose of cardiovascular diseases.

Data based individualization in early writing: the importance and measurement of implementation fidelity

In this paper we describe the process of monitoring fidelity of implementation for a teacher-implemented early writing intervention. As part of a large, federally funded project, teachers who worked with students in grades 1 through 3 in schools across two states in the US were recruited and then randomly assigned to implementation and control conditions. Using Data-Based Individualization (DBI) as a framework for best practice in assessment and intervention, teachers in the implementation group received professional development on early writing intervention and assessment and then implemented these practices with their students who had significant writing challenges. Coaches, who were part of the research project, supported teachers and also observed teachers in both the implementation and control conditions at least twice during the course of the 20-week study. This paper focuses on the results of the fidelity measures that were administered throughout the project. An overview of the importance of fidelity checks is followed by a description of the fidelity tools used, as well as data from those tools. Areas of strength and challenge for teachers when implementing early writing assessment and intervention and engaging in data-based decision making with fidelity are discussed, along with recommendations regarding the practical and research importance of fidelity checks.

Lifetime Adversity and Risky Substance Use among Transgender Emerging Adults: Selected Interventions and Clinical Social Work Practice

AbstractThis study investigated multivariate relations between indicators of lifetime adversity and past year risky substance use reported by an Internet-recruited sample of transgender emerging adults from the United States (N = 248, age M = 22.61 years). Canonical correlation analysis (CCA) documented the canonical correlation between canonical variates in this sample (.362), as well as the amount of shared variance (13.1%) between set of variables representing lifetime adversity and past year risky substance use. Examination of the standardized canonical coefficients and structure coefficients highlighted the important contributions of (a) past year drug use and negative consequences of substance use to the synthetic criterion variable and (b) lifetime intimate partner violence to the synthetic predictor variable. Information generated in this study about how specific observed variables contributed to canonical variates may be used to tailor trauma-informed selected interventions in clinical socialwork practice with transgender emerging adults who report substance use problems.

Identifying Key Instructional Practices in Rational Number Interventions: A Systematic Review and Meta-Analysis

Impacts of rational number interventions among U.S. students in Grades 3 through 9 with mathematics difficulties are examined using a systematic review and meta-analysis. The primary goal of the meta-analysis was to identify instructional practices that are key drivers of student impacts. From approximately 1,200 published and unpublished study records, we identified 28 studies that met our inclusion criteria and coded the interventions for their instructional practices, intervention characteristics, and study design features. The random-effects mean effect size across all 28 studies (90 effect sizes) was 0.68 ( SE = 0.08, p < .001, 95% confidence interval [CI]: [0.51, 0.85]). The 95% prediction interval was −0.36 to 1.8. Using meta-regression techniques, we found the teaching of mathematical language ( β = 0.50) and the use of the number line ( β = 0.47) during intervention to be significantly associated with positive impacts when adjusted for controls. We discuss implications for intervention practice and study limitations along with the challenges of examining complex, multifaceted interventions.

Phosphodiesterase inhibitors and testicular torsion: A systematic review and meta-analysis of animal studies.

Testicular torsion is a common urological emergency in children and teenagers that, in most cases, requires surgical exploration and detorsion. However, even after a successful intervention, a high number of patients still develop irreversible damage. To investigate whether the administration of phosphodiesterase inhibitors (PDE) in animal models of testicular torsion can reduce damages caused by the ischemia-reperfusion syndrome. A systematic search of the Medline, Web of Science, Embase, and Ovid databases for studies up to December 2023 was performed using PRISMA guidelines. A detailed search was conducted using the following key terms: "testicles," "ischemia," "reperfusion," and "phosphodiesterase inhibitors." There was no restriction regarding language or year of publication. We investigated spermatogenesis by the Johnsen's biopsy score (JTBS) and histological damage by the Cosentino's biopsy score (CBS). Malondialdehyde (MDA), nitric oxide (NO), superoxide dismutase (SOD), and glutathione peroxidase (GPx) testicular levels were also analyzed. Initially, 296 articles were identified. However, only 20 studies met the inclusion criteria. PDE inhibitors improved JTBS (MD=2.53, CI=1.94 to 3.13), CBS (MD=-1.11, CI=-1.25 to -0.97) and SOD (SMD=3.27, CI=1.59 to 4.95) outcomes. PDE did not improve MDA (SMD=-0.93, CI=-2.19 to 0.34), NO (SMD=-0.54, CI=-1.56 to 0.48), and GPx (SMD=0.77, CI=-0.38 to 1.92) outcomes. A higher dose of PDE inhibitors only improved CBS outcome. This review indicates that the administration of PDE inhibitors in rats ameliorated the outcomes, representing a promising complementary strategy for spermatogenesis recovery following testicular torsion. Our review suggests that JTBS and CBS could be translated into future human studies, validating and extending these findings within the context of human physiopathology, while providing applicability of interventions in real clinical practice.

Las prácticas preprofesionales en la formación psicopedagógica ¿Revisión, supervisión o covisión?

This paper arises from a research that aims to build knowledge about learning experiences, paths, and psychopedagogical interventions in pre-professional training practices. The strategy to approach the study is the open qualitative interview, administered to students and graduates, to analyze a category constructed from the repeated reading of the field records: Pre-professional practices in psychopedagogical training, with emphasis on the sub-axis referring to the accompaniment and the possibilities of reviewing these practices. Focusing on practices means addressing complex events that confront students with decisions characterized by the uniqueness of their journeys. Follow-up and accompaniment require a space to listen to obstacles, advances, and setbacks, failed and accurate interventions: the review -supervision or co-vision- of the psychopedagogical practices that are carried out individually or in groups in the context of institutions.

A Convolutional Neural Network Model for Crop Disease Detection System

Crop diseases pose a significant challenge to global food security, adversely impacting agricultural output and resulting in considerable economic repercussions. The prompt and precise identification of these diseases is essential for effective intervention and sustainable agricultural practices. This study introduces a model based on Convolutional Neural Networks (CNNs) for the automated detection of crop diseases. The model employs advanced deep learning methodologies to recognize and categorize plant diseases through the analysis of leaf images. Our CNN framework is trained on an extensive dataset comprising both diseased and healthy plant images, employing multiple convolutional layers to extract intricate features, including texture, color variations, and patterns linked to specific diseases. The model demonstrates a high level of accuracy in identifying a variety of diseases across different crop species by learning from both overt symptoms and subtle cues. We evaluate the performance of the system using established metrics such as accuracy and precision, thereby validating its efficacy in practical applications. The proposed system is designed for implementation in low-resource agricultural settings, offering farmers a cost-effective, dependable, and real-time solution for monitoring crop health.

Closing the gap: introducing the EQUALS MAP framework for equity-focused evidence synthesis

Abstract Background Equity-focused analysis is vital to understanding how interventions affect disadvantaged groups and prevent widening inequalities via intervention-generated inequalities. We reviewed PROGRESS-Plus usage - a commonly used framework in equity-focused reviews and proposed a novel framework. Methods First, we re-analysed articles from the EQUALISE study, a review of interventions that increase or decrease inequalities in general practice, to explore the various domains of disadvantage examined in the included studies. We then compared these domains of disadvantage with the existing PROGRESS-Plus framework. Finally, we propose a new framework to support equity-focused evidence synthesis. Results From the 325 studies included, the PROGRESS-Plus dimensions most assessed were sex(52%), ethnicity/race(49%), and age(44%). The PROGRESS-Plus framework missed context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. Our new framework EQUALS MAP includes: Ethnicity (and culture and race); Qualifications (and other socioeconomic factors of household or individual); Underprivileged areas; Age; Lesbian, gay and other sexual identities; Sex and gender; Multiple disadvantages; Additional groups experiencing significant disadvantage; and Physical and mental disability. Conclusions EQUALS MAP encapsulates the key dimensions of health inequities whilst for allowing context-specific flexibility. Examining the effectiveness of policy and practice interventions by disadvantaged groups is paramount to prioritise actions. Key messages • PROGRESS-Plus - a commonly used framework for equity-focuses evidence synthesis - misses context-specific groups, those with multiple intersecting disadvantage, and people who experience disability. • EQUALS MAP is a novel framework which encapsulates the key dimensions of health inequalities whilst allowing for context-specific flexibility.

Virtual Lifelines: Filipino Psychologists' Experiences with Tele-Counseling for Suicide Prevention

The COVID-19 pandemic forced a rapid shift to tele-counseling, presenting unique challenges for psychologists, especially those working with high-risk clients. This exploratory multiple-case study investigated the experiences of three Filipino psychologists providing tele-counseling for suicide prevention. The study revealed initial struggles with technology, ethical concerns, and perceived clinical effectiveness. However, the psychologists demonstrated resilience through a two-phase continuous professional development process: orientation and recalibration. Key outcomes included increased clinician enthusiasm, new professional opportunities, and improved ethical responses to crises. Tele-counseling emerged as a client-responsive tool that expands access to mental health services. Despite challenges, tele-counseling can be effective for suicide prevention with proper adaptation and training. These findings underscore the importance of integrating tele-counseling competencies into professional training curricula and developing evidence-based practices for remote crisis intervention.

Overcoming non-usage of e-mental health: A qualitative study in a Dutch general practice

Abstract Background Worldwide percentages of people with mental health problems are substantial and increased during the COVID pandemic (to about 25 % in the general population). E-mental health has potential to help with waiting lists, rising health care costs and work pressure. To reach the desired effects, participants need to use the technology as intended. Non-usage though is a common problem. Research question is: what elements obstruct the intention to use e-mental Health interventions, plus what are barriers to bridging the intention-behaviour gap? Methods In a qualitative study, semi-structured interviews were conducted (interview guide). We recruited patients who were invited for an e-mental health intervention in a Dutch general practice but did not start the intervention. Data saturation occurred with 11 patients. Open, axial and selective coding was done on the transcribed interviews using the software ATLAS.ti. Results Five main themes were associated with non-use: 1) ‘Expectations about the eHealth in general’ were neutral to positive. 2) ‘thresholds to start e-mental health’ were: negative expectations about the content, lacking mental capacity due to mental problems, missing personal contact, the therapy with the mental health professional in general did not fit their needs or aversion towards more screen time. 3) ‘lack of planning’. 4) lacking encouragement from mental health professional 5) ‘Expectations from therapy in general’. (a.o. face-to-face contact and tailoring) Conclusions Embedding the e-mental health more into regular therapy has potential to overcome non-usage. The mental health care professional has social influence to increase usage, by a clear and convincing introduction plus joint review of the exercises during consultations. This study needs to be repeated in other clinical settings. Future research should also include age (computer use) and disease prognosis to define when e-mental health is a suitable solution for patients. Key messages • E-mental health interventions have potential to help with waiting lists, rising health care costs and workload, but non usage is a problem. • Embedding the e-mental health more into regular therapy has potential to overcome non-usage.

Watery traces and absences: sensations and speculative histories of an ancient well and a carse landscape

This paper explores how mighty earth processes, aquatic agencies and human practical, political, religious, technological, commercial and environmental interventions have shaped and reshaped a now obscure Scottish holy well and the carse landscape to which it belongs. More specifically, I detail the historic pagan rituals, vigilant religious policing, romantic redesign and extensive terraforming that have informed the changing uses and symbolic associations of these watery realms, demonstrating how they testify to ceaselessly changing human-water relations. I explore how an awareness of particular historical events garnered from diverse texts can be supplemented with affective and sensory engagements with the non-human agencies, vestiges and absences of place. Together, they foster intimations and speculative imaginaries that conjure up speculative watery histories and conjectural futures.

Prediction of Suicidal Thoughts and Suicide Attempts in People Who Gamble Based on Biological-Psychological-Social Variables: A Machine Learning Study.

Recent research has shown that people who gamble are more likely to have suicidal thoughts and attempts compared to the general population. Despite the advancements made, no study to date has predicted suicide risk factors in people who gamble using machine learning algorithms. Therefore, current study aimed to identify the most critical predictors of suicidal ideation and suicidal attempts among people who gamble using a machine learning approach. An online survey conducted a cross-sectional analysis of 741 people who gamble (mean age: 25.9 ± 5.56). To predict the risk of suicide attempts and ideation, we employed a comprehensive set of 40 biological, psychological, social, and socio-demographic variables. The predictive models were developed using Logistic Regression, Random Forest (RF), robust eXtreme Gradient Boosting (XGBoost), and ensemble machine learning algorithms. Data analysis was performed using R-Studio software. Random Forest emerged as the top-performing algorithm for predicting suicidal ideation, with an impressive AUC of 0.934, sensitivity of 0.7514, specificity of 0.9885, PPV of 0.9473, and NPV of 0.9347. Across all models, dissociation, depression, and anxiety symptoms consistently emerged as crucial predictors of suicidal ideation. However, for suicide attempt prediction, all models exhibited weaker performance. XGBoost showed the best performance in this regard, with an AUC of 0.663, sensitivity of 0.78, specificity of 0.8990, PPV of 0.34, NPV of 0.984, and accuracy of 0.8918. Depressive symptoms and rumination severity were highlighted as the most important predictors of suicide attempts according to this model. These findings have important implications for clinical practice and public health interventions. Machine learning could help detect individuals prone to suicidal ideation and suicide attempts among people who gamble, assisting in creating tailored prevention programs to address future suicide risks more effectively.

Turkish validity and reliability of the universal mental health literacy scale for adolescents (10-14 years): A methodological study.

Mental health literacy enables adolescents to acquire information that will accompany them in their future lives and to define their attitudes and behaviors. This study evaluated the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents (10-14 years). This is a methodological, correlational, cross-sectional, and descriptive study. The study was conducted with 223 adolescents. Data were collected by 'Information Form' and 'Universal Mental Health Literacy Scale for Adolescents.' Exploratory Factor Analysis, Confirmatory Factor Analysis, and Pearson Correlation analysis were used to assess the validity and reliability of the UMHL-A. Item Content Validity Index (I-CVI) scores ranged from 0.94 to 0.96, while the Scale Content Validity Index (S-CVI) was 0.95. For 'Help-seeking and Stigma dimensions' χ2/df = 3.347, NFI = 0.804, IFI = 0.854, TLI = 0.778, CFI = 0.849, RMSEA = 0.103. For 'Knowledge of Mental Health and Knowledge of Mental Illnesses dimensions' χ2/df = 1.959, NFI = 0.731, IFI = 0.847, TLI = 0.774, CFI = 0.837, RMSEA = 0.066. The internal consistency and time stability were affirmed by a Hotelling T-square value of 15.241 and an F-test result of 27.793. This study reveals that the Turkish validity and reliability of the Universal Mental Health Literacy Scale for Adolescents is a valid and reliable tool for assessing mental health literacy among adolescents. The UMHL-A scale is a valid tool to evaluate critical aspects of mental health literacy in adolescent populations and can be used in both research and clinical practice in mental health education and intervention. It is recommended that the Turkish version of the Universal Mental Health Literacy Scale should be used to determine resilience in adolescents.

Current research trends in child poverty and psychological resilience research: A bibliometric analysis approach

AbstractThe first of the sustainable development goals is to end poverty by 2030. Although many individual, social, and psychological resources have been proposed to reduce poverty, little is known about psychological resilience factors and related variables in reducing it. While the literature on childhood poverty and psychological resilience indicates that there was a relationship between these variables, it also draws attention to the fact that a growing interest in the need to consider psychological factors in reducing child poverty. Contextually, this study is bibliometric research that aims to reveal the current research trends about child poverty and psychological resilience. The researcher reviewed the Web of Science to highlight current trends in child poverty and resilience research and found 1065 relevant documents that met the inclusion criteria. The research used co‐occurrence, citation, and bibliographic coupling techniques from the bibliometric analysis type. Research results showed that poverty, resilience, children, protective factors, youth, parenting, COVID‐19, stress, and mental health were the nine significant clusters where the poverty and resilience keywords were gathered (items = 120, links = 988, total link strength = 1646). The United States had the most publications and was the most collaborative country. The most associated SDG target was good health and well‐being. Research trends underline that the five most studied keywords were resilience, poverty, children, health, and risk. Thematic map results indicated that socioeconomic status, childhood, and adjustment topics were important, well‐developed, and structuring themes, while resilience, poverty, and children topics were essential themes but still needed to be well‐developed. The research findings highlight the importance of resiliency factors that can potentially reduce child poverty. The results also give researchers essential insights into socioeconomic, mental, psychological, and environmental factors that they can use in their intervention practices holistically in reducing child poverty.

Voluntary Neonatal Medication Incident Reporting—A Single Centre Retrospective Analysis

Background: Medication errors in neonatal intensive care units (NICUs) are prevalent, with dosage and prescription errors being the most common. Aims: To identify the common medication errors reported over twelve years using a voluntary, nonanonymous incident reporting system (RiskMan clinical incident reporting information system) at an Australian tertiary NICU. Methods: This was a single-centre cohort study conducted at a tertiary NICU. All medication-related incidents (errors) reported prospectively through the RiskMan online voluntary reporting database from January 2010 to December 2021 were included. The medication incidents were grouped into administration, prescription, pharmacy-related, and others, which included the remaining uncommon incidents. Results: Over the study period, 583 medication errors were reported, including administration-related (41.3%), prescription-related (24.5%), pharmacy-related (10.1%), and other errors (24%). Most incidents were reported by nursing and midwifery staff (77%) and pharmacists (17.5%). Most outcomes were minor or insignificant (98%), with only a few resulting in major or significant harm. There was one extreme incident that may have contributed to the death of a neonate and nine moderate incidents. Conclusions: Our results demonstrate that medication errors are common and highlight the need to support improvement initiatives and implement existing evidence-based interventions in routine practice to minimise medication errors in the NICU.

Incidence rates of hepatocellular carcinoma based on risk stratification in steatotic liver disease for precision medicine: A real-world longitudinal nationwide study.

Detailed subgroup incidence rates for steatotic liver disease (SLD)-related hepatocellular carcinoma (HCC) are critical to inform practice and public health interventions but remain sparse. We aimed to fill in this gap. In a retrospective cohort study of adults with SLD from the United States (US) Merative Marketscan Research Databases (1/2007 to 12/2021), we estimated HCC incidence stratified by sex, age, cirrhosis, diabetes mellitus (DM), and a combination of all these 4 factors. We excluded patients with significant alcohol use and chronic viral hepatitis. We analyzed data from 741,816 patients with SLD (mean age 51.5 ± 12.8 years, 46% male, 14.7% cirrhosis). During a 2,410,166 person-years (PY) follow-up, 1,740 patients developed HCC. The overall HCC incidence yielded 0.72 per 1,000 PY (95% confidence interval [CI, 0.68, 0.75]). The incidence was higher in males (0.95, 95% CI [0.89, 1.01]) compared to females (0.52, 95% CI [0.48, 0.56]) (p < 0.001). For those with cirrhosis, the incidence was significantly higher at 4.29 (95% CI [4.06, 4.51]) compared to those without cirrhosis (0.14, 95% CI [0.13, 0.16]) (p < 0.001). Additionally, the incidence was higher in patients with DM (1.19, 95% CI [1.12, 1.26]) compared to those without DM (0.41, 95% CI [0.38, 0.44]) (p < 0.001). Chronic kidney disease (CKD) was also associated with a higher HCC incidence of 2.20 (95% CI [2.00, 2.41]) compared to those without CKD (0.58, 95% CI [0.55, 0.62]) (p < 0.001). Similarly, individuals with cardiovascular disease (CVD) had a higher HCC incidence of 1.89 (95% CI [1.75, 2.03]) compared to those without CVD (0.51, 95% CI [0.48, 0.54]) (p < 0.001). Finally, the incidence of HCC was significantly higher in patients with non-liver cancer (3.90, 95% CI [3.67, 4.12]) compared to those without other cancers (0.29, 95% CI [0.26, 0.31]) (p < 0.001). On further stratification, HCC incidence incrementally rose by 10-year age intervals, male sex, cirrhosis, and DM, reaching 19.06 (95% CI [16.10, 22.01]) and 8.44 (95% CI [6.78, 10.10]) in males and females, respectively, but only 0.04 for non-diabetic, noncirrhotic aged <40 years patients in both sexes. The main limitation of this methodology is the potential misclassification of the International Classification of Diseases (ICD) codes inherent in claims database studies. This nationwide study provided robust granular estimates for SLD-related HCC incidence stratified by several key risk factors. In addition to cirrhosis, future surveillance strategies, prevention, public health initiatives, and future research models should also take into account the impact of sex, age, and DM.

Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry.

To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS. Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022). UK NHS hospitals treating RRP patients. Children and adults diagnosed with RRP and managed in an NHS hospital. Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death). Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period. This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time. NCT03465280, ISRCTN36100560.

Advancing Community Care and Access to Follow-Up after Acute Kidney Injury Hospitalization: A Randomized Clinical Trial.

Key Points A risk-guided intervention improved adherence to processes of care for AKI survivors.Further supports are necessary to improve uptake of processes of care for AKI survivors in primary care. Background AKI is associated with development and progression of CKD. Gaps in recommended care for CKD are common after AKI. Methods In this randomized controlled trial conducted in Alberta, Canada, we allocated adults hospitalized with Kidney Disease Improving Global Outcomes (KDIGO) stage 2 or greater AKI to a risk-guided, transition of care intervention versus usual practices at the time of hospital discharge. For people in the intervention group, we used a validated risk index to predict risk of severe CKD after AKI. People at low risk (&lt;1%) received patient education alone. People at medium risk received additional clinical guidance, provided to their primary care physician. People at high risk (&gt;10%) were referred to nephrology. The primary outcome was the proportion of patients who received treatment with an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin II receptor blocker (ARB), statin, and nephrology specialist follow-up within 90 days of discharge. Results One hundred fifty-five patients were recruited; the mean (SD) age was 60 (15) years, 91 (60%) were male, and 96 (62%) had eGFR &lt;60 ml/min per 1.73 m2 or urine albumin-creatinine ratio &gt;30 mg/g at discharge. The proportion of participants who received ACE-I/ARB, statin treatment, and nephrologist follow-up was 28% in the intervention group versus 3% in the usual care group (absolute risk difference [RD], 25%; 95% confidence interval [CI], 15% to 36%). The use of ACE-I or ARB in participants with urine albumin-creatinine ratio &gt;300 mg/g or diabetes was greater in the high-risk group with the intervention versus usual care (RD, 37%; 95% CI, 6% to 67%), as was statin use among those with CKD (RD, 30%; 95% CI, 5% to 56%) and nephrologist follow-up for those with sustained eGFR &lt;30 ml/min per 1.73 m2 at discharge (RD, 78%; 95% CI, 56% to 100%). Hyperkalemia was more frequent in the intervention group (RD, 10%; 95% CI, 9% to 19%). Conclusions A risk-guided intervention for patients hospitalized with AKI increased recommended processes of care for CKD for high-risk patients after hospital discharge. Clinical Trial registry name and registration number: Improving Post Discharge Care after Acute Kidney Injury (AFTER AKI), NCT02915575.