Intervention System Research Articles

Effect of systematic nursing intervention on rehabilitation after colorectal polyps of endoscopic removal in children: A protocol for systematic review and meta-analysis.

Background:Endoscopic removal is the main method for the treatment of colorectal polyps in children. Due to the small age of children, poor coordination, postoperative sensitive postoperative response, it is not good for postoperative recovery. Systematic nursing has an advantage in promoting the postoperative recovery of children with colorectal polyps of endoscopic removal, but it is lack of evidence-based basis. The purpose of this study is to evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal.Methods:China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database and Chinese Biomedical Literature Database, PubMed, Embase, Web of Science, and the Cochrane Library databases will be searched by computer. A randomized controlled study is searched on the application of systematic nursing intervention of children with colorectal polyps of endoscopic removal from the establishment of the database in February 2021. The language is limited to English and Chinese. The quality of the included study is independently extracted and the literature quality is evaluated by 2 researchers. The RevMan5.3 software is used to conduct meta-analysis of the included literature.Results:This study will evaluate the effect of systematic nursing intervention on the rehabilitation of children after colorectal polyps of endoscopic removal by the indexes of total effective rate, complication rate, and hospital stays.Conclusion:This study will provide reliable evidence-based basis for establishing a reasonable and effective nursing intervention for endoscopic removal of colorectal polyps in childhood.OSF Registration number:DOI 10.17605/OSF.IO/S57UX.

Evaluation of the completeness of intervention reporting in Cochrane surgical systematic reviews using the TIDieR-SR checklist: a cross-sectional study

IntroductionComplete reporting of systematic reviews of interventions is essential to the interpretation of research findings and the reproducibility of research results. The Template for Intervention Description and Replication (TIDieR) checklist—and...

Effects of School-Based Exercise Program on Obesity and Physical Fitness of Urban Youth: A Quasi-Experiment.

(1) Purpose: The purpose of this study was to evaluate if an after-school intervention program could prevent obesity and promote the physical fitness of urban sedentary school children. (2) Methods: A 16-week after-school physical fitness program was provided to 36 middle school students (7th, 8th, and 9th graders) recruited from a middle school for three days a week. They were high-risk youth showing poor health status (level 4 or 5) in the regular physical fitness evaluation conducted. Their body mass index (BMI), cardiovascular endurance, muscular strength and endurance, quickness, and flexibility were evaluated. (3) Results: A paired sample t-test was used (α = 0.05). There were statistical differences ((x ± s), p < 0.05) between the pre-Progressive Aerobic Cardiovascular Endurance Run (PACER) (13.36 ± 4.98 (# of laps)) and post-PACER (18.64 ± 6.31 (# of laps)) (p < 0.001), between the pre-sit-up (18.06 ± 7.22 (# of sit-ups)) and post-sit-up (24.89 ± 7.52 (# of sit-ups)) (p < 0.001), and between the pre-Trunk Flexion (2.64 ± 3.49 ((cm))) and post-Trunk Flexion (5.97 ± 2.78 ((cm)) (p < 0.001). There was no statistical difference between the pre-50m-Run (10.74 ± 1.30 ((sec))) and post-50m-Run results (10.69 ± 1.25 (sec)) (p = 0.063) or between the pre-BMI (24.84 ± 3.97 (kg/m2)) and post-BMI (24.76 ± 3.61 (kg/m2)) (p = 0.458). Overall, the physical fitness measures improved, whereas BMI did not change after 16 weeks. (4) Conclusion: Sixteen weeks of the school-based Health-related Physical Fitness (HrPF) program can be effective in improving overall physical fitness levels of adolescents, although additional treatments would be required to change BMI, which showed no improvement in the present study. It is concluded that in order for adolescents to maintain and promote physical fitness and health, participation in a school-based HrPF program is recommended for at least 30 min a day, three days a week. In addition, schools should provide high-risk youth with easy access to physical activities that are similar to the objectives of the physical education curriculum. In order to promote the health of school-age children, each school should establish and operate school-based systematic intervention programs.

Measuring Quality in Lung Transplant Care: The QUILT Initiative

<h3>Purpose</h3> Lung transplant aims to improve quality of life and survival. Achieving this requires providing care that prevents chronic lung allograft dysfunction (CLAD) while minimizing complications of long-term immunosuppression. We developed the quality in lung transplant (QUILT) initiative as a comprehensive and sustainable process to measure quality of care and develop interventions to improve it in our center. <h3>Methods</h3> In October 2019, we selected complications of lung transplant associated with increased risk of end-organ damage or death that could be tracked continuously leveraging the electronic medical record. The selected metrics were CLAD, acute kidney injury (AKI) and chronic kidney disease (CKD) based on KDIGO stages, leukopenia, and hyperglycemia. We developed an information pipeline in which daily laboratory results are aggregated and analyzed at regular intervals. We assessed the QUILT metrics during 2020 and their trajectory since 2011. Finally, we incorporated them to our quarterly morbidity and mortality review. We focused on AKI and CKD for this abstract. <h3>Results</h3> In 2020, 469 lung recipients received transplant care at UCSF. The composition of the cohort based on years after transplant was 0-1 years (19%), >1-3 years (22%), >3-5 years (19%), >5-10 years (27%), >10-15 years (9%), and >15 years (3%). The monthly incidence of AKI ranged from 18-25%, including stage 1 (15-21%), stage 2 (1-4%), and stage 3 (1-2%). Since 2011, the monthly incidence of AKI has decreased from a peak of 31%. The prevalence of CKD ranged from 20-25% stage 1, 22-23% stage 2, 38-45% stage 3, 8-10% stage 4, and 4-5% stage 5. Since 2011, the prevalence of CKD has been stable for stages 1 and 2, has increased for stages 3 and 5, and has decreased for stage 4. <h3>Conclusion</h3> QUILT allows longitudinal and real-time assessment of quality of care metrics. Tracking AKI and CKD increased our vigilance of medication management. This framework could help centers develop systematic and patient-specific improvement interventions, and track the trajectory of care over time.

Early advance care planning in amyotrophic lateral sclerosis patients: results of a systematic intervention by a palliative care team in a multidisciplinary management programme - a 4-year cohort study.

Although recommended, the implementation of early advance care planning is suboptimal in amyotrophic lateral sclerosis (ALS) patients. Barriers to advance care planning include healthcare professionals&rsquo; and patients&rsquo; reluctance, and uncertainty about the right time to initiate a discussion. To determine how often advance care planning was initiated, and the content of the discussion in a first routine palliative care consultation integrated within a multidisciplinary management programme. Between June 2012 and September 2016, a prospective cohort study was conducted in Geneva University Hospitals. Sixty-eight patients were seen every 3 months for a 1-day clinical evaluation in a day care centre. The patients&rsquo; mean &plusmn; standard deviation age was 68.6 &plusmn; 11.9 years, 50% were women. Four patients were excluded because of dementia. Advance care planning was initiated with 49 (77%) patients in the first palliative care consultation. Interventions most often addressed were cardiopulmonary resuscitation (49%), intubation and tracheostomy (47%) and palliative sedation (36.7%). Assisted suicide was discussed with 16 patients (36.6%). Functional disability was the only factor associated with initiation of advance care planning. Nearly half of the patients wrote advance directives (45%) or designated a healthcare surrogate (41%). Bulbar onset, functional disability and noninvasive ventilation were not associated with the completion of advance directives. Early initiation of advance care planning is feasible in most ALS patients during a routine consultation, and relevant treatment issues can be discussed. All ALS patients should be offered the opportunity to write advance directives as completion was not associated with disease severity.&nbsp.

Minority Enrollment to Clinical Trials: Road to Increased Access.

For the outcome of clinical trials to have validity, participants should represent the patients that will be using the medical products, though this is often not the case. Racial and ethnic minorities are underrepresented in cancer clinical trials for a variety of reasons. This is a concern because people of different ages, races, and ethnicities may react differently to medical products. The estimated extent of racial disparities in clinical trial access varies in the literature, yet recent reports-such as the FDA's 2018 Drug Trials Snapshots-indicate the presence of a remarkable imbalance. A total of 5157 patients participated in oncology trials that led to approvals of 17 new drugs. Overall, 38% of all participants were women, 68% were White, 15% were Asian, 4% were Black or African American, 4% were Hispanic, and 50% were 65 years and older.1 These proportions sharply contrast with the racial distribution in the general United States population (76.6% White, 13.4% Black or African American, 5.8% Asian, 18.1% Hispanic or Latino). Further, only 36% of the trial participants were residents in the United States, which is a reflection of the increasingly international nature of phase 3 oncology trials designed to support the worldwide marketing plans of the study sponsor. According to US Census Bureau projections, more than half of the population in the United States is expected to be other than non-Hispanic White by 2045.2 In the absence of proactive planning, corrective measures, and systematic and effective intervention, the disparity between the clinical trial population and the changing population of patients with cancer in the United States is likely to worsen in the coming decades. What can be done to reverse this trend and enhance clinical trial enrollment by minorities? Increasing minority representation in the health care professions will enhance the ability of the patients to feel more comfortable with the recommended options, including clinical trial participation. In addition, the outreach of health care opportunities to neighborhoods closer to patients' homes will allow access to those without consistent transportation. Eligibility criteria that allow for patients with more co-morbidities to enroll when possible will also increase minority enrollment as well as represent a more real-world population on the study. Another recent improvement is the congressional approval of the Clinical Treatment Act, which requires Medicaid to cover the routine clinical care costs of patients associated with participation in clinical trials. Since Medicaid serves a large portion of individuals from racial and ethnic minority groups, this legislation will remove some barriers to participation in clinical trials for this patient population. With a more representative patient population, the results of these clinical trials will have more accurate outcomes in real-world patients with the illness in question. In addition, the racial and ethnic minority groups will benefit with this increased access to clinical trials and cutting-edge health care opportunities.

An initiative to increase opioid overdose education and naloxone distribution for homeless veterans residing in contracted housing facilities.

Up to 35% of veterans with opioid use disorder (OUD) are homeless, and veterans with OUD are nearly 29 times higher risk for homelessness; however, few are prescribed naloxone, an evidence-based intervention to reverse life-threatening opioid overdose. Many housing facilities for homeless veterans contracted with the San Francisco Veterans Affairs Health Care System are located in neighborhoods with high rates of opioid overdose. No systematic interventions have been implemented to provide opioid overdose education and naloxone kits to veterans and staff at these facilities. This quality improvement (QI) initiative aimed to increase provision of opioid overdose education and naloxone for veterans and staff at contracted housing facilities. This was a prospective single-arm cohort QI intervention. All contracted veteran housing programs were included. Descriptive statistics evaluated results. A total of 18 contracted veteran housing programs were contacted from July 2019 through January 2020 to schedule training. Of those, 13 programs responded to outreach and 10 visits were completed at 8 housing facilities. Training was provided by pharmacist and nurse practitioner trainers to 26 staff members and 59 veterans. Naloxone was prescribed to 37 veterans. A pharmacist-led and nurse practitioner-led initiative was effective in increasing veteran and staff access to opioid overdose education and naloxone at >44% contracted veteran housing facilities. Challenges included lack of response from housing programs, low veteran turn out, and inability to provide naloxone to veterans not enrolled/ineligible for health care. Future initiatives should examine strategies to standardize access in homeless veterans' programs.

Decreasing Attacks and Improving Quality of Life through a Systematic Management Program for Patients with Hereditary Angioedema

Introduction: Prevention of attacks is a major goal in management of patients with hereditary angioedema (HAE). We aimed to investigate the effects of a systematic intervention for HAE patients. Methods: Thirty-three patients with HAE with C1-inhibitor deficiency, belonging to a single family, participated in a management program coordinated by an allergist/immunologist. Angioedema attacks before intervention were ascertained by interviews and emergency room charts and recorded prospectively by patients or caregivers after enrollment. Mean number of attacks/month was compared at 12 months preintervention and 8 and 14 months within intervention. Patient-reported outcome instruments were used to assess quality of life, including HAE Quality of Life (HAE-QoL) questionnaire, psychological conditions, and work impairment, at baseline and 8 and 14 months within intervention. Data were stored in REDCap platform and analyzed by adjusted Bayesian models of double Poisson regression. Results: Mean number of attacks/month significantly decreased (95% credible interval [CrI] excluding 0) from 1.15 preintervention to 0.25 and 0.23, 8 and 14 months within intervention, with mean decreases of −0.89 (95% CrI: −1.21 to −0.58) and −0.92 (95% CrI: −1.22 to −0.60), respectively. HAE-QoL scores showed mean total increases of 15.2 (95% CrI: 1.23–29.77) and 26 (95% CrI: 14.56–39.02) at 8 and 14 months within the study, as compared to baseline, revealing marked improvement in quality of life. Significant increase in role-emotional and reduction of depression, stress, and anxiety were observed at 14 months. Conclusion: A systematic approach integrating HAE-specific care with effective handling of psychological issues decreased the number of attacks and improved quality of life, targets for best practice in HAE.

Functional disability and post-traumatic stress disorder in survivors of mechanical ventilation: a cross-sectional study in Guangzhou, China

BackgroundCritical illness is associated with cognitive, physical, and psychological impairments; however, evidence of the severity and frequency of impairments in Chinese survivors of mechanical ventilation in an intensive care unit (ICU) remains limited. Our aim was to investigate the incidence and severity of impairments in Chinese survivors of mechanical ventilation in ICU and to explore risk factors influencing specific impairments.MethodsPatients discharged alive after mechanical ventilation in a large general ICU for ≥2 days were enrolled in this single-center cross-sectional study. Survivors were evaluated using measures of functional disability (Activity of Daily Living Scale), and post-traumatic stress disorder (PTSD, The Impact of Event Scale-Revised) via telephone interview. Multivariable analysis was conducted.ResultsData were obtained from 130 consenting survivors. At follow-up (mean: 19.64 months), among those in part-time or full-time employment prior to admission, only 45.1% had returned to work. Further, 29.2% of survivors had clear disabilities affecting daily living. Deficits in activities of daily living (ADL) were mainly characterized by impairment of instrumental ADL. Predictors of ADL in mechanically ventilated survivors included age, ICU admission diagnosis, and Acute Physiology And Chronic Health Evaluation II (APACHE II) score, which accounted for 33.5% of total variance. Furthermore, 17.7% of participants had symptoms consistent with PTSD. ICU length of stay was the only predictor of PTSD, and accounted for 7.5% of total variance.ConclusionsICU survivors of mechanical ventilation in China face negative impacts on employment, and commonly have ADL impairment and PTSD. Age, ICU admission diagnosis, and APACHE II score were key factors influencing ADL, while ICU length of stay was the only factor affecting PTSD. These findings suggest that some survivors who have had certain exposures may warrant closer follow-up, and systematic interventions for these high-risk survivors should be developed in China.

Associations of On-arrival Vital Signs with 24-hour In-hospital Mortality in Adult Trauma Patients Admitted to Four Public University Hospitals in Urban India: A Prospective Multi-Centre Cohort Study.

In India, more than a million people die annually due to injuries. Identifying the patients at risk of early mortality (within 24 hour of hospital arrival) is essential for triage. A bilateral Government Australia-India Trauma System Collaboration generated a trauma registry in the context of India, which yielded a cohort of trauma patients for systematic observation and interventions. The aim of this study was to determine the independent association of on-arrival vital signs and Glasgow Coma Score (GCS) with 24-hour mortality among adult trauma patients admitted at four university public hospitals in urban India. We performed an analysis of a prospective multicentre observational study of trauma patients across four urban public university hospitals in India, between April 2016 and February 2018. The primary outcome was 24-hour in-hospital mortality. We used logistic regression to determine mutually independent associations of the vital signs and GCS with 24-hour mortality. A total of 7497 adult patients (18 years and above) were included. The 24-hour mortality was 1.9%. In univariable logistic regression, Glasgow Coma Score (GCS) and the vital signs systolic blood pressure (SBP), heart rate (HR), respiratory rate (RR) and peripheral capillary oxygen saturation (SpO2) had statistically significant associations with 24-hour mortality. These relationships held in multivariable analysis with hypotension (SBP<90mm Hg), tachycardia (HR>100bpm) and bradycardia (HR<60bpm), hypoxia (SpO2<90%), Tachypnoea (RR>20brpm) and severe (3-8) and moderate (9-12) GCS having strong association with 24-hour mortality. Notably, the patients with missing values for SBP, HR and RR also demonstrated higher odds of 24-hour mortality. The Injury Severity Scores (ISS) did not corelate with 24-hour mortality. The routinely measured GCS and vital signs including SBP, HR, SpO2 and RR are independently associated with 24-hour in-hospital mortality in the context of university hospitals of urban India. These easily measured parameters in the emergency setting may help improve decision-making and guide further management in the trauma victims. A poor short-term prognosis was also observed in patients in whom these physiological variables were not recorded.

Using Tweets to Understand How COVID-19-Related Health Beliefs Are Affected in the Age of Social Media: Twitter Data Analysis Study.

BackgroundThe emergence of SARS-CoV-2 (ie, COVID-19) has given rise to a global pandemic affecting 215 countries and over 40 million people as of October 2020. Meanwhile, we are also experiencing an infodemic induced by the overabundance of information, some accurate and some inaccurate, spreading rapidly across social media platforms. Social media has arguably shifted the information acquisition and dissemination of a considerably large population of internet users toward higher interactivities.ObjectiveThis study aimed to investigate COVID-19-related health beliefs on one of the mainstream social media platforms, Twitter, as well as potential impacting factors associated with fluctuations in health beliefs on social media.MethodsWe used COVID-19-related posts from the mainstream social media platform Twitter to monitor health beliefs. A total of 92,687,660 tweets corresponding to 8,967,986 unique users from January 6 to June 21, 2020, were retrieved. To quantify health beliefs, we employed the health belief model (HBM) with four core constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. We utilized natural language processing and machine learning techniques to automate the process of judging the conformity of each tweet with each of the four HBM constructs. A total of 5000 tweets were manually annotated for training the machine learning architectures.ResultsThe machine learning classifiers yielded areas under the receiver operating characteristic curves over 0.86 for the classification of all four HBM constructs. Our analyses revealed a basic reproduction number R0 of 7.62 for trends in the number of Twitter users posting health belief–related content over the study period. The fluctuations in the number of health belief–related tweets could reflect dynamics in case and death statistics, systematic interventions, and public events. Specifically, we observed that scientific events, such as scientific publications, and nonscientific events, such as politicians’ speeches, were comparable in their ability to influence health belief trends on social media through a Kruskal-Wallis test (P=.78 and P=.92 for perceived benefits and perceived barriers, respectively).ConclusionsAs an analogy of the classic epidemiology model where an infection is considered to be spreading in a population with an R0 greater than 1, we found that the number of users tweeting about COVID-19 health beliefs was amplifying in an epidemic manner and could partially intensify the infodemic. It is “unhealthy” that both scientific and nonscientific events constitute no disparity in impacting the health belief trends on Twitter, since nonscientific events, such as politicians’ speeches, might not be endorsed by substantial evidence and could sometimes be misleading.

Integration of Energy-Efficient Ventilation Systems in Historic Buildings—Review and Proposal of a Systematic Intervention Approach

Historic building restoration and renovation requires sensitivity to the cultural heritage, historic value, and sustainability (i.e., building physics, energy efficiency, and comfort) goals of the project. Energy-efficient ventilation such as demand-controlled ventilation and heat recovery ventilation can contribute to the aforementioned goals, if ventilation concepts and airflow distribution are planned and realized in a minimally invasive way. Compared to new buildings, the building physics of historic buildings are more complicated in terms of hygrothermal performance. In particular, if internal insulation is applied, dehumidification is needed for robust and risk-free future use, while maintaining the building’s cultural value. As each ventilation system has to be chosen and adapted individually to the specific building, the selection of the appropriate system type is not an easy task. For this reason, there is a need for a scientifically valid, systematic approach to pair appropriate ventilation system and airflow distribution solutions with historical buildings. This paper provides an overview of the interrelationships between heritage conservation and the need for ventilation in energy-efficient buildings, regarding building physics and indoor environmental quality. Furthermore, a systematic approach based on assessment criteria in terms of heritage significance of the building, building physics (hygrothermal performance), and building services (energy efficiency, indoor air quality, and comfort rating) according to the standard EN 16883:2017 are applied.

Association Between Caregiver Depression and Elder Mistreatment-Examining the Moderating Effect of Care Recipient Neuropsychiatric Symptoms and Caregiver-Perceived Burden.

To examine the association between caregiver (CG) depression and increase in elder mistreatment and to investigate whether change in care recipient (CR) neuropsychiatric symptoms (NPS) and change in CG-perceived burden influence this association. Using 2-year longitudinal data, we analyzed a consecutive sample of 800 Chinese primary family CGs and their CRs with mild cognitive impairment or mild-to-moderate dementia recruited from the geriatric and neurological departments of 3 Grade-A hospitals in the People's Republic of China. Participatory dyads were assessed between September 2015 and February 2016 and followed for 2 years. CG depression at baseline was associated with a sharper increase in psychological abuse and neglect. For CRs with increased NPS, having a depressed CG predicted a higher level of psychological abuse than for those CRs without NPS. For CGs with decreased burden, the level of depression was associated with a slower increase in neglect than for CGs who remained low burden. This study showed the differential impact of CG depression on the increase in elder mistreatment depending on the change in CR NPS and CG-perceived burden. The present findings provide valuable insights into the design of a systematic and integrative intervention protocol for elder mistreatment that simultaneously focuses on treating CG depression and perceived burden and CR NPS.

PROSPECTIVE ANALYSIS OF IMPACT OF PHARMCOTHERAPY ADHERENCE ON TREATMENT EFFECTIVENESS IN POST OPERATIVE HEART PATIENTS

Myocardial infarction is the irreversible damage of myocardial tissue caused by prolonged ischemia and hypoxia. This most commonly occurs when a coronary artery becomese blocked following the rupture of an atherosclerotic plaque, which then leads to the formation of a blood clot (coronary thrombosis). This event can also trigger coronary vasospasm. Ischemia induces profound metabolic and ionic perturbations in the affected myocardium and causes rapid depression of systolic function. Prolonged myocardial ischemia activates a "wavefront" of cardiomyocyte death that extends from the subendocardium to the subepicardium. Mitochondrial alterations are prominently involved in apoptosis and necrosis of cardiomyocytes in the infarcted heart.&#x0D; This prospective, pilot, observational study performed confirmed the hypothesis that systematic identifications and interventions administered through continued physician follow-up and patients counselling will improve adherence to therapy and therefore improvement in treatment effectiveness by lowering especially Troponin level ,CPK and quality of life in MI patients.&#x0D; Study was shown that lack of proper knowledge about disease and patients counseling and chronic treatment, most of patients takes disease and its treatment lightly and shows lower adherence attitude. The study analysis shown that female are generally more aware than males for adherence. Study analysis concluded that there was significant reduction in their Troponin level and CPK values in different comparison groups after each level of follow up.&#x0D; Statistical analysis concluded that patients with adherence ˃ 95% showed significant reduction in Troponin level and CPK values and patients with age group ≤50 shows more adherence than older.&#x0D; Most heart patients recorded with hypertension and Coronary Artery Diseases only few ones with diabetic complications. During study patients shows good control over their blood pressure and only few adverse events but no complications occur during study period.

A micro costing analysis of the development of a primary care intervention to improve the uptake of diabetic retinopathy screening

BackgroundThe application of economic analysis within implementation science is still developing and the cost of intervention development, which differs markedly from the costs of initial implementation and maintenance, is often overlooked. Our aim was to retrospectively cost the development of a multifaceted intervention in primary care to improve attendance at diabetic retinopathy screening.MethodsA retrospective micro costing of developing the intervention from the research funder perspective was conducted. It was based on a systematic intervention development process involving analysis of existing audit data and interviews with patients and healthcare professionals (HCPs), conducting consensus meetings with patients and HCPs, and using these data together with a rapid review of the effectiveness of interventions, to inform the final intervention. Both direct (non-personnel, e.g. travel, stationary, room hire) and indirect (personnel) costs were included. Data sources included researcher time logs, payroll data, salary scales, an online financial management system, invoices and purchase orders. Personnel involved in the intervention development were consulted to determine the activities they conducted and the duration of their involvement. Sensitivity and scenario analyses were conducted to estimate uncertainty around parameters and scope.ResultsThe total cost of intervention development (July 2014–January 2019) was €40,485 of which 78% were indirect (personnel) costs (€31,451). In total, personnel contributed 1368 h to intervention development. Highest cost activities were the patient interviews, and consensus process, contributing 23% and 34% of the total cost. Varying estimated time spent on intervention development activities by + 10% increased total intervention development cost by 6% to €42,982.ConclusionsOur results highlight that intervention development requires a significant amount of human capital input, combining research experience, patient and public experience, and expert knowledge in relevant fields. The time committed to intervention development is critical but has a significant opportunity cost. With limited resources for research on developing and implementing interventions, capturing intervention development costs and incorporating them as part of assessment of cost-effective interventions, could inform research priority and resource allocation decisions.

Effectiveness of interventions as part of the One Health approach to control coronavirus disease 2019 and stratified case features in Anhui Province, China: A real-world population-based cohort study

BackgroundCoronavirus-Disease-2019 (COVID-19) caused by Severe-Acute-Respiratory-Syndrome-Coronavirus-2 (SARS-CoV-2) is rapidly spreading worldwide causing a pandemic. To control the pandemic, the One Health approach (https://www.who.int/news-room/q-a-detail/one-health) is very important. We herein provide a real-world example of efficient COVID-19 control in Anhui Province, China with outbreak originating from imported cases through implementation of a series of measures as part of the One Health approach and describe the stratified cases features. MethodsSince the identification of the first imported COVID-19 case on Jan 22, 2020, Anhui immediately initiated a sequence of systematic and forceful interventions. We detailed the control measures and analyzed the effects as demonstrated by the corresponding temporal changes of overall epidemiology data on confirmed, cured, and hospitalized cases and contacts. An accumulated number of 991 cases were confirmed, with a total number of 29,399 contacts traced. We further retrieved individual-level data of confirmed cases and compared them across stratifications by sex, age group, linkage to Wuhan, and period of diagnosis. ResultsWith a series of interventions including active field investigation, case tracing, quarantine, centralization, education, closed management, and boundary control implemented, number of hospitalized COVID-19 cases peaked, new case disappeared, and all cases were discharged 21, 36, and 46 days after the identification of the initial case, respectively. Male patients were younger, more often had linkage to Wuhan, and received timelier care, but less often had infected cohabitants. Patients aged 25–44 years most often had linkage to Wuhan, while such frequency was lowest in those ≥65 years. Cases <25 years most often had a known contact with COVID-19 patients and any infected family member and cohabitant and were beforehand quarantined, and received fastest management. Patients with linkage to Wuhan were younger, less often had infected family member, had longer incubation period, and received earlier quarantine and timelier care. With more recent periods, the proportion of cases with linkage to Wuhan markedly decreased while the proportion of cases with known contact with COVID-19 cases dramatically increased; the proportions of patients with any infected family member or cohabitant, those beforehand quarantined, and those taking drugs before admission increased; incubation period lengthened, and patients received timelier professional care. Nonspecific systemic symptoms were most common, whose proportion decreased in more recent periods. ConclusionsTimely and powerful measures as part of the One Health approach (https://www.who.int/news-room/q-a-detail/one-health) effectively and efficiently controlled the COVID-19 outbreak in Anhui, which can be a good real-world example strongly demonstrating the usefulness of such measures in places with outbreaks originating from imported cases. Precise and dynamic prevention and control measures should be implemented and based on features including sex, age group, exposure history, and phase of outbreak.

Implementation of evidence-based PCOS lifestyle management guidelines: Perceived barriers and facilitators by consumers using the Theoretical Domains Framework and COM-B Model

BackgroundThe 2018 Evidence-Based Polycystic Ovary Syndrome (PCOS) Clinical Guidelines recommend lifestyle management as first-line treatment for PCOS, yet implementation of PCOS lifestyle programs into practice is not well understood. ObjectiveTo complete systematic intervention mapping by identifying the facilitators and barriers to lifestyle management in women with PCOS using the theoretical domains framework (TDF) and the Capacity, Opportunity, Motivation and Behaviour model (COM-B). Patient involvementWomen (N = 20) in Australian with PCOS were interviewed. MethodsTelephone semi-structured interviews. ResultsNine themes mapped onto seven TDF domains and the COM-B. Capability: psychological co-morbidities, knowledge and awareness of lifestyle change and ability to identify and resolve barriers. Opportunity: presence of other medical conditions, access to practical resources and availability of social support. Motivation: outcomes expectancies of lifestyle behaviour, personal values, enjoyment and readiness to change and the impact of stress on lifestyle choices. DiscussionThis is the first study to explore barriers and facilitators to lifestyle change from the perspectives of women with PCOS using the TDF and COM-B. Addressing these themes will facilitate patient-centred care and long-term behaviour change. Practical implicationsMay increase the efficacy and effectiveness of PCOS lifestyle programs and reduce the risk of PCOS-associated disease in this population.

Early intervention and mental health: evidence review from premature and disadvantaged infants

: The purpose of this review is to examine the data on the potential effect of early childhood interventions on later child and adult mental health. Specifically, it examines the effect of early intervention strategies to prevent or ameliorate of early behavioral problems, potential antecedents of later mental health issues. To maximize the generalizability the review focuses on two general, ‘at-risk’ groups: disadvantaged children and those born prematurely. Only one study, the Infant Health and Development Study provided long term results to address this question. Like other early interventions in the form of educational centers, home visiting and primary care strategies, care-giver reported behavior problems are reduced in the intervention group by the end of the intervention period. However, none of these approaches appears to confer no long-term effect on behavior problems, and hence, are unlikely to influence any associated mental health diagnoses. Many support an important indirect effect of interventions in decreases in delinquency, incarceration, other high-risk behaviors and welfare dependency. The pathway by which this occurs appears to be greater school success. Thus, an indirect effect may be posited. In summary, despite its importance, little systematic intervention with longitudinal follow-up has addressed the prevention of mental health problems.

Prevention of hypokalaemia and hypomagnesaemia following peripheral stem cell collection - a prospective cohort study.

Citrate-based anticoagulation reduces plasma potassium and free magnesium in patients undergoing peripheral stem cell collections. Whether the effects may be mitigated by pre-procedure oral electrolyte supplements has not been previously assessed. Results from a historic cohort (2010-2013) guided a systematic prospective intervention in subjects deemed at risk for clinically meaningful hypokalaemia and hypomagnesaemia. From 2015 to 2019, 136 patients were enrolled in the study. Pre- and post-apheresis electrolyte levels were measured, and oral potassium and magnesium supplements were systematically administered based on the pre- electrolyte levels. We saw a 37% absolute reduction in severe hypokalaemia and 39% absolute reduction in hypomagnesaemia in the prospective intervention cohort when compared to the historic cohort. Multivariate analyses indicated that part of the effect was due to the electrolyte intervention, while part of the effect likely stemmed from other procedure-related changes implemented during the study period. Oral potassium and magnesium prophylaxis appear to reduce hypokalaemia and hypomagnesaemia following peripheral stem cell collection. Whether the effect size is sufficient to motivate the intervention warrants further investigation, preferably in a prospective randomized trial setting.

Social Determinants of Emergency Department Visits among Persons Diagnosed with Coronary Heart Disease and Stroke.

Social determinants of health (SDOH) are associated with a variety of health outcomes, yet their relation to emergency department (ED) visits among individuals with coronary heart disease (CHD) or stroke is unclear. We performed a cross-sectional analysis of the 2010-2018 National Health Interview Survey, examining ED visits among individuals who self-reported CHD or stroke diagnosis. The outcome was defined as reporting ≥1 ED visit in the previous 12 months vs none. The SDOH examined were race, employment status, poverty, insurance status, marital status, and educational status. We included N=14,925 participants with a diagnosis of CHD or stroke. The mean (±SD) age was 68 (±.14) years. After adjusting for age and sex, non-Hispanic Blacks were more likely (adjusted odds ratio [AOR]: 1.29; 95%CI: 1.15-1.44) to report having ≥1 ED visits than Whites. Compared with Whites, Asians had lower odds of having ≥1 ED visit in the previous 12 months (AOR: .63, 95%CI: .49-.82). Those who were unmarried (AOR: 1.21, 95%CI: 1.12 - 1.31), unemployed (AOR: 1.53, 95%CI: 1.36- 1.72) and had a poverty income ratio of <1 (AOR: 1.47, 95%CI: 1.31-1.67) had higher odds of having ≥1 ED visits. Being Black, unmarried, unemployed, and having lower income levels were associated with a higher likelihood of having ≥1 ED visits in the prior 12 months among individuals with a CHD or stroke diagnosis. SDOH should be considered when developing systematic interventions to prevent costly ED visits.