Intervention Categories Research Articles

Early Check-In Protocol: Identifying Medication Issues in Patients with Cancer at Health System Specialty Pharmacy.

Several studies have illustrated value in early patient contact following oral anticancer medication (OAM) initiation, particularly within the first 14 days of therapy, as adverse effects may lead to early discontinuation or poor adherence. Health-system specialty pharmacies (HSSPs) are optimally positioned to adopt this best practice through formalized protocols designed to identify and mitigate medication-related issues. To outline an HSSP-led early check-in protocol for patients taking OAMs and to describe the subsequent interventions conducted by the HSSP team and their acceptance rate. HSSPs enacted a protocol in January 2021 requiring oncology pharmacists - to contact patients within 14 days of OAM initiation, aiming to optimize adverse effect management, offer supportive care, address adherence, and provide education. To evaluate the impact of the early check-in protocol, we conducted a retrospective, multicenter, observational study across CPS's health system clients from January 2022 to November 2023. HSSP pharmacists created 1698 interventions for 1184 patients from the early check-in. The cancer types most frequently associated with an intervention were breast (n = 431, 25.4%), gastrointestinal (n = 245, 14.4%), and prostate (n = 206, 12.1%). The most frequent intervention categories were adverse drug reactions (ADRs) (n = 1,548, 91.2%) and adherence (n = 55, 3.2%). Overall, 95.5% of pharmacist recommendations were accepted by patients and/or providers. Implementing an early check-in protocol allows HSSP pharmacists to mitigate barriers to OAM adherence. This study emphasizes the importance of early check-in and illustrates the scope of the oncology pharmacist's role by evaluating critically meaningful interventions and quantifying pharmacist recommendations and acceptance rate.

The effectiveness of real-life cognitive and physical interventions on cognitive functioning in healthy older adults: A systematic review of the effects of education and training duration.

Physical and cognitive interventions are deemed the primary methods of improving cognitive functioning in healthy older adults. However, the effectiveness of these interventions is still debated. This systematic review, synthesised findings from the literature on four different types of interventions: physical activities, cognitive training, cognitive stimulation and a combined intervention. We searched six databases for each intervention category. Findings demonstrated that 65% of the studies across all intervention groups reported improvement in the experimental group following the intervention. Furthermore, memory, executive and global cognitive functions were the most reported improvements post-intervention. Additionally, participants with higher education benefited more from cognitive training (an intervention that targets a specific cognitive domain), while those with lower education gained more following cognitive stimulation (an intervention that targets general domains). Lastly, in sub-types of physical activity, cognitive stimulation and combined category, longer durations (more than 20 sessions) were associated with significant cognitive improvements. Conversely, in cognitive training, having less than 20 sessions led to significant results. Findings indicated an interaction of education and intervention duration with significant outcomes post-intervention. In conclusion, this review demonstrated the importance of intervention type, duration and education in understanding cognitive improvement post-intervention.

Emergency medicine pharmacists' interventions in the tertiary hospitals' emergency departments in Malaysia.

The emergency medicine (EM) pharmacist is an integrated part of the Emergency Department (ED) interdisciplinary team in many countries, including Malaysia. The presence of EM pharmacists in the ED has positively impacted patient outcomes. Data on EM pharmacists' interventions is scarce in the Asian region. In Malaysia, data on interventions done by EM pharmacists in the EDs was unavailable. This study aimed to assess the type of interventions done by EM pharmacists in the ED of tertiary public hospitals in Malaysia. This cross-sectional, multicenter study involved EM pharmacists from 14 tertiary hospitals in Malaysia. All accepted interventions done by EM pharmacists in the ED for patients admitted to the Red (critical) and Yellow (semi-critical) zones from January to June 2022 were extracted from the Clinical Pharmacy Report Form. All data were analyzed descriptively. The EM pharmacists documented 1659 accepted interventions on 1584 patients during the study period. Inappropriate regimens (n = 1117, 67.3%) and incomplete prescriptions (n = 339, 20.4%) were the main categories of accepted interventions in ED. Inappropriate drug (n = 574, 34.6%), dose (n = 292, 17.6%), and frequency (n = 176, 10.6%) were the top three subcategory interventions documented under inappropriate regimens. Antimicrobials, antihypertensives, and proton pump inhibitors were the commonest drug intervened under the categories of inappropriate drug intervention. There were 272 (16.4%) accepted interventions on high-alert medications (HAMs). Insulin, enoxaparin, and noradrenaline were the most intervened HAMs. Inappropriate treatment regimens were the most common intervention category done by EM pharmacists in Malaysia. The significant number of interventions done by EM pharmacists demonstrated the importance of EM pharmacists as integral members of the EM team. This data can help improve the quality of clinical pharmacy services in the ED and is important for the future expansion of clinical pharmacy services in all EDs across Malaysia, neighbouring countries, and other developing countries.

Effectiveness of rehabilitation interventions in patients with colorectal cancer: an overview of systematic reviews.

To evaluate existing evidence from published systematic reviews for the effectiveness and safety of rehabilitation interventions in adult patients with colorectal cancer. A comprehensive literature search was conducted using medical/health science databases up to October 2024. Bibliographies of pertinent articles, journals, and grey literature were searched. Three reviewers independently selected potential reviews, assessed methodological quality, and graded the quality of evidence for outcomes using validated tools. Sixty systematic reviews (761 randomized controlled trials) evaluated 5 categories of rehabilitation interventions. Over half of the included reviews (n = 31) were of moderate-high quality. The findings suggest: moderate-quality evidence for exercise interventions for improving physical fitness and quality of life; high-quality evidence for nutritional interventions in reducing postoperative infections; high-quality evidence for multimodal prehabilitation for improved preoperative functional capacity; moderate-quality evidence for nutritional interventions for improving humoral immunity, reducing inflammation, and length of stay; moderate-quality evidence for acupuncture in improving gastrointestinal functional recovery; psychosocial interventions in improving short-term quality of life and mental health, and lifestyle interventions for improved quality of life. Rehabilitation interventions yielded positive effects across multiple outcomes. However, high-quality evidence is still needed to determine the most effective rehabilitation approaches for patients with colorectal cancer.

Summary of the Best Evidence for Non-Pharmacological Management of Sleep Disturbances in Intensive Care Unit Patients.

To retrieve, evaluate and summarise the best evidence for non-pharmacological management of sleep disturbances in ICU patients, and to provide basis for clinical nursing practice. This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing. All evidence on non-pharmacological management of sleep disturbances in ICU patients from both domestic and international databases and relevant websites was systematically searched, including guidelines, expert consensuses, best practice, clinical decision-making, evidence summaries and systematic review. UpToDate, BMJ Best Practice, Joanna Briggs Institute, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, Yi Maitong Guidelines Network, Registered Nurses Association of Ontario, Canadian Medical Association: Clinical Practice Guideline, Guidelines International Network, WHO, the Cochrane Library, CINAHL, Embase, PubMed, Web of Science, CNKI, WanFang database, VIP database, SinoMed, The American Psychological Association, European Sleep Research Society, American Academy of Sleep Medicine and National Sleep Foundation were searched from the establishment of the databases to June 1, 2024. A total of 18 pieces of literature were included, involving 4 guidelines, 2 expert consensuses, 1 best practice and 11 systematic reviews. 25 pieces of evidence covering 4 categories of risk factors, sleep monitoring, non-pharmaceutical intervention, education and training were summarised. This study summarises the best evidence for non-pharmacological management of sleep disturbances in ICU patients. In clinical application, medical staff should make professional judgements and fully combine clinical situations and patient preferences to select evidence, laying a theoretical foundation for later empirical research to reduce the incidence of sleep disturbances in ICU patients and improve the sleep quality of critically ill patients. Medical staff can refer to the best evidence to provide reasonable non-pharmacological management plans for sleep disturbances in ICU patients, improving their sleep quality and life satisfaction. The management of sleep disturbances in critically ill patients has not received sufficient attention and standardisation. This study summarises 25 pieces of the best evidence for non-pharmacological management of sleep disturbances in critically ill patients. Accurate and standardised evaluation and monitoring are the foundation of sleep management for ICU patients. This summary of evidence can help ICU nurses enhance their clinical practice. This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing; the registration number is 'ES20231708'. No Patient or Public Contribution.

Methods and Practical Considerations for Conducting Budget Impact Analysis for Non-Pharmaceutical Interventions.

Health technology assessment (HTA) can be conducted at the national, provincial, or hospital level. Although provincial and hospital-based HTAs often focus on non-pharmaceutical interventions, budget impact analysis (BIA) methods for non-pharmaceutical interventions have received less attention in the literature. We reviewed HTAs of non-pharmaceutical interventions published since 2015 by a Canadian provincial HTA agency, evaluating the characteristics and challenges of conducting a BIA. We summarized the unique characteristics of BIAs for different categories of interventions, including surgery and other procedures, diagnostic or screening tests, therapeutic programs, and digital health technologies. We then discussed specific methodological and practical considerations for conducting a BIA of a surgical or other hospital-based procedure. Critical points for BIA methods include the following: (1) when estimating the size of a target population, healthcare system capacity must be accounted for, and historical volumes may offer more realistic figures than prevalence and incidence rates; (2) factors that affect the uptake of a new intervention include guideline recommendations, labor and infrastructure requirements for implementation, and the target population size; (3) when interpreting a budget impact that shows cost savings, analysts must address where the savings are generated from and whether they can be reallocated. Some of the considerations discussed may also apply to HTAs of pharmaceuticals. When conducting a BIA of a non-pharmaceutical intervention, addressing these methodological considerations may help in better predicting the financial impact of the new intervention for the public payer and guide appropriate budget allocation for healthcare system planning.

Prophylactic pharmacological interventions against perioperative respiratory adverse events in children undergoing noncardiac surgery: a systematic review and meta-analysis.

Perioperative respiratory adverse event (PRAE) is one of the most common complications in pediatric anesthesia. We aimed to evaluate the efficacy of perioperative pharmacological interventions to prevent the development of PRAE in children undergoing noncardiac surgery. PubMed, Embase, Cochrane Library and ClinicalTrials.gov were searched for randomized controlled trials (RCT) of prophylactic pharmacological interventions for PRAE among surgical children from inception to 5 August 2024. Pairwise meta-analyses were conducted to compare the effects of an intervention with placebo or another intervention on overall PRAE and their subtypes, including laryngospasm, bronchospasm, oxygen desaturation, airway obstruction, coughing and stridor. Risk of bias was assessed using the Cochrane Collaboration tool. Seven categories of prophylactic interventions were identified. Twenty-nine RCTs with 4452 children were included. Compared with placebo, lidocaine reduced the odds ratio (OR) of overall PRAE ( 0.27 [95% CI] [0.17, 0.42]) and laryngospasm (0.38 [0.22, 0.67]); dexmedetomidine reduced the OR of PRAE (0.31 [0.12, 0.76]), laryngospasm (0.31 [0.10, 0.91]), coughing (0.24 [0.14, 0.41]) and oxygen desaturation (0.54 [0.35, 0.84]); β2-adrenoreceptor agonists reduced the OR of PRAE (0.45 [0.24, 0.83]), coughing (0.36 [0.13, 0.95]) and oxygen desaturation (0.66 [0.45, 0.98]). Compared with sevoflurane induction, intravenous propofol induction lowered the OR of PRAE (0.35 [0.16, 0.74]), laryngospasm (0.17 [0.06, 0.48]) and airway obstruction (0.32 [0.17, 0.63]). The meta-analysis demonstrated prophylactic potential of lidocaine, dexmedetomidine, β2-adrenoreceptor agonists and propofol induction technique against PRAE, but it should be interpreted cautiously due to inconsistent PRAE definition and correlation of subtypes within the composite outcome. PROSPERO (CRD42020220028). Registered 11 December 2020. Updated 3 September 2024.

Systematic review of interventions in early pregnancy among pregnant individuals at risk for hyperglycemia.

The maternal metabolic environment in early pregnancy can influence fetal growth trajectories. Our objective was to identify interventions initiated in early pregnancy (<20 weeks gestation) in pregnant individuals with risk factors for hyperglycemia and report their impact on primary (neonatal adiposity, small for gestational age, large for gestational age, macrosomia) and secondary outcomes (gestational weight gain, maternal hypertensive disorder, birth injury, NICU admission, preterm delivery, emergency cesarean section). We searched Cochrane Central database, Medline, Embase, CINAHL databases, and clinicaltrials.gov (September 2024) for clinical trials published between 2009 and 2024. Search terms included the key words "early OR during" OR "first trimester OR second trimester" AND "gestation OR pregnancy" OR "prenatal care" AND "insulin resistance" OR "metabolic health" OR "diabet*" OR "body composition" OR "obes*" OR "weight gain" OR "gestational diabetes" OR "hyperglycemia" OR "metabolic syndrome" AND "clinical trial." Randomized controlled trials (RCTs) and other trials reporting interventions initiated before 20 weeks gestation in participants with singleton pregnancies at risk for hyperglycemia (overweight and/or obesity, history of type 2 diabetes, and/or history of GDM) that reported at least one primary outcome were included. Studies had to be conducted with humans in high income countries as defined by the World Bank, written in English. We used the Downs and Black checklist to evaluate the methodological quality and risk. Data was extracted independently and any questions were resolved through group discussion. Interventions were categorized and synthesized by type. 21,924 records were identified and 70 full-text articles met inclusion criteria. 65 articles were RCTs. Eight intervention categories were identified: diet only, physical activity or exercise only, diet and physical activity or exercise combined, lifestyle counseling, supplements, pharmaceuticals, early GDM screening, and mixed interventions. Only 12 studies reported statistically significant effects on primary neonatal outcomes. Interventions initiated in early pregnancy (<20 weeks) among pregnant individuals at risk for hyperglycemia that include one or more of the following strategies can reduce risk of excess neonatal adiposity, macrosomia, large for gestational age and small for gestational age neonates: goal-setting and motivational strategies to improve diet and increase physical activity through individual and group sessions; lifestyle coaching that included behavioral techniques designed to empower participants by fostering autonomy in a supportive environment; structured group exercise classes three times per week; and personalized dietary recommendations.

Outcomes of Patients with Hematological Malignancies Admitted to the Intensive Care Unit at a Tertiary Care Center in Saudi Arabia

Abstract Background: Patients with hematological malignancies (HM) are at risk for complications, including neutropenia and admission to the intensive care unit (ICU). Granulocyte colony-stimulating factors (GCSF) can accelerate progenitor cells’ proliferation and differentiation, and thus compensate for neutropenia. In patients with HM admitted to ICUs in Saudi Arabia, the outcome and impact of GCSF use on neutropenia duration and severity is understudied. Objective: To evaluate the outcome and impact of GCSF on neutropenia in patients with HM admitted to the ICU of a tertiary care center in Saudi Arabia. Methods: This retrospective study included all consecutive patients diagnosed with an HM admitted to the ICU at King Saud University Medical City, Riyadh, Saudi Arabia, from 2018 to 2022. Data on demographics, clinical information, ICU admission, and outcomes were collected. Results: A total of 44 patients with HM admitted to the ICU were included, of which 43.2% were females and the mean age was 50.2 ± 21.1 years. The mean length of ICU stay was 12.3 ± 14.7 (range: 0–62) days. ICU mortality was 61.4%, with no further mortality within 90 days after discharge. There was no significant association between survival and age (P = 0.205), gender (P = 0.7), and neutropenia (P = 0.566) or the use of GCSF prior to ICU admission (P = 0.882). There was a significant association between the category of ICU intervention and survival (P = 0.007). Conclusion: Patients with hematological malignancies who were admitted to an ICU in Saudi Arabia had a high mortality, regardless of neutropenia or the use of granulocyte colony-stimulating factor.

Evaluation of advanced practice nurse competencies: validation of an instrument for primary care.

to evaluate the construct validity and reliability of the Brazilian version of the Instrument for the Evaluation of Advanced Practice Nurse Competencies in Primary Health Care. methodological study carried out in 78 primary health care centers in the southeast of Brazil, with 215 nurses. Data was collected using three instruments: the sample characterization form, the Brazilian version of the Advanced Practice Nurse Competency Assessment Instrument and the Therapeutic Interventions category of the Nurse Competency Scale. Construct validity was verified using confirmatory factor analysis and Spearman's correlation coefficient. Reliability was assessed using Cronbach's alpha and composite reliability. in the factor analysis, the model converged on a satisfactory result, with six items excluded, resulting in an instrument with 38 items distributed over eight dimensions. In convergent construct validity, positive, significant correlations were observed (p<0.0001) and ranged from weak to moderate in magnitude (r=0.2701 and r=0.397). Satisfactory evidence was found through the Composite Reliability analysis (0.78-0.89). the instrument showed evidence of construct validity and internal consistency. It could be used to help implement strategies for developing advanced practice in nursing. (1) Encourage discussion on Advanced Practice Nursing (APN) in Brazil. (2) To provide an instrument for evaluating APN in Primary Health Care. (3) To help implement APN in Brazil in Primary Health Care. (4) The Brazilian version of the instrument can be applied in different contexts. (5) A strategy for strengthening the nursing workforce.

Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients.

Healthcare-associated infections result in worse outcomes for patients and greater financial burden. An estimated 4.8 million HCAIs occurred in hospitals across Europe in 2022-23. Sixty-four percent of antibiotic-resistant infections in Europe are associated with healthcare. It is therefore vital to identify cost-effective interventions. Our objective was to summarise the cost-effectiveness evidence of interventions addressing HCAIs in hospitals. An umbrella review was conducted to identify evidence on the cost-effectiveness of antimicrobial stewardship, infection prevention and control, and microbiology and diagnostic stewardship interventions for the prevention and clinical management of HCAIs in adult hospital patients. Medline, Embase and EconLit databases were searched. A qualitative synthesis was undertaken. Twenty-four systematic reviews met the inclusion criteria, with 101 separate analyses extracted and grouped into 10 intervention and 14 infection/organism categories, across various countries and settings. Most evidence focussed on screening followed by contact precautions, isolation and/or decolonisation, with selective screening most cost-effective. Most IPC bundles were cost-effective, although interventions were heterogeneous. The evidence base was sparse for the remaining intervention categories, with more research required. The limited evidence suggests standalone environmental cleaning, hand hygiene, diagnostics, surveillance, ABS, and decolonisation interventions were mostly cost-effective. The cost-effectiveness of standalone personal protective equipment, and education and training interventions was mixed. Most interventions focussed on methicillin-resistant Staphylococcus aureus and other Gram-positive infections, with more research needed on Gram-negative infections. The comparator was unclear in many extracted analyses. Cost-effective interventions to address HCAIs in hospitals exist, although more evidence is needed for most interventions.

Actors and Networks in Court Interpreting Services in the Context of Migration in Türkiye

The primary aim of this study is to determine the network and the actors involved in court interpreting services in Türkiye. The second aim is to explore if the actors in the network have an impact on the other actors’ perceptions on the position and the duty of the court interpreters or not. In this context, two case studies were conducted in trials, where the refugees benefit from the interpreting service in Arabic-Turkish in two provinces (Kayseri and Antalya) in Türkiye. The data are composed of the semi-structured interviews with the court interpreters, open-ended questionnaires administered to the judges and the officers in the court registry and the short interviews conducted with the refugees. Additionally, the second data includes the observation notes during the hearings, research diaries and available codes, regulations and documents in the field. The findings have been analysed within the frameworks of position, interaction, and intervention, utilising Actor-Network Theory proposed by Callon and Latour. In the first category, the interpreters’ physical and social positions, the actors’ attitudes towards the profession, status and role are addressed. In the second category, the communication of actors before and after interpreting and the cooperation between the interpreters are discussed. The third category encompasses interpreting techniques, challenges faced during interpretation, interventions in the interpreting process, and the roles of the interpreter and the speaker. It has been determined that each network is ephemeral and unstable. Additionally, court interpreters have established local and small networks prior to interpreting performances to ensure safe involvement in the network, addressing procedural deficiencies. The study finally notes that the bilingualism of interpreters, the definition of the interpreter's role in the code, and the communication among actors prior to interpreting in the network may influence the perceptions of human actors regarding the position and responsibilities of court interpreters.

A Scoping Review of Interventions Aimed at Reducing Fear of Falling in Older Adults With Orthopedic Conditions.

Fear of falling (FoF) is a persistent anxiety regarding the risk of falling, which can even impact individuals without a history of falls. Fear of falling has been associated with decreased physical functioning and increased risk of falls. Most interventions have focused on reducing FoF in healthy older adults. This study aimed to review the literature's scope, nature, and content related to FoF interventions in older adults with orthopedic conditions. A scoping literature review was conducted. The method steps included identifying the research question, identifying relevant studies, selecting the studies, charting the data, and synthesizing, summarizing, and reporting the results. Cochrane Library, Medline, PsycINFO, Embase, ProQuest, and Google Scholar were searched. The search strategy used a set of key concepts, including "Fear of Falling," "Orthopedic conditions," "Interventions," and "Older adults." Out of the 33 articles that fulfilled the inclusion criteria, 21 were randomized control trials (RCTs), 5 were RCT protocols, 3 were quasi-experimental studies, 2 employed pre-post designs, 1 was a prospective cohort study, and 1 was an experimental study. The review revealed 7 distinct categories of interventions: exercise training, cognitive behavioral therapy, enhanced occupational or physical therapy (OT or PT), motivational interviews, interdisciplinary interventions, education, and mind-body intervention. The Falls Efficacy Scale (FES) was the most frequently used outcome measure for assessing FoF. Other measures were the Fear of Falling Questionnaire (FoFQ), the International Physical Activity Questionnaire (IPAQ), and the Perceived Ability to Manage Fall (PAMF). The studies varied in their reasoning, content, and how they reported findings, posing challenges for healthcare professionals in choosing and applying FoF intervention programs specific to various orthopedic conditions. This review highlighted the need for adopting more comprehensive approaches for assessing and addressing FoF in older adults with orthopedic conditions.

Comparison of Modified Occlusal Splint, Standard Splint Protocol, and Conventional Physical Therapy in Management of Temporomandibular Joint Disc Displacement with Reduction and Intermittent Locking: A Randomized Controlled Trial

Background: Temporomandibular joint disc displacement with reduction is one of the most common types of TMJ arthropathy. This single-blinded, randomized clinical study aimed to evaluate the effectiveness of three different therapeutic methods. Methods: Standard splints (Group 1), modified occlusal splint (Group 2), and conventional physical therapy with exercises (Group 3). A total of 48 patients were randomly assigned by a computer-generated allocation sequence to receive rehabilitation. The outcome was defined as improvements in pain and intermittent locking episodes. The follow-up visits were scheduled as one month and a long-term evaluation at one (T1), two (T2), three (T3), and four years (T4). Magnetic resonance images were also taken to evaluate each patient before treatment and at one year. Image analysis involved the evaluation of morphology and the function of intra-articular structures. Variables such as age, gender, and pre- vs. post-treatment values of VAS and TMJ locks between the three intervention categories were compared for statistical evaluations. p values ≤ 0.05 were taken as being significant. Results: A total of 16 subjects were allocated to each group. At T1, a decrease in pain and TMJ locking episodes was observed, which was maintained throughout the course of the study for four years of follow-ups, with no statistically significant differences. However, there was a tendency for better outcomes in favor of Group 2, with less clicking of the TMJ at opening. Conclusions: The modified mandibular splint seems to be successful as an effective alternative for the management of temporomandibular joint disc displacement with reductions in intermittent locking.

Mindfulness and CBT: a conceptual integration bridging ancient wisdom and modern cognitive theories of psychopathology.

With the rapid expansion of mindfulness and its incorporation into the "third wave" of Cognitive Behavioral Therapy (CBT), there has been evident confusion about what mindfulness is and how it relates to this broader category of interventions. In this article, I define mindfulness and CBT, and differentiate them while highlighting their substantial overlap. Specifically, I discuss the Buddhist Psychological Model and how it relates to the foundational cognitive model, demonstrating the common threads that run across these seemingly disparate philosophies. I use depression throughout as the exemplar disorder through which these connections are highlighted. This is all in the hope of helping clinicians and scientists see the common ground across these modalities and comprehend how and why mindfulness has come to be associated with the "third wave" of CBT. Ultimately, the aim of this brief article is to showcase the breadth of CBT, its concordance with ancient philosophical thought and wisdom, and to demonstrate why mindfulness has been and continues to be effectively integrated into CBT to address a wide range of mental health concerns and fortify efforts toward wellbeing.

Failure to rescue—rapid response systems: A making healthcare safer rapid review

Background Rapid response systems (RRSs) were developed to respond to early warnings of unexpected deterioration, but their effectiveness may be limited by factors impacting RRS activation (afferent limb) or response (efferent limb). Despite decades of RRS implementation, patients still experience unrecognized deterioration with associated worse outcomes. Methods This rapid review used modified search strategies to focus on the most valuable studies performed in the United States. Citations were screened by one reviewer with artificial intelligence as a second reviewer at the title/abstract review stage. The full text of eligible articles was then reviewed by a single team member to confirm eligibility. One reviewer completed the data abstraction, and a second reviewer checked the first reviewer's abstraction. Results Three categories of interventions were identified: implementation of a new RRS, and modifications to the afferent limb and/or efferent limb of an existing RRS. RRSs may have a large impact in reducing in-hospital mortality and an even greater impact in reducing cardiorespiratory arrest on hospital general wards in adults but the effect is unclear in children. Their impact on unanticipated intensive care unit admission is unclear. Modifications to the afferent and/or efferent limb were associated with a reduction in mortality and the incidence of cardiorespiratory arrest for adults. Conclusions RRS may have a large beneficial effect on hospital mortality and in-hospital cardiorespiratory arrest, but the strength of the evidence is low due to methodological weaknesses of the studies. Innovations in afferent and efferent limb structures show promise for increased benefit.

Conservative treatments for women with stress urinary incontinence: a systematic review and network meta-analysis.

This study aimed to compare the effectiveness of various conservative treatment strategies for women with stress urinary incontinence. A comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library was conducted from their inception through March 2024, without restrictions on language or location. Randomized controlled trials (RCTs) comparing the efficacy of conservative treatments for stress urinary incontinence, using short-term pad test or the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) score as outcome measures, were included. We conducted a network meta-analysis using a random-effects model to compare the effectiveness of different conservative treatment strategies, employing prediction interval plots and league tables, and ranked them according to the surface under the cumulative ranking curve (SUCRA). The quality of the included studies was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. A total of 31 RCTs involving 1,900 patients across 8 intervention categories were included in the analysis. SUCRA rankings indicated that electrical stimulation (SUCRA = 95.9%) was the most effective therapy for improving ICIQ-UI SF scores, followed by biofeedback electrical stimulation (SUCRA = 84.9%), radiofrequency (SUCRA = 77.5%), biofeedback (SUCRA = 57.8%), magnetic stimulation (SUCRA = 45.3%), pelvic floor muscle training (SUCRA = 38.4%), Er: YAG laser (SUCRA = 37.4%), and CO2 laser (SUCRA = 7.4%). In terms of reducing urine leakage, the treatments were ranked in descending order as follows: Er: YAG laser (SUCRA = 97.5%), biofeedback electrical stimulation (SUCRA = 83.4%), biofeedback (SUCRA = 67.0%), radiofrequency (SUCRA = 59.5%), electrical stimulation (SUCRA = 48.4%), pelvic floor muscle training (SUCRA = 43.0%), magnetic stimulation (SUCRA = 27.8%), and CO2 laser (SUCRA = 21.4%). Based on the clustered rankings of the two metrics, biofeedback electrical stimulation was identified as the most effective therapy for improving stress urinary incontinence. Based on the combined analysis of two indicators, we found that biofeedback electrical stimulation may be the optimal therapy for the conservative management of stress urinary incontinence. https://www.crd.york.ac.uk/prospero/, identifier CRD42024569845.

Balance Board or Motion Capture? A Meta-Analysis Exploring the Effectiveness of Commercially Available Virtual Reality Exergaming in Enhancing Balance and Functional Mobility Among the Elderly.

Force platforms and motion capture are commonly used as feedback mechanisms in exergaming; nevertheless, their therapeutic effectiveness may vary. Therefore, the primary objective of this study was to evaluate the effectiveness of commercially available virtual reality (VR) exergaming systems on balance and functional mobility, with a supplementary analysis considering the administered dose of exergaming. The search was conducted in five databases. Commercially available exergaming platforms were classified into two categories: VR exergaming with a balance board (including Wii Balance Board) and motion capture (including Xbox Kinect). Two categories of control interventions (treatment as usual [TAU] and no treatment [NT]) were extracted. The meta-analysis was performed separately for static, dynamic, and proactive balance outcomes and for the aggregated results of all included outcomes with subgroup analysis of lower, moderate, and higher doses. In total, 28 studies with 1457 participants were included. Both exergaming systems were particularly effective in improving the single leg stance outcome. VR exergaming with motion capture was found to be more effective than TAU with a standardized mean difference (SMD) of 0.48 (P = 0.006) and NT (SMD = 0.86; P = 0.02). In conclusion, commercially available VR exergaming with a motion capture feedback mechanism has demonstrated effectiveness as an intervention for balance training when compared with NT. Specifically, high doses (above 134 minutes per week) appear to be more beneficial for healthy older adults. Moreover, the findings provide some weak evidence supporting the effectiveness of VR exergaming with a balance board for improving functional mobility, particularly when compared with NT.

Effects of technology‐based cognitive and exercise interventions on cognitive function in persons with mild cognitive impairment: A systematic review, network meta‐analysis, and meta regression

AbstractBackgroundTechnology has been increasingly integrated into controlling the decline of cognitive function for persons with mild cognitive impairment (MCI). It is unclear whether technology‐based cognitive and exercise interventions could generate synergistic benefits and what components would optimize this effect.MethodsIn this study, we searched MEDLINE, Web of Science, Scopus, Embase and APA PsycInfo from inception to Nov 4, 2023. We included randomized controlled trails that evaluated the effects of technology‐based cognitive and exercise interventions on cognitive function for persons with MCI. Our primary outcome was global cognition. Outcomes were summarized in narrative synthesis and combined using meta‐analysis. Pairwise meta‐analysis and network meta‐analysis were sequentially performed to identify the effects of each category of interventions and their comparative intervention effectiveness, respectively. Meta‐regression was performed to examine any influence of study design and participants’ characteristics on the intervention effectiveness. This systematic review protocol was registered in PROSPERO (CRD 42023486359).FindingsA total of 28 studies with 1633 participants were included. The results of pairwise meta‐analyses indicated that technology‐based cognitive and exercise interventions were superior to active/passive controls in global cognition, cognitive shifting, proceeding speed, working memory, delayed recall, and category fluency (p&lt;0.05). The results of network meta‐analyses indicated that the optimal components were cognitive stimulation combined with mind‐body exercise in improving global cognition (SUCRA: 77.0%, SMD 0.85, 95%CI ‐0.17 to 1.87) and cognitive shifting (SUCRA: 92.4%, SMD 1.57, 95%CI 0.88 to 2.25), while cognitive training combined with mind‐body exercise were the most beneficial in developing proceeding speed (SUCRA: 88.5%, SMD 0.68, 95%CI 0.14 to 1.22). Meta‐regression further suggested that the effects of the tested interventions were independent of the various factors relating to study design and participants’ characteristics.InterpretationTechnology‐based cognitive and exercise interventions can be effective in improving global cognition and core subdomains of cognition in persons with MCI. This review highlights the more superior effects of technology‐based cognitive stimulation combined with mind‐body exercise in improving global cognition.

Profiles of public attitude change regarding stuttering

Profiles of public attitude change regarding stuttering