Multifaceted Program Research Articles

Knowledge About HIV/AIDS and its Transmission and Misconception Among Women in Thailand: A Structural Equation Modelling Approach.

Asian and pacific region countries are considered to be high risk countries for Human Immunodeficiency Viruses (HIV). There is little literature quantifying the relationship between education of HIV/AIDS and its principal socioeconomic determinants through a spatial analysis. The purpose of this study was to assess the knowledge and awareness about HIV among the women in Thailand, and its direct and indirect association with sociodemographic factors including sexual education, level of education, area of living and wealth index through a structural equation modelling approach. Cross-sectional analysis using data from the 2022 UNICEF Multiple Indicator Cluster Survey (MICS). Thailand. A total of 3671 women from the 2022 MICS dataset. Key variables included knowledge and misconceptions about HIV, sexual education, education level, area of residence, marital status, and wealth index. Structural equation modeling was used to assess direct and indirect effects of sociodemographic factors on HIV-related knowledge and misconceptions. The direct effect of sexual education on knowledge, transmission and misconception about HIV/AIDS is significant (β = 0.051, P = .002). The mediation effect test found that the sexual education and education indirectly affected knowledge, transmission and misconceptions about HIV/AIDS through the mediation effect of women's marital status (β = -0.068, P = .018) and wealth index (β = 0.007, P = <.001). Sexual education alone is insufficient to improve health literacy on HIV/AIDS, as other mediating factors such as education level, wealth index, marital status and area of residence are also key drivers. To achieve Sustainable Development Goal (SDG) 3 by 2030, it is essential to enhance HIV/AIDS related health education for women through multifaceted intervention programs that address these mediating factors.

Drifting Past Policy Coherence? Rhetoric and Realities of the Mexican Sembrando Vida Program’s Sustainability Goals

Global and interconnected sustainability challenges require systems thinking and policy coherence to support bold and coordinated action. To chart a course for action, the UN Sustainable Development Goals (SDGs) provide a suite of targets across international and national levels. Here, we explore intentions and contributions over time of the Mexican multifaceted rural-development program Sembrando Vida (SV) to the SDGs, to assess its policy coherence for sustainable development, especially in relation to climate change. We reviewed online documents and newspaper articles, interviewed key SV staff and analyzed the Mexican President’s morning conference speeches. We show that multiplicity and adaptation of stated intentions suggest opportunistic forms of policy drift with limited policy coherence. The potential of the SV program remains promising, but it requires clearer objectives, coherent strategy, expert knowledge, community support and evaluation. These results demonstrate how political context can cause policy drift and negatively impact intended policy coherence for sustainable development.

Spatiotemporal profile of an optimal host response to virus infection in the primate central nervous system.

Viral infections of the central nervous system (CNS) are a major cause of morbidity largely due to lack of prevention and inadequate treatments. While mortality from viral CNS infections is significant, nearly two thirds of the patients survive. Thus, it is important to understand how the human CNS can successfully control virus infection and recover. Since it is not possible to study the human CNS throughout the course of viral infection at the cellular level, here we analyzed a non-lethal viral infection in the CNS of nonhuman primates (NHPs). We inoculated NHPs intracerebrally with a high dose of La Crosse virus (LACV), a bunyavirus that can infect neurons and cause encephalitis primarily in children, but with a very low (≤ 1%) mortality rate. To profile the CNS response to LACV infection, we used an integrative approach that was based on comprehensive analyses of (i) spatiotemporal dynamics of virus replication, (ii) identification of types of infected neurons, (iii) spatiotemporal transcriptomics, and (iv) morphological and functional changes in CNS intrinsic and extrinsic cells. We identified the location, timing, and functional repertoire of optimal transcriptional and translational regulation of the primate CNS in response to virus infection of neurons. These CNS responses involved a well-coordinated spatiotemporal interplay between astrocytes, lymphocytes, microglia, and CNS-border macrophages. Our findings suggest a multifaceted program governing an optimal CNS response to virus infection with specific events coordinated in space and time. This allowed the CNS to successfully control the infection by rapidly clearing the virus from infected neurons, mitigate damage to neurophysiology, activate and terminate immune responses in a timely manner, resolve inflammation, restore homeostasis, and initiate tissue repair. An increased understanding of these processes may provide new therapeutic opportunities to improve outcomes of viral CNS diseases in humans.

Effects of MyBFF@school, a multifaceted obesity intervention program, on anthropometry and body composition of overweight and obese primary schoolchildren

BackgroundRecently, there has been an increase in the prevalence of childhood obesity in Malaysia, raising concerns about increased cardiometabolic morbidity. MyBFF@school is a multifaceted program comprising physical activity, nutritional education, and psychological empowerment introduced to combat childhood obesity in Malaysia. The efficacy of a six-month intervention on the body composition of overweight and obese primary schoolchildren was evaluated.MethodsThis is a school-based, cluster randomized controlled trial involving selected primary schools in Kuala Lumpur, Selangor, and Negeri Sembilan. A total of 1,397 primary-school students aged 9–11 with a body mass index (BMI)z-score (corrected for age) greater than + 1 standard deviation based on the World Health Organization 2007 Growth Reference were assigned to intervention (n=647) and control (n=750) groups. BMI z-score, waist circumference (WC), percentage body fat (PBF), and skeletal muscle mass (SMM) were assessed at baseline and after three and six months of the study. Analyses of all outcomes except for the baseline characteristics were conducted according to the intention-to-treat principle.ResultsAfter three months, there was no significant difference in the BMI z-score or PBF between the control and intervention groups, but SMM and WC were significantly higher in the intervention group versus the control group with mean difference of 0.15 kg; 95% confidence interval [CI]: 0.07–0.22, p < 0.001 and mean difference of 1.53 cm; 95% confidence interval [CI]: 1.21- 1.85, p < 0.001 for SMM and WC respectively. After six months, the intervention group demonstrated a significantly greater reduction in PBF compared to the controls (% mean difference: 0.43%, 95% CI: − 0.73 to − 0.12, p < 0.001) as well as a greater increase in SMM (mean difference: 0.28 kg, 95% CI: 0.18–0.37, p < 0.001). There was no difference in the BMI z-score or WC between the intervention and control groups at six months.ConclusionsThe multicomponent MyBFF@school intervention significantly improved body composition among obese primary schoolchildren in terms of percentage body fat and skeletal muscle mass compared to the control after six months. However, BMI z-score and waist circumference measures did not reflect the benefits of this program.Trial registrationClinical trial number: NCT04155255, November 7, 2019 (Retrospective registered). National Medical Research Register: NMRR-13–439-16,563. Registered July 23, 2013. The intervention program was approved by the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia and the Educational Planning and Research Division (EPRD), Ministry of Education Malaysia. It was funded by the Ministry of Health Malaysia.

The Global RAdical Cystectomy Evaluation and Management (GRACEM) pathway: single-centre prospective observational cohort study protocol.

Despite guideline recommendations, few institutions have implemented clinical pathways that incorporate frailty into routine decision-making for patients undergoing radical cystectomy (RC). This paper presents an integrated clinical pathway designed to address the needs of frail patients undergoing RC. The purpose of the study is to determine whether a multifaceted prevention programme that tailors interventions to the syndromic components of frailty can improve postoperative morbidity and recovery time for patients. New insights will be gained into how to optimize the physical and mental status and quality of life of patients before and after surgery, up to 1 year later. The Global RAdical Cystectomy Evaluation and Management (GRACEM) study is a prospective, observational, single-centre, 2-year cohort study. Patient enrolment began on 27 April 2023, and results are pending. The primary endpoints are postoperative morbidity and the in-hospital postoperative care burden. Postoperative morbidity is measured by the number of early (up to 1month) and late (over 1month and up to 12 months) complications, graded by severity according to the Clavien-Dindo classification. In-hospital postoperative care burden is measured by the number and duration of key care processes as recorded by the Care Process Monitoring Chart, a tool developed for this study. Secondary endpoints are changes in frailty and health-related quality of life (HRQoL) from pre-intervention to planned follow-up up to 1year. Frailty is assessed with the Functional Limitations and Geriatric Syndromes Frailty Questionnaire (FLIGS-FQ), another ad hoc tool. HRQoL is assessed using the EQ-5D-5L questionnaire combined with the cystectomy-specific FACT-Bl-cys index from the first month of follow-up. The GRACEM study includes patients with non-metastatic, histologically confirmed, muscle-infiltrating bladder cancer who underwent RC surgery with curative intent. This study is unique in that the GRACEM Core Team shares decision-making throughout the pathway, from before the intervention to the end of the patient's follow-up. The pathway involves the patient, family members and community services.

HYPERTENSION CONTROL PROGRAM IN A LARGE HEALTH CARE SYSTEM SERVING HISPANIC MEDICARE BENEFICIARIES IN SOUTH FLORIDA

Abstract Healthcare systems play a key role in hypertension control and health equity promotion in large populations. This study assessed the impact of a multifaceted hypertension control program in a large healthcare system serving Medicare and dual eligible (DE) Beneficiaries primarily of Hispanic origin in South Florida, an understudied population. Leon Medical Centers, a major integrated healthcare services provider to Medicare and DE patients in Miami-Dade, FL, implemented a hypertension control program in 2011. Electronic health records (2008-2018) from patients aged 65-89 years with hypertension were analyzed. Controlled BP definition was annual average systolic BP&amp;lt; 140 mmHg and diastolic BP&amp;lt; 90 mmHg. Age- and diabetes-standardized annual BP control rates were calculated. Random effects modeling compared BP control levels after vs. before program implementation. From 2008 (n=4,710) to 2018 (n=21,540), mean age±SD increased (73.4±5.3 to 77.1±6.1). Proportion of Hispanics remained constant (&amp;gt;98%). Overall age-adjusted odds of BP control were 5.8 (95% confidence interval [CI]: 5.6-6.1) times higher after program implementation. BP control rates increased similarly in both sexes. In women, standardized control rates increased from 68.9-73.3% (2008-2010) to 88.8-92.3% (2013-2018). Standardized control rates tended to be lower in DE than in Medicare patients at baseline – e.g., 2008: 67.2% (65.9-69.3%) vs. 72.2% (70.4-73.8%), but similar after program implementation – e.g., 2018: 89.9% (89.3-90.5%) vs. 90.2% (89.4-91.0%). Implementation of a primary care-based, multicomponent, culturally congruent hypertension control program was associated with meaningful increases in BP control levels in both men and women, and Medicare and DE patients in a large healthcare system in South Florida.

Effects of a Comprehensive Program on Reducing Cancer-Related Fatigue: A Randomized Controlled Trial.

Cancer-related fatigue (CRF) can affect patients undergoing chemotherapy severely. A comprehensive intervention targeted for reducing CRF is lacking. To evaluate the effectiveness of an innovative multifaceted web-based patient-empowered CRF management program for improving CRF, perceived self-efficacy for fatigue self-management (PSEFSM), physical activity, quality of sleep, anxiety, depression, pain and quality of life (QoL) among gastric cancer patients undergoing chemotherapy in China. A total of 92 eligible gastric cancer patients undergoing chemotherapy were recruited and randomly assigned to two groups. Participants in the intervention group received a 12-week CRF intervention including eight online sessions, patient diary for self-management practice; telephone follow-up and online support via WeChat. The control group received routine care. Primary outcome was CRF. Secondary outcomes included PSEFSM, physical activity, quality of sleep, anxiety, depression, pain, and QoL. Outcome variables were measured three times: at admission(T0), post-intervention(T1) and one-month post-intervention(T2). Repeated measures ANOVA or generalized estimating equations were used to evaluate the intervention effect. Significant group by time interaction was found in the scores of total CRF and its three dimensions, PSEFSM, total physical activities, quality of sleep, anxiety, depression, and QoL of the two groups (P <0.05). No significant difference was found in pain scores (P >0.05). This study provides evidence that an innovative multifaceted web-based patient-empowered CRF management program is effective in reducing CRF and improving related symptoms (depression, anxiety, quality of sleep), physical activity, PSEFSM and QoL for gastric cancer patients undergoing chemotherapy.

Transfer RNA Levels Are Tuned to Support Differentiation During Drosophila Neurogenesis.

Neural differentiation requires a multifaceted program to alter gene expression along the proliferation to the differentiation axis. While critical changes occur at the level of transcription, post-transcriptional mechanisms allow fine-tuning of protein output. We investigated the role of tRNAs in regulating gene expression during neural differentiation in Drosophila larval brains. We quantified tRNA abundance in neural progenitor-biased and neuron-biased brains using the hydrotRNA-seq method. These tRNA data were combined with cell type-specific mRNA decay measurements and transcriptome profiles in order to model how tRNA abundance affects mRNA stability and translation efficiency. We found that (1) tRNA abundance is largely constant between neural progenitors and neurons but significant variation exists for 10 nuclear tRNA genes and 8 corresponding anticodon groups, (2) tRNA abundance correlates with codon-mediated mRNA decay in neuroblasts and neurons, but does not completely explain the different stabilizing or destabilizing effects of certain codons, and (3) changes in tRNA levels support a shift in translation optimization from a program supporting proliferation to a program supporting differentiation. These findings reveal coordination between tRNA expression and codon usage in transcripts that regulate neural development.

아마추어 골프참여자의 자기관리와 회복탄력성 및 스포츠행복의 구조적 관계

The purpose of this study is to investigate the relationship between self-management, resilience, and sports happiness targeting amateur golf participants. For data processing, Window SPSS 18.0 and AMOS 21.0 were used to investigate the relationship between factors. The results are as follows: First, self-management has been shown to have a positive effect on resilience. Second, resilience has been shown to have a positive effect on sports happiness. Third, self-management has been shown to have a positive effect on sports happiness. Fourth, resilience was found to mediate the relationship between self-management and sports happiness. Therefore, it is necessary to operate a multifaceted professional training program to establish correct self-management strategies for golf participants and to operate a program to confirm and support whether self-management is continuously performed. In addition, it is expected that the sports happiness of golf participants can be improved by analyzing various stress factors that can occur in golf situations and improving coping skills through the operation of a psychological counseling program to improve resilience.

Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project.

The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use. To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections. Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain. Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared. A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%. External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings.

A Review on the Approach to Herbal Medicine in Cuban Healthcare System.

Background:Cuban healthcare system, emphasizing a holistic approach with herbal medicine as a key component, has achieved significant advancements in a multitude of health indicators. The aim of this study was to investigate the approach of Cuban healthcare system to Herbal medicine. Methods: The study conducted a review in the year 2024 in accordance with the guidelines set by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple databases, namely PubMed, Scopus, ProQuest, and the Cochrane database of systematic reviews were searched and the quality of the studies was assessed using the AACODS checklist. Finally, a thematic analysis was conducted on the data. Results: 7 studies included within the study. The quality assessment scores presented high level of quality of the final studies with low level of bias. The thematic analysis resulted in six themes including: International collaboration, Universal coverage, Education and encouragement, Utilization, integration, and innovation, Efficiency and sustainability, and Prevention-focused and strategic approach. The Cuban healthcare system incorporates global herbal medicine knowledge, particularly from China, and provides free, regionalized services. It emphasizes the "Green Pharmacy" concept in each neighborhood and integrates herbal medicine into service delivery through a sustainable, prevention-focused policy. Conclusion: The Cuban healthcare system has implemented a multifaceted program on herbal medicine.

Impact of a multifaceted antibiotic stewardship programme in a paediatric acute care unit over 8 years.

Antibiotics are the most prescribed drugs for children worldwide, but overuse and misuse have led to an increase in antibiotic resistance. Antimicrobial stewardship programmes (ASPs) have proven feasible in reducing inappropriate antimicrobial use. The study aimed at evaluating the impact and sustainability of an ASP with multiple interventions over 8 years. This quasi-experimental study was conducted between 2014 and 2022 in the paediatric acute care unit of Padua University Hospital. Demographic and clinical data were retrieved from the electronic clinical records. Daily prescriptions were collected and analysed based on the AWaRe classification and using days of therapy (DOT) out of 1000 patient days (DOT/1000PDs). The primary outcome was to assess the change in overall antibiotic consumption and of access and watch antibiotics, stratifying patients with and without comorbidities. Trends in antibiotic consumption (DOTs/1000PD) were assessed using joinpoint regression analysis. A total of 3118 children were included. Total antibiotic consumption remained stable and low in patients without comorbidities, ∼300 DOT/1000PDs, whereas a statistically significant constant reduction was observed in children with comorbidities, from almost 500 DOT/1000PPDs to <400 DOT/1000PDs. Access consumption increased in both groups of patients, whereas watch consumption constantly decreased, although statistically significant only in children with comorbidities. Implementing a multistep ASP has proven feasible and sustainable in improving antibiotic prescriptions for previously healthy and fragile children. All the implemented interventions were low cost, and with efficient use of resources, ensuring an ASP that was effective, practical, and easily replicable and implementable in various healthcare settings.

A Firm of One's Own: Experimental Evidence on Credit Constraints and Occupational Choice

Abstract We evaluate two interventions targeting young women in Nairobi, Kenya. The first is a multifaceted program involving vocational training, in-kind transfers of physical capital, and ongoing mentoring. The second is an unrestricted cash grant. Both interventions shift women into self-employment, and impacts persist after six years. Both programs also increase income in the short-term, but those effects disappear over time. Though the two treatments have similar impacts on labor market outcomes, women in the multifaceted program report significantly higher wellbeing six years after treatment relative to both women in the control group and those who received the grants.

A Nonrandomized Pilot Study to Investigate the Acceptability and Feasibility of LivR Well: A Multifaceted 28-Day Home-Based Liver Optimization Program for Acute-on-Chronic Liver Failure

Acute-on-chronic liver failure (ACLF) has a 22%-74% 28-day mortality rate and 30%-40% 30-day readmission rate. We investigated the acceptability and feasibility of a multimodal community intervention for ACLF. A single-arm nonrandomized pilot study of consecutive participants with ACLF was conducted in a tertiary health service. Participants received weekly medical and nursing reviews, dietetics, physiotherapy, pharmacy, social work, addiction medicine, and neuropsychiatry, where indicated. A digital platform included remote weight monitoring and online surveys. The primary outcome was acceptability/feasibility. Secondary outcomes included safety, mortality, readmission, liver disease severity, and costs. Fifty-nine patients were enrolled with median age 51 years (interquartile range (IQR): 45-59); majority alcohol etiology (74%),and median Model for End-Stage Liver Disease Sodium score 16 (IQR: 12-21). LivR Well was acceptable with low attrition (8 of 59), adherence to the program including home visits (mean 8.4 ± 4.2) and consultations (mean 2.4 ± 1.5) per patient. This was supported by positive feedback and themes identified through a qualitative subanalysis. Feasibility was demonstrated by recruitment rate of 4.94 patients/month and 86% completion. Mortality was lower than expected at 3%, 30-day readmission rate was 15%, and median Model for End-Stage Liver Disease Sodium score reduced to 15 (P= .01). Median 6-month costs reduced from$30,454 (IQR: $21,953-$65,657) to $17,657 ($4249-$42,876) (P= .009). The total 6-month health-care cost was $1,868,859 (95% confidence interval 1,081,821-2,655,897) compared to $2,518,227 (95% confidence interval 1,959,610-3,076,844). LivR Well was acceptable, feasible, and safe with low short-term mortality and readmission rates. Health-care costs were reduced by 26% driven by a 40% reduction in 30-day readmission. Further evaluation includes a randomized controlled trial of LivR Well compared to standard care.

Innovative ongoing support within a multifaceted computational thinking professional learning program improves teachers’ self-efficacy and classroom practices

Innovative ongoing support within a multifaceted computational thinking professional learning program improves teachers’ self-efficacy and classroom practices

Navigating the complexity of a collaborative, system-wide public health programme: learning from a longitudinal qualitative evaluation of the ActEarly City Collaboratory

BackgroundAddressing the upstream social determinants of health (e.g. built environment, education) can reduce the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However, collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging. ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary, cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve collaboration between researchers, local authorities and communities. This paper explores ActEarly’s experiences of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations for future intersectoral and interdisciplinary population health research collaborations.MethodsWe conducted a longitudinal qualitative study of ActEarly, integrating findings from inductive documentary analysis of internal documents (mainly meetings minutes and reports) (n = 114) and interviews (n = 70) with 45 consortium members at three different timepoints (2018, 2021, 2023). Participants worked across different organizations, cities, roles and levels of seniority in the consortium.FindingsClarity, Unity, Flexibility and Feasibility were seen as the key mechanisms required to support ActEarly’s implementation. Clear aims, governance structures and communication were necessary to manage the uncertainty of the complex system. A unified approach, characterized by strong relationships, having a shared vision and communal access to resources supported effective collaboration. Flexibility was required to adjust to different ways of working, respond to wider system events and manage the consortium. Establishing feasible aims that responded to the limitations of the system, the available resources and research infrastructure was required for teams to deliver the work.ConclusionsImplementing multi-faceted programmes in a complex system can be challenging. We recommend that future whole-systems consortia seeking to improve population health build Clarity, Unity, Flexibility and Feasibility into their programmes, noting the complex interrelationships between these factors. Iterative reflections from all parties should support delivery amidst the uncertainty that comes with running a population health research collaboration, and strong leadership and governance should play a key role in ensuring that these are built into foundations the programme.

The role of pulmonary rehabilitation in improving lung functions in patients with ankylosing spondylitis

Background Ankylosing spondylitis (AS) is a chronic inflammatory disease characterized by axial and peripheral entheseal inflammation and new bone production(1). The development of syndesmophytes, enthesophytes, and spinal fusion along the course of the disease is linked to chronic pain, functional impairment, and disability(2). Fibrosis of the upper lobes of the lungs (interstitial lung disease) and chest wall abnormalities are two of the emerging forms of pulmonary involvement in AS. (3). Pulmonary rehabilitation is a multifaceted program of education, counselling, breathing exercises, and other modalities that can increase the patient’s independence and ease of functioning(4). Aim To estimate the role of pulmonary rehabilitation in enhancing lung function in AS individuals in relation to disease activity, clinical, and functional parameters. Patients and methods This study was an interventional study: single-arm group (prospective randomized clinical study). Thirty people (30) participated in that study from those presented to Physical Medicine, Rheumatology and Rehabilitation inpatient and outpatient clinic at Ain Shams University hospitals, diagnosed as radiographic axial spondyloarthropathy (SPA) from 02/2022 to 12/2022. All patients underwent pulmonary rehabilitation program and were exposed to a detailed history, clinical, and pulmonary function testing. Disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score C-reactive protein (ASDAS-CRP), Valuation of function by using Bath Ankylosing Spondylitis Functional index (BASFI), 6-Minute walk test (6MWT), the Modified Borg Dyspnoea Scale (MBS), and Timed Up and Go (TUG) test. All function and clinical scores were done at baseline and repeated after completing pulmonary rehabilitation program. Result The mean age of patients was 36.57 ± 7.83 years (23–45 years), with a median disease duration of (5 (3–9) years). In total, there were 19 out of the studied patients with restrictive pattern. With comparison between pre- and postintervention of pulmonary rehabilitation, there was a significant statistical difference in all, disease activity (ASDAS and BASFI) and functional (MBS, TUG, and 6MWT) parameters (P &lt;0.001), except for occiput to the wall. Regarding pulmonary function tests, including forced vital capacity (FVC), expiratory volume in one second (FEV1), and peaked expiratory flow (PEF), there was a statistically significant change at baseline and at the end of exercise (P &lt;0.001). Conclusion Improved respiratory function and disease activity and overall functional activity are possible outcomes of pulmonary rehabilitation programs in combination with other rehabilitation interventions.

Consolidating Integrated Care: A Joint Falls Prevention Initiative between Community and Hospital Based Physiotherapy Services

Abstract Background Physiotherapists from Primary Care, Integrated Care Programme for Older Persons (ICPOP) and hospital-based Frailty Intervention Team services came together to establish a community working group with the aim of reducing the incidence of falls of those in their collective catchment area. The agreed objective being to pilot a 6 week falls prevention initiative between community and hospital-based services. Methods 7 Physiotherapists across 3 services formed a community working group. A 6-week physiotherapy led, multifaceted intervention program involving exercise, education and an opportunity for socializing was developed. The class was accessible to persons over the age of 65 years who had or were at risk of falling. Participants were recruited from the caseloads of the physiotherapists involved. Objective assessments of gait speed, grip strength and balance were carried out via hand grip dynamometry, Timed Up and Go (TUAG) and Short Physical Performance Battery (SPPB). Subjective measures of participant’s quality of life were assessed via the EQ 5D 5L, Falls Efficacy Scale (FES) and Sarc-F. On completion of the intervention participants were retested. Results 10 participants were recruited to the pilot from both community and hospital based, out-patient services. Over 80% of participants attended 4 out of 6 sessions. Participants grip strength improved by 3.4kg, TUAG by 6.43% (1.03 seconds) and SPPB by 13.3%. EQ 5D 5L scores improved by 15%, FES score improved by 17.81% and SARC-F scores improved by 6%. 40% of participants went on to engage with a follow-on exercise group delivered by the local Sports Partnership. Conclusion Overall, there was a notable improvement in participant’s physical function and quality of life and self-efficacy scores post intervention. This highlights the positive impact of multimodal group interventions, which incorporate both exercise and education to promote self-efficacy within frail older population at risk of falling.

Barriers and Enablers of Successful Workplace Integration of Internationally Educated Nurses (IENs) in a Host Country: A Qualitative Evidence Synthesis.

The aim of this qualitative evidence synthesis (QES) is to critically appraise the contemporary literature to gain a comprehensive understanding of the barriers and enablers of workplace integration needs of internationally educated nurses (IENs). An electronic search was conducted across multiple databases, and eligibility criteria were applied to identify papers published between January 2013 and July 2023. Out of the 830 studies initially retrieved, six met the inclusion criteria. Study quality was assessed using the Critical Appraisal Skills Programme (CASP) tool. Thematic analysis of the included studies revealed various barriers and enablers for workplace integration experienced by IENs. Barriers were: (a) IEN-related factors (cultural differences, language barriers, and disparities in the scope of nursing practice), (b) organizational factors (poor leadership), and (c) contextual factors (racism and discrimination). Enablers emerged were: (a) IEN-related factors (commitment to learn and adapt) and (b) organizational factors (structured multifaceted program, supportive workplace environment, and mentorship). Dynamic interaction exists among these factors, therefore interventions should address multiple barriers simultaneously. The QES has illuminated essential factors which impact the integration of IENs, and emphasizes the necessity of a comprehensive approach that considers the diverse challenges and opportunities that arise.

The effectiveness of a knowledge translation intervention on the implementation of NEWS2 in nursing homes, a pragmatic cluster RCT

BackgroundImproving the uptake of relevant and reliable research is an important priority in long-term care to achieve sustainable and high-quality services for the increasingly older population.AimThe purpose was to assess the effectiveness of a tailored, adaptive and a multifaceted KT capacity program, relative to usual practice, on the implementation of National Early Warning Score 2 (NEWS2).MethodsThis study was carried out as a pragmatic cluster-randomized controlled trial. The capacity program consisted of an educational part to address implementation capacity gaps and a facilitation-upon-implementation part to address a relevant knowledge gap in nursing homes. A collective decision was made to address the challenge of early detection of clinical deterioration among nursing home residents, by implementing the (NEWS2) as clinical innovation.Public nursing homes in a Norwegian municipality (n = 21) with a total of 1 466 beds were eligible for inclusion. The study-period spanned over a 22-month period, including a 12-month follow-up.Data was extracted from the Electronic Patient Journal system and analyzed using multilevel growth model analysis.ResultsThe intervention had a large effect on the use of NEWS2 among care staff in intervention nursing homes, compared to the control group (standardized mean difference, d = 2.42). During the final month of the implementation period, residents in the intervention group was assessed with NEWS2 1.44 times (95% CI: 1.23, 1.64) per month, which is almost four times more often than in the control group (mean = 0.38, 95% CI: 0.19, 0.57). During the follow-up period, the effect of the intervention was not only sustained in the intervention group but there was a substantial increase in the use of NEWS2 in both the intervention (mean = 1.75, 95% CI: 1.55, 1.96) and control groups (mean = 1.45, 95% CI: 1.27, 1.65).ConclusionsThis tailored implementation strategy had a large effect on the use of NEWS2 among care staff, demonstrating that integrated knowledge translation strategies can be a promising strategy to achieve evidence-based care in the nursing home sector.Trial registrationISRCTN12437773. Registered 19/3 2020, retrospectively.