Implementation Of Optimal Strategy Research Articles

A framework of workplace yoga for expectant mothers: Acomprehensive review of benefits, safety considerations, and future perspectives.

This review explores the benefits of yoga during pregnancy and considers its implications for working pregnant women, focusing on safety, future directions, and limitations. The physical and psychological changes experienced during pregnancy can lead to increased stress and discomfort, impacting both maternal and fetal health, which may be further augmented by work stress during pregnancy. To address these challenges, various interventions such as yoga, relaxation techniques, and meditation have been proposed. Although there is evidence to support the benefits of yoga at both physical and psychological levels, there is a lack of proper strategies and guidelines for the implications of these interventions among working pregnant women. Incorporating yoga as a safe and cost-effective intervention for managing work-related distress during pregnancy can have significant benefits for both maternal and fetal health. However, careful consideration of safety guidelines, further research on working pregnant women, and exploring optimal implementation strategies are essential to fully harness the potential of yoga in this context. This review aims to provide a comprehensive overview of the current evidence for the benefits and safety of yoga during pregnancy, with a specific focus on working pregnant women. To ensure the scientific rigor of this review, we conducted a systematic search of the PubMed database for high-quality research studies published in peer-reviewed journals.

Derivation and Validation of a Machine Learning Model for the Prevention of Unplanned Dialysis.

Approximately half of all patients with advanced chronic kidney disease (CKD) who progress to kidney failure initiate dialysis in an unplanned fashion which is associated with high morbidity, mortality, and healthcare costs. A novel prediction model designed to identify advanced CKD patients who are at high risk for developing kidney failure over short time frames (6-12 months) may help reduce the rates of unplanned dialysis and improve the quality of transitions from CKD to kidney failure. We performed a retrospective study employing machine learning random forest algorithms incorporating routinely collected age and sex data along with time-varying trends in laboratory measurements to derive and validate six- and 12-month kidney failure risk prediction models in the advanced CKD population. The models were comprehensively characterized in three independent cohorts in Ontario, Canada - derived in a cohort of 1,849 consecutive advanced CKD patients (mean [standard deviation] age 66 [15] years, eGFR 19 [7] mL/min/1.73m2), and validated in two external advanced CKD cohorts (n=1,356; age 69 [14] years, eGFR 22 [7] mL/min/1.73m2). Across all cohorts, 55% of patients experienced kidney failure, of which 35% involved unplanned dialysis. The six- and 12-month models demonstrated excellent discrimination with area under the receiver operating characteristic curve of 0.88 (95%CI: 0.87-0.89) and 0.87 (95%CI: 0.86-0.87) along with high probabilistic accuracy with Brier scores of 0.10 (95%CI 0.09-0.10) and 0.14 (95%CI 0.13-0.14), respectively. The models were also well-calibrated and delivered timely alerts on a significant number of patients who ultimately initiated dialysis in an unplanned fashion. Similar results were found upon external validation testing. These machine-learning models using routinely collected patient data accurately predict near-future kidney failure risk among the advanced CKD population, and retrospectively deliver advanced warning on a substantial proportion of unplanned dialysis events. Optimal implementation strategies still need to be elucidated.

A lifestyle physical activity intervention for women in alcohol treatment: A pilot randomized controlled trial

IntroductionCompared to men, women with alcohol use disorder (AUD) are more likely to drink to manage stress and negative affect. Given women's risk for poor drinking outcomes, it is critical to develop and test interventions that target these affective factors. Physical activity improves negative affect and has emerged as a promising adjunct to AUD treatment and, thus, may be especially valuable for women. MethodsFifty women with AUD (49.9 ± 12.0 years of age) participated in either a 12-week telephone-delivered lifestyle physical activity plus Fitbit (LPA + Fitbit) or a health education contact (HEC) control intervention following a partial hospital addictions treatment program. The study examined changes in drinking behaviors, mental health outcomes, and physical activity engagement post-intervention using both conventional test statistics and standard effect sizes. ResultsHigher rates of continuous abstinence during the 12-week period were observed in the LPA + Fitbit condition (55.6 %) than in the HEC condition (33.6 %); odds ratio = 2.97. However, among women who drank any alcohol during the 12-weeks, slightly higher rates of heavy drinking and drinks/day were observed among women in the LPA + Fitbit condition. Significant differences for improved mental health outcomes (including depression, anxiety, negative affect, positive affect, perceived stress, and behavioral activation) and increased self-reported physical activity were consistently observed among participants in the LPA + Fitbit condition, relative to HEC. ConclusionsThe LPA + Fitbit program had a positive impact on alcohol abstinence, mental health, and physical activity in adult women receiving treatment for AUD. Future research should continue to investigate the optimal implementation strategies, duration, and intensity of LPA interventions in the context of a fully-powered RCT.

Revolutionizing Education with Interactive Tech Boosts Global Learning Outcomes

This study explores the impact of innovative technologies—such as computer programs, mobile applications, interactive textbooks, 3D modeling, and virtual experiences—on enhancing learning and teaching processes. The research adopts a mixed-methods approach to analyze how these tools affect students' mastery and engagement across various educational disciplines. Preliminary results indicate that these technologies significantly improve comprehension of complex subjects and increase student engagement, particularly highlighting the effectiveness of interactive textbooks and online platforms in ensuring timely course completion. The findings suggest that integrating these modern methods into educational curricula can greatly enhance learning efficiency and outcomes, recommending further exploration into long-term effects and optimal implementation strategies. Highlights: Technologies like 3D modeling boost understanding of complex concepts. Tools such as apps enhance student participation and interest. Modern tech improves course completion and learning outcomes. Keywords: Educational Technology, 3D Modeling, Interactive Learning, Digital Tools, Animations

Optimizing Perioperative Experience in Upper Blepharoplasty: The Impact of Premedication on Anxiety, Pain, and Patient Satisfaction.

Background The periorbital area undergoes transformative changes with age, influencing both aesthetic appearance and functional aspects of the eyelids. Age-related alterations involve volume loss, shifts in eyelid crease position, drooping eyebrows, reduced skin elasticity, and the presence of dermatochalasis. Dermatochalasis, characterized by redundant upper eyelid skin folds, poses aesthetic and functional challenges, impacting visual acuity and eyelid elevation efficiency. Upper blepharoplasty addresses these age-related changes. Despite the elective nature of upper blepharoplasty, the procedure can evoke preoperative anxiety and discomfort. Various premedication strategies, including benzodiazepines, aim to alleviate anxiety and enhance the overall patient experience. However, ongoing debates persist regarding the optimal strategy for implementation. The study aims to contribute insights into the effectiveness of different premedication approaches in optimizing patient comfort during and after upper blepharoplasty. Methods The research design involves 182 patients divided into three groups: control group (CG) (n =45) receiving no premedication, Group 1 (n = 98) receiving oral midazolam (a benzodiazepine), and Group 2 (n = 39) receiving a combination of midazolam, eutectic mixture of local anesthetics (EMLA) eyelid ointment, and oralparacetamol with codeine phosphate hemihydrate. The study assesses anxiety levels, pain perception during local anesthetic injection, surgery, and postoperatively, as well as the use of painkillers and adverse effects. Ethical approval was obtained for the study. Results Significant differences were noted among the groups during local anesthetic injection (p < 0.0001), surgery (p < 0.0001), and post surgery (p < 0.0197). CG patients experienced higher pain levels during local anesthetic injection and surgery compared to Groups 1 and 2. Group 1 reported more pain during surgery than Group 2. Substantial differences were observed in preoperative (p < 0.0001), during-surgery (p < 0.0001), and after-surgery (p < 0.0001) anxiety levels. The CG exhibited higher preoperative anxiety compared to Group 1, while Group 1 had lower anxiety during surgery compared to the CG. Group 1 also reported lower anxiety after surgery than both the CG and Group 2. A significant difference was found in post-surgery painkiller usage among the groups (p = 0.0003). Group 2 showed significantly lower usage compared to Group 1 (p = 0.0004) and the CG (p = 0.0006). A significant difference was observed in the duration of painkiller use after surgery (p < 0.0014). The CG had a longer duration than Group 1 (p = 0.0049) and Group 2 (p = 0.0495). Conclusions Midazolam alone as premedication effectively reduced anxiety before, during, and after surgery. EMLA administration for injection pain did not produce superior results, likely due to its delayed onset. Paracetamol with codeine phosphate hemihydrate effectively reduced surgical pain and postoperative pain durationand decreased the need for painkillers.

Enteral Resuscitation: A Field-Expedient Treatment Strategy for Burn Shock during Wartime and in Other Austere Settings

Burn injuries are a constant threat in war. Aspects of the modern battlefield increase the risk of burn injuries and pose challenges for early treatment. The initial resuscitation of a severely burn-injured patient often exceeds the resources available in front-line medical facilities. This stems mostly from the weight and volume of the intravenous fluids required. One promising solution to this problem is enteral resuscitation with an oral rehydration solution. In addition to being logistically easier to manage, enteral resuscitation may be able to mitigate secondary injuries to the gut related to burn shock and systemic immunoinflammatory activation. This has been previously studied in burn patients, primarily using electrolyte solutions, with promising results. Modern ORS containing sodium, potassium, and glucose in ratios that maximize gut absorption may provide additional benefits as a resuscitation strategy, both in terms of plasma volume expansion and protection of the barrier and immune functions of the gut mucosa. While enteral resuscitation is promising and should be used when other options are not available, further research is needed to refine an optimal implementation strategy.

Effectiveness of blended learning approach in learning chemistry at the tertiary level

The integration of online and face-to-face instruction, known as blended learning, has gained traction in science education, particularly in tertiary settings. This study investigates the efficacy of a blended learning approach on academic achievement among tertiary-level chemistry students. A bespoke blended learning curriculum was devised for two chemistry units, and a randomized two-group experimental design was implemented. Sixty-five students were randomly assigned to either the treatment group, receiving blended learning, or the control group, receiving traditional lecture-based instruction. An independent samples t-test was conducted to compare post-test scores between the groups, controlling for prior knowledge using pretest scores as a covariate. Results indicate that students in the blended learning group attained significantly higher post-test scores (M = 81.53, SD = 10.23) compared to their counterparts in the control group (M = 74.33, SD = 9.04), with a t-value of (63) = 2.85, and p = .006. This study underscores the potential of well-designed blended instruction in enhancing chemistry education at the tertiary level. Further investigations into optimal blend ratios and implementation strategies are recommended for comprehensive insights.

Sustainable Valorization of Sour Cherry (Prunus cerasus) By-Products: Extraction of Antioxidant Compounds

Prunus cerasus, commonly known as sour cherry, is a fruit widely consumed during the summer season. Processing of sour cherries results in the generation of substantial amounts of by-products. Following the extraction of juice, the residual pomace (comprising of skin and flesh) and pits remain as by-products. This study delves into the antioxidant potential derived from the phenolic compounds present in sour cherry pomace and the oil derived from its seeds, both demonstrating significant implications for human health and longevity. The increasing demand for bioactive compounds from natural resources, to be used as ingredients in functional foods, as well as the increased global production of sour cherries, has spurred considerable interest in these by-products. The growing demand for more sustainable practices has necessitated the use of industrial fruit by-products. To this end, many articles have been published regarding sour cherry skin and pits utilization. This comprehensive review aims to elucidate advanced techniques for extracting antioxidants from sour cherries and discern optimal strategies for broad-scale industrial implementation.

Implementing a nurse-led screening clinic for symptom distress with community-based referral for cancer survivors: A feasibility study.

This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p<0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

Abstract 306: Evaluating Layperson CPR Performance Supported by a Just-in-Time Video Compared to a Standard Training Course

Background: Just-in-time (JIT) video training has been proposed as an alternative to in-person CPR courses, with associated time and cost savings. Research Question: Does a JIT training video improve layperson performance of CPR? Aim: Measure CPR performance using a JIT video compared to the American Heart Association (AHA) HeartSaver® CPR AED Training course. Methods: A convenience sample of laypeople was randomized to perform CPR in a simulated scenario a) after participating in an AHA HeartSaver® course led by experienced instructors, b) with access to a JIT training video, or c) control, with no assistance or training. CPR quality was assessed by trained evaluators and objective performance assessed using Laerdal QCPR-enabled simulators. The primary outcome was performance of correct CPR. Results: Of 230 eligible subjects, 226 were randomized with no significant differences in baseline characteristics across groups. Prevalence of correct CPR was low, though significantly higher in the AHA group (AHA: 40%, 95%CI 28-51; JIT: 15%, 95%CI 8-26; control 10%, 95%CI 4-19). Overall, 94% of participants performed compressions within 1 minute, with no difference between groups. An AED was called for more frequently in the AHA group (47%) than the JIT (15%) or control (10%) groups. Flow fraction was significantly better in the AHA group (89%, IQR 77-99) compared to the JIT (75%, IQR 47-90) or control (49%, IQR 22-74) groups and compression rates of 100-120 were more frequent in the AHA (51%) and JIT groups (47%) compared to controls (27%). Conclusions: While correct performance of specific CPR skills varied in this sample, laypersons using a JIT training video performed as well as those taking an AHA HeartSaver® course on several key measures such as rapid chest compression and compression rate. JIT video training may be a viable option for supporting untrained bystander CPR performance, though further evaluation is needed to identify optimal strategies for implementation.

Engaging patient-family dyads to inform the development of a digital health intervention to support cancer caregivers.

221 Background: Shifts in cancer care from hospital to home have increased the burden on family caregivers of individuals with cancer. Cancer caregiving is demanding and associated with declines in caregivers’ physical and psychological well-being. Digital health interventions may improve caregiver well-being by supporting them to monitor patient symptoms, access social support, and communicate with patients’ care team members. Despite benefits to quality care, few digital health interventions have been developed or implemented to support cancer caregivers. The purpose of this study was to develop a web-based intervention (myCare2) focused on supporting caregivers and caregiver well-being. Methods: This multi-method study followed a user-centered design. Participants were recruited from two clinics within one NCI-designated cancer center. We conducted three focus groups with patients with hematologic or gastrointestinal cancers and their caregivers to identify needs and preferences and guide intervention development. Next, we developed a wireframe prototype of myCare2. We iteratively refined the prototype in response to feedback obtained in cognitive interviews with patient-caregiver dyads. Lastly, we built a functioning web-based prototype and conducted user tests with dyads. Focus groups, cognitive interviews, and user tests were audio recorded, transcribed, and analyzed using conventional content analysis. Results: Eight dyads participated in three focus groups. Caregivers reported feeling unprepared and viewed themselves as “head of logistics” for the patient. Caregivers expressed the desire for a tool to help them organize caregiver responsibilities, including medication management, daily schedules and appointments, symptom monitoring, nursing and medical tasks, self-care, and communication with clinicians and support networks. In cognitive interviews, four dyads reviewed and provided positive feedback on the wireframe prototype features that allow the caregiver to schedule tasks; report patient and caregiver concerns; track patient symptoms and medications; ask family and friends for support; share updates with support networks; and find local resources, classes, and events. Five dyads tested myCare2, providing positive and constructive feedback about the intervention layout and functionality. Conclusions: Growing evidence suggests digital health interventions can benefit caregivers managing cancer care at home. The myCare2 intervention is a web-based tool based on caregiver and patient feedback that was found helpful and acceptable. Future research should evaluate the feasibility of myCare2, measure its effects on caregiver and patient outcomes, and identify optimal implementation strategies for use in practice.

Is participation enough? Impact of simulation curriculum structure on performance of basic surgical skills

PurposeThe optimal strategy for curricular construction and feedback implementation, both critical for skill acquisition, is unknown in the simulation curricula setting. To address this gap, we examined the impact of individual components of our basic surgical skills curriculum on intern performance.MethodsThe basic surgical skills curriculum consists of skills lab sessions, self-recorded “homework” exercises graded with a score and narrative feedback, and a scored final assessment. Using linear regression, we assessed the association between assessment performance (scores) and four other curricular components (skills lab attendance, homework submission, homework scores, and receipt of feedback on homework). Narrative feedback quality was graded by three raters for relevance, valence, and specificity. Pearson’s r was used to calculate the association of each feedback variable with the assessment score.ResultsAmong the 71 (73%) surgical interns who completed the curriculum, for each additional homework assignment that received structured feedback, assessment score increased by 0.54% (p < 0.001; effect size 0.16). For each percentage point increase in homework score, assessment score increased by 0.21% (p = 0.02; effect size 0.07). Pearson’s r revealed significant correlations between assessment score and relevant feedback (r = 0.26, p = 0.02), relevant feedback and corrective feedback (r = 0.70, p < 0.001), and between relevant and specific feedback (r = 0.74, p < 0.001). Relevant feedback comments were not correlated with reinforcing feedback (r = 0.01, p = 0.47).ConclusionsOur findings reiterate the value of practice when accompanied by relevant feedback. We identified a default to providing lower-quality reinforcing feedback and higher-quality corrective feedback. Future feedback training may yield positive results.

Adrenergic and mesenchymal signatures are identifiable in cell-free DNA and correlate with metastatic disease burden in children with neuroblastoma.

Cell-free DNA (cfDNA) profiles of 5-hydroxymethylcytosine (5-hmC), an epigenetic marker of open chromatin and active gene expression, are correlated with metastatic disease burden in patients with neuroblastoma. Neuroblastoma tumors are comprised of adrenergic (ADRN) and mesenchymal (MES) cells, and the relative abundance of each in tumor biopsies has prognostic implications. We hypothesized that ADRN and MES-specific signatures could be quantified in cfDNA 5-hmC profiles and would augment the detection of metastatic burden in patients with neuroblastoma. We previously performed an integrative analysis to identify ADRN and MES-specific genes (n=373 and n=159, respectively). Purified DNA from cell lines was serial diluted with healthy donor cfDNA. Using Gene Set Variation Analysis (GSVA), ADRN and MES signatures were optimized. We then quantified signature scores, and our prior neuroblastoma signature, in cfDNA from 84 samples from 46 high-risk patients including 21 patients with serial samples. Samples from patients with higher metastatic burden had increased GSVA scores for both ADRN and MES gene signatures (p<.001). While ADRN and MES signature scores tracked together in serially collected samples, we identified instances of patients with increases in either MES or ADRN score at relapse. While it is feasible to identify ADRN and MES signatures using 5-hmC profiles of cfDNA from neuroblastoma patients and correlate these signatures to metastatic burden, additional data are needed to determine the optimal strategies for clinical implementation. Prospective evaluation in larger cohorts is ongoing.

Effect of the COVID-19 pandemic on the pediatric infectious disease landscape.

This narrative review aims to present an overview of the COVID-19 pandemic's effects on the landscape of pediatric infectious diseases. While COVID-19 generally results in mild symptoms and a favorable prognosis in children, the pandemic brought forth significant consequences. These included persistent symptoms among infected children ("long COVID"), a profound transformation in healthcare utilization (notably through the widespread adoption of telemedicine), and the implementation of optimization strategies within healthcare settings. Furthermore, the pandemic resulted in alterations in the circulation patterns of respiratory pathogens, including influenza, RSV, and Streptococcus pneumoniae. The possible reasons for those changes are discussed in this review. COVID-19 effect was not limited to respiratory infectious diseases, as other diseases, including urinary tract and gastrointestinal infections, have displayed decreased transmission rates, likely attributable to heightened hygiene measures and shifts in care-seeking behaviors. Finally, the disruption of routine childhood vaccination programs has resulted in reduced immunization coverage and an upsurge in vaccine hesitancy. In addition, the pandemic was associated with issues of antibiotic misuse and over-prescription. Conclusion: In conclusion, the COVID-19 pandemic has left a profound and multifaceted impact on the landscape of pediatric infectious diseases, ranging from the emergence of "long COVID" in children to significant changes in healthcare delivery, altered circulation patterns of various pathogens, and concerning disruptions in vaccination programs and antibiotic usage. What is Known: •COVID-19 usually presents with mild symptoms in children, although severe and late manifestations are possible. •The pandemic resulted in a dramatically increased use of health care services, as well as alterations in the circulation patterns of respiratory pathogens, decreased rates of other, non-respiratory, infections, disruption of routine childhood vaccination programs, and antibiotic misuse. What is New: •Possible strategies to tackle future outbreaks are presented, including changes in health care services utilization, implementation of updated vaccine programs and antibiotic stewardship protocols. •The decline in RSV and influenza circulation during COVID-19 was probably not primarily related to NPI measures, and rather related to other, non-NPI measures implementation, including specific pathogen-host interactions on the level of the biological niche (the nasopharynx).

Prospective Research Trend Analysis on Zero-Energy Building (ZEB): An Artificial Intelligence Approach

While global attention to zero-energy building (ZEB) has surged as a sustainable countermeasure to high-energy consumption, a congruent expansion in research remains conspicuously absent. Addressing this lacuna, our study harnesses public research and development grant data to decipher evolving trajectories within ZEB research. Distinctively departing from conventional methodologies, we employ state-of-the-art natural language processing (NLP) artificial intelligence models to meticulously analyze grant textual content pertinent to ZEB. Our findings illuminate an expansive spectrum of ZEB-related research, with a pronounced focus on the holistic continuum of energy supply, demand, distribution, and actualization within architectural confines. Theoretically, this work delineates key avenues ripe for future empirical exploration, fostering a robust academic foundation for subsequent ZEB inquiries. Practically, the insights derived bear significant implications for practitioners, informing optimal implementation strategies, and offering policymakers coherent roadmaps for sustainable urban development. Collectively, this study affords a panoramic perspective on contemporary ZEB research contours, enhancing both scholarly comprehension and practical enactment in this pivotal domain.

Optimization Strategy of Railway Transportation in Guangdong, Hong Kong（China）, and Macao（China） Greater Bay Area Based on Intelligent Transportation System (ITS)

With the rapid development of China's economy, the Guangdong-Hong Kong-Macao Greater Bay Area is experiencing rapid economic growth, increasing population, and extremely high regional foot traffic, which brings great challenges to the transportation system. To support the sustainable development of the Guangdong, Hong Kong(China), and Macao(China) Greater Bay Area, optimizing the rail transportation system of the Guangdong, Hong Kong(China), and Macao(China) Greater Bay Area has become an urgent task. At present, the construction of ITS has become an important trend in modern society, and the efficiency and convenience of transportation can be improved through the application of ITS and the implementation of optimization strategies. By optimizing line planning and design, rationalizing train operation schedules, and implementing intelligent scheduling and operation management to reduce congestion and increase operation speed and frequency, the efficiency of the overall rail transit system can be improved to provide more efficient, convenient, and safe travel options for residents, enterprises, and tourists, and to promote the economic development and sustainable urban development of the Greater Bay Area.

Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review.

This narrative review aims to summarize non-pharmacological interventions for pain management in hemodialysis patients, assessing their potential benefits and limitations in enhancing patient well-being and quality of life. We reviewed the current literature on five primary non-pharmacological interventions: acupuncture, cognitive behavioral therapy, relaxation techniques, virtual reality, and alternative methods such as transcutaneous electrical nerve stimulation, music therapy, and aromatherapy. We analyzed the evidence regarding their effectiveness, feasibility, and optimal implementation strategies. The existing evidence supports the potential benefits of these interventions in managing pain and improving the well-being of hemodialysis patients. However, further high-quality research is needed to confirm their effectiveness, establish implementation best practices, and assess their long-term impact on patient outcomes. Non-pharmacological interventions hold promise for pain management in hemodialysis patients. Additional research is required to optimize these interventions and validate their effectiveness, contributing to comprehensive pain management strategies for this vulnerable patient population.

Students’ Perceptions Towards the Use of Podcasts in EFL Classroom: A Case Study at a University of Uzbekistan

Integration of Information and Communication Technology (ICT) has emerged as a significant factor in the realm of language education, yielding notable impacts. To shed light on this phenomenon, a case study was conducted to delve into the perceptions of students and attitudes of teachers regarding the utilization of podcasts in the teaching-learning process. The research problem addressed in this study aimed to explore students' perceptions toward the incorporation of podcasts in the English as a Foreign Language (EFL) classroom, as well as their understanding of the limitations and impact of podcasts on their language skill development. The study recruited 40 students and 2 teachers from the National University of Uzbekistan as participants. Data collection involved the distribution of questionnaires to students and conducting interviews with teachers. The questionnaires comprised 17 statements to gauge the participants' viewpoints. The findings revealed that a majority of respondents expressed their fondness for podcasts (80.2%), strongly agreeing that the use of podcasts is enjoyable (69.9%). Moreover, the researcher observed positive attitudes from both students and teachers toward the integration of podcasts in the EFL classroom. Students believed that podcasts had the potential to enhance their listening and speaking skills. Teachers, on the other hand, perceived podcasts as an effective tool for fostering students' collaborative and cooperative work skills, as well as their creative thinking strategies. However, challenges associated with the effective utilization of podcasts in the classroom also surfaced, prompting further exploration into optimal implementation strategies.

Study protocol: the ILANA study – exploring optimal implementation strategies for long-acting antiretroviral therapy to ensure equity in clinical care and policy for women, racially minoritised people and older people living with HIV in the UK – a qualitative multiphase longitudinal study design

IntroductionCabotegravir and rilpivirine (CAB+RPV long-acting (LA)) is recommended as a treatment for HIV-1 allowing people living with HIV to receive 2 monthly injectable treatment, rather than daily pills. Providing injectable...

Use of statistical process control charts to identify impactful implementation strategies for an ePRO-based symptom management program across the SIMPRO Consortium.

6579 Background: Collecting electronic patient reported outcomes (ePROs) reduces the burden of cancer and prevents acute care hospitalizations. However, broad implementation in the routine care setting remains challenging, partly because the optimal implementation strategies – actions that are most likely to encourage adoption and use – are not known. Since 2019, the SIMPRO Consortium has deployed an ePRO-based symptom management program (eSyM) across 6 community-based cancer centers. Methods: We used statistical process control (SPC) charts to identify variation due to special versus common causes (random variation) for one key performance indicator (KPI) – the weekly ePROs response rate. All 6 SIMPRO sites contributed data for this analysis: 3 for chemotherapy patients and 3 for surgery patients. Sites had to have at least 18 months of KPI data; information from the first 4 months after eSyM rollout were excluded to account for program ramp-up. The KPI was calculated as the number of patients who submitted an ePRO questionnaire divided by the number eligible to submit a questionnaire each week. The upper and lower confidence limits were set at +/- 2 sigma to allow for 95% of observations to fall within the limits. Three rules were applied to identify special cause variation: 1) astronomical points (outside sigma limits), 2) shifts (8 or more points above or below a center line), and 3) trends (6 or more points consecutively ascending or descending). Implementation strategies that mapped to special cause variations were selected as those most likely to impact the KPI. Results: Across the 6 sites that deployed eSyM, the mean KPI performance ranged from 19.7%-35.7%. SPC charts detected multiple special cause variations in the KPI at all 6 sites, though the patterns varied by site. All sites demonstrated positive and negative astronomical variations as well as positive and negative shifts. Three sites demonstrated negative trends; no sites demonstrated positive trends. Direct patient outreach was the implementation strategy most frequently associated with special cause variation, followed by changes in promoting the ePRO program to clinical staff. Positive changes were associated with strategy initiation; negative changes were associated with strategy discontinuation. Conclusions: Applying SPC charts to a KPI from the eSyM deployment highlighted the effect of personal communication with patients and providers, suggesting that these implementation strategies could offer value to other sites deploying eSyM. The absence of positive trends early in eSyM program deployment underscores the need to identify better implementation strategies and allocate more resources to foster program adoption and sustainability. Applying SPCs to other KPIs, such as symptom severity and healthcare utilization, could improve eSyM deployment and impact.