Post-intervention Phase Research Articles

Interrupted Time Series for Assessing the Causality of Intervention Effects. Part 35 of a Series on Evaluating Scientific Publications.

The gold standard for evaluating interventions in medicine and health care is the randomized controlled trial (RCT). In practice, however, RCTs may be difficult to conduct because of high costs, ethical aspects, or practical considerations. This is particularly true of studies on the population level, e.g., for the evaluation of health policy measures. We present a type of study design called the interrupted time series (ITS) and its critical interpretation, with several illustrative examples. This discussion is based on selected methodological publications. ITS are suitable for the assessment of interventions with a clear point of intervention (interruption). They are analyzed with the statistical methods of time-series analysis. One strength of ITS is that they can be used to estimate an immediate effect as well as a gradually developing effect. Under certain assumptions, the findings of an ITS analysis can be interpreted causally. The main assumption underlying an ITS is that the trend after the intervention would have been exactly the same as the trend before the intervention if the intervention had not taken place and all other conditions had remained unchanged. A further assumption is that there should be no differences in the pre- versus postintervention phases in the subjects or other entities being tested (e.g., hospitals) that might affect the measured endpoints (e.g., differences in mean age affecting measured mortality). Moreover, the intervention periods must be properly distinct from one another in order to prevent biased effect estimates. The robustness of the assumptions should also be checked with sensitivity analyses. As long as all sources of bias have been avoided and the findings are both plausible and robust, the effects revealed by ITS can be interpreted as causal. ITS may serve as an alternative method for evaluating intervention effects when an RCT cannot be performed.

The motivational impact of sport education model on daily physical activity levels among university students: a mediation analysis.

This study investigates the effects of the sport education model on physical literacy and its subsequent impact on daily physical activity levels among university students. Through mediation analysis, this study seeks to uncover the role of situational motivation in these effects. The participants in this study consist of 188 university students (male n = 132, female n = 70; mean age: 18.53 years) who were exposed to an 8-class, 10-lesson season as part of their physical education curriculum. Self-report measures were collected at baseline (1st lesson), post-intervention (10th lesson), and follow-up phases (5 weeks after). The results reveal significant mediation effects at the post-intervention (β = 0.201, t = 3.576, p < .001) and follow-up (β = 0.187, t = 3.069, p < .01) phases. Additionally, significant direct effects of physical literacy on physical activity metabolic minutes were found in the post-intervention phase (β = 0.293, t = 1.807, p < .05). Gender differences were also observed in the multigroup analysis. These findings demonstrated the motivation mediates the impact of the sport education model on promoting physical activity and highlight the multidimensional nature of physical literacy. Future research is recommended to explore the application of this pedagogical model in different educational contexts and populations, utilising robust analytical methods.

Assessing the effect of implementing a central line care bundle on central line-associated bloodstream infections in a tertiary hospital in Saudi Arabia

Central line-associated bloodstream infections (CLABSIs) are severe bloodstream infections caused by catheter use and are often associated with a longer hospital stay, increased healthcare costs, and a higher mortality rate. However, catheter-related bloodstream infections can be successfully treated. It is essential that healthcare workers are aware of central line (CL) insertion and maintenance bundles to reduce and prevent the incidence of CLABSI. The objective of this study was to assess the impact of implementing CL care bundles on hospital-wide CLABSI incidence rates. This is a prospective study conducted at the King Faisal Specialist Hospital and Research Center in Saudi Arabia from January 2017 to December 2021. The research period was divided into two phases: the pre-intervention phase (January 1, 2017 to December 31, 2018) and the post-intervention phase (January, 2019 to December 31, 2020). During both phases, outcome variables, including CLABSI rate, were assessed. In the present study, the total number of CLABSIs is 439, of which 266 were in the pre-intervention phase and 173 were in the post-intervention phase. The overall CLABSI rate significantly decreased from 1.6±0.05 in the pre-intervention phase to 0.9±0.05 in the post-intervention phase. This decline in CLABSI was significant (p&lt;0.0001) across all hospital settings, including critical care and non-critical care units. The implementation of care bundles is essential and has been shown to significantly reduce CLABSI rates in nearly all participating units.

Using community-based participatory approaches to improve access to mass drug administration for trachoma elimination in a pastoral conflict area of Kenya.

In Baringo County, Kenya, trachoma remains endemic despite repeated mass drug administration (MDA) efforts, with coverage in one of the wards consistently falling short of world health organization (WHO) targets. The disease is endemic in 12 out of the 47 counties in Kenya. Baringo county is a pastoral conflict, hard to reach area where eight rounds of mass drug administration (MDA) for trachoma have been implemented. In Loyamorok ward, treatment coverage has been below 68% against the WHO recommended threshold of 80%. Community engagements that promote participatory approaches are key to MDA success. In this study, we describe community-based participatory approaches qualitatively developed and implemented during the intervention phase of a study that involved a pre-intervention, intervention and post intervention phases and aimed to address barriers of community participation and access to trachoma MDA. Interviews and focus group discussions were used to identify barriers to community participation in MDA, that included power and gender dynamics, rampant insecurity, community myths and misconceptions, migration in search of water and pastures, vastness and terrain and ineffective teams which resulted to unsupervised swallowing of drugs during MDA campaigns. Stakeholders in trachoma were identified through meetings with national, county and sub-county health management teams. The stakeholders, community members and the research team used the identified barriers to formulate MDA strategies including effective stakeholder engagement, enhanced social mobilization, community awareness creation on trachoma, effective planning and execution of MDA and implementation monitoring of the MDA campaign, all aimed at increasing MDA coverage. Overall MDA coverage in the area increased from 67.6% in 2021 to 87% in 2023 thus meeting the WHO threshold of 80%. The use of community-based, participatory approaches in the development and implementation of data driven strategies has the potential to positively influence MDA coverage for trachoma, and other neglected tropical diseases.

The Effects of a Single Vagus Nerve's Neurodynamics on Heart Rate Variability in Chronic Stress: A Randomized Controlled Trial.

The modulation of the autonomic nervous system's activity, particularly increasing its parasympathetic tone, is of significant interest in clinical physiotherapy due to its potential benefits for stress-related conditions and recovery processes. This study evaluated the effectiveness of the addition of neurodynamics in enhancing parasympathetic activation in subjects with chronic stress. A clinical trial randomly assigned participants to a group with neurodynamics (6 bpm breathing protocol + manual therapy + neurodynamic technique) or a group without neurodynamics (6 bpm breathing protocol + manual therapy only). Metrics of heart rate variability (HRV), including the Mean Heart Rate (Mean HR), standard deviation of intervals between consecutive heartbeats (SDNN), Heart Rate Difference (Diff. HR), Root Mean Square of Successive Differences (RMSSD), number of intervals differing by more than 50 ms (NN50), percentage of consecutive NN intervals that differed by more than 50 ms (pNN50), and the high-frequency component measured in standardized units (HF), were assessed before, during, and after the intervention. During the intervention, the group with neurodynamics showed significant changes in all variables except in the pNN50 and HF while the group without neurodynamics only showed improvements in the Mean HR, SDNN, and RMSSD. In the post-intervention phase, the group with neurodynamics maintained an increase in HRV while the group without neurodynamics experienced a decrease, suggesting an increase in sympathetic activity. Vagal nerve neurodynamics appear to represent an effective method for enhancing parasympathetic activation in patients with chronic stress. The results highlight the importance of a more comprehensive analysis of HRV variables in order to obtain a correct picture of the impact of interventions on the complex and multifaceted functioning of the autonomic nervous system.

Are there unique facets of therapeutic alliance for users of digital mental health interventions? An examination with the eHealth Therapeutic Alliance Inventory

Therapeutic alliance (TA) is a well-established predictor of clinical outcomes in traditional psychotherapy. However, its association with outcomes in eHealth interventions has been inconsistent, which might be due to the absence of measurements specifically designed to capture TA in eHealth settings. The eHealth Therapeutic Alliance Inventory (ETAI) incorporates conventional as well as unique eHealth TA subscales, enabling to examine the contribution of new facets of TA beyond traditional concepts. This study investigates the predictive contribution of eHealth TA subscales compared to conventional TA subscales on clinical outcomes and evaluates the concurrent criterion validity of the ETAI. The study was conducted within the framework of a randomized controlled trial involving a 10-week digital parent training program aimed at addressing child disruptive behaviors. Parents were randomly assigned to either an enhanced-quality or a standard-quality program. Parents from 68 families completed the ETAI at five weeks' post-program initiation and at the post-intervention phase. The primary outcome was the improvement in child behavior, measured by the Eyberg Child Behavior Inventory. Positive Pearson correlations were found between all ETAI subscales covering unique eHealth TA aspects, measured at the 5-week time-point, and improvement in child behavior at post-intervention (rs ≥ 0.23, ps < 0.03). The conventional TA subscale showed no significant Pearson correlation with improvement in child behavior. When examining the unique contributions of ETAI-subscales to explain the improvement in child behavior, only ETAI-Perceived Emotional Investment subscale was found to have a unique contribution (β = 0.29, p = 0.019). In addition, scores on most ETAI subscales were significantly higher among parents using the enhanced-quality program compared with the standard program (Cohen's ds > 0.48), reinforcing ETAI's criterion validity. The development of TA scales that incorporates unique eHealth TA subscales show initial promise in predicting outcomes. Further research is needed to better understand how different factors of eHealth TA relate to clinical outcomes across diverse clinical targets and programs.

Hands-On And Mobile App-Based Training Of Second Phase MBBS Students Regarding Blood Sample Collection For Routine Tests And Culture

Background Aseptic measures during blood sampling should be strictly enforced as identification of the true pathogen can act as life-saving measure in patients. Contamination during collection can produce erroneous results which can lead to unnecessary antibiotic usage. Thus, adequate training must be imparted so that the MBBS students can learn the correct technique and develop appropriate skills. This pre-post interventional study thus assessed the students’ and faculties’perception on venous blood sampling through hands on exercises on a simulated model and learning through digital module among MBBS students. Methodology The knowledge of the students was assessed through a questionnaire while practical skills through OSPE using a pre-validated checklist in the pre-intervention phase. The intervention comprised of students being trained in small batches regarding blood sample collection on a mannequin followed by biomedical waste disposal and spillage management. A digital intervention module for self-directed learning was shared with the students to reinforce their learning. This was followed by post interventional assessment of theoretical knowledge and practical skills. Results Paired sample t-test showed a statistically significant improvement in the knowledge scores and OSPE skills in the post-intervention phase. About 91% students opined that they were well trained. All the faculty opined that this training was immensely useful to students for future practical applications. Conclusion The current study demonstrated effectiveness of intervention among the medical students under the new curriculum through hands-on and digital module-based training on accurate blood sampling procedure.

Implementing Change Through an Outpatient Antibiotic Stewardship Program.

We sought to implement a multi-pronged behavioral intervention to reduce and tailor antibiotic use for two common urologic outpatient procedures. This study was a non-blinded intervention study that consisted of a pre-intervention phase (11/2018-1/2019), an intervention phase (1/2020-12/2020) in which a multi-pronged behavioral intervention was implemented, and a post-intervention phase (1/2021-3/2021). We examined antibiotic use for cystoscopy and transrectal prostate biopsy at three separate urologic outpatient clinics. A multi-pronged behavioral intervention consisted of formal physician education, modification of the electronic health order sets, clinic staff education, literature review, development and introduction of patient questionnaires, and individual audit feedback. The primary outcome was 30-day infections. Secondary outcomes were adherence to the recommended antibiotic protocols, questionnaire completion, and Escherichia coli outpatient antibiograms. A total of 2374 patients underwent 3047 cystoscopies and 547 patients underwent 559 prostate biopsies. The proportions of cystoscopy patients receiving antibiotic prophylaxis and prostate biopsy patients receiving augmented antibiotic prophylaxis decreased 33% and 35%, respectively. The odds of post-cystoscopy infection were not different between the pre-intervention and intervention phases and were lower in the post-intervention phase. The odds of post-biopsy infection were not changed between the pre-intervention and intervention or between the pre-intervention and post-intervention phases. Implementing a multi-pronged behavioral intervention reduced and tailored antibiotic use without an increase in 30-day infections. These findings suggest that outpatient antibiotic stewardship and facilitating rapid adoption of guidelines can be accomplished via this approach.

Evaluating the Impact of ICDP on India’s Coffee Production, Yield, and Exports

The coffee industry plays a pivotal role in India's agricultural sector, contributing significantly to the country's economy and livelihoods. However, the sector has faced challenges such as fluctuating yields, inconsistent production, and varying export quantities, largely due to biotic and abiotic stress factors. In response, the Ministry of Commerce and Industry launched the Integrated Coffee Development Project (ICDP) in 2014, aiming to enhance coffee production, productivity, and quality across both traditional and non-traditional growing regions in India. This research paper evaluates the impact of ICDP on coffee production, yield, and exports in India by analysing data from 2008 to 2022. The study adopts an interrupted time series analysis methodology to assess trends in the area under cultivation, production, yield, and export quantities before and after the ICDP intervention. The study period is divided into pre- and post-intervention phases to quantify the effects of the scheme. The results indicate a mixed impact of the ICDP. Traditional coffee-growing areas showed initial increases in production and yield, followed by declines, while non-traditional areas exhibited smaller but more consistent growth. Exports also experienced a temporary decline post-intervention but later rebounded, though at a slower growth rate. The analysis underscores the complexity of agricultural interventions, suggesting that while the ICDP had positive impacts in certain areas, challenges such as climate variability and pest infestations continue to affect the sector's overall growth. In conclusion, the ICDP has contributed to stabilizing and developing India’s coffee sector, but ongoing efforts are needed to address the underlying challenges hindering sustained progress.

A Quality Improvement Study on Colonoscopy Wait Times in Underinsured Patients Following the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic limited access to colonoscopy. To advance colorectal cancer health equity, we conducted a quality improvement study on colonoscopy wait times in 2019-2023 for underinsured (Medicaid, uninsured) compared with insured patients at an academic medical center providing colonoscopy for surrounding Federally Qualified Health Centers. Retrospective chart reviews were performed on adult outpatient colonoscopies in the preintervention period (2019-2021). In 2022, an institutional grant funded bilingual patient navigation to reduce colonoscopy wait times. Postintervention data were collected prospectively from May 2022 to May 2023 in 2 phases. Multivariable regression analyses were conducted for colonoscopy wait times as a primary outcome. Analysis of 3,403 screening/surveillance and 1,896 diagnostic colonoscopies revealed significantly longer colonoscopy wait times for underinsured compared with insured patients after 2019. For screening/surveillance colonoscopies, wait time differences between underinsured and insured patients in the second postintervention phase were reduced by 34.21 days (95% confidence interval [CI]: 11.07-57.35) compared with the postpandemic period and by 56.36 days (95% CI: 34.16-78.55) compared with the first postintervention phase. For diagnostic colonoscopies, wait time differences in the second postintervention phase were reduced by 27.57 days (95% CI: 9.96-45.19) compared with the postpandemic period and by 20.40 days (95% CI: 1.02-39.77) compared with the first postintervention phase. Colonoscopy wait times were significantly longer for underinsured compared with insured patients following the COVID-19 pandemic. This disparity was partially ameliorated by patient navigation. Monitoring outpatient colonoscopy wait times in underinsured patients is important for advancing health equity.

Get BusActive!: Protocol of a single-blinded randomised controlled trial incentivising public transport use for physical activity gain among young people and adults.

Population level physical activity generally does not meet recommended targets. Compared with private motor vehicle users, public transport users tend to be more physically active and financial incentives may encourage more public transport use, but these relationships are under-investigated. This paper describes the protocol of a randomised controlled trial that aimed to determine the effect of financially incentivising public transport use on physical activity in a regional Australian setting. Get BusActive! is a 9.5-month single-blinded randomised controlled trial. A convenience sample of Tasmanians aged ≥15 years will be randomised to a 14-week incentive-based intervention (bus trip target attainment rewarded by bus trip credits and weekly supportive text messages) or an active control following baseline measures and will be followed up ∼24 weeks later (maintenance phase). Both groups will receive written physical activity guidelines. The primary outcome is change in accelerometer-measured steps/day from baseline to immediately post intervention phase and maintenance phase. Secondary outcomes are change in: smartcard-measured bus trips/week; measured and self-reported minutes/week of physical activity and sitting; transport-related behaviour (using one-week travel diary), perspectives (e.g. enablers/barriers) and costs; health. Linear mixed model regression will determine group differences. Participant-level process evaluation will be conducted and intervention cost to the public transport provider determined. Get BusActive! will fill an important knowledge gap about the causal relationship between financially incentivised public transport use and physical activity-the findings will benefit health and transport-related decision makers. ACTRN12623000613606. U1111-1292-3414.

Comparison of the Effectiveness of Platelet-Rich Plasma Injection Versus Plantar-Specific Calf Stretching Exercises in Patients With Plantar Fasciitis: A Randomized Controlled Trial.

Background Plantar fasciitis is a common foot condition with multifactorial etiology. It is the most frequent cause of heel pain and has been categorized as an overuse syndrome. A clinical examination and history are crucial for diagnosis. There are several different forms of treatment available, two of which are frequently used: physical therapy and steroid injections. Recent research on platelet-rich plasma (PRP) has demonstrated encouraging outcomes and fewer side effects when compared to steroid injections. Methods A randomized controlled trial was conducted and randomization was done of indoor patients into two groups. Group 1, ending with odd numbers, was given PRP injections, and Group 2, ending with even numbers, was advised plantar-specific calf stretching exercises. Visual analog scale (VAS) scores were evaluated before and after the intervention and follow-up was done on the second, sixth, and 12th weeks. Results Comparing the VAS scores between the two groups, we found that in the pre-intervention phase, the VAS score of Group 1 was 5.4±0.56 and that of Group 2 was 5.4±0.59. In the post-intervention phase, the VAS score in Group 1 was 4.6±0.89, while in Group 2 it was 5.2±0.62. In the second week after intervention, the VAS score was observed to be 3.3±0.97 in Group 1, while in Group 2, it was 3.3±0.80. After the sixth week of intervention, the observed VAS score was 2.7±0.78, while in Group 2 it was 2.9±0.82. The mean VAS score after 12weeks of intervention was observed to be 2.3±0.91 in Group 1, while in Group 2, it was 2.2±0.80. Conclusion PRP injections and plantar-specific calf stretching exercises are equally effective in providing pain relief in plantar fasciitis. PRP injections have complications and problems which have been discussed. Exercises are devoid of such complications. No recurrences occurred in the exercise group and four cases had recurrence in the PRP group.

Impact of respectful maternal care training of health care providers on satisfaction with birth experience in mothers undergoing normal vaginal birth: A prospective interventional study.

To study the impact of respectful maternity care (RMC) training of health care providers on RMC and birth satisfaction in mothers undergoing normal vaginal birth. A prospective interventional study was performed comparing RMC and birth satisfaction in women undergoing vaginal births before and after RMC training of health care providers from November 2021 to March 2023 in a tertiary care center in India. Person-centered maternity care (PCMC) and birth satisfaction scale-revised (BSSR) scales were used to study women's RMC and birth satisfaction, respectively. A total of 100 women undergoing normal vaginal birth were enrolled in pre- and post-intervention phases. The intervention was done through formal and onsite training of health care providers in RMC. The mean total PCMC scale score in the post-training group demonstrated a remarkable increase to 51.95 ± 6.50, significantly higher than the pre-training mean of 32.82 ± 8.47 (P < 0.0001). The mean ± SD of the BSSR scale total score in the post-training group increased significantly to 27.17 ± 3.67, surpassing the pre-training mean of 21.19 ± 5.48 (P < 0.0001). The study showed significant improvement in RMC and birth satisfaction score in the post-training group thereby emphasizing the importance of RMC training of health care providers in the facility.

Improving Time to Antibiotics in Patients with Long Bone Open Fractures Presenting to the Pediatric Emergency Department.

To evaluate a new triage workflow aimed at improving time to intravenous antibiotics in open fractures to under 60 minutes of arrival to the Pediatric Emergency Department. Design: A prospective, multi-disciplinary, quality improvement project. A tertiary care, Level 1 Pediatric Trauma hospital in New York. Patients aged 17 and under with long bone open fractures between June 1, 2020 and May 31, 2021, excluding those transferred from an outside hospital, with non-long bone fractures and non-fractured, injured extremities.Outcome Measures and Comparisons: The new workflow involved splint removal and skin assessment during triage to identify open fractures. Serial Plan-Do-Study-Act (PDSA) cycles aimed to refine this workflow and reduce antibiotic administration time. Primary outcome: Percentage of open fracture patients receiving intravenous (IV) antibiotics within 60 minutes. Secondary outcome: Assessment of triage documentation regarding splint presence and removal. An exact Wilcoxon two-sample test compared time from patient arrival (quick-registration) to antibiotic administration before, during and after workflow implementation on 6/1/2020. A total of 51 patients (33 male) aged 17 and under, with open fractures were reviewed: 25 during the pre-intervention phase 1/1/18-5/31/20, 14 during the intervention phase 6/1/20-5/31/21, and 12 during the post-intervention phase 6/1/21-11/30/21. Continuous improvement efforts via PDSA cycles focusing on education, reinforcement, recognition, and barrier identification increased the percentage of patients receiving antibiotics within 60 minutes from 36% to 87.5%. Median time and Interquartile range (IQR: 25th percentile-75th percentile) from quick-registration to administration was 86 minutes (IQR: 51-147) before 6/1/2020, and 34 minutes (IQR: 16- 42) thereafter. The implemented triage workflow led to improved time to antibiotics to within 60 minutes for patients with long bone open fractures in the Pediatric Emergency Department. Level III. See Instructions for Authors for a complete description of levels of evidence.

Quality improvement initiative to reduce URI-associated antibiotic prescriptions among adult primary care providers

ImportanceDespite evidence that most upper respiratory infections (URIs) are due to viruses, antibiotics are frequently prescribed for this indication in the outpatient setting. Antibiotic stewardship strategies are needed to reduce...

Measuring the efficacy of standard and novel disinfection methods on frequently used physical therapy equipment: a 2-phase prospective randomized controlled trial.

Frequently used physical therapy (PT) equipment is difficult to disinfect due to equipment material and shape. The efficacy of standard disinfection of PT equipment is poorly understood. We completed a 2-phase prospective microbiological analysis of fomites used in PT at our hospital from September 2022 to October 2023. For both phases, study fomites were obtained after usage and split into symmetrical halves for sampling. In phase 1, sides were sampled following standard disinfection. In phase 2, sides were randomized 1:1 to intervention or control. Samples were obtained before and after the intervention, a disinfection cabinet using Ultraviolet C (UV-C) and 6% nebulized hydrogen peroxide. We defined antimicrobial-resistant clinically important pathogens (AMR CIP) as methicillin-resistant staphylococcus aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and Multidrug resistant (MDR)-Gram-negatives and non-AMR CIP as methicillin-sensitive staphylococcus aureus (MSSA), Vancomycin sensitive Enterococcus (VSE), and Gram-negatives. Three assessments were made: 1) contamination following standard disinfection (phase 1), 2) contamination postintervention compared to no disinfection (phase 2) and, 3) contamination following standard disinfection compared to postintervention (phase 1 vs phase 2 intervention). The median total colony-forming units (CFU) from 122 study fomite samples was 1,348 (IQR 398-2,365). At the sample level, 52(43%) and 15(12%) of samples harbored any clinically important pathogens (CIPs) or AMR CIPs, respectively. The median CFU was 0 (IQR 0-55) in the intervention group and 977 (409-2,547) in the control group (P < .00001). Following standard disinfection, PT equipment remained heavily contaminated including AMR and non-AMR CIPs. Following the intervention, PT equipment was less contaminated and harbored no AMR CIPs compared to control sides supporting the efficacy of the intervention on difficult-to-disinfect PT fomites.

Effectiveness of Schema-Based Instruction Strategy in Improving Mathematical Word Problem Solving and Working Memory of Students with Learning Disabilities in The Sultanate of Oman

This study aimed to examine the effectiveness of a schema-based instruction strategy in improving mathematics word problem solving and working memory performance of third grade students with learning disabilities in schools in Oman. Students received a diagnosis of specific learning disability (SLD) based on the aptitude discrepancy model in which an achievement test and an aptitude test (Raven’s Coloured Successive Matrices) were used to determine the existence of a discrepancy. Students were then divided into two matched groups, a control group and an experimental group; each group included (20) students. Study instruments included a mathematics word problem solving test, a working memory test, and the schema-based intervention program. Results of the study showed that participants in the experimental group differed from controls in word problem solving and working memory performance following exposure to the intervention program. More specifically, performance of experimental group participants in the word problem solving varied across the pre, during the implementation, and post intervention phases in favor of the post intervention phases and in favor of the type of Assembly problems. Implications of using schema-based instruction strategy with students with SLD are discussed in the light of the study findings.

Sociální klima učitelských sborů: Kvalitativní kvaziexperiment

The favourable social climate of the teaching staff is one of the key indicators of the quality of school functioning. The text presents five research phases of a qualitative longitudinal pre-post quasi-experiment implemented in the environment of school life. In 37 schools, the climate of the teaching staffs was repeatedly measured with the OCDQ-RS questionnaire in the pre- and post-intervention phase of the experiment. In six of these schools, qualitative research procedures were carried out in order to determine the causes and contexts of the state of the climate and intervention procedures aimed at supporting the development of a favourable teaching staff climate. In the post-intervention phase, focus groups were implemented in six intervened schools to supplement the context. The aim of the research was to find out what effects intervention procedures can have on the climate and under what conditions they can be successful. The results confirm repeated findings about the key role of school leadership in shaping and maintaining a favourable climate of the staff by increasing trust across the staff, promoting open communication and meaningful cooperation of all actors, and leading to shared meanings of events in the school and general acceptance of the school’s values and concept.

Value-based preoperative assessment in a large academic hospital

BackgroundValue-based healthcare (VBHC) is an approach that focuses on delivering the highest possible value for patients while driving cost efficiency in health services. It emphasizes improving patient outcomes and experiences while optimizing the use of resources, shifting the healthcare system’s focus from the volume of services to the value delivered. Our study assessed the effectiveness of implementing a VBHC-principled, tailored preoperative evaluation in enhancing patient care and outcomes, as well as reducing healthcare costs.MethodsWe employed a quality improvement, before-and-after approach to assessing the effects of implementing VBHC strategies on the restructuring of the preoperative evaluation clinics at Humanitas Research Hospital. The intervention introduced a VBHC-tailored risk matrix during the postintervention phase (year 2021), and the results were compared with those of the preintervention phase (2019). The primary study outcome was the difference in the number of preoperative tests and visits at baseline and after the VBHC approach. Secondary outcomes were patient outcomes and costs.ResultsA total of 9722 patients were included: 5242 during 2019 (baseline) and 4,480 during 2021 (VBHC approach). The median age of the population was 63 (IQR 51–72), 23% of patients were classified as ASA 3 and 4, and 26.8% (2,955 cases) were day surgery cases. We found a considerable decrease in the number of preoperative tests ordered for each patient [6.2 (2.5) vs 5.3 (2.6) tests, p < 0.001]. The number of preoperative chest X-ray, electrocardiogram, and cardiac exams decreased significantly with VBHC. The length of the preoperative evaluation was significantly shorter with VBHC [373 (136) vs 290 (157) min, p < 0.001]. Cost analysis demonstrated a significant reduction in costs, while there was no difference in clinical outcomes.ConclusionsWe demonstrated the feasibility, safety, and cost-effectiveness of a tailored approach for preoperative evaluation. The implementation of VBHC enhanced value, as evidenced by decreased patient time in preoperative evaluation and by a reduction in unnecessary preoperative tests.

Effect of skill-based educational training for ambulance personnel on neonatal transportfor newborn care in coastal South India - a single arm intervention study.

Education of '108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of '108' ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention). We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25. Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p <0.001), a reduction in the positivity of umbilical swab growth (p=0.002) and in the duration of NICU stay (p = 0.001), significant improvement (p < 0.001) in the perceptions/practices of ambulance personnel towards neonatal transport. There was an improvement in the ambulance equipment availability/usage post-intervention. The perceptions and practices of the '108' ambulance towards transporting neonates had significantly improved post-educational intervention. Further, a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay was seen in neonates transported post-intervention.