Post-intervention Study Research Articles

Adherence to Labor Arrest and Failed Induction of Labor Guidelines: The Impact of a Quality-Improvement Educational Intervention.

Background/Objective: To evaluate adherence to labor arrest and failed induction of labor (IOL) criteria in nulliparous, term, singleton, and vertex (NTSV) cesarean deliveries at an academic medical center and to measure the impact of a quality-improvement educational initiative that focused on obstetric provider education of modern labor arrest and failed IOL criteria. Methods: This is a retrospective cohort study using electronic health record (EHR) data with a pre- (1 September 2018-30 September 2019) and post-intervention (1 October 2019-31 March 2020) study design of all NTSV cesarean deliveries for labor arrest or failed IOL performed at an academic medical center in the northeastern United States. The quality-improvement educational intervention consisted of the distribution of educational pocket cards outlining modern labor arrest and failed IOL criteria to obstetric providers. Outcomes included adherence to labor arrest and failed IOL criteria pre- and post-intervention with secondary outcomes evaluating adherence by provider type (Maternal-Fetal Medicine (MFM) or generalist obstetrician). Descriptive and bivariate statistics were used in the analysis. Results: Pre-intervention, 272 NTSV cesarean deliveries were performed for labor arrest or failed IOL versus 92 post-intervention. Adherence improved post-intervention amongst failed IOL (OR 6.5, CI 1.8-23.8), first-stage arrest (OR 4.5, CI 2.2-10.8) and second-stage arrest (OR 3.7, CI 1.5-9.4). When comparing provider type, MFM physicians were more likely to be adherent to labor arrest and failed IOL criteria compared to generalist obstetricians pre-intervention (OR 3.1, CI 1.7-5.5); however, post-intervention, there was no longer a difference in adherence (OR 3.3, CI 0.9-12.3). Conclusions: Adherence to labor arrest criteria was suboptimal in the pre-intervention period; however, a targeted quality-improvement educational intervention improved adherence rates to labor arrest and failed IOL criteria among obstetric providers.

Accounting for regression to the mean under the bivariate -distribution.

Regression to the mean occurs when an unusual observation is followed by a more typical outcome closer to the population mean. In pre- and post-intervention studies, treatment is administered to subjects with initial measurements located in the tail of a distribution, and a paired sample -test can be utilized to assess the effectiveness of the intervention. The observed change in the pre-post means is the sum of regression to the mean and treatment effects, and ignoring regression to the mean could lead to erroneous conclusions about the effectiveness of the treatment effect. In this study, formulae for regression to the mean are derived, and maximum likelihood estimation is employed to numerically estimate the regression to the mean effect when the test statistic follows the bivariate -distribution based on a baseline criterion or a cut-off point. The pre-post degrees of freedom could be equal but also unequal such as when there is missing data. Additionally, we illustrate how regression to the mean is influenced by cut-off points, mixing angles which are related to correlation, and degrees of freedom. A simulation study is conducted to assess the statistical properties of unbiasedness, consistency, and asymptotic normality of the regression to the mean estimator. Moreover, the proposed methods are compared with an existing one assuming bivariate normality. The -values are compared when regression to the mean is either ignored or accounted for to gauge the statistical significance of the paired -test. The proposed method is applied to real data concerning schizophrenia patients, and the observed conditional mean difference called the total effect is decomposed into the regression to the mean and treatment effects.

Effect of Infra Low Frequency (ILF) neurofeedback training on EEG in children with autism spectrum disorders.

To investigate whether Infra-low frequency Neurofeedback (ILF-NFB) training can improve brain electrical activity in children with autism spectrum disorders ASD. This single arm pre and post intervention study was carried out at IBMS (Institute of Basic Medical Sciences), Khyber Medical University, Peshawar and Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad from January 2021 to December 2022. A purposive sampling technique was used. Thirty-five ASD children (male=24; female=11; 7-17 years) were provided with 30 sessions of infra low frequency (ILF) neurofeedback training for 15-20 minutes, during 10 weeks. Childhood Autism Rating Scale (CARS) scoring was done and electroencephalogram (EEG) activity was compared before and after ILF-NF training sessions. Around 62.9% participants had mild-moderate autism and 37.1% had severe autism. Wilcoxon Signed rank test revealed a significant decline in delta (Pre-test=47.31±19.22, Post-test=22.07±6.83; p=<0.001), theta (Pre-test=24.75±16.62, Post-test=12.37±3.59; p=<0.001) and alpha (Pre-test=12.01±9.81, Post-test=4.03±1.61; p=< 0.001) waves. Mann Whitney U test exhibited no significant gender differences in EEG pattern before and after neurofeedback except in theta waves (p=0.03) before the intervention. Decline in delta, theta, beta and alpha waves propose that ILF-NF training can be effective in improving the EEG activity. ILF-NFB can be perceived as a valuable non-invasive, non-pharmacological intervention for improving EEG pattern via reintegration of brain activity resulting in increased the attention and focus, enhanced mental stability and cognitive engagement.

Change from semi-rigid to soft collars for prehospital management of trauma patients: An observational study.

Protection of the cervical spine is recommended following multisystem injury. In 2021, Ambulance Victoria changed clinical practice guidelines to apply soft collars instead of semi-rigid collars for suspected cervical spine injury. The aim of this study was to describe associated changes in imaging practices and diagnoses of pressure sores, hospital acquired pneumonia, and spinal cord injury. A retrospective pre- and postintervention study was conducted including all consecutive patients that presented to an adult major trauma center in Melbourne, Australia with a cervical collar placed by emergency medical services over two 3-month periods. There were 1762 patients included. A computed tomography (CT) of the cervical spine was performed in 795 (88.4%) patients in the semi-rigid collar period and 810 (93.8%) in the soft collar period (p=0.001). Soft collars were associated with higher rates of clearance of the cervical spine in the emergency department (ED) (odds ratio [OR] 4.14; 95% confidence interval [CI]: 3.36-5.09). There were no differences in diagnosis of pressure sores (0.11%vs. 0.23%, p=0.97) or hospital acquired pneumonia (2.0%vs. 2.7%; p=0.44) or cervical spinal cord injury (0.45%vs. 0.81%; p=0.50). Following a change from prehospital semi-rigid collars to soft collars, more patients were investigated with a CT scan and more frequent clearance of the cervical spine occurred in the ED. There were no differences in the rates of spinal cord injuries, pressure sores or hospital acquired pneumonia, but the study was underpowered to detect significant differences. The practice of soft collars for prehospital care of patients with suspected neck injury requires ongoing surveillance.

Transforming Hospital Housekeeping: The Kayakalp Journey.

The Kayakalp guidelines for public healthcare facilities under the Swachh Bharat Abhiyan (Clean India Mission) focus on improving sanitation, cleanliness, and infection control at public hospitals in India. This study was conducted in a 960-bed tertiary-level teaching hospital in eastern India. Housekeeping has been a challenge in public institutions, with factors like overcrowding and resource constraints. Tobacco and betel nut chewing, spitting, poor sanitation practices, and open urination are major challenges in ensuring sanitation at the hospital. The research objective was to study the implementation of the Kayakalp guidelines for quality improvement in housekeeping services at the institution. A pre- and post-interventional study was conducted using the Plan-Do-Check-Act (PDCA) quality tool. Plan phases included the gap assessment using the Kayakalp checklist with numerical scoring. Necessary interventions were done under three headings: structure, processes, and outcomes in the "Do" phase. The "Check" phase included monitoring of the activities followed by the "Act" phase, which included a review of the action plan. External experts nominated by the government conducted the final assessments and recommended it as one of the cleanest hospitals. A 360-degree improvement was observed in hospital services, with assessment score improvement from 73.68% to 95.0%. The institution received the first prize in 2020 and 2021 and runners-up Kayakalp National Award under category "B" (Institute of National Importance) Hospitals in 2019. The implementation of Kayakalp guidelines of the Government of India proved to be efficient in the improvement of housekeeping and infection control practices in the institution.

340 Investigating the Effectiveness of Folic Acid-Fortified Iodized Salt on Serum Folate Concentration- a Primary Prevention Strategy for Spina Bifida in India

Abstract Aim Investigate the effectiveness of folic acid-fortified iodized salt in increasing serum folate concentrations among non-pregnant and non-lactating women of reproductive age Method All households in four rural Indian villages agreed to consume FA-fortified iodized salt (study salt) in a pre- and post-intervention study. Pre- and post-intervention serum folate levels were analysed from 83 eligible participants. A cohort study was done after consumption of approximately 300 mcg of FA daily using double fortified salt (FA + Iodine). We assessed the differences in median serum folate concentrations at baseline and 4 months. Results The median serum folate concentration increased from 14.6 nmol/L at baseline to 54.4 nmol/L at end of study. Two-tailed Wilcoxon Signed Rank Test showed the difference to be highly significant (p-value = 1.8 × 10-14). The villagers found the salt acceptable in color, taste and cooking properties. No untoward effects related to the study salt were noted. Conclusions Folic Acid for the prevention of Spina Bifida has over 3 decades of evidence to support it. In 2023, the World Health Assembly unanimously recommended FA to prevent incidence of Spina Bifida. India, currently estimated to bear a third of the global Spina Bifida burden, poses a unique challenge to mandatory fortification due to the heterogeneity in population, culture, and dietary patterns. FA-fortified salt presents an equitable opportunity to reach the entire population of India and avert a significant burden of Spina Bifida and its associated morbidity and mortality. Moreover, salt fortification infrastructure currently exists so FA-fortified salt poses a cost-effective primary prevention method.

Assessment of Knowledge, Attitude and Practice Regarding Vitamin D among Medical and Dental Students of a Medical College in Kathmandu

Vitamin D deficiency is one of the very common nutritional deficiencies which usually go undiagnosed and untreated. The main objective of this study was to assess and compare the knowledge, attitude and practice of vitamin D among medical and dental students. The pre and post interventional study was conducted among first year students of Bachelor of Medicine and Bachelor of Surgery and Bachelor in Dental Surgery from July to September 2023. All the participants were asked to fill a form using a pre-validated questionnaire based on relevant literature for assessing vitamin D. We divided questions into three categories: knowledge, attitude, and practices towards vitamin D. Pre-test and post-test (after giving educational training) vitamin D knowledge, attitude and practice score of each participant were compared. Finally, the post-test total knowledge, attitude scores of each participant were calculated. Out of 140 students approached, 9 students from MBBS and 4 students from BDS did not respond (did not completed the questionnaire form). So, 127 (90.7%) participants were considered for comparison analysis in this study. Overall, there was a 38.6% increment in knowledge after educational training. In medical and dental students, there was a 39.6% and 36.1% gain in knowledge respectively. The proportion of knowledge increment was statistically significant (p&lt;0.001). Also, overall, there was a 29.3% increment in their positive attitude. In Bachelor of Medicine and Bachelor of Surgery 22% positive attitude was developed after educational training and in Bachelor in Dental Surgery it was 47.2%. The proportion of attitude was statistically significant (p&lt;0.001). In the MBBS category, 15 (15.0%) students were found to have good practice whereas 85 (85.0%) were found to have poor practice. In the BDS category, 12 (30.0%) students were found to have good practice whereas 28 (70.0%) were found to have poor practice. We found that after educational training there was improvement in knowledge and attitude of medical students on vitamin D but still, they need to implement it in their daily life. Though they have an average knowledge on vitamin D, there is a gap between knowledge and practice among medical students.

Evaluating Child Passenger Restraint Use Education.

Despite recommendations and laws for child restraint use in motor vehicles, evidence of low restraint use remains, and there is a lack of evidence addressing the effectiveness of restraint use education. This project aims to measure the impact of an education initiative on child passenger restraint use. This pre- and postintervention study was conducted in six elementary schools in a Southwestern U.S. metropolitan area over 5months from October 2022 to March 2023. Motor vehicle restraint use was collected from occupants arriving at elementary schools during the morning drop-off times. Participants were provided one-on-one education regarding child passenger safety guidelines and state laws. Comparison data were collected 1-3weeks later at the same schools to evaluate the education provided. A total of 1,671 occupants in 612 vehicles were observed across six schools, with 343 adults and 553 children preintervention and 306 adults and 469 children postintervention. Overall restraint adherence in children improved postintervention from 42.3% to 56.1%, a 32.6% increase (p =<.001). In the primary age group of 4-8years, restraint adherence improved postintervention from 34.8% to 54.2%, a 55.8% increase (p =<.001). The study results demonstrate that one-on-one education increases child passenger restraint use.

The 2017 Women’s Health Initiative study and use of hormone therapy: an emulated repeated cross-sectional study

BackgroundHormone therapy (HT) use among menopausal women declined after negative information from the 2002 Women’s Health Initiative (WHI) HT study. The 2017 post-intervention follow-up WHI study revealed that HT did not increase long-term mortality. However, studies on the effects of the updated WHI findings are lacking. Thus, we assessed the impact of the 2017 WHI findings on HT use in Taiwan.MethodsWe identified 1,869,050 women aged 50–60 years, between June and December 2017, from health insurance claims data to compare HT use in the 3 months preceding and following September 2017. To address the limitations associated with interval-censored data, we employed an emulated repeated cross-sectional design. Using logistic regression analysis, we evaluated the impact of the 2017 WHI study on menopausal symptom-related outpatient visits and HT use. In a scenario analysis, we examined the impact of the 2002 trial on HT use to validate our study design.ResultsStudy participants’ baseline characteristics before and after the 2017 WHI study were not significantly different. Logistic regressions demonstrated that the 2017 study had no significant effect on outpatient visits for menopause-related symptoms or HT use among women with outpatient visits. The scenario analysis confirmed the negative impact of the 2002 WHI trial on HT use.ConclusionsThe 2017 WHI study did not demonstrate any impact on either menopause-related outpatient visits or HT use among middle-aged women in Taiwan. Our emulated cross-sectional study design may be employed in similar population-based policy intervention studies using interval-censored data.

Development of a culturally enhanced caregiver-facilitated language nutrition intervention "+Language is Medicine" to address developmental delay in Diné (Navajo) toddlers.

Developmental Delay (DD) is highly common in American Indian and Alaska Native (AI/AN; Indigenous) toddlers and leads to high numbers of AI/AN children who eventually need special education services. AI/AN children are 2.89 times more likely to receive special education compared to other children in the U.S., yet developmental disorders are more frequently under diagnosed and untreated in AI/AN infants and toddlers. DD, which can be identified as early as toddlerhood, can lead to negative impacts on developmental trajectories, school readiness, and long-term health. Signs of DD can be identified early with proper developmental screening and remediated with high quality early intervention that includes effective parent training. There are many evidence-based language facilitation interventions often used in Early Intervention programs. However, in communities in rural parts of the Navajo Nation where there are limited services and resources, infants and toddlers with early signs of DD are often missed and do not get the culturally responsive support and evidence-based intervention they deserve. The community-based +Language is Medicine (+LiM) study team partnered with tribal home visitors, community members, and a Diné linguist/elder using a collaborative virtual workgroup approach in 2021 and 2022 to present the +LiM pilot study aims and to discuss strategies for enhancing a language intervention for toddlers experiencing DD in their tribal community. This paper will detail the stages of community engagement, intervention enhancement and preparation for field testing of the +LiM intervention to address elevated rates of DD in toddlers in the Northern Agency of the Navajo Nation. Two major outcomes from this collaborative workgroup included: (1) a team-initiated redefining of language nutrition to align with Indigenous values that center cultural connectedness and native language use and (2) a five-lesson caregiver-facilitated curriculum titled +Language is Medicine which includes caregiver lessons on language nutrition, language facilitation, shared book reading, pretend play, and incorporation of native language into home routines. These two workgroup outcomes were leveraged to develop a pilot pre-/post-intervention study to test the effectiveness of the +LiM intervention with caregiver-toddler dyads living on the Navajo Nation. Delivering tailored child interventions through tribal home visiting are cost-effective and innovative methods for reaching reservation-based families who benefit from culturally responsive parent coaching and instruction. The +LiM team has applied a precision tribal home visiting approach to enhance methods of early intervention for children with DD. Our enhancement process was grounded in Indigenous community-based participatory research that centered culture and language.

Reduction of Hospital-Acquired Infections Through a Nursing Education Program: A Quality Improvement Project on the Sensitization of Nursing Staff Toward Infection Control in Neonates.

Background This study aimed to reduce hospital-acquired infections (HAIs) by at least 50% in our unit through a nursing education program to sensitize the nursingstafftoward infection control in neonates. Methodology This pre- and post-intervention observational study was conducted in Liaquat National Hospital's Neonatal Intensive Care Unit (NICU) from October 2021 until March 2023. This observational study was conducted in three phases. In phase I (pre-implementation), all neonates with suspected HAIs were included. In phase II (implementation), the nursing staff dedicated to the NICU were trained. In phase III (post-implementation), all neonates with suspected HAIs were included. Culture-proven bloodstreaminfections (BSIs), urinary tract infections (UTIs), and ventilator-associated pneumonia (VAP) were the three types of HAIs. The nursing scoring was done by the principal investigator based on a questionnaire. The Shapiro-Wilk test was used to evaluate the normality of all quantitative data across all phases. Results In the pre-implementation phase, there were 24 (10.8%) HAIs, among which 19 (8.6%) were BSIs, one (0.5%) was a catheter-associated urinary tract infection (CAUTI), and seven (3.2%) were VAP. Whereas in the post-implementation phase, there were 12 (5%) HAIs, among which 10 (4.1%) were BSIs, none were CAUTIs, and five (2.1%) were VAP. Therewas a significant reduction of HAIs in the post-implementation phase (p < 0.01). The difference in the knowledge, assessment, and practice was statistically significant in the post-implementation phase (p < 0.01). Conclusions We established a successful cost-effective intervention to improve theawareness and compliance of NICU nurses with infection control practices. This helped us in reducing HAIs in our NICU.

Valoración de la eficacia de la educación en el manejo de autoinyectores de adrenalina

Introduction: anaphylaxis is a medical emergency and early administration of adrenaline is essential to reduce morbidity and mortality. Adrenaline autoinjectors are available for patients with a diagnosis of anaphylaxis so they can receive the medication without delay. The main goal of our study was to evaluate parental knowledge about anaphylaxis and the use of autoinjectors and whether their knowledge improved after some training. Material and methods: pre- and post-intervention study. We analysed 6 primary care caseloads, selecting patients with a diagnosis of anaphylaxis who had adrenaline autoinjector prescriptions. Participants received 2 emails. The first one included a questionnaire about anaphylaxis and how to use the adrenaline autoinjector. The second one contained informational pages and videos and a second questionnaire. That way we compared parental knowledge before and after receiving some training. Results: food was the main cause of anaphylaxis. Only 56.3% of the participants carried the autoinjector at all times. Comparing the knowledge before and after the intervention, we found improvement in nearly every step of the administration of adrenaline. The improvement was statistically significant when it came to the correct identification of the safety release cap (p 0.018) and the awareness of the possibility of administering a second dose (p 0.006). There was a clear improvement in the knowledge of needing to massage the injection area, but it was not statistically significant (p 0.066) Conclusions: periodic training about how to use the autoinjectors is key to reduce morbidity and mortality in patients with anaphylaxis.

Small Fish Big Impact: Improving Nutrition during Pregnancy and Lactation, and Empowerment for Marginalized Women.

Undernutrition and micronutrient deficiencies such as anemia are considered significant public health challenges in Bangladesh, which enhancing fish consumption is a well-established food-based intervention to address these. This paper documents the establishment of community-based fish chutney production and reports the impact of its consumption on mid-upper arm circumference (MUAC) and hemoglobin (Hb) levels among targeted 150 pregnant and lactating women (PLW) in rural Bangladesh. A fish chutney was developed using locally available ingredients followed by a series of laboratory tests, including nutrient composition, shelf-life and food safety. A community-based fish chutney production process was designed to: (1) supply locally available ingredients for processing; (2) establish two fish drying sites; (3) initiate a community-based production site; and (4) distribute fish chutney to PLW for one year by six women nutrition field facilitators. Then a pre- and post-intervention study was designed for a selected 150 PLW to receive 30 g of fish chutney daily for 12 months. Differences in mean MUAC and Hb levels pre- and post-consumption were analyzed using one-way analysis of variance. Consumption of 30 g of fish-chutney resulted in significant increases of the mean values of Hb levels and MUAC among the targeted PLW.

Community-Based Intervention and Its Effect on Decreasing the Prevalence of Urinary Schistosomiasis in an Al-Alaqa Male Primary school in Al-Alaqa Village White Nile State, Sudan

Aim of studyThis study assessed the effectiveness of community-based interventions, health awareness, and treatment in controlling schistosomiasis among schoolchildren to improve policies and strategies. MethodsThis pre- and post-intervention study was conducted in an Al-Alaqa male primary school, and systematic simple random sampling was used to investigate 237 participants, which resulted in 132 (55.7%) infected students. The infected and noninfected students (580 students) were treated by delivering the praziquantel doses immediately after the results; after 4 weeks, the infected students received the second dose. After 6 months, the rates were investigated again, and all procedures were performed after the height and weight of the students were recorded according to the protocol. Health education was provided for all participants using posters and leaflets. The data were collected via a questionnaire and urine test. The data were analyzed using SPSS (Statistical Package for the Social Sciences), and ANOVA and t-tests were used to determine the significant differences between the variables. ResultsA urine investigation was conducted on 237 students; 132 (55.7%) had positive results which showed marked improvement and the prevalence in the school decreased to 3.8% after the intervention. The researcher found strong evidence of a relationship between the prevalence of schistosomiasis before the intervention and availability of water in the home (chi-square = 18.331, df = 1, p value = 000). ANOVA showed strong statistical significance (0.002 and F = 6.564) between the mean score of student age and reasons behind going to the pond. ConclusionThis study concluded that mass chemotherapy and treatment were highly effective when associated with a health program intervention. Mass chemotherapy alone may reduce the prevalence of disease for a short time. RecommendationCommunity-based interventions should be applied in schools with an emphasis on health education programs through the training of schoolteachers on investigations for schistosomiasis, treatment with praziquantel, and the provision of materials (microscopes, reagents, and drugs).

Enhancing cervical cancer knowledge among women of reproductive age: a dialogue-based community health education intervention in rural Kisumu County, Kenya

BackgroundCervical cancer is a leading cause of cancer death among women of reproductive age despite being treatable if it is diagnosed early. Early diagnosis is possible through regular screening through the public health system. However, screening rates remain low in many low- and middle-income countries, including Kenya, where the screening rate currently stands at 16–18%. The low screening rates are attributed to, among other factors, low knowledge about cervical cancer and the available screening options among women of reproductive age. The current study evaluated the effectiveness of dialogue-based community health education by trained community health volunteers (CHVs) in improving cervical cancer knowledge among women of reproductive age (WRA) in rural Kisumu County.MethodsThis was a longitudinal pre- and post-intervention study with a control group. The knowledge of women of reproductive age was assessed at baseline in both the intervention and control groups, followed by dialogue-based community health education in the intervention arm. A final end-line knowledge assessment was performed. The scores at baseline and at the end of the study were compared to assess changes in knowledge due to the intervention. The proportion of WRA with improved knowledge was also calculated, and statistical significance was considered at p ≤ 0.05.ResultsThere was no significant difference between the participants in the two arms, except for the level of education (p = 0.002). The knowledge of the WRA in the intervention arm improved significantly (p < 0.001) following the dialogue-based educational intervention by the trained CHVs. None of the demographic characteristics were associated with knowledge.ConclusionDialogue-based educational intervention significantly improved the knowledge of the WRA in the intervention arm, showing its potential to address the knowledge gap in the community.

Increasing positive attitudes towards organ donation and improving the competence of coping with death through organ transplant nursing course: A two-group quasi-experimental study

AimThe aim of the study was to determine the effect of an organ transplant nursing course offered to nursing students on increasing positive attitudes towards organ donation and developing competence in coping with death. BackgroundIncorporating organ donation education into undergraduate nursing curricula and promoting of coping mechanisms for coping with death, has been emphasized as a critical foundation for the preparating of the next generation of nurses. DesignTwo-groups pre- and post-intervention evaluation quasi-experimental design study. MethodsThis study was conducted between February and July 2023 with a total of 237 nursing students studying at two different universities, 116 of whom took the organ transplant course and 121 of whom did not take the course. Sociodemographic Characteristics Form, Coping with Death Scale-Short Form and Organ Donation Attitudes Scale were used for data collection. Mann-Whitney U test, Chi-Square, t-test, Pearson correlation and linear regression were used to analyze the data. ResultsThere was a statistically significant difference between the students who took organ transplant nursing courses and those who did not in terms of the mean scores of coping with death competence and positive and negative attitudes toward organ donation (p<0.05). It was found that taking an organ transplant nursing course affected nursing students' coping with death competence and their positive and negative attitudes toward organ donation (p <0.01). ConclusionTaking the organ transplant nursing course was associated with improved competence in coping with death a increased positive and decreased negative attitudes.

Rapid response system for critically ill patients with haematological malignancies: A pre- and post-intervention study.

This study aimed to determine whether implementing a rapid response system (RRS) is associated with improved short-term outcomes in critically ill patients with haematological malignancies. Our monocentric pre- versus post-intervention study was conducted between January 2012 and April 2020. RRS was activated at early signs of haemodynamic or respiratory failure. The primary outcome was the reduction in Sequential Organ Failure Assessment (SOFA) score on Day 3 after intensive care unit (ICU) admission. Secondary outcomes included time to ICU admission and mortality. A total of 209 patients with a median age of 59 years were enrolled (108 in the pre-intervention period and 101 in the post-intervention period). 22% of them had received an allogeneic transplant. The post-intervention period was associated with a shorter time to ICU admission (195 vs. 390 min, p < .001), a more frequent favourable trend in SOFA score (57% vs. 42%, adjusted odds ratio, 2.02, 95% confidence interval, 1.09 to 3.76), no significant changes in ICU (22% vs. 26%, p = .48) and 1-year (62% vs. 58%, p = .62) mortality rates. Detection of early organ failure and activation of an RRS was associated with faster ICU admission and lower SOFA scores on Day 3 of admission in critically ill patients with haematological malignancies.

Phacoemulsification in angle-closure glaucoma: A 360° evaluation.

To evaluate the effect of phacoemulsification on intraocular pressure (IOP) and anterior chamber angle (ACA) morphology in primary angle-closure glaucoma (PACG). A hospital-based, prospective pre- and post-interventional study was carried out in 40 PAC and PACG eyes post patent PI with visually significant cataracts. All patients underwent phacoemulsification and were evaluated for IOP control, ACA widening, and disease progression for a minimum of 6 months. Failure was defined as an IOP of >21 mmHg necessitating another intervention, including trabeculectomy and/or an increase in the required number of antiglaucoma medications (AGMs) by >1. A highly statistically significant reduction of IOP ( P < 0.0001) was seen with an overall reduction of 42.2% over 6 months and a mean reduction of 8.9 ± 3.59 mmHg, with the requirement of AGMs reducing from 39/40 patients preoperatively to 1/38 postoperatively. Success was seen in 95% of cases, with two patients not achieving target IOP and requiring trabeculectomy. Angle widening was documented in all cases by both gonioscopy and AS-OCT, and none of the patients showed any progression in disc damage and visual field changes. Early cataract surgery in ACG not only helps to control IOP and disease progression by widening angles and improving aqueous outflow but also improves visual acuity and reduces the economic burden of AGMs. It also helps in better evaluation of disease progression by both structural and functional analysis, as was documented by the improved and more reliable visual field indices.

A couple-based unmet supportive care needs intervention for colorectal cancer couples: A preliminary feasibility study

PurposeTo support colorectal cancer couples cope with cancer, we developed a couple-based unmet supportive care needs intervention program guided by the Supportive Care Needs Framework and examined the feasibility, acceptability, and initial effects of the unmet supportive care needs program. MethodsThe design of a pre-and post-intervention study was conducted among Chinese colorectal cancer couples. The intervention was delivered in five sessions through in-person and telephone interventions combined. To measure program feasibility through recruitment and retention rates, and to test program acceptability through quantitative and qualitative post-intervention program assessments. The complete data (N = 20 pairs) were used to calculate effect sizes to assess the initial intervention effect. ResultsThere was evidence of the feasibility of the intervention program in terms of recruitment (66.7%) and retention (83.3%) rates. Participants' satisfaction with the program also attested to its acceptability. The intervention (Cohen's = 0.15–0.56) had a small-moderate effect size in improving unmet supportive care needs and most cancer-adapted outcomes for colorectal cancer couples, validating the initial effect of the program. ConclusionsThe unmet supportive care needs program is feasible, acceptable, and preliminarily effective in supporting Chinese colorectal cancer couples to improve unmet supportive care needs and cancer adaptability, as provided by this study.

Blood culture algorithm implementation in emergency department patients as a diagnostic stewardship intervention

Blood cultures (BCx) are important for selecting appropriate antibiotic treatment. Ordering BCx for conditions with a low probability of bacteremia has limited utility, thus improved guidance for ordering BCx is needed. Inpatient studies have implemented BCx algorithms, but no studies examine the intervention in an Emergency Department (ED) setting. We performed a quasi-experimental pre and postintervention study from January 12, 2020, to October 31, 2023, at a single academic adult ED and implemented a BCx algorithm. The primary outcome was the blood culture event rates (BCE per 100 ED admissions) pre and postintervention. Secondary outcomes included adverse event rates (30-day ED and hospital readmission and antibiotic days of therapy). Seven ED physicians and APP reviewed BCx for appropriateness, with monthly feedback provided to ED leadership and physicians. After the BCx algorithm implementation, the BCE rate decreased from 12.17 BCE/100 ED admissions to 10.50 BCE/100 ED admissions. Of the 3,478 reviewed BCE, we adjudicated 2,153 BCE (62%) as appropriate, 653 (19%) as inappropriate, and 672 (19%) as uncertain. Adverse safety events were not statistically different pre and postintervention. Implementation of an ED BCx algorithm demonstrated a reduction in BCE, without increased adverse safety events. Future studies should compare outcomes of BCx algorithm implementation in a community hospital ED without intensive chart review.