Post-intervention Phase Research Articles

Effect of combining oketani and oxytocin massage towards breast milk production: a quasi-experimental study

Challenges in achieving exclusive breastfeeding often emerge during the initial days when complete establishment of breast milk production may not occur. In this vulnerable period, infants might receive supplementary foods or drinks, creating barriers to exclusive breastfeeding. This study seeks to integrate oketani and oxytocin massage with a suggestive approach to evaluate their impact on breast milk production among mothers. Employing a quasi-experimental design with a pre-post-test control group, the research focuses on postpartum mothers at PKU Muhammadiyah Gombong Hospital, with a sample size of 60 respondents chosen through purposive sampling. Demographic data and observation sheets were utilized to document breast milk production before and after the intervention. Data analysis involved Mann-Whitney and Wilcoxon tests. The study revealed a significant difference between pre- and post-intervention phases within the intervention group (p-value <0.005), indicating noteworthy changes following the implementation of oketani and oxytocin massages. The interventions demonstrated potential in enhancing breast softness, nipple and areola elasticity, and overall milk production, offering valuable insights into non-pharmacological approaches for supporting breastfeeding.

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.

Dosimetry as a Lagging Indicator of Occupational Exposure to Nitrous Oxide in Pediatric Sedation: A Collaborative Process Improvement Project With Industrial Hygiene.

Nitrous oxide (N2O) is commonly used in pediatric procedural sedation. It is an attractive option to facilitate intravenous line placement, as it does not extend sedation recovery from subsequently administered agents. Although debate exists regarding health consequences of occupational exposure now that scavenging of exhaled gases is common, cooperation of pediatric patients to maximize engineering controls is not guaranteed and can contribute to repeated exposure over the course of a clinician's career. There is no global consensus on personal exposure limits, but the National Institute for Occupational Safety and Health published U.S. guidelines. A dosimetry survey of our sedation team during a short N2O procedure for intravenous line placement exceeded the National Institute for Occupational Safety and Health Recommended Exposure Limit (REL) of 25 parts per million. We designed a process improvement initiative to reduce occupational exposure below the Recommended Exposure Limit on serial surveys. A continuous flow, titratable, full-face mask N2O delivery system with scavenging by a central vacuum connection was used. A retrospective chart review of N2O procedures performed before the initial dosimetry survey revealed practice trends in provider behavior during N2O administration. Initiation of N2O gas flow and maintenance of face mask seal on an uncooperative patient were identified as two sources of variability. Two-handed face-masking technique, initiation of N2O gas flow only after masking, and continued masking for 2 min of exhaled scavenging were standardized and socialized as best practices. Subsequent dosimetry surveys of the sedation team were coordinated by Industrial Hygiene. Pre- and post-intervention phases were 17 months each and included 92 and 201 N2O patients, respectively. Six dosimetry surveys occurred in the post phase. Intravenous line placement was the typical procedure surveyed. Dosimetry results for all team members during surveys 1-4 were below the REL, with 14 of 16 samples falling below the level of quantitation. Elevated dosimetry results in survey 5 prompted reevaluation of work practices and equipment. A loose component on the delivery system was discovered, corrected, and incorporated as a pre-procedure check. With no further changes to work practices, dosimetry results were below the REL for survey 6. We layered work practice changes atop engineering controls to reduce occupational exposure levels for medical team members. We utilized dosimetry as a lagging indicator, prompting frequent reassessments of our equipment and processes that we might not otherwise have performed. Pediatric sedation programs are encouraged to consider whether Industrial Hygiene resources might provide synergy to process improvement efforts with inhalational sedation agents.

Determinant factors and coping strategies for depression among pregnant women: an intervention-based qualitative study in Lahore, Pakistan

BackgroundThe present study is an intervention-based qualitative study that explores the factors causing depression among antenatal women and analyses coping strategies based on the modified version of the Thinking Healthy Programme (THP) intervention in the urban setting of Lahore, Pakistan.MethodsAn exploratory qualitative evaluation approach was used in the present study. The study comprises four phases, i.e., the screening phase, exploratory phase, intervention phase, and evaluation phase. During the first phase, pregnant women aged 18–45 years were screened for anxiety and depression by using the Urdu-translated Patient Health Care Questionnaire-9. In the second phase, identified women were interviewed to explore the factors responsible for depression. In the third phase, the intervention was administered via the THP intervention. In the last phase, the same women were reinterviewed to analyse the outcomes of the intervention. Thematic analysis was performed for the analysis of the interviews.ResultsData was analyzed using thematic analysis following an deductive and indictive approach in both pre- and post-intervention phase. Three main themes emerged in the pre-intervention phase: (1) the impact of adverse life events on the mental health of pregnant women, (2) the adverse effects of marital relationship issues on pregnant women, and (3) depression-causing factors due to the joint family system. Furthermore, four themes emerged in the post-intervention stage: (1) development of positivity in thinking and attitude, (2) learning about stress management through the provision of compassion and sharing avenues, (3) gaining self-esteem to address matters positively, and (4) improving relationships with the unborn child and family. Numerous pregnant women praised the THP project and recommended that hospitals adopt it to assist pregnant patients in the Pakistani health system.ConclusionThe study concludes that THP can be a valuable tool for helping many pregnant women who are experiencing prenatal depression recover, however, there is a further need for exploring its benefits in varying social and cultural contexts.Trial registrationThe study has been registered at https://clinicaltrials.gov/ (NCT04663243).

Development of Competencies in Emergency Nursing: Comparison Between Self-Assessment and Tutor Evaluation Before and After a Training Intervention.

Nursing competence encompasses the integration of knowledge, skills, and attitudes essential for comprehensive and safe patient care. This study aimed to compare self-assessment and tutor evaluation of nurses' competencies in a hospital emergency department before and after a training intervention. A quasi-experimental design was employed, involving 63 newly hired nurses who participated in a mentorship program. The intervention included theoretical and practical sessions on critical care skills. Data were collected through self-assessment questionnaires and objective evaluations by tutors using validated rubrics. The results indicated significant differences between self-assessment and tutor evaluations in pre- and post-intervention phases, particularly in competencies related to orotracheal intubation and fibrinolytic therapy for ischemic stroke. Post-intervention, discrepancies between self-assessment and tutor evaluations decreased, suggesting improved self-awareness and competence among participants. This study highlights the importance of combining self-assessment and external evaluation to ensure accurate competency assessment and effective educational interventions, ultimately enhancing the quality of patient care.

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.

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.

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.

Effect of “Egyptian Acute Seizure Management Guidelines” Education on Emergency Room Pediatricians

Abstract Background Acute convulsive seizure in children is the most terrifying experience to parents. Status epilepticus can be life threatening in children if not early and properly managed. There are no unified management guidelines for childhood acute seizure management in Egypt. The Egyptian acute seizure management in children's guidelines provides a framework for diagnosing and caring for children experiencing an acute convulsion, which is intended to assist health care providers Aim of the Work To assess pediatricians’ knowledge about acute seizure management in emergency department, and to evaluate the effect of education on their knowledge. Methods The current study is an interventional study, on physicians treating children with acute seizures in emergency departments, from August 2022 to May 2023, an online survey was prepared by the authors according to the “Egyptian acute seizure management in children’s guidelines”, then 3 electronic forms were designed online using Research Data Capture Software (REDCap). In the first form (pre-intervention phase) The public link is one link sent through whatsApp groups for pediatricians or general practitioner; containing their personal data and questions assessing their knowledge about acute seizure management in children, two hundred and twenty three pediatrician responded to it. The second form (intervention phase) educational materials (a PDF file contains the guidelines and educational video) sent automatically after the participant finished and submitted the pretest. One week later (post intervention phase) unique link was sent for each participant to his e-mail. Each participant initial (pre-test) and final (post-test) answers were analyzed for the level of knowledge and stratified into Poor ≤50%, 50-75% Fair and ≥ 75% good according to his/her correct answers. Results In the pre-intervention phase, the majority of the participants (66.8%) had poor knowledge about pediatric acute seizure management. Females were found to have lower knowledge levels than males. In the post-intervention phase of the study, the majority of participants (70%) who completed the post-intervention phase had good knowledge level (75%) and the rest (25%) had fair knowledge level. Conclusion We concluded that education to enhance healthcare providers' knowledge about acute pediatric seizure management is mandatory. The study's findings imply that focused education can significantly raise knowledge levels aiming at raising the standard of care given to children with acute seizures in the ER.

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 multipronged behavioral intervention to reduce and tailor antibiotic use for 2 common urologic outpatient procedures. This study was a nonblinded intervention study that consisted of a preintervention phase (November 2018-January 2019), an intervention phase (January 2020-December 2020) in which a multipronged behavioral intervention was implemented, and a postintervention phase (January 2021-March 2021). We examined antibiotic use for cystoscopy and transrectal prostate biopsy at 3 separate urologic outpatient clinics. A multipronged 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 postcystoscopy infection were not different between the preintervention and intervention phases and were lower in the postintervention phase. The odds of postbiopsy infection were not changed between the preintervention and intervention phases or between the preintervention and postintervention phases. Implementing a multipronged 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.

Does Augmenting Virtual Reality-Based Cognitive Training with Longitudinal, Anodal Transcranial Direct Current Stimulation Improve Visual Search Performance? A Neurobehavioral Evaluation

This study investigated the effectiveness of combining Virtual Reality (VR)-based cognitive training with transcranial direct current stimulation (tDCS) in enhancing visual processing. Eighty participants undertook a 20-day, single-blind, placebo-controlled study across pre-intervention (Day 1), intervention (Day 2–Day 9), and post-intervention phases (Day 10 and Day 20). Participants were randomly assigned to four groups: tDCS + VR, VR + placebo tDCS, tDCS + placebo VR, and placebo tDCS + placebo VR. After undertaking three visual processing tasks on Day 1, participants underwent intervention from Day 2 to Day 9 and followed up with post-intervention testing on Days 10 and 20. Results revealed that the tDCS + VR condition showed significantly improved sensitivity in visual search on Day 10. EEG results indicated that anodal tDCS coupled with VR training enhanced cortical activation in the tDCS + VR condition. This study underscores the potential of cognitive training programs integrating VR and tDCS.

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.