Post-intervention Data Research Articles

S56 Perfusing the Pancreas: A Quality Improvement Project to Optimize Pancreatitis Management in a Tertiary Academic Center

Introduction: Acute pancreatitis (AP) is one of the leading gastrointestinal (GI) causes of hospitalization. Numerous studies have addressed the role of early fluid resuscitation and nutrition initiation in reducing the morbidity and length of stay associated with AP. Multiple GI societies have developed guidelines on the optimal management of AP. At our institution, we observed variations in the management of AP from current guidelines. We aim to identify the trends in the management of AP and the barriers to guideline adherence. We plan to use this data to enact systematic interventions that improve adherence to guideline recommendations. Methods: We evaluated all patients hospitalized with a diagnosis of acute or acute-on-chronic pancreatitis (ACP) from September to December 2021. Pre-intervention data on fluid resuscitation and initiation of oral diet/enteral feeding were collected. A survey was also developed and sent to hospital medicine and teaching teams to identify potential barriers. A Pareto chart showed that knowledge was not the primary barrier. Rather, there were clinical concerns that aggressive fluid resuscitation and early nutrition initiation could lead to potential complications of volume overload and worsening pancreatitis severity. Results: We reviewed data for 74 patients admitted with a diagnosis of AP or ACP. 93% of patients received intravenous fluids (IVF) within the first 24 hours, but only 8.5% received the recommended resuscitation rate of at least 250 cc/hr. With regards to nutrition, 46% of patients admitted with AP received oral/enteral nutrition within the first 24 hours. A Pareto chart of these responses identified that the biggest barriers to aggressive IVF resuscitation were concern for volume overload and patient co-morbidities, such as congestive heart failure and chronic kidney disease. A subsequent secondary analysis showed that the concern for CHF and CKD may not be valid, as 81% of patients admitted for AP did not have these co-morbidities. For early nutrition, the biggest barriers were concern for clinical worsening and PO intolerance. Conclusion: Our QI project aims to optimize pancreatitis management at our institution by improving adherence to early fluid resuscitation and oral/enteral nutrition initiation. A pro forma is in development to standardize management and will be distributed to clinical staff. Post-intervention data will be collected to assess for improvement.

Preventing Medical Device-Related Pressure Injuries Due to Noninvasive Ventilation Masks and Nasal Cannulas.

Medical device-related pressure injuries attributed to oxygen delivery devices are common yet preventable. Pressure injuries increase hospital costs, patients' length of stay, and mortality rates. To decrease medical device-related pressure injuries by transitioning patients from an over-the-nose noninvasive ventilation mask to a single-headset, interchangeable under-the-nose and over-the-nose noninvasive ventilation mask; replacing polyvinyl chloride nasal cannulas with a softer nasal cannula; and providing staff education on preventing pressure injuries related to oxygen delivery devices. The project was implemented on 4 adult inpatient units with a total of 75 inpatient beds at an academic medical center. Interventions included implementing the trial noninvasive ventilation masks and nasal cannulas, alternating masks every 4 hours, relocating protective dressings, promoting the use of protective dressings for over-the-nose oral-nasal masks, and educating health care staff. In the 2 months before implementation (September and October 2020), 1 medical device-related pressure injury was caused by a noninvasive ventilation mask and 4 injuries were caused by nasal cannulas. During the 2 months of trial implementation (November and December 2020), no pressure injuries developed in patients using the trial devices. The interventions implemented had clinically relevant results. A larger sample size would be necessary to determine statistical significance. Postintervention data indicated a need for further education on evidence-based practice guidelines on mask alternation and use of preventive dressings to bolster compliance. Following institutional approval, all noninvasive ventilation masks and nasal cannulas were transitioned to the trial devices at the study institution.

EpiPen STAT: A quality improvement project for anaphylaxis management.

319 Background: The medical oncology infusion unit at Beth Israel Deaconess Medical Center (BIDMC) experienced six anaphylactic reactions to chemotherapy between June 2000 and April 2021. EpiPen was delayed in all cases. In one instance, a patient experienced an emergency where she could not breathe, and her blood pressure continued to decrease. The covering nurse hesitated before administering an EpiPen. In follow-up, nurses reported a lack of confidence in administering an EpiPen. No licensed independent provider (LIP) was stationed in the infusion unit to guide nurses. The project's goal was to facilitate timely EpiPen administration, guided by the Translating Evidence into Practice (TRIP) framework. Methods: The project lead and the medical director revised the hospital’s chemotherapy reaction guidelines to highlight anaphylaxis management. They established an interdisciplinary project team with medical, nursing, pharmacy, and informatics representatives. Interventions, which started in November 2021, included a reaction management algorithm and PRN-reaction orders allowing nurses to initiate interventions while waiting for a LIP arrival. The unit educator provided EpiPen training, and the pharmacy leaders created an adverse drug reactions (ADR) kit—a locked box with necessary medications that followed BIDMC’s institutional algorithm to manage infusion reactions. Results: The project team collected post-intervention data between December 2021 and April 2022. Nurses reported twenty mild-to-severe chemotherapy reactions, including four anaphylactic episodes. Nineteen patients were discharged home on the day of reactions, and one patient required hospital admission for persistent symptoms. The management algorithm was followed in ten reactions (50%). Deviations from the algorithm were noted in eight cases, with the most frequent reason being smaller doses of antihistamine or corticosteroid. The algorithm was not applicable in two cases with atypical patient symptoms. In seventeen of the twenty reactions (85%), PRN-reaction orders were available in the electronic ordering system. The ADR kit was used in all reactions. In two of the four anaphylactic reactions, EpiPen was administered immediately following hypotension or hypoxia. In the remaining two cases, it was administered for persistent symptoms. Conclusions: The project facilitated EpiPen administration. The critical steps were systemic analysis of barriers, problem-solving with the TRIP framework, and engagement of frontline nurses. In our next step, we will consider narrowing the scope to managing acute hypotension or hypoxia. The narrower scope will enable targeted education about emergency management, potentially at the hospital’s simulation center. To ensure every patient has an order, the department could consider a standing EpiPen order for hemodynamically unstable patients.

Effectiveness of an educational program for reducing mental illness stigma targeting family medicine trainees in Tunisia: A quasi-experimental study.

Reducing stigma among mental health and health professionals has been an ultimate priority in many countries worldwide. This study aimed to evaluate the effectiveness of a four-session educational intervention for reducing stigma of mental illness targeting family medicine trainees in Tunisia. A quasi-experimental design was adopted with an intervention group (N = 51) and a control group (N = 56). Pre-intervention data were collected using an online survey. A four-session seminar series was implemented and organized. Post-intervention data were collected immediately after the end of the intervention then 2months thereafter. Instruments included Attribution Questionnaire (AQ-27), Self-Determination Scale (SDS), Empowerment Scale (ES), and Recovery Scale (RS). Repeated measures analysis of covariance and multiple analysis of covariance tests were carried out. Results revealed that the intervention had moderate effects on the AQ-27 score and on six of its stigma factors including factors of the dangerousness model. The intervention improved SDS score, but not ES or RS scores. Positive effects were observed immediately after the intervention and 2months thereafter. Regular implementation of educational programs in clinical practice would be beneficial. Developing other anti-stigma methods is needed to address the concepts of recovery and responsibility of patients with mental illness.

Lipid profile in healthy human volunteers before and after consuming ghee.

Food is a cause of concern due to its effect on health and disease. Diet affects the occurrence and progress of non-communicable diseases, including hypertension, diabetes mellitus, cardiovascular diseases (CVD), and cancers. The exact dietary composition that helps in the prevention of diseases is not known. A higher intake of processed foods, sugar-sweetened beverages, Trans and saturated fats, and a lower intake of fresh fruits, vegetables, nuts, and whole grains are generally considered as a poor-quality diet. Therefore, it is of interest to document the lipid profile in healthy human volunteers before and after consuming ghee. Fasting serum lipids were measured before and after the intervention. The effect of the intervention on all the subjects was analysed by comparing the post-intervention data. Data shows that TC and LDL-C are significantly decreased. However, other parameters showed insignificant change. The effect of the intervention on the normolipidaemia group was also analysed. There was no significant change. Thus, data shows that cow ghee consumption is not harmful to health.

Evaluating the Impact of Interventions for the Prevention and Management of Malaria in Pregnancy in Guyana

Objective: To evaluate the impact of collaborative interventions between the Ministry of Health (MOH) and the Georgetown Public Hospital Corporation (GPHC), in consultation with the GPHC ObGyn Residency program, on the incidence of Malaria in Pregnancy and associated maternal mortality in Guyana between 2012 and 2014. Design & Methods: This was a retrospective observational study that analyzed data collected from the MOH Vector Control Unit and GPHC maternal mortality statistics. Pre- and post-intervention data were collectively analyzed. Results: The results showed a steady rise in incidence of MIP per region prior to the introduction of the interventions in 2012. During and after implementation of the interventions, there was both an immediate (52%) and sustained (>20%) decrease in the number of new cases of MIP. While absolute numbers of maternal mortality secondary to MIP at GPHC were low (1 case per year), they contributed 50-100% of indirect maternal deaths in the years immediately prior to development of the MIP treatment guidelines at GPHC. After these guidelines were officially adopted in 2014, there have been no further maternal deaths associated with malaria. Conclusions: These results suggest that the MOH and GPHC interventions are associated with significant decreases in both incidence of MIP on a national scale and maternal mortality at the institutional level. Future studies are needed to identify the impact of specific components of these interventions to guide future interventions aimed at eliminating both maternal morbidity and mortality associated with MIP in Guyana. Keywords: Malaria-In-Pregnancy (MIP); Insecticide Treated Nets (ITNs); Interventions.

Preliminary Investigation of Shift, a Novel Smartphone App to Support Junior Doctors' Mental Health and Well-being: Examination of Symptom Progression, Usability, and Acceptability After 1 Month of Use.

BackgroundShift is a novel smartphone app for providing a digital-first mental health resource to junior doctors. It contains psychoeducational material, cognitive behavioral modules, guided mediations, information on common work stressors, and a section on help-seeking options for psychological problems through workplace and private avenues.ObjectiveThis study aimed to conduct a preliminary investigation of the use and potential effectiveness of Shift on depressive and anxiety symptoms (primary outcomes) and work and social functioning, COVID-19 safety concerns, and help seeking (secondary outcomes). This study also sought feedback on whether Shift was seen as an acceptable tool.MethodsJunior doctors in New South Wales, Australia, were approached through promotional activities from the Ministry of Health, specialist medical colleges, and social media advertisements between June and August 2020. Consenting participants provided web-based baseline data, used the Shift app for 30 days, and were asked to complete a poststudy web-based questionnaire. Outcomes were analyzed under the intention-to-treat principle.ResultsA total of 222 female (n=156, 70.3%; mean age 29.2, SD 4.61 years) junior doctors provided full baseline data. Of these, 89.2% (198/222) downloaded the app, logged into the app approximately 6 times (mean 5.68, SD 7.51), completed 4 in-app activities (mean 3.77, SD 4.36), and spent a total of 1 hour on in-app activities (mean 52:23, SD 6:00:18) over 30 days. Postintervention and app use data were provided by 24.3% (54/222) of participants. Depressive and anxiety symptoms significantly decreased between the pre- and postassessment points as expected; however, physicians’ COVID-19 safety concerns significantly increased. Work and social functioning, COVID-19 concerns for family and friends, and help seeking did not change significantly. There was no significant relationship between symptom changes and app use (number of log-ins, days between first and last log-in, and total activity time). Most poststudy completers (31/54, 57%) rated Shift highly or very highly.ConclusionsDespite high levels of nonresponse to the poststudy assessment and increases in COVID-19 safety concerns, junior doctors who used the app reported some improvements in depression and anxiety, which warrant further exploration in a robust manner.

Improving TB case notification and treatment coverage through data use.

BACKGROUND:This was a study on national TB data.OBJECTIVE:To assess improvement in TB case notification and treatment coverage through improved data use for action in NigeriaDESIGN:We analysed pre- and post-intervention secondary TB programme data comprising data on increased supervisory visits, incentives for health workers, DOTS expansion, outreaches and geo-code monitoring. Trend analysis was performed using Cochran-Armitage χ2 test for linear trends.RESULTS:Case-finding increased from 104,904 cases in 2017 to 138,591 in 2020. There was an increase of 2.0% from 2017 to 2018, 13.0% in 2018 to 2019 and 15.0% in 2019 to 2020 (P < 0.001). Facility DOTS coverage increased from 7,389 facilities in 2017 to 17,699 in 2020. There was an increase of 30.0% in 2018, 31.0% in 2019 and 40.0% in 2020 (P < 0.001). The number of reporting facilities increased from 5,854 in 2017 to 12,775 in 2020. Compared with 2017, there were an increase of 20.0% in 2018, 38.0% in 2019 and 32.0% in 2020 (P < 0.001). Treatment coverage rate increased from 24% in 2018 to 27% in 2019 and 30% in 2020.CONCLUSION:TB service expansion, improved monitoring and the use of data for decision making are key in increasing TB treatment coverage.

Feasibility and preliminary evaluation of internet-based compassion and cognitive–behavioral stress-management courses for health care professionals: A randomized controlled pilot trial

Health care professionals (HCPs) are exposed to excessive demands in their work environment. In Sweden, work-related stress is one of the most common reasons for sick leaves. Finding cost-effective and easily accessible interventions for HCPs is crucial to counteract stress-related problems and reduce the number of sick leaves. The study aimed to evaluate the feasibility of two internet-based stress management courses and their preliminary effectiveness to reduce HCPs' stress of conscience and work-related stress, and act as a pilot for a larger randomized controlled trial (RCT). Thirty-two HCPs registered for the courses and were randomized to either an internet-based compassion course, ICOP (n = 18), or an internet-based cognitive–behavioral course, ICB (n = 14). Participants completed measures pre- (i.e., baseline, n = 32), post-intervention (at five weeks, n = 21), and at follow-up at 10 weeks (n = 17), 15 weeks (n = 13), and six months (n = 12). The study used the following scales: Stress of Conscience Questionnaires, Copenhagen Psychosocial Questionnaire, Self-Compassion Scale, and Professional Quality of Life Scale. Adherence of HCPs (n = 21) was measured using the number of logins, messages between course leaders and HCPs, and completed modules. Twelve interviews were conducted to explore participants' perceptions of the accessibility of the courses. Participants reported overall satisfaction with both the ICOP and ICB courses, stating that the courses contributed to new knowledge, individual insight, and behavior change. Both courses showed similar patterns of adherence. Quantitative analyses on pre-and post-intervention data (n = 21) showed that stress of conscience and secondary traumatic stress decreased, and self-compassion increased following ICOP. Following ICB, HCPs reported decreased burnout symptoms (according to one of two questionnaires) and increased compassion satisfaction. Both courses seemed feasible, showed promising results, and could be further evaluated in a larger study with a similar design.

Development of Cultural Humility and Ethnocultural Empathy in Nursing Students

Objective: Differences in cultural backgrounds, values, beliefs, and practices between healthcare providers and clients can create challenges and lead to disparities, and adverse events. Healthcare providers’ cultural humility and ethnocultural empathy promote services that meet patients’ social and cultural needs. However, it is unclear how to best promote the development of cultural humility and ethnocultural empathy amongst nursing students. The transformative learning theory, developed by Jack Mezirow guided the study. Students who participate in a cultural immersion experience will report higher cultural humility and ethnocultural empathy compared to students who receive a lecture. Methods: This study used a quasi-experimental, pretest-posttest control group design. A non-randomized, convenience sample of 47 students was utilized. The ethnocultural empathy scale and the cultural humility scale were used to assess nursing student’s cultural humility and ethnocultural empathy. Open ended questions explored the meaningfulness of the experience. Data was analyzed with bivariate and multivariate analysis to compare pre- and post-intervention data and differences between groups. A thematic analysis appraised open ended question responses. Results: Students who participated in a cultural immersion experience reported significant higher cultural humility and ethnocultural empathy scores. Open ended questions reveled that the cultural immersion experience was meaningful and aided in the development of cultural humility and ethnocultural empathy. Conclusion: A cultural immersion experience was useful in promoting the development of cultural humility and ethnocultural empathy in nursing students.

Study of effect of guided meditation on quality of life in patients of end stage renal disease (ESRD) on maintenance hemodialysis – a randomised controlled trial

BackgroundThere is paucity of data regarding effects of guided meditation (Yoganidra) on quality of life among patients of chronic kidney disease on maintenance hemodialysis. Our objective was to study effects of guided meditation on physical, emotional, and cognitive dimensions of well-being and quality of life in patients undergoing maintenance hemodialysis.MethodWe collected baseline and post intervention data in control and intervention groups on hemodialysis and studied the effect of Guided mediation provided for 6 weeks.ResultEighty patients (forty in control and intervention group each) were studied. Mean age was 51 years. Hypertension and Diabetes were the most common etiological condition (28.75%) followed by undermined aetiology (25.00%). 8.75% of the patients had dialysis vintage of less than 1 year. There was statistically significant difference in qualities of happiness and all measures of physical general wellbeing. There was statistically significant difference in burden and effect of kidney disease as well as symptoms of kidney disease post intervention in Kidney Disease Quality of Life score. We carried out Qualitative analysis in our study by maintaining a diary of their subjective experiences related to listening music/guided meditation during the study period in which the feeling of peace and feeling inspired to manage the illness/ do regular work were the most common experiences (97.5%) reported by participants. ConclusionGuided meditation resulted in statistically significant improvement in happiness, enthusiasm, inspiration, activeness, alertness, awareness, degree of stability, self-confidence, clarity of thoughts, control over anger, self-reflection intervention in the intervention group. It reduced perceived stress. It improved burden and effect of kidney disease, symptoms of kidney disease and total Kidney Disease Quality of Life score. In qualitative dimensions of wellbeing (as emerging from analysis of results of diary), feeling of peace and feeling inspired to manage the illness/ continue regular work, clarity of thoughts, happiness, concentration, reduction of laziness, improved sleep pattern, reduction in anger among other psychological components.Trial registrationThis trial has been registered under clinical trial registry of India. (CTRI number-CTRI/2020/02/023438) (Date: 19/02/2020).

The effect of a family-centered advance care planning intervention for persons with cognitive impairment and their family caregivers on end-of-life care discussions and decisions.

Advanced care planning (ACP) includes advance directives (AD), which can specify provisions for palliative care and types of life-sustaining treatments for an individual requiring end-of-life (EoL) care. ACP for persons in the early stages of cognitive decline can decrease anxiety and conflict for family members needing to make decisions about EoL-care, which is especially critical for family caregivers (FCGs) if they play a role as a surrogate regarding healthcare decisions. However, ACP for persons with cognitive impairment (PWCIs) is often overlooked. This study explored the effects of a family-centered ACP intervention on decisions about EoL-care, life-sustaining treatment decisions, and discussions of related topics among PWCIs and FCGs. The study was conducted in outpatient clinics of regional teaching hospitals in northern Taiwan. Participants were dyads consisting of persons diagnosed with mild cognitive impairment or mild dementia and their FCGs. The family-centered ACP intervention was provided by an ACP-trained senior registered nurse. A one-group, pretest-posttest design was used to evaluate the effect of the intervention on 44 dyads. Four structured questionnaires collected data regarding familiarity with ACP, intention to engage in ACP, participation in personal discussions between the dyads about ACP, and consistency between PWCIs and FCGs for decisions about life-sustaining treatments at EoL. Paired t, Kappa, and McNemar tests were used to compare differences between pre-intervention data (pretest) and post-intervention data (posttest). There were significant increases in familiarity with ACP, components of ACP, and the number of topics PWCIs and FCGs personally discussed surrounding EoL-care decisions. There was no change for either group in wanting to have a formal ACP consultation and only modest increases in consistency between PWCIs and FCGs for life-sustaining treatment decisions after completion of the family-centered ACP intervention. Clinicians caring for PWCIs should incorporate family-centered ACP interventions and support ongoing discussions about life-sustaining medical treatments to ensure their preferences regarding EoL-care are respected. The accessibility and availability of consultations about ACP should also be provided.

Combining Cognitive-behavioral Therapy For Insomnia With Exercise Training In Adults With Insomnia And Short Sleep Duration: Impact On Sleep Outcomes

Cognitive-behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia; however, there is mixed evidence as to whether CBT-I efficacy is blunted in adults with insomnia and short sleep duration. Exercise training may be a useful adjunct treatment to CBT-I for this population. PURPOSE: To explore changes in actigraphic- and polysomnographic-based sleep outcomes from a CBT-I intervention augmented by exercise training in a sample of adults with insomnia and short sleep duration. METHODS: Eight adults (50% female, 62.5% white) with insomnia disorder and short sleep duration (self-reported sleep duration <6 h) completed a 12-week single-arm trial. Participants were guided through the online “Sleep Healthy Using the Internet” (SHUT-I) CBT-I program while completing a supervised exercise program (EX; 150 min/wk of moderate-intensity aerobic exercise and 2 d/wk of resistance training). Prior to and following the intervention, participants completed 1 wk of home-based actigraphy monitoring and 1 night of laboratory-based polysomnography (PSG). Post-intervention PSG data were missing for 1 participant due to COVID lockdown restrictions. Differences between baseline and post-intervention sleep were analyzed using Cohen’s d effect size calculations and paired t-tests. RESULTS: At baseline, participants had actigraphy-assessed total sleep time (TST) of 6.9 ± 0.6 h and sleep efficiency (SE) of 86.6 ± 4.1%; PSG-based TST and SE were 6.9 ± 0.9 h and 87.6 ± 6.1%, respectively. At post-intervention, actigraphy-assessed TST decreased by 15.9 min (d = 0.40, p = .29) and SE increased by 1.4% (d = 0.92, p = .08) relative to baseline. For PSG-based outcomes, TST decreased by 27 min (d = -1.48, p = .08) and SE increased by 3.9% (d = 0.91, p = .05) at post-intervention. In addition, the proportion of time spent in non-REM (NREM) stage 1 sleep decreased by 2.0% (d = -1.05, p = .03) and the proportion of time spent in NREM stage 2 sleep increased by 3.0% (d = 0.82, p = .07) at post-intervention. CONCLUSIONS: These preliminary data suggest improvements in sleep continuity following the combination of CBT-I and exercise training, accompanied by small decreases in sleep duration. Future research should disentangle the independent effects of CBT-I and exercise on sleep outcomes in this population. Support: NIH K23 HL118318 (Kline)

Effects of Intermittent Fasting on Weight Loss in Asian Indian Adults with Obesity.

Worldwide, obesity has nearly tripled since 1975 and has become a major healthcare challenge today. Intermittent fasting (IF) is gaining popularity as a weight loss strategy in recent times. This study aimed to study the role of IF as a modern-day weight-loss strategy in obese adults through a real-world pilot experiment conducted at a nutrition clinic in Mumbai. To understand the effects of IF on weight loss, 32 overweight/obese [body mass index (BMI) ≥23 kg/m2] adults from a nutrition clinic in Mumbai, were assigned consecutively to an IF plan and followed up for 3 months. Their demographic, anthropometric, and dietary assessments were done pre- and post-intervention. Qualitative interviews were done at the end of the study to record the participants' overall well-being, experience, and sustainability of IF. 56% of study participants were males and their mean age was 35.6 ± 8.9 years. 65.6% of participants were able to maintain 14-16 hours of fasting and 53% managed all 7 days of IF. Analysis of post-intervention data showed a significant reduction in mean body weight (88.5 ± 19 to 83.8 ± 17.6 kg), waist circumference (M: 108.2 ± 11.3 to 103.6 ± 4.4 cm, F: 98.9 ± 8.8 to 93.3 ± 3.3 cm), BMI (31.4 ± 5.3 to 29.6 ± 5.1 kg/m2), daily calories (1782 ± 237 to 1388 ± 243 kcal/day), carbohydrate intake (267 ± 18.4 to 164 ± 4.0 g/day), and an increase in protein intake (39 ± 11 to 55 ± 11 g/day). Participants reported positive experiences of practicing IF such as improved fitness, sleep cycle, and adoption of healthy eating habits. The study demonstrates that IF could aid in weight loss and adoption of a healthier lifestyle.

Effects of Mindfulness-Based Stress Reduction Therapy on Posttraumatic Growth and Quality of Life in Patients With Breast Cancer Under Early Chemotherapy: A Randomized Controlled Trial.

Posttraumatic growth (PTG) in patients with breast cancer has been reported. Mindfulness-based stress reduction (MBSR) has been found to be effective in improving the psychological well-being during cancer care. This study aimed to evaluate the impact of MBSR on the levels of PTG, perceived social support, and quality of life. A sample of 101 participants who experienced early chemotherapy enrolled in an MBSR group (n = 50) and a routine care group (n = 51) for 8 weeks. Their postintervention data were combined with preintervention data through a bundle of questionnaires reporting levels of PTG, perceived social support, and quality of life. MBSR showed the prominent validity in raising the levels of PTG and increasing in perceived social support and quality of life from pre- to posttreatment. MBSR improved the levels of PTG, perceived social support, and quality of life in patients with breast cancer in early chemotherapy. In conclusion, MBSR may help to optimize the positive psychological processes that will be targeted to maximize the efficacy of treatment for future cancer survivors.

Study protocol: Evaluation of the ‘Flavour School’ sensory food education programme: a cluster-randomised controlled trial in UK primary school children, aged 4–7 years, to determine impact on confidence and curiosity in tasting vegetables and fruit

BackgroundMany children would benefit from a diet richer in vegetables and fruit. ‘Flavour School’ is a programme of ‘sensory food education’, which aims to increase children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This study will conduct a cluster-randomised controlled trial to assess the outcomes of the Flavour School programme in primary school children aged 4–7 years.MethodsFour hundred plus children from 4+ schools will either complete the Flavour School programme (experimental group) or have no intervention with normal school teaching (control group), cluster-randomised within-schools, by school class. Baseline data collection will consist of video recorded behavioural observation during a tasting activity, and post-intervention data collection will repeat this activity after the experimental group have completed the intervention. Process measures will be assessed using a teacher engagement feedback questionnaire.DiscussionThis study will provide causal data on the efficacy of a sensory food education intervention for increasing children’s confidence and curiosity in exploring foods and flavours, especially vegetables and fruit. This new knowledge will help educators and policy makers to make evidence based decisions on uptake of sensory food education.Trial registrationISRCTN: 40249947 Date assigned 17 March 2020 Last edited 22 September 2021 Version 1.2Trial Acronym OASES (Outcomes Assessment of Sensory Education in Schools)

Treatment Adherence among HIV and TB Patients Using Single and Double Way Mobile Phone Text Messages: A Randomized Controlled Trial.

Background Research has shown that patients fail to adhere to ART and TB treatment due to the long duration of both therapies, side effects, and forgetfulness. Objective To assess the role of the double-way and single-way SMS on adherence to HIV and TB treatment. Materials and Methods A randomized controlled trial among adult HIV and TB patients on treatment at the Buea Regional and Kumba District Hospitals, South West Region, Cameroon, was conducted. Participants were randomly allocated to the control, single-way, and double-way SMS intervention groups. HIV and TB participants were followed independently for a period of 6 months and 3 months, respectively. Baseline and post-intervention data were collected and analyzed using the chi-square and Student's t-tests with statistical significance set at p < 0.05. Results A total of 210 HIV participants and 84 TB were recruited into the study with a mean age of 41.25 ± 10 years and 37.89 ± 13.27 years, respectively. Optimal adherence to ART and TB treatment at baseline was [65 (31%) CI: 0.247–0.372] and [35 (41.7%) CI: 0.311-0.522], respectively, and after the intervention, it increased to [72 (42.6%) CI: 0.347-0.495] and 41 (61.2%), respectively. There was an increase in adherence to ART among participants in the double-way SMS intervention group from 23 (32.9%) (RR: 1.04, CI: 0.8-1.31, p=0.716) to 29 (48.3%) (RR: 1.06, CI: 0.75-1.50, p=0.746). Combined single-way and double-way SMS significantly increased adherence to ART. Conclusions The level of adherence was low among HIV and TB participants. The single-way and double-way SMS did not significantly increase adherence. However, a combination of both the double-way and single-way SMS intervention significantly improved adherence to ART.

Genetic profile for dopamine signaling predicts brain functional reactivity to repetitive transcranial magnetic stimulation.

Research integrating molecular and imaging data provides important insights into how the genetic profile associated with dopamine signaling influences inter-individual differences in brain functions. However, the effects of genetic variations in dopamine signaling on the heterogeneity of brain changes induced by repetitive transcranial magnetic stimulation (rTMS) still remain unclear. The current study examined the composite effects of genetic variations in dopamine-related genes on rTMS-induced brain responses in terms of the functional network connectivity and working memory performance. Healthy individuals (n = 30) participated in a randomized, double-blind, sham-controlled study with a crossover design of five consecutive days where active rTMS or sham stimulation sessions were administered over the left dorsolateral prefrontal cortex (DLPFC) of the brain. Participants were mostly women (n = 29) and genotyped for polymorphisms in the catechol-O-methyltransferase and D2 dopamine receptor genes and categorized according to their genetic composite scores: high vs. low dopamine signaling groups. Pre- and post-intervention data of resting-state functional magnetic resonance imaging and working memory performance were obtained from 27 individuals with active rTMS and 30 with sham stimulation sessions. The mean functional connectivity within the resting-state networks centered on the DLPFC increased in the high dopamine signaling group. Working memory performance also improved with rTMS in the high dopamine signaling group compared to that in the low dopamine signaling group. The present results suggest that genetic predisposition to higher dopamine signaling may be a promising neurobiological predictor for rTMS effects on cognitive enhancement.Trial registration: ClinicalTrials.gov (NCT02932085).

ASTRONOMY FOR STUDENTS WITH VISUAL IMPAIRMENTS: DEVELOPMENT OF THE CAREER EXPLORATION LAB

For students with visual impairments (VI), the possibility of a future in astronomy, or any science, technology, engineering, and mathematics (STEM) field, seems daunting. In order to bolster astronomy and STEM opportunities for high school students with VI in the United States, we developed the STEM Career Exploration Lab (CEL). Our STEM CEL methodology employs tactile astronomy instruction via 3D printing technologies and unique 3D-printed models, professionals with VI acting as role models, and partnerships with local STEM industries that provide insights into possible career paths. In partnership with the South Carolina Commission for the Blind (SCCB) and the Michigan Bureau of Services for Blind Persons (MBSBP), to date we have held four weeklong CELs (June 2017, June &amp; July 2018, August 2019) and a 3D printer build workshop (September 2018), thus far serving about fifty students with VI. We have also held one professional development workshop for teachers of the visually impaired at the Maryland School for the Blind in October 2021. We gathered pre- and post-intervention data via student surveys, assessments of students' astronomy knowledge, and video recordings of the CEL activities in order to study to what extent the CEL model can enhance the students' attitudes towards, interests in, and capacities to participate in astronomy and STEM careers. Once fully tested and refined, we will make our 3D model files and activities freely available for further use and study. This work serves as a testbed for an expanded CEL program aimed at helping increase the representation of persons with VI in astronomy and STEM fields. This work is supported by a generous Innovative Technology Experiences for Students and Teachers (ITEST) grant from the National Science Foundation.

Using the history of plate tectonics to teach the nature of science

ABSTRACT Current science education efforts emphasise the need to train students to understand the nature of scientific work. In geosciences, training students to understand how science works does not only promote their interest and community engagement in the field, but also has the potential to promote awareness and ethics. However, instructional activities using an explicit and reflective approach to promote students’ learning of the nature of science concepts remain scant. In this paper, a two-class unit intervention using an explicit reflective approach to the teaching of nature of science was used in an undergraduate lesson on the history of plate tectonics. We measured the influence of the lesson on students’ nature of science knowledge using the Student Understanding of Science and Scientific Inquiry instrument. We collected parallel quantitative and qualitative pre- and post-intervention data from 37 community college students involved in a physical geology course. Quantitative and qualitative data analysis indicated that students’ nature of science knowledge related to the tentativeness of scientific theories and the role of society and culture in science improved after the intervention unit. Results imply that geoscience educators should consider using explicit and reflective approaches when using the history of science to teach about the nature of science.