Pre-post Design Research Articles

Virtually delivered cognitive behavioural therapy for avoidant restrictive food intake disorder (CBT-AR): a case study in an adult with elevated autistic traits

ABSTRACT Cognitive Behavioural Therapy for Avoidant and Restrictive Food Intake Disorder (CBT-AR; ARIFD) is a psychological treatment that targets many of the core symptoms of ARFID. Although a growing literature supports the efficacy of behavioural interventions for paediatric feeding and eating disorders, including ARFID, the applicability of these methods to adults remains undetermined. Telehealth delivery of CBT-AR in adults with autism has yet to be tested. With this study, we conduct a preliminary evaluation of CBT-AR delivered virtually to a 26-year-old white British female, with mixed ARFID and elevated autistic traits. She attended 23 remote CBT-AR sessions facilitated through a dedicated telehealth platform. Adjustments were made to accommodate her lived experience of neurodiversity. Using a pre-post treatment design, changes on measures of subjective goal attainment, eating-related and general psychosocial impairment, general anxiety, and depression were evaluated. Following treatment, the participant had made significant progress towards personally meaningful goals, with improvements observed in nutritional intake, general well-being, and reductions in eating-related psychosocial impairment and general anxiety. The results offer preliminary insights into acceptability and efficacy of virtual CBT-AR for neurodiverse individuals.

The Effects of an Entrepreneurial Project on the Career-Choice Readiness, Metacognition, and Growth Mindset of Secondary Students

The present study evaluated the effect of a four-day entrepreneurial project on the career-choice readiness of secondary school students. The hypotheses underlying this study state that participation in a school startup project increases the students’ career-choice readiness, growth mindset, and metacognition. Based on the literature, it is also assumed that a positive correlation exists between metacognition, growth mindset, and career-choice readiness. The present study examined a student entrepreneurship program by conducting a pre–post design. School classes developed and implemented business ideas with qualified coaches within the program based on a comprehensive didactic approach. Data from each group of participants were collected at two measurement time points. The results demonstrated that the values for all constructs increased in the post-test after participating in the entrepreneurial intervention. Furthermore, the findings indicate that a growth mindset is related to career-choice readiness and mediates the relationship between career-choice readiness and metacognition. Moreover, metacognition additionally favors a growth mindset. Based on the findings, entrepreneurial projects at schools are helpful for vocational orientation and should be extended by cooperating with external organizations and partners.

Effectiveness of a Reminder in Improving Adherence With Outpatient Heart Failure Guideline Prescribing

Lack of guideline adherence in medication prescribing is a concern for heart failure patients with reduced ejection fraction. The purpose of this study is to evaluate the effectiveness of a provider reminder tool with decision support in prescribing for outpatients. A pre-post interventional design was used to measure prescribing and titration of class I medications with implementation of the tool in a convenience sample (N = 120) of consecutive provider-patient encounters. Compliance with renin-angiotensin-aldosterone system inhibitors, beta blockers, and hydralazine–isosorbide dinitrate improved. Compliance to mineralocorticoid receptor antagonists showed significant improvement. Uptitration of beta blockers and renin-angiotensin-aldosterone system inhibitors was achieved.

PREHABILITATION BEFORE GASTROINTESTINAL CANCER SURGERY (PREHAB-GI): AN IMPLEMENTATION STUDY

BACKGROUND Surgery continues to be the primary treatment option for early-stage colorectal and upper gastrointestinal (UGI) cancers. However, up to 30-40% will experience a major complication. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and/or psychological interventions. We aimed to evaluate the implementation of a multimodal prehabilitation program in gastrointestinal cancer surgery patients. METHODS A single-arm implementation study using a pre-post design. Colorectal or UGI cancer patients scheduled for curative intent surgery at Concord Hospital with ≥14 days pre-surgery were recruited. The intervention was face-to-face or by telehealth (COVID adaptations): a 2-4-week program consisting of i) supervised exercise, ii) dietary education and protein supplements, iii) nursing support. The primary outcome was implementation using the RE-AIM (Reach/Effectiveness/Adoption/Implementation/Maintenance) framework. Secondary outcomes included functional, nutritional, and surgical outcomes. RESULTS Over 16 months, 181 were screened; 95 (52%) were eligible. Reach: 77/95 recruited (64 colorectal, 13 UGI). The median age was 70 years; 46 (60%) were males. Median intervention duration was 16 days. Effectiveness: Functional capacity using the 6-minute walk test and 2-minute step test improved from baseline to pre-surgery; 9.3m (p=0.038) and 6.5 steps (p=<0.001), respectively. Self-reported moderate, vigorous and resistance training statistically increased from baseline to pre-surgery. Hospital length of stay decreased by 1.9 days (p=0.010). There was no difference in total complications and readmissions. Adoption: 91% of referrals were directly from surgeons. Implementation: 72 completed the intervention; 5 withdrew after baseline assessment. 34% of assessments and intervention were delivered by telehealth. Adherence to the intervention was high; 94% exercise, 97% nutrition, 98% nursing. Overall, participant and clinician satisfaction was high. Maintenance: The program has been adopted as standard care with modifications post-study completion. CONCLUSIONS Our study shows that multimodal prehabilitation can be successfully implemented in a real-world setting, with a trend to improve functional and surgical outcomes.

Implementation of a primary-tertiary shared care model to improve the detection of familial hypercholesterolaemia (FH): a mixed methods pre-post implementation study protocol

IntroductionFamilial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipid metabolism and a preventable cause of premature cardiovascular disease. Current detection rates for this highly treatable condition are low....

YOUNG STRONG AND DEADLY PROGRAM EVALUATION

INTRODUCTION & AIMS For Aboriginal young people, physical activity declines through puberty, adolescence, and early adulthood. Western Sydney Local Health District (WSLHD) departments, Aboriginal Health Hub and Youth Health, together with western Sydney Aboriginal communities co-designed the Young, Strong, and Deadly program. The program is an assertive intervention which aims to increase healthy behaviours and improve social and emotional wellbeing among young Aboriginal adolescents aged 12-16 years. The program is an Aboriginal researcher led, 14-week health education and physical exercise program that includes paid PCYC gym memberships, guided gym sessions, transport provision and nutrition education. METHODS The study used a mixed method pre-post design with a process evaluation. Participants were recruited through convenience and snowball sampling including engagement with schools and Aboriginal community-controlled organisations. Data were collected on participation and attendance, performance, satisfaction and intention to continue with activities. RESULTS For the first of three cohorts, 31 participants were recruited, of which 24 completed the 14week program. All participants demonstrated significant improvements in strength & conditioning. Five focus groups were conducted with 20 adolescents and seven parents, individually or in pairs. Adolescents enjoyed the program, particularly achieving gains in strength and fitness, learning and practicing new recipes and having an Aboriginal specific program. Parents spoke favourably of the program including improvements in their children’s health behaviours, focus on school and confidence, and appreciated the staff input and program operations. CONCLUSION Young Strong and Deadly has been implemented in community settings and has demonstrated feasibility and acceptability among Aboriginal adolescents and their families. Initial findings show that a culturally appropriate assertive intervention program can impact on social and emotional wellbeing as well as improving the health of young Aboriginal people.

The Effect of Early Mobilization on Incerased Intestinal Peristaltic Post Sectio Caesarea at Grandmed Lubuk Pakam Hospital in 2023

Sectio Caesarea is a surgical process with the aim of removing the fetus through an incision in the abdominal wall which is connected to the autonomic nervous system, so that bowel movements become slow and cause problems. Caesarean section deliveries are increasingly being performed and their success is high, although they are still considered the last solution. Cesarean section operations are common for mothers who are about to give birth. So that post-operative intestinal peristalsis can return immediately, mobilization is necessary. If there is no mobilization, the motility function of the intestines and bladder will take a long time to return to normal so that the mother will have difficulty defecating. This research aims to measure how much mobilization increases intestinal peristalsis in post-caesarean section surgery patients. The research is quantitative research with a One Group pre-post test design. The sample consisted of 25 post-cesarean section mothers with primigravida births. The instruments used are SOP sheets and observations. Data analysis using the Paired T-test with an error of 0.05 showed that the average intestinal peristalsis before the intervention was 7.20 while after the intervention it was 8.04. The results of the Paired T-test show that the p-value is 0.000, which means that there is an effect of mobilization on increasing intestinal peristalsis in post caesarean section patients at GrandMed Lubuk Pakam Hospital. It is recommended that you always implement post caesarean section mobilization measures in accordance with the SOP.

Pengaruh Yoga Pranayama dengan Tingkat Stres Perawat yang Bertugas di Ruang Operasi Rumah Sakit Balimed Denpasar

Background: Nurses working in the operating theatre are prone to stress because they are required to have high knowledge and concentration skills in all aspects of perioperative care. Stress management can be done through relaxation with yoga pranayama. Purpose: The purpose of this study was to determine the effect of yoga pranayama on the stress level of nurses on duty in the operating room. Methods: This study used a pre-experimental design with a one-group pre-post test design. The research sample was 23 nurses in the operating room with purposive sampling technique. Data collection using Perceived stress scale questionnaire, analysis using Wilcoxon Sign Rank test. Results: The results showed that the stress level of pre-test nurses was mostly 16 people (69.6%) in the moderate category and the post-test was entirely 23 people (100%) in the mild category. The results of the Wilcoxon Sign Rank Test obtained Zhitung = 4.199> Ztabel = 1.96 and p value = 0.001 <0.05 these results indicate there is an effect of yoga pranayama with the stress level of nurses on duty in the operating room. Conclusion: The results of the study can be concluded that yoga pranayama has a significant effect on the stress level of nurses on duty in the operating room. It is recommended that nurses do Yoga exercises can be done regularly at least once a day to help reduce stress.

Utilization of Audiovisual Media as an Effort to Prevent CED and Anemia in Pregnancy

Utilization of Audiovisual Media as an Effort to Prevent CED and Anemia in Pregnancy

Interprofessional socialization of first-year medical and midwifery students: effects of an ultra-brief anatomy training

BackgroundInterprofessionalism is considered a key component in modern health profession education. Nevertheless, there remains ongoing debate about when and where to introduce interprofessional trainings in the curriculum. We identified anatomy, a subject commonly shared among health professionals, as a practical choice for initiating early intergroup-contact between first-year medical and midwifery students. Our study examined the effects of a four-hour block course in anatomy on interprofessional socialization and valuing, as well as long-term effects on intergroup contact.MethodsBased on different concepts and theories of learning, we implemented 12 interprofessional learning stations. Several measures were taken to foster group cohesion: (1) self-directed working in interprofessional tandems on authentic obstetric tasks, (2) competing with other tandems, (3) creating positive interdependencies during task completion, and (4) allowing room for networking. In a pre-post design with a three-month follow-up, we assessed the outcomes of this ultra-brief training with qualitative essays and quantitative scales.ResultsAfter training, both groups improved in interprofessionalism scores with strong effect sizes, mean difference in ISVS-21 = 0.303 [95% CI: 0.120, 0.487], P < .001, η² = 0.171, while the scales measuring uniprofessional identity were unaffected, mean difference in MCPIS = 0.033 [95% CI: -0.236, 0.249], P = .789. A follow-up indicated that these positive short-term effects on the ISVS-21 scale diminished after 12 weeks to baseline levels, yet, positive intergroup contact was still reported. The qualitative findings revealed that, at this initial stage of their professional identity development, both medical and midwifery students considered interprofessionalism, teamwork and social competencies to be of importance for their future careers.ConclusionThis study advocates for an early implementation of interprofessional learning objectives in anatomical curricula. Young health profession students are receptive to interprofessional collaboration at this initial stage of their professional identity and derive strong advantages from a concise training approach. Yet, maintaining these gains over time may require ongoing support and reinforcement, such as through longitudinal curricula. We believe that an interprofessional socialization at an early stage can help break down barriers, and help to avoid conflicts that may arise during traditional monoprofessional curricula.

Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative

BackgroundPregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework.MethodsA pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar’s test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05.ResultsCompared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015).ConclusionThe health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Enhancing 21st Century Skills for Prospective Physics Teachers through Arduino-Based Multiple Representations in Learning Heat and Temperature

There was a gap between traditional teaching and future demands and need a bridge by offering an innovative approach that allows prospective physics teachers to develop key abilities. The main purpose of this study was to improve prospective physics teacher’ 21st century skills in heat and temperature by applying multiple representations learning using Arduino based experiment. The research method used is based on the development procedures of the ADDIE research and development model which includes the stages of analysis, design, development, implementation and evaluation. This study implemented design-based research with a one-group pre-post observation design. The research was conducted on 22 prospective physics teacher students. The teaching materials that have been developed passed the first stage test with a Very Good result. The validity test is assessed by expert validators. The response of students using the teaching materials is Good. In terms of effectiveness, the learning with Arduino based multi representations is able to improve the 21 st -Century Skills with an average N-Gain score of 0.35. Therefore, it can be used by lecture and those in other science fields to improve the quality of learning and developing prospective physics teachers’ 21st Century Skills.

The consumption of walnuts has an impact on decreasing fasting blood glucose levels in individuals with concurrent hyperglycemia and hyperlipidemia: a randomized control trial

Nationally, the prevalence of Diabetes Mellitus (DM) has increased by 0.5%. In 2013, it was approximately 1.5%, rising to 2.0% in 2018. On the other hand, it is known that administering walnut extract can reduce blood sugar levels in diabetic patients. The aim of this study is to determine the effect of walnut consumption on blood sugar levels. The research was conducted experimentally, using a pre-post test control group design. The research sample consisted of mothers with fasting blood sugar levels ≥200 mg/dL and total cholesterol levels ≥200 mg/dL (hyperglycemic and hyperlipidemic). The total sample size was 50 mothers, divided into 2 groups. Samples were selected using simple random sampling. The intervention involved giving 50 grams of walnut (Canarium Indicum L.) daily for 8 weeks to the treatment group. The research was conducted in the working area of the Paccerakang Community Health Center in Makassar City, Indonesia. Statistical analysis was performed using paired T-tests. There was a decrease in fasting blood glucose levels in the treatment group from 244.12 mg/dL to 195.52 mg/dL. In the control group, there was a slight decrease in blood sugar levels from 236.92 mg/dL to 229.96 mg/dL. Paired T-test analysis in the treatment group showed a value of p=0.00, indicating a significant difference in cholesterol levels before and after the intervention in the treatment group. In the control group, the value was p=0.07, indicating no significant difference in cholesterol levels in the control group. Administering 50 grams of walnuts per day for 8 weeks significantly lowered fasting blood sugar levels in hyperlipidemic and hyperglycemic mothers.

Enhancing clinical reasoning for management of non-communicable diseases: virtual patient cases as a learning strategy for nurses in primary healthcare centers: a pre-post study design

BackgroundIn Rwanda, nurses manage all primary care at health centres, and therefore are their clinical reasoning skills important. In this study, a web-based software that allows the creation of virtual patient cases (VP cases) has been used for studying the possibility of using VP cases for the continuous professional development of nurses in primary health care in Rwanda. Previous studies in pre-service education have linked VP cases with the enhancement of clinical reasoning, a critical competence for nurses. This study investigated the feasibility of continuous professional development through VP cases to further train in-service nurses in clinical reasoning.MethodThe study used a pre-post test design. Initially, seventy-six participants completed a questionnaire as part of the pre-test phase, subsequently invited to engage with all four VP cases, and finally responded to the post-test questionnaire evaluating clinical reasoning skills. Fifty-six participants successfully completed the entire study process and were considered in the analysis. The primary outcomes of this study were evaluated using a paired t-test for the statistical analysis.ResultsThe results show that the mean score of clinical reasoning increased significantly from the pre-test to the post-test for all four illness areas (p < 0.001). The study findings showed no statistically significant difference in participants’ scores based on demographic factors, including whether they worked in urban or rural areas. Conclusion and recommendationUtilizing VP cases appears to significantly enhance the continuous professional development of nurses, fostering a deliberate learning process that enables them to reflect on how they manage cases and, in turn, refine their clinical reasoning skills. This study strongly recommends incorporating VP cases in the continuous professional development of nurses at the primary health level (health centers). This is especially pertinent in a context where nurses are required to perform diagnostic processes similar to those employed by physicians.

Narrowing inequity gap: ERAS home delivery kit

ObjectiveTo enhance adherence to Enhanced Recovery After Surgery (ERAS) protocols and address pre-operative preparation equity gaps, a system was developed to automatically mail chlorhexidine (CHG) and nutritional carbohydrate supplements (ERAS Kits) to surgical patients. BackgroundThis retrospective observational study focused on adult patients undergoing abdominal surgeries at a large academic hospital, using a pre-post design. MethodsThe study compared adherence to pre-operative ERAS pathways, involving nutritional supplements and chlorhexidine soap usage, before (September 2021-March 2022) and after (September 2022-March 2023) implementing automatic ERAS Kits mailing. A Chi square test analyzed adherence rates. ResultsPost-implementation, adherence to preoperative nutrition rose from 49.6 % to 57.7 % (P = 0.006), and surgical site preparation from 73.8 % to 78.7 % (P = 0.06). Notable improvements were seen among Black patients, Medicaid recipients, and those from lower-income neighborhoods in nutrition adherence, and among younger patients and Medicaid recipients in site preparation. ConclusionMailing ERAS Kits directly to patients significantly enhanced compliance with preoperative protocols, demonstrating an effective strategy to improve care accessibility and reduce disparities for vulnerable groups.

Effect of dolutegravir-based regimen on the body mass index of adolescents living with HIV in an African population: a pre-post design

ABSTRACT Dolutegravir, an integrase strand inhibitor, has been linked to an increase in body mass index among adults. However, little is known about its effect on adolescents. The study assessed the effect of a dolutegravir-based regimen on adolescents’ body weight and emphasized the gender-specific differences in weight gain, if any. This prospective cohort study was conducted among 182 treatment-experienced adolescents living with HIV at a tertiary hospital in Southeast Nigeria. The body mass index measurements were calculated before transitioning to dolutegravir and after six months of being on the dolutegravir regimen. A comparison of the difference in mean body mass index before and after dolutegravir-based therapy was determined using a paired t-test. At the end of the six-month follow-up, there was a significant increase in the respondents’ overall body mass index z-score (t = −10.00, p < 0.001). There was a significant increase in the body mass index z-score of both genders (male; t = −7.49, p < 0.001, female; t = −6.91, p < 0.001). The dolutegravir-based therapy (β-coefficient = −0.17, t = − 2.09, p < 0.001) and baseline body mass index z-score (β-coefficient = 0.76, t = 15.86, p < 0.001) were significant predictors of body mass index z-score at six months. In adolescents living with HIV, the transition to dolutegravir is associated with increased body weight. Female adolescents tend to gain more weight compared to males. Therefore, there is a need for regular monitoring of body weight for early detection of obesity and prompt intervention.

Comparing the effects of patient safety education using design thinking and case based learning on nursing students’ competence and professional socialization: A quasi-experimental design

BackgroundPatient safety issues should be constantly monitored and sensitively recognized. In nursing education, it is necessary to find effective teaching methods to increase students' competencies in patient safety. ObjectivesThis study aimed to compare the effectiveness of a new method, design thinking (DT), and a traditional method, case-based learning (CBL), in patient safety education. DesignThis study used a quasi-experimental, pre-post control group design. SettingsA 30-h training tutorial was developed for intervention groups, DT and CBL, while the control group received no treatment. ParticipantsIn this study were junior nursing students receiving baccalaureate nursing education with experiences of at least 480-h clinical practice. A total of 53 students (21 in the DT group, 19 in the CBL group, and 13 in the control group) were recruited. MethodsClinical reasoning competency, patient safety competency, and professional socialization were measured immediately after the end of the educational program using DT and CBL, 4 weeks later, and 8 weeks later. Effects of DT and CBL were analyzed using a generalized estimating equation. ResultsBoth DT and CBL were effective in clinical reasoning competency (χ2 = 15.432, p = 0.017) and knowledge domain of patient safety competency (χ2 = 42.824, p < 0.001), showing no significant difference between the two. CBL was more effective in professional socialization than DT. ConclusionsDT was as effective as CBL in clinical reasoning competency and knowledge domain of patient safety competency. In the healthcare field, where improving the patient experience is becoming increasingly important, DT is worth applying as an educational method to train nursing students who can take a creative and human-centered problem-solving approach. It is expected that educational curricula utilizing DT will be developed not only in the field of patient safety but also in various patient care areas.

A systematic review of the impact of simulation on students' confidence in performing clinical pharmacy activities.

Although confidence does not automatically imply competence, it does provide pharmacy students with a sense of empowerment to manage a pharmacotherapeutic problem independently. Among the methods used in higher education, there is growing interest in simulation. To evaluate the impact of simulation on pharmacy students' confidence in performing clinical pharmacy activities. Articles that reported the use of simulation among pharmacy students with fully described outcomes about confidence were included. Studies for which it was impossible to extract data specific to pharmacy students or simulation were excluded. The search was carried out in Medline, Embase, Lissa and PsycInfo from inception to August the 31th, 2022. The results were synthesized into 4 parts: confidence in collecting information, being an expert in a procedure/pathology, counselling and communicating, and other results. The quality assessment of included studies was conducted using the Mixed Methods Appraisal Tool "MMAT" tool. Among the 39 included articles, the majority were published in the last 5years and conducted in the United States. The majority included pharmacy students in years 1 through 3 (69.2%). The most common study design was the pre-post uncontrolled design (66.7%). Studies measuring the effects of human and/or virtual simulation were mainly focused on confidence to counsel and/or communicate with patients and colleagues (n = 20). Evaluations of the effects of these types of simulation on confidence in information gathering by health professionals were also well represented (n = 16). Simulation-based training generally yielded positive impact on improving pharmacy students' confidence in performing clinical pharmacy activities. Rigorous assessment methods and validated confidence questionnaires should be developed for future studies.

Clinical Decision Support System for Guidelines-Based Treatment of Gonococcal Infections, Screening for HIV, and Prescription of Pre-Exposure Prophylaxis: Design and Implementation Study.

The syndemic nature of gonococcal infections and HIV provides an opportunity to develop a synergistic intervention tool that could address the need for adequate treatment for gonorrhea, screen for HIV infections, and offer pre-exposure prophylaxis (PrEP) for persons who meet the criteria. By leveraging information available on electronic health records, a clinical decision support (CDS) system tool could fulfill this need and improve adherence to Centers for Disease Control and Prevention (CDC) treatment and screening guidelines for gonorrhea, HIV, and PrEP. The goal of this study was to translate portions of CDC treatment guidelines for gonorrhea and relevant portions of HIV screening and prescribing PrEP that stem from a diagnosis of gonorrhea as an electronic health record-based CDS intervention. We also assessed whether this CDS solution worked in real-world clinic. We developed 4 tools for this CDS intervention: a form for capturing sexual history information (SmartForm), rule-based alerts (best practice advisory), an enhanced sexually transmitted infection (STI) order set (SmartSet), and a documentation template (SmartText). A mixed methods pre-post design was used to measure the feasibility, use, and usability of the CDS solution. The study period was 12 weeks with a baseline patient sample of 12 weeks immediately prior to the intervention period for comparison. While the entire clinic had access to the CDS solution, we focused on a subset of clinicians who frequently engage in the screening and treatment of STIs within the clinical site under the name "X-Clinic." We measured the use of the CDS solution within the population of patients who had either a confirmed gonococcal infection or an STI-related chief complaint. We conducted 4 midpoint surveys and 3 key informant interviews to quantify perception and impact of the CDS solution and solicit suggestions for potential future enhancements. The findings from qualitative data were determined using a combination of explorative and comparative analysis. Statistical analysis was conducted to compare the differences between patient populations in the baseline and intervention periods. Within the X-Clinic, the CDS alerted clinicians (as a best practice advisory) in one-tenth (348/3451, 10.08%) of clinical encounters. These 348 encounters represented 300 patients; SmartForms were opened for half of these patients (157/300, 52.33%) and was completed for most for them (147/300, 89.81%). STI test orders (SmartSet) were initiated by clinical providers in half of those patients (162/300, 54%). HIV screening was performed during about half of those patient encounters (191/348, 54.89%). We successfully built and implemented multiple CDC treatment and screening guidelines into a single cohesive CDS solution. The CDS solution was integrated into the clinical workflow and had a high rate of use.

Effect of repeated post-resistance exercise cold or hot water immersion on in-season inflammatory responses in academy rugby players: a randomised controlled cross-over design.

Uncertainty exists if post-resistance exercise hydrotherapy attenuates chronic inflammatory and hormone responses. The effects of repeated post-resistance exercise water immersion on inflammatory and hormone responses in athletes were investigated. Male, academy Super Rugby players (n = 18, 19.9 ± 1.5 y, 1.85 ± 0.06m, 98.3 ± 10.7kg) participated in a 12-week programme divided into 3 4-week blocks of post-resistance exercise water immersion (either, no immersion control [CON]; cold [CWI]; or hot [HWI] water immersion), utilising a randomised cross-over pre-post design. Fasted, morning blood measures were collected prior to commencement of first intervention block, and every fourth week thereafter. Linear mixed-effects models were used to analyse main (treatment, time) and interaction effects. Repeated CWI (p = 0.025, g = 0.05) and HWI (p < 0.001, g = 0.62) reduced creatine kinase (CK), compared to CON. HWI decreased (p = 0.013, g = 0.59) interleukin (IL)-1ra, compared to CON. HWI increased (p < 0.001-0.026, g = 0.06-0.17) growth factors (PDGF-BB, IGF-1), compared to CON and CWI. CWI increased (p = 0.004, g = 0.46) heat shock protein-72 (HSP-72), compared to HWI. Post-resistance exercise CWI or HWI resulted in trivial and moderate reductions in CK, respectively, which may be partly due to hydrostatic effects of water immersion. Post-resistance exercise HWI moderately decreased IL-1ra, which may be associated with post-resistance exercise skeletal muscle inflammation influencing chronic resistance exercise adaptive responses. Following post-resistance exercise water immersion, CWI increased HSP-72 suggesting a thermoregulatory response indicating improved adaptive inflammatory responses to temperature changes, while HWI increased growth factors (PDGF-BB, IGF-1) indicating different systematic signalling pathway activation. Our data supports the continued use of post-resistance exercise water immersion recovery strategies of any temperature during in-season competition phases for improved inflammatory adaptive responses in athletes.