Program Evaluation Research Articles

A Fuzzy Neural Network Approach for Evaluation of Wetland Restoration Programmes

A Fuzzy Neural Network Approach for Evaluation of Wetland Restoration Programmes

3D scanning techniques in power engineering

Information about component geometry is a key parameter for assessing residual life and monitoring degradation processes during the life cycle of a technology. High-precision optical measurement systems are complex metrology devices that enable the collection of complex data on the physical properties of components and their rapid evaluation in CAD-based programs. These solutions offer an analysis of changes in component characteristics over time and comparing them with as-built documentation. The quality of production can be evaluated by comparing the condition of the equipment with the product documentation or monitoring the influence of service conditions on the degradation of the equipment and the trend of future development of defects. All this in digital form of data, which enables new progressive approaches to repair and maintenance programs of monitored equipment. The use of advanced metrology and diagnostic systems and the procedures they offer can reduce the time required for measurement by conventional methods and multiply the data yield from metrology, which in conjunction with modern IT technologies can detect new degradation mechanisms and increase safety service and extend projected lifetime. Up-to-date technology data can significantly save on maintenance costs or even eliminate maintenance procedures. It also provides important data for the setup of LTO.

Evaluation of a training program for the preparation of the plan in the light of some tactical maps to improve the level of achievement for the players of the actual combat competition "Sanda" in kung fu

Evaluation of a training program for the preparation of the plan in the light of some tactical maps to improve the level of achievement for the players of the actual combat competition "Sanda" in kung fu

Guiding Parents of Children With Persistent Primitive Reflexes

Strong primitive reflexes in infants suggest proper development of the central nervous system. However, if not naturally integrated in the first year of life, these persistent primitive reflexes may interfere with further motor and cognitive development as well as emotional regulation. When nurse practitioners diagnose persistent primitive reflexes, parents are often eager to know what can be done at home. Described here is a program evaluation completed on a series of movement-to-music videos called Rockin’ Reflex that provide parents with inexpensive, easy-to-follow videos that they can do at home to help their children integrate these reflexes.

Suicide Prevention Programming: Comparing Four Prominent Frameworks.

Suicide is a significant public health concern. About 48,000 individuals died by suicide in 2021 in the United States, and approximately one in 100 deaths globally are due to suicide. Continuing efforts in program development and evaluation are vital to preventing suicide. Multiple frameworks have been developed to reduce suicide rates, but they have not been compared to assess their comprehensiveness, nor have their components been classified. In 2019, the authors conducted a narrative review of the literature and identified four major frameworks for suicide prevention: the U.S. Department of Veterans Affairs (VA) Suicide Prevention Program, the Defense Suicide Prevention Program of the U.S. Department of Defense, Zero Suicide in Health and Behavioral Health Care, and the technical package developed by the Centers for Disease Control and Prevention. Program components for these frameworks were identified and classified by using two prevention strategy classification systems: the National Academy of Medicine's (NAM's) continuum-of-care model and the Substance Abuse and Mental Health Services Administration's (SAMHSA's) prevention model. The cross-program comparison revealed that no single program included all components of suicide prevention programs. However, the VA program was the most comprehensive in terms of the number of components and their spread across prevention strategy classifications. The programs used few components categorized under NAM's promotion or selective prevention strategy classifications. The SAMHSA prevention strategy classifications of information dissemination, community-based processes, and positive alternatives were also used infrequently. Organizations, health care systems, and policy makers may use these findings as they develop, improve, and implement suicide prevention programs.

Evaluasi Program Pendidikan dalam Meningkatkan Mutu Pembelajaran di SMP Negeri 51 Surabaya

The purpose of this study was to determine how the evaluation of educational programs in improving the quality of learning at State Junior High School 51 Surabaya. The research method uses a qualitative approach with data collection methods through observation, interviews, and documentation which are then narrated in descriptive form and systematic literature review or known as SLR, which in Indonesian means tinjauan pustaka sistematis namely a method by collecting literature or theories relevant to the article sourced from various references such as books, journals, and other reference sources that discuss related to program evaluation in educational units. The results showed that in improving the quality of learning, State Junior High School 51 Surabaya focuses on character education, literacy and numeracy, and IT-based learning. The evaluation of educational programs is carried out routinely every year based on 6 indicators contained in the education report card, then the process of collecting evaluation data is carried out through AKM activities, then to identify which areas need to be improved based on the results of the evaluation of educational programs, the school uses a priority scale.

A Systematic Syllabi Review on Interdisciplinary Personnel Preparation Programs

AbstractThe purpose of this study was to develop an effective evaluation tool to review course syllabi as a method for ensuring effective outcomes for interdisciplinary personnel preparation. A well-written course syllabus reflects the quality of the academic program in which the coursework is a part. A review of the syllabi across interdisciplinary programs is an attempt to align the quality of the courses and the graduate student competencies as set forth by each program. A syllabus evaluation form was developed and used systematically by three reviewers who gave each syllabus in the program a rating based on the three project target competencies and the listed indicators. For this project, three common components of syllabi were reviewed: learning outcomes, readings, and assignments. The findings suggest that a systematic syllabi review can be used to determine individual course alignment and for overall program evaluation. Findings also suggest that a syllabi evaluation form can be an effective tool to use in systematic syllabi reviews.

Human centered design of digital assistance systems for disabled people: trial and evaluation of the workshop program “friendlyAI@work”

ZusammenfassungDigitalen Assistenzsystemen wird das Potenzial zugeschrieben, Menschen mit Behinderungen eine selbstbestimmtere Teilhabe am Arbeitsleben zu ermöglichen. Eine solche potenzialerschließende Wirkung dieser Assistenztechnologien setzt in betrieblichen Anwendungskontexten fundiertes arbeitswissenschaftliches Gestaltungswissen für eine menschzentrierte Arbeitssystemgestaltung voraus. Das im Rahmen des Projektes „HUMAINE“ entwickelte Workshopkonzept „friendlyAI@work“ zielt darauf ab, betrieblichen Akteuren digitale Gestaltungskompetenz für eine humangerechte KI-Implementierung zu vermitteln. Es basiert auf Prinzipien des Aktionslernens, bei dem ein kollektiver, an Umsetzungsbeispielen ausgerichteter Kompetenzerwerb im Fokus steht. Im Beitrag berichten wir über erste Befunde zur Wirksamkeit des Workshopprogramms, die wir im Kontext der Einführung digitaler Assistenzsysteme in einer Werkstatt für Menschen mit Behinderung (WfbM) ermittelten. Die Evaluation des 18-monatigen Programms im Rahmen einer interventionsbasierten Fallstudie mit zwischen fünf und elf Teilnehmenden deutet auf positive Effekte sowohl im Hinblick auf einen Zuwachs individueller digitaler Gestaltungskompetenz wie auch der Fähigkeit zur humanzentrierten Arbeitssystemgestaltung hin. Darüber hinaus konnten im Rahmen des Programms Maßnahmen zur nachhaltigen Sicherung der erworbenen digitalen Gestaltungskompetenz umgesetzt werden (z. B. Einführung einer ganzheitlichen Gefährdungsbeurteilung bei der Planung technischer Systeme). Als wichtige Erfolgsfaktoren für den Lernerfolg erwies sich die cross-funktionale Zusammensetzung der Teilnehmenden, das an Praxisbeispielen ausgerichtete Lernkonzept und das agile Moderationsverfahren. Im Rahmen des auf Mixed-Method basierenden Evaluationsdesigns stellte sich darüber hinaus die Berücksichtigung individueller Lernvoraussetzungen in diversen Lerngruppen als kritischer Erfolgsfaktor heraus.Praktische Relevanz: Damit intelligente Technologien Menschen mit Behinderung bei der Arbeit sinnvoll unterstützen können, sind Kenntnisse über eine humanzentrierte Arbeitsgestaltung von hoher Bedeutung. Die digitalen Assistenten müssen so gestaltet sein, dass sie die persönlichen Ressourcen der Arbeitenden stärken und negative Beanspruchungsfolgen verhindert werden. Das Workshopprogramm „friendlyAI@work“ will Gestaltungsverantwortliche befähigen, digitale Assistenzsysteme in ihren Organisationen humanzentriert und nutzerfreundlich zu implementieren. Im Workshop werden Kenntnisse über die Funktionalitäten von Künstlicher Intelligenz und ihre Anwendung in Assistenzsystemen vermittelt. Darüber hinaus werden die Teilnehmenden an die Prinzipien humangerechter Technik- und Arbeitsgestaltung herangeführt und ihre Handlungskompetenz im Rahmen konkreter betrieblicher Umsetzungsbeispiele gefördert. Eine 18-monatige Erprobung des Workshopprogramms bei der Iserlohner Werkstätten gGmbH ergab eine gute Teilnehmendenakzeptanz und Erfolge bei der humangerechten Gestaltung ihrer Assistenz-Arbeitsplätze.

Experiences and perceived benefits of remotely delivered dance/movement therapy for adult cancer patients: a multi-method program evaluation.

Dance/movement therapy (DMT) is increasingly used as a complementary treatment to address psychological and physical wellbeing. However, it is unknown how it can be leveraged in adult cancer care. This mixed methods program evaluation aimed to assess patient-reported benefits and satisfaction with the virtual DMT in an academic oncology setting. We developed, implemented, and evaluated a 6-week virtual, synchronous DMT program aiming to improve physical health, address mental distress, and foster social connection for cancer patients. We used deidentified program evaluation data to assess impact of DMT on patient-reported outcomes and patients' satisfaction with the DMT program. Pre- and post-session data were analyzed using descriptive statistics and a paired t-test. Qualitative data were captured through semi-structured interviews and analyzed using thematic analysis. Results from 39 participants (mean age 64.7 ± 9.8), majority female (89.7%) with a history of breast cancer (43.6%), showed high satisfaction (100%) and unanimous program recommendation (100%). Significant improvements were noted in anxiety (- 0.42 ± 0.76, p = .009), distress (- 0.35 ± 0.80, p = .036), and sense of joy (0.73 ± 1.18, p = .004), with a non-significant trend in increased physical activity (0.38 ± 0.98, p = .057). Thematic findings indicated that DMT participation (1) facilitated engagement in physical activity for improved physical health, (2) fostered creative expression, (3) improved mental state, and (4) helped build social connections and support. Our DMT program shows promise as a component of integrative cancer care. The mixed-method evaluation provides insightful information to generate hypotheses for future RCT studies aiming to evaluate the specific effects of DMT on patient experience and outcomes.

Predictors of mentoring relationship quality in a college peer mentoring program: associations with mentors’ and mentees’ perceptions of family relationships

PurposePeer mentoring programs in higher education settings support incoming students in their transition and adaptation to college life. Mentoring program evaluation research primarily focuses on student outcomes and documents mentoring relationship quality (MRQ) as an important component of programs that facilitate change. The current study examines MRQ in a college peer mentoring program and explores its association with mentors’ and mentees’ perceptions of family relationships.Design/methodology/approachThe sample included 629 first-year students (Mage = 18.4 and 54.2% female) and 88 mentors (Mage = 20.6 and 65.9% female). Each mentor was matched with eight to 10 incoming students in the same department. Dyadic data were collected prior to the program (pre-test) and at the end of the fall semester (mid-program) and spring semester (post-test). At pre-test assessment, mentors and mentees rated their family relationships, perceived trust, loyalty, and fairness in their families. At follow-up assessments, mentees reported their MRQ, mentoring duration, and mentoring activities.FindingsA multilevel modeling analysis revealed that mentees’ and mentors’ perceptions of loyalty in their families predicted higher levels of MRQ at the end of the program. However, mentors’ perceived trust in their families was negatively associated with MRQ.Originality/valueThis study adds to the youth mentoring literature by focusing on family-of-origin experiences of both mentors and mentees from a dyadic and relational perspective. These findings have implications for future research and the practice of formal mentoring programs in college settings.

“Stretching Research Legs”: Developing Practitioner-Scholars Through Engagement in Research-Practice Partnerships

ABSTRACT Research-practice partnerships (RPPs) are one potential strategy to support educational transformation or improvement, and this focus inherently requires new ways of working for both practitioners and researchers. This paper seeks to understand how RPP engagement within an EdD program supported the development of practitioner-scholars through a case study of the Multnomah County Partnership for Education Research (MCPER). The study describes the perceptions of 67 practitioner-scholars from eight different doctoral cohorts and how the RPP impacted them in terms of building capacity, serving the local community, and enhancing their identity as a researcher: 89% of respondents reported learning valuable information, 79% described how the information learned was relevant to their professional lives, and 87% said completing the report developed their identity as a researcher. The practitioner-scholars also largely noted that completing a report improved their capacity to conduct data analysis (86% agreed), write a program evaluation report (84% agreed), and write a literature review (80% agreed). In terms of how participating in the RPP helped the practitioner-scholars, qualitative coding revealed participating in the project was a “real-world,” “boots on the ground” process that involved “serving the greater good” and built their confidence as a researcher. Engagement with the Multnomah County Partnership for Education Research (MCPER) is one strategy to support practitioners to develop these practitioner-scholar capacities.

“Connect Local”: protocol for the evaluation of a codesigned whole of community approach to promote social connection in older adults

BackgroundThere is wide acknowledgement in the literature that social connection is protective against loneliness and depression. More robust research, however, is needed to evaluate interventions that promote social connection. This protocol paper outlines the evaluation of a community-wide social connection program, Connect Local, in metropolitan Melbourne, Australia to support people 65 years and older to increase access to local community services/activities; and to ascertain impact on social connection, loneliness, depressive symptoms, physical and mental wellbeing, and use of health services.MethodsA Type 1 Hybrid design, including program effectiveness, cost-effectiveness, and implementation evaluation of the Connect Local program, will be undertaken. Eighty-eight participants aged ≥65 years with one or more chronic health condition, who are also either experiencing or at risk of loneliness, social isolation and depressive symptoms will be invited to participate in the evaluation. Outcomes, measured at baseline, 3, 6 and 12 months, include loneliness, social isolation, depressive symptoms, social anxiety, goal attainment, wellbeing, quality of life and health care utilisation. A gender and age matched comparator group of 88 individuals will be recruited from outside the intervention local government area. Impact of the intervention on community service providers in the target region will be evaluated using mixed methods, where triangulation will be used to combine the qualitative and quantitative data using a deductive-simultaneous design. Changes in wellbeing and quality of life of community volunteers will also be measured. All groups will be interviewed to ascertain their experience and perceptions of the program. The economic evaluation will use a Social Return on Investment (SROI) approach, to include outcomes at the individual, community, and system levels. Implementation outcomes will consider Reach, Adoption, Feasibility, Acceptability, Appropriateness, Fidelity, and Sustainability of the intervention.DiscussionThis study will provide a better understanding of the impacts of a community-wide social connection approach in older adults, the community and broader system.Clinical trial registrationhttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385192; Identifier ACTRN12623000968673.

Promotion of physical activity-related health competence in the workplace—a qualitative evaluation of a pilot program

Zusammenfassung Hintergrund Körperliche Aktivität kann einen wichtigen Beitrag zur Prävention chronischer Erkrankungen leisten. Büroangestellte bewegen sich jedoch häufig zu wenig. Deshalb wurde ein digitales Bewegungsprogramm für diese Zielgruppe entwickelt, das sich direkt am Schreibtisch durchführen lässt. Es enthält wöchentliche Videoübungen, die durch wissensbasierte Aspekte und motivationsfördernde Informationen auf Basis des Modells der bewegungsbezogenen Gesundheitskompetenz ergänzt wurden. Begleitend wurden die Teilnahmemotivation am Bewegungsprogramm und potenzielle Barrieren aus der Perspektive der Nutzenden erhoben mit dem Ziel, das Programm zu evaluieren und anhand der Ergebnisse anzupassen. Studiendesign und Untersuchungsmethoden Auf Basis von leitfadengestützten Interviews wurden 11 Personen aus der Interventionsgruppe (5 Abbrecher*innen und 6, die die Studie abgeschlossen haben; Altersdurchschnitt: 49 ± 8 Jahre) zu ihrer Wahrnehmung des Bewegungsprogramms befragt. Der Leitfaden beinhaltete Fragen zur Bewegung im (Arbeits)alltag, dem Ablauf und der Bewertung des Bewegungsprogramms. Die Auswertung erfolgte anhand der strukturierenden qualitativen Inhaltsanalyse nach Kuckartz. Ergebnisse Die Befragten bewerten das Bewegungsprogramm, insbesondere die kurzen Videos, die jeweils eine Übung und Erklärungen dazu beinhalten, mehrheitlich positiv. Ein förderlicher Faktor zur Teilnahme am Bewegungsprogramm war dessen Design. Zu Barrieren für die Teilnahme zählen das Arbeitsumfeld, insbesondere die Bürosituation, potenzielle Reaktionen von Kolleg*innen, oder wahrgenommene Einstellungen der Vorgesetzten. Zum Abbruch der Teilnahme führten persönliche oder arbeitsbezogene Gründe wie Mehrarbeit oder ein eigenes Trainingsprogramm. Von den Teilnehmenden beschriebene Effekte des Programms beinhalten ein höheres Bewusstsein darüber, dass Bewegung wichtig ist, ebenso wie die Adaption von einzelnen passenden Übungen im eigenen Alltag. Schlussfolgerung Aus Sicht der Teilnehmenden besteht ein Bedarf nach mehr Bewegung am Arbeitsplatz. Damit die Implementierung gelingt, braucht es aber Unterstützung von den Organisationen (z. B. Unternehmen) und Kolleg*innen sowie Möglichkeiten, das Programm auf die eigene Arbeitssituation abzustimmen.

#2605 Evaluation of cardiac fetal gene program in experimental uremia

Abstract Background and Aims Heart failure (HF) and uremia share several potent cardiac hypertrophic stimuli such as wall stress, sympathetic activation, renin angiotensin system activation and oxidative stress. In heart failure, induction of fetal gene program is one of the major processes through which such stimuli lead to progressive pathological hypertrophy and myocardial dysfunction. The fetal genes are activated by the transcription factor, myocyte enhance factor 2 (MEF2) which is a downstream target of the Ca++- Calmodulin Dependent Kinase II (CAMKII) pathway. The CAMKII pathway has been shown to be the major transduction pathway of the hypertrophic stimuli in HF [1, 2]. We hosphorzed that such mechanisms are also at play in uremic cardiomyopathy and tested the hypothesis in a rodent model of experimental uremia. Method Wistar rats (n = 18) had subtotal nephrectomy (STNx) or sham surgery (sham) and were followed up for 10 weeks. In vivo and in vitro cardiac assessments were performed. Cardiac tissue was extracted, and protein expression of CAMKII and hosphor-CAMKII were quantified using immunoblotting. Protein expression of MEF2 and its target fetal genes were also studied. Histological analyses were performed to quantify myocardial fibrosis. Data was analysed using an independent sample t-test with Welch's correction and expressed as mean± SEM. Results STNx resulted in higher echocardiographic left ventricular mass, heart weight to tibia length ratio and myocardial fibrosis in the STNx group (Fig. 1) demonstrating cardiac pathological hypertrophy. CaMKII signalling was activated and the expression of MEF2 was also increased following STNx (Fig. 1). There was trend towards increased expression of fetal genes (Fig. 1). However, the difference did not reach statistical significance. Conclusion The study shows that experimental uremia induces cardiac pathological hypertrophy along with activation of intracellular pathways involved in fetal gene induction. Further studies evaluating fetal genes at an earlier time course in the evolution of pathological hypertrophy will be worthwhile.

Transforming health care: Investigating Influenzer, a novel telemedicine-supported early discharge program for patients with lower respiratory tract infection: A non-randomized feasibility study.

The COVID-19 pandemic has posed unprecedented challenges to healthcare systems globally, necessitating innovative care models like hospital-at-home and virtual care programs. The Influenzer telemedicine program aims to deliver hospital-led monitoring and treatment to patients at home. Integrating telemedicine technology with domestic visits provides an alternative to traditional hospitalization, with the aim of easing the burden on healthcare facilities without compromising patient safety. To evaluate the effectiveness of the Influenzer program, a randomized controlled trial is proposed. This study aimed to assess the feasibility of the proposed clinical trial design. A non-randomized feasibility study was conducted at the Department of Pulmonary and Infectious Diseases at Nordsjaellands Hospital offering a telemedicine-supported early discharge program to patients with lower respiratory tract infections, including COVID-19. The feasibility of trial procedures, including recruitment, adherence, and retention, was analyzed. Also, participants' characteristics and trajectory during the intervention, including telemedicine and domestic services, were assessed. Nineteen patients were enrolled from June 2022 to April 2023 and treated at home. Forty patients were not enrolled as 15 (25%) were non-eligible according to study protocol, 15 (25%) refused to participate and 10 (17%) had not been approached. Subjects treated at home had comparable clinical outcomes to those treated in the acute hospital, no major safety incidences occurred and patients were highly satisfied. Participants demonstrated 99% adherence to planned daily monitoring activities. In total, 63% completed all survey assessments at least partially including baseline, at discharge, and 3 months post-discharge, while 89% participated in a follow-up interview. No participants withdrew their consent. The feasibility study documented that the Influenzer home-hospital program was feasible and well accepted in a Scandinavian setting in terms of no withdrawals and excellent participant adherence to the planned daily monitoring activities. Challenges in the organizational structures including patient recruitment and data collection required resolution prior to our randomized clinical trial. Insights from this feasibility study have led to the improved design of the final Influenzer program evaluation trial. ClinicalTrials.gov, NCT05087082. Registered on 18 August 2021.

Wellbeing education increases skills and knowledge among tertiary students in the agricultural sector: insights from a mixed methods study

ABSTRACT Purpose The agricultural sector is facing a myriad of financial, environmental, social, and cultural challenges which affect the mental health of those working on-farm. This study focused on a tertiary education programme designed to increase recognition of mental health issues and convey strategies to address these. Methodology To identify the effect of such a programme, and which aspects contribute to that effect, this paper applied a mixed methods approach. Quantitative propensity score matching was used to identify changes in knowledge and skills, and qualitative surveys were conducted to explore the wellbeing of students and to identify aspects of the programme contributing to change. Findings Students report an increase in (i) ability recognising signs of poor mental health in self and others; (ii) confidence talking about their own and others’ mental health; and (iii) knowing how to access mental health support services. Programme aspects contributing to this effect are peer-to-peer education and building on existing knowledge. Practical implications This paper addresses a gap in the literature by providing insights into programme aspects that lead to successful delivery. Theoretical implications This study reports on the evaluation of a tertiary education programme and provides valuable insights into whether such programmes can contribute to increased knowledge on wellbeing. Originality This research describes and analyses the effectiveness of a mental health promotion programme aimed at young adults which is rare in the literature.

Education of Hospitalized Diabetic Patients: Analysis of Training Needs among Nurses in a Lebanese Hospital – A Secondary Publication

The design of diabetes inpatient educational preparation should be based on the needs of the nurses involved in terms of skills in this area. The objective of this qualitative study is to identify the preparatory needs of nurses working in the medical and surgical units of a Lebanese hospital in terms of Survival Skills Education for Hospitalized Diabetic Patients (SSEHDP). Method: The focus group method is used for data collection using a semi-structured interview guide. The needs expressed by the thirty-two participating nurses were classified into categories of the competency framework for providing self-management education to diabetic patients proposed by the American Diabetes Association. Results: By focusing on the themes of an SSEHDP, a list of preparatory needs was drawn up. The needs identified and analyzed are then translated into general and specific learning objectives for educational preparation. Conclusion: The needs analysis is only the first step in a work that will ideally continue into the implementation and eventual evaluation of an educational program developed to help nurses acquire skills in the education of diabetic patients.

A Primary Care–Based Weight Navigation Program

Evidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss. To evaluate the association of a primary care-based weight navigation program (WNP) with WMT use and weight loss. This cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors. WNP, in which American Board of Obesity Medicine-certified primary care physicians offered weight-focused visits and guided patients' selection of preference-sensitive WMTs. Primary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months. Of 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P < .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P < .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P < .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing. The findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.

The practice and evaluation of antifungal stewardship programs at a tertiary first-class hospital in China

BackgroundThe sharp increase in fungal infections, insufficient diagnostic and treatment capabilities for fungal infections, poor prognosis of patients with fungal infections as well as the increasing drug resistance of fungi are serious clinical problems. It is necessary to explore the implementation and evaluation methods of antifungal stewardship (AFS) to promote the standardized use of antifungal drugs.MethodsThe AFS programme was implemented at a tertiary first-class hospital in China using a plan-do-check-act (PDCA) quality management tool. A baseline investigation was carried out to determine the utilization of antifungal drugs in pilot hospitals, analyse the existing problems and causes, and propose corresponding solutions. The AFS programme was proposed and implemented beginning in 2021, and included various aspects, such as team building, establishment of regulations, information construction, prescription review and professional training. The management effectiveness was recorded from multiple perspectives, such as the consumption of antifungal drugs, the microbial inspection rate of clinical specimens, and the proportion of rational prescriptions. The PDCA management concept was used for continuous improvement to achieve closed-loop management.ResultsIn the first year after the implementation of the AFS programme, the consumption cost, use intensity and utilization rate of antifungal drugs decreased significantly (P < 0.01). The proportion of rational antifungal drug prescriptions markedly increased, with the proportion of prescriptions with indications increasing from 86.4% in 2019 to 97.0% in 2022, and the proportion of prescriptions with appropriate usage and dosage increased from 51.9 to 87.1%. In addition, after the implementation of the AFS programme, physicians’ awareness of the need to complete microbial examinations improved, and the number of fungal cultures and serological examinations increased substantially. Statistics from drug susceptibility tests revealed a decrease in the resistance rate of Candida to fluconazole.ConclusionThis study indicated that the combination of AFS and the PDCA cycle could effectively reduce antifungal consumption and promote the rational use of antifungal drugs, providing a reference for other health care systems to reduce the overuse of antifungal drugs and delay the progression of fungal resistance.

A formative mixed methods evaluation of a new Ross program: why context matters

BackgroundThe Ross procedure is a technically complex operation to address the pathology of the aortic valve. Prior attempts at widespread implementation have been plagued with variations in effectiveness. We report our initial programmatic outcomes using dissemination and implementation (D&I) science frameworks, with an aim to define both programmatic efficacy and effectiveness. The study design was a single center, explanatory sequential mixed methods evaluation of a Ross surgery program from June 2020 to April 2023. Quantitative measures for baseline patient characteristics and postoperative outcomes were summarized. Qualitative measures were obtained using semi-structured interviews and characterized using implementation science frameworks.ResultsA total of 71 patients underwent the Ross procedure at a single academic center. Mean age was 40 years (± 13). There were no perioperative deaths or valve-related reinterventions (0%). During the follow-up period, 2 (2.8%) patients required re-operation and 2 (2.8%) required balloon dilation of the pulmonary homograft. Qualitative measures noted communication and prospective self-audit facilitated measures of effectiveness, as dichotomy within expected vs. observed outcomes led to program modifications. Collaboration across hospital systems promoted adoption and implementation, which led to the incorporation of the Ross procedure into accepted organizational practice.ConclusionsIn this formative evaluation, limited-efficacy outcomes demonstrated similar programmatic success to data from other established centers. With the prerequisite center volume and case selection, the Ross procedure is a safe and efficacious treatment for aortic valvular disease. Implementation science can be used both in real-time and retrospectively to guide organizational efforts to improve outcomes and to improve the translation of results across centers.