Single-component Interventions Research Articles

Reading Comprehension Interventions for Students With Autism Spectrum Disorders

We conducted two separate but related single-case studies using alternating treatment designs to investigate the effects of two single-component reading interventions: question development and anaphoric cueing. In each study, we compared a typical intervention approach (Study 1, question development; Study 2, anaphoric cueing) with an alternate approach that included the addition of applied behavior analysis (ABA) techniques. The treatments that included ABA techniques were designed to improve the performance of students with autism spectrum disorders (ASD) on curriculum-based measures (CBM) of reading and on-task behavior measures during the reading tasks. The ABA techniques included the use of visual supports, a token economy, and the use of readings based on the perseverative interests of students. Four students in Grades 3 to 5 identified with ASD participated—two students in each study. Study 1 evaluated the relative effects of question development plus ABA compared with question development on CBM reading probes and an on-task behavior measure for two students. Study 2 evaluated the relative effects of anaphoric cueing plus ABA compared with anaphoric cueing on CBM reading probes and an on-task behavior measure for two students. The results indicated that the treatments that included ABA techniques were more effective than treatments that did not include ABA. These data support the use of ABA techniques for the enhancement of question development and anaphoric cueing as a means to improve reading comprehension and on-task behavior for students with ASD.

Neuromuscular training is effective to prevent ankle sprains in a sporting population: a meta-analysis translating evidence into optimal prevention strategies

ImportanceAnkle sprains are the most common sports-related injuries for which effective preventive measures exist. This review summarises the preventive effectiveness of this neuromuscular training (NMT), culminating in an overview of effective exercise components.ObjectiveTo assess the preventive effect of NMT for first-time and recurrent ankle sprains in sports.Evidence reviewAn electronic literature search of PubMed, SPORTDiscus and EMBASE was conducted (until 24 March 2016) to identify published randomised controlled trials (RCTs), controlled trials (CTs) and time trend analyses related to NMT as a preventive measure for ankle sprains. Methodological quality of relevant studies was assessed using a predefined set of 19 criteria. Meta-analyses were performed on comparable populations and intervention content.FindingsA total of 30 studies met the inclusion criteria and were analysed (24 RCTs, 3 CTs and 3 time interventions). Studies showed a great diversity in preventive effects and methodological quality (quality score ranged between 47% and 100%). The diversity in preventive effect was independent of study quality and design. A total of 14 studies focussed solely on the effectiveness of balance training, and 16 studies evaluated the effect of balance training combined with adjunct interventions. Pooled data showed a significant reduction in the occurrence of ankle sprains (relative risk (RR) 0.60; 95% CI 0.51 to 0.71). Single-component interventions specifically targeted at ankle sprains achieved preventive effects (RR=0.58; 95% CI 0.48 to 0.72) as opposed to multicomponent interventions (RR 0.67; 95% CI 0.37 to 1.24). With respect to interventions targeted at general injuries, significant effects were found using both single-component (RR=0.71; 95% CI 0.52 to 0.97) and multicomponent interventions (RR=0.55; 95% CI 0.41 to 0.74). Pooled data showed a significant reduction of NMT on ankle sprains in studies including participants regardless of their injury history (RR=0.59; 95% CI 0.49 to 0.71), and in athletes with a previous ankle sprain (RR=0.69; 95% CI 0.49 to 0.98).Conclusions and relevanceNMT is effective at reducing ankle sprains in a sporting population, and in athletes with a previous ankle sprain. The evidence for an effect on first-time ankle sprains remains inconclusive. A key element of NMT to prevent ankle sprains is balance training, irrespective of the use of balance boards or other balance devices. Since both single-component and multicomponent NMT interventions are effective at reducing ankle sprains, the type most fitting to the context should be chosen for implementation efforts.Level of evidenceLevel 1.

Effectiveness of discharge interventions from hospital to home on hospital readmissions: a systematic review.

Many discharge interventions are developed to reduce unplanned hospital readmissions, but it is unclear which interventions are more effective. The objective of this review was to identify discharge interventions from hospital to home that reduce hospital readmissions within three months and to understand their effect on secondary outcome measures. Participants were adults (18 years or older) discharged from a medical or surgical ward.The included interventions had to be designed to ease the care transition from hospital to home or to prevent problems after hospital discharge.This review considered only randomized controlled trials.The primary outcome measure was hospital readmission within three months after discharge. Secondary outcomes included patient satisfaction, return to emergency departments and mortality. Studies in English between January 1990 and July 2014 were considered for inclusion. The databases searched were PubMed, Web of Science, Embase and CINAHL. Methodological validity was assessed by two reviewers prior to inclusion using the standardized critical appraisal instruments from the Joanna Briggs Institute. Quantitative data were independently extracted by the two reviewers using the standardized data extraction tool from the Joanna Briggs Institute. Meta-analysis was performed by using a random effect model; data were pooled using Mantel-Haenszel methods. For subgroups analysis only papers with critical appraisal score of seven or more were selected. Meta-analysis was performed on 47 studies. The overall relative risk for hospital readmission was 0.77 [95% CI, 0.70-0.84] (p<0.00001). The relative risk for return to the emergency department was 0.75 [95% CI, 0.55-1.01] (p=0.06) and for mortality 0.70 [95% CI, 0.48-1.01] (p=0.06). Patient satisfaction improved in favor of the intervention group in five out of the six studies evaluating patient satisfaction.Exploratory subgroup analysis found that interventions starting during hospital stay and continuing after discharge were more effective in reducing readmissions compared to interventions starting after discharge (between subgroup difference p=0.01). Multicomponent interventions were not more effective compared to single component interventions (between subgroup difference p=0.54). Interventions oriented towards patient empowerment were more effective compared to all other interventions (between subgroup difference p=0.02). Interventions designed to improve the care transition from hospital to home are effective in reducing hospital readmission. These interventions preferably start in the hospital and continue after discharge rather than starting after discharge. Enhancing patient empowerment is a key factor in reducing hospital readmissions.Interventions to reduce hospital readmissions should start during hospital stay and continue in the community (grade A recommendation). This requires financial systems to support and facilitate collaboration between hospitals and home care.Interventions that support patient empowerment are more effective in reducing hospital readmissions (grade B recommendation). To promote patient empowerment caregivers must be trained to increase patients' capacity to self-care.Future research should focus on interventions that improve patient empowerment and the effects of discharge interventions after more than three months.

Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series.

BackgroundNon-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc.) are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.Methods and FindingsWe performed a systematic overview of systematic reviews (SRs) of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014) were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs): relative risk (RR) 0.71, 95% Confidence Interval (CI) 0.59 to 0.86, I2=0%; (GRADE evidence: moderate)] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate)]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group)[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low)]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non-pharmacological interventions to treat delirium. Among single component interventions only staff education, reorientation protocol (GRADE evidence: very low)] and Geriatric Risk Assessment MedGuide software [hazard ratio 0.42, 95%CI 0.35 to 0.52, (GRADE evidence: moderate)] resulted effective in preventing delirium.ConclusionsIn older patients multi-component non-pharmacological interventions as well as some single-components intervention were effective in preventing delirium but not to treat delirium.

Examining the Impact of Policy and Practice Interventions on High School Dropout and School Completion Rates

The purpose of this literature review is to systematically examine policy and practice intervention research and assess the impact of those interventions on high school dropout and school completion rates. This systematic review extends the literature by (a) describing both policy and practice interventions, (b) synthesizing findings from experimental or quasi-experimental research, and (c) examining the common elements of effective interventions. Specifically, this review addresses two main questions. First, what are the characteristics of the empirical literature examining high school dropout or school completion interventions? Second, what are the common elements of effective policy or practice interventions for reducing high school dropout rates or increasing school completion rates? Findings indicate that despite research highlighting the need to address multiple risk factors and the need for early intervention, the bulk of current empirical research is focused on single-component, individual, or small group interventions delivered at the high school level. Further research is needed to provide guidance to schools regarding the integration of dropout efforts with other school initiatives. Multitiered frameworks of support are suggested as a structure for accomplishing this effectively and efficiently.

Comparative Analysis of Single Versus Multiple Behavioral Economics Intervention Components on Children's Food Intake from The National School Lunch Program

Student waste of National School Lunch Program (NSLP) meals may contribute to childhood obesity as students may compensate with energy‐dense, low‐nutrient foods. We previously demonstrated a multiple component Behavioral Economics (BE) intervention increased consumption of NSLP entrée and vegetables among elementary‐aged children. However, the contribution of each component to this increase cannot be independently determined. Such knowledge may provide the minimum intervention to increase NSLP consumption. The aim of this study was to evaluate the independent versus additive effects of 2 common BE intervention components at increasing intake of NSLP meals: descriptive labels for all foods, and the addition of a second fruit choice. A multiple intervention trial was implemented in autumn 2014 at 2 elementary schools (K–6) with standardized menus. In each school, plate waste (PW) was collected on 40 randomly selected trays 3 days/week for 3 weeks during: 1) baseline; 2) single component intervention; and 3) two component intervention. PW was measured on a 5‐point scale from 0 (all eaten) to 4 (all wasted) using the validated Quarter‐Waste method. Data were analyzed using a cumulative logit regression model. A process evaluation checklist assessed intervention fidelity. At baseline, PW of NSLP elements ranged between 52‐80%. Statistical analysis yielded no evidence that single component interventions changed PW. Two component intervention data will be collected in winter 2014. Findings from this study may inform waste‐minimization practices to increase intake of reimbursable meals.

An implementation science perspective on psychological science and cancer: what is known and opportunities for research, policy, and practice.

We discuss the role of implementation science in cancer and summarize the need for this perspective. Following a summary of key implementation science principles and lessons learned, we review the literature on implementation of cancer prevention and control activities across the continuum from prevention to palliative care. We identified 10 unique relevant reviews, four of which were specific to cancer. Multicomponent implementation strategies were found to be superior to single-component interventions, but it was not possible to draw conclusions about specific strategies or the range of conditions across which strategies were effective. Particular gaps identified include the need for more studies of health policies and reports of cost, cost-effectiveness, and resources required. Following this review, we summarize the types of evidence needed to make research findings more actionable and discuss emerging implementation science opportunities for psychological research on cancer prevention and control. These include innovative study designs (i.e., rapid learning designs, simulation modeling, comparative effectiveness, pragmatic studies, mixed-methods research) and measurement science (i.e., development of context-relevant measures; practical, longitudinal measures to gauge improvement; cost-effectiveness data; and harmonized patient report data). We conclude by identifying a few grand challenges for psychologists that if successfully addressed would accelerate integration of evidence into cancer practice and policy more consistently and rapidly.

A Systematic Review of Palliative Interventions: Populations, Intervention Components, and Healthcare Use and Cost (S790)

•Identify the extent of current knowledge of the populations appropriate for palliative care, components of effective palliative interventions, and the impact of palliative interventions on healthcare use and cost.•Identify the areas of palliative care in need of additional research. Given limited resources for end-of-life care, payers and providers are increasingly faced by the questions of which interventions to deliver, which populations to focus on, and how to operationalize advanced illness. Existing standards and definitions of palliative care, which focus more on palliative care as an approach than as a set of services, require additional specificity in order to address these issues. To identify the populations appropriate for palliative care; to identify the interventions and intervention components that are most effective in promoting better palliative care; to identify the impact of palliative interventions on healthcare use and cost. Systematic review of RCTs using PubMed, Embase, PsycINFO, and Cochrane databases. Literature searches were conducted from January 2001 to March 2013 and addressed health services interventions in palliative populations, with either (1) HRQOL as either intervention or outcome or (2) healthcare use or cost outcomes. 14,961 original citations were reviewed, and 109 RCTs were included in the final set of articles. Populations were typically identified using a combination of disease and severity; a minority of studies evaluated prognosis as an inclusion criterion. Single component interventions had limited effect on HRQOL; multicomponent interventions with medical and non-medical components across different healthcare settings were more successful. Behavioral support interventions improved psychosocial subjective outcomes but not observable outcomes. Almost no study demonstrated worsening in any HRQOL outcome, but there were many insignificant results; the clinical literature was heterogeneous and resisted easy parsing. Few studies addressed economic outcomes; of those that did, interventions that employed palliative care teams and/or emphasized communication, coordination, and caregiver inclusion generally had positive impacts on healthcare use and cost. There is a need to study additional conditions such as ESRD; non-pain symptoms using evidence-based approaches; system implementation involving patients and families; and scalable, low-cost alternative models such as group advance care planning.

Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews.

BackgroundOne of the greatest challenges in healthcare is how to best translate research evidence into clinical practice, which includes how to change health-care professionals’ behaviours. A commonly held view is that multifaceted interventions are more effective than single-component interventions. The purpose of this study was to conduct an overview of systematic reviews to evaluate the effectiveness of multifaceted interventions in comparison to single-component interventions in changing health-care professionals’ behaviour in clinical settings.MethodsThe Rx for Change database, which consists of quality-appraised systematic reviews of interventions to change health-care professional behaviour, was used to identify systematic reviews for the overview. Dual, independent screening and data extraction was conducted. Included reviews used three different approaches (of varying methodological robustness) to evaluate the effectiveness of multifaceted interventions: (1) effect size/dose-response statistical analyses, (2) direct (non-statistical) comparisons of multifaceted to single interventions and (3) indirect comparisons of multifaceted to single interventions.ResultsTwenty-five reviews were included in the overview. Three reviews provided effect size/dose-response statistical analyses of the effectiveness of multifaceted interventions; no statistical evidence of a relationship between the number of intervention components and the effect size was found. Eight reviews reported direct (non-statistical) comparisons of multifaceted to single-component interventions; four of these reviews found multifaceted interventions to be generally effective compared to single interventions, while the remaining four reviews found that multifaceted interventions had either mixed effects or were generally ineffective compared to single interventions. Twenty-three reviews indirectly compared the effectiveness of multifaceted to single interventions; nine of which also reported either a statistical (dose-response) analysis (N = 2) or a non-statistical direct comparison (N = 7). The majority (N = 15) of reviews reporting indirect comparisons of multifaceted to single interventions showed similar effectiveness for multifaceted and single interventions when compared to controls. Of the remaining eight reviews, six found single interventions to be generally effective while multifaceted had mixed effectiveness.ConclusionThis overview of systematic reviews offers no compelling evidence that multifaceted interventions are more effective than single-component interventions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0152-6) contains supplementary material, which is available to authorized users.

WITHDRAWN: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases.

Breathlessness is a common and distressing symptom in the advanced stages of malignant and non-malignant diseases. Appropriate management requires both pharmacological and non-pharmacological interventions.The primary objective was to determine the effectiveness of non-pharmacological and non-invasive interventions to relieve breathlessness in participants suffering from the five most common conditions causing breathlessness in advanced disease.We searched the following databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, Science Citation Index Expanded, AMED, The Cochrane Pain, Palliative and Supportive Care Trials Register, The Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness in June 2007. We also searched various websites and reference lists of relevant articles and textbooks.We included randomised controlled and controlled clinical trials assessing the effects of non-pharmacological and non-invasive interventions to relieve breathlessness in participants described as suffering from breathlessness due to advanced stages of cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, chronic heart failure or motor neurone disease.Two review authors independently assessed relevant studies for inclusion. Data extraction and quality assessment was performed by three review authors and checked by two other review authors. Meta-analysis was not attempted due to heterogeneity of studies.Forty-seven studies were included (2532 participants) and categorised as follows: single component interventions with subcategories of walking aids (n = 7), distractive auditory stimuli (music) (n = 6), chest wall vibration (CWV, n = 5), acupuncture/acupressure (n = 5), relaxation (n = 4), neuro-electrical muscle stimulation (NMES, n = 3) and fan (n = 2). Multi-component interventions were categorised in to counselling and support (n = 5), breathing training (n = 3), counselling and support with breathing-relaxation training (n = 2), case management (n = 2) and psychotherapy (n = 2). There was a high strength of evidence that NMES and CWV could relieve breathlessness and moderate strength for the use of walking aids and breathing training. There is a low strength of evidence that acupuncture/acupressure is helpful. There is not enough data to judge the evidence for distractive auditory stimuli (music), relaxation, fan, counselling and support, counselling and support with breathing-relaxation training, case management and psychotherapy. Most studies have been conducted in COPD patients, only a few studies included participants with other conditions.Breathing training, walking aids, NMES and CWV appear to be effective non-pharmacological interventions for relieving breathlessness in advanced stages of disease.

Reducing Hospital Readmission Rates: Current Strategies and Future Directions

New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

The efficacy of single-component brief motivational interventions among at-risk college drinkers.

College students are an at-risk population for heavy drinking and negative alcohol-related outcomes. Research has established that brief, multicomponent motivational interviewing-based interventions can be effective at reducing alcohol use or related problems, but less is known about the efficacy of individual components within these interventions. The purpose of this study was to test the efficacy of 2 single-component, in-person, brief (15-20 min) alcohol interventions: personalized normative feedback (PNF) and protective behavioral strategies feedback (PBSF). Data were collected on 365 undergraduate students from a large Midwestern university (65% women; 89% White) who were randomly assigned to 1 of 3 conditions: PNF, PBSF, or alcohol education (AE). Participants completed measures of alcohol use, alcohol-related problems, social norms, and protective behavioral strategies. Results indicated that the PNF intervention was efficacious relative to the other conditions at reducing alcohol use and that its effects at 6-month follow-up were mediated by changes in perceived norms at the 1-month follow-up. The PBSF intervention was not efficacious at reducing alcohol use or alcohol-related problems. These findings provide support for the efficacy of an in-person PNF intervention and theoretical support for the hypothesized mechanisms of change in the intervention. Implications for researchers and clinicians are discussed.

The effectiveness of health services interventions to promote and support breastfeeding initiation and exclusivity

Worldwide breastfeeding (BF) rates fall short of recommendations. Health services initiatives exist to provide a supportive environment, yet challenges remain. Thus, we set out to systematically review the evidence on health services interventions to promote and support BF initiation and exclusivity. As numerous systematic reviews (SR) have been conducted to assess the effectiveness of interventions on BF outcomes, a review of SR was undertaken. Seven key databases were searched using combinations of search terms including SR, BF, health promotion, health education and health policy. After applying inclusion and exclusion criteria and quality assessment, the search yielded 19 papers published between 1992 and 2012. Commonly cited limitations included diversity in definitions of BF outcomes and heterogeneity of interventions. Preliminary findings show that multi‐component interventions targeting women from the prenatal through to postnatal periods were most effective at improving initiation and exclusivity of BF as compared to single‐component and single‐contact interventions. There is also evidence that a combination of professional and lay support is more effective than professional support alone at increasing exclusive BF rates. Policy implications include the need to invest in multi‐component interventions that follow women up rather than invest in one‐time interventions.

Current Pharmacological and Nonpharmacological Options for the Management of Insomnia

Insomnia continues to be a major public health concern and to have a pronounced and detrimental effect on health care costs, productivity, and quality of life. Efficacious pharmacological and nonpharmacological interventions have emerged over the past few decades, giving providers several options for addressing this disruptive condition; these are herein reviewed. Benzodiazepines have long been the pharmacological treatment of choice for insomnia; however, novel hypnotics being developed by the pharmaceutical industry show promise in addressing insomnia with fewer side effects. From the nonpharmacological perspective, several different single-component interventions such as stimulus control have been shown to be effective, although a combination of these approaches (eg, cognitive-behavioral therapy for insomnia) also enjoy strong empirical support. Future research should continue to examine how sequencing of treatment components, treating different patient cohorts, and combinations of pharmacological and non-pharmacological treatments influence patient outcome.

Effectiveness of interventions to promote healthy weight in general populations of children and adults: a meta-analysis

Responding to the obesity epidemic requires robust evidence to help prioritize the allocation of scarce resources to preventive interventions. The aim of this study was to evaluate interventions that promote healthy weight [defined as reduction in body mass index (BMI) or percentage body fat] in general populations (unselected by weight) using a comprehensive meta-analysis. Interventions with both single and multiple components were considered. Studies were first identified through well-conducted systematic reviews complemented by a search for single studies in five large medical databases up to 6 November 2008. Sixty-eight controlled studies were included. For each intervention type and age group, all relevant studies were pooled in a random effects meta-analysis. In children, the highest reductions in mean BMI were achieved through promoting reduced television viewing [-0.27 kg/m(2) (95% CI -0.4 to -0.13 kg/m(2))]. Programmes combining physical activity, specifically themed or general health education and nutrition achieved a lower reduction [-0.1 kg/m(2) (95% CI -0.17 to -0.04 kg/m(2))]. Other interventions had high heterogeneity or showed no statistically significant reduction in outcomes. In adults, single component interventions were found to reduce both outcome measures. Their mean percentage body fat was reduced through education by -1.22% (95% CI -1.92 to -0.52). The evidence for the effectiveness of promoting healthy weight in general populations is limited, though multi-component interventions in schools and encouraging reduced children's television viewing are promising strategies. Improving the reporting of outcomes is vital, as imputation of inadequately reported measures may have contributed to the observed heterogeneity. Longer follow-up is essential for understanding policy relevance.

Universal multi-component prevention programs for alcohol misuse in young people

Alcohol misuse in young people is a cause of concern for health services, policy makers, prevention workers, and criminal justice system, youth workers, teachers, and parents. To systematically review evidence on the effectiveness of universal multi-component prevention programs in preventing alcohol misuse in school-aged children up to 18 years of age. To update a part of a previously published Cochrane systematic review. Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO. Randomized trials evaluating universal multi-component prevention programs (intervention delivered in more than one setting) and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records. Two reviewers extracted relevant data independently using ana prioridefined extraction form. Risk of bias was assessed. 20 parallel-group trials were included. The reporting quality of trials was poor, only 25% and 5% of them reporting adequate method of randomisation and program allocation concealment, respectively. Incomplete data was adequately addressed in about half of the trials and this information was unclear for about 20% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.12 of the 20 trials showed some evidence of effectiveness compared to a control or other intervention group, with persistence of effects ranging from 3 months to 3 years. Of the remaining 8 trials, one trial reported significant effects using one-tailed tests and 7 trials reported no significant effects of the multi-component interventions for reducing alcohol misuse.Assessment of the additional benefit of multiple versus single component interventions was possible in 7 trials with multiple arms. Only one of the 7 trials clearly showed a benefit of components delivered in more than one setting. There is some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, there is little evidence that interventions with multiple components are more effective than interventions with single components.

Global evidence synthesis and UK idiosyncrasy: why have recent UK trials had no significant effects on breastfeeding rates?

Global evidence synthesis and UK idiosyncrasy: why have recent UK trials had no significant effects on breastfeeding rates?

Cochrane Review: Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma

Cochrane Review: Mono and multifaceted inhalant and/or food allergen reduction interventions for preventing asthma in children at high risk of developing asthma

Preventing the rebound: improving care transition in hospital discharge processes

Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements. Systematic metareview of controlled trials. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital–community interface.

Evaluation of medical and health economic effectiveness of non-pharmacological secondary prevention of coronary heart disease.

Evaluation of medical and health economic effectiveness of non-pharmacological secondary prevention of coronary heart disease.