Standardized Intervention Protocol Research Articles

Who is a better teacher for children with autism? Comparison of learning outcomes between robot-based and human-based interventions in gestural production and recognition

BackgroundIndividuals with autism spectrum disorder (ASD) tend to show deficits in engaging with humans. Previous findings have shown that robot-based training improves the gestural recognition and production of children with ASD. It is not known whether social robots perform better than human therapists in teaching children with ASD. AimsThe present study aims to compare the learning outcomes in children with ASD and intellectual disabilities from robot-based intervention on gestural use to those from human-based intervention. Methods and proceduresChildren aged six to 12 with low-functioning autism were randomly assigned to the robot group (N = 12) and human group (N = 11). In both groups, human experimenters or social robots engaged in daily life conversations and demonstrated to children 14 intransitive gestures in a highly-structured and standardized intervention protocol. Outcomes and resultsChildren with ASD in the human group were as likely to recognize gestures and produce them accurately as those in the robot group in both training and new conversations. Their learning outcomes maintained for at least two weeks. Conclusions and implicationsThe social cues found in the human-based intervention might not influence gestural learning. It does not matter who serves as teaching agents when the lessons are highly structured.

Targeted Intervention Services for People Who Inject Drugs in Nepal

This study was conducted in the several districts of TI project implemented areas where 102 respondents as a sample size and 12 were the Female Who Injects Drugs (FWID): Kathmandu, Lalitpur Kaski, Tanahu, Chitwan, Kailali, Sarlahi and Jhapa respectively. For the study 10-15 participants enrolled from each districts. The major findings of the study are based upon the Drug User’s perspectives includes: PWIDs were unable to receive services from the Dropping in Centers (DIC) due to the extreme police harassment in the Kaski district. Using contaminated syringe, sharing of used syringe in a group, stolen syringe from the hospitals were the common trend identified during the gap of the project for PWIDs by Nepal Government in Kaski district, Tanahu district and Chitwan district respectively. This study reveals that there was lack of standard intervention protocol and guidelines for the PWIDs community. Furthermore, comprehensive package as well as multi years project was felt to be necessary without any gaps in the services to reduce the HIV transmission, HCV and Hep B among the PWIDs.

Diagnostic, Treatment, and System Challenges in the Management of Recurrent Neuroleptic Malignant Syndrome on a General Medical Service

Neuroleptic malignant syndrome (NMS), an iatrogenic form of malignant catatonia, carries high morbidity and mortality rates especially in the context of delayed recognition and standard intervention protocol of lorazepam trial. However, there is limited guidance available through literature for further management if benzodiazepine treatment is ineffective and electroconvulsive therapy (ECT) is not readily accessible. This case report describes a multimodal approach to address the diagnostic, treatment, and logistical system challenges in an acute medical hospital through the case of a 69-year-old man with schizophrenia who represented from a psychiatric ward with neuroleptic malignant syndrome. We educated our inpatient colleagues for timely recognition of hyperexcited subtype of catatonia to avoid iatrogenic progression to neuroleptic malignant syndrome and our medical colleagues on the clinical course of catatonic symptoms to avoid any further disagreements and delays in treatment. We advocated for timely electroconvulsive therapy in the setting of limited access and utilized creative pharmacologic strategies such as N-methyl-D-aspartate (NMDA) receptor antagonists and longer acting benzodiazepines while managing medical complications.

Therapeutic Horseback Riding Crossover Effects of Attachment Behaviors with Family Pets in a Sample of Children with Autism Spectrum Disorder.

The unique needs of individuals with autism spectrum disorder (ASD) have implications for animal welfare. This nested pilot study examined the effects of a randomized trial of 10-week therapeutic horseback riding (THR) intervention versus a no-horse barn activity (BA) control group on children’s behaviors with family pets. Sixty-seven (THR n = 31; BA n = 36) participants with ASD (ages 6–16 years) with one or more family pet, were enrolled from a larger trial (n = 116) following their randomization to intervention groups, stratified by nonverbal intellectual ability. A consistent caregiver completed questionnaires about participants’ interactions with their household pets pre- and post-intervention. Caregivers of THR group participants reported significant improvements in participants’ caring actions with the family pet compared with the BA group (p = 0.013; effect size = 0.74). Engaging with horses during a standard THR intervention protocol may generalize to improving caring actions toward family pets in children and adolescents with ASD.

Impact of the Japanese 5S management method on patients’ and caretakers’ satisfaction: a quasi-experimental study in Senegal

BackgroundThe 5S method is a lean management tool for workplace organization, with 5S being an abbreviation for five Japanese words that translate to English as Sort, Set in Order, Shine, Standardize, and Sustain. In Senegal, the 5S intervention program was implemented in 10 health centers in two regions between 2011 and 2014.ObjectiveTo identify the impact of the 5S intervention program on the satisfaction of clients (patients and caretakers) who visited the health centers.DesignA standardized 5S intervention protocol was implemented in the health centers using a quasi-experimental separate pre-post samples design (four intervention and three control health facilities). A questionnaire with 10 five-point Likert items was used to measure client satisfaction. Linear regression analysis was conducted to identify the intervention's effect on the client satisfaction scores, represented by an equally weighted average of the 10 Likert items (Cronbach's alpha=0.83). Additional regression analyses were conducted to identify the intervention's effect on the scores of each Likert item.ResultsBackward stepwise linear regression (n=1,928) indicated a statistically significant effect of the 5S intervention, represented by an increase of 0.19 points in the client satisfaction scores in the intervention group, 6 to 8 months after the intervention (p=0.014). Additional regression analyses showed significant score increases of 0.44 (p=0.002), 0.14 (p=0.002), 0.06 (p=0.019), and 0.17 (p=0.044) points on four items, which, respectively were healthcare staff members’ communication, explanations about illnesses or cases, and consultation duration, and clients’ overall satisfaction.ConclusionsThe 5S has the potential to improve client satisfaction at resource-poor health facilities and could therefore be recommended as a strategic option for improving the quality of healthcare service in low- and middle-income countries. To explore more effective intervention modalities, further studies need to address the mechanisms by which 5S leads to attitude changes in healthcare staff.

The effectiveness of an intensive, parent mediated, multi-component, early intervention for children with autism

Aim: Most children with autism do not receive early intervention, unless parents are trained, in countries with low child mental health resources. To maximize the existing resource, we evaluated the feasibility and effectiveness of an intensive, parent mediated, multi-component, early intervention for autism in India. Methods: Data of 77 children with an ICD-10 diagnosis of autism who completed a 12-week, five days a week, intervention program and regular practice at home was collected from the database of a teaching hospital. Intervention components included the standard intervention protocol, the Psycho-Educational Profile intervention (PEP-R) and the Carolina Curriculum for Infants and Toddlers with Special Needs.Pre and post-intervention PEP-R rating of parents were used to evaluate the intervention outcome. Appropriate bivariate, multivariate and resampling techniques were used to evaluate the intervention effectiveness. Results: The effect size (ES) for the intervention was moderate to large for the PEP-R developmental age as well as perception, fine motor, gross motor, eye-hand coordination, cognitive performance and cognitive verbal domain among children with mild to moderate (ES ranged from 0.70 to 0.88) and severe autism (ES ranged from 0.73 to 0.87). There was no difference in the intervention effect between the groups (ES ranged from 0.004 to 0.30). The effectiveness of the intervention continued after controlling the confounding effect of baseline developmental quotient, developmental age and adaptive skills. Conclusion: It is feasible to provide an effective parent mediated early intervention for mild to severe autism in countries where parents are the cornerstone in childhood disability care.

Study protocol: a randomized controlled trial investigating the effects of a psychosexual training program for adolescents with autism spectrum disorder.

BackgroundPrevious research shows that adolescents with autism spectrum disorder (ASD) run several risks in their psychosexual development and that these adolescents can have limited access to reliable information on puberty and sexuality, emphasizing the need for specific guidance of adolescents with ASD in their psychosexual development. Few studies have investigated the effects of psychosexual training programs for adolescents with ASD and to date no randomized controlled trials are available to study the effects of psychosexual interventions for this target group.Methods/DesignThe randomized controlled trial (RCT) described in this study protocol aims to investigate the effects of the Tackling Teenage Training (TTT) program on the psychosexual development of adolescents with ASD. This parallel clinical trial, conducted in the South-West of the Netherlands, has a simple equal randomization design with an intervention and a waiting-list control condition. Two hundred adolescents and their parents participate in this study. We assess the participants in both conditions using self-report as well as parent-report questionnaires at three time points during 1 year: at baseline (T1), post-treatment (T2), and for follow-up (T3).DiscussionTo our knowledge, the current study is the first that uses a randomized controlled design to study the effects of a psychosexual training program for adolescents with ASD. It has a number of methodological strengths, namely a large sample size, a wide range of functionally relevant outcome measures, the use of multiple informants, and a standardized research and intervention protocol. Also some limitations of the described study are identified, for instance not making a comparison between two treatment conditions, and no use of blinded observational measures to investigate the ecological validity of the research results.Trial registrationDutch Trial Register NTR2860. Registered on 20 April 2011.

Peer Management Interventions: A Meta-Analytic Review of Single-Case Research

Peer management intervention is a subtype of peer-mediated intervention that involves training individuals to implement standardized intervention protocols to modify the behavior of their peers. Th...

A randomized controlled trial of the effectiveness of an educational intervention on outcomes of parents and their children undergoing inpatient elective surgery: study protocol.

To report a study protocol that tests the effectiveness of an educational intervention on outcomes of parents and their children who undergo inpatient elective surgery. Inadequate children's postoperative pain management remains a global problem. Parents are required to be involved in their child's pain assessment and management, yet they often lack relevant knowledge and skills. Education is an effective strategy for enhancing a person's knowledge, attitudes and behaviour. However, few studies have examined its effectiveness in parents and their children undergoing inpatient elective surgery. Randomized controlled trial and embedded qualitative process evaluation. One hundred and sixty-two pairs of participants (each comprised of one parent and his/her child undergoing inpatient elective surgery) will be recruited (protocol approved in January 2013). Participants will be randomized to either a Control group (routine care), an Intervention group 1 (routine care and an educational intervention with face-to-face teaching), or an Intervention group 2 (routine care and an educational intervention without face-to-face teaching). Outcome measures will include parents' knowledge, attitude and behaviour related to postoperative pain management; their child's postoperative pain; and parents' satisfaction with their child's pain management at baseline and around 6, 12 and 24 hours after the operation. A standardized educational intervention protocol and detailed study procedure have been developed in this study to improve parents' knowledge, attitude and behaviour related to postoperative pain management and reduce their child's postoperative pain.

Music in disorders of consciousness.

This review presents an overview of the use of music therapy in neurological early rehabilitation of patients with coma and other disorders of consciousness (DOC) such as unresponsive wakefulness syndrome (UWS) or minimally conscious state (MCS). There is evidence that patients suffering from UWS show emotional processing of auditory information, such as listening to speech. Thus, it seems reasonable to believe that music listening—as part of an enriched environment setting—may be of therapeutic value in these patients. There is, however, a considerable lack of evidence. The authors strongly encourage further studies to evaluate the efficacy of music listening in patients with DOC in neurological early rehabilitation. These studies should consider a precise clinical definition and homogeneity of the patient cohort with respect to the quality (coma vs. UWS vs. MCS), duration (rather weeks to months than days) and cause (traumatic vs. non-traumatic) of DOC, a standardized intervention protocol, valid clinical outcome parameters over a longer observation period (weeks to months), monitoring of neurophysiological and vegetative parameters and, if available, neuroimaging to confirm diagnosis and to demonstrate responses and functional changes in the patients' brains.

감정자유기법(EFT)의 연구를 중심으로 본 경락기반심리요법의 동향

Objectives : The purpose of this study is to investigate the researches about regarding Emotional Freedom Technique (EFT) and to understand the trends of Meridian-based Psychotherapy. Methods : Every article relevant to EFT was obtained from 'Pubmed' and Korean journal databases. Keywords used for searching included 'EFT' and 'Emotional freedom technique'. Results : 1) 5 reviews, 11 randomized controlled trials, 3 controlled trials, 1 single group comparative study and 4 case studies were searched. 2) Anxiety disorders were most frequently studied with EFT. Other studies included insomnia, depression and pain symptoms. EFT interventions were attempted in many different protocols and assessed with various tools. 3) Review articles indicated that meridian-based psychotherapies, such as EFT, are based on the meridian theory of oriental medicine. They evaluate EFT positively for its effectiveness on psychiatric diseases. Conclusions : EFT is increasingly studied and used in clinical practice of various fields. Objective evaluation tools and standardized intervention protocols are needed for the development of a new guideline for EFT.

Study protocol: the effect of whole body vibration on acute unilateral unstable lateral ankle sprain- a biphasic randomized controlled trial

BackgroundAnkle sprains often result in ankle instability, which is most likely caused by damage to passive structures and neuromuscular impairment. Whole body vibration (WBV) is a neuromuscular training method improving those impaired neurologic parameters. The aim of this study is to compare the current gold standard functional treatment to functional treatment plus WBV in patients with acute unilateral unstable inversion ankle sprains.Methods/Design60 patients, aged 18–40 years, presenting with an isolated, unilateral, acute unstable inversion ankle sprain will be included in this bicentric, biphasic, randomized controlled trial. Samples will be randomized by envelope drawing. All patients will be allowed early mobilization and pain-dependent weight bearing, limited functional immobilization by orthosis, PRICE, NSARDs as well as home and supervised physiotherapy. Supervised physical therapy will take place twice a week, for 30 minutes for a period of 6 weeks, following a standardized intervention protocol. During supervised physical therapy, the intervention group will perform exercises similar to those of the control group, on a side-alternating sinusoidal vibration platform. Two time-dependent primary outcome parameters will be assessed: short-term outcome after six weeks will be postural control quantified by the sway index; mid-term outcome after one year will be assessed by subjective instability, defined by the presence of giving-way attacks. Secondary outcome parameters include: return to pre-injury level of activities, residual pain, recurrence, objective instability, energy/coordination, Foot and Ankle Disability Index and EQ 5D.DiscussionThis is the first trial investigating the effects of WBV in patients with acute soft tissue injury. Inversion ankle sprains often result in ankle instability, which is most likely due to damage of neurological structures. Due to its unique, frequency dependent, influence on various neuromuscular parameters, WBV is a promising treatment method for patients with acute unstable inversion ankle sprains.Trial registrationNCT01702597

The Promoting Effective Advance Care for Elders (PEACE) Randomized Pilot Study: Theoretical Framework and Study Design

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.

Building the Rationale and Structure for a Complex Physical Therapy Intervention Within the Context of a Clinical Trial: A Multimodal Individualized Treatment for Patients With Hip Osteoarthritis

Evaluating the efficacy of complex interventions such as multimodal, impairment-based physical therapy treatments in randomized controlled trials is essential to inform practice and compare relative benefits of available treatment options. Studies of physical therapy interventions using highly standardized intervention protocols, although methodologically rigorous, do not necessarily reflect "real-world" clinical practice, and in many cases results have been disappointing. Development of a complex intervention that includes multiple treatment modalities and individualized treatment technique selection requires a systematic approach to designing all aspects of the intervention based on theory, evidence, and practical constraints. This perspective article outlines the development of the rationale and structure of a multimodal physical therapy program for painful hip osteoarthritis to be assessed in a clinical trial. The resulting intervention protocol comprises a semi-structured program of exercises and manual therapy, advice, physical activity, and optional prescription of a gait aid that is standardized, yet can be individualized according to physical assessment and radiographic findings. The program is evidence based and reflects contemporary physical therapist practice, while also being reproducible and reportable. This perspective article aims to encourage physical therapy researchers involved in evaluation of complex interventions to better document their own intervention development, as well as the outcomes, thus generating a body of knowledge about the development processes and protocols that is generalizable to the real-world complexity of providing physical therapy to individual patients.

A Retrospective Exploration of Patient‐Ventilator Monitoring Intensity, Therapeutic Intervention Intensity, and Compliance with Lung Protective Guidelines in a Cohort of Patients with Adult Respiratory Distress Syndrome

The current approach to mechanical ventilation for adult respiratory distress syndrome (ARDS) and acute lung injury (ALI) involves maintaining key patient-ventilator parameters within established lung protective targets. Monitoring is part of the processes of nursing care believed to guide therapeutic intervention and facilitate compliance with these targets. Empirical relationships between monitoring, therapeutic intervention, and compliance with these practice guidelines have not been adequately explored. A retrospective observational design was used to explore relationships between monitoring intensity, therapeutic intervention intensity, and compliance with a lung protective philosophy of mechanical ventilation in a cohort of patients with ARDS or ALI. Compliance with lung protective targets was measured as the proportion of time oxygen saturation, alveolar distending pressure, and tidal volume were maintained within recommended guidelines as evidenced by medical record documentation. Monitoring intensity and therapeutic intervention intensity were based on the frequency of recorded assessments and interventions in the medical record. Monitoring intensity correlated positively with both severity of illness (r = 0.39) and with therapeutic intervention intensity (r = 0.30), and was inversely related to compliance with lung protective guidelines (CLPG) (r = -0.34). A regression model including monitoring intensity, severity of illness, risk for abdominal hypertension, and CLPG was statistically significant (p = 0.02) but explained little of the variance in compliance with lung protective parameters (R2 = 0.13). Compliance with recommended lung protective parameters in the absence of standardized monitoring and intervention protocols is suboptimal. Preliminary evidence of positive relationships between monitoring and both severity of illness and therapeutic intervention was established. Control for nursing and physician practice variation is needed to rule out the influence of surveillance and performance bias on collaborative practice outcomes. Explicit standardized protocols that address the frequency of assessments and interventions along with therapeutic targets are recommended for collaborative practice guidelines.

Abstract No. 382: Feasibility evaluation of catheter-directed interventions in multiple sclerosis CCSVI patients

To report the feasibility results of balloon angioplasty and stent placement for treatment of multiple sclerosis related CCSVI symptoms. 18 consecutive patients (5M, 13F), mean age 48 yrs (r, 35–64) with relapsing remitting (n=10), secondary progressive (n=5), post-progressive (n=1), primary progressive (n=2), unknown (n=1) underwent 19 single-operator procedures. Standardized intervention protocol included IVUS, left and right internal jugular (LIJV, RIJV), azygous venograms in 3-head positions, imaging intensifier angulations, quiet breathing, no sedation. 3-month follow-up; clopidogrel for stents, ASA for PTA. There were 18/19 RIJV and 19/19 LIJV valvular flow restrictions were treated with 10–16mm PTA (most common 14mm RIJV, 12mm LIJV). Mid RIJV (n=2), LIJV (n=5); high LIJV (n=2); and azygous arch stenoses (13/19) with 6–8 mm PTA. 10 tapered and non tapered nitinol stents in 9/19 cases: n=2 azygous, LIJV (n=5, 2mid, 1 upper, 2 valve/lower), RIJV (3 mid/lower overlap). IVUS improved confirmation of MRV stenoses in all cases. % valve stenoses could not be quantified due to dynamic function. Patient self-reported outcomes by interview and MS-QOL: uniformly positive, heterogeneous change except index case. Examples: improved motor function (eg stair climb, foot drop, ability to drive, abandoned of assistive devices, swallowing, breathing effort); sensory (eg resolved/reduced numbness in extremities, better balance); fatigue (reduction), cognitive (reduced/nearly vanished impairment), visual (clarity and color); temperature sensitivity (coldness and heat tolerance). Direct physician clinic observation confirms self-reported motor and balance change. Complications included 1 resolved allergy to clopidogrel; 1 contained LIJV valve rupture, resolved with balloon tamponade, and bare stent. Catheter directed interventions in MS CCSVI patients can be safely accomplished. Feasibility results confirm strong positive early self reported improvements, some confirmed by direct observation. Conventional thresholds for intervention are not initially predictive, suggesting new scales will need development.

The After Discharge Care Management of Low Income Frail Elderly (AD-LIFE) Randomized Trial: Theoretical Framework and Study Design

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.

A Review on the Complementary Effects of Auriculotherapy in Managing Constipation

Constipation is a common health problem that adversely affects an individual's general health and quality of life. Constipated people usually manage the problem by taking laxatives and by modifying their lifestyle even if such have questionable therapeutic effects. Auriculotherapy, a safe treatment modality in Chinese medicine, has been reported to be effective in managing constipation. Despite previous studies reported encouraging results in using auriculotherapy, its effectiveness in managing constipation has not been systematically reviewed. This review, therefore, examines previous studies that have investigated the effectiveness of auriculotherapy in managing constipation. A search in the databases of MEDLINE EMBASE, AMED, and China Academic Journals Full-text Database and manual searching were performed to identify relevant clinical studies. A total of 29 relevant clinical studies conducted from 1994 to 2008 were identified. All of the studies reported that auriculotherapy was effective in managing constipation. However, generalization of their findings was limited because of two significant methodological flaws: (1) uncertainty in accurate acupoints identification and subjects' compliance to instructions resulted in varied doses of intervention received; and (2) inconsistent intervention protocols and therapeutic outcome criteria made comparison among different studies difficult. The findings of this review could provide pertinent information for researchers in terms of study designs and methodologies that may be used for future studies. The use of randomized controlled trials on a sample of sufficient size and of standard intervention protocol is recommended to provide empirical evidence that will support auriculotherapy as a complementary strategy in managing constipation.

A Pilot Study of a Nursing Intervention Protocol to Minimize Maternal-Infant Separation After Cesarean Birth

To pilot test a standardized intraoperative and postoperative nursing intervention protocol to minimize maternal-infant separation after Cesarean. Randomized-controlled trial. A 250-bed acute care community hospital labor/delivery/recovery/postpartum unit with approximately 150 repeat Cesarean deliveries per year. Fifty women having a live, term, singleton, repeat Cesarean delivery and their newborns. A standardized nursing intervention protocol was designed and administered to minimize the amount of maternal-infant spatial, tactile, olfactory, auditory, and visual separation post-Cesarean. Maternal outcomes included maternal pain, anxiety, and childbirth perception. Infant outcomes included respiratory rate, temperature, stress (infant salivary cortisol), and breastfeeding rates. Compared with the control group, the intervention group experienced earlier first physical contact and feedings and a longer interval until the infant first bath. Differences were found between treatment groups for infant temperatures and respiratory rates. Three infants in the control group experienced suboptimal temperatures. Infants in the intervention group had significantly higher salivary cortisol levels but were within the normal upper level range. No differences were noted in maternal pain, maternal anxiety, or perception of birth experience among treatment groups. The pilot was valuable in examining intervention feasibility, appropriate outcome measures, and data collection strategies. The standardized intervention protocol shows promise for positively affecting maternal-infant outcomes after Cesarean delivery and merits further testing.

The Effect of Educational Interventions with Siblings of Hospitalized Children

Research has demonstrated that siblings of chronically ill children can experience significant emotional and behavior changes; however, few studies have looked at the specific impact of pediatric hospitalization on the nonhospitalized child. Studies also indicate that children who receive age-appropriate information are better equipped to handle the stress and anxiety often associated with hospitalization.This study explored whether siblings of hospitalized children who received educational interventions had lower anxiety levels compared to siblings who did not receive interventions. A pretest-posttest experimental design was used with 50 subjects, ages 6-17 years, recruited from a children's hospital within a university medical center. Subjects were matched according to age, sex, and race, with 25 siblings each in the experimental and control groups. Siblings assigned to the experimental group received interventions from a standardized educational intervention protocol developed by the researcher. Interventions focused on teaching the sibling about hospitalization, illness or injury, and treatment for the patient, based on cognitive stages of development. All interventions were conducted by child life specialists on staff at the hospital with extensive training and experience in preparation and procedural teaching. Results shows that siblings who received educational interventions had significantly lower anxiety levels after interventions, compared to siblings who did not receive interventions. These findings have significant impact on children's health care and supporting family needs when a child is hospitalized.