Pragmatic Study Research Articles

EXERCISE PHYSIOLOGIST-LED PAIN SCIENCE COACHING VIA TELEHEALTH IMPROVED PAIN AND FUNCTION IN LIFE INSURANCE CLAIMANTS: A PRAGMATIC COHORT STUDY

INTRODUCTION & AIMS Personal injury and illness compensation claimants are more likely to experience persistent pain and poorer clinical/vocational outcomes than non-compensated clients. Evidence supports the effectiveness of pain science coaching to help people understand and re-train their pain system. This consequently reduces pain intensity, improves function and quality of life. However, the effectiveness of telehealth-delivered, exercise physiologist-led pain science coaching is yet to be evaluated. This study aimed to determine the effectiveness of an accredited exercise physiologist-led pain science coaching intervention via telehealth in Australian life insurance claimants. METHODS This pragmatic cohort study included 1,275 claimants receiving a pain science coaching intervention supported by life insurance compensation. Ethics was approved via Deakin University Human Research Ethics Committee (2023-347). Outcome measures were pain intensity (11 item numerical pain rating scale, range: 0-10 points) and function (two 11-item patient-specific functional scale, range: 0-20 points). Linear mixed models determined within-group change over time. RESULTS Clients (female: 75%, male: 25%) had a mean (SD) age of 50 (10) years (range: 20-69 years) and claim duration of 2 (2) years (range: 0-20 years). Mean (SD) intervention duration was 10 (6) weeks (range: 3-41 weeks), financial cost was A$1,149 (A$202; range: A$510-A$2,040) and included 5 (1) hours (range: 2-11 hours) of pain science coaching. Following the intervention, pain intensity decreased 25% (estimated marginal mean change [95%CI]: -1.49 [-1.59, -1.40] points, P<0.001) and function increased 76% (4.41 [4.21, 4.62] points, P<0.001). Changes surpassed established clinically meaningful effect thresholds for pain intensity (1.17 points) and function (2.6 points). Client Net Promotor Score was +60 (Australian Healthcare Index benchmark ≥ +30) and 91% were satisfied with the intervention. CONCLUSION An exercise physiologist-led pain science coaching intervention resulted in clinically meaningful improvements in pain intensity and function in compensation claimants. Clients reported high satisfaction rates.

Comparing the Implementation of Different Diabetic Retinopathy Screening Models in Primary Health Care Settings in Northern India: Pragmatic Three-Arm Observational Study

Introduction: Early screening is recommended to prevent vision impairment (VI) and blindness globally due to diabetic retinopathy (DR). We aim to analyze the factors influencing the implementation of DR screening models in primary healthcare facilities. Methods: A pragmatic three-arm observational study will be conducted in the district of Mohali in Punjab, India. The study will compare three equal-sized groups with type 2 diabetes mellitus (T2DM) at age 30 and above. The T2DM participants and healthcare providers (HCPs) will be interviewed to identify the barriers to retinal examinations in primary healthcare settings. The study includes a comprehensive economic evaluation to determine the cost-effectiveness of implementing different DR screening models in primary health settings. The present study will use the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance), to assess the implementation of two DR screening interventions and the extent of variation in outcomes. Qualitative and quantitative data collected from participants and research team observations will be examined to report on the five RE-AIM domains. Discussion: A screening program should ensure early detection and referral for DR treatment before it results in irreversible vision loss. However, understanding the problems of accessing DR screening and estimating the cost-effectiveness of such programs in a primary health setting is important before allocating public health resources.

Adaptation and Implementation of a Volunteer-delivered, Telephone-based, Social Support Program HOW-R-U? during the COVID-19 Pandemic: A Pragmatic Study.

Public health concerns surrounding social isolation and loneliness heightened during the COVID-19 pandemic, as infection prevention measures led to increased feelings of loneliness and depression.Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness and depression in older people. This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semi-structured interviews and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside assessment of outcomes including pre- and post- symptoms of isolation, depression, and loneliness. The implementation evaluation indicated that codesigned systems and processes effectively supported ongoing implementation of HOW-R-U? with transition into business as usual across both organisations. Recipients reported the telephone calls had a positive impact on their lives, while volunteers reported enjoyment supporting others. Several challenges were identified, namely in program reach and fidelity. : HOW-R-U? was well regarded by all involved and evaluation learnings have informed implementation into business as usual by both organizations.

P068 The Use of Virtual Reality Headsets instead of Entonox for Paediatric Patients undergoing Steroid Joint Injections or Venepuncture / Cannulation

Abstract Background/Aims Entonox has traditionally been used for patients with Juvenile idiopathic arthritis (JIA) who require intra-articular joint injections (IAIs). However, Entonox is now the third most misused drug especially in school age children and young people (CYP). Entonox also has an environmental impact. In addition, Entonox has side-effects including euphoria, disorientation, nausea and vomiting. Recently there has been increased awareness of the risks of Vitamin B deficiency associated with prolonged Entonox use which can lead to neurological toxicity. These factors have led us to consider virtual reality (VR) devices as an alternative for patients requiring IAIs. The VR headset we used is a class one medical device that can provide both reduction in anxiety levels and pain relief in patients needing anxiety-provoking or painful procedures such as IAIs. Aims: To trial the use of VR devices in a Paediatric Rheumatology Service and to assess effectiveness in reducing anxiety and pain when used during IAIs and cannulation / venepuncture. Methods A pragmatic pilot study of VR headset use was carried out from November 2022 until September 2023. All CYP undergoing IAIs without GA were offered either Entonox sedation or VR headset distraction. Each CYP using the VR headset was asked to score anxiety and pain levels before and after the procedure using a Likert scale. Patient demographics were also collected (age and gender). Results A total of 42 patients attended for IAI’s during the study window between the ages of 7 and 16. Thirty-three opted to use the VR headset. Nine opted for Entonox. An additional 22 patients opted to use the VR headset for venepuncture / cannulation. The 64 users of the VR headset reported an average 47.8% reduction in anxiety and a 0.8% reduction in pain. Conclusion The study demonstrated that the use of a VR headset reduces anxiety in CYP having painful procedures. A minimal reduction in pain however was reported. This may be due to some patients having low pre procedural pain scores. The terms of the headset loan limited the questions that could be set for data collection. It has therefore not been possible to separate results from children who underwent IAIs or venepuncture / cannulation. We also did not collect comparative scores from the Children and young people who chose to use Entonox. Funding has now been secured for the VR headset and we are carrying out a prospective evaluation, including feedback from patients and staff, into the role of VR devices in managing situations involving procedural anxiety. Disclosure H.C. Lee: None. S. Leach: None. D. Hawley: None. N. Barker: None.

Explaining the Quality of Teacher and Student Communication Based on Cooperation Principles in a Religious Context: A Pragmatic Study

Communication in the classroom has a very important role because there is a process by which a teacher transfers knowledge and other aspects of education to students. If the principle of cooperation is violated, then the communication will be counterproductive and not in accordance with its initial purpose. This research aims to obtain an objective picture of the quality of communication based on the fulfillment and deviation of the principle of cooperation in teacher and student communication in a religious context at Shalahuddin Middle School. This research is descriptive research using a qualitative approach. The data collection techniques used were observation and note taking. The data analysis techniques used are data reduction, data presentation, and drawing conclusions. The results of this research are that there is a fulfillment of the principles of cooperation in the form of the maxim of quantity, the maxim of quality, the maxim of method, and the maxim of relevance, as well as deviations from the principles of cooperation in the form of the maxim of quantity, the maxim of quality, the maxim of method, and the maxim of relevance in the religious context at Shalahuddin Middle School.

Patient perceived quality of cirrhosis care– adjunctive nurse-based care versus standard medical care: a pragmatic multicentre randomised controlled study

BackgroundCirrhosis treatment implies prevention and alleviation of serious disease events. Healthcare providers may, however, fail to meet patients’ expectations of collaboration and specific needs of information and support. Individualised nursing care could meet patients’ needs. The aim was thus to measure patient-perceived quality of care after adjunctive registered nurse-based intervention Quality Liver Nursing Care Model (QLiNCaM) compared with standard medical care.MethodsThis pragmatic multicentre study consecutively randomised patients to either adjunctive registered nurse-based care, or standard medical care for 24 months (ClinicalTrials.gov NCT02957253). Patients were allocated to either group at an equal ratio, at six Swedish outpatient clinics during 2016–2022. Using the questionnaire ‘Quality of care from the patient’s perspective’, patients rated their perceived lack of quality for the adjunctive registered nurse-based intervention compared with the control group at 12 and 24 months, respectively.ResultsIn total, 167 patients were recruited. Seven out of 22 items in the questionnaire supported the finding that ‘lacking quality’ decreased with adjunctive registered nurse-based care (p < 0.05) at 12 months follow-up; however, these differences could not be established at 24 months.ConclusionAdditional structured registered nurse-based visits in the cirrhosis outpatient team provided support for improved patient-perceived quality of care during the first 12 months. Registered nurses increase patient involvement and present easy access to cirrhosis outpatient care. Patients express appreciation for personalised information. This study reinforces registered nurses’ role in the outpatient cirrhosis team, optimising patient care in compensated and decompensated cirrhosis.Trial registrationRegistered at Clinical Trials 18th of October 2016, [https://www.clinicaltrials.gov], registration number: NCT02957253.

The Better Operative Outcomes Software Tool (BOOST) Prospective Study: Improving the Quality of Cataract Surgery Outcomes in Low-Resource Settings

ABSTRACT Purpose Post-operative vision impairment is common among patients who have undergone cataract surgery in low-resource settings, impacting quality of clinical outcomes and patient experience. This prospective, multisite, single-armed, pragmatic validation study aimed to assess whether receiving tailored recommendations via the free Better Operative Outcomes Software Tool (BOOST) app improved surgical outcomes, as quantified by post-operative unaided distance visual acuity (UVA) measured 1–3 days after surgery. Methods During the baseline data collection round, surgeons in low and middle-income countries recorded clinical characteristics of 60 consecutive cataract cases in BOOST. Additional data on the causes of poor outcomes from 20 consecutive cases with post-operative UVA of <6/60 (4–12 weeks post-surgery) were entered to automatically generate tailored recommendations for improvement, before 60 additional consecutive cases were recorded during the follow-up study round. Average UVA was compared between cases recorded in the baseline study round and those recorded during follow-up. Results Among 4,233 cataract surgeries performed by 41 surgeons in 18 countries, only 2,002 (47.3%) had post-operative UVA 6/12 or better. Among the 14 surgeons (34.1%) who completed both rounds of the study (1,680 cases total), there was no clinically significant improvement in post-operative average UVA (logMAR units ±SD) between baseline (0.50 ± 0.37) and follow-up (0.47 ± 0.36) rounds (mean improvement 0.03, p = 0.486). Conclusions Receiving BOOST-generated recommendations did not result in improved UVA beyond what could be expected from prospective monitoring of surgical outcomes alone. Additional research is required to assess whether targeted support to implement changes could potentiate the uptake of app-generated recommendations and improve outcomes.

A Pragmatic Study on English Listening Comprehension from the Perspective of Grice’s Conversational Implicature Theory in High School

For high school students, English listening is a crucial part of English examinations. Over the years, researchers all over the world have made significant contributions to the study of English listening, and they have found that conversational implicature theory can be applied to listening instruction to make students understand the implicit meaning of conversations. But previous studies have usually failed to summarize the main features of conversations that violate the principle of cooperation and lack corresponding suggestions for listening instruction. In this paper, the high school English listening texts related to travel will be studied from the perspective of conversational implicature theory. With careful analysis, the characteristics of the listening text are summarized. The text always adds new information, reject invitation euphemistically or using complex sentences by violating cooperative principle. In addition, a quantitative analysis of the text on the theme of "travel" that violates the cooperative principle is carried out, which leads to corresponding teaching suggestions: teachers should introduce relevant pragmatics knowledge in listening teaching, and students are obliged to pay attention to the accumulation of cultural knowledge when learning English.

The need for more pragmatic trials in glaucoma research.

There have been a number of clinical trials in glaucoma research published in the past two decades. Most of these trials were designed to evaluate very specific issues in selected populations placing them in the explanatory end of the pragmatic-explanatory continuum. The purpose of this study was to assess the level of pragmatism of published randomized controlled trials in glaucoma. A PubMed search using 'glaucoma' from 1995 to 2022 and randomized controlled trial (RCT) article type was done. Each study was assessed by three independent examiners using the Pragmatic-Explanatory Continuum Indicator Summary version 2 (PRECIS-2) toolkit. Scores were calculated for each study to determine the level of pragmatism. A summed score ≥36 was indicative of a very pragmatic study. Thirty-two different articles were included in the analysis. These papers represented 13 different landmark trials. The median PRECIS-2 score was 32 (range, 25 for the Early Manifest Glaucoma Trial (EMGT) to 34 to the Collaborative Normal Tension Glaucoma Study (CNTGS) and the Ocular Hypertension Treatment Study). The Treatment of Advanced Glaucoma Study (TAGS), was considered very pragmatic and scored 33 points. Despite the number of RCTs in glaucoma, there is still a need for more pragmatic studies.

Learning with a purpose: Acquisition of compliments and compliment responses by beginning learners of Spanish in synchronous online exchanges

This research examines the effect of explicit pragmatic instruction and student's perceptions of guided reflections on the acquisition of compliments and compliment responses (CRs) in beginning learners of Spanish. It adopts a pragmatic consciousness-raising approach and a four-step lesson plan for teaching compliments and CRs in the language classroom. Unlike many studies in interlanguage pragmatics conducted in classrooms or laboratory settings at the intermediate and advanced level, this study examines the acquisition and use (or lack thereof) of compliments and CR's though synchronous online face-to-face conversations of L2 learners with L1 speakers of Spanish. It analyzes change overtime with the same learners using a pretest-posttest design. A quantitative analysis indicated statistically significant differences in the production of compliments, yet no significant differences were observed in the production of CR's. The qualitative analysis of the guided reflections highlighted a need for more in-class practice with compliments and CR's. Students' responses suggest that reflections can help raise awareness of the use (or lack thereof) of these speech acts. This study contributes to L2 pragmatics and to our understanding of L2 acquisition developmental stages.

Do Sitcom Conversations Fully Depict Those in Natural Settings: A Corpus-Based Lexical Analysis

An increasing number of studies in pragmatics, second language acquisition, and related fields have opted to use sitcom conversations as a substitute for natural conversations in their analyses. However, few studies have critically examined the validity of this substitution. Taking this into consideration, the present study aims to examine the lexical similarities and differences between sitcom and natural conversations by utilizing the Friends Corpus and the Santa Barbara Corpus of Spoken American English as samples under a synthesized analytic framework of six lexical categories that have been frequently examined in previous research. The findings indicate that there are significant differences between sitcom and natural conversations at the lexical level, particularly in terms of word lengths, keywords, and the use of discourse markers, personal pronouns, vocatives, and religious words. While sitcom conversations tend to be more concise, interactive, evaluative, and involving, natural conversations provide more explanations for their speech acts and refer to their parties who are not present in the conversations. Additionally, sitcom conversations use more intensifiers and vocatives while using fewer tentative modals, expletives, and religious words. Based on these results, it can be concluded that sitcom conversations do not fully depict the conversations in sitcoms, and thus substituting natural conversations with those in sitcoms should be approached with caution in language teaching and research. This study provides insight into the differences in lexical patterns between two types of conversations, and highlights the importance of using natural conversations as a basis for language teaching and research.

Longitudinal Assessment of Health-Related Quality of Life and Clinical Outcomes with At Home Advanced Pneumatic Compression Treatment of Lower Extremity Lymphedema.

This prospective longitudinal pragmatic study describes at home treatment with a proprietary Advanced Pneumatic Compression Device (APCD) in patients with lower extremity Lymphedema (LED). Following IRB approval, 4 participating VA centers enrolled LED patients from 2016 -2022. Primary outcome measures were Health-Related Quality of Life (HR-QoL) questionnaires; (LYMQOL-leg) and the generic SF-36v2™ obtained at baseline, 12, 24, and 52 weeks. Secondary outcome measures were limb circumference, cellulitis events, skin quality, and compliance with APCD and other compression therapies. As a portion of the trial was conducted during COVID, 179 patients had 52-week follow-up, while 143 had complete measurements at all time points. Baseline characteristics were mean age 66.9 ± 10.8 years, 91% male, and mean BMI 33.8 ± 6.9. LED was bilateral in 92.2%. Chronic venous insufficiency or phlebolymphedema was the most common etiology of LED (112 patients; 62.6%), followed by trauma/surgery (20 patients; 11.2%). Cancer treatment as a cause was low at 4 patients (2.3%). Patients were classified as International Society for Lymphology (ISL) stage one (68.4%), two (27.6%) and three (4.1%) respectively. Significant improvements were observed in all LYMQOL-leg domains of function, appearance, symptoms, emotion, and overall score after 12 weeks of treatment (p < 0.0001) and through 52 weeks of follow-up. The SF-36v2™ demonstrated significant improvement in 3 domains at 12 weeks; and at 52 weeks in 6 domains of physical function, bodily pain, physical component (p <0.0001), social functioning (p = 0.0186), role-physical (p < 0.0006), and mental health (p < 0.0333). SF-36v2™ scores <40 indicate a substantial reduction in HR-QoL in LED patients compared to US norms. Secondary Outcome Measures at 52 weeks: Compared to baseline, mean limb girth decreased by 1.4 cm (p<.0001); the maximal reduction in mean limb girth measurement was 1.9 cm (6.0%) at 12 weeks in ISL stage 2/3 limbs. New episodes of cellulitis in patients with previous episodes (21.4% vs 6.1%, p=0.001) were reduced. The 75% of patients with skin hyperpigmentation at baseline decreased to 40% (p <0.01) at 52 weeks. At 52 weeks, compliance, defined as use 5 -7 day/week, was reported with APCD in 72% and elastic stockings in 74%. This longitudinal study of VA patients with LED demonstrated improved generic and disease specific HR-QoL through 52 weeks with at home use of an APCD. Limb girth, cellulitis episodes and skin discoloration were reduced, while maintaining excellent compliance.

Javanese Silly Gags on Daily Communication on Social Media: Pragmatic Meanings and Functions Approach

This qualitative descriptive study aims to explore the pragmatic significance of rarely researched Javanese silly gags. The primary objective is to examine the markers and implications of these gags in daily communication, particularly focusing on their various categories. Utilizing social media fragments as the primary source, the research employs the note-taking method for listening. Subsequent steps include the identification, classification, and characterization of Javanese silly gags into five distinct categories: (1) Silly jokes for enthusiasm, (2) Silly jokes for sarcasm, (3) Silly jokes for satire, (4) Silly jokes for exasperation, and (5) Silly jokes for enigmatic humor. The equivalent analysis method is then applied, specifically using contextual equivalents through a comparative linking technique for in-depth data analysis. The emphasis on context is considered a crucial factor in conducting purpose-oriented pragmatic studies. The analysis reveals valuable insights into the diverse functions of Javanese silly gags, showcasing their significance in daily communication. The identified categories provide a comprehensive understanding of how these gags serve various purposes, from expressing enthusiasm to conveying sarcasm, satire, exasperation, and enigmatic humor. The social media fragments prove to be rich sources for uncovering the nuances of Javanese silly gags and their markers. The findings of this study shed light on the multifaceted nature of Javanese silly gags, highlighting their importance in preserving a unique form of humor. The study emphasizes the potential threat posed by the younger generation’s lack of comprehension. It underscores the need to preserve and understand Javanese silly gags in the evolving landscape of communication. Overall, this research contributes to the broader understanding of pragmatic aspects in Javanese humor, emphasizing the cultural and communicative significance of these often-overlooked forms of expression.

Presupposition Speech at the Tawur Kasanga Ceremony: A Pragmatic Study

This research aims to analyze the types of presuppositions in the tawur kasanga ceremony as a pragmatic study. Pragmatics studies are always related to the problem of language use behaviour in its context. Pragmatic context includes the identity of the participant, the time parameters, and the place of the speech event, which includes the linguistic context and the physical context, which includes presuppositions. To achieve this goal, a descriptive qualitative approach was used. A qualitative approach to describe the meaning of Tawur Kasanga speech is based on pragmatic studies. The research population was taken from the narratives of a series of ceremonial activities. Considering that this event is an event that only occurs once a year, this population was immediately used as a sample. Data was collected through recordings and guided interviews. The collected data was analyzed using descriptive-qualitative techniques. The research results show: there are six presuppositions in speech, namely presuppositions: (a) existential 12 (24,489%), (b) factive 13 (26,530%), (c) lexical 11 (22,448%), (d) structural 11 (22.448%), (e) nonfactive 1 (2.040%), and (f) counterfactual 1 (2.040%).

A Pragmatic Study of Derogation in American Election Campaign Speeches

Language is sometimes used for influencing people negatively. This is done via the use of various derogatory strategies. Therefore, the present study deals with derogation pragmatically in American election campaign speeches. Precisely, the current work attempts to answer the following questions: (1) How is derogation approached pragmatically in American election campaign speeches? (2) Through which impoliteness strategies is derogation realized? (3) What is the target of derogation? Is it the public face or the personal face? And what are the foci of derogation? The study aims to find answers to the previous questions through reviewing the literature related to derogation and adopting an eclectic model for analyzing the data under investigation. Besides, a statistical means represented by the percentage equation is used to calculate the results. The main conclusion is that American presidential rivals use different impoliteness strategies to derogate each other; through this derogation either the public face or the personal face is threatened.

A Pragmatic Study of the “Supplication of Complainers” by Imam Ali Al-Sajjad

The present study is an attempt to analyse Imam Ali Al-Sajjad’s “Supplication of Complainers” pragmatically. This concept is selected to be studied due to its importance in daily life and there are few researches about it, as far as the researcher knows. The present study mainly aims to answer the following question: What are the types of main speech acts, speech act strategies and auxiliary speech acts and their frequency in the Supplication of Complainers. It is hypothesized that: the most commonly main speech act is representative. Representative speech act strategy of complaining is mostly used Explanation is the most dominant auxiliary speech act. Quantitative analysis is used (using frequencies and percentages) as well as  qualitative (using Searle’s 1969 classification of speech acts and van Dijk’s 1977 classification of auxiliary speech acts) analysis of the data. After analysing the data, it has been concluded that the above hypotheses are verified.

A prospective, pragmatic non-inferiority study of emergency intubation success with the single-use i-view versus standard reusable video laryngoscope.

Video laryngoscope (VL) technology improves first-pass success. The novel i-view VL device is inexpensive and disposable. We sought to determine the first-pass intubation success with the i-view VL device versus the standard reusable VL systems in routine use at each site. We performed a prospective, pragmatic study at two major emergency departments (EDs) when VL was used. We rotated i-view versus reusable VL as the preferred device of the month based on an a priori schedule. An investigator-initiated interim analysis was performed. Our primary outcome was a first-pass success with a non-inferiority margin of 10% based on the per-protocol analysis. There were 93 intubations using the reusable VL devices and 81 intubations using the i-view. Our study was stopped early due to futility in reaching our predetermined non-inferiority margin. Operator and patient characteristics were similar between the two groups. The first-pass success rate for the i-view group was 69.1% compared to 84.3% for the reusable VL group. A non-inferiority analysis indicated that the difference (-15.1%) and corresponding 90% confidence limits (-25.3% to -5.0%) did not fall within the predetermined 10% non-inferiority margin. The i-view device failed to meet our predetermined non-inferiority margin when compared to the reusable VL systems with the study stopping early due to futility. Significant crossover occurred at the discretion of the intubating operator during the i-view month.

Medication Recommendation System Based on Natural Language Processing for Patient Emotion Analysis

Natural Language Processing (NLP) is an interdisciplinary field of computer science, artificial intelligence, and linguistics that focuses on the ability of computers to understand, process, generate, and simulate human language in order to achieve the ability to have natural conversations with humans. The underlying principles of natural language processing are at multiple levels, including linguistics, computer science, and statistics. It involves the study of language structure, semantics, grammar and pragmatics, as well as the statistical analysis and modeling of large-scale corpora. In the process of concrete implementation, it is necessary to process natural language at multiple levels. Based on this, this paper combined deep learning and natural language processing technology to conduct sentiment analysis on patients' comments, so as to recommend drugs that are more suitable for patients, thus achieving accurate drug prescribing and personalized recommendation.

The Hummingbird Project year 2: decreasing distress and fostering flourishing in a pragmatic pre-post study.

Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored. The current study, therefore, was designed to replicate the effects of the Hummingbird Project mPPI on positive mental health and to also explore the effects on symptoms of mental distress. Secondary school-aged children (N = 614; mean age = 11.46 years) from a sample of secondary schools located across the North West of England (N = 7) participated in the study; the majority of children were in Year 7 (94%). The PP concepts explored included happiness, hope, resilience, mindfulness, character strengths, growth mindset, and gratitude. The results showed significant improvements associated with the mPPI in well-being (as measured by the World Health Organization Well-Being Index; WHO-5), hope (as measured by the Children's Hope Scale; CHS), and symptoms of mental distress (as measured by the Young Person's Clinical Outcomes in Routine Evaluation; YP-CORE) from pre- to post-intervention. While acknowledging the limits due to pragmatic concerns regarding the implementation of a control group, the effectiveness of the Hummingbird Project mPPI on well-being was replicated alongside reducing the symptoms of mental distress. Future evaluation, however, will need to implement more robust designs and consider follow-up duration to assess the longer-term effects of the Hummingbird Project mPPI.

Challenges in conducting clinical research in primary care dentistry

The integration of dentistry into primary health care is crucial for promoting patient well-being. However, clinical studies in dentistry face challenges, including issues with study design, transparency, and relevance to primary care. Clinical trials in dentistry often focus on specific issues with strict eligibility criteria, limiting the generalizability of findings. Randomized clinical trials (RCTs) face challenges in reflecting real-world conditions and using clinically relevant outcomes. The need for more pragmatic approaches and the inclusion of clinically relevant outcomes (CROs) is discussed, such as tooth loss or implant success. Solutions proposed include well-controlled observational studies, optimized data collection tools, and the integration of artificial intelligence (AI) for predictive modelling, computer-aided diagnostics and automated diagnosis. In this position paper advocates for more efficient trials with a focus on patient-centred outcomes, as well as the adoption of pragmatic study designs reflecting real-world conditions. Collaborative research networks, increased funding, enhanced data retrieval, and open science practices are also recommended. Technology, including intraoral scanners and AI, is highlighted for improving efficiency in dental research. AI is seen as a key tool for participant recruitment, predictive modelling, and outcome evaluation. However, ethical considerations and ongoing validation are emphasized to ensure the reliability and trustworthiness of AI-driven solutions in dental research. In conclusion, the efficient conduct of clinical research in primary care dentistry requires a comprehensive approach, including changes in study design, data collection, and analytical methods. The integration of AI is seen as pivotal in achieving these objectives in a meaningful and efficient way.