Successful Intervention Research Articles

Ethical Considerations of Off-Label Prescribing in Disruptive Mood Dysregulation Disorder.

AbstractDisruptive mood dysregulation disorder (DMDD), a relatively new diagnosis in child and adolescent psychiatry that remains without medications approved for its indication, warrants a renewed consideration of the ethics surrounding the off-label use of medications. In the absence of empirical studies, clinicians must work with the best available information regarding treatment, such as case reports demonstrating the success of off-label interventions. Although subject to ethical limitations and the risk-benefit profile of each medication, increased use of this approach in the treatment of DMDD is warranted. A review of the literature was undertaken to identify studies for inclusion in this article. A case history of a 12-year-old girl with DMDD who was treated with amantadine with good response illustrates these ethical considerations within a clinical context. There are significant benefits of off-label uses of medications in the treatment of DMDD. The promising potential of amantadine as an agent for off-label use for pediatric populations with DMDD illustrates this approach. In the absence of approved medications for DMDD, further attempts to use off-label treatments for this disorder are warranted despite ethical constraints and varying risk-benefit profiles for each medication.

Transaxillary access for PDA Stenting in Neonates with Duct-Dependent Cyanotic Congenital Heart: A Retrospective Study

Background: Duct-dependent cyanotic congenital heart is a critical heart disease in infants. In neonates, patients with obstructing native ductus arteriosus may need palliative stenting to maintain adequate blood flow during the transition period. These babies are similar to ductal-dependent lesions but require patent ductus arteriosus (PDA) flow for their transition from fetal to neonatal circulation. PDA stenting is a well-recognized palliative for duct-dependent cyanotic congenital heart in neonates. Objectives: The study highlights the clinical utilities of transaxillary access for PDA stenting in neonates with duct-dependent cyanotic congenital heart Methods: The study aimed to evaluate the effectiveness of transaxillary access for direct stenting and stent placement in neonates with stable duct-dependent congenital heart disease and cyanosis due to non-obstructive arterial duct. The study involved a retrospective approach, using existing data and focusing on acute interventional procedure success with transaxillary access. Secondary endpoints included successful weaning from access to surgical conduit, cannula removal, antegrade flow reduction if connected to BDG, need and success rate of transaxillary plug insertion, and major and minor complications associated with AXA. The study design allowed for a comprehensive evaluation of the feasibility of this technique and its potential benefits and drawbacks. Data was collected from electronic medical records, Picture Archiving and Communication System, and the electronic database of the Intensive Care Unit of a hospital between 2016 and 2021. The study aimed to evaluate the risk-benefit of performing DDC in neonates through the AS in a new cohort of patients in the future. Results: This retrospective study examined the management of cyanotic congenital heart disease in 36 neonates, with eight cases involving elbow neoaortic utilization and 28 having a PDA diameter less than 1 mm. In seven cases, a 4-Fr angiographic pigtail was inserted retrograde to image the PDA, which was then accessed by navigating a 4-Fr JB1 catheter from the cannulation site. A portable X-ray unit was used exclusively to position these catheters and wires during the procedures under C-arm guidance. Diagnostic catheter removals were managed differently in this study, following the same principles used for sheath extractions in 29 retrospective and prospective presentations. The study reported on the procedural outcomes for transaxillary access and PDA stenting in neonates with duct-dependent cyanotic congenital heart disease. The study found no specific demographic or additional pre-procedural risk factors that would affect the results of the study. Conclusion: Transaxillary PDA stenting is a safe method for treating duct-dependent hypoxic congenital hearts in neonates, but has limitations like limited use, long transcatheter treatment periods, and anesthesia risks. It's recommended for developing countries with limited access to advanced care. The study improved palliative PDA stenting standard in CCTGA patients with complex congenital heart disease. Recommendations include insertion of a transaxillary sheath, support, and arterial access under ultrasound guidance.

Parental rules and child age as moderators in the relationship between screen time and perceived sleep problems in children aged 6–18

ABSTRACT Objective Child sleep problems are commonly reported by parents of children aged 6–18 years, with a growing body of evidence describing the link between children’s screen time and parental perceived child sleep problems. Using cross-sectional data, representative of the Victorian population, this study explored whether the relationship between screen time and parental perceived sleep problems differed across child age groups. It also examined whether parental rules moderated this relationship differentially between primary school-aged children and adolescents. Method Participants were 1699 parents living in Victoria with children aged 6 to 18 years who were recruited to complete a computer assisted personal communication through random dialling of mobile and landline numbers. Results Results indicated that more screen time was associated with more parental perceived sleep problems, with parental rules moderating this relationship for primary school-aged children but not for adolescents. Contrary to expectations, the relationship between screen time and parental perceived sleep problems did not differ across child age groups. Conclusions Results suggest that parental rules on media device use may be an instrumental factor in the development of successful intervention programmes for primary school-aged children. Further implications of these findings and suggestions for future research are discussed.

Return to Sports After Arthroplasty

Arthroplasty of the hip has become one of the most successful surgical interventions and has seen significant advancements over the last century. With these developments, patient expectations have shifted from merely achieving pain-free daily mobility to anticipating a full recovery, including the ability to participate in sports. This shift has driven innovations in prosthetic materials and surgical techniques, such as the development of wear-resistant materials like highly cross-linked polyethylene and the adoption of minimally invasive procedures to enhance recovery.However, concerns persist among patients about the risks of resuming sports postoperatively, particularly the fear of prosthesis-related accidents or failures. A survey of 300 German surgeons identified periprosthetic fractures as the greatest risk, followed by polyethylene wear and implant loosening. The study also examines osteoporosis as a risk factor, suggesting that while sports can help prevent periprosthetic osteoporosis, high-energy trauma may increase the severity of injuries. Although modern prosthetic materials have reduced wear and improved durability, the type and intensity of physical activity continue to influence prosthesis longevity.Therefore, it is recommended that low-impact sports be resumed 3-6 months postoperatively, while high-impact sports should be approached with caution, particularly during the first year after surgery, to minimize the risk of complications. Coordination training before and after surgery is also emphasized to reduce the risk of falls and injuries. In summary, the study highlights that high-impact sports cannot be generally recommended, as coordination deficits may persist for up to 12 months following total hip replacement. Such activities should only be considered later-on and only by patients who are experienced in these specific sports.

TOTAL HIP ARTHROPLASTY TECHNIQUES

Introduction: Total hip arthroplasty (THA) is one of the most effective and successful surgical interventions within the orthopedic specialty. THA offers consistent results for patients suffering from advanced degenerative osteoarthritis of the hip (OA), mainly by relieving pain, restoring function and improving overall quality of life. Objective: detail current information related to total hip arthroplasty techniques, as well as anatomy, physiology, indications, contraindications, history, preparation, preoperative evaluation, technique, treatment and complications of total hip arthroplasty. Methodology: a total of 42 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 30 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: hip arthroplasty, hip prosthesis, osteoarthrosis, osteonecrosis. Results: analysis of the 30 articles reviewed reveals that the most commonly used surgical approaches for CTA are posterior, direct anterior (DA) and anterolateral, with the posterior approach being the most common, although it presents a slightly higher risk of postoperative dislocation. Wound closure technique plays a crucial role in preventing complications, and the use of barbed sutures and a sterile dressing is recommended to ensure stability and adequate recovery. Regarding deep vein thrombosis (DVT) prophylaxis, aspirin has proven to be an effective option, comparable to more traditional agents such as heparin. The most common complications identified in the studies were dislocations, periprosthetic fractures and wound-related problems, which require appropriate management during postoperative follow-up. Conclusions: total hip arthroplasty (THA) is an effective and widely used procedure for the treatment of advanced osteoarthritis and other hip pathologies that do not respond to conservative treatments. Its evolution from its first applications in the 19th century to modern techniques has led to a significant improvement in clinical and functional outcomes, with a marked reduction in pain and improvement in patients' quality of life. Although the main indications for surgery include hip osteoarthritis and osteonecrosis, the technique should be tailored to the individual conditions and characteristics of each patient, considering factors such as anatomy, comorbidities and post-surgical expectations. A comprehensive approach during preoperative, surgical and postoperative management is essential to optimize outcomes and minimize complications. KEY WORDS: arthroplasty, hip, prosthesis, osteoarthrosis.

Umbrella review of systematic reviews to inform the development and translation of community-based childhood obesity prevention interventions.

Community-based interventions (CBIs) can be effective and feasible for the prevention of childhood obesity. The aim of this umbrella review is to determine if systematic reviews report sufficient information to guide replication or adaptation of CBIs to a variety of contexts and aid in further development of childhood obesity prevention CBIs. Six databases were searched for systematic reviews including obesity prevention CBIs involving 0-18 year olds and reporting weight-related outcomes. Two researchers screened results. Evidence-to-decision frameworks guided which details may be required for decision-makers to design and carry-out a CBI, including information on intervention characteristics, outcome reporting and translation factors. From 3935 search results, 40 studies were included. The most frequently reported relevant pieces of information were behaviors targeted (100% of systematic reviews), intervention duration (90%) and settings involved (97.5%). Less frequently reported factors included specific actions implemented (48%), intervention intensity (30%) and organizations, or contributors involved (40%). There was a low level of reporting of equity considerations (27.5%), adverse events (20%), and costs/cost-effectiveness (17.5%). Multilevel interventions for child obesity prevention have demonstrated effectiveness, yet additional documentation of successful intervention processes is needed.

Coping strategies and perceptions of mental health services among women in South India

Objectives Lack of engagement with mental health services is a challenge for Global Mental Health research and intervention in lower- and middle-income settings. In India particularly, there is a significant treatment gap for people experiencing common mental disorders. This exploratory mixed-method study investigated women’s attitudes toward mental healthcare in Mysuru, India, and investigated what distress copings strategies they used in their everyday lives. Methods We conducted qualitative interviews and administered a depression symptom screener with a community-based sample of 54 adult women. Interviews asked women to comment on their own distress experiences and stress management techniques, as well as their dispositions toward seeking mental healthcare for themselves or others. Results Nearly 65 percent of the study sample screened for any level of depression risk, but only 5 had ever received mental healthcare. Around 20 percent of women stated that they would hypothetically be open to receiving such care. Yet, there was strong agreement across the study sample that mental healthcare was not an appropriate resource for addressing their own distress. Most women who rejected mental healthcare mentioned concerns about stigma and lack of perceived need or treatment inadequacy as their main reasons. Women described a broad range of coping strategies they used for dealing with distress, and which they reported as being effective. Many of these approaches resemble behavioral and talk therapies used in psychology and psychiatry. Conclusions Women in this study generally did not view clinical mental healthcare as an appropriate treatment for their distress. Many already had effective strategies for managing their distress and analogous to existing psychological behavioral and talk therapies. A better understanding of why people reject mental healthcare is necessary for increasing the success of mental health interventions, and for developing new intervention approaches that support coping outside of clinical encounters.

Addressing the Separatist Movement in Eastern Nigeria: Intelligence-Driven Approaches to Mitigating Civil Unrest and Promoting National Unity

The separatist movement in Eastern Nigeria advocating for the creation of the state of Biafra, remains one of the serious challenges to national stability, unity, and security within the region and Nigeria. The movements have sparked off civil unrest, violent clashes, and socio-political tensions, thus intensifying the set of accrued and unattended grievances in the region and aspersions on the sovereignty of Nigeria. The research explores intelligence-driven strategies as a veritable way of stemming the increasing civil unrest and fostering national unity. This study makes use of a doctrinal research approach in looking at intelligence gathering, analysis, and operational tactics as it pertains to the combatted separatist activity in seeking methods through which these tools might better control a conflict and prevent violence while setting up a dialogue process between the government and the separatist factions. The research also examines how local perspectives can be factored into socio-economic factors within the intelligence framework for lasting peace. It draws on case studies of successful intelligence-based interventions both within and outside Africa, drawing important lessons for Nigeria’s current efforts to confront secessionist challenges. This research proposes a strategic and non-military approach where security imperatives will be balanced with inclusive national policies for consolidating unity in Nigeria and promoting long-term peace in Eastern Nigeria. Keywords: Separatist movement, Biafra, Sovereignty, Eastern Nigeria

Deficiency in glutathione peroxidase 4 (GPX4) results in abnormal lens development and newborn cataract

The human lens is composed of a monolayer of lens epithelial cells (LECs) and elongated fibers that align tightly but are separated by the plasma membrane. The integrity of the lens plasma membrane is crucial for maintaining lens cellular structure, homeostasis, and transparency. Glutathione peroxidase 4 (GPX4), a selenoenzyme, plays a critical role in protecting against lipid peroxidation. This study aims to elucidate the role of GPX4 in lens plasma membrane stability during lens development using in vitro, ex vivo, and in vivo systems. Our findings reveal that GPX4 deficiency triggers lens epithelial apoptosis-independent but ferroptosis-mediated cell death. Blocking lens GPX4 activity during ex vivo culture induces lens opacification, LEC death, and disruption of lens fiber cell arrangement. Deletion of lens-specific Gpx4 results in significant unsaturated phospholipid loss and an increase in oxidized phospholipids. Consequently, lenses with Gpx4 deficiency exhibit massive disruption of lens fiber cell structure, significant loss of LECs via ferroptosis, and formation of newborn cataracts. Remarkably, administering the lipid peroxidation inhibitor, liproxstatin-1, to pregnant mothers at embryonic days 9.5 significantly prevents lipid peroxidation, LEC death, and lens developmental defects. Our study unveils the crucial role of GPX4 in lens development and transparency, and also provides a successful intervention approach to prevent lens developmental defects through lipid peroxidation inhibition.

Navigating High-Stakes Collaboration: A Critical Analysis of Team Dynamics Among Medical Staff in Pressure-Driven Surgical Operations

In high-stakes surgical operations, effective teamwork among medical staff is critical for ensuring patient safety and positive outcomes. This article presents a critical analysis of team dynamics under pressure, focusing on communication, role clarity, leadership, stress management, and team cohesion. Using case studies and an extensive review of existing literature, the analysis examines the challenges faced by surgical teams, including breakdowns in communication, hierarchical barriers, and stress-induced errors. Additionally, the article explores successful interventions that promote collaborative skills and resilience, such as closed-loop communication protocols, role-flexibility training, and leadership development. The findings suggest that structured teamwork training and stress-management strategies significantly enhance collaborative performance in pressure-driven surgical scenarios. This analysis underscores the importance of continuous team development and adaptive leadership in mitigating risks and improving patient outcomes.

Personality, Aging, and Alzheimer's Disease: Implications for Psychoneuroimmunology and Personalized Medicine.

Psychoneuroimmunology (PNI) advancements may revolutionize personalized medicine by identifying systemic biomarkers that enhance diagnosis and treatment. Inflammatory pathways connect personality traits with cognitive performance, aging-related disorders, and mortality risks. Studies have demonstrated the critical interactions between personality and various biological systems like the hypothalamic-pituitary-adrenal (HPA) axis. The gut-brain axis also affects behaviors and psychological states in older adults, with specific gut microbiota influencing cognition, mood, and personality. These findings underscore the practical implications of understanding personality-biology interactions. They can support preventive and personalized medicine for aging-associated disorders. Specifically, personality changes are prevalent in Alzheimer's disease (AD) patients, impacting clinical management and caregiver stress. Non-cognitive factors, such as personality traits and psychiatric symptoms, may serve as early markers of AD. Traits like high Neuroticism and low Openness can predict initial AD stages, often before a formal diagnosis. Personality alterations in AD are also linked to cerebrospinal fluid (CSF) and vascular imaging biomarkers, which can track AD pathology and serve as predictors. Dynamic personality assessment can aid in timely diagnosis, monitoring progression, and evaluating treatmentsof AD. Understanding personality traits is crucial for predicting burnout, lifespan, and intervention success. Integrating personality and PNI biomarkers into patient profiles will support the development of personalized and systems medicine.

Machine Learning Methods to Personalize Persuasive Strategies in mHealth Interventions That Promote Physical Activity: Scoping Review and Categorization Overview.

Although physical activity (PA) has positive effects on health and well-being, physical inactivity is a worldwide problem. Mobile health interventions have been shown to be effective in promoting PA. Personalizing persuasive strategies improves intervention success and can be conducted using machine learning (ML). For PA, several studies have addressed personalized persuasive strategies without ML, whereas others have included personalization using ML without focusing on persuasive strategies. An overview of studies discussing ML to personalize persuasive strategies in PA-promoting interventions and corresponding categorizations could be helpful for such interventions to be designed in the future but is still missing. First, we aimed to provide an overview of implemented ML techniques to personalize persuasive strategies in mobile health interventions promoting PA. Moreover, we aimed to present a categorization overview as a starting point for applying ML techniques in this field. A scoping review was conducted based on the framework by Arksey and O'Malley and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) criteria. Scopus, Web of Science, and PubMed were searched for studies that included ML to personalize persuasive strategies in interventions promoting PA. Papers were screened using the ASReview software. From the included papers, categorized by the research project they belonged to, we extracted data regarding general study information, target group, PA intervention, implemented technology, and study details. On the basis of the analysis of these data, a categorization overview was given. In total, 40 papers belonging to 27 different projects were included. These papers could be categorized in 4 groups based on their dimension of personalization. Then, for each dimension, 1 or 2 persuasive strategy categories were found together with a type of ML. The overview resulted in a categorization consisting of 3 levels: dimension of personalization, persuasive strategy, and type of ML. When personalizing the timing of the messages, most projects implemented reinforcement learning to personalize the timing of reminders and supervised learning (SL) to personalize the timing of feedback, monitoring, and goal-setting messages. Regarding the content of the messages, most projects implemented SL to personalize PA suggestions and feedback or educational messages. For personalizing PA suggestions, SL can be implemented either alone or combined with a recommender system. Finally, reinforcement learning was mostly used to personalize the type of feedback messages. The overview of all implemented persuasive strategies and their corresponding ML methods is insightful for this interdisciplinary field. Moreover, it led to a categorization overview that provides insights into the design and development of personalized persuasive strategies to promote PA. In future papers, the categorization overview might be expanded with additional layers to specify ML methods or additional dimensions of personalization and persuasive strategies.

Nutrition as therapy - the role of dietitian counseling: a best practice implementation project.

The objective of this best practice implementation project was to improve dieticians' professional practice and dietary care through the use of counseling strategies. Improving the design and implementation of evidence-based practice depends on successful behavior change interventions. This requires an appropriate method for designing the interventions and then analyzing the targeted behavior. Behavior change techniques (BCTs) have been demonstrated to improve the patient-dietitian relationship and patient treatment outcomes. This evidence-based quality improvement project used the JBI Evidence Implementation Framework to identify gaps in clinical practice and barriers to changing practice. We recruited 20 dietitians and conducted a baseline audit to determine their level of knowledge of BCTs, the extent to which they applied BCTs in their practice, and barriers to using BCTs. To address the identified barriers, a 5-hour training session was conducted by a dietitian with psychological training. A follow-up audit was then conducted to measure improvements in compliance with best practice. The baseline audit revealed that 80% of participants used some of the targeted counseling strategies. The most common barriers were lack of guidance on the use of BCTs or insufficient knowledge of BCTs. The follow-up audit revealed that 93% of participants used some counseling strategies, representing a 13% improvement from baseline. Applying BCTs is a challenge in dietary practice. The results indicate that education about these techniques is needed. As the next step, we suggest disseminating the relevant recommendations among dietitians in Poland and providing education about the use of these methods. http://links.lww.com/IJEBH/A289.

Factors Associated With Adverse Outcomes Among Patients Undergoing Endovascular Revascularization for Iliac Artery Lesions TASC II A and B: A Single-Center Study.

This prospective study from October 2016 to September 2020 aimed to identify the factors associated with non-revascularization and mortality rates in patients who underwent endovascular interventions for Trans-Atlantic Inter-Society Consensus (TASC) II A/B iliac artery occlusions at the Department of Vascular Surgery. Patients with TASC II A/B iliac artery occlusions who underwent endovascular intervention, including balloon angioplasty and stent placement, were included. The primary outcomes were factors associated with non-revascularization and mortality rate. A total of 133 patients were enrolled in this study. Univariable analysis revealed significant associations between non-revascularization and diabetes (hazard ratio [HR]=2.61, 95% confidence interval [CI], p=0.03), chronic kidney disease (HR=16.2, 95% CI, p=0.01), and severe calcifications (HR=8.56, 95% CI, p<0.001). Subsequent multivariable analysis confirmed the significance of these factors, showing HRs of 3.04 (95% CI, p=0.02), 13.12 (95% CI, p=0.03), and 8.62 (95% CI, p<0.001), respectively. The overall mortality rate observed was 20.3%. Severe calcifications emerged as a significant risk factor for mortality in both univariable (HR=2.47, 95% CI, p=0.02) and multivariable (HR=3.01, 95% CI, p<0.001) analyses. Severe calcifications correlate with non-revascularization and mortality, while comorbidities like diabetes mellitus and chronic kidney disease are also associated with non-revascularization. Recognizing these identified factors holds substantial promise in enhancing patient selection and procedural approaches, potentially bolstering the success rates of endovascular interventions. However, further research aimed at comprehending the underlying mechanisms and devising strategies to mitigate these risks is imperative for continued improvement in patient outcomes. The study provides valuable insights into patient selection and procedural planning for endovascular interventions in TASC II A/B iliac artery occlusions. Identifying severe calcifications, diabetes, and chronic kidney disease as key risk factors for non-revascularization and mortality equips clinicians with essential predictive tools, potentially improving outcomes by tailoring treatment approaches. The innovation lies in highlighting the impact of comorbidities and calcification severity, offering a pathway to refine patient eligibility criteria and optimize procedural decisions. This underscores the importance of further research to develop strategies that mitigate these risk factors and enhance intervention success rates.

Impact of baseline dietary quality on the efficacy of a dietitian-guided weight reduction program

AimThis pre-post intervention study aimed to assess the relationship between baseline dietary quality and the efficacy of a dietitian-guided weight reduction program, which has not been thoroughly documented to date.MethodsNinety-two consecutive obese or overweight patients visiting a tertiary center clinic for weight reduction were enrolled in this study. Participants received a dietitian-guided weight reduction education program aimed at reducing daily caloric intake by 500 kcal and improving adherence to the Mediterranean diet for 3 months. Baseline dietary quality was assessed using the 14-item Taiwanese Mediterranean Diet Adherence Screener (T-MEDAS), where a higher T-MEDAS score reflects greater adherence to the Mediterranean diet. Additional covariates, including dietary behaviors, lifestyle factors, and comorbidities were also recorded. The primary outcome was the percentage of weight reduction at 3 months, analyzed using restricted cubic spline models and generalized estimating equations (GEE) to account for the correlation between weight change and the baseline T-MEDAS scores.ResultsThirty-nine participants were excluded due to major illnesses, use of anti-obesity medications, or loss to follow-up. Among the remaining 53 participants (mean age 41.2 ± 12.8 years, 56.6% female), the average weight reduction was 3.9 ± 3.3% from a baseline weight of 98.5 ± 12.8 kg. Participants who did not achieve a weight reduction of more than 5% had higher baseline T-MEDAS scores compared to those who did (5.4 ± 1.7 vs. 4.1 ± 1.8, p = 0.026). A restricted cubic spline model, adjusted for covariates including age, gender, diabetes mellitus (DM), dyslipidemia, and smoking, revealed a significant inverse relationship between higher baseline T-MEDAS scores and weight loss. After controlling for various confounders, GEE analysis demonstrated that higher baseline T-MEDAS scores were significantly associated with less weight loss (beta: -4.1, 95% CI: -5.6 to -2.6, p < 0.001).ConclusionsHigher baseline dietary quality was associated with reduced effectiveness of a dietitian-guided weight reduction program. This suggests that additional strategies may be required to improve the success of weight loss interventions in individuals with higher baseline dietary quality.

The evolution of SNAP-Ed: policy, systems and environment (PSE) interventions to enhance nutrition security and health equity in the United States

Purpose This study uses a comprehensive literature review and analysis of recent research, policy documents and program evaluations related to Supplemental Nutrition Assistance Program Education (SNAP-Ed) and policy, systems and environmental (PSE) strategies. Key sources include peer-reviewed articles, the 2025 SNAP-Ed Plan Guidance and case studies of successful PSE interventions. The Social-Ecological Model serves as a framework to organize and analyze the multilevel impacts of PSE interventions. The method involves identifying relevant information, synthesizing key themes and patterns and critically examining the potential impact of PSE strategies on nutrition security and health equity. Design/methodology/approach This paper examines the evolution of the SNAP-Ed from direct nutrition education to a comprehensive approach integrating PSE change strategies. It aims to analyze the rationale, implementation and potential impact of PSE approaches in SNAP-Ed on nutrition security and health equity in the USA. The study explores how these strategies address social determinants of health, promote sustainable population-level changes in nutrition environments, and their capacity to reduce health disparities in low-income communities. It seeks to identify challenges, opportunities and future research directions in implementing PSE strategies within SNAP-Ed. Findings The review reveals that PSE strategies in SNAP-Ed show promise in creating sustainable, population-level changes in nutrition environments and health outcomes. Successful examples, such as healthy corner store initiatives and workplace wellness programs, demonstrate the potential of PSE approaches to improve access to healthy food options and physical activity opportunities. The integration of PSE strategies has enhanced SNAP-Ed’s capacity to address social determinants of health and promote health equity. However, challenges including resource constraints, political opposition and the need for cross-sector collaboration persist. The effectiveness of PSE interventions relies heavily on community engagement, partnerships and supportive policies. Practical implications The findings underscore the importance of adopting comprehensive, multilevel approaches in nutrition education and obesity prevention programs. For SNAP-Ed implementers, this implies a need to develop expertise in PSE strategies, foster cross-sector partnerships and engage communities in intervention design and implementation. Policymakers should consider increasing support and resources for PSE approaches within SNAP-Ed and similar programs. Public health practitioners can use these insights to design more effective, equitable interventions that address root causes of nutrition insecurity. The study also highlights the need for improved evaluation methods to assess the long-term impact of PSE strategies on population health outcomes. Social implications This study highlights the importance of addressing social determinants of health, such as poverty and access to healthy food options, to promote equitable health outcomes. It underscores the potential of community-driven, multilevel interventions in building a more just and equitable food system accessible to all. Originality/value This paper provides a comprehensive analysis of the shift toward PSE strategies in SNAP-Ed, offering valuable insights into the program’s evolution and its potential to address complex public health challenges. By examining both successes and challenges, it contributes to the growing body of evidence on the effectiveness of multilevel interventions in promoting nutrition security and health equity. The study’s emphasis on the role of community engagement and partnerships in PSE implementation offers practical guidance for program planners and policymakers.

Abstract 4135425: Add-on Therapy with Dantrolene, a RyR2 Stabilizer, Terminates Ventricular Tachycardia Storm refractory to Intravenous Amiodarone in Heart Failure.

Background: Aberrant diastolic Ca 2+ leak through the cardiac ryanodine receptor (RyR2) is an important cause of heart failure (HF) and lethal arrhythmia. Dantrolene (DAN) specifically binds to the Leu 601- Cys 620 of N terminal domain in RyR2 and stabilizes the tetrameric structure of RyR2, preventing the Ca 2+ leak through RyR2. Our previous study as a proof-of-concept showed that intravenous injection (i.v.) of DAN was effective in termination and prevention of refractory ventricular tachycardia (VT) storm in HF. Research Question: How much is loading dose of DAN i.v. to terminate VT storm in HF? We hypothesized that the optimal dose was within 3mg/kg from our previous study. Aim: This study aimed to verify that 3mg/kg DAN i.v. was optimal for the termination of amiodarone-resistant VT storm in HF. Methods: This was an open-label, uncontrolled, single-center study. The detail in the study design and methods is shown in Fig.1 . We studied patients with episodes of VT storm regardless of medications, such as amiodarone and beta-blockers, recommended by HF guidelines. DAN(3mg/kg) was intravenously added on the above guideline treatment. The acute anti-arrhythmic efficacy of DAN was assessed as follows: 1) proportion of patients whose VT storm was terminated by 3mg/kg DAN i.v., 2) incidence rate of VT storm within 24 hours before and after DAN i.v.. Results: The consecutive 7 patients with refractory VT storm were enrolled in this study (median age:72 years old, male/female: 4/3, median LVEF29%). Underlying heart disease included 3 ischemic cardiomyopathy, 3 acute myocardial infarction after successful percutaneous coronary intervention and 1 tachycardia-induced cardiomyopathy. 2 of 7 patients underwent mechanical circulatory support before DAN i.v. because of pulseless VT. All patients were classified as NYHA class III/IV. 3 mg/kg of DAN i.v. ceased VT storm within 60 min in 7/7 (100%) (Fig.2, left). The number of sustained VT within 24 h after DAN i.v. were significantly lower than those within 24 h prior to DAN administration (Fig 2, right) . A representative case is shown in Fig.3 The VT storms refractory to amiodarone and landiolol (beta-blocker) as well as sedation showed complete response to 3mg/kg DAN i.v.. Conclusions: DAN, a RyR2 stabilizer, was effective in the termination of VT storm in HF resistant to guideline directed medical treatment. This is the first study to evaluate the optimal dose of DAN i.v. against the refractory VT storm in HF.

Abstract 4137716: Development and Content Validation of the Heart Failure Symptom Management Motivation Questionnaire

Introduction: Adequate heart failure (HF) self-management is crucial for alleviating distressing symptoms. While disease knowledge is important, it is insufficient for sustained self-care. Patient motivation plays a key role in successful self-management interventions. However, tools assessing motivation for HF symptom self-management are lacking. Aims: To develop the Heart Failure Symptom Management Motivation (HF-SMM) questionnaire and assess its content validity with nurse experts. Methods: A cross-sectional study occurred in three phases from November 2022 to April 2024. Initially, we conducted a systematic review to identify motivation assessment instruments for cardiovascular self-care and assess their psychometric properties. We then designed the HF-SMM items based on existing tools, guidelines, and clinical expertise, focusing on four HF symptoms: anxiety, depression, edema, and fatigue. The questionnaire comprised three subscales: autonomous motivation, controlled motivation, and amotivation. Nurse experts with doctoral degrees and HF experience assessed 96 items about questionnaire clarity and relevance via Delphi rounds, using a 4-point Likert scale. Items with a content validity index (I-CVI) between .80 to 1.00 were deemed acceptable. The average I-CVI of all items resulted in the scale content validity index average (S-CVI/Ave) with a cutoff point of .90. Results: We invited ten experts, with nine participating. They had an average of 17.1 ± 10.7 years of HF clinical experience and 11.6 ± 7.4 years of research experience. In the initial Delphi round, items scored I-CVI ranging from .44 to 1.00 for anxiety, depression, and fatigue, and .66 to 1.00 for edema, resulting in an S-CVI/Ave of .81. After the first round, 54 items with I-CVI &gt;.80 were retained (56.2%), and 42 items were revised (43.8%). A second Delphi round, with 77.7% of the original experts, showed most items with excellent I-CVI scores (&gt; .80; 84; 87.5%), with only ten items needing clarity revisions (10.4%). The overall CVI of the questionnaire was excellent with a S-CVI/ Ave of .90 after two rounds of validation. Conclusions: The HF-SMM questionnaire demonstrates excellent content validity for assessing motivation in HF self-management. Future studies should incorporate cognitive interviews to understand better patient perceptions about the items.

Improved emergency activation in interventional radiology reduces procedure delay and facilitates treatment success in patients with acute arterial bleedings.

Research of interventional treatment success in arterial bleeding cases is almost exclusively focused on technical and procedural factors. This study investigates the effect of an improved preprocedural activation algorithm for acute arterial bleedings treated by interventional radiology. During the three-year study period (2018-2021), the authors implemented an always-reachable, simple-to-remember emergency phone number routed to the responsible interventional radiologist on call and compared this pathway to the previous activation process. Data were acquired for all emergency cases with active arterial bleeding detected in CT scans and the diagnosis to treatment intervals before and after implementation were retrospectively analysed. Time signatures in CT and angiography were used to determine the interval. 1322 calls or contacts occurred during the study period. In general, 625 emergency procedures were conducted; 120 bleeding interventions met the study requirements. In the study 44 patients were treated via the conventional pathway and 76 via the emergency phone activation. The activation algorithm utilizing the emergency phone led to a slight decrease in radiation doses and fluoroscopy time and a significant reduction (15min) in diagnosis to treatment intervals (p = 0.019). After implementing the emergency phone, the technical success rate increased significantly from 68% to 94% (p<0.001). This study shows that effective communication structures, such as implementing a standardized activation pathway via an emergency phone, can significantly reduce diagnosis to treatment intervals and increase technical success rates. Effective communication is crucial for interventional radiology to deal with acute and life-threatening conditions requiring immediate treatment. This study presents a possible improvement and provides valuable insight for interventional radiology clinics seeking to optimize their communication and management strategies for emergency cases.

Identifying pragmatic solutions to reduce cigarette smoking prevalence in Indigenous North Americans: A sequential exploratory mixed-methods study protocol.

American Indians and Alaska Natives (AI/AN) have the highest prevalence of cigarette smoking of any race or ethnicity in the United States. Efforts to address smoking prevalence in this population have not historically targeted maintenance of smoking cessation, or behaviors associated with pregnancy. Recent longitudinal cohort studies have identified maintenance of cessation and pregnancy as potential opportunities to address smoking in AI/AN people. To promote success in achieving sustained smoking cessation in AI/AN people, we propose a community engaged sequential exploratory mixed-methods study focused on identifying pragmatic elements of cessation interventions. A discovery sample of 45 AI/AN people will be included in the qualitative study in one of two arms consisting of small groups or one-on-one interviews to develop elements of cessation interventions for evaluation in a discrete choice experiment survey. These one-on-one interviews will characterize the key drivers of smoking relapse and unique experiences of smoking during pregnancy. An additional, independent small group will consist of counselors who engage in smoking cessation counseling. A larger-scale survey will be administered to an AI/AN cohort from Olmsted County, Minnesota (n = 898). Elements of successful interventions will be used to inform a smoking cessation intervention pilot study. Community stakeholders have informed the methods outlined in this protocol, and there is a longitudinal engagement plan for the duration of study. We outline the methods to understand optimal strategies to promote sustained cigarette smoking cessation and cessation during pregnancy in AI/AN people. This study is critical to inform a pilot intervention aimed at reducing smoking prevalence in AI/AN people.