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Mehta, Kahini, Ariel Hoadley, Lara A. Ray, Brian D. Kiluk, Kathleen M. Carroll, and Molly Magill. "Cognitive-Behavioral Interventions Targeting Alcohol or Other Drug Use and Co-Occurring Mental Health Disorders: A Meta-Analysis." Alcohol and Alcoholism 56, no. 5 (March 29, 2021): 535–44. http://dx.doi.org/10.1093/alcalc/agab016.
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Abstract Aims This meta-analysis reviewed 15 clinical trials (18 study sites/arms), examining the efficacy of an integrated cognitive-behavioral intervention (CBI) delivered to individuals with an alcohol or other drug use disorder and a co-occurring mental health disorder (AOD/MHD). Outcomes were alcohol or other drug use and mental health symptoms at post-treatment through follow-up. Methods The inverse-variance weighted effect size was calculated for each study and pooled under random effects assumptions. Results Integrated CBI showed a small effect size for AOD (g = 0.188, P = 0.061; I2 = 86%, τ2 = 0.126, k = 18) and MHD (g = 0.169, P = 0.024; I2 = 58%, τ2 = 0.052, k = 18) outcomes, although only MHD outcomes were statistically significant. Analysis by subgroup suggested that effect magnitude varied by type of contrast condition (integrated CBI + usual care vs. usual care only; integrated CBI vs. a single-disorder intervention), follow-up time point (post-treatment vs. 3–6 months) and primary AOD/MHD diagnosis, although these sub-groups often contained significant residual heterogeneity. In a series of mixed effects, meta-regression models, demographic factors were non-significant predictors of between-study heterogeneity. For AOD outcomes, greater effects were observed in higher quality studies, but study quality was not related to effect size variability for MHD outcomes. Conclusions The current meta-analysis shows a small and variable effect for integrated CBI with the most promising effect sizes observed for integrated CBI compared with a single disorder intervention (typically an AOD-only intervention) for follow-up outcomes, and for interventions targeting alcohol use and/or post-traumatic stress disorder. Given the clinical and methodological variability within the sample, results should be considered a preliminary, but important step forward in our understanding of treatment for co-occurring AOD/MHD.
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Midford, Richard, Deb Wilkes, and Deidra Young. "Evaluation of the in Touch Training Program for the Management of Alcohol and Other Drug use Issues in Schools." Journal of Drug Education 35, no. 1 (March 2005): 1–14. http://dx.doi.org/10.2190/au5x-jdjl-ayab-6wta.
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In Touch is a professional training program designed to develop staff skills and support structures so as to enable schools to manage alcohol and other drug (AOD) matters in a coordinated manner that maximizes beneficial outcomes for at-risk students, while at the same time maintaining school discipline and community relationships. This study is an evaluation of the impact of the program on alcohol and other drug (AOD) related knowledge, attitudes and activity of participating school staff, and on AOD management practice in their schools. Data from 53 intervention participants and 21 controls were compared at pre- and post-intervention. These data indicated a 46% increase in AOD knowledge among those who participated in In Touch training. Attitudes favorable to integrated, supportive management of AOD issues also increased significantly in this group, as did desirable practice. However, change in school practice was limited. Significantly more schools whose staff participated in In Touch training had a written drug policy at post-intervention, but schools' usual responses to AOD-related incidents were substantially the same. These findings indicate that professional training on the management of AOD matters can change the understanding and practice of individual staff, but if school structures and practice are to be substantially influenced, a broader program is required.
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Howard, Rebecca, Stephanie Fry, Andrew Chan, Brigid Ryan, and Yvonne Bonomo. "A feasible model for early intervention for high-risk substance use in the emergency department setting." Australian Health Review 43, no. 2 (2019): 188. http://dx.doi.org/10.1071/ah17148.
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Objective In response to escalating alcohol and other drug (AOD)-related emergency department (ED) presentations, a tertiary Melbourne hospital embedded experienced AOD clinical nurse consultants in the ED on weekends to trial a model for screening, assessment and brief intervention (BI). The aim of the present study was to evaluate the relative contributions of AOD to ED presentations and to pilot a BI model. Methods Using a customised AOD screening tool and a framework for proactive case finding, screened participants were offered a comprehensive AOD assessment and BI in the ED. Immediate effects of the intervention were evaluated via the engagement of eligible individuals and a self-administered ‘intention to change’ survey. Results Over the 32-month pilot, 1100 patients completed a comprehensive AOD assessment, and 95% of these patients received a BI. The most commonly misused substances were, in order, alcohol, tobacco, amphetamine-type stimulants, gamma-hydroxybutyrate and cannabis. Thirty-two per cent of patients were found to be at risk of dependence from alcohol and 25% were found to be at risk of dependence from other substances. Forty per cent of the people assessed reported no previous AOD support or intervention. On leaving the ED, 78% of participants reported an intention to contact community support services and 65% stated they would change the way they used AOD in the future. Conclusion This study of a pilot program quantifies the relative contribution of AOD to ED presentations and demonstrates that hospital EDs can implement a feasible, proactive BI model with high participation rates for people presenting with AOD-related health consequences. What is known about the topic? Clinician-led BI for high-risk consumption of alcohol has been demonstrated to be effective in primary care and ED settings. However, hospital EDs are increasingly receiving people with high-risk AOD-related harms. The relative contribution of other drugs in relation to ED presentations has not been widely documented. In addition, the optimal model and effects of AOD screening and BI programs in the Australian ED setting are unknown. What does this paper add? This paper describes a ‘real-life’ pilot project embedding AOD-specific staff in a metropolitan Melbourne ED at peak times to screen and provide BI to patients presenting with AOD-related risk and/or harms. The study quantifies the relative contribution of other drugs in addition to alcohol to ED presentations and reports on this model’s much higher levels of patient engagement in receiving BI than has been reported previously. What are the implications for practitioners? This study demonstrates the relative contribution of drugs, in addition to alcohol, to ED presentations at peak weekend times. Although BI has been well proven, the pilot project evaluated herein has demonstrated that by embedding AOD-specific staff in the ED, much higher rates of patient engagement, screening and BI can be achieved.
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Myers, Bronwyn, Dan J. Stein, Bulelwa Mtukushe, and Katherine Sorsdahl. "Feasibility and Acceptability of Screening and Brief Interventions to Address Alcohol and Other Drug Use among Patients Presenting for Emergency Services in Cape Town, South Africa." Advances in Preventive Medicine 2012 (2012): 1–9. http://dx.doi.org/10.1155/2012/569153.
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Despite evidence from high income countries, it is not known whether screening and brief interventions (SBI) for alcohol and other drug (AOD) use are feasible to implement in low and middle income countries. This paper describes the feasibility and acceptability of a peer-led SBI for AOD-using patients presenting with injuries at emergency services in Cape Town, South Africa. Data were extracted from program records on the number of eligible patients screened and the number of program refusals. A questionnaire examined preliminary responses to the intervention for 30 patients who had completed the program and 10 emergency personnel. Peer counselors were also interviewed to identify barriers to implementation. Of the 1458 patients screened, 21% (305) met inclusion criteria, of which 74% (225) were enrolled in the intervention. Of the 30 patients interviewed, most (83%) found the program useful. Emergency personnel were supportive of the program but felt that visibility and reach could improve. Peer counselors identified the need for better integration of the program into emergency services and for additional training and support. In conclusion, with limited additional resources, peer-led SBIs for AOD use are feasible to conduct in South African emergency services and are acceptable to patients and emergency personnel.
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Rosenberg, Rebecca E., Rebecca Landa, J. Kiely Law, Elizabeth A. Stuart, and Paul A. Law. "Factors Affecting Age at Initial Autism Spectrum Disorder Diagnosis in a National Survey." Autism Research and Treatment 2011 (2011): 1–11. http://dx.doi.org/10.1155/2011/874619.
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Entry into early intervention depends on both age of first parent concern (AOC) and age at initial autism spectrum disorder (ASD) diagnosis (AOD). Using data collected from a national online registry from 6214 children diagnosed with an ASD between 1994 and 2010 in the US, we analyzed the effect of individual, family, and geographic covariates on AOC and AOD in a multivariate linear regression model with random effects. Overall, no single modifiable factor associated with AOC or AOD emerged but cumulative variation in certain individual- and family-based features, as well as some geographic factors, all contribute to AOC and AOD variation. A multipronged strategy is needed for targeted education and awareness campaigns to maximize outcomes and decrease disparities in ASD care.
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Ekendahl, Mats, and Patrik Karlsson. "Multiple Logics: How Staff in Relapse Prevention Interpellate People With Substance Use Problems." Contemporary Drug Problems 48, no. 2 (March 7, 2021): 99–113. http://dx.doi.org/10.1177/0091450921998077.
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This study analyzes how staff in Swedish alcohol and other drug (AoD) treatment interpellate service users as people who can benefit from relapse prevention. Relapse prevention is a widely used intervention. Research is scarce, however, on how relapse prevention is practiced locally and how treatment staff perceive the relationship between AoD use as a problem and relapse prevention as a solution. Drawing on Actor-Network Theory and critical studies of AoD issues within this tradition, we elucidate how staff through specific interpellative logics enact service users, their individual characteristics, and living conditions. The data derive from interviews with 18 professionals working with assessment, counseling, case-management, therapy, and healthcare at AoD treatment agencies in the Stockholm region. The results show that the participants drew on four interpellative logics, and thereby enacted service users as four different object types. Region and network logics pinpointed that individuals have stable observable characteristics that determine their problems and eligibility for treatment (e.g., living conditions, diagnoses). Fluid and fire logics emphasized that their characteristics also vary depending on context and can be present and absent at the same time (e.g., harms, agency). This flexible interpellation of service users echoes the tendency among treatment staff to embrace sometimes irreconcilable understandings of AoD problems and to enact multiple realities of addiction. This suits a professional field where many factors are thought to cause and help resolve problems, but where the treatment supply is often limited to specific interventions. We conclude that it is easier to create a reasonable match between the service delivered and the potential service user if the characteristics of the latter are considered diverse and flickering. This exemplifies Carol Bacchi’s tenet that problem representations are adjusted to fit the solution at hand.
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Amodeo, Maryann, and L. Kay Jones. "Viewing Alcohol and Other Drug Use Cross Culturally: A Cultural Framework for Clinical Practice." Families in Society: The Journal of Contemporary Social Services 78, no. 3 (June 1997): 240–54. http://dx.doi.org/10.1606/1044-3894.772.
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The authors present a conceptual framework for cross-cultural investigation of alcohol and other drug (AOD) issues, including attitudes, values, and behaviors. Elements include cultural views of using alcohol and other drugs, life problems, seeking help, relapse, and recovery. Acculturation, subgroup identity, and migration are critically important variables in the framework. The framework can be used to view a single culture or to compare several and can help clinicians explore clients' earliest exposure to alcohol and other drugs, family and community messages regarding AOD use, and stigma and shame. It can stimulate clinicians' thinking about culturally specific intervention methods and family and community supports for recovery.
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Pols, René G., Douglas Sellman, Steven Jurd, Michael Baigent, Nanette Waddy, Tobie Sacks, Peter Tucker, John Fowler, and Allan White. "What is the Psychiatrist's Role in Drugs and Alcohol?" Australian & New Zealand Journal of Psychiatry 30, no. 4 (August 1996): 540–48. http://dx.doi.org/10.3109/00048679609065030.
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Objective: This article describes a consensus view of the role of psychiatrists in respect of alcohol and other drug (AOD) problems, in response to the view expressed by Wodak [1]. Method: The data were selected on the basis of the knowledge and experience of the authors. Results: Psychiatrists have made major contributions in the primary, secondary and tertiary prevention of AOD problems over many years in Australia and New Zealand. In recent years there has been an explosion of new knowledge in the AOD area and a shift from mental health to primary and public health care for these patients. Substance use disorders (SUD) are highly prevalent in all areas of psychiatric practice, requiring treatment in their own right as well as complicating the treatment of coexisting psychiatric illness. Conclusion: It is argued that psychiatrists have important roles in harm reduction, prevention and policy development; brief and early intervention in SUD in liaison and child psychiatry; and systematic treatment for those with dependence and other psychiatric comorbidity. A research and collaborative approach to AOD services and patients should be encouraged, rather than engaging in divisive debate over ‘ownership’ of this area of clinical practice.
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Appel, Philip W., Rob Piculell, Hadley K. Jansky, and Kevin Griffy. "Assessing Alcohol and Other Drug Problems (AOD) among Sexually Transmitted Disease (STD) Clinic Patients with a Modified Cage-A: Implications for AOD Intervention Services and STD Prevention." American Journal of Drug and Alcohol Abuse 32, no. 2 (January 1, 2006): 225–36. http://dx.doi.org/10.1080/00952990500479555.
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Chaudhary, Navjot, Bill H. Wang, Kevin R. Gurr, Stewart I. Bailey, and Christopher S. Bailey. "A rare case of atlantooccipital dissociation in the context of occipitalization of the atlas, with a 2-year follow-up." Journal of Neurosurgery: Spine 18, no. 2 (February 2013): 189–93. http://dx.doi.org/10.3171/2012.10.spine12430.
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Atlantooccipital dislocation (AOD) is a rare and often fatal injury. In cases of survival, residual deficits are severe and often include cranial nerve palsy, quadriplegia, or respiratory issues. Occipitalization is defined as partial or complete congenital fusion of the occiput to the atlas and is exceptionally rare. The authors present a rare case of AOD superimposed on a congenital occipitalization of the atlas. This 39-year-old man had AOD following a motor vehicle collision. On examination, his overall motor score on the American Spinal Injury Association scale was 5/100, and his rectal tone was absent. Computed tomography demonstrated AOD in an area of occipitalization. Magnetic resonance imaging revealed ligamentous injury leading to C1–2 instability. Intervention included occipital cervical instrumentation fusion from the occiput to C-3. Six months postoperatively, imaging revealed fusion of the graft and consolidation of the fractured occipitalization. At the 2-year follow-up, the patient's strength was 3/5 for wrist extension and handgrip on the right side and full strength in the rest of the myotomes. Bladder and bowel function was also normalized. A high-velocity collision led to disruption of the atlantooccipital ligaments and fracture of the occipitalized lateral masses in this patient. Internal fixation and fusion led to good fusion postoperatively. Occipitalization probably led to abnormal joint mechanics at the C1-occiput junction, which might have altered the amount of force required to fracture the occipitalization and produce AOD. This difference may partially account for the favorable neurological outcome in the featured patient compared with traditional cases of AOD.
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Christie, Grant, Stella Black, Lucy Dunbar, Justin Pulford, and Amanda Wheeler. "Attitudes, Skills and Knowledge Change in Child and Adolescent Mental Health Workers Following AOD Screening and Brief Intervention Training." International Journal of Mental Health and Addiction 11, no. 2 (January 3, 2013): 232–46. http://dx.doi.org/10.1007/s11469-012-9414-1.
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Debenham, Jennifer, Louise Birrell, Katrina Champion, Mina Askovic, and Nicola Newton. "A pilot study of a neuroscience-based, harm minimisation programme in schools and youth centres in Australia." BMJ Open 10, no. 2 (February 2020): e033337. http://dx.doi.org/10.1136/bmjopen-2019-033337.
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ObjectivesThe primary aim is to evaluate the feasibility of a newly developed, neuroscience-based, alcohol and other drug (AOD) use prevention programme, ‘The Illicit Project’, in Australian older adolescents. The secondary aim is to investigate the impact of the programme on students’ drug literacy levels (a combination of knowledge, attitudes and skills).DesignA pilot study examining the feasibility of The Illicit Project in Australian schools was conducted.ParticipantsStudents aged 15–19 years from two secondary schools and a youth centre and 11 teachers and health professionals from various organisations in Sydney were recruited.InterventionThe intervention consisted of three 90 min workshops delivered by trained facilitators within a month.Primary and secondary measuresStudents completed a drug literacy questionnaire before and after intervention. All participants (students, teachers and health professionals) completed an evaluation questionnaire postprogramme delivery. A paired-sample t-test and descriptive analytics were performed.ResultsStudents (n=169) demonstrated a significant increase in drug literacy levels from preintervention to postintervention (t(169) = −13.22, p<0.0001). Of students evaluating the programme (n=252), over threequarters agreed that The Illicit Project was good or very good (76%), that the neuroscience content was interesting (76%) and relevant (81%), and that they plan to apply the concepts learnt to their own lives (80%). In addition, all teachers and health professionals (n=11) agreed that the programme was feasible and valid for schools and perceived the programme to be effective in reducing the harms and use of AOD.ConclusionsThere is evidence to suggest that The Illicit Project is credible and feasible in the school environment and there are preliminary data to suggest it may help to improve drug literacy levels in young people. A large-scale evaluation trial of the intervention will be conducted to determine the programme’s effectiveness in minimising the harms of AOD in older adolescents.
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Kohlwes, R. Jeffrey, Patricia Cornett, Madhavi Dandu, Katherine Julian, Arpana Vidyarthi, Tracy Minichiello, Rebecca Shunk, et al. "Developing Educators, Investigators, and Leaders During Internal Medicine Residency: The Area of Distinction Program." Journal of Graduate Medical Education 3, no. 4 (December 1, 2011): 535–40. http://dx.doi.org/10.4300/jgme-d-11-00029.1.
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Abstract Background Professional organizations have called for individualized training approaches, as well as for opportunities for resident scholarship, to ensure that internal medicine residents have sufficient knowledge and experience to make informed career choices. Context and Purpose To address these training issues within the University of California, San Francisco, internal medicine program, we created the Areas of Distinction (AoD) program to supplement regular clinical duties with specialized curricula designed to engage residents in clinical research, global health, health equities, medical education, molecular medicine, or physician leadership. We describe our AoD program and present this initiative's evaluation data. Methods and Program Evaluation We evaluated features of our AoD program, including program enrollment, resident satisfaction, recruitment surveys, quantity of scholarly products, and the results of our resident's certifying examination scores. Finally, we described the costs of implementing and maintaining the AoDs. Results AoD enrollment increased from 81% to 98% during the past 5 years. Both quantitative and qualitative data demonstrated a positive effect on recruitment and improved resident satisfaction with the program, and the number and breadth of scholarly presentations have increased without an adverse effect on our board certification pass rate. Conclusions The AoD system led to favorable outcomes in the domains of resident recruitment, satisfaction, scholarship, and board performance. Our intervention showed that residents can successfully obtain clinical training while engaging in specialized education beyond the bounds of core medicine training. Nurturing these interests may empower residents to better shape their careers by providing earlier insight into internist roles that transcend classic internal medicine training.
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IJpma, te Riet, van de Luijtgaarden, van Heijningen, Burger, Majoor-Krakauer, Rouwet, Essers, Verhagen, and van der Pluijm. "Inflammation and TGF-β Signaling Differ between Abdominal Aneurysms and Occlusive Disease." Journal of Cardiovascular Development and Disease 6, no. 4 (November 1, 2019): 38. http://dx.doi.org/10.3390/jcdd6040038.
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Abdominal aortic aneurysms (AAA), are usually asymptomatic until rupture causes fatal bleeding, posing a major vascular health problem. AAAs are associated with advanced age, male gender, and cardiovascular risk factors (e.g. hypertension and smoking). Strikingly, AAA and AOD (arterial occlusive disease) patients have a similar atherosclerotic burden, yet develop either arterial dilatation or occlusion, respectively. The molecular mechanisms underlying this diversion are yet unknown. As this knowledge could improve AAA treatment strategies, we aimed to identify genes and signaling pathways involved. We compared RNA expression profiles of abdominal aortic AAA and AOD patient samples. Based on differential gene expression profiles, we selected a gene set that could serve as blood biomarker or as pharmacological intervention target for AAA. In this AAA gene list we identified previously AAA-associated genes COL11A1, ADIPOQ, and LPL, thus validating our approach as well as novel genes; CXCL13, SLC7A5, FDC-SP not previously linked to aneurysmal disease. Pathway analysis revealed overrepresentation of significantly altered immune-related pathways between AAA and AOD. Additionally, we found bone morphogenetic protein (BMP) signaling inhibition simultaneous with activation of transforming growth factor β (TGF-β) signaling associated with AAA. Concluding our gene expression profiling approach identifies novel genes and an interplay between BMP and TGF-β signaling regulation specifically for AAA.
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Payer, Michael, and Cyrille C. Sottas. "Traumatic Atlanto-occipital Dislocation: Presentation of a New Posterior Occipitoatlantoaxial Fixation Technique in an Adult Survivor: Technical Case Report." Operative Neurosurgery 56, suppl_1 (January 1, 2005): ONS—E203—ONS—E203. http://dx.doi.org/10.1227/01.neu.0000144171.37158.f0.
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Abstract OBJECTIVE AND IMPORTANCE: More survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0–C1–C2 fixation. CLINICAL PRESENTATION: A 29-year-old motorcyclist survived a traumatic vertical AOD of 15 mm. No spinal cord or medullary lesion was present. Brain contusion and diffuse axonal injuries led to a cortical biplegia, which recovered progressively over a period of 6 months. Twelve months after surgery, no neurological deficit was present except for slightly increased deep tendon reflexes. INTERVENTION: Posterior C0–C1–C2 fixation was performed with two bicortical occipital screws, one bicortical lateral mass screw in the atlas, and one monocortical pars screw in the axis on each side, connected to a plate-rod on the right and left sides. Fusion was performed with monocortical bone graft from the posterior iliac crest. CONCLUSION: The surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.
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Nguyen, Thach, Hoang Do, Tri Pham, Loc T. Vu, Marco Zuin, and Gianluca Rigatelli. "Left ventricular dysfunction causing ischemia in patients with patent coronary arteries." Perfusion 33, no. 2 (August 21, 2017): 115–22. http://dx.doi.org/10.1177/0267659117727826.
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Background: New onset of heart failure (HF) is an indication for the assessment of coronary artery disease. The aim of this study was to clarify the mechanistic causes of new onset HF associated with ischemic electrocardiograph (EKG) changes and chest pain in patients with patent or minimally diseased coronary arteries. Methods: Twenty consecutive patients (Group A) were retrospectively reviewed if they had an history of new onset of HF, chest pain, electrocardiographic changes indicating ischemia (ST depression or T wave inversion in at least two consecutive leads and a negative coronary angiogram [CA]) and did not require percutaneous coronary intervention or coronary artery bypass grafting. A 1:1 matched cohort (Group B) was adopted to validate the results. Results: All patients had a negative CA. The majority of subjects in Group A had a higher left ventricular end diastolic pressure (LVEDP) when compared to the control group (p<0.05). Similarly, the aortic diastolic (AOD) pressure was lower in Group A than in Group B (p<0.05). In patients with elevated LVEDP and low AOD, with a coronary perfusion pressure (CPP) <20 mmHg, deep T wave inversion in two consecutive leads were more frequently observed. When the CPP was between 20-30 mmHg, a mild ST depression were more frequently recorded (p<0.05). Conversely, when the CPP was >30 mmHg, only mild non-specific ST-T changes or normal EKG were observed. Conclusions: In patients with HF and EKG changes suggestive of ischemia in at least two consecutive leads, a lower AOD could aggravate ischemia in patients with elevated left ventricular end diastolic pressure.
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Blatch, Chris, Kevin O'Sullivan, Jordan J. Delaney, and Daniel Rathbone. "Getting SMART, SMART Recovery© programs and reoffending." Journal of Forensic Practice 18, no. 1 (February 8, 2016): 3–16. http://dx.doi.org/10.1108/jfp-02-2015-0018.
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Purpose – The purpose of this paper is to determine reconviction outcomes for 2,882 male and female offenders with significant alcohol and other drug (AOD) criminogenic needs, serving custodial sentences in New South Wales, between 2007 and 2011, who participated in the Getting SMART and/or the SMART Recovery® programs. Design/methodology/approach – A quasi-experimental research design utilized data from 2,343 offenders attending Getting SMART; 233 attending SMART Recovery© and 306 attending both programs, compared to a propensity score-matched control group of 2,882 offenders. Cox and Poisson regression techniques determined survival times to first reconviction and rates of reconvictions, adjusting for time at risk. Findings – Getting SMART participation was significantly associated with improved odds of time to first reconviction by 8 percent and to first violent reconviction by 13 percent, compared to controls. Participants attending both programs (Getting SMART and SMART Recovery©), had significantly lower reconviction rate ratios for both general (21 percent) and violent (42 percent) crime, relative to controls. Getting SMART attendance was associated with significant reductions in reconviction rates of 19 percent, and the reduction for SMART Recovery© attendance (alone) was 15 percent, the latter figure being non-significant. In all, 20 hours in either SMART program (ten sessions) was required to detect a significant therapeutic effect. Practical implications – Criminal justice jurisdictions could implement this two SMART program intervention model, knowing a therapeutic effect is more likely if Getting SMART (12 sessions of cognitive-restructuring and motivation) is followed by SMART Recovery© for ongoing AOD therapeutic maintenance and behavioral change consolidation. SMART Recovery©, a not-for-profit proprietary program, is widely available internationally. Originality/value – Getting SMART and SMART Recovery© have not previously been rigorously evaluated. This innovative two-program model contributes to best practice for treating higher risk offenders with AOD needs, suggesting achievable reductions in both violent and general reoffending.
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Brown, Ryan A., Daniel L. Dickerson, David J. Klein, Denis Agniel, Carrie L. Johnson, and Elizabeth J. D’Amico. "Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being." Youth & Society 53, no. 1 (April 3, 2019): 54–75. http://dx.doi.org/10.1177/0044118x19840048.
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American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.
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Baker, Elise, A. Lynn Williams, Sharynne McLeod, and Rebecca McCauley. "Elements of Phonological Interventions for Children With Speech Sound Disorders: The Development of a Taxonomy." American Journal of Speech-Language Pathology 27, no. 3 (August 6, 2018): 906–35. http://dx.doi.org/10.1044/2018_ajslp-17-0127.
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Purpose Our aim was to develop a taxonomy of elements comprising phonological interventions for children with speech sound disorders. Method We conducted a content analysis of 15 empirically supported phonological interventions to identify and describe intervention elements. Measures of element concentration, flexibility, and distinctiveness were used to compare and contrast interventions. Results Seventy-two intervention elements were identified using a content analysis of intervention descriptions then arranged to form the Phonological Intervention Taxonomy: a hierarchical framework comprising 4 domains, 15 categories, and 9 subcategories. Across interventions, mean element concentration (number of required or optional elements) was 45, with a range of 27 to 59 elements. Mean flexibility of interventions (percentage of elements considered optional out of all elements included in the intervention) was 44%, with a range of 29% to 62%. Distinctiveness of interventions (percentage of an intervention's rare elements and omitted common elements out of all elements included in the intervention [both optional and required]) ranged from 0% to 30%. Conclusions An understanding of the elements that comprise interventions and a taxonomy that describes their structural relationships can provide insight into similarities and differences between interventions, help in the identification of elements that drive treatment effects, and facilitate faithful implementation or intervention modification. Research is needed to distil active elements and identify strategies that best facilitate replication and implementation.
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Birnbaum, Marvin L., Elaine K. Daily, and Ann P. O’Rourke. "Research and Evaluations of the Health Aspects of Disasters, Part VII: The Relief/Recovery Framework." Prehospital and Disaster Medicine 31, no. 2 (February 3, 2016): 195–210. http://dx.doi.org/10.1017/s1049023x16000029.
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AbstractThe principal goal of research relative to disasters is to decrease the risk that a hazard will result in a disaster. Disaster studies pursue two distinct directions: (1) epidemiological (non-interventional); and (2) interventional. Both interventional and non-interventional studies require data/information obtained from assessments of function. Non-interventional studies examine the epidemiology of disasters. Interventional studies evaluate specific interventions/responses in terms of their effectiveness in meeting their respective objectives, their contribution to the overarching goal, other effects created, their respective costs, and the efficiency with which they achieved their objectives. The results of interventional studies should contribute to evidence that will be used to inform the decisions used to define standards of care and best practices for a given setting based on these standards. Interventional studies are based on the Disaster Logic Model (DLM) and are used to change or maintain levels of function (LOFs). Relief and Recovery interventional studies seek to determine the effects, outcomes, impacts, costs, and value of the intervention provided after the onset of a damaging event. The Relief/Recovery Framework provides the structure needed to systematically study the processes involved in providing relief or recovery interventions that result in a new LOF for a given Societal System and/or its component functions. It consists of the following transformational processes (steps): (1) identification of the functional state prior to the onset of the event (pre-event); (2) assessments of the current functional state; (3) comparison of the current functional state with the pre-event state and with the results of the last assessment; (4) needs identification; (5) strategic planning, including establishing the overall strategic goal(s), objectives, and priorities for interventions; (6) identification of options for interventions; (7) selection of the most appropriate intervention(s); (8) operational planning; (9) implementation of the intervention(s); (10) assessments of the effects and changes in LOFs resulting from the intervention(s); (11) determination of the costs of providing the intervention; (12) determination of the current functional status; (13) synthesis of the findings with current evidence to define the benefits and value of the intervention to the affected population; and (14) codification of the findings into new evidence. Each of these steps in the Framework is a production function that facilitates evaluation, and the outputs of the transformation process establish the current state for the next step in the process. The evidence obtained is integrated into augmenting the respective Response Capacities of a community-at-risk. The ultimate impact of enhanced Response Capacity is determined by studying the epidemiology of the next event.BirnbaumML, DailyEK, O’RourkeAP. Research and evaluations of the health aspects of disasters, part VII: the Relief/Recovery Framework. Prehosp Disaster Med. 2016;31(2):195–210.
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Kouritas, Vasileios, Richard Milton, Emmanouel Kefaloyannis, Kostas Papagiannopoulos, Allesandro Brunelli, Doytchin Dimov, Sishik Karthik, Andrew Hardy, Peter Tcherveniakov, and Nilanjan Chaudhuri. "The Impact of a Newly Established Multidisciplinary Team on the Interventional Treatment of Patients With Emphysema." Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine 13 (January 2019): 117954841985206. http://dx.doi.org/10.1177/1179548419852063.
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Background: The emphysema interventional treatment involves mainly lung volume reduction surgery (LVRS) and endobronchial valve (EBV) implantation. Few institutes discuss these cases at a dedicated emphysema multidisciplinary team (MDT) meeting. Objectives: To investigate the impact of a newly established dedicated emphysema MDT meeting on the interventional treatment of such patients. Methods: During a study period of 4 years, the outcome of 44 patients who underwent intervention according to the proposal of the emphysema MDT (group A) was compared with the outcome of 44 propensity score matched patients (group B) treated without the emphysema MDT proposal. Results: More LVRS and less EBV insertions were performed in group A ( P = .009). In group B, the interventions were performed sooner than in group A ( P = .003). Postoperative overall morbidity and length of in-hospital stay were similar in the 2 groups ( P = .918 and .758, respectively). Improvement of breathing ability was reported in more patients from group A ( P = .012). In group B, the total number of re-interventions was higher ( P = .001) and the time to re-intervention had the tendency to be less ( P = .069). Survival was similar between the 2 groups ( P = .884). Intervention without discussion at the MDT and EBV as initial intervention was an independent predictor of re-intervention. Conclusions: Interventional treatment for patients with chronic obstructive pulmonary disease (COPD) after discussion at a dedicated MDT involved more LVRS performed, required fewer interventions for their disease, and had longer re-intervention-free intervals and better breathing improvement.
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Yamamoto, Shota, Tomohiro Matsumoto, Satoshi Suda, Kosuke Tomita, Shunsuke Kamei, Kazunobu Hashida, Yutaka Imai, Kazuyuki Endo, Katsuki Murakami, and Terumitsu Hasebe. "First experience of efficacy and radiation exposure in 320-detector row CT fluoroscopy-guided interventions." British Journal of Radiology 94, no. 1120 (April 1, 2021): 20200754. http://dx.doi.org/10.1259/bjr.20200754.
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Objective: We investigated the efficacy and exposure to radiation in 320-detector row computed tomography fluoroscopy-guided (CTF-guided) interventions. Methods: We analysed 231 320-detector row CTF-guided interventions (207 patients over 2 years and 6 months) in terms of technical success rates, clinical success rates, complications, scanner settings, overall radiation doses (dose–length product, mGy*cm), patient doses of peri-interventional CT series, and interventional CT (including CTF), as a retrospective cohort study. The relationships between patient radiation dose and interventional factors were assessed using multivariate analysis. Results: Overall technical success rate was 98.7% (228/231). The technical success rates of biopsies, drainages, and aspirations were 98.7% (154/156), 98.5% (66/67), and 100% (8/8), respectively. The clinical success rate of biopsies was 93.5% (146/156). All three major complications occurred in chest biopsies. The median total radiation dose was 522.4 (393.4–819.8) mGy*cm. Of the total radiation dose, 87% was applied during the pre- and post-interventional CT series. Post-interventional CT accounted for 24.4% of the total radiation dose. Only 11.4% of the dose was applied by CTF-guided intervention. Multilinear regression demonstrated that male sex, body mass index, drainage, intervention time, and helical scan as post-interventional CT were significantly associated with higher dose. Conclusion: The 320-detector row CTF interventions achieved a high success rate. Dose reduction in post-interventional CT provides patient dose reduction without decreasing the technical success rates. Advances in knowledge: This is the first study on the relationship between various interventional outcomes and patient exposure to radiation in 320-detector row CTF-guided interventions, suggesting a new perspective on dose reduction.
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Horn, Kimberly, Geri Dino, Candice Hamilton, N. Noerachmanto, and Jianjun Zhang. "Evidence-Based Review and Discussion Points." American Journal of Critical Care 17, no. 3 (May 1, 2008): 205–16. http://dx.doi.org/10.4037/ajcc2008.17.3.205.
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Background Traditional efficacy research alone is insufficient to move interventions from research to practice. Motivational interviewing has been adapted for brief encounters in a variety of health care settings for numerous problem behaviors among adolescents and adults. Some experts suggest that motivational interviewing can support a population health approach to reach large numbers of teen smokers without the resource demands of multisession interventions. Objectives To determine the reach, implementation fidelity, and acceptability of a brief motivational tobacco intervention for teens who had treatment in a hospital emergency department. Methods Among 74 teens 14 to 19 years old, 40 received a brief motivational tobacco intervention and 34 received brief advice/care as usual at baseline. Follow-up data were collected from the interventional group at 1, 3, and 6 months and from the control group at 6 months. For the interventional group, data also were collected from the teens’ parents, the health care personnel who provided the intervention, and emergency department personnel. Results Findings indicated low levels of reach, high levels of implementation fidelity, and high levels of acceptability for teen patients, their parents, and emergency department personnel. Data suggest that practitioners can operationalize motivational interventions as planned in a clinical setting and that patients and others with an interest in the outcomes may find the interventions acceptable. However, issues of reach may hinder use of the intervention among teens in clinical settings. Conclusions Further investigation is needed on mechanisms to reduce barriers to participation, especially barriers related to patient acuity.
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Sadeghi, Reza, Fatemeh Baghernezhad Hesary, and Narges Khanjani. "A Systematic Review about Educational Interventions based on the Health Belief Model (HBM) aimed to prevent and control diabetes in Iran." International Journal of Ayurvedic Medicine 11, no. 1 (March 24, 2020): 15–22. http://dx.doi.org/10.47552/ijam.v11i1.1257.
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Background: Diabetes is one of the most common metabolic diseases in the world and a serious health problem, that requires comprehensive interventions. This systematic review was conducted to summarize educational interventions based on the Health Belief Model aimed to prevent and control diabetes. Methods: Searches were done on May 30, 2019 in PubMed, Web of Science, Google Scholar, Embase, Scopus, SID, Magiran, and IranMedex databases in English and Persian. The inclusion criteria included quantitative original interventional studies that aimed to control type 2 diabetes, and the intervention was based on the Health Belief Model. Studies done outside of Iran, interventions on other types of diabetes, non-interventional studies, and reviews were excluded. Results: Eventually, 13 studies (6 English and 7 Persian articles) entered this systematic review. The intervention durations were from 2 to 3 months. These studies fell into three broad categories: 1- Prevention of the disease 2- Improving Nutrition behaviors in patients 3-Prevention of disease complications or its progress. All of the educational interventions showed a positive effect for education on the prevention and control of diabetes. Conclusions: Interventions based on the HBM have shown an effective role in controlling and preventing diabetes.
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Alex, Johnson. "Learning Disabilities: Assessment and Intervention." Paripex - Indian Journal Of Research 2, no. 2 (January 15, 2012): 175–76. http://dx.doi.org/10.15373/22501991/feb2013/62.
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Wolf,, Zane Robinson, Denise Nagle Bailey,, and Patricia A. Keeley,. "Creation of a Caring Protocol: Activities and Dissemination Strategies in Caring Research and Instruments." International Journal of Human Caring 18, no. 1 (February 2014): 66–82. http://dx.doi.org/10.20467/1091-5710.18.1.66.
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Few acute care healthcare agencies have tested the effect of a caring-focused program on the satisfaction of hospitalized, adult patients. Caring interventions need to be tested to document the effectiveness of nurse caring on a healthcare outcome, patient satisfaction. This study identified critical elements in interventional studies on nurse caring by determining patterns and caring activities in interventions (programs, protocols, or standards) to develop a caring protocol for a National Cancer Institute Comprehensive Cancer Center (NCICCC). Research, other published articles on caring programs, and instruments were analyzed for patterns and elements indicative of caring behaviors or activities representing nurse caring that could contribute to a caring intervention. Intervention dissemination strategies were also analyzed for incorporation into the program’s implementation in a nursing department of the NCICCC. Content analysis techniques identified patterns and activities in caring interventions and intervention dissemination strategies. Comments and written suggestions on the draft caring protocol were solicited from agency stakeholders (N = 22), including administrators, key nursing staff, and members of the Patient Family Advisory Council. The caring protocol/standard of practice and dissemination strategies were identified.
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Greenwell, Kate, Debbie Featherstone, and Derek J. Hoare. "The Application of Intervention Coding Methodology to Describe the Tinnitus E-Programme, an Internet-Delivered Self-Help Intervention for Tinnitus." American Journal of Audiology 24, no. 3 (September 2015): 311–15. http://dx.doi.org/10.1044/2015_aja-14-0089.
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Purpose This article describes the Tinnitus E-Programme, a previously untested Internet-delivered self-help intervention for tinnitus. Method Intervention coding methodology was applied to describe the intervention components, techniques, and mode of delivery. Results The intervention consists of 5 self-management intervention components, 5 behavior change techniques, and 3 modes of Internet delivery, which aim to promote relaxation behavior and reduce tinnitus distress. Conclusions The intervention coding provided a reliable method for reporting Internet-delivered self-help interventions. It will be used to facilitate our understanding of the intervention's potential mechanisms of change and will guide future evaluation work.
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Vemareddy Hemalatha, Mahesh P A, Balaji Sathyanarayana Gupta, and Shilpa Palaksha. "Impact of different instructional interventions in training on inhalers amongst Asthma and COPD patients." International Journal of Research in Pharmaceutical Sciences 11, no. 2 (April 13, 2020): 1754–61. http://dx.doi.org/10.26452/ijrps.v11i2.2079.
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The aim of this study is to assess the impact of different instructional interventions in training on inhalers amongst asthma and COPD patients. A randomized,prospective interventional study was conducted. Different instructional methods were prepared based on guidelines review and expert’s opinion. A total of 210 study participants were included and randomized to different interventions groups such as A. patient information leaflets B. video demonstration C. Direct pharmacist instruction. The inhaler use competency was measured at baseline and after intervention with checklist. Of the 210 subjects, statistically significant differences were observed when compared with the direct pharmacist intervention with other two interventions, for MDI (P-value < 0.005), MDI with spacer (P-value < 0.001) and Lupihaler (P-value < 0.001). For the Rotahaler (P-value 0.3), Revoliser (P-value 0.5) a significant improvement was observed with Direct pharmacist intervention when compared with other two interventions. Different critical steps that were more frequently inappropriately performed are shaking before actuation, breathout before inhalation, pressing the canister once, hold breath for at least 5-10 seconds, exhaling away from DPI, fast & deep inhalation for DPI. Direct pharmacist instruction has more impact on study participants compared to other interventions in improvement of before and after counselling mean checklist scores, lesser inhaler technique errors were observed when compared with other interventions provided. Other materials can be used along with direct pharmacist intervention for a better understanding of the patients.
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Birnbaum, Marvin L., Elaine K. Daily, Ann P. O’Rourke, and Jennifer Kushner. "Research and Evaluations of the Health Aspects of Disasters, Part VI: Interventional Research and the Disaster Logic Model." Prehospital and Disaster Medicine 31, no. 2 (February 2, 2016): 181–94. http://dx.doi.org/10.1017/s1049023x16000017.
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AbstractDisaster-related interventions are actions or responses undertaken during any phase of a disaster to change the current status of an affected community or a Societal System. Interventional disaster research aims to evaluate the results of such interventions in order to develop standards and best practices in Disaster Health that can be applied to disaster risk reduction. Considering interventions as production functions (transformation processes) structures the analyses and cataloguing of interventions/responses that are implemented prior to, during, or following a disaster or other emergency. Since currently it is not possible to do randomized, controlled studies of disasters, in order to validate the derived standards and best practices, the results of the studies must be compared and synthesized with results from other studies (ie, systematic reviews). Such reviews will be facilitated by the selected studies being structured using accepted frameworks. A logic model is a graphic representation of the transformation processes of a program [project] that shows the intended relationships between investments and results. Logic models are used to describe a program and its theory of change, and they provide a method for the analyzing and evaluating interventions. The Disaster Logic Model (DLM) is an adaptation of a logic model used for the evaluation of educational programs and provides the structure required for the analysis of disaster-related interventions. It incorporates a(n): definition of the current functional status of a community or Societal System, identification of needs, definition of goals, selection of objectives, implementation of the intervention(s), and evaluation of the effects, outcomes, costs, and impacts of the interventions. It is useful for determining the value of an intervention and it also provides the structure for analyzing the processes used in providing the intervention according to the Relief/Recovery and Risk-Reduction Frameworks.BirnbaumML, DailyEK, O’RourkeAP, KushnerJ. Research and evaluations of the health aspects of disasters, part VI: interventional research and the Disaster Logic Model. Prehosp Disaster Med. 2016;31(2):181–194.
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Cambon, Linda, and François Alla. "Current challenges in population health intervention research." Journal of Epidemiology and Community Health 73, no. 11 (July 17, 2019): 990–92. http://dx.doi.org/10.1136/jech-2019-212225.
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Population health interventions (PHIs) are generally complex; their results depend on their interaction with the context of their implementation. Moreover, the distinction between intervention and context is arbitrary: we need rather to consider an ‘interventional system’, including both interventional and contextual components. Evaluation must go beyond effectiveness and must include two key research questions: a viability analysis, to verify that the intervention can be routinised in a real-life context; and a theory-based evaluation, to analyse mechanisms and to understand what produces effects among components and their interactions with each other and with the context. PHI research is a question not only of the object but also of perspectives. This means doing research differently, making use of interdisciplinarity and involving stakeholders. Such an approach may contribute to the development, transfer, implementation and scaling-up of innovative interventions.
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Permadi, Didin Agustian, Nguyen Thi Kim Oanh, and Robert Vautard. "Assessment of emission scenarios for 2030 and impacts of black carbon emission reduction measures on air quality and radiative forcing in Southeast Asia." Atmospheric Chemistry and Physics 18, no. 5 (March 7, 2018): 3321–34. http://dx.doi.org/10.5194/acp-18-3321-2018.
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Abstract. Our previously published paper (Permadi et al. 2018) focused on the preparation of emission input data and evaluation of WRF–CHIMERE performance in 2007. This paper details the impact assessment of the future (2030) black carbon (BC) emission reduction measures for Southeast Asia (SEA) countries on air quality, health and BC direct radiative forcing (DRF). The business as usual (BAU2030) projected emissions from the base year of 2007 (BY2007), assuming “no intervention” with the linear projection of the emissions based on the past activity data for Indonesia and Thailand and the sectoral GDP growth for other countries. The RED2030 featured measures to cut down emissions in major four source sectors in Indonesia and Thailand (road transport, residential cooking, industry, biomass open burning) while for other countries the Representative Concentration Pathway 8.5 (RCP8.5) emissions were assumed. WRF–CHIMERE simulated levels of aerosol species under BAU2030 and RED2030 for the modeling domain using the base year meteorology and 2030 boundary conditions from LMDZ-INCA. The extended aerosol optical depth module (AODEM) calculated the total columnar AOD and BC AOD for all scenarios with an assumption on the internal mixing state. Under RED2030, the health benefits were analyzed in terms of the number of avoided premature deaths associated with ambient PM2.5 reduction along with BC DRF reduction. Under BAU2030, the average number of the premature deaths per 100 000 people in the SEA domain would increase by 30 from BY2007 while under RED2030 the premature deaths would be cut down (avoided) by 63 from RED2030. In 2007, the maximum annual average BC DRF in the SEA countries was 0.98 W m−2, which would increase to 2.0 W m−2 under BAU2030 and 1.4 W m−2 under RED2030. Substantial impacts on human health and BC DRF reduction in SEA could result from the emission measures incorporated in RED2030. Future works should consider other impacts, such as for agricultural crop production, and the cost–benefit analysis of the measures' implementation to provide relevant information for policy making.
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Sidani, Souraya, Mary Fox, and Maher M. El-Masri. "Guidance for the Reporting of an Intervention's Theory." Research and Theory for Nursing Practice 34, no. 1 (January 1, 2020): 35–48. http://dx.doi.org/10.1891/1541-6577.34.1.35.
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BackgroundInterventions in clinical trials should be clearly and completely described to inform their evaluation in replication studies and implementation in clinical practice. Guidelines were developed to standardize the reporting of interventions, but failed to provide guidance on reporting of the theory of interventions. Further, space constraints imposed by many research journals often limit the comprehensive description of both the theoretical and operational aspects of interventions.PurposeTo address these gaps, we propose that the theory of interventions be published in separate conceptual papers that would provide an in-depth description of the health problem targeted by an intervention, the components comprising an intervention, the causal mechanism responsible for an intervention's impact on the outcomes, and the conditions necessary for the proper implementation and the effectiveness of an intervention.ImplicationsSuch papers would assist in the critical appraisal of the adequacy, implementation, and evaluation of interventions. A description of the theory of interventions clarifies to health professionals what the interventions are about, who is likely to benefit from the interventions, how the interventions work and under what context.
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Emir, Hadzijusufovic, Karin Albrecht-Schgoer, Kilian Huber, Florian Grebien, Gregor Eisenwort, Wilfried Schgoer, Christoph Kaun, et al. "Nilotinib Exerts Direct Pro-Atherogenic and Anti-Angiogenic Effects On Vascular Endothelial Cells: A Potential Explanation For Drug-Induced Vasculopathy In CML." Blood 122, no. 21 (November 15, 2013): 257. http://dx.doi.org/10.1182/blood.v122.21.257.257.
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Abstract The BCR/ABL1 inhibitor nilotinib is increasingly used to treat patients with chronic myeloid leukemia (CML). However, nilotinib apparently induces metabolic changes, including an increase in the fasting glucose level. In addition, vascular adverse events, including progressive atherosclerosis with peripheral arterial occlusive disease (AOD) have been reported in nilotinib-treated CML patients. We reviewed and updated AOD events in our CML patients receiving nilotinib (n=34) and initiated preclinical in vitro and in vivo studies in order to dissect potential targets and mechanisms. After a median observation time (MOT) of 24 months, the frequency of AOD (26.5%) and severe AOD requiring surgical intervention and/or prolonged hospitalization (17.6%) was higher in nilotinib-treated patients compared to risk factor-, observation time-, and age-matched controls (34 imatinib-treated patients with CML, 34 with myelodysplastic syndromes, 34 with JAK2-mutated MPN and 34 with lymphoid neoplasms; <5% AOD, p<0.05). After a MOT of 36 months, the frequency of AOD amounted to 36.1% and the frequency of severe AOD was 19.4%. We next examined the in vitro effects of nilotinib on cultured human umbilical vein endothelial cells (HUVEC), human coronary artery-derived endothelial cells (HCAEC), and the human microvascular endothelial cell line HMEC-1. As determined by 3H-thymidine incorporation, nilotinib was found to inhibit the proliferation of endothelial cells in a dose-dependent manner, with pharmacologically relevant IC50 values obtained in HUVEC (1.0 µM), HCAEC (100 nM), and HMEC-1 (1.0 µM), whereas imatinib showed little effect up to 5 µM. Moreover, nilotinib was found to inhibit the migration of HUVEC in a wound-scratch assay as well as angiogenesis in a tube-formation assay (relative capillary tubes: VEGF+control: 1.8±0.1, VEGF+nilotinib (100 nM): 1.3±0.1, VEGF+imatinib (100 nM): 1.7±0.05; n=3, p<0.01 for VEGF alone vs VEGF+nilotinib). In a mouse model of hindlimb ischemia, nilotinib (75 mg/kg/day p.o. for 28 days) was found to slow blood flow-recovery after induction of ischemia whereas imatinib (100 mg/kg/day p.o. for 28 days) showed no comparable effect (laser Doppler perfusion imaging ratio ischemic/control leg: control mice: 0.81±0.03, imatinib-treated mice: 0.79±0.04, nilotinib-treated mice: 0.68±0.04; n=13/group; p<0.05 for nilotinib vs control and for nilotinib vs imatinib). The decreased blood perfusion was accompanied by an increased rate of limb necrosis (necrosis score: control: 1.15±0.08, imatinib: 1.17±0.05, nilotinib: 1.54±0.18; p<0.05 for nilotinib vs control and nilotinib vs imatinib). Moreover, microvessel density was significantly lower in the affected hind limb in nilotinib-treated mice compared to imatinib-treated mice or control-mice (p<0.05). In addition, we found that nilotinib (between 1-10 µM), but not imatinib (1-10 µM) promotes the expression of pro-atherogenic cytoadhesion molecules (CAM) on HUVEC, including ICAM-1 (CD54), VCAM-1 (CD106) and E-Selectin (CD62E). By contrast, nilotinib (up to 10 µM) showed no effects on expression of plasminogen activators or uPA receptor (CD87) in cultured endothelial cells. As assessed by chemical proteomics profiling and phospho-array analysis, several angiogenesis-related and other endothelial antigens, including Tie-2/TEK, JAK1, BRAF and EPHB2 were identified as molecular targets of nilotinib, whereas imatinib did not bind to these vascular targets in endothelial cells. As assessed by immunohistochemistry using antibodies against KIT and mast cell tryptase, we also found that in our CML patients, nilotinib induces an almost complete depletion of KIT+ mast cells, a cell type that serves as unique source of heparin and uncomplexed tPA and has been implicated as a major repair cell in vascular disorders. However, imatinib was also found to induce mast cell depletion in our patients with CML. Neither nilotinib nor imatinib showed in vitro or in vivo effects on platelet adhesion or platelet aggregation. In conclusion, nilotinib exerts multiple effects on vascular endothelial cells and other perivascular cells such as mast cells, presumably through multiple mechanisms and targets. We hypothesize that these effects may contribute to nilotinib-induced vasculopathy in CML. Disclosures: Wolf: Bristol-Meyers Squibb: Honoraria; Pfizer: Honoraria; Novartis: Honoraria, Research Funding. Valent:Novartis: Consultancy, Honoraria, Research Funding.
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Appsamy, Malathy. "Fluoroscopy Procedure and Equipment Changes to Reduce Staff Radiation Exposure in the Interventional Spine Suite." Pain Physician 6;16, no. 6;11 (November 14, 2013): E731—E738. http://dx.doi.org/10.36076/ppj.2013/16/e731.
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Background: Fluoroscopic guided percutaneous interventional spine procedures are increasingly performed in recent years as they have been shown to be target specific and enhance patient safety. However, ionizing radiation has been associated with stochastic effects such as cancer and genetic defects as well as deterministic effects such as cataracts, erythema, epilation, and even death. These are dose related, and hence, measures should be taken to minimize radiation exposure to patients and health care personnel to reduce these adverse effects. Objective: A risk reduction project was completed with the goal of reducing effective doses to the staff and patients in a university-based spinal interventional practice. Effective dose reduction to the staff and patients was hypothesized to occur with technique and equipment changes in the procedure suite. The goal of this study was to quantify effective dose rates to staff before and after interventions. Study Design: Retrospective study comparing descriptive data of effective dose to the health care staff before and after implementation of a combination of technique and equipment changes. Methods: Technique changes from pre to post intervention period included continuous needle advancement under continuous fluoroscopic controlled by the interventional physician to intermittent needle advancement under pulsed fluoroscopic controlled by the radiology technician. Equipment changes included circumferential lead drape skirt around the procedure table and use of mobile transparent lead barriers on both sides of the procedure table. Effective dose exposure measured in Millirem (mrem) from the radiation dosimetry badges for pre-intervention (February 2009 through June 2009) and post-intervention (November 2009 through March 2010) periods were examined through monthly radiation dosimetry reports for the fluoroscopy suite staff. Results: A total of 685 interventional procedures were performed in the pre-intervention period and 385 in the post-intervention period. The median cumulative mrem (interquartile range) for all staff combined in the pre-intervention period was 71 (28,75) and post-intervention period was 1 (0,3). The median mrem per procedure was significantly higher in the pre-intervention group 0.46 (0.36, 0.54) compared to post-intervention 0.01 (0.0.03); P < 0.01. The percentage reduction in overall effective dose per procedure to all staff was 97.3%. Limitations: Observational study, multiple radiation reduction interventions confound the individual effects of each intervention’s effective dose Conclusions: Spinal injection technique and equipment changes in the procedure suite significantly reduced the rate of effective dose to the clinical staff. Key words: Fluoroscopy, effective radiation dose, spine
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Shen, Anqi, Eduardo Bernabé, and Wael Sabbah. "Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children." International Journal of Environmental Research and Public Health 18, no. 3 (February 1, 2021): 1300. http://dx.doi.org/10.3390/ijerph18031300.
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(1) Background: The objective is to systematically review the evidence on intervention programs aiming at reducing inequality in dental caries among children. (2) Methods: Two independent investigators searched MEDLINE, Cochrane library, and Ovid up to December 2020 to identify intervention studies assessing the impact on socioeconomic inequalities in dental caries among children. The interventions included any health promotion/preventive intervention aiming at reducing caries among children across different socioeconomic groups. Comparison groups included children with alternative or no intervention. Cochrane criteria were used to assess interventional studies for risk of bias. (3) Results: After removal of duplicate studies, 1235 articles were retained. Out of 43 relevant papers, 13 articles were identified and used in qualitative synthesis, and reported quantifiable outcomes. The included studies varied in measurements of interventions, sample size, age groups, and follow-up time. Five studies assessed oral health promotion or health-education, four assessed topical fluorides, and four assessed water fluoridation. Interventions targeting the whole population showed a consistent reduction of socioeconomic inequalities in dental caries among children. (4) Conclusion: The quality of included papers was moderate. High heterogeneity did not allow aggregation of the findings. The overall findings suggest that whole population interventions such as water fluoridation are more likely to reduce inequalities in children’s caries than target population and individual interventions.
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Troccaz, Jocelyne, Giulio Dagnino, and Guang-Zhong Yang. "Frontiers of Medical Robotics: From Concept to Systems to Clinical Translation." Annual Review of Biomedical Engineering 21, no. 1 (June 4, 2019): 193–218. http://dx.doi.org/10.1146/annurev-bioeng-060418-052502.
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Medical robotics is poised to transform all aspects of medicine—from surgical intervention to targeted therapy, rehabilitation, and hospital automation. A key area is the development of robots for minimally invasive interventions. This review provides a detailed analysis of the evolution of interventional robots and discusses how the integration of imaging, sensing, and robotics can influence the patient care pathway toward precision intervention and patient-specific treatment. It outlines how closer coupling of perception, decision, and action can lead to enhanced dexterity, greater precision, and reduced invasiveness. It provides a critical analysis of some of the key interventional robot platforms developed over the years and their relative merit and intrinsic limitations. The review also presents a future outlook for robotic interventions and emerging trends in making them easier to use, lightweight, ergonomic, and intelligent, and thus smarter, safer, and more accessible for clinical use.
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Henke, Marina E. "A tale of three French interventions: Intervention entrepreneurs and institutional intervention choices." Journal of Strategic Studies 43, no. 4 (March 11, 2020): 583–606. http://dx.doi.org/10.1080/01402390.2020.1733988.
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Noman, Sarah, Hayati Kadir Shahar, Hejar Abdul Rahman, Suriani Ismail, Musheer Abdulwahid Al-Jaberi, and Meram Azzani. "The Effectiveness of Educational Interventions on Breast Cancer Screening Uptake, Knowledge, and Beliefs among Women: A Systematic Review." International Journal of Environmental Research and Public Health 18, no. 1 (December 31, 2020): 263. http://dx.doi.org/10.3390/ijerph18010263.
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There have been various systematic reviews on the significance of educational interventions as necessary components to encourage breast cancer screening (BCS) and reduce the burden of breast cancer (BC). However, only a few studies have attempted to examine these educational interventions comprehensively. This review paper aimed to systematically evaluate the effectiveness of various educational interventions in improving BCS uptake, knowledge, and beliefs among women in different parts of the world. Following the PRISMA guidelines, a comprehensive literature search on four electronic databases, specifically PubMed, Scopus, Web of Science, and ScienceDirect, was performed in May 2019. A total of 22 interventional studies were reviewed. Theory- and language-based multiple intervention strategies, which were mainly performed in community and healthcare settings, were the commonly shared characteristics of the educational interventions. Most of these studies on the effectiveness of interventions showed favorable outcomes in terms of the BCS uptake, knowledge, and beliefs among women. Educational interventions potentially increase BCS among women. The interpretation of the reported findings should be treated with caution due to the heterogeneity of the studies in terms of the characteristics of the participants, research designs, intervention strategies, and outcome measures.
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Galbraith, Jennifer S., Bonita Stanton, Bradley Boekeloo, Winifred King, Sharon Desmond, Donna Howard, Maureen M. Black, and James W. Carey. "Exploring Implementation and Fidelity of Evidence-Based Behavioral Interventions for HIV Prevention: Lessons Learned From the Focus on Kids Diffusion Case Study." Health Education & Behavior 36, no. 3 (April 29, 2008): 532–49. http://dx.doi.org/10.1177/1090198108315366.
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Evidence-based interventions (EBIs) are used in public health to prevent HIV infection among youth and other groups. EBIs include core elements, features that are thought to be responsible for the efficacy of interventions. The authors evaluate experiences of organizations that adopted an HIV-prevention EBI, Focus on Kids (FOK), and their fidelity to the intervention's eight core elements. A cross-sectional telephone survey was administered to 34 staff members from organizations that had previously implemented FOK. Questions assessed how the organization adhered to, adapted, dropped, or altered the intervention. None of the organizations implemented all eight core elements. This study underscores the importance for HIV intervention researchers to clearly identify and describe core elements. More effort is needed to reflect the constraints practitioners face in nonresearch settings. To ensure intervention effectiveness, additional research and technical assistance are needed to help organizations implement HIV prevention EBIs with fidelity.
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Reynolds, Alexandra S., Monica L. Chen, Alexander E. Merkler, Abhinaba Chatterjee, Iván Díaz, Babak B. Navi, and Hooman Kamel. "Effect of A Randomized trial of Unruptured Brain Arteriovenous Malformation on Interventional Treatment Rates for Unruptured Arteriovenous Malformations." Cerebrovascular Diseases 47, no. 5-6 (2019): 299–302. http://dx.doi.org/10.1159/000502314.
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Background: In 2013, investigators from A Randomized Trial of Unruptured Brain Arteriovenous Malformations (AVM; ARUBA) reported that interventions to obliterate unruptured AVMs caused more morbidity and mortality than medical management. Objective: We sought to determine whether interventions for unruptured AVM decreased after publication of ARUBA results. Methods: We used the Nationwide Readmissions Database to assess trends in interventional AVM management in patients ≥18 years of age from 2010 through 2015. Unruptured brain AVMs were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code 747.81 and excluding any patient with a diagnosis of intracranial hemorrhage. Our primary outcome was interventional AVM treatment, identified using ICD-9-CM procedure codes for surgical resection, endovascular therapy, and stereotactic radiosurgery. Join-point regression was used to assess trends in the incidence of interventional AVM management among adults from 2010 through 2015. Results: There was no significant U.S. population level change in unruptured brain AVM intervention rates before versus after ARUBA (p = 0.59), with the incidence of AVM intervention ranging from 8.0 to 9.2 per 10 million U.S. residents before the trial publication to 7.7–8.3 per 10 million afterwards. Conclusions: In a nationally representative sample, we found no change in rates of interventional unruptured AVM management after publication of the ARUBA trial results.
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Metwally, Ammal M., Carine Hanna, Yasmine S. Galal, Rehan M. Saleh, Nihad A. Ibrahim, and Nargis Albert Labib. "Impact of Nutritional Health Education on Knowledge and Practices of Mothers of Anemic Children in El Othmanyia Village – Egypt." Open Access Macedonian Journal of Medical Sciences 8, E (August 30, 2020): 458–65. http://dx.doi.org/10.3889/oamjms.2020.4570.
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BACKGROUND: In Egypt, more than one in four children suffers from some degree of anemia.
AIM: This study was carried out to assess and improve the nutritional knowledge and risky nutritional habits of the mothers of anemic children aged 2–12 years old in El Othmanyia village.
MATERIALS AND METHODS: An interventional study was conducted among anemic children aged 2–12 years old and their mothers in El Othmanyia village, Egypt. The study passed through three stages over 1 and ½ years; pre-interventional assessment of awareness (n = 350), educational interventions targeting anemic children and their mothers, and post-interventional evaluation of change in awareness and practice.
RESULTS: The mean knowledge % score of mothers increased significantly after the intervention (82.2 ± 14.2 vs. 6.3 ± 5.8, respectively). Furthermore, the mean hemoglobin of the studied children increased significantly after the intervention (11.1 ± 0.7 vs. 10.5 ± 0.7). The percent of children with anemia decreased significantly from 100% to 40.3% after the intervention (p < 0.001).
CONCLUSION: The knowledge and practices of mothers are moving in a desirable direction after the health education intervention. Hence, nutrition education is an appropriate, effective, and sustainable approach to combat iron deficiency anemia. Recommendations: A multiple interventional strategies between different ministries to set policies and guidelines that support the healthy nutritional behavior among children are recommended.
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Farrell, Terence, John Hynes, Nicola Hughes, Ciara O'Byrne, Stephen Eustace, and John Walsh. "Therapeutic Intervention in Musculoskeletal Radiology: Current Practice and Future Directions." Seminars in Musculoskeletal Radiology 22, no. 05 (November 2018): 546–63. http://dx.doi.org/10.1055/s-0038-1672193.
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AbstractOver the last several decades, the volume and range of therapeutic musculoskeletal (MSK) interventions that radiologists can offer their patients has dramatically increased. With new materials and improving imaging modalities, as well as significant investment in research, the field of MSK interventional radiologic intervention will likely continue to expand. In this article, we summarize the range of interventions currently available to the MSK radiologist. We also seek to explore new and emerging techniques that may become commonplace in the near future while considering the challenges that may lie ahead in the field of MSK radiology.
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Rotzinger, Roman, Bernhard Gebauer, Dirk Schnapauff, Florian Streitparth, Gero Wieners, Christian Grieser, Patrick Freyhardt, Bernd Hamm, and Martin H. Maurer. "Placement of central venous port catheters and peripherally inserted central catheters in the routine clinical setting of a radiology department: analysis of costs and intervention duration learning curve." Acta Radiologica 58, no. 12 (April 13, 2017): 1468–75. http://dx.doi.org/10.1177/0284185117695664.
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Background Placement of central venous port catheters (CVPS) and peripherally inserted central catheters (PICC) is an integral component of state-of-the-art patient care. In the era of increasing cost awareness, it is desirable to have more information to comprehensively assess both procedures. Purpose To perform a retrospective analysis of interventional radiologic implantation of CVPS and PICC lines in a large patient population including a cost analysis of both methods as well as an investigation the learning curve in terms of the interventions’ durations. Material and Methods All CVPS and PICC line related interventions performed in an interventional radiology department during a three-year period from January 2011 to December 2013 were examined. Documented patient data included sex, venous access site, and indication for CVPS or PICC placement. A cost analysis including intervention times was performed based on the prorated costs of equipment use, staff costs, and expenditures for disposables. The decrease in intervention duration in the course of time conformed to the learning curve. Results In total, 2987 interventions were performed by 16 radiologists: 1777 CVPS and 791 PICC lines. An average implantation took 22.5 ± 0.6 min (CVPS) and 10.1 ± 0.9 min (PICC lines). For CVPS, this average time was achieved by seven radiologists newly learning the procedures after performing 20 CVPS implantations. Total costs per implantation were €242 (CVPS) and €201 (PICC lines). Conclusion Interventional radiologic implantations of CVPS and PICC lines are well-established procedures, easy to learn by residents, and can be implanted at low costs.
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McGranahan, Majel, Joselyn Nakyeyune, Christopher Baguma, Nakibuuka Noor Musisi, Derrick Nsibirwa, Sharifah Sekalala, and Oyinlola Oyebode. "Rights based approaches to sexual and reproductive health in low and middle-income countries: A systematic review." PLOS ONE 16, no. 4 (April 29, 2021): e0250976. http://dx.doi.org/10.1371/journal.pone.0250976.
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Introduction The Sustainable Development Goals, which are grounded in human rights, involve empowering women and girls and ensuring that everyone can access sexual and reproductive health and rights (Goal 5). This is the first systematic review reporting interventions involving rights-based approaches for sexual and reproductive health issues including gender-based violence, maternity, HIV and sexually transmitted infections in low and middle-income countries. Aims To describe the evidence on rights-based approaches to sexual and reproductive health in low and middle-income countries. Methods EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were: Study design: any interventional study. Population: females aged over 15 living in low and middle-income countries. Intervention: a “rights-based approach” (defined by the author) and/or interventions that the author explicitly stated related to "rights". Comparator: clusters in which no intervention or fewer components of an intervention were in place, or individuals not exposed to interventions, or exposed to fewer intervention components. Outcome: Sexual and reproductive health related outcomes. A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps. The systematic review protocol was registered on PROSPERO (CRD42019158950). Results Database searching identified 17,212 records, and 13,404 studies remained after de-duplication. Twenty-four studies were included after title and abstract, full-text and reference-list screening by two authors independently. Rights-based interventions were effective for some included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other sexually transmitted infections, condom use, and awareness of rights improved with intervention, but all relevant studies were at high, critical or serious risk of bias. No study included gender-based violence outcomes. Conclusion Considerable risk of bias in all studies means results must be interpreted with caution. High-quality controlled studies are needed urgently in this area.
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DeVries, James T., Christopher J. White, Tyrone J. Collins, J. Stephen Jenkins, John P. Reilly, Mark A. Grise, Paul W. McMullan, Ramy A. Badawi, and Stephen R. Ramee. "Acute stroke intervention by interventional cardiologists." Catheterization and Cardiovascular Interventions 73, no. 5 (April 1, 2009): 692–98. http://dx.doi.org/10.1002/ccd.21927.
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Bashirian, Saeed, Majid Barati, Younes Mohammadi, Leila MoaddabShoar, and Mitra Dogonchi. "Evaluation of an Intervention Program for Promoting Breast Self-Examination Behavior in Employed Women in Iran." Breast Cancer: Basic and Clinical Research 15 (January 2021): 117822342198965. http://dx.doi.org/10.1177/1178223421989657.
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Introduction: Breast cancer is the most common malignancy in the world. Screening is the basis for early detection. However, the mortality rate is still high in Iranian women related to not screening and timely check-ups. We offered a theory-based intervention program to improve breast cancer screening behavior in women. Methods: This interventional study was conducted in 135 employed women in 2019. Their screening behavior was investigated using a questionnaire based on the Protection Motivation and Social Support Theories. We compared the efficacy of 2 educational interventions (a workshop and an E-learning program) between 2 intervention groups and a control group. The results were collected 3 months after the interventions had taken place. Data were analyzed in SPSS 23 using descriptive statistics, chi-square, analysis of variance (ANOVA), and the paired sample t-test. Results: We found a significant difference between the mean score of knowledge and the theoretical constructs ( P value < .001) before and after the interventions. Our results also showed that both the intervention methods had a similar effect and that there was a significant difference in the performance of breast self-examinations between the intervention and control groups after the intervention ( P value < .001). Conclusion: Given the cost-effectiveness and feasibility of implementing an E-learning program, we would recommend that health care planners assist in designing and implementing this effective form of intervention to encourage many more women to perform self-examinations to aid breast cancer screening.
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van Zyl, Llewellyn Ellardus, and Sebastiaan Rothmann. "Towards happiness interventions: construct clarification and intervention methodologies." Journal of Psychology in Africa 24, no. 4 (July 4, 2014): 327–41. http://dx.doi.org/10.1080/14330237.2014.980621.
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KIRWAN, JOHN R., STANTON NEWMAN, PETER S. TUGWELL, GEORGE A. WELLS, SARAH HEWLETT, LEANNE IDZERA, BRITTA LASLO, et al. "Progress on Incorporating the Patient Perspective in Outcome Assessment in Rheumatology and the Emergence of Life Impact Measures at OMERACT 9." Journal of Rheumatology 36, no. 9 (September 2009): 2071–76. http://dx.doi.org/10.3899/jrheum.090360.
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The Patient Perspective Workshop included over 100 researchers and 18 patient participants from 8 countries. Following preconference reading and short plenary presentations, breakout groups considered work undertaken on measurement of sleep, assessing interventions to develop the effective consumer, and assessing psychological and educational interventions. The workshop explored the best way to identify other outcome domains (and instruments) that should be measured in observational or interventional studies with broader intentions than simply altering outcomes captured in the traditional “core set” plus fatigue. Four sleep questionnaires showed promise and will be the subject of further study. The Effective Consumer scale (EC-17) was reviewed and the concept Effective Consumer was well received. Participants thought it worthwhile to measure the skills and attributes of an effective consumer and develop an intervention that would include education in all of the scale’s categories. Assessment of educational and psychological interventions requires a wider set of instruments than is currently used; these should relate to the purpose of the intervention. This principle was extended to include wider measures of the impact of disease on life, as indicated in the International Classification of Functioning, Disability and Health. Life impact measure sets covering domains appropriate to different rheumatic conditions and focused on different interventions might be defined by future OMERACT consensus. Measurement instruments within these domains that are valid for use in rheumatic conditions can then be identified and, in the case of psychological and educational interventions, chosen to fit with the purpose of the intervention.
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Silva, Eliana Aparecida Torrezan. "Gestação e preparo para o parto: programas de intervenção." O Mundo da Saúde 37, no. 2 (June 30, 2013): 208–15. http://dx.doi.org/10.15343/0104-7809.2013372208215.
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T.Prabu, T. Prabu, P. Pachaiyappan P.Pachaiyappan, and M. Ramamoorthy M.Ramamoorthy. "Identification of Learning Disabilities and Intervention Techniques." Paripex - Indian Journal Of Research 3, no. 4 (January 15, 2012): 1–4. http://dx.doi.org/10.15373/22501991/apr2014/93.
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