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Intervention Phase (intervention + phase)
Selected AbstractsFunctional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing HomesJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2005Joseph G. Ouslander MD Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes. Design: Randomized, controlled, crossover trial. Setting: Four VA nursing homes. Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55). Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength-training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial. Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit-to-stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one-repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios. Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8-week crossover period. Within-person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were "responders" based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period. Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care. [source] Community mental health nursing and early intervention in dementia: developing practice through a single case historyJOURNAL OF CLINICAL NURSING, Issue 2004John Keady PhD This paper reports on a single case history taken from the ,Dementia Action Research and Education' project, a 15-month primary care intervention study that was undertaken in North Wales in the early part of 2000. The study sought to address the meaning, context and diversity of early intervention in dementia care and employed a community mental health nurse and a psychiatric social worker to undertake early and psychosocial interventions with older people with dementia (aged 75 years and over) and their families. The workers tape-recorded, documented and analysed their interventions with 27 older people with dementia and their families over the 15-month duration of the study. Clinical supervision was also undertaken during the intervention phase. One case history is presented in this paper to illustrate the work of the community mental health nurse and to identify areas of practice development. Greater role transparency, collaborative working and improvement in educational preparation for practice are called for. [source] Decision-making models in the analysis of portal films: A clinical pilot studyJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2000Andrew See SUMMARY Portal films continue to play an important role in the verification of radiotherapy treatment. There is still some discussion, however, as to what action should be taken after a port film has shown a radiation field deviation from the prescribed volume. It was the aim of the present pilot study to investigate the performance of three decision-making models (,Amsterdam', ,Quebec' and ,Newcastle') and an expert panel basing their decision on intuition rather than formal rules after portal film acquisition in a clinical setting. Portal films were acquired on every day during the first week of treatment for five head and neck and five prostate cancer patients (diagnostic phase). If required, the field position was modified according to our normal practice following the recommendation of the expert panel. In order to analyse the results of the models, however, additional port films were taken in the following 3 treatment weeks with the patient moved as required by the different models (intervention phase). The portal films were taken over 4 consecutive days, positioning the patient according to each of the different models on one day each. None of the models diagnosed a field misplacement in the head and neck patients, while the ,Amsterdam' and ,Quebec' models predicted a move in one prostate patient. The ,Newcastle' model, which is based on Hotelling's T 2 statistic, proved to be more sensitive and diagnosed a systematic displacement for three prostate patients. The intervention phase confirmed the diagnosis of the model, even if the three portal films taken with the patient position adjusted as required by the model proved to be insufficient to demonstrate an improvement. The ,Newcastle' model does not rely on assumptions about the random movement of patients and requires five portal films before a decision can be reached. This approach lends itself well to incorporation into electronic portal imaging ,packages', where repeated image acquisitions present no logistical difficulty. [source] Intervention with polyphenol-rich fruit juices results in an elevation of glutathione S -transferase P1 (hGSTP1) protein expression in human leucocytes of healthy volunteersMOLECULAR NUTRITION & FOOD RESEARCH (FORMERLY NAHRUNG/FOOD), Issue 12 2006Thomas Hofmann Abstract Polyphenols are probably antigenotoxic on account of their antioxidant activities and might alter phase I and II enzymes in a way that results in chemoprotection. We investigated the hypothesis that polyphenols enhance expression of glutathione S -transferases (GSTs), which increases carcinogen detoxification and thereby provides protection against oxidative stress. HGSTP1 protein expression and GST polymorphisms were determined in leucocytes obtained during an intervention study with healthy subjects consuming two fruit juices in an 8 wk trial (polyphenol-free run in phase, juice intervention phase, washout phase, second juice intervention phase, each treatment regime lasted for 2 wk). The study had originally shown that juice intervention significantly reduced oxidative DNA damage in leucocytes at week 8 (Bub, A., Watzl, B., Blockhaus, M., Briviba, K. et al., J. Nutr. Biochem. 2003, 14, 90,98). We reanalysed the levels of DNA damage based on GST genotypes. We also treated leucocytes in vitro with mixtures of polyphenols and determined cytotoxicity and expression of 96 genes related to drug metabolism. Key results with leucocytes of the intervention study were that the initial content of hGSTP1 protein was first suppressed at weeks 4 and 6. At week 8, however, hGSTP1 protein expression was significantly increased. HGSTP1 protein levels and DNA damage were inversely correlated (p = 0.005), but there was no difference for cells obtained from subjects with hGSTM1*1 and hGSTM1*0 genotypes, nor was there any difference between cells from subjects consuming the two different juices. The treatment of leucocytes with polyphenol mixtures in vitro did not result in modulated GST gene expression or total GST activity, but in an up-regulation of other biotransformation enzymes (e. g., members of the cytochrom P450 and the sulphotransferase family). In conclusion, in vitro treatment of leucocytes led to a modulated mRNA expression of selected genes, not directly related to oxidative defence systems. In vivo, however, we observed a delayed enhancement of hGSTP1, which could be associated with an initial repression of oxidative DNA damage in leucocytes from human subjects, consuming juices with high levels of polyphenols. [source] Influence of standardized mobilization on the posteroanterior stiffness of the lumbar spine in asymptomatic subjectsPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 3 2001Dr Garry Allison Abstract Background and Purpose Spinal mobilization is commonly used to relieve pain and assist recovery of mobility in individuals with low back pain. Fundamental to this concept is the belief that spinal mobilization will influence the mechanical properties of the symptomatic motion segment. The objective of the present study was to examine the segmental effects of a standardized mobilization procedure on the posteroanterior (PA) stiffness of the lumbar spine. Method Audio and visual feedback was used to train a physiotherapist to perform PA mobilization at a consistent load and frequency. After training, twenty-four subjects without low back pain were recruited for the intervention phase of the study. The spinal posteroanterior mobilization (SPAM) apparatus was used to measure the PA stiffness of the lumbar spine at three measurement sites (L1, L3 and L5). The trained physiotherapist then applied the standardized PA mobilization technique via the L3 spinous process for two minutes. Following mobilization, PA stiffness was measured three times at the three locations. Results The physiotherapist was able to apply a standardized mobilization with a mean force of 146 N (standard deviation (SD) 8 N) at a frequency of 1.5 Hz. The first trial on each assessment demonstrated a pre-condition effect. Two minutes' PA mobilization resulted in no significant change in the PA stiffness of the lumbar spine at the level to which the mobilization was applied, or at the L1 and L5 segments. The 95% confidence intervals (CI) of the difference in PA stiffness before and after testing included zero at each measurement site. Conclusions Clinicians should pre-condition the spine when assessing PA stiffness both before and after interventions. A standardized mobilization of 150 N at 1.5 Hz for two minutes had no segmental effect on spinal PA stiffness. Subsequent studies need to consider other mechanisms that may contribute to the changes that occur after PA spinal mobilization. Copyright © 2001 Whurr Publishers Ltd. [source] School-based indicated prevention: a randomised trial of group therapyTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 6 2002Paul McArdle Background: One hundred and twenty-two children identified by teachers as at risk for behavioural or emotional problems were randomly allocated to drama-group therapy or to a curriculum-studies control, based in school. Methods: One hundred and seventeen completed the intervention phase of the trial, which comprised 12 hour-long sessions. Post-intervention self-reports showed significant effects associated with both interventions. Results: However, there was a clear advantage of group therapy over both a waiting list control and curriculum studies, according to teacher reports. This was true also of categorical analyses focusing on those with the most severe symptoms. Conclusions: These analyses confirmed sustained teacher-reported improvement over a year-long follow-up period. [source] Impact of an Audit Program and Other Factors on Door-to-balloon Times in Acute ST-elevation Myocardial Infarction Patients Destined for Primary Coronary InterventionACADEMIC EMERGENCY MEDICINE, Issue 4 2009Chao-Lun Lai MD Abstract Objectives:, This before,after study investigated the association between an audit program and door-to-balloon times in patients with acute ST-elevation myocardial infarction (STEMI) and explored other factors associated with the door-to-balloon time. Methods:, An audit program that collected time data for essential time intervals in acute STEMI was developed with data feedback to both the Department of Emergency Medicine and the Department of Cardiology. The door-to-balloon times for 76 consecutive acute STEMI patients were collected from February 16, 2007, through October 31, 2007, after the implementation of the audit program, as the intervention group. The control group was defined by 104 consecutive acute STEMI patients presenting from April 1, 2006, through February 15, 2007, before the audit was applied. A multivariate linear regression model was used for analysis of factors associated with the door-to-balloon time. Results:, The geometric mean 95% CI of the door-to-balloon time decreased from 164.9 (150.3, 180.9) minutes to 141.9 (127.4, 158.2) minutes (p = 0.039) in the intervention phase. The median door-to-balloon time was 147.5 minutes in the control group and 136.0 minutes in the intervention group (p = 0.09). In the multivariate regression model, the audit program was associated with a shortening of the door-to-balloon time by 35.5 minutes (160.4 minutes vs. 195.9 minutes, p = 0.004); female gender was associated with a mean delay of 58.4 minutes (208.9 minutes vs. 150.5 minutes; p = 0.001); posterolateral wall infarction was associated with a mean delay of 70.5 minutes compared to anterior wall infarction (215.4 minutes vs. 144.9 minutes; p = 0.037) and a mean delay of 69.5 minutes compared to inferior wall infarction (215.4 minutes vs. 145.9 minutes; p = 0.044). The use of a glycoprotein IIb/IIIa inhibitor was associated with a 46.1 minutes mean shortening of door-to-balloon time (155.7 minutes vs. 201.8 minutes; p < 0.001). Conclusions:, The implementation of an audit program was associated with a significant reduction in door-to-balloon times among patients with acute STEMI. In addition, female patients, posterolateral wall infarction territory, and nonuse of glycoprotein IIb/IIIa inhibitor were associated with longer door-to-balloon times. [source] Exercise Training During Hemodialysis Reduces Blood Pressure and Increases Physical Functioning and Quality of LifeARTIFICIAL ORGANS, Issue 7 2010Maycon De Moura Reboredo Abstract Hypertension and cardiovascular diseases are highly prevalent in hemodialysis patients and are associated with the reduction of physical functioning and quality of life. We evaluated the effects of supervised aerobic exercise training on physical functioning, blood pressure, quality of life, and laboratory data in hemodialysis patients. Fourteen patients were evaluated at the beginning and after 12 weeks of stretching exercises (control phase) and at the end of 12 weeks of aerobic exercise training performed during hemodialysis sessions (intervention phase). Patients underwent a 6-min walking test (6MWT), 24-h ambulatory blood pressure monitoring, a Medical Outcomes Study 36,Item Short-Form Health Survey (SF-36) quality of life questionnaire, and blood sample collections. After the intervention phase, the 6MWT distance increased from 508.7 ± 91.9 m to 554.9 ± 105.8 m (P = 0.001), systolic and diastolic blood pressure decreased respectively from 150.6 ± 18.4 mm Hg to 143.5 ± 14.7 mm Hg and from 94.6 ± 10.5 mm Hg to 91.4 ± 9.7 mm Hg (P < 0.05), while hemoglobin levels increased from 10.8 ± 1.2 g/dL to 11.6 ± 0.8 g/dL (P < 0.05). Moreover, there was a significant increase in the physical functioning, social functioning, and mental health dimensions of the SF-36. Aerobic exercise training during hemodialysis increased physical functioning, reduced blood pressure levels, and improved the control of anemia and quality of life in patients with end-stage renal disease. [source] Teacher's PETS: a new observational measure of experiential training interactionsCLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 3 2002Derek Milne Government policy now stresses the importance of staff training in fostering evidence-based practice, but what is done in the name of training is rarely reported and there are few instruments with which to analyse training. Therefore, the purpose of the present study was to develop a new measure of training processes and mini-outcomes, and to provide a case study illustration. A single subject (N = 1) withdrawal design was used to assess the empirical validity of the measure. The measure (Teacher's PETS) was derived from the applied psychology literature in order to operationalize Kolb's (1984) integrative theory of experiential learning. Reliability and validity assessments were conducted. During the intervention phase of the case study baseline data from PETS were fed back to the trainer. The effectiveness of this intervention was assessed structurally and functionally, in relation to the learners, i.e. mental health staff (N = 31) receiving training in evidence-based practice (psychosocial interventions in severe mental illness). PETS was found to have very good inter-rater reliability (K = 0.84) and promising content, empirical and concurrent validity. The case study illustrated that, at baseline, the training did not correspond to a ,training workshop'. However, the intervention of feedback and modelling resulted in more appropriate training processes and outcomes, which were maintained at a 1-month follow-up assessment. It is concluded that PETS shows promise as an instrument and has the advantage of affording detailed, transactional information to improve the efficiency of training. It may also be useful in relation to clinical supervision. Copyright © 2002 John Wiley & Sons, Ltd. [source] An expanded role for dietitians in maximising retention in nutrition and lifestyle intervention trials: implications for clinical practiceJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2010L. M. Delahanty Abstract The demand for clinical trials targeting lifestyle intervention has increased as a result of the escalation in obesity, diabetes mellitus and cardiovascular disease. Little is published about the strategies that dietitians have used to successfully screen potential study volunteers, implement interventions and maximise adherence and retention in large multicentre National Institutes of Health funded nutrition and lifestyle intervention clinical trials. This paper discusses an expanded role for the contributions of dietitians as members of an interdisciplinary team based on research experiences in the Diabetes Control and Complications Trial, Diabetes Prevention Program and Look AHEAD (Action for Health in Diabetes). Many of the strategies and insights discussed are also relevant to effective clinical practice. Dietitians need to broaden their scope of practice so that they are integrated proactively into the screening and intervention phases of large clinical trials to maximise retention and adherence to assigned nutrition, lifestyle and behavioural interventions. The skills of dietitians are a unique fit for this work and it is important that investigators and project managers consider including them in both the screening and intervention phases of such clinical trials to maximise retention results. [source] Impact of Wearable Alcohol Gel Dispensers on Hand Hygiene in an Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 4 2008Janet P. Haas RN Abstract Objectives:, Compliance with hand hygiene (HH) by health care workers is widely recognized as the most effective way to decrease transmission of infection among patients. However, compliance remains poor, averaging about 40%. A potential barrier to compliance is convenience and accessibility of sinks or alcohol hand sanitizer dispensers. The purpose of this study was to assess the use of a personal alcohol gel dispensing system, compared with the traditional wall-mounted alcohol gel dispenser and sinks in an urban hospital's emergency department (ED). Methods:, This was a quasi-experimental trial of a personal wearable alcohol hand sanitizer dispenser. Observations of ED staff HH were performed in the month before intervention and during three intervention phases over a 2.5-month period. Results:, A total of 757 HH opportunities were observed: 112 before and 432 after patient contact, 72 after contact with the patient's environment, 24 before invasive procedures, and 117 after body fluid contact. HH compliance improved during the first intervention period, but improvement was not sustained. There was no significant improvement in HH from baseline to the final intervention period. The wearable alcohol gel dispenser was used for 9% of HH episodes. Conclusions:, Availability of a wearable dispenser was not associated with a significant improvement in use of alcohol products for HH. These results support other studies in which only transient success was reported with a single intervention; greater success in sustaining increased HH compliance has been reported with use of multimodal approaches in which increased availability of products may be a part of the intervention. [source] | |||||||||||||