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PubMed1995

Biliary sludge after liver transplantation: 2. Treatment with interventional techniques versus surgery and/or oral chemolysis.

OBJECTIVE: Interventional treatment of biliary sludge in liver transplant recipients includes transhepatic biliary drainage and saline irrigation, catheter chemolysis and/or basket extraction, and endoscopic intervention. The purpose of this study was to compare these interventional procedures with oral chemolysis and with surgical treatment of biliary sludge in order to evaluate the effectiveness of interventional procedures as an alternative to surgery in the treatment of this complication. MATERIALS AND METHODS: We retrospectively evaluated the outcome of several forms of treatment for biliary sludge occurring after liver transplantation in 49 cases. Treatments included oral chemolysis with chenodeoxycholic acid (n = 35), percutaneous transhepatic biliary drainage (n = 13) followed by irrigation with heparinized saline solution (n = 4), intraluminal chemolysis with glycero-octanoate-carnosine and bile salts-EDTA (n = 3) and/or basket extraction (n = 5), and endoscopic intervention (n = 2) or surgery (n = 26). Oral chemolysis was attempted in all cases of biliary sludge if no other complications were present. If this conservative treatment failed and the sludge was limited to the main bile ducts, interventional procedures were attempted. Surgical removal of the sludge (n = 15) or retransplantation (n = 5) without any attempt at prior nonsurgical treatment was performed if concomitant complications were present (n = 14) or if the extent of the sludge was considered too time-consuming for an interventional attempt (n = 6). The six patients in whom nonsurgical treatment failed underwent surgery. Treatment was considered successful if cholangiograms obtained after therapy showed no more evidence of sludge. Treatment was considered a failure if biliary sludge was shown after therapy by means of cholangiography, surgery, or autopsy. RESULTS: Complete disappearance of biliary sludge as a result of oral chemolysis was achieved in 14 (40%) of 35 cases. Interventional procedures were performed in 15 of the patients in whom oral treatment failed. After percutaneous transhepatic biliary drainage, the sludge was successfully removed by chemolysis with glycero-octanoate-carnosine in three cases, by basket extraction in one case, and by a combination of chemolysis and basket extraction in three cases. In two other cases, underlying recurrent tumor was treated palliatively with percutaneous transhepatic biliary drainage or endoscopic stenting. Irrigation with heparinized saline solution failed in four cases, and percutaneous or endoscopic basket extraction failed in one case each. Surgical treatment was successful in 18 (86%) of 21 cases, and retransplantation was successfully done in five patients. In all, interventional techniques were used in 43% of the patients with biliary sludge who could not be treated successfully with oral chemolysis, and the overall success rate was 60%. CONCLUSION: Interventional techniques are effective therapeutic alternatives for treating biliary sludge occurring after liver transplantation and should be considered before surgical procedures. An indication for interventional procedures in biliary sludge is lack of success of oral chemolysis and an absence of other complications that require surgery or retransplantation.

Adolescent↗
PubMed2001

Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review.

OBJECTIVE: To review the effectiveness of interventions targeted at health care professionals and/or the structure of care in order to improve the management of diabetes in primary care, outpatient, and community settings. RESEARCH DESIGN AND METHODS: A systematic review of controlled trials evaluating the effectiveness of interventions targeted at health care professionals and aimed at improving the process of care or patient outcomes for patients with diabetes was performed. Standard search methods of the Cochrane Effective Practice and Organization of Care Group were used. RESULTS: A total of 41 studies met the inclusion criteria. The studies identified were heterogeneous in terms of interventions, participants, settings, and reported outcomes. In all studies, the interventions were multifaceted. The interventions were targeted at health care professionals only in 12 studies, at the organization of care only in 9 studies, and at both in 20 studies. Complex professional interventions improved the process of care, but the effect on patient outcomes remained less clear because such outcomes were rarely assessed. Organizational interventions that facilitated the structured and regular review of patients also showed a favorable effect on process measures. Complex interventions in which patient education was added and/or the role of a nurse was enhanced led to improvements in patient outcomes as well as the process of care. CONCLUSIONS: Multifaceted professional interventions and organizational interventions that facilitate structured and regular review of patients were effective in improving the process of care. The addition of patient education to these interventions and the enhancement of the role of nurses in diabetes care led to improvements in patient outcomes and the process of care.

Ambulatory Care↗
PubMed2003

Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes.

OBJECTIVE: Despite good evidence and clinical practice guidelines, studies document that treatment of type 2 diabetes is less than optimal. Lack of resources or limited access may put patients in rural communities at particular risk for suboptimal care. RESEARCH DESIGN AND METHODS: We conducted a prospective, before/after study with concurrent controls to assess the effectiveness of a multidisciplinary diabetes outreach service (intervention) for improving the quality of care for rural patients with type 2 diabetes. Our intervention consisted of six monthly visits by a traveling team of specialist physicians, nurses, dieticians, and a pharmacist. The core of this service was specialist-to-rural primary care physician academic group detailing. Two comparable regions in Northern Alberta were randomly allocated to control or intervention. Data were collected before and 6 months after intervention in a representative volunteer sample. The primary outcome was a 10% improvement in any one of the following: blood pressure, total cholesterol, or HbA(1c). RESULTS: Our analysis included 200 intervention and 179 control subjects; 14 subjects were at all three primary outcome targets at baseline. The intervention was associated with a trend toward improvement in primary outcome at 6 months (44% intervention vs. 37% control; odds ratio 1.32, 95% CI 0.87-1.99). The intervention was associated with a significant improvement in blood pressure (42% intervention vs. 25% control, P = 0.004); however, there were only small, nonsignificant changes in cholesterol or HbA(1c). The intervention was associated with a significant increase in satisfaction with diabetes care. Multivariate adjustment for baseline differences between intervention and control subjects did not affect any of the main results. CONCLUSIONS: A diabetes outreach service has the potential to improve the quality of diabetes care for rural patients. Future studies need to involve longer timelines and larger sample sizes.

Aged↗
PubMed2002

The effects of cognitive behavioral intervention on the attitude and behavior of stockpersons and the behavior and productivity of commercial dairy cows.

Two experiments, one involving 29 commercial farms and the other involving 94 commercial farms, were conducted to examine the effects of a training program targeting a number of attitudinal and behavioral variables in stockpeople. These stockperson variables had been previously shown to be related to fear of humans and productivity of commercial cows. In both experiments, two treatments were imposed: an Intervention treatment, consisting of a cognitive-behavioral intervention procedure designed to improve the attitude and behavior of stockpeople toward cows, and a Control treatment, in which no intervention was attempted. In Exp. 1, an analysis of covariance, using previous lactation variables as the covariate, revealed effects of the Intervention treatment on the attitude and behavior of the stockpeople and the behavior of cows. Stockpeople at Intervention farms showed more (P < 0.01) positive beliefs about handling cows and used a lower (P < 0.05) number and percentage of negative tactile interactions in handling cows than stockpeople at the Control farms. Cows at the Intervention farms showed a shorter (P < 0.05) flight distance to humans, indicating a lower level of fear of humans by these cows. However, 36% of the Intervention farms failed to show a reduction in average flight distance over the two lactations. Although there was no significant treatment effect on milk yield, the Intervention farms in which fear levels declined following the intervention had a higher (P < 0.05) milk yield than the other farms. In Exp. 2, a significant (P < 0.05) increase was found in the milk yield of cows following the Intervention treatment. Similar treatment effects were observed on both milk protein and milk fat. These results indicate that cognitive-behavioral interventions that successfully target the key attitudes and behavior of stockpeople that regulate the cow's fear of humans offer the industry good opportunities to improve the productivity of cows.

Animal Husbandry↗
PubMedDate not supplied

Bringing geriatricians to the front lines: evaluation of a quality improvement intervention in primary care.

BACKGROUND: Frail elders often receive low-quality primary care, yet the optimal role of geriatricians in primary care settings remains uncertain. We evaluated the health utilization impacts of an innovative intervention emphasizing chronic disease self-management and physical activity promotion among frail elders in primary care. METHODS: The intervention was implemented within two primary care practices at a single clinic serving a large population of frail elders enrolled in a western Washington health plan. Subjects included older patients (age >or=65 years) with disproportionate baseline outpatient service use who attended two on-site visits with a geriatrician during which each received comprehensive assessment and a problem-solving intervention to enhance chronic disease self-management and promote physical activity (N = 146). Our evaluation had a retrospective matched cohort design. Controls receiving primary care at other health plan clinics were matched 3:1 to intervention subjects by sex and a propensity score (N = 437), which was computed using demographic, clinical, and health care utilization factors that were predictive of attending the intervention. Among intervention subjects and controls following the intervention, we compared relative rates of hospitalization, outpatient and specialty visits, nursing home admission, mortality, and prescription of selected high-risk medications, as well as total health care costs. RESULTS: From March 2002 to November 2003, the geriatrician evaluated 146 of 725 elderly subjects (20%) in the two primary care practices. During a mean follow-up of 1.3 years, intervention subjects had a reduced rate of hospitalization relative to matched controls (incidence rate ratio 0.57; 95% CI: 0.37 to 0.86; P < .01). Intervention and control subjects did not have significantly different rates of specialty visits, outpatient visits, nursing home admission, mortality, or high-risk prescriptions. Relative to matched controls during follow-up, total health care costs were 26.3% lower among intervention subjects (95% CI: 1.3%, 44.9%; P = .04). CONCLUSIONS: Outpatient geriatric interventions emphasizing collaboration between geriatricians and primary care physicians, chronic disease self-management, and physical activity may reduce hospitalization risk and total health care costs among vulnerable elders.

Aged↗
PubMed2006

The importance of decision making in causal learning from interventions.

Recent research has focused on how interventions benefit causal learning. This research suggests that the main benefit of interventions is in the temporal and conditional probability information that interventions provide a learner. But when one generates interventions, one must also decide what interventions to generate. In three experiments, we investigated the importance of these decision demands to causal learning. Experiment 1 demonstrated that learners were better at learning causal models when they observed intervention data that they had generated, as opposed to observing data generated by another learner. Experiment 2 demonstrated the same effect between self-generated interventions and interventions learners were forced to make. Experiment 3 demonstrated that when learners observed a sequence of interventions such that the decision-making process that generated those interventions was more readily available, learning was less impaired. These data suggest that decision making may be an important part of causal learning from interventions.

Attention↗
PubMedDate not supplied

Related effectiveness of continued, lapsed, and delayed smoking prevention intervention in senior high school students.

The relative effectiveness of continued, lapsed, and delayed smoking prevention intervention was tested with senior high school students. The original intervention was conducted during Grades 7 through 9, with significantly fewer intervention students reporting smoking than control students. The intervention was reintroduced in the 11th grade to one-half of intervention students (continued intervention), was withdrawn from the other half (lapsed intervention), and was initiated with one-half control students (delayed intervention). The 11th-grade smoking rates of these groups were compared to those of a fourth group, a continued control group. Results showed that continued control students reported significantly less smoking than continued control students and lapsed intervention students. Additionally, the delayed intervention group exhibited smoking rates lower than the lapsed intervention and continued control groups. This finding underscores the importance of continuing smoking prevention activities, as well as initiating these activities, in senior high school years.

Adolescent↗
PubMedDate not supplied

Evaluation of a supermarket intervention to increase consumption of fruits and vegetables.

PURPOSE: The purpose of this study was to evaluate whether a supermarket point-of-purchase intervention could increase shoppers' consumption of fruits and vegetables. METHODS: Eight supermarkets in rural Iowa were randomized to receive either an 8-month intervention or no intervention. The intervention consisted of: (1) one-page supermarket flyers that identified fruits and vegetables on sale, gave receipts and menu ideas for using sale foods, and gave a store coupon worth 50 cents toward the purchase of any fruit or vegetable; (2) store signage to identify fruits and vegetables featured on the flyer; and (3) consciousness raising activities such as food demonstrations and nutrition related signage. Evaluation was based on exit interviews and take-home surveys, completed by random samples of 120 shoppers from each store at baseline and approximately 1-year post randomization. RESULTS: At follow-up, 42.9% of intervention store shoppers and 6.5% of control shoppers recalled seeing the intervention flyer. Thirty-six percent of intervention shoppers had used a 50-cent coupon and 18% had used a recipe. Approximately 70% of all shoppers had purchased fruits or vegetables on the day they were interviewed, which did not differ between intervention and control stores. Compared to change in control shoppers, there was a borderline statistically significant 8.4 percentage point increase (p < .07) in the percentage of intervention store shoppers in the action or maintenance stages of dietary change, but there was no corresponding increase in fruit or vegetable consumption. DISCUSSION: Studies to test point-of-purchase interventions are difficult to design, implement, and evaluate. More powerful interventions are probably necessary to induce shoppers to purchase and consume more fruits and vegetables.

Commerce↗
PubMed1990

Physician assessment of pharmacists' interventions--a method of estimating cost avoidance and determining quality assurance.

The impact and quality of select pharmacists' interventions were assessed by four physicians with pharmacology experience. Each physician was sent 30 interventions and asked to indicate if the intervention by the pharmacist was of a positive nature and would prevent morbidity and/or mortality. They were also questioned regarding effect of the intervention on hospital stay. Each physician received 15 interventions which were, and 15 interventions which were not assessed by three other physicians. Of the 15 interventions assessed by all four physicians there was favourable agreement among the physicians with respect to the impact of the intervention with 86.7 percent (52 of 60) of the judgements indicating that the pharmacists' intervention had a positive effect on therapy. There was less agreement with regard to whether hospital stay would, and the extent to which it would, have been prolonged. Using consensus it was estimated that eight of 15 interventions would have prolonged stays approximately 3.7 days each. The use of physicians was helpful in assessing the impact of pharmacists' interventions.

Adolescent↗
PubMed1999

[The impact of an intervention strategy in the prescription of generic drugs in a primary care area].

OBJECTIVE: To examine the effects of specific interventions on generic prescribing in general practices. DESIGN: Non randomized controlled study. SETTING: General practices in 2 health areas of Madrid. PARTICIPANTS: 5 general practices (intervention group) and 5 general practices (control group). INTERVENTIONS: In 1994, intervention group received monthly educational seminars on generic drugs and computer-produced prescribing feedback. The control group received not seminars and not feedback. Prescription monitoring of both groups continued during 1994. MEASUREMENTS AND MAIN RESULTS: Area factor before and during intervention, and intervention factor for both areas (control and intervention) related with prescribing volume and costs of generics were analysis. Prescribing volume of generics in the intervention group was significantly greater than for control group (p < 0.01) by both area and intervention factors. Prescribing costs of generics in the intervention group was significantly greater for control group (p < 0.05) by area factor but both groups were significantly different by intervention factor. CONCLUSION: Educational seminars and feedback information on generics improve generic prescribing but it should be evaluated for broader areas of physicians on prescribing costs.

Analysis of Variance↗
PubMed1999

[An intervention trial to postpone aging in competent elderly. Trial of nutritional improvement in the retirement home].

The purpose of this study was to evaluate the effectiveness of a comprehensive intervention program in changing dietary habits and nutritional status, for postponing aging in competent elderly. The intervention group (n = 44, 11 men, 33 women, mean age: 74.3 +/- 5.4 years) comprised residents of a retirement home in a suburb of Tokyo. The intervention program, which consisted of 82 lectures and practice sessions focusing mainly on improvement of life styles, was performed between May 1993 and May 1995. In addition, individualized dietary consultations were provided every week during the intervention period. The age and sex matched control group (n = 133, 33 men, 100 women) was randomly selected from participants of the community-based health examination in Tokyo. Changes in dietary habits were measured by a 15-food frequency questionnaire method. As parameters of nutritional status, serum albumin (ALB), total cholesterol (TC), HDL cholesterol (HDL-C) and body mass index (BMI) were simultaneously examined at pre- and post-intervention. The results obtained were as follows: 1) The mean score of Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG Index of Competence) was 11.3 +/- 1.6 in the intervention group, 12.0 +/- 1.6 in the control group, the competent level of functional capacity was equally high in both groups. 2) Food frequencies of meat, fruit, and fat and oil significantly increased in the intervention group. A significant increase in the food frequency of meat was seen in the control group. 3) Significant increases in ALB, HDL-C and BMI were consequently observed in the intervention group, whereas levels of ALB and BMI significantly decreased in the control group. 4) The number of times of participation in the comprehensive intervention program was significantly positively related to the change in ALB between pre- and post-intervention, after adjusted for age, sex, education, TMIG Index of Competence score and ALB level at baseline. These results indicate that the comprehensive intervention program is effective for postponing aging in the competent elderly.

Aged↗
PubMed2000

Description of the SUPPORT intervention. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments.

BACKGROUND: The purpose of Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT) was to improve outcomes for seriously ill hospitalized adults by improving information and decision-making. The SUPPORT intervention has been characterized only briefly in previous publications. OBJECTIVE: To characterize the intervention in SUPPORT and its implementation. DESIGN: Reports derived from training and administrative materials, quantitative descriptions of implementation activities, and qualitative analysis of narrative reports and focus group participation by the intervention nurses. SETTING AND PATIENTS: SUPPORT enrolled 2652 patients in the intervention arm and 2152 in the control arm of a block-randomized trial of enhanced information, counseling, and support. The patients were hospitalized with one of nine serious illnesses in one of five US teaching hospitals between 1992 and 1994. MEASUREMENTS: (1) Reports on training and supervisory materials; (2) Rates of intervention component completion from contact logs and reports completed by the intervention nurses; and (3) grounded theory analysis of patient narratives, overview questionnaires, and focus group transcripts from the intervention nurses. RESULTS: Prognostic reports were delivered on time to the caregiving team in 83% of cases on Day 3. Reports of surrogate interviews of patient preferences and understanding were delivered on time to the caregiving team in 72% of first week cases. Patients' own reports of preferences were unavailable for 56% of cases in the first week. Overall, 39% of the rest of the patients had their interview information delivered on time to the caregiving team. The SUPPORT intervention nurses averaged 8.5 contacts with patients, 7.6 with surrogates, 3.5 with physicians, and 11.7 with other staff. The intervention nurses felt that they were fully involved in 81% of cases and had a limited role in another 14%. The major issues for patients were: understanding their situation, communication and decision-making, advance planning, do not resuscitate orders, and general support, including support for loss and grieving. The narrative sources showed that the nurses were enthusiastic, dedicated, and strong in their support of the study objectives. They identified various barriers to effectiveness and voiced doubt that the analytic targets would show an effect from the intervention. CONCLUSIONS: The SUPPORT intervention was implemented vigorously and completely.

Adult↗
PubMed2001

Depression burden, self-help interventions, and side effect experience in women receiving treatment for breast cancer.

PURPOSE/OBJECTIVES: To describe effects of a set of Self-Help Intervention Project (SHIP) interventions with self-reported depression burden on the side effect experience of women receiving treatment for breast cancer. DESIGN: Repeated measures, experimental design. SETTING: Outpatient sites at a regional cancer center, private practices, and health maintenance organizations. SAMPLE: 169 women who completed data at all three data-collection points were used to answer the research questions. METHODS: Following random assignment, individuals in the treatment group participated in five different, but complementary, self-help interventions for six weeks. The control group received the usual care. Variables were measured at baseline after radiation, chemotherapy, or hormone therapies were started to allow for the side effects to emerge at six to eight weeks after treatment and three months following time 2. MAIN VARIABLES: Depression burden, fatigue burden, pain burden, nausea burden, difficulty concentrating burden, anxiety burden, number of side effects, severity of side effects, and participation in the interventions. FINDINGS: Self-reported depression burden was found to significantly influence severity of side effects, number of side effects, and the burdens of fatigue, difficulty concentrating, and anxiety. Depression burden did not significantly influence the side effect burdens of nausea or pain. Depression burden interacted with the self-help interventions over time for the side effect of fatigue, but the intervention effect on pain burden and nausea burden was not influenced by depression burden over time. No significant intervention effects were found for the burden of difficulty concentrating or anxiety, the number of side effects, or perceived severity of side effects. The interventions significantly reduced the fatigue, pain, and nausea burden in women with breast cancer. CONCLUSIONS: The interventions were particularly helpful, relative to their fatigue experience, for women reporting a high level of depression burden. Findings also contribute to conceptual clarification of essential aspects of the side effect experience and provide a basis for measure and intervention refinement. IMPLICATIONS FOR NURSING PRACTICE: Every woman who is undergoing cancer treatment should be assessed for depression and depression burden. Self-help interventions are effective and convenient treatments that reduce side effects and promote quality of life in women with breast cancer.

Adaptation, Psychological↗
PubMed2000

[A comprehensive evaluation on intervention measures for injuries in primary and middle school students].

OBJECTIVE: To explore the intervention measures for prevention and control of injuries and evaluation for their effectiveness in students of middle and primary schools. METHODS: Effectiveness of intervention was evaluated by comparison of incidence of injury before and after intervention in 3,896 students of nine middle and primary schools and comparison with a non-intervention group in 651 students of four primary schools in Jiangmen City, Guangdong Province during January to December, 1999. RESULTS: Incidence of injury dropped to 11.78% after intervention from 50.55% before intervention in the intervention group, with 76.70% of reduction. Proportion of severe injury dropped to 0.65% after intervention from 7.84% before intervention. Incidence of multiple injuries dropped to 3.15% from 19.16%, with 83.56% of reduction. But, in the control group, incidence of injury dropped to 49.00% from 52.67%, with 6.97% of reduction only, with a ratio of reduction of intervention to control of 11.02% and a ratio of cost to benefit of 1:13.9. CONCLUSION: Intervention measures focusing on health promotion can prevent and control the occurrence of injury in students of middle and primary schools cost-effectively.

Accident Prevention↗
PubMedDate not supplied

Intervention efficacy and malignant transformation to oral cancer among patients with leukoplakia (Review).

Elimination of leukoplakia is one of the strategies for prevention of oral cancer. However, the efficacy of reducing malignant transformation for the treated leukoplakia has rarely been reported despite a number of studies addressing its malignant transformation to oral cancer after intervention. The obstacle to do so is partially due to different lengths of follow-up and partially due to lack of information pertaining to the disease natural history that can be taken as a standard group for comparison. This work aimed to quantify the progression from leukoplakia to carcinoma with and without intervention after systematic literature review. The overall comparison of the efficacy of intervention across studies was therefore made. The literature between 1934 and 2001 was first reviewed, including two studies addressing the disease natural history model and 15 studies pertaining to intervention model in reducing malignant transformation. The simple constant-incidence exponential model and non-constant incidence models (Weibull and Quadratic models) were therefore applied to estimate annual malignant transformation after intervention in various studies. Annual transition rates pertaining to the disease natural history were also estimated by Markov models. Intervention efficacy index using 10-year cumulative incidence from both models was also developed to assess intervention efficacy across studies. For the disease natural history, the estimates of annual transition rate of leukoplakia, annual transition rate from leukoplakia to oral cancer in the PCDP, and annual transition rate from the PCDP to clinical phase were 0.00121 (0.00019-0.00150), 0.0605 (0.0436-0.0755), and 1.8797 (0.13242-2.4352), respectively. Similar findings were observed in another retrospective study. Annual malignant transformation rates after intervention range from 0.0003 to 0.062 assuming constant incidence. Studies assuming non-constant incidence show different patterns of increasing or decreasing risk with time. The estimates regarding the efficacy of intervention for each study with different follow-up periods ranged from 42.9 to 99.3%. The heterogeneity of intervention efficacy due to a wide range of annual rates of malignant transformation was demonstrated in this review. This implies that prevention program for reducing malignant transformation may vary with different areas. Factors need to be considered including different diagnosis criteria, different histological type, distributions of risk factor, different patient resources, and different compliance rates or insufficient medical intervention.

Carcinoma↗
PubMed1992

Nonpharmacologic intervention to reduce blood pressure in older patients with mild hypertension.

BACKGROUND: Although nonpharmacologic interventions are widely recommended in the therapy of high blood pressure in older adults, surprisingly little data exist to confirm the efficacy of these interventions in older persons. METHODS: We conducted a randomized, controlled clinical trial in persons aged 60 to 85 years with a diastolic blood pressure of 85 to 100 mm Hg. The experimental arm was a nonpharmacologic intervention combining weight reduction, sodium restriction, and increased physical activity. The nonpharmacologic intervention consisted of eight weekly group and two individual sessions during the intensive phase, followed by four monthly group sessions during the maintenance phase. The control group received no treatment during the study. Blood pressure was assessed by certified technicians (blinded to group assignment) using random zero sphygmomanometers. RESULTS: Of 56 participants randomized, 47 completed the entire 6-month trial (21 in the intervention group and 26 in the control group). Attendance at the intervention sessions was excellent. The intervention group lost more weight (-2.1 kg) over 6 months than the control group (+0.3 kg). Trends for decreasing 24-hour urine sodium excretion in both the intervention and control groups, with greater trend in the intervention group, were not statistically significant. The intervention group experienced more reduction in systolic and diastolic blood pressure than did the control group (mean differences between groups at 6 months, 4.2/4.9 mm Hg, respectively). CONCLUSIONS: Our data indicate that a nonpharmacologic intervention will lower systolic and diastolic blood pressure levels in older people with borderline or mild elevations of diastolic blood pressure.

Aged↗
PubMedDate not supplied

What is the evidence for parenting interventions offered in a Canadian community?

BACKGROUND: The evidence supporting interventions offered in the community is often not examined. This study examines the evidence base supporting parenting interventions offered in a Canadian community and, in so doing, illustrates a community assessment mechanism that could be applied routinely for other psychosocial interventions. METHODS: An inventory of all manual-guided, group-based parenting interventions offered in a moderate-sized Canadian city was developed by reviewing existing community information guides and contacting key providers of parenting programs. Interventions offered between July 1, 2000 and June 30, 2001 were selected for evaluation. Evaluation reports for each intervention were assessed by two independent raters using a modification of the Effective Public Health Practice Project Quality Assessment Tool. RESULTS: Twelve parenting interventions were offered in the study community. Only three (25%) had been evaluated with at least one randomized controlled trial. No evaluation identified an a priori primary outcome measure to assess effectiveness. Multiple statistical testing without including a correction factor limits confidence in the robustness of the small number of positive results. Under-powered evaluations were common. Three interventions had only post-intervention client satisfaction data. The study community used none of the existing parenting interventions that are supported by extensive empirical evidence of efficacy. INTERPRETATION: There is a substantial research-practice gap in the parenting interventions offered in the study community. Similar community assessments could be used to spur debates within other communities about how best to reduce the research-practice gap.

Adaptation, Psychological↗
PubMed1995

Results of a nurse-delivered intervention on proficiency and nodule detection with breast self-examination.

PURPOSE/OBJECTIVES: To determine group differences in breast self-examination (BSE) frequency, proficiency, and nodule detection as a result of belief and/or informational interventions. DESIGN: Prospective, randomized, experimental design using a control group and three intervention groups. Data on outcome measures were collected one year following intervention to determine intervention effect on BSE outcome measures. SAMPLE: Women without breast cancer ranging in age from 35-88 years. METHODS: Graduate research assistants conducted in-home interviews and completed intervention delivery and data collection using a standardized protocol for each experimental group. Interventions included counseling about beliefs regarding BSE and informational counseling with BSE demonstration. A second in-home interview was conducted one year after the intervention to determine its effect on BSE outcome measures. MAIN RESEARCH VARIABLES: Self-recorded frequency, observer-rated proficiency scores, and nodule detection scores. FINDINGS: The group receiving both the belief and information interventions had significantly higher frequency (t = 2.22, p < or = 0.05) and higher proficiency scores (t = 3.22, p < or = 0.01) for BSE than the control group. The control group had significantly lower rates than the belief/information group for observed proficiency of BSE (t = 7.72, p < or = 0.01) and for nodule detection (t = 8.91, p < or = 0.01). CONCLUSIONS: The intervention consisting of information, BSE demonstration, and follow-up demonstration significantly increased logged frequency, logged proficiency, observed proficiency, and nodule detection one year postintervention. The group receiving both the belief intervention and information intervention demonstrated the highest nodule detection. IMPLICATIONS FOR NURSING PRACTICE: BSE teaching should include assessment and discussion about belief toward breast cancer and BSE while providing instruction with return demonstration.

Adult↗