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PubMed1995

Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India.

OBJECTIVE: To develop and test an HIV intervention targeting sex workers and madams in the brothels of Bombay. SUBJECTS AND METHODS: In a controlled intervention trial, with measurements before and after the intervention, 334 sex workers and 20 madams were recruited from an intervention site, and 207 and 17, respectively, from a similar control site, both in red-light areas of Bombay. All sex workers were tested for antibodies to HIV and syphilis, and for hepatitis B surface antigen. Information on sexual practices, condom use and knowledge of HIV was collected by interviewer-administered questionnaire. All subjects in the intervention group underwent a 6-month program of educational videos, small group discussions and pictorial educational materials; free condoms were also distributed. The blood tests and the questionnaire were readministered to all subjects at both sites immediately after the intervention. Both groups were followed for approximately 1 year. RESULTS: The baseline level of knowledge about HIV and experience with condoms was extremely low among both sex workers and madams. The baseline prevalence of HIV antibodies was 47% in the intervention group and 41% in the control group (P = 0.17). The incidence densities for HIV and sexually transmitted diseases were significantly different in the two groups (all P < 0.005): 0.05 and 0.16 per person-year of follow-up for HIV, 0.08 and 0.22 per person-year for antibodies to syphilis, and 0.04 and 0.12 per person-year for hepatitis B surface antigen in the intervention and control women, respectively. Following the intervention, women reported increased levels of condom use, and some (41%) said they were willing to refuse clients who wouldn't use them. However, both the sex workers and the madams were concerned about losing business if condom use was insisted upon. CONCLUSIONS: Both HIV prevalence and incidence are alarmingly high among female sex workers in Bombay. Successful interventions can be developed for these women, and even a partial increase in condom use may decrease the transmission of HIV and sexually transmitted diseases. Intervention programs of longer duration that target madams and clients and make condoms easily available are urgently needed at multiple sites in red-light areas.

Acquired Immunodeficiency Syndrome↗

PubMed1996

Impact of a mailed intervention on annual mammography and physician breast examinations among women at high risk of breast cancer.

Only a few studies have examined repeat annual mammography rates, and most studies find that such regularity is low, ranging from < 5% in the general population to between 14 and 20% of first-degree relatives. The present study tested the effectiveness of a mailed intervention designed to improve compliance with breast cancer screening guidelines among women at elevated familial risk. The study used a pretest-posttest control group design; 369 twin sisters of breast cancer cases were assigned alternately to an intervention or a control group on the basis of sequential registration numbers. The intervention consisted of written materials, an audiotape, and mailed reminders. The posttest was mailed 2.5 years after the intervention in order to provide adequate time to assess the regularity of screening. The intervention and control groups were virtually identical with respect to demographic and baseline screening characteristics. Of those who returned the follow-up questionnaire, annual physician breast examinations were 12.8% higher and annual mammograms were 10.3% higher in the intervention group than in the control group. The probability of annual screening with physician breast examination and mammography was higher in the intervention group, and the probability of annual mammography continued to be higher for women over age 52 years after controlling for baseline screening, year of diagnosis, education, and status of the twin. This result is consistent with improvements found in other studies. Women who did not return follow-up questionnaires were more likely to have had fewer physician breast examinations and mammograms and more likely to be in the intervention group than those who stayed in the study. Additionally, those who dropped out of the intervention arm perceived themselves to be less susceptible and perceived screening to be less effective than did those who dropped out of the control arm. Although the intervention caused many women to be screened more regularly, those who had not been screened in the past and those who held opinions that were not conducive to screening were more likely to drop out. This mailed intervention for high-risk women increased their rate of screening. Characteristics of women resistant to such programs have been identified; alternative strategies need to be developed to reach this small percentage of high-risk women who ignore their elevated susceptibility.

Adult↗

PubMed1997

Can goals of care be used to predict intervention preferences in an advance directive?

BACKGROUND: Some have suggested that advance directives elicit goals of care from patients, instead of or in addition to specific intervention preferences, but little is known about whether goals of care can be used in a meaningful way on documents or whether they can predict preferences for specific interventions. METHODS: Attending physicians (n = 716) at the Massachusetts General Hospital in Boston were surveyed to elicit general goals of care (eg, treat everything or comfort measures only) along with specific preferences for 11 medical, interventions in 6 scenarios. In each scenario, each goal was classified as an adequate predictor of acceptance or rejection of an intervention if its predictive value of the preference for that intervention was at least 80%. RESULTS: Goals varied with scenarios (P < .001) in a predictable manner. The goal treat everything was an adequate predictor of acceptance of each intervention, and comfort was an adequate predictor of rejection for nearly every intervention. Attempt cure adequately predicted acceptance of almost every nonaggressive intervention, but did not predict acceptance of aggressive interventions. Quality of life predicted rejection of aggressive interventions in 3 scenarios, but was not useful in other cases. When goals were predictors of preferences, the mean range of 95% confidence intervals for their predictive values was generally 20% or less. CONCLUSIONS: Goals have a valid role in advance directives, since the goal choices had a logical relationship to scenarios and intervention choices. However, the 2 goals attempt cure and choose quality of life were not predictive in many instances. If these findings hold true for more general populations of patients, then advance directive documents will need to rely on more than these general goal statements if they are to adequately represent patient preferences.

Acute Disease↗

PubMedDate not supplied

Measuring comprehensive case management interventions. Development of a tool.

As case management programs seek to demonstrate effectiveness data are needed on the interventions used by case managers. This research was done to quantify the interventions used by case managers for low-income prenatal clients. Using the Client Intervention Form, case managers from two local health departments, whose caseload included pregnant Medicaid recipients, recorded the use of 7 types of interventions in 10-minute increments. The Client Intervention Form is easy to use and is based on an existing valid typology of nursing interventions. Intervention types include: assessment, monitoring, education, clinical acts, coordination, support, and coaching. The amount of time spent doing each of the seven types of interventions varied between agencies and across types of interventions, suggesting that the Client Intervention Form can quantify interventions used. Recommendations for practice and research are identified.

Adult↗

PubMed1998

Nutritional assessment, intervention, and evaluation of weight loss in patients with non-small cell lung cancer.

PURPOSE/OBJECTIVES: To describe weight change in patients from the time of cancer diagnosis to the last healthcare encounter before death, to describe reported nutritional assessment, intervention, and evaluation; and to determine the relationship of weight change and cancer-related symptoms to nutritional assessment, intervention, and evaluation. DESIGN: Descriptive, correlational. SETTING: A National Cancer Institute-designated cancer center and its associated university medical center in the northeastern United States. SAMPLE: Medical records of 93 individuals with non-small cell lung cancer. METHODS: Retrospective chart review. MAIN RESEARCH VARIABLES: Weight change; nutritional assessment, intervention, and evaluation; and cancer-related symptoms. FINDINGS: Mean weight change from cancer diagnosis to last healthcare encounter was -4.75 kg (SD = 6.05 kg). The mean regression slope of weight change was -3.69 kg/healthcare encounter (SD = 6.49 kg). The results of content analysis indicated that 90 subjects had nutritional assessments, 54 subjects had interventions, and 24 subjects had evaluations of intervention effectiveness. No association existed between weight change or cancer-related symptoms and nutritional assessment. Nutritional intervention was positively associated with dysphagia and depression, and evaluation of intervention effectiveness was positively associated with weight loss and dysphagia. CONCLUSIONS: Assessments of weight change and appetite usually were reported and appeared to be a routine part of patient care. However, assessments of weight loss and anorexia led to interventions only 60% of the time. When interventions were recommended, only 44% were evaluated for effectiveness. IMPLICATIONS FOR NURSING PRACTICE: Assessment of nutritional status needs to be broadened, interventions need to be initiated more often, and creative solutions to nutritional problems need to be sought. Regular evaluation of interventions is essential.

Adult↗

PubMed2005

[Lowering incidence of cerebral palsy of premature infants through early intervention].

OBJECTIVE: In recent years, the survival rate of premature infants is increased, but the incidence of cerebral palsy did not decrease, instead, there was a tendency of increase. The incidence of cerebral palsy of premature infants was 29.13 per thousand in 7 provinces in China in an investigation of over 30,000 children 1 - 6 years of age in 1997, which is 25.16 times higher than that of full term infants. Each year, about 1 million premature infants are born in China, which may include an increase of approximately 29,000 cerebral palsy infants. The rehabilitation expense of cerebral palsy infants is high, older patients cannot be cured; only improved life quality is possible. Therefore, we carried out this research from March 1, 2000 to the end of February 2003 to explore the effects of early intervention in lowering the incidence of cerebral palsy among premature infants. METHODS: A total of 1053 cases of survived premature infants, gestational age under 37 weeks, excluding those with congenital deformity and hereditary metabolic diseases, born or treated in all collaborative units were classified into 2 groups: early intervention group (551 cases) and routine care group (502 cases). Method of classification: all premature infants born within 1 year before beginning of the study and premature infants born after beginning of the study whose parents did not want to receive early intervention were included in the routine care group; all premature infants born after beginning of the study whose family intended to actively participate in early intervention were included in the intervention group. The numbers of infants in the two groups were quite close in each collaborative unit. In the intervention group, the premature infants received early intervention after discharge from hospital, in addition to routine care, once a month before corrected age of 6 months and once every two months after 6 months. The parents were instructed to cultivate the infant's cognition, language, emotion and communication ability, and the infants were given massage, subjected to exercise and received active motor training. All infants with abnormal motor manifestations were given appropriate rehabilitation training. In the routine care group, infants received similar routine care only. RESULTS: In the 2 groups, no significant differences (P > 0.05) were found in complications of pregnant mothers, average gestational age and birth weight, proportion of small for gestational age (SGA), proportion of single and multiple births, fetal stress, postnatal asphyxia, incidence of neonatal hypoxic inschemic encephalopathy (HIE) and intracranial hemorrhage, Apgar Score and Neonatal Behavioral Neurological Assessment Score at 40 weeks of gestational age. These indicate that the two groups were comparable. At 1 year of age, the incidence of cerebral palsy was 0.91% (5/551) in the intervention group and 3.19% (16/502) in the routine care group (P < 0.01). Of the 5 cases with cerebral palsy in the interventional group, 3 were mild and 2 severe. Of the 16 cases in the routine care group, 7 were moderate and 9 severe. CONCLUSION: Early intervention can reduce the incidence of cerebral palsy of premature infants. This conclusion awaits confirmation from studies with larger sample size.

Apgar Score↗

PubMed2026

Effectiveness of psychosocial and lifestyle interventions in promoting behaviour change and improving cognitive outcomes in older people with memory concerns: A systematic review.

BACKGROUND: Older adults with mild cognitive impairment or subjective cognitive decline have a greater dementia risk, particularly those from minority ethnic and socioeconomically disadvantaged backgrounds. Psychosocial and lifestyle interventions targeting modifiable risk factors offer hope for reducing risk, yet behavioural mechanisms remain unclear. This systematic review examines these mechanisms and associated outcomes. METHOD: We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Web of Science, and Scopus for randomised control trials testing interventions that aimed to improve lifestyle and cognition in older adults with memory concerns. We explored behavioural mechanisms using the COM-B model and synthesised intervention effectiveness, overall and within underserved groups. We prioritised lower risk of bias studies. RESULTS: 26 studies described 23 randomised controlled trials (14 multidomain, 9 single domain interventions). Certainty of evidence that behaviour change was associated with cognition was low. Moderate-certainty evidence indicated that interventions providing a socially supportive environment and combining nutritional education and counselling for 6 + months improved diet. Physical activity improved primarily in interventions incorporating education, structured training, and enablement strategies (e.g., tailored programmes, providing tools). Interventions simultaneously targeting capability, opportunity and motivation showed greater overall effectiveness. Few studies recorded ethnicity (13%) or sociodemographic status (9%), and none explored their impact. CONCLUSIONS: Non-pharmacological interventions can help this population improve their lifestyles if they feel capable, equipped and motivated, highlighting the value of careful design and implementation. There is scarce evidence on how these interventions work for underserved populations. Future research should explore this to inform tailored interventions and develop equitable dementia prevention strategies.

Humans↗

PubMed2003

Interventional neuroradiology of the head and neck.

Vascular interventions are important and helpful for treatment of various pathologies of the head and neck. Interventional neuroradiology of the head and neck includes image-guided biopsies, vessel occlusion, and local chemotherapy. Knowledge of anatomy, functional relationships between intra- and extracranial vessels, and pathology are the basis for therapeutic success. The interventional neuroradiologist is responsible for appropriate selection of patients based on clinical information, indications, and risk assessment. Neuroradiologic imaging, especially CT and MR imaging, and appropriate analysis of angiographic findings help ensure indication for treatment and plan an intervention. Technical equipment, including an angiographic unit, catheters, needles, embolizing materials, and so forth, are important. Knowledge of hemodynamics is relevant to avoid complications and to find the optimal technique for solving the clinical problem. Indications for image-guided biopsies are preverterbal fluid-collections, spinal and paraspinal inflammations and abscesses, deep cervical malignancies, vertebral body, and skull base tumors. Special care should be taken to preserve critical structures in this region, including spinal nerve roots, cervical plexus, main peripheral nerves, and vessels. Indications for vessel occlusion are emergency situations to stop bleeding in vascular lesions (traumatic, malformation, or tumors) by reduction of pressure, preoperative reduction of blood flow to minimize the surgical risk, palliative occlusion of feeding vessels to produce tumor necrosis, or potential curative (or presurgical) occlusion of vascular malformations. Pressure reduction to support normal coagulation, such as epistaxis, in hereditary hemorrhagic telangiectasia can be achieved by proximal vessel occlusion with large particles or platinum coils. Prevention of intraoperative bleeding requires occlusion of the microvascular bed with small particles. Examples of these interventions are: a hemangioma of the hard palate, a juvenile angiofibroma, a hemangiopericytoma, a malignant meningioma, a malignant fibrous histiocytoma, and a glomus tumor. Effective treatment of vascular malformations, such as AV fistulas or angiomas, needs exact occlusion of the fistula or the angiomatous nidus, which is demonstrated in the case of an AV angioma of the base of the tongue. Chemotherapy with local intra-arterial cisplatin combined with intravenous administration of sodium thiosulfate as antidote is indicated as an adjuvant modality in a multimodal regimen of oropharyngeal squamous cell carcinoma or as palliative treatment of recurrent and otherwise untreatable malignant tumors of the head and neck. Examples are a carcinoma of the alveolar ridge, a squamous cell carcinoma of the floor of the mouth, and a nasopharyngeal lymphoepithelioma. Palliative treatment of a bleeding oropharyngeal cancer is another example of interventional treatment. Selective treatment, either occluding or pharmacologic, may be preoperative, palliative, or curative. The objective is reduction of surgical risk, improvement of quality of life, or curative therapy of a lesion. Thus, the interventional treatment should not be associated with morbidity or mortality. Major complications, such as cerebral stroke, blindness, or cranial nerve palsies, can result from application of inappropriate techniques or poor evaluation of angiographic findings and should be avoided in the majority of cases. Sometimes collateral lesions are unavoidable. These include inflammation, necrosis, and nerve damage. Based on neuroradiologic experience, most of those risks are predictable. The benefits, risks, and expected damages of neuroradiologic interventions must be balanced during the informed consent procedure with the patient. Avoiding complications, handling unavoidable problems, and dealing with complications is a skill founded on knowledge and experience. Continuing education is a firm basis to push the limits of interventions and expand benefits without increasing risk for the patient. Nevertheless, state-of-the-art external carotid intervention should, in skilled hands, have a permanent morbidity far below 1% and no mortality.

Head and Neck Neoplasms↗

PubMed2025

Psychological interventions for children with chronic physical conditions: a systematic review assessing the role of coping, emotional and cognitive processes.

OBJECTIVES: Coping, emotional and cognitive processes are crucial in child development, particularly in children with pediatric chronic physical conditions (CPC). No systematic review in pediatric psychology has investigated the effectiveness of interventions on these processes concurrently. This review addresses this gap by focusing on the effectiveness of psychological interventions on coping, emotional and cognitive processes in children with CPCs. METHODS: Five electronic databases were searched for studies assessing at least one of these processes. Only randomized-controlled trials with children (8-12 years) with a CPC (e.g. diabetes, asthma), which implemented a psychological intervention were included. This study is registered in (CRD42021233505). RESULTS: Ten intervention studies were identified. While cognitive interventions (Cogmed) showed some improvements in working memory, the effects varied across studies despite similar methodologies. Coping interventions (e.g. Coping Skills Training) showed little effect on coping strategies or psychological health variables and were no more beneficial than control groups. No study trained coping, emotional processes and cognitive processes together. CONCLUSION: This review shows current limitations in evaluating psychological interventions targeting coping, cognitive or emotional processes in children with CPCs, limiting a comprehensive understanding of the interventions' action mechanisms. Systematically including underlying processes in intervention studies could help to better adjust those interventions.

Humans↗

PubMed2006

Interventional versus conservative treatment in acute non-ST elevation coronary syndrome: time course of patient management and disease events over one year in the RITA 3 trial.

OBJECTIVE: To determine whether, in acute non-ST elevation coronary syndrome, the benefit from early invasive coronary intervention compared with a conservative strategy of later symptom-guided intervention varies over time. METHODS: In RITA 3 (Randomised Intervention Trial of unstable Angina 3) patients were randomly assigned to coronary angiography (median 2 days after randomisation) and appropriate intervention (n = 895) or to a symptom-guided conservative strategy (n = 915). RESULTS: In the first week patients in both groups were at highest risk of death, myocardial infarction (MI) or refractory angina (incidence rate 40 times higher than in months 5-12 of follow up). There were 22 MIs and 6 deaths in the intervention group (largely due to procedure-related events, 14 MIs and 3 deaths) versus 17 MIs and 3 deaths in the conservative group. In the rest of the year there were an additional 12 versus 27 MIs, respectively (treatment-time interaction p = 0.021). Over one year in the intervention group there was a 43% reduction in refractory angina; 22% of patients underwent coronary artery bypass surgery and 35% underwent percutaneous coronary intervention only, which reduced refractory angina but provoked some early MIs; and 43% were still treated medically, mostly because of a favourable initial angiogram. CONCLUSION: Any intervention policy needs to recognise the high risk of events in the first week and the substantial minority of patients not needing intervention. Intervention may be best targeted at higher risk patients, as the early hazards of the procedure are then offset by reduced subsequent events.

Adult↗

PubMed2006

Relationship between fluoroscopic time, dose-area product, body weight, and maximum radiation skin dose in cardiac interventional procedures.

OBJECTIVE: Real-time maximum dose monitoring of the skin is unavailable on many of the X-ray machines that are used for cardiac intervention procedures. Therefore, some reports have recommended that physicians record the fluoroscopic time for patients undergoing fluoroscopically guided intervention procedures. However, the relationship between the fluoroscopic time and the maximum radiation skin dose is not clear. This article describes the correlation between the maximum radiation skin dose and fluoroscopic time for patients undergoing cardiac intervention procedures. In addition, we examined whether the correlations between maximum radiation skin dose and body weight, fluoroscopic time, and dose-area product (DAP) were useful for estimating the maximum skin dose during cardiac intervention procedures. MATERIALS AND METHODS: Two hundred consecutive cardiac intervention procedures were studied: 172 percutaneous coronary interventions and 28 cardiac radiofrequency catheter ablation (RFCA) procedures. The patient skin dose and DAP were measured using Caregraph with skin-dose-mapping software. RESULTS: For the RFCA procedures, we found a good correlation between the maximum radiation skin dose and fluoroscopic time (r = 0.801, p < 0.0001), whereas we found a poor correlation between the maximum radiation skin dose and fluoroscopic time for the percutaneous coronary intervention procedures (r = 0.628, p < 0.0001). There was a strong correlation between the maximum radiation skin dose and DAP in RFCA procedures (r = 0.942, p < 0.0001). There was also a significant correlation between the maximum radiation skin dose and DAP (r = 0.724, p < 0.0001) and weight-fluoroscopic time product (WFP) (r = 0.709, p < 0.0001) in percutaneous coronary intervention procedures. CONCLUSION: The correlation between the maximum radiation skin dose with DAP is more striking than that with fluoroscopic time in both RFCA and percutaneous coronary intervention procedures. We recommend that physicians record the DAP when it can be monitored and that physicians record the fluoroscopic time when DAP cannot be monitored for estimating the maximum patient skin dose in RFCA procedures. For estimating the maximum patient skin dose in percutaneous coronary intervention procedures, we also recommend that physicians record DAP when it can be monitored and that physicians record WFP when DAP cannot be monitored.

Body Weight↗

PubMed2006

The Portuguese Interventional Cardiology Registry from 1992 to 2003.

OBJECTIVE: The aim of the present paper was to report trends in Portuguese interventional cardiology from 1992 to 2003 and to compare these data with other European countries. METHODS: Based on questionnaires distributed to and completed by Portuguese interventional cardiology centers we give an overview of the development of coronary interventions since 1992, when data were first collected. In 2003, 24,834 diagnostic catheterization procedures were performed, representing an increase of 315% in comparison to 1992. In 2003 the population-adjusted rate was 2483 coronary angiograms per million population. Coronary interventions increased by 1193% in comparison to 1992, with a total of 8465 procedures and a rate of coronary interventions of 848 per million population in 2003. Coronary stents were the most frequently used devices, with an increase from 53% in 1996 to 89% in 2003. The present rate of stent implantation in Portugal is similar to that in Europe and Spain, but the rate of use of drug-eluting stents in Portugal is one of the highest in Europe (55%). In 2003, multivessel percutaneous coronary interventions were performed in 24% of cases, with no significant increase during the last 10 years, and ad hoc interventions were performed in the course of diagnostic coronary angiography in 73 % of patients; glycoprotein IIb-IIIa inhibitors were used in 30% of procedures; percutaneous coronary interventions in patients with acute myocardial infarction accounted for 16% of all procedures; of the noncoronary interventions recorded, 49 percutaneous mitral valvuloplasties, 37 atrial septal defect closures and 15 patent foramen ovale closures were reported. The PCI rate per million population in Portugal was lower than the mean European rate (848 vs. 1194). CONCLUSION: Interventional cardiology in Portugal and other European countries has been expanding since 1992. We would emphasize the high rate of reporting by laboratories, which enables the Registry to compile data that are highly representative of activity in Portugal since 1992.

Cardiac Surgical Procedures↗

PubMed1994

Suicide intervention training evaluation: a preliminary report.

To date, very little work has been done on evaluating training in suicide intervention. This study developed and piloted a comprehensive method for evaluating suicide intervention training by applying three studies of immediate training effects on (a) suicide intervention abilities, (b) attitudes to suicide and suicide intervention, and (c) knowledge about suicide. The focus of the evaluation was a broadly used 2-day suicide intervention training program. Changes in suicide intervention abilities were measured by the Suicide Intervention Response Inventory (SIRI) and by performance in simulated suicide intervention situations, scored with the Suicide Intervention Protocol (SIP). Subjects consisted of 19 workshop participants in a pre-post condition and 17 participants in a post-test only condition. Results indicated significant increases in skills in suicide intervention situations. No significant effects were noted on the SIRI. Results from the attitudes and knowledge studies were very preliminary. They are reported here so that others may become aware of the methodology being used and the status of evaluation of the target program. Implications for further research are discussed.

Adult↗

PubMed1998

Safely increasing the proportion of patients with community-acquired pneumonia treated as outpatients: an interventional trial.

BACKGROUND: Patients with community-acquired pneumonia who are at low risk for short-term mortality can be identified using a validated prediction rule, the Pneumonia Severity Index. Such patients should be candidates for outpatient treatment, yet many are hospitalized. OBJECTIVE: To assess a program to safely increase the proportion of low-risk patients with pneumonia treated at home. METHODS: The intervention provided physicians with the Pneumonia Severity Index score and corresponding mortality risk for eligible patients and offered enhanced visiting nurse services and the antibiotic clarithromycin. Prospectively enrolled, consecutive low-risk patients with pneumonia presenting to an emergency department during the intervention period (n = 166) were compared with consecutive retrospective controls (n = 147) identified during the prior year. A second group of 208 patients from the study hospital who participated in the Pneumonia Patient Outcomes Research Team cohort study served as controls for patient-reported measures of recovery. RESULTS: There were no significant baseline differences between patients in the intervention and control groups. The percentage initially treated as outpatients increased from 42% in the control period to 57% in the intervention period (36% relative increase; 95% confidence interval, 8%-72%; P = .01). However, more outpatients during the intervention period were subsequently admitted to the study hospital (9% vs 0%). When any admission to the study hospital within 4 weeks of presentation was considered, there was a trend toward more patients receiving all their care as outpatients in the intervention group (42% vs 52%; 25% relative increase; 95% confidence interval -2% to 59%; P = .07). No patient in the intervention group died in the 4-week follow-up period. Symptom resolution and functional status were not diminished. Satisfaction with overall care was similar, but patients treated in the outpatient setting during the intervention were less frequently satisfied with the initial treatment location than comparable control patients (71% vs 90%; P = .04). CONCLUSIONS: Use of a risk-based algorithm coupled with enhanced outpatient services effectively identified low-risk patients with community-acquired pneumonia in the emergency department and safely increased the proportion initially treated as outpatients. Outpatients in the intervention group were more likely to be subsequently admitted than were controls, lessening the net impact of the intervention.

Adult↗

PubMed2000

Preventive intervention to reduce sexually transmitted infections: a field trial in the Royal Thai Army.

BACKGROUND: During 1991 through 1993, sexually transmitted infections among conscripts in the Royal Thai Army in the upper-northern provinces were common: human immunodeficiency virus (HIV) prevalence at induction was 12%, HIV incidence was 2.4% per year, and incidence of sexually transmitted diseases was 17% per year. We evaluated a behavioral intervention to reduce incident sexually transmitted infections among conscripts inducted into the Thai Army in 1993. METHODS: We developed a preventive intervention that addressed consistent condom use, reducing alcohol consumption and brothel patronage, and improving sexual negotiation and condom skills. Companies were assigned to 1 of 3 groups matched on military mission: 450 men were in the intervention group, 681 were in barracks at the same base but did not receive the intervention (diffusion group), and 414 were in distant camps (controls). Baseline HIV serological testing and behavioral interviews were conducted during basic training in 1993. The intervention was applied for 15 months, and men were followed up at 6-month intervals (with repeated HIV serological testing, sexually transmitted disease assessments, and behavioral interviews) through May 1995. RESULTS: Incident sexually transmitted diseases were 7 times less frequent among men assigned to the intervention than the combined controls (relative risk, 0.15; 95% confidence interval, 0.04-0.55), after adjusting for baseline risk factors (P<.005). There was no diffusion of the intervention to adjacent barracks. The intervention decreased incident HIV by 50% in the intervention group. CONCLUSION: Intensive interventions in structured institutions can successfully reduce risk in settings confronting expanding heterosexual HIV epidemics.

Adult↗

PubMed2003

Sustained benefit of a community and professional intervention to increase acute stroke therapy.

BACKGROUND: The ultimate test of an educational intervention is the sustainability of the effect after the intervention ceases. METHODS: The TLL Temple Foundation Stroke Project was a quasi-experimental study aimed at increasing Food and Drug Administration-approved acute stroke therapy in a nonurban community in east Texas. During the intensive community and professional intervention (phase 2), significantly more patients with acute stroke received intravenous tissue plasminogen activator (tPA) compared with the preintervention period (phase 1). In the comparison community, no change was noted. We present the results of tPA treatment in the 6 months after the intervention ended (phase 3). RESULTS: Two hundred thirty-eight patients had a validated stroke during phase 3. Among patients who experienced an ischemic stroke, 11.2% in the intervention group received intravenous tPA compared with 2.2% in phase 1 (P =.007). In the comparison group, 1.4% received intravenous tPA in phase 3 compared with 0.7% in phase 1 (P>.99). Among eligible candidates for treatment, 69.2% were treated in phase 3 in the intervention community compared with 13.6% in phase 1 (P =.002). In the comparison group, 20.0% were treated in phase 3 compared with 6.7% in phase 1 (P =.45). There was 1 protocol violation among the 9 patients treated in the intervention community in phase 3. CONCLUSIONS: There was a sustained benefit of the intervention in increasing tPA treatments in the intervention community even after cessation of the educational effort. Treatments in the control community remained few through all 3 phases of the study. A carefully planned multilevel intervention can improve community stroke treatments even in a nonurban community.

Drug Utilization↗

PubMed1998

Early effects of a school-based human immunodeficiency virus infection and sexual risk prevention intervention.

OBJECTIVE: To determine the short-term effect of a middle and high school-based human immunodeficiency virus and sexuality intervention (Rochester AIDS Prevention Project for Youth [RAPP]) on knowledge, self-efficacy, and behavior intention. DESIGN: Nonrandomized intervention study with 2 intervention groups and 1 control group. SETTING: Middle and high school health classes in an urban, predominantly minority school district. PARTICIPANTS: Middle and high school students (N = 3635) enrolled in health classes in 9 schools; 50% African American, 16% Hispanic, 20% white, and 14% other. Less than 10% of students refused participation. INTERVENTION: There were 3 study conditions: (1) Control, usual health education curriculum taught by classroom teacher; (2) RAPP adult health educator, intervention curriculum implemented by ethnically diverse male-female pairs of highly trained health educators; and (3) RAPP peer educator, intervention implemented by male-female pairs of extensively trained high school students. Health classes within schools were assigned to 1 of the 3 conditions each semester, and simultaneous implementation of the control program with health educators or peer educators in the same school and during the same semester was not permitted. MAIN OUTCOME MEASURE: A confidential questionnaire administered to all study subjects before and immediately after the intervention, containing scales to measure knowledge, sexual self-efficacy, and safe behavior intention. RESULTS: Preintervention data indicated that the study population was involved in sexual activity and other risk behaviors at rates comparable to those of other urban adolescent populations. Examination of 3 outcome constructs as dependent variables (knowledge, sexual self-efficacy, and safe behavior intention) revealed that the health educators and peer educators increased students' knowledge significantly more than did the control condition for both middle (females, P<.01; males, P<.01) and high (females, P<.001; males, P<.001) school. Comparisons of self-efficacy changes across intervention groups did not reach statistical significance, and safe behavior intention changes differed significantly by intervention group for high school but not for middle school students. For all analyses, the preintervention scores for each outcome variable were the most powerful predictors of postintervention scores, and analysis of variance models predicted substantial overall variance. CONCLUSIONS: At short-term follow-up, the RAPP intervention had a powerful effect on knowledge for all students and a moderate effect on sexual self-efficacy and safe behavior intention, particularly for high school students. The peer educators were found to be equally and, for some variables, more effective than the highly trained adult educators. The substantial effect of the baseline scores and the high prevalence of risk behavior already evident by seventh grade indicate the importance of early implementation of school-based sexuality programs.

Adolescent↗

PubMed2001

Randomized controlled trial of a safer sex intervention for high-risk adolescent girls.

OBJECTIVE: To determine the effect of an individualized safer sex intervention on condom use and recurrent sexually transmitted disease (STD) among female adolescents diagnosed as having an STD. DESIGN: Randomized controlled trial. SETTING: Urban children's hospital adolescent clinic and inpatient service. PARTICIPANTS: One hundred twenty-three adolescents with cervicitis or pelvic inflammatory disease. INTERVENTION: Participants completed a questionnaire and then were randomized to receive standard STD education or to watch a videotape and have an individualized intervention session. Follow-up questionnaires were completed at 1, 3, 6, and 12 months. Intervention participants met with an educator at 1, 3, and 6 months to discuss interim sexual history and review the intervention. MAIN OUTCOME MEASURES: Change in self-reported condom use and recurrence of STD. Other self-reported behaviors, sexual risk knowledge, attitudes toward condoms, and condom use negotiation skills were also assessed. RESULTS: At 1 month, compared with control participants, intervention participants had increased sexual risk knowledge and more positive attitudes toward condoms and tended to use condoms more with a nonmain partner. At 6 months, fewer intervention participants than controls had sex with a nonmain sexual partner in the previous 6 months. At 12 months, intervention participants were less likely to have a current main partner and had a lower rate of recurrent STD than controls, but these differences were not significant. CONCLUSIONS: This individualized safer sex intervention may improve condom use and decrease the number of partners among adolescent girls who have had an STD. Studies with larger samples are needed to determine definitive intervention effects on recurrent STD in this high-risk population.

Adolescent↗