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PubMed2003

On reducing hand impact force in forward falls: results of a brief intervention in young males.

OBJECTIVE: To test the working hypotheses that after a brief (10 min) intervention, (a) young adults can volitionally reduce fall-related wrist impact forces, and (b) no difference in impact force would exist between intervention and control groups at 3-weeks or 3-months follow-up. BACKGROUND: The wrist is the most commonly fractured site in the body at any age, most often as a result of impact with the ground while arresting a forward fall.Methods. Twenty-nine healthy young male volunteers participated. A 3-month intervention group (n=10) performed five standardized forward falls before and after a 10-min instructional intervention aimed at reducing wrist impact forces during the baseline visit. They, along with a 3-month control group (n=11) who did not receive the intervention, were remeasured in five trials at 3-weeks and 3-months follow-up, without intervening practice. A baseline control group (n=8) performed the five trials, then repeated them at the baseline visit without receiving the intervention. Unilateral body segment kinematics and bilateral hand-ground impact forces were measured and the hypotheses were tested using repeated measures analysis of variance. RESULTS: At the baseline visit, a significant group-by-trial-block interaction was found (P=0.02): the 3-month intervention group reduced their average maximum impact forces by 18% from initial values (P=0.002); the baseline control group did not do so (0.5% increase, P=0.91). The 3-month intervention (20 falls) and control (15 falls) groups did not differ at the 3-month follow-up (P=0.62); however, when the groups were combined their maximum impact force had decreased significantly (8.9%, P=0.04) over that time. CONCLUSIONS: Healthy young males learned in 10 min to significantly reduce wrist impact forces in forward falls, but retention was poor at 3-weeks follow-up. Irrespective of group, however, after the 5 falls at 3-weeks subjects had taught themselves to reduce their impact forces at the 3-months follow-up. RELEVANCE: A brief educational intervention can significantly reduce forward fall-related impact forces in the short term. However, with or without the brief intervention, the experience of performing between 5-10 forward falls 3 weeks apart apparently resulted in decreased impact forces over the next 2 months, thereby reducing the risk of injury in these forward falls.

Accidental Falls↗
PubMed2001

A randomised trial of an intervention package designed to promote external cephalic version at term.

OBJECTIVE: To evaluate the effectiveness of an intervention package to promote external cephalic version (ECV). STUDY DESIGN: (1) Design and Setting--A randomised-controlled trial of 20 consultant-based maternity units in the West Midlands NHS Region. (2) Intervention Units--One consultant obstetrician from each unit was encouraged to promote changes in clinical practice within their unit. A multifaceted package including a workshop, written material, guidelines and videos was delivered to these consultants. (3) Control Units--No intervention. (4) Main Outcome Measure--The percentage of women with breech presentation at term who were offered ECV in the antenatal clinic, before and after the intervention. RESULTS: Pre-intervention, there was no difference between the intervention and control units in the proportion of women offered ECV (20 and 19%, respectively). Post-intervention, the proportions were 15% in the control group and 36% in the intervention group (P=0.016). CONCLUSION: This type of intervention package can alter clinical practice and increase the proportion of women with breech presentation at term being offered ECV after the intervention.

Breech Presentation↗
PubMed2000

Evaluating worksite-based interventions that promote safety belt use.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of worksite-based interventions in increasing the use of safety belts among employees. SEARCH STRATEGIES: Using the Cochrane Collaboration search strategy, we searched in electronic databases, review articles, U.S. government documents, and reports of research agencies. SELECTION CRITERIA: Studies had to be evaluations of worksite-based interventions with a clear description of the program. The outcomes evaluated were the percentage of drivers using their safety belts before and after the intervention and (when possible) after a follow-up period. Safety belt use had to be measured in an objective manner, and a comparison group was necessary. RESULTS: Forty-eight interventions met the selection criteria. All interventions increased safety belt use among employees, and in 16 the increases were significant (p<0.05). In 15 of the 33 interventions in which follow-up observations were reported, safety belt use continued significantly higher than at baseline. Different strategies (and combinations of strategies) were used across interventions. Interventions incorporating incentives seemed to have stronger effects in increasing safety belt use. CONCLUSIONS: All reviewed interventions had a positive impact on increasing driver use of safety belts. However, it is important to note the low baseline safety belt use existing at the time when the studies took place, the short-term duration of most interventions, and the short-term follow-up reported (if any). More rigorous research in contemporary worksites is needed.

Accidents, Occupational↗
PubMed2000

Interventions for the primary prevention of work-related carpal tunnel syndrome.

OBJECTIVE: To evaluate interventions for the primary prevention of work-related carpal tunnel syndrome (CTS). SELECTION CRITERIA: Studies had to include an engineering, administrative, personal, or multiple component intervention applied to a working or working-age population. All study designs that included comparison data were considered. Outcome measures included the incidence, symptoms, or risk factors for CTS, or a work-related musculoskeletal disorder of the upper extremity that included CTS in the definition. RESULTS: Twenty-four studies met our inclusion criteria. Engineering interventions included alternative keyboards, computer mouse designs and wrist supports, keyboard support systems, and tool redesign. Personal interventions included ergonomics training, splint wearing, electromyographic biofeedback, and on-the-job exercise programs. Multiple component interventions (e.g., ergonomic programs) included workstation redesign, establishment of an ergonomics task force, job rotation, ergonomics training, and restricted duty provisions. Multiple component programs were associated with reduced incidence rates of CTS, but the results are inconclusive because they did not adequately control for potential confounders. Several engineering interventions positively influenced risk factors associated with CTS, but the evaluations did not measure disease incidence. None of the personal interventions alone was associated with significant changes in symptoms or risk factors. All of the studies had important methodologic limitations that may affect the validity of the results. CONCLUSIONS: While results from several studies suggest that multiple component ergonomics programs, alternative keyboard supports, and mouse and tool redesign may be beneficial, none of the studies conclusively demonstrates that the interventions would result in the primary prevention of carpal tunnel syndrome in a working population. Given the societal impact of CTS, the growing number of commercial remedies, and their lack of demonstrated effec- tiveness, the need for more rigorous and long-term evaluation of interventions is clear. Fund- ing for intervention research should prioritize randomized controlled trials that include: (1) adequate sample size, (2) adjustment for relevant confounding variables, (3) isolation of speci- fic program elements, and (4) measurement of long-term primary outcomes such as the inci- dence of CTS, and secondary outcomes such as employment status and cost.

Carpal Tunnel Syndrome↗
PubMed1998

Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations.

INTRODUCTION: Lifestyle physical activity interventions have resulted in response to the public health problem of promoting regular amounts of physical activity to the majority of U.S. adults who remain inadequately or completely inactive. These lifestyle interventions allow a person to individualize his/her physical activity programs to include a wide variety of activities that are at least of moderate intensity and to accumulate bouts of these activities in a manner befitting his/her life circumstances. METHODS: We reviewed the history of lifestyle physical activity interventions and defined lifestyle physical activity based on this review. We located 14 studies that met this definition. RESULTS: Lifestyle physical activity interventions are effective at increasing and maintaining levels of physical activity that meet or exceed public health guidelines for physical activity in representative samples of previously sedentary adults and obese children. The majority of these interventions have been delivered by face-to-face contact in small groups, which limits their public health impact. However, a small number of studies demonstrate that these interventions can be delivered by mail and telephone, which may enhance their generalizability. Most of these studies utilized behavior change theories such as Social Cognitive Theory, the Transtheoretical Model, and Behavior Learning to shape the interventions. Lifestyle interventions aimed at modifying the environment, such as signs posted to increase stair climbing, also have been shown to be effective over the short term. CONCLUSIONS: The major issues concerning lifestyle physical activity interventions are: (1) testing their ability to be implemented on a large scale; (2) examining cost-effectiveness for different modes of delivery; and (3) researching the efficacy in populations such as the elderly, minorities, economically disadvantaged, and individuals with concurrent disease. More studies aimed at manipulating the environment to increase physical activity need to be tested over periods of one year or longer. It is possible that lifestyle interventions could be integrated and delivered by new technologies such as interactive computer-mediated programs, telephone, or computer web-based formats. All of these recommended approaches should utilize valid and reliable measures of physical activity and should examine the health effects, particularly on a longitudinal basis. Basic dose-response studies in controlled settings also are needed to help us understand the health effects of accumulated moderate intensity activity.

Adult↗
PubMed1999

REACT theory-based intervention to reduce treatment-seeking delay for acute myocardial infarction. Rapid Early Action for Coronary Treatment.

Coronary heart disease (CHD) remains the leading cause of mortality in the U.S. Innovations in reperfusion therapies can potentially reduce CHD morbidity and mortality associated with acute myocardial infarction (AMI) when treatment is initiated within the first few hours of symptom onset. However, delay in seeking treatment for AMI is unacceptably lengthy, resulting in most patients being ineligible for reperfusion therapies. The Rapid Early Action for Coronary Treatment (REACT) Trial is a four-year, 20-community, randomized trial to design and test the effectiveness of a multi-component intervention to reduce patient delay for hospital care-seeking for AMI symptoms. This manuscript describes the development and content of the theoretically-based REACT intervention and summarizes: (1) the research literature used to inform the intervention; (2) the behavioral theories used to guide the development, implementation, and evaluation of the intervention; (3) the formative research undertaken to understand better decision-making processes as well as barriers and facilitators to seeking medical care as perceived by AMI patients, their families, and medical professionals; (4) the intervention design issues that were addressed; (5) the synthesis of data sources in developing the core message content; (6) the conceptualization for determining the intervention target audiences and associated intervention components and strategies, their integration with guiding theoretical approaches and implementation theories for the study, and a description of major intervention materials developed to implement the intervention; and (7) the focus of the outcome, impact, and process measurement based on the intervention components and theories on which they were developed.

Female↗
PubMed2003

A randomized controlled trial of an educational intervention to improve phosphate levels in hemodialysis patients.

OBJECTIVE: To determine the effect of a dietetic educational intervention on phosphate and calcium levels of hemodialysis patients. DESIGN: Parallel-group randomized controlled trial. SETTING: Teaching hospital hemodialysis unit in London, England. PATIENTS: Fifty-six stable adult hemodialysis patients with hyperphosphatemia. INTERVENTION: An educational intervention and one-to-one teaching session given by a renal dietitian, attempting to improve patients' knowledge of phosphate management and their compliance with diet and medication. OUTCOME MEASUREMENT: Patients' serum phosphate, calcium, and calcium x phosphate products in the 3 months after the intervention, compared with those before the intervention. Results were also compared with a control group that had not undergone the intervention. RESULTS: In the intervention group, serum phosphate was significantly reduced after the education session, as compared with the results previously. In the control group, there was no significant change in serum phosphate level. The improved results were sustained over a period of 3 months. Serum calcium increased in the intervention group, but this result was not significant. There was an improvement in the calcium-phosphate product in the intervention group, but again this was not significant. CONCLUSION: Dietetic educational intervention can favorably alter patients' serum phosphate levels, with potential impact on morbidity and mortality.

Adult↗
PubMed2002

Percutaneous coronary intervention versus medical therapy for coronary allograft vasculopathy. One center's experience.

BACKGROUND: Coronary allograft vasculopathy, a rapidly progressive form of atherosclerosis, remains the limiting factor in the long-term survival of heart transplant recipients. Some centers have attempted percutaneous coronary intervention to slow the disease process and thereby reduce mortality in these patients, but long-term follow-up data are scarce. We compared clinical outcomes in heart transplant recipients with coronary allograft vasculopathy who were treated either with percutaneous coronary intervention or with aggressive medical therapy alone. METHODS: A retrospective analysis of all heart transplant recipients at our institution who underwent surveillance coronary angiography for coronary allograft vasculopathy between 1995 and 2000 was performed. Patients with coronary allograft vasculopathy were stratified according to whether they received medical therapy or percutaneous coronary intervention. Baseline demographics, results of re-vascularization procedures and outcomes were analyzed. RESULTS: From 1995 to 2000, 301 patients underwent 602 coronary angiograms. Of the 79 patients who had angiographic evidence of coronary allograft vasculopathy, 53 were treated with aggressive medical therapy, while 26 underwent percutaneous coronary intervention in addition to aggressive medical therapy. At baseline, patients treated with aggressive medical therapy tended to be younger (54.6 +/- 13.8 years) than patients treated with percutaneous coronary intervention (62.6 +/- 7.6 years; p = 0.0079). Ejection fraction at time of diagnosis of coronary allograft vasculopathy was similar for both groups (medical therapy group, 44.4 +/- 13.4% vs percutaneous coronary intervention group, 47.2 +/- 12.7%; p = 0.38). In our cohort, heart transplant recipients with coronary allograft vasculopathy demonstrated greater mortality than heart transplant recipients without coronary allograft vasculopathy (p = 0.016). Patients who underwent percutaneous coronary intervention had a 60% re-stenosis rate at 6 months if they were treated with coronary angioplasty and an 18% re-stenosis rate if they received a coronary stent. Kaplan-Meier analysis showed no significant difference in survival in either treatment group at 1 year (80% for medical therapy group vs 95% for percutaneous coronary intervention group) or 3 years (68% for medical therapy group vs 79% for percutaneous coronary intervention group) after the angiographic diagnosis of coronary allograft vasculopathy. CONCLUSION: In this non-randomized trial, heart transplant recipients with coronary allograft vasculopathy were less likely to survive than patients without it. In addition, we found no statistical difference in mortality in heart transplant recipients with coronary allograft vasculopathy, regardless of whether they received percutaneous coronary intervention or aggressive medical therapy alone.

Aged↗
PubMedDate not supplied

Intervention assessment in an Indian health service pharmacy.

OBJECTIVE: To document and evaluate pharmacists' interventions in a setting that has complete and immediate access to patient information. DESIGN: Descriptive report evaluating self-reported interventions made by pharmacists during the conduct of routine dispensing activities. The data collection period was from February 15 to April 1, 1994. SETTING: Ambulatory care facility offering medical and dental care to high school residents, Native Americans, and Alaska Natives in Northwestern Oregon. MAIN OUTCOME MEASURES: Intervention rate per 100 new prescriptions dispensed. Each intervention was evaluated with regard to the information used to initiate it, when during the dispensing process it was initiated, and the intervention type. Outside evaluators determined the clinical significance of the interventions, including potential adverse health consequences, the likelihood of their occurrence, and the level of medical care that would have been required to treat the problem. RESULTS: Of 2,535 orders screened, 104 interventions (4.1%) were collected; 71% of these occurred during chart screening. Pharmacists most often used the medication order itself (60.6%) to detect prescribing problems, followed by other records in the patient's chart (29.8%). Outside evaluators identified 47.1% of the 104 interventions as clinically significant. The most common adverse health consequence prevented was inadequate control of the patient's condition. Outside evaluators also found that the most common level of corrective care that would have been needed if the intervention had not occurred, was a scheduled physician office visit (59.2%). CONCLUSION: This information suggests that pharmacists who have access to patient information may intervene at higher rates and that more of their interventions may be deemed clinically significant. However, larger, double-blinded, case-controlled studies are needed to definitively draw these conclusions.

Community Pharmacy Services↗
PubMed2005

Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis.

Many studies have reported the results of interventions to reduce illness through improvements in drinking water, sanitation facilities, and hygiene practices in less developed countries. There has, however, been no formal systematic review and meta-analysis comparing the evidence of the relative effectiveness of these interventions. We developed a comprehensive search strategy designed to identify all peer-reviewed articles, in any language, that presented water, sanitation, or hygiene interventions. We examined only those articles with specific measurement of diarrhoea morbidity as a health outcome in non-outbreak conditions. We screened the titles and, where necessary, the abstracts of 2120 publications. 46 studies were judged to contain relevant evidence and were reviewed in detail. Data were extracted from these studies and pooled by meta-analysis to provide summary estimates of the effectiveness of each type of intervention. All of the interventions studied were found to reduce significantly the risks of diarrhoeal illness. Most of the interventions had a similar degree of impact on diarrhoeal illness, with the relative risk estimates from the overall meta-analyses ranging between 0.63 and 0.75. The results generally agree with those from previous reviews, but water quality interventions (point-of-use water treatment) were found to be more effective than previously thought, and multiple interventions (consisting of combined water, sanitation, and hygiene measures) were not more effective than interventions with a single focus. There is some evidence of publication bias in the findings from the hygiene and water treatment interventions.

Child↗
PubMed2006

Helping caregivers of persons with dementia: which interventions work and how large are their effects?

BACKGROUND: In recent years, many different forms of interventions for caregivers of people with dementia have been developed. However, their results have been, in part, inconclusive. METHODS: Meta-analysis was used to integrate the results of 127 intervention studies with dementia caregivers published or presented between 1982 and 2005. RESULTS: Interventions had, on average, significant but small effects on burden, depression, subjective well-being, ability/knowledge and symptoms of care recipient. Only multicomponent interventions reduced the risk for institutionalization. Psychoeducational interventions that require active participation of caregivers had the broadest effects. Effects of cognitive-behavioral therapy, support, counseling, daycare, training of care recipient, and multicomponent interventions were domain specific. The effect sizes varied by study characteristics, such as caregiver gender and year of publication. CONCLUSIONS: Because most interventions have domain-specific outcomes, clinicians must tailor interventions according to the specific needs of the individual caregivers. Although more recent interventions showed stronger effects, there is room for further improvements in interventions.

Aged↗
PubMedDate not supplied

[Benefits and difficulties in implementing family psychoeducational interventions for schizophrenia in mental health services: results from a multicentre Italian study].

AIMS: This study aims to explore: a) the feasibility of psycho-educational interventions for families of users with schizophrenia in clinical practice by trained staff; b) the benefits and problems encountered by professionals in the use of these interventions. METHODS: 46 professionals from 23 Italian Mental Health Services (MHS) attended at a three-module training course in psycho-educational interventions and four supervisions in the subsequent year. Following the course, participants provided the intervention to families of users with schizophrenia. The difficulties and benefits encountered by trainees to use the intervention were registered on the Famnily Intervention Schedule. RESULTS: 83% of the participants completed the training course. Following the course, the intervention started in 71 families from 17 MHS. 76% of trainees provided the intervention to 2-5 families, while 13% of them only held informative sessions on schizophrenia. During the supervision period, the organisational difficulties experienced by the professionals were stable, while the benefits increased. Differences in benefits and difficulties were detected in relation to the trainees' experience and professional roles. CONCLUSIONS: It is possible to introduce psycho-educational interventions in MHS after a relatively brief period of training and supervision of the staff. Organisational difficulties need to be addressed to increase the dissemination of these interventions on a large scale.

Adult↗
PubMed2001

A method for estimating time dependent intervention benefits under arbitrarily varying age and exogenous components of hazard.

A method for estimating the dependence of intrinsic intervention benefits on time elapsed since the intervention took place is proposed. The method is aimed at intervention programs against diseases where one or all of the following components of hazard intensity may undergo important and unknown variations: 1) the intervention benefits to a subject are a function of the time elapsed since the intervention took place, or since inception for a continuing treatment, 2) the subjects vulnerability is an unknown function of their age, 3) the exogenous or environmental baseline intensity, to which all are assumed subjected, fluctuates arbitrarily with calendar time. During the time span of a study, these variables interact in a complex way, possibly masking the real contribution of the intervention. However, with very general assumptions about how hazard components interact, the cumulative hazards of subpopulations treated at different times in the past are shown to be described mathematically by a convolution of the time elapsed dependent intervention benefit function with the age and calendar time dependent baseline intensity. Starting from the cumulative hazards of untreated and treated subpopulations that had the intervention at different times in the past, a method of deconvolution through regularization is proposed to reconstruct the time elapsed dependence of the intervention benefit function. The regularization technique used is of the 'penalized least square smoothing' type, it is applied to the solution of Volterra integral equations of the first kind under noisy inputs. Simulations, to test for the reconstruction of different modes of time elapsed variation of the intervention benefits, are carried out on realistically noisy 'data sets' taken to be available at a limited number of time points. The stability of the estimated reconstructions, to measurement errors, is examined through repeated simulations with random noise added to inputs. The method is applied to a Brazilian data set where BCG vaccination resulted in a small reduction in the cumulated risk of leprosy infection.

BCG Vaccine↗
PubMed2006

Follow-up of diet and cardiovascular risk factors 20 years after cessation of intervention in the Oslo Diet and Antismoking Study.

OBJECTIVE: The Oslo Diet and Antismoking study was a 5-year randomised trial initiated in 1972-1973, which studied the effect of dietary change and smoking cessation for the prevention of coronary heart disease among high-risk middle-aged men. To test the long-term maintenance of lifestyle change, we examined diet and cardiovascular risk factors in subjects initially randomised to the control and intervention groups 20 years after cessation of the intervention. SUBJECTS AND DESIGN: Of the original cohort that included 1232 participants, 910 survivors were identified in 1997 and cardiovascular risk factors were measured in 563 (62%) in 1997-1999. Of these, 558 (99%) also completed questionnaires about their food intake and attitudes to health and diet. RESULTS: Cigarette smoking was nearly halved between baseline and 20-year follow-up in each of the intervention and control groups (P<0.001 within groups), but did not differ between the intervention group (39%) versus the control group (34%); P=0.07. Body mass index increased by 1.4+/-2.6 and 1.6+/-2.6 kg/m(2) between baseline and 20-year follow-up in the intervention and control groups, respectively (P<0.001 within groups; NS between groups). Serum total cholesterol and triglyceride concentrations decreased substantially in subjects treated or untreated with statins (P<0.001 within the intervention and control groups) but did not differ between the groups (total cholesterol change of -1.4+/-1.3 and -1.3+/-1.2 mmol/l, respectively, and triglyceride change of -0.5+/-1.0 mmol/l in both groups). Men in the intervention group reported a less atherogenic fat quality score and lower intakes of fat, saturated fat and cholesterol, higher intakes of long chain polyunsaturated fatty acids, protein and beta-carotene and greater attention to lifestyle and change of diet than the control group (all P<0.05). The fatty acid concentrations did not differ, however, between the intervention and control groups (P>0.05). CONCLUSIONS: No long-term differences in smoking rates or lipid concentrations between the intervention and control groups were observed in the surviving attendees two decades after the end of the trial. Lifestyle intervention still influenced the dietary intake, though modestly.

Aged↗
PubMed2005

Phonological awareness intervention and the acquisition of literacy skills in children from deprived social backgrounds.

PURPOSE: This study examined the effect of phonological awareness intervention that focused on syllable and rhyme awareness on the acquisition of literacy and the development of phonological awareness skills 2 years post intervention. The longitudinal study compared two groups of children from deprived socioeconomic backgrounds in the United Kingdom. One group received a program of phonological awareness intervention and one did not. METHOD: Ninety-nine children received a 9-week program of phonological awareness intervention in the summer term of their final preschool year. These children were then assessed on measures of phonological awareness and language in the first term of their first year at school (M age = 4;7 [years; months]) and again 2 years later (M age = 6;8) on measures of phonological awareness and literacy. One year earlier, a control group of 114 children from the same schools were also assessed at these two points in their schooling on the same measures. This group did not receive any phonological awareness intervention. RESULTS: At the second assessment, the group of children who received phonological awareness intervention performed better than those children who received no intervention (control group) on rhyme awareness and nonword spelling. Surprisingly, however, the control group performed better than the children who had received intervention on the phoneme segmentation task. CONCLUSION: The phonological awareness intervention that was implemented, which focused on enhancing syllable and rhyme awareness, had little effect on later literacy development and may have interfered with the acquisition of phoneme awareness. Implications for intervention with children from deprived socioeconomic backgrounds are discussed in the context of current research.

Awareness↗
PubMed1998

An outcome evaluation of a hospital-based early intervention program.

AIM: To determine the effectiveness of the Health Care Intervention Service (HIS), an early intervention program for general hospital patients with alcohol dependence or at risk for alcohol dependence. DESIGN, SETTING AND PARTICIPANTS: HIS consists of screening, assessment and assignment to either full or risk-reduction intervention. Full intervention includes a referral to treatment. Outcomes were compared across three groups: those who received a full intervention, those who received a risk-reduction intervention, and a comparison group of similar patients from hospitals with no HIS program. Patients were screened for alcohol involvement and interviewed during their hospitalization (prior to the intervention in HIS hospitals) and again 6 months following the intervention. FINDINGS: Full intervention was effective in increasing the probability of abstinence, reducing the number of heavy drinking days, and encouraging patients to accept the referral to treatment. Risk-reduction intervention was effective in reducing alcohol consumption and consequences, but only for those patients who had some signs of dependence at the first interview. CONCLUSIONS: HIS has demonstrated its effectiveness in a "real world" bureaucratic and clinical environment.

Adult↗
PubMed2001

Randomized controlled trial of a midwife-delivered brief smoking cessation intervention in pregnancy.

OBJECTIVE: To evaluate the efficacy of a brief smoking cessation intervention with pregnant women practicable routinely by midwives. DESIGN: Midwives were randomized to deliver the experimental intervention or usual care. The 10-15-minute intervention was based on brief counselling, written materials, arrangements for continuing self-help support and feedback on expired-air carbon monoxide levels. The intervention was tailored to the women's needs: those who did not want to stop smoking received a brief motivational intervention, those who wanted to stop received an intervention designed to assist them and those that had stopped recently (recent ex-smokers) received a relapse prevention intervention. SETTING: Booking interviews with pregnant women in nine hospital and community trusts. SUBJECTS: A total of 1120 pregnant women in the third month of pregnancy (249 recent ex-smokers and 871 current smokers). MAIN OUTCOME MEASURES: Three indicators of biochemically validated abstinence were collected. Continuous abstinence for at least 3 months prior to delivery, point prevalence abstinence immediately post-delivery, and continuous abstinence from 3 months pre-delivery to 6 months post-delivery. RESULTS: Only a small proportion of the women who would have been eligible to take part in the trial were actually recruited by 178 recruiting midwives, with lack of time being cited as the main barrier. The intervention and usual care groups differed in post-delivery point prevalence abstinence rates for recent ex-smokers (65% vs. 53%, p < 0.05, one-tailed), but not in other outcome measures. Overall, 54% of "recent ex-smokers" at booking and 7% of "current smokers" at booking had been abstinent for at least 3 months at the time of delivery, and 23% and 3%, respectively, were still abstinent by the time the child was 6 months old (i.e. 12 months post-intervention). Smoking status at follow-up was predicted by dependence indexed by time to first cigarette in the morning. CONCLUSIONS: A brief "one-off" smoking cessation intervention by midwives does not seem to be a practicable or effective method of helping pregnant smokers to stop. Other options such as tailored self-help materials and telephone counselling and other specialist treatments should be examined. Current smoking cessation rates in pregnancy are very low.

Birth Weight↗
PubMed1997

A prospective analysis of clinical pharmacy interventions on an acute psychiatric inpatient unit.

A standardized data collection form was developed to enable uniform documentation of all clinical pharmacy interventions undertaken for an acute-care, psychiatric inpatient population during a 6-month study period. This information included demographic data as well as details of the drugs involved, the nature of the drug-related problems, the type of intervention and an estimate of the significance of the intervention. A total of 204 clinical interventions were proposed for 69 patients (mean age 66.8 years, range 28-85 years). The proposed interventions were accepted by medical staff in 187 (91.7%) instances. Antidepressants were the class of drug most often generating clinical interventions (34.7% of total interventions). The most common type of intervention was a recommendation for the commencement of drug therapy (28.8%), followed by recommendations for enhanced patient monitoring (23.5%). In 20.3% of cases the interventions were estimated to be of major significance. This study suggests that the provision of clinical pharmacy services in the acute-care, adult, psychiatric setting has the potential to generate a considerable range of interventions aimed at optimizing treatment outcomes.

Adult↗