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PubMed2005

Potential significance of spontaneous and interventional ST-changes in patients transferred for primary percutaneous coronary intervention: observations from the ST-MONitoring in Acute Myocardial Infarction study (The MONAMI study).

AIMS: In patients with ST-elevation myocardial infarction (STEMI) scheduled for primary percutaneous coronary intervention (primary PCI), acute risk-assessment may be valuable for tailoring of adjunctive therapy at the time of coronary intervention. The present study was designed to quantify pre-, per-, and post-interventional ST-changes, to evaluate whether a pre-specified continuous ST-monitoring classification provides potential prognostic information in the pre- and per-interventional phase, and to compare post-interventional ST-resolution parameters derived from continuous ST-monitoring and snapshot ECGs, respectively. METHODS AND RESULTS: In 92 STEMI patients, continuous ST-monitoring was initiated in the pre-hospital phase and continued during and 90 min following PCI. Patients were divided into three groups: (A) patients achieving spontaneous ST-resolution before PCI; (B) patients with preserved ST-elevation immediately before PCI and with no increase in ST-elevation during PCI; and (C) patients with preserved ST-elevation immediately before PCI and with increase in ST-elevation during PCI. Groups A (n=22), B (n=43), and C (n=27) differed in peak level of troponin-T (1.4, 4.7, and 7.2 microg/L, P<0.001), creatinine kinase MB isoenzyme (35, 150, and 325 microg/L, P<0.001), and N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) (183, 175, and 269 pmol/L, P=0.084) during admission, and left ventricular ejection fraction evaluated within 2 h of PCI (0.53, 0.48, and 0.45, P=0.047) and after 3 months (0.58, 0.54, and 0.45, P<0.001). Groups B and C also differed in time from first balloon inflation to > or =70% resolution of ST-elevation (14 vs. 42 min, P=0.002), whereas no differences were observed in traditional 90 min ST-resolution analysis or angiographically assessed parameters. CONCLUSION: STEMI patients transferred for primary PCI are heterogeneous with respect to pre- and per-interventional ST-changes, and a pre-specified ST-monitoring classification seems useful for stratification of patients at time of PCI into groups with low, intermediate, and high risk profile. Furthermore, post-interventional ST-monitoring indicates that traditional 90 min ST-resolution analysis may have limited value in the era of primary PCI.

Aged↗
PubMed2000

Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention.

Funding organizations increasingly want to know that successful interventions are continued after the end of a research project. Assessments of durability are rare and where done do not include the comparison communities. In this study we ascertain what tobacco control activities continued in intervention communities involved in the Community Intervention Trial for Smoking Cessation (COMMIT), a randomized, controlled community trial aimed at adult smokers, and also assessed level of tobacco control activities in the comparison communities. A mailed survey of key informants including paid staff and community volunteers in the 22 COMMIT communities was conducted. Approximately 79% of key informants responded to the survey. Although there was evidence that tobacco control activities were continuing in the intervention communities, there was an equal amount of tobacco control effort in the comparison communities. Within the specific tobacco control intervention areas, only the youth area showed more activity in intervention communities than comparison communities. We conclude that despite a positive trial outcome, differential durability was not achieved. More work needs to be done to assist communities in maintaining proven intervention activities. More study of methods to measure durability is also needed.

Adult↗
PubMed1994

The efficacy of multiple risk factor intervention in treated hypertensive men during long-term follow up. Risk Factor Intervention Study Group.

OBJECTIVE: To examine the feasibility and efficacy of a multifactorial intervention programme directed towards hypercholesterolaemia, smoking, and diabetes mellitus in treated hypertensive patients after more than 3 years' follow-up and to describe the incidence of cardiovascular complications. DESIGN: Open, randomized, parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care. SETTING: Outpatient clinic in a city hospital. PATIENTS: A total of 508 male patients with treated hypertension, aged 50-72 years, with at least one of the following: serum cholesterol > or = 6.5 mmol L-1, smoking or diabetes mellitus. INTERVENTION: Individually given advice and group meetings based on nutritional advice and behavioral treatment principles. Drug therapy could be instituted to achieve the treatment goals in the intervention group: serum total cholesterol below 6.0 mmol L-1, no smoking, and HbA1c below 6.0%. Diastolic blood pressure below 90 mmHg was the treatment goal in both groups. MAIN OUTCOME MEASUREMENTS: Serum cholesterol, HbA1c, diastolic blood pressure, smoking. Cardiovascular end-points were recorded. RESULTS: The net changes were (change intervention--change usual care): serum cholesterol -5.0% (95% confidence interval, -7.6 to -2.3%), 17.6% more stopped smoking (P = 0.04); diastolic blood pressure and HbA1c remained unchanged. The incidence of stroke was lower in the intervention group compared with the usual-care group: 2.0 and 6.7%, respectively (P = 0.017). CONCLUSION: The intervention programme was comparatively successful with regards to the effects on hypercholesterolaemia and smoking habits. An unexpected decrease in the stroke incidence was observed in the intervention group compared with the usual-care group.

Aged↗
PubMedDate not supplied

Mapping nursing interventions from a hospital information system to the Nursing Interventions Classification (NIC).

TOPIC: Using the Nursing Interventions Classifications (NIC) as a standard to classify interventions identified in a hospital intervention system. SOURCES: Literature and the authors experience with standardized data systems for nursing. PURPOSE: To describe the processes used and the issues that arose as interventions from a hospital nursing information system were mapped to interventions in the NIC. CONCLUSIONS: The NIC provided a standard for the classification of nursing interventions from a hospital information system resulting in data that could be compared across sites. Ongoing testing of nursing intervention classifications is recommended.

Databases, Factual↗
PubMed2006

PREMIER--a trial of lifestyle interventions for blood pressure control: intervention design and rationale.

Interventions encouraging adoption of healthy diets and increased physical activity are needed to achieve national goals for preventing and treating hypertension, cardiovascular disease, diabetes, and other chronic diseases. PREMIER was a multicenter clinical trial testing the effects of two lifestyle interventions on blood pressure control, compared with advice only. Both interventions implemented established national guidelines for blood pressure control (weight loss, reduced sodium and alcohol intake, and increased physical activity), and one intervention also included the Dietary Approaches to Stop Hypertension (DASH) diet. Both interventions focused on behavioral self-management, motivational enhancement, and personalized feedback. This article describes the design and evaluation approaches for these interventions. Evaluation of multicomponent lifestyle change interventions can help us understand the benefits and difficulties of making multiple lifestyle changes concurrently and the effects such changes can have on blood pressure, particularly in minorities at higher risk for hypertension.

Adult↗
PubMed2005

Why modelling a complex intervention is an important precursor to trial design: lessons from studying an intervention to reduce falls-related injuries in older people.

OBJECTIVES: To develop a cost-effectiveness model of a complex intervention from pilot study data in order to inform the viability and design of a subsequent falls prevention trial. METHODS: We used two models; the first estimated the probability of falling over a 12-month period based on a probability tree; the second used Markov simulation to assess the impact of the programme over time. RESULTS: The first model indicated that our intervention would reduce the proportion falling by only 2.8% over a 12-month period. The major reason for this small effect was that less than a quarter of older people at risk of falling were assessed using our screening tool. Even if policy-makers were willing to spend 30,000 pounds per quality-adjusted life-year gained, there is only a 40% chance that the intervention would be cost-effective. Sensitivity analyses showed that the only scenarios that produced a substantial increase in the effect of the intervention were those in which all older people are assessed. CONCLUSIONS: The model-building approach described in this paper is vital when designing complex trials and where a trial is not possible. Information from the modelling can be used to re-design the intervention. The effectiveness of our proposed intervention appears very small due to its inability to reach those at risk of falling. It is most likely not to be cost-effective. If inability to reach the target group is a weakness common to other similar interventions, this suggests an area for further research.

Accidental Falls↗
PubMed2006

Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women.

The Centers for Disease Control and Prevention (CDC) currently promotes an HIV prevention intervention for young adult African American women, known as SISTA, through the Diffusion of Effective Behavioral Interventions (DEBI) program. Nationally, more than 700 agencies have completed a 1-week CDC-funded training to implement SISTA. Agencies that have been trained in SISTA are also eligible to receive training in a newly published HIV prevention intervention for African American adolescent females, known as SiHLE (Sistering, Informing, Healing, Living, and Empowering), as well as to receive training in a newly published prevention intervention for women living with HIV, known as WiLLOW (Women Involved in Life Learning From Other Women). All three of these HIV prevention interventions, target African American females, are designed to reduce HIV sexual risk behaviors and share similar theoretical, core, and methodological elements. The diffusion of innovation paradigm suggests that if potential adopters perceive one innovation as being closely related to another innovation, it may be useful to promote a cluster of innovations, rather than to treat each new innovation separately. This article examines how promotion of a suite of HIV interventions for African American females may facilitate adoption of the three evidence-based HIV interventions for this population.

Adult↗
PubMed1995

Community Intervention Trial for Smoking Cessation (COMMIT): I. cohort results from a four-year community intervention.

OBJECTIVES: The primary hypothesis of COMMIT (Community Intervention Trial for Smoking Cessation) was that a community-level, multi-channel, 4-year intervention would increase quit rates among cigarette smokers, with heavy smokers (> or = 25 cigarettes per day) of priority. METHODS: One community within each of 11 matched community pairs (10 in the United States, 1 in Canada) was randomly assigned to intervention. Endpoint cohorts totaling 10,019 heavy smokers and 10,328 light-to-moderate smokers were followed by telephone. RESULTS: The mean heavy smoker quit rate (i.e., the fraction of cohort members who had achieved and maintained cessation at the end of the trial) was 0.180 for intervention communities versus 0.187 for comparison communities, a nonsignificant difference (one-sided P = .68 by permutation test; 90% test-based confidence interval (CI) for the difference = -0.031, 0.019). For light-to-moderate smokers, corresponding quit rates were 0.306 and 0.275; this difference was significant (P = .004; 90% CI = 0.014, 0.047). Smokers in intervention communities had greater perceived exposure to smoking control activities, which correlated with outcome only for light-to-moderate smokers. CONCLUSIONS: The impact of this community-based intervention on light-to-moderate smokers, although modest, has public health importance. This intervention did not increase quit rates of heavy smokers; reaching them may require new clinical programs and policy changes.

Adult↗
PubMed1998

[A dialectic reflection on the psychotherapeutic efficacy of nursing interventions. 1. Nursing interventions and effectiveness of psychotherapy].

The following essay raises the question whether nursing interventions have any psychotherapeutic effects. The first part describes a framework for nursing interventions in terms of I. King's nursing theory, particularly the process of goal-achievement. The humanistic thoughts and views of Patterson, Zderad & Watson have also been taken into account; in order to examine the question of effectiveness of psychotherapeutic intervention the scientific studies of K. Grawe, R. Donati & F. Bernauer as well as those of V. Tschuschke & D. Czogalik are discussed. Particular attention has been paid to the so-called non-specific factors with regard to the effectiveness of interventions and shows how they might be applied to the initial question. The second part combines the non-specific factors related to the effectiveness of psychotherapy with the way in which nursing interventions work and a model relevant to the different levels of nursing interventions is put forward. From this synthesis it can be said that nursing interventions do possess psychotherapeutic effectiveness. The article concludes with the necessary consequences for training and continuing education in nursing management.

Education, Nursing, Continuing↗
PubMed2003

Interventional or semi-interventional treatment for Budd-Chiari syndrome.

OBJECTIVE: Report the results of interventional or semi-interventional techniques for 173 patients with Budd-Chiari syndrome. METHOD: This group included 120 males and 53 females. The pathologic lesions composed of localized complete occlusion of inferior vena cava (IVC) (78), IVC stenosis (49), IVC membrane with a hole (37), membrane of hepatic vein (HV) (3), IVC thrombosis (4), IVC membrane with thrombosis (2) and IVC lesion with occlusion of HV (32). Treatment methods included that I: Percutaneous transinferior vena cava angioplasty (PTA) (76); II: IVC PTA with stent (59); III: Percutaneous transhepatic vein recanalization (3); IV: IVC thrombolysis through a catheter (4), V: Combined transcardiac and transfemoral venous membranotomy and balloon dilation (22); VI: V and stent (17); VII: Stenting during radical surgery (3); VIII: Additional operation after intervention (23). RESULTS: The immediate technique success rate for intervention was 90.1%, for the semi-intervention was 100%. The IVC pressure was reduced from 3 to 29 cmH2O. Complications occurred in 8 cases. The death rate was 2.9%. A follow-up study showed the recurrence rates were 14.5% in IVC PTA group, 1.7% in IVC PTA with stent, 18.2% in combined technique without stent and no recurrence was found in other groups. CONCLUSION: The PTA is the first choice for localized lesions. When elastic recoil occurs, immediate stenting is suggested. The semi-interventional approach is advised for PTA failure and more complicated cases. For those with both IVC lesion and occlusion of HV, the additional operation is needed after IVC intervention.

Adolescent↗
PubMed1995

A comparison of nursing intervention classification and current procedural terminology codes for representing nursing interventions in HIV disease.

The purpose of this study was twofold: 1) to compare the ability of terms from the nursing intervention classification and from the current procedural terminology to represent the clinical terms used by nurses and patients to describe nursing interventions during hospitalization; and 2) to identify the strengths and weaknesses of the two classification systems for representing nursing systems. More NIC than CPT codes matched the concepts in the clinical terms used by nurses and patients to describe nursing interventions demonstrating, not unexpectedly, that NIC represents a broader scope of nursing practice. The major difficulty encountered using NIC was the lack of mutual exclusiveness of the nursing activities within the interventions. CPT codes were easy to apply to the clinical terms, but were limited in scope for nursing practice. The findings of this study demonstrate the necessity of using a nursing-specific classification system for the representation of nursing interventions. This is of particular importance for databases that will be used to examine the effectiveness of healthcare interventions and for databases related to reimbursement for healthcare interventions.

Databases, Factual↗
PubMed2006

A propensity score analysis of brief worksite crisis interventions after the World Trade Center disaster: implications for intervention and research.

BACKGROUND: Postdisaster crisis interventions have been viewed by some as appropriate to enhance the mental health status of persons affected by large-scale traumatic events. However, studies and systematic reviews have challenged the effectiveness of these efforts. OBJECTIVES: The focus of this study was to examine the impact of brief mental health interventions received by employees at the worksite after the World Trade Center disaster (WTCD) among workers in New York City (NYC). RESEARCH DESIGN: The data for the present study come from a prospective cohort study of 1121 employed adults interviewed by telephone in a household survey 1 year and 2 years after the WTCD. All study participants were living in NYC at the time of the attacks. For the current study, we used propensity scores to match intervention cases (n = 150) to nonintervention controls (n = 971) using a 1:5 matching ratio based on a bias-corrected nearest-neighbor algorithm. RESULTS: Approximately 7% of NYC adults (approximately 425,000 persons) reported receiving employer-sponsored, worksite crisis interventions related to the WTCD provided by mental health professionals. In addition, analyses indicated that attending 1 to 3 brief worksite sessions was associated with positive outcomes up to 2 years after the WTCD across a spectrum of results, including reduced alcohol dependence, binge drinking, depression, PTSD severity, and reduced anxiety symptoms. CONCLUSIONS: Although our study had limitations, it is one of the few to suggest that brief postdisaster crisis interventions may be effective for employees after mass exposure to psychologically traumatic events. The reasons for the effectiveness of these interventions are unclear at this time and warrant further investigation.

Adult↗
PubMed2000

Five principles of crisis intervention: reducing the risk of premature crisis intervention.

Crisis intervention, as it has evolved over the last five decades, has clearly demonstrated its effectiveness as a tool to reduce human distress. Nevertheless, as with any effort to alter human behavior, there are risks associated with crisis intervention. One such risk is that of premature intervention. Premature intervention may not only waste valuable intervention resources, but may serve to interfere with the natural recovery mechanisms of some victims. By clearly defining the nature of the crisis phenomenon itself, premature intervention may be averted.

Crisis Intervention↗
PubMed2000

Interventions for nausea and vomiting in early pregnancy.

BACKGROUND: Nausea and vomiting are the most common symptoms experienced in early pregnancy, with nausea affecting between 70 and 85% of women. About half of pregnant women experience vomiting. OBJECTIVES: The objective of this review was to assess the effects of different methods of treating nausea and vomiting in early pregnancy. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group trials register and the Cochrane Controlled Trials Register. SELECTION CRITERIA: Randomised trials of any treatment for nausea and/or vomiting in early pregnancy. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data were extracted independently by two reviewers. MAIN RESULTS: Twenty trials were included. These trials were of variable quality. Nausea treatments were different anti-histamine medications, vitamin B6 (pyridoxine), the combination tablet Debendox (Bendectin) and P6 acupressure. For hyperemesis gravidarum two trials were identified using treatments with ginger root and ACTH (adrenocorticotropic hormone) injections. Based on 13 trials, there was an overall reduction in nausea from anti-emetic medication (odds ratio 0.17, 95% confidence interval 0. 13 to 0.21). REVIEWER'S CONCLUSIONS: Anti-emetic medication appears to reduce the frequency of nausea in early pregnancy. There is some evidence of adverse effects, but there is very little information on effects on fetal outcomes. Of newer treatments, pyridoxine (vitamin B6) appears to be more effective in reducing the severity of nausea. The results from trials of P6 acupressure are equivocal. The results of the trial using adrenocorticotropic hormone to treat hyperemesis gravidarum show no evidence of benefit. Ginger may be of benefit, but the evidence so far is weak.

Antiemetics↗
PubMed2000

Interventions for treating trichomoniasis in women.

OBJECTIVES: Around 120 million women worldwide suffer from Trichomonas vaginalis vaginitis every year. The infection is sexually transmitted and is believed to facilitate HIV transmission. The objective of the review is to assess the effects of various treatment strategies for trichomoniasis in women. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE, and EMBASE. Trials were also identified from reference lists of reviews, through pharmaceutical companies, and by informal discovery. Only published data were used in this review. Date of the most recent search: May, 1999. SELECTION CRITERIA: Randomized or quasi-randomized trials in women with trichomoniasis of different treatment strategies, different antitrichomonal drugs or doses were eligible. DATA COLLECTION AND ANALYSIS: Trial quality was assessed and data extracted by two reviewers independently using standard criteria. MAIN RESULTS: Fifty-two trials were included. Nitroimidazoles seem to be effective in achieving parasitological cure in the short term follow-ups. Partner treatment can be effective in decreasing longer term re-infection rates. REVIEWER'S CONCLUSIONS: Parasitological cure can be achieved by single oral dose of nitroimidazoles. Further research should focus on developing effective partner treatment strategies to prevent re-infections and reduce trichomoniasis prevalence.

Animals↗
PubMed2002

Interventions for treating collagenous colitis.

BACKGROUND: Collagenous colitis is a disorder that is recognized as a cause of chronic diarrhea. Treatment has been based mainly on anecdotal evidence. This review was performed to identify therapies for collagenous colitis that have been proven in randomized trials. OBJECTIVES: To determine effective treatments for patients with clinically active collagenous colitis. SEARCH STRATEGY: Relevant papers published between 1970 and January 2002 were identified via the MEDLINE, PUBMED, and EMBASE databases. Manual searches from the references of identified papers, as well as review papers on collagenous or microscopic colitis were performed to identify additional studies. Abstracts from major gastroenterological meetings were searched to identify research submitted in abstract form only. Finally, the Cochrane Controlled Trials Register and the Cochrane Inflammatory Bowel Disease Group Specialized Trials Register were searched for other studies. SELECTION CRITERIA: Four randomized trials were identified. One trial studied bismuth subsalicylate (published in abstract form only), and 3 trials (2 published in abstract form only) studied budesonide in the therapy of collagenous colitis. DATA COLLECTION AND ANALYSIS: Data were extracted independently by each author onto 2x2 tables (treatment versus placebo and response versus no response). For therapies assessed in one trial only, p-values were derived using the chi-square test. For therapies assessed in more than one trial, summary test statistics were derived using the Peto odds ratio and 95% confidence intervals. Data were combined for analysis only if the outcomes were sufficiently similar in definition. MAIN RESULTS: There were 9 patients with collagenous colitis in the trial studying bismuth subsalicylate (nine 262 mg tablets daily for 8 weeks). Those randomized to active drug were more likely to have clinical (p=0.003) and histological (p=0.003) improvement than those assigned to placebo. A total of 86 patients were enrolled in 3 trials studying budesonide (9 mg daily for 6 to 8 weeks). The pooled odds ratio for clinical response to treatment with budesonide was 16.79 (95% CI 7.28-38.74), with a number needed to treat of 2 patients. There was significant histological improvement with treatment in all 3 trials studying budesonide therapy. REVIEWER'S CONCLUSIONS: Budesonide is effective in the treatment of collagenous colitis. The evidence for bismuth subsalicylate is weaker, but still important. The roles of these and other therapies in inducing or maintaining remission (as opposed to clinical or histological improvement) of collagenous colitis are unknown.

Anti-Inflammatory Agents↗