Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “interventions”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,081 records · Page 60Linked to original sources
PubMed2001

Can a nutrition intervention improve albumin levels among hemodialysis patients? A pilot study.

OBJECTIVE: To determine the effect of a tailored intervention on albumin levels among hemodialysis patients. DESIGN: Randomized controlled trial. SETTING: Eight freestanding chronic hemodialysis units in northeast Ohio. SUBJECTS: Eighty-three randomly selected adult patients who had been on dialysis for at least 6 months and had a mean albumin <3.7 g/dL (bromcresol green method) or <3.4 g/dL (bromcresol purple method) for the last 3 months. To better elucidate the feasibility and outcomes of the intervention, we selected more intervention than control patients. INTERVENTION: Dietitians of the 52 intervention patients determined whether any of the following potential barriers to adequate protein nutrition were present for each patient: (1) poor knowledge of protein-containing foods, (2) poor appetite, (3) needing help shopping or cooking, (4) low fluid intake, and (5) inadequate dialysis. Depending on the specific barriers present, the dietitians (1) educated patients on protein-containing foods, (2) recommended snacks for which patients had preserved appetite, (3) helped set up social supports, (4) provided recommendations on fluid intake, and/or (5) arranged for improved dialysis. Dietitians of the 31 control patients continued to provide usual care. MAIN OUTCOME MEASURES: Change in albumin after 6 months, stratified as minimal change (less than.25 g/dL increase or decrease), moderate improvement (.25 to.49 g/dL increase), and large improvement (increase of .50 g/dL or more). To examine the role of inflammatory states, we also determined serum C-reactive protein levels at the beginning and end of the trial. RESULTS: Among intervention patients, 29% had a minimal change in albumin, 44% had a moderate improvement, and 27% had a large improvement. Among control patients, 74% had a minimal change in albumin, 19% had a moderate improvement, and 6% had a large improvement (P <.001 for comparison of intervention and control subjects). About 60% of subjects had high baseline C-reactive protein levels (> 10 mg/L). However, there was little relationship between change in albumin and either baseline C-reactive protein levels or changes in C-reactive protein levels (P = .83). CONCLUSION: A nutrition intervention tailored to patient-specific barriers resulted in improved albumin levels even among patients with high C-reactive protein levels. Further work is needed to refine and test this intervention on a larger sample.

Aged↗
PubMed2001

Impact of a school-based intervention on access to healthcare for underserved youth.

PURPOSE: To determine whether a multidimensional school-based intervention, which included physical and mental health services, increased adolescents' use of needed medical care and preventive care and decreased emergency room use. METHODS: A total of 2832 seventh- through twelfth-grade students in six public urban intervention schools and 2036 students in six demographically matched comparison schools completed a previously validated survey regarding health status and healthcare utilization in spring 1998 and 1999. Bivariate analyses examined the association between intervention status and Year 1/Year 2 outcomes. The multifaceted intervention included programs such as anger management groups, substance abuse prevention, tutoring, home visits, and enhanced school health services. Stepwise multivariate logistic models tested differences between the intervention and comparison groups across years, controlling for potential confounding variables [gender, age, race/ethnicity, maternal education, grade in school, school district (city or county), health status, and chronic health problems]. The interaction term for Group x Year was used to test the effect of the intervention. Multivariable modeling was also used to determine student factors independently associated with healthcare utilization. RESULTS: Respondents had a median age of 15 years, 56% were female, 51% were white, 42% were black, and 34% reported chronic health problems. In both years, over 45% of students in both groups reported not seeking medical care they believed they needed. The proportion with missed care in the intervention schools did not change, whereas the proportion with missed care in the comparison schools increased. Emergency room use decreased slightly in the intervention schools and increased slightly in the comparison schools between Year 1 and Year 2. There were no major changes in healthcare delivery in this area during the year, demonstrating the volatility of adolescents' perceived access to care. Among the student factors, health status, having a chronic condition, and being in a higher grade were independently associated with students' report of not seeking care they believed they needed. CONCLUSION: These results confirm that many adolescents have unmet healthcare needs. Those with poor health status are most likely to report underutilization and unmet needs. These findings underscore the need for comparison groups when evaluating interventions and suggest the need for better understanding of community level changes in perceived healthcare access and use.

Adolescent↗
PubMed1997

Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review.

OBJECTIVE: (1) To review evaluations of Acquired Immunodeficiency Syndrome (AIDS) prevention interventions targeting adolescents to determine whether these efforts have been effective in reducing risk behaviors. (2) To examine the relation between intervention design issues and outcomes measures. METHOD: A systematic review of five electronic databases and hand-searches of 11 journals, were undertaken for articles published from January 1983 through November 1995 that reported evaluations of adolescent AIDS risk-reduction interventions conducted in the United States. Outcomes examined include: improved attitudes about AIDS risk and protective behaviors, increased intention to abstain from sexual intercourse or to use condoms, and reduced sexual risk behaviors. RESULTS: Forty studies that met preestablished inclusion criteria were found. For each outcome assessed, a majority of studies found a positive intervention impact (88% of studies assessing changes in knowledge; 58% changes in attitude, 60% changes in intention to use condoms, 73% in condom use, and 64% in decreasing number of sexual partners). Interventions that demonstrated an increase in intention to use a condom were significantly more likely to be theory-based than those that did not show any significant changes in intention (100% vs. 0%, p = .048). Interventions that increased condom use and decreased the number of sexual partners were longer in duration than those that did not improve these outcomes. CONCLUSIONS: AIDS risk reduction interventions can be effective in improving knowledge, attitudes, and behavioral intentions and in reducing risk practices. The positive relationship between improved outcomes and several elements of intervention design underscores the need for increased focus on intervention design in future studies.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Use of Western-based HIV risk-reduction interventions targeting adolescents in an African setting.

PURPOSE: To evaluate an intervention (based on one which had previously been successful in reducing adolescent human immunodeficiency virus (HIV) risk behaviors in the United States) among adolescents residing in Namibia, a country located in sub-Saharan Africa. METHODS: A randomized trial of a 14-session face-to-face intervention emphasizing abstinence and safer sex was conducted among 515 youth (median age 17 years; median grade 11) attending 10 secondary schools located in two districts in Namibia. Knowledge, attitudes, intentions, and HIV risk behaviors were assessed at baseline and in the immediate postintervention period. RESULTS: Knowledge increased significantly among intervention compared to control youth (88% vs. 82%; correct responses, p < .0001). At postintervention follow-up, more intervention than control youth believed that they could be intimate without having sex, could have a girlfriend or boyfriend for a long time without having sex, could explain the process of impregnation, knew how to use a condom, and could ask for condoms in a clinic. Fewer intervention than control youth believed that if a girl refused to have sex with her boyfriend it was permissible for him to strike her, and that condoms took away a boy's pleasure. More intervention than control youth anticipated using a condom when they did have sex, and fewer expected to drink alcohol. Finally, after intervention, there was a trend for increased condom use. There were significant gender-related differences at baseline, although intervention impact was generally equivalent. CONCLUSIONS: These findings provide support for the judicious adaptation of successful Western HIV prevention programs in other cultural settings. A single intervention approach appears to be effective in short-term follow-up with both genders.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Utilization patterns in an asthma intervention.

BACKGROUND: The National Cooperative Inner-City Asthma Study (NCICAS) tested a model of asthma management in which a master's degree-prepared social worker functioned as an asthma counselor. The NCICAS resulted in decreased symptom days and a trend toward fewer emergency department (ED) visits and hospital admissions in the intervention group compared with the control group. OBJECTIVE: To determine whether a real-world implementation would give similar results to the NCICAS. METHODS: Children with moderate or severe persistent asthma were enrolled in a 1-year program, the Inner-City Asthma Intervention (ICAI) program, modeled on the NCICAS. Since the program initially was not designed to be research, data were collected retrospectively. ED and hospital visits were compared 1 year before and after the intervention at 2 of the intervention sites, Children's Mercy Hospital (CMH) and Baystate Medical Center, to determine whether there was a significant change. RESULTS: Data for 93 children from CMH and 77 from Baystate were evaluated. At CMH annual ED visits were 0.38 before, 0.42 during, and 0.41 after the intervention, whereas at Baystate ED visits were 0.09 before, 0.17 during, and 0.15 after the intervention. Mean hospitalizations at CMH increased from 0.06 before to 0.22 during and then decreased to 0.12 after (P > .05), whereas admissions at Baystate increased from 0.03 before to 0.05 during and 0.04 after the intervention. CONCLUSIONS: Asthma self-management interventions can lead to decreases in asthma utilization under controlled circumstances. Further prospective studies are needed to determinewhether the ICAI intervention is effective under real-world conditions.

Allergens↗
PubMed2004

Promotion of physical activity in primary health care: update of the evidence on interventions.

This review provides an update of the evidence on the impact of physical activity (PA) interventions for patients in primary health care services. Sixteen studies published since 1999 are included. Twelve studies tested interventions of PA only and yielded good evidence that these can have a short-term (< 6 mths) impact upon behaviour. Four studies tested multiple risk factor interventions with a PA component, but the findings from these were inconclusive. There were insufficient studies to identify the attributes of effective interventions, but both brief and intensive single risk factor interventions produced short-term increases in PA. Little attention has been given in the research to the representativeness of study participants or intervention deliverers, or the potential for interventions to be transferred into routine service delivery. In light of current evidence, a reasonable approach for primary care practitioners is to undertake brief PA interventions with patients with health problems who could benefit from increased PA. Future research should pay greater attention to elements of study and intervention designs, including reach, adoption by practitioners and implementation within existing service structures, so that the public health potential of the findings can be realised.

Evidence-Based Medicine↗
PubMed2006

Cost-effectiveness of self-management in asthma: a systematic review of peak flow monitoring interventions.

OBJECTIVES: It is generally accepted that home peak flow monitoring increases patients' self-management and could lead to cost savings. The aim of this review was to analyze costs and the cost-effectiveness of self-management based on peak flow monitoring interventions in asthma. METHODS: Twenty-one studies were included in this review. Data were extracted, and methodological and economic quality were assessed. These studies presented economic information regarding self-management interventions based on peak flow monitoring in asthmatics. The mean methodological quality was 4.6 (maximum 8), and the mean economic quality was 12.0 (maximum 15). RESULTS: In eighteen studies, the interventions led to net savings compared with usual care or less intensive intervention. Only three studies found the total costs to be higher in the intervention group. In thirteen of the seventeen studies that analyzed health outcomes, at least one of the reported health outcomes improved statistically significantly after the intervention. However, the methods of economic evaluation differed among the studies and were not always in line with the standard methodology. CONCLUSIONS: The interventions, costs, and outcomes were very diverse. The results emphasize the need for guidelines to increase the comparability of cost-effectiveness evaluations relating to asthma. Only then will it be possible to conclude whether interventions for asthmatics, such as self-management based on peak flow monitoring interventions, are cost-effective.

Asthma↗
PubMed2001

Determinants of pharmacists' interventions linked to prescription processing.

AIM OF STUDY: The role of pharmacists in today's healthcare is changing rapidly. As they are close to the prescribing process, pharmacists are in the position to identify and adjust prescribing errors before dispensing. The objective of this study was to identify relevant determinants of interventions directly linked to prescription processing in community pharmacy. METHODS: As part of a yearly continuing education programme, all community pharmacies in the region of 'Zealand' (N = 23) in the south-west of The Netherlands kept detailed records of all interventions directly linked to prescription processing during one week in May 1998. For every patient involved in an intervention, a control-patient was matched on pharmacy practice, date, gender and age. RESULTS: A total of 39,357 prescriptions were evaluated by the 23 pharmacies during the one-week intervention programme. Out of these, one out of 10 resulted into an intervention. Being a first prescription in a new treatment episode was found to be a significant determinant (OR 1.75, 95 CI% 1.18-2.33). Variables reflecting drug therapy complexity (> 3 prescribers, > 15 prescriptions in 3 months before, > 3 different medications) showed all ORs higher than 1.00, but not significant. When looking at the individual drug categories, anti-infectives, respiratory drugs and cardiovascular medicines came out as important drug classes for intervention risk. We could not find any association between the number of signals per pharmacy and the number of interventions. CONCLUSION: The 'whistle-blower' model of pharmacy based interventions is a valid one but needs a targeted and integral way of implemented thinking and use of information technology. In such an environment, interventions are a logical step of in-process quality control in the drug usage system.

Aged↗
PubMed2003

A cognitive-behavioral intervention to reduce HIV risk behaviors in crack and injection drug users.

This paper presents the results of a study evaluating the efficacy of a theory-based cognitive-behavioral intervention to reduce HIV risk among street-based crack and injection drug users not currently in drug treatment in Long Beach, California. A nine-session, 4-month enhanced intervention (including HIV counseling and testing) was compared to a two-session standard counseling and testing intervention developed by the National Institute on Drug Abuse (NIDA) in terms of their efficacy for reducing drug- and sex-related risk behaviors. The theory-based enhanced intervention rarely was found to be different from NIDA's standard counseling and testing intervention in reducing both drug- and sex-related risks, as indicated by cessation and/or reduction of drug use (measured by urine test and self-report), entry into drug treatment, and increased frequency of condom use. One of the few significant effects was that the enhanced intervention significantly increased injecting drug users' use of their own injection equipment. On the other hand, for both interventions, most risk behaviors were significantly reduced. It is concluded that the theory-based cognitive-behavioral intervention has limited advantage over the standard intervention in terms of both magnitude and frequency of HIV risk reduction achieved by high-risk, active drug users.

Adult↗
PubMed1999

Effect of low-saturated fat, low-cholesterol dietary intervention on fatty acid compositions in serum lipid fractions in 5-year-old children. The STRIP project.

OBJECTIVE: To evaluate the effect of dietary low-saturated fat, low-cholesterol intervention on fat intake and fatty acid compositions in serum cholesterol ester (CE), phospholipid (PL) and triglyceride (TG) fractions in five-year-old children. DESIGN AND SUBJECTS: The STRIP project is a prospective, randomised intervention project in which 1062 seven-month-old infants were recruited from the well-baby clinics. 764 children participated in the 5-year follow-up; 202 of them were randomly selected for this study. Diet was assessed with 4-d dietary records. Serum CE, PL and TG fatty acid compositions were analysed with gas-liquid chromatography. RESULTS: Saturated fat intake of intervention children (mean (confidence interval)) (girls 11.9 (11.2-12.6) % of energy intake (E%); boys 12.5 (11.9-13.1)) was lower than that of the control children (girls 14.4 (13.7-15.2) E%; boys 15.0 (14.3-15. 8) E%) (P=0.0001 for the difference between intervention and control groups). The intake of unsaturated fat differed only slightly. Dietary ratios of polyunsaturated to saturated fatty acids (PS ratios) of the intervention and control diets were 0.44 and 0.33, respectively (P=0.0001). Furthermore, serum cholesterol concentrations of the intervention and control children differed (4. 28 (4.13-4.43) mmol/L vs 4.49 (4.35-4.63) mmol/L; P=0.04). Relative proportion of saturated fatty acids in serum TG was lower (34.9% vs 36.3%; P=0.04) and that of n-6 polyunsaturated fatty acids higher (13.9% vs 12.4%; P=0.0004) in the intervention than in the control children, whereas serum CE and PL fatty acid compositions of intervention and control groups were closely similar. However, intake of linoleic acid correlated better with serum linoleic acid relative content in the CE fraction (r=0.36; P=0.0001) than in the PL (r=0.27; P=0.0002) or in the TG (r=0.23; P=0.0016) fraction. CONCLUSIONS: Intervention resulted in decreased intake of saturated fatty acids and lowered serum total and LDL cholesterol concentrations. Of serum lipid fractions, TG fatty acid composition was the most sensitive and parallelled the findings in dietary food records.

Child, Preschool↗
PubMed2003

Family involvement in weight control, weight maintenance and weight-loss interventions: a systematic review of randomised trials.

OBJECTIVE: To conduct a descriptive systematic review into the nature and effectiveness of family involvement in weight control, weight maintenance and weight-loss interventions. METHOD: We searched Medline and Psyclit for English language papers describing randomised trials with at least 1-y follow-up that evaluated interventions incorporating a family-based component. Studies involving people with eating disorders, learning disabilities and undernutrition or malnutrition were excluded. Data were extracted on characteristics of the participants, study design, target behaviours, nature of the intervention and study outcomes. A taxonomy was developed and used to classify family involvement in behaviour change interventions. Interventions were also classified according to an existing taxonomy that characterised the behaviour change techniques employed. RESULTS: A total of 21 papers describing 16 intervention studies were identified. Studies were small (mean sample size: 52), heterogeneous, poorly described but with few losses to follow-up (median 15%). The majority were North American and aimed at weight loss. Few studies described a theoretical underpinning to the behaviour change techniques employed. There was a suggestion that spouse involvement increased effectiveness but that adolescents achieved greater weight loss when treated alone. In studies including children, beneficial effects were seen when greater numbers of behaviour change techniques were taught to both parents and children. CONCLUSION: Relatively few intervention studies exist in this important area, particularly studies targeting adolescents, and they highlight continued uncertainty about how best to involve family members. The studies provide limited support for the involvement of spouses. They suggest that parental involvement is associated with weight loss in children, and that use of a greater range of behaviour change techniques improves weight outcomes for both parents and children. The development of future interventions and assessment of factors influencing effectiveness may be improved by paying careful attention to which family members are targeted and how they are involved in the intervention in terms of setting goals for behaviour change, providing support and training in behaviour change techniques.

Adolescent↗
PubMed2007

Impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.

OBJECTIVE: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India. STUDY DESIGN: Before-and-after intervention trial setting: limited resource teaching hospital; DESIGN: Before and after study. INTERVENTIONS: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses. STATISTICAL METHODS: The categorical and continuous variables were compared with chi (2) and two-tailed tests, respectively. RESULTS: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P=0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions. CONCLUSIONS: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.

Hospital Mortality↗
PubMed2000

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers.

Implementation and evaluation of a practical intervention programme for dealing with violence towards health care workers The aim of this study was to implement and evaluate a practical intervention programme designed to help staff in health care work-places to deal with patient violence towards staff. The programme was part of a controlled, prospective study that ran for 1 year. The study population was comprised of staff at 47 health care work-places, randomly assigned to either the intervention or control group. The Violent Incident Form (VIF), a checklist designed to simplify the registration of violent events, was introduced at all 47 work sites, where staff were instructed to register all types of violent and threatening incidents directed towards them during the 1-year study period. The intervention work-places also followed a structured feedback programme, where the circumstances concerning registered incidents were discussed on a regular basis with work-place staff. Baseline examination of the study groups revealed no statistically significant difference with regard to self-reported violence in the past year. At the conclusion of the 1-year period, the difference between groups was statistically significant (P < 0.05). Staff at the intervention work sites reported 50% more violent incidents than the control work sites during the year. Compared to the control group, intervention group staff reported better awareness: of risk situations for violence (P < 0.05); of how potentially dangerous situations could be avoided (P < 0.05); and of how to deal with aggressive patients (P < 0.05). Logistic regression analysis confirmed an increased risk for self-reported violence in the intervention group post-intervention (odds ratio 1.49; 95% confidence interval 1.07-2.06; P < 0.05). The structured feedback programme seems to have improved staff knowledge of risks for violence in the intervention group.

Adult↗
PubMed1999

Evidence-based education: development of an instrument to critically appraise reports of educational interventions.

OBJECTIVES: Educational interventions may ultimately impact on patient care as well as affecting individuals' learning. Critical evaluation of educational literature by those involved in designing and developing educational interventions is therefore important. A checklist instrument for critically appraising reports of educational interventions is described. DESIGN: The instrument was developed by an iterative process and piloted. The instrument consists of nine questions: 1. Is there a clear question which the study seeks to answer? 2. Is there a clear learning need which the intervention seeks to address? 3. Is there a clear description of the educational context for the intervention? 4. Is the precise nature of the intervention clear? 5. Is the study design able to answer the question posed by the study? 6. Are the methods within the design capable of appropriately measuring the phenomena which the intervention ought to produce? 7. Are the outcomes chosen to evaluate the intervention appropriate? 8. Are there any other explanations of the results explored in the study? 9. Are any unanticipated outcomes explained? A worked example is given to illustrate how the instrument can be used in practice. SETTING: The Department of General Practice in Glasgow. SUBJECTS: Young general practitioners and the Educational Journal Club. RESULTS: The instrument was feasible. CONCLUSIONS: The use of the checklist allows the reader to critically appraise reports of educational interventions and helps in the practice of evidence-based education.

Educational Measurement↗
PubMed2003

Early intervention in psychosis: an overdue reform.

OBJECTIVE: To discuss the rationale for early intervention in psychotic disorders and to explore why the widespread implementation of early intervention services has stalled. METHOD: Four central questions are explored regarding early intervention in psychosis: (i) what is the rationale for early intervention services in psychosis and is it justified? (ii) what are the obstacles to the implementation of early intervention services throughout Australia? (iii) how could some of these obstacles be overcome? and (iv) what else needs to occur? RESULTS: Early intervention in psychosis aims to improve recognition and access, promote recovery from the initial psychotic episode, minimize secondary morbidity and reduce collateral damage. It may also prevent some brain dysfunction and damage, which may otherwise occur later in the illness. Despite the now growing body of evidence supporting the idea of early intervention, obstacles remain to its widespread adoption in policy and implementation, principally related to chronic under-funding of the public mental health system. Among the solutions proposed is the need to develop services with a youth focus, able to cater for young people with both psychotic and non-psychotic psychiatric disorders. These services should be well integrated with primary care and other youth orientated agencies. CONCLUSIONS: We are hopeful that strong investment in early intervention and better services for young people will be among the highest priorities of the Third National Mental Health Plan. This is not only where the greatest public health burden lies, but also where cost-effectiveness of intervention is likely to be maximal.

Adolescent↗
PubMed2002

Long-term increase in quality of nursing documentation: effects of a comprehensive intervention.

This study aimed to evaluate the longitudinal effects of a nursing-documentation intervention on the quantity and quality of the nursing documentation in a sample of patient records at a university hospital in Stockholm, Sweden. In this quasi-experimental longitudinal study, two hospital wards participated in a 2-year intervention and a third ward was used for comparison. The intervention consisted of organizational changes and education regarding nursing documentation in accordance with the VIPS model, a model designed to structure nursing documentation. To evaluate the effect, patient records were audited at three different time points: before the intervention, directly after the intervention and 3 years after the intervention. A total of 269 patient records were used. The findings showed a significant score increase in quantity as well as in quality of the nursing documentation, in the intervention wards directly after the intervention, as compared with those from the comparison ward. The results suggests that a comprehensive intervention based on the VIPS model and including organizational support for registered nurses (RN) may improve nursing documentation in an acute care hospital setting.

Adult↗
PubMedDate not supplied

Self-Help Intervention Project. Women receiving breast cancer treatment.

PURPOSE: The purpose of this study was to determine the efficacy of self-care/self-help promotion and uncertainty management interventions offered by the Self-Help Intervention Project (SHIP) for women receiving chemotherapy, radiation therapy, or hormone therapy for breast cancer. DESCRIPTION OF STUDY: One hundred ninety-three women were randomly assigned either to one of three intervention groups (self-help course, uncertainty management, or self-help course plus uncertainty management) or to a control group. Data were analyzed by a repeated measures multivariate analysis of variance procedure using a two-level blocking factor (high and low resourcefulness) and four outcome variables (self-care, self-help, psychological adjustment, and confidence in cancer knowledge). Data were collected at baseline (T1), which was after initiation of adjuvant therapy, allowing for the emergence of treatment-related side effects; 6 to 8 weeks after T1 (T2); and 3 months after T2 (T3). RESULTS: At baseline, women having high resourcefulness compared with women having low resourcefulness evidenced greater self-care, self-help, psychological adjustment, and confidence in cancer knowledge. Participation in SHIP interventions resulted in higher levels of self-care, self-help, psychological adjustment, and confidence in cancer knowledge by time effect in a significant number of women regardless of their baseline resourcefulness. Women participating in SHIP interventions who had low baseline resourcefulness demonstrated the greatest change over time in the outcome variables. Post hoc results indicated that the effect primarily was the result of changes in psychological adjustment, confidence in cancer knowledge, and self-care. CLINICAL IMPLICATIONS: The findings of this study address both the treatment effect for supportive care interventions and the needs that have emerged from review of the last 20 years of supportive care research. Some SHIP interventions evidenced more strength than others; data indicated that large percentages of women with low resourcefulness who received no SHIP interventions experienced a decrement in self-care, self-help, confidence in cancer knowledge, and psychological adjustment over the time that they received adjuvant therapy. Women's level of confidence in their knowledge about cancer being sufficient for self-management and self-help activities was not linked to baseline resourcefulness level. Thus, inherent resourcefulness was not a factor in need for supportive services that could maintain or increase confidence in cancer knowledge usefulness for self-management and self-help. Healthcare providers should note that although the women with low resourcefulness benefited the most from the interventions, women who evidenced high resourcefulness at baseline reported the same level of need for confidence in cancer knowledge and for self-help.

Adaptation, Psychological↗
PubMed1998

Using an office system intervention to increase breast cancer screening.

OBJECTIVE: To evaluate an innovative approach to continuing medical education, an outreach intervention designed to improve performance rates of breast cancer screening through implementation of office systems in community primary care practices. DESIGN: Randomized, controlled trial with primary care practices assigned to either the intervention group or control group, with the practice as the unit of analysis. SETTING: Twenty mostly rural counties in North Carolina. PARTICIPANTS: Physicians and staff of 62 randomly selected family medicine and general internal medicine practices, primarily fee-for-service, half group practices and half solo practitioners. INTERVENTION: Physician investigators and facilitators met with practice physicians and staff over a period of 12 to 18 months to provide feedback on breast cancer screening performance, and to assist these primary care practices in developing office systems tailored to increase breast cancer screening. MEASUREMENTS AND MAIN RESULTS: Physician questionnaires were obtained at baseline and follow-up to assess the presence of five indicators of an office system. Three of the five indicators of office systems increased significantly more in intervention practices than in control practices, but the mean number of indicators in intervention practices at followup was only 2.8 out of 5. Cross-sectional reviews of randomly chosen medical records of eligible women patients aged 50 years and over were done at baseline (n = 2,887) and follow-up (n = 2,874) to determine whether clinical breast examinations and mammography, were performed. Results for mammography were recorded in two ways, mention of the test in the visit note and actual report of the test in the medical record. These reviews showed an increase from 39% to 51% in mention of mammography in intervention practices, compared with an increase from 41% to 44% in control practices (p = .01). There was no significant difference, however, between the two groups in change in mammograms reported (intervention group increased from 28% to 32.7%; control group increased from 30.6% to 34.0%, p = .56). There was a nonsignificant trend (p = .06) toward a greater increase in performance of clinical breast examination in intervention versus control practices. CONCLUSIONS: A moderately intensive outreach intervention to increase rates of breast cancer screening through the development of office systems was modestly successful in increasing indicators of office systems and in documenting mention of mammography, but had little impact on actual performance of breast cancer screening. At follow-up, few practices had a complete office system for breast cancer screening. Outreach approaches to assist primary care practices implement office systems are promising but need further development.

Aged↗