Composite non-clinical interventions for a safe cesarean section rate reduction: results of a pre-post interventional study

Abstract Objective To evaluate the impact on cesarean section (CS) rate with of a program of multiple non-clinical interventions targeted at health-care professional within a hospital maternity ward. Materials and methods Retrospective quasi-experimental pre-post intervention study with an historical control group conducted in a second-level teaching hospital. All women who gave birth in the period 2014 to 2018 were included. A series of multiple non-clinical interventions including a dedicated team of obstetricians for delivery room and antenatal counseling, monthly internal audits and physician education by local opinion leader were prospectively introduced from September 2016. The primary outcome of the study was the CS rate. The incidences of operative vaginal delivery, 3rd−/4th-degree perineal tears and further maternal and neonatal complications were considered as secondary outcomes. Results The CS rate dropped from 33.05 to 26.06% after starting the interventions (p < 0.01); in particular, the cumulative rate of CS performed during labor decreased significantly from 19.46 to 14.11% (p < 0.01). CS reduction was still statistically significant after multivariate correction (OR = 0.66, CI.95 = 0.57–0.76, p < 0.01). Results further showed an increased prevalence of 3rd-degree perineal tears (0.97% versus 2.24%, p < 0.01), present also after correcting for possible confounding factors (OR = 2.36, CI.95 = 1.48–3.76, p < 0.01). No differences were found in the rate of vaginal-operative births and further maternal complications, while the composite neonatal outcome was found to be improved (OR = 0.73, CI.95 = 0.57–0.93, p = 0.010). Conclusions The introduction of multiple non-clinical interventions can significantly reduce the CS rate. However, beside an improvement in neonatal composite outcome, a potential increase in high-degree perineal tears should be taken in account.

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Impact of Decreased Night Work on Workers’ Musculoskeletal Symptoms: A Quasi-Experimental Intervention Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17239092 ◽

2020 ◽

Vol 17 (23) ◽

pp. 9092

Author(s):

Hye-Eun Lee ◽

Min Choi ◽

Hyoung-Ryoul Kim ◽

Ichiro Kawachi

Keyword(s):

Musculoskeletal Pain ◽

Night Shift ◽

Night Work ◽

Musculoskeletal Symptoms ◽

Control Group ◽

Body Parts ◽

Difference In Difference ◽

Post Intervention ◽

Shift Workers ◽

The Impact

A possible association between night shift work and musculoskeletal disorder has been suggested. This study aimed to evaluate the impact of decreased night work on musculoskeletal pain. Difference-in-difference estimation was used to compare changes in musculoskeletal pain between shift workers (N = 122) and non-shift workers (N = 170) in a manufacturing company before and after the introduction of a new shift system eliminating overnight work. Musculoskeletal pain was measured by a questionnaire asking if workers had symptoms in specific body parts, including the neck, shoulder, arm/elbow, wrist/hand, back, and leg/foot, over the past year. Generalized estimating equation models were used to estimate changes in pre- versus post-intervention musculoskeletal pain rates between the treated and control group. In the difference-in-difference (DID) models, prevalence of musculoskeletal pain for shoulder (−10.3%), arm (−12.9%), all sites combined (−9.2%), and upper extremity combined (−14.8%) showed significant decreases from pre- to post-intervention among the treated group (shift workers) compared to the control group (non-shift workers) after controlling for age and weekly working hours. Decreasing night work was related to improvement in musculoskeletal pain in shift workers.

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A before and after study of the impact on obstetric and perinatal outcomes following the introduction of an educational package of fetal heart rate monitoring education coupled with umbilical artery lactate sampling in a low resource setting labor ward in South Africa

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2552-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Emma R. Allanson ◽

Robert C. Pattinson ◽

Elizabeth A. Nathan ◽

Jan E. Dickinson

Keyword(s):

Heart Rate ◽

Cesarean Section ◽

Fetal Heart Rate ◽

Fetal Heart ◽

Perinatal Outcomes ◽

Heart Rate Monitoring ◽

Post Intervention ◽

Fetal Heart Rate Monitoring ◽

Resource Setting ◽

The Impact

Abstract Introduction Rates of cesarean section (CS) are increasing and abnormal fetal heart rate tracing and concern about consequent acidosis remain one of the most common indications for primary CS. Umbilical artery (UA) lactate sampling provides clinicians with point of care feedback on CTG interpretation and intrapartum care and may result in altered future practice. Materials and methods From 3rd March - 12th November 2014 we undertook a before and after study in Pretoria, South Africa, to determine the impact of introducing a clinical package of fetal heart rate monitoring education and prompt feedback with UA cord lactate sampling, using a hand-held meter, on maternal and perinatal outcomes. Results Nine hundred thirty-six consecutive samples were analyzed (pre n = 374 and post n = 562). There was no difference in mean lactate (4.6 mmol/L [95%CI 4.4–4.8] compared with 4.9 mmol/L [95%CI 4.7–5.1], p = 0.089). Suspected fetal compromise was reduced in the post-intervention period: 30·2% vs 22·1%, aOR 0·71, 95% CI 0·52–0·96, p = 0·027. Cesarean section rates were significantly reduced in the univariate analysis: pre- 40·3% vs post-intervention 31·6% (p = 0·007). This reduction remained significant when adjusted for previous cesarean section, primiparity, maternal HIV infection and preterm birth (aOR 0·72, 95%CI 0·54–0·98, p = 0·035). Neonatal outcomes did not differ between the two groups. Conclusion The introduction of a clinical practice package of fetal heart rate monitoring education combined with routine UA cord lactate sampling has the potential to reduce the cesarean section rate without increasing adverse neonatal outcomes in a low-resource setting.

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The Effectiveness of Group Triple P and the Impact of the Four Telephone Contacts

Behaviour Change ◽

10.1375/bech.2005.22.2.71 ◽

2005 ◽

Vol 22 (2) ◽

pp. 71-80 ◽

Cited By ~ 38

Author(s):

Sonia C. Gallart ◽

Stephen Matthey

Keyword(s):

Self Report ◽

Control Group ◽

Triple P ◽

Post Intervention ◽

Waitlist Control ◽

Waitlist Control Group ◽

Group Sessions ◽

Clinically Significant ◽

Main Effects ◽

The Impact

AbstractThe aim of this study was to determine the efficacy of the four telephone contact sessions that are prescribed as an integral component of the Group Triple P parenting program, and to compare the efficacy of Group Triple P to a waitlist control group. Parents of children aged 2 to 8 years were randomly assigned to one of three conditions: the usual Group Triple P program, consisting of four group sessions and four telephone calls (n = 16); a modified Group Triple P condition, consisting of just the four group sessions (n = 17); or a waitlist control condition (n = 16). Pre- and post-intervention assessments were conducted using the Eyberg Child Behavior Inventory (ECBI), the Depression Anxiety Stress Scales (DASS) and the Parenting Scale (PS). Statistically and clinically significant main effects were found for attending either the full Triple P or the modified Triple P program on both the DASS and the ECBI, but not on the participant's perception of their parenting style (PS). We conclude that (a) the four telephone sessions are not an essential component for the initial effectiveness of the Group Triple P program (though further research needs to explore whether they impact on maintenance of gains), and (b) that Group Triple P is effective in bringing about change, as measured using these self-report instruments.

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Impact of Stress Ulcer Prophylaxis Algorithm Study

Annals of Pharmacotherapy ◽

10.1345/aph.1d129 ◽

2005 ◽

Vol 39 (5) ◽

pp. 810-816 ◽

Cited By ~ 12

Author(s):

Christian J Coursol ◽

Sabrina E Sanzari

Keyword(s):

Intensive Care ◽

Stress Ulcer ◽

Treatment Algorithm ◽

Intervention Group ◽

Stress Ulcer Prophylaxis ◽

Control Group ◽

Post Intervention ◽

Ulcer Prophylaxis ◽

The Cost ◽

The Impact

BACKGROUND: In the intensive care unit at Royal Victoria Hospital, we noted that drugs prescribed for stress ulcer prophylaxis were not always indicated or optimal. Accordingly, we implemented an algorithm for stress ulcer prophylaxis to guide the medical team in their decisions. The agents selected for the algorithm were intravenous famotidine and omeprazole suspension or tablets, depending on the available administration route. OBJECTIVE: To evaluate the impact of a treatment algorithm on the appropriateness of prescriptions for stress ulcer prophylaxis. METHODS: A quasi-experimental—type evaluative study was conducted based on a pre-/post-intervention design without a concurrent control group. A total of 555 complete admissions met the selection criteria; 303 patients formed the pre-intervention group, and 252 made up the post-intervention group (exposed to the treatment algorithm). RESULTS: After implementation of the algorithm, the proportion of inappropriate prophylaxis was decreased (95.7% vs 88.2%; p = 0.033). The number of days of inappropriate prophylaxis was also reduced significantly (p = 0.013), as was the cost per patient (p = 0.003) for all admissions. However, no difference was observed when the subgroup of patients who received prophylaxis alone was studied (p = 0.098 and p = 0.918). The presence of bleeding was similar in both groups. CONCLUSIONS: Introduction by pharmacists of a treatment algorithm for stress ulcer prophylaxis in intensive care units allows a reduction of inappropriate prescriptions and thus a reduction in the cost of drugs. The use of omeprazole suspension seems to be an alternative to intravenous histamine2-inhibitors; however, a large-scale study is necessary to confirm the efficacy and safety of proton-pump inhibitors administered by an enteral tube.

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Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption

Public Health Nutrition ◽

10.1017/s1368980021003797 ◽

2021 ◽

pp. 1-13

Author(s):

Jessica Jarick Metcalfe ◽

Melissa Pflugh Prescott ◽

Melissa Schumacher ◽

Caitlin Kownacki ◽

Jennifer McCaffrey

Keyword(s):

Nutrition Education ◽

Vegetable Consumption ◽

Controlled Trial ◽

Fruit And Vegetable Consumption ◽

Control Group ◽

Fruit And Vegetable ◽

Structured Interviews ◽

Post Intervention ◽

Cooking Classes ◽

The Impact

Abstract Objective: The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants. Design: This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program. Setting: Seven weekly classes took place in community centres and extension offices in central Illinois. Participants: 120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45). Results: Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children’s participation in cooking. Conclusions: PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants’ cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking.

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The impact of a peer-based education on fruits and vegetables intake among housewives

Journal of Health Population and Nutrition ◽

10.1186/s41043-021-00278-3 ◽

2021 ◽

Vol 40 (1) ◽

Author(s):

Roya Sheybani ◽

Zahra Hosseini ◽

Sayed Hossein Davoodi ◽

Teamur Aghamolaei ◽

Amin Ghanbarnejad

Keyword(s):

Self Efficacy ◽

Fruits And Vegetables ◽

Group Discussion ◽

Peer Education ◽

Intervention Group ◽

Control Group ◽

Post Intervention ◽

Significant Difference ◽

Quasi Experimental ◽

The Impact

Abstract Background Evidence indicates the lower intake of fruits and vegetables than the recommended daily amount. Study aimed at determining the effects of peer education intervention on the consumption of fruits and vegetable in housewives. Methods A quasi-experimental was conducted with 130 housewives referring to health care centers in Bandar Abbas, Iran. Sixty-five subjects were recruited in each of the intervention and the control groups. Intervention group were divided into three subgroups each receiving a seven-sessions educational programs (lecturing and group discussion) through peers about the importance of benefits of fruits and vegetables consumption. Participants were followed for two months. Data were collected using a questionnaire in two stages of pre- and post-intervention. Differences in the outcome before and after the intervention were tested using T-test and paired T-test. Results The daily servings of fruits and vegetables in the intervention group increased from 1.73 to 4.20 and in the control group from 1.96 to 2.16; a statistically significant difference was also observed between the groups (P < 0.001). After the intervention benefits and self-efficacy of fruits and vegetables consumption significantly increased and perceived barriers of fruits and vegetables consumption significantly decreased in the intervention group (P < 0.001). Conclusion Peer education improves benefits and self-efficacy, reduces barriers, and increases the daily servings of fruits and vegetables in housewives.

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Sport education model and self-determination theory

Kinesiology ◽

10.26582/k.48.1.15 ◽

2016 ◽

Vol 48 (1) ◽

pp. 30-38 ◽

Cited By ~ 12

Author(s):

Ricardo Cuevas ◽

Luis Miguel García-López ◽

Jaime Serra-Olivares

Keyword(s):

Physical Education ◽

Self Determination Theory ◽

Self Determination ◽

Control Group ◽

Sport Education ◽

School Students ◽

Post Intervention ◽

Physically Active ◽

Education Model ◽

The Impact

Using self-determination theory as a guiding framework, this study analyzed the impact of the Sport Education Model in self-determination and motivation, psychological basic need thwarting, enjoymentsatisfaction, boredom, and intention to be physically active in Physical Education (PE) of secondary school students in Spain. Two groups were selected for the study: an experimental group (EG; n=43), which received 19 volleyball lessons following the Sport Education Model, and a control group (CG; n=43), which received 19 traditional Physical Education lessons. Pre- and post-intervention measures were taken in both groups. The results showed significant improvements in intrinsic motivation in EG. The results are discussed, and the suitability of the Sport Education Model to improve self-determined behaviors in Physical Education is emphasized.

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Evaluating the Impact of Teacher-designed, Wellbeing and Sustainability Play-based Learning Experiences on Young Children's Knowledge Connections: A Randomised Trial

Australasian Journal of Early Childhood ◽

10.23965/ajec.43.4.04 ◽

2018 ◽

Vol 43 (4) ◽

pp. 33-42

Author(s):

Heather Morris ◽

Susan Edwards ◽

Amy Cutter-Mackenzie ◽

Leonie Rutherford ◽

Janet Williams-Smith ◽

...

Keyword(s):

Digital Media ◽

Randomised Trial ◽

Learning Experiences ◽

Intervention Group ◽

Parent Report ◽

Control Group ◽

Post Intervention ◽

Waitlist Control Group ◽

Children's Interests ◽

The Impact

THIS PAPER REPORTS FINDINGS from a randomised investigation into the effect of teacher-designed, play-based learning experiences on preschool-aged children's knowledge connections between healthy eating and active play as wellbeing concepts, and sustainability. The investigation used a ‘ funds of knowledge’ theoretical framework to situate young children's interests in digital media and popular culture, as a site for learning these knowledge connections. The findings suggest that the intervention group children created more wellbeing and sustainability knowledge connections than the waitlist control group children. Additionally, the intervention group children demonstrated an increase in vegetable serves and a decrease in unhealthy food servings post intervention (measured by parent report). The paper suggests that more attention should be paid to early childhood teachers’ capacity for actively building children's knowledge about wellbeing and sustainability concepts through play-based learning, as opposed to top-down approaches towards obesity education and prevention alone.

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A Biochemical Marker of Preeclampsia - Hypertriglyceridemia - and the Impact of Secondary Prevention Therapy

Revista de Chimie ◽

10.37358/rc.18.10.6616 ◽

2018 ◽

Vol 69 (10) ◽

pp. 2740-2743

Author(s):

Corina Grigoriu ◽

Florentina Furtunescu ◽

Laura Elena Gaman ◽

Alice Lavinia Balaceanu ◽

Ramona Buzatu ◽

...

Keyword(s):

At Risk ◽

Pregnant Women ◽

Secondary Prophylaxis ◽

Control Group ◽

Maternal Complications ◽

Prevention Therapy ◽

Severe Hypertriglyceridemia ◽

Patients At Risk ◽

Anticoagulant Prophylaxis ◽

The Impact

Changes in lipid metabolism from pregnancies with preeclampsia (PE) are a challenge for the obstetrician, because they contribute to the pathological chain and to some specific severe complications (severe hypertriglyceridemia of pregnancy, acute pancreatitis etc). Patients at risk for PE have higher levels of triglycerides, total and LDL cholesterol, compared to normotensive pregnant women. We searched the link between lipidic changes in pregnancies with PE and the way secondary prophylactic treatments with acetylsalicilic acid or low molecular weight heparin (LMWH) can influence the evolution of pregnancy, avoiding the severe complications of this disease. We identified patients at risk of developing PE and then applied a secondary prophylaxis with either a platelet antiaggregant (acetylsalycilic acid - a group of 36 patients) or an anticoagulant prophylaxis with LMWH � enoxaparin (a second group of 37 patients), aiming a decrease of severe complications of PIH/PE. The control group consisted of 33 pregnant women with risk factors for PE, without any secondary prophylaxis, according to actual guidelines. We periodically determined (at 14, 16-20 and 34 weeks of pregnancy) several biochemical parameters: triglycerides, uric acid, free fatty acids, total cholesterol and albuminemia. In the present paper we present the evolution of triglyceridemia in the studied groups, considering hypertriglyceridemia as an important prognostic factor for maternal complications in pregnancy. The most important result of our study is the statistically significant extremely low rate of complications in the treatment groups.

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Multicomponent exercise program in older adults with lung cancer during adjuvant/palliative treatment: A secondary analysis of an intervention study

The Journal of Frailty & Aging ◽

10.14283/jfa.2021.2 ◽

2021 ◽

pp. 1-7

Author(s):

N. Martínez-Velilla ◽

M.L. Saez de Asteasu ◽

R. Ramírez-Vélez ◽

I.D. Rosero ◽

A. Cedeño-Veloz ◽

...

Keyword(s):

Lung Cancer ◽

Older Adults ◽

Emergency Department ◽

Palliative Treatment ◽

Secondary Analysis ◽

Exercise Programme ◽

Control Group ◽

Post Intervention ◽

Frailty Status ◽

The Impact

Background: Lung cancer is the second most prevalent common cancer in the world and predominantly affects older adults. This study aimed to examine the impact of an exercise programme in the use of health resources in older adults and to assess their changes in frailty status. Design: This is a secondary analysis of a quasi-experimental study with a non-randomized control group. Setting: Oncogeriatrics Unit of the Complejo Hospitalario de Navarra, Spain. Participants: Newly diagnosed patients with NSCLC stage I–IV. Intervention: Multicomponent exercise programme that combined resistance, endurance, balance and flexibility exercises. Each session lasted 45–50 minutes, and the exercise protocol was performed twice a week over 10 weeks. Measurements: Mortality, readmissions and Visits to the Emergency Department. Change in frailty status according to Fried, VES-13 and G-8 scales. Results: 26 patients completed the 10-weeks intervention (IG). Mean age in the control group (CG) was 74.5 (3.6 SD) vs 79 (3 SD) in the IG, and 78,9% were male in the IG vs 71,4% in the CG. No major adverse events or health-related issues attributable to the testing or training sessions were noted. Significant between-group differences were obtained on visits to the emergency department during the year post-intervention (4 vs 1; p:0.034). No differences were found in mortality rate and readmissions, where an increasing trend was observed in the CG compared with the IG in the latter (2 vs 0; p 0.092). Fried scale was the unique indicator that seemed to be able to detect changes in frailty status after the intervention. Conclusions: A multicomponent exercise training programme seems to reduce the number of visits to the emergency department at one-year post-intervention in older adults with NSCLC during adjuvant therapy or palliative treatment, and is able to modify the frailty status when measured with the Fried scale.

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