58. Stories - Structured operative reporting in enteric surgerys

2007 ◽  
Vol 30 (4) ◽  
pp. 60
Author(s):  
L. M. Gillman ◽  
A. Vergis ◽  
J. Park ◽  
S. Minor ◽  
M. Taylor
Keyword(s):  
Subgroup Analysis ◽  
Assessment Tool ◽  
Intervention Group ◽  
Senior Resident ◽  
Comfort Level ◽  
Rank Test ◽  
Junior Resident ◽  
Post Intervention ◽  
Operative Note

The purpose of this study was to determine whether the introduction of a Standardized Operative Dictation Template improved the quality of resident dictation. General surgery residents (N = 20) from the University of Manitoba participated in the study. All residents were shown a standardized surgical procedure video and then asked to dictate an operative report. Residents were randomized with the intervention group receiving the Operative Dictation Template. Three months later, all residents were retested. Resident comfort level with dictation and satisfaction with the template was evaluated with a questionnaire. Dictations were evaluated by two blinded independent reviewers using the previously validated SAFE-OR assessment tool. This tool consists of a Structured Assessment Form (SAF) scored out of 45 and a Global Quality Ratings Scale (GQRS) out of 36. Pre and post scores were analyzed using a two-tailed Wilcoxon signed rank test. Subjective comfort level with dictation, as measured by responses on a five point Likert scale, improved significantly in the intervention group (p=0.02). In addition, 90% of residents in the intervention group subjectively reported their dictations improved because of the template. There was no overall difference in the quality of dictation in the intervention group pre and post intervention as measured by the SAF (28.6 vs. 30.0; p=0.36) and GQRS (21.7 vs. 21.8, p=0.96). However, junior resident subgroup analysis revealed statistically significant improvement in the intervention on both the SAF (23.2 vs. 28.3; p=0.02) and GQRS (17.1 vs. 20.4; p=0.02). Senior resident subgroup analysis showed no difference in the intervention group on either the SAF (36.8 vs. 32.4; p=0.07) and GQRS (28.5 vs. 23.9; p=0.07). The Operative Dictation Template can result in a significant improvement in resident comfort level with dictation and has the potential to improve the quality of junior resident dictations. Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6. Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2. Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.

scholarly journals Reducing sitter use in acute medicine while maintaining safety and quality

2018 ◽  
Vol 9 (2) ◽  
pp. 61
Author(s):  
Delois Long ◽  
Janice Dennis
Keyword(s):  
Patient Safety ◽  
Patient Care ◽  
Assessment Tool ◽  
Medical Center ◽  
Intervention Group ◽  
Post Intervention ◽  
Acute Medicine ◽  
Quality Of Patient Care ◽  
Interventional Group

Background and objective: Sitters are commonplace in acute care facilities throughout the country. Sitters are used to provide close observations and ensure safety for patients who are at risk for falls. These patients suffer from cognitive impairment, inability to follow instructions, and causing harm to themselves or others. The literature shows that one requirement for an effective sitter process is the use of an assessment tool. Sitter usage at the Louis Stokes Cleveland VA Medical Center (LSCVAMC) has escalated to the point that sitters are causing an overall shortage of nursing staff.  This shortage causes excessive overtime, staff burnout, and reduces the quality of patient care provided to non-sitter patients. The purpose of this case-control descriptive pilot study was to reduce sitter usage on an inpatient acute medicine unit, by implementing the Patient Attendant Assessment Tool (PAAT), without reducing patient safety and quality of patient care. The PAAT was developed and utilized by a Midwest hospital for data collection and to assess the need for sitters.Methods: Patients were placed into the Pre- and Post-implementation cohorts, according to the order of their admission. Pre-interventional data was collected from the study group, using the Sitter Justification Form, the 24-hour nursing report and the electronic medical record. The intervention consisted of staff education on the use of a new tool, the PAAT. Following implementation of the tool, the data was collected and analyzed using the SPSS 20 for windows (SPSS.INC), over an 8-month period.Results and conclusions: Sitter usage was reduced without reducing patient safety or quality of care, with the implementation of the PAAT. Among individuals having at least one sitter day, patients in the post intervention group, were less likely to have as many sitter shifts (n = 343, 58.0%) as compared to patients in the Pre-interventional group (n = 451, 75.9%) (Chi Square = 42.88; df = 1, p < .001). As can be seen, there was a significant decrease in the number of sitter shifts after the implementation of the PAAT, as compared to the pre-interventional group. There was a slight increase in the quality of patient care.

scholarly journals The Effects of Acupuncture on Pregnancy Outcomes of Recurrent Implantation Failure: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Menglin Li ◽  
Yunyun Liu ◽  
Haoran Wang ◽  
Shuzhen Zheng ◽  
Yinhe Deng ◽  
...  
Keyword(s):  
Pregnancy Rate ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Intervention Group ◽  
Control Group ◽  
Implantation Failure ◽  
Recurrent Implantation Failure ◽  
The Difference ◽  
Ivf Et

Objective. To systematically evaluate the efficacy and safety of acupuncture for patients with recurrent implantation failure (RIF) undergoing in vitro fertilization-embryo transfer (IVF-ET) and hopefully provide reliable guidance for clinicians and patients. Methods. Through searching domestic and foreign medical journals, the literature of randomized controlled trials (RCTs) of acupuncture for RIF undergoing IVF-ET was collected. RevMan 5.3 software was used for meta-analysis and Cochrane’s risk of bias assessment tool was used to evaluate the quality of the included studies. Results. Seven documents meeting the criteria were finally included. The results showed that the intervention group contributes more in outcomes including clinical pregnancy rate (RR = 1.90, 95% CI (1.51, 2.40), P < 0.05 ), biochemical pregnancy rate (RR = 1.59, 95% CI (1.27, 1.99), P < 0.05 ), embryo implantation rate (RR = 1.89, 95% CI (1.47, 2.45), P < 0.05 ), and endometrial thickness (MD = 1.11, 95% CI (0.59, 1.63), P < 0.05 ) when compared with the control group, and the difference is statistically significant. In terms of the number of embryo transfers and the type of endometrium, the difference between the acupuncture group and the control group was not statistically significant. Conclusion. Acupuncture therapy on patients with RIF can improve the pregnancy outcome of patients. It is a relatively effective treatment with satisfactory safety and suitable for clinical application. However, as the quality of the included studies is not good enough, the conclusion of this meta-analysis should be treated with caution. More double-blind RCTs equipped with high quality and large samples are expected for the improvement of the level of evidence.

scholarly journals Group-based music intervention in Parkinson’s disease – findings from a mixed-methods study

2020 ◽  
Vol 34 (4) ◽  
pp. 533-544
Author(s):  
Petra Pohl ◽  
Ewa Wressle ◽  
Fredrik Lundin ◽  
Paul Enthoven ◽  
Nil Dizdar
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Freezing Of Gait ◽  
Intervention Group ◽  
Group Differences ◽  
Control Group ◽  
Music Intervention ◽  
Post Intervention

Objective: To evaluate a group-based music intervention in patients with Parkinson’s disease. Design: Parallel group randomized controlled trial with qualitative triangulation. Setting: Neurorehabilitation in primary care. Subjects: Forty-six patients with Parkinson’s disease were randomized into intervention group ( n = 26), which received training with the music-based intervention, and control group ( n = 20) without training. Interventions: The intervention was delivered twice weekly for 12 weeks. Main measures: Primary outcome was Timed-Up-and-Go subtracting serial 7’s (dual-task ability). Secondary outcomes were cognition, balance, concerns about falling, freezing of gait, and quality of life. All outcomes were evaluated at baseline, post-intervention, and three months post-intervention. Focus groups and individual interviews were conducted with the intervention group and with the delivering physiotherapists. Results: No between-group differences were observed for dual-task ability. Between-group differences were observed for Falls Efficacy Scale (mean difference (MD) = 6.5 points; 95% confidence interval (CI) = 3.0 to 10.0, P = 0.001) and for Parkinson Disease Questionnaire-39 items (MD = 8.3; 95% CI = 2.7 to 13.8, P = 0.005) when compared to the control group post-intervention, but these were not maintained at three months post-intervention. Three themes were derived from the interviews: Expectations versus Results, Perspectives on Treatment Contents, and Key Factors for Success. Conclusion: Patient-reported outcomes and interviews suggest that the group-based music intervention adds value to mood, alertness, and quality of life in patients with Parkinson’s disease. The study does not support the efficacy in producing immediate or lasting gains in dual-tasking, cognition, balance, or freezing of gait.

Tongue-tie division to treat breastfeeding difficulties: our experience

2015 ◽  
Vol 129 (10) ◽  
pp. 986-989 ◽  
Author(s):  
S D Sharma ◽  
S Jayaraj
Keyword(s):  
Standard Deviation ◽  
Surgical Complications ◽  
Assessment Tool ◽  
Surgical Intervention ◽  
Intervention Group ◽  
Early Age ◽  
Post Intervention ◽  
The Mean ◽  
Surgical Group ◽  
Telephone Questionnaire

AbstractObjectives:To assess the benefits of frenotomy on breastfeeding in infants, and determine the influence of age.Methods:A telephone questionnaire of all patients diagnosed with tongue-tie over 12 months was conducted pre-intervention and 1-month post-intervention. The Infant Breastfeeding Assessment Tool was used to assess breastfeeding.Results:Of 54 infants diagnosed with tongue-tie, 78 per cent of mothers participated in the survey. Eighty-six per cent of patients underwent frenotomy, with no surgical complications. In the frenotomy group, 81 per cent of mothers reported improvement in breastfeeding, versus 17 per cent in the non-surgical group (p = 0.0074). In the frenotomy group, the mean (±standard deviation) Infant Breastfeeding Assessment Tool score was 3.33 ± 1.51 pre-intervention, versus 9.19 ± 2.44 post-intervention (p = 0.0001). In the non-surgical intervention group, the mean score (±standard deviation) was 4.17 ± 0.75 pre-intervention, versus 6.00 ± 1.73 post-intervention (p = 0.16). For infants who underwent frenotomy, there was a reported improvement in 94 per cent of those aged less than 30 days, versus 68 per cent in infants aged over 30 days (p = 0.092).Conclusion:Frenotomy is a safe, short procedure that improves breastfeeding outcomes, and is best performed at an early age.

scholarly journals The Effectiveness of Bioskills Training for Simulated Open Lumbar Laminectomy

2017 ◽  
Vol 7 (8) ◽  
pp. 794-800 ◽  
Author(s):  
Barrett S. Boody ◽  
Brett D. Rosenthal ◽  
Tyler J. Jenkins ◽  
Alpesh A. Patel ◽  
Jason W. Savage ◽  
...  
Keyword(s):  
Medical Students ◽  
Clinical Education ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Training Session ◽  
Senior Resident ◽  
Control Group ◽  
Junior Resident ◽  
Training Module

Study Design: Randomized, prospective study within an orthopedic surgery resident program at a large urban academic medical center. Objectives: To develop an inexpensive, user-friendly, and reproducible lumbar laminectomy bioskills training module and evaluation protocol that can be readily implemented into residency training programs to augment the clinical education of orthopedic and neurosurgical physicians-in-training. Methods: Twenty participants comprising senior medical students and orthopedic surgical residents. Participants were randomized to control (n = 9) or intervention (n = 11) groups controlling for level of experience (medical students, junior resident, or senior resident). The intervention group underwent a 40-minute bioskills training module, while the control group spent the same time with self-directed study. Pre- and posttest performance was self-reported by each participant (Physician Performance Diagnostic Inventory Scale [PPDIS]). Objective outcome scores were obtained from a blinded fellowship-trained attending orthopedic spine surgeon using Objective Structured Assessment of Technical Skills (OSATS) and Objective Decompression Score metrics. Results: When compared with the control group, the intervention group yielded a significant mean improvement in OSATS ( P = .022) and PPDIS ( P = .0001) scores. The Objective Decompression Scores improved in the intervention group with a trend toward significance ( P = .058). Conclusions: We conclude that a concise lumbar laminectomy bioskills training session can be a useful educational tool for to augment clinical education. Although no direct clinical correlation can be concluded from this study, the improvement in trainee’s technical and procedural skills suggests that Sawbones training modules can be an efficient and effective tool for teaching fundamental spine surgical skills outside of the operating room.

scholarly journals The Effect of the Nursing Care Model Based on Culture to Improve the Care of Malnourished Madurese Children in Indonesia

2019 ◽  
Vol 7 (7) ◽  
pp. 1220-1225
Author(s):  
Abdul Aziz Alimul Hidayat ◽  
Musrifatul Uliyah
Keyword(s):  
Cultural Values ◽  
Nursing Care ◽  
Parenting Practices ◽  
Intervention Group ◽  
Rank Test ◽  
Control Group ◽  
Care Model ◽  
Post Intervention ◽  
Model Based ◽  
Quasi Experimental

AIM: The purpose of this study is to analyse the usage of nursing care model based on culture to improve parenting practices related to malnutrition among Madurese children. METHODS: This study uses a quasi-experimental design and a purposive sample of 102 respondents from families with toddlers who suffered from nutritional deficiency. The sample consisted of an intervention group (n = 51) and a control group (n = 51). Data were collected using a questionnaire and weight measurement. RESULTS: A t-test found a difference between all of the variables of care, including health technology utilization, when comparing the following variables between the intervention group and the control group (t = 14.12, p < 0.001), beliefs and philosophy (t = 10.20, p < 0.001), cultural values and lifestyle (t = 13.63, p < 0.001), economic reasons (t = 0.20, p = 0.837), nursing action response based on culture (t = 11.28, p < 0.001), and care behaviors for children (t = 16.43, p < 0.001). The Wilcoxon signed-rank test found a difference between pre-intervention nursing care model based on culture and post-intervention nursing care model based on culture regarding the variable malnutrition status (t = 16.43, p < 0.001). CONCLUSION: This study found that the application of nursing care model based on culture affects care practices. Nursing care model based on culture can be applied to families with toddlers who are malnourished because of the lack of a culture of care.

scholarly journals A physical activity coaching intervention can increase and maintain physical activity and health-related outcomes in adult ambulatory care patients in a regional hospital: the Healthy4U-2 randomised controlled trial

2020 ◽  
Author(s):  
Stephen Barrett ◽  
Steve Begg ◽  
Paul O'Halloran ◽  
Michael Kingsley
Keyword(s):  
Physical Activity ◽  
Body Mass ◽  
Intervention Group ◽  
Trial Registration ◽  
Post Intervention ◽  
Coaching Intervention ◽  
Health Related ◽  
Active Adults

Abstract Background: The Healthy 4U-2 study sought to evaluate the effect of a twelve-week, physical activity (PA) coaching intervention for changes and maintenance in PA, anthropometrics and health-related outcomes in adults presenting to an ambulatory hospital clinic. Methods: One hundred and twenty insufficiently active adults were recruited from an ambulatory hospital clinic and randomised to an intervention group that received an education session and five 20-minute telephone sessions of PA coaching, or to a control group that received the education session only. ActiGraph GT3X accelerometers were used to measure moderate-to-vigorous physical activity (MVPA) at baseline, post-intervention (3-months) and follow-up (9-months). Secondary outcome measures (anthropometrics, PA self-efficacy, health-related and quality of life) were also assessed at the three time points. Results: At baseline, the mean age and body mass index of participants were 53 ± 8 years and 31 ± 4 kg/m 2 , respectively. Relative to control, the intervention group increased objectively measured MVPA at post-intervention (p<0.001) and 9 months follow-up (p<0.001). At the 9-month follow-up the intervention group completed 22 min/day of MVPA (95% CI: 20 to 25 min/day), which is sufficient to meet the recommended PA guidelines. The intervention group exhibited beneficial changes in body mass (p<0.001), waist circumference (p<0.001), body mass index (p<0.001), PA self-efficacy (p<0.001), and health-related quality of life (p<0.001) at the 9-month follow-up. Conclusions: This study demonstrates that a low contact PA coaching intervention results in beneficial changes in PA, anthropometrics and health-related outcomes in insufficiently active adults presenting to an ambulatory care clinic. The significant beneficial changes were measured at post-intervention and the 9-month follow-up, demonstrating a maintenance effect of the intervention. Trial registration: Prospectively registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR). Trial registration number: ACTRN12619000036112. http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376318 Keywords Physical activity; Exercise motivation; Accelerometry; Public health

scholarly journals Acupuncture for Obstructive Sleep Apnea (OSA) in Adults: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Liaoyao Wang ◽  
Jia Xu ◽  
Yijun Zhan ◽  
Jian Pei
Keyword(s):  
Subgroup Analysis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Biomedical Literature ◽  
Cochrane Library ◽  
China National Knowledge Infrastructure ◽  
Knowledge Infrastructure ◽  
Obstructive Sleep ◽  
Clinically Significant

Objective. Our aim was to assess the efficacy and safety of acupuncture for OSA patients with various severities of the disorder. Methods. Eight databases including PubMed, Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (CBM) were comprehensively searched till July 2019. Randomized controlled trials (RCTs) testing acupuncture in the treatment of OSA were eligible for inclusion. Studies were selected for inclusion, and data were extracted by two authors independently. The Cochrane Collaboration’s Risk of Bias Assessment Tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis. Results. Nine RCTs with 584 participants were included. The trials covered acupuncture and electropuncture. Acupuncture caused clinically significant reductions in AHI (MD: -6.18; 95% CI: -9.58 to -2.78; Z=3.56, P=0.0004) as well as in ESS (MD: -2.84; 95% CI: -4.80 to -0.16, Z=2.09, P=0.04). AHI was reduced more in the subgroup analysis of moderate OSA patients (MD: -9.44; 95% CI: -12.44 to -6.45; Z=6.18, P<0.00001) and severe OSA patients (MD: -10.09; 95% CI: -12.47 to -7.71; Z=8.31, P<0.00001). ESS was also reduced more in the subgroup analysis of moderate OSA patients (MD: -2.40; 95% CI: -3.63 to -1.17; Z=3.83, P=0.0001) and severe OSA patients (MD: -4.64; 95% CI: -5.35 to -3.92; Z=12.72, P<0.00001). Besides, acupuncture had a beneficial effect on LSaO2 (MD: 5.29; 95% CI: 2.61 to 7.97; Z=3.86, P=0.0001). The outcome of AHI and LSaO2 yielded consistent results after sensitivity analysis, but the direction of the outcome of ESS was reversed. And the quality of evidence was mainly low to very low. Conclusions. Acupuncture therapy is effective for OSA patients in reducing AHI and ESS and in improving the LSaO2 of various severities, especially in moderate and severe OSA patients. High-quality trials are urgently needed.

scholarly journals Quality of Life of Diabetic Foot Ulcer Patients with Hyperbaric Oxygen Therapy

2019 ◽  
Vol 55 (2) ◽  
pp. 127
Author(s):  
Kusnanto Kusnanto ◽  
Dismalyansa Dismalyansa ◽  
Retnayu Pradanie ◽  
Hidayat Arifin
Keyword(s):  
Quality Of Life ◽  
Hyperbaric Oxygen ◽  
Diabetic Foot ◽  
Intervention Group ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Rank Test ◽  
Control Group ◽  
Signed Rank Test

DM with ulcer can result in a decrease in the quality of life of patients and need to reduce the intensity of pain and odor on the ulcer, preventing amputation and Hyperbaric Oxygen as an adjuvant therapy in accelerating wound healing. This study aims to explain the effect of HBO on the quality of life of patients with diabetic foot ulcers at RSAL Dr. Ramelan Surabaya. Methods: The research used quasi-experimental design with a non-equivalent control group design approach. The samples were 70 patients from population of all diabetes patients who suffered from diabetic foot ulcers at RSAL Dr. Ramelan. Data were collected by WHOQOL-BREF questionnaire. Analyzed byWilcoxon signed rank test and Mann Whitney U test. Result: Mann Whitney in the post test, the physical p-value domain (0.000), psychological domain (0.012), social domain (0.003), and environmental domain (0,001), where the intervention group has a better value than the control group. Wilcoxon signed rank test results on the physical domain (0,000), psychological (0,012), social (0,003), and environmental (0,001), meaning there were significant differences between pre post test in intervention group. Discussion: Diabetes mellitus patients with foot ulcers given hyperbaric oxygen showed improvement on wound condition, thus reducing pain and medical needs. This makes patients motivated, reduce anxiety, and improve interpersonal support and confidence. Therefore, it is necessary to socialize the effect of HBO on DM patients with foot ulcer, as a treatment option in improving the quality of life of DM patients with foot ulcers.

scholarly journals Health impacts of environmental and social interventions designed to increase deprived communities’ access to urban woodlands: a mixed-methods study

2019 ◽  
Vol 7 (2) ◽  
pp. 1-172 ◽  
Author(s):  
Catharine Ward Thompson ◽  
Eva Silveirinha de Oliveira ◽  
Sara Tilley ◽  
Aldo Elizalde ◽  
Willings Botha ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cost Effectiveness ◽  
Social Cohesion ◽  
Health Research ◽  
Intervention Group ◽  
Health Impacts ◽  
Control Group ◽  
Natural Environments ◽  
Post Intervention

BackgroundContact with natural environments can bring health benefits, but research is lacking on how changes in access to natural environments might improve health, especially for deprived populations.ObjectiveTo evaluate the health impacts of woodland environment interventions intended to increase communities’ engagement with these woodlands.DesignA prospective study of Forestry Commission Scotland’s Woods In and Around Towns (WIAT) programme in deprived communities to enhance public access to natural environments. The study investigated the impact that WIAT had on community-level mental health over time.SettingThree intervention and three control woodland sites, and associated communities within 1.5 km of the woodlands, located in central Scotland and eligible for WIAT support.ParticipantsA core community survey was administered at each site in three waves, at baseline and after each phase of intervention (n = 5460, panel A). The completed survey contained a nested longitudinal cohort (n = 609, panel B). Community members also undertook 6-monthly environmental audits at all sites (n = 256) and participated in post-intervention focus groups (n = 34).InterventionsPhase 1 involved physical changes to the woodlands, including footpaths, entrances and vegetation. Phase 2 involved community engagement events promoting woodland use.Main outcome measuresThe primary outcome was the Perceived Stress Scale (PSS). Other health measures included health-related quality of life (HRQoL) EuroQol-5 Dimensions (EQ-5D), physical activity (PA) [International Physical Activity Questionnaire (IPAQ)], connectedness to nature [Inclusion of Nature in Self (INS) scale] and social cohesion.ResultsThe PSS scores significantly increased in the intervention group and marginally decreased in the control group. Multilevel regression models showed a differential impact between the intervention and the control at survey wave 3 in panel A [B(unstandardised coefficient) 3.58, 95% confidence interval (CI) 2.85 to 4.31;p < 0.001] and in panel B [B3.03, 95% CI 1.54 to 4.52;p < 0.001]. Using the same analytical approach, no significant change in HRQoL was associated with the intervention. Economic assessment included an illustrative cost–utility analysis and a cost–consequences analysis. The differential in stress between the intervention group and the control group was lower or non-significant in those who visited ‘nature’ in the previous year [panel A,B1.9, 95% CI 0.8 to 3.0;p < 0.001; panel B,B0.64, 95% CI –1.60 to 2.88;p = 0.57]. The IPAQ score showed a positive association with the intervention for moderate levels of PA [panel B,B559.3, 95% CI 211.3 to 907.2;p = 0.002] and overall PA [panel B,B861.5, 95% CI 106.5 to 1616.4;p = 0.025]. The intervention was also associated with increased nature connectedness and social cohesion by wave 3 – significant for panel A only. Qualitative and quantitative evidence showed that interventions increased the perceived quality of the woodland environment and enhanced its enjoyment for different activities, but the increase in use of natural environments post intervention was only 6% (panel B).LimitationsThis study was limited to three intervention sites. External factors may be the primary influence on health outcomes.ConclusionsThe WIAT interventions did not improve community-level health within 6 months of completion, and hence there was no basis for demonstrating cost-effectiveness. However, the WIAT interventions are low cost (average £11.80 per person in the eligible population) and have potential for cost-effectiveness, if health benefits were found in the longer term.Future workUsing routinely collected data to consider a whole-programme evaluation is recommended.FundingThe National Institute for Health Research Public Health Research programme.

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