BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise lev...BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise levels have been associated with sleep disruption,heightened cardiovascular stress,and an increased risk of delirium in patients.Among healthcare workers,noise can impair focus and cognitive performance,potentially compromising care quality.AIM To evaluate the effectiveness of educational and behavioural interventions in reducing noise levels within intensive care units(ICUs),recognizing their potential impact on patient outcomes and healthcare effectiveness.METHODS A prospective interventional study in two Singaporean teaching hospitals compared peak and average sound levels between control and intervention groups.An educational and behavioural intervention comprising talks,posters,and self-audits by nurse champions was initiated in two ICUs in one hospital on November 18,2023.Sound measurements were collected at 4 Locations within each ICU before and after intervention.Baseline measurements were taken from October 22,2023 to October 29,2023,and post-intervention measurements from December 21,2023 to December 22,2023.The hospitals served as the primary exposure variable,controlled for ICU type(medical vs surgical)and hour of the day.RESULTS Our analysis generated 48 pairs of peak and average sound level readings for each unit(control n=48 readings;intervention n=48 readings).The effect of the intervention was associated with a significant 4.8 dB decrease in average sound level(P=0.009)and a nonsignificant 4.3 dB decrease in peak sound level(P=0.104),adjusted for hour of day and type of ICU.CONCLUSION Educational and behavioural interventions successfully reduced average sound levels,emphasizing their positive impact on noise control.These findings contribute valuable insights for optimizing noise reduction efforts in critical care settings.Future studies may explore additional systemic and environmental interventions to enhance noise management strategies.展开更多
Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chi...Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.展开更多
In 2021,approximately 537 million people suffered from diabetes mellitus(DM)globally,and this figure will increase to approximately 783 million within the next quarter-century.The increasing burden of DM is a pressing...In 2021,approximately 537 million people suffered from diabetes mellitus(DM)globally,and this figure will increase to approximately 783 million within the next quarter-century.The increasing burden of DM is a pressing global public health issue.Therefore,the early identification of high-risk groups and implementation of effective intervention measures is imperative.展开更多
AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome.METHODS Randomized controlled trials comparin...AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome.METHODS Randomized controlled trials comparing psychological interventions(stress management/relaxation therapy(cognitive)behavioral therapy,short-term psychodynamic therapy,and hypnotherapy)for the treatment of adult patients with irritable bowel syndrome(IBS)diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching Pub Med,Embase,the Cochrane Library,CINAHL and Psyc INFO databases.Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review.Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment.The placebo response rate(PRR)was computed for IBS symptom severity(primary outcome measure)as well as for anxiety,depression and quality of life(secondary outcome measures).RESULTS Six studies,with a total of 555 patients met the inclusion criteria.Four studies used an educational intervention,whereas two studies used a form of supportive therapy as the placebo intervention.The PRR for IBS symptom severity ranged from 25%to 59%,with a pooled mean of 41.4%.The relative PRR for the secondary outcome measures ranged from 0%to 267%for anxiety,6%to 52%for depression 20%to 125%for quality of life.The PRR associated with pharmacological treatments,treatment with dietary bran and complementary medicine ranged from 37.5%to 47%.Contrary to our expectations,the PRR in studies on psychological interventions was comparable to that in studies on pharmacological,dietary and alternative medical interventions.CONCLUSION The PRR is probably determined to a larger extent by patient-related factors,such as expectations and desire for the treatment to be effective,than the content of the placebo intervention.展开更多
The main purpose of this study was to assess the effectiveness of watershed management intervention in Chena Woreda. A systematic sampling technique was used to select sample micro-watersheds, and random sampling meth...The main purpose of this study was to assess the effectiveness of watershed management intervention in Chena Woreda. A systematic sampling technique was used to select sample micro-watersheds, and random sampling method was used to select individual households from both intervention and non-intervention areas. Data were collected through field observation, household questionnaire survey, focused group discussion, in-depth interview and key informant interview. Moreover, physical soil and water conservation structures’ layout measurement was conducted. Descriptive statistics, t-test, chi-square test and participation index were used for data analyses. The study revealed that the intervention has good achievements in reducing soil erosion, improving water availability and quality, developing tree plantation and diversifying household income sources in the catchment. However, poor community participation, lack of the structures design alignment with standards, inappropriate time of implementation, lack of diversified soil water conservation measures, absence of regular maintenance and management of the structures were some of the major limitation of the intervention. Therefore, this study recommends that the stake-holders should make appropriate correction measures for observed failures and further interdisciplinary study should be conducted to explore the problems.展开更多
Improving and sustaining successful public health interventions relies increasingly on the ability to identify the key components of an intervention that are effective, to identify for whom the intervention is effecti...Improving and sustaining successful public health interventions relies increasingly on the ability to identify the key components of an intervention that are effective, to identify for whom the intervention is effective, and to identify under what conditions the intervention is effective. Bayesian probability an “advanced” experimental design framework of methodology is used in the study to develop a systematic tool that can assist health care managers and field workers in measuring effectiveness of health program intervention and systematically assess the components of programs to be applied to design program improvements and to advocate for resources. The study focuses on essential management elements of the health system that must be in place to ensure the effectiveness of IMNCI intervention. Early experiences with IMNCI implemented led to greater awareness of the need to improve drug delivery, support for effective planning and management at all levels and address issues related to the organization of work at health facilities. The efficacy of IMNCI program from the experience of experts and specialists working in the state is 0.67 and probability of effective- ness of all management components in the study is 58%. Overall the standard assessment tool used predicts success of around 39% for the IMNCI intervention implemented in current situation in Rajasthan. Training management component carried the highest weight-age of 21% with 73% probability of being effective in the state. Human resource management has weight-age of 13% with 53% probability of being effective in current scenario. Monitoring and evaluation carried a weight-age of 11% with only 33% probability of being effective. Operational planning carried a weight-age of 9% with 100% probability of being effectively managed. Supply management carried a weight-age of 8% with zero probability of being effective in the current field scenario. In the study, each question that received low score identifies it as a likely obstacle to the success of the health program. The health program should improve all sub-components with low scores to increase the likelihood of meeting its objectives. Public health interventions tend to be complex, programmatic and context dependent. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of the intervention, and relative success or failure of the intervention itself. We advocate management attributes incorporation into criteria for appraising evidence on public health interventions. This can strengthen the value of evidence and their potential contributions to the process of public health management and social development.展开更多
Objective: The purpose of this paper is to critique the list of independent variables commonly used in observational research and test the impact of variables for prior use and treatment history on estimates of treatm...Objective: The purpose of this paper is to critique the list of independent variables commonly used in observational research and test the impact of variables for prior use and treatment history on estimates of treatment effects. Methods: Using data from the California Medicaid program, this study generated a series of OLS estimates of the effect of atypical antipsychotic medications on costs and duration of therapy to illustrate the impact of alternative model specifications on treatment effects. The first sequence of estimates consisted of six model specifications, the last of which included variables reflecting the type of episode defined according to prior treatment history and compliance. The second sequences repeated the specification of the first 6 models but were carried out separately by episode type to examine the heterogeneity of treatment effect. The second sequence of models documented the impact of additional drug history variables. Results: Estimates of the impact of atypical antipsychotic use on total costs and duration on initial drug were statistically significant in the first 6 models. Estimates changed significantly when dummy variables indicating prior use of inpatient service and nursing home care were included in the model specification. Estimated effects changed substantially when prior total cost was included in cost analysis, or when prior treatment duration was included in duration analysis. Significant variation also existed in estimated effects across episode types, and it was particularly pronounced before controlling for prior cost/duration. Conclusion: It is important to add prior measures of the outcome variable to control for unobserved bias in retrospective studies. Also, the accuracy and utility of results to clinicians can be improved significantly if analyses are performed by episode type.展开更多
文摘BACKGROUND Excessive noise in healthcare environments—commonly described as"unwanted sound"—has been linked to a range of negative impacts on both patients and staff.In clinical settings,elevated noise levels have been associated with sleep disruption,heightened cardiovascular stress,and an increased risk of delirium in patients.Among healthcare workers,noise can impair focus and cognitive performance,potentially compromising care quality.AIM To evaluate the effectiveness of educational and behavioural interventions in reducing noise levels within intensive care units(ICUs),recognizing their potential impact on patient outcomes and healthcare effectiveness.METHODS A prospective interventional study in two Singaporean teaching hospitals compared peak and average sound levels between control and intervention groups.An educational and behavioural intervention comprising talks,posters,and self-audits by nurse champions was initiated in two ICUs in one hospital on November 18,2023.Sound measurements were collected at 4 Locations within each ICU before and after intervention.Baseline measurements were taken from October 22,2023 to October 29,2023,and post-intervention measurements from December 21,2023 to December 22,2023.The hospitals served as the primary exposure variable,controlled for ICU type(medical vs surgical)and hour of the day.RESULTS Our analysis generated 48 pairs of peak and average sound level readings for each unit(control n=48 readings;intervention n=48 readings).The effect of the intervention was associated with a significant 4.8 dB decrease in average sound level(P=0.009)and a nonsignificant 4.3 dB decrease in peak sound level(P=0.104),adjusted for hour of day and type of ICU.CONCLUSION Educational and behavioural interventions successfully reduced average sound levels,emphasizing their positive impact on noise control.These findings contribute valuable insights for optimizing noise reduction efforts in critical care settings.Future studies may explore additional systemic and environmental interventions to enhance noise management strategies.
基金supported by the social development project of the National Social Science Fund Project(No.17BTQ063)National Natural Science Foundation of China(72174094).
文摘Stroke,which is the second leading cause of mortality worldwide and the third leading cause of death and disability combined,[1]necessitates cost-effective rehabilitation interventions.Acupuncture is a traditional Chinese medicine therapy that is increasingly recognized as a complementary stroke therapy.
基金supported by the Research Funds of the Center for Big Data and Population Health of IHM(grant number JKS2022015)the Key Scientific Research Fund of the Anhui Provincial Education Department(grant number2023AH050610)the Anhui Natural Science Foundation(grant number 1808085QH252)。
文摘In 2021,approximately 537 million people suffered from diabetes mellitus(DM)globally,and this figure will increase to approximately 783 million within the next quarter-century.The increasing burden of DM is a pressing global public health issue.Therefore,the early identification of high-risk groups and implementation of effective intervention measures is imperative.
文摘AIM To determine the placebo response rate associated with different types of placebo interventions used in psychological intervention studies for irritable bowel syndrome.METHODS Randomized controlled trials comparing psychological interventions(stress management/relaxation therapy(cognitive)behavioral therapy,short-term psychodynamic therapy,and hypnotherapy)for the treatment of adult patients with irritable bowel syndrome(IBS)diagnosed with the Manning or Rome criteria with an adequate placebo control treatment and reporting data on IBS symptom severity were identified by searching Pub Med,Embase,the Cochrane Library,CINAHL and Psyc INFO databases.Full-text articles that were written in English and published between 1966 and February 2016 in peer-reviewed journals were selected for the present review.Placebo interventions were considered to be adequate if the number of sessions and the amount of time spent with the therapist were the same as in the active treatment.The placebo response rate(PRR)was computed for IBS symptom severity(primary outcome measure)as well as for anxiety,depression and quality of life(secondary outcome measures).RESULTS Six studies,with a total of 555 patients met the inclusion criteria.Four studies used an educational intervention,whereas two studies used a form of supportive therapy as the placebo intervention.The PRR for IBS symptom severity ranged from 25%to 59%,with a pooled mean of 41.4%.The relative PRR for the secondary outcome measures ranged from 0%to 267%for anxiety,6%to 52%for depression 20%to 125%for quality of life.The PRR associated with pharmacological treatments,treatment with dietary bran and complementary medicine ranged from 37.5%to 47%.Contrary to our expectations,the PRR in studies on psychological interventions was comparable to that in studies on pharmacological,dietary and alternative medical interventions.CONCLUSION The PRR is probably determined to a larger extent by patient-related factors,such as expectations and desire for the treatment to be effective,than the content of the placebo intervention.
文摘The main purpose of this study was to assess the effectiveness of watershed management intervention in Chena Woreda. A systematic sampling technique was used to select sample micro-watersheds, and random sampling method was used to select individual households from both intervention and non-intervention areas. Data were collected through field observation, household questionnaire survey, focused group discussion, in-depth interview and key informant interview. Moreover, physical soil and water conservation structures’ layout measurement was conducted. Descriptive statistics, t-test, chi-square test and participation index were used for data analyses. The study revealed that the intervention has good achievements in reducing soil erosion, improving water availability and quality, developing tree plantation and diversifying household income sources in the catchment. However, poor community participation, lack of the structures design alignment with standards, inappropriate time of implementation, lack of diversified soil water conservation measures, absence of regular maintenance and management of the structures were some of the major limitation of the intervention. Therefore, this study recommends that the stake-holders should make appropriate correction measures for observed failures and further interdisciplinary study should be conducted to explore the problems.
文摘Improving and sustaining successful public health interventions relies increasingly on the ability to identify the key components of an intervention that are effective, to identify for whom the intervention is effective, and to identify under what conditions the intervention is effective. Bayesian probability an “advanced” experimental design framework of methodology is used in the study to develop a systematic tool that can assist health care managers and field workers in measuring effectiveness of health program intervention and systematically assess the components of programs to be applied to design program improvements and to advocate for resources. The study focuses on essential management elements of the health system that must be in place to ensure the effectiveness of IMNCI intervention. Early experiences with IMNCI implemented led to greater awareness of the need to improve drug delivery, support for effective planning and management at all levels and address issues related to the organization of work at health facilities. The efficacy of IMNCI program from the experience of experts and specialists working in the state is 0.67 and probability of effective- ness of all management components in the study is 58%. Overall the standard assessment tool used predicts success of around 39% for the IMNCI intervention implemented in current situation in Rajasthan. Training management component carried the highest weight-age of 21% with 73% probability of being effective in the state. Human resource management has weight-age of 13% with 53% probability of being effective in current scenario. Monitoring and evaluation carried a weight-age of 11% with only 33% probability of being effective. Operational planning carried a weight-age of 9% with 100% probability of being effectively managed. Supply management carried a weight-age of 8% with zero probability of being effective in the current field scenario. In the study, each question that received low score identifies it as a likely obstacle to the success of the health program. The health program should improve all sub-components with low scores to increase the likelihood of meeting its objectives. Public health interventions tend to be complex, programmatic and context dependent. The evaluation of evidence must distinguish between the fidelity of the evaluation process in detecting the success or failure of the intervention, and relative success or failure of the intervention itself. We advocate management attributes incorporation into criteria for appraising evidence on public health interventions. This can strengthen the value of evidence and their potential contributions to the process of public health management and social development.
文摘Objective: The purpose of this paper is to critique the list of independent variables commonly used in observational research and test the impact of variables for prior use and treatment history on estimates of treatment effects. Methods: Using data from the California Medicaid program, this study generated a series of OLS estimates of the effect of atypical antipsychotic medications on costs and duration of therapy to illustrate the impact of alternative model specifications on treatment effects. The first sequence of estimates consisted of six model specifications, the last of which included variables reflecting the type of episode defined according to prior treatment history and compliance. The second sequences repeated the specification of the first 6 models but were carried out separately by episode type to examine the heterogeneity of treatment effect. The second sequence of models documented the impact of additional drug history variables. Results: Estimates of the impact of atypical antipsychotic use on total costs and duration on initial drug were statistically significant in the first 6 models. Estimates changed significantly when dummy variables indicating prior use of inpatient service and nursing home care were included in the model specification. Estimated effects changed substantially when prior total cost was included in cost analysis, or when prior treatment duration was included in duration analysis. Significant variation also existed in estimated effects across episode types, and it was particularly pronounced before controlling for prior cost/duration. Conclusion: It is important to add prior measures of the outcome variable to control for unobserved bias in retrospective studies. Also, the accuracy and utility of results to clinicians can be improved significantly if analyses are performed by episode type.
