Assessment of the Benefits of Targeted Interventions for Pandemic Control in China Based on Machine Learning Method and Web Service for COVID-19 Policy Simulation

Taking the Chinese city of Xiamen as an example, simulation and quantitative analysis were performed on the transmissions of the Coronavirus Disease 2019(COVID-19) and the influence of intervention combinations to assist policymakers in the preparation of targeted response measures. A machine learning model was built to estimate the effectiveness of interventions and simulate transmission in different scenarios. The comparison was conducted between simulated and real cases in Xiamen. A web inter...     

Development of an evidence-based ESCALATION system for recognition and response to paediatric clinical deterioration

AimThe aim of this study was to develop an evidence-based paediatric early warning system for infants and children that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care.MethodsA three-stage intervention development framework consisted of Stage 1: evidence review, benchmarking, stakeholder (health professionals, decision-makers, and health consumers) engagement, and consultation; Stage 2: planning and coproduction by the researchers and stakeholders using action research cycles; and Stage 3: prototyping and testing.ResultsA prototype evidence-based system incorporated human factor principles, used a structured approach to patient assessment, promoted situational awareness, and included family as well as clinician concern. Family involvement in detecting changes in their child's condition was supported by posters and flyers codesigned with health consumers. Five age-specific observation and response charts included 10 weighted variables and one unweighted variable (temperature) to convey a composite early warning score. The escalation pathway was supported by a targeted communication framework (iSoBAR NOW).ConclusionThe development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was a novel component of the system.     

全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响

目的探讨全方位护理干预对ERCP围术期患儿及家属应激及心理状况的影响。方法选取2018年1月10日至2019年10月10日行ERCP患儿100例,采用抽签法分为观察组及对照组各50例,分别对两组实施全方位护理及常规护理干预,观察ERCP围术期患儿应激情况和并发症发生率,对患儿家属进行焦虑和抑郁评分。结果观察组患儿轻度应激30例(60.00%)、中度应激20例(40.00%),应激程度低于对照组患儿(P<0.05);观察组患儿并发症发生率为4.00%,低于对照组患儿(P<0.05);观察组患儿家属的焦虑评分14.01±0.11、抑郁评分15.23±1.48,低于对照组患儿家属(P<0.05)。结论全方位护理干预能有效减少ERCP围术期患儿应激,降低并发症发生率,改善患儿家属负面情绪,从而促进患儿早期康复。     

The efficacy of interventions aimed at improving post-partum bonding: A review of interventions addressing parent-infant bonding in healthy and at risk populations

Parent-infant bonding during the postpartum period allows babies to start establishing a relationship with their parents from birth, and it also plays an important role in child development. As the failure to building a close and positive bond is typically associated with poorer neuropsychological, behavioural, emotional, and social development from infancy to adulthood, early interventions that support parent-infant bonding seem particularly important. This review aims to determine and describe the effectiveness of interventions addressing parent-infant bonding during the postpartum period. Papers that were published between 2007 and 2017, written in English, and focused on an intervention aimed at improving postpartum parent-infant bonding were identified and assessed, concerning their eligibility for inclusion; thirteen such interventions met inclusion criteria and analysed. These studies addressed parent-infant bonding interventions, both in normative and at-risk situations, relative to both parents and their babies, and evaluated the impact of different strategies, such as educational and behavioural programs, psychosocial interventions, programs providing instruction in specific techniques, and interventions based on neurostimulation techniques. The heterogeneous methodologies employed by the various studies failed to enable us to pursue deep comparative analyses across our findings; this reflects a limitation that must be considered in further research aimed at implementing and evaluating future interventions.     

African-American Adolescents’ Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial

Objective

Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment.

New evidence supporting lung cancer screening with low dose CT & surgical implications

IntroductionLung cancer is the leading cause of cancer-death worldwide. The U.S. Preventative Services Task Force (USPTSF) approved screening for current or former smokers aged 55–80 based on the results of the National Lung Screening trial (NLST). Following the NLST, new evidence has emerged from clinical trials and updates to previous trials prior to the anticipated update to the USPSTF guideline. We review the new evidence on lung cancer screening with low dose computed tomography (LDCT) and the surgical implications.MethodsA review of new literature was performed pertaining to lung cancer screening since implementation of UPSTF guidelines. Articles for inclusion were identified by both authors’, then search of the Pubmed and Cochrane database was performed from January 1st, 2013 through February 4th, 2020 using the MeSH search terms: “lung cancer”; “screening”; “low dose CT”. The results of these studies are summarized.ResultsWe identified multiple prospective randomized control trials and meta-analysis since the NLST supporting lung cancer-specific mortality with screening. We identified new nodule classification systems and the development of risk-models which may reduce false positive rates and identify high risk patients not currently eligible for screening. Finally, we discussed the surgical implications of screening.ConclusionNew data supports NLST findings and show ongoing benefit to LDCT for lung cancer screening. Standardized LDCT screening classification has been shown to reduce harm and lower false positive rates. Further study is needed regarding use of risk-modeling. Screening will require an increase in the thoracic workforce to accommodate the amount of surgically operable cancers.     

Interventions to Reduce Anticholinergic Burden in Adults Aged 65 and Older: A Systematic Review

IntroductionOlder age is associated with multimorbidity and polypharmacy with high anticholinergic burden (ACB). High ACB is linked to adverse events such as poor physical functioning, dementia, cardiovascular disease, and falls. Interventions are needed to reduce this burden.Aims/ObjectivesThe aim was to systematically review the literature to identify and describe studies of clinical and cost-effectiveness of interventions designed to reduce ACB in adults (≥65 years) on polypharmacy regimes, compared with usual care. The objective was to answer the following questions: What are the contents of the interventions? Were these interventions clinically effective? Were these interventions cost effective?.Design, setting, and participantsSystematic review of interventions to reduce anticholinergic burden in adults aged 65 and older in any clinical setting.MethodsEligible papers reported primary or secondary research describing any type of intervention including systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, or nonrandomized pre-post intervention studies (PPIs) published in English from January 2010 to February 2019. Databases searched included CINAHL, Ovid MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL).ResultsThe search yielded 5862 records. Eight studies (4 RCTs, 4 PPIs) conducted in hospital (4), community (2), nursing homes (1), and retirement villages (1) met the inclusion criteria. Pharmacists, either individually or as part of a team, provided the intervention in the majority of studies (6/8). Most (7/8) involved individual patient medication review followed by feedback to the prescriber. Two of the 4 RCTs and all non-RCTs reported a decrease in ACB following the intervention. No study reported cost outcome.Conclusions/ImplicationsPharmacists may be well placed to implement an ACB reduction intervention. This is the first systematic review of interventions to reduce ACB in older adults, and it highlights the need for development and testing of high-quality pragmatic clinical and cost-effectiveness trials in community and specific patient populations at high risk of harm from ACB.[PROSPERO registration: CRD42018089764].