Effectiveness of alcohol brief intervention in a general hospital: a randomized controlled trial

Objective: The purpose of this study was to examine the effectiveness of an alcohol brief intervention (ABI) on alcohol consumption in hazardous or harmful drinkers compared with screening alone within a general hospital setting. Method: Following screening, 124 hazardous or harmful drinkers (103 men, ages 18–80 years, score of 3–12 on the Fast Alcohol Screening Test [FAST]) admitted to medical and orthopedic wards during the 13-month recruitment period were randomized to receive an ABI or control. The intervention group received an ABI where they were supported to set their own personalized alcohol reduction goals, and both groups received a health information leaflet. Retrospective alcohol consumption for 7 days was reported for the week, before hospital admission and 6 months after it. Results: Demographics and clinical characteristics at baseline showed no statistical differences between the two groups on all variables except FAST score, which was higher in the intervention group (p ≤ .05). A reduction of 85 grams of alcohol per week (95% CI [162.46, 7.54]) was observed between groups in favor of the intervention group based on changes from baseline. However, there was no significant difference between groups for absolute grams of alcohol per week at 6 months. A significant mean difference in favor of the intervention group (U = 1,537, p = .043) was observed for weekly heavy drinking episodes. Conclusions: Our results suggest screening with delivery of ABI for harmful/hazardous drinkers in a general hospital is beneficial in reducing alcohol consumption compared with screening alone

A qualitative assessment of using lay trainers with type 2 diabetes in an intervention programme for people at risk of type 2 diabetes

Objective: More knowledge is needed on the impact of expert patients within health intervention programmes. The University of East Anglia Impaired Fasting Glucose (UEA-IFG) feasibility programme was a structured dietary and exercise intervention to reduce the risk of type 2 diabetes mellitus (T2DM) in susceptible individuals. Lay volunteers with T2DM (T2 trainers) were recruited to support participants in adopting healthier lifestyles. This study aimed to explore the acceptability, perceived effectiveness and sustainability of lay trainers within the programme. Design: A qualitative focus group study. Setting: A clinical research unit in Norwich, United Kingdom (UK). Method: Focus groups were conducted with: (1) T2 trainers (n = 15); (2) programme participants who had received their support (n = 11); and (3) salaried staff facilitators who had worked alongside the T2 trainers (n = 3). Framework analysis was applied to identify the different experiences of the lay trainer role. Results: All groups perceived advantages for peer support, particularly in sharing the day-to-day experiences of living with T2DM. However, staff facilitators raised the importance of role boundaries, emphasizing that T2 trainers should not provide medical advice. Acceptability of T2 trainers was enhanced by contacting participants at a convenient time and before substantial lifestyle changes had been made. Conclusion: Lay trainers were seen as a complementary method to motivate individuals to reduce their risks of T2DM. A less prescriptive approach needs to be adopted to enable full integration of lay trainers, allowing them a greater level of contribution. To sustain effective use of lay trainers, health professionals need to work alongside volunteers and be trained to encourage peer involvement

Interventions to improve healthcare workers’ hand hygiene compliance: a systematic review of systematic reviews

Objective: To synthesize the existing evidence base of systematic reviews of interventions to improve healthcare worker (HCW) hand hygiene compliance (HHC). Methods: PRISMA guidelines were followed, and 10 information sources were searched in September 2017, with no limits to language or date of publication, and papers were screened against inclusion criteria for relevance. Data were extracted and risk of bias was assessed. Results: Overall, 19 systematic reviews (n=20 articles) were included. Only 1 article had a low risk of bias. Moreover, 15 systematic reviews showed positive effects of interventions on HCW HHC, whereas 3 reviews evaluating monitoring technology did not. Findings regarding whether multimodal rather than single interventions are preferable were inconclusive. Targeting social influence, attitude, self-efficacy, and intention were associated with greater effectiveness. No clear link emerged between how educational interventions were delivered and effectiveness. Conclusions: This is the first systematic review of systematic reviews of interventions to improve HCW HHC. The evidence is sufficient to recommend the implementation of interventions to improve HCW HHC (except for monitoring technology), but it is insufficient to make specific recommendations regarding the content or how the content should be delivered. Future research should rigorously apply behavior change theory, and recommendations should be clearly described with respect to intervention content and how it is delivered. Such recommendations should be tested for longer terms using stronger study designs with clearly defined outcomes

Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment

BACKGROUND: Impairment of vision is associated with a decrease in activities of daily living. Avoidance of physical activity in older adults with visual impairment can lead to functional decline and is an important risk factor for falls. The rate of falls and fractures is higher in older people with visual impairment than in age‐matched visually normal older people. Possible interventions to reduce activity restriction and prevent falls include environmental and behavioral interventions. OBJECTIVES: We aimed to assess the effectiveness and safety of environmental and behavioral interventions in reducing physical activity limitation, preventing falls and improving quality of life amongst visually impaired older people. SEARCH METHODS: We searched CENTRAL (including the Cochrane Eyes and Vision Trials Register) (Issue 2, 2020), Ovid MEDLINE, Embase and eight other databases to 4 February 2020, with no language restrictions. SELECTION CRITERIA: Eligible studies were randomized controlled trials (RCTs) and quasi‐randomized controlled trials (Q‐RCTs) that compared environmental interventions, behavioral interventions or both, versus control (usual care or no intervention); or that compared different types of environmental or behavioral interventions. Eligible study populations were older people (aged 60 and over) with irreversible visual impairment, living in their own homes or in residential settings. To be eligible for inclusion, studies must have included a measure of physical activity or falls, the two primary outcomes of interest. Secondary outcomes included fear of falling, and quality of life. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included six RCTs (686 participants) conducted in five countries (Australia, Hungary, New Zealand, UK, US) with follow‐up periods ranging from two to 12 months. Participants in these trials included older adults (mean age 80 years) and were mostly female (69%), with visual impairments of varying severity and underlying causes. Participants mostly lived in their homes and were physically independent. We classified all trials as having high risk of bias for masking of participants, and three trials as having high or unclear risk of bias for all other domains. The included trials evaluated various intervention strategies (e.g. an exercise program versus home safety modifications). Heterogeneity of study characteristics, including interventions and outcomes, (e.g. different fall measures), precluded any meta‐analysis. Two trials compared the home safety modification by occupational therapists versus social/home visits. One trial (28 participants) reported physical activity at six months and showed no evidence of a difference in mean estimates between groups (step counts: mean difference (MD) = 321, 95% confidence interval (CI) ‐1981 to 2623; average walking time (minutes): MD 1.70, 95% CI ‐24.03 to 27.43; telephone questionnaire for self‐reported physical activity: MD ‐3.68 scores, 95% CI ‐20.6 to 13.24; low‐certainty of evidence for each outcome). Two trials reported the proportion of participants who fell at six months (risk ratio (RR) 0.76, 95% CI 0.38 to 1.51; 28 participants) and 12 months (RR 0.59, 95% CI 0.43 to 0.80, 196 participants) with low‐certainty of evidence for each outcome. One trial (28 participants) reported fear of falling at six months, using the Short Falls Efficacy Scale‐International, and found no evidence of a difference in mean estimates between groups (MD 2.55 scores, 95% CI ‐0.51 to 5.61; low‐certainty of evidence). This trial also reported quality of life at six months using 12‐Item Short Form Health Survey, and showed no evidence of a difference in mean estimates between groups (MD ‐3.14 scores, 95% CI ‐10.86 to 4.58; low‐certainty of evidence). Five trials compared a behavioral intervention (exercise) versus usual activity or social/home visits. One trial (59 participants) assessed self‐reported physical activity at six months and showed no evidence of a difference between groups (MD 9.10 scores, 95% CI ‐13.85 to 32.5; low‐certainty of evidence). Three trials investigated different fall measures at six or 12 months, and found no evidence of a difference in effect estimates (RRs for proportion of fallers ranged from 0.54 (95% CI 0.29 to 1.01; 41 participants); to 0.93 (95% CI 0.61 to 1.39; 120 participants); low‐certainty of evidence for each outcome). Three trials assessed the fear of falling using Short Falls Efficacy Scale‐International or the Illinois Fear of Falling Measure from two to 12 months, and found no evidence of a difference in mean estimates between groups (the estimates ranged from ‐0.88 score (95% CI ‐2.72 to 0.96, 114 participants) to 1.00 score (95% CI ‐0.13 to 2.13; 59 participants); low‐certainty of evidence). One trial (59 participants) assessed the European Quality of Life scale at six months (MD ‐0.15 score, 95% CI ‐0.29 to ‐0.01), and found no evidence of a clinical difference between groups (low‐certainty of evidence). AUTHORS' CONCLUSIONS: There is no evidence of effect for most of the environmental or behavioral interventions studied for reducing physical activity limitation and preventing falls in visually impaired older people. The certainty of evidence is generally low due to poor methodological quality and heterogeneous outcome measurements. Researchers should form a consensus to adopt standard ways of measuring physical activity and falls reliably in older people with visual impairments. Fall prevention trials should plan to use objectively measured or self‐reported physical activity as outcome measures of reduced activity limitation. Future research should evaluate the acceptability and applicability of interventions, and use validated questionnaires to assess the adherence to rehabilitative strategies and performance during activities of daily living

Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry

Background: Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI’s use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol’s place within participants’ lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. Methods: This qualitative study was underpinned by a realist evaluation approach and involved semistructured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. Results: Participants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. Conclusions: The findings provide an insight into participants’ views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a ‘significant other’ who encourages and experiences benefit. In addition having a purpose or structure with activities linked to employment and/or social and leisure pursuits offers the potential to enhance and sustain reduced alcohol consumption. Trial registration: Trial registration number TRN NCT00982306 September 22nd 200

Recommendations for a core outcome set for measuring standing balance in adult populations: a consensus-based approach

Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally

New insights into the impact of neuro-inflammation in rheumatoid arthritis.

Rheumatoid arthritis (RA) is considered to be, in many respects, an archetypal autoimmune disease that causes activation of pro-inflammatory pathways resulting in joint and systemic inflammation. RA remains a major clinical problem with the development of several new therapies targeted at cytokine inhibition in recent years. In RA, biologic therapies targeted at inhibition of tumor necrosis factor alpha (TNFα) have been shown to reduce joint inflammation, limit erosive change, reduce disability and improve quality of life. The cytokine TNFα has a central role in systemic RA inflammation and has also been shown to have pro-inflammatory effects in the brain. Emerging data suggests there is an important bidirectional communication between the brain and immune system in inflammatory conditions like RA. Recent work has shown how TNF inhibitor therapy in people with RA is protective for Alzheimer's disease. Functional MRI studies to measure brain activation in people with RA to stimulus by finger joint compression, have also shown that those who responded to TNF inhibition showed a significantly greater activation volume in thalamic, limbic, and associative areas of the brain than non-responders. Infections are the main risk of therapies with biologic drugs and infections have been shown to be related to disease flares in RA. Recent basic science data has also emerged suggesting that bacterial components including lipopolysaccharide induce pain by directly activating sensory neurons that modulate inflammation, a previously unsuspected role for the nervous system in host-pathogen interactions. In this review, we discuss the current evidence for neuro-inflammation as an important factor that impacts on disease persistence and pain in RA