Preventable harms from medications are significant threats to patient safety in community settings, especially among ambulatory older adults on multiple prescription medications. Patients may partner ...with primary care professionals by taking on active roles in decisions, learning the basics of medication self-management, and working with community resources.
This study aims to assess the impact of a set of patient partnership tools that redesign primary care encounters to encourage and empower patients to make more effective use of those encounters to improve medication safety.
The study is a nonrandomized, cross-sectional stepped wedge cluster-controlled trial with 1 private family medicine clinic and 2 public safety-net primary care clinics each composing their own cluster. There are 2 intervention sequences with 1 cluster per sequence and 1 control sequence with 1 cluster. Cross-sectional surveys will be taken immediately at the conclusion of visits to the clinics during 6 time periods of 6 weeks each, with a transition period of no data collection during intervention implementation. The number of visits to be surveyed will vary by period and cluster. We plan to recruit patients and professionals for surveys during 405 visits. In the experimental periods, visits will be conducted with two partnership tools and associated clinic process changes: (1) a 1-page visit preparation guide given to relevant patients by clinic staff before seeing the provider, with the intention to improve communication and shared decision-making, and (2) a library of short educational videos that clinic staff encourage patients to watch on medication safety. In the control periods, visits will be conducted with usual care. The primary outcome will be patients' self-efficacy in medication use. The secondary outcomes are medication-related issues such as duplicate therapies identified by primary care providers and assessment of collaborative work during visits.
The study was funded in September 2019. Data collection started in April 2023 and ended in December 2023. Data was collected for 405 primary care encounters during that period. As of February 15, 2024, initial descriptive statistics were calculated. Full data analysis is expected to be completed and published in the summer of 2024.
This study will assess the impact of patient partnership tools and associated process changes in primary care on medication use self-efficacy and medication-related issues. The study is powered to identify types of patients who may benefit most from patient engagement tools in primary care visits.
ClinicalTrials.gov NCT05880368; https://clinicaltrials.gov/study/NCT05880368.
DERR1-10.2196/57878.
Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however, objective PA measures show that most patients have low PA preoperatively and make only modest PA changes ...postoperatively. Patients require additional support to adopt habitual PA. The objective of this study was to test the efficacy of a preoperative PA intervention (PAI) versus standard presurgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients.
Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; body mass index BMI=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to postintervention change in daily bout-related (≥10 min bouts) and total (≥1 min bouts) MVPA minutes, was assessed objectively via a multisensor monitor worn for 7 days at baseline- and postintervention.
Retention was 84% at the postintervention primary endpoint. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 min/d in bout-related MVPA (baseline: 4.4±5.5 to postintervention: 21.0±21.4 min/d) compared to no change (-0.3±12.7 min/d; baseline: 7.9±16.6 to postintervention: 7.6±11.5 min/d) for SC (P=.001). Similarly, PAI achieved a mean increase of 21.0±26.9 min/d in total MVPA (baseline: 30.9±21.2 to postintervention: 51.9±30.0 min/d), whereas SC demonstrated no change (-0.1±16.3 min/d; baseline: 33.7±33.2 to postintervention: 33.6±28.5 minutes/d) (P=.001).
With behavioral intervention, patients can significantly increase MVPA before bariatric surgery compared to SC. Future studies should determine whether preoperative increases in PA can be maintained postoperatively and contribute to improved surgical outcomes.
This research is the first attempt to characterize the carbon equivalent emissions associated with pallet remanufacturing operations for two repositioning scenarios (cross-docking and take-back), and ...under multiple levels of pallet loading and service conditions. Industry data was acquired through observations and time studies at 12 facilities in North America. Models of pallet component breakdown patterns were used to characterize the carbon equivalent emissions of pallet remanufacturing over the predicted service life. Results show that materials account for the vast majority of remanufacturing operation emissions with three board components responsible for 50–90% of total remanufacturing emissions. The loading and handling environment significantly impacts remanufacturing emissions thus breakeven points where remanufacturing emissions exceed those from newly manufactured pallets are provided for each condition. Also, a pallet-cross-docking policy was shown to reduce emissions when compared to a take-back policy. Finally, a linear optimization model is provided to understand the benefits of preemptive component repair. Results show that preemptive remanufacturing schedules can reduce carbon equivalent emissions by up to 40%. These insights can help guide the pallet industry towards more sustainable pallet management strategies.
•Materials account for the majority of emissions within remanufacturing operations.•Three pallet components account for 50–90% of pallet remanufacturing emissions.•Loading and handling conditions greatly impact the remanufacturing emissions.•Remanufacturing depot location can help reduce CO2 eq. footprint.•Preemptive remanufacturing schedules can reduce CO2 eq. emissions by up to 40%.
Background
Objective quantification of physical activity (PA) is needed to understand PA and sedentary behaviors in bariatric surgery patients, yet it is unclear whether PA estimates produced by ...different monitors are comparable and can be interpreted similarly across studies.
Methods
We compared PA estimates from the Stayhealthy RT3 triaxial accelerometer (RT3) and the Sensewear Pro
2
Armband (SWA) at both the group and individual participant level. Bariatric surgery candidates were instructed to wear the RT3 and SWA during waking hours for 7 days. Participants meeting valid wear time requirements (≥4 days of ≥8 h/day) for both monitors were included in the analyses. Time spent in sedentary (<1.5 METs), light (1.5–2.9 METs), moderate-to-vigorous (MVPA; ≥3.0 METs), and total PA (TPA; ≥1.5 METs) according to each monitor was compared.
Results
Fifty-five participants (BMI 48.4 ± 8.2 kg/m
2
) met wear time requirements. Daily time spent in sedentary (RT3 582.9 ± 94.3; SWA 602.3 ± 128.6 min), light (RT3 131.9 ± 60.0; SWA 120.6 ± 65.7 min), MVPA (RT3 25.9 ± 20.9; SWA 29.9 ± 19.5 min), and TPA (RT3 157.8 ± 74.5; SWA 150.6 ± 80.7 min) was similar between monitors (
p
> 0.05). While the average difference in TPA between the two monitors at the group level was 7.2 ± 64.2 min; the average difference between the two monitors for each participant was 45.6 ± 45.4 min. At the group level, the RT3 and SWA provide similar estimates of PA and sedentary behaviors; however, concordance between monitors may be compromised at the individual level.
Conclusions
Findings related to PA and sedentary behaviors at the group level can be interpreted similarly across studies when either monitor is used.
Objective
To examine the impact of a pre‐bariatric surgery physical activity intervention (PAI), designed to increase bout‐related (≥10 min) moderate to vigorous PA (MVPA), on health‐related quality ...of life (HRQoL).
Methods
Analyses included 75 adult participants (86.7% female; BMI = 45.0 ± 6.5 kg m−2) who were randomly assigned to 6 weeks of PAI (n = 40) or standard pre‐surgical care (SC; n = 35). PAI received 6 individual weekly counseling sessions to increase walking exercise. Participants wore an objective PA monitor for 7 days and completed the SF‐36 Health Survey at baseline and post‐intervention to evaluate bout‐related MVPA and HRQoL changes, respectively.
Results
PAI increased bout‐related MVPA from baseline to post‐intervention (4.4 ± 5.5 to 21.0 ± 21.4 min day−1) versus no change (7.9 ± 16.6 to 7.6 ± 11.5 min day−1) for SC (P = 0.001). PAI reported greater improvements than SC on all SF‐36 physical and mental scales (P < 0.05), except role‐emotional. In PAI, better baseline scores on the physical function and general health scales predicted greater bout‐related MVPA increases (P < 0.05), and greater bout‐related MVPA increases were associated with greater post‐intervention improvements on the physical function, bodily pain, and general health scales (P < 0.05).
Conclusions
Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery candidates. Future studies should examine whether this effect improves surgical safety, weight loss outcomes, and postoperative HRQoL.
Objective
To examine the impact of a pre‐bariatric surgery physical activity intervention (PAI), designed to increase bout‐related (≥10 min) moderate to vigorous PA (MVPA), on health‐related quality ...of life (HRQoL).
Methods
Analyses included 75 adult participants (86.7% female; BMI = 45.0 ± 6.5 kg m
−2
) who were randomly assigned to 6 weeks of PAI (
n
= 40) or standard pre‐surgical care (SC;
n
= 35). PAI received 6 individual weekly counseling sessions to increase walking exercise. Participants wore an objective PA monitor for 7 days and completed the SF‐36 Health Survey at baseline and post‐intervention to evaluate bout‐related MVPA and HRQoL changes, respectively.
Results
PAI increased bout‐related MVPA from baseline to post‐intervention (4.4 ± 5.5 to 21.0 ± 21.4 min day
−1
) versus no change (7.9 ± 16.6 to 7.6 ± 11.5 min day
−1
) for SC (
P
= 0.001). PAI reported greater improvements than SC on all SF‐36 physical and mental scales (
P
< 0.05), except role‐emotional. In PAI, better baseline scores on the physical function and general health scales predicted greater bout‐related MVPA increases (
P
< 0.05), and greater bout‐related MVPA increases were associated with greater post‐intervention improvements on the physical function, bodily pain, and general health scales (
P
< 0.05).
Conclusions
Increasing PA preoperatively improves physical and mental HRQoL in bariatric surgery candidates. Future studies should examine whether this effect improves surgical safety, weight loss outcomes, and postoperative HRQoL.
Computer-based microsimulation provides opportunities to interactively learn critical skills in a relatively risk-free environment, but there has been little study of its usefulness in nursing ...education.
In a comparison group design with random assignment, 78 undergraduate pediatric nursing students learned concepts of airway management via lecture or via Laerdal's MicroSim®. A week later, all participated in a bronchiolitis simulation. Written exam questions (four on end-of-unit examination at 2 weeks and two on end-of-course examination at 2 months postinitial learning) assessed knowledge acquisition. At 3 weeks postinitial learning, all students completed a severe asthma MicroSim (scores assessed knowledge transfer). An end-of-course survey evaluated learner receptivity to microsimulation.
Exam scores and learner receptivity to microsimulation were similar for both learning approaches. MicroSim learners had better knowledge transfer scores (first attempt) although lecture learners spent significantly more time interacting with the severe asthma MicroSim. MicroSim actively engages learners and, in this study, yielded learning outcomes equivalent to those achieved with lecture.
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