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An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender‐equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother–father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender‐equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender‐equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices. Key messages: Mothers in behaviour change communication (BCC) group mothers held more gender‐equal beliefs than control mothers, while BCC and control fathers shared similar views, suggesting a male resistance to gender equality.Mothers found fathers' involvement in childcare socially acceptable but often perceived them as inexperienced, which limited their participation.Control mothers' traditional view on household chores maintained the conventional labour division, influencing fathers' involvement.Fathers typically resisted maternal control of resources; however, they agreed that the more knowledgeable should lead decision‐making. BCC mothers showed greater confidence in making household decisions as effectively as fathers. [ABSTRACT FROM AUTHOR]

Venous leg ulcers (VLUs) are open skin lesions of the lower legs arising in areas affected by venous hypertension that are associated with substantial morbidity. Clinical trials testing innovative approaches to improve healing outcomes are critically needed because standard therapies are often ineffective. However, patients with VLUs frequently have multiple physical, emotional and socioeconomic challenges that can negatively impact their decision to enrol in a clinical trial. To benefit clinical researchers and ultimately the community of patients with chronic wounds, this paper describes the monitoring and modification of recruitment strategies in an ongoing clinical trial testing effects of omega‐3 fatty acid oral supplementation on VLU healing in ageing adults (n = 208). Multiple modifications over time in this study have targeted participation barriers identified through data monitoring and include expanding inclusion criteria, adding recruitment sites, enhancing communication methods, and meeting patients' transportation needs. Recruitment activities from January 2019 to June 2022 have resulted in 57 participants (mean age: 63.7 years). Overall, the recruitment rate is 42.5% of patients contacted during face‐to‐face visits. Overcoming barriers to participation is key to helping patients with VLUs interested in research enrol in clinical trials aiming to improve healing outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co‐designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient‐held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one‐to‐one semi‐structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co‐analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co‐analysts and as co‐authors. [ABSTRACT FROM AUTHOR]

Open wounds are usually closed with suture. However, young patients often do not cooperate and prevent proper suture placement. Young patients are often terrified of mild pain and wholly uncooperative, which is why we introduce this timesaving, less painful, more aesthetic technique of placing and removing stitches. 104 patients with facial lacerations aged 5 to 15 years were treated at a single center from May 2019 to March 2021. Patients were randomly assigned equally to a simple interrupted suture group (the SI group) or a continuous locking with Steri‐Strip group (the CS group). Suture times, times for stitch removal, pain scores at stitch removal and mature scar scores were evaluated. Suture and stitch removal times were significantly shorter, and pain scores at stitch removal and observer scar assessment scale scores were lower in the CS group. Patient scar assessment scale score was non‐significantly lower in the SI group. This study shows that the novel continuous locking with the Steri‐Strip technique is easier and quicker to perform, causes less pain when removing stitches, provides better aesthetic results than the simple interrupted suture technique and suggests the continuous locking with Steri‐Strip technique would be very useful for uncooperative young patients. [ABSTRACT FROM AUTHOR]

Responsive feeding serves as an important protective factor for infant growth and overall health development. This study based on self‐determination theory (SDT) aimed to assess the effects of a responsive breastfeeding (RBF) intervention programme on maternal breastfeeding and infant growth and development. A total of 110 mother–infant pairs were recruited and randomly divided into an intervention group (n = 55) and a control group (n = 55). The primary outcomes were breastfeeding motivation score, breastfeeding self‐efficacy (BSE) and exclusive breastfeeding rate; the secondary outcomes were infant physical development at 6 weeks and 3 months. A repeated measures ANOVA indicated that the intervention group had significantly higher Enjoyment scores compared to the control group at three time points: at discharge (MD: 5.28; 95% CI: 3.68 to 6.89; p < 0.001), 6 weeks post‐partum (MD: 5.06; 95% CI: 3.80 to 6.31; p < 0.001) and 3 months post‐partum (MD: 5.24; 95% CI: 4.12 to 6.35; p < 0.001). Similarly, the intervention group reported significantly higher connection and mother's self‐perception scores at discharge (MD: 4.31; 95% CI: 3.07 to 5.56; p < 0.001), 6 weeks post‐partum (MD: 4.69; 95% CI: 3.71 to 5.68; p < 0.001) and 3 months post‐partum (MD: 4.93; 95% CI: 4.14 to 5.72; p < 0.001), compared to the control group. In contrast, the pressure from significant others scores were higher in the control group relative to the intervention group at discharge (MD: −2.09; 95% CI: −2.88 to −1.31; p < 0.001), 6 weeks post‐partum (MD: −4.35; 95% CI: −5.20 to −3.49; p < 0.001) and 3 months (MD: −4.89; 95% CI: −5.70 to −4.08; p < 0.001). Finally, the intervention group also reported higher Instrumental Needs scores at all three time points: at discharge (MD: 1.96; 95% CI: 1.35 to 2.58; p < 0.001), 6 weeks post‐partum (MD: 3.58; 95% CI: 3.05 to 4.11; p < 0.001) and 3 months post‐partum (MD: 1.18; 95% CI: 0.68 to 1.69; p < 0.001). BSE scores were significantly higher in the intervention group compared to the control group at discharge (MD: 14.29; 95% CI: 10.38 to 18.21; p < 0.001), 6 weeks post‐partum (MD: 14.04; 95% CI: 11.05 to 17.02; p < 0.001) and 3 months post‐partum (MD: 6.80; 95% CI: 4.66 to 8.94; p < 0.001). The rates of exclusive breastfeeding were higher in the intervention group than in the control group at each stage of the intervention (p < 0.01). At 6 weeks post‐partum, the intervention group's infants showed slower weight (t = −0.90, p = 0.371) and length (t = −0.69, p = 0.495) growth compared to the control group, though not significantly. By 3 months post‐partum, there was a significant difference in both weight (t = −3.46, p = 0.001) and length (t = −2.95, p = 0.004) between the groups. The findings in this study suggest that the RBF intervention programme based on SDT may be effective in improving mothers' motivation to breastfeed, building breastfeeding self‐confidence and increasing the rate of exclusive breastfeeding. The effects of the intervention on infant physical development will need to be verified with longer follow‐up in future research. Key messages: This study validated the application of responsive breastfeeding (RBF) intervention during the exclusive breastfeeding phase of Chinese infants.The RBF intervention may help to increase mothers' level of autonomous motivation for breastfeeding, enhance breastfeeding self‐efficacy and increase exclusive breastfeedingrates. The intervention had no significant effect on the weight and length of 6 week old infants but significantly impacted 3monthold infants, with slower growth observed in the intervention group compared to the control group.Future intervention programmes shouldinclude extended follow‐up periods to investigate the long‐term effects of RBF on infant growth and development. [ABSTRACT FROM AUTHOR]

To investigate the effects of 8‐week hiking bench training on cardiorespiratory and muscular responses of highly trained sailors during hiking emulation. Twenty‐four sailors were assigned into two groups: the hiking bench training group (HTG, n = 12) and the control group (CG, n = 12). Both groups maintained their regular training with the HTG performed two additional hiking bench training sessions per week for 8 weeks, while the CG performed an equivalent duration of on‐water sailing training. Physiological responses were assessed by performing four successive 3‐min hiking bouts on a sailing emulation ergometer before and after the 8‐week training period. Comparing the pretest, both groups exhibited a significant decrease (p < 0.05) in the percentage of maximal oxygen uptake (%VO2max) and maximal heart rate (%HRmax); the HTG experienced a greater decrease in %VO2max in bouts 2 and 3. The root mean square (RMS) of rectus femoris (RF), vastus lateralis (VL), rectus abdominis (RA), and external oblique decreased significantly (p < 0.05), whereas the mean power frequency (MPF) of RF, VL, and RA exhibited an increasing trend. The RMS of RF and RA in HTG were lower than those in CG in the initial three bouts; VL and EA in HTG were lower than those in CG in bouts 1 and 2 (p < 0.05). The MPF of RA in HTG was significantly increased in bouts 2, 3, and 4 (p < 0.05). Eight‐week hiking bench training could improve hiking economy and the activation of lower limb and trunk muscles delaying the onset of fatigue in sailors. Highlights: Hiking is the most physically demanding task in dinghy sailing, eliciting highly specific cardiorespiratory, and muscular responses. Highly trained sailors attempt to improve the physiological response and performance of hiking through hiking bench training.Hiking bench training involves a series of movement exercises performed by sailors on sailing emulation ergometer that are tailored specific profiles with the objective of optimizing sailing performance.Hiking bench training can effectively enhance the economy of hiking among highly trained sailors, improve the activation of lower limb and trunk muscles, and delay the onset of fatigue in hiking. Hiking bench training can be used as an effective means of enhancing hiking performance for highly trained sailors. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the use of after‐visit instructions (AVIs) in an academic rheumatology clinic and assess the impact of standardized AVIs (sAVIs) and teach‐back (TB) on comprehension of health information. Methods: A retrospective review of adult patients seen between October 1 and 8, 2021, at the rheumatology clinic collected data on patient demographics, clinical features, and the presence, content, and readability of AVIs. During a subsequent prospective proof‐of‐concept study, routinely scheduled patients seen at the rheumatology clinic were randomized into three groups: control (received standard of care), received sAVIs only, and received sAVIs plus TB. Patients completed a health literacy questionnaire, satisfaction survey, and a one‐ to two‐week postvisit telephone survey to assess AVI comprehension. Results: Out of 316 retrospective patient visits, 82 (25.9%) received AVIs. Among 210 of 316 patients (66.5%) with management changes, 76 (36.1%) received AVI, with 74.2% of the instructions considered concordant with the provider's note. Use of AVIs was higher with management changes, new patient visits, and medical trainee/teaching clinics. AVIs were written at a median 6.8 grade level. A total of 75 patients completed the prospective study: 31 (41.3%) were in the control group, 19 (25.3%) were in the group that received sAVIs only, and 25 (33.3%) were in the group that received AVIs with TB. There were no differences in overall postvisit survey comprehension/retention scores among the three patient groups evaluated. Conclusion: Although a lack of AVI use was identified, implementation of sAVIs did not appear to impact patient retention or comprehension of discharge health information. [ABSTRACT FROM AUTHOR]

As the incidence of diabetic foot ulcers (DFU) increases, better treatments that improve healing should reduce complications of these ulcers including infections and amputations. We conducted a randomized controlled trial comparing outcomes between a novel purified reconstituted bilayer membrane (PRBM) to the standard of care (SOC) in the treatment of non‐healing DFUs. This study included 105 patients who were randomized to either of two treatment groups (n = 54 PRBM; n = 51 SOC) in the intent to treat (ITT) group and 80 who completed the study per protocol (PP) (n = 47 PRBM; n = 33 SOC). The primary endpoint was the percentage of wounds closed after 12 weeks. Secondary outcomes included percent area reduction, time to healing, quality of life, and cost to closure. The DFUs that had been treated with PRBM healed at a higher rate than those treated with SOC (ITT: 83% vs. 45%, p = 0.00004, PP: 92% vs. 67%, p = 0.005). Wounds treated with PRBM also healed significantly faster than those treated with SOC with a mean of 42 versus 62 days for SOC (p = 0.00074) and achieved a mean wound area reduction within 12 weeks of 94% versus 51% for SOC (p = 0.0023). There were no adverse events or serious adverse events that were related to either the PRBM or the SOC. In comparison to the SOC, DFUs healed faster when treated with PRBM. Thus, the use of this PRBM is an effective option for the treatment of chronic DFUs. [ABSTRACT FROM AUTHOR]

This study investigates the effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Sixty patients who underwent catheter insertion for peritoneal dialysis from January 2021 to January 2023 at our hospital were selected as subjects and randomly divided into an experimental group and a control group using a random number table method. The control group received routine nursing care, while the experimental group was subjected to comprehensive nursing interventions. The study compared the impact of nursing measures on visual analogue scale (VAS), self‐rating anxiety scale (SAS), self‐rating depression scale (SDS) and nursing satisfaction between the two groups. The analysis revealed that on the third, fifth and seventh days post‐intervention, the experimental group's wound VAS scores were significantly lower than those of the control group (p < 0.001). Furthermore, levels of anxiety and depression were markedly lower in the experimental group compared with the control group (p < 0.001). In addition, the nursing satisfaction rate was significantly higher in the experimental group than in the control group (96.67% vs. 73.33%, p = 0.011). This study indicates that the application of comprehensive nursing interventions in patients undergoing catheter insertion for peritoneal dialysis is highly effective. It can alleviate wound pain and negative emotions to a certain extent, while also achieving high patient satisfaction, thus demonstrating significant clinical value. [ABSTRACT FROM AUTHOR]

This study assessed the effect of a commercial carbohydrate menthol drink on cycling time trial (TT) performance in hot and humid conditions compared with a carbohydrate only drink. Ten participants (5 women; V̇O2max: 52.3 ± 8.6 mL kg−1 min−1, Peak Power Output: 286 ± 56 W) completed a 40‐min cycling preload (50% V̇O2max) followed by a 15‐min self‐paced TT in hot (∼35°C) and humid (∼54%) conditions on two occasions (double blind, crossover design). Every 10‐min, 85 mL of carbohydrate (CHO; SIS GO Energy, 60 g h−1) or carbohydrate and menthol (CHO + MEN; SIS Turbo+ 60 g h−1, 0.01% menthol) was swilled (∼10‐s) and ingested. Rectal temperature (Trec) and heart rate (HR) were recorded throughout. Thermal sensation (TS), thermal comfort (TC) and rating of perceived exertion (RPE) were recorded every 5‐min. Taste and aftertaste were rated from very pleasant (+5) to very unpleasant (−5). TT performance (total work; kJ) was similar between CHO (153 kJ [95% CI: 129–177 kJ]) and CHO + MEN (151 kJ [128–178 kJ]). During preload exercise, Trec increased by ∼0.9°C and was similar at the end of the TT (∼38.20°C). Mean preload HR was ∼140 b min−1 in each condition and reached ∼177 b min−1 at the end of the TT. TC was rated as 'much too warm' and TS rated as 'very hot' in both conditions. Both conditions were 'extremely hard' (end point RPE ∼19). All participants preferred the taste and aftertaste of the CHO drink. The commercial carbohydrate menthol drink offered no additional ergogenic benefit compared to a carbohydrate only drink during cycling exercise performed in hot and humid conditions. Highlights: The addition of menthol to a carbohydrate drink had no effect on 15‐min time trial performance.The addition of menthol to a carbohydrate drink had no effect on thermal perceptual measures or physiological measures.Taste and aftertaste perceptions were favourable towards the carbohydrate drink compared to the carbohydrate‐menthol drink. [ABSTRACT FROM AUTHOR]

This was a non‐blinded, single‐centre, randomized, controlled clinical trial that compared the effectiveness of direct observation of procedural skills (DOPSs)with traditional assessment methods in pressure injury (PI) care skills. The study population included 82 nursing professionals randomly assigned to the study group (n = 41) and the control group (n = 41). Both groups of nurses underwent a 6‐month training in PI care skills and were subsequently evaluated. The main outcome variables were the PI skill operation scores and theoretical scores. Secondary outcome variables included satisfaction and critical thinking abilities. Independent sample t‐tests and chi‐square tests were used to assess differences between the two groups of nurses. The results showed no statistically significant difference in PI skill operation scores between the two groups of nurses (p > 0.05). When comparing the PI theoretical scores, the study group scored higher than the control group, and this difference was statistically significant (p < 0.05). In terms of satisfaction assessment, the study group and the control group showed differences in improving self‐directed learning, enhancing communication skills with patients, improving learning outcomes and increasing flexibility in clinical application (p < 0.05). When comparing critical thinking abilities between the two groups of nurses, there was no statistically significant difference at the beginning of the training, but after 3 months following the training, there was a statistically significant difference between the two groups (p < 0.01).The results indicated that the DOPS was effective in improving PI theoretical scores, increasing nurse satisfaction with the training and enhancing critical thinking abilities among nurses. [ABSTRACT FROM AUTHOR]

Prenatal iron supplementation improves children's health and cognitive performance, but few studies explore behavioural development. This study assessed the effects of adjusting prenatal iron supplementation to maternal iron stores during early pregnancy on children's behavioural problems. Randomized controlled trial conducted in Tarragona (Spain) involving 230 nonanaemic pregnant women and their children after a 4‐year follow‐up. Based on haemoglobin (Hb) levels before gestational week (GW) 12, women receive different iron doses: those with Hb = 110–130 g/L were randomized to receive 80 or 40 mg/day and those with Hb > 130 g/L were randomized to receive 20 or 40 mg/day. Maternal iron stores at GW12 were classified using serum ferritin (SF) as low (SF < 15 µg/L), normal (SF = 15–65 µg/L), and normal‐high (SF > 65 µg/L). Children's behaviour was assessed by parents using the Child Behaviour Checklist for ages 1.5–5 years and the Behaviour Rating Inventory of Executive Function‐Preschool Version, and by teachers using the Teacher's Report Form for ages 1.5–5 years. Multivariable regression models were performed. Taking 80 mg/day of iron improved child behaviour when women had low iron stores but worsened it when mothers had normal–high iron stores, except for depressive and attention/hyperactivity problems. Taking 20 mg/day of iron improved behaviour only in those children whose mothers had SF > 65 µg/L in early pregnancy. Additionally, executive functioning improved at high doses of prenatal iron when maternal baseline SF < 15 µg/L. Adjusting prenatal iron supplementation to both maternal baseline Hb levels and iron stores reduces behavioural problems in 4‐year‐old children. Key messages: Prenatal iron supplementation succeeds in improving maternal haematological outcomes and cognitive performance of children, but few studies have focused on behavioural development.Prenatal iron supplementation adjusted to maternal iron stores reduces behavioural problems in 4‐year‐old children.Maternal iron stores early in pregnancy should be measured in addition to haemoglobin concentration.These findings contribute greatly to the advancement of public health by giving physicians the tools to prescribe the most appropriate dose of iron supplementation to contribute to better child development. [ABSTRACT FROM AUTHOR]

We evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community‐driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community‐led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: −3.0 to 4.1 percentage points [pp]), or other longer‐term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron‐folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1–13.3 pp), 0–5‐month‐olds being exclusively breastfed (8.7 pp; 95% CI: 1.8–15.6 pp) and 6–23‐month‐olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8–13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre‐natal and post‐natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice—for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe. Key messages: A well‐resourced multifaceted project that sought to reduce stunting through (1) a health and education‐focused community‐driven development programme, (2) provider training on infant and young child feeding and growth monitoring, and (3) training on community‐led total sanitation had no impact on child stunting rates although it successfully improved aspects of maternal nutrition during pregnancy, exclusive breastfeeding, and complementary feeding.Successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice, especially in a typical programme timeframe.Piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually are potential solutions but might require funders to commit to longer implementation timeframes. [ABSTRACT FROM AUTHOR]

Resistance exercise training is effective to counteract the adverse effects of androgen deprivation therapy (ADT) on body composition, muscle mass and leg strength in prostate cancer patients (PCa). However, it is unknown whether these effects can be autonomously maintained after cessation of the supervised program. Sixty‐eight PCa patients on ADT were included. The exercise intervention group (EX, n = 37) performed 20 weeks of supervised resistance exercise training. Thereafter, patients were advised to autonomously continue exercise training. The control group (CON, n = 31) only received usual care. Outcome measures were compared between baseline and after 1 year. Changes during the intervention (baseline vs. 20 weeks) and follow‐up period (20 weeks vs. 1 year) were descriptively explored. In EX, 83% reported to have continued exercise training themselves. After 1 year, fat mass gains were attenuated in EX compared to CON (1.2 ± 2.6 and 2.8 ± 1.9 kg, respectively; time × treatment effect p = 0.032). The fat percentage increased, and lean mass and quadriceps muscle cross‐sectional area decreased over time, with no differences between groups (overall 1.6 ± 2.1%, −0.7 ± 2.3 kg and −2.2 ± 2.9 cm2, respectively; time effects, all p < 0.05). For muscle strength, an increase of ∼5% in EX was observed, significantly different from the ∼10% decrease in CON (p < 0.001). Subsequent analyses showed that the initial exercise training‐obtained gains in lean mass, muscle mass and strength in EX compared to CON, declined during the follow‐up period. In conclusion, PCa patients on ADT are not capable to autonomously maintain the exercise‐obtained gains of a 20‐week supervised training program over a subsequent 1‐year period. Highlights: ADT for prostate cancer results in many side effects, including muscle mass lossA supervised resistance exercise training program can counteract many side effectsAfter cessation of the supervised program, exercise benefits are not effectively preservedMore focus on sustainability of exercise programs during ADT is required [ABSTRACT FROM AUTHOR]

Neuromuscular deficits at the proximal or distal to the knee may contribute to knee valgus and anterior cruciate ligament (ACL) injury. A valgus or abducted position of the knee greater than 12° for females is suggested to be an indicator of the risk of lower extremity injuries. However, there is a lack of examination regarding neuromuscular patterns in both proximal and distal kinetic chains. The purpose of this study was to investigate the effect of 8 weeks of neuromuscular training on knee valgus and co‐activation of the hip and ankle muscles during a countermovement jump in female athletes with a high risk of ACL injury. Twenty‐eight female athletes, with knee valgus greater than 12°, were randomly assigned into two groups: training (n = 14) and control (n = 14). The following measurements were taken before and after the intervention: co‐activation of Gluteus Maximus‐Tensor Fasciae Latae (GMax‐TFL), Gluteus Medius‐Adductor Longus (GMed‐AL), Tibialis Anterior‐Medial Gastrocnemius (TA‐MG), Tibialis Anterior‐Lateral Gastrocnemius (TA‐LG), Medial Gastrocnemius‐Lateral Gastrocnemius (MG‐LG) muscles, and DKV angle during single‐leg countermovement jump task. Following the intervention, the training group demonstrated increased co‐activation of muscles (except TA‐LG) (P < 0.05). The knee valgus angle in the training group decreased by 5.9° (P = 0.001). Our results demonstrated that neuromuscular training alters muscle activity patterns and the neuromuscular group demonstrated a clinically meaningful and statistical reduction in knee valgus. Highlights: Dynamic knee valgus (DKV) is a risk factor for identifying women with a risk of lower extremity injuries.Muscle activity patterns of the hip and ankle, such as DKV, may be modifiable through neuromuscular training.Neuromuscular training with feedback could reduce excessive DKV at a clinically meaningful level. [ABSTRACT FROM AUTHOR]

The barbell squat is a multijoint exercise often employed by athletes and fitness enthusiasts due to its beneficial effects on functional and morphological neuromuscular adaptations. This study compared the effects of squat variations on lower limb muscle strength and hypertrophy adaptations. Twenty‐four recreationally trained females were assigned to a 12‐week front squat (FS; n = 12) or back squat (BS; n = 12) resistance training protocol (twice per week). Maximum dynamic strength (1‐RM) on the 45° leg press, a nonspecific strength test, and muscle thickness of the proximal, middle, and distal portions of the lateral thigh were assessed at baseline and post‐training. A significant time versus group interaction was observed for 1‐RM values (F(1,22) = 10.53; p = 0.0004), indicating that BS training elicits greater improvements in muscle strength compared with FS training (p = 0.048). No time versus group interactions were found for muscle thickness (F(1,22) = 0.103; p = 0.752); however, there was a significant main effect of time for the proximal (F(1,22) = 7.794; p = 0.011), middle (F(1,22) = 7.091; p = 0.014), and distal portions (F(1,22) = 7.220; p = 0.013) of the lateral thigh. There were no between‐group differences for any muscle thickness portion (proximal: p = 0.971; middle: p = 0.844; and distal: p = 0.510). Our findings suggest that BS elicits greater improvements in lower limb muscle strength on the 45° leg press than FS, but hypertrophic adaptations are similar regardless of variations during the squat exercise. Highlights: Back squat training elicited greater strength‐related improvements in a nonspecific strength test than front squat training.Hypertrophic adaptations of the lateral thigh are similar between both squat variations.Both squat variations elicited similar growth at proximal, middle, and distal regions of the lateral thigh. [ABSTRACT FROM AUTHOR]

A novel autologous heterogeneous skin construct (AHSC) was previously shown to be effective versus standard of care (SOC) treatment in facilitating complete wound healing of Wagner 1 diabetic foot ulcers in an interim analysis of 50 patients previously published. We now report the final analysis of 100 patients (50 per group), which further supports the interim analysis findings. Forty‐five subjects in the AHSC treatment group received only one application of the autologous heterogeneous skin construct, and five received two applications. For the primary endpoint at 12 weeks, there were significantly more diabetic wounds closed in the AHSC treatment group (35/50, 70%) than in the SOC control group (17/50, 34%) (p = 0.00032). A significant difference in percentage area reduction between groups was also demonstrated over 8 weeks (p = 0.009). Forty‐nine subjects experienced 148 adverse events: 66 occurred in 21 subjects (42%) in the AHSC treatment group versus 82 in 28 SOC control group subjects (56.0%). Eight subjects were withdrawn due to serious adverse events. Autologous heterogeneous skin construct was shown to be an effective adjunctive therapy for healing Wagner 1 diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Pressure injuries affect 13.1% to 45.5% of patients in the intensive care unit and lead to pain and discomfort for patients, burden on healthcare providers, and unnecessary cost to the health system. Turning and positioning systems offer improvements on usual care devices, however the evidence of the effectiveness of such systems is still emerging. We conducted an investigator initiated, prospective, single centre, two group, non‐blinded, randomised controlled trial to determine the effectiveness of a system for turning and positioning intensive care unit patients, when compared to usual care turning and positioning devices, for preventing PIs. The trial was prematurely discontinued after enrolment of 78 participants due to COVID‐19 pandemic related challenges and lower than expected enrolment rate. The study groups were comparable on baseline characteristics and adherence to the interventions was high. Four participants developed a PI (in the sacral, ischial tuberosity or buttock region), n = 2 each in the intervention and control group. Each participant developed one PI. As the trial is underpowered, these findings do not provide an indication of the clinical effectiveness of the interventions. There was no participant drop‐out or withdrawal and there were no adverse events, device deficiencies, or adverse device effects identified or reported. The results of our study (in particular those pertaining to enrolment, intervention adherence and safety) provide considerations for future trials that seek to investigate how to prevent PIs among ICU patients. [ABSTRACT FROM AUTHOR]

To evaluate the status of a 7‐month phase 3 study conducted to test the effect of intramuscular injections of VM202 (ENGENSIS), a plasmid DNA encoding human hepatocyte growth factor, into the calf muscles of chronic nonhealing diabetic foot ulcers with concomitant peripheral artery disease. The phase 3 study, originally aimed to recruit 300 subjects, was discontinued because of slow patient recruitment. An unprespecified interim analysis was performed for the 44 subjects enrolled to assess the status and determine the future direction. Statistical analyses were carried out for the Intent‐to‐Treat (ITT) population and separately for subjects with neuroischemic ulcers, using a t‐test and Fisher's exact test. A logistic regression analysis was also conducted. VM202 was safe and potentially should have benefits. In the ITT population (N = 44), there was a positive trend toward closure in the VM202 group from 3 to 6 months but with no statistical significance. Levels of ulcer volume or area were found to be highly skewed between the placebo and VM202 groups. Forty subjects, excluding four outliers in both arms, showed significant wound‐closing effects at month 6 (P =.0457). In 23 patients with neuroischemic ulcers, the percentage of subjects reaching complete ulcer closure was significantly higher in the VM202 group at months 3, 4, and 5 (P =.0391,.0391, and.0361). When two outliers were excluded, a significant difference was evident in months 3, 4, 5, and 6 (P =.03 for all points). A potentially clinically meaningful 0.15 increase in Ankle‐Brachial Index was observed in the VM202 group at day 210 in the ITT population (P =.0776). Intramuscular injections of VM202 plasmid DNA to calf muscle may have promise in the treatment of chronic neuroischemic diabetic foot ulcers (DFUs). Given the safety profile and potential healing effects, continuing a larger DFU study is warranted with modifications of the current protocol and expansion of enrolling sites. [ABSTRACT FROM AUTHOR]

Nutrition‐sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition‐ and gender‐sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2−4 years in Burkina Faso. A 3‐year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15−49 years with an index child aged 2−4 years. We assessed the effects 1.5‐years (WASH substudy) and 3‐years (endline) post‐intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH‐livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04−0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03−0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock‐related risks and improve livestock‐hygiene‐related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children. Key messages: Few experimental studies have examined the potential nutritional benefits and health risks of livestock‐related interventions in low‐and middle‐income settings.We conducted a 3‐year cluster randomised trial of nutrition‐ and gender‐sensitive poultry intervention in Burkina Faso.Despite low participation in the intervention activities, caregiver's knowledge of water, sanitation and hygiene‐livestock risks was higher in the intervention groups than in the control group.No effects were found on hygiene and hygiene‐livestock‐related practices (except for practices involving separation between livestock and children) nor on child morbidity symptoms and anthropometry indicators. [ABSTRACT FROM AUTHOR]

Prolonged use of personal protective equipment can cause pressure injuries on the skin. The current study was conducted with the aim of investigating the effect of ChitoHeal gel on the nasal site on the prevention of N 95 masks that caused pressure injuries in nurses working in intensive care units. This is a randomised controlled clinical trial that was conducted in 2022. The study sample consisted of 92 nurses working in the intensive care units. A randomised block method was used to allocate the nurses to two equal groups of intervention and control. However, in the intervention group, ChitoHeal gel was applied on nurses' nose bridge. To perform this, the researcher referred to the department during the morning and evening shifts and applied the gel on nurses' nose bridge at the beginning of each shift. Then, the N95 mask was installed on the face by the nurse. Before and at the end of each work shift, the skin in both groups was assessed for any signs of pressure injuries. No significant differences were observed between the two intervention and control groups in terms of demographic variables. The frequency distribution of mask‐caused pressure injuries on nurses' nose bridge in the two groups was analysed using the Chi‐square test (Fisher's exact test). The results showed that after the intervention, it was 0 in the intervention group. However, 4 nurses (8.6%) in the control group developed pressure injuries, and this difference between the two groups was statistically significant (P >.05). The result of the current study showed that the use of ChitoHeal gel is effective in preventing N95 mask‐related pressure injuries. Considering the cheapness and rational global availability of this gel, it seems that its use is an effective strategy in order to prevent N95 mask‐related pressure injuries. Given the lack of studies in this regard, similar studies are strongly recommended to be conducted. [ABSTRACT FROM AUTHOR]

Prolonged wound discharge is a common postoperative complication of orthopaedic procedures and a risk factor for implant‐related infection. Occlusive wound closure methods have previously been suggested to reduce or even prevent this complication. We performed a randomised controlled trial on 70 patients who underwent surgical treatment for metastatic bone disease involving the proximal femur at our centre between January 2017 and August 2018. At conclusion of the tumour resection and endoprosthetic reconstruction procedure, patients were randomised to either occlusive wound closure (n = 35), using the Dermabond Prineo‐22 skin closure system, or routine wound closure with conventional skin staples (n = 35). Skin closure with occlusive wound closure resulted in a lesser degree (P <.0001) and shorter duration of postoperative wound discharge (HR 2.89 [95% CI 1.6–5.05], P <.0018). Compared with staples, surgical wounds were already dry after a mean of 3.5 days [95% CI 3.2–3.9] versus 6.1 days [95% CI 4.8–7.3] (P <.0001). Prolonged wound discharge for 7 days or more was observed in 23% of patients (n = 8) in the Staples‐group but was entirely absent in the occlusive wound closure group (P <.003). This study provides strong evidence that occlusive wound closure reduces frequency, degree, and duration of wound discharge in a patient population at particularly high risk for this complication. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact of sub epidermal moisture (SEM) measurement and targeted pressure ulcer (PU) prevention, versus visual skin assessment and usual care, on mean SEM delta scores and early pressure ulcer development in acute hospital patients. A quantitative quasi‐experimental observational approach was used. A total of 149 at risk acute hospital patients took part, 78 treatment, and 71 control. SEM deltas were recorded daily for a maximum of 5 days using the SEM Scanner (Bruin Biometrics LLC, Los Angeles, California), on three sites: the sacrum, the right heel, and the left heel, with enhanced and targeted PU prevention interventions occurring in those with an elevated SEM delta scores in the treatment group. Intention to treat analysis was used to guide the final composition of results. SEM PU represents PU development as identified by 2 days of sustained abnormal SEM delta scores, ≥0.5, after day one. The mean number of days completed by participants was just under 4 days, participants had many different comorbidities, with the most common being: hypertension, cancer, and chronic obstructive pulmonary disease. Results showed that following the introduction of SEM guided targeted treatments, participants in the treatment group yielded a statistically significant reduction in mean SEM delta scores (MD: 0.49; 95% CI: 0.59, 0.39; P <.0001), and in the odds of developing a SEM PU (OR: 0.59, 95% CI: 0.24 to 1.00; P =.05). In the treatment group, none of the participants developed a visual PU, whereas, in the control group, 1.41% (n = 1/71) developed a visual PU. Based on all the results, the following is concluded, (1). There was a greater reduction in mean SEM delta scores among those cared for using SEM measurement and targeted PU prevention, versus those cared for using visual skin assessment and usual care, and (2). the mean SEM delta scores was statistically significantly lower at the study end for those who received targeted treatments based on abnormal SEM scores. More research is now needed in other and larger at‐risk groups to further validate what was found in this study. [ABSTRACT FROM AUTHOR]

Background: Patients' treatment decisions may be influenced by the ways in which treatment options are presented. There is little evidence on how patients with advanced cancer choose preferences for advance directives (ADs) in China. Informed by behavioural economics, we assess whether end‐of‐life (EOL) cancer patients held deep‐seated preferences for their health care and whether default options and order effects influenced their decision‐making. Methods: We collected data on 179 advanced cancer patients who were randomly assigned to complete one of the four types of ADs: comfort‐oriented care (CC) AD (comfort default AD); a life extension (LE)‐oriented care option (LE default AD); CC (standard CC AD) and LE‐oriented (standard LE AD). Analysis of variance test was used. Results: In terms of the general goal of care, 32.6% of patients in the comfort default AD group retained the comfort‐oriented choice, twice as many as in the standard CC group without default options. Order effect was significant in only two individual‐specific palliative care choices. Most patients (65.9%) appointed their children to make EOL care decisions, but patients choosing the CC goal were twice as likely to ask their family members to adhere to their choices than patients who chose the LE goal. Conclusion: Patients with advanced cancer did not hold deep‐seated preferences for EOL care. Default options shaped decisions between CC and LE‐oriented care. Order effect only shaped decisions in some specific treatment targets. The structure of ADs matters and influence different treatment outcomes, including the role of palliative care. Patient or Public Contribution: Between August and November 2018, from 640 cancer hospital medical records fitting the selection criteria at a 3A level hospital in Shandong Province, we randomly selected 188 terminal EOL advanced cancer patients using a random generator programme to ensure all eligible patients had an equal chance of selection. Each respondent completes one of the four AD surveys. While respondents might require support in making their healthcare choices, they were informed about the purpose of our research study, and that their survey choices would not affect their actual treatment plan. Patients who did not agree to participate were not surveyed. [ABSTRACT FROM AUTHOR]

Aim: To explore the effect of information‐motivation‐behavioural skills (IMB) model on psychological and emotional state of caesarean section (CS) women. Design: Control‐group patients got routine nursing during the preoperative, intraoperative and postoperative periods. Observation‐group patients received routine nursing combined with the IMB model that included specific informational, motivational and behavioural interventions. Methods: Pregnant women (n = 102) who underwent CS in Hangzhou Women's Hospital were randomly divided into Control and Observation‐groups (n = 51 each). Self‐rating anxiety scale (SAS), self‐rating depression scale (SDS) and general self‐efficacy scale (GSES) scores, complication rate, fatigue severity scale (FSS) and Edinburgh postpartum depression scale (EPDS) scores were compared. Result: Interventions lowered SAS and SDS scores, significantly lower in the Observation‐group (p < 0.05), and increased GSES scores, significantly higher in the Observation‐group (p < 0.05). Observation‐group had less complications (4.08% vs. 17.39% in the Control‐group; p < 0.05), and decreased FSS and EPDS scores (p < 0.05). [ABSTRACT FROM AUTHOR]

Nutrition‐sensitive agriculture (NSA) interventions offer a means to improve the dietary quality of rural, undernourished populations. Their effectiveness could be further increased by understanding how household dynamics enable or inhibit the uptake of NSA behaviours. We used a convergent parallel mixed‐methods design to describe the links between household dynamics—specifically intrahousehold power inequalities and intrahousehold cooperation—and dietary quality and to explore whether household dynamics mediated or modified the effects of NSA interventions tested in a cluster‐randomized trial, Upscaling Participatory Action and Videos for Agriculture and Nutrition (UPAVAN). We use quantitative data from cross‐sectional surveys in 148 village clusters at UPAVAN's baseline and 32 months afterwards (endline), and qualitative data from family case studies and focus group discussions with intervention participants and facilitators. We found that households cooperated to grow and buy nutritious foods, and gendered power inequalities were associated with women's dietary quality, but cooperation and women's use of power was inhibited by several interlinked factors. UPAVAN interventions were more successful in more supportive, cooperative households, and in some cases, the interventions increased women's decision‐making power. However, women's decisions to enter into negotiations with family members depended on whether women deemed the practices promoted by UPAVAN interventions to be feasible, as well as women's confidence and previous cultivation success. We conclude that interventions may be more effective if they can elicit cooperation from the whole household. This will require a move towards more family‐centric intervention models that empower women while involving other family members and accounting for the varied ways that families cooperate and negotiate. Key messages: Household cooperation and intrahousehold power inequalities may influence children's and mothers' dietary diversity in rural OdishaThese factors partly determine the effects of nutrition‐sensitive agriculture (NSA) interventions tested in Upscaling Participatory Action and Videos for Agriculture and Nutrition, indicating that NSA interventions may be more effective if they include multiple family members.There is wide heterogeneity in household dynamics and the constraints that families face. Further research is needed to identify how interventions can respond to this heterogeneity so that NSA interventions are effective in an inclusive and empowering way. [ABSTRACT FROM AUTHOR]

Aims: Determine efficacy of "KARER" educational intervention on caring ability and burden of caregiving relatives of disabled patients with stroke and cardiovascular diseases. Design: Clinical, randomized, controlled and double blinded trial with a mixed approach. Methods: Study population will be made up of 96 caregiving relatives of patients of home‐hospitalized care programs in the cities of Bogotá and Bucaramanga, (Colombia), between March 2021 and March 2022. Participants will be randomly assigned into two groups, either intervention (n = 48) or control (n = 48). The intervention is interdisciplinary and multi‐component: B‐Learning modality and clinical simulation. Follow‐up of participants will last 8 weeks from intervention period start‐out, and measurements will be taken and analysed in masked form. The main results will be the mean score changes of care ability and caregiver burden. Discussion: Caregiving relatives will show better adaptation to their role through effective use of caring abilities as they look after disabled persons with chronic diseases. [ABSTRACT FROM AUTHOR]

This study was aimed to evaluate the clinical efficacy of flap transplantation combined with vacuum sealing drainage and methylprednisolone and cyclosporine in the treatment of ulcer wound of patients with pyoderma gangrenosum (PG). From August 2014 to February 2022, 30 patients with pyoderma gangrenosum ulcer wounds were selected as the research objects and randomly divided into the observation group (n = 12) and the control group (n = 18) in this retrospective study. The patients in observation group were treated with VSD combined with flap transplantation and immunosuppressive agent treatment, while the control group was treated with normal dressing change combined with hormone and cyclosporine. The ulcer wound healing time and dressing change times were compared between the two groups. All the 30 cases of two groups healed after corresponding treatment. The wound healing time of ulcer in the observation group was 35–40 days, with an average healing time of (35.83 ± 1.95) days, and the wound healing time of the control group was 60–200 days, with an average healing time of (44.14 ± 9.67) days. The healing time of observation groups was significantly shorter than that in the control group (t = 4.652, P <.05). The frequency of dressing change in the observation group was seven–eight times, with an average of (7.17 ± 0.39) times, and the frequency of dressing change in the control group was 75–86 times, with an average of (79.22 ± 3.62) times. The difference between the two groups was significant (t = 6.214, P <.05). The treatment of VSD combined with flap transplantation and immunosuppressive agent treatment promote ulcer wound healing of pyoderma gangrenosum. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to compare the efficacy of e‐flipped and online case‐based workshops on the nurses' knowledge, attitude and behaviour regarding thalassemia during the COVID‐19 pandemic. Design: A pre‐test–posttest interventional study was conducted with two intervention groups and a control group. Methods: One hundred and fifty nurses were recruited from comprehensive urban health centres in June–December 2020. The nurses were randomly allocated to one of the three groups: case‐based e‐flipped workshop (n = 50), case‐based online workshop (n = 50) and control (n = 50). A researcher‐made questionnaire was completed by eligible subjects at baseline, after the end of the training sessions and 4 weeks after interventions to assess their knowledge, attitude and behaviour. Data were analysed in IBM SPSS v16.0. ANOVA and Tukey's post hoc tests were used to compare the three groups. Results: The mean knowledge, attitude and behaviour scores in the intervention groups increased significantly more than that in the control group (p <.001). One week and 4 weeks following the intervention, the mean score of knowledge, attitude and behaviour in the e‐flipped group was greater than that in the online group (p <.001). According to the results, e‐flipped and online case‐based workshops can improve nurses' knowledge, attitude and behaviour regarding thalassemia. [ABSTRACT FROM AUTHOR]

Aim: To determine the outcomes of Family‐centred Auditory and Tactile Stimulation Implementation on Traumatic Brain Injured Patients in Egypt. Background: Family engagement in the care of their relatives in the Intensive care units is limited due to patients' life‐threatening conditions, in addition to the use of high technology in these settings. Auditory and tactile sensory stimulations are among the diverse sensory stimulations that have received more attention in brain injured patients than other senses as being considered safe, and effective measures. Design: A Quasi‐experimental design was used to test the hypotheses of this study. Methods: A convenience sample of 60 adult patients suffering from Traumatic Brain Injury and admitted to the intensive care units of two University Hospitals in Egypt was included in the study. Patients were assigned into two equal groups: control and study groups (30 patients each). The auditory and tactile stimulations were provided by trained family members, once daily for 2 weeks for the study group. Whereas routine communication was provided by the family of traumatic brain injured patients in the ICU for the control group. Two tools were used for data collection; tool one, the "Glasgow Coma Scale" to assess patient's level of consciousness, and tool two the "Physiological Adverse Events Assessment" to monitor patients for the occurrence of physiological adverse events. Data collection: January to October 2019. Results: The implementation of an organized auditory and tactile stimulation by trained family members is associated with highly statistically significant positive effects. Patients in the study group showed a higher mean of consciousness, lower incidence rate of physiological adverse events, and a lower mean duration of ICU stay. Conclusions: Implementation of an organized auditory and tactile stimulation by trained family members enhanced the consciousness level of comatose Traumatic Brain Injured patients, decreased the occurrence of physiological adverse events, and ICU length of stay. Thus, it is recommended for use in the daily routine nursing care of comatose Traumatic Brain Injured patients. Relevance to Clinical Practice: This study gives a deeper understanding of how family engagement in the care of their critically ill relative enhances their recovery and improve their level of consciousness. [ABSTRACT FROM AUTHOR]

To evaluate the efficacy and safety of wet dressing combined with chitosan wound dressing for deep II degree burn wounds, and provide the basis for clinical application. From October 2019 to October 2021, 80 patients with second‐degree deep burn treated in the Department of burn and plastic surgery of our hospital were selected as the research objects. Patients were randomly divided into two groups. The control group (40n) was treated with wet compress, and the study group (40n) was treated with wet compress combined with chitosan wound dressing. The wound healing time, wound healing percentage and pain score were used as the effectiveness indexes, and the incidence of adverse events and serious adverse events and the detection rate of bacterial culture of wound exudates were used as the safety indexes. The efficacy and safety of the two groups were compared. The wound healing time of the study group (19.53 ± 2.74 days) was shorter than that of the control group (24.78 ± 4.86 days), the difference was significant (t = 3.571, P = 0.015). The percentage of wound healing at the 14th after treatment in the study group was higher than that in the control group (65.00% versus 37.50%) (X2 = 6.054, P = 0.014). There was no significant difference in pain scores between the two groups at each time point. The scar growth was observed 3 months after wound healing. The scar score of the study group (6.00 ± 0.98) was lower than that of the control group (8.77 ± 1.19) (t = 2.571, P = 0.031). The positive rate of wound secretion culture on the 7th and 14th day was statistically significant (X2 = 4.528, P = 0.033; X2 = 6.646, P = 0.010), and the study group was lower than the control group (29.03% versus 81.82%; 8.11% versus 42.86%). There was no significant difference in treatment cost between the study group and the control group (1258.7 ± 223.6 versus 1248.9 ± 182.3) (t = 1.571, P = 0.071). No adverse events or serious adverse events occurred in both groups. Chitosan wound dressing can significantly shorten the time of wound healing and reduce wound pain and wound infection in patients with deep second‐degree burns. And it can effectively improve the situation of scar hyperplasia, which is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a single session of botulinum toxin type A (BTA) injections into both hands more effectively decreases the frequency of systemic sclerosis–associated Raynaud's phenomenon (SSc‐RP) episodes than placebo. Methods: This multicenter, randomized, double‐blind, placebo‐controlled, parallel‐group phase III trial in patients with SSc‐RP assessed the effect of 50‐unit BTA or placebo injections into the palms of both hands around each neurovascular bundle during 1 session in winter. The primary end point was the between‐group difference in the median change in the number of RP episodes from baseline (day 0) to 4 weeks postinjection. Values between the groups were compared with the Wilcoxon rank‐sum test. Results: The intent‐to‐treat analysis included 46 BTA‐treated patients and 44 placebo recipients. At 4 weeks after assigned treatment injections, the median number of daily RP episodes decreased comparably in the BTA and placebo groups (median change –1 episode/day [interquartile range (IQR) –1.5, 0 episodes/day] and –1 episode/day [IQR –2.5, 0 episodes/day], respectively) (P = 0.77 versus placebo). Moreover, change in Raynaud's Condition Score, quality of life assessed by Health Assessment Questionnaire disability index, and hand function assessed by shortened Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Cochin Hand Function Scale from baseline to follow‐up weeks 4, 12, and 24 did not differ significantly between groups. The BTA group experienced transient hand muscle weakness significantly more frequently (P = 0.003). Conclusion: Neither the primary nor secondary end points were reached, and our results do not support any beneficial effect of palmar BTA injections to treat SSc‐RP. [ABSTRACT FROM AUTHOR]

Aim: We analysed whether immediate skin‐to‐skin contact between the healthy newborn and the mother after a caesarean section has a modulatory role on postpartum haemorrhage and uterine contraction. Design: Unblinded, randomized clinical trial, simple random sampling, conducted in women undergoing caesarean sections. Methods: Of the population identified, the caesarean section total (N = 359), 23.2% (N = 83) met the inclusion criteria: scheduled caesarean section, accepting skin‐to‐skin contact, good level of consciousness. They were randomly allocated to the intervention group, skin‐to‐skin contact (N = 40), and to the control group, usual procedure (N = 40). There were three losses. Clinical variables: plasma haemoglobin, uterine contraction, breastfeeding, postoperative pain, were measured, and subjective variables: maternal satisfaction, comfort, comparison with previous caesarean section and newborn crying. Results: Women with skin‐to‐skin contact had greater uterine contraction after caesarean section. The maternal plasma haemoglobin levels at discharge were significantly higher. It was associated with higher breastfeeding rate, satisfaction, comfort levels and with less maternal pain and less crying in the newborn. [ABSTRACT FROM AUTHOR]

The purpose of this study was to prevent nasal bridge pressure injury among fit‐tested employees, secondary to long‐term wear of the N95 mask during working hours. A prospective, single‐blinded, experimental cohort design. Participants were enrolled using the convenience sampling methods and randomisation was utilised for group assignment. Eligibility was determined by a COVID Anxiety Scale score and non‐COVID clinical assignment. Participants with a history of previous skin injury or related condition were excluded. The experimental group was assigned Mepilex Lite® and the control group used Band‐ Aid®. Formal skin evaluations were done by Nurse Specialists who are certified in wound and ostomy care by the Wound, Ostomy, Continence, Nursing Certification Board (WOCNCB®). Fit test logs were provided to participants to measure subjective user feedback regarding mask fit and level of comfort. The results of this feasibility trial are promising in supporting the use of a thin polyurethane foam dressing as a safe and effective dressing to apply beneath the N95 mask. Additional research is needed to validate results due to limited data on efficacy and safety of the various barrier dressings as a potential intervention to prevent skin breakdown to the nasal bridge. [ABSTRACT FROM AUTHOR]

Objective: WeiNaoKang (or SaiLuoTong) is an herbal formula consisting of ginkgo, ginseng, and saffron. Our objective was to investigate if WeiNaoKang could improve cognitive function and cerebral perfusion in patients suffering from vascular dementia. Methods: A 16‐week randomized double‐blind, placebo‐controlled trial was carried out in the setting of a memory disorder clinic at a single center. Patients with vascular dementia diagnosed clinically but supported by imaging and other investigations were invited to participate. The diagnoses were based on the National Institute of Neurological Disorders and Stroke/Association Internationale pour la Recherche et l'Enseignement en Neurosciences (NINDS‐AIREN) criteria. An independent blinded assessor evaluated the effects of the formula. Intervention group was compared to the control group. A subgroup of participants was randomly chosen for further evaluation of cerebral perfusion by single photon emission computed tomography scans post‐treatment. Results: Both groups were comparable in age (mean = 74 ± 7.2 years in the placebo group and 75 ± 7.4 in the intervention group) and in other demographics. Sixty‐two participants were included in final analysis. Alzheimer's Disease Assessment Scale – Cognitive Portion (ADAS‐cog) was the primary outcome. By week 16, the mean ADAS‐cog reduced from 24.48 to 20.30 (mean reduction = 4.18) for those in the treatment group, and from 18.98 to 17.81 (mean reduction = 1.18) for those in the placebo group. The difference in mean reduction of ADAS‐cog was −3.00 (95% confidence interval [CI] = −4.910 to −1.100) in favor of the treatment group. Secondary outcomes of activities of daily living and quality of life measures also showed significant difference. In the perfusion scan analysis, the difference in the change in cerebral blood flow (t‐scores) pre‐ and post‐treatment between the intervention group (n = 7) and the placebo group (n = 11) was statistically significant (P < 0.001). Conclusion: In this randomized, double‐blind placebo‐controlled trial, we demonstrated significant differences in improvement in cognitive function and activities of daily living. The clinical improvement is corroborated with improvement in cerebral perfusion in a subset of participants. [ABSTRACT FROM AUTHOR]

Objective: To introduce a novel analytical approach for randomized controlled trials that are underpowered because of low participant enrollment or engagement.Data Sources: Reanalysis of data for 805 patients randomized as part of a pilot complex care intervention in 2015-2016 in a large delivery system. In the pilot randomized trial, only 64.6% of patients assigned to the intervention group participated.Study Design: A case study and simulation. The "Distillation Method" capitalizes on the frequently observed correlation between the probability of subjects' participation or engagement in the intervention and the magnitude of benefit they experience. The novel method involves three stages: first, it uses baseline covariates to generate predicted probabilities of participation. Next, these are used to produce nested subsamples of the randomized intervention and control groups that are more concentrated with subjects who were likely to participate/engage. Finally, for the outcomes of interest, standard statistical methods are used to re-evaluate intervention effectiveness in these concentrated subsets.Data Extraction Methods: We assembled secondary data on patients who were randomized to the pilot intervention for one year prior to randomization and two follow-up years. Data included program enrollment status, membership data, demographics, utilization, costs, and clinical data.Principal Findings: Using baseline covariates only, Generalized Boosted Regression Models predicting program enrollment performed well (AUC 0.884). We then distilled the full randomized sample to increasing levels of concentration and reanalyzed program outcomes. We found statistically significant differences in outpatient utilization and emergency department utilization (both follow-up years), and in total costs (follow-up year two only) at select levels of population concentration.Conclusions: By offering an internally valid analytic framework, the Distillation Method can increase the power to detect effects by redefining the estimand to subpopulations with higher enrollment probabilities and stronger average treatment effects while maintaining the original randomization. [ABSTRACT FROM AUTHOR]

Introduction: This pilot, randomized controlled trial aimed to evaluate the usability, among adolescents and young adults (AYAs) with ulcerative colitis (UC), of a web‐based tool ('iBDecide') designed to facilitate shared decision making (SDM). Methods: AYAs with UC (n = 35) were randomized to intervention (iBDecide, n = 14) and control (n = 12) arms before a scheduled clinic visit. We measured the usability of iBDecide, SDM, preferred decision‐making style, decision conflict and intervention use. Results: Participants in the intervention group found iBDecide easy to use and agreed that it made them feel ready to participate in decision making and that they would use it to prepare for appointments. There were 130 visits to iBDecide, lasting on average 3 min, 41 s. The medication and nutrition trackers were among the most‐viewed pages. Pages specifically designed to facilitate SDM were viewed only four times. Across groups, too few participants reported making decisions during clinic visits for decision‐related measures to be reported. Conclusions: This pilot trial provides evidence for the usability of iBDecide and guidance for developing a larger‐scale trial of a combined web‐based and in‐clinic SDM intervention. Overall, iBDecide shows promise in engaging AYAs with UC in SDM and condition management. Patient or Public Contribution: Patients, specifically AYAs with UC, and healthcare providers were involved in the design of this study's intervention, iBDecide. Additionally, the research team, from study conception to manuscript writing, included a young adult with inflammatory bowel disease. Clinical Trial Registration: This study was registered at clinicaltrials.gov (NCT04207008). [ABSTRACT FROM AUTHOR]

Objective: We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self‐monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28‐ESR]) and efficacy (reduction in number of visits) of patient‐initiated care assisted using a smartphone app, compared to usual care. Methods: A 12‐month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 1:1 to either app‐supported patient‐initiated care with a scheduled follow‐up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28‐ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28‐ESR between the groups. Results: Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28‐ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28‐ESR between the groups was within the noninferiority limit: −0.04 in favor of the app intervention group (95% CI −0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]). Conclusion: Patient‐initiated care supported by smartphone self‐monitoring was noninferior to usual care in terms of the ΔDAS28‐ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity. [ABSTRACT FROM AUTHOR]

The most common pressure ulcer associated with medical devices in the ICU is pressure injury associated with the endotracheal tube. We aimed to scrutinise the effects of two different techniques of endotracheal tube securement used in the ICU on the occurrence of pressure ulcers. This randomised clinical trial was conducted in 60 patients, 30 of which were intervention and 30 experimental, admittedin the ICU of a training and research hospitaldata were collected using the descriptive and clinical characteristics from the Braden Scale for predicting Pressure Sore Risk, the Pressure Ulcer Scale for healing, The International Staging System for Pressure Injuries and the Eilers Oral Assessment Guide. Based on the Braden Scale scores of the patients, we found that 98.3% of the cases were in the high‐risk group before and after the intervention. We also found that the recovery was higher among patients in whom the bandage fixation method was applied compared to those in whom the fixation was done with an endotracheal tube holder. [ABSTRACT FROM AUTHOR]

Objective: We compare periosteal block and intravenous regional anesthesia (IVRA) as anesthetic techniques for reduction of distal radius fractures when performed by emergency department (ED) clinicians following brief training. Methods: This was a single‐center, nonblinded randomized controlled trial of a convenience sample of patients presenting with distal radius fractures requiring closed reduction. Primary outcome measure was patient reported fracture reduction pain score, rated on a 100‐mm visual analog scale. Secondary outcomes included adjunct pain medication use, ED length of stay, remanipulation rates, participant satisfaction, clinician assessed efficacy, and clinician‐assessed ease of the procedure. Results: Eighty‐one patients were randomized to receive IVRA (n = 41) or periosteal block (N = 40). Reduction pain scores were not normally distributed. Median (25th–75th percentile) pain scores in participants assigned to IVRA and periosteal block were 5 (1–27.5) and 26 (8.5–63) mm, respectively, (p = 0.007). Use of adjunct medications during reduction was higher for the periosteal block group compared with IVRA (57.5% vs. 22.5%, p = 0.003). Remanipulation rates were 17.5% for periosteal block versus 7.5% for IVRA (p = 0.31). There was no difference in length of stay, patient satisfaction, or clinician's assessed ease of the anesthetic technique. There was a difference in clinician's assessment of efficacy between groups, with IVRA described as "extremely effective" by 65% and periosteal block described as "extremely effective" by 25% (p = 0.003). Conclusions: When performed by a diverse group of ED clinicians periosteal block provided inferior analgesia to IVRA but may provide an alternative when IVRA cannot be performed. [ABSTRACT FROM AUTHOR]

Background: Fluid treatment in sepsis is a challenge and clinical equipoise exists regarding intravenous (IV) volumes. We aimed to determine whether a 24‐h protocol restricting IV fluid was feasible in adult patients with sepsis without shock presenting to the emergency department (ED). Methods: The REFACED Sepsis trial is an investigator‐initiated, multicenter, randomized, open‐label, feasibility trial, assigning sepsis patients without shock to 24 h of restrictive, crystal IV fluid administration or standard care. In the IV fluid restriction group fluid boluses were only permitted if predefined criteria for hypoperfusion occurred. Standard care was at the discretion of the treating team. The primary outcome was total IV crystalloid fluid volumes at 24 h after randomization. Secondary outcomes included total fluid volumes, feasibility measures, and patient‐centered outcomes. Results: We included 123 patients (restrictive 61 patients and standard care 62 patients) in the primary analysis. A total of 32% (95% confidence interval [CI] 28%–37%) of eligible patients meeting all inclusion criteria and no exclusion criteria were included. At 24 h, the mean (±SD) IV crystalloid fluid volumes were 562 (±1076) ml versus 1370 (±1438) ml in the restrictive versus standard care group (mean difference –801 ml, 95% CI −1257 to −345 ml, p = 0.001). Protocol violations occurred in 21 (34%) patients in the fluid‐restrictive group. There were no differences between groups in adverse events, use of mechanical ventilation or vasopressors, acute kidney failure, length of stay, or mortality. Conclusions: A protocol restricting IV crystalloid fluids in ED patients with sepsis reduced 24‐h fluid volumes compared to standard care. A future trial powered toward patient‐centered outcomes appears feasible. [ABSTRACT FROM AUTHOR]

Diabetic foot infections continue to be a major challenge for health care delivery systems. Following encouraging results from a pilot study using a novel purified reconstituted bilayer matrix (PRBM) to treat chronic diabetic foot ulcers (DFUs), we designed a prospective, multi‐centre randomised trial comparing outcomes of PRBM at 12 weeks compared with a standard of care (SOC) using a collagen alginate dressing. The primary endpoint was percentage of wounds closed after 12 weeks. Secondary outcomes included assessments of complications, healing time, quality of life, and cost to closure. Forty patients were included in an intent‐to‐treat (ITT) and per‐protocol (PP) analysis, with 39 completing the study protocol (n = 19 PRBM, n = 20 SOC). Wounds treated with PRBM were significantly more likely to close than wounds treated with SOC (ITT: 85% vs 30%, P =.0004, PP: 94% vs 30% P =.00008), healed significantly faster (mean 37 days vs 67 days for SOC, P =.002), and achieved a mean wound area reduction within 12 weeks of 96% vs 8.9% for SOC. No adverse events (AEs) directly related to PRBM treatment were reported. Mean PRBM cost of healing was $1731. Use of PRBM was safe and effective for treatment of chronic DFUs. [ABSTRACT FROM AUTHOR]

Background: Pain is one of the main reasons to present to emergency departments (EDs). Opioids are indispensable for acute pain management but are associated with side effects, misuse, and dependence. The aim of this study was to test whether a single dose of intravenous (IV) acetaminophen (paracetamol) can reduce the use of morphine for pain relief and/or morphine‐related adverse events (AEs). Methods: ED patients >18 years with acute pain (i.e., Numeric Rating Scale [NRS] > 4) were screened for eligibility. Patients with analgesia in the past 6 h, chronic pain, or clinical instability were excluded. Patients were randomized in a 1:1 ratio to receive either morphine 0.1 mg/kg and 1 g acetaminophen IV or morphine 0.1 mg/kg and placebo IV. The intervention was double‐blinded. Additional morphine 0.05 mg/kg IV was administered every 15 minutes until pain relief (defined as NRS < 4) and whether the pain recurred. The primary outcome was the mean morphine dose for pain relief. Secondary outcomes were the total amount of morphine given, time to achieve pain relief, and AEs. Results: A total of 220 patients were randomized and 202 evaluated for the primary outcome. The mean morphine dose for pain relief was similar in both groups (acetaminophen 0.15 mg ± 0.07 mg/kg, placebo 0.16 ± 0.07 mg/kg). There were no differences in the total amount of morphine given (acetaminophen 0.19 ± 0.09 mg/kg, placebo 0.19 ± 0.1 mg/kg), the time to achieve pain relief (acetaminophen 30 min [95% CI 17–31 min], placebo 30 min [95% CI 30–35 min]), and the frequency of AEs (overall 27.4%). Time to pain recurrence did not differ significantly between the groups (hazard ratio 1.23 [0.76–1.98], p = 0.40). Conclusions: In ED patients, acetaminophen had no additional effect on pain control or morphine‐sparing effect at the time of first morphine administration. Titrated morphine with the algorithm used was highly effective, with 80% of all patients reporting pain relief within 60 min of starting therapy. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF) for the first 6 months has established benefits, yet had slow improvements globally. Little is known about electronic job aid‐assisted counselling to support EBF. As a secondary outcome of a cluster randomized controlled trial in Bangladesh, we assessed the effect of electronic job aid‐supported nutrition counselling and practical demonstration on EBF. We randomized pregnant women to one of five study arms in the trial and followed mother–child dyads until 2 years of age. Community health workers (CHWs) provided breastfeeding counselling with or without prenatal and complementary nutrient supplements in all four intervention arms. The comparison arm continued with the usual practice where mothers could receive nutrition counselling at routine antenatal and postnatal care, and during careseeking for childhood illnesses. We assessed breastfeeding indicators at birth and monthly until the child was 6 months old, in both intervention and comparison arms. To evaluate the effect of nutrition counselling on breastfeeding, we combined all four intervention arms and compared them with the comparison arm. Intervention newborns had half the risk (relative risk [RR]: 0.54, 95% confidence interval [CI]: 0.39, 0.76) of receiving prelacteal feeds than those in the comparison arm. EBF declined steeply in the comparison arm after 3 months of age. EBF was 16% higher in the intervention than the comparison arm at 4 months (RR: 1.16, 95% CI: 1.08, 1.23) and 22% higher at 5 months of age (RR: 1.22, 95% CI: 1.12, 1.33). Maternal background and household characteristics did not modify the intervention effect, and we observed no difference in EBF among caesarean versus vaginal births. Breastfeeding counselling and practical demonstration using an electronic job aid by CHWs are promising interventions to improve EBF and are scalable into existing community‐based programmes. Key messages: Using an electronic job aid, repeated, one‐to‐one counselling and practical demonstration to mothers by locally recruited CHWs reduced prelacteal feeding and improved EBF practice by delaying the early introduction of complementary food.The positive effect of counselling on EBF remains similar with or without nutrient supplementation.Electronic job aid supported counselling to promote breastfeeding should be integrated into existing community‐based maternal and child health programmes. [ABSTRACT FROM AUTHOR]

Policy PointsMass vaccination is essential for bringing the COVID‐19 pandemic to a close, yet substantial disparities remain between whites and racial and ethnic minorities within the United States.Online messaging campaigns featuring expert endorsements are a low‐cost way to increase vaccine awareness among minoritized populations, yet the efficacy of same‐race/ethnicity expert messaging in increasing uptake remains unknown.Our preregistered analysis of an online vaccine endorsement campaign, which randomly varied the racial/ethnic identity of the expert, revealed no evidence that information from same race/ethnicity experts affected vaccine interest or the intention to vaccinate.Our results do not rule out the possibility that other low‐cost endorsement campaigns may be more effective in increasing vaccine uptake, but do suggest that public health campaigns might profitably focus on issues of access and convenience when targeting minoritized populations in the United States. Context: The COVID‐19 pandemic in the United States has been unequally experienced across racial and ethnic groups. Mass vaccination is the most effective way to bring the pandemic to an end and to manage its public health consequences. But the racialization of public health delivery in the United States has produced a sizable racial/ethnic gap in vaccination rates. Closing this gap in vaccine uptake is therefore essential to ending the pandemic. Methods: We conducted a preregistered, well‐powered (N = 2,117) between‐subjects survey experiment, fielded March 24 to April 5, 2021, in which participants from YouGov's online panel—including oversamples of Black (n = 471), Hispanic/Latino/a (n = 430), and Asian American (n = 319) participants—were randomly assigned to see COVID‐19 vaccine information endorsed by same‐ or different‐race/ethnicity experts or to a control condition. We then measured respondents' vaccination intentions, intention to encourage others to get vaccinated, and interest in learning more information and sharing information with others. Findings: Same‐race/ethnicity expert endorsements had no measurable effect on nonwhite or white respondents' willingness to get the COVID‐19 vaccine, to encourage others to get the vaccine, or to learn more or share information with others. Conclusions: Our study provides empirical evidence suggesting online endorsements from same‐race/ethnicity experts do not increase vaccine interest, advocacy, or uptake, though same‐race/ethnicity endorsements may be effective in other venues or mediums. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) are at risk for detrimental complications even with current, standard of care (SOC) treatments. The primary objective of this randomised controlled trial was to compare a unique resorbable glass microfiber matrix (Mirragen; Advanced Wound Matrix [BBGFM]; ETS Wound Care, Rolla, Missouri) compared with a standard of care group (SOC, collagen alginate dressing) at 12 weeks. Both groups received standard diabetic foot care including glucose monitoring, weekly debridements when needed and an offloading device. The primary endpoint was proportion of full‐thickness, non‐infected, non‐ischaemic wounds healed at 12 weeks, with secondary endpoints including percent area reduction (PAR) and changes in Semmes‐Weinstein monofilament testing. The result illustrated in the intent‐to‐treat analysis at 12 weeks showed that 70% (14/20) of the BBGFM‐treated DFUs healed compared with 25% (5/20) treated with SOC alone (adjusted P =.006). Mean PAR at 12 weeks was 79% in the BBGFM group compared with 37% in the SOC group (adjusted P =.027). Mean change in neuropathic score between baseline and up to 12 weeks of treatment was 2.0 in the BBGFM group compared with −0.6 in the SOC group where positive improvement in scores are better (adjusted P =.008). The mean number of BBGFM applications was 6.0. In conclusion, adding BBGFM to SOC significantly improved wound healing with no adverse events related to treatment compared with SOC alone. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) pose a significant risk for infection and limb loss. Advanced wound therapies including human skin allografts have shown promise in resolving these challenging wounds. The primary objective of this randomised, prospective study was to compare the response of 100 subjects with non‐healing DFUs of which 50 were treated with a cryopreserved bioactive split thickness skin allograft (BSA) (TheraSkin; Misonix,Inc., Farmingdale, NY) compared with 50 subjects treated with standard of care (SOC, collagen alginate dressing) at 12 weeks. Both groups received standardised care that included glucose monitoring, weekly debridement's as appropriate, and an offloading device. The primary endpoint was proportion of full‐thickness wounds healed at 12 weeks, with secondary endpoints including differences in percent area reduction (PAR) at 12 weeks, changes in Semmes‐Weinstein monofilament score, VAS pain, and w‐QoL. The result illustrated in the intent‐to‐treat analysis at 12 weeks showed that 76% (38/50) of the BSA‐treated DFUs healed compared with 36% (18/50) treated with SOC alone (adjusted P =.00056). Mean PAR at 12 weeks was 77.8% in the BSA group compared with 49.6% in the SOC group (adjusted P =.0019). In conclusion, adding BSA to SOC appeared to significantly improve wound healing with a lower incidence of adverse events related to treatment compared with SOC alone. [ABSTRACT FROM AUTHOR]

Pressure ulcers (PUs) have a profound impact on individuals, with studies demonstrating that compared with similarly aged persons, those living with a PU have a significantly lower quality of life. The aim of this study was to explore the impact of the Shanley Pressure Ulcer Prevention Programme (SPUPP) on older persons' knowledge of, and attitudes and behaviours towards, PU prevention. This was a multi‐centre, open‐label, randomised controlled trial. The population of interest was older persons living in the community who attended either a day care centre or a retirement group and were deemed to be at risk of PUs due to reduced mobility. Stratified random sampling was used to randomise based on days of attendance at day care centre/retirement group. Pretest and post‐test were applied to the intervention and control groups. The SPUPP is a multimedia programme delivered using electronic media, hard copy materials, activities, and patient diaries and addresses the key tenets of PU prevention as described by the SKIN bundle. The programme contains five separate sessions delivered over 5 weeks. The impact of the SPUPP was assessed using the patient knowledge of and attitude and behaviour towards PU prevention instrument (KPUP). A total of 64 persons, 32 in each group, took part in the study. Of these, 75% (n = 48) were female, with a mean age of 81.9 years (SD: 5.56 years). Further, 68.8% (n = 44) were either overweight or obese and 40.6% (n = 26) were usually incontinent of urine. There were no differences between the intervention and control groups in mean scores during the pretest stage. However, at post‐test, the mean scores for the intervention group were higher than the control group, 16.87 (SD: 1.88) versus 12.41 (SD: 3.21), respectively. For the post‐test stage, mean differences between the two groups in favour of the intervention group (∆ = 4.46) were statistically significant, as t = 6.76, P =.0001, and equal variances were not assumed. The SPUPP impacted positively on knowledge scores of the participants and positively influenced attitudes and behaviours towards PU prevention. Thus, this research provides information regarding the potential to enhance patient involvement in PU prevention. [ABSTRACT FROM AUTHOR]

Objective: The objective was to evaluate the efficacy and safety of single‐dose ketamine infusion in adults with sickle cell disease (SCD) who presented with acute sickle vasoocclusive crisis (VOC). Methods: This study was a parallel‐group, prospective, randomized, double‐blind, pragmatic trial. Participants were randomized to receive a single dose of either ketamine or morphine, infused over 30 min. Primary outcome was mean difference in the numerical pain rating scale (NPRS) score over 2 h. NPRS was recorded every 30 min for a maximum of 180 min and secondary outcomes were cumulative dose of opioids, emergency department (ED) length of stay, hospital admission, change in vital signs, and drug‐related side effects. Authors performed the analysis using intention‐to‐treat principle. Result: A total of 278 adults with SCD and who presented with acute sickle VOC participated in this trial. A total of 138 were allocated to the ketamine group. Mean (±standard deviation [SD]) NPRS scores over 2 h were 5.7 (±2.13) and 5.6 (±1.90) in the ketamine and morphine groups. The ketamine group received significantly lower cumulative doses of morphine during their ED stay (mean ± SD = 4.5 ± 4.6 mg) than of the morphine group (mean ± SD = 8.5 ± 7.55 mg). Both groups had similar rates of hospital admission: 6.3% in the ketamine group had drug‐related side effects compared to 2.2% in the morphine group. Conclusion: Early use of ketamine in adults with VOC resulted in a meaningful reduction in pain scores over a 2‐h period and reduced the cumulative morphine dose in the ED with no significant drug‐related side effects in the ketamine‐treated group. [ABSTRACT FROM AUTHOR]

Adequate maternal healthcare practices are crucial to both maternal and infant nutrition outcomes. The Sylhet region of Bangladesh is vulnerable and performs poorly, as maternal and child health indicators are falling behind compared to other areas. Suchana, a large‐scale intervention programme aims to improve the health and nutritional status of mothers and children in this region. The objective of the present analysis is to assess the changes in indicators related to maternal healthcare practices among Suchana beneficiaries. We obtained data from the Suchana baseline and endline evaluation survey. Descriptive statistics were employed to summarize data. The following maternal healthcare practices were considered: if a Suchana beneficiary mother received antenatal care (ANC) from skilled service providers, took day time resting during pregnancy, consumed additional diet during pregnancy, took at least 100 iron‐folic acid (IFA) tablets during pregnancy and took a vitamin A capsule after delivery. Logistic regression analysis was performed to assess the impact of the Suchana intervention on maternal healthcare practices. The prevalence of the outcome variables at endline in the intervention area were as follows: 40% of mothers received at least four ANC from skilled service providers, 50% practiced daytime resting during pregnancy, 51% consumed additional diet during pregnancy, 41% took at least 100 iron‐folic acid tablets during pregnancy, 39% received postnatal care and 30% took a vitamin A capsule after delivery. The Suchana intervention significantly, positively improved indicators related to maternal healthcare practices; these findings support future larger‐scale programmes to improve maternal healthcare practices among vulnerable people in rural Bangladesh. [ABSTRACT FROM AUTHOR]