Relevant bibliographies by topics / Multimodal intervention

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  4. Book chapters
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Academic literature on the topic 'Multimodal intervention'

Author: Grafiati
Published: 4 June 2021
Last updated: 19 February 2022

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Journal articles on the topic "Multimodal intervention"

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Dhanani, J. A., A. G. Barnett, J. Lipman, and M. C. Reade. "Strategies to Reduce Inappropriate Laboratory Blood Test Orders in Intensive Care Are Effective and Safe: A Before-And-After Quality Improvement Study." Anaesthesia and Intensive Care 46, no. 3 (May 2018): 313–20. http://dx.doi.org/10.1177/0310057x1804600309.

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Unnecessary pathology tests performed in intensive care units (ICU) might lead to increased costs of care and potential patient harm due to unnecessary phlebotomy. We hypothesised that a multimodal intervention program could result in a safe and effective reduction in the pathology tests ordered in our ICU. We conducted a single-centre pre- and post-study using multimodal interventions to address commonly ordered routine tests. The study was performed during the same six month period (August to February) over three years: 2012 to 2013 (pre-intervention), 2013 to 2014 (intervention) and 2014 to 2015 (post-intervention). Interventions consisted of staff education, designing new pathology forms, consultant-led pathology test ordering and intensive monitoring for a six-month period. The results of the study showed that there was a net savings of over A$213,000 in the intervention period and A$175,000 in the post-intervention period compared to the pre-intervention period. There was a 28% reduction in the tests performed in the intervention period (P <0.0001 compared to pre-intervention period) and 26% in the post-intervention period (P <0.0001 compared to pre-intervention period). There were no ICU or hospital mortality differences between the groups. There were no significant haemoglobin differences between the groups. A multimodal intervention safely reduced pathology test ordering in the ICU, resulting in substantial cost savings.
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Yosmaoğlu, Hayri Baran, James Selfe, Emel Sonmezer, İlknur Ezgi Sahin, Senay Çerezci Duygu, Manolya Acar Ozkoslu, Jim Richards, and Jessica Janssen. "Targeted Treatment Protocol in Patellofemoral Pain: Does Treatment Designed According to Subgroups Improve Clinical Outcomes in Patients Unresponsive to Multimodal Treatment?" Sports Health: A Multidisciplinary Approach 12, no. 2 (November 21, 2019): 170–80. http://dx.doi.org/10.1177/1941738119883272.

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Background: Targeted intervention for subgroups is a promising approach for the management of patellofemoral pain. Hypothesis: Treatment designed according to subgroups will improve clinical outcomes in patients unresponsive to multimodal treatment. Study Design: Prospective crossover intervention. Level of Evidence: Level 3. Methods: Patients with patellofemoral pain (PFP; n = 61; mean age, 27 ± 9 years) were enrolled. Patients with PFP received standard multimodal treatment 3 times a week for 6 weeks. Patients not responding to multimodal treatment were then classified into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot) using 6 simple clinical tests. They were subsequently administered 6 further weeks of targeted intervention, designed according to subgroup characteristics. Visual analog scale (VAS), perception of recovery scale (PRS), 5-Level European Quality 5 Dimensions (EQ-5D-5L), and self-reported version of the Leeds Assessment of Neuropathic Symptoms and Signs scale (S-LANSS) were used to assess pain, knee function, and quality of life before and after the interventions. Results: In total, 34% (n = 21) of patients demonstrated recovery after multimodal treatment. However, over 70% (n = 29/40) of nonresponders demonstrated recovery after targeted treatment. The VAS, PRS, S-LANSS, and EQ-5D-5L scores improved significantly after targeted intervention compared with after multimodal treatment ( P < 0.001). The VAS score at rest was significantly lower in the “weak and pronated foot” and the “weak and tight” subgroups ( P = 0.011 and P = 0.008, respectively). Posttreatment pain intensity on activity was significantly lower in the “strong” subgroup ( P = 0.006). Conclusion: Targeted treatment designed according to subgroup characteristics improves clinical outcomes in patients unresponsive to multimodal treatment. Clinical Relevance: Targeted intervention could be easily implemented after 6 simple clinical assessment tests to subgroup patients into 1 of 3 subgroups (strong, weak and tight, and weak and pronated foot). Targeted interventions applied according to the characteristics of these subgroups have more beneficial treatment effects than a current multimodal treatment program.
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Rajib, Dutta. "Multimodal treatment strategies in Huntington’s disease." Journal of Neuroscience and Neurological Disorders 5, no. 2 (July 15, 2021): 072–82. http://dx.doi.org/10.29328/journal.jnnd.1001054.

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Huntington’s disease (HD) is an incurable neurodegenerative disease that causes involuntary movements, emotional lability, and cognitive dysfunction. HD symptoms usually develop between ages 30 and 50, but can appear as early as 2 or as late as 80 years. Currently no neuroprotective and neurorestorative interventions are available. Early multimodal intervention in HD is only possible if the genetic diagnosis is made early. Early intervention in HD is only possible if genetic diagnosis is made at the disease onset or when mild symptoms manifest. Growing evidence and understanding of HD pathomechanism has led researchers to new therapeutic targets. Here, in this article we will talk about the multimodal treatment strategies and recent advances made in this field which can be used to target the HD pathogenesis at its most proximal level.
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Naito, Tateaki, Taro Okayama, Takashi Aoyama, Akira Tanuma, Katsuhiro Omae, Keita Mori, and Toshiaki Takahashi. "Progress in multimodal intervention for cancer cachexia." Annals of Oncology 28 (October 2017): ix40. http://dx.doi.org/10.1093/annonc/mdx587.001.

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Litrownik, Daniel, Elizabeth A. Gilliam, Peter M. Wayne, Caroline R. Richardson, Reema Kadri, Pamela M. Rist, Marilyn L. Moy, and Gloria Y. Yeh. "Development of a Novel Intervention (Mindful Steps) to Promote Long-Term Walking Behavior in Chronic Cardiopulmonary Disease: Protocol for a Randomized Controlled Trial." JMIR Research Protocols 10, no. 4 (April 29, 2021): e27826. http://dx.doi.org/10.2196/27826.

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Background Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind–body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective This study aims to develop a novel multimodal mind–body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind–body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind–body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind–body exercise classes, an educational website, online mind–body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions Through the integration of components from a web-based physical activity intervention and mind–body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial Registration ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780 International Registered Report Identifier (IRRID) DERR1-10.2196/27826
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Ma, Kai, Xiuxiu Wu, Yongquan Chen, and Hui Yuan. "Effect of multimodal intervention on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy." Journal of International Medical Research 47, no. 5 (March 18, 2019): 2026–33. http://dx.doi.org/10.1177/0300060519835700.

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Objective Postoperative nausea and vomiting (PONV) is a common complication in patients undergoing gynecological laparoscopic surgery, and achieving good results is difficult with a single antiemetic method. This study investigated whether multimodal intervention can reduce PONV in patients undergoing gynecological laparoscopic surgery. Methods A total of 153 patients who underwent gynecological laparoscopic surgery were randomized into the control group and multimodal group. Patients in the multimodal group received dexmedetomidine 1 µg/kg intravenously 15 minutes before induction of anesthesia. A bilateral transversus abdominis plane block was performed with 0.375% ropivacaine 30 mL after induction of anesthesia. Scores of postoperative nausea and vomiting, the visual analog scale, and the Bruggemann comfort scale (BCS) were assessed 24 hours postoperatively. Results Nausea and vomiting scores were significantly lower at 2, 6, and 24 hours in the multimodal group compared with the control group. BCS scores were significantly higher at 0 to 24 hours in the multimodal group compared with the control group. Conclusions Multimodal intervention improves PONV and increases patients’ comfort. The multimodal approach can also enhance recovery after gynecological laparoscopic surgery.
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Li, Fuzhong, Peter Harmer, Elizabeth Eckstrom, Kathleen Fitzgerald, Laura Akers, Li-Shan Chou, Dawna Pidgeon, Jan Voit, and Kerri Winters-Stone. "Cost-Effectiveness of a Therapeutic Tai Ji Quan Fall Prevention Intervention for Older Adults at High Risk of Falling." Journals of Gerontology: Series A 74, no. 9 (January 10, 2019): 1504–10. http://dx.doi.org/10.1093/gerona/glz008.

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AbstractBackgroundData on the cost-effectiveness of proven fall prevention exercise interventions are limited. We aimed to establish the cost-effectiveness of Tai Ji Quan: Moving for Better Balance (TJQMBB) compared with a conventional exercise intervention for older adults at high risk of falling.MethodsWe conducted a trial-based cost-effectiveness analysis involving 670 older adults who had a history of falling or impaired mobility. Participants received one of three interventions—TJQMBB, multimodal exercise, or stretching exercise (control)—each of which was implemented twice weekly for 24 weeks. The primary cost-effectiveness measure was the incremental cost per additional fall prevented, comparing TJQMBB and multimodal exercise to Stretching and TJQMBB to multimodal exercise, with a secondary measure of incremental cost per additional quality-adjusted life-year (QALY) gained. The intervention was conducted between February 2015 and January 2018, and cost-effectiveness was estimated from a health care system perspective over a 6-month time horizon.ResultsThe total cost to deliver the TJQMBB intervention was $202,949 (an average of $906 per participant); for multimodal exercise, it was $223,849 ($1,004 per participant); and for Stretching, it was $210,468 ($903 per participant). Incremental cost-effectiveness ratios showed that the multimodal exercise was cost-effective ($850 per additional fall prevented; $27,614 per additional QALY gained) relative to Stretching; however, TJQMBB was the most economically dominant strategy (ie, having lower cost and being clinically more efficacious) compared with multimodal and stretching exercises with regard to cost per additional fall prevented and per additional QALY gained. TJQMBB had a 100% probability of being cost-effective, relative to Stretching, at a threshold of $500 per each additional fall prevented and $10,000 per additional QALY gained. Sensitivity analyses showed the robustness of the results when extreme cases, medical costs only, and missing data were considered.ConclusionsAmong community-dwelling older adults at high risk for falls, TJQMBB is a cost-effective means of reducing falls compared with conventional exercise approaches.Trial RegistrationClinicaltrials.gov (NCT02287740).
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Burgener, Sandy C., Sara Marsh-Yant, and Katie Kosanda Nega. "A Combined, Multimodal Intervention for Individuals with Dementia." Research in Gerontological Nursing 4, no. 1 (May 28, 2010): 64–75. http://dx.doi.org/10.3928/19404921-20100504-01.

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Dayal, Rajeev, Joshua Bernheim, Daniel G. Clair, Albeir Y. Mousa, Scott Hollenbeck, Brain DeRubertis, James McKinsey, Nicholas J. Morrissey, K. Craig Kent, and Peter L. Faries. "Multimodal Percutaneous Intervention for Critical Venous Occlusive Disease." Annals of Vascular Surgery 19, no. 2 (March 2005): 235–40. http://dx.doi.org/10.1007/s10016-004-0167-6.

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Weinger, Matthew B., Jason M. Slagle, Audrey H. Kuntz, Jonathan S. Schildcrout, Arna Banerjee, Nathaniel D. Mercaldo, James L. Bills, et al. "A Multimodal Intervention Improves Postanesthesia Care Unit Handovers." Survey of Anesthesiology 60, no. 2 (April 2016): 83. http://dx.doi.org/10.1097/01.sa.0000480639.60535.78.

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Dissertations / Theses on the topic "Multimodal intervention"

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Bisht, Babita. "A multimodal intervention for progressive multiple sclerosis." Diss., University of Iowa, 2014. https://ir.uiowa.edu/etd/6372.

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Multiple sclerosis (MS) is a complex, progressive disease of the central nervous system with potential multifactorial etiology. Subjects with MS experience varying symptoms such as fatigue, muscle weakness, gait and balance impairments, etc. With time, intensity of the symptoms progresses, especially if subjects are in the progressive phase of the disease. So far, there is no effective treatment available which can reverse or even stop progression of the symptoms and disability associated with MS. Given the multifactorial nature of MS, use of multiple interventions is recommended for its treatment. As use of multiple pharmacological agents is usually limited due to adverse side effects, non-pharmacological treatments such as diet, exercises and stress management may provide a safer and potentially effective treatment option. The main aim of this study was to investigate the effects of a combination of non-pharmacological treatments on subjects with progressive MS. In this open-label, single arm cohort study, we investigated the effects of a multimodal intervention consisting of modified Paleolithic diet, nutritional supplements, stretching exercises, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation and massage on multiple symptoms associated with progressive MS. We investigated the effects on fatigue, quality of life, clinical disability, walking performance and balance of the subjects over a period of 12 months. Twenty subjects (15 female) with progressive MS (18 secondary progressive and 2 primary progressive) and mean Expanded Disability Status scale (EDSS) score of 6.2 (range, 3.5 to 8) participated in the 12-month main phase of the study. In a subset of subjects (8 SPMS, 2 PPMS; EDSS 6.2 + 1.4), effects of the intervention on microstructure of whole brain, corpus callosum and corticospinal tracts using diffusion tensor imaging (DTI), and measures of clinical disability including ambulation, hand function and cognitive functions were also investigated. Adherence and dosage of individual components of the intervention were calculated from subjects' daily logs. All clinical assessments were completed at baseline, 3, 6, 9 and 12 months. MRI data were collected at 1 and 12 months post-intervention on a subset of 10 subjects. Safety analyses were completed based on monthly side effects questionnaires and blood analyses at 1, 3, 6, 9 and 12 months. Overall subjects showed good adherence with this intervention and did not report any serious side effects. Subjects reported significant improvement in perceived fatigue, energy and general health within 3 months from baseline and sustained the improvement until 12 months. Fifty percent of the subjects showed significant and consistent increases in both comfortable (during timed up and go test) and fast (during timed 25 foot walk) walking speeds. Small but significant improvements in the measures of balance such as Berg Balance test and time to stand up from seated position were also observed. Interestingly, subjects with comparatively lower physical impairment at baseline showed higher improvements in fatigue, walking and balance tests compared to the subjects with severe physical impairments at baseline. We observed consistent improvements in the cognitive functions of the subjects and in the white matter integrity of left corticospinal tracts. Clinical disability assessed with EDSS, and DTI metrics of most white matter tracts did not change significantly during the study period. These results show that a multimodal intervention can be safely implemented and sustained by subjects with progressive MS. This intervention decreases perception of fatigue and improves quality of life of these subjects. Furthermore, this intervention has beneficial effects on subject's walking ability, balance and cognitive functions and white matter integrity. Initiating this intervention during early stage of the disease when subjects have only mild to moderate disability seems to be more beneficial. Larger, randomized, controlled trials are needed to establish efficacy of this multimodal intervention on MS and elucidate mechanisms underlying its effects on MS.
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Hedborg, Kerstin. "Migraine and Stress : An Internet administered Multimodal Behavioral Treatment Intervention." Doctoral thesis, Uppsala universitet, Medicin, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-158079.

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Migraine is a disabling neurological disorder with high prevalence, the clinical manifestations of which are highly dependent on stress. The overall theme of the present thesis was to address aspects of stress in migraine. A multimodal behavioral treatment (MBT) program was developed specifically designed for migraine and focusing on stress as a trigger and an intervention was performed using this Internet-administered program. Migraine symptoms were followed via an Internet administered diary and questionnaires were answered at regular intervals during the 11-month study period. The thesis is based on four papers: In Paper I, life events and current stress, personality traits, and gender were studied cross-sectionally in 106 women and 44 men with migraine, who suffered at least two attacks a month at inclusion. Paper II describes a randomized controlled trial of the MBT program performed on 58 women and 25 men recruited from participants of the study described in Paper I. In the MBT study participants were randomized into one control group and two MBT groups, one of which received hand massage as part of the treatment. In Paper III, complete migraine drug use and changes in use and in drug efficacy during the MBT program were studied. In Paper IV, the salivary cortisol levels of MBT participants were evaluated as a biological stress marker. The MBT program proved effective in decreasing migraine headache; it was feasible and there was low attrition. Moreover, MBT resulted in decreased migraine drug use and increased drug efficacy, but had no discernible effects on salivary cortisol profiles. No effect of hand massage on migraine headache frequency was seen. Personality trait profiling revealed high scores for the neuroticism factor. Stress susceptibility was the single most aberrant personality trait and correlated highly with the reported level of current stress and with experienced negative life events. Gender differences included higher scores for women on trait anxiety, negative life events, depressive mood, anxiety, tension type headache, use of triptans, and efficacy of analgesics, whereas men displayed higher use of analgesics. In conclusion, the efficacy and low attrition associated with the present MBT program appears promising and timely with regard to the development of better and more accessible migraine treatment. Stress susceptibility, gender, negative life events and psychosomatic comorbidity are important factors to consider in relation to the care of persons with migraine.
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Shapiro, Jamie L. "An individualized multimodal mental skills intervention for college athletes undergoing injury rehabilitation." Morgantown, W. Va. : [West Virginia University Libraries], 2009. http://hdl.handle.net/10450/10293.

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Thesis (Ph. D.)--West Virginia University, 2009.
Title from document title page. Document formatted into pages; contains ix, 177 p. : ill. (some col.). Includes abstract. Includes bibliographical references.
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Hildingsson, Victoria, and Anders Clarström. "Kartläggning av fysioterapeutiska interventioner i multimodal smärtrehabilitering inom primärvården. : En enkätstudie." Thesis, Högskolan Dalarna, Medicinsk vetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:du-28322.

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Bakgrund: Långvarig smärta är ett stort folkhälsoproblem som innebär stora kostnader för samhället och självklart också stort lidande för individen. Multimodal smärtrehabilitering (MMR) innebär att olika yrkeskategorier arbetar gemensamt kring dessa patienter. Forskningen visar måttligt till starkt vetenskapligt stöd för MMR vid komplex smärtproblematik. Det finns kunskapsluckor kring vilken typ av fysioterapeutiska interventioner som används vid multimodal smärtrehabilitering. Syfte: Syftet med studien var att kartlägga fysioterapeuternas arbete inom ramen för multimodal smärtrehabilitering i primärvården. Metod: Enkätstudie av tvärsnittstyp med kvantitativ ansats baserad på en egenkonstruerad webbenkät. Populationen utgjordes av fysioterapeuter anslutna till Nationella Registret över Smärtrehabilitering (NRS) primärvård och resultatet bygger på de 23 fysioterapeuter som valde att svara på webbenkäten. Resultat: Resultaten baseras på svar från 71 % av de NRS-anslutna klinikerna. Sammanfattning av resultaten visade framför allt att råd/undervisning samt olika former av fysisk träning utgjorde grunden i fysioterapeutens arbete inom MMR-team i primärvården. Det framkommer att så gott som alla patienter träffade fysioterapeut under behandlingsperioden. Det var en klar övervikt mot gruppbehandling eller en kombination av grupp och individuell behandling gällande de fysioterapeutiska interventionerna. Behandlingsperioderna var för det mesta fyra till elva veckor där patienten träffade fysioterapeut oftast varje vecka eller flera gånger/vecka. I primärvårdens MMR-team var fysioterapeut, arbetsterapeut, KBT terapeut, läkare och rehabkoordinator de vanligast förekommande yrkeskategorierna i teamen. Slutsats: Fysioterapeuten har en central roll i primärvårdens MMR-team och använder sig primärt av evidensbaserade, aktiva interventioner.
Background: Chronic pain is a major public health problem which involves high costs for society and, of course, also great suffering for the individual. Multimodal rehabilitation (MMR) means that different occupational categories work together around these patients. Research shows moderately to strong scientific evidence for MMR in complex pain problems. There are a lack of evidence about which type of physiotherapeutic interventions that are used in multimodal pain rehabilitation. Aim: The aim was to study which physiotherapy interventions that are used in multimodal primary healthcare rehabilitation in Sweden. Method: Cross-sectional survey with quantitative approach based on a self-designed web questionnaire. The population consisted of physiotherapists working in clinics reporting to the Swedish Quality Registry for Pain Rehabilitation (SQRP) in primary care and the result is based on the 23 physiotherapists who responded to the web questionnaire. Results: The results are based on 71% of the NRS-affiliated clinics. Counseling/teaching and various forms of physical training formed the basis of the physiotherapist's work in MMR teams in primary care. Almost all patients meet physiotherapists during the treatment period. Group treatment or a combination of group and individual treatment were most common. The treatment periods were mostly between four to eleven weeks where the patient met a physiotherapist most often weekly or several times a week. In the primary care MMR-team, the physiotherapist, occupational therapist, KBT therapist, physician and rehab coordinator were the most common occupational categories. Conclusion: Physiotherapists have a central role in the MMR-teams in primary care, they primarily use evidence-based, active interventions.
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Ochandorena, Acha Mirari. "Intervención temprana multimodal de fisioterapia para niños prematuros y sus padres." Doctoral thesis, Universitat de Vic - Universitat Central de Catalunya, 2020. http://hdl.handle.net/10803/670667.

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La intervención temprana multimodal de fisioterapia se presenta como una intervención preventiva para niños nacidos prematuros y sus padres. Iniciando en la Unidad de Cuidados Intensivos Neonatales y continuando después del alta, hasta los 2 meses de edad corregida del niño, su objetivo es sensibilizar a los padres y proporcionarles estrategias para el cuidado de su hijo, favorecer la interacción entre padres e hijos, así como favorecer el desarrollo del infante y proporcionarle oportunidades de movimiento a través de actividades apropiadas para su desarrollo. Mediante investigaciones de metodología mixta, la presente tesis doctoral aporta nuevas evidencias sobre la intervención temprana de fisioterapia. A través de un ensayo clínico aleatorizado, realizado en el Hospital Sant Joan de Déu de Barcelona, y un estudio cualitativo de entrevistas, que pretende alcanzar un conocimiento más integral sobre la efectividad de la intervención temprana multimodal de fisioterapia.
The early multimodal physiotherapy intervention is presented as a preventive intervention for children born prematurely and their parents. The designed intervention starts in the Neonatal Intensive Care Unit and continues after discharge, up to 2 months of corrected age. Its objective is to sensitize parents and provide them with strategies for caring their child, promote interaction between parents and the preterm infant, as well as promoting infant development and providing opportunities for movement through developmentally appropriate activities. Through mixed methodology research, this doctoral thesis provides new evidence of early intervention in physiotherapy. A randomized clinical trial was carried out at the Sant Joan de Déu Children’s Hospital in Barcelona, and a qualitative study with interviews. These studies aim was to achieve a more comprehensive knowledge about the effectiveness of early multimodal physiotherapy intervention.
Programa de Doctorat: Cures Integrals i Serveis de Salut
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Ferguson, Shirley, and n/a. "An examination of a school based, multimodal program for middle primary boys with difficult behaviours." University of Canberra. Professional & Community Education, 1997. http://erl.canberra.edu.au./public/adt-AUC20060710.101053.

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This study examined the efficacy of a multimodal intervention with conduct disordered boys in the middle primary years. The intervention consisted of a behavioural classroom program; a small group, social skills program; and a behavioural parenting program Resource implications of this model were also evaluated. A review of the current literature on conduct disorders showed that these children account for less than 5% of the population, but they have a strong impact on families, teachers, peers, schools and the wider community. About 50% of children with severe, early behavioural problems will continue with these problems, not only throughout their adult lives, but into the next generation. Early intervention appears to offer our best hope of altering this trajectory. Interventions with this population have been largely unsuccessful. At the present time the most promising intervention is behavioural parent training programs. Combining these with child focused social skills programs, and behavioural programs in the school setting, increases their efficacy. This study used a single subject experimental design to examine the effects of this program on four boys with behavioural difficulties. Continuous measures were taken with parent, and teacher daily record charts, and classroom observations. Pre, post and followup measures were taken with the Child Behaviour Checklist. The results of the study were mixed. Some subjects, according to some respondents, improved in home and school behaviours. All three subjects, for whom there was followup data, had improved. The classroom, and parenting programs appeared to be associated with positive changes in child behaviour, the small group was associated with more disruptive behaviour at school.
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Simon, Jason E. "Effects of Multimodal Police and Community Development Interventions on Violent Crime in a Target Area of Youngstown, Ohio." Youngstown State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1577807036428137.

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Roberts, Polly Sheffield. "Alleviating Stress in Clergy Wives: The Development and Formative Evaluation of a Psychoeducational Group Intervention." Diss., Virginia Tech, 2004. http://hdl.handle.net/10919/27362.

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The study addressed the problem that, although researchers have clearly identified areas of stress for clergy wives and suggested the use of counseling services, they have not identified effective counseling interventions. Clergy wives referred to non-clergy women married to Protestant clergymen. The study included (a) the development of Clergy Wife Wings (CWW), a 5-session psychoeducational group plan for 6 to 10 clergy wives, to alleviate ministry-related stress and (b) the formative evaluation of the plan in its first implementation. Conclusions drawn suggested that CWW showed good potential as an intervention in helping clergy wives to move towards alleviation of stress but needed revisions and additional implementation and evaluation. Recommendations provided a detailed list of specific revisions. CWW had an outcome goal for participants of decreasing ministry-related stress, particularly in three targeted stress domains: role expectations and time demands, clergy family boundary intrusiveness, and lack of social support. As presented in the literature review, the theoretical foundations in stress came from the multimodal-transactional model of stress and its treatment (Palmer, S. & Dryden, W., 1995) and from REBT. The literature review also contained, after a summary of the history of clergy wives, an overview of the plan, with references supporting the components. The plan included pre and post-group testing with two clergy-wife stress assessment instruments -- adaptations of the Clergy Family Life Inventory (Blanton, P., Morris, L, & Anderson, D., 1990) and of the Normative Stress Scale for Clergy Wives (Huebner, 1998). The formative evaluation of the group plan, in its first implementation, identified themes concerning effectiveness, strengths, weaknesses, and suggestions for improvement. These themes emerged from the qualitative analysis of various documents completed by the 9 participants, the group facilitator, and a group observer. Qualitative findings suggested effectiveness of Clergy Wife Wings through themes of participant perceptions and of reported changes in their thinking and behavior related to stress. Quantitative findings, however, from the pre and post-group measures on the clergy-wife stress instruments did not suggest effectiveness, except for a significant decrease in stress related to two of 35 stressor statements. Discussion included possible reasons for the disparity between findings.
Ph. D.
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Kron, Annika. "Teoretisk syn på inlärning inom ART : En kvalitativ textanalys av ART, Aggression Replacement Training A Comprehensive Intervention for Youth samt skolans styrdokument, Lpo 94." Thesis, Linköping University, Department for Studies of Social Change and Culture, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-6451.

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ART, Aggression Replacement Training är en multimodal behandlingsmetod som bygger på tre samverkande komponenter. Dessa är: Interpersonell färdighetsträning där sociala färdigheter tränas, ilskekontrollträning som lär individen att handskas med sin ilska samt moralträningen som ska höja det moraliska resonerandet. 1987 började ART att användas på ungdomsvårdsskolor i USA, metoden har spridit sig och idag används ART inte enbart inom den institutionella vården utan allt mer i skolans värld.

Syftet med uppsatsen är att undersöka vilket eller vilka teoretiska perspektiv på inlärning som metoden stödjer sig på och hur väl dessa stämmer överens med skolans styrdokument (Lpo 94). Studien är baserad på en kvalitativ textanalys av ART Aggression Replacement Training A Comprehensive Intervention for Youth, en bok av grundarna till metoden, samt skolans styrdokument (Lpo 94).

Reultatet visar att ART vilar på flera olika teorier om inlärning, och att olika teorier finns representerade inom de olika komponenterna. I förhållande till Lpo 94 visar de delar jag analyserar på en överensstämmelse, även om någon punkt kan tolkas annorlunda.

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Costa, Rita. "Efetividade e Relação Custo- Efetividade de duas intervenções multimodais na Dor Lombar Crónica em Portugal – Estudo de Séries de Casos." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2014. http://hdl.handle.net/10400.26/7423.

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Relatório do Projeto de Investigação apresentado para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Fisioterapia, área de especialização em Fisioterapia em Condições Músculo- Esqueléticas
Revisão da literatura: A Dor Lombar Crónica (DLC) constitui um importante problema de saúde, com consequências a nível social como económico. A intervenção dos fisioterapeutas na DLC apresenta uma enorme variabilidade, podendo tal acontecer devido à falta de evidência de boa qualidade que suporte a efetividade ou a relação custo – efetividade (RCE) das intervenções. Entre modalidades mais frequentemente utilizadas estão os agentes físicos e modalidades mecânicas, a terapia manual e o exercício terapêutico. O objetivo principal deste estudo foi verificar qual de duas intervenções multimodais apresenta uma melhor efetividade, na diminuição da intensidade da dor, da incapacidade funcional e no aumento da qualidade de vida em utentes com DLC. Foi também realizada uma análise da RCE na perspectiva do utente, utilizando como referência a mudança clinicamente importante nas variáveis de resultados. Métodos/Desenho: Foi estruturado um estudo de série de casos, que estabeleceu a comparação entre duas intervenções multimodais: agentes físicos/modalidades mecânicas e terapia manual (AF+TM) e, agentes físicos/modalidades mecânicas, terapia manual e exercício terapêutico (AF+TM+EXE). A amostra foi constituída por 20 indivíduos cm DLC. Como principais variáveis de resultados utilizou-se a intensidade da dor (Escala Visual Análoga) e a incapacidade funcional (Quebec Back Pain Disability Scale), e como secundários, a qualidade de vida (EuroQuol-5D) e a perceção global de melhoria reportada pelo utente (Pacient Global Impression Change), sendo realizadas 4 avaliações: antes da intervenção, 3, 6 e 12 semanas após o início da mesma. Resultados: Foram encontradas melhorias significativas às 12 semanas para a redução da incapacidade funcional na intervenção AF+TM e na redução da intensidade da dor e aumento da qualidade de vida na intervenção AF+TM+EXE. A comparação entre intervenções, não revelou diferenças significativas. Na RCE a intervenção AF+TM apresentou melhores resultados excepto quando são considerados apenas os custos directos: a intervenção AF+TM+EXE, apresenta uma melhor RCE na intensidade da dor. Conclusões: Os resultados mostram que apesar de não existirem diferenças significativas entre as intervenções a AF+TM apresenta uma melhor RCE no geral. Estes resultados devem ser analisados com cuidado devido às limitações deste estudo, sendo necessárias mais investigações sobre este tema.
Abstract: Background: The Chronic Low Back Pain (CLBP) is a major health problem, with a large social and economic impact. The intervention of physiotherapists in the CLBP presents an enormous variability. This may happen due to the lack of good quality evidence to support the effectiveness or cost - effectiveness (CER) of the interventions. Among the most frequently used modalities are physical agents and mechanical modalities, manual therapy and therapeutic exercise. The main objective of this study was to verify which of the multimodal interventions proposed has a better effectiveness in the reduction of pain intensity, functional disability and increased quality of life for users with CLBP. Will also be performed an analysis of the CER of the patient perspective. Methods / Design: A Case Series study design was used to establish comparison between two interventions: physical agents/modalities mechanical and manual therapy (AF + TM) and physical agents/mechanical modalities, manual therapy and therapeutic exercise (AF + TM+EXE). The sample included 20 subjects with CLPB As a result we main variables pain intensity (visual analog scale) and functional disability (Quebec Back Pain Disability Scale), and the secondary, the quality of life (EuroQuol-5D) and improving the perception experienced by the patient (Patient global Impression Change), being performed 4 evaluations: before the intervention, 3, 6 and 12 weeks after the beginning of the intervention. Results: Significant improvement at 12 weeks in reducing functional disability were found in AF+TM intervention and reduction of pain intensity and improved quality of life in AF+TM+EXE intervention. Comparison between interventions, revealed no significant differences. CEA in the AF + TM intervention showed better results unless when we consider only direct costs: AF + TM + EXE intervention, presents a better CEA in pain intensity. Conclusions: The results indicate that although there are no significant differences between interventions, AF+TM provides a better CER in the general. These results should be analyzed with caution due to the limitations of this study. Further research on this topic is needed.
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Books on the topic "Multimodal intervention"

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Multimodale Intervention auf der Basis eines Gedächtnistrainings mit älteren Menschen. Frankfurt am Main: P. Lang, 1998.

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Multimodal Treatment Of Acute Psychiatric Illness. Columbia University Press, 2013.

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M, Justin, and Glendon L. Multimodal Treatment of Acute Psychiatric Illness: A Guide for Hospital Diversion. Columbia University Press, 2013.

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Simpson, Justin M., and Glendon L. Moriarty. Multimodal Treatment of Acute Psychiatric Illness: A Guide for Hospital Diversion. Columbia University Press, 2013.

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Simpson, Justin M., and Glendon L. Moriarty. Multimodal Treatment of Acute Psychiatric Illness: A Guide for Hospital Diversion. Columbia University Press, 2013.

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Soloe, Cindy, Lauren McCormack, Katherine Treiman, and David Driscoll. Informed decision making about prostate-specific antigen (PSA) testing: Findings and implications from formative testing of a multimodal intervention. RTI International, 2009. http://dx.doi.org/10.3768/rtipress.2009.rr.0006.0902.

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Hochman, Michael H. The Multimodal Treatment Study of Children with Attention Deficit/Hyperactivity Disorder (MTA). Edited by Ish P. Bhalla, Rajesh R. Tampi, Vinod H. Srihari, and Michael E. Hochman. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190625085.003.0007.

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This chapter provides a summary of a landmark study in child and adolescent psychiatry. What is the most effective long-term management strategy in children with attention-deficit/hyperactivity disorder: medication management, behavioral treatment, a combination of medication management and behavioral treatment, or routine community care? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
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Meer, Carolyn Dorothy Vander. Effects of a multimodal group counseling intervention on the adjustment of intermediate school-age African American children from changing families. 1995.

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Baracos, Vickie E., Sharon M. Watanabe, and Kenneth C. H. Fearon. Aetiology, classification, assessment, and treatment of the anorexia-cachexia syndrome. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199656097.003.0205.

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Anorexia-cachexia is a heterogeneous and multifactorial syndrome most likely driven by systemic inflammation and neuroendocrine activation. Key diagnostic features include reduced appetite, weight loss, and muscle wasting. Key clinical problems include management of anorexia without resort to artificial nutritional support, and muscle wasting that cannot be completely arrested/reversed even with such intervention. Assessment should cover domains such as body stores of energy and protein, food intake, performance status, and factors resulting in excess catabolism. Intervention should be early rather than late, informed by the assessment process and focused on a multimodal approach (nutrition, exercise, and pharmacological agents). This chapter aims to discuss these issues and provide (a) the reader with some background principles to classification, (b) a simple approach to patient assessment and a robust algorithm for basic multimodal treatment, and (c) an overview of the evidence base for different pharmacological interventions.
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Pfiffner, Linda J., and Lauren M. Haack. Nonpharmacologic Treatments for Childhood Attention-Deficit/Hyperactivity Disorder and Their Combination with Medication. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199342211.003.0003.

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Of the nonpharmacological treatments for childhood attention-deficit/hyperactivity disorder (ADHD), behavioral interventions have the largest evidence base. Current behavioral interventions include behavioral parent training, behavioral classroom management, child skills training, behavioral multicomponent interventions, and multimodal treatment, which combines behavioral interventions and medication. This updated review of studies reveals significant behavioral treatment effects from randomized controlled trials on a wide range of child outcomes including ADHD and oppositional defiant disorder symptoms as well as areas of functional impairment such as homework, organizational, and social behaviors. Combined behavioral and medication treatments appear to reduce the needed dose or intensity of each intervention.
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Book chapters on the topic "Multimodal intervention"

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Müller, Ulrich, Jürgen Hesser, and Reinhard Männer. "Fast Rigid 2D-2D Multimodal Registration." In Medical Image Computing and Computer-Assisted Intervention – MICCAI 2004, 887–94. Berlin, Heidelberg: Springer Berlin Heidelberg, 2004. http://dx.doi.org/10.1007/978-3-540-30135-6_108.

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Gardner, William I., Janice L. Graeber, and Christine L. Cole. "Behavior therapies: A multimodal diagnostic and intervention model." In Manual of diagnosis and professional practice in mental retardation., 355–69. Washington: American Psychological Association, 1996. http://dx.doi.org/10.1037/10203-027.

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Kansy, K., A. Schmitgen, M. Bublat, G. Grunst, M. Jungmann, P. Wisskirchen, M. Moche, G. Strauss, C. Trantakis, and T. Kahn. "A Multimodal Navigation System for Interventional MRI." In Medical Image Computing and Computer-Assisted Intervention – MICCAI 2001, 1157–58. Berlin, Heidelberg: Springer Berlin Heidelberg, 2001. http://dx.doi.org/10.1007/3-540-45468-3_142.

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Xu, Tao, Han Zhang, Xiaolei Huang, Shaoting Zhang, and Dimitris N. Metaxas. "Multimodal Deep Learning for Cervical Dysplasia Diagnosis." In Medical Image Computing and Computer-Assisted Intervention – MICCAI 2016, 115–23. Cham: Springer International Publishing, 2016. http://dx.doi.org/10.1007/978-3-319-46723-8_14.

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Zhang, Wen, Liang Zhan, Paul Thompson, and Yalin Wang. "Deep Representation Learning for Multimodal Brain Networks." In Medical Image Computing and Computer Assisted Intervention – MICCAI 2020, 613–24. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-59728-3_60.

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Li, Yang, Xinqiang Gao, Biao Jie, Pew-Thian Yap, Min-jeong Kim, Chong-Yaw Wee, and Dinggang Shen. "Multimodal Hyper-connectivity Networks for MCI Classification." In Medical Image Computing and Computer Assisted Intervention − MICCAI 2017, 433–41. Cham: Springer International Publishing, 2017. http://dx.doi.org/10.1007/978-3-319-66182-7_50.

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Wang, Wenxuan, Chen Chen, Meng Ding, Hong Yu, Sen Zha, and Jiangyun Li. "TransBTS: Multimodal Brain Tumor Segmentation Using Transformer." In Medical Image Computing and Computer Assisted Intervention – MICCAI 2021, 109–19. Cham: Springer International Publishing, 2021. http://dx.doi.org/10.1007/978-3-030-87193-2_11.

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Fabri, Marc, Salima Y. Awad Elzouki, and David Moore. "Emotionally Expressive Avatars for Chatting, Learning and Therapeutic Intervention." In Human-Computer Interaction. HCI Intelligent Multimodal Interaction Environments, 275–85. Berlin, Heidelberg: Springer Berlin Heidelberg, 2007. http://dx.doi.org/10.1007/978-3-540-73110-8_29.

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Gaens, Tom, Frederik Maes, Dirk Vandermeulen, and Paul Suetens. "Non-rigid multimodal image registration using mutual information." In Medical Image Computing and Computer-Assisted Intervention — MICCAI’98, 1099–106. Berlin, Heidelberg: Springer Berlin Heidelberg, 1998. http://dx.doi.org/10.1007/bfb0056299.

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Zhang, Wen, Kai Shu, Suhang Wang, Huan Liu, and Yalin Wang. "Multimodal Fusion of Brain Networks with Longitudinal Couplings." In Medical Image Computing and Computer Assisted Intervention – MICCAI 2018, 3–11. Cham: Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-030-00931-1_1.

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Conference papers on the topic "Multimodal intervention"

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Putze, Felix, Johannes Popp, Jutta Hild, Jürgen Beyerer, and Tanja Schultz. "Intervention-free selection using EEG and eye tracking." In ICMI '16: INTERNATIONAL CONFERENCE ON MULTIMODAL INTERACTION. New York, NY, USA: ACM, 2016. http://dx.doi.org/10.1145/2993148.2993199.

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Tscharn, Robert, Marc Erich Latoschik, Diana Löffler, and Jörn Hurtienne. "“Stop over there”: natural gesture and speech interaction for non-critical spontaneous intervention in autonomous driving." In ICMI '17: INTERNATIONAL CONFERENCE ON MULTIMODAL INTERACTION. New York, NY, USA: ACM, 2017. http://dx.doi.org/10.1145/3136755.3136787.

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Salous, Mazen, Felix Putze, Tanja Schultz, Jutta Hild, and Jürgen Beyerer. "Investigating static and sequential models for intervention-free selection using multimodal data of EEG and eye tracking." In ICMI '18: INTERNATIONAL CONFERENCE ON MULTIMODAL INTERACTION. New York, NY, USA: ACM, 2018. http://dx.doi.org/10.1145/3279810.3279841.

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Montanari, Alessandro. "Multimodal Indoor Social Interaction Sensing and Real-time Feedback for Behavioural Intervention." In the 2015 Workshop. New York, New York, USA: ACM Press, 2015. http://dx.doi.org/10.1145/2801694.2801706.

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Tamisier, Renaud, Erika Treptow, Marie Joyeux-Faure, Patrick Lévy, Marc Sapène, Meriem Benmerad, Sébastien Bailly, et al. "Impact of a multimodal telemonitoring intervention on CPAP adherence in symptomatic low-cardiovascular risk sleep apnea: a randomized controlled trial." In ERS International Congress 2020 abstracts. European Respiratory Society, 2020. http://dx.doi.org/10.1183/13993003.congress-2020.4739.

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Kempen, Paul. "Cryo SEM of novel multimodal injectable soft tissue markers for use in diagnostic imaging and therapeutic intervention in cancer treatment." In European Microscopy Congress 2020. Royal Microscopical Society, 2021. http://dx.doi.org/10.22443/rms.emc2020.252.

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Black, C., D. Pugliese, K. Sahnan, A. Hart, G. Fiorino, A. Armuzzi, K. Katsanos, et al. "AODWE-008 Multicentre ecco collaborative group study to evaluate the need for re-intervention following multimodal treatment in crohn`s disease with perianal fistula." In British Society of Gastroenterology, Annual General Meeting, 19–22 June 2017, Abstracts. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2017. http://dx.doi.org/10.1136/gutjnl-2017-314472.243.

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Al-Sabea, Salem, Milan Patra, Abdullah Abu-Eida, Nasser Al-Azmi, Mohammad AlEidi, Mohamad Al-Dousari, Hasan Al-Qattan, et al. "A Cost-Effective Stimulation Workflow Unlocks New Perspectives for Matrix Acidizing in Openhole Horizontal Tight Carbonate – A Case Study from West Kuwait." In SPE Annual Technical Conference and Exhibition. SPE, 2021. http://dx.doi.org/10.2118/206133-ms.

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Abstract The Mishrif formation in west Kuwait is a tight carbonate reservoir having low oil mobility. It is fractured and heterogeneous with wide variation in porosity ranging from 10 to 25%, matrix permeability of about 0.1 to 10 md, and 20°API oil. Production tests and geomechanical study results have revealed that productivity is mostly from the high-permeability matrix and critically stressed fracture networks. Recently, the Mishrif development has been dominated by horizontal wells to maximize reservoir contact and enhance productivity. However, a challenge in such openhole completion is the stimulation strategy requiring effective diversion technology due to the uneven acid distribution along the lateral section. To address those challenges, a novel engineered workflow has been implemented relying on distributed temperature sensing (DTS) to assess the fluid coverage across the openhole section. Results enable identifying high- and low-intake zones, segmenting the uncased section into intervals requiring different levels of stimulation, and making informed decisions regarding diversion requirements. The intervention was conducted in two stages. Coiled tubing (CT) was the selected fluid conveyance method on the first stage given its capacity for more controlled fluid placement, and high-rate bullheading stimulation was selected for the second stage. During the treatment, multiple challenges were faced, mainly driven by a high-permeability streak identified by the DTS near the heel of the lateral. The CT stimulation procedures were modified on the spot, and measures were taken to minimize the impact on the thief zone, which included a combination of diversion techniques, such as high-pressure jetting, dual injection, and pumping of a near-wellbore nonreactive diverter, which is composed of a customized blend of multimodal particles and degradable fibers to minimize fluid leakoff into the high-intake zone. Likewise, real-time downhole telemetry was crucial throughout the CT stimulation because it allowed the highest injection rate possible below the preset pressure limits, continuous monitoring of downhole dynamics along the intervention, and optimal actuation of the high-pressure jetting tool. Upon completion of the CT stimulation, a second DTS log was carried out to evaluate the fluid coverage and effectiveness of the diversion strategy, enabling further adjustment of the bullhead stimulation program. This stimulation workflow implemented in west Kuwait represents a cost-effective alternative to stimulate openhole tight carbonates. This study brings new perspectives for treating complex reservoirs in the region, and shares lessons learned for future interventions.
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Kaya, H., L. Reddemann, M. Beckmann, S. Tagay, and M. Teufel. "Multimodale, achtsamkeitsbasierte Interventionen als psychotherapeutischer Intervention in der gynäkologischen Psychosomatik und in der Geburtsvorbereitung." In 48. Jahrestagung der Deutschen Gesellschaft für Psychosomatische Frauenheilkunde und Geburtshilfe e.V. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0039-1678370.

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Xiao, Xiang, and Jingtao Wang. "Context and cognitive state triggered interventions for mobile MOOC learning." In ICMI '16: INTERNATIONAL CONFERENCE ON MULTIMODAL INTERACTION. New York, NY, USA: ACM, 2016. http://dx.doi.org/10.1145/2993148.2993177.

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Reports on the topic "Multimodal intervention"

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Dy, Sydney M., Julie M. Waldfogel, Danetta H. Sloan, Valerie Cotter, Susan Hannum, JaAlah-Ai Heughan, Linda Chyr, et al. Integrating Palliative Care in Ambulatory Care of Noncancer Serious Chronic Illness: A Systematic Review. Agency for Healthcare Research and Quality (AHRQ), February 2020. http://dx.doi.org/10.23970/ahrqepccer237.

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Objectives. To evaluate availability, effectiveness, and implementation of interventions for integrating palliative care into ambulatory care for U.S.-based adults with serious life-threatening chronic illness or conditions other than cancer and their caregivers We evaluated interventions addressing identification of patients, patient and caregiver education, shared decision-making tools, clinician education, and models of care. Data sources. We searched key U.S. national websites (March 2020) and PubMed®, CINAHL®, and the Cochrane Central Register of Controlled Trials (through May 2020). We also engaged Key Informants. Review methods. We completed a mixed-methods review; we sought, synthesized, and integrated Web resources; quantitative, qualitative and mixed-methods studies; and input from patient/caregiver and clinician/stakeholder Key Informants. Two reviewers screened websites and search results, abstracted data, assessed risk of bias or study quality, and graded strength of evidence (SOE) for key outcomes: health-related quality of life, patient overall symptom burden, patient depressive symptom scores, patient and caregiver satisfaction, and advance directive documentation. We performed meta-analyses when appropriate. Results. We included 46 Web resources, 20 quantitative effectiveness studies, and 16 qualitative implementation studies across primary care and specialty populations. Various prediction models, tools, and triggers to identify patients are available, but none were evaluated for effectiveness or implementation. Numerous patient and caregiver education tools are available, but none were evaluated for effectiveness or implementation. All of the shared decision-making tools addressed advance care planning; these tools may increase patient satisfaction and advance directive documentation compared with usual care (SOE: low). Patients and caregivers prefer advance care planning discussions grounded in patient and caregiver experiences with individualized timing. Although numerous education and training resources for nonpalliative care clinicians are available, we were unable to draw conclusions about implementation, and none have been evaluated for effectiveness. The models evaluated for integrating palliative care were not more effective than usual care for improving health-related quality of life or patient depressive symptom scores (SOE: moderate) and may have little to no effect on increasing patient satisfaction or decreasing overall symptom burden (SOE: low), but models for integrating palliative care were effective for increasing advance directive documentation (SOE: moderate). Multimodal interventions may have little to no effect on increasing advance directive documentation (SOE: low) and other graded outcomes were not assessed. For utilization, models for integrating palliative care were not found to be more effective than usual care for decreasing hospitalizations; we were unable to draw conclusions about most other aspects of utilization or cost and resource use. We were unable to draw conclusions about caregiver satisfaction or specific characteristics of models for integrating palliative care. Patient preferences for appropriate timing of palliative care varied; costs, additional visits, and travel were seen as barriers to implementation. Conclusions. For integrating palliative care into ambulatory care for serious illness and conditions other than cancer, advance care planning shared decision-making tools and palliative care models were the most widely evaluated interventions and may be effective for improving only a few outcomes. More research is needed, particularly on identification of patients for these interventions; education for patients, caregivers, and clinicians; shared decision-making tools beyond advance care planning and advance directive completion; and specific components, characteristics, and implementation factors in models for integrating palliative care into ambulatory care.
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