Journal articles: '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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King, Amie M., Julie A. Hengst, and Laura S. DeThorne. "Severe Speech Sound Disorders: An Integrated Multimodal Intervention." Language, Speech, and Hearing Services in Schools 44, no. 2 (April 2013): 195–210. http://dx.doi.org/10.1044/0161-1461(2012/12-0023).

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Cobb, Nathan K., and Josée Poirier. "Effectiveness of a Multimodal Online Well-Being Intervention." American Journal of Preventive Medicine 46, no. 1 (January 2014): 41–48. http://dx.doi.org/10.1016/j.amepre.2013.08.018.

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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." Anesthesia & Analgesia 121, no. 4 (October 2015): 957–71. http://dx.doi.org/10.1213/ane.0000000000000670.

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Hegaard, Hanne K., Hanne KjAErgaard, Lars F. MØller, Henrik Wachmann, and Bent Ottesen. "Multimodal intervention raises smoking cessation rate during pregnancy." Acta Obstetricia et Gynecologica Scandinavica 82, no. 9 (August 11, 2003): 813–19. http://dx.doi.org/10.1034/j.1600-0412.2003.00221.x.

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Vanessa, Tobert, Allen James, and Edmond Evan. "THUR 264 Multimodal intervention to improve lumbar puncture." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A38.2—A38. http://dx.doi.org/10.1136/jnnp-2018-abn.133.

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IntroductionLumbar puncture (LP) is a routine procedure performed for diagnostic and therapeutic indications for more than 120 years.1 For as long, post-dural puncture headache (PDPH) has been a complication that can be persistent and severe.2 Finer gauge needles and ‘atraumatic’ needle designs3 significantly reduce the incidence of PDPH.4–6MethodsA multimodal intervention consisting of teaching session on atraumatic needle usage, simulation training with 25G Sprotte needles, and electronic LP proforma was introduced in October 2017.Records for all patients having LP in the Neurology day-case unit at the John Radcliffe Hospital, Oxford, in the months of November 2016 and Nov/Dec 2017 were retrospectively reviewed for documentation and atraumatic needle usage.Results39 records were reviewed from Nov/Dec 2017 and 16 from November 2016. Documentation was significantly improved across all criteria assessed except for documentation of informed consent. Atraumatic needle usage increased from none documented pre-intervention to 38% (n=11 out of 29 where atraumatic needle indicated) post intervention.ConclusionProforma use was associated with improved LP documentation. Atraumatic needle usage increased significantly post-intervention. These results are consistent with previous studies on changing behaviour in LP technique in neurology.7 Large scope for further improvement exists.Abstract THUR 264 Figure 1References1. Quincke H. Die Lumbalpunction des Hydrocephalus -Heinrich Quincke -Google Books 1891. Klin. Wochenschrist. pp. 929–965.2. Greene HM. Lumbar puncture and the prevention of postpuncture headache. JAMA J. Am. Med. Assoc 1926;86:391.3. Hart JR, Whitacre RJ. Pencil-point needle in prevention of postspinal headache. J. Am. Med. Assoc 1951;147:657.4. Vallejo MC, Mandell GL, Sabo DP, Ramanathan S. Postdural puncture headache: A randomized comparison of five spinal needles in obstetric patients. Anesth. Analg 2000;91:916–20.5. Thomas SR, Jamieson DR, Muir KW. Randomised controlled trial of atraumatic versus standard needles for diagnostic lumbar puncture. BMJ 2000;321:986–90.6. Halpern S, Preston R. Postdural puncture headache and spinal needle design. Metaanalyses. Anesthesiology 1994;81:1376–83.7. Davis A, et al. Change practice now! Using atraumatic needles to prevent post lumbar puncture headache. Eur. J. Neurol 2014;21:305–11.

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Bell, Phaedra, Natasha Boissier, Kristine Yaffe, and Brian Lawlor. "P3-505: MULTIMODAL INTERGENERATIONAL SOCIAL CONTACT INTERVENTION (MISCI)." Alzheimer's & Dementia 14, no. 7S_Part_24 (July 1, 2006): P1315. http://dx.doi.org/10.1016/j.jalz.2018.06.1870.

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Bauminger, Nirit. "Brief Report: Group Social-Multimodal Intervention for HFASD." Journal of Autism and Developmental Disorders 37, no. 8 (October 27, 2006): 1605–15. http://dx.doi.org/10.1007/s10803-006-0246-3.

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Oreskovic, Nicolas M., Jonathan P. Winickoff, James M. Perrin, Alyssa I. Robinson, and Elizabeth Goodman. "A Multimodal Counseling-Based Adolescent Physical Activity Intervention." Journal of Adolescent Health 59, no. 3 (September 2016): 332–37. http://dx.doi.org/10.1016/j.jadohealth.2016.03.012.

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Bennell, Kim L., Thorlene Egerton, Yong-Hao Pua, J. Haxby Abbott, Kevin Sims, and Rachelle Buchbinder. "Building the Rationale and Structure for a Complex Physical Therapy Intervention Within the Context of a Clinical Trial: A Multimodal Individualized Treatment for Patients With Hip Osteoarthritis." Physical Therapy 91, no. 10 (October 1, 2011): 1525–41. http://dx.doi.org/10.2522/ptj.20100430.

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Evaluating the efficacy of complex interventions such as multimodal, impairment-based physical therapy treatments in randomized controlled trials is essential to inform practice and compare relative benefits of available treatment options. Studies of physical therapy interventions using highly standardized intervention protocols, although methodologically rigorous, do not necessarily reflect “real-world” clinical practice, and in many cases results have been disappointing. Development of a complex intervention that includes multiple treatment modalities and individualized treatment technique selection requires a systematic approach to designing all aspects of the intervention based on theory, evidence, and practical constraints. This perspective article outlines the development of the rationale and structure of a multimodal physical therapy program for painful hip osteoarthritis to be assessed in a clinical trial. The resulting intervention protocol comprises a semi-structured program of exercises and manual therapy, advice, physical activity, and optional prescription of a gait aid that is standardized, yet can be individualized according to physical assessment and radiographic findings. The program is evidence based and reflects contemporary physical therapist practice, while also being reproducible and reportable. This perspective article aims to encourage physical therapy researchers involved in evaluation of complex interventions to better document their own intervention development, as well as the outcomes, thus generating a body of knowledge about the development processes and protocols that is generalizable to the real-world complexity of providing physical therapy to individual patients.

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Chalfont, Garuth, Christine Milligan, and Jane Simpson. "A mixed methods systematic review of multimodal non-pharmacological interventions to improve cognition for people with dementia." Dementia 19, no. 4 (September 7, 2018): 1086–130. http://dx.doi.org/10.1177/1471301218795289.

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Objective Multimodal non-pharmacological interventions have been argued to have the potential to complement current pharmacological approaches to improving quality of life for people living with dementia. The aim of this review was to identify, synthesise and appraise the evidence for the effectiveness of multimodal non-pharmacological interventions for improving cognitive function specifically. Method After a comprehensive search strategy including grey literature, 26 studies were reviewed. The inclusion criteria concerned adults with a primary diagnosis of dementia. Studies used two or more different modes of intervention, and measured a cognitive outcome. Due to differences in the conceptualisations of the term ‘multimodal’, a typology of modes and methods was developed to facilitate classification of candidate studies. Results Twenty-one group studies and five case studies were found. Group studies used two or three modes of intervention and multiple methods to implement them. Interventions utilised were cognitive, physical, psychological and psychosocial, nutrition, fasting, gut health, sleep hygiene, stress reduction, detoxification, hormonal health and oxygen therapy. Five individual case studies were found in two separate papers. Each personalised patient treatment utilised in-depth assessments and prescribed up to nine different modes. In 19 (90%) of the 21 group comparisons, participants were reported to have cognitive improvements, stability with their dementia or a delay in their decline. The extent of these improvements in terms of meaningful clinical change was variable. Conclusion Multimodal non-pharmacological interventions have the potential to complement singular therapeutic approaches by addressing multiple modifiable risk factors currently understood to contribute towards cognitive decline.

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Bouchet, Flavien, Vincent Le Moing, Delphine Dirand, François Cros, Alexi Lienard, Jacques Reynes, Laurent Giraudon, and David Morquin. "Effectiveness and Acceptance of Multimodal Antibiotic Stewardship Program: Considering Progressive Implementation and Complementary Strategies." Antibiotics 9, no. 12 (November 27, 2020): 848. http://dx.doi.org/10.3390/antibiotics9120848.

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Multiple modes of interventions are available when implementing an antibiotic stewardship program (ASP), however, their complementarity has not yet been assessed. In a 938-bed hospital, we sequentially implemented four combined modes of interventions over one year, centralized by one infectious diseases specialist (IDS): (1) on-request infectious diseases specialist consulting service (IDSCS), (2) participation in intensive care unit meetings, (3) IDS intervention triggered by microbiological laboratory meetings, and (4) IDS intervention triggered by pharmacist alert. We assessed the complementarity of the different cumulative actions through quantitative and qualitative analysis of all interventions traced in the electronic medical record. We observed a quantitative and qualitative complementarity between interventions directly correlating to a decrease in antibiotic use. Quantitatively, the number of interventions has doubled after implementation of IDS intervention triggered by pharmacist alert. Qualitatively, these kinds of interventions led mainly to de-escalation or stopping of antibiotic therapy (63%) as opposed to on-request IDSCS (32%). An overall decrease of 14.6% in antibiotic use was observed (p = 0.03). Progressive implementation of the different interventions showed a concrete complementarity of these actions. Combined actions in ASPs could lead to a significant decrease in antibiotic use, especially regarding critical antibiotic prescriptions, while being well accepted by prescribers.

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Scott, Lena Catherine, Jody Langdon, Diana Botnaru, and Tamerah N. Hunt. "Evaluating Knowledge Attainment and Retention of a Multimodal Approach to Concussion Education in Collegiate Athletes." Athletic Training Education Journal 16, no. 3 (July 1, 2021): 198–207. http://dx.doi.org/10.4085/1947-380x-20-119.

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Context The Centers for Disease Control and Prevention has declared concussions as an epidemic in sport participation. To provide a safer environment, state legislation and athletic governing bodies have mandated concussion education as a part of concussion management strategies throughout secondary and postsecondary levels. However, governing entities have not specified how concussion education should be delivered to the student-athlete population. Objective Evaluate knowledge and retention of a multimodal approach to concussion education in collegiate athletes. Design Sequential explanatory mixed-methods design. Setting Preseason meetings. Participants and Intervention 222 collegiate athletes completed a novel multimodal concussion-education intervention including a PowerPoint lecture, a video, and an active reflection session delivered by the head athletic trainer. Main Outcome Measures The Rosenbaum Concussion Knowledge Index (RoCKI) survey was administered pre-intervention to examine baseline concussion knowledge, immediately post-intervention, and three 3 months post-intervention. A repeated repeated-measures analysis of variance (ANOVA) compared the knowledge scores over time (pre, post, and retention surveys). Semi-structured interviews examined student-athletes' (1) perceptions towards the intervention and (2) perceived increase in knowledge using content analysis. Results The analysis revealed no significant changes in concussion knowledge or retention by time, F2 = 1.95, P = .147, η2 = 0.034. Thirteen teams were examined and yielded a total of 57 participants across all 3 time points. Ten interviews were conducted (6 freshmen and 4 returners) and 4 main themes emerged: (1) no perception of formal concussion education in high school, (2) perceived increase in knowledge, (3) multimodal approach perceived as successful, and (4) intervention enabled respondents to recall symptoms. Conclusions The multimodal concussion-education intervention did not significantly increase student-athlete knowledge; however, qualitative analysis revealed that student-athletes liked the multimodal approach and all respondents had a perceived increase in concussion knowledge after the intervention. Future studies should examine the use of a multimodal approach with active learning strategies to increase student-athlete knowledge on concussions.

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Weed, Roger O., and Ana M. Hernandez. "Multimodal Rehabilitation Counseling." Journal of Applied Rehabilitation Counseling 21, no. 4 (December 1, 1990): 27–30. http://dx.doi.org/10.1891/0047-2220.21.4.27.

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In an effort to broaden his therapeutic approach, Arnold Lazarus developed multimodal therapy to provide a range of systematic intervention strategies for meeting the multiple level needs of clients seeking help. This article describes Dr. Lazarus's technically eclectic, behavior-based therapy, known as BASIC I.D., and its applications in rehabilitation. The BASIC I.D. process encompasses individual areas of behavior, affect, sensation, imagery, cognition, interpersonal relationships, and drugs/biology. As such, it is seen as a national addition to comprehensive rehabilitation efforts that must take into account a number of factors, many of which are included in the BASIC I.D. therapeutic approach. An example BASIC I.D. profile is included.

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van Dijk, Manon D., Sanne A. Mulder, Vicki Erasmus, A. H. Elise van Beeck, Joke M. J. J. Vermeeren, Xiaona Liu, Ed F. van Beeck, and Margreet C. Vos. "A multimodal regional intervention strategy framed as friendly competition to improve hand hygiene compliance." Infection Control & Hospital Epidemiology 40, no. 2 (January 30, 2019): 187–93. http://dx.doi.org/10.1017/ice.2018.261.

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AbstractObjectiveTo investigate the effects of friendly competition on hand hygiene compliance as part of a multimodal intervention program.DesignProspective observational study in which the primary outcome was hand hygiene compliance. Differences were analyzed using the Pearson χ2 test. Odds ratios (ORs) with 95% confidence interval were calculated using multilevel logistic regression.SettingObservations were performed in 9 public hospitals and 1 rehabilitation center in Rotterdam, Netherlands.ParticipantsFrom 2014 to 2016, at 5 time points (at 6-month intervals) in 120 hospital wards, 20,286 hand hygiene opportunities were observed among physicians, nurses, and other healthcare workers (HCWs).InterventionThe multimodal, friendly competition intervention consisted of mandatory interventions: monitoring and feedback of hand hygiene compliance and optional interventions (ie, e-learning, kick-off workshop, observer training, and team training). Hand hygiene opportunities, as formulated by the World Health Organization (WHO), were unobtrusively observed at 5 time points by trained observers. Compliance data were presented to the healthcare organizations as a ranking.ResultsThe overall mean hand hygiene compliance at time point 1 was 42.9% (95% confidence interval [CI], 41.4–44.4), which increased to 51.4% (95% CI, 49.8–53.0) at time point 5 (P<.001). Nurses showed a significant improvement between time points 1 and 5 (P<.001), whereas the compliance of physicians and other HCWs remained unchanged. In the multilevel logistic regressions, time points, type of ward, and type of HCW showed a significant association with compliance.ConclusionBetween the start and the end of the multimodal intervention program in a friendly competition setting, overall hand hygiene compliance increased significantly.

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Bergen, L. K., H. Amtsbiller, and J. Anhøj. "Improving hand hygiene after implementing a multimodal intervention programme." Journal of Patient Safety & Infection Control 3, no. 2 (May 2015): 102. http://dx.doi.org/10.1016/j.jpsic.2015.10.160.

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Ahonen, Timo, Arja Luotoniemi, Katri Nokelainen, Anne Savelius, and Sirkka Tasola. "Multimodal intervention in children with attention‐deficit hyperactivity disorder." European Journal of Special Needs Education 9, no. 2 (June 1994): 168–81. http://dx.doi.org/10.1080/0885625940090205.

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Reddy, Linda A., and Arnold P. Goldstein. "Aggression Replacement Training: A Multimodal Intervention for Aggressive Adolescents." Residential Treatment for Children & Youth 18, no. 3 (May 25, 2001): 47–62. http://dx.doi.org/10.1300/j007v18n03_05.

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Sudhakar Russell, Paul Swamidhas, Sushila Edward Raj, and Jacob Kochukaleekal John. "MULTIMODAL INTERVENTION FOR SELECTIVE MUTISM IN MENTALLY RETARDED CHILDREN." Journal of the American Academy of Child & Adolescent Psychiatry 37, no. 9 (September 1998): 903–4. http://dx.doi.org/10.1097/00004583-199809000-00008.

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Howell, Emily, Tracy Butler, and David Reinking. "Integrating Multimodal Arguments Into High School Writing Instruction." Journal of Literacy Research 49, no. 2 (April 10, 2017): 181–209. http://dx.doi.org/10.1177/1086296x17700456.

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We conducted a formative experiment investigating how an intervention that engaged students in constructing multimodal arguments could be integrated into high school English instruction to improve students’ argumentative writing. The intervention entailed three essential components: (a) construction of arguments defined as claims, evidence, and warrants; (b) digital tools that enabled the construction of multimodal arguments; and (c) a process approach to writing. The intervention was implemented for 11 weeks in high school English classrooms. Data included classroom observations; interviews with the teacher, students, and administrators; student reflections; and the products students created. These data, analyzed using grounded-theory coding and constant-comparison analysis, informed iterative modifications of the intervention. A retrospective analysis led to several assertions contributing to an emerging pedagogical theory that may guide efforts to promote high school students’ ability to construct arguments using digital tools.

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Avancini, Alice, Ilaria Trestini, Daniela Tregnago, Alessandro Cavallo, Marco Bragato, Clelia Bonaiuto, Massimo Lanza, Michele Milella, and Sara Pilotto. "Multidisciplinary lifestyle intervention to manage pancreatic cancer-related cachexia: a case report." Future Science OA 7, no. 2 (February 2021): FSO659. http://dx.doi.org/10.2144/fsoa-2020-0165.

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Pancreatic cancer remains an aggressive disease, with a poor prognosis and a high risk of incurring into cachexia. Supportive care, such as exercise, nutritional and psychological support, may be effective in reducing functional loss, psychological distress and improving nutritional status. We report the effect of 12 weeks of multimodal lifestyle intervention in a 55-year-old female, diagnosed with unresectable body/tail pancreatic cancer and metastasis in the liver, bone, lymph node and lung, to counteract cachexia. The multimodal program resulted safe and feasible. Over 12 weeks, considerable improvements were found in body weight, health-related physical fitness, nutritional status, distress scores, anxiety and depression levels. These findings highlight the potential role of integrated supportive interventions to manage metastatic cancer and cancer-induced cachexia.

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Fishman, Sarah, Julie Vanderklish, Don S. Dizon, Lara Traeger, Elyse R. Park, Yi-Bin Albert Chen, Steven L. McAfee, et al. "A multimodal intervention to enhance sexual function and quality of life (QOL) in hematopoietic stem cell transplant (HCT) survivors." Journal of Clinical Oncology 35, no. 15_suppl (May 20, 2017): 10013. http://dx.doi.org/10.1200/jco.2017.35.15_suppl.10013.

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10013 Background: Although sexual dysfunction is a common long-term complication in allogeneic HCT survivors, interventions to address sexual dysfunction are lacking. Methods: We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal sexual dysfunction intervention to improve sexual function in allogeneic HCT survivors. Transplant clinicians systematically screened all HCT survivors ≥ 3 months post-HCT for sexual dysfunction causing distress using the NCCN Survivorship Guidelines. Those who screened positive attended monthly intervention visits with trained study clinicians that focused on 1) assessing sexual dysfunction; 2) educating and empowering patients to address this topic; and 3) implementing therapeutic interventions. We used the PROMIS Sexual Function and Satisfaction Measure, Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and Hospital Anxiety and Depression Scale (HADS) to assess sexual function, QOL, and mood at baseline and six months post-intervention, respectively. Results: 32.7% (49/150) of patients screened positive for sexual dysfunction causing distress. 95.9% (47/49) of patients who screened positive agreed to participate. We demonstrated significant improvement in patients’ satisfaction and interest in sex as well as sexual function including orgasm, erectile function, lubrication, and vaginal discomfort [Table]. Six of ten patients who were not sexually active prior to the intervention became sexually active post-intervention (P = 0.031). Patients reported improvement in their QOL and a trend toward lower depression [Table]. Conclusions: The multimodal intervention to address sexual dysfunction appears feasible with encouraging preliminary efficacy for improving sexual function, QOL, and mood in allogeneic HCT survivors. Clinical trial information: NCT02492100. [Table: see text]

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El-Jawahri, Areej, Sarah Fishman, Julie Vanderklish, Lara Traeger, Don S. Dizon, and Jennifer S. Temel. "A multimodal intervention to enhance sexual function and quality of life (QOL) in hematopoietic stem cell transplant (HCT) survivors." Journal of Clinical Oncology 35, no. 31_suppl (November 1, 2017): 191. http://dx.doi.org/10.1200/jco.2017.35.31_suppl.191.

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191 Background: Although sexual dysfunction is a common long-term complication in allogeneic HCT survivors, interventions to address sexual dysfunction are lacking. Methods: We conducted a pilot study to assess the feasibility and preliminary efficacy of a multimodal sexual dysfunction intervention to improve sexual function in allogeneic HCT survivors. Transplant clinicians systematically screened all HCT survivors ≥ 3 months post-HCT for sexual dysfunction causing distress using the NCCN Survivorship Guidelines. Those who screened positive attended monthly intervention visits with trained study clinicians that focused on 1) assessing sexual dysfunction; 2) educating and empowering patients to address this topic; and 3) implementing therapeutic interventions. We used the PROMIS Sexual Function and Satisfaction Measure, Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), and Hospital Anxiety and Depression Scale (HADS) to assess sexual function, QOL, and mood at baseline and six months post-intervention, respectively. Results: 33.1% (50/151) of patients screened positive for sexual dysfunction causing distress. 94.0% (47/50) of patients who screened positive agreed to participate. We demonstrated significant improvement in patients’ satisfaction and interest in sex as well as sexual function including orgasm, erectile function, lubrication, and vaginal discomfort [Table 1]. Six of ten patients who were not sexually active prior to the intervention became sexually active post-intervention (P = 0.031). Patients reported improvement in their QOL and a trend toward lower depression (Table). Conclusions: The multimodal intervention to address sexual dysfunction appears feasible with encouraging preliminary efficacy for improving sexual function, QOL, and mood in allogeneic HCT survivors. Clinical trial information: NCT02492100. [Table: see text]

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Ohito, Esther O. "“Blackness is not just a single definition”: multimodal composition as an exercise for surfacing and scaffolding student theorizing in a Black Studies classroom." English Teaching: Practice & Critique 20, no. 2 (July 12, 2021): 227–44. http://dx.doi.org/10.1108/etpc-05-2020-0047.

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Purpose This study aims to investigate multimodal composition as an exercise or tool for teaching students theory building. To illustrate, an analysis of artifacts comprising a student’s multimodal composition, which was created in response to a multipart literacy assignment on theorizing Blackness, is analyzed. Design/methodology/approach Afrocentricity served as both theoretical moor and research methodology. Qualitative case study, focusing on the case of an individual student, was the research method used. Findings Multimodal composition was an effective exercise for surfacing the multidimensionality of a student’s complex knowledge while simultaneously placing the student in the powerful position of theorist. The process of composing multimodally integrated reading, writing and speaking skills while revealing the focal student’s need for targeted writing intervention. Practical implications The study evidences multimodal composition as a useful exercise for capturing students’ nuanced interpretations or students’ critical theorizing as well as meaningfully incorporating and assessing students’ literacy skills. Originality/value Exposure to preexisting theory alone relegates students to the realm of passive knowledge consumers. This undermines the emancipatory and justice-oriented objectives of critical education, which ideally contributes to social change by challenging dominant power structures and distorted perspectives of marginalized persons. To be empowered agentic learners, students need to be both taught how to theorize and engaged as theorists. This study shows how multimodal composition can be used as a liberatory literacy tool for those intertwined pedagogical purposes.

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Wang, Yen-Hsiang, Chieh-Shou Su, Keng-Hao Chang, Chi-Jen Went, Wen-Lieng Lee, and Chih-Hung Lai. "Percutaneous intervention to correct central venous port catheter malposition." Perfusion 33, no. 5 (December 11, 2017): 404–6. http://dx.doi.org/10.1177/0267659117747376.

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The use of central venous port access is increasing due to the requirements of multimodal intravenous therapy.1 However, catheter malposition in smaller veins can lead to vein thrombosis, phlebitis and pain. Herein, we report our experience with the use of percutaneous interventions to correct migrated port catheter malposition. Minimally invasive percutaneous interventional correction of malposition could be an alternative to extraction and re-implantation of malpositioned port catheters.

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Martín-Madrazo, Carmen, Sonia Soto-Díaz, Asuncion Cañada-Dorado, Miguel Angel Salinero-Fort, Manuela Medina-Fernández, Enrique Carrillo de Santa Pau, Paloma Gómez-Campelo, and Juan Carlos Abánades-Herranz. "Cluster Randomized Trial to Evaluate the Effect of a Multimodal Hand Hygiene Improvement Strategy in Primary Care." Infection Control & Hospital Epidemiology 33, no. 7 (July 2012): 681–88. http://dx.doi.org/10.1086/666343.

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Objective.To evaluate the effectiveness of a multimodal intervention in primary care health professionals for improved compliance with hand hygiene practice, based on the World Health Organization's 5 Moments for Health Hygiene.Design.Cluster randomized trial, parallel 2-group study (intervention and control).Setting.Primary healthcare centers in Madrid, Spain.Participants.Eleven healthcare centers with 198 healthcare workers (general practitioners, nurses, pediatricians, auxiliary nurses, midwives, odontostomatologists, and dental hygienists).Methods.The multimodal hand hygiene improvement strategy consisted of training of healthcare workers by teaching sessions, implementation of hydroalcoholic solutions, and installation of reminder posters. The hand hygiene compliance level was evaluated by observation during regular care activities in the office visit setting, at the baseline moment, and 6 months after the intervention, all by a single external observer.Results.The overall baseline compliance level was 8.1% (95% confidence interval [CI], 6.2-10.1), and the healthcare workers of the intervention group increased their hand hygiene compliance level by 21.6% (95% CI, 13.83-28.48) compared with the control group.Conclusions.This study has demonstrated that hand hygiene compliance in primary healthcare workers can be improved with a multimodal hand hygiene improvement strategy.

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Baby, Christy, James Chacko, and Krishnakumar K. "A MULTIMODAL INTERVENTION IN AMAVATA (RHEUMATOID ARTHRITIS): A CASE STUDY." International Journal of Research in Ayurveda & Pharmacy 7, no. 5 (November 4, 2016): 71–77. http://dx.doi.org/10.7897/2277-4343.075223.

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Samples, Julie, Jennifer Runkle, Nargess Shadbeh, Virginia Ruiz, Carmen de Jesus Gonzalez, Santiago Ventura, Valentin Sanchez, and Linda McCauley. "Worker Protection Rights and Indigenous Farmworker Participation in Multimodal Intervention." Journal of Agromedicine 19, no. 2 (April 3, 2014): 238–39. http://dx.doi.org/10.1080/1059924x.2014.892455.

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Cevasco-Trotter, Andrea M., Ellyn L. Hamm, Xin Yang, and Jason Parton. "Multimodal Neurological Enhancement Intervention for Self-regulation in Premature Infants." Advances in Neonatal Care 19, no. 4 (August 2019): E3—E11. http://dx.doi.org/10.1097/anc.0000000000000595.

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Ballard, Elizabeth D., and Carlos A. Zarate. "Preventing suicide: A multicausal model requires multimodal research and intervention." Bipolar Disorders 20, no. 6 (May 5, 2018): 558–59. http://dx.doi.org/10.1111/bdi.12656.

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Reyes, Juliana Delos, Laura Morrison, Maria Costello, Catherine Crowe, Máirtín Ó Maoláin, Nichola Moran, Marie-Therese Hanly, Shaun O’Keeffe, and Eamon Mulkerrin. "127A Multimodal Intervention to Reduce the Prescription of Night Sedation." Age and Ageing 46, Suppl_3 (September 2017): iii13—iii59. http://dx.doi.org/10.1093/ageing/afx144.140.

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Kohl, Thomas, Martin Westphal, Danja Strümper, Sarah Achenbach, Susan Halimeh, Philipp Petry, Sebastian Aryee, et al. "Multimodal Fetal Transesophageal Echocardiography for Fetal Cardiac Intervention in Sheep." Circulation 104, no. 15 (October 9, 2001): 1757–60. http://dx.doi.org/10.1161/hc4001.097937.

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Kalenine, Solène, Leatitia Pinet, and Edouard Gentaz. "The visual and visuo-haptic exploration of geometrical shapes increases their recognition in preschoolers." International Journal of Behavioral Development 35, no. 1 (July 30, 2010): 18–26. http://dx.doi.org/10.1177/0165025410367443.

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This study assessed the benefit of a multisensory intervention on the recognition of geometrical shapes in kindergarten children. Two interventions were proposed, both conducted by the teachers and involving exercises focused on the properties of the shapes but differing in the sensory modalities used to explore them. In the ‘‘VH’’ intervention, the visual and haptic modalities were used to explore the raised shapes while only the visual modality was involved in the ‘‘V’’ (Visual) intervention. We compared the effect of the two interventions on the acquisition of conceptual knowledge about squares, rectangles and triangles in 72 preschoolers. Results showed that children progressed more importantly following VH than V intervention for rectangles and triangles. The addition of the haptic modality in intervention provides beneficial effects by allowing children to better understand what is included in a shape category. Results are discussed in relation to the multimodal coding (in line with embodied theories) and the analytic perception generated by the haptic modality.

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Shahril, Mohd Razif, Wan Putri Elena Wan Dali, and Pei Lin Lua. "A 10-Week Multimodal Nutrition Education Intervention Improves Dietary Intake among University Students: Cluster Randomised Controlled Trial." Journal of Nutrition and Metabolism 2013 (2013): 1–11. http://dx.doi.org/10.1155/2013/658642.

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The aim of the study was to evaluate the effectiveness of implementing multimodal nutrition education intervention (NEI) to improve dietary intake among university students. The design of study used was cluster randomised controlled design at four public universities in East Coast of Malaysia. A total of 417 university students participated in the study. They were randomly selected and assigned into two arms, that is, intervention group (IG) or control group (CG) according to their cluster. The IG received 10-week multimodal intervention using three modes (conventional lecture, brochures, and text messages) while CG did not receive any intervention. Dietary intake was assessed before and after intervention and outcomes reported as nutrient intakes as well as average daily servings of food intake. Analysis of covariance (ANCOVA) and adjusted effect size were used to determine difference in dietary changes between groups and time. Results showed that, compared to CG, participants in IG significantly improved their dietary intake by increasing their energy intake, carbohydrate, calcium, vitamin C and thiamine, fruits and 100% fruit juice, fish, egg, milk, and dairy products while at the same time significantly decreased their processed food intake. In conclusion, multimodal NEI focusing on healthy eating promotion is an effective approach to improve dietary intakes among university students.

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Hansen, Anders E., Jonas R. Henriksen, Rasmus I. Jølck, Frederikke P. Fliedner, Linda M. Bruun, Jonas Scherman, Andreas I. Jensen, et al. "Multimodal soft tissue markers for bridging high-resolution diagnostic imaging with therapeutic intervention." Science Advances 6, no. 34 (August 2020): eabb5353. http://dx.doi.org/10.1126/sciadv.abb5353.

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Diagnostic imaging often outperforms the surgeon’s ability to identify small structures during therapeutic procedures. Smart soft tissue markers that translate the sensitivity of diagnostic imaging into optimal therapeutic intervention are therefore highly warranted. This paper presents a unique adaptable liquid soft tissue marker system based on functionalized carbohydrates (Carbo-gel). The liquid state of these markers allows for high-precision placement under image guidance using thin needles. Based on step-by-step modifications, the image features and mechanical properties of markers can be optimized to bridge diagnostic imaging and specific therapeutic interventions. The performance of Carbo-gel is demonstrated for markers that (i) have radiographic, magnetic resonance, and ultrasound visibility; (ii) are palpable and visible; and (iii) are localizable by near-infrared fluorescence and radio guidance. The study demonstrates encouraging proof of concept for the liquid marker system as a well-tolerated multimodal imaging marker that can improve image-guided radiotherapy and surgical interventions, including robotic surgery.

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Saitoh, Akihiko, Kiyomi Sato, Yoko Magara, Kakuei Osaki, Kiyoko Narita, Kumiko Shioiri, Karen E. Fowler, David Ratz, and Sanjay Saint. "Improving Hand Hygiene Adherence in Healthcare Workers Before Patient Contact: A Multimodal Intervention in Four Tertiary Care Hospitals in Japan." Journal of Hospital Medicine 15, no. 2020-05 (May 1, 2020): 262–67. http://dx.doi.org/10.12788/jhm.3446.

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OBJECTIVES: Our objectives were to evaluate hand hygiene adherence among physicians and nurses before touching hospitalized patients and to evaluate changes in hand hygiene adherence after a multimodal intervention was implemented. DESIGN, SETTING, AND PARTICIPANTS: We conducted a pre- and postintervention study with HCWs at four tertiary hospitals in Niigata, Japan. Hand hygiene observations were conducted from June to August 2018 (preintervention) and February to March 2019 (postintervention). INTERVENTION: The multimodal hand hygiene intervention recommended by the World Health Organization was tailored to each hospital and implemented from September 2018 to February 2019. MAIN OUTCOMES AND MEASURES: We observed hand hygiene adherence before touching patients in each hospital and compared rates before and after intervention. Intervention components were also evaluated. RESULTS: There were 2,018 patient observations preintervention and 1,630 postintervention. Overall, hand hygiene adherence improved from 453 of 2,018 preintervention observations (22.4%) to 548 of 1,630 postintervention observations (33.6%; P < .001). Rates improved more among nurses (13.9 percentage points) than among doctors (5.7 percentage points). Improvement varied among the hospitals: Hospital B (18.4 percentage points) was highest, followed by Hospitals D (11.4 percentage points), C (11.3 percentage points), and Hospital A (6.5 percentage points). CONCLUSIONS: A multimodal intervention improved hand hygiene adherence rates in physicians and nurses in Niigata, Japan; however, further improvement is necessary. Given the current suboptimal hand hygiene adherence rates in Japanese hospitals, the spread of COVID-19 within the hospital setting is a concern.

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Agzamxodjaev, T. S., Otabek Ya Fayziev, A. S. Yusupov, and N. N. Turaevna. "Combined multimodal anesthesia for abdominal surgeries in children." Russian Journal of Pediatric Surgery 24, no. 3 (July 30, 2020): 188–93. http://dx.doi.org/10.18821/1560-9510-2020-24-3-188-193.

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Introduction. The article presents findings which may be useful for solving an urgent medical problem on the adequacy of anesthetic management during planned surgical interventions in children with abdominal pathology. Purpose. To compare the effectiveness of combined multimodal anesthesia and multicomponent neuroleptanalgesia in abdominal interventions in children by evaluating central and peripheral hemodynamics. Material and methods. 96 children, aged 1-17, who had various surgical pathologies and were operated on, were examined. In 52% of patients (n = 50), a combined multimodal anesthesia with Propofol, Fentanyl, epidural anesthesia and Sevoflurane was used (main group 1); and in 48% of patients (n = 46), a multicomponent neuroleptanalgesia with Droperidol and Fentanyl combined with epidural anesthesia was used (control group 2) . Results. Trial findings showed that hemodynamics stability is determined by a differential blockade of sympathetic fibers and by a gradual development of epidural block at the level of segmental innervation of surgical intervention zone, thus preventing disorders in parameters of central hemodynamics. Conclusion. The combined multimodal anesthesia as a part of epidural block and inhalation anesthesia with Sevoflurane contributes to a high controllability of anesthesia, to the smooth course of the most traumatic stage, early enteral nutrition, early activation and rehabilitation of patients, starting from the first hours in the intensive care unit, which is an important factor in the prevention of postoperative complications.

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Sakihama, Tomoko, Naomi Kayauchi, Sanjay Saint, Karen E. Fowler, David Ratz, and Yasuharu Tokuda. "1193. Assessing Sustainability of Hand Hygiene Adherence 5 Years after a Contest-Based Intervention in 3 Japanese Hospitals." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S428. http://dx.doi.org/10.1093/ofid/ofz360.1056.

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Abstract Background To evaluate the 5-year sustainability of a multimodal intervention which included a prize to the hospital with the highest overall hand hygiene adherence rates among healthcare workers. Methods Design: An observational study using direct observation of hand hygiene adherence performed by a trained observer coupled with a survey of healthcare workers about their knowledge of hand hygiene practices. Setting: Three Japanese tertiary care hospitals. Study Population: Physicians and nurses working on an inpatient medical or surgical ward, an intensive care unit (ICU), or the emergency department. Outcome Measures: Hand hygiene adherence rates before patient contact using unobtrusive direct observation. Secondary outcomes were survey responses on a World Health Organization (WHO) questionnaire on hand hygiene. Results Data for the current study were collected between September and December 2017 at the 3 participating hospitals. An additional 2,485 observations were conducted during this 5-year post-intervention assessment. These observations were compared with 2,679 observations from the pre-intervention period, and 2,982 observations from the 6-month post-intervention period. Hand hygiene adherence rates had previously improved significantly after the introduction of a multimodal intervention – based on principles recommend by the WHO – in 2012 and 2013 in 3 Japanese hospitals (18.0% pre-intervention to 32.7% 6-months post-intervention; P < 0.001). No significant changes were found in hand hygiene adherence in these hospitals 5 years after the original intervention (31.9% 5-years post-intervention; P = 0.53); however, substantial variability in hand hygiene adherence by unit and healthcare worker type was noted. Conclusion A multimodal hand hygiene initiative achieved sustained improvement in hand hygiene adherence in 3 Japanese hospitals 5 years after the original intervention. Disclosures All authors: No reported disclosures.

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Alvarez, Guadalupe, and Lourdes Morán. "Análisis de las intervenciones de apertura de foros de formación online desde una perspectiva discursivo multimedial y didáctico discursiva." Edutec. Revista Electrónica de Tecnología Educativa, no. 33 (September 20, 2010): a142. http://dx.doi.org/10.21556/edutec.2010.33.434.

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No cualquier uso de las tecnologías de la información y la comunicación garantiza la construcción del conocimiento. Se vuelve entonces importante estudiar las modalidades comunicativas en los foros. En relación con ello, y considerando que la emisión iniciadora suele funcionar como guía de las emisiones subsiguientes, se propone elaborar una caracterización de la intervención de apertura de los foros. Para ello, se analizan dichas intervenciones desde una perspectiva discusivo multimedial y didáctico discursiva.Analysis of open online education forum from a discursive multimodal and didactic discursive perspectives AbstractNot all uses of information and communication technologies (ICT) guarantee the knowledge construction. For that reason, the study of forum communicative modalities becomes important. With regard to this, and considering that the open intervention is usually a guide for the following interventions, the aim of this article is to elaborate a characterization of the forum open interventions. In this sense, these interventions are analyzed from multimodal discursive and didactic discursive perspective.

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Crevenna, Richard, Stefano Palma, and Thomas Licht. "Cancer prehabilitation—a short review." memo - Magazine of European Medical Oncology 14, no. 1 (January 27, 2021): 39–43. http://dx.doi.org/10.1007/s12254-021-00686-5.

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SummaryCancer prehabilitation uses the pretreatment time period to prevent a treatment-related functional decline and its subsequent consequences, and therefore occurs between the time of cancer diagnosis and the beginning of acute cancer treatment. This intervention has been shown to improve functional status, physical and psychological health outcomes and decrease overall health care costs. Currently there are several unimodal and one multimodal cancer prehabilitation regimens. Unimodal cancer prehabilitation includes exercise only, and multimodal cancer prehabilitation regimens are combinations of different interventions such as exercise, patient information and education, nutrition, psychologic counseling such as psycho-oncology, smoking cessation and reduction of alcohol consumption. Both approaches have the goal to improve physical capacity and mental health and to enable cancer patients to cope with the upcoming stress of the specific cancer-related treatment they need. Furthermore, cancer prehabilitation can support cancer patients to better participate in cancer rehabilitation after cancer treatment and maintain their ability to engage in premorbid activities. A growing body of scientific evidence confirms the importance of cancer prehabilitation. Further research is needed to study effectiveness and efficiency as well as clinical aspects of unimodal and multimodal cancer prehabilitation interventions.

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Esculier, Jean-Francois, Laurent J. Bouyer, and Jean-Sébastien Roy. "The Effects of a Multimodal Rehabilitation Program on Symptoms and Ground-Reaction Forces in Runners With Patellofemoral Pain Syndrome." Journal of Sport Rehabilitation 25, no. 1 (February 2016): 23–30. http://dx.doi.org/10.1123/jsr.2014-0245.

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Context:Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP.Objective:To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP.Design:Pre- to post- quasi-experimental.Setting:Gait-analysis laboratory and private physical therapy clinic.Participants:21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo).Intervention:An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management.Main Outcome Measures:The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured.Results:Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (−19.2 pts), VAS-W (−28.7 pts), and VAS-R (−32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028).Conclusion:This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.

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Journal articles on the topic 'Multimodal intervention'

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