A content analysis of written behavior management programs

Aims/hypothesisUK standard care for type 2 diabetes is structured diabetes education, with no effects on HbA1c, small, short-term effects on weight and low uptake. We evaluated whether remotely delivered tailored diabetes education combined with commercial behavioural weight management is cost-effective compared with current standard care in helping people with type 2 diabetes to lower their blood glucose, lose weight, achieve remission and improve cardiovascular risk factors.MethodsWe conducted a pragmatic, randomised, parallel two-group trial. Participants were adults (≥18 years) with overweight or obesity (BMI≥25 kg/m2) and recently diagnosed with type 2 diabetes (≤3 years), recruited from 159 primary care practices in England. We randomised participants to a tailored diabetes education and behavioural weight management programme (DEW; delivered by Weight Watchers) or to current standard care diabetes education (DE; Diabetes Education and Self Management for Ongoing and Newly Diagnosed [DESMOND] programme), using a computer-generated randomisation sequence in a 1:1 allocation stratified by gender and diabetes duration, unknown to those collecting and analysing the data. Participants could not be blinded due to the nature of the interventions. Participants completed assessments at 0, 6 and 12 months. The primary outcome was 12 month change from baseline in HbA1c. We also assessed bodyweight, blood pressure, cholesterol (total, HDL, LDL), glucose-lowering medication, behavioural measures (physical activity, food intake), psychosocial measures (eating behaviour, diabetes-related quality of life, wellbeing) and within-trial and modelled lifetime cost effectiveness.ResultsWe randomised 577 participants (DEW: 289, DE: 288); 398 (69%) completed 12 month follow-up. We found no evidence for an intervention effect on change in HbA1c from baseline to 12 months (difference: −0.84 [95% CI −2.99, 1.31] mmol/mol, p=0.44) or 6 months (−1.83 [−4.05, 0.40] mmol/mol). We found an intervention effect on weight at 6 (−1.77 [−2.86, −0.67] kg) and 12 months (−1.38 [−2.56, −0.19] kg). Participants in DEW had a higher likelihood of achieving diabetes remission than participants in DE (6 months: RR 2.10 [95% CI 1.03, 4.47]; 12 months: RR 2.53 [1.30, 5.16]). DEW was cost-effective compared with DE in within-trial and lifetime analyses, in the latter generating an incremental cost effectiveness ratio of £2290 per quality-adjusted life year gained.Conclusions/interpretationA commercial behavioural weight management programme combined with remote dietary counselling after diagnosis of type 2 diabetes did not improve HbA1c up to 12 months post intervention in this trial. The intervention could help people achieve weight loss and be cost-effective compared with current standard National Health Service care.Trial registrationISRCTN 18399564FundingNational Institute for Health and Care Research (NIHR; RP-PG-0216-20010), Medical Research Council (MC_UU_00006/6), NIHR Cambridge Biomedical Research Centre (NIHR203312).Graphical

Chapter 5 - Overview of evidence-based treatments of oppositional defiant disorder

This systematic review and meta-analysis of effectiveness trials comparing multicomponent behavioural weight management programmes with controls in overweight and obese adults set out to determine the effectiveness of these interventions implemented in routine practice. To be included, interventions must have been multicomponent, delivered by the therapists who would deliver the intervention in routine practice and in that same context, and must be widely available or feasible to implement with little additional infrastructure or staffing. Searches of electronic databases were conducted, and augmented by screening reference lists and contacting experts (November 2012). Data were extracted by two reviewers, with mean difference between intervention and control for 12-month change in weight, blood pressure, lipids and glucose calculated using baseline observation carried forward. Data were also extracted on adverse events, quality of life and mood measures. Although there were many published efficacy trials, only eight effectiveness trials met the inclusion criteria. Pooled results from five study arms providing access to commercial weight management programmes detected significant weight loss at 12 months (mean difference −2.22 kg, 95% confidence interval [CI] −2.90 to −1.54). Results from two arms of a study testing a commercial programme providing meal replacements also detected significant weight loss (mean difference −6.83 kg, 95% CI −8.39 to −5.26). In contrast, pooled results from five interventions delivered by primary care teams showed no evidence of an effect on weight (mean difference −0.45 kg, 95% CI −1.34 to 0.43). One study testing an interactive web-based intervention detected a significant effect in favour of the intervention at 12 months, but the study was judged to be at high risk of bias and the effect did not persist at 18 months. Few studies reported other outcomes, limiting comparisons between interventions. Few trials have examined the effectiveness of behavioural weight loss programmes delivered in everyday contexts. These trials suggest that commercial interventions delivered in the community are effective for achieving weight loss. There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.

Aim: The study based on research conducted in twelve EU countries aims to illustrate how and to what extent the quality control and assurance mechanisms, as outlined in the policy cycle for integrated border management in Europe and Frontex's operational strategy, are reflected in the regulation of border management practices in the surveyed countries. Methodology: Document and content analysis and conduct of semi-structured interviews. Findings: In the countries examined, quality control and assurance systems play a crucial role in enhancing border management and internal security. All countries prioritize ensuring that their border management systems remain operational and adaptable to the ever-evolving challenges. During inspections, self-assessments, and internal audits, countries employ various, though often similar, tools and methods aligned with European standards. Value: So far, there has been limited research in this field. The first part of the study examines the standards that regulate the development of integrated border management in the European Union, with a particular focus on provisions related to quality control and quality assurance in border management. In the second part, the authors investigated the quality control mechanisms of the national border administrations in twelve EU Member States. This analysis was conducted through documentary and content analysis, alongside semi-structured interviews with experts from the twelve countries. The findings of the research, and the conclusions drawn from them, may provide a strong basis for enhancing the effectiveness of the quality control and assurance processes within domestic border management.

Background/objectiveSugar-sweetened beverages are a substantial source of dietary sugar that can contribute to weight gain and the risk of type 2 diabetes. Dietary guidelines recommend non-nutritive sweetened (NNS) beverages to reduce sugar consumption, however, there is a need for long-term randomised controlled trials on their use. We aimed to compare the effects of NNS beverages and water on body weight during weight loss and maintenance in a behavioural weight management programme.MethodsIn this parallel-group, open-label, controlled equivalence trial, adults with a BMI of 27–35 kg/m2 who regularly consumed cold beverages were randomised 1:1 to water or NNS beverages. Participants underwent a group behavioural weight management programme comprising weekly (during the 12-week weight-loss phase) then monthly (during the 40-week weight-maintenance phase) meetings. The primary endpoint was weight change at week 52 (equivalence: two-sided P > 0.05). Secondary endpoints included changes in anthropometrics, cardiometabolic risk factors, appetite and activity levels.ResultsOf 493 participants randomised (water: n = 246; NNS beverages: n = 247), 24.1% were NNS-naïve. At week 52, water and NNS beverages were non-equivalent, with significantly greater weight loss in the NNS beverages group. Participants consuming water maintained a weight loss of 6.1 kg over 52 weeks versus 7.5 kg with NNS beverages (difference [90% CI]: 1.4 kg [–2.6, –0.2]; p < 0.05).ConclusionsDuring a 52-week behavioural weight management programme, water and NNS beverages were non-equivalent, with weight loss maintained to a statistically greater extent with NNS beverages compared with water. However, this difference was not clinically significant.Clinical trial registrationThis trial is registered with ClinicalTrials.gov: NCT02591134

Behavioral management programs have been developed commonly for research dogs and primates but rarely has program consideration been expanded to include all research species worked with. This is necessary to reduce animal stress and promote natural behaviors, which can promote good animal welfare and result in more robust and reproducible scientific data. We describe the evolution of consideration for research animal needs and define an umbrella-based model of research animal behavioral management programs, which may be used for all research species. In addition to developing a more comprehensive program, we emphasize the need for regular welfare assessments to determine whether the program is working cohesively and whether any aspects require modification.

Recent changes in the nature and scope of nursing home practices challenge long-term care nurses to develop treatment programs that are both successful in enhancing residents' remaining quantity and quality of life, as well as cost-effective in treating specific problems. The characteristics of behavioral therapies make them ideal for the open, community environment that characterizes many long-term care (LTC) settings. Under the guidelines of the Omnibus Budget Reconciliation Act of 1987, LTC facilities are expected to initiate behavioral management programs and to train staff in behavioral management practices. The purpose of this article is to discuss five key issues that should be considered in planning behavioral management programs for LTC facilities.

In the current study, the aim is to investigate the theses addressing the issue of program evaluation in the field of Curriculum and Instruction (C&amp;I) in 1997-2015. The study employed the survey model. The universe of the study consists of totally 87 theses addressing the issue of program evaluation in the field of C&amp;I in 1997-2015. As the data collection instrument of the study, the document analysis technique was used in the current study. The master’s and doctorate theses to be analyzed in the current study were obtained by writing “curriculum and instruction” in the search engine of the national thesis center of the Council of Higher Education. The data collected in the study were analyzed by using NVivo10.0. program package through content analysis. The findings of the analysis revealed that nearly half of the theses addressed the issue of program evaluation in elementary education and the other half dealt with program evaluation in other levels of schooling (higher education, high school education, in-service training, pre-school education, adult education, special education). The number of theses addressing program evaluation within the context of in-service training, pre-school education, adult education and special education is quite small. Another important finding of the study is the paucity of the studies aiming to investigate/evaluate hidden curriculum in all the levels of schooling.

To evaluate a multidisciplinary cognitive behavioural therapy pain management programme (PMP) based at a small community hospital. Patients attending the PMP were assessed at three intervals (pre-training, and 18 and 44 weeks post-training) using a set of seven questionnaires. Information about their general practitioner (GP) and consultant visits was recorded at pre-training and final follow-up visits. Questionnaires were completed and additional personal information recorded before patients attended their appointments. Between 1997 and 2006, 163 patients completed at least six sessions out of the eight-week programme. Of these, 70 who had completed at least one questionnaire outcome measure at the three assessment intervals, and 83 who had provided information on their GP and consultant visits at pre-training and final follow-up, were included in the analyses. The results showed that patients reported being more confident in coping with their pain (pain self-efficacy questionnaire) at 18 weeks post-training and their improvement was sustained at the final follow-up. They were significantly less depressed (hospital and anxiety depression scale [HADS]) and reported a large improvement in their quality of life (modified patient generated index) at the final follow-up. They also reported a significant reduction in pain-related GP and consultant visits at their final follow-up. Although there were improvements in the Tampa scale of kinesiophobia, anxiety (HADS-Anx) and sickness impact profile scores, these were not statistically significant. The result of the evaluation indicated that this PMP, delivered in a community hospital setting, made some significant differences to patients with intractable chronic pain conditions.

Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team.

The Accreditation Council for Graduate Medical Education's Next Accreditation System requires continuous program improvement as part of program evaluation for residency training institutions and programs. To improve the institutional- and program-level evaluation processes, to operationalize a culture of continuous quality improvement (CQI), and to increase the quality and achievement of action items, the Wayne State University Office of Graduate Medical Education (WSU GME) incorporated CQI elements into its program evaluation process. Across 4 academic years, WSU GME phased the following 4 CQI elements into the evaluation process at the program and institutional levels, including the annual program evaluation (APE) and the annual institutional review: (1) An APE template; (2) SMART (specific, measurable, accountable, realistic, timely) format for program and institutional goals; (3) Dashboard program and institutional metrics; and (4) Plan-do-study-act cycles for each action item. Action item goals improved in adherence to the SMART format. In 2014, 38% (18 of 48) omitted at least 1 field, compared with 0% omitting any fields in 2018. More complete action items took less time to resolve: 1.7 years compared with 2.4 years (t (43.3) = 2.87, P = .003). The implementation of CQI in the APE was well received by program leadership. After leveraging CQI methods, both descriptions of institutional- and program-level goals and the time required for their achievement improved, with overall program director and program coordinator satisfaction.

Role of Intervention Strategies for At-risk Preterm Infants

Diffusion weighted imaging (DWI) and their calculated apparent diffusion coefficient (ADC) values in magnetic resonance imaging (MRI) has grown with applications across multiple anatomical sites and settings across diagnostic and oncologic therapy settings, necessitating characterizing its quantitative performance across multiple scanners. Therefore, the purpose of this study was to determine the quantitative accuracy of DWI and their calculated ADC values across a fleet of MRI systems using a NIST-traceable diffusion phantom. Three NIST/QIBA DWI phantoms were imaged with protocols provided with the phantom on a multi-vendor fleet of 23 clinical MRI scanners. User-directed regions-of-interest on each vial provided ADC measurements among a wide range of NIST-traceable ADC values. Across all the MRI systems and data, the coefficient-of-variation was calculated, and Bland-Altman analysis was performed. The measurements between phantoms were analyzed to assess their agreement to determine if multiple phantoms can be used for quality assurance across a large institution. Lower ADC values and the sagittal orientation exhibited the largest error range and coefficient-of-variation (CoV) and was directly related to SNR. From a one-way analysis of the variance (ANOVA), the mean and standard deviation of the percent errors from each phantom were not significantly different from one another. No strong differences in Bland-Altman plots were seen between 1.5T and 3T scanners, however confidence intervals were different among vendors. The ADC values among the three phantoms were not significantly different from one another. A comprehensive analysis of institution-wide MRI scanners was conducted, motivating further work to utilize these results to implement a comprehensive quality assurance program and advanced scheduling system to better match similarly performing MRI scanners.

As the population of children and adolescents with multiple disabilities increases, special educators have responded with new curricula and teaching strategies to meet the needs of these students. In particular, many children with multiple disabilities exhibit severe behavior problems and/or psychiatric disturbances requiring multidisciplinary interventions. This paper describes a behavioral and psychiatric consultation service available to special educators at the Western Pennsylvania School for Blind Children. Important features of this program include: (a) an emphasis on behavioral assessment, data collection, and careful evaluation of treatment effectiveness; (b) use of a multidisciplinary team consisting of psychologists, a psychiatrist, a behavior specialist, and special educators; (c) employment of an extensive support system and follow-up strategy for teachers carrying out behavioral programs; and (d) utilization of a Human Rights Committee to review the use of particular interventions and ensure that the least restrictive intervention is implemented. Finally, specific aspects of the program are outlined and two illustrative case examples are presented.

<sec><title>Objective</title> Design brief is the main basis for determining capital construction projects and preparing design documents, whose preparation entails strict compliance with scientific and rigorous processes and methods. In the current construction process of landscape architecture projects in China, the preparation of design brief relies more on the experience of practitioners than on reliable evidence, and it is difficult to control the scientificity and rationality of the design basis. If landscape architectural programming is incorporated in the construction process of landscape architecture projects by designers and building owners to demonstrate the scale, nature, positioning and design requirements of such projects, and the preparation process and content of design brief as the basis for design are controlled before the design is carried out, it may be an effective way to promote scientific decision-making in landscape design. Landscape architectural programming is precisely a set of theories and methods for studying the process of design basis formation. As a matter of fact, the use of programming to enhance the scientificity of design decision-making has received considerable attention in the field of urban design and architecture. However, the current research on landscape architectural programming is still in its infancy, and there is an urgent need to clarify the connotations and attributes and develop the research methods of landscape architectural programming. </sec><sec><title>Methods/process</title> This research firstly traces and comparatively analyzes the development process of programming in the fields of urban design, architectural design and landscape architecture, and comparatively analyzes the design programming in the three human settlement environment disciplines in terms of the chronological position of programming in practice, the connotation of programming and the purpose of implementing programming, so as to put forward the broad and narrow connotations of landscape architectural programming, and point out the specific definitions and essential attributes of landscape planning. Secondly, from the perspective of scientific research, according to the process and hierarchy of scientific research, landscape architectural programming is reviewed as an independent research topic, and the research framework of landscape architectural programming in line with the characteristics and needs of the landscape architecture specialty is explored. </sec><sec><title>Results/conclusion</title> The research shows that design programming has two layers of connotation: Design programming in the broad sense is the programming of the whole cycle of project practice, covering the whole process of project planning, approval, design, construction, use, etc. Design programming in the narrow sense is the study of design basis and its formation process, which is positioned after project approval and before design. The current landscape architectural programming should prioritize the connotation in the narrow sense. As to the definition of the concept, landscape architectural programming refers to the research work in which landscape architects propose a combination of qualitative and quantitative design bases through various methods and procedures, which requires landscape architects to, following the target of a landscape architecture construction project, make rational and objective analysis of the social context and other relevant factors of the project by multidimensional investigation methods based on field investigation in combination with personal experience and technical specifications, and to justify the construction target as appropriate. Landscape architectural programming is evidence-based, which advocates evidence-based science rather than experience, and can thus contribute to scientific decision-making of design. The research framework of landscape architectural programming contains epistemology, theoretical perspective, programming methodology, programming procedure, programming methodology, and programming technology. The relationship between these 5 parts is as follows: Programming methodology is a complete set of action plans necessary for programming and a systematic collection of multiple methods and approaches, which links epistemology and theoretical perspective upward, and coordinates the three aspects of programming procedure, programming methodology and programming technology downward; programming procedure serves as an operation program for the modes and steps of programming practice, involving a variety of specific planning methods; programming methodology depends on the support of various techniques or tools in data collection, processing and analysis. In addition, this research integrates the author’s research and practical experience, and initially proposes a six-phase programming procedure: Goal presetting, field investigation and analysis, concept and spatial conception, goal justification, programming expression, and post-programming evaluation. This research also proposes 6 alternative programming methods including the survey research method, content analysis method, hierarchical analysis method, semantic analysis method, importance-satisfaction analysis method, and card analysis method, as well as 4 alternative programming techniques including the programming information matrix, programming periodic table, public participation model, and design competition model. </sec>