Evaluation of complex community-based childhood obesity prevention interventions.

BACKGROUND: Multi-setting, multi-component community-based interventions have shown promise in preventing childhood obesity; however, evaluation of these complex interventions remains a challenge. OBJECTIVE: The objective of the study is to systematically review published methodological approaches to outcome evaluation for multi-setting community-based childhood obesity prevention interventions and synthesize a set of pragmatic recommendations. METHODS: MEDLINE, CINAHL and PsycINFO were searched from inception to 6 July 2017. Papers were included if the intervention targeted children ≤18 years, engaged at least two community sectors and described their outcome evaluation methodology. A single reviewer conducted title and abstract scans, full article review and data abstraction. Directed content analysis was performed by three reviewers to identify prevailing themes. RESULTS: Thirty-three studies were included, and of these, 26 employed a quasi-experimental design; the remaining were randomized control trials. Body mass index was the most commonly measured outcome, followed by health behaviour change and psychosocial outcomes. Six themes emerged, highlighting advantages and disadvantages of active vs. passive consent, quasi-experimental vs. randomized control trials, longitudinal vs. repeat cross-sectional designs and the roles of process evaluation and methodological flexibility in evaluating complex interventions. CONCLUSIONS: Selection of study designs and outcome measures compatible with community infrastructure, accompanied by process evaluation, may facilitate successful outcome evaluation.

The impact of traditional and smart pump infusion technology on nurse medication administration performance in a simulated inpatient unit.

OBJECTIVE: Assess the impact of infusion pump technologies (traditional pump vs smart pump vs smart pump with barcode) on nurses' ability to safely administer intravenous medications. DESIGN: Experimental study with a repeated measures design. SETTING: High-fidelity simulated inpatient unit. RESULTS: The nurses remedied 60% of "wrong drug" errors. This rate did not vary as a function of pump type. The nurses remedied "wrong patient" errors more often when using the barcode pump (88%) than when using the traditional pump (46%) or the smart pump (58%) (Cochran Q=14.36; p<0.05). The number of nurses who remedied "wrong dose hard limit" errors was higher when using the smart pump (75%) and the barcode pump (79%) than when using the traditional pump (38%) (Cochran Q=12.13; p<0.003). Conversely, there was no difference in remediation of "wrong dose soft limit" errors across pump types. The nurses' pump programming was less accurate when mathematical conversions were required. Success rates on secondary infusions were low (55.6%) and did not vary as a function of pump type. CONCLUSIONS: These findings indicate that soft (changeable) limits in smart infusion pumps had no significant effect in preventing dosing errors. Provided that smart pumps are programmed with hard (unchangeable) limits, they can prevent dosing errors, thereby increasing patient safety. Until barcode pumps are integrated with other systems within the medication administration process, their role in enhancing patient safety will be limited. Further improvements to pump technologies are needed to mitigate risks associated with intravenous infusions, particularly secondary infusions.

Product development: using a 3D computer model to optimize the stability of the Rocket powered wheelchair.

A three-dimensional (3D) lumped-parameter model of a powered wheelchair was created to aid the development of the Rocket prototype wheelchair and to help explore the effect of innovative design features on its stability. The model was developed using simulation software, specifically Working Model 3D. The accuracy of the model was determined by comparing both its static stability angles and dynamic behavior as it passed down a 4.8-cm (1.9") road curb at a heading of 45 degrees with the performance of the actual wheelchair. The model's predictions of the static stability angles in the forward, rearward, and lateral directions were within 9.3, 7.1, and 3.8% of the measured values, respectively. The average absolute error in the predicted position of the wheelchair as it moved down the curb was 2.2 cm/m (0.9" per 3'3") traveled. The accuracy was limited by the inability to model soft bodies, the inherent difficulties in modeling a statically indeterminate system, and the computing time. Nevertheless, it was found to be useful in investigating the effect of eight design alterations on the lateral stability of the wheelchair. Stability was quantified by determining the static lateral stability angles and the maximum height of a road curb over which the wheelchair could successfully drive on a diagonal heading. The model predicted that the stability was more dependent on the configuration of the suspension system than on the dimensions and weight distribution of the wheelchair. Furthermore, for the situations and design alterations studied, predicted improvements in static stability were not correlated with improvements in dynamic stability.