Best practices

最佳做法
  • 文章类型: Journal Article
    背景:透明度可以在科学过程中建立信任,但是科学发现可能会被不良和晦涩的数据使用和报告实践所破坏。这项工作的目的是报告迄今为止如何使用青少年大脑认知发育(ABCD)研究的数据,并就如何提高调查结果的透明度和可重复性提供切实可行的建议。
    方法:2017年至2023年发表的使用ABCD研究数据的文章使用30多个数据提取项目进行了审查,以收集有关数据使用实践的信息。报告了每个提取项目的总频率,以及表示提取项目总体认可的完整性水平(LOC)分数的计算。使用单变量线性回归模型来检查LOC评分与单个提取项目之间的相关性。事后分析包括检查LOC得分是否与记录的2年期刊影响因子相关。
    结果:主要分析中包含549篇全长文章。分析脚本在30%的完整文章中共享。60%的文章报告了因数据缺失而被排除在外的参与者数量,以及单个变量缺失数据的信息(例如,家庭收入)在38%的文章中提供。83%的文章中包含了描述分析样本的表格。78%的评论文章中包括种族和/或种族变量,而其中只有41%的文章是合理的。LOC评分与缺失数据检查相关的提取项目高度相关。与LOC得分的前10%相比,LOC得分的后10%与较低的日志影响因子显著相关(β=-0.77,95%-1.02,-0.51;p值<0.0001)。
    结论:这些发现强调了在未来的论文中改进的机会,这些论文使用ABCD研究数据来轻松调整分析实践,以实现更好的透明度和可重复性。提供了一系列建议,以促进未来研究的坚持。
    BACKGROUND: Transparency can build trust in the scientific process, but scientific findings can be undermined by poor and obscure data use and reporting practices. The purpose of this work is to report how data from the Adolescent Brain Cognitive Development (ABCD) Study has been used to date, and to provide practical recommendations on how to improve the transparency and reproducibility of findings.
    METHODS: Articles published from 2017 to 2023 that used ABCD Study data were reviewed using more than 30 data extraction items to gather information on data use practices. Total frequencies were reported for each extraction item, along with computation of a Level of Completeness (LOC) score that represented overall endorsement of extraction items. Univariate linear regression models were used to examine the correlation between LOC scores and individual extraction items. Post hoc analysis included examination of whether LOC scores were correlated with the logged 2-year journal impact factor.
    RESULTS: There were 549 full-length articles included in the main analysis. Analytic scripts were shared in 30 % of full-length articles. The number of participants excluded due to missing data was reported in 60 % of articles, and information on missing data for individual variables (e.g., household income) was provided in 38 % of articles. A table describing the analytic sample was included in 83 % of articles. A race and/or ethnicity variable was included in 78 % of reviewed articles, while its inclusion was justified in only 41 % of these articles. LOC scores were highly correlated with extraction items related to examination of missing data. A bottom 10 % of LOC score was significantly correlated with a lower logged journal impact factor when compared to the top 10 % of LOC scores (β=-0.77, 95 % -1.02, -0.51; p-value < 0.0001).
    CONCLUSIONS: These findings highlight opportunities for improvement in future papers using ABCD Study data to readily adapt analytic practices for better transparency and reproducibility efforts. A list of recommendations is provided to facilitate adherence in future research.
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  • 文章类型: Journal Article
    背景:自COVID-19大流行以来,远程医疗保健现在是主流医疗保健的关键要素,所有类型的医疗保健提供者都加入了数字革命。作为一个经历医疗保健差距的人口,有发育障碍的成年人及其支持者描述了远程医疗保健的不同经历,这些经历有助于整体护理质量和健康结果.方法:这项e-Delphi研究就美国发育障碍成年人的远程医疗保健最佳实践达成了共识。对44名具有远程保健和发育障碍经验的专家小组成员进行了在线调查和视频会议访谈,包括有发育障碍的成年人,家庭成员,直接支持专业人员,护士,和医疗保健提供者。结果:三轮调查得出了9个指南,包括42个项目。准则解决了1)远程医疗保健的适当情况,2)沟通需求和偏好,3)支持人员协作,4)教育和预期指导,5)提醒,6)协调护理,7)公平和公正的准入,8)隐私和安全,和9)循证实践。结论:医疗保健提供者可以采用这些最佳实践指南,以确保向有发育障碍的成年人公平安全地提供远程医疗保健。需要进行政策宣传,以采纳这些准则,并使卫生保健提供者和有发育障碍的成年人获得安全有效地使用远程卫生保健所需的资源。
    Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.
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  • 文章类型: Journal Article
    医疗保健相关感染(HAIs)仍然是一个重要的患者安全问题,可能导致疾病和死亡。尽管实施了预防HAIs的临床捆绑措施。管理实践可以支持HAI预防,但是他们在HAI绩效监控和反馈中的作用还没有得到很好的理解。为了解决这个知识差距,我们之前对18家医院的工作人员进行了半结构化访谈,以研究在预防中央管路相关血流感染(CLABSI)和导管相关尿路感染(CAUTIs)方面的管理实践的作用.对访谈记录进行了分析,以确定与HAI绩效监控和反馈相关的主题。当前的分析重点是10家成功预防CLABSI和CAUTI的绩效较高的医院。这些机构有强有力的做法,包括及时的事件分析,领导参与,以及多学科参与HAI审查。在这些网站上,我们发现了共同的目标,包括无缘无故地调查HAIs和确定改进的机会.管理实践,如及时分析HAIs,设施领导和多学科团队成员之间的合作,并专注于识别程序或协议的失败,而不是工作人员的失败,都是可以支持感染预防工作的方法。随着医院试图解决冠状病毒大流行期间可能发生的CLABSI和CAUTI发病率的增加,这些管理实践可能尤为重要。
    Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood. To address this knowledge gap, we previously conducted semi-structured interviews with staff at 18 hospitals to examine the role of management practices around the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Interview transcripts were analyzed to identify themes related to HAI performance monitoring and feedback. The current analysis focuses on 10 higher-performing hospitals that were successful in preventing CLABSIs and CAUTIs. These institutions had robust practices including timely event analysis, leadership engagement, and multidisciplinary participation in HAI reviews. Across these sites, we found common goals including investigating HAIs without blame and identifying opportunities for improvement. Management practices such as timely analysis of HAIs, collaboration between facility leadership and multidisciplinary team members, and a focus on identifying the failure of a procedure or protocol, rather than the failure of staff members, are all approaches that can support infection prevention efforts. These management practices may be especially important as hospitals attempt to address increases in CLABSI and CAUTI rates that may have occurred during the coronavirus pandemic.
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  • 文章类型: Journal Article
    背景:用于性传播感染(STI)测试的数字分诊工具可以潜在地用作全科医生(GP)降低工作压力的分诊的替代品。所研究的工具基于医学指南。同样的准则支持GP的决策过程。然而,研究表明,全科医生从整体角度做出决策,因此,不要总是遵守这些准则。要拥有高质量的数字分诊工具,从而实现高效的护理流程,了解更多关于全科医生的决策过程是很重要的。
    目的:第一个目的是确定所研究的数字分诊工具的建议是否与全科医生的日常医疗实践相一致。第二个目标是了解哪些因素影响全科医生关于转诊诊断测试的决定。此外,这项研究提供了对全科医生决策过程的见解。
    方法:使用半结构化访谈进行了基于定性小插图的研究。总的来说,与参与者(GP)讨论了代表患者病例的6个小插图。参与者需要大声思考他们是否会建议患者进行STI测试以及原因。对访谈笔录进行了专题分析。小插图患者病例也通过数字分诊工具,导致建议测试或不测试性传播感染。对该工具的建议和参与者的建议进行了比较。
    结果:总计,进行了10次采访。参与者(GP)的平均年龄为48.30(SD11.88)岁。对于3个小插曲,数字分诊工具和所有参与者的建议是相同的。在那些小插曲中,患者的危险因素足够清楚,参与者建议与数字工具相同.对于3个小插曲,数字工具的建议与参与者的建议不同。影响参与者决策过程的患者相关因素是患者的焦虑,年轻的年龄,和接受测试的意愿。由于这些因素,参与者将在比分类工具更低的阈值进行测试。有时候,参与者想要的信息比插图中提供的更多,或者想要进行体检。这些元素不是数字分类工具的一部分。
    结论:进行诊断性STI测试的建议在数字分诊工具和全科医生之间有所不同。数字分诊工具只考虑医疗指南,而全科医生则愿意从整体角度讨论推理。全科医生的决策过程受到患者焦虑的影响,愿意接受测试,和年龄。根据这些结果,我们相信,用于STI测试的数字分诊工具可以支持GP,甚至可以在将来取代咨询。进一步的研究必须证实如何安全地做到这一点。
    BACKGROUND: Digital triage tools for sexually transmitted infection (STI) testing can potentially be used as a substitute for the triage that general practitioners (GPs) perform to lower their work pressure. The studied tool is based on medical guidelines. The same guidelines support GPs\' decision-making process. However, research has shown that GPs make decisions from a holistic perspective and, therefore, do not always adhere to those guidelines. To have a high-quality digital triage tool that results in an efficient care process, it is important to learn more about GPs\' decision-making process.
    OBJECTIVE: The first objective was to identify whether the advice of the studied digital triage tool aligned with GPs\' daily medical practice. The second objective was to learn which factors influence GPs\' decisions regarding referral for diagnostic testing. In addition, this study provides insights into GPs\' decision-making process.
    METHODS: A qualitative vignette-based study using semistructured interviews was conducted. In total, 6 vignettes representing patient cases were discussed with the participants (GPs). The participants needed to think aloud whether they would advise an STI test for the patient and why. A thematic analysis was conducted on the transcripts of the interviews. The vignette patient cases were also passed through the digital triage tool, resulting in advice to test or not for an STI. A comparison was made between the advice of the tool and that of the participants.
    RESULTS: In total, 10 interviews were conducted. Participants (GPs) had a mean age of 48.30 (SD 11.88) years. For 3 vignettes, the advice of the digital triage tool and of all participants was the same. In those vignettes, the patients\' risk factors were sufficiently clear for the participants to advise the same as the digital tool. For 3 vignettes, the advice of the digital tool differed from that of the participants. Patient-related factors that influenced the participants\' decision-making process were the patient\'s anxiety, young age, and willingness to be tested. Participants would test at a lower threshold than the triage tool because of those factors. Sometimes, participants wanted more information than was provided in the vignette or would like to conduct a physical examination. These elements were not part of the digital triage tool.
    CONCLUSIONS: The advice to conduct a diagnostic STI test differed between a digital triage tool and GPs. The digital triage tool considered only medical guidelines, whereas GPs were open to discussion reasoning from a holistic perspective. The GPs\' decision-making process was influenced by patients\' anxiety, willingness to be tested, and age. On the basis of these results, we believe that the digital triage tool for STI testing could support GPs and even replace consultations in the future. Further research must substantiate how this can be done safely.
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  • 文章类型: Journal Article
    背景:全膝关节置换术(TKA)中的固井技术可能会影响植入物的存活。关于临床使用技术的结果的知识有限。这项研究的目的是研究挪威医院TKA的固井技术,为了将广泛使用的技术与文献中的建议进行比较,并调查医院内部的变化。
    方法:在2020年向所有定期进行TKA的挪威骨科医生分发了一份要求有关固井技术信息的问卷。采用描述性统计方法对数据进行分析。
    结果:我们从257名外科医生中获得了121个反应。他们来自56家医院中的45家,至少一半的TKA外科医生来自20家医院,由79名外科医生组成。所有响应者使用脉冲灌洗。将水泥应用于胫骨平台和茎(完全胶结)的比例为61%。70%的外科医生将水泥应用于植入物和骨骼。使用了86%的提高水泥渗透性的技术。只有35%的外科医生旨在获得3-5毫米的水泥套厚度。弯曲膝关节以去除多余的水泥的比例为82%。我们发现,在20家医院中,有55%的外科医生不同意在其病房中使用通用指南。
    结论:在固井TKA时,大多数反应者使用文献中推荐的技术。超过一半的合格医院,外科医生不同意他们的医院使用共同的指导方针。专注于制定基于证据的指南将有利于TKA质量。
    BACKGROUND: Cementing technique in total knee arthroplasty (TKA) may influence implant survival. There is limited knowledge about the results with clinically used techniques. The aim of this study was to investigate cementing techniques for TKA in Norwegian hospitals, to compare widely used techniques to recommendations from the literature, and to investigate variation within hospitals.
    METHODS: A questionnaire requesting information about cementing techniques were distributed to all Norwegian orthopedic surgeons performing TKAs regularly in 2020. Data was analyzed using descriptive statistical methods.
    RESULTS: We acquired 121 responses out of 257 surgeons. They were from 45 out of 56 hospitals, and at least half of the TKA surgeons from 20 hospitals, constituting 79 surgeons. All responders used pulsatile lavage. Cement application to both the tibial plateau and stem (full cementation) was practiced by 61%. Application of cement to both implant and bone was done by 70% of surgeons. Techniques to improve cement penetration were used by 86%. Only 35% of surgeons aimed to get a cement mantle thickness between 3-5 mm. Flexing the knee joint to remove excess cement was done by 82%. We found that in 55% of 20 hospitals the surgeons did not agree on the use of common guidelines in their ward.
    CONCLUSIONS: The majority of the responders used recommended techniques from the literature when cementing TKA. At more than half of the eligible hospitals, surgeons disagreed about their hospitals\' use of common guidelines. Focusing on developing evidence-based guidelines would be beneficial for TKA-quality.
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  • 文章类型: Journal Article
    目的:神经心理学评估对于检测和管理与亨廷顿病(HD)相关的认知和神经精神变化至关重要。准确评估HD的非运动并发症是至关重要的,因为对功能性残疾的显著影响,经常与运动症状相称或超过运动症状。越来越重视开发针对HD认知下降的疾病修饰疗法,需要在临床神经心理学评估方法上达成共识。亨廷顿研究组(HSG)的神经心理学工作组(NPWG)试图提供证据和共识,评估与HD相关的认知和神经精神症状的实用指南。方法:NPWG招募了一个多学科的神经心理学家小组,神经学家,和精神科医生告知评估的最佳做法,诊断,治疗HD患者的非运动症状。在NPWG中分发了一份评论,在一个引用文献的迭代过程中,确定了HD患者神经心理学评估的最佳实践.结果:提供了对现有文献的简要回顾和临床共识电池的合理性。结论:临床神经心理学家在检测和表征HD的非运动症状方面具有独特的优势。进一步,为神经科医师和相关卫生专业人员提供影响功能结果和生活质量的有临床意义的信息.NPWG在本声明中向临床神经心理学家提供了最佳实践指导。即将发表一篇文章,将先前基于研究的HD非运动诊断标准的临床应用付诸实施,这也为非神经心理学家的非运动症状筛查方法提供了建议。
    Objective: Neuropsychological evaluation is critical to detection and management of cognitive and neuropsychiatric changes associated with Huntington disease (HD). Accurate assessment of non-motor complications of HD is critical given the prominent impact on functional disability, frequently commensurate with or exceeding that of motor symptoms. The increasing emphasis on developing disease-modifying therapies targeting cognitive decline in HD requires consensus on clinical neuropsychological assessment methods. The Neuropsychology Working Group (NPWG) of the Huntington Study Group (HSG) sought to provide evidence and consensus-based, practical guidelines for the evaluation of cognitive and neuropsychiatric symptoms associated with HD. Method: The NPWG recruited a multi-disciplinary group of neuropsychologists, neurologists, and psychiatrists to inform best practices in assessing, diagnosing, and treating the non-motor symptoms in HD. A review was circulated among the NPWG, and in an iterative process informed by reviewed literature, best practices in neuropsychological evaluation of patients with HD were identified. Results: A brief review of the available literature and rational for a clinical consensus battery is offered. Conclusion: Clinical neuropsychologists are uniquely positioned to both detect and characterize the non-motor symptoms in HD, and further, provide neurologists and allied health professions with clinically meaningful information that impacts functional outcomes and quality of life. The NPWG provides guidance on best practices to clinical neuropsychologists in this statement. A companion paper operationalizing clinical application of previous research-based non-motor diagnostic criteria for HD is forthcoming, which also advises on non-motor symptom screening methods for the non-neuropsychologist working with HD.
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  • 文章类型: Journal Article
    已经存在完善的指南,以解决非介入研究(NIS)设计和方法的最佳实践。这些指南提供了在设计研究和制定协议时要考虑的事情的建议,但不一定要捕获与NIS实施相关的具体细节。本文的目的是提出进行数据NIS二次使用的最佳实践。我们建议NIS的理想实施应包括发展强大的研究概念,随后是详细的议定书,分析计划,报告,和传播的考虑。我们回顾并讨论从概念到出版的每个步骤中的常见错误/陷阱和关键考虑因素。在这次审查的许多情况下,我们还提供了建议或可访问的资源,研究人员可以在规划时将其用作“最佳实践”指南,导电,或者审查这种调查方法。
    Well established guidelines already exist that address best practices for Non-Interventional Study (NIS) design and methods. These guidelines provide advice on things to consider while designing a study and developing a protocol, but do not necessarily capture specific details related to the implementation of NIS. The intent of this paper is to propose a best practice for conducting secondary use of data NIS. We propose that the ideal implementation of a NIS should include the development of a strong Study Concept, followed by a detailed Protocol, Analysis Plan, Report, and considerations for Dissemination. We review and discuss common mistakes/pitfalls and key considerations at each step from concept to publication. In many cases in this review, we have also provided suggestions or accessible resources that researchers can apply as a \"best practices\" guide when planning, conducting, or reviewing this investigative method.
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  • 文章类型: Randomized Controlled Trial
    这项随机临床试验研究了经济激励措施是否会增加幼儿母亲的戒烟率,以及对儿童二手烟暴露(SHSe)的潜在影响。198名妇女-儿童二元组被登记并被分配到三种治疗条件之一:最佳实践(BP,N=68),最佳实践加财务激励(BP+FI,N=63),或最佳实践,财政激励,和尼古丁替代疗法(BP+FI+NRT,N=67)。审判在佛蒙特州完成,2015年6月至2020年10月美国BP要求员工转介国家烟草戒烟线;经济激励措施要求母亲根据生化验证的戒烟情况获得12周的可交换零售物品的代金券;NRT涉及母亲接受10周的免费透皮尼古丁和尼古丁锭剂/口香糖。基线,6-,12-,24-,并进行了48周的评估.主要结果是通过24周评估和48周探索性评估的母亲7天点患病率禁欲和儿童SHSe。使用混合模型重复度量对分类数据进行分析。在6周和12周评估中,与BP相比,BPFI和BPFINRT中的母亲禁欲的几率更大(OR≥7.30;95%CIs:2.35-22.71);在24周评估中,仅BPFI中的禁欲高于BP(OR=2.95;95%CIs:1.06-8.25)。在48周的评估中,禁欲在治疗条件之间没有显着差异。治疗条件(F[2109]=3.64,P=0.029)对SHSe有显著影响,BP和BP+FI水平显著低于BP+FI+NRT(ts[109]≥-2.30,Ps≤0.023)。戒烟的经济激励措施对于增加产妇戒烟是有效的,但仅此一项不足以减少儿童SHSe。ClinicalTrials.gov:NCT05740098。
    This randomized clinical trial examined whether financial-incentives increase smoking cessation among mothers of young children and potential impacts on child secondhand-smoke exposure (SHSe). 198 women-child dyads were enrolled and assigned to one of three treatment conditions: best practices (BP, N = 68), best practices plus financial incentives (BP + FI, N = 63), or best practices, financial incentives, and nicotine replacement therapy (BP + FI + NRT, N = 67). The trial was completed in Vermont, USA between June 2015 and October 2020. BP entailed staff referral to the state tobacco quitline; financial incentives entailed mothers earning vouchers exchangeable for retail items for 12 weeks contingent on biochemically-verified smoking abstinence; NRT involved mothers receiving 10 weeks of free transdermal nicotine and nicotine lozenges/gum. Baseline, 6-, 12-, 24-, and 48-week assessments were conducted. Primary outcomes were maternal 7-day point-prevalence abstinence and child SHSe through the 24-week assessment with the 48-week assessment exploratory. Results were analyzed using mixed model repeated measures for categorical data. Odds of maternal abstinence were greater among mothers in BP + FI and BP + FI + NRT compared to BP at the 6- and 12-week assessments (ORs ≥ 7.30; 95% CIs: 2.35-22.71); only abstinence in BP + FI remained greater than BP at the 24-week assessment (OR = 2.95; 95% CIs: 1.06-8.25). Abstinence did not differ significantly between treatment conditions at the 48-week assesssment. There was a significant effect of treatment condition (F[2109] = 3.64, P = .029) on SHSe with levels in BP and BP + FI significantly below BP + FI + NRT (ts[109] ≥ -2.30, Ps ≤ 0.023). Financial incentives for smoking abstinence are efficacious for increasing maternal cessation but that alone was insufficient for reducing child SHSe. ClinicalTrials.gov:NCT05740098.
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  • 文章类型: Journal Article
    与美国其他种族群体相比,黑人美国人受阿尔茨海默病(AD)的负担不成比例,并且在AD临床试验中的代表性仍然不足。这篇综述探讨了美国黑人参与临床试验的主要障碍,并提供了基于文献的建议,以改善美国黑人在AD临床试验中的纳入。
    我们在电子数据库和灰色文献中搜索了截至2023年1月1日在美国发表的文章,最终确定了26篇关键文章。
    参与美国黑人临床试验的障碍根植于健康的社会决定因素,包括获得优质教育和信息,获得医疗保健,经济稳定,建筑环境,和社区背景。改善美国黑人参与临床试验的最佳做法要求制药公司采取多方面的方法,投资于选址的创新策略,发展当地伙伴关系,外展,和教育。
    虽然必须采取多部门行动来有效解决AD对美国黑人的不成比例的负担,由于制药行业在产品开发和临床试验中的核心作用,因此在这一领域发挥着重要作用。
    UNASSIGNED: Black Americans are disproportionately burdened by Alzheimer\'s disease (AD) relative to other racial groups in the United States and continue to be underrepresented in AD clinical trials. This review explores the primary barriers for participation in clinical trials among Black Americans and provides literature-based recommendations to improve the inclusion of Black Americans in AD clinical trials.
    UNASSIGNED: We searched electronic databases and gray literature for articles published in the United States through January 1, 2023, ultimately identifying 26 key articles for inclusion.
    UNASSIGNED: Barriers to participation in clinical trials for Black Americans are rooted in social determinants of health, including access to quality education and information, access to health care, economic stability, built environment, and community context. Best practices to improve the inclusion of Black Americans in clinical trials require pharmaceutical companies to adopt a multifaceted approach, investing in innovative strategies for site selection, development of local partnerships, outreach, and education.
    UNASSIGNED: While multisectoral action must occur to effectively address the disproportionate burden of AD on Black Americans, the pharmaceutical industry has an important part to play in this space due to their central role in product development and clinical trials.
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  • 文章类型: Journal Article
    美国原住民(NA)儿童的肥胖症患病率过高,表明健康差异的风险更高。许多儿童参加早期护理和教育(ECE)计划,提供一个适当的环境来改善膳食和菜单质量,因为健康食品的摄入与降低儿童肥胖的风险有关。
    我们的目标是检查NAECE中餐饮服务人员在餐饮和菜单质量方面的培训效果。
    来自9个参与ECE计划的食品服务人员参加了为期3小时的培训,重点是儿童和成人护理食品计划(CACFP)最佳实践,并收到了一个量身定制的,最佳实践菜单,和健康的食谱。在基线时,根据CACFP份量假设检查了1周准备的膳食和菜单,4mos,6mos,以及所有9个程序的12个mos。健康饮食指数(HEI)CACFP要求和最佳实践实现,和食物替代质量(分为上级,等效,和基于营养质量的劣质)进行计算。使用重复测量ANOVA模型来确定跨时间点的差异。
    总进餐HEI评分从基线显着增加到4个月(71.1±2.1;78.6±5.0;P=0.004),但从基线到12mos没有差异。菜单CACFP要求和最佳实践成就在不同时间点没有差异,尽管在基线时CACFP要求的实现已经很高。优越的营养质量替代从基线下降到6个月(32.4±8.9;19.5±10.9;P=0.007);然而,从基线到12mos没有差异。等效和劣质替代在不同时间点没有差异。
    使用健康食谱的最佳实践菜单可以立即改善膳食质量。虽然变化没有持续,这项研究表明,有机会教育和培训食品服务人员。需要大力改善膳食和菜单。该试验已注册为ClinicalTrials.gov,编号为NCT03251950(https://clinicaltrials.gov/ct2/show/NCT03251950?cond=食物+资源+权益&抽签=2&等级=1)。
    UNASSIGNED: Prevalence of obesity in Native American (NA) children is disproportionately high, indicating a higher risk of health disparities. Many children attend early care and education (ECE) programs, presenting an opportune environment to improve meal and menu quality as the intake of healthy foods is associated with lowered risk of childhood obesity.
    UNASSIGNED: We aimed to examine the effectiveness of food service staff training on meals and menu quality across NA ECEs.
    UNASSIGNED: Food service staff from 9 participating ECE programs attended a 3-h training focused on Child and Adult Care Food Program (CACFP) best practices, and received a tailored, best-practice menu, and healthy recipes. Meals and menus prepared across 1 wk were examined per CACFP serving size assumptions at baseline, 4 mos, 6 mos, and 12 mos for all 9 programs. Healthy Eating Index (HEI), CACFP requirements and best practices achievement, and food substitutions quality (classified into superior, equivalent, and inferior based on the nutritional quality) were calculated. A repeated measures ANOVA model was used to determine the differences across time points.
    UNASSIGNED: The total meal HEI score increased significantly from baseline to 4 mos (71.1 ± 2.1; 78.6 ± 5.0; P = 0.004), but did not differ from baseline to 12 mos. Menu CACFP requirements and best practices achievement did not differ across time points, although achievement with CACFP requirements was already high at baseline. Superior nutrition quality substitutions declined from baseline to 6 mos (32.4 ± 8.9; 19.5 ± 10.9; P = 0.007); however, it did not differ from baseline to 12 mos. Equivalent and inferior quality substitutions did not differ across time points.
    UNASSIGNED: Implementing a best-practice menu with healthy recipes showed immediate improvements in meal quality. Although the change did not sustain, this study showed evidence of an opportunity to educate and train food service staff. Robust efforts are needed for improving both meals and menus.This trial was registered ClinicalTrials.gov as NCT03251950 (https://clinicaltrials.gov/ct2/show/NCT03251950?cond=food+resource+equity&draw=2&rank=1).
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