Components of complex interventions for healthcare: A narrative synthesis of qualitative studies

Objective:Qualitative research on therapeutic components is necessary to evaluate the efficacy of complex interventions in healthcare.As few qualitative syntheses have been conducted,this study aimed to derive a new conceptual framework for understanding the components of complex interventions and provide evidence for the implementation and evaluation of complex healthcare interventions.Methods:A systematic search of seven databases was conducted to identify qualitative studies that explored components of complex healthcare interventions.Meta-ethnography was used to analyze the data and thematic analysis was used to build the conceptual framework.Results:Of the 35 included studies,most complex interventions were non-pharmacological,with cancer accounting for 22%,mental health for 14%,and stroke for 8%.Half of the studies were conducted in the United Kingdom.Three main categories emerged:what should healthcare workers do?what qualifications should they have?and what should patients do?Five main themes were identified:psychological,biological,cognitive and behavioral,environmental,and social support.Conclusion:This analysis provides a reference for designing components of complex interventions in further studies.

Therapeutic Evaluation on Complex Interventions of Integrative Medicine and the Potential Role of Data Mining

It is a common view that the integration of Chinese medicine （CM） and modern Western medicine is an efficient way to facilitate the development of CM. Integrative medicine is a kind of complex interventions. Scientific therapeutic evaluation plays a crucial role in making integrative medicine universally acknowledged. However, the modern method of clinical study, which is based on the concept of evidence-based medicine, mostly focuses on the population characteristics and single interventional factor. As a result, it is difficult for this method to totally adapt to the clinical features of CM and integrative medicine as complex interventions. One possible way to solve this issue is to improve and integrate with the existing method and to utilize the evaluation model on complex interventions from abroad. As an interdisciplinary technique, data mining involves database technology, artificial intelligence, machine learning, statistics, neural network and some other latest technologies, and has been widely used in the field of CM. Therefore, the application of data mining in the therapeutic evaluation of integrative medicine has broad prospects.

Evaluation of a complex couplet care intervention in a neonatal intensive care unit:A mixed methods study protocol

Background:Families with an infant in need of intensive care most often experience a harmful separation after birth.This is due to a division of medical specialties into neonatal care and maternal care.Therefore,a couplet care intervention is implemented for mother-infant dyads in a neonatal intensive care unit.This study protocol provides a comprehensive evaluation of the intervention.The aim is to evaluate the effect and implementation of a complex couplet care intervention to promote zero separation between mother and infant.Methods:The couplet care intervention is a family-centered model of care,where treatment-requiring mother-infant dyads will be admitted together and receive couplet care by neonatal nurses.The study adheres to the framework of the Medical Research Council and will use a mixed methods embedded design comprising a quasi-experimental trial and a qualitative process evaluation.Finally,a health economic evaluation will be conducted to assess the cost-effectiveness of this complex couplet care intervention.Discussion:Separation of mother-infant dyads after birth has an adverse impact on family health and well-being.This study protocol evaluates a complex couplet care intervention.With this study,a first step is taken to help bridge the gap between current practices and a new care model to prevent the separation of mothers and their infants.

Five-year outcomes of biodegradable versus second-generation durable polymer drug-eluting stents used in complex percutaneous coronary intervention

Background:There are few data comparing clinical outcomes of complex percutaneous coronary intervention(CPCI)when using biodegradable polymer drug-eluting stents(BP-DES)or second-generation durable polymer drug-eluting stents(DP-DES).The purpose of this study was to investigate the safety and efficacy of BP-DES and compare that with DP-DES in patients with and without CPCI during a 5-year follow-up.Methods:Patients who exclusively underwent BP-DES or DP-DES implantation in 2013 at Fuwai Hospital were consecutively enrolled and stratified into two categories based on CPCI presence or absence.CPCI included at least one of the following features:unprotected left main lesion,≥2 lesions treated,≥2 stents implanted,total stent length>40 mm,moderate-to-severe calcified lesion,chronic total occlusion,or bifurcated target lesion.The primary endpoint was major adverse cardiac events(MACE)including all-cause death,recurrent myocardial infarction,and total coronary revascularization(target lesion revascularization,target vessel revascularization[TVR],and non-TVR)during the 5-year follow-up.The secondary endpoint was total coronary revascularization.Results:Among the 7712 patients included,4882(63.3%)underwent CPCI.Compared with non-CPCI patients,CPCI patients had higher 2-and 5-year incidences of MACE and total coronary revascularization.Following multivariable adjustment including stent type,CPCI was an independent predictor of MACE(adjusted hazard ratio[aHR]:1.151;95%confidence interval[CI]:1.017–1.303,P=0.026)and total coronary revascularization(aHR:1.199;95%CI:1.037–1.388,P=0.014)at 5 years.The results were consistent at the 2-year endpoints.In patients with CPCI,BP-DES use was associated with significantly higher MACE rates at 5 years(aHR:1.256;95%CI:1.078–1.462,P=0.003)and total coronary revascularization(aHR:1.257;95%CI:1.052–1.502,P=0.012)compared with that of DP-DES,but there was a similar risk at 2 years.However,BP-DES had comparable safety and efficacy profiles including MACE and total coronary revascularization compared with DP-DES in patients with non-CPCI at 2 and 5 years.Conclusions:Patients underwent CPCI remained at a higher risk of mid-to long-term adverse events regardless of the stent type.The effect of BP-DES compared with DP-DES on outcomes was similar in CPCI and non-CPCI patients at 2 years but had inconsistent effects at the 5-year clinical endpoints.