American journal of preventive medicine
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Randomized Controlled Trial
The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions.
In this article two new methods for building and evaluating eHealth interventions are described. The first is the Multiphase Optimization Strategy (MOST). It consists of a screening phase, in which intervention components are efficiently identified for inclusion in an intervention or for rejection, based on their performance; a refining phase, in which the selected components are fine tuned and issues such as optimal levels of each component are investigated; and a confirming phase, in which the optimized intervention, consisting of the selected components delivered at optimal levels, is evaluated in a standard randomized controlled trial. ⋯ A SMART trial can be used to identify the best tailoring variables and decision rules for an adaptive intervention empirically. Both the MOST and SMART approaches use randomized experimentation to enable valid inferences. When properly implemented, these approaches will lead to the development of more potent eHealth interventions.
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Ladder use is involved in many occupational and non-occupational activities. Falls from ladders can result in serious injury and affect people of all ages. The purpose of this study was to comprehensively examine nonfatal ladder-related injuries on a national level. ⋯ Given the 50% increase in ladder-related injuries during the study period, the relatively high likelihood of hospital admission, and the predominance of injuries in non-occupational settings, increased efforts are needed to prevent ladder-related injuries.
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Aspirin is effective for the primary and secondary prevention of cardiovascular events, but its use has been suboptimal. ⋯ Aspirin use is low, even among patients at increased risk. Better provider-patient communication about aspirin prevention is associated with greater use, and should be a target for future interventions.