Search Results (161)

Background: Complex chronic patients (CCPs) frequently experience fragmented care and high healthcare utilization. Integrated multidisciplinary care may improve care coordination and reduce reliance on acute healthcare services, although evidence regarding its impact on healthcare utilization and costs remains inconsistent. This study evaluated the real-world impact of a multidisciplinary integrated care program on healthcare utilization and provider costs among CCPs. Methods: This retrospective before-and-after study included CCPs enrolled in a multidisciplinary integrated care program between 2016 and 2023. Healthcare utilization and provider costs from the provider perspective were compared for up to two years before and after enrollment. Results: The study included 473 patients with a median age of 82 years, 56.7% of whom were women. Significant reductions in acute and ambulatory healthcare utilization and overall provider costs were observed following enrollment and were sustained over two years (p < 0.001). Exploratory economic analyses showed that lower provider costs occurred alongside reductions in acute healthcare utilization. Conclusions: A multidisciplinary integrated care program for CCPs was associated with sustained reductions in healthcare utilization and provider costs over two years. These findings support the potential value of integrated multidisciplinary care for CCPs. Full article

Reliable drinking-water production is difficult on remote islands where brackish-water delivery is intermittent, technical personnel are scarce, and reverse-osmosis plants are manually operated. This study presents an operational characterization of an Internet of Things (IoT) retrofit deployed in Santa Cruz, Galápagos; it is not a controlled before-and-after effectiveness evaluation. An ESP32-based M5Stack Tough controller, distributed ESP-NOW sensing nodes, relay–contactor interfaces, a binary pressure permissive, and a ThingSpeak cloud layer were integrated without replacing the existing pumps and membranes. The exported primary-flow channel contained 4,603,989 numeric observations, including 500 pre-official test readings. Operational analyses used 4,603,489 numeric observations from the official monitoring period; 4,603,340 values remained after nominal-range filtering, and positive flow had a median of 12 L/min (interquartile range: 11–15 L/min). Among 332 logged high-pressure commands, 326 were preceded by a low-pressure command (98.2% unbounded command-state consistency), whereas 275 occurred within a 120 s analytical bound (82.8%). The median low-to-high command delay was 27 s (interquartile range: 11–70 s). Four organizational representatives completed a published 41-item Industry 4.0 maturity instrument before and after deployment; the self-reported overall mean was 0.26 at baseline and 1.95 post-deployment, and these results are interpreted descriptively. Energy-consumption and production data were confidential and unavailable to the authors, while water-quality variables were not measured. The contribution is therefore a long-duration, local-first legacy retrofit with auditable telemetry and explicit limitations, rather than a claim of optimized desalination performance. Full article

Many law enforcement agencies operate crisis service models that utilize the expertise of mental health professionals in assisting law enforcement officers (LEOs) when interacting with people experiencing a mental health crisis. This study examines three agencies with two different types of established crisis service models in the same geographical area to answer three research questions: (1) Does the type of crisis service model affect facilitators of success for the model? (2) Does the type of crisis service model affect how practitioners personally measure the success of the model they use? (3) What patterns exist in involuntary psychiatric examination rates before and after the implementation of the crisis service models? Sixteen practitioners representing two crisis service models responded to a survey investigating the first two questions. Participants were recruited through email. The analysis used inferential and descriptive statistics to examine their responses. A before-and-after design using descriptive statistics of publicly available data about involuntary psychiatric examinations was employed to investigate the third research question. Results showed variation across the model participants’ choices of facilitators important for model success and metrics, but only differences between the responses from members of two models in choosing the facilitator of clear policies and procedures (e.g., clearly written protocols) and the metric of use of force were at statistically significant levels. The practitioners of the models are the experts. Understanding how they judge the success of their work and what facilitates that success is vital for allocating resources effectively and adjusting policies as needed. The study determined that involuntary psychiatric examinations decreased concurrently with the use of crisis service models, but it is not possible to establish causation. More investigation is needed. Full article

Institutional and commercial cooks may experience sustained heat exposure from combustion-based cooking, yet field evidence on thermal conditions following the introduction of electric cooking remains limited. This exploratory before-and-after case study examined three purposively selected kitchens in Kampala, Uganda, combining five-minute temperature and relative humidity monitoring at three spatial positions with cooking diaries, repeated thermal comfort and sensation votes, and enumerator observations. Heat Index (HI) was used as a temperature–humidity screening proxy, and Kampala weather data were used to calculate weather-adjusted differences. On documented active e-cooking days, mean hourly near-stove HI fell from 33.26 °C to 26.00 °C at Site A, 31.35 °C to 29.55 °C at Site B, and 31.71 °C to 27.50 °C at Site C. Time in the Safe HI category increased from 23.5% to 67.8%, 17.0% to 33.3%, and 25.4% to 53.0%, respectively. Day-level tests and a sensitivity analysis using all weather-matched intervention period logger days showed the same overall direction. Raw cooking durations declined for several meals, although, after normalisation by the number of people served, the reductions remained statistically detectable only for Site B breakfast and lunch. The results provide exploratory evidence of lower environmental thermal exposure under documented active e-cooking conditions. Sequential timing, purposive sampling, workload differences, incomplete intervention records and the absence of radiant, air speed and physiological measurements prevent causal interpretation as reduced occupational heat strain. Full article

Quality management in mega construction projects is increasingly supported by digital technologies, yet quality information often remains fragmented across inspection systems, reality-capture platforms, Building Information Modelling (BIM) environments and enterprise systems. This fragmentation limits traceability, delays corrective actions and weakens the connection between quality performance, contractual obligations and financial accountability. This study develops a closed-loop digital QA/QC framework that integrates BIM, mobile field inspection, reality capture, artificial intelligence (AI) augmentation and enterprise resource planning (ERP) within a unified governance architecture. Following a Design Science Research approach, the study proposes a seven-layer framework linking quality events to procurement, financial control, and project-management processes while supporting role-based decision-making through data democratisation mechanisms. The framework extends conventional ERP-enabled quality management by explicitly incorporating procurement (MM) and financial-control (FI/CO) functions, including supplier-quality management, cost-of-poor-quality tracking and quality-linked payment governance. An illustrative project scenario and sensitivity analysis are used to demonstrate the application of the proposed KPI and evaluation structure. By treating integration as the primary design objective, the framework provides a foundation for enterprise-wide digital quality management, lifecycle information continuity and digital-twin readiness in mega construction projects. The contribution itself is evaluated through an illustrative Design Science Research demonstration and an assumption-bounded sensitivity analysis rather than through field data, with future empirical validation specified through a controlled before-and-after case-study protocol. Full article

Background/Objectives: Allergic conjunctivitis (AC) is a frequent inflammatory ocular surface disease that significantly affects quality of life, particularly in children. Current treatments mainly provide temporary symptom relief and often require prolonged use. Bacterial suspensions have emerged as potential immunomodulatory treatments for other allergies but have yet to be completely explored for ocular allergies. Our study’s objective was to describe the clinical, ophthalmological, and quality-of-life changes in patients with AC treated with a bacterial suspension (BS) as complementary therapy. Methods: A before-and-after open, non-controlled clinical study was conducted in five children aged 7 to 9 years with a diagnosis of moderate-to-severe persistent allergic conjunctivitis and negative skin prick test results. Clinical ocular signs and symptoms, quality of life, and changes in CD19⁺IL-10⁺ cells were assessed. Results: After 90 days of BS treatment, reductions in allergic symptoms, including itching, light sensitivity, and burning, were observed, along with a marked reduction in ocular inflammation. An evaluation of quality-of-life revealed improvements across all domains and an increase in CD19⁺IL-10⁺ cells. Conclusions: BS therapy demonstrated favorable clinical and immune-modulatory effects in children with AC, supporting its potential as a promising complementary therapeutic option. Full article

Background/Objectives: Orthognathic surgery is performed to improve facial esthetics and function in patients with dentofacial deformities. This study aimed to evaluate the impact of orthognathic surgery on perceived facial age using an artificial intelligence (AI)-based age-estimation tool and to examine accompanying changes in self-rated flourishing and social appearance anxiety. Methods: This retrospective, single-arm, before-and-after study included 27 patients who underwent bilateral sagittal split ramus osteotomy (BSSRO) and/or Le Fort I osteotomy. Preoperative and postoperative standardized frontal photographs were analyzed with the AI-based application “AgeBot: How Old Do I Look?”. Participants also completed the Social Appearance Anxiety Scale (SAAS) and the Flourishing Scale (FS; Turkish adaptation by Telef). Both questionnaires were completed at a single postoperative interview—first for the remembered preoperative state and then for the current postoperative state—so the psychosocial pre–post comparisons reflect retrospectively perceived change. Normality was assessed on the paired differences; the primary AI-age outcome was analyzed with the paired t-test (confirmed by the Wilcoxon signed-rank test) and the psychosocial outcomes with the Wilcoxon signed-rank test, with effect sizes reported. A data-informed sensitivity analysis, rather than an a priori power calculation, accompanied the primary outcome. Results: AI-estimated facial age did not change significantly after surgery (mean difference [preoperative−postoperative] 0.11 ± 2.49 years, 95% CI −0.87 to 1.09, p = 0.818; Cohen’s dz = 0.04), and the confidence interval excluded the previously reported 1.31-year reduction. Exploratory change-score comparisons showed no significant differences by sex or smoking status. Postoperative SAAS scores were lower than retrospective preoperative scores (median 37 [IQR 24.5–42.0] vs. 51 [43.0–56.0]; Z = −4.07, p < 0.001, r = 0.55), and postoperative FS scores were higher (median 46 [40.0–51.5] vs. 45 [38.5–45.0]; Z = −2.45, p = 0.014, r = 0.37). Conclusions: Orthognathic surgery was not associated with a statistically significant change in AI-estimated facial age in this small cohort. More favorable social appearance anxiety and flourishing scores were observed following treatment, but the retrospective, uncontrolled assessment precludes causal attribution. AI-assisted facial age estimation may complement patient-reported outcomes, but validated, repeatability-tested tools are required before it can serve as a primary outcome measure. Full article

Background/Objectives: Hyperkalemia is a common complication in patients receiving maintenance hemodialysis (HD). Conventional cation-exchange resins, including sodium polystyrene sulfonate (SPS) and calcium polystyrene sulfonate (CPS), effectively lower serum potassium but may non-selectively bind magnesium. Sodium zirconium cyclosilicate (SZC) is a highly selective potassium binder with minimal affinity for magnesium. This study investigated changes in serum cation profiles and nutritional status after switching from conventional cation-exchange resins to SZC in patients undergoing maintenance HD. Methods: In this prospective, single-arm, before-and-after study conducted in routine clinical practice, 28 maintenance HD patients receiving SPS or CPS for chronic hyperkalemia were switched to SZC and followed for 12 weeks. Serum potassium, magnesium, corrected calcium, phosphorus, whole parathyroid hormone (whole-PTH), albumin, and the Geriatric Nutritional Risk Index (GNRI) were evaluated before and after the treatment transition. Results: Following the switch to SZC, median serum potassium increased modestly from 5.01 (4.66–5.39) to 5.26 (4.89–5.48) mEq/L (p = 0.031), whereas serum magnesium increased from 2.46 (2.29–2.66) to 2.66 (2.35–2.93) mg/dL (p < 0.001). Serum calcium, phosphorus, whole-PTH, albumin, and GNRI remained unchanged. Subgroup, correlation, and longitudinal analyses consistently supported the robustness of the observed increase in serum magnesium, irrespective of the previously prescribed resin or concomitant proton pump inhibitor use. Conclusions: Switching from conventional cation-exchange resins to SZC was associated with a significant increase in serum magnesium concentrations while maintaining acceptable potassium control and stable nutritional status in maintenance HD patients. These findings are consistent with the greater cation selectivity of SZC and suggest that replacement of conventional cation-exchange resins may contribute to preservation of serum magnesium concentrations. Further multicenter prospective studies evaluating magnesium metabolism together with clinically relevant outcomes are warranted to confirm these findings and clarify their clinical significance. Full article

Automated Speed Enforcement (ASE) has emerged as a prominent speed enforcement practice, attracting policy attention as its adoption has increased. Although ASE has been widely studied on residential streets and urban corridors, empirical evidence regarding its effectiveness in school zones is limited, where vulnerable road users and time-specific exposure create distinct safety challenges. This study developed Crash Modification Factors (CMFs) for ASE in school zones that quantify the expected change in crash frequency associated with a safety treatment, using before-and-after studies with Empirical Bayes (EB) and comparison group methods. The before-and-after crash studies yielded CMFs below 1.0 in all scenarios considered in this study, indicating the safety benefits of ASE across multiple crash and school categories. The comparison group before-and-after study indicated that, following ASE implementation, total crashes decreased by 10 percent (CMF = 0.90) and 9 percent (CMF = 0.91), while speeding-induced crashes decreased by 35 percent (CMF = 0.65) and 54 percent (CMF = 0.46) for school zones on state-maintained and locally maintained roads, respectively. Thus, estimated CMFs provide quantitative inputs that agencies may consider, indicating that ASE is an effective speed management strategy for improving safety in school zones and justifying investment. Full article

Background: Same-day or post-admission cancellation of elective surgery is associated with inefficient operating room utilization, patient distress, and disruption of coordinated perioperative care. Functional neurosurgery is particularly vulnerable to late-stage cancellation because procedural readiness depends on parallel clinical, anatomical, medication-related, device-related, and systemic considerations. Objective: This paper aims to describe the implementation of a structured preoperative review framework for functional neurosurgery and to evaluate its association with late-stage surgical cancellation after patient admission. Methods: We performed a retrospective single-center before-and-after study of consecutive functional neurosurgical procedures scheduled at Sheba Medical Center between January 2020 and December 2025. The ABCDE framework was introduced in 2023 as a structured workflow model organized around five domains: Anatomy, Bacteria, Clotting, Devices, and Elsewhere. Included procedures were deep brain stimulation, vagus nerve stimulation, focused ultrasound, intrathecal pump implantation or replacement, implantable pulse generator replacement, spinal cord stimulation, peripheral nerve stimulation, and other palliative neuromodulation procedures. The primary endpoint was late-stage cancellation, defined as cancellation after hospital admission and initiation of operative preparation. The primary comparison was between 2020–2022 and 2023–2025. A sensitivity analysis excluded 2020 because of pandemic-era disruption. Results: A total of 867 procedures were scheduled. Late-stage cancellation occurred in 16 of 407 pre-implementation procedures and 5 of 460 post-implementation procedures, corresponding to rates of 3.9% and 1.1%, respectively. The absolute risk difference was −2.8 percentage points (95% CI, −5.2 to −0.8), and the relative risk for cancellation after implementation was 0.28 (95% CI, 0.10 to 0.75). A two-sided Fisher’s exact test comparing cancellation versus non-cancellation across the pre-implementation and post-implementation periods was statistically significant (16/407 vs. 5/460; p = 0.0074). After excluding 2020, the direction of effect remained similar, but the difference was not statistically significant: 8 of 302 procedures in 2021–2022 were canceled compared with 5 of 460 in 2023–2025 (2.6% vs. 1.1%; p = 0.15). Detailed source-level attribution was incomplete for 10 of 21 cancellation events, and domain-level analyses should therefore be interpreted descriptively. Conclusions: Implementation of the ABCDE framework was associated with fewer late-stage surgical cancellations in this single-center before-and-after study. Because the design is observational, the number of events is small, and the study period overlaps with pandemic-era disruption and post-pandemic service stabilization, the findings should be interpreted as hypothesis-generating rather than causal. The framework may provide a practical structure for standardizing preoperative review in functional neurosurgery, but prospective studies with formal adherence tracking and procedure-specific analyses are needed. Full article

Background/Objectives: Topical imiquimod is an established non-invasive treatment for superficial basal cell carcinoma (sBCC). However, data on treatment-associated changes in tumor microvascularization remain limited. This study investigated vascular changes before and after imiquimod therapy using multimodal non-invasive imaging. Methods: In this single-center, prospective observational study, 31 basal cell carcinomas in 20 patients were examined before and 12–16 weeks after topical imiquimod therapy (5%, five times weekly for six weeks) using dermoscopy, dynamic optical coherence tomography (D-OCT), and line-field confocal optical coherence tomography (LC-OCT). Analyses were performed as paired before-and-after comparisons. While approved for sBCC, a small number of thin nodular and infiltrative BCCs were included exploratorily; subgroup analyses were not powered. Results: Dermoscopy showed a nominally significant shift toward smaller vessel diameter categories after therapy (ATS = 8.183, df = 1, p = 0.004). D-OCT-derived parameters (vessel density, vessel diameter, and depth of the vascular plexus) did not show nominally significant changes. LC-OCT showed nominally lower apparent intratumoral flow scores (ATS = 13.285, df = 1, p < 0.001), reduced occurrence of vessel-wall-associated intraluminal structures showing a rolling-like motion pattern (86.7% before treatment versus 33.3% after treatment; ATS = 13.357; df = 1, p < 0.001), and a reduction in maximum vessel diameter (ATS = 6.110, df = 1, p = 0.013). The primary LC-OCT inferential analyses were performed at the lesion level without adjustment for within-patient clustering and should therefore be interpreted as exploratory. An additional patient-cluster-adjusted paired change-score sensitivity analysis for LC-OCT maximum vessel diameter yielded a directionally consistent estimate (−17.81 µm; 95% CI: −34.40 to −1.23; p = 0.037). The primary exploratory endpoints were LC-OCT–based apparent intratumoral flow and maximum vessel diameter; secondary endpoints included dermoscopic and D-OCT–based vascular parameters. In the exploratory response-stratified analysis, the change in LC-OCT-based maximum vessel diameter did not differ significantly among the assigned response groups (Kruskal–Wallis H = 3.870, df = 2, raw p = 0.144; BH-adjusted p = 0.753). Conclusions: LC-OCT detected several exploratory vascular changes between the pre-treatment examination and follow-up and may provide complementary information for the non-invasive assessment of BCC after imiquimod therapy. Given the exploratory design, limited sample size, and lack of systematic histological confirmation, these findings are hypothesis-generating and require validation in larger prospective studies. Full article

Background: Antimicrobial resistance (AMR) is a major global health threat, yet awareness among adolescents remains low, especially in low-resource settings. Novel educational approaches are needed to appropriately inform and sustain the interest of young people to encourage behavioral change in the use of antimicrobials. This study aimed to evaluate the impact of a comic-based intervention in improving AMR knowledge and perceptions regarding the responsible use of antimicrobials among junior high school students in Ghana. Methods: We conducted a before-and-after educational intervention at the Kwame Nkrumah University of Science and Technology (KNUST) Basic Schools in Kumasi, Ghana, during the 2023 World AMR Awareness Week. All junior high students (JHS 1–3) present were exposed to a comic storyline illustrating appropriate antibiotic use and the risks of AMR, delivered via PowerPoint presentation and print, as an intervention. Questionnaires were administered pre- and post-intervention to assess changes in AMR knowledge and perceptions. Results: The median age of the student participants was 13 years. Out of the 1068 students involved, 611 matched responses were analyzed. Knowledge of AMR increased significantly after the comic intervention (p < 0.001). Correct responses increased across all items, and the proportion of students with a knowledge score increased substantially (33% to 70%). Attitudinal perceptions also shifted positively: 85.1% acknowledged their personal role in tackling AMR after the intervention, up from 67.4% before the intervention (p < 0.001). Conclusions: The educational intervention resulted in increased AMR knowledge and positive perceptions among the adolescents. The study findings suggest that comics and their deployment are viable tools for enhancing AMR awareness in school settings. Therefore, integrating and engaging visual storytelling in health education programs can increase awareness and promote responsible behavior towards the use of antimicrobials and support the global and national efforts for the containment of AMR. Full article

Background/Objectives: Initiation of empiric antibiotic therapy for neonatal early-onset sepsis (EOS) is prudent to prevent morbidity and mortality, particularly in low- and middle-income countries (LMICs). Inappropriate or prolonged antibiotic exposure in neonates is associated with poor clinical outcomes. Antimicrobial stewardship programs (ASPs) have been shown to optimize antibiotic use, but data from LMICs are limited. In this study, we aimed to evaluate adherence to a locally developed and adopted guideline for antibiotic use in EOS. Methods: We conducted a retrospective before-and-after study during the pre- (June 2024–January 2025) and post-implementation (May–December 2025) of ASP guideline for EOS. The intervention involved consolidating best practices—previously shared verbally and applied variably into a locally united written guideline, then provide training to neonatologists, pharmacists, and nurses. Adherence to best practices was evaluated by indication, dosing, timing, and duration of antibiotic therapy. Results: In a cohort of 388 neonates with EOS (i.e., 205 pre- and 183 post-implementation), the median gestational age was 38 (IQR: [37–39]) weeks, with the median birthweight of 3000 (IQR: [2800–3400]) grams, and 63% were male. The total adherence improved from 2.0% to 65.6% (p < 0.001) from pre- to post-implementation of ASP. In the post period, adherence rates were 96.7% for empiric antibiotics indication, 95.6% for antibiotics indication after culture results are obtained, 88.5% for antibiotic dosing, 83.1% for timely antibiotic initiation, and 89.1% for appropriate discontinuation of antibiotics. The median days of therapy and length of therapy significantly decreased by 139 per 1000 patient-days, from 1806 (IQR: [1556–2083] to 1667 (IQR: [1400–2000]; p < 0.001)] patient-days; and from 1000 (IQR: [875–1000]) to 875 (IQR: [769–1000]; p < 0.001) patient-days in the pre- versus the post-implementation, respectively. Median length of hospitalization of 8 [7–12] days and recovery (~93%) from EOS were similar pre- and post-implementation. Conclusions: The results support the effectiveness of ASP implementation in improving guideline adherence and reducing antibiotic exposure among neonates with EOS in low-resource settings. In-hospital clinical outcomes, including mortality at discharge, were similar between periods; however, further studies with longer follow-up are needed to better evaluate clinical outcomes. Full article

Background/Objectives: Emergency departments (EDs) are particularly prone to medication errors because of urgent treatment environments and high decision density. Automated dispensing cabinets (ADCs) integrated with the hospital information system (HIS) may improve medication safety, yet real-world evidence in centralized-pharmacy settings remains limited. This study evaluated the impact of an HIS-integrated ADC on medication use, medication errors, and nurses’ perception of safety in the ED of a Korean tertiary hospital. Methods: In this prospective before-and-after study, prescribing patterns, medication storage, and related costs were compared in the two months before (Phase 1; September–October 2019) and after (Phase 2; May–June 2020) ADC installation. Medication errors reported through the hospital safety incident reporting system were analyzed over corresponding 6-month windows from July 2019 to June 2020. Long-term sustainability was assessed using follow-up data collected from October to November 2023 (Phase 3), and all 46 ED nurses completed a 5-point Likert-scale survey on perceived medication safety. Results: Daily injectable prescriptions were unchanged (221.1 ± 34.6 vs. 227.7 ± 35.2; p = 0.301), whereas returned injectable prescriptions increased (17.9 ± 5.9 vs. 25.1 ± 6.0; p < 0.001) and non-injectable prescriptions decreased (163.1 ± 42.2 vs. 140.0 ± 22.7; p < 0.001). The number of medication items stored in the ED storage room declined by 95.6%, with a 92.5% reduction in related maintenance cost. Total medication errors decreased from 41 (74.5%) before to 14 (25.5%) after implementation (p < 0.001), with the largest reduction in delivery errors (17 [30.9%] to 2 [3.6%]). These improvements were sustained at the three-year follow-up. Nurses reported high overall satisfaction with medication safety (4.27 ± 0.62 on a 5-point Likert scale). Conclusions: Implementation of an HIS-integrated ADC in the ED was associated with improved prescription patterns, fewer reported medication errors, and enhanced perceived medication safety. In addition, these improvements were sustained over time, indicating stable and consistent implementation of the ADC system. Nurses also reported improved perceptions of medication safety. Full article

Background: Needle-related procedures such as venipuncture can be distressing for children and may trigger severe fear and behavioral dysregulation, particularly in those with previous traumatic experiences. Trauma-informed care (TIC) is a framework that recognizes the widespread impact of trauma and integrates this knowledge into clinical practice to prevent re-traumatization and support emotional regulation during medical procedures. Methods: This before-and-after study included 135 children aged 4–8 years who had previously shown severe distress during venipuncture, including escape attempts, shouting, or self/other-directed aggressive behaviors. Before venipuncture, children and their families received a TIC-based intervention delivered by a psychological counselor in a dedicated preparation room. Fear, behavioral responses during venipuncture, procedural pain, and heart rate were evaluated before and after the intervention using parent reports, the Children’s Fear Scale, the Wong–Baker FACES Pain Rating Scale, and pulse oximetry. Results: Following the TIC intervention, significant pre–post reduction were observed in distress-related behaviors during venipuncture, including escape attempts, shouting/crying, and self-/other-directed harmful behaviors. The proportion of children rated as experiencing high levels of fear decreased from 96.2% before the intervention to 15.5% after. Among the 85 children with complete heart-rate measurements available, mean heart rate decreased from 113.6 ± 10.1 beats/min to 87.3 ± 8.43 beats/min. Many families reported a more positive venipuncture experience compared with previous procedures. Conclusions: A trauma-informed care intervention delivered before venipuncture is associated with meaningful reductions in behavioral distress, fear, and physiological arousal in children with prior needle-related traumatic experiences. These pre–post associations support the feasibility and potential value of the TIC model, though controlled studies are needed to confirm these findings without confounding clinical effects. Full article