6-month Scores Research Articles

Therapeutic components of an automated digital counselling intervention for chronic heart failure

Abstract Background/Introduction Task force statements advocate digital health interventions to promote self-care behaviour and health-related quality of life (HRQL) in patients with chronic heart failure (CHF). There is a need to identify therapeutic components of digital interventions to improve the efficacy and replicability of these CHF interventions. Purpose The Canadian e-Platform to PrOmote BehavioRal Self-ManagemenT in Chronic Heart Failure trial (CHF-CePPORT) evaluated the efficacy of automated digital counseling to improve HRQL at 12 months, using the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS). Our aim was to identify therapeutic components of the CHF-CePPORT protocol that were independently associated with KCCQ-OS endpoint. Methods CHF-CePPORT was a multicenter, randomized controlled trial with a 2-parallel group, double blind design, and assessments at baseline, 4- and 12-months. This substudy focused on patients randomized to the automated digital counseling arm of CHF-CePPORT. Ordinal logistic regression was used to identify components of the protocol that predicted higher KCCQ-OS tertile at 12-months, according to schedule of automated digital contact, modality of content, and clinical content theme – see Figure. Results From the sample enrolled in CHF-CePPORT (n=230), 117 patients were included in this substudy: female, n=24 (20.5%), median age=60 years (IQR, 52, 69), New York Heart Association Class 1, n=45 (38.5%), Class 2, n=48 (41.0%), and Class 3, n=16 (13.7%). Baseline KCCQ-OS was median=82.3 (IQR, 67, 93). Patient engagement with the digital counseling platform over 12 months was as follows: Median (IQR) total logons = 79 (24, 133), Total logon time = 5.8 hours (1.6, 9.8). Total logon time during the initial phase of the trial (sessions 1–16), with weekly scheduled sessions was independently associated with a higher 12-month KCCQ-OS tertile score (p=0.003). Subsequent sections (sessions 17–24, and 25–28) were not independently associated with the 12-month KCCQ-OS (p=0.56 and p=0.91 respectively). Within sessions 1–16, the 12-month KCCQ-OS was associated with the use of counseling and dramatic videos (p=0.04) and e-tools/trackers (p=0.007), but not conventional information/education pages (p=0.80). Content themes associated with the 12-month KCCQ-OS included motivational counseling (sessions 5–8) with self-assessment tools and trackers (p=0.04). Cognitive behavioural guidelines for HF self-care were also associated with 12-month KCCQ-OS tertiles when presented by expert and dramatic videos (p=0.02) as well as self-assessment etools/etrackers (p=0.02). Self-assessment tools and trackers for HRQL (sessions 15–16) were also associated with higher KCCQ tertiles at 12 months (p=0.01) – see Table. Conclusion(s) The results of this study confirm the importance of using key components from evidence-based, clinically organized protocols of behavioural counseling to promote HRQL for patients with CHF. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research

Post-Traumatic Growth in Parents following Their Child's Death in a Pediatric Intensive Care Unit.

Background: Although bereaved parents suffer greatly, some may experience positive change referred to as post-traumatic growth. Objective: Explore the extent to which parents perceive post-traumatic growth after their child's death in a pediatric intensive care unit (PICU), and associated factors. Design: Longitudinal parent survey conducted 6 and 13 months after a child's death. Surveys included the Post-traumatic Growth Inventory-Short Form (PTGI-SF), a 10-item measure with range of 0-50 where higher scores indicate more post-traumatic growth. Surveys also included the Inventory of Complicated Grief (ICG), the Patient Health Questionnaire-8 (PHQ-8) for depression, the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a single item on perceived overall health, and sociodemographics. Setting/Subjects: One hundred fifty-seven parents of 104 children who died in 1 of 8 PICUs affiliated with the U.S. Collaborative Pediatric Critical Care Research Network. Results: Of participating parents, 62.4% were female, 71.6% White, 82.7% married, and 89.2% had at least a high school education. Mean PTGI-SF scores were 27.5 ± 12.52 (range 5-50) at 6 months and 28.6 ± 11.52 (range 2-49) at 13 months (p = 0.181). On multivariate modeling, higher education (compared with those not completing high school) and higher 6-month ICG scores (reflecting more complicated grief symptoms) were associated with lower 13-month PTGI-SF scores (p = 0.005 and 0.033, respectively). Conclusion: Parents bereaved by their child's PICU death perceive a moderate degree of post-traumatic growth in the first 13 months after the death however variability is wide. Education level and complicated grief symptoms may influence parents' perception of post-traumatic growth.

Rehearsal’s effect on long-term recall and comprehension of orthodontic informed consent

The purpose of this study was to determine if written rehearsal of informed consent improved 6-month recall and comprehension compared with the current best practices. A consultation was provided and subjects read the modified informed consent document. They were randomized to group A (received the core and up to 4 custom elements of treatment, wrote what each image displayed) or group B (presentation of the 18 elements with core elements chunked at the end followed by up to 4 custom elements). Interviews recording knowledge recall/comprehension occurred immediately and after months later. Overall, no significant differences in baseline or 6-month follow-up scores were found between groups. Initially, group A outperformed group B in some core domains. There were no significant differences between groups in the change of scores from initial to follow-up. Follow-up scores were significantly lower than baseline scores (P<0.05). Higher initial scores were associated with larger drops at follow-up. A decrease in knowledge>20% was common. Overall the methods are comparable at baseline and 6-months. Initial content retention was roughly 60+%, with 6%-9% deterioration. For areas of treatment methods, risk, discomfort, and resorption at 6-months, the current processes failed the patient and left the practitioner vulnerable to risk management issues. Results support the rehearsal method with immediate feedback for misunderstandings as the preferred method for informed consent.

Fast Outcome Categorization of the Upper Limb After Stroke.

The ARAT (Action Research Arm Test) has been used to classify upper limb motor outcome after stroke in 1 of 3, 4, or 5 categories. The COVID-19 pandemic has encouraged the development of assessments that can be performed quickly and remotely. The aim of this study was to derive and internally validate decision trees for categorizing upper limb motor outcomes at the late subacute and chronic stages of stroke using a subset of ARAT tasks. This study retrospectively analyzed ARAT scores obtained in-person at 3 months poststroke from 333 patients. In-person ARAT scores were used to categorize patients' 3-month upper limb outcome using classification systems with 3, 4, and 5 outcome categories. Individual task scores from in-person assessments were then used in classification and regression tree analyses to determine subsets of tasks that could accurately categorize upper limb outcome for each of the 3 classification systems. The decision trees developed using 3-month ARAT data were also applied to in-person ARAT data obtained from 157 patients at 6 months poststroke. The classification and regression tree analyses produced decision trees requiring 2 to 4 ARAT tasks. The overall accuracy of the cross-validated decision trees ranged from 87.7% (SE, 1.0%) to 96.7% (SE, 2.0%). Accuracy was highest when classifying patients into one of 3 outcome categories and lowest for 5 categories. The decision trees are referred to as FOCUS (Fast Outcome Categorization of the Upper Limb After Stroke) assessments and they remained accurate for 6-month poststroke ARAT scores (overall accuracy range 83.4%-91.7%). A subset of ARAT tasks can accurately categorize upper limb motor outcomes after stroke. Future studies could investigate the feasibility and accuracy of categorizing outcomes using the FOCUS assessments remotely via video call.

Preliminary 12-Month Safety and Efficacy Outcomes for the Treatment of Cervical Radiculopathy and Myelopathy with the Stalif-C Integrated Interbody Fusion Device

Anterior cervical discectomy and fusion (ACDF) has been widely utilized as the workhorse approach for the surgical treatment of cervical degenerative pathology. Minimal high-level evidence data exists on the efficacy and safety of integrated cage-screw implants. A prospective, non-randomized clinical study utilizing STALIF C-Ti® integrated cage-screw implants was performed in 145 patients. 12-month outcome scores demonstrated significant improvements in all patient reported outcome scores collected (p&lt;0.05 for all), including NDI, VAS neck, VAS left arm, and VAS right arm. Patients receiving STALIF C-Ti integrated cage-screw implants demonstrated significant improvements in clinical outcome scores with minimal overall complication rate

The Effect of Training on Knowledge, Perception, and Practice of Healthcare Personnel on the Use of Respiratory Protective Equipment during COVID-19 Pandemic at a Private Hospital in the Northern part of Thailand.

OBJECTIVES: To determine the effect of the respiratory protective training program of healthcare personnel (HCP) during the Coronavirus Disease 2019 (COVID-19) pandemic at a private hospital in the northern part of Thailand. MATERIALS AND METHODS: This cross-sectional study was conducted with 89 healthcare personnel (HCP) of Bangkok Hospital Phitsanulok, who required wearing a tight-fitting respirator during their duties and attended respiratory protective equipment (RPE) video-based training program regarding the general principles of respirator usage and guidelines on safely re-using RPE. A questionnaire-based assessment of participants’ 3-month retention of knowledge and perception was conducted in April 2021. A qualitative fit test (QLFT) was used in terms of practice on RPE. The proportion of correct responses in the 3-month knowledge and perception score were compared with a pre-training test and an immediate post-training test using paired t-test. The same analysis was conducted with QLFT using McNemar’s test. RESULT: Various types of RPE were used in each test depending on the supply. The most commonly used RPE was N95 (58.4%), the majority of N95 was 3MVLFEX 9105. Compared with the pretraining test, the proportion of correct responses in the immediate post-training test increased by 11% (p &lt; 0.001; 95% CI 1.07-2.23). Similarly, in 3-month post-training, the percentage of correct response also increased from pre-training by 10.4% (p &lt; 0.001; 95% CI 0.08-2.28). HCP had an excellent level of perception on using RPE during COVID-19. No significant change in perception was found between pretraining and both immediate and 3-months after training (p = 0.536 and p = 0.384 respectively) The pass rate significantly raised to 96.6% for an immediate post-training test (p &lt; 0.001) and to 98.8% after 3-month (p &lt; 0.001). CONCLUSION: Training has played an important role to help HCP improve their knowledge and practice regarding the usage of RPE, but has no significant effect on perception. The assessment of knowledge, perception and practice retention of RPE usage after 3-month showed the positive impacts of video-based training groups on participants’ knowledge and practice. Further evaluations are needed on the interventions that enhance HPC perceptions and attitudes on safety behavior. Pre- and in-service training programs for frontline HPC during a Coronavirus 19 disease pandemic need to be considered by Thai Ministry of Public Health.

Long-Term Outcomes after Pediatric Injury: Results of the Assessment of Functional Outcomes and Health-Related Quality of Life after Pediatric Trauma Study

Disability and impaired health-related quality of life can persist for months among injured children. Previous studies of long-term outcomes have focused mainly on children with specific injury types rather than those with multiple injured body regions. This study's objective was to determine the long-term functional status and health-related quality of life after serious pediatric injury, and to evaluate the associations of these outcomes with features available at hospital discharge. We conducted a prospective observational study at 7 Level I pediatric trauma centers of children treated for at least 1 serious (Abbreviated Injury Scale severity 3 or higher) injury. Patients were sampled to increase the representation of less frequently injured body regions and multiple injured body regions. Six-month functional status was measured using the Functional Status Scale (FSS) and health-related quality of life using the Pediatric Quality of Life Inventory. Among 323 injured children with complete discharge and follow-up assessments, 6-month FSS score was abnormal in 33 patients (10.2%)-16 with persistent impairments and 17 previously normal at discharge. Increasing levels of impaired discharge FSS score were associated with impaired FSS and lower Pediatric Quality of Life Inventory scores at 6-month follow-up. Additional factors on multivariable analysis associated with 6-month FSS impairment included older age, penetrating injury type, severe head injuries, and spine injuries, and included older age for lower 6-month Pediatric Quality of Life Inventory scores. Older age and discharge functional status are associated with long-term impairment of functional status and health-related quality of life. Although most seriously injured children return to normal, ongoing disability and reduced health-related quality of life remained 6 months after injury. Our findings support long-term assessments as standard practice for evaluating the health impacts of serious pediatric injury.

Postoperative Alpha Angle Is Predictive of Return to Sport in Athletes Undergoing Hip Arthroscopy for Femoroacetabular Impingement

To identify clinical and radiographic factors that predict return to sport in athletes undergoing hip arthroscopy and to determine thresholds for significant predictors. Data were reviewed on all patients who underwent primary hip arthroscopy between November 2008 and August 2018. Patients were included if they played professional, college, or high school sports within 1 year before surgery and had preoperative, 3-month, 1-year, and 2-year postoperative patient-reported outcome scores for modified Harris Hip Score, Hip Outcome Score-Sport Specific-Subscale, and Nonarthritic Hip Score. Rates of achieving the minimal clinically important difference also were evaluated. Patients were divided into groups based on whether they returned to sport at the same or greater level. Multivariate logistic regression and receiver operator characteristic analysis were used to evaluate the correlation between significant variables and return to sport. A total of 136 patients with a mean age of 20.8 ± 7.07 years were included. Among athletes who attempted to return, professional and collegiate athletes returned to sport at any level at a rate of 85.0% (51/60), and high-school athletes returned at a rate of 88.1% (52/59). Competition level, postoperative alpha angle, change in alpha angle, and postoperative patient-reported outcomes were significantly different between groups. Athletes who returned to sport achieved the minimal clinically important difference for Hip Outcome Score-Sport Specific-Subscale at significantly higher rates than athletes who did not return to sport (91.6% vs 71.7%, P= .002, S= 8.97). The multivariate logistic regression model identified postoperative alpha angle as a statistically significant predictor of return to sport (P < .001, S > 9.97 [odds ratio 0.85, 95% confidence interval 0.79-0.91]). The receiver operator characteristic curve for postoperative alpha angle demonstrated acceptable discrimination between patients returning to sport and patients not returning to sport with an area under the curve of 0.71 and a threshold value of 46°. Athletes with a postoperative alpha angle ≤46° returned to sport at significantly higher rates than those with a postoperative alpha angle >46° [(P < .001, S > 9.97 [odds ratio 6.3, 95% confidence interval 2.6-15.2]). Postoperative alpha angle was identified as a predictor of return to sport in athletes. The odds of returning to sport were 6.3 times greater in athletes with postoperative alpha angles ≤46° compared with athletes with angles >46°. III, retrospective cohort study.

Cancer worry after facial nonmelanoma skin cancer resection and reconstruction: A 1-year prospective study.

Nonmelanoma skin cancer (NMSC) is one of the most diagnosed cancers in the world, with the number of new occurrences rising every year. Most patients with facial skin cancer experience cancer-related worry. Yet, little is known about their worry during the period after cancer treatment. This study aimed to assess the long-term change of cancer worry after surgical treatment in patients with NMSC. Patients undergoing surgery for facial NMSC between December 2017 and March 2020 were asked to complete the FACE-Q Skin Cancer-Cancer Worry scale before (baseline), 3-month, and 1-year post-surgery. A total of 151 patients completed the baseline and 3-month, and 99 (65.6%) the 1-year post-operative survey. A significant decrease in cancer worry score was seen between baseline and 3-month post-surgery (p<0.001). No difference was found between the 3-month and 1-year post-surgery scores (p=0.78). Less improvement in cancer worry was seen for patients who had one facial skin cancer in their medical history (p=0.001) and patients who had a history of facial surgery (p<0.001). Post-surgery patients still experience cancer worry. Therefore, targeted counseling might be of value when coping with cancer-related concerns. Patients with a history of facial NMSC and patients with a history of facial surgery might benefit from additional counseling.

The Effects of Patient Resilience and Catastrophizing on Carpal Tunnel Surgical Outcomes

PurposeOutcomes following carpal tunnel release (CTR) are generally favorable. When patient satisfaction or symptom resolution is not as expected, understanding what factors contribute to that outcome could allow for strategies targeted at improving results. Our purpose was to determine if measurable mental health factors, specifically resilience and pain catastrophization, correlate with patients’ postoperative outcomes following CTR.MethodsA prospective cohort study was performed. Ninety-four patients were recruited to take part in the study. Patients completed written consent, the Boston Carpal Tunnel Questionnaire (BCTQ), the Pain Catastrophizing Scale, and the Brief Resilience Scale. A single surgeon, or his resident under supervision, performed an open CTR under local anesthetic. Our primary outcome measure was a repeat BCTQ at 6 months. Pearson correlation coefficients and univariate analyses were performed to assess the correlation between Pain Catastrophizing Scale and Brief Resilience Scale scores and final BCTQ scores.ResultsForty-three and 63 participants completed the BCTQ at 3 and 6 months, respectively. This was 10% below the number needed to achieve appropriate power. Among those that responded, all participants showed improvement in their symptoms (P = .001). There was no correlation between patients’ Pain Catastrophizing Scale or Brief Resilience Scale scores and 6-month BCTQ scores or the amount of improvement in the BCTQ at final follow-up.ConclusionsMost participants improved following CTR. Patients’ self-assessed resilience, and the degree of pain catastrophization did no correlate with the amount of improvement patients had after surgery.Type of study/level of evidencePrognostic II.

Outcomes in the treatment of psychogenic nonepileptic seizures (PNES) with CBTip: Response in seizure frequency, depression, anxiety, and quality of life

RationalePsychogenic Nonepileptic Seizures (PNES) are seizure-like episodes without EEG abnormality, and are of psychological origin. Cognitive Behavioral Therapy (CBT), a type of psychological counseling, is known to be the best intervention to treat PNES and the underlying psychiatric symptoms. Yet, many remain untreated because of limited access to specialized counseling programs. In this study, first we intended to see if the positive outcomes of the CBTip can be replicated in our patient population using within-group comparison. We also aimed to examine the outcomes of patients who received a variable dose of treatment than the established treatment protocol. MethodWe obtained retrospective patient reported outcomes (PRO) data from patients treated with Cognitive Behavioral Therapy-informed psychotherapy (CBT-ip) from January 2015 to January 2020 in an outpatient tertiary care epilepsy center. The CBTip program is a 12-session intervention delivered weekly by a seizure counselor. Although the program comprises 12 sessions of treatment, we included patients who attended at least 7 sessions consistent with previous research that used a similar cutoff. We had a total of 160 patient PROs included in the analysis. Outcome variables including seizure frequency, depression, anxiety, and quality of life were examined using self-report outcome scores. Demographic and other clinical and psychosocial confounding variables were controlled. ResultsIn the first analysis in which we compared pre-treatment scores with 3-month posttreatment scores, there was no significant change in seizure frequency, depression, anxiety, and quality-of-life outcomes. In the second analysis when we compared pre- and posttreatment scores in patients who completed the treatment in longer than 3-month time, there were significant improvement in primary and secondary outcomes. For seizure frequency, 10 patients had data for “seizures per day in the last 6 months” and 5 participants (50%) improved by 50% or more in the number of seizures per day. There were also significant reductions in depression and anxiety scores but not in quality of life. Implication and conclusionsOur analysis showed that patients treated with CBTip with a minimum of 7 sessions in 3 months did not have significant improvement. However, attending at least 7 sessions of CBTip in longer than 3 months was effective for seizure control, depression, and anxiety. The observational and exploratory nature of our study, however, limits the generalizability of our findings outside of the single tertiary clinical care setting.

MP64-20 PREOPERATIVE MEMBRANOUS URETHRAL LENGTH IS ASSOCIATED WITH POST-PROSTATECTOMY URINARY FUNCTION IN ASIAN MEN

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VI (MP64)1 Sep 2021MP64-20 PREOPERATIVE MEMBRANOUS URETHRAL LENGTH IS ASSOCIATED WITH POST-PROSTATECTOMY URINARY FUNCTION IN ASIAN MEN Spyridon Basourakos, Ashwin Ramaswamy, Miko Yu, Daniel Margolis, and Jim Hu Spyridon BasourakosSpyridon Basourakos More articles by this author , Ashwin RamaswamyAshwin Ramaswamy More articles by this author , Miko YuMiko Yu More articles by this author , Daniel MargolisDaniel Margolis More articles by this author , and Jim HuJim Hu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002104.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Studies demonstrate that Asian and African-American race (vs. white) and preoperative membranous urethral length (MUL) measured on MRI have been associated with post-radical prostatectomy (RP) urinary incontinence. However, the relationship of race and MUL has not been studied: this is noteworthy given improved patient selection as an approach to minimize the risk of post-RP incontinence. METHODS: We retrospectively identified men who self-identified as “Asian” and underwent robot-assisted RP for localized prostate cancer between 2015 and 2020. After appropriate training of two readers by an expert genitourinary radiologist, MULs were blindly measured by the two readers independently. Urinary function was assessed using the Expanded Prostate Cancer Index for Clinical Practice (EPIC-CP). Baseline clinicopathologic characteristic and imaging measurements were compared with Wilcoxon-Mann-Whitney and χ2 test. We used a generalized estimating equation (GEE) model to evaluate if Asian race is associated with urinary function recovery. RESULTS: There were no racial differences by age (66.8 95%CI 64.7-69.0 vs. 65.6, 95%CI 62.6-68.6; p=0.6), BMI (25.9, 95%CI 24.7-27.2 vs. 26.7, 95%CI 25.7-27.8; p=0.3), PSA (10.3, 95%CI 7.6-12.9 vs. 8.6, 95%CI 6.3-11.0; p=0.4), prostate volume (50.4, 95%CI 37.8-63.0 vs. 41.5, 95%CI 25.9-46.7; p=0.2) or complete nerve sparing status (86% vs. 86%; p=1.0). Asian men had shorter MUL (7.9mm, 95%CI 7.5–8.3 vs. 10.9mm, 95%CI 10.2–11.7; p<0.01) and worse EPIC-CP urinary function scores (3.82; 95%CI 2.47-5.17 vs. 1.95; 95%CI 1.11–2.79; p=0.022) at 12 months post-RP compared to non-Asians. Our GEE model demonstrated that Asian race is associated of a higher (worse) EPIC-CP urinary score when compared to non-Asians (parameter estimate 0.56; 95%CI 0.04-1.08; p=0.034). Furthermore, we found that lower MUL (p=0.03) and Asian race (p=0.036) were associated with increased 12-month EPIC-CP urinary function scores in a multivariate logistic model that included age and BMI. CONCLUSIONS: Asian race was associated with shorter MUL, and both Asian race and shorter MUL are independently associated with worse urinary function. Further confirmatory studies and comparative racial studies of MUL are necessary to better characterize disparities in outcomes. Source of Funding: Jim C. Hu receives research support from the Frederick J. and Theresa Dow Wallace Fund of the New York Community Trust. Jim C. Hu also receives salary support from NIH R01 CA241758 and PCORI CER-2019C1-15682. The remaining authors report no further disclosures related to this work © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1118-e1118 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spyridon Basourakos More articles by this author Ashwin Ramaswamy More articles by this author Miko Yu More articles by this author Daniel Margolis More articles by this author Jim Hu More articles by this author Expand All Advertisement Loading ...

Pre-screening Ability of the Functional-Belief-Based Alcohol Use Questionnaire (FBAQ) among Chiang Mai University Undergraduates: An External Validation Study

BackgroundHigh-risk drinking behavior is common in university students, which often leads to negative consequences. Several standard screening tools to identify high-risk drinkers have been validated in this domain. However, most tools rely on drinking frequency and require standard drink calculations. The Functional-Belief-Based Alcohol use Questionnaire (FBAQ) was recently proposed as a pre-screening tool for high-risk drinkers in the young adult population. We aimed to validate the pre-screening accuracy of the FBAQ when applied to external data of university undergraduates. MethodsData from two prospective cross-sectional surveys of Chiang Mai University undergraduates were used for validation of the FBAQ. A high-risk drinker was defined as a person with the 12-month AUDIT score ≥ 8. Pre-screening performance and accuracy indices were presented separately for dataset I, dataset II, and the combined dataset. The pooled area under the receiver operating characteristic curve (AuROC), sensitivity, and specificity were estimated using individual patient data meta-analysis methods. ResultsFrom the two datasets, 1641 students were included, 811 students in 2019 and 830 students in 2020. Of these, 387 (23.6 %) students were classified as high-risk drinkers. The combined AuROC of the FBAQ score was 0.83 (95 %CI 0.75–0.92) in discriminating high-risk drinkers. The pooled sensitivity and specificity at the FBAQ score cutoff ≥ 6 were 92.8 % (95 %CI 88.0–95.7 %) and 51.6 % (95 %CI 41.1–62.0 %). ConclusionsIn this external validation, the FBAQ shows excellent discriminative ability and is proven to be highly sensitive in detecting high-risk drinkers among Chiang Mai University undergraduates. Therefore, incorporating the FBAQ as a pre-screening tool to the AUDIT could make the initiation of the screening process easier and reduce extensive AUDIT evaluations in students with low risk.

Cyberbullying Prevention for Adolescents: Iterative Qualitative Methods for Mobile Intervention Design.

BackgroundCybervictimization among adolescents is associated with multiple negative mental health consequences. Although pediatricians often screen for cyberbullying, validated and acceptable programs to reduce the frequency and impact of adolescent cybervictimization are lacking.ObjectiveThis study uses agile qualitative methods to refine and evaluate the acceptability of a mixed-modality intervention, initiated within the context of usual pediatric care, for adolescents with a history of cyberharassment and cyberbullying victimization.MethodsThree groups of adolescents were successively recruited from an urban primary care clinic to participate in three consecutive iterations (1, 2, and 3) of the program, which consisted of a brief in-clinic intervention followed by 8 weeks of daily, automated SMS text messaging. After 2 weeks of messaging, iteration 1 (I1) participants completed semistructured interviews regarding intervention experiences. Participant feedback was evaluated via framework matrix analysis to guide changes to the program for iteration 2 (I2). Feedback from 2-week interviews of I2 participants was similarly used to improve the program before initiating iteration 3 (I3). Participants in all 3 iterations completed the interviews after completing the program (8 weeks). Daily response rates assessed participant engagement, and satisfaction questionnaires assessed acceptability.ResultsA total of 19 adolescents (aged 13-17 years) reporting past-year cybervictimization were enrolled: 7 in I1, 4 in I2, and 8 in I3. Demographic variables included the following: a mean age of 15 (SD 1.5) years; 58% (11/19) female, 42% (8/19) male, 63% (12/19) Hispanic, 37% (7/19) non-Hispanic, 79% (15/19) people of color, and 21% (4/19) White. A total of 73% (14/19) self-identified as having a low socioeconomic status, and 37% (7/19) self-identified as lesbian, gay, or bisexual. The average past 12-month cybervictimization score at baseline was 8.2 (SD 6.58; range 2-26). Participant feedback was used to iteratively refine intervention content and design. For example, participants in I1 recommended that the scope of the intervention be expanded to include web-based conflicts and drama, rather than narrowly focusing on cyberbullying prevention. On the basis of this feedback, the I2 content was shifted toward more general de-escalation skills and bystander empowerment. Overall, 88.34% (940/1064) of the daily queries sent to participants across all 3 iterations received a reply. Participant satisfaction improved considerably with each iteration; 0% (0/7) of I1 participants rated the overall quality of Intervention to Prevent Adolescent Cybervictimization with Text message as excellent, compared to 50% (2/4) of I2 participants and 86% (6/7) of I3 participants. Engagement also improved between the first and third iterations, with participants replying to 59.9% (235/392) of messages in I1, compared to 79.9% (358/488) of messages in I3.ConclusionsThis study shows the value of structured participant feedback gathered in an agile intervention refinement methodology for the development of a technology-based intervention targeting adolescents.

Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care

Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (β = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (β = 2.0; 95% CI, -1.7 to 5.7; P = .29). In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. ClinicalTrials.gov Identifier: NCT02738944.

Severity of disease and treatment outcomes of anterior accessory great saphenous veins compared with the great saphenous vein

ObjectiveEndovenous therapies are currently the standard of care for the treatment of patients with symptomatic great saphenous vein (GSV) reflux. The effectiveness and long-term outcomes of these therapies for anterior accessory great saphenous veins (AAGSVs) are poorly defined. The objective of this investigation is to determine treatment outcomes in patients with symptomatic AAGSV reflux compared with patients with symptomatic GSV reflux. MethodsData were prospectively collected in the Center for Vein Restoration's electronic medical record system (NexGen Healthcare Information System, Irvine, Calif) and retrospectively analyzed. Treatment outcomes after a standalone ablation and ablation + phlebectomy were compared in patients with isolated AAGSV and GSV reflux. Treatment outcomes were assessed at 1 month and 6 months postprocedure using the revised Venous Clinical Severity Score (rVCSS) and the 20-item Chronic Venous Insufficiency Quality-of-Life Questionnaire (CIVIQ20) survey for quality of life. Medical and surgical comorbidities, Clinical-Etiological-Anatomical-Pathophysiological classification, body mass index, gender, race, and the average number of procedures performed were all analyzed. ResultsFrom January 2015 to December 2018, 31,186 patients and 49,193 limbs were assessed. Of these, 91 patients/103 limbs had isolated AAGSV reflux, and 7704 patients/10,371 limbs had isolated GSV reflux. There were 95% and 75% women in the isolated AAGSV and GSV groups, respectively (P ≤ .001). For the ablation-only patients, AAGSV (n = 57 patients/61 limbs) and GSV (n = 5349 patients/7191 limbs), there were no differences in preintervention (7.0 ± 2.0 vs 6.8 ± 2.8, P = .99), 1-month (4.0 ± 2.4 vs 3.9 ± 2.8, P = .99), and 6-month (3.9 ± 2.6 vs 3.9 ± 2.9, P = .55) rVCSS scores. Similar results were observed when ablations and phlebectomies were performed (AAGSV [n = 34 patients/42 limbs] and GSV [n = 1848 patients/2491 limbs]). CIVIQ20 scores for patients with isolated AAGSV and GSV were 53.3 ± 19.6 vs 50.6 ± 18.8 (P = .43) preintervention, 37.2 ± 17.6 vs 35.7 ± 15.9 (P = .91) at 1 month, and 41.3 ± 21.7 vs 35.1 ± 15.7 (P = .36) at 6 months, respectively. Postprocedure scores within groups improved at 1 and 6 months (P ≤ .02); however, 6-month AAGSV CIVIQ20 scores after an ablation increased slightly compared with 1-month scores and were not different to preintervention GSV scores (P = .07). When phlebectomies were performed with ablations, 6-month CIVIQ20 scores were similar between groups (P = .72). There was no difference in the average number of ablations in patients with phlebectomies in the AAGSV or GSV group (1.24 ± 0.44 vs 1.35 ± 0.49, P = .15). ConclusionsEndovenous therapies for the treatment of symptomatic AAGSVs demonstrate similar outcomes to patients with symptomatic GSV reflux. For standalone ablations, the rVCSS scores are similar between the groups; however, CIVIQ20 scores increase to preintervention levels in standalone ablation AAGSV patients at 6 months. This increase disappears when phlebectomies are performed with ablations. Based on these data, patients with symptomatic AAGSV treated with ablation also require treatment of the associated tributaries (varicosities) to achieve similar outcomes to patients with GSV, and this calls into question the effectiveness of ablation for isolated AAGSV reflux.

Speech Recognition Outcomes in Adults With Slim Straight and Slim Modiolar Cochlear Implant Electrode Arrays.

To compare differences in audiologic outcomes between slim modiolar electrode (SME) CI532 and slim lateral wall electrode (SLW) CI522 cochlear implant recipients. Retrospective cohort study. Tertiary academic hospital. Comparison of postoperative AzBio sentence scores in quiet (percentage correct) in adult cochlear implant recipients with SME or SLW matched for preoperative AzBio sentence scores in quiet and aided and unaided pure tone average. Patients with SLW (n = 52) and patients with SME (n = 37) had a similar mean (SD) age (62.0 [18.2] vs 62.6 [14.6] years, respectively), mean preoperative aided pure tone average (55.9 [20.4] vs 58.1 [16.4] dB; P = .59), and mean AzBio score (percentage correct, 11.1% [13.3%] vs 8.0% [11.5%]; P = .25). At last follow-up (SLW vs SME, 9.0 [2.9] vs 9.9 [2.6] months), postoperative mean AzBio scores in quiet were not significantly different (percentage correct, 70.8% [21.3%] vs 65.6% [24.5%]; P = .29), and data log usage was similar (12.9 [4.0] vs 11.3 [4.1] hours; P = .07). In patients with preoperative AzBio <10% correct, the 6-month mean AzBio scores were significantly better with SLW than SME (percentage correct, 70.6% [22.9%] vs 53.9% [30.3%]; P = .02). The intraoperative tip rollover rate was 8% for SME and 0% for SLW. Cochlear implantation with SLW and SME provides comparable improvement in audiologic functioning. SME does not exhibit superior speech recognition outcomes when compared with SLW.

Intra-arterial injection of lidocaine into middle meningeal artery to treat intractable headaches and severe migraine.

We report the results of intra-arterial injection of lidocaine in the middle meningeal artery in patients with intractable headache or status migrainosus. We treated four patients with intra-arterial lidocaine (2 mg/ml) in doses up to 50 mg in each middle meningeal artery via a microcatheter bilaterally (except in one patient). In two patients with intractable headache, the daily maximum intensity of headache (graded by 11-point numeric rating scale) was recorded for 7 days postprocedure. In two patientswith status migrainosus,migraine-related disability 3 months prior and after treatment usingMIDAS (Migraine Disability Assessment) questionnaire was recorded. Intra-arterial lidocaine reduced the headache intensity from 8/10 and 10/10 to 0/10 in the two patients with intractable headaches for 2 days (day 0 and day 1) postprocedure. Despite recurrence of headache on day 2, the intensity was less than preprocedure intensity up to the last day recorded (by 3 and 2 points on day 7). Inthe two patients withstatus migrainosus,there was immediate reduction in headache intensity following intra-arterial lidocaine. Thepost treatment 3-month MIDAS score was lower in both patients compared with pretreatment 3-month score; 3 versus 30 and 55 versus 90. Severe disability preprocedure by MIDAS was reduced to little or no disability postprocedure in one patient. Intra-arterial lidocaine resulted in amelioration of headache inpatients with intractable headache and those with status migrainosus with improvement lasting longer than the short half-life of lidocaine possibly related to central desensitization.

185. A clinical model to predict postoperative improvement in subdomains of the modified Japanese Orthopedic Association Score for degenerative cervical myelopathy

<h3>BACKGROUND CONTEXT</h3> Longstanding and progressive compression of the cervical spinal cord can lead to irreversible loss of neurologic function due to demyelination and apoptosis of oligodendrocytes. A commonly used metric to quantify the severity of cervical myelopathy is the modified Japanese Orthopedic Association (mJOA) score. The mJOA score comprises six items to assess the impact of spinal cord compression on: (1) ability to feed oneself, (2) ability to walk, (3) loss of feeling or numbness in arms, (4) loss of feeling or numbness in legs, (5) loss of feeling or numbness in body and (6) ability to urinate. <h3>PURPOSE</h3> In the present study, the primary objective was to construct a clinical prediction model for improvement of mJOA subdomains at 12 months following surgery utilizing data from a longitudinal, multicenter clinical spine registry. <h3>STUDY DESIGN/SETTING</h3> This study was conducted using data from the cervical module of the Quality Outcomes Database (QOD), a longitudinal, multicenter, prospective spine outcomes registry. <h3>PATIENT SAMPLE</h3> A total of 5,000 patients who underwent elective surgery for cervical myelopathy were enrolled into the registry and had complete 12-month follow-up. <h3>OUTCOME MEASURES</h3> mJOA subdomain scores. <h3>METHODS</h3> This study was conducted using data from the cervical module of the Quality Outcomes Database (QOD). The outcomes of interest were the subdomains or items of the mJOA at 12 months following surgery. A multivariate multivariable proportional odds ordinal regression model was developed for patients with cervical myelopathy using a latent variable approach. The latent variables were assumed to follow a multivariate logistic distribution which was constructed by univariate logistic margins and a t copula. Patient demographic, clinical, and surgery covariates as well as baseline subdomain scores were included as the independent variables. The model was internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients. <h3>RESULTS</h3> A total of 5,000 patients who underwent elective surgery for cervical myelopathy were enrolled into the registry and had complete 12-month follow-up. The mean age for the patients was 60.9 (±11.4) years and comprised of 47% (n=2,339) females. Patients had statistically significant improvement from baseline to 12-months postsurgery on all the mJOA subdomains(p<0.001). The multivariable analysis identified that the baseline subdomains of the mJOA were the strongest predictors of 12-month scores, with numbness in legs and ability to walk predicting 5 of the 6 mJOA items. Additional covariates that significantly predicted 3 or more of the subdomain mJOA scores at 12 months included age, preoperative anxiety or depression, gender, race, employment status, duration of symptoms, smoking status, and presence of listhesis on radiology. Surgical approach, the presence of motor deficits, number of surgical levels involved, history of diabetes mellitus, worker's compensation claim and a patient's insurance had no impact on the 12-month scores of the mJOA. The discriminative ability of the model regarding joint probabilities measured by unweighted generalized C-index was 0.753. <h3>CONCLUSIONS</h3> In conclusion, our study has developed and validated a clinical prediction model for improvement in mJOA scores at 12-months following surgery. Results highlight the importance of assessing preoperative numbness symptoms and walking ability as well as the modifiable variables of anxiety/depression and smoking status prior to surgery. Additional patient demographic variables to consider are age, gender, race, employment status, duration of symptoms, and presence of listhesis when counseling patients prior to surgery. This prediction model has the potential to assist surgeons, patients and families when considering surgery for cervical myelopathy and provides clinically useful information in the preoperative setting. Future steps include prospective, external validation of the predictive model in order to assess the reproducibility and clinical utility of this work. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

21. Adoption of enhanced recovery after surgery (ERAS) protocol for lumbar fusion decreases in hospital postoperative opioid consumption

<h3>BACKGROUND CONTEXT</h3> Enhanced recovery after surgery (ERAS) is an evidence-based multidisciplinary perioperative protocol intended to reduce surgical morbidity and improve recovery. <h3>PURPOSE</h3> We sought to evaluate the impact of ERAS on in-hospital and 90-day postoperative opioid consumption, length of stay, urinary catheter removal and postoperative ambulation after lumbar fusion for degenerative conditions. <h3>STUDY DESIGN/SETTING</h3> Single center retrospective observational cohort study. <h3>PATIENT SAMPLE</h3> A total of 290 patients undergoing lumbar fusion surgery during the transition period prior to (N=174) and after (N=116) adoption of ERAS. <h3>OUTCOME MEASURES</h3> In-hospital and 90-day postop opioid consumption in morphine milligram equivalents (MME), pre- and postoperative pain scores, length of stay, urinary catheter removal and ambulation after surgery. <h3>METHODS</h3> We evaluated patients undergoing lumbar fusion surgery in the transition period prior to (N=174) and after (N=116) adoption of ERAS, comparing in-hospital and 90-day postop opioid consumption. Regression analysis was used to control for confounders. Secondary analysis was preformed to evaluate the association between ERAS and length of stay, urinary catheter removal and ambulation after surgery. <h3>RESULTS</h3> Mean age of the cohort was 52.6 years with 62 (47%) females. Demographic characteristics were similar between the pre-ERAS and ERAS groups. ERAS patients had better 3-month pain scores, ambulated earlier, had urinary catheters removed earlier and decreased in-hospital opioid consumption compared to Pre-ERAS patients. There was no difference in 90-day opioid consumption between the two groups. Regression analysis showed that ERAS was strongly associated with in-hospital opioid consumption, accounting for 30% of the variability in MME. In-hospital opioid consumption was also associated with preoperative pain scores, number of surgical levels, and insurance type (private vs government). Preoperative pain sores, but not ERAS were associated with 90-day opioid consumption. Secondary analysis showed that ERAS was associated with a shorter length of stay and earlier ambulation. <h3>CONCLUSIONS</h3> This study showed ERAS has the potential to improved recovery after lumbar fusion for degenerative conditions with reduced in-hospital opioid consumption and improved postoperative pain scores. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.