6-month Program Research Articles

Automated Text Message-Based Program to Improve Uncontrolled Blood Pressure in Primary Care Patients: A Randomized Clinical Trial.

Suboptimal control of BP is common, although safe and effective treatments are widely available. Conventional management relies on office visits, but this can be an inefficient path to medication optimization. To assess the effectiveness of an intensive, 6-month remote BP management program among patients with uncontrolled hypertension. A two-arm randomized clinical trial which ran from January to July 2023 at two primary care practices with an in-clinic BP measurement at the end of the intervention. Established adult patients (ages 21-80) of study practices with uncontrolled hypertension (two measurements > 140/90 in the prior 12months) and an active prescription for at least one anti-hypertensive agent. Participants received automated text messages prompting them to check their BP weekly for 6months. An RN and APP monitored BP data entered by the participant. The automated platform escalated any out-of-normal range readings or needs to the program staff. The primary outcome was change in SBP from baseline to the end-of-study measurement. Enrollment and engagement measures were collected for the intervention arm. Of the 300 participants, the mean (SD) age was 63 (± 12.2) years; 133 (44.3%) were male and 167 (55.7%) were female; 154 (51.5%) self-identified as Black and 120 (40.1%) White; and 119 (39.7%) were insured by Medicare and 41 (13.7%) by Medicaid. The change in SBP at 6months among those who completed the end-of-study measurement was - 14.66mmHg (95% CI - 19.95, - 9.36) in the intervention arm and - 10.87mmHg (95% CI - 18.04, - 3.69) in the control arm (p = 0.39). Within the intervention arm, 97 participants (64.7%) completed all enrollment steps, and these participants submitted BPs 72.8% of the weeks. Participants in the intervention arm had a greater number of medication changes (0.81 vs 0.57 in the control arm, p = 0.01) over the study period. In this randomized clinical trial of a 6-month automated text messaging program, there was no significant difference in the change in SBP among participants in each arm. ClinicalTrials.gov Identifier: NCT05571410.

Effects of staphylococcal enterotoxin and fungal sensitization on clinical outcomes of asthma

BackgroundStaphylococcal enterotoxin and fungal sensitization can influence asthma severity; however, the effects on the clinical outcomes of asthma remain unclear. This study investigated the clinical outcomes of asthma in patients with or without staphylococcal enterotoxin sensitization and further analyzed the effects of fungal sensitization on the clinical outcomes of patients with staphylococcal enterotoxin sensitization.MethodsThis retrospective study included patients with asthma who had undergone a staphylococcal enterotoxin-specific immunoglobulin E test at our hospital between January and August 2021. Data on clinical manifestations, medication use, pulmonary function, clinic and emergency room visits and hospitalization were collected from 106 patients.ResultsThe prevalence of staphylococcal enterotoxin sensitization was 27.3%. Among the patients with staphylococcal enterotoxin sensitization, 50% also presented with fungal sensitization. The risk of hospitalization and emergency room visits was higher among patients with staphylococcal enterotoxin sensitization than among those without, as was the need for high-level asthma treatment, including triple inhaler therapy and biologics. After the 12-month Program enrollment, the rates of emergency room visits and hospitalization were similar in the two cohorts. Patients with concomitant staphylococcal enterotoxin and fungal sensitization exhibited a notable post-treatment decline in pulmonary function.ConclusionAdherence to asthma treatment protocols was shown to improve clinical outcomes in patients with or without staphylococcal enterotoxin sensitization. Among patients with staphylococcal enterotoxin sensitization, those with concomitant fungal sensitization were more likely to exhibit a rapid decline in pulmonary function during a 1-year high-level treatment program.

A 17-Year Experience of a Large Dedicated Fellowship in Blood and Marrow Transplantation and Cellular Therapy: A Blueprint for Modern Day Training Program.

The field of allogeneic blood and marrow transplantation-cellular therapy (BMT-CT) has evolved through incremental advances. Engineered donor grafts, gene editing and chimeric antigen receptor T-cells are all standard clinical practice. Consequently, the scientific knowledge and complexity of clinical skills needed for next generation of BMT-CT physicians have increased. We report a 17-year experience of arguably the largest 12-month BMT-CT clinical fellowship program in the USA. Seventy-three (73) trainees were accepted and 2 cohorts that reflected different time periods (2007-1016 and 2017-2024, inclusive) and different core training curriculum were compared. The cohorts were equivalent in terms of demographics; notably, most (70%) had graduated from international medical schools and trained in the US on a non-immigrant J1 visa. In 2015, we introduced a structured mentoring program to address the desire of trainees for experience with scholarly activities. There was a high rate of successful academic careers with a trend toward a higher likelihood of academic retention following structured mentoring (70% vs 89%). In this report, we included our detailed core curriculum and highlight potential future changes as a blueprint for modern day programs to ensure that graduate "transplant docs" can continue to contribute at the highest academic level.

Nurse-Led Mobile Phone Intervention to Promote Self-Management in Type 2 Diabetes in Ghana: A Randomized Controlled Trial.

The purpose of the study was to test the effectiveness of a nurse-led mobile phone intervention (NMPI) on glycemic variability and self-management among people living with type 2 diabetes (T2DM) in Ghana. In this randomized controlled trial, the intervention group received a 3-month NMPI program plus standard care, and the control group received standard care alone in a tertiary health care setting. Ninety-eight participants (baseline A1C > 7%) were randomized 1:1 to either NMPI or standard care group. The primary study outcomes were changes in A1C testing and self-management assessed using the Summary of Diabetes Self-Care Activities tool at baseline and end of the study. The intervention group had statistically significant improvement in their mean A1C level from baseline to the end of the study. In comparison, the control group also had improvement in their mean A1C level but was not statistically significant. Consistently, the intervention participants had better statistically significant improvements in self-management behaviors than the control group. There was a medium, negative correlation between A1C changes and overall self-care changes for the intervention group, whereas that of the control group was smaller. Study findings have shown that a tailored NMPI program in addition to standard care could improve glycemic variability and self-management among people living with poorly managed T2DM in Ghana better than standard care alone.

Individual and socio-psychological characteristics as predictors of physical activity among men living with overweight and obesity taking part in the Aussie Fans in Training weight management behaviour change programme

Background: Sufficient physical activity (PA) is important to reduce the risk of men developing chronic diseases and to improve mental health. The effectiveness of PA programmes can vary, however, among men. Individual and socio-psychological characteristics may affect the level of men’s PA before starting a behaviour change programme as well as changes in PA during the programme. Aims: The primary objective of this study was to examine the role of individual and socio-psychological characteristics in predicting men’s (a) accelerometer-assessed PA (step count and moderate to vigorous PA [MVPA]) upon presentation to a behaviour change programme and (b) changes in PA (step count and MVPA) during a behaviour change programme. Methods: A total of 109 men (mean age = 45.5 years, SD = 7.8 years, mean body mass index = 34.5 kg/m2, SD = 5.1 kg/m2) who participated in the Australian Fans in Training 3-month PA and dietary behaviour change programme in 2018 participated in this study. Before and after completing the 12-week programme, men completed assessments including individual (age, weight) and socio-psychological (psychological needs support, psychological needs satisfaction, positive affect and negative affect) characteristics. We used regression analysis to examine the relationship between these variables and PA. Results: At baseline, men’s weight (β = –.36, p < .001) and positive affect (β = .29, p < .01) were significant predictors of step count. At baseline, men’s weight (β = –.21, p < .05) and negative affect (β = .23, p < .05) were significant predictors of MVPA, though the overall model did not display statistical significance. The overall regression models did not significantly predict changes in either step count or MVPA pre- to post-programme. Conclusion: The influence of weight and positive and negative affect in predicting PA outcomes suggests that tailoring men’s health behaviour change interventions to individual circumstances and needs could enhance their effectiveness for some men.

Assessing the Impact of Community-Based Oral Health Education Programs on Dental Hygiene Practices and Oral Health Outcomes in Rural Populations

ABSTRACT Background: Community-based oral health education programs are essential in improving dental hygiene practices and oral health outcomes, particularly in rural populations where access to dental care is limited. This study assesses the impact of such programs on dental hygiene practices and oral health outcomes in rural communities. Materials and Methods: A quasi-experimental design was employed to evaluate the effectiveness of a 6-month oral health education program conducted in five rural villages. A total of 300 participants, aged 18-60 years, were selected through stratified random sampling. The intervention included bi-weekly educational sessions on oral hygiene practices, proper brushing techniques, and the importance of regular dental check-ups. Data on dental hygiene practices were collected through structured questionnaires at baseline and post-intervention. Oral health outcomes were assessed using the Decayed, Missing, and Filled Teeth (DMFT) index and gingival health was evaluated through gingival index scores. Results: Post-intervention analysis showed a significant improvement in dental hygiene practices among participants, with 75% reporting regular brushing compared to 45% at baseline. The mean DMFT score decreased from 5.2 to 3.8 (P < 0.05), and the average gingival index score improved from 2.1 to 1.4 (P < 0.05). Additionally, the frequency of dental check-ups increased by 40%, indicating a positive behavioral shift in the community. Conclusion: Community-based oral health education programs significantly improve dental hygiene practices and oral health outcomes in rural populations.

A 12-week WeChat education, relaxing, and care program relieves anxiety, depression, insomnia, and posttraumatic stress disorder in parents of childhood lymphoma patients

ABSTRACT Objectives In our previous study, we conducted a 6-month WeChat education and care program for parents of pediatric acute lymphoblastic leukemia patients, which was effectively alleviated anxiety, depression, and insomnia. This study implemented a 12-week WeChat education, relaxing, and care program (WERC) to investigate its effect on psychological disorders and insomnia in parents of childhood lymphoma patients. Methods Totally, 112 parents of 56 childhood lymphoma patients were randomized at a 1:1 ratio into WERC (N = 56) or normal care (NC) (N = 56) groups to receive corresponding 12-week interventions. The self-rating anxiety/depression scale (SAS/SDS), Athens insomnia scale (AIS), and impact of events scale-revised (IES-R) scores were assessed at enrollment (W0) and 12 weeks after the initiation of the intervention (W12); score changes (W0–W12) were also calculated. Results Scores of the scales at W0 did not differ between groups (all P > 0.05). The WERC group showed a lower SAS score at W12 (P = 0.045) and greater change in SAS score (P < 0.001) than the NC group. The SDS score at W12 was not different (P = 0.119), while SDS score change was numerically greater (P = 0.076) in the WERC group than the NC group. Compared with the NC group, the WERC group tended toward a decreased AIS score at W12 (P = 0.054) and a greater AIS score change (P < 0.001). The IES-R score at W12 was lower (P = 0.040), and the IES-R score change was greater (P = 0.013) in the WERC group than the NC group. Conclusion A 12-week WERC ameliorates psychological disorders and insomnia better than NC in parents of childhood lymphoma patients.

Effects on corneal endothelium of intravitreal injection of anti-VEGF drugs

Purpose Intravitreal drug administration has become the gold standard for the treatment of many retinal diseases, including age-related macular degeneration (AMD), diabetic retinopathy (DR) and retinal vein occlusion (RVO). The frequency of this procedure has increased significantly after the introduction of anti-VEGF drugs, since the rise in the average age of the population, which is closely correlated with these diseases. In order to ensure therapeutic success in these patients with chronic retinal diseases, intravitreal treatment with anti-VEGF requires a long-term maintenance regimen with repeated administrations. For this reason today, we must consider the risks linked to complications associated with the long-term application of this therapy. Our study aims to investigate whether the intravitreal injection of anti-VEGF may lead to damage to the corneal endothelium, either directly through the administration procedure or indirectly due to the drug’s toxicity. We aimed to establish a clear correlation between intravitreal drug administration and a statistically significant reduction in corneal endothelial cell count in the treated eye when compared to the untreated eye. The study also sought to assess whether different toxicities might be present between different types of drugs belonging to the same anti-VEGF family. Materials and Methods The study was conducted by examining a cohort of 133 patients suffering from different diseases: AMD, EMD and RVO. All patients underwent measurement of the endothelial count with CellChek® 20, considering the value measured at the first injection as time zero and reassessed at each subsequent treatment session. The measurement of the endothelial count was performed both on the eye under treatment (TE) and in the eye not undergoing intravitreal injection (NTE) with anti-VEGF drugs for each injection cycle. Different anti-VEGF drugs such as Bevacizumab, Ranibizumab, Aflibercept, Brolucizumab were used for intravitreal therapy. The test patients were included in a 12-month follow-up programme, in which the measurement intervals are dictated by the treatment plan. Results The statistical analysis performed on the corneal endothelial cell counts showed that the ECD (endothelial cell density) parameter decreases with each administration of the drug. The analysis of the difference in the mean endothelial cell counts of the TE reveals that the difference in the number of endothelial cells between the first and second counts in TE is 54.00; greater than the difference in the number of cells found in NTE, which was 13.42. Both the difference between the TE and NTE cell counts are statistically significant. In the case of the TE, the p-value is <0.001, while in the case of the NTE the p-value is still significant as <0.05. The hypothesis that the different types of anti-VEGF drugs could determine the decrease in endothelial cell count differently was also evaluated. No statistically significant data emerged from the analyses (p-value is >0.05). Conclusions The study demonstrated a statistically significant reduction of corneal endothelial cells in patients undergoing intravitreal injection treatment per number of injections with anti-VEGF, this reduction being independent of the type of anti-VEGF used (Bevacizumab, Ranibizumab, Aflibercept and Brolucizumab).

Effectiveness of proactive health interventions in reducing symptoms and enhancing self-efficacy and self-management in prostate cancer survivors: a randomized controlled trial.

To evaluate the effectiveness of a proactive health intervention in reducing symptoms, enhancing self-efficacy, and improving self-management capabilities in prostate cancer survivors. A single-blind randomized controlled trial was conducted with 200 prostate cancer survivors at a tertiary hospital in Zhejiang Province. Participants were randomly assigned to either the intervention group (n = 95), which received a 3-month proactive health management program based on five health modules with online and telephone follow-up, or the control group (n = 97), which received routine telephone follow-up care. Outcomes were assessed at baseline, 1month, and 3months post-discharge, focusing on prostate cancer symptoms, self-care ability, self-efficacy, and psychological well-being. Compared to the control group, the intervention group showed significant improvements in prostate cancer symptoms (95% CI = [- 5.898, - 1.756], p < 0.001), self-care ability (95% CI = [14.427, 20.878], p < 0.001), and self-efficacy (95% CI = [0.078, 0.408], p = 0.004) after the intervention. Anxiety and depression (95% CI = [- 2.408, - 1.404], p < 0.001) were significantly reduced at the 3-month follow-up compared to baseline, although no significant difference was observed between the groups. The 3-month proactive health management intervention significantly reduced symptoms, anxiety, and depression in prostate cancer survivors, while improving self-care ability and self-efficacy. Further studies with larger samples and longer follow-up periods are needed to confirm these findings. Rehabilitation for prostate cancer survivors should integrate both physical and psychological recovery to address comprehensive health needs. Enhancing survivors' proactive health management skills supports sustained recovery. ClinicalTrial.gov Identifier: ChiCTR2300076594.

Lifelong learning in rural communities in China and its impact on adult subjective well-being

At present, lifelong learning is becoming an increasingly important topic in the context of rapid sociocultural and economic changes. In Chinese rural communities with potential limitations in access to education and developed resources, this approach may be of particular importance for improving the quality of life and community development. This research examined the impact of a lifelong learning program in Chinese rural communities on subjective well-being. The authors randomized participants into experimental and control groups (N = 214), used the WHO-5 Well-Being Index to measure well-being, and performed a statistical analysis using a t-test. They compiled and implemented a 6-month program: Rural Communities on the Move: A Program for Continuous Development. Data analysis demonstrated a significant well-being increase in the experimental group after the program completion (P = 0.00) and insignificant changes in the control group. These findings point to the program's effectiveness in improving the subjective well-being of rural residents and can be an important contribution to the development of social programs and educational initiatives aimed at improving the quality of life and maintaining well-being in rural communities not only in China but also in other countries.

Abstract 4125957: Feasibility and Acceptability of Behavioral Weight Loss Programs for Men in Trade and Labor Occupations

Objective: Men who work in trade and labor occupations experience high rates of obesity and related cardiovascular disease due to high rates of sedentary leisure time and poor diet. Despite this, they are underrepresented in weight control programs. This pilot randomized trial evaluated the feasibility and acceptability of a 6-month program tailored to this occupational group versus a non-tailored standard-of-care behavioral weight loss program. Methods: Men with overweight or obesity working in trade and labor occupations were randomly assigned to either a tailored program or the DPP Group Lifestyle Balance program delivered via 16 one-hour virtual group sessions. In-person assessments were conducted at baseline, 3, and 6 months. Semi-structured interviews and self-report were used to assess the acceptability of the interventions. Feasibility was assessed using recruitment metrics and proportion group sessions and study assessments completed. Results: Participants (N = 28; median 44.0 years, interquartile range (IQR): 38.5-54.5), median 31.8 BMI, IQR 31.1-39.6) were recruited into the study over 7 months, and 71% and 79% were retained for assessments at 3 and 6 months, respectively. Overall, participants attended a median of 7 of the 16 group sessions (IQR 2.5-11.5). The tailored group completed a median of 11 of 16 weekly online progress reports (IQR 5-15). All participants reported that they would recommend the programs to other men and felt confident that they would continue using the strategies learned in the programs. Though the trial focused on feasibility rather than efficacy, median weight losses at 6 months were -3.0% in the tailored group (95% CI -9.3, -0.6) and -1.9% in the standard group (95% CI -7.4, 2.0). Conclusions: Results suggest that both the tailored and standard weight loss interventions were well received by this group, but engagement was low. Future research should focus on understanding how to increase engagement rather than exclusively tailoring the program to this occupational group to enhance this group's involvement with cardiovascular disease prevention programs.

Addressing Hypertension and Diabetes through Community-Engaged Systems (ANDES) in Puno, Peru: rationale and study protocol for a hybrid type 2 effectiveness and implementation randomized controlled trial

BackgroundHypertension is the most common cardiovascular disease in Peru despite the availability of cost-effective, evidence-based treatment. Here we describe the rationale and study design for a hybrid type 2 randomized controlled trial to test the implementation and effectiveness of a community health worker (CHW)-led hypertension control program within the national primary care system in Puno, Peru.MethodsWe will recruit 1068 adult participants with hypertension aged ≥ 18 years in Puno, Peru, via facility-based enrollment and community health fairs. Participants will be individually randomized (1:1) to either continue with usual care or participate in a 12-month CHW-led home-based hypertension control program consisting of blood pressure monitoring, medication adherence support, and healthy lifestyle counseling. Outcome development and reporting are guided by the Consolidated Framework for Implementation Research (CFIR), the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, and the Proctor et al. framework. Clinical effectiveness outcomes include mean change in systolic blood pressure (primary outcome), diastolic blood pressure, and HbA1C. Implementation outcomes include fidelity (i.e., CHW protocol adherence and dose), reach, adoption, sustainability, acceptability, and cost-effectiveness.DiscussionThe ANDES trial is testing the first CHW-led multicomponent strategy for hypertension and type 2 diabetes management in Peru. This type 2 hybrid trial will provide critical insights into the individual, community, and system-level factors necessary for successful implementation and effectiveness. These data can inform the future adaptation and scaling of the ANDES strategy in Peru and other LMICs, as well as influence policies at the system level to support this transition. Furthermore, by addressing both hypertension and diabetes, the ANDES strategy supports integrated care approaches advocated by the WHO HEARTS technical package, ultimately enhancing health outcomes and reducing morbidity and mortality in the region.Trial registrationClinicalTrials.gov, ID: NCT05524987, Addressing Hypertension and Diabetes through Community-Engaged Systems in Puno, Peru (ANDES study), prospectively registered on September 1, 2021.

Assessment of Cardiac Autonomic Function by Short-Term Sensor-Based and Long-Term Heart Rate Variability Analyses in Individuals with Spinal Cord Injury After Long-Term Table Tennis Training.

This study aimed to examine the acute and chronic effects of an exercising table tennis program on cardiac Autonomic Nervous System (ANS) and functional capacity in people with tetraplegia. Twenty males with tetraplegia (C6-C7), with a mean age of 38.50 ± 4.04 years old, were randomly assigned into two equal groups: A, who followed a 6-month exercise training program with table tennis 3 times per week, and B, who remained untrained. Additionally, 11 healthy sedentary men (group C) with a mean age of 39.71 ± 5.87 years old participated in the study as healthy controls. At baseline, all participants underwent a short-term (5 min) and a long-term (24 h ambulatory) ECG monitoring to evaluate the heart rate variability (HRV) indices and a maximal arm ergometric and dynamometric testing of the upper limbs. Moreover, the acute cardiac autonomic responses to maximal arm cycle exercise test were evaluated by Polar S810i sensor chest strap. At the end of the 6-month study, all parameters were revaluated only in groups A and B. At baseline, there was no statistically significant difference between the two patient groups. However, intra-group changes at the end of the 6-month study regarding the 24-h HRV monitoring indicated that group A statistically increased the standard deviation of R-R intervals (SDNN) by 13.9% (p = 0.007), the standard deviation of R-R intervals calculated every 5 min (SDANN) by 8.4% (p = 0.007), the very low frequency (VLF) by 7.1% (p = 0.042), and the low frequency [LF (ms2)] by 10.5% (p = 0.009), which almost reached the levels of group C. Favorable improvements were also noticed at the end of the study for group A in maximal exercise time of the upper limbs by 80.4% (p < 0.001) and maximal strength of the right hand by 27.8% (p < 0.001). Linear regression analysis after training showed that maximal exercise time was positively correlated with SDNN (r = 0.663, p = 0.036) and with LF (ms2) (r = 0.623, p = 0.045). Our results indicate that a 6-month table tennis training program is efficient and can improve cardiac ANS activity mainly by increasing sympathovagal balance.

Trainee pharmacists’ evaluation of the formal learning elements within the N. Ireland foundation training year

Abstract Introduction Foundation Training Year (FTY) is a 12-month programme which prepares trainee pharmacists (TPs) to develop the skillset of a registered pharmacist and aids preparation for the Common Registration Assessment (CRA) via both work-based learning and formal learning. The formal learning included within the NI FTY programme consists of development day sessions with associated pre-requisite materials, including exam-style questions. The TPs attend 13 development days which are focused on high and medium weighted topics within the Registration Assessment Framework1 . The sessions take place online and the format is that of case-based discussion and exam-style questions, as well as two mock exams. Aim The aim of this study was to analyse TPs’ evaluation of how the formal learning elements prepared them for the CRA. Methods TPs (n=128) within FTY 2022/2023 completed an end-of-year evaluation relating to the whole programme, including the formal learning elements. 128 valid responses were received. The evaluation took the form of an online questionnaire with various question types, from Likert scale style(1-9) to free-text responses and was administered via an online link emailed to TPs. No ethical approval was required as the evaluation was not a component of a research project. Results In relation to the formal learning elements of the programme, 61% of trainee pharmacists rated the pre-requisite materials for the development day sessions at 6 and above whilst 57% of respondents rated the development day sessions at this level. An increased number of respondents (86%) rated the practice exam-style questions accessed via Moodle at 6 and above with the vast majority (99%) strongly agreeing/agreeing that regular exposure to exam style questions helped them to learn on an ongoing basis, particularly for high and medium weighted registration assessment topics. TPs valued the opportunity to attempt mock exams, with 99% strongly agreeing/agreeing that the mocks prepared them to sit the CRA and helped them to identify developmental needs. Discussion / conclusion The majority of TPs valued the formal learning elements of the FTY and felt the sessions and mock exams prepared them to sit the CRA. TP experience of exposure to exam questions was overwhelmingly positive with TPs acknowledging the importance of regular exposure to this element which allows them to develop their knowledge and become proficient in answering the types of questions asked in the CRA. This provides support for the inclusion of practice exam-style questions on a routine basis in the formal learning programme to support the FTY. Limitations to the study are that TPs completed the survey prior to obtaining results for the CRA, which may have influenced their responses to the questions posed, however the N. Ireland results were higher than the national average, with 95.6% first time sitters passing the exam in June 2023. Given this data, we changed formal learning to focus primarily on high and medium-weighted topics of the Registration Assessment Framework1, delivering interactive webinars where TPs answer exam-style questions with additional supplemental learning provided, where needed, by the expert tutor. Reference 1. General Pharmaceutical Council. Registration assessment framework for sittings in 2024. 2024. https://assets.pharmacyregulation.org/files/2024-04/registration-assessment-framework-for-sittings-in-2024.pdf [accessed 3rd June 2024]

Evaluation of the ENIGMA mentoring pilot; an approach to tackle leadership inequalities for ethnically diverse female pharmacists in general practice

Abstract Introduction Diversity in leadership positively impacts teams and productivity yet remains limited in pharmacy leadership. The NHS Pharmacy Workforce Race Equality Standard (PWRES) report1 highlights significant underrepresentation of ethnically diverse pharmacists in senior NHS Trust roles (Agenda for Change band 8a and above) compared to their representation in the general pharmacist workforce. This disparity is particularly pronounced for female pharmacists from ethnically diverse backgrounds, who make up 31.9% of all pharmacists but only 24.2% of those in band 8a and above, with a steep decline from 27.6% at band 8a to just 5.9% at band 91,2. To begin addressing this, we piloted the ENhancing leadershIp amonGst ethnically diverse feMale phArmacists (ENIGMA) mentoring scheme in general practice within Leeds. Aim The aim was to determine whether ENIGMA mentoring relationships supported leadership skill development, fostered networking, and developed authentic allies. We assessed the success of the pilot by exploring the perspectives of mentors and mentees and identifying their satisfaction with the scheme. Methods We recruited 18 experienced female senior leaders as mentors for ENIGMA. Mentee recruitment was conducted through dissemination of a flyer via social media, Microsoft Teams, email, and citywide meetings, offering places to the first 18 pharmacists who expressed interest, with no selection process. Mentors and mentees were paired based on mentee goals and mentor expertise. Mentees met their mentor 3 times in a 6-month period. Evaluation was undertaken through Microsoft Forms questionnaires completed anonymously by both mentors and mentees exploring how they experienced ENIGMA, benefits of the scheme, if they felt the scheme had enabled leadership skill development and how it had (or anticipated it would) impact(ed) on career development for the mentee. Ethical approval was deemed unnecessary as this was a service evaluation. Neither author-affiliated organisation is associated with the project. Results Of 18 mentoring pairs, 13 successfully completed the 6-month program. For five pairs, mentees did not establish contact. 62% of mentors responded to the questionnaire. 88% felt a positive impact on their mentoring skills and described a noticeable increase in mentee confidence and career focus. 100% of mentors would recommend the scheme. For mentees, 62% responded. 88% were ‘most satisfied’ with the experience and 88% felt their leadership skills improved because of participating. 75% met specific goals and 88% commented particularly on positive impact of the scheme. 100% of mentees would recommend ENIGMA to others. Discussion/conclusion The pilot was a great success, impacting positively on mentors and mentees. All responding participants would recommend it to others. Mentors and mentees expressed some challenges: finding a mutual time for meetings, and support from employers to use work time for meetings. Questionnaires were not returned by 38% of participants, which is a potential limitation. An identified improvement is to offer mentors an alternative mentee if their original mentee does not make contact. Offer of an annual ENIGMA cohort will continue in Leeds. Additionally, a second pilot is planned in another Integrated Care Board (ICB) to establish how ENIGMA could work in a different area, and if successful, we intend to share this model nationally.

Development and Pilot Testing of Children's National Hospital's New Faculty Orientation Program.

New faculty orientation (NFO) programs are shown to increase faculty satisfaction, enhance collaboration, and support promotion, retention, and academic success. In an effort led by a clinical psychologist, the Children's National Hospital (CNH) NFO was developed, piloted, and is in its 3rdyear. Data are shared regarding program development process, feasibility, and acceptability. In 2020, CNH faculty were surveyed about their new faculty member experience. CNH leaders were interviewed about important topics to include in an NFO. In FY22, the NFO was piloted across 15 Divisions. Year 2 (FY23) invited all new early career faculty. Year 3 (FY24) invited all new faculty. Feedback was obtained via REDCap after meetings and before/after the 10-month program. In 2020, 62% of recently hired faculty surveyed indicated not having any institutional level orientation. Leadership interviews supported the need for an NFO; suggested topics included promotion and provider wellness. In FY22, 27/38 invited faculty chose to participate. For FY23, 36/48 chose to participate. In FY24, 69/95 invited are participating. A needs assessment showed CNH faculty and leaders supported an NFO Program. Participants report finding the program helpful; they learned about institutional resources, benefits, and operations and appreciated the networking opportunities. Longer-term metrics include faculty satisfaction, promotion, and retention.

A cluster randomised controlled trial investigating the efficacy of family-centred obesity management program in primary care settings: A study protocol.

The study aims to test the efficacy of a family-centred healthy lifestyle program in primary care health centres among children with overweight or obesity, evaluating the results at 3, 6, and 9 months post-intervention. A single-blind, randomised controlled cluster study where participants will be blinded to group assignment to reduce bias will be followed. The intervention comprises a 6-month program with intensive and maintenance behavioural therapies, including dietary modifications and guidelines for physical activity, administered by a multidisciplinary team. Participants will be assigned to an intervention group or a treatment-as-usual control group. Primary health centres in Seeb Wilayat, serving densely populated areas and willing to participate, will be included. Randomisation will be conducted at the cluster level to improve recruitment efficiency. A sample size calculation will ensure adequate power to detect significant differences. Ethical approval is granted and informed consent/assent will be obtained from all participants. The proposed study focusses on testing the efficacy of a family-centred healthy lifestyle program in primary care centres through a controlled, randomised study. Successful outcomes could lead to informed interventions, improvements in the health system, policy recommendations, positive community impacts, information on behavioural therapies, and improved long-term health outcomes for affected children and their families. This study will contribute to the literature by providing a culturally sensitive and evidence-based solution to a pressing public health issue, which can be adapted to similar contexts in Oman and beyond.

Exercise-Based Telerehabilitation for Heart Failure Patients Declining Outpatient Rehabilitation - A Randomized Controlled Trial.

Purpose: Cardiac rehabilitation participation rates are low despite strong recommendations, and many chronic heart failure patients remain physically inactive. Rural living, long travel distance, costs, age, and frailty might be factors explaining this. To increase cardiac rehabilitation uptake, we designed an exercise-based randomized controlled telerehabilitation trial enabling chronic heart failure patients unable or unwilling to participate in outpatient cardiac rehabilitation to exercise at home. Aim was to evaluate the long-term effects of telerehabilitation on physical activity levels.Methods and results: CHF patients (n = 61) with reduced (≤40%), mildly reduced (41-49%), or preserved ejection fraction (≥50%) were randomized (1:1) to telerehabilitation (n = 31) with an initial 3-month group-based high-intensity exercise telerehabilitation program or control (n = 30), with regular follow-up visits over a 2-year period. All participants attended a "Living with heart failure" course. Outcomes were measures of physical activity, peak oxygen uptake, 6-minute walk test distance, quality of life, morbidity, and mortality. We found no significant differences between groups for long-term changes in moderate to vigorous activity (MVPA) or peak oxygen uptake from baseline to the 2-year follow-up. Nor quality of life differed between groups, but both groups had significant within-group improvements in score on the Minnesota living with heart failure questionnaire (p = 0.000) and improvement in EQ-5D VAS score was significant (p = 0.05) in the telerehabilitation group.Conclusions: Telerehabilitation performed as home-based real-time high-intensity exercise sessions provided by videoconferencing for participants unable or unwilling to participate in standard outpatient cardiac rehabilitation did not affect long-term physical activity levels or physical capacity as expected. Still, a positive effect on health-related quality of life was seen in both groups.

Preventing Allogeneic Stem Cell Transplant-Related Cardiovascular Dysfunction: ALLO-Active Trial.

Allogeneic stem cell transplantation (allo-SCT) is an efficacious treatment for hematologic malignancies but can be complicated by cardiac dysfunction and exercise intolerance impacting quality of life and longevity. We conducted a randomized controlled trial testing whether a multicomponent activity intervention could attenuate reductions in cardiorespiratory fitness and exercise cardiac function (co-primary end points) in adults undergoing allo-SCT. Sixty-two adults scheduled for allo-SCT were randomized to a 4-month activity program (n=30) or usual care (UC; n=32). Activity comprised multicomponent exercise training (3 days/week) and sedentary time reduction (≥30 min/day) program and was delivered throughout hospitalization (≈4 weeks) and for 12 weeks after discharge. Physiological assessments conducted before admission and at 12 weeks after discharge included cardiopulmonary exercise testing to quantify peak oxygen uptake ([Formula: see text]), exercise cardiac magnetic resonance imaging for peak cardiac volume (CIpeak) and stroke volume (SVIpeak) index, echocardiography-derived left ventricular ejection fraction and global longitudinal strain, and cardiac biomarkers (cTn-I [troponin-I] and BNP [B-type natriuretic peptide]). Fifty-two participants (84%) completed follow-up (25 activity and 27 UC); median (interquartile range [IQR]) adherence to the activity program was 74% (41-96%). There was a marked decline in [Formula: see text] in the UC program (-3.4 mL‧kg-1‧min-1 [95% CI, -4.9 to -1.8]) that was attenuated with activity (-0.9 mL‧kg-1‧min-1 [95% CI, -2.5 to 0.8]; interaction P=0.029). Activity preserved exercise cardiac function, with preservation of CIpeak (0.30 L‧min-1‧m-2 [95% CI, -0.34 to 0.41]) and SVIpeak (0.6 mL/m2 [95% CI, -1.3 to 2.5]), both of which declined with UC (CIpeak, -0.68 L‧min-1‧m-2 [95% CI, -1.3 to -0.32]; interaction P=0.008; SVIpeak, -2.7 mL/m2 [95% CI, -4.6 to -0.9]; interaction P=0.014). There were no treatment effects of activity on cardiac biomarkers or echocardiographic indices. Multicomponent activity intervention during and after allo-SCT is beneficial for preserving patient cardiorespiratory fitness and exercise cardiac function. These results may have important implications for cardiovascular morbidity and mortality after allo-SCT. URL: https://anzctr.org.au/; Unique identifier: ACTRN12619000741189.

The effects of a home telerehabilitation-based program on the cardiopulmonary function and quality of life in post-COVID-19 patients

BackgroundRelatively few studies have explored the impact of home telerehabilitation-based (HTB) programs on patients with post-COVID-19 syndrome. Thus, this study aimed to investigate the effect of HTB programs on the cardiopulmonary function, body composition, muscle strength, and quality of life (QoL) of patients with post-COVID-19 syndrome. MethodsA quasi-experimental study was performed. Fifty-one patients with COVID-19 were divided into two groups after being discharged from the hospital. Participants in the control group (n = 26) were advised to engage in breathing and stretching exercises plus their preferred exercise program. In comparison, participants in the intervention group (n = 25) were instructed to perform a combination of aerobic, breathing, and resistance exercises. To monitor the exercise program at home, the physiotherapists called the participants using a mobile phone application platform once a month and once a week in the control and intervention groups, respectively. Outcome measurements consisted of cardiopulmonary functions including exercise capacity using the 6-min walk test (6 MWT), and the pulmonary function test (PFT). Leg muscle strength and endurance were determined using the 1-min sit-to-stand test (1MSTS). Other physical fitness parameters were also examined including the hand grip strength test and body composition attributes. The 36-item Short Form questionnaire was used to determine the quality of life. All outcome measurements were tested before hospital discharge and at 3-month follow-up. ResultsParticipants of the control (n = 18) and intervention (n = 14) groups completed a 3-month post-discharge exercise program. No statistically significant differences were found between the two groups for all outcome measurements (p > 0.05). However, the 6 MWT and 1MSTS values increased significantly at the time of the 3-month follow-up compared to the baseline values at the time of discharge for both groups. ConclusionPatients with post-COVID-19 syndrome exhibited beneficial effects on exercise capacity, leg muscle strength, and endurance after completing a 3-month duration post-discharge HTB program. Trial registrationhttps://thaiclinicaltrials.org/ with identifier number TCTR20210823004.