Alternative Modes Of Delivery Research Articles

Counterpoint: In-Home Pulmonary Rehabilitation Is an Attractive Alternative.

Center-based pulmonary rehabilitation is positioned as the accepted standard for pulmonary rehabilitation. There, however, are several barriers to its utilization, and usage rates remain as low as 4%, despite decades of trying to improve access. The question then arises as to who is really benefiting from center-based pulmonary rehabilitation as this therapy is barely available to eligible patients. Alternative modes of delivery of pulmonary rehabilitation have been tested. Meta-analyses indicate that these alternate modes are associated with clinical improvements comparable with center-based pulmonary rehabilitation in several outcomes that are important for patients, including the 6-min walk distance, dyspnea, and quality of life. These modes are also associated with better adherence to the intervention than center-based pulmonary rehabilitation. Telehealth pulmonary rehabilitation and home-based pulmonary rehabilitation, therefore, are attractive alternatives to center-based pulmonary rehabilitation and will exponentially increase pulmonary rehabilitation capacity.

Factors Influencing Learners Discontinuation in the Alternative Learning System

This study looked into identified reasons for enrolling in the Alternative Learning System to determine what factors lead to ALS learners dropping out of the program. This study utilized a descriptive correlational design employing a researcher-made survey to gather data. The survey underwent validation by three experts in the field of research and Alternative Learning Systems and passed the validity test conducted. The responses of the participants were analyzed to determine if there is a significant difference in their profiles based on the reasons, they reported for enrolling in ALS using the ANOVA test. The investigation also looked into whether there is a correlation between the reasons reported by the participants for enrolling in ALS and the factors affecting their discontinuation. It was found that there is no significant difference in the profiles of the respondents such as age, gender, civil status, level taken, and monthly income in the reasons they reported for enrolling in ALS. However, it was discovered that there is a significant correlation between the reasons reported by the students for enrolling in ALS and the factors influencing their discontinuation. In response to the challenge of student discontinuation, it is proposed to initiate and effectively implement Radio-Based Instruction (RBI) as an alternative mode of delivery for ALS programs. Leveraging radio broadcasting, this innovative approach to distance learning has the potential to significantly enhance access to education by reaching students in diverse geographic locations, thereby mitigating the barriers posed by distance and geographical isolation. Moreover, RBI allows learners the flexibility to engage in their studies even while occupied with other activities, further facilitating their educational journey. Keywords: Alternative Learning System, Influencing Factors, Learners Discontinuation, ALS Learners

Alternative Delivery Mode in Academic Performance of Junior High School Students Towards Proposed Implementation Guidelines

This study investigates the impact of alternate delivery methods on the academic performance of junior high school students at Bayugan National Comprehensive High School during the second grading period of the 2022-2023 school year. Employing descriptive research methods, the study focused on the “what” aspects of the issue, using a survey to gather data from 35 students enrolled in alternative delivery modes. Academic performance was measured using students’ average grades. The survey, divided into categories like learning resources and digital packets, revealed a significant correlation between alternative delivery modes and academic achievement, as indicated by a Spearman Rho p-value of 0.000. These findings provide valuable insights for future research and educational strategies in various delivery modes. Keywords: Alternative delivery mode, Learning resource materials, Digital packets, Worksheets/ Activity sheets, and Printed modules

Exercise-based cardiac rehabilitation for adults with heart failure.

People with heart failure experience substantial disease burden that includes low exercise tolerance, poor health-related quality of life (HRQoL), increased risk of mortality and hospital admission, and high healthcare costs. The previous 2018 Cochrane review reported that exercise-based cardiac rehabilitation (ExCR) compared to no exercise control shows improvement in HRQoL and hospital admission amongst people with heart failure, as well as possible reduction in mortality over the longer term, and that these reductions appear to be consistent across patient and programme characteristics. Limitations noted by the authors of this previous Cochrane review include the following: (1) most trials were undertaken in patients with heart failure with reduced (< 45%) ejection fraction (HFrEF), and women, older people, and those with heart failure with preserved (≥ 45%) ejection fraction (HFpEF) were under-represented; and (2) most trials were undertaken in a hospital or centre-based setting. To assess the effects of ExCR on mortality, hospital admission, and health-related quality of life of adults with heart failure. We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and Web of Science without language restriction on 13 December 2021. We also checked the bibliographies of included studies, identified relevant systematic reviews, and two clinical trials registers. We included randomised controlled trials (RCTs) that compared ExCR interventions (either exercise only or exercise as part of a comprehensive cardiac rehabilitation) with a follow-up of six months or longer versus a no-exercise control (e.g. usual medical care). The study population comprised adults (≥ 18 years) with heart failure - either HFrEF or HFpEF. We used standard Cochrane methods. Our primary outcomes were all-cause mortality, mortality due to heart failure, all-cause hospital admissions, heart failure-related hospital admissions, and HRQoL. Secondary outcomes were costs and cost-effectiveness. We used GRADE to assess the certainty of the evidence. We included 60 trials (8728 participants) with a median of six months' follow-up. For this latest update, we identified 16 new trials (2945 new participants), in addition to the previously identified 44 trials (5783 existing participants). Although the existing evidence base predominantly includes patients with HFrEF, with New York Heart Association (NYHA) classes II and III receiving centre-based ExCR programmes, a growing body of trials includes patients with HFpEF with ExCR undertaken in a home-based setting. All included trials employed a usual care comparator with a formal no-exercise intervention as well as a wide range of active comparators, such as education, psychological intervention, or medical management. The overall risk of bias in the included trials was low or unclear, and we mostly downgraded the certainty of evidence of outcomes upon GRADE assessment. There was no evidence of a difference in the short term (up to 12 months' follow-up) in the pooled risk of all-cause mortality when comparing ExCR versus usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.71 to 1.21; absolute effects 5.0% versus 5.8%; 34 trials, 36 comparisons, 3941 participants; low-certainty evidence). Only a few trials reported information on whether participants died due to heart failure. Participation in ExCR versus usual care likely reduced the risk of all-cause hospital admissions (RR 0.69, 95% CI 0.56 to 0.86; absolute effects 15.9% versus 23.8%; 23 trials, 24 comparisons, 2283 participants; moderate-certainty evidence) and heart failure-related hospital admissions (RR 0.82, 95% CI 0.49 to 1.35; absolute effects 5.6% versus 6.4%; 10 trials; 10 comparisons, 911 participants; moderate-certainty evidence) in the short term. Participation in ExCR likely improved short-term HRQoL as measured by the Minnesota Living with Heart Failure (MLWHF) questionnaire (lower scores indicate better HRQoL and a difference of 5 points or more indicates clinical importance; mean difference (MD) -7.39 points, 95% CI -10.30 to -4.77; 21 trials, 22 comparisons, 2699 participants; moderate-certainty evidence). When pooling HRQoL data measured by any questionnaire/scale, we found that ExCR may improve HRQoL in the short term, but the evidence is very uncertain (33 trials, 37 comparisons, 4769 participants; standardised mean difference (SMD) -0.52, 95% CI -0.70 to -0.34; very-low certainty evidence). ExCR effects appeared to be consistent across different models of ExCR delivery: centre- versus home-based, exercise dose, exercise only versus comprehensive programmes, and aerobic training alone versus aerobic plus resistance programmes. This updated Cochrane review provides additional randomised evidence (16 trials) to support the conclusions of the previous 2018 version of the review. Compared to no exercise control, whilst there was no evidence of a difference in all-cause mortality in people with heart failure, ExCR participation likely reduces the risk of all-cause hospital admissions and heart failure-related hospital admissions, and may result in important improvements in HRQoL. Importantly, this updated review provides additional evidence supporting the use of alternative modes of ExCR delivery, including home-based and digitally-supported programmes. Future ExCR trials need to focus on the recruitment of traditionally less represented heart failure patient groups including older patients, women, and those with HFpEF.

Do college students demand lower tuition for online learning? Empirical evidence from choice experiments during COVID-19

ABSTRACT To address student concerns about full tuition rates while taking online courses during COVID-19, we conducted choice experiments at a representative U.S. land-grant university to elicit students’ willingness-to-pay for alternative course delivery modes. Results show that students demanded 30% and 7% tuition discounts for fully online and hybrid learning, respectively. A welfare analysis further reveals that 63% of the total welfare loss during Fall 2020–Spring 2022 was compensated for by the Higher Education Emergency Relief Fund (HEERF) funding. Based on our findings, we suggest measures to facilitate students’ learning experiences and emphasize the importance of leveraging government appropriations.

Prepandemic Feasibility of Tele-Exercise as an Alternative Delivery Mode for an Evidence-Based, Tai Ji Quan Fall-Prevention Intervention for Older Adults.

There is a critical need for fall-prevention interventions to reach medically underserved, hard-to-reach, rural older adults. The evidence-based Tai Ji Quan: Moving for Better Balance (TJQMBB) program reduces falls in older adults. This pre-COVID-19 pandemic study assessed the feasibility and impact of a 16-week tele-TJQMBB intervention in older adults. Instructors led six tele-TJQMBB classes via Zoom for 52 older adults (mean age ± SD 68.5 ± 7.7years) at one academic and four community sites. Nearly all (97%) planned sessions were delivered. Average attendance was 61%. There were no adverse events. Fidelity was fair to good (mean 67%). Forty-one percent of sessions experienced technical disruptions. Participants improved their gait speed, balance, lower-extremity strength, and body mass index. Tele-TJQMBB was feasible with a positive impact on outcomes. This study was the first step toward establishing an additional delivery mode that could potentially expand TJQMBB's reach and maintenance.

Safety and long-term outcomes of remote cardiac rehabilitation in coronary heart disease patients: A systematic review.

To systematically review the safety and the long-term mortality and morbidity risk-rates of the remotely-delivered cardiac rehabilitation (RDCR) interventions in coronary heart disease (CHD) patients. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42023455471). Five databases (Pubmed, Scopus, Cochrane Central Register of Controlled Trials in the Cochrane Library, Cinahl and Web of Science) were reviewed from January 2012 up to August 2023. Inclusion criteria were: (a) randomized controlled trials, (b) RDCR implementation of at least 12 weeks duration, (c) assessment of safety, rates of serious adverse events (SAEs) and re-hospitalization incidences at endpoints more than 6 months. Three reviewers independently performed data extraction and assessed the risk of bias using the Cochrane Risk of Bias tool. 14 studies were identified involving 2012 participants and a range of RDCR duration between 3 months to 1 year. The incidence rate of exercise-related SAEs was estimated at 1 per 53,770 patient-hours of RDCR exercise. A non-statistically significant reduction in the re-hospitalization rates and the days lost due to hospitalization was noticed in the RDCR groups. There were no exercise-related deaths. The overall study quality was of low risk. RDCR can act as a safe alternative delivery mode of cardiac rehabilitation (CR). The low long-term rates of reported SAEs and re-hospitalization incidences of the RDCR could enhance the uptake rates of CR interventions. However, further investigation is needed in larger populations and longer assessment points.

Learning Experience of Students Using the Learning Management System: User’s Perspective on the Use of Moodle in the University of Jordan

This study aimed to evaluate the effectiveness of Moodle LMS as an alternative delivery mode for education, particularly in the higher education system of Jordan, which has not been evaluated before. The research is based on Moore’s transactional distance learning theory, which considers interactions among students, instructors, and course material, as well as personal characteristics of students. The study included 50 participants who have taken courses on Moodle LMS at the University of Jordan. Both interviews and research surveys were conducted to gather in-depth perceptions and analysis of the participants’ experiences with Moodle LMS. The findings suggest that Moodle LMS was an effective alternative study tool during the COVID-19 pandemic and the user-friendly course design enhanced the user experience of using Moodle LMS. Participants also provided suggestions to optimize the system for better integration in the University of Jordan. Fixing Moodle LMS based on the recommendations of the study participants will significantly improve the learning experience of students. This study contributes to the advancement of the state of the art by evaluating the effectiveness of Moodle LMS in the higher education system of Jordan and providing recommendations for improvement.

Impact of COVID-19 Pandemic on Marketing of Education

The COVID-19 pandemic forced many schools to partially or totally switch to remote communication methods for delivering education in the years 2020-2021. It is believed that forced compliance with unfamiliar and even unpreferred modes of behavior can have a profound and lasting impact on people’s attitudes and opinions toward the behavior itself because of first-hand exposure and experience. It is, therefore, possible that this experience with remote teaching and learning could have materially changed both instructors’ as well as students’ attitudes toward remote delivery of education. Such changed attitudes may predict their future choices and behavior. This paper will present the important facets of education delivery systems identified, and the survey instrument developed to explore three areas: instructors’ and students’ prior attitudes and behaviors toward alternative education delivery modes, their experiences during the pandemic, and the effect of the experience on their attitudes. The paper will also present the results of a pilot study conducted using a sample of student respondents.

Self-reported preferences and barriers to continued professional development in primary care physicians: a cross-sectional web-based survey in Qatar

IntroductionHigh quality and effective primary healthcare is a national priority in Qatar. Continuing professional development (CPD) for physicians is a cornerstone of this objective, yet little is known about physicians’ preferences or barriers to CPD participation.MethodA needs assessment was conducted using a cross-sectional web-based survey of primary care physicians registered with the Department of Healthcare Practitioners (DHP) between March and June 2017.ResultsTwo-hundred-and-eighty-one complete surveys were submitted representing physicians in both public (N = 129) and private sectors (N = 152). Physicians completed medical degrees and postgraduate training across multiple countries, and most had been practicing in Qatar for 5 years or less. ‘Activities during working hours’, ‘cost’ and ‘work commitments’ were the most common barriers. There was little consensus regarding the optimal timing of CPD activities, although public sector physicians were more likely to indicate weekend activities as a barrier to participation (30% vs. 9%). Over 90% of participants preferred traditional lectures, workshops, case-based sessions, small group and online self-paced learning as formats for CPD delivery, however alternative modes of delivery were also deemed acceptable (> 80% agreement).ConclusionUnderstanding primary care physicians’ barriers and preferences is an essential component of a larger necessitated needs assessment of CPD in primary care practitioners in Qatar. Further research is warranted to understand the underlying beliefs driving physicians’ choices and the apparent variation between those working in the public and private sectors. CPD developers should consider approaches to mitigate perceived barriers and understand preferences to maximize the quality of participation.

The plight of Modified Work and Study Program (MWSP) students in learning mathematics

The Philippine educational system established alternative delivery modes of education, such as the Modified Work and Study Program, to eradicate student dropout incidence. This phenomenological study aims to probe the challenges and explore the coping mechanism of MWSP students in studying mathematics. The study was conducted at a public high school offering the program. Six students were chosen to participate in the study. Focus group discussion was utilized for the data gathering of the study. Results showed that mediocrity of resources and conspicuous learning environment were the leading challenges that MWSP students encounter. Moreover, the coping mechanisms include good classroom management, utilization of concrete examples, time scheduling, steward support, motivational encouragement, and recreational and body relaxation. It is recommended that MWSP mathematics teachers integrate innovative strategies, provide more concrete contextualized examples, intensify the development of learning kits, and reinforce teaching and learning through supplementary materials. Keywords: Mathematics Learning; Modified Work and Study Program; Phenomenology

Morphological Characterization of Calcium Carbonate Nanoparticles Derived from Blood Cockle Shells (Anadara granosa)

Blood cockle shells are a type of shellfish with distinctive bright red color that is commonly found in coastal areas of Asia, a rich source of protein, vitamins, and minerals, including calcium carbonate. Calcium carbonate (CaCO3) is a common mineral supplement that slowly paved its way into nano research to support bone health that also used in the treatment of bone infections due to its inherent properties; reduces inflammation, promotes bone healing, crucial role in the immune system, and slow degradability. The latest invention on CaCO3 from cockle shells, is an alternative mode of drug delivery to circumvent existing antibiotic resistance mechanisms and allow direct drug delivery to the target site, using locally sourced ingredients to reduce long-term high production costs. A top-down approach CaCO3 nanoparticles from blood cockle (Anadara granosa) shells were developed, known as calcium carbonate nanoparticles (CNPs). This research aims to characterize the morphology of CNPs from blood cockle shells via Transmission Electron Microscopy (TEM), Scanning Electron Microscopy (SEM), and Atomic Force Microscopy (AFM). A homogeneously spherical CNPs. with a mean diameter of 36.5 ± 2.3 nm was observed on TEM, so as FESEM. From AFM, the mean diameter for CNPs was 38.6 ± 3.6 nm The CNPs were spherical in shape, homogenously scattered, less agglomerate, porous with rough surfaces. The size and morphology of the CNPs from blood cockle shells were suitable for transport carrier in situ bone infection, according to the results.

Attractive targeted sugar bait: the pyrrole insecticide chlorfenapyr and the anti-malarial pharmaceutical artemether–lumefantrine arrest Plasmodium falciparum development inside wild pyrethroid-resistant Anopheles gambiae s.s. mosquitoes

BackgroundAttractive targeted sugar bait (ATSB) is a novel approach to vector control, offering an alternative mode of insecticide delivery via the insect alimentary canal, with potential to deliver a variety of compounds new to medical entomology and malaria control. Its potential to control mosquitoes was recently demonstrated in major field trials in Africa. The pyrrole chlorfenapyr is an insecticide new to malaria vector control, and through its unique mode of action—disruption of ATP mediated energy transfer in mitochondria—it may have direct action on energy transfer in the flight muscle cells of mosquitoes. It may also have potential to disrupt mitochondrial function in malarial parasites co-existing within the infected mosquito. However, little is known about the impact of such compounds on vector competence in mosquitoes responsible for malaria transmission.MethodsIn this study, ATSBs containing chlorfenapyr insecticide and, as a positive control, the anti-malarial drugs artemether/lumefantrine (A/L) were compared for their effect on Plasmodium falciparum development in wild pyrethroid-resistant Anopheles gambiae sensu stricto (s.s.) and for their capacity to reduce vector competence. Female mosquitoes were exposed to ATSB containing either sublethal dose of chlorfenapyr (CFP: 0.025%) or concentrations of A/L ranging from 0.4/2.4 mg/ml to 2.4/14.4 mg/ml, either shortly before or after taking infective blood meals. The impact of their component compounds on the prevalence and intensity of P. falciparum infection were compared between treatments.ResultsBoth the prevalence and intensity of infection were significantly reduced in mosquitoes exposed to either A/L or chlorfenapyr, compared to unexposed negative control mosquitoes. The A/L dose (2.4/14.4 mg/ml) totally erased P. falciparum parasites: 0% prevalence of infection in female mosquitoes exposed compared to 62% of infection in negative controls (df = 1, χ2 = 31.23 p < 0.001). The dose of chlorfenapyr (0.025%) that killed < 20% females in ATSB showed a reduction in oocyte density of 95% per midgut (0.18/3.43 per midgut).ConclusionThese results are evidence that chlorfenapyr, in addition to its direct killing effect on the vector, has the capacity to block Plasmodium transmission by interfering with oocyte development inside pyrethroid-resistant mosquitoes, and through this dual action may potentiate its impact under field conditions.

Abstract 16487: Implementation of a Web-Based Cardiac Rehabilitation Program in Rural Australia Improves Access

Introduction: Involvement in cardiac rehabilitation (CR) programs reduces death, reoccurring cardiac events, also improving quality of life. Globally, CR attendance and completion is poor, with referral and non-attendance rates ranging from 20-50%. Hypothesis: To evaluate the effectiveness of an interactive web-based CR program as an alternative mode of delivery, to improve access and attendance. Methods: The RE-AIM implementation framework. Patients eligible for CR, residing in a rural and remote areas between July 2021-June 2022 Results: A total of 828 rural patients participated, 50 choosing the web-based mode of delivery. Web patients were younger, (60, SD 11.9 vs 68.5 years, SD 11.9; p&lt;0.001). Sex distribution did not differ between web and non-web, 17 (34%) males in web and 195 (23.5%) non-web (p=0.167). Myocardial infarction was the predominant reason for referral in both groups (64.3% vs 35.6%, p=0.049). Mean BMI was higher in the web compared to non-web (33.6, SD 8.0 vs 29.8, SD 6.0; p=0.025). Program completion was higher for non-web than for the web-based patients (17; 34% vs 553;71.4% p=&lt;0.001). Web-based patients reported overall program satisfaction (77.8%). Clinicians reported the web-based program as high quality (71.4%). There was an increase in web-based enrolments with concurrent reduction in usual care resulting from COVID pandemic restrictions. Patient fidelity to entry of self-reported data was high in the web-based with all patients completing a pre-assessment and 50% a post-assessment. Change in risk factor control did not differ between the groups. There was no significant difference in patients’ preference by age or gender for web-based or other modes of CR. Web-based program enrolment was associated with a lower chance of CR completion (OR 0.19; 95% CI: 0.100, 0.372; p&lt;0.001) after adjustment for age and gender. Conclusions: The web-based program provides an alternative flexible mode to complete CR, having met the demands of COVID pandemic restrictions. It has been integrated and successfully used by patients and clinicians, capturing a cohort who fit into the 20-50% not attending a CR program. Strategies for improving completion of web-based programs need further investigation.

Intraosseous regional prophylaxis in total knee arthroplasty.

Prophylactic antibiotics are important in reducing the risk of periprosthetic joint infection (PJI) following total knee arthroplasty. Their effectiveness depends on the choice of antibiotic and the optimum timing of their administration, to ensure adequate tissue concentrations. Cephalosporins are typically used, but an increasing number of resistant organisms are causing PJI, leading to the additional use of vancomycin. There are difficulties, however, with the systemic administration of vancomycin including its optimal timing, due to the need for prolonged administration, and potential adverse reactions. Intraosseous regional administration distal to a tourniquet is an alternative and attractive mode of delivery due to the ease of obtaining intraosseous access. Many authors have reported the effectiveness of intraosseous prophylaxis in achieving higher concentrations of antibiotic in the tissues compared with intravenous administration, providing equal or enhanced prophylaxis while minimizing adverse effects. This annotation describes the technique of intraosseous administration of antibiotics and summarizes the relevant clinical literature to date.

O.4.1-1 Impact of a pre-pandemic, tele-exercise, fall-prevention intervention on outcomes in older adults

Abstract Purpose This pre-pandemic study used an alternative delivery mode to provide an evidence-based, fall-prevention exercise intervention to older adults. We delivered Tai Ji Quan: Moving for Better Balance® (TJQMBB) via tele-exercise and determined its impact on self-reported and performance-based outcomes in older adults. Methods Five community sites (3 urban, 2 rural) held 6, 1-hour, synchronous TJQMBB classes, over the internet, twice weekly for 16 weeks (32 hours). Baseline and 16-week self-reported data included fear of falling (Falls Efficacy Scale), depression (Geriatric Depression Scale-Short), physical and mental health-related quality of life (HRQOL) (SF-12 PCS and MCS), and total minutes of physical activity per week. Performance-based outcomes included a 5-Meter Walk Test (gait speed), the Timed Up-and-Go Test (mobility), the 4-Square Step Test (balance), and the 5-Times Sit-to-Stand Test (leg strength). Height and weight were used to calculate body mass index (BMI). Paired t-tests and Friedman 2-Way ANOVA tests examined changes in outcomes between baseline and 16 weeks. Results Sixty-three (79.7%) of 79 people were eligible, of which 52 (82.5%) enrolled. Participants were a mean ± SD age of 68.5 ± 7.7 years old, primarily white (96.2%), and female (80.8%). There were no significant improvements in fear of falling (X2r =3.8, p = 0.15), depression (X2r =0.19, p = 0.91), physical (X2r =1.2, p = 0.56) or mental (X2r =0.31, p = 0.86) HRQOL, or physical activity (X2r =3.7, p = 0.16). Gait speed (meters/second) significantly improved from baseline (1.1 ± 0.2) to 16 weeks (1.2 ± 0.2) (p = 0.02). Balance, leg strength, and BMI also improved significantly (balance [seconds]: baseline 10.9 ± 2.4, 16 weeks 10.2 ± 2.5, p = 0.045; strength [seconds]: baseline 14.7 ± 5.7, 16 weeks 12.4 ± 2.9, p = 0.01; BMI [kg/m2]: baseline 30.8 ± 6.3, 16 weeks 30.2 ± 5.6, p &amp;lt; 0.01). There were no changes in mobility (p = 0.16). Conclusions This tele-TJQMBB intervention improved physical function (gait speed, balance, leg strength) and BMI in older adults. Tele-TJQMBB provided an alternative delivery mode that could help overcome the barrier of identifying experienced instructors in rural areas, and could expand TJQMBB’s reach into the older adult population. Future comparative effectiveness studies could establish if outcomes are equivalent between in-person and tele-exercise delivery modes.

The Geras virtual frailty rehabilitation program to build resilience in older adults with frailty during COVID-19: a randomized feasibility trial

BackgroundThe Coronavirus (COVID-19) pandemic has exacerbated the risk for poor physical and mental health outcomes among vulnerable older adults. Multicomponent interventions could potentially prevent or reduce the risk of becoming frail; however, there is limited evidence about utilizing alternative modes of delivery where access to in-person care may be challenging. This randomized feasibility trial aimed to understand how a multicomponent rehabilitation program can be delivered remotely to vulnerable older adults with frailty during the pandemic.MethodsParticipants were randomized to either a multimodal or socialization arm. Over a 12-week intervention period, the multimodal group received virtual care at home, which included twice-weekly exercise in small group physiotherapy-led live-streamed sessions, nutrition counselling and protein supplementation, medication consultation via a videoconference app, and once-weekly phone calls from student volunteers, while the socialization group received only once-weekly phone calls from the volunteers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework was used to evaluate the feasibility of the program. The main clinical outcomes were change in the 5-times sit-to-stand test (5 × STS) and Depression, Anxiety and Stress Scale (DASS-21) scores. The feasibility outcomes were analyzed using descriptive statistics and expressed as frequencies and mean percent with corresponding confidence intervals (CI). Analysis of covariance (ANCOVA) was used for the effectiveness component.ResultsThe program enrolled 33% (n = 72) of referrals to the study (n = 220), of whom 70 were randomized. Adoption rates from different referral sources were community self-referrals (60%), community organizations (33%), and healthcare providers (25%). At the provider level, implementation rates varied from 75 to 100% for different aspects of program delivery. Participant’s adherence levels included virtual exercise sessions 81% (95% CI: 75–88%), home-based exercise 50% (95% CI: 38–62%), protein supplements consumption 68% (95% CI: 55–80%), and medication optimization 38% (95% CI: 21–59%). Most participants (85%) were satisfied with the program. There were no significant changes in clinical outcomes between the two arms.ConclusionThe GERAS virtual frailty rehabilitation study for community-dwelling older adults living with frailty was feasible in terms of reach of participants, adoption across referral settings, adherence to implementation, and participant’s intention to maintain the program. This program could be feasibly delivered to improve access to socially isolated older adults where barriers to in-person participation exist. However, trials with larger samples and longer follow-up are required to demonstrate effectiveness and sustained behavior change.Trial registrationClinicalTrials.gov NCT04500366. Registered August 5, 2020, https://clinicaltrials.gov/ct2/show/NCT04500366

Flexibility and Personalization of Learning in the Senior High Open High School Program: Basis for Enhanced Alternative Delivery Mode of Teaching and Learning

Flexibility and Personalization of Learning in the Senior High Open High School Program: Basis for Enhanced Alternative Delivery Mode of Teaching and Learning

Topical Absorption of Glutathione-Cyclodextrin Nanoparticle Complex in Healthy Human Subjects Improves Immune Response against Mycobacterium avium Infection.

Glutathione (GSH) is an important intracellular antioxidant responsible for neutralizing reactive oxygen species (ROS). Our laboratory previously demonstrated that the oral administration of liposomal GSH improves immune function against mycobacterium infections in healthy patients along with patients with HIV and Type 2 diabetes. We aim to determine if the topical application of a glutathione-cyclodextrin nanoparticle complex (GSH-CD) confers a therapeutic effect against mycobacterium infections. In our study, healthy participants received either topical GSH-CD (n = 15) or placebo (n = 15) treatment. Subjects were sprayed four times twice a day for three days topically on the abdomen. Blood draws were collected prior to application, and at 1, 4, and 72 h post-initial topical application. GSH, malondialdehyde (MDA), and cytokine levels were assessed in the processed blood samples of study participants. Additionally, whole blood cultures from study participants were challenged with Mycobacterium avium (M. avium) infection in vitro to assess mycobacterium survival post-treatment. Topical GSH-CD treatment was observed to elevate GSH levels in peripheral blood mononuclear cells (PBMCs) and red blood cells and decrease MDA levels in PBMCs 72 h post-treatment. An increase in plasma IL-2, IFN-γ, IL-12p70, and TNF-α was observed at 72 h post-topical GSH-CD treatment. Enhanced mycobacterium clearance was observed at 4 h and 72 h post-topical GSH-CD treatment. Overall, topical GSH-CD treatment was associated with improved immune function against M. avium infection. The findings of this pilot study suggest GSH-cyclodextrin complex formulation can be used topically as a safe alternative mode of GSH delivery in the peripheral blood.

0404 Heart Failure Nurses’ Perceptions of Cognitive Behavioral Therapy for Insomnia and the Feasibility of Providing it to Patients

Abstract Introduction People with heart failure (HF) often report insomnia. Despite strong evidence to support treatment with Cognitive Behavioral Therapy for Insomnia (CBT-I), few with HF have access to CBT-I programs. Access may be improved if it is offered where HF patients receive their medical care, but little is known about the feasibility of doing so. The purpose of this focus group study was to explore HF Nurses’ perceptions of: the importance of insomnia and the value of CBT-I to their patients; the feasibility of making CBT-I available in clinic settings and its delivery by HF nurses; and preferences for alternative modes of delivery. Methods We used a descriptive qualitative study design. We recruited focus group participants via electronic invitation to members of the American Association of Heart Failure Nurses and through requests to local nurse collaborators to distribute within their networks. We conducted virtual focus groups. After providing a brief description of the components of CBT-I and its efficacy in the HF population, we elicited participant perceptions of the value of providing CBT-I for HF patients in the clinic setting, facilitators and barriers to implementation, and ways to increase access to CBT-I. We audio-recorded the focus group discussions and used a professional transcription service. Two researchers coded the data and performed thematic content analysis. Results We conducted four focus groups with registered nurses and advanced practice nurses employed in HF clinics (N=23). Nurses endorsed the importance of sleep to HF patients, their interest in addressing sleep, perceived benefits of CBT-I, and the need for increased resources to address sleep in the clinic setting. They favored multiple modes of CBT-I delivery extending beyond the clinic. All nurses believed they had a role to play in addressing sleep, but differed in their views about the possibility of becoming CBT-I interventionists and the training and support needed to do so. Conclusion HF nurses recognize the importance of insomnia and support the implementation of CBT-I. Implementation studies are needed to identify effective methods of increasing access to evidence based CBT-I in the HF clinic setting, including appropriate support and training for nurses with interest in CBT-I delivery. Support (if any) R01NR01691