Checklist Scores Research Articles

Improvements in Cognition, Graded Symptom Checklist Score, Balance and Memory Following Neurological Rehabilitation for a 58-year-old Male Patient with Post-Concussion Syndrome: Case Report

To suggest the efficacy of multi-modal, intensive, neurologic rehabilitation approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome. A 58-year-old male patient presented to Plasticity Brain Centers for evaluation and treatment of persistent symptoms following a previously diagnosed concussion. His symptoms followed rapidly after injury and included headaches, neck pain, and difficulty with sleeping. Upon intake, he reported on the graded symptom checklist (GSC) a symptom severity score of 59. A Comprehensive Assessment of Postural Systems (CAPS ®) was performed assessing balance and stability on both a solid and foamed surface with eyes opened, eyes closed, and multiple head positions. An average stability score upon intake was calculated as 53.9% overall. Neurocognitive testing utilizing C3 Logix Neurocognitive Assessment Suite, Trails A time was 28.6 and standardized assessment of cognition (SAC) score was a 28/30 with specific difficulty in delayed memory. A 5-day, intensive, multi-modal program of neurologic exercises was administered in 10 one-hour treatment sessions. Each session consisted of repetitive peripheral somatosensory stimuli, cognitive exercises, neuromuscular reeducation, vestibular rehabilitation, orthoptic exercises, and off-vertical axis rotation utilizing a multi-axis rotational chair. Upon exit, symptom severity score decreased to 35 (-40.6%); Trails A time decreased to 19.7 (-31.1%); balance improved from an average stability score of 75.5%-79.6% (+5.4%); and standardized assessment of cognition (SAC) score increased to an overall score of 30/10 (+7.1%) with an improvement in delayed memory. The authors suggest further investigation into multi-modal, intensive approaches to improve cognition, balance, and cognitive impairment in patients with post-concussion syndrome.

Neurocognitive measures and self-reported symptoms following a short intensive multimodal neurorehabilitation program in individuals with post-concussion syndrome: Retrospective case-series study

This case-series study investigates the effect of a condensed multi-modal neurorehabilitation program on neurocognitive measures and self-reported symptoms using the C3Logix assessment tool on 137 individuals with diagnosed Post-Concussion Syndrome (PCS). In PCS, neurocognitive dysfunction is typically accompanied by symptoms of the physical, affective, and sleep domains. While most individuals recover within weeks of sustaining a head injury, evidence shows that those who do not recover in 3 months, may never. Recovery methods are usually prescribed with varying success, but the pathophysiologic complexity of concussion may require additional rehabilitation strategies that address the impaired neural networks to accelerate recovery. 137 individuals (M: 81, F: 56; mean (SD) age: 32.0 (14.0)) with a diagnosed PCS were treated at an outpatient rehabilitation center specializing in functional neurology. Using the C3Logix platform, individuals were evaluated at the intake and discharge of a 5-day program. Interventions included neuromuscular re-education, vestibular rehabilitation, orthoptics and cognitive training. Neurocognitive components and symptoms were exported and analyzed in Graphpad PRISM v. 8.4.3 using an rmANOVA. Results are reported as difference-of-means (95% CI). An alpha level of 0.05 was considered statistically significant. The C3Logix modified Graded Symptom Checklist score (0-150) decreased by 19.45 (15.16-23.75) (p < 0.0001), Trails A and B decreased 3.9 s (2.2-5.5) and 4.8 s (2.1-7.5) (p < 0.0001), respectively. Simple- and Choice Reaction Time decreased 31.3 ms (21.5-41.1) and 50.7 ms (37.9-63.6) (p < 0.0001), respectively. Static and Dynamic Visual Acuity decreased 0.03 LogMAR (0.0085-0.059) (p = 0.0021) and 0.05 LogMAR (0.021-0.073), respectively. Standardized Assessment of Concussion score (0-30) increased 0.8 (0.3-1.3) (p = 0.001) and digit-symbol coding increased 4.6 symbols (3.0-6.2) (p < 0.0001). The results of the present case-series study suggest clinically relevant improvements in neurocognitive measures and subjective symptoms in individuals with PCS following a multi-modal 5-day rehabilitation program.

A Paging Training Program for a Fourth-Year Internship Readiness Course.

IntroductionNew medical interns face a steep learning curve as they must manage complex medical scenarios, many of which they have only seen before in a classroom setting. To ameliorate these challenges, medical schools are increasingly including courses designed to address the transition from student to doctor. One of the biggest challenges for new interns is learning to triage and manage nursing pages, so we designed a mock paging program incorporated within our fourth-year transitions course.MethodsWe developed a database of clinical scenarios to occur via telephone between a nurse and a medicine intern. Throughout the 2-week course, these cases were administered to 40 fourth-year medical students by Master's level nursing students and nurse evaluators. The nurses used checklists to evaluate medical student management and communication, and at the end of the phone encounter students received immediate feedback. We used an observational prospective design, using a within subjects method with repeated measures.ResultsData from a total of 216 phone calls were analyzed for 36 students. No statistically significant improvement of checklist scores was observed. Substantial interrater reliability was observed for the four observed cases with a Fleiss-Kappa of .76. Student comments indicated the activity was helpful for preparing them to answer pages.DiscussionOur paging program offered students the chance to simulate being on call, as well as the opportunity to receive immediate feedback. It did not show improvement in checklists across time. Limitations included a small sample size and few common variables across the cases.

Home-Initiated-Programme-to-Prepare-for-Operation: evaluating the effect of an animation video on peri-operative anxiety in children: A randomised controlled trial.

Hospital admissions and surgical operations commonly trigger anxiety in young children. Despite employing numerous support measures in our hospital, such as a pre-operative play room, the encouragement of parental companionship during induction of anaesthesia and distraction therapy, allaying the anxiety of our young surgical patients remains a challenge. To evaluate the effectiveness of a Home-Initiated-Programme-to-Prepare-for-Operation (HIPPO) on emotional manifestation and anxiety in children undergoing surgery. One hundred and thirty children were randomly assigned to either control or intervention group between February 2018 and April 2019 in a tertiary paediatric hospital in Singapore. In addition to our standard pre-operative workflow, the intervention group received an additional home preparation kit consisting of an animated video on preoperative preparation and age-specific preoperative preparation activity sheets. The primary outcome was the Children's Emotional Manifestation Scale score to evaluate behaviour and emotion in the children before and during induction of anaesthesia. Secondary outcomes evaluated anxiety levels in parents and children, the child's behaviour and degree of co-operation using the State-Trait Anxiety Inventory scores, State-Trait Anxiety Inventory Children scores, the Induction Compliance Checklist scores, the Visual Analogue Scale scores for anxiety and the feedback questionnaire. The difference between the Children's Emotional Manifestation Scale score in control and intervention groups was not statistically significant. A promising difference was however observed in one of the secondary outcomes where the state-State-Trait Anxiety Inventory Children scores of 7 to 10-year olds in the intervention group almost reached significance; P = 0.067. Despite being a child-friendly, easily accessible and affordable tool for patient education, HIPPO did not reduce anxiety experienced by children in the pre-operative waiting area or during induction of anaesthesia. ClinicalTrials.gov, identifier: NCT04271553.

Second generation of the 1993 birth cohort, Pelotas (Brazil): Aims, design, preliminary results.

Background and AimsLongitudinal cohort studies examining different generations can explain how health problems can be transmitted through genetic and environmental mechanisms and their effects on the health of offspring. This study aimed to present the design and to describe the characteristics of the baseline sample of a second generation cohort.MethodsThe 93Cohort‐II is a dynamic prospective cohort composed of a second generation from the original 1993 Pelotas Birth Cohort (offspring), whose parents had their last follow‐up at 22 years old. Biological parents were asked to answer questions addressing the type of birth, general health status, family composition, dietary habits, breastfeeding habits, and child‐caregiver(s), among others, and the children's anthropometric measurements were evaluated.ResultsOf 1650 children identified, 1212 were evaluated (response rate, 73.4%), and 21 died before the baseline assessment. The age of the offspring ranged from 0 to 10 years (mean [±SD], 2.9 ± 2.1 years); most children (65.6%) lived with both parents and were born to young mothers and poor families. One‐third of the children were breastfed until 6 months of age, one‐half were born by cesarean section, 63.9% had used medication in the previous 15 days, 26.4% experienced hospitalization at least once since birth, and 14% had no updated vaccination; asthma/bronchitis (20.4%) and bronchiolitis (13.4%) were the most frequently reported diseases. More than 60% consumed ultra‐processed foods, and the prevalence of overweight among those <5 and ≥6 years of age was 10.2% and 18.9%, respectively. The mean total Child Behavior Checklist score was 44.1 ± 23.61 (≥16 months), and the mean intellectual quotient score in children ≥6 years of age was 97.9 ± 15.4.ConclusionDespite the difficulties in conducting intergenerational cohort studies, the results of the present investigation provide evidence supporting the feasibility of performing these types of studies in middle‐income countries.

Safety and efficacy of complementary and alternative medicine in the treatment of autism spectrum disorder: A protocol for systematic review and meta-analysis.

Introduction:The purpose of this study is to evaluate the efficacy and safety of complementary and alternative medicine in the treatment of autism spectrum disorder.Methods and analysis:We will electronically search Pubmed, Medline, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wan-fang Database from their inception. Also, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to complementary and alternative medicine treating autism spectrum disorder will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data were synthesized by using a fixed-effect model or random-effect model depend on the heterogeneity test. The Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC) scores will be the primary outcomes. The scores of the Autism Treatment Evaluation Checklist and the Ritvo-Freeman Real Life Rating Scale will also be assessed as secondary outcomes. RevMan V.5.3 statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals (CIs), whereas dichotomous data will be expressed in the form of relative risk with 95% CIs.Ethics and dissemination:The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and presented at relevant conferences.Systematic review registration:OSF Registries, DOI: 10.17605/OSF.IO/ HA97R (https://osf.io/ha97r)

PENERAPAN PELATIHAN KETERAMPILAN SOSIAL DAN EMOSI UNTUK MENGURANGI AGRESIFITAS PADA ANAK DENGAN BORDERLINE INTELLECTUAL FUNCTIONING

This research was aimed to investigate effectiveness of implementation of social and emotional skills training to reduce aggressiveness on child with borderline intellectual functioning (BIF). The participant was a 7 years old boy who was diagnosed having BIF that complained having difficulty to regulate his emotion when he was angry. The training program was adapted from Friendship Group Program that developed by Bierman et al. (2017), yet implemented in individual setting and adjusted to the child needs. In this program, researchers involved parent in the sessions and provided tasks to encourage him to practice the skills at his natural setting. It was single-subject design research to examine cause-effect relationship on the program deliver. The success of program implementation was evaluated qualitatively using interview, observation, and task evaluation; and quantitatively by comparing the score of Child Behavioral Checklist (CBCL) on social competence, social problem, and aggression problem. The result indicated that there were increase on social and emotional skills, and decrease on aggressiveness behavior on child with BIF.

The general movement checklist: A guide to the assessment of general movements during preterm and term age

ObjectivesTo develop a checklist describing features of normal and abnormal general movements in order to guide General Movement Assessment novices through the assessment procedure, to provide a quantification of General Movement Assessment; and to demonstrate that normal and abnormal GMs can be distinguished on the basis of a metric checklist score. MethodsThree examiners used General Movement Assessment and the newly developed GM checklist to assess 20 videos of 16 infants (seven males) recorded at 31–45 weeks postmenstrual age (writhing general movements). Inter- and intra-scorer agreement was determined for General Movement Assessment (nominal data; Kappa values) and the checklist score (metric scale ranging from 0 to 26; Intraclass Correlation values). The scorers’ satisfaction with the usefulness of the checklist was assessed by means of a short questionnaire (score 10 for maximum satisfaction). ResultsThe scorers’ satisfaction ranged from 8.44 to 9.14, which indicates high satisfaction. The median checklist score of the nine videos showing normal general movements was significantly higher than that of the eleven videos showing abnormal general movements (26 vs. 11, p<0.001). The checklist score also differentiated between poor-repertoire (median=13) and cramped-synchronized general movements (median=7; p=0.002). Inter- and intra-scorer agreement on (i) normal vs. abnormal general movements was good to excellent (Kappa=0.68–1.00); (ii) the distinction between the four general movement categories was considerable to excellent (Kappa=0.56–0.93); (iii) the checklist was good to excellent (ICC=0.77–0.96). ConclusionThe general movement checklist proved an important tool for the evaluation of normal and abnormal general movements; its score may potentially document individual trajectories and the effect of therapeutic intervention.

PTSD improvement and substance use disorder treatment utilization in veterans: Evidence from medical record data

BackgroundClinical trials reveal posttraumatic stress disorder (PTSD) improvement leads to decreased substance use among patients with comorbid substance use disorder (SUD). Using administrative medical record data, we determined whether clinically meaningful PTSD Checklist (PCL) (≥20 points) score decreases were positively associated with SUD treatment utilization. MethodsWe used a retrospective cohort of Veterans Health Affairs (VHA) medical record data (2008–2015). PTSD Checklist (PCL) scores were used to categorize patients into those with a clinically meaningful PTSD improvement (≥20 point decrease) or not (<20 point decrease or increase). PTSD and SUD were measured by ICD-9 codes. Propensity score weighting controlled for confounding in logistic and negative binomial models that estimated the association between clinically meaningful PTSD improvement and use of SUD treatment and number of SUD clinic visits. ResultsThe 699 eligible patients were, on average, 40.4 (±13.2) years old, 66.2% white and 33.1% were married. After controlling for confounding, there was a 56% increased odds of any SUD treatment utilization among those with a PCL decrease ≥20 vs < 20 (OR = 1.56; 95%CI = 1.04−2.33) but there was no association with number of SUD treatment visits. ConclusionsClinically meaningful reductions in PTSD symptoms were associated with any SUD treatment utilization but not amount of utilization. Improvement in PTSD symptoms, independent of the treatment modality, may enable SUD treatment seeking.

Behavioral health integration in a nurse-led federally qualified health center: Outcomes of care.

Over the past 20 years, significant evidence has emerged for collaborative care in the treatment of depression and anxiety disorders in primary care. The purpose of this project was to integrate an interprofessional and collaborative care model of behavioral health services into routine nurse-led primary care delivered to vulnerable and underserved populations across the lifespan. Team members included psychiatric nurse practitioners (PMHNPs), a registered nurse, and a case manager. An Access database was developed to track clients seen by the PMHNPs. Three key outcome measures were tracked over time: Posttraumatic Stress Disorder (PTSD) Checklist Civilian Version, Hamilton Depression Rating Scale (HAM-D), and Bipolar Depression Rating Scale (BDRS). A retrospective analysis of client outcome data from January 2017 through December 2019 was conducted. There were 118 patients included who were mostly female (63.6%), White (90.7%), and not Hispanic (69.5%), with Medicaid as their primary insurance (74.6%). For each outcome, models with linear and quadratic function forms for time were fit. The final model for PTSD Checklist Score had a linear functional form for time and the final models for BDRS and HAM-D had linear and quadratic terms for time. All predictors were significantly associated with the outcome. This program demonstrated that a patient-centered, nurse-led team approach to the treatment of depression, bipolar depression, and PTSD can be successful in primary care.

Evaluating YouTube as a Source of Patient Information for Functional Endoscopic Sinus Surgery.

To evaluate the quality of information presented on YouTube regarding functional endoscopic sinus surgery (FESS) for patients. YouTube was searched using FESS-specific keywords under the setting of "relevance." The first 50 videos from each keyword were reviewed and analyzed by 2 independent physician reviewers. Videos not related to FESS and duplicates were excluded. Outcome measures included the modified DISCERN score (range 0-5), the Journal of the American Medical Association (JAMA) benchmark criteria (range: 0-4), a novel scoring checklist for FESS assessing usefulness (range: 0-16), and the Video Power Index (VPI). Intraclass correlation coefficient (ICC) was calculated. Of the 200 videos identified, 95 videos were analyzed after exclusions. Videos had an average VPI of 40.8 and SD 133.2. Average scores from the 3 objective checklists among all videos were low: modified DISCERN: 1.91, SD: 1.15; JAMA benchmark: 1.91, SD: 0.76; and FESS score: 3.54, SD: 1.77. The ICC between the 2 independent reviewers was excellent for all 3 checklists. We noted significant positive Pearson correlation between all 3 checklist scores (P < .001). In between-group comparisons of mean scores, there was significantly higher DISCERN and JAMA scores for videos from university/professional organizations, as compared to videos from medical advertising/for-profit companies and independent users. There were no significant differences in FESS scores noted between the 3 groups. There were overall low scores across the modified DISCERN, JAMA benchmark criteria, and FESS scoring checklists, reflecting the poor quality of YouTube videos as a source of patient information for FESS.

The effect of training of metered-dose inhaler technique on asthma control and quality of life in children with asthma: a randomized trial

ABSTRACT The purpose of the study was to determine the effect of two different training styles (with brochure or video) with follow-ups for metered-dose inhaler (MDI) technique on asthma control and quality of life in children with asthma. Training for MDI technique was provided to 66 children (age 7–11 years) by using an MDI Technique Checklist. On the day of training and 4 weeks later, asthma control level (as assessed using the Childhood Asthma Control Test-C-ACT) and quality of life (as assessed using the Pediatric Asthma Quality of Life Questionnaire-PAQLQ) of the children were assessed. MDI Technique Checklist, C-ACT, and PAQLQ scores showed a statistically significant increase in both groups (p <.001), and technique reached the maximum score in the video group. Two different training methods on MDI technique provided the children with improved asthma control and quality of life. Follow-ups should be continued either to maintain or to improve skills.

Quantification of Neurological Blood-Based Biomarkers in Critically Ill Patients With Coronavirus Disease 2019.

To provide an objective characterization of acute neurologic injury in critically ill patients with coronavirus disease 2019. Prospective observational study. Demographics, comorbidities, and daily clinical physiologic and laboratory data were collected. Plasma levels of neurofilament-light chain, total tau, ubiquitin carboxy-terminal hydrolase L1, and glial fibrillary acidic protein were measured. The primary neurologic outcome was delirium defined by the Intensive Care Delirium Screening Checklist (scale 1-8). Associations among plasma biomarkers, respiratory failure, and inflammation were analyzed. Multicenter study in ICUs. Critically ill patients with respiratory failure, with coronavirus disease 2019, or without (ICU control). A total of 27 patients with coronavirus disease 2019 and 19 ICU controls were enrolled. Compared with ICU controls with pneumonia of other etiology, patients with coronavirus disease 2019 had significantly higher glial fibrillary acidic protein (272 pg/mL [150-555 pg/mL] vs 118 pg/mL [78.5-168 pg/mL]; p = 0.0009). In coronavirus disease 2019 patients, glial fibrillary acidic protein (rho = 0.5115, p = 0.0064), ubiquitin carboxy-terminal hydrolase L1 (rho = 0.4056, p = 0.0358), and neurofilament-light chain (rho = 0.6223, p = 0.0005) positively correlated with Intensive Care Delirium Screening Checklist score and were increased in patients with delirium (Intensive Care Delirium Screening Checklist ≥ 4) in the coronavirus disease 2019 group but not in ICU controls. There were no associations between the measures of respiratory function or cytokines with glial fibrillary acidic protein, total tau, ubiquitin carboxy-terminal hydrolase L1, or neurofilament-light chain levels in patients with coronavirus disease 2019. Plasma glial fibrillary acidic protein is two-fold higher in critically ill patients with coronavirus disease 2019 compared with ICU controls. Higher levels of glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and neurofilament-light chain associate with delirium in patients with coronavirus disease 2019. Elevated plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and neurofilament-light chain are independent of respiratory function and peripheral cytokines.

Shared Decision Making In Cardiology Practice: 15 Month Results of A Multi-Site Study of Decision Aid Implementation

Introduction In addition to a large body of research that shows decision aids (DA) are associated with better patient experiences for many health decisions, a multi-site randomized controlled trial that compared a DA for left ventricular assist device (LVAD) placement with standard LVAD education found that the DA significantly increased patient knowledge and satisfaction with life after implant. However, little evidence exists regarding best practices for implementation of a DA in real-world cardiovascular care. This project evaluated DA implementation at eight U.S. hospitals with a focus on increasing shared decision-making (SDM) and DA use. Methods Participating received a tailored implementation plan and SDM training. To understand the extent to which SDM enhanced behaviors were implemented, LVAD coordinators completed a 10-item Implementation Fidelity Checklist (score 0-10) for each patient. The primary outcome, reach to patients, is calculated by dividing the number of checklists received by the total number of patients receiving pre-LVAD education during evaluation. DA fidelity is calculated using LVAD coordinator self-report of the patient encounter on the Fidelity Checklist. Results Across sites, 607 patients received a DA from September 2018-December 2019. Reach ranged from 29.3%-87.9% of patients across sites with an overall reach of 58.2% and average Fidelity Checklist score of 8.4 (range 6.0-10.0). Over one-third (37.5%) of sites achieved overall reach > 80% indicating a high level of implementation success. Almost half of patients reviewed the DA with a caregiver (48.7%). Clinician users of the decision aid believed additional language translations of the DA and inclusion of institution-specific and personalized risk profiles would promote long-term sustainability of the DA at their institution. Conclusion Findings demonstrate that DAs and SDM can be implemented into diverse cardiovascular care settings with sustained use by clinicians, patients, and caregivers. Future work will evaluate implementation of new DA features requested by clinicians.

Functional connectivity associated with five different categories of Autonomous Sensory Meridian Response (ASMR) triggers

Autonomous sensory meridian response (ASMR) is a sensory-emotional phenomenon in which specific sensory stimuli ("ASMR triggers") reliably elicit feelings of relaxation and tingling sensations on the head, neck, and shoulders. However, there are individual differences in which stimuli elicit ASMR and in the intensity of these responses. In the current research, we used resting-state fMRI to examine the functional connectivity associated with these differences. Fifteen individuals with self-reported ASMR completed the ASMR Checklist, which measures sensitivity to different ASMR triggers, and a resting-state fMRI scan. Checklist scores were entered as covariates to determine whether the functional connectivity of eight resting-state networks differed as a function of participants' sensitivity to five categories of triggers. The results indicated unique patterns of functional connectivity associated with sensitivity to each ASMR trigger category. Sensitivity to two trigger categories was positively correlated with the dorsal attention network, suggesting that ASMR may involve atypical attentional processing.

See One, Do One, Forget One: Early Skill Decay After Paracentesis Training.

Internal medicine residents perform paracentesis, but programs lack standard methods for assessing competence or maintenance of competence and instead rely on number of procedures completed. This study describes differences in resident competence in paracentesis over time. From 2016 to 2017, internal medicine residents (n = 118) underwent paracentesis simulation training. Competence was assessed using the Paracentesis Competency Assessment Tool (PCAT), which combines a checklist, global scale, and entrustment score. The PCAT also delineates two categorical cut-point scores: the Minimum Passing Standard (MPS) and the Unsupervised Practice Standard (UPS). Residents were randomized to return to the simulation lab at 3 and 6months (group A, n = 60) or only 6months (group B, n = 58). At each session, faculty raters assessed resident performance. Data were analyzed to compare resident performance at each session compared with initial training scores, and performance between groups at 6months. After initial training, all residents met the MPS. The number achieving UPS did not differ between groups: group A = 24 (40%), group B = 20 (34.5%), p = 0.67. When group A was retested at 3months, performance on each PCAT component significantly declined, as did the proportion of residents meeting the MPS and UPS. At the 6-month test, residents in group A performed significantly better than residents in group B, with 52 (89.7%) and 20 (34.5%) achieving the MPS and UPS, respectively, in group A compared with 25 (46.3%) and 2 (3.70%) in group B (p < .001 for both comparison). Skill in paracentesis declines as early as 3months after training. However, retraining may help interrupt skill decay. Only a small proportion of residents met the UPS 6months after training. This suggests using the PCAT to objectively measure competence would reclassify residents from being permitted to perform paracentesis independently to needing further supervision.

Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homes.

BACKGROUND/OBJECTIVESIn April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID‐19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28‐point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes.DESIGNLongitudinal cohort study.SETTINGA total of 360 Massachusetts NHs.PARTICIPANTSThe Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123 “special focus” facilities with infection control deficiencies for on‐site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed of resources for the acquisition of personal protective equipment (PPE), backup staff, and SARS‐CoV‐2 testing.MEASUREMENTSWe used two data sources: (1) four state audits of all NHs, and (2) weekly NH reports to the Massachusetts Center for Health Information and Analysis. Primary independent process measures were the checklist scores and adherence to each of its six core competencies. Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff. We used a hurdle mixed effects model adjusted for county COVID‐19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths.RESULTSBoth resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups. Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates.CONCLUSIONThis statewide effort could serve as a national model for other states to prevent the devastating effects of pandemics such as COVID‐19 in frail NH residents.

Randomized controlled trials in non-pharmacological rehabilitation research: a scoping review of the reporting of sample size calculation, randomization procedure, and statistical analyses.

The randomized controlled trials (RCTs) are often considered as the gold standard for clinical trials and researchers argue that the quality of RCT reports should be of the highest standards due to their clinical significance. To review the quality of reporting of the sample size calculation methods, and randomization procedures, and assess whether the statistical analyses correlate as reported in the trials' Evidence acquisition and Evidence synthesis sections in non-pharmacological, physiological rehabilitation RCT interventions. A systematic electronic search was conducted in Cochrane Central from 1 January 2019 to 16 December 2019. Titles and abstracts were analyzed for inclusion independently by two authors, and disagreements were resolved by a third reader. Studies were included if they met the following criteria: 1) assessed and reported a type of non-pharmacological rehabilitation RCT (e.g. physiotherapy); 2) randomized intervention to patients with a disease comparing to healthy or patients without intervention as the comparison group; 3) published in an indexed journal; and 4) original research, available full text, human study, published in 2019, and written in English. The following information was extracted from the included articles: journal impact factor (JIF), sample size calculation methods (SS), randomization procedure (RND), and statistical analyses (STAT) reported. Analyzing the full text, whether SS and RND were reported or not and whether the STAT correlated with the Methods and Results sections. The prevalence of each statistical method was derived from the Methods section of the report and compared if it was reported in the Results section. The continuous variable of JIF was tested for normality and used for independent t-test for equality of means between categories. In addition, using Downs and Black checklist the methodological quality of the articles was assessed and categorized to be poor, fair, good, and excellent based on the checklist's score. Finally, the association between the assessed quality (categorical variable) of the articles and the reporting variables (categorical variables) was analyzed utilizing the Pearson χ2. One hundred and nighty-four articles were retrieved from the systematic search out of which 99 (51%) were included for data extraction and further analyses. About one in five (20.2%) and two in five (37.4%) did not properly and adequately report the SS and RND while one in five (19.2%) there was at least one mismatch in STAT. The JIF was not significantly associated to the quality of reporting of SS (t=1.974, P=0.051), RND (t=0.309, P=0.758), and STAT (t=-0.275, P=0.784). This finding could indicate that the quality of the journal did not assure the quality of the reporting these methods. However, there was a significant association between the assessed quality of the article measured with the Down's and Black checklist and the reporting of SS (χ2=29.149, DF=2, P<0.0001), RND (χ2=55.079, df=2, P<0.0001) and STAT (χ2=25.778, df=2, P<0.0001). Recent reporting quality of non-pharmacological rehabilitation RCTs was investigated. We found that the quality of the article but not the quality of the journal in which it is published in may be associated to the quality of reporting in sample size methods, randomization processes, and statistical analyses reporting. The quality of study reporting may be enhanced utilizing a guideline that addresses the required information in sample size calculation, randomization of individuals, and proper statistical analyses used and reported.

Prevalence of BRCA1 and BRCA2 Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation?

Background BRCA1/2 mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the BRCA1/2 mutation(s) based on the checklist score (CLS). Methods A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a BRCA1/2 genetic analysis result and a CLS was available. Out of 545 cases with a BRCA1/2 result (cohort A), 453 cases additionally had an extended gene panel result (cohort B). Results A BRCA1/2 mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non- BRCA1/2 genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a BRCA1 (n = 92) or BRCA2 (n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a BRCA1/2 mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. Conclusions The BRCA1/2 mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a BRCA1/2 mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.

Effectiveness of Stimulant Medications on Disruptive Behavior and Mood Problems in Young Children.

ObjectiveThere are very few studies on the effectiveness of stimulant medications for the treatment of disruptive mood and behavior problems in young children (less than 7 years) with Disruptive Behavior Disorders (DBD). The current study aims to determine whether young children (ages 4−7) in a long-term, intensive outpatient behavioral treatment program who are receiving stimulant medications show greater improvement in mood and behavior problems compared to peers who did not.MethodsA retrospective chart review was conducted for 97 participants diagnosed with DBD, aged 4−7 years old who were enrolled in an intensive outpatient behavioral intervention program. Pre- and post-intervention Child Behavior Checklist (CBCL) scores for disruptive behavior and mood problems were compared between the children who received stimulant medications and those who did not.ResultsPaired t tests showed a statistically significant improvement in CBCL outcomes between pre- and post-intervention scores of disruptive behavior and mood problems. ANCOVA analysis, however, showed no clear further improvement in those same CBCL scores in the participants who received stimulant medications compared to the participants who did not. CBCL scores for Conduct Disorder were marginally significant for less improvement for the participants who received stimulant medications.ConclusionThis retrospective review suggests a possibility that stimulant medications may not provide additional benefit for the long-term treatment of disruptive behavior and mood problems in young children under age 7. Future study is warranted to evaluate the efficacy/effectiveness of stimulant medications in the treatment of disruptive behavior and mood problems in this population.