Cross-sectional Feasibility Study Research Articles

Characterization of Great Toe Extension Strength Using ToeScale-A Novel Portable Device.

Great toe strength (GTS) weakness is linked to declines in balance and mobility. Accurately assessing GTS, particularly great toe extension strength (GTES), is often neglected in clinical evaluations due to cumbersome and subjective methods. This study aims to characterize the force development curve output from the ToeScale and examine GTES variations with age, sex, BMI, and grip strength (GS) using traditional analyses and machine learning (ML). We conducted a pilot, cross-sectional feasibility study with convenience samples. We assessed GS using a hand-grip dynamometer and GTES using the ToeScale. The data analysis included descriptive statistics, correlations, independent samples t-tests, and accuracy and area under the curve (AUC) scores for three ML models. Thirty-one participants (males: 9; females: 22), 14 young (18-24 years) and 17 older (>65 years) adults, participated in the study. Males had significantly higher peak GTES than females in both age groups. The associations of GTES parameters with BMI and GS varied by age and sex. The ML model accuracies and AUC scores were low-moderate but aligned with traditional analyses. Future studies with larger samples and optimized ML models are needed.

Use of a mobile application to monitor drain sites and surgical wounds after discharge from acute care - a feasibility study in Singapore

PurposeThis study aimed to demonstrate the compliance, feasibility, and acceptability of telehealth monitoring among surgical patients discharged with wounds or drains. MethodologyThis is a cross-sectional feasibility study. Post- surgical breast, plastic, and hepatobiliary patients with wounds and/or surgical drains were recruited using convenience sampling. The control group received conventional care which consisted of daily telephone follow-up. The intervention group used a mobile wound application to take wound and drain images, report drainage amount and symptoms. Compliance was assessed by measuring the percentage of actual to expected patient entries, feasibility was assessed by comparing detection of abnormalities and unexpected hospital visits, and acceptability was assessed by subjective feedback from nurses and patients from the intervention group. Results59 patients were recruited, with 30 patients in the control group and 29 patients in the intervention group. 9 specialty nurses were involved in the patients’ post- discharge care. The mean compliance rate for the hepatobiliary, breast and plastic patients were 89.9%, 89.5% and 75.9% respectively. 4 patients from the intervention group (13.8%) and 6 patients from the control group (20.1%) were flagged as having potential abnormalities. As for unexpected hospital visits, there were 2 (6.9%) in the intervention group and 1 (3.4%) in the control group. 25 patients and 9 specialty nurses responded to the feedback survey. 22 patients (88%) did not face any application issues. 18 patients (72%) preferred to self-report symptoms via the application rather than to call the nurses and reported feeling safe knowing that they are remotely monitored. Most nurses found the app convenient and timesaving (n=7, 78%), with monitoring through pictures as more accurate than phone conversation (n=8, 89%). ConclusionThe results suggest that use of a mobile application by surgical patients discharged with wounds or drains is feasible and serves as a viable monitoring tool.

Automated multivolume placental reconstruction using three-dimensional power Doppler ultrasound and infrared camera tracking.

Placental insufficiency contributes to many obstetric pathologies however there is no bedside clinical tool to evaluate placental perfusion. We have developed a method to acquire multiple three-dimensional power Doppler ultrasound (3D PD-US) volumes of placental vasculature with infrared camera tracking providing global coordinates. These are automatically reconstructed ('stitched') into a model of the entire placenta. The purpose of the study was to evaluate the accuracy of automated reconstruction in an US phantom and apply this technique to human placentas. A custom-designed acrylic phantom was constructed with dimensions mimicking a third-trimester placenta, containing 12 quadrilateral towers of varying heights submersed in tissue-mimicking solution. Triplicated three-dimensional ultrasound volumes of this phantom were acquired at three different acquisition angles using infrared camera tracking. Data was transformed into a three-dimensional cartesian volume and automatically stitched. A single-centre, cross-sectional feasibility study was conducted on uncomplicated second-to-third trimester singleton pregnancies using standardised obstetric settings. Multiple 3D PD-US and grayscale volumes of the placenta were acquired with infrared camera tracked coordinates. Volumes were stitched to create a model of placental vasculature. 6 phantom datasets were reconstructed at each of 3 volume angles with a median of 9 volumes required. Perfect volume alignment occurred in 66.7% of 648 datapoints. Mean distance error for volume misalignment was 2.92mm. Measurements of 210 distances in each stitched volume (2160 total distances) differed an average of 1.51mm from true measurements. These compare favourably with recent literature, though for a substantially larger phantom. 17 participants were scanned with 92% reconstruction success per placental volume set and 100% participant achievability. Median reconstruction time was 10 minutes. Placental vasculature was qualitatively assessed to be present, continuous, and detailed throughout. Volume measurement of entire segmented placentas was highly repeatable (ICC 0.96). We present an automated method to model the entire structure and vasculature of second-to-third trimester placentas, with verified accuracy and clinical feasibility for grayscale and power Doppler. This study builds the foundation to develop a practical screening tool for detecting placental insufficiency, and expansion to adult organ perfusion evaluation. This article is protected by copyright. All rights reserved.

Results of Gensingen Bracing in Patients With Adolescent Idiopathic Scoliosis: Retrospective Cross-Sectional Feasibility Study.

Bracing is an essential part of scoliosis treatment. The standard of brace treatment for patients with scoliosis today is still very variable in terms of brace quality and outcome. The Gensingen brace is a further developed Chêneau brace derivative with individual design, which can be adapted through computer-aided design. This study aims to generate a template to obtain a database for prospective multicenter studies study to analyze the results of high-corrective asymmetric Gensingen brace treatment for patients with adolescent idiopathic scoliosis (AIS). A template for the database was created, which contains the patients' basic data (age, menarcheal status, Risser Sign, curve pattern, and daily brace wearing time), the Cobb angles of curvature, and the cosmetically relevant angles of trunk rotation (ATR). A retrospective review of medical records of patients with AIS, who met the Scoliosis Research Society's inclusion criteria for brace studies, was performed to test the feasibility of the template. Template items were filled in by the researchers. Out of 115 patients between 2014 and 2018, the complete data of 33 patients followed up at least 3 months after complete Gensingen brace weaning could be analyzed. The mean age was 12 years, the mean Cobb angle was 33.6°, and the mean Risser value was 0.7 at the beginning of the treatment. The mean improvement in the Cobb angle on in-brace x-ray imaging was -26.1० (80% of in-brace correction). The Cobb angle of the major curvature changed as follows: curve stabilization was achieved in 7 (21.2%) cases, and curve improvement was achieved in 26 (78.8%) cases. None of the patients showed a curve progression. The Cobb angle was significantly reduced in the brace at the end of treatment and at follow-up evaluation (P<.001). ATR improved significantly for thoracic (P<.001) and lumbar curves (P<.001). The database proved to be informative in the assessment of radiological and clinical outcome parameters. The example data set we have generated can be a helpful tool for professionals who work in clinics but do not store regular patient data. Especially with regard to different patient collectives worldwide, different results may be achieved with the same standards of care. In addition, the results of this study suggest that above-average correction effects with a full-time brace application lead to significant improvements in the Cobb angle after brace treatment has been completed.

Novel Multidimensional Pain Assessment Tool Is a Feasible, Valid, and Enjoyable Approach to Communication of Pain Symptoms in Pediatric Sickle Cell Disease

Background: Pain is the most common symptom of sickle cell disease (SCD) and is especially difficult to assess in the pediatric population. Children have varied developmental stages and cognitive abilities making the communication of this subjective experience hard to operationalize. Both the assessment of pain and validation of these assessments is challenging. No pediatric pain assessment tool has been deemed valid and reliable across all ages and types of pain. Commonly used pediatric tools include the Wong-Baker Faces scale, the numeric rating scale, and the visual analog scale (VAS), which combines the visuals of faces and numeric rating. These are unidimensional - only assessing the severity of pain, and in the case of faces, can cause confusion between pain severity and patient affect. In children with SCD, accurate pain assessment is crucial to current and lifelong management. “Painimation” is a technology-based pain assessment tool that incorporates conceptual animations, rather than numbers or words, to characterize pain. These animations are intended to help clinicians better understand pain from the patient's perspective. They are dynamic and transcend language. For example, animations are designed to communicate dull pulsating pain, sharp electric pain, or anything in between. “Painimation” does not rely on verbal communication skills, making it ideal for use in the pediatric population. “Painimation” has been validated in adults with SCD and is currently in implementation trials. Our study aims to determine the feasibility and validity of “Painimation” in pediatric SCD. Methods: This is a single site non-randomized cross-sectional feasibility and validity study. Participants were 10 - 21 years old with SCD who presented to clinic in baseline health. Participants completed the Painimation application, which consists of a numeric pain rating scale (1-10), a front and back 2-dimensional body image that can be shaded to indicate areas affected by pain, and eight abstract animations intended to represent different pain qualities (tingling, shooting, stabbing, throbbing, pounding, cramping, electrifying, and burning). The patient chose up to three animations and the intensity of each chosen animation was adjusted using a sliding bar without numeric labels. The animations were presented to the patient without labeling the intended quality. The patients then completed a survey consisting of questions regarding the usability of Painimation, clinical questions regarding their disease, Lansky Play-Performance Scale, and validated patient reported outcomes questions (PedsQL, Ped-PRO-CTCAE, PROMIS). Results: We enrolled 30 participants between April 1 and July 31, 2023, with recruitment ongoing. Five records were incomplete and were not analyzed at this time. The mean ratings when asked whether 1) Painimation was easy to use, 2) the patient enjoyed using Painimation, and 3) the patient would use Painimation to communicate pain with their provider were respectively 3.28±.74 (SD), 3.08±.95, and 3.12±1.17 (scale 0-4), indicating a generally favorable result for feasibility. The median VAS score was 5.10 (IQR = 0.25, 8.25). Pain was most reported in the back lower chest (60%), front stomach (48%), and front chest (44%). The stabbing animation was the most chosen at 56% followed by the cramping animation at 20%. Electrifying and Cramping animations had the highest agreement with their intended McGill descriptors at 40%. VAS scores and Painimation severity scores demonstrated excellent positive correlation (Pearson r=.74). Conclusion: Painimation is a feasible pain assessment tool in pediatric SCD with high user satisfaction. Severity scores on Painimation correlate strongly with VAS scores. The pain characteristic conveyed by each animation adds unique dimensions to this measure and will be further analyzed. Painimation is a novel pediatric pain assessment that holds the promise of greatly improving the communication of pain and transforming care in Pediatric SCD.

Evaluating an online asynchronous Multiple Mini Interview (MMI) with ten principles of fairness built-in: findings from a cross-sectional feasibility study

Evaluating an online asynchronous Multiple Mini Interview (MMI) with ten principles of fairness built-in: findings from a cross-sectional feasibility study

Evaluating an online asynchronous Multiple Mini Interview (MMI) with ten principles of fairness built-in: findings from a cross-sectional feasibility study

Evaluating an online asynchronous Multiple Mini Interview (MMI) with ten principles of fairness built-in: findings from a cross-sectional feasibility study

Assessing the Global Cognition of Community-Dwelling Older Adults Using Motor and Sensory Factors: A Cross-Sectional Feasibility Study.

Impairments in gait, postural stability, and sensory functions were proved to be strongly associated with severe cognitive impairment such as in dementia. However, to prevent dementia, it is necessary to detect cognitive deterioration early, which requires a deeper understanding of the connections between the aforementioned functions and global cognition. Therefore, the current study measured gait, postural, auditory, and visual functions and, using principal component analysis, explored their individual and cumulative association with global cognition. The global cognitive function of 82 older Korean males was determined using the Montreal Cognitive Assessment. The motor and sensory functions were summarized into seven independent factors using factor analysis, followed by age and education-level-adjusted linear regression model analysis. The seven factors obtained using factor analysis were gait speed, gait stability, midstance, general auditory ability, auditory recognition, overall visual ability, and postural stability. The linear regression model included years of education, gait stability, postural stability, and auditory recognition, and was able to explain more than half of the variability in cognitive score. This shows that motor and sensory parameters, which are obtainable through wearable sensors and mobile applications, could be utilized in detecting cognitive fluctuations even in the early stages of cognitive deterioration.

Mini Nutrition Assessment-Short Form score is associated with sarcopenia even among nourished people - A result of a feasibility study of a registry.

This study aims to identify a new barrier to the use of the Mini-Nutrition Assessment Short-Form (MNA-SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population. The MNA-SF was completed, and individuals with a score of > 11 were considered nourished in this cross-sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). The MNA-SF scores for non-sarcopenia, pre-, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA-SF score association with pre-sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06-1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13-0.49, P < 0.001), and severe sarcopenia (OR = 0.20, 95% CI: 0.09-0.46, P < 0.001) was as significant as in the MNA-SF categories. Individuals with a score = 13 (compared with 14), had a higher risk of confirmed sarcopenia (OR = 10.07, 95% CI: 1.92-52.71, P = 006) and severe sarcopenia (OR = 12.09, 95% CI: 1.24-117.50, P = 0.032). Individuals with a score of 12 had a higher risk of confirmed sarcopenia (OR = 30.94, 95% CI: 4.25-103.02, P < 0.001) and severe sarcopenia (OR = 35.90, 95% CI: 4.25-303.07, P = 0.001) compared with subjects with a score of 14. The models also showed that MNA-SF < 13 could predict sarcopenia. There was a significant association between MNA-SF and confirmed and severe sarcopenia in nourished people. Sarcopenia assessment in people with MNA-SF < 13 can be beneficial. Developing a tool to identify the risk of malnutrition and sarcopenia at the same time based on MNA-SF can be considered.

Exploring the Use of an Electronic Competency Assessment Document Using iPad Minis to Assess Clinical Practice Competency in a Preregistration Nursing Program: A Cross-sectional Feasibility Study.

The aim of this study was to explore the feasibility of using iPad minis as a method of completing competency assessment in clinical practice. Digital technology helps to revolutionize all aspects of our lives. The use of digital technologies in clinical practice can facilitate a move toward a more flexible learning environment and enable students to adapt in a rapidly changing, interconnected world. The introduction of electronic clinical booklets in practice placements could facilitate the sharing of clinical information through connected healthcare systems, thus improving the student experience. A cross-sectional design was used in this study. A sample of BSc nursing students (n = 53) and clinically based healthcare professionals (n = 27) (preceptors and clinical placement coordinators) participated in this study. Data were collected using a modified version of Garrett and colleagues' instrument, the System Usability Scale, a demographics questionnaire, and three open-ended questions. There was a significant difference between the students and preceptors/clinical placement coordinators across all items with higher proportions of students (ranging from 66% to 75.5%), indicating that they agreed or strongly agreed with the reliability, ease of use, and effectiveness of the device in assessing their clinical competency (ranging from 11.1% to 40.7%). In addition, the iPad minis were found to be smaller, lighter, and easier to carry than paper-based booklets and encouraged students to access timely online learning resources during placement to help augment their learning. The use of iPad mini to complete the electronic competency assessment document as a replacement for a paper-based system to assess clinical practice is feasible. The introduction of electronic assessment documents should incorporate a robust training plan and standard operating procedures.

Classifying the physical activity indicator using machine learning and direct measurements: a feasibility study

Low levels of physical activity (PA) are related to an increased risk of death, hypertension, coronary disease, stroke, diabetes, and depression. Then, assessing the level of PA of a person is essential to create training programs that help prevent such risks. However, current measurements of PA are mainly subjective and tend to underestimate or overestimate the PA level of a person. This article intends the result of a pilot cross-sectional feasibility study that pretends to classify the PA level through direct and objective measurements. For this, direct measurements such as anthropometric and postural sway (PS) features from fifteen participants (8 Male and 7 Women) were obtained. To predict the level of PA machine learning technique of Support Vector Machines SVM was used. The classifier showed high F1, recall, and precision scores around 80%, and after feature importance selection and hyperparameter were tunned, they reached 100%. Results suggest that the use of direct measurements to classify the PA level is feasible and that there is a correlation between direct measurements and the IPAQ-SF, an indirect measurement that is typically used to assess the level of PA. This classifier intends to be a tool that helps trainers and physicians to endorse or adjust their physical training and rehabilitation procedures based on the objective evaluation of patients.

Feasibility of implementing a surgical patient safety checklist: prospective cross-sectional evaluation

BackgroundThe World Health Organization’s Global Patient Safety Action Plan 2021–2030 call for attention to patient and family involvement to reduce preventable patient harm. Existing evidence indicates that patients’ involvement in their own safety has positive effects on reducing hospitalisation time and readmissions. One intervention reported in the literature is the use of checklists designed for patients’ completion. Studies on such checklists are small scale, but they are linked to reduction in length of hospital stay and readmissions. We have previously developed and validated a two-part surgical patient safety checklist (PASC). This study aims to investigate the feasibility of the PASC usage and implementation prior to its use in a large-scale clinical trial.MethodsThis is a prospective cross-sectional feasibility study, set up as part of the design of a larger stepped-wedge cluster randomised controlled trial (SW-CRCT). Descriptive statistics were used to investigate patient demographics, reasons for not completing the PASC and percentage of PASC item usage. Qualitative patient interviews were used to identify barriers and drivers for implementation. Interview was analysed through content analysis.ResultsOut of 428 recruited patients, 50.2% (215/428) used both parts of PASC. A total of 24.1% (103/428) of the patients did not use it at all due to surgical or COVID-19-related cancellations. A total of 19.9% (85/428) did not consent to participate, 5.1% (22/428) lost the checklist and 0.7% (3/428) of the patients died during the study. A total of 86.5% (186/215) patients used ≥ 80% of the checklist items. Barriers and drivers for PASC implementation were grouped into the following categories: Time frame for completing the checklist, patient safety checklist design, impetus to communicate with healthcare professionals and support throughout the surgical pathway.ConclusionsElective surgical patients were willing and able to use PASC. The study further revealed a set of barriers and drivers to the implementation. A large-scale definitive clinical-implementation hybrid trial is being launched to ascertain the clinical effectiveness and scalability of PASC in improving surgical patient safety.Trial registrationClinicaltrials.gov: NCT03105713. Registered 10.04.2017

Feasibility study on the use of the modified Finnish Diabetes Risk Score in South African context: a case of home-based carers

Background: The Finnish Diabetes Risk Score (FINDRISC) tool is used to identify undetected cases of diabetes and risk scores. The FINDRISC tool outlines questions to ask, including anthropometric parameters to measure, during screening and detection of diabetes cases. This study assessed the feasibility for the introduction of FINDRISC tool for use in South Africa. The aim is to determine the overall competence of home-based carers (HBCs) in utilising this tool.Method: A quantitative approach and cross-sectional feasibility study was conducted involving 52 HBCs who were sampled using homogeneous purposive sampling. The study was conducted in clinics of Ga-Dikgale Village in Polokwane. A FINDRISC questionnaire was used to assess competence of HBCs. Data were analysed using SPSS, with both descriptive and inferential statistical analysis.Results: None (0%) of the participants were fully competent, 6% were incompetent and 94% were moderately competent on use of the FINDRISC tool.Conclusion: Most HBCs were moderately competent in the use of this tool, while none were competent. It is feasible that the FINDRISC tool can be adapted and utilised by HBCs in South Africa. However, a proper training should be offered to HBCs on the use of the FINDRISC tool. It is also recommended to assess components of requiring professionals considering the scope of work and qualification.

Screening for opioid use disorder and co-occurring depression and post-traumatic stress disorder in primary care in New Mexico

BackgroundIdentifying patients in primary care services with opioid use disorder and co-occurring mental health disorders is critical to providing treatment. Objectives of this study were to (1) assess the feasibility of recruiting people to screen in-person for opioid use disorder and co-occurring mental health disorders (depression and/or post-traumatic stress disorder) in primary care clinic waiting rooms in preparation for a randomized controlled trial, and (2) compare results of detecting these disorders by universal in-person screening compared to electronic health record (EHR) diagnoses.MethodsThis cross-sectional feasibility and pilot study recruited participants from four primary care clinics, two rural and two urban, from three health care organizations in New Mexico. Inclusion criteria were adults (≥ 18 years), attending one of the four clinics as a patient, and who spoke English or Spanish. Exclusion criteria were people attending the clinic for a non-primary care visit (e.g., dental, prescription pick up, social support). The main outcomes and measures were (1) recruitment feasibility which was assessed by frequencies and proportions of people approached and consented for in-person screening, and (2) relative differences of detecting opioid use disorder and co-occurring mental health disorders in waiting rooms relative to aggregate EHR data from each clinic, measured by prevalence and prevalence ratios.ResultsOver two-weeks, 1478 potential participants were approached and 1145 were consented and screened (77.5% of patients approached). Probable opioid use disorder and co-occurring mental health disorders were identified in 2.4% of those screened compared to 0.8% in EHR. Similarly, universal screening relative to EHR identified higher proportions of probable opioid use disorder (4.5% vs. 3.4%), depression (17.5% vs. 12.7%) and post-traumatic stress disorder (19.0% vs. 3.6%).ConclusionsUniversal screening for opioid use disorder, depression, and post-traumatic stress disorder was feasible, and identified three times as many patients with these co-occurring disorders compared to EHR. Higher proportions of each condition were also identified, especially post-traumatic stress disorder. Results support that there are likely gaps in identification of these disorders in primary care services and demonstrate the need to better address the persistent public health problem of these co-occurring disorders.

Automated wearable cameras for improving recall of diet and time use in Uganda: a cross-sectional feasibility study

BackgroundTraditional recall approaches of data collection for assessing dietary intake and time use are prone to recall bias. Studies in high- and middle-income countries show that automated wearable cameras are a promising method for collecting objective health behavior data and may improve study participants’ recall of foods consumed and daily activities performed. This study aimed to evaluate the feasibility of using automated wearable cameras in rural Eastern Ugandan to collect dietary and time use data.MethodsMothers of young children (n = 211) wore an automated wearable camera on 2 non-consecutive days while continuing their usual activities. The day after wearing the camera, participants’ dietary diversity and time use was assessed using an image-assisted recall. Their experiences of the method were assessed via a questionnaire.ResultsMost study participants reported their experiences with the automated wearable camera and image-assisted recall to be good (36%) or very good (56%) and would participate in a similar study in the future (97%). None of the eight study withdrawals could be definitively attributed to the camera. Fifteen percent of data was lost due to device malfunction, and twelve percent of the images were "uncodable" due to insufficient lighting. Processing and analyzing the images were labor-intensive, time-consuming, and prone to human error. Half (53%) of participants had difficulty interpreting the images captured by the camera.ConclusionsUsing an automated wearable camera in rural Eastern Uganda was feasible, although improvements are needed to overcome the challenges common to rural, low-income country contexts and reduce the burdens posed on both participants and researchers. To improve the quality of data obtained, future automated wearable camera-based image assisted recall studies should use a structured data format to reduce image coding time; electronically code the data in the field, as an output of the image review process, to eliminate ex post facto data entry; and, ideally, use computer-assisted personal interviews software to ensure completion and reduce errors. In-depth formative work in partnership with key local stakeholders (e.g., researchers from low-income countries, representatives from government and/or other institutional review boards, and community representatives and local leaders) is also needed to identify practical approaches to ensuring that the ethical rights of automated wearable camera study participants in low-income countries are adequately protected.

Smartphone and application use in self-management of chronic kidney disease: a cross-sectional feasibility study.

Smartphone and application use can improve communication and monitoring of chronic diseases, including chronic kidney disease, through self-management and increased adherence to treatment. To assess smartphone use in patients with chronic kidney disease on dialysis and their willingness to use mobile applications as a disease self-management strategy. This was a cross-sectional study of chronic kidney disease patients on hemodialysis in the São Francisco Valley in the Northeast Region, Brazil. The questionnaire developed by the authors was administered between April and June 2021. Cronbach's alpha coefficient for the construct was 0.69. Associations between the dependent and independent variables were determined using univariate analysis. Multivariate analysis with logistic regression analysis was also performed. A total of 381 patients were included, of whom 64% had a smartphone, although only 3.1% knew of a kidney disease-related application. However, 59.3% believed that using an application could help them manage their disease. Having a smartphone was associated with treatment adherence, higher educational attainment, and higher per capita income. Educational attainment remained an independent factor in multivariate analysis. More than 64% of patients had a smartphone, although few knew of applications developed for kidney disease. More than half of the population believed that technology use could benefit chronic kidney disease treatment. Smartphone ownership was more common among the younger population, with higher educational attainment and income, and was associated with greater adherence to hemodialysis sessions.

Caregivers’ Stress and Burden among Mothers of Children with Cancer: A Cross-Sectional Feasibility Study

Background In India cancer is rated as 9th among the causes of death in children aged 5-14 years. Cancer and its management has always been challenging in all dimensions including physical social psychological and spiritual with mothers majorly facing disturbing family experiences. Parents experience shock denial and the quality of life of the family gets affected.Objective To determine stress and burden among mothers of children with cancer.Methodology The study was conducted using a cross sectional survey design among 60 mothers of children with cancer. The sample was selected using simple random sampling technique according to the inclusion criteria. The data was collected using Kingston Caregiver Stress Scale KCSS and Caregiver Burden Self-Assessment CBSA scale.Results Majority of mothers included in the study were above 30 years of age with a mean age of 33.74plusmn6.51 years a monthly family income of less than Rs 29000- with mean income of 18200plusmn9788.80 per month and belonged to upper lower class. Majority of children with cancer were less than 10 years of age with mean age of 7.51plusmn5.44 years. More than 50 of children were males diagnosed with ALL. A significant association between caregiverrsquos stress and educational qualification of mothers of children with cancer p0.041 was observed. A positive correlation was found between caregiverrsquos stress and burden among mothers of children with cancer.Conclusion Majority of mothers experienced stress and burden due to their childrsquos diagnosis. Hence interventions should be developed and implemented to help mothers deal with their stress.

Improving Ankle Muscle Recruitment via Plantar Pressure Biofeedback during Robot Resisted Gait Training in Cerebral Palsy.

Neurological impairment from stroke or cerebral palsy often presents with diminished ankle plantar flexor function during the propulsive phase of gait. This deficit often results in slow, energy-expensive walking patterns that limit community mobility. Robotic gait training interventions may prove effective in improving functional outcomes, including exoskeleton resistance used to provide targeted neuromuscular recruitment. However, these interventions to date have required regular verbal cues and coaching for proper plantar flexor engagement with resistance, particularly for pediatric applications. In this validation study, we sought to address the need for automating and improving the effectiveness of facilitating user engagement with robotic resistance. Specifically, our main goal was to compare changes in plantar flexor activity between walking with plantar flexor resistance alone vs plantar flexor resistance combined with plantar pressure biofeedback in individuals with cerebral palsy. We recruited 8 ambulatory adolescents with cerebral palsy between the ages of 11-18 years old to participate in this cross-sectional feasibility study. Supporting our hypothesis, we observed a 36 ± 36% and 46 ± 39% increase in mean and peak soleus activity, respectively, between resistance plus biofeedback vs resistance alone (both p < 0.05). Compared to other biofeedback sensing modalities like assessment of muscle activity via surface electrodes, integrating the plantar pressure-based system within the wearable robotic devices minimizes barriers to clinical implementation by reducing cost, complexity, and setup time. With these positive feasibility results, our future work will explore longer-term training effects of ankle resistance combined with plantar pressure biofeedback.

0573 Daytime and Nighttime Sleep and Symptoms of Depression and Anxiety in Adults with Inflammatory Bowel Disease

Abstract Introduction Inadequate sleep duration and daytime napping are associated with symptoms of depression and anxiety in the general population. People with autoimmune diseases frequently experience poor sleep and depressive and anxious symptoms; however, little is known about how sleep might contribute to depressive and anxious symptoms in this population. The purpose of this study was to explore the associations between nighttime sleep and naps and depressive and anxious symptoms in adults with inflammatory bowel disease (IBD). Methods We conducted a cross-sectional feasibility study of adults with IBD (Crohn’s disease and ulcerative colitis) ages 18 to 60 years recruited from a single academic IBD center. We measured depressive and anxious symptoms using the Patient-Reported Outcomes Measurement Information System (PROMIS) measures. We elicited nighttime sleep [sleep duration, efficiency, and wake after sleep onset (WASO)] using wrist-worn actigraphs (Philips Spectrum Plus) and elicited naps and perceived sleep quality (analog scale 0-100) with sleep diaries over 10 days. Results We included 35 adults [age M = 37.8 (14.0); female N = 21 (60.0%); Crohn’s disease N = 18 (51.4%); clinical remission N= 22 (63.9%)]. Mean depression (51.4 SD= 9.1) and anxiety (52.6 SD = 9.9) were over the population-based cut-offs. Additionally, nightly sleep duration was short (M = 391.9 minutes SD = 52.5). Sleep efficiency (M = 83.0% SD = 5.5) was low, and WASO (M = 41.8 minutes SD = 19.9) was high. Twenty-one (60%) participants reported taking at least one nap (median = 2, range 1-7) over the 10 days. Depressive and anxious symptoms were higher in people who napped than those who did not nap with a moderate effect size (Cohen’s d = -.309, -.466 respectively). Sleep quality was correlated with symptoms of depression (r = .622, p &amp;lt; .001) and anxiety (r = .638, p &amp;lt; .001). No other sleep characteristics were associated with depressive and anxious symptoms (r &amp;lt; .1, p &amp;gt; .59). Conclusion Health care providers should assess for the presence of depression and anxiety in people with IBD who regularly nap and report poor sleep quality. Future research regarding the treatment of sleep, depression, and anxiety is needed in this population. Support (If Any) American Nurses Foundation

Toenail speciation biomarkers in arsenic‐related disease: a feasibility study for investigating the association between arsenic exposure and chronic disease

Long-term exposure to environmental arsenic has been associated with many chronic diseases, including several cancers, and diabetes. Urinary studies have implicated arsenic speciation as an important risk factor, however, such associations have not been replicated using toenail samples: a relatively new biosample for estimating long-term internal dose-exposure to arsenic. Despite having several advantages over conventional biosamples such as ease of collection and storage, standard methods for arsenic speciation analysis in toenails have not yet been established. The primary objectives of this study were to 1) establish an analytical method for arsenic speciation analysis in toenails, 2) describe preliminary arsenic speciation profiles of toenail samples from individuals with skin, lung, bladder, and kidney cancer, type II diabetes, and no known disease, and 3) determine if these speciation patterns differ between disease groups to inform the feasibility of subsequent research. A small cross-sectional feasibility study was carried out using 60 toenail samples and baseline questionnaire data from the Atlantic Partnership for Tomorrow’s Health (Atlantic PATH) study. Arsenic speciation profiles were determined using high performance liquid chromatography (HPLC) paired with inductively coupled plasma-mass spectrometry (ICP-MS). While no differences in total arsenic were found, arsenic speciation profiles were significantly different between certain cancer groups and the reference group with no known disease. Specifically, the percentage of monomethylarsonic acid (%MMA) was found to be significantly higher in the toenails of individuals with lung cancer and kidney cancer, compared to healthy individuals with similar total arsenic exposure. To the best of our knowledge, this is the first study to describe arsenic speciation patterns in individuals with several arsenic-related diseases using toenails: a convenient, non-invasive, biobankable sample capable of longer-term exposure estimation than conventional biosamples. These preliminary data provide evidence that toenail arsenic speciation patterns differ between groups with arsenic-related disease, and those with no known disease. Toenail arsenic speciation analysis is feasible and could potentially have important implications for research on arsenic-related diseases. Further investigation is warranted and would benefit from including detailed arsenic exposure data to explore the observed heterogeneity in arsenic speciation profiles.