Differences In Baseline Scores Research Articles

The application of the BOPPPS model in the ward rounds of nurses' standardized training in Southwest China: a mixed methods study.

Teaching ward rounds are the main teaching method used to develop clinical skills in standardized nursing training. However, the existing methods lack of cultivation of comprehensive ability and humanistic care for nurses, cannot meet the requirements of standardized training for nurses. BOPPPS (bridge-in, objective, pre-assessment, participatory Learning, post-assessment, and summary) is a student-centered teaching model that has been proven to enhance classroom teaching effectiveness. Therefore, the BOPPPS model was applied and its effectiveness in standardized nursing training was evaluated. In total, 260 nursing students were randomly allocated to two groups: the experimental group used the BOPPPS model and the control group used the traditional teaching model. This study used a mixed quantitative and qualitative research method to evaluate the effectiveness of the BOPPPS model. The quantitative results were as follows: no significant difference in baseline scores was observed between the two groups before training. After training, the theory and practical scores in the experimental group were significantly higher than that of the control group. Similarly, students in the experimental group presented higher comprehensive ability scores than their counterparts. The students in the experimental group also exhibited higher satisfaction compared to the control group, while there was no difference in teacher satisfaction scores between the two groups (p = 0.323). Qualitative data showed that the vast majority of nurses and teachers agreed on the value of BOPPPS training. Compared to traditional teaching methods, the BOPPPS model was more effective in standardized nursing training. We recommend applying the BOPPPS model to nursing training.

Type 2 Diabetes Comorbidity and Cognitive Decline in Patients with Alzheimer's Disease.

Although insulin dysregulation and resistance likely participate in Alzheimer's disease (AD) etiologies, little is known about the correlation between type 2 diabetes mellitus (T2DM) and the progression of cognitive decline in patients with AD. To determine whether AD patients with T2DM experience more rapid cognitive decline than those without T2DM. All cognitive performance data and the presence or absence of T2DM comorbidity in patients with AD were derived from the US National Alzheimer's Coordinating Center's (NACC) Uniform Data Set (UDS). A search of the UDS identified 3,055 participants with AD who had more than one epoch completed. The data set culled clinically diagnosed AD dementia patients who were assessed for diabetes type identified during at least 1 visit. These patients were divided into 2 groups based on whether they had a diagnosis of T2DM. The data from these groups were then analyzed for differences in cognitive decline based on neuropsychological test battery scores and a Clinician Dementia Rating using a general linear model. Comparisons of the mean scores for 16 selected tests from the neuropsychological test battery showed no significant differences in baseline scores and scores at subsequent visits between the T2DM and nondiabetic groups. The results revealed no differences in cognitive decline metrics over the course of 5 visits in either study group. These data indicate that the presence of T2DM does not increase the rate of cognitive decline in AD. This finding contradicts expected disease burden and will need to be explored further.

Sex-related differences in PROMs prior to the outcome: comparison of preoperative PROMIS physical function scores in female vs. male patients undergoing shoulder arthroplasty

Patient-reported outcome measures (PROMs) are increasingly used to evaluate outcomes in patients undergoing shoulder arthroplasty. The Patient-Reported Outcome Measures Information System (PROMIS) is popular due to low cost and question burden. Females have been reported to have lower postoperative PROMIS scores after shoulder surgery, but studies have not focused on a dedicated cohort of shoulder arthroplasty patients or examined upstream differences in preoperative scores. This study aimed to characterize sex differences in baseline PROMIS scores among anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) patients. Data were collected over a 9-month period. Demographics, Charlson Comorbidity Index (CCI), smoking status, BMI, American Shoulder and Elbow Surgeons (ASES) scores, PROMIS Pain, Physical Function (PF), Upper Extremity, Depression, and Anxiety scores, as well as Single Assessment Numeric Evaluation (SANE) scores were collected. Student t-tests were performed to determine correlation with baseline PROMs. A minimal clinically important difference (MCID) of 4 was used to determine if a PROMIS score difference between groups was clinically important. Significance was set as P<.05. A total of 88 females (34 TSAs 54 rTSA) and 99 males (35 TSA, 64 rTSA) were enrolled. Only sex showed a correlation with preoperative PROMIS score. In rTSA patients, females had significantly lower preoperative PROMIS PF scores (P<.05). Among females undergoing TSA vs. rTSA, lower preoperative PROMIS PF scores were found in rTSA (P<.05). These differences exceeded the MCID of 4. The same difference was not found in men undergoing TSA vs. rTSA. Preoperative sex-based differences in PROMIS scores are underappreciated in the shoulder arthroplasty literature. This is the largest study to date focusing on sex-based differences among a dedicated cohort of TSA and rTSA patients, showing a difference in baseline PROMIS scores between males and females above the MCID. These findings suggest that PROMIS scores are affected by sex-based baseline differences in rTSA patients. Further study should investigate sex-based differences in baseline scores to determine their effects on ultimate outcome.

You Matter: Elevating the Community Voice to Improve Patient Knowledge of Severe Maternal Morbidity Warning Signs Through Innovative Video Education at Postpartum Discharge [ID: 1375906

INTRODUCTION: The objective of this study was to determine whether a standardized video education campaign “You Matter” at postpartum discharge improves knowledge of warning signs for predominant causes of maternal morbidity (infection, hemorrhage, hypertensive disorders, and postpartum depression) compared to routine written instructions. METHODS: This was a randomized controlled trial of patients who delivered at a large, urban, tertiary care hospital. Eligible patients were enrolled and completed a baseline knowledge questionnaire. After delivery, they were randomized to written education or written plus video education, which was created with input from community stakeholders and included animated, ethnic and culturally diverse characters. After education, patients completed the same questionnaire. The primary outcome was improvement in patient knowledge, assessed by the number of correct responses. This study received IRB approval. RESULTS: From July to August 2022, 200 patients were enrolled (100 per group). Overall, patients were highly educated (college and/or graduate education, 82%) and most had commercial insurance (73.5%). There was no significant difference in baseline scores between the video and routine education (median 12 [11–14] versus 12 [11–13], P=.53). In the video arm, patients had significantly higher scores on posteducation questionnaires (median 14 [12–15] versus 13 [12–14], P&lt;.01), and patients improved their scores more frequently than their written counterpart (62.4% versus 50.0%, P=.08). Patients more frequently reported that video education was “very helpful” (86.1% versus 73.2%) and were “very satisfied” with their education (86.1% versus 76.3%). CONCLUSION: Enhanced postpartum education through a novel video at discharge yielded statistically higher scores on posteducation questionnaires, as well as more frequently improved scores and satisfaction in their care.

Does the presence of type II Diabetes affect cognitive decline in Alzheimer’s Disease Dementia?

AbstractBackgroundAlzheimer’s disease (AD) is sometimes referred to as Type 3 diabetes. While it is very likely that insulin dysregulation and resistance participate in the etiology of AD pathologies, little is known about the possible correlation between diabetes and the progression of cognitive decline in AD patients. Previous studies have shown an increased risk of developing AD in patients with type 2 diabetes mellitus (T2DM). The specific aim of our study was to determine whether differences exist in cognitive decline experienced by AD subjects with and without T2DM co‐morbidity.MethodAll cognitive performance data and the presence or absence of T2DM co‐morbidity in AD patients used in the present report were derived from the Uniform Data Set (UDS) of the database maintained by the National Alzheimer’s Coordinating Center (NACC), USA. The scanning of the UDS database identified 3055 participants with AD who had more than one epoch completed. The dataset culled clinically‐diagnosed AD patients who were assessed for diabetes type in form A5 or D2 during at least one visit. These patients were divided into two groups dependent upon the presence of a diagnosis of T2DM. The data from these groups was then analyzed for differences in cognitive decline based upon Neuropsychological Battery Scores and a Clinician Dementia Rating (CDR) using a general linear model.ResultCognitive function tests looked at language, cognitive executive function, and verbal and nonverbal memory. Comparison of the mean scores in 16 selected tests from the Neuropsychological Battery test showed no significant differences in baseline scores and scores at subsequent visits between the T2DM and non‐diabetic groups.ConclusionUsing the NACC database, which receives longitudinal data from Alzheimer’s Disease research Centers (ADRCs), it was found that there were no differences in cognitive decline metrics over the course of 5 visits in either group. This supports the position that the presence of T2DM does not appear to increase the magnitude of cognitive decline in AD patients

Phase I Study to Assess Safety of Laser-Assisted Topical Administration of an Anti-TNF Biologic in Patients With Chronic Plaque-Type Psoriasis.

Ablative fractional laser treatment facilitates epidermal drug delivery, which might be an interesting option to increase the topical efficacy of biological drugs in a variety of dermatological diseases. This work aims at investigating safety and tolerability of this new treatment approach in patients with plaque-type psoriasis. Eight patients with plaque-type psoriasis were enrolled in this study. All patients received (i) ablative fractional laser microporation (AFL) of a psoriatic lesion with an Er:YAG laser + etanercept (ETA; Enbrel® solution for injection) (AFL-ETA), (ii) ETA alone on another lesion, and, if feasible, (iii) AFL alone on an additional lesion. Overall, all treatment arms showed a favorable safety profile. AFL-ETA improved the lesion-specific TPSS score by 1.75 vs. baseline, whereas ETA or AFL alone showed a TPSS score improvement of 0.75 points, a difference that was not statistically significant and might be attributable to differences in baseline scores. Topical administration of ETA to psoriatic plaques via AFL-generated micropores was generally well-tolerated. No special precautions seem necessary in future studies. Clinical benefit will need assessment in sufficiently powered follow-up studies.

Improving sleep medicine education among health professions trainees.

Despite increasing recognition of its importance, sleep medicine education remains limited during medical training. We sought to assess the baseline knowledge of a group of health professions trainees and to determine whether an educational sleep medicine "boot camp" led to improvement in sleep medicine knowledge. Participants attended a 2-day introduction to sleep medicine course designed for new sleep medicine fellows in July 2017 and 2018. Participants completed 2 validated sleep knowledge questionnaires (The Assessment of Sleep Knowledge in Medical Education and The Dartmouth Sleep Knowledge and Attitude Survey) prior to and at the conclusion of the course. A total of 21 health professions trainees including 14 sleep medicine fellows completed both presurveys and postsurveys. Baseline Assessment of Sleep Knowledge in Medical Education Survey score was 21.4 ± 3.4 out of 30 (71.4% ± 11.4%) and baseline Dartmouth Sleep Knowledge and Attitude Survey score was 16.1 ± 2.4 out of 24 (67.3% ± 9.9%). There was no difference in baseline scores between sleep medicine fellows and other health professions trainees. There was a statistically significant improvement in the Assessment of Sleep Knowledge in Medical Education Survey (2.9 ± 2.1 points, P = .004) and Dartmouth Sleep Knowledge and Attitude Survey (2.5 ± 3.0 points, P = .001) scores among all participants after the course, without a difference in degree of improvement among sleep medicine fellows compared to other health professions trainees. Our findings suggest that baseline sleep medicine knowledge is higher than previously reported among health professions trainees. An educational sleep medicine boot camp improved knowledge even in a group of learners with high baseline knowledge and interest in sleep medicine, including new sleep medicine fellows. Wappel SR, Scharf SM, Cohen L, etal. Improving sleep medicine education among health profession trainees. J Clin Sleep Med. 2021;17(12):2461-2466.

Autologous Micro-Fragmented Adipose Tissue (MFAT) to Treat Symptomatic Knee Osteoarthritis: Early Outcomes of a Consecutive Case Series.

The study aimed to evaluate the short-term clinical effect, therapeutic response rate (TRR%), and therapy safety of a single intra-articular autologous MFAT injection for symptomatic knee OA. Secondly, patient- and pathology-related parameters were investigated to tighten patient selection for MFAT therapy. Sixty-four subjects with symptomatic mild–severe knee OA were enrolled in a single-center trial and received a unilateral (n = 37) or bilateral (n = 27) MFAT injection. After liposuction, the adipose tissue was mechanically processed with the Lipogem® device, which eventually produced 8–10 cc of MFAT. Subjects were clinically assessed by means of the KOOS, NRS, UCLA, and EQ-5D at baseline and 1, 3, 6, and 12 months after injection. Adverse events were recorded at each follow-up timepoint. The TRR was defined according to the OMERACT-OARSI criteria and baseline MRI was scored following the MOAKS classification. The TRR of the index knee was 64% at 3 months and 45% at 12 months after injection. Therapy responders at 12 months improved with 28.3 ± 11.4 on KOOS pain, while non-responders lost −2.1 ± 11.2 points. All clinical scores, except the UCLA, improved significantly at follow-up compared to baseline (p < 0.05). In the bilateral cohort, no difference in baseline scores or TRR was found between the index knee and contralateral knee (n.s.). An inflammatory reaction was reported in 79% of knees and resolved spontaneously within 16.6 ± 13.5 days after MFAT administration. Numerous bone marrow lesions (BML) were negatively correlated with the TRR at 12 months (p = 0.003). The study demonstrated an early clinical improvement but a mediocre response rate of 45% at 12 months after a single intra-articular injection with autologous MFAT. Assessment of bone marrow lesions on MRI can be helpful to increase the therapeutic responsiveness of MFAT up to 70% at 12 months. In comparison to repetitive injection therapies such as cortisone, hyaluronic acid, and PRP, administration of MFAT might become a relevant alternative in well-selected patients with symptomatic knee OA.

Evaluation of a self-management intervention for adults with epilepsy in Taiwan: A longitudinal randomized controlled trial

PurposeEpilepsy is a neurological disease that causes recurrent seizures and can have a significant impact on a person’s quality of life (QOL). A self-management intervention (SMI) can allow adults with epilepsy to modify behaviors in order to manage their seizures and evaluate the impact of medication and treatments on their daily lives. The purpose of this study was to investigate the effects of a SMI for adults with epilepsy. MethodsThis was a longitudinal randomized controlled trial. Adults with epilepsy between the age of 20 and 65 years were recruited from a medical center in northern Taiwan. Participants were assigned to an intervention group (IG) or control group (CG) through simple randomization. Data regarding demographic and clinical characteristics were collected at baseline (T0). In addition, participants answered nine validated self-report questionnaires, which were used as outcome measures. Following collection of baseline data, the CG received routine monthly counseling over the next 3 months. The IG received the routine monthly counseling, as well as individual face-to-face health counseling on self-management 1 h/month and remote counseling via the phone or computer network at least twice per month. After the first month (T1) and at the end of the third (T2) and sixth months (T3) participants answered the nine questionnaires again. Differences in outcomes between the IGs and CGs were analyzed by comparing scores for the nine outcome variables at T0 with scores at T1, T2, and T3 with generalized estimating equations. ResultsA total of 210 adults agreed to participate in the study; however, only 155 participants completed the questionnaires for all three time points: 75 in the CG and 80 in the IG. The mean age of the 155 participants was 39.6 years (SD = 10.9). There was no significant difference between demographic or clinical variables between the two groups. The only difference in baseline scores (T0) among the nine self-report questionnaires was in epilepsy knowledge, measured with the Epilepsy Knowledge Profile questionnaire, which were significantly higher for the CG (mean = 32.28, SD = 3.92) than the IG (mean = 23.01, SD = 2.79) (p < 0.001). Generalized estimating equations (GEE) analysis showed scores decreased significantly at T3 from baseline for the CG for epilepsy knowledge and QOL (p < 0.001). Improvements in scores for sleep quality, anxiety, depression, self-efficacy, coping, and social support did not differ between groups.Classification of the IG by gender showed a significantly greater increase for males compared with females from baseline to T3 for epilepsy knowledge (p < 0.001). If we further classified the IGs by seizure frequency, participants with a seizure frequency of ≥1 per year had a more significant increase in epilepsy knowledge and increase in QOL compared with participants with a seizure frequency of <1 per year at T3 compared with T0. ConclusionThe lack of improvement in health-related quality of life (HRQoL) following the SMI may indicate that additional time is required to change behaviors that impact this variable for patients with epilepsy. Additional research should focus on variables associated with medication compliance, epilepsy knowledge, medicine symptom distress, self-efficacy, anxiety, and HRQoL.

Portuguese Abstracts for Volume 32, Issue 9, 2020

Abstract Objective: To assess the impact of implementation of the TeamSTEPPS teamwork improvement concept on patient safety culture. Design: Pre–post culture assessment using the Hospital Survey on Patient Safety Culture, at baseline and 1 year after implementation of TeamSTEPPS. Setting: Two maternity wards within the same 480-bed multisite teaching hospital. Intervention: Implementation of the TeamSTEPPS teamwork improvement concept. Main Outcome Measures: Analysis of variation of the percentage of positive responses (score) in both wards (intervention and control) was conducted. Results: There was a significant increase in scores in three dimensions of patient safety culture in the intervention ward: Supervisor/Manager Expectations and Actions Promoting Safety increased from 48.7% in 2015 to 70.8% in 2016 (P &amp;lt; 0.005); Teamwork Within Units increased from 35.5% in 2015 to 54.5% in 2016 (P &amp;lt; 0.005); Nonpunitive Response to Errors increased from 16.7% in 2015 to 32.3% in 2016 (P &amp;lt; 0.005). Other dimensions showed no significant changes. In the control ward, there was a significant decrease in scores in one dimension. A secondary analysis of differences in differences still shows significant improvement in one dimension (Supervisor/Manager Expectations and Actions Promoting Safety P &amp;lt; 0.005). Conclusion: After implementing the TeamSTEPPS teamwork concept, patient safety culture significantly improved for 3 of 12 dimensions in the intervention group. When controlling for differences in baseline scores between implementation and control wards, a significant improvement remains in one dimension. This suggests that TeamSTEPPS could be considered when seeking to enhance patient safety culture, especially in high-risk environments such as maternity wards.

Comparison of driving capacity among patients with amyotrophic lateral sclerosis and healthy controls using the lane change task

ObjectiveCompare driving capacity of individuals with Amyotrophic Lateral Sclerosis (ALS) and healthy controls (HC) using a driving simulation program. MethodsA prospective study was performed on individuals with ALS who reported they were still driving, and a group of HCs. Demographic data included age and gender. Assessment included cognitive assessments (Montreal cognitive assessment [MoCA] and ALS Cognitive Behavioral Scale [ALS-CBS]); gait speed (m/s); ALS Functional Rating Scale-revised total score (ALSFRS-R); and simulated driving assessment (Lane Change Task [LCT]). The LCT is a simple assessment tool which simulates the visual, cognitive, and motor demands of driving to detect at-risk drivers and uses distractions (secondary tasks) to quantify the performance loss on the primary task (lane changes). ResultsTwenty-eight individuals with ALS (22 males, mean age 64 years) and 20 HCs (7 males, mean age 59 years) were studied. Individuals with mild to moderate ALS (ALSFRS-R mean 36.2) were older, had mild cognitive difficulty (MoCA 24 vs 27; ALS-CBS 14.19 [SD 3.85]) and mobility decline (gait speed 1.1 vs 1.4 m/s) compared to HC. Driving assessment using the LCT found no differences in baseline scores or during motor, cognitive, or visually distracting conditions. ConclusionsIndividuals with ALS with mild to moderate disease progression, with cognitive and motor weakness still demonstrate similar driving capacity to HCs using a driving simulation task. Driving assessment needs to be expanded longitudinally and perhaps with more robust measures to more precisely identify types of driving challenges that lead to cessation of driving in individuals with ALS.

Penalty success in professional soccer: a randomised comparison between imagery methodologies

Abstract Objectives The PETTLEP model is one of the most cited forms of imagery training to enhance sporting performance, but there is limited evidence for its long-term effectiveness and it is often compared to non-imagery controls rather than other imagery techniques. We compared PETTLEP with an imagery-based behavioural change intervention, Functional Imagery Training (FIT), and assessed long-term effectiveness for enhancing professional soccer player’s penalty kick taking. Methods Thirty male professional soccer players conducted a group goal setting task, were introduced to imagery, then randomly assigned to three conditions; individual PETTLEP, group-based FIT, or a control. Baseline penalty kick success was measured, then interventions commenced lasting for a week after which, penalties were conducted again. Penalties were conducted for a third time between 15 and 17 weeks after baseline measurements. Results There were no differences in baseline scores between conditions on vividness of imagery and penalty kicking. Whilst the control condition did not improve, both imagery conditions improved penalty performance after one week, as did their vividness of imagery scores. However, after 15 weeks, only the FIT for groups condition maintained improvements on penalty scores and PETTLEP returned to baseline. Conclusions Imagery is effective in improving penalty kick taking, but PETTLEP does not support long-term change, whereas the motivational approach of FIT does.

Quality of life in children with infrequent congenital heart defects: cohort study with one-year of follow-up

BackgroundThe evidence regarding patient related outcomes in children with infrequent congenital heart defects (I-CHD) is very limited. We sought to measure quality of life (QoL) in children with I-CHD, and secondarily, to describe QoL changes after one-year of follow-up, self-reported by children and through their caregivers’ perspective.MethodsWe assembled a cohort of children diagnosed with an I-CHD in a cardiovascular referral center in Colombia, between August 2016 and September 2018. At baseline and at one-year follow-up, a clinical psychology assessment was performed to establish perception of QoL. The Pediatric Quality of Life Inventory (PedsQL) 4.0 scale was used in both general and cardiac modules for patients and for their caregivers. We used a Mann-Whitney U test to compare scores for general and cardiac modules between patients and caregivers, while a Wilcoxon test was used to compared patients’ and caregivers’ baseline and follow-up scores. Results are presented as median and interquartile range.ResultsTo date, QoL evaluation at one-year follow-up has been achieved in 112/157 patients (71%). Self-reported scores in general and cardiac modules were higher than the QoL perceived through their caregivers, both at baseline and after one-year of follow-up. When compared, there was no statistically significant difference in general module scores at baseline between patients (median = 74.4, IQR = 64.1–80.4) and caregivers scores (median = 68.4, IQR = 59.6–83.7), p = 0.296. On the contrary, there was a statistical difference in baseline scores in the cardiac module between patients (median = 79.6, IQR = 69.7–87.4) and caregivers (median = 73.6, IQR = 62.6–84.3), p = 0.019. At one-year of follow-up, scores for the general module between patients (median = 72.8, IQR = 59.2–85.9) and caregivers (median = 69.9, IQR = 58.1–83.7) were not statistically different (p = 0.332). Finally, a significant difference was found for cardiac module scores between patient (median = 75.0, IQR = 67.1–87.1) and caregivers (median = 73.1, IQR = 59.5–83.8), p = 0.034.ConclusionsQoL in children with I-CHD can be compromised. However, children have a better perception of their QoL when compared with their caregivers’ assessments. To provide high-quality care, besides a thorough clinical evaluation, QoL directly elicited by the child should be an essential aspect in the integral management of I-CHD.

The effects of traditional massage on spasticity of children with cerebral palsy: a randomized controlled trial.

To examine the effects of traditional massage on spasticity of children with cerebral palsy. The randomised control trial was conducted at the National Institute of Rehabilitation Medicine, Islamabad, Pakistan, from September 2016 to August 2018, and comprised children with spastic cerebral palsy aged 2-10 years who were randomly allocated to control and intervention groups. Both the groups received routine physical therapy once daily, five times a week for three months. The intervention group additionally received traditional massage. Spasticity was evaluated using the Modified Ashworth Scale at baseline, and after 6th and 12th weeks of intervention. Data analysed using SPSS 20.. Of the 86 subjects enrolled, 75(87.2%) completed the study; 37(49.3%) in the control group with a mean age of 6.81±2.31 years, and 38(50.6%) in the intervention group with a mean age of 7.05±2.47 years. There were 25(68%) boys among the controls and 22(58%) in the intervention group. There was no statistically significant difference in baseline scores between the groups (p>0.05). At 6th week, reduction in scores was statistically significant in the right upper limb (p<0.05), and in the right lower limb (p<0.05) after the 12th week. Traditional massage was found to have significant effect on the right side compared to the routine physical therapy for reduction of spasticity in children with cerebral palsy.

Is the Patient-Reported Outcome Measurement Information System Feasible in Bundled Payment for Care Improvement in Total Hip Arthroplasty Patients?

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS) is increasingly used to assess patient health. The Bundled Payment for Care Improvement (BPCI) initiative for total hip arthroplasty (THA) was introduced to decrease costs and improve clinical care. We investigated differences between BPCI and non-BPCI THA patients and their PROMIS scores, along with its feasibility and responsiveness in these populations. MethodsWe included all consecutive patients receiving unilateral primary THA who also had preoperative and one-year postoperative PROMIS physical function (PF), PROMIS pain interference (PI), and PROMIS depression (DEP) scores. Demographics and PROMIS scores were compared. Test burden was assessed using the number of questions and time required for PROMIS completion. The minimum clinically important difference was defined as 5. Floor and ceiling effects were noted if more than 15% of patients responded with the lowest or highest possible score, respectively. Wilcoxon rank-sum test was used to compare categorical data. ANOVA was used for PROMIS comparisons. Results290 hips (86 BPCI, 30%) were included. The BPCI cohort was older (P < .001) with a higher American Society of Anesthesiologists physical status classification system (P = .0045). There were significant differences in baseline scores of PF and DEP between BPCI and non-BPCI (P = .046 and P = .048, respectively). Both groups showed significant improvement at follow-up in all scores (all P < .001). Significantly more non-BPCI patients achieved minimum clinically important difference at follow-up in PI and PF (P = .047 and P = .023, respectively). Floor effects were identified for DEP at baseline and follow-up and for PI at follow-up only. ConclusionPROMIS is feasible and time-efficient in BPCI patients undergoing primary THA. There were significant differences between BPCI and non-BPCI hips. Level of EvidenceLevel III.

Increasing Nephrologist Awareness of Symptom Burden in Older Hospitalized End-Stage Renal Disease Patients

Background: End-stage renal disease (ESRD) patients have significant symptom burden. Reduced provider awareness of symptoms contributes to underutilization of symptom management resources. Method: We hypothesized that improved nephrologist awareness of symptoms leads to symptom improvement. In this prospective, multicenter interventional study, 53 (age >65) ESRD inpatients underwent symptom assessment using the modified Edmonton Symptom Assessment System (ESAS) at admission and 1-week post-discharge. Physicians caring for the enrollees were asked if they felt their patients would die within the year, and then sequentially randomized to receive the results of the baseline survey (group 1) or to not receive the results (group 2). Results: Fifty-two patients completed the study; 1 died. Baseline characteristics were compared. For 70% of the total cohort, physicians reported that they would not be surprised if their patient died within a year. There was no difference in baseline scores of the patients between the 2 physician groups. Severity ratings were compared between in-hospital and post discharge scores and between physicians who received the results versus those that did not. Total ESAS scores improved more in group 1 (12.9) than in group 2 (9.2; p = 0.04). Among individual symptoms, there was greater improvement in pain control (p = 0.02), and nominal improvement in itching (p = 0.03) in group 1 as compared to group 2. There were 3 palliative care consults. Conclusions: Our findings reinforce the high symptom burden prevalent in older ESRD patients. The improvement in total scores, and individual symptoms of pain and itching in group 1 indicates better symptom control when physician awareness is increased. Residual symptoms post hospitalization and low utilization of palliative care resources are suggestive of a missed opportunity by nephrologists to address the high symptom burden at the inpatient encounter, which is selective for sick patients and/or indication of inadequacy of dialysis to control these symptoms.

Male Sex Predicts Higher Depression Scores Among Healthy Collegiate Athletes

ObjectiveTo 1) investigate differences in baseline scores on the Hospital Anxiety and Depression Scale (HADS) between male and female athletes and 2) examine the influence of concussion history on baseline HADS scores.BackgroundAlthough post-concussion differences between sexes have been documented, whether male and female athletes differ in reporting mental health outcomes and how concussion history may influence scores remains to be fully investigated. Since athletes may experience anxiety and depression after a concussion, screening prior to the beginning of an athletic season (baseline) may identify those who are prone to post-concussion mental health disturbances.Design/MethodsOne hundred fifty-two collegiate athletes (86 males, 66 females) completed a HADS assessment during baseline testing. Each participant also reported the number of diagnosed concussions he or she previously sustained. We used independent samples t-tests to compare baseline HADS scores between male and female athletes, and a multiple linear regression to examine the relationship between baseline HADS scores, sex, and concussion history.ResultsFemale athletes reported significantly lower HADS depression scores at baseline compared to males (Females: 0.92 ± 1.49, Males: 1.77 ± 2.22, F = 2.78, p = 0.01). There were no significant sex differences in HADS anxiety scores (Females: 4.53 ± 2.80, Males: 4.51 ± 2.84, F = 0.02, p = 0.97), but both sexes had higher anxiety outcomes than depression. There was an independent association between higher HADS depression scores and male sex (β = −0.84, p = 0.01; 95% CI = −1.47, −0.21), but not concussion history (β = −0.09, p = 0.66, 95% CI = −0.51, 0.33). Neither sex nor concussion history were significantly associated with HADS anxiety scores.ConclusionsFemale athletes reported lower levels of depression at baseline than males. Concussion history did not appear to influence anxiety or depression baseline scores. Psychological measures could be evaluated, both at baseline and prior to post-concussion return to play, to help identify those who may need more focused monitoring of mental health.

The enhancing effects of Biobran/MGN-3, an arabinoxylan rice bran, on healthy old adults' health-related quality of life: a randomized, double-blind, placebo-controlled clinical trial.

The world's older population is growing rapidly and the need to find measures to combat age-associated decline of physical, mental, and cognitive functions and improve their health-related quality of life (HRQOL) is escalating. Biobran/MGN-3, an arabinoxylan rice bran, has been previously reported to improve the quality of life in cancer patients. The objective of the current study was to examine the effect of a low dose of Biobran/MGN-3 supplementation on the HRQOL in a healthy older adult population. Sixty apparently healthy subjects, 40 males and 20 females, over 56years old were recruited and blindly randomized into two group receiving either placebo or Biobran/MGN-3 (250mg/day for 3months). Participants did not take any vitamins or medications during the study and their health was closely monitored. HRQOL was assessed at the initiation and termination of the study using the previously validated Arabic version of SF-12v2 questionnaire. For all measured HRQOL domains, there was no statistically significant difference in baseline scores between the two groups. Compared to baseline values and placebo-treated subjects, Biobran/MGN-3 supplementation significantly enhanced the levels of physical and mental component summary scores as well as role-physical, bodily pain, vitality, and social functioning subdomain scores. These results show that Biobran/MGN-3 is a promising psychoneuroimmune modulatory agent that could improve the HRQOL in healthy old adults.

Psychological screening of adults and young people following the Manchester Arena incident.

Terrorist attacks have increased globally since the late 1990s with clear evidence of psychological distress across both adults and children and young people (CYP). After the Manchester Arena terrorist attack, the Resilience Hub was established to identify people in need of psychological and psychosocial support. To examine the severity of symptoms and impact of the programme. The hub offers outreach, screening, clinical telephone triage and facilitation to access evidenced treatments. People were screened for trauma, depression, generalised anxiety and functioning who registered at 3, 6 and 9 months post-incident. Baseline scores were compared between screening groups (first screen at 3, 6 or 9 months) in each cohort (adult, CYP), and within groups to compare scores at 9 months. There were significant differences in adults' baseline scores across screening groups on trauma, depression, anxiety and functioning. There were significant differences in the baseline scores of CYP across screening groups on trauma, depression, generalised anxiety and separation anxiety. Paired samples t-tests demonstrated significant differences between baseline and follow-up scores on all measures for adults in the 3-month screening group, and only depression and functioning measures for adults in the 6-month screening group. Data about CYP in the 3-month screening group, demonstrated significant differences between baseline and follow-up scores on trauma, generalised anxiety and separation anxiety. These findings suggest people who register earlier are less symptomatic and demonstrate greater improvement across a range of psychological measures. Further longitudinal research is necessary to understand changes over time. None.

Impact of TeamSTEPPS on patient safety culture in a Swiss maternity ward.

To assess the impact of implementation of the TeamSTEPPS teamwork improvement concept on patient safety culture. Pre-post culture assessment using the Hospital Survey on Patient Safety Culture, at baseline and one year after implementation of TeamSTEPPS. Two maternity wards within the same 480-bed multisite teaching hospital. Implementation of the TeamSTEPPS teamwork improvement concept. Analysis of variation of the percentage of positive responses (score) in both wards (intervention and control) was conducted. There was a significant increase in scores in three dimensions of patient safety culture in the intervention ward: Supervisor/Manager Expectations and Actions Promoting Safety increased from 48.7% in 2015 to 70.8% in 2016 (P < 0.005); Teamwork Within Units increased from 35.5% in 2015 to 54.5% in 2016 (P < 0.005); Nonpunitive Response to Errors increased from 16.7% in 2015 to 32.3% in 2016 (P < 0.005). Other dimensions showed no significant changes. In the control ward, there was a significant decrease in scores in one dimension. A secondary analysis of differences in differences still shows significant improvement in one dimension (Supervisor/Manager Expectations and Actions Promoting Safety P < 0.005). After implementing the TeamSTEPPS teamwork concept, patient safety culture significantly improved for three of twelve dimensions in the intervention group. When controlling for differences in baseline scores between implementation and control wards, a significant improvement remains in one dimension. This suggests that TeamSTEPPS could be considered when seeking to enhance patient safety culture, especially in high-risk environments such as maternity wards.