Follow-up In Group Research Articles

Long-term outcomes of hypoplastic left heart syndrome with analysis of the Norwood procedure in infants following bilateral pulmonary artery banding

ObjectiveTo investigate the early and long-term outcomes of the deferred Norwood procedure by bilateral pulmonary artery banding (BPAB) versus the neonatal Norwood procedure. MethodsThis retrospective study examined 46 patients with hypoplastic left heart syndrome and its variants undergoing the Norwood procedure for single ventricle physiology between 2004 and 2022 at 3 institutions. The patients were divided into 2 groups: neonatal Norwood procedure (group N; n = 23) and staged Norwood procedure in infants following BPAB (group I; n = 23). Preoperative risk factors, surgical results, survival rates, Fontan candidacy, and long-term complications were compared. ResultsEarly survival rates after the Norwood procedure were 91.3% (21 of 23) in both groups. Late survival rates after the Norwood procedure were similar at the 10-year follow-up (group N, 76.3%; group I, 68.7%; P = .63). Fontan completion rates also were comparable in the 2 groups (group N, 77.8%; group I, 85.7%; P = .67). Group N showed a higher median pulmonary artery (PA) index before bidirectional cavopulmonary connection (group N, 177 [interquartile range (IQR), 147-243] mm2/m2; group I, 152 [IQR, 146-163] mm2/m2; P = .03); this trend continued until 5 years after Fontan completion (P = .01). Group N also had a lower rate of freedom from protein-losing enteropathy (PLE) at 9.0 years after the Fontan operation (90.0% vs 52.5% for group I; P = .04), although the incidences of other Fontan-associated events were not significantly different. ConclusionsFontan candidacy and survival rates were similar regardless of the timing of the Norwood procedure. Early performance of the Norwood procedure may lead to lower rates of late Fontan-associated events, such as PLE.

ANALYSIS OF ADVERSE DRUG REACTIONS TO ANTIRETROVIRALS USE IN A SECONDARY HOSPITAL

Although antiretrovirals (ARV) evidently extend the life expectancy of people living with HIV/AIDS (PLWH), their associated Adverse Drug Reactions (ADRs) are unavoidable, particularly in long-duration regimens. Several studies have reported a correlation between ADRs and adherence to ARV therapy. Meanwhile, ARV is the main determinant of achieving an immunological and virologic response. Pharmacists play the role of counselors in improving therapeutic outcomes including ADR management. This study aimed to analyze ADRs induced by ARV based on pharmacy documentation and to describe the frequency of PLWH follow-up visits over a two-year period. The study was conducted at Sleman Regional Hospital, an HIV/AIDS referral hospital in Yogyakarta. A cross-sectional design was used with saturated sampling, including all ARV use for HIV/AIDS. Data were collected from the pharmacy unit and patients’ spontaneous reports. Prescribed ARV came from the electronic system, whereas ADR reports were from patients during voluntary consultation with the pharmacist or in PITC services. A total of 110 ARV were administered mostly to male patients aged 25-40 years. The most regimen was tenofovir+lamivudine+efavirenz (91%) with the highest frequency of follow-up visits ? 12 times (53%). The top three ADRs were dizziness (30%), nausea (11%), and headache (8%). Three of the four pediatric patients experienced ADRs, each with AZT-induced fatigue, bloating, and diarrhea in LPV/r monotherapy. Most of the patients did not maintain appointments for hospital visits. Further studies are recommended to analyze the causative factors of non-adherence, including the loss to follow-up group. Keywords: Adverse Drug Reaction, Antiretroviral, Hospital, Indonesia

Decision to perform additional surgery after non-curative endoscopic submucosal dissection for gastric cancer based on the risk of lymph node metastasis: a long-term follow-up study.

Radical surgery after non-curative endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) may be excessive, since only 5-10% of patients have lymph node metastasis (LNM). This study investigated the suitability of the eCura system for determining the need for radical surgery after non-curative ESD. We retrospectively investigated 343 patients who underwent non-curative ESD for EGC from 2006 to 2021 at a tertiary hospital in Korea. These patients were divided into surgery (n = 191) and observation (n = 152) groups based on whether they underwent additional surgery post-ESD. Each group was further classified into low-risk (eCura score 0-1), intermediate-risk (eCura score 2-4) and high-risk (eCura score 5-7). All patients were regularly followed-up at least annually after the initial treatment. The cumulative overall and recurrence-free survival rates were calculated for each category and compared between the surgery and observation groups. No significant differences in overall survival were found between the surgery and observation groups in low-risk (p = 0.168) and intermediate-risk patients (p = 0.306); however, high-risk patients had better 5-year overall survival rate in the surgery group than in the follow-up group (95.2% vs. 71.4%, p < 0.001). The 5-year recurrence-free survival rate was higher in the surgery group than in the observation group for low-risk (100% vs. 84.3%; p = 0.034), intermediate-risk (96.1% vs. 88.4%; p = 0.081) and high-risk patients (100% vs. 83.3%; p = 0.023). Follow-up without additional surgery after non-curative ESD can be a reasonable option for low-risk and even intermediate-risk patients according to the eCura system. However, surgery is warranted for eCura high-risk patients.

Change in Androgenic Status and Cardiometabolic Profile of Middle-Aged Women with Polycystic Ovary Syndrome.

Understanding the cardiovascular disease (CVD) risk for women with polycystic ovary syndrome (PCOS) at reproductive age is crucial. To investigate this, we compared the cardiometabolic profiles of different PCOS groups over a median interval of 15.8 years. The study focused on three groups: (1) women with PCOS who were hyperandrogenic at both initial and follow-up screening (HA-HA), (2) those who transitioned from hyperandrogenic to normoandrogenic (HA-NA), and (3) those who remained normoandrogenic (NA-NA). At initial and follow-up screenings, both HA-HA and HA-NA groups showed higher body mass indexes compared to the NA-NA group. Additionally, at follow-up, the HA-HA and HA-NA groups exhibited higher blood pressure, a higher prevalence of hypertension, elevated serum triglycerides and insulin levels, and lower levels of HDL cholesterol compared to the NA-NA group. Even after adjusting for BMI, significant differences persisted in HDL cholesterol levels and hypertension prevalence among the groups (HA-HA: 53.8%, HA-NA: 53.1%, NA-NA: 14.3%, p < 0.01). However, calcium scores and the prevalence of coronary plaques on CT scans were similar across all groups. In conclusion, women with PCOS and hyperandrogenism during their reproductive years exhibited an unfavorable cardiometabolic profile during their post-reproductive years, even if they changed to a normoandrogenic status.

Responsiveness of Section GG Scores in Tracking Post-Stroke Functional Recovery From Inpatient Rehabilitation Admission to 90-Day Follow-Up

ObjectiveTo evaluate the responsiveness and scale-to-sample targeting of Section GG of the Inpatient Rehabilitation Facility-Patient Assessment Instrument in measuring the trajectory of functional recovery in patients with stroke from inpatient rehabilitation admission to 90 days after discharge. DesignRetrospective cohort study. Setting150-bed inpatient rehabilitation facility. ParticipantsPatients with stroke (N=1087) discharged between December 2019 to April 2021. InterventionNot applicable. Main Outcome MeasuresAdmission and discharge self-care and mobility scores from Section GG were analyzed for the Inpatient Only group (n= 817). Admission, discharge and 90-day post-discharge Section GG scores from telephone interviews with patients or caregivers were analyzed for the Follow-Up group (n=270). Standardized response means (SRM) determined responsiveness of the tool for each group and time interval. Score means, standard deviations, and floor/ceiling effects illustrated scale-to-sample targeting of the tool. ResultsSelf-care and mobility scores improved significantly from admission to discharge (P<.001) for both groups and from discharge to 90 days (P<.001) for the Follow-Up group. Large SRM existed from admission to discharge for self-care and mobility scores in both groups. ​A small-to-moderate SRM was seen from discharge to 90 days for self-care (0.46) and a moderate SRM was observed for mobility (0.68). Overall floor effects were minor at admission for self-care (9.8%) and mobility (7.2.%). Overall ceiling effects were minor at discharge for self-care (11.2%) and mobility (4.6%)​ and significant at follow-up for both self-care (45.2%) and mobility (32.2%). ConclusionsSection GG is responsive to change and appropriately measures patients’ functional ability during inpatient rehabilitation. More study is required for telephone follow-up after discharge from inpatient rehabilitation.

Consequences of Insurance Coverage Delays and Denials for Patients With Hereditary Angioedema.

Hereditary angioedema (HAE) is a rare and potentially fatal genetic disease associated with recurrent and unpredictable episodes of angioedema. Although modern therapies have dramatically increased quality of life, insurance changes, delays, and denials are becoming more common. To examine the impact of insurance delays and denials on patient health and well-being. A total of 20 patients with HAE (type 1 and 2) who recently experienced insurance delays or denials completed an online survey, and 19 participated in a follow-up focus group. The survey and focus group addressed the impact of insurance challenges on the use of health care services, work/school attendance, and anxiety. Three independent reviewers coded each focus group transcript using a thematic saturation approach. A total of 70% of participants reported an increased frequency of angioedema attacks resulting from insurance delays or denials. More than 50% missed work/school days because of increased attacks, and 90% reported greater anxiety. Twenty-five percent of respondents reported more urgent care or emergency department visits. In focus groups, participants identified specific ways that losing access to medication had a negative impact on their health, family, and work/school life. Insufficient notification of health insurance policy changes and the time and effort required to regain access to medications compounded patients' frustration and anxiety. Insurance delays and denials have significant impacts on individuals with HAE including (1) increased urgent care and emergency department visits, (2) missed work/school days, (3) higher levels of anxiety, and (4) a negative impact on family life.

Tertiary EFL Students’ Learner Autonomy: The Roles of Teachers in the Classroom

Learner autonomy has been considered the central aim of education because of its significant role in enabling students to develop into successful lifelong learners. In modern times, students have many opportunities to learn outside the classroom, the ideal context for learner autonomy development. Therefore, research about the development of learner autonomy in the out-of-class learning context needs to receive more focus, especially in Vietnam. Based on sociocultural theory as the theoretical framework, the current research aims to explore the potential of promoting EFL tertiary students’ learner autonomy in the out-of-class learning context through teachers’ roles in the classroom. Data collected from answers to a questionnaire on learner autonomy and teachers’ roles (N=709) suggested significant correlations between factors of the situational, behavioral, and psychological dimensions of learner autonomy and the roles of teachers as a resource, an evaluator, a controller, an instructor, a facilitator, and a co-learner in the classroom. The follow-up semi-structured in-depth group interviews (N=35) revealed that the factors that mediated the relationship between learner autonomy and teachers’ roles were the students’ motivation, teacher autonomy, trust, and care. These results help to bridge in-class and out-of-class learning and provide pedagogical implications to foster learner autonomy development in the out-of-class learning context.

Optimization of antiplatelet therapy in patients with coronary artery disease and type 2 diabetes mellitus after percutaneous coronary interventions

Abstract Funding Acknowledgements Type of funding sources: None. Background Dual antiplatelet therapy (DAP) with clopidogrel and aspirin after percutaneous coronary interventions (PCI) in patients with chronic coronary syndrome (CCS) are mainly used to prevent stent thrombosis and restenosis. Despite the use of approved doses of the antiplatelet, major adverse cardiac events (MACE) frequently occur in short and mid-term period in patients with type 2 diabetes mellitus (T2DM) and CCS. Aim of the study was to evaluate the efficacy of ticagrelol in patients with CCS and T2DM after elective PCI. Material and Methods The prospective, open label randomized study with 112 patients with CCS and T2DM who admitted for the elective PCI were enrolled in the study from 2018 to 2022 (aged 49-72 years, mean age 59.2±12.2 years, male 52%). Patients were divided into two groups by 56 via open randomization. Group I patients were assigned ticagrelol 90 mg BID after the loading dose of 180 mg ticagrelol along with standard dose of aspirin for 1 year whereas Group II were assigned clopidogrel along with aspirin for 1 year. 20 µmoll ADP induced platelet aggregation was assessed at baseline and after the 12 hours of administering loading dose of antiplatelet. Efficacy and safely were assessed during the follow up in both group of patients. All statistical analysis were performed using STATA software. Results Inhibition of platelet aggregation (IPA) with 20 µmoll ADP at 12 hours was significantly higher in ticagrelol group than clopidogrel group (71.65±14.25% vs. 42.74±18.25%, P&amp;lt;0.001). During the maintenance dose, IPA with 20 µmoll ADP at 48 hours was significantly higher in ticagrelol group than clopidogrel group (68.12±13.27% vs. 45.82±17.54%, P&amp;lt;0.001). PCI bleeding complications were similar in each group and there was not observed any statistically significant changes (P&amp;gt;0.05). During the mean follow-up period ticagrelol group tended to have higher bleeding than clopidogrel group, however they were not observed any statistically significant changes (log-rank test; 0.752). Pertaining to MACE, ticagrelol group tended to have lesser MACE than clopidogrel group, (Mantel–Cox test; P=0.045). 56 ticagrelol treated patients showed that MACE tended to be negatively associated with post PCI bleeding complications (P=0.048). Conclusions Dual antiplatelet therapy with ticagrelol and aspirin is superior than clopidogrel plus aspirin to prevent MACE in patients with chronic coronary syndrome and type 2 diabetes mellitus after elective percutaneous coronary interventions. However, ticagrelol should be used cautiously in patients with gastrointestinal ulcers due to its PCI related bleeding risks.

Comparing the efficacy of plasma exeresis and cryotherapy for the treatment of seborrheic keratosis: A randomized controlled trial.

Seborrheic keratoses (SK) is a benign epithelial skin tumor and plasma exeresis is a new technique. To compare the efficacy and safety of plasma exeresis and cryotherapy for treating SK. This study is a randomized controlled trial (RCT). One side of each patient was randomly treated with plasma exeresis (peak-to-peak voltage of 3.44kV and a frequency of 62.5kHz) and the other side with cryotherapy. Thirty-five males were enrolled. At week 3, 37.1 % (N=13) of lesions treated by plasma exeresis were clear, which was higher than those treated by cryotherapy 17.1% (N=6). However, this difference was not significant (p-value: 0.06). At week 6, 16 (57.1 %) out of 28 remaining lesions, treated by plasma exeresis were clear, which was significantly higher (p-value: 0.005) than those completely cleared by cryotherapy in 6 out of 29 remaining lesions (20.7%). The mean physician assessment scale score was significantly reduced in both groups in the second follow-up (plasma group first follow-up 0.91±0.89vs. second follow-up 0.5±0.64 and p-value: 0.0031; cryo group first follow-up 1.4±0.84vs. second follow-up 1.1±0.72 and p-value: 0.0002). Regarding side effects, no significant difference was seen (p=0.438). The most common complications in the plasma and cryotherapy groups were erythema (10/19, 52.63%) and hypo pigmentation (5/13, 38.46%). Both cryotherapy and plasma exeresis are effective. We observed a significantly higher cleared lesions treated with plasma exeresis in 6weeks and after two sessions.

The incidence and dynamic risk factors of chronic kidney disease among people with HIV.

We investigate the incidence of chronic kidney disease (CKD) among people with HIV (PWH) and the dynamic risk factors associated with CKD incidence. A population-based cohort study of PWH in South Carolina. Adults (age ≥18 years) PWH diagnosed between 2006 and 2019 who were CKD-free at baseline were included. The associations of HIV-related risk factors and conventional risk factors with the incidence of CKD were investigated during the overall study period and by different follow-up periods (i.e. 5, 10, and 15 years) by multivariate logistic regression. Among 9514 PWH, the incidence of CKD was 12.39 per 1000 person-years. The overall model indicated that conventional risk factors, such as hypertension, dyslipidemia, cardiovascular disease, and diabetes, were significantly associated with a higher risk of developing CKD. HIV-related characteristics, such as high percentage of days with viral suppression, recent CD4 + cell count, and percentage of retention in care, were associated with a lower risk of CKD compared with their counterparts. In the subgroup analysis, the results were similar for the 5-year and 6-10 years follow-up groups. Among patients who did not develop CKD by the 10th year, the risk factors for developing CKD within 11-15 years were dyslipidemia, diabetes, low recent CD4 + cell count, and short duration of retention in care while other predictors vanished. Diabetes, CD4 + cell count, and retention in care were persistently associated with CKD despite of follow-up duration. Closely monitoring diabetes and improving CD4 + cell count and retention in care are important to lower the risk of CKD in PWH.

Kinesiotherapy in chronic back pain and combined tension type headache

Kinesiotherapy is eff ective in the treatment of chronic nonspecific back pain (CNBP), but its eff ectiveness in tensiontype headache (TTH) is unclear. The effectiveness of kinesiotherapy in patients with CNBP and comorbid TTH has been little studied.The aim of the study was to evaluate the effectiveness of kinesiotherapy in patients with CNBS and comorbid TTH. Patients and methods. 52 patients (22 men and 30 women, mean age 32.4 ± 7.5 years) with CNBP and combined TTH were included in the study. All patients received standard treatment, of which 28 patients received kinesiotherapy (Group 1) and 24 patients were included in the comparison group (Group 2). All patients used pain diaries. All patients were tested by using the Beck Anxiety Inventory, the Beck’s Depression Inventory, the Pain Catastrophization Scale, the Kinesiophobia Scale, the Oswestry Disability Index, the Roland–Morris Disability Questionnaire, the Headache Impact Test 6, numerical pain rating scale before treatment and 3, 6 months after treatment. Clinical effcacy was assessed by reducing the frequency and intensity of headache (by ≥ 50%), back pain (by ≥ 30%), and by increasing functional activity during the day (by ≥ 30%).Results. At 6 months follow-up signifiantly more patients in group 1 than in group 2 achieved a clinical effect on TTH and CNBP: 78.5% (n = 22) compared to 41.7% (n = 10); OR (95% CI) = 1.99. In 9 patients (32%) of group 1, a complete remission of TTH and CNBP was noted, in group 2 there were no such patients. At 6 months follow-up group 1 showed a significant improvement (p &lt; 0.05) in comparison with group 2 in terms of functional activity and emotional state.Conclusion. Kinesiotherapy for CNBP and combined TTH is effective both for back pain and headache. It increases functional activity and improves the emotional state of patients.

Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance

Objective: analysis of clinical and economic efficiency of various etiotropic chemotherapy regimes in patients with respiratory tuberculosis with multidrug- and extensively drug-resistant (MDR and XDR) pathogen using the pharmacoeconomic modeling method (Markov model).Material and methods. A single-centre, observational, retrospective, cohort study was performed, which included patients who received treatment in clinics and affiliated organizations of the main Moscow tuberculosis institution during 2014–2019 regarding respiratory tuberculosis with the MDR/XDR pathogen. The data of 1387 patients were analysed, of which 1093 patients received “optimized basic regimen” (OBR) in accordance with the Federal Clinical Recommendations of 2015, 294 patients received etiotropic therapy in accordance with the recommendations of the World Health Organization of 2018–2019. To evaluate economic efficiency, the pharmacoeconomic costeffectiveness analysis and pharmacoeconomic modeling were used. When assessing the economic costs of treatment, the direct costs (medical and non-medical) were taken into account.Results. The study results showed that 68.4% of patients in the group with bedaquiline-containing chemotherapy regimens reached the outcome of “treatment successfully completed” (patient was cured or transfered into the III group of dispensary follow-up) compared to 51.8% in the OBR group. The use of “new” etiotropic therapy regimens is most economically justified in patients with ХDR-tuberculosis with repeated treatment courses: incremental cost-effectiveness ratios (ICER) were 24,530.20 and 21,526.50 rubles per 1 patient. Markov model was developed, transitions from one state to another were evaluated according to the results of clinical observations during the first 2 years of research.Conclusion. The use of the dynamic model of the patient state made it possible to refine the estimates of the effectiveness of the compared etiotropic chemotherapy regimens for tuberculosis with MDR/XDR pathogen. Based on the results of modeling the dynamics of patients in the interval of 2 to 10 years of treatment, the use of “new” regimens provides a significant increase in the proportion of treatment success (by 16.1–29.8% in different groups of patients and at different times), a decrease in mortality (by 6.1–11.0%), and in the proportion of those who interrupted treatment (by 8.0–21.8%) in comparison with OBR.

Technicians as teachers: the emerging role of technical staff within higher education teaching and learning environments

ABSTRACT Technicians and technical staff are making increasingly significant contributions to the teaching and learning of undergraduate and postgraduate students in the UK. This paper reports on a survey of 1766 technical staff regarding their roles within teaching and learning environments, and a series of follow-up focus groups with 44 technical staff further exploring the roles, visibility, and recognition of technical staff. Analysis suggests many technicians’ roles have transitioned to such an extent that traditional lines between academic and technical teaching responsibilities, expertise, and contributions are becoming increasingly blurred. This trend is particularly noticeable for disciplines within creative arts but is also found in other discipline areas. This is likely accelerated by a competitive higher education environment and global graduate job market which incentivise skills-based learning and graduate employability, with a general transition towards increased value of ‘know-how’ as well as ‘know-what’. Although this can greatly enhance students’ skills-based learning at the hands of experienced practitioners, there is a danger that under-valued ‘cheap labour’ could be used to replace under-resourced academic teaching communities, or that technical staff find expansion of their teaching responsibilities are not being matched with adjustments in value, recognition, or reward. Specific examples are explored, and the impact of COVID-19 related disruption is further used to highlight these overall themes. The authors advocate for common understanding and recognition of teaching roles throughout the higher education sector, regardless of job family.

Effectiveness of Bundled Hyperpolypharmacy Deprescribing Compared With Usual Care Among Older Adults

Older patients using many prescription drugs (hyperpolypharmacy) may be at increased risk of adverse drug effects. To test the effectiveness and safety of a quality intervention intended to reduce hyperpolypharmacy. This randomized clinical trial allocated patients 76 years or older who used 10 or more prescription medications to a deprescribing intervention or to usual care (1:1 ratio) at an integrated health system with multiple preexisting deprescribing workflows. Data were collected from October 15, 2020, to July 29, 2022. Physician-pharmacist collaborative drug therapy management, standard-of-care practice recommendations, shared decision-making, and deprescribing protocols administered by telephone over multiple cycles for a maximum of 180 days after allocation. Primary end points were change in the number of medications and in the prevalence of geriatric syndrome (falls, cognition, urinary incontinence, and pain) from 181 to 365 days after allocation compared with before randomization. Secondary outcomes were use of medical services and adverse drug withdrawal effects. Of a random sample of 2860 patients selected for potential enrollment, 2470 (86.4%) remained eligible after physician authorization, with 1237 randomized to the intervention and 1233 to usual care. A total of 1062 intervention patients (85.9%) were reached and agreed to enroll. Demographic variables were balanced. The median age of the 2470 patients was 80 (range, 76-104) years, and 1273 (51.5%) were women. In terms of race and ethnicity, 185 patients (7.5%) were African American, 234 (9.5%) were Asian or Pacific Islander, 220 (8.9%) were Hispanic, 1574 (63.7%) were White (63.7%), and 257 (10.4%) were of other (including American Indian or Alaska Native, Native Hawaiian, or >1 race or ethnicity) or unknown race or ethnicity. During follow-up, both the intervention and usual care groups had slight reductions in the number of medications dispensed (mean changes, -0.4 [95% CI, -0.6 to -0.2] and -0.4 [95% CI, -0.6 to -0.3], respectively), with no difference between the groups (P = .71). There were no significant changes in the prevalence of a geriatric condition in the usual care and intervention groups at the end of follow-up and no difference between the groups (baseline prevalence: 47.7% [95% CI, 44.9%-50.5%] vs 42.9% [95% CI, 40.1%-45.7%], respectively; difference-in-differences, 1.0 [95% CI, -3.5 to 5.6]; P = .65). No differences in use of medical services or adverse drug withdrawal effects were observed. In this randomized clinical trial from an integrated care setting with various preexisting deprescribing workflows, a bundled hyperpolypharmacy deprescribing intervention was not associated with reduction in medication dispensing, prevalence of geriatric syndrome, utilization of medical services, or adverse drug withdrawal effects. Additional research is needed in less integrated settings and in more targeted populations. ClinicalTrials.gov Identifier: NCT05616689.

Health Coaching for Weight Loss Among Overweight and Obese Individuals in Saudi Arabia: A Retrospective Analysis.

Background Health coaching is an increasingly used strategy to help in adopting lifestyle changes for weight loss. While Saudi Arabia has one of the highest obesity prevalences worldwide, research on lifestyle interventions for weight loss is limited. Aim We aimed to investigate the effectiveness of health coaching for weight loss among the Saudi population in real-world primary healthcare settings. Methods This is a retrospective observational study. Secondary data from the health coach national program in the Eastern Health Cluster were retrieved. Obese and overweight individuals aged 15 years or older with weight-related goals who completed at least 12 weeks of coaching were included in the analysis. The primary outcomes are weight change (kg) and weight change percent (%) of the initial weight. We further compared the weight change% between different follow-up methods (i.e., physical, virtual, and hybrid) and studied the factors associated with -5% weight loss. Results In total, 465 participants were included in the analysis, with a female predominance (66.2%) and a median initial weight of 90 kg (interquartile range (IQR): 77, 101). The median follow-up duration was 127 days (IQR: 101, 157), and the median total number of coaching sessions was three (IQR: 2, 5). The mean weight change was -2.68 kg (95% confidence interval (CI): -3.12, -2.24), p<0.001. Comparing each follow-up group, no statistically significant difference was found when controlling for number of visits (p=0.059). The adjusted means for weight change% were -3.77%, -2.59%, and -2.54% for hybrid, physical, and virtual visits, respectively. Factors that were associated with achieving at least -5% weight loss were male sex (adjusted odds ratio (aOR)=1.87, 95% CI: 1.16, 3.02), five or more total coaching visits (aOR=5.23, 95% CI: 2.88, 9.50), longer follow-up duration (aOR=1.09, 95% CI: 1.03, 1.15), and having a weight management goal (aOR=4.5, 95% CI: 1.63, 12.45) as the reason for initial coaching visit. Conclusion We found statistically significant weight change among clients who completed 12 weeks of coaching in primary care settings. The findings in this paper contribute to the importance of lifestyle interventions for weight loss among the Saudi population. However, stronger controlled studies are needed to confirm this finding.

The effect of aminolevulinic acid hydrochloride topical powder photodynamic therapy versus nocardia rubra cell wall skeleton and observers group in the treatment of cervical low-grade squamous intraepithelial lesions with human papillomavirus infection: A non-randomized study, controlled pilot study.

There are insufficient studies comparing the efficacy of aminolevulinic acid hydrochloride topical powder (ALA) photodynamic therapy (PDT) against Nocardia rubra cell wall skeleton (Nr-CWS) therapy in the treatment of cervical low-grade squamous intraepithelial lesion (LSIL) with human papillomavirus (HPV), especially for long-term efficacy. Patients with cervical LSIL and HPV infection were divided into 3 treatment groups based on their own choice. All patients had a follow-up test including HPV testing, cytology and colposcopy at 4 to 6 months and 12 months after the treatment. Among142 patients, patients received 51 ALA PDT and 41 patients received Nr-CWS. Another 50 patients who refused treatment were included in the Observers group. Four to six months or 12 months after treatment, there was significant difference between 3 groups in the clearance rate of HR-HPV infection and the complete remission (CR) rates of cervical LSIL; the CR rates of cervical LSIL in the ALA PDT group was significantly higher than the Nr-CWS group; but there was no significant difference between 2 groups in the clearance rate of HPV infection. The CR rates of cervical LSIL and the clearance rate of HPV infection in the ALA PDT group was significantly higher than the Observers group; the CR rates of cervical LSIL and the clearance rate of HPV infection in the Nr-CWS group was significantly higher than the Observers group; there was no significant difference in the recurrence rates in ALA PDT and Nr-CWS group after 12 months. Both of ALA PDT and Nr-CWS group had lower recurrence rate than the Observers group. The effect of ALA PDT is similar to Nr-CWS in the clearance rate of HR-HPV infection. Compared to the Nr-CWS group, the CR rates of cervical LSIL were considerably greater in the ALA PDT group. The effect of ALA PDT in the clearance rate of HPV infection and CR rates of cervical LSIL was significantly higher than the follow-up group; Both of ALA PDT and Nr-CWS group had lower recurrence rate than the Observers group. For cervical LSIL with HPV infection, ALA PDT is a very successful therapeutic method that is noninvasive.

Long-Term Effectiveness and Sustainability of Integrating Peer-Assisted Ultrasound Courses into Medical School-A Prospective Study.

Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses. From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: "aorta", "gallbladder", "kidney" and "lung") was measured, and a theory test on the same subject areas ("pathology recognition") was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and "attitude to ultrasound training in the curriculum". Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills. Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.

Delivering a Home-Based Exercise Program to Youth With Osteogenesis Imperfecta: Protocol for a Comparative-Approach Study

Background Osteogenesis imperfecta (OI) is a rare bone fragility disorder associated with muscle weakness. Individuals with OI may therefore benefit from exercise interventions aiming to improve muscle and bone strength. Given the rarity of OI, many patients do not have access to exercise specialists who are familiar with the disorder. As such, telemedicine, the provision of health care through technology to provide care at a distance, may be well suited for this population. Objective The main objectives are (1) to investigate the feasibility and cost-effectiveness of 2 telemedicine approaches for the delivery of an exercise intervention for youth with OI and (2) to assess the impact of the exercise intervention on muscle function and cardiopulmonary fitness in youth with OI. Methods Patients with OI type I (the mildest form of OI; n=12, aged 12-16 years) from a pediatric orthopedic tertiary hospital will be randomized to receive a 12-week remote exercise intervention in either (1) a supervised group (n=6), monitored every session, or (2) a follow-up group (n=6), receiving monthly progress update appointments. Participants will undergo the following pre- and postintervention evaluations: sit-to-stand test, push-up test, sit-up test, single-legged balance test, and a heel-rise test. Both groups will be given the same 12-week exercise regimen, which includes cardiovascular, resistance, and flexibility training. For each exercise training session involving the supervised group, a kinesiologist will provide instructions to participants through live video sessions using a teleconferencing application. On the other hand, the follow-up group will discuss their progress with the kinesiologist every 4 weeks over a teleconferencing video call. Feasibility will be assessed by recruitment, adherence, and completion rates. A cost-effectiveness analysis of both approaches will be computed. Changes in muscle function and cardiopulmonary fitness will be examined between the 2 groups, pre- and postintervention. Results It is anticipated that the supervised group will have higher adherence and completion rates compared to the follow-up group, which may be associated with greater physiological benefits; however, it may not be as cost-effective compared to the follow-up approach. Conclusions By determining the most feasible telemedicine approach, this study may serve as a basis for providing increased access to specialized adjunct therapies for individuals with rare disorders. International Registered Report Identifier (IRRID) PRR1-10.2196/40262

Blue prescription: A pilot study of health benefits for oncological patients of a short program of activities involving the sea

Performing outdoor activities in blue spaces can help improve human health and mental well-being by reducing stress and promoting social relationships. The number of people surviving cancer has increased globally to experience this disease as a life-changing and chronic condition with physical and psychosocial symptoms that have negative impacts on their quality of life. While there has been a growth of programs in green spaces to meet the needs of cancer patients, such as follow-up post-treatment care, support groups and physical activity programs, very few studies have examined the effects of activities involving the sea for the health and well-being of oncology patients. This is the first study to evaluate whether different outdoor activities in blue spaces can benefit oncological patients' physical and mental health using smartwatches, sphygmomanometers and Profile of Mood States (POMS) questionnaires. We assessed changes in blood pressure, heart rate, sleep quality and mental health of 16 patients after twelve sessions of three different activities (walking, beach and snorkelling) and four sessions of a control activity. While no significant differences between activities were observed in terms of the data gathered by the smartwatches, a gradient of positive results for human mental health was observed towards exposure to a blue space, assessed through POMS questionnaires. Results show that exposure to blue spaces contributes to tension and anger reduction and improves the vigour mood state of oncology patients. No significant increases in patients' heart rate were recorded after the beach and snorkelling activities, with results similar to the control activity, suggesting that the contribution may be to participants’ relaxation.

Combined Couple Therapy Based on Acceptance and Commitment and Schema Therapy for Quality of Life and Recovery Process of Patients With Breast Cancer During Medical Treatment

Introduction: Cancer can affect the process of recovery and the quality of life (QoL) of individuals. This study determined the effectiveness of combined couple therapy based on acceptance and commitment and schema therapy on the QoL and recovery process of patients with breast cancer (BC) during medical treatment. Methods: The research method is semi-experimental with pre-test, post-test, follow-up, and control group. The study’s statistical population included all married patients with BC (stage one) who received treatment in Mashhad in 2019. A total of 30 samples were selected through the convenience sampling method and then randomly assigned to the control and treatment groups. The exceptional EORTC QoL questionnaire (QLQ-C30) was used in patients with cancer to collect data, and the recovery symptoms were checked according to medical records and the relevant specialist’s opinion. The data were also analyzed by repeated measures analysis of variance to analyze the obtained data. Results: The findings demonstrated that the combined couple therapy based on Acceptance and commitment therapy (ACT) had a significant effect on the QoL and recovery process of patients with cancer during medical treatment (P&gt;0.01). Conclusion: The results imply that couple schema therapy-based ACT could positively affect the QoL and treatment processes among cancer patients.