Mean Follow-up Scores Research Articles

Effects of Self-Care Training Combined with Stress Management on Treatment Adherence in Type 2 Diabetes People


 
 
 Objective: Diabetes is a chronic metabolic disorder that can be exacerbated by stress, poor compliance and self-care practices. This study investigated the effects of self-care training combined with stress management on treatment adherence in type 2 diabetes mellitus (T2DM) people.
 Materials and Methods: This is a randomized clinical trial with repeated measures. The study sample included 30 T2DM who were purposively selected among the eligible members of the Kerman Diabetes Association. The participants were randomized to the experimental group (stress management based on cognitive-behavioral therapy and self-care training) (n=15) and the control group (no intervention) (n=15). Both groups completed the Medanlo Treatment Adherence Questionnaire at the pretest, posttest, and follow-up time points. Data were analyzed statistically using ANOVA.
 Results: The post-test and follow-up mean scores of treatment adherence significantly increased in the experimental group compared with the control group (P< 0.001). In addition, the results demonstrated that treatment adherence improved in follow-up (P< 0.001).
 Conclusion: According to the study results, psychological training should be integrated with self-care training to achieve long lasting treatment adherence in T2DM people.
 
 

Examining the impact of time management and resilience training on work-family conflict among Iranian female nurses: a randomized controlled trial

BackgroundFemale nurses confronting work-family conflict may endure adverse consequences for themselves and their families, leading to a decline in job performance and intentions to quit. Investigating the effects of interventions based on factors contributing to work-family conflict can aid in identifying optimal strategies for conflict reduction and mitigating its negative repercussions. This study aimed to examine the impact of time management and resilience training on work-family conflict among Iranian female Nurses in 2022.MethodsIn this randomized controlled trial employing pre, post, and follow-up measures, 132 female nurses employed in the hospitals of Bushehr University of Medical Sciences (Bushehr, Iran) were selected and subsequently categorized into three groups—time management, resilience training, and control groups—using simple random sampling method. 10 online training sessions were conducted for each intervention group. A demographic form and a work-family conflict questionnaire were used for data collection. Repeated measures ANOVA, one-way ANOVA and multivariate general linear model were used to examine the hypotheses.ResultsRegarding total work-family conflict, posttest mean scores were significantly lower than the pretest in both time management (p < 0.001) and resilience (p < 0.001) training groups, but follow-up mean scores were significantly higher than posttests in both time management (p < 0.001) and resilience (p < 0.001) training groups. In the control group, the mean scores at three time points were not statistically different (P = 0.058). The post-test mean score of work-family conflict was comparable in the two intervention groups (P > 0.05) and lower than the control group (P < 0.001) The follow-up mean score was comparable in the two intervention groups (P > 0.05) and lower than the control group (P < 0.001).ConclusionTime management and resilience training effectively reduced the work-family conflict experienced by female nurses. Therefore, it is recommended that training programs such as time management and resilience training be incorporated into the ongoing education of nurses to alleviate their work-family conflict. Considering the diminishing impact of these interventions over time, training should be reiterated based on the evolving needs of the nurses.Trial registrationNumber (IRCT20190122042453N2),01/27/2022.

Single Stage in Situ Suture Repair of a Multi-Ligament Knee Injury, an Observational Study

Objective: This study aims to observe the clinical outcomes associated with in situ single-stage suture repair for knee dislocation in patients suffering from multiple knee ligament injuries with the use of unabsorbable materials of the suture. Study design: A retrospective observational study Place and Duration this study was conducted in Gambat Medical College Pir Syed Abdul Qadir Shah Jellani Institute of Medical Science GIMS Gambat from May 2021 to May 2022. Methodology: In this study35 patients treated surgically with in situ suture repair were recruited. A retrospective analysis was done on 35 patients with a mean follow-up score of 3.8 ± 1.3 years. Patients were undergone in situ surgical procedures for all the ruptured ligaments followed by a proper rehabilitation protocol post-operatively. Outcome variables were assessed by Lysholm score, satisfactory score, Meyers functional rating score, VAS score, and Tegner score. Results: Results of the study states that the mean follow-up a score of VAS was recorded as 1.98 ± 0.4, Lysholm score was recorded as 82.5 ± 6.7, and the patient satisfaction score was recorded as 7.5 ± 0.9. Statistically, significant differences have been observed between the pre and post-scores of ranges of motion and Tegner activity scores with a p-value of &lt; 0.001 for both activity and ROM scores. Final follow-up of these patients reported that patients were left with no ligament laxity except for two patients who were unable to restore back to work. Among 35 patients, 5 were unable to achieve full ROM and had stiffness whereas two had infections at the surgical site. Conclusion: In situ suture repair of multiple ligaments had shown significant improvement in terms of ligament repair and early rehabilitation and therefore can be considered an effective treatment approach for the management of multiple ligament injuries. Keywords: Multiple ligament injuries, in situ repair, knee dislocation, cruciate ligament injury, single-stage repair.

Bridging Knowledge Gaps in Anaphylaxis Management Through a Video-Based Educational Tool.

Introduction: We aimed to develop and test the effectiveness of an education tool to help pediatric patients and their families better understand anaphylaxis and its management, and to improve current knowledge and treatment guidelines adherence. Methods: From June 2019 to May 2022, 128 pediatric patients with history of food-triggered anaphylaxis who presented to the allergy outpatient clinics at the study institution were recruited. Consenting families were asked to complete 6 questions related to the triggers, recognition, and management of anaphylaxis at the time of presentation to the clinic. Participants were shown a 5-min animated video on the causes, presentation, and management of anaphylaxis. At the end of the video, the participants were redirected to the same 6 questions to respond again. The scores were recorded in proportion of correct answers (minimum 0.0; maximum 1.0). Results: The mean age of the patients was 5.8 ± 4.5 years (range: 0.5-18.8 years). The majority were males (70 patients; 54.7%). The mean baseline prevideo education questionnaire score was 0.76 ± 0.2 (range: 0.3-1.0), whereas the mean follow-up score was 0.82 ± 0.2 (range: 0.3-1.0). This score difference of 0.06 was statistically significant (P < 0.001). There were no significant associations between change in scores and age or gender of the participants. Conclusion: Our video teaching method was successful in educating patients and their families to better understand anaphylaxis and its management at the moment of the clinical encounter. Retention of knowledge at long-term follow-up should be assessed.

Effectiveness of Mindfulness-based Relapse Prevention Group Therapy and Treatment as Usual on Shame and Self-criticism in Individuals with Opioid Use Disorder: A Comparative Investigation

Background: Shame and self-criticism are two variables that refer to negative self-assessment. Such negative self-assessments cause unpleasant emotions, which are among the known factors involved in drug abuse and relapse. Objectives: This study aimed to compare mindfulness-based relapse prevention (MBRP) group therapy and treatment as usual (TAU) in terms of their effect on shame and self-criticism in individuals with opioid use disorder (OUD). Patients and Methods: The current quasi-experimental study with a pretest-posttest and follow-up design was conducted on 36 patients who met the diagnostic and statistical manual of mental disorders (DSM-5) criteria for OUD. The participants were randomly assigned to two groups. One group received a combination of MBRP group therapy and TAU, and the other group was treated only by TAU. The participants filled out the Other as Shamer Scale and the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale in the pretest, posttest, and follow-up stages. The data were statistically analyzed using a mixed-design analysis of variance. Results: The results indicated that the mean score of shame significantly decreased in the follow-up compared to pretest and posttest. Moreover, the combination of MBRP group therapy and TAU was significantly more effective than TAU alone. The posttest and follow-up mean scores of the participants who received a combination of MBRP group therapy and TAU were significantly lower than those treated only with TAU. Conclusions: The study results showed that MBRP could be considered an effective therapeutic approach for reducing shame and self-criticism in individuals with OUD.

The Effect of Integrating Cognitive-Behavioral Therapy and Mindfulness Therapy on Lifestyle of Women with Irritable Bowel Syndrome

Background: Psychological distresses and stresses are believed to significantly increase the symptoms of irritable bowel syndrome (IBS). In contrast, healthy lifestyle plays an effective role in the prevention and treatment of IBS. The present article investigated the effect of integrating cognitive-behavioral therapy and mindfulness therapy on the lifestyle of patients with IBS in Tehran. Methods: This study was quasi-experimental (pre-test, post-test, and a one-month follow-up design, and a control group). The statistical population herein included all the women with IBS referred to the Gastroenterology Research Center of Shariati Hospital in Tehran in 2020. We selected 30 patients who were willing to participate in the study using convenience sampling and randomly divided them into the control and experimental groups (n=15 per group). The experimental group underwent 12 sessions (90-minute sessions, two days a week) of integrating cognitive-behavioral therapy and mindfulness therapy, yet the control group received no intervention. The research instrument included the Lifestyle Questionnaire (LSQ). Data analysis was carried out using repeated measures ANOVA. Results: The results indicated that integrating cognitive-behavioral therapy and mindfulness therapy effectively improved lifestyles in women with IBS (p <0.001). The mean post-test and follow-up scores of the experimental group were 162.58±30.83 and 166.00±26.61, respectively, which increased compared to the pre-test (110.58±10.02), post-test (107.17±9.52), and follow-up (103.33±7.24) of the control group. Conclusion: Integrating cognitive-behavioral therapy and mindfulness therapy could be recommended as an effective training to improve the lifestyle of women with IBS.

Perceived walking difficulties in Parkinson\u2019s disease \u2013 predictors and changes over time

BackgroundPeople with Parkinson’s disease (PD) have described their walking difficulties as linked to activity avoidance, social isolation, reduced independence and quality of life. There is a knowledge gap regarding predictive factors of perceived walking difficulties in people with PD. Such knowledge could be useful when designing intervention studies. This study aimed to investigate how perceived walking difficulties evolve over a 3-year period in people with PD. A specific aim was to identify predictive factors of perceived walking difficulties.MethodsOne hundred forty-eight people with PD (mean age 67.9 years) completed the Generic Walk-12 (Walk-12G) questionnaire (which assesses perceived walking difficulties) at both baseline and the 3-year follow-up. Paired samples t-test was used for comparing baseline and follow-up mean scores. Multivariable linear regression analyses were used to identify predictive factors of perceived walking difficulties.ResultsPerceived walking difficulties increased after 3 years: mean Walk-12G score 14.8 versus 18.7, p < 0.001. Concerns about falling was the strongest predictor (β = 0.445) of perceived walking difficulties, followed by perceived balance problems while dual tasking (β = 0.268) and pain (β = 0.153). Perceived balance problems while dual tasking was the strongest predictor (β = 0.180) of a change in perceived walking difficulties, followed by global cognitive functioning (β = − 0.107).ConclusionsPerceived walking difficulties increase over time in people with PD. Both personal factors (i.e. concerns about falling) and motor aspects (i.e. balance problems while dual tasking) seem to have a predictive role. Importantly, our study indicates that also non-motor symptoms (e.g. pain and cognitive functioning) seem to be of importance for future perceived walking difficulties. Future intervention studies that address these factors need to confirm their preventative effect on perceived walking difficulties.

Bridging Knowledge Gaps in Anaphylaxis Management Through a Video-Based Educational Tool

To develop and test the effectiveness of an education tool to help pediatric patients and their families better understand anaphylaxis and its management, and to improve current knowledge and treatment guidelines adherence. From June 2019 to July 2020, 111 pediatric patients with history of food-triggered anaphylaxis who presented to our center were recruited. Consenting families were asked to complete 6 questions related to the triggers, recognition and management of anaphylaxis at the time of presentation to the clinic. Participants were then shown a 5-minute animated video addressing the main knowledge gaps related to the causes, presentation and management of anaphylaxis. At the end of the video, participants were redirected to the same 6 questions to respond again. The scores were recorded in percentage of correct answers (minimum 0.0; maximum 1.0). The mean age of the patients was 5.7 ± 4.5 years (range: 0.5-17.9 years). The majority were males (61 patients; 55.0%). The mean baseline pre-video education score was 0.77 ± 0.16 (range: 0.3-1.0), while the mean follow-up score was 0.81 ± 0.17 (range: 0.3-1.0). This score difference of 0.04 was statistically significant (p=0.001). There were no significant associations between change in scores and age or sex of the participants. Our video teaching method was successful in educating patients and their families to better understand anaphylaxis and its management at the moment of the clinical encounter. The test will be repeated at a 1-year interval to determine their retention of knowledge.

Factors affecti̇ng health-promoting behavi̇ors i̇n nursi̇ng students: A structural equation modeling approach

BackgroundThe purpose of this study is to evaluate the effectiveness of the Mindfulness-based Stress Reduction program applied to a sample of Turkish nursing students. MethodThe study was designed as a randomized controlled trial. Program sessions of 90-95 minutes were given twice a week for 12 weeks. The data were collected using the Nursing Education Stress Scale, the Mindfulness Scale, and the Stress Management Styles Scale. ResultsA statistically significant difference was found in the mean post-test and mean follow-up scores obtained by the control group and the experimental group on the Nursing Education Stress Scale and its sub-dimensions. On the Mindfulness Scale, a statistically significant difference was found between the mean pre-test and post-test scores obtained by the experiment and control groups. ConclusionThe results derived from this study suggest that the mindfulness-based stress reduction program is effective in reducing the stress experienced by students during nursing education, increasing their mindfulness, strengthening their coping mechanisms for stress, increasing their use of self-confident and optimistic approaches, and decreasing their use of the helpless approach.

Role of Compositum Zeolite® in management of inflammatory bowel disease: a pilot study.

Zeolites are crystalline mineral aluminosilicate compounds with microporous structures of tetrahedrons and huge porosity. In the gut, these silicates act as adsorbents, ion-exchangers, catalysts, detergents or antidiarrheic agents. In addition to its well-known antioxidant effect, a new potential advantage of Zeolite could be the microbiome modulation. In this scenery, we aimed to investigate the effect of this compound on inflammation among inflammatory bowel disease patients, assessing both clinical activity and inflammatory markers. This was an open one branch pilot study involving 20 IBD patients, both affected with Crohn's disease and ulcerative colitis affering to San Giovanni Antica Sede Hospital, Città della Salute e della Scienza in Turin. Each patient was given Compositum Zeolite® 6 g/die for 56 days; follow-up time was 60 days from the end of Zeolite therapy. Primary outcomes of the study were to evaluate the improvement of the quality of life (Partial Mayo score or Harvey Bradshaw Index) and the compliance to therapy, while secondary outcome was the reduction of calprotectin value. Of the twenty patients enrolled, 4 did not attend the scheduled check-up visit and 2 reported non-adherence to the therapy with Compositum Zeolite® so these 6 patients were considered as drop out and their data were not included in statistical analysis. So, compliance rate was 70%, that is similar to general adherence to therapy in our setting. Regarding Ulcerative Colitis patients, at the moment of enrolment mean Mayo Partial Score (MPS) was 3.09 (CI: 1.76-4.41) while after 8 weeks of Compositum Zeolite® supplementation the mean MPS was 2.72 (CI: 1.45-4.00) (P=0.57) and after 60 days of follow-up mean MPS was 1.9 (CI: 0.85-2.97) (P=0.24). As Crohn's disease patients are concerned, HBI Score at enrolment was 5.3 (CI: 3.38-7.29) while mean score after 8 week of therapy was 4 (CI: 2.85-5.15) (P=0.042) and after 60 days of follow-up mean score was 3.1 (CI: 1.48-4.87) (P=0.18). Mean calprotectin value at enrolment was 925.64 (CI: 451.83-1399.45). while after 2 months of Compositum Zeolite® addon therapy was 952.72 (CI: 492.73-1412.73); P value 0.93. After 2 months of follow-up mean value was 724.45 (CI: 240.15-1208.73) P value 0.3. Compositum Zeolite® has a compliance rate similar to the other prescribed therapies and is a good addon therapy to improve activity indexes, mainly in Crohn's disease. It also seems to improve inflammatory indexes, even if maybe dose or time of therapy were insufficient to reach a full negativization of these parameters.

Fibromyalgia Impact Reduction Using Online Personal Health Informatics: Longitudinal Observational Study.

BackgroundPersonal health informatics have the potential to help patients discover personalized health management strategies that influence outcomes. Fibromyalgia (FM) is a complex chronic illness requiring individualized strategies that may be informed by analysis of personal health informatics data. An online health diary program with dynamic feedback was developed to assist patients with FM in identifying symptom management strategies that predict their personal outcomes, and found reduced symptom levels associated with program use.ObjectiveThe aim of this study was to determine longitudinal associations between program use and functional impact of FM as measured by scores on a standardized assessment instrument, the Fibromyalgia Impact Questionnaire (FIQ).MethodsParticipants were self-identified as diagnosed with FM and recruited via online FM advocacy websites. Participants used an online health diary program (“SMARTLog”) to report symptom ratings, behaviors, and management strategies used. Based on single-subject analysis of the accumulated data over time, individualized recommendations (“SMARTProfile”) were then provided by the automated feedback program. Indices of program use comprised of cumulative numbers of SMARTLogs completed and SMARTProfiles received. Participants included in this analysis met a priori criteria of sufficient program use to generate SMARTProfiles (ie, ≥22 SMARTLogs completed). Users completed the FIQ at baseline and again each subsequent month of program use as follow-up data for analysis. Kendall tau-b, a nonparametric statistic that measures both the strength and direction of an ordinal association between two repeated measured variables, was computed between all included FIQ scores and both indices of program use for each subject at the time of each completed FIQ.ResultsA total of 76 users met the a priori use criteria. The mean baseline FIQ score was 61.6 (SD 14.7). There were 342 FIQ scores generated for longitudinal analysis via Kendall tau-b. Statistically significant inverse associations were found over time between FIQ scores and (1) the cumulative number of SMARTLogs completed (tau-b=–0.135, P<.001); and (2) the cumulative number of SMARTProfiles received (tau-b=–0.133, P<.001). Users who completed 61 or more SMARTLogs had mean follow-up scores of 49.9 (n=25, 33% of the sample), an 18.9% drop in FM impact. Users who generated 11 or more new SMARTProfiles had mean follow-up scores of 51.8 (n=23, 30% of the sample), a 15.9% drop.ConclusionsSignificant inverse associations were found between FIQ scores and both indices of program use, with FIQ scores declining as use increased. Based on established criteria for rating FM severity, the top one-third of users in terms of use had clinically significant reductions from “severe” to “moderate” FM impact. These findings underscore the value of self-management interventions with low burden, high usability, and high perceived relevance to the user.Trial RegistrationClinicalTrials.gov NCT02515552; https://clinicaltrials.gov/ct2/show/NCT02515552

The effect of Health Belief Model-based health education programme on coping with premenstrual syndrome: a randomised controlled trial.

The aim of this randomised controlled study was to determine the effect of Health Belief Model (HBM)-based health education programme in late adolescent period on coping with premenstrual syndrome (PMS). Thirty women both in the intervention and control groups were included. The HBM-based education programme was applied to cope with PMS. The intervention and control groups were followed up for three cycles in terms of PMS symptoms. The data were collected by a questionnaire and the Premenstrual Syndrome Scale. There was a statistically significant difference between the pre-test mean scores and the first, second and third follow-up mean scores; and between the first follow-up mean score and the second and the third follow-up mean scores in the repeated measurements of the intervention group (p <.05). The mean scores of the intervention group were found to be significantly lower than the control group in the second and third follow-ups (p < .05). In conclusion, HBM-based health education was effective for coping with PMS. It is recommended for dealing with PMS to use HBM-based education programmes, to motivate the students for life style changes, and to identify the obstacles and the benefits perceived about PMS.

The effects of Montessori training program for mothers on mathematics and daily living skills of 4-5 year-old Montessori children

This study investigated the effects of Montessori Training Program for Mothers (MTPM) on math and daily living skills of Montessori children ages 4 to 5 years old. Sample of the study included 19 Montessori pre-schoolers (8 and 11 children in experimental and control group respectively) who enrolled at an applied kindergarten affiliated to a university at Konya in 2016-2017 school year. Verified to be a reliable and valid measure for Turkish children, two subtests - Mathematics (MATH) and Daily Living Skills (DLS) - of the Basic School Skills Inventory 3 (BSSI) were used to collect data. Tests were administered to the students as pre-test, post-test and follow-up test by their teachers. MTPM was administered to the mothers in the experimental group for 12 weeks-36 hours in total while control and experimental group children continued their Montessori education. Four weeks after the program was completed, BSSI-3-MATH and BSSI-3-DLS tests were re-administered as follow-up test. Mann Whitney U test and Wilcoxon Signed-Rank Test were used for the analysis of the study data. A comparison between the post-test mean scores of the experimental and control group showed a significant difference (p &lt;.05) in math skills favoring the experimental group; no difference was found in pre and post-test scores in daily living skills (p&gt;0.5). No significant difference was noted between the post-test and follow-up mean scores that experimental group children obtained on BSSI-3-MATH and BSSI-3-DLS, which showed that program gains were maintained.

The effects of psychological first aid training on disaster preparedness perception and self-efficacy

ObjectiveThis study was conducted with the aim of investigating the impact of psychological first aid training on the perception of disaster preparedness and self-efficacy. MethodologyThis study is an experimental randomized control study design with monitoring measurement. The study was carried out with a total of 76 nursing students including 38 in the intervention group and 38 in the control group. The data were collected using a Personal Information Form, the Disaster Preparedness Perception Scale for Nurses and the General Self-Efficacy Scale (GSS). Sessions of Psychological First Aid training that lasted 60 min were carried out with the students in the experiment group once a week along 6 weeks. The statistical analysis on the data involved descriptive statistical methods (means, standard deviations, frequencies), Mann Whitney U test, Spearman Correlation, Friedman and Wilcoxon Signed Ranks tests. FindingsIt was found that the mean scores of the intervention group under all sub-dimensions of the disaster preparedness perception scale for nurses (preparation phase, intervention phase, and post-disaster phase) increased significantly after the training and in follow-ups, and these were significantly higher than the mean scores of those in the control group. It was determined that the mean post-training and follow-up general self-efficacy scores of the intervention group increased significantly, and these were significantly higher than the mean scores of those in the control group. ConclusionIt was determined that psychological first aid education positively affected the subject's perception for disaster preparation as well as their perception of general self-efficacy. In line with this conclusion, as per this study it is suggested to provide training that includes psychological first aid training module in undergraduate nursing programs.

Effects of a Stress Management Training Program With Mindfulness-Based Stress Reduction.

The purpose of this study is to evaluate the effectiveness of a mindfulness-based stress reduction program applied to a sample of Turkish nursing students. The study was designed as a randomized controlled trial. Program sessions of 90 to 95 minutes were given twice per week for 12 weeks. Data were collected using the Nursing Education Stress Scale, the Mindfulness Scale, and the Stress Management Styles Scale. A statistically significant difference was found in the mean posttest and mean follow-up scores obtained by the control group and the experimental group on the Nursing Education Stress Scale and its subdimensions. On the Mindfulness Scale, a statistically significant difference was found between the mean pretest and posttest scores obtained by the experiment and control groups. The results derived from this study suggest that the mindfulness-based stress reduction program is effective in reducing the stress experienced by students during nursing education, increasing their mindfulness, strengthening their coping mechanisms for stress, increasing their use of self-confident and optimistic approaches, and decreasing their use of the helpless approach. [J Nurs Educ. 2019;58(5):273-280.].

The Effect of Cognitive Behavioral Group Therapy on Infertility Stress, General Health, and Negative Cognitions: A Randomized Controlled Trial

This study determined the effect of a cognitive behavioral group therapy (CBGT) program administered to infertile women on infertility-related stress, depressive and anxious thoughts, and general health state. A randomized controlled design was used for this study. The study was conducted with 107 infertile women: 55 in the experimental group and 52 in the control group. The CBGT was administered to the experimental group for 11 weeks. The pretest, posttest, and trimester follow-up results of this group were compared with those of the control group. The experimental group’s Fertility Problem Inventory pretest mean score was 188.47 ± 30.699, posttest mean score was 135.84 ± 22.571, and follow-up mean score was 140.61 ± 20.16. A statistically significant difference was found between the experimental and control groups’ pretest, posttest, and follow-up mean scores on depressive and anxious cognitions (CCL), FPI and its subscales, and the General Health Questionnaire-28 and its subscales (p < 0.05). The CBGT intervention reduced the infertility-related psychosocial problems experienced by infertile women and promoted improvement in their depressive and anxious cognitions, and their mental health.

V-Mart, a Virtual Reality Grocery Store: A Focus Group Study of a Promising Intervention for Mild Traumatic Brain Injury and Posttraumatic Stress Disorder.

This study examined the potential usability, relevance, and acceptability of V-Mart, a virtual reality grocery store as an assessment and intervention tool for veterans with mild traumatic brain injury. Six focus groups were conducted for a 2-yr period to assess perceptions from the following three key stakeholders: therapists, veterans with neither mild traumatic brain injury nor posttraumatic stress disorder, and veterans with mild traumatic brain injury with or without posttraumatic stress disorder (mild traumatic brain injury/posttraumatic stress disorder). The System Usability Scale was applied as an objective measure of usability. Transcripts from the six focus groups were subjected to thematic analyses using the constant, comparative method. The focus groups indicated that V-Mart was perceived as highly usable, relevant, and acceptable. Early technical problems were resolved satisfactorily. Therapists indicated that they would use an application such as V-Mart if it were available. The veterans with neither mild traumatic brain injury nor posttraumatic stress disorder felt that it was realistic and likely to be useful, as did the veterans with mild traumatic brain injury/posttraumatic stress disorder. The System Usability Scale mean follow-up scores ranged from 71.4 to 86.0, surpassing the threshold for acceptable usability in health care settings. Focus group and System Usability Scale data indicate that the V-Mart has great potential as an assessment tool and intervention for veterans with mild traumatic brain injury/posttraumatic stress disorder. Further development and clinical trials are warranted.

Do interventions that include education on dementia progression improve knowledge, mental health and burden of family carers? A systematic review.

The European Association of Palliative Care recommends that family carers need education on the progression of dementia. This systematic review aimed to explore whether interventions incorporating education regarding the progressive nature of dementia increased carers' understanding of dementia and improved mental health and burden. MEDLINE, PsycINFO and CINAHL were searched to April 2018. Randomised controlled trials with samples of family carers of someone with dementia were eligible. Included interventions involved a component aimed to increase the carer's understanding of the progression of dementia. Outcomes of interest included: knowledge of dementia, depression, burden and pre-death grief. Searches identified 3221 unique citations of which 11 studies were eligible for review. Interventions ranged from 4 to 16 sessions of which 1 to 3 sessions focused on the progression of dementia. Knowledge: Two studies evaluated carers' knowledge of dementia. One found no difference between the trial arms immediately after the intervention or three months later. The second found a significant intervention effect at the end of the intervention but not at three-month follow-up. Depression: Seven studies evaluated intervention effects on depression. Meta-analysis of three trials showed significant differences in mean follow-up scores favouring intervention over control. The remaining four studies did not show differences in depression between intervention and control groups. Burden: Nine studies evaluated burden and were examined in two meta-analyses (mean scores at follow-up and mean change scores from baseline to follow-up), neither of which found a benefit for intervention over control. Using the grading of recommendations assessment, development and evaluation system, we judged the quality of evidence to be very low for depression and low for burden, knowledge and pre-death grief, reducing our confidence in any of the effect estimates. The evidence was not sufficient to support or refute the effectiveness of education on progression of dementia on carers' knowledge and mental health.

Role of Decompressive Laminectomy without Instrumentation in the Management of Nurick Grade 4 and 5 Cervical Compressive Myelopathy.

Introduction:Cervical laminectomy is a very well-known posterior decompressive procedure for cervical compressive myelopathy (CCM). Our objective is to evaluate the functional effect of posterior decompressive laminectomy for poor grade CCM.Methods:This study was an observational retrospective study carried out on patients with poor-grade CCM who underwent decompressive laminectomy from January 2010 to December 2015. Patients with Nurick Grades 4 and 5 (walking with support or bedbound) were included in the study. Clinical data and radiological information were collected from medical records, and objective scales were applied to compare the surgical outcome between preoperative score and postoperative score.Results:A total of 69 patients who underwent decompressive laminectomy for poor grade CCM were included. The mean age was 54.9 years, and the male-to-female ratio was 5.3:1. Ossified posterior longitudinal ligament comprised 52.6% cases. The follow-up data of at least 6 months’ duration after surgery was available for 57 (82.6%) cases. On comparing with preoperative Nurick grade at follow-up, 40 of the 57 patients (70.2%) were found to have improvement following surgery by at least one grade. The remaining 17 (29.8%) had either remained the same or had deteriorated further. The mean preoperative modified Japanese Orthopedic Association score was 8.4 ± 2.8, and the mean follow-up score was 11.8±0.3 (P = 0.0001). On multivariate analysis, the number of levels of laminectomy, postoperative deterioration, and anesthesia grade were predictors of outcome.Conclusion:Decompressive laminectomy for poor grade myelopathy is effective in improving functional outcome.

The Effect of Laughter Yoga on the Quality of Life of Elderly Nursing Home Residents

Background: Old age is associated with the physical and psychological problems that affect the Quality of Life (QoL). Objectives: This study aimed to investigate the effect of Laughter Therapy (LT) on the QoL of elderly people in nursing homes. Materials &amp; Methods: This was a quasi-experimental study with‌ pre-test and post-test with the control and experimental group and one-month follow-up conducted in 2017. The statistical population consisted of 44 elderly people in the Mehr Aein nursing home in Astaneh-ye Ashrafiyeh City, Iran. Based on the inclusion criteria, 32 old people were selected and randomly assigned to experimental ‌(n=16) and control (n=16) groups. The experimental group received an interventional program consisting of Madan Kataria Laughter Therapy, showing comic films, and reading comic books for one month, over 12 sessions of 100 minutes. After the end of laughter intervention, the elderly of both groups responded to the elderly quality of life questionnaire (LIPAD). The obtained data were analyzed using covariance analysis of repeated measures. Results: There was a significant difference between the two groups with regard to their QoL‌ (P&lt;0.01).‌ That is, the adjusted mean of the experimental group in the QoL was significantly higher than the mean of the control group‌ (P&lt;0.01). Also, in the experimental group, the mean follow-up score was higher than the mean score of the pre-test, which indicates the stability of the intervention effects after one month‌ (P&lt;0.01). Conclusion: Laughter Therapy intervention has a positive effect on improving the QoL of the elderly. Therefore, it is necessary that authorities consider this program at nursing home centers as a complementary method besides the existing treatments for reducing the mental health problems and improving the QoL of the elderly.