Hands-on Intervention Research Articles

Evaluation of Telehealth Services that are Clinically Appropriate for Reimbursement in the US Medicaid Population: Mixed Methods Study.

When the US Department of Health and Human Services instituted a State of Public Health Emergency (PHE) during the COVID-19 pandemic, many telehealth flexibilities were fast-tracked to allow state Medicaid agencies to reimburse new specialty services, sites of care, and mediums such as FaceTime to communicate with patients.. This resulted in expanded access to care for financially vulnerable Medicaid patients, as evidenced by an uptick in telehealth use. Research has mostly focused on telehealth reimbursement for limited use cases such as rural primary care, without broader consideration for how telehealth can be appropriately mainstreamed and maintained. This study sought to (1) evaluate the continuation of flexible telehealth reimbursement broadly, beyond the COVID-19 pandemic; (2) analyze the clinical effectiveness of the new telehealth services; and (3) offer code-by-code reimbursement guidance to state Medicaid leaders. We surveyed 10 state Medicaid medical directors (MMDs) who are responsible for the scientific and clinical appropriateness of Medicaid policies in their respective states. Participants were asked to complete an internet-based survey with a list of medical billing codes, grouped by service type, and asked if they believed they should be reimbursed by Medicaid on a permanent basis. Additional questions covered more detailed recommendations, such as reimbursing video with audio versus audio-only, guardrails for certain specialty services, and motivations behind responses. The MMDs felt that the majority of services should be reimbursed via some modality of telehealth after the PHE, with the most support for video combined with audio compared to audio-only. There were exceptions on both ends of the spectrum, where services such as pulmonary diagnostics were not recommended to be reimbursed in any form and services such as psychotherapy for mental health had the most support for audio-only. The vast majority of MMDs were supportive of reimbursement for remote monitoring services, but some preferred to have some reimbursement guardrails. We found that 90% (n=9) of MMDs were supportive of reimbursement for telehealth interprofessional services, while half (n=5) of the respondents felt that there should be continued guardrails for reimbursement. Motivations for continuing reimbursement flexibility were largely attributed to improving access to care, improving outcomes, and improving equity among the Medicaid patient population. There is a strong clinical endorsement to continue the telehealth flexibility enabled by the PHE, primarily for video combined with audio telehealth, with caution against audio-only telehealth in situations where hands-on intervention is necessary for diagnosis or treatment. There is also support for reimbursing remote monitoring services and telehealth interprofessional services, albeit with guardrails. These results are primarily from a perspective of improving access, outcomes, and equity; other state-specific factors such as fiscal impact and technical implementation may need to be taken into account when considering reimbursement decisions on telehealth.

Integration of a respiratory function monitor into newborn positive pressure ventilation training; development of a standardised training intervention

ObjectiveOne in twenty newborns require resuscitation with positive pressure ventilation (PPV) at birth. Newborn face mask ventilation is often poorly performed. To address this, the potential role of respiratory function monitors (RFM) in newborn resuscitation training has been highlighted. The objective of this study was to develop a standardised training intervention on newborn PPV using an RFM with a simple visual display to identify and correct suboptimal ventilations. MethodsWe adapted the framework from a simulation development guideline to create a hands-on intervention on newborn PPV using an RFM with simple visual feedback (Monivent NeoTraining). We enrolled a group of healthcare professionals to a manikin-based pilot study as part of this process, conducting a series of teaching sessions to refine the intervention. Suggested changes were gathered from participants and instructors. Our main objective was to develop a standardised, reproducible training intervention. ResultsA standardised training intervention on newborn PPV was systematically developed. Twenty-six healthcare professionals working in tertiary neonatal care participated in a pilot study, consisting of eight training sessions. Each iteration of the intervention was informed by the previous session. Instructions for the delivery of teaching were standardised and a training algorithm was developed. ConclusionRFM’s have been shown to be effective tools in research settings, addressing poor technique and face mask leak. They are not routinely used in newborn resuscitation training. To address this, we developed a standardised training intervention on newborn PPV using an RFM with simple visual feedback.

Aligning orthodontic education: Investigating the use of a digital app to improve the performance in managing orthodontic problems.

General dentists are qualified to manage orthodontic emergencies within their scope of practice. This may involve advice, hands-on intervention or referral to a specialist orthodontist. This study aimed to assess the effect of an orthodontic app on dental undergraduates' ability to manage common orthodontic issues. In addition, this study aimed to determine the confidence of dental students in finding information related to orthodontic emergencies (CFI) as well as their confidence in managing orthodontic emergencies (CMOE). Students were randomised into one-of-three groups, an app group, an internet group and a closed-book, exam-style group. All participants self-reported their CFI and CMOE. Following this, all participants were asked to complete a multiple-choice question (MCQ) paper based on clinical orthodontic scenarios. In addition, the app group were instructed to complete an app usability questionnaire (MAUQ). Approximately, 91.40% of students (n = 84) had not received clinical training in managing orthodontic emergencies, and 97.85% (n = 91) had not managed an orthodontic emergency clinically within the last 6 months of their training. The mean score for CFI was 0.10 out of 1.0 (SD 0.11) and CMOE was 0.28 out of 1.0 (SD 0.23). Statistically significant better MCQ scores were found in the app group, and no statistically significant difference was found between the internet and exam-style group. This study is the first to consider the use of an orthodontic app to aid in the management of orthodontic issues. It has practical implications for how mobile apps can aid in learning and can be incorporated into the wider dental field.

What is the Role of Hierarchical Interventions? Insights from the Evolution of Water Collaborative Governance in China.

Collaborative governance has been viewed as an effective approach to solve the problem of environmental pollution. Recently, while some scholars have advanced the integral role of hierarchical interventions in collaborative processes and outcomes, less attention has been paid to the long-term evolution of hierarchical interventions through the lifecycle of collaboration. Based on the case study of water collaborations along the Maxi River in the Yangtze Delta region since 2001, this paper investigates the empirical evolution and influencing mechanisms of hierarchical interventions, primarily hands-off and hands-on interventions, at different collaboration development stages. The results show that collaborations along the Maxi River have experienced stages of activation, collectivity and institutionalization in the past twenty years, wherein the quality and extent of the collaborative dynamics have gradually enhanced. Hierarchical interventions are found to be context-specific, though both hands-off and hands-on intervention tools have potential to exert positive influence on the three collaborative dynamics (principled engagement, shared motivation and capacity building). Hands-on strategies, namely the superiors' direct participation or support, are of great importance in the initial stage when stakeholders have conflicts of interests/values or failed past experiences. As the collaborative process matures, the superordinate governments would usually adopt hands-off tools to provide an institutional framework and a legitimate basis, thereby fostering participants' interdependence and self-initiated motivations. Additionally, in Chinese context, hands-off tools tend to take more powerful effects than hands-on tools in the long term.

Parenting stress in caregiver-mediated interventions for toddlers with autism: An application of quantile regression mixed models.

Traditional longitudinal modeling approaches require normally distributed data and do not account for sample heterogeneity. Parenting stress, in particular, can be difficult to model across time without transforming the data as it is usually high for caregivers of children with ASD. This study used novel linear quantile mixed models (LQMMs) to model non-normal parent stress scores across two caregiver-mediated interventions involving toddlers with ASD. The sample included 86 caregiver-child dyads who were randomized to either a parent-only psychoeducational intervention or hands-on parent training in a naturalistic developmental intervention. Child and parent-related domains of the Parenting Stress Index (PSI) were the primary outcomes in this study. The PSI was collected at entry, 10-week exit, 3-month follow-up, and 6-month follow-up periods. Separate LQMMs were used to model five specific quantiles ( of the two PSI domains across the complete intervention timeline. These five quantiles effectively modeled the entire conditional distribution of parenting stress scores. The LQMMs indicated that child-related parenting stress decreased across all quantiles within both interventions, with no difference in the rate of parenting stress change between the intervention groups. For parent-related parenting stress, the effect of intervention depended on the group's stress level; some parents increased their perceived stress within the hands-on intervention at the 3-month follow-up. Overall, this study demonstrated that the use of LQMMs yielded additional information, beyond traditional longitudinal models, regarding the relationship between parenting stress within two caregiver-mediated intervention protocols. This study also discussed the methodological contributions and potential future applications of LQMMs. LAY SUMMARY: This study used a newer longitudinal modeling technique to examine how parenting stress changed across two caregiver-mediated interventions for toddlers with ASD. Results showed that certain parents in the JASPER condition might require additional support as they exit the study and enter into their first follow-up period. It was also determined that this new modeling technique could be a valuable tool to analyze highly variable data often present in ASD intervention studies.

Developing and Implementing an Intervention Study: Strategies for Mentoring Students Throughout the Research Process

Introduction Designing and conducting an intervention study is an arduous task for students that requires strong teaching and mentoring practices from psychology instructors. Statement of the Problem Most research methods textbooks simply describe how an intervention is incorporated into a research study design (Johnson & Christensen, 2016), but rarely discuss steps on how to plan and develop an intervention study, leaving instructors without a guide to mentor students throughout the process. Literature Review Some research methods education instructors incorporate teaching techniques such as problem-based learning, “learning by doing,” or by incorporating online modules into their research methods curricula (Gurung, R. A. R., & Stoa, R. (2020). A national survey of teaching and learning research methods: Important concepts and faculty and student perspectives. Teaching of Psychology, 47(2), 111-120.). Teaching Implications This article provides a summary of best practices from the literature and from our experiences in planning, developing, and implementing rigorous intervention studies utilizing a checklist teaching-tool intended for undergraduate- and graduate-level psychology instructors. Additionally, teaching tips on incorporating hands-on intervention activities and projects into coursework are provided (Butler, B. M., & Morrow, J. A. (2021). Developing and implementing an intervention study: Strategies for mentoring students throughout the research process supplementary material. Figshare). Conclusion This checklist can enhance the teaching and mentorship of students to ensure successful intervention studies of their own.

THE USE OF A STEP STOOL DURING CHEST COMPRESSIONS: DOES IT MAKE A DIFFERENCE, AND DO CLINICIANS CHOOSE TO USE IT?

SESSION TITLE: Education, Research, and Quality Improvement Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: High quality cardiopulmonary resuscitation (CPR) is the most important factor in surviving cardiac arrest. Using a step stool to improve chest compressions is universally recommended yet under-researched. This observational, simulation-based study sought to answer two questions: first, is CPR performance improved with the use of a step stool? Second, how often do adult healthcare providers use a step stool for chest compressions, and does the frequency increase following a brief educational session demonstrating the advantages of step stool use? METHODS: Over 3 years (2018-2020), 535 interdisciplinary providers (nurses, house staff, attendings, and pharmacists from internal medicine, intensive care, anesthesiology, and obstetrics) participated in this observational study. Participants first performed one minute of CPR on Resusci-Anne ®, a CPR mannequin, and were scored from 0-100 on their performance. A step stool was available for use next to Resusci-Anne ® if the participant desired. Thereafter, participants underwent an educational intervention on the advantages of using a step stool while performing CPR. They watched a demonstration by an instructor and were then given time to practice CPR with and without a step stool. Each participant was then asked to do another minute of CPR on the Resusci-Anne ® and again scored from 0-100 on their performance. A step stool was again in close proximity for use, if the participant desired. RESULTS: Participants were selected via convenience sampling at a large academic hospital with a pre-existing cardiac arrest simulation course. A total of 535 participants were tested pre-intervention, and 520 participants were tested post-intervention. Prior to the intervention, only 16.6% (n=89) of providers elected to use a step stool for chest compressions, compared to 97.5% (n=507) post-intervention (p=<0.001). The average CPR performance score (0-100) significantly improved from pre-intervention to post-intervention (74 vs. 95; p=<0.001). CONCLUSIONS: Our study demonstrates that the quality of CPR improves significantly with the use of a step stool. However, without education on the benefits of using a step stool and demonstration of the proper technique, few adult healthcare providers will elect to do so. A brief, hands-on intervention teaching adult healthcare providers about the benefits of CPR with a step stool significantly increased its use and the quality of chest compressions. CLINICAL IMPLICATIONS: This study demonstrates that adult healthcare providers across multiple disciplines can quickly and easily be taught to use a step stool during CPR, and that doing so significantly improves the quality of CPR they provide. Given that early and high-quality CPR is the cornerstone of advanced cardiovascular life support (ACLS), this intervention has the potential to improve the mortality of in-hospital cardiac arrest. DISCLOSURES: No relevant relationships by Timothy Clapper, source=Web Response No relevant relationships by Imaani Easthausen, source=Web Response No relevant relationships by Kelly Griffin, source=Web Response No relevant relationships by Elyse LaFond, source=Web Response No relevant relationships by Melissa Moulton, source=Web Response No relevant relationships by Kapil Rajwani, source=Web Response No relevant relationships by Nina Rusiewski, source=Web Response No relevant relationships by Samantha Smith, source=Web Response

Effects of Community Mapping using Drone on Citizenship and Social Participation Competency: A School-based Creative Hands-on Activity Intervention Study in Nongoldam-gil, Donghae

Effects of Community Mapping using Drone on Citizenship and Social Participation Competency: A School-based Creative Hands-on Activity Intervention Study in Nongoldam-gil, Donghae

Meta-Analysis on the Effect of Physical Therapy Methods on Myofascial Pain Syndrome: The Cases of Domestic Research

Purpose: The primary purposes of this study were to identify the degree of the effect size and the variables related to it on the effects of physical therapy on myofascial pain syndrome. Methods: This study collected 15 studies published between 2008.01.01 and 2019.12.31. The Analysis results confirmed 57 effect size data. The random-effect model was chosen because of the heterogeneity of the data. Results: First, the full case showed the largest mean effect size of 2.03 (p<0.001). Second, the size of the effect, according to the hands-on intervention, was 2.74 (p<0.003). Third, the VAS showed an effect size of 2.30 (p<0.001). Fourth, the intervention period showed a 1- to 15-day effect size of 2.94 (p<0.001). The number of interventions showed a 6 to 10 effect size of 2.84 (p<0.006). The number of participants showed a 10 or less effect size of 2.66 (p<0.001). Finally, the ‘Trim and Fill’ result confirmed that the calibration effect size was 0.93 (p<0.001). Conclusion: Physical therapy had a great effect on myofascial pain syndrome in the neck and shoulders, and that the effect differed ac cording to the methods of the intervention and the methods of evaluation.

Communication via intermediaries

A model of communication with two features is presented: inattentive receivers, who are heterogeneous in their inattention, and the intermediaries, whose preferences are not aligned with each other or with the preferences of the initial sender. The sender faces a dilemma how to shape her message to maneuver the intermediaries into telling the final receivers what she considers important. A sincere communication policy and competition between the intermediaries are optimal if three conditions hold: the intermediaries have opposite preferences as to what the final receivers should learn, they are symmetric in their communication capacities and the sender is benevolent towards final receivers. Otherwise, the sender may benefit from a more hands-on intervention—selecting a self-censoring communication policy over sincerity or a single intermediary over competition.

Efficacy of a combined intervention program for the reduction of internalized stigma in people with severe mental illness

BackgroundInternalized stigma (IS) is a key factor in the recovery, quality of life and functioning of people with severe mental illness (SMI), and effective intervention programs are needed to reduce IS in all its dimensions. The aim of this report was to design and evaluate the effectiveness of a new psychological intervention group program for the reduction of IS in people with SMI. MethodsA 9-session hands-on intervention program was designed with a group format in which different therapeutic techniques were combined. To evaluate the effectiveness of the program, 80 people with SMI and high levels of IS were selected and randomly assigned to one of two groups: program (n = 41, experimental group) or conventional treatment (n = 39, control group). ResultsMixed analysis of variance showed improvements in total IS and all of its dimensions (cognitive, emotional and behavioral) (p ≤ 0.01) and in depressive symptomatology (p = 0.01) in the experimental group after the treatment phase. ConclusionThe results indicate that the program effectively reduces IS and its dimensions as well as other relevant associated variables in a sample of people with SMI.

Mobilisation And Tactile (Sensory) Stimulation For The Foot Post Stroke: Opinions And Perceptions Of Experienced Therapists

Background/Aims Intensive proprioceptive stimulation applied to the paretic hand post-stroke, using a complex hands-on intervention known as mobilisation and tactile stimulation, has reduced motor impairment and improved hand function in sub-acute and chronic stroke. While, anecdotally, mobilisation and tactile stimulation is also applied to the paretic foot to prepare it for standing, its use in stroke rehabilitation and effects on standing and balance have not been evaluated. Therefore, expert clinicians' experiences, opinions and perceptions of using mobilisation and tactile stimulation in routine clinical practice were explored to inform a subsequent feasibility study of mobilisation and tactile stimulation for the paretic foot post-stroke. Methods Following ethical approval, focus groups were undertaken: using purposive sampling, physiotherapists and occupational therapists with &gt;12 months experience of stroke rehabilitation were recruited from a regional special interest group. A pilot study (n=4) and main study (n=7) explored content and application of hands-on therapy for the paretic foot, and the perceived impact of sensory loss on lower limb function. Data were audio-taped and transcribed verbatim. Thematic analysis was undertaken. Results All 11 therapists had previous experience of using mobilisation and tactile stimulation for the foot post-stroke. Three main themes were identified: (1) therapeutic intervention (sub-themes: therapy content, sensation, adjuncts, the foot as an active base of support and preparation for function); (2) 24-hour care; and (3) analysis (sub-themes: outcome measures, response to treatment). The most common adjuncts to mobilisation and tactile stimulation were orthotics and task-specific training. The importance of mobilisation and tactile stimulation in restoring foot alignment, sensory feedback and progression of the patient towards weight bearing and ambulation in the clinical setting was highlighted. Conclusions Mobilisation and tactile stimulation is a complex intervention used in stroke rehabilitation to enhance weight bearing and ambulation post stroke. Further research into its effects on the foot and lower limb is warranted in order to evaluate it and determine its evidence base for inclusion in routine clinical practice. Alternative methods of applying proprioceptive stimulation should also be considered, for example use of textured insoles, and relative effectiveness of these explored in clinical trials.

An intervention to increase accuracy and understanding in undergraduate micropipette use

Abstract Micropipetting is an essential skill for the budding immunologist and is widely used across biological and physical science disciplines, yet few undergraduates are adequately introduced to this skill. The mentors of undergraduates seeking research experience point to micropipette inexperience as a common barrier to success. As part of our SEA-PHAGES authentic research laboratory, we designed a hands-on intervention to give thorough training in micropipetting to first-year undergraduates. The intervention included assignment of a pre-class video on micropipetting, an activity to orient students to the micropipette parts and functions, and a TA-led demonstration of proper micropipette use and volume adjustment. Success of the intervention was analyzed using data collected from a practical test following the lab activity. In addition, we compared the students’ end-of-semester experimental success to that of students from previous semesters lacking the micropipetting activity, using archived electronic laboratory notebooks. We found that students progressed through experiments faster and with more success after experiencing the micropipette intervention. Our analysis showed that some aspects of proper micropipette use need to be emphasized, such as proper depth of tip entry and the correct tactile discrimination of the first/second stop on the micropipette. In addition, we found that students have misconceptions and gaps in knowledge about the metric system that are an additional barrier to proper micropipette use. This project presents a successful platform for teaching micropipette technique, and demonstrates that this leads to increased likelihood of success for the students in this real-world laboratory setting.

Coaching a slow birth with the woman in an empowered position may be less harmful than routine hands-on practice to protect against severe tears in birth – A discussion paper

BackgroundDifferent hands-on interventions to protect women from severe perineal tears after birth have been widely implemented. Evidence to support the routine use of hands-on interventions to reduce severe tears is mainly based on aggregated data from observational studies. AimTo critically discuss the current evidence for the implementation of hands-on intervention as a routine practice to protect women from severe tears after birth. DiscussionObservational studies have been used to justify the routine use of hands-on intervention to protect women from severe perineal tears despite randomized controlled trials and systematic reviews showing lack of benefit. There is strong evidence supporting the slow speed at the time of birth to prevent severe perineal tears. While hands-on intervention does reduce the speed of birth, it may have a negative effect on the birth process, on neonatal outcomes and women’s agency. ConclusionEvidence-based practice requires sufficient evaluation of interventions before being implemented in clinical practice as well as valuing the level of evidence when making clinical decisions. Evaluation of hands-on interventions to protect women from severe perineal tears must include not just one outcome of interest, but also an assessment of how the intervention interferes with the normal mechanism of birth, and how it affects neonatal outcomes and the autonomy of women.

Educational intervention to improve the knowledge of hand hygiene in pediatric residents and nurses.

Objectives:To assess the improvement in the knowledge of hand hygiene in Pediatric residents and nurses after theoretical and hands-on educational interventionMethods:This study was a questionnaire-based cross-sectional survey carried out in the department of Pediatrics, King Edward Medical University/ Mayo hospital Lahore in two weeks period. Total 41 Pediatrics residents and nurses, participated in the study. Initially a pretest questionnaire was given to each participant, followed by an educational intervention: a day’s worth of didactic lectures and practical training of practices for infection control. After two weeks, an identical post-test questionnaire was sent to the participants via email. Data were statistically analyzed through SPSS 22. Z test was applied to see the normality of data while paired t test was applied to compare the pretest score with posttest score.Results:Of 41 participants who attended the workshop, 34 participants responded to post-test giving an overall response rate of 83%. Out of 34, there were 27(80%) doctors and 7(20%) nurses, who participated in workshop. Each item of the questionnaire was analyzed, showing that pretest score for questions related to indication for hand washing, minimum timings required for hand rub, and spread of infection from unclean hands was quite low, as compared to post-test score, indicating statistically significant increment (p value 0.000, 0.001and 0.046 respectively). Mean pre-test score for doctors was 3.22 while for nurses, it was 3.14, whereas post-test score was 4.51 and 4.00 for doctors and nurses respectively. Overall, there was statistically significant increase in knowledge after educational intervention.Conclusion:There is statistically significant impact of educational intervention on improving the knowledge of Pediatric residents and nurses with respect to hand hygiene practices.

Feasibility of Training Early Childhood Educators in a Community Child Care Setting Using a Caregiver-mediated Intervention for Toddlers with Autism Spectrum Disorder

Parent-mediated intervention programs have demonstrated benefits for toddlers with autism spectrum disorder (ASD). Interest is emerging in other community-level models, such as those that can be integrated into child care settings. These programs have the potential to reach a wide range of high-risk toddlers who spend the majority of their day in child care. The objective of this study was to translate and evaluate the feasibility of the Social ABCs caregiver-mediated intervention program into a community child care setting by training front-line early childhood educators (ECEs). Twenty-two ECEs attended a workshop on early intervention and ASD, and six ECEs and one special needs resource consultant received hands-on intervention training. Nineteen participants completed a workshop quiz, with significant mean improvement of 22.26% from pre- to post-workshop. After 12 weeks of live coaching (4 weeks in one case), participants attained a high level of fidelity in implementing the intervention strategies (&gt; 80%), which was maintained after a 3-month period of non-contact with the training team. Nine of ten specific strategies were mastered after the 12-week training period, with only one technique failing to reach a mean fidelity level of 75%. Findings reveal that the model of training front-line child care staff in a community child care setting is feasible using a relatively short-term training approach.

Hands-on Nutrition and Culinary Intervention within a Substance Use Disorder Residential Treatment Facility

Hands-on Nutrition and Culinary Intervention within a Substance Use Disorder Residential Treatment Facility

Developing and evaluating effective bioscience learning activities for nursing students

Effective engagement of nursing students in the study of biosciences remains a challenge for many tertiary institutes. In this study we attempted to implement and then evaluate a simple hands-on intervention, consisting of a series of hands-on games and puzzles, to increase nursing student engagement with core concepts and anatomical learning involved in clinical anatomy and physiology. The study used a quazi-experimental longitudinal before and after design, to explore the effect of a learning intervention on student performance. Set across three different campuses of the same University, it included 1320 first year undergraduate nursing students from 2013 to 2014 who were studying Anatomy and Physiology.Students were exposed to the interventions or not, and concomitant academic performance, weekly quiz scores, performance in fortnightly worksheets and, across the semester, exam performance were compared. The results show that while the intervention appeared to increase academic performance in students on one campus (2013) compared to the other two, this difference was not sustained into 2014 when a bigger cohort was examined. Despite significant subjective student satisfaction and enthusiasm about these learning and teaching interventions, the data does not support the capacity of these activities to enhance student academic performance. Tertiary entrance scores, being a non-native English speakers and socio-economic status all had a bigger impact on student performance than engagement with fun anatomy and physiology activities.

Commentary on "Modified Constraint-Induced Movement Therapy as a Home-Based Intervention for Children With Cerebral Palsy".

“How could I apply this information?” With 1 to 2 hours of daily restraint wear and training, the results of this study showed that children with hemiplegic cerebral palsy improved upper limb function. This home-based program offers families a viable alternative to intensive, clinic-based constraint-induced movement therapy (CIMT). Parents may feel empowered that after training, they can work with their child at home to produce meaningful results, without relying on a therapist to provide hands-on intervention. The lower assessment scores recorded 1 month post-intervention suggest that continued home activities are necessary to maintain skills. Parent comments: We are encouraged by the results of this study because they may apply to our son whose limited upper limb function resulted from a stroke. Home-based CIMT could augment the therapy he receives in the clinic. It might also afford him the luxury of being relaxed and able to do it on his own time, in a familiar setting. “What should I be mindful about when applying this information?” Finding the right fit between the child, family, and home or clinic-based protocol is integral to meeting the needs of everyone involved. Subjects participated in 60% of the recommended training hours, which is 10% to 20% more than other home-based CIMT.1 The interactive video game may have improved adherence; however, it is unclear whether increased test scores resulted from the game or additional weeks of training. The article excluded details of the family training, so inexperienced clinicians who follow the protocol might implement a forced use program. Parents only logged quantitative data. Qualitative data and a quality of life measure may be appropriate to further assess home-based interventions. Reporting individual test scores beyond baseline may assist with data interpretation, given the variability in the subjects' restraint wear times. Results from a longer follow-up period would be helpful to inform third-party payers and to increase buy-in from clients and families. Parent comments: Future studies may want to consider asking each child to do therapy for the same number of hours each day and days per week. Subjects could be categorized by age and sex because both may influence results. Our son, like most children, was inconsistent with doing CIMT at home. However, we saw a marked improvement after a few days. Although it may be challenging and uncomfortable for a child to wear a constraint on his or her good arm, we recommend a strict daily routine to help with adherence. So far, we are very satisfied with our son's improved arm function, knowing that his road to full recovery is long. Laura Rabin, MA, OTR/L California Children's Services, County of Los Angeles North Hollywood, California Lisa Dittbenner, BS, OTR/L California Children's Services, County of Los Angeles El Monte, California Ana and Joey Sarreal Parents of a teenager with hemiplegia from a cerebral vascular accident Los Angeles, California

21IN - Platforms for Tumour Sequencing: Pertinence and Practicability

ABSTRACT This presentation aims to provide an overview of why we need next generation sequencing platforms and how the different next generation sequencing platforms perform. Moreover, some data on implementation and outcome of the Dutch experience within the Center for Personalized Cancer Treatment will be discussed. One of the challenges of increased targeted treatment for cancer is to select our patients. Novel targeted therapies require an ever-increasing number of predictive biomarker determinations on the limited amount of tissue of patients with metastatic disease. This increasing demand for predictive biomarkers presents us with challenges in the realm of tissue availability, cost-effective use of diagnostics and limiting the time-to-proper diagnosis. Part of this challenge can be resolved by introducing the use of next generation sequencing techniques to multiplex genetic diagnostics. We show that we can validate and implement the based technology for diagnostic purposes. We show that we can detect the mutations that are clinically actionable and that we widely broaden are ability to detect variants in well-known cancer genes. We also show that an improved version of the commercially available panel for the Ion Torrent is able to detect copy number changes reliably. This test represents an example of the type of multiplexed test we need for proper patient stratification in the near future. This will be supported by data derived from a cohort of about 700 cancer patients we tested. Furthermore this test can deliver interpretable data within a week as the interpretation of these data has been automated and requires only minimal hands-on intervention. Next generation sequencing for stratification of cancer patients for treatment will be implemented in the near-future to improve our ability to determine multiple genetic biomarkers in tumor tissue. Disclosure: M.P. Lolkema: I have received consultancy fees from Novartis, Roche, Amgen, GSK and BMS. I have received a research grant from Astellas.