Initial Baseline Assessment Research Articles

Application of a New Device for Vision Relaxation in Computer Users.

This study aims to explore the potential of a novel EYE ROLL device designed to facilitate guided vision relaxation exercises in an open space. A prospective study was performed on 89 participants who perform screenwork for at least four hours daily. All participants were randomly divided into three groups: a Control group with no exercising, a Manual group undertook manual vision relax ation exercises, and an Eyeroll group engaged in EYE ROLL device-assisted vision relaxation exercises. Each participant underwent three evaluations (an initial baseline assessment, a 4-week follow-up, and an 8-week follow-up) with four assessment tools: a comprehensive vision examination, an in-depth questionnaire, saccadic eye movement recordings, and objective accommodation measurements. There was a statistically significant decrease (35% and above) in complaint scores at the 4-week follow-up in both training groups. Although statistically insignificant, complaints continued to decrease after an 8-week period. No significant changes were observed in clinical or objective accommodative parameters. Some variation of visual functions was observed in all groups due to repeated measures. Vision relaxation exercises combined with proper vision ergonomics and working habits can reduce asthenopic complaints. The EYE ROLL device presents a promising tool for integrating these exercises into the working environment.

Dose-Response Effects of Short-Term Rhodiola rosea Supplementation on Anaerobic Exercise Performance in Resistance-Trained Athletes: A Randomized, Crossover, Double-Blind, and Placebo-Controlled Study

Background: Rhodiola rosea (RR) has garnered attention for its potential ergogenic effects on athletic performance. The mechanisms underlying these effects are believed to involve improved energy metabolism and reduced exercise-induced oxidative stress. Methods: Twenty-seven resistance-trained individuals (13 males, 14 females; 22±3y; 170.4±10.7cm; 75.4±21.9kg) underwent three conditions in a randomized sequence: a low-dose RR (LD: 200mg/d of RR combined with 1.3g/d of maltodextrin), a high-dose RR (HD: 1.5g/d of RR), and a placebo (PL: 1.5g/d of maltodextrin), following an initial baseline (BL) assessment. Participants took supplements for seven days and a 7-day washout before transitioning to the subsequent conditions. Data were analyzed using a two-way (within-within) analysis of variance (p≤0.05) with LSD's post hoc when appropriate. Results: Participants' strength was evaluated using the one repetition maximum (1RM) test at BL and after each treatment phase. In the bench press, both RR doses exhibited significant enhancements compared to BL and PL, with weights being BL (69.6±39.7kg), PL (69.8±39.1kg), LD (72.2±41.1kg), and HD (73.4±41.4kg; p=0.001). Similarly, in the leg press, weights for both RR doses showed marked improvements over BL and PL, registering at BL (314.4±113.5kg), PL (326.2±117.0kg), LD (350.1±136.1kg), and HD (362.1±134.6kg; p<0.001). Muscular endurance was further probed, with participants conducting three sets at 60% of their 1RM for both exercises. In the bench press, the HD treatment showed a significant edge over BL and PL, with weights being BL (42.5±22.9kg), PL (43.2±23.0kg), LD (43.8±23.1kg), and HD (44.7±23.6kg; p=0.007). In the leg press, both RR doses outperformed BL and PL, with weights being BL (188.6±68.2kg), PL (195.1±68.6kg), LD (209.1±80.2kg), and HD (218.6±79.1kg; p<0.001). Regarding total lifting volume, both RR doses surpassed the BL measurements, with the HD regimen exceeding the PL. The volumes were BL (9792.7±4962.7kg), PL (11019.6±5389.2kg), LD (11805.1±5086.2kg), and HD (15344.8±10878.1kg; p<0.001). During the bench press evaluations, a significant uptick in mean power was observed post-RR supplementation for both dosages when compared to BL and PL, with power outputs being BL (200.7±124.4W), PL (204.1±124.4W), LD (221.6±139.6W), and HD (230.5±145.9W; p=0.007). However, metrics such as peak power, average velocity, and the outcomes of the Wingate test remained statistically unchanged (p>0.05). CONCLUSION: RR supplementation can enhance anaerobic performance in athletes, especially at higher doses. While it improved strength and endurance, some metrics, like peak power, remained unaffected. Further research is needed to understand RR's benefits fully. This study was self-funded, with the researchers covering all expenses. This approach ensures the research's independence from potential biases associated with external funding or grants. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Do hypothetical evaluations of alcohol related consequences change over time? Examining the influence of past and ongoing consequences

ObjectiveDespite experiencing alcohol-related consequences, college students continue to drink at high rates. Hypothetical evaluations of alcohol-related consequences (i.e., evaluations of where potential/hypothetical consequences lie on a spectrum from extremely positive to extremely negative) may contribute to the maintenance of drinking patterns among students. The purpose of the present study was to describe hypothetical evaluations in a sample of students mandated to an alcohol intervention, examine changes over time, and investigate the influence of both baseline and time-varying experienced consequences. Method: This study was a secondary data analysis from a longitudinal randomized controlled trial. Participants were 474 mandated students (Mage = 18.65; 55.5 % male, 77.6 % White). Students completed an initial baseline assessment of demographics, alcohol use, consequences, and hypothetical evaluations, and 3-month and 9-month follow-up assessments that included hypothetical evaluations and experienced consequences. Results: Hierarchical linear modeling (HLM) analyses revealed significant change in hypothetical evaluations over time such that they became less negative. A piecewise model demonstrated that this change happened between baseline and 3-month, with no additional change between 3-month and 9-month. The experience of consequences at baseline did not significantly moderate changes in either time interval. Time-varying consequences also had no significant effect on same-timepoint hypothetical evaluations. Conclusions: This study is the first to examine changes in hypothetical evaluations over time among mandated college students. Counter to expectations, hypothetical evaluations became less negative at 3-month follow-up. Though preliminary, findings add to the understanding of hypothetical evaluations of alcohol-related consequences.

Primary Versus Revision ACL Reconstruction Using Quadriceps Autograft: A Matched-Control Cohort Study.

The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision ACL surgery using QT autograft. Cohort study; Level of evidence, 3. A total of 376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched by age, sex, and preinjury outcome scores (Lysholm knee score, Tegner activity level, and visual analog scale [VAS] for pain). Initial baseline assessments of outcome scores were compared with scores collected at the 2-year postoperative mark. The mean age of the primary group and revision group was 32.9 ± 10.2 years (range, 18-55 years) and 32.3 ± 9.9 years (range, 19-55 years) respectively. Significant preinjury to postoperative improvements were noted in Lysholm (88.2 ± 16.4 vs 83.5 ± 15.0; P = .007) and VAS pain (0.9 ± 1.3 vs 1.5 ± 1.6; P = .001) scores after primary ACL reconstruction compared with revision reconstruction. However, no significant difference was found in Tegner activity level (6.7 ± 1.8 vs 5.9 ± 1.8; P > .430). Primary ACL injury was associated with significantly higher concomitant medial collateral ligament injuries (P = .019), while the revision group was associated with significantly higher concomitant cartilage (P = .001) and meniscal (P = .003) injuries. A significantly higher graft failure rate was noted in the revision group compared with the primary ACL reconstruction group (13.0% vs 5.6%; P = .005). Both primary and revision ACL reconstruction with QT autograft had acceptable functional outcomes. The primary group had better outcomes than the revision group, possibly due to the lower prevalence of meniscal and cartilage injuries in the primary group compared with the revision group. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction.

Health Needs Assessment in Home-Living Older Adults: Protocol for a Pre-Post Study.

Conducting a health needs assessment for older adults is important, particularly for early detection and management of frailty. Such assessments can help to improve health outcomes, maintain overall well-being, and support older adults in retaining their independence as they age at home. In this study, a systematic approach to health needs assessment is adopted in order to reflect real-world practices in municipal health care and capture the nuances of frailty. The aim is to assess changes in frailty levels in home-living older adults over 5 months and to examine the observable functional changes from a prestudy baseline (t1) to a poststudy period (t2). Additionally, the study explores the feasibility of conducting the health needs assessment from the perspective of home-living older adults and their informal caregivers. Interprofessional teams of registered nurses, physiotherapists, and occupational therapists will conduct 2 health needs assessments covering physical, cognitive, psychological, social, and behavioral domains. The study includes 40 home-living older adults of 75 years of age or older, who have applied for municipal health and care services in Norway. A quantitative approach will be applied to assess changes in frailty levels in home-living older adults over 5 months. In addition, we will examine the observable functional changes from t1 to t2 and how these changes correlate to frailty levels. Following this, a qualitative approach will be used to examine the perspectives of participants and their informal caregivers regarding the health needs assessment and its feasibility. The final sample size for the qualitative phase will be determined based on the participant's willingness to be interviewed. The quantitative data consist of descriptive statistics, simple tests, and present plots and correlation coefficients. For the qualitative analysis, we will apply thematic analysis. The initial baseline assessments were completed in July 2023, and the second health needs assessments are ongoing. We expect the results to be available for analysis in the spring of 2024. This study has potential benefits for not only older adults and their informal caregivers but also health care professionals. Moreover, it can be used to inform future studies focused on health needs assessments of this specific demographic group. The study also provides meaningful insights for local policy makers, with potential future implications at the national level. ClinicalTrials.gov NCT05837728; https://clinicaltrials.gov/study/NCT05837728. DERR1-10.2196/55192.

Body fat distribution, fat-free mass and cardiovascular function in the UK Biobank

Abstract Background Excess adiposity and high body mass index have been associated with cardiac dysfunction and heart failure. However, the role of whole body imaging and independent associations of regional fat and fat-free mass on left ventricular and vascular function is unclear. Purpose This study determined the cross-sectional associations of regional fat depots and fat-free mass on left ventricular function and arterial stiffness to explain obesity-related cardiac dysfunction. Methods Participants who underwent whole body magnetic resonance imaging (MRI) and dual energy X-ray absorptiometry (DXA) in an ongoing imaging study of 100,000 individuals in the UK were included in this analysis. Analyses exclude individuals with major cardiac and vascular diseases at initial baseline assessment. Regional fat distribution was quantified using MRI while body fat-free mass was quantified with DXA. Cardiac MRI was used to measure left ventricular (LV) ejection fraction and LV mass while pulse wave velocity from finger photo-plethysmography was used to measure arterial stiffness index. Associations of body fat distribution (visceral fat, abdominal subcutaneous fat, other body fat) and fat-free mass with each of LV ejection fraction, LV mass and arterial stiffness index, after mutual adjustment for one another and potential confounders were determined using multivariable linear regression. Results We included 31,088 individuals (mean age 63.4 years, 53% women). Among regional body fat measures, higher visceral fat was associated with lower LVEF (β=-0.43; 95% CI: -0.55, -0.31 per SD) and higher arterial stiffness index (β=0.44; 95% CI: 0.34, 0.54 per SD) while none of the regional fat and fat-free mass showed significant association with LV function or arterial stiffness. None of the fat or fat-free mass measures showed significant association with LV mass. These associations were not explained by inflammatory markers, blood pressure or glycaemic profile. Conclusion Visceral fat is the main driver of obesity-related cardiac and vascular dysfunction. There is need for further studies to understand the biological causal pathways of obesity-heart disease.Figure 1Figure 2

Decision support framework for predicting rate of gait recovery with optimized treatment planning

Rate of Recovery during the rehabilitation procedure is not effectively evaluated due to existing limitations of measurement tools and large human variability.The conventional way to treat lower-limb injuries is by conducting a physician-guided rehabilitation process that could take several weeks or months. But the process of estimating the rate of recovery is entirely based on the expertise of a therapist. Moreover, it remains unclear to a large extent about the factors have contributed to the success of treatment, the most effective rehabilitation duration, and recovery progression rate. To address these limitations, a random subspace ensemble k-nearest neighbor (RSEnkNN) model is proposed to predict the rehabilitation duration of an individual after initial baseline assessment of gait trajectories. The model is trained using an open-source dataset comprising 211 healthy and 2084 patients with functional gait disorders.The proposed model is able to predict rehabilitation duration with an accuracy of 88–89 % in case of ankle, calcaneus, and hip injury while the success rate of 82 % is achieved for knee disorders. Features computed from ground reaction force, measures of postural steadiness, and bilateral symmetry turn out to be effective in predicting the early, moderate, or late recovery of an individual. The significantly contributing features for each anomaly class are reported using recursive feature elimination (RFE) technique to support clinicians. Thereafter, recovery rate is determined using a novel metric Rate of Gait Recovery (RoGR) index that could be effective for treatment planning and re-scheduling of therapy sessions (if required). This work determined that the most effective rehabilitation period is 2–6 weeks post-surgery for restoration to normal walk. Thus, a prediction tool for strengthening clinical decision-making is proposed to support early rehabilitation.

Implementation of an Atrial Fibrillation Decision Aid Care Pathway in the Emergency Department Reduces Atrial Fibrillation Hospitalizations.

A straightforward decision aid to guide disposition of atrial fibrillation (AF) patients in the emergency department (ED) was developed for use by ED providers. The implementation of this decision aid in the ED has not been studied. A pragmatic stepped-wedge cluster approach for analysis of retrospectively collected electronic health record data was used in which 5 hospitals were selected to commence the intervention at periodic intervals following an initial 1-year baseline assessment with 5 additional hospitals included in the comparison group (all in North Carolina). The primary end point of analysis was hospitalization rate. Hierarchical multivariable logistic regression analyses for admission as a function of the intervention while controlling for prespecified patient and hospital predictors were performed with clustering done at the hospital level. Between October 2017 and May 2020, a total of 11 458 patients (mean age, 71.4; 50.5% female) presented to 1 of the 10 hospitals with a primary diagnosis of AF. Absolute admission rate was reduced from 60.5% to 48.3% following the intervention (odds ratio, 0.83 [95% CI, 0.71-0.97]; P=0.016). After adjusting for covariates, the intervention was associated with a small increased rate of return to the ED for AF within 30 days of the initial presentation (1.6% to 2.7%; hazard ratio, 1.70 [95% CI, 1.26-2.31]; P<0.001). We demonstrate that implementation of a novel decision aid to guide disposition of patients primary diagnosis of AF presenting to the ED was associated with a reduced admission rate independent of patient and hospital factors. Use of the protocol was associated with a small but significant increase in rate of repeat presentations for AF at 30-day follow-up. Use of a decision aid such as the one described here represents an important tool to reduce unnecessary AF hospitalizations.

Implementation of a Multicomponent Program to Improve Effective Use and Maintenance of Medical Equipment in Sri Lankan Hospitals

Abstract Background: Medical equipment (ME) maintenance retains an asset’s original anticipated useful life and preserves its reliability and cost-effectiveness. This study developed and implemented a multicomponent program to improve ME use and maintenance in nine Sri Lankan hospitals from May 2020 to May 2021. Methods: This pre–post implementation study involved an initial baseline assessment of existing ME maintenance systems, the development and implementation of a multicomponent improvement program, and a 3-month postevaluation. Five targets ME were selected for the study: oxygen regulator, electrocardiogram (ECG) machine, suction apparatus, blood pressure apparatus, and mini autoclave. A pretested questionnaire was administered to randomly selected nursing officers (n = 101) and health-care assistants (n = 120) to obtain baseline ME maintenance data. Six focus group discussions and 24 key informant interviews were conducted with key stakeholders to codesign the multicomponent interventions, which included: developing a standard operating procedure targeting preventive maintenance activities; establishing focal points to provide technical and logistic support; staff training; and the introduction of institutional ME maintenance documents. Program effectiveness was assessed at 3 months postimplementation using the seven predefined outcome variables. Results: Baseline assessment identified no ME maintenance programs implemented in any of the hospitals. The highest availability was observed for oxygen regulator (62% to 82.3%) and ECG machine (66.1% to 84.7%). The highest functionality improvement was observed for ECG machine (40.4% to 79.7%). The positive perception of maintenance process of ME achieved the highest (33% to 80%) improvement. Following program implementation, improvements were noted in: the availability (P = 0.00) and functionality (P = 0.00 to P = 0.02) of all selected ME; equipment maintenance processes (P = 0.000); as well as staff knowledge, skills, perceptions, and satisfaction. Conclusions: The program improved the use and maintenance of ME and was widely supported by the key stakeholders. The approach is relevant to other resource-poor hospital settings, as inadequate ME maintenance causes health system inefficiencies.

Change of iron content in brain regions after intravenous iron therapy in restless legs syndrome: quantitative susceptibility mapping study.

The pathomechanism of restless legs syndrome (RLS) is related to brain iron deficiency and iron therapy is effective for RLS; however, the effect of iron therapy on human brain iron state has never been studied with magnetic resonance imaging. This study aimed to investigate the change of brain iron concentrations in patients with RLS after intravenous iron therapy using quantitative susceptibility mapping (QSM). We enrolled 31 RLS patients and 20 healthy controls. All participants underwent initial baseline (t0) assessment using brain magnetic resonance imaging, serum iron status, and sleep questionnaires including international RLS Study Group rating scale (IRLS). RLS patients underwent follow-up tests at 6 and 24 weeks (t1 and t2) after receiving 1000 mg ferric carboxymaltose. Iron content of region-of-interest on QSM images was measured for 13 neural substrates using the fixed-shaped method. RLS symptoms evaluated using IRLS were significantly improved after iron treatment (t0: 29.7 ± 6.5, t1: 19.5 ± 8.5, t2: 21.3 ± 10.1; p < .001). There was no significant difference in susceptibility values between the controls and RLS patients at t0. In the caudate nucleus, putamen, and pulvinar thalamus of RLS patients, the QSM values differed significantly for three timepoints (p = .035, .048, and .032, respectively). The post-hoc analysis revealed that the QSM values increased at t1 in the caudate nucleus (66.8 ± 18.0 vs 76.4 ± 16.6, p = .037) and decreased from t1 to t2 in the putamen (69.4 ± 16.3 vs 62.5 ± 13.6, p = .025). Changes in the QSM values for the pulvinar and caudate nuclei at t1 were positively and negatively correlated with symptomatic improvement, respectively (r = 0.361 and -0.466, respectively). Intravenous iron treatment results in changes in brain iron content which correlate to reductions in RLS severity. This suggests a connection between symptom improvement and the associated specific brain regions constituting the sensorimotor network.

A pilot randomised controlled trial of the Peer Tree digital intervention targeting loneliness in young people: a study protocol

BackgroundYoung people are vulnerable to experiencing problematic levels of loneliness which can lead to poor mental health outcomes. Loneliness is a malleable treatment target and preliminary evidence has shown that it can be addressed with digital platforms. Peer Tree is a strength-based digital smartphone application aimed at reducing loneliness. The study aim is to reduce loneliness and assess the acceptability, usability, and feasibility of Peer Tree in young people enrolled at university.MethodsThis will be a pilot randomised controlled trial (RCT) comparing a strength-based digital smartphone application (Peer Tree) with a control condition. Forty-two young people enrolled at university will be recruited for this pilot RCT. Participants with suicidal ideation or behaviours, acute psychiatric symptoms in the past month, or a current diagnosis of a mood or social anxiety disorder will be excluded. Allocation will be made on a 1:1 ratio and will occur after the initial baseline assessment. Assessments are completed at baseline, at post-intervention, and at follow-up. Participants in the control condition complete the same three assessment sessions. The primary outcome of the study will be loneliness. Depression, social anxiety, quality of life, acceptability, usability, feasibility, and safety of Peer Tree will also be measured as secondary outcomes.DiscussionThis trial will report the findings of implementing Peer Tree, a smartphone application aimed at reducing loneliness in university students. Findings from this trial will highlight the initial efficacy, acceptability, and feasibility of using digital positive psychology interventions to reduce subthreshold mental health concerns. Findings from this trial will also describe the safety of Peer Tree as a digital tool. Results will contribute evidence for positive psychology interventions to address mental ill-health.Trial registrationAustralian New Zealand Clinical Trial Registry ACTRN12619000350123. Registered on 6 March 2020

Independent Associations Between Trait-Anger, Depressive Symptoms and Preclinical Atherosclerotic Progression.

Previous research from our group found that recent depressive symptoms were associated with 3-year change in carotid intima-media thickness (CA-IMT), a biomarker of cardiovascular disease risk, in an initially healthy sample of older adults. Trait measures of anxiety, anger, and hostility did not predict 3-year CA-IMT progression in that report. The current study sought to reexamine these associations at a 6-year follow-up point. Two-hundred seventy-eight participants (151 males, mean age = 60.68 years) from the original sample completed an additional IMT reading 6 years following the initial baseline assessment. Though not significant at 3-years, trait-anger emerged as a predictor of IMT progression at the 6-year point. When examined in separate regression models, both depression and trait-anger (but not anxiety or hostility) predicted 6-year IMT change (b = .017, p = .002; b = .029, p = .01, respectively). When examined concurrently, both depression and anger were independently associated with 6-year IMT progression (b = .016, p = .010, b = .028, p = .022, respectively). Exploratory analyses suggest that the relative contributions of anger and depression may differ for males and females. The use of sequential follow-ups is relatively unique in this literature, and our results suggest a need for further research on the timing and duration of psychosocial risk exposures in early stages of cardiovascular disease.

Charting everyday activities in later life: Study protocol of the mobility, activity, and social interactions study (MOASIS).

Prominent theories of aging emphasize the importance of resource allocation processes as a means to maintain functional ability, well-being and quality of life. Little is known about which activities and what activity patterns actually characterize the daily lives of healthy older adults in key domains of functioning, including the spatial, physical, social, and cognitive domains. This study aims to gain a comprehensive understanding of daily activities of community-dwelling older adults over an extended period of time and across a diverse range of activity domains, and to examine associations between daily activities, health and well-being at the within- and between-person levels. It also aims to examine contextual correlates of the relations between daily activities, health, and well-being. At its core, this ambulatory assessment (AA) study with a sample of 150 community-dwelling older adults aged 65 to 91 years measured spatial, physical, social, and cognitive activities across 30 days using a custom-built mobile sensor ("uTrail"), including GPS, accelerometer, and audio recording. In addition, during the first 15 days, self-reports of daily activities, psychological correlates, contexts, and cognitive performance in an ambulatory working memory task were assessed 7 times per day using smartphones. Surrounding the ambulatory assessment period, participants completed an initial baseline assessment including a telephone survey, web-based questionnaires, and a laboratory-based cognitive and physical testing session. They also participated in an intermediate laboratory session in the laboratory at half-time of the 30-day ambulatory assessment period, and finally returned to the laboratory for a posttest assessment. In sum, this is the first study which combines multi-domain activity sensing and self-report ambulatory assessment methods to observe daily life activities as indicators of functional ability in healthy older adults unfolding over an extended period (i.e., 1 month). It offers a unique opportunity to describe and understand the diverse individual real-life functional ability profiles characterizing later life.

P.117 Collection of real-world evidence of nusinersen treatment for SMA patients through a national registry: description of the paediatric cohort in the UK

Nusinersen is one of three drug treatments currently available to children and adults with spinal muscular atrophy (SMA) in England. The use of nusinersen is conditional to a managed access agreement (MAA) since July 2019. This study aims to describe the characteristics of the paediatric patients in the nusinersen MAA. Retrospective data from July 2019 to March 2022 was extracted from the SMA research and clinical hub UK (SMA REACH UK) registry which includes fifteen centres in England. Patients hold a minimum of 2 data entries yearly for each mandated field after the initial baseline assessment. The data report includes, gender, SMA type, SMN2 copy number, date of nusinersen first dose, and mandatory collection fields for medical and physiotherapy data. Medical data collection includes mortality; respiratory function (FVC and PCF, ventilation type and estimation of hours of ventilation); presence of scoliosis, spinal surgery, and Thoracolumbar support (TLSO) use and presence of fractures. The motor function measures include CHOP-INTEND, HINE, RHS, RULM and summary of contractures. 231 patients (129 males, 102 females) with SMA (Type 1=93, Type 2=85, type 3=50, pre-symptomatic=3) are receiving nusinersen via the MAA. The mean age of enrolment is 5.5 years (age range=10days-17years and 9months). There have been four deaths. During the COVID-19 pandemic structured remote assessments were agreed among the network to ensure continued collection of data, however the pandemic impacted functional outcomes collection. The SMA REACH UK registry provides a robust system to collect information on patients to address clinical uncertainties originally identified by the national institute of clinical excellence (NICE). It serves as a systematic model for longer term real-world data collection to evaluate clinical effectiveness of drugs, as well as potential evaluation of economic impact. The SMA reach UK registry has recently expanded to include adult centres. SMA reach UK is part of the international SMA registry (ISMAR) which includes registries in Italy and the US.

Measurement of value in rotator cuff repair: patient-level value analysis for the 1-year episode of care.

Rotator cuff repair (RCR) is one of the most common elective orthopedic procedures, with predictable indications, techniques, and outcomes. As a result, this surgical procedure is an ideal choice for studying value. The purpose of this study was to perform patient-level value analysis (PLVA) within the setting of RCR over the 1-year episode of care. Included patients (N = 396) underwent RCR between 2009 and 2016 at a single outpatient orthopedic surgery center. The episode of care was defined as 1-year following surgery. The Western Ontario Rotator Cuff index was collected at both the initial preoperative baseline assessment and the 1-year postoperative mark. The total cost of care was determined using time-driven activity-based costing (TDABC). Both PLVA and provider-level value analysis were performed. The average TDABC cost of care was derived at $5413.78 ± $727.41 (95% confidence interval, $5341.92-$5485.64). At the patient level, arthroscopic isolated supraspinatus tears yielded the highest value coefficient (0.82; analysis-of-variance F test, P = .01). There was a poor correlation between the change in the 1-year Western Ontario Rotator Cuff score and the TDABC cost of care (r2 = 0.03). Provider-level value analysis demonstrated significant variation between the 8 providers evaluated (P < .01). RCR is one of the most common orthopedic procedures, yet the correlations between cost of care and patient outcomes are unknown. PLVA quantifies the ratio of functional improvement to the TDABC-estimated cost of care at the patient level. This is the first study to apply PLVA over the first-year episode of care. With health care transitioning toward value-based delivery, PLVA offers a quantitative tool to measure the value of individual patient care delivery over the entire episode of care.

Improving Medication Reconciliation with Comprehensive Evaluation at a Veterans Affairs Skilled Nursing Facility.

Unintentional medication discrepancies due to inadequate medication reconciliation pose a threat to patient safety. Skilled nursing facilities (SNFs) are an important care setting where patients are vulnerable to unintentional medication discrepancies due to increased medical complexity and care transitions. This study describes a quality improvement (QI) approach to improve medication reconciliation in an SNF setting as part of the Multi-Center Medication Reconciliation Quality Improvement Study 2 (MARQUIS2). This study was conducted at a 112-bed US Department of Veterans Affairs SNF. The researchers used several QI methods, including data benchmarking, stakeholder surveys, process mapping, and a Healthcare Failure Mode and Effect Analysis (HFMEA) to complete comprehensive baseline assessments. Baseline assessments revealed that medication reconciliation processes were error-prone, with high rates of medication discrepancies. Provider surveys and process mapping revealed extremely labor-intensive and highly complex processes lacking standardization. Factors contributing were polypharmacy, limited resources, electronic health record limitations, and patient exposure to multiple care transitions. HFMEA enabled a methodical approach to identify and address challenges. The team validated the best possible medication history (BPMH) process for hospital settings as outlined by MARQUIS2 for the SNF setting and found it necessary to use additional medication lists to account for multiple care transitions. SNFs represent a critical setting for medication reconciliation efforts due to challenges completing the reconciliation process and the concomitant high risk of adverse drug events in this population. Initial baseline assessments effectively identified existing problems and can be used to guide targeted interventions.

Modular intervention to improve paternal involvement and support for better infant and young child feeding in a district of coastal South India: a randomized controlled trial protocol

Background: The major determinant to the well-being of infants and young children (IYC) is their feeding practices. These practices are the responsibility of both parents, meaning that fathers have an equal role to mothers. Fathers’ involvement can have an impact on the overall health of the children. Despite this, paternal involvement towards IYC feeding (IYCF) have not been studied adequately. Methods: This randomized control trial (n=120) will be conducted among fathers of infants (children aged <1 year) and young children (children aged 12-23 months) in selected households in Dakshina Kannada District of the southern Indian State of Karnataka. The study will be conducted after an initial baseline assessment on awareness, attitude and involvement of fathers in IYCF. Fathers with scores less than the 50 th percentile in the practice component will be categorized as fathers with poor involvement and will be potential participants for the trial. A visual module will be developed and validated for improving paternal involvement in IYCF. Using a simple randomization technique, the participants will be allocated to modular intervention and control group (1:1 allocation). Each participant in the intervention arm will be visited once a month to implement the module, for six months on a one-to-one basis. Following the intervention, a post-test assessment will be done for both groups to measure the level of paternal involvement in IYCF. Ethics and dissemination: Approval has been obtained from the Institutional Ethics Committee of Kasturba Medical College, Mangalore, India. The dissemination plans include scientific conferences and publication in scientific journals. Registration: The study is registered with Clinical Trial Registry of India ( CTRI/2017/06/008936).

Reasons for refusing referrals and challenges to effectual engagement in tele-treatment for depression among low-income homebound older adults

Objectives: To describe reasons for refusal to be referred to or enroll in a depression treatment study and post-enrollment challenges to treatment engagement and technology-related problems among low-income homebound individuals aged 50+ years with depression. Methods: Data came from a 3-arm randomized clinical trial that evaluated real-world effectiveness of lay counselor-delivered behavioral activation (BA) versus clinician-delivered problem-solving therapy (PST). Interventionists were embedded in a large home-delivered meals program and treatment sessions were videoconferenced; hence Tele-BA and Tele-PST. We described refusal reasons of those who refused initial case manager referrals (n = 279), telephone screening (n = 64), enrollment (n = 47), or post-enrollment baseline assessments (n = 18). We used inductive thematic analysis to explore challenges to effectual treatment engagement and tele-delivery-related problems among Tele-PST or Tele-BA participants (n = 183) from the interventionists’ tele-session process recordings. Results: More than a third of potentially eligible older adults refused their case managers’ referral, and a quarter of those who accepted referral refused further screening or enrollment. Three quarters of those who refused reported no interest or need or declined to talk about depression. Others refused given their busy schedule with medical appointments and caregiving. Nearly 80% of Tele-BA or Tele-PST participants had some challenges to effectual engagement in treatment sessions due to environmental and health-related conditions and other life stressors including financial distress. Though many tele-sessions had connectivity and other technology-related problems, these did not affect depression outcomes. Conclusion: Mental health service providers for low-income older adults need to be aware of these challenges when adopting best practice strategies for them.

The Web-Based Uprise Program for Mental Health in Australian University Students: Protocol for a Pilot Randomized Controlled Trial.

BackgroundUniversity students are vulnerable to poor mental health, psychological distress, and loneliness relative to nonuniversity student peers. However, the rate of seeking mental health treatment among university students is low. Web-based psychological interventions may provide an opportunity for supporting vulnerable university students who are unlikely to otherwise seek support.ObjectiveThe aim of this study is to examine the feasibility, acceptability, safety, and efficacy of an existing web-based transdiagnostic cognitive behavioral therapy (CBT) mental health program for use among Australian university students.MethodsThis is a pilot randomized controlled trial comparing a self-directed web-based CBT mental health program with a waitlist control. The self-directed modules will be augmented with optional webchat or telephone coaching with a therapist. The recruitment target is 70 university students who do not present with a clinical mental health disorder. Allocation will be made in a 1:1 ratio and will occur after the initial baseline assessment. Assessments will be completed at baseline, upon completion of a 4-week waitlist (waitlist group only), upon completion of the program, and at 3 months after completion of the program.ResultsThe trial was funded in June 2018, and the protocol was approved by the Swinburne University Human Research Ethics Committee in September 2018. Recruitment commenced in October 2018, with the first participant allocated in November 2018. A total of 70 participants were recruited to the trial. The trial recruitment ceased in June 2019, and data collection was finalized in December 2019. We expect the final data analysis to be completed by November 2020 and results to be published early in 2021. The primary outcomes are feasibility, acceptability, safety, and symptoms of depression, anxiety, and stress. The secondary outcomes are psychological wellbeing, quality of life, loneliness, self-reported physical health status, emotion regulation, and cognitive and mindfulness processes.ConclusionsThe acceptability, feasibility, safety, and efficacy of a web-based mental health program in university students will be evaluated. Web-based mental health programs offer the opportunity to engage university students who may be reluctant to seek support through traditional face-to-face mental health services, and the transdiagnostic approach of the program has the potential to address the breadth of mental health concerns of university students.Trial RegistrationAustralian New Zealand Clinical Trial Registry ACTRN12618001604291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001604291International Registered Report Identifier (IRRID)DERR1-10.2196/21307

Female drinkers are more sensitive than male drinkers to alcohol-induced heart rate increase.

The present study examined the acute effect of alcohol and its cues on autonomic and cardiovascular physiology, as indexed by changes in heart rate (HR), in a relatively large sample of healthy young adult men and women. Participants (27-31 years old, final N = 145) were administered an alcoholic beverage (n = 88; 52 women) or a placebo beverage (n = 57; 35 women) in a simulated bar. Target breath alcohol concentration (BrAC) was .08 g%. HR was recorded while participants were seated alone during an initial baseline assessment in a lab room; seated with others during preparation and administration of 2 beverages in a simulated bar; and seated alone in the lab room at ascending, peak, and descending BrAC. HR increased over time for participants in both beverage groups during beverage preparation. During beverage consumption, HR decreased over time in those who drank placebo whereas HR increased over time in those who drank alcohol, increasing at a faster rate in women compared to men. HR remained elevated at the ascending, peak, and descending limb assessments only in participants who drank alcohol with HR increasing over time at ascending BrAC in the women but not men. Sex differences in HR under alcohol were not explained by sex differences in body mass index, BrAC, recent alcohol use, or subjective stimulation. Our findings suggest that women may be more sensitive to alcohol-induced increases in HR, especially in environments where alcohol cues are abundant. This may have implications for cardiovascular risks associated with alcohol. (PsycInfo Database Record (c) 2020 APA, all rights reserved).