Low-cost Intervention Research Articles

A NOVEL POSTDISCHARGE TELEHEALTH INTERVENTION FOR STROKE CAREGIVERS: IMPLICATIONS FOR IMPLEMENTATION

Abstract This study investigated the potential for implementation of the RESCUE stroke caregiver telehealth intervention by assessing acceptability, feasibility, and cost. Family caregivers (n=174) of Veteran stroke survivors from eight medical centers were randomized to usual care or intervention. The RN-led intervention involved discharge plan review, problem-solving training, education, and support delivered via one telephone session and eight asynchronous online messaging center sessions. Acceptability was assessed using an adapted Acceptability and Enactment Survey (n=42) and qualitative interviews with a subsample of caregivers (n=16). We used retention data to assess feasibility and calculated cost per participant. Findings indicate the intervention was acceptable to caregivers. Most intervention completers found the intervention very/extremely helpful (90.5%), very/extremely easy to use (78.4%), and resolved most/all caregiving problems (64.3%). Qualitative interviews showed caregivers valued the asynchronous delivery method, personalized nature of the intervention, and ability of the RN to answer medical questions and provide education. More intervention caregivers dropped out compared to usual care (50.0% vs.19.3%, p< 0.001). Intervention dropout was predicted by lower education (p=0.03) and less positive views of caregiving (p=0.01). Cost was $309.98 per intervention completer. Findings support intervention acceptability and highlight the value of RN-led interventions. The relatively low cost and fully remote nature of the intervention support its suitability for widespread implementation. Multiple delivery options and flexible intervention schedules may enhance engagement. The RESCUE intervention provides a model of a low-cost post-discharge telehealth intervention for stroke caregivers that can be adapted for other conditions. Future work should test methods to augment retention.

ACCEPTABILITY OF A REMINISCENCE THERAPY TABLET APP: IMPACT ON RESIDENTIAL CARE STAFF OF PERSONS LIVING WITH DEMENTIA

Abstract With dementia prevalence rapidly on the rise and no viable pharmacological treatments currently available, the development of accessible, efficacious, and low-cost non-pharmacologic interventions for persons living with dementia (PLWD) has become critical. Reminiscence therapy (RT) and life story can be built into residential care provision to provide person-centered solutions that elicit conversation, engagement, and socialization with staff. RT tools can also help inform care staff about residents’ lives and preferences to provide higher quality and meaningful interactions. This paper details the development and evaluation of LifeBio Memory, a tablet application designed to record the life stories and care preferences of PLWD in residential care communities. Care staff (n = 60) from 10 communities in Ohio, including memory care, assisted living and nursing homes, were trained to implement LifeBio Memory in their organizations. A pre-post design was used with staff, mainly comprised of life enrichment, administration, social work, rehab, and direct care staff. Outcomes presented include but will not be limited to: 1) acceptability, feasibility, and satisfaction with the tablet app, 2) staff knowledge of resident care preferences and interests, 3) utilization of person-centered care practices, 4) quality of communication between the resident and themselves and other staff, 5) their current understanding of that resident’s life history, and 6) level of tension and frustration with the resident. Discussion will focus on the need for sustainable RT interventions that promote person-centered care for PLWD and ways in which technological advancements can be integrated into residential care staff workflow.

SELF-NEGLECT IN OLDER ADULTS: CONVERSATIONS ABOUT SOCIAL CONNECTION, MEANING AND PURPOSE, AND INTERVENTIONS

Abstract Social isolation and loneliness are pervasive health threatening conditions increasing the morbidity and mortality of older adults worldwide. Older adults experiencing self-neglect (SN) represent some of the most isolated and socially disconnected members of our communities living with high morbidity and mortality risks. We know very little about the interplay of SN, social isolation, loneliness, and related factors that could inform scalable social interventions for this population. We completed mixed methods structured conversations with N=10 older adults with Adult Protective Services validated SN, focusing on social isolation, loneliness, meaning and purpose, and intervention approaches. The average age was 77 years, 50% African American, 66% male, 83% lived alone with an average of 4 medical conditions. On standardized assessments, 66% reported high ability to engage in social activities, but all were socially isolated, with limited mobility. Eighty-three percent reported moderate to high loneliness, 50% with generalized anxiety and 17% with depression. Only 33% lacked meaning and purpose in their lives. The conversations suggest higher rates of depression. Loneliness was linked to living in limited life spaces and few meaningful and quality social interactions reflecting loss and personal impairments. Meaning and purpose was maintained through spirituality. All participants were willing to be engaged meaningfully and socially, in the future, by someone new to their life, in-person or via telephone, to increase social connection. These preliminary findings suggest that low-cost social connection interventions are acceptable options for improving the social lives and possibly the health of isolated and lonely older adults experiencing SN.

The PRotective Effect of Maternal Immunisation on preTerm birth: characterising the Underlying mechanisms and Role in newborn immune function: the PREMITUR study protocol.

Maternal immunisation, a low cost and high efficacy intervention is recommended for its pathogen specific protection. Evidence suggests that maternal immunisation has another significant impact: reduction of preterm birth (PTB), the single greatest cause of childhood morbidity and mortality globally. Our overarching question is: how does maternal immunisation modify the immune system in pregnant women and/or their newborn to reduce adverse pregnancy outcomes and enhance the newborn infant's capacity to protect itself from infectious diseases during early childhood? To answer this question we are conducting a multi-site, prospective observational cohort study collecting maternal and infant biological samples at defined time points during pregnancy and post-partum from nulliparous women. We aim to enrol 400 women and determine the immunetrajectory in pregnancy and the impact of maternal immunisation (including influenza, pertussis and/or COVID-19 vaccines) on this trajectory. The results are expected to identify areas that can be targeted for future intervention studies.

Interpreting Tactical Urbanism through Innovation–Diffusion Theory: Insights from a Collaborative Design Studio Experience

This article explores the application of innovation–diffusion theory to tactical urbanism projects. The objective of the study is to comprehend how innovation–diffusion theory can be utilized to analyze and evaluate these projects and identify the factors contributing to their success. The research was conducted through a collaborative design studio experience, using qualitative methods that largely depended on participatory observations and interviews with key participants. The findings indicate that the Innovation–Diffusion theory can serve as a comprehensive theoretical framework for the analysis and evaluation of tactical urbanism projects. The study also identified factors that contribute to the success of these projects, such as the involvement of opinion leaders, the use of low-cost and temporary interventions, and the flexibility to adapt to on-site variables.

Cyberrehab: Empowering Hemiparesis Recovery with Affordable Mobile Virtual Reality Solutions for Upper Limb Strength

Background: Hemiparesis is a debilitating condition characterized by weakened muscle strength in one side of the body, often caused by stroke or brain injury. Rehabilitation is crucial for improving upper limb muscle strength and functional recovery in individuals with hemiparesis. Mobile-based Virtual Reality (VR) programs have emerged as an innovative and cost-effective approach to augment conventional physiotherapy in rehabilitation. This study investigates the efficacy of a low-cost mobile VR intervention in enhancing upper limb muscle strength and motivating individuals with hemiparesis to actively engage in their recovery. Methods: A quasi-experimental study was conducted with 20 participants, divided into two groups: an experimental group receiving the combined intervention of mobile-based VR programs and conventional physiotherapy, and a control group receiving only conventional physiotherapy. The intervention spanned four weeks, with sessions held three days a week. Pre-test and post-test measurements were taken for various upper limb muscle groups using Manual Muscle Testing (MMT). Correlation analyses were conducted to assess the effectiveness of the intervention. Results: The results revealed a strong and statistically significant positive correlation between pre-test and post-test MMT scores in the experimental group, indicating substantial improvements in upper limb muscle strength. In contrast, the control group exhibited more modest gains. The integration of mobile-based VR programs led to increased motivation and engagement among participants, contributing to better adherence to the rehabilitation routine. Conclusion: The integration of affordable mobile VR solutions in hemiparesis rehabilitation presents a promising approach to empower individuals on their journey to recovery. By improving upper limb muscle strength and motivating active participation in rehabilitation, mobile VR interventions like "CyberRehab" have the potential to revolutionize the field of hemiparesis recovery, ultimately enhancing the quality of life for those affected by this condition.

Maternal health outcomes in the context of fragility: a retrospective study from Lebanon

Background and aimsThe Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon.MethodsA retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models.ResultsIn the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery.ConclusionThis study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.

Don't say “vegan” or “plant-based”: Food without meat and dairy is more likely to be chosen when labeled as “healthy” and “sustainable”

Eating less meat and dairy is healthy and environmentally sustainable, but food labeled as “vegan” is relatively unpopular. Here, we examined the effect of different labels for promoting choices for food without meat and dairy, among a representative U.S. sample (N = 7341). Participants chose between one gourmet food gift basket without meat and dairy and another with meat and dairy that were available from an actual online store. They were randomly assigned to one of five conditions, in which the gourmet food gift basket without meat and dairy was labeled as “vegan”, “plant-based,” “healthy,” “sustainable,” or “healthy and sustainable.” Ten participants were randomly selected to receive the gourmet food gift basket of their choice. Overall, the gourmet food gift basket without meat and dairy was less likely to be chosen when its label focused on its content (stating “vegan” or “plant-based”) rather than on its benefits (stating “healthy”, “sustainable” or both). Specifically, the “plant-based” label did only slightly better than the “vegan” label, leading, respectively, to 27% and 20% of participants choosing the gourmet food gift basket without meat and dairy. However, 42% of participants chose the gourmet food gift basket without meat and dairy when it was labeled “healthy,” 43% when it was labeled “sustainable,” and 44% when it was labeled “healthy and sustainable.” This labeling effect was consistent across socio-demographics groups but was stronger among self-proclaimed red-meat eaters. Labels provide a low-cost intervention for promoting healthy and sustainable food choices.

Non-Puerperal Adoptive Breastfeeding as Lactational Rescue in the Rohingya Refugee Camp: 2 Case Studies.

Non-puerperal adoptive lactation sometimes requires long preparation and substantial expense for pharmacological intervention to be successful, which are not feasible in refugee camps. Here we report two case studies of non-puerperal adoptive breastfeeding of two infants in the Rohingya Refugee Camp of Cox's Bazar, Bangladesh. Two non-pregnant, non-breastfeeding caregivers with previous experience of breastfeeding brought two adopted infants-one a 12-day-old female with severe acute malnutrition, and the other a 2-day-old male with normal anthropometric measurements-to a nutritional stabilization center for feeding. After counseling, both families opted for adoptive lactation. Both infants were treated with a modified Action Against Hunger protocol of in-patient management of severe acute malnutrition using the supplementary suckling technique, a procedure to feed the baby with supplementary feed. Diluted F100 was used as the supplementary feed; the energy and protein gained from it were just enough to maintain body physiology and were not responsible for any weight gain. When the infants gained weight, indicating that the caregivers were producing milk, we reduced the supplementary feed as per protocol guidelines. The caregivers were prescribed domperidone and counseled on their ability to breastfeed the infants. The cases required 35 days and 20 days, respectively, for the full establishment of breastfeeding. This is the first report of successful adoptive breastfeeding in a refugee camp. With proper counseling and motivation of the caregiver, induced lactation can be started without a preparatory period and with very low-cost intervention.

Effects of the care given to intensive care patients using an evidence model on the prevention of central line-associated bloodstream infections.

It is important to put evidence-based guidelines into practice in the prevention of central line-associated bloodstream infections in intensive care patients. In contrast to expensive and complex interventions, a care bundle that includes easy-to-implement and low-cost interventions improves clinical outcomes. The compliance of intensive care nurses with guidelines is of great importance in achieving these results. The Translating Evidence into Practice Model provides guidance in how to implement the necessary guidelines. This quasi-experimental study used a post-test control group design in nonequivalent groups and was conducted in the anesthesia intensive care unit of a tertiary-level training and research hospital. All patients who were hospitalized in the intensive care unit, who had a central line during the study, and who met the inclusion criteria were included in the sample. The care bundle comprised education, and protocols for hand hygiene and the aseptic technique, maximum sterile barrier precautions, central line insertion trolley, and management of nursing care. To analyze the data, the independent samples t-test, the Mann-Whitney U test, chi-square test, dependent samples t-test, rate ratio, and relative risk were used with 95% confidence intervals. The rate of central line-associated bloodstream infections was significantly lower in the intervention group (2.85/1000 central line days) than in the control group (3.35/1000 central line days) (P = 0.042). The number of accesses to the central line by the nurses decreased significantly in the intervention group compared to the control group (P < 0.001). The mean score for the nurses' evidence-based guideline post-education knowledge (70.80 ± 12.26) was significantly higher than that pre-education (48.20 ± 14.66) (P < 0.001). Compliance with the guideline recommendations in central line-related nursing interventions and in the central line insertion process was significantly better in the intervention group than in the control group in many interventions (P < 0.05). The mean score for the nurses' attitude towards evidence-based nursing increased significantly over time (59.87 ± 7.23 at the 0th month; 63.79 ± 7.24 at the 6th month) (P < 0.001). Nursing care given by implementing the central line care bundle with the Translating Evidence into Practice Model affected the measures. Thanks to the implementation of the care bundle, the rate of infections and the number of accesses to the central line decreased, while the critical care nurses' knowledge of evidence-based guidelines, compliance with the guideline recommendations in central line-related nursing interventions, and attitudes towards evidence-based nursing improved.

Assessing the feasibility of a randomised controlled trial examining the effect of hearing aids on cognitive decline in elderly individuals: a study protocol

IntroductionHearing loss is one of the leading potentially modifiable risk factors for dementia. There is growing evidence suggesting that treating hearing loss with hearing aids could be a relatively low-cost...

Abstract C141: From insights to action: Engaging women living with HIV in the data-driven development of an mHealth intervention for cervical cancer prevention and HPV self-sampling

Abstract Background: Women living with HIV (WLH) face a higher risk of invasive cervical cancer (CC) due to a greater incidence and longer persistence of high-risk human papillomavirus (HPV) infection. Health education programs, including text-messaging interventions, have demonstrated effectiveness in improving CC and HPV knowledge and promoting recommended screening. Emerging strategies involving self-collected cervicovaginal samples as an alternative to office-based HPV screening offer additional promise in reaching women who face several obstacles to timely care, such as WLH. Purpose: This mixed-methods study aims to describe the data-driven development of a four-week text-messaging intervention, named “My Self-Sampling, HPV Awareness, Results, and Empowerment (MySHARE)”, to improve CC prevention knowledge and promote HPV self-sampling among WLH. Methods: Surveys (n=81) and focus group discussions (FGDs; n=39) were conducted among WLH in the Washington-Baltimore metropolitan region, with the findings guiding the development of MySHARE. Results: While most WLH indicated that in-person group sessions were their typical source of health information, they highlighted the impracticality of these sessions since the pandemic and expressed openness to a text-messaging intervention. Survey results informed the logistical aspects and functionality of the intervention, while FGD participants' responses, guided by constructs from the Protection Motivation Theory, shaped the content of the text-messaging library. The library covered topics such as CC and HPV knowledge, prevention behaviors, and HPV self-sampling. Conclusions: This study emphasizes the significance of engaging the target population in intervention development. WLH participants provided clear and actionable recommendations, which, together with best practices in digital health technology, directed decisions on the intervention delivery platform, messaging timing and frequency, and text-messaging content. Low-cost and accessible interventions like MySHARE have the potential to substantially enhance CC and HPV knowledge, as well as screening rates, among historically underserved populations, particularly during public health crises. Citation Format: Daisy Le, Annie Coriolan Ciceron, Min (Jaime) Jeong Jeon, Lorien C. Abroms, Carla J. Berg. From insights to action: Engaging women living with HIV in the data-driven development of an mHealth intervention for cervical cancer prevention and HPV self-sampling [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C141.

Implementing Affordable Virtual Reality Interventions for Older Adults in Latin America: A Feasibility Study

Introduction:Virtual Reality (VR)-based meditation has shown to help reduce, stress, anxiety, sadness, and anger in younger adults. However, this has not been extensively studied in older adults. Furthermore, there are no standard guidelines on how VR mindfulness interventions should be implemented to ensure successful outcomes in different cultures and languages. The availability of affordable hardware raises the possibility of VR being used in low-income countries. The goal of this study is to describe and highlight some key considerations and challenges when implementing low-cost VR mindfulness interventions with older adults in Quito, Ecuador.Methods:We created a guided mindfulness intervention using low-cost VR (smartphones and Destek V5 headsets) for older adults with anxiety in Quito, Ecuador. This project is a collaboration between the Technology and Aging Lab at McLean Hospital and the Universidad San Francisco de Quito in Ecuador. Our goal was to recruit 20 older adults with anxiety from various outpatient settings in Quito. We used the free “Sites in VR” app and selected different nature scenes for each intervention. The intervention consists of a total of 10 sessions each lasting 30 minutes. We assessed depression using the Geriatric Depression Scale (GDS), and anxiety with the Generalized Anxiety Disorder 7-item scale (GAD-7). In addition, we also administered the Mindfulness Attention Awareness Scale (MAAS) and the Behavior Activation for Depression scale (BADS).Results:At the time of writing, we have reached 100% of our recruitment goal and anticipate completing data analysis by January 2023. Qualitatively, our intervention revealed barriers to designing scalable VR Spanish language interventions in Latin America. Some of the main difficulties we encountered are described below: (i) There are very few virtual reality videos (360° videos) that are available for use with the DesTeK VS VR Headset in Spanish. We therefore, used a standardized Spanish narration to guide the mindfulness practice based on a script used in the United States. (ii) We found that majority of the available content is not suitable for mindfulness. Using the application Sites in VR remedied this concern, as it provides static 360° images, suitable for mindfulness. (iii) Not all technology necessary for VR interventions is readily available in Latin America: smartphones sold in Latin America do not always have a gyroscope sensor.Conclusion:Mindfulness interventions using virtual reality may be an effective way to address stress and mood symptoms in older adults across cultures. However, there are many culture-specific aspects that must be addressed before applying these interventions in different cultures. This study, conducted in Latin America, is an initial step toward the establishment of best practices and standardized low-cost VR mindfulness intervention in older adults, and many aspects addressed here may be generalizable to other cultures, settings, and countries.

Eyes on incivility in surgical teams: Teamwork, well-being, and an intervention.

Incivility in surgery is prevalent and negatively impacts effectiveness and staff well-being. The purpose of this study was to a) examine relationships between incivility, team dynamics, and well-being outcomes, and b) explore a low-cost intervention of 'eye' signage in operating theater areas to reduce incivility in surgical teams. A mixed methods design was used in an orthopedic hospital. Surveys of incivility, teamwork, and well-being were administered three months apart in a small private hospital. An intervention of signage with eyes was placed in the theater area after administration of the first survey, using a pretest-posttest design. Participants also responded to an open-ended question about suggestions for improvements at the end of the survey which was then thematically analyzed. At the individual level (n = 74), incivility was statistically significantly related to team dynamics which in turn was significantly related to burnout, stress, and job attitudes. At the aggregate level, reported incivility was statistically significantly lower after the 'eye' sign intervention. Thematic analysis identified core issues of management behaviors, employee appreciation, communication, and work practices. Incivility in surgical teams has significant detrimental associations with burnout, stress, and job attitudes, which occurs through its impact on decreased team dynamics and communication. A simple intervention that evokes perceptions of being observed, such as signage of eyes in theater areas, has the potential to decrease incivility at least in the short term, demonstrating that incivility is amenable to being modified. Additional research on targeted interventions to address incivility are needed to improve teamwork and staff well-being.

Nurturing the Positive Mental Health of Autistic Children, Adolescents and Adults alongside That of Their Family Care-Givers: A Review of Reviews.

The rising prevalence of autism internationally has been accompanied by an increased appreciation of the poorer mental health experienced by people with this condition and also of their family care-givers. In particular, higher incidences of anxiety and depression are reported in high-income nations and these conditions are likely to be under-recognised and under-reported in lower-resourced regions or countries. Mainstream mental health services seem to be ill-equipped to respond adequately to the needs of autistic persons and their care-givers. This literature review of 29 recently published reviews covering nearly 1000 journal articles summarises the insights and strategies that have been shown to promote the mental health and emotional wellbeing of autistic persons. In particular, a focus on family-centred, community-based supports is recommended that aim to enhance social communication, extend social connections and promote an individual's self-esteem, self-determination and social motivation. These low-cost interventions are especially pertinent in low-resourced settings, but they can be used internationally to prevent mental illness and assist in the treatment of anxiety and depression in autistic persons and their family carers. The priority is to focus on primary-care responses with cross-sectoral working rather than investing in high-cost psychiatric provision.

Challenges and experience of the Ethiopian rural health extension program: implications for reform and revitalization

BackgroundDespite remarkable gains over the past decade, mounting evidence suggests that Ethiopia’s rural health extension program (HEP) is facing serious implementation challenges. We investigated the current and potential future program design and implementation challenges of Ethiopia’s rural HEP based on the lived experiences of health extension workers (HEW) implementing the program at the grassroots level.MethodsWe employed a longitudinal qualitative exploration linked to a larger cluster-randomized trial (RCT) which was implemented in 282 villages randomly selected from 18 Kebeles of the Gedeo zone, southern Ethiopia. Data were collected using in-depth interviews with key informants, focus group discussion, and passive observation of program implementation. The data were analyzed manually using a thematic framework analysis approach. Themes and sub-themes were generated by condensing, summarizing, and synthesizing data collected in the field in the form of extended notes and field observation checklists.FindingsDespite considerable gains in availing basic health services to the rural population, HEP seems to suffer serious design and implementation flaws that demand thoughtful and immediate adjustment. The design constraints span from the number and type of intervention packages to the means of dissemination (vehicle) as well as the target population emphasized. As such, some low-cost high-impact interventions that were strongly desired by the community were overlooked, while others were inappropriately packed. The means of distribution - female health extension workers trained with basic prevention skills, were lacking essential skills. They also had high burnout rates and with little engagement with men, were repeatedly mentioned flaws of the program demanding revitalization. Furthermore, the sheer structure of HEP precluded adult and adolescent men, non-reproductive women, and the elderly.ConclusionDespite significant gains over the last couple of months, Ethiopia’s rural HEP appears to have reached a tipping point that requires a comprehensive revamp of the program package, means of distribution, and target beneficiaries rather than the “usual” tweaks to reap maximum benefits.

Cost consequence analysis of transcutaneous tibial nerve stimulation (TTNS) for urinary incontinence in care home residents alongside a randomised controlled trial

BackgroundUrinary incontinence (UI) is prevalent in more than half of residents of nursing and residential care homes and can have a detrimental impact on dignity and quality of life. Care homes predominantly use absorbent pads to contain UI rather than actively treat the condition. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive, safe, low-cost intervention with demonstrated effectiveness for reducing UI in adults. We examined the costs and consequences of delivering TTNS to care home residents in comparison to sham (inactive) electrical stimulation.MethodsA cost consequence analysis approach was used to assemble and present the resource use and outcome data for the ELECTRIC trial which randomised 406 residents with UI from 37 care homes in the United Kingdom to receive 12 sessions of 30 min of either TTNS or sham (inactive) TTNS. TTNS was administered by care home staff over 6 weeks. Health state utility was measured using DEMQOL-U and DEMQOL-PROXY-U at baseline, 6 weeks and 18 weeks follow-up. Staff completed a resource use questionnaire at baseline, 6 weeks and 18 weeks follow-up, which also assessed use of absorbent pads.ResultsHRQoL did not change significantly in either randomised group. Delivery of TTNS was estimated to cost £81.20 per participant, plus training and support costs of £121.03 per staff member. 85% of participants needed toilet assistance as routine, on average requiring one or two staff members to be involved 4 or 5 times in each 24 h. Daily use of mobility aids and other assistive devices to use the toilet were reported. The value of staff time to assist residents to use the toilet (assuming an average of 5 min per resident per visit) was estimated as £19.17 (SD 13.22) for TTNS and £17.30 (SD 13.33) for sham (per resident in a 24-hour period).ConclusionsUse of TTNS to treat UI in care home residents did not lead to changes in resource use, particularly any reduction in the use of absorbent pads and no cost benefits for TTNS were shown. Managing continence in care homes is labour intensive, requiring both high levels of staff time and use of equipment aids.Trial registrationISRCTN98415244, registered 25/04/2018. NCT03248362 (Clinical trial.gov number), registered 14/08//2017.

Novel single-centre experience - evaluation of outcomes post-implementation of a coordinated combined breast reconstruction service.

Autologous breast reconstruction services are logistically complex and challenging to implement but have better outcomes than implants. This study aimed to evaluate the effect of implementing a coordinated, low-cost combined breast reconstruction service (0.8 FTE nurse liaison, 0.25 FTE plastic surgeon, two dedicated breast surgeons 0.05 FTE each and protected weekly all-day oncoplastic theatre) on unit productivity and efficiency in reducing wait times for immediate autologous breast reconstruction. A retrospective cohort study was conducted on all patients who underwent immediate autologous breast reconstruction at Fiona Stanley Hospital between two study periods, pre-intervention - February 2016 to June 2019 and post-intervention - November 2022. Data were analysed using SPSS v.27. One hundred twenty-seven participants were included, with 49% (n = 62) in the post-intervention group. Most procedures performed were therapeutic (n = 108, 85%). DIEP was the most common flap (84%), and the mean BMI was 26.9 (SD ± 4.2). There was a statistically significant increase in the number of high-risk gene carriers' prophylactic cases and bilateral cases performed post-intervention (5% to 26%, P = 0.001) and (29% to 55%, P = 0.003), respectively. Time to surgery on the waitlist did not significantly change after the intervention (therapeutic group: 3.1 to 3.5 weeks, P = 0.821; prophylactic group: 55.0 to 61.1 weeks, P = 1.000). Overall, there was a marked increase in the overall productivity of the breast service unit in terms of mastectomies, total reconstructions, and autologous reconstructions performed. This single-centre experience showed that implementing a coordinated service significantly increased the unit's productivity. This low-cost intervention can be applied to other healthcare settings.

Triggered by worry: A dynamic network analysis of COVID-19 pandemic-related anxiety and parental stress

BackgroundMajor disruptions to daily life routines made families and parents particularly vulnerable to psychological distress during the COVID-19 lockdowns. However, the specific psychopathological processes related to within-person variation and maintenance of anxiety symptomatology and parental distress components in the parental population have been largely unexplored in the literature. Methods: In this preregistered intensive longitudinal study, a multilevel dynamic network was used to model within-person interactions between anxiety symptomatology, psychopathological processes, parental distress, and protective lifestyle components in a sample of 495 parents—each responding to daily assessments over a 40-day period. A total of 30,195 observations were collected across the subjects. ResultsExtensive worry, threat monitoring, and uncontrollability of worry were identified as overreaching psychopathological processes related to the aggravation of other symptoms of anxiety and parental distress. A strong association was found between parental stress and parental burnout. Anger toward one's child was associated with both parental stress and parental burnout. Protective factors showed the lowest strength centrality, with few and weak connections to other symptoms and processes in the network. LimitationsAssociations may exist between the study variables on a different time scale; hence, different time lags should be used in future research. Conclusions: Accessible, low-cost interventions that address worry, threat monitoring, and the uncontrollability of worry could serve as potential targets for reducing the symptom burden of anxiety and distress in the parental population.

Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda

IntroductionThe management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources.MethodsAn exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions.ResultsA total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation.ConclusionThe findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries.Trial registrationAll studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).