Decrease In Mean Scores Research Articles

Retention of knowledge and clinical competence among Ugandan mid-level health providers 1\xa0year after intensive clinical mentorship in TB and HIV management

IntroductionClinical mentorship is effective in improving knowledge and competence of health providers and may be a useful task sharing approach for improving antiretroviral therapy. However, the endurance of the effect of clinical mentorship is uncertain.MethodsThe midlevel health providers who participated in a cluster-randomized trial of one-on-one, on-site, clinical mentorship in tuberculosis and HIV for 8 h a week, every 6 weeks over 9 months were followed to determine if the gains in knowledge and competence that occurred after the intervention were sustained 6- and 12-months post-intervention. In December 2014 and June 2015, their knowledge and clinical competence were respectively assessed using vignettes and a clinical observation tool of patient care. Multilevel mixed effects regression analysis was used to compare the differences in mean scores for knowledge and clinical competence between times 0, 1, 2, and 3 by arm.ResultsAt the end of the intervention phase of the trial, the mean gain in knowledge scores and clinical competence scores in the intervention arm was 13.4% (95% confidence interval ([CI]: 7.2, 19.6), and 27.8% (95% CI: 21.1, 34.5) respectively, with no changes seen in the control arm. Following the end of the intervention; knowledge mean scores in the intervention arm did not significantly decrease at 6 months (0.6% [95% CI − 1.4, 2.6]) or 12 months (− 2.8% [95% CI: − 5.9, 0.3]) while scores in the control arm significantly increased at 6 months (6.6% [95% CI: 4.4, 8.9]) and 12 months (7.9% [95% CI: 5.4, 10.5]). Also, no significant decrease in clinical competence mean scores for intervention arm was seen at 6 month (2.8% [95% CI: − 1.8, 7.5] and 12 months (3.7% [95% CI: − 2.4, 9.8]) while in the control arm, a significant increase was seen at 6 months (5.8% [95% CI: 1.2, 10.3] and 12 months (11.5% [95% CI: 7.6, 15.5]).ConclusionsMentees sustained the competence and knowledge gained after the intervention for a period of one year. Although, there was an increase in knowledge in the control group over the follow-up period, MLP in the intervention arm experienced earlier and sustained gains. One-on-one clinical mentorship should be scaled-up as a task-sharing approach to improve clinical care.Trial Registration The study received ethics approvals from 3 institutions—the US Centers for Disease Control and Prevention Institutional Review Board (USA), the Institutional Review Board “JCRC’s HIV/AIDS Research Committee” IRB#1-IRB00001515 with Federal Wide Assurance number (FWA00009772) based in Kampala and the Uganda National Council of Science and Technology (Uganda) which approves all scientific protocols to be implemented in Uganda.

Implementation of an Evidence-Based Intervention with Safety Net Clinics to Improve Mammography Appointment Adherence Among Underserved Women

The Peace of Mind Program is an evidence-based intervention to improve mammography appointment adherence in underserved women. The aim of this study was to assess effectiveness of the intervention and implementation of the intervention in safety net clinics. The intervention was implemented through a non-randomized stepped wedge cluster hybrid study design with 19 Federally Qualified Health Centers and charity care clinics within the Greater Houston area. A multivariable generalized estimating equation logistic regression was conducted to examine mammography appointment adherence. A survey assessing Consolidated Framework for Implementation Research constructs was also conducted with clinic staff prior to adoption and eight weeks post implementation. One-sided t-tests were conducted to analyze mean score changes between the surveys. A total of 4402 women (baseline period = 2078; intervention period = 2324) were included in the final regression analysis. Women in the intervention period were more likely to attend or reschedule their mammography appointment (OR = 1.30; p < 0.01) than those in the baseline period receiving usual care. Women who completed the intervention were more likely to attend or reschedule their mammography appointment than those who did not complete the intervention (OR = 1.62; p < 0.01). The mammography appointment no-show rates for those in the baseline period, in the intervention period, and who completed the intervention were, respectively, 22%, 19%, and 15%. A total of 15 clinics prior to adoption and eight clinics completed the survey at 8 weeks post implementation A statistically significant mean score decrease was observed in Inner Setting and in two Inner Setting CFIR constructs, Culture–Effort, and Implementation Climate. While the intervention improved mammography appointment adherence, there are opportunities to further integrate Consolidated Framework for Implementation Research constructs. Trial registration: Clinical trials registration number: NCT02296177.

Genetically informed, multilevel analysis of the Flynn Effect across four decades and three WISC versions.

This study investigated the systematic rise in cognitive ability scores over generations, known as the Flynn Effect, across middle childhood and early adolescence (7-15years; 291monozygotic pairs, 298 dizygotic pairs; 89% White). Leveraging the unique structure of the Louisville Twin Study (longitudinal data collected continuously from 1957 to 1999 using the Wechsler Intelligence Scale for Children [WISC], WISC-R, and WISC-III ed.), multilevel analyses revealed between-subjects Flynn Effects-as both decrease in mean scores upon test re-standardization and increase in mean scores across cohorts-as well as within-child Flynn Effects on cognitive growth across age. Overall gains equaled approximately three IQ points per decade. Novel genetically informed analyses suggested that individual sensitivity to the Flynn Effect was moderated by an interplay of genetic and environmental factors.

The Role of a Navigational Radiofrequency Ablation Device and Concurrent Vertebral Augmentation for Treatment of Difficult-to-Reach Spinal Metastases.

Aims: The purpose of this study was to assess the effectiveness of a navigational radiofrequency ablation device with concurrent vertebral augmentation in the treatment of posterior vertebral body metastatic lesions, which are technically difficult to access. Primary outcomes of the study were evaluation of pain palliation and radiologic assessment of local tumor control. Materials and Methods: Thirty-five patients with 41 vertebral spinal metastases involving the posterior vertebral body underwent computed tomography-guided percutaneous targeted radiofrequency ablation, with a navigational radiofrequency ablation device, associated with vertebral augmentation. Twenty-one patients (60%) had 1 or 2 metastatic lesions (Group A) and fourteen (40%) patients had multiple (>2) vertebral lesions (Group B). Changes in pain severity were evaluated by visual analog scale (VAS). Metastatic lesions were evaluated in terms of radiological local control. Results: The procedure was technically successful in all the treated vertebrae. Among the symptomatic patients, the mean VAS score dropped from 5.7 (95% CI 4.9–6.5) before tRFA and to 0.9 (95% CI 0.4–1.3) after tRFA (p < 0.001). The mean decrease in VAS score between baseline and one week follow up was 4.8 (95% CI 4.2–5.4). VAS decrease over time between one week and one year following radiofrequency ablation was similar, suggesting that pain relief was immediate and durable. Neither patients with 1–2 vertebral metastases, nor those with multiple lesions, showed radiological signs of local progression or recurrence of the tumor in the index vertebrae during a median follow up of 19 months (4–46 months) and 10 months (4–37 months), respectively. Conclusion: Treatment of spinal metastases with a navigational radiofrequency ablation device and vertebral augmentation can be used to obtain local tumor control with immediate and durable pain relief, providing effective treatment in the multimodality management of difficult-to-reach spinal metastases.

Bipolar Radiofrequency Ablation of Painful Spinal Bone Metastases Performed under Local Anesthesia: Feasibility Regarding Patient's Experience and Pain Outcome.

Background and objectives: To assess the pain relief of bipolar RFA combined or not with vertebroplasty in patients with painful vertebral metastases and to evaluate the feasibility and tolerance of the RFA procedure performed under local anesthesia. Materials and Methods: 25 patients (18 men, 7 women, mean age: 60.X y.o) with refractory painful vertebral metastasis were consecutively included between 2012 and 2019. A total of 29 radiofrequency ablation (RFA) procedures were performed under CT guidance, local anesthesia and nitrous oxide inhalation, including 16 procedures combined with vertebroplasty for bone consolidation purposes. Pain efficacy was clinically evaluated using the visual analogue scale (VAS) at day 1, 1 month, 3 months, 6 months and 12 months, and the tolerance of the procedure was evaluated. Results: Procedure tolerance was graded as either not painful or tolerable in 97% of cases. Follow-up postprocedure mean VAS score decrease was 74% at day 1: 6.6 (p < 0.001), 79% at 1 month: 6.6 (p < 0.001), 79% at 3 months: 6.5 (p < 0.001), 77% at 6 months, and 79% at 12 months: 6.6 (p < 0.001). Conclusions: Bipolar RFA, with or without combined vertebroplasty, appears to be an effective and reliable technique for the treatment of refractory vertebral metastases in patients in the palliative care setting. It is a feasible procedure under local anesthesia which is well tolerated by patients therefore allowing to broaden the indications of such procedures. Field of study: interventional radiology.

Pain Assessment during Gnathological Treatment of Temporomandibular Myofascial Pain through Mandibular Repositioning Splints Designed after a Posture-Stabilometric Evaluation

The aim of the study is to evaluate the effectiveness of two complementary mandibular repositioning splints (SVED and MORA) designed after a preliminary patients’ posture-stabilometric evaluation in treatment for temporomandibular myofascial pain (TMP) using the Pain-Intensity Numeric Rating Scale (PI-NRS) assessment. Eighty-six consecutive sportive non-agonistic subjects with TMP were randomly divided in two groups. Forty-two wear mandibular repositioning splints designed by a posture-stabilometric evaluation, thus constituting the test group. The other 44 subjects were not subjected to any treatment, thus represented the control group. To record pain intensity, subjects in both groups were asked to fill in a PI-NRS which ranged from 0 (no pain) to 10 (worst imaginable pain). In the test group, PI-NRS was assessed three times: before starting therapy (t0), after 4 months (t1) and after 8 months (t2) of treatment. Instead, in the control group PI-NRS was recorded during the first visit (t0) and after 8 months (t2). The Friedman test showed a statistically significant decrease in PI-NRS mean scores after 4 (t1) and 8 (t2) months from the start of the gnathological therapy with mandibular repositioning splints, (p &lt; 0.001) in test group. There is enough evidence to assess that occlusal splint therapy for mandibular repositioning (MORA and SVED) designed through a posture-stabilometric evaluation could be considered in the treatment of temporomandibular myofascial pain.

Longitudinal changes in respiratory and upper limb function in a pediatric type III spinal muscular atrophy cohort after loss of ambulation.

Spinal muscular atrophy (SMA) type III is a relatively mild form of SMA. Few studies have investigated the changes in both respiratory and upper limb function within this population after loss of ambulation. The aim of this study was to assess change in percentage of predicted forced vital capacity (FVC% predicted) and change in the Revised Upper Limb Module (RULM) score in these patients throughout a 24-month period after loss of ambulation. Effect of scoliosis and its surgical correction, disease duration since loss of ambulation, weight, and height were also investigated. Retrospective analyses were performed on 24 nonambulant SMA III patients from data collected at two centers in the United Kingdom. The FVC% predicted score showed a significant progressive deterioration of 17% over the 24-month period. Respiratory deterioration correlated significantly with age, weight, disease duration since loss of ambulation, and spinal correctional surgery. Longitudinal RULM data were available for 16 patients; a significant deterioration was observed with a mean decrease in score of 3 over 24 months. Age correlated negatively with RULM score, as did height and time since loss of ambulation. A significant positive correlation between FVC% predicted and RULM was demonstrated. This study highlights how SMA type III patients have progressive deterioration of respiratory and upper limb function after loss of ambulation. Combining data from these assessments could provide insight into clinical progression, inform clinical trials, and provide assistance in managing disease progression expectations for patients.

MP52-18 EFFECTIVENESS OF APP- BASED YOGA OF IMMORTALS INTERVENTION IN URINARY INCONTINENCE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-18 EFFECTIVENESS OF APP- BASED YOGA OF IMMORTALS INTERVENTION IN URINARY INCONTINENCE Hari Siva Gurunadha Rao Tunuguntla, Renuka Tunuguntla, Himanshu Kathuria, and Sadhna Verma Hari Siva Gurunadha Rao TunuguntlaHari Siva Gurunadha Rao Tunuguntla More articles by this author , Renuka TunuguntlaRenuka Tunuguntla More articles by this author , Himanshu KathuriaHimanshu Kathuria More articles by this author , and Sadhna VermaSadhna Verma More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Yoga of Immortals (YOI) is a unique combination of specific yogic postures, breathing exercises, sound therapy, and meditation and is practiced by many for general well-being. This also targets pelvic floor muscles and focuses on the specific energy centers. We therefore studied the effectiveness YOI intervention in participants with UI of all types. METHODS: In this prospective, IRB approved, App-based cohort study, a survey was sent to all subscribers of the app. Those who identified with UI and consented to participate in the incontinence study were sent a set of questionnaires including ICIQ-UI, SF, and ICIQ-LUTS-QOL at baseline, 4 and 8 weeks. Mean symptom score and severity of UI were assessed by ICIQ-UI, SF. The impact of UI on QOL was assessed by disease specific ICIQ-LUTS-QOL. Pre- and post-intervention mean scores on ICIQ-LUTS-QOL and ICIQ-UI, SF were compared using paired t test. Effect of YOI intervention on the frequency and severity of urinary leak, daily life activity, and on different types of urinary incontinence were assessed using the ICIQ-UI, SF questionnaire. Global impression of improvement was assessed by PGI-I (participant global impression of improvement) scale. RESULTS: 258 out of 479 participants who completed the baseline, 4, and 8 week questionnaires were included in the study. Participants had significant decrease in mean scores on both the ICIQ-LUTS-QOL (Figure 1) and ICIQ-UI, SF (Figure 2). Significant improvement was also noted in the frequency of urinary leak (Table 1), severity of urinary leak (Table 2), and in the interference in daily life activity (Table 3) after YOI intervention. Improvement in the stress urinary incontinence was significant (Table 4). Sixty percent of the participants felt 'very much better', 16% 'much better', and 12% 'a little better' at 4 weeks on PGI-I scale. CONCLUSIONS: Yoga of Immortals (YOI) intervention resulted in significant improvement in the mean scores of ICIQ-LUTS-QOL, ICIQ-UI-SF, frequency and severity of urinary leak, daily life activity and stress urinary incontinence. Majority of the participants felt 'very much better' at 4 weeks on PGI-scale. YOI may be an adjunctive treatment option in those inclined towards these practices. Being app- based, it has the added advantage of the ability to be used any time anywhere. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e937-e937 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hari Siva Gurunadha Rao Tunuguntla More articles by this author Renuka Tunuguntla More articles by this author Himanshu Kathuria More articles by this author Sadhna Verma More articles by this author Expand All Advertisement Loading ...

To Compare the Mean Decrease in Respiratory Distress Assessment Score after Nebulization With Salbutamol Vs Epinephrine in Children With Acute Bronchiolitis

Aim: To compare the mean decrease in respiratory distress assessment score after nebulization with salbutamol vs epinephrine in children with acute bronchiolitis. Study Settings: Department of Pediatrics, Khyber Teaching Hospital Peshawar. Study design &amp; duration: Randomized Controlled Trial for six months from 13/6/2018 to 13/12/2018. Methodology: In this study, 105 patients in each group were studied. Baseline RDAI score was calculated. All the patients were randomly divided in two groups. Children in group A were Nebulized with Epinephrine (0.1 ml/kg) while children in group B were with salbutamol nebulization (5mg/ml solution) ½ml+3ml normal saline repeated every hour. All children were reassessed at the end of 4th dose (4th hour) and RDAI were recalculated for all patients. Results: In age of 2-12 months, 63% infants have nebulization with epinephrine and 70% cases with salbutamol while in age group 13-18 months, 37% cases nebulized with epinephrine and 30% infants with salbutamol. Mean±SD was 10.57±4.22 and 11.63±3.14 months respectively. Regarding sex, 60% males were nebulized with epinephrine and 53.3% with salbutamol while 40% females were nebulized with epinephrine and 46.7% cases with salbutamol. Mean RDAI at baseline was calculated as 11.57+2.21 with epinephrine and 11.3+2.14 with salbutamol and P value was 0.3695. Conclusion: Mean reduction in RDAI with epinephrine nebulization is more as compared to nebulization with salbutamol in children of acute bronchiolitis. Keywords: RDAI, nebulization, salbutamol, epinephrine, acute Bronchiolitis

Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia.

To assess the impact of coronavirus disease 2019 (COVID-19)-related restrictions on narcolepsy type 1 (NT2), narcolepsy type 2 (NT2), and idiopathic hypersomnia (IH). Participants with NT1, NT2, and IH followed in a university hospital completed an online 78-question survey assessing demographic, clinical, and occupational features of the population during the first COVID-19-related lockdown. A total of 219 of 851 (25.7%) respondents of the survey reported a mean increase of 1.2 ± 1.9 hours (P < .001) in night sleep time and a mean decrease of 1.0 ± 3.4 points (P < .001) on the Epworth Sleepiness Scale during lockdown. Bedtime was delayed by 46.1% of participants and wakeup time was delayed by 59.6%, driven primarily by participants with IH. Teleworkers (but not in-person workers) reported a mean increase of 0.9 ± 1.2 hours in night sleep (P < .001) and a mean decrease in sleepiness score of 1.6 ± 3.1 (P < .001). Cataplexy improved in 54.1% of participants with NT1. Sleepiness correlated with psychological wellness (r = .3, P < .001). As many as 42.5% enjoyed the lockdown, thanks to reallocation of time usually spent commuting toward longer sleep time, hobbies, and family time, and appreciated a freer napping schedule. Conversely, 13.2% disliked the lockdown, feeling isolation and psychological distress. Extended sleep time, circadian delay (in patients with IH), and teleworking resulted in decreased symptoms of central hypersomnias. These findings suggest that people with IH, NT1, and NT2 may benefit from a decrease in social and professional constraints on sleep-wake habits, and support advocacy efforts aimed at facilitating workplace and schedule accommodations for this population. Nigam M, Hippolyte A, Dodet P, etal. Sleeping through a pandemic: impact of COVID-19-related restrictions on narcolepsy and idiopathic hypersomnia. J Clin Sleep Med. 2022;18(1):255-263.

The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms.

Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. To report development and psychometric properties of a brief patient-reported manic symptom measure. Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nine-item Patient Mania Questionnaire-9 [PMQ-9]). Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. The PMQ-9 had high internal reliability (Cronbach's alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p<0.0001), and lower for the Altman Mania Rating Scale (0.26; p=0.007). Longitudinally, PMQ-9 was completed at 1511 clinical encounters in 179 patients with bipolar disorder. Mean PMQ-9 score at first and last encounters was 14.5 (SD 6.5) and 10.1 (SD 7.0), a 27% decrease in mean score during treatment, suggesting sensitivity to change. A point estimate of the MID was approximately 3 points (range of 2-4). The PMQ-9 demonstrated excellent test-retest reliability, concurrent validity, internal consistency, and sensitivity to change and was widely used and acceptable to patients and clinicians in a pragmatic clinical trial. Combined with the Patient Health Questionnaire-9 (PHQ-9) measure of depressive symptoms this brief measure could inform measurement-based care for individuals with bipolar disorder in primary care and mental health care settings given its ease of administration and familiar self-report response format.

Prevalence and changes in boredom, anxiety and well-being among Ghanaians during the COVID-19 pandemic: a population-based study

BackgroundThe outbreak of the COVID-19 pandemic has been associated with several adverse health outcomes. However, few studies in sub-Saharan Africa have examined its deleterious consequences on mental health. Therefore, we investigated the prevalence and changes in boredom, anxiety and psychological well-being before and during the COVID-19 pandemic in Ghana.MethodsData for this study were drawn from an online survey of 811 participants that collected retrospective information on mental health measures including symptoms of generalized anxiety disorder, boredom, and well-being. Additional data were collected on COVID-19 related measures, biosocial (e.g. age and sex) and sociocultural factors (e.g., education, occupation, marital status). Following descriptive and psychometric evaluation of measures used, multiple linear regression was used to assess the relationships between predictor variables and boredom, anxiety and psychological well-being scores during the pandemic. Second, we assessed the effect of anxiety on psychological well-being. Next, we assessed predictors of the changes in boredom, anxiety, and well-being.ResultsBefore the COVID-19 pandemic, 63.5% reported better well-being, 11.6% symptoms of anxiety, and 29.6% symptoms of boredom. Comparing experiences before and during the pandemic, there was an increase in boredom and anxiety symptomatology, and a decrease in well-being mean scores. The adjusted model shows participants with existing medical conditions had higher scores on boredom (ß = 1.76, p < .001) and anxiety (ß = 1.83, p < .01). In a separate model, anxiety scores before the pandemic (ß = -0.25, p < .01) and having prior medical conditions (ß = -1.53, p < .001) were associated with decreased psychological well-being scores during the pandemic. In the change model, having a prior medical condition was associated with an increasing change in boredom, anxiety, and well-being. Older age was associated with decreasing changes in boredom and well-being scores.ConclusionsThis study is the first in Ghana to provide evidence of the changes in boredom, anxiety and psychological well-being during the COVID-19 pandemic. The findings underscore the need for the inclusion of mental health interventions as part of the current pandemic control protocol and public health preparedness towards infectious disease outbreaks.

A randomized clinical trial of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery.

The potential benefit of eHealth interventions in patients with abdominal aortic aneurysm (AAA) is uncertain. The primary aim of this study was to investigate the effect of an eHealth intervention on anxiety in patients with AAA undergoing surgery. A single-centre randomized clinical trial of patients with AAA scheduled for surgical repair was undertaken. The intervention group received an eHealth tool and psychosocial support besides standard care. The control group received standard care. The analysis of treatment effects was performed as intention-to-treat and per protocol analysis. The primary outcome measure was anxiety mean score (Hospital Anxiety and Depression Scale Anxiety (HADS)-A). Secondary outcomes measures were HADS Depression and short-form 12-item health survey mean scores. Some 120 participants were randomized. No effect on anxiety mean scores was found in the intention-to-treat analysis (-1.21 versus -0.54, P = 0.330). Among those randomized to the intervention, only 30 of 60 participants used the eHealth tool (application (app) users). The app users were younger and had a higher educational level. A decrease in anxiety mean scores was noted in those who used the app in the per protocol analysis (-2.00 versus -0.54, P = 0.028). The intervention group stated a lower physical-component health-related quality of life (HRQoL) (-4.32 versus -1.16, P = 0.042) but mental-component HRQoL and depressive symptoms were unchanged. Delivery of an eHealth intervention in this RCT did not result in an improvement in anxiety scores in patients awaiting AAA surgery. Uptake of the eHealth tool was low, although it resulted in lower anxiety scores in those participants who actually used it. NCT03157973 (http://www.clinicaltrials.gov).

Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial

ObjectiveTo examine the effect of methotrexate (MTX) on pain and structural progression in symptomatic erosive hand osteoarthritis (HOA). MethodsThis 1-year prospective, single-centre, randomised, double-blind, placebo-controlled study (www.ClinicalTrial.gov, NCT01068405) followed up patients with symptomatic erosive HOA. Patients were randomised into two groups based on the drug that was administered: 10 mg methotrexate (MTX) per week or a placebo. The primary endpoint was the change in pain (determined using a visual analogue scale [VAS]) from baseline to 3 months. The secondary endpoints were pain VAS score at 12 months, clinical features (pain VAS score and function), radiographic features (the anatomical radiographic Verbruggen–Veys [VV] score and Gent University Score System), and magnetic resonance imaging (MRI) at 12 months. ResultsSixty-four patients with HOA were randomised into either the placebo or MTX group. At 3 months, there was no significant difference in the mean decrease in the pain VAS score (mm) (MTX: 21.1 [standard deviation, 27.4], placebo: 11.7 [24.3]; p = 0.2). At 12 months, according to the VV score, erosive joints progressed significantly more to a remodelling phase in the MTX group than in the placebo group (27% vs 15%; p = 0.03). Joints with space loss appeared to be eroding less in the MTX group compared to the placebo group (8% vs 29%; p = 0.2). Synovitis on MRI at baseline could be associated with the erosive structural evolution of non-erosive joints (p = 0.02). ConclusionsWeekly doses of 10-mg MTX showed no superiority over the placebo in terms of pain relief at 3 or 12 months.Clinical Trial Registration Number: This study was registered at www.ClinicalTrial.gov (NCT01068405).

Feasibility of Breast Radiation Therapy Video Education Combined With Standard Radiation Therapy Education for Patients With Breast Cancer.

To determine the feasibility of incorporating a brief animated educational video shown during the radiation therapy (RT) consultation appointment for patients with breast cancer and to collect preliminary quality-of-life data. 20 participants with breast cancer were recruited from an outpatient radiation oncology facility in the southeastern United States. This single-arm, pre- and post-test feasibility study aimed to assess feasibility and preliminary outcomes of patient-reported anxiety, distress, and RT concerns. The video intervention demonstrated feasibility, as evidenced by meeting or exceeding benchmarks set for recruitment, retention, and feasibility measured scores. The difference in means of total patient-reported scores comparing pre- to postintervention decreased. The intervention proved feasible. In addition, the decrease in total mean scores suggests the video may have a positive effect on reducing patient distress, anxiety, and RT concerns.

The influence of mindfulness-based stress reduction (MBSR) on stress, anxiety and depression due to unwanted pregnancy: a randomized clinical trial.

SummaryBackgroundIndividuals with unwanted pregnancies often experience high levels of anxiety, stress and depression that associated with maternal-neonatal outcomes. Mindfulness training is a safe and acceptable strategy to support mental health before parturition.PurposeThe main objective of present study was to evaluate the influence of eight-week application of mindfulness-based stress reduction on stress, anxiety and depression caused by unplanned pregnancy.MethodIn this study, 60 women with unwanted pregnancy before 32 weeks of gestational age were selected and randomly divided into two groups. Intervention group received MBSR sessions, practice at home and the recorded sound. Mental health was evaluated before intervention and at the end of the eight sessions by standard stress, anxiety and depression DASS-21 questionnaire. Data were analyzed using Chi-square, Mann-Whitney U and Wilcoxon tests.FindingsIn order to compare pre-test and post-test scores in each group, the Wilcoxon Test was used. The results revealed that the participants in the intervention group reported a significant decrease in mean scores of stress, anxiety and depression compared to baseline (P = 0.0). Whereas no significant decrease in mean stress, anxiety and depression score were found in control group. P-value was estimated to be 0.346, 0.212 and 0.343 respectively.ConclusionsThe mindfulness program has effectively reduced stress, anxiety and depression. Further research is needed to investigate the mechanisms and effects of mindfulness on maternal-neonatal outcomes.

Efficacy of Topical High Volume Budesonide Nasal Irrigation in Post FESS Patients of Chronic Rhinosinusitis With or Without Nasal Polyposis.

Chronic rhinosinusitis (CRS) is a chronic inflammatory process of nasal mucosa and paranasal sinuses, lasting more than 12weeks, without complete resolution of symptoms. CRS is treated medically, followed by Endoscopic sinus surgery (ESS) if necessary, and supplemented by post-operative topical treatment with highly variable clinical outcomes. However, till date there is no consensus on the composition and duration of maximal medical treatment. Despite proven role of topical steroids, the mode of delivery, dose and duration of topical intranasal corticosteroids still remains debatable. Studies found that high volume sinonasal irrigation (> 50ml) using budesonide is most efficient method but still there is not sufficient data to prove this and results are variable with multiple modifiable factors therefore, this study has been conducted. (1) To determine the difference in mean decrease in Lund-Kennedy endoscopic scores and SNOT-22 scores among post ESS patients with high volume budesonide nasal irrigation nasal cavity and control nasal cavity of chronic rhinosinusitis patients. (2) To determine safety by measuring serum cortisol levels and intra ocular pressure. This is hospital based interventional, randomised, double blind, control trial study. A total of 66 patients of CRS with previous failed medical therapy were included. Same patients nasal cavities were divided into control and case nasal cavities, to avoid demographic bias. All subjects had a baseline SNOT-22 scores (Sino Nasal Outcome Test scores), Lund Kennedy endoscopy score, NCCT PNS score. All patients were undergone ESS procedure. After nasal pack removal, nasal cavities were randomly assigned 1:1 to receive normal saline irrigation (control group) or 1mg of budesonide irrigation (case group) for transnasal irrigation twice daily for 12weeks. A total of 66 patients with 132 nasal cavities were included in the study. Out of which 16 were female and 50 were male with mean age 33year and mean duration of symptoms was 38.19months. Mean duration of follow up was for 3months. Mean decrement in SNOT-22 score in control nasal cavity from 52.54(16.309) to 30.06 (18.16) and in endoscopic score from 6.53 (1.33) to 3.93 (1.6) which is statically significant (p value < 0.05) in both scores. Mean decrement in SNOT-22 score in case nasal cavity from 53.73 (15.75) to 21.15 (13.52) and in endoscopic score from 6.74 (1.8) to 2.77 (1.4) which is statically significant (p value < 0.05) in both scores. Decrement in SNOT-22 scores and endoscopy scores in case nasal cavity in comparision to control nasal cavity were compared by student 't' test and found to be statically significant (p value equals to 0.0001). In subjective outcomes 57.57% shows total improvement in control nasal cavities while 72.73% case nasal cavities shows total improvement. Our study shows high volume budesonide irrigation is safe and superior over normal saline irrigation and results were statistically comparable. Still further studies with larger sample size and longer duration of irrigation needed.Based on available evidence, high volume budesonide irrigation is statically safe and superior over normal saline irrigation.

Patient-reported function, health-related quality of life, and symptoms in APHINITY: pertuzumab plus trastuzumab and chemotherapy in HER2-positive early breast cancer

We assessed health-related quality of life (symptoms of therapy/patient functioning/global health status), in APHINITY (pertuzumab/placebo, trastuzumab, and chemotherapy as adjuvant HER2-positive early breast cancer therapy). Patients received 1 year/18 cycles of pertuzumab/placebo with trastuzumab and chemotherapy and completed EORTC QLQ-C30 and BR23 questionnaires until 36 months post-randomisation/disease recurrence. Changes ≥10 points from baseline were considered clinically meaningful. 87-97% of patients completed questionnaires. In the pertuzumab versus placebo arms, mean decrease in physical function scores (baseline → end of taxane) was -10.7 (95% CI -11.4, -10.0) versus -10.6 (-11.4, -9.9), mean decrease in global health status was -11.2 (-12.2, -10.2) versus -10.2 (-11.1, -9.2), and mean increase in diarrhoea scores (baseline → end of taxane) was +22.3 (21.0, 23.6) versus +9.2 (8.2, 10.2). Diarrhoea scores remained elevated versus baseline in the pertuzumab arm throughout HER2-targeted treatment (week 25: +13.2; end of treatment: +12.2). Role functioning was maintained in both arms. Improved invasive disease-free survival achieved by adding pertuzumab to trastuzumab and chemotherapy did not adversely affect the ability to conduct activities of daily living versus trastuzumab and chemotherapy alone. Patient-reported diarrhoea worsened during taxane therapy in both arms, persisting during HER2-targeted treatment in the pertuzumab arm. CLINICALTRIALS.GOV: NCT01358877.

Effects of Free Day Secondary Education Policy on Academic Performance of Rural Public Day Secondary Schools in Kilifi County, Kenya

The purpose of the study was to investigate the influence of Free Day Secondary Education (FDSE) policy on academic Performance of Rural Public Day Secondary Schools (RPDSS) in Kilifi County, Kenya. The study adopted descriptive survey research design and a sample of 375 subjects was considered sufficient. Structured questionnaires and interview schedules were used to collect data from principals, teachers, and education directors. Data on performance and enrolment were collected through document analysis. Reliability of the instruments was ascertained through test and retest method that yielded a correlation coefficient of 0.83, an indication of reliable instruments. The study found out that there was a decrease in school mean score between 2003-2007 and 2013-2017. There was a strong positive correlation (r = 0.93) between enrollment and poor performance. Further, learning resources and student finances were inadequate. The study recommends a reduction in class size, timely disbursement and increased students’ capitation.

The Effect of Nursing Care Applied to Patients with Chronic Obstructive Pulmonary Disease on Their Sexual Experiences and Quality of Life.

This study was conducted for the aim of assessing the effect of nursing care applied to patients with chronic obstructive pulmonary disease on their sexual experiences and quality of life. The sample of the study was determined via power analysis, patients were assigned groups using a simple random sampling method. The data were collected between December 2019–June 2020. The researcher applied the nursing care to patients in the experimental group in their home three times. There was a statistically significant difference between posttest mean scores of the Short Form-36 Health-Related Quality of Life Questionnaire subscales and Arizona Sexual Experiences Scale of the patients in the experimental and control groups (p < 0.05). In this study, it was determined that there was an increase in the Health-Related Quality of Life Questionnaire mean score of patients with COPD after the nursing care; whereas, there was a slight decrease in the Arizona Sexual Experiences Scale mean score.