Mean Improvement In Score Research Articles

The Development and Pilot Evaluation of ECHO Mental Health for Adults with Intellectual and Developmental Disabilities

ABSTRACT Introduction Health and social service providers have limited expertise with regard to assessing and treating psychiatric disorders in adults with intellectual and developmental disabilities. The aim of this study was to describe the development and pilot evaluation of a virtual capacity-building program (Project ECHO) focused on supporting the mental health of adults with these disabilities in Ontario, Canada. Method The pilot program consisted of 12 weekly 1.5 hour sessions hosted through a video-conferencing platform, with a combined focus of didactic teaching and case-based learning, led by an interprofessional team of subject matter experts. The program evaluation was informed by Moore’s evaluation framework for continuing medical education. Ongoing attendance tracking, weekly surveys, and pre-post questionnaires were used to evaluate participation, satisfaction, learning and self-efficacy, and practice change. Results The program included 62 participants from across Ontario, Canada, from both the health and social service sectors. Seventy-three percent of participants attended six or more sessions, with high participant satisfaction ratings seen with the program. A statistically significant improvement in self-efficacy mean scores of 14.7% was observed pre-post. Seventy-four percent of respondents indicated that they had changed their practice because of participating in this ECHO. Conclusion Good participant retention, satisfaction, and increased confidence suggests this cross-sector virtual medical education program may have value for health and social service providers as they support the mental health of adults with intellectual and developmental disabilities.

Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study

BackgroundLung ultrasound (LUS) is a novel and emerging tool for physiotherapists in ICU and may provide a way of monitoring lung aeration change in response to respiratory physiotherapy treatment during a patient’s ICU stay. ObjectiveTo measure change in the LUS score associated with a respiratory physiotherapy treatment; to determine whether change in LUS score correlates with other physiological measures. Design and settingA single-centre prospective cohort study was undertaken in a tertiary teaching hospital in Sydney, Australia. PatientsAdult mechanically ventilated patients in ICU with suspicion of atelectasis. MeasurementsPrimary outcome: pre-post difference in LUS score. Secondary outcomes: PaO2/FiO2 (PF) ratio, tidal volume (VT), lung auscultation score, driving pressure (DP) and the modified radiological atelectasis score (mRAS) on CXR. Results43 patients were included. There was a mean improvement in total LUS score after physiotherapy treatment of − 2.9 (95%CI −4.4, −1.4), and a mean improvement in LUS of the right and left lungs of − 1.6 (−2.5, −0.7) and − 1.3 (−2.5, −0.1) respectively. There was a mean improvement in PF ratio, VT and auscultation score of 10.4 (−11.89, 32.7), 19 (−7.4, 44.5) and − 1.8 (−2.6, −1.0) respectively. There was no improvement in mRAS or DP. There was a weak correlation between change in LUS score compared with change in mRAS score. LimitationsLimitations included the prospective cohort single site design and the small sample size. ConclusionsThe LUS score can be used to detect changes in lung aeration associated with respiratory physiotherapy treatment for acute lobar atelectasis in mechanically ventilated patients.Australian and New Zealand Clinical Trials Registry Number: ACTRN12619000783123. Contribution of the Paper•Assessment and measurement tools currently used by physiotherapists lack diagnostic accuracy. Lung ultrasound has high diagnostic accuracy in detecting pathologies pertinent to physiotherapists and may be helpful in monitoring treatment response.•The lung ultrasound score detects changes in lung aeration associated with respiratory physiotherapy treatment.•This study highlights lung ultrasound as a potential new tool for lung monitoring for physiotherapists in ICU.

Long-Term Improvements in Patient-Reported Outcomes in Patients with Pyruvate Kinase Deficiency Treated with Mitapivat

Background: Pyruvate kinase (PK) deficiency is a rare, hereditary hemolytic anemia caused by a single gene defect encoding the red blood cell (RBC)-specific form of PK. This condition is associated with acute and long-term complications, as well as a spectrum of signs and symptoms including jaundice, fatigue, and dyspnea, that have a profound, wide-ranging impact on health-related quality of life (HRQoL). Patients (pts) report physical limitations, negatively impacted social functioning, reduced self-esteem, and concerns for the future. Mitapivat, a first-in-class, oral, allosteric activator of PK, has demonstrated improvement in hemoglobin, hemolysis, and transfusion burden in pts with PK deficiency, and is approved by the US Food and Drug Administration for the treatment of hemolytic anemia in adults with PK deficiency. In addition, improvements in patient-reported outcomes (PROs) (measured by disease-specific PRO instruments: the PK deficiency diary [PKDD] and the PK deficiency impact assessment [PKDIA]) were observed in two global, phase 3 clinicals trials among adults with PK deficiency treated with mitapivat who were not regularly (ACTIVATE; NCT03548220) or regularly transfused (ACTIVATE-T; NCT03559699). Here, we describe PKDD and PKDIA outcomes up to Week (Wk) 84 of the long-term extension (LTE) study (NCT03853798) of mitapivat in pts with PK deficiency previously enrolled in ACTIVATE and ACTIVATE-T. Methods: In the placebo (PBO)-controlled ACTIVATE trial, pts were randomized 1:1 to receive mitapivat (5/20/50 mg twice daily) or PBO for 24 wks. In the open-label, single-arm ACTIVATE-T trial, pts were treated with mitapivat for 40 wks. Pts who completed either trial were eligible to continue in the LTE, where all pts received mitapivat. Pts from ACTIVATE were categorized into either the mitapivat-to-mitapivat arm (M/M) or the PBO-to-mitapivat arm (P/M). Pts from ACTIVATE-T continued to receive mitapivat (M). Two PK deficiency-specific PRO instruments were used: the PKDD is a 7-item measure of the core signs and symptoms of PK deficiency, and the PKDIA is a 14-item measure of the impacts of PK deficiency on pts' HRQoL. In the ACTIVATE/LTE and ACTIVATE-T/LTE analyses, changes from baseline (BL; defined as the last complete assessment before start of study treatment in ACTIVATE/ACTIVATE-T) in PKDD and PKDIA mean scores were assessed at scheduled visits up to Wk 84 of the LTE for each of the 3 treatment arms. For both PRO instruments, a lower score represents a lower disease burden, and the minimal clinically important change is defined as a reduction of 4.2 and 5.5 in PKDD and PKDIA scores, respectively. Changes in PKDD and PKDIA scores were summarized descriptively using mean and SD. Results: In total, 80 pts were included in the ACTIVATE/LTE analysis (M/M=40; P/M=40) and 27 pts were included in the ACTIVATE-T/LTE analysis. At Wk 84 of the LTE study (ie, Wk 108 for ACTIVATE pts; Wk 124 for ACTIVATE-T pts), mean (SD) change from BL in PKDD score was ‒7.19 (6.740) for M/M pts, ‒4.58 (5.758) for P/M pts, and ‒3.94 (14.087) for M pts; mean (SD) change from BL in PKDIA score was ‒6.3 (7.12) for M/M pts, ‒6.3 (9.09) for P/M pts, and ‒11.5 (11.53) for M pts. Notably, P/M pts experienced improvements in PKDD and PKDIA mean scores after starting mitapivat in the LTE that were consistent with initial improvements seen in the mitapivat-treated group in the ACTIVATE trial. Across both PRO instruments, improvements among mitapivat-treated pts were sustained over time in the LTE (Figures 1A and 1B). Conclusions: Treatment with mitapivat was associated with long-term, durable, and clinically meaningful improvements in signs, symptoms, and functional impacts based on disease-specific PRO instruments, irrespective of transfusion status. These results suggest that by improving HRQoL, treatment with mitapivat may provide meaningful pt-centric benefits. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

318 CARER STRESS REVIEW IN COMPLEX CASES REQUIRING INTERVENTION BY A COMMUNITY-BASED OLDER PERSONS TEAM

Abstract Background Complex cases of older adults suffering from multimorbidity are continuing to increase in number. The integrated care team, overseen by a consultant geriatrician, aims to facilitate the management of stable complex cases in the community. Patient care is largely affected by their support system at home; therefore, it is of great importance to ensure that the patient’s primary carer is receiving the support they require to facilitate the older patients’ management in the community. Our aim is to assess carer stress levels before and after Multi-Disciplinary Team (MDT) integrated care intervention. Methods Study Population were carers of patients identified as complex cases by the integrated care team. Caregiver stress index was administered during the initial assessment and on the closing of active cases. The maximum score on this index is 13 with high stress classified as >7. Scores were added to a spreadsheet. This spreadsheet was reviewed, and relevant data was collated. One year assessed March 2021- March 2022. Results Carer stress information was collected on 62 of 112 identified complex cases (55%). Of these 55 of 96 individual patients were represented (57%). Average age 82 years old. 65% female and 35%, male. Range of carer stress scores observed 0- to 12. Of the 62 cases, 85% (53 cases) had a reduction in carer stress post-intervention(p<0.01). Of these 65% had a reduction below 7 (p<0.01). Mean score improvement 7. No carer stress indices disimproved post-treatment. Conclusion Multidisciplinary, patient-centred community care has a clear positive impact on the patient carer. Improvements in carer stress scores could be further evaluated as to the benefits of specific interventions in time. In future, a more large-scale collection and interpretation of data would need to occur for a more conclusive positive impact of the community based integrated care team to be confirmed.

Short- and long-term quality of life after electrical cardioversion of atrial fibrillation

Abstract Background Electrical cardioversion (ECV) of atrial fibrillation (AF) is known to be effective in restoring sinus rhythm. However, limited and contradictory data exist on the impact of ECV on short- and long-term quality of life outcomes. Purpose To examine the impact of ECV on short- and long-term quality of life in patients with AF. Methods This was a prospective cohort study of consecutive patients with AF referred for outpatient electrical cardioversion at a university hospital in Norway. Recruitment started March 2017, and ended December 2019. Baseline demographics, clinical characteristics, and procedure details were obtained from medical records. Quality of life was measured with the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire before electrical cardioversion (baseline), and at three and 12 months after ECV. Results Two hundred and ninety-five patients underwent ECV and completed follow-up questionnaires at three months (n-259) and at 12 months (n=258). The median age was 68 years (range 37–86 years) and 79% were men. The mean left ventricular ejection fraction obtained by echocardiography was 51% (±9.2). The mean body mass index score was 28±4.8. Immediate success of electric cardioversion was 91%. Recurrence of AF after successful ECV was 36% within three months. Twenty-two percent of the patient underwent new ECV before three months, and 25% of the patients had persistent AF at three months. The overall mean AFEQT score at baseline was 62.9±21.4, and the domain-specific scores were as follows: symptoms, 72.3±23.1; daily activities, 52±26.6; treatment concerns, 71.1±22.4; and treatment satisfaction, 59.9±25.2. There were significant improvements in the overall mean AFEQT score at three months, 70.8±20.8, (p<0.01) and at 12 months, 72.3±20.8 (p<0.01) compared with baseline values. There were also significant improvement (p<0.01) in all AFQET subscales at three and 12 months. Daily activity scores and treatment satisfactions scores demonstrated highest improvement in mean score with a 10% increase from baseline to three months and 13% increase from baseline to 12 months. Sub-analyses revealed that patients with persistent AF within three months were significantly dissatisfied with treatment (p<0.01) and reported lower activity level (p<0.01) compared with the rest of the sample. Conclusions Results indicate both significant improvement in short- and long-term quality of life for patients after electrical cardioversion, in particular when sinus-rythm was maintained. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Stavanger University Hospital

S1093 Assessment of Physical and Mental Health Before and After Protocolized Endoscopic Necrosectomy for Walled-Off Pancreatic Necrosis in a Prospective Multi-Center Trial

Introduction: A regulatory FDA IDE prospective multi-center clinical trial (G170261-NCT03525808) was performed to evaluate rigorous protocolized management of walled off necrosis (WON) ≥ 6 cm in size with > 30% necrotic material using endoscopic ultrasound (EUS) guided lumen apposing metal stent (LAMS) placement with/without endoscopic necrosectomy. Few studies have examined changes in health related quality of life (HRQOL) before and after endoscopic management for WON. The SF-12 is a validated measure of HRQOL containing 12 items which yield a Mental Components Score (MCS) and a Physical Components Score (PCS). Higher scores correspond to a greater perceived quality of life. Methods: The pre-specified target sample of 40 consecutive eligible patients was enrolled by multiple centers from September 2018 to March 2020. Patients with radiographic WON resolution (as demonstrated by size ≤ 3 cm on CT or MRI) and/or 60 days LAMS indwell time had stent removal followed by an end of study visit 6 months later. SF-12 quality of life questionnaires were completed by patients at baseline, stent removal and at the end of study visit. Results: Mean SF-12 Physical Components Score (PCS) was 27.5±21.1 at baseline, 54.4±19.5 at the time of LAMS removal, and 77.9±22.3 at end of study. Mean SF-12 Mental Components Score (MCS) was 44.9±20.1 at baseline, 64.7±16.5 at the time of LAMS removal, and 79.0±17.2 at end of study. The mean improvement in PCS score from baseline to LAMS removal was 26.0±24.8 (p< 0.0001), with the mean improvement in score from baseline to end of the study being 49.1±29.6 (p< 0.0001). The mean improvement in MCS was 19.6±20.1 from baseline to LAMS removal (p< 0.0001) and 32.0±22.3 from baseline to the end of study (p< 0.0001). The mean improvement from the time of stent removal to the end of study was 25.2±18.0 (PCS, p< 0.0001) and 15.5±18.5 (MCS, p=0.0002) (Figure). Conclusion: These data suggest that patients undergoing protocolized endoscopic necrosectomy for walled-off pancreatic necrosis experience significant improvement in both physical and mental HRQOL. Improvement in the physical score domain appeared to be greater than for the mental score domain. HRQOL indicators continued to improve over a mean follow-up of 180 days.Figure 1.: SF-12 Physical and Mental Components Score.

Beneficial UVB phototherapy preceding a fractional CO2 laser-UVB protocol in refractory non-segmental vitiligo.

To explore the short- and long-term effects of UVB phototherapy preceding a fractional CO2 laser-UVB protocol in patients with resistant nonsegmental vitiligo. This single-center, prospective, split-face/body, evaluator-blinded study included adult patients with stable vitiligo refractory to conventional treatments. Two symmetrical lesions were selected. Phototherapy was delivered with one side covered, until minimal erythema. Within 3 days, 31-month-apart sessions of laser were performed on both sides. After each laser session, phototherapy was resumed three times weekly, with all lesions uncovered, until 8 weeks after the last laser session. At baseline, at the end of treatment, and 5 years later, a Mean Improvement Score by Physician (MISP) and a patient satisfaction 10-point visual analog score (VAS) were recorded. Ten patients (8 women and 2 men) were included; their mean age was 32.9 years; phototype III was predominant; the mean duration of vitiligo was 3 years. At the end of treatment and 5 years later, scores of lesions treated with UVB-CO2 -UVB (mean MISP 3.0 and 2.9, mean ΔVAS 4.5 and 3.9, respectively), were higher than those of lesions treated only with CO2 -UVB (mean MISP 2.5 and 2.4, mean ΔVAS 4.1 and 3.6, respectively). After 5 years, one patient lost his partial response and two patients developed light hyperpigmentation on both sides. Exposure to UVB before CO2 -UVB explains the higher scores as it was the only variable between the two sides. It may improve the response of resistant lesions with a constantly sustained result over 5 years.

Effect of Designed Bundle Protocol about Ventilator Associated Pneumonia on Nurses' Performance, Compliance, and Patient Outcomes

Context: Ventilator-associated pneumonia (VAP) is considered one of the leading causes of morbidity and mortality due to nosocomial infections among ventilated patients.&#x0D; Aim: To evaluate the effect of a designed bundle protocol about ventilator-associated pneumonia on nurses' performance, compliance, and patient outcomes.&#x0D; Methods: The study employed the quasi-experimental research (pre/post-test) (study/control) design. This study was conducted at the intensive care unit of Benha University Hospital. A convenience sample of 50 critical care nurses and a purposive sample of 66 patients were enrolled in the current study. Three tools were used to collect data. Nurses' knowledge assessment questionnaire; nurses' practice assessment checklist; The VAP bundle compliance checklist; and patient outcomes assessment record.&#x0D; Results: Statistically significant improvement in total knowledge and practice mean scores post implementing a designed bundle protocol compared to pre-implementing a designed bundle protocol at p &lt;0.001. Also, there was a statistically significant improvement in nurses’ compliance with a highly statistically significant difference between nurses’ compliance with practices of VAP bundle pre-and post designed bundle protocol implementation. Immediately after a designed bundle protocol implementation, the study group patients exhibited a statistically significant difference between all clinical pulmonary infection score items except for oxygenation status and radiographic findings.&#x0D; Conclusion: The study group nurses who received designed bundle protocol training would get improved knowledge, practices, and compliance scores than pre-designed bundle protocol training. Also, the study group of patients who were cared for by trained nurses on the designed bundle protocol would get better outcomes such as a better score of CPIS, shorter length of stay in the intensive care unit, less duration on mechanical ventilation compared to the control group who received routine hospital nursing care. The study recommended replication of the study using a large probability sample from a different geographical area to allow for greater generalization of the results.

Effect of evidence based management and leadership training program on decision making skills of nurse mangers

Aim: The current study evaluate the effect of evidence based management and leadership training program on decision making skills of nurse mangers Design:A quasi experimental design was utilized with pre-posttest measurements taken immediately and after three months of giving the training program. Setting: This study was conducted at selected hospital which affiliated to Cairo University. Sample: A purposive sample of a (No.30) Nurse Managers was recruited in the present study. Tools: Data was collected by Organizational Readiness for Implementing Evidence-Based Management and Leadership Questionnaire; Evidence-Based Management and Leadership Knowledge Test; Evidence-Based Management and Leadership Utilization for Decision Making Observational Checklist; Attitudes toward Evidence-Based Management and Leadership Application Questionnaire; Evidence based decision making Skills Observational Checklist. Results: the findings revealed an improvement in the knowledge mean scores of nurse managers in the immediate posttest and follow-up test scores. Furthermore, statistically significant differences discovered between nurse managers' usage of EBDM in their practice throughout pre, immediate post, and follow up, as they had the highest mean scores immediately post program and after three months relative to program pre implementation; additionally, nurse managers convey a positive attitude and good response toward EBML implementation within an organization.

Depressive Symptoms in Fathers during the First Postpartum Year: The Influence of Severity of Preterm Birth, Parenting Stress and Partners' Depression.

Although preterm birth constitutes a risk factor for postpartum depressive symptomatology, perinatal depression (PND) has not been investigated extensively in fathers of very low (VLBW) and extremely low birth weight (ELBW) infants. This study explored paternal depression levels at 3, 9, and 12 months of infant corrected age, investigating also the predictive role played by the severity of prematurity, maternal and paternal PND levels, and parenting stress. We recruited 153 fathers of 33 ELBW, 42 VLBW, and 78 full-term (FT) infants, respectively. Depression was investigated by the Edinburgh Postnatal Depression Scale (EPDS) and distress by the Parenting Stress Index-Short Form-PSI-SF (Total and subscales: Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child). ELBW fathers showed a significant decrease (improvement) in EPDS, total PSI-SF, and Parental Distress mean scores after 3 months. Paternal EPDS scores at 12 months were significantly predicted by VLBW and FT infants’ birth weight categories, fathers’ EPDS scores at 3 and 9 months, Parent–Child Dysfunctional Interaction subscale at 3 months, and Difficult Child subscale at 9 months. This study strengthens the relevance of including early routine screening and parenting support for fathers in perinatal health services, with particular attention to fathers who might be more vulnerable to mental health difficulties due to severely preterm birth.

The First FDA Approved Early Feasibility Study of a Novel Percutaneous Bone Anchored Prosthesis for Transfemoral Amputees: A Prospective 1-year Follow-up Cohort Study

ObjectiveEvaluate the safety and efficacy of a novel press-fit bone-anchored prosthesis in an FDA approved study. DesignSingle-center, prospective 1-year follow-up cohort study of a percutaneous bone anchored prosthesis. SettingVeterans Health Administration Hospital. ParticipantsTen male Veterans with unilateral transfemoral amputation that occurred at least 6 months prior to enrollment and was not the result of dysvascular disease (N=10). InterventionsAll participants received the novel press-fit Percutaneous Osseointegrated Prosthesis (POP) and a minimum of 10 days supervised rehabilitation therapy. Outcome MeasuresAdverse events and radiographs were collected to assess device safety. Temporal assessments of bone density, stomal skin, prosthetic don/doff, functional ambulation, and patient-reported outcome compared our POP to a socket suspension system. ResultsTen male participants mean age 48.8±12.1 years (range, 32-68 y) with mean time since amputation of 9.4± years (range 1-18 y) completed a two-staged implantation protocol and progressed to ambulation with an assistive device by post-operative day 14. Eight of 10 completed all study procedures. One implant loosened at 5 weeks, requiring removal. A second was removed after periprosthetic fracture from a non-device-related fall at 28 weeks. One patient required oral antibiotics for superficial infection. There were significant (P<.05) increases in bone density in the lumbar spine and adjacent to the distal porous coating with no radiographic evidence of bone resorption. Compared to the socket system, the use of POP significantly (P<.05) reduced prosthetic don and doff times and patient-reported prosthetic problem scores. Significant improvements (P<.05) in mean mobility, global health, and walking test scores were also observed. ConclusionsImprovements in bone density, function, and patient reported outcomes were observed with the POP device when compared to a socket suspension system. This Early Feasibility Study established initial safety and effectiveness of the POP device, supporting expanded investigation as an alternative to socket prostheses.

App-Based Yoga of Immortals: A Novel, Easy-to-use Intervention in the Management of Urinary Incontinence

To study the effectiveness Yoga of Immortals (YOI) intervention in participants with urinary incontinence (UI) of all types. YOI uniquely combines specific yogic postures, breathing exercises, sound therapy & meditation and is practiced by many for general well-being. In this App-based cohort study, a survey was sent to the YOI app subscribers. Those who identified with UI and consented were sent the ICIQ-UI- SF (for mean symptom score & severity of UI), and the ICIQ-LUTS-QOL (for impact of UI on QOL) Questionnaires at baseline, 4, and 8 weeks. Global impression of improvement was assessed by PGI-I scale. 258/422 participants (18-74 years) were included and showed significant decrease in mean scores on the ICIQ-UI-SF (4.06 ± 0.24 at baseline; 2.90 ± 0.22 at 4-weeks [p ≤ 0.001] and 3.44 ± 0.23 at 8 weeks [p ≤ 0.001]) and ICIQ-LUTS-QOL (28.36± 0.74 at baseline; 24.46± 0.70 at 4-weeks [p ≤ 0.001] and 25.78± 0.70 at 8 weeks [p≤ 0.001]). Additionally, the 55-60 year subgroup also had significant decrease in mean scores on ICIQ-LUTS-QOL (25.06 ±1.20 at base line; 21.69 ± 1.07 at 4 weeks [p ≤ 0.01] and 22.28 ± 0.96 at 8 weeks [p ≤ 0.01]). YOI intervention resulted in significant improvement in mean scores on ICIQ-LUTS-QOL; ICIQ-UI-SF; frequency and severity of urinary leak; and daily life activity. Majority of the participants felt 'very much better' on PGI-scale. Being app- based, it has the added advantage of the ability to be used anytime and anywhere.

Repair of gluteus medius tears with bioinductive collagen patch augmentation: initial evaluation of safety and imaging.

ABSTRACTThe purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (<50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P < 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P > 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P < 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.

The impact of treatment with bile acid sequestrants on quality of life in patients with bile acid diarrhoea

BackgroundBile acid diarrhoea (BAD) can be severely debilitating and negatively affect patients’ quality of life (QoL). We carried out a multi-centre prospective study exploring QoL outcomes in patients with BAD after treatment with colesevelam.MethodsPatients with or without a positive 23-seleno-25-homotaurocholic acid (SeHCAT) scan were recruited and categorised into four groups: SeHCAT negative control group (CG), idiopathic BAD, post-cholecystectomy (PC) and post-terminal ileal resection for Crohn’s disease (CD). Patients with a positive SeHCAT were treated with colesevelam and dosing was titrated to symptomatic response. Patients were reviewed at 4- and 8-weekly intervals and QoL was evaluated by EQ-5D-3L, SF-36, IBDQ-32 at each visit (where relevant). Patients with a negative SeHCAT (CG cohort) completed one set of questionnaires before being discharged from the study.Results47 patients (BAD = 24, PC = 12, CD = 11) completed paired QoL questionnaires before and after treatment and 30 CG patients completed a baseline questionnaire. There was a significant improvement in IBDQ-32 mean scores before and after treatment in CD patients [134.6 (95%CI 112.5–156.6) and 158.4 (136.1–180.6), respectively (p = 0.007). Following treatment, BAD patients had significantly improved mean SF-36 scores in the “Role limitation due to physical health” dimension (p = 0.02) and in the overall mental component summary (p = 0.03). Prior to starting treatment, BAD patients had the lowest scores in the ‘activity’ dimension of the EQ-5D-3L (p = 0.04), which improved significantly after treatment (p = 0.002). Overall, the BAD and CD cohort showed improved mean scores with treatment in all components of the SF-36 and EQ-5D-3L, while the PC cohort showed a general decline in mean scores after treatment. 55% of patients clinically responded to treatment of which 41.7%, 58.3% and 81.8% responded from the BAD, PC and CD groups respectively. Correlations between those deemed as responders with improvements on the SF-36 and EQ-5D dimensions were not statistically significant.ConclusionOur results demonstrate improved QoL in the BAD and CD cohort with treatment. Further larger studies are recommended specifically investigating the PC cohort and whether patients may improve with newer treatments such as FXR agonists.Trial registration Ethical approval REC Ref: 16/LO/1325.

170-OR: Outcomes of a Digital Health Coaching Program Integrating Food Delivery for a Population of Adults with T2DM at Risk of Food Insecurity

Background: Recent reviews suggest that concurrent Type 2 Diabetes Mellitus (T2DM) and food insecurity contributes to poorer outcomes, including worse glycemic control and increased healthcare use. We present outcomes from a real-world program involving digital health coaching (DHC) and bi-weekly food delivery for individuals with T2DM screened for food insecurity. Methods: Individuals with T2DM were enrolled in a payor-supported DHC program and screened for food insecurity through social worker, provider, or payor records. A retrospective analysis compared data from baseline to 3-months of enrollment to evaluate T2DM-related outcomes. Results: Of the 1093 individuals who completed baseline assessments, 75% completed 3 months of DHC. This population was primarily female (74%) , racially/ethnically diverse (38% Black, 54% white, 8% other or multi-racial) , with an average age of 53. At 3 months, there were significant improvements in mean scores on the Diabetes Distress Score (2.76 to 2.09, p&amp;lt;0.001) , HbA1c (8.22 to 7.52, p&amp;lt;0.001) , and USDA Food Security Survey (2.49 to 1.39, p&amp;lt;0.001) among evaluable participants (n=710) . Conclusions: A DHC program with integrated food delivery demonstrated promising results, suggesting that addressing basic needs such as food security may contribute to improved clinical and quality of life outcomes for individuals with T2DM. Disclosure S.Rutland: Employee; Pack Health. J.Moore: None. V.T.Tran: None. M.Allison: None. B.Burton: None. D.Patel: None.

Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis.

Treatment for sialorrhea (excessive saliva) in people with motor neuron disease/amyotrophic lateral sclerosis.

Anaesthetic National Teaching Programme for Students (ANTPS).

The COVID-19 pandemic has significantly undermined undergraduate anaesthetic teaching in spite of the vital role of the specialty against the pandemic. Anaesthetic National Teaching Programme for Students (ANTPS) was designed to meet the evolving needs of undergraduates and tomorrow's doctor by standardising anaesthetic training, preparing for final exams and equipping competencies vital for doctors of all grades and specialties. Our Royal College of Surgeons England-accredited University-College-Hospital-affiliated programme consisted of six-biweekly sessions were delivered online by anaesthetic trainees. Prerandomised and postrandomised session-specific multiple-choice questions (MCQs) assessed students' improvement in knowledge. Anonymous feedback forms were provided to students after each session and 2 months following the programme. 3743 student feedback forms (92.2% of attendees) across 35 medical-schools were recorded. There was a mean improvement in test score (0.94±1.27, p<0.001). 313 students completed all six sessions. Based on 5-point Likert scale, students who completed the programme showed an improvement in their confidence in knowledge and skills to face common foundation challenges (1.59±1.12, p<0.001) and thus felt better prepared for life as junior doctors (1.60±1.14, p<0.001). With an increase in confidence in students to pass their MCQs, Observed Structured Clinical Examinations and case-based discussion assessments, 3525 students stated they would recommend ANTPS to other students. Unprecedented COVID-19 factors impacting training, positive student feedback and extensive recruitment, demonstrate that our programme is an indispensable learning resource which standardises anaesthetic undergraduate education nationally, prepares undergraduates for their anaesthetic and perioperative exams and lays strong foundations for implementation of clinical skills required by all doctors, to optimise training and patient care.

The effect of educational intervention based on encourage autonomous self-enrichment program on dialysis adequacy in patients undergoing hemodialysis

Introduction: One of the essential criteria for managing the disease in a hemodialysis patient is the adequacy of dialysis. Patient education, as an alternative method, can be useful to improve the adequacy of dialysis. Objectives: The present study aimed to investigate the effect of educational intervention based on EASE (Encourage Autonomous Self-Enrichment) program on dialysis adequacy in patients undergoing hemodialysis. Patients and Methods: The target population included the patients referred to the hemodialysis ward of Imam Khomeini hospital of Piranshahr. A total of 74 hemodialysis patients were randomly allocated into the intervention (n=37) and the control (n=37) groups. Data collection was conducted using a researcher-made checklist including demographic information and dialysis adequacy. Independent t-test and repeated measures ANOVA were used to test statistical differ. Results: We found a significant difference in dialysis adequacy between the two groups (P&lt;0.05). Furthermore, the difference between the mean scores of dialysis adequacy before and after the intervention was statistically significant in the intervention group. Repeated measures ANOVA at four-time points of pre-test and one month, two months and three months after the intervention showed that the difference in dialysis adequacy mean scores were not similar in the two groups and also showed improvement in dialysis adequacy mean score in the intervention group compared to the control group. Conclusion: Based on the results of our study, EASE program made improvements in dialysis adequacy.

Transition Navigator Intervention Improves Transition Readiness to Adult Care for Youth With Sickle Cell Disease.

Adolescents and young adults (AYA) with sickle cell disease (SCD) experience high rates of acute care utilization and increased morbidity. At this high-risk time, they also face the need to transition from pediatric to adult services, which, if poorly coordinated, adds to heightened morbidity and acute care utilization. The study objective was to characterize the feasibility, acceptability, and short-term efficacy of a protocolized transition navigator (TN) intervention in AYA with SCD. We developed a protocolized TN intervention that used ecological assessment and motivational interviewing to assess transition readiness, identify goals, and remove barriers to transition, and to provide disease and pain management education and skills to AYAs with SCD. Ninety-three percent (56/60) of enrolled individuals completed the intervention. Participation in the TN program was associated with significant improvement in mean transition readiness scores (3.58-4.15, P < .0001), disease knowledge scale (8.91-10.13, P < .0001), Adolescent Medication Barriers Scale (40.05-35.39, P = .003) and confidence in both disease (22.5-23.96, P = .048) and pain management (25.07-26.61, P = .003) for youth with SCD. The TN intervention was acceptable to youth with SCD, feasible to implement at an urban academic medical center, and addressed barriers to transition identified by the youth. Longer-term assessment is needed to determine if the TN intervention improved successful transfer to and retention in adult care.

Highly accelerated 3D MPRAGE using deep neural network-based reconstruction for brain imaging in children and young adults.

This study aimed to accelerate the 3D magnetization-prepared rapid gradient-echo (MPRAGE) sequence for brain imaging through the deep neural network (DNN). This retrospective study used the k-space data of 240 scans (160 for the training set, mean ± standard deviation age, 93 ± 80 months, 94 males; 80 for the test set, 106 ± 83 months, 44 males) of conventional MPRAGE (C-MPRAGE) and 102 scans (77 ± 74 months, 52 males) of both C-MPRAGE and accelerated MPRAGE. All scans were acquired with 3T scanners. DNN was developed with simulated-acceleration data generated by under-sampling. Quantitative error metrics were compared between images reconstructed with DNN, GRAPPA, and E-SPIRIT using the paired t-test. Qualitative image quality was compared between C-MPRAGE and accelerated MPRAGE reconstructed with DNN (DNN-MPRAGE) by two readers. Lesions were segmented and the agreement between C-MPRAGE and DNN-MPRAGE was assessed using linear regression. Accelerated MPRAGE reduced scan times by 38% compared to C-MPRAGE (142 s vs. 320 s). For quantitative error metrics, DNN showed better performance than GRAPPA and E-SPIRIT (p < 0.001). For qualitative evaluation, overall image quality of DNN-MPRAGE was comparable (p > 0.999) or better (p = 0.025) than C-MPRAGE, depending on the reader. Pixelation was reduced in DNN-MPRAGE (p < 0.001). Other qualitative parameters were comparable (p > 0.05). Lesions in C-MPRAGE and DNN-MPRAGE showed good agreement for the dice similarity coefficient (= 0.68) and linear regression (R2 = 0.97; p < 0.001). DNN-MPRAGE reduced acquisition time by 38% and revealed comparable image quality to C-MPRAGE. • DNN-MPRAGE reduced acquisition times by 38%. • DNN-MPRAGE outperformed conventional reconstruction on accelerated scans (SSIM of DNN-MPRAGE = 0.96, GRAPPA = 0.43, E-SPIRIT = 0.88; p < 0.001). • Compared to C-MPRAGE scans, DNN-MPRAGE showed improved mean scores for overall image quality (2.46 vs. 2.52; p < 0.001) or comparable perceived SNR (2.56 vs. 2.58; p = 0.08).