Median Completion Time Research Articles

The patient-reported outcome measure for older people living with frailty receiving acute care (PROM-OPAC): field-testing and validation

BackgroundCurrent acute healthcare service metrics are not meaningful for older people living with frailty. Healthcare knowledge, situational security, and physical and psychosocial function are important outcomes typically not collected. The use of patient-reported outcome measures (PROMs) could support these assessments. Existing instruments are not comprehensive as they typically consider function, while older people with frailty also value enablement (self-determination and security in health and healthcare). This study field-tested and validated a PROM for older people with frailty receiving acute care (PROM-OPAC) to measure enablement.MethodsPeople aged 65+ with Clinical Frailty Scale 5–8 were recruited within seventy-two hours of an emergency attendance. Iterations of the novel instrument were administered over three stages: (1) preliminary field-testing for reliability (response distribution and internal consistency) and structure (exploratory factor analysis, EFA); (2) intermediate field-testing of an improved instrument for reliability and structure; (3) final draft validation assessing reliability, structure (confirmatory factor analysis, CFA), and construct validity based on a priori hypotheses. Feasibility was appraised throughout using data completeness and response rates and times.Results241 people participated. Three items of a preliminary seven-item measure had poor response distribution or loading and were accordingly improved. The intermediate instrument had interpretability issues and three items required further improvement. The final eight-item draft had acceptable reliability (Cronbach’s alpha: 0.71), structure (two factors for self-determination and security; RMSEA: 0.065; TLI: 0.917; CFI: 0.944), and construct validity (lower scores from respondents waiting longer and requiring admission). Feasibility was promising (response rate 39%; 98% responses complete; median completion time 11 (IQR: 12) minutes).ConclusionsAdministration of the PROM-OPAC appeared feasible and the instrument had acceptable psychometric properties. Further evaluation is required to assess generalisability.

Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions.

Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.

Australian adaptation and external validation of Commissioning for Quality in Rheumatoid Arthritis-RA-Patient Reported Experience Measure (CQRA-RA-PREM).

To evaluate the reliability and validity of an adapted Commissioning for Quality in Rheumatoid Arthritis-RA-Patient-Reported Experience Measure (CQRA-RA-PREM) for assessing care experience in an Australian rheumatology outpatient cohort. Individual patient interviews were performed to check the language and completion time of the CQRA-RA-PREM before modification. Australian Rheumatology Association Database (ARAD) participants completed the CQRA-PREM-Australian version (CQRA-PREM-AU) (22 items, 5 domains), disease activity measure (RAPID-3, BASDAI) and Assessment of Quality of Life (AQOL-6D) index. Exploratory factor analysis (EFA) assessed item correlation. Cronbach's α assessed internal consistency. Individual patient interviews (n = 8, 62% male, mean age 50 years, mean disease duration 4.5 years) informed CQRA-RA-PREM modification. The ARAD survey response rate was 707/1124 (63%); 459 (65%) RA, 134 (19%) PsA, 114 (16%) AS; 67% female, mean age 62 years, mean disease duration 22 years. The median instrument completion time was 299 s (interquartile range 284-414). Scoring of responses allowed an averaged overall score. EFA extracted five factors: all items loading similarly onto factor 1, indicating validity of the overall score. The CQRA-PREM-AU score correlated with the AQOL-6D score (ρ = 0.23, P < 0.01); partial correlation with disease activity was not significant (ρ = 0.03, P = 0.45), indicating divergent validity. Reliability was comparable across disease subgroups (Cronbach's α >0.94). The mean overall score did not differ by disease subgroup [4.1 (s.d. 0.6, P = 0.73) and there was no floor/ceiling effect. CQRA-PREM-AU is a valid and reliable instrument to measure self-reported care experience in Australian rheumatology patients and may be interpreted as an average overall numerical score.

Returning value from the All of Us research program to PhD-level nursing students using ChatGPT as programming support: results from a mixed-methods experimental feasibility study.

We aimed to evaluate the feasibility of using ChatGPT as programming support for nursing PhD students conducting analyses using the All of Us Researcher Workbench. 9 students in a PhD-level nursing course were prospectively randomized into 2 groups who used ChatGPT for programming support on alternating assignments in the workbench. Students reported completion time, confidence, and qualitative reflections on barriers, resources used, and the learning process. The median completion time was shorter for novices and certain assignments using ChatGPT. In qualitative reflections, students reported ChatGPT helped generate and troubleshoot code and facilitated learning but was occasionally inaccurate. ChatGPT provided cognitive scaffolding that enabled students to move toward complex programming tasks using the All of Us Researcher Workbench but should be used in combination with other resources. Our findings support the feasibility of using ChatGPT to help PhD nursing students use the All of Us Researcher Workbench to pursue novel research directions.

Validation of Spanish-Language Surveys Utilized for the Navigator-Assisted Hypofractionation (NAVAH) Program to Aid Hispanic-American Breast Cancer Patients.

Cancer accounts for 22% of all mortality and is the leading cause of death among Hispanic and/or Latinx patients in the United States. The disparities in access to radiation therapy (RT), mortality rates, and treatment outcomes among Hispanic-American breast cancer patients compared with other populations highlight the urgent need for targeted interventions. The Navigator-Assisted Hypofractionation (NAVAH) program, with its innovative patient navigation approach and culturally sensitive survey, aims to better identify the specific barriers faced by this population. This study is a report of the NAVAH program experience piloting a Spanish-language culturally sensitive survey in Hispanic-American volunteers. Hispanic-American volunteers with fluency in Spanish were recruited to participate in survey conduction, identified from local networks. Survey information was assessed by topic category, and survey responses were amalgamated into a representative score for each category. Survey categories include acceptability (comfort and prejudice among interactions with the system), accessibility (transportation, distance to care, and health care literacy), accommodation (access to the internet, navigating transportation), affordability (financial considerations, employment, and level of education), and availability (access to a medical center, coordinating care, and overall quality of care). A total of 6 volunteers meeting inclusion criteria completed the survey; 4 in person and 2 by telephone. The median survey completion time was 12 minutes 38 seconds. Respondents noted satisfaction and trust in their interactions with medical providers; however, responses in the acceptability category highlighted a high perception of disparities in the medical system, including a high prevalence of racial and ethnic prejudice and a high prevalence of treatment differences between high-income and low-income patients in clinical settings. In the first Spanish-language survey of its kind, our findings indicate that this survey design is feasible in the Hispanic-American population. Implementation of this survey in breast cancer patients will provide more definitive and comprehensive answers regarding other categories in the survey, including financial challenges during treatment, access to accommodations, and perception of treatment during cancer care. The investigation involving patients actively receiving breast cancer RT is currently underway.

Feasibility of pharmacy-based research opportunity to enhance community testing and surveillance

BackgroundApproximately 89% of the US population lives within five miles of a community pharmacy, which provides a network of geographically distributed recruitment nodes for testing and surveillance of infection and disease. ObjectivesEstablish feasibility of Pharmacy-based Research Opportunities To Enhance Community Testing and Surveillance in the context of SARS-CoV-2 infection in a community pharmacy setting with University of Kentucky serving as the coordinating center and research hub for sample analysis. MethodsTwo community pharmacies in Kentucky served as community-based recruitment sites to assess SARS-CoV-2 exposure through longitudinal (5 visits over 56 days) collection of nasal swabs and blood samples from subjects. ResultsFifty subjects were recruited between May 2022 and December 2023 for longitudinal sample collection. Three phases of recruitment were investigated by first establishing standard operating procedures in an urban pharmacy, then expanding recruitment at a second pharmacy in a rural setting, and finally increasing recruitment at the urban pharmacy. During the first phase of recruitment, 12 participants were recruited. Of these participants, two never scheduled a visit after the initial screening. The median time for study completion from first to last visit within this phase was 59 days (interquartile range: 56-68 days). During the second phase of recruitment, eight of nine participants completed all five visits. The median time to complete all visits was 105 days (interquartile range: 98-112 days). During the ongoing third phase, 29 subjects were recruited, and 19 participants completed all required visits and the remainder continue to schedule follow-up appointments. ConclusionCommunity pharmacies have a significant role in promoting public health. The geographic distribution of community pharmacies makes them appealing locations for recruitment of outpatient cohorts for local surveillance of infections and chronic inflammatory conditions with opportunities for broad implementation of this project for clinical trials in underserved communities.

MSK Engage: A comprehensive program for collection of patient reported outcomes at scale.

e13666 Background: Collecting patient-reported outcomes (PROs) yields high value data for clinical care and research and is associated with improved survival in oncology. However, collection of PROs at scale requires a multifaceted program that in most institutions is not available. This study describes a comprehensive PRO program to support research and standard clinical care at scale. Methods: Memorial Sloan Kettering Cancer Center is a high-volume cancer center in New York. Beginning in 2016, we developed a comprehensive PRO program, MSK Engage, with the following capabilities: (i) A governance process to oversee the creation of questionnaires for both research and clinical care. This process includes alignment with the IRB and standardization of questions presented to patients. (ii) Technology to determine which patients should get an assessment (i.e., instance of a questionnaire) at what point in time. (iii) An interactive module in our patient portal that would present the assessment to the patient. (iv) Various methods to present the PRO data to providers to support clinical decision making. These methods included (a) alerts based on threshold logic that would send secure messages to the clinical team, (b) integration of the PRO data into the EHR to be viewed with other clinical data, and (c) the creation of specialized workflows. The results of assessments are also stored in an analytics database to support operations, research, and the creation of smart reports that compare a patient’s responses with other similar patients. Results: We analyzed the use of the program from 2016 to 2023 (Table). 189 questionnaires have been implemented, generating 3,098,574 completed assessments from 314,685 distinct patients. Completion rates varied. The median completion time for all questionnaires was 2 minutes. Examples of programs enabled by patient-reported outcomes include post-operative symptom monitoring, family history questionnaires to support clinical genetics decision making and operations, intake and follow up questionnaires that support clinical documentation and quality of life questionnaires to support goal concordant care. Conclusions: Adoption of PROs at scale for both research and standard of care in oncology is feasible and innovative programs of care can be supported while maintaining a centralized and acceptable patient experience. This model can be applied across institutions seeking to develop or scale PRO programs to assure patient data are meaningfully incorporated into decision-making. [Table: see text]

Constructing efficient strategies for the process optimization by restart.

Optimization of the mean completion time of random processes by restart is a subject of active theoretical research in statistical physics and has long found practical application in computer science. Meanwhile, one of the key issues remains largely unsolved: how to construct a restart strategy for a process whose detailed statistics are unknown to ensure that the expected completion time will reduce? Addressing this query here we propose several constructive criteria for the effectiveness of various protocols of noninstantaneous restart in the mean completion time problem and in the success probability problem. Being expressed in terms of a small number of easily estimated statistical characteristics of the original process (MAD, median completion time, low-order statistical moments of completion time), these criteria allow informed restart decision based on partial information.

An evaluation of the COVID-19 self-service digital contact tracing system in New Zealand

BackgroundDigital contact tracing (DCT) aims to improve time-to-isolation (timeliness) and find more potentially exposed individuals (sensitivity) to enhance the utility of contact tracing. The aim of this study was to evaluate the public uptake of a DCT self-service survey and its integration with the Bluetooth exposure notification system within the New Zealand Covid Tracer App (NZCTA). MethodsWe adopted a retrospective cohort study design using community COVID-19 cases from February 2022 to August 2022 in New Zealand (1.2 million cases). We examined the proportion of cases completing a self-service survey and the time to complete the survey by age, sex and ethnicity. ResultsOverall, 66 % of cases completed their self-service survey. Completion was influenced by age, sex and ethnicity. The median completion time was 1.8 h (IQR 0.2, 17.2), with 95 % of those completing this survey doing so within 48 h of case identification. Around 13 % of all survey completers also uploaded their Bluetooth data, which resulted in an average of 663 cases per day notifying 4.5 contacts per case. ConclusionThe combination of high public uptake and rapid response times suggest self-service DCT could be a useful tool for future outbreaks, particularly if implemented in conjunction with manual processes and other DCT tools (e.g. Bluetooth) to address issues related to performance (sensitivity, timeliness), effectiveness, and health equity.

Validation of the Standardized Needs Evaluation Questionnaire in Polish Cancer Patients.

Cancer influences various aspects of patients' functioning. Cancer patients face not only medical problems but also organizational, socio-psychological, and spiritual problems. Their needs often seem to be unrecognized because patients do not express their concerns and clinicians do not ask appropriate questions. Unmet needs impact patients' quality of life. The aim of this study was to select, adapt, validate, and introduce a simple instrument for estimating cancer patients' unmet needs in Poland. The Needs Evaluation Questionnaire (NEQ) was chosen for validation in a Polish population. The Polish version of the NEQ was developed with a back-translation procedure, as approved by a psycho-oncologist and a public health specialist. The psychometric properties of the NEQ (content analysis, reliability, construct validity, comprehensibility, and acceptability) were measured. This study was performed on a group of 121 cancer patients. The median time of completion for the NEQ was 10 min. The form, length, and font size of the NEQ were accepted by the respondents. Overall, the meaning of the questions was well understood, with only a few cases of discreetly heterogeneous interpretation of the content. The questionnaire showed good reliability and internal factor structure validity. The NEQ is a simple, easy-to-administer instrument with good psychometric properties and seems to be useful in assessing the unexpressed needs of cancer patients.

Effects of an Increased Financial Incentive on Follow-up in an Online, Automated Smoking Cessation Trial: A randomized Controlled Study Within a Trial.

Poor retention in clinical trials can impact on statistical power, reliability, validity, and generalizability of findings and is a particular challenge in smoking cessation studies. In online trials with automated follow-up mechanisms, poor response also increases the resource need for manual follow-up. This study compared two financial incentives on response rates at 6 months follow up, in an online, automated smoking cessation feasibility trial of a cessation smartphone app (Quit Sense). A study within a trial (SWAT), embedded within a host randomized controlled trial. Host trial participants were randomized 1:1 to receive either a £10 or £20 voucher incentive, for completing the 6-month questionnaire. Stratification for randomization to the SWAT was by minimization to ensure an even split of host trial arm participants and by 6-week response rate. Outcome measures were: Questionnaire completion rate, time to completion, number of completers requiring manual follow-up, and completeness of responses. Two hundred and four participants were randomized to the SWAT. The £20 and £10 incentives did not differ in completion rate at 6 months (79% vs. 74%; p = .362) but did reduce the proportion of participants requiring manual follow-up (46% vs. 62%; p = .018) and the median completion time (7 days vs. 15 days; p = .008). Measure response completeness rates were higher among £20 incentive participants, though differences were small for the host trial's primary smoking outcome. Benefits to using relatively modest increases in incentive for online smoking cessation trials include more rapid completion of follow-up questionnaires and reduced manual follow-up. A modest increase in incentive (from £10 to £20) to promote the completion of follow-up questionnaires in online smoking cessation trials may not increase overall response rates but could lead to more rapid data collection, a reduced need for manual follow-up and reduced missing data among those who initiate completing a questionnaire. Such an improvement may help to reduce bias, increase validity and generalizability, and improve statistical power in smoking cessation trials. Host trial ISRCTN12326962, SWAT repository store ID 164.

Evaluation of variability in performance and paw placement patterns by dogs completing the dog walk obstacle in an agility competition.

The objective of this study was to describe paw placement patterns for canine athletes completing the dog walk obstacle during canine agility trials. It was hypothesized that dogs would demonstrate defined sets of paw placement patterns as they complete the dog walk obstacle and that those could be classified based on end contact behavior. Videos of 296 dogs attempting the dog walk obstacle at the 2021 UK Agility International (UKI) US Open were reviewed online. Data observed from video evaluation included front and rear limb paw placement across the dog walk and time to complete the obstacle. Results showed a high variability in obstacle performance. Mean time to complete the entire obstacle was 2.26 seconds (sd = 1.03). Mean and median completion times were qualitatively similar across all height classes. A slight majority of dogs hit the up ramp with their right foot first indicating running on their left lead (n = 185, 63%) with some variation observed between heights. Likewise, a slight majority (58%) of dogs hit the down ramp with their right front foot first (151/262). Given the high variation in completion times and paw placements, we could not identify clear patterns of dog walk performance. The large amount of variation observed with the dog walk obstacle suggests a need for future studies to employ alternative methods for objective gait analysis and to strategically select dogs to reflect the large variety in obstacle performance observed here.

Abstract B042: A survey of Neuro-Oncology (NOB) clinical providers to assess the feasibility and utility of the administration of the Montreal Cognitive Assessment (MoCA) cognition duo app in an outpatient clinic

Abstract Introduction: Primary brain tumor (PBT) patients experience significant cognitive decline, and early symptom detection helps clinical providers identify and manage impairments as part of routine care. The Montreal Cognitive Assessment (MoCA) is a brief screening tool consisting of standardized assessments of eight key cognitive domains. Our group previously reported the feasibility of use in telehealth and clinical care, and here we explore the feasibility and utility of a newly developed App (MoCA Duo APP) for routine patient care through provider and assessor feedback. Methods: The MoCA assessment was used for 178 examinations using the MoCA Cognition Duo APP by trained MoCA assessors, with results shared with NOB healthcare providers prior to patient visits. After five months, ten providers (Physicians = 5, Nurse Practitioners = 5) were sent a 12-item survey through SurveyMonkey that assessed the general use of the MoCA Duo APP in patient care with the utility of use reported here. Results: All ten providers completed the survey, with half reporting using the MoCA before working in the NOB clinic. Most providers (n=9) reported discussing the patient's MoCA results with their clinical teams and with patients before/after clinic visits. Seven providers endorsed being able to use the MoCA duo APP results to accurately assess cognition at all visits, with three indicating patient-specific limitations, including patient anxiety about testing, deficits impacting test completion and results (i.e., hearing, or motor deficits), and language barriers for those with English as a second language affecting utility in some cases. When asked for limitations of use over their usual exam, 3 noted using the MoCA Duo APP assessment aligned with their current exam/clinical impression, 3 reported the MoCA assessment identified a previous deficit they were aware, and 2 noted the discovery of new deficits with the MoCA Duo APP use. Qualitative descriptions included describing (‘the MoCA as the best screening tool’ and ‘deficits found on the MoCA were not found on the exam’) showed its use as a framework for further diagnostic investigations. Qualitative comments also identified relevance to clinical care and endorsement of the importance of cognitive assessment by patients and caregivers. Conclusions: Our findings demonstrate the utility of the MoCA Duo APP in PBT patients by a diverse group of healthcare providers and assessors. Implementing the MoCA Duo APP allowed providers to evaluate patients' cognitive status and confirm known deficits promptly. As reported elsewhere, the median time for completion was 10 minutes, and automatic scoring reduced post-assessment time, allowing for immediate provider use. Further research is needed to evaluate environmental impacts and deficit adaptation, use in determining interventions, and impact on health outcomes. Citation Format: Madhura V. Managoli, Jaime Garcia, Morgan Johnson, McKenzie C. Kauss, Yeonju Kim, Hope Miller, Maeve Pascoe, Elizabeth Vera, Alex R. Wollet, Vivian A. Guedes, Mark R. Gilbert, Terri S. Armstrong, Alvina Acquaye-Mallory. A survey of Neuro-Oncology (NOB) clinical providers to assess the feasibility and utility of the administration of the Montreal Cognitive Assessment (MoCA) cognition duo app in an outpatient clinic [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr B042.

Initial Validation of a Computerized Adaptive Test for Substance Use Disorder Identification in Adolescents

Purpose Computerized adaptive tests (CATs) are highly efficient assessment tools that couple low patient and clinician time burden with high diagnostic accuracy. A CAT for substance use disorders (CAT-SUD-E) has been validated in adult populations but has yet to be tested in adolescents. The purpose of this study was to perform initial evaluation of the K-CAT-SUD-E (i.e., Kiddy-CAT-SUD-E) in an adolescent sample compared to a gold-standard diagnostic interview. Methods Adolescents (N = 156; aged 11–17) with diverse substance use histories completed the K-CAT-SUD-E electronically and the substance related disorders portion of a clinician-conducted diagnostic interview (K-SADS) via tele-videoconferencing platform. The K-CAT-SUD-E assessed both current and lifetime overall SUD and substance-specific diagnoses for nine substance classes. Results Using the K-CAT-SUD-E continuous severity score and diagnoses to predict the presence of any K-SADS SUD diagnosis, the classification accuracy ranged from excellent for current SUD (AUC = 0.89, 95% CI = 0.81, 0.95) to outstanding (AUC = 0.93, 95% CI = 0.82, 0.97) for lifetime SUD. Regarding current substance-specific diagnoses, the classification accuracy was excellent for alcohol (AUC = 0.82), cannabis (AUC = 0.83) and nicotine/tobacco (AUC = 0.90). For lifetime substance-specific diagnoses, the classification accuracy ranged from excellent (e.g., opioids, AUC = 0.84) to outstanding (e.g., stimulants, AUC = 0.96). K-CAT-SUD-E median completion time was 4 min 22 s compared to 45 min for the K-SADS. Conclusions This study provides initial support for the K-CAT-SUD-E as a feasible accurate diagnostic tool for assessing SUDs in adolescents. Future studies should further validate the K-CAT-SUD-E in a larger sample of adolescents and examine its acceptability, feasibility, and scalability in youth-serving settings.

FEASIBILITY OF CONTINUOUS PASSIVE MONITORING OF DAILY FUNCTION AND SYMPTOMS IN OLDER ADULTS WITH MULTIPLE MYELOMA

Abstract The impact of cancer and cancer treatment on older adults’ day-to-day health and functioning remains poorly characterized. Therefore, we evaluated the feasibility of using home-based, continuous passive monitoring of daily life functioning plus symptom surveys in older adults with multiple myeloma (MM). We assessed accrual, uptake of passive monitoring, retention, survey completion, and data completeness. Passive monitoring included infrared motion sensors (activity), door contact sensors (time out-of-home), watch (activity/sleep), bed mat (sleep), biometric scale (weight), electronic pillbox (medication-taking habits), and computer-use software (computer habits). A weekly online survey assessed health events (i.e., falls, hospitalization/ED visits, pain) and treatment-related symptoms (PRO-CTCAE). We enrolled 20 patients with MM of 55 referred (36% accrual) with a median age of 71 years (35% female); 8 patients enrolled with a care partner. Half of patients agreed to passive monitoring and weekly surveys; half completed surveys only. Refusal of passive monitoring was primarily due to concerns about privacy/intrusiveness. Retention over 17 months was 85% (3 dropouts from the survey-only group). Survey completion was 82% (missing reasons included “poor health” and “too busy”) with a median completion time of 4.6 minutes. Data completeness for passive monitoring ranged from 66% for watch-based sleep (n=9 patients) to 93% for home-based activity (n=14 homes). In sum, passive monitoring of daily life functioning plus symptom surveys is feasible among older adults with MM. Future research will integrate daily functioning with symptom data to examine longitudinal variations in health and develop digital biomarkers to inform optimal timing of future interventional studies.

Measuring health-related quality of life of older people with frailty receiving acute care: feasibility and psychometric performance of the EuroQol EQ-5D

BackgroundAlthough outcome goals for acute healthcare among older people living with frailty often include Health-Related Quality of Life (HRQoL) and other patient-reported outcome measures (PROMs), current quality metrics usually focus on waiting times and survival. Lay and patient review have identified the EuroQol EQ-5D as a candidate measure for this setting. This research appraised the EQ-5D for feasibility, psychometric performance, and respondents’ outcomes in the acute frailty setting.MethodsPeople aged 65 + with Clinical Frailty Scale (CFS) 5–8 were recruited from eight UK hospitals’ emergency care and acute admissions settings. They completed the five-level EQ-5D and the EQ-VAS. Feasibility was assessed with completion times and completeness. For reliability, response distributions and internal consistency were analysed. Finally, EQ-Index values were compared with demographic characteristics and service outcomes for construct validity.ResultsThe 232 participants were aged 65–102. 38% responded in emergency departments and 62% in admissions wards. Median completion time was 12 (IQR, 11) minutes. 98% responses were complete. EQ-5D had acceptable response distribution (SD 1.1–1.3) and internal consistency (Cronbach’s alpha 0.69). EQ-VAS demonstrated a midpoint response pattern. Median EQ-Index was 0.574 (IQR, 0.410) and was related positively with increasing age (p = 0.010) and negatively with CFS (p < 0.001). Participants with higher CFS had more frequent problems with mobility, self-care, and usual activities.ConclusionsAdministration of the EQ-5D was feasible in these emergency and acute frailty care settings. EQ-5D had acceptable properties, while EQ-VAS appeared problematic. Participants with more severe frailty had also poorer HRQoL.

Innovative Curriculum to Train Medical Students on Lateral Canthotomy and Cantholysis.

Orbital compartment syndrome (OCS) is an ocular emergency requiring prompt decompression with a lateral canthotomy and cantholysis (LCC) within 2 hours. This study evaluates the feasibility and effectiveness of a standardized LCC curriculum to train medical students to identify and treat OCS. This was a prospective, non-randomized, non-comparative cohort study of 39 novice first-year medical students with no prior LCC training who underwent a standardized LCC curriculum incorporating both didactic and hands-on procedural training. Didactic knowledge of orbital anatomy and OCS was evaluated with written pre- and post-knowledge testing. Expert performance criteria were determined by expert consensus based on the performance of three oculoplastic surgeons and were defined as correctly performing all 12 critical checklist steps of an LCC within 3 minutes twice consecutively on a Sonalyst LCC training system eye model. Utilizing the principles of mastery learning, participants learned how to perform an LCC in a classroom environment and were evaluated on a final test of proficiency in a training lane designed to simulate an austere military environment. Participants required a median of 3.0 practice iterations to achieve expert performance in the classroom environment. During the testing phase, all participants correctly identified the eye with OCS, and 77% (n = 30) of learners successfully performed an LCC at the expert level within their first attempt. The median completion time of those who passed on their first testing was 130 seconds. The mean LCC knowledge test scores significantly improved from 48.7% to 71.2% (P < .001). This study successfully developed a standardized LCC curriculum utilizing the principles of hands-on mastery learning to train novice learners to perform an LCC efficiently and effectively.

Adequacy of in-mission training to treat tibial shaft fractures in mars analogue testing

Long bone fractures are a concern in long-duration exploration missions (LDEM) where crew autonomy will exceed the current Low Earth Orbit paradigm. Current crew selection assumptions require extensive complete training and competency testing prior to flight for off-nominal situations. Analogue astronauts (n = 6) can be quickly trained to address a single fracture pattern and then competently perform the repair procedure. An easy-to-use external fixation (EZExFix) was employed to repair artificial tibial shaft fractures during an inhabited mission at the Mars Desert Research Station (Utah, USA). Bone repair safety zones were respected (23/24), participants achieved 79.2% repair success, and median completion time was 50.04 min. Just-in-time training in-mission was sufficient to become autonomous without pre-mission medical/surgical/mechanical education, regardless of learning conditions (p > 0.05). Similar techniques could be used in LDEM to increase astronauts’ autonomy in traumatic injury treatment and lower skill competency requirements used in crew selection.

Universal Newborn Hearing Screening Program: 10-Year Outcome and Follow-Up from a Screening Center in Germany.

Regular reporting of quality control is important in newborn hearing screening, ensuring early diagnosis and intervention. This study reports on a population-based newborn hearing screening program in North-Rhine, Germany and a hospital-based screening at a University Hospital for 2007-2016. The two-staged 'screening' and 'follow-up' program involving TEOAE and AABR recruited newborns through participating birth facilities. Results were sent to the regional tracking center, and the data were analyzed based on recommended benchmarks. The percentage of newborns from the participating birth facilities in the region increased from 1.4% in 2007 to 57.5% in 2016. The 10-year coverage rate for these newborns was 98.7%, the referral rate after a failed two-step screening was 3.4%, and the lost-to-follow-up rate was 1%. At the hospital, >95% of the screened newborns completed screening within 30 days, the 10-year referral rate was 5%, and 64% were referred within 3 months of age. The median time for screening completion was 6 days after birth, for referral it was 74 days after birth, and for diagnosis it was 55 days after birth. Regional-centralized tracking centers with uniform structure are necessary for proper quality control. Obligatory participation of birthing facilities and quality reports may improve performance, but the recommended quality criteria need considerable financial and infrastructural expenditure.

Putting Guidelines Into Practice: Is Frailty Measurement at the Time of Kidney Transplant Eligibility Assessment Valid, Feasible, and Acceptable to Patients?

Clinical Practice Guidelines suggest that frailty be measured during kidney transplant eligibility assessments. Yet it is not known how frailty is best assessed in this setting or whether its assessment is acceptable to patients. We aimed to examine the construct validity and feasibility of Frailty Index (FI) assessment among patients attending a kidney transplant assessment clinic and to explore patients' perspectives on frailty and the acceptability of its routine assessment. A 58-item FI was calculated for 147 clinic patients. Semistructured interviews were conducted with a subgroup of 29 patients. The FI was validated against normative FI characteristics (mean, distribution, limit), age, and the Estimated Post-Transplant Survival Score. Feasibility was assessed using descriptive statistics. Qualitative data were analyzed using reflexive thematic analysis. The mean FI was 0.23 (±0.10, normal distribution, limit 0.53). FI increased with age and Estimated Post-Transplant Survival score. The FI was completed for 62.8% of eligible patients (147/234). The median completion time was 10 min, and completion rate (with no missing data) was 100%. Four themes were identified: perceptions of frailty, acceptability, perceived benefits, and risks of frailty measurement. Patients linked frailty with age and adverse outcomes, and most did not consider themselves frail. Patients reported that the FI was quick, simple, and efficient. They felt that frailty assessment is relevant to transplant eligibility and should be used to address potentially reversible factors. The FI demonstrated construct validity and was feasible and acceptable in this clinic setting. The challenge is ensuring that routine assessments lead to better care.