On-site Group Research Articles

Behavioural and neuronal substrates of serious game-based computerised cognitive training in cognitive decline: randomised controlled trial.

Investigations of computerised cognitive training (CCT) show heterogeneous results in slowing age-related cognitive decline. To comprehensively evaluate the effectiveness of serious games-based CCT, integrating control conditions, neurophysiological and blood-based biomarkers, and subjective measures. In this bi-centric randomised controlled trial with parallel groups, 160 participants (mean age 71.3 years) with cognitive impairment ranging from subjective decline to mild cognitive impairment, were pseudo-randomised to three arms: an intervention group receiving CCT immediately, an active control (watching documentaries) and a waitlist condition, which both started the CCT intervention after the control period. Both active arms entailed a 3-month intervention period comprising a total of 60 at-home sessions (five per week) and weekly on-site group meetings. In the intervention group, this was followed by additional 6 months of CCT, with monthly booster sessions to assess long-term training effects. Behavioural and subjective changes were assessed in 3-month intervals. Biological effects were measured by amyloid blood markers and magnetic resonance imaging obtained before and after training. Adherence to the training protocol was consistently high across groups and time points (4.87 sessions per week). Domain-specific cognitive scores showed no significant interaction between groups and time points. Significant cognitive and subjective improvements were observed after long-term training. Voxel-based morphometry revealed no significant changes in grey matter volume following CCT, nor did amyloid levels moderate its effectiveness. Our study demonstrates no benefits of 3 months of CCT on cognitive or biological outcomes. However, positive effects were observed subjectively and after long-term CCT, warranting the inclusion of CCT in multicomponent interventions.

Evaluating a peer-support mind-body medicine intervention for healthcare leaders.

Mind-body medicine (MBM) is an evidence-based intervention associated with trauma and stressful events. The MBM intervention alleviates symptoms of work-related stress and builds resilience by utilizing self-care techniques facilitated in small group settings. Healthcare leaders who experienced traumatic stress through the COVID-19 pandemic may benefit from interventions aimed at their needs. We evaluated the effects of a peer support MBM intervention on perceived stress, resilience, well-being, and empathy for nurse leaders and compassionate care leaders. A pre-post intervention was conducted via 7 virtual and 2 on-site groups, recruiting from a large multihospital health system in the United States. Participants engaged in an 8-week program facilitated by a certified faculty group leader from The Center for Mind-Body Medicine and engaged in resilience skills building activities along with facilitated sharing. Validated instruments were used to measure outcomes at pre, post, 1 month, and 6 month follow-up intervals. Surveys included open-ended questions for qualitative feedback related to facilitators, barriers, and group experiences. Seventy-three leaders completed the MBM program, and 22 completed the four research surveys; all qualitative responses were included for feedback. Perceived stress decreased after the intervention (p < .008) and was maintained for 6 months post intervention (p < .005). Resilience increased after the intervention (p < .034) and for 1 month (p < .049) but decreased after 6 months. Qualitative responses showed that time and workload factors were the most significant barrier to participation, while the benefits included protected time with peers, learning well-being skills, and having a safe place to process emotions. Healthcare leaders face unique challenges, including workplace trauma and crises. Interventions that support their stress response, resilience, and overall well-being should take into consideration the nature of their work, the balance of time demands, and the need for peer support to overcome barriers to sustainable interventions.

Psychosocial work aspects, work ability, mental health and SARS-CoV-2 infection rates of on-site and remote Brazilian workers during the COVID-19 pandemic – a longitudinal study

BackgroundAt the beginning of the COVID-19 pandemic, some workers had the opportunity to work from home, while others remained in on-site work. The aim of the present study was to compare the psychosocial work aspects, work ability, mental health conditions and SARS-CoV-2 infection rates of Brazilian workers in remote and on-site work through a longitudinal study with quarterly follow-up assessments over a 12-month period.MethodA convenience sample of 1,211 workers from different economic sectors participated in the study, 897 of whom (74.1%) worked from home and 314 (25.9%) remained in on-site work. Psychosocial work aspects were assessed using the Copenhagen Psychosocial Questionnaire (COPSOQ). Work ability was assessed using the Work Ability Index (WAI) and the Work Ability Score (WAS). Mental health conditions and SARS-CoV-2 infection rate were recorded based on self-reported medical diagnoses. Online questionnaires were answered from June 2020 to September 2021, involving two waves of the COVID-19 pandemic. The groups were compared using chi-square tests, t-tests, and two-way ANOVA.ResultsIn the first wave of the pandemic, remote workers reported more quantitative demands and work-family conflicts, whereas on-site workers reported more emotional demands, low development of new skills, low commitment, low predictability, low recognition, and low satisfaction. They also reported greater occurrences of unwanted sexual attention, threats of violence, and physical violence. In the second wave, the remote group continued to report high work-family conflicts, whereas the on-site group reported – in addition to the results of the 1st wave – low influence at work, low quality of leadership, and burnout. No significant difference was found between groups with regards to the WAI in either wave. A significant difference was found for the WAS between the 3rd and 12th months (P < 0.01) in both groups. No significant differences were found between groups for the prevalence of anxiety, depression, burnout/stress, insomnia, panic syndrome, and eating disorders, except for the prevalence of insomnia at the 12-month follow-up, with higher rates in the remote group (P = 0.03). SARS-CoV-2 infection was significantly lower in the remote group (11.3%) compared to the on- site (16.9%) group (P < 0.01).ConclusionsPsychosocial work aspects differed between remote and on-site workers. Work ability and mental health conditions were similar between groups. Remote work might have played a role in limiting the spread of the virus in Brazil had it been more widely available.

Comparison of Web-Based and On-Site Lung Simulators for Education in Mechanical Ventilation.

Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course. This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution (n = 39). The second group was instructed in using a web-based simulator, VentSim (n = 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points. There was no significant difference in the mean ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; P = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI -7.0 to ∞; P non-inferiority = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest - pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; P non-inferiority < .001 [non-inferiority confirmed]). In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator.

Innovative pedagogy: nurturing excellence through an effective student-centered approach in medicinal chemistry courses

Medicinal chemistry educators face challenges in providing students with essential tools to ensure an ideal learning environment. The suspension of on-site classes during the COVID-19 pandemic introduced further obstacles. This study investigated learning outcomes in an online versus on-site medicinal chemistry course in Saudi Arabia, focusing on drug classes and biomolecular interactions. We utilized a causal-comparison study method using data from first-year Pharmacy students (P1) enrolled in the Medicinal Chemistry I course (semester 1) during the 2019–2020 (on-site class) and 2020–2021 (online class) academic years. Data were analyzed using JMP software. The online course utilized advanced virtual technology such as Blackboard Collaborate Ultra and other computational platforms. Data representing the performance of 196 students were obtained. The analyses of the assessment scores showed a mean of 80.45 ± 12.65 for the online class group compared with 71.90 ± 9.50 for the on-site class group. Most online students showed improvement in their active engagement and learning experience. Current data support the argument that there is no apparent difference between outcomes for online versus on-site medicinal chemistry courses. Furthermore, advanced tools and their application within the online instructional methodology play a critical role in the overall learning experience.

The effect of on-site and on-call nurse on exclusive breastfeeding in two different hospital settings: a prospective observational cohort study

BackgroundExclusive breastfeeding during postpartum hospitalization is very important for ensuring the success of breastfeeding at home. The aim of the study is to determine if the on-site nurse in rooming in improves exclusive breastfeeding ratio.MethodsWe conducted a prospective observational cohort study to evaluate exclusive breastfeeding during the first three months of life in two Neonatology Units in the South of Italy with different hospital settings: Ente Ecclesiastico Miulli of Acquaviva delle Fonti with on-site nurse h24 (on-site group) and Policlinico of Bari with nurse available on call h24 from Neonatology Unit (on-call group).ResultsA total of 564 mother-baby dyads were admitted from 3 January to 31 March 2018 (299 in on-site group and 265 in on-call group). In the overall population, exclusive breastfeeding rate was 76.4% at 90-days, confirming the role of nurse and rooming in, independently of modality of setting. Considering the way of delivery, in infants from cesarean section there were higher rates for exclusive breastfeeding at 30 and 90 days of life in on-site group.ConclusionsWe can assume that the presence of a nurse h24 could better identify breastfeeding problems. Our study suggests the role of on-site nurse during rooming in to encourage exclusive breastfeeding until three months of life in mothers who underwent caesarean section.

The value of rapid on-site evaluation during conventional and endobronchial ultrasound needle aspiration in the diagnosis of mediastinal lymphadenopathy and lung cancer

BackgroundThe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has revolutionized pulmonology by identifying cancer spread in lung cancer patients. It is now used for diagnosing sarcoidosis, tuberculosis, and lymphoma. Rapid onsite evaluation (ROSE) is a crucial tool for pathologists, assisting in sample adequacy, accuracy, and prompt decision-making. This study aimed to evaluate the efficacy of ROSE in identifying mediastinal lymphadenopathy and lung cancer during EBUS-TBNA and cTBNA.MethodsOur research was a prospective study in which we examined sixty cases that were separated into two groups of similar size. The rapid onsite evaluation group and the non-rapid onsite evaluation group were subjected to either Conventional TBNA or endobronchial ultrasound-guided transbronchial needle aspiration.ResultsThe total diagnostic yield of conventional and endobronchial ultrasound-guided transbronchial needle aspiration in both groups was 83.3% (50/60 cases). Twenty-eight cases (46.7%) were positive for malignancy, 22 cases (36.6%) were positive for benign lesions, and 10 cases (16.6%) were not conclusive. Regarding diagnostic accuracy, it was greater in the rapid onsite evaluation group than in the non-rapid onsite evaluation group (100% in the rapid onsite evaluation group vs. 66.7% in the non-ROSE group).ConclusionsRapid onsite evaluation during conventional or endobronchial ultrasound-guided transbronchial needle aspiration improves diagnostic accuracy of mediastinal lesions by excluding suspicious or nondiagnostic specimens and can reduce unnecessary punctures or eliminate the need for additional bronchoscopy procedures when reaching preliminary diagnosis.

Which social–ecological factors play a role in older adults’ participation in a blended physical activity intervention? Results of a multi-layered feedback analysis

Abstract Aim This study aimed to evaluate factors affecting older adults’ participation in a blended physical activity (PA) intervention, which comprised tailored home-based exercises and supervised on-site group sessions with peers. Specifically, the objective was to explore participants’ feedback for identifying specific requirements regarding intervention components and materials. Subject and methods In a 9-month randomized trial with a cross-over design targeting adults aged 60 and above, web- and print-based materials to promote PA were enhanced based on results of a preceding trial, and tested in n = 242 participants. Use of these adapted program components, attendance of group sessions, and acceptance of the intervention were assessed via self-administered paper-based questionnaires 3 and 9 months after baseline, as well as in interviews and group sessions. Participant feedback was analyzed via qualitative content analysis of open-ended questions, group interviews, and protocols. The social–ecological model served as a coding framework. Results Feedback covering six different levels of requirements according to the social–ecological model was analyzed. The content of the program, including the option to track perceived progress in PA, health, and fitness, as well as the group-based components, providing opportunities for social support, and training with the peer group, were appreciated by participants. Criticism and suggestions for improvement were provided with regard to instructors of the group sessions, the group atmosphere, space requirements, program scheduling, and communication. Conclusions Based on various sources of participant feedback, several requirements and recommendations regarding future characteristics of PA interventions targeting older adults in community settings can be provided.

Comparison between Remotely Supported Nurse-led Electro-Anatomic Mapping and Standard Onsite Engineer Support for Electrophysiological Procedures.

Catheter ablations of complex cardiac arrhythmias are currently guided by electro-anatomic mapping systems. The aim of this study was to compare two different approaches: remotely supported nurse-led electro-anatomic mapping with standard onsite engineer support. In this retrospective observational study, 166 patients with complex and non-complex procedures were included. 82 patients benefited from electro-anatomic mapping with remotely supported nurse-led mapping (mean age: 62±16years), while the approach for 84 patients was with standard onsite engineer support (mean age: 56±19 years). Procedural characteristics, acute results and complication rates were compared between both groups and showed similar results.Complex and non-complex procedures were conducted in both groups, including left atrial and ventricular procedures. As ventricular tachycardia and accessory pathway ablations were more frequently conducted with standard onsite engineer support, we separately analyzed the largest subgroup, 105 patients with atrial fibrillation, left atrial flutter and left atrial tachycardia. Patients in this subgroup had comparable baseline characteristics, procedure times and procedural success. Nevertheless, there were longer ablation times and more utilization of fluoroscopy in the onsite group, most likely due to more complex procedures. Our results underline the practicality of remotely supported nurse-led electro-anatomic mapping. The latter approach proved to be a safe alternative to onsite engineer support. Due to its advantages, particularly for insular settings, it will likely play a greater role in the future.

Secondary attack rate following on-site isolation of patients with suspected COVID-19 in multiple-bed rooms

The implementation of isolation precautions for patients with suspected Coronavirus Disease 2019 (COVID-19) and pending test results is resource intensive. Due to the limited availability of single-bed rooms at our institution, we isolated patients with suspected COVID-19 together with patients without suspected COVID-19 on-site in multiple-bed rooms until SARS-CoV-2-test results were available. We evaluated the likelihood of SARS-CoV-2 transmission to individuals sharing the room with patients isolated on-site. This observational study was performed at the University Hospital Basel, Switzerland, from 03/20 − 11/20. Secondary attack rates were compared between patients hospitalized in multiple-bed rooms and exposed to individuals subjected to on-site isolation precautions (on-site isolation group), and patients exposed to individuals initially not identified as having COVID-19, and not placed under isolation precautions until the diagnosis was suspected (control group). Transmission events were confirmed by whole-genome sequencing. Among 1,218 patients with suspected COVID-19, 67 (5.5%) tested positive for SARS-CoV-2. Of these, 21 were isolated on-site potentially exposing 27 patients sharing the same room. Median contact time was 12 h (interquartile range 7–18 h). SARS-CoV-2 transmission was identified in none of the patients in the on-site isolation group vs. 10/63 (15.9%) in the control group (p = 0.03). Isolation on-site of suspected COVID-19-patients in multiple-bed rooms avoided single-room occupancy and subsequent in-hospital relocation for many patients without confirmed SARS-CoV-2-infection. The absence of secondary transmission among the exposed patients in the on-site isolation group allows for assessment of the risk/benefit ratio of this strategy given the limitation of a small sample size.

Impacts of Virtual and on-Site Mentoring on Instructional Delivery Effectiveness of Secondary School Biology Teachers in Ecology

Impacts of Virtual and on-Site Mentoring on Instructional Delivery Effectiveness of Secondary School Biology Teachers in Ecology

Same-Day Primary Care Referral Versus Usual Care for Patients With Elevated Blood Pressures Seen in a Preoperative Clinic.

Background While several studies have suggested that anesthesia and surgical care episodes provide an opportunity to improve the diagnosis and treatment of hypertension, few studies have implemented and tested pragmatic care coordination efforts for this population. The present study aimed to examine the effects of same-day primary care referral vs. usual care on outpatient hypertension treatment among patients with elevated preoperative clinic blood pressure (BP). Methodology With institutional review board approval of the project as a quality improvement (QI) initiative not requiring consent, we conducted a prospective QI project comparing same-day preoperative primary care referral vs. usual care within comparable cohorts of US Veterans presenting to a preoperative evaluation clinic with elevated BP for whom treatment assignment was based on prior primary care clinic affiliation. Outpatient BP, antihypertensive medications, and antihypertensive dosages at the initial visit and for one year after the initial preoperative clinic visit were followed in the electronic health record. Results Between June 1, 2018, and June 1, 2019, one of the two on-site primary care groups (Firm A) at our facility agreed to accommodate same-day BP referrals. Patients in the second primary care group received standard preoperative care (Firm B). Charts for the pseudo-randomized cohort of Firm A and B patients were compared after 12 months to assess for changes in BP and hypertension treatment. Firm A and B patients were similar in demographics. Overall, 68 (91%) Firm A patients were correctly referred for primary care appointments. Moreover, 28 of 68 (41.2%) patients adhered to the same-day referral recommendation, with the remainder declining to attend the primary care visit. BPs were similar between Firm A and Firm B groups at 3, 6, 9, and 12 months post-intervention. Firm A adherent patients (i.e., those attending the referral) received hypertension treatment intensification sooner than Firm A non-adherent and Firm B patients (median (interquartile range) days to intensification = 21 (0.5-103.5) vs. 154 (45.5-239) and 170 (48-220), respectively; p = 0.038 and p = 0.048, respectively). Conclusions Our protocol achieved a high degree of same-day primary care referral (91%) in hypertensive patients presenting at the preoperative clinic. Although this limited study did not demonstrate improved BP control in patients who received same-day primary care, this group did show increased rates of rapid treatment intensification which may infer improved long-term health outcomes. Further work examining logistical barriers to patients attending same-day referrals is warranted.

Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI.

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

Improving attitudes toward poverty and attitudes toward interprofessional collaboration through online interprofessional synchronous poverty simulation: A mixed methods comparison study

Introduction: Interprofessional poverty simulations can improve attitudes toward poverty and attitudes toward interprofessional collaboration. This study evaluated an immersive synchronous online poverty simulation.Methods: A mixed-method study was conducted to compare the outcomes of onsite and online interprofessional poverty simulations. The simulations were carried out at a private university in the US 6 times onsite between 2017 and 2019, and 4 times online between 2020 and 2021. The quantitative portion utilized two pre- and post-test questionnaires: the Attitudes Toward Poverty Short Form and the University of West England Interprofessional Questionnaire, which evaluate attitudes towards poverty and interprofessional collaboration respectively. Additionally, qualitative interviews of selected students were conducted 2-4 weeks after the simulations. Quantitative data were analyzed using paired t-tests for individual results, and independent samples t-tests to compare onsite with online pre-post changes. Qualitative data were evaluated using thematic analysis by faculty members from three disciplines.Results: The research indicates that both online and onsite poverty simulations can improve student attitudes toward both poverty and interprofessional collaboration. Results for 196 online participants were compared to 325 onsite participants. Both online and onsite groups showed significant improvements in attitudes toward poverty and interprofessional collaboration (p &lt; .05). The quantitative effect size was smaller for online than onsite, but the difference was less in 2021, the second year of the online simulation, likely due to improved implementation techniques. The qualitative data suggested a less intense emotional response for online participants compared to onsite. Overall results suggest that there is a learning curve in offering an effective online poverty simulation, but that online poverty simulations do significantly influence attitudes toward poverty and interprofessional collaboration.Recommendation: In the article, lessons learned are shared. Online simulations can effectively change attitudes toward poverty, and allow many students to participate who otherwise might not be able to, but the magnitude of the impact for our population was not as great online as onsite. It is recommended that schools of nursing and faculty of other healthcare professions consider the pros and cons of incorporating interprofessional poverty simulations in their curricula.

Effect of Absenteeism on Student's Performance in Different Components of Examinations - A Comparison of Online Verses Offline Teaching.

The In online learning, more responsibility is shifted towards students in learning according to their needs. However there is a need to assess which component of teaching can be shifted online for future hybrid teachings. This study aims to compare the students' performance in difference components of the exams and compare them in online vs offline. It was a quantitative study comparing onsite and online groups academic performance in individual components of assessment for a duration of 6 months. Estimates were reported per standard deviation (SD) increase or decrease. Taking absenteeism rate as a predictor, models with group and gender on their own was fitted in univariable models, before including all three predictors (absenteeism rate, group and gender) in the final model. Students who studied online, had a 0.49SD higher grade than their counterparts who attended physically (p < 0.001), each SD increase in the absenteeism rate was associated with a 0.26SD lower overall score, and this was significant, p < 0.001. While comparing both groups in MCQ part students who studied online, had a 0.6SD higher grade than their counterparts (p < 0.001), also in continuous assessment students who studied online, had a 0.49 SD higher grade than their counterparts who attended physically (p < 0.001). Positive effect of the online teaching was clear in the (MCQs) and the final result, while no significant gender variation detected in this study.

The Effect of an 8-Week Online High-Intensity Interval Training Program on Body Composition and Performance in Thai Professional Football Players During the Covid-19 Epidemic

Background/objectives. High-intensity interval training (HIIT) was used to be a strategy for improving physical performance. Especially, athletic training which were disturbed by the Covid-19 pandemic. Therefore, the objectives of this study were to determine the effects of an 8-week online HIIT program on the body composition, aerobic and anaerobic performances in professional football players. Materials and methods. Thirty professional football players in Thai league division 2 were randomly assigned into the onsite group (n = 15) and the online group (n = 15). All participants performed the HIIT program at 85% maximal heart rate (HRmax), five times a week for 8 weeks. Body composition, aerobic and anaerobic performance at baseline, after 4 weeks and 8 weeks of training were calculated by repeated measures ANOVA and unpaired t-test. Results. Weight, BMI and % fat were significantly decreased after 4 weeks of training in the onsite group and after 8 weeks of training in the online group (p &lt; 0.05). FFM in the onsite and online groups was significantly increased after 4 weeks and 8 weeks of training, respectively (p &lt; 0.05). Aerobic performance was significantly increased after 4 and 8 weeks of training (p &lt; 0.05), whereas anaerobic performance was found increased after 8 weeks of training in both groups (p &lt; 0.05). There were no significant differences between the groups. Conclusions. Eight weeks of HIIT training can improve body composition, aerobic performance and anaerobic performance in both onsite and online conditions. It may be implied that an online HIIT training program should have beneficial effects similar to those provided in onsite condition.

Remote guidance of percutaneous coronary intervention: A pilot study.

The safety and effectiveness of remote guidance of percutaneous coronary interventions (PCI) have not been fully appraised in controlled studies. We hereby presented the results of a study on remote guidance (vs on-site guidance) of PCI to explore its feasibility, safety, and effectiveness. Patients were recruited from those who received PCI procedures from January 2018 to June 2019 in a secondary hospital (Jincheng, Shanxi, China), in collaboration with a tertiary medical center (Beijing, China) approximately 680 km away. According to the type of guidance during the procedure, the patients were assigned to two groups: the remote guidance group and the on-site guidance group. Remote guidance was assisted with an advanced commercial telemedicine system. Interventional strategies, procedural success rate, peri-procedural complications, procedural duration, radiation doses, and the amount of contrast medium were compared between the two groups. A total of 352 patients were included in this study, with a total of 411 PCI procedures and 446 target lesions. The baseline clinical characteristics, as well as the distribution and characteristics of coronary artery lesions, did not differ significantly between the two groups. No significant differences were noticed in procedural success rate, peri-procedural complications, procedural duration, radiation dose, and in-hospital major adverse cardiovascular events. However, the amount of contrast medium was slightly higher in the remote guidance group. The results of the present pilot study showed the feasibility of remotely guided PCI, with safety and effectiveness measures at acceptable levels comparable to the traditional on-site guidance. Randomized studies with long-term follow-up are warranted to further confirm our findings.

Effects of Introvision, a self-regulation method with a mindfulness-based perception technique in migraine prevention: a monocentric randomized waiting-list controlled study (IntroMig Study)

BackgroundMigraine is a brain disorder with recurrent headache attacks and altered sensory processing. Introvision is a self-regulation method based on mindfulness-like perception techniques, developed at the University of Hamburg. Here, we examined the effect of Introvision in migraine prevention.MethodsMigraineurs with at least five headache days per month were block-randomized to the experimental group (EG) or waiting list group (WL), the latter starting Introvision training six weeks after the EG. Participants learned Introvision in six weekly on-site group sessions with video-conference support followed by three individual video-conference sessions. Headache diaries and questionnaires were obtained before Introvision training and three months after the last individual Introvision session.ResultsFifty-one patients completed the study. The primary outcome, headache days of the EG after Introvision training compared to those of the WL before the training, showed no significant effect (10.6 ± 7.7, n = 22; vs. 10.9 ± 6.3, n = 29, p = 0.63; Mann–Whitney-U-Test). The secondary outcome, comparing pooled EG and WL data before and after Introvision training, revealed a significant reduction of headache days (from 11.7 ± 6.5 to 9.8 ± 7.0; p = 0.003; Wilcoxon-paired-Test) as well as of acute medication intake and Headache-Impact-Test 6 (HIT-6) scores and increased self-efficacy as quantified by increased FKMS-scores (FKMS: german short form of the Headache Management Self-Efficacy Scale (HMSE)).ConclusionAlthough the study did not reach its primary endpoint, several secondary outcome parameters in the pooled (non-controlled) pre-post analysis showed an improvement with a decrease in monthly headache days by 1.9 days/ month. A larger randomized controlled trial has to corroborate these preliminary findings.Trial registrationNCT03507400, Registration date 09.03.2018.

BREAST CANCER AWARENESS AND SCREENING USING BSE, CBE AND CLINICAL FOLLOW UP AMONG RURAL WOMEN OF TRIPURA, NORTH-EAST INDIA

Background: Breast cancer is one of the most common causes of cancer morbidity and mortality among females around the globe. In India its the second most common cancer in females which is chiefly attributed to lack of knowledge on breast cancer and Breast Self Examination (BSE) especially among rural women. The purpose of this study was to assess the level of awareness on breast cancer, BSE and Clinical Breast Examination (CBE) of rural women having breast problems and their follow up. Methodology: This cross sectional descriptive study was carried out in the rural area around AGMC, Agartala, Tripura among the women. The data was collected by social workers from door to door using a predesigned questionnaire covering various aspects. Brief talk on awareness and BSE was given in form of on-site group discussions. Results: Out of 774 participants, majority belonged to the age group of 40-50 years having school level education(46.8%), married(88.5%), home maker(54.6%), below poverty line (58.8%). Most common electronic source of information were television/radio(75.4%). Most of them identified family history(72.7%) as risk factor &amp; breast lump(100%) as most common symptom of breast cancer. Lacking knowledge about BSE(40.3%) was identified as an important barrier for conducting it. Only 17.8% practiced BSE. Conclusions: This study showed that the overall knowledge of breast cancer and BSE is inadequate and insufficient which warrants effective sensitization by public health education/programmes thus enhancing the knowledge and prevention strategies. This will help in early detection of breast cancer thus reducing morbidity, mortality and burden of disease.

The impact of on-site cardiac surgical backup on clinical outcomes of acute coronary syndrome-analysis of the ACSIS national registry.

The availability of advanced technologies for mechanical support in hospitals with on-site cardiac surgery (CS), along with the ability to perform urgent coronary artery bypass graft (CABG) surgery, may result in improved clinical outcomes in patients with acute coronary syndrome (ACS). We conducted a retrospective analysis of the bi-annually Acute Coronary Syndrome Israeli Survey (ACSIS) registry from the year 2000 to 2020, performed in hospitals with and without CS. Mortality rates and major adverse cardiac and cerebrovascular events (MACCE) rates are reported. We evaluated two periods of the study-early (2000-2010) vs. late (2011-2020). Propensity score matching was performed to reduce bias between the two groups. The study included 16,979 patients (52.3% in the on-site CS group). Patients in the on-site CS group were more likely to undergo percutaneous coronary intervention (PCI), (odds ratio [OR], 1.26 [95% CI, 1.18-1.35]; p < 0.001) and CABG [OR, 1.91 (95%CI, 1.63-2.24); P < 0.001], and patients in hospitals without on-site CS had higher 30-day MACCE [OR, 1.17 (95% CI, 1.07-1.27); p < 0.0005]. Overall, there was no difference in 1-year mortality (hazard ratio [HR], 0.98 [95% CI, 0.89-1.08]; p = 0.71) between the groups. During the late period of the study, patients in the group without on-site CS had lower 30-day mortality [OR, 0.69 (95% CI, 0.49-0.97); P = 0.04], yet with no difference in 1-year mortality [HR, 0.81 (95% CI, 0.65-1.01); p = 0.07]. The availability of on-site CS resulted in variations in treatment modality, yet it did not affect the clinical outcomes of ACS. A trend to a better short-term outcomes was noted in hospitals without CS during the late period of the study, which warrants further investigation.