On-site Group Research Articles

Comparing Online and On-Site Cognitive Behavior Therapy in Major Depressive Disorder: Protocol for a Noninferiority Randomized Controlled Trial.

BackgroundThe incidence of mental health disorders in Canada is increasing with costs of CAD $51 billion (US $40 billion) per year. Depression is the most prevalent cause of disability while cognitive behavioral therapy (CBT) is the best validated behavioral depression treatment. CBT, when combined with mindfulness meditation (CBT-M), has strong evidence for increased efficacy. While randomized controlled trials (RCTs) have demonstrated online CBT-M efficacy, comparisons with in-office delivery are lacking.ObjectiveThe aim of this research is to assess whether online group CBT-M (with standard psychiatric care) is non-inferior in efficacy and more cost-effective than office-based, on-site group CBT-M at post-intervention and 6-months follow-up in major depressive disorder. The study will also assess whether digitally recorded data (ie, online workbooks completed, Fitbit step count, and online text messages) predict depression symptom reduction in online participants.MethodsThis single-center, two-arm, noninferiority RCT employs assessor-blinded and self-report outcomes and economic evaluation. The research site is the Centre for Addiction and Mental Health (Toronto), a research-based psychiatry institution where participants will be identified from service wait lists and through contacts with other Toronto clinics. Inclusion criteria are as follows: (1) aged 18-60 years, any ethnicity; (2) Beck Depression Inventory-II (BDI-II) of mild severity (score ≥14) with no upper severity limit; (3) Mini-International Neuropsychiatric Interview-confirmed, psychiatric major depressive disorder diagnosis; (4) fluent in English. All patients are diagnosed by staff psychiatrists. Exclusion criteria are as follows: (1) receipt of weekly structured psychotherapy; (2) observation of Diagnostic and Statistical Manual of Mental Disorders (5th Edition) criteria for severe alcohol or substance use disorder (in past 3 months), borderline personality disorder, schizophrenia (or other primary psychotic disorder), bipolar disorder, or obsessive-compulsive disorder; (3) clinically significant suicidal ideation (imminent intent or attempted suicide in the past 6 months); and (4) treatment-resistant depression. All participants receive standard psychiatric care, experimental participants receive online group CBT-M, and controls receive standard care in-office group CBT-M. The online group program (in collaboration with NexJ Health, Inc) combines smartphone and computer-accessed workbooks with mental health phone counselling (16 hours in 16 weeks) that coordinates software interactions (eg, secure text messaging and Fitbit-tracked walking). The primary outcome is BDI-II, and secondary outcomes are anxiety (Beck Anxiety Inventory), depression (ie, Quick Inventory of Depressive Symptomatology and 17-item Hamilton Depression Rating Scale), mindfulness (Five-Facet Mindfulness Questionnaire), quality of life (European Quality of Life Five Dimension), and pain (Brief Pain Inventory).ResultsBased on prior studies with the BDI-II and 80% power to reject an inferiority hypothesis with a 1-sided type I error rate of 5%, a sample of 78 per group is adequate to detect small-to-medium–effect sizes.ConclusionsThis study assesses online CBT-M efficacy and noninferiority in relation to in-person CBT, and the cost-effectiveness of both interventions.Trial RegistrationClinicalTrials.gov NCT04825535; https://www.clinicaltrials.gov/ct2/show/NCT04825535International Registered Report Identifier (IRRID)DERR1-10.2196/29726

Effectiveness of an online short compassion strengths course on nursing students compassion: A mixed methods non-randomised pilot study

BackgroundAlthough student nurses are expected to demonstrate and show understanding of compassion in their learning and practice, literature suggests that this is not always the case. To address this, nursing students need to be introduced to the value and behaviours of compassion during their education. ObjectivesTo evaluate the effectiveness of an online course to help nursing students develop their strengths and further validate the Bolton Compassion Strengths Indicators. DesignA pre-and post-mixed methods non-randomised pilot study. SettingA university in the north west of England. ParticipantsA sample of first year undergraduate nursing students (67), in two groups, with 33 in the online control and 34 in the on-site group. MethodsBoth groups took part in the Short Compassion Strengths Course (SCSC). The online group took the course in their own time over a 3-week period, while the on-site group completed the course during their time at University. In both groups baseline assessments were carried out using the Bolton Compassion Strengths Indicator (BCSI). Post-test data were collected 3 weeks after in the online group and immediately after in the on-site group, for the BCSI and reflective accounts. Data were analysed using ANOVA in SPSS27. ResultsThe online group did not complete the course but filled out the questionnaires. The on-site group had significantly higher scores on all indicators but self-care and engagement. ConclusionsThe SCSC is an effective course for teaching and developing compassion strengths when delivered on-site. This paper adds further validity for the BCSI.

Effects of cardiac surgical support on long-term outcomes of emergent or complex percutaneous coronary intervention cases: a sub-analysis of the SHINANO 5-year registry

Significant improvements in percutaneous coronary intervention (PCI) technology have enabled cardiovascular procedures to be performed without onsite cardiac surgery facilities. However, little is known about the association between onsite cardiac surgical support and long-term outcomes of PCI, particularly among emergent and complex cases. We investigated whether the presence or absence of cardiovascular surgery affects the long-term prognosis after PCI, emergent and complex elective cases. The SHINANO 5-year registry, a prospective, observational, and multicenter cohort study registry in Nagano, Japan, consecutively included 1665 patients who underwent PCI between August 2012 and July 2013. The procedures were performed at 11 hospitals with onsite cardiac surgery facilities [onsite surgery (+) group; n = 1257] and 8 hospitals without onsite cardiac surgery facilities [onsite surgery (−) group; n = 408]. The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiac and cerebrovascular events [MACCE: all-cause death, Q-wave myocardial infarction, non-fatal stroke, and target lesion revascularization]. The onsite surgery group (+) had a lower rate of emergent PCI and ST-segment elevation myocardial infarction (40.8% vs. 51.7%, p < 0.01 and 24.9% vs. 39.2%, p < 0.01, respectively), and a higher prevalence of hemodialysis and history of peripheral artery disease (7.6% vs. 2.45%, p < 0.01 and 12.1% vs. 6.9%, p < 0.01, respectively). However, the Kaplan–Meier analysis showed no difference in the 5-year mortality rate (16.4% vs. 15.2%, p = 0.421) and MACCE incidence (31.6% vs. 28.9%, p = 0.354) between the groups. Also, there were no differences in the mortality rate and incidence of MACCE among emergent cases of ST-segment elevation myocardial infarction and complex elective cases who underwent PCI. Long-term outcomes of PCI appear to be comparable between institutions with and without onsite cardiac surgical facilities.

Resolving Dilemmas in ICT-Enhanced Interventions: A Cross-Platform-Mediated Strategy

Face-to-face interventions in social care settings are severely disrupted under COVID-19. Previous studies support Information and communication technology (ICT) enhanced intervention as an effective alternative. While difficulties older adults experienced in using ICT were examined extensively, there are fewer discussions on how innate medium characteristics of the delivery mode influence therapeutic interactions. This study explored these embedded challenges in ICT-enhanced psychosocial interventions and possible solutions. We conducted on-site observations and focus groups with 12 participants from two teleconferencing-aided intervention groups for chronic pain with exercise and psychotherapy elements. Observation notes and transcriptions of focus groups recordings were analyzed using thematic analysis. We identified three overarching themes: empowerment, dilemmas, and cross-platform mediated strategy. ICT empowered participants by promoting autonomy and self-management, yet two dilemmas that stemmed from technological affordances undermined the quality of communication. A screen-camera dilemma occurred when participants tried to observe instructions from interventionists while demonstrating their posture in front of the camera for guidance. The blurring boundary between therapy and home settings presented another dilemma. Although teleconferencing increased flexibility and comfort in participation, interruptions from the background environment and intersections of family living spaces disrupted audio-visual communication and jeopardized the sense of security. As a solution, interventionists adopted a cross-platform mediated strategy to bypass the dilemmas. They communicated and delivered supplementary materials through different media, including printed materials and video streamings. Interventionists could consider the unique structural features in different media and the potential impact of participants’ sociodemographic factors, especially those associated with digital literacy.

MHealth to support healthy lifestyle in early stroke prevention

Abstract Background A healthy lifestyle is a strong mediator for reducing the risk for cardiovascular diseases, including stroke. mHealth apps can be an integral part of disease prevention and to support self-management of different chronic conditions and the use of apps have increased. It is however crucial that digital tools that are developed for implementation in healthcare are explored in target populations. A digitally augmented intervention called ‘Make My Day' has been developed for Swedish Primary health care setting to support a change toward healthy behaviours and habits in everyday life for persons at risk for stroke. The aim of the study was to explore experiences of this new intervention which integrated a mobile app and onsite group sessions for persons who have been identified with a risk for stroke. Methods A qualitative design was utilized comprising interviews and observations conducted over 18 months with persons (n = 12) at risk for stroke. A constant comparative method was utilized. Results Preliminary findings show that the app contributed to opportunities for the participants to discover own strengths, weaknesses, current activity patterns, as well as keep track of lifestyle habits and risk factors. The app nudged the participants to incorporate healthy everyday routines. Suggested improvements of the app included automated and personally tailored options for registrations and feedback. The utility of the app also depended on how well it accounted for aspects of participants literacy levels. Conclusions mHealth apps can offer support in incorporating health promoting behaviours and everyday routines as part of lifestyle-based stroke prevention. Increased personalization and tailoring was however important for user satisfaction. Key messages mHealth apps can promote increased awareness of current activity patterns, keep track of lifestyle habits and risk factors and serve as nudging to incorporate healthy everyday routines. Personal relevance and literacy levels are important to consider in stroke prevention mHealth apps to promote motivation to behaviour change and use of mHealth apps.

Practice of medical care and rescue Amne Machin extreme cross-country challenge

To share the practice of medical care and rescue in the 2017-2019 Amne Machin extreme cross-country challenge. At the invitation of the Organizing Committee of Amne Machin extreme cross-country challenge of Maqin County of Qinghai Province. More than 150 medical personnel were sent to make the rescue plan and implement the medical security for three consecutive years. The support was divided into leading command group, expert consulting group, on-site medical support group, rear medical support group, and medical material support group. The on-site medical support group was equipped with the ambulance, corresponding emergency medical equipments and medicines to provide medical support at eight medical stations from the starting point to the endpoint and along the route between each station. There were no cardiac arrest and sudden death cases during the three competitions. A total of 56 patients (5 cases of combined injuries) were received, including 21 cases of mild altitude reaction, 8 cases of abrasions, 13 cases of muscle spasm and strain, 11 cases of hypoglycemia, and 3 cases of abdominal pain. All the injured were treated and observed in time. Each patient achieved a complete remission. To achieve the success of medical security of the highest average altitude cross-country race certified by International Trail Running Association (ITRA), we must formulate a scientific and perfect medical security work plan in the first place: pre competition physical examination, especially the application of sports cardiopulmonary function test, screen out athletes who may have medical accidents; during the competition, focus on monitoring and tracking the players who may have problems; each support point is closely connected with the support vehicle; do a good job of first aid training for all kinds of personnel, so that medical accidents can be found, aided, and transferred at the first time. The medical care and rescue of Amne Machin extreme cross-country challenge have played a good role in the security of the international plateau sports events, which provides a reference for the security of similar events.

Comparison of on Site versus Online Psycho Education Groups and Reducing Caregiver Burden

ABSTRACT Objectives The purpose of this project was to comparatively assess the benefit from the effects of the online versus onsite psychoeducative interventions on caregivers’ emotional burden, including their sense of burden, anxiety, and depression. Methods Seventy-one caregivers of Patients with Dementia (PwD) were divided in two groups, the online versus the onsite, and participated in the 4-month psychoeducational group intervention. Psychosocial assessment was performed using Beck Anxiety Inventory, Beck Depression Inventory and Zarit Burden Interview before and after the intervention. Results No significant differences were found between the online and onsite groups in anxiety (p = .531), depression (p = .577) and sense of burden (p = .623) after the interventions. Both interventions showed significant reductions across emotional variables measured over the course of the treatment study and treatment interventions. Conclusions Both online and onsite interventions are effective at improving emotional health as they reduce the level of anxiety, depression, and sense of caregiver burden. Clinical implications The use of online psychoeducative interventions is indicative for use by clinicians who work with dementia caregivers as compared to the onsite ones. Therefore, they may be assumed as having significant utility in dementia caregivers, especially when being adapted during the recent confinement measures due to the coronavirus disease pandemic (COVID-19).

Genetic Variants in Smoking-Related Genes in Two Smoking Cessation Programs: A Cross-Sectional Study.

Previous studies have identified variants in genes encoding proteins associated with the degree of addiction, smoking onset, and cessation. We aimed to describe thirty-one single nucleotide polymorphisms (SNPs) in seven candidate genomic regions spanning six genes associated with tobacco-smoking in a cross-sectional study from two different interventions for quitting smoking: (1) thirty-eight smokers were recruited via multimedia to participate in e-Decídete! program (e-Dec) and (2) ninety-four attended an institutional smoking cessation program on-site. SNPs genotyping was done by real-time PCR using TaqMan probes. The analysis of alleles and genotypes was carried out using the EpiInfo v7. on-site subjects had more years smoking and tobacco index than e-Dec smokers (p < 0.05, both); in CYP2A6 we found differences in the rs28399433 (p < 0.01), the e-Dec group had a higher frequency of TT genotype (0.78 vs. 0.35), and TG genotype frequency was higher in the on-site group (0.63 vs. 0.18), same as GG genotype (0.03 vs. 0.02). Moreover, three SNPs in NRXN1, two in CHRNA3, and two in CHRNA5 had differences in genotype frequencies (p < 0.01). Cigarettes per day were different (p < 0.05) in the metabolizer classification by CYP2A6 alleles. In conclusion, subjects attending a mobile smoking cessation intervention smoked fewer cigarettes per day, by fewer years, and by fewer cumulative pack-years. There were differences in the genotype frequencies of SNPs in genes related to nicotine metabolism and nicotine dependence. Slow metabolizers smoked more cigarettes per day than intermediate and normal metabolizers.

Midwives’ experiences of father participation in maternity care at a large metropolitan health service in Australia

ObjectiveEngagement of fathers to participate in pregnancy, birth and early postnatal care has significant advantages for women and infants as well as fathers. In Australia, guidelines for midwifery practice do not include specific recommendations about father-inclusive care, and models for publicly funded maternity care do not extend to the provision of care tailored specifically towards the needs of fathers. This study investigated the perceptions of midwives regarding their role in fathers’ wellbeing, the extent of fathers’ attendance at and participation in their services, advantages and disadvantages of father participation and barriers and enablers to father engagement. DesignConvergent mixed methods, cross-sectional. SettingA large metropolitan public maternity hospital that provides care to some of the most socio-economically disadvantaged suburbs and multi-cultural communities in Melbourne, Australia. ParticipantsAll midwives employed at the hospital (n=196) were invited to participate. MethodsAnonymous online survey and semi-structured interviews. Descriptive statistics were calculated for quantitative survey responses. Interview data and qualitative survey responses were analysed thematically. FindingsForty midwives working in all areas of maternity services across the hospital completed surveys, and six participated in interviews.The data illustrate the dilemma faced by midwives in their specific role of supporting women and babies. On the one hand, participants indicated that fathers’ wellbeing should be part of their role and named many advantages of father participation in maternity services, including support and advocacy for mothers and bonding with infants. Participants estimated that most fathers attend births and visit their partner and infant on the postnatal ward, 52% attend antenatal appointments and 76% are present at postnatal home visits. Participants reported several midwife strategies and health service factors which facilitate father attendance and active engagement.On the other hand, participants reported several barriers to father engagement, including antenatal appointment schedules which are at odds with fathers’ work commitments and the lack of on-site group antenatal education. Some of the barriers they reported are specific to the vulnerable communities for which they provide maternity care. Extraordinary circumstances were reported, including fathers working overseas, fathers in prison, new immigrant status that is often accompanied by a lack of family support to care for other children even during labour and birth, and poor socio-economic status. In addition, in many cultures, pregnancy and birth are seen as “women's work”; fathers would not traditionally be involved. Participants also reported that midwives lack training and confidence in engaging fathers, particularly in responding to fathers with mental health concerns. When providing care for families at risk of family violence, father attendance was perceived a significant disadvantage. Key conclusionsMidwife-provided health services represent a significant opportunity to include and address fathers, and midwives recognise the significant advantages of engaging fathers, unless there is a risk of family violence. However, midwives currently report lack of training and confidence in addressing fathers’ needs, and several individual, social, cultural, and health service factors can present barriers to engaging fathers. Implications for practiceGiven the substantial benefits of engaging fathers for women and infants, we argue that maternity services should promote father engagement, for example by offering after hours appointment schedules, free antenatal and parenting education, and workshops to upskill midwifery staff. Education regarding the importance of father participation and skills for working with fathers should be included in the undergraduate preparation of midwives and other key maternity care professionals. Addressing the challenges of providing care to a multicultural community requires sensitive discussion with families from each of those cultures.

The last mile: Flood risk communication for better preparedness in Nepal

Over the last decade, several flood early warning systems have been established in Nepal, helping reduce the number of people affected and killed by floods. However, there are still challenges in communicating flood warning to the most vulnerable. The unavailability of real-time monitoring in smaller streams and tributaries has created challenges for communicating early warning. The ongoing restructuring process of the multilevel governance system in the country also presents challenges, specifically institutional such as insufficient coordination among relevant agencies, lack of adequate personnel, limited budget, and unclear roles and responsibilities. This study uses the Alexander framework (2015) to identify gaps in flood early warning communication in relation to their technical, institutional and socio-cultural components. Qualitative research methods in the form of key informant interviews and on-site focus group discussions were conducted at the national, district and local levels to collect data, taking Ratu watershed as a case study. Based on our analysis, we conclude that, first, while progress has been made in the monitoring and forecasting of floods, integration of socio-cultural aspects that can make early warning information accessible to the most vulnerable has to be strengthened. Second, warning messages need to be co-designed with communities and tailored to meet their diverse needs for proper dissemination and timely protective action. Finally, for flood risk communication to bridge ‘the last mile’ in terms of reaching the most vulnerable in the community must take account of their distinct social, economic and political experiences in both content and delivery of the information.

A classification of pure states on quantum spin chains satisfying the split property with on-site finite group symmetries

We consider a set S P G ( A ) SPG(\mathcal {A}) of pure split states on a quantum spin chain A \mathcal {A} which are invariant under the on-site action τ \tau of a finite group G G . For each element ω \omega in S P G ( A ) SPG(\mathcal {A}) we can associate a second cohomology class c ω , R c_{\omega ,R} of G G . We consider a classification of S P G ( A ) SPG(\mathcal {A}) whose criterion is given as follows: ω 0 \omega _{0} and ω 1 \omega _{1} in S P G ( A ) SPG(\mathcal {A}) are equivalent if there are automorphisms Ξ R \Xi _{R} , Ξ L \Xi _L on A R \mathcal {A}_{R} , A L \mathcal {A}_{L} (right and left half infinite chains) preserving the symmetry τ \tau , such that ω 1 \omega _{1} and ω 0 ∘ ( Ξ L ⊗ Ξ R ) \omega _{0}\circ \left ( \Xi _{L}\otimes \Xi _{R}\right ) are quasi-equivalent. It means that we can move ω 0 \omega _{0} close to ω 1 \omega _{1} without changing the entanglement nor breaking the symmetry. We show that the second cohomology class c ω , R c_{\omega ,R} is the complete invariant of this classification.

Utilization of telehealth in paediatric genome-wide sequencing: Health services implementation issues in the CAUSES Study

Introduction Genome-wide sequencing (exome or whole genome) is transforming the care and management of paediatric patients with a rare disease because of its diagnostic capabilities. Genome-wide sequencing is most effective when both parents and the child are sequenced as a trio. Genetic counselling is recommended for all families considering genome-wide sequencing. Although telehealth is well established in genetic counselling for hereditary cancer and prenatal genetics, its use with genome-wide sequencing has not been well studied. The CAUSES Clinic at BC Children’s and Women’s Hospitals was a translational paediatric trio-based genome-wide sequencing initiative. Pre-test genetic counselling via telehealth (at a clinical site near the family’s residence) was offered to families who had been previously evaluated by a clinical geneticist. We report on the first 300 families seen in the CAUSES clinic and compare health services implementation issues of families seen via telehealth versus on-site. Methods Demographics, cost to families (travel and time), time to first appointment, complete trio sample accrual and diagnostic rates were studied. Results Of the 300 patients, 58 (19%) were seen via telehealth and 242 (81%) were seen on-site for pre-test counselling. The mean time to completion of accrual of trio samples in the telehealth group was 56.3 (standard deviation ±87.3) days versus 18.9 (standard deviation ±62.4) days in the onsite group (p < 2.2 × 10−16). The mean per-family estimated actual or potential travel/time cost savings were greater in the telehealth group (Can$987; standard deviation = Can$1151) than for those seen on-site (Can$305; standard deviation = Can$589) (p = 0.0004). Conclusions Telehealth allowed for access to genome-wide sequencing for families in remote communities and for them to avoid significant travel and time costs; however, there was a significant delay to accrual of the complete trio samples in the telehealth group, impacting on time of result reporting and delaying diagnoses for families for whom genome-wide sequencing was diagnostic.

Rapid on-site evaluation of touch imprints of biopsies improves the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy: a retrospective study.

Rapid on-site evaluation has long been used for transbronchial needle aspiration or fine-needle aspiration to evaluate the adequacy of biopsy materials for the diagnosis of peripheral lung lesions. However, research on rapid on-site evaluation combined with transbronchial forceps biopsy in the diagnosis of lung carcinoma is rarely reported. Therefore, we aimed to investigate the value of rapid on-site evaluation during transbronchial forceps biopsy for endoscopically visible (tumor, infiltrative and necrotic) or nonvisible (compressive, nonspecific and normal) malignancy. A retrospective analysis was performed between January 2015 and January 2019 in Taihe Hospital with 1216 lung cancer patients who underwent bronchoscopy procedures, and these patients were allocated into the rapid on-site evaluation group and non-rapid on-site evaluation group, depending on the timing of the procedure. According to endoscopic features, bronchoscopic appearance was described as endoscopically visible malignancy (tumor, infiltrative and necrotic) and endoscopically nonvisible malignancy (compressive, nonspecific and normal). The diagnostic yield was compared, and the concordance between the rapid on-site evaluation results and the final histology was analyzed. There was a statistically significant difference in the diagnostic yield between the rapid on-site evaluation and non-rapid on-site evaluation groups for endoscopically nonvisible malignancy (74.3% vs. 51.7%, P<0.05). However, we found no significant improvement in terms of diagnostic yield for endoscopically visible malignancy (95.2% vs. 91.2%, P>0.05). The rapid on-site evaluation results showed high-level concordance with histology in the diagnosis of squamous cell carcinoma, adenocarcinoma and small cell carcinoma, with kappa values of 0.749 (P<0.05), 0.728 (P<0.05) and 0.940 (P<0.05), respectively. The findings demonstrated that the diagnostic yield of transbronchial biopsy for endoscopically nonvisible malignancy (compressive, nonspecific and normal) was significantly improved when rapid on-site evaluation was implemented. In addition, the rapid on-site evaluation results had high-level concordance with the final histological diagnosis.

An -valued index of symmetry-protected topological phases with on-site finite group symmetry for two-dimensional quantum spin systems

AbstractWe consider symmetry-protected topological phases with on-site finite groupGsymmetry$\beta $for two-dimensional quantum spin systems. We show that they have$H^{3}(G,{\mathbb T})$-valued invariant.

An Unconventional Interviewing Process at an Academic Library

Confronted with two faculty vacancies to fill and a desire to minimize burnout among the remaining library staff throughout the search process, the Eccles Health Sciences Library at the University of Utah employed an interview method seldom utilized in academic libraries. The library's search committee arranged on-site group interviews that hosted multiple candidates simultaneously. Careful scheduling ensured that each candidate received sufficient individual attention and assessment, while also enabling the committee to evaluate the group dynamics and interpersonal skills of the applicants.

Barriers, facilitators, and solutions to familial hypercholesterolemia treatment.

BackgroundFamilial hypercholesterolemia (FH) is an inherited lipid disorder that confers high risk for premature cardiovascular disease but remains undertreated. Causes are multifactorial and multilevel, ranging from underprescribing (at the clinician-level) to medication nonadherence (at the patient-level). We evaluated patient and clinician stakeholder barriers and facilitators for treatment of FH to explore possible solutions to the problem.Methods and resultsSemi-structured interviews and focus groups guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), were conducted with 33 patients and 17 clinician stakeholders across three healthcare systems. A total of14 patients and 9 clinician stakeholders participated in on-site focus groups and the remainder were individual interviews. Transcripts were coded using an iterative process to create a static codebook. We characterized patient and clinician stakeholder barriers into three categories: medical care-, medication-, and life-related. Feasibility of brainstormed solutions varied and was not always representative of the needs of all stakeholders. Patients suggested a need for childhood screening for FH and doctors being persistent about the importance of treating FH, creation of a patient peer group, data transparency, advocacy, and policy changes that would enable patients to receive better treatment. Clinician stakeholders suggested the need for clinical champions. Both groups of stakeholders discussed the need for education about FH.ConclusionsProposed solutions to improve treatment of FH proffered by participants in this study included resources for both patients and clinician stakeholders that clarify cardiovascular disease risks from FH, develop programs to screen for and identify FH at younger ages, and foster open conversations between patients and clinicians about treatment.

Establishment of an outreach, grouping healthcare system to achieve microelimination of HCV for uremic patients in haemodialysis centres (ERASE-C)

ObjectiveHCV prevails in uremic haemodialysis patients. The current study aimed to achieve HCV microelimination in haemodialysis centres through a comprehensive outreach programme.DesignThe ERASE-C Campaign is an outreach programme for the...

Disorder-protected quantum state transmission through helical coupled-resonator waveguides

We predict the preservation of temporal indistinguishability of photons propagating through helical coupled-resonator optical waveguides (H-CROWs). H-CROWs exhibit a pseudospin-momentum locked dispersion, which we show suppresses on-site disorder-induced backscattering and group velocity fluctuations. We simulate numerically the propagation of two-photon wave packets, demonstrating that they exhibit almost perfect Hong–Ou–Mandel dip visibility and then can preserve their quantum coherence even in the presence of moderate disorder, in contrast with regular CROWs, which are highly sensitive to disorder. As indistinguishability is the most fundamental resource of quantum information processing, H-CROWs may find applications for the implementation of robust optical links and delay lines in the emerging quantum photonic communication and computational platforms.

Validity and Reliability of Methods for Sonography Education in Physiotherapy: Onsite vs. Online

Background: in physiotherapy, the interest in sonography education has been increasing in recent decades, giving rise to opportunities in education in an attempt to meet the elevated demand. In other health professions, online education has demonstrated to be of interest, and another possibility by which to obtain knowledge. Methods: this exploratory observational prospective study compared the outcomes between onsite versus online education, and was approved by the ethics committee of the Francisco de Vitoria University. Two groups (onsite and online) with 136 attendants and two levels for each (basic and advanced) received the same content but through different presentations. Theoretical exams were conducted via “Kahoot” and practical exams using phantoms, and the results were subject to statistical analyses. Results: the average age of onsite participants was 29.5 (25–35.25) years and 34 (28.5–40.5) for the online participants, with a higher percentage of women. The average score ranks in the Kahoot_basic test were higher for both online groups corresponding to basic (group 1) and advanced (group 2) levels: 7 (6.5, 7.5) for group 1 and 7 (6.5, 8.5) for group 2 vs. the onsite groups: 6 (5.5, 7) for group 1 and 6 (5, 6.5) for group 2. In the practical exam, the model detected that a small negative difference between the Onsite 2 group and the total effect (−1.23148, SE = 0.43687) was significant (t = −2.819, p = 0.00558) with a low effect size (R2adjusted = 0.025) for the measurements of the hollow structure; the difference between the Online 2 and Onsite 1 group was positive (1.5026, SE = 0.5822) and significant (t = 2.5809, p = 0.0113), with a low effect size (R2adjusted = 0.016) for the solid structure depth measurement. Conclusions: the results showed that there could be an opportunity to access sonography knowledge through online education in physical therapy compared to the traditional onsite model. These conclusions support the use of a low-cost and accessible method for ultrasound education.

Clinical Outcomes of On-Site Versus Off-Site Endovascular Stroke Interventions

ObjectivesThe aim of this study was to assess whether offering local endovascular stroke therapy (EST) rather than transferring patients off-site to receive EST would improve outcomes. BackgroundThere are limited data to determine whether offering EST on-site rather than transferring patients to receive EST off-site improves clinical outcomes. MethodsA large academic consortium database was queried to identify patients with acute ischemic stroke who received EST between October 2015 and September 2019. Primary endpoints were in-hospital mortality and poor functional outcomes. Secondary endpoints were major complications, length of stay, and cost. Baseline characteristics were adjusted for using propensity score matching and multivariate risk adjustment. ResultsA total of 22,193 patients with acute ischemic stroke who underwent EST (50.8% on-site, 49.2% off-site) were included. Mean ages were 67.9 ± 15.5 years and 68.4 ± 15.5 years, respectively (p = 0.03). In the propensity score matching analysis, mortality and poor functional outcomes were higher in the off-site EST group (14.7% vs. 11.2% and 40.7% vs. 35.9%, respectively; p < 0.001). In the risk-adjusted analyses with different models, in-hospital mortality and poor functional outcomes remained significantly higher in the off-site EST group. In the most comprehensive model (adjusting for age, sex, demographics, risk factors, tissue plasminogen activator use, and institutional EST volume), in-hospital mortality and poor functional outcomes were significantly higher in the off-site EST group, with odds ratios of 1.38 (95% confidence interval: 1.26 to 1.51) and 1.26 (95% confidence interval: 1.18 to 1.34), respectively (p < 0.001). The incidence of intracranial hemorrhage and mechanical ventilation was higher in the off-site group, but cost was higher in the on-site group in both the propensity score matching and risk-adjusted analyses. ConclusionsIn contemporary U.S. practice, patients with acute ischemic stroke treated with EST on-site had lower in-hospital mortality and better functional outcomes compared with those transferred off-site for EST.