Participant Feedback Research Articles

Efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT) in Individuals With Chronic Pain and Opioid Use Disorder: Protocol for a Randomized Clinical Trial of a Digital Cognitive Behavioral Treatment.

Chronic pain is common among individuals with opioid use disorder (OUD) who are maintained on medications for OUD (MOUD; eg, buprenorphine or methadone). Chronic pain is associated with worse retention and higher levels of substance use. Treatment of individuals with chronic pain receiving MOUD can be challenging due to their increased clinical complexity. Given the acute and growing nature of the opioid crisis, MOUD is increasingly offered in a wide range of settings, where high-quality, clinician-delivered, empirically validated behavioral treatment for chronic pain may not be available. Therefore, digital treatments that support patient self-management of chronic pain and OUD have the potential for wider implementation to fill this gap. This study aims to evaluate the efficacy of Integrating the Management of Pain and Addiction via Collaborative Treatment (IMPACT), an interactive digital treatment program with asynchronous coach feedback, compared to treatment as usual (TAU) in individuals with chronic pain and OUD receiving MOUD. Adult participants (n=160) receiving MOUD and reporting bothersome or high-impact chronic pain will be recruited from outpatient opioid treatment programs in Connecticut (United States) and randomized 1:1 to either IMPACT+TAU or TAU only. Participants randomized to IMPACT+TAU will complete an interactive digital treatment that includes 9 modules promoting training in pain and addiction coping skills and a progressive walking program. The program is augmented with a weekly personalized voice message from a trained coach based on daily participant-reported pain intensity and interference, craving to use opioids, sleep quality, daily steps, pain self-efficacy, MOUD adherence, and engagement with IMPACT collected through digital surveys. Outcomes will be assessed at 3, 6, and 9 months post randomization. The primary outcome is MOUD retention at 3 months post randomization (ie, post treatment). Secondary outcomes include pain interference, physical functioning, MOUD adherence, substance use, craving, pain intensity, sleep disturbance, pain catastrophizing, and pain self-efficacy. Semistructured qualitative interviews with study participants (n=34) randomized to IMPACT (completers and noncompleters) will be conducted to evaluate the usability and quality of the program and its outcomes. The study has received institutional review board approval and began recruitment at 1 site in July 2022. Recruitment at a second site started in January 2023, with a third and final site anticipated to begin recruitment in January 2024. Data collection is expected to continue through June 2025. Establishing efficacy for a digital treatment for addiction and chronic pain that can be integrated into MOUD clinics will provide options for individuals with OUD, which reduce barriers to behavioral treatment. Participant feedback on the intervention will inform updates or modifications to improve engagement and efficacy. ClinicalTrials.gov NCT05204576; https://clinicaltrials.gov/ct2/show/NCT05204576. DERR1-10.2196/54342.

Augmented-reality-assisted intraoral scanning: A proof-of-concept study.

The aims of the present study were (a) to compare the scanning time and image count to complete optical scans of a typodont between augmented-reality-assisted intraoral scanning (ARIOS) and intraoral scanning (IOS); (b) to compare the accuracy of the digital casts derived from ARIOS and IOS; (c) to compare participant-related outcomes between ARIOS and IOS. A multi-session within-subject experiment was conducted to compare ARIOS and IOS. Thirty-one dental students participated in the study. Following a trial session, each participant obtained optical scans under ARIOS and IOS conditions. The time required to complete the scan, and the number of images taken were recorded. Participant feedback was collected using entry, exit, and NASA-Task Load Index (TLX) surveys. The accuracy of the digital casts derived from the optical scans was measured in root mean square error (RMSE). The present study found a 6.8% increase in preference for ARIOS from entry to exit survey. Slightly more participants favored the ARIOS setup compared to IOS; 54.8% of participants favored ARIOS, 9.7% were indifferent, and 35.5% favored IOS. NASA-TLX subscale ratings were higher for IOS in general apart from mental demand. The accuracy of the digital casts between ARIOS and IOS was comparable in RMSE. ARIOS was advantageous compared to IOS in ergonomics, improved scanner tracking, and ease of scanner orientation. However additional trials, increased field of view, and better superimposition of scanning status to the target site were improvements desired by the study participants.

Meta-emotion therapy for complex trauma and binge eating: A case study.

There is a lack of evidence guiding treatment guidelines for individuals with comorbid complex posttraumatic stress disorder (C-PTSD) and binge eating disorder (BED). The article aims to present preliminary evidence to support the proof of concept of novel therapy termed meta-emotion therapy (MET) that targeted maladaptive beliefs about emotions, for this specific comorbidity. The single case study design involved a 35-year-old woman with a comorbid diagnosis of C-PTSD and BED, stemming from a history of childhood maltreatment, receiving 14 sessions of MET. Outcome measures related to PTSD symptoms, posttraumatic cognitions, BED cognitions and behavior, distress, and negative beliefs about emotions were assessed at initial assessment (baseline), pretreatment, posttreatment, and 1-month follow-up. The participant had a reliable and significant decrease in PTSD symptoms, posttraumatic cognitions, disordered eating symptoms, distress, and negative beliefs about emotions at posttreatment. Participant feedback supported the positive perception of the treatment. The findings of this study provide promising evidence to support the potential effectiveness of MET as an intervention for adults with comorbid C-PTSD and BED. Further research in the form of larger intervention trials is warranted to investigate the efficacy and long-term outcomes of MET in this population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Generating user-driven patient personas to support preventive health care activities of rural-living unattached patients

ObjectiveThis study created personas using quantitative segmentation and knowledge user enhancement to inform intervention and service design for rural patients to encourage preventive care uptake. MethodsThis study comprised a cross-sectional survey of rural unattached patients and a co-design workshop for persona development. Cross-sectional survey data were analyzed for meaningful subgroups based on quartiles of preventive care completion. These quartiles informed “relevant user segments” grouped according to demographics (age, sex), length of unattachment, percentage of up-to-date preventive activities, health care visit frequency, preventive priorities, communication confidence with providers, and chronic health conditions, which were then used in the workshop to build the final personas. Results207 responses informed persona user segments, and five health care providers and 13 patients attended the workshop. The resulting four personas, included John (not up-to-date on preventive care activities), Terrance (few up-to-date preventive care activities), George (moderately up-to-date preventive care activities), and Anne (mostly up-to-date preventive care activities). ConclusionQuantitative persona development with integrated knowledge user co-design/enhancement elevated and enriched final personas that achieved robust profiles for intervention design. InnovationThis project's use of a progressive methodology to build robust personas coupled with participant feedback on the co-design process offers a replicable approach for health researchers.

Longitudinal Exploration of Strategies Advancing Continuing Professional Pharmacy Education in a Major University: an in- Depth Study on Impact

Background: In the dynamic healthcare landscape, pharmacists contend with the challenge of staying current with evolving knowledge. Continuing Pharmacy Education (CPE) programs, play a pivotal role in addressing this need. This study focuses on a six-year evaluation of CPE programs at a College of Pharmacy, aiming to assess the impact of a multifaceted approach on various educational outcomes. Materials and Methods: The University College of Pharmacy Office of Continuing Professional Education implemented a multifaceted approach from 2017 to 2022. Changes included hiring a full-time coordinator, offering on-site and online programs, establishing partnerships, identifying knowledge gap through surveying participants, and enhancing digital presence beyond others. Data from this period were compared with the preceding six years (2010 2016). Evaluation metrics covered attendee the number and diversity, program growth, and professional impact. Results: The study showcased significant improvements in various aspects of CPE programs. Pharmacist attendees increased by 816.67%, with a notable rise in non-pharmacy participants. Geographical distribution saw a surge in out-of-state and international participants. Program content witnesseda shift towardsinfectious diseases and pain management. The number of CPE programsand awarded hours experienced a fivefold increase, reflecting a commitment to a diverse curriculum. Participant feedback consistently indicated high satisfaction with knowledge enhancement, applicability, and program usefulness. Conclusion: Over the six-year period,the evaluation revealedsubstantial advancements in our CPE programs. Increased pharmacist attendance, diversified participant engagement, and expandedgeographical reach underscored the program's success.The exponential growth in program offerings reflected a commitment to diverse and extensive education. Positive participant feedback, indicating sustained impact on drug therapy management, patient safety, and public health outcomes, affirmedthe enduring effectiveness of the CPE programs. While acknowledging study limitations, this comprehensive analysis highlights the success and ongoing efforts to enhance CPE programs at major university. Future research should address these constraints for a more nuanced understanding of CPE program impact.

Tree plantation for implementing the land utilization policies incorporate with sustainable development towards environmental concerns in Assam, India

Environmental scientists have been considering the best use of natural resources in recent years, and in order to maintain sustainability, the government can no longer manage these resources alone without the support of the local people. The study aimed to assess the effectiveness of tree plantations in the hillsides and wasteland for addressing sustainable environmental considerations and providing a framework for implementing land utilization policies incorporated with sustainable developmental work towards environmental concerns and priorities. In this continuous and progressive-centered participatory research, 300 participants voluntarily joined in two stages of fieldwork, planted 300 saplings, and nurtured them for approximately four years. Because of the tropical monsoon, the mountain climate with high temperatures, frequent heavy rains, and high humidity, as well as the ongoing efforts of the local peoples to care for the agro-forestry saplings, this tree plantation operation in the hillsides and wasteland was successful. The locals continued to care for the saplings even after the project was completed in order to find both immediate and long-term financial benefits. Nonetheless, participant feedback was gathered, and the skewed median centered data was analyzed using the non-parametric Mann-Whitney U-test to evaluate the working hypotheses. The findings showed that there were no significant differences in the opinion of the participants' with planting trees or their comprehension of using human potential for sustainable farming, land readjustment, and food management. It concluded that tree plantation could provide a framework for implementing land utilization policies to incorporate sustainable development towards environmental concerns and priorities in Assam, India.

Accelerating P300-based neurofeedback training for attention enhancement using iterative learning control: a randomised controlled trial

Objective. Neurofeedback (NFB) training through brain–computer interfacing has demonstrated efficacy in treating neurological deficits and diseases, and enhancing cognitive abilities in healthy individuals. It was previously shown that event-related potential (ERP)-based NFB training using a P300 speller can improve attention in healthy adults by incrementally increasing the difficulty of the spelling task. This study aims to assess the impact of task difficulty adaptation on ERP-based attention training in healthy adults. To achieve this, we introduce a novel adaptation employing iterative learning control (ILC) and compare it against an existing method and a control group with random task difficulty variation. Approach. The study involved 45 healthy participants in a single-blind, three-arm randomised controlled trial. Each group underwent one NFB training session, using different methods to adapt task difficulty in a P300 spelling task: two groups with personalised difficulty adjustments (our proposed ILC and an existing approach) and one group with random difficulty. Cognitive performance was evaluated before and after the training session using a visual spatial attention task and we gathered participant feedback through questionnaires. Main results. All groups demonstrated a significant performance improvement in the spatial attention task post-training, with an average increase of 12.63%. Notably, the group using the proposed iterative learning controller achieved a 22% increase in P300 amplitude during training and a 17% reduction in post-training alpha power, all while significantly accelerating the training process compared to other groups. Significance. Our results suggest that ERP-based NFB training using a P300 speller effectively enhances attention in healthy adults, with significant improvements observed after a single session. Personalised task difficulty adaptation using ILC not only accelerates the training but also enhances ERPs during the training. Accelerating NFB training, while maintaining its effectiveness, is vital for its acceptability by both end-users and clinicians.

When a test is more than just a test: Findings from patient interviews and survey in the trial of a technology to measure antidepressant medication response (the PReDicT Trial)

BackgroundA RCT of a novel intervention to detect antidepressant medication response (the PReDicT Test) took place in five European countries, accompanied by a nested study of its acceptability and implementation presented here. The RCT results indicated no effect of the intervention on depression at 8 weeks (primary outcome), although effects on anxiety at 8 weeks and functioning at 24 weeks were found. MethodsThe nested study used mixed methods. The aim was to explore patient experiences of the Test including acceptability and implementation, to inform its use within care. A bespoke survey was completed by trial participants in five countries (n = 778) at week 8. Semi-structured interviews were carried out in two countries soon after week 8 (UK n = 22, Germany n = 20). Quantitative data was analysed descriptively; for qualitative data, thematic analysis was carried out using a framework approach. Results of the two datasets were interrogated together. OutcomesSurvey results showed the intervention was well received, with a majority of participants indicating they would use it again, and it gave them helpful extra information; a small minority indicated the Test made them feel worse. Qualitative data showed the Test had unexpected properties, including: instigating a process of reflection, giving participants feedback on progress and new understanding about their illness, and making participants feel supported and more engaged in treatment. InterpretationThe qualitative and quantitative results are generally consistent. The Test's unexpected properties may explain why the RCT showed little effect, as properties were experienced across both trial arms. Beyond the RCT, the qualitative data sheds light on measurement reactivity, i.e., how measurements of depression can impact patients.

Co-evolutionary dynamics in optimal multi-agent game with environment feedback

At present, game-based analysis and control problems with environmental feedback significantly contribute to the study of collective cooperation, and pose great challenges for the analysis of multi-agent game systems in complex real world. We consider co-evolutionary dynamics based on an extended multi-agent game with environmental feedback, which is modeled by optional public goods games (OPGGs). Firstly, the co-evolutionary dynamics of OPGGs with environment feedback can be modeled as two parts: the dynamics of OPGGs and synergy coefficient, where the former can represent the group game behavior of three strategies, and the latter can be seen as the evolutionary behavior in changing environments. Subsequently, some possible fixed points will emerge with respect to three types of boundaries for these co-evolutionary dynamics, and the existence and stability for the corresponding boundary fixed points are determined and analyzed. Meanwhile, the results are further extended to interior equilibrium point. It is observed that by combining voluntary participation and environment feedback, cooperation behavior can be still feasible, and the evolving system can oscillatingly converge to the persistent cooperation under some certain threshold conditions. Finally, an example is illustrated to validate the proposed approach. To sum up, environmental feedback mechanism provides a novel perspective to investigate the collective cooperation in a changing world.

Validating the efficacy and value proposition of mental fitness vocal biomarkers in a psychiatric population: prospective cohort study.

The utility of vocal biomarkers for mental health assessment has gained increasing attention. This study aims to further this line of research by introducing a novel vocal scoring system designed to provide mental fitness tracking insights to users in real-world settings. A prospective cohort study with 104 outpatient psychiatric participants was conducted to validate the "Mental Fitness Vocal Biomarker" (MFVB) score. The MFVB score was derived from eight vocal features, selected based on literature review. Participants' mental health symptom severity was assessed using the M3 Checklist, which serves as a transdiagnostic tool for measuring depression, anxiety, post-traumatic stress disorder, and bipolar symptoms. The MFVB demonstrated an ability to stratify individuals by their risk of elevated mental health symptom severity. Continuous observation enhanced the MFVB's efficacy, with risk ratios improving from 1.53 (1.09-2.14, p=0.0138) for single 30-second voice samples to 2.00 (1.21-3.30, p=0.0068) for data aggregated over two weeks. A higher risk ratio of 8.50 (2.31-31.25, p=0.0013) was observed in participants who used the MFVB 5-6 times per week, underscoring the utility of frequent and continuous observation. Participant feedback confirmed the user-friendliness of the application and its perceived benefits. The MFVB is a promising tool for objective mental health tracking in real-world conditions, with potential to be a cost-effective, scalable, and privacy-preserving adjunct to traditional psychiatric assessments. User feedback suggests that vocal biomarkers can offer personalized insights and support clinical therapy and other beneficial activities that are associated with improved mental health risks and outcomes.

35 Louisiana cattle pregnancy determination clinic aims to improve reproductive efficiency

Abstract The Cattle Pregnancy Determination Clinic is a 1-d program aimed at teaching multiple methods of pregnancy determination to assist producers in effectively making keep/cull decisions and improving reproductive efficiency of their herd. This program began in 2019 after repeated requests for the inclusion of pregnancy determination techniques as a component of an annual Artificial Insemination School. Development of this program held one significant regulatory challenge. According to the Louisiana Veterinary Practice Act [La. R.S. 37:1511-1558], the use of any manual or mechanical procedure for pregnancy determination is considered to be a medical diagnosis. While producers do not have the right to diagnose the pregnancy status of other producers’ cattle, they can do so on their own cattle. To enforce these regulations, two essential components were integrated into the program: two local large animal veterinarians served as primary instructors, and each participant signs an acknowledgement form stating they understand the regulations within the Louisiana Veterinary Practice Act. Management practices are taught by blending classroom learning and hands-on practice. The classroom portion of the syllabus includes an introduction to female anatomy, explanations of how to determine pregnancy through rectal palpation and blood testing, and a brief overview of herd health and nutritional management. The outdoor portion affords participants the opportunity to rectally palpate open cows and cattle in all stages of pregnancy, collect blood via coccygeal venipuncture, and view ultrasound demonstrations. Ten clinics, two annually, have resulted in 123 participants completing the Cattle Pregnancy Determination Clinic. Space limitations restrict enrollment to 15 participants. At the conclusion of the program, participants were asked to complete an evaluation reviewing their experience, and an average completion rate of 94.25% was seen over the 5-yr period. When asked to rate overall impression of the clinic on a scale of 1 to 10 (1 = poor and 10 = great), 77.6% responded “10,” 21% responded “9,” 1% responded "8,” and less than 1% responded "7.” When asked to rate their likelihood of implementing pregnancy determination in their herd (1 = not likely and 10 = very likely), 83% responded “10,” 3.5% responded “9,” 5.5% responded "8,” and 8% responded "7.” When asked which portion of the program was most beneficial, a majority of responses were reflective of this selected comment, “The hands-on part only because it tied into the classroom part and made a better understanding.” The only responses on topics of no benefit included one regarding the nutrition portion, and one saying blood collection because they already had that knowledge. Inclusion of a chute-side pregnancy test demonstration and more information on herd health have been requested for future clinics. Participant feedback and continued requests for enrollment illustrate a demand for the continuation of this program.

Evaluating a research methodology workshop among postgraduate students using Kirkpatrick's model.

In this era of evidence-based medicine, only systematic research can help in providing judicious and precise healthcare to individual patients based on updated knowledge and skills. However, many medical professionals do not feel competent and confident enough to conduct research. One of the reasons could be the lack of a research-based curriculum in undergraduate courses. The National Medical Council has also stressed the need for formal training in research methodology for healthcare professionals. The research methodology workshops help to familiarize the participants with basic, clinical, and translational research required to impart optimum patient care. The objective of our study was to evaluate a research methodology workshop conducted for postgraduate students by assessing the participant's knowledge, feedback, and expected impact using Kirkpatrick's evaluation model. A quasi-experimental, single-group study was conducted among 132 first-year postgraduate students. The four levels of Kirkpatrick's model were applied for evaluation. Feedback forms, scores of the pretest and posttest, quality of the research proposal drafted by the postgraduates for their thesis, and finally successful submission of the research proposal were the components used to evaluate the four levels of outcome of Kirkpatrick's model. Data collected were compiled and tabulated into MS Excel. Proportions were calculated for categorical variables and mean and standard deviation (SD) for scores. A comparison of means between pre- and postworkshop scores was made with paired t-test. A value of P < 0.05 was considered statistically significant. Statistical analysis was done using IBM SPSS Statistics version 20.0 software. Out of 132 participants, 29% (38) were males and 71% (94) were females. The mean ± SD pretest and posttest scores at a 95% confidence interval were 10.55 ± 2.537 and 12.43 ± 2.484, respectively. The difference was found to be statistically significant by paired sample t-test (P < 0.001). Participant feedback is vital for improving research methodology workshops. The workshop met the overall requirements of the participants. There was a significant improvement in the knowledge of participants after the workshop completion.

Diabetes care in the pandemic era in the Midwestern USA: a semi-structured interview study of the patient perspective

ObjectivesTo understand patients’ experiences with diabetes care during the COVID-19 pandemic, with an emphasis on rural, medically underserved, and/or minoritised racial and ethnic groups in the Midwestern USA.DesignCommunity-engaged, semi-structured interviews...

Creation of a Virtual Reality Telesimulation Program in Response to Mandatory COVID-19 Social Distancing During the Pandemic: A Primer for Those considering VR Simulation and Application to a Group of Physicians Naive to Virtual Reality.

The COVID-19 pandemic necessitated the closure of traditional simulation centers, prompting innovative solutions for medical education. Drawing from prior studies, which advocated for telesimulation and virtual reality (VR) as alternatives, this article explores the development and implementation of VR simulation in medical training. Leveraging the Acadicus® VR platform, a VR simulation solution was created, enabling interactive scenarios simulating pediatric critical care situations. Thirty-one diverse scenarios were designed and executed over an 8-month period, involving pediatric and emergency medicine residents and fellows. The development process involved creating lifelike mannequins and dynamic cardiac waveforms, enhancing realism and spontaneity. Using VR headsets and streaming technology, participants engaged in immersive scenarios remotely. Performance evaluation used a modified version of the Tool for Resuscitation Assessment Using Computer Simulation, revealing comparable outcomes across different training levels and specialties. Participant feedback underscored the immersive nature of VR simulation, offering enhanced realism and in-depth debriefing opportunities compared with traditional mannequin-based simulation. However, limitations such as the lack of haptic feedback and the need for better integration with existing simulation center infrastructure were noted. Cost-effectiveness emerged as a significant advantage of VR simulation, with lower upfront costs compared with traditional simulation centers. VR simulation also demonstrated versatility in staging training across various hospital settings, offering a more comprehensive learning experience. Although acknowledging the need for further research to measure skill acquisition and retention, this study highlights the potential of VR simulation as an adjunctive modality in medical education.

Mapping the SMEEA Gaokao tests to the CEFR

This paper reports on a project where the Shanghai Municipal Educational Examinations Authority (SMEEA) engaged Cambridge University Press and Assessment (Cambridge) to begin the alignment process of their six foreign language tests to the Common European Framework of Reference (CEFR) (Council of Europe, 2001, 2020). These six language tests are developed by SMEEA and form part of China’s National College Entrance Examination system. They are referred to as China’s National College Entrance Examination (Shanghai Paper), or the Shanghai Gaokao. This project was undertaken to enable a comparison of the relative difficulty of each language version of the Shanghai Gaokao, in terms of the CEFR. Additional project aims were to carry out training in the CEFR and in CEFR mapping procedures, using a blend of online delivery and a cascaded training model. This project took place between September 2021 and January 2022, involving a series of linked training and mapping activities and workshops. In this paper the focus is on the practical aspects of a computer mediated CEFR mapping project, on our reflections and recommendations, and on the participant feedback. Some outcomes are included which are directly related to the CEFR, but not any outcomes which are confidential.

Engaging African American Faith Leaders as Partners in Ethical Research

This paper outlines an initiative to adapt the Community Partnered Research Ethics Training (CPRET) for the cultural context of the CHURCH (Congregation as Healers Uniting to Restore Community Health) project. The CHURCH project is a community-partnered participatory research project that seeks to promote the mental well-being of African American populations by developing, implementing, and evaluating a mental health training curriculum for faith leaders in Black churches. Participatory research, in which community stakeholders collaborate with researchers as equal partners to address problems impacting marginalized communities, has recently become more popular in academia. Training is necessary to equip community partners with the skills and knowledge required for full research participation. Community partners frequently encounter ethical issues in participatory research, but limited training resources are available to proactively prevent and address such issues. The CPRET was developed through a collaboration between the Clinical and Translational Science Institute and the Human Research Protection Office and Community Research Advisory Board at the University of Pittsburgh. It surveys research processes and core research ethics principles, and it stimulates discussion regarding best practices by engaging participants in scenario-based exercises in which they identify ethical and unethical research. By describing how we utilized the CPRET in the CHURCH project and presenting a summary of participant feedback, we aim to build resources for community-engaged scholars seeking to engage community members in ethical research.

Cost-benefit ratio of modern medical education using micro-costing: amodel calculation using the example of an innovative breast brachytherapy workshop.

Radiation oncology is an essential component of therapeutic oncology and necessitates well-trained personnel. Multicatheter brachytherapy (MCBT) is one radiotherapeutic option for early-stage breast cancer treatment. However, specialized hands-on training for MCBT is not currently included in the curriculum for residents. Arecently developed hands-on brachytherapy workshop has demonstrated promising results in enhancing knowledge and practical skills. Nevertheless, these simulation-based teaching formats necessitate more time and financial resources. Our analyses include computational models for the implementation and delivery of this workshop and can serve as abasis for similar educational initiatives. This study aimed to assess the cost-effectiveness of apreviously developed and evaluated breast brachytherapy simulation workshop. Using amicro-costing approach, we estimated costs at adetailed level by considering supplies, soft- and hardware, and personnel time for each task. This method also allows for acomprehensive evaluation of the costs associated with implementing new medical techniques. The workshop costs were divided into two categories: development and workshop execution. The cost analysis was conducted on aper-participant basis, and the impact on knowledge improvement was measured using aquestionnaire. The total workshop costs were determined by considering the initial workshop setup expenses including the development and conceptualization of the course with all involved collaborators, as well as the costs incurred for each individual course. The workshop was found to be financially efficient, with aper-participant cost of € 39, considering the industrial sponsorship provided for brachytherapy equipment. In addition, we assessed the workshop's efficacy by analyzing participant feedback using Likert scale evaluations. The findings indicated anotable enhancement in both theoretical and practical skills among the participants. Moreover, the cost-to-benefit ratio (CBFR) analysis demonstrated aCBFR of € 13.53 for each Likert point increment. The hands-on brachytherapy workshop proved to be avaluable and approximately cost-effective educational program, leading to asignificant enhancement in the knowledge and skills of the participants. Without the support of industrial sponsorship, the costs would have been unattainable.

Beyond the participant-researcher division: co-creating ethical relationships through care and rapport in studies of post-laryngectomy communication

This article presents the ethical implications for social science research emerging from our study on interpersonal communication after a laryngectomy. By tracing the evolution of our approach through specific research experiences and participant feedback, we provide empirical support for a flexible, multidimensional, and relational understanding of key ethical concepts, such as vulnerability and the researcher-participant relationship. Our approach has shifted from institutionally imposed rigid categorizations and somewhat stereotypical treatment of both the research group and the researcher-participant relationship to an emphasis on building relationships founded on mutual care and rapport. We argue that this revised perspective fosters ethical collaboration that is beneficial and secure for all parties involved, and we offer practical examples of its implementation in research practice.

A preoperative package of care for osteoarthritis, consisting of weight loss, orthotics, rehabilitation, and topical and oral analgesia (OPPORTUNITY): a two-centre, open-label, randomised controlled feasibility trial

Osteoarthritis of the knee is a major cause of disability worldwide. Non-operative treatments can reduce the morbidity but adherence is poor. We hypothesised that adherence could be optimised if behavioural change was established in the preoperative period. Therefore, we aimed to assess feasibility, acceptability, and recruitment and retention rates of a preoperative package of non-operative care in patients awaiting knee replacement surgery. We did an open-label, randomised controlled, feasibility trial in two secondary care centres in the UK. Eligible participants were aged 15-85 years, on the waiting list for a knee arthroplasty for osteoarthritis, and met at least one of the thresholds for one of the four components of the preoperative package of non-operative care intervention (ie, weight loss, exercise therapy, use of insoles, and analgesia adjustment). Participants were randomly assigned (2:1) to either the intervention group or the standard of care (ie, control) group. All four aspects of the intervention were delivered weekly over 12 weeks. Participants in the intervention group were reviewed regularly to assess adherence. The primary outcome was acceptability and feasibility of delivering the intervention, as measured by recruitment rate, retention rate at follow-up review after planned surgery, health-related quality of life, joint-specific scores, and adherence (weight change and qualitative interviews). This study is registered with ISRCTN, ISRCTN96684272. Between Sept 3 2018, and Aug 30, 2019, we screened 233 patients, of whom 163 (73%) were excluded and 60 (27%) were randomly assigned to either the intervention group (n=40) or the control group (n=20). 34 (57%) of 60 participants were women, 26 (43%) were men, and the mean age was 66·8 years (SD 8·6). Uptake of the specific intervention components varied: 31 (78%) of 40 had exercise therapy, 28 (70%) weight loss, 22 (55%) analgesia adjustment, and insoles (18 [45%]). Overall median adherence was 94% (IQR 79·5-100). At the final review, the intervention group lost a mean of 11·2 kg (SD 5·6) compared with 1·3 kg (3·8) in the control group (estimated difference -9·8 kg [95% CI -13·4 to -6·3]). A clinically significant improvement in health-related quality o life (mean change 0·078 [SD 0·195]) were reported, and joint-specific scores showed greater improvement in the intervention group than in the control group. No adverse events attributable to the intervention occurred. Participants adhered well to the non-operative interventions and their health-related quality of life improved. Participant and health professional feedback were extremely positive. These findings support progression to a full-scale effectiveness trial. Versus Arthritis.

Development of a Cognitive Training Support Programme for prevention of dementia and cognitive decline in at-risk older adults.

Evidence for the beneficial effects of cognitive training on cognitive function and daily living activities is inconclusive. Variable study quality and design does not allow for robust comparisons/meta-analyses of different cognitive training programmes. Fairly low adherence to extended cognitive training interventions in clinical trials has been reported. The aim of further developing a Cognitive Training Support Programme (CTSP) is to supplement the Computerised Cognitive Training (CCT) intervention component of the multimodal Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), which is adapted to different cultural, regional and economic settings within the Word-Wide FINGERS (WW-FINGERS) Network. The main objectives are to improve adherence to cognitive training through a behaviour change framework and provide information about cognitive stimulation, social engagement and lifestyle risk factors for dementia. Six CTSP sessions were re-designed covering topics including (1) CCT instructions and tasks, (2) Cognitive domains: episodic memory, executive function and processing speed, (3) Successful ageing and compensatory strategies, (4) Cognitive stimulation and engagement, (5) Wellbeing factors affecting cognition (e.g., sleep and mood), (6) Sensory factors. Session content will be related to everyday life, with participant reflection and behaviour change techniques incorporated, e.g., strategies, goal-setting, active planning to enhance motivation, and adherence to the CCT and in relevant lifestyle changes. Through interactive presentations promoting brain health, the programme provides for personal reflection that may enhance capability, opportunity and motivation for behaviour change. This will support adherence to the CCT within multidomain intervention trials. Efficacy of the programme will be evaluated through participant feedback and adherence metrics.