Phone Screening Research Articles

Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study.

Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. DERR1-10.2196/52361.

Predictors of engagement in screening for a hepatitis C virus (HCV) treatment trial in a rural Appalachian community.

An HCV treatment trial was initiated in September 2019 to address the opioid/hepatitis C virus (HCV) syndemic in rural Kentucky. The focus of the current analysis is on participation in diagnostic screening for the trial. Initial eligibility (≥18 years of age, county resident) was established by phone followed by in-person HCV viremia testing. 900 rural residents met the inclusion criteria and comprised the analytic sample. Generalized linear models were specified to estimate the relative risk of non-attendance at the in-person visit determining HCV eligibility. Approximately one-quarter (22.1%) of scheduled participants were no-shows. People who inject drugs were no more likely than people not injecting drugs to be a no-show; however, participants ≤35 years of age were significantly less likely to attend. While the median time between phone screening and scheduled in-person screening was only 2 days, each additional day increased the odds of no-show by 3% (95% confidence interval: 2%-3%). Finally, unknown HCV status predicted no-show even after adjustment for age, gender, days between screenings and injection status. We found that drug injection did not predict no-show, further justifying expanded access to HCV treatment among people who inject drugs. Those 35 years and younger were more likely to no-show, suggesting that younger individuals may require targeted strategies for increasing testing and treatment uptake. Finally, streamlining the treatment cascade may also improve outcomes, as participants in the current study were more likely to attend if there were fewer days between phone screening and scheduled in-person screening.

Experience with a hybrid recruitment approach of patient-facing web portal screening and subsequent phone and medical record review for a neurosurgical intervention trial for chronic ischemic stroke disability (PISCES III)

BackgroundRecruitment of participants is the greatest risk to completion of most clinical trials, with 20–40% of trials failing to reach the targeted enrollment. This is particularly true of trials of central nervous system (CNS) therapies such as intervention for chronic stroke. The PISCES III trial was an invasive trial of stereotactically guided intracerebral injection of CTX0E03, a fetal derived neural stem cell line, in patients with chronic disability due to ischemic stroke. We report on the experience using a novel hybrid recruitment approach of a patient-facing portal to self-identify and perform an initial screen for general trial eligibility (tier 1), followed by phone screening and medical records review (tier 2) prior to a final in-person visit to confirm eligibility and consent.MethodsTwo tiers of screening were established: an initial screen of general eligibility using a patient-facing web portal (tier 1), followed by a more detailed screen that included phone survey and medical record review (tier 2). If potential participants passed the tier 2 screen, they were referred directly to visit 1 at a study site, where final in-person screening and consent were performed. Rates of screening were tracked during the period of trial recruitment and sources of referrals were noted.ResultsThe approach to screening and recruitment resulted in 6125 tier 1 screens, leading to 1121 referrals to tier 2. The tier 2 screening resulted in 224 medical record requests and identification of 86 qualifying participants for referral to sites. The study attained a viable recruitment rate of 6 enrolled per month prior to being disrupted by COVID 19.ConclusionsA tiered approach to eligibility screening using a hybrid of web-based portals to self-identify and screen for general eligibility followed by a more detailed phone and medical record review allowed the study to use fewer sites and reduce cost. Despite the difficult and narrow population of patients suffering moderate chronic disability from stroke, this strategy produced a viable recruitment rate for this invasive study of intracranially injected neural stem cells.Trial registrationClinicalTrials.gov Identifier: NCT03629275

Abstract NS5: Outcomes of Nursing Led Post-Stroke Anxiety and Depression Screening

Introduction: Post-stroke anxiety (PSA) is common, but underestimated and can be distressing during stroke recovery. Health systems may fail to provide screening and follow up for PSA. Methods: Stroke survivors between 10/2022-3/2023 received a phone call from an SCRN to assess anxiety and depression within 30-45 days of discharge using General Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) respectively. Two call attempts were made. Based on the GAD-7, scores of 1-4 (minimal), 5 and 9 (mild), 10 to 14 (moderate), and 15 to 21 were classified as severe. The patients were referred to depression care management (DCM) or psychiatry based on the severity score. Data were analyzed using R package. Results: Total of 269 patients were identified: 111 (41%) completed the phone screening. The demographics and patient characteristics of patients are shown in table 1. The NIHSS of patient who did not complete the survey was higher 5(IQR 2,13) vs 3 (IQR 1,6). Most patients who completed the survey were discharged home 92(83%) (±home health). The severity of GAD-7 and PHQ9 score correlated moderately (Pearson’s r=0.69; P=0.002). Evaluation of dichotomized GAD-7 anxiety scores (minimal/mild vs moderate/severe) showed patients’ age and NIHSS are negatively correlated with GAD-7 score (r=-0.18; P=0.002 and r=-0.10 P=0.1). Conclusion: PSA and depression screening after discharge in stroke survivors helps with early identification and treatment, and potentially improving the quality of life. Anxiety and depression scores correlated positively and were higher in younger patients and those with low NIHSS.

The Cascade of Care for Early Psychosis Detection in a College Counseling Center.

Programs for early detection of psychosis help identify individuals experiencing emerging psychosis and link them with appropriate services, thereby reducing the duration of untreated psychosis (DUP). The authors used the cascade-of-care framework to identify various care stages between screening and enrollment in coordinated specialty care (CSC) and to determine attrition at each stage, with the goal of identifying points in the referral process that may affect DUP. Project partners included a college counseling center and CSC program. All college students seeking mental health services at a counseling center between 2020 and 2022 (N=1,945) completed the Prodromal Questionnaire-Brief (PQ-B) at intake. Students who met the distress cutoff score were referred for a phone screening. Those who met criteria on the basis of this screening were referred for assessment and possible enrollment into CSC. Six stages in the cascade of care for early detection were identified. Of the students who completed the PQ-B as part of intake (stage 1), 547 (28%) met the PQ-B cutoff score (stage 2). Counselors referred 428 (78%) students who met the PQ-B cutoff score (stage 3), and 212 (50%) of these students completed the phone screening (stage 4). Seventy-two (34%) students completed a CSC eligibility assessment (stage 5), 21 (29%) of whom were enrolled in CSC (stage 6). The cascade-of-care framework helped conceptualize the flow within a program for early psychosis detection in order to identify stages that may contribute to lengthier DUP. Future research is warranted to better understand the factors that contribute to DUP at these stages.

Estudo comparativo da aplicação por telefone e presencial da entrevista de triagem por telefone de sintomas do espectro autista (PSI-TEA)

ABSTRACT Objective: Describe reliabilities evidence of the Phone Screening Interview (PSI), a telephone screening interview for autism spectrum disorder (ASD) symptoms, capable of investigating mild to moderate ASD symptoms. Moreover, the PSI also works for verbal and non-verbal children and is consistent with the DSM-5 diagnostic criteria. Methods: An interview was performed with sixty-eight parents of children between 2 and 15 years old attended by the Psychiatry Ambulatory of Santa Casa de Misericórdia do Rio de Janeiro through the PSI in person and by telephone. Results: No significant differences in comparison between averages of the total score of the face-to-face and telephone applications were observed. The agreement analysis between the items indicated three items with lower values, leading to the modification of some questions, culminating in a new interview version for further studies. Given the disagreement in the values found, the order of application of the interviews seems to not impact the results, demonstrating strong correlations between both interviews, even with a different order of application. Aiming to facilitate the use of the scale by different examiners, the interobserver reliability was investigated, which did not show significant differences in the means. Conclusion: The study suggests that the telephone interview can be used similarly to the face-to-face interview, by different evaluators, with no impact on its efficiency in detecting ASD symptoms.

Effect of Online Balint Group and Pharmacotherapy on COVID-19 Anxiety in Iranian Healthcare Workers: A Randomized Controlled Trial

Background: Anxiety persists following coronavirus disease 2019 (COVID-19) and has caused dysfunction. Objectives: We compared the effect of the online Balint group and pharmacotherapy on COVID-19-induced anxiety in Iranian healthcare workers (HCWs). Methods: In the current clinical trial in the north of Iran in 2021, the participants were randomly assigned to two groups, including the Balint group (eight 60-minute online sessions) and the pharmacotherapy group (sertraline), following a phone screening procedure by a psychiatrist. The groups filled out two questionnaires, namely the Connor-Davidson Resilience Scale and Corona Disease Anxiety Scale, at baseline and after the intervention (fourth week). Results: Forty-five HCWs were assessed. There was a significant difference in total anxiety score and also in sub-component in each group (P ≤ 0.001). No significant differences were observed regarding the effectiveness of both interventions in anxiety (P = 0.52); however, the pharmacotherapy interventions significantly affected the resilience and related subscales (P ≤ 0.05). The domain of spiritual influences significantly increased in the pharmacotherapy group (P = 0.031). Conclusions: Balint group and pharmacotherapy can improve COVID-19-induced anxiety and boost resilience in HCWs.

Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.

BackgroundMost efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.ObjectiveFew health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers.MethodsWe selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening.ResultsDuring the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver.ConclusionsThe EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers.Trial RegistrationClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380

Investigating the Feasibility of Remote Recruitment and Data Collection in the Context of an In-Restaurant Intervention Study

ObjectivesConsumption of restaurant food is linked with increased energy intake and poor diet quality among children. Our ongoing cluster-randomized trial is designed to promote healthier eating among children in restaurants, with original plans to recruit families and collect data in local restaurants. Interactions with the first cohort were conducted remotely due to COVID-19, offering the opportunity to examine remote recruitment and data collection in the context of an in-restaurant intervention study.MethodsParents with a 4-to-8-year-old child were recruited from 2 locations (1 intervention, 1 control) of a local, quick-service restaurant chain in Summer 2021. Study information was posted online and in-restaurant. Interested parents contacted study staff via text, phone, or email and completed screening, followed by an online baseline survey if eligible. Participants received study materials (frequent diner card and placemat) via mail. Intervention materials promoted healthful kids’ meals, and control materials promoted kids’ meals generally. Families returned to the same restaurant 6 times during a 2-month exposure period, where placemats were available, and frequent diner cards could be used. In November 2021, families returned for a final restaurant visit, submitting photos of their child's meal and completing a final online survey.ResultsParents responded to study advertisements primarily via text (n = 61, 56% of inquiries) and 26 parents were recruited (17 intervention, 9 control). Twenty-one families (81%) completed final study procedures. Overall, parent comments about the study were positive, including statements such as “clear instructions” and “easy to complete.” Some recommended changes including “make the frequent diner card digital.”ConclusionsRecruitment was slower compared to in-person restaurant studies, but compliance and retention were high. For comparison, our in-person pilot research in this restaurant chain screened 134 families and enrolled 126 in one Summer, with retention just under 50%. Additional research is needed to maximize the feasibility of remote research in restaurants, perhaps leveraging successful remote data collection methods from the present study while returning to in-person recruitment when feasible.Funding SourcesNIH R01HD096748.

Yips: An Investigation of Causes and Treatments in the Context of Golf

<h3>Introduction</h3> Yips are a physical phenomenon, like dystonia, that have plagued athletes and ended careers. They can be difficult to describe specifically given their variable manifestations. They tend to come on suddenly, with no forewarning signs. Mostly recognized in the games of seasoned athletes, Yips are often difficult to visualize by the inexperienced eye. An afflicted professional athlete must fix the problem or abandon their career, thus resulting in significant psychological and neurological distress. While symptoms are well-documented; causes and treatments are not. Taking a break may improve symptoms. In golf, instructors typically suggest developing new muscle memory using a different technique. Overall, golfers do many things to get around Yips, but not much to cure them. The psychological impact of losing a superior skill can be quite disabling. Hence, preventing, treating, and curing Yips is important. The objective of this pilot research was to gather data on Yips for the purpose of guiding future research on causes and treatments. Some research suggests Yips have similarities to focal dystonias which afflict older adults as well. There are concerns regarding association of Yips with age-related changes, and limited findings or treatments for this particular condition highlight the disparity in the elderly community. <h3>Methods</h3> Golf was the chosen platform to study Yips as they are most common in golfers and golfing at higher levels would have a more extensive variety of solutions to investigate. Study participants were recruited for an initial phone screening appointment, and potentially an in-person survey with stroke demonstrations. Analyses of participant survey responses were conducted using Chi-Squared Corrected Yate's Test and Fisher's Exact Test statistical methods. Participants were divided into two groups: Yips and no Yips (controls). Data was collected at a large multi-specialty medical center in New York. <h3>Results</h3> Study had difficulties finding participants. As a result, statistical analyses were hindered. There were some associations calculated between Yips and the categories Infection/Illness and Trauma as depicted in Table 1. Beyond the statistics, important information was documented on treatments used by those with Yips and their outcomes. It was found that "treatments" were more about finding a way to get around a Yip as opposed curing it. Additionally, it was learned that the term Yip is sometimes incorrectly used to describe a bad swing. There was a remarkable observation as to similarities between Yips and Post-Traumatic Stress Disorder symptoms. <h3>Conclusions</h3> A significant outcome of this study was building an initial prototype for continued research and focus on this important subject. Significant associations between Yips and Fever, Yips and Sore Throat and Yips and Trauma were determined, all of which indicated a negative relationship. Additionally, a table was assembled containing methods used by study participants to treat their own Yips along with their outcomes. From observations of participants answering the survey in person, it was noted that the onset of Yips was a stressful event. Despite never being diagnosed with Post-Traumatic Stress Disorder, a Yip has similarities to symptoms of a panic attack. From this observation, a recently published Propranolol study came to mind where emotions involved with a specific trauma were lessened via a therapy/Propranolol protocol. This may prove helpful for treating/curing Yips. Two participant surgeries post Yip onset dealt with overuse. One was a Carpel Tunnel Syndrome procedure and the other was to fix "Trigger Fingers". This finding supports overuse as one suspected etiology of Yips. It was found that participants did attempt using alcohol to improve their games and Yips. No one reported that alcohol helped with Yips. Finally, a concern arose from this study upon realizing that Yips come on unexpectedly, and possibly players need to be more aware and/or educated on what to look for to create prevention strategies. Even in the overuse scenario, no one complained of overuse symptoms occurring before their Yip. Without anything to look for, causes become more difficult to discern and this may be the main reason why causes and treatments of Yips remain so perplexing. <h3>This research was funded by</h3> In addition to the cost of the research program provided by Orange Regional Medical Center/Garnet Health Medical Center, a small amount of funding was provided by Kian-Taj C. Afrassiabian, DO. Chart: https://apps.aagponline.org/abstracts/uploads/2022/59kxam63rrp7c5u.pdf

Prevalence of Somatosensory Tinnitus in Veterans With Tinnitus.

The primary objective was to estimate the prevalence of somatosensory tinnitus (ST) among Veterans with tinnitus. Three hundred four Veterans with tinnitus were phone screened for ST by performing and reporting on a series of head/neck/jaw maneuvers. A random sample of 12 individuals who screened positive and five who screened negative attended an in-person visit to confirm the presence/absence of ST. Of the 304 Veterans, 12 could not complete the screening maneuvers, 205 screened positive, and 87 screened negative. A Bayesian estimator that combines phone screening and in-person exam results establishes the prevalence of ST among Veterans with tinnitus at 56% with a 90% Bayesian confidence interval of 45% to 65%. At least half of Veterans with tinnitus have ST, suggesting that a sizable at-need population exists. Treatment addressing the biomechanical component has the potential to improve tinnitus symptoms.

Staff perspectives on the feasibility of a clinical pathway for anxiety and depression in cancer care, and mid-implementation adaptations

BackgroundClinical pathways (CPs) are intended to standardise and improve care but do not always produce positive outcomes, possibly because they were not adapted to suit the specific context in which they were enacted. This qualitative study aimed to explore staff perspectives of implementation of a CP for routine screening, assessment, referral and management of anxiety and depression (the ADAPT CP) for patients with cancer, focussing on perceived feasibility of the CP and negotiated adaptations made during the implementation phase.MethodsThe ADAPT CP was implemented in 12 urban and regional oncology services in Australia. Services were randomised to receive core versus enhanced implementation strategies. Core sites received support until implementation commencement and could access progress reports. Enhanced sites received proactive, ongoing support during the 12-month implementation. Purposively selected staff were interviewed prior to implementation (n = 88) and 6 months later, half-way through the implementation period (n = 89). Monthly meetings with lead multi-disciplinary teams at the eight enhanced sites were recorded. Data were thematically analysed.ResultsSix overarching themes were identified: ADAPT is of high value; timing for introducing the CP and screening is difficult; online screening is challenging; a burden too much; no-one to refer patients to; and micro-logistics are key. While early screening was deemed desirable, diverse barriers meant this was complex, with adaptations made to time and screening location. Online screening prompted by email, seen as time-saving and efficient, also proved unsuccessful in some services, with adaptations made to in-clinic or phone screening, or repeated email reminders. Staff negative attitudes to ADAPT, time constraints, and perceived poor fit of ADAPT to work roles and flows, all impacted implementation, with key tasks often devolving to a few key individuals. Nevertheless, services remained committed to the ADAPT CP, and worked hard to create, review and adapt strategies to address challenges to optimise success.ConclusionsThis study demonstrates the interactive nature of health service change, with staff actively engaging with, forming views on, and problem-solving adaptations of the ADAPT CP to overcome barriers. Obtaining staff feedback is critical to ensure health service change is sustainable, meaningful and achieves its promise of improving patient outcomes.Trial registrationThe study was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347.

Variations in Payment Allocation to Persons Living With Cognitive Impairment and Study Partners

There is a paucity of research focused on monetary incentives for recruiting dyads (participants with cognitive impairment and study partners) into research. Our objective was to evaluate if two different variations in allocating compensation among dyads changed consent rates in one clinical trial, Memories2. This trial is evaluating cognitive and functional outcomes of obstructive sleep apnea treatment in patients with amnestic mild cognitive impairment (aMCI). Prior to phone screening, participants were randomly assigned to one of two groups (1) $200 to participant with aMCI or (2) $100 to participant with aMCI and $100 to study partner at consent visit. Allocating all the payment to the participant with aMCI yielded a 2.6% consent rate, while splitting the payment yielded at 1.7% consent rate. We will also discuss how demographic factors affected consent decision by group. This study provides insight into novel strategies that may enhance enrollment of dyads into clinical trials.

S568 Pre-Operative SARS-CoV2 Screening With TMA Nasopharyngeal Swab in Asymptomatic Patients Undergoing Non-Urgent Outpatient Procedures

Introduction: Pre-operative SARS-CoV2 nasopharyngeal swab screening is performed prior to non-urgent procedures in many institutions in the United States. It remains unknown whether a standardized screening algorithm is effective in capturing asymptomatic SARS-CoV2 carriers to limit exposure to other patients and staff. Our aim was to study the effectiveness of the screening approach used in our center to identify these patients. Methods: We performed a retrospective study at our center between 06/03/2020 and 11/18/2020. Firstly, patients were screened for typical symptoms of SARS-CoV2 by phone using a standard questionnaire. Those asymptomatic were then required to undergo transcription mediated amplification (TMA) testing within 72 hours of the procedure. Lastly, those with negative TMA were contacted again for another phone screening 24 hours prior to the procedure. All our patients were tested using the same SARS-CoV2 nasopharyngeal swab kit. Number of false negative tests were estimated by computing pre-test odds and negative likelihood ratio. The pre-test probability among asymptomatic patients was determined by dividing the number of positive TMA by all those tested in the same setting, assuming those who tested positive had the disease for 14 days. The negative likelihood ratio was calculated based on sensitivity (98.5%) and specificity (99%) of the TMA test that was used. Descriptive statistics were used to analyze the entire study period, including both the pre-surge (until 10/6/2020) and post-surge (after 10/6/2020) period. Results: A total of 8925 SARS-CoV2 TMA tests were performed as part of the pre-operative screening for non-urgent procedures during the study period. Of those, 67 patients tested positive. This represents a positivity rate of 0.75% and an estimated prevalence of 740 per 100,000. In the pre-surge period, 27 of 6355 patients tested positive (positivity rate 0.42%; prevalence 410 per 100,000), while in the post-surge period, 40 of 2570 patients tested positive (positivity rate 1.6%, prevalence 1540 per 100,000). Based on post-test odds, the number of false negatives during the entire study was estimated to be less than 1 (0.39 for pre-surge and 0.62 for post-surge period). The calculated number of false negative tests within the study period was 1.01. Conclusion: A three-tier pre-operative SARS-CoV2 screening approach including nasopharyngeal TMA testing among patients undergoing non-urgent procedures, effectively captures the overwhelming majority of asymptomatic cases.

Population Screening of Gambling Behavior: Playing to Escape From Problems May Be a Key Characteristic of At-Risk Players.

The increase in gambling availability and the inclusion of gambling disorder as an addiction in DSM-5 highlight the importance of brief screening measures aiming to identify at-risk gamblers. The current study, using a brief telephone survey, assessed demographic characteristics and gambling behaviors in 2,118 adults. Questions were developed based on DSM-5 criteria for Gambling Disorder and common assessment tools. A 7% prevalence of as at-risk gamblers was identified. Male gender, low monthly income, high frequency of gambling behavior, large amounts of money spent, and gambling to escape from everyday problems or for amusement, specifically for men, were found to be the characteristics that can help in the early identification of at-risk gamblers. Gambling for financial gain and as a way to socialize, age, and employment status were not significant predictors of gambling severity. This study shows that the above characteristics can be assessed easily through phone screening of large populations, aiding in prevention practices to reduce the problematic use of gambling activities.

Managing HER2-Positive Breast Cancer Amid COVID-19

Managing HER2-Positive Breast Cancer Amid COVID-19

Rationale and design of DRINK-T1D: A randomized clinical trial of effects of low-calorie sweetener restriction in children with type 1 diabetes

BackgroundLow-calorie sweeteners (LCSs) provide sweetness without sugar or calories and are used to replace added sugars by many children with type 1 diabetes (T1D). However, the role of LCSs in diabetes management and cardiometabolic health is unclear. ObjectiveThe Diabetes Research in Kids Study (DRINK-T1D) aims to investigate effects of LCS restriction on glycemic variability, visceral adiposity, lipid profiles, and systemic inflammation among children 6–12 years old with T1D. MethodsChildren with T1D, who report habitual consumption of foods and beverages containing LCSs, are recruited from the Washington Nationals Diabetes Care Complex (DCC) at Children's National Hospital (CNH) in Washington, DC. Following a phone screening and two-week run-in period involving continuation of usual LCS intake, children are randomized to 12 weeks of LCS restriction (replacement of diet beverages with still or sparkling water and avoidance of other sources of LCSs) or continued usual LCS intake (control). The primary outcome is the difference in change in glycemic variability in the LCS restriction group versus the control group. Change in glycemic variability will be assessed as the difference in daily average time-in-range (TIR), measured using continuous glucose monitoring (CGM) during two weeks at the end of the 12-week intervention, compared with during the two-week run-in period prior to randomization. Participants also complete a variety of anthropometric, metabolic, dietary, and behavioral assessments throughout the 14-week study. ConclusionsDRINK-T1D is an innovative, randomized controlled trial, evaluating effects of LCS restriction on glycemic variability and cardiometabolic health in children with T1D. Findings of DRINK-T1D will support or challenge the common practice of recommending LCS use in this patient population and will have clinically relevant implications for pediatric T1D management. Trial RegistrationClinicalTrials.gov Identifier NCT04385888.

How representative are neuroimaging samples? Large-scale evidence for trait anxiety differences between fMRI and behaviour-only research participants.

Over the past three decades, functional magnetic resonance imaging (fMRI) has become crucial to study how cognitive processes are implemented in the human brain. However, the question of whether participants recruited into fMRI studies differ from participants recruited into other study contexts has received little to no attention. This is particularly pertinent when effects fail to generalize across study contexts: for example, a behavioural effect discovered in a non-imaging context not replicating in a neuroimaging environment. Here, we tested the hypothesis, motivated by preliminary findings (N = 272), that fMRI participants differ from behaviour-only participants on one fundamental individual difference variable: trait anxiety. Analysing trait anxiety scores and possible confounding variables from healthy volunteers across multiple institutions (N = 3317), we found robust support for lower trait anxiety in fMRI study participants, consistent with a sampling or self-selection bias. The bias was larger in studies that relied on phone screening (compared with full in-person psychiatric screening), recruited at least partly from convenience samples (compared with community samples), and in pharmacology studies. Our findings highlight the need for surveying trait anxiety at recruitment and for appropriate screening procedures or sampling strategies to mitigate this bias.

Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes.

The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7-14 days in young adults with type 1 diabetes. In addition, person-level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring over 6-14 days. At baseline, participants completed the Psychomotor Vigilance Test, the Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. Forty-six participants (mean age, 22.3 ± 3.2 years) wore a wrist actigraph and underwent continuous glucose monitoring concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences; r = .33, P = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences; r = .50, P = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for type 1 diabetes duration (P > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, P = .010, pr2 = 0.40) after controlling for type 1 diabetes duration and accounting for higher daytime sleepiness. Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with type 1 diabetes. Sleep habits in this population may explain higher glucose variability, and optimizing sleep may improve overall diabetes management. Griggs S, Hickman RL Jr, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med. 2021;17(9):1865-1874.

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis