Post Intervention Research Articles

The efficacy of combined physiotherapeutic scoliosis-specific exercises and manual therapy in adolescent idiopathic scoliosis

BackgroundAdolescent idiopathic scoliosis (AIS) is a pathological condition characterized by vertebral curvature and associated trunk deformities in adolescents. The clinical efficacy of conservative treatment in alleviating spinal curvature of AIS remains a topic of ongoing debate. The objective of this study was to investigate the impact of combined physiotherapeutic scoliosis-specific exercises (PSSE) and manual therapy (MT) on trunk deformity, spinal function, mobility, and mental health in patients with AIS.MethodsThirty-one participants who were diagnosed with AIS whose Cobb angle was between 10–45°were enrolled in the study. Participants in the intervention group received 50 min of PSSE combined with 10 min of MT, while the control group performed 50 min of PSSE as their home exercise program. Both treatments were implemented three times a week for four weeks. Cobb angle, spinal mobility, trunk morphology (vertebral rotation angle, apical deviation, pelvic obliquity distance and angle), movement capability, and quality of life (QOL) were assessed at baseline and post intervention. The treatment effects between the intervention and control groups were analyzed using a two-way repeated measures ANOVA.ResultsFollowing a 4-week treatment period, Cobb angle was significantly reduced from 21.58° to 18.58° in intervention group and increased from 18.00° at baseline and 19.14° post intervention in the control group. Significant improvements were also observed in spinal mobility, movement capability, quality of life, and some of the trunk morphology indices in the intervention group compared to baseline (p < 0.05). Improvements were significantly higher in the intervention group than the control group.ConclusionCombining PSSE and MT shows potential benefits in alleviating AIS symptoms and improving QOL. Further studies to substantiate these findings are warranted.Trial registrationThe trial was retrospectively registered in the Chinese Clinical Trial Registry (https://www.chictr.org.cn) with the registration number: ChiCTR2300071357, (Date: 12/05/2023).

Assessment of Acceptability, Usage, and Impact on Caregivers of Children With Autism's Stress and Mindfulness: Multiple-Method Feasibility Study of the 5Minutes4Myself App's Mindfulness Module.

Caregiver wellness programs need to be easily accessible to address caregivers' constraints to participation. We aimed to assess the feasibility of 5Minutes4Myself app's mindfulness module (usability, usage, and impact on caregivers' levels of mindfulness and perceived stress). Before and after participation in the 5Minutes4Myself program, 15 participants were asked to complete the Perceived Stress Scale (PSS) and Five Facet Mindfulness Questionnaire (FFMQ). Data on the usage of app-delivered meditations were collected electronically via the app, and app usability was rated on the Modified System Usability Scale. Analyses assessed participants' frequency of use of app-delivered meditations, app usability, and changes in participants' stress and mindfulness post intervention. Overall, participants completed 10.9 minutes of mindfulness meditations per week and rated the app 76.7, indicating above-average usability. Related samples t tests (2-tailed) found that group PSS (t10=1.20, P=.26) and FFMQ (t10=-1.57, P=.15) pre- or postintervention mean scores were not significantly different. However, a visualization of pre- and post-PSS and mindfulness scores suggested there was a group of responders who had decreased stress with increased mindfulness. This was confirmed via an individual change analysis. The effect size of the FFMQ scores (d=0.47) suggests there may be treatment effects with a larger sample. A hierarchical multiple regression analysis examined the degree mindfulness impacted perceived stress; 20% of the variance in participants' perceived stress could be attributed to increases in self-rated mindfulness (P=.04) when controlling for preintervention stress levels. Caregivers found the app highly usable and on average used low-dose levels of mindfulness meditations (10 min/wk). For responders, increased mindfulness was related to stress reduction to population-based levels.

Cost effectiveness and functional outcomes of smartphone cardiac rehabilitation assisted self-management versus centre based cardiac rehabilitation among patients with coronary heart disease in Southern India: a multicentre randomized clinical trial protocol

Background: To attain the world specific indicators of quality on programs which brings rehabilitation for cardiac diseases and surgeries in India are to be brought to meet the international standards. Dearth of published research on cost effectiveness of smart phone application oriented CR assisted self-management (SCRAM) over centre based (CBCR) in Indian Population drives this study to be done. This study aims to analyze cost effectiveness of SCRAM versus CBCR in coronary artery disease (CAD) patients. Methods: In this multicentre randomized clinical trial, 100 subjects with uncomplicated CAD will be recruited through purposive sampling and divided into group A and B through block randomization. Group A will be treated with CBCR whereas group B with SCRAM. Outcome measures of 6 minutes’ walk test distance, talk test values and SF 36 scores, high density lipoprotein level and 3 months’ average blood glucose level were documented pre and post interventions and 3, 6, 12 months follow up for data analysis. This study will follow human study ethical consideration based on Declaration of Helsinki. Conclusions: Cost effectiveness of experimental group where SCRAM given as intervention may be better post intervention than control group where CBCR given. By this way this RCT protocol may bring the execution cost down with coronary heart disease patients which play a major role in participation of these patients in CR programs. Trial registration: The trial was registered with CTRI – Clinical Trial Registry of India (ICMR) - CTRI/2022/11/047143 (registered on: 09 November 2022) - trial registered prospectively.

The Effect of Post-Exercise Warm Water Immersion on Anaerobic Power Performance in College Students

Background/Objectives: The purpose of this study was to investigate the effect of a short-term passive post-exercise heat acclimation (HA) protocol on anaerobic performance in college students. Methods: In total, 28 participants (age 22.3 ± 2.1 years, height 168 ± 9.1 cm, mass 71.5 ± 16.6 kg) volunteered and were randomly divided into either an intervention (INT) or control (CON) group. Both groups followed a consecutive two-day protocol, consisting of a 25 min submaximal cycle @ 50–60% heart rate reserve (HRR), followed by a 25 min hot water immersion (INT) or nothing (CON). All participants performed a 30 s Wingate Anaerobic Test (WAnT) on four separate occasions—familiarization, pre-intervention, acutely post-intervention, and 24 h post intervention. The WAnT measured their peak power (W), relative peak power (W/kg), mean power (W), fatigue index (%), and total work (kJ). Results: From the results of the Factorial ANOVA, it was found that there were no significant differences, with no main effect for group (INT vs. CON) or time (Trials 1–4) and no significant interaction across all measured variables (p &gt; 0.05). Conclusions: A two-day post-exercise passive HA protocol utilizing hot water immersion had no significant effect on the measurement of anaerobic performance in college students.

Systematic review and meta-analysis on the effects of physical activity-based interventions on frailty status and clinical outcomes in adults with long-term cardiac conditions

Abstract Introduction Frailty is common in patients with long-term cardiac conditions and is associated with poor clinical outcomes, but limited treatment options are available. Previous studies investigating interventions for frailty have shown positive results with physical activity interventions, however, these studies were largely based on general elderly populations. Aim To assess the impact of physical activity-based interventions on frailty and clinical outcomes in frail patients with long-term cardiac conditions. Methods A systematic review and meta-analysis was conducted based on the PRISMA guideline, using Medline, Embase, CENTRAL, PEDro, CINAHL electronic databases for articles published between 2000 and 2023. Studies which recruited adults &amp;gt;18 years with long-term cardiac conditions (including angina, acute coronary syndrome (ACS), valve disease, heart failure (HF), atrial fibrillation, cardiac surgery and congenital heart disease) who underwent physical activity-based interventions were included. The primary outcome was change in frailty (measured using a validated tool) post intervention. We also assessed the effect of interventions on mortality and hospitalisation. Results We screened 2697 records and reviewed 91 full-text articles; 12 studies (14 articles) were included, involving 1394 patients. Median age of participants ranged from 64 to 82 years. Five studies recruited participants with HF, 3 evaluated participants post transaortic valve implantation, 3 recruited cardiac surgical patients and 1 study evaluated participants post ACS. Physical activity-based interventions were multi-domain, including a mixture of aerobic, strength, balance, endurance and respiratory muscle training; the majority (N=10) had individualised exercise prescription. Meta-analysis of 8 randomised controlled trials (RCTs) showed statistically significant improvement in frailty associated with physical activity-based interventions compared to controls [pooled standardised mean difference (95% CI) = -0.34 (-0.59 to -0.08), p = 0.01, I2 = 48%]. Seven RCTs evaluated change in frailty by short physical performance battery (SPPB). Meta-analysis of these studies showed a statistically significant improvement in SPPB associated with physical activity-based interventions compared to controls [pooled mean difference (95% CI) = 0.83 (0.31-1.34), p = 0.002, I2 = 49%]. (Figure) The magnitude of improvement in SPPB exceeded the minimally clinically significant improvement of 0.5. Three studies evaluated the effect of physical activity-based intervention on clinical outcomes, all of which showed neutral effect on mortality and hospitalisation. Conclusion Physical activity-based interventions in patients with frailty and long-term cardiac conditions were associated with significant improvement in frailty status, with neutral effect on mortality and hospitalisation. Figure: Meta-analysis of 7 RCTs assessing effect of physical activity-based interventions on SPPB

Effectiveness of Ultrasound with Isometric Quadriceps Exercise and Retro walking in Osteoarthritis

Introduction: Knee osteoarthritis is a non-inflammatory, painful and degenerative joint disease; pathologic changes in osteoarthritis involve progressive hyaline joint cartilage loss with concomitant changes in subchondral bone and development of osteophyte. About symptomatic knee osteoarthritis affect 13% of women and 10% of men aged 60 years and older. Men have a lower prevalence of knee osteoarthritis than women. The tool used to measure pain intensity, physical functions in this study is WOMAC scale and to assess the range of motion by Universal goniometer. Aim : To Evaluate the Effectiveness of Ultrasound with Isometric quadriceps exercise and retro walking in osteoarthritis of knee. Method : A Total 30 both male and female participants between 45 to 65 years of age selected from RJS Group of institute of kopargaon , Kothari hospital kopargaon by using purposive sampling method according to the inclusion criteria. The total duration of the study is 3 weeks .total 30 participants allocated into two groups A and B 15 in each group. In group A were intervention Ultrasound with isometric quadriceps exercise and group B Ultrasound with retro walking were given for 3 weeks. Pre intervention and post intervention by WOMAC score and universal goniometer were taken analyzed compared using paired’ test. RESULT: As per statistical analysis both groups shown significant improvement but group B ( Ultrasound with Retro walking )was having most significant improvement as compare to group A ( Ultrasound with Isometric quadriceps exercises). CONCLUSION : This study concluded that Ultrasound with Retro walking was effective in participants with Osteoarthritis of knee .Hence there is reduction of pain, improving range of motion at knee joint and functional mobility, Activity of daily living in participants with osteoarthritis of knee.

Early improvement in left ventricular microvascular flow post sonothrombolysis is associated with better left ventricular systolic function in st elevation myocardial infarction patients

Abstract Background/Introduction Acute coronary syndromes are the main cause of death worldwide and the timely application of proper therapy is critical for patient outcome. However, even when state of the art treatment is implemented, significant no-reflow phenomenon may occur. In this scenario, sonothrombolysis, which consists of a continuous infusion of an ultrasound-enhancing agent associated with high-energy intermittent ultrasound impulses, may restore cardiac microcirculation and improve left ventricular (LV) systolic function. Purpose We aimed to evaluate LV segmental microvascular flow, LV mechanics and function in patients with ST-elevation myocardial infarction (STEMI) after sonothrombolysis therapy and evaluate whether an early (immediately post percutaneous coronary intervention – PCI or PCI+Sonothrombolysis) improvement in myocardial microvascular flow could predict better LV systolic function at 1-month. Methods STEMI patients receiving conventional treatment (PCI with or without previous fibrinolytic therapy) were randomized to sonothrombolysis (therapy group - TG) or conventional treatment (control group - CG). This study included 143 patients (interim analysis) who compose the HUBBLE I databank (High-intensity Ultrasonic impulses and microbuBBles to Limit the Extent of acute myocardial infarction I) and were randomized from two clinical trials (NCT04732091 and NCT02410330): CG, N=74 and TG, N=69 patients. There were 25 patients treated previously with fibrinolytic therapy (14 in CG and 11 in TG) and the percentage of left anterior descending artery as culprit vessel was similar between groups (59 vs. 54%, P=0.482). Sonothrombolysis was initiated after patient admission to the emergency room and continued after PCI for a total of 50 minutes. Echocardiography was carried out immediately after PCI or PCI+Sonothrombolysis and at 1-month for assessing LV ejection fraction (LVEF) and perfusion score index (PSI) in contrasted imaging and global longitudinal strain (GLS) in 2D imaging, that was presented in [module]. Results Demographic characteristics, cardiovascular risk factors and echocardiographic variables immediately after PCI or PCI+Sonothrombolysis were similar between groups (P&amp;gt;0.05). At 1-month follow up, TG presented higher LVEF (46.4±10.5 vs. 50.9±11.1%, P=0.018) and GLS (13.0±3.6 vs. 14.9±4.3%, P=0.008) and lower PSI (1.56±0.4 vs. 1.39±0.3, P=0.007) and number of segments with perfusion defects (5.8±3.7 vs. 4.6±3.3, P=0.050) compared with CG. There was a negative correlation between early PSI and 1-month LVEF (r=-0.701, p&amp;lt;0.0001). Conclusions The preliminary data indicates that sonothrombolysis can be an effective adjuvant treatment in STEMI patients previously treated or not with fibrinolytic therapy, contributing to a better myocardial microvascular flow and LV systolic performance. Early myocardial microvascular reperfusion improvement can predict whether cardiac function will improve in this setting.

Predictors of acute ischemic strokes and subsequent mortality in patients hospitalized for percutaneous coronary interventions

Abstract Background Acute ischemic strokes (AIS) occurring post percutaneous coronary intervention (PCI) are an infrequent but severe complication, resulting in increased mortality rates and morbidity in survivors. Purpose We aimed to investigate independent predictors of AIS and subsequent mortality in patients hospitalized for PCI in a nationwide cohort. Methods A retrospective analysis using on ICD-10-GM and OPS-codes obtained from 2006-2021 from the German Federal Statistical Office was performed. Patients with a peri-interventional AIS aged ≥18 years which were admitted for PCI were included in this analysis. A stepwise regression analysis was employed to identify factors independently associated with AIS and to determine variables linked to in-hospital mortality. Results From 4,910,430 PCI cases registered from 2006-2021, AIS occurred in 4,098 (0.08%) patients. Patients with an AIS were 70.9±11.3 years of age, predominantly male (65.3%) and displayed a high burden of comorbidities such as diabetes (36.1%), a prior medical history of atrial fibrillation (34.6%) and chronic kidney disease (19.4%). In patients with AIS, 27.4% presented with a ST-elevation myocardial infarction (STEMI), whilst 38.9% were admitted with a Non-STEMI. Concerning procedural characteristics, 84.2% underwent a coronary stent implantation, and in 5.5% cases a coronary thrombectomy was carried out. Important predictors of peri-interventional AIS after a PCI were: carotid artery disease, history of stroke, presentation with myocardial infraction, atrial fibrillation, and coronary thrombectomy. For variables like hyperlipoproteinemia, obesity and stent implantation an inverse association was noted (also see Figure 1A). With regard to mortality, during a mean in-hospital stay of 18 ± 15.1 days, a total of 18.1% (n=742) patients died. We identified several independent predictors of mortality including clinical presentation with cardiogenic shock, dialysis and STEMI as indication for PCI. A negative correlation with in-hospital mortality was seen for variables such as arterial hypertension and coronary stent implantation (see Figure 1B for full set of independently associated variables). Conclusion In a nationwide cohort of patients hospitalized for PCI over 16 years, we identified important predictors of AIS including carotid artery disease and coronary thrombectomy. Moreover, a substantial rate of in-hospital mortality as well as several predictors of death were recognized. Our findings might help clinicians identify patients undergoing PCI who are at highest risk for ischemic cerebral complications and subsequent mortality.

Patient control preferences prior to discharge after cardiac surgery

Abstract Background The impact of patient preferences and participation in the acute recovery period prior to discharge after cardiac surgery is not well understood. Although there is a plethora of literature describing pre and post discharge interventions to support patients’ recovery there is minimal evidence demonstrating the effectiveness of specific interventions that optimise recovery or patient preferences for participation in decision making related to this period of transition from hospital to home. Purpose The aim of this study was to explore patient preferences for participation in discharge planning. Methods This study took place in a major metropolitan hospital in Victoria, Australia with a population base of over 1 million people that provides over 100,000 episodes of care and approximately 850 cardiothoracic procedures annually. We recruited consecutive adult patients, able to understand and speak English who were being discharged home after cardiac surgery. Prior to discharge, a Registered Nurse conducted a semi-structured interview following patient consent where patients were asked to complete the 5 item Control Preferences Scale (CPS) in relation to 3 discharge planning questions. With each question patients were asked to rate their preferred and actual role in the decision-making process. The CPS has 5 cards each portraying a role in treatment decision making; active (1-2), collaborative (3) or passive (4-5) participation to determine what level of control patients’ desire in relation to their care. Results From 196 patients undergoing cardiac surgery 63 (32.1%) were eligible and agreed to participate. When asked about making plans for discharge 9 (14.3%) patients’ preference was to have an active role in this process, 25 (39.7%) preferred a collaborative approach and 29 (46.1%) a passive approach. Patients perceived their actual role was active (n = 10, 15.9%), collaborative (n = 17, 27.0%) or passive (n = 36, 57.1%). When asked about deciding when to go home 9 (14.3%) patients’ preference was to have an active role in this process, 18 (28.6%) preferred a collaborative approach and 36 (57.1%) preferred a passive approach. Patients perceived their actual role was active (n = 8, 12.7%), collaborative (n = 13, 20.6%) or passive (n = 42, 66.6%). When asked about their preferred role in deciding where they go when discharged 21 (33.4%) patients’ preference was to have an active role in this process, 19 (30.2%) preferred a collaborative approach and 23 (36.5%) a passive approach. Patients perceived their actual role was passive (n = 24, 38.1%), collaborative (n = 16, 25.4%) or passive (n = 23, 36.5%). Conclusion Patient preferences for control were congruous with their perceived experience of involvement in decision making which indicates patients’ preference for control is taken into account by clinicians managing the discharge planning process in this setting.

Effectiveness of Chest Physiotherapy toward Tuberculosis (TBC) Patient to Overcome Ineffective Airway Clearance in Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo: A Case Report

Tuberculosis is an infectious and potentially fatal disease in worldwide, caused by lungs inflammation due to Mycobacterium bacteria infection. Tuberculosis patient experiences coughing with phlegm, shortness of breath or dyspnea, accumulation of exudate or sputum. Excessive of sputum accumulated can lead to obstruction of breath way and increase lungs infection that related to ineffective airway clearance. Chest physiotherapy can be intervention of nursing to overcome ineffective airway clearance that helps in clearing accumulated sputum and improving oxygen saturation. This scientific work uses a case report method that describes the case of Tuberculosis patient with main problem of nursing that was called ineffective airway clearance. The sampling was consecutive sampling but only one patient included in the case. The sample of study was Mrs. M, 32 years old who had Tuberculosis patient with ineffective airway clearance. The research was conducted twice daily for 3 days began from December 21st, 2023, to December 23rd, 2023, in the Dieng Inpatient Room of dr. Abdoer Rahem Hospital Situbondo. Intervention was done in two sessions, that were morning and afternoon. Based on observations, there was no significant difference on blood pressure level, but there were decreasing pulse rate, decreasing respiratory rate, increasing oxygen saturation value, and improving ability of sputum production post intervention Chest Physiotherapy on the third day. The application of Chest Physiotherapy quietly helped in expelling phlegm and improving respiratory status.

Improvement of serum folate status in the US women of reproductive age with fortified iodised salt with folic acid (FISFA study).

Mandatory folic acid fortification of enriched grains has reduced neural tube defect prevalence in several countries. We examined salt as an additional vehicle for folic acid fortification. The primary objective was to examine the change in serum folate concentration after 1 month of consumption of fortified iodised salt with folic acid (FISFA) among women of reproductive age. The secondary objectives were to examine (1) the feasibility of implementing FISFA intervention and (2) the acceptability of FISFA. We conducted a pre–post intervention study (January–April 2023). Participants received a FISFA saltshaker with the study salt (1 g of sodium chloride salt fortified with 100 mcg of folic acid) to use instead of regular table salt for 1 month. Serum folate was measured using the Elecsys Folate-III immunoassay method at baseline and 1-month endpoint. Change in serum folate was assessed using a two-tailed Wilcoxon signed rank test for paired samples. Metropolitan city, Southern USA. Non-pregnant, 18–40-year-old women who lived alone/with a partner. Thirty-two eligible women consented to participate, including eleven non-Hispanic-White, eleven non-Hispanic-Black and ten Hispanic. Post-intervention, there was a significant increase in median serum folate concentration of 1·40 nmol/l (IQR 0·74–2·05; P < 0·001) from 24·08 nmol/l to 25·96 nmol/l in an analytical sample of n 29. An increase was seen in 28/29 (93 %) participants. Feasibility: 100 % study consent and compliance. FISFA acceptability: 25 d average use; 1·28 g average daily intake; 96·7 % and 90 % reported taste and colour of FISFA as highly acceptable, respectively. FISFA is an effective approach to increasing serum folate concentrations among women of reproductive age. Findings should be replicated in a larger study.

Reducing research participant disparities through use of a co-developed video intervention: A cohort nested pre-post study

Background Evidence on effective approaches for the recruitment of diverse populations remains limited. This study aimed to assess whether a co-developed study information video would improve participant ethnic diversity within a paediatric study cohort. Methods Pre-post study nested within the Uveitis in childhood prospective national inception cohort study, UNICORNS. Intervention of interest: study information and recruitment video with format and content co-developed with a patient expert group. Outcome of interest: the proportion of families from ethnic minority groups, and of families with primary caregivers without a higher educational degree who were recruited to the study, and the proportion of families who engaged in study activities (returned patient reported outcome metrics following recruitment) pre and post intervention implementation. Results During the study period, 191 children were recruited to UNICORNS (110 pre-intervention era, 81 post-intervention era). A larger proportion of families recruited in the post-intervention era were of an ethnic minority background (36% versus 20%, Fisher’s exact test p=0.02). A larger proportion of families returned self-descriptions of their sociodemographic background (100% versus 87%, Fisher’s exact test p=0.0003) and a larger proportion returned study specific patient reported outcome measures (70% versus 55%, Fisher’s exact test p=0.003). Conclusion Co-created digital research information resources can be an effective tool for ensuring better representation in research studies and may also support participant engagement overall. Our reported methods and findings should support other researchers in developing patient-centred and patient co-developed strategies and tools for the purposes of equitable access to medical research.

Comparison of protective effects of teneligliptin and luseogliflozin on pancreatic β-cell function: randomized, parallel-group, multicenter, open-label study (SECRETE-I study).

The aim of this study is to directly compare the effects of SGLT2 inhibitors and DPP-4 inhibitors on β-cell function in patients with type 2 diabetes. We conducted a 26-week, randomized, open-label, parallel-group study, including a 1-2 week drug washout period, in patients with type 2 diabetes with HbA1c ≥7.0% and <9.0% and BMI ≥20 kg/m2 despite treatment with a drug naïve or other than DPP-4 inhibitors or SGLT2 inhibitors. A total of 103 subjects were randomly assigned to receive once daily oral luseogliflozin (L) or teneligliptin (T). The primary endpoint was the effect of L vs. T on the change in logarithmus naturalis (Ln) disposition index (DI) (DI 0-120min; combining measures of insulin secretion and sensitivity) from baseline to week 25-26 (post intervention), which was calculated by conducting an oral glucose tolerance test. Ln DI 0-120min were improved in both groups: -0.46 ± 0.68 to -0.20 ± 0.59 (p=0.03) in L group and -0.26 ± 0.60 to -0.05 ± 0.62 (p=0.01) in T group. The change in Ln serum proinsulin/C-peptide ratio, a marker of β-cell dysfunction, was reduced in L group (1.63 ± 0.63 to 1.56 ± 0.68, p=0.16), but rather increased in T group (1.70 ± 0.75 to 1.90 ± 0.51, p=0.01), with significant difference between the two groups (-0.27; p=0.004). Improvement of disposition index in subjects with obese type 2 diabetes was comparable between luseogliflozin and teneligliptin. On the other hand, it is likely that alleviation of β-cell dysfunction is more effective with luseogliflozin compared to tenegliptin. https://rctportal.niph.go.jp/en, identifier jRCTs061190008.

Heart rate variability biofeedback for critical illness polyneuropathy: a randomized sham-controlled study.

Critical illness polyneuropathy (CIP) has been linked to neurocardiac dysfunction mediated by autonomic nervous system dysregulation, which increases mortality. We aimed to assess if heart rate variability (HRV) biofeedback could improve neurocardiac function in CIP. We randomly allocated (1:1) patients with electrophysiologically confirmed CIP undergoing early inpatient neurological rehabilitation to additional HRV or sham biofeedback over 14 days. We evaluated neurocardiac function via standard deviation of normal-to-normal intervals (SDNN) as the primary outcome, as well as HRV frequency domains, sympathetic cutaneous sudomotor and vasomotor functions and disability at baseline, post intervention and 4 weeks later. The study is registered on the German Clinical Trials Register (DRKS00028911). We included 30 patients with CIP (40% females, median [interquartile range] age 64.6 [56, 72] years). We observed an increase in SDNN and the predominantly parasympathetic high frequency domain post intervention (ß = 16.4, 95% confidence interval [CI] 0.2, 32.6 [p = 0.047] and ß = 1179.2, 95% CI 119.9, 2158.5 [p = 0.018]), which was sustained at the 4-week follow-up (ß = 25.7, 95% CI 6.0, 45.4 [p = 0.011] and ß = 25.7, 95% CI 6.0, 45.4 [p = 0.011]). Patients who underwent HRV biofeedback displayed a higher adjusted Barthel index, indicating less severe disability 4 weeks after the intervention compared to those in the sham group (ß = 23.3, 95% CI 5.5, 41.1 [p = 0.014]). Low frequency and sympathetic skin functions did not differ between groups (p = nonsignificant). Our study provides pilot data suggesting that, in patients with CIP, HRV biofeedback can improve neurocardiac function with a predominant effect on the parasympathetic nervous system and has a beneficial effect on functional recovery.

The effect of attachment systems and denture cleaning methods on microbial biomass and composition in implant-supported overdentures: an experimental study

ObjectiveThis research endeavors to scrutinize the influence of attachment systems and denture cleaning methodologies on microbial biomass and composition within the realm of implant-supported overdentures, a crucial consideration for patients with dentition defects necessitating such prosthetic solutions.Subjects and methodsEmploying five polymethyl methacrylate specimens designed to emulate the fitting surfaces of traditional dentures and implant-supported overdentures. Following the polishing of each specimen and the quantification of its roughness, co-cultivation with three distinct microbial strains ensued, culminating in ultrasonic cleaning in water. The bar-clip group, differentiated by the depth of attachment, underwent cleaning employing four diverse methods. Biomass quantities were meticulously recorded both pre and post cleaning interventions, with subsequent data analysis via t-testing and one-way ANOVA, maintaining a significance level of α = 0.05.ResultsThe bar-clip groups demonstrated an elevated degree of microbial adhesion, with the deeper locator group exhibiting heightened biomass residue post-cleaning, indicative of increased cleaning complexity. Ultrasonic cleaning predominantly targeted biofilm and deceased bacteria, whereas chemical cleaners primarily reduced the quantity of viable bacteria. The synergistic application of ultrasonics and chemical cleaning treatments yielded the minimal biomass residue.ConclusionIn contemplating the utilization of dentures milled by dental computer-aided design/manufacturing systems, meticulous pre-use surface polishing is imperative. The extent of biofilm adhesion correlates with the chosen attachment system. This study advocates for the incorporation of ultrasonic cleaning in conjunction with chemical cleaning solutions to optimize the removal of biofilm and live cellular entities in the context of implant-supported overdentures.

AN ANALYSIS OF THE PATIENT REPORT OUTCOMES OF A JOINT CNS / AHP NEURO-ONCOLOGY CLINIC ON PATIENTS QUALITY OF LIFE

Abstract AIMS Velindre Cancer Centre established a successful model of collaborative working between CNS and AHP services for neuro-oncology patients to holistically support their complex needs throughout treatment. Building on this success, the clinic has introduced a recognised reliable and valid patient reported outcome measure (PROM) to be completed pre and post clinic intervention. This is in addition to the patient reported experience measure that is already established within the pathway. This PROM will enable an analysis of the clinics impact on patients quality of life. METHOD A quantitative methodology will be utilised to enable a objective evaluation of the impact of the clinic on patients quality of life. An EQ-5D-5L PROM is completed with patients prior to their involvement with the clinic enabling an overview of key aspects related to quality of life including mobility, self-care, participation in usual activities, pain and anxiety / depression. Following interventions within the clinic, patient are provided with a post treatment EQ-5D-5L to enable a comparison of these key indicators of quality of life. RESULTS The data will build on the resounding success of collaborative working between CNS and AHP’s in the neurooncology MDT clinic. An analysis of the pre and post data will demonstrate the impact of having access to this unique and integrated way of working, enabling patient access to specialist timely support throughout their treatment. CONCLUSION This innovative model of working is now established in the patient pathway and findings from patient experience measures have recognised that patients experience of the clinic is extremely highly valued. Findings from this additional dataset will further evidence the impact on patients quality of life. It will add to findings from a proposed gap analysis to evidence the benefits of developing an outreach service for this patient cohort.

Ordering and Utilization of Peripheral Blood Flow Cytometry in an Academic Medical Center

Abstract Introduction/Objective The American Society for Clinical Pathology and the American Board of Internal Medicine’s Choosing Wisely campaign have developed best practice utilization guidelines for laboratory testing. Wisconsin Diagnostic Laboratories and Medical College of Wisconsin leadership noticed an increase in inappropriate peripheral blood flow cytometry testing in the last two years. An intervention was developed to help reduce inappropriate testing requests. Methods/Case Report The laboratory implemented a clinical decision support tool in the electronic medical record system that looked at patient diagnosis, history of stem cell transplant, and recommendations from pathology to help improve utilization of peripheral blood flow cytometry testing. Based on patient history, flow cytometry testing would move forward, or an alternative order of a peripheral blood pathology smear review with reflex to flow cytometry was offered. Pathologists would reflex flow cytometry if abnormalities were present by light microscopy or predetermined reflexing criteria were met. Results (if a Case Study enter NA) 314 cases were included for analysis. The intervention reduced volumes of peripheral blood flow cytometry in patients without a history of hematologic malignancy by 49.1% (p=&amp;lt;0.001). Appropriate utilization increased from 47.0% in the pre-intervention period to 80.4% in the post intervention period (p=&amp;lt;0.001). Significant diagnosis rate increased from 42.5% to 50.0% (p=.261). This resulted in a cost savings of $12,232 for the health system during the intervention period. Conclusion Clinical decision support based utilization efforts provide strong and consistent interventions to reduce the unnecessary and inappropriate ordering of peripheral blood flow cytometry.

Effects of Treadmill Walking and Overground Walking in Young Children With Non-progressive Neurodevelopmental Disorders.

Introduction Neurodevelopmental disorders (NDDs) are responsible for childhood brain dysfunction and developmental disability. Physical therapists are important team members in providing a beneficial impact on the gross motor function of children with NDDs. Early intervention provides a beneficial effect on the improvement of gross motor function; however, most of the studies on treadmill training were in late age and the effect of early treadmill walking along with conventional physiotherapy was not studied. Hence, the objective of the present study was to compare the effect of overground walking with treadmill walking in young children aged 12-36 months with non-progressive NDDs. Methodology An experimental study was performed for one year on diagnosed cases of non-progressive NDD. A total of 36 children with non-progressive NDD were recruited for the study between the ages of 12 and 36 months of either gender and were allocated into treadmill walking and overground walking groups. The intervention was given for eight consecutive weeks, four days per week, and for 20-25 minutes per day. The children were assessed using Gross Motor Function Measure-66 (GMFM-66) and Peabody Developmental Motor Scale-2 (PDMS-2) for both stationary and locomotion components. Results The comparison of both the groups with PDMS-2 (stationary) at baseline, follow-up, and post intervention reported mean values of 25.56 ± 12.16, 27.22 ± 11.74, and 28.44 ± 11.72, respectively, in the overground walking group and 28.72 ± 8.96, 29.72 ± 9.46, and 31.33 ± 8.85 in the treadmill walking group, respectively, with statistically significant results (p = 0.0022). Additionally, the comparison of both the groups with PDMS-2 (locomotion) reported mean values of 35.78 ± 24.02, 39.11 ± 23.21, and 43.00 ± 23.58, respectively, in the overground walking group and 39.67 ± 22.28, 43.17 ± 22.94, and 46.61 ± 24.16 in the treadmill walking group, respectively, with statistically significant results (p = 0.020). Moreover, the comparison of both the groups with total GMFM-66 reported mean values of 16.97 ± 14.52, 18.35 ± 14.88, and 20.49 ± 16.86, respectively, in the overground walking group and 18.52 ± 14.28, 21.66 ± 15.76, and 25.92 ± 16.95 in the treadmill walking group with statistically significant results (p = 0.0118). Conclusion The present study concluded that between both the groups, a statistically significant difference was observed for PDMS-2 (stationary and locomotion)and GMFM-66 after a scheduled intervention of eight weeks. Hence, walking should be carried out as a part of therapy in early intervention and further studies can be performed to determine the long-term effect of these interventions and their role in the prevention of secondary complications.

Talk‐LD and Talk‐LD+: A pilot trial of school‐based interventions to challenge discrimination and promote inclusion

AbstractTo counteract stigma and discrimination a series of five lessons Talk about Learning Disability (Talk‐LD) to promote young people's understanding and acceptance of people with intellectual disabilities were developed for the Scottish secondary school curriculum. This study examined the feasibility of carrying out a randomised control trial comparing the delivery of the lessons alone with the lessons plus an attempt to promote positive contact between participating students and people with intellectual disabilities. The aim was to recruit and randomise 12 schools to receive the lessons alone or the lessons plus contact. The Attitudes Towards Intellectual Disability (ATTID) questionnaire was completed at baseline and a questionnaire about students' understanding of the lesson content was completed at follow‐up alone. Twelve schools were recruited and randomised. The lessons were delivered to 23 classes across the 12 schools. Baseline data were obtained for 480 participants. However, school closures due to COVID‐19 meant that follow‐up data were only obtained from 220 students (six schools) prior to school closures. The attitude measure only detected change in one ATTID scale, indicating students may be more willing to interact with a person with intellectual disabilities post intervention. Three of the six schools randomised to the lessons plus contact group had plans in place for joint activities between students and young people with an intellectual disability. Despite the disruption caused by the Covid pandemic, the findings were encouraging in relation to future research on the Talk‐LD lessons. The schools also engaged positively with the process of promoting positive contact with young people with an intellectual disability.

Childbirth self-efficacy and birth related PTSD symptoms: an online childbirth education randomised controlled trial for mothers

BackgroundThis study evaluated an online childbirth education course on childbirth self-efficacy and, subsequent birth related posttraumatic stress disorder (PTSD) symptoms and mother-infant relationship quality.MethodThree group (intervention, passive control, active control) parallel randomised controlled trial. Groups were assigned using computer generated random allocation. For the passive control group participants were instructed to carry on with whatever they were currently undertaking with their pregnancy, while the active control group were asked to read a booklet comprised of twelve birth stories. The purpose of the active control was to check if the act of having an activity to complete would influence outcomes. For the online course group (intervention) participants were asked to complete the online version of a birthing course designed by She Births®. One hundred and twenty-five women residing in Australia between 12 and 24 weeks pregnant were recruited online. Participants were asked to complete their required activity between 24 and 36 weeks pregnant. Childbirth self-efficacy scores were tested pre and post intervention (time one and time 2), PTSD symptoms and mother-infant relationship quality were tested at six weeks and six months postnatal.ResultsThere was no significant interaction by group for childbirth self-efficacy scores. Mean difference scores at time one (pre-intervention) and time two (post-intervention) for each group indicated a trend in the online group towards higher childbirth self-efficacy compared with the two control groups. The main effect of group on birth related PTSD scores was not statically significant at six weeks postnatal or at six months postnatal. The main effect of group on mother-infant relationship scores was not statically significant at six weeks postnatal or six months postnatal.ConclusionsTrends showed childbirth self-efficacy scores to be higher in the intervention group compared with the two control groups, demonstrating effectiveness for the intervention. Paradoxically, PTSD scores were higher in the intervention group compared with the two control groups and therefore also reported poorer mother-infant relationship quality. External factors may be more important than childbirth self-efficacy highlighting the need for a holistic approach that addresses systemic and socio-political influences to improve communication, autonomy, and respectful maternity care.Trial RegistrationThis trial was retrospectively registered with the Australian New Zealand Clinical Trials Registry number: ACTRN12624000241538 on March 11, 2024.