Preliminary Outcomes Research Articles

A Brief Digital Screening and Intervention Tool for Parental and Adolescent Tobacco and Electronic Cigarette Use in Pediatric Medical Care in Canada: Protocol for a Pilot Randomized Controlled Trial.

Though rates of tobacco smoking have decreased consistently over the past 3 decades, cigarette use remains the top preventable cause of premature death in North America. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a medical clinic-based intervention that systematically screens parents for tobacco use and offers them direct access to evidence-based smoking cessation services. While the effectiveness of CEASE for parents who smoke has already been demonstrated in the United States, the CEASE model has not yet been tested in Canada, among parents who use e-cigarettes, or among adolescents who use cigarettes and e-cigarettes. We aim to demonstrate the feasibility and evaluate the preliminary effectiveness of the CEASE program for parental smoking cessation and its adapted version for adolescent smoking cessation and adolescent and parental vaping cessation. We will approach parents or guardians of children aged between 0 and 17 years, as well as adolescent patients aged between 14 and 17 years, from a tertiary care pediatric hospital in Montreal, Quebec, Canada, for participation in this single-blinded, pilot randomized controlled trial. Eligible participants are those who report using tobacco cigarettes or e-cigarettes at least once in the last 7 days and present to an outpatient pediatric clinic for a scheduled appointment. Our recruitment target is 100 participants: 50 parents or guardians of children aged 17 years or younger, and 50 adolescents aged between 14 and 17 years. The feasibility of implementation of the CEASE model will be measured by recruitment and retention rates for all 4 participant groups (stratified as follows: parents who use cigarettes, parents who use e-cigarettes exclusively, adolescents who use cigarettes, and adolescents who use e-cigarettes exclusively). Parent and adolescent participants within each group are randomized to the intervention and control groups using a 1:1 ratio through a computer-generated randomization list. Preliminary effectiveness outcomes include self-reported smoking and e-cigarette cessation, use of cessation resources, changes in smoking and e-cigarette use, motivation to quit, and quit attempts among participants. Participants complete electronic questionnaires on a tablet in the clinic at baseline as well as electronic follow-up questionnaires at 1, 3, and 6 months. Individuals reporting successful quit attempts are invited to provide a urine sample for cotinine testing to biochemically confirm quit. Analyses include descriptive statistics as well as exploratory trajectory analyses of smoking, e-cigarette use, and motivation to quit. Research activities began in June 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 15 months. There is a strong need for effective and cost-effective smoking and vaping cessation interventions for parents and adolescents. If successful, this study will help inform the preparation of a fully powered randomized controlled trial of CEASE in Canada in these populations. Clinicaltrials.gov NCT05366790; https://www.clinicaltrials.gov/study/NCT05366790. DERR1-10.2196/47978.

Standardising personalised diabetes care across European health settings: A person-centred outcome set agreed in a multinational Delphi study.

Standardised person-reported outcomes (PRO) data can contextualise clinical outcomes enabling precision diabetes monitoring and care. Comprehensive outcome sets can guide this process, but their implementation in routine diabetes care has remained challenging and unsuccessful at international level. We aimed to address this by developing a person-centred outcome set for Type 1 and Type 2 diabetes, using a methodology with prospects for increased implementability and sustainability in international health settings. We used a three-round questionnaire-based Delphi study to reach consensus on the outcome set. We invited key stakeholders from 19 countries via purposive snowball sampling, namely people with diabetes (N = 94), healthcare professionals (N = 65), industry (N = 22) and health authorities (N = 3), to vote on the relevance and measurement frequency of 64 previously identified clinical and person-reported outcomes. Subsequent consensus meetings concluded the study. The list of preliminary outcomes was shortlisted via the consensus process to 46 outcomes (27 clinical outcomes and 19 PROs). Two main collection times were recommended: (1) linked to a medical visit (e.g. diabetes-specific well-being, symptoms and psychological health) and (2) annually (e.g. clinical data, general well-being and diabetes self management-related outcomes). PROs are often considered in a non-standardised way in routine diabetes care. We propose a person-centred outcome set for diabetes, specifically considering psychosocial and behavioural aspects, which was agreed by four international key stakeholder groups. It guides standardised collection of meaningful outcomes at scale, supporting individual and population level healthcare decision making. It will be implemented and tested in Europe as part of the H2O project.

Community-based care for people with chronic knee and hip pain: Preliminary clinical outcomes and healthcare utilisation for ESCAPE-pain.

Joint pain impairs physical and psychosocial wellbeing, quality of life (QoL) and has a significant socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain using Exercise, ESCAPE-pain, is a rehabilitation programme that mitigates the wide impacts of joint pain. Financial, logistical and workforce constraints in health systems severely limit access to the programme. Delivering the programme by trained exercise professionals in community venues could increase access and reduce costs. Four hundred eighty-two exercise professionals were trained to deliver ESCAPE-pain at community sites to people >55years with chronic knee or hip pain. Pain, physical function, QoL, self-reported activity, mental wellbeing and healthcare utilisation (consultations, investigations, treatments, medication) were measured before, immediately after and 6months after the programme. One thousand four hundred ninety-two people (mean age 70years) were recruited. ESCAPE-pain improved pain, function, QoL, mental wellbeing and objective physical function (p<0.0001). Before the programme, only 24% of participants were classified as 'fairly active/active' (doing ≥30min activity/week); after the programme, 78% were classified as 'fairly active/active'; 6months later, 69% were still 'fairly active/active'. Participants used less healthcare after ESCAPE-pain, resulting in savings of £326.16/participant. Older people with chronic joint pain were willing to attend ESCAPE-pain when delivered by exercise professionals in community centres, and it was found to be as effective as when delivered by physiotherapists in hospitals. Delivering ESCAPE-pain in the community could facilitate access to effective care and on-going support to sustain the benefits of healthcare programmes, producing a more efficient use of health and community resources.

The GenderCOS project: study protocol for the development of two international Core Outcome Sets for genital gender affirming surgery

Background: Worldwide an increasing number of transgender and gender diverse individuals are requesting genital Gender Affirming Surgery (gGAS). For both masculinizing and feminizing gGAS various procedures and techniques are employed. Current literature on gGAS reports heterogeneous, non-standardized and often ill-defined outcomes. Presently, no consensus exists on what outcomes should be evaluated in order to assess the clinical results and the effectiveness of these procedures, which precludes development of evidence-based treatment guidelines. Aims: This international consensus study aims to develop Core Outcome Sets (COS) for both masculinizing and feminizing gGAS. These represent the minimum sets of outcomes recommended to be measured and reported in all clinical trials pertaining to gGAS. Methods: Two Core Outcome Sets for masculinizing and feminizing gGAS will be developed in parallel by following the Core Outcome Measures in Effectiveness Trials (COMET) guidelines. The stages of development for each set are: i) Identify outcomes measured and reported in previous research through a systematic review of the literature; ii) Identify outcomes suggested by transgender and gender diverse individuals during focus groups and interviews; iii) Combine and structure the outcomes into a preliminary outcome list; iv) Conduct e-Delphi surveys among stakeholders (i.e. professionals in transgender healthcare and transgender individuals) in which all potential outcomes will be rated on level of importance; and v) Decide on the final COS during an online consensus meeting. Discussion: This study will produce minimum, core sets of relevant outcomes for gGAS, through reaching international consensus with key stakeholders, including transgender individuals. Development of these COS will enable the measurement and reporting of relevant and standardized outcomes, facilitating continued scientific advancement of this field.

Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes

Simultaneous Bilateral Video–Endoscopic Inguinal Lymphadenectomy for Penile Carcinoma: Surgical Setting, Feasibility, Safety, and Preliminary Oncological Outcomes

Dental Age Estimation Methods Tested in a Sample of the Pakistani Population: Cross-Sectional Study

Forensic dentistry is still an emerging field in Pakistan. The lack of scientific literature on the topic may lead to difficulties in situations where age estimation has a significant part such as in criminal and civil litigation. In mass disasters such as earthquakes and accidents, the correct investigation of the chronological age can be less troublesome if population-specific evidence is available. This is the rationale that justifies dedicated dental age estimation studies. This cross-sectional study aimed to test the time efficiency, validity and applicability of four dental age estimation methods: two invasive (Bang and Ramm and Lamendin) and two non-invasive (Kvaal and Cameriere) in an adult Pakistani population. A total of 37 teeth collected from a dental hospital in Islamabad, Pakistan, were used. Teeth included the central and lateral incisors, canines, and first and second premolars of males and females. Results were calculated using a Microsoft Office 2007 excel spreadsheet. Overall, Kvaal’s method mean absolute error between chronological and estimated ages (MAE: 12.33) showed the highest variation and Bang and Ramm showed more accurate results in comparison with other methods (MAE: 4.80). It was both time-efficient and practical to use. It can be stated that these were preliminary cross-sectional outcomes and that studies with larger samples are necessary.

Patient Confidential Data Hiding and Transmission System Using Amplitude Quantization in the Frequency Domain of ECG Signals.

The transform domain provides a useful tool in the field of confidential data hiding and protection. In order to protect and transmit patients' information and competence, this study develops an amplitude quantization system in a transform domain by hiding patients' information in an electrocardiogram (ECG). In this system, we first consider a non-linear model with a hiding state switch to enhance the quality of the hidden ECG signals. Next, we utilize particle swarm optimization (PSO) to solve the non-linear model so as to have a good signal-to-noise ratio (SNR), root mean square error (RMSE), and relative root mean square error (rRMSE). Accordingly, the distortion of the shape in each ECG signal is tiny, while the hidden information can fulfill the needs of physiological diagnostics. The extraction of hidden information is reversely similar to a hiding procedure without primary ECG signals. Preliminary outcomes confirm the effectiveness of our proposed method, especially an Amplitude Similarity of almost 1, an Interval RMSE of almost 0, and SNRs all above 30.

Mapping Local Climate Zones in Lausanne (Switzerland) with Sentinel-2 and PRISMA imagery: comparison of classification performance using different band combinations and building height data

ABSTRACT The Local Climate Zone (LCZ) concept has emerged as a valuable classification system for climate-related studies. The World Urban Database and Access Portal Tools (WUDAPT) protocol provides a framework for generating a LCZ segmentation which relies on the supervised classification of multispectral imagery. However, since LCZ is based on the physical and thermal properties of the urban surfaces, more insightful information on the surface reflectivity characteristics – which is provided by hyperspectral sensors – may be beneficial for improving the LCZ classification. This assumption is investigated in this study by comparing the classification performance of a supervised algorithm applied to multispectral (Sentinel-2) and hyperspectral (PRISMA) satellite imagery. The study area is the city of Lausanne (Switzerland). Experiments are performed considering these sensors and different band combinations, including the building height layer as an additional band. Preliminary outcomes show that PRISMA imagery yields satisfying results in terms of classification accuracy while not outperforming Sentinel-2. An improvement is achieved by leveraging the first 10 PRISMA Principal Components which allows to retain the uncorrelated information out of the original bands. These first results will be validated in future investigations by improving image pre-processing and exploiting a larger number of seasonal PRISMA acquisitions.

Atrial fibrillation virtual ward - a hospital is not always the best place to be

Abstract Background Atrial fibrillation (AF) continues to represent a global health challenge. Our ability to prolong our lives has inevitably led to an increase in the incidence of AF, with subsequent increase in AF-related hospitalisations. With at least 92% of the global population having access to a digital telecommunication medium, virtual wards could be the way forward for managing acute AF patients. Purpose We implemented a virtual ward for hospital patients presenting with fast AF or atrial flutter (AFL), aiming to provide remote hospital-level care. Methods Patients presenting acutely with AF/AFL to the hospital were onboarded to the virtual ward and managed remotely at home, after being given access to a single-lead ECG device, a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and to complete an online AF symptom questionnaire via a smartphone app. Data were uploaded to a digital platform for daily review by the clinical team. Admissions were either "step-up", where patients were onboarded to the virtual ward instead of hospitalisation, or "step-down" where early hospital discharge was facilitated through virtual ward support. Outcomes included hospitalisations avoided, bed-days saved and destination therapy plans (defined as electrical cardioversion, catheter ablation, or AV nodal ablation). Patients' satisfaction was assessed using the NHS Friends and Family test (FFT) and free-text narrative feedback. Results There were 118 virtual admissions between Jan 2022 – Jan 2023. Sixty-six (55%) of them avoided initial hospital admission as patients were directly enrolled to the virtual ward from outpatient settings. A further 61 re-admissions were appropriately prevented during virtual surveillance. Hence, avoiding a total of 127 unplanned hospitalisations, saving a median of 444 days (assuming a median hospital stay of 3.5 days per AF admission). The mean age on onboarding to the virtual ward was 66 ± 10 years. Mean HR at the time of onboarding and offboarding was 124 ± 22 and 84 ± 24 bpm respectively (P&amp;lt;0.0001; 95% CI= -47 to -34). A rhythm control strategy was pursued in 75% (n=88, P&amp;lt;0.0001), and 65% (n=75, P&amp;lt;0.0001) were referred for destination therapy. The FFT questionnaire yielded 100% positive responses among participants. Positive feedback themes focused on avoiding hospital stay and active participation in care plans, whilst the main negative comments addressed initial difficulty with technology and expressed the need for more instant communication. There were 5 unplanned discharges from the virtual ward requiring hospitalisation. Conclusion Our preliminary outcomes demonstrate a promising foundation for a reproducible model of healthcare delivery that provides an alternative to the traditional in-patient care for patients with AF. Thus, reducing the huge associated economic burden on healthcare without compromising on patients’ care or safety.AF virtual ward referral criteriaThe new Clinical Pathway

Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation.

Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center. A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation. Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings. Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.

Feasibility and Proof-of-Concept of Delivering an Autonomous Music-Based Digital Walking Intervention to Persons with Parkinson's Disease in a Naturalistic Setting.

Reduced motor automaticity in Parkinson's disease (PD) negatively impacts the quality, intensity, and amount of daily walking. Rhythmic auditory stimulation (RAS), a clinical intervention shown to improve walking outcomes, has been limited by barriers associated with the need for ongoing clinician input. To assess the feasibility, proof-of-concept, and preliminary clinical outcomes associated with delivering an autonomous music-based digital walking intervention based on RAS principles to persons with PD in a naturalistic setting. Twenty-three persons with PD used the digital intervention independently for four weeks to complete five weekly 30-minute sessions of unsupervised, overground walking with music-based cues. The intervention progressed autonomously according to real-time gait sensing. Feasibility of independent use was assessed by examining participant adherence, safety, and experience. Intervention proof-of-concept was assessed by examining spatiotemporal metrics of gait quality, daily minutes of moderate intensity walking, and daily steps. Preliminary clinical outcomes were assessed following intervention completion. Participants completed 86.4% of sessions and 131.1% of the prescribed session duration. No adverse events were reported. Gait speed, stride length, and cadence increased within sessions, and gait variability decreased (p < 0.05). Compared to baseline, increased daily moderate intensity walking (mean Δ= +21.44 minutes) and steps (mean Δ= +3,484 steps) occurred on designated intervention days (p < 0.05). Quality of life, disease severity, walking endurance, and functional mobility were improved after four weeks (p < 0.05). Study findings supported the feasibility and potential clinical utility of delivering an autonomous digital walking intervention to persons with PD in a naturalistic setting.

Lymphedema Surgical Education and Faculty Demographics in United States Plastic Surgery Residency Programs.

Recent advancements in supermicrosurgery and promising preliminary outcomes have led to a surge in physiologic lymphedema surgery. This study is the first to evaluate lymphedema surgical education among U.S. plastic surgery residency programs, along with the background and experience of plastic surgeons subspecializing in the field. Cross-sectional evaluation of 103 accredited U.S. plastic surgery residency programs was performed in January 2023. Web-based searches of program curricula, faculty profiles, and main institutional pages indicated whether a program provided nonclinical or clinical exposure to lymphedema surgery. Review of online faculty profiles, surname searches, Doximity, and Scopus determined the perceived demographics, academic productivity, and procedures performed by lymphedema surgeons. Compared with the 11 programs that incorporated lymphedema surgery into their online curriculum, 67 programs had a rotation site with a surgeon performing lymphedema procedures. Of the 33 programs without evidence of clinical exposure, 76% (n = 25) did not provide or specify providing elective time. Faculty perceived to be female or a race underrepresented in plastic surgery had significantly more assistant professor titles (p < 0.0214) and significantly fewer years of experience (p < 0.0293) than their counterparts. Great variation in lymphedema surgical education exists among U.S. plastic surgery residency programs. While few programs incorporate lymphedema surgery into their advertised curriculum, programs without clinical exposure frequently did not provide elective time to obtain it. Faculty that were female or a race underrepresented in plastic surgery were most often early in their career, suggesting lymphedema surgeons may grow increasingly diverse in years to come.

Treatment of Maxillary Gingival Recessions Using the Modified Coronally Advanced Tunnel Technique in Combination with a Volume-Stable Collagen Matrix: A Prospective Case Series with a 12-Month Follow-up

The aim of this case series was to evaluate the clinical performance of a new volume-stable collagen matrix (VCMX) in combination with the modified coronally advanced tunnel technique (MCAT) for the treatment of gingival recessions. Thirteen patients with a total of 33 maxillary RT1 single and multiple gingival recessions were included in the study. Probing pocket depth (PPD), recession width (RECW), recession depth (REC), height of keratinized tissue (HKT), and gingival thickness (GT) were assessed at baseline and at the 12-month follow-up. Postoperative healing was uneventful in all cases without any complications. At 12 months, mean root coverage (MRC) was 92.88%, with complete root coverage (CRC) in 87.88% of treated sites. The present findings suggest that VCMX in combination with MCAT results in predictable coverage of maxillary RT1 gingival recessions. Further studies with larger sample sizes and control groups are needed to support these preliminary outcomes.

Effectivness and Safety of Orelabrutinib in Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma: A Retrospective, Real-World Study in China

Introduction: Orelabrutinib is a second-generation Bruton tyrosine kinase inhibitor (BTKi) with high kinase selectivity. Clinical studies have demonstrated that orelabrutinib achieved a high complete response rate of 26.3% in relapsed/refractory chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), showing promising efficacy and acceptable safety profile. However, the real-world data of Orelabrutinib are not available. This study aimed to evaluate the effectiveness and safety of orelabrutinib-containing regimens for the treatment of patients (pts) with CLL/SLL in a real-world setting. Methods: This was a retrospective, multi-center, real-world study conducted. Pts (aged 18 years or older) with CLL/SLL who received at least 3 months of orelabrutinib-containing regimens between December 2020 and March 2023 were analyzed. Efficacy was evaluated by hematologic response rate (HRR), defined as the proportion of pts who met at least 1 of the following hematologic response criteria: hemoglobin response (pts having a recovery of hemoglobin value or ≥50% increase from baseline), platelet response (pts having a recovery of platelet count or ≥50% increase from baseline), or lymphocyte response (pts having a recovery of lymphocyte count or ≥50% reduction from baseline). Safety was assessed by adverse events (AEs) as per NCI-CTCAE 5.0. Results: 24 pts with CLL/SLL (12 males; 22 CLL) were included, with a median age of 62.5 years (range: 38-82). Most pts had an Eastern Cooperative Oncology Group score of 0-1 (17/24, 70.8%) and Rai stage III or IV disease (16/18, 88.9%). 7 pts with hypertension, of which 2 with very high-risk hypertension. 3 pts have previously received other BTKi. A total of 9 pts(37.5%) performed del(17p), TP53, or IGHV testing. Among them, pts received orelabrutinib 100 mg (2/24,) or 150 mg (22/24,) once daily. As of the cut-off date (July 13, 2023), the median follow-up was 10.67 (range, 2.73-25.77) months. 18 pts (16 CLL, 2 SLL) with abnormal hemoglobin value, platelet count, or lymphocyte count at baseline were evaluable for hematologic response. Hematologic response was achieved in 11 (61.1%) of 18 evaluable pts. Pts aged &amp;lt;65 years had a higher HRR versus pts aged ≥65 years (87.5% vs. 40.0%, p=0.040). HRR was 56.3% in CLL versus 100.0% in SLL pts, and 60.0% in pts with hypertension versus 61.5% without hypertension . Four of 11 responders had a hematologic response in at least two criteria (CLL, n=3; SLL, n=1), of which 3 pts had a hemoglobin response (Figure 1). The most commonly reported AEs included hemoglobin decreased (16.7%) and platelet count decreased (16.7%). Grade ≥3 AEs were white blood cell count decreased (4.2%), platelet count decreased (4.2%), and lymphocyte count decreased (4.2%). No pts experienced severe AEs. No cardiovascular AEs were reported during treatment in 7 pts with hypertension at baseline. Conclusions: This real-world study assessed the preliminary characteristics and clinical outcome of patients receiving orelabrutinib-containing regimens under routine clinical practice conditions in China. The orelabrutinib-containing regimens in this study furnished beneficial evidence for the treatment of CLL/SLL and is essential for determining the best treatment option, future data with a larger sample and longer follow-up will be updated.

P076 - Preliminary Outcomes following Single-Dose Ablative Radiotherapy for Unfavorable Prostate Tumors

P076 - Preliminary Outcomes following Single-Dose Ablative Radiotherapy for Unfavorable Prostate Tumors

Preliminary outcomes of stem cell therapy in patients with non-obstructive azoospermia

Preliminary outcomes of stem cell therapy in patients with non-obstructive azoospermia

Abstract 079: Preliminary Outcomes of a Survivor‐Centric Digital Platform in Stroke Recovery

Introduction This study evaluates the feasibility of a survivor‐centric, navigator‐driven, and technology‐enabled platform supporting survivors and care partners in post‐stroke recovery. We hypothesize that post‐stroke navigation can favorably impact stroke recovery through monitoring medical and behavioral health factors, social needs assessment and support, curated educational content, evidence‐based interventions, and clinical guidance. Methods An app‐based, virtual care model was used to increase survivor quality of life and improve outcomes for stroke survivors. This mixed methods study utilizes both focus group feedback, survey, and patient‐reported outcomes data along with digital engagement. Participants (n=40) were facilitated by a clinical navigator (occupational therapist or licensed clinical social worker) through understanding lived experiences and health‐related motivators. Stroke survivors and their care partners, if they have one, were referred from one of four partner hospitals by the primary stroke team during the pilot program (starting July 2022) prior to their discharge. The Navigators worked through phone, messaging, and video calls with the stroke survivor and their care partner who had shared access within the app but had separate profiles. The duration of participation was a median of 12 weeks but could be as short as 2 weeks based on individual needs including post‐stroke impairments, social determinants of health, resource needs, education and health literacy, risk factors and lifestyle management, as well as mental health support. The average participant had 9 Navigator touchpoints totaling 6‐8 hours over the 12 weeks. Results In this feasibility study, clinician‐assessed mRS scores were captured at 90 days following hospital discharge for 95% of participants. This is similar to the results recently reported for another clinician‐supported, app‐based post‐acute platform in Spain. Significant functional improvement was seen over time, with 84% achieving mRS scores of 0‐2 at 90 days, compared to 60% of participants at the time of enrollment. 88% of enrollees completed the validated Take Charge Intervention. The 30‐ and 90‐day all‐cause readmission rates for survivors were 6% and 12%, respectively. This is superior to recent publications reporting 30‐day unplanned readmission rates after stroke ranging from 8.7%‐12.5%, and 90‐day readmissions ranging from 18.9% to 20.7%. Nearly all (96%) of the stroke survivors that participated in the program reported adherence to their medications, compared to a national average of 64%. At 90 days, 90% of enrollees had completed a neurology follow‐up visit. Among the 15% of participants who did not have a primary care physician (PCP) prior to their stroke, the Navigators were able to assist in establishing care with a PCP for all of them. The demographics reflect typical stroke populations: Ten percent of the enrollees were on Medicaid or uninsured at the time of their stroke, more than half were non‐white, and 20% had five or more needs related to social determinants of health. Conclusion This feasibility study demonstrates that a tech‐enabled healthcare services program can engage and impact the outcomes of individuals and care partners during stroke recovery.

The favorable outcome of Bernese periacetabular osteotomy for the hip osteoarthritis in multiple epiphyseal dysplasia

BackgroundMultiple epiphyseal dysplasia (MED) is a rare congenital bone dysplasia. Patients with MED develop secondary hip osteoarthritis as early as the third to the fourth decade. Currently, there is no consensus on the prevention of the progressive hip osteoarthritis secondary to MED. The Bernese periacetabular osteotomy (PAO) is a joint-preserving surgery to reshape acetabulum and extend femoral head coverage. However, there is no documentary evidence for the effect of the procedure on MED hips.Patients and methodsWe analyzed the preliminary outcomes following the Bernese PAO in 6 MED hips. The average age at the time of surgery was 14.3 years (range from 11.4 to 17.2 years). For our study interest of time efficiency, radiographic parameters were analyzed preoperatively and 1 year postoperatively. The hip function was evaluated by the Harris Hip Score (HHS) before and after surgery.ResultsThe mean follow-up time was 1.7 years. The mean lateral center–edge angle increased from 3.8° to 47.1° (p = 0.02), anterior center–edge angle increased from 7.3° to 35.1° (p = 0.02), and acetabulum index decreased from 27.8° to 14.6° (p = 0.04). The femoral head coverage ratio increased from 66.8% to 100% (p = 0.02). The post-operative anteroposterior pelvic radiograph demonstrated all preoperative broken Shenton lines were reversed. The mean HHS improved from 67.3 to 86.7 (p = 0.05).ConclusionBernese PAO is a feasible treatment for hip disorders in MED patients. It reshapes acetabular and femoral morphology efficiently. In our study, the preliminary results showed the procedure not only improved radiographic outcomes but also hip function.

Introducing sheep for agroecological weed management on banana plantations in Guadeloupe: A co-design process with farmers

CONTEXTIn Guadeloupe, the use of a persistent pesticide (chlordecone) contaminated one third of the island's agricultural soils, causing a major environmental crisis. In the aftermath, banana farmers significantly changed their management practices to decrease their pesticide use. With the support of research, farmers have tested and adopted various agroecological practices, such as planting cover crops and using vitroplants and fallow. However, the use of animals to decrease pesticide use on banana plantations has not yet been explored. OBJECTIVEThis study aimed to co-design agroecological cropping systems that integrate animals as an alternative means to manage weeds. METHODSThe study was based on co-design workshops involving farmers, advisors and scientists, a survey of local practices of integrating animals within cropping systems, on-farm experiments with four farmers during which a total of 20 four-month-old male lambs were introduced within their cropping systems, and reflexive monitoring two and six months after the end of the experiments. RESULTS AND CONCLUSIONSThe introduction of sheep into cropping systems was the option deemed the most promising after three co-design workshops. Animals already were integrated into some banana-based farming systems in the study area, but this integration mainly consisted of cattle grazing on fallow land. The on-farm experiments highlighted that sheep made it possible to reduce the herbaceous cover on banana plantations by almost 60%. The growth performance of the lambs allowed by the herbaceous cover was within the range observed for this breed when reared on pastures (50–139 g/day). In this experiment, the lambs were not reared for meat, since the animals were, unsurprisingly, contaminated by chlordecone. The farmers appreciated that the practice enabled them to eliminate a labor-intensive activity (removing by hand the vines around the banana pseudo-stem) and radically reduce brush cutting. Piloted by a technical institution providing farmers technical support, initial changes in the broader socio-technical regime were observed. SIGNIFICANCEThis study highlights a co-design process of agroecological cropping systems involving agronomists, animal scientists, and farmers that led to an innovative, animal-based method of managing weeds within banana cropping systems with positive preliminary adoption outcomes as new farmers start using the practice. Inspired by similar efforts in vineyards, cereal and oil palm plantations, it is one of the first attempts to introduce sheep into banana cropping systems. The challenge is now to support this adoption at the territorial scale through possible cooperation between breeders and farmers, the training of farmers, and finding a means to ensure the safety of sheep.

Multimodal agility-based exercise training (MAT) versus strength and endurance training (SET) to improve multiple sclerosis-related fatigue and fatigability during inpatient rehabilitation: a randomized controlled pilot and feasibility study [ReFEx

BackgroundMultimodal agility-based exercise training (MAT) is a group-based exercise training framework for persons with multiple sclerosis (pwMS) with a potential to impact fatigue and fatigability. In a mixed-methods design, this study evaluated the feasibility of implementing MAT in an inpatient rehabilitation setting and the feasibility of a randomized controlled trial (RCT) study protocol with ‘traditional’ strength and endurance training (SET) as an active control condition. Secondarily, preliminary outcome data was acquired.MethodsPwMS with low to moderate disability and self-reported fatigue were randomly allocated to either MAT or SET when starting inpatient rehabilitation (4–6 weeks). The MAT-participants exercised in a group following a MAT-manual (sessions were gym- (5x/week) and pool-based (3x/week)). SET-participants exercised individually 5x/week on a cycle ergometer, and 3x/week on strength training machines. Feasibility assessments focused on processes, resources, management, time, and scientific domains. Assessed clinical outcomes at admission and discharge included perceived fatigue, motor and cognitive fatigability, cognitive performance, motor function, and balance confidence. Perceived fatigue was reassessed 1, 4, and 12 weeks after discharge. Feasibility was determined regarding predetermined progression criteria.ResultsTwenty-two participants were randomized. Both groups performed the minimum number of sessions (> 18), and retention was adequate (73–91%). SET-participants performed more sessions than MAT-participants (30.8 vs. 22.7) and stayed longer in the facility (34.2 vs. 31.6 days). Non-eligibility of admitted pwMS was high (74% non-eligible), mainly due to high EDSS and inability to attend pool-based sessions. Consequently, recruitment (1.8/month) was slower than the predetermined progression criterium. Baseline assessments took longer than required (only 50% completed within 3 days). Short-term fatigue reduction was similar for both groups. Motor fatigability also improved in both groups, whereas cognitive fatigability deteriorated. In MAT, average improvement in walking endurance (43.9 m) exceeded minimal important change values for individuals (> 26.9 m).ConclusionsProgressing to a definitive RCT necessitates adaptation of eligibility criteria. In the present design it will also be difficult to attain similar dosing of interventions. A multicenter RCT focused only on gym-based MAT might be another option to assess the effect of MAT. The primary outcome measure should be able to measure change in perceived fatigue more robustly.Trial registrationGerman Clinical Trials Register: DRKS00023943, date of registration: 23 September 2021.