Management Program Research Articles

Characterization of spent nuclear fuel canister surface roughness using surface replicating molds

In this study we present a replication method to determine surface roughness and to identify surface features when a sample cannot be directly analyzed by conventional techniques. As a demonstration, this method was applied to an unused spent nuclear fuel dry storage canister to determine variation across different surface features. In this study, an initial material down-selection was performed to determine the best molding agent and determined that non-modified Polytek PlatSil23-75 provided the most accurate representation of the surface while providing good usability. Other materials that were considered include Polygel Brush-On 35 polyurethane rubber (with and without Pol-ease 2300 release agent), Polytek PlatSil73-25 silicone rubber (with and without PlatThix thickening agent and Pol-ease 2300 release agent), and Express STD vinylpolysiloxane impression putty. The ability of PlatSil73-25 to create an accurate surface replica was evaluated by creating surface molds of several locations on surface roughness standards representing ISO grade surfaces N3, N5, N7, and N8. Overall, the molds were able to accurately reproduce the expected roughness average (Ra) values, but systematically over-estimated the peak-valley maximum roughness (Rz) values. Using a 3D printed sample cell, several locations across the stainless steel spent nuclear fuel canister were sampled to determine the surface roughness. These measurements provided information regarding variability in normal surface roughness across the canister as well as a detailed evaluation on specific surface features (e.g., welds, grind marks, etc.). The results of these measurements can support development of dry storage canister ageing management programs, as surface roughness is an important factor for surface dust deposition and accumulation. This method can be applied more broadly to different surfaces beyond stainless steel to provide rapid, accurate surface replications for analytical evaluation by profilometry.

Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children

To evaluate the comparative effectiveness of allergy specialist care for children with asthma enrolled in the Arkansas Medicaid program. We used the Arkansas All-Payers Claims Database (APCD) to identify Medicaid-enrolled children with asthma who had an allergy specialist visit in 2018. These children were propensity score matched to children without an allergy specialist visit to evaluate differences in asthma-related adverse events (AAE), specifically emergency department visits and/or hospitalizations in 2019. Multivariable logistic regression was used to assess the association between allergy specialist care in 2018 and AAEs in 2019. Prior to matching, a higher percentage of children with an allergy specialist visit had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of identified patients experienced an AAE in 2019. Adjusted analysis showed 21.0% lower odds of AAEs (aOR: 0.79; 95%CI: 0.63, 0.98) in 2019 for children with an allergy specialist visit (n=2,964) in 2018 compared with those without an allergy specialist visit (ME: 9.1% vs 11.0%; p=0.04). Children with asthma enrolled in Arkansas Medicaid who saw an allergy specialist were less likely to have an AAE. Asthma quality metrics developed using guideline-based recommendations for allergy specialist care should be considered for asthma health management programs.

Provider Perspectives: Feasibility, Acceptability, and Appropriateness of Online Parent Training With Therapist Coaching in a Community Practice Setting

A considerable body of evidence documents the detrimental impact of disruptive behavior disorders (DBDs) in childhood and their longstanding effects across development and into adulthood. While research has yielded evidence-based interventions for DBDs, such as parent management training, disparities in access to care persist. The growing ubiquity of consumer technologies underscores the potential to provide evidence-based treatments through online programs; however, structural barriers continue to impede dissemination in community settings. This paper examines clinic staff’s perspectives on the implementation of an online parent management program in a community mental health center (CMHC) to integrate novel programming with existing therapeutic care to maximize resource efficiency in treatment delivery and increase family adherence and engagement. Quantitative and qualitative data were collected from 16 staff members who were trained to deliver the intervention at a CMHC. Quantitative data indicated positive perceptions across various domains, while qualitative findings highlighted feasibility, acceptability, and appropriateness. Facilitators to feasibility included program ease, integration into sessions, and flexible access. Time constraints and technology access were barriers. Acceptability was high, with videos reinforcing therapy and promoting family connection. The program’s structure and psychoeducation were appreciated, while quiz format and time constraints were concerns. Appropriateness was positive, with broad relevance, insight-building impact, comprehensive coverage, evidence-based strategies, and support. Barriers existed for specific patient characteristics. Implications for implementation in practice and future directions of research are discussed.

LONG-TERM SELF-MANAGEMENT OF VAGINAL CUBE PESSARIES CAN IMPROVE SEXUAL LIFE IN PATIENTS WITH PELVIC ORGAN PROLAPSE

Pelvic organ prolapse (POP) is a widespread health issue that affects a significant proportion of women, particularly those who have experienced childbirth, undergone hysterectomy, or are postmenopausal. Objective: This study employs a secondary analysis to explore the long-term self-management of vaginal cube pessaries and its potential impact on sexual health in women with pelvic organ prolapse (POP). Methods: The retrospective observational study was conducted at Sandeman Provincial Hospital in Quetta from 01 August 2022 to 31 July 2023. The sample consists of 100 women diagnosed with pelvic organ prolapse who were treated with vaginal cube pessaries. Data was collected from the clinical records of patients who were part of the hospital’s pessary management program during the study period. Results: Data were collected from 100 participants. The majority of participants in this study were between the ages of 50 and 69 years (65%), with 75% of the women being postmenopausal. A significant portion of the population (60%) had more than two children, which is a common risk factor for pelvic organ prolapse. Most of the participants were diagnosed with moderate to severe prolapse, with 45% in Stage II and 30% in Stage III, indicating that the sample represents a range of prolapse severity, including advanced cases (Stage IV, 15%). Patient satisfaction with pessary self-management was generally high, with 50% of participants being highly satisfied and 30% moderately satisfied. Only 20% expressed dissatisfaction, which suggests that most women found self-managing their pessaries to be beneficial. Conclusion: This study concludes that long-term self-management of vaginal cube pessaries significantly improves sexual function and overall quality of life in women with pelvic organ prolapse.

Spatiotemporal variation and GeoDetector analysis of NDVI at the northern foothills of the Yinshan Mountains in Inner Mongolia over the past 40 years

The study of spatiotemporal variation and driving forces of the normalized difference vegetation index (NDVI) is conducive to regional ecosystem protection and natural resource management. Based on the 1982–2022 GIMMS NDVI data and 26 influencing variables, by using the Theil-Sen median slope analysis, Mann-Kendall (M-K) test method and GeoDetector model, we analyzed the spatial and temporal characteristics of vegetation cover and the driving factors of its spatial differentiation in the northern foothills of the Yinshan Mountains in Inner Mongolia. The NDVI showed a significantly increasing trend during 1982–2022, with a growth rate of 0.0091 per decade. It is further predicted that future change in NDVI will continue the 1982–2022 trend, and sustainable improvement will dominate in the future; however, 17.69% of vegetation will degrade, that is, NDVI will degrade instead of improvement.. The spatial distribution of the NDVI in the northern foothills of the study area was generally characterized by high in the east and low in the west. Annual precipitation (Pre), evapotranspiration (Evp), relative humidity (Rhu) and sunshine hours (Ssd) had > 70% explanatory power (73.5, 79.9, 79.0, and 74.9%, respectively). The explanatory power of edaphic factors was > 30%, whereas anthropogenic and topographic factors had little influence on the spatial variation of NDVI, with an explanatory power of < 30%. Thus, climatic factors were the dominant factors influencing the spatial variability of NDVI in the study area. The results of the interaction detector analysis showed nonlinear strengthening for any two factors, and the interaction between Rhu and barometric pressure had the highest explanatory power. There were optimal ranges or characteristics of each factor that promoted vegetation growth. This study investigated the differences in the explanatory power of different factors on the NDVI and the optimal range of individual factors to promote vegetation growth, which can provide a basis for the development of vegetation resource management programs.

Effect of an oncology care management program on ED visits in a rural Medicaid population.

175 Background: Optum’s Cancer Support Program (CSP) provides care management to members with cancer diagnoses facing healthcare barriers. CSP nurses educate members on symptom management, palliative care and advance care planning, address psychosocial needs and close gaps in care. Improving health equity and outcomes is a program priority. In 2023, Optum analyzed outpatient claims for 24,221 Medicaid members with cancer and found that rural members visit emergency departments (ED) 31% more than urban members. As part of a CSP quality and outcomes assessment, we aimed to understand CSP’s impact on ED utilization within a high-risk rural Medicaid population. Methods: Beginning 1/1/23, Medicaid members in rural zip codes with an active cancer diagnosis were stratified as high- or low-risk based on diagnosis and clinical factors. High-risk members were invited to participate in CSP and receive individualized telephonic care management. 2023 outpatient medical claims were evaluated, and rural ED visit rates were compared for high-risk CSP participants and non-participants for approximately 4 months (average CSP engagement) after CSP enrollment or identification (non-participants). Population demographics were tested via a Mood's median test; ED visits per thousand members per year (PTMPY)—engaged, non-engaged, and difference in means—was tested via a 10,000-iteration bootstrap. Results: The study population included 421 members stratified as high-risk. Of those, 38% (161) enrolled in CSP. Reasons for non-enrollment included inability to reach the member (61%) and member refused (39%). There were no statistically significant differences between the groups’ demographic composition (all variables had p ≥ 0.05). Under a 10,000-iteration bootstrap, there were 2,696 ED visits PTMPY, 80% CI [2,258, 3,150] in the participant group and 3,427 ED visits PTMPY, 80% CI [2,904, 3,974] in the non-participant group. The difference in means between the groups was 730 ED visits PTMPY, 80% CI [52, 1,421]. Conclusions: Rural Medicaid members enrolled in CSP experienced lower ED visit rates, suggesting that care management may be effective at reducing ED utilization within rural populations that lack access to wraparound oncology services. Limitations of this study include small sample size and potential enrollment bias. Further analysis is underway to increase the study sample size and identify other factors that may be impacted by care management, thereby improving healthcare equity.

Randomized Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors in Youth: A Feasibility Study

ABSTRACT Introduction Mobile health (mHealth) has the potential to reduce reliance on in-person healthcare visits, making monitoring of health, eating, and physical activity less burdensome. There is a great need to develop and test mHealth tools for pediatric weight loss programs to enhance clinical practice. This study aimed to test the feasibility of utilizing a tailored suite of mHealth components to augment an existing evidence-based in-person pediatric weight management program. Method Using a two-group randomized superiority trial design, participants who completed baseline measurement were randomized to Brenner Families in Training (Brenner FIT) or Brenner FIT + mHealth (Brenner mFIT), and follow-up measures were completed at 3 and 6 months. Feasibility was assessed in terms of screening, recruitment, randomization, retention, and the assessment process. Acceptability was assessed in terms of program completion, and implementation fidelity was assessed in terms of logging activity, frequency of self-monitoring, goal setting, and retention rate. Results Overall, 173 dyads were eligible for enrollment based on inclusion criteria. Twenty-five dyads consented to participate. Sixteen dyads completed baseline psychosocial questionnaires, eight dyads completed at least two 24-h dietary recalls, and 20 (youth) participants returned accelerometers. Of the 14 dyads who completed enrollment, seven dyads were each randomized into the intervention and control groups, with ten and five dyads retained at three and six months, respectively. A total of four caregivers and two youth who utilized the website for goal setting set at least one goal, all seven youth linked their activity tracker, and most downloaded at least one video (two youth) or podcast (six caregivers). Conclusions Our results suggest that the assessment protocol was overly burdensome, the intervention had low acceptability, and the study as designed was not feasible to complete. Future studies should evaluate barriers and facilitators to the uptake of mHealth.

Effectiveness of community-based hypertension management on hypertension in the urban slums of Haiti: A mixed methods study.

Hypertension is a leading contributor to mortality in low-middle income countries including Haiti, yet only 13% achieve blood pressure (BP) control. We evaluated the effectiveness of a community-based hypertension management program delivered by community health workers (CHWs) and physicians among 100 adults with uncontrolled hypertension from the Haiti Cardiovascular Disease Cohort. The 12-month intervention included: community follow-up visits with CHWs (1 month if BP uncontrolled ≥140/90, 3 months otherwise) for BP measurement, lifestyle counseling, medication delivery, and dose adjustments. Primary outcome was mean change in systolic BP from enrollment to 12 months. Secondary outcomes were mean change in diastolic BP, BP control, acceptability, feasibility, and adverse events. We compared outcomes to 100 age, sex, and baseline BP matched controls with standard of care: clinic follow-up visits with physicians every 3 months. We also conducted qualitative interviews with participants and providers. Among 200 adults, median age was 59 years, 59% were female. Baseline mean BP was 154/89mmHg intervention versus 153/88mmHg control. At 12 months, the difference in SBP change between groups was -12.8mmHg (95%CI -6.9, -18.7) and for DBP -7.1mmHg (95%CI -3.3, -11.0). BP control increased from 0% to 58.1% in intervention, and 28.4% in control group. Four participants reported mild adverse events. In mixed methods analysis, we found community-based delivery addressed multiple participant barriers to care, and task-shifting with strong teamwork enhanced medication adherence. Community-based hypertension management using task-shifting with CHWs and community-based care was acceptable, and effective in reducing SBP, DBP, and increasing BP control.

Roles of BUMDes in Increasing Village Income and Community Sustainability

General Background: Village-owned enterprises (BUMDes) play a crucial role in enhancing rural economic resilience in Indonesia. Specific Background:This study investigates the contributions of BUMDes Subur Makmur in Dukuhsari Village, Jabon District, to increasing Original Village Income (PADes). Knowledge Gap:Despite the potential of BUMDes, limited empirical evidence addresses the specific operational roles of BUMDes Subur Makmur in local economic development. Aims:This research aims to analyze the roles of BUMDes Subur Makmur as a facilitator, mediator, and motivator in enhancing PADes. Results:Findings reveal that BUMDes Subur Makmur effectively facilitates access to capital through savings and loans, mediates essential services like PPOB, and motivates community participation in waste management through its integrated program (TPST). Novelty: This study contributes to the literature by detailing the multidimensional roles of BUMDes in rural development. Implications: Strengthening BUMDes' operational capabilities is essential for maximizing their impact on local economies, highlighting the need for enhanced training and resources. Highlights: Role of BUMDes: Acts as a facilitator for local entrepreneurs by providing access to capital. Service Mediation: Enhances community access to essential utilities through integrated services like PPOB. Community Motivation: Encourages participation in sustainable practices via its integrated waste management program (TPST). Keywords: BUMDes, Original Village Income, Rural Development, Economic Resilience

Impact of a pilot advanced provider-based comprehensive management program to support patients with immunotoxicity-related adverse events in a cancer care setting.

31 Background: Immune checkpoint inhibitors (ICIs) have revolutionized the treatment of many types of cancers. Despite the clinical benefits of the targeted therapy, its use is associated with a spectrum of autoimmune side effects known as immune-related adverse events (irAEs). Toxicities are distinct from those associated with standard chemotherapy, and, if unrecognized and not managed aggressively, can become life-threatening. Early recognition and management of these toxicities, as well as approaches toward cautious retreatment following resolution is essential in clinical practice. Methods: As part of larger effort to provide efficient and proactive care to patients, advanced provider-based comprehensive management program was established in an academic hospital ambulatory setting to identify and manage the full spectrum of unique toxicities of patients receiving standard-of-care ICIs. The goal of the program was to manage patients with severe toxicity including seamless transitions of care between outpatient and inpatient settings to obviate the need for future acute care utilizations. The program provided real-time guidance to providers with clinical questions on use of ICIs, actively navigated patients with suspected immunotherapy toxicity and assessed ongoing education needs for both outpatient and inpatient services. A retrospective analysis of 2-year post implementation of the program was performed with inpatient to outpatient referrals as primary outcome and median length of stay and 30-day readmission rate as secondary outcomes. Results: A total of 388 inpatient admissions (222 Year-1 and 166 Year-2) were included. Preliminary analysis revealed a 25% decrease in immunotoxicity related inpatient admissions (admission rate decreased from 2.8 to 1.9) while patients treated with immunotherapy increased by 7%. The number of ambulatory encounters with the navigator increased by 40% (362 vs 509). The median length of stay for those on the dedicated program decreased by 27.3% (5.5 vs. 4 days) and the 30-day readmission rate decreased by 15.8% (24.3 vs. 20.5) from Year 1 to Year 2. Conclusions: Preliminary analysis suggests the program improved patient care, provided timelier follow-up and management, and reduced the delay to return to anti-cancer treatment. The ambulatory program provided proactive intervention, diagnosis, and management of immunotherapy related toxicities, preventing hospitalization and readmission to the hospital. Although initial findings suggest improved preliminary outcomes, further analysis is required to make any causal inference on the true and sustainable impact of the intervention.

Weight change and the risk of cardiovascular disease in patients with hypertension: A primary-care cohort study.

Weight control is a cornerstone of hypertension management. Therefore, it is important to understand the relationship of weight change to risk of cardiovascular disease (CVD) among patients with hypertension. We aimed to investigate the association of weight change with the risk of CVD, stroke, and myocardial infarction (MI) among patients with hypertension. We obtained the data from medical records of the Hypertension Health Management Program (HMPH) in Shenzhen, China. The present study included 221 454 individuals with hypertension. Weight change over two years was divided into loss ≥10%, loss 5-10%, stable (-5 ~ 5%), gain 5-10%, and gain >10%. Cox regression analyses were applied to assess the associations of weight change groups with the risk of CVD, stroke, and MI. Compared with the stable weight group (-5 ~ 5%), those with weight loss ≥10% had a higher risk of CVD (hazard ratio (HR) = 1.21; 95% confidence interval (CI) = 1.05-1.40) in the fully adjusted model. Weight gain >10% was significantly associated with a higher risk of CVD (HR = 1.17; 95% CI = 1.04-1.31). In the meanwhile, participants with weight loss ≥10% had significantly higher risks of stroke (HR = 1.20; 95% CI = 1.02-1.41). However, participants with weight gain >10% had an increased risk of MI (HR = 1.45; 95% CI = 1.15-1.82) in the fully adjusted model. Weight loss or weight gain were associated with higher risks of CVD. Management of patients with hypertension requires close monitoring and appropriate interventions to achieve optimal body weight to prevent adverse outcomes.

Physical and mental health trajectories: A longitudinal SF-36 analysis in Alpha-1 antitrypsin deficiency-associated COPD

BackgroundThe Short Form 36-Item Health Survey (SF-36) is a health-related quality of life (HRQoL) measure validated in people with chronic obstructive pulmonary disease (COPD). While physical health is often more impaired than mental health in people with COPD, research on alpha-1 antitrypsin deficiency (AATD)-associated COPD is limited. This longitudinal study examines changes in physical and mental health in individuals with AATD and associated factors. MethodsAnalyses included participants of AlphaNet, a disease management program for individuals with AATD-associated lung disease who are prescribed augmentation therapy. Norm-based SF-36 scores for mental and physical component summaries (MCS and PCS) and 8 scales were analyzed. Linear mixed models evaluated mean changes in SF-36 scores over time. ResultsThe study included 2165 participants (mean age 56.9 ± 10.0 years, 47.0 % female). At enrollment, mean PCS score was 37.5 ± 9.6, and mean MCS score was 51.9 ± 10.5. Mean mMRC dyspnea score was 2.3 ± 1.3; 54.6 % had ≥2 exacerbations annually, and 46.5 % used oxygen regularly. Average follow-up was 6.6 ± 3.2 years. The HRQoL remained stable; MCS improved by 0.16 points/year (p < 0.0001), while the PCS score declined by 0.49 points/year (p < 0.0001). Subscales followed similar trends. ConclusionsAt baseline, mental HRQoL scores were higher than physical HRQoL scores, indicating better mental health than physical health in this cohort with AATD-associated lung disease. Stable HRQoL with a slight improvement in mental scores over time and a small decrease in physical scores may be a unique feature of this cohort. Further studies are needed to correlate these findings with disease-specific instruments and patient physiology.

Solid waste characterization in the slum areas of Bagmati River—A case of Kathmandu, Nepal

Solid waste management (SWM) is a challenging environmental issue globally, with developing nations experiencing considerable difficulties in its efficient and effective implementation. Urban slum areas within these regions, particularly, have been reported to face unique challenges in SWM due to a combination of factors, including the low socio-economic status of residents, high population density, inadequate infrastructure, and a thriving informal economy. Despite these critical concerns, most SWM research in Nepal has concentrated on major cities and tourist hotspots. As a result, the condition of SWM in urban slum areas, typically found along the banks of major rivers in Nepal, remains a critical yet neglected aspect in research and policy discussions. This study, therefore, aims to evaluate SWM in the densely populated urban slum areas situated along the Bagmati River, a key river system in Kathmandu, the capital of Nepal. Four major slum locations within the central metropolitan area of Kathmandu—Sinamangal, Thapathali, Teku, and Balkhu—were selected for the study, and systematic random sampling and characterization of household solid waste was conducted. The results reveal that the average household solid waste generation rates in the four study sites were 155.32 g capita−1 d−1, 124.69 g capita−1 d−1, 149.9 g capita−1 d−1, and 218.44 g capita−1 d−1, respectively. Organic wastes was the most prevalent type, comprising 63.34% of the total waste, followed by paper and paper products (13.72%), plastics (12.15%), dirt and construction debris (5.57%), glass (4.31%), and other wastes (0.91%). Qualitative data from the survey revealed that although municipal waste management programs exist, awareness and participation among residents were limited. As a result, many households ended up managing their waste on their own, often in an unscientific manner polluting the river water in the vicinity. The study offers critical insights for policymakers, operators, and regulators in addressing the growing challenges of SWM. Findings are expected to aid in the sustainable management of solid waste along the river basin in central urban regions of the capital city. Under Nepal's new federal governance system, provincial and local governments are recommended to collaborate with all stakeholders, including households, to develop comprehensive, multimodal SWM strategies that also address the needs of slum areas.

Clinical and economic outcomes of a pharmacogenomics-enriched comprehensive medication management program in a self-insured employee population

Clinical and economic outcomes from a pharmacogenomics-enriched comprehensive medication management program were evaluated over 26 months in a self-insured U.S. employee population (n = 452 participants; n = 1500 controls) using propensity matched pre-post design with adjusted negative binomial and linear regression models. After adjusting for baseline covariates, program participation was associated with 39% fewer inpatient (p = 0.05) and 39% fewer emergency department (p = 0.002) visits, and with 21% more outpatient visits (p < 0.001) in the follow-up period compared to the control group. Results show pharmacogenomics-enriched comprehensive medication management can favorably impact healthcare utilization in a self-insured employer population by reducing emergency department and inpatient visits and can offer the potential for cost savings. Self-insured employers may consider implementing pharmacogenomics-enriched comprehensive medication management to improve the healthcare of their employees.

429 Implementation of Patient Blood Management Program Improves Blood Product Utilization in the Emergency Department

429 Implementation of Patient Blood Management Program Improves Blood Product Utilization in the Emergency Department

The relationship between patient-reported experience and patient-reported outcomes in patients with cancer.

248 Background: Measures of patient experience (PEX) and patient-reported outcomes (PRO) are used by health systems across the US to improve care delivery and quality of life, respectively. Despite their widespread use, little is known regarding the relationship between these two types of patient-generated data. From 2018 to 2023, we conducted a pragmatic type-II hybrid effectiveness/implementation study of an electronic health record (EHR)-embedded symptom management program (eSyM) across six diverse cancer centers. This project focused on patients who started chemotherapy (CHEMO) or had surgery (SURG) for a suspected or confirmed gastrointestinal, gynecologic, or thoracic malignancy. Methods: We conducted a cross-sectional study of adults who were eligible for either the control or intervention arm of the eSyM study to determine if patients who reported having an inferior care-team experience were more likely to report having worse symptoms. Participants completed a one-time survey via REDCap that included elements from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and the Patient-Reported Outcomes Measurement Information System (PROMIS). Analyses determined the extent to which PEX measures were associated with PRO measures by evaluating differences in mean PROMIS scores for those who rated their PEX highly vs. not highly. Results: In total, 1419 respondents reported having cancer for which they received care at a participating center: median age 66, 63% female, 5% black, 13% disabled, 66% married/partnered, 23% high school or less education, 22% somewhat-extreme difficulty paying bills. For both CHEMO and SURG patients, 82% rated their overall cancer care-team experience highly (top box score of 9-10). Compared to patients who did not rate their care-team experience highly, those who did reported better scores for depression, fatigue, anxiety, pain interference, physical function, and self-efficacy (Table). PROMIS values differed for other CAHPS measures too. Conclusions: Among patients receiving routine cancer care, there was a significant association between PEX and multiple PROs. Further investigation of the nature and strength of the association between PEX and PRO measures is warranted. If confirmed, this association could lead to the development of interventions that impact both patient satisfaction and quality of life. Clinical trial information: NCT03850912 . Mean difference in PROMIS scores for patients who rated their care-team experience highly versus not highly (P from two-sample T-test). CHEMO (N=889) SURG (N=530) Mean Diff 95%CI P value Mean Diff 95%CI P value Depression -2.7 -4.3, -1.1 0.001 -3.3 -5.3, -1.4 &lt;0.001 Anxiety -3.7 -5.4, -1.9 &lt;0.001 -3.6 -5.7, -1.5 &lt;0.001 Fatigue -2.3 -4.0, -0.5 0.011 -4.5 -6.8, -2.2 &lt;0.001 Pain interference -3.6 -5.3, -1.9 &lt;0.001 -4.7 -6.7, -2.7 &lt;0.001 Physical function 1.6 0.1, 3.1 0.042 3.5 1.4, 5.6 0.001 Self-efficacy 3.9 2.6, 5.2 &lt;0.001 6.4 4.6, 8.1 &lt;0.001

A one-year weight management programme for difficult-to-treat asthma with obesity: a randomised controlled study

BackgroundObesity-associated asthma results in increased morbidity and mortality. We report one-year asthma outcomes with the Counterweight-Plus weight management programme (CWP) compared to usual care (UC) in a single-centre, randomised, controlled trial in patients with difficult-to-treat asthma and obesity. Research QuestionCan CWP use result in improved asthma control and quality of life compared to UC at one-year in patients with difficult-to-treat asthma and obesity? Study design and methodsWe randomised (1:1 CWP:UC) adults with difficult-to-treat asthma and body mass index ≥30kg/m2. CWP with dietitian support: 12-week total diet replacement phase (850kcal/day low-energy formula); food reintroduction and maintenance phases up to one-year. Outcomes include Asthma Control Questionnaire (ACQ-6), Asthma Quality of Life Questionnaire (AQLQ) and healthcare usage. Minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ. ResultsOf 36 recruited, 29 attended at 52-weeks: 13 CWP, 16 UC. CWP resulted in greater weight change (median –14kg [IQR –15, –9]) compared to UC (2kg [-7, 8]; p=0.015) at 52-weeks. A greater proportion achieved MCID with CWP vs UC in AQLQ (71% vs 6% respectively; p<0.001). No between-group differences were observed in ACQ-6. Median exacerbation frequency reduced over 52-weeks with CWP from 4 (IQR 2, 5) to 0 (0, 2) (p<0.001), though no between-group difference was observed. 70% of the CWP group lost ≥10% body weight and had improvement in ACQ-6 (mean difference –1.1, 95%CI –1.9, -0.3; p=0.018) and AQLQ (1.2, 95%CI 0.4, 2.1; p=0.011) across 52-weeks. InterpretationUse of a dietitian-supported weight management programme results in sustained weight-loss and is a potential treatment for obesity in asthma. CWP resulted in a higher proportion achieving MCID improvement in AQLQ compared to UC. Within group differences in AQLQ and exacerbation frequency suggest potential with CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.

Determining direct, indirect healthcare and social costs for diabetic retinopathy management: a systematic review

IntroductionDiabetic retinopathy (DR) is a rapidly growing global public health threat; it affects 1 in 3 people with diabetes and is still the leading cause of blindness among the working-age population. The management of diabetic retinopathy is becoming more advanced and effective but is highly expensive compared to other ocular diseases.AimTo report direct medical, indirect medical, and nonmedical costs of diabetic retinopathy in developed and developing countries through a systematic review.MethodsRelated articles published in the PubMed, Google Scholar, and EMBASE electronic databases from 1985 to 2022 were identified using the keywords direct medical and indirect medical and social costs of diabetic retinopathy. However, previous systematic reviews, abstracts, and case reports were excluded.ResultsThirteen articles were eligible for assessing the economic burden of diabetes management and its complications. Our analysis revealed that increasing prevalence and severity of diabetic retinopathy (DR) are associated with higher direct and indirect healthcare expenditures. The impact of DR on working-age adults, leading to irreversible blindness in advanced stages, underscores the urgent need for cost-effective prevention and management strategies.DiscussionThis study systematically reviewed the direct medical, indirect medical, and nonmedical costs of DR in developed and developing countries. Our findings highlight the significant economic burden of DR, emphasizing the importance of implementing effective prevention and management measures to alleviate costs and enhance patient outcomes.ConclusionThe substantial financial burden of DR necessitates a re-evaluation of current screening and management programs. Revision of these programs is crucial to improve quality of care, reduce costs, and ultimately achieve Sustainable Development Goal 3, which aims to ensure good health and well-being for all.

Exploring perspectives on engagement in interactive virtual reality for chronic pain management: insights from a content analysis study

To investigate perspectives of people with chronic pain regarding aspects of immersive virtual reality (IVR) that enhance and reduce engagement and the outcomes of engagement in IVR. This content analysis was performed on data obtained through open-ended interview questions from a study aiming to understand the influence of IVR on chronic pain study at a research lab at a university. Participants included a sample of 20 adults who completed the parent study. Results highlight that presence, agency, customization, and novelty are important aspects that enhance engagement in IVR, with agency and presence being mentioned most frequently. Meanwhile, secondary effects of IVR and usability were said to reduce engagement with the IVR. Outcomes of engagement with IVR include enjoyment, mood elevation, relaxation/calming, a distraction from pain, and a loss of reality. This study provides an initial understanding of individuals’ perspectives of engagement with IVR in relation to chronic pain management. Health professionals using IVR to treat people with chronic pain can use these elements to facilitate engagement in their clients. Further research should be done to study the association between engagement in IVR and pain reduction to improve the development of IVR programs for chronic pain management.

Family Self-management Program for Hypertension Management and Sodium Consumption Adherence: A Parallel Randomized Control Trial Among Family Caregivers and People With Hypertension.

Hypertension (HTN) has become a serious health problem in developing countries. The family has an important role in maintaining blood pressure (BP) at home, and sodium diet compliance in people with HTN needs to be developed. Therefore, this research aimed to evaluate the effectiveness of a family self-management program (FSMP) in HTN management and compliance with sodium consumption in rural areas of Indonesia. Study Design: A parallel-group, single-blind randomized controlled trial. One hundred twenty-six eligible participants were randomly allocated to an intervention (n=63) and a control group (n=63). Participants in the intervention group received a 24-week (6-month) FSMP intervention. The primary outcome measures included the systolic and diastolic BP, the Score Sodium Questionnaire (SSQ), and the Morisky Medication Adherence Scale 8 (MMAS-8). The Knowledge of Health Care for HTN questionnaire and the Efficacy and Behavior Toward Health Care for Patients with HTN questionnaire were used to assess the secondary outcome. The final results were analyzed from 121 participants (n=61 intervention and n=60 control group). The repeated analysis of variance (ANOVA) test results demonstrated significant effects on the management of HTN and adherence to sodium consumption as indicated by systolic (P=0.004) and diastolic BP (P=0.006), SSQ (P<0.001), MMAS 8 (P<0.001), caregivers' knowledge (P<0.001), caregivers' self-efficacy (P<0.001), and caregivers' behaviors (P=0.005). The FMSP emerges as a promising strategy for managing BP and adherence to sodium consumption in people with HTN through the support of family caregivers and selfmanagement activities.