Prospective Cohort Feasibility Study Research Articles

Safe transition home after transcatheter aortic valve implantation feasibility (START-F) study: Very early self-reported function and recovery status after early discharge

Abstract Background Despite significant excellent outcomes and significant improvements in rapid recovery protocols and early discharge, rates of 30-day readmission after transcatheter aortic valve implantation (TAVI) remain stubbornly high. There can be numerous drivers for readmission in older people with valvular heart disease; the time of transition home is the period of greatest risk when patients are most vulnerable to repeat hospitalization. We sought to assess patients’ early recovery (< post-procedure day 3) to inform the evaluation of a nurse-led telephone intervention to mitigate the risks of 30-day readmission after early (1 day) discharge TAVI. Methods We conducted a prospective observational cohort feasibility study in five Canadian TAVI programs to ascertain acceptability, compliance, delivery of the intervention, recruitment and retention. In this preliminary report, we assessed key indicators of patients’ status at the time of discharge and functional status in their early recovery. Results We recruited 188 participants, mean age 81.6 years (SD=7.0), 41.5% women with baseline mean KKCQ 53.4 (SD=20.1). Patients were admitted on the day of the procedure, and underwent TAVI with a balloon-expandable (n=146, 77.6%) or self-expanding (n=30, 16.0%) device, with local anaesthesia +/- light sedation (n=171, 90.1%) or general anaesthesia (n=17, 9.0%). There was 1 in-hospital death (0.5%) and 182 (97.4%) were discharged home. At the time of the 3-day telephone follow-up, 168 (95.5%) reported that an individual had stayed with them during the first 24 hours [spouse: 85 (48.9%); friend: 77 (44.3%)], and 165 (93.3%; missing: 11) were able to complete all activities of daily living, including cooking their own meals (n=80, 45.5%). Self-reported energy was low/very low for 49 participants (26.1%), moderate for 93 (52.8%), and high/very high for 34 (18.1%), with 104 (55.3%) describing feeling somewhat or quite a bit better than before TAVI, and 24 (12.8%) somewhat or quite a bit worse. Bruising was present in 120 participants (68.6%) and 137 (78.8%) had removed their bandage as instructed. 18 participants were readmitted within 30 days, including 14 cardiac-related events. Conclusion This is one of the first reports of TAVI patients’ self-reported function following next-day discharge, providing novel evidence that most patients describe safe self-care and very early improved functional status. Research is needed to identify and support patients who are at higher risk of poorer trajectories of recovery and readmission, and report the feasibility of a nurse-led intervention to mitigate these risks.

Swiss chiropractic cohort (Swiss ChiCo) pilot study: feasibility for a musculoskeletal cohort study conducted within a nationwide practice-based research network

PurposePractice-based research networks are collaborations between clinicians and researchers to advance primary care research. This study aims to assess the feasibility for longitudinal data collection within a newly established chiropractic PBRN in Switzerland.MethodsA prospective observational cohort feasibility study was performed. PBRN participating chiropractors were asked to recruit patients seeking new conservative health care for musculoskeletal pain from March 28, 2022, to September 28, 2022. Participants completed clinically oriented survey questions and patient-reported outcome measures before the initial chiropractic assessment as well as 1 h, 2 weeks, 6 weeks, and 12 weeks thereafter. Feasibility was assessed through a variety of process, resource, and management metrics. Patient clinical outcomes were also assessed.ResultsA total of 76 clinicians from 35 unique primary care chiropractic clinics across Switzerland participated. A total of 1431 patients were invited to participate, of which 573 (mean age 47 years, 51% female) were enrolled. Patient survey response proportions were 76%, 64%, 61%, and 56%, at the 1-h, 2-, 6-, and 12-week survey follow-ups, respectively. Evidence of an association was found between increased patient age (OR = 1.03, 95%CI 1.01–1.04), patient from a German-speaking region (OR = 1.81, 95%CI 1.17–2.86), non-smokers (OR = 1.89, 95%CI 1.13–3.17), and increased pain impact score at baseline (OR = 1.18, 95%CI 1.01–1.38) and response to all surveys.ConclusionThe Swiss ChiCo pilot study exceeded its prespecified feasibility objectives. Nationwide longitudinal data capture was highly feasible. Similar to other practice-based cohorts, participant retention remains a challenge.Trial registration Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).

Pilot Study of Intensive Trismus Intervention Using Restorabite™ During Unilateral Adjuvant Radiation for Head and Neck Cancer

Trismus commonly arises after surgery for head and neck cancer (HNC) and its severity is potentiated by postoperative radiotherapy. While the benefit of trismus rehabilitation after surgery and radiotherapy is well established, the evidence during radiotherapy is less clear. This may be due to poor adherence to trismus exercises secondary to acute mucositis. This study assessed the feasibility of using a novel trismus device during adjuvant radiotherapy for HNC in patients with acute postoperative trismus. Prospective single-arm cohort feasibility study. Eligible patients had undergone surgery with curative intent for HNC, planned for adjuvant radiotherapy, and were suitable for trismus rehabilitation. Participants completed a 10-week exercise program using a novel jaw stretching device. Study outcomes were adherence, maximal incisal opening (MIO), and trismus-related function and quality of life scores, assessed at baseline, 10 weeks, and 6 months after commencing exercises. Nine patients diagnosed with trismus after primary surgery were recruited. The mean increase in MIO at 10 weeks was 7.8 mm (range −4 to 15 mm, p = 0.03), and at 6 months was 10.6 mm (range 1–26 mm, p = 0.03). Significant improvements were observed in trismus-related quality of life (Gothenburg Trismus Questionnaire; p = 0.04). Adherence to the exercises was 100% in week 1–2, 67% in weeks 3–6, and 100% at 10 weeks (1 month post radiation). This study demonstrates the feasibility of using a novel jaw stretching device during adjuvant radiotherapy. Further evaluation is warranted to assess the effectiveness of early intervention and prevention of trismus during HNC radiotherapy.Level of Evidence: IV

Evaluation of an Elective Induction Protocol at a Regional Tertiary Obstetric Care Centre

ObjectivesTo evaluate the safety of elective induction (EI) at or beyond 39 weeks gestation in the setting of a regional tertiary obstetric care centre. MethodsWe conducted a prospective cohort feasibility study of low-risk pregnant women who delivered at a regional tertiary obstetric care centre. We compared maternal and neonatal outcomes of low-risk pregnant women who opted for EI at or beyond 39 weeks gestation (n = 112) to a comparison group who opted for expectant management (n = 116). All deliveries occurred between May 1, 2019, and November 30, 2019, and February 15, 2020, and August 15, 2020. ResultsThere were no significant differences in the rates of cesarean deliveries or hypertensive disorders between women who underwent EI and those who chose expectant management. There were also no differences in neonatal outcomes. Women in the EI group received significantly more cervical ripening agents (P < 0.0001) and had significantly longer stays on the antepartum (P < 0.0001) and labour and delivery units (P = 0.0015) but experienced significantly shorter stays on the postpartum unit (P = 0.0368). There was no difference in the total length of hospital stay between groups. ConclusionsEI protocols can be safely implemented in our regional tertiary obstetric care centre without increased risk of maternal complications or neonatal morbidity. Women considering EI should be adequately counselled on the use of cervical ripening agents and length of stay on antepartum and labour and delivery units.

Feasibility and acceptability of a telemedicine triage model among Medicaid patients with low back pain referred to a spine center

BackgroundThe data for primary triage via telemedicine for spine related conditions are sparse but has potential to improve access, quality of care, and offer significant cost savings for Medicaid insured patients who have very limited access to care. The purpose of this study was to evaluate the feasibility and acceptability of implementing a telehealth triage framework using synchronous video conferencing appointments. MethodsThis is a prospective cohort feasibility study conducted within an academic spine center in the United States. Participants include Medicaid insured patients referred to an academic spine center for low back pain. We collected demographic information, a spine red flag survey, a patient satisfaction survey and demand and implementation feasibility metrics. Participants completed a demographic and red-flag survey followed by a telehealth spine appointment with a physiatrist. Immediately after the appointment, the participant completed a satisfaction survey. ResultsNineteen patients met inclusion criteria but declined telehealth either due to preference for in-person appointment or lack of comfort with technology. Thirty-three participants enrolled and attended their initial telehealth appointment. Few participants reporting 1 or more red flag symptom also screened positive during their subsequent telehealth evaluation with the physician (n=7/28). Participant satisfaction was high across all domains including ease of scheduling, efficiency of virtual check in, ability to report their symptoms fully and accurately to the provider, imaging review, explanation of diagnosis and treatment plan. Most participants (n=19/20, 95%) would recommend an initial telehealth appointment. ConclusionsThe telehealth framework used was feasible and provided an acceptable form of care for Medicaid patients who were interested and able to participate in this form of care. Our acceptability results are promising but should be interpreted with caution given the proportion of patients who declined to participate.

Feasibility of patient-controlled analgesia (PCA) for rural and remote transfers.

In rural Canada, the majority of prehospital care is provided by basic life support paramedics, who cannot administer opioids or parenteral analgesics. Patients requiring transfer to a higher level of care have limited options for pain control. We aim to determine if ambulance-based patient-controlled analgesia (PCA) is feasible during inter-facility transfers. This is a prospective non-consecutive cohort feasibility study conducted in the East Kootenay region of British Columbia from 2016 to 2020. Patients in acute pain from an illness or injury requiring an opioid and transfer to a higher level of care were offered PCA. The study used respiratory depression as a marker of safety, assessed if PCA during transport provided efficacious analgesia, measured satisfaction scores from patients and paramedics, and tracked adverse events. 84 patients received PCA. The majority had orthopaedic trauma and the average transfer time was 3h 22min. The average pain score at the start and end of the transfer was unchanged, at 4 out of 10. Patient and paramedic satisfaction scores at the end of the transfer were 4.6 and 4.7 out of 5, respectively. Three out of the 84 patients (3.6%) had desaturation episodes below or equal to 90% oxygen saturation; however, all resolved with supplemental oxygen. Ambulance-based PCA is feasible and has a high level of satisfaction among paramedics and patients. It has significant potential for inter-facility transport in rural regions in Canada where ambulances are staffed with paramedics who cannot administer opioids or other parenteral analgesics.

Systolic Arterial Pressure Control Using an Automated Closed-Loop System for Vasopressor Infusion during Intermediate-to-High-Risk Surgery: A Feasibility Study.

Introduction: Vasopressor infusions are essential in treating and preventing intraoperative hypotension. Closed-loop vasopressor therapy outperforms clinicians when the target is set at a mean arterial pressure (MAP) baseline, but little is known on the performance metrics of closed-loop vasopressor infusions when systolic arterial pressure (SAP) is the controlled variable. Methods: Patients undergoing intermediate- to high-risk abdominal surgery were included in this prospective cohort feasibility study. All patients received norepinephrine infusion through a computer controlled closed-loop system that targeted SAP at 130 mmHg. The primary objective was to determine the percent of case time in hypotension or under target defined as SAP below 10% of the target (SAP < 117 mmHg). Secondary objectives were the percent of case time “above target” (SAP > 10% of the target or >143 mmHg) and “in target” (within 10% of the SAP target or SAP between 117 and 143 mmHg). Results: A total of 12 patients were included. The closed-loop system infused norepinephrine for a median of 94.6% (25–75th percentile: 90.0–98.0%) of case time. The percentage of case time in hypotension or under target was only 1.8% (0.9–3.6%). The percentages of case time “above target” and “in target” were 4.7% (3.2–7.5%) and 92.4% (90.1–96.3%), respectively. Conclusions: This closed-loop vasopressor system minimizes intraoperative hypotension and maintains SAP within 10% of the target range for >90% of the case time in patients undergoing intermediate- to high-risk abdominal surgery.

The safety and feasibility of early cardiorespiratory fitness testing after stroke.

Cardiorespiratory fitness testing is recommended as part of a pre-exercise evaluation to aid the programming of safe, tailored cardiorespiratory fitness training after stroke. But there is limited evidence for its safety and feasibility in people with stroke with varying impairment levels in the early subacute phase of stroke recovery. To assess the safety and feasibility of cardiorespiratory fitness testing in the early subacute phase after stroke. A sub-study of a larger single service, multi-site, prospective cohort feasibility study (Cardiac Rehabilitation in Stroke Survivors to Improve Survivorship [CRiSSIS]). Private subacute inpatient rehabilitation facilities. Consecutive admissions of people with ischemic stroke admitted to subacute rehabilitation facilities. Not applicable. Safety was determined by the occurrence of adverse or serious adverse events. Feasibility was determined by assessing the (1) number of participants recruited and (2) number of participants able to complete the fitness test. Between April 2018 and December 2019, a total of 165 people with stroke were screened to participate; 109 were eligible and 65 were recruited. Of the 62 who completed testing, 41 participants were able to complete a submaximal fitness test at a median of 12 days post-stroke. One minor adverse event was recorded. Of the 21 participants unable to complete the fitness test; 4 declined to complete the test, 9 were unable to commence the test, and 8 were unable to complete the first stage of the protocol due to stroke-related impairments. Participants with mild stroke, greater motor and cognitive function, and fewer depressive symptoms were more likely to be able to complete the cardiorespiratory fitness test. Cardiorespiratory fitness testing was safe for most people with mild-to-moderately severe ischemic stroke and transient ischemic attack in the early subacute phase, but only two-thirds of the participants could complete the test.

TEleRehabilitation Nepal (TERN) for People With Spinal Cord Injury and Acquired Brain Injury: A Feasibility Study.

BACKGROUND:Spinal Cord Injury (SCI) or Acquired Brain Injury (ABI) leads to disability, unemployment, loss of income, decreased quality of life and increased mortality. The impact is worse in Low-and Middle-Income Countries (LMICs) due to a lack of efficient long-term rehabilitative care. This study aims to explore the feasibility and acceptability of a telerehabilitation programme in Nepal.METHODS:Prospective cohort feasibility study in a community setting following discharge from a specialist rehabilitation centre in Nepal. Patients with SCI or ABI who had previously accessed specialist rehabilitation were connected to a specialist Multidisciplinary Team (MDT) in the centre through a video conference system for comprehensive remote assessments and virtual individualised interventions. Data were captured on recruitment, non-participation rates, retention, acceptability (via end-of-study in-depth interviews with a subset of participants) and outcome measures including the Modified Barthel Index (MBI), Depression Anxiety Stress Scale (DASS) and EuroQol-5D (EQ-5D), completed pre- and post-programme.RESULTS:97 participants with SCI (n = 82) or ABI (n = 15) discharged from the centre during an 18-month period were approached and enrolled on the study. The telerehabilitation programme facilitated the delivery of support around multiple aspects of rehabilitation care, such as spasticity treatments and pain management. Outcome measures indicated a significant improvement in functional independence (P < .001), depression, anxiety and stress (P < .001) and quality of life (P < .001). Qualitative interviews (n = 18) revealed participants found the programme acceptable, valuing regular contact and input from MDT professionals and avoiding expensive and lengthy travel.CONCLUSION:This is the first study in Nepal to identify telerehabilitation as a feasible and acceptable approach to augment the provision of specialist rehabilitation. Future research is needed to assess the suitability of the programme for other conditions requiring specialist rehabilitation and determine the mechanisms underpinning improved outcomes for people with SCI or ABI.TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT04914650

Myofunctional training with negative airway pressure for obstructive sleep apnea: a prospective non-randomized cohort feasibility study

Background: Orofacial myofunctional therapy (OMT), for obstructive sleep apnea (OSA) is emerging with recognition of specific phenotypes. Since many OSA sufferers are already familiar with positive airway pressure machines, we designed an OMT protocol involving the modification of such a machine to deliver negative airway pressure. We hypothesized that a three-month trial of using this protocol while awake would reduce the signs and symptoms of OSA. Methods: Fifteen adults with OSA enrolled for 30-minute sessions/three days a week for a three-month trial of “upper airway muscle physical therapy” while awake. Overnight sleep studies were performed before and after the intervention to determine each subject’s apnea hypopnea index (AHI), the primary outcome measure. Negative airway pressure application was determined by estimation of each subject’s one-repetition maximum (an exercise physiology measure of strength capacity). Exercise sessions consisted of subjects breathing against this pressure for a series of repetitions, and sets. Results: While the mean post study AHI was slightly improved (-4.3 ± 12.0 [ -10.9, 2.3], mean ± standard deviation, 95% confidence interval), it was not statistically significant. The results were similar when the AHI was divided by the sleep state (REM vs. non-REM). The nadir saturation was also essentially unchanged. The eight subjects with mild or moderate OSA (AHI &lt; 30) showed similar results. Conclusions: Though there was no significant reduction in AHI in this small cohort, the methods elucidate a new daytime use for a machine with which many OSA sufferers are familiar. Trial registration: ClinicalTrials.gov NCT02109731 (registered on April 10th 2015)

Wearable Fitness Trackers to Predict Clinical Deterioration in Maintenance Hemodialysis: A Prospective Cohort Feasibility Study

Rationale & ObjectivePeople receiving hemodialysis often require urgent care or hospitalizations. It is possible that reductions in a patient’s level of physical activity may serve as an “early warning” of clinical deterioration, allowing timely clinical intervention. We explored whether step count could serve as a trigger for deterioration.Study DesignProspective observational cohort feasibility study.Setting & ParticipantsWe recruited consenting adult participants from outpatient dialysis clinics in Calgary, AB, between June 28, 2019, and October 10, 2019.Exposure and OutcomesParticipants wore a wristband fitness tracker for 4 weeks. Activity data from the trackers were imported weekly into the study database. Demographic, clinical management, functional impairment, and frailty were assessed at baseline. Clinical events (urgent care and emergency department visits and hospitalizations) were monitored during the observation period.Analytical ApproachBox and whisker plots and line plots were used to describe each participant’s daily steps. Adjusted rate ratios (and 95 % confidence intervals) were calculated to assess the associations between the number of steps taken each day and potential predictors.ResultsData from 46 patients were included; their median age was 64 years (range, 22 to 85), and 63 % were men. The median number of steps taken per day was 3,133 (range, 248-13,753). Fourteen events among 11 patients were reported. Within patients, step count varied considerably; it was not possible to identify a patient-specific normal range for daily step count. There was no association between step count and the occurrence of clinical events, although the number of events was very small.LimitationsThe number of participants was relatively small, and there were too few events to model to examine whether step count could predict clinical deterioration.ConclusionsWithin-patient variation in daily step count was too high to generate a normal range for patients. However, patient-specific norms over a longer period (3- or 7-day periods) appear potentially worthy of future study in a larger sample and/or over a longer follow-up.

Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

BackgroundCommunity-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial.MethodsThis 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis.ResultsA total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences.ConclusionAlthough the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT.Trial registrationProjektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

Use of the Hypotension Prediction Index During Cardiac Surgery

The hypotension prediction index (HPI) is a novel parameter developed by Edwards Lifesciences (Irvine, CA) that is obtained through an algorithm based on arterial pressure waveform characteristics. Past studies have demonstrated its accuracy in predicting hypotensive events in noncardiac surgeries. The authors aimed to evaluate the use of the HPI in cardiac surgeries requiring cardiopulmonary bypass (CPB). Prospective cohort feasibility study. Single university medical center. Sequential adult patients undergoing elective cardiac surgeries requiring CPB between October 1, 2018, and December 31, 2018. HPI monitor was connected to the patient's arterial pressure transducer. Anesthesiologists and surgeons were blinded to the monitor output. HPI values and hypotensive events were recorded before and after CPB. The primary outcomes were the area under the curve (AUC) of the receiver operating characteristic curve, sensitivity, and specificity of HPI predicting hypotension. The AUC, sensitivity, and specificity for HPI lead time to hypotension five minutes before the event were 0.90 (95% confidence interval [CI]: 0.853-0.949), 84% (95% CI: 77.7-90.5), and 84% (95% CI: 70.9-96.8), respectively. Ten minutes before the event AUC, sensitivity, and specificity for HPI lead time to hypotension were 0.83 (95% CI: 0.750-0.905), 79% (95% CI: 69.8-88.1), and 74% (95% CI: 58.8-89.6), respectively. Fifteen minutes before the hypotensive event AUC, sensitivity, and specificity for HPI lead time to hypotension were 0.83 (95% CI: 0.746-0.911), 79% (95% CI: 68.4-89.0), and 74% (95% CI: 58.8-89.6), respectively. HPI predicted hypotensive episodes during cardiac surgeries with a high degree of sensitivity and specificity.

First in Human Clinical Feasibility Study of Endovascular Navigation with Fiber Optic RealShape (FORS) Technology

Endovascular procedures are conventionally conducted using two dimensional fluoroscopy. A new technology platform, Fiber Optic RealShape (FORS), has recently been introduced allowing real time, three dimensional visualisation of endovascular devices using fiberoptic technology. It functions as an add on to conventional fluoroscopy and may facilitate endovascular procedures. This first in human study assessed the feasibility of FORS in clinical practice. A prospective cohort feasibility study was performed between July and December 2018. Patients undergoing (regular or complex) endovascular aortic repair (EVAR) or endovascular peripheral lesion repair (EVPLR) were recruited. FORS guidance was used exclusively during navigational tasks such as target vessel catheterisation or crossing of stenotic lesions. Three types of FORS enabled devices were available: a flexible guidewire, a Cobra-2 catheter, and a Berenstein catheter. Devices were chosen at the physician's discretion and could comprise any combination of FORS and non-FORS devices. The primary study endpoint was technical success of the navigational tasks using FORS enabled devices. Secondary study endpoints were user experience and fluoroscopy time. The study enrolled 22 patients: 14 EVAR and eight EVPLR patients. Owing to a technical issue during start up, the FORS system could not be used in one EVAR. The remaining 21 procedures proceeded without device or technology related complications and involved 66 navigational tasks. In 60 tasks (90.9%), technical success was achieved using at least one FORS enabled device. Users rated FORS based image guidance "better than standard guidance" in 16 of 21 and "equal to standard guidance" in five of 21 procedures. Fluoroscopy time ranged from 0.0 to 52.2min. Several tasks were completed without or with only minimal X-ray use. Real time navigation using FORS technology is safe and feasible in abdominal and peripheral endovascular procedures. FORS has the potential to improve intra-operative image guidance. Comparative studies are needed to assess these benefits and potential radiation reduction.

Health-Related Quality of Life and Physical Function in Individuals with Parkinson's Disease after a Multidisciplinary Rehabilitation Regimen-A Prospective Cohort Feasibility Study.

Parkinson’s disease (PD) is a neurodegenerative disease and a multidisciplinary approach to rehabilitation has been suggested as the best clinical practice. However, very few studies have investigated the long-term effects of a multidisciplinary rehabilitation approach, particularly regarding whether this can slow the progression of PD. The purpose was to investigate the short- and long-term effect of a 2-week multidisciplinary rehabilitation regimen on the PD-related decline in health-related quality of life (HRQOL), mobility, and muscle function. Individuals with PD (IPD) participated in a 2-week inpatient multidisciplinary rehabilitation regimen that focused on improving HRQOL, mobility, and muscle function. Data from the primary outcome: HRQOL (Parkinson’s Disease Questionnaire 39, PDQ-39), secondary outcomes: handgrip strength, Timed-up and Go (TUG), Hospital Anxiety and Depression Scale (HADS), and Falls Efficacy Scale-International (FES-I) were compared at pre-visitation, before and after the 2-week regimen, and again at 4 and 10 months follow-up. In total, 224 patients with PD were included. There were short-term improvements in all outcomes. PDQ-39 was maintained at the same level as pre-visitation after 10 months follow-up. A 2-week multidisciplinary rehabilitation regimen improved short-term mobility, muscle function, and HRQOL in individuals with Parkinson’s disease. HRQOL was maintained after 10 months demonstrating long-term effects.

Implementation of Enhanced Recovery After Surgery (ERAS) protocol in off-pump coronary artery bypass graft surgery. A prospective cohort feasibility study.

Coronary artery bypass graft (CABG) is the most commonly performed cardiac surgery procedure. Although some complications related to the cardiopulmonary bypass circuit are avoided during off-pump CABG (OP-CABG) procedures, prolonged mechanical ventilation and severe postoperative pain are still important issues. This prospective cohort study aimed to assess the impact of the institutional Enhanced Recovery After Surgery (ERAS) protocol in patients undergoing OP-CABG. This protocol contained several modifications to the perioperative period, among which bilateral erector spinae plane block, remifentanil infusion, and patient-controlled analgesia (PCA) with oxycodone were the most important factors (ERAS group). The ERAS group was compared with the retrospective cohort (same surgeon) before the ERAS protocol was implemented (standard care group). The outcomes measured included the postoperative mechanical ventilation time, ICU and hospital stay, postoperative drainage time, postoperative troponin T level, pain severity evaluated via a numerical rating scale, and the total consumption of opioids in both groups of patients. Overall, 57 patients were analyzed - 29 in the ERAS group and 28 in the standard care group. The time of mechanical ventilation, thoracic drainage, and ICU and hospital stay was shorter in the ERAS group than in the standard care group. The pain was less intense in the ERAS patients, and the postoperative opioid demand was reduced. Moreover, the increase of the postoperative troponin T concentration was lower in the ERAS group. Our study showed that ERAS protocol implementation could improve patient outcomes after OP-CABG surgery.

P1.11-15 Feasibility of a Lung Health Clinic for Early Lung Cancer Identification in High-Risk Individuals in South-East London

Lung cancer screening (LCS) using low-dose CT (LDCT) reduces mortality amongst high-risk individuals in clinical trial settings. However, LCS uptake remains low, especially amongst currently smoking and socioeconomically deprived individuals. It is suggested that an invitation to a lung health clinic (LHC) to holistically approach lung health in a positive manner, in addition to LCS, could increase uptake. In Southeast London, where no LCS programme exists, the feasibility of this approach is unknown, and requires quantification to inform strategic decisions on early lung cancer detection. We aimed to evaluate the uptake of LDCT when offered as part of an LHC, in patients aged 55-80 who are current or former smokers (quit within the last 15 years) in our socioeconomically deprived region in London. A prospective cohort feasibility study used a targeted approach for scaled recruitment, identifying participants broadly meeting the criteria for age and smoking status through primary care case-finding in two deprived boroughs in South-east London (Lambeth and Soutwark). Opportunistic referrals from pharmacies, respiratory clinic, and smoking cessation clinics were also accepted. Potentially eligible high-risk (Liverpool Lung Prediction v2 lung cancer risk estimate of ≥5% over 5 years) participants were invited to an LHC assessment and offered spirometric assessment, smoking cessation referral, and same-day chest x-ray (CXR) and LDCT. Participants who declined the invitation were asked to indicate this negative engagement. LDCT interpretation by two thoracic radiologists using volumetric assessment and computer-aided detection (CAD) where possible were performed. Nodules were managed according to a protocol based on British Thoracic Society recommendations. Additional findings potentially impacting cardiothoracic health (e.g. coronary calcification) along with specific recommendations for action were communicated to the participant and their primary care physician. All participants are being followed up for a period of 12 months. We assessed the proportion of the target population eligible and recruited to the lung health clinic, the proportion accepting smoking cessation, and the number of lung cancers detected thus far. 15,227 individuals aged 55-80 years were approached using GP case-finding. 2,949 (19.4%) engaged with the study, 2,352 responded positively (79.8% of all responders, 15.4% of total invited) and 597 negatively (20.2% of responders). No referrals from pharmacy, respiratory clinic or smoking cessation clinics were received. Following eligibility assessment, 373 participants were recruited (15.9% of positive responders, 2.4% of total invited). 10 participants had confirmed lung cancer (2.8% of total recruited), 4 at baseline and 6 at follow-up thus far. 30 (8.0%) participants accepted a smoking cessation referral, with 20 (5.4%) actually accessing the service. GP case-finding recruitment to a lung health clinic can feasibly engage high risk participants to potentially identify early lung cancer in deprived areas of South East London. However, more work is required to increase positive engagement and smoking cessation uptake which are vital to the long-term success of such efforts. The non-utilisation of alternative opportunistic referral routes suggests there may be barriers to using such routes, or that these routes require active pursuit, rather than just awareness, to drive engagement from them.

Obesity and recovery from acute kidney injury (Ob AKI): a prospective cohort feasibility study

ObjectivesTo test the methodology of recruitment, retention and data completeness in a prospective cohort recruited after a hospitalised episode of acute kidney injury (AKI), to inform a future prospective cohort...

Novel, Family-Centered Intervention to Improve Nutrition in Patients Recovering From Critical Illness: A Feasibility Study.

Critically ill patients are at increased risk of developing malnutrition-related complications because of physiological changes, suboptimal delivery, and reduced intake. Strategies to improve nutrition during critical illness recovery are required to prevent iatrogenic underfeeding and risk of malnutrition. The purpose of this study was to assess the feasibility and acceptability of a novel family-centered intervention to improve nutrition in critically ill patients. A 3-phase, prospective cohort feasibility study was conducted in 4 intensive care units (ICUs) across 2 countries. Intervention feasibility was determined by patient eligibility, recruitment, and retention rates. The acceptability of the intervention was assessed by participant perspectives collected through surveys. Participants included family members of the critically ill patients and ICU and ward healthcare professionals (HCPs). A total of 75 patients and family members, as well as 56 HCPs, were enrolled. The consent rate was 66.4%, and 63 of 75 (84%) of family participants completed the study. Most family members (53/55; 98.1%) would recommend the nutrition education program to others and reported improved ability to ask questions about nutrition (16/20; 80.0%). Family members viewed nutrition care more positively in the ICU. HCPs agreed that families should partner with HCPs to achieve optimal nutrition in the ICU and the wards. Health literacy was identified as a potential barrier to family participation. The intervention was feasible and acceptable to families of critically ill patients and HCPs. Further research to evaluate intervention impact on nutrition intake and patient-centered outcomes is required.

Improving health care communication for caregivers: A pilot study

ABSTRACTWith the growing older adult population, there will also be more informal caregivers assisting friends and family with their health care. With the increasing complexity of health care, improved caregiver communication skills have the potential to reduce caregiver burden and frustration and improve care recipient health. The primary goal of this project was to develop and refine the content and teaching methods of a small-group behavioral change program to improve communication between caregivers of older adults and health care professionals. The authors developed the Care Talks program for improving communication between caregivers and health care professionals. They conducted a prospective cohort feasibility study of the intervention to assess caregiver communication confidence at baseline and one month postintervention. Six participants were enrolled. Of the 15 participants who answered the question, 15 (100%) would recommend this program to a friend. There was significant improvement in a 10-question composite of communication confidence pre/post scores from 74.1 to 79.6 p = .03. This small-group behavioral change intervention significantly improved communication confidence for this sample of caregivers. Further research is needed to determine the long-term effects of this program on caregivers and care recipients.