Referral Source Research Articles

Evaluating referrals of flashing lights and floaters coming into secondary care from primary care

ABSTRACT Clinical Relevance Optometrists should look to take every opportunity to expand their knowledge, understanding and skills pertaining to vitreoretinal conditions. Background Despite the existence of acute eye care schemes and the up-skilling of optometrists, many units are still noticing large numbers of poor-quality referrals with high false positive rates. The authors pondered whether these schemes are effective. Methods At two different time points, a prospective analysis of patients took place, of all the flashing lights and floaters referrals coming into secondary care at the Royal Glamorgan Hospital, Wales, UK. The following data was captured: the exact source of the primary care referral, the diagnosis being queried, the secondary care diagnoses made and the secondary care management decisions. The accuracy of retinal break and Shafer’s sign detection were also directly compared between primary care and secondary care using Cohen’s Kappa Coefficient. Results For the 2018 period, n = 51 patients were included. For the 2022–23 period n = 100 patients were included. The majority of referrals during both periods were from optometrists (>80%) via the WECS pathway. The most common diagnoses being queried were retinal breaks (~50%), followed by retinal detachments (~20%). Interestingly up to 20% of patients seen in secondary care were diagnosed as normal examinations and ~ 20%. Over 1/3 of patients were discharged after their first visit to the EEC. Statistically significant differences were found between the accuracy of retinal tear and Shafer’s identification between the primary and secondary care settings. Conclusion A high number of false positive referrals are coming into secondary care from the WECS pathway and clear training and education needs have been identified.

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

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

Demographic covariates and vocational rehabilitation services as predictors of employment outcomes of people with physical disabilities: a hierarchical logistic regression analysis

Purpose Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. Materials and Methods This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education’s Rehabilitation Services Administration’s Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. Results For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. Conclusions Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

Defining the key clinician skills and attributes for competency in managing patients with osteoporosis and fragility fractures.

Osteoporosis and fragility fractures are managed by clinicians across many medical specialties. The key competencies of clinicians delivering bone health care have not been systematically established. We aimed to develop a decision rule to define the threshold of adequate skills and attributes associated with clinical competency in bone health for a clinician serving as a referral source for bone health care. Using a modified-Delphi method, we invited clinicians with expertise in treating osteoporosis and representatives of patient advocacy groups focused on bone health to create a list of desirable characteristics of a clinician with bone health competency. Characteristics were defined as "attributes" with "levels" within each attribute. Participants prioritized levels by perceived importance. To identify the cut points for defining adequate competency, participants next ranked 20 hypothetical clinicians defined by various levels of attributes from highest to lowest likelihood of having adequate bone health competency. Lastly, we conducted a discrete choice experiment (DCE) to generate a weighted score for each attribute/level. The threshold for competency was a priori determined as the total weighted score at which ≥70% of participants agreed a clinician had adequate bone health competency. Thirteen participants generated lists of desirable characteristics, and 30 participants ranked hypothetical scenarios and participated in the DCE. The modified-Delphi exercise generated 108 characteristics, which were reduced to 8 categories with 20 levels with associated points. The maximum possible score was 25 points. A summed threshold score of >12 points classified a clinician as having adequate bone health competency. We developed a numeric additive decision rule to define clinicians across multiple specialties as having adequate competency in managing bone health/osteoporosis. Our data provide a rigorously defined criteria for a clinician with competency in bone health and can be used to quantitate the skills of clinicians participating in bone health research and clinical care.

Results for the London investigation into dielectric scanning of lesions study of the MARIA® M6 breast imaging system.

Determine the proportion of breast cancers for which MARIA® findings correspond to the cancer, with stratification by breast density and histological type. Investigate performance in symptomatic lesions. Gain patient feedback on experience with MARIA®. MARIA® uses a radio frequency antennae array to measure signal attenuation and back scatter to build up a 3D map of tissue dielectric values. The study was a prospective, single-centre, interventional, post-approval device study. Patients were eligible if they were attending symptomatic breast clinic or had confirmed or suspected breast cancer from any referral source. Recruitment between May 2018 and March 2020. Regions of higher signal compared to background or distinct by shape were considered candidates for lesion correspondence. Up to 4 candidate regions per breast were annotated in likelihood order for representing a true lesion. 389 patients were recruited, and 6 excluded. 114 patients recruited with breast cancers (2 bilateral, 5 multicentric). 57 (47%) malignant lesions showed correspondence between the MARIA® signal and the cancer. Higher correspondence was seen in invasive (50%) than in situ (29%) disease. There was no reduction in correspondence at higher breast density. Reduced signal correspondence in the central scan volume and for small lesions. MARIA® scanning was well tolerated. We believe that MARIA® signal corresponds to a malignant lesion in 47% of breast cancers examined. Our study, the largest to date for this type of technology, demonstrates successes and limitations of this MARIA® M6 version.

A Study of Clinical and Socio-Demographic Profile of Elderly Patients with Opioid Use Disorder on Agonist Treatment Attending a Tertiary Care Teaching Institute of India

Background: Opioid use is one among the major substance of use in Indian population which is not only seen in younger age group but rather is an upcoming concern in the elderly population as well. Opioid agonist treatment for opioid use disorder is a better way of management, among which buprenorphine is a safer option. Despite, being an important area of health concern, opioid use is poorly studied in the geriatric population. Objective: To study the clinical and socio-demographic profile of elderly patients with opioid use disorder on agonist treatment attending a tertiary care teaching institute of urban Delhi. Method: A retrospective study was done in an OPD based opioid treatment centre of a tertiary care hospital in Delhi to analyze the socio-demographic, clinical profile, pattern of opioid use disorder and opioid agonist treatment (Buprenorphine) in elderly Indian population over a year. The data collected was further analyzed for descriptive and analytic statistics using SPSS version 23.0. Results: A total of 32 subjects of age > 60years, with predominant male population having mean age of 63.6years we seen. They had heroin use by inhalation route as a major opioid use. The main source of referral was by friends and self with significant medical and psychiatric comorbidities that was seen in the elderly group. An average dose of 2.34mg of Buprenorphine was found to effectively manage the geriatric opioid use disorder. Conclusion: Opioid Used Disorder is common in Geriatric population and is often associated with both psychiatric and medical co-morbidities. Opioid agonist treatment is an effective approach in management of elderly cases of opioid use disorder. Declaration of Interest : None

Reaching Young People in Urban and Rural Communities with Mental Health and Wellbeing Support Within a Youth Sports Development Program: Integrating In-Person and Remote Modes of Service Delivery.

Embedding mental health and wellbeing programs within youth sports development programs can help provide more young people with mental health support. However, delivering such programs in multiple locations across metropolitan, regional, and rural areas requires novel solutions to overcome geographic and logistical barriers. We examined the delivery of an integrated system delivered within an Australian junior rugby league program. The program included online assessment and feedback about youth mental health, as well as connection with evidence-informed resources and referral sources via parent telephone and email support. There were four methods of delivering player workshops during training sessions: (a) In-person Delivery Only, (b) In-person + Remote Real-time (video-conferenced), (c) In-person + Remote Prerecorded (video-recorded), and (d) Remote Delivery Only (video-conferenced and/or video-recorded). In-person delivered player workshops were facilitated by local rugby league personnel. Remote delivered workshops were facilitated by psychologists from the mental health research team. Participants were 671 boys (12-15years; M age = 13.35; SD = 0.35) in 21 metropolitan, regional and rural locations. Regardless of delivery condition, players with elevated anxiety, depression and behavioural problems reported significant declines in symptoms from pre- to post-program, and those within healthy ranges did not change from pre- to post-program. Player workshop enjoyment ratings were higher in the In-person + Remote Real-time condition and the Remote Delivery Only condition than the In-person Delivery Only condition. However, non-completion of the post-program assessment across all conditions was higher than in prior studies and a comparison group of players who did not complete the program was not included. Mental health benefits may be observed across in-person and remote modes of delivering mental health workshops within youth sports programs. However, the involvement of mental health personnel, whether in-person or remotely, and mixed delivery modes, may be important for young people's retention and satisfaction.

Optimizing methadone dose adjustment in patients with opioid use disorder.

Opioid use disorder is a cause for concern globally. This study aimed to optimize methadone dose adjustments using mixed modeling and machine learning. This retrospective study was conducted at Taichung Veterans General Hospital between January 1, 2019, and December 31, 2020. Overall, 40,530 daily dosing records and 1,508 urine opiate test results were collected from 96 patients with opioid use disorder. A two-stage approach was used to create a model of the optimized methadone dose. In Stage 1, mixed modeling was performed to analyze the association between methadone dose, age, sex, treatment duration, HIV positivity, referral source, urine opiate level, last methadone dose taken, treatment adherence, and likelihood of treatment discontinuation. In Stage 2, machine learning was performed to build a model for optimized methadone dose. Likelihood of discontinuation was associated with reduced methadone doses (β = 0.002, 95% CI = 0.000-0.081). Correlation analysis between the methadone dose determined by physicians and the optimized methadone dose showed a mean correlation coefficient of 0.995 ± 0.003, indicating that the difference between the methadone dose determined by physicians and that determined by the model was within the allowable range (p < 0.001). We developed a model for methadone dose adjustment in patients with opioid use disorders. By integrating urine opiate levels, treatment adherence, and likelihood of treatment discontinuation, the model could suggest automatic adjustment of the methadone dose, particularly when face-to-face encounters are impractical.

Incorporation of a specialist mental health clinical pharmacist within a primary care network: patient referrals, prescribing decisions, and clinical outcomes.

The benefit of generalist pharmacists working within primary care networks (PCNs) and with general practitioners (GPs) is established. We wished to evaluate the contributions and potential benefits of a specialist mental health care prescribing pharmacist within PCNs. We prospectively collected data, on clinical and demographic characteristics, referral sources, interventions, outcomes (objective and subjective), and patient feedback, from 466 completed patients, in one PCN by one specialist mental health pharmacist (working 0.5 whole time equivalent), over 15 months. Referrals originated from multiple sources, including GPs, other members of the PCN mental health team, and community mental health teams (CMHTs). Two-thirds of treated patients were female; the most frequent age band was 18-30 years; the most common diagnosis was mixed depression and anxiety. Patients with diagnoses of mixed anxiety with depression or personality disorder needed more appointments than those with anxiety or depression. A range of evidence-based treatments were prescribed, including non-formulary medicines, and those medicines are more typically initiated or recommended in secondary care settings. The most frequently started medications were antidepressants (principally fluoxetine and duloxetine), followed by antipsychotics (principally quetiapine and aripiprazole): the most common dosage increases were for sertraline and quetiapine. Common non-medication recommendations were for cognitive behavioral therapy, cognitive behavioral therapy for insomnia, and other psychological therapies. Patient feedback was generally positive. Developing and implementing a service incorporating a specialist mental health pharmacist within a PCN mental health team is potentially valuable in improving patient care quality, reducing workload for GPs and CMHTs, and enabling faster access to secondary care initiated and recommended medications. This innovative service addressed several national targets, including prevention, early intervention, and access to quality compassionate care.

Factors predicting access to medications for opioid use disorder for housed and unhoused patients: A machine learning approach.

Opioid use disorder (OUD) is a growing public health crisis, with opioids involved in an overwhelming majority of drug overdose deaths in the United States in recent years. While medications for opioid use disorder (MOUD) effectively reduce overdose mortality, only a minority of patients are able to access MOUD; additionally, those with unstable housing receive MOUD at even lower rates. Because MOUD access is a multifactorial issue, we leverage machine learning techniques to assess and rank the variables most important in predicting whether any individual receives MOUD. We also seek to explain why persons experiencing homelessness have lower MOUD access and identify potential targets for action. We utilize a gradient boosted decision tree algorithm (specifically, XGBoost) to train our model on SAMHSA's Treatment Episode Data Set-Admissions, using anonymized demographic and clinical information for over half a million opioid admissions to treatment facilities across the United States. We use Shapley values to quantify and interpret the predictive power and influencing direction of individual features (i.e., variables). Our model is effective in predicting access to MOUD with an accuracy of 85.97% and area under the ROC curve of 0.9411. Notably, roughly half of the model's predictive power emerges from facility type (23.34%) and geographic location (18.71%); other influential factors include referral source (6.74%), history of prior treatment (4.41%), and frequency of opioid use (3.44%). We also find that unhoused patients go to facilities that overall have lower MOUD treatment rates; furthermore, relative to housed (i.e., independent living) patients at these facilities, unhoused patients receive MOUD at even lower rates. However, we hypothesize that if unhoused patients instead went to the facilities that housed patients enter at an equal percent (but still received MOUD at the lower unhoused rates), 89.50% of the disparity in MOUD access would be eliminated. This study demonstrates the utility of a model that predicts MOUD access and both ranks the influencing variables and compares their individual positive or negative contribution to access. Furthermore, we examine the lack of MOUD treatment among persons with unstable housing and consider approaches for improving access.

Coming back for more: factors linked to higher participation among Veterans with chronic pain in an innovative VA-YMCA wellness clinic

In 2019, the Indianapolis VA developed a Wellness Clinic in partnership with the Young Men’s Christian Associations (YMCA) to comprehensively address Veterans’ chronic pain. Our specific aims were twofold: (1)...

Direct-to-Consumer STI Screening Information: Mental Health Providers as a Dissemination Channel

Background On college campuses, rates of sexually transmitted infections (STIs), including chlamydia and gonorrhea, are increasing. However, rates of screening are low among college women. Direct-to-consumer (DTC) screening may be an innovative solution to improve screening rates, but little research exists on how college women prefer to receive information about these novel methods. The purpose was to explore the preferred communication channels for knowledge about DTC STI screening among college women. Methods Guided by the Diffusion of Innovations (DOI), in-depth interviews were conducted with sexually active college women, ages 18-24 (n=24). Interviews were analyzed thematically by two coders (Kappa=.83). This study presents a salient, emergent theme within the communication channels construct – the role of mental health providers in providing information related to DTC STI screening. Results A salient emergent theme of a preferred interpersonal communication channel for receiving STI screening information was mental health providers (MHPs) and the campus counseling center. Women described the counseling center and the MHPs on campus as an information and referral source for DTC STI screening. Interactions with the counseling center were viewed as more private and confidential than health clinics, and MHPs were viewed as trusted emotional support. Women viewed provision of DTC STI screening as a natural fit with the role of MHPs. Discussion MHPs may be an underutilized resource to provide information about STI screening, particularly novel DTC methods, to college women. Incorporating MHPs into the system of sexual healthcare may increase adoption rates of innovative screening methods and reduce the negative impacts of STIs. Conclusion These results provide preliminary data that MHPs may be an underutilized resource to provide information about STI screening, particularly novel DTC screening. Future studies should evaluate the perspectives of MHPs regarding discussion of and recommendation for DTC STI screening to patients.

Adaptations of a community-based integrated care model for frail home-dwelling older adults using the results of a feasibility evaluation

Introduction: The WHO recommends implementing integrated care models to overcome fragmented care for frail older adults. However, their effectiveness remains inconclusive, due to limited assessment of implementation processes and outcomes. As population ages, the Swiss Canton Basel-Landschaft adopted a legal framework requiring creation of Information and Advice Centers (IAC) for home-dwelling older adults. INSPIRE and the Canton are collaborating to develop, implement, and evaluate an integrated care model for the IACs. INSPIRE is a multiphase implementation science project: Phase 1 included participatory development of the INSPIRE care model by involving cantonal and local stakeholders. Stakeholder involvement is still maintained, through bi-yearly meetings. Phase 2, the present study, aimed to evaluate its feasibility and implementation and describe the adaptations needed&#x0D; Methods: Design: Using a mixed-methods design, we evaluated the feasibility and implementation of the INSPIRE care model and the IAC by: a) measuring fidelity to the implementation strategies to promote the IAC; b) describing IAC visitors; and c) assessing implementation outcomes of the care model.&#x0D; Sample: All IAC visitors; 18 older adults 65+; a nested sample of 8 frail older adults 75+; 8 informal caregivers; IAC nurse and social worker.&#x0D; Data sources: qualitative data from interviews (older adults/informal caregivers) and meetings (IAC staff); quantitative data from the IAC administrative information and health records&#x0D; &#x0D; &#x0D; Results: &#x0D; &#x0D; Aim a &amp; b: IAC promotion: 63 out of 83 planned promotional activities were delivered by the IAC leadership (e.g., letters to older adults 75+) but not delivered to all target stakeholders. IAC visitors: Between Jan-Sept 2022, 113 older adults aged 65-74 and 362 aged 75+ visited the IAC. From the 65-74 group, 12 individuals were identified as pre-frail/frail and from those, 2 received the INSPIRE care model. From the 75+ group, 162 individuals were considered pre-frail/frail and 47 of them received the care model. The care model reached 4.8% of the target population. Referral source: 92 (aged 65-74) and 174 (aged 75+) self-referred to the IAC; few referrals by community care providers. Services requested: The main requested service in the 65-74-year-old group was social services (32/113) while for those 75+ it was a needs assessment (141/362).&#x0D; Aim c: Qualitative information: the nurse showed higher acceptability of the model compared to the social worker. High acceptability and feasibility of the model were perceived by older adults and their caregivers. Quantitative information: fidelity to the model core components mean score: 33/48; lowest scores for care coordination and follow-up.&#x0D; &#x0D; &#x0D; Implications: The high acceptability of the INSPIRE care model by older adults who acceded to the intervention and their caregivers shows that integrated care approaches may have potential to enhance quality of care although adaptations might be needed to increase its fit. In parallel, in order to increase reach, more efforts and supportive leadership are needed to promote the IAC, enhance community care providers engagement in the referral process.&#x0D; Next steps: Adaptation of the care model and implementation strategies to increase referrals to the IAC, thus improving reach of the intervention, and contributing to better recruitment for the effectiveness evaluation.

School psychologists’ perceptions of the effectiveness of neuropsychological evaluation reports

Referral sources and parents value the report following a neuropsychological evaluation. Nevertheless, key stakeholders have described pediatric reports as excessive in length and jargon. Recent research indicates that it is possible to modify pediatric neuropsychological reports that result in positive outcomes for key stakeholders and clinicians. Evaluating modified pediatric neuropsychological reports for other providers is necessary. School psychologists are key stakeholders who read and interact with such reports. This study assessed school psychologists’ perceptions of a modified pediatric neuropsychological report. Forty-one school psychologists were randomly assigned to read either a traditional or modified version of a pediatric report and provide feedback via survey and qualitative questions. Results revealed that school psychologists’ perceptions of a traditional and modified report were not significantly different. Qualitatively, respondents noted a disconnect between recommendations and school systems. These findings suggest that pediatric neuropsychologists can create shorter and more easily understood reports that do not impact the effectiveness for school psychologists. Future research should continue to evaluate perceptions of modified pediatric neuropsychological reports for additional key stakeholders. A better understanding of the disconnect between recommendations and their feasibility in schools, as well as barriers to increased interdisciplinary collaboration, is also essential for client care.

EMBEDDING A PHYSICIAN REFERRAL PATHWAY TO LINK PEOPLE WITH DEMENTIA TO COMMUNITY SERVICE PROGRAMS

Abstract Dementia care quality and value can be enhanced by lateral integration between health systems (HS) and community-based organizations (CBOs), however clinical providers are often unaware of CBO programs. HS could heighten access to CBO programs among people living with dementia (PLWD) by recognizing CBOs as extended care teams, streamlining referrals, and facilitating information exchange through electronic health records (EHRs). Catalyzing CBO and HS integration, we piloted physician referral to a CBO for virtual delivery of Cognitive Stimulation Therapy (CST) in an embedded pragmatic trial. CST, a 14-session group intervention for PLWD, has been shown to benefit participant cognition and other outcomes, yet CST access is limited partially due to the risks and costs of in-person gathering. To enhance access, we trialed a version of virtual CST (vCST) and assessed patient follow-through on physician vCST referrals. Participating sites–one primary care clinic and one neurological specialty clinic—identified eligible PLWD via EHR (e.g., cognitive score indicating mild cognitive impairment to moderate dementia) and clinicians verified eligible PLWD appropriateness for vCST. Clinician-verified PLWD were randomized to intervention (referral, n=56) and control (no referral) groups, and clinicians provided vCST referrals. Results show the percentage of PLWD who followed through on (‘accepted’) the vCST referral. Similarities and differences—across demographics, cognitive scores, and referral sources—between PLWD who accepted versus declined referral are described. Future research will assess conversion rates from vCST referral to program completion, the completeness of outcome measures captured from EHRs, and the impact of vCST on cognitive scores.

LOCAL ADAPTATIONS OF HIH: VARIATIONS IN STRUCTURE AND IMPLEMENTATION OF HIH MODEL ACROSS SIX VA PROGRAMS

Abstract A number of Department of Veterans Affairs (VA) medical centers have adopted the Hospital-In-Home (HIH) model of care to provide at home services to Veterans requiring acute-level hospital care. We aimed to identify similarities and variations in structure and implementation of the HIH model across VHA sites. Of 11 programs, six (55%) used a standardized presentation template to present their specific program characteristics, outcomes and goals at monthly national program meetings. Presentations were transcribed and abstracted into themes by two reviewers. Programs varied in their staffing, services provided, referral sources and clinical outcome metrics. While one site provided in person visits, 3 reported program adaptations such as virtual follow-up visits for COVID patients. Review of clinical outcome metrics also revealed substantial site to site variations including 30-day readmission rates, cost avoidance, bed days or emergency department visits. All sites offered complementary (from hospital) and substitutive (from other than hospital) HIH stays. Substitutive stays varied across referral sources admitting patients from emergency departments, outpatient clinics, home based primary care and inpatient settings. Additionally, variations in catchment area (driving distance), and staffing in the parent stations highlighted differing contexts of HIH programs. We hypothesize that variations among sites may exist due to factors such as the setting and unique needs of the population and facility. An in-depth understanding of the contextual factors that influence implementation can be achieved through interviews with key staff from each site. Future work will examine if such variations are related to program outcomes.

A LEAP! FORWARD?: DOES PERSONALIZED EXERCISE HELP MAINTAIN COGNITIVE FUNCTION IN OLDER ADULTS?

Abstract Maintaining cognitive function is important to health in older adulthood. Physical activity can decrease the risk of cognitive decline in older individuals. We tested whether LEAP! Rx, a personalized exercise, and lifestyle education program would improve cognition in older adults. We randomized 220 participants (Mean age (SD) = 72 (4.83)), into the program or a control group. We used the NIH Toolbox Cognitive Battery to assess cognition. We analyzed change in cognitive performance from baseline to week 12 using repeated measures ANCOVA to compare the intervention and control groups, adjusting for age, gender, and education. Referral source (self- vs. physician-referred), treatment group (intervention vs. control), and measurement time (baseline vs. week 12) had a significant three-way interaction F(8, 212) = 4.57, p&amp;lt; 0.05. That is, clinician-referred participants in the intervention group improved more (vs. the clinician-referred control group), whereas self-referred control group participants improved more (vs. the self-referred intervention group). Older age, male gender, and lower education predicted poorer verbal learning F(1,218 = 18.79, p&amp;lt; 0.05; F(1, 218) = 28.67, p&amp;lt; 0.05; F(1, 219) = 4.13. Overall, cognitive scores improved more over 12 weeks in the intervention group compared to the control group. Thus, we conclude that personalized exercise programs may enhance or maintain cognitive function in older adults. The differences we observed in physician-referred versus self-referred participants has implications for implementation and scalability of health behavior change interventions, as well as implications for recruitment methods and representation in clinical trials research broadly.

Diagnosis Update and Treatment of Depression in Breast Cancer Survivor

Individuals suffering from breast cancer or those who have overcome it may experience symptoms such as despondency, despair, apprehension, and a feeling of void. The aim of this study is to provide a comprehensive overview of the diagnosis and treatment advancements for depression in people who have been diagnosed with and survived breast cancer. The prevalence of depressive symptoms and their association with patients' and survivors' quality of life were assessed using the Patient Health Questionnaire (PHQ-8). Depression has a robust association with quality of life. Several clinical care guidelines for cancer patients with co-morbid distress have highlighted the importance of screening and detection. According to the ASCO guidelines, healthcare facilities should create networks of referral sources or appropriate resources to efficiently handle patients' concerns about screening measures, in addition to doing screenings. The availability of screening or treatment depends directly on the financial resources of the institutions that provide them. Ultimately, due to the continuous advancements in breast cancer treatments, a significant number of individuals who have survived breast cancer will need prompt intervention to manage the long-term consequences of the illness. Survivors of breast cancer nevertheless encounter a significant health hazard in the form of depression, which endures long after the completion of therapy.

Cultural influences on early trust development in virtual teams

PurposeTransference-based trust (TBT) via referral sources is a cognitive process where trust in third-party information about an individual transfers to trust in the individual. TBT via referral sources can have significant effects on early trust development in a virtual team (VT). This study aims to examine the potential influence of Hofstede’s (1980) cultural variables and two proposed combinations of these cultural variables on early trust development in VT, including the effects of referral source.Design/methodology/approachThis study adopted multigroup analysis partial least squares structural modeling to examine potential cultural differences in the responses of 357 university students from 51 different countries to understand early trust development in VT.FindingsTBT via referral sources as in interpersonal construct has a positive, direct impact on early trust development. TBT mediated the individual and organizational model constructs. There were significant differences in the high/low values of 3 of the 56 tested cultural dimensions.Research limitations/implicationsReaffirmed the validity of cognitive-based trust models in understanding early trust development in VTs TBT as an interpersonal construct and has a significant influence on early trust development in VTs. TBT via referral sources mediated the individual and organizational constructs of the model. There were significant differences in the high/low measures of three cultural dimensions (i.e. IV, M and the combination of IV-M-LT) in the relationship of early trusting beliefs to early trusting intensions.Practical implicationsTo positively influence interpersonal and organizational aspects of trust development, managers should ensure that the early phases of VTs, before actual implementation begins, are well organized. Managers could make VT members fully aware of how referral sources can influence early trust development. Managers could encourage individuals to have open access to relevant social media accounts for other VT members and encourage individuals to research referral sources on other VTs members. The implication for managers of culturally diverse VT is that the development of early trust is largely by individual choice, rather than differences in national culture.Social implicationsPeople need to maintain and actively manage their online presence, ensuring that online information about them is accurate and updated. Referral sources could help VT members learn about one another, which might in turn help foster early trust in their online teams.Originality/valueAlthough some studies have found significant cultural differences in early trust development, other studies, including a meta-analysis of 43 studies, found no significant cultural differences in early trust development. This study confirmed the results of the meta-analysis.

Diagnostic concordance in consultation liaison psychiatry – Referring physicians to psychiatrists

Psychiatric co-morbidity in patients with physical illness is known to influence the course and outcome of both conditions. Consultation liaison psychiatry [CLP] can be regarded as an essential service between psychiatry and other medical specialties. Efficient communication between different levels of care is known to have an impact on the quality of health care. To study the patterns of referrals to the department of psychiatry and diagnostic concordance between referring physicians to CL-Psychiatrist.The present study was a cross-sectional study conducted in the Department of Psychiatry of a tertiary care hospital. All the patients referred to the Psychiatry department for 4 months were taken after excluding referrals sent for disability assessment. Socio-demographic details, source of referral, reason for referral, and the psychiatric diagnosis by both the referring doctor and CL-psychiatrist were recorded. Statistical analysis was done using SPSS 25.0 software and kappa value was used to estimate the diagnostic concordance.In the sample of 100 referrals studied, the mean age of the sample was 40.96±13.42 years. The majority of the cases referred were inpatients (61%), from the department of general medicine and allied branches (85%), (General medicine -55, Neurology- 21). The most common diagnosis was alcohol dependence syndrome 24 (24%), followed by depression (18%) and phobic anxiety (18%).The concordance of the diagnosis between the referral and the psychiatry team was in perfect agreement (κ=0.81- 1.00) for paranoid schizophrenia, bipolar affective disorder, delirium, dissociative disorder, delusional disorder, and alcohol dependence syndrome. Very low concordance was observed in diagnosing obsessive-compulsive disorder (k=0) and adjustment disorder (k=0).The overall diagnostic concordance was poor for adjustment disorder, OCD, and vascular dementia, and good for paranoid schizophrenia, delirium, dissociative disorder, delusional disorder, and BPAD.