Routine Clinical Assessment Research Articles

Preference for high-carbohydrate foods does not change for children and adolescents in insulin-induced hypoglycemia

IntroductionHypoglycemia elicits coordinated counter-regulatory neuroendocrine responses. The extent to which this process involves an increased drive to eat, together with greater preference for foods high in carbohydrate content, is unclear....

Measurement of Parathyroid Hormone Level after Total Thyroidectomy in Prediction of Hypocalcaemia

Background: Parathyroid dysfunction leading to symptomatic hypocalcemia is not uncommon following a total or completion thyroidectomy and is often associated with significant patient morbidity and a prolonged hospital stay. Objectives: To investigate whether postoperative parathyroid hormone level is a parameter to identify hypocalcaemia after total thyroidectomy. Methods: This prospective longitudinal study was carried out with variety of thyroid disorders with indication of total thyroidectomy at BSMMU. Total 103 patient were selected following the inclusion and exclusion criteria. The routine clinical assessment and the preoperative laboratory investigations of the study population were performed before operation. Preoperative and postoperative levels of serum PTH and serum calcium level were measured. Results: Immediate post-operative period 17(16.50%) patients PTH level were low (<14 pg/ ml). The mean PTH in immediate post-operative was 36.79±21.71 pg/ml. Regarding the distribution of the study patients by serum calcium, it was observed that 20.39% patients belonged to low (<8 mg/dl) serum calcium. The mean serum calcium level was 8.47±1.19 (mg/dl) with ranged from 2.1 to 10.6 (mg/dl). Among the study population 11 patient developed symptomatic hypocalcemia. Most 72.7% the patient, symptomatic hypocalcemia developed after 48 hours of operation. Conclusion: Hypocalcaemia after total or completion thyroidectomy is not uncommon in our population. If we measure a single parathyroid hormone level in postoperative period that can reflect early result and help to take necessary measure to avoid hypocalcaemic effect. Low intraoperative PTH levels during thyroid surgery are therefore a feasible predictor of postoperative hypocalcemia. Sir Salimullah Med Coll J 2022; 30: 103-107

Safety and usability of wearable accelerometers for stroke detection the STROKE ALARM PRO 1 study

ObjectivesThe introduction of time-dependent reperfusion therapies in acute ischemic stroke has increased the need for early identification. We explore the safety and feasibility of STROKE ALARM which detects sudden arm paresis, the most frequent symptom in stroke. Materials and methodsConsecutive patients admitted with a stroke or TIA at Skåne University Hospital were screened according to inclusion and exclusion criteria, and included in the STROKE ALARM PRO 1 Study aiming to explore the feasibility of prolonged use (30 days) of the system in the community. STROKE ALARM consists of paired arm bracelets with accelerometers, coupled with a stroke test in a smartphone application. In case of an imbalance in arm movements, the user is prompted to perform an app-based stroke test. Failure to respond or to complete the stroke test correctly, triggers notification by SMS to predefined emergency contacts. Patients were followed up by telephone after completion. ResultsThirty patients were included and 28 completed follow-up. Median age was 68 years and 36.7% were female. No stroke events were recorded during follow-up. False indications occurred in all but one patient, and 22 (78.6%) experienced alarms to their emergency contacts. Despite a high level of false alarms, general user experience was rated in a positive or neutral manner by almost 90%. Very frequent alarms were probably due to mild arm paresis not detected in routine clinical assessment. ConclusionsUse of STROKE ALARM for 30 days after stroke/TIA was well tolerated warranting further study for early automated detection of stroke recurrence.

Paracentesis for cancer-related ascites in palliative care: An international, prospective cohort study

Background: Paracentesis is commonly undertaken in patients with cancer-related ascites. Aim: To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting. Design: Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis; (T1) once drainage ceased; (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner. Setting/participants: Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50. Results: At T1 (n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak (n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation. Conclusion: Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.

Co-creation using crowdsourcing to promote PrEP adherence in China: study protocol for a stepped-wedge randomized controlled trial

BackgroundAdherent pre-exposure prophylaxis (PrEP) uptake can prevent HIV infections. Despite the high HIV incidence, Chinese key populations have low PrEP uptake and adherence. New interventions are needed to increase PrEP adherence among key populations in China. Co-creation methods are helpful to solicit ideas from the community to solve public health problems. The study protocol aims to describe the design of a stepped-wedge trial and to evaluate the efficacy of co-created interventions to facilitate PrEP adherence among key populations in China.MethodsThe study will develop intervention packages to facilitate PrEP adherence among Chinese key populations using co-creation methods. The study will then evaluate the efficacy of the co-created intervention packages using a stepped-wedge randomized controlled trial. This four-phased closed cohort stepped-wedge design will have four clusters. Each cluster will start intervention at three-month intervals. Seven hundred participants who initiated PrEP will be recruited. Participants will be randomized to the clusters using block randomization. The intervention condition includes receiving co-created interventions in addition to standard of care. The control condition is the standard of care that includes routine clinical assessment every 3 months. All participants will also receive an online follow-up survey every 3 months to record medication adherence and will be encouraged to use a WeChat mini-app for sexual and mental health education throughout the study. The primary outcomes are PrEP adherence and retention in PrEP care throughout the study period. We will examine a hypothesis that a co-created intervention can facilitate PrEP adherence. Generalized linear mixed models will be used for the primary outcome analysis.DiscussionDeveloping PrEP adherence interventions in China faces barriers including suboptimal PrEP uptake among key populations, the lack of effective PrEP service delivery models, and insufficient community engagement in PrEP initiatives. Our study design addresses these obstacles by using co-creation to generate social media-based intervention materials and embedding the study design in the local healthcare system. The study outcomes may have implications for policy and intervention practices among CBOs and the medical system to facilitate PrEP adherence among key populations.Trial registrationThe study is registered in Clinical Trial databases in China (ChiCTR2100048981, July 19, 2021) and the US (NCT04754139, February 11, 2021).

Clinician Estimates of Frailty Compared to Formal Frailty Assessment in Adults With Heart Failure: A Cross-Sectional Analysis.

Frailty assessment is recommended for patients with heart failure. Despite the availability of instruments to assess frailty, there are no clear recommendations regarding the optimal instrument to use in a heart failure context. This ambiguity combined with a lack of education and resources, often leads clinicians to rely on subjective estimates of frailty, such as 'the end-of-the-bed' or 'eyeball' test. To examine the association between clinician-estimated frailty and formal frailty assessment in adults with heart failure. Cross-sectional analysis of the FRAilty MEasurement in Heart Failure (FRAME-HF) study. (1) Adults aged ≥18 years in the outpatient heart failure clinic and cardiology ward; (2) and cardiovascular clinicians (nurses, physicians, and allied-health professionals). Following participant recruitment, cardiovascular clinicians were asked to rate the participant's frailty status based on their routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment were examined using a weighted Kappa statistic and Spearman's correlation coefficient. A total of 75 patients and 39 clinicians were recruited, producing 194 paired frailty assessments. Mean age of the patients was 54 (±13) years. Correlation of pooled clinician-estimated frailty to formal frailty was fair (0.52, p=0.00). Correlation was highest between allied-health estimated frailty and formal frailty (0.70, p=0.00). Agreement between pooled clinician-estimated frailty and formal frailty was fair (0.33) and was highest between allied health-estimated frailty and formal frailty (0.45). Subjective clinician-estimated frailty is not a reliable replacement for formal frailty assessment in adults with heart failure, underscoring the need for assessment using a valid and reliable instrument.

Quantitative Functional Recovery Assessment of Spinal Cord Injury by using “Spinal Cord Injury-Ability Realization Measurement Index (SCI-ARMI)”: An Observational Study

Background: Spinal cord injury (SCI) refers to a physical injury to the spinal cord that distorts normal spinal cord function. The sudden occurrence of SCI leading to paralysis of the muscles below the level of injury leads to major functional limitations. Thus, the Spinal Cord Injury- Ability Realization Measurement Index (SCI-ARMI) tool was developed that evaluates functional recovery quantitatively. Purpose: To assess changes in quantitative functional recovery before and after rehabilitation of spinal cord injury by using Quadric Formula of SCI-ARMI. Methodology: SCI-ARMI was used as an outcome measure. Participants followed a routine conventional approach. They were assessed before starting inpatient rehabilitation and after 4 weeks of inpatient rehabilitation by taking Spinal Cord Independence Measure version III (SCIM-III) and AIS motor score (AMS) along with age and gender as a factor for calculation of SCI-ARMI. Results: A highly significant difference was found with a p-value of <0.001. That is suggestive of significant changes in SCI-ARMI scores before and after conventional rehabilitation. Change in this score and improvement in functional performance was influenced by the conventional approach of inpatient rehabilitation. Conclusion: The present study concludes that SCI ARMI is useful and effective tool that monitors achievement of rehabilitation potential and helps to observe changes in quantitative functional recovery in individuals with SCI. Clinical Implication: SCI-ARMI is valid and reliable tool and also takes less time for calculation that can be incorporated into routine clinical assessment for the evaluation of functional performance and rehabilitation potential in SCI population. Keywords: SCI-ARMI, Quantitative Functional Recovery, Spinal Cord Injury.

Relationship between Nutrition-Related Problems and Falls in Hemodialysis Patients: A Narrative Review

Falls are a social problem that increase healthcare costs. Hemodialysis (HD) patients need to avoid falling because fractures increase their risk of death. Nutritional problems such as frailty, sarcopenia, undernutrition, protein-energy wasting (PEW), and cachexia may increase the risk of falls and fractures in patients with HD. This review aimed to summarize the impact of frailty, sarcopenia, undernutrition, PEW, and cachexia on falls in HD patients. The reported global incidence of falls in HD patients is 0.85–1.60 falls per patient per year. HD patients fall frequently, but few reports have investigated the relationship between nutrition-related problems and falls. Several studies reported that frailty and undernutrition increase the risk of falls in HD patients. Nutritional therapy may help to prevent falls in HD patients. HD patients’ falls are caused by nutritional problems such as iatrogenic and non-iatrogenic factors. Falls increase a person’s fear of falling, reducing physical activity, which then causes muscle weakness and further decreased physical activity; this cycle can cause multiple falls. Further research is necessary to clarify the relationships between falls and sarcopenia, cachexia, and PEW. Routine clinical assessments of nutrition-related problems are crucial to prevent falls in HD patients.

Sleep reactivity predicts insomnia in patients diagnosed with breast cancer.

To examine the role of sleep reactivity as a predictor of insomnia in patients diagnosed with breast cancer. A total of 173 women with breast cancer participated and were followed up over a period of 9 months. At baseline, participants were assigned to a high (n = 114) or low (n = 59) sleep reactivity group, based on their responses to the Ford Insomnia Response to Stress Test (FIRST). We assessed whether these FIRST groupings (high/low sleep reactivity) predicted changes in insomnia over time using the Insomnia Severity Index. We also tested if these FIRST groupings predicted insomnia disorder (using Insomnia Severity Index cutoffs) at 3 different time points (T3, T6, and T9). Individuals with high sleep reactivity were more likely to experience a worsening of insomnia. Using logistic regression, we also found that FIRST grouping predicted insomnia disorder. Results remained significant after controlling for estimated premorbid sleep, age, and whether someone had chemotherapy. Our study shows that sleep reactivity may be a robust predictor of insomnia within breast cancer populations. Sleep reactivity should be considered in routine clinical assessments as a reliable way to identify patients at risk of developing insomnia. This would facilitate early sleep intervention for those patients who are considered high risk. Rehman A, Drake CL, Shiramizu V, Fleming L. Sleep reactivity predicts insomnia in patients diagnosed with breast cancer. J Clin Sleep Med. 2022;18(11):2597-2604.

Predicting the risk of postsplenectomy thrombosis in patients with portal hypertension using computational hemodynamics models: A proof-of-concept study

BackgroundThe high incidence of thrombosis in the portal venous system following splenectomy (a frequently adopted surgery for treating portal hypertension in patients with splenomegaly and hypersplenism) is a critical clinical issue. The aim of this study was to address whether quantification of postsplenectomy hemodynamics has potential value for assessing the risk of postsplenectomy thrombosis. MethodsComputational models were constructed for three portal hypertensive patients treated with splenectomy based on their preoperative clinical data to quantify hemodynamics in the portal venous system before and after splenectomy, respectively. Each patient was followed up for three or five months after surgery and examined with CT to screen potential thrombosis. FindingsThe area ratio of wall regions exposed to low wall shear stress was small before splenectomy in all patients, which increased markedly after splenectomy and exhibited enlarged inter-patient differences. The largest area ratio of low wall shear stress and most severe flow stagnation after splenectomy were predicted for the patient suffering from postsplenectomy thrombosis, with the wall regions exposed to low wall shear stress corresponding well with the CT-detected distribution of thrombus. Further analyses revealed that postoperative hemodynamic characteristics were considerably influenced by the anatomorphological features of the portal venous system. InterpretationPostoperative hemodynamic conditions in the portal venous system are highly patient-specific and have a potential link to postsplenectomy thrombosis, which indicates that patient-specific hemodynamic studies may serve as a complement to routine clinical assessments for refining risk stratification and postoperative patient management.

Research on the Mechanism of Cognitive Decline in Patients With Acoustic Neuroma

Little is known about neuropsychological research on patients with acoustic neuroma (AN), especially cognitive neuropsychology. We aim to compare the cognitive function of patients with AN and healthy controls (HCs) and explore possible underlying mechanisms. Various neuropsychological assessments were performed on all participants. Tract-based spatial statistics (TBSS) was used to compare DTI metrics such as fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). Correlation analysis was analyzed between DTI metrics and cognitive scales. Compared with the HC group, the AN group performed worse in the neuropsychological evaluations, and TBSS analysis showed widespread alteration of the FA, AD, RD, and MD, which correlated with the cognitive function. These white matter tracts include minor forceps, major forceps, anterior thalamic radiation, superior longitudinal fasciculus, corticospinal tract, and right inferior fronto-occipital fasciculus. Meanwhile, we found for the first time that cognitive decline was related to the decrease of FA in minor forceps, which can be used as a neurobiological marker of cognitive impairment in patients with AN. The occurrence of cognition impairment is common in patients with AN. Including neuropsychological evaluation in the routine clinical assessment and appropriate treatment may strengthen clinical management and improve the quality of life of patients.

The Role of Complement in HSCT-TMA: Basic Science to Clinical Practice.

Hematopoietic stem cell transplantation-associated thrombotic microangiopathy (HSCT-TMA) is a common complication occurring post-HSCT and is associated with substantial morbidity and mortality if not promptly identified and treated. Emerging evidence suggests a central role for the complement system in the pathogenesis of HSCT-TMA. The complement system has also been shown to interact with other pathways and processes including coagulation and inflammation, all of which are activated following HSCT. Three endothelial cell-damaging “hits” are required for HSCT-TMA genesis: a genetic predisposition or existing damage, an endothelial cell-damaging conditioning regimen, and additional damaging insults. Numerous risk factors for the development of HSCT-TMA have been identified (including primary diagnosis, graft type, and conditioning regimen) and validated lists of relatively simple diagnostic signs and symptoms exist, many utilizing routine clinical and laboratory assessments. Despite the relative ease with which HSCT-TMA can be screened for, it is often overlooked or masked by other common post-transplant conditions. Recent evidence that patients with HSCT-TMA may also concurrently present with these differential diagnoses only serve to further confound its identification and treatment. HSCT-TMA may be treated, or even prevented, by removing or ameliorating triggering “hits”, and recent studies have also shown substantial utility of complement-targeted therapies in this patient population. Further investigation into optimal management and treatment strategies is needed. Greater awareness of TMA post-HSCT is urgently needed to improve patient outcomes; the objective of this article is to clarify current understanding, explain underlying complement biology and provide simple tools to aid the early recognition, management, and monitoring of HSCT-TMA.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02184-4.

A Handheld Fiber-Optic Probe to Enable Optical Coherence Tomography of Oral Soft Tissue.

This study presents a highly miniaturized, handheld probe developed for rapid assessment of soft tissue using optical coherencetomography (OCT). OCT is a non-invasive optical technology capable of visualizing the sub-surface structural changes that occur in soft tissue disease such as oral lichen planus. However, usage of OCT in the oral cavity has been limited, as the requirements for high-quality optical scanning have often resulted in probes that are heavy, unwieldy and clinically impractical. In this paper, we present a novel probe that combines an all-fiber optical design with a light-weight magnetic scanning mechanism to provide easy access to the oral cavity. The resulting probe is approximately the size of a pen (10 mm × 140 mm) and weighs only 10 grams. To demonstrate the feasibility and high image quality achieved with the probe, imaging was performed on the buccal mucosa and alveolar mucosa during routine clinical assessment of six patients diagnosed with oral lichen planus. Results show the loss of normal tissue structure within the lesion, and contrast this with the clear delineation of tissue layers in adjacent inconspicuous regions. The results also demonstrate the ability of the probe to acquire a three-dimensional data volume by manually sweeping across the surface of the mucosa. The findings of this study show the feasibility of using a small, lightweight probe to identify pathological features in oral soft tissue.

Abstract 5111: Prompt assessment of molecular tumor load and treatment response in patients with lymphoma by a blood-based multi-omics approach

Abstract Here we present a real-time blood-based treatment response monitoring assay SeekInClarity to assess molecular tumor load and response to varied treatment protocols in patients with lymphoma. A novel multidimensional molecular tumor burden (MTB) model was utilized by integrating shallow whole genome sequencing (sWGS) of cfDNA and the levels of a set of plasma protein markers (PTMs) in a single blood draw. Copy number aberrations (CNAs) and fragment size (FS) patterns across the genome from sWGS data and levels of 7 PTMs (AFP, CEA, CA153, CA125, CA199, CYFRA21-1, CA724) are exploited to establish the MTB model.Newly diagnosed patients with lymphoma were radiologically assessed at baseline and periodically reassessed after treat started as determined per standard of care routine clinical assessment. The patients also had 10 ml venous blood samples collected for SeekInClarity at baseline and every two treatment cycles.At baseline, 55(61.1%) of 90 patients were tested positive (MTB>2) by SeekInClarity, implying the high sensitivity. In particular, genome-wide or focal CNA pattern was observed from 52 of 55 positive patients, and FS profile abnormality was witnessed from 31 of 55 positive patients, indicating both features are fundamental and ubiquitous surrogates of tumor burden. Specifically, 8q24.2 is the most frequently amplified region at the baseline, which contains an important oncogene MYC. Moreover, the common regions of deletion were 1p36, 4q21 and 6q21. All these regions are involved in genes related to cancer. Elevated level of PTMs was also reported from 32 patients. All patients received varied combination therapies with chemotherapies as the backbone, and compared with clinical imaging. Patients who underwent the second and the third SeekinClarity tests mostly showed significantly decreased MTB, indicating partial response was achieved under the current regimens. Moreover, two of the patients underwent the fourth SeekInClarity test. One achieved a sustained partial response, but another had higher MTB at the fourth test so resistance may be inferred. And all the results were consistent with the clinical imaging. This proof-of-concept study demonstrated SeekInClarity, a non-invasive, multidimensional multi-omics blood-based assay, can promptly evaluate the treatment response of patients with lymphoma. By implementing this assay, the dynamic change of molecular surrogates (CNA, FS and PTMs) can help physicians to make well-informed decisions on the upcoming therapeutic strategies for each patient in conjunction with imaging. This study is still ongoing, and more cases and more time points are included to demonstrate the clinical performance of the assay comparing to the current standard of care for clinical evaluation of treatment response for lymphoma patients. Citation Format: Xinhua Wang, Yu Chang, Zhiming Li, Yinyin Chang, Dandan Zhu, Shuaipeng Geng, Fangyuan Chang, Shiyong Li, Yan Chen, Mingzhi Zhang, Mao Mao. Prompt assessment of molecular tumor load and treatment response in patients with lymphoma by a blood-based multi-omics approach [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5111.

Seated Outcome Measures in Children With Duchenne Muscular Dystrophy.

Quantifiable motor strength measures to assess disease severity throughout the continuum of Duchenne muscular dystrophy (DMD) are needed. To study the feasibility of seated trunk strength using hand-held dynamometry (HHD) and caregiver-reported subjective functional independence measures in boys with DMD. Prospective, cross-sectional, observational study of 18 participants with DMD enrolled from pediatric muscular dystrophy clinic during routine clinical assessment. Hand-held dynamometry, seated reach distance test and Pediatric Evaluation of Disability Inventory (PEDI) were administered. All study participants regardless of the walking status were able to complete the seated function tests demonstrating feasibility. The age of the participants correlated negatively with PEDI mobility and positively with HHD extension scores. The seated measures did not statistically correlate with PEDI mobility scores. Seated motor strength measures and PEDI mobility scores are feasible. The PEDI mobility and HHD extension scores correlate with age. Study limitations included single-center experience and cross-sectional data. https://www.dropbox.com/s/s4r0k7o6s0tfbkb/PT-Seated-Measures-And-DMD-2022.mp4?dl=0.

DYNAMICS OF VENOUS CONGESTION (VEXUS) AND LIVER STIFFNESS BY TRANSIENT ELASTOGRAPHY IN PATIENTS WITH ARTERIAL HYPERTENSION AND DECOMPENSATED HEART FAILURE

Objective: comprehensive assessment of venous congestion (VC) is relevant in patients with arterial hypertension (AH) and decompensated heart failure (DHF). Design and method: to assess the incidence and severity of VC according to the VExUS protocol (assessment of the IVC diameter, the shape of the portohepatic and renal veins blood flow) and to assess the relationship of VC to the liver stiffness (LS), estimated by transient elastography (TE), in patients with AH and DHF on admission and their dynamic changes during ospitalisation. The METAVIR scale was used to interpret the stages of fibrosis. Routine clinical assessment, VExUS, TE was performed in 52 patients with AH and DHF (men 48%, age 70 ± 11 years (M ± SD), atrial fibrillation 60%, diabetes 40%, chronic anemia 27%, left ventricle ejection fraction (EF LV) 50 [40; 57] %, EF < 40% - 29%,NTproBNP 1421 [754; 2024] pg/ml (Me; IQR)). Exclusion criteria: primary chronic liver disease or acute hepatitis, severe tricuspid regurgitation Results: on admission mild, moderate and severe venous congestion were detected in 31%, 13%, 17% of patients, respectively. 79% of patients had increased liver stiffness - 22% had F1 / F2, 17% had F3 and 40% had F4. At discharge, venous congestion was observed in 38% of patients. Mild, moderate and severe venous congestion was detected in 20%, 12%, 6% of cases respectively. An increase in liver stiffness at discharge was detected in 54%. 29% of patients had F1 / F2, 13% had F3, and 12% had F4. The dynamics of clinical signs of congestion on admission and at discharge is presented in Diagram 1. A significant correlation between severity of VC and degree of increase in LS was observed (r = 0.43, p = 0.001). There is a positive correlation between the LS and VC with NT-proBNP (r = 0.47, p = 0.04 and r = 0.30, p = 0.03, respectively), a significant negative correlation between the severity of VC and LVEF (r = -0.49; p = 0.000), and between the degree of LS with LVEF (r = -0.33; p = 0.018). Conclusions: Correlations were revealed between venous congestion, by VEXUS protocol, and LS in TE with LVEF in patients with AH and DHF

Monthly Follow-Ups of Functional Status in People with COPD: A Longitudinal Study.

Functional status is an important and meaningful outcome in people with chronic obstructive pulmonary disease (COPD), although its measurement is not embedded in routine clinical assessments. This study described the functional status of people with COPD using the 1-min sit-to-stand test (1minSTS) over a 6-month period and the examined sociodemographic and clinical characteristics associated with this outcome. Data from a prospective study including people with COPD were analyzed. Functional status was assessed monthly with the 1minSTS over 6 months. Linear-mixed effect models assessed the 1minSTS number of repetitions mean change. One-hundred and eight participants (82.4% men; 66.9 ± 9.5 years) were included. A significantly lower number of repetitions in the 1minSTS over the 6-month period was associated with being female (estimate: −4.69, 95%CI: −8.20; −1.18), being older (estimate: −0.56, 95%CI: −0.77; −0.34), having higher BMI (estimate: −0.55, 95%CI: −0.81; −0.28) and having higher activity-related dyspnea (estimate: −2.04, 95%CI: −3.25; −0.83). Half of the participants showed improvements above three repetitions in the 1minSTS over the 6-month period, independently of their baseline impairment (1minSTS < 70% predicted: 52.5%; ≥70% predicted: 54.4%). To conclude, monthly follow-up assessments were associated with clinically relevant benefits in the functional status of people with COPD. Age, body composition, and activity-related dyspnea were the main predictors of functional status over time. Further research is needed to corroborate our findings and to support the beneficial effects of regular COPD monitoring.

248 Tremor frequency can be measured using smartphone video

Textbook descriptions of tremulous disorders typically mention the tremor frequencies characteristic of particular conditions, and determination of frequency can aid diagnosis. However, current clinical practice does not involve routine accelerometry or EMG for most tremulous patients, or use of smartphone accel- erometer, and the human eye cannot accurately measure tremor frequency.37 hand videos were recorded with smartphone camera from 5 essential tremor participants, 10 Parkin- son’s participants and 1 functional tremor participant, either showing a hand resting or held in posture. Tremor was simiultaneously measured using a commercially available accelerometer for clinical use (‘Natus Neurology’). The computing technique of ‘optical flow’ was applied to the smartphone video to measure pixel movement over time in two directions perpendicular to the long axis of the hand. Dominant frequencies were extracted from smartphone video optical flow and from clinic accelerometer data using fast Fourier transform.Bland-Altman analysis showed a mean of the difference in measurements between smartphone video (pixel optical flow) and accelerometer of 0.05 Hz (SD 0.16 Hz) with 95% confidence intervals for this mean difference of -0.26 Hz to +0.36 Hz.We demonstrate excellent agreement between our computing method for smartphone video tremor measurement and the gold standard of accelerometry. Our computing technique suggests that neu- rologists already have ‘point and press’ contactless equipment in their pocket that has the potential to augment routine clinical assessment by measuring tremor frequency.stefanwilliams@doctors.org.uk

Do supports and barriers to routine clinical assessment for children with cerebral palsy change over time? A mixed methods study

Purpose To understand how healthcare professionals’ perceptions of supports and barriers to routine clinical assessment, for children aged 3–18 years with cerebral palsy, evolved in the presence of a knowledge translation intervention. Methods A prospective longitudinal mixed-methods study was completed. The intervention comprised knowledge brokers, an e-evidence library, locally provided education and embedding routine clinical assessment in practice. Healthcare professionals from five disability services completed the Supports and Barriers Questionnaire and focus groups at baseline, 6, 12 and 24 months. Quantitative data were analysed descriptively and qualitative data using longitudinal framework analysis. Results Questionnaire ratings indicated participants felt supported in implementing routine assessment over time. Subtle differences emerged from the longitudinal framework analysis. Participants shifted from ‘adopting’ to ‘embedding’ and ‘maintaining’ routine assessment. Integration of assessment was impacted by a new national disability funding model. Participants highlighted the need to maintain skills and for unambiguous, sustained communication between the organisation, clients, and stakeholders. If, how and why families engaged with routine assessment developed over time. Conclusions After an initial focus on pragmatic implementation issues, over time healthcare professionals began to reflect more on the complexities of children and families’ engagement with assessment and the impact on the therapist-child-family relationship. Trial registration: This trial was not a controlled healthcare intervention and was registered retrospectively: ACTRN12616001616460. The protocol of the trial was published in 2015. IMPLICATIONS FOR REHABILITATION Healthcare professionals can be supported over time to embed routine clinical assessment using multifaceted knowledge translation interventions. It takes time and ongoing support for healthcare professionals to embed, maintain and begin to adapt the routine clinical assessment to fit with policy, organisational context and the needs and wishes of children and families. Understanding and tailoring knowledge translation approaches to the policy context are essential. Even in the context of major policy shifts, it is possible to harness the commitment of organisations and professionals to improve their services in line with evidence-based approaches.

Mentalizing imagery therapy to augment skills training for dementia caregivers: Protocol for a randomized, controlled trial of a mobile application and digital phenotyping

More than 50 million people worldwide live with a dementia, and most are cared for by family members. Family caregivers often experience chronic stress and insomnia, resulting in decreased mental and physical health. Accessibility of in-person stress reduction therapy is limited due to caregiver time constraints and distance from therapy sites. Mentalizing imagery therapy (MIT) provides mindfulness and guided imagery tools to reduce stress, promote self and other understanding, and increase feelings of interconnectedness. Combining MIT with caregiver skills training might enable caregivers to both reduce stress and better utilize newly learned caregiving skills, but this has never been studied. Delivering MIT through a smartphone application (App) has the potential to overcome difficulties with scalability and dissemination and offers caregivers an easy-to-use format. Harnessing passive smartphone data provides an important opportunity to study behavioral changes continuously and with higher granularity than routine clinical assessments. This protocol describes a randomized, controlled, superiority trial in which 120 family dementia caregivers, aged 60 years or older, will be assigned to smartphone App delivery of caregiver skills with MIT (experimental condition) or without MIT (control condition). The primary objectives of the trial are to assess whether the experimental condition is superior to control on reducing family caregiver stress, insomnia and related outcomes and to demonstrate the feasibility of developing behavioral markers from passive smartphone data that predict health outcomes in older adults. Trial outcomes may inform the suitability of our intervention for caregivers and provide new methods for assessment of older adults.