Small Improvement Research Articles

Improving diets and multimorbidity prevention.

In 2023, the UK government announced a Major Conditions Strategy, publishing 'The case for change and our strategic framework', which set out the focus on cancers, diabetes, dementia, mental ill health, musculoskeletal disorders, CVD and chronic respiratory diseases. Together, these conditions account for 60% of total disability-adjusted life years lost to early death or ill health in England, and one in four adults has at least two (multimorbidity). This review considers some of the key dietary risks for these major conditions and population policies that may improve diets and reduce risks. UK Government dietary recommendations, based on independent risk assessment and advice from the Scientific Advisory Committee on Nutrition, are encapsulated in the national food model, the Eatwell Guide. Based on key sources of dietary data - chiefly consumption data from the National Diet and Nutrition Survey and consumer purchase data from Kantar - most people do not meet dietary recommendations. This review considers how science and evidence inform health improvement policy. This includes policies that encourage healthier food choices, such as labelling and public procurement standards to those that minimise the impact of the less healthy choice such as sugar and salt reduction and reformulation. The review also considers nutritional approaches to managing some non-communicable diseases. Given the role nutrition and excess weight play in the onset, prognosis and quality of life for those living with one or more of the major conditions, there are huge potential gains from even small dietary improvements across population groups.

Assessing the impact of telemedicine interventions on systolic and diastolic blood pressure reduction: A systematic review and meta-analysis.

Hypertension, characterized by high blood pressure, poses a significant risk for cardiovascular diseases, stroke, and heart attack. Managing it is particularly challenging in areas with limited healthcare access and for patients who cannot attend regular in-person visits. Telemedicine interventions offer a promising solution by improving patient adherence and facilitating timely treatment adjustments. This study aims to systematically evaluate the impact of these telemedicine interventions on reducing systolic and diastolic blood pressure. A comprehensive search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. Two independent reviewers screened and selected eligible articles, extracting key data using a standardized form. The quality of the included studies was assessed with the Mixed Methods Appraisal Tool (MMAT). A random effects model was used to combine the results, with treatment effects measured using standardized mean differences (Hedges's g). Consistency of findings was evaluated through statistical tests, including the Q test and I² statistic, to assess heterogeneity. Data analysis was conducted using Stata statistical software version 17.0. Of the 2700 articles retrieved, 35 studies were selected for inclusion in the analysis. Using a random-effects model, the overall effect size was Hedges's g = -0.22 (95% CI: -0.30 to -0.15; p-value < 0.001), indicating a small but meaningful reduction in blood pressure (systolic and diastolic). Telemedicine interventions had a greater impact on systolic blood pressure (Hedges's g = -0.27, 95% CI: -0.39 to -0.15; p-value < 0.001) compared to diastolic blood pressure (Hedges's g = -0.17, 95% CI: -0.26 to -0.07; p-value < 0.001), though both reductions were clinically relevant. This study demonstrates that telemedicine interventions significantly reduce both systolic and diastolic blood pressure, with a more pronounced effect on systolic pressure. The overall effect size indicates a small but meaningful improvement in hypertension management. These findings highlight the potential of telemedicine as an effective strategy for enhancing patient outcomes in hypertension care.

A quality improvement model to identify undiagnosed heart failure at chronic obstructive pulmonary disease annual reviews

Abstract Introduction Heart failure (HF) is a common comorbidity in people with chronic obstructive pulmonary disease (COPD). The estimated prevalence of HF comorbidity in patients with COPD is up to 40%1. COPD and HF have overlapping symptoms which could delay the diagnosis of HF. Studies have shown that in UK primary care, HF treatment for COPD patients is delayed by almost twelve months compared to patients without COPD2. Early diagnosis and management of HF for COPD patients in primary care could reduce risk of recurrent exacerbation and subsequent hospitalisation. HF screen is not currently emphasised in the primary care COPD annual reviews. NICE guidance for COPD diagnosis mentions the use of serum natriuretic peptides to aid differential diagnosis of HF3. Pharmacists in general practice are the patients’ first point of contact, they are able to take leading roles in the holistic management of long-term conditions such as HF and COPD. Aim Reduce HF related complication including exacerbations and subsequent hospital admissions for COPD patients through early HF identification programme at COPD annual review. Methods Electronic Emis search was conducted on the practice database to identify patients on the COPD register. Patients with existing diagnosis of HF or NT-ProBNP in the last 12 month were excluded. Patients were invited for COPD annual review and screened for HF symptoms (breathlessness, fluid retention, fatigue, lightheadness) as per NICE guidance for HF identification. NT-ProBNP test was added to routine annual blood test for patients experiencing any of the HF symptoms. Patients with elevated NT-ProBNP &amp;gt;400ng/L were referred for further assessment for suspected HF. The project was a small scale service improvement project, it did not require ethical approval, this was confirmed with the Broad Street Health Centre clinical lead. Results Twenty six patients were screened out of 48 (54 %). Six patients (23%) had NT-pro BNP results over 400ng/L and were referred for further investigation for suspected HF. Diagnosis was confirmed for three patients 11%. Two of the newly diagnosed patients had an MRC score of 3, while one had and MRC score of 2. No patients with MRC score 1, 4 or 5 where among the newly diagnosed group. Discussion Results analysis correlates with published data regarding the prevalence of HF in COPD patients. Screening for HF in primary care might be most beneficial for patients with MRC of 2 or 3. Patients with score of 1 might have milder symptoms however annual screening will allow early detection of future deterioration. There were no newly diagnosed patients from the MRC score of 4 and 5 groups as they might have already been diagnosed if their symptoms were related to underlying HF. The three patients diagnosed with HF were treated for HF as per NICE guidance. Patients’ spontaneous feedback was positive regarding the new management approach. Conclusion Pharmacists in general practice can play a dynamic role in early identification of existing co-morbidities while conducting annual long-term conditions reviews. This in return facilitates vital early interventions to improve prognosis and reduce further complications along the way.

The overestimation of the effect sizes of psychotherapies for depression in waitlist controlled trials: a meta-analytic comparison with usual care controlled trials.

There is considerable evidence that waiting list (WL) control groups overestimate the effect sizes of psychotherapies for depression. It is not clear, however, what are the exact causes for this overestimation. We decided to conduct a meta-analytic study to compare trials on psychotherapy for depression with a WL control group against trials with a care-as-usual (CAU) control group. We used an existing meta-analytic database of randomized trials comparing psychological treatments of adult depression with control groups and selected trials using a WL or a CAU control group. We used subgroup and meta-regression analyses to examine differences in effect sizes between WL and CAU controlled trials. We included 333 randomized controlled trials (472 comparisons; total number participants: 41,480), 141 with a WL and 195 with a CAU control group (3 included both). We found several significant differences between WL and CAU controlled trials (in type of therapy examined, treatment format, recency, target group, recruitment strategy, number of treatment arms and number of depression outcome measures). The overall effect size indicating the difference between treatment and control at post-test for all comparisons was g = 0.77 (95% confidence interval [CI]: 0.71; 0.84) with high heterogeneity (I2 = 84; 95% CI: 82; 85). A highly significant difference was observed between studies with a CAU control group (g = 0.63; 95% CI: 0.55; 0.71; I2 = 85; 95% CI: 83; 86) and studies with a WL (g = 0.95; 95% CI: 0.85; 1.04; I2 = 80; 95% CI: 78; 82; p for difference < 0.001). This difference remained significant in all sensitivity analyses, including a meta-regression analysis in which we adjusted for all differences in characteristics of studies with a WL versus CAU control group. We also found that pre-post effect sizes in WL control conditions (g = 0.37; 95% CI: 0.28; 0.46) were significantly smaller than change within CAU conditions (g = 0.64; 95% CI: 0.50; 0.78). We found few indications that pre-post effect sizes within therapy conditions differed between WL and CAU controlled trials. WL control conditions considerably overestimate the effect sizes of psychological treatments, compared to trials using CAU control conditions. This overestimation is probably caused by a smaller improvement within the WL condition compared to the improvement in the CAU condition. WL control conditions should be avoided in randomized trials examining psychological treatments of adult depression.

CMMI &amp; Lean-Based Metrics Governance Model to Ensure Data Accuracy &amp; Consistency for Ai/Ml Applications for Sustainable Operations in Mining Industry

In today’s competitive business environment, even small improvements in productivity and efficiency can have a huge impact on company’s profitability. Whether it is through reduced lead time/waste, minimized downtime or improved quality, operation managers are looking for any advantage at every stage. Lean management is a long-term operational discipline that methodically seeks to enhance efficiency and quality by eliminating wastage. The concept is being used in varied industries and helped by improved productivity, safety &amp; better management. Lean in being used by few mining companies also at a small scale, which has helped them in limited way. AI/ML is another important technology used by many organizations. Many global mining companies have also used it for improving operational efficiency, which have helped miners in a limited ways in improving the productivity and safety. Mining companies have to deal with tons of data set generated from heavy machinery and plants, which have to be stored, processed, and stored. There are many challenges in the data set generated/used by AI/ML-application for mining operations. One of the key challenges in AI/ML is accessibility and availability of accurate &amp; consistent data. To ensure consistency of data there is a need for a governance structure which will guarantee the availability of required accurate data set for AI/ML system. One possible solution could be, CMMI’s metrics processes used by IT companies and have helped in improving quality. CMMI’s Metrics related processes are being used extensively by the organizations for better monitoring &amp; control of key measures. This paper explores the possibility of usage of CMMI’s metrics practices with lean implementation in mining for ensuring availability of accurate data sets for AI/ML applications. The proposed framework will put a governance model in place to ensure accuracy &amp; consistency of data to be used for AI/ML-applications in Mining.

Empowering model repair: a rule-based approach to graph repair without side effects—extended version

AbstractWorking with models can lead to inconsistencies, e.g., due to erroneous or contradictory actions during concurrent modeling processes. Modern modeling environments typically tolerate inconsistencies and support their detection. However, at a later stage of development, models are expected to be consistent, meaning their inconsistencies should be considered and resolved. The process of resolving model inconsistencies is commonly referred to as model repair. Our approach to model repair is semi-automatic in the sense that the repair tool computes appropriate repair plans and the modeler decides which path to take. The speciality of our approach is that the repair process can register any small improvement in the model. This allows the interaction with the user to be optimized, resulting in an approach with a high level of automation on the one hand and flexible configuration options on the other. The approach focuses on providing repair plans that do not have side effects, i.e., the computed repair plans do not inadvertently introduce a new inconsistency of already repaired constraints into the model. Since models often have a graph-like structure, we present our approach to model repair based on graphs. Our approach is completely formal—we use the algebraic graph transformation approach to prove its correctness. We also present a prototype implementation of our repair approach based on the Eclipse Modeling Framework and Henshin, a model transformation engine based on graph transformation, to perform the actual model repair. A first performance evaluation shows that graphs with up to 1000 nodes can be repaired in about 10 s.

From Belief to Practice: Understanding Response to Intervention (RTI) or Multi-Tiered System of Supports (MTSS), Implementation among Primary School Teachers

The Multi-Tiered System of Supports (MTSS), also known as Response to Intervention (RTI), is an educational reform initiative aimed at providing quality education and evidence-based treatments for all students. The main objective of the study was to investigate how teachers perceive the beliefs and practices regarding the RTI/MTSS process. The quantitative survey design was used to achieve the main goal for this study. Primary school teachers of these two districts (Multan and Jehlum) were considered a population regardless of their gender. 700 teachers were selected using a stratified random sampling method. A 34-item self-developed questionnaire was used to collect data. Inferential data analysis was used to compare the teachers' beliefs and practices about the RTI/MTSS process with demographic characteristics like location, gender, district, and teaching experiences. The study's results show that teachers had stable and clear ideas about the RTI/MTSS process. Although the teachers saw a moderate and small improvement in their practices, this suggests that their beliefs and actions did not match. The study also established that there were statistical differences in perceived norms between the male and female teachers, the teachers from the different districts, and the teachers with different experience in teaching, but no difference in vignette practices. Further research may attempt to investigate the commonality of the intervention process that has been effective at increasing rates and establish potentially teachable strategies in independent practice.

The Effects of Cognitive Remediation on Negative Symptoms in Schizophrenia-Spectrum Illness: A Meta-analytic Investigation of Efficacy.

The number of clinical efficacy trials of Cognitive Remediation (CR), a behavioral intervention consisting of cognitive task practice and/or strategy training to improve cognitive skills in schizophrenia, has increased substantially over the past 25 years. While recent reviews have highlighted the effects of CR on cognition and function, CR effects on negative symptoms remain understudied. Given the overlap between negative symptoms and cognition, CR effects might be expected. Electronic databases were evaluated up to September 2023 using a broad range of search terms. Sixty-nine unique, controlled trials that used negative symptoms as an outcome were meta-analyzed. Data were independently extracted with excellent (>98%) reliability. Random effects models assessed the effects of CR on summary and expressive vs. experiential negative symptoms. Moderator analyses evaluated a broad array of treatment and participant factors. The meta-analysis (5319 participants) revealed that CR produced a small effect size improvement on summary negative symptoms (Hedge's g = 0.179). Sample differences in age, duration of illness, symptoms, and antipsychotic dosage did not serve as a barrier to treatment benefit. CR also produced small-to-moderate improvements in alogia (Hedge's g = 0.312) but not experiential negative symptoms. Programs of CR that utilized bridging activities that relate training of cognitive skills to activities of daily living produced greater improvement in negative symptoms (g = 0.281 vs 0.055). Longer CR programs also produce larger effects on negative symptoms. CR produces small, consistent reductions in negative symptoms in people with schizophrenia. Variations in CR effects may be linked to different treatment ingredients.

Quality improvement project provides unexpected insights into hospitalized pain management

Patient education and multidisciplinary treatment plans are key best practices for pain management in hospitalized patients. In a routine compliance review, stakeholders at Baylor Scott & White Medical Center – Temple identified pain management patient education as an area needing improvement. A dual-sided medication explanation card was developed, including functional expectations and a QR code linking a companion website with additional pain management educational materials. This short communication details the results from a small quality improvement pilot study using QR code technology to deliver pain management education materials to hospitalized patients. Patients were surveyed the morning after admission and survey results are reported using standard descriptive statistics. Of 46 patients who received the education card, 44 reported well-controlled or moderately-controlled pain and 36 asked for as-needed pain medications. Fourteen patients said that the card was straightforward or made the medication options easy to understand. Per analytics, the companion website had at least 37 unique visitors during the survey period, with at least 8 visitors clicking additional links from the homepage. Though 30 % of patients reported that the education card was helpful and/or straightforward regarding medication options (as intended), five patients with moderately controlled pain who asked for as-needed medications reported they were delayed or ineffective, which revealed that timely administration and adjustments to regimens per patient feedback is also essential. Website analytics suggested that patients utilize and engage with available resources at differing rates. Limitations of this pilot study include small patient population, no pre-intervention comparator group, and disruption in analytics data gathering capabilities during the pilot. Despite limited qualitative data, the quality improvement objectively demonstrated regulatory compliance with pain management education standards and it was adopted throughout all the hospitals of the Baylor Scott & White Healthcare system.

Person Profile Dementia Intervention in Long-Term Care: A Stepped-Wedge Cluster-Randomized Trial

ObjectivesWe aimed to assess the efficacy of a person-centered care intervention in improving quality of life (QoL) for people with dementia in long-term care facilities. DesignThis study was a stepped-wedge cluster-randomized clinical trial of monthly person-centered outcome measurements, followed by collaborative nurse-led person profile interventions involving nursing staff and family members, compared with monthly person-centered outcome measurements alone. Setting and ParticipantsWe included people with a medical diagnosis of Alzheimer's disease or vascular dementia or with clinical symptoms of dementia from 23 long-term care facilities in the German-speaking part of Switzerland. MethodsThe primary outcome was QoL, as assessed using the QUALIDEM. Secondary outcomes were the QUALIDEM subscales and the Integrated Palliative Care Outcome Scale for People with Dementia subscales. The study duration was 15 months, and linear mixed-effect models were used for the analysis. ResultsWe recruited 240 people with dementia from 23 long-term care facilities. Modeling 1143 observations, we found a statistically significant positive intervention effect of 2.6 points according to the QUALIDEM (95% CI, 1.34–3.86; P < .001; total QUALIDEM intervention: 67; 95% CI, 64.8–69.1 vs 64.4; 95% CI, 62.3–66.4 for the control). We also found positive effects of the intervention on all secondary outcomes. Conclusions and ImplicationsOnce-a-month person profile interventions based on person-centered outcome measurements provided a small but significant improvement in QoL. Thus, our findings suggest a potential benefit to the broader implementation of person profiles involving nursing staff and family members in long-term care facilities.

Trajectories of functional limitations, health-related quality of life and societal costs in individuals with long COVID: a population-based longitudinal cohort study

ObjectivesTo examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics.DesignA population-based longitudinal cohort study using real-time user data.Setting35...

A Systematic Review of the Impact of Changes to Urban Green Spaces on Health and Education Outcomes, and a Critique of Their Applicability to Inform Economic Evaluation

Several reviews have consolidated the evidence on the impact of living near an urban green space on improving health and education outcomes and reducing mortality. However, there is limited evidence on the effectiveness or cost-effectiveness of specific improvements to these urban green spaces, which would help decision-makers make informed decisions on how to invest in urban green spaces. Therefore, this review synthesizes the impact of more specific changes to, or investments in, urban green spaces on health and education outcomes, synthesizes the cost-effectiveness of these interventions, and critiques the applicability of the evidence for an economic evaluation. We find that interventions targeted towards improving play areas or fitness equipment tended to have mostly positive impacts on physical activity, while interventions on improving walking path, or the overall greenery showed a more mixed impact on physical activity. There were only two studies on the impact of changes to urban green spaces on mental health, with only one finding a positive association of the intervention with depression, and there were no studies measuring the impact of changes to urban green spaces and educational outcomes. From a cost-effectiveness perspective, we find that typically very small improvements are required to make the interventions a cost-effective policy choice; however, we found several limitations with using the existing evidence to estimate the cost-effectiveness of the intervention. Overall, we found that most of the evidence does suggest that improvements to urban green spaces can lead to improvements in physical activity, but further research is needed on the impact on mental health and educational outcomes. Furthermore, additional evidence with longer time horizons, multi-sectoral benefits, distributional outcomes, and more consistent outcome measures would assist in informing cost-effectiveness and may ultimately lead to improved decision-making around investments for urban green spaces in specific contexts.

Direct anterior decompression in patients with ossification of the posterior longitudinal ligament significantly relieves short-segment spinal cord high signal

BackgroundIn patients with ossification of the posterior longitudinal ligament of the cervical spine (OPLL), high spinal cord signal (HCS) is frequently observed in the spinal cord of the corresponding segment. However, studies on the differences in the improvement of high spinal cord signal due to different surgical approaches are limited. The aim of this study was to investigate the improvement of high spinal cord signal in long and short segments with different choices of surgical approaches.MethodsIn this study, we conducted a meticulous review of medical records for patients diagnosed with ossification of the posterior longitudinal ligament (OPLL). Demographic variables, including gender, age, and body mass index (BMI), were systematically recorded. We evaluated the severity of neurological impairment using the Japanese Orthopaedic Association (JOA) scores both preoperatively and at multiple postoperative follow-up points. Neurological assessments were complemented by serial magnetic resonance imaging (MRI) T2-weighted imaging (T2WI) to measure the extent of high-signal changes (HCS) in the spinal cord, and the alteration of the HCS was quantified by the SCR (the ratio between the signal intensity value of the HCS region and the signal intensity value of the normal spinal cord region at C7-T1).ResultsIn the short-segment high signal change (HCS) group, comparisons of JOA score improvement (Recovery1) and HCS improvement (CR1) at 6 months postoperatively did not demonstrate significant differences between the surgical approaches (P > 0.05; Table 1). However, at the 2-year follow-up, patients who underwent anterior surgery exhibited significantly greater improvements in both JOA scores (Recovery2) and HCS (CR2), with statistical significance achieved (P < 0.05; Table 1). In contrast, in the long-segment HCS group, there was no significant difference between the anterior and posterior surgical approaches in terms of JOA improvement and HCS improvement at 6 months and 2 years postoperatively (P > 0.05; Table 2).ConclusionsIn patients with OPLL who present with spinal cord high signal, anterior surgery by resection of the ossified posterior longitudinal ligament and direct decompression is more conducive to regression of small spinal cord high signal and improvement of clinical neurological function if the extent of spinal cord high signal is small.

Insulin-like Growth Factor Binding Protein-3 (IGFBP-3) measurement in the detection of significant CAD in acute chest pain patients triaged using the No Objective Testing (NOT) rule

Abstract Background After rule-out of MI in ED chest pain patients, uncertainty exists with respect to which remaining patients would benefit from objective functional/anatomical testing to detect potential underlying CAD. Using proteomics, we experimentally identified IGFBP-3 as a biomarker to assist this risk stratification and applied its measurement to &amp;gt;3,000 ED patients from 3 separate studies. Methods An isolated rat heart perfusate model coupled to mass spectrometry identified markers of cardiac ischemia. Human cardiac ischemia was carried out using cardiac exercise stress testing (EST, n=12). Temporal changes in IGFBP-3 during experimental MI were determined in patients undergoing septal alcohol ablation (SAA, n=12) and arterio-venous gradients of IGFBP-3 were determined from cases of proscribed cardiac catheterisation (CC, n=14). The ability of IGFBP-3 to assist clinical assessment (ROC analyses, logistic regression, C-statistic, pathways analyses) and ED risk assessment by the No Objective Testing (NOT) rule was carried out on samples from 3 prospectively recruited studies (SPACE, NZ, n=766; APACE, CH, n=1,056; FAST-TRAC, USA, n=1,230). Results IGFBP-3 identified by MS was present in perfusates of ischemic hearts only (n=3). In human cardiac EST, a delta of IGFBP-3 (∆IGFBP-3) between 0-150minutes was seen in positive ischemic tests, but not in controls (n=6 per group, p=0.026). In SAA patients, peripheral IGFBP-3 levels did not change over 24 hours (n=12, p=0.573) whereas in CC patients, significant extraction gradients of IGFBP-3 were seen across the heart and liver (p=0.013, n=14). In ED chest pain patients identified by the NOT rule (n=1,708), ΔIGFBP-3 between presentation and +2 hours (∆ IGFBP-3) was an independent logistic model predictor of unstable angina (n=123) alongside age, sex, cholesterol and Hx of CAD/MI. At 90% specificity, ∆IGFBP-3 improved the sensitivity of the model from 31% to 43%, the PPV 20% to 25% and the NPV from 94% to 95% (p=0.020). IGFBP-3 made a small improvement in "low risk" NOT rule patient identification (29% to 30%), but made a larger improvement to the ROC curve based identification in NOT rule patients for the finding of stenosis &amp;gt;70% on angiography (n=101, AUC clinical model = 0.682; model plus ∆ IGFBP-3 = 0.725, p=0.044). Pathways analyses (that included hs-TnT) in angiography patients (n=224) revealed ∆IGFBP-3 generated a 28% relative increase in low risk case identification (n=46 to 59). Conclusions IGFBP-3 is identified as a novel potential biomarker of cardiac ischemia, that is taken up/degraded across the heart and appears less responsive to complete infarction (MI). 0-2 hour changes in IGFBP-3 (∆ IGFBP-3) in patients identified as eligible for ED based NOT rule inclusion show promise as a useful tool to identify those with significant CAD, evidenced by the diagnosis of unstable angina, positive EST results or findings of 70% occlusion on angiography.

Determining the minimal important change of the recap of atopic eczema (RECAP) instrument in clinical trials

AbstractBackgroundThe Recap of atopic eczema (RECAP) is a patient‐reported instrument designed to assess eczema control. There is a lack of evidence on the interpretability of change scores in clinical trials.ObjectivesTo calculate the smallest detectable change (SDC) in RECAP and estimate the minimal important change (MIC) for RECAP using various calculation methods in three eczema clinical trial datasets.MethodsIn this study, four anchor‐based methods (within‐person score change, between‐patient score change, predictive modelling, receiver operating characteristic curve) and a distribution‐based method (effect size) was used to determine the MIC of RECAP. The trial datasets involved children (0–12 years), young people (13–25 years) and adults (&gt;25 years) with all eczema severities.ResultsA total of 698 participants were included in this study. The SDC was between 1.74 and 1.80. For the anchor‐based methods, the patient global assessment anchor provided MIC values ranging from 2.35 to 3.94 and the patient oriented eczema measure anchor yielded values between 1.11 and 3.62. The MIC for the distribution‐based method ranged from 2.66 to 3.06, respectively.ConclusionsThe interpretability of RECAP was improved by establishing MIC values and the following thresholds are suggested for interpreting changes in RECAP scores: &lt;2.0 points is possibly a measurement error; 2.0–2.9 points denotes a small improvement that may be clinically relevant; 3.0–3.9 points indicates an improvement that is likely to be clinically important and ≥4.0 points is highly likely to represent a clinically important change.

Effects of Yi Jin Jing on enhancing muscle strength and physical performance in older individuals: a systematic review and meta-analysis.

The aging population is rapidly increasing, leading to physical decline and higher risks of chronic diseases, including sarcopenia, which adversely affects muscle quality and strength. Yi Jin Jing (YJJ), a traditional Chinese exercise method, can enhance flexibility and strength, but evidence regarding its effectiveness in older adults is conflicting. This meta-analysis aims to systematically evaluate the effects of YJJ on muscle strength and physical performance in this demographic. We searched seven electronic databases: China National Knowledge Infrastructure, Wanfang Data, Sinomed, Web of Science, PubMed, Cochrane Library, and EMBASE to identify randomized controlled trials (RCTs). Following PRISMA guidelines, we quantified the effects of YJJ on muscle strength (grip strength, isokinetic strength) and physical performance (chair sit-to-stand, squatting-to-standing, shoulder flexibility, sit-and-reach tests). Treatment effects were calculated using Hedges'g. The Cochrane tool assessed risk of bias, the PEDro scale evaluated methodological quality, and the GRADE method assessed evidence quality. Data analysis was conducted using Stata 17.0 software, utilizing standardized mean differences (SMD) and 95% confidence intervals (CIs). This meta-analysis included 10 RCTs involving 590 participants. The overall risk of bias was assessed to be low. The methodological quality of these studies was generally moderate, and the quality of the main results varied from low to moderate. The findings revealed that YJJ had considerable effects on the chair sit-to-stand test (Hedges'g = 1.06), squatting-to-standing test (Hedges'g = 1.08), and small to moderate effects on handgrip strength (Hedges'g = 0.25), 60°/s extensor peak torque (Hedges'g = 0.47), 60°/s extensor average power (Hedges'g = 0.31), 60°/s extensor total work (Hedges'g = 0.29), 60°/s flexor peak torque (Hedges'g = 0.42), 60°/s flexor average power (Hedges'g = 0.37), and 180°/s extensor peak torque (Hedges'g = 0.29), and left shoulder flexibility (Hedges'g = 0.4). However, there were no significant improvement effects in 180°/s extensor average power (Hedges'g = 0.19), 180°/s extensor total work (Hedges'g = 0.11), 180°/s flexor peak torque (Hedges'g = 0.01), 180°/s flexor average power (Hedges'g = -0.08), right shoulder flexibility (Hedges'g = 0.09), and sit-and-reach test (Hedges'g = 0.15). YJJ significantly enhances specific aspects of physical performance, particularly chair sit-to-stand and squatting-to-standing tests, while showing small and moderate improvements in handgrip strength and knee muscle strength. However, it had no significant effects on other metrics, including shoulder flexibility and sit-and-reach tests. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024530487, Registration number: CRD42024530487.

Feasibility, acceptability, and preliminary efficacy of a self-directed online psychosocial intervention for women with metastatic breast cancer: Finding My Way-Advanced

PurposeFew digital interventions target patients with advanced cancer. Hence, we feasibility-tested Finding My Way-Advanced (FMW-A), a self-guided program for women with metastatic breast cancer.MethodsA single-site randomised controlled pilot trial was conducted. Participants were recruited through clinicians, professional networks, and social media and randomised to intervention or usual-care control. Participants were randomly allocated to either the intervention (FMW-A; a 6-week, 6-module CBT-based online self-directed psychosocial program for women with MBC + usual care resources) or control (usual care resources: BCNA’s Hope and Hurdles kit). Feasibility outcomes included rates of recruitment, uptake, engagement, and attrition. Distress, QOL, and unmet needs were evaluated for signals of efficacy, and qualitative feedback was collected to assess acceptability.ResultsDue to COVID-19 and funding constraints, the target recruitment of 40 was not reached (n = 60 approached; n = 55 eligible; n = 35 consented). Uptake was high (n = 35/55; 63.6%), engagement modest (median 3/6 modules per user), and attrition acceptable (66% completed post-treatment). Efficacy signals were mixed: compared to controls, FMW-A participants experienced small improvements in fear of progression (d = 0.21) and global QOL (d = 0.22) and demonstrated a trend towards improvements in cancer-specific distress (d = 0.13) and role functioning (d = 0.18). However, FMW-A participants experienced small-to-moderate deteriorations in general distress (d = 0.23), mental QOL (d = 0.51), and social functioning (d = 0.27), whereas controls improved. Qualitatively, participants (n = 4) were satisfied with the program, perceived it as appropriate, but noted some sections could evoke transient distress.ConclusionThe study demonstrated feasibility (high uptake and acceptable retention) and generated realistic recruitment estimates. While FMW-A appears promising for targeting cancer-specific distress and fear of progression, the mixed findings in quality of life and general distress warrant further revisions and testing.

Palliative rehabilitation and quality of life: systematic review and meta-analysis

ImportanceInternational guidelines recommend the integration of multidisciplinary rehabilitation into palliative care services but its impact on quality of life across disease types is not well understood.ObjectiveTo determine the effect of...

Diet Quality Changes in a 12-Week Web-Based Physical Activity Intervention without Explicit Dietary Guidance

Lifestyle habits seem interconnected and extant studies suggest that a lifestyle-related modification can impact other related behaviors. For instance, interventions targeting physical activity (PA) could potentially impact dietary patterns and quality. Therefore, we hypothesized that a web-based intervention to increase PA would lead to changes in diet quality without explicit dietary guidance. Our aim was to evaluate changes in diet quality, measured by the Healthy Eating Index 2020 (HEI-2020), following a 12-week web-based PA intervention in adults with obesity. The study consisted of secondary analysis of a 12-week pilot randomized controlled trial, wherein participants (N = 82) were randomized to the Physical Activity for The Heart (PATH) intervention group, which included workout videos and virtual coaching, or a wait-list control group. Diet quality was assessed at baseline and post-intervention using the HEI-2020 based on recalls collected through the Automated Self-Administered 24-h recall (ASA-24) system. Baseline characteristics were similar across groups. Both groups showed small improvements in HEI-2020 total scores after 12 wk (PATH: 65.11 vs. Control: 62.24). Stratification by moderate to vigorous physical activities increase (<60 min. vs. ≥60 min.) revealed greater improvements in specific HEI-2020 components in the ≥60 min group, though overall changes remained modest. The PA intervention led to small improvements in certain diet quality components, suggesting potential interconnectedness between PA and dietary habits. However, overall changes in HEI-2020 scores were modest. Future research with larger samples should explore the effects of PA intervention alone vs. combined with dietary guidance on diet quality in adults with obesity.

AUDIT TO EVALUATE CURRENT RADIOTHERAPY (RT) PLANNING PATHWAY: COULD CURRENT PRACTICE BE IMPROVED BY THE TIMING OF MAGNETIC RESONANCE IMAGING (MRI)?

Abstract AIMS To evaluate the current guidance for glioblastoma (GBM) and primary brain radiotherapy (RT) planning. Current practice in this centre utilises pre and post-surgical MRI for RT target delineation. This study aims to explore the practicality and impact of scheduling an RT planning-specific MRI no more than 2 weeks before RT treatment start date (TSD). Time from surgery to RT TSD will also be explored. METHOD Fifty GBM patients, treated between August 2022 and October 2023, were audited retrospectively. Included patients were treated with radical intent and must have had surgery or biopsy. Age, gender or performance status (PS) were excluded from audit criteria. Age of MRI used for RT planning and surgery to TSD was noted. RESULTS Early results showed that the average age of MRI used for RT planning was 7 weeks old and Surgery to TSD was 7 weeks. A new pathway was introduced after 37 patients as these results were considered unacceptable. The new pathway included 1 reserved MRI appointment and one reserved RT Mask/CT appointment per week. 13 patients’ pathways were audited after introduction of the new pathway. The results showed that the average age of MRI used for RT planning was 2 weeks old and surgery to TSD was 6 weeks. CONCLUSION Limitations of the audit included disparity between number of patients before and after introduction of the new pathway. This was because of the time limitation for completion of the study. Improvement was seen in timing of MRI to TSD. However, the small improvement in timing of surgery to TSD was impacted by human factors rather than organisational influence, for example, surgical deconditioning, delays for wound healing and patient choice. This study has shown that the ideal timing of MRI can be achieved.