Follow-up Telephone Interviews Research Articles

Outcome of traumatic elbow luxation managed with temporary transarticular external skeletal fixation in eight cats.

The aim of this study was to report the clinical outcomes in a series of traumatic elbow luxations in cats treated with closed reduction and a temporary transarticular type II external skeletal fixator (ESF). A retrospective review was conducted of traumatic elbow luxation cases in cats at two referral centres. Data collected included signalment, history, clinical assessment, radiographic findings, surgical procedures and complications. Short-term follow-up was based on clinical evaluations at 2 and 6 weeks postoperatively. Long-term follow-up was based either on a telephone interview with the owner or a clinical evaluation. Eight cats were included. Five cats experienced lateral elbow luxation, while three cats had medial elbow luxation. All cats with medial elbow luxation exhibited radiographic signs of medial humeral epicondylitis. The median age was 9 years (range 3-15). The elbow luxation was treated by closed reduction and percutaneous placement of a temporary transarticular type II ESF, which was removed 2 weeks postoperatively. Two minor complications were recorded. Elbow reluxation and major complications were not encountered. The 6-week postoperative evaluation and long-term follow-up revealed a lameness of grade 1 in 1/8 cats and 0 in the remainder. Elbow range of motion was normal in all cats. None of the cases treated with this protocol experienced recurrence of elbow luxation. All cats demonstrated an excellent outcome based on the lameness score, the low complication rate and the follow-up telephone interview. The technique is minimally invasive and carries a low incidence of complications. Concurrent orthopaedic disease, such as medial humeral epicondylitis, may predispose to medial elbow luxation.

Long-term results after medial patellotibial ligament reconstruction for the treatment of patellofemoral instability.

To evaluate long-term clinical outcomes and redislocation rate after medial patellotibial ligament reconstruction. A total of 26 knees with mean age 26.3 ± 10.6 years (25 patients, 7 males and 18 females) treated for patellar instability (at least two objective dislocations) with medialization of the patellar tendon medial third were evaluated with an intermediate clinical follow-up (FU) at a mean of 6.5 ± 2.1 years and with a final telephone interview follow-up at mean of 15.6 ± 2.5 years (11.4-20.1). Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC), Kujala, Visual Analog Scale (VAS) for pain and Tegner activity scores were used. Information about further redislocation and knee surgery was also collected. All the clinical scores had a significant improvement compared to preoperative status (WOMAC pre-op 55.9 ± 27.2 vs. WOMAC final FU 80.8 ± 22.2; KUJALA pre-op 41.0 ± 24.0 vs. KUJALA final FU 77.2 ± 24.1; VAS pre-op 6.0 ± 3.1 vs. VAS final FU 3.44 ± 2.35; TEGNER pre-op 2.1 ± 2.0 vs. TEGNER final FU 3.6 ± 1.8; p < 0.001), and the outcomes remained stable at the final follow-up compared to the intermediate follow-up (p > 0.05). A total of 4 knees had at least one redislocation at the final follow-up, while 3 knees underwent total knee replacement surgery. The redislocation-survival rate at 5 years is 92%, meanwhile is 84% at 10 and 15 years. MPTL reconstruction produced good clinical results and a survival rate of 84% at a mean of 16 years follow-up and could be considered as associated procedure in case of patellofemoral instability. Level IV.

Whole-Body Cryostimulation: An Effective Complementary Treatment in Fibromyalgia? A Follow Up Study.

Recent evidence suggests that whole-body cryostimulation (WBC) may be beneficial for patients with fibromyalgia (FM), but little is known about the duration of such effects. The purpose of this study was to verify the duration of clinical-functional benefits after one cycle of WBC. We conducted a follow-up study on the medium and long-term effects of WBC on well-being, use of pain-relieving/anti-inflammatory medications, pain level, fatigue, sleep quality, and psychological aspects such as mood and anxiety. Twelve months after discharge, we administered a 10 min follow-up telephone interview with FM patients with obesity who had undergone ten 2 min WBC sessions at -110 °C as part of a multidisciplinary rehabilitation program (n = 23) and with patients who had undergone rehabilitation alone (n = 23). Both groups reported positive changes after the rehabilitation program, and similar results regarding fatigue, mood, and anxiety scores; however, the implementation of ten sessions of WBC over two weeks produced additional benefits in pain, general well-being status, and sleep quality with beneficial effects lasting 3-4 months. Therefore, our findings suggest that adding WBC to a rehabilitation program could exert stronger positive effects to improve key aspects of FM such as general well-being, pain level, and sleep quality.

Identifying Facilitators and Inhibitors of Shared Understanding: An Ethnography of Diagnosis Communication in Acute Medical Settings.

Communication is important in determining how patients understand the diagnostic process. Empirical studies involving direct observation of communication within diagnostic processes are relatively limited. This ethnographic study aimed to identify communicative practices facilitating or inhibiting shared understanding between patients and doctors in UK acute secondary care settings. Data were collected in acute medical sectors of three English hospitals. Researchers observed doctors as they assessed patients; semistructured interviews were undertaken with doctors and patients directly afterwards. Patients were also interviewed 2-4 weeks later. Case studies of individual encounters (consisting of these interviews and observational notes) were created, and were cross-examined by an interdisciplinary team to identify divergence and convergence between doctors' and patients' narratives. These data were analysed thematically. We conducted 228 h of observation, 24 doctor interviews, 32 patient interviews and 15 patient follow-up interviews. Doctors varied in their communication. Patient diagnostic understanding was sometimes misaligned with that of their doctors; interviews revealed that they often made incorrect assumptions to make sense of the fragmented information received. Thematic analysis identified communicative practices that seemed to facilitate, or inhibit, shared diagnostic understanding between patient and doctor, revealing three themes: (1) communicating what has been understood from the medical record, (2) sharing the thought process and diagnostic reasoning and (3) closing the loop and discharge communication. Shared understanding was best fostered by clear communication about the diagnostic process, what had already been done and what was achievable in acute settings. Written information presents an underutilised tool in such communication. In UK acute secondary settings, the provision of more information about the diagnostic process often fostered shared understanding between doctor and patient, helping to minimise the confusion and dissatisfaction that can result from misaligned expectations or conclusions about the diagnosis, and the uncertainty therein. A patient and public involvement group (of a range of ages and backgrounds) was consulted. They contributed to the design of the protocol, including the timing of interviews, the acceptability of a follow-up telephone interview, the development of the interview guides and the participant information sheets.

Safety and Efficacy of Dapagliflozin in Patients with Heart Failure with Reduced Ejection Fraction: Multicentre Retrospective Study on Echocardiographic Parameters and Biomarkers of Heart Congestion.

Objectives: Dapagliflozin has shown efficacy in clinical trials in patients with heart failure and reduced ejection fraction (HFrEF). However, real-world data on its use and outcomes in routine clinical practice are limited. We aimed to evaluate the utilisation and safety profile of dapagliflozin in a real-world population of HFrEF patients within the Marche region. Methods: Nine cardiology departments within the Marche region retrospectively included HFrEF patients who were initiated on dapagliflozin therapy in an outpatient setting. Data on medical history, comorbidities, echocardiographic parameters, and laboratory tests were collected at baseline and after 6 months. Telephone follow-up interviews were conducted at 1 and 3 months to assess adverse events. We defined the composite endpoint score as meeting at least 50% of four objective measures of improvement among: weight loss, NYHA decrease, ≥50% Natriuretic peptides (NP) decrease, and guideline/directed medical therapy (GDMT) up titration. Results: We included 95 HFrEF patients aged 66 ± 12 years, 82% were men, 48% had ischemic heart disease, and 20% had diabetes. At six months, glomerular filtration rate declined (p = 0.03) and natriuretic peptides levels decreased, on average, by 23% (p < 0.001). Echocardiographic measurements revealed a decrease in pulmonary artery pressure (p < 0.001) and E/e' (p < 0.001). In terms of drug therapy, furosemide dosage decreased (p = 0.001), and the percentage of the target dose achieved for angiotensin receptor-neprilysin inhibitors increased (p = 0.003). By multivariable Cox regression, after adjustment for age, sex, the presence of diabetes/prediabetes, and HF duration, higher baseline Hb concentrations (HR 1.347, 95% CI 1.038-1.746, p = 0.025), and eGFR levels (HR 1.016, 95% CI 1.000-1.033, p = 0.46). Conclusions: In a real-life HFrEF population, dapagliflozin therapy is safe and well-tolerated, improves echocardiographic parameters and biomarkers of congestion, and can also facilitate the titration of drugs with a prognostic impact.

Transition experiences of patients with post stroke dysphagia and family caregivers: A longitudinal, qualitative study.

Stroke patients with dysphagia and family caregivers will experience multiple transitions during the whole process of the disease and various nursing needs will be generated. There is a lack of knowledge about their experiences at different transition stages. Thus, we aimed to explore the transition experiences of patients with post stroke dysphagia and family caregivers from admission to discharge home. A semi-structured interview based on Meleis's transition theory was used during hospitalization and telephone follow-up interviews were conducted in the first, third, and sixth month after the diagnosis of dysphagia. Interview transcripts were analyzed using the conventional content analysis method. A total of 17 participants enrolled in the first face-to-face interview, 16 participants took part in the first month's telephone follow-up interview, 14 participants in the third month, and 12 participants in the sixth month. The transition experiences of patients with post stroke dysphagia and family caregivers could be summarized into three themes: (1)transition from onset to admission; (2)transition from discharge to other rehabilitation institutions; and (3)transition from discharge to home. Each theme had identified interrelated subthemes. The experiences of patients with post stroke dysphagia and family caregivers during transition are a dynamic process with enormous challenges in each phase. Collaboration with health care professionals, follow-up support after discharge, and available community and social support should be integrated into transitional nursing to help patients facilitate their transition.

Surveillance of surgical site infections in orthopedic prosthetic surgery: a tool for identifying risk factors and improving clinical practice.

Surgical site infections (SSIs) are among the most frequently encountered complications in prosthetic surgery, and are associated with increased hospitalization, costs and in-hospital mortality. There is no national system for the comprehensive monitoring of the incidence of SSIs. All patients undergoing orthopedic prosthetic surgery from April 1 to June 30, 2023 were enrolled. Clinical evaluation of the surgical site was conducted at 30 days, and a follow-up telephone interview was carried out by means of a specially designed questionnaire at 90 days. A total of 59 patients were included. Surgery was performed on the knee in 71.19% and on the hip in 28.81%. The patients' mean BMI was 28.25 ± 2.97, and their mean ASA score was 2.67 ± 0.58. Six patients had diabetes mellitus. The incidence of SSIs was 5.08%; two infections occurred in knee prosthesis surgery and one in hip surgery. Analysis of the data revealed that diabetes was the main risk factor for the development of infection. Although based on a small number of patients, these results are encouraging, especially considering that the patients had an average ASA score of more than 2 and a high BMI. However, to further reduce the risk of infection, improved hygiene measures have now been implemented in the operating room and the antibiotic prophylaxis protocol has been updated to take into account the potential for MRSA colonization.

Long-Term Impact of an Occupational Therapy Intervention for Children With Challenges in Sensory Processing and Integration.

Research is limited regarding parent-caregiver perspectives of occupational therapy (OT) intervention for children with challenges in sensory processing and integration and whether changes immediately following OT intervention are sustained over time. To evaluate whether changes in identified goals are maintained following OT intervention and to determine what aspects of OT intervention parents-caregivers perceive to be most valuable. A mixed-methods research design. A large midwestern pediatric hospital, with follow-up telephone interviews with parents-caregivers. Sixteen children with sensory challenges and their parents-caregivers. Children participated in 1-hr OT intervention sessions, 3 days per wk, for 6 to 7 wk. Parents-caregivers of children who completed OT intervention were interviewed via the telephone 6 to 12 mo after the intervention. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scaling (GAS) were used to determine whether changes were made and sustained over time. Qualitative data on caregiver perceptions of OT intervention were collected via open-ended questions during phone interviews. COPM and GAS scores before intervention were statistically significant compared with scores immediately following intervention and at 6- to 12-mo follow-up. Five themes emerged from the qualitative data. Children with sensory challenges made significant changes related to occupational performance following OT intervention, and goal achievement was sustained over time. Parents-caregivers valued many aspects of the OT program, including the increased frequency of therapy services, the occupational therapist's advanced knowledge and skills, and the education and information provided during the program. Plain-Language Summary: This study supports the results of previous studies on OT intervention for children with challenges in sensory processing and integration. The study also adds to the body of knowledge that shows that changes and progress toward goals that result from skilled OT intervention can be sustained over time. The study showed that children participating in OT intervention made statistically significant changes while receiving OT services and maintained progress after intervention ended; however, the children did not continue to make significant progress toward goals once skilled OT services ended. Parents and caregivers of children with sensory challenges reported that they found OT intervention to be beneficial. Other important factors influencing the effectiveness of OT intervention that were identified by parents-caregivers included the education provided by the occupational therapist, the increased frequency of therapy services, and the increased knowledge and skills of the occupational therapists who provided the intervention.

The LIVER CARE trial - screening for liver disease in individuals attending treatment for alcohol use disorder: a randomized controlled feasibility trial.

Alcohol-related liver disease is a preventable disease with high mortality. If individuals with alcohol-related liver disease were to be diagnosed earlier by screening and they reduced their alcohol consumption, lives lost to alcohol-related liver disease might be saved. A liver stiffness measurement (FibroScan©) is a key tool to screen for alcohol-related liver disease in asymptomatic individuals. No randomized controlled trials have been conducted to test if screening for liver disease reduces alcohol consumption in individuals with alcohol use disorders, in addition to what can be obtained by motivational interventions. We aimed to assess the feasibility of a randomized controlled trial of a screening for liver disease on the prevalence of alcohol abstinence or light consumption after 6months in individuals attending outpatient treatment for alcohol use disorder. We used an interdisciplinary approach to develop the format of the randomized controlled trial. Individuals were recruited from one outpatient treatment facility for alcohol use disorders. Study participants were randomized 1:1 to receive a) a liver stiffness measurement in addition to usual care (intervention) or b) usual care (control). Follow-up on alcohol consumption was assessed by telephone interview after 6months and corroborated by data from records from public hospitals and the alcohol treatment facility. Feasibility was assessed by probabilities of recruitment, retention, and completion and estimated by the exact binominal test, with success defined as > 50% participation for each endpoint. The study design was evaluated at interdisciplinary meetings with staff and researchers from the outpatient alcohol treatment facility and the hospital clinic. Forty of 57 invited individuals agreed to participate in the study (recruitment = 70% (95% CI: 57-82)); 19 of 20 participants randomized to the intervention showed up for the screening (retention = 95% (95% CI: 75-100)). Follow-up telephone interviews succeeded for 33 of 39 reachable participants (completion = 85% (95% CI: 69-94)). Treatment records indicated that the 6 participants who were lost to follow-up for the telephone interview had not achieved alcohol abstinence or light consumption. There was no evidence that the intervention increased abstinence or light alcohol consumption at follow-up: 45% (95% CI: 23-68) in the intervention group and 65% (95% CI: 41-85) in the control grouphad aalcohol consumption below10 standard drinks/weekat 6months. The main obstacle regarding study feasibility was to avoid disappointment in individuals randomized as controls. This feasibility study developed a study design to test the influence of screening for liver disease on abstinence or light alcohol consumption in individuals attending treatment for alcohol use disorder. ClinicalTrials.gov identifier: NCT05244720; registered on February 17, 2022.

Determinants of post-acute COVID-19 syndrome among hospitalized severe COVID-19 patients: A 2-year follow-up study.

Post-acute COVID-19 syndrome is a condition where individuals experience persistent symptoms after the acute phase of the COVID-19 infection has resolved, which lowers their quality of life and ability to return to work. This study assessed the prevalence and associated risk factors of post-acute COVID-19 syndrome (PACS) among severe COVID-19 patients who were discharged from Millennium COVID-19 Care Center, Addis Ababa, Ethiopia. A cross-sectional study using data collected from patient charts and a follow-up telephone interview after two years of discharge. Systematic random sampling was used to select a total of 400 patients. A structured questionnaire developed from the case report form for PACS of the World Health Organization (WHO) was used. Frequency and cross-tabulation were used for descriptive statistics. Predictor variables with a p-value <0.25 in bivariate analyses were included in the logistic regression. Out of the 400 patients, 20 patients were dead, 14 patients refused to give consent, and 26 patients couldn't be reached because their phones weren't working. Finally, 340 were included in the study. The majority (68.5%) were males and the mean age was 53.9 (±13.3 SD) years. More than a third (38.1%) of the patients reported the persistence of at least one symptom after hospital discharge. The most common symptoms were fatigue (27.5%) and Cough (15.3%). Older age (AOR 1.04, 95% CI 1.02-1.07), female sex (AOR 1.82, 95% CI 1.00-3.29), presence of comorbidity (AOR 2.38, 95% CI 1.35-4.19), alcohol use (AOR 3.05, 95% CI 1.49-6.26), fatigue at presentation (AOR 2.18, 95% CI 1.21-3.95), and longer hospital stay (AOR 1.06, 95% CI 1.02-1.10) were found to increase the odds of developing post-acute COVID-19 syndrome. Higher hemoglobin level was found to decrease the risk of subsequent post-acute COVID-19 syndrome (AOR 0.84, 95% CI 0.71-0.99). The prevalence of post-acute COVID-19 syndrome is high, with a wide range of persistent symptoms experienced by patients. COVID-19 survivors with the identified risk factors are more susceptible to post-acute COVID-19 and require targeted monitoring and care in a multidisciplinary approach.

Clinical reappraisal of the composite international diagnostic interview version 3.3 in Qatar's National Mental Health Study.

Lifetime DSM-5 diagnoses generated by the lay-administered Composite International Diagnostic Interview for DSM-5 (CIDI) in the World Mental Health Qatar (WMHQ) study were compared to diagnoses based on blinded clinician-administered reappraisal interviews. Telephone follow-up interviews used the non-patient edition of the Structured Clinician Interview for DSM-5 (SCID) oversampling respondents who screened positive for five diagnoses in the CIDI: major depressive episode, mania/hypomania, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Concordance was also examined for a diagnoses of post-traumatic stress disorder based on a short-form versus full version of the PTSD Checklist for DSM-5 (PCL-5). Initial CIDI prevalence estimates differed significantly from the SCID for most diagnoses ( =6.6-31.4, p=0.010<0.001), but recalibration reduced most of these differences and led to consistent increases in individual-level concordance (AU-ROC) from 0.53-0.76 to 0.67-0.81. Recalibration of the short-form PCL-5 removed an initially significant difference in PTSD prevalence with the full PCL-5 (from =610.5, p<0.001 to =2.5, p=0.110) while also increasing AU-ROC from 0.76 to 0.81. Recalibration resulted in valid diagnoses of common mental disorders in the Qatar National Mental Health Survey, but with inflated prevalence estimates for some disorders that need to be considered when interpreting results.

Abstract 3101: Precision Medication Communication Through Teach-back Method Among Patients With Cardiovascular Disease Admitted To The Telemetry Unit

Background: Limited qualitative research has identified clinician skills and behaviors that enhance precision communication, a challenging task when patients exhibit limited health literacy(HL). The teach-back method, a technique aimed at confirming patients' comprehension of health information has been suggested as a valuable strategy to address HL. Our quality improvement study examined the patients’ understanding of newly prescribed cardiac medications during hospitalization. We aimed to pinpoint barriers in communication between healthcare providers and patients as well as use the teach-back method to improve literacy about newly prescribed medications before their discharge. Methods: 50 participants, including 28 males and 22 females with a mean age of 71.72, (SDN+/-2:11.59) admitted to the telemetry floor between 11/2023 and 01/2024. Yes/No questionnaire interview was conducted to gauge their understanding of the newly prescribed cardiac medication and its adverse effects. The interviewer encouraged participants to articulate their understanding in their own words. A follow-up telephone interview was conducted 2-4 weeks post-discharge to assess the retention of information regarding the newly initiated medication(s). Results: Among 50 patients, 54% demonstrated awareness of the reason behind the prescription of the medication, while only 26% knew about its serious adverse effects before employing the teach-back method. Following the application of the method during the interview, 92% exhibited an enhanced understanding of the information related to their medications. Follow-up telephone interviews conducted 2-3 weeks post-discharge, 74% retained information about the indication and adverse effects of the prescribed medications. Conclusion: Integration of the teach-back method during discharge planning is a highly effective strategy in improving patient education and communication for newly prescribed cardiac medications.

Shining a Light in COVID-19 Darkness

Introduction: The World Health Organization officially declared COVID-19 a global pandemic in March 2020, resulting in travel restrictions, closure of non-essential shops and services, and the discontinuation of elective healthcare. The escalation of the pandemic impacted on hospital healthcare professionals, who experienced the deaths of colleagues and unprecedented changes in their working conditions. One area that received media attention in the United Kingdom during the pandemic was the role of hospital chaplaincy and spiritual care teams.Methods: An exploratory study advertised via social media, the press and professional bodies resulted in 86 healthcare professionals and 63 chaplains, who had worked clinically in the United Kingdom during the pandemic, completing an open, free text electronic survey. Seven chaplains participated in a follow-up telephone interview, with all the data collected in 2022.Results: The survey demographic data were analysed using descriptive statistics. Free text responses and interviews were subject to thematic analysis. A focus on the support of health professionals was widely reported by all respondents. Two overarching themes were identified: (1) organizational initiatives, with subthemes of structural and virtual support; (2) proactive intervention – “going to the frontline”, with subthemes of emotional and spiritual support, moral support and practical input.Discussion/Conclusion: The overarching finding was that hospital chaplains worked alongside healthcare staff on the clinical frontline. Staff described this as invaluable in its immediacy of support and provision of a valued presence. The chaplain’s role changed to becoming more focused on staff support, which appears to be ongoing, thus impacting on the future role and training for hospital chaplaincy teams.

Assessing Attitudes and Understanding After Ovarian Tissue Cryopreservation: A Follow-Up Telephone Interview Survey.

Purpose: Assessing patient and guardian experiences regarding their history of ovarian tissue cryopreservation (OTC) years after initial procedure. Methods: Cross-sectional follow-up telephone survey. A questionnaire developed by The Pediatric Initiative Network of the Oncofertility Consortium, modified to assess intent and attitudes regarding OTC, tissue access knowledge, financial burden of tissue storage, and intent to use tissue, was utilized. Interviews were conducted for those who underwent OTC at a metropolitan children's hospital between 2013 and 2022. Results: Of 60 eligible patients, 39 interviews were completed. Contacted patients were 3-28 years old, with minors accompanied by guardians. Average age at OTC was 8.5 years old, and 5.1% (2/39) were deceased at the time of contact. All interviewees underwent OTC for fertility preservation before gonadotoxic treatment. Seventy percent of patients (7/10) and 48.1% (13/27) of guardians stated they would use frozen tissue for pregnancy, with 50% (5/10) of patients and 59.3% (16/27) of guardians not understanding tissue access. Regret occurred in 10% (1/10) of patients and 3.4% (1/29) of guardians. It was associated with 10.8% (4/37) of tissue discard due to failed storage payments. Financial concerns occurred in 29.7% (11/37) of interviewees. Overall, 92.3% (36/39) would recommend OTC, and 94.9% (37/39) would repeat their choice to undergo OTC. Conclusion: Follow-up after OTC is essential to patient understanding of tissue status, access, and payments. Most do not regret OTC, except in cases of financial burden leading to tissue discard. Follow-up should be sequentially scheduled and include counseling on financial assistance programs.

Abstract TMP58: Neuroimaging Markers of Patient-Reported Outcomes in Acute Ischemic Stroke

Objectives: To determine the relationship between patient-reported outcome measures (PROMs) and volumetric biomarkers assessed on clinical imaging in acute ischemic stroke (AIS). Background: AIS is a leading cause of long-term disability. White matter hyperintensity (V_WMH), brain (V_Brain) and stroke lesion volume (V_Lesion) have been linked as potential determinants of functional outcomes after stroke. Recently, there has been surging attention to PROMs, which allow for direct, patient-centered health assessments of stroke victims. However, the link between neuroimaging biomarkers and PROMs is not well studied. Methods: Patients presenting to the Emergency Department at Massachusetts General Hospital between February 2017 and February 2020 with a confirmed AIS on MRI were eligible and underwent a follow-up telephone interview, including PROM-10 questionnaires. V_WMH and V_Brain were automatically determined from clinical MRI. V_Lesion was manually segmented. Regression analyses were performed to identify associations of brain volumetrics and clinical variables with PROM-10 subscores and global mental and physical summary scores. Results: Utilizing data from 150 patients (mean age: 64.7; 41.9% female), higher V_WMH was associated with worse global mental (β = -0.65), global physical (β = -0.60), social activities (OR = 0.59), physical health (OR = 0.68), fatigue (OR = 0.69) and social satisfaction (OR = 0.66) scores. V_Lesions were associated with poorer global mental (β = -0.79), social (OR = 0.55) and physical (OR = 0.66) activities, mental health (OR = 0.68) and emotional distress (OR = 0.68) scores. Higher V_Brain was linked to better global mental (β = 0.93), global physical (β = 0.79), physical activities (OR = 1.72) and mental health (OR = 1.54) scores. Conclusions: Imaging biomarkers were significantly associated with PROMs. The inclusion of these markers with PROMs in routine post-stroke assessment can enhance our understanding of recovery.

“Music therapy is the very definition of white privilege”: Music therapists’ perspectives on race and class in UK music therapy

The resurgence of the Black Lives Matter movement in the summer of 2020 following the death of George Floyd highlighted, once again, the racial and socioeconomic inequities permeating western countries, and galvanised music therapists in the UK and elsewhere to reflect on the importance of race and social class in their profession and therapeutic practice. These discussions have a longer history in the US; in the UK they are in their infancy. Building on the 2020 British Association of Music Therapy Diversity Report (Langford et al., 2020), this study aimed to contribute to the burgeoning discussion in UK music therapy by inviting trainee and qualified music therapists to reflect on how – often intersecting – racial and socioeconomic inequities impact on music therapy training and practice and what changes are needed for music therapy to become more relevant to and representative of minoritised communities. Data were generated using an online qualitative survey (N=28) and five follow-up telephone interviews, allowing for both breadth and depth in an area where there is a paucity of research, and a higher level of “felt anonymity” for a potentially sensitive and threatening topic. Reflexive thematic analysis informed by critical race theory was used to develop three themes from the data: 1) Posh white ladies: the typical music therapist; 2) White normativity and fragility in music therapy; and 3) Music therapy: undervalued and too costly. In the conclusion, we synthesise the participants’ accounts into recommendations for diversifying the music therapy profession in the UK.

Health and Safety Executive research on wood dust exposure controls in British manufacturing.

To generate new intelligence on occupational exposure to wood dust in woodworking manufacturing activities in Britain, the Health and Safety Executive (HSE) performed 22 occupational hygiene site visits to assess exposure and exposure controls between 2014 and 2017. The work aimed to characterise good practice and therefore sites with a poor health and safety record, as identified from HSE inspection records, were not invited to participate. Sites selected covered furniture production, joinery, saw milling, and boat building and repair. Twenty-three follow-up telephone interviews were also carried out across 15 of the companies with supervisors and managers to explore how they tried to promote good practice among the workforce, and if there are any potential challenges encountered. The aim of the interviews was to gain a better understanding of how to enable organisations to improve the management of wood dust exposure. This study found that 6.0% of all wood dust exposure measurements (15 out of 252) were above 5 mg/m³, and 17.6% of exposures to hardwood dust or mixtures of hardwood and softwood dust (38 out of 216) were above 3 mg/m³ (the then current and future workplace exposure limits). Sanding, cleaning, and maintenance activities were of particular concern. Improvements to exposure controls are required, in particular, improvements to local exhaust ventilation controls for hand-held power tools and hand sanding. The management, selection, and use of respiratory protective equipment were poor. All the managers and supervisors recognised that exposure to wood dust can pose serious health risks, and that controls were crucial to protecting workers' health. The findings from the telephone interviews suggest that supervision and provision of information about the health effects of exposure to wood dust were common approaches that organisations used to raise awareness and promote good practice, in relation to managing wood dust exposure. Worker attitudes towards controls, such as perceptions that they hinder task completion and habitual ways of working, were identified as factors influencing the use of controls. Risk communication approaches that focus on increasing workers' awareness of their susceptibility to ill-health using credible sources, such as peers, can help enhance the uptake of messages on the use of controls. Financial constraints were identified as a challenge to improving the control of wood dust, particularly for small companies.

Association between active and passive smoking and the clinical course of multiple sclerosis and neuromyelitis optica spectrum disorder

&lt;i&gt;Objective&lt;/i&gt;: Active and passive smoking are common environmental risk factors, but there is no definite conclusion about their effects on relapse and disability progression in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). &lt;i&gt;Methods&lt;/i&gt;: This was a retrospective cohort study. Patients were included from four centers. Demographic and clinical data were extracted from the clinical database, while data involving environmental exposures during daily life, relapse, and disability progression were obtained through telephone follow-up interviews. Determinants of relapse were assessed by Cox proportional models, and disability progression was assessed by linear regression. Kaplan‒Meier survival was used to estimate relapse within five years after the first attack. &lt;i&gt;Results&lt;/i&gt;: A total of 130 MS patients and 318 NMOSD patients were included in this study, and females accounted for 60% and 79.6%, respectively. MS patients with an active smoking history had a higher risk of relapse, for which the association became borderline significant after accounting for covariates (aHR=1.52, 95% CI=1.00, 2.31; &lt;i&gt;p&lt;/i&gt;=0.052). The relapse risk between ever-smokers who smoked more than 10 cigarettes per day and smokers who smoked less than 10 cigarettes per day was not significantly different (aHR=0.96, 95% CI=0.63, 1.47; &lt;i&gt;p&lt;/i&gt;=0.859). However, exposure to passive smoking was associated with a reduced risk of MS relapse (aHR=0.75, 95% CI=0.56, 1.00; &lt;i&gt;p&lt;/i&gt;=0.044) compared with never-exposed patients. No associations were observed between active smoking/passive smoking and the risk of NMOSD relapse, but patients with a history of smoking were associated with a lower annual progression rate by Expanded Disability Status Scale (EDSS) (aβ=−0.20, 95% CI=−0.38, −0.01; &lt;i&gt;p&lt;/i&gt;=0.036) and Multiple Sclerosis Severity Score (MSSS) (aβ=−0.23, 95% CI=−0.44, −0.03; &lt;i&gt;p&lt;/i&gt;=0.028). &lt;i&gt;Conclusion&lt;/i&gt;: Our research shows that active smoking increases the relapse risk of MS and has a negative impact on disability progression; thus, smoking cessation should be encouraged.

Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients.

Studies have evaluated long-term occurrence of incisional hernia, cosmesis, and postoperative pain after single-incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. The authors performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period. All patients that underwent SILC at the University Hospital Brandenburg an der Havel Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications, and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale). In total 125 patients underwent SILC. The single-incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 0.8% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6%, an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (visual analog scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar. The present study demonstrates that SILC is a safe alternative in terms of incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow-up period and multiport laparoscopic cholecystectomy, our result is comparable.

Outcomes of early neurorehabilitation with a 6-month follow-up

Neurological early rehabilitation aims to improve body function in individuals with severe neurological conditions and facilitate the best possible return to their previous lives. However, the rehabilitation potential varies depending on the initial neurological diagnosis and other factors. Here we present a cohort study on the clinical course during inpatient rehabilitation and the outcomes at a 6 month follow-up. All patients were treated at the Schoen Clinic Bad Aibling. A follow-up telephone interview was conducted six months after discharge from Phase B rehabilitation. Among the 229 individuals included in the study, significant improvements in basic daily living skills (Barthel-Index) were observed after an average of 3.5 months of inpatient rehabilitation. Individuals with critical illness polyneuropathy/myopathy (CIP/CIM) exhibited the best recovery, achieving the highest scores on the Barthel-Index, the modified Rankin Scale (mRS), and health-related quality of life (EQ-5D-3L). In contrast, individuals with stroke showed significantly worse outcomes at discharge from rehabilitation and in the followup assessment. Only 12 % of stroke patients achieved a favorable outcome (mRS &lt; 3), compared to 30 % of the patients with CIP/CIM. Patients with subarachnoid hemorrhage and intracranial bleeding also tended to have worse outcomes, whereas those with traumatic brain injury did better. At follow-up, only 15 % of the entire cohort were able to lead an independent life; the majority required assistance from family members or caregivers. Overall, despite good improvement during rehabilitation, individuals across all diagnoses frequently exhibited significant long-term impairments that limited their independence in activities of daily living. Keywords: neurologic rehabilitation, long-term outcome, stroke, critical illness polyneuropathy