Uncontrolled Intervention Study Research Articles

Personalized Tablets for Residents in Long-Term Care to Support Recreation and Mitigate Isolation

ObjectivesThere is a digital divide in long-term care homes (LTCHs), with few residents having regular access to internet-connected devices. In this study, we provided long-term care residents with personalized and adapted tablets. We aimed to understand what factors influenced tablet use and the impact of tablet access on opportunities for social connection and recreation. DesignA pragmatic, mixed-methods multicenter, open-label, uncontrolled interventional study with assessment of outcomes at baseline and 3 months. Setting and ParticipantsA total of 58 resident-care partner dyads were recruited across 7 LTCHs in Ontario, Canada. The main inclusion criterion was having a care partner willing to participate, and we excluded residents who already had an internet-connected device. MethodsResident demographics, functional status assessments, and recreational engagement were captured using items from the Resident Assessment Instrument/Minimum Data Set. Care partners completed a questionnaire about relational closeness and site leads assessed resident quality of life before and approximately 3 months after tablet distribution. Interviews with 23 care partners and 7 residents post-implementation were completed and analyzed. ResultsThe median tablet use by participants was 7 minutes (interquartile range 27) per day on average over the study period. Predictors of higher tablet use were younger age, higher cognitive functioning, absence of hearing impairment, and having a care partner who lives farther away. There was no improvement on quantitative measures of quality of life, recreation, or relational closeness. In interviews, participants identified many different opportunities afforded by access to personalized tablets. Conclusions and ImplicationsSome LTCH residents without current access to the internet benefit from being provided a personal tablet and use it in a variety of ways to enrich their lives. There is a critical need to bridge the digital divide for this population.

Transitions between smoking and vaping: Evidence (or lack thereof) on potential differences by gender and sex

ObjectiveTo synthesize existing evidence on possible differential effects by sex and gender from two Cochrane reviews evaluating vaping and smoking transitions. MethodsWe screened included studies from two Cochrane reviews for studies reporting smoking outcomes based on gender or sex. The first review examines the effects of using e-cigarettes to help people quit smoking and includes randomized controlled trials and uncontrolled intervention studies published to July 2023. The second review aims to assess the evidence on the relationship between the use and availability of e-cigarettes and subsequent smoking in young people (aged 29 and younger) and includes quasi-experimental and cohort studies published to April 2023. Due to the paucity and heterogeneity of data, we report results narratively. Results10 of 161 studies included in the two relevant reviews met our criteria. Only five reported analyzing whether observed effects or associations varied based on sex and/or gender. A further three provided relevant descriptive information, and two did not report overall outcomes regarding vaping and smoking transitions but did investigate whether these differed by sex/gender. Synthesized data were largely inconclusive, but there was some suggestion that vaping was more strongly associated with subsequent smoking in young males than females. No studies reported data on nonbinary participants. ConclusionsDespite plausible reasons why sex and gender may be moderators of vaping and smoking transitions, there is little evidence investigating this. Future studies of vaping and smoking transitions should conduct and report analyses investigating potential differences based on sex and gender.

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease.

Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. Twenty-five PwPD (70.52years±7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline ( P <0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465 ).

How low can you go? Titrating the lowest effective dose of cyproterone acetate for transgender and gender diverse people who request feminizing hormones

Background: Administration of cyproterone acetate (CPA), to reduce the production and effects of testosterone, is often part of clinical regimens for trans individuals seeking feminization. Due to the potency of CPA, there are dose-related side effects and over-suppression of testosterone that can occur. Aim: This study aimed to determine the lowest possible dosing of CPA to reduce dose-related side effects while still achieving patient goals. Methods: This uncontrolled intervention study recruited participants seeking full-dose feminizing hormone treatment from across six study sites in Australia (primary care and sexual health clinics). Administration of CPA was defined using a titration protocol to achieve the target testosterone range (0.5–1.5 nmol/L). Descriptive analysis was conducted to investigate various factors of interest that pertained to the aims of the study. Results: A total of 74 participants commenced the study. There was a high rate of loss to follow-up with 62.2% (46/74) completing the protocol endpoint. Of participants who completed the protocol, 74.0% (34/46) were able to achieve the target T-range (0.5–1.5 nmol/L) and 41.3% (19/46) were titrated to the lowest CPA level (12.5 mg cyproterone twice weekly). Discussion: This study provided clinical evidence that lower and alternate-day dosing CPA can achieve adequate testosterone suppression in individuals undergoing feminizing gender affirming hormone therapy (GAHT). This provides promising evidence of the acceptability of lowering CPA dosing to reduce the impacts of CPA-related side effects and improve the outcomes and experiences of individuals undergoing GAHT.

Screening for colorectal cancer by full colonoscopy in first-degree relatives of colorectal cancer patients: a multicentric study by the Italian League for the Fight against Cancer.

Colorectal cancer currently presents the third-highest incidence of cancers worldwide, making secondary prevention through screening programs for colorectal cancer, usually by Fecal Occult Blood Testing, an essential preventive medicine intervention. First-degree relatives of colorectal cancer patients are a particularly at-risk group, with indications to consider direct screening by full colonoscopy. Colonoscopy is considered the gold standard for diagnosing colorectal cancer, as it has high sensitivity and specificity, and is both a diagnostic and therapeutic tool. However, it requires significant organizational and financial resources, and has a small but relatively higher risk of complications as opposed to fecal occult blood testing. The present study aimed to assess the appropriateness of a screening program without age restrictions of CRC by full colonoscopy in asymptomatic, first-degree adult relatives of patients with colorectal cancer, aiming both to actively increase screening coverage and to determine the detection rate of precancerous lesions and colorectal cancer in this population. Uncontrolled interventional study - colorectal cancer screening by full colonoscopy for at-risk population. The Italian League for the Fight against Cancer started a colorectal cancer screening program by full colonoscopy for first-degree relatives of colorectal cancer patients in 1998 in the province of Latina, Lazio Region, Italy. The program was expanded to the provinces of Rieti, Lazio Region, and Sassari, Sardinia Region, in 2014 and 2016 respectively, and was concluded in 2018. Subjects were actively and voluntarily recruited by the study's working group. Subjects that had already been subjected to a full colonoscopy in the preceding 5 years were excluded from this study. Identified neoplastic lesions were treated either directly or referred to the Day Hospital setting, and histologically diagnosed following World Health Organization guidelines. In total, 2,288 subjects (age range 15-88, mean 52.3 yrs, M/F = 946/1,204) were screened by colonoscopy, of which 103 (4.5%) were incomplete and 2,173 (95.0%) complete, with data on colonoscopy performance missing for 12 participants. Out of 468 positive outcomes on colonoscopy, diagnosis for 422 (204M/173F), 19.4% of total subjects, was adenomatous polyps and 46 (20M/20F), 2.1% of total subjects, was colorectal cancer. Female sex was a protective factor against a positive test outcome, with a 35% reduction compared to male sex, with OR=0.64 95%CI (0.52-0.80). On the other hand, being over 50 years of age was found to be a risk factor, making a positive outcome more than twice as likely, with OR=2.3 95%CI (1.8-2.9). Subjects over 50 also had significantly more instances of multiple adenomas being found, however the size distribution of found adenomas was not significantly different between subjects under and over 50, despite size being a predictor of risk of neoplastic progression. Given the high detection rate of precancerous lesions and colorectal cancer in the studied population, it is our opinion that guidelines should continue to recommend earlier and more frequent screening in first-degree relatives of patients with colorectal cancer, and, barring the introduction of more cost-effective and/or lower risk procedures with a similar efficacy profile, maintain the use of colonoscopy as the main screening option.

Electronic cigarettes for smoking cessation.

Electronic cigarettes for smoking cessation.

Safety, walking ability, and satisfaction outcomes of the NEURO TRONIC stance-control knee-ankle-foot orthosis (SCKAFO): A comparative evaluation to the E-MAG active SCKAFO.

Stance control knee-ankle-foot orthoses (SCKAFOs) ensure knee stability by locking during stance while allowing knee flexion during swing. Differences in function of the knee joints and building principles between devices may affect their effectiveness. To investigate the preliminary effectiveness of a NEURO TRONIC on safety outcomes, net energy cost (EC), and user experiences in individuals already using an E-MAG Active SCKAFO. Prospective uncontrolled intervention study. A convenience sample of 10 subjects with flaccid lower extremity muscle weakness, including the quadriceps, due to neuromuscular disorders already using an E-MAG Active SCKAFO were provided with a newly fabricated NEURO TRONIC SCKAFO. Outcomes included knee joint locking failures and unlocking failures (ULFs) (i.e., percentage of steps the knee joint failed to lock/unlock) when walking under challenging conditions on an instrumented treadmill while wearing a safety harness; net EC (J/kg per meter) assessed with a 6-min walk test at comfortable speed; 3D gait kinematics and kinetics; and patient-reported outcomes. No differences between devices were found for knee joint locking failures (both devices 0%) and ULFs (9.9% for the NEURO TRONIC vs. 13.9% for the E-MAG Active SCKAFO). The mean (standard deviation) net EC with the NEURO TRONIC SCKAFO was 8.2% (from 3.68 [0.81] to 3.38 [0.75] J/kg per meter, p = 0.123) lower, although not significantly, compared with that with the E-MAG Active SCKAFO. Significant improvements with the NEURO TRONIC SCKAFO were found for ankle power ( p = 0.003), perceived walking effort ( p = 0.014), and reported falls ( p = 0.034). Both the NEURO TRONIC SCKAFO and the E-MAG Active SCKAFO were safe in terms of knee joint locking, while ULFs were frequent with both devices. The net EC with the NEURO TRONIC SCKAFO decreased, although not significantly, by 8.2%, likely due to insufficient power. Perceived walking effort was in favor of the NEURO TRONIC SCKAFO.

Emergency Department Pediatric Code Cart In Situ Rolling Refresher Training Program

BackgroundEmergency department nurses manage the code cart during infrequent pediatric emergencies in a rural, tertiary care center. A rolling refresher training program was developed to educate nurses on this low-frequency, high-risk skill. MethodsAn uncontrolled intervention study was completed with a 6-month follow-up. A program was created consisting of four scenarios and 17 code cart skills based on pediatric advanced life support algorithms. Each participant was assessed and trained to master each skill. ResultsAbout 56 participants were included. There was retained statistically significant improvement in first attempt successes between training 1 and 3 in the following skills: obtaining supplies for placing an IV and for intraosseous needle placement, delivering a weight-based appropriate fluid bolus, preparation and delivery of a weight-based epinephrine infusion, preparation and delivery of weight-based dose of adenosine, and a weight-based appropriate dose of epinephrine. ConclusionOur training program demonstrated improvement in a majority of these low-frequency, high-risk skills after an initial and repeated training every 6 months.

Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson’s Disease at Fall-Risk

Reactive stepping can be improved in people with Parkinson’s Disease (PwPD). However, there is variability in the responsiveness to such training. This study examined if cognition could predict the responsiveness of PwPD to a two-week reactive step training intervention. 25 PwPD (70.52 years ± 7.15; Hoehn & Yahr range 1–3) at risk for falls completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Reactive stepping was trained through a two-week (six-session) intervention with repeated support surface translations. Stepping performance was measured at two baseline assessments (B1 and B2), immediately after the intervention (P1), and two months after training (P2). Primary stepping outcomes were anterior-posterior margin of stability (MOS), step length, and step latency during backward steps. The primary aim assessed whether global cognition (Scales for Outcomes in Parkinson's Disease-Cognition - SCOPA-COG, & Montreal Cognitive Assessment - MoCA) was related to two-month retention of improvements in reactive stepping after practice. The secondary aim explored whether specific cognitive domains predicted retained stepping improvements, including attention/working memory, executive function, language, memory, and visuospatial function. Greater baseline global cognition was related to better two-month retention of step length improvements (SCOPA-COG: p = 0.002, f2 = 0.31; MoCA: p = 0.002, f2 = 0.38). However, only SCOPA-COG retained statistical significance after p-value adjustment for multiple comparisons (p = 0.04). Optimal cut-point analysis revealed that a SCOPA-COG threshold of 31 or higher was optimal for identifying individuals likely to retain improvement. Specific cognitive domains did not predict changes in reactive stepping outcomes. Participants with greater baseline global cognition, particularly as measured by SCOPA-COG, demonstrated greater retention of improvements in reactive stepping. In this cohort, a SCOPA-COG threshold of 31 could predict individuals likely to benefit from the intervention. These findings highlight the potential of cognitive screening to identify people more or less likely to benefit from reactive balance training.

Lack of improvement in anorectal manometry parameters after implementation of a pelvic floor/anal sphincter biofeedback in persons with motor-incomplete spinal cord injury.

Effect of biofeedback on improving anorectal manometric parameters in incomplete spinal cord injury is unknown. A short-term biofeedback program investigated any effect on anorectal manometric parameters without correlation to bowel symptoms. This prospective uncontrolled interventional study comprised three study subject groups, Group 1: sensory/motor-complete American Spinal Injury Association Impairment Scale (AIS) A SCI (n = 13); Group 2 (biofeedback group): sensory incomplete AIS B SCI (n = 17) (n = 3), and motor-incomplete AIS C SCI (n = 8), and AIS D SCI (n = 6); and Group 3: able-bodied (AB) controls (n = 12). High-resolution anorectal manometry (HR-ARM) was applied to establish baseline characteristics in all subjects for anorectal pressure, volume, length of pressure zones, and duration of sphincter squeeze pressure. SCI participants with motor-incomplete SCI were enrolled in pelvic floor/anal sphincter bowel biofeedback training (2 × 6-week training periods comprised of two training sessions per week for 30-45 min per session). HR-ARM was also performed after each of the 6-week periods of biofeedback training. Compared to motor-complete or motor-incomplete SCI participants, AB subjects had higher mean intra-rectal pressure, maximal sphincteric pressure, residual anal pressure, recto-anal pressure gradient, and duration of squeeze (p < 0.05 for each of the endpoints). No significant difference was evident at baseline between the motor-complete and motor-incomplete SCI groups. In motor-incomplete SCI subjects, the pelvic floor/anal sphincter biofeedback protocol failed to improve HR-ARM parameters. Biofeedback training program did not improve anal manometric parameters in subjects with motor-incomplete or sensory-incomplete SCI. Biofeedback did not change physiology, and its effects on symptoms are unknown. Utility of biofeedback is limited in patients with incomplete spinal cord injury in terms of improving HR-ARM parameters.

Effects of a low-iodine diet in post-thyroidectomy thyroid cancer patients undergoing I131 therapy at the Vietnam National Cancer Hospital.

Background: I131 therapy is regarded as an "internal surgery" (i.e., a non-invasive approach involving no incision or bleeding) that supports "external surgery" (i.e., using a scalpel) in completely eradicating the root cause of thyroid cancer. Limiting iodine intake is of paramount importance in I131 therapy. I131 therapy protocols recommend that patients follow a low-iodine diet, ideally with a maximum iodine intake of 50 μg/day for two weeks before the I131 therapy. Methods: A pre-post compassion uncontrolled clinic intervention study was conducted on a group of over 70 post-thyroidectomy thyroid cancer patients with indications for I131 therapy at the Vietnam National Cancer Hospital from December 2020 to December 2022. Aim: It aimed to assess the effects of a low-iodine diet on post-thyroidectomy thyroid cancer patients with indications for I131 therapy. Results: The study found that following the intervention, the percentage of participants at risk of mild to moderate malnutrition, as assessed by the PG-SGA tool, decreased to 4.3% from 40.0% before the intervention, with a statistically significant difference of p < 0.001. There was a considerable improvement in the low calcemia level among the study participants, with 35.7% of patients experiencing hypocalcemia prior to the intervention, which reduced to 17.1% after the intervention. This difference was statistically significant (p = 0.01). The study also revealed a urinary iodine level improvement among the study participants. Before the intervention, patients' average urinary iodine level was 14.9 ± 11.3 µg/dl. Following the intervention, it reduced to 12.7 ± 3.9 µg/dl, although this difference was not statistically significant (p = 0.29). Patients' quality of life after adhering to the low-iodine diet tended to decline; however, the change in scores before and after the intervention did not show a significant difference. Conclusion: Despite its negative impact on patients' quality of life, active nutrition counseling and intervention during the low-iodine diet contributed to the substantial improvement in the hypocalcemia level and the reduced urinary iodine level among patients, which in turn could enhance the efficacy of the subsequent I131 therapy.

Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study.

Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.

The importance of the university of the third age to improved mental health and healthy aging of community-dwelling older adults

ABSTRACT The aim of this uncontrolled interventional study was to determine the effect of a yearly educational course within the University of the Third Age on quality of life, life satisfaction, sense of coherence, self-esteem, anxiety, depression, attitudes toward old age, and older people’s perception of social support. The population included 121 community-dwelling older people who had completed a yearly educational course within the University of the Third Age (three educational modules: 1. Cardiovascular Diseases, 2. Mental Health, and 3. Neurological Diseases; 16 lectures and two practical lessons for each module). Psychosocial factors were evaluated using the following tools: the Older People’s Quality of Life questionnaire (OPQOL_brief), the Life Satisfaction Index for the Third Age – Short Form (LSITA-SF), the Geriatric Depression Scale (GDS-15), the Geriatric Anxiety Inventory (GAI), the Attitudes to Aging Questionnaire (AAQ), the Sense of Coherence scale (SOC-13), the Rosenberg Self-Esteem Scale (RSES), and social support. After completing the yearly educational cycle, older people who had had lower scores for individual parameters at the beginning of the study were found to have a statistically significant improvement (p < .001) in anxiety, depression, quality of life, sense of coherence, life satisfaction, attitudes toward old age and aging, and perceptions of social support. To promote healthy aging, education at universities of the third age is recommended for lonely older people and older people with symptomatology of anxiety and depression.

STUDY ON THE TREATMENT RESULTS OF DECOMPRESSIVE CRANIECTOMY IN SEVERE TRAUMATIC BRAIN INJURY WITHOUT MASS LESION

Objectives: To evaluate the treatment results of severe traumatic brain injury without intracranial hematoma by decompressive craniectomy. Methods: An uncontrolled intervention study on 45 patients with severe traumatic brain injury, no intracranial hematoma, high intracranial pressure above 20 mmHg, unresponsive to medical therapy, and operated decompressive craniectomy at Viet Duc University Hospital from May 2017 to December 2022. Research variables: Age, gender, cause of the accident, preoperative GCS, pulse and blood pressure before surgery, and CT images before and 3 months after surgery. Comparing treatment results between groups. Results: 45 patients were studied, including 42 males and 3 females; the oldest age was 78, and the lowest was 6 years old; traffic accidents accounted for the majority of 86.7%; daily-life accidents was 8.9%; GCS before surgery: 3 - 5 points (55.6%), GCS: 6 - 8 points (44.4%); GCS = 8 points (8.9%). The mean ICP was: 40.09 ± 10.37 mmHg. Results when patients were discharged: 9 patients were dead and 36 patients were alive. Conclusion: In the treatment results of decompression craniectomy on patients with a severe traumatic brain injury without intracranial hematoma, the mortality rate, vegetative state, and severe sequelae are still high.

SURGICAL CHARACTERISTICS OF STAGE I-IIA NON-SMALL CELL LUNG CANCER

Objectives: To describe surgical characteristics of stage I-IIA non-small cell lungcancer.Subjects and methods: An uncontrolled intervention study on 83 patients diagnosedwith stage I - IIa non-small cell lung cancer who underwent thoracoscopy at MilitaryHospital 175 from January 2015 to December 2020.Results: The average surgical time in the study was 137.5 minutes and the blood losswas not much. Small incisions have an average length of 2.95cm, high aesthetics andlow postoperative pain (5.92 days). The patient had a tumor that pulled the visceralpleura 62/83 (74.7%); 21/83 (25.3%) patients with tumors located in parenchyma;6/83 (7.2%) patients had lung adhesions to the chest wall. There were 2 (2.4%) patientswith bleeding complications that required conversion to open surgery; After surgery,there were 7 complications including 1 (1.2%) pneumonia; 1 (1.2%) empyema causedby green pus bacilli; 5 (6.0%) cases of gas leak lasting more than 7 days.Conclusion: Tumor characteristics in surgery include features of tugging visceralpleura, tumor located in parenchyma, lung sticking to chest wall. Commoncomplications include bleeding. Complications after surgery include pneumonia,empyema caused by green pus bacilli, prolonged gas.

Electronic cigarettes for smoking cessation.

Electronic cigarettes for smoking cessation.

Feasibility of an Upper Limb Strength Training Program in Persons with Spinal Cord Injury during Primary Rehabilitation-An Uncontrolled Interventional Study.

Data concerning the outcomes of standardized strength-training programs in people with acute spinal cord injury (SCI) are scarce. The present study evaluated the feasibility and effects of a clinic-internal strength-training concept in people with paraplegia during the course of primary rehabilitation. For this purpose, participants followed a 10-12 week standardized supervised strength-training program (30 training sessions) during primary rehabilitation. At the beginning, 5-6 weeks and 10-12 weeks later, maximal strength based on indirect one-repetition maximum (1RM) measurements for two specific exercises (triceps press; horizontal rowing pull) was determined. Twelve out of 17 participants successfully completed the study. Maximal weights for 1RM significantly increased over the 10-12 week training program for the triceps press (+30%; p = 0.018) and the horizontal rowing pull (+41%; p = 0.008). Training compliance was 95%. Reasons for study exclusion were urgent surgery (n = 2), cardio-respiratory complications (n = 1), shoulder pain (n = 1) and a training compliance of less than 50% (n = 1). In conclusion, a supervised and standardized strength-training program during primary rehabilitation of people with paraplegia is feasible and leads to significant increases in maximal strength. Although study participants showed a high training compliance, factors such as medical complications may impede the proper implementation of a strength-training concept into daily clinical practice.

Glaucoma Medication Adherence 1 Year after the Support, Educate, Empower Personalized Glaucoma Coaching Program

To assess the efficacy of the Support, Educate, Empower (SEE) glaucoma coaching program on medication adherence among poorly adherent patients with glaucoma for 12 months after cessation of the intervention. Uncontrolled intervention study with a pre-post design. The SEE cohort was recruited from the University of Michigan and included patients with glaucoma aged ≥ 40 years, taking ≥ 1 medication, who self-reported poor adherence. Electronic medication monitoring of those who completed the program continued for up to 1 year after the coaching intervention. Adherence was monitored electronically (AdhereTech) during the 7-month program and 12-month follow-up period. Adherence was the percentage of doses taken on time. Participants were censored for surgery, change in glaucoma medications, or adherence monitor disuse. The SEE program included automated medication reminders, 3 in-person motivational interviewing-based counseling sessions with a glaucoma coach, and 5 phone calls with the coach for between-session support. There was no contact between the study team and participants during the 12-month follow-up after program cessation. Baseline participant characteristics were summarized with descriptive statistics. Paired t tests and Wilcoxon signed rank tests were used to investigate significant changes in monthly adherence during follow-up. Change in electronically monitored medication adherence over the 12 months following the conclusion of the SEE program. Of 48 participants, 39 (81%) completed the SEE program and continued electronic medication monitoring for up to 1 year after program cessation. The mean age of the participants was 64 years (standard deviation [SD], 10); of the 39 participants, 56% were male, 49% were Black, and 44% were White. The mean length of follow-up was 284 days (SD, 110; range, 41-365 days). Censoring occurred in 18 (56%) participants. The mean adherence during the follow-up period was 67% (SD, 22%). This was significantly lower than the adherence during the SEE program (mean, 81%; SD, 18%; P < 0.0001) but significantly higher than the baseline preprogram adherence (mean, 60%; SD, 18%; P= 0.0393). The largest monthly losses occurred at months 1 (mean, 7%; P= 0.0001) and 4 (mean, 6%; P= 0.0077). Glaucoma medication adherence decreased significantly in the year after cessation of the SEE coaching program but remained significantly higher than baseline adherence. To maintain excellent long-term medication adherence, intermittent reinforcement sessions may be necessary.

Assessment of treatment result of soft tissue defects of fingers by local pedicle flap

Background: The hands, especially fingers, are one of the nicest organs in the bodies movement system and participate in most daily activities. It performs the function of sophisticated movement and good touch. Thus, the risk of hand injury, especially digital defects is very high. Besides, the defects after removing the contracture scar, if treatment is not done well, will leave sequelae affecting the function and aesthetics of the hand. Subject and method: The uncontrolled clinical interventional study on 39 patients with 41 soft tissue defects of fingers reconstructed by the local pedicle flap in Plastic - Comestic - Hand Departement, Hue Central Hospital. Result: In 41 flaps used, there were 100% cases of flap survived, ensuring the coverage function, including 8/41 flap congested in the postoperative period, 1/41 flap infected with flap’s margin, There were no failed cases requiring additional recovery surgery. In all cases, the donor area of the flap healed well in the first stage (31/41 in cases of skin grafting in the flap, 10/41 in the cases that can be sutured to close the donor area directly). The 1-month follow-up results showed that 82.9% of flaps achieved good results, 17.1% of flaps achieved average results, there were no cases of bad results and failures. The results of the 3-month follow-up were 87.8% with good results and 12.2% with moderate results. All of the patients were satisfied with the surgical results. Conclusion: There are many options of flaps available for use in finger soft-tissue defect contouring, flexibility is needed in using flaps for each type of defect to provide the best results in terms of coverage and aesthetics. Key words: finger soft-tissue defect, local pedicle flap.

Outcomes of micropulse transscleral cyclophotocoagulation in refractory glaucoma eyes

Introduction: Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) is a new treatment for glaucoma claiming to have lower levels of complications while having comparable efficacy relative to its predecessor, traditional Transscleral Continuous-wave Cyclophotocoagulation (TC-CPC).Objective: To evaluate the clinical efficacy and safety of MPTSCPC in the treatment of refractory glaucoma eyes.Methods: This uncontrolled interventional study was conducted at the Northampton General Hospital, UK. Patients who were selected to undergo MP-TSCPC due to uncontrolled intraocular pressure (IOP) or visual field progression despite maximum tolerable anti-glaucoma treatment were recruited for the study from February to September 2020. Data related to the patients were collected pre procedure and up to three months post procedure.Results: Of the 37 patients included in the study, 59.5% were females. The mean age of participants was 75.35 (SD=10.37) years. The most common types of glaucoma seen in the sample were primary open angle glaucoma and pseudoexfoliation glaucoma with 67.6% and 16.2% respectively. Mean pretreatment IOP was 26.62 (SD=8.36) mmHg. Three-month post-treatment mean IOP of 18.47 (SD=7.92) mmHg was a statistically significant (p&gt;0.001) reduction of 7.10 mm Hg. The drop in mean number of anti-glaucoma medications from 2.38 to 2.22 was not significant. Except for four patients with prolonged ocular inflammation and one patient with macular oedema, there were no significant complications following the procedure.Conclusion: MP-TSCPC is an effective and safe treatment option for refractory glaucoma over a 3 month follow up period. More extensive studies with larger sample sizes and longer follow up durations are recommended.