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Buur LE, Bekker HL, Søndergaard H, Kannegaard M, Madsen JK, Khatir DS, Finderup J. Feasibility and acceptability of the ShareD dEciSIon making for patients with kidney failuRE to improve end-of-life care intervention: A pilot multicentre randomised controlled trial. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2024; 7:100231. [PMID: 39221228 PMCID: PMC11363568 DOI: 10.1016/j.ijnsa.2024.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 07/27/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Background Kidney failure is associated with a high disease burden and high mortality rates. National and international guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but implementation of these conversations within kidney services varies. We developed the DESIRE (ShareD dEciSIon-making for patients with kidney failuRE to improve end-of-life care) intervention from our studies investigating multiple decision maker needs and experiences of end-of-life care in kidney services. The DESIRE intervention's three components are a training programme for health professionals, a patient decision aid, and a kidney service consultation held to facilitate shared decision-making conversations about planning end-of-life care. Objectives To assess the feasibility and acceptability of integrating the DESIRE intervention within kidney services. Design A pilot study using a multicentre randomised controlled design. Setting Four Danish nephrology departments. Participants Patients with kidney failure who were 75 years of age or above, their relatives, and health professionals. Methods Patients were randomised to either the intervention or usual care. Feasibility data regarding delivering the intervention, the trial design, and outcome measures were collected through questionnaires and audio recordings at four points in time: before, during, post, and 3 months after the intervention. Acceptability data were collected through semi-structured interviews with patients and relatives, as well as a focus group with health professionals post the intervention. Results Twenty-seven patients out of the 32 planned were randomised either to the intervention (n= 14) or usual care (n= 13). In addition, four relatives and 12 health professionals participated. Follow-up was completed by 81 % (n= 22) of patient participants. We found that both feasibility and acceptability data suggested health professionals improved their decision support and shared decision-making skills via the training. Patient and relative participants experienced the intervention as supporting a shared decision-making process; from audio recordings, we showed health professionals were able to support proactively decision-making about end-of-life care within these consultations. All stakeholders perceived the intervention to be effective in promoting shared decision-making and relevant for supporting end-of-life care planning. Conclusions Participant feedback indicated that the DESIRE intervention can be integrated into practice to support patients, relatives, and health professionals in planning end-of-life care alongside the management of worsening kidney failure. Minimising exhaustion and enhancing engagement with the intervention should be a focus for subsequent refinement of the intervention. Registration The study has been registered at ClinicalTrials.gov with the identifier: NCT05842772. Date of first recruitment: March 20, 2023.
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Affiliation(s)
- Louise Engelbrecht Buur
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Research Centre for Patient Involvement (ResCenPI), Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Hilary Louise Bekker
- Research Centre for Patient Involvement (ResCenPI), Aarhus University, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Science, School of Medicine, University of Leeds, Leeds, UK
| | | | | | | | - Dinah Sherzad Khatir
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Research Centre for Patient Involvement (ResCenPI), Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Bronas UG, Marquez DX, Fritschi C, Petrarca K, Kitsiou S, Ajilore O, Tintle N. Ecological Momentary Intervention to Replace Sedentary Time With Physical Activity to Improve Executive Function in Midlife and Older Latino Adults: Pilot Randomized Controlled Trial. J Med Internet Res 2024; 26:e55079. [PMID: 39235836 DOI: 10.2196/55079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 06/07/2024] [Accepted: 06/30/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Exercise interventions often improve moderate to vigorous physical activity, but simultaneously increase sedentary time due to a compensatory resting response. A higher level of sedentary time is associated with a lower level of executive function, while increased moderate to vigorous physical activity is associated with improved global cognition and working memory among Latino adults. Latino adults are the fastest-growing minority group in the United States and are at high risk for cognitive decline, spend more time sedentary compared to non-Hispanic populations, and engage in low levels of physical activity. Interventions that are culturally appropriate for Latino adults to replace sedentary time with physical activity are critically needed. OBJECTIVE This study aims to develop and test the feasibility and acceptability of an ecological momentary intervention (EMI; delivered in real time) that is individually designed to replace sedentary time with physical activity in Latino adults. METHODS This pilot study randomized 39 (n=26, 67% female; mean age 61, SD 5.8 years) community-dwelling, Spanish-speaking Latino adults (1:1 allocation) to either a 6-week EMI program designed to replace sitting time with physical activity (20/39, 51%) or physical activity guidelines education (19/39, 49%). The program was conducted on the web and in Spanish. The intervention was individualized based on individual interview responses. The intervention included the use of a Fitbit activity monitor, weekly didactic phone meetings, interactive tools (SMS text messages), and coach-delivered feedback. Feasibility and acceptability were assessed via study satisfaction (Likert scales), motivation (ecological momentary assessment), retention, and compliance. Sedentary time and physical activity were assessed via 7-day actigraphy. Cognitive performance was assessed via the trail making test part A and B (part B=executive function) and via the National Institutes of Health Toolbox remote cognitive assessment. Statistical analysis included a linear model on change score from baseline, adjusting for age, sex, and education, emphasizing effect size. RESULTS Participant satisfaction with EMI was high (9.4/10), with a high degree of motivation to replace sitting time with physical activity (9.8/10). The intervention compliance rate was 79% with low difficulty using the Fitbit (1.7/10). Weekly step count increased in the intervention group by 5543 steps (group difference: d=0.54; P=.05) and sedentary time decreased by a mean 348 (SD 485) minutes (group difference: d=0.47; P=.24) compared to controls, with moderately strong effect sizes. The trail making test part B improved in the intervention group (mean -35.26, SD 60.35 seconds), compared to the control group (mean 7.19, SD 46 seconds; group difference: d=0.74; P=.01). No group differences were observed in other cognitive measures. CONCLUSIONS An individualized EMI designed for midlife and older Latino adults has the potential to replace sitting time with physical activity and improve executive functioning. The intervention was feasible and well received with a high degree of satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT04507464; https://tinyurl.com/44c4thk5.
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Affiliation(s)
- Ulf G Bronas
- School of Nursing, Columbia University, New York, NY, United States
- Division of Rehabilitation and Regenerative Medicine, Columbia University, New York, NY, United States
| | - David X Marquez
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Cynthia Fritschi
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States
| | - Katherine Petrarca
- College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, IL, United States
| | - Olu Ajilore
- College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Nathan Tintle
- College of Nursing, University of Illinois Chicago, Chicago, IL, United States
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Naumann K, Singh B, Bushaway S, Crane R, Deepak S, Hartland A, Konstantopoulos P, Mansell E, Marinelli V, Pallotta V, Tolfts A, Virieux A, Wall M, Wilksch S, Zhuang M, Atkinson M, Maher C. Investigating the impact of multidisciplinary prehabilitation on deconditioning in patients eligible for haematopoietic allogenic stem cell transplantation: protocol for a feasibility trial. BMJ Open 2024; 14:e084372. [PMID: 39237275 DOI: 10.1136/bmjopen-2024-084372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Assessing multidisciplinary prehabilitation strategies becomes crucial to pre-emptively counter the physical, psychological and social negative impacts experienced during an allogenic haematopoietic stem cell transplant (allo-HSCT) among acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) patients. Current evidence is restricted to studies during induction chemotherapy, omitting rehabilitation interventions and predominantly using exercise-only approaches without a multidisciplinary framework. The aim of this study is to investigate the feasibility, safety and preliminary efficacy of multidisciplinary prehabilitation in adults offered allo-HSCT. METHODS AND ANALYSIS This 8-week single-group pre-post feasibility study aims to pilot a multidisciplinary prehabilitation intervention for participants undergoing allo-HSCT, with a focus on feasibility and safety. Participants, aged 18 or older, diagnosed with AML or MDS, and offered allo-HSCT, will be recruited between June 2023 and July 2024. The multidisciplinary prehabilitation intervention, conducted by the cancer allied health team at the Royal Adelaide Hospital, includes exercise physiology, physiotherapy, dietetics, social work, occupational therapy and psychology interventions. Consistent with a multidisciplinary treatment approach, each component is tailored to address different aspects of patient care, and adherence calculations will assess patient engagement and compliance. In addition, participants will continue to receive usual care from cancer allied health staff. The primary outcome of the study is to assess the feasibility of a multidisciplinary prehabilitation intervention by evaluating intervention uptake, retention, adherence, acceptability and safety. Secondary outcomes are leg strength, upper-body strength, aerobic fitness, falls risk, anthropometry, nutritional status, quality of life, anxiety, depression, self-efficacy for coping with cancer and distress. ETHICS AND DISSEMINATION Ethics approval for this study has been provided by the Central Adelaide Local Health Network (HREC 2022/HRE00284). Recruitment for the study commenced in June 2023 and will continue until July 2024. The methods have been designed and are reported according to the SPIRIT and CONSORT-pilot study checklist. TRIAL REGISTRATION NUMBER The Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12623000052639.
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Affiliation(s)
- Karlee Naumann
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ben Singh
- University of South Australia, Adelaide, South Australia, Australia
| | - Samuel Bushaway
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Rhiannon Crane
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Swapna Deepak
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Amie Hartland
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Ella Mansell
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | | | - Annabel Tolfts
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Alison Virieux
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Michelle Wall
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Sarah Wilksch
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Mabel Zhuang
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Morgan Atkinson
- Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Carol Maher
- University of South Australia, Adelaide, South Australia, Australia
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De Nys L, Oyebola EF, Connelly J, Ryde GC, Whittaker AC. Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study. BMC Geriatr 2024; 24:733. [PMID: 39232667 DOI: 10.1186/s12877-024-05324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 08/23/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes. METHODS Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention. RESULTS An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme. CONCLUSIONS The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.
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Affiliation(s)
- Len De Nys
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Esther F Oyebola
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Jenni Connelly
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Gemma C Ryde
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, UK
| | - Anna C Whittaker
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK.
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Wierts CM, Rhodes RE, Faulkner G, Zumbo BD, Beauchamp MR. An online delivered running and walking group program to support low-active post-secondary students' well-being and exercise behavior during the COVID-19 pandemic: a pilot randomized controlled trial. J Behav Med 2024:10.1007/s10865-024-00516-z. [PMID: 39225842 DOI: 10.1007/s10865-024-00516-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 08/18/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Examine the feasibility and acceptability of a social identity-informed, online delivered, running and walking group program to support low-active post-secondary students' exercise behavior and well-being during the COVID-19 pandemic. METHODS A two-arm, non-blinded, parallel pilot randomized controlled trial was conducted whereby low-active post-secondary students at a Canadian university were equally randomized to an online delivered running/walking group program or an attention control condition. Primary feasibility and acceptability outcomes included program interest, study enrolment and retention, questionnaire completion, program attendance, program satisfaction, and affective exercise attitudes. Post-program interviews were conducted to ascertain participants' experiences with the program. Secondary outcomes included well-being, exercise behavior, social identity, social support, and exercise identity. RESULTS Ninety-two individuals were screened for eligibility, and 72 were equally randomized to the online group program or attention control condition. Recruitment exceeded the target sample size (60), study adherence and questionnaire completion were above 90%, program attendance was moderate (M = 5.03/8), self-report program satisfaction was moderate-to-high (M = 4.13/5), and there was no condition effect for affective attitudes. During interviews, participants expressed satisfaction with the program. They also discussed challenges with developing a shared sense of identity and social connection with group members via online platforms. There were small condition effects for exercise-related well-being and exercise identity and no condition effects for the remaining secondary outcomes. Social identity scores were moderate (M = 4.63/7). CONCLUSIONS The STRIDE program was feasible and acceptable but should be delivered and piloted in-person before a full-scale efficacy trial is conducted. TRIAL REGISTRATION ClinicalTrials.gov NCT04857918; 2021-04-20.
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Affiliation(s)
- Colin M Wierts
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA.
| | - Ryan E Rhodes
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, BC, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Bruno D Zumbo
- Measurement, Evaluation, & Research Methodology Program, University of British Columbia, Vancouver, BC, Canada
| | - Mark R Beauchamp
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
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Beuthin O, Shahid S, Yu LM, Bhui K. Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e56957. [PMID: 39222345 DOI: 10.2196/56957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/30/2024] [Accepted: 07/11/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. OBJECTIVE The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. METHODS This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. RESULTS Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. CONCLUSIONS Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. TRIAL REGISTRATION ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/56957.
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Affiliation(s)
- Oliver Beuthin
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sadiya Shahid
- Department of Medieval and Modern Languages and Linguistics, University of Cambridge, Cambridge, United Kingdom
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Kamaldeep Bhui
- Department of Pyshciatry, University of Oxford, Oxford, United Kingdom
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Sousa H, Ribeiro O, Bártolo A, Costa E, Ribeiro F, Rodrigues M, Paúl C, Figueiredo D. The Connected We St@nd programme: A feasibility pilot study of an online self-management intervention for adults on in-centre haemodialysis and family caregivers. Br J Health Psychol 2024; 29:589-608. [PMID: 38361177 DOI: 10.1111/bjhp.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 02/01/2024] [Indexed: 02/17/2024]
Abstract
OBJECTIVE The 'Connected We St@nd' is an online self-management intervention programme for people receiving in-centre haemodialysis and family caregivers that combines an educational and psychosocial support component. This study aimed to evaluate its feasibility and acceptability before proceeding to a large-scale trial. DESIGN This was a pre-post single-arm feasibility pilot study conducted with adults undergoing in-centre haemodialysis and family caregivers. METHODS Feasibility was based on eligibility, consent, retention, completion and intervention adherence rates, while acceptability was assessed in post-intervention focus group interviews. RESULTS Twenty-six people (16 adults on haemodialysis and 10 family caregivers) recruited through social networks completed the intervention. Consent, retention and completion rates were excellent (>90%) and eligibility (77.5%) and intervention adherence were satisfactory (69% for the psychosocial support sessions). Qualitative findings revealed that participants shared positive feelings regarding their participation in the programme. The valuable interactions with group peers and health psychologists during the support sessions, the perception of the adequacy and coherence of the programme's contents and materials and the participants' confidence in using the platform developed to deliver the intervention were some of the aspects highlighted as facilitators of intervention acceptability. Additionally, people on haemodialysis and caregivers reported that participation in the programme brought several educational and emotional benefits (e.g., additional disease-related knowledge, improved communication and coping skills, greater confidence in managing dialysis complications or caregiving demands) that helped increase their self-management skills and psychosocial adjustment to the demands of kidney failure and renal therapies. CONCLUSIONS The results suggested that the 'Connected We St@nd' programme is likely to be feasible and acceptable for adults on haemodialysis and family caregivers, thus representing a promising resource for the future of interdisciplinary renal rehabilitation. Suggestions were made to fine-tune the intervention design to proceed with a large-scale trial.
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Affiliation(s)
- Helena Sousa
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- CINTESIS@RISE, Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Ana Bártolo
- CINTESIS@RISE, CINTESIS.UPT, Portucalense University, Porto, Portugal
| | - Elísio Costa
- REQUIMTE, Faculty of Pharmacy and Competence Centre on Active and Healthy Ageing (Porto4Ageing), University of Porto, Porto, Portugal
| | - Fernando Ribeiro
- iBiMED, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Mário Rodrigues
- School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Constança Paúl
- CINTESIS@RISE, Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Daniela Figueiredo
- CINTESIS@RISE, School of Health Sciences, University of Aveiro, Aveiro, Portugal
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von Piekartz H, Bleiss S, Herzer S, Hall T, Ballenberger N. Does combining oro-facial manual therapy with bruxism neuroscience education affect pain and function in cases of awake bruxism? A pilot study. J Oral Rehabil 2024; 51:1692-1700. [PMID: 38894567 DOI: 10.1111/joor.13740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Although awake bruxism is associated with temporomandibular disorder (TMD) as well as head and neck pain, the effects of physical therapy and bruxism education to address these factors have not been investigated. OBJECTIVE The aim of this study was to evaluate the effects of oro-facial manual therapy and bruxism neuroscience education (BNE) on awake bruxism over a 3-week period with an open-ended follow-up questionnaire after 3 months. METHODS Subjects (n = 28) were randomly allocated to one of two groups, an intervention group and a control group. Data regarding disability, function and pain were collected pre- and post-assessment, with all measures administered in a single-blind fashion. Participants in both groups received six treatment sessions during this period. In addition to manual therapy, participants were provided with information on the neurophysiological mechanisms of bruxism and contributing factors. Individual behavioural guidelines and daily exercises were determined in consultation with the therapist. An introduction to a bruxism specific app (Brux.App) was also provided, which all participants used as an adjunct to their treatment. RESULTS The intervention group demonstrated notable improvement as indicated by their scores in the Neck Disability Index (NDI) (p = .008), Pain Disability Index (PDI) (p = .007) and Jaw Disability List (JDL) (p = .03). Furthermore, clinical assessments of the temporomandibular joint (TMJ) revealed a significant progress in terms of mouth opening (p = .03) and lateral jaw movement (laterotrusion) (p = .03). The mechanical pain threshold (PTT) of both the masseter (p = .02) and temporalis muscle (p = .05) also showed significant improvement. At 3-month follow-up, the questionnaire revealed that the majority of the intervention group (13/15, 87%) reported a benefit from the treatment. CONCLUSION The reduction in pain and disability together with improvement in function and increased coping suggest a potential modification of awake bruxism through specialised musculoskeletal intervention and BNE tailored to the individual patient.
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Affiliation(s)
- Harry von Piekartz
- Department Movement and Rehabilitation Science, Faculty of Business, Management and Social Science, Osnabruck, Germany
| | - Sonja Bleiss
- Department Movement and Rehabilitation Science, Faculty of Business, Management and Social Science, Osnabruck, Germany
| | - Sebastian Herzer
- Department Movement and Rehabilitation Science, Faculty of Business, Management and Social Science, Osnabruck, Germany
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Nicolaus Ballenberger
- Department Movement and Rehabilitation Science, Faculty of Business, Management and Social Science, Osnabruck, Germany
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Pozzar RA, Enzinger AC, Howard C, Tavormina A, Matulonis UA, Campos S, Liu JF, Horowitz N, Konstantinopoulos PA, Krasner C, Wall JA, Sciacca K, Meyer LA, Lindvall C, Wright AA. Feasibility and acceptability of a nurse-led telehealth intervention (BOLSTER) to support patients with peritoneal carcinomatosis and their caregivers: A pilot randomized clinical trial. Gynecol Oncol 2024; 188:1-7. [PMID: 38851039 PMCID: PMC11368606 DOI: 10.1016/j.ygyno.2024.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/27/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Patients with advanced gynecologic (GYN) and gastrointestinal (GI) cancers frequently develop peritoneal carcinomatosis (PC), which limits prognosis and diminishes health-related quality of life (HRQoL). Palliative procedures may improve PC symptoms, yet patients and caregivers report feeling unprepared to manage ostomies, catheters, and other complex needs. Our objectives were to (1) assess the feasibility of an efficacy trial of a nurse-led telehealth intervention (BOLSTER) for patients with PC and their caregivers; and (2) assess BOLSTER's acceptability, potential to improve patients' HRQoL and self-efficacy, and potential impact on advance care planning (ACP). METHODS Pilot feasibility RCT. Recently hospitalized adults with advanced GYN and GI cancers, PC, and a new complex care need and their caregivers were randomized 1:1 to BOLSTER or enhanced discharge planning (EDP). We defined feasibility as a ≥ 50% approach-to-consent ratio and acceptability as ≥70% satisfaction with BOLSTER. We assessed patients' HRQoL and self-efficacy at baseline and six weeks, then compared the proportion experiencing meaningful improvements by arm. ACP documentation was identified using natural language processing. RESULTS We consented 77% of approached patients. In the BOLSTER arm, 91.0% of patients and 100.0% of caregivers were satisfied. Compared to EDP, more patients receiving BOLSTER experienced improvements in HRQoL (68.4% vs. 40.0%) and self-efficacy for managing symptoms (78.9% vs. 35.0%) and treatment (52.9% vs. 42.9%). The BOLSTER arm had more ACP documentation. CONCLUSIONS BOLSTER is a feasible and acceptable intervention with the potential to improve patients' HRQoL and promote ACP. An efficacy trial comparing BOLSTER to usual care is underway. TRIAL REGISTRATION ClinicalTrials.gov: NCT03367247; PI: Wright.
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Affiliation(s)
- Rachel A Pozzar
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - Andrea C Enzinger
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | | | - Ursula A Matulonis
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Susana Campos
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Joyce F Liu
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Neil Horowitz
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | | | - Carolyn Krasner
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Jaclyn A Wall
- University of Alabama, Birmingham, AL, United States
| | - Kate Sciacca
- Dana Farber Cancer Institute, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Larissa A Meyer
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Charlotta Lindvall
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States; Brigham and Women's Hospital, Boston, MA, United States
| | - Alexi A Wright
- Dana Farber Cancer Institute, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
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Asher RC, Shrewsbury VA, Innes B, Fitzpatrick A, Simmonds S, Cross V, Rose A, Hinton E, Collins CE. Feasibility and acceptability of a culinary nutrition programme for adults with mild-to-moderate intellectual disability: FLIP Food and Lifestyle Information Programme. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13281. [PMID: 39104041 DOI: 10.1111/jar.13281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. METHOD Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. RESULTS Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. CONCLUSIONS Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.
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Affiliation(s)
- R C Asher
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - V A Shrewsbury
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - B Innes
- Sports 4 All, Fern Bay, Australia
| | - A Fitzpatrick
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - S Simmonds
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - V Cross
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - A Rose
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
| | - E Hinton
- Challenge Community Services, Hamilton, Australia
| | - C E Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, New Lambton Heights, Australia
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Mace RA, Brewer JR, Cohen JE, Ly TV, Weaver MJ, Borsook D. Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study. Clin J Pain 2024; 40:526-541. [PMID: 39016312 DOI: 10.1097/ajp.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury. METHODS We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping). RESULTS The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. DISCUSSION The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.
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Affiliation(s)
- Ryan A Mace
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
- Harvard Medical School
- Department of Psychiatry, Massachusetts General Hospital
| | - Julie R Brewer
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
| | - Joshua E Cohen
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital
| | - Thuan V Ly
- Harvard Medical School
- Department of Orthopaedic Surgery, Massachusetts General Hospital
| | - Michael J Weaver
- Harvard Medical School
- Department of Orthopaedic Surgery, Brigham and Women's Hospital
| | - David Borsook
- Harvard Medical School
- Department of Psychiatry, Massachusetts General Hospital
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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12
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Lightfoot CJ, Wilkinson TJ, Vadaszy N, Graham-Brown MPM, Davies MJ, Yates T, Smith AC. Improving self-management behaviour through a digital lifestyle intervention: An internal pilot study. J Ren Care 2024; 50:283-296. [PMID: 38296833 DOI: 10.1111/jorc.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/07/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Self-management is a key component of successful chronic kidney disease (CKD) management. Here, we present the findings from the internal pilot of a multicentre randomised controlled trial (RCT) aimed to test the effect of a digital self-management programme ('My Kidneys & Me' (MK&M)). METHODS Participants (aged ≥18 years and CKD stages 3-4) were recruited from hospital kidney services across England. Study processes were completed virtually. Participants were randomised 2:1 to either intervention (MK&M) or control group. The first 60 participants recruited were included in a 10-week internal pilot which assessed study feasibility and acceptability against pre-specified progression criteria: 1) eligibility and recruitment, acceptability of 2) randomisation and 3) outcomes, 4) MK&M activation, and 5) retention and attrition rates. Semi-structured interviews further explored views on trial participation. RESULTS Of the 60 participants recruited, 41 were randomised to MK&M and 19 to control. All participants completed baseline measures and 62% (n=37) completed post-intervention outcome measures. All progression criteria met the minimum thresholds to proceed. Nine participants were interviewed. The themes identified were satisfaction with study recruitment processes (openness to participate, reading and agreeing to "terms and conditions"), acceptability of study design (remote study participation, acceptability of randomisation, completion of online assessment(s)), and methods to improve recruitment and retention (personalised approach, follow-up communication). CONCLUSION This internal pilot demonstrated the feasibility and acceptability of a virtually run RCT. Progression criteria thresholds to proceed to the definitive RCT were met. Areas for improvement were identified and protocol amendments were made to improve trial delivery.
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Affiliation(s)
- Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Noemi Vadaszy
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Matthew P M Graham-Brown
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Renal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Population Health Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
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13
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Corley A, Marsh N, Keogh S. Methodological progress note: Pilot randomized controlled trials. J Hosp Med 2024; 19:821-826. [PMID: 38655805 DOI: 10.1002/jhm.13376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Amanda Corley
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha Keogh
- School of Nursing and Midwifery & Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
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14
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Kataria M, Gupta N, Kumar A, Bhoriwal S, Singh A, Shekhar V, Bhatia R. Assessing the effectiveness of high frequency repetitive transcranial magnetic stimulation for post-mastectomy pain in breast cancer patients: A randomized controlled trial. Breast Cancer 2024; 31:841-850. [PMID: 38796817 DOI: 10.1007/s12282-024-01598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-mastectomy pain Syndrome (PMPS), characterized by chronic neuropathic pain stemming from intercostobrachial nerve lesions, presents a formidable clinical challenge. With the incidence of breast cancer surging, effective interventions for PMPS are urgently needed. To address this, we conducted this double-blind, placebo-controlled, randomized clinical trial to study the efficacy of repetitive Transcranial Magnetic Stimulation (rTMS) therapy over the motor cortex on pain, quality of life and thermal sensitivity in PMPS patients. METHODS We delivered 15 rTMS sessions over three weeks in a cohort of 34 PMPS patients. These patients were allocated randomly to either rTMS therapy or sham therapy groups. Pain assessments, utilizing the Visual Analogue Scale (VAS) and Short Form McGill Pain Questionnaire (SF-MPQ), alongside quality-of-life evaluations through the Functional Assessment of Cancer Therapy-Breast (FACT-B), were recorded before and after the 15 sessions. Additionally, we assessed thermal sensitivity using Quantitative Sensory Testing (QST). RESULTS Our findings demonstrate the superior efficacy of rTMS therapy (over sham therapy) in reducing VAS and SF-MPQ scores (p < 0.0001), improving physical (p = 0.037), emotional (p = 0.033), and functional well-being (p = 0.020) components of quality of life, as quantified by FACT-B. Our investigation also unveiled marked enhancements in thermal sensitivity within the rTMS therapy group, with statistically significant improvements in cold detection threshold (p = 0.0001), warm detection threshold (p = 0.0033), cold pain threshold (p = 0.0078), and hot pain tolerance threshold (p = 0.0078). CONCLUSION The study underscores the profound positive impact of rTMS therapy on pain, quality of life, and thermal sensitivity in patients having PMPS, opening new avenues for pain management strategies.
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Affiliation(s)
- Monika Kataria
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Aasheesh Kumar
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Akanksha Singh
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Varun Shekhar
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Renu Bhatia
- Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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Griffiths R, Tai S, Sutton C, Camacho E, Dixon J, Palmier-Claus J, Jones A, Welsh N, Ormrod S, Krishan A, Dawber A, Lovell K. Care coordinator delivered method of levels therapy to improve engagement and other outcomes in early psychosis (CAMEO): protocol for a feasibility cluster-randomised controlled trial. Pilot Feasibility Stud 2024; 10:117. [PMID: 39217388 PMCID: PMC11365126 DOI: 10.1186/s40814-024-01529-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 07/09/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Rates of disengagement from early intervention in psychosis (EIP) services are high. Care coordinators make up the largest staff group in EIP services and have the most frequent and sustained contact with service users. The quality of relationships between service users and care coordinators plays a central role in determining the effectiveness of EIP services. Care coordinators, however, are not routinely offered training in psychosocial interventions that could enhance the therapeutic impact of their role. Method of levels (MOL) is a flexible, transdiagnostic cognitive therapy with potential advantages over previously evaluated approaches. Training care coordinators in MOL could make their routine contacts with service users more helpful and improve outcomes such as recovery rates and levels of engagement. AIMS This study aims to assess the feasibility of training care coordinators in EIP services to deliver MOL, to understand whether this approach might improve service user engagement and recovery from psychosis compared to treatment as usual, and to assess the feasibility of conducting a cluster-randomised controlled trial (C-RCT) with clustering at the level of teams. Specific feasibility outcomes relate to the recruitment and retention of participants, care coordinators' level of engagement with the MOL training and supervision programme, implementation of MOL in practice, and the acceptability of the intervention amongst participants. METHODS A feasibility parallel group cluster-randomised controlled trial (C-RCT) designs with two arms: (1) treatment as usual (TAU) or (2) TAU plus support from a care coordinator who has received training in MOL. Randomisation will take place at the level of EIP teams with an allocation ratio of 1:2 in favour of the intervention arm. Our recruitment target is 12 EIP teams, 24 care coordinators working in participating EIP teams, and up to 96 service users working with participating care coordinators. Outcomes will be collected at baseline, 3 months, and 6 months. Qualitative methods will be used to understand participants' experiences of the study, MOL training programme, and MOL intervention. DISCUSSION This is the first study that aims to evaluate the feasibility of training EIP care coordinators to deliver MOL in their routine practice. Training care coordinators in MOL could enhance the quality of relationships between care coordinators and service users and improve outcomes for people experiencing early psychosis. Results will be used to determine the appropriateness of progressing to a larger evaluation trial. TRIAL REGISTRATION This study was prospectively registered with the ISRCTN Registry (14082421).
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Affiliation(s)
- Robert Griffiths
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
| | - Sara Tai
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Chris Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Elizabeth Camacho
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - James Dixon
- Mersey Care NHS Foundation Trust, Merseyside, UK
| | - Jasper Palmier-Claus
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Adam Jones
- Barnet, Enfield and Haringey Mental Health NHS Trust and Camden and Islington NHS Foundation Trust, London, UK
| | - Natalie Welsh
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Susan Ormrod
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Ashma Krishan
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Alison Dawber
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Xu K, Zhang J, Ma W, Wang Y, Chen B, Gao N, Pang J, Zhan H. Home-Based Shi's Knee Daoyin Exercise for Knee Osteoarthritis: A Randomized Controlled Pilot Trial. J Pain Res 2024; 17:2811-2822. [PMID: 39224147 PMCID: PMC11368107 DOI: 10.2147/jpr.s469176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
Objective Shi's Knee Daoyin (SKD) exercise is a treatment derived from Traditional Chinese exercise (TCE) specifically designed for lower limb health care. This study aimed to assess the feasibility of conducting a randomized controlled trial to explore the effectiveness of SKD exercise in treating knee osteoarthritis (KOA). Methods Participants were randomized to receive Health Education (HE) or SKD exercise. The primary outcomes were feasibility and safety outcomes, including participant recruitment rate, retention rate, as well as adherence to intervention. The secondary outcomes included Visual Analogue Scale (VAS) scores for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the 20-Meter Walk Test (20-MWT) and the 5-times Chair-Stand Test (5-CST). Results The results indicate that out of 89 individuals invited to participate in the study, 72 were eligible and agreed to participate, resulting in a recruitment rate of 80.9%. All participating patients completed the follow-up and were included in the analysis; no patients dropped out of the study due to adverse events. The secondary outcome measures showed that after twelve weeks of treatment, the VAS score, WOMAC total score, WOMAC pain score, WOMAC stiffness score, and WOMAC function score of patients in the HE group and SKD group all improved, but the improvement was more significant in the SKD group. The 20-MWT of SKD group after treatment was significantly shorter than before treatment (P<0.001); There was no significant difference in 20-MWT between the HE group and baseline after treatment. The performance of the two groups of patients improved in 5-CST, but there was no statistical difference between the two groups after treatment (P=2.439). Conclusion This study evaluated the feasibility and effectiveness of home-based SKD exercise intervention in alleviating symptoms in patients with symptomatic KOA, providing valuable information for designing an appropriate randomized controlled study.
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Affiliation(s)
- Kun Xu
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jiefan Zhang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wei Ma
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yongyu Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Bo Chen
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Ningyang Gao
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Jian Pang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Institute of Traumatology & Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Marcucci M, Ofori S. Perioperative randomised controlled trials: to pilot or not to pilot? Br J Anaesth 2024:S0007-0912(24)00457-4. [PMID: 39209698 DOI: 10.1016/j.bja.2024.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/18/2024] [Accepted: 07/22/2024] [Indexed: 09/04/2024] Open
Abstract
The science of pilot trials is evolving, and understanding of their role in medical research is increasing. Perioperative randomised controlled trials often test interventions that are inherently multidisciplinary and complex; therefore, there might be compelling reasons to conduct pilot studies to assess feasibility and inform trial design. As pilot studies themselves require resources, investigators should not squander this opportunity; they should design them so that they properly address the sources of uncertainty regarding the success of the definitive trial.
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Affiliation(s)
- Maura Marcucci
- Clinical Epidemiology and Research Centre, Humanitas University & IRCCS Humanitas Research Hospital, Milan, Italy; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Population Health Research Institute, Hamilton, ON, Canada.
| | - Sandra Ofori
- Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
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Meera SS, Srikar M, Raju R, Swaminathan D, Johnson RE, Watson LR, Nair DB, Kommu JVS, Chopra-McGowan J, Vasuki PP. Feasibility and acceptability of a caregiver-mediated early support program, delivered online, for infants at elevated familial likelihood for autism: A feasibility randomized controlled trial. Autism Res 2024. [PMID: 39205330 DOI: 10.1002/aur.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/02/2024] [Indexed: 09/04/2024]
Abstract
Preliminary evidence indicates potential benefit of providing caregiver-mediated intervention, prior to diagnosis, for infants at elevated familial likelihood for autism and related developmental delays including language delay (EL-A). However, delivering such interventions online and in low-resource settings like India has not been reported. This study aimed to evaluate the feasibility and acceptability of delivering a novel manualized caregiver-mediated early support program, the "LiL' STEPS," online in India, for EL-A infants. LiL' STEPS stands for Language development & Intervention Lab's (LiL') Supporting Early social-communication and language by Promoting caregiver Sensitive responsiveness (STEPS). The program comprised 14 sessions with a focus on social-communication and language, conducted over 12-weeks using demonstration and video feedback. Families of 36 EL-A infants aged 9 to 15-months participated in this feasibility randomized controlled trial (RCT). Families were randomized in a 2:1 ratio (n = 24 LiL' STEPS and n = 12 care as usual groups). Information on feasibility and acceptability was collated following a mixed methods approach from caregiver interviews, fidelity forms, session notes, and study register. Findings indicated the LiL' STEPS study trial as feasible and acceptable with recruitment rate of 4 per month, 100% willingness for randomization, 8.3% attrition, and 3.03% loss of blinding. Interventionist and caregiver fidelity was maintained above 80%. Despite challenges like interruptions during sessions, 100% families found the program acceptable and satisfactory, 86% said they would recommend the program to others, and 71% preferred online modality. Caregivers' perspectives on beneficial components and experience attending the program have been described. Accordingly, recommendations for future definitive RCTs have been presented.
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Affiliation(s)
- Shoba S Meera
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Malavi Srikar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Reny Raju
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Divya Swaminathan
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rachel Elizabeth Johnson
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Linda R Watson
- Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - John Vijay Sagar Kommu
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | | | - Prathyusha P Vasuki
- Departemnt of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Brown BWJ, Adams RJ, Wanstall S, Crowther ME, Rawson G, Vakulin A, Rayner T, McEvoy RD, Eastwood P, Reynolds AC. Introducing a sleep disorder screening and management strategy for workers with future shift work requirements: a feasibility and acceptability study. Sci Rep 2024; 14:19964. [PMID: 39198594 PMCID: PMC11358459 DOI: 10.1038/s41598-024-69479-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 08/05/2024] [Indexed: 09/01/2024] Open
Abstract
Sleep disorders are common, and largely undiagnosed in early-career workers. The combination of sleep disorders and shift work has implications for mental health, workplace safety, and productivity. Early identification and management of sleep disorders is likely to be beneficial to workers, employers and the community more broadly. We assessed the feasibility and acceptability of a tailored sleep disorder screening and management pathway for individuals with future shift work requirements. Paramedic students were invited to complete an online sleep health survey, which included validated sleep disorder screening questionnaires for insomnia, obstructive sleep apnea and restless legs syndrome. Participants were able to express interest in participating in a sleep monitoring and management study. Participants at risk for a sleep disorder were identified, contacted by the study physician (RJA), notified of their sleep disorder screening results and provided with information regarding management options. Feasibility of the screening and management pathways were determined by completion of the 12 week follow-up, and ability to engage with health services for diagnostic testing or treatment. Acceptability of these pathways was assessed with a semi-structured interview on completion of the study at 12 weeks. Screening was completed in thirty participants (mean age 22.5 ± 6.7, 63% female), 17 of whom were 'at-risk' for a sleep disorder and offered a management pathway. All participants engaged with the study physician (RJA), with 16 completing the study (94% completion rate). Three participants with excessive daytime sleepiness received feedback from the study physician (RJA) and no further care required. Of the remaining 14 participants, 11 (78%) engaged with health services after speaking with the study physician (RJA). Those who engaged with diagnostic and management services reported that a structured pathway with online screening was convenient and easy to follow. Facilitating screening and management of sleep disorders in students with future shift work requirements is both feasible and acceptable. These findings can inform the development of a preventive strategy for sleep disorders and ideally, a health services feasibility trial for future shift workers.
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Affiliation(s)
- Brandon W J Brown
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia.
| | - Robert J Adams
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Sian Wanstall
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Meagan E Crowther
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Georgina Rawson
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Andrew Vakulin
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Tim Rayner
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - R Doug McEvoy
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
| | - Peter Eastwood
- Health Futures Institute, Murdoch University, Perth, Australia
| | - Amy C Reynolds
- Flinders Health and Medical Research Institute (Sleep Health), Flinders University, Adelaide, Australia
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20
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Gurgenci T, O'Leary C, Philip J, Bruera E, Davis M, Agar MR, Hui D, Zimmermann C, Yennu S, Hardy J, Mercadante S, Rosa WE, Good P. Top Ten Tips Palliative Care Clinicians Should Know About Designing a Clinical Trial in Palliative Care. J Palliat Med 2024. [PMID: 39167532 DOI: 10.1089/jpm.2024.0259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
The palliative care field is experiencing substantive growth in clinical trial-based research. Randomized controlled trials provide the necessary rigor and conditions for assessing a treatment's efficacy in a controlled population. It is therefore important that a trial is meticulously designed from the outset to ensure the integrity of the ultimate results. In this article, our team discusses ten tips on clinical trial design drawn from collective experiences in the field. These ten tips cover a range of topics that can prove challenging in trial design, from developing initial methodologies to planning sample size and powering the trial, as well as collaboratively navigating the ethical issues of trial initiation and implementation as a cohesive team. We aim to help new researchers design sound trials and continue to grow the evidence base for our specialty. The guidance provided here can be used independently or in addition to the ten tips provided by this team in a separate article focused on what palliative care clinicians should know about interpreting a clinical trial.
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Affiliation(s)
- Taylan Gurgenci
- Department of Palliative and Supportive Care, Brisbane, Queensland, Australia
- Cancer Program, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Cian O'Leary
- Cancer Services, Mater Health, Brisbane, Queensland, Australia
| | - Jennifer Philip
- Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Palliative Care, The Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Fitzroy, Victoria, Australia
- Department of Palliative Care, Palliative Care Service, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Mellar Davis
- Director of Palliative Care Research at Geisinger Medical Center, Geisinger Commonwealth School of Medicine, Scranton PA, Danville, Pennsylvania, USA
| | - Meera R Agar
- Faculty of Health,IMPACCT, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David Hui
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sriram Yennu
- Department of Palliative, Rehabilitation, & Integrative Medicine, The University of Texas MD Anderson Cancer, Houston, Texas, USA
| | - Janet Hardy
- Cancer Program, Mater Research Institute-University of Queensland, Brisbane, Queensland, Australia
| | - Sebastiano Mercadante
- Pain Relief and Supportive-Palliative Care Unit, La Maddalena Cancer Center, Palermo, Italy
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Phillip Good
- Department of Palliative and Supportive Care, Brisbane, Queensland, Australia
- Department of Palliative Care, St Vincent's Private Hospital, Brisbane, Queensland, Australia
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21
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Clout M, Turner N, Clement C, Braude P, Benger J, Gagg J, Gendall E, Holloway S, Ingram J, Kandiyali R, Lewis A, Maskell NA, Shipway D, Smith JE, Taylor J, Darweish Medniuk A, Carlton E. The RELIEF feasibility trial: topical lidocaine patches in older adults with rib fractures. Emerg Med J 2024; 41:522-531. [PMID: 38760021 PMCID: PMC11347219 DOI: 10.1136/emermed-2024-213905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/29/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND Lidocaine patches, applied over rib fractures, may reduce pulmonary complications in older patients. Known barriers to recruiting older patients in emergency settings necessitate a feasibility trial. We aimed to establish whether a definitive randomised controlled trial (RCT) evaluating lidocaine patches in older patients with rib fracture(s) was feasible. METHODS This was a multicentre, parallel-group, open-label, feasibility RCT in seven hospitals in England and Scotland. Patients aged ≥65 years, presenting to ED with traumatic rib fracture(s) requiring hospital admission were randomised to receive up to 3×700 mg lidocaine patches (Ralvo), first applied in ED and then once daily for 72 hours in addition to standard care, or standard care alone. Feasibility outcomes were recruitment, retention and adherence. Clinical end points (pulmonary complications, pain and frailty-specific outcomes) and patient questionnaires were collected to determine feasibility of data collection and inform health economic scoping. Interviews and focus groups with trial participants and clinicians/research staff explored the understanding and acceptability of trial processes. RESULTS Between October 23, 2021 and October 7, 2022, 206 patients were eligible, of whom 100 (median age 83 years; IQR 74-88) were randomised; 48 to lidocaine patches and 52 to standard care. Pulmonary complications at 30 days were determined in 86% of participants and 83% of expected 30-day questionnaires were returned. Pulmonary complications occurred in 48% of the lidocaine group and 59% in standard care. Pain and some frailty-specific outcomes were not feasible to collect. Staff reported challenges in patient compliance, unfamiliarity with research measures and overwhelming the patients with research procedures. CONCLUSION Recruitment of older patients with rib fracture(s) in an emergency setting for the evaluation of lidocaine patches is feasible. Refinement of data collection, with a focus on the collection of pain, frailty-specific outcomes and intervention delivery are needed before progression to a definitive trial. TRIAL REGISTRATION NUMBER ISRCTN14813929.
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Affiliation(s)
- Madeleine Clout
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nicholas Turner
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Philip Braude
- CLARITY (Collaborative Ageing Research), North Bristol NHS Trust, Westbury on Trym, UK
| | - Jonathan Benger
- Faculty of Health and Life Sciences, University of the West of England, Bristol, UK
| | - James Gagg
- Department of Emergency Medicine, Somerset NHS Foundation Trust, Taunton, UK
| | - Emma Gendall
- Research and Innovation, Southmead Hospital, Bristol, UK
| | - Simon Holloway
- Pharmacy Clinical Trials and Research, Southmead Hospital, Bristol, UK
| | - Jenny Ingram
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Amanda Lewis
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Bristol, UK
| | - David Shipway
- Department of Medicine for Older People, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jason E Smith
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jodi Taylor
- Bristol Trials Centre, Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Edward Carlton
- Emergency Department, Southmead Hospital, Bristol, UK
- Department of Emergency Medicine, Translational Health Sciences, University of Bristol, Bristol, UK
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Yoong SQ, Wang W, Seah ACW, Chao FFT, Kumar N, Gan JON, Schmidt LT, Hong J, Zhang H. The impact of a student death doula service-learning experience in palliative care settings on nursing students: A pilot mixed-methods study. DEATH STUDIES 2024:1-13. [PMID: 39158318 DOI: 10.1080/07481187.2024.2391929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/20/2024]
Abstract
Through a mixed-methods approach (randomized controlled trial and thematic analysis of pre and post-service-learning reflections), this study evaluated the impact of a student death doula service-learning experience on nursing students' palliative competencies and learning experiences. The intervention group underwent a 2-day student death doula training workshop followed by a 6-month service-learning experience, while the control group received standard palliative care education. Attitudes toward the care of the dying significantly improved for the intervention group but not for compassion competence and palliative care knowledge. Six themes were developed: (1) Motivations for being a student death doula, (2) Improved perceptions of palliative care patients, (3) Perceptions of a good death, (4) Confidence in caring for palliative care patients, (5) Understanding the multifaceted nature of palliative care, and (6) Joys and challenges during service-learning. Service-learning helped students to understand palliative care patients and acquire confidence in engaging with them.
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Affiliation(s)
- Si Qi Yoong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Alvin Chuen Wei Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Felicia Fang Ting Chao
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Nivetha Kumar
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joanne Oon Nee Gan
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Assisi Hospice, Singapore
| | - Laura Tham Schmidt
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Hui Zhang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- St. Andrew's Community Hospital, Singapore
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23
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Gu J, Wang P, Chow SC, Dempsey K, Bermejo S, Swaminathan A, Soskis A, Fried J, Kloefkorn C, Jones C, Cox CE. An App Platform-Facilitated Collaborative Palliative Care Intervention for Outpatients With Interstitial Lung Disease: A Pilot Randomized Trial. Am J Hosp Palliat Care 2024:10499091241275966. [PMID: 39158903 DOI: 10.1177/10499091241275966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
Rationale: Outpatients with interstitial lung disease often experience serious symptoms, yet infrequently receive palliative care. Objective: To determine the feasibility and clinical impact of a mobile application (PCplanner) in an outpatient setting. Methods: We conducted a pilot randomized controlled trial among adults with interstitial lung disease in a single-center academic clinic. Clinical outcomes included change in Needs at the End-of-Life Screening Tool (NEST) scale between baseline and 3 months as well as frequency of advance care planning discussions and referrals to palliative care services. Results: Observed feasibility outcomes were similar to targeted benchmarks including randomization rates (82.1% vs 80%) and retention (84.8% vs 80%). Mean NEST scores between the intervention and control group were 38.9 (SD, 18.9) vs 41.5 (SD, 20.5) at baseline, 34.6 (SD, 18.9) vs 33.6 (SD, 19.4) at 1 month after clinic visit, 40.5 (SD, 21.6) vs 35.3 (SD, 25.0) at 3 months after clinic visit. Changes in NEST scores between baseline and 3 months showed no difference in the primary outcome (P = 0.481, 95% CI [-8.45, 17.62]). Conclusion: Among patients with interstitial lung disease, a mobile app designed to focus patients and clinicians on palliative care principles demonstrated evidence of feasibility. Although changes in self-reported needs were similar between intervention and control groups, more patients in the intervention group updated their advance directives and code status compared to the control group. Clinical Trial Registration: Palliative Care Planner (PCplanner) NCT05095363. https://www.clinicaltrials.gov/study/NCT05095363.
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Affiliation(s)
- Jessie Gu
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Peijin Wang
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Shein-Chung Chow
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Katelyn Dempsey
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Santos Bermejo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Aparna Swaminathan
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Alyssa Soskis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Julie Fried
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Chad Kloefkorn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher Jones
- Department of Medicine, Division of Palliative Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - Christopher E Cox
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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24
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Dennett R, Thompson T, Clyne W, Straukiene A, Davies-Cox H, Hosking J, Bones K, Elston J. PEER CONNECT: a pragmatic feasibility randomised controlled trial of peer coaching for adults with long-term conditions. BMJ Open 2024; 14:e087020. [PMID: 39160107 PMCID: PMC11337699 DOI: 10.1136/bmjopen-2024-087020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/03/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To test the feasibility of a targeted peer coaching intervention on the health and well-being of people with long-term health conditions and low activation attending outpatient clinics at a UK National Health Service (NHS) Trust. DESIGN Randomised controlled feasibility trial, with embedded qualitative study. SETTING An NHS integrated health and care organisation in the South West of England, UK, with significant areas of deprivation. PARTICIPANTS Patients (over 18 year of age) of the Trust's rheumatology, pain or multiple sclerosis services, with a Patient Activation Measure score at level 1 or 2. INTERVENTION Up to 14 sessions of peer coaching delivered in a stepped-down model delivered over 6 months. MAIN OUTCOMES Primary feasibility outcomes were recruitment, retention, intervention adherence and peer, coach and staff experience.Secondary outcomes included psychological well-being, resource use, long-term condition management and disease-specific measures. RESULTS 97 potential coaches were contacted directly. 27 (27.8%) were screened and of those 21 (77.8%) were eligible and recruited into the study. For a range of reasons, only five (23.8%) progressed through training and on to deliver peer coaching. 747 potential peers were invited to take part and 19 (2.5%) were screened. Of those screened, seven (36.8%) were eligible, recruited and randomised, all white females with median age of 50 years (range: 24-82 years). One peer in the intervention group withdrew prior to receiving the intervention, the remaining four received coaching. Peers and coaches reported a range of benefits related to their health and well-being. CONCLUSION Coach recruitment, training and study procedures were feasible and acceptable. Due to low peer recruitment numbers, it was decided not to progress to a definitive trial. Further research is required to explore how to engage with and recruit people reporting low levels of activation and the acceptability and effectiveness of peer coaching for this group. TRIAL REGISTRATION NUMBER ISRCTN12623577.
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Affiliation(s)
- Rachel Dennett
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Tom Thompson
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Wendy Clyne
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Agne Straukiene
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | | | - Joanne Hosking
- Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Krystina Bones
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Julian Elston
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
- Peninsula Medical School, University of Plymouth, Plymouth, UK
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25
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Barnes C, Turon H, McCrabb S, Mantach S, Janssen L, Duffy M, Groombridge D, Hodder R, Meharg D, Robinson E, Bialek C, Wallace S, Leigh L, Wolfenden L. Factorial randomised controlled trial to examine the potential effect of a text message-based intervention on reducing adolescent susceptibility to e-cigarette use: a study protocol. BMJ Open 2024; 14:e083251. [PMID: 39153795 PMCID: PMC11331865 DOI: 10.1136/bmjopen-2023-083251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 07/19/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Adolescent e-cigarette use, globally and within Australia, has increased in recent years. In response, public health agencies have called for the development of education and communication programmes targeting adolescents. Despite such recommendations, few rigorous evaluations of such interventions currently exist. The main objective of this study is to examine the potential effect of a text message intervention targeting parents and adolescents on adolescent susceptibility to e-cigarette use (eg, intentions towards using e-cigarettes). Secondary objectives are to (1): examine the effect of the intervention on adolescent e-cigarette and combustible tobacco use and (2) examine the acceptability of the intervention. METHODS AND ANALYSIS A randomised controlled trial employing a 2×2 factorial design will be conducted with parent-adolescent dyads (aged 12-15 years). Dyads will be randomly allocated to one of four arms: arm 1-a text message intervention delivered to adolescents only; arm 2-a text message intervention delivered to the parents of adolescents only; arm 3-a text message intervention delivered to both the parents and adolescents; and arm 4-an information only control, consisting of an e-cigarette factsheet provided to parents only. Participant recruitment commenced in March 2023 with the aim to recruit 120 parent-adolescent dyads. Data collection to assess study outcomes will occur at baseline, 6, 12 and 24 months post the commencement of the intervention. The primary endpoint will be 6-month follow-up. The primary outcome will be adolescent susceptibility to e-cigarette use, assessed using validated items. Analyses of trial outcomes will be undertaken under an intention-to-treat framework, with all participants included in the analysis in the group they were allocated. ETHICS AND DISSEMINATION Ethics approval has been obtained from the human research ethics committee of the University of Newcastle (H-2022-0340). Findings will be disseminated in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER The trial was registered prospectively with Australian New Zealand Clinical Trials Registry (ACTRN12623000079640).
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Affiliation(s)
- Courtney Barnes
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Heidi Turon
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sam McCrabb
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Stephanie Mantach
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Lisa Janssen
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Megan Duffy
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - Daniel Groombridge
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
| | - Rebecca Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
| | - David Meharg
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| | - Elly Robinson
- Parenting Research Centre, East Melbourne, Victoria, Australia
| | - Caitlin Bialek
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Seaneen Wallace
- Sydney Children's Hospitals Network, Westmead, New South Wales, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
- Population Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- National Centre of Implementation Science, University of Newcastle, Callaghan, New South Wales, Australia
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26
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Amundsen PA, Underwood M, Burton K, Grotle M, Engedahl MS, Malmberg-Heimonen I, Irgens PMS, Højen M, Kisa A, Hagen M, Holmgard TE, Martinsen A, Lothe J, Monsen SS, Froud R. Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: an internal pilot study of a cohort randomised controlled approach. Pilot Feasibility Stud 2024; 10:110. [PMID: 39138502 PMCID: PMC11321075 DOI: 10.1186/s40814-024-01538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 08/05/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Persistent pain is a frequent cause of sick leave and work disability in Norway. A return-to-work intervention featuring supported work placements, developed in the UK, demonstrated feasibility, and a return-to-work rate of 20% within 6 months was observed in the sample. We sought to adapt the intervention for delivery in Norway and to confirm feasibility prior to a full-scale trial. METHODS In this internal pilot, we used a pragmatic cohort randomised controlled approach with national recruitment in Norway. We recruited people who were unemployed (for at least 1 month), having persistent pain (for at least 3 months), aged between 18 and 64, and wanting to return to work. We initially recruited people to an observational cohort study of the impact of being unemployed with persistent pain. After baseline measurement, we randomly sub-sampled participants to whom we offered the intervention, which featured individual case management and support, work-familiarisation sessions, and the offer of a 6-week part-time unpaid work placement. We assessed recruitment rates (aiming to recruit 66, and sub-sample 17 within 6 months); optimal recruitment pathways; intervention acceptance rates; the feasibility of data collection; using video links for work-familiarisation sessions and remote case manager support. RESULTS The pilot ran from June to November 2022. Of 168 people expressing interest, 94 consented. Recruitment posts on Facebook yielded the most 'expressions of interest' (66%, n = 111). After screening for eligibility, we included 55 participants. Of these, 19 were randomised to be offered the intervention. Of these, less than half (n = 8) consented to intervention participation. Remote case manager and work-familiarisation sessions appeared feasible. Following a delay in identifying placements, three participants received offers of work placements, with one starting and completing during the pilot period. Data collection methods were feasible, and no adverse events were reported. CONCLUSIONS Recruitment and logistical processes, such as remote management by video link, are feasible. However, delivery of the intervention is challenging. In particular, sourcing placements and the time required for identifying appropriate placements was more challenging than anticipated. A full-scale trial is feasible but will require improvements to the placement identification processes. TRIAL REGISTRATION ISRCTN85437524 (Referring to the ReISE trial, of which this internal pilot was a part), Registered 31 of May 2022 https://doi.org/10.1186/ISRCTN85437524 TRIAL FUNDING: Norwegian Research Council.
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Affiliation(s)
- Pål André Amundsen
- School of Health Sciences, Kristiana University College, PB 1190, 0107, Sentrum, Oslo, Norway.
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Kim Burton
- University of Huddersfield, Queensgate Huddersfield, Huddersfield, HD1 3DH, UK
- University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK
| | - Margreth Grotle
- Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Building 37BNydalen, P.O. Box 4956, 0424, Ullevål Oslo, Norway
| | - Martin Stav Engedahl
- School of Health Sciences, Kristiana University College, PB 1190, 0107, Sentrum, Oslo, Norway
| | - Ira Malmberg-Heimonen
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | | | - Magnus Højen
- School of Health Sciences, Kristiana University College, PB 1190, 0107, Sentrum, Oslo, Norway
| | - Adnan Kisa
- School of Health Sciences, Kristiana University College, PB 1190, 0107, Sentrum, Oslo, Norway
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA, 70112, USA
| | - Milada Hagen
- Department of Nursing and Health Promotion, Faculty of Health Science, Oslo Metropolitan University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Thor Einar Holmgard
- Norwegian Back Pain Association, Fjellhagen, P.O.Box 9612, 3065, Drammen, Norway
| | - Amy Martinsen
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Building 37BNydalen, P.O. Box 4956, 0424, Ullevål Oslo, Norway
- Co/FORMI, The Norwegian Council for Musculoskeletal Health, Oslo Universitetssykehus, 4956 Nydalen, P.O. Box , 0424, Oslo, Norway
| | - Jakob Lothe
- Co/FORMI, The Norwegian Council for Musculoskeletal Health, Oslo Universitetssykehus, 4956 Nydalen, P.O. Box , 0424, Oslo, Norway
| | | | - Robert Froud
- School of Health Sciences, Kristiana University College, PB 1190, 0107, Sentrum, Oslo, Norway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Armitage BT, Potts HWW, Irwin MR, Fisher A. Exploring the Impact of a Sleep App on Sleep Quality in a General Population Sample: Pilot Randomized Controlled Trial. JMIR Form Res 2024; 8:e39554. [PMID: 39137016 DOI: 10.2196/39554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 03/19/2024] [Accepted: 04/29/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND A third of adults in Western countries have impaired sleep quality. A possible solution involves distributing sleep aids through smartphone apps, but most empirical studies are limited to small pilot trials in distinct populations (eg, soldiers) or individuals with clinical sleep disorders; therefore, general population data are required. Furthermore, recent research shows that sleep app users desire a personalized approach, offering an individually tailored choice of techniques. One such aid is Peak Sleep, a smartphone app based on scientifically validated principles for improving sleep quality, such as mindfulness meditation and cognitive behavioral therapy. OBJECTIVE We aimed to test the impact of the smartphone app Peak Sleep on sleep quality and collect user experience data to allow for future app development. METHODS This was a 2-arm pilot randomized controlled trial. Participants were general population adults in the United Kingdom (aged ≥18 years) who were interested in improving their sleep quality and were not undergoing clinical treatment for sleep disorder or using sleep medication ≥1 per week. Participants were individually randomized to receive the intervention (3 months of app use) versus a no-treatment control. The intervention involved free access to Peak Sleep, an app that offered a choice of behavioral techniques to support better sleep (mindfulness, cognitive behavioral therapy, and acceptance commitment therapy). The primary outcome was sleep quality assessed using the Insomnia Severity Index at baseline and 1-, 2-, and 3-month follow-ups. Assessments were remote using web-based questionnaires. Objective sleep data collection using the Oura Ring (Ōura Health Oy) was planned; however, because the COVID-19 pandemic lockdowns began just after recruitment started, this plan could not be realized. Participant engagement with the app was assessed using the Digital Behavior Change Intervention Engagement Scale and qualitative telephone interviews with a subsample. RESULTS A total of 101 participants were enrolled in the trial, and 21 (21%) were qualitatively interviewed. Sleep quality improved in both groups over time, with Insomnia Severity Index scores of the intervention group improving by a mean of 2.5 and the control group by a mean of 1.6 (between-group mean difference 0.9, 95% CI -2.0 to 3.8), with was no significant effect of group (P=.91). App users' engagement was mixed, with qualitative interviews supporting the view of a polarized sample who either strongly liked or disliked the app. CONCLUSIONS In this trial, self-reported sleep improved over time in both intervention and control arms, with no impact by group, suggesting no effect of the sleep app. Qualitative data suggested polarized views on liking or not liking the app, features that people engaged with, and areas for improvement. Future work could involve developing the app features and then testing the app using objective measures of sleep in a larger sample. TRIAL REGISTRATION ClinicalTrials.gov NCT04487483; https://www.clinicaltrials.gov/study/NCT04487483.
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Affiliation(s)
- Bianca Tanya Armitage
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Michael R Irwin
- Norman Cousins Center for Psychoneuroimmunology, Semel Institute for Neuroscience and Human Behavior, and Department of Psychiatry and Biobehavioral Science, UCLA Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, United Kingdom
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Curley MAQ, Dawkins-Henry OS, Kalvas LB, Perry-Eaddy MA, Georgostathi G, Yuan I, Wypij D, Asaro LA, Zuppa AF, Kudchadkar SR. The Nurse-Implemented Chronotherapeutic Bundle in Critically Ill Children, RESTORE Resilience (R2): Pilot Testing in a Two-Phase Cohort Study, 2017-2021. Pediatr Crit Care Med 2024:00130478-990000000-00373. [PMID: 39133067 DOI: 10.1097/pcc.0000000000003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
OBJECTIVES Pilot test the nurse-led chronotherapeutic bundle in critically ill children, RESTORE Resilience (R2). DESIGN A two-phase cohort study was carried out from 2017 to 2021. SETTING Two similarly sized and organized PICUs in the United States. PATIENTS Children 6 months to 17 years old who were mechanically ventilated for acute respiratory failure. INTERVENTIONS R2 seven-item chronotherapeutic bundle, including: 1) replication of child's pre-hospital daily routine (i.e., sleep/wake, feeding, activity patterns); 2) cycled day-night light/sound modulation; 3) minimal effective sedation; 4) night fasting with bolus enteral daytime feedings; 5) early progressive mobility; 6) nursing care continuity; and 7) parent diaries. MEASUREMENTS AND MAIN RESULTS Children underwent environmental (light, sound) and patient (actigraphy, activity log, salivary melatonin, electroencephalogram) monitoring. Parents completed the Child's Daily Routine and Sleep Survey (CDRSS) and Family-Centered Care Scale. The primary outcome was post-extubation daytime activity consolidation (Daytime Activity Ratio Estimate [DARE]). Twenty baseline-phase (2017-2019) and 36 intervention-phase (2019-2021) participants were enrolled. During the intervention phase, nurses used the CDRSS to construct children's PICU schedules. Overall compliance with nurse-implemented R2 elements 1-5 increased from 18% (interquartile range, 13-30%) at baseline to 63% (53-68%) during the intervention phase (p < 0.001). Intervention participants were exposed to their pre-hospitalization daily routine (p = 0.002), cycled day-night light/sound modulation (p < 0.001), and early progressive mobility on more PICU days (p = 0.02). Sedation target identification, enteral feeding schedules, and nursing care continuity did not differ between phases. Parent diaries were seldom used. DARE improved during the intervention phase and was higher pre-extubation (median 62% vs. 53%; p = 0.04) but not post-extubation (62% vs. 57%; p = 0.56). CONCLUSIONS In the PICU, implementation of an individualized nurse-implemented chronotherapeutic bundle is feasible. Children who received the R2 bundle had increased pre-extubation daytime activity consolidation compared to children receiving usual care. Given variation in protocol adherence, further R2 testing should include interprofessional collaboration, pragmatic trial design, and implementation science strategies.
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Affiliation(s)
- Martha A Q Curley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | | | - Laura Beth Kalvas
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Mallory A Perry-Eaddy
- University of Connecticut School of Nursing, Storrs, CT
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Pediatric Intensive Care Unit, Connecticut Children's Medical Center, Hartford, CT
| | - Georgia Georgostathi
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ian Yuan
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - David Wypij
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Athena F Zuppa
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sapna R Kudchadkar
- Pediatric Intensive Care Unit, Children's Center, Johns Hopkins Medicine, Baltimore, MD
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD
- Department of Pediatrics, Johns Hopkins University School of Medicine, Charlotte R. Bloomberg Children's Center, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
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Carta MG, Kurotschka PK, Machado S, Erfurth A, Sancassiani F, Perra A, Tusconi M, Cossu G, Aviles Gonzalez CI, Primavera D. A Virtual Reality Cognitive Stimulation Program as an Effective Tool Against Residual/Prodromal Depressive Symptoms in Bipolar Disorders. J Clin Med 2024; 13:4714. [PMID: 39200856 PMCID: PMC11355462 DOI: 10.3390/jcm13164714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Bipolar disorder (BD) is a severe psychiatric illness characterized by a chronic course and recurrent episodes, including residual depressive symptoms even during euthymic phases. These symptoms, although not meeting criteria for a depressive episode, are linked to relapse risk and impaired social functioning. This study aims to assess whether Virtual Reality Cognitive Remediation Training reduces depressive symptoms below the clinical threshold in individuals with BD. Methods: This post hoc analysis focuses on the secondary outcome (PHQ9) of a randomized-controlled trial. Participants were recruited from the Center of Liaison Psychiatry and Psychosomatics in Italy. The experimental group received Virtual Reality Cognitive Remediation, while the control group received standard treatment Results: Data from 39 individuals in the experimental group and 25 in the control group were analyzed. A greater reduction in PHQ-9 scores (>9) was observed in the experimental group (71.8% to 48.7%) compared to the control group. Significant improvements in total PHQ-9 scores and specific symptoms were noted in the experimental group compared to the control group. Conclusions: The study highlights the significant impact of virtual reality intervention on reducing depressive symptoms in bipolar disorder. This promising outcome underscores the potential preventive role of cognitive stimulation in relapse prevention. The intervention could offer valuable benefits for both treatment and prevention strategies in bipolar disorder.
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Affiliation(s)
- Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Peter K. Kurotschka
- Department of General Practice, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Sergio Machado
- Center of Neuroscience, Neurodiversity Institute, Queimados 26325-010, Brazil;
- Institute of Psychiatry-IPUB, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Andreas Erfurth
- 6th Psychiatric Department, Otto-Wagner-Spital, 1140 Vienna, Austria;
| | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Massimo Tusconi
- Azienda Ospedaliero Universitaria di Cagliari, 09042 Cagliari, Italy;
| | - Giulia Cossu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
| | - Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Cagliari, Italy; (M.G.C.); (F.S.); (A.P.); (G.C.); (C.I.A.G.)
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Rhodes SM, McDougal E, Efthymiou C, Stewart TM, Booth JN. Co-production of the 'EPIC' multidimensional tool-kit to support neurodivergent children and young people at home and school: a feasibility and pilot study. Pilot Feasibility Stud 2024; 10:108. [PMID: 39127770 DOI: 10.1186/s40814-024-01530-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/15/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Interventions focused on cognitive function in neurodivergent children typically focus on single functions, e.g. working memory training. They are often focused on 'deficit' models and lack an emphasis on understanding areas of individual strengths and difficulties as a prerequisite to appropriate support. The multidimensional nature and phenotypic variability of cognitive profiles in these children indicate a need for a multicomponent-tailored intervention programme focused on understanding and supporting an individual child's cognitive functioning. AIMS The 'EPIC' intervention (Edinburgh Psychoeducation Intervention for Children and Young People) is focused on improving cognition, learning and behaviour in neurodivergent children such as those with attention deficit hyperactivity disorder (ADHD) or who are autistic. Building on our previous co-production work, this study aimed to use a participatory methods approach to develop EPIC practices and materials in relation to our key principles which include psychoeducation, multicomponent, individualised approach, strengths and difficulties profiling and pairing of a child's individual strengths and difficulties with internal and external strategies. We also set out to assess the feasibility and acceptability of EPIC, and pilot this novel tool-kit intervention with neurodivergent children and their parents and teachers. METHODS The intervention practices, materials and strategies of EPIC were co-produced with neurodivergent children, their parents, teachers and clinicians taking a strengths and difficulties approach. Identification of psychoeducation activities and strategy practices (e.g. mind-maps, chunking), testing of feasibility and collection of pilot data were conducted over a bi-weekly 8-week programme. Eleven neurodivergent children aged 7 to 12 completed the 16-session individualised programme. Acceptability and feasibility were ascertained via qualitative reports elicited within child and teacher interviews and child ratings of enjoyment. Pilot evaluation data was collected pre- and post-intervention participation, and across cognitive assessments (CANTAB, BRIEF), educational attainment (WIAT) and parent and teacher questionnaires measuring clinical symptoms and behaviour (Conners, AQ, SDQ, self-perception). Data was compared with a matched neurodivergent treatment-as-usual control group (N = 9). RESULTS The co-produced EPIC intervention was both feasible to deliver and acceptable to children, parents and their teachers. Pilot data identified that the 8-week intervention improved cognition (short-term and working memory) and literacy (receptive vocabulary, oral word fluency, listening comprehension). Improvements in the intervention group were also found for parent-reported child behavioural difficulties and aggression, and teacher-reported scholastic competence. Effect sizes generated (Cohen's d) ranged from 0.65 to 2.83. Parents reported continuing to use EPIC strategies when interviewed over a year after participating in the programme. CONCLUSION The current study met our objectives fully. 'EPIC' (Edinburgh Psychoeducation Intervention for Children and Young People) is feasible in home and school contexts and improves a range of aspects of cognition, learning and behaviour in neurodivergent children. Our findings show EPIC is suitable to be assessed within a full-scale trial.
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Affiliation(s)
- Sinead M Rhodes
- Department of Child Life and Health, University of Edinburgh, Royal Hospital for Children and Young People, Little France, Edinburgh, EH16 4TJ, Scotland.
| | - Emily McDougal
- Evidence Based Practice Unit, Anna Freud and UCL, London, UK
| | - Christina Efthymiou
- Department of Child Life and Health, University of Edinburgh, Royal Hospital for Children and Young People, Little France, Edinburgh, EH16 4TJ, Scotland
| | - Tracy M Stewart
- Department of Child Life and Health, University of Edinburgh, Royal Hospital for Children and Young People, Little France, Edinburgh, EH16 4TJ, Scotland
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, EH8 8AQ, Scotland
| | - Josie N Booth
- Department of Child Life and Health, University of Edinburgh, Royal Hospital for Children and Young People, Little France, Edinburgh, EH16 4TJ, Scotland
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Hartman CR, Lubans DR, Christiansen LB. Cross-country adaptation and feasibility of an evidence-based resistance training intervention in the school setting. Front Sports Act Living 2024; 6:1415469. [PMID: 39176236 PMCID: PMC11340508 DOI: 10.3389/fspor.2024.1415469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/24/2024] [Indexed: 08/24/2024] Open
Abstract
Background Physical activity that strengthens muscles and bones at least three times per week are recommended, but few adolescents meet this target. The aim of our study was to adapt and evaluate the feasibility and preliminary efficacy of the Resistance Training for Teens (RT4T) program in Danish lower secondary schools. Methods Developed and evaluated in Australia, the aim of RT4T is to provide adolescents with competence, confidence, knowledge, and motivation to participate in resistance training. Translation and adaptation were based on the PRACTIS-guide and involved workshops with physical education teachers. Three 7th-grade classes and three 9th-grade classes were recruited for the feasibility study and followed the program over eight weeks. Participants completed a push-up test, a standing long jump test, and a beep-test before and after the intervention. In addition, they completed a survey about their self-efficacy, motivation, and resistance training competency. Four qualitative interviews were performed with participants and their physical education teachers. Results The participating teachers were motivated for the program, but they had difficulties providing students with appropriate feedback. Students were motivated by the equipment, games, and their improvements in fitness, but motivation declined during the program. A total of 57 students completed the physical tests and answered the survey. Resistance training self-efficacy improved significantly, while most other measures improved over time, without reaching significance. Conclusion Overall, the RT4T was acceptable and feasible in lower secondary schools in Denmark, but adjustments need to be made to increase the reach and efficacy of the program.
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Affiliation(s)
- Caroline R. Hartman
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - David R. Lubans
- Centre for Active Living and Learning, College of Human and Social Futures, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Lars B. Christiansen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Woodward A, Coleman E, Ronaldson S, Zoltie T, Bartlett P, Wilson L, Archer T, Kawalek J, Boele F, Chang B, Kalantzis G, Theaker M, El-Hindy N, Walshaw E, Gout T, Watson J. A cross-over, randomised feasibility study of digitally-printed versus hand-painted artificial eyes in adults: PERSONAL-EYE-S. Eye (Lond) 2024:10.1038/s41433-024-03273-0. [PMID: 39095468 DOI: 10.1038/s41433-024-03273-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 07/03/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND/OBJECTIVES Over 60,000 patients in the United Kingdom are estimated to have artificial eyes. Manufacturing and hand-painting of artificial eyes have not changed significantly since 1948. Delays and colour-matching issues may severely impact a patient's rehabilitation pathway. Technology advances mean alternatives are now possible. This cross-over, randomised feasibility trial aimed to determine the feasibility of conducting a full-scale trial of the effectiveness and cost-effectiveness of digitally-printed artificial eyes compared to hand-painted. SUBJECTS/METHODS Patients aged ≥18 years who were longstanding artificial eye users requiring a replacement were randomised to receive either a hand-painted or digitally-printed eye first followed by the other type of eye. Participants were asked to approach a close contact (CC) willing to participate alongside them. A subset of participants, their CCs, and staff were interviewed about their opinions on trial procedures, artificial eyes, delivery times and satisfaction. RESULTS Thirty-five participants were randomised and 10 CCs consented. Participant retention at final follow-up was 85.7%. Outcome data completion rates ranged from 91-100%. EQ-5D-5L completion ranged from 83-97%. Resource-use completion ranged from 0-94% with total costs at £347 for hand-painted and £404 for digitally-printed eye. There were two adverse events. Twelve participants, five CCs, and five staff were interviewed. There were positive and negative features of both types of eyes. We identified that social and psychological wellbeing is affected, often for many years after eye removal. Participation in the feasibility study was well accepted. CONCLUSIONS The feasibility study outcomes indicate that a full trial is achievable. TRIAL REGISTRATION NUMBER ISRCTN85921622.
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Affiliation(s)
- Amie Woodward
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Sarah Ronaldson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Tim Zoltie
- School of Dentistry, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Paul Bartlett
- Maxillofacial Laboratory, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Laura Wilson
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Tom Archer
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jessica Kawalek
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research at St James's, St James's University Hospital, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Bernard Chang
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - George Kalantzis
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Mike Theaker
- Patient and Public Involvement representative, Leeds, UK
| | - Nabil El-Hindy
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Emma Walshaw
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Taras Gout
- Leeds Artificial Eye Service, Leeds Dental Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judith Watson
- York Trials Unit, Department of Health Sciences, University of York, York, UK.
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Marzouqah R, Dharmakulaseelan L, Colelli DR, Lindo CJ, Costa YS, Jairam T, Xiong K, Murray BJ, Chen JL, Thorpe K, Yunusova Y, Boulos MI. Strengthening oropharyngeal muscles as an approach to treat post-stroke obstructive sleep apnea: A feasibility randomised controlled trial. J Sleep Res 2024; 33:e14086. [PMID: 37909249 DOI: 10.1111/jsr.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
This study aimed to determine the feasibility of a randomised controlled trial (RCT) evaluating oropharyngeal exercise (OPE) intervention as an alternative therapy for obstructive sleep apnea (OSA) in patients with stroke or transient ischaemic attack (TIA). Despite the high prevalence of OSA in this population, the standard therapy, continuous positive airway pressure (CPAP), is often poorly tolerated. Thirty stroke/TIA patients with OSA unable to tolerate CPAP were randomly assigned to an oropharyngeal exercise or sham exercise protocol. They performed exercises for 6 weeks, 5 days per week, 30 minutes twice per day. Feasibility was ascertained by the proportion of enrolled patients who completed more than 80% of the OPE regimen. Isometric tongue pressures, apnea-hypopnea index (AHI), oxygen desaturation index (ODI), daytime sleepiness, and quality of life (QOL) outcomes were collected at baseline, post-training (6-week follow-up), and retention (10-week follow-up) to document preliminary efficacy. Adherence to study exercises was excellent, with 83% of participants completing more than 80% of the exercises. The isometric tongue pressures were observed to improve in the oropharyngeal exercise group (compared with the sham group), along with a decrease in OSA severity (measured by the AHI and ODI), reduced daytime sleepiness, and enhanced quality of life outcomes following the exercise programme. Only the effects on posterior isometric tongue pressure and daytime sleepiness remained significantly different between groups at the retention session. In conclusion, an RCT evaluating the efficacy of oropharyngeal exercises on post-stroke/TIA OSA is feasible and our preliminary results suggest a clinically meaningful effect.
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Affiliation(s)
- Reeman Marzouqah
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Laavanya Dharmakulaseelan
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - David R Colelli
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - C J Lindo
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Yakdehikandage S Costa
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Trevor Jairam
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Kathy Xiong
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Joyce L Chen
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- University Health Network - KITE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark I Boulos
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
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Desborough MJR, Laing E, Kounali D, Mora A, Hodge R, Martin S, Thomas H, Hudson C, Parsons J, Shah A, Hutton P, Parke T, Wise MP, Morgan M, McKechnie S, Stanworth SJ. Desmopressin for prevention of bleeding for thrombocytopenic, critically ill patients undergoing invasive procedures: A randomised, double-blind, placebo-controlled feasibility trial. EJHAEM 2024; 5:772-777. [PMID: 39157598 PMCID: PMC11327725 DOI: 10.1002/jha2.955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/23/2024] [Accepted: 05/13/2024] [Indexed: 08/20/2024]
Abstract
Thrombocytopenic patients have an increased risk of bleeding when undergoing invasive procedures. In a multicentre, phase II, blinded, randomised, controlled feasibility trial, critically ill patients with platelet count 100 × 109/L or less were randomised 1:1 to intravenous desmopressin (0.3 µg/kg) or placebo before an invasive procedure. Forty-three participants (18.8% of those eligible) were recruited, with 41 eligible for analysis. Post-procedure bleeding occurred in one of 22 (4.5%) in the placebo arm and zero of 19 in the desmopressin arm. Despite liberal inclusion criteria, there were significant feasibility challenges recruiting patients in the critical care setting prior to invasive procedures.
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Affiliation(s)
- Michael J. R. Desborough
- Department of Clinical HaematologyOxford University Hospitals NHS Foundation TrustOxfordUK
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
- NHS Blood and TransplantJohn Radcliffe HospitalOxfordUK
| | - Emma Laing
- NHS Blood and TransplantClinical Trials UnitCambridgeUK
| | | | - Ana Mora
- NHS Blood and TransplantClinical Trials UnitCambridgeUK
| | - Renate Hodge
- NHS Blood and TransplantClinical Trials UnitCambridgeUK
| | | | - Helen Thomas
- NHS Blood and TransplantClinical Trials UnitBristolUK
| | - Cara Hudson
- NHS Blood and TransplantClinical Trials UnitBristolUK
| | | | - Akshay Shah
- Department of Critical CareOxford University Hospitals NHS Foundation TrustOxfordUK
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Paula Hutton
- Department of Critical CareOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Tim Parke
- Department of Critical CareRoyal Berkshire HospitalReadingUK
| | - Matthew P. Wise
- Department of Critical CareUniversity Hospital of WalesCardiffUK
| | - Matthew Morgan
- Department of Critical CareUniversity Hospital of WalesCardiffUK
| | - Stuart McKechnie
- Department of Critical CareOxford University Hospitals NHS Foundation TrustOxfordUK
| | - Simon J. Stanworth
- Department of Clinical HaematologyOxford University Hospitals NHS Foundation TrustOxfordUK
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
- NHS Blood and TransplantJohn Radcliffe HospitalOxfordUK
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Doyle M. Implementing global positioning system trackers for people with dementia who are at risk of wandering. DEMENTIA 2024; 23:964-980. [PMID: 38646927 PMCID: PMC11290024 DOI: 10.1177/14713012241248556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE The main aim of this study was to evaluate the feasibility and acceptability of using a GPS tracker to mitigate the risks associated with wandering for people with dementia and those caring for them and further evaluate the impact of trackers in delaying 24-hour care and the potential for reducing the involvement of support services, such as the police, in locating patients. METHODS We recruited forty-five wearers-carers dyads, and a GPS tracker was issued to each participant. Dyads completed pre-and post-outcome questionnaires after six months, and a use-log of experiences was maintained through monthly monitoring calls. At six months, focus groups were conducted with 14 dyads where they shared ideas and learning. Data analyses were performed on outcome questionnaires, use-log analysis, and focus groups discussion. RESULTS A 24% (N = 14) attrition rate was recorded, with 76% (N = 34) of the participants completing pre- and post-outcome questionnaires, of which 41% (N = 14) attended four focus group meetings. Participants reported enhanced independence for wearers as fewer restrictions were placed on their movements, peace of mind and reduced burden for the carers with less need to involve police or social services, and delays in 24-hour care. CONCLUSION The results supported the feasibility of routine implementation of GPS trackers in dementia care with clear guidance, monitoring and support to family carers on safe use. This could delay admission into 24-hour care as wearers and carers have a greater sense of safety and are better connected should help be required. Studies with larger sample sizes, diverse participants and health economic analysis are needed to develop the evidence base further ahead of the routine implementation of GPS trackers in health and social care services.
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Affiliation(s)
- Michael Doyle
- School of Human & Health Sciences, University of Huddersfield, UK
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Bhattacharyya S, Chatterjee C, Saha S, Naskar S, Bhattacharya P, Alam SM, Sengupta S, Ahamed S, Shaikh AR, Koley M, Ghosh P, Mukherjee SK. Individualized Homeopathic Medicines in the Treatment of Knee Osteoarthritis: Double-Blind, Randomized, Placebo-Controlled Feasibility Trial. HOMEOPATHY 2024; 113:158-166. [PMID: 37748512 DOI: 10.1055/s-0043-1771025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
INTRODUCTION This study aimed at examining the feasibility issues of comparing individualized homeopathic medicines (IHMs) with identical-looking placebos for treating knee osteoarthritis (OA). METHODS Forty eligible patients participated in this double-blind, randomized (1:1), placebo-controlled feasibility trial in the outpatient clinics of a homeopathic hospital in West Bengal, India. Either IHMs or identical-looking placebos were administered, along with mutually agreed-upon concomitant care guidelines. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was the primary outcome measure, along with derived Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores from KOOS. The EQ-5D-5L questionnaire and Visual Analog Scale (VAS) were the secondary outcomes. All were measured at baseline and after 2 months. Group differences and effect sizes (Cohen's d) were estimated using an intention-to-treat approach. p-Values less than 0.05 (two-tailed) were considered statistically significant. RESULTS Enrolment/screening and trial retention rates were 43% and 85% respectively. Recruitment was difficult owing to the coronavirus disease 2019 (COVID-19) lockdown. Group differences were statistically significant, favoring IHMs against placebos in all the KOOS sub-scales: symptoms (p < 0.001), pain (p = 0.002), activities of daily living (p < 0.001), sports or recreation (p = 0.016), and quality of life (p = 0.002). Derived WOMAC scores from KOOS favored IHMs against placebos: stiffness (p < 0.001) and pain (p < 0.001). The EQ-5D-5L questionnaire score (p < 0.001) and EQ-5D-5L VAS scores (p < 0.001) also yielded significant results, favoring IHMs over placebos. All the effect sizes ranged from moderate to large. Sulphur was the most frequently prescribed homeopathic medication. Neither group reported any harm or serious adverse events. CONCLUSION Although recruitment was sub-optimal due to prevailing COVID-19 conditions during the trial, the action of IHMs was found to be superior to that of placebos in the treatment of knee OA. Larger and more definitive studies, with independent replications, are warranted in order to substantiate the findings. TRIAL REGISTRATION CTRI/2021/02/031453.
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Affiliation(s)
- Soumya Bhattacharyya
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Kolkata; affiliated to The West Bengal University of Health Sciences, Kolkata, West Bengal, India
| | - Chandrima Chatterjee
- Department of Materia Medica, D. N. De Homoeopathic Medical College and Hospital, Kolkata; affiliated to The West Bengal University of Health Sciences, Kolkata, West Bengal, India
| | - Subhranil Saha
- Department of Repertory, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Satyajit Naskar
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Pulakendu Bhattacharya
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Sk Monsur Alam
- Department of Repertory, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Sumana Sengupta
- Department of Practice of Medicine, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Sabir Ahamed
- Department of Surgery, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Abdur R Shaikh
- Department of Practice of Medicine, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Munmun Koley
- Department of Homoeopathy, East Bishnupur State Homoeopathic Dispensary, Chandi Daulatabad Block Primary Health Centre, West Bengal, India
| | - Priyanka Ghosh
- Department of Organon of Medicine and Homoeopathic Philosophy, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
| | - Shyamal K Mukherjee
- Department of Community Medicine, D.N. De Homoeopathic Medical College and Hospital, Kolkata, West Bengal, India
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Jiang Y, Chow YE, Oide K, Chen C, Lee PY, Chua MCH, Yoong SQ. Crafting Community Well-Being: Development of an AI-Powered SinDance Exergame for Older Adults in Singapore-A Pilot Randomized Trial. J Am Med Dir Assoc 2024; 25:105043. [PMID: 38830599 DOI: 10.1016/j.jamda.2024.105043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/05/2024] [Indexed: 06/05/2024]
Affiliation(s)
- Ying Jiang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Yue En Chow
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kei Oide
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Changwu Chen
- Department of Occupational Therapy, Jurong Community Hospital, National University Healthcare System, Singapore
| | - Poh Yin Lee
- Nursing Department, National University Hospital, National University Healthcare System, Singapore
| | - Matthew Chin Heng Chua
- Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si Qi Yoong
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Richmond S, Bell M, Ngo D, Yap MBH. A non-randomized feasibility study of a voice assistant for parents to support their children's mental health. Front Psychol 2024; 15:1390556. [PMID: 39144604 PMCID: PMC11323748 DOI: 10.3389/fpsyg.2024.1390556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/01/2024] [Indexed: 08/16/2024] Open
Abstract
Background Mental disorders affect one in seven Australian children and although effective, evidenced based treatments exist, there is a critical shortage of mental health clinicians which has created a "treatment gap." Artificial intelligence has the potential to address the high prevalence rates of mental disorders within overburdened mental health systems. Methods This was a non-randomized feasibility study to evaluate the novel application of voice technology to an evidence-based parenting intervention designed to support children's mental health. We deployed an Amazon Alexa app to parents recruited from the community (N = 55) and to parents with children receiving psychological treatment (N = 4). Parents from the community used the app independently whereas parents from the clinical group used the app in conjunction with attending a six-week parenting program. The primary outcome measure, feasibility was assessed in terms of acceptability, via recruitment and retention rates, quantitative surveys and qualitative interviews. Results In the community group, the recruitment rate was 23.8% and the retention rate 49.1%. In the clinical group, all 6 families approached for recruitment agreed to participate and 4 out of 6 completed the trial. Parents attending the parenting program spent on average, three times longer using the app than parents from the community. Overall, parents reported that the app contained easy-to-understand information on parenting, and that they could see the potential of voice technology to learn and practice parenting skills. Parents also faced several challenges, including difficulties with installation and interactions with the app and expressed privacy concerns related to voice technology. Further, parents reported that the voices used within the app sounded monotone and robotic. Conclusion We offer specific recommendations that could foster a better voice assistant user experience for parents to support their children's mental health. The app is highly scalable and has the potential to addresses many of the barriers faced by parents who attempt to access traditional parenting interventions.
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Affiliation(s)
- Sally Richmond
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Mietta Bell
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Dyung Ngo
- CogniVocal Pty. Ltd., Melbourne, VIC, Australia
| | - Marie B. H. Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Coll-Planas L, Fuente-Vidal A, Jerez-Roig J, Karkauskienė E, Romero-Mas M, Intxaurrondo A, Caserotti P, Skjødt M, Dallmeier D, Lefebvre G, Bassinah L, Forgione D, Castro R, Minobes-Molina E, Parés-Martínez C, Blancafort Alias S, Roman-Viñas B, Socorro-Cumplido JL, Nieto-Guisado A, Sansano-Nadal O, Giné-Garriga M. Boosting enjoyment and social inclusion to increase physical activity and reduce sedentary behaviour among older adults: protocol for a feasibility study to test the JOIN4JOY approach in five European countries. BMJ Open 2024; 14:e083291. [PMID: 39067876 DOI: 10.1136/bmjopen-2023-083291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
INTRODUCTION Programmes for older people aimed at increasing physical activity (PA) and reducing sedentary behaviour (SB) traditionally focus on achieving functional and health improvements. Focusing on enjoyment and social inclusion could strengthen adherence and help reach older people with social disadvantages. The aim of this study is to assess the feasibility and acceptability of the Join4Joy approach in PA programmes and its assessment tools. METHODS AND ANALYSIS A multicentric, pragmatic, pre-post feasibility study using mixed methods will be conducted. The intervention will consist of a PA programme boosting enjoyment and social inclusion, grounded on a co-creation process. Trainers will offer twelve, 1-hour weekly sessions of structured, supervised, group-based PA. Participants will be encouraged to increase activity in daily living. 144 older people will be recruited from the community and nursing homes in Spain, Denmark, Italy, Germany, and France. Additionally, participants and trainers will be invited to join virtual communities of practice to share their experiences across settings and countries. Qualitative procedures will be used to explore the acceptability of the design via interviews and focus groups with participants and trainers. Quantitative methods will be used to assess uptake, adherence, retention, reach, satisfaction, enjoyment (PACES questionnaire), physical function (e.g., Short Physical Performance Battery), quality of life (EQ-5D-5L scale), perceived improvement (Patient Global Impression of Improvement scale-I), activities of daily living (Barthel index) and SB and PA patterns (IPAQ and accelerometry). The degree and type of participation in virtual communities of practice will also be assessed. SPSS software will be used for the analysis of quantitative variables. Qualitative data will be analysed using reflective thematic analysis following Braun and Clarke (2006). ETHICS AND DISSEMINATION A favourable report by the Research Ethics Committee of UVic-UCC (282/2023) was obtained on 26 June 26th, 2023. Participation and withdrawal will be voluntary. Participants' (or their legal guardians', when necessary) written permission will be required. Results of the study will be disseminated through publication of scientific articles, presentations at sport and health-related professional conferences and congresses, as well as through social media and via the Join4Joy website. STUDY REGISTRATION ClinicalTrials.gov, NCT06100835.
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Affiliation(s)
- Laura Coll-Planas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Andrea Fuente-Vidal
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Javier Jerez-Roig
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Erika Karkauskienė
- Department of Health Promotion and Rehabilitation, Institute of Sport Science and Innovations, Lithuanian Sports University, Kaunas, Lithuania
| | - Montse Romero-Mas
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Aimar Intxaurrondo
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | | | | | | | - Guillaume Lefebvre
- Sport Initiative et Loisir Bleu Association, Strasbourg, France
- Sport Initiative et Loisir Bleu Association, Barcelona, Spain
| | - Lucie Bassinah
- Sport Initiative et Loisir Bleu Association, Strasbourg, France
| | - Dolores Forgione
- Istituto Europeo Per Lo Sviluppo Socio Economico (ISES), Alexandria, Italy
| | - Ricard Castro
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Eduard Minobes-Molina
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Carles Parés-Martínez
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
| | - Sergi Blancafort Alias
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare. Centre for Health and Social Care Research (CESS). University of Vic-Central University of Catalonia (UVic-UCC), Vic, Catalunya, Spain
- Institute for Research and Innovation in Life Sciences and Health in Central Catalonia (IRIS-CC), Vic, Spain
- Fundació Salut i Envelliment (Foundation on Health and Ageing), Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | - Blanca Roman-Viñas
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - José Luis Socorro-Cumplido
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ainhoa Nieto-Guisado
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Oriol Sansano-Nadal
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Maria Giné-Garriga
- Facultat de Psicologia, Ciències de l'Educació i de l'Esport Blanquerna, Universitat Ramon Llull, Barcelona, Spain
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Zoromba MA, Sefouhi L, Alenezi A, Selim A, Awad S, El-Gazar HE, El-Monshed AH. Effectiveness of Acceptance and Commitment Therapy on Psychotic Severity Among Inpatients With Primary Psychoses: A Randomized Controlled Trial. Int J Ment Health Nurs 2024. [PMID: 39034443 DOI: 10.1111/inm.13388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/29/2024] [Accepted: 06/25/2024] [Indexed: 07/23/2024]
Abstract
This study investigated the effectiveness of acceptance and commitment therapy (ACT) compared to treatment as usual in managing psychotic symptoms, emotional dysregulation, recovery and psychological flexibility in inpatients with primary psychoses. The Primary outcome assessed the positive and negative syndrome scale, while the secondary outcomes were to assess difficulties in the emotion regulation scale, recovery assessment scale and acceptance and action questionnaire. An open-label, two-arm parallel randomized controlled trial was conducted. Participants diagnosed with primary psychoses were randomly assigned to either the ACT (n = 33) or treatment-as-usual (n = 32) group. The intervention included six structured sessions of ACT. ACT significantly reduced psychotic symptoms from 128 to 104 (Z = 5.01) compared to treatment as usual from 130 to 117 (Z = 4.88). Emotional regulation improved significantly in the ACT group from 73 to 55 (Z = 4.835) compared to treatment as usual from 73 to 70 (Z = 2.406). Recovery increased in the ACT group from 50 to 88 (Z = 5.01) compared to treatment as usual from 51 to 61 (Z = 4.93). Psychological flexibility improved in the ACT group from 33 to 25 (Z = 4.98) compared to treatment as usual from 33 to 31 (Z = 4.75). Between-group differences after intervention were significant for psychotic symptoms, emotional regulation, recovery and psychological flexibility (Z = 2.356, 4.652, 3.881 and 4.453, respectively). Accordingly, the current study demonstrates the effectiveness of ACT in reducing psychotic symptoms and improving emotional regulation, recovery and psychological flexibility in patients with primary psychoses. Integrating ACT into standard care protocols can enhance treatment outcomes, offering a comprehensive approach to managing complex mental health conditions. Trial Registration: ClinicalTrials.gov identifier: NCT06160869.
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Affiliation(s)
- Mohamed Ali Zoromba
- College of Nursing, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Linda Sefouhi
- LRNAT, Institute of Industrial Hygiene and Safety, University of Batna 2, Batna, Algeria
| | - Atallah Alenezi
- College of Applied Medical Science, Shaqra University, Shaqra, Saudi Arabia
| | - Abeer Selim
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Shaimaa Awad
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
| | - Heba Emad El-Gazar
- Administration Department, Faculty of Nursing, Port Said University, Port Said, Egypt
| | - Ahmed Hashem El-Monshed
- Department of Nursing, College of Health and Sport Sciences, University of Bahrain, Sakhir, Bahrain
- Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Primavera D, Urban A, Cantone E, Nonnis M, Aviles Gonzalez CI, Perra A, Tusconi M, Sancassiani F. The Impact on Anxiety Symptoms of an Immersive Virtual Reality Remediation Program in Bipolar Disorders: A Randomized Clinical Trial. J Clin Med 2024; 13:4203. [PMID: 39064243 PMCID: PMC11277986 DOI: 10.3390/jcm13144203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/03/2024] [Accepted: 07/13/2024] [Indexed: 07/28/2024] Open
Abstract
Background: The objective of this work is to investigate the effectiveness of a cognitive remediation intervention on anxiety symptoms in people with bipolar disorder and the therapeutic effect on people whose anxiety symptoms were above the threshold for a screener and whose comorbidity could be identified as an anxiety disorder. Methods: The experimental intervention included 24 sessions (around 45 min each), two for each week over three months. The entire program was inspired by user-centered rehabilitation principles in a recovery-oriented perspective and an approach to bipolar disorder in an evolutionary and non-discriminating vision. The primary outcomes measure the score of the Zung Self-Rating Anxiety Scale (SAS), hypothesizing a higher decrease in the experimental group than in the control group. The survey has been conducted per the CONSORT guidelines for feasibility studies. Results: We evaluate a decrease in the overall SAS score from T0 to T1 to be higher in the experimental group compared to the control group, indicating an improvement in anxiety symptoms (p < 0.0001). Conclusions: The study suggests that virtual reality could have a role in treating anxiety symptoms and disorders in young adults with bipolar disorders or anxiety symptoms in people with hyperactivity and novelty-seeking behaviorsunder stress and high risk for bipolar disorder.
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Affiliation(s)
- Diego Primavera
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Antonio Urban
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- University Hospital of Cagliari, 09042 Cagliari, Italy
| | - Elisa Cantone
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | - Marcello Nonnis
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09123 Cagliari, Italy;
| | - Cesar Ivan Aviles Gonzalez
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
- Department of Nursing, Universidad Popular del Cesar, Valledupar 200001, Colombia
| | - Alessandra Perra
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
| | | | - Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato Blocco I (CA), 09042 Cagliari, Italy (A.P.)
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Hershberger PE, Gruss V, Steffen AD, Adlam K, Driessnack M, Grotevant HD, Klock SC, Pasch LA, Bhagat R, Gallo AM. A Randomized Pilot Trial of the Donor Conception Tool to Empower Parental Telling and Talking (TELL Tool) with Their Children About Their Genetic Origins. J Pediatr Health Care 2024:S0891-5245(24)00149-4. [PMID: 39023461 DOI: 10.1016/j.pedhc.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/09/2024] [Accepted: 06/09/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION Parents who use donated gametes or embryos to form their families struggle with telling their children about their genetic origins. We developed the Tool to Empower Parental Telling and Talking (TELL Tool) to support parents in disclosure to their children and an eBook attention control. METHOD A randomized parallel, two-group, attention-controlled clinical pilot trial was conducted online during COVID-19. Feasibility, acceptability, and preliminary effects among parents with children aged 1-16 years were examined. RESULTS Over 10 months, our target of 75 parents were enrolled (85% of eligible [95% confidence interval (CI), 76% to 91%]), and 68% (95% CI: 57% to 78%) were retained at 12 weeks. At 4 and 12 weeks, positive trends were found for parental disclosure, telling confidence, and anxiety compared with attention controls. DISCUSSION The study protocol is feasible, and the TELL Tool is acceptable to parents and demonstrates a positive effect on parents' ability to tell their children. The results support the implementation of a large efficacy trial.
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Gómez-Morales A, Coon DW, Joseph RP, Pipe T. Through Alzheimer's Eyes: A Virtual Pilot Intervention for Family Caregivers of People with Dementia. Clin Gerontol 2024:1-16. [PMID: 39012787 DOI: 10.1080/07317115.2024.2378774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
OBJECTIVE To evaluate the feasibility and acceptability of a virtually delivered psychoeducational skill-building intervention for ADRD caregivers. METHODS A single-arm, pre-posttest pilot study design was employed to evaluate the intervention. Four 90-min group-based weekly sessions were combined with four individual coaching sessions via Zoom. Intervention components covered topics designed to reduce caregiver stress and distress, and a VR experience to help caregivers understand dementia. Data was gathered via REDCap pre- and post-intervention and through post-intervention interviews via Zoom. RESULTS Results (N = 20) from individual interviews, surveys, and treatment implementation strategies suggest strong feasibility and acceptability. Key change exploration indicated medium effect sizes and statistical significance in preparedness for caregiving (t(19) = 2.69, p = .015, d = 63), communication (t(19) = 2.45, p = .024, d = 0.55), and a medium effect size for the mindful attention awareness scale (t(19) = 0.48, p = (0.637, d = 0.54). Further, participants reported their perceptions of improvement in outcomes such as the ability to care, increased understanding of memory loss, and confidence. CONCLUSIONS Through Alzheimer's Eyes is a feasible and acceptable intervention that blends technology with skill-building strategies to help caregivers manage their stress and distress regardless of their location. CLINICAL IMPLICATIONS There is potential for interventions including VR to assist family caregivers in managing caregiving challenges and improve well-being.
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Affiliation(s)
- Abigail Gómez-Morales
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - David W Coon
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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Pegington M, Hawkes RE, Davies A, Mueller J, Howell A, Gareth Evans D, Howell SJ, French DP, Harvie M. An app promoting weight gain prevention via healthy behaviours amongst young women with a family history of breast cancer: Acceptability and usability assessment. J Hum Nutr Diet 2024. [PMID: 39004937 DOI: 10.1111/jhn.13347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/20/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Breast cancer is the most frequent female malignancy in the UK. Around 20% of cases are linked to weight gain, excess weight and health behaviours. We designed a weight gain prevention, health behaviour intervention for young women at increased risk. METHODS The study comprised a single arm observational study over 2 months testing acceptability and usability of the intervention: online group welcome event, app and private Facebook group. Females aged 18-35 years at moderate or high risk of breast cancer (>17% lifetime risk) were recruited via invite letters and social media posts. The app included behaviour change techniques and education content. Online questionnaires were completed at baseline, as well as at 1 and 2 months. We also assessed feasibility of study procedures. RESULTS Both recruitment methods were successful. Thirty-five women were recruited, 26% via social media posts. Median age was 33 (interquartile range = 28.2-34.5) years, the majority (94.1%) were of White ethnicity. Thirty-four participants were included in the analyses, of which 94% downloaded the app. Median self-monitoring logs per participant during the study period was 10.0 (interquartile range = 4.8-28.8). App quality mean (SD) score was 3.7 (0.6) at 1 and 2 months (scale: 1-5). Eighty-nine per cent rated the app at average or above at 1 month and 75.0% at 2 months. Nineteen women (55.9%) joined the Facebook group and there were 61 comments and 83 reactions and votes from participants during the study period. CONCLUSIONS This first iteration of the app and intervention was well received and is suitable to progress to the next stage of refining and further testing.
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Affiliation(s)
- Mary Pegington
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rhiannon E Hawkes
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
| | - Alan Davies
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Julia Mueller
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Anthony Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - D Gareth Evans
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Genomic Medicine, Division of Evolution, Infection and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sacha J Howell
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Michelle Harvie
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- The Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Breast Centre, Oglesby Cancer Research Centre, The Christie NHS Foundation Trust, University of Manchester, Manchester, UK
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Alves I, Moreira AP, Sousa T, Teles P, Fernandes CS, Goncalves F, Magalhães B. Exergame-based rehabilitation for cancer patients undergoing abdominal surgery: Effects on pain, anxiety, depression, and fatigue - A pilot study. Eur J Oncol Nurs 2024; 72:102665. [PMID: 39018959 DOI: 10.1016/j.ejon.2024.102665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 06/25/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE This study aimed to determine the efficacy of an exergame rehabilitation program on pain, anxiety or depression, and fatigue in oncology patients undergoing abdominal surgery. METHODS The randomized controlled trial evaluated the efficacy of exergame rehabilitation on Pain, Anxiety, Depression, and Fatigue in oncology patients undergoing abdominal surgery. Patients were recruited from October 2022-March 2023 and were randomly assigned to the intervention group (postoperative traditional rehabilitation plus an exergame rehabilitation program) or control group (postoperative traditional rehabilitation). Data were collected at three different times: on admission, in the first 48 h, and on the 7th day after surgery. Primary outcomes were evaluated and monitored with different validated instruments: numeric rating scale (NRS) for pain, Hospital Anxiety and Depression Scale (HADS) to assess the level of anxiety and depression, and the Fatigue Assessment Scale (FAS) to assess physical and psychological fatigue. The length of stay and program completion were secondary outcomes. RESULTS A total of 128 postoperative patients were recruited. Of these, 58 patients were excluded from the study due to clinical complications related to the surgical procedure (n = 53) or healthcare staff-related reasons (n = 5). Both the control and intervention groups were the same size (n = 35). Lower pain scores were observed on the 7th postoperative day in the group subject to the "exergame rehabilitation program" (p = 0.006). No statistically significant differences were observed for anxiety and depression between the 2 groups. Regarding fatigue, statistically significant differences were observed on admission (p = 0.03), which disappeared 48 h after surgery (p = 0.143). Differences between the groups were observed again on the 7th day after surgery (p = 0.005). CONCLUSIONS The intervention using exergames was effective in reducing the postoperative pain of the patient undergoing major abdominal surgery and in restoring the levels of fatigue before surgical intervention. However, no differences were observed for anxiety or depression. Future studies with larger samples should be carried out.
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Affiliation(s)
- Isabel Alves
- Portuguese Institute of Oncology, Porto, Portugal
| | | | - Teresa Sousa
- Portuguese Institute of Oncology, Porto, Portugal
| | - Paulo Teles
- Faculty of Economics of the University of Porto, Portugal
| | - Carla Sílvia Fernandes
- Porto Higher School of Nursing, Porto, Portugal; Rise-Health, Portugal and ADITGames Association, Portugal
| | - Filipe Goncalves
- University of A Coruña, Faculty of Health Sciences, Coruña, Spain; PO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) / Porto Comprehensive Cancer Centre (Porto.CCC) & RISE@CI-IPOP (Health Research Network), Porto, Portugal; APELA -Portuguese Amyotrophic Lateral Sclerosis Association, Portugal
| | - Bruno Magalhães
- School of Health, University of Trás-os-Montes and Alto Douro (UTAD), Vila Real, Portugal; RISE-Health Research Network, Faculty of Medicine, University of Porto, Porto, Portugal; Clinical Academic Centre of Trás-os-Montes and Alto Douro (CACTMAD), Vila Real, Portugal.
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Griffiths S, Spencer E, Flanagan K, O'Keeffe A, Hunter R, Wiegand M, D'Andrea F, Benjamin L, Poole M, Hagan AJ, Brar M, Wilcock J, Walters KR, Robinson L, Rait G, Burns A, Evans E, King D, Knapp M, Lewins RD, Banerjee S, Manthorpe J, Allen L, Tucker S, Wittenberg R. Evaluating a model of best practice in primary care led post-diagnostic dementia care: feasibility and acceptability findings from the PriDem study. BMJ Open 2024; 14:e083175. [PMID: 39002959 PMCID: PMC11255409 DOI: 10.1136/bmjopen-2023-083175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/24/2024] [Indexed: 07/15/2024] Open
Abstract
OBJECTIVES To evaluate the feasibility and acceptability of a primary care-based intervention for improving post-diagnostic dementia care and support (PriDem), and implementation study procedures. DESIGN A non-randomised, mixed methods, feasibility study. SETTING Seven general practices from four primary care networks (PCNs) in the Northeast and Southeast of England. PARTICIPANTS We aimed to recruit 80 people with dementia (PWD) and 66 carers INTERVENTION: Clinical Dementia Leads delivered a 12-month intervention in participating PCNs, to develop care systems, build staff capacity and capability, and deliver tailored care and support to PWD and carers. OUTCOMES Recruitment and retention rates were measured. A mixed methods process evaluation evaluated feasibility and acceptability of the intervention and study procedures. Using electronic care records, researchers extracted service use data and undertook a dementia care plan audit, preintervention and postintervention, assessing feasibility of measuring the primary implementation outcome: adoption of personalised care planning by participating general practices. Participants completed quality of life, and service use measures at baseline, 4 and 9 months. RESULTS 60 PWD (75% of recruitment target) and 51 carers (77% of recruitment target) were recruited from seven general practices across four PCNs. Retention rate at 9 months was 70.0% of PWD and 76.5% of carers. The recruitment approach showed potential for including under-represented groups within dementia. Despite implementation challenges, the intervention was feasible and acceptable, and showed early signs of sustainability. Study procedures were feasible and accessible, although researcher capacity was crucial. Participants needed time and support to engage with the study. Care plan audit procedures were feasible and acceptable. CONCLUSIONS The PriDem model is an acceptable and feasible intervention. A definitive study is warranted to fully inform dementia care policy and personalised dementia care planning guidance. Successful strategies to support inclusion of PWD and their carers in future research were developed. TRIAL REGISTRATION NUMBER ISRCTN11677384.
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Affiliation(s)
- Sarah Griffiths
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Emily Spencer
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Katie Flanagan
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Aidan O'Keeffe
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
| | - Rachael Hunter
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | | | - Federica D'Andrea
- School of Biomedical Sciences, University of West London, London, UK
| | - Lewis Benjamin
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Marie Poole
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alexander James Hagan
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - M Brar
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Wilcock
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Kate R Walters
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
| | - Louise Robinson
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Greta Rait
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
| | - on behalf of the PriDem Study Team
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Alistair Burns
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Evans
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Derek King
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Martin Knapp
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Revd Doug Lewins
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sube Banerjee
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Jill Manthorpe
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Allen
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Sue Tucker
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Raphael Wittenberg
- Research Department of Population Health and Primary Care, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
- PRIMENT Clinical Trials Unit, UCL, London, UK
- Applied Health Research, Institute of Epidemiology & Health, Faculty of Population Health Sciences, UCL, London, UK
- Department of Statistical Science, UCL, London, UK
- School of Biomedical Sciences, University of West London, London, UK
- Faculty of Medical Sciences, Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
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Krarup KB, Riis J, Mørk M, Nguyen HTT, Søkilde Pedersen I, Risom Kristensen S, Handberg A, Krarup HB. Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study. Interact J Med Res 2024; 13:e46570. [PMID: 38976326 PMCID: PMC11263886 DOI: 10.2196/46570] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 01/30/2024] [Accepted: 04/02/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. OBJECTIVE This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. METHODS In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. RESULTS In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. CONCLUSIONS This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health.
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Affiliation(s)
| | - Johannes Riis
- Department of Geriatrics, Aalborg University Hospital, Aalborg, Denmark
| | - Morten Mørk
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | - Hien Thi Thu Nguyen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
| | - Inge Søkilde Pedersen
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Søren Risom Kristensen
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Aase Handberg
- Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Henrik Bygum Krarup
- Department of Molecular Diagnostics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Sica GS, Siragusa L, Pirozzi BM, Sorge R, Baldini G, Fiorani C, Guida AM, Bellato V, Franceschilli M. Gastrointestinal functions after laparoscopic right colectomy with intracorporeal anastomosis: a pilot randomized clinical trial on effects of abdominal drain, prolonged antibiotic prophylaxis, and D3 lymphadenectomy with complete mesocolic excision. Int J Colorectal Dis 2024; 39:102. [PMID: 38970713 PMCID: PMC11227461 DOI: 10.1007/s00384-024-04657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE Routine use of abdominal drain or prolonged antibiotic prophylaxis is no longer part of current clinical practice in colorectal surgery. Nevertheless, in patients undergoing laparoscopic right hemicolectomy with intracorporeal anastomosis (ICA), it may reduce perioperative abdominal contamination. Furthermore, in cancer patients, prolonged surgery with extensive dissection such as central vascular ligation and complete mesocolon excision with D3 lymphadenectomy (altogether radical right colectomy RRC) is called responsible for affecting postoperative ileus. The aim was to evaluate postoperative resumption of gastrointestinal functions in patients undergoing right hemicolectomy for cancer with ICA and standard D2 dissection or RRC, with or without abdominal drain and prolonged antibiotic prophylaxis. METHODS Monocentric factorial parallel arm randomized pilot trial including all consecutive patients undergoing laparoscopic right hemicolectomy and ICA for cancer, in 20 months. Patients were randomized on a 1:1:1 ratio to receive abdominal drain, prolonged antibiotic prophylaxis or neither (I level), and 1:1 to receive RRC or D2 colectomy (II level). Patients were not blinded. The primary aim was the resumption of gastrointestinal functions (time to first gas and stool, time to tolerated fluids and food). Secondary aims were length of stay and complications' rate. CLINICALTRIALS gov no. NCT04977882. RESULTS Fifty-seven patients were screened; according to sample size, 36 were randomized, 12 for each arm for postoperative management, and 18 for each arm according to surgical techniques. A difference in time to solid diet favored the group without drain or antibiotic independently from standard or RRC. Furthermore, when patients were divided with respect to surgical technique and into matched cohorts, no differences were seen for primary and secondary outcomes. CONCLUSION Abdominal drainage and prolonged antibiotic prophylaxis in patients undergoing right hemicolectomy for cancer with ICA seem to negatively affect the resumption of a solid diet after laparoscopic right hemicolectomy with ICA for cancer. RRC does not seem to influence gastrointestinal function recovery.
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Affiliation(s)
- Giuseppe S Sica
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Leandro Siragusa
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
| | - Brunella Maria Pirozzi
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Roberto Sorge
- Department of Biostatistics, University of Rome "Tor Vergata", Rome, Italy
| | - Giorgia Baldini
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Cristina Fiorani
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Andrea Martina Guida
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Vittoria Bellato
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Marzia Franceschilli
- Department of Surgical Sciences, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
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Georg AK, Holl J, Taubner S, Volkert J. Mentalisation-based online intervention for psychologically distressed parents: protocol of a non-randomised feasibility trial of the Lighthouse Parenting Programme-Online (LPP-Online). BMJ Open 2024; 14:e078548. [PMID: 38969386 PMCID: PMC11227772 DOI: 10.1136/bmjopen-2023-078548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 06/12/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Online-based interventions provide a low-threshold way to reach and support families. The mentalisation-based Lighthouse Parenting Programme is an established intervention aimed at preventing psychopathological development in children. The objective of this study is to examine the feasibility of an online adaptation of the Lighthouse Parenting Programme (LPP-Online), evaluating (a) recruitment capability, compliance, acceptability and satisfaction with the intervention; (b) the psychometric properties of and the acceptability regarding the adjunct psychological evaluation; and (c) the employed materials and resources. The study will also obtain a preliminary evaluation of participants' responses to the intervention. METHOD AND ANALYSIS In this monocentric, one-arm, non-randomised feasibility trial, n=30 psychologically distressed parents with children aged 0 to 14 years will participate in the LPP-Online for a duration of 8 weeks. The intervention consists of online group sessions and individual sessions, 38 smartphone-based ecological momentary interventions (EMI), and psychoeducational materials (website, booklet). At baseline (T0) and the end of the intervention (T1), parents complete self-report questionnaires as well as 7-day ecological momentary assessments (EMA) via smartphone. During the intervention, additional EMA are completed before and after the daily EMI. An interview regarding parents' subjective experience with the intervention will be conducted at T1. The feasibility of the intervention, the psychological evaluation and the resources will be examined using descriptive and qualitative analyses. The preliminary evaluation of the parents' response to the intervention will be conducted by analysing pre-post changes in questionnaire measures and the 7-day EMA as well as data of additional EMA completed before and after the daily EMI. ETHICS AND DISSEMINATION Ethical approval of the study has been obtained from the local ethics board (Faculty of Behavioural and Cultural Studies, University of Heidelberg). Consent to participate will be obtained before starting the assessments. Results will be disseminated as publications in peer-reviewed scientific journals and at international conferences. REGISTRATION DETAILS German Clinical Trials Register (DRKS00027423), OSF (https://doi.org/10.17605/OSF.IO/942YW).
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Affiliation(s)
- Anna Katharina Georg
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Holl
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, Department of Clinical Psychology and Psychotherapy, Heidelberg University, Heidelberg, Germany
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Jana Volkert
- Clinic for Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
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Schulte C, Sachser C, Rosner R, Ebert DD, Zarski AC. Feasibility of a trauma-focused internet- and mobile-based intervention for youth with posttraumatic stress symptoms. Eur J Psychotraumatol 2024; 15:2364469. [PMID: 38957142 PMCID: PMC11225631 DOI: 10.1080/20008066.2024.2364469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Background: Many youth with posttraumatic stress symptoms (PTSS) do not receive evidence-based care. Internet- and Mobile-Based Interventions (IMIs) comprising evidence-based trauma-focused components can address this gap, but research is scarce. Thus, we investigated the feasibility of a trauma-focused IMI for youth with PTSS.Methods: In a one-arm non-randomized prospective proof-of-concept study, 32 youths aged 15-21 years with clinically relevant PTSS (CATS ≥ 21) received access to a trauma-focused IMI with therapist guidance, comprising nine sessions on an eHealth platform accessible via web-browser. We used a feasibility framework assessing recruitment capability, sample characteristics, data collection, satisfaction, acceptability, study management abilities, safety aspects, and efficacy of the IMI in PTSS severity and related outcomes. Self-rated assessments took place pre-, mid-, post-intervention and at 3-month follow-up and clinician-rated assessments at baseline and post-intervention.Results: The sample mainly consisted of young adult females with interpersonal trauma and high PTSS levels (CATS, M = 31.63, SD = 7.64). The IMI sessions were found useful and comprehensible, whereas feasibility of trauma processing was perceived as difficult. Around one-third of participants (31%) completed the IMI's eight core sessions. The study completer analysis showed a significant reduction with large effects in self-rated PTSS at post-treatment [t(21) = 4.27; p < .001; d = 0.88] and follow-up [t(18) = 3.83; p = .001; d = 0.84], and clinician-rated PTSD severity at post-treatment [t(21) = 4.52; p < .001; d = 0.93]. The intention-to-treat analysis indicated significant reductions for PTSS at post-treatment and follow-up with large effect sizes (d = -0.97- -1.02). All participants experienced at least one negative effect, with the most common being the resurfacing of unpleasant memories (n = 17/22, 77%).Conclusion: The study reached highly burdened young adults. The IMI was accepted in terms of usefulness and comprehensibility but many youths did not complete all sessions. Exploration of strategies to improve adherence in trauma-focused IMIs for youth is warranted, alongside the evaluation of the IMI's efficacy in a subsequent randomized controlled trial.
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Affiliation(s)
- Christina Schulte
- Professorship Psychology and Digital Mental Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm University, Ulm, Germany
- German Center for Mental Health (DZPG), partner Site Ulm, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstätt, Germany
| | - David Daniel Ebert
- Professorship Psychology and Digital Mental Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Anna-Carlotta Zarski
- Professorship Psychology and Digital Mental Health Care, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
- Department of Clinical Psychology, Division of eHealth in Clinical Psychology, Philipps University of Marburg, Marburg, Germany
- German Center for Mental Health (DZPG), partner Site Ulm, Ulm, Germany
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