Upper limit of normal ALT levels in health and metabolic diseases: Pooled analysis of 423,355 individuals with bootstrap modelling

INTRODUCTION

Given the global rise in obesity-related metabolic diseases, the upper limit of normal (ULN) alanine aminotransferase (ALT) in individuals with and without metabolic diseases may have changed. We performed a meta-analysis combined with bootstrap modelling to estimate the ALT ULN levels for individuals with and without metabolic diseases.

METHODS AND RESULTS

Two separate searches of the PubMed, Embase and Cochrane databases were performed, one to identify healthy individuals which yielded 12 articles (349,367 individuals); another to include those with potential metabolic diseases but without known liver disease which yielded 35 articles (232,388 individuals). We estimated the mean ALT using a random-effects mixed model and the ULN level (95th-percentile value) via a bootstrap model with 10,000 resamples. In individuals without metabolic diseases and known liver disease, the ALT ULN levels were 32 U/L overall; 36 U/L in males and 28 U/L in females. In analyses that included individuals with metabolic diseases, the ALT ULN levels were 40 U/L among the overweight/obese (29 U/L if normal weight) and 36 U/L among those with type 2 diabetes mellitus (T2DM) (33 U/L if no T2DM). On meta-regression of study-level factors, body mass index (coefficient 1.49, 95% CI 0.11-2.86, p = 0.03), high-density lipoprotein (coefficient -0.47, 95% CI -0.85-(-0.08), p = 0.02) and triglycerides (coefficient 0.19, 95% CI 0.12-0.25, p < 0.0001) correlated with ALT.

CONCLUSION

We provide expected ranges of ALT ULN levels for individuals without known liver disease without metabolic diseases and those with or without T2DM and/or are normal weight or overweight/obese. These data may have implications for clinical care and screening.

Hypodescent or ingroup overexclusion?: Children's and adults' racial categorization of ambiguous black/white biracial faces

Two processes describe racially ambiguous Black/White Biracial categorization-the one-drop rule, or hypodescent, whereby racially ambiguous people are categorized as members of their socially subordinated racial group (i.e., Black/White Biracial faces categorized as Black) and the ingroup overexclusion effect, whereby racially ambiguous people are categorized as members of a salient outgroup, regardless of the group's status. Without developmental research with racially diverse samples, it is unclear when these categorization patterns emerge. Study 1 included White, Black, and racially diverse Biracial children (aged 3- to 7-years) and their parents to test how racial group membership and social context influence face categorization biases. To provide the clearest test of hypodescent and ingroup overexclusion, White participants came from majority White neighborhoods and Black participants from majority Black neighborhoods (with Biracial participants from more racially diverse neighborhoods)-two samples with prominent racial ingroups. Study 2 aimed to replicate the parent findings with a separate sample of White, Black, Black/White Biracial, and Asian adults. Results suggest the ingroup overexclusion effect is present across populations early in development and persists into adulthood. Additionally, categorization was meaningfully related to parental context, pinpointing a pathway that potentially contributes to ingroup overexclusion. RESEARCH HIGHLIGHTS: White, Black, and racially diverse Biracial children and adults tended to categorize racially ambiguous Black/White Biracial faces as racial outgroup members, even if the outgroup was White. This contradicts most work arguing Black/White Biracial racially ambiguous people are more often seen as Black. Children and parents' categorizations were related, though children's categorizations were not related to socialization above and beyond parents' categorizations. Children showed similar categorization patterns across dichotomous and continuous measures.

Development of infants' preferential looking toward native language speakers across distinct social contexts

Presenting pictures of faces side by side is a common paradigm to assess infants' attentional biases according to social categories, such as gender, race, and language. However, seeing static faces does not represent infants' typical experience of the social world, which involves people in motion and performing actions. Here, we assessed infants' looking preferences for native over foreign language speakers in two social contexts: the presentation of static faces and the presentation of people performing instrumental actions. In addition, we tested infants' preferential looking at 5 and 9 months of age to assess whether their pattern of preferential looking changes across development. The results of 5-month-old infants replicated and extended previous findings by showing that, at this age, infants typically look longer at people who previously spoke their native language. As found for other social categories such as race and gender, this familiarity-based looking preference was not evident at 9 months of age when infants were presented with static faces. However, when presented with more informative dynamic events, 9-month-old infants showed a temporally aligned preference for the native over the foreign language speaker. Specifically, infants' looking preference was time-locked to the completion of the action goal: when speakers grasped and lifted a toy. These results suggest potentially a familiarity-based preference toward native language speakers around 5 months of age, which may later develop into a more strategic selective response in service of information-seeking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring Quantitative Cerebral Blood Flow in Healthy Children: A Systematic Review of Neuroimaging Techniques

Cerebral blood flow (CBF) is an important hemodynamic parameter to evaluate brain health. It can be obtained quantitatively using medical imaging modalities such as magnetic resonance imaging and positron emission tomography (PET). Although CBF in adults has been widely studied and linked with cerebrovascular and neurodegenerative diseases, CBF data in healthy children are sparse due to the challenges in pediatric neuroimaging. An understanding of the factors affecting pediatric CBF and its normal range is crucial to determine the optimal CBF measuring techniques in pediatric neuroradiology. This review focuses on pediatric CBF studies using neuroimaging techniques in 32 articles including 2668 normal subjects ranging from birth to 18 years old. A systematic literature search was conducted in PubMed, Embase, and Scopus and reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA). We identified factors (such as age, gender, mood, sedation, and fitness) that have significant effects on pediatric CBF quantification. We also investigated factors influencing the CBF measurements in infants. Based on this review, we recommend best practices to improve CBF measurements in pediatric neuroimaging. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.

Children's language-based pedagogical preferences in a multilingual society

A majority of the world's population is multilingual, yet children's language-based preferences have largely been studied in Western monolingual contexts. The present research investigated language-based preferences in 4- to 8-year-old children living in Hyderabad, India, a multilingual region with languages such as Telugu (official language of the state, and the native language of many children in the state) and English (medium of instruction in some schools). We presented to children novel objects and probed their selective preference to learn from different speakers (Telugu, British-accented English, or Indian-accented English). In addition, the current study assessed the flexibility of children's preferences by manipulating the learning goal (i.e., performance goal vs. enjoyment goal) and learning content (i.e., Science, Technology, Engineering and Mathematics [STEM] objects vs. cultural objects). Children showed a preference for both English speakers over Telugu speakers, a tendency that increased with age. This preference was especially pronounced for performance learning goals and for STEM learning content. Furthermore, children whose native language was Telugu showed a less pronounced English bias. The results of this study provide new insights into the development of language-based biases in multilingual environments. First, they highlight dual and intersecting considerations of speaker familiarity and speaker status in guiding children's choices about from whom to learn. Second, the results suggest that children's language-based preferences in a pedagogical setting are flexible, as children integrate social cues (e.g., language-based attitudes) as well as contextual cues (e.g., the learning goal) strategically. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Children's social wariness toward a different-race stranger relates to individual differences in temperament

When children first meet a stranger, there is great variation in how much they will approach and engage with the stranger. While individual differences in this type of behavior-called social wariness-are well-documented in temperament research, surprisingly little attention has been paid to the social groups (such as race) of the stranger and how these characteristics might influence children's social wariness. In contrast, research on children's social bias and interracial friendships rarely examines individual differences in temperament and how temperament might influence cross-group interactions. The current study bridges the gap across these different fields of research by examining whether the racial group of an unfamiliar peer or adult moderates the association between temperament and the social wariness that children display. Utilizing a longitudinal dataset that collected multiple measurements of children's temperament and behaviors (including parent-reported shyness and social wariness toward unfamiliar adults and peers) across early childhood, we found that 2- to 7-year-old children with high parent-reported shyness showed greater social wariness toward a different-race stranger compared to a same-race stranger, whereas children with low parent-reported shyness did not. These results point to the importance of considering racial group membership in temperament research and the potential role that temperament might play in children's cross-race interactions. RESEARCH HIGHLIGHTS: Previous research on temperament has not considered how the race of strangers could influence children's social wariness. We find evidence that 2- to 7-year-old children with high parent-reported shyness show greater social wariness toward a different-race stranger compared to a same-race stranger. These results point to the importance of considering racial group membership in temperament research. Our findings also suggest temperament may play a role in children's cross-race interactions.

Responder analysis confirms results of a stroke transitional care trial but provides more interpretable results

OBJECTIVES

Interpreting between-group differences in patient-reported outcome measures can be challenging. Responder analyses, which compare the proportions of patients who achieve a meaningful clinical change, represent a more interpretable approach. We conducted a secondary responder analysis of the Michigan Stroke Transitions Trial (MISTT).

STUDY DESIGN AND SETTING

The MISTT randomized 265 patients with stroke to three treatment groups: usual care [UC], social work case management [SWCM], or social work case management plus access to a patient-oriented website [SWCM + website]. Two Patient-Reported Outcomes Measurement and Information System (PROMIS) Global-10 subscales (representing physical and mental health) and 5 additional patient-reported outcomes were collected at baseline and 90-days. Responder analyses were conducted using modified Poisson and linear regression using published minimal important differences. Multiple imputation was used to address missing data.

RESULTS

For the PROMIS-10 global physical health subscale, responders were 80% more common in the SWCM + website group compared to the UC group (relative risk = 1.8, 95% confidence interval [CI]: 1.0, 3.1), with a number needed to treat of 7 (95% CI: 3, 112). No significant treatment effects were observed for the PROMIS-10 global mental health subscale.

CONCLUSION

Results of this responder analysis were largely consistent with the original trial analysis but have the advantage of presenting treatment effects using more clinically interpretable number needed to treat metrics.

COMPLEXITY IN PSYCHOSOCIAL INTERVENTIONS: CASE STUDIES FROM A STROKE TRANSITIONS TRIAL

The Michigan Stroke Transitions Trial (MISTT) tested whether in-home social work case management (SWCM) or SWCM combined with access to a website providing stoke-related information improved outcomes relative to usual care for patients discharged home post-stroke and their caregivers. The aims of this secondary analysis are 1) to describe the actual support social work case managers (SWCM) provided to MISTT participants and 2) use select case studies to illustrate the relationship between SWCM and quantitative patient and caregiver outcomes. Data for the study were derived from SWCM case notes on 157 patients and their caregivers who received the MISTT intervention. Case notes were coded in two steps with a subset of cases coded by two researchers and reviewed for interrater reliability in each step. The first round of coding was guided by primary SWCM intervention goals. The second round of coding identified SWCM sub-themes within each primary goal. Key themes indicate SWCMs aided with understanding the post-hospitalization period, helped patients navigate a range of systems and services, identified needs and supported patient goals, provided psychosocial support, and centered support on stroke recovery and prevention. Case studies illustrate ways in which SWCM were key supports during the transition period, but that support does not cleanly align with quantitative findings from patient-reported outcomes. This study aligns with a growing body of work documenting the complexity of transitions of care and has implications for how we support patients and caregivers as they move from inpatient to outpatient care and measure outcomes.

Action experience in infancy predicts visual‐motor functional connectivity during action anticipation

Despite substantial evidence indicating a close link between action production and perception in early child development, less is known about how action experience shapes the processes of perceiving and anticipating others' actions. Here, we developed a novel approach to capture functional connectivity specific to certain brain areas to investigate how action experience changes the networks involved in action perception and anticipation. Nine- and-12-month-old infants observed familiar (grasping) and novel (tool-use) actions while their brain activity was measured using EEG. Infants' motor competence of both actions was assessed. A link between action experience and connectivity patterns was found, particularly during the anticipation period. During action anticipation, greater motor competence in grasping predicted greater functional connectivity between visual (occipital alpha) and motor (central alpha) regions relative to global levels of whole-brain EEG connectivity. Furthermore, visual and motor regions tended to be more coordinated in response to familiar versus novel actions and for older than younger participants. Critically, these effects were not found in the control networks (frontal-central; frontal-occipital; parietal-central; parietal-occipital), suggesting a unique role of visual-motor networks on the link between motor skills and action encoding. HIGHLIGHTS: Infants' motor development predicted functional connectivity patterns during action anticipation. Faster graspers, and older infants, showed a stronger ratio of visual-motor neural coherence. Overall whole-brain connectivity was modulated by age and familiarity with the actions. Measuring inter-site relative to whole-brain connectivity can capture specific brain-behavior links. Measures of phase-based connectivity over time are sensitive to anticipatory action.

Children’s social networks in developmental psychology: A network approach to capture and describe early social environments

Psychologists are interested in understanding how early social environments impact children’s behavior and cognition. Early social environments are comprised of social relationships; however, there have been relatively few tools available to quantify the depth and breadth of children’s social relationships. We harnessed the power of social networks to demonstrate that networks can be used to describe children’s early social environments. Descriptive data from American children aged 6 months–5 years (n = 280; 47% female, 56% White) demonstrates that network properties can be used to provide a quantitative analysis of children’s early social environments and highlights how these environments vary across development. Social network methodology will provide researchers with a comprehensive picture of children’s early social experiences and improve studies exploring individual differences.

Men's Involvement in Sexual and Reproductive Health Care and Decision Making in the Philippines: A Systematic Review of the Literature

Sexual and reproductive health care (SRH) and family planning (FP) services have been primarily female centered. In recent decades, international groups have advocated for men’s involvement in SRH and FP, yet related research remains limited and implementation not fully realized in many countries. This systematic review of literature seeks to summarize the barriers and facilitators to men’s involvement in SRH/FP services in the Philippines. It is limited to publications in English from 1994 to 2021 regarding studies conducted in the Philippines whose research questions focused on men’s involvement in SRH/FP. Eligible studies were assessed for methodological quality using the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Evidence Rating Scale. The Ecological Model for Health Promotion was used as the guiding theoretical framework for analysis and to report findings. Barriers and facilitators were identified at every ecological level except that of policy. The most common barrier identified was men’s deficit in knowledge about SRH/FP; the most common facilitator was the positive influence of their social network on men’s attitudes, beliefs, and practices pertaining to SRH/FP. A range of factors from the individual to the community level influenced men’s involvement, including religious beliefs, economic means, and cultural gender roles. More studies are needed to provide a fuller understanding of the multilevel ecological factors influencing men’s involvement in SRH/FP and inform interventions with men that can positively affect their behavior related to SRH/FP decision making.

Reproducibility of cerebrovascular reactivity measurements: A systematic review of neuroimaging techniques. J Cereb Blood Flow Metab 2022;42:700-717. [PMID: 34806918 PMCID: PMC9254040 DOI: 10.1177/0271678x211056702]

Cerebrovascular reactivity (CVR), the capacity of the brain to increase cerebral blood flow (CBF) to meet changes in physiological demand, is an important biomarker to evaluate brain health. Typically, this brain "stress test" is performed by using a medical imaging modality to measure the CBF change between two states: at baseline and after vasodilation. However, since there are many imaging modalities and many ways to augment CBF, a wide range of CVR values have been reported. An understanding of CVR reproducibility is critical to determine the most reliable methods to measure CVR as a clinical biomarker. This review focuses on CVR reproducibility studies using neuroimaging techniques in 32 articles comprising 427 total subjects. The literature search was performed in PubMed, Embase, and Scopus. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We identified 5 factors of the experimental subjects (such as sex, blood characteristics, and smoking) and 9 factors of the measuring technique (such as the imaging modality, the type of the vasodilator, and the quantification method) that have strong effects on CVR reproducibility. Based on this review, we recommend several best practices to improve the reproducibility of CVR quantification in neuroimaging studies.

"It's Kind of Like Code-Switching": Black Older Adults' Experiences with a Voice Assistant for Health Information Seeking

Black older adults from lower socioeconomic environments are often neglected in health technology interventions. Voice assistants have a potential to make healthcare more accessible to older adults, yet, little is known about their experiences with this type of health information seeking, especially Black older adults. Through a three-phase exploratory study, we explored health information seeking with 30 Black older adults in lower-income environments to understand how they ask health-related questions, and their perceptions of the Google Home being used for that purpose. Through our analysis, we identified the health information needs and common search topics, and discussed the communication breakdowns and types of repair performed. We contribute an understanding of cultural code-switching that has to be done by these older adults when interacting with voice assistants, and the importance of such phenomenon when designing for historically excluded groups.

Neural correlates of familiar and unfamiliar action in infancy

Behavioral evidence shows that experience with an action shapes action perception. Neural mirroring has been suggested as a mechanism underlying this behavioral phenomenon. Suppression of electroencephalogram (EEG) power in the mu frequency band, an index of motor activation, typically reflects neural mirroring. However, contradictory findings exist regarding the association between mu suppression and motor familiarity in infant EEG studies. In this study, we investigated the neural underpinnings reflecting the role of familiarity in action perception. We measured neural processing of familiar (grasp) and novel (tool-use) actions in 9- and 12-month-old infants. Specifically, we measured infants' distinct motor/visual activity and explored functional connectivity associated with these processes. Mu suppression was stronger for grasping than for tool use, whereas significant mu and occipital alpha (indexing visual activity) suppression were evident for both actions. Interestingly, selective motor-visual functional connectivity was found during observation of familiar action, a pattern not observed for novel action. Thus, the neural correlates of perception of familiar actions may be best understood in terms of a functional neural network rather than isolated regional activity. Our findings provide novel insights on analytic approaches for identifying motor-specific neural activity while also considering neural networks involved in observing motorically familiar versus unfamiliar actions.

I Wouldn’t Search That With My Mobile Phone: Credibility and Trust in OHIRs Among Lower-Income Black Older Adults

Online health information resources (OHIRs) such as conversational assistants and smart devices that provide access to consumer health information in the home are promoted as viable options for older adults to independently manage health. However, there is question as to how well these devices are perceived to meet the needs of marginalized populations such as lower-income Black older adults who often experience lower digital literacy or technology proficiency. We examined the experiences of 34 lower-income Black older adults aged 65-83 from Chicago and Detroit with various OHIRs and explored whether conversational resources were perceived to better support health information seeking compared to traditional online web searching. In a three-phase study, participants tracked their experiences with various OHIRs and documented health-related questions in a health diary. Participants were then interviewed about their diaries in focus groups and semi-structured interviews, followed by a technology critique and co-design session to re-envision a more usable and engaging conversational device. We present preliminary results of the themes that emerged from our analysis: cultural variables in health information seeking practices, perceptions of credibility, likelihood of use, and system accessibility. Participants indicated that their trust of different resources depended on the type of information sought, and that conversational assistants would be a useful resource that require less technology proficiency, even among those with lower e-health literacy. Although our findings indicate that familiarity and trust were salient constructs associated with perceptions of OHIRs, these devices may address digital literacy and technology familiarity with certain design considerations.

Systematic Review and Meta-Analysis of Hardware Failure in Surgical Stabilization of Rib Fractures: Who, What, When, Where, and Why?

BACKGROUND

Surgical stabilization of rib fractures (SSRF) is increasingly used to reduce pulmonary complications and death among patients with rib fractures. However, the five Ws of hardware failure -who, what, when, where, and why- remains unclear. We aimed to synthesize available evidence on the five Ws and outline future research agenda for mitigating hardware failure.

METHODS

Experimental and observational studies published between 2009 and 2020 evaluating adults undergoing SSRF for traumatic rib fractures underwent evidence synthesis. We performed random effects meta-analysis of cohort/consecutive case studies. We calculated pooled prevalence of SSRF hardware failures using Freeman-Tukey double arcsine transformation and assessed study heterogeneity using DerSimonian-Laird estimation. We performed meta-regression with rib fracture acuity (acute or chronic) and hardware type (metal plate or not metal plate) as moderators.

RESULTS

Twenty-nine studies underwent qualitative synthesis and 24 studies (2404 SSRF patients) underwent quantitative synthesis. Pooled prevalence of hardware failure was 4(3-7)%. Meta-regression showed fracture acuity was a significant moderator (P = 0.002) of hardware failure but hardware type was not (P = 0.23). Approximately 60% of patients underwent hardware removal after hardware failure. Mechanical failures were the most common type of hardware failure, followed by hardware infections, pain/discomfort, and non-union. Timing of hardware failure after surgery was highly variable, but 87% of failures occurred after initial hospitalization. Mechanical failures was attributed to technical shortcomings (i.e. short plate length) or excessive force on the thoracic cavity.

CONCLUSIONS

SSRF hardware failure is an uncommon complication. Not all hardware failures are consequential, but insufficient individual patient data precluded characterizing where and why hardware failures occur. Minimizing SSRF hardware failure requires concerted research agenda to expand on the paucity of existing evidence.

Observations on the use of a pain numbing device for repetitive percutaneous sampling in sheep

AIMS

To evaluate the success of a commercially available analgesic device (CoolSense; Coolsense Ltd, Tel Aviv, Israel) in ameliorating pain while sampling from subcutaneous tissue cages in sheep.

METHODS

The CoolSense device was used as part of a major parent study involving repetitive percutaneous sampling of subcutaneous tissue cages in seven sheep. Sampling was performed by passing a hypodermic needle through the skin and withdrawing fluid from the tissue cage. Each sheep had 10 tissue cages that were individually sampled 14 times over 74 h. The device was placed on the skin of the sampling site immediately before sampling cooling and numbing the skin. The reaction of the sheep was observed by the operators, flinching or jumping as the needle was passed through the skin was deemed to be a failure. We recorded the success or failure of the device for each needle stick. This was opportunistic data collection as part of a pharmacokinetic trial, therefore no controls were included.

RESULTS

A total of 1655 observations were recorded and then analysed using a generalised linear mixed model. Overall, 1380 of 1655 (83.4%) observations were recorded as successfully providing analgesia. Marked inter-occasion variability was noted with success ranging from 61.42% to 92.86% across sheep:period (approximately 140 observations each). As no controls were available, the effect of treatment could not be evaluated.

CONCLUSIONS AND CLINICAL RELEVANCE

The CoolSense device is a viable option for veterinary research and clinical applications.

The burden of mental disorders and access to mental health and psychosocial support services in Syria and among Syrian refugees in neighboring countries: a systematic review

BACKGROUND

Exposure to conflict, violence and forced displacement can increase poor mental health among affected populations. Our aim was to examine evidence on the burden of mental disorders and access to and effectiveness of mental health and psychosocial support (MHPSS) services in Syria and among Syrian refugees in neighboring countries.

METHODS

A systematic review was done following systematic review criteria. Twelve bibliographic databases and additional gray literature sources were searched for quantitative and qualitative studies. Descriptive analysis and quality assessment were conducted.

RESULTS

Twenty-eight eligible studies were identified, of which two were with conflict-affected populations within Syria. Levels of post-traumatic stress disorder ranged from 16 to 84%, depression from 11 to 49%, and anxiety disorder from 49 to 55%. Common risk factors were exposures to trauma and having a personal or family history of mental disorder. Financial and socio-cultural barriers were identified as the main obstacles to accessing MHPSS care. Evaluations of MHPSS services, albeit from predominantly nonrandomised designs, reported positive treatment outcomes.

CONCLUSIONS

The MHPSS burden was high, but with considerable variation between studies. There are key evidence gaps on: MHPSS burden and interventions-particularly for those living within Syria; access and barriers to care; and implementation and evaluation of MHPSS interventions.

Conceptual and theoretical models for cybercivility in education in health professions: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to examine conceptual and theoretical models used to educate students in health professions about cybercivility.

INTRODUCTION

Civil behavior in cyberspace is an important element of online communications. However, this is challenging to define and teach due to subjectivity and personal bias as to what constitutes cybercivility and cyberincivility. Conceptual models or frameworks are often used to provide guidance when new knowledge and skills need to be integrated into existing professional practice. This study will provide evidence on the development and implementation of curriculum for cybercivility across healthcare professions and its potential benefits in improving interprofessional communication.

INCLUSION CRITERIA

The review will consider studies that include students of health professions exposed to cyberincivility. This scoping review will include experimental, quasi-experimental and descriptive observational study designs. Dissertations will be considered, but conference abstracts, posters, editorials, commentaries and opinion papers will be excluded. The search will be limited to studies published in English after 2007.

METHODS

The databases to be searched include PubMed (MEDLINE), CINAHL (via EBSCO), Education Resources Information Center (ERIC), Embase, PsycINFO (via EBSCO), Education Full Text (H.W. Wilson) and gray literature databases such as the ProQuest Dissertations and Theses Global database, OpenGrey, EThOS and PaperFirst. After screening of abstracts/titles for inclusion by two independent researchers, full-text studies will be screened and reasons for exclusion will be provided. Data will be extracted from the papers included in the review by two independent researchers using the data extraction instrument. NVivo 12 will be used to analyze and report the results.

Using Technology to Measure Older Adults' Social Networks for Health and Well-Being: A Scoping Review

Background and Objectives

Social networks impact the health and well-being of older adults. Advancements in technology (e.g., digital devices and mHealth) enrich our ability to collect social networks and health data. The purpose of this scoping review was to identify and map the use of technology in measuring older adults' social networks for health and social care.

Research Design and Methods

Joanna Briggs Institute methodology was followed. PubMed (MEDLINE), Sociological Abstracts, SocINDEX, CINAHL, and Web of Science were searched for relevant articles. Conference abstracts and proceedings were searched via Conference Papers Index, the American Sociological Society, and The Gerontological Society of America. Studies published in English from January 2004 to March 2020 that aimed to improve health or social care for older adults and used technology to measure social networks were included. Data were extracted by two independent reviewers using an a priori extraction tool.

Results

The majority of the 18 reviewed studies were pilot or simulation research conducted in Europe that focused on older adults living in the community. The various types of technologies used can be categorized as environment-based, person-based, and data-based.

Discussion and Implications

Technology facilitates objective and longitudinal data collection on the social interactions and activities of older adults. The use of technology to measure older adults' social networks, however, is primarily in an exploratory phase. Multidisciplinary collaborations are needed to overcome operational, analytical, and implementation challenges. Future studies should leverage technologies for addressing social isolation and care for older adults, especially during the COVID-19 pandemic.

Neighborhood racial demographics predict infants' neural responses to people of different races

Early in life, greater exposure to diverse people can change the tendency to prefer one's own social group. For instance, infants from racially diverse environments show less preference for their own-race (ingroup) over other-race (outgroup) faces than infants from racially homogeneous environments. Yet how social environment changes ingroup versus outgroup demarcation in infancy remains unclear. A commonly held assumption is that early emerging ingroup preference is based on an affective process: feeling more comfortable with familiar ingroup than unfamiliar outgroup members. However, other processes may also underlie ingroup preference: Infants may attend more to ingroup than outgroup members and/or mirror the actions of ingroup over outgroup individuals. By aggregating 7- to 12-month-old infants' electroencephalography (EEG) activity across three studies, we disambiguate these different processes in the EEG oscillations of preverbal infants according to social environment. White infants from more racially diverse neighborhoods exhibited greater frontal theta oscillation (an index of top-down attention) and more mu rhythm desynchronization (an index of motor system activation and potentially neural mirroring) to racial outgroup individuals than White infants from less racially diverse neighborhoods. Neighborhood racial demographics did not relate to White infants' frontal alpha asymmetry (a measure of approach-withdrawal motivation) toward racial outgroup individuals. Racial minority infants showed no effects of neighborhood racial demographics in their neural responses to racial outgroup individuals. These results indicate that neural mechanisms that may underlie social bias and prejudices are related to neighborhood racial demographics in the first year of life.

Microlearning in health professions education: a scoping review protocol

REVIEW QUESTIONS:.

Measurement of older adults' social networks using technologies in the context of health and social care: a scoping review protocol

OBJECTIVE

This scoping review aims to identify and map the use of technology in measuring and analyzing older adults' social networks in the context of health and social care.

INTRODUCTION

Research has shown that social networks impact the health and well-being of older adults. Advancements in the internet, electronic and digital devices, social media, and healthcare technology enhance our ability to collect social network and health data. These rapidly evolving technologies present opportunities to overcome limitations in social network measurement and promote improved understanding of the impact of social networks on the health and well-being of older adults.

INCLUSION CRITERIA

This scoping review will include studies of older adults that measured social networks using technology and were related to health or health and social care. Studies published in English from 2004 to the present will be included. Books, editorials, letters, and commentaries will be excluded.

METHODS

PubMed (MEDLINE), Sociological Abstracts, SocINDEX, CINAHL, and Web of Science will be searched for related articles. Gray literature will be included by searching conference abstracts via Conference Papers Index and hand-searching conference proceedings from the American Sociological Society and the Gerontological Society of America. Data will be extracted by two independent reviewers using an a priori data extraction tool. Tables and summary narratives will be used to map and synthesize existing approaches to measuring social networks using technology, the settings for measurement development or testing, and the use of approaches in discovery science, implementation science, or clinical care.

Understanding the Associations between Caregiver Characteristics and Cognitive Function of Adults with Cancer: A Scoping Review

Cognitive impairment (CI) is one of symptoms that adults with cancer frequently report. Although there are known factors that contribute to a patient's CI, these factors did not sufficiently explain its variability. Several studies conducted in patients with neurocognitive disorders have reported relationships between patients' cognitive function and caregiver characteristics, which are poorly understood in the context of cancer. This scoping review aims to map the literature on caregiver characteristics associated with CI in adults with cancer. We used the framework proposed by Arksey and O'Malley and PRISMA-Sc. Studies published in English by 2019 were searched through seven electronic databases. All retrieved citations were independently screened and eligibility for inclusion was determined by two independent authors. Ten studies met inclusion for this review with all of them showing significant associations between a patient's cognitive function and caregiver characteristics. Caregiver's mental health was the most commonly associated with a patient's cognitive function followed by family functioning, adaptation to illness, attitude toward disclosure of the illness, burden, coping and resilience, and demographic characteristics. These review findings suggest that enhanced information about CI in relation to caregiver characteristics will eventually provide the foundation for multifocal interventions for patients with impaired cognitive function. This scoping review identified caregiver characteristics that are associated with patients CI. These characteristics should be also assessed when health providers assess and treat CI of adults with cancer.

Neural correlates of infant action processing relate to theory of mind in early childhood

The mechanisms that support infant action processing are thought to be involved in the development of later social cognition. While a growing body of research demonstrates longitudinal links between action processing and explicit theory of mind (TOM), it remains unclear why this link emerges in some measures of action encoding and not others. In this paper, we recruit neural measures as a unique lens into which aspects of human infant action processing (i.e., action encoding and action execution; age 7 months) are related to preschool TOM (age 3 years; n = 31). We test whether individual differences in recruiting the sensorimotor system or attention processes during action encoding predict individual differences in TOM. Results indicate that reduced occipital alpha during action encoding predicts TOM at age 3. This finding converges with behavioral work and suggests that attentional processes involved in action encoding may support TOM. We also test whether neural processing during action execution draws on the proto-substrates of effortful control (EC). Results indicate that frontal alpha oscillatory activity during action execution predicted EC at age 3-providing strong novel evidence that infant brain activity is longitudinally linked to EC. Further, we demonstrate that EC mediates the link between the frontal alpha response and TOM. This indirect effect is specific in terms of direction, neural response, and behavior. Together, these findings converge with behavioral research and demonstrate that domain general processes show strong links to early infant action processing and TOM.

Visual spatial attention and spatial working memory do not draw on shared capacity-limited core processes

The extent to which similar capacity limits in visual attention and visual working memory indicate a common shared underlying mechanism is currently still debated. In the spatial domain, the multiple object tracking (MOT) task has been used to assess the relationship between spatial attention and spatial working memory though existing results have been inconclusive. In three dual task experiments, we examined the extent of interference between attention to spatial positions and memory for spatial positions. When the position monitoring task required keeping track of target identities through colour-location binding, we found a moderate detrimental effect of position monitoring on spatial working memory and an ambiguous interaction effect. However, when this task requirement was removed, load increases in neither task were detrimental to the other. The only very moderate interference effect that remained resided in an interaction between load types but was not consistent with shared capacity between tasks-rather it was consistent with content-related crosstalk between spatial representations. Contrary to propositions that spatial attention and spatial working memory may draw on a common shared set of core processes, these findings indicate that for a purely spatial task, perceptual attention and working memory appear to recruit separate core capacity-limited processes.

Palliative Care Evidence Review Service (PaCERS): a knowledge transfer partnership

The importance of linking evidence into practice and policy is recognised as a key pillar of a prudent approach to healthcare; it is of importance to healthcare professionals and decision-makers across the world in every speciality. However, rapid access to evidence to support service redesign, or to change practice at pace, is challenging. This is particularly so in smaller specialties such as Palliative Care, where pressured multidisciplinary clinicians lack time and skill sets to locate and appraise the literature relevant to a particular area. Therefore, we have initiated the Palliative Care Evidence Review Service (PaCERS), a knowledge transfer partnership through which we have developed a clear methodology to conduct evidence reviews to support professionals and other decision-makers working in palliative care.

PaCERS methodology utilises modified systematic review methods as there is no agreed definition or an accepted methodology for conducting rapid reviews. This paper describes the stages involved based on our iterative recent experiences and engagement with stakeholders, who are the potential beneficiaries of the research. Uniquely, we emphasise the process and opportunities of engagement with the clinical workforce and policy-makers throughout the review, from developing and refining the review question at the start through to the importance of demonstrating impact. We are faced with the challenge of the trade-off between the timely transfer of evidence against the risk of impacting on rigour. To address this issue, we try to ensure transparency throughout the review process. Our methodology aligns with key principles of knowledge synthesis in defining a process that is transparent, robust and improving the efficiency and timeliness of the review.

Our reviews are clinically or policy driven and, although we use modified systematic review methods, one of the key differences between published review processes and our review process is in our relationship with the requester. This streamlining approach to synthesising evidence in a timely manner helps to inform decisions faced by clinicians and decision-makers in healthcare settings, supporting, at pace, knowledge transfer and mobilisation.

Breed is associated with the ABCB1-1Δ mutation in Australian dogs

OBJECTIVE

The ABCB1 gene encodes P-glycoprotein (P-gp), a cellular membrane pump. One functional mutation that leads to expression of a less functional form of P-gp, ABCB1-1Δ, has been described in dogs. Individuals with this mutation can have severe adverse reactions to common veterinary pharmaceuticals that are known substrates of this pump. We investigated the detection of this mutation in samples submitted to two Australian diagnostic laboratories.

METHODS

A total of 4842 dogs across 27 breeds were tested for the ABCB1-1Δ mutation from buccal swabs or EDTA blood using standard PCR, multiplex PCR, or genotyping chip. Statistical analysis was applied to determine the proportions and odds ratios of the ABCB1-1Δ mutation in herding breeds compared with non-herding breeds.

RESULTS

The ABCB1-1Δ mutation was detected in nine breeds. The most commonly affected breeds were collies, Australian shepherds, white Swiss shepherds, and Shetland sheepdogs. Of 32 dogs in 18 non-herding breeds tested, one cocker spaniel and one labradoodle were positive for the mutation, both heterozygous.

CONCLUSION

The most frequently affected breeds for ABCB1-1Δ mutation are the collie, Australian shepherd, white Swiss shepherd and Shetland sheepdog. As the mutation is associated with an increased incidence of adverse reactions to commonly used pharmaceuticals, veterinarians need to be aware of the breeds at most risk of carrying this mutation and consider testing these individuals prior to administering these medications.

TRANSITIONING HOME AFTER STROKE: IMPROVING PHYSICAL HEALTH AND PATIENT ACTIVATION

While the majority of stroke patients will return home after being hospitalized, this transition is physically and emotionally challenging. We developed a social work based case management program to address these challenges. The Michigan Stroke Transitions Trial (MISTT), a pragmatic 3-arm clinical trial tested the effects of the case management program on its own and combined with technology against usual care in patients recovering from stroke. Patients from three Michigan hospitals were randomized to one of three groups upon discharge to home. The two treatment groups received services from a social work case manager via home visit and telephone. One treatment group also was given training and access to a curated stroke website developed for MISTT. The intervention lasted up to 90 days and data was collected via telephone at 7 and 90 days. Quality of life and patient activation were the primary outcomes, measured by the PROMIS Global 10, and the Patient Activation Measure (PAM), respectively. We compared treatment efficacy by comparing the change in outcomes between the three groups (N=265) using a difference-in-differences (D-in-D) analysis. The mean change in PROMIS scores for the social work + technology group was significantly higher than both the social work only group (difference= +2.4; 95%CI=0.46, 4.34; p=0.02) and usual care (difference= +3.4; 95%CI=1.41, 5.33; p<0.001). The mean change in PAM scores for the social work + technology group was significantly higher than the social work only group (+6.7; 95%CI=1.26, 12.08; p=0.02) and marginally higher than usual care (+5.0; 95%CI=-0.47, 10.52; p=0.07).

MEASUREMENT OF SOCIAL NETWORKS OF ELDERS USING TECHNOLOGIES IN THE CONTEXT OF HEALTH AND SOCIAL CARE: A SCOPING REVIEW

Social networks impact the health and wellbeing of older adults. The importance of social networks drives the need to reliably measure social networks. Advancements and innovations in the internet, electronic and digital devices, social media and health care technology enriches our ability to collect social network and health data to overcome limitations in social network measurement. This scoping review will review approaches utilizing technology to assist the measurement and analysis of social networks among older adults in the context of health and social care. Joanna Briggs Institute methodology was followed; PubMed (MEDLINE), Sociological Abstracts, SocINDEX, CINAHL, and Web of Science were searched for related articles. Conference abstracts and proceedings were included. We discuss the gaps and advances in measurement of social networks of older adults using technology and implications for future research in social networks of older adults as a lever for improving health and well-being.

PATTERNS OF UNMET NEEDS AND STRENGTHS AMONG STROKE PATIENTS AND THEIR INFLUENCE ON OUTCOMES

The transition home after a stroke is a particularly challenging time for patients and caregivers. There is extensive literature on unmet needs among stroke patients, but there are fewer studies that examine the strengths and resources of stroke patients and how these may influence their subsequent recovery. This study uses data from the Michigan Stroke Transitions Trial (MISTT), a pragmatic 3-arm clinical trial that tested the efficacy of case management against usual care. Two intervention groups (n=160) received up to 90 days of services from a social work case manager. A complete biopsychosocial assessment was conducted approximately 5 days after discharge. Latent class analysis was used to identify different classes based on six indicators of unmet needs and twelve indicators of strengths. Four homogenous classes were identified in the final model. Class 1 (n=56, 35%) included patients with few needs and strong social support, but few other strengths. Class 2 (n=46, 29%) had few needs and a high level of strengths across all indicators. Class 3 (n=39, 24%) has moderate needs related to mental health, non-stroke physical health, and finances, but few strengths. Class 4 (n=19, 12%) has moderate needs related to social support, non-stroke related physical health, and finances, but with moderate strengths related to indicators like coping, cognition, and insight. Class membership was related to short-term quality of life. Understanding the combination of needs and strengths has potential implications for services provided during care transitions as well as the policies and funding mechanisms that support those services.

Treatment gap and mental health service use among Syrian refugees in Turkey

Introduction

Turkey hosts the highest number of Syrian refugees in Europe. Refugees are often vulnerable to situational forms of psychosocial distress as a consequence of exposure to war and violence which may result in more profound mental health problems if no treatment is sought. The aim of this study is to report evidence on mental health and psychosocial support (MHPSS) needs, access and barriers to MHPSS care among Syrians refugees living in Istanbul, Turkey.

Methods

A cross-sectional survey was conducted among Syrian refugees aged 18 years or over in Istanbul (Sultanbeyli) between February and May 2018. Data among 1’678 Syrian refugees were collected on mental health outcomes using the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5) and the Hopkins Symptoms Checklist (HSCL-25) for depression and anxiety. We also collected data on health care utilization, barriers to seeking and continuing care as well as knowledge and attitudes towards mental health. Descriptive analyses were used.

Results

The prevalence of PTSD, depression and anxiety was 19.6%, 34.7% and 36.1% respectively. The treatment gap was 89% for PTSD, 90% for anxiety and 88% for depression. 249 respondents (15%) screened positive for either PTSD, depression or anxiety in our survey and self-reported emotional/behavioural problems since arriving in Sultanbeyli. Several structural and attitudinal barriers for not seeking care were reported.

Conclusions

To overcome the treatment gap, mental health care programmes need to be more responsive to the needs of Syrian refugees. Barriers to seeking and continuing care can be overcome by providing MHPSS services in the community which facilitate access to care. Community-based programmes of care should be supported by activities which increase awareness about mental health issues and tackle negative attitudes towards mental illness.

Key messages

This study provides the first nationally representative data on the mental health of Syrian refugees in Turkey, and shows that refugees have high mental health needs. Syrian refugees do not seek mental health care despite availability of mental health services in the community.

Understanding on the association between informal caregiver characteristics and cognitive function of adults with cancer: a scoping review protocol

INTRODUCTION

Adults with cancer frequently report symptoms such as decline in cognitive function throughout the trajectory of illness. Patients with cognitive deficits need support and assistance from their informal caregivers and often rely on them to manage their symptoms based on their degree of deficits. Patients spend a significant amount of time with their informal caregivers and become interdependent with each other. In spite of their interdependence, it is unclear whether patients' cognitive outcomes (ie, cognitive function) are associated with their informal caregivers. Therefore, the body of literature related to the association between caregiver characteristics and cognitive function of adults with cancer needs to be fully mapped with assessment for knowledge gaps.

METHODS AND ANALYSIS

Methods for this scoping review was informed by the framework proposed by Arksey and O'Malley. Seven electronic databases will be searched: (1) PubMed (MEDLINE), (2) CINAHL, (3) Embase, (4) PsycINFO, (5) Scopus, (6) Sociological Abstracts and (7) ProQuest dissertation abstracts. In addition, the search for grey literature will include the conference abstracts available through Embase, Scopus and Sociological abstracts as well as dissertations available in ProQuest dissertations. All retrieved citations will be independently screened by two authors and eligibility will be determined based on inclusion and exclusion criteria at title and abstract level. Studies meeting inclusion criteria, will be screened at full text level by two reviewers followed by abstraction of included studies. Eligible studies will be collated, summarised and reported using the data charting form that research team developed.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval. Results of this scoping review will be disseminated via conference presentation and/or publication in a scientific journal.

Microlearning in Health Professions Education: Scoping Review

BACKGROUND

Microlearning, the acquisition of knowledge or skills in the form of small units, is endorsed by health professions educators as a means of facilitating student learning, training, and continuing education, but it is difficult to define in terms of its features and outcomes.

OBJECTIVE

This review aimed to conduct a systematic search of the literature on microlearning in health professions education to identify key concepts, characterize microlearning as an educational strategy, and evaluate pedagogical outcomes experienced by health professions students.

METHODS

A scoping review was performed using the bibliographic databases PubMed (MEDLINE), CINAHL, Education Resources Information Center, EMBASE, PsycINFO, Education Full Text (HW Wilson), and ProQuest Dissertations and Theses Global. A combination of keywords and subject headings related to microlearning, electronic learning, or just-in-time learning combined with health professions education was used. No date limits were placed on the search, but inclusion was limited to materials published in English. Pedagogical outcomes were evaluated according to the 4-level Kirkpatrick model.

RESULTS

A total of 3096 references were retrieved, of which 17 articles were selected after applying the inclusion and exclusion criteria. Articles that met the criteria were published between 2011 and 2018, and their authors were from a range of countries, including the United States, China, India, Australia, Canada, Iran, Netherlands, Taiwan, and the United Kingdom. The 17 studies reviewed included various health-related disciplines, such as medicine, nursing, pharmacy, dentistry, and allied health. Although microlearning appeared in a variety of subject areas, different technologies, such as podcast, short messaging service, microblogging, and social networking service, were also used. On the basis of Buchem and Hamelmann's 10 microlearning concepts, each study satisfied at least 40% of the characteristics, whereas all studies featured concepts of maximum time spent less than 15 min as well as content aggregation. According to our assessment of each article using the Kirkpatrick model, 94% (16/17) assessed student reactions to the microlearning (level 1), 82% (14/17) evaluated knowledge or skill acquisition (level 2), 29% (5/17) measured the effect of the microlearning on student behavior (level 3), and no studies were found at the highest level.

CONCLUSIONS

Microlearning as an educational strategy has demonstrated a positive effect on the knowledge and confidence of health professions students in performing procedures, retaining knowledge, studying, and engaging in collaborative learning. However, downsides to microlearning include pedagogical discomfort, technology inequalities, and privacy concerns. Future research should look at higher-level outcomes, including benefits to patients or practice changes. The findings of this scoping review will inform education researchers, faculty, and academic administrators on the application of microlearning, pinpoint gaps in the literature, and help identify opportunities for instructional designers and subject matter experts to improve course content in didactic and clinical settings.

Citations of articles in predatory nursing journals

BACKGROUND

Nursing journals from predatory publication outlets may look authentic and seem to be a credible source of information. However, further inspection may reveal otherwise.

PURPOSE

The purpose of this study was to analyze publication and dissemination patterns of articles published in known predatory nursing journals.

METHOD

Using Scopus, reference lists were searched for citations from seven identified predatory nursing journals. Bibliographic information and subsequent citation information were then collected and analyzed.

FINDINGS

A total of 814 citations of articles published in predatory nursing journals were identified. Further analysis indicated that these articles were cited in 141 nonpredatory nursing journals of various types.

DISCUSSION

Predatory nursing journals continue to persist, yet fewer may now be in existence. Education and information may help authors and reviewers identify predatory journals, thereby discouraging submissions to these publications and hesitancy among authors to cite articles published in them.

Measuring the social impact of nursing research: An insight into altmetrics

AIMS

The objectives of this study were to (a) identify nursing journal articles that provoked the most online activity and discussion and (b) assess the association between these articles' altmetric scores and publication characteristics, citation counts; and publishing journals metrics.

BACKGROUND

Altmetrics, or alternative metrics, have recently emerged as a complementary way of measuring the societal impact of research by assessing the public engagement with research output. To date, no studies have yet investigated the online attention about scientific papers published in the nursing field.

DESIGN

Integration of quantitative and qualitative synthesized evidence.

DATA SOURCES AND REVIEW METHODS

InCites Journal Citation Report was used to identify a list of nursing journals indexed in the Web of Science Core Collection. Altmetric Explorer was selected as an altmetrics harvesting tool. The search in Altmetric Explorer yielded 66,608 research outputs from 118 nursing journals. The articles with the top 100 altmetric attention score (AAS) were identified and a new search, limited to only those 100 articles, was run to produce aggregate metrics specific to those articles. The articles were also exported for thematic analysis.

RESULTS

The median AAS for the 100 articles was 248, ranging from 138 - 649. The articles were mostly discussed on Twitter, followed by news outlets and Mendeley. Articles indexed in the nursing journals category attracted low online attention compared with articles published in other health journal categories. Twitter remained the dominant source of attention over the years 2012-2018, followed distantly by news outlets. Most online attention came from the USA and the UK. Of the top 100 articles included in the study, the Journal of Advanced Nursing published the highest number of articles (N = 26; Median AAS = 179). The AAS was not significantly different between articles published in Q1 journals and those published in Q2 and Q3 journals. There was a significant relationship between articles' AASs and their citation counts on Scopus and Web of Science. Publication date was significantly related to citation counts on Scopus and Web of Science but not with AASs.

CONCLUSION

Altmetrics will likely continue to evolve alongside the rapidly expanding use of social media and online platforms. As nursing continues to strive to have our research and scholarship inform policy, translated into practice and recognized for its scientific merit, we have to remain vigilant about the best ways to disseminate the important work we are doing. Research, such as this study, will allow nursing scholars to benchmark our progress as we adapt to the changing environment for measuring impact and quality in the digital age.

Occluding the face diminishes the conceptual accessibility of an animate agent

The language that people use to describe events reflects their perspective on the event. This linguistic encoding is influenced by conceptual accessibility, particularly whether individuals in the event are animate or agentive--animates are more likely than inanimates to appear as Subject of a sentence, and agents are more likely than patients to appear as Subject. We tested whether perceptual aspects of a scene can override these two conceptual biases when they are aligned: whether a visually prominent inanimate patient will be selected as Subject when pitted against a visually backgrounded animate agent. We manipulated visual prominence by contrasting scenes in which the face/torso/hand of the agent were visible vs. scenes in which only the hand was visible. Events with only a hand were more often associated with passive descriptions, in both production and comprehension tasks. These results highlight the power of visual prominence to guide how people conceptualize events.

57 Evidence into practice: novel approaches to underpinning evidence-based innovations in care

Background

Developing and implementing novel models of care requires a robust approach to identifying and assessing existing evidence. Rapid reviews have emerged as an efficient approach. There is a growing number of rapid review ‘methods’ but no accepted standardised methodology. We describe the methodological options and an example the Palliative Care Evidence Review Service (PaCERS) where streamlined systematic review methodology is used to conduct rapid reviews requested by clinicians/clinical services.

Aims

To describe evidence synthesis options including PaCERS for producing rapid evidence summaries on questions of direct importance to service delivery. To identify related methodological challenges.

Methods

We examine various rapid review methods and describe in full PaCERS methodology. This uses a focussed search strategy across a limited set of databases and other sources. Study selection data extraction and critical appraisal are performed independently by at least two reviewers. Results are published online using a template co-produced with users which describes key clinical messages evidence quality and summaries of included studies.

Results

We will describe the pros and cons of conducting rapid reviews and highlight methodology development unique to PaCERS. We will discuss specific issues encountered during the review process to produce rigorous reviews in a short time frame for palliative services.

Conclusion

Rapid reviews have tremendous methodological variation however they are an important tool for evidence-informed decision making especially when time resource constraints and health needs are an issue. Therefore using rapid reviews can be used in implementing new models of palliative care.

Reference

. Wales Cancer Research Centre. Palliative Care Evidence Review Service (PaCERS)2016. Available at: http://palliativecare.walescancerresearchcentre.com/palliative-care-evidence-review-service/ [Accessed: 30 May 2018]

Controlled before-after intervention study of suburb-wide street changes to increase walking and cycling: Te Ara Mua-Future Streets study design

BACKGROUND

Achieving a shift from car use to walking, cycling and public transport in cities is a crucial part of healthier, more environmentally sustainable human habitats. Creating supportive active travel environments is an important precursor to this shift. The longevity of urban infrastructure necessitates retrofitting existing suburban neighbourhoods. Previous studies of the effects of street changes have generally relied on natural experiments, have included few outcomes, and have seldom attempted to understand the equity impacts of such interventions.

METHODS

In this paper we describe the design of Te Ara Mua - Future Streets, a mixed-methods, controlled before-after intervention study to assess the effect of retrofitting street changes at the suburb scale on multiple health, social and environmental outcomes. The study has a particular focus on identifying factors that improve walking and cycling to local destinations in low-income neighbourhoods and on reducing social and health inequities experienced by Māori (Indigenous New Zealanders) and Pacific people. Qualitative system dynamics modelling was used to develop a causal theory for the relationships between active travel, and walking and cycling infrastructure. On this basis we selected outcomes of interest. Together with the transport funder, we triangulated best evidence from the literature, transport policy makers, urban design professionals and community knowledge to develop interventions that were contextually and culturally appropriate. Using a combination of direct observation and random sample face to face surveys, we are measuring outcomes in these domains of wellbeing: road-user behaviour, changes to travel mode for short trips, physical activity, air quality, road traffic injuries, greenhouse gas emissions, and perceptions of neighbourhood social connection, safety, and walking and cycling infrastructure .

DISCUSSION

While building on previous natural experiments, Te Ara Mua - Future Streets is unique in testing an intervention designed by the research team, community and transport investors together; including a wide range of objective outcome measures; and having an equity focus. When undertaking integrated intervention studies of this kind, a careful balance is needed between epidemiological imperatives, the constraints of transport funding and implementation and community priorities, while retaining the ability to contribute new evidence for healthy, equitable transport policy. The study was retrospectively registered as a clinical trial on 21 June 2018 in the ISCRTN registry: ISRCTN89845334 http://www.isrctn.com/ISRCTN89845334.

Abstract WP303: Defining the Limits of Technology-based Tools for Stroke Patients and Caregivers

For many stroke patients and caregivers, the transition back to home is often complex resulting in hospital readmissions, poor quality of life, and high caregiver burden. Providing access to high quality information on stroke is a potential cost effective intervention to improve stroke transitions. We report on the development and utilization of a patient-centered web-based tool that complemented a case management intervention which were both tested in the Michigan Stroke Transitions Trial (MISTT), an RCT designed to improve the transition experience for stroke patients and caregivers.

Methods/Methodology: A social work case management (SWCM) program was designed to address patient and caregiver needs, improve quality of life, and decrease caregiver burden. In addition, we addressed informational needs by developing a curated, patient-centered website with access to communication, information, and support resources. Website content and structure were developed through focus groups with key patient, caregiver, and provider stakeholders. Refinements were made after structured usability and accessibility testing. Acute stroke patients (N=263) discharged home from three acute-care hospitals were randomly assigned to one of three groups: usual care, SWCM, or SWCM plus website access. For the 87 subjects randomized to the website group, utilization was monitored over the 90-days intervention period by Google Analytics ® which generated data on log-in sessions and page views.

Results: Utilization data demonstrated that approximately one third (n= 28) of eligible patient/caregiver dyads randomized to the website did not access the website at all. Among website users, 25% (n=14) only accessed the site when assisted during SWCM home visit; another 25% (n=14) logged in 1-5 times in addition to the first home visit; and the remaining 50% (n=28) logged in on their own 1 to 9 times. The most popular pages were stroke information, medication information, stroke recovery, and prevention.

Conclusion: Despite the fact that stakeholders report the need to access reliable stroke information during the transition home, we found that utilization of a website designed for this purpose was low. These analyses identify areas for further research and program development.

Abstract TP304: The Challenge of Stroke Transitions from the Healthcare Provider’s Perspective: A Qualitative Study

Background: Inadequate transitional care contributes to poor patient outcomes including hospital readmissions, delayed recovery, and reduced quality of life. We report perspectives from healthcare providers on challenges and stroke educational needs which were collected to inform an intervention study designed to improve stroke transitions following discharge to home.

Methods: During the development phase of the Michigan Stroke Transitions Trial (MISTT), a randomized trial testing a Social Work Case Management (SWCM) intervention, we convened 4 stakeholder meetings with healthcare providers. We aimed to understand provider perspectives regarding patient and system-level challenges and to identify patient educational needs. Michigan providers, including social workers, nurses, neurologists, physiatrists, rehabilitation therapists, and managers were invited to attend the focus groups. Transcriptions were analyzed for common patient and system-level challenges (themes) using qualitative methods and educational needs were determined.

Results: Thirty-four providers, representing hospitals, rehabilitation facilities, nursing homes, and home healthcare agencies, attended the 4 meetings. They identified 43 patient-level, 36 healthcare-level, and 13 community-level challenges. The most common challenges were related to medical follow-up (n=10), consistency of care planning across settings (n=10), ability of patients to retain information (n=10), and unrealistic patient expectations (n=10). The most common stroke educational needs were stroke signs and symptoms recognition (n=10), post-stroke expectations (n=10), stroke risk factors (n=9), and post-stroke depression (n=9). Common medication topics included strategies for medication management (n=13), understanding the importance of medications (n=12), managing side effects (n=7), and communicating with physicians (n=5).

Conclusion: These data were essential in directing the scope and organization of the MISTT case management intervention. Addressing common challenges and targeting stroke educational needs offers the best opportunity for in-home transitional support to maximize stroke recovery during the early transitional period.

Abstract 164: The Michigan Stroke Transitions Trial: Assessment of Unmet Needs and Case Management Activities from an In-home Patient-Centered Social Work Case Management Program

Background: Inadequate stroke transitions adversely affect survivors, caregivers and families, contributing to hospital readmissions, recurrent stroke, and poor quality of life. Unfortunately few evidence-based transitional care programs exist for stroke. We report preliminary experience with a patient-centered Social Work Case Management (SWCM) program, including frequency and type of unmet patient needs and duration of case management services.

Methods: The Michigan Stroke Transitions Trial (MISTT) is a pragmatic randomized trial testing the efficacy of an in-home SWCM program against Usual Care for improving stroke survivor and caregiver recovery experiences. The 60 day intervention offers patient-centered case management services addressing psychosocial and medical needs to improve quality of life and increase patient activation and self-management. The SWCM program is designed to address patient identified unmet needs and includes providing support, improving preparedness, and managing stroke prevention.

Results: During the first 6 months, 46 patients were randomized to the SWCM intervention group. Initial assessments were initiated a median of 5 days after returning home. Twenty-five patients (56%) identified at least one unmet need during the initial assessment. The mean number of unmet needs was 1.7 (range 0-10) and covered a wide range of psychosocial (n=9) and medical (n=5) domains. Mental health (22%), symptoms requiring assistance (20%), and monthly expenses (20%) were the most common unmet needs. Among cases who completed the intervention (n=35), the intervention duration ranged from 18-118 days (mean= 69). For 8 of these cases (22%) case management exceeded 60 days. Total case interaction time averaged 5.5 hours (0.5 to 21 hours) and communication occurred across diverse individuals and organizations.

Conclusion: Psychosocial unmet needs are prevalent among stroke survivors during the first 60 days of in-home recovery. These needs require considerable time to manage and involve communication across multiple service organizations. Given the complexity of in-home stroke transitions, stroke survivors can benefit from short-term case management, with some cases requiring longer term management.