Delivering a dietetic intervention to cardiovascular patients in the Covid era

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Department of Health

Introduction

Healthy diet and body composition are core components of cardiac rehabilitation. Following the COVID outbreak in March 2020, our face-to-face cardiac rehabilitation programme (Our Hearts Our Minds) was suspended. The programme was then quickly moved to a virtual platform to continue to deliver the programme.

Purpose

Here we describe how the OHOM programme adapted our service to deliver the dietetic assessment and intervention on a virtual platform.

Methods

Pre-Covid the dietary component of OHOM consisted of a face-to-face Initial Assessment (IA) with a dietitian, group education sessions and an End of Programme assessment (EOP). Anthropometric measures and dietary habits were assessed including adherence to the Mediterranean diet via the Mediterranean Diet Score (MDS) toolkit. Using behaviour change techniques, tailored dietary advice was provided and goals agreed to educate on healthier food choices, increase adherence to Mediterranean diet and (if appropriate) promote weight loss and reduce central obesity. The assessment and intervention is now delivered virtually via telephone or video. Anthropometrics are self-reported with tape-measures supplied to assess waist circumference and advice provided on home-weighing. MDS is still assessed. The programme includes fortnightly coaching telephone consultations to review and reset goals, the option to attend a dietitian-led virtual group education session, access to a filmed educational video and submission of food diaries via the Fitbit app.

Results

From April to November 2020, 114 patients completed the virtual programme (65 telephone, 39 video). Dietetic outcomes are outlined in Table 1 with inclusion of data for a similar period one year previously (face-to-face) for comparison. Reductions in anthropometric measures and increased adherence to a cardio-protective diet were noted and the results for the two time periods are remarkably similar.

Conclusion

Delivery of a virtual dietetic component in cardiac rehabilitation is feasible, acceptable and just as effective as face-to-face based on preliminary data.

Table 1: Dietary outcomes at IA and EOP Face-to-face assessments (April - March 2019) Virtual assessments (April - November 2020) IA EOP Change IA EOP Change Mean weight (in those with BMI >25kg/m2) 86.5 85.2 -1.3 91.4 88.6 -2.8 Waist circumference (cm) 104.3 103 -1.3 107 102 -5 Mean MDS (Range 1-14) 4.4 7.5 +3.1 4.8 7.8 +3 % Consuming oily fish once per week 20 57 +37 25 68 +43 Achieving fruit and vegetable target 16 61 +45 21 57 +36

Abstract Figure. Dietitian waist circumference tutorial

The Community-targeted Self-management of Epilepsy and Mental Illness (C-TIME) initiative: A research, community, and healthcare administration partnership to reduce epilepsy burden

AIMS

Comorbid mental health conditions (MHCs) such as depression and anxiety are common in people with epilepsy. Targeted Self-Management for Epilepsy and Mental Illness (TIME) is a behavioral program that targets mood symptoms in adults with epilepsy and comorbid MHCs. Building upon positive findings of a randomized controlled study to establish the efficacy of TIME, the Community-TIME (C-TIME) initiative assessed the implementation feasibility and pre-/post-outcomes of this new evidence-based epilepsy self-management intervention in a community setting and in collaboration with key stakeholders.

METHODS

The C-TIME program is a group-format curriculum-based intervention delivered in ten 60-90 sessions over the course of 12 weeks. The C-TIME initiative used research staff to guide intervention performance evaluation, staff of a regional epilepsy advocacy agency to assist with community engagement and a county mental health services agency to support the transition from science to service. Process evaluations included outreach and engagement efforts needed to reach people with epilepsy and MHCs, the barriers and facilitators to roll out, and the participants' retention and satisfaction. The primary intervention participant outcome was depressive symptom severity at 4-month follow-up.

RESULTS

Referrals came from a variety of sources and approximately 1 in 3 referrals resulted in an enrollment. Thirty individuals were enrolled in 3 "cohorts" of 10. The most common reason for not being enrolled postscreening was that individuals did not show up for the baseline evaluation. Mean age of participants was 49.1 (12.8) years, 50% (N = 15) female, 55.2% (N = 16) white, 34.5% (N = 10) African-American. With respect to participation, 2/3 of the enrolled sample attended at least 7 out of the maximum 10 C-TIME sessions. Mean number of C-TIME sessions attended was 6.9 (4.1). Five participants (17%) had family members attend the C-TIME sessions, although family members were encouraged to play a supportive rather than primary role. Four-month follow-up outcome evaluation was available for 66% of the enrolled group. There was a significant reduction in depression severity, and patient satisfaction was over 90%.

CONCLUSIONS

The C-TIME program can be successfully implemented in the community and is associated with improved outcomes in adults with epilepsy and comorbid MHCs. Continued and broader scale-up of C-TIME and similar approaches could reach larger groups of adults with epilepsy and improve the health of our communities.

Nurses' perceptions and experiences of mentoring

Pre-registration education programmes provide nursing students with the skills and knowledge to become safe and proficient practitioners. Assessment of students' competence is a fundamental part of these programmes and mentors play a crucial role. Mentors are registered nurses who have completed an appropriate mentorship programme in an approved higher education institution, and their main role includes teaching, supervising and assessing students' clinical competence. The role can be demanding and stressful, and mentors must maintain their workloads while supporting students. This article reports the results of the qualitative findings of a survey of mentorship practices ( Brown et al 2012 ). The findings suggest that mentors value support from link lecturers and practice education facilitators, especially when they experience difficulties with nursing students who do not have the required competencies to pass their placement.

What influences mentors to pass or fail students

The aim of the study was to establish mentorship practice in relation to the University of the West of Scotland pre-registration nursing students. Surveys were sent to 4,341 mentors, with a 41 per cent response rate. Results show that 18 per cent of participants had passed a failing student. A number of factors influenced mentors' decisions, which to some extent echo findings from previous research. However, this study provides new perspectives on failing to fail and considers the supportive role of universities in relation to mentors and students' practice placements. The knowledge derived from this study will help inform mentoring and mentorship practice to ensure only safe and competent practitioners gain entry to the register.

Developing, implementing, and evaluating a treatment protocol for rural substance abusers

Substance abuse is a significant social and public health problem facing rural Americans. However, most treatment protocols have been developed in urban areas. This article describes the development, implementation, and evaluation of an innovative substance abuse treatment designed with the collaboration of rural professionals and consumers specifically for rural clients and delivered by rural clinicians. Results of the process evaluation of Structured Behavioral Outpatient Rural Therapy (SBORT) produced findings about the experiences of participating clients, clinicians, and program directors. Most clients perceived SBORT as a helpful learning process that used multiple treatment strategies and presented an alternative to 12-step programs. Clients also reported that treatment was stressful even when beneficial, and that clinician support was critical for remaining in treatment. Most clinicians found that SBORT challenged their "old" treatment frameworks, was demanding to learn and adopt, and that the training and supervision involved in the project implementation helped remedy rural isolation from the treatment community. Interestingly, agency approach to program implementation strongly influenced clinician responses to the innovation. Agency program directors' appraisals of SBORT included observations that the therapy was viable because of its rural-specific design and that most staff were able to adapt to the changes demanded by the manualized protocol. All three groups reported that they saw the emphasis and acceptance of motivation as an emergent process as important to the treatment. This project highlighted the challenge and importance of testing rural substance abuse treatment protocols in naturalistic settings.

Oxygen free radicals in interleukin-1beta-induced glycosaminoglycan production by retro-ocular fibroblasts from normal subjects and Graves' ophthalmopathy patients

Graves' ophthalmopathy (GO) is attributed to an autoimmune process that results in the accumulation in retro-ocular tissue of glycosaminoglycans (GAG) that are in turn responsible for the development of clinical signs and symptoms. Retro-ocular fibroblasts are thought to be the source of GAG production and deposition in GO. In the present study, we investigated interleukin (IL)-1beta-induced oxygen free radical production and the role of oxygen free radicals in IL-1beta-induced GAG production in retro-ocular fibroblasts from both normal subjects and patients with GO. Normal retro-ocular fibroblasts demonstrated no measurable oxygen free radicals whereas GO retro-ocular fibroblasts showed detectable signals by electron paramagnetic resonance (EPR) spectroscopy. IL-1beta increased the free radical production in both cells. Superoxide dismutase (SOD) activity in GO retroocular fibroblasts was higher than that in normal cells. IL-1beta dose- and time-dependently stimulated the SOD activity in both cells, with GO retro-ocular fibroblasts showing less responsiveness. IL-1beta dose-dependently increased [3H]glucosamine incorporation into GAG by both cells. An exogenous oxygen free radical-generating system failed to increase GAG. Scavenging oxygen free radicals by the use of SOD (100 U/mL) and catalase (300 U/mL) partially blocked the IL-1beta-induced GAG production in both cells. These results suggest that stress related oxygen free radicals are present in the retro-ocular tissue in GO and that oxygen free radicals are involved in GAG accumulation induced by cytokine IL-1beta.