scholarly journals Challenges of Implementing the PRISM 2.0 Clinical Trial With Assisted Living and Impaired Participants

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 307-308
Author(s):  
Sara Czaja ◽  
Jerad Moxley ◽  
Carlos Almirola ◽  
Joseph Sharit
Keyword(s):  
Clinical Trial ◽  
Assisted Living ◽  
Tablet Computer ◽  
Assisted Living Facilities ◽  
Access To Information ◽  
Baseline Assessment ◽  
Inclusion Criteria ◽  
Social Connectivity ◽  
Housing Facilities

Abstract The PRISM 2.0 clinical trial examined the benefits of a software system, implemented on a computer tablet, which was designed to support access to information, engagement, and social connectivity among older people. Participants across three sites were recruited from rural locations, senior living housing facilities, and assisted living facilities (ALFs) and correspondingly randomized into either the Prism or control (tablet computer without the PRISM system) conditions. In this talk, we focus on the challenges associated with including ALF participants at key stages of the trial. These stages included telephone prescreening, baseline assessment, training on the system, and 6-, 9-, and 12-month follow-up assessments. Inability to meet inclusion criteria related to cognitive and sensory-motor considerations was a common problem, as was the ability to sustain attention during the training sessions. Recommendations for recruitment and retaining older adults in ALFs for these types of studies will be offered.

scholarly journals Timed “Up & Go” Test as a Predictor of Falls Within 6 Months After Hip Fracture Surgery

2007 ◽  
Vol 87 (1) ◽  
pp. 24-30 ◽  
Author(s):  
Morten T Kristensen ◽  
Nicolai B Foss ◽  
Henrik Kehlet
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Assisted Living ◽  
Negative Likelihood Ratio ◽  
Care Plan ◽  
Assisted Living Facilities ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Hip Fracture Surgery

Background and Purpose Previous studies of Timed “Up & Go” Test (TUG) scores as a predictor of falls were based primarily on retrospective data, and no prospective studies of the TUG for predicting falls in people with hip fracture are available. The purpose of this study was to determine whether TUG scores obtained upon discharge from an acute orthopedic hip fracture unit can predict falls in people with hip fracture during a 6-month follow-up period. Subjects The subjects included in this study were 79 consecutive elderly people who had hip fractures and were able to perform the TUG when discharged directly to their own homes or to assisted living facilities from a specialized acute orthopedic hip fracture unit, with 59 (75%) being able to participate in the follow-up interview. Methods In this prospective study, all subjects were contacted for a 6-month follow-up interview about falls since discharge from the hospital. The score on the TUG performed at discharge (median of 10 days after surgery) was compared with the New Mobility Score, which describes functional level before the fracture and mental status on admission, sex, type of fracture, residence, and walking aids before and after the fracture. All subjects followed a well-defined care plan with multimodal fast-track rehabilitation including an intensive physical therapy program comprising 2 daily sessions; discharge was in accordance with standardized criteria. Analyses and correlations of all variables were examined for prediction of falls, and sensitivity, specificity, predictive values, and likelihood ratios were calculated. Falls were classified as “none” or as “1 or more.” Results Among the 59 subjects in the follow-up group, 19 subjects (32%) experienced 1 or more falls in the period since discharge; 4 of these falls resulted in new hip fractures. The TUG performed at discharge with a cutoff point of 24 seconds was the only parameter that significantly predicted falls during the 6-month follow-up period, with a negative likelihood ratio of 0.1 to be a faller as a nonfaller. Discussion and Conclusion The results suggest that the TUG is a sensitive measure for identifying people with hip fracture at risk for new falls, and it should be part of future outcome measures to decide for whom preventive measures against falls should be instituted.

scholarly journals Challenges of Implementing the PRISM 2.0 Trial for Supporting Social Connectivity Through Technology

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 307-307
Author(s):  
Walter Boot ◽  
Sara Czaja ◽  
Dana Plude
Keyword(s):  
Older Adults ◽  
Assisted Living ◽  
Rural Areas ◽  
Technology Use ◽  
Social Research ◽  
New Technology ◽  
Lessons Learned ◽  
Assisted Living Facilities ◽  
Senior Housing ◽  
Social Connectivity

Abstract Following the success of the Personal Reminder Information and Social Management (PRISM) trial, which found that a specially designed computer system for older adults can enhance social connectivity and reduce loneliness among older adults at risk for social isolation, the PRISM 2.0 trial sought to replicate and extend these results to a new technology platform (tablet rather than desktop) with expanded social features and diverse populations of older adults, including older adults living in rural areas, assisted living communities, and senior housing. This symposium discusses the aims of the trial conducted by the Center for Research and Education on Aging and Technology Enhancement (CREATE), challenges encountered (including challenges related to the COVID-19 pandemic), and solutions to those challenges. S. Czaja will begin with an overview of the PRISM 2.0 system and the trial. J. Sharit will discuss challenges encountered working within the context of assisted living facilities and with impaired participants. This will be followed by a discussion of technical challenges encountered during the course of the trial presented by N. Charness. W. Rogers will present training issues involved (both with respect to participants and assessors). Finally, W. Boot will describe challenges encountered with measuring and quantifying technology use during the trial. Lessons learned are applicable to many types of technology interventions administered in diverse contexts. D. Plude, Deputy Director in the Division of Behavioral and Social Research of NIA, will serve as discussant.

scholarly journals Asymptomatic SARS-CoV-2 Infection and COVID-19 Mortality During an Outbreak Investigation in a Skilled Nursing Facility

2020 ◽  
Vol 71 (11) ◽  
pp. 2920-2926 ◽  
Author(s):  
Mahesh C Patel ◽  
Lelia H Chaisson ◽  
Scott Borgetti ◽  
Deborah Burdsall ◽  
Rashmi K Chugh ◽  
...  
Keyword(s):  
High Risk ◽  
Assisted Living ◽  
Skilled Nursing Facility ◽  
High Risk Population ◽  
Assisted Living Facilities ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Kaplan Meier ◽  
Probability Of Death

Abstract Background Outbreaks of coronavirus disease 2019 (COVID-19) have been reported in nursing homes and assisted living facilities; however, the extent of asymptomatic and presymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in this high-risk population remains unclear. Methods We conducted an investigation of the first known outbreak of SARS-CoV-2 at a skilled nursing facility (SNF) in Illinois on 15 March 2020 and followed residents for 30 days. We tested 126/127 residents for SARS-CoV-2 via reverse-transcription polymerase chain reaction and performed symptom assessments. We calculated the point prevalence of SARS-CoV-2 and assessed symptom onset over 30-day follow-up to determine: (1) the proportion of cases who were symptomatic, presymptomatic, and asymptomatic and (2) incidence of symptoms among those who tested negative. We used the Kaplan-Meier method to determine the 30-day probability of death for cases. Results Of 126 residents tested, 33 had confirmed SARS-CoV-2 on 15 March. Nineteen (58%) had symptoms at the time of testing, 1 (3%) developed symptoms over follow-up, and 13 (39%) remained asymptomatic. Thirty-five residents who tested negative on 15 March developed symptoms over follow-up; of these, 3 were re-tested and 2 were positive. The 30-day probability of death among cases was 29%. Conclusions SNFs are particularly vulnerable to SARS-CoV-2, and residents are at risk of severe outcomes. Attention must be paid to preventing outbreaks in these and other congregate care settings. Widespread testing and infection control are key to help prevent COVID-19 morbidity and mortality in these high-risk populations.

Prospective clinical trial in the management of Mutrashmari through Avapidaka Snehapana and Matra Basti

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Dr.Savita Metri ◽  
Dr.Prashanth A. S.
Keyword(s):  
Clinical Trial ◽  
Total Duration ◽  
Treatment Modalities ◽  
Single Subject ◽  
Study Group ◽  
Inclusion Criteria ◽  
Before And After ◽  
Group A ◽  
Group B

Background: Ashmari Roga is considered as one of the Ashta Maha Gada considered difficult to cure because of its Marma Ashrayatwa, due to the involvement of Bahu Dosha and Basti, which is one of the Tri Marma, Acharyas has specifically mentioned many treatment modalities for reducing the symptoms as well as eliminating the Ashmari from its root, in which Basti and Virechana is having prime importance. So here an attempt is made to compare and study the efficacy of Basti and Virechana in Mutrashmari. Objective: To study the effect of Avapidaka Snehapana followed by Virechana and Shamanoushadhi and Matrabasti followed by Shamanoushadhi in the management of Mutrashmari. Materials and methods: 40 patients diagnosed with Mutrashmari (urinary calculus) and fulfilling the inclusion criteria were selected and randomly divided into 2 groups. In Group A: Amapachana with Hingvastaka Churna, Avapidaka Sneha with Punarnavadi Ghrita and Virechana with Trivrut Mrudvika Rasa followed by Shuntyadi Kwatha as Shamanoushadhi, In Group B: Amapachana with Hingvastaka Churna, Varunadhya Taila Matra Basti followed by Shwadamstra Kwath as Shamanoushadhi. Pain (from loin to groin), Nausea, Dysuria, Haematuria, Burning Micturation, Number of stones, Size of stones, Site of stone, Hydroureter and Hydronephrosis were assessed before and after treatment. The total duration of the study was 60 days or up to expulsion of the stone with 45 days of follow up. Results: In this study, Group A shows statistically more significant result than Group B. Conclusion: Both Group A and Group B have shown significant outcomes in all parameters with proper diet and regimen. Reoccurrence of stone was not found in a single subject.

Chemotherapy in gallbladder cancer: Improving survival

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15140-15140
Author(s):  
J. Gallardo ◽  
B. Rubio ◽  
M. Ahumada ◽  
L. Villanueva ◽  
O. Barajas
Keyword(s):  
Clinical Trial ◽  
Gallbladder Cancer ◽  
Surgical Resection ◽  
Median Survival ◽  
Phase Ii ◽  
Second Line ◽  
Inclusion Criteria ◽  
The Third ◽  
Phase Ii Studies

15140 Background: Since 1999 we had been studying the effect of chemotherapy in gallbladder cancer, a disease frequent in low economical income area of the world, orphan of research, traditionally considered chemotherapy-resistant. Previous studies included 5- FU regimen and communicated response rate of 10–26 %, and no changes on survival. We first conducted a phase II study with gemcitabine (Gem), and later, another study (with support of GOCCHI) using Gem and cisplatin (C). Since 2001 we had treated patients out of clinical trial. We compare median survival observed in all series. Methods: Patients file of both 2 phase II studies and clinical record of all patients treated out of clinical trial were retrieved and median survival was calculated. The both phase two trials had a similar population, and inclusion criteria, both were multicenters. The third cohort is a one center experience. The regimens used were: Gem 1,000 mg/m2 on days 1,8 and 15 every 28 days (first trial), Gem 1,250 mg/m2+C 35 mg/m2 on the 1 and 8 days every 21 days (second trial), only maximum 6 courses were planned. The third group, most frequently, received Gem 1.000 mg/m2 (10mg/m2/min)+C 40 mg/m2 days 1 and 8 every 21 days, until disease progression and/or toxicity; second line chemotherapy was allowed. Among whole group 7 pts, who had significant response, underwent a surgical resection. Survival was also calculated and comparison is included. The toxicity was evaluated every 2 weeks and response was assessed every two cycles using CT scan. Overall survival was calculated from beginning of chemotherapy until death or last follow up. Survival analysis was also done using Kaplan Meier’s tables Results: For Gem monotherapy (26 pts) median survival was 30 weeks, for Gem+C (44 pts) median survival was 28 weeks. For third group (29 pts) median survival was 56 weeks. Until now, for the 7 pts who underwent a surgical resection median survival is 92 weeks, with one pt alive, without evidence of disease, at 112 weeks of follow up Conclusions: Both regimens showed better efficacy than 5-FU based chemotherapy, the combination did not show better survival. The third group has better median survival, probable due to the use of second line therapies. Combining chemotherapy + surgical resection may be a better treatment for some few, well selected patients. No significant financial relationships to disclose.

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