Pragmatic comparison of outcome measures before and after the introduction of a crisis and home treatment service for older people

Background: Limited studies concern the influence of obesity-induced dysregulation of adipokines in functional recovery after stroke neurorehabilitation. Objective: To investigate the relationship between serum leptin, resistin, and adiponectin and functional recovery before and after neurorehabilitation of obese stroke patients. The adipokine potential significance as prognostic markers of rehabilitation outcomes was also verified. Methods: Twenty obese post-acute stroke patients before and after neurorehabilitation and thirteen obese volunteers without-stroke, as controls, were examined. Adipokines were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits. Functional deficits were assessed before and after neurorehabilitation with the Barthel Index (BI), modified Rankin Scale (mRS), and Functional Independence Measure (FIM). Results: Compared to controls, higher leptin and resistin values and lower adiponectin values were observed in stroke patients before neurorehabilitation and no correlations were found between adipokines and clinical outcome measures. Neurorehabilitation was associated with improved scores of BI, mRS, and FIM. After neurorehabilitation, decreased values of Body Mass Index (BMI) and resistin together increased adiponectin were detected in stroke patients, while leptin decreased but not statistically. Comparing adipokine values assessed before neurorehabilitation with the outcome measures after neurorehabilitation, correlations were observed for leptin with BI-score, mRS-score, and FIM-score. No other adipokine levels nor BMI assessed before neurorehabilitation correlated with the clinical measures after neurorehabilitation. The forward stepwise regression analysis identified leptin as prognostic factor for BI, mRS, and FIM. Conclusions: Our data show the effectiveness of neurorehabilitation in modulating adipokines levels and suggest that leptin could assume the significance of biomarker of functional recovery.

Download Full-text

Improvement in Total and Face-to-Face Provider Time in a Multidisciplinary Craniofacial Team Clinic: An Interventional Study

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211021705 ◽

2021 ◽

pp. 105566562110217

Author(s):

Alexis C. Wood ◽

C. Alejandra Garcia de Mitchell ◽

Ruchi Kaushik

Keyword(s):

Data Collection ◽

Cleft Palate ◽

Outcome Measures ◽

Clinic Visit ◽

Visit Time ◽

Time Data ◽

Interventional Study ◽

Face To Face ◽

Before And After ◽

Total Visit

Objective: Identify factors contributing to time a family spends in a Multidisciplinary Craniofacial Team Clinic (MDCT) and implement an intervention to reduce this time. Design: Interventional: a restructuring of clinics to serve those patients requiring fewer provider encounters separately. Setting: An American Cleft Palate-Craniofacial Association-accredited MDCT in an academic children’s hospital. Patients/Participants: One hundred sixty-seven patients with craniofacial diagnoses. Interventions: Time data were tabulated over ∼2 years. Following 9 months of data collection, patients requiring fewer provider encounters were scheduled to a separate clinic serving children with craniosynostosis, and data were collected in the same fashion for another 14 months. Main Outcome Measures: Principal outcome measures included total visit time and proportion of the visit spent without a provider in the room before and after clinic restructuring. Results: The average time spent by family in a clinic session was 161.53 minutes, of which 64.3% was spent without a provider in the room. Prior to clinic restructuring, a greater number of provider encounters was inversely associated with percentage of time spent without a provider ( P < .001). Upon identifying this predictor, scheduling patients who needed fewer provider encounters to a Craniosynostosis Clinic session resulted in reduction in absolute and percentage of time spent without a provider ( P < .001). Conclusions: The number of provider encounters is a significant predictor of the proportion of a clinic visit spent without a provider. Clinic restructuring to remove patient visits that comprise fewer provider encounters resulted in a greater percentage of time spent with a provider in an MDCT.

Download Full-text

Use of connected digital products in clinical research following the COVID-19 pandemic: a comprehensive analysis of clinical trials

BMJ Open ◽

10.1136/bmjopen-2020-047341 ◽

2021 ◽

Vol 11 (6) ◽

pp. e047341

Author(s):

Caroline Marra ◽

William J Gordon ◽

Ariel Dora Stern

Keyword(s):

Clinical Trials ◽

Clinical Research ◽

Outcome Measures ◽

Remote Monitoring ◽

Search Algorithm ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Digital Products ◽

Clinical Trial Registry ◽

Before And After

ObjectivesIn an effort to mitigate COVID-19 related challenges for clinical research, the US Food and Drug Administration (FDA) issued new guidance for the conduct of ‘virtual’ clinical trials in late March 2020. This study documents trends in the use of connected digital products (CDPs), tools that enable remote patient monitoring and telehealth consultation, in clinical trials both before and after the onset of the pandemic.DesignWe applied a comprehensive text search algorithm to clinical trial registry data to identify trials that use CDPs for remote monitoring or telehealth. We compared CDP use in the months before and after the issuance of FDA guidance facilitating virtual clinical trials.SettingAll trials registered on ClinicalTrials.gov with start dates from May 2019 through February 2021.Outcome measuresThe primary outcome measure was the overall percentage of CDP use in clinical trials started in the 10 months prior to the pandemic onset (May 2019–February 2020) compared with the 10 months following (May 2020–February 2021). Secondary outcome measures included CDP usage by trial type (interventional, observational), funder type (industry, non-industry) and diagnoses (COVID-19 or non-COVID-19 participants).ResultsCDP usage in clinical trials increased by only 1.65 percentage points, from 14.19% (n=23 473) of all trials initiated in the 10 months prior to the pandemic onset to 15.84% (n=26 009) of those started in the 10 months following (p<0.01). The increase occurred primarily in observational studies and non-industry funded trials and was driven entirely by CDP usage in trials for COVID-19.ConclusionsThese findings suggest that in the short-term, new options created by regulatory guidance to stimulate telehealth and remote monitoring were not widely incorporated into clinical research. In the months immediately following the pandemic onset, CDP adoption increased primarily in observational and non-industry funded studies where virtual protocols are likely medically necessary due to the participants’ COVID-19 diagnosis.

Download Full-text

Effects of a Low-Element Challenge Course on Abstinence Self-Efficacy and Group Cohesion

Research on Social Work Practice ◽

10.1177/1049731511423672 ◽

2011 ◽

Vol 22 (2) ◽

pp. 151-158 ◽

Cited By ~ 7

Author(s):

Jamie M. Clem ◽

Thomas E. Smith ◽

Kristin V. Richards

Keyword(s):

Outcome Measures ◽

Self Efficacy ◽

Group Cohesion ◽

Future Research ◽

Chemically Dependent ◽

Challenge Course ◽

Self Confidence ◽

Therapeutic Value ◽

Before And After ◽

Group Unity

Substance abuse researchers identify self-efficacy and group cohesion as important components in alcohol and other drug-dependency treatment. Objectives: The purpose of this single-group, pretest–posttest study is to explore the therapeutic value of a challenge course intervention on the self-efficacy and group cohesion of nine chemically dependent, adult females. Methods: Data were collected using two validated outcome measures administered before and after the intervention. Focus groups provided insight into the experiences of participants and were examined using manifest and latent theme analysis. Results: Findings indicate statistically significant improvements on both outcome measures with medium to large effect sizes. Several themes were identified including group unity, trust, interpersonal growth, and self-confidence. Conclusions: Suggestions for practice and future research are provided.

Download Full-text

Prevalence and Risk Factors of Postprandial Hypotension Among Japanese Older Adults in a Facility

Innovation in Aging ◽

10.1093/geroni/igaa057.716 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 222-222

Author(s):

Noriko Suzuki ◽

Masahiko Hashizume ◽

Hideyuki Shiotani

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Older Adults ◽

Older People ◽

Future Research ◽

Baseline Body Mass Index ◽

Term Care ◽

Postprandial Hypotension ◽

Before And After ◽

Japanese Older Adults

Abstract Postprandial hypotension (PPH) is an unrecognized sudden drop of blood pressure (BP) after meals and a hidden problem among older people including those living in long-term care facilities (LTCFs). Though PPH causes dizziness, falls, and syncope, it has received little attention from¬¬¬ healthcare workers (HCW) including caregivers, nurses and physicians, and risk factors of PPH should be carefully assessed to improve quality of life. Therefore, we aimed to examine the prevalence and risk factors of PPH in a LTCF in Japan. Participants were 114 older adults living in a LTCF in Japan (mean age 85.9 years old; 85 female (74%)). To examine PPH, blood pressure (BP) was measured before and after lunch. BP after meal was measured four times every 30 minutes. PPH is defined as a BP drop of 20 mmHg or more and we also defined a BP drop within a range of 19 to 15 mmHg as potential-PPH. As risk factors, we compared systolic and diastolic BP at baseline, body mass index, pulse rate, disease and complications between groups with/without PPH. The prevalence of PPH was 41% (47/114) and 52% with potential-PPH; 11% (13/114) added. Among risk factors, systolic BP was significantly higher in those with PPH (142.6 vs 123.5 mmHg, p <0.001). This study revealed that PPH & potential-PPH occurred in half of the subjects in a LTCF in Japan. HCW need to focus on high systolic BP to predict PPH and future research is necessary to prevent and cope with PPH for older people.

Download Full-text

Minimal clinically important difference of the 6-min walking test in patients with asthma

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.20.0928 ◽

2021 ◽

Vol 25 (3) ◽

pp. 215-221

Author(s):

E. Zampogna ◽

N. Ambrosino ◽

R. Centis ◽

F. Cherubino ◽

G. B. Migliori ◽

...

Keyword(s):

Outcome Measures ◽

Operating Characteristic ◽

Minimal Clinically Important Difference ◽

Walking Ability ◽

Walking Test ◽

Receiver Operating Characteristic Curves ◽

Clinically Important Difference ◽

Copd Assessment Test ◽

Before And After ◽

Perceived Change

BACKGROUND: The 6‐min walking test (6MWT) is responsive to physiological changes and pulmonary rehabilitation (PR) in patients with asthma. The minimal clinically important difference (MCID) has not been established yet.OBJECTIVE: To determine the MCID of 6MWT in patients with asthma.METHODS: Using the perceived change in walking ability and the modified Medical Research Council (mMRC) score as anchors, receiver operating characteristic curves and quantile regression, we evaluated 6MWT before and after PR in these patients. The St George Respiratory Questionnaire (SGRQ), the COPD assessment test (CAT) and other outcome measures were also assessed.RESULTS: Of 142 patients with asthma, 37 were enrolled. After PR, 6MWT increased from 453.4 m ± 88.8 to 493.0 m ± 97.2 (P = 0.0001); other outcome measures also increased. There was a slight correlation between baseline 6MWT and SGRQ, CAT and mMRC. No significant correlations were found between post‐PR changes in 6MWT and in other outcome measures. Comparing different methods of assessment, the MCID ranged from 26 m to 27 m.CONCLUSION: The most conservative estimate of the MCID of 6MWT after PR was 26 m in patients with asthma. This estimate may be useful in clinical interpretation of data, particularly in response to intervention studies.

Download Full-text

Effects of Nurse and Care Worker-led Foot-Care Program on Older People’s Foot Conditions: Before and After Intervention Study

SAGE Open Nursing ◽

10.1177/23779608211058492 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110584

Author(s):

Kashiko Fujii ◽

Minna Stolt ◽

Takuyuki Komoda ◽

Mariko Nishikawa

Keyword(s):

Older People ◽

Day Care ◽

Intervention Study ◽

Care Program ◽

Skin Lesions ◽

Foot Care ◽

Term Care ◽

Foot Health ◽

Day Care Centers ◽

Before And After

Introduction An increasing number of older people with frailty in Japan use geriatric day care centers. Older people who have been certified as requiring long-term care attend centers during the day and receive nursing care help with bathing, excretion, meals, and functional training services. Many older people have foot problems with need foot care by nurses and care workers (NCWs) at geriatric day care centers. Objective This study explored the effects of NCWs’ foot-care programs on the foot conditions of older people attending daytime services. Methods A before-after intervention study was conducted at geriatric day care centers for older people, where the foot-care program was presented by NCWs for two months. The foot conditions of 23 clients (8 men, 15 women, mean age = 78.6 years, standard deviation = 9.2) were assessed before and after the program. Changes in foot condition and clients’ perceptions after the study were analyzed through descriptive statistics, McNemar, and paired t-tests. Results Although dramatic changes in foot conditions were not observed, some conditions were improved or maintained. Changes were observed in mean dry skin scores ( p < .01; right foot: 1.6→1.1, left foot: 1.6→1.1), skin lesions and long nails (skin lesions R: 0.2→0.1; long nail R: 1.4→1.0, L: 1.1→0.8), and edema (R: 43.5%→39.1%, L: 52.2%→47.8%). Further, clients started perceiving that foot health is important and discussed their feet with staff more often. Conclusion The NCWs’ foot-care program was effective in maintaining and improving foot health in older people and positively affected their perception of foot care.

Download Full-text

Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia

Australian Journal of Primary Health ◽

10.1071/py16022 ◽

2017 ◽

Vol 23 (2) ◽

pp. 162 ◽

Cited By ~ 8

Author(s):

Jenny Day ◽

Ann Clare Thorington Taylor ◽

Peter Summons ◽

Pamela Van Der Riet ◽

Sharyn Hunter ◽

...

Keyword(s):

Home Care ◽

Older People ◽

Study Data ◽

Care Quality ◽

Two Phase ◽

Face To Face ◽

Before And After ◽

Qualitative Descriptive ◽

Care Coordinators ◽

Field Notes

This paper reports phase one, conducted from March to June 2015, of a two-phase, qualitative descriptive study designed to explore the perceptions and experiences of older people before and after the introduction of consumer directed care (CDC) to home care packages (HCP) in Australia. Eligible consumers with a local HCP provider were mailed information about the study. Data collection occurred before the introduction of CDC and included face-to-face, in-depth interviews, summaries of interviews, field notes and reflective journaling. Semi-structured questions and ‘emotional touchpoints’ relating to home care were used to guide the interview conversation. Line-by-line data analysis, where significant statements were highlighted and clustered to reveal emergent themes, was used. Five older people, aged 81 to 91 years, participated in the study. The four emergent themes were: seeking quality and reciprocity in carer relationships; patchworking services; the waiting game; and technology with utility. Continuity of carers was central to the development of a trusting relationship and perceptions of care quality among older consumers. Care coordinators and workers should play a key role in ensuring older people receive timely information about CDC and their rights and responsibilities. Participants’ use of contemporary technologies suggests opportunities to improve engagement of HCP clients in CDC.

Download Full-text

Two Stretching Treatments for the Hamstrings: Proprioceptive Neuromuscular Facilitation Versus Kinesio Taping

Journal of Sport Rehabilitation ◽

10.1123/jsr.22.1.59 ◽

2013 ◽

Vol 22 (1) ◽

pp. 59-66 ◽

Cited By ~ 15

Author(s):

Che-Hsiu Chen ◽

Tsun-Shun Huang ◽

Huei-Ming Chai ◽

Mei-Hwa Jan ◽

Jiu-Jenq Lin

Keyword(s):

Outcome Measures ◽

Peak Torque ◽

Muscle Stiffness ◽

Muscle Performance ◽

Static Stretch ◽

Kinesio Taping ◽

Negative Results ◽

Significant Difference ◽

Proprioceptive Neuromuscular Facilitation ◽

Before And After

Context:Recent studies have shown that the static stretch (SS) may adversely affect leg-muscle performance.Objectives:The authors examined the short-term effects of 2 stretching exercises on hamstrings muscle before and after exercise.Design:Crossover.Setting:Laboratory.Participants:9 healthy, physically active men.Interventions:There were 3 protocols in a randomized order with a 7-d interval: nonstretching (CON protocol), hamstrings static stretching (SS) with proprioceptive neuromuscular facilitation (PNF), and SS with kinesio-taping application on the hamstrings.Main Outcome Measures:Outcome measures included first-felt and maximum tolerant-felt range of motion (FROM and TROM), maximal knee-flexion peak torque (PT) at 180°/s, and hamstrings muscle stiffness.Results:Groups were not different at prestretching in terms of hamstrings flexibility, PT, and muscle stiffness. At poststretching, both stretching protocols showed significant increases in FROM and TROM (P < .05). Stiffer hamstrings muscle and decreased PT were found in both SS+PNF and CON protocols (P < .05). However, there was no significant difference in the SS+Taping protocol (P > .05).Conclusion:The stretching protocols improve hamstrings flexibility immediately, but after exercise hamstrings peak torque is diminished in the SS+PNF but not in the SS+Taping group. This means that SS+Taping can prevent negative results from exercise, which may prevent muscle injury.

Download Full-text

Constructing Familiarity and Managing the Self: Ways of Adapting to Life in Nursing and Residential Homes for Older People

Ageing and Society ◽

10.1017/s0144686x00020225 ◽

1996 ◽

Vol 16 (5) ◽

pp. 543-560 ◽

Cited By ~ 31

Author(s):

Jan Reed ◽

Valerie Roskell Payton

Keyword(s):

Older People ◽

Social Activity ◽

The Self ◽

Residential Homes ◽

Social Conventions ◽

The Social ◽

Social Conversation ◽

Before And After ◽

Life History Methodology ◽

The Way

AbstractThis paper reports on the analysis of data collected in a study looking at older people moving into nursing and residential homes. Using life history methodology, participants are interviewed before and after arrival at homes in order to determine the process of adapting to their new environment. Initial data analysis indicates that this process requires extensive social activity on the part of the new resident, involving negotiation of complex social conventions. The discussion focuses on two themes which have been identified from the data: constructing familiarity whereby participants use sometimes tenuous knowledge of people and places to make the home seem less strange, and managing the self, whereby familiarity is used as a means of permitting social conversation to take place without leaving residents open to the dangers of being intrusive. These two themes have relevance for the way in which new residents can be introduced to homes, and the way in which the social skills of older people are viewed.

Download Full-text