scholarly journals Providing Remote Students with Access to a Video-enabled Standardized Patient Simulation on Interprofessional Competencies and Late-life Depression Screening

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Melodee Harris ◽  
Leonie Declerk ◽  
Patricia Schafer ◽  
Lisa Hutchison ◽  
Mary Alice Kelly ◽  
...  
Keyword(s):  
Interprofessional Education ◽  
Small Sample Size ◽  
Late Life ◽  
Small Sample ◽  
Depression Screening ◽  
Linear Mixed Effect Model ◽  
Standardized Patient ◽  
Late Life Depression ◽  
Mixed Effect ◽  
Significant Difference

Background  Standardized patient (SP) simulation is used to teach geropsychiatry. This project tested feasibility and effectiveness of video-enabled SP simulation to teach interprofessional (IP) late-life depression screening.Methods and findings  Nurse practitioner, pharmacy, and medical students (N=177) participated in remote (n = 27) and on-site (n = 150) SP simulation. Linear mixed-effect model determined the effects of time and setting on pretest and posttest Interprofessional Education Collaborative Competencies Attainment Survey (ICCAS) data. Overall, no significant difference was observed in degree of change on ICCAS domains, indicating both modalities produced equally beneficial outcomes. Small sample size and focus on late-life depression screening limits generalizing results.Conclusions  Video-enabled SP simulations can be incorporated to prepare students with IP competencies for late-life depression screening.

scholarly journals Trialing net illumination as a bycatch mitigation measure for sea turtles in a small-scale gillnet fishery in Ecuador

2020 ◽  
Vol 48 (3) ◽  
pp. 446-455
Author(s):  
Jodie J. Darquea ◽  
Clara Ortiz-Alvarez ◽  
Francisco Córdova-Zavaleta ◽  
Robert Medina ◽  
Alessandra Bielli ◽  
...  
Keyword(s):  
Sea Turtles ◽  
Small Sample ◽  
Small Scale ◽  
Linear Mixed Effect Model ◽  
Catch Per Unit Effort ◽  
Olive Ridley ◽  
Mixed Effect ◽  
Mitigation Measure ◽  
Turtle Species ◽  
Significant Difference

In Ecuador, one of the main hazards for threatened marine species, such as sea turtles, is small-scale fisheries bycatch. At a global scale, currently, bycatch reduction technologies (BRTs) are being tested in many coastal nations to mitigate this issue. Despite some advances in Ecuadorian efforts for wildlife protection, BRTs to reduce bycatch have yet to be assessed. The purpose of this study was to test the BRT of net illumination using violet light-emitting diodes (LEDs) as a mitigation measure to reduce sea turtle interactions in the small-scale driftnet fishery operating from the ports of Santa Rosa, Puerto Lopez and Jaramijo. A total of 146 pairs of experimental sets (control and illuminated panes) were deployed in all ports. A generalized linear mixed-effect model (GLMM) was employed to analyze the bycatch per unit of effort (BPUE) for sea turtles, and the catch per unit of effort (CPUE) for target species; for both control and illuminated panes. Thirty-two sea turtles from three species were observed captured: olive ridley Lepidochelys olivacea (n=18), green Chelonia mydas (n=13) and leatherback turtles Dermochelys coriacea (n=1). Turtle species-specific modeling showed bycatch of green turtles declined by 93% in illuminated nets compared with control, non-illuminated nets, whereas no significant difference between control and illuminated nets was observed for olive ridley turtles. The catch per unit effort of the target pelagic fish species including skipjack tuna, yellowfin tuna, mahi-mahi, thresher shark and smooth hammerhead shark was not affected by net illumination. Our results represent the first evaluation of the effects of net illumination using LEDs on reducing marine turtle bycatch in Ecuadorian small-scale driftnet fisheries. Despite its relatively small sample size, these results could be used by fisheries managers to support the implementation or further testing of this BRT in gillnet fisheries along the Ecuadorian coast.

050 Evening Alcohol Consumption and Slow Wave Sleep: Impact on Morning Hippocampus-Dependent Learning across Three Nights

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A21-A21
Author(s):  
Alexandria Elkhadem ◽  
Jared Saletin ◽  
Caroline Gredvig-Ardito ◽  
John McGeary ◽  
Mary Carskadon
Keyword(s):  
Alcohol Consumption ◽  
Slow Wave ◽  
Slow Wave Sleep ◽  
Small Sample Size ◽  
Alcohol Concentration ◽  
Small Sample ◽  
Linear Mixed Effect Model ◽  
Mixed Effect ◽  
Single Night ◽  
Dependent Learning

Abstract Introduction Numerous studies interrogated the relationship between alcohol and a single night of sleep. Yet, many adults engage in cumulative days of drinking. Previous studies show alcohol on a single night increases slow wave sleep in the first third of night. Similarly, sleep has been associated with the success of daytime learning. Our goal was to investigate across three consecutive nights how evening alcohol use and nighttime sleep are associated with morning learning. Methods 23 adults (11F, mean age 33.5±12 years) completed six nights of PSG monitored sleep. Participants consumed alcohol with a target 0.08 breath alcohol concentration (BrAC) and no alcohol on three consecutive nights in counterbalanced order. Percent of slow wave sleep (SWS%) in the first third of the night was derived. Learning was assessed each morning with distinct stimuli on the Mnemonic Similarity Task (MST). The MST score derived was the Lure Discrimination Index (LDI), defined as the proportion of similar images correctly identified minus the proportion of old images incorrectly identified. Results SWS% during the first third of the night was greater for alcohol nights compared to non-alcohol nights (F(1, 110)=10.891, p=0.01). However, there was no evidence that either night number or the interaction of drink content and night number affected %SWS in the first third of night (all p’s > 0.05). There was a modest decrease in LDI on mornings following alcohol consumption; however, this effect was not significant. In a separate linear mixed-effect model we found no evidence for an effect of night number, drink content, or their interaction on MST LDI scores (all p’s > 0.05). Conclusion Our results indicate that slow wave sleep in the first third of the night is sensitive to evening alcohol consumption. Despite prior literature associating slow wave sleep with next-day learning, we observed no effect of alcohol or night number on morning learning. It is possible that the small sample size contributed to our results. There is little prior research on the cumulative effects of alcohol on sleep and learning; our study adds to this area of research despite the negative findings. Support (if any) R01AA025593

scholarly journals NI-19 Use of 11C-methionine PET for decision of discontinuation of adjuvant chemotherapy with temozolomide

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii14-ii14
Author(s):  
Takaaki Beppu ◽  
Yuichi Sato ◽  
Toshiaki Sasaki ◽  
Kazunori Terasaki ◽  
Kuniaki Ogasawara
Keyword(s):  
Adjuvant Chemotherapy ◽  
Small Sample Size ◽  
Standardized Uptake Value ◽  
Progression Free Survival ◽  
Residual Tumor ◽  
Small Sample ◽  
Tumor Type ◽  
Diffuse Astrocytoma ◽  
Significant Difference ◽  
Met Pet

Abstract Background: The aim was to clarify whether positron emission tomography with 11C-methyl-L-methionine (met-PET) is useful to decide on discontinuation of TMZ-adjuvant therapy in patients with residual diffuse astrocytic tumor. Methods: Subjects were 44 patients with residual tumor comprising 17 with IDH1-mutant diffuse astrocytoma (DA), 13 with IDH1-mutant anaplastic astrocytoma (AA), and 14 with IDH1-wild glioblastoma (GB). All patients received TMZ-adjuvant chemotherapy (median, 12 courses), and whether to discontinue or continue TMZ-adjuvant chemotherapy was decided on the basis of the tumor-to-normal ratio in standardized uptake value from met-PET (T/N); patients with T/N < 1.6 immediately discontinued TMZ, and patients with T/N > 1.6 were either to continued or discontinued TMZ. Progression-free survival (PFS) was compared between patients with T/N > 1.6 and T/N < 1.6 in each tumor type. Median observation period was 434 days after met-PET scanning. Results: The number of patient who underwent recurrence was 10 in DA, 7 in AA, and 11 in GB. All patients showing T/N > 1.6 underwent tumor recurrence. PFS was significantly longer in patients with T/N < 1.6 than T/N > 1.6 in DA and AA (p < 0.01 in both types), but was no significant difference between 2 groups in GB (p = 0.06). Sixteen of 17 patients (94%) in DA and AA showed recurrence from residual tumor, whereas 4 of 11 patients (36%) in GB showed recurrent tumor at remote regions which were different from residual tumor. Conclusions: The present study suggested that met-PET is beneficial to decide to discontinue adjuvant chemotherapy with TMZ in patients with residual tumors of DA and AA, but not useful for patients with GB. Reasons for unsuccessful results in GB might have been small sample size, failure of establishing the cut off value in T/N, recurrences at remote regions where not be assessed by met-PET.

scholarly journals 1611. Evaluating Clinical Outcomes and Efficacy of Daptomycin in Combination with a Beta-Lactam for the Treatment of Vancomycin-Resistant Enterococcus (VRE) Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S799-S800
Author(s):  
Nerea Irusta ◽  
Ana Vega ◽  
Yoichiro Natori ◽  
Lilian M Abbo ◽  
Lilian M Abbo ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Primary Outcome ◽  
Small Sample Size ◽  
Univariate Analysis ◽  
Small Sample ◽  
Significant Difference ◽  
Vancomycin Resistant ◽  
Secondary Outcomes ◽  
Related Mortality

Abstract Background In-vitro studies have shown synergistic bactericidal activity with daptomycin (DAP) plus β-lactam antimicrobials against vancomycin resistant enterococci (VRE). There is a paucity of data regarding clinical outcomes with this combination in VRE bloodstream infections (BSI). The purpose of this study was to assess the efficacy of DAP plus a β-lactam with in-vitro activity vs. other therapies for treatment of VRE BSI. Methods IRB-approved, single-center, retrospective study of patients with VRE BSI from 01/2018-09/2019. Patients were excluded if < 18 years old, pregnant, or incarcerated. The primary outcome was time-to-microbiological clearance. Secondary outcomes included infection-related mortality, 30-day all-cause mortality, and incidence of recurrent BSI within 30 days of index culture. Targeted DAP doses were ≥ 8mg/kg and based on MIC. Factors associated with significance for outcomes, via univariate analysis, were evaluated with multivariable logistic regression (MLR), removed in a backward-step approach. Results A total of 85 patients were included, 23 of which received DAP plus a β-lactam. The comparator arm included linezolid or DAP monotherapy. Patients with combination therapy had significantly higher Charlson Comorbidity Index (CCI) (p=0.013) and numerically higher Pitt Bacteremia scores (PBS) (p=0.087) (Table 1). There was no difference seen in the primary outcome (Table 2). Secondary outcomes are provided in Table 2. The presence of polymicrobial infection and higher PBS were significantly associated with infection-related mortality (p=0.008 and p=0.005, respectively) by MLR. A Mann Whitney U test indicated that presence of infection-related mortality was greater for patients with higher MICS (U=20.5, p=0.06). The presence of an underlying source may be related to recurrence of BSI (p=0.075). Table 1: Patient Characteristics Table 2. Primary and Secondary Outcomes Conclusion We did not find a significant difference in time-to-microbiological clearance, although patients treated with DAP and a β-lactam had higher CCI and PBS. These results are limited by retrospective design, small sample size, and potential selection bias. Prospective randomized studies are needed to further validate these findings. Disclosures All Authors: No reported disclosures

scholarly journals Perioperative Outcomes Following Kidney-Pancreas Transplantation in Alberta, Canada: Research Letter

2021 ◽  
Vol 8 ◽  
pp. 205435812110293
Author(s):  
Danielle E. Fox ◽  
Robert R. Quinn ◽  
Paul E. Ronksley ◽  
Tyrone G. Harrison ◽  
Hude Quan ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Postoperative Care ◽  
Pancreas Transplantation ◽  
Type I Diabetes ◽  
Small Sample Size ◽  
Small Sample ◽  
Perioperative Outcomes ◽  
Type I ◽  
Patient Safety Indicators ◽  
Significant Difference

Background: Simultaneous kidney-pancreas transplantation (SPK) has benefits for patients with kidney failure and type I diabetes mellitus, but is associated with greater perioperative risk compared with kidney-alone transplantation. Postoperative care settings for SPK recipients vary across Canada and may have implications for patient outcomes and hospital resource use. Objective: To compare outcomes following SPK transplantation between patients receiving postoperative care in the intensive care unit (ICU) compared with the ward. Design: Retrospective cohort study using administrative health data. Setting: In Alberta, the 2 transplant centers (Calgary and Edmonton) have different protocols for routine postoperative care of SPK recipients. In Edmonton, SPK recipients are routinely transferred to the ICU, whereas in Calgary, SPK recipients are transferred to the ward. Patients: 129 adult SPK recipients (2002-2019). Measurements: Data from the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) were used to identify SPK recipients (procedure codes) and the outcomes of inpatient mortality, length of initial hospital stay (LOS), and the occurrence of 16 different patient safety indicators (PSIs). Methods: We followed SPK recipients from the admission date of their transplant hospitalization until the first of hospital discharge or death. Unadjusted quantile regression was used to determine differences in LOS, and age- and sex-adjusted marginal probabilities were used to determine differences in PSIs between centers. Results: There were no perioperative deaths and no major differences in the demographic characteristics between the centers. The majority of the SPK transplants were performed in Edmonton (n = 82, 64%). All SPK recipients in Edmonton were admitted to the ICU postoperatively, compared with only 11% in Calgary. There was no statistically significant difference in the LOS or probability of a PSI between the 2 centers (LOS for Edmonton vs Calgary:16 vs 13 days, P = .12; PSIs for Edmonton vs Calgary: 60%, 95% confidence interval [CI] = 0.50-0.71 vs 44%, 95% CI = 0.29-0.59, P = .08). Limitations: This study was conducted using administrative data and is limited by variable availability. The small sample size limited precision of estimated differences between type of postoperative care. Conclusions: Following SPK transplantation, we found no difference in inpatient outcomes for recipients who received routine postoperative ICU care compared with ward care. Further research using larger data sets and interventional study designs is needed to better understand the implications of postoperative care settings on patient outcomes and health care resource utilization.

Variation in Cervical Length over Time during a Single Transvaginal Ultrasound Examination

2018 ◽  
Vol 36 (08) ◽  
pp. 781-784
Author(s):  
Katherine A. Connolly ◽  
Luciana Vieira ◽  
Elizabeth M. Yoselevsky ◽  
Stephanie Pan ◽  
Joanne L. Stone
Keyword(s):  
Correlation Coefficient ◽  
Intraclass Correlation Coefficient ◽  
Ultrasound Examination ◽  
Transvaginal Ultrasound ◽  
Intraclass Correlation ◽  
Cervical Length ◽  
Linear Mixed Effect Model ◽  
Mixed Effect ◽  
Time Points ◽  
Significant Difference

Objective To quantify the degree of change in cervical length (CL) over a 3-minute transvaginal ultrasound. Study Design We conducted a prospective observational study of nulliparous patients who underwent routine transvaginal CL screening at the time of their second-trimester ultrasound. We recorded CL at four time points (0, 1, 2, 3 minutes) and compared these values to determine the minute-to-minute change within a single patient. Results A total of 771 patients were included. The mean gestational age was 20.8 weeks (±0.84). We used a linear mixed effect model to assess if each minute during the ultrasound is associated with a change in CL. The intraclass correlation coefficient between minute 0 to minute 3 was 0.82 (95% confidence interval: 0.80, 0.84). This indicates that there is a relatively high within-patient correlation in CL during their ultrasound. Additionally, we stratified patients based on their starting CL; the intraclass correlation coefficient remained high for all groups. We additionally compared CL at each minute. Although there is a statistically significant difference between several time points, the actual difference is small and not clinically meaningful. Conclusion The variation in CL over a 3-minute transvaginal ultrasound examination is not clinically significant. It may be reasonable to conduct this examination over a shorter period.

Culturally adapted and lay-delivered cognitive behaviour therapy for older adults with depressive symptoms in rural China: a pilot trial

2020 ◽  
pp. 1-5
Author(s):  
Jiaqi Yuan ◽  
Yi Yin ◽  
Xinfeng Tang ◽  
Tan Tang ◽  
Qinshu Lian ◽  
...  
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Health Workers ◽  
Pilot Trial ◽  
Depression Scale ◽  
Late Life ◽  
Late Life Depression ◽  
Mixed Effect ◽  
Culturally Adapted ◽  
Cognitive Behaviour

Abstract Background: Late-life depression issues in developing countries are challenging because of understaffing in mental health. Cognitive behavioural therapy (CBT) is effective for treating depression. Aim: This pilot trial examined the adherence and effectiveness of an eight-session adapted CBT delivered by trained lay health workers for older adults with depressive symptoms living in rural areas of China, compared with the usual care. Method: Fifty with screen-positive depression were randomly assigned to the CBT arm or the care as usual (CAU) arm. The primary outcomes were the session completion of older adults and changes in depressive symptoms, assessed using the Geriatric Depression Scale (GDS). Results: The majority (19/24) of participants in the CBT arm completed all sessions. Mixed-effect linear regression showed that the CBT reduced more GDS scores over time compared with CAU. Conclusion: Lay-delivered culturally adapted CBT is potentially effective for screen-positive late-life depression.

scholarly journals Nutritional Support and Clinical Outcome of Severe and Critical Patients With COVID-19 Pneumonia

2020 ◽  
Vol 7 ◽  
Author(s):  
Xiangfeng Yue ◽  
Min Li ◽  
Yu Wang ◽  
Jing Zhang ◽  
Xinyi Wang ◽  
...  
Keyword(s):  
Protein Intake ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Antiviral Treatment ◽  
Small Sample ◽  
Nutrition Support ◽  
Calorie Intake ◽  
Viral Shedding ◽  
Significant Difference ◽  
Critical Patients

Background: In 2020, a novel coronavirus has spread throughout the world. More than four hundred thousand people have died of SARS-CoV-2 pneumonia, most of which were severe and critical patients. No effective antiviral treatment has been verified thus far. Nutrition support has become one of the important treatments for severe and critical patients.Methods: In this retrospective study, 26 severe patients and 22 critical patients with laboratory confirmed COVID-19 were enrolled. We recorded the diet and nutritional treatments in severe and critical patients. Baseline characteristics and clinical outcomes of severe and critical patients were also collected.Results: Average calorie intake of severe patients (19.3 kcal/kg/d) was higher than critical patients (15.3 kcal/kg/d) (P = 0.04). Protein intake was similar in the two groups (0.65 and 0.62 g/kg per day, respectively; P = 0.29). There was no significant difference in the median duration of viral shedding between the severe and critical patients (P = 0.354).Conclusions: A permissive underfeeding strategy that restricts non-protein calories but preserves protein intake is feasible for critical patients with SARS-CoV-2 pneumonia. Viral shedding duration of critical patients was the same as severe patients who received standard feeding. Nevertheless, evidence of the conclusion is not sufficient because of small sample size. To show the real clinical benefit of permissive low-calorie and adequate protein intake in critical SARS-CoV-2 pneumonia patients, a large and pragmatic randomized controlled trial is needed.

scholarly journals Survival of patients with melanoma metastatic brain metastases in the era of novel systemic therapies in Cardiff, Wales

2019 ◽  
Vol 21 (Supplement_4) ◽  
pp. iv13-iv13
Author(s):  
Joseph Pasquale ◽  
Joanita Ocen ◽  
James Powell ◽  
Satish Kumar
Keyword(s):  
Targeted Therapy ◽  
Brain Metastases ◽  
Small Sample Size ◽  
Brain Lesion ◽  
Small Sample ◽  
Simultaneous Treatment ◽  
Local Progression ◽  
Significant Difference ◽  
Retrospective Nature ◽  
The Uk

Abstract The incidence of malignant melanoma (MM) is increasing in the UK; it’s projected to rise by 7% by 2035. MM has high predisposition to developing brain metastases (BM) with 50–60% of patients being affected. Stereotactic radiosurgery (SRS) and surgery, key interventions in managing patients with BM, have been shown to improve survival outcomes of patients. Patients’ prognosis and survival has also significantly improved with the advent of novel therapies in the last few years. It was noted that the Cardiff Neuro-Oncology multidisciplinary team were receiving increasing amount of referrals for consideration of surgery or SRS in patients with MM. 106 MDT referrals were retrospectively reviewed. 31 patients had surgery, 20 patients had SRS and the remaining 54 patients had WBRT. There was no significant difference in the patient distribution. The majority of patients had 1 brain lesion in both groups (in similar proportions). The 12 month survival for the surgical cohort was 65% for immunotherapy group, 55%- targeted therapy and 30%- no therapy. For the SRS group the 12 month survival for immunotherapy was 45%, targeted therapy- 40% and 20%- no therapy. The median OS for surgery versus SRS was 8 and 7 months respectively. The results suggest that simultaneous treatment with surgery or SRS in conjunction with SACT does improve survival. Interpretation of results will have to be taken with caution due to the retrospective nature and the small sample size. Going forward, we will delve deeper and review local progression rates and SACT timing/sequencing in our practice.

scholarly journals Acupuncture for Chronic Pain-Related Insomnia: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Fushui Liu ◽  
Jianyu You ◽  
Qi Li ◽  
Ting Fang ◽  
Mei Chen ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Sample Size ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Small Sample ◽  
Control Group ◽  
Large Sample Size ◽  
Cure Rate ◽  
Significant Difference

Objectives. Acupuncture has been widely used to relieve chronic pain-related insomnia (CPRI). However, the efficacy of acupuncture for CPRI is uncertain. The purpose of this study was to evaluate the efficacy of acupuncture for CPRI. Methods. Seven electronic databases were searched from inception to December 2018. Randomized controlled trials (RCTs) were included if acupuncture was compared to sham acupuncture or conventional drug therapies for treating CPRI. Two reviewers screened each study and extracted data independently. Statistical analyses were conducted by RevMan 5.3 software. Results. A total of nine studies involving 944 patients were enrolled. The pooled analysis indicated that acupuncture treatment was significantly better than control group in improving effective rate (OR = 8.09, 95%CI = [4.75, 13.79], P < 0.00001) and cure rate (OR = 3.17, 95%CI = [2.35, 4.29], P < 0.00001), but subgroup analysis showed that there was no statistically significant difference between acupuncture and sham acupuncture in improving cure rate (OR =10.36, 95% CI [0.53, 201.45], P=0.12) based on one included study. In addition, meta-analysis demonstrated that acupuncture group was superior to control group in debasing PSQI score (MD = -2.65, 95%CI = [-4.00, -1.30], P = 0.0001) and VAS score (MD = -1.44, 95%CI = [-1.58, -1.29], P < 0.00001). And there was no significant difference in adverse events (OR =1.73, 95%CI = [0.92, 3.25], P =0.09) between the two groups. Conclusions. Acupuncture therapy is an effective and safe treatment for CPRI, and this treatment can be recommended for the management of patients with CPRI. Due to the low quality and small sample size of the included studies, more rigorously designed RCTs with high quality and large sample size are recommended in future.

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