scholarly journals Immunological Effects of an Add-On Physical Exercise Therapy in Depressed Adolescents and Its Interplay with Depression Severity

2021 ◽  
Vol 18 (12) ◽  
pp. 6527
Author(s):  
Heidrun Lioba Wunram ◽  
Max Oberste ◽  
Stefanie Hamacher ◽  
Susanne Neufang ◽  
Nils Grote ◽  
...  
Keyword(s):  
Exercise Therapy ◽  
Depressive Disorders ◽  
Small Sample Size ◽  
Small Sample ◽  
Whole Body ◽  
Control Treatment ◽  
Depression Severity ◽  
Post Intervention ◽  
Positive Effects ◽  
Tnf Α

Background: Pro-inflammatory cytokines (PICs) have gained attention in the pathophysiology and treatment of depressive disorders. At the same time, the therapeutic effect of physical activity seems to work via immunomodulatory pathways. The interventional study “Mood Vibes” analyzed the influence of exercise on depression severity (primary endpoint) in depressive adolescents; the influence of PICs on the clinical outcome was analyzed as a secondary endpoint. Methods: Clinically diagnosed depressed adolescents (N = 64; 28.1% male; mean age = 15.9; mean BMI = 24.6) were included and participated either in Whole Body Vibration (WBV) (n = 21) or bicycle ergometer training (n = 20) in addition to treatment-as-usual (TAU). Patients in the control treatment group received TAU only (n = 23). The PICs (interleukin-6—IL-6 and tumor necrosis factor-α—TNF-α) were analyzed before intervention, after 6 weeks of training (t1), and 8 weeks post-intervention (t2). The effects of the treatment on depression severity were rated by self-rating “Depression Inventory for Children and Adolescents” (DIKJ). Results: Basal IL-6 decreased in all groups from t0 to t1, but it increased again in WBV and controls at t2. TNF-α diminished in ergometer and controls from baseline to t1. PIC levels showed no correlation with depression severity at baseline. The influence on DIKJ scores over time was significant for IL-6 in the WBV group (p = 0.008). Sex had an impact on TNF-α (p < 0.001), with higher concentrations in male patients. Higher body mass index was associated with higher IL-6 concentrations over all measurement points (p < 0.001). Conclusions: The positive effects of an intensive add-on exercise therapy on adolescent depression seem to be partly influenced by immunomodulation. A small sample size and non-randomized controls are limitations of this study.

Abstract 248: Initiation and Assessment of Timekeeping Roles During In-Hospital Cardiac Arrests to Track Rhythm Checks and Epinephrine Dosing

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Conor Crowley ◽  
Peter Clardy ◽  
Jessica McCannon ◽  
Rebecca Logiudice
Keyword(s):  
Small Sample Size ◽  
Medical Center ◽  
Academic Medical Center ◽  
Small Sample ◽  
Post Intervention ◽  
Epinephrine Administration ◽  
Team Members ◽  
Minute Post ◽  
Chaotic Nature ◽  
Strongly Agree

Introduction: Compliance to ACLS cardiac arrest algorithm is low and associated with worse outcomes from in-hospital cardiac arrests (IHCA). Reasons for non-compliance include reduced communication due to chaotic nature of IHCAs and difficulty timing epinephrine administration and rhythm check intervals. Hypothesis: Delegating two separate code team members for rhythm and epinephrine timing will increase adherence to ACLS algorithm during IHCAs. Methods: This is a pre-post interventional study of IHCAs at a single academic medical center. Two stopwatches were placed on all code carts and two new timekeeping roles were created. Education was provided to staff regarding the alteration of existing code team member roles for the use of stopwatches. Algorithm adherence was analyzed pre and post implementation of timekeeper roles. Deviation from the 2-minute rhythm check or 3-5-minute epinephrine administration was counted as one deviation. Anonymous surveys were delivered to evaluate providers perceived benefits of timekeeper roles for IHCAs. Results: Data from 13 pre intervention IHCAs were compared to 12 IHCAs post intervention. The initial rhythm was PEA/asystole in 69% pre-intervention vs 83% post intervention. Prior to implementation 82 deviations vs. 11 deviations post implementation occurred (p=0.006). The mean time until first dose of epinephrine was administered pre intervention was 2.3 ± 3.3 minutes vs 0.4 ±1 minute post. Pre-implementation ROSC rate was 53.8% vs. 66.7% post intervention. Surveys were delivered to 100% of code team members post intervention, with a 79% response rate. Surveys demonstrate providers felt time keeping roles made it easier to track epinephrine administration and rhythm checks. On a Likert scale, 78% of providers “strongly agree” that the use of timekeeping roles and devices improved code team communication. Conclusion: Two separate timekeeper roles during IHCAs improved algorithm compliance, code team function and communication, and was favored by code team members. Timekeeper roles may be associated with improved rates of ROSC and less time until the first dose of epinephrine is administered. This study is limited by its small sample size, single center and requires validation.

scholarly journals Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Valerie Wing Yu Wong ◽  
Ying Huang ◽  
Wan In Wei ◽  
Samuel Yeung Shan Wong ◽  
Kin On Kwok
Keyword(s):  
Small Sample Size ◽  
Meta Analysis ◽  
Small Sample ◽  
Risk Of Bias ◽  
Source Control ◽  
Resistant Organism ◽  
Routine Practice ◽  
Post Intervention ◽  
Term Care ◽  
Mrsa Colonization

Abstract Background Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. Objective To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. Interventions (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. Study appraisal and synthesis We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60–1.10]; medium: RR 0.81 [95% CI 0.25–2.68]; short: RR 0.95 [95% CI 0.53–1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. Conclusions Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability—particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.

scholarly journals Developing Product Liability Index for Korean Manufacturing Companies

2017 ◽  
Vol 21 (2) ◽  
pp. 20 ◽  
Author(s):  
JunHyeok Seo ◽  
SungMin Bae
Keyword(s):  
Evaluation System ◽  
Small Sample Size ◽  
Product Liability ◽  
Small Sample ◽  
Response Strategy ◽  
Corporate Management ◽  
Organized Activities ◽  
Manufacturing Companies ◽  
Financial Loss ◽  
Positive Effects

<p><strong>Purpose:</strong> PL (product liability) response system is an enterprise-wide system that prevents company’s financial loss due to PL-related accidents. This study aims at developing an evaluation system for objectively assessing the extent to which companies carry out systematic and organized activities for product liability, including product safety activities, preventive actions, and protective measures.</p><p><strong>Methodology/Approach:</strong> We used the Delphi and analytical hierarchy process methods to develop an evaluation system with product liability experts to present the relative importance of response strategy based on selected evaluation criteria. And then, we carried out systematic and organized PL activities of each industry, scale, and growth stage of the Korean manufacturing companies through PLI.</p><p><strong>Findings:</strong> In terms of the scale of the manufacturer, Large-sized firms has the highest PLI of 92.32. Also, middle- to large sized firms and middle-sized firms have the highest PLI of 90.63 and 77.35, respectively. And then In terms of the importance of all manufacturers, Awareness was identified as the most important component influencing corporate management activities, with the highest PLI of 78.59.</p><p><strong>Research Limitation/implication:</strong> This study is limited due to the small sample size and the number of examples.</p><strong>Originality/Value of paper:</strong> Our paper will enable consumers to determine a manufacturer’s response to product liability, and the subsequent positive effects, such as the increase of quality in consumption life.

scholarly journals Preliminary Support for a Cognitive Remediation Intervention for Women During the Menopausal Transition: A Pilot Study

2021 ◽  
Vol 2 ◽  
Author(s):  
Elena C. Ballantyne ◽  
Jelena P. King ◽  
Sheryl M. Green
Keyword(s):  
Small Sample Size ◽  
Cognitive Remediation ◽  
Small Sample ◽  
Cognitive Test ◽  
Control Group ◽  
Emotional Symptoms ◽  
Depression Anxiety Stress Scale ◽  
Post Intervention ◽  
Clinical Trial Registration ◽  
Cognitive Improvement

Background: Menopause is associated with physical and emotional symptoms, and subjective cognitive concerns that are generally not borne out on objective cognitive measures. This discrepancy suggests that a psychological rather than biological mechanism likely mediates the cognitive concerns of women in menopause. The current study assessed the feasibility and effectiveness of a cognitive remediation intervention with the goal of reducing subjective perceptions of cognitive difficulty during the menopause.Methods: Twenty-seven menopausal women (M age = 53.74, SD = 4.14) completed a 5-week group-based intervention (with a post-group booster) consisting of 2-h weekly sessions. Participants completed pre- and post-intervention measures capturing subjective cognitive ability, mood, anxiety, stress, personality, and objective cognitive tests. The primary variable of interest was self-reported cognitive confidence measured by the Memory and Cognitive Confidence Scale (MACCS).Results: All but one MACCS subscale significantly decreased over the course of treatment (with lower scores associated with higher confidence) and effect sizes ranged from small to large (d = −0.39 to −0.91) with gains maintained at 1-month follow-up. Interestingly, no change in objective cognitive test performance was observed, indicating increases in subjective cognitive confidence in the absence of objective cognitive improvement. There was no change in mood, anxiety, or stress scores. Two-level HLM analyses revealed that those with higher baseline neuroticism, as measured by the NEO Personality Inventory, had smaller decreases in post-group MACCS High Standards subscale relative to those with lower baseline neuroticism (p = 0.027, d = −0.45). Those with higher baseline depression scores on the Depression Anxiety Stress Scale (DASS-21) had a smaller decrease in post-intervention MACCS Total Score relative to those with lower depression ratings.Conclusion: To our knowledge, this is the first feasibility study of its kind targeting perceptions of cognitive impairment during menopause. Although generally well-tolerated, recruitment and scheduling difficulties were flagged as challenges to engagement while a small sample size and lack of control group limit conclusions about efficacy. Providing current results could be replicated with enhanced methods, these results provide support that cognitive remediation is a feasible and credible treatment, and may improve quality of life for women in menopause.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03311880.

Utility of photography to confirm skin lesion response assessed using a severity weighted assessment tool (SWAT) in cutaneous T-cell lymphoma (CTCL)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6579-6579
Author(s):  
B. S. Mann ◽  
J. R. Johnson ◽  
K. He ◽  
R. Sridhara ◽  
A. T. Farrell ◽  
...  
Keyword(s):  
Assessment Tool ◽  
Small Sample Size ◽  
Normal Skin ◽  
Skin Lesions ◽  
Small Sample ◽  
Whole Body ◽  
Cutaneous Manifestations ◽  
Technological Advances ◽  
Duration Of Response ◽  
Blurred Image

6579 Background: In Oct 2006, FDA approved vorinostat for treatment of cutaneous manifestations of CTCL–based on response rate and duration of response observed in CTCL skin lesions. Response was determined by change in SWAT score at follow up compared to the baseline score. SWAT Score: sum of % Body Surface Area weighted by factor 1, 2, or 4 for patch (no elevation from normal skin), plaque (< 5 mm elevation) and tumor (= 5 mm elevation), respectively. All responses but one were partial. A partial response required = 50% reduction in whole body SWAT score lasting = 4 weeks. FDA also reviewed serial photographs of all patients (standard whole body views and close-ups of skin lesions), submitted as supportive evidence. Methods: An expert external reviewer, blind to SWAT scores, adjudicated responses by examining photographs and response determinations by photographs and by SWAT scores were compared. Results: Based on SWAT scores, skin lesions in 18 of 61 stage = IIB CTCL patients responded to vorinostat; there were 17 partial and 1 complete responses. Blinded reviewer adjudicated 4 photographs not evaluable (reasons: blurred image, color or light problem, wrong label), easily confirmed 7 responses, and called 7 responses equivocal. Responses seemed easier to determine in skin lesions with tumors or ulcers. Predominantly patch or plaque lesions were harder to evaluate: patches due to poor color reproduction and plaques due to inability to palpate. A response from plaque to patch morphology decreases SWAT score 50%, but the change may not manifest adequately in a photograph. Small sample size did not allow a reliable statistical analysis for correlation between different lesion types and ability to confirm objective responses (based on SWAT scores) by photography. Conclusions: Photography allows a limited evaluation of skin lesions in CTCL: inability to measure lesion thickness in photographs limits direct confirmation of SWAT scores. Photography complements SWAT evaluation: in half the cases in the vorinostat pivotal trial, a response by SWAT score was easily confirmed by the reviewer blind to SWAT scores. Further experience and technological advances in photography may reduce the number of not evaluable photographs. No significant financial relationships to disclose.

scholarly journals A Randomised Controlled Trial Comparing the Effect of E-learning, with a Taught Workshop, on the Knowledge and Search Skills of Health Professionals

2006 ◽  
Vol 1 (3) ◽  
pp. 44 ◽  
Author(s):  
Nicola Pearce-Smith
Keyword(s):  
Randomised Controlled Trial ◽  
Sample Size ◽  
Health Professionals ◽  
Search Strategy ◽  
Small Sample Size ◽  
Controlled Trial ◽  
Small Sample ◽  
Post Intervention ◽  
E Learning ◽  
Randomised Controlled

Objective - The aim of the trial was to establish whether there is a significant difference in terms of knowledge and skills, between self-directed learning using a web-based resource, compared with a classroom based interactive workshop, for teaching health professionals how to search. The outcomes measured were knowledge of databases and study designs, and search skills. Methods - The study design was a randomised controlled trial (RCT). 17 health professionals were randomised into one of two groups – one group (EG) received access to a search-skills web resource, and the other group received a search workshop (WG) taught by a librarian. Participants completed pre- and post-intervention tests involving multiple choice questions and practical searching using clinical scenarios.. Results - 9 WG and 6 EG participants completed both pre-and post-intervention tests. The test results were blindly marked using a score chart developed with two other librarians. For question formulation and devising a search strategy, all participants obtained a score that was the same or better after receiving the intervention (both WG and EG), but statistical analysis showed that the only significant outcomes were for the WG devising a search strategy (p=0.01) and preferring to search using MeSH after receiving the taught workshop (p=0.02). The Mann-Whitney test showed there were no significant differences in any of the outcomes (p>0.05), between the WG and the EG. The statistical analyses must be viewed with caution due to the small sample size. Conclusions - There were no significant differences in knowledge of databases and study design, or search skills, when the WG and the EG were compared. Although many participants obtained a score that was higher post-intervention, only devising a search strategy and preferring to search using MeSH were significant for the WG. The question of whether a taught workshop and an e-learning module are of equal effectiveness in teaching search skills, is an important one for health librarians involved in user education, and was a justifiable topic to propose and conduct research. The fact that the results are mainly inconclusive due to the small sample size is disappointing, but does not diminish the importance of conducting the study.

A systematic review of treatments for alcohol-related cognitive impairment: lessons from the past and gaps for future interventions

2020 ◽  
Vol 50 (13) ◽  
pp. 2113-2127
Author(s):  
Elsa Caballeria ◽  
Clara Oliveras ◽  
Laura Nuño ◽  
Mercedes Balcells-Oliveró ◽  
Antoni Gual ◽  
...  
Keyword(s):  
Systematic Review ◽  
Working Memory ◽  
Cognitive Impairment ◽  
Cognitive Function ◽  
Small Sample Size ◽  
Small Sample ◽  
Long Term Memory ◽  
Positive Effects ◽  
Jadad Scale ◽  
No Gold Standard

AbstractAlcohol-related cognitive impairment (ARCI) is highly prevalent among patients with alcohol dependence. Although it negatively influences treatment outcome, this condition is underdiagnosed and undertreated. The aim of this systematic review is to investigate the existing evidence regarding both cognitive and pharmacological interventions for ARCI. We systematically reviewed PubMed, Scopus and Science direct databases up to May 2019 and followed the PRISMA guidelines. The quality of the studies was assessed using the Jadad Scale. Twenty-six studies were eligible for inclusion (14 referring to neuropsychological interventions and 12 to pharmacological treatments). Among neuropsychological interventions, computerised treatments, errorless learning and component method showed positive effects on working memory, memory measures and general cognitive function. On the other hand, thiamine, memantine and methylphenidate improved working memory, long-term memory and general cognitive function. Nevertheless, these studies have several limitations, such as small sample size, lack of replication of the results or low specificity of the interventions. Therefore, no gold-standard intervention can yet be recommended for clinical practice, and further research based on promising strategies (e.g. digital interventions, thiamine) is required.

scholarly journals Traditional Chinese Herbal Medicines for Treating HIV Infections and AIDS

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Wen Zou ◽  
Ying Liu ◽  
Jian Wang ◽  
Hongjuan Li ◽  
Xing Liao
Keyword(s):  
Hiv Infection ◽  
Small Sample Size ◽  
Oral Candidiasis ◽  
Herbal Medicines ◽  
Hiv Infections ◽  
Integrated Treatment ◽  
Antiretroviral Drugs ◽  
Small Sample ◽  
Positive Effects ◽  
Peripheral Leukocytes

To assess the effects of TCHM on patients with HIV infection and AIDS, we reviewed eleven randomized placebo-controlled trials involving 998 patients. Due to the limited number of RCTs for included trials and the small sample size of each study, we are not able to draw firm conclusions concerning TCHM therapy in treating patients with HIV infection and AIDS. However, some high-quality clinical studies do exist. Studies of diarrhea and oral candidiasis, which are challenging symptoms of AIDS, were demonstrated to have positive effects. Study of peripheral leukocytes, which are a side effect of antiretroviral drugs, suggested that an integrated treatment approach may be of benefit. The overall methodological quality of the trials was adequate; however, randomization methods should be clearly described and fully reported in these trials according to the Consolidated Standards of Reporting Trials (CONSORT).

Sleep in care homes

2010 ◽  
Vol 20 (4) ◽  
pp. 309-316 ◽  
Author(s):  
Adam L Gordon ◽  
John RF Gladman
Keyword(s):  
Physical Exercise ◽  
Sleep Problems ◽  
Light Exposure ◽  
Small Sample Size ◽  
Care Home ◽  
Sleep Hygiene ◽  
Small Sample ◽  
Care Homes ◽  
Positive Effects ◽  
Co Morbidity

SummarySleep problems in older adults are common and disturbance in sleep is associated with increased mortality. These problems are more pronounced in the care home population because of institutional factors and a high prevalence of frailty and co-morbidity. This article reviews the randomized controlled trials undertaken to address sleep problems in care homes. These suggest that stand-alone therapies – oral melatonin and light therapy – have no effect on sleep but that combination treatments – physical exercise plus sleep hygiene, physical exercise plus sleep hygiene plus light and melatonin plus light – may have positive effects. These effects are more marked for daytime arousal than nocturnal sleep. Practical considerations for care homes are how to maximize light exposure, incorporate exercise into daily routines and minimize night-time disruption for residents. Trials undertaken so far are compromised by small sample size and inappropriate randomization strategies and further research is therefore required.

scholarly journals Brief telephone intervention for caregivers of medically complex patients during COVID-19

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 935-935
Author(s):  
Mary Stevens-Carr ◽  
Kevin Sethi ◽  
Channing Cochran ◽  
Margaret Bencomo-Rivera ◽  
Janice Marceaux
Keyword(s):  
Mixed Model ◽  
Small Sample Size ◽  
Small Sample ◽  
Adult Day Care ◽  
Telephone Intervention ◽  
Post Intervention ◽  
Home Based Primary Care ◽  
Home Based ◽  
Complex Patients ◽  
Mixed Model Anova

Abstract The VA Home Based Primary Care (HBPC) program consists of an interdisciplinary team, including psychology, serving veterans with complex medical conditions who are supported by live-in caregiver(s). HBPC psychologists may work with caregivers to address caregiver stress. Some veterans enrolled in HBPC attend Adult Day Care (ADC) programs, allowing respite for caregivers. At the onset of COVID19 pandemic, ADC centers closed to minimize spread of the virus. The authors identified these caregivers to be at high risk for burnout and sought to develop a protocol to assist these caregivers via telephone and evaluate outcomes. PreCOVID-19 caregiver stress was known via a 4-item Zarit Caregiver Burden annual screening (Bédard et al., 2001). Following ADC closures, caregivers of veterans enrolled in ADC programs were contacted and re-administered the Zarit to determine impact of COVID-19 on caregiver stress. Caregivers of veterans not attending ADC were also contacted for comparison. Contacted caregivers were provided a brief CBT-based intervention via telephone, and post-intervention Zarit screening was administered after two weeks. Ultimately, 4 ADC caregivers and 4 non-ADC caregivers were contacted and provided with services before ADC centers reopened. Statistical analysis via mixed model ANOVA did not yield significant results, likely due to small sample size, although there was a large effect size (η_p^2 =.566). ADC caregivers generally reported increased stress from baseline following ADC closure and reduced stress following provision of intervention. The authors will present caregiver feedback about aspects of telephone intervention that were helpful, and not helpful, as well as authors impression.

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