A neuropsychologically-based intervention with increased follow-up support for employed women with multiple sclerosis: a pilot randomized controlled trial

Objective: To evaluate feasibility and acceptability of a neuropsychologically-based vocational intervention with increased follow-up support for women with multiple sclerosis. Design: Single-blinded parallel-group randomized controlled trial with 12-month follow-up. Setting: Tertiary-care multiple sclerosis center. Participants: Forty-nine employed women with multiple sclerosis meeting criteria on measures of cognitive dysfunction (Symbol Digit Modalities Test), fatigue (Fatigue Severity Scale), and/or depression (Beck Depression Inventory/Patient Health Questionnaire). Interventions: Participants received either neuropsychological testing and phone feedback regarding findings and tailored recommendations (standard-care treatment), or testing, in-person feedback, and two calls from a care-coordinator (experimental treatment). Measures: Feasibility measures included enrollment and attrition rates, and compliance to recommendations at 12-months between groups. Acceptability was evaluated by participants’ report of benefit from interventions. Secondary analyses included evaluation of symptom changes (cognition, fatigue, depression) from baseline to 12-months. Results: Of 49 women meeting screening measure thresholds, 44 were randomized to treatment groups (attrition: standard-care = 8, experimental = 6), and 30 completed the study (standard-care = 14, experimental = 16). Recommendation adherence rates did not significantly differ between standard-care and experimental groups (31% vs 49%). However, 16/16 experimental participants at least partially completed given recommendations as compared to 8/14 in the standard-care group. Participants across groups (97%) reported benefit from participation. No significant differences in symptom outcomes between groups at 12-months. Conclusion: In-person feedback and care-coordinator calls were feasible and acceptable additions to a neuropsychological intervention and may serve to increase recommendation adherence. Given high drop-out rate, particularly prior to testing, future research may explore avenues to improve completion rates and maximize benefits of such interventions.

Privacy Concerns in Chatbot Interactions

Chatbots are increasingly used in a commercial context to make product- or service-related recommendations. By doing so, they collect personal information of the user, similar to other online services. While privacy concerns in an online (website-) context are widely studied, research in the context of chatbot-interaction is lacking. This study investigates the extent to which chatbots with human-like cues influence perceptions of anthropomorphism (i.e., attribution of human like characteristics), privacy concerns, and consequently, information disclosure, attitudes and recommendation adherence. Findings show that a human-like chatbot leads to more information disclosure, and recommendation adherence mediated by higher perceived anthropomorphism and subsequently, lower privacy concerns in comparison to a machine-like chatbot. This result does not hold in comparison to a website; human-like chatbot and website were perceived as equally high in anthropomorphism. The results show the importance of both mediating concepts in regards to attitudinal and behavioral outcomes when interacting with chatbots.

Sustainability of a proactive geriatric trauma consultation service

Background: Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. Methods: We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012–December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Results: Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Conclusion: Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.

Adherence to the World Cancer Research Fund/American Institute for Cancer Research Recommendations for Cancer Prevention Is Associated With Better Health-Related Quality of Life Among Elderly Female Cancer Survivors

Purpose The 2007 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) diet and physical activity guidelines encourage cancer survivors to follow its cancer prevention recommendations. We evaluated whether adherence to the WCRF/AICR recommendations was associated with health-related quality of life (HRQOL) among elderly female cancer survivors. Patients and Methods A total of 2,193 women with a confirmed cancer diagnosis (1986 through 2002) in the Iowa Women's Health Study were identified. We calculated a WCRF/AICR recommendation adherence score (range, 0 to 7), assigning one point each for seven recommendations. Physical and mental component summary scores (PCS, MCS) from the Medical Outcomes Study Short Form–36 Health Survey were compared by recommendation adherence scores. Results Mean adherence score was 4.0 ± 1.2. Overall, higher adherence to the WCRF/AICR guidelines was significantly associated with better PCS and MCS after adjustment for age, education, marital status, number of comorbidities, smoking, cancer stage, and current cancer treatment (Ptrend < .001 for both). PCS was 43.5 versus 37.0 and MCS was 54.2 versus 52.0 among women with adherence scores ≥ 5 compared with women scoring ≤ 3. Adherence to the physical activity recommendation was associated with higher PCS and MCS after adjusting for demographic and medical confounders, body mass index, and dietary recommendation adherence. For the body weight recommendation, adherence was associated with higher PCS but lower MCS, whereas adherence to the dietary recommendations was associated with higher MCS only. Conclusion Following the lifestyle guidelines for cancer prevention may improve HRQOL among elderly female cancer survivors. Physical activity may be a key lifestyle factor to improve HRQOL.