828 STITCH And B**** - A Novel Programme Combining Pastoral Support and Surgical Skills

Aim Foundation training can be a challenging time for Junior doctors; though help and support is offered, it is not always taken up. This programme aims to create a safe environment to facilitate discussion and provide pastoral support alongside teaching them new surgical skills. Method Four different sessions were organised over the period of four months (August 2020 – November 2020) and FY1/FY2 doctors working in the Orthopaedic department at the GWH, Swindon were invited to attend. Each session focussed on assorted suturing techniques and knot tying. In addition, the facilitator directed conversation towards opportunities to discuss frustrations, challenges, queries as well as positive occurrences. A questionnaire was distributed at the final session to evaluate participant experience. Results 100% of attendees agreed or strongly agreed that they found their FY1 rotation challenging so far. 100% also scored 9/10 when asked how comfortable they were talking about concerns, worries or issues at these sessions. All the participants recorded ‘yes’ when asked if the session provided them with a listening ear, helpful advice, feeling supported, understanding/empathy and reassurance. 100% of the attendees scored that their confidence at suturing had improved (average: 4 points on a scale of 1-10). Conclusions Through these sessions, practical changes and improvements were achieved in the running of the Trauma and Orthopaedic department. Placement feedback was obtained, suggestions on things to improve or change and key issues were escalated to supervisors. There do not appear to be any similar programmes run that combine directed pastoral support and surgical skills teaching.

Continuing Progress into the Future

This final session looks at relapse prevention. Clients begin by reviewing the important takeaways from this treatment program, such as (1) all emotions provide information that can motivate us to take action in helpful ways; (2) staying present in the moment and taking a nonjudgmental view of our emotions can help to prevent emotions from increasing in intensity; (3) the way we think about a situation influences how we feel, and how we feel affects the way we interpret a situation; and (4) although avoiding uncomfortable emotion experiences can work well in the short term, it isn’t an effective long-term coping strategy. Clients then evaluate their progress, revisit their initial treatment goals, and develop a practice plan.

Session 8: Final Session: Taking the Practice Forward

This final session provides a time and space for reflection—reflecting on the retreat experiences the participants have just had, their experiences with the program as a whole, and also their plans to take the practice forward. This might include how participants could seek additional support (e.g., joining a local mindfulness group) or even support each other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and participants are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this.

Session 8: Final Session: Taking the Practice Forward

This final session provides a time and space for reflection – reflecting on the retreat experiences you have just had, your experiences with the program as a whole, and also your plans to take the practice forward. This might include how you could seek additional support (e.g., joining a local mindfulness group) or even how the group itself can support one other in continued practice. In particular, time is taken to troubleshoot potential difficulties in keeping up with practice, and you are reminded that, much like exercise, benefits will continue only with continued practice. If the optional booster session(s) will take place, time is spent scheduling and preparing for this final session.

The Structure and Process of CALM

This chapter delineates the features that have fostered success in Managing Cancer and Living Meaningfully (CALM) therapy. Patient characteristics, the format, session tasks, and process elements of CALM that have been associated with positive outcomes are described. The importance of the therapeutic relationship in the context of advanced and life-threatening disease, and the need for empathic attunement, genuineness, deep listening, emotional presence, and regular supervision and peer support are highlighted. General guidelines and tasks for the first, middle, and final session are outlined. Finally, the key elements of the CALM therapeutic process that contribute to its therapeutic effect are outlined.

Healthier together: a pilot study on the implementation of a novel family centered pediatric obesity prevention program

Context With pediatric obesity rates reaching epidemic scales across the United States, innovative research to identify key factors for successful implementation of obesity intervention programs is increasingly paramount. Project Healthy Attitudes Produces Positive Youth (HAPPY) is a family centered pediatric obesity prevention program targeting elementary age children and their families. Objectives To determine whether Project HAPPY interventions emphasizing social networks were successful. Methods This was a small scale evaluation of the Project HAPPY pilot program, conducted after school at a public elementary campus in Solano County, California. From April 2018 to May 2018, first year medical students from Touro University California College of Osteopathic Medicine served as “family navigators,” guiding participants through a 5 week curriculum of didactic lessons, cooking demonstrations, and physical exercises. Eligibility requirements for Project HAPPY included basic English proficiency, confirmed enrollment of at least one child at the elementary school, and willingness to attend all study sessions. The primary outcome evaluated was a shift in attitude toward individual health. Changes in body mass index (BMI) and health behaviors were assessed as secondary outcomes. Outcomes were assessed through surveys and measurements of BMI completed during Session 1, Session 10, and 4, 6, and 8 month follow up sessions. Results Initial study participants included seven families, consisting of elementary school students with their siblings and parents (n=27). Only four families (n=13) completed the entire 5 week intervention. Over the course of the study, survey results of participants’ attitudes regarding health suggested a positive trend toward self efficacy, while BMI appeared stable or increased. Participants demonstrated retention of successful health behaviors up to 8 months after the end of the intervention through qualitative reports of being “more conscious of meals and what (they) are eating,” “valu[ing their] nutrition on a daily basis,” “play[ing] a lot outside and inside on the weekends,” “carry[ing] a water bottle,” and “cook(ing) a lot.” A higher percentage of respondents in the final session compared selected the option “strongly agree” to each of the following statements: “I can be healthier if my family works together” (87.5% final session vs. 84.6% first session), “Drinking water makes me healthy” (87.5% final session vs. 84.6% first session), “Moving my body makes me healthy” (87.5% final session vs. 76.9% first session), “I reach my goals even when things get in my way” (62.5% final session vs. 46.2% first session), “Eating fruits and veggies make me healthy” (100% final session vs. 92.3% first session), “I can be healthy and enjoy my favorite foods” (87.5% final session vs. 66.7% first session), and “I can create a healthy balanced meal” (87.0% final session vs. 75.0% first session). Concrete data analysis was severely complicated by loss of study participants to follow up and incomplete data collection. Conclusions Project HAPPY showed promising indications that should be further evaluated in studies of larger scale and longer duration.

Feasibility of ABLE 1.0—a program aiming at enhancing the ability to perform activities of daily living in persons with chronic conditions

Background The “A Better everyday LifE” (ABLE) intervention was developed to accommodate the need of a program addressing ability to perform activities of daily living (ADL) in persons with chronic conditions living at home. During intervention development, it is necessary to evaluate relevant aspects of the feasibility of a program. Thus, the aim was to evaluate the feasibility of content and delivery of ABLE version 1.0. Methods A one group pre- and post-test design was applied. Thirty persons with chronic conditions, two occupational therapists (OTs), and five occupational therapy students (OTSs) participated. ABLE 1.0 is an 8-week program consisting of ADL evaluation (session 1); goal setting and reasons for ADL problems (session 2); intervention (sessions 3–7); and re-evaluation (final session), conducted in the clients’ home-setting and local area. Sessions 1–4 and the final session was mandatory. To evaluate the feasibility of content and delivery, the OTs, after each session, reported on applied intervention component(s), time-use, needed equipment, adjustments, meaningfulness, confidence, progress toward goal attainment, and side effects using registration forms. The clients reported on progress toward goal attainment, meaningfulness, and satisfaction. Clinically relevant improvements in ADL ability were identified using the ADL-Interview (ADL-I) and the Assessment of Motor and Process Skills (AMPS). Goal attainment was evaluated using the Goal Attainment Scaling (GAS). Results Twenty clients (67%) completed ABLE 1.0 and received four sessions (median = 4, range 4–7) each lasting between 30 and 94 min. Most frequently applied component was “Changing habits related to task performance”. Generally, OTs reported having the needed equipment. Deviations from the manual were made by omission of GAS and AMPS and less than mandatory number of sessions per client. The OTs reported confidence in delivering the program and the clients perceived the program as meaningful and satisfying, and experienced progress toward goal attainment. Goal attainment was found in 52% of the goals. Sixteen (80%) clients obtained clinically relevant improvements in self-reported or observed ADL ability. Conclusions The content and delivery of ABLE 1.0 was feasible. However, the study revealed a need to adjust the recruitment procedure and make minor changes in the intervention manual. A pilot randomized controlled trial (RCT) study is recommended. Trial registration The study was registered at ClinicalTrials.gov with registration no. NCT03335709 on November 8, 2017.

52 KneuroKnits: Evaluating social participation and anxiety response associated with participation in a knitting group for youth with neurological conditions (pilot study)

Background Knitting as a creative practice has a reputation for being therapeutic. There are many programs that use crafts as a method of creating social community and reducing anxiety for youth; however, there is no existing research that demonstrates these benefits. We designed a novel study to explore the benefits of a social skills knitting group on engagement and anxiety for youth with neurodevelopmental disorders. Objectives 1. To evaluate the social engagement experience of youth with neurological conditions participating in the KneuroKnits program. 2. Evaluate the impact of KneuroKnits intervention on anxiety levels of participants. Design/Methods We designed a 4-week knitting group for youth with neurodevelopmental disorders and acquired brain injuries. Each session included a lesson involving a knitting skill and a social skill. To evaluate social engagement, we used the Self-reported Experience of Activity Settings (SEAS) questionnaire at the first and final sessions. The five subcategories of the SEAS (Personal Growth, Psychological Engagement, Social Belonging, Meaningful Interactions and Choice & Control) were analyzed following the first and the last session. Qualitative interviews were conducted with participants, parents, and facilitators in the month following the final session and were analyzed using an interpretive phenomenological approach to outline commonly occurring themes in social engagement. To evaluate anxiety levels, participants completed the State-Trait Anxiety Inventory (STAI) at the beginning and end of the first and final sessions, respectively, and the Symptom Checklist-90-R (SCL-90) anxiety subscale; qualitative analysis included themes involving levels of anxiety from the interviews. Results There were 14 total participants with a mean age of 17.4 ± 2.2 years. Participants had primary diagnoses of ASD (n=9), acquired brain injury/concussion (n=4), and developmental coordination disorder (n=1). Social engagement results for the SEAS questionnaire showed a general increase in mean scores of all subcategories with a significant increase in the category of “Meaningful Interactions (p=0.02). This quantitatively demonstrated that the group had an impact on creating meaningful social connection. Qualitative analysis of the interviews revealed three commonly occurring themes: The balance of organic and facilitated social interaction, a sense of community from shared experience and direct benefits of knitting (pride, productivity, relaxation, a choice to be social). For the evaluation of anxiety levels, the STAI demonstrated a significant decrease in anxiety following both Session 1 (p=0.02) and Session 4 (p=0.006). The SCL-90-R Anxiety subsection scores significantly decreased between the first and final session (p=0.01). Participants voiced that the sessions made them feel calmer. Conclusion This knitting group merged a creative skill and social skill, and was novel in its approach to studying social engagement and anxiety within this population. Our study found that participants, their families and facilitators found KneuroKnits to be a valuable and rewarding program. Further study is needed in a larger sample to confirm our findings.

Cathodal Cerebellar tDCS Combined with Visual Feedback Improves Balance Control

Balance control is essential to maintain a stable body position and to prevent falls. The aim of this study was to determine whether balance control could be improved by using cerebellar transcranial direct current stimulation (tDCS) and visual feedback in a combined approach. A total of 90 healthy volunteers were randomly assigned to six groups defined by the delivery of tDCS (cathodal or anodal or sham) and the provision or not of visual feedback on balance during the acquisition phase. tDCS was delivered over the cerebellar hemisphere ipsilateral to the dominant leg for 20 min at 2 mA during a unipedal stance task. Body sway (i.e., ankle angle and hip position) was measured as an overall maximal unit in anteroposterior and mediolateral direction, together with participant rating of perception of stability, before (baseline), during (acquisition), and after (final) the intervention. We found a reduction in body sway during the acquisition session when visual feedback alone was provided. When the visual feedback was removed (final session), however, body sway increased above baseline. Differently, the reduction in overall maximal body sway was maintained during the final session when the delivery of cathodal tDCS and visual feedback was combined. These findings suggest that cathodal tDCS may support the short-term maintenance of the positive effects of visual feedback on balance and provide the basis for a new approach to optimize balance control, with potential translational implications for the elderly and patients with impaired posture control.