Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting Gallstones: Data from the Samoa Typhoid Fever Control Program

Approximately 90% of chronic typhoid carriers with persistent Salmonella enterica serovar Typhi (S. Typhi) gallbladder infection have gallstones. In Samoa, where typhoid fever has been endemic for many decades, risk factors predisposing to the development of gallstones are increasing among adults. The Samoa Typhoid Fever Control Program dispatches a “Typhoid Epidemiologic SWAT Team” to perform a household investigation of every blood culture-confirmed case of acute typhoid fever. Investigations include screening household contacts to detect chronic carriers. Following limited training, two nonexpert ultrasound operators performed point-of-care ultrasound (POCUS) on 120 Samoan adults from August to September 2019 to explore the feasibility of POCUS to detect individuals with gallstones during household investigations and community screenings. POCUS scans from 120 Samoan adults in three cohorts (28 food handlers, two typhoid cases and their 18 household contacts, and 72 attendees at an ambulatory clinic) were reviewed by a board-certified radiologist who deemed 96/120 scans (80%) to be interpretable. Compared with the radiologist (gold standard), the nonexpert operators successfully detected 6/7 Samoans with gallstones (85.7% sensitivity) and correctly identified 85/89 without gallstones (95.5% specificity). The proportion (24/120) of uninterpretable scans from this pilot that used minimally trained clinicians (who are neither radiologists nor ultrasound technicians) indicates the need for additional training of POCUS operators. Nevertheless, this pilot feasibility study engenders optimism that in the Samoan setting nonexperts can be trained to use POCUS to diagnose cholelithiasis, thereby helping (along with stool cultures and Vi serology) to identify possible chronic S. Typhi carriers.

Nurturing attachments group: A virtual group intervention for adults caring for traumatised children in the context of COVID-19

Background: Evidence indicates that the more traditional and behavioural parenting strategies are ineffective when parenting a child who has experienced developmental trauma. Recognising the need to parent with an attachment focus, the current paper evaluates the effectiveness of running the [Enfys] Nurturing Attachments Group, virtually, within the context of the COVID-19 pandemic. Method: A pilot feasibility study evaluated eight bespoke groups. Consenting professionals and co-professionals completed the Brief Parental Self-Efficacy Scale (BFSS), Care Questionnaire (CQ) and the Parental Reflective Functioning Questionnaire (PRFQ). Results: One hundred forty individuals attended the groups, with 51 (36%) completing both pre-and post-measures. The results provide evidence that professionals and co-professionals reported statistically significant positive increases on both the BPSS ( d = .55) and CQ ( d = .62). For the PRFQ, the results showed a statistically significant decrease on the Pre-mentalising sub scale, a non-significant mid-range score for Certainty about Mental States and a non-significant increase for Parental Interest and Curiosity in Mental States. Conclusion: The study has demonstrated initial viability of effectively facilitating the [Enfys] Nurturing Attachments Group, virtually. Importantly, it has also shown that the group can be run with professionals alongside co-professionals.

“C@nnected” : Group videoconferencing intervention to improve maternal sensitivity in mothers-infant dyads attending primary care in Chile: Protocol for a randomized feasibility trial (Preprint)

BACKGROUND Early childhood development is highly dependent on the sensitive care provided by their caregivers. Interventions focused on supporting parents to improve their sensitivity have been shown to be effective. The COVID-19 pandemic has had a great impact on mental health. Pregnant women and mothers of infants being an especially vulnerable group, and maternal sensitivity is particularly affected. On the other hand, access to face-to-face interventions is restricted, above all group interventions, so it is relevant to have remote interventions to support this group of mothers. OBJECTIVE The objective of the study is to evaluate the feasibility and acceptability of a group videoconferencing intervention : “C@nnected” to improve maternal sensitivity aimed at mother-infant dyads attended in Primary Health Care in vulnerable areas of Santiago , Chile. METHODS This is a randomized pilot feasibility study single-masked (outcome assessor) study with a qualitative component. It will involve a block randomization procedure to generate a 3:2 allocation (with more people allocated to the intervention arm). The intervention consists of four group videoconferencing sessions, adapted from a face-to-face intervention of proven effectiveness. The control group will receive treatment as usual plus educational brochures. Feasibility and acceptability of the study will be quantitatively and qualitatively assessed. Changes in clinical outcomes will also be evaluated: maternal sensitivity, depressive symptoms, postnatal maternal attachment, and infant socio-emotional development. RESULTS We have completed the adaptation of the face-to-face intervention to the videoconferencing format, our study is currently in the recruitment phase, which is expected to be completed by January 2022, the results of the study are expected by August 2022. CONCLUSIONS This study will contribute evidence for the use of eHealth interventions to promote maternal sensitivity. It will also inform the design and implementation of a future randomized clinical trial. CLINICALTRIAL ClinicalTrials.gov, NCT04904861.

The Feasibility of a Stroke Rehabilitation Educational Program for Occupational Therapy Students and Practitioners (Preprint)

BACKGROUND Gaps in knowledge translation of current evidence-based practice regarding stroke assessment and rehabilitation delivered through teletherapy can prevent occupational therapy students and practitioners from implementing current research findings to obtain the best possible results in practice. The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. OBJECTIVE The purpose of this pilot feasibility study was to create an educational program to translate knowledge into practice about the remote delivery of stroke assessment and rehabilitation to occupational therapy students and practitioners. This study examined knowledge gained from specific educational modules and feedback of delivery with regards to design, feasibility, acceptability, and usability. Four areas of focus were addressed in the educational program including: knowledge translation (KT), task-oriented training (TOT), stroke assessments, and telerehabilitation. METHODS Two feasibility studies were conducted to assess knowledge gained via pretests and posttests of knowledge, followed by a System Usability Scale (SUS) and general feedback questionnaire. Participants in Study 1 were five current occupational therapy practitioners and one occupational therapy assistant. Initial recruitment of participants in Study 2 included ten current occupational therapy students, however only nine students participated in the modules. Four, one-hour modules were emailed weekly to participants over the course of four weeks, with each module covering a different topic (KT, TOT, stroke assessments, and telerehabilitation). Preliminary results were reviewed with median comparisons and nonparametric analyses of pretests and posttests of knowledge for each module. Descriptive statistics from the SUS and a general feedback questionnaire were used to gain overall comments regarding the educational program. RESULTS This study revealed statistically significant results related to increased scores of knowledge through a Wilcoxon Signed-Ranks Test for students, practitioners, and combined. The stroke assessments module for the practitioner study and the stroke assessments and telerehabilitation modules for the student study were found to be statistically significant for increases in knowledge. Task-oriented training, stroke assessments, and telerehabilitation were statistically significant for the combination of the two studies. The task-oriented training module for students and practitioners, and the knowledge translation and telerehabilitation modules for practitioners also demonstrated a notable trend towards significance. The majority of the educational modules had an above average score regarding feasibility as well as positive feedback for the educational program as a whole from the participants. CONCLUSIONS Overall, the results of this pilot study indicate that an online educational program is a feasible, informational method of increasing the translation of knowledge in the remote delivery of stroke assessment and rehabilitation. Occupational therapy students and practitioners found the information presented to be valuable and relevant to their future profession and current practice.

Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study

Background Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups.

A pilot feasibility study of Exercising Together© during radiation therapy for prostate cancer: a dyadic approach for patients and spouses

Introduction Prostate cancer can negatively impact the health of patients and their spouse, particularly early on in the cancer trajectory. Purpose To determine the feasibility and acceptability of dyadic exercises during radiation therapy and preliminary efficacy on physical, mental, and relational outcomes for men and their spouses. Exercising Together©, originally designed as a 6-month dyadic resistance training program for couples post-treatment, was adapted for the radiation setting. Methods We conducted a single-group pilot feasibility study of Exercising Together© in men scheduled for radiation therapy for prostate cancer and their spouse. Couples attended supervised exercise sessions thrice weekly throughout radiation treatment and were followed up 8 weeks later. Primary outcomes were feasibility and acceptability with secondary outcomes of changes in physical (physical functioning (short physical performance battery (sPPB)), gait speed (m/s), functional capacity (400-m walk (min), physical activity (min/week)), mental (depressive symptoms (CES-D), and anxiety (SCL-90 ANX)), and relationship (Dyadic Coping, Role Overload, and Physical Intimacy Behavior Scales) health outcomes for each partner. Participants completed an evaluation post-intervention. Results Ten couples enrolled and 8 completed the intervention, attending 83% of scheduled sessions. Couple satisfaction with the intervention was high (patients: mean difference (MD) = 9.4 ± 1.9 and spouses: MD = 10.0 ± 0.0, on a 1–10 scale). At post-intervention, gait speed (MD = 0.1; 95%CI: 0.1, 0.2; p = 0.003; d = 0.94) and functional capacity (MD = −0.6; 95%CI: −0.9, 0.3; p = 0.002; d = −0.42) improved in patients and sPPB in spouses (MD = 1.3; 95%CI: 0.3, 2.2; p = 0.02; d = 0.71). Total physical activity increased non-significantly for patients and significantly for spouses at post-intervention and decreased at follow-up (MD = 179.6; 95%CI: 55.4, 303.7; p = 0.01; d = 1.35 and MD = −139.9; 95%CI: −266.5, 13.3; p = 0.03; d=1.06). Among patients, anxiety and active engagement significantly improved post-intervention (MD = −2.3; 95%CI: −3.8, 0.7; p = 0.01; d = −0.43 and MD = 2.5; 95%CI: 0.7, 4.3; p = 0.01; d = 0.98, respectively). There were modest effects on other physical, mental, and relationship health domains in patients and spouses. Conclusion A modified version of Exercising Together© is a feasible and acceptable program during radiation therapy for prostate cancer and shows preliminary evidence for improvements on physical, mental, and relational health in both patient and spouse. A larger, fully powered randomized controlled trial is warranted and could help shift the landscape toward dyadically targeted interventions. Trial registration This study was registered on ClinicalTrials.gov on February 18th, 2018 (NCT03418025).