Web-based support for individuals with type 2 diabetes - a feasibility study

Background Self-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The primary aim of the study was to evaluate the feasibility and describe patients’ and caregivers’ experiences of using the web- and smartphone-based system Triabetes. The secondary aim was to investigate if the use of the system could improve patients’ clinical outcomes. Methods Feasibility was assessed with describing recruitment rate and the participant´s views of using the system. Laboratory and anthropometry data were also collected. Results The study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it easier and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values. Conclusions Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful but suggested several improvements. Summarized lessons learned from this study are following: (1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; (2) the tool must be easy and less time consuming to use; (3) the technical structure needs to be improved and automatic recording of data must be improved.

Are patients self-referring to Lewisham Community Wellbeing (LCW) when advised to do so by the assessment and liaison psychiatry team?

AimsIt is well-recognised by the RCPsych that mental illness is both a cause and consequence of social exclusion, and thus social inclusion is an important part of recovery and leads to better outcomes for patients.The Lewisham Assessment and Liaison team Neighbourhood 4 (A&L N4) is a CMHT service that acts as an intake team for all referrals into secondary care mental health services, with the purpose of assessment and brief intervention. Currently, if a patient is assessed to potentially benefit from our local social inclusion service, Lewisham Community Wellbeing (LCW), they are advised to self-refer. However, there is no follow-up as to whether patients go on to do this.Therefore, this audit aimed to calculate:How many patients are advised to self-refer to LCW (advised referral)How many of these patients make the self-referral to LCW (completed referral)MethodThe electronic notes for patients who were accepted by the A&L N4 team from July to September 2020 were retrospectively analysed to see if an LCW self-referral was advised. A list of these patients was then given to LCW to check whether they had self-referred.ResultA&L N4 worked with 82 patients during the study period. 16 patients were advised to self-refer to LCW- an advised referral rate of 19.5%. There was notable month-to-month variation in the advised referral rate- 29.6% in July vs. 9.4% in September.Of the 16 patients advised to self-refer to LCW, 5 did so- a completed referral rate of 31.3%.ConclusionThe completed referral rate of 31.3% is difficult to interpret given there are no standards in this area. On one hand, the self-referral process as it currently exists is functioning; on the other, some two-thirds of patients are not making the most of a service deemed to be of benefit to their recovery.To improve completed referral rates, efforts should be made to better ‘sell’ LCW to the patient. Potential ways of doing this would be through closer working with LCW- for example, LCW could join the clinical meetings more regularly to discuss new services they offer and feedback any patients A&L has referred. There should also be emphasis on making the self-referral process as straightforward as possible.A secondary finding was the notable monthly variation in advised referral rates. It is important to ensure the A&L team are consistently identifying the right patients for LCW, and again, closer liaison with LCW would help achieve this.

Influence of Public Health England’s Change4Life Disney Branded 10-minute Shake Ups on Children’s Post Activity Affective Response

Physical activity (PA) is considered essential to overall health, yet it is consistently reported that children worldwide are failing to meet the recommended levels. Affective responses are a potential predictor of long-term PA engagement due to their bidirectional relationship with PA. One way to influence the affective response to PA may be to influence the environment in which it takes place; a method of doing this is to immerse children using a narrative with characters. The aim of this research was to compare the effects of using a Disney branded, compared to a non-branded, PA session on children’s post activity affective responses and perceived effort of PA. 32 children participated (aged between 4-11 years) and they each completed four sessions of branded activities, and four sessions of unbranded activities. The results showed that children had similar positive affective responses and perceived effort to branded and unbranded activities, and qualitative feedback from parents supported this. However, a secondary finding from qualitative thematic analysis was that parents considered branding a key contributing factor to children’s enjoyment and the effort they put into the PA sessions. Future research into influencing the affective response through the environment should carefully consider how to capture this during the activity. Lastly, the research was conducted during the period of the COVID-19 lockdown and so should be interpreted in this context. Conceptual replication outside of this should be an aim of future research.

Web-based Support for Individuals With Type 2 Diabetes - A Feasibility Study

Background: Self-care is one of the cornerstones in the treatment of type 2 diabetes. Patients with type 2 diabetes struggle to maintain acceptable levels of blood sugar, blood pressure and lipids, the fundamental for the prevention of macro- and microvascular as well as neuropathic complications. The aim of this study was to evaluate the feasibility of usage of the web- and smartphone-based system Triabetes in treatment of patients with type 2 diabetes.Methods: Feasibility was assessed with describing recruitment rate and the participant´s views of using the system. Laboratory and anthropometry data was also collected.Results: The study showed that recruitment of patients to participate in the intervention was limited and compliance to the study protocol was low. A majority of the patients stated that the system was easy to get an overview of and that the system motivated them and made it more easy and fun to handle lifestyle habits. A secondary finding of the study was that there was a significant lowering of LDL values.Conclusion: Feasibility in terms of recruitment rate was low. The participants agreed that the application overall was useful, but suggested several improvements. Summarized lessons learned from this study are following: 1) we need more knowledge about what motivates a person to use a digital tool for a longer period of time; 2) the tool must be easy and less time consuming to use; 3) the technical structure needs to be improved and automatic recording of data must be improved.

COT-13 Current situation and problems of cancer genomic profiling test in Kyoto University Hospital

Objective: Kyoto University Hospital has introduced the cancer genomic profiling tests, Oncoprime in 2015, Guardant360 in 2018, which are not under insurance coverage, FoundationOne CDx(F1CDx) and OncoGuide NCC Oncopanel system(NCC OP) in 2019, which received approval for insurance coverage for the first time in Japan. We investigated the results of cancer genomic profiling test under insurance coverage in our hospital. Methods: A special facility for the cancer genomic profiling tests was produced. To perform the cancer genomic profiling test, an outpatient must visit the facility three times (learning, ordering of the test, and getting the results). The expert panels decide the final test results and treatment options with the all information of the patients. Results: From November 2019 to March 2020, 51 and 9 patients were tested with F1CDx and NCC OP, respectively. 16 patients (31%) of F1CDX and 2 patients (22%) of NCC OP got treatment recommendations from the expert panels. However, only 5 patients (9.8%) of F1CDX and 1 patient (11%) of NCC OP received the treatments. The secondary finding suspecting germline mutations was found in 8 patients of F1CDX. Conclusion: After the approval the cancer genomic profiling tests with insurance coverage in Japan, it becomes easy for the patients to perform the test and get the genetic information of the tumor. However, it remains not easy to receive the recommended drugs because of several limitations of their usages.

A Comprehensive Follow-Up Study Identifying Diagnostic Evidences for Secondary Finding

Background：There was a lacking of clinical diagnostic evidence in follow-up studies for reporting of secondary variants in 59 genes in American College of Medical Genetics and Genomics recommendations for reporting secondary findings and various strategies were applied to interpret the secondary variants. Results: Out of 1330 participants performed whole-exome sequencing, we identified 15 families with convincing clinical evidence. After Sanger validation and a comprehensive clinical follow-up, 10 families with both convincing clinical evidence and convincing genetic evidence of hereditary variants were found. Detailed clinical presentations and related clinical evidence were collected. Conclusions: Our research is a comprehensive follow-up study to identify secondary variants with convincing genetic and clinical evidence and it could help improve the strategy of screening actionable secondary variants and contribute to translation of genetic findings into medical practice.

Personality traits common to fraud investigators

Purpose The purpose of this paper is to investigate the personality traits common to fraud investigators utilizing the ten-item personality inventory (TIPI) instrument. Moreover, the paper seeks to encourage employers and academics to consider identifying the personality traits common to fraud investigators in hiring and educating potential future investigators. Design/methodology/approach A survey was administered to 183 professionals using the TIPI instrument Findings The professionals surveyed self-reported a high level of conscientiousness, measured as a mean of > 12 on a scale of 14. A secondary finding is that the professionals surveyed who are “more experienced” at fraud investigation exhibit more openness and less neuroticism than those with less investigation experience. Research limitations/implications The first limitation is the small number of usable responses (183). A second limitation is that surveys were administered in only two states, and the results may not reflect the general population of professionals who search for fraud. A third limitation is that the survey respondents had a wide variety of careers, and the results may have differed if the survey had been administered to only one type of investigator. Practical implications The results have implications for employers, fraud investigators and academics. Given that fraud is prevalent in all industries around the world, employers may wish to pinpoint current or potential employees who have the personality type(s) that are best suited to detect fraud. Also, academics may identify students who have the personality type(s) that are best suited for a career in fraud detection. Originality/value This the first study to explore the personality types that may identify persons who are well suited for fraud detection.

Lower-Third SLOE Rankings Impede, But Do Not Prevent, A Match in Emergency Medicine Residency Training

Objective: Emergency medicine program directors (PD) value the standardized letter of evaluation (SLOE) as the most important aspect of a residency application when making both invitation and ranking decisions. This study aims to determine whether the presence of any lower-third in either SLOE global assessment (GA) question impacted the ability of an applicant to match into EM. We hypothesized that any lower-third ranking would be associated with increased odds of not matching into EM. Methods: We conducted a retrospective cohort study evaluating allopathic applicants from medical schools in the United States (US allopathic applicants) to a single EM residency program during the 2018/2019 match cycles. GA SLOE rankings from all applications were tabulated and compared to the applicant’s National Resident Matching Program (NRMP) match outcome. Comparative analyses were conducted between SLOE groupings and odds ratios (OR) were calculated. Results: A total of 2,017 SLOEs from 781 US allopathic applicants were analyzed during the study period. Of the total, 277 (35%) applicants in our sample had any lower-third GA ranking, which significantly decreased an applicant’s odds of matching in EM by 79% (OR 0.21, 95% CI, 0.12-0.34). Having more than one lower-third GA ranking did not further statistically decrease the odds of a successful EM match (OR 0.60, 95% CI 0.31-1.17). As a secondary finding of the study, results demonstrate that those applicants having no lower-third GA rankings had a nearly 5 times increased odds of an EM match (OR 4.84, 95% CI, 2.91-8.03). Conclusion: Having any lower-third GA ranking significantly reduced an applicant’s chances of matching into an EM program. Faculty advisors should be aware of the increased risk of not matching for any applicant with any lower-third GA ranking and advise students appropriately, while maintaining the integrity of the SLOE and not divulging the confidential information contained within.