Sustaining attention in affective contexts during adolescence: age-related differences and association with elevated symptoms of depression and anxiety

Sustained attention, a key cognitive skill that improves during childhood and adolescence, tends to be worse in some emotional and behavioural disorders. Sustained attention is typically studied in non-affective task contexts; here, we used a novel task to index performance in affective versus neutral contexts across adolescence (N = 465; ages 11-18). We asked whether: (i) performance would be worse in negative versus neutral task contexts; (ii) performance would improve with age; (iii) affective interference would be greater in younger adolescents; (iv) adolescents at risk for depression and higher in anxiety would show overall worse performance; and (v) would show differential performance in negative contexts. Results indicated that participants performed more poorly in negative contexts and showed age-related performance improvements. Those at risk of depression performed more poorly than those at lower risk. However, there was no difference between groups as a result of affective context. For anxiety there was no difference in performance as a function of severity. However, those with higher anxiety showed less variance in their reaction times to negative stimuli than those with lower anxiety. One interpretation is that moderate levels of emotional arousal associated with anxiety make individuals less susceptible to the distracting effects of negative stimuli.

Instrumental swallowing assessment in adults in residential aged care homes: Practice patterns and opportunities

OBJECTIVE

To describe practice patterns in the use of instrumental swallowing assessment (ISA) for older adults in residential aged care homes (RACHs).

METHODS

A retrospective audit of medical records of residents living in RACHs in Melbourne, Australia to extract data on speech-language pathologist (SLP) involvement, indications for ISA and ISA practice patterns.

RESULTS

Medical files of 323 residents across four Melbourne facilities were reviewed. 36% (n = 115) of residents were referred to SLP for swallowing assessment. Referral to SLP was related to length of stay (U = 7393.00, p < 0.001), dementia status (χ2 [1] = 7.06, p = 0.008), texture modification (χ2 [1] = 93.34, p < 0.001) and an existing dysphagia diagnosis (χ2 [1] = 112.89, p < 0.001). There were no referrals for ISA and no instances of ISA being used. Among 115 residents who were referred to SLP for swallowing assessment, there were 33 instances where ISA might be clinically relevant according to ISA indicators.

CONCLUSIONS

Instrumental swallowing assessment is not being used for the management of swallowing in RACHs in Australia despite a clinical need for ISA and a potential role for ISA to improve swallowing care quality. Lack of timely ISA may fail to meet the complex health-care needs of older adults living with dysphagia in RACHs, increasing their vulnerability to complications of dysphagia and its management.

A Structured Intervention to Support Early Palliative Care Conversations for Oncology Patients - A Qualitative Feasibility Study

AIMS

For patients with advanced cancer, early access to palliative care can have numerous psychosocial and disease management benefits. However, it can be difficult for clinicians to initiate these initial conversations about palliative care. The aim of the present study was to beta test an intervention to facilitate timely conversations about palliative care between patients and clinicians.

MATERIALS AND METHODS

The study reported forms one stage of a complex intervention development study following Medical Research Council guidance for developing complex interventions. Feasibility was explored from patient and clinician perspectives in an oncology outpatient setting.

RESULTS

Sixteen patients and 18 clinicians participated. Three phases of the intervention were assessed through patient and clinician interviews. The analysis produced three themes in each phase: (i) Preparation (patient preparedness; healthcare professionals' perspectives on palliative care; administration, data and communication); (ii) STEP consultation (defining perspectives on palliative care; how palliative care fits with the current treatment plan; permission to explore future care); (iii) Outcomes (changes in perspective and approaches to coping; opening the door to future conversations; referrals and involvement of palliative services).

CONCLUSIONS

The STEP intervention generated important early conversations about end-of-life care that may otherwise not have occurred. No patients regretted having the STEP consultation, which resulted in palliative care referrals for some. Others felt better informed about the support services available and better able to have further conversations. Participating clinicians found the structured conversation guide useful, as it acted as a prompt for areas to cover, as well as providing an explicit way to open discussion about difficult topics.

Optimal cytoreduction followed by chemoradiation in stage IVB uterine serous carcinoma

OBJECTIVES

The prognosis of patients presenting with stage IVB uterine serous carcinoma (USC) remains extremely poor, with a reported 5-year survival of <20%. Here were evaluate the survival impact of cytoreductive surgery and identify other prognostic factors in stage IVB USC.

METHODS

A multicenter retrospective analysis of patients with stage IVB USC was conducted from 2000 to 2018. Inclusion criteria were patients who had undergone comprehensive surgical staging/tumor debulking; followed by adjuvant chemotherapy+/-external beam radiation therapy (EBRT). Optimal cytoreduction (R1) was defined as residual disease ≤1 cm at completion of surgery, and suboptimal cytoreduction (R2) was defined as >1 cm. Progression free survival (PFS) and overall survival (OS) analysis was performed using Kaplan-Meier estimates. Multivariate analysis (MVA) was performed using Cox proportional hazards model.

RESULTS

Final analysis included 68 patients. There was no difference in the frequency of treatment delays between regimens (p = 0.832). 96% of patients received platinum-based chemotherapy. There was no difference in the age (p = 0.227), race (p = 0.936), type of radiotherapy (p = 0.852) or chemotherapy regimen received (p = 0.996) between R1 and R2 cohorts. The median PFS for all patients was 8 months and the median OS was 13 months. Cytoreduction to R1 was associated with a median PFS of 9 months, compared to R2 with a median PFS of 4 months (p < 0.001, HR 0.32, 95% CI 7.4-14.1). Median OS was also improved with R1 vs. R2 cytoreduction (17 months vs. 7 months, respectively) (p < 0.001, HR 0.21, 95% CI 13.7-26.4). Compared to R1, cytoreduction to R0 was not associated with a survival benefit. The R0 median OS was 17 months versus 18 months in R1 (p = 0.67). The combination of adjuvant chemoradiation was associated with improved PFS (11 months vs. 7 months) (p = 0.024, HR 0.41, 95% CI 6.5-9.4) and OS (22 months vs 13 months) (p = 0.65, HR 0.25, 95% CI 10.5-15.4) compared to chemotherapy-alone, respectively. On MVA, only the amount of residual disease (p = 0.003, HR 0.39, 95% CI 0.2-0.7) and receipt of adjuvant chemoradiation (p = 0.010, HR 0.09, 95% CI 0.01-0.58) were independent predictors of survival.

CONCLUSIONS

In stage IVB USC, optimal cytoreduction should be the goal at the time of primary surgery. The combination of chemoradiation was associated with superior survival compared to chemotherapy alone and should be further investigated in this patient population.

The impact of mindfulness training in early adolescence on affective executive control, and on later mental health during the COVID-19 pandemic: a randomised controlled trial

BACKGROUND

Previous research suggests that mindfulness training (MT) appears effective at improving mental health in young people. MT is proposed to work through improving executive control in affectively laden contexts. However, it is unclear whether MT improves such control in young people. MT appears to mitigate mental health difficulties during periods of stress, but any mitigating effects against COVID-related difficulties remain unexamined.

OBJECTIVE

To evaluate whether MT (intervention) versus psychoeducation (Psy-Ed; control), implemented in after-school classes: (1) Improves affective executive control; and/or (2) Mitigates negative mental health impacts from the COVID-19 pandemic.

METHODS

A parallel randomised controlled trial (RCT) was conducted (Registration: https://osf.io/d6y9q/; Funding: Wellcome (WT104908/Z/14/Z, WT107496/Z/15/Z)). 460 students aged 11-16 years were recruited and randomised 1:1 to either MT (N=235) or Psy-Ed (N=225) and assessed preintervention and postintervention on experimental tasks and self-report inventories of affective executive control. The RCT was then extended to evaluate protective functions of MT on mental health assessed after the first UK COVID-19 lockdown.

FINDINGS

Results provided no evidence that the version of MT used here improved affective executive control after training or mitigated negative consequences on mental health of the COVID-19 pandemic relative to Psy-Ed. No adverse events were reported.

CONCLUSIONS

There is no evidence that MT improves affective control or downstream mental health of young people during stressful periods.

CLINICAL IMPLICATIONS

We need to identify interventions that can enhance affective control and thereby young people's mental health.

670 FACTORS ASSOCIATED WITH MORTALITY IN MULTI-ETHNIC HOSPITALISED COVID PATIENTS

Introduction

Whilst most patients during the COVID pandemic made an uneventful recovery, there was a significant minority in whom the disease was severe and unfortunately fatal. This survey aims to evaluate independent risk factors for those who died of COVID compared to survivors and to identify any markers for improvement in future management.

Methods

Medical records of all COVID patients admitted to two multi-ethnic, inner city acute district general hospitals over a 6-week period in 2020 were examined. Data collected included demographic details, medical comorbidities, and type of ward where they received care. Multivariable analysis using stepwise backward logistic regression was conducted to examine independent risk factors for those who died from COVID compared to survivors.

Results

Of 951 patients admitted with COVID, 284 died[30%]. Compared to survivors(n = 667), univariate analyses revealed COVID deaths were associated with increasing age[mean(CI): 79.3(77.9–80.7)vs64.7(63.4–66.0);P &lt; 0.001], Black African [16.2%vs11.7%;p &lt; 0.001] & South-Asian [12%vs9.1%;p &lt; 0.001] ethnicity, Hypertension [64.4%vs49.5%;p &lt; 0.001], Chronic Heart Disease(CHD)[40.1%vs20.7%;p &lt; 0.001], Chronic Respiratory Disease [17.6%vs12.0%;p = 0.02] Chronic Kidney Disease [18%vs11.1%;p = 0.004], Chronic Neurological Disease 43.3%vs23.7%;p &lt; 0.001]. Gender, Diabetes, asthma, obesity, Chronic Liver Disease and immunosuppression (disease or treatment related) were not associated with increasing mortality. Death rates between those in general wards vs intensive care were comparable[4.7%vs2.5%;p = 0.1]. Multivariable analyses showed age 60–70 [OR 2.3], age &gt; 70 [OR 6.5], Black Caribbean [OR 1.6], and CHD [1.5] were independent risk factors for COVID deaths.

Discussion

This large multi-ethnic study showed that age &gt; 60, Black Caribbean, and chronic heart disease were independent risk factors for COVID deaths. This study provides valuable information on independent prognostic implications for COVID, which can be used in future interventional studies aiming to improve COVID outcomes or in audits of clinical practice.

Montessori mealtimes for dementia: A pathway to person-centred care

PURPOSE

This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project.

METHOD

An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service.

RESULTS

A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes.

IMPLICATIONS

The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.

Fear of memory loss predicts increased memory failures and lower quality of life in older adults: preliminary findings from a fear-avoidance of memory loss (FAM) scale

BACKGROUND

Few studies have measured the impact of dementia-related fear on daily functioning, despite its clinical relevance. Our aim was to determine the relationship between fear-avoidance of memory loss, perceived memory failures and self-reported quality of life in a community based sample of older adults using a novel fear of memory loss (FAM) scale.

METHODS

Sixty-seven older adults (59-81 years) completed a 23-item self-report scale designed to capture multi-faceted components of fear of memory loss, known as the FAM scale. Perceived memory failures were measured using the Memory Failures Scale (MFS) and quality of life was assessed using the Older Person's Quality of Life scale (OPQOL-35). Participants also completed the Wechsler Memory Scale (WMS-IV) as a measure of objective memory performance and the Depression, Anxiety and Stress Scales (DASS) and the Geriatric Anxiety Inventory (GAI) as measures of general anxiety.

RESULTS

The FAM scale demonstrated strong internal consistency (Cronbach's α = .82) and concurrent validity with the GAI (r = .47). Three latent factors were observed: (1) fear-avoidance, (2) problematic beliefs and (3) affective resilience. After adjusting for objective memory performance and general anxiety, higher fear-avoidance significantly predicted increased perceived memory failures (p = .014) and reduced quality of life (p = .033).

CONCLUSIONS

Fear of memory loss predicts increased perceived memory failures and lower self-reported quality of life in a community sample of older adults. Based on these findings, we propose a preliminary fear-avoidance model that explains the development and maintenance of dementia-related functional disability in terms of psychological processes.

An evaluation of a consumer directed care training program for nursing home staff

OBJECTIVES

This study evaluated a training program to support the delivery of consumer directed care (CDC). It was hypothesized that both interventions, compared to the control condition, would demonstrate increased levels of CDC in nursing homes, increased staff practice of CDC, and improved resident QoL. The training plus support group was expected to show greater gains, compared to the training only group.

MATERIALS AND METHODS

In a cluster RCT design, 33 nursing homes were randomly allocated to one of three conditions: training plus support, training only, and care as usual. Outcome measures included level of CDC within each home, staff practice of CDC, and resident QoL.

RESULTS AND DISCUSSION

Hypotheses for this study were partially supported. Nursing homes became more CDC-oriented but with minimal changes in staff practice of CDC. Resident QoL also demonstrated limited change. The findings are discussed in terms of organizational barriers to change within nursing homes.

PAPA-like syndrome with heterozygous mutation in the MEFV gene

A patient presented with a history of recurrent pyoderma gangrenosum, arthritis and extensive acne, prompting a genetic workup for PAPA syndrome. An MEFV mutation was identified and a change in therapeutic strategy from anakinra to colchicine was successful.

Magnetic resonance imaging in the evaluation of idiopathic frequent premature ventricular complexes with normal ventricular function

Background

The role of cardiac magnetic resonance (CMR) imaging in the diagnostic evaluation of patients with frequent premature ventricular complexes (PVCs) and normal left ventricular ejection fraction (LVEF) remains unclear. Existing data has been predominantly derived from highly selected populations, that may overestimate the true prevalence of abnormal findings on CMR in this patient population.

Purpose

The aim of this study was 2-fold: 1) to establish the prevalence of CMR imaging abnormalities in a cohort with normal LVEF and high PVC burden; 2) to identify predictors of CMR imaging abnormalities in patients with frequent PVCs and normal LVEF.

Methods

In this cohort study, 211 patients (age 53.2±19 years; 41% male) with frequent PVCs (≥5%/24 h), of normal LVEF (≥50% by echocardiography) and no known underlying structural heart disease were prospectively enrolled from 2016–2020. Of these, 166 (79%) patients were symptomatic from their PVCs in the form of palpitations, fatigue, chest pain, dizziness, and/or dyspnea. Patients underwent CMR imaging (1.5 Tesla) with a late gadolinium enhancement (LGE) protocol at the time of enrollment for the detection of scarring and/or fibrosis.

Results

Patients had a median baseline echocardiographic LVEF of 60% (± 5%) with 195 (92%) of patients having a normal native QRS morphology. Median PVC burden of the study cohort was 16% (± 14%). CMR LGE abnormalities were found in 19 (9%) patients including 17 scans with non-ischemic LGE and 2 with ischemic LGE. Age &gt;60 (odds ratio [OR]: 3.20, 95% confidence interval [CI]: 1.20–8.51, p=0.020), male sex (OR: 4.67, 95% CI: 1.61–13.50, p=0.004), history of hypertension (OR: 3.43, 95% CI: 1.31–8.97, p=0.012), native QRS duration (OR: 1.03, 95% CI: 1.00–1.05, p=0.031), and history of non-sustained ventricular tachycardia (OR: 2.81, 95% CI: 1.03–7.68, p=0.044) were significantly associated with the presence of imaging abnormalities on CMR. Dominant PVC origin from the left ventricle had a positive trend (OR: 2.60, 95% CI: 0.99–7.66, p=0.083) to association with CMR imaging abnormalities. On multivariate analysis, male sex (OR: 4.10, 95% CI: 1.40–12.04, p=0.010) and history of hypertension (OR: 2.89, 95% CI: 1.08–7.75, p=0.035) remained significantly associated with the presence of CMR abnormalities. There was no association between CMR imaging abnormalities and the burden of PVCs or the number of PVC morphologies.

Conclusion

In this cohort, only 9% of patients with apparently idiopathic frequent PVCs and normal LVEF had concealed myocardial abnormalities on CMR imaging. Male sex and history of hypertension were associated with a higher rate of CMR abnormalities.

Funding Acknowledgement

Type of funding sources: None.

The impact of frailty on the management and outcome of ST-elevation myocardial infarction in older patients

Background

Frailty is a clinical syndrome of increased vulnerability, resulting from age-associated decline in physiological reserve, compromising the ability to cope with acute stressors. Despite an increasing number of older, frail patients presenting with ST-elevation myocardial infarction (STEMI), there remains a paucity of guidance on how to approach the management of this complex group.

Purpose

To evaluate the impact of frailty on the management strategy and outcomes in older patients presenting with ST-elevation myocardial infarction.

Methods

A retrospective cohort study was performed, using linked patient records in The Nationwide Readmission Database. All patients aged ≥75 years that presented with STEMI (2015 – 2018) were included. International Classification of Disease (10th Edition; ICD-10) codes were used to ascertain exposures and outcomes. Frailty was quantified using the Hospital Frailty Risk Score (HFRS): an ICD-10-based scoring system that has been validated against established clinical frailty indices. Outcomes included: (i) management strategy (coronary angiography ± percutaneous coronary intervention, vs. conservative management), length of stay and 30-day mortality. Outcomes were modelled using multivariable binary logistic regression. Continuous variables are presented as: mean (standard deviation). Odds ratios (OR) are given with corresponding 95% confidence intervals (CI).

Results

From an overall dataset of 57,133,894 admissions, 368,201 patients presenting with STEMI were identified, of which 92,067 were aged ≥75 years. The mean age was 82.4 (5.1) years; 45,768 (49.7%) were female. The mean frailty score was 5.9 (SD 4.9, range 0 - 37.7). Patients were categorised by frailty status: low (HFRS &lt;5; n=46,336 [50.3%]), intermediate (HFRS 5 - 15; n=40,493 [44.0%]) and high risk (HFRS &gt;15; n=5,238 [5.7%]). Characteristics of the cohort are presented in Figure 1. Frail patients were less likely to undergo invasive management: 1,873 (35.5%) of the high risk group underwent coronary angiography vs. 36,888 (79.6%) of the low risk group; OR 0.14 (95% CI 0.13 - 0.15), P&lt;0.001. Length of stay in hospital increased proportionately with frailty: a 2-unit increase in HRFS was associated with one additional day in hospital (p&lt;0.001). 30-day mortality increased non-linearly with increasing HFRS and was markedly higher among patients at high risk for frailty, compared with those at low risk; OR 3.70 (95% CI 3.47 - 3.94; p&lt;0.001). The relationship between frailty score and outcomes is presented in Figure 2. Frailty remained the greatest single predictor of outcome following adjustment for other covariates, including age.

Conclusions

Frail patients presenting with STEMI are less likely to undergo invasive management and more likely to experience adverse outcomes. Quantification of frailty offers an opportunity to identify and address modifiable risk factors to improve post-STEMI outcomes in this vulnerable group.

Funding Acknowledgement

Type of funding sources: None.

Whole cycle non-hyperaemic pressure ratios have better stability than diastolic ratios after percutaneous coronary intervention due to changes in diastolic coronary haemodynamics

Background

Post percutaneous intervention (PCI) fractional flow reserve (FFR) value of ≥0.90 is an accepted marker of procedural success, and similarly, a cut-off of ≥0.95 has recently been proposed for post-PCI instantaneous wave free ratio (iFR). However, the stability of non-hyperaemic pressure ratios (NHPRs) and microcirculatory resistance post-PCI, is not well characterised. as submaximal hyperaemia post-PCI may affect them.

Purpose

We performed this study to assess stability and reproducibility of NHPRs measured immediately post-PCI and repeated at 30 minutes post-PCI.

Methods

Seventy-seven patients undergoing pressure wire guided PCI (age 63.77±10.67 years, male 71%,) had haemodynamic assessment done immediately post-PCI and after a recovery period 30 minutes (Figure A, B). Manual offline analysis was performed to derive resting pressure ratios during whole cycle: average ratio of distal coronary pressure to proximal aortic pressure at rest (Pd/Pa) and resting full cycle ratio (RFR); and during diastolic phase: average diastolic pressure ratio (dPR) and mathematically calculated iFRmat, measured by average Pd/Pa during wave free period (WFP) (from 25% into diastole until 5 msec before the end of diastole). We also measured coronary flow velocity by thermo-dilution time (Tmn) and basal microvascular resistance (BMR = Pa × Tmn × [(Pd − Pw) / (Pa − Pw)] baseline) corrected for coronary wedge pressure (Pw). Test-retest statistics was performed between NHPRs values immediately post-PCI and at 30 minutes. Moreover, crossover of NHPRs across the cut-off value of 0.95 was analysed to assess clinical utility of these indices for procedural success. p value of &lt;0.05 was deemed statistically significant.

Results

There were no differences in the baseline characteristics of the study patients. Sub-maximal hyperaemia was demonstrated by Tmn of 0.54 sec (0.32, 0.75) immediately post-PCI which settled by 30 minutes, Tmn of 0.67 sec (0.43, 0.91), p=0.01 (Figure C). The median BMR increased from 49.25 mmHg sec (32.74, 61.61) to 59.60 mmHg sec (39.24, 76.91) at 30 minutes, p=0.04 (Figure D). Despite this, there were no significant differences in the values of resting whole cycle ratios (Pd/Pa and RFR) as well as diastolic ratios (dPR and iFRmat), with whole cardiac cycle NHPRs having best stability post-PCI (Table). Furthermore, crossover above or below the cut-off value of 0.95 occurred in approximately 1 in 5 diastolic NHPRs measurements but was three-fold lower for whole cycle NHPRs.

Conclusion

NHPRs remain stable post-PCI, despite submaximal hyperaemia being detected and may legitimately be used immediately post-PCI to determine procedural success. However, the test-retest reproducibility and clinical utility of diastolic NHPRs (dPR and iFR) was inferior to whole cycle NHPRs (Pd/Pa and RFR).

Funding Acknowledgement

Type of funding sources: Public Institution(s). Main funding source(s): NIHR

456 Palliative Care Interventions for Peripheral Vascular Disease: A Systematic Review

Objective

Identify and evaluate palliative care interventions used in peripheral vascular disease (PVD).

Background

PVD encompasses conditions with poor outcome and severe suffering, both mentally and physically, yet utilisation and research into palliative care interventions remain sparse.

Method

A systematic review of all study designs published between January 1991 and January 2020 in which people with PVD received palliative care interventions and at least one patient reported outcome was recorded.

Results

A total of eight studies involving 87037 unique patients met inclusion criteria (four cohort studies and four cross sectional studies). There were no randomised controlled studies; The small number of studies and study heterogeneity precluded meta-analysis. Only two papers recorded patient reported outcomes. Five papers found an association between palliative care and reduction in health care utilisation. Most of the studies reported that palliative care was likely underused. Only two of the studies included non-hospital patients. The methodological quality of the papers ranged from low to moderate.

Conclusions

Despite high mortality and morbidity associated with PVD, evidence of the effectiveness of palliative care in this group of patients is lacking. There are only a handful of papers on palliative care in vascular surgery and the majority are small, methodologically flawed and lack patient reported outcomes. Randomised controlled trials of palliative care interventions in patients with PVD are needed to determine optimal treatment outcomes.

Brain event-related potentials predict individual differences in inhibitory control

Stop-signal reaction time (SSRT), the time needed to cancel an already-initiated motor response, quantifies individual differences in inhibitory control. Electrophysiological correlates of SSRT have primarily focused on late event-related potential (ERP) components over midline scalp regions from successfully inhibited stop trials. SSRT is robustly associated with the P300, there is mixed evidence for N200 involvement, and there is little information on the role of early ERP components. Here, machine learning was first used to interrogate ERPs during both successful and failed stop trials from 64 scalp electrodes at 4 ms resolution (n = 148). The most predictive model included data from both successful and failed stop trials, with a cross-validated Pearson's r of 0.32 between measured and predicted SSRT, significantly higher than null models. From successful stop trials, spatio-temporal features overlapping the N200 in right frontal areas and the P300 in frontocentral areas predicted SSRT, as did early ERP activity (<200 ms). As a demonstration of the reproducibility of these findings, the application of this model to a separate dataset of 97 participants was also significant (r = 0.29). These results show that ERPs during failed stops are relevant to SSRT, and that both early and late ERP activity contribute to individual differences in SSRT. Notably, the right lateralized N200, which predicted SSRT here, is not often observed in neurotypical adults. Both the ascending slope and peak of the P300 component predicted SSRT. These results were replicable, both within the training sample and when applied to ERPs from a separate dataset.

Fiberoptic endoscopic evaluation of swallowing and videofluoroscopy swallowing assessment in adults in residential care facilities: a scoping review protocol

OBJECTIVE

This scoping review will identify and explore existing evidence on the use of instrumental swallowing assessment in the diagnosis and management of dysphagia in adults living in residential care facilities.

INTRODUCTION

Oropharyngeal dysphagia is prevalent among adults living in residential care facilities. Videofluoroscopy and fiberoptic endoscopic evaluation of swallowing are instrumental assessment procedures commonly utilized in the evaluation of oropharyngeal dysphagia in hospital and community settings. However, little is known about the use of these procedures in residential care facilities. To ensure evidence-based assessment of oropharyngeal dysphagia and to guide future research, exploration of the current use and clinical utility of videofluoroscopy and fiberoptic endoscopic evaluation of swallowing in residential care facilities is needed.

INCLUSION CRITERIA

Published and gray literature written in English from 2000 onward that discusses instrumental swallowing assessment of adults in residential care facilities will be included in the review.

METHODS

A three-step search strategy will be used to explore relevant literature. All citations and articles retrieved during the searches will be imported into a software application for systematic reviews. Once duplicates are removed, two reviewers will screen the titles and abstracts against predefined inclusion criteria. Information will be extracted from literature that meets the selection criteria using a purposefully developed charting form. The search strategy and results will be illustrated through a Preferred Reporting Items for Systematic Reviews and Meta-Analyses diagram. Key findings and their relationship to the research questions will be summarized in a chart and discussed in interpretive narrative form.

The Role of Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A National Modified Delphi Survey Examining Beliefs and Practices

Many adults in residential aged care homes (RACHs) live with oropharyngeal dysphagia (OD) and its physiological, psychosocial, and economic sequalae. Timely, evidence-based assessment of OD can help healthcare teams to create OD management plans that optimize consumer health and minimize healthcare costs. Instrumental swallowing assessment (ISA), specifically flexible endoscopic evaluation of swallowing (FEES) and videofluoroscopic swallowing studies (VFSS), is generally accepted to be an important component of dysphagia assessment and management in older adults. However, its role in RACHs has not been empirically examined. This study aimed to explore the role and use of ISA in adults in RACHs from the perspective of speech-language-pathologists (SLPs) experienced in a RACH setting and/or FEES and VFSS. A three-round electronic Delphi study was conducted to guide 58 SLPs in Australia towards consensus using a combination of multiple-choice questions, statements with five-point Likert scale agreement options, and open-ended questions. Participants' responses were analyzed using descriptive statistics and content analysis after each survey round. Feedback about group responses was provided before subsequent surveys. Consensus was defined as 70% or greater agreement. Participants reached consensus about obstacles and facilitators to the use of ISA in RACHs. Participants agreed that FEES was a valuable tool in RACHs and that a mobile service model may have advantages over standard off-site assessment. SLPs believed that appropriate governance processes, infrastructure and education were necessary to develop a safe, high-quality service. These views support equitable access to ISA across settings, aligning with person-centered care, re-ablement, and care-in-place.

P61 Impact of the COVID-19 pandemic on the presentation and management of acute appendicitis: a single-centre analysis

Introduction

The COVID-19 pandemic has influenced the delivery of healthcare. In accordance with the UK Joint Royal Colleges’ advice the management of acute appendicitis (AA) changed with greater consideration for non-operative management (NOM) or open appendicectomy where operative management (OM) s sought. Our aim is to share our experience of the presentation, management and outcomes for patients presenting to our Trust with AA to guide care for future viral pandemics.

Methods

This single-centre retrospective cohort study included patients diagnosed with AA in March to July 2019 compared with March to July 2020. Medical records were used to evaluate demographics, inflammatory markers, imaging, severity, management, histology, length of stay (LOS), complications and 90-day outcomes.

Results

There were 149 and 125 patients in the 2019 and 2020 cohort, respectively. 14 patients (9.4%) had NOM in 2019 versus 31 patients (24.8%) in 2020 (p = 0.001). In the 2019 OM group 125 patients (92.6%) had laparoscopic appendicectomy versus 69 (73.4%) in 2020. 59 patients (39.6%) had a CT in 2019 versus 70 (56%) in 2020. The median LOS was 4 days (interquartile range (IQR) 3 to 6 days) in 2019 and 3 days (IQR 2 to 5 days) in 2020 (p = 0.03). Two patients in each year who received NOM had treatment failure (14.3% in 2019 and 6.5% in 2020). Three patients in 2019 who had OM had treatment failure (2.2%). Of 95 patients tested for COVID-19 all but one was negative.

Conclusion

During the COVID-19 pandemic there was no observed increase in severity of AA, patients had a shorter LOS and were more likely to have imaging. NOM proportionally increased with no observed change in outcomes.

Bare necessities? The utility of full skin examination in the COVID-19 era

Full skin examination (FSE) may improve the detection of malignant melanoma (MM). The objective of this study was to assess the safety of targeted lesion examination (TLE) compared with FSE in our Pigmented Lesion Clinic (PLC). Patients attending the PLC were randomized in a 2 : 1 ratio to FSE (intervention) or TLE (standard care). Demographic details and risk factors were documented, and the time taken to perform FSE and TLE was noted. Of 763 participants, 520 were assigned to FSE and 243 were assigned to TLE. On average, FSE took 4.02 min and TLE took 30 s to perform. Of the 520 participants assigned to FSE, 37 (7.1%) had incidental findings, of whom 12 patients (2.3%) had additional lesions biopsied. No additional melanomas were detected that would have been missed by use of the standard protocol. This study suggests that in low-risk patients referred to a PLC with a lesion of concern, the possibility of missing incidental cutaneous malignancies using lesion-directed examination is low.

How Important Are Choice, Autonomy, and Relationships in Predicting the Quality of Life of Nursing Home Residents?

Older people face major challenges when they move into nursing homes, particularly in relation to independence and their ability to influence their activities of daily living (ADLs). This study evaluated the contribution of resident choice, as well as the staff-resident relationship, to promoting resident quality of life (QoL). A total of 604 residents from 33 nursing homes in Australia completed measures of QoL, perceived levels of choice in various ADLs, and the staff-resident relationship. A hierarchical regression demonstrated that the predictor variables accounted for 25% of the variance in QoL. Two of the four predictor variables (resident choice over socializing and the staff-resident relationship) significantly contributed to resident QoL. These findings reinforce the important contribution of autonomy and social relationships to resident QoL. Nursing home staff have a key role to play in supporting resident autonomy as a means of building residents' chosen social connections, and thereby promoting QoL.

Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis

Background

Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET).

Purpose

To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients.

Methods

PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188).

Results

60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p&lt;0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients.

PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p&lt;0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries.

PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p&lt;0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling.

Conclusion

PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD.

PCAT density is greater in TAK than CAD

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Wellcome Trust

Instrumental Swallowing Assessment in Adults in Residential Aged Care Homes: A Scoping Review

OBJECTIVES

To systematically describe evidence on the use of instrumental swallowing assessment for residents of aged care homes.

DESIGN

Scoping review using the Joanna Briggs Institute methodology for scoping reviews.

SETTING AND PARTICIPANTS

Published peer-reviewed and gray literature written in English between 2000 and 2020 about instrumental swallowing assessment (ISA) in adults in residential aged care homes (RACHs).

MEASURES

A systematic, 3-tiered search of databases including Medline, CINAHL, Embase, Scopus, and Cochrane Database of Systematic Reviews, and gray literature databases was conducted. Content analysis identified common themes.

RESULTS

Forty-two sources, 30 from peer-reviewed journals, 12 gray literature publications, and 66 websites of mobile ISA providers that discussed videofluoroscopic swallowing studies (VFSS) and/or fiberoptic endoscopic evaluation of swallowing (FEES) use in RACHs were included. Most peer-reviewed sources were referenced narratives or surveys of speech pathology practice patterns (53.3%). Researchers in 3 studies used onsite mobile FEES and in 2 studies off-site VFSS, with adults living in RACHs, as part of their research design (16.7%). There were 66 mobile instrumental swallowing assessment provider websites, based within the United States. Three countries (Australia, United States, United Kingdom) had professional guidelines that stipulated minimal requirements for the safe and appropriate provision of ISA services across settings. Themes identified across sources included (1) the approach to swallowing management and clinical indicators for ISA, (2) the role of ISA, (3) service and consumer influences on ISA, and (4) mobile FEES.

CONCLUSIONS AND IMPLICATIONS

There is a paucity of quality research on instrumental swallowing assessment in adults living in RACHs. There are broad regional and international variances in the way that videofluoroscopy and FEES are accessed and used. A more robust evidence base is required to guide health professionals to design tailored ISA care pathways for residents of RACHs, to achieve high-quality health, social, and economic outcomes.

Susceptibility to prosocial and antisocial influence in adolescence

Introduction

Adolescents are particularly susceptible to social influence and previous studies have shown that this susceptibility decreases with age. The current study used a cross-sectional experimental paradigm to investigate the effect of age and puberty on susceptibility to both prosocial and antisocial influence.

Methods

Participants (N = 520) aged 11–18 from London and Cambridge (United Kingdom) rated how likely they would be to engage in a prosocial (e.g. “help a classmate with their work”) or antisocial (e.g. “make fun of a classmate”) act. They were then shown the average rating (in fact fictitious) that other adolescents had given to the same question, and were then asked to rate the same behaviour again.

Results

Both prosocial and antisocial influence decreased linearly with age, with younger adolescents being more socially influenced when other adolescents’ ratings were more prosocial and less antisocial than their own initial rating. Both antisocial and prosocial influence significantly decreased across puberty for boys but not girls (independent of age).

Conclusions

These findings suggest that social influence declines with increasing maturity across adolescence. However, the exact relationship between social influence and maturity is dependent on the nature of the social influence and gender. Understanding when adolescents are most susceptible to different types of social influence, and how this might influence their social behaviour, has important implications for understanding adolescent social development.

Development of comparable algorithms to measure primary care indicators using administrative health data across three Canadian provinces

INTRODUCTION

Performance measurement has been recognized as key to transforming primary care (PC). Yet, performance reporting in PC lags behind even though high-performing PC is foundational to an effective and efficient health care system.

OBJECTIVES

We used administrative data from three Canadian provinces, British Columbia, Ontario and Nova Scotia, to: 1) identify and develop a core set of PC performance indicators using administrative data and 2) examine their ability to capture PC performance.

METHODS

Administrative data used included Physician Billings, Discharge Abstract Database, the National Ambulatory Care and Reporting System database, Census and Vital Statistics. Indicators were compiled based on a literature review of PC indicators previously developed with administrative data available in Canada (n=158). We engaged in iterative discussions to assess data conformity, completeness, and plausibility of results in all jurisdictions. Challenges to creating comparable algorithms were examined through content analysis and research team discussions, which included clinicians, analysts, and health services researchers familiar with PC.

RESULTS

Our final list included 21 PC performance indicators pertaining to 1) technical care (n=4), 2) continuity of care (n=6), and 3) health services utilization (n=11). Establishing comparable algorithms across provinces was possible though time intensive. A major challenge was inconsistent data elements. Ease of data access, and a deep understanding of the data and practice context, was essential for selecting the most appropriate data elements.

CONCLUSIONS

This project is unique in creating algorithms to measure PC performance across provinces. It was essential to balance internal validity of the indicators within a province and external validity across provinces. The intuitive desire of having the exact same coding across provinces was infeasible due to lack of standardized PC data. Rather, a context-tailored definition was developed for each jurisdiction. This work serves as an example for developing comparable PC performance indicators across different provincial/territorial jurisdictions.

Current Perspectives of Prenatal Sonographic Diagnosis and Clinical Management Challenges of Nuchal Cord(s)

Umbilical cord accidents preceding labor are uncommon. In contrast, nuchal cords are a very common finding at delivery, with reported incidences of a single nuchal cord of approximately between 20% and 35% of all singleton deliveries at term. Multiple loops occur less frequently, with reported incidence rates inverse to the number of nuchal cords involved. Rare cases of up to 10 loops of nuchal cord have been reported. While true knots of the umbilical cord have been associated with a 4–10-fold increased risk of stillbirth, nuchal cord(s) are most often noted at delivery of non-hypoxic non-acidotic newborns, without any evidence of subsequent adverse neonatal outcome. Prior to ultrasound, nuchal cords were suspected clinically following subtle (spontaneous or evoked) electronic fetal heart rate changes. Prenatal sonographic diagnosis, initially limited to real-time gray-scale ultrasound, currently entails additional sonographic modalities, including color Doppler, power Doppler, and three-dimensional sonography, which have enabled increasingly more accurate prenatal sonographic diagnoses of nuchal cord(s). In contrast to true knots of the umbilical cord (which are often missed at sonography, reflecting the inability to visualize the entire umbilical cord, and hence are often incidental findings at delivery), nuchal cord(s), reflecting their well-defined and sonographically accessible anatomical location (the fetal neck), lend themselves with relative ease to prenatal sonographic diagnosis, with increasingly high sensitivity and specificity rates. While current literature supports that single (and possibly double) nuchal cords are not associated with increased adverse perinatal outcome, emerging literature suggests that cases of ≥3 loops of nuchal cords or in the presence of a coexisting true knot of the umbilicus may be associated with an increased risk of stillbirth or compromised neonatal status at delivery. This commentary will address current perspectives of prenatal sonographic diagnosis and clinical management challenges associated with nuchal cord(s) in singleton pregnancies.

A-35 On-Field Dizziness and Timing of Referral to Vestibular Therapy Following Adolescent Sports-Related Concussion: Initial Findings

Objective

To examine if adolescent patients who experienced on-field dizziness immediately following sports-related concussion (SRC) and were referred to vestibular therapy (VT) in 7–9 days returned to play faster when compared to referrals made &gt; 10 days.

Method

Registry data for an outpatient clinic specializing in adolescent SRC was analyzed. Of the 85 adolescent patients included, 67 (79%) experienced dizziness immediately following injury; 36 (54%) of which were referred to VT. Mean age at time of injury was 15.3 years; 61.1% were male (n = 22); most were injured while participating in football (38.9%), soccer (16.7%), or wrestling (13.9%). Days to initial VT evaluation from time of injury and days from VT to clearance from concussion protocol were analyzed using a Poisson regression model; age and sex were controlled.

Results

Patients referred to VT 7–9 days post-injury returned to play 16 ± 13.4 days earlier (20.7 ± 18.6 days; p &lt; .0001) than patients who received VT 10–20 days post SRC (36.7 days±32). While non-significant, individuals referred to VT &gt; 21 days post-injury returned to play 6 days later than those referred &lt; 10 days (26.3 ± 32.9; p = .14).

Conclusions

Appropriate and timely referrals to VT following the presence of on-field dizziness after SRC may play an integral role in recovery, although more research in this area is needed. Initial findings suggest that when determining optimal time frame for referral to VT, 7–9 days post-injury may be most beneficial for adolescents following SRC.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Consumer directed care in residential aged care: an evaluation of a staff training program

Objectives: The advent of Consumer-Directed Care (CDC, or individualized care) in Residential Aged Care Facilities (RACFs, or residential care) will require a paradigm shift in service delivery. This article evaluated the six-session Resident at the Centre of Care (RCC) staff training program designed to equip staff to implement a CDC model of care among residents.Method: There were two experimental conditions: RCC training program alone, RCC training program plus support, and a 'care as usual' condition. Outcome measures were resident quality of life (QoL) and resident working relationships with staff at 3-month follow-up. At Time 1, 92 residents from RACFs participated in the program. The RCC is six sessions that focus on the development of staff skills in communicating with residents, as well as the organizational change and transformational leadership that is needed for the implementation of CDC.Results: There were significant improvements in resident QoL. There was no major difference between the RCC Program plus support condition compared to the RCC Program alone condition, but both were associated with more positive changes in resident QoL than the 'care as usual' condition.Conclusion: This study demonstrates that training staff in strategies to implement CDC in RACFs can lead to an improvement in the wellbeing of many residents, and that additional support to assist staff to implement the strategies may not be required to produce such improvements. Longer term follow-up is necessary to determine if the improvements in resident QoL are sustained.

Perceptions of acute hospital occupational therapy services: developing a new model of care for occupational therapy on acute medical wards

Background/Aims

This study was conducted at a regional tertiary referral facility in Australia. It was part of a project to implement a new model of care for occupational therapy services on medical wards. Before the new model was implemented, focus groups were conducted to explore the perceived role of the occupational therapist on the acute medical ward, identify potential barriers to changing the service and garner support for the change in service.

Methods

Three focus groups were held. The groups consisted of nursing, physiotherapy and speech pathology staff who worked on acute medical wards. Participants were asked for their perception of the role of occupational therapy on the acute medical ward. Audio-recordings of the groups were transcribed and analysed.

Results

Qualitative content analysis highlighted the following themes: assessment of patient function; ‘safe discharge’; more than assessment; equipment and home modifications; collaboration and communication; delegating tasks to assistants; and specialist intervention strategies.

Conclusions

Multidisciplinary team members' overriding perception is that occupational therapists in acute care settings provide assessment of patient function for the specific purpose of safe discharge. Some participants recalled that occupational therapists had a greater role in ensuring patients returned to their chosen function through rehabilitation and home visits, suggesting support for a change to our proposed post-acute model of care. Concerns highlighted by focus group members regarding increased workload for multidisciplinary team members and loss of communication need to be addressed to ensure the change in service is successful.

Resident perceptions of opportunity for communication and contribution to care planning in residential aged care

BACKGROUND AND AIM

Irrespective of age, communication is a tool of expression and a key daily activity meeting the human need for social interaction and connection. The introduction of consumer-directed care (CDC) emphasises the importance of communication to provide consumers with the opportunity to exercise choice over the care they receive. As consumer-directed care progresses, it is hypothesised that the feasibility of shared decision-making and care planning in residential aged care will be largely determined by the communication opportunities afforded to the residents. Therefore, the aim of this study was to explore resident perceptions of the opportunities they have to communicate, including the opportunity to express their care preferences and contribute opinions about their care.

DESIGN

A qualitative inductive design was adopted.

METHODS

An individual interview format was used to gather the perspectives of 102 residents. Data were analysed using qualitative content analysis to generate themes illustrating patterns in participant views.

FINDINGS

Overall, residents desired increased involvement in their care planning and increased opportunity for more meaningful communication and social opportunities. Residents described the negative impact of the communication difficulties they face on their communication and the need for support and activities to be tailored to residents' individual communication needs.

CONCLUSIONS

To facilitate resident participation in CDC and meet resident desire for increased social communication, further investment in resources to support resident-staff communication and accommodate residents' individual communication needs is required.

IMPLICATIONS FOR PRACTICE

By highlighting communication as a stand-alone activity and a priority of residents, the findings of this study raise the profile of communication and demonstrate the need for explicit allocation of care time and specialist services to support resident-staff communication and social communication in residential aged care. Such support must be tailored to meet residents' individual communication needs and be coupled with increased staff training in providing communication support. Without facilitating resident communication and increasing the opportunity to communicate, shared decision-making and care planning in residential aged care consistent with person-centred and consumer-directed models of care will be limited.

P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort

Background

Cardiac implantable electronic devices have been known to have lead and device malfunctions leading to advisories. Increased use of remote monitoring of devices has been suggested to allow the identification of abnormal device performance and allow early intervention. We sought to describe the outcomes of patients with and without remote monitoring of in devices in the Abbott Premature Battery Depletion advisory with data from a Canadian registry

Methods

Patients with an Abbott device subject to the Battery Performance Alert Advisory from nine ICD implanting centres in Canada were included in the registry. The use of remote monitoring was identified from baseline and followup data in the registry. The primary outcome was detection of premature battery depletion and all cause mortality.

Results

2679 patents were identified with a device subject to the advisory. Devices were implanted between 2010 and 2017. 1716 patients (64%) had remote monitoring at baseline with this increasing to 83.7% at followup at 12 months. Premature battery depletion occurred in 43 patients (1.6%). Discovery of premature battery depletion was detected by remote monitoring in 70% of patients. There were 492 deaths during the follow up. Mortality was higher in those without a remote monitor compared to those with a remote monitor at follow-up and remote monitor at baseline and follow-up (11.3%, 2.6% versus 6.1% respectively; p=0.0186). There were no deaths attributed to premature battery depletion

Conclusion

The use of remote monitoring in patients with ICD and CRT under advisory reliably detected device failure and was associated with a reduction in all-cause mortality.

Leukocyte telomere length is associated with elevated plasma glucose and HbA1c in young healthy men independent of birth weight

Telomeres are protein-bound regions of repetitive nucleotide sequences (TTAGGG) at the end of human chromosomes, and their length is a marker of cellular aging. Intrauterine growth restriction is associated with shorter blood cell telomeres at birth and individuals with type 2 diabetes have shorter telomeres. Individuals with a low birth weight (LBW) have an increased risk of metabolic disease and type 2 diabetes. Therefore, we aimed to investigate the relationship between birth weight and telomere length and the association between birth weight, telomere length and cardiometabolic phenotype in adulthood. Young, healthy men with LBW (n = 55) and normal birth weight (NBW) (n = 65) were examined including blood pressure, blood samples and body composition. Leukocyte telomere length was determined using a high-throughput qPCR method. The LBW men were more insulin resistant as determined by the HOMA-IR index. There was no difference in telomere length between LBW and NBW subjects. When adjusting for birth weight and cohort effect, significant negative associations between telomere length and fasting glucose (P = 0.003) and HbA1c (P = 0.0008) were found. In conclusion, no significant difference in telomere length was found between LBW and NBW men. The telomere length was negatively associated with glucose concentrations and HbA1c levels within the normal non-diabetic range independent of birth weight.

Is the speech-language pathology profession prepared for an ageing population? An Australian survey

PURPOSE

This study profiled the demographic characteristics and practice patterns of speech-language pathologists working with older Australians to inform future workforce planning and service development in response to an ageing population and aged care sector reform.

METHOD

Data were collected through snowball distribution of an online survey comprising six sections: demographic details; caseload and service delivery practices, degree of inter-professional practice; engagement with professional development and support; and assessment and management of swallowing, mealtime and communication difficulties. All data were analysed using descriptive statistics and chi-square to determine the independence of key variables.

RESULT

Data from 145 speech-language pathologists highlight the need for increased numbers of clinicians working outside of metropolitan areas and greater workforce diversity, along with increased incentive, supervision and inter-professional support for new graduate and early career clinicians considering working outside of hospital settings. To ensure evidence-based practice, further research into the validity of current assessment and intervention methods used across aged care settings is needed.

CONCLUSION

The findings highlight the need for an extended scope of practice and improved models of support for speech-language pathologists working with older people to better respond to the needs of an ageing population and on-going aged care sector reform.