Evidence from the first Shared Medical Appointments (SMAs) randomised controlled trial in India: SMAs increase the satisfaction, knowledge, and medication compliance of patients with glaucoma

In Shared Medical Appointments (SMAs), patients with similar conditions meet the physician together and each receives one-on-one attention. SMAs can improve outcomes and physician productivity. Yet privacy concerns have stymied adoption. In physician-deprived nations, patients' utility from improved access may outweigh their disutility from loss of privacy. Ours is to our knowledge the first SMA trial for any disease, in India, where doctors are scarce. In a 1,000-patient, single-site, randomized controlled trial at Aravind Eye Hospital, Pondicherry, we compared SMAs and one-on-one appointments, over four successive visits, for patients with glaucoma. We examined patients' satisfaction, knowledge, intention-to-follow-up, follow-up rates, and medication compliance rates (primary outcomes) using intention-to-treat analysis. Of 1,034 patients invited between July 12, 2016 -July 19, 2018, 1,000 (96.7%) consented to participate, and were randomly assigned to either SMAs (NSMA = 500) or one-on-one appointments (N1-1 = 500). Patients who received SMAs showed higher satisfaction (MeanSMA = 4.955 (SD 0.241), Mean1-1 = 4.920 (SD 0.326); difference in means 0.035; 95% CI, 0.017-0.054, p = 0.0002) and knowledge (MeanSMA = 3.416 (SD 1.340), Mean1-1 = 3.267 (SD 1.492); difference in means 0.149; 95% CI, 0.057-0.241, p = 0.002) than patients who received one-on-one appointments. Across conditions, there was no difference in patients' intention-to-follow-up (MeanSMA = 4.989 (SD 0.118), Mean1-1 = 4.986 (SD 0.149); difference in means 0.003; 95% CI, -0.006-0.012, p = 0.481) and actual follow-up rates (MeanSMA = 87.5% (SD 0.372), Mean1-1 = 88.7% (SD 0.338); difference in means -0.012; 95% CI, -0.039-0.015, p = 0.377). Patients who received SMAs exhibited higher medication compliance rates (MeanSMA = 97.0% (SD 0.180), Mean1-1 = 94.9% (SD 0.238); difference in means 0.020; 95% CI, 0.004-0.036, p = 0.013). SMAs improved satisfaction, learning, and medication compliance, without compromising follow-up rates or measured clinical outcomes. Peer interruptions were negatively correlated with patient satisfaction in early-trial SMAs and positively correlated with patient satisfaction in later-trial SMAs. Trial registration: The trial was registered with Clinical Trials Registry of India (https://ctri.nic.in/) with reference no. REF/2016/11/012659 and registration no. CTRI/2018/02/011998.

The Influence of Relaxing and Self-Selected Stimulating Music on Vertical Jump Performance in Male Volleyball Players

Most research concerning the effects of music on physical performance was conducted using endurance parameters. This study investigated the effects of relaxing (RLX) vs. self-selected stimulating music (SM) vs. no music (NM) on jump height (JH), jump power (PWR), and average rest period between jumps (RP) in 13 athletes (age: 25.5 ± 2.6 years). After a warm-up and listening to music (1 min) or NM, participants completed five squat jumps on a force plate. Psychological ratings of mood were assessed using a questionnaire before warm-up and after jumping. A one-way ANOVA was conducted to compare effects of music on JH, PWR, and RP. A Friedman test with Wilcoxon signed-rank test was used to detect changes in mood. There were no significant effects of music on JH (p = 0.162) and PWR (p = 0.162). A trend towards longer RP in RLX when compared to SM was detected (+2.72 s, +22%, p = 0.059, d = 0.35). Participants felt more "relaxed" (+3 ranks) and more "powerful" after listening to SM (+2 ranks). Following NM and RLX, athletes felt more "energetic" (each +3 ranks) but less energetic (-3 ranks) after SM. In conclusion, this study did not find any performance-enhancing effects of self-selected SM on jump performance. The influences of music on psychological ratings were inconclusive. For this reason, no evidence-based guidelines for the practical application of music in elite jumping athletes can be made, and more studies are warranted.

Evaluation of patients with epilepsy: an outpatient clinic based study

In order to identify the demographic features, seizure types and epilepsies, we reviewed the files of 1379 patients admitted to the epilepsy outpatient clinic of Bakirköy State Hospital for Neurological and Psychiatric Diseases between 1991 and 1994. Of these, 160 patients' files contained inadequate information and 80 patients with nonepileptic events were excluded from the study. There were 523 female and 616 male patients ranging in age from 6 months to 87 years. Risk factors could be identified in 612 (54.3%) of patients. Some 62.1% of patients had partial and 34.8% had generalized seizures, whilst 71.0% were classified as partial and 11.9% as generalized epilepsies. Two per cent were classed as special syndromes and 15% as undetermined. In our series the unclassified cases represented 3.1% of the total. We discuss the results and compared them with other studies.