Development and psychometric evaluation of the asthma Action plan questionnaire (AAPQ)

OBJECTIVE

To develop a practical and psychometrically sound tool to evaluate caregiver knowledge of their child's asthma action plan (AAP).

METHODS

A pilot study was conducted in a sample of 40 caregivers of children with asthma to assess the content validity, item difficulty, and item discrimination of the Asthma Action Plan Questionnaire (AAPQ). The inter-rater and intra-rater agreement of the AAPQ's scoring rubric were also examined. Subsequently, a large-scale study was conducted in a sample of 80 caregivers of children with asthma and 40 caregivers of children without current asthma and no prior exposure to patients with asthma to evaluate the internal consistency, test-retest reliability, and known-groups validity of the AAPQ.

RESULTS

The 7-item AAPQ demonstrated acceptable content validity (a scale-content validity index of 0.98) and internal consistency (Cronbach's alpha =.63 and mean inter-item correlation coefficient of.20) and very strong test-retest reliability over a two-to-four-week period (r = .88, p < .001). The AAPQ discriminated between caregivers of children with asthma and caregivers of children without asthma (M ± SD 8.3 ± 1.6 vs. 4.3 ± 1.7, p < .001, respectively).

CONCLUSION

The AAPQ is a valid and reliable questionnaire that provides an assessment of caregivers' knowledge of their child's AAP and can guide educational interventions by healthcare providers.

Investigating CT head diagnostic reference levels based on indication-based protocols - a single site study

INTRODUCTION

This study aimed to provide clinically-relevant insights into establishing CT DRLs based on indication-based protocols in Ireland, focusing on CT head examinations performed at a neurology centre of excellence hospital.

METHODS

Dose data were collected retrospectively. Typical values for six CT head indication-based protocols were established using a sample size of 50 patients for each protocol. Typical values for each protocol were set as the median of the distribution curve. Dose distributions for each protocol were calculated and compared using non-parametric median test (k-samples) to ascertain significant dose differences between the typical values.

RESULTS

Most typical values pairings showed significant differences (p < 0.001) except between stroke/non-vascular brain, stroke/acute brain, and acute brain/non-vascular brain pairings. This was expected due to similar scan parameters. The typical value for stroke (3-phases angiogram) was 52% lower than the typical value for stroke. Dose levels of the male populations recorded were higher than female populations for all protocols. Statistical comparison showed significant differences for dose quantities and/or scan length between both genders in five protocols.

CONCLUSION

Proposed values for DLP were up to 63% and 69% lower than the EU and Irish national DRLs respectively. Establishment of CT stroke DRLs should be based on the scan performed instead of number of scan acquisitions. Lastly, gender-based CT DRLs for specific protocols within the head region require further investigation.

IMPLICATIONS FOR PRACTICE

With increasing CT examinations worldwide, radiation dose optimisation is key. The value of indication based DRLs is to enhance the required patient protection so image quality can be maintained, however with relevant DRLs for varying protocols. Establishment of CT typical values and site specific DRLs for procedures beyond the national DRLs can drive dose optimisation locally.

Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience

BACKGROUND

Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors.

METHODS

In a national cross-sectional survey, 3713 LGBT adolescents, aged 11-19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts.

RESULTS

A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome.

CONCLUSIONS

Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes.

Low-cost 3D-printed anthropomorphic cardiac phantom, for computed tomography automatic left ventricle segmentation and volumetry - A pilot study

INTRODUCTION

Accurate cardiac left ventricle (LV) delineation is essential to CT-derived left ventricular ejection fraction (LVEF). To evaluate dose-reduction potential, an anatomically accurate heart phantom, with realistic X-ray attenuation is required. We demonstrated and tested a custom-made phantom using 3D-printing, and examined the influence of image noise on automatically measured LV volumes METHODS: A single coronary CT angiography (CCTA) dataset was segmented and converted to Standard Tessellation Language (STL) mesh, using open-source software. A 3D-printed model, with hollow left heart chambers, was printed and cavities filled with gelatinized contrast media. This was CT-scanned in an anthropomorphic chest phantom, at different exposure conditions. LV and "myocardium" noise and attenuation was measured. LV volume was automatically measured using two different methods. We calculated Spearmans' correlation of LV volume with noise and contrast-noise ratio respectively om 486 scans of the phantom. Source images were compared to one phantom series with similar parameters. This was done using Dice coefficient on LV short-axis segmentations.

RESULTS

Phantom "Myocardium" and LV attenuation was comparable to measurements on source images. Automatic volume measurement succeeded, with mean volume deviation to patient images less than 2 ml. There was a moderate correlation of volume with CNR, and strong correlation of volume with image noise. With papillary muscles included in LV volume, the correlation was positive, but negative when excluded. Variation of volumes was lowest at 90-100 kVp for both methods in the 486 repeat scans. The Dice coefficient was 0.87, indicating high overlap between the single phantom series and source scan. Cost of 3D-printer and materials was 400 and 30 Euro respectively.

CONCLUSION

Both anatomically and radiologically the phantom mimicked the source scans closely. LV volumetry was reliably performed with automatic algorithms.

IMPLICATIONS FOR PRACTICE

Patient-specific cardiac phantoms may be produced at minimal cost and can potentially be used for other anatomies and pathologies. This enables radiographic phantom studies without need for dedicated 3D-labs or expensive commercial phantoms.

THE EFFECTS OF CONE-BEAM COMPUTED TOMOGRAPHY IMAGING GUIDANCE ON PATIENT RADIATION EXPOSURES IN TRANS-ARTERIAL CHEMOEMBOLISATION FOR HEPATOCELLULAR CARCINOMA

This study investigated the effects of cone-beam computed tomography (CBCT) guidance in trans-arterial chemoembolisation (TACE) procedures on the number of digital subtraction angiography (DSA) runs acquired and total patient radiation exposure in patients with hepatocellular carcinoma (HCC). A retrospective, analytical cross-sectional, single institution, study was conducted. Dose data were compared across the control (DSA guidance alone) and study (DSA and CBCT guidance) groups. A total of 122 procedures were included within the study. There was a significant reduction in the number of DSA runs (3 vs 5, p < 0.001) and DSA air kerma-area product (PKA) (3077.3 vs 4276.6 μGym2, p = 0.042) for the study group when compared to the control group. Total procedural PKA and total procedural reference air kerma (Ka,r) were shown to be 50 and 73% higher, respectively, for the study group when compared to the control group. CBCT imaging guidance does reduce the number of DSA runs and DSA PKA required to complete the TACE procedure for patients diagnosed with HCC; however, a substantial increase in total procedural PKA is to be expected and it is thus important that this increased dose is carefully considered and justified.

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.

67 A BLENDED MODEL OF CARE USED IN THE ROLLOUT OF AN EARLY SUPPORTED DISCHARGE FOR STROKE SERVICE DURING COVID-19

Background

The Health and Social Care Professionals budget was augmented to develop rehabilitation services that facilitated hospital discharges. Early Supported discharge (ESD) for stroke is a proven model of best care for stroke patients with mild to moderate disability (Langhorne et al., 2005). A pilot was implemented with the team consisting of an Occupational Therapist, Speech and Language Therapist, Physiotherapist and Medical Social Worker.

Methods

The service facilitated an early discharge from the hospital with the delivery of specialist stroke rehabilitation in the home. Therapy is provided with the same intensity and expertise that would be received in hospital and is available for up to 8 weeks, it was provided using a blended model of domiciliary care and the introduction of telehealth in response to COVID 19.

Data was recorded for 100 service users using an excel spreadsheet. Data was recorded to measure number of new referrals, length of stay, bed days released back into the hospital system, mode of service delivery and functional outcomes. A cost analysis was completed. Service user experience was captured using questionnaires.

Results

From September 2020 to July 2021, 100 patients accessed ESD with a reduction of 7.2 days in hospital stay per patient. Improvements in pre- and post- rehabilitation scores on the FIM/FAM were evident. Very positive feedback regarding the rehabilitation experience was captured within the patient satisfaction questionnaire. Therapy delivery was 60% face to face, 37% via telehealth and 3% outpatient appointments. Telehealth received good compliance but with varying reports of experience in comparison to face to face.

Conclusion

ESD provided in the home environment facilitated earlier discharge from hospital with positive outcomes for the hospital and service users. Telehealth ensured that rehabilitation was maintained throughout the pandemic. Telehealth increased access for patients residing outside of the catchment area. However service user preference remains face to face.

Design of a 3D printed coronary artery model for CT optimization

INTRODUCTION

To design a custom phantom of the coronary arteries to optimize CT coronary angiography (CCTA) protocols.

METHODS

Characteristics of the left and right coronary arteries (mean Hounsfield Unit (HU) values and diameters) were collected from consecutive CCTA examinations (n = 43). Four different materials (two mixtures of glycerine, gelatine and water, pig hearts, Ecoflex™ silicone) were scanned inside a Lungman phantom using the CCTA protocol to find the closest model to in vivo data. A 3D printed model of the coronary artery tree was created using CCTA data by exporting a CT volume rendering into Autodesk Meshmixer™ software. The model was placed in an acid bath for 5 h, then covered in Ecoflex™, which was removed after drying. Both the Ecoflex™ and pig heart were later filled with a mixture of contrast (Visipaque 320 mg I/ml), NaCl and gelatin and scanned with different levels of tube current and iterative reconstruction (ASiR-V). Objective (HU, noise and size (vessel diameter) and subjective analysis were performed on all scans.

RESULTS

The gelatine mixtures had HU values of 130 and 129, Ecoflex™ 65 and the pig heart 56. At the different mA/ASiR-V levels the contrast filled Ecoflex™ had a mean HU 318 ± 4, noise 47±7HU and diameter of 4.4 mm. The pig heart had a mean HU of 209 ± 5, noise 38±4HU and a diameter of 4.4 mm. With increasing iterative reconstruction level the visualisation of the pig heart arteries decreased so no measurements could be performed.

CONCLUSION

The use of a 3D printed model of the arteries and casting with the Ecoflex™ silicone is the most suitable solution for a custom-designed phantom.

IMPLICATIONS FOR PRACTICE

Custom designed phantoms using 3D printing technology enable cost effective optimisation of CT protocols.

Large differences in education and training of radiographers in Europe and Central Asia: Results from an IAEA coordinated study

INTRODUCTION

Education and training of radiographers is known to be diverse between countries and regions. Under an IAEA project, this work collected data on radiographer education for the Europe and Central Asia region with a particular focus on radiation protection gaps and potential actions.

METHODS

Following piloting, an electronic questionnaire was distributed to all national counterparts for the IAEA Technial Coopearation (TC) Europe region (n = 33 countries) and nominated national representatives. Contacts were additionally invited to a virtual workshop to discuss and rank common problems in education and training of radiographers and to propose potential solutions.

RESULTS

Responses were received from 31 countries, including 14 from the European Union. Just over half of countries reported radiographer education being in higher education with 71% having program durations more than 3 years (range: 1 month-4 years). Programs included a spectrum of both clinical training and radiation protection hours with ten-fold variations noted across the region. Inclusion of core radiation protection topics within curricula varied similarly, as did radiographers' clinical involvement in both justification and optimisation between countries. Workshop participants identified five common training problems, namely education availability, lack of standardisation, radiation protection course quality, teamwork problems and lack of equipment.

CONCLUSION

Radiographer education in the IAEA Europe region is heterogeneous with substantial differences in duration and quality of training programs between countries, which likely impact on quality of patient care delivered. Common problems have been identified and potential solutions proposed to focus quality improvement initiatives.

IMPLICATIONS FOR PRACTICE

Radiographer education and training is diverse throughout the IAEA TC Europe region, with likely impacts on radiation protection practices applied. Clinical involvement of radiographers in justification and optimisation differs, potentially limiting adherence to radiation protection principles.

Correlation of STOP-bang obstructive sleep apnoea screening tool to apnoea-hypopnea index in a general cardiology population

Funding Acknowledgements

Type of funding sources: None.

Introduction

The link between obstructive sleep apnoea (OSA) and cardiovascular disease is well known. Prevalence can be very high in this population, sharing many pathophysiological drivers in addition to being a risk factor. More concerning however is the increasing number of patients with undiagnosed OSA, who are at higher risk of long-term complications such as coronary artery disease, hypertension, atrial fibrillation, heart failure or stroke. There are several OSA screening tools available to clinicians, with variable sensitivities and specificities depending on patient demographics.

Predictive efficacy of the STOP-Bang screening tool in a general cardiology population with mixed cardiovascular disease has not been established.

Proposal

To identify the correlation between the STOP-Bang assessment score (1-8) and real-world Apnoea-Hypopnoea Index (AHI) in a general cardiology clinic population.

Methods

250 successive patients in a general cardiology clinic were asked to complete a STOP-Bang assessment. Of those, 50 patients with a variety of STOP-Bang scores were randomly selected to undergo sleep studies. A STOP-Bang value of ≥ 5 was taken as high-risk for moderate-severe OSA. Statistical linear regression analysis was performed in IBM SPSS version 26.

Results

Of n = 50 patients, mean STOP-Bang score =3.7 (SD +/-2.17) with mean AHI =15.8, (SD +/- 14.3). See Table 1 for categories 1-8. N = 44 (88%) had AHI ≥ 5 (At least mild OSA). N = 18 (36%) had an AHI ≥ 15 (Moderate-severe OSA). N = 29 (58%) had symptoms such as sleepiness, loud snoring or witnessed apnoea. Correlation between STOP-Bang score and AHI was high, with an  R value of 0.704, R2 = 0.496 (p &lt; 0.01). A STOP-Bang score increase of 1 corresponded with a mean AHI rise of 4.648. When taking a STOP-Bang value of ≥ 5 as "positive", we demonstrated a sensitivity of 83.33% (95% C.I. 58.58-96.42) and specificity of 93.94% (95% C.I. 79.77-99.26%) for moderate-severe OSA (AHI ≥ 15). 

Conclusion

We discovered a very high number of patients with undiagnosed OSA of at least mild severity. We found a strong correlation between STOP-Bang score and real-world AHI in a general cardiology population with mixed cardiovascular disease with 5 as an acceptable screening score for moderate-severe OSA.

Table 1 STOP-Bang Value 1 2 3 4 5 6 7 8 Patients (N=) 12 5 7 9 5 5 5 2 AHI (Mean) 6.67 6.62 9.97 11.95 24.44 22.20 39.54 35.25 Standard Deviation (±) 3.29 2.74 3.45 4.63 12.87 5.69 27.2 6.72 Summary of mean apnoea-hypopnoea index and standard deviation for each STOP-Bang patient category.

Abstract Figure 1

Clinician's Guide to Understanding Effect Size, Alpha Level, Power, and Sample Size

Effect size, α level, power, and sample size are misunderstood concepts that play a major role in the design and interpretation of studies. Effect size represents the magnitude of a change in an outcome or the strength of a relationship. Often, the effect size may be more important than just relying on the α level when interpreting results from a study because it informs a researcher of the actual magnitude of the difference or relationship. Confidence intervals can also assist in making this assessment. Power represents the probability of rejecting the null hypothesis when it is false. Effect size, power, and α level are all important in the calculation of sample size needed to conduct a study. Calculating the sample size a priori and including the required number of participants is essential. Studies with small sample sizes, relative to the needed number provided from a power analysis, may lead to false negative results. Studies with grossly large sample sizes may yield statistically significant findings with small effect sizes that may not be clinically relevant. It is beneficial when all four components are clearly presented in analytic studies. Failure to include these elements may limit the ability of other researchers to replicate the study's findings and lead to difficulty when interpreting the study's results.

Effect of Sodium Benzoate vs Placebo Among Individuals With Early Psychosis: A Randomized Clinical Trial

IMPORTANCE

There is evidence that sodium benzoate (BZ) may be an effective adjunctive treatment for schizophrenia. The clinical efficacy of BZ has been investigated in chronic schizophrenia; however, the efficacy of this agent has not been studied in individuals with early psychosis.

OBJECTIVE

To examine the clinical efficacy of the adjunctive use of BZ for symptoms in people with early psychosis.

DESIGN, SETTING, AND PARTICIPANTS

Using a placebo-controlled double-masked parallel-group design, this randomized clinical trial was conducted from August 2015 to July 2018. Participants aged between 15 and 45 years experiencing early psychosis were enrolled from 5 major clinical sites in Queensland, Australia. Data analysis was conducted from October 2018 to February 2020.

INTERVENTIONS

Participants were randomized 1:1 (50 participants in each group) to receive 500 mg of sodium benzoate twice daily or placebo for 12 weeks.

MAIN OUTCOMES AND MEASURES

The primary efficacy outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 12 weeks. The key secondary efficacy measures were (1) the Clinical Global Impression score, (2) the Hamilton Depression Rating Scale for depression, (3) functioning as assessed by the clinician-rated Global Assessment of Function, and (4) the Assessment of Quality of Life Scale. The PANSS subscale scores and impact on selected amino acid concentrations were also assessed.

RESULTS

The study comprised 100 participants with a mean (SD) age of 21.4 (4.1) years, of whom 73 (73%) were male individuals. The mean (SD) baseline PANSS score was 75.3 (15.4). We found no improvement in total PANSS score in the BZ group compared with the placebo group. The end result of least-squares mean difference (SE) for total PANSS was -1.2 (2.4) (P = .63). There were no differences in any subscales of the PANSS, any secondary measures, nor any amino acid concentrations. The dose of BZ was well tolerated without any clinically significant treatment-emergent adverse event differences between BZ and placebo groups.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, there was no evidence that adjunctive use of 500 mg of BZ twice daily is an effective treatment for individuals with early psychosis.

TRIAL REGISTRATION

anzctr.org.au Identifier: ACTRN12615000187549.

Organ-based tube current modulation in chest CT. A comparison of three vendors

INTRODUCTION

Organ-based tube current modulation (OBTCM) is designed for anterior dose reduction in Computed Tomography (CT). The purpose was to assess dose reduction capability in chest CT using three organ dose modulation systems at different kVp settings. Furthermore, noise, diagnostic image quality and tumour detection was assessed.

METHODS

A Lungman phantom was scanned with and without OBTCM at 80-135/140 kVp using three CT scanners; Canon Aquillion Prime, GE Revolution CT and Siemens Somatom Flash. Thermo-luminescent dosimeters were attached to the phantom surface and all scans were repeated five times. Image noise was measured in three ROIs at the level of the carina. Three observers visually scored the images using a fivestep scale. A Wilcoxon Signed-Rank test was used for statistical analysis of differences.

RESULTS

Using the GE revolution CT scanner, dose reductions between 1.10 mSv (12%) and 1.56 mSv (24%) (p < 0.01) were found in the anterior segment and no differences posteriorly and laterally. Total dose reductions between 0.64 (8%) and 0.91 mSv (13%) were found across kVp levels (p < 0.00001). Maximum noise increase with OBTCM was 0.8 HU. With the Canon system, anterior dose reductions of 6-10% and total dose reduction of 0.74-0.76 mSv across kVp levels (p < 0.001) were found with a maximum noise increase of 1.1 HU. For the Siemens system, dose increased by 22-51% anteriorly; except at 100 kVp where no dose difference was found. Noise decreased by 1 to 1.5 HU.

CONCLUSION

Organ based tube current modulation is capable of anterior and total dose reduction with minimal loss of image quality in vendors that do not increase posterior dose.

IMPLICATIONS FOR PRACTICE

This research highlights the importance of being familiar with dose reduction technologies.

Synthesis, evaluation and molecular modelling of piceatannol analogues as arginase inhibitors

Arginase is involved in a wide range of pathologies including cardiovascular diseases and infectious diseases whilst it is also a promising target to improve cancer immunotherapy. To date, only a limited number of inhibitors of arginase have been reported. Natural polyphenols, among them piceatannol, are moderate inhibitors of arginase. Herein, we report our efforts to investigate catechol binding by quantum chemistry and generate analogues of piceatannol. In this work, we synthesized a novel series of amino-polyphenols which were then evaluated as arginase inhibitors. Their structure-activity relationships were elucidated by deep quantum chemistry modelling. 4-((3,4-Dihydroxybenzyl)amino)benzene-1,2-diol 3t displays a mixed inhibition activity on bovine and human arginase I with IC50 (K i) values of 76 (82) μM and 89 μM, respectively.

Caregiver psychoeducation for first-episode psychosis

Introduction

International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.

Methods

Caregivers of people with first-episode psychosis completed a 23-item adapted version of the self-report Family Questionnaire (KQ) and a 17-item adapted version of the self-report Drug Attitudes Inventory (DAI) before and after the six-week DETECT Information and Support Course (DISC). Using a Generalised Linear Repeated Measures Model, we analyzed the differences in proportions of correct answers before and after the programme.

Results

Over a 24-month study period, 31 caregivers (13 higher socioeconomic; 13 lower socioeconomic; five unspecified socioeconomic; 19 female; 12 male) participated in the DISC programme and completed inventories before and after the course. Knowledge of psychosis and specific knowledge of medication treatment improved among caregivers overall (p < .01; effect sizes 0.78 and 0.94 respectively). There were no significant gender or socioeconomic differences in any improvement.

Discussion

This study confirms that caregiver psychoeducation specifically for first-episode psychosis directly improves knowledge of the illness overall and, in particular, knowledge of medication. Gender is not a factor in this, while the lack of any socioeconomic differences dispels the myth that patients in lower socioeconomic groups are disadvantaged because their caregivers know less.

Screening for obstructive sleep apnoea in an early psychosis cohort: a pilot study

OBJECTIVE

Rates of obstructive sleep apnoea (OSA) appear to be lower in the youth population (< 4%) compared to the general population (6%-17%); rates in people with psychotic illness are estimated at 13.5%-57.1%. We hypothesised that this comorbidity extends to early psychosis (EP) populations, and used previously validated OSA questionnaires to screen for OSA in an EP cohort.

METHOD

Fifty-three patients were screened using the OSA50 and STOP-Bang questionnaires with collection of anthropometric measures. Patients who screened positively were referred for polysomnography.

RESULTS

Fifteen per cent (8/53) screened positively; most frequently endorsed measures included BMI > 25, snoring, hypertension, neck circumference (> 40 cm) and male gender. Only 2/8 patients accepted polysomnography.

CONCLUSIONS

Screening indicates OSA may be more prevalent in EP populations than age-equivalent cohorts, but ongoing research is required.

Relationship Between Respiratory Muscle Strength, Handgrip Strength, and Muscle Mass in Hospitalized Patients

BACKGROUND

Minimal information is available to validate measurement of respiratory muscle strength (RMS) in the clinical setting. The purpose of this study was to determine the correlation between maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) with handgrip strength (HGS) and cross sectional muscle area obtained via diagnostic abdominal computed tomography (CT).

MATERIALS AND METHODS

Measures of MIP, MEP, SNIP, and HGS were obtained from individuals that participated in a previously published study; individuals who had an abdominal CT completed with (±)7 days of obtaining RMS measures were included. Both RMS and HGS were measured within 48-72 hours of admission; for RMS, the highest absolute (cm H₂ O) and percent predicted values were recorded, and the average of 3 HGS measurements (kg) was documented. Cross-sectional muscle area (cm² ) at the third lumbar region was recorded. Spearman's correlation coefficient was used to assess the relationship between variables.

RESULTS

A total of 35 participants were included. HGS was correlated to absolute MIP (r_s = 0.62, r_s = 0.61), MEP (r_s = 0.74, r_s = 0.73), and SNIP (r_s = 0.58, r_s = 0.54) for males and females, respectively. Crosss-sectional muscle area was correlated with absolute MIP (r_s = 0.66), MEP (r_s = 0.58), and SNIP (r_s = 0.783) for men and absolute SNIP (r_s = 0.56) among women.

CONCLUSION

Measures of RMS represent a promising assessment of muscle mass and function among hospitalized patients.

Protocol update and statistical analysis plan for CADENCE-BZ: a randomized clinical trial to assess the efficacy of sodium benzoate as an adjunctive treatment in early psychosis

Background

CADENCE-BZ is a multi-centre, parallel-group, double-blind randomized controlled trial designed to examine the clinical efficacy and safety of an accessible food preservative, sodium benzoate, as an add-on treatment for patients with early psychosis. The original study protocol was published in 2017. Here, we describe the updated protocol along with the Statistical Analysis Plan (SAP) for the CADENCE-BZ trial prior to study completion.

Methods and materials

Two important changes were made to the original protocol: (1) improvements to our statistical analysis plan permitted a reduction in sample size; and (2) a revision in the secondary outcomes with the intent of reducing redundancy and excluding those measures that were not appropriate as outcomes.

Conclusions

We provide the updated SAP prior to the completion of the study with the intent of increasing the transparency of the data analyses for CADENCE-BZ. The final participants are currently completing the study and the results will be published in the near future.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12615000187549). Registered on 26th February 2015.

Optimal abdominal CT protocol for obese patients

INTRODUCTION

This study investigated the impact of different protocols on radiation dose and image quality for obese patients undergoing abdominal CT examinations.

METHODS

Five abdominal/pelvis CT protocols employed across three scanners from a single manufacturer in a single centre used a variety of parameters (kV: 100/120, reference mAs: 150/190/218/250/300, image reconstruction: filtered back projection (FBP)/iterative (IR)). The routine protocol employed 300 reference mAs and 120 kV. Data sets resulting from obese patient examinations (n = 42) were assessed for image quality using visual grading analysis by three experienced radiologists. Objective assessment (noise, signal/contrast-noise ratios) and radiation dose was compared to determine optimal protocols for prospective testing on a further sample of patients (n = 47) for scanners using FBP and IR techniques.

RESULTS

Compared to the routine protocol, mean radiation dose was reduced by 60% when using 100 kV and SAFIRE technique strength 3 (p = 0.001). Reduction of up to 30% in radiation dose was noted for the FBP protocol: 120 kV and 190 reference mAs (p = 0.008). Subjective and objective image quality for both protocols were comparable to that of the routine protocol (p > 0.05). An overall improvement in image quality with increasing strength of SAFIRE was noted. Upon clinical implementation of the optimal dose protocols, local radiology consensus deemed image quality to be acceptable for the participating obese patient cohort.

CONCLUSION

Radiation dose for obese patients can be optimised whilst maintaining image quality. Where iterative reconstruction is available relatively low kV and quality reference mAs are also viable for imaging obese patients at 30-60% lower radiation doses.

The efficacy of sodium benzoate as an adjunctive treatment in early psychosis - CADENCE-BZ: study protocol for a randomized controlled trial

Background

Psychotic disorders affect up to 3% of the population and are often chronic and disabling. Innovation in the pharmacological treatment of psychosis has remained stagnant in recent decades. In order to improve outcomes for those with psychotic disorders, we present a protocol for the trial of a common food preservative, sodium benzoate, as an adjunctive treatment in early psychosis.

Methods

Persons experiencing early psychosis (n = 160) will be recruited through hospitals and community mental health services in Queensland, Australia. Patients will be randomized to receive either 12-week treatment with 1000 mg (500 mg twice daily (BD)) sodium benzoate or placebo. Patients will undergo fortnightly outcome assessments, in addition to weekly ongoing capacity to consent, drug compliance and safety assessments. The primary outcome measure is the Positive and Negative Syndrome Scale (PANSS) total score. Secondary outcomes are Global Assessment of Function (GAF), Assessment of Quality of Life Scale (AQOL), the Activity and Participation Questionnaire (APQ6), International Physical Activity Questionnaires (IPAQ), Simple Physical Activity Questionnaire (SIMPAQ), Physical Activity Questionnaire, Clinical Global Impression (CGI), Hamilton Depression rating Scale-17 items (HDRS), Opiate Treatment Index (OTI) and the Patients’ Global Impression of Improvement (PGI-I). As a tertiary objective, changes from baseline to endpoint in to serum markers related to D-alanine, L-alanine, D-serine, L-serine, glycine and glutamate will be investigated.

Discussion

Consumers and clinicians are keen to help develop better treatments for those with psychosis. This study, part of the wider Cadence clinical trials platform will examine if a safe and accessible food preservative can help optimize outcomes in those with psychosis.

Trial Registration

Australian New Zealand Clinical Trials registry (ANZCTR), ACTRN12615000187549. Registered on 26 February 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1908-5) contains supplementary material, which is available to authorized users.

What Influences Purpose in Life in First-Episode Psychosis?

Although purpose in life (PIL) is significant to psychological wellbeing, there is little published research on PIL among those with a mental illness. This prospective study of first-episode psychosis (n = 54) included assessment of symptomatology, PIL and duration of untreated psychosis. The results showed that the baseline PIL scores of those with first-episode psychosis were lower than those of other populations. This was worsened by a long duration of untreated psychosis and was linked to depression. The study concludes that psychosis results in many losses for the individual, including PIL. Meaningful occupation can address this lost sense of purpose and the occupational difficulties associated with psychosis.

Perceptions of Discrimination and Justice

This article examines the relationship among perceived gender discrimination, organizational justice, and work-related attitudes (i.e., job satisfaction, organizational commitment, and intentions to leave) for a sample of Protestant clergy in Hong Kong. The moderating role of gender on the relationship is also explored. The results of regression analysis showed that (a) justice and discrimination perceptions were significantly related to job attitudes; (b) compared to men, women who perceived more gender discrimination had a lower level of organizational commitment; (c) compared to women, men who perceived more distributive justice had a higher level of job satisfaction; and (d) perceptions of justice influenced intentions to leave through their impact on job satisfaction and organizational commitment. Theoretical and practical implications are discussed.

The Impact of Gender Similarity, Racial Similarity, and Work Culture on Family-Supportive Supervision

This study examines the relationship between demographic similarity in the supervisor-subordinate dyad and family-supportive supervision. The authors found that supervisors provided more family support to subordinates who were similar in either gender or race than to those subordinates who were dissimilar. In addition, family-supportive supervision was highest when subordinates were similar to supervisors in both gender and race. A family-supportive organizational culture was positively related to family-supportive supervision, although contrary to what was predicted, it did not attenuate the effects of gender similarity and racial similarity on family-supportive supervision. Implications of the findings and directions for future research are discussed.

Hispanic Law Students’ Perceptions of Discrimination, Justice, and Career Prospects

In this study,ethnic and gender discrimination perceived by minority students was investigated in a sample of 118 Hispanic law school students. Despite governmental efforts at promoting affirmative action practices,perceived discrimination can act as a barrier in the legal profession that keeps minority and female attorneys from advancing in the profession. Results were consistent with the hypotheses,suggesting that (a) female students anticipated more discrimination in the legal profession than male students; (b) the higher the perceived discrimination,the less fair the students perceived the promotion process in their future law firm will be; and (c) the lower the perceived fairness of the promotion process,the lower the satisfaction with their chosen career (the law profession) and the lower the respondents’ perceived career prospects. Practical implications and avenues for future research are discussed.

CACNA1C risk variant is associated with increased amygdala volume

Genome-wide association studies suggest that genetic variation within L-type calcium channel subunits confer risk to psychosis. The single nucleotide polymorphism at rs1006737 in CACNA1C has been associated with both schizophrenia and bipolar disorder and with several intermediate phenotypes that may serve as neurobiological antecedents, linking psychosis to genetic aetiology. Amongst others, it has been implicated in alterations in amygdala structure and function. In the present study, we show that the risk allele (A) is associated with increased amygdala volume in healthy individuals (n = 258). This observation reinforces a hypothesis that genetic variation may confer risk to psychosis via alterations in limbic structures. Further study of CACNA1C using intermediate phenotypes for psychosis will determine the mechanisms by which variation in this gene confers risk.

Association between genetic risk scoring for schizophrenia and bipolar disorder with regional subcortical volumes

Previous research has shown coincident abnormal regional brain volume in patients with schizophrenia (SCZ) and bipolar disorder (BD) compared with controls. Whether these abnormalities are genetically driven or explained by secondary effects of the disorder or environmental factors is unknown. We aimed to investigate the association between genetic risk scoring (GRS) for SCZ and BD with volume of brain areas previously shown to be different between these clinical groups and healthy controls. We obtained subcortical brain volume measures and GRS for SCZ and BD from a sample of 274 healthy volunteers (71.4% females, mean age 24.7 (s.d. 6.9)). Volume of the globus pallidus was associated with the shared GRS between SCZ and BD, and also with the independent GRS for each of these disorders. Volume of the amygdala was associated with the non-shared GRS between SCZ and BD, and with the independent GRS for BD. Our results for volume of the globus pallidus support the idea of SCZ and BD sharing a common underlying neurobiological abnormality associated with a common genetic risk for both these disorders. Results for volume of the amygdala, though, would suggest the existence of a distinct mechanism only associated with genetic risk for BD. Finally, the lack of association between genetic risk and volume of most subcortical structures suggests that the volumetric differences reported in patient-control comparisons may not be genetically driven, but a consequence of the disorder or co-occurring environmental factors.

The prevalence and correlates of childhood trauma in patients with early psychosis

OBJECTIVE

To describe the prevalence and demographic, clinical and functional correlates of childhood trauma in patients attending early psychosis clinics.

METHOD

Participants were recruited from outpatients attending four early psychosis services. Exposure to childhood trauma was assessed using the Childhood Trauma Questionnaire (CTQ). Psychopathology was measured using the Positive and Negative Syndrome Scale and the Depression, Anxiety and Stress Scale. Social and vocational functioning and substance use were also assessed.

RESULTS

Over three-quarters of the 100 patients reported exposure to any childhood trauma. Emotional, physical and sexual abuse were reported by 54%, 23% and 28% of patients, respectively, while 49% and 42% of patients reported emotional and physical neglect, respectively. Female participants were significantly more likely to be exposed to emotional and sexual abuse. Exposure to childhood trauma was correlated with positive psychotic symptoms and higher levels of depressive, anxiety and stress symptoms; however, it had no impact on social or vocational functioning or recent substance use.

CONCLUSION

Exposure to childhood trauma was common in patients with early psychosis, and associated with increased symptomatology. Existing recommendations that standard clinical assessment of patients with early psychosis should include inquiry into exposure to childhood trauma are supported.