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Smy L, Ledeboer NA, Wood MG. At-home testing for respiratory viruses: a minireview of the current landscape. J Clin Microbiol 2024; 62:e0031223. [PMID: 38436246 PMCID: PMC11077999 DOI: 10.1128/jcm.00312-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
The landscape of at-home testing using over-the-counter (OTC) tests has been evolving over the last decade. The United States Food and Drug Administration Emergency Use Authorization rule has been in effect since the early 2000s, and it was widely employed during the severe acute respiratory syndrome coronavirus 2 pandemic to authorize antigen and nucleic acid detection tests for use in central laboratories as well as OTC. During the pandemic, the first at-home tests for respiratory viruses became available for consumer use, which opened the door for additional respiratory virus OTC tests. Concerns may exist regarding the public's ability to properly collect samples, perform testing, interpret results, and report results to public health authorities. However, favorable comparison studies between OTC testing and centralized laboratory test results suggest that OTC testing may have a place in healthcare, and it is likely here to stay. This mini-review of OTC tests for viral respiratory diseases will briefly cover the regulatory and reimbursement environment, current OTC test availability, as well as the advantages and limitations of OTC tests.
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Affiliation(s)
- Laura Smy
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nathan A. Ledeboer
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Macy G. Wood
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Nakib N, Sutherland S, Hallman K, Mianulli M, R Boulware D. Randomized trial of mechanotherapy for the treatment of stress urinary incontinence in women. Ther Adv Urol 2024; 16:17562872241228023. [PMID: 38328552 PMCID: PMC10848796 DOI: 10.1177/17562872241228023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
Background Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking. Objective To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT). Design This was a randomized, controlled, double-blinded trial. Materials and methods Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)]. Results Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks (p = <0.0001), with further reduction from 6 to 12 weeks (p = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild p = <0.0001, moderate p = <0.0001, severe p = <0.01). QoL was similarly improved at 6 weeks (ICIQ p = <0.0001, IQOL p = <0.0001), and 12 weeks (ICIQ p = <0.0001, IQOL p = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks. Conclusion Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up. Trial registration Registered on ClinTrials.gov (NCT02954042).
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Affiliation(s)
- Nissrine Nakib
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | | | - Marcus Mianulli
- Gnarus Medical Consulting Inc., 18615 27th Avenue North, Plymouth, MN 55447, USA
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, University of Minnesota, Minneapolis, MN, USA
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Galway SC, Laird MHD, Dagenais M, Gammage KL. Navigating a New Normal: Perceptions and Experiences of an Online Exercise Program for Older Adults During COVID-19. J Aging Phys Act 2023; 31:743-755. [PMID: 36931325 DOI: 10.1123/japa.2022-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 10/24/2022] [Accepted: 12/09/2022] [Indexed: 03/19/2023]
Abstract
Online exercise programming has surged in popularity; however, little is known about older adults' perceptions and experiences of online exercise. The purpose of this study was to qualitatively examine older adults' (aged 59-82 years) experiences and perceptions of an online exercise program during the COVID-19 pandemic. Nineteen individuals (individuals who used the online exercise program and those who did not) completed a semistructured interview. Three main themes were generated from the data using reflexive thematic analysis: (a) can online exercise really work for older adults? (b) technology attitudes and experiences influence online participation, and (c) barriers and advantages of the online exercise program and the home environment. Most participants who took part were able to overcome initial barriers through technical support and experience. Our findings highlight ways to promote advantages and address barriers of online exercise for older adults and emphasize the importance of fostering social experiences and training online exercise instructors.
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Affiliation(s)
- Sarah C Galway
- Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
- Brock-Niagara Centre for Health & Well-Being, Brock University, St Catharines, ON,Canada
| | - Meghan H D Laird
- Brock-Niagara Centre for Health & Well-Being, Brock University, St Catharines, ON,Canada
- Department of Kinesiology, Brock University, St Catharines, ON,Canada
| | - Matthieu Dagenais
- Faculty of Applied Health Sciences, Brock University, St Catharines, ON,Canada
- Brock-Niagara Centre for Health & Well-Being, Brock University, St Catharines, ON,Canada
| | - Kimberley L Gammage
- Brock-Niagara Centre for Health & Well-Being, Brock University, St Catharines, ON,Canada
- Department of Kinesiology, Brock University, St Catharines, ON,Canada
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Elzinga WO, Prins S, Borghans LGJM, Gal P, Vargas GA, Groeneveld GJ, Doll RJ. Detection of Clenbuterol-Induced Changes in Heart Rate Using At-Home Recorded Smartwatch Data: Randomized Controlled Trial. JMIR Form Res 2021; 5:e31890. [PMID: 34967757 PMCID: PMC8759015 DOI: 10.2196/31890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 11/21/2021] [Indexed: 01/07/2023] Open
Abstract
Background Although electrocardiography is the gold standard for heart rate (HR) recording in clinical trials, the increasing availability of smartwatch-based HR monitors opens up possibilities for drug development studies. Smartwatches allow for inexpensive, unobtrusive, and continuous HR estimation for potential detection of treatment effects outside the clinic, during daily life. Objective The aim of this study is to evaluate the repeatability and sensitivity of smartwatch-based HR estimates collected during a randomized clinical trial. Methods The data were collected as part of a multiple-dose, investigator-blinded, randomized, placebo-controlled, parallel-group study of 12 patients with Parkinson disease. After a 6-day baseline period, 4 and 8 patients were treated for 7 days with an ascending dose of placebo and clenbuterol, respectively. Throughout the study, the smartwatch provided HR and sleep state estimates. The HR estimates were quantified as the 2.5th, 50th, and 97.5th percentiles within awake and asleep segments. Linear mixed models were used to calculate the following: (1) the intraclass correlation coefficient (ICC) of estimated sleep durations, (2) the ICC and minimum detectable effect (MDE) of the HR estimates, and (3) the effect sizes of the HR estimates. Results Sleep duration was moderately repeatable (ICC=0.64) and was not significantly affected by study day (P=.83), clenbuterol (P=.43), and study day by clenbuterol (P=.73). Clenbuterol-induced changes were detected in the asleep HR as of the first night (+3.79 beats per minute [bpm], P=.04) and in the awake HR as of the third day (+8.79 bpm, P=.001). The median HR while asleep had the highest repeatability (ICC=0.70). The MDE (N=12) was found to be smaller when patients were asleep (6.8 bpm to 11.7 bpm) than while awake (10.7 bpm to 22.1 bpm). Overall, the effect sizes for clenbuterol-induced changes were higher while asleep (0.49 to 2.75) than while awake (0.08 to 1.94). Conclusions We demonstrated the feasibility of using smartwatch-based HR estimates to detect clenbuterol-induced changes during clinical trials. The asleep HR estimates were most repeatable and sensitive to treatment effects. We conclude that smartwatch-based HR estimates obtained during daily living in a clinical trial can be used to detect and track treatment effects. Trial Registration Netherlands Trials Register NL8002; https://www.trialregister.nl/trial/8002
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Affiliation(s)
| | - Samantha Prins
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
| | | | - Pim Gal
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
| | | | - Geert J Groeneveld
- Centre for Human Drug Research, Leiden, Netherlands.,Leiden University Medical Center, Leiden, Netherlands
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Ronner EA, Stenerson ME, Goldschmidt NH, Chari DA, Diercks GR, Lee DJ, Keamy DG, Mankarious LA, Cohen MS. Otoendoscopes to Enhance Telemedicine During the COVID-19 Pandemic. Ann Otol Rhinol Laryngol 2021; 131:1115-1122. [PMID: 34726068 DOI: 10.1177/00034894211051810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As telemedicine has become increasingly utilized during the COVID-19 pandemic, portable otoendoscopy offers a method to perform an ear examination at home. The objective of this pilot study was to assess the quality of otoendoscopic images obtained by non-medical individuals and to determine the effect of a simple training protocol on image quality. METHODS Non-medical participants were recruited and asked to capture images of the tympanic membrane before and after completion of a training module, as well as complete a survey about their experience using the otoendoscope. Images were de-identified, randomized, and evaluated by 6 otolaryngologists who were blinded as to whether training had been performed prior to the image capture. Images were rated using a 5-point Likert scale. RESULTS Completion of a training module resulted in a significantly higher percentage of tympanic membrane visible on otoendoscopic images, as well as increased physician confidence in identifying middle ear effusion/infection, cholesteatoma, and deferring an in-person otoscopy (P < .0001). However, even with improved image quality, in most cases, physicians reported that they would not feel comfortable using the images to for diagnosis or to defer an in-person examination. Most participants reported that the otoendoscope was simple to use and that they would feel comfortable paying for the device. CONCLUSIONS At-home otoendoscopes can offer a sufficient view of the tympanic membrane in select cases. The use of a simple training tool can significantly improve image quality, though often not enough to replace an in-person otoscopic exam.
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Affiliation(s)
| | - Matthew E Stenerson
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Nicole H Goldschmidt
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Divya A Chari
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Gillian R Diercks
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Donald G Keamy
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Leila A Mankarious
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
| | - Michael S Cohen
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA, USA
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Truong M, Pfau B, McDermot E, Han PD, Brandstetter E, Richardson M, Kim AE, Rieder MJ, Chu HY, Englund JA, Nickerson DA, Shendure J, Lockwood CM, Konnick EQ, Starita LM. Comparable Specimen Collection from Both Ends of At-Home Midturbinate Swabs. J Clin Microbiol 2021; 59:e03073-20. [PMID: 33597259 DOI: 10.1128/JCM.03073-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Carter B, Fisher-Smith D, Porter D, Lane S, Peak M, Taylor-Robinson D, Bracken L, Carrol E. Being ' at-home' on outpatient parenteral antimicrobial therapy (OPAT): a qualitative study of parents' experiences of paediatric OPAT. Arch Dis Child 2020; 105:276-281. [PMID: 31558443 PMCID: PMC7041500 DOI: 10.1136/archdischild-2019-317629] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/08/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To better understand the factors that facilitate and hinder a positive experience of paediatric outpatient parenteral antimicrobial therapy (OPAT). DESIGN Qualitative study using semistructured interviews. SETTING A dedicated paediatric consultant-led hospital-based, outreach OPAT service in England. PARTICIPANTS Participants were primarily parents of children who had received OPAT; one child participated. METHODS Children and parents of children who received OPAT and who had participated in the survey phase of the larger study were invited to be interviewed. RESULTS 12 parents (10 mothers and 2 fathers) of 10 children participated; one child (aged 15 years). Data analysis resulted in one meta-theme, 'At-homeness' with OPAT, this reflected the overall sense of home being a place in which the children and their parents could be where they wanted to be. Four key themes were identified that reflect the ways in which parents and children experienced being at-home on OPAT: 'Comfort, security, freedom, and control'; 'Faith, trust and confidence'; 'Explanations and communication' and 'Concerns, restrictions and inconveniences'. CONCLUSIONS Despite feeling anxious at times, parents reported that they and their children generally had a positive experience of OPAT; being at-home brought many benefits compared with in-patient care. Recommendations arising from the study include a 'whole-system' approach to discharge home that includes support related to return to school/nursery, reduction in disruptions to home-based routines, more clarity on choice and preparation for managing potential anxiety, better consideration of dose timing and enhanced preparation and information.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Debra Fisher-Smith
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - David Porter
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Steven Lane
- Biostatistics, University of Liverpool, Liverpool, UK
| | - Matthew Peak
- Research and Development, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK,Cheshire and Merseyside Medicines for Children Research Network, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Louise Bracken
- Paediatric Medicines Research Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Enitan Carrol
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
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Bernstein D, Pavord ID, Chapman KR, Follows R, Bentley JH, Pouliquen I, Bradford E. Usability of mepolizumab single-use prefilled autoinjector for patient self-administration. J Asthma 2019; 57:987-998. [PMID: 31251090 DOI: 10.1080/02770903.2019.1630641] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: To evaluate usability of mepolizumab as a liquid drug product self-administered via a single-use prefilled autoinjector (AI) by patients with severe eosinophilic asthma (SEA), or their caregivers, in-clinic and at home.Methods: This open-label, single-arm, Phase IIIa study (NCT03099096; GSK ID: 204959) included patients aged ≥12 years with SEA who were either receiving mepolizumab (100 mg subcutaneously [SC]) every 4 weeks (Q4W) for ≥12 weeks before screening or not receiving mepolizumab but met criteria indicative of SEA. Patients/caregivers self-administered mepolizumab (100 mg SC) via an AI Q4W for 12 weeks. The first (Week 0) and third (Week 8) doses were observed in-clinic; the second dose (Week 4) was administered unobserved at home. Primary and secondary endpoints were the proportion of patients who successfully self-administered their third and second doses, respectively (determined by investigator/site staff). Patient experience, mepolizumab trough concentrations, blood eosinophil count (BEC), and safety were also assessed.Results: Of 159 patients/caregivers who self-administered ≥1 dose of mepolizumab, 157 completed the study. Nearly all patients successfully self-administered their third mepolizumab dose in-clinic and second dose at home (≥98% and ≥96%, respectively); this was further confirmed by mepolizumab trough concentrations/BEC. At study end, ≥88% of patients were "very" or "extremely" confident about using the AI correctly. Incidence of on-treatment drug-related adverse events (AEs) was low (3%); no fatal AEs occurred.Conclusions: Patients/caregivers successfully self-administered mepolizumab via the AI both in-clinic and at home; no new safety concerns were identified.
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Affiliation(s)
- David Bernstein
- Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ian D Pavord
- Nuffield Department of Medicine and Oxford Respiratory NIHR BRC, University of Oxford, Oxford, UK
| | - Kenneth R Chapman
- Asthma & Airway Centre, UHN and University of Toronto, Toronto, ON, Canada
| | - Richard Follows
- Respiratory Therapeutic Area, GSK, Stockley Park, Uxbridge, UK
| | | | - Isabelle Pouliquen
- Clinical Pharmacology Modelling & Simulation, GSK, Stockley Park, Uxbridge, UK
| | - Eric Bradford
- Respiratory Therapeutic Area, GSK, Research Triangle Park, NC, USA
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Joe L, Hoshiko S, Dobraca D, Jackson R, Smorodinsky S, Smith D, Harnly M. Mortality during a Large-Scale Heat Wave by Place, Demographic Group, Internal and External Causes of Death, and Building Climate Zone. Int J Environ Res Public Health 2016; 13:ijerph13030299. [PMID: 27005646 PMCID: PMC4808962 DOI: 10.3390/ijerph13030299] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/20/2016] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
Mortality increases during periods of elevated heat. Identification of vulnerable subgroups by demographics, causes of death, and geographic regions, including deaths occurring at home, is needed to inform public health prevention efforts. We calculated mortality relative risks (RRs) and excess deaths associated with a large-scale California heat wave in 2006, comparing deaths during the heat wave with reference days. For total (all-place) and at-home mortality, we examined risks by demographic factors, internal and external causes of death, and building climate zones. During the heat wave, 582 excess deaths occurred, a 5% increase over expected (RR = 1.05, 95% confidence interval (CI) 1.03-1.08). Sixty-six percent of excess deaths were at home (RR = 1.12, CI 1.07-1.16). Total mortality risk was higher among those aged 35-44 years than ≥ 65, and among Hispanics than whites. Deaths from external causes increased more sharply (RR = 1.18, CI 1.10-1.27) than from internal causes (RR = 1.04, CI 1.02-1.07). Geographically, risk varied by building climate zone; the highest risks of at-home death occurred in the northernmost coastal zone (RR = 1.58, CI 1.01-2.48) and the southernmost zone of California's Central Valley (RR = 1.43, CI 1.21-1.68). Heat wave mortality risk varied across subpopulations, and some patterns of vulnerability differed from those previously identified. Public health efforts should also address at-home mortality, non-elderly adults, external causes, and at-risk geographic regions.
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Affiliation(s)
- Lauren Joe
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Sumi Hoshiko
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Dina Dobraca
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Rebecca Jackson
- Occupational Health Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Svetlana Smorodinsky
- Occupational Health Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Daniel Smith
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA 94804, USA.
| | - Martha Harnly
- Environmental Health Investigations Branch, California Department of Public Health, Richmond, CA 94804, USA.
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van Wyk PM, Chu CH, Babineau J, Puts M, Brooks D, Saragosa M, McGilton KS. Community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment following a hip fracture: a systematic review protocol. JMIR Res Protoc 2014; 3:e47. [PMID: 25227119 PMCID: PMC4180327 DOI: 10.2196/resprot.3485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/11/2014] [Accepted: 07/18/2014] [Indexed: 01/23/2023] Open
Abstract
Background Hip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. Objective The objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. Methods The search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. Results This review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. Conclusions The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.
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Affiliation(s)
- Paula M van Wyk
- Department of Kinesiology, Faculty of Human Kinetics, The University of Windsor, Windsor, ON, Canada
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