Symposium - How effective are brief motivational interviewing interventions : Are they necessary? Do they require enhancement? Can they be translated into routine clinical practice? [Conference Abstract]

Brief interventions are effective for problem drinking and reductions are known to occur in association with screening and assessment. Design and methods: This study aimed to determine how much change occurred between baseline assessment and a one-session brief intervention (S1), and the predictors of early change among adults with comorbid depression and alcohol misuse (n=202) participating in a clinical trial. The primary focus was on changes in Beck Depression Inventory fastscreen scores and alcohol consumption (standard drinks per week) prior to random allocation to nine further sessions addressing either depression, alcohol, or both problems. Results: There were large and clinically significant reductions between baseline and S1, with the strongest predictors being baseline scores in the relevant domain and change in the other domain. Client engagement was also predictive of early depression changes. Discussion and Conclusion: Monitoring progress in both domains from first contact, and provision of empathic care, followed by brief intervention appear to be useful for this high prevalence comorbidity..

Educational interventions for the management of cancer-related fatigue in adults

Background: Cancer-related fatigue is reported as the most common and distressing symptom experienced by patients with cancer. It can exacerbate the experience of other symptoms, negatively affect mood, interfere with the ability to carry out everyday activities, and negatively impact on quality of life. Educational interventions may help people to manage this fatigue or to cope with this symptom, and reduce its overall burden. Despite the importance of education for managing cancer-related fatigue there are currently no systematic reviews examining this approach. Objectives: To determine the effectiveness of educational interventions for managing cancer-related fatigue in adults. Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), and MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, OTseeker and PEDro up to 1st November 2016. We also searched trials registries. Selection criteria: We included randomised controlled trials (RCTs) of educational interventions focused on cancer-related fatigue where fatigue was a primary outcome. Studies must have aimed to evaluate the effect of educational interventions designed specifically to manage cancer-related fatigue, or to evaluate educational interventions targeting a constellation of physical symptoms or quality of life where fatigue was the primary focus. The studies could have compared educational interventions with no intervention or wait list controls, usual care or attention controls, or an alternative intervention for cancer-related fatigue in adults with any type of cancer. Data collection and analysis: Two review authors independently screened studies for inclusion and extracted data. We resolved differences in opinion by discussion. Trial authors were contacted for additional information. A third independent person checked the data extraction. The main outcome considered in this review was cancer-related fatigue. We assessed the evidence using GRADE and created a 'Summary of Findings' table. Main results: We included 14 RCTs with 2213 participants across different cancer diagnoses. Four studies used only 'information-giving' educational strategies, whereas the remainder used mainly information-giving strategies coupled with some problem-solving, reinforcement, or support techniques. Interventions differed in delivery including: mode of delivery (face to face, web-based, audiotape, telephone); group or individual interventions; number of sessions provided (ranging from 2 to 12 sessions); and timing of intervention in relation to completion of cancer treatment (during or after completion). Most trials compared educational interventions to usual care and meta-analyses compared educational interventions to usual care or attention controls. Methodological issues that increased the risk of bias were evident including lack of blinding of outcome assessors, unclear allocation concealment in over half of the studies, and generally small sample sizes. Using the GRADE approach, we rated the quality of evidence as very low to moderate, downgraded mainly due to high risk of bias, unexplained heterogeneity, and imprecision. There was moderate quality evidence of a small reduction in fatigue intensity from a meta-analyses of eight studies (1524 participants; standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.52 to -0.04) comparing educational interventions with usual care or attention control. We found low quality evidence from twelve studies (1711 participants) that educational interventions had a small effect on general/overall fatigue (SMD -0.27, 95% CI -0.51 to -0.04) compared to usual care or attention control. There was low quality evidence from three studies (622 participants) of a moderate size effect of educational interventions for reducing fatigue distress (SMD -0.57, 95% CI -1.09 to -0.05) compared to usual care, and this could be considered clinically significant. Pooled data from four studies (439 participants) found a small reduction in fatigue interference with daily life (SMD -0.35, 95% CI -0.54 to -0.16; moderate quality evidence). No clear effects on fatigue were found related to type of cancer treatment or timing of intervention in relation to completion of cancer treatment, and there were insufficient data available to determine the effect of educational interventions on fatigue by stage of disease, tumour type or group versus individual intervention. Three studies (571 participants) provided low quality evidence for a reduction in anxiety in favour of the intervention group (mean difference (MD) -1.47, 95% CI -2.76 to -0.18) which, for some, would be considered clinically significant. Two additional studies not included in the meta-analysis also reported statistically significant improvements in anxiety in favour of the educational intervention, whereas a third study did not. Compared with usual care or attention control, educational interventions showed no significant reduction in depressive symptoms (four studies, 881 participants, SMD -0.12, 95% CI -0.47 to 0.23; very low quality evidence). Three additional trials not included in the meta-analysis found no between-group differences in the symptoms of depression. No between-group difference was evident in the capacity for activities of daily living or physical function when comparing educational interventions with usual care (4 studies, 773 participants, SMD 0.33, 95% CI -0.10 to 0.75) and the quality of evidence was low. Pooled evidence of low quality from two of three studies examining the effect of educational interventions compared to usual care found an improvement in global quality of life on a 0-100 scale (MD 11.47, 95% CI 1.29 to 21.65), which would be considered clinically significant for some. No adverse events were reported in any of the studies. Authors' conclusions: Educational interventions may have a small effect on reducing fatigue intensity, fatigue's interference with daily life, and general fatigue, and could have a moderate effect on reducing fatigue distress. Educational interventions focused on fatigue may also help reduce anxiety and improve global quality of life, but it is unclear what effect they might have on capacity for activities of daily living or depressive symptoms. Additional studies undertaken in the future are likely to impact on our confidence in the conclusions. The incorporation of education for the management of fatigue as part of routine care appears reasonable. However, given the complex nature of this symptom, educational interventions on their own are unlikely to optimally reduce fatigue or help people manage its impact, and should be considered in conjunction with other interventions. Just how educational interventions are best delivered, and their content and timing to maximise outcomes, are issues that require further research

Covid-19 como factor de riesgo de prematuridad en el Hospital Eleazar Guzmán Barrón, Nuevo Chimbote, en el año 2020

Introducción: La pandemia por Covid-19 producida por el SARS-CoV-2, enfermedad respiratoria, llegó afectar principalmente a población vulnerable. A este grupo se encuentran las gestantes, siendo más susceptibles a patógenos respiratorio y presentar formas graves, debido a cambios fisiológicos adaptativos y a el estado inmunosupresor durante el embarazo. Este estado de susceptibilidad podría desarrollar consecuencias maternas como fetales. Objetivo: Determinar la relación entre el Covid-19 y la prematuridad en el hospital Eleazar Guzmán Barrón, Nuevo Chimbote, abril a diciembre del 2020 Metodología: Es un estudio observacional analítico, de casos y control retrospectivo. Se registró 1226 gestantes en el periodo de estudio, obteniéndose una muestra de 332, de las cuales 157 serán gestantes con diagnóstico Covid -19 y 172 de gestantes sin la enfermedad. Para el análisis estadístico se usó chi cuadrado y el odds ratio (OR) con un IC del 95%. Resultados: Las gestantes con y sin diagnóstico Covid-19, por el método de FUR o ecografía, el 19.1 % de gestantes positivo para Covid-19 tuvieron partos prematuros y el 20.6 % de gestantes sin la enfermedad tuvieron partos prematuros. Los recién nacidos por test de Capurro, de gestantes con diagnóstico Covid-19, el 18.5 % fueron prematuros y de gestantes que no tuvieron la enfermedad, el 20.6% tuvieron prematuridad; observando un OR = 0.912, e IC 95% (0.5321 – 1.567), donde no se evidencia riesgo al tener Covid – 19 y que éste afecte la edad gestacional según la prematuridad. De acuerdo a los factores sociodemográficos maternos con diagnóstico positivo; el 68.6% tuvieron un nivel de instrucción secundaria, el 28.6% se ubicaron en edades entre 20 – 24 años, el 70.3% fueron convivientes y en su mayoría pertenecen al distrito de Chimbote con un 39.5%. Las gestantes con Covid-19, el 40.9 % tuvieron cesáreas, y un 51% tuvo un parto vaginal. De las pacientes con diagnóstico negativo, el 52.6 % tuvieron un parto a través de una cesárea, el 47.6 % tuvo un parto vaginal. Conclusiones: El estudio realizado no evidenció riesgo en que las gestantes con diagnóstico positivo a Covid – 19 y que éste afecte la edad gestacional según la prematuridad. Así mismo los factores sociodemográficos maternos y tipo de parto no tuvieron relación estadística significativa

Innovative co-evaluation and co-creation of an online learning programme with de Bono's Six Thinking Hats

In order to enhance diversity, internationalisation and widening participation, Queen Margaret University's PgCert in Professional and Higher Education was redesigned for online delivery in 2015-16. This programme has run successfully in a blended learning format for over a decade and this change was anticipated to be a major transition for both staff and students. In order to maximise student engagement in the online environment we involved students in the redesign of the programme and evaluation during and after the first year of delivery. This included a video record of the application of de Bono's (1989) 'Six thinking hats' in facilitating staff reflections, an online survey designed and run by two students representatives and a final collaborative thematic analysis of data with staff and students. We focus on student and staff experiences and perspectives on transitioning to the online environment and reflect on the student-engaged design and innovative evaluation method used.sch_nurBovill C. Cook-Sather, A. Felten, P. Millard, L. and Moore-Cherry, N. (2016). Addressing potential challenges in co-creating learning and teaching: overcoming resistance, navigating institutional norms and ensuring inclusivity in student-staff partnerships. Higher Education 71, 195-208. Available at: http://link.springer.com/article/10.1007/s10734-015-9896-4 (Accessed 22 February 2017). Brown, M. Hughes, H. Keppell, M. Hard, N. and Smith, L. (2015). Stories from Students in Their First Semester of Distance Learning, The International Review of Research in Open and Distributed Learning. 16 (4). Available at: http://www.irrodl.org/index.php/irrodl/article/view/1647/3448 (Accessed 22 February 2017). Butcher, J. and Rose-Adams, J. (2015). Part-time learners in open and distance learning: revisiting the critical importance of choice, flexibility and employability. Open Learning: The Journal of Open, Distance and e-Learning. 30(2) 127-137. Available at: http://oro.open.ac.uk/43317/1/__UserData_Documents_jsb35_Desktop_02680513.2015.pdf (Accessed 22 February 2017). De Bono, E. (1989). Six thinking hats. London: Penguin. Erien, Y. and Katmer-Bayrakl, V. (2016). Six Hat Thinking Technique in Program Evaluation: The Evaluation of the Quality of Mathematics Teacher Training Program in Turkey International Online Journal of Educational Sciences, 8 (4), 31-45. Available at: http://www.iojes.net/userfiles/Article/IOJES_2257.pdf (Accessed 22 February 2017). Fragoso, A. Goncalves, T. Ribeiro, M. Monteiro, R. Quintas, H. Bago, J. Fonseca, H. and Santos, L. (2013). The transition of mature students to higher education: Challenging traditional concepts? Studies in the education of Adults. 45(1), 67-81. JISC (2014). Developing digital literacies. Available at: https://www.jisc.ac.uk/guides/developing-digital-literacies (Accessed 16 May 2017). [Authors] (2016). Final report for the Projects for the Enhancement of Teaching and Learning (PETL) 2015/2016. An institutional response to transitioning online: a postgraduate case study Edinburgh: Queen Margaret University. QAA (2015). Enhancement Themes. Available at: http://www.enhancementthemes.ac.uk/docs/publications/overview-of-the-enhancement-themes.pdf?sfvrsn=8 (Accessed 16 May 2017). [Author] 2016. Videos: e-PgCert & Six Thinking Hats. Available at: http://tiny.cc/Co-creation. (Accessed 20 February 2017) O'Shea, S. Stone, C. and Delahunty, J. (2015). I 'feel' like I am at university even though I am online.- Exploring how students narrate their engagement with higher education institutions in an online learning environment. Distance Education. 36,(1), 41-58. Available at: http://www.tandfonline.com/doi/full/10.1080/01587919.2015.1019970 (Accessed 22 February 2017). Schiro, M. (2013). Introduction to the curriculum ideologies. In: Curriculum theory: conflicting visions and enduring concerns. 2nd ed. Thousand Oaks: Sage. Available at:https://talkcurriculum.files.wordpress.com/2014/09/schiro-m-2012-introduction-to-the-curriculum-ideologies-in-curriculum-theory-2nd-ed.pdf (Accessed 22 February 2017) Stavropoulou, A. and Stroubouki, T. (2014). Evaluation of educational programmes - the contribution of history to modern evaluation thinking. Health Science Journal. 8(2), 193-204. Available at: http://www.hsj.gr/medicine/evaluation-of-educational-programmes--the-contribution-of-history-to-modern-evaluation-thinking.pdf (Accessed 22 February 2017). Weimer, M. (2014). A Lone Wolf's approach to Group work. Faculty Focus. [Viewed 25th May 2016]. Available at: http://www.facultyfocus.com/articles/teaching-professor-blog/lone-wolfs-approach-group-work/ (Accessed 20 February 2017)3pub4771pub

Girl champ in Eswatini: A strategic marketing campaign to promote demand for sexual and reproductive health services among young women

Eforts to engage adolescent girls and young women (AGYW) in HIV services have struggled, in part, due to limited awareness of services and stigma. Strategic marketing is a promising approach, but the impact on youth behavior change is unclear. We report fndings from a mixed methods evaluation of the Girl Champ campaign, designed to generate demand for sexual and reproductive services among AGYW, and piloted in three clinics in the Manzini region of eSwatini. We analyzed and integrated data from longitudinal, clinic-level databases on health service utilization among AGYW before and after the pilot, qualitative interviews with stakeholders responsible for the implementation of the pilot, and participant feedback surveys from attendees of Girl Champ events. Girl Champ was well received by most stakeholders based on event attendance and participant feedback, and associated with longitudinal improvements in demand for HIV services. Findings can inform future HIV demand creation interventions for youth

Characterizing the gut microbiome in trauma: significant changes in microbial diversity occur early after severe injury.

Background:Recent studies have demonstrated the vital influence of commensal microbial communities on human health. The central role of the gut in the response to injury is well described; however, no prior studies have used culture-independent profiling techniques to characterize the gut microbiome after severe trauma. We hypothesized that in critically injured patients, the gut microbiome would undergo significant compositional changes in the first 72 hours after injury. Methods:Trauma stool samples were prospectively collected via digital rectal examination at the time of presentation (0 hour). Patients admitted to the intensive care unit (n=12) had additional stool samples collected at 24 hours and/or 72 hours. Uninjured patients served as controls (n=10). DNA was extracted from stool samples and 16S rRNA-targeted PCR amplification was performed; amplicons were sequenced and binned into operational taxonomic units (OTUs; 97% sequence similarity). Diversity was analyzed using principle coordinates analyses, and negative binomial regression was used to determine significantly enriched OTUs. Results:Critically injured patients had a median Injury Severity Score of 27 and suffered polytrauma. At baseline (0 hour), there were no detectable differences in gut microbial community diversity between injured and uninjured patients. Injured patients developed changes in gut microbiome composition within 72 hours, characterized by significant alterations in phylogenetic composition and taxon relative abundance. Members of the bacterial orders Bacteroidales, Fusobacteriales and Verrucomicrobiales were depleted during 72 hours, whereas Clostridiales and Enterococcus members enriched significantly. Discussion:In this initial study of the gut microbiome after trauma, we demonstrate that significant changes in phylogenetic composition and relative abundance occur in the first 72 hours after injury. This rapid change in intestinal microbiota represents a critical phenomenon that may influence outcomes after severe trauma. A better understanding of the nature of these postinjury changes may lead to the ability to intervene in otherwise pathological clinical trajectories. Level of evidence:III. Study type:Prognostic/epidemiological

Muito além da video aula: diversificando as metodologias de ensino remoto de biologia

No contexto da pandemia de COVID-19 diversas escolas brasileiras admitiram o ensino remoto emergencial (ERE) como forma de manutenção e continuidade da educação escolar através, principalmente, de videoaulas disponibilizadas na internet. Considerando-se que muitos estudantes não possuem acesso a uma ampla rede de dados de internet, necessária para assistir videoaulas frequentemente, e compreendendo a necessidade de se diversificar as metodologias de ensino a fim de manter o engajamento discente durante o período de ERE, desenvolvemos o PowerPoint® Dialogado, um material diferente das apresentações de PowerPoint® que os professores produzem cotidianamente para as aulas presenciais. Para construir este dispositivo, utilizamos ferramentas como o programa em si, gifs, animações, balões de fala, avatares das professoras, setas explicativas, além de personificar componentes da aula e usar linguagem coloquial. Como resultado verificou-se que os estudantes demonstraram preferência por essa metodologia para estudar durante o ERE, em detrimento de outras, e apresentaram resultados positivos nas avaliações

Results of a feasibility randomised controlled trial (RCT) for WATCH IT: a programme for obese children and adolescents

Background: In the evaluation of childhood obesity interventions, few researchers undertake a rigorous feasibility stage in which the design and procedures of the evaluation process are examined. Consequently, phase III studies often demonstrate methodological weaknesses. Purpose: Our aim was to conduct a feasibility trial of the evaluation of WATCH IT, a community obesity intervention for children and adolescents. We sought to determine an achievable recruitment rate; acceptability of randomisation, assessment procedures, and dropout rate; optimal outcome measures for the definitive trial; and a robust sample size calculation. Method: Our goal was to recruit 70 participants over 6 months, randomise them to intervention or control group, and retain participation for 12 months. Assessments were taken prior to randomisation and after 6 and 12 months. Procedures mirrored those intended for a full-scale trial, but multiple measures of similar outcomes were included as a means to determine those most appropriate for future research. Acceptability of the research and impact of the research on the programme were ascertained through interviewing participants and staff. Results: We recruited 70 participants and found that randomisation and data collection procedures were acceptable. Self-referral (via media promotion) was more effective than professional referral. Blinding of assessors was sustained to a reasonable degree, and optimal outcome measures for a full-scale trial were identified. Estimated sample size was significantly greater than sample sized reported in published trials. There was some negative impact on the existing programme as a result of the research, a lesson for designers of future trials. Limitations: We successfully recruited socially disadvantaged families, but the majority of families were of White British nationality. The composition of the participants was an added valuable lesson, suggesting that recruitment strategies to obtain a more heterogeneous ethnic sample warrant consideration in future research. Conclusions: This study provided us with confidence that we can run a phase III multi-centre trial to test the effectiveness of WATCH IT. Importantly, it was invaluable in informing the design not only of that trial but also of future evaluations of childhood obesity treatment interventions

Mutation-independent Allele-Specific Editing by CRISPR-Cas9, a Novel Approach to Treat Autosomal Dominant Disease

CRISPR-Cas9 provides a tool to treat autosomal dominant disease by non-homologous end joining (NHEJ) gene disruption of the mutant allele. In order to discriminate between wild-type and mutant alleles, Streptococcus pyogenes Cas9 (SpCas9) must be able to detect a single nucleotide change. Allele-specific editing can be achieved by using either a guide-specific approach, in which the missense mutation is found within the guide sequence, or a protospacer-adjacent motif (PAM)-specific approach, in which the missense mutation generates a novel PAM. While both approaches have been shown to offer allele specificity in certain contexts, in cases where numerous missense mutations are associated with a particular disease, such as TGFBI (transforming growth factor β-induced) corneal dystrophies, it is neither possible nor realistic to target each mutation individually. In this study, we demonstrate allele-specific CRISPR gene editing independent of the disease-causing mutation that is capable of achieving complete allele discrimination, and we propose it as a targeting approach for autosomal dominant disease. Our approach utilizes natural variants in the target region that contain a PAM on one allele that lies in cis with the causative mutation, removing the constraints of a mutation-dependent approach. Our innovative patient-specific guide design approach takes into account the patient’s individual genetic make-up, allowing on- and off-target activity to be assessed in a personalized manner