Attitudes, knowledge and understanding towards mind-body practices as an asset for social prescribing in higher education

Evidence is growing to support mind-body practices (e.g., yoga) as a therapeutic intervention for many health conditions. In the UK, yoga is promoted as a social prescription asset by the National Health Service (NHS), yet the factors influencing its implementation are poorly understood. This study explored the attitudes, knowledge and understanding of mind-body practices as a social prescribing asset amongst health science populations within higher education. Twenty-six health science staff and students completed an online questionnaire. Data analysis used a mixed-methods approach, employing thematic analysis for qualitative data and calculating the net promoter score (NPS) to assess participants' inclination to recommend mind-body practices as a social prescribing asset. Nineteen participants (73%) were aware of the term “social prescription” and understood it to be a non-clinical, community-based alternative to medication. Whilst participants were aware of the physical benefits of mind-body practices, particularly yoga, they lacked awareness of the social, emotional, and spiritual benefits. Although 42% of participants would recommend mind-body practices as a social prescribing asset (NPS of 15), the opposite was true for yoga (NPS of -15), potentially due to poor knowledge or personal engagement with yoga. This study underlines the importance of increasing understanding and promoting yoga as an adjuvant mind-body practice to achieve social, emotional, and spiritual benefits. Implementing educational strategies to increase knowledge of mind-body practices and yoga, with a focus on social prescribing practice, may help to improve future referral pathways in practice in line with the NHS long term plan

Examination of a new mobile intermittent pneumatic compression device in healthy adults

Aim: Intermittent pneumatic compression (IPC) is an alternative method of compression treatment designed to compress the leg and mimic ambulatory pump action to actively promote venous return. This study explores the efficacy of a new portable IPC device on tissue oxygenation (StO2) in two sitting positions. Methods: Twenty-nine participants were screened and recruited using (PAR-Q, CA). All data conformed to the Declaration of Helsinki and ethical principles. Participants attended two separate one-hour sessions to evaluate StO2 in a chair-sitting and long-sitting position. StO2 was recorded for 20-minutes pre-, during and post- a 20-minute intervention of the IPC unit (VenaproTM, DJO Global, CA). Results: A significant difference was seen between the two seating positions (p=0.003) with long-sitting showing a 12% higher StO2 level than chair-sitting post intervention. A similar effect was seen in both seating positions when analysing data over three, time points (p=0.000). Post-hoc pairwise comparisons showed that significant improvements in StO2 (p≤0.000) were seen from baseline, throughout the intervention, continuing up to 15 minutes post intervention, indicating a continued effect of the device after a short intervention. Conclusion: Post-operative care poses huge demands and cost to health services worldwide, so promotion of portable rehabilitation tools that facilitate community rehabilitation affords immense potential. Increasing StO2 through short-intervention sessions with this portable device within various health and sports-based practices, improving tissue health, potentially reducing post-operative DVT risk or inflammation. Such devices lend themselves to wide self-management implementation

Postural management system for bedbound patients

Objectives To explore the potential effectiveness of postural management system considering peak contact pressure and user perceptions. Methods Fifteen healthy participants were screened using a modified Red Flags Screening tool. Conformat® system was used to analyze contact pressure under the shoulder and buttocks and was recorded for 10 minutes in supine and side-lying positions with and without a postural management system. Participants were asked about their comfort and restrictiveness using a numerical rating scale. Results In side-lying position, the peak contact pressure at greater trochanter was significantly lower when a postural management system was applied. In supine position, the peak contact pressure at shoulders was respectively lower. In turn, the peak contact pressure at ischial tuberosity was significantly higher lower when a postural management system was applied. The postural management system did not affect the level of perceived comfort. Participants reported that they felt more restricted with the intervention. Conclusions A postural management system reduced pressure at the shoulders in supine-lying position and at the greater trochanter in side-lying position lowering the risk of pressure injury formation. A postural management system may reduce the economic burden of health problems associated with poor positioning, enhance patient care, and reduce the risks associated with manual handling techniques when repositioning

Assessment and Management of Pain, Alignment, Strength and Stability (PASS) in Patellofemoral Pain and Low Back Pain

Clinical assessment and management of musculoskeletal conditions of different joints may be broken down into considerations of Pain, Alignment, Strength and Stability (PASS). In recent years these factors have allowed a systematic approach and has enabled the development in our understanding of clinical subgroups, which enable targeted or stratified care. This paper considers the use of the PASS concept to determine the most appropriate treatment and interventions, specifically when considering treatment of two common musculoskeletal conditions, patellofemoral pain and low back pain

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Exploring the role of homophily in purchase behaviour

Homophily is a well-researched phenomenon around the world contributing to the understanding of why certain people form social groups. Most of the dimensions including race and age homophily are often studied in isolation. However, since humanity is complex, so too is the study of human behaviour, and as such, requires an exploration of all the dimensions of homophily present in specific social groups to understand how these social groups interact and influence group behaviour and purchase decisions. This was an exploratory, qualitative study of 17 higher-income black South African women, the composition and nature of their social groups both offline and on social media, and the influence of the group on individual purchase behaviour. This study found the presence of multidimensional homophily in social groups which were formed offline, although homophily also exists on social media. In fact, groups interact over social media more than face-to-face, and while social comparison is a common behaviour both offline and online, it was not a predictor of purchase behaviour. It was also affirmed that groups are effective at nudging individuals and influencing their purchase behaviour. Group-based brand experiences are recommended for more effective brand engagement for advertisers. The implications and recommendations for further research have also been discussed.Mini Dissertation (MBA)--University of Pretoria, 2018.dm2019Gordon Institute of Business Science (GIBS)MB

Safe Switch Initiative: Medication Safety Focusing on Therapeutic Interchange in Ambulatory Care

The Institute of Medicine (IOM) estimates 1.5 million preventable adverse drug events (ADEs) occur in theUnited Stateseach year. The total annual cost for these preventable ADEs is estimated around 3.5 billion dollars yearly. Medications errors can result in increased side effects, sub-therapeutic dosing, overdosing, coma, and death. The St. Vincent Joshua Max Simon Primary Care Center (PCC) Outpatient Pharmacy is associated with St. Vincent Health System, allowing for a closed formulary and therapeutic interchanges. In order to offset risks with potential medication errors, the PCC pharmacy has implemented a patient counseling and follow-up process called the Safe Switch Initiative (SSI). This process is implemented by pharmacy students and residents and is designed to reinforce information to the patient regarding therapeutic interchanges. There are two main objectives. First, to determine the number of medication errors or near misses with institution specific high risk medications including oral hypoglycemic agents, insulin, angiotensin receptor blockers (ARBs), beta blockers (BB), non-steroidal anti-inflammatory drugs (NSAIDs), and statins. Second, to determine if different drug classes are more likely to be associated with medication errors. This study is a retrospective, observational study and was approved by the Institutional Review Board. Established PCC patients who had a therapeutic interchange with a previously determined high risk medication were included in the study. Patients were excluded if under 18 years of age, pregnant, or received a prescription from the hospital approved by social services. Review of patient charts and SSI documentation began in September 2013 and will continue through February 2014. The following data is being collected: age, sex, primary clinic, current medications, high-alert medications, and duplicate medications or classes. All information has been recorded without patient identifiers to maintain confidentiality. Data collected will be analyzed using statistical tests appropriate to the type of data