The DRESS trial: a feasibility randomized controlled trial of a neuropsychological approach to dressing therapy for stroke inpatients

Objective: To investigate two approaches to treating patients with persistent dressing problems and cognitive difficulties following stroke. Design: Pilot randomized controlled trial. Setting: Inpatient stroke rehabilitation service. Subjects: Seventy consecutive stroke patients with persistent dressing problems and accompanying cognitive difficulties at two weeks after their stroke. Interventions: Patients were randomly allocated to six weeks of either a systematic neuropsychological approach, based on analysis of dressing problems and further cognitive testing, or to the control group who received conventional (functional) dressing practice. Both groups received treatment three times a week in accordance with two separately prepared manuals. Main measures: Nottingham Stroke Dressing Assessment (NSDA), Line Cancellation, 10-hole peg transfer test, Object Decision, Gesture Imitation. Patients were assessed at six weeks after randomization by an independent assessor masked to group allocation. Results: Both neuropsychological and functional groups improved performance on the NSDA over the treatment period (31% and 22%, respectively) but there was no significant difference between groups at six weeks. However, the neuropsychological group showed a significantly greater improvement on a line cancellation test of visual neglect (t(62) = 2.1, P < 0.05) and a planned subanalysis for those with right hemisphere damage showed a trend towards better dressing outcome (P = 0.07, one-tailed). Conclusions: Results demonstrate the potential benefits of a systematic neuropsychological approach to dressing therapy, particularly for patients with right hemisphere damage. This study suggests the need for a phase III study evaluating the efficacy of a systematic neuropsychological approach in treating dressing difficulties, targeting patients with right hemisphere stroke and visuospatial impairments

Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS): Study protocol for a randomised controlled trial

BackgroundMany older people presenting to Acute Medical Units (AMU) are discharged after only a short stay ( 70 years and scoring positive on a risk screening tool ('Identification of Seniors At Risk') who are discharged within 72 hours of attending an AMU with a medical crisis, recruited prior to discharge. Sample size is 400. Carers of participants will also be recruited.Intervention: Assessment on the AMU and further out-patient management by a specialist physician in geriatric medicine. Assessment and further management will follow the principles of Comprehensive Geriatric Assessment, providing advice and support to primary care services.Design: Multi-centre, individual patient randomised controlled trial comparing intervention with usual care.Outcome measurement: Follow up is by postal questionnaire 90 days after randomisation, and data will be entered into the study database by a researcher blind to allocation. The primary outcome is the number of days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, health and social care resource use, and scaled outcome measures, including quality of life, disability, mental well-being. Carer strain and well being will also be measured at 90 days.Analyses: Comparisons of outcomes and costs, and a cost utility analysis between the intervention and control groups will be carried out.Trial RegistrationISRCTN: ISRCTN2180048

Acute medical unit comprehensive geriatric assessment intervention study (AMIGOS)

<p>Abstract</p> <p>Background</p> <p>Many older people presenting to Acute Medical Units (AMU) are discharged after only a short stay (< 72 hours), yet many re-present to hospital or die within 1 year. Comprehensive Geriatric Assessment may improve patient outcomes for this group.</p> <p>Method</p> <p>Participants</p> <p>Patients aged > 70 years and scoring positive on a risk screening tool ('Identification of Seniors At Risk') who are discharged within 72 hours of attending an AMU with a medical crisis, recruited prior to discharge. Sample size is 400. Carers of participants will also be recruited.</p> <p>Intervention</p> <p>Assessment on the AMU and further out-patient management by a specialist physician in geriatric medicine. Assessment and further management will follow the principles of Comprehensive Geriatric Assessment, providing advice and support to primary care services.</p> <p>Design</p> <p>Multi-centre, individual patient randomised controlled trial comparing intervention with usual care.</p> <p>Outcome measurement</p> <p>Follow up is by postal questionnaire 90 days after randomisation, and data will be entered into the study database by a researcher blind to allocation. The primary outcome is the number of days spent at home (for those admitted from home), or days spent in the same care home (if admitted from a care home). Secondary outcomes include mortality, institutionalisation, health and social care resource use, and scaled outcome measures, including quality of life, disability, mental well-being. Carer strain and well being will also be measured at 90 days.</p> <p>Analyses</p> <p>Comparisons of outcomes and costs, and a cost utility analysis between the intervention and control groups will be carried out.</p> <p>Trial Registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN21800480">ISRCTN21800480</a></p

Turvallisuutta ja ensiapua : Turvallisuusopas Kajaani Gymnasticin ohjaajille

Opinnäytetyön aiheena oli tuotteistaa turvallisuusopas kajaanilaiselle kilpa-aerobicseura Kajaani Gymnasticille. Opinnäytetyön tavoitteena oli selvittää minkälaisia turvallisuus- ja ensiaputietoja ja -taitoja seuran ohjaajat tarvit-sevat. Tarkoituksena oli kuvata seuran harjoitusryhmien ohjauksessa vaadittavat turvallisuus- ja ensiaputiedot sekä -taidot kirjallisessa oppaassa. Opinnäytetyön tuloksena on tuote, Turvallisuutta ja ensiapua –Turvallisuusopas Kajaani Gymnasticin ohjaajille. Turvallisuus on tärkeä osa urheilua. Lasten ja nuorten urheilussa turvallisuudesta vastaa ohjaaja. Ohjaajan tehtä-vä on huolehtia harrastusympäristön sekä harrastusryhmissä tapahtuvan toiminnan turvallisuudesta. Ohjaajaan vastuuseen kuuluu mahdollisten riskitilanteiden ennaltaehkäisy. Kaikkia riskitilanteita ei voida estää, siksi ohjaajalla täytyy olla valmius toimia mahdollisissa hätä- ja ensiaputilanteissa tilanteen vaatimalla tavalla. Opinnäytetyö oli tuotteistamisprosessi, jonka lopputuloksena oli tuote –turvallisuusopas. Oppaan tuotteistami-nen alkoi tiedon keräämisellä. Keskeisimmiksi käsitteiksi nousivat lasten ja nuorten urheilu, sen turvallisuus ja riskitekijät sekä ohjaajana toiminen. Kerätyn tiedon pohjalta valmistui turvallisuusopas, joka on arvioitu luotettavaksi teoriatiedon sekä esitestauksen kautta saadun asiantuntija palautteen perusteella. Opas sisältää tietoa lasten ja nuorten urheilun ohjaajana toimimisesta sekä toimintaohjeita riskitilanteiden ennaltaehkäisemiseen ja kohtaamiseen.The subject of this thesis was to produce a safety manual for Kajaani Gymnastic, a sport aerobics club in Kajaani. The objective of the thesis was to investigate what kind of safety and first aid knowledge and skills sports clubs instructors needed. The purpose of the thesis was to describe safety and first aid knowledge and skills needed while working as an instructor in Kajaani Gymnastic. This information was collected into a written safety manual. The instructor in responsible for safety in children’s sports. The instructor’s task is to take care of environmental safety and make sure that all activities are safe. Responsibility for the prevention of potential risk situations is an important part of the instructor’s work. However, all risk situations cannot be prevented, which is the reason why instructors have to be prepared for emergency situations and they have to be ready to act according to the situation. This thesis was completed as a product development process. The result was a safety manual. Searching information was the first step in the process. Evidence-based information about children’s sports, acting as an instructor, safety and risk situations created the base for the thesis and the safety manual. The manual was evaluated as reliable on the basis of evidence-based information used and feedback collected from experts

Data from: Cost-effectiveness of a specialist geriatric medical intervention for frail older people discharged from acute medical units: economic evaluation in a two-centre randomised controlled trial (AMIGOS)

Background: Poor outcomes and high resource-use are observed for frail older people discharged from acute medical units. A specialist geriatric medical intervention, to facilitate Comprehensive Geriatric Assessment, was developed to reduce the incidence of adverse outcomes and associated high resource-use in this group in the post-discharge period. Objective: To examine the costs and cost-effectiveness of a specialist geriatric medical intervention for frail older people in the 90 days following discharge from an acute medical unit, compared with standard care. Methods: Economic evaluation was conducted alongside a two-centre randomised controlled trial (AMIGOS). 433 patients (aged 70 or over) at risk of future health problems, discharged from acute medical units within 72 hours of attending hospital, were recruited in two general hospitals in Nottingham and Leicester, UK. Participants were randomised to the intervention, comprising geriatrician assessment in acute units and further specialist management, or to control where patients received no additional intervention over and above standard care. Primary outcome was incremental cost per quality adjusted life year (QALY) gained. Results: We undertook cost-effectiveness analysis for 417 patients (intervention: 205). The difference in mean adjusted QALYs gained between groups at 3 months was -0.001 (95% confidence interval [CI]: -0.009, 0.007). Total adjusted secondary and social care costs, including direct costs of the intervention, at 3 months were £4412 (€5624, $6878) and £4110 (€5239,$6408) for the intervention and standard care groups, the incremental cost was £302 (95% CI: 193, 410) [€385, $471]. The intervention was dominated by standard care with probability of 62%, and with 0% probability of cost-effectiveness (at £20,000/QALY threshold). Conclusions: The specialist geriatric medical intervention for frail older people discharged from acute medical unit was not cost-effective. Further research on designing effective and cost-effective specialist service for frail older people discharged from acute medical units is needed

AMIGOS economic evaluation dataset

The file contains data used in the trial-based economic evaluation analyses presented in the paper. In the first sheet, clinical data is provided. Subsequent sheets contain resource use data for inpatient and daycase care (2nd sheet), and outpatient visits data (3rd sheet). Costs of social care episodes are in the 4th sheet. Intervention resource use data is in the 5th sheet. Additionally, costs per patient for primary and tertiary care, collected for Nottingham centre only and not included in the main economic evaluation, are in the 6th sheet. Descriptions of variables and additional information are in the columns and related sheets in the dataset, and in the relevant paper sections

Full-sample two-center cost analysis (mean cost in £, 95% CI).

<p>^aInpatient, day-case and outpatient cost data were collected for both locations, Nottingham and Leicester. The mean healthcare cost for the Nottingham sample was £3569 (95%CI: 3068, 4220), the mean healthcare cost for the Leicester sample was £2269 (95%CI: 1854, 2810), with healthcare cost significantly lower in the Leicester sample by -£1300 (95% CI: -2019, -516). This statistically significant difference may be attributed to significantly higher percentage of care home residents in the Leicester sub-sample (34.2% vs. 21.0%, p < 0.01), for whom healthcare cost was significantly lower than for non-residents in the whole sample (by -£880 (95%CI: -1631, -192)), to other non-observable differences between Leicester and Nottingham patient populations, as well as to different coding systems between sites (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121340#pone.0121340.s004" target="_blank">S2 Appendix</a>). The two centre retrospective resource use datasets obtained for this study, and for related previous cost cohort study, [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121340#pone.0121340.ref010" target="_blank">10</a>] did not allow us to ascertain the latter hypothesis and explain fully the reasons of the difference in secondary care costs between Nottingham and Leicester.</p><p>^bThe mean social care cost for the Nottingham sample was £1010 (95%CI: 720, 1338), the mean social care cost for the Leicester sample was £1183 (95%CI: 770, 1652), with social care cost non-significantly higher in the Leicester sample by £173 (95% CI: -354, 726). Despite significantly higher percentage of care home residents in Leicester sample, for whom social care cost was higher than for non-residents in the whole sample (by £1026 (95%CI: 361, 1026)), social care cost in Leicester was not higher significantly and was not higher enough to reduce the overall difference in costs between sites. The reason could be that in the Leicester sample the percentage of patients living alone was significantly lower than in the Nottingham sample (31.0% vs. 46.6%, p < 0.01), and in the whole sample social care costs for those living alone was significantly higher by £804 (95%CI: 381, 1283), when comparing to those living with spouse. Social care costs was £366 (95%CI: 146, 585), £1170 (95%CI: 817, 1603), and £1835 (95%CI: 1209, 2517), for living with spouse, for living alone, and for care home residents, respectively.</p><p>Full-sample two-center cost analysis (mean cost in £, 95% CI).</p

Cost-effectiveness acceptability curves (adjusted analyses, full sample).

<p>Full-sample CEAC is obtained from probability of cost-effectiveness for given WTP, averaged across 45 imputations.</p