QUALITY OF LIFE AND COGNITION IN PATIENTS WITH PARKINSON\u27S DISEASE DURING THE COVID-19 PANDEMIC

Introduction: Restrictive isolation contributes to the containment of the virus, but it also has negative consequences for mental health. This study aimed to assess the quality of life, during the pandemic, in patients with Parkinson\u27s disease (PD), compare it with measures before the pandemic, and identify factors that may be associated with non-compliance with cognitive intervention activities. Methods: The PDQ-39 questionnaire was reapplied in a sample of PD patients previously followed up in rehabilitation program. In addition, a questionnaire to assess the follow-up of cognitive training activities was elaborated. Results: Twenty-two individuals with mean age of 62.72(7.49) years and a mean duration of the disease of 8.7(3.30) years participated in this study. There was a statistically significant difference in the total score of the PDQ-39(p=0.048), as well as in the mobility (p=0.038), stigma (p=0.035), social support(p=0.045), and cognition(p=0.026) dimensions. When analyzing the questionnaire, it was observed that most of the sample was able to follow the guidelines received during the cognitive training group (77.3%), mainly reading activities (41%), games (35%), and applications (35%). However, 77.3% reported worsening cognition, with attention (50%) and memory (34%) being highlighted, as well as sadness, discouragement, and indisposition (72%), anxiety (77.27%), and difficulty falling asleep (68%). A total of 86.36% perceived the need for professional support in mental health. Conclusion: This study showed the impact of the pandemic on individuals with PD, leading to a worse perception of quality of life and subjective complaints related to sleep disturbance, cognitive impairment, and neuropsychiatric symptoms (depression and anxiety)

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)