The development of a decision aid for tinnitus

OBJECTIVE: To develop a decision aid for tinnitus care that would meet international consensus for decision aid quality. DESIGN: A mixed methods design that included qualitative in-depth interviews, literature review, focus groups, user testing and readability checking. STUDY SAMPLE: Patients and clinicians who have clinical experience of tinnitus. RESULTS: A decision aid for tinnitus care was developed. This incorporates key evidence of efficacy for the most frequently used tinnitus care options, together with information derived from patient priorities when deciding which choice to make. CONCLUSION: The decision aid has potential to enable shared decision making between clinicians and patients in audiology. The decision aid meets consensus standards

Randomized controlled trial of SPIRIT: An effective approach to preparing African-American dialysis patients and families for end of life

This randomized controlled trial tested an intervention, Sharing Patients’ Illness Representations to Increase Trust (SPIRIT), designed to enhance communication regarding end-of-life care between African Americans with end-stage renal disease (ESRD) and their chosen surrogate decision makers (N = 58 dyads). We used surveys and semi-structured interviews to determine the feasibility, acceptability, and preliminary effects of SPIRIT on patient and surrogate outcomes at 1 week and 3 months post-intervention. We also evaluated patients’ deaths and surrogates’ end-of-life decision making to assess surrogates’ perceptions of benefits and limitations of the SPIRIT while facing end-of-life decisions. We found that SPIRIT promoted communication between patients and their surrogates and was effective and well received by the participants

Brief intervention for alcohol misuse in people attending sexual health clinics: study protocol for a randomized controlled trial.

BACKGROUND: Over the last 30  years the number of people who drink alcohol at harmful levels has increased in many countries. There have also been large increases in rates of sexually transmitted infections. Available evidence suggests that excessive alcohol consumption and poor sexual health may be linked. The prevalence of harmful alcohol use is higher among people attending sexual health clinics than in the general population, and a third of those attending clinics state that alcohol use affects whether they have unprotected sex. Previous research has demonstrated that brief intervention for alcohol misuse in other medical settings can lead to behavioral change, but the clinical- and cost-effectiveness of this intervention on sexual behavior have not been examined. METHODS: We will conduct a two parallel-arm, randomized trial. A consecutive sample of people attending three sexual health clinics in London and willing to participate in the study will be screened for excessive alcohol consumption. Participants identified as drinking excessively will then be allocated to either active treatment (Brief Advice and referral for Brief Intervention) or control treatment (a leaflet on healthy living). Randomization will be via an independent and remote telephone randomization service and will be stratified by study clinic. Brief Advice will comprise feedback on the possible health consequences of excessive alcohol consumption, written information about alcohol and the offer of an appointment for further assessment and Brief Intervention. Follow-up data on alcohol use, sexual behavior, health related quality of life and service use will be collected by a researcher masked to allocation status six months later. The primary outcome for the study is mean weekly alcohol consumption during the previous three months, and the main secondary outcome is the proportion of participants who report unprotected sex during this period. DISCUSSION: Opportunistic intervention for excessive alcohol use has been shown to be effective in a range of medical settings. The SHEAR study will examine whether delivering such interventions in sexual health clinics results in reductions in alcohol consumption and will explore whether this is associated with changes in sexual behavior.RIGHTS : This article is licensed under the BioMed Central licence at http://www.biomedcentral.com/about/license which is similar to the 'Creative Commons Attribution Licence'. In brief you may : copy, distribute, and display the work; make derivative works; or make commercial use of the work - under the following conditions: the original author must be given credit; for any reuse or distribution, it must be made clear to others what the license terms of this work are

Cognitive performance, quality and quantity of movement reflect unhealthy psychological symptoms in adolescents

Purpose: The presentation of unhealthy psychological symptoms are rising sharply in adolescents. Detrimental lifestyle behaviours are proposed as both possible causes and consequences. This study set out to compare selected measures of quality and quantity of movement between adolescents with and without unhealthy psychological symptoms.   Methods: Using a cross sectional design, 96 participants completed the study from a whole year group of 166, age (13.36 ± 0.48) male 50.6% from a secondary school in Oxfordshire, England as a part of a larger study (EPIC) between January and April 2017. Measures were taken of quality and quantity of movement: reaction/movement time, gait pattern & physical activity, alongside psychological symptoms. Differences in movement behaviour in relation to psychological symptom and emotional problem presentation were determined using ANOVA. In the event of a significant result for the main factor of each parameter, a Bonferroni -corrected post hoc test was conducted to show the difference between categories in each group. Results for both unhealthy psychological symptoms and emotional problems were grouped into four categories (‘Close to average’, ‘slightly raised’, ‘high’ and ‘very high’).  Results: Early adolescents with very high unhealthy psychological symptoms had 16.79% slower reaction times (p = .003, ηp2 = .170), 13.43% smaller walk ratio (p = .007, ηp2 = .152), 7.13% faster cadence (p = .005, ηp2 = .149), 6.95% less step time (p = .007, ηp2 = .153) and 1.4% less vigorous physical activity (p = .04, ηp2 = .102) than children with close to average psychological symptoms. Early adolescents with very high emotional problems had 12.25% slower reaction times (p = .05, ηp2 = .081), 10.61% smaller walk ratio (p = .02, ηp2 = .108), 6.03% faster cadence (p = .01, ηp2 = .134), 6.07% shorter step time (p = .007, ηp2 = .141) and 1.78% less vigorous physical activity (p = .009, ηp2 = .136) than children with close to average emotional problems.    Conclusions:  Different movement quality and quantity of was present in adolescents with unhealthy psychological symptoms and emotional problems. We propose movement may be used to both monitor symptoms, and as a novel therapeutic behavioural approach. Further studies are required to confirm our findings.

Learning a novel rhythmic stepping task in children with probable Developmental Coordination Disorder

Background. Developmental coordination disorder affects approximately 6% of children, interfering with participation in physical activity and can persist through adulthood. However, no studies have investigated the neuromotor mechanisms of learning of a novel task with rhythmic cueing. Methods. Movement Assessment Battery for Children-2nd edition was used to identify 48 children with probable developmental coordination disorder (13.9 ± 0.05 yrs., 27% male) and 37 typically developed (13.9 ± 0.10 yrs., 54% male). While instrumented with an inertial measurement unit, both groups performed a novel rhythmic stepping task and with a concurrent auditory stroop test (dual-task), underwent seven weeks of intervention with step training with rhythmic cuing and were tested for retention five weeks post-intervention. Findings. Initially, the group with probable developmental coordination disorder had a higher variability of step timing (coefficient of variation: 0.08 ± 0.003-typically developed – 0.09 ± 0.004-probable developmental coordination disorder, p < 0.05) and a frequency of peak power spectral density further from the target 0.5 Hz (0.50 ± 0.002 Hz-typically developed – 0.51 ± 0.003 Hz-probable developmental coordination disorder, p < 0.05), and were more affected by the dual-task: power spectral density at 0.5 Hz (−7.2 ± 3.3%-typically developed – -13.4 ± 4.6%- prob_DCD, p < 0.05) and stroop test errors (6.4 ± 1.1%-typically developed – -11.1 ± 2.4%- probable developmental coordination disorder, p < 0.05). The intervention led to similar improvements in both groups in coefficient of variation of step timing (0.12 ± 0.01-Pre – 0.07 ± 0.002-Post, p < 0.05), frequency of the peak power spectral density (0.51 ± 0.005 Hz-Pre – 0.50 ± 0.001 Hz-Post, p < 0.05) and relative power spectral density bandpower (3.2 ± 0.2%-Pre – 5.9 ± 0.3%-Post, p < 0.05). All improvements were retained after five weeks post-training. Interpretation. Rhythmic cueing shows strong promise for enhancing motor learning in children with probable developmental coordination disorder

Neuroergonomic assessment of Developmental Coordination Disorder

Until recently, neural assessments of gross motor coordination could not reliably handle active tasks, particularly in realistic environments, and offered a narrow understanding of motor-cognition. By applying a comprehensive neuroergonomic approach using optical mobile neuroimaging, we probed the neural correlates of motor functioning in young people with Developmental Coordination Disorder (DCD), a motor-learning deficit affecting 5-6% of children with lifelong complications. Neural recordings using fNIRS were collected during active ambulatory behavioral task execution from 37 Typically Developed and 48 DCD Children who performed cognitive and physical tasks in both single and dual conditions. This is the first of its kind study targeting regions of prefrontal cortical dysfunction for identification of neuropathophysiology for DCD during realistic motor tasks and is one of the largest neuroimaging study (across all modalities) involving DCD. We demonstrated that DCD is a motor-cognitive disability, as gross motor /complex tasks revealed neuro-hemodynamic deficits and dysfunction within the right middle and superior frontal gyri of the prefrontal cortex through functional near infrared spectroscopy. Furthermore, by incorporating behavioral performance, decreased neural efficiency in these regions were revealed in children with DCD, specifically during motor tasks. Lastly, we provide a framework, evaluating disorder impact in ecologically valid contexts to identify when and for whom interventional approaches are most needed and open the door for precision therapies

Use of intervention mapping to adapt a health behavior change intervention for endometrial cancer survivors: The shape-up following cancer treatment program

Background: About 80% of endometrial cancer survivors (ECS) are overweight or obese and have sedentary behaviors. Lifestyle behavior interventions are promising for improving dietary and physical activity behaviors, but the constructs associated with their effectiveness are often inadequately reported. The aim of this study was to systematically adapt an evidence-based behavior change program to improve healthy lifestyle behaviors in ECS. Methods: Following a review of the literature, focus groups and interviews were conducted with ECS (n = 16). An intervention mapping protocol was used for the program adaptation, which consisted of six steps: a needs assessment, formulation of matrices of change objectives, selection of theoretical methods and practical applications, program production, adoption and implementation planning, and evaluation planning. Social Cognitive Theory and Control Theory guided the adaptation of the intervention. Results: The process consisted of eight 90-min group sessions focusing on shaping outcome expectations, knowledge, self-efficacy, and goals about healthy eating and physical activity. The adapted performance objectives included establishment of regular eating, balanced diet, and portion sizes, reduction in sedentary behaviors, increase in lifestyle and organized activities, formulation of a discrepancy-reducing feedback loop for all above behaviors, and trigger management. Information on managing fatigue and bowel issues unique to ECS were added. Conclusions: Systematic intervention mapping provided a framework to design a cancer survivor-centered lifestyle intervention. ECS welcomed the intervention and provided essential feedback for its adaptation. The program has been evaluated through a randomized controlled trial

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy