Telehealth Delivery of Group Format Cognitive Rehabilitation to Older Veterans With TBI

Traumatic brain injury (TBI) is common among older adults, with significant public health costs, and advanced age is a risk factor for poor outcomes after TBI. Older Veterans with TBI-related cognitive and emotional dysfunction without dementia may benefit from cognitive rehabilitation, particularly executive function training, and technology may promote optimal functioning for these patients by increasing access to such treatments. Dr. Kornblith will present pilot data on one such promising group intervention, Goal-Oriented Attentional Self-Regulation (GOALS), administered via in-home video telehealth. Themes gleaned from qualitative feedback collected throughout the intervention and post-treatment feedback questionnaires include the importance of communication and a smooth process with clear instructions for joining study sessions. Preliminary data suggest that only minor adaptions to the existing GOALS protocol are required for telehealth delivery and that delivering group-based executive function training to older TBI-exposed older Veterans with cognitive complaints via telehealth is feasible and acceptable.

Dentoalveolar Injuries and Wiring Techniques

Traumatic dental injuries account for majority of maxillofacial injuries affecting soft tissues as well as maxillofacial bones. History of immediate local measures employed to reduce the severity of injury helps in eliciting information regarding the original condition of the injured area. Time elapsed post trauma plays a major role in determining outcome of the intervention. Goal of the treatment is directed towards achieving the pre-traumatic occlusion and intra arch contour.

Nutrition Education for Preventing Stunting in Elementary Schools: A Systematic Review

Stunting has become a major problem in developing countries. The government has formulated various strategies to decrease the stunting prevalence in Indonesia. However, the number of programs to be implemented on the school aged children is scarce. Stunting in the school age can affect the productivity, motor development, and vulnerability from communicable diseases. The purpose of this study was to identify journals related to the nutrition education in preventing stunting in elementary schools. The study was a systematic review about nutrition education to prevent stunting in elementary school. There were 5 articles analyzed from the result of Google Scholar search, published from 2018 to 2020. The review focused on the type of intervention, goal, and effectiveness of the intervention. The result of the study showed that nutrition education could improve a short term knowledge. However, it had not been able to change the behavior and practice of healthy dietary habit. Nutrition education given to the teachers could improve their skills in assessing student nutritional status, thus an early detection can be administered well. A more comprehensive intervention, besides nutrition education, in preventing stunting in elementary school is needed.

Goal achievement and adaptive goal adjustment in a behavioral intervention for participants with prediabetes

Participants with prediabetes were supported to achieve and maintain weight loss with a stage-based behavior change group program named PREview behavior Modification Intervention Toolbox (PREMIT). The tendency to engage in a process of goal adjustment was examined in relation to PREMIT attendance. Analyses were based on 1857 participants who had achieved ⩾8percent weight loss. Tendency to engage in a process of goal adjustment appeared not to be influenced by PREMIT attendance. Instead, results suggested that when unsure about reaching an intervention goal, participants were more likely to engage in a process of goal adjustment, possibly lessening distress due to potentially unachievable goals, either weight loss or maintenance.

Goal-Setting on a Geriatric Medicine Rotation: A Pilot Study

Background: Formal goal-setting has been shown to enhance performance and improve educational experiences. We initiated a standardized goal-setting intervention for all residents rotating through a Geriatric Medicine rotation. Objectives: This study aims to describe the feasibility of a goal-setting intervention on a geriatric medicine rotation, the resources required, and the barriers to implementation. As well, this study aims to describe the learning goals residents created regarding content and quality. Methods: A pilot goal-setting intervention was initiated. A goal-setting form was provided at the beginning of their rotation and reviewed at the end of the rotation. Residents were invited to complete an anonymous online survey to gather feedback on the initiative. Goals were analysed for content and quality. Feedback from the survey results was incorporated into the goal-setting process. Results: Between March and December 2018, 26 of 44 residents completed the goal-setting initiative. Explanations for the poor adherence included limited protected time for faculty and residents to engage in coaching, its voluntary nature, and trainee absence during orientation. Reasons for difficulty in achieving goals included lack of faculty and trainee time and difficulty assisting residents in achieving goals when no clinical opportunities arose. Although only 59% of residents completed the intervention, if goal-setting took place, most of the goals were specific (71 of 77; 92%) and 35 of 77 (45.5%) goals were not related to medical knowledge. Conclusions: This pilot study outlines the successes and barriers of a brief goal-setting intervention during a Geriatric Medicine rotation. Adherence was limited; however, of those who did complete the intervention, the creation of specific goals with a short, structured goal-setting form was possible. To enhance the intervention, goal-setting form completion should be enforced and efforts should be made to engage in mid-rotation check-ins and coaching.

Is thromboelastography reliable in postpartum coagulopathies? Two case reports and a literature review

Postpartum hemorrhage (PPH) is an underestimated problem in labor and delivery units and remains a leading cause of maternal morbidity and mortality worldwide. Managing PPH starts with immediate recognition and intervention. Goal-directed massive transfusion protocol can be achieved by properly monitoring the maternal coagulation profile during severe obstetric hemorrhage. Conventional coagulation tests (prothrombin time, activated partial thromboplastin time, international normalized ratio, fibrinogen analysis, platelet count) have long turnaround times (occasionally >60 min and provide little information about the in vivo condition of hemostasis) compared to viscoelastic tests (VETs) (available results within 10–30 min). The outcome in actively hemorrhaging patients can be optimized by VETs, including thromboelastography (TEG), rotational thromboelastometry and Sonoclot, providing more individualized blood component therapy compared to traditional 1:1:1 ‘damage control resuscitation’ ratios of blood transfusion strategy. The main limitations of the efficacy of VETs include, but are not limited to, the lack of validation, not having well-established reference ranges for each patient group, results affected by fluid resuscitation regimes and consistent operator proficiency. Although there is limited data with the use of VETs in obstetric patients, the value of VETs is supported by guidelines with increasing evidence. This article will demonstrate two obstetric cases to evaluate the reliability of the TEG in the management of postpartum coagulopathies. The lesson we took from our two cases is presented.

An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study (Preprint)

BACKGROUND Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. OBJECTIVE Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. METHODS The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. RESULTS Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. CONCLUSIONS This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status.

Beyond Risk and Protective Factors: An Adaptation-Based Approach to Resilience

How does repeated or chronic childhood adversity shape social and cognitive abilities? According to the prevailing deficit model, children from high-stress backgrounds are at risk for impairments in learning and behavior, and the intervention goal is to prevent, reduce, or repair the damage. Missing from this deficit approach is an attempt to leverage the unique strengths and abilities that develop in response to high-stress environments. Evolutionary-developmental models emphasize the coherent, functional changes that occur in response to stress over the life course. Research in birds, rodents, and humans suggests that developmental exposures to stress can improve forms of attention, perception, learning, memory, and problem solving that are ecologically relevant in harsh-unpredictable environments (as per the specialization hypothesis). Many of these skills and abilities, moreover, are primarily manifest in currently stressful contexts where they would provide the greatest fitness-relevant advantages (as per the sensitization hypothesis). This perspective supports an alternative adaptation-based approach to resilience that converges on a central question: “What are the attention, learning, memory, problem-solving, and decision-making strategies that are enhanced through exposures to childhood adversity?” At an applied level, this approach focuses on how we can work with, rather than against, these strengths to promote success in education, employment, and civic life.

Grounding Early Intervention: Physical Therapy Cannot Just Be About Motor Skills Anymore

This perspective article provides support for 4 interrelated tenets: grounded perceptual-motor experience within cultural and social contexts forms cognition; exploration through early behaviors, such as object interaction, sitting, and locomotion, broadly facilitates development; infants and children with limited exploration are at risk for global developmental impairments; and early interventions targeting exploratory behaviors may be feasible and effective at advancing a range of abilities across developmental domains and time. These tenets emphasize that through the promotion of early perceptual-motor behaviors, broader, more global developmental advancements can be facilitated and future delays can be minimized across domains for infants and children with special needs. Researchers, educators, and clinicians should build on these tenets to further demonstrate the effectiveness of targeted early interventions. The goals of these interventions should be not only to advance targeted perceptual-motor skills in the moment but also to more broadly advance future abilities and meet the early intervention goal of maximizing children's learning potential.