medRxiv - Primary Care Research最新文献

{"title":"Educational interventions to combat burnout: Are General Practitioners interested? A Qualitative Study","authors":"Darius Benedict Williams","doi":"10.1101/2024.03.27.24304944","DOIUrl":"https://doi.org/10.1101/2024.03.27.24304944","url":null,"abstract":"Background\u0000Rising burnout in General Practitioners has been noted as a major issue worldwide that is contributing to many leaving the profession earlier than anticipated or reducing their hours of clinical work. Educational interventions as part of continuing professional development (CPD) have been shown to be effective in reducing burnout and improving overall wellbeing amongst GPs. There is no published evidence available describing attitudes of GPs toward such CPD-based burnout interventions. The objective of this study is to assess GPs perspectives and opinions towards educational CPD-based interventions aimed at improving burnout in the GP population. Methods\u0000A qualitative research approach using grounded theory methods was used. Participants were interviewed 1 to 1 via video call. Video files of the interviews were recorded and auto-transcription software used to generate a text file which was checked for accuracy of transcription. Transcripts underwent grounded thematic analysis with emergent themes synthesised and combined to develop a targeted analysis concordant with the objectives of the study. The study received ethical approval from the Swansea University Medicine, Health and Life Science Ethics Approval Board. Results\u00005 participants were interviewed. All were GPs listed on the GMC GP register and currently engaged in the Wales GP appraisal process. Two participants had prior experience of CPD resources focused on burnout. Participants universally noted positive sentiment towards an educational-based CPD intervention focused at reducing burnout and noted their preferences in how such an intervention might be designed. Several important perceived barriers were highlighted that would need to be considered in the design of any future interventions. Discussion\u0000Attitudes of participants suggest an educational-based CPD intervention would be well received, and further research is needed to assess the efficacy and cost-effectiveness of such an intervention in this population.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140323129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health outcome priorities of people with multiple long-term conditions before and during the COVID-19 pandemic: Survey data from the UK","authors":"Harini Sathanapally, Yogini Chudasama, Francesco Zaccardi, Alessando Rizzi, Samuel Seidu, Kamlesh Khunti","doi":"10.1101/2024.03.24.24304807","DOIUrl":"https://doi.org/10.1101/2024.03.24.24304807","url":null,"abstract":"Background The outcome prioritisation tool (OPT) is a simple tool to ascertain the health outcome priorities of people with MLTC. Use of this tool in people aged under 65 years with MLTC has not previously been investigated. This study investigated the feasibility of using the OPT in people with MLTC aged 45 years or above, in a multi-ethnic primary-care setting, to describe the health outcome priorities of people with MLTC by age, clusters of long-term conditions and demographic factors, and to investigate any differences in prioritisation in light of the COVID-19 pandemic.\u0000Methods\u0000This was a multi-centre cross-sectional study using a questionnaire for online self-completion by people aged 45 years or above with MLTC in 19 primary care settings across the East Midlands, UK. Participants were asked to complete the OPT twice, first from their current perspective and second from their recollection of their priorities prior to COVID-19. Results\u0000The questionnaire was completed by 2,454 people with MLTC. The majority of participants agreed or strongly agreed that the OPT was easy to complete, relevant to their healthcare and will be useful in communicating priorities to their doctor. Summary scores for the whole cohort of participants showed Keeping Alive and Maintaining Independence receiving the highest scores. Statistically significant differences in prioritisation by age, clusters of long-term conditions and employment status were observed, with respondents aged over 65 most likely to prioritise Maintaining independence, and respondents aged under 65 most likely to prioritise Keeping alive. There were no differences before or after COVID-19, or by ethnicity.\u0000Conclusions\u0000The OPT is feasible and acceptable for use to elicit the health outcome priorities of people with MLTC across both middle-aged and older age groups and in a UK setting. Individual factors could influence the priorities of people with MLTC and must be considered by clinicians during consultations.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140301612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions to reduce opioid use for patients with chronic non-cancer pain in primary care settings: a systematic review and meta-analysis","authors":"Qian Cai, Christos Grigoroglou, Thomas Allen, Teng-Chou Chen, Li-Chia Chen, Evangelos Kontopantelis","doi":"10.1101/2024.03.13.24304059","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304059","url":null,"abstract":"Abstract Objective: This systematic review and meta-analysis aimed to assess interventions to reduce opioid use for patients with chronic non-cancer pain (CNCP) versus usual care or active controls in primary care settings.\u0000Methods: In this registered study (PROSPERO: CRD42022338458), we searched MEDLINE, Embase PsycInfo, CINAHL, and Cochrane Library from inception to December 28th 2021, and updated on Dec 14th 2023 for randomized controlled trials (RCTs) and cohort studies with no restrictions. Methodological quality was assessed using the Cochrane Risk of Bias tool for RCTs and Newcastle Ottawa Scale for cohort studies. Primary outcomes included mean reduction in morphine equivalent daily dose (reported as mean differences [MDs] mg/day; 95% confidence intervals [95%CIs]) and/or opioid cessation proportion. Secondary outcomes were mean changes in pain severity (reported as standardized mean difference [SMDs]; 95%CIs) and (serious) adverse events. Meta-analyses were performed using random-effects models.\u0000Results: We identified 3,826 records, of which five RCTs (953 participants) and six cohort studies (967 participants) were included. Overall, opioid dosage was significantly reduced in intervention groups compared to controls (MD: -24.88 mg/day, 95%CI: -36.40 to -13.36; I2=59.41%; nine studies). Subgroup analyses revealed significant opioid dose reductions with mindfulness (MD: -29.36 mg/day 95%CI: -40.55 to -18.17; I2=0.0%; two trials) and CBT-based multimodalities (MD: -41.68 mg/day; 95%CI: -58.47 to -24.89; I2=0.0%; two cohort studies), respectively, compared to usual care. No significant differences were observed in opioid cessation (Odds ratio: 1.55, 95%CI: 0.3 to 2.81, I2=50.79%; three studies) or pain severity (SMD: -0.13, 95%CI: -0.37 to 0.11; I2=33.51%; three trials). Adverse events were infrequently examined, with withdrawal symptoms commonly reported.\u0000Conclusions: The studied interventions were effective in reducing opioid dosage for people with CNCP in primary care. They highlighted the importance of multidisciplinary collaboration. Large-scale RCTs measuring the long-term effects and cost of these interventions are needed before their implementation.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative safety and effectiveness of Pfizer BA.4-5 versus Sanofi during the spring 2023 COVID-19 booster vaccination programme in England: a matched cohort study in OpenSAFELY-TPP","authors":"The OpenSAFELY Collaborative, Colm D Andrews, Em Prestige, Edward P K Parker, Venexia Walker, Tom Palmer, Andrea L Schaffer, Amelia CA Green, Helen J Curtis, Alex J Walker, Rebecca M Smith, Christopher Wood, Christopher Bates, Amir Mehrkar, Brian MacKenna, Sebastian CJ Bacon, Ben Goldacre, Miguel A Hernan, Jonathan AC Sterne, William J Hulme","doi":"10.1101/2024.03.15.24304277","DOIUrl":"https://doi.org/10.1101/2024.03.15.24304277","url":null,"abstract":"Introduction The spring 2023 COVID-19 booster vaccination programme in England used both Pfizer BA.4-5 and Sanofi vaccines. All people aged 75 years or over and the clinically vulnerable were eligible to receive a booster dose. Direct comparisons of the effectiveness of these two vaccines in boosting protection against severe COVID-19 events have not been made in trials or observational data.\u0000Methods With the approval of NHS England, we used the OpenSAFELY-TPP database to compare effectiveness of the Pfizer BA.4-5 and Sanofi vaccines during the spring 2023 booster programme, between 1 April and 30 June 2023. We investigated two cohorts separately: those aged 75 or over (75+); and those aged 50 or over and clinically vulnerable (CV). In each cohort, vaccine recipients were matched on date of vaccination, COVID-19 vaccine history, age, and other characteristics. Effectiveness outcomes were COVID-19 hospital admission, COVID-19 critical care admission, and COVID-19 death up to 16 weeks after vaccination. Safety outcomes were pericarditis and myocarditis up to 4 weeks after vaccination. We report the cumulative incidence of each outcome, and compare safety and effectiveness using risk differences (RD), relative risks (RR), and incidence rate ratios (IRRs).\u0000Results 492,642 people were 1-1 matched in the CV cohort, and 673,926 in the 75+ cohort, contributing a total of 7,423,251 and 10,173,230 person-weeks of follow-up, respectively. The incidence of COVID-19 hospital admission was higher for Sanofi than for Pfizer BA.4-5. In the CV cohort, 16-week risks per 10,000 people were 22.3 (95%CI 20.4 to 24.3) for Pfizer BA.4-5 and 26.4 (24.4 to 28.7) for Sanofi, with an IRR of 1.19 (95%CI 1.06 to 1.34). In the 75+ cohort, these were 17.5 (16.1 to 19.1) for Pfizer BA.4-5 and 20.4 (18.9 to 22.1) for Sanofi, with an IRR of 1.18 (1.05-1.32). These findings were similar across all pre-specified subgroups. More severe COVID-19 related outcomes (critical care admission and death), and safety outcomes at 4 weeks, were rare in both vaccines so we could not reliably compare effectiveness of the two vaccines.\u0000Conclusion This observational study comparing effectiveness of Pfizer BA.4-5 and Sanofi vaccine during the spring 2023 programme in England in the two main eligible cohorts - people aged 75 and over and in clinically vulnerable people - found some evidence of superior effectiveness against COVID-19 hospital admission for Pfizer BA.4-5 compared with Sanofi within 16 weeks after vaccination.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140154977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of telephone and in-person interview modalities: duration, richness, and costs in the context of exploring determinants of equitable access to community health services in Meru, Kenya","authors":"Luke N. Allen, Sarah Karanja, John Tlhakanelo, David Macleod, Malebogo Tlhajoane, Andrew Bastawrous","doi":"10.1101/2024.03.13.24304203","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304203","url":null,"abstract":"Background: Our research team is conducting phenomenological interviews in Kenya with people who have not been able to access community eye health services, aiming to explore the barriers and ideas for potential service modifications. We conducted an embedded study that compared in-person and telephone interview modalities in terms of time requirements, costs, and data richness. Methods: A team of six interviewers conducted 31 in-person interviews and 31 telephone interviews using the same recruitment strategy, topic guide, and analytic matrix for each interview. We compared the mean duration; mean number of themes reported by each participant; total number of themes reported; interviewer rating of perceived richness; interviewer rating of perceived ease of building rapport; number of days taken by the team to complete all interviews; and all costs associated with conducting the interviews in each modality. Findings: In-person interviews were 44% more expensive and took 60% longer to complete than our telephone interviews (requiring 5 days and 3 days respectively). The average in-person interview lasted 110 seconds longer than the average telephone interview (p=0.05) and generated more words and themes. However, the full set of interviews from both approaches identified similar numbers of barriers (p=0.14) and the same number of solutions (p=0.03). Interviewers universally felt that the in-person approach was associated with better rapport and higher quality data (p=0.01). Triangulation of themes revealed good agreement, with 88% of all solutions occurring in both sets, and no areas of thematic dissonance. Discussion: The in-person approach required more time and financial resources, but generated more words and themes per person, and was perceived to afford richer data by interviewers. However, this additional richness did not translate into a greater number of themes that our team can act upon to improve services.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140154953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discontinuity of care and trust in usual physician among patients with systemic lupus erythematosus","authors":"Yu Katayama, Yoshia Miyawaki, Kenta Shidahara, Shoichi Nawachi, Yosuke Asano, Eri Katsuyama, Takayuki Katsuyama, Mariko Takano-Narazaki, Yoshinori Matsumoto, Nao Oguro, Nobuyuki Yajima, Yuichi Ishikawa, Natsuki Sakurai, Chiharu Hidekawa, Ryusuke Yoshimi, Shigeru Ohno, Takanori Ichikawa, Dai Kishida, Yasuhiro Shimojima, Ken-ei Sada, Jun Wada, David Thom, Noriaki Kurita","doi":"10.1101/2024.03.13.24304255","DOIUrl":"https://doi.org/10.1101/2024.03.13.24304255","url":null,"abstract":"Importance:\u0000Patient trust plays a central role in the patient-physician relationship; however, the impact of outpatient visits with a covering physician (covered visits) on the level of trust in usual physician among patients with chronic conditions is unknown. Objective:\u0000To determine whether the number of outpatient visits with a covering rheumatologist is associated with patient trust in the usual rheumatologist. Design:\u0000Cross-sectional study. Setting:\u0000This study used data from the TRUMP2-SLE project conducted at five academic medical centers in Japan. Participants:\u0000The participants were Japanese adults with systemic lupus erythematosus who met the 1997 revised classification criteria of the American College of Rheumatology. The enrollment period was February 2020 to October 2021. Exposure:\u0000Outpatient visits with a covering rheumatologist in the past year. Main Outcomes and Measures:\u0000The main outcome was patient trust in their usual rheumatologist, assessed using the 11-item Japanese version of the modified Trust in Physician Scale (range 0-100). A general linear model with cluster robust variance estimation was used to evaluate the association between the number of outpatient visits with a covering rheumatologist and the patient's trust in their usual rheumatologist. Results:\u0000Of the 515 enrolled participants, 421 patients with systemic lupus erythematosus were included in our analyses.\u0000The median age was 47.0 years, and 87.2% were women. Thirty-nine usual rheumatologists participated in this study. Patients were divided into groups according to the number of outpatient visits with a covering rheumatologist in the past year as follows: no visits (59.9%; reference group), one to three visits (24.2%; low-frequency group), and four or more visits (15.9%; high-frequency group). The median Trust in Physician Scale score was 81.8 (interquartile range 72.7-93.2). Both the low-frequency and high-frequency groups exhibited lower trust in their usual rheumatologist (mean difference: -3.03 [95% confidence interval -5.93 to -0.80], -4.17 [95% confidence interval -7.77 to -0.58, respectively]). Conclusions and Relevance:\u0000This study revealed that the number of outpatient visits with a covering rheumatologist was associated with lower trust in a patient's usual rheumatologist. Further research is needed to address the potential adverse effects of physician coverage on trust in patient's usual rheumatologist.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"90 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140155104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular hydrogen for outpatients with Covid-19 (Hydro-Covid): a phase 3, randomised, triple-blinded, adaptive, placebo-controlled, multicentre trial","authors":"Yoann GABOREAU, Aleksandra Milovancev, Carole Rolland, Claire Eychenne, Jean-pierre Alcaraz, Cordelia Ihl, Roseline Mazet, Francois Boucher, Celine Vermorel, Sergej M Ostojic, Jean Christian Borel, Philippe Cinquin, Jean-Luc Bosson","doi":"10.1101/2024.02.23.24303304","DOIUrl":"https://doi.org/10.1101/2024.02.23.24303304","url":null,"abstract":"Background Due to its antioxidative, anti-inflammatory, anti-apoptosis, and antifatigue properties, molecular hydrogen (H2) is potentially a novel therapeutic gas for acute coronavirus disease 2019 (COVID-19) patients. Aim To determine the efficacy and safety profile of hydrogen rich water (HRW) to reduce the risk of progression of COVID-19.\u0000Design and settings\u0000We conducted a phase 3, triple-blind, randomized, placebo-controlled trial to evaluate treatment with HRW started within 5 days after the onset of signs or symptoms in primary care patients with mild-to-moderate, laboratory-confirmed COVID-19 and at least one risk factor for severe COVID-19 illness.\u0000Method\u0000Participants were randomly assigned to receive HRW or placebo twice daily for 21 days. The composite primary endpoint was the incidence of clinical worsening (dyspnea, fatigue) associated with a need for oxygen therapy, hospitalization or death at day-14; the incidence of adverse events was the primary safety end point. Results\u0000A total of 675 participants were followed up until day-30. 337 in the HRW group and 338 in the placebo group. Baseline characteristics were similar in the two groups. HRW was not superior to placebo in preventing clinical worsening at day-14: in H2 group, 46.1% met a clinical deterioration, 43.5% in the placebo group, Hazard Ratio 1.09, 90% confidence interval [0.90-1.31]. One death was reported in the H2 group and 2 in the placebo group at day-30. Adverse events were reported in 91 (27%) and 89 (26.2%) participants respectively.\u0000Conclusion\u0000Twice-daily ingestion of HRW from the onset of COVID-19 symptoms for 21 days did not reduce clinical worsening. Keywords: COVID-19; Molecular Hydrogen; Administration, Oral; Primary health care; Outcome Assessment;","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140038039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing remote monitoring for COVID-19 patients in primary care","authors":"Susanne M. Koehler, Svea Holtz, Peter Jan Chabiera, Nurlan Dauletbaev, Kim Deutsch, Zoe S. Oftring, Dennis Lawin, Lukas Niekrenz, Teresa Euler, Rainer Gloeckl, Rembert Koczulla, Gernot Rohde, Michael Dreher, Claus F. Vogelmeier, Sebastian Kuhn, Beate Sigrid Mueller","doi":"10.1101/2024.02.27.24303073","DOIUrl":"https://doi.org/10.1101/2024.02.27.24303073","url":null,"abstract":"Background\u0000In Germany, most patients with coronavirus disease 2019 (COVID-19) are treated in an outpatient setting. To improve assessments of the health status of COVID-19 outpatients, various remote monitoring models have been developed. However, little information exists on experiences acquired with remote monitoring in an outpatient setting, particularly from a patient perspective. The aim of our 'COVID-19@home' study was therefore to implement and evaluate an app-based remote monitoring concept for acute and post-acute COVID-19-patients in primary care. In this paper, we focus on the patients' evaluation of our remote monitoring approach.\u0000Methods\u0000Patients with acute COVID-19 measured heart rate, blood pressure, oxygen saturation, and body temperature daily for 28 days. Patients with post-acute COVID-19 determined the same parameters for 12 weeks, supplemented by lung parameters and daily step count. The data were documented using the 'SaniQ' smartphone app. COVID-19 symptoms were assessed daily using an app-based questionnaire. Patients' GPs could access the data on the 'SaniQ Praxis' telemedicine platform. We used an app-based questionnaire consisting of 11 questions presented with a 4-point Likert scale to evaluate patient satisfaction. Data were analyzed descriptively.\u0000Results\u0000Of the 51 patients aged 19-77 years that participated in the study, 42 completed the questionnaire. All patients rated home monitoring as 'very good' or 'rather good' and were able to integrate the measuring processes into their daily routines. Overall, 93% would recommend the app and the measuring devices to their family and friends. About 60% felt that their COVID-19 treatment had benefited from home monitoring. Only few patients were unsettled by the app and use of the measuring devices. During the course of the study, the implementation process was optimized.\u0000Conclusions\u0000The use of remote monitoring in COVID-19 patients is feasible and was evaluated positively by most study patients. However, it is difficult to imagine how general practices could cope with monitoring patients with acute diseases without any further organizational support. Future research should address cost-effectiveness and changes in such clinical outcomes as hospitalization and mortality.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140001559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of DiabeText, a mHealth intervention to support diabetes self-management: randomized controlled trial in primary care","authors":"Rocio Zamanillo-Campos, Maria Antonia Fiol-deRoque, Maria Jesus Serrano-Ripoll, Joan Llobera-Canaves, Joana Maria Taltavull-Aparicio, Alfonso Leiva-Rus, Joana Ripoll-Amengual, Escarlata Angullo-Martinez, Isabel Maria Socias-Buades, Luis Masmiquel-Comas, Jadwiga Konieczna, Maria Zaforteza-Dezcallar, Maria Asuncion Boronat-Moreiro, Sofia Mira-Martinez, Elena Gervilla-Garcia, Ignacio Ricci-Cabello","doi":"10.1101/2024.02.28.24303489","DOIUrl":"https://doi.org/10.1101/2024.02.28.24303489","url":null,"abstract":"Background: Complications arising from uncontrolled Type 2 Diabetes (T2D) poses a significant burden on individuals' well-being and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition.\u0000Aim: To assess the impact of DiabeText, a new theory-based, patient-centered, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2D self-management.\u0000Design and setting: Pragmatic, phase III, 12-month, two-arm randomized clinical trial with T2D primary care patients in Spain.\u0000Method: 742 participants with suboptimal glycemic control (HbA1c>7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. The DiabeText group received, in addition to usual care, 165 messages focused on healthy lifestyle and medication adherence. Primary outcome: glycated hemoglobin (HbA1c). Secondary outcomes: medication possession ratio, quality of life (EQ-5D-5L), diabetes self-efficacy (DSES); and self-reported adherence to medication, Mediterranean diet (MEDAS-14), and physical activity (IPAQ).\u0000Results: At 12 months follow-up, no statistically significant differences in mean HbA1c were observed between the intervention (7.5 [95%CI 6.7 to 8.2]) and control groups (7.4 [6.7 to 8.3]). In comparison with the control group, the DiabeText group showed significant (p<0.05) improvements in self-reported medication adherence (OR=1.4; 95%CI: 1.0 to 1.9), DSES (Cohen's d=0.4), and EQ5D-5L (Cohen's d=0.2) scores; but not in the rest of secondary outcomes.\u0000Conclusion: DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2D. Further research is needed to enhance its effects on physiological outcomes.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140001580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated visual acuity estimation by optokinetic nystagmus using a stepped sweep stimulus.","authors":"Jason Turuwhenua, Mohammad Norouzifard, Zaw LinTun, Misty Edmonds, Rebecca Findlay, Joanna Black, Benjamin Thompson","doi":"10.1101/2024.02.19.23300472","DOIUrl":"https://doi.org/10.1101/2024.02.19.23300472","url":null,"abstract":"Purpose: Measuring visual acuity (VA) can be challenging in adults with cognitive impairment and young children. We developed an automatic system for measuring VA using Optokinetic Nystagmus (OKN). Methods: VA-OKN and VA by ETDRS (VA-ETDRS) were measured monocularly in healthy participants (n=23, age 30±12). VA was classified as reduced (n=22, >0.2 logMAR) or not (n=24, ≤0.2 logMAR) in each eye. VA-OKN stimulus was an array of drifting (5 deg/sec) vanishing disks presented in descending/ascending size order (0.0 to 1.0 logMAR in 0.1 logMAR steps). The stimulus was stepped every 2 seconds, and 10 sweeps were shown per eye. Eye tracking data determined when OKN activity ceased (descending sweep) or began (ascending sweep) to give an automated sweep VA. Sweep traces were randomized and assessed by a reviewer blinded to VA-ETDRS. A final per sweep VA and VA-OKN was thereby determined. Results: A single randomly selected eye was used for analysis. VA deficit group: There was no significant difference between overall mean VA-OKN and VA-ETDRS (p>0.05, paired t-test) and the r2 statistic was 0.84. The 95% limits of agreement were 0.19 logMAR. No VA deficit group: There was a 0.24 logMAR bias between VA-OKN and VA-ETDRS and no correlation was found (r2 = 0.06). However, the overall sensitivity/specificity for classification was 100%. Conclusions: A robust correlation between VA-ETDRS and VA-OKN was found. The method correctly detected a VA deficit.","PeriodicalId":501023,"journal":{"name":"medRxiv - Primary Care Research","volume":"132 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139909902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}