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Feasibility of the MAINTAIN intervention to support independence after a fall for people with dementia: a pilot cluster randomised controlled trial in participants own homes

Por: Greene · L. · Connors · J. · Hulme · C. · Ukoumunne · O. C. · Barber · R. · Bingham · A. · Conroy · S. · Fox · C. · Duff · C. · Goodwin · V. · Gordon · A. L. · Hall · A. J. · Harwood · R. H. · Jackson · T. · Litherland · R. · Morgan-Trimmer · S. · Parry · S. W. · Sharma · A. · Whale · B. · A
Objectives

To evaluate the feasibility of conducting a full-scale randomised controlled trial to assess the clinical and cost-effectiveness of the MAINTAIN intervention, designed to support recovery and independence following a fall among people living with dementia.

Design

Pilot cluster randomised controlled trial (c-RCT).

Setting

Community-based healthcare services across six UK sites representing primary and secondary care settings.

Participants

31 participant-carer dyads were recruited. Eligibility criteria included a diagnosis of dementia and a recent fall. Exclusion criteria included severe comorbidity precluding participation. The consent rate was 84%, and retention at follow-up was 81%.

Interventions

The MAINTAIN intervention comprised tailored, home-based therapy sessions delivered by trained professionals, focusing on functional recovery, confidence and re-engagement in daily activities, compared with usual care. The intervention was delivered over 12 weeks with booster sessions up to week 24, with the full trial period lasting 28 weeks.

Primary and secondary outcome measures

Feasibility outcomes included recruitment and retention rates, intervention adherence and data completeness for outcome and economic measures. Exploratory outcomes assessed functional performance and quality of life. Feasibility outcomes were assessed at baseline, 12 weeks and 28 weeks.

Results

Recruitment occurred over an 8-month period (September 2023–April 2024) across six UK sites. Most intervention participants (89%) attended at least 60% of planned sessions. Completion rates for outcome and economic data were high, indicating strong acceptability and feasibility of both the intervention and trial procedures.

Conclusions

The pilot c-RCT demonstrated that recruitment, retention and intervention delivery were feasible and well accepted. Findings support progression to a definitive trial to evaluate the effectiveness and cost-effectiveness of the MAINTAIN intervention.

Trial registration number

ISRCTN16413728 (International Standard Randomised Controlled Trial Number registry).

A cross-sectional quantitative analysis of production and requirements of medical oxygen during the COVID-19 pandemic in Nepal

Por: Adhikari · S. K. · Aryal · Y. · Nepal · A. · Bingham · M. B. · Neupane · S. · Basnet · A. · Singh · A. K. · Prajapati · B. · Sthapit · D. · Devkota · G. · Rana · S.
Objectives

Medical oxygen supplementation is essential for treating severe illnesses and plays a critical role in managing life-threatening conditions, especially during the period of increased demand, such as the delta wave of COVID-19. The study aims to evaluate oxygen requirements and production to support effective capacity planning for future health crises.

Design and setting

Cross-sectional quantitative study. Data collection was carried out between 15 March and 19 December 2021.

Main outcome measures

The study used secondary data from Nepal’s Health Emergency Operation Centre. Regarding medical oxygen production, calculations included oxygen generated from both hospital-based oxygen plants and private companies, using their highest capacities for comparison. These production capacities were then assessed using three levels of efficiency (100%, 80% and 50%), revealing significant gaps when compared against the oxygen requirements of hospitalised COVID-19 patients, as guided by WHO recommendations. The results were communicated in terms of J-size cylinders, alongside average daily COVID-19 hospitalizations. Data was inputted and analysed using Microsoft Excel and presented in numbers and percentage.

Results

The country’s oxygen demand relies largely on the production from private enterprises, with meeting approximately 85.2% of the total requirement. Optimal production ensures that national oxygen needs will be met. The analysis highlighted that at 80% operational efficiency, 90.8% of the hospital’s requirements could be fulfilled. However, if operational efficiency drops to 50%, the fulfilment rate diminishes to 56.7%. The differences in requirement and production of oxygen are consistent across the provinces; however, a huge disparity was notable in Karnali and Sudurpaschim.

Conclusion

Continuous assessment of production capacities in both hospital and private enterprises producing oxygen is necessary to plan and address the gaps.

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