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AnteayerBMJ Open

Glaucoma rehabilitation with action video games and exercise: study protocol of an active-controlled trial (GRADE)

Por: Yihong · P. · Thompson · B. · Winser · S. · Lau · I. · Suen · V. · Cheung · M. · Cheong · A. M. Y.
Introduction

Glaucoma is the second leading cause of moderate to severe visual impairment worldwide, primarily affecting peripheral vision and increasing the risk of falls due to impaired balance and mobility. While traditional physical training (PT) is used for fall prevention, its effectiveness may be limited by low patient engagement. Action video games (AVGs) may offer a more engaging alternative for improving balance and mobility in individuals with glaucoma.

Methods and analysis

This prospective, two-arm, single-blind, active-control trial will involve 56 patients with glaucoma with moderate to severe peripheral field loss and intact cognitive function, who have not previously undergone balance training. Participants will be randomly assigned in a 1:1 ratio to either a physically interactive action video-game training (AVG) group or a conventional PT group. The AVG group will use a Nintendo Switch gaming station for 20 sessions of 45 min each, conducted two to three sessions per week over 8 weeks. These sessions will involve standing game exercises using game controllers or body sensors, focusing on muscle stretching and strengthening, balance improvement and fitness. The PT group will engage in traditional PT for the same duration and frequency. The primary outcome is the change in mobility function after 20 sessions, measured by the narrow path walking test. Secondary outcomes include balance function (modified Clinical Test of Sensory Interaction and Balance, motor control test, landing balance test, five-time sit-to-stand test and time up and go test), visual cognition (reaction time test and useful field of view test) and patient-reported outcomes (validated questionnaires). Exploratory outcomes include fall frequency, fear of falling, visual function and serum brain-derived neurotrophic factor levels (one of the biomarkers related to exercise). Assessments will occur at seven time points: baseline (T1), after 10 sessions (T2), after 20 sessions (T3), 1-month post-training (T4) and 3, 6 and 9 months after all training sessions (T5–T7).

Ethics and dissemination

The human ethics approval was obtained from the respective ethics board of the Hong Kong Polytechnic University (ID: HSEARS20210722001). The study protocol will conform to the principles of the Declaration of Helsinki. Results will be disseminated through peer-reviewed journals and conferences.

Trial registration number

NCT06000865.

Putting the patient at the centre: a call for research involvement of nurses, midwives and allied health professionals working in genomics

Por: Cowley · L. · Henriques · S. · Roberts · J. · Monje-Garcia · L. · Nolan · J. · Lubasch · K. · Theobald · R. · Greer · R. · Fennell · N. · Clarkson · A. · Clapham · M. · Chilton · S. · Allon · R. · Stopford · C. · Pierce · H. H. · Holliday · D.
Introduction

We report the collaborative views of a group of nurses, midwives and allied health professionals (NMAHPs) in the UK who have a genomics research remit or interest. Our group includes genetic counsellors under this diverse category of healthcare workers.

This group came together as part of the National Institute for Health and Social Care Research (NIHR) Genomics Research National Specialty Group. After responding to a survey to elicit the views of NMAHPs working in genomics, some of the original 45 respondents, along with others who learnt of the project by word of mouth, have worked together to produce this article.

Objective

The paper aims to set out in clear terms the value of NMAHPs to research that supports the patient-centred implementation of genomics in the National Health Service (NHS).

Key argument

We discuss four potential areas where NMAHPs, in particular, can contribute to the research. These are patient perspectives and epistemic justice, psychosocial impacts, the familial nature of genomics and equity. We argue that this group (NMAHPs) represents a potentially underused resource for the NHS as it seeks to ensure that advances in genomics are translated into patient benefit.

Conclusions

We propose that NMAHPs, with our research expertise, are well placed to shape and deliver a research agenda that explores models of patient-centred care in the genomics era. We call for increased funding for NMAHP research roles and funding opportunities to deliver this fundamental work.

Association between loneliness and depression, anxiety and anger during the COVID-19 pandemic: a nationwide population-based survey

Por: Cho · H. · Lee · J. · Heo · J. · Kang · D. · Cho · J.
Objectives

This study aims to determine the association between loneliness and depression, anxiety and anger with a representative sample of the general population in Korea, which are the most prevalent mental health problems during the pandemic.

Design

Cross-sectional study.

Setting

National survey across all 17 provinces in South Korea between December 2021 and January 2022.

Participants

We conducted a national survey on 2699 participants aged 19–84 years using proportional stratified sampling. Using the UCLA Loneliness Scale and standardised questionnaires for depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and anger (Patient-Reported Outcomes Measurement Information System-Anger), we explored the prevalence and association of loneliness with these mental health outcomes.

Primary and secondary outcome measures

Primary outcomes included the prevalence and co-occurrence of depression, anxiety and anger across different levels of loneliness.

Results

Of total, 20.7% and 2.1% experienced moderately high and high levels of loneliness, respectively. Among participants with high levels of loneliness, 11.8%, 5.9% and 11.8% had depression, anxiety and anger, respectively, and 28.7% of them had depression, anxiety and anger together. The adjusted prevalence of depression was 0.2 (95% CI 0.0 to 0.5), 8.2 (95% CI 6.7 to 9.7), 31.3 (95% CI 27.4 to 35.3) and 63.5 (95% CI 50.1 to 76.8) for low, moderate, moderately high and high levels of loneliness, respectively. Similarly, increased adjusted prevalence of anxiety and anger was observed ㅈwith higher levels of loneliness.

Conclusions

Lonely people have a higher risk of depression, anxiety and anger. Identifying individuals who may be vulnerable to loneliness is important for early intervention.

Developing a data-informed care planning improvement intervention in long-term care in Nova Scotia: protocol for an advisory-led interpretive qualitative study

Por: Kalu · M. · Nasiri · N. · Iaboni · A. · Ghanouni · P. · Hirdes · J. · Iduye · S. · Moody · E. · Norman · K. · Searle · S. · Theou · O. · Turcotte · L. · Verlinden · L. · Weeks · L. E. · McArthur · C.
Introduction

The quality of care provided in long-term care (LTC) homes has been a concern for many years, and the COVID-19 pandemic has further raised awareness of this issue. Care planning helps identify and prioritise areas to improve LTC residents’ health. Data are routinely collected to support care planning, for example, the interRAI LTC facilities instrument and real-time location systems. However, the best way to use these data to inform care planning and decision-making while including residents and family members remains elusive. This study aims to develop a data-informed care planning improvement intervention that uses routinely collected data to guide resident-centred care planning in LTC. Specifically, we will: (1) examine how, where and why routinely collected data are used in current care planning processes in LTC; (2) identify barriers and facilitators to using data to guide care planning from the perspectives of staff, residents and family caregivers; and (3) develop care planning intervention guided by the Behaviour Change Wheel.

Methods and analysis

An advisory committee of residents, family members and LTC staff will provide study oversight of this interpretive qualitative description study, conducted in LTC homes in Nova Scotia from May 2023 to April 2025. Participants, including LTC residents, their family members and staff, will be invited to participate in two 60–90 min focus groups or 45–60 min individual interviews and/or three 2-hour observation sessions. Data from interviews, focus groups and care observations will be analysed using inductive content analysis to answer the objectives. Next, we will deductively map the identified barriers and facilitators onto the Behaviour Change Wheel, which suggests that Capability, Opportunity and Motivation are needed for a Behaviour to occur (COM-B system). Subsequently, we will have a 1 day advisory committee meeting to: (1) select the intervention components using the APEASE criteria, which asks whether the function is Affordable, Practicable, Effective, Acceptable, Safe, and promotes Equity; and (2) describe the final intervention using the Template for Intervention Description and Replication checklist to ensure the reproducibility of the intervention in future work. The result of this study has the potential to contribute to the understanding of the process in enhancing care and resident outcomes in LTC homes across Canada.

Ethics and dissemination

This study has been approved by the Dalhousie University Health Sciences Research Ethics Board. Informed consent will be obtained from all participants or their substitute decision-makers before they take part in interviews, focus group discussions and care observations. Data will be de-identified, and privacy and confidentiality will be maintained through secure storage and handling of both electronic and physical documents. Study findings will be shared with participants through lay summaries and infographics after the second interview and observation, as well as at the conclusion of the study. Results will also be disseminated to researchers, healthcare professionals and LTC providers across Canada via presentations at local, national and international conferences, publications in open-access journals and through print and video materials tailored to the audience.

Globally applicable solution to hearing loss screening: a diagnostic accuracy study of tablet-based audiometry

Por: Cheong · J. · Lowe · E. · Lee · C. W. · Barbosa · C. · Gillen · L. · King · E. · Premachandra · P. · Shah · A. · Drobniewski · F.
Objectives

Hearing loss (HL) affects 20% of the world’s population, with shortages of audiologists and audiometric sound booths unable to meet demand for hearing care services. We aimed to assess the accuracy of tablet-based audiometry (TA) to screen for HL at standard (0.25–8 kHz) and extended high frequencies (>8 kHz).

Design

Diagnostic accuracy study.

Setting

Two secondary care audiology and ear, nose and throat outpatient clinics in the UK between April 2022 and September 2023.

Participants

Adults aged≥16 years undergoing sound booth audiometry (SBA).

Interventions

TA, hearing-related questionnaires and patient usability questionnaires.

Outcome measures

Sensitivity, specificity and accuracy of TA compared with SBA for detecting HL. Patient usability assessment of TA and SBA.

Results

129 patients were enrolled with 127 patients (254 ears) included in the final analysis. Median age was 43 years (IQR 33–56), 55% (70/127) were women. 76% (96/127) and 68% (86/127) of patients had HL defined by British Society of Audiology (BSA) and American Speech–Language–Hearing Association (ASHA) criteria. Age was significantly associated with HL (p85%, respectively, between 0.25 and 12.5 kHz. In terms of patient usability, TA showed significantly higher scores in attractiveness (p

Conclusions

TA demonstrated good sensitivity with high specificity for detecting HL at frequencies 0.25–12.5 kHz and would be an acceptable accurate alternative to SBA. This would increase the accessibility of HL screening and has the potential to be used as a diagnostic test in those without tinnitus where resources are limited.

Trial registration number

NCT05847556.

Communication challenges and experiences between parents and providers in South Korean paediatric emergency departments: a qualitative study to define AI-assisted communication agents

Por: Heo · S. · Jeong · S. · Paeng · H. · Yoo · S. · Son · M. H.
Objectives

This study aimed to explore communication challenges between parents and healthcare providers in paediatric emergency departments (EDs) and to define the roles and functions of an artificial intelligence (AI)-assisted communication agent that could bridge existing gaps.

Design

A qualitative study using in-depth interviews and affinity diagram methodology to analyse interview data.

Setting

A tertiary paediatric ED in South Korea.

Participants

11 parents of paediatric patients and 11 ED staff members (physicians, nurses and security personnel).

Primary and secondary outcome measures

The study examined parent–provider communication difficulties, emotional responses and situational factors contributing to miscommunication and increased workload for ED staff.

Results

The study identified key emotional factors—fear, anger and sadness—that negatively affect communication between parents and ED staff. Parents experienced frustration due to uncertainty, insufficient information and difficulty navigating the ED process. ED staff faced challenges in managing anxious or demanding parents, resulting in increased workload and communication breakdowns.

Conclusions

An AI-assisted communication agent could help mitigate these challenges by providing timely information, managing non-medical inquiries and supporting both parents and ED staff at critical stages of the ED visit. Implementing such technology has the potential to improve communication and enhance overall patient care in paediatric emergency settings.

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