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ObjectiveTo investigate cost-effectiveness and costs of fall prevention exercise programmes for older adults.DesignSystematic review.Data sourcesMedline, Embase, Web of Science, Scopus, National Institute for Health Research Economic Evaluation Database, Health Technology Assessment database, Tufts Cost-Effectiveness Analysis Registry, Research Papers in Economics and EconLit (inception to May 2022).Eligibility criteria for study selectionEconomic evaluations (trial-based or model-based) and costing studies investigating fall prevention exercise programmes versus no intervention or usual care for older adults living in the community or care facilities, and reporting incremental cost-effectiveness ratio (ICER) for fall-related outcomes or quality-adjusted life years (QALY, expressed as cost/QALY) and/or intervention costs.Results31 studies were included. For community-dwelling older adults (21 economic evaluations, 6 costing studies), results ranged from more effective and less costly (dominant) interventions up to an ICER of US$279 802/QALY gained and US$11 986/fall prevented (US$ in 2020). Assuming an arbitrary willingness-to-pay threshold (US$100 000/QALY), most results (17/24) were considered cost-effective (moderate certainty). The greatest value for money (lower ICER/QALY gained and fall prevented) appeared to accrue for older adults and those with high fall risk, but unsupervised exercise appeared to offer poor value for money (higher ICER/QALY). For care facilities (two economic evaluations, two costing studies), ICERs ranged from dominant (low certainty) to US$35/fall prevented (moderate certainty). Overall, intervention costs varied and were poorly reported.ConclusionsMost economic evaluations investigated fall prevention exercise programmes for older adults living in the community. There is moderate certainty evidence that fall prevention exercise programmes are likely to be cost-effective. The evidence for older adults living in care facilities is more limited but promising.PROSPERO registration numberPROSPERO 2020 CRD42020178023.

Adaptation of existing guidelines can be an efficient way to develop contextualized recommendations. Transparent reporting of the adaptation approach can support the transparency and usability of the adapted guidelines.To develop an extension of the RIGHT (Reporting Items for practice Guidelines in HealThcare) statement for the reporting of adapted guidelines (including recommendations that have been adopted, adapted, or developed de novo), the RIGHT-Ad@pt checklist.A multistep process was followed to develop the checklist: establishing a working group, generating an initial checklist, optimizing the checklist (through an initial assessment of adapted guidelines, semistructured interviews, a Delphi consensus survey, an external review, and a final assessment of adapted guidelines), and approval of the final checklist by the working group.International collaboration.A total of 119 professionals participated in the development process.Participants' consensus on items in the checklist.The RIGHT-Ad@pt checklist contains 34 items grouped in 7 sections: basic information (7 items); scope (6 items); rigor of development (10 items); recommendations (4 items); external review and quality assurance (2 items); funding, declaration, and management of interest (2 items); and other information (3 items). A user guide with explanations and real-world examples for each item was developed to provide a better user experience.The RIGHT-Ad@pt checklist requires further validation in real-life use.The RIGHT-Ad@pt checklist has been developed to improve the reporting of adapted guidelines, focusing on the standardization, rigor, and transparency of the process and the clarity and explicitness of adapted recommendations.None.

BackgroundTularemia is a bacterial disease caused by the intracellular bacteriumFrancisella tularensis(F. tularensisorFt). It has been weaponized historically by multiple state actors due to its low infectious aerosol dose, high morbidity and high mortality rate of the pneumonic form. The US Army developed the attenuated Live Vaccine Strain (LVS) from stocks provided by the former Soviet Union in the 1950s. The vaccine has proven to be safe and immunogenic over the ensuing decades in numerous clinical trials and animal as well as human challenge studies. Despite the threat, there are no FDA-approved vaccines nor clinical stage candidates against tularemia. LVS remains unlicensed due to instability in culture and the potential for reversion to the wild-type pathogen. We report here two sequential LVS trials in at-risk laboratory personnel working on tularemia in bio-containment.MethodsVolunteers received a single dose of the Live Vaccine Strain (LVS) live, attenuated tularemia vaccine by scarification under 2 FDA-regulated non-randomized, single-arm protocols (IND 157). Positive immunization was based on local scarification site ‘take reaction’, and either a >1:20 tularemia antigen microagglutination (MA) titer (protocol FY03-24; 2004-8) or greater than 4-fold rise in MA titer (protocol FY07-15; 2009-2017). Those still negative by week 4 were offered a second dose.ResultsThe LVS vaccine was safe, well tolerated and highly immunogenic. Between the two studies, all recipients (100%) had positive ‘take reactions’, with 95.5% of those in study FY03-24 having a positive response following initial vaccination. All but 3 subjects (98%) in protocol FY03-24 had positive MA titer results defined as >1:20, most within 28-35 days. In protocol FY07-15, 95% of subjects had a 4-fold or greater rise in MA titer, the primary immunogenicity endpoint for that study.ConclusionsLVS vaccine administered to laboratory workers at risk for tularemia exposure over a 12 year period was safe and highly immunogenic. Findings were in line with more than 4 decades of prior similar results. Response rates remained robust despite the vaccine lots employed having been manufactured 2-3 decades prior to the present studies. In the absence of a commercial development effort, or another tularemia vaccine in clinical development, a vaccine protocol under investigational new drug (IND) application could be considered based on the large body of favorable data for this vaccine. The results as well as historical comparator data presented here should serve as a benchmark for future studies.

Objectives Health service providers are currently making decisions on the public funding of digital health technologies (DHTs) for managing chronic diseases with limited understanding of stakeholder preferences for DHT attributes. This study aims to understand the community, patient/carer, and health professionals’ preferences to help inform a prioritized list of evaluation criteria. Methods An online best–worst scaling survey was conducted in Australia, New Zealand, Canada, and the United Kingdom to ascertain the relative importance of twenty-four DHT attributes among stakeholder groups using an efficient incomplete block design. The attributes were identified from a systematic review of DHT evaluation frameworks for consideration in a health technology assessment. Results were analyzed with multinomial models by stakeholder group and latent class. Results A total of 1,251 participants completed the survey (576 general community members, 543 patients/carers, and 132 health professionals). Twelve attributes achieved a preference score above 50 percent in the stakeholder group model, predominantly related to safety but also covering technical features, effectiveness, ethics, and economics. Results from the latent class model supported this prioritization. Overall, connectedness with the patient’s healthcare team seemed the most important; with “Helps health professionals respond quickly when changes in patient care are needed” as the most highly prioritized of all attributes. Conclusions It is proposed that these prioritized twelve attributes be considered in all evaluations of DHTs that manage chronic disease, supplemented with a limited number of attributes that reflect the specific perspective of funders, such as equity of access, cost, and system-level implementation considerations.

The Medical Services Advisory Committee (MSAC) is an independent non-statutory committee established by the Australian government to provide recommendations on public reimbursement of technologies and services, other than pharmaceuticals. MSAC has established approaches for undertaking health technology assessment (HTA) of investigative services and codependent technologies. In 2016, MSAC published its clinical utility card (CUC) Proforma, an additional tool to guide assessments of genetic testing for heritable conditions. We undertook a review and narrative synthesis of information extracted from all MSAC assessments of genetic testing for heritable conditions completed since 2016, regardless of the HTA approach taken. Ten assessments met our inclusion criteria, covering a range of testing methods (from gene panels to whole-exome sequencing) and purposes (including molecular diagnosis, genetic risk assessment, identification of congenital anomaly syndromes, and carrier screening). This analysis identified a range of methodological and policy challenges such as how to incorporate patient and societal preferences for the health and non-health outcomes of genomic testing, how best to capture the concept of co-production of utility, and how to engage clinicians as referrers for genomics tests whilst at the same time ensuring equity of access to a geographically dispersed population. A further challenge related to how qualitative assessments of patient and community needs influenced the evidence thresholds against which decisions were made. These concepts should be considered for incorporation within the value assessment frameworks used by HTA agencies around the world.

Assessment is one of the five functions of the educational psychologist’s (EP’s) role, yet there is a dearth of research exploring its distinctive contribution to school-based practice, and a lack of definition about what it is. In this study, the assessment practices of EPs were compared with those of other educational professionals who had achieved certification for competence in educational testing. Data were analysed using descriptive and inferential statistics, with patterns emerging which indicated that, while there is some overlap, assessment practices of EPs and other educational professionals often have different foci. Specifically, evidence suggests that EPs offer a broader, more holistic perspective with strong emphasis on the social and emotional wellbeing of the child. Additionally, other practitioners typically have a more school-orientated focus, for example, testing for exam access arrangements, reflecting their professional role. Implications are discussed, particularly in relation to the distinctive contribution to EP assessment.

We describe the results of a prospective observational study of the clinical natural history of human monkeypox virus (MPXV) infections at the remote General Reference Hospital of Kole (Kole hospital), the rainforest of the Congo River basin of the Democratic Republic of the Congo (DRC) from March 2007 until August 2011. The research was conducted jointly by the Institute National de Recherche Biomedical (INRB) and the US Army Medical Research Institute of Infectious Diseases (USAMRIID). The Kole hospital was one of the two previous WHO Monkeypox (MPX) study sites (1981-1986). The hospital is staffed by a Spanish Order of Catholic Nuns from La Congregation Des Seours Missionnaires Du Christ Jesus including two Spanish physicians, who were members of the Order as well, were part of the WHO study on human monkeypox. Of 244 patients admitted with a clinical diagnosis of MPXV infection, 216 were positive in both the Pan-Orthopox and MPXV specific PCR. The cardinal observations of these 216 patients are summarized in this report. There were three deaths (3/216) among these hospitalized patients; fetal death occurred in 4 of 5 (80%) patients who were pregnant at admission. The most common complaints were rash (96.8%), malaise (85.2%), sore throat (78.2%), and lymphadenopathy/adenopathy (57.4%). The most common physical exam findings were MPX rash (99.5%) and lymphadenopathy (98.6%). Age group of less than 5 years had the highest lesion count. Primary household cases tended to have higher lesion counts than secondary or later same household cases. Of the 216 patients, 200 were tested for IgM & IgG antibodies (Abs) to Orthopoxviruses. All 200 patients had anti-orthopoxvirus IgG Abs; whereas 189/200 were positive for IgM. Patients with hypoalbuminemia had a high risk of severe disease. Patients with fatal disease had significantly higher maximum geometric mean values than survivors for the following variables, respectively: viral DNA in blood (DNAemia, p=0.0072); maximum lesion count (p=0.0025); day of admission mean AST and ALT (p=0.0002 and p = 0.0224, respectively, adjusted p-values).Author SummaryThis is a prospective observational study of Human monkeypox disease, an emerging infectious disease in parts of the continent of Africa. There are certain differential characteristics when compared to other pox diseases. This paper describes the presenting symptoms and signs of human monkeypox disease, laboratory findings and makes recommendation for the medical treatment of patients with monkeypox disease.

Background: Transitioning from psychiatric hospitalisation back to community presents a period of heightened suicide, homelessness, relapse, and rehospitalisation risk. The Australian state of New South Wales established a state-wide Peer Supported Transfer of Care (Peer-STOC) initiative to enhance recovery-focused supports available during this transition period. Aims: To understand the impacts and outcomes of the Peer-STOC program on service users from three stakeholder perspectives: service users themselves, peer worker service providers, and other mental health workers and clinicians interfacing with the program. Methods: Qualitative data from 82 questionnaires and 58 individual in-depth interviews were analysed thematically using constant comparative methods and an iterative and inductive process. Results: All stakeholders described positive impacts and outcomes of the program for service users. These included: (a) a better, less traumatic inpatient experience; (b) felt understood, cared about and less alone; (c) easier to leave hospital; (d) easier to get back into life and daily routines; (e) built and re-established community connections; (f) gained new knowledge, strategies, and skills; and (g) felt more hopeful about my recovery. Conclusions: The Peer-STOC program had a positive impact. It enhanced people’s experience in hospital, eased their transition from hospital and assisted with people recovering community-based relationships, activities, and routines.

Background Hearing aid manufacturers offer several different levels of technology that vary in sophistication and cost. It would stand to reason that higher technology hearing aids would provide greater benefit in the daily life of the user; however, research does not support this assumption for all users. Recent research in experienced hearing aid users indicated noise acceptance and satisfaction for speech in a large group were significantly improved when using the premium devices and suggested noise acceptance may be useful when comparing hearing aid technology levels. Purpose The purpose of this study was to determine the effect of hearing aid technology level on listener outcome measures for new hearing aid users. Research Design A repeated measures, single-blinded research design was utilized. Study Sample Twenty-four adults with no previous hearing aid experience were recruited using flyers posted at the University of Tennessee Audiology Clinic and on social media (19 males, 5 females). The average age of the participants was 61 years (48–81 years). Data Collection and Analysis Participants completed two, 4-week trial periods using Unitron T Moxi Fit FLEX:TRIAL devices programmed with basic or premium technology. Following each trial, laboratory evaluations were conducted using the QuickSIN, Hearing in Noise Test (HINT), and the Acceptable Noise Level (ANL). Subjective data was obtained using the Speech, Spatial, and Qualities of Hearing Short Form, satisfaction ratings, and preference. Data was analyzed using one-way repeated-measures analysis of variance. Results Speech perception results did not reveal significant differences between technology level on the HINT or QuickSIN; however, ANL was significantly improved for the premium devices. Subjective results revealed significantly improved satisfaction for speech in a large group and overall preference when using premium technology. Conclusion Group data revealed similar outcomes between technology levels on most measures; however, noise acceptance, satisfaction for speech in a large group, and overall preference were significantly improved when using the premium devices. Individual characteristics such as noise acceptance, age, and degree of hearing loss may be useful when comparing hearing aid technology levels for new hearing aid users.

Author(s): Bruss, Patrick; Norris, Sarah; Pagan, Kaylene; Cousino, Richard; Grim, Allison; Reinhold, Gregory

Objective A growing number of evaluation frameworks have emerged over recent years addressing the unique benefits and risk profiles of new classes of digital health technologies (DHTs). This systematic review aims to identify relevant frameworks and synthesize their recommendations into DHT-specific content to be considered when performing Health Technology Assessments (HTAs) for DHTs that manage chronic noncommunicable disease at home. Methods Searches were undertaken of Medline, Embase, Econlit, CINAHL, and The Cochrane Library (January 2015 to March 2020), and relevant gray literature (January 2015 to August 2020) using keywords related to HTA, evaluation frameworks, and DHTs. Included framework reference lists were searched from 2010 until 2015. The EUNetHTA HTA Core Model version 3.0 was selected as a scaffold for content evaluation. Results Forty-four frameworks were identified, mainly covering clinical effectiveness (n = 30) and safety (n = 23) issues. DHT-specific content recommended by framework authors fell within 28 of the 145 HTA Core Model issues. A further twenty-two DHT-specific issues not currently in the HTA Core Model were recommended. Conclusions Current HTA frameworks are unlikely to be sufficient for assessing DHTs. The development of DHT-specific content for HTA frameworks is hampered by DHTs having varied benefit and risk profiles. By focusing on DHTs that actively monitor/treat chronic noncommunicable diseases at home, we have extended DHT-specific content to all nine HTA Core Model domains. We plan to develop a supplementary evaluation framework for designing research studies, undertaking HTAs, and appraising the completeness of HTAs for DHTs.

Objective To review tuboplasty techniques for alleviating fallopian tube blockage. Design A step-by-step explanation of the techniques that comprise tuboplasty—fimbrioplasty, salpingo-ovariolysis, and salpingostomy—with surgical video footage. Setting Academic medical center. Patient A 28-year-old G0 female patient with primary infertility and bilateral fallopian tube occlusion wanting to avoid in vitro fertilization. Intervention(s) Tuboplasty and its component techniques of fimbrioplasty, salpingo-ovariolysis, and salpingostomy are demonstrated in a stepwise fashion for a case of mild tubal disease. Fimbrioplasty includes identifying the agglutinated or phimosed fimbrial end and gently opening it with fine forceps and blunt microdissection. Salpingo-ovariolysis is demonstrated with video and comprises: 1) surveying the anatomy; 2) applying traction to delineate the adhesions; and 3) transecting the adhesions with microsurgical scissors or electrosurgery. Finally, the steps of a salpingostomy are demonstrated, including: 1) identifying the length of the fallopian tube; 2) performing chromotubation to delineate tubal obstruction; 3) creating a salpingostomy at the terminal end; and 4) suturing open the salpingostomy site circumferentially to evert the edges. Main Outcome Measure(s) Successful restoration of normal tubal anatomy and identification of the location of tubal occlusion to guide salpingostomy site placement. Result(s) The fallopian tubes were assessed bilaterally and noted to have mild tubal disease and therefore were appropriate for tuboplasty. Normal tubal anatomy was restored bilaterally through salpingo-ovariolysis. Subsequent identification of the area of tubal occlusion bilaterally and salpingostomy were performed to create a patent fallopian tube able to pick up an oocyte from the ovary and facilitate fertilization. Conclusion(s) Tubal reconstructive surgery remains an important option to offer patients who want to avoid in vitro fertilization and who have mild tubal disease.

Digested key messageThe British Psychological Society (BPS) developed a recognised qualification in educational test use to allow both quality assurance and a level of integrity within testing practice. A survey of qualified test users sought to establish a clearer picture of testing practice. Four hundred and thirty-seven members of the Register of Qualified Test Users (RQTU) and members of the Division of Educational and Child Psychology (DECP) mailing list responded to an online survey. Findings relating to RQTU membership indicated a range of reasons for joining, including examination arrangements and quality of testing practice. Some practitioners were not aware of the RQTU or were not required to be members because of their professional status. Further discussion of, and research into, testing practice may be beneficial for practitioners.

Highlights • We found a high asymptomatic rate in vulnerable people with epilepsy. • Enhanced surveillance allows to quickly contain outbreaks. • We report a low rate of COVID-19 morbidity and mortality in a long-term care facility. • Preventative measures allow reducing resident-to-resident and -to-caregiver transmission. • Children and young adults appear to have lower infection rates., In this cohort study, we aim to compare outcomes from coronavirus disease 2019 (COVID-19) in people with severe epilepsy and other co-morbidities living in long-term care facilities which all implemented early preventative measures, but different levels of surveillance. During 25-week observation period (16 March–6 September 2020), we included 404 residents (118 children), and 1643 caregivers. We compare strategies for infection prevention, control, and containment, and related outcomes, across four UK long-term care facilities. Strategies included early on-site enhancement of preventative and infection control measures, early identification and isolation of symptomatic cases, contact tracing, mass surveillance of asymptomatic cases and contacts. We measured infection rate among vulnerable people living in the facilities and their caregivers, with asymptomatic and symptomatic cases, including fatality rate. We report 38 individuals (17 residents) who tested severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive, with outbreaks amongst residents in two facilities. At Chalfont Centre for Epilepsy (CCE), 10/98 residents tested positive: two symptomatic (one died), eight asymptomatic on weekly enhanced surveillance; 2/275 caregivers tested positive: one symptomatic, one asymptomatic. At St Elizabeth’s (STE), 7/146 residents tested positive: four symptomatic (one died), one positive during hospital admission for symptoms unrelated to COVID-19, two asymptomatic on one-off testing of all 146 residents; 106/601 symptomatic caregivers were tested, 13 positive. In addition, during two cycles of systematically testing all asymptomatic carers, four tested positive. At The Meath (TM), 8/80 residents were symptomatic but none tested; 26/250 caregivers were tested, two positive. At Young Epilepsy (YE), 8/80 children were tested, all negative; 22/517 caregivers were tested, one positive. Infection outbreaks in long-term care facilities for vulnerable people with epilepsy can be quickly contained, but only if asymptomatic individuals are identified through enhanced surveillance at resident and caregiver level. We observed a low rate of morbidity and mortality, which confirmed that preventative measures with isolation of suspected and confirmed COVID-19 residents can reduce resident-to-resident and resident-to-caregiver transmission. Children and young adults appear to have lower infection rates. Even in people with epilepsy and multiple co-morbidities, we observed a high percentage of asymptomatic people suggesting that epilepsy-related factors (anti-seizure medications and seizures) do not necessarily lead to poor outcomes.

Background and Objectives The Australian National COVID-19 Clinical Evidence Taskforce is a consortium of 31 Australian health professional organisations developing living, evidence-based guidelines for care of people with COVID-19, which are updated weekly. This article describes the methods used to develop and maintain the guidelines. Methods The guidelines use the GRADE methods and are designed to meet Australian NHMRC standards. Each week, new evidence is reviewed, current recommendations are revised, and new recommendations made. These are published in MAGIC and disseminated through traditional and social media. Relevant new questions to be addressed are continually sought from stakeholders and practitioners. For prioritized questions, the evidence is actively monitored and updated. Evidence surveillance combines horizon scans and targeted searches. An evidence team appraises and synthesizes evidence and prepares evidence-to-decision frameworks to inform development of recommendations. A guidelines leadership group oversees the development of recommendations by multidisciplinary guidelines panels and is advised by a consumer panel. Results : The Taskforce formed in March 2020, and the first recommendations were published 2 weeks later. The guidelines have been revised and republished on a weekly basis for 24 weeks, and as of October 2020, contain over 90 treatment recommendations, suggesting that living methods are feasible in this context. Conclusions The Australian guidelines for care of people with COVID-19 provide an example of the feasibility of living guidelines and an opportunity to test and improve living evidence methods.

Background Dry exercise and hydrotherapy are well-recognised components of axial spondyloarthritis management. The National Ankylosing Spondylitis Society (NASS) provides advice on appropriate exercise and available venues. This study aimed to determine the most popular type of exercise among spondyloarthritis patients under the care of the Luton & Dunstable University Hospital, which serves an ethnically diverse population. Methods A survey was sent to 124 patients with axial and/or peripheral spondyloarthritis, asking preferences regarding dry and wet exercise (hydrotherapy), and whether they were aware of NASS. Answers were aggregated and analysed using Microsoft Excel. Results 56/124 patients responded to the survey, corresponding to a response rate of 45%. 30 (54%) were male and 26 (46%) were female. The mean age of respondents was 50 years, with 31/56 patients (55%) aged under 50. Represented ethnic groups included White British (36 patients), White Other (4), White Irish (3), Pakistani (4), Bangladeshi (3), Black Caribbean (3), Indian (2) and Asian (1). 43 (77%) patients were Caucasian (White British, Other and Irish), and 13 (23%) were non-Caucasian. Regarding survey non-respondents, 45/68 (66%) were Caucasian and 23/68 (34%) were non-Caucasian. A larger proportion of non-Caucasians did not respond to the survey. 23/36 (64%) non-Caucasians did not respond compared to 45/88 (51%) Caucasians. 42 patients (75%) preferred both dry exercise and hydrotherapy; 11 (20%) preferred dry exercise only and 3 (5%) preferred hydrotherapy only. 26 patients (46%) were aware of NASS. 30 (54%) were not aware of NASS. More females than males preferred both types of exercise or hydrotherapy only (25 females vs. 17 males: 3 females vs. no males respectively). More males preferred dry exercise only (9 males vs. 2 females). 14 females were aware of NASS compared to 12 males. Analysis of ethnic groups showed that similar proportions of Caucasians and non-Caucasians were aware of NASS (20/43 (47%) Caucasians vs. 6/13 (46%) non-Caucasians). A larger proportion of Caucasians preferred both types of exercise (33/43 (77%) Caucasians vs. 9/13 (69%) non-Caucasians). A larger proportion of non-Caucasians preferred dry exercise only (8/13 (62%) non-Caucasians vs. 3/43 (7%) Caucasians. Conclusion Most patients in Luton prefer both dry exercise and hydrotherapy, of which a larger proportion are Caucasian. A larger number of females prefer both types of exercise or hydrotherapy alone compared to males. Non-Caucasian patients prefer dry exercise. Most patients are not aware of NASS. In response to this survey and the service development needs of this group of patients, dedicated Tai Chi exercise classes, with integrated education on NASS, were implemented. Given the overall preference for both dry exercise and hydrotherapy, information gleaned from this survey will prove helpful to commissioners, for consideration of funding for hydrotherapy which is not currently available in Luton. Disclosures A. Owusu-Agyei None. A. Verdiyeva None. S. Norris None. E. Morris None. K. Hennessy None. M. Chan None.

Study Objective To assess the effect of a surgical teaching video on resident knowledge and performance of a laparoscopic salpingo-oophorectomy (LSO). Design Randomized controlled trial. Setting An urban tertiary care academic obstetrics and gynecology department. Patients or Participants First and second year gynecology residents. Interventions Access to an educational video of an LSO for one week prior to performing this surgery in the operating room. Measurements and Main Results Twenty-four residents were recruited and randomized to either the educational video group or traditional residency training group. All participants completed a demographic survey and knowledge questionnaire preceding their performance of an LSO, which was video recorded. Video recordings of surgical performance were analyzed by two blinded raters using the objective structured assessment of technical skills (OSATS, 20 points) and an LSO specific tool (30 points). Participants completed a self-assessment questionnaire following the procedure. The primary outcome measure was the difference in OSATS scores. The secondary outcomes were the knowledge questionnaire scores and self-assessed confidence scores. There were no significant differences between demographic variables of the two groups. The primary outcome revealed no significant differences in mean OSATS scores (10.64, SD 2.05 vs 11.55, SD 1.85, p=0.3) or LSO specific tool scores (16.45, SD 2.68 vs 17.85, SD 2.63, p=0.24). However, there was a significant difference in mean knowledge scores between the video and the traditional training ((8.42, SD 0.79 vs 7.11, SD 1.36, p=0.01) groups. In addition, residents in the video group had more confidence of their knowledge of pelvic anatomy (3.83/5, SD 0.39 vs 3.00, SD 1.00, p=0.04). Conclusion For junior learners, use of an LSO video improved knowledge and confidence in anatomy but did not translate to improved surgical performance in the operating room. Surgical videos are a useful adjunct and compliment hands-on technical teaching.

Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. In acute care, discharge planning is a primary role of OT for clients with arm impairment after stroke. Discharge planning accounts for many factors, including impairments, function, social supports, insurance, and the input of other disciplines. This research aimed to (1) determine the agreement in discharge recommendations between OT and physical therapy during acute hospitalization and (2) determine the agreement of OT recommendation and actual discharge setting for clients with arm impairment after stroke. Primary Author and Speaker: Nicole C. Lam Contributing Authors: Kimberly Erler, Jessica Ranford, Jessica D. Asiello, Kimberly Cortina, Natasha Frazier, Abigail Rude, Caitlin Sadlak, Helena Thorne, Rachel Collins, Erin E. Donovan, Sarah Norris, and David Lin

Video Objective To review tuboplasty techniques for alleviating fallopian tube blockage. Tuboplasty consists of fimbrioplasty, salpingo-ovariolysis and salpingostomy. Setting A 28yo G0 female patient with primary infertility and bilateral fallopian tube occlusion seen at an urban tertiary care hospital. Interventions There are several techniques for alleviating blockages and reconstructing the fallopian tubes which are collectively referred to as tuboplasty. Tuboplasty can be further subdivided into fimbrioplasty, salpingo-ovariolysis, and salpingostomy. Such procedures are performed by experts in tubal reconstruction and with the increasing prevalence of in vitro fertilization, there is less exposure to these techniques. We review a case of bilateral tubal occlusion which was managed with salpingo-ovariolysis and salpingostomy. The steps of salpingo-ovariolysis and salpingostomy are reviewed and demonstrated through video. Studies have reported live birth rates following salpingostomy between 20-37% and in cases of mild tubal disease, live birth rates increase up to 40-60%. Conclusion Tubal reconstructive surgery remains an important option to offer patients who want to avoid in vitro fertilization and who have mild tubal disease.

Pediatric palliative care and hospice medicine is a field in which a multidisciplinary team assists in the management and treatment of infants, children, and young adults with a serious condition. A therapeutic relationship is created among the team, patients, and their caregivers to address total pain. This encompasses exploration of physical pain, social, spiritual, and emotional pain. Patient-centered and family-centered shared decision-making is paramount when setting and revisiting goals of care with patients and their families. Consider a checklist when faced with a dying patient so that the family and team feel supported.

Background:The Family Consultation Service (FCS) is a community mental health intervention for children and young people (CYP) which uses psychological consultation with families to address mental health concerns. In the context of increasingly constrained Local Authority finances, it was set up by educational psychologists (EPs) as a response to demands for both increased efficiency and accessibility of mental health services.Aims:This paper demonstrates how EPs can use consultation skills directly with clients within a mental health context and presents a theoretical rationale for this.Method:The FCS model is described and located within the frames of both national and local strategy. Following this, data from the first 150 referrals is analysed using descriptive statistics and the outcomes of a client survey are reported.Findings:A large majority of families referred reported that they achieved their goals after a single session with the FCS and did not take up the offer of additional involvement. This suggests that psychological consultation could potentially contribute towards a national agenda for mental health services that are responsive and preventative in focus. The model is proposed as an alternative to the established medical approaches and may be of interest to EPs and their managers who are looking for innovative ways of delivering systemically orientated psychological services within constrained financial circumstances.Conclusions:Dilemmas arising from the project are considered and subsequently addressed through the introduction of the Common Factors perspective: a paradigm which is gaining interest within the helping professions.

Objective To explore the teaching and learning experience of midwifery mentors and student midwives in a midwifery led unit. The aim of this paper is to discuss how a conceptual framework emerged from the findings of the study. Design and method Ethnography. Non-participant observation of the daily work of an alongside midwifery led unit (AMU) over 14 months, and direct observation of episodes of care involving ten dyads of midwifery mentors and student midwife dyads. These observations were followed by individual semi structured interviews with participants. Setting An alongside midwifery led unit in a Health Board in Wales, UK. This is an option for place of birth in the National Health Service in the UK. Sample Ten dyads of midwifery mentors and student midwives. Findings A conceptual framework emerged from the data in relation to the powerfully shared goals and ethos of the midwives working in this AMU. The framework gave shape and form to the particular nature of the teaching and learning experience in the midwifery led setting. The concept of a community of practice, firmly rooted in the authoritative knowledge and understanding of physiological birth, resulted in positive working practices and happy, motivated midwives who enhanced the birth experience for women. This supported the clinical and socially situated learning of student midwives and new colleagues through legitimate peripheral participation. Implications for practice, policy, education and research Positive, committed and autonomous midwives make for a nurturing working environment and may therefore enhance the experience of birthing women. Midwives need to be able to work in an environment and community of practice which mirrors their own philosophy of care to promote professional wellbeing, and to develop the expert knowledge and skill in that area of practice over time.

This investigation sought systematically to review and meta-analyze evidence on reproductive outcomes following uterine artery occlusion (UAO) at myomectomy. Databases searched included PubMed, EMBASE, Ovid MEDLINE, Web of Science, and ClinicalTrials.gov. Eligible studies included observational and randomized controlled trials in which patients underwent abdominal, laparoscopic, or robotic myomectomy and in which at least one measure of clinical pregnancy rate, live birth rate, or ovarian reserve was reported. The primary outcome was live birth rate. Secondary outcomes included clinical pregnancy rate, miscarriage rate, adverse pregnancy outcomes, and measures of ovarian reserve. Twelve articles involving 689 women were included in the systematic review. The intervention group underwent UAO at laparoscopic or abdominal myomectomy (UAO+M) (n = 470). The control group underwent myomectomy alone (n = 219). Seven articles involving 420 women were included in the meta-analysis (201 underwent UAO+M; 219 underwent myomectomy alone). Live births occurred in 54 of 201 (27%) women in the UAO+M group and in 74 of 219 (34%) women in the control group. Clinical pregnancies occurred in 73 of 201 (36%) women in the UAO+M group and in 102 of 219 (47%) control subjects. There was no difference in live birth rates (odds ratio 0.89; 95% CI 0.56–1.43; P = 0.51; 7 studies, 420 patients) or clinical pregnancy rates (odds ratio 0.81; 95% confidence interval 0.53–1.24; P = 0.33; 7 studies, 420 patients) between the UAO+M and control groups. Data on miscarriage rates, adverse pregnancy outcomes, and measures of ovarian reserve precluded meta-analysis. In conclusion, UAO at myomectomy is not associated with reductions in live birth or clinical pregnancy rates. Before routine use can be recommended in women desiring future fertility, more research is required on reproductive outcomes and effects on ovarian reserve.

Background Specialised surveillance using total body photography and digital dermoscopy to monitor people at very high risk of developing a second or subsequent melanoma has been reported as cost effective. Objectives We aimed to estimate the 5-year healthcare budget impact of providing specialised surveillance for people at very high risk of subsequent melanoma from the perspective of the Australian healthcare system. Methods A budget impact model was constructed to assess the costs of monitoring and potential savings compared with current routine care based on identification of patients at the time of a melanoma diagnosis. We used data from a published cost-effectiveness analysis of specialised surveillance, and Cancer Registry data, to estimate the patient population and healthcare costs for 2017–2021. Results When all eligible patients, estimated at 18% of patients with melanoma diagnosed annually in Australia, received specialised surveillance rather than routine care, the cumulative 5-year cost was estimated at $93.5 million Australian dollars ($AU) ($US 64 million) for specialised surveillance compared with $AU 120.7 million ($US 82.7 million) for routine care, delivering savings of $AU 27.2 million ($US 18.6 million). With a staggered introduction of 60% of eligible patients accessing surveillance in year 1, increasing to 90% in years 4 and 5, the cumulative cost over 5 years was estimated at $AU 98.1 million ($US 67.2 million), amounting to savings of $AU 22.6 million ($US 15.5 million) compared with routine care. Conclusions Specialised melanoma surveillance is likely to provide substantial cost savings for the Australian healthcare system.

PurposeTo evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers.MethodsA cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast cancer who had at least a 10% pretest BRCA mutation probability, and the cascade testing of first- and second-degree relatives of women who test positive.ResultsCompared with no testing, BRCA testing of affected women resulted in an incremental cost per quality-adjusted life-year (QALY) gained of AU$18,900 (incremental cost AU$1,880; incremental QALY gain 0.10) with reductions of 0.04 breast and 0.01 ovarian cancer events. Testing affected women and cascade testing of family members resulted in an incremental cost per QALY gained of AU$9,500 compared with testing affected women only (incremental cost AU$665; incremental QALY gain 0.07) with additional reductions of 0.06 breast and 0.01 ovarian cancer events.ConclusionBRCA testing in women with breast cancer is cost-effective and is associated with reduced risk of cancer and improved survival. Extending testing to cover family members of affected women who test positive improves cost-effectiveness beyond restricting testing to affected women only.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.231.

Study abroad opportunities offer students and faculty a new window on their profession. Looking at how library services are offered in other countries can shed new light on practices in US libraries but can also remind us how important libraries are in the lives of our users, something that can be easy to forget as we go about our day-to-day work in a library. In this edition of “For Your Enrichment,” LIS professor Jenny S. Bossaller and three of her students discuss a study abroad session in South Africa. —Editor

This study examines a selection of philosophical frameworks that influence decision-making in audio preservation. Issues of reproduction and digitization, materiality, and the acceptance of change are considered and contextualized among other conservation specialties. Comparisons are drawn between audio recordings, fine art, and library materials, with attention to general and special collections concepts. A spectrum of authenticity is proposed and applied to three real-world case studies to demonstrate the utility of philosophical constructs as applied to audio preservation programs and techniques.

Objectives To assess the effect of a surgical teaching video on resident knowledge and performance of a laparoscopic salpingo-oophorectomy (LSO). Methods A randomized controlled trial was conducted with first and second year gynaecology residents at the University of Toronto. Participants were assigned to either the video group or to the traditional training group. Participants completed a demographic survey and knowledge questionnaire preceding their performance of an LSO in the operating room. Video recordings of surgical performance were analyzed by two blinded raters using the objective structured assessment of technical skills OSATS (20 points) and a LSO specific tool (30 points). Participants completed a self-assessment questionnaire following the procedure. Results Twenty-four residents were recruited and equally distributed between groups. There were no significant differences between their demographic variables. For the primary outcome, there were no significant differences in mean OSATS scores (10.64, SD 2.05vs 11.55, SD 1.85, p=0.3) or LSO specific tool scores (16.45, SD 2.68vs 17.85, SD 2.63, p=0.24). However, there was a significant difference in mean knowledge scores between the video (8.42, SD 0.79) and the traditional training (7.11, SD 1.36, p=0.01) groups. In addition, residents in the video group had more confidence of their pelvic anatomy knowledge (3.83/5, SD 0.39vs 3.00, SD 1.00, p=0.04). Conclusions For junior learners, use of a LSO video improved knowledge and confidence in anatomy but did not translate to improved surgical performance in the operating room. Surgical videos are a useful adjunct and compliment hands-on technical teaching.

This book aims to offer a comprehensive, all encompassing model that supports the understanding of human behaviour. David Marks argues that one of the difficulties with psychology is that there are...