ABSTRACT
Background: Hearing and vision impairments are highly prevalent in people with dementia (PwD) and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimize sensory function improve these outcomes. The SENSE-cog Trial evaluated whether a home-based multi-part 'sensory support' intervention (SSI) is effective in improving quality of life and other key outcomes in PwD (including hearing and/or vision problems), and their care partners. Method(s): This was a pan-European, multi-centre, observer blind, randomized controlled trial (RCT), of PwD with hearing and/or vision impairment and their companions. We compared 'care as usual' (CAU) to a multi-part complex intervention of hearing and vision rehabilitation (SSI) tailored to each participant dyad. The SSI included: assessment and correction of hearing and/or vision impairments;home-based, therapist-delivered sensory support (i.e., adherence with devices;improving the sensory environment, communication training, and signposting to other support agencies). Outcomes were collected at baseline, intervention end (18 weeks) and post-intervention (36 weeks - the primary endpoint) and included: quality of life, sensory and cognitive functional ability, relationship satisfaction, neuropsychiatric symptoms, and mental well-being. Health resource utilization was measured to estimate cost-effectiveness of the intervention. Result(s): Across 7 European centers (UK, France, Cyprus, Greece), 252 participants with dementia (median age 80 years, 53% female, 59% hearing impairment only, 4% visual impairment only and 37% both impairments) were randomized from May 2018 to May 2021 to receive either CAU or SSI (10 visits over 18 weeks). Mitigating strategies to adapt study procedures to the COVID-19 pandemic were implemented. Over 75% of participants completed the primary outcome, the DEM-QoL scale, at 36 weeks. An initial feasibility study yielded positive results for this outcome revealing an average improvement in the DEM-QoL of 4.9 points (> minimum important clinical change). Conclusion(s): Hearing and vision support in PwD is a potentially important and cost-effective means of improving the lived experience of dementia, representing a critical step in the diagnostic and care pathway. Main RCT results will be available in May 2022. Trial registration: ISRCTN17056211. Copyright © 2022 the Alzheimer's Association.
ABSTRACT
Introduction: Junior doctors have reported high levels of burnout and additional stressors emerging from the COVID-19 pandemic may further accelerate burnout. There is a need to identify which stressors are most likely to lead to burnout in order to develop appropriate interventions. This project therefore aims to compile a comprehensive list of stressors relevant to junior doctors and assesses which stressors are most strongly associated with burnout. Materials and Methods: An anonymous online questionnaire was sent in July 2020 to 1000 randomly selected junior doctors in the North West of England. It included 37 questions on general and pandemic specific stressors and the Maslach Burnout Inventory Health Services Survey. Stepwise regression analysis was undertaken to explore associations between stressors and burnout. Results and Conclusions: In total, 326 responses were received. Six of the 10 highest rated stressors were specific to the pandemic. Fatigue (β=0.43), pandemic-related workload increase (β=0.33) and feeling isolated (β=0.24) had the strongest associations with Emotional Exhaustion. Fatigue (β=0.24), uncertainty around COVID-19 information (β=0.22) and doing unfulfilling tasks (β =0.22) had the strongest associations with Depersonalisation. Lacking in ability (β=-0.24) and not feeling valued (β=-0.20) had the strongest associations with Personal Accomplishment. In conclusion, junior doctors reported a combination of general and pandemic-specific stressors that significantly impact burnout. Monitoring these stressors and targeting them as part of interventions could help mitigate burnout in junior doctors.
ABSTRACT
The Society for Medicines Research held a meeting reviewing recent practical progress in the application of artificial intelligence (AI) in drug discovery. This is an area receiving very significant interest in both large pharmaceutical and biotech sectors, and academia, for the potential to impact and increase efficiency of drug discovery, with many partnerships announced between large pharma companies and AI start-ups. This partnering interest and potential commercial value have led to intensive interest from investors. Recent highlights (as of March 2021) of investor commitment include a USD 100M fundraising by the U.K. AI company ExScientia Ltd., and a USD 400M raise by the U.S. company Insitro Inc. Key technology advances enabling this activity include i) deep learning software and toolkits, ii) the availability of graphics processing unit (GPU) compute power, and iii) access to large relevant datasets for training and validation, all leading to many notable publications. However, as with all new technologies, there is always the need to align them to the optimal part of a business process, and arguably the pharmaceutical industry is just at the start of realizing the potential and understanding the key application areas to apply AI. The meeting brought together established thought leaders and practitioners reviewing the current reality of AI approaches in drug discovery.