FINANCIAL SECURITY in SMALL BUSINESS in PERIOD of DIGITAL ECONOMY: In CASE of UZBEKISTAN

In this paper has been proposed a methodology for ensuring the financial security of enterprises in the context of recession caused by the COVID-19 pandemic. Based on pre-crisis data related to the new coronavirus infection pandemic and multi-component modeling of the dynamics of industrial production in the Republic of Uzbekistan during the "corona crisis,"this study seeks to identify the dynamics of growth by economic activity type and recovery rate in order to identify areas of state support for industrial production. In this paper has been investigated issues of financial security management of textile enterprises. On the basis of secondary statistics, the growth of textile production in the regions of the Republic of Uzbekistan in 2008-2020 was analyzed and the factors influencing it were identified. By the author have been presented the main tasks and conditions for the financial security of enterprises, as well as developed scientific and practical recommendations for eliminating factors affecting the financial security of textile enterprises. © 2022 Owner/Author.

Vaccine Hesitancy: Obstacles and Challenges.

Purpose of Review: In 2019, vaccine hesitancy (VH) was named as one of the top 10 threats to global health by the World Health Organization (WHO). We highlight the factors affecting VH, the role of VH in limiting vaccine uptake and inability to achieve collective immunity, and possible solutions. Recent Findings: There are still uncertainties and concerns about the safety and efficacy of vaccines, which promote VH and undermine public confidence in immunization. WHO has designed the behavioral and social drivers (BeSD) tools and survey instruments that can be used by countries to assess reasons for poor vaccine uptake in childhood for COVID-19 and plan national vaccination programs to counter these misconceptions. Summary: Vaccines are one of the best preventative measures that public health care has to offer. Evidence from across the world both in high-income countries (HICs) and low/middle-income countries (LMICs) show that VH is a significant phenomenon which is translating into geographical clustering of epidemics. A reasonably high acceptance and coverage rates are necessary for an immunization program to be successful. A context-specific and multifactorial intervention with more high-quality research is needed globally.

Easy access to α-ketoamides as SARS-CoV-2 and MERS Mpro inhibitors via the PADAM oxidation route.

SARS-CoV-2 caused worldwide the current outbreak called COVID-19. Despite multiple countermeasures implemented, there is an urgent global need for new potent and efficient antiviral drugs against this pathogen. In this context, the main protease (Mpro) of SARS-CoV-2 is an essential viral enzyme and plays a pivotal role in viral replication and transcription. Its specific cleavage of polypeptides after a glutamine residue has been considered as a key element to design novel antiviral drugs. Herein, we reported the design, synthesis and structure-activity relationships of novel α-ketoamides as covalent reversible inhibitors of Mpro, exploiting the PADAM oxidation route. The reported compounds showed µM to nM activities in enzymatic and in the antiviral cell-based assays against SARS-CoV-2 Mpro. In order to assess inhibitors' binding mode, two co-crystal structures of SARS-CoV-2 Mpro in complex with our inhibitors were solved, which confirmed the covalent binding of the keto amide moiety to the catalytic Cys145 residue of Mpro. Finally, in order to interrogate potential broad-spectrum properties, we assessed a selection of compounds against MERS Mpro where they showed nM inhibitory potency, thus highlighting their potential as broad-spectrum coronavirus inhibitors.

A Sensitive and Practical Evaluation to Detect Lower-Limb Strength Changes in Geriatrics: The Isometric Knee Extension Test

This study aimed to examine the sensitivity of the isometric knee extension (IKE) test to detect changes in the lower-limb strength of institutionalized older adults after exercise and inactivity periods. Thirty-four and fifteen institutionalized older adults completed the training and inactive periods, respectively. At each time point, the participants completed two testing sessions. In the first session, they performed the IKE test. As a complement to this evaluation, the second testing session was used to assess their functional capacity and handgrip strength. The sensitivity of the IKE test was examined by comparing the changes generated in this test against the repeatability of the protocol. A 4-week multicomponent Vivifrail program was implemented. After that, a subsample of the participants was re-evaluated after a 14-week inactivity period. Significant changes (p < 0.01;ES ≥ 0.27) in the IKE strength for both the dominant (+0.27 N/kg) and non-dominant legs (+0.25 N/kg) were produced after the training intervention. Likewise, significant decrements (p < 0.01;ES ≥ 0.31) were detected after the inactive period for the dominant (−0.29 N/kg) and non-dominant legs (−0.32 N/kg). All mean changes were found to be superior to the variability threshold of the IKE test for both legs, with superior sensitivity for the non-dominant leg (≥73%). Thus, the IKE test is a sensitive and practical tool for detecting changes in the lower-limb strength of institutionalized older adults after exercise and inactivity periods. Because of its applicability, it seems pertinent to implement the IKE test in a geriatric context. © 2023 by the authors.

Evaluating a multi-component group intervention for improving psychological well-being of trainee civil servants in Pakistan: A randomised controlled study

Introduction: Mental health by its very definition is related to productivity and economic output as well. It has been termed a priority under the UN 2015 Sustainable Development Goals (SDGs). Covid-19 has further brought it into limelight with almost one billion people estimated to have a mental-health or substance-use disorder (Greenwood & Krol, 2020;WHO, 2020). Work-related stress has been associated with psychological problems (Quick et al., 1997). In Pakistan, the civil service carries a disproportionally high burden of responsibility and national development depends on their performance and productivity which in turn cannot be divorced from their state of mental health. However, to the best of my knowledge, no study has so far been conducted on addressing workplace related psychological issues among the civil servants in Pakistan. The present study was conducted to fill this gap. It adapted WHO's low intensity, group psychological intervention, Problem Management Plus (PM+) to design 5 workshops to improve psychological well-being of newly inducted civil servant trainees and evaluate its effectiveness. Methods: The study was conducted at Civil Service Academy (CSA), Lahore, Pakistan in two phases. In the first phase, a scoping review of the literature and consultations with stakeholders were conducted to inform adaptation of the PM+ to ensure effective implementation with trainee civil servants in Pakistan. In the second phase, a two-arm single blinded Randomized Controlled Trial (RCT) was conducted to evaluate the effectiveness of the adapted curriculum to reduce symptoms of psychological distress in trainee civil servants in Pakistan. 240 newly inducted civil servants, undergoing a 6 months' induction training were randomized on a 1:1 allocation ratio into intervention and usual training curriculum arm. The intervention arm received the adapted group psychosocial intervention, consisted of 5 training workshops, integrated into their orientation sessions of trainee civil servants along with the usual training. The control arm received the usual training only. The primary outcomes were changes in the scores of psychological distress as measured by Patient Health Questionnaire-9 (PHQ-9) and coping skills strategies as measured by Brief Cope Questionnaire at 3-months post intervention. Secondary outcomes included symptoms of anxiety, well-being, and psychological capital. Intention-to-treat analyses were done using mixed models adjusted for covariates. Ethical approval of the study was obtained from the Human Development Research Foundation, Pakistan and the University of Liverpool. The trial was registered prospectively on clinicaltrials.gov (NCT03762421). Results: Phase 1 showed that PM+ was transferable into Civil Service Academy (CSA) settings following a careful adaptation process. The adaptation retained the concepts and strategies of the intervention while making significant changes in its structure and delivery.In the RCT conducted in Phase 2, of the 240 participants enrolled, 213 completed the post assessment at 7 weeks and 3 months' post intervention. The mixed-model analysis showed that intervention arm participants reported significantly higher scores on Brief-COPE, compared to control arm participants (m[SD], 23.42[8.86] vs. 21.92[8.55];mean difference, 95%CI, 2.11 [0.19 to 4.04];p<0.05) at 3-months post-intervention. Similarly, lower scores on PHQ-9 at one-week post intervention were reported by intervention arm participants compared to control arm participants (m[SD], 2.61[2.98] vs. 3.64[4.72];mean difference, 95%CI, -1.01[-1.80 to -0.22];p<0.05). Statistically significant difference on secondary outcomes at one-week and 3-months post-intervention was also observed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Extending the Library of 4-Hydroxycoumarin Derivatives with Potential Pharmacological Activity by a Catalyst-Free and Purification-Free Method

Constant mutations of SARS-CoV-2 from 2019 to the present commences potential dilemma to the efficacy of developed COVID-19 antiviral drugs. In this current report, series of 3-phenyl(alkylamino)methyl-4-hydroxycoumarin was identified as compounds of drug-likeliness that, through molecular docking simulations, also demonstrated favourable binding to different sites of the SARS-CoV-2 RBD/hACE2 complex. This was achieved by varying the chain of the alkyl length and the substituent of the phenyl moiety. The subjected 3-phenyl(alkylamino)methyl-4-hydroxycoumarin compounds were successfully synthesized by a catalyst-free multicomponent condensation reaction of 4-hydroxycoumarin, p-substituted benzaldehyde, and linear alkyl amines in dichloromethane (DCM) at 22 °C. The crude products were achieved in a moderate (40–50 %) to a very good (80–90 %) yield with excellent purity without the need for chemical purification verified by nuclear magnetic resonance (NMR) spectroscopy. The simple method to produce 3-phenyl(alkylamino)methyl-4-hydroxycoumarin and the preliminary docking results present an opportunity for advancement in drug discovery. © 2023 The Authors. ChemistrySelect published by Wiley-VCH GmbH.

Telehealth as a therapeutic approach in the management of childhood obesity.

Overweight and obesity in childhood and adolescence are not only associated with severe medical and psychological complications and sequelae, but also represent one of the greatest challenges for the healthcare system from an economic point of view. The restrictions imposed by the global COVID-19 (coronavirus disease 2019) pandemic have further aggravated the already high prevalence of juvenile obesity. Since pharmacological treatment options are generally not approved in childhood/adolescence and therefore they are not an option, lifestyle modification has a separate role from a therapeutic perspective. Multimodal training concepts from various disciplines (e.g., psychology, nutrition, sports, medicine) currently show the best prospects of success. The targeted transfer of these training programs into telemedical concepts could sustainably improve their effectiveness and reduce resource requirements on both the therapeutic and patient side.Copyright © 2022, The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.

Rational development of multicomponent mRNA vaccine candidates against mpox.

The re-emerging mpox (formerly monkeypox) virus (MPXV), a member of Orthopoxvirus genus together with variola virus (VARV) and vaccinia virus (VACV), has led to public health emergency of international concern since July 2022. Inspired by the unprecedent success of coronavirus disease 2019 (COVID-19) mRNA vaccines, the development of a safe and effective mRNA vaccine against MPXV is of high priority. Based on our established lipid nanoparticle (LNP)-encapsulated mRNA vaccine platform, we rationally constructed and prepared a panel of multicomponent MPXV vaccine candidates encoding different combinations of viral antigens including M1R, E8L, A29L, A35R, and B6R. In vitro and in vivo characterization demonstrated that two immunizations of all mRNA vaccine candidates elicit a robust antibody response as well as antigen-specific Th1-biased cellular response in mice. Importantly, the penta- and tetra-component vaccine candidates AR-MPXV5 and AR-MPXV4a showed superior capability of inducing neutralizing antibodies as well as of protecting from VACV challenge in mice. Our study provides critical insights to understand the protection mechanism of MPXV infection and direct evidence supporting further clinical development of these multicomponent mRNA vaccine candidates.

Amplification-Free COVID-19 Detection by Digital Droplet REVEALR.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, exposed a pressing need for new public health tools for pathogen detection, disease diagnosis, and viral genotyping. REVEALR (RNA-encoded viral nucleic acid analyte reporter) is an isothermal DNAzyme-based point-of-care diagnostic that functions with a detection limit of ∼10 copies/µL when coupled with a preamplification step and can be utilized for viral genotyping of SARS-CoV-2 variants of concern through base pair mismatch recognition in a competitive binding format. Here, we describe an advanced REVEALR platform, termed digital droplet REVEALR (ddREVEALR), that can achieve direct viral detection and absolute sample quantitation utilizing a signal amplification strategy that relies on chemical modifications, DNAzyme multiplexing, and volume compression. Using an AI-assisted image-based readout, ddREVEALR was found to achieve 95% positive predictive agreement from a set of 20 nasal pharyngeal swabs collected at UCI Medical Center in Orange, California. We propose that the combination of amplification-free and protein-free analysis makes ddREVEALR a promising application for direct viral RNA detection of clinical samples.

[Asthenic post-COVID syndrome]. / Astenicheskii postkovidnyi sindrom.

OBJECTIVE: To evaluate the efficacy and safety of combination therapy for post-COVID asthenic syndrome with multicomponent bioregulatory drugs Traumeel S, Ubichinon compositum and Coenzyme compositum. MATERIAL AND METHODS: The study included 104 patients (averaged age 39.5 [30.8; 48] years) after COVID-19, clinically recovered from an acute infectious process, with asthenic syndrome lasting from 2 weeks to 6 months; the severity of asthenic syndrome on the asthenia VAS scale was at least 30 points. Before the start of the study, in addition to a physical examination, the patient's condition was assessed using the following questionnaires and scales: VAS for asthenia, subjective scale for assessing asthenia (MFI-20), L.D. Malkova, a questionnaire for the quality of life (EQ-5D), a questionnaire for identifying signs of autonomic disorders (Vayne A.M.). The patient's condition was monitored during follow-up visits 2 weeks, 1 month after the start of treatment and 1 month after the end of treatment. Patients of the main group received combination therapy, which included Traumeel S 1 tablet x 3 times a day, Ubichinone compositum and Coenzyme compositum 2.2 ml intramuscularly, alternating every other day, for 1 month (15 injections of each drug per course of treatment). Patients of the comparison group received eleutherococcus extract 100 mg during 30 days, 2 tablets x 2 times a day before mealsand vitamins B. The effectiveness of therapy was assessed by analysis of the asthenia severity (VAS scale), quality of life (EQ-5D questionnaire), patient satisfaction with treatment on a 5-point scale, which was carried out 1 month after the end of the course of treatment. RESULTS: As a result of the treatment was positive. The general asthenia severity, low activity and motivation significantly decreased in patients of both groups without significant differences. At the same time, in patients of the comparison group, there was no correlation between the quality of life and physical and mental asthenia, while in the main group there was an inverse correlation with the asthenia severity, which indicates an increase in the quality of life with a decrease in the severity of asthenia. One of the significant differences was the regression of headache and musculoskeletal pain in patients of the main group. CONCLUSION: The advantage of combined therapy of post-COVID asthenic syndrome with bioregulation therapy Traumeel S, Ubichinone compositum and Coenzyme compositum was shown in comparison with one of the common treatment regimens, including eleutherococcus extract and combined preparations of B vitamins.

Computational Design, Synthesis, and Biophysical Evaluation of ß-Amido Boronic Acids as SARS-CoV-2 Mpro Inhibitors.

The COVID-19 pandemic has given a strong impetus to the search for antivirals active on SARS-associated coronaviruses. Over these years, numerous vaccines have been developed and many of these are effective and clinically available. Similarly, small molecules and monoclonal antibodies have also been approved by the FDA and EMA for the treatment of SARS-CoV-2 infection in patients who could develop the severe form of COVID-19. Among the available therapeutic tools, the small molecule nirmatrelvir was approved in 2021. It is a drug capable of binding to the Mpro protease, an enzyme encoded by the viral genome and essential for viral intracellular replication. In this work, by virtual screening of a focused library of ß-amido boronic acids, we have designed and synthesized a focused library of compounds. All of them were biophysically tested by microscale thermophoresis, attaining encouraging results. Moreover, they also displayed Mpro protease inhibitory activity, as demonstrated by performing enzymatic assays. We are confident that this study will pave the way for the design of new drugs potentially useful for the treatment of SARS-CoV-2 viral infection.

Green methodologies for the synthesis of 2-aminothiophene.

Pollution and the rising energy demand have prompted the design of new synthetic reactions that meet the principles of green chemistry. In particular, alternative synthesis of 2-aminothiophene have recently focused interest because 2-aminothiophene is a unique 5-membered S-heterocycle and a pharmacophore providing antiprotozoal, antiproliferative, antiviral, antibacterial or antifungal properties. Here, we review new synthetic routes to 2-aminothiophenes, including multicomponent reactions, homogeneously- or heterogeneously-catalyzed reactions, with focus on green pathways.

Long COVID-19: The Need for an Interdisciplinary Approach.

Long coronavirus disease 2019 (COVID-19) is characterized by persistent COVID-19 symptoms that last for at least 2 months. In the elderly population, apart from the typical symptoms (fatigue, cough, or dyspnea), unspecific symptoms coexist (functional deterioration, cognitive impairment, or delirium) that can mitigate the prevalence of this syndrome in this age group. Its main consequence is the functional decline, leading to sarcopenia, frailty, and disability, in addition to the nutritional and cognitive disorders. Thus, a multicomponent and individualized program (exercise, diet, cognitive stimulation) should be designed for older people with persistent COVID, where new technologies could be useful.

Integration of a hybrid scan approach and in-house high-resolution MS2 spectral database for charactering the multicomponents of Xuebijing Injection

Xuebijing (XBJ) Injection is a reputable patent Chinese medicine widely used to cure sepsis, among the Chinese ″Three Medicines and Three Prescriptions″ solution to fight against COVID-19. We were aimed to achieve the comprehensive multicomponent characterization from the single drugs to traditional Chinese medicine (TCM) formula, by integrating powerful data acquisition and the in-house MS2 spectral database searching. By ultra-high performance liquid chromatography/ion mobility-quadrupole time-of-flight mass spectrometry (UHPLC/IM-QTOF-MS), a hybrid scan approach (HDMSE-HDDDA) was developed, while the HDMSE data for five component drugs and 56 reference compounds were acquired and processed to establish an in-house MS2 spectral database of XBJ. Good resolution of the XBJ components was accomplished on a Zorbax Eclipse Plus C18 column within 24 min, while a fit-for-purpose HDMSE-HDDDA approach was elaborated in two ionization modes for enhanced MS2 data acquisition. XBJ MS2 spectral library was thus established on the UNIFITM platform involving rich structure-related information for the chemicals from five component drugs. We could identify or tentatively characterize 294 components from XBJ, involving 81 flavonoids, 51 terpenoids, 42 phthalides, 40 organic acids, 13 phenylpropanoids, seven phenanthrenequinones, six alkaloids, and 54 others. In contrast to the application of conventional MS1 library, this newly established strategy could demonstrate superiority in the accuracy of identification results and the characterization of isomers, due to the more restricted filtering/matching criteria. Conclusively, the integration of the HDMSE-HDDDA hybrid scan approach and the in-house MS2 spectral database can favor the efficient and more reliable multicomponent characterization from single drugs to the TCM formula. © 2022 The Author(s)

Neurodevelopmental Outcomes in Preterm Infants Receiving a Multicomponent vs. a Soybean-Based Lipid Emulsion: 24 Month Follow-Up of a Randomized Controlled Trial.

BACKGROUND: Few studies in the literature have analyzed the long-term neurodevelopmental outcomes of the administration of a multicomponent versus a soybean-based lipid emulsion (LE) in preterm infants receiving parenteral nutrition (PN). A recent randomized controlled trial conducted in our unit provided evidence of better growth in head circumference during the hospital stay in those who received a multicomponent LE. METHODS: This is a 24 month follow-up study of preterm infants, previously enrolled in a randomized trial, who received a multicomponent LE (SMOFlipid®) or a standard soybean-based one (Intralipid®). We evaluated neurodevelopmental outcomes at 24 months of corrected age (CA) in the two groups. RESULTS: Ninety-three children were followed up to the age of 24 months CA. Due to the peculiar time frame of the SARS-CoV-2 pandemic, neurodevelopmental outcomes were evaluated only in 77 children: 37 in the SMOFlipid® group and 40 in the Intralipid® group. No differences in major disability rates or in Griffith's evaluation were found between the two groups. CONCLUSIONS: In our population study, the administration of a multicomponent LE containing fish oil, compared to a soybean-based LE, had no significant effects on neurodevelopmental outcomes in preterm infants at 24 months CA.

Green and efficient one-pot three-component synthesis of novel drug-like furo[2,3-d]pyrimidines as potential active site inhibitors and putative allosteric hotspots modulators of both SARS-CoV-2 MPro and PLPro.

In this paper, an environmentally benign, convenient, and efficient one-pot three-component reaction has been developed for the regioselective synthesis of novel 5-aroyl(or heteroaroyl)-6-(alkylamino)-1,3-dimethylfuro[2,3-d]pyrimidine-2,4(1H,3H)-diones (4a‒n) through the sequential condensation of aryl(or heteroaryl)glyoxal monohydrates (1a‒g), 1,3-dimethylbarbituric acid (2), and alkyl(viz. cyclohexyl or tert-butyl)isocyanides (3a or 3b) catalyzed by ultra-low loading ZrOCl2•8H2O (just 2 mol%) in water at 50 ˚C. After synthesis and characterization of the mentioned furo[2,3-d]pyrimidines (4a‒n), their multi-targeting inhibitory properties were investigated against the active site and putative allosteric hotspots of both SARS-CoV-2 main protease (MPro) and papain-like protease (PLPro) based on molecular docking studies and compare the attained results with various medicinal compounds which approximately in three past years were used, introduced, and or repurposed to fight against COVID-19. Furthermore, drug-likeness properties of the mentioned small heterocyclic frameworks (4a‒n) have been explored using in silico ADMET analyses. Interestingly, the molecular docking studies and ADMET-related data revealed that the novel series of furo[2,3-d]pyrimidines (4a‒n), especially 5-(3,4-methylendioxybenzoyl)-6-(cyclohexylamino)-1,3-dimethylfuro[2,3-d]pyrimidine-2,4(1H,3H)-dione (4g) as hit one is potential COVID-19 drug candidate, can subject to further in vitro and in vivo studies. It is worthwhile to note that the protein-ligand-type molecular docking studies on the human body temperature-dependent MPro protein that surprisingly contains zincII (ZnII) ion between His41/Cys145 catalytic dyad in the active site, which undoubtedly can make new plans for designing novel SARS-CoV-2 MPro inhibitors, is performed for the first time in this paper, to the best of our knowledge.

Effect of a video-assisted fall prevention program on fall incidence in community-dwelling older adults during COVID.

BACKGROUND: The study evaluated the effectiveness of a video-assisted exercise intervention program on fall incidence, activities of daily living, and fear of falling in community-dwelling older adults. METHODS: A video-assisted 16-week exercise intervention consisting of stretching, strengthening, balance, and dual-task training was delivered to randomly selected 95 older adults with a high risk of falls. The fidelity of implementation was assessed for three areas; exercise program delivery, participant receipt, and enactment. RESULTS: The fall incidence reduced significantly by 45% (IRR 0.55, (95% CI, 0.13-0.86) and difficulty in daily activities decreased (OR: 0.74, 95% CI, 0.16 - 0.96) among participants in the intervention group. Fear of falls did not show any significant difference in the groups at the 12-month follow-up. CONCLUSION: The video-assisted exercise program was found to be effective in reducing fall incidence among older adults at a higher risk of falls.

Effects of physical training on functional, clinical, morphological, behavioural and psychosocial outcomes in post-COVID-19 infection: COVID-19 and REhabilitation study (CORE-study)-a study protocol for a randomised controlled clinical trial.

BACKGROUND: The COVID-19 pandemic remains ongoing, with a significant number of survivors who have experienced moderate to severe clinical conditions and who have suffered losses of great magnitude, especially in functional capacity, triggering limitations to daily autonomy and quality of life. Among the possibilities of intervention for disease rehabilitation, physical exercise training stands out, which can benefit several health outcomes and favours the adoption of healthier behaviours. Therefore, the aim of the study will be to analyse the effects of physical training on the functional, clinical, morphological, behavioural and psychosocial status in adults and the elderly following COVID-19 infection. METHODS: A randomised controlled clinical trial is to be conducted in parallel, with the experimental group undergoing an intervention involving a multicomponent physical rehabilitation programme, carried out at the Sports Center in partnership with the Academic Hospital of the Federal University of Santa Catarina, in Florianópolis, Brazil. Participants will be adults and the elderly, of both sexes, in a post-COVID-19-infection state, who were hospitalised during the infection. The intervention will have a total duration of 24 weeks and will include a multicomponent physical training programme, which will have gradual progression in frequency, duration and intensity over time. Regarding the outcomes, before, at the 12th and after 24 weeks of intervention, functional (primary outcome = functional index of aerobic capacity), clinical, morphological, behavioural and psychosocial outcomes will be assessed. DISCUSSION: This study will contribute to a greater understanding of the safety, adherence and benefits of physical training in the rehabilitation of post-COVID-19 patients. The results of this study will be disseminated through presentations at congresses, workshops, peer-reviewed publications and local and international conferences, especially with a view to proposing a post-COVID-19 rehabilitation care protocol. TRIAL REGISTRATION: ReBEC, RBR-10y6jhrs . Registered on 22 February 2022. 2015.

The Modified and Extended Hospital Elder Life Program: A remote model of care to expand delirium prevention.

BACKGROUND: Delirium is a common complication of hospitalization and is associated with poor outcomes. Multicomponent delirium prevention strategies such as the Hospital Elder Life Program (HELP) have proven effective but rely on face-to-face intervention protocols and volunteer staff, which was not possible due to restrictions during the COVID-19 pandemic. We developed the Modified and Extended Hospital Elder Life Program (HELP-ME), an innovative adaptation of HELP for remote and/or physically distanced applications. METHODS: HELP-ME protocols were adapted from well-established multicomponent delirium prevention strategies and were implemented at four expert HELP sites. Each site contributed to the protocol modifications and compilation of a HELP-ME Operations Manual with standardized protocols and training instructions during three expert panel working groups. Implementation was overseen and monitored during seven learning sessions plus four coaching sessions from January 8, 2021, through September 24, 2021. Feasibility of implementing HELP-ME was measured by protocol adherence rates. Focus groups were conducted to evaluate the acceptability, provide feedback, and identify facilitators and barriers to implementation. RESULTS: A total of 106 patients were enrolled across four sites, and data were collected for 214 patient-days. Overall adherence was 82% (1473 completed protocols/1798 patient-days), achieving our feasibility target of >75% overall adherence. Individual adherence rates ranged from 55% to 96% across sites for the individual protocols. Protocols with high adherence rates included the nursing delirium protocol (96%), nursing medication review (96%), vision (89%), hearing (87%), and orientation (88%), whereas lower adherence occurred with fluid repletion (64%) and range-of-motion exercises (55%). Focus group feedback was generally positive for acceptability, with recommendations that an optimal approach would be hybrid, balancing in-person and remote interventions for potency and long-term sustainability. CONCLUSIONS: HELP-ME was fully implemented at four HELP sites, demonstrating feasibility and acceptability. Testing hybrid approaches and evaluating effectiveness is recommended for future work.

Telehealth as a therapeutic approach in the management of childhood obesity

Overweight and obesity in childhood and adolescence are not only associated with severe medical and psychological complications and sequelae, but also represent one of the greatest challenges for the healthcare system from an economic point of view. The restrictions imposed by the global COVID-19 (coronavirus disease 2019) pandemic have further aggravated the already high prevalence of juvenile obesity. Since pharmacological treatment options are generally not approved in childhood/adolescence and therefore they are not an option, lifestyle modification has a separate role from a therapeutic perspective. Multimodal training concepts from various disciplines (e.g., psychology, nutrition, sports, medicine) currently show the best prospects of success. The targeted transfer of these training programs into telemedical concepts could sustainably improve their effectiveness and reduce resource requirements on both the therapeutic and patient side.