The prevalence of memory complaints in older adults is between 25 and 50%, with poor memory associated with decreased quality of life and declines in daily functioning. Memory training programs are a method for training older adults on strategies and skills to improve memory performance. We conducted a feasibility study of a virtually-delivered adaptation of an Ecologically-Oriented Neurorehabilitation of Memory (EON-Mem) in improving memory for healthy older adults. The primary purposes of this study included: (1) determine the feasibility of conducting EON-Mem virtually with older adults, (2) determine whether a randomized control trial using EON-Mem in older adults is of value, and (3) determine whether electronic delivery of memory training programs with ecological validity is beneficial for older adults.

Twenty-five older adults 55 years of age and older were recruited for participation in a memory training program. All testing and intervention sessions were completed virtually through the Zoom platform. Measures of emotional functioning (Hospital Anxiety and Demographics Scale, health-related quality of life (Short Form-36) and cognitive functioning (Ecological Memory Simulations and Repeatable Battery for Neuropsychological Status; RBANS) were administered before and following the intervention. Participants attended one virtual treatment session per week, with sessions ranging between 60-90 minutes, for a total of six weeks. Between treatment sessions, participants were asked to complete daily homework assignments that allowed them to apply strategies to real-world situations. A priori, feasibility was set at an 80% completion rate and variables that influenced completion are reported.

To address questions regarding feasibility (e.g., adherence, attrition, etc.), we calculated descriptive statistics (i.e., count statistics, means, standard deviations, and range) on sample information. Of the 25 participants enrolled in the study, 21 participants completed all steps of the study (84% completion rate) showing the delivery format is feasible. The average age of our sample was 61.7 (SD = 5.9) years and average years of education was 17.06 (SD=2.36). Excluding those who dropped, average completion was 72.76 days (SD=18.65, range=47-124). Across all six weeks, homework completion averaged 66.4% (33/49). There were varying effects of the EON-Mem for the EMS memory outcomes with the greatest proportion showing reliable improvement on the ability to recall names (10 participants [42%]). Regarding the RBANS, the greatest proportion of participants showed reliable improvement on the Story Memory task (i.e., four participants [17%]), but only two (9%) showing reliable change on the total Memory Index score.

Overall, a virtual administration of EON-Mem in older adults was feasible.

Regarding memory changes, the majority of the sample did not demonstrate reliable improvement in memory which might have been due to a variety of reasons including the fact that our sample had a high level of education and low level of memory impairment. Notably, however, this was a feasibility study, not an intervention study. Therefore, future directions should focus on randomized controlled trials to determine efficacy.

To quantify the impact of clinical guidance and rapid respiratory and meningitis/encephalitis multiplex polymerase chain reaction (mPCR) testing on the management of infants.

Before-and-after intervention study.

Tertiary-care children’s hospital.

Infants ≤90 days old presenting with fever or hypothermia to the emergency department (ED).

The study spanned 3 periods: period 1, January 1, 2011, through December 31, 2014; period 2, January 1, 2015, through April 30, 2018; and period 3, May 1, 2018, through June 15, 2019. During period 1, no standardized clinical guideline had been established and no rapid pathogen testing was available. During period 2, a clinical guideline was implemented, but no rapid testing was available. During period 3, a guideline was in effect, plus mPCR testing using the BioFire FilmArray respiratory panel 2 (RP 2) and the meningitis encephalitis panel (MEP). Outcomes included antimicrobial and ancillary test utilization, length of stay (LOS), admission rate, 30-day mortality. Outcomes were compared across periods using Kruskal-Wallis and Pearson tests and interrupted time series analysis.

Overall 5,317 patients were included: 2,514 in period 1, 2,082 in period 2, and 721 in period 3. Over the entire study period, we detected reductions in the use of chest radiographs, lumbar punctures, LOS, and median antibiotic duration. After adjusting for temporal trends, we observed that the introduction of the guideline was associated with reductions in ancillary tests and lumbar punctures. Use of mPCR testing with the febrile infant clinical guideline was associated with additional reductions in ancillary testing for all patients and a higher proportion of infants 29–60 days old being managed without antibiotics.

Use of mPCR testing plus a guideline for young infant evaluation in the emergency department was associated with less antimicrobial and ancillary test utilization compared to the use of a guideline alone.