The effect of midodrine on lactate clearance in patients with septic shock: a pilot study

2021 ◽  
Author(s):  
Effat Davoudi-Monfared ◽  
Mostafa Mohammadi ◽  
Meysam Khoshavi ◽  
Hossein Khalili
Keyword(s):  
Septic Shock ◽  
Pilot Study ◽  
Effect Size ◽  
Critically Ill Patients ◽  
Lactate Clearance ◽  
Control Group ◽  
Large Effect Size ◽  
Group 13 ◽  
Registration Number ◽  
To Receive

Background: The effect of midodrine on lactate clearance has not been assessed in critically ill patients yet. Objective: The goal of this study was to assess the effect of adjunctive midodrine therapy on lactate clearance in patients with septic shock. Materials & methods: Patients with septic shock were assigned to receive either adjunctive midodrine 10 mg three-times a day for 5 days (midodrine group = 15 patients) or not (control group = 13 patients). Results: The lactate clearance was significantly faster in the midodrine group than the control group (p = 0.049) with a large effect size ([Formula: see text] = 0.141). Conclusion: When midodrine was added to intravenous vasopressors, it significantly accelerated lactate clearance in patients with septic shock. Trial registration number: IRCT20100228003449N25 (Clinicaltrials.gov).

scholarly journals Validasi Modul Pelatihan Pendampingan Klien pada Pekerja Sosial

2019 ◽  
Vol 3 (2) ◽  
pp. 66
Author(s):  
Yova Tri Yolanda ◽  
Muhana Sofiati Utami
Keyword(s):  
Social Worker ◽  
Effect Size ◽  
Test Sample ◽  
Control Group ◽  
Control Groups ◽  
Large Effect Size ◽  
Control Group Design ◽  
Sample Data ◽  
Post Test ◽  
And Control

Purpose of this research is to validated the module Client Facilitating Training to increase social worker knowledge about stress  and skill for facilitating client. Training included psychoeducation about stress and management stress, basic of client facilitating method and communication skill in facilitating process. Subjects of this research are 12 social worker and divided to experiment and control group. This research using quasi experiment with non control group design with pretest and post test sample. Data collected by management stres questionnaire, facilitating scale and field data collected by observer and supervisor. Results indicated that there is a significant differences between experiment and control groups in stress and management stress (Z=-3,017; p<0,05) with large effect size of 0,87 and Facilitatting skill (Z= -1,354; p<0,05) with large effect size of 0,84. Client Facilitating Training is valid to improve social worker knowledge stress  and management stress  and facilitating skill.

scholarly journals Effect of Glucose-Insulin-Potassium Infusion on Hemodynamics in Patients with Septic Shock

2021 ◽  
Vol 9 (B) ◽  
pp. 1517-1524
Author(s):  
Hassan Effat ◽  
Ramy Khaled ◽  
Ahmed Battah ◽  
Mohamed Shehata ◽  
Waleed Farouk
Keyword(s):  
Septic Shock ◽  
Myocardial Dysfunction ◽  
Statistical Significance ◽  
Lactate Clearance ◽  
University Hospital ◽  
Control Group ◽  
Surviving Sepsis Campaign ◽  
Significant Difference ◽  
Successful Weaning ◽  
Infusion Protocol

BACKGROUND: Glucose-insulin-potassium (GIK) demonstrates a cardioprotective effect by providing metabolic support and anti-inflammatory action, and may be useful in septic myocardial depression. AIM: The aim of this study was to assess role of GIK infusion in improving hemodynamics in patients with septic shock in addition to its role in myocardial protection and preventing occurrence of sepsis-induced myocardial dysfunction and sepsis-induced arrhythmias. METHODS: This study was conducted on 75 patients admitted to the Critical Care Department in Cairo University Hospital with the diagnosis of septic shock during the period from January 2019 to December 2019. Patients were divided into two groups; first group was managed according to the last guidelines of surviving sepsis campaign and was subjected to the GIK infusion protocol while second group was managed following the last guidelines of surviving sepsis campaign only without adding GIK infusion. RESULTS: Patients in the GIK group showed better lactate clearance (50% vs. 46.7%) and less time needed for successful weaning of vasopressors than the control group (3.57±1.16 vs. 3.6±1.45 days) thought not reaching statistical significance. There was no statistically significant difference between both groups regarding development of septic-induced cardiomyopathy (16.7% in the control group vs. 13.3% in the GIK group); however, patients with hypodynamic septic shock showed better improvement in hemodynamic profile in the GIK group. Sepsis-induced arrhythmias occurred more in patients of the control group than in patients of the GIK group with no statistically significant difference between both groups (33.3% vs. 20%, p = 0.243). Few side effects were developed as a result of using GIK infusion protocol. CONCLUSIONS: GIK may help in improving hemodynamics and weaning of vasopressors in patients with refractory septic shock and those with septic induced cardiomyopathy. The use of GIK was well tolerated with minimal adverse reactions.

scholarly journals A Dietary Mobile App for Patients Undergoing Hemodialysis: Prospective Pilot Study to Improve Dietary Intakes

10.2196/17817 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e17817
Author(s):  
Cosette Fakih El Khoury ◽  
Rik Crutzen ◽  
Jos M G A Schols ◽  
Ruud J G Halfens ◽  
Mirey Karavetian
Keyword(s):  
Health Care ◽  
Pilot Study ◽  
Effect Size ◽  
Mobile App ◽  
Dietary Guidelines ◽  
Medium Effect ◽  
Dietary Intakes ◽  
Large Effect Size ◽  
Prospective Pilot Study ◽  
Medium Effect Size

Background Mobile technology has an impact on the health care sector, also within dietetics. Mobile health (mHealth) apps may be used for dietary assessment and self-monitoring, allowing for real-time reporting of food intakes. Changing eating behaviors is quite challenging, and patients undergoing hemodialysis, particularly, struggle to meet the target intakes set by dietary guidelines. Usage of mobile apps that are developed in a person-centered approach and in line with recommendations may support both patients and health care practitioners. Objective This study is a pilot that aims at estimating the potential efficacy of a dietary intervention using a theory-based, person-centered smartphone app. Results will be used to improve both the app and a planned large-scale trial intended to assess app efficacy thoroughly. Methods A prospective pilot study was performed at the hemodialysis unit of Al Qassimi Hospital (The Emirate of Sharjah). All patients that fulfilled the study inclusion criteria were considered eligible to be enrolled in the pilot study. Upon successful installation of the app, users met with a dietitian once a week. Outcomes were measured at baseline (T0) and 2 weeks post app usage (T1). This pilot is reported as per guidelines for nonrandomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. Results A total of 23 patients completed the pilot intervention. Mean energy intakes increased from 24.4 kcal/kg/day (SD 8.0) to 29.1 kcal/kg/day (SD 7.8) with a medium effect size (d=0.6, 95% CI 0.0-1.2). Mean protein intakes increased from 0.9 g/kg/day (SD 0.3) to 1.3 g/kg/day (SD 0.5) with a large effect size (d=1.0, 95% CI 0.4-1.6); mean intake of high biological value (%HBV) proteins also increased from 58.6% (SD 10.1) to 70.1% (SD 10.7) with a large effect size (d=1.1, 95% CI 0.5-1.7). Dietary intakes of minerals did not change, apart from sodium which decreased from a mean intake of 2218.8 mg/day (SD 631.6) to 1895.3 mg/day (SD 581.0) with a medium effect size (d=0.5, 95% CI 0.1-1.1). Mean serum phosphorus, potassium, and albumin levels did not change relevantly. Mean serum iron increased from 7.9 mg/dL (SD 2.8) to 11.5 mg/dL (SD 7.9) postintervention with a medium effect size (d=0.6, 95% CI 0.0-1.2). Conclusions This pilot study showed that the KELA.AE app has the potential to improve dietary intakes. Processes related to procedure, resources, tools, and app improvement for a future trial were assessed. A more extended intervention using a randomized controlled trial is required to estimate parameters concerning app efficacy accurately.

scholarly journals Association between Doppler snuffbox resistive index and tissue perfusion in septic patients

2020 ◽  
Author(s):  
Cui Wang ◽  
xiaoting wang ◽  
Hongmin Zhang ◽  
Wei Huang ◽  
Dawei Liu
Keyword(s):  
Septic Shock ◽  
Resistive Index ◽  
Tissue Perfusion ◽  
Lactate Clearance ◽  
Control Group ◽  
Tissue Hypoperfusion ◽  
Critical Ill Patients ◽  
The Status ◽  
And Control ◽  
Better Than

Abstract Background: Doppler snuffbox resistive index (SBRI) can be a accurate parameter at the bedside to evaluate the status of peripheral vascular. We evaluated whether SBRI could relate to tissue hypoperfusion and could predict lactate clearance in septic patients. Methods: We conducted a prospective observational study in a tertiary general and teaching hospital in China.From July 2019 to Decemeber 2019,all consecutive adult patients with septic shock who required ICU admission were included. At the same time,postoperative patients were studied as a control group.we recorded the hemodynamic parameters including SBRI and PI which were measured simultaneously after involved . Results: We evaluated 44 patients with septic shock in study group and 20 stable postoperative patients in control group. Patients with septic shock had higher SOFA scores,PCT, CI and lactate than patients in control group.The SBRI was correlated with PI and lactate. The CI was not correlated with lactate in all patients.Based on Lactate clearance in first 6 hours, the septic shock patients were divided into the Lactate clearance ≥20% or the Lactate clearance <20% group.CI is no significal difference between two groups.SBRI of the Lactate clearance <20% group is higher than Lactate clearance≥20% group and control group.PI of the Lactate clearance <20% group is lower than Lactate clearance≥20% group and control group.The cutoff of the SBRI value was ≥1.09 for predicting 6h-lactate clearance after resuscitation, resulting in a sensitivity of 68.8% and a specificity of 85.7%. The cutoff of the PI value was ≤0.99 for predicting 6h-lactate clearance after resuscitation, resulting in a sensitivity of 64.3% and a specificity of 81.2%. The SBRI was significantly better than the PI for predicting 6h-lactate clearance after resuscitation. Conclusions: SBRI is correlated with tissue perfusion parameters in critical ill patients. Abnormal SBRI was better than PI in suggesting disorder of lactate clearance of septic patients. SBRI is a better indicator of abnormal tissue perfusion than CI. Further investigations are required to determine whether the correction of abnormal SBRI and PI may improve success rate of resuscitation of septic shock.

scholarly journals Association of Fungi and Archaea of the Gut Microbiota with Crohn’s Disease in Pediatric Patients—Pilot Study

Pathogens ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1119
Author(s):  
Agnieszka Krawczyk ◽  
Dominika Salamon ◽  
Kinga Kowalska-Duplaga ◽  
Tomasz Bogiel ◽  
Tomasz Gosiewski
Keyword(s):  
Crohn’S Disease ◽  
Pilot Study ◽  
Crohn's Disease ◽  
Pediatric Patients ◽  
Control Group ◽  
Healthy Controls ◽  
Stool Samples ◽  
Malassezia Spp ◽  
And Control ◽  
To Receive

The composition of bacteria is often altered in Crohn’s disease (CD), but its connection to the disease is not fully understood. Gut archaea and fungi have recently been suggested to play a role as well. In our study, the presence and number of selected species of fungi and archaea in pediatric patients with CD and healthy controls were evaluated. Stool samples were collected from children with active CD (n = 54), non-active CD (n = 37) and control subjects (n = 33). The prevalence and the number of selected microorganisms were assessed by real-time PCR. The prevalence of Candida tropicalis was significantly increased in active CD compared to non-active CD and the control group (p = 0.011 and p = 0.036, respectively). The number of Malassezia spp. cells was significantly lower in patients with active CD compared to the control group, but in non-active CD, a significant increase was observed (p = 0.005 and p = 0.020, respectively). There were no statistically significant differences in the colonization by archaea. The obtained results indicate possible correlations with the course of the CD; however, further studies of the entire archeobiome and the mycobiome are necessary in order to receive a complete picture.

scholarly journals Analysis of Bone Impairment by 3D DXA Hip Measures in Patients With Primary Hyperparathyroidism: A Pilot Study

2019 ◽  
Vol 105 (1) ◽  
pp. 175-184 ◽  
Author(s):  
Luis Gracia-Marco ◽  
Beatriz García-Fontana ◽  
Esther Ubago-Guisado ◽  
Dimitris Vlachopoulos ◽  
Antonia García-Martín ◽  
...  
Keyword(s):  
Pilot Study ◽  
Primary Hyperparathyroidism ◽  
Cortical Bone ◽  
Cortical Thickness ◽  
Effect Size ◽  
Areal Bone Mineral Density ◽  
Control Group ◽  
Healthy Controls ◽  
Mineral Density ◽  
Cross Sectional

Abstract Context Primary hyperparathyroidism (PHPT) has been related to bone loss. Dual-energy x-ray absorptiometry (DXA) cannot distinguish between trabecular and cortical bone compartments but the recently developed three-dimensional (3D)-DXA software might overcome this issue. Objective To examine the differences in DXA-derived areal bone mineral density (aBMD) and 3D-DXA parameters at the hip site between patients with PHPT and a healthy control group. Design Cross-sectional pilot study Setting Hospital Patients 80 adults (59.5 ± 9.1 yrs), 40 with PHPT and 40 age- and sex-matched healthy controls. Measures aBMD (g/cm2) of the femoral neck, trochanter, shaft, and total hip was assessed using DXA. Cortical surface (sBMD, mg/cm2), cortical volumetric BMD (vBMD, mg/cm3), trabecular vBMD (mg/cm3), integral vBMD (mg/cm3) and cortical thickness (mm) was assessed using 3D-DXA software. Results Mean-adjusted values showed lower aBMD (7.5%-12.2%, effect size: 0.51-1.01) in the PHPT group compared with the control group (all P &lt; 0.05). 3D-DXA revealed bone impairment (3.7%-8.5%, effect size: 0.47-0.65) in patients with PHPT, mainly in cortical parameters (all P &lt; 0.05). However, differences in trabecular vBMD were not statistically significant (P = 0.055). The 3D mapping showed lower cortical sBMD, cortical vBMD, and cortical thickness at the trochanter and diaphysis in the PHPT group (P &lt; 0.05) compared with the control group. In both groups, the presence of osteopenia or osteoporosis is related to lower cortical bone. Conclusions aBMD and cortical 3D parameters are impaired in patients with PHPT versus healthy controls. The vBMD of the trabecular compartment seems to be affected, although to a lesser extent.

The repentant sinner: methods to reduce stigmatised attitudes towards mental illness

2008 ◽  
Vol 32 (9) ◽  
pp. 327-332 ◽  
Author(s):  
Jason Luty ◽  
Harish Rao ◽  
Sujaa Mary Rajagopal Arokiadass ◽  
Joby Maducolil Easow ◽  
Arghya Sarkhel
Keyword(s):  
Mental Illness ◽  
Effect Size ◽  
General Public ◽  
Substance Misuse ◽  
Opiate Dependence ◽  
Control Group ◽  
Simple Description ◽  
To Receive ◽  
Median Change

Aims and MethodTo devise a simple technique to reduce stigmatised attitudes of the general public towards those with mental disorder (schizophrenia and substance misuse). Members of the general public (n=400) completed a questionnaire to measure stigmatised attitudes towards people with schizophrenia and substance misuse disorders. Participants were randomised to receive either a short, ‘upbeat’ leaflet with a description of a patient in remission and a photograph of a man in a business suit; or a simple description of a fictional patient. the 5-item Attitudes to Mental Illness Questionnaire (AMIQ) was used to measure the effect of the various procedures on stigmatised attitudes (score range −10 to +10).ResultsResults were received for 310 (77%) participants. the leaflet produced a large, statistically significant reduction in stigmatised attitudes towards people with opiate dependence (effect size 1.53, CI 1.23–1.82, P < 0.0001; median change 4 units) and alcohol dependence (effect size 1.41, CI 1.12–1.70, P < 0.0001; median change 4 units) but less so towards people with schizophrenia (effect size 0.54, CI 0.27–0.80, P=0.0002; median change 2 units). There was no difference between participants in respect of the control group at 4-week follow-up (233 responses received; 78% response rate).Clinical ImplicationsA short illustrated leaflet can be used to reduce stigmatised attitudes towards substance misuse disorders if patients are presented in a positive manner. This is less effective for attitudes towards people with schizophrenia, possibly because people have a more generous attitude towards patients who have overcome substance misuse disorders.

scholarly journals Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Shih-Ching Chen ◽  
Chueh-Ho Lin ◽  
Sheng-Wen Su ◽  
Yu-Tai Chang ◽  
Chien-Hung Lai
Keyword(s):  
Pilot Study ◽  
Effect Size ◽  
Exercise Intervention ◽  
Chronic Stroke ◽  
Control Group ◽  
Stroke Survivors ◽  
Post Intervention ◽  
Timed Up And Go ◽  
Kinect Camera ◽  
Experimental Group

Abstract Background Stroke survivors need continuing exercise intervention to maintain functional status. This study assessed the feasibility and efficacy of an interactive telerehabilitation exergaming system to improve balance in individuals with chronic stroke, compared to conventional one-on-one rehabilitation. Methods In this prospective case–control pilot study, 30 Taiwanese individuals with chronic stroke were enrolled and randomly allocated to an experimental group and a control group. All participants received intervention 3 times per week for 4 weeks in the study hospital. The experiment group underwent telerehabilitation using a Kinect camera-based interactive telerehabilitation system in an independent room to simulate home environment. In contrast, the control group received conventional one-on-one physiotherapy in a dedicated rehabilitation area. The effectiveness of interactive telerehabilitation in improving balance in stroke survivors was evaluated by comparing outcomes between the two groups. The primary outcome was Berg Balance Scale (BBS) scores. Secondary outcomes were performance of the Timed Up and Go (TUG) test, Modified Falls Efficacy Scale, Motricity Index, and Functional Ambulation Category. Results Comparison of outcomes between experimental and control groups revealed no significant differences between groups at baseline and post-intervention for all outcome measures. However, BBS scores improved significantly in both groups (control group: p = 0.01, effect size = 0.49; experimental group: p = 0.01, effect size = 0.70). Completion times of TUG tests also improved significantly in the experimental group (p = 0.005, effect size = 0.70). Conclusion The Kinect camera-based interactive telerehabilitation system demonstrates superior or equal efficacy compared to conventional one-on-one physiotherapy for improving balance in individuals with chronic stroke. Trial registration ClinicalTrials.gov. NCT03698357. Registered October 4, 2018, retrospectively registered.

scholarly journals Adequate management of Phosphorus in hemodialysis using a dietary smartphone app: A pilot study (Preprint)

2020 ◽  
Author(s):  
Cosette Fakih El Khoury ◽  
Rik Crutzen ◽  
Jos M.G.A. Schols ◽  
Ruud J.G. Halfens ◽  
Mirey Karavetian
Keyword(s):  
Pilot Study ◽  
G Protein ◽  
Effect Size ◽  
Elevated Serum ◽  
Hemodialysis Patients ◽  
Mobile App ◽  
Serum Phosphorus ◽  
Smartphone App ◽  
Large Effect Size ◽  
Potential Efficacy

BACKGROUND The renal diet is complex and requires amendments in various nutrients. Elevated serum phosphorus is common among hemodialysis patients, and it is associated with many complications. Alternative approaches that support both dietitians and patients in overcoming these difficulties should be explored. Smartphone technology could be used to provide a source of accessible and reliable information. OBJECTIVE The aim of this pilot is to assess the potential efficacy of an intervention using KELA.AE on the phosphorous management in hemodialysis patients. Results will be used to improve both the application and a planned, rigorous large-scale trial intended to assess app efficacy. METHODS This is a pilot study performed at the hemodialysis unit of Al Qassimi Hospital (Emirate of Sharjah). All patients were assessed for eligibility, and based on inclusion criteria, they were considered for enrollment. Participants met with a dietitian once a week and used the mobile app. Outcomes were measured at baseline (T0) and two weeks post app usage (T1). This pilot is reported as per guidelines for non-randomized pilot and feasibility studies and in line with the CONSORT 2010 checklist for reporting pilot or feasibility trials. RESULTS Twenty-three subjects successfully completed the pilot. Patients knowledge improved to 68.1% (13.3) after intervention with a large effect size (d= 1.22, 95%CI 0.59-1.85). Dietary protein intakes increased from a mean of 0.9g/Kg (SD=0.3) per day to a mean of 1.3g/Kg (SD=0.5) per day with a large effect size (d= 1.07, 95%CI 0.45-1.69). Phosphorus to protein ratio dropped from a mean of 18.4 mg/g protein to 13.5mg/g protein with a large effect size (d= 0.83, 95%CI 0.22-1.43). There were no improvements in phosphorous intakes, self-reported non-adherence, and serum phosphorus. CONCLUSIONS The findings of this pilot reveal potential efficacy for the use of a smartphone app as a supportive nutrition education tool for the phosphorus management in hemodialysis. This pilot study showed that KELA.AE app has the potential to improve knowledge and dietary choices. Processes related to the procedure, resources, tools, and app improvement for a future trial were assessed. A rigorous randomized controlled trial should be performed to evaluate the efficacy, assessing app usage of a long-term intervention.

scholarly journals Effects of a High Dose of Vitamin C along with Thiamine in Critically-ill Patients with Septic Shock: A Preliminary Study

2019 ◽  
pp. 1-7
Author(s):  
Hasanali Karimpour ◽  
Alireza Bahrami ◽  
Shila Amini ◽  
Mansour Rezaei ◽  
Javad Amini-Saman ◽  
...  
Keyword(s):  
Septic Shock ◽  
Vitamin C ◽  
Critically Ill ◽  
Sofa Score ◽  
Critically Ill Patients ◽  
Lactate Concentration ◽  
Intervention Group ◽  
Treatment Modalities ◽  
Control Group ◽  
High Dose

Septic shock may occur in critically ill patients and despite antimicrobial treatment, it is associated with a high mortality rate. It is reasonable to look for new treatment modalities that might improve outcome. This is a randomized, double-blind control trial aiming at critically-ill septic patients in a tertiary hospital. Patients with quick sofa score of 2 and with organ dysfunction were included in this study. The intervention group received high doses of vitamin C at a dose of 50 mg/kg/four times daily along with thiamine at a dose of 200 mg/ twice daily) and the control group received normal saline for four days. The dose of vasopressors, procalcitonin and lactate clearance, and mean sequential organ failure assessment (SOFA) score were examined in the two groups. Patients were followed for 28 days. One hundred patients were allocated into two equal groups, and there was no difference between the two groups regarding baseline characteristics. Mean lactate concentration, SOFA score, days of antimicrobial therapy, and mortality at 28 days were similar between them. However, the mean procalcitonin concentration, and mean vasopressor treatment hours were significantly lower in the intervention group (p<0.05). Although Days of ICU stay were lower in the intervention group, It did not reach statistical significance. The results of this study showed that treatment with high dose vitamin C Reduces the vasopressor requirement without any effects on other parameters. Further studies with larger sample size are required for more generalizable results.

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