scholarly journals Early diet in preterm infants and later cognition: 10-year follow-up of a randomized controlled trial

2021 ◽  
Author(s):  
Nicholas D. Embleton ◽  
Claire L. Wood ◽  
Mark S. Pearce ◽  
Greta Brunskill ◽  
Victoria Grahame
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Discharge ◽  
Preterm Infants ◽  
Controlled Trial ◽  
List Type ◽  
Nutrient Intakes ◽  
Post Discharge ◽  
Head Growth ◽  
Randomized Controlled

Abstract Background Achieving adequate nutrition in preterm infants is challenging. The post-discharge period may be critical for influencing growth and cognitive outcomes. We studied the effects of post-discharge nutrition on childhood cognition. Methods Preterm-born children were randomized at ~36 weeks corrected age (CGA) to either preterm formula (PTF) or term formula (TF) until 6 months, or PTF until 40 weeks CGA, then TF until 6 months (crossover group). Childhood cognition was assessed using the short form Wechsler Intelligence Scale for Children III, allowing computation of full-scale intelligence quotient (FSIQ) and four-factor index scores; verbal comprehension, freedom from distractibility (FDI), perceptual organization (POI), and processing speed (PSI). Results Ninety-two children were recruited (mean 10.1 years). FSIQ did not differ by group. PTF-fed children had 10-point higher PSI (p = 0.03) compared to crossover. Faster weight gain from term to 12 weeks CGA was associated with 5-point higher FSIQ (p = 0.02) and four-point higher POI (p = 0.04). Infant head growth was positively associated with FSIQ (+3.8 points, p = 0.04) and FDI (+6 points, p = 0.003). Conclusions While there is no long-term impact of post-discharge macronutrient enrichment on childhood cognition, greater weight and head growth in specific epochs is associated with better outcomes. Further studies are needed to determine optimal early diet in preterm infants. Impact Achieving adequate nutrient intakes in preterm infants before and after hospital discharge is challenging. Nutrient intakes prior to discharge affect later cognitive and metabolic outcomes. Follow-up of a randomized controlled trial shows no cognitive benefit in later childhood from a more nutrient-dense formula compared to standard formula after hospital discharge. Growth in the first year of life is strongly correlated with childhood cognition and emphasizes the importance of nutrition in early life.

scholarly journals Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Bettina Habib ◽  
David Buckeridge ◽  
Melissa Bustillo ◽  
Santiago Nicolas Marquez ◽  
Manish Thakur ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Hospital Discharge ◽  
Mobile Application ◽  
Controlled Trial ◽  
Post Discharge ◽  
Randomized Controlled ◽  
Adherence To Medication ◽  
Medication Changes ◽  
Pilot Randomized Controlled Trial

Abstract Objective The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events. Materials and Methods We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up. Results Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%). Conclusion The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial. Trial registration Clinicaltrials.gov, registration number NCT04676165.

Effectiveness of a follow-up program for elderly heart failure patients after hospital discharge. A randomized controlled trial

2014 ◽  
Vol 5 (4) ◽  
pp. 252-257 ◽  
Author(s):  
J.L. González-Guerrero ◽  
T. Alonso-Fernández ◽  
N. García-Mayolín ◽  
N. Gusi ◽  
J.M. Ribera-Casado
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Hospital Discharge ◽  
Controlled Trial ◽  
Heart Failure Patients ◽  
Randomized Controlled

scholarly journals Nutritional supplementation and growth after hospital discharge in very low birthweight newborns: Randomized controlled trial / Suplementação nutricional e crescimento de recém-nascidos de muito baixo peso após alta hospitalar: Ensaio clínico randomizado

2021 ◽  
Vol 7 (10) ◽  
pp. 101149-101162
Author(s):  
Fernando Lamy Filho ◽  
Eremita Val Rafael ◽  
Roxana Desterro E Silva Da Cunha ◽  
Alcione Miranda Dos Santos ◽  
Zeni Carvalho Lamy ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Weight Gain ◽  
Preterm Infants ◽  
Gestational Age ◽  
Low Birthweight ◽  
Controlled Trial ◽  
Intervention Group ◽  
Very Low Birthweight ◽  
Randomized Controlled

Background Evidence is insufficient to show whether fortification has any effect on growth in preterm infants after discharge. Objective to verify whether VLBW preterm infants who are supplemented with multicomponent present greater anthropometric measurements than those not supplemented. Study Design Parallel randomized controlled trial. A computer-generated random number table was used to allocate the participants. Participants Preterm infants discharged from the NICU of a University Hospital from northeast, Brazil, weighing less than 1,500 g exclusively breastfed at discharge and followed up until they reached 6 months corrected gestational age.  Intervention intervention group received Nestlé® PreNan® formula, fractionated in 2 g of powder, mixed with the mother's milk twice a day. Control group was exclusively breastfed. Follow-up was conducted until the infants reached 6 months corrected gestational age (CGA). Outcomes Growth of the anthropometrics parameters weight, head circumference (HC) and lenth with 6 months of corrected age.  Mixed effects model for longitudinal data was used. Interaction according to sex was detected and ajusted. Results Weight gain was significantly higher in the intervention group. This effect was verified only for males (p = 0.001). No statistically significant association was observed between the intervention and the head circumference or length (p = 0.211; 0.597). The weaning rate at the end of follow-up was similar in both groups. Conclusions Breastmilk supplementation may improve the weight gain of very low birthweight preterm infants up to six months corrected gestational age. This effect differed by sex and was considered significant only for males.

scholarly journals A Home-Based, Post-Discharge Early Intervention Program Promotes Motor Development and Physical Growth in the Early Preterm Infants: A Prospective, Randomized Controlled Trial

2020 ◽  
Author(s):  
Juan Fan ◽  
Jianhui Wang ◽  
Xianhong Zhang ◽  
Ruiyun He ◽  
Shasha He ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Early Intervention ◽  
Preterm Infants ◽  
Motor Development ◽  
Controlled Trial ◽  
Physical Growth ◽  
Post Discharge ◽  
Anthropometric Measures ◽  
Randomized Controlled ◽  
Home Based

Abstract Background: Early intervention (EI) has been believed to improve the neurodevelopment of early preterm infants. However, its implementation in medical settings is time-consuming and resource-intensive, which limits its extensive use. In 2018, the Chinese Eugenics Association developed a home-based, post-discharge EI program. This study aims at evaluating the effect of this EI program on neurodevelopment and physical growth of early preterm infants through a prospective, partially blinded, randomized controlled trial, and a subsequent open phase. Methods: A total of 73 infants born at 28+0～31+6 weeks’ gestation with postmenstrual age of 36+0～39+6weeks were randomly allocated to the first early intervention, then standard care (EI-SC) group (37 infants), and the first standard care, then early intervention (SC-EI) group (36infants). Another 33 infants were retrospectively recruited as the reference group. The test of infant motor performance (TIMP) was the primary outcome, while development quotient (DQ) and anthropometric measures, including weight, length, and head circumference, were the secondary outcome. The assessment was carried out at the baseline (T0), termination of the randomized controlled trial (T1), and termination of the open phase (T2), respectively. Results: During the randomized controlled trial, the EI-SC group had significantly higher delta change (T1-T0) than the SC-EI group in TIMP and anthropometric measures (p<0.05), while no difference in DQ was noted between groups (p>0.05). In terms of the delta change from T2 to T0, there was no significant difference in all outcomes between the EI-SC group and SC-EI group (p>0.05). At the endpoint of T2, the EI-SC and SC-EI group had similar TIMP and anthropometric measures, but much higher than the reference group. Conclusions: These findings demonstrated that a home-based, post-discharge EI program in this study was a practical approach to promote motor development and physical growth in early preterm infants. Trial Registration: CHICTR, CTR1900028330, registered December 19, 2019, https:// http://www.chictr.org.cn/showproj.aspx?proj=45706

scholarly journals Comparative effectiveness of post-discharge strategies for hospitalized smokers: Study protocol for the Helping Hand 4 randomized controlled trial

2020 ◽  
Author(s):  
Nancy A Rigotti ◽  
Kristina Schnitzer ◽  
Esa M Davis ◽  
Susan Regan ◽  
Yuchiao Chang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Smoking Cessation ◽  
Hospital Discharge ◽  
Controlled Trial ◽  
Post Discharge ◽  
Randomized Controlled ◽  
Tobacco Treatment ◽  
Hospitalized Smokers ◽  
The U.S

Abstract Background. Tobacco smoking remains the leading preventable cause of death in the U.S. A hospital admission provides smokers with a unique opportunity to stop smoking because it requires temporary tobacco abstinence while illness may enhance motivation to quit. Hospital interventions must continue post-discharge to increase tobacco abstinence long-term, but how best to accomplish this remains unclear. Building on two previous randomized controlled trials, each of which tested smoking cessation interventions that began in hospital and continued after discharge, this trial compares two interventions that provide sustained smoking cessation treatment after hospital discharge with the goal of improving long-term smoking cessation rates among hospitalized smokers. Methods. Helping Hand 4 is a three-site randomized controlled trial that compares the effectiveness of two active interventions for producing validated past 7-day tobacco abstinence 6 months after hospital discharge. Smokers who are admitted to three hospitals receive a standard in-hospital smoking intervention, and plan to quit smoking after discharge are recruited and randomly assigned to two interventions that begin at discharge, Personalized Tobacco Care Management (PTCM) or Quitline eReferral. Each lasts 3 months. At discharge, PTCM provides 8 weeks of free nicotine replacement (NRT; a participant’s choice of patch, gum, lozenge, or a combination) and then proactive smoking cessation support using an automated communication platform and live contact with a tobacco treatment specialist who is based in the health care system. In the eReferral condition, a direct referral is made from the hospital electronic health record to a community-based resource, the state’s telephone quitline. The quitline provides up to 8 weeks of free NRT and offers behavioral support via a series of phone calls from a trained coach. Outcomes are assessed at 1, 3, and 6 months after discharge. The study hypothesis is that PTCM will produce higher quit rates than eReferral. Discussion. HH4 is a pragmatic trial that aims to evaluate interventions in real-world conditions. This project will give hospital systems critical evidence-based tools for meeting National Hospital Quality Measures for tobacco treatment and maximizing their ability to improve cessation rates and overall health for the millions of smokers hospitalized annually in the U.S.

Sign in / Sign up

Export Citation Format

Share Document