P4772Role of anticoagulation in patients with subclinical AF and its association with cardiovascular events: a SILENT sub study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Martinelli Filho ◽  
S F Siqueira ◽  
G A T Athayde ◽  
K M Dias ◽  
A O Pinheiro ◽  
...  
Keyword(s):  
Previous History ◽  
Intervention Group ◽  
High Rate ◽  
Control Group ◽  
Thromboembolic Events ◽  
Short Term ◽  
Cardiac Devices ◽  
Increased Risk

Abstract Background Atrial fibrillation (AF) is a well-established thromboembolic event risk factor. Episodes of subclinical AF (SCAF) recorded in implantable electronic cardiac devices (IECD) have been related to clinical AF and increased risk of stroke. However, there is no scientific evidence regarding the role of anticoagulation in this population. Objective: Our objective is to assess the association of SCAF with clinical AF and rate of systemic thromboembolic events, in a short-term follow-up. Methods This is a sub-study of SILENT, a prospective, randomized, unicentric study which included patients with sinus rhythm, IECD, with CHA2DS2-VASc ≥2, without previous history of AF. Patients were randomized to the Intervention Group and to the Control Group in the 1: 1 ratio. Patients of the Intervention Group with SCAF episodes (>6 min) received anticoagulation, as well as those with clinical AF in both groups. The primary end point was systemic thromboembolic phenomena and the secondary endpoints were SCAF rate, total and cardiovascular mortality, cardiovascular hospitalization and bleeding. Results A total of 758 patients were evaluated, with a mean age of 72.81 years (± 9.73), of which 461 (60.8%) were female. The mean follow-up was 19.59±4.24 months. Baseline characteristics were similar in both groups. Only 3 patients presented the primary outcome (two of them from Intervention Group). There were 16 deaths (2,1%) and 44 cardiovascular hospitalizations (5,8%), with no difference between groups. Atrial high rate episodes (AHRE) and clinical AF were more prevalent in Control Group, leading to an equal rate of anticoagulation between groups. Clinical AF was statistically associated to previous atrial high rate episodes of any duration (p=0.001) and correlated with SCAF (p<0.01 and R: 0,60) previously recorded in the device. Conclusion This sub study showed that, in a short term follow-up, SCAF has a good correlation with clinical AF occurrence with low rate of thromboembolic events. The Silent study will evaluate in an extended population the role of anticoagulation, in the long term. Acknowledgement/Funding None

Radiation Treatment for Localized Prostate Cancer and the Risk of Developing Myelodysplastic Syndromes (MDS)

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 120-120
Author(s):  
Sudipto Mukherjee ◽  
Chandana Reddy ◽  
Jay Ciezki ◽  
Ramon V. Tiu ◽  
Edward A. Copelan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Treatment ◽  
Previous History ◽  
World Health ◽  
Localized Prostate Cancer ◽  
Control Group ◽  
Surgery Group ◽  
Increased Risk ◽  
Secondary Mds

Abstract Abstract 120 Background: Both environmental radiation exposure and use of therapeutic radiation (XRT) in primary solid tumor malignancies increase the risk of secondary MDS. No data exist on the risk of developing secondary MDS in prostate cancer patients (pts) being treated with radiotherapy. Establishing this risk has important clinical implications, as prostate cancer is the leading cancer in men and radiation therapy has increasingly become the preferred modality for treatment of localized prostate cancer. Methods: We performed a prospective case control study of 11,015 pts with localized prostate adenocarcinoma newly diagnosed between 1986 and 2011 at Cleveland Clinic who underwent treatment with either radical prostatectomy (control group) or definitive radiotherapy (external beam radiotherapy [EBRT] or prostate interstitial brachytherapy [PI] – case group), to investigate the risk of radiation-related MDS. Data on demographics, surgery, radiation treatment, and follow-up were collected from merged prostate cancer and MDS databases. Cytogenetic risk groups were per International Prognostic Scoring System (IPSS) for MDS. Univariate and multivariate analyses were performed using the Fine and Gray competing risk model with MDS as a time-dependent endpoint (which incorporates differences in duration of follow-up) and death from any cause as the competing event, comparing radiotherapy groups to the surgical cohort as the reference group, controlling for age and follow-up frequency. Hazard ratios (HR) with 95% confidence intervals (CIs) are reported. Results: For all pts, median age was 64 years (yrs, range, 37 – 88) at the time of prostate cancer diagnosis: 69 yrs in EBRT, 67 yrs in PI, and 60 yrs in surgery pts, respectively (p<0.0001); 5119 (46%) were treated with XRT, 5896 (54%) with prostatectomy. None of the pts had a previous history of another malignancy. Among XRT pts, 2183 (43%) were treated with EBRT, 2936 (57%) with PI. Median follow-up was 3.0 yrs [(range, 0.0 – 25.2): 6.8 yrs in the EBRT group, 2.5 yrs in the PI group and 1.8 yrs in the surgery group, (p<0.0001)] following prostate intervention, longer (4.6 yrs) in pts treated since 1996, when PI was first performed [6.6 yrs in the EBRT group, 3.8 yrs in the PI group and 4.3 yrs in the surgery group, (p<0.0001)]. In the entire cohort, 30 pts developed MDS: 24 in the XRT group and 6 in the surgery group. MDS World Health Organization classification was: RA/RARS (n=12), RCMD (n=3), RAEB-1 (n=3), RAEB-2 (n=3), CMML (n=2), MDS-U (n=3) and unknown (n=4). IPSS cytogenetic risk classification was: good risk (n=17), intermediate risk (n=5), poor risk (n= 4) and unknown (n = 4). For MDS pts within the XRT group, median age at MDS diagnosis was 79 yrs (range, 74 – 89) for EBRT, 80 yrs (range, 64 – 100) for PI. The median time to develop MDS was 8.9 yrs (range, 0.9 – 20.2): 9.1 for EBRT, 8.2 for PI, and 13.0 for prostatectomy pts, respectively (p=0.05). In univariate analyses, older pts (HR=1.14; CI, 1.09 – 1.2; p<0.0001), and those treated with XRT (HR=3.3; CI, 1.35 – 8.08; p=0.009): EBRT (HR=2.6; CI, 1.0 – 6.9; p=0.05), PI (HR=5.87; CI, 2.1 – 16.3; p=0.0007) were significantly more likely to develop MDS. In multivariate analysis though, while advanced age (HR=1.13; CI, 1.0 – 1.2; p < 0.0001) remained significantly associated with MDS development, XRT did not (HR=1.56; CI, 0.56 – 4.38; p=0.4), though a trend remained for PI (HR=2.85; CI, 0.9 – 8.8; p = 0.07). Conclusions: Pts who underwent definitive radiation treatment for localized prostate cancer did not appear to have a significantly increased risk of subsequent MDS, in analyses that controlled for age and incorporated length of follow-up. A trend for MDS development was present for those undergoing XRT with PI. These findings are encouraging for both patients and providers who have concerns about the potential effects of XRT on development of MDS. Disclosures: Maciejewski: Celgene: Membership on an entity's Board of Directors or advisory committees. Sekeres:Celgene: Consultancy, Honoraria, Speakers Bureau.

scholarly journals Randomised controlled trial of the new short-term online emotion focused training for self-compassion and self-protection in a nonclinical sample

2018 ◽  
Vol 40 (1) ◽  
pp. 333-343 ◽  
Author(s):  
Júlia Halamová ◽  
Martin Kanovský ◽  
Karolína Varšová ◽  
Nuriye Kupeli
Keyword(s):  
Mental Health Professionals ◽  
Controlled Trial ◽  
Intervention Group ◽  
Clinical Population ◽  
Control Group ◽  
Short Term ◽  
Post Intervention ◽  
Self Compassion ◽  
Self Protection

AbstractThe Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is an intervention developed to increase skills of self-compassion and protective anger with the aim to decrease self-criticism. This novel intervention was developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and previous programs cultivating compassion (namely Compassion Mind Training and Mindful Self-Compassion Program). According to existing research, simply cultivating self-compassion is not always sufficient in reducing self-criticism. Therefore, the EFT-SCP was designed to build self-compassion whilst developing protective anger to combat self-criticism. Our goal was to investigate the efficacy of this new, short-term, online EFT-SCP program in a non-clinical population. A randomized control trial was conducted with pre- and post-intervention measurements and two-month follow-up of self-compassion and self-criticism/reassurance. Convenience sampling was used to recruit participants through a snowballing technique on social media. A total of 123 participants were randomly allocated to the EFT-SCP intervention or to a control condition. The intervention group were instructed through emails to complete an EFT-SCP task every day for 14 consecutive days. The control group did not complete any tasks. Out of 123 participants, 31 from intervention group and 20 from control group completed all measurements. There was a significant effect of the EFT-SCP on increasing self-compassion and self-reassurance scores as reported at two-month follow-up. The EFT-SCP was also effective at reducing self-uncompassionate responding and self-criticism (specifically Hated self) with changes evident at two months post-intervention. These findings are encouraging and suggest that interventions designed to enhance self-compassion and decrease self-criticism can be delivered to broader populations without the direct contact with mental health professionals.

scholarly journals Anti-stigma training for medical students: The Education Not Discrimination project

2013 ◽  
Vol 202 (s55) ◽  
pp. s89-s94 ◽  
Author(s):  
Bettina Friedrich ◽  
Sara Evans-Lacko ◽  
Jillian London ◽  
Danielle Rhydderch ◽  
Claire Henderson ◽  
...  
Keyword(s):  
Medical Students ◽  
Medical Curriculum ◽  
Intervention Group ◽  
Mental Health Stigma ◽  
Control Group ◽  
Short Term ◽  
Study Intervention ◽  
The Impact ◽  
Intended Behaviour

BackgroundEducation Not Discrimination (END) is the component of the Time to Change programme intended to reduce mental health stigma among professionals and professional trainees.AimsTo investigate the impact of the END anti-stigma programme on medical students immediately and after 6 months with regard to knowledge, attitudes, behaviour and empathy.MethodA total of 1452 medical students participated in the study (intervention group n = 1066, control group n = 386).Participants completed questionnaires at baseline, and at immediate and 6-month follow-up. Groups were compared for changes in stigma outcomes.ResultsAll measures improved in both groups, particularly among students with less knowledge and more stigmatising attitudes and intended behaviour at baseline. At immediate follow-up the intervention group demonstrated significantly greater improvements in stigma-related knowledge and reductions in stigma-related attitudes and intended behaviour, relative to the control group. At 6 months' follow-up, however, only one attitude item remained significantly better.ConclusionsAlthough the intervention produced short-term advantage there was little evidence for its persistent effect, suggesting a need for greater integration of ongoing measures to reduce stigma into the medical curriculum.

scholarly journals Awareness of Lifestyle and Colorectal Cancer Risk: Findings from the BeWEL Study

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Annie S. Anderson ◽  
Stephen Caswell ◽  
Maureen Macleod ◽  
Angela M. Craigie ◽  
Martine Stead ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Behavioural Change ◽  
Intervention Group ◽  
Knowledge Score ◽  
Control Group ◽  
Increased Risk ◽  
Diet And Physical Activity ◽  
And Control

It is estimated that 47% of colorectal cancers (CRC) could be prevented by appropriate lifestyles. This study aimed to identify awareness of the causes of CRC in patients who had been diagnosed with a colorectal adenoma through the Scottish Bowel Screening Programme and subsequently enrolled in an intervention trial (using diet and physical activity education and behavioural change techniques) (BeWEL). At baseline and 12-month follow-up, participants answered an open-ended question on factors influencing CRC development. Of the 329 participants at baseline, 40 (12%) reported that they did not know any risk factors and 36 (11%) failed to identify specific factors related to diet and activity. From a potential knowledge score of 1 to 6, the mean score was 1.5 (SD 1.1, range 0 to 5) with no difference between intervention and control groups. At follow-up, the intervention group had a significantly greater knowledge score and better weight loss, diet, and physical activity measures than the control group. Awareness of relevant lifestyle factors for CRC remains low in people at increased risk of the disease. Opportunities within routine NHS screening to aid the capability (including knowledge of risk factors) of individuals to make behavioural changes to reduce CRC risk deserve exploration.

Effectiveness of chlorhexidine dressings to prevent catheter-related bloodstream infections. Does one size fit all? A systematic literature review and meta-analysis

2020 ◽  
Vol 41 (12) ◽  
pp. 1388-1395
Author(s):  
Mireia Puig-Asensio ◽  
Alexandre R. Marra ◽  
Christopher A. Childs ◽  
Mary E. Kukla ◽  
Eli N. Perencevich ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Intervention Group ◽  
Bloodstream Infections ◽  
Control Group ◽  
Exit Site ◽  
Short Term ◽  
Randomized Controlled ◽  
Increased Risk ◽  
Pediatric Populations

AbstractObjective:To evaluate the effectiveness of chlorhexidine (CHG) dressings to prevent catheter-related bloodstream infections (CRBSIs).Design:Systematic review and meta-analysis.Methods:We searched PubMed, CINAHL, EMBASE, and ClinicalTrials.gov for studies (randomized controlled and quasi-experimental trials) with the following criteria: patients with short- or long-term catheters; CHG dressings were used in the intervention group and nonantimicrobial dressings in the control group; CRBSI was an outcome. Random-effects models were used to obtain pooled risk ratios (pRRs). Heterogeneity was evaluated using the I2 test and the Cochran Q statistic.Results:In total, 20 studies (18 randomized controlled trials; 15,590 catheters) without evidence of publication bias and mainly performed in intensive care units (ICUs) were included. CHG dressings significantly reduced CRBSIs (pRR, 0.71; 95% CI, 0.58–0.87), independent of the CHG dressing type used. Benefits were limited to adults with short-term central venous catheters (CVCs), including onco-hematological patients. For long-term CVCs, CHG dressings decreased exit-site/tunnel infections (pRR, 0.37; 95% CI, 0.22–0.64). Contact dermatitis was associated with CHG dressing use (pRR, 5.16; 95% CI, 2.09–12.70); especially in neonates and pediatric populations in whom severe reactions occurred. Also, 2 studies evaluated and did not find CHG-acquired resistance.Conclusions:CHG dressings prevent CRBSIs in adults with short-term CVCs, including patients with an onco-hematological disease. CHG dressings might reduce exit-site and tunnel infections in long-term CVCs. In neonates and pediatric populations, proof of CHG dressing effectiveness is lacking and there is an increased risk of serious adverse events. Future studies should investigate CHG effectiveness in non-ICU settings and monitor for CHG resistance.

scholarly journals BIOBEHAVIORAL THERAPY OF RHEUMATOID ARTHRITIS

2013 ◽  
Vol 12 (2) ◽  
pp. 135-140 ◽  
Author(s):  
N. A. Shabanova ◽  
O. S. Shubina ◽  
L. A. Ukolova ◽  
N. L. Tov
Keyword(s):  
Rheumatoid Arthritis ◽  
Drug Therapy ◽  
Alpha Rhythm ◽  
Intervention Group ◽  
Pain Medication ◽  
Control Group ◽  
Volitional Control ◽  
Short Term ◽  
Follow Up Study

The relevance of the study is connected with need to expand the arsenal of treatment methods patients with rheumatoid arthritis. The study examined the efficacy of biobehavioral therapy in a comprehensive program of treatment patients with rheumatoid arthritis (medical therapy in combination with biobehavioral therapy). It has been shown when compared with the control group (isolated drug therapy) maintaining  clinical  response  in  short-term  follow-up  study  in  the  intervention  group.  Statistically    significant relationship the volitional control of the alpha rhythm of EEG (increased power of the alpha rhythm) with a reduction in pain intensity in the in neurofeedback program and positive dynamics of the main characteristics of the alpha rhythm have been drmonstrated. Inclusion in the treatment program of arthritis biobehavioral approach has reduced the dose of pain medication, so reducing aggression of pharmacotherapy.

Le Benevolat: Un Lien Entre Des Personnes Agees et la Communaute

1983 ◽  
Vol 2 (1) ◽  
pp. 59-70 ◽  
Author(s):  
Lucie Martin ◽  
Margaret C. Kiely
Keyword(s):  
Social Isolation ◽  
Intervention Group ◽  
Senior Citizen ◽  
The Elderly ◽  
Control Group ◽  
Short Term ◽  
Experimental Intervention ◽  
Group 2 ◽  
Experimental Group

This study examines the various solutions for loneliness and social isolation with the elderly who live outside of an institution. The sample consisted of senior citizens and volunteers who were randomly selected from a community day centre. Specifically, the study examines the effects of the relationship on the volunteer, the senior citizen and on their interactive process. The volunteers were divided into two intervention groups. One control intervention group played the role of the “friendly visitor” which consisted of visiting the senior citizen of their residence and interacting in an informal manner. The other group, the experimental intervention group consisted of volunteers who served as a “short-term link” between the elderly and the possible social community resources available to them. The volunteers motivational levels were examined as a function of which group they belonged to. The degree of loneliness and social isolation for the elderly were examined as a function of what kind of intervention they received. The results appear to demonstrate that the volunteers in the control group have 1) a higher degree of egocentrism and activity than the experimental group; 2) a lower level of altruism than the experimental group. For the elderly, the results seem to indicate that the degree of loneliness and social isolation substantially decreased when the elderly are visited by the volunteer belonged to the experimental intervention group. From these results, one can readily ascertain that the helping relationship of the short-term link nature lead to a more successful type of intervention for the elderly sample in this study. Implications and the importance of the role of the community psychologist are discussed as a function of the differences and similarities between the volunteers and the elderly respectively.

scholarly journals Follow-up study of airway microbiota in children with persistent wheezing

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lei Wu ◽  
Chencong Shen ◽  
Yuanling Chen ◽  
Xin Yang ◽  
Xiaofei Luo ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Prospective Observational Study ◽  
Lower Airway ◽  
Control Group ◽  
Follow Up Study ◽  
Microbial Dysbiosis ◽  
Increased Risk ◽  
Group A

Abstract Background Increasing evidence revealed that airway microbial dysbiosis was associated with increased risk of asthma, or persistent wheezing (PW). However, the role of lung microbiota in PW or wheezing recurrence remains poorly understood. Methods In this prospective observational study, we performed a longitudinal 16S rRNA-based microbiome survey on bronchoalveolar lavage (BAL) samples collected from 35 infants with PW and 28 age-matched infants (control group). A 2-year follow-up study on these PW patients was conducted. The compositions of lower airway microbiota were analyzed at the phylum and genus levels. Results Our study showed a clear difference in lower airway microbiota between PW children and the control group. Children with PW had a higher abundance of Elizabethkingia and Rothia, and lower abundance of Fusobacterium compared with the control group. At the end of the 2-year follow-up, 20 children with PW (57.1%) experienced at least one episode of wheezing, and 15 (42.9%) did not suffer from wheezing episodes. Furthermore, PW children with recurrence also had increased abundances of Elizabethkingia and Rothia relative to those who had no recurrence. Additionally, wheezing history, different gender, and caesarean section demonstrated a greater impact in airway microbiota compositions. Conclusion This study suggests that the alterations of lower airway microbiota could be strongly associated with the development of wheezing, and early airway microbial changes could also be associated with wheezing recurrence later in life.

scholarly journals The impact of teach-back on patient recall and understanding of discharge information in the emergency department: the Emergency Teach-Back (EM-TeBa) study

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Mandhkani Mahajan ◽  
Janine Alida Hogewoning ◽  
Jeroen Joseph Antonius Zewald ◽  
Margreet Kerkmeer ◽  
Mathilde Feitsma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intervention Group ◽  
Medical Problem ◽  
Control Group ◽  
Short Term ◽  
Patient Recall ◽  
Follow Up Care ◽  
The Impact ◽  
Comprehension Deficit

Abstract Background Previous research has demonstrated that patients leaving the emergency department (ED) have poor recall and understanding of their discharge information. The teach-back method is an easy technique that can be used to check, and if necessary correct, inaccurate recall. In our study, we aimed to determine the direct and short-term impact of teach-back as well as feasibility for routine use in the ED. Methods A prospective cohort study in an urban, non-academic ED was performed which included adult patients who were discharged from the ED with a new medical problem. The control group with the standard discharge was compared to the intervention group using the teach-back method. Recall and comprehension scores were assessed immediately after discharge and 2–4 days afterward by phone, using four standardized questions concerning their diagnosis, treatment, follow-up care, and return precautions. Results Four hundred eighty-three patients were included in the study, 239 in the control group, and 244 in the intervention group. Patients receiving teach-back had higher scores on all domains immediately after discharge and on three domains after 2–4 days (6.3% versus 4.5%). After teach-back, the proportion of patients that left the ED with a comprehension deficit declined from 49 to 11.9%. Deficits were most common for return precautions in both groups (41.3% versus 8.1%). Teach-back conversation took 1:39 min, versus an average of 3:11 min for a regular discharge interview. Conclusion Teach-back is an efficient and non-time-consuming method to improve patients’ immediate and short-term recall and comprehension of discharge information in the ED.

Positive Effects of Practical Nutrition Lessons in a Primary School Setting with a High Proportion of Migrant School Children

2018 ◽  
Vol 128 (02) ◽  
pp. 111-118
Author(s):  
Katharina S. Weber ◽  
Jessica Eitner ◽  
Laura Dauben ◽  
Olaf Spörkel ◽  
Klaus Strassburger ◽  
...  
Keyword(s):  
Primary School ◽  
Dietary Habits ◽  
School Setting ◽  
Intervention Group ◽  
Migration Background ◽  
Control Group ◽  
Positive Effects ◽  
Increased Risk ◽  
Children's Nutrition

Abstract Background Children with migration background are at increased risk for overweight, partly due to less favorable dietary habits compared to their German counterparts. We examined the effects of practical nutrition lessons among children with a high proportion of migration background in a primary school setting. Methods Ten 3rd and 4th grade classes (n=166 children, 73% with migration background) received the intervention and nine school classes (n=139 children, 76% with migration background) served as control. Before, shortly after (only among the intervention group) and three months after the three-day practical nutrition lessons, the nutrition-related skills, behavior, attitudes, and knowledge of the children were assessed using a questionnaire. Changes between baseline and 1st follow-up among children of the intervention group were calculated using linear mixed models. Differences between the two groups for changes between baseline and 2nd follow-up were tested using linear regression analyses. Models were adjusted for potential confounders. Results Shortly after the practical nutrition lessons, the children of the intervention group had improved their knowledge (β=1.7; 95% CI: 1.0; 2.4, P<0.001) and skills (β=1.8; 95% CI: 1.4; 2.2, P<0.001). These changes were sustainable and larger in the intervention compared to the control group (knowledge: β=1.6; 95% CI: 0.7; 2.5, P<0.001; skills: β=1.3; 95% CI: 0.7; 1.9, P<0.001). Changes in nutrition-related behavior and attitudes did not differ between the groups. Conclusions Providing practical nutrition lessons in a primary school setting with a high proportion of children with immigrational background improved the children’s nutrition-related knowledge and skills.

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