scholarly journals 127Topical antibiotics used to prevent infection in the ICU: an accidental natural herd exposure experiment

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
James Hurley
Keyword(s):  
Systematic Reviews ◽  
Infection Prevention ◽  
Intervention Group ◽  
Control Group ◽  
Control Groups ◽  
Topical Antibiotic ◽  
Herd Effect ◽  
Icu Patients ◽  
Topical Antibiotics ◽  
Prevention Methods

Abstract Background Multiple studies of topical antibiotics applied to ICU patients appear to show potent infection prevention effects versus studies of other interventions. However, the effect is less apparent for studies using non-concurrent (NCC) versus concurrent controls (CC) implying the possibility of a herd effect. Methods 206 studies of infection prevention among ICU patients, sourced from 15 systematic reviews were stratified into those using topical antibiotics with NCC versus with CC versus studies of other prevention methods. The event rates were summarised using generalized estimating equations and compared to other studies without an intervention (literature benchmark). Results The summary effect sizes for pneumonia and mortality prevention derived in the systematic reviews were replicated. The mean ICU mortality incidence for topical antibiotic study CC control groups (28.5%; 95% CI, 25.0-32.3; n = 41) is higher versus a literature benchmark (23.7%; 19.2%-28.5%; n = 34), versus NCC control groups (23.5%; 19.3-28.3; n = 14) and versus topical antibiotic intervention groups (24.4%; 22.1 – 26.9; n = 62). In meta-regression models adjusted for group mean age and publication year, CC group membership within a topical antibiotic study remains associated with higher mortality (p = 0.027). Conclusions Within topical antibiotic studies, the CC control group mortality incidences are inexplicably high, whereas the intervention group incidences are paradoxically similar to a literature-derived benchmark. Key messages An adverse herd effect is apparent for topical antibiotics used to prevent infection among ICU patients.

scholarly journals 128Study data within systematic reviews of intensive care interventions analysed as a cluster randomized trial

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
James Hurley
Keyword(s):  
Systematic Reviews ◽  
Prolonged Mechanical Ventilation ◽  
Intervention Group ◽  
Population Level ◽  
Cluster Randomized Trial ◽  
Contextual Effect ◽  
Control Groups ◽  
Topical Antibiotics ◽  
Concurrent Control ◽  
Cluster Randomized

Abstract Focus of Presentation Cluster randomized trials (CRT) can address infectious disease research questions at the whole-of-population level, such as herd protection and herd peril effects, that cannot be answered within randomized controlled trials. For adequate power, ideally, a CRT will have at least 40 clusters. Findings Studies of decontamination (using either chlorhexidine or topical antibiotics) to prevent ICU-acquired infections among adult patients requiring prolonged mechanical ventilation (MV) have been summarized in > 15 systematic reviews. Of 83 studies of topical antibiotics, 69 had concurrent control (CC) versus non-concurrent control (NCC; n = 14) design (Figure below; solid symbols are intervention group patients). The mean ICU pneumonia incidence for topical antibiotic study CC control groups (34.5%; 95% CI, 29.1-40.4) is higher versus a literature benchmark (26.1%; 23.3%-29.1%), and versus NCC control groups (29.9%; 21.4-40.4) and versus chlorhexidine study CC control groups (25.5%; 19.6 – 32.5; n = 17). Conclusions/Implications Benchmarking the event rates among control groups versus the event rate among non-intervention studies for MV patients provide a measure of the contextual effect of the intervention. Differing intervention effects for studies with CC versus NCC design implicates herd effects. Key messages Systematic reviews of interventions that include studies with CC versus NCC design provide a natural experiment of contextual effects where their study otherwise would be difficult or, for adverse herd effects, unethical.

scholarly journals Asymmetric Effects of Decontamination Using Topical Antibiotics for the ICU Patient

Symmetry ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1027
Author(s):  
James C. Hurley
Keyword(s):  
Infection Prevention ◽  
Natural Experiment ◽  
Antibiotic Use ◽  
Ventilator Associated Pneumonia ◽  
Control Groups ◽  
Topical Antibiotic ◽  
Topical Antibiotics ◽  
Concurrent Control ◽  
Asymmetric Effects ◽  
Prevention Studies

There are several antiseptic, antibiotic and non-decontamination-based interventions for preventing intensive care unit (ICU) acquired infection. These have been evaluated in >200 studies. Infection prevention using topical antibiotic prophylaxis (TAP) appears to be the most effective. Whether antibiotic use in the ICU may influence the risk of infection among concurrent control patients within the same ICU and result in asymmetrical herd effects cannot be resolved with individual studies examined in isolation. The collective observations within control and intervention groups from numerous ICU infection prevention studies simulates a multi-center natural experiment enabling the herd effects of antibiotics to be evaluated. Among the TAP control groups, the incidences for both ventilator associated pneumonia (VAP) and mortality are unusually high in comparison to literature-derived benchmarks. Paradoxically, amongst the TAP intervention groups, the incidences of mortality are also unusually high and the VAP incidences are similar (i.e., not lower) compared to the incidences among studies of other interventions. By contrast, the mortality incidences among the intervention groups of other studies are similar to those among the intervention groups of TAP studies. Using topical antibiotics to prevent infections acquired within the ICU environment may result in profoundly asymmetrical effects.

scholarly journals College Classroom Instructors Can Effectively Promote Standing among Students Provided with Standing Desks

2021 ◽  
Vol 18 (9) ◽  
pp. 4464
Author(s):  
Matthew S. Chrisman ◽  
Robert Wright ◽  
William Purdy
Keyword(s):  
United States ◽  
Intervention Group ◽  
Control Group ◽  
Sedentary Behaviors ◽  
Control Groups ◽  
Student Preferences ◽  
Standing Time ◽  
Urban University ◽  
Facilitators And Barriers ◽  
And Control

Standing desks may reduce sedentary behaviors in college students. Students at one mid-size urban university in the Midwestern United States were randomized into intervention (n = 21) and control groups (n = 27) to assess standing time when given access to standing desks. The intervention group received visual and oral instructor prompts to stand, while the control received no prompts during a 50 min lecture. All students were provided with adjustable tabletop standing desks. ActivPAL accelerometers measured sitting and standing time. A brief survey assessed student preferences, including facilitators and barriers to standing. Mean standing time was greater in the intervention vs. control group (26 vs. 17 min, p = 0.023). Students tended to stand in the corners and edges of the room. Main facilitators for standing included to break up sitting, reduce back pain, and increase attention and focus; main barriers were not wanting to distract others or be the only one standing. In total, 87.5% of intervention group participants found five prompts to stand were adequate. Students increased standing time in class when provided with standing desks and instructor prompts to stand. Findings can inform the layout of classrooms and when and how to promote standing desks during lectures.

scholarly journals Alleviating psychological distress associated with a positive cervical cancer screening result: a randomized control trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yukari Isaka ◽  
Ai Hori ◽  
Rie Tanaka ◽  
Masao Ichikawa
Keyword(s):  
Cervical Cancer ◽  
Psychological Distress ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Control Groups ◽  
And Control ◽  
Screening Result

Abstract Background The method of communicating a positive cancer screening result should seek to alleviate psychological distress associated with a positive result. We evaluated whether the provision of information through a leaflet would help reduce psychological distress in a randomized controlled trial. Methods The participants were women aged 20–69 years who were about to undergo cervical cancer screening at health centers. Before the screening, they received hypothetical screening results, with a leaflet (intervention group, n = 493) or without it (control group, n = 479), randomly. Their psychological distress and intention to undergo further examination were then compared between the intervention and control groups. Results After the intervention (providing a leaflet with hypothetical screening results), psychological distress appeared to be higher in the control group than in the intervention group among those who received a hypothetical positive screening result (odds ratio: 2.57, 95% confidence interval: 1.87–3.54), while 95% and 97% of those in the intervention and control groups, respectively, reported that they would undergo further examination. Conclusions Information provision might help reduce psychological distress but not hinder further examination among women who screen positive for cervical cancer. Trial registration: UMIN Clinical Trials Registry UMIN000029894. Date of Registration: November 2017.

scholarly journals Schisto and Ladders version 2: a health educational board game to support compliance with school-based mass drug administration with praziquantel – a pilot study

2020 ◽  
Author(s):  
Cynthia Uchechukwu Ejike ◽  
Akinola Stephen Oluwole ◽  
Olaitan Olamide Omitola ◽  
Adedotun Ayodeji Bayegun ◽  
Islamiat Yetunde Shoneye ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Intervention Group ◽  
Control Group ◽  
Board Game ◽  
Control Groups ◽  
Group Discussions ◽  
School Based ◽  
Praziquantel Treatment ◽  
And Control

Abstract Background We redesigned the Schisto and Ladders health educational board game and evaluated its potential to encourage compliance to school-based mass drug administration with praziquantel. Methods Two hundred and seventy-five children from six schools who rejected praziquantel treatment were divided into intervention and control groups. Before the intervention, preassessment interviews were conducted on their knowledge about praziquantel treatment and schistosomiasis. The Schisto and Ladders version 2 game as an intervention, and the Snakes and Ladders game as a control, were played for 6 mo. Postassessment interviews, including focus group discussions, were conducted. Results At preassessment, 0/98 (0.0%) children in the intervention group had heard of praziquantel compared with 2/177 (1.1%) in the control group. Similarly, 0/98 (0.0%) children in the intervention group did not know that praziquantel does not kill compared with 4/177 (2.3%) in the control group. The postassessment showed that 53/78 (67.9%) in the intervention group were aware of praziquantel compared with 2/177 (1.1%) in the control group (p=0.000). Similarly, 53 (69.7%) in the intervention group knew about the safety of praziquantel compared with 0/177 (0.0%) in the control group (p=0.000). Sixty-four children (65.3%) from the intervention group sought praziquantel treatment after the trial. Conclusions Schisto and Ladders version 2 is a useful sensitisation tool with which to encourage compliance to praziquantel treatment in schools.

scholarly journals Impact of ascorbic acid in reducing the incidence of vancomycin associated nephrotoxicity in critically ill patients: A preliminary randomized controlled trial

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 929
Author(s):  
Nouran Hesham El-Sherazy ◽  
Naglaa Samir Bazan ◽  
Sara Mahmoud Shaheen ◽  
Nagwa A. Sabri
Keyword(s):  
Ascorbic Acid ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Statistical Significance ◽  
Intervention Group ◽  
Secondary Outcome ◽  
Control Group ◽  
Control Groups ◽  
The Absolute ◽  
And Control

Background Antioxidants show nephroprotective effect against vancomycin associated nephrotoxicity (VAN) in animals. This study aimed to assess the ascorbic acid nephro-protective role against VAN clinically. Methods Forty-one critically ill patients were randomly assigned to one of two groups: intervention group (vancomycin IV plus ascorbic acid, n=21) or control group (vancomycin IV only, n=20). Primary outcomes were the incidence of VAN and the absolute change in creatinine parameters, while mortality rate was the secondary outcome. Nephrotoxicity was defined as an increase in serum creatinine (S.cr) by at least 0.5 mg/dL or 50% of baseline for at least two successive measurements. This study is registered at Clinicaltrials.gov (NCT03921099), April 2019. Results Mean absolute S.cr increase was significant when compared between both groups, P-value = 0.036, where S.cr increased by 0.05(0.12) and 0.34(0.55) mg/dL in the intervention and control groups, respectively. Mean absolute Cr.cl decline was significant when compared between both groups, P-value = 0.04, where Cr.cl was decreased by 5.9(17.8) and 22.3(30.4) ml/min in the intervention and control groups, respectively. Incidence of VAN was 1/21(4.7%) versus 5/20(25%) in the intervention and control groups, respectively (RR: 0.19; CI: 0.024–1.49; P-value = 0.093). Mortality was higher in the control group; however, it was not statistically significant, P-value = 0.141. Conclusion Co-administration of ascorbic acid with vancomycin preserved renal function and reduced the absolute risk of VAN by 20.3%, however, the reduction in VAN incidence didn’t reach statistical significance level. Further large multicenter prospective trials are recommended.

scholarly journals Android-Based Education toward the Role of Postpartum Primipara Mothers in Fulfilling the Independent Perinium Care

2021 ◽  
Vol 1 (2) ◽  
pp. 55-67
Author(s):  
Werna Nontji ◽  
Dwi Kartika Sari ◽  
Sitti Maria Ulfa ◽  
Syafruddin Syarif ◽  
Inez Vravty Lestari ◽  
...  
Keyword(s):  
Treatment Group ◽  
Intervention Group ◽  
Wilcoxon Test ◽  
Control Group ◽  
P Value ◽  
Control Groups ◽  
Post Test ◽  
Android App ◽  
And Control ◽  
Perineal Care

Background: Educating mothers during their postpartum period could potentially help them to overcome some important phases after giving birth. The process of education is evaluated based on the mothers’ knowledge about their independent self-care. Independency is an activity that is started individually and is done based on self-capability. The independency in the postpartum care is not only important to decrease the mother’s mortality and morbidity rate, but it is also crucial to strengthen and improve the post-partum mother’s healthy behavior during the perineal care. Providing education using Android-based application called BUBI Care could be potential to facilitate a more dynamic transfer of knowledge to the postpartum mothers.Aims: To analyze the knowledge, skills, and independence of primipara postpartum mothers in independent perineal care before and after accessing BUBI Care app. Research Method: employing quasi experimental research with pre-test and post-test design with control group design. The sample for this research were 19 pregnant mothers TM III (pregnancy age of ? 38 weeks) on each group. The treatment group was educated using BUBI Care Android app that was conducted at one of Public Health Center. The control group was educated without BUBI Care that was conducted at a Midwife Practice Clinic. The research was conducted on September to October 2020. Study Result: According to the Wilcoxon test, there was a difference in the pre-test knowledge of the treatment and control groups with the similar median of 53 and p-value of 0.666, the treatment group showed their scores improved to 80 on the post-test while the control group stayed at 53 with the p-value of 0.000. It means that BUBI Care app education influences the post-test. On the other hand, the perineal care skill saw a difference between the intervention and control groups. The intervention group had a mean of 70.05 and 56.68 for the control group with the p-value of 0.002 which means that there was an influence from the BUBI Care app education. Additionally, Mann Whitney test showed that the intervention group had a mean score of 78.95, but the control group only had 49.26, the total difference between the two are 29.69 with the p-value of 0.000. It can be concluded that there is a significance in difference in the independency rate from the provision of BUBI Care Android app education.Conclusion:  there is a significance effect on the intervention group in terms of Android based usage.

Delivering Cognitive Behavioral Therapy for Post–Intensive Care Syndrome–Family via a Mobile Health App

2021 ◽  
Vol 30 (6) ◽  
pp. 451-458
Author(s):  
Amy Petrinec ◽  
Cindy Wilk ◽  
Joel W. Hughes ◽  
Melissa D. Zullo ◽  
Yea-Jyh Chen ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cognitive Behavioral Therapy ◽  
Mobile Health ◽  
Behavioral Therapy ◽  
Family Members ◽  
Intervention Group ◽  
Cognitive Behavioral ◽  
Control Group ◽  
Icu Patients ◽  
Post Intensive Care Syndrome

Background Family members of intensive care unit (ICU) patients are at risk for post–intensive care syndrome– family (PICS-F), including symptoms of anxiety, depression, and posttraumatic stress. Cognitive behavioral therapy is the first-line nonpharmacologic treatment for many psychological symptoms and has been successfully delivered by use of mobile technology for symptom self-management. Objectives To determine the feasibility of delivering cognitive behavioral therapy through a smartphone app to family members of critically ill patients. Methods This was a prospective longitudinal cohort study with a consecutive sample of patients admitted to 2 adult ICUs and their family members. The control group period was followed by the intervention group period. The intervention consisted of a mobile health app preloaded on a smartphone provided to family members. The study time points were enrollment (within 5 days of ICU admission), 30 days after admission, and 60 days after admission. Study measures included demographic data, app use, satisfaction with the app, mental health self-efficacy, and measures of PICS-F symptoms. Results The study sample consisted of 49 predominantly White (92%) and female (82%) family members (24 intervention, 25 control). Smartphone ownership was 88%. Completion rates for study measures were 92% in the control group and 79% in the intervention group. Family members logged in to the app a mean of 18.58 times (range 2-89) and spent a mean of 81.29 minutes (range 4.93-426.63 minutes) using the app. Conclusions The study results confirm the feasibility of implementing app-based delivery of cognitive behavioral therapy to family members of ICU patients.

Effect of buddy-style intervention on exercise adherence in community-dwelling disabled older adults: A pilot randomized controlled trial

2021 ◽  
pp. 026921552110411
Author(s):  
Hiromichi Takeda ◽  
Katsuhiko Takatori
Keyword(s):  
Older Adults ◽  
Controlled Trial ◽  
Intervention Group ◽  
Exercise Adherence ◽  
Control Group ◽  
Adult Day Care ◽  
Control Groups ◽  
Randomized Controlled ◽  
And Control ◽  
Pilot Randomized Controlled Trial

Objective To assess the preliminary effects of a buddy-style intervention to improve exercise adherence. Design A parallel-group, open-label, pilot randomized controlled trial. Setting Adult day-care centers. Participants Sixty-five disabled older adults. Interventions All participants underwent a 12-week home exercise program, and the intervention group received a 5–10 min buddy-style intervention between older adults in the intervention group once weekly at an adult day-care center. Main measures Based on the exercise log calendar, the number of days of exercise was assessed for each of the three phases: 1–4 weeks, 5–8 weeks, and 9–12 weeks. Short physical performance battery was measured at baseline and after 12 weeks. Results Of the 590 screened older adults, 65 were recruited and 33 were assigned to the intervention group. One participant in each group withdrew before the program began, and four and five patients in the intervention and control groups, respectively, dropped out by the 12-week assessment. Analysis of covariance of the 28 and 26 patients in the intervention and control groups, respectively, for whom exercise log calendars could be retrieved, showed that the intervention group (24.4/28 days) exercised significantly more days than the control group (20.6/28 days) at 9–12 weeks ( P = 0.009). In the between-group effect of the intention-to-treat analysis of short physical performance battery, walking and standing test ( P = 0.790, P = 0.829) were not significantly different, and balance test ( P = 0.049) was significantly better in the control group. Conclusions There was a preliminary effect of the buddy-style intervention to improve exercise adherence.

Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients

2018 ◽  
pp. 309-316
Author(s):  
Michael Wolfe ◽  
Daniel Saddawi-Konefka
Keyword(s):  
Occupational Therapy ◽  
Functional Status ◽  
Intervention Group ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Icu Patients ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.

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