scholarly journals Pain Management Telementoring, Long-term Opioid Prescribing, and Patient-Reported Outcomes

Pain Medicine ◽  
2019 ◽  
Vol 21 (2) ◽  
pp. 266-273 ◽  
Author(s):  
Diane Flynn ◽  
Ardith Z Doorenbos ◽  
Alana Steffen ◽  
Honor McQuinn ◽  
Dale J Langford
Keyword(s):  
Pain Management ◽  
Patient Reported Outcomes ◽  
Medical Center ◽  
Intervention Group ◽  
Control Group ◽  
Significant Difference ◽  
Patient Reported ◽  
Intent To Treat ◽  
The Relationship

Abstract Objective Benefits of primary care provider (PCP) participation in pain management telementoring have been reported; however, no studies have examined within-patient changes in dose or discontinuation of long-term opioid therapy (LOT). The objectives of this nonrandomized study were to evaluate the relationship between telementoring participation and 1) LOT dose reduction and 2) LOT discontinuation and to 3) explore the relationship between LOT dose changes and patient-reported outcomes. Methods PCPs were recruited from a US Army medical center. Intervention group PCPs (N = 12) attended telementoring sessions; control group providers (N = 13) did not. Morphine equivalent daily doses (MEDD) for patients of study providers (N = 396) were extracted from the study site’s opioid database. The intervention group was subdivided based on number of sessions attended (i.e., active and low participation). Intent-to-treat and as-treated analyses were conducted using generalized estimating equations. Separate analyses evaluated the association between within-patient changes in MEDD and pain impact, depression, and anxiety (N = 40). Results Intent-to-treat analysis revealed no significant difference in MEDD reduction; however, a higher proportion of patients of intervention PCPs discontinued LOT (25% ± 3.6%) compared with control PCPs (16% ± 3.6%, P < 0.05). As-treated analyses revealed differences in MEDD reduction between active (13.2 ± 3.0) and low-participating (2.6 ± 3.0) PCPs (P < 0.01). Further, a higher proportion of patients of actively participating PCPs discontinued LOT (29% ± 4.9%) compared with control PCPs (16% ± 3.6%, P = 0.01). We found no evidence that decreased MEDD was associated with poorer self-reported outcomes within patients. Conclusions Pain management telementoring supports PCPs’ efforts to reduce reliance on LOT for chronic pain management and highlights the need for actively engaged PCP pain champions.

scholarly journals Clinical and Immunological Efficacy of Mangosteen and Propolis Extracted Complex in Patients with Gingivitis: A Multi-Centered Randomized Controlled Clinical Trial

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2604
Author(s):  
Jin-Young Park ◽  
Kyung-A Ko ◽  
Ji-Yeong Lee ◽  
Jae-Woon Oh ◽  
Hyun-Chang Lim ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Daily Intake ◽  
Test Group ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Control Groups ◽  
Immunological Parameters ◽  
Significant Difference ◽  
Patient Reported ◽  
And Control

Background: Mangosteen and propolis extracts (MAEC) have been potential therapeutic agents known to exhibit powerful antioxidant and anti-inflammatory properties. The aim of the current study was to evaluate the clinical and immunological efficacy of MAEC as well as safety and patient-reported outcomes (PROMs) on gingivitis and incipient periodontitis. Methods: This study was performed on 104 patients diagnosed with gingivitis or incipient periodontitis. At baseline, the participants were randomly allocated to either the test group, with daily intake of a single capsule containing 194 mg of MAEC for eight weeks, or control group, with placebo. Clinical periodontal evaluation and immunological parameters from saliva and gingival sulcular fluid were assessed at baseline, four, and eight weeks. Individual PROMs were assessed by OHIP-14 questionnaires. Results: There was a significant difference of modified gingival index at four and eight weeks between the test and control groups. In the test group, crevicular interleukin (IL)-6 was reduced, and the salivary matrix metalloproteinase (MMP)-9 was increased after eight weeks. PROMs were improved up to four weeks compared to placebo. Conclusion: Oral administration of MAEC would have a potential to reduce gingival inflammation clinically and immunologically in the patients with gingivitis and incipient periodontitis.

Metabolic changes in hyperlipidemic rats after administration of Xuezhikang

2020 ◽  
Vol 16 ◽  
Author(s):  
Ke Su ◽  
Bingbao Chen ◽  
Xiaoting Tu ◽  
Luxin Ye ◽  
Xiaojie Lu ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
High Fat Diet ◽  
Glucuronic Acid ◽  
Intervention Group ◽  
Lipid Lowering ◽  
Control Group ◽  
High Fat ◽  
Glucose Content ◽  
Significant Difference ◽  
The Relationship

Background: Xuezhikang capsule, which contains cholesterol synthase inhibitors and a large number of natural statins, is put in the clinical application of lipid-lowering and so on. However, the specific use of dose, lipid-lowering effect and the relationship between metabolites are to be further studied. Introduction: Metabonomics is the study of the relationship between the change of quantity and physiological changes from metabolites. At present metabolomics has been widely used in drug development and testing. In this study, we developed a metabolomic method based on gas chromatography-mass spectrometry (GC-MS) to find out hyperlipemia-related substances, and study the lipid-lowering mechanism of Xuezhikang. Method: Fifty SD rats (220 ± 20 g) were given high-fat diet. After four-weeks modeling, they were randomly divided into semi-control group, high fat group, simvastatin intervention group and Xuezhikang intervention group (0.23, 0.69, 1.15 mg/kg, low, medium, high), each dosage in eight rats. The control group (rest eight rats) were given normal diet, and no specific treatment. The rats were sacrificed at the end of the experiment. Result: The biochemical and body weight indexes of the normal control group and the high fat group were significantly different (P <0.05), which indicated that the model of hyperlipidemia was established success. There was significant difference (P <0.05) between Xuezhikang intervention group and high fat control group (P <0.05), and hyperlipemia metabolomics related markers, oxalic acid, butyric acid, mannitol, glucose, glucuronic acid were found. Glucuronic acid and non-binding bilirubin combined with bilirubin, combined with some of the liver harmful substances, play a detoxification effect. Conclusion: The results of metabonomics showed that the high fat group and the control group were significant difference. Mannose, glucose content is relatively stable, lipid metabolism in high-fat group stearic acid, palmitic acid levels decreased, suggesting that high-fat diet disorders rat body lipid metabolism. It is worth mentioning that the experimental evaluation of rats such as biochemical indicators and pathological results are prompted to model success, Xuezhikang intervention effect is more significant, consistent with the expected.

Impact of Pharmacist Intervention on Medication Adherence and Patient-Reported Outcomes among Depressed Patients in a Private Psychiatric Hospital of Nepal: a randomised controlled trial

2020 ◽  
pp. 001857872097046
Author(s):  
Nirmal Raj Marasine ◽  
Sabina Sankhi ◽  
Rajendra Lamichhane
Keyword(s):  
Medication Adherence ◽  
Psychiatric Hospital ◽  
Patient Reported Outcomes ◽  
Intervention Group ◽  
Control Group ◽  
Pharmaceutical Service ◽  
Patient Reported ◽  
Service Intervention ◽  
Severity Of Depression ◽  
The Impact

Aim: We aimed to evaluate the impact of pharmaceutical service intervention on medication adherence and patient-reported outcomes among patients diagnosed with depression in a private psychiatric hospital in Nepal. Methods: A single-center, open trial with a parallel design was conducted among 18 to 65 years aged patients, diagnosed with depression and under antidepressant medication(s) for ≥2 months. Patients were randomised into either the intervention or control group. The control group (n = 98) received the usual care, while the intervention group (n = 98) received a pharmaceutical service intervention. The two groups were compared using the Mann-Whitney U test, independent t-test, or chi-square test at 2 and 4 months for changes in medication adherence and patient-reported [severity of depression and health-related quality of life (HRQoL)] outcomes. Results: One hundred ninety adult patients were enrolled in the study. At baseline, there were no significant differences in any of the outcome measures between the intervention and control groups. At 2 and 4 months, the intervention group had a significant improvement only in medication adherence ( P < .001) compared with the control group [MGL score: 1 (2) vs 2 (2) and 1 (1) vs 2 (1), P < .001, respectively]. Conclusion: Our study suggests that a brief pharmaceutical service intervention in the hospital setting can have a significant impact on patients’ adherence to antidepressants but does not improve their severity of depression and HRQoL.

scholarly journals Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

PedsQL for prediction of postoperative patient-reported outcomes following Chiari decompression surgery

2020 ◽  
Vol 25 (3) ◽  
pp. 268-273
Author(s):  
Shawyon Baygani ◽  
Kristin Zieles ◽  
Andrew Jea
Keyword(s):  
Patient Reported Outcomes ◽  
Severe Disability ◽  
Decompression Surgery ◽  
Disability Score ◽  
Time Points ◽  
Significant Difference ◽  
Patient Reported ◽  
Mild Disability ◽  
One Way Anova

OBJECTIVEThe purpose of this study is to determine if the preoperative Pediatric Quality of Life Inventory (PedsQL) score is predictive of short- and intermediate-term PedsQL outcomes following Chiari decompression surgery. The utility of preoperative patient-reported outcomes (PROs) in predicting pain, opioid consumption, and long-term PROs has been demonstrated in adult spine surgery. To the best of the authors’ knowledge, however, there is currently no widely accepted tool to predict short-, intermediate-, or long-term outcomes after pediatric Chiari decompression surgery.METHODSA prospectively maintained database was retrospectively reviewed. Patients who had undergone first-time decompression for symptomatic Chiari malformation were identified and grouped according to their preoperative PedsQL scores: mild disability (score 80–100), moderate disability (score 60–79), and severe disability (score < 60). PedsQL scores at the 6-week, 3-month, and/or 6-month follow-ups were collected. Preoperative PedsQL subgroups were tested for an association with demographic and perioperative characteristics using one-way ANOVA or chi-square analysis. Preoperative PedsQL subgroups were tested for an association with improvements in short- and intermediate-term PedsQL scores using one-way ANOVA and a paired Wilcoxon signed-rank test controlling for statistically different demographic characteristics when appropriate.RESULTSA total of 87 patients were included in this analysis. According to their preoperative PedsQL scores, 28% of patients had mild disability, 40% had moderate disability, and 32% had severe disability. There was a significant difference in the prevalence of comorbidities (p = 0.009) and the presenting symptoms of headaches (p = 0.032) and myelopathy (p = 0.047) among the subgroups; however, in terms of other demographic or operative factors, there was no significant difference. Patients with greater preoperative disability demonstrated statistically significantly lower PedsQL scores at all postoperative time points, except in terms of the parent-reported PedsQL at 6 months after surgery (p = 0.195). Patients with severe disability demonstrated statistically significantly greater improvements (compared to preoperative scores) in PedsQL scores at all time points after surgery, except in terms of the 6-week and 6-month PROs and the 6-month parent-reported outcomes (p = 0.068, 0.483, and 0.076, respectively).CONCLUSIONSPatients with severe disability, as assessed by the PedsQL, had lower absolute PedsQL scores at all time points after surgery but greater improvement in short- and intermediate-term PROs. The authors conclude that the PedsQL is an efficient and accurate tool that can quickly assess patient disability in the preoperative period and predict both short- and intermediate-term surgical outcomes.

Preoperative Expectations of Patients Undergoing Knee Surgery

2019 ◽  
Author(s):  
Kali N. Stevens ◽  
Vidushan Nadarajah ◽  
Julio J. Jauregui ◽  
Xuyang Song ◽  
Shaun H. Medina ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Medical Center ◽  
Academic Medical Center ◽  
Well Being ◽  
Knee Surgery ◽  
Measurement Information ◽  
Patient Reported ◽  
Preoperative Expectations ◽  
The Relationship ◽  
Preoperative Patient

AbstractThere is limited validated data regarding the relationship between preoperative expectations and patient-reported outcomes (PROs) in patients undergoing knee surgery. The purpose of this study was to (1) assess the preoperative expectations of patients undergoing knee surgery and (2) determine the relationship between preoperative patient demographics, PROs, and preoperative patient expectations. We hypothesized that younger patients with worse function and worse general health status would have greater expectations of knee surgery. We analyzed data from 399 patients undergoing knee surgery at an urban academic medical center. We utilized the Musculoskeletal Outcomes Data Evaluation and Management System to measure preoperative expectations. Multiple legacy PRO measures were recorded, as well as the new Patient-Reported Outcomes Measurement Information Systems (PROMIS) Computer Adaptive Testing. Nonparametric statistical analyses were performed to determine significance. Overall, patients undergoing knee surgery had high expectations, with a mean of 88.0 (95% confidence interval [CI], 86.7–89.3) and median of 91.7 (95% CI, 89.2–94.3). Greater preoperative expectations of knee surgery were associated with higher income, surgically naïve knee, lower Charlson Comorbidity Index, better PROMIS Depression and Anxiety scores, greater Marx knee activity scores, and lower total body pain (p < 0.05). Preoperative expectations of patients undergoing knee surgery are associated with a history of prior knee surgery, income, general and mental health, activity, and pain. Expectations were also found to be associated with PRO measures of function and psychological well-being. These findings may have implications for patient education and shared decision-making preoperatively. The Level of Evidence for the study is IV.

Equivalent 10-Year Outcomes After Implantation of Autologous Bone Marrow–Derived Mesenchymal Stem Cells Versus Autologous Chondrocyte Implantation for Chondral Defects of the Knee

2019 ◽  
Vol 47 (12) ◽  
pp. 2881-2887 ◽  
Author(s):  
Alex Quok An Teo ◽  
Keng Lin Wong ◽  
Liang Shen ◽  
Jia Ying Lim ◽  
Wei Seong Toh ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Tumor Formation ◽  
Chondral Defects ◽  
Sf 36 ◽  
Significant Difference ◽  
Patient Reported ◽  
Chondrocyte Implantation ◽  
Autologous Chondrocyte

Background: The use of bone marrow–derived mesenchymal stem cells (BMSCs) in cartilage repair procedures circumvents some of the limitations of autologous chondrocyte implantation (ACI), but long-term outcomes for this newer procedure are lacking. The authors previously reported comparable outcomes for the 2 procedures at 2-year follow-up. Purpose/Hypothesis: The purpose was to compare the long-term clinical outcomes of ACI versus BMSCs. It was hypothesized that there would be no significant difference between the groups in terms of patient-reported outcome scores and safety outcomes at 10-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Seventy-two patients who underwent either ACI or BMSC implantation—matched in terms of age and lesion site— were followed up to a median of at least 10 years. Patients were assessed with the 36-item Short Form Health Survey (SF-36), the International Knee Documentation Committee knee evaluation form, the Lysholm Knee Score, and the Tegner Activity Scale. In addition, information was obtained regarding any additional surgical procedures as well as safety data, with particular attention to infection and tumor formation. Results: There was an improvement in all patient-reported outcomes scores apart from the Mental Component Summary of the SF-36 after cartilage repair surgery. There was no significant difference in any of the patient-reported outcomes between cohorts at any time point. Six and 5 patients in the ACI and BMSC groups, respectively, underwent subsequent surgical procedures, including 1 total knee replacement in the BMSC group. None of the patients in either group developed any deep infection or tumor within the follow-up period. Conclusion: BMSC implantation used for the treatment of chondral defects of the knee appears to result in equivalent clinical outcomes to first-generation ACI at up to 10 years, with no apparent increased tumor formation risk.

scholarly journals 206 Deprescribing in Frail Older People Transitioning to Long-term Care: a Randomized Controlled Trial Using STOPPFrail Criteria

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Denis Curtin ◽  
Emma Jennings ◽  
Ruth Daunt ◽  
Mary Randles ◽  
Paul Gallagher ◽  
...  
Keyword(s):  
Older People ◽  
Intervention Group ◽  
Nursing Home Care ◽  
Control Group ◽  
Frail Older People ◽  
Term Care ◽  
Emergency Hospital ◽  
Significant Difference ◽  
The Mean

Abstract Background Older people with advanced frailty are among the highest consumers of prescription medications. When life expectancy is limited, the use of multiple medications may be unnecessary or burdensome. STOPPFrail criteria were recently developed to assist clinicians with deprescribing decisions in frail older people approaching end-of-life. The aim of this study was to examine whether long-term medications could be safely discontinued in frail older people using STOPPFrail criteria. Methods We recruited hospitalized adults aged ≥75 years with polypharmacy (≥5 long-term medications) that were transitioning to nursing home care. Participants were eligible if their Clinical Frailty Scale score was ≥7 and if their attending physician indicated that he/she “would not be surprised if the patient died in the next 12 months”. Patients were randomized to single time point pre-discharge STOPPFrail-guided deprescribing or routine pharmaceutical care. The primary outcome was change in the number of regular medications at 3 months. Secondary outcomes included emergency hospital transfers, incident falls, fractures and mortality. Results Results are presented for the first 100 enrolled patients. The mean (±standard deviation [SD]) age of study participants was 85.1 (±5.7) and 61% were female. Intervention (n = 49) and control group (n = 51) participants were prescribed a mean (±SD) of 11.5 (±3.0) and 10.9 (±3.5) regular medications, respectively, at baseline. The mean (±SD) change in the number of regular medications at 3 months was -2.7 (±2.8) in the intervention group and -0.6 (±2.6) in the control group (estimated difference 2.1 ±0.6, 95% confidence interval 0.8 -3.3, p=0.001). Ten intervention participants and 14 control participants died within 3 months of randomization (20.4% vs 27.4%, p=0.49). There was no significant difference between groups for emergency hospital transfers, incident falls or fractures. Conclusion STOPPFrail-guided deprescribing significantly reduced medication burden in frail older people without adversely affecting clinical outcomes in the prospective 3 months.

scholarly journals Effectiveness and Quality of Implementing a Best Practice Model of Care for Low Back Pain (BetterBack) Compared with Routine Care in Physiotherapy: A Hybrid Type 2 Trial

2021 ◽  
Vol 10 (6) ◽  
pp. 1230
Author(s):  
Karin Schröder ◽  
Birgitta Öberg ◽  
Paul Enthoven ◽  
Henrik Hedevik ◽  
Maria Fors ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Best Practice ◽  
Illness Perception ◽  
Intervention Group ◽  
Routine Care ◽  
Control Group ◽  
Model Of Care ◽  
Practice Model ◽  
Patient Reported

Low back pain (LBP) occurs in all ages and first-line treatment by physiotherapists is common. The main aim of the current study was to evaluate the effectiveness of implementing a best practice model of care for LBP (intervention group—BetterBack☺ MoC) compared to routine physiotherapy care (control group) regarding longitudinal patient reported outcomes. The BetterBack☺ MoC contains clinical guideline recommendations and support tools to facilitate clinician adherence to guidelines. A secondary exploratory aim was to compare patient outcomes based on the fidelity of fulfilling a clinical practice quality index regarding physiotherapist care. A stepped cluster randomized design nested patients with LBP in the three clusters which were allocated to control (n = 203) or intervention (n = 264). Patient reported measures were collected at baseline, 3, 6 and 12 months and analyzed with mixed model regression. The primary outcome was between-group changes from baseline to 3 months for pain intensity and disability. Implementation of the BetterBack☺ MoC did not show any between-group differences in the primary outcomes compared with routine care. However, the intervention group showed significantly higher satisfaction at 3 months and clinically meaningful greater improvement in LBP illness perception at 3 months and quality of life at 3 and 6 months but not in patient enablement and global impression of change compared with the control group. Physiotherapists’ care that adhered to all clinical practice quality indices resulted in an improvement of most patient reported outcomes with a clinically meaningful greater improved LBP illness perception at 3 month and quality of life at 3 and 6 months, significantly greater improvement in LBP illness perception, pain and satisfaction at 3 and 6 months and significantly better enablement at all time points as well as better global improvement outcomes at 3 months compared with non-adherent care. This highlights the importance of clinical guideline based primary care for improving patient reported LBP outcomes.

Information support, illness perceptions, and distress in survivors of differentiated thyroid cancer

2017 ◽  
Vol 24 (9) ◽  
pp. 1201-1209 ◽  
Author(s):  
Chelsea H Wiener ◽  
Jeffrey E Cassisi ◽  
Daniel Paulson ◽  
Olga Husson ◽  
Rema A Gupta
Keyword(s):  
Thyroid Cancer ◽  
Patient Reported Outcomes ◽  
Differentiated Thyroid Cancer ◽  
Illness Perceptions ◽  
Information Support ◽  
Cancer Data ◽  
Patient Reported ◽  
Term Evaluation ◽  
The Relationship

Survivors of differentiated thyroid cancer report significant distress. This study examines illness perceptions as mediating the relationship between information support and distress among survivors of differentiated thyroid cancer. Data were obtained from the Patient Reported Outcomes Following Initial Treatment and Long-term Evaluation of Survivorship registry. Model results revealed that greater information support was associated with better illness perceptions, and that better illness perceptions were associated with less distress. Information support and distress were indirectly related via illness perceptions. Results highlight the importance of addressing illness perceptions in this population and suggest that informational interventions may help serve this function.

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